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Ellis R, Sinnott S, Karam K, Assefa A, Osborne M, Seligowski A. Impact of cognitive behavioural therapy on neural, inflammatory, & autonomic markers in a sample with PTSD and cardiovascular risk: protocol for a pilot randomised controlled trial. Eur J Psychotraumatol 2024; 15:2378618. [PMID: 39045795 PMCID: PMC11271075 DOI: 10.1080/20008066.2024.2378618] [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: 05/08/2024] [Revised: 06/25/2024] [Accepted: 07/02/2024] [Indexed: 07/25/2024] Open
Abstract
Background: Individuals with posttraumatic stress disorder (PTSD) are at heightened risk for cardiovascular disease (CVD) compared to the general population. Inflammation and autonomic dysfunction are candidate mechanisms of CVD risk in PTSD; however, these mechanisms have not been well-characterised in the PTSD-CVD link. Further, these mechanisms may operate through altered stress-related neural activity (SNA). Yet, it remains unknown if changes in PTSD are associated with changes in CVD risk mechanisms.Objective: This manuscript describes the design and procedures of a pilot randomised controlled trial to assess the impact of a first-line treatment for PTSD (Cognitive Processing Therapy; CPT) versus waitlist control on mechanisms of CVD risk. Further, this study will test the hypothesis that CPT reduces CVD risk through its effects on inflammation and autonomic function and that these changes are driven by changes in SNA.Methods: Adults with PTSD and CVD risk (N = 30) will be randomised to CPT or waitlist control. Participants complete two laboratory visits (baseline and post-treatment) that include surveys, brain and peripheral imaging via 18F-fluorodeoxyglucose positron emission tomography (FDG-PET), and resting measures of autonomic function. Primary outcomes include arterial inflammation and heart rate variability. Secondary outcomes include leukopoiesis (bone marrow uptake), heart rate, and blood pressure. The indirect effects of PTSD treatment on changes in inflammation and autonomic function through SNA will also be examined.Conclusions: This study seeks to characterise candidate neuroimmune mechanisms of the PTSD-CVD link to identify treatment targets and develop personalised interventions to reduce CVD events in PTSD populations.Trial registration: ClinicalTrials.gov identifier: NCT06429293..
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Affiliation(s)
- Robyn Ellis
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- McLean Hospital, Belmont, MA, USA
| | - Sinead Sinnott
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- McLean Hospital, Belmont, MA, USA
| | - Krystel Karam
- Cardiovascular Imaging Research Center, Massachusetts General Hospital, Boston, MA, USA
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Alula Assefa
- Cardiovascular Imaging Research Center, Massachusetts General Hospital, Boston, MA, USA
| | - Michael Osborne
- Cardiovascular Imaging Research Center, Massachusetts General Hospital, Boston, MA, USA
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Antonia Seligowski
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Cardiovascular Imaging Research Center, Massachusetts General Hospital, Boston, MA, USA
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Gharios C, van Leent MMT, Chang HL, Abohashem S, O’Connor D, Osborne MT, Tang CY, Kaufman AE, Robson PM, Ramachandran S, Calcagno C, Mani V, Trivieri MG, Seligowski AV, Dekel S, Mulder WJM, Murrough JW, Shin LM, Tawakol A, Fayad ZA. Cortico-limbic interactions and carotid atherosclerotic burden during chronic stress exposure. Eur Heart J 2024; 45:1753-1764. [PMID: 38753456 PMCID: PMC11107120 DOI: 10.1093/eurheartj/ehae149] [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: 05/04/2023] [Revised: 02/05/2024] [Accepted: 02/28/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND AND AIMS Chronic stress associates with cardiovascular disease, but mechanisms remain incompletely defined. Advanced imaging was used to identify stress-related neural imaging phenotypes associated with atherosclerosis. METHODS Twenty-seven individuals with post-traumatic stress disorder (PTSD), 45 trauma-exposed controls without PTSD, and 22 healthy controls underwent 18F-fluorodeoxyglucose positron emission tomography/magnetic resonance imaging (18F-FDG PET/MRI). Atherosclerotic inflammation and burden were assessed using 18F-FDG PET (as maximal target-to-background ratio, TBR max) and MRI, respectively. Inflammation was assessed using high-sensitivity C-reactive protein (hsCRP) and leucopoietic imaging (18F-FDG PET uptake in spleen and bone marrow). Stress-associated neural network activity (SNA) was assessed on 18F-FDG PET as amygdala relative to ventromedial prefrontal cortex (vmPFC) activity. MRI diffusion tensor imaging assessed the axonal integrity (AI) of the uncinate fasciculus (major white matter tract connecting vmPFC and amygdala). RESULTS Median age was 37 years old and 54% of participants were female. There were no significant differences in atherosclerotic inflammation between participants with PTSD and controls; adjusted mean difference in TBR max (95% confidence interval) of the aorta 0.020 (-0.098, 0.138), and of the carotids 0.014 (-0.091, 0.119). Participants with PTSD had higher hsCRP, spleen activity, and aorta atherosclerotic burden (normalized wall index). Participants with PTSD also had higher SNA and lower AI. Across the cohort, carotid atherosclerotic burden (standard deviation of wall thickness) associated positively with SNA and negatively with AI independent of Framingham risk score. CONCLUSIONS In this study of limited size, participants with PTSD did not have higher atherosclerotic inflammation than controls. Notably, impaired cortico-limbic interactions (higher amygdala relative to vmPFC activity or disruption of their intercommunication) associated with carotid atherosclerotic burden. Larger studies are needed to refine these findings.
