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Zantvoord JB, Ensink JBM, Op den Kelder R, Diehle J, Lok A, Lindauer RJL. Autonomic nervous system function before and after trauma-focused psychotherapy in youth with (partial) posttraumatic stress disorder. Psychoneuroendocrinology 2024; 162:106945. [PMID: 38244488 DOI: 10.1016/j.psyneuen.2023.106945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 11/17/2023] [Accepted: 12/21/2023] [Indexed: 01/22/2024]
Abstract
While trauma-focused psychotherapies have been shown effective in youth with PTSD, the relationship between treatment response and alterations in the autonomic nervous system (ANS) associated with PTSD, remains incompletely understood. During neutral and personalized trauma script imagery heart rate (HR), pre-ejection period (PEP) and respiratory sinus arrhythmia (RSA) were recorded in youth aged 8-18 with PTSD or partial PTSD (n = 76) and trauma-exposed controls (TEC) (n = 27) to determine ANS activity and stress reactivity. Within the patient group, 77.6% met the full DSM-IV diagnostic criteria for PTSD, the remaining 22.4% met the criteria for partial PTSD. Youth with (partial) PTSD were subsequently treated with eight sessions of either trauma-focused cognitive behavioral therapy or eye movement desensitization and reprocessing. PTSD severity was assessed using the Clinician-Administered PTSD scale for Children and Adolescents to divide patients into responders and non-responders. Youth with (partial) PTSD relative to TEC had higher overall HR during both neutral and trauma imagery (p = .05). Youth with (partial) PTSD showed RSA decrease during trauma imagery relative to neutral imagery, the reverse of TEC (p = .01). Relative to non-responders, responders demonstrated a significant baseline to posttreatment increase of RSA response to stress only when employing a ≥ 50% response criterion (p = .05) and not with the primary ≥ 30% criterion (p = .12). Our results suggest overall higher HR and sympathetic nervous system activity as well as vagal withdrawal in response to stress in youth with (partial) PTSD and only provide partial support for normalization of the latter with successful trauma-focused psychotherapy.
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Affiliation(s)
- Jasper B Zantvoord
- Department of Psychiatry, Amsterdam University Medical Center, Amsterdam, the Netherlands; Department of Child and Adolescent Psychiatry, Amsterdam University Medical Center, Amsterdam, the Netherlands.
| | - Judith B M Ensink
- Department of Child and Adolescent Psychiatry, Amsterdam University Medical Center, Amsterdam, the Netherlands; Levvel, Academic Centre for Child and Adolescent Psychiatry, Amsterdam, the Netherlands
| | - Rosanne Op den Kelder
- Levvel, Academic Centre for Child and Adolescent Psychiatry, Amsterdam, the Netherlands
| | - Julia Diehle
- WODC-Research and Documentation Centre, The Hague, the Netherlands
| | - Anja Lok
- Department of Psychiatry, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Ramon J L Lindauer
- Department of Child and Adolescent Psychiatry, Amsterdam University Medical Center, Amsterdam, the Netherlands; Levvel, Academic Centre for Child and Adolescent Psychiatry, Amsterdam, the Netherlands
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2
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González-Alemañy E, Ostrosky F, Lozano A, Lujan A, Perez M, Castañeda D, Diaz K, Lara R, Sacristan E, Bobes MA. Brain structural change associated with Cognitive Behavioral Therapy in maltreated children. Brain Res 2024; 1825:148702. [PMID: 38070819 DOI: 10.1016/j.brainres.2023.148702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Revised: 11/30/2023] [Accepted: 12/01/2023] [Indexed: 01/28/2024]
Abstract
BACKGROUND Severely maltreatment child is a harmful social factor that can disrupt normal neurodevelopment. Two commonly reported effects of maltreatment are post-traumatic stress disorder (PTSD) symptoms and brain structural and functional alteration. While Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT) is effectively used to reduce PTSD symptoms in maltreated children, yet, its impact on brain structural alterations has not been fully explored. This study investigated whether TF-CBT can attenuate alterations in brain structures associated with PTSD in middle childhood. METHODS The study evaluated the longitudinal effects of Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT) on post-traumatic stress disorder (PTSD) symptoms and gray matter volume (GMV) in two groups of children under 12 years old: maltreated children (MC) and healthy non- maltreatmentd children (HC). Structural magnetic resonance images T1 were obtained before and after TF-CBT in the MC group, while the HC group was scanned twice within the same time interval. Voxel-based morphometry (VBM) was used to analyze GMV changes over time. RESULTS After TF-CBT, maltreated children showed significantly reduced PTSD symptoms. Furthermore, a significant group-by-time interaction effect was observed in certain areas of the Left Temporal, Left Occipital, and bilateral Frontal Cortex, the Basal Ganglia and Cerebellum. These interaction effects were driven by a GMV decrease in the MC group compared to the HC group. GMV changes can be predicted with clinical improvement in the left Middle Temporal gyrus, left Precuneus, and Cerebellum. CONCLUSIONS Our results suggest that TF-CBT intervention in very young maltreated children may have an effect on gray matter. This evidence demonstrates the importance of timely intervention when neuroplasticity mechanisms may be activated.
