INTRODUCTION: The administration of questionnaires presents an easy way of obtaining important knowledge about phobic patients. However, it is not well known how these subjective measurements correspond to the patient's objective condition. Our study aimed to compare scores on questionnaires and image evaluation to the objective measurements of the behavioral approach test (BAT) and the neurophysiological effect of spiders extracted from fMRI measurements. The objective was to explore how reliably subjective statements about spiders and physiological and behavioral parameters discriminate between phobics and non-phobics, and what are the best predictors of overall brain activation. METHODS: Based on a clinical interview, 165 subjects were assigned to either a "phobic" or low-fear "control" group. Finally, 30 arachnophobic and 32 healthy control subjects (with low fear of spiders) participated in this study. They completed several questionnaires (SPQ, SNAQ, DS-R) and underwent a behavioral approach test (BAT) with a live tarantula. Then, they were measured in fMRI while watching blocks of pictures including spiders and snakes. Finally, the respondents rated all the visual stimuli according to perceived fear. We proposed the Spider Fear Index (SFI) as a value characterizing the level of spider fear, computed based on the fMRI measurements. We then treated this variable as the "neurophysiological effect of spiders" and examined its contribution to the respondents' fear ratings of the stimuli seen during the fMRI using the redundancy analysis (RDA). RESULTS: The results for fear ranks revealed that the SFI, SNAQ, DS-R, and SPQ scores had a significant effect, while BAT and SPQ scores loaded in the same direction of the first multivariate axis. The SFI was strongly correlated with both SPQ and BAT scores in the pooled sample of arachnophobic and healthy control subjects. DISCUSSION: Both SPQ and BAT scores have a high informative value about the subject's fear of spiders and together with subjective emotional evaluation of picture stimuli can be reliable predictors of spider phobia. These parameters provide easy and non-expensive but reliable measurement wherever more expensive devices such as magnetic resonance are not available. However, SFI still reflects individual variability within the phobic group, identifying individuals with higher brain activation, which may relate to more severe phobic reactions or other sources of fMRI signal variability.

Department of Economy and Management Ambis University Prague Czechia

Department of Zoology Faculty of Science Charles University Prague Czechia

Institute of Computer Science of the Czech Academy of Sciences Prague Czechia

National Institute of Mental Health Klecany Czechia

Zobrazit více v PubMed

American Psychiatric Association . Diagnostic and statistical manual of mental disorders. 5th ed. Arlington, VA: Author; (2013).

Eaton WW, Bienvenu OJ, Miloyan B. Specific phobias. Lancet Psychiatry. (2018) 5:678–86. doi: 10.1016/S2215-0366(18)30169-X, PMID: PubMed DOI PMC

Wardenaar KJ, Lim CC, Al-Hamzawi AO, Alonso J, Andrade LH, Benjet CD, et al. . The cross-national epidemiology of specific phobia in the world mental health surveys. Psychol Med. (2017) 47:1744–60. doi: 10.1017/S0033291717000174, PMID: PubMed DOI PMC

Craske MG. Origins of phobias and anxiety disorders: Why more women than men? Amsterdam: Elsevier; (2003).

LeBeau RT, Glenn D, Liao B, Wittchen HU, Beesdo-Baum K, Ollendick T, et al. . Specific phobia: a review of DSM-IV specific phobia and preliminary recommendations for DSM-V. Depress Anxiety. (2010) 27:148–67. doi: 10.1002/da.20655, PMID: PubMed DOI

Antony MM, McCabe RE. Health care costs for anxiety disorders in primary care: are they a good investment? CNS Drugs. (2004) 18:11–22.

Greenberg PE, Sisitsky T, Kessler RC, Finkelstein SN, Berndt ER, Davidson JR, et al. . The economic burden of anxiety disorders in the 1990s. J Clin Psychiatry. (1999) 60:427–35. doi: 10.4088/JCP.v60n0702, PMID: PubMed DOI

Bruce SE, Yonkers KA, Otto MW, Eisen JL, Weisberg RB, Pagano M, et al. . Influence of psychiatric comorbidity on recovery and recurrence in generalized anxiety disorder, social phobia, and panic disorder: a 12-year prospective study. Am J Psychiatr. (2005) 162:1179–87. doi: 10.1176/appi.ajp.162.6.1179, PMID: PubMed DOI PMC

O'Toole MS, Buckroyd J. The impact of social isolation and loneliness on the mental health and wellbeing of older women. Ageing Soc. (2013) 33:405–25.