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Affiliation(s)
- Charbel Gharios
- Cardiovascular Imaging Research Center, Massachusetts General Hospital and Harvard Medical School, 55 Fruit St, Yawkey 5E, Boston, MA 02114-2750, USA
| | - Mandy M T van Leent
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1234, New York, NY 10029-6574, USA
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1234, New York, NY 10029-6574, USA
- Cardiovascular Research Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Helena L Chang
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Shady Abohashem
- Cardiovascular Imaging Research Center, Massachusetts General Hospital and Harvard Medical School, 55 Fruit St, Yawkey 5E, Boston, MA 02114-2750, USA
- Division of Cardiology, Massachusetts General Hospital and Harvard Medical School, 55 Fruit St, Yawkey 5E, Boston, MA 10029-6574, USA
| | - David O’Connor
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1234, New York, NY 10029-6574, USA
| | - Michael T Osborne
- Cardiovascular Imaging Research Center, Massachusetts General Hospital and Harvard Medical School, 55 Fruit St, Yawkey 5E, Boston, MA 02114-2750, USA
- Division of Cardiology, Massachusetts General Hospital and Harvard Medical School, 55 Fruit St, Yawkey 5E, Boston, MA 10029-6574, USA
| | - Cheuk Y Tang
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1234, New York, NY 10029-6574, USA
| | - Audrey E Kaufman
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1234, New York, NY 10029-6574, USA
| | - Philip M Robson
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1234, New York, NY 10029-6574, USA
| | - Sarayu Ramachandran
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1234, New York, NY 10029-6574, USA
| | - Claudia Calcagno
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1234, New York, NY 10029-6574, USA
| | - Venkatesh Mani
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1234, New York, NY 10029-6574, USA
| | - Maria Giovanna Trivieri
- Cardiovascular Research Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Division of Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Antonia V Seligowski
- Cardiovascular Imaging Research Center, Massachusetts General Hospital and Harvard Medical School, 55 Fruit St, Yawkey 5E, Boston, MA 02114-2750, USA
| | - Sharon Dekel
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Willem J M Mulder
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1234, New York, NY 10029-6574, USA
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1234, New York, NY 10029-6574, USA
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
- Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, The Netherlands
- Laboratory of Chemical Biology, Department of Biochemical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - James W Murrough
- Depression and Anxiety Center, Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Lisa M Shin
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychology, Tufts University, Medford, MA, USA
| | - Ahmed Tawakol
- Cardiovascular Imaging Research Center, Massachusetts General Hospital and Harvard Medical School, 55 Fruit St, Yawkey 5E, Boston, MA 02114-2750, USA
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Zahi A Fayad
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1234, New York, NY 10029-6574, USA
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1234, New York, NY 10029-6574, USA
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Carpenter JK, Pineles SL, Griffin MG, Werner K, Resick PA, Galovski TE. Effect of PTSD treatment on cardiovascular reactivity during trauma memory recall and correspondence with symptom improvement. Eur J Psychotraumatol 2024; 15:2335865. [PMID: 38597201 PMCID: PMC11008309 DOI: 10.1080/20008066.2024.2335865] [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: 10/31/2023] [Accepted: 03/18/2024] [Indexed: 04/11/2024] Open
Abstract
