***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Little is known about the effects of successful psychotherapy on brain function in subjects with anxiety disorders . The present study aim ed to identify changes in brain activation following cognitive-behavioral therapy ( CBT ) in subjects suffering from specific phobia . Using functional magnetic resonance imaging ( fMRI ) , brain activation to spider videos was measured in 28 spider phobic and 14 healthy control subjects . Phobics were r and omly assigned to a therapy-group ( TG ) and a waiting-list control group ( WG ) . Both groups of phobics were scanned twice . Between scanning sessions , CBT was given to the TG . Before therapy , brain activation did not differ between both groups of phobics . As compared to control subjects , phobics showed greater responses to spider vs. control videos in the insula and anterior cingulate cortex ( ACC ) . CBT  strongly reduced phobic symptoms in the TG while the WG remained behaviorally unchanged . In the second scanning session , a significant reduction of hyperactivity in the insula and ACC was found in the TG compared to the WG . These results propose that increased activation in the insula and ACC is associated with specific phobia , whereas an attenuation of these brain responses correlates with successful therapeutic intervention Neurofunctional mechanisms underlying cognitive behavior therapy ( CBT ) are still not clearly understood . This functional magnetic resonance imaging ( fMRI ) study focused on changes in brain activation as a result of one-session CBT in patients suffering from spider phobia . Twenty-six female spider phobics and 25 non-phobic subjects were presented with spider pictures , generally disgust-inducing , generally fear-inducing and affectively neutral scenes in an initial fMRI session . Afterwards , the patients were r and omly assigned to either a therapy group ( TG ) or a waiting list group ( WG ) . The scans were repeated one week after the treatment or after a one-week waiting period . Relative to the non-phobic participants , the patients displayed increased activation in the amygdala and the fusiform gyrus as well as decreased activation in the medial orbitofrontal cortex ( OFC ) during the first exposure . The therapy effect consisted of increased medial OFC activity in the TG relative to the WG . Further , therapy-related reductions in experienced somatic anxiety symptoms were positively correlated with activation decreases in the amygdala and the insula . We conclude that successful treatment of spider phobia is primarily accompanied by functional changes of the medial OFC . This brain region is crucial for the self-regulation of emotions and the relearning of stimulus-reinforcement associations BACKGROUND Neurofunctional changes underlying effective antianxiety treatments are incompletely characterized . This study explored the effects of citalopram and cognitive-behavioral therapy on regional cerebral blood flow ( rCBF ) in social phobia . METHODS By means of positron emission tomography with oxygen 15-labeled water , rCBF was assessed in 18 previously untreated patients with social phobia during an anxiogenic public speaking task . Patients were matched for sex , age , and phobia severity , based on social anxiety question naire data , and r and omized to citalopram medication , cognitive-behavioral group therapy , or a waiting-list control group . Scans were repeated after 9 weeks of treatment or waiting time . Outcome was assessed by subjective and psychophysiological state anxiety measures and self-report question naires . Questions were readministered after 1 year . RESULTS Symptoms improved significantly and roughly equally with citalopram and cognitive-behavioral therapy , whereas the waiting-list group remained unchanged . Four patients in each treated group and 1 waiting-list patient were classified as responders . Within both treated groups , and in responders regardless of treatment approach , improvement was accompanied by a decreased rCBF-response to public speaking bilaterally in the amygdala , hippocampus , and the periamygdaloid , rhinal , and parahippocampal cortices . Between-group comparisons confirmed that rCBF in these regions decreased significantly more in treated groups than control subjects , and in responders than nonresponders , particularly in the right hemisphere . The degree of amygdalar-limbic attenuation was associated with clinical improvement a year later . CONCLUSIONS Common sites of action for citalopram and cognitive-behavioral treatment of social anxiety were observed in the amygdala , hippocampus , and neighboring cortical areas , ie , brain regions subserving bodily defense reactions to threat BACKGROUND Functional brain imaging studies in major depression have suggested abnormalities of areas , including