Antony MM, Barlow DH. In: Barlow DH, editor. Specific phobias, in anxiety and its disorders: The nature and treatment of anxiety and panic. New York, NY: Guilford Press; (2002). 380–417.

Kirsch I, Deacon BJ, Huedo-Medina TB, Scoboria A, Moore TJ, Johnson BT. Initial severity and antidepressant benefits: a meta-analysis of data submitted to the Food and Drug Administration. PLoS Med. (2014) 5:e45. doi: 10.1371/journal.pmed.0050045, PMID: PubMed DOI PMC

Rapee RM, Heimberg RG. A cognitive-behavioral model of anxiety in social phobia. Behav Res Ther. (1997) 35:741–56. doi: 10.1016/S0005-7967(97)00022-3 PubMed DOI

Coelho CM, Gonçalves-Bradley D, Zsido AN. Who worries about specific phobias? A population-based study of risk factors. J Psychiatr Res. (2020) 126:67–72. doi: 10.1016/j.jpsychires.2020.05.001, PMID: PubMed DOI

Kendall PC. In: Barlow DH, editor. Assessment of anxiety disorders, in clinical handbook of psychological disorders: a step-by-step treatment manual. New York, NY: Guilford Press; (2013). 86–125.

Klorman R, Weerts TC, Hastings JE, Melamed BG, Lang PJ. Psychometric description of some specific-fear questionnaires. Behav Ther. (1974) 5:401–9. doi: 10.1016/S0005-7894(74)80008-0 DOI

Polák J, Sedláčková K, Nácar D, Landová E, Frynta D. Fear the serpent: a psychometric study of snake phobia. Psychiatry Res. (2016) 242:163–8. doi: 10.1016/j.psychres.2016.05.024, PMID: PubMed DOI

Polák J, Sedláčková K, Janovcová M, Peléšková Š, Flegr J, Vobrubová B, et al. . Measuring fear evoked by the scariest animal: Czech versions of the Spider Questionnaire and Spider Phobia Beliefs Questionnaire. BMC Psychiatry. (2022) 22:18. doi: 10.1186/s12888-021-03672-7, PMID: PubMed DOI PMC

Klieger DM. The Snake Anxiety Questionnaire as a measure of ophidophobia. Educational and Psychological Measurement. (1987) 47:449–459.

Klieger DM, Siejak KK. Disgust as the source of false positive effects in the measurement of ophidiophobia. J Psychol. (1997) 131:371–82. doi: 10.1080/00223989709603523 PubMed DOI

Kindt M, Brosschot JF, Muris P. Spider phobia questionnaire for children (SPQ-C): a psychometric study and normative data. Behav Res Ther. (1996) 34:277–82. doi: 10.1016/0005-7967(95)00069-0, PMID: PubMed DOI

Klein AM, Niekerk RE, Baartmans JM, Rinck M, Becker ES. The spider anxiety and disgust screening for children: reliability and validity of a screening for children. Aust J Psychol. (2017) 69:178–83. doi: 10.1111/ajpy.12132 DOI

Booth RW, Peker M, Oztop P. Turkish adaptation of the fear of spiders questionnaire: reliability and validity in non-clinical samples. Cogent Psychol. (2016) 3:1144250. doi: 10.1080/23311908.2016.1144250 DOI

Olatunji BO, Woods CM, de Jong PJ, Teachman BA, Sawchuk CN, David B. Development and initial validation of an abbreviated Spider Phobia Questionnaire using item response theory. Behav Ther. (2009) 40:114–30. doi: 10.1016/j.beth.2008.04.002, PMID: PubMed DOI

Polák J, Sedláčková K, Landová E, Frynta D. Faster detection of snake and spider phobia: revisited. Heliyon. (2020) 6:e03968. doi: 10.1016/j.heliyon.2020.e03968, PMID: PubMed DOI PMC

Davey GCL, Marzillier S. Disgust and animal phobias In: Olatunji BO, McKay D, editors. Disgust and its disorders: theory, assessment, and treatment implications. Washington, DC: American Psychological Association; (2009). 169–90.