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Affiliation(s)
| | | | | | | | | | | | | | - Rafael Lara
- Centro Nacional de Investigación en Imagenología e instrumentación Médica (CI3M, Universidad Nacional Autónoma de México UNAM), México.
| | - Emilio Sacristan
- Centro Nacional de Investigación en Imagenología e instrumentación Médica (CI3M, Universidad Nacional Autónoma de México UNAM), México.
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3
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Russell JD, Heyn SA, Herringa RJ. Through a Developmental Lens: Emerging Insights to Understand and Treat Pediatric PTSD. Am J Psychiatry 2023; 180:636-644. [PMID: 37654114 PMCID: PMC10636806 DOI: 10.1176/appi.ajp.20230523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Affiliation(s)
- Justin D Russell
- Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison
| | - Sara A Heyn
- Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison
| | - Ryan J Herringa
- Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison
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4
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Kotzalidis GD, Ferrara OM, Margoni S, Ieritano V, Restaino A, Bernardi E, Fischetti A, Catinari A, Monti L, Chieffo DPR, Simonetti A, Sani G. Are the Post-COVID-19 Posttraumatic Stress Disorder (PTSD) Symptoms Justified by the Effects of COVID-19 on Brain Structure? A Systematic Review. J Pers Med 2023; 13:1140. [PMID: 37511753 PMCID: PMC10381510 DOI: 10.3390/jpm13071140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 07/07/2023] [Accepted: 07/12/2023] [Indexed: 07/30/2023] Open
Abstract
COVID-19 affects brain function, as deduced by the "brain fog" that is often encountered in COVID-19 patients and some cognitive impairment that is observed in many a patient in the post-COVID-19 period. Approximately one-third of patients, even when they have recovered from the acute somatic disease, continue to show posttraumatic stress disorder (PTSD) symptoms. We hypothesized that the persistent changes induced by COVID-19 on brain structure would overlap with those associated with PTSD. We performed a thorough PubMed search on 25 April 2023 using the following strategy: ((posttraumatic OR PTSD) AND COVID-19 AND (neuroimaging OR voxel OR VBM OR freesurfer OR structural OR ROI OR whole-brain OR hippocamp* OR amygd* OR "deep gray matter" OR "cortical thickness" OR caudate OR striatum OR accumbens OR putamen OR "regions of interest" OR subcortical)) OR (COVID-19 AND brain AND (voxel[ti] OR VBM[ti] OR magnetic[ti] OR resonance[ti] OR imaging[ti] OR neuroimaging[ti] OR neuroimage[ti] OR positron[ti] OR photon*[ti] OR PET[ti] OR SPET[ti] OR SPECT[ti] OR spectroscop*[ti] OR MRS[ti])), which produced 486 records and two additional records from other sources, of which 36 were found to be eligible. Alterations were identified and described and plotted against the ordinary PTSD imaging findings. Common elements were hypometabolism in the insula and caudate nucleus, reduced hippocampal volumes, and subarachnoid hemorrhages, while white matter hyperintensities were widespread in both PTSD and post-COVID-19 brain infection. The comparison partly supported our initial hypothesis. These data may contribute to further investigation of the effects of long COVID on brain structure and function.