the frontal cortex , cingulate gyrus , basal ganglia , and temporal cortex . We hypothesized that venlafaxine hydrochloride and interpersonal psychotherapy ( IPT ) might each alter brain blood flow in some or all of these areas on sequential single photon emission computed tomography ( SPECT ) scans . METHODS Twenty-eight men and women aged 30 to 53 years with a DSM-IV major depressive episode , a 17-item Hamilton Rating Scale for Depression ( HAM-D ) rating of 18 or higher , and antidepressant-naive for at least 6 months were studied . After baseline (99m)technetium-hexa-methyl-propylene-amine-oxime scan , 1-T magnetic resonance imaging , and psychometric ratings , patients were assigned to different treatments . Thirteen patients had 1-hour weekly sessions of IPT from the same supervised therapist ( E.M. ) . Fifteen patients took 37.5 mg twice-daily of venlafaxine hydrochloride . Single-photon emission computed tomography scans and ratings were repeated at 6 weeks . RESULTS Both treatment groups improved substantially , more so with venlafaxine ( mean [ SD ] HAM-D scores at pretreatment : IPT , 22.7 [ 2.7 ] , and venlafaxine , 22.4 [ 3.1 ] ; and posttreatment : IPT , 16.2 [ 7.1 ] , and venlafaxine , 10.9 [ 8.6 ] ) . No patients had structural brain abnormalities . On analysis with statistical parametric mapping 96 , the venlafaxine group showed right posterior temporal and right basal ganglia activation ( P = .01 ) , while the IPT group had limbic right posterior cingulate and right basal ganglia activation ( P = .01 ) . CONCLUSIONS This preliminary investigation has shown limbic blood flow increase with IPT yet not venlafaxine , while both treatments demonstrated increased basal ganglia blood flow . This was , however , a short trial with a small sample , no control group , and different symptom reduction in the 2 groups BACKGROUND Magnetic resonance imaging ( MRI ) studies have especially reported smaller hippocampal volume in patients with post-traumatic stress disorder ( PTSD ) , most of them war or sexual abuse victims . The present study compares the hippocampal volumes of out- patients with PTSD who had low co-morbidity rates to those of trauma-exposed control subjects without PTSD , and measures hippocampal volume changes in these patients after brief eclectic psychotherapy . We hypothesized that smaller hippocampal volumes are specific to PTSD and that hippocampal volume changes after effective psychotherapy would be measurable . METHOD Eighteen patients with PTSD and 14 traumatized control subjects were examined with MRI .  In a r and omized clinical trial , the PTSD patients were assigned to treatment ( n = 9 ) or waiting-list group ( n = 9 ) . After the former received psychotherapy for 4 months , the MRI was repeated on both PTSD groups . Three temporal lobe structures were manually segmented : hippocampus , amygdala , and parahippocampal gyrus . Volumetric analysis was used to measure grey matter , white matter , and cerebrospinal fluid . RESULTS PTSD patients had significantly smaller hippocampal volumes at baseline ( total 13.8 % , right 13.5 % , left 14.1 % ) compared to the control subjects . After effective psychotherapy , however , no volume changes were found in the smaller hippocampi . CONCLUSIONS We confirmed previous findings of smaller hippocampal volume in PTSD in a new population made up of out- patients who experienced different types of traumas , reducing co-morbidity to a minimum . Smaller hippocampal volumes did not change after effective psychotherapy , even while symptoms resolved Background Post-traumatic stress disorder ( PTSD ) is a derangement of mood control with involuntary , emotionally fraught re collection s that may follow deep psychological trauma in susceptible individuals . This condition is treated with pharmacological and /or cognitive therapies as well as psychotherapy with eye movement desensitization and reprocessing ( EMDR ) . However , only a very limited number of studies have been published dealing with work-related PTSD , and investigations on the effect of treatment on cerebral blood flow represent an even smaller number . Aim To investigate the short-term outcome of occupation-related PTSD after EMDR therapy by 99mTc-HMPAO SPECT . Method Fifteen patients , either train drivers suffering from PTSD after having been unintentionally responsible for a person-under-train accident or employees assaulted in the course of duty , were recruited for the study .  