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  • Gowin, J. L., Harlé, K. M., Stewart, J. L., Wittmann, M., Tapert, S. F., & Paulus, M. P. (2014). Attenuated insular processing during risk predicts relapse in early abstinent methamphetamine-dependent individuals. Neuropsychopharmacology : Official Publication of the American College of Neuropsychopharmacology, 39(6), 1379–1387. https://doi.org/10.1038/npp.2013.333

    There is some evidence that neuroimaging can be used to predict relapse among abstinent methamphetamine-dependent (MD) individuals. However, it remains unclear what cognitive and neural processes contribute to relapse. This investigation examined whether insula activation during risk-taking decisions-a process shown to be disrupted in MD-is able to predict susceptibility for relapse. Sixty-eight MD enrolled in a treatment program during early abstinence completed a risk-taking task during functional magnetic resonance imaging. Sixty-three of the sixty-eight individuals were followed up 1 year after the study. Of these, 18 MD reported relapse. The 45 abstinent MD showed patterns of insula activation during risky decisions that resembled those found in prior studies of healthy controls, consisting of lower insula activation during safe decisions paired with higher activation during risky decisions. In contrast, the 18 relapsed MD showed similar insula activation during safe and risky decisions. An increase in one standard deviation in the difference in insula activation between risky and safe choices was associated with a 0.34 odds ratio for relapse at any given time. A median split of insula activation (difference between risky and safe) showed that individuals in the bottom half were two times more likely to relapse. In addition, a model that included several other brain regions increased prediction accuracy compared with insula-based model alone. These results suggest that failure to differentially activate the insula as a function of risk is a part of an altered risk-processing network associated with an increased susceptibility to relapse.

  • Schienle, A., Schäfer, A., Stark, R., & Vaitl, D. (2009). Long-term effects of cognitive behavior therapy on brain activation in spider phobia. Psychiatry Research, 172(2), 99–102. https://doi.org/10.1016/j.pscychresns.2008.11.005

    This functional magnetic resonance imaging study investigated long-term effects of cognitive behavior therapy (CBT) in individuals suffering from spider phobia. Ten female patients who had shown positive immediate CBT effects were invited to take part in a 6-month follow-up investigation. Here, the patients, along with eight non-phobic females, were presented with the same pictures depicting spiders, generally disgust-inducing, generally fear-inducing and neutral content, which they had viewed 6 months earlier. Patients' self-report and overt behavior indicated a positive long-term clinical improvement. Related hemodynamic changes included an increase in medial orbitofrontal cortex (OFC) activity. As the medial OFC is involved in emotion-related learning, especially in the representation of positive stimulus-outcome associations, we conclude that the medial OFC effect constitutes the neuronal basis of the lasting positive CBT outcome. Activity to disorder-irrelevant pictures decreased across the sessions in the lateral OFC and in the insula, which most likely reflects general habituation.

  • Zimmermann, M., Stark, R., Kern, G., Laiacker, M., Kirsch, P., & Vaitl, D. (2006). Positive and negative spatial priming in schizophrenia. Journal of Clinical and Experimental Neuropsychology, 28(5), 706–720. https://doi.org/10.1080/13803390590954290

    Priming tasks are used for investigating the deficits of selective attention in schizophrenia, which are thought to be related to the psychotic symptoms. Priming was assessed in acutely psychotic unmedicated (n = 22) and medicated (n = 36) schizophrenia patients and in control subjects (n = 42). The subjects had to indicate the location of a target stimulus in two consecutive stimulus displays (prime and probe). Each stimulus appeared together with a distractor on a screen. Negative Priming is characterized by an increase in reaction time, whenever a probe target is presented at a prime distractor location. Positive Priming is characterized by a decrease in reaction time, when the probe target is presented at the prime target location. Schizophrenia patients altogether showed no abnormalities in priming effects, neither in the acute phase of illness (medicated and unmedicated) nor in partial remission (one month later, medicated). In unmedicated patients however Negative Priming was inversely correlated with the severity of positive symptoms. This indicates a priming deficit in a small subgroup of severely ill patients. The data support the notion that automatic (implicit) mechanisms of learning are unimpaired in schizophrenia patients unless symptoms exceed a certain critical level.

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