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Affiliation(s)
- Georgios D Kotzalidis
- NESMOS (Neurosciences, Mental Health, and Sensory Organs) Department, Faculty of Medicine and Psychology, Sant'Andrea Hospital, Sapienza-Università di Roma, 00189 Rome, Italy
- Department of Neuroscience, Section of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCSS, 00168 Rome, Italy
- Centro Lucio Bini, 00193 Rome, Italy
| | - Ottavia Marianna Ferrara
- Department of Neuroscience, Section of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCSS, 00168 Rome, Italy
| | - Stella Margoni
- Department of Neuroscience, Section of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCSS, 00168 Rome, Italy
| | - Valentina Ieritano
- Department of Neuroscience, Section of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCSS, 00168 Rome, Italy
| | - Antonio Restaino
- Department of Neuroscience, Section of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCSS, 00168 Rome, Italy
| | - Evelina Bernardi
- Department of Neuroscience, Section of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCSS, 00168 Rome, Italy
| | - Alessia Fischetti
- Department of Neuroscience, Section of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCSS, 00168 Rome, Italy
| | - Antonello Catinari
- Department of Neuroscience, Section of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCSS, 00168 Rome, Italy
| | - Laura Monti
- UOS Clinical Psychology, Clinical Government, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Daniela Pia Rosaria Chieffo
- UOS Clinical Psychology, Clinical Government, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
- Women, Children and Public Health Department, Catholic University of the Sacred Heart, 00168 Rome, Italy
| | - Alessio Simonetti
- Department of Neuroscience, Section of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCSS, 00168 Rome, Italy
- Centro Lucio Bini, 00193 Rome, Italy
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX 77030, USA
- Institute of Psychiatry, Department of Neuroscience, Catholic University of the Sacred Heart, 00168 Rome, Italy
| | - Gabriele Sani
- Department of Neuroscience, Section of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCSS, 00168 Rome, Italy
- Institute of Psychiatry, Department of Neuroscience, Catholic University of the Sacred Heart, 00168 Rome, Italy
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Lan Q, Ge J, Dai H, Lu J, Wu L, Liu B, Zhang L, Lu G, Qi R, Cao Z, Luo Y. Longitudinal changes in brain structure and their relationship with subclinical psychiatric symptoms in parents who lost their only child in China. Eur J Psychotraumatol 2023; 14:2216624. [PMID: 37334993 DOI: 10.1080/20008066.2023.2216624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 04/28/2023] [Accepted: 05/09/2023] [Indexed: 06/21/2023] Open
Abstract
BACKGROUND Losing an only child (Shidu) is a grievous traumatic event that may affect brain structure, even if it does not lead to psychiatric disorders. However, longitudinal changes in brain structure and their relationship to subclinical psychiatric symptoms (SPS) have not been well investigated in Shidu parents without any psychiatric disorders (SDNP). OBJECTIVES This study aimed to investigate cross-sectional and longitudinal changes in cortical thickness and surface area in SDNP, and to explore their relationship with SPS. METHODS A total of 50 SDNP and 40 matched healthy controls (HC) were enrolled. All participants underwent structural MRI scans and clinical assessment at baseline and at the 5-year follow-up. Differences in brain structural phenotypes (cortical thickness, surface area, and their annual rate of change) between the SDNP and HC groups were compared using FreeSurfer. Correlations between significant brain structural phenotypes and SPS in the SDNP group were evaluated using multiple linear regressions. RESULTS The SDNP group showed a smaller surface area in the left inferior parietal cortex than the HC group at baseline and follow-up. The SDNP group showed slower rates of cortical thinning and surface area loss in several brain regions than the HC group from baseline to follow-up. Moreover, slower rates of cortical thinning in the left insula, superior frontal cortex, and superior temporal cortex were associated with greater reductions in avoidance, depression, and trauma re-experiencing symptoms scores over time in the SDNP group, respectively. CONCLUSIONS Shidu trauma-induced structural abnormalities in the inferior parietal cortex may persist over time and be independent of the severity of psychiatric symptoms. The expansion of prefrontal, temporal, and insular cortex implicated in emotional regulation may contribute to improvements in psychiatric symptoms in Shidu parents.