Davey GC. The disgusting spider: the role of disease and illness in the perpetuation of fear of spiders. Soc Anim. (1994) 2:17–25. doi: 10.1163/156853094X00045 DOI

de Jong PJ, Merckelbach H. Blood-injection-injury phobia and fear of spiders: domain specific individual differences in disgust sensitivity. Personal Individ Differ. (1998) 24:153–8. doi: 10.1016/S0191-8869(97)00178-5 DOI

Gerdes AB, Uhl G, Alpers GW. Spiders are special: fear and disgust evoked by pictures of arthropods. Evol Hum Behav. (2009) 30:66–73. doi: 10.1016/j.evolhumbehav.2008.08.005 DOI

Landová E, Janovcová M, Štolhoferová I, Rádlová S, Frýdlová P, Sedláčková K, et al. . Specificity of spiders among fear-and disgust-eliciting arthropods: spiders are special, but phobics not so much. PLoS One. (2021) 16:e0257726. doi: 10.1371/journal.pone.0257726, PMID: PubMed DOI PMC

Matchett G, Davey GC. A test of a disease-avoidance model of animal phobias. Behav Res Ther. (1991) 29:91–4. doi: 10.1016/S0005-7967(09)80011-9, PMID: PubMed DOI

de Jong PJ, Muris P. Spider phobia: interaction of disgust and perceived likelihood of involuntary physical contact. J Anxiety Disord. (2002) 16:51–65. doi: 10.1016/S0887-6185(01)00089-5, PMID: PubMed DOI

Frynta D, Janovcová M, Štolhoferová I, Peléšková Š, Vobrubová B, Frýdlová P, et al. . Emotions triggered by live arthropods shed light on spider phobia. Sci Rep. (2021) 11:22268. doi: 10.1038/s41598-021-01325-z, PMID: PubMed DOI PMC

Mühlberger A, Sperber M, Wieser MJ, Pauli P. A virtual reality behavior avoidance test (VR-BAT) for the assessment of spider phobia. J Cyberther Rehabil. (2008) 1:147–58.

Rinck M, Becker ES. Approach and avoidance in fear of spiders. J Behav Ther Exp Psychiatry. (2007) 38:105–20. doi: 10.1016/j.jbtep.2006.10.001, PMID: PubMed DOI

Teachman BA, Woody SR. Staying tuned to research in implicit cognition: relevance for clinical practice with anxiety disorders. Cogn Behav Pract. (2004) 11:149–59. doi: 10.1016/S1077-7229(04)80026-9 DOI

Klein AM, Becker ES, Rinck M. Direct and indirect measures of spider fear predict unique variance in children's fear-related behaviour. Cognit Emot. (2011) 25:1205–13. doi: 10.1080/02699931.2010.530454, PMID: PubMed DOI

Effting M, Salemink E, Verschuere B, Beckers T. Implicit and explicit measures of spider fear and avoidance behavior: examination of the moderating role of working memory capacity. J Behav Ther Exp Psychiatry. (2016) 50:269–76. doi: 10.1016/j.jbtep.2015.10.003, PMID: PubMed DOI

Huijding J, de Jong PJ. Specific predictive power of automatic spider-related affective associations for controllable and uncontrollable fear responses toward spiders. Behav Res Ther. (2006) 44:161–76. doi: 10.1016/j.brat.2005.01.007 PubMed DOI

Van Bockstaele B, Verschuere B, Koster EH, Tibboel H, De Houwer J, Crombez G. Differential predictive power of self-report and implicit measures on behavioural and physiological fear responses to spiders. Int J Psychophysiol. (2011) 79:166–74. doi: 10.1016/j.ijpsycho.2010.10.003, PMID: PubMed DOI

Fredrikson M. Reliability and validity of some specific fear questionnaires. Scand J Psychol. (1983) 24:331–4. doi: 10.1111/j.1467-9450.1983.tb00507.x PubMed DOI