99mTc-HMPAO SPECT was performed on these patients both before and after EMDR therapy while they listened to a script portraying the traumatic event . Tracer distribution analysis was then carried out at volume of interest ( VOI ) level using a three-dimensional st and ardized brain atlas , and at voxel level by SPM . The CBF data of the 15 patients were compared before and after treatment as well as with those of a group of 27 controls who had been exposed to the same psychological traumas without developing PTSD . Results At VOI analysis significant CBF distribution differences were found between controls and patients before and after treatment ( P=0.023 and P=0.0039 , respectively ) . Eleven of the 15 patients responded to treatment , i.e. , following EMDR they no longer fulfilled the DSM-IV criteria for PTSD . When comparing only the eleven responders with the controls , the significant group difference found before EMDR ( P=0.019 ) disappeared after treatment . Responders and non-responders showed after therapy significant regional differences in frontal , parieto-occipital and visual cortex and in hippocampus . SPM analysis showed significant uptake differences between patients and controls in the orbitofrontal cortex ( Brodmann 11 ) and the temporal pole ( Brodmann 38 ) both before and after treatment . A significant tracer distribution difference present before treatment in the uncus ( Brodmann 36 ) disappeared after treatment , while a significant difference appeared in the lateral temporal lobe ( Brodmann 21 ) . ConclusionS ignificant 99mTc-HMPAO uptake regional differences were found , mainly in the peri-limbic cortex , between PTSD patients and controls exposed to trauma but not developing PTSD . Tracer uptake differences between responders and patients not responding to EMDR were found after treatment suggesting a trend towards normalization of tracer distribution after successful therapy . These findings in occupational related PTSD are consistent with previously described effects of psychotherapy on anxiety disorders Several neuroanatomical hypotheses of panic disorder have been proposed focusing on the significant role of the amygdala and PAG-related " panic neurocircuitry . " Although cognitive-behavioral therapy is effective in patients with panic disorder , its therapeutic mechanism of action in the brain remains unclear . The present study was performed to investigate regional brain glucose metabolic changes associated with successful completion of cognitive-behavioral therapy in panic disorder patients . The regional glucose utilization in patients with panic disorder was compared before and after cognitive-behavioral therapy using positron emission tomography with (18)F-fluorodeoxyglucose . In 11 of 12 patients who showed improvement after cognitive-behavioral therapy  , decreased glucose utilization was detected in the right hippocampus , left anterior cingulate , left cerebellum , and pons , whereas increased glucose utilization was seen in the bilateral medial prefrontal cortices . Significant correlations were found between the percent change relative to the pretreatment value of glucose utilization in the left medial prefrontal cortex and those of anxiety and agoraphobia-related subscale of the Panic Disorder Severity Scale , and between that of the midbrain and that of the number of panic attacks during the 4 weeks before each scan in all 12 patients . The completion of successful cognitive-behavioral therapy involved not only reduction of the baseline hyperactivity in several brain areas but also adaptive metabolic changes of the bilateral medial prefrontal cortices in panic disorder patients BACKGROUND Functional brain-imaging studies in post-traumatic stress disorder ( PTSD ) have suggested functional alterations in temporal and prefrontal cortical regions . Effects of psychotherapy on these brain regions have not yet been examined . METHOD Twenty civilian PTSD out- patients and 15 traumatized control subjects were assessed at baseline using psychometric ratings . Cerebral blood flow was measured using trauma script-driven imagery during 99mtechnetium hexamethyl-propylene-amine-oxime single-photon emission computed tomography scanning .  All 20 out- patients were r and omly assigned to treatment or wait-list conditions . Treatment was brief eclectic psychotherapy ( BEP ) in 16 weekly individual sessions . RESULTS At baseline , greater activation was found in the right insula and right superior/middle frontal gyrus in the PTSD group than in the control group . PTSD patients treated with BEP significantly improved on all PTSD symptom clusters compared to those on the waiting list . After effective psychotherapy , lower activation was measured in the right middle frontal gyrus , compared to the P 
    Output:
    
Psychological interventions changed neural circuits involved in the pathophysiology of anxiety disorders , especially activity in frontal-striatal circuits in OCD and prefrontal areas in arachnophobia .
Despite the variety of method ological concerns , initial neuroimaging studies have showed that psychological interventions can change brain function related to anxiety disorders in the patients who respond to treatment .