Efficacy Of Imaginary Exposure In Patients With Acrophobia And Related Resting-state Functional Magnetic Resonance Imaging Studies

Objectives:This study aims to evaluate the efficacy of imaginal exposure(IE)on acrophobia patients through the clinical study of imaginal exposure in the treatment of acrophobia.At the same time,functional Magnetic Resonance Imaging(f MRI)was used to explore the characteristics of local neural activity changes in the resting state of patients with acrophobia,and to explore the relevant mechanism of imaginal exposure therapy for acrophobia.Methods:1.In this study,a case-control study was designed to compare the acrophobia group and the normal control group(HC).Acrophobia questionnaire(AQ),attitude high questionnaire(ATHQ),behavior avoidance test(BAT)scores and f MRI data were collected from the acrophobia subjects recruited online(n = 30)and the HC subjects matched in gender and age(n = 30).The voxel based regional homogeneity(Re Ho)method was used to analyze the imaging data,and the differences of brain function time series attributes between the two groups were compared by independent sample t-test.2.30 cases of acrophobia were treated with IE for 3 weeks(2 times a week for 6times).AQ,ATHQ,BAT evaluation and resting f MRI were performed on the treated acrophobia.The changes of AQ,ATHQ and BAT before and after IE treatment were compared by paired sample t test.The difference of Re Ho value of whole brain before and after treatment was compared by paired sample t test.Results:1.Compared with HC group,acrophobia questionnaire anxiety(AQ-Anxiety)(t =19.793,p = 0.000),acrophobia questionnaire avoidance(AQ-Avoidance)(t = 17.739,p = 0.000),ATHQ(t = 7.284,p = 0.000)and BAT(t = 17.597,p = 0.000)were significantly different in baseline.Compared with HC group,the Re Ho values of the right dorsolateral prefrontal cortex(DLPFC),the right ventrolateral prefrontal cortex(VLPFC)and right orbitofrontal cortex(OFC)were significantly increased(p < 0.05,GRF correction)and the Re Ho values of the left visual cortex were significantly reduced(p < 0.05,GRF correction).2.After IE treatment for 6 times,the scores of AQ-Anxiety,AQ-Avoidance,ATHQ and BAT decreased and reached statistical significance(p < 0.01).In the abnormal brain area,the Re Ho values of right DLPFC and VLPFC and right OFC decreased,while the Re Ho values of visual cortex increased,which reached statistical significance(p < 0.05,GRF correction).Compared with HC group,there was no significant difference in the whole brain Re Ho value(p < 0.05,GRF correction),but AQ-Anxiety,AQ-Avoidance,ATHQ and BAT scores were still significantly different(p < 0.01).Conclusions:1.Patients with acrophobia had abnormal resting brain functions in visual cortex,orbitofrontal cortex and cognitive control cortex,indicating that these brain regions were closely related to the brain pathological mechanism of acrophobia.2.After IE treatment,the clinical symptoms of acrophobia subjects recovered and the abnormal brain regions returned to normal levels.This suggests that IE has a significant effect on acrophobia and mainly acts on the visual cortex and cognitive control cortex.