ABSTRACTBackground: Prior research has shown PTSD treatment leads to reductions in cardiovascular reactivity during trauma recall, but the extent to which such reductions are associated with changes in PTSD symptoms is less clear. Moreover, such relationships have not been investigated in a cognitively focused PTSD treatment.Objective: To examine changes in cardiovascular reactivity to the trauma memory in patients receiving cognitive processing therapy (CPT), CPT with a written trauma account, and a written account only condition. We also examined the association of such changes with symptom improvement.Method: 118 women with PTSD secondary to interpersonal violence completed pre- and post-treatment assessments of PTSD symptoms and cardiovascular reactivity during a script-driven imagery task.Results: Results indicated a significant but modest reduction in cardiovascular reactivity in CPT conditions. Changes in cardiovascular reactivity and reexperiencing symptoms were significantly associated among the whole sample. Among individuals with the greatest reactivity to the trauma memory at pretreatment, associations were also seen with changes in total PTSD, numbing, and trauma-related guilt.Conclusions: Results indicate that previous findings on the effect of PTSD treatment on cardiovascular reactivity during trauma recall extend to cognitively oriented treatment. Baseline cardiovascular reactivity may influence the extent to which reductions in PTSD symptoms and reactivity during trauma recall are related.
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Affiliation(s)
- Joseph K. Carpenter
- National Center for PTSD, Women’s Health Sciences Division, Boston, MA, USA
- Veterans Affairs (VA) Boston Healthcare System, Boston, MA, USA
- Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Suzanne L. Pineles
- National Center for PTSD, Women’s Health Sciences Division, Boston, MA, USA
- Veterans Affairs (VA) Boston Healthcare System, Boston, MA, USA
- Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Michael G. Griffin
- Department of Psychological Sciences, University of Missouri St. Louis, St. Louis, MO, USA
| | - Kimberly Werner
- College of Nursing, University of Missouri St. Louis, St. Louis, MO, USA
| | - Patricia A. Resick
- Department of Psychiatry and Behavioral Sciences, Duke University Medical School, Durham, NC, USA
| | - Tara E. Galovski
- National Center for PTSD, Women’s Health Sciences Division, Boston, MA, USA
- Veterans Affairs (VA) Boston Healthcare System, Boston, MA, USA
- Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
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Thurston RC. Trauma and its implications for women's cardiovascular health during the menopause transition: Lessons from MsHeart/MsBrain and SWAN studies. Maturitas 2024; 182:107915. [PMID: 38280354 PMCID: PMC10922894 DOI: 10.1016/j.maturitas.2024.107915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 12/21/2023] [Accepted: 01/13/2024] [Indexed: 01/29/2024]
Abstract
Trauma exposure, whether experienced during childhood or adulthood, is prevalent among women. While experiences of trauma are well known to impact mental health, emerging research also links them to women's physical health. The Study of Women's Health Across the Nation (SWAN) and the MsHeart/MsBrain studies, two separate studies devoted to studying midlife women's health, have contributed importantly to the understanding of the implications of trauma to women's health at midlife and beyond. Specifically, findings from these studies have revealed that both childhood and adult trauma exposure are associated with poorer cardiovascular and cerebrovascular health in women, including greater subclinical cardiovascular disease, indicators of cerebral small vessel disease, and increased risk for clinical cardiovascular disease events. When considering trauma types, findings have pointed to the particular importance of sexual and interpersonal violence, such as childhood sexual abuse, intimate-partner violence, sexual harassment, and sexual assault to women's vasculatures. Further, using a range of measures of menopausal vasomotor symptoms, the SWAN and the MsHeart/MsBrain studies have also shown that women with greater trauma exposure have more objectively assessed and self-reported vasomotor symptoms. Finally, although links between trauma exposure and health are not typically explained by post-traumatic stress disorder, work also points to the additional importance of post-traumatic stress disorder to women's cardiovascular and brain health. Collectively, these studies have underscored the importance of trauma to the occurrence of menopausal symptoms, to cardiovascular health, and to women's brain health at midlife and beyond. Future directions and implications for prevention and intervention are discussed.
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Affiliation(s)
- Rebecca C Thurston
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA, United States of America; Department of Psychology, School of Arts and Sciences, University of Pittsburgh, Pittsburgh, PA, United States of America; Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States of America.
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