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Affiliation(s)
- Qingyue Lan
- Department of Radiology, the Affiliated Yixing Hospital of Jiangsu University, Wuxi, People's Republic of China
| | - Jiyuan Ge
- Department of Radiology, the Affiliated Yixing Hospital of Jiangsu University, Wuxi, People's Republic of China
| | - Huanhuan Dai
- Department of Radiology, the Affiliated Yixing Hospital of Jiangsu University, Wuxi, People's Republic of China
| | - Junjie Lu
- Department of Intensive Care Unit, the Affiliated Yixing Hospital of Jiangsu University, Wuxi, People's Republic of China
| | - Luoan Wu
- Department of Psychiatry, Yixing mental health center, Wuxi, People's Republic of China
| | - Bo Liu
- Department of Radiology, the Affiliated Yixing Hospital of Jiangsu University, Wuxi, People's Republic of China
| | - Li Zhang
- Mental Health Institute, the Second Xiangya Hospital, National Technology Institute of Psychiatry, Key Laboratory of Psychiatry and Mental Health of Hunan Province, Central South University, Changsha, People's Republic of China
| | - Guangming Lu
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, People's Republic of China
| | - Rongfeng Qi
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, People's Republic of China
| | - Zhihong Cao
- Department of Radiology, the Affiliated Yixing Hospital of Jiangsu University, Wuxi, People's Republic of China
| | - Yifeng Luo
- Department of Radiology, the Affiliated Yixing Hospital of Jiangsu University, Wuxi, People's Republic of China
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Heyn SA, Bailowitz S, Russell JD, Herringa RJ. Sex-based variations of prefrontal structure and longitudinal symptoms in pediatric posttraumatic stress disorder. Depress Anxiety 2022; 39:902-912. [PMID: 36349877 PMCID: PMC9762118 DOI: 10.1002/da.23296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 10/25/2022] [Accepted: 10/30/2022] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Pediatric posttraumatic stress disorder (pPTSD) is more than three times as likely to develop in trauma-exposed female youth than males. Despite the staggering sex differences in the prevalence rates of pPTSD and symptom expression, relatively little is known about the underlying biomarkers of these sex-based variations in pPTSD as compared to typically development. METHODS The Youth PTSD study recruited 97 youth, ages of 7 and 18, to undergo comprehensive clinical assessments and T1-weighted MRI to evaluate the extent to which sex can explain PTSD-related variations in brain structure. Whole-brain VBM as well as whole-brain estimates of cortical thickness and surface area were analyzed to identify group-by-sex interactions. Finally, we tested whether current or future symptom severity was predictive of regions exhibiting sex-based variations. RESULTS Clinically, females with PTSD were significantly more likely to report exposure to and higher severity of interpersonal violence and symptoms of hyperarousal. Sex and PTSD status were predictive of gray matter across the lateral prefrontal cortex (PFC), including the ventrolateral PFC and frontal pole, where increased volume and surface area was found in PTSD females as compared to PTSD males. Interestingly, the ventrolateral prefrontal cortex and frontal pole were negatively predictive of symptoms 1 year later in only males with PTSD. CONCLUSIONS Together, these results establish that youth with PTSD exhibit sex-based variations in clinical and trauma characteristics and prefrontal cortical structure relative to normative development. This work demonstrates the importance of examining the role that sex may play in the behavioral and neurobiological presentation of pPTSD.
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Affiliation(s)
- Sara A. Heyn
- Department of Psychiatry, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
| | - Sophie Bailowitz
- Department of Psychiatry, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
| | - Justin D. Russell
- Department of Psychiatry, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
| | - Ryan J. Herringa
- Department of Psychiatry, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
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7
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Brewerton TD. Mechanisms by which adverse childhood experiences, other traumas and PTSD influence the health and well-being of individuals with eating disorders throughout the life span. J Eat Disord 2022; 10:162. [PMID: 36372878 PMCID: PMC9661783 DOI: 10.1186/s40337-022-00696-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 11/09/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Multiple published sources from around the world have confirmed an association between an array of adverse childhood experiences (ACEs) and other traumatic events with eating disorders (EDs) and related adverse outcomes, including higher morbidity and mortality. METHODS In keeping with this Special Issue's goals, this narrative review focuses on the ACEs pyramid and its purported mechanisms through which child maltreatment and other forms of violence toward human beings influence the health and well-being of individuals who develop EDs throughout the life span. Relevant literature on posttraumatic stress disorder (PTSD) is highlighted when applicable. RESULTS At every level of the pyramid, it is shown that EDs interact with each of these proclaimed escalating mechanisms in a bidirectional manner that contributes to the predisposition, precipitation and perpetuation of EDs and related medical and psychiatric comorbidities, which then predispose to early death. The levels and their interactions that are discussed include the contribution of generational embodiment (genetics) and historical trauma (epigenetics), social conditions and local context, the ACEs and other traumas themselves, the resultant disrupted neurodevelopment, subsequent social, emotional and cognitive impairment, the adoption of health risk behaviors, and the development of disease, disability and social problems, all resulting in premature mortality by means of fatal complications and/or suicide. CONCLUSIONS The implications of these cascading, evolving, and intertwined perspectives have important implications for the assessment and treatment of EDs using trauma-informed care and trauma-focused integrated treatment approaches. This overview offers multiple opportunities at every level for the palliation and prevention of EDs and other associated trauma-related conditions, including PTSD.
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Affiliation(s)
- Timothy D Brewerton
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA.