Muris P, Merckelbach H. A comparison of two spider fear questionnaires. J Behav Ther Exp Psychiatry. (1996) 27:241–4. doi: 10.1016/S0005-7916(96)00022-5, PMID: PubMed DOI

Zsido AN, Arato N, Inhof O, Janszky J, Darnai G. Short versions of two specific phobia measures: the snake and the spider questionnaires. J Anxiety Disord. (2018) 54:11–6. doi: 10.1016/j.janxdis.2017.12.002, PMID: PubMed DOI

Wikström J, Lundh LG, Westerlund J, Högman L. Preattentive bias for snake words in snake phobia? Behav Res Ther. (2004) 42:949–70. doi: 10.1016/j.brat.2003.07.002, PMID: PubMed DOI

Wright LM, Holborn SW, Resutek PE. An experimental test of stimulus estimation theory: danger and safety with snake phobic stimuli. Behav Res Ther. (2002) 40:911–22. doi: 10.1016/S0005-7967(01)00078-X PubMed DOI

Zsido AN. The spider and the snake–a psychometric study of two phobias and insights from the Hungarian validation. Psychiatry Res. (2017) 257:61–6. doi: 10.1016/j.psychres.2017.07.024 PubMed DOI

Haidt J, McCauley C, Rozin P. Individual differences in sensitivity to disgust: a scale sampling seven domains of disgust elicitors. Personal Individ Differ. (1994) 16:701–13. doi: 10.1016/0191-8869(94)90212-7 DOI

Olatunji BO, Williams NL, Tolin DF, Abramowitz JS, Sawchuk CN, Lohr JM, et al. . The Disgust Scale: item analysis, factor structure, and suggestions for refinement. Psychol Assess. (2007) 19:281–97. doi: 10.1037/1040-3590.19.3.281, PMID: PubMed DOI

Polák J, Landová E, Frynta D. Undisguised disgust: a psychometric evaluation of a disgust propensity measure. Curr Psychol. (2019) 38:608–17. doi: 10.1007/s12144-018-9925-4 DOI

van Overveld M, De Jong PJ, Peters ML, Schouten E. The Disgust Scale-R: a valid and reliable index to investigate separate disgust domains? Personal Individ Differ. (2011) 51:325–30. doi: 10.1016/j.paid.2011.03.023 DOI

Oksanen J, Blanchet FG, Friendly M, Kindt R, Legendre P, McGlinn D, et al. .. vegan: community ecology package. R package version 2.5-7. (2020). Available at: https://CRAN.R-project.org/package=vegan

Ter Braak CJ, Šmilauer P. Canoco reference manual and user’s guide: Software for ordination (version 5.10). (2018) Biometris, Wageningen University & Research., PMID: PubMed

StatSoft Inc . Statistica (data analysis software system), Version 13. Available at: http://www.statsoft.com/

R Core Team (2021) . R: A language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria. Available at: https://www.R-project.org/

Venables WNN, Ripley BD. Modern Applied Statistics with S, Fourth edition. (2002) Springer, New York. Available at: https://www.stats.ox.ac.uk/pub/MASS4/, PMID: PubMed

Fonov V, Evans AC, Botteron K, Almli CR, McKinstry RC, Collins DL, et al. . Unbiased average age-appropriate atlases for pediatric studies. NeuroImage. (2011) 54:313–27. doi: 10.1016/j.neuroimage.2010.07.033 PubMed DOI PMC

Del Casale A, Ferracuti S, Rapinesi C, Serata D, Piccirilli M, Savoja V, et al. . Functional neuroimaging in specific phobia. Psychiatry Res Neuroimaging. (2012) 202:181–97. doi: 10.1016/j.pscychresns.2011.10.009 PubMed DOI

Gentili C, Messerotti Benvenuti S, Lettieri G, Costa C, Cecchetti L. ROI and phobias: the effect of ROI approach on an ALE meta-analysis of specific phobias. Hum Brain Mapp. (2019) 40:1814–28. doi: 10.1002/hbm.24492, PMID: PubMed DOI PMC

Linares IM, Trzesniak C, Chagas MHN, Hallak JE, Nardi AE, Crippa JAS. Neuroimaging in specific phobia disorder: a systematic review of the literature. Braz J. Psychiatry. (2012) 34:101–11. doi: 10.1016/S1516-4446(12)70017-X, PMID: PubMed DOI

Peñate W, Fumero A, Viña C, Herrero M, Marrero RJ, Rivero F. A meta-analytic review of neuroimaging studies of specific phobia to small animals. Eur J Psychiatry. (2017) 31:23–36. doi: 10.1016/j.ejpsy.2016.12.003 DOI

Fumero A, Marrero RJ, Rivero F, Alvarez-Pérez Y, Bethencourt JM, González M, et al. . Neuronal correlates of small animal phobia in human subjects through fMRI: the role of the number and proximity of stimuli. Life. (2021) 11:275. doi: 10.3390/life11040275, PMID: PubMed DOI PMC

Ipser JC, Singh L, Stein DJ. Meta-analysis of functional brain imaging in specific phobia. Psychiatry Clin Neurosci. (2013) 67:311–22. doi: 10.1111/pcn.12055, PMID: PubMed DOI

Schrammen E, Roesmann K, Rosenbaum D, Redlich R, Harenbrock J, Dannlowski U, et al. . Functional neural changes associated with psychotherapy in anxiety disorders–a meta-analysis of longitudinal fMRI studies. Neurosci Biobehav Rev. (2022) 142:104895. doi: 10.1016/j.neubiorev.2022.104895, PMID: PubMed DOI

Cisler JM, Olatunji BO, Lohr JM. Disgust sensitivity and emotion regulation potentiate the effect of disgust propensity on spider fear, blood-injection-injury fear, and contamination fear. J Behav Ther Exp Psychiatry. (2009) 40:219–29. doi: 10.1016/j.jbtep.2008.10.002, PMID: PubMed DOI PMC

van Overveld WJM, De Jong PJ, Peters ML, Cavanagh K, Davey GC. Disgust propensity and disgust sensitivity: separate constructs that are differentially related to specific fears. Personal Individ Differ. (2006) 41:1241–52. doi: 10.1016/j.paid.2006.04.021 DOI

Michałowski JM, Matuszewski J, Droździel D, Koziejowski W, Rynkiewicz A, Jednoróg K, et al. . Neural response patterns in spider, blood-injection-injury and social fearful individuals: new insights from a simultaneous EEG/ECG–fMRI study. Brain Imaging Behav. (2017) 11:829–45. doi: 10.1007/s11682-016-9557-y, PMID: PubMed DOI

Rosenbaum D, Leehr EJ, Kroczek A, Rubel JA, Int-Veen I, Deutsch K, et al. . Neuronal correlates of spider phobia in a combined fNIRS-EEG study. Sci Rep. (2020) 10:12597. doi: 10.1038/s41598-020-69127-3, PMID: PubMed DOI PMC

Knopf K, Pössel P. Individual response differences in spider phobia: comparing phobic and non-phobic women of different reactivity levels. Anxiety Stress Coping. (2009) 22:39–55. doi: 10.1080/10615800802169358, PMID: PubMed DOI

Soares SC, Kessel D, Hernández-Lorca M, García-Rubio MJ, Rodrigues P, Gomes N, et al. . Exogenous attention to fear: differential behavioral and neural responses to snakes and spiders. Neuropsychologia. (2017) 99:139–47. doi: 10.1016/j.neuropsychologia.2017.03.007, PMID: PubMed DOI

Klieger DM, Siejak KK. Disgust as the source of false positive effects in the measurement of ophidiophobia. J Psychol. (1997) 131:371–82. doi: 10.1080/00223989709603523, PMID: PubMed DOI

Attentional, emotional, and behavioral response toward spiders, scorpions, crabs, and snakes provides no evidence for generalized fear between spiders and scorpions

Are vipers prototypic fear-evoking snakes? A cross-cultural comparison of Somalis and Czechs

Animals evoking fear in the Cradle of Humankind: snakes, scorpions, and large carnivores