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8
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Xiao S, Yang Z, Su T, Gong J, Huang L, Wang Y. Functional and structural brain abnormalities in posttraumatic stress disorder: A multimodal meta-analysis of neuroimaging studies. J Psychiatr Res 2022; 155:153-162. [PMID: 36029627 DOI: 10.1016/j.jpsychires.2022.08.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 08/09/2022] [Accepted: 08/15/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Numerous resting-state functional and structural studies have revealed that many brain regions are involved in the pathogenesis of posttraumatic stress disorder (PTSD), but their findings have been inconsistent. Moreover, there has no study explored the functional and structural alterations across languages in PTSD. METHODS A meta-analysis of whole-brain on the amplitude of low-frequency fluctuation (ALFF) and voxel-based morphometry (VBM) studies that explored alterations in the spontaneous functional brain activity and grey matter volume (GMV) in PTSD patients across languages by using the Seed-based d Mapping with Permutation of Subject Images (SDM-PSI) software. RESULTS A total of 15 studies (19 datasets) comprising 577 PTSD patients and 499 HCs for ALFF, and 27 studies (31 datasets) comprising 539 PTSD patients and 693 HCs for VBM were included. Overall, PTSD patients across languages displayed decreased ALFF in the in the left amygdala. For VBM meta-analysis, PTSD patients across languages displayed reduced GMV in the bilateral anterior cingulate cortex/medial prefrontal cortex (ACC/mPFC), striatum, insula, superior temporal gyrus, left postcentral gyrus, and occipital gyrus. CONCLUSIONS The multimodal meta-analysis suggest that PTSD patients showed similar pattern of aberrant resting-state functional brain activity and structure mainly in the amygdala, suggesting that structural deficits might underlie alterations in function. In addition, some regions exhibited only structural abnormalities in PTSD, including the ACC/mPFC, striatum, insula, primary visual, auditory and sensorimotor cortices. Moreover, consistent alterations in PTSD patients across languages may draw attention to the disparity in multi-cultural considerations in psychiatric research and further understanding the neurophysiopathology of PTSD.
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Affiliation(s)
- Shu Xiao
- Medical Imaging Center, First Affiliated Hospital of Jinan University, Guangzhou, 510630, China; Institute of Molecular and Functional Imaging, Jinan University, Guangzhou, 510630, China
| | - Zibin Yang
- Medical Imaging Center, First Affiliated Hospital of Jinan University, Guangzhou, 510630, China; Institute of Molecular and Functional Imaging, Jinan University, Guangzhou, 510630, China
| | - Ting Su
- Medical Imaging Center, First Affiliated Hospital of Jinan University, Guangzhou, 510630, China; Institute of Molecular and Functional Imaging, Jinan University, Guangzhou, 510630, China
| | - Jiaying Gong
- Institute of Molecular and Functional Imaging, Jinan University, Guangzhou, 510630, China; Department of Radiology, Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510655, China
| | - Li Huang
- Medical Imaging Center, First Affiliated Hospital of Jinan University, Guangzhou, 510630, China; Institute of Molecular and Functional Imaging, Jinan University, Guangzhou, 510630, China
| | - Ying Wang
- Medical Imaging Center, First Affiliated Hospital of Jinan University, Guangzhou, 510630, China; Institute of Molecular and Functional Imaging, Jinan University, Guangzhou, 510630, China.
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9
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Young G. Psychotherapeutic Change Mechanisms and Causal Psychotherapy: Applications to Child Abuse and Trauma. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2022; 15:911-923. [PMID: 35958715 PMCID: PMC9360301 DOI: 10.1007/s40653-022-00438-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/07/2022] [Indexed: 05/07/2023]
Abstract
The study of change mechanisms in psychotherapy needs to be integrated with the causality of behavior, which leads to the concept of causal psychotherapy. Causal psychotherapy is posited as a useful adjunct to standard, evidence based psychotherapies for child and youth victims of abuse and trauma. The article illustrates six processes that could be involved in causal psychotherapy in this context, from the distal to the proximal. They include the distal mechanism of activation-inhibition coordination. The most proximal one relates to executive function. The intermediate levels include ones related to co-regulation (e.g., self control), analysis-synthesis, objectivity-subjectivity, and psychological reserve, which is a new concept in the domain of psychological change mechanisms. Each of the variables can vary from high to low, with the low end being more problematic. Psychotherapy can aim to bring the patient toward adaptive levels. The literature review focuses on psychotherapeutic change mechanisms, and standard psychotherapies for child/youth abuse/trauma, especially trauma-focused cognitive behavior therapy (TF-CBT). Then, it considers causal aspects of child/youth abuse and trauma, including PTSD. The discussion relates causal therapy to the question of unifying psychology and psychotherapy under the rubric of causality as a core integrative mechanism.
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Affiliation(s)
- Gerald Young
- Glendon College, York University, Toronto, Canada
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10
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Manzler CA, Radoman M, Khorrami KJ, Gorka SM. Association between startle reactivity to uncertain threats and structural brain volume. Psychophysiology 2022; 59:e14074. [PMID: 35579909 PMCID: PMC10080733 DOI: 10.1111/psyp.14074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 01/03/2022] [Accepted: 01/10/2022] [Indexed: 11/29/2022]
Abstract
Sensitivity to uncertain threat (U-threat) is a clinically important individual difference factor in multiple psychopathologies. Recent studies have implicated a specific frontolimbic circuit as a key network involved in the anticipation of aversive stimuli. In particular, the insula, thalamus, and dorsal anterior cingulate cortex (dACC) have recently been found to be robustly activated by anticipation of U-threat. However, no study to date has examined the association between U-threat reactivity and structural brain volume. In the present study, we utilized a pooled sample of 186 young adult volunteers who completed a structural MRI scan and the well-validated No-Predictable-Unpredictable (NPU) threat of electric shock task. Startle eyeblink potentiation was collected during the NPU task as an objective index of aversive reactivity. ROI-based analyses revealed that increased startle reactivity to U-threat was associated with reduced gray matter volume in the right insula and bilateral thalamus, but not the dACC. These results add to a growing literature implicating the insula and thalamus as core nodes involved in individual differences in U-threat reactivity.
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Affiliation(s)
- Charles A Manzler
- Department of Psychiatry and Behavioral Health, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Milena Radoman
- Department of Psychiatry, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Kia J Khorrami
- Department of Psychiatry and Behavioral Health, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Stephanie M Gorka
- Department of Psychiatry and Behavioral Health, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.,Institute for Behavioral Medicine Research, The Ohio State University, Columbus, Ohio, USA
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11
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Zhutovsky P, Zantvoord JB, Ensink JBM, Op den Kelder R, Lindauer RJL, van Wingen GA. Individual prediction of trauma-focused psychotherapy response in youth with posttraumatic stress disorder using resting-state functional connectivity. Neuroimage Clin 2022; 32:102898. [PMID: 34911201 PMCID: PMC8645516 DOI: 10.1016/j.nicl.2021.102898] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 11/15/2021] [Accepted: 11/23/2021] [Indexed: 01/23/2023]
Abstract
ML and rs-fMRI have shown promise in predicting treatment-response in adults with PTSD. Currently, no biomarkers for treatment-response are available in youth with PTSD. FC between the FPN and SMN was stronger in treatment non-responders on the group-level. A network within the bilateral STG predicted response for individual youth with 76% accuracy. Future studies should test generalizability of these findings and test if larger cohorts increase accuracy.
Randomized controlled trials have shown efficacy of trauma-focused psychotherapies in youth with posttraumatic stress disorder (PTSD). However, response varies considerably among individuals. Currently, no biomarkers are available to assist clinicians in identifying youth who are most likely to benefit from treatment. In this study, we investigated whether resting-state functional magnetic resonance imaging (rs-fMRI) could distinguish between responders and non-responders on the group- and individual patient level. Pre-treatment rs-fMRI was recorded in 40 youth (ages 8–17 years) with (partial) PTSD before trauma-focused psychotherapy. Change in symptom severity from pre- to post-treatment was assessed using the Clinician-Administered PTSD scale for Children and Adolescents to divide participants into responders (≥30% symptom reduction) and non-responders. Functional networks were identified using meta-independent component analysis. Group-differences within- and between-network connectivity between responders and non-responders were tested using permutation testing. Individual predictions were made using multivariate, cross-validated support vector machine classification. A network centered on the bilateral superior temporal gyrus predicted treatment response for individual patients with 76% accuracy (pFWE = 0.02, 87% sensitivity, 65% specificity, area-under-receiver-operator-curve of 0.82). Functional connectivity between the frontoparietal and sensorimotor network was significantly stronger in non-responders (t = 5.35, pFWE = 0.01) on the group-level. Within-network connectivity was not significantly different between groups. This study provides proof-of-concept evidence for the feasibility to predict trauma-focused psychotherapy response in youth with PTSD at an individual-level. Future studies are required to test if larger cohorts could increase accuracy and to test further generalizability of the prediction models.
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Affiliation(s)
- Paul Zhutovsky
- Amsterdam UMC, University of Amsterdam, Department of Psychiatry, Amsterdam Neuroscience, Amsterdam, The Netherlands.
| | - Jasper B Zantvoord
- Amsterdam UMC, University of Amsterdam, Department of Psychiatry, Amsterdam Neuroscience, Amsterdam, The Netherlands; Amsterdam UMC, University of Amsterdam, Department of Child and Adolescent Psychiatry, Amsterdam Neuroscience, Amsterdam, The Netherlands.
| | - Judith B M Ensink
- Amsterdam UMC, University of Amsterdam, Department of Child and Adolescent Psychiatry, Amsterdam Neuroscience, Amsterdam, The Netherlands; Levvel, Academic Centre for Child and Adolescent Psychiatry, Amsterdam, The Netherlands.
| | - Rosanne Op den Kelder
- Levvel, Academic Centre for Child and Adolescent Psychiatry, Amsterdam, The Netherlands; Research Institute of Child Development and Education, University of Amsterdam, Amsterdam, The Netherlands.
| | - Ramon J L Lindauer
- Amsterdam UMC, University of Amsterdam, Department of Child and Adolescent Psychiatry, Amsterdam Neuroscience, Amsterdam, The Netherlands; Levvel, Academic Centre for Child and Adolescent Psychiatry, Amsterdam, The Netherlands.
| | - Guido A van Wingen
- Amsterdam UMC, University of Amsterdam, Department of Psychiatry, Amsterdam Neuroscience, Amsterdam, The Netherlands.
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12
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George GC, Keding TJ, Heyn SA, Herringa RJ. Longitudinal hippocampal circuit change differentiates persistence and remission of pediatric posttraumatic stress disorder. Depress Anxiety 2022; 39:8-18. [PMID: 34843625 PMCID: PMC8763137 DOI: 10.1002/da.23229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 11/03/2021] [Accepted: 11/16/2021] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Previous studies have identified functional brain abnormalities in pediatric posttraumatic stress disorder (pPTSD) suggesting altered frontoparietal-subcortical function during emotion processing. However, little is known about how the brain functionally changes over time in recovery versus the persistence of pPTSD. METHODS This longitudinal study recruited 23 youth with PTSD and 28 typically developing (TD) youth (ages: 8.07-17.99). Within the PTSD group, nine remitted by the 1-year follow-up (Remit) while the remaining 14 persisted (PTSD). At each visit, youth completed an emotional processing task in which they viewed threat and neutral images during functional magnetic resonance imaging (fMRI). Voxelwise activation analyses using linear mixed-effects regression were conducted using a group (TD, Remit, PTSD) by time (baseline, follow-up) by valence (threat, neutral) design. Based on activation findings, a subsequent analysis of hippocampal functional connectivity was performed using a similar model. RESULTS PTSD youth showed significantly increasing hippocampal activation to threatening images compared to TD youth, while the Remit group showed more similar patterns to TD youth. Subsequent hippocampal functional connectivity analyses reveal the Remit group showed increasing functional connectivity between the hippocampus and visual cortex (V4) while viewing threat stimuli. CONCLUSIONS These findings represent one of the first preliminary reports of functional brain substrates of persistence and remission in pPTSD. Notably, increased hippocampal activation to threat and decreased connectivity in the hippocampal-V4 network over time may contribute to persistence in pPTSD. These findings suggest potential biomarkers that could be utilized to advance the treatment of pediatric PTSD.
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Affiliation(s)
- Grace C. George
- Neuroscience & Public Policy Program, University of Wisconsin-Madison, Madison, WI, USA,Neuroscience Training Program, University of Wisconsin-Madison, Madison, WI, USA,Department of Psychiatry, BRAVE Youth Lab, 6001 Research Park Blvd., Madison, WI 53719, USA
| | - Taylor J. Keding
- Neuroscience Training Program, University of Wisconsin-Madison, Madison, WI, USA,Department of Psychiatry, BRAVE Youth Lab, 6001 Research Park Blvd., Madison, WI 53719, USA
| | - Sara A. Heyn
- Department of Psychiatry, BRAVE Youth Lab, 6001 Research Park Blvd., Madison, WI 53719, USA
| | - Ryan J. Herringa
- Neuroscience Training Program, University of Wisconsin-Madison, Madison, WI, USA,Department of Psychiatry, BRAVE Youth Lab, 6001 Research Park Blvd., Madison, WI 53719, USA
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13
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Benedetti F, Palladini M, Paolini M, Melloni E, Vai B, De Lorenzo R, Furlan R, Rovere-Querini P, Falini A, Mazza MG. Brain correlates of depression, post-traumatic distress, and inflammatory biomarkers in COVID-19 survivors: A multimodal magnetic resonance imaging study. Brain Behav Immun Health 2021; 18:100387. [PMID: 34746876 PMCID: PMC8562046 DOI: 10.1016/j.bbih.2021.100387] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 10/31/2021] [Indexed: 01/08/2023] Open
Abstract
Psychiatric sequelae substantially contribute to the post-acute burden of disease associated with COVID-19, persisting months after clearance of the virus. Brain imaging shows white matter (WM) hypodensities/hyperintensities, and the involvement of grey matter (GM) in prefrontal, anterior cingulate (ACC) and insular cortex after COVID, but little is known about brain correlates of persistent psychopathology. With a multimodal approach, we studied whole brain voxel-based morphometry, diffusion-tensor imaging, and resting-state connectivity, to correlate MRI measures with depression and post-traumatic distress (PTSD) in 42 COVID-19 survivors without brain lesions, at 90.59 ± 54.66 days after COVID. Systemic immune-inflammation index (SII) measured in the emergency department, which reflects the immune response and systemic inflammation based on peripheral lymphocyte, neutrophil, and platelet counts, predicted worse self-rated depression and PTSD, widespread lower diffusivity along the main axis of WM tracts, and abnormal functional connectivity (FC) among resting state networks. Self-rated depression and PTSD inversely correlated with GM volumes in ACC and insula, axial diffusivity, and associated with FC. We observed overlapping associations between severity of inflammation during acute COVID-19, brain structure and function, and severity of depression and post-traumatic distress in survivors, thus warranting interest for further study of brain correlates of the post-acute COVID-19 syndrome. Beyond COVID-19, these findings support the hypothesis that regional GM, WM microstructure, and FC could mediate the relationship between a medical illness and its psychopathological sequelae, and are in agreement with current perspectives on the brain structural and functional underpinnings of depressive psychopathology.
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Affiliation(s)
- Francesco Benedetti
- Vita-Salute San Raffaele University, Milano, Italy
- Psychiatry & Clinical Psychobiology, Division of Neuroscience, IRCCS Scientific Institute Ospedale San Raffaele, Milano, Italy
| | - Mariagrazia Palladini
- Psychiatry & Clinical Psychobiology, Division of Neuroscience, IRCCS Scientific Institute Ospedale San Raffaele, Milano, Italy
| | - Marco Paolini
- Vita-Salute San Raffaele University, Milano, Italy
- Psychiatry & Clinical Psychobiology, Division of Neuroscience, IRCCS Scientific Institute Ospedale San Raffaele, Milano, Italy
- PhD Program in Molecular Medicine, University Vita-Salute San Raffaele, Milan, Italy
| | - Elisa Melloni
- Vita-Salute San Raffaele University, Milano, Italy
- Psychiatry & Clinical Psychobiology, Division of Neuroscience, IRCCS Scientific Institute Ospedale San Raffaele, Milano, Italy
| | - Benedetta Vai
- Vita-Salute San Raffaele University, Milano, Italy
- Psychiatry & Clinical Psychobiology, Division of Neuroscience, IRCCS Scientific Institute Ospedale San Raffaele, Milano, Italy
| | - Rebecca De Lorenzo
- Vita-Salute San Raffaele University, Milano, Italy
- Division of Immunology, Transplantation and Infectious Diseases, IRCCS Scientific Institute Ospedale San Raffaele, Milan, Italy
| | - Roberto Furlan
- Clinical Neuroimmunology, Division of Neuroscience, IRCCS Scientific Institute Ospedale San Raffaele, Milano, Italy
| | - Patrizia Rovere-Querini
- Vita-Salute San Raffaele University, Milano, Italy
- Division of Immunology, Transplantation and Infectious Diseases, IRCCS Scientific Institute Ospedale San Raffaele, Milan, Italy
| | - Andrea Falini
- Vita-Salute San Raffaele University, Milano, Italy
- Department of Neuroradiology, IRCCS Scientific Institute Ospedale San Raffaele, Milan, Italy
| | - Mario Gennaro Mazza
- Vita-Salute San Raffaele University, Milano, Italy
- Psychiatry & Clinical Psychobiology, Division of Neuroscience, IRCCS Scientific Institute Ospedale San Raffaele, Milano, Italy
- PhD Program in Cognitive Neuroscience, University Vita-Salute San Raffaele, Milan, Italy
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