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Strigo IA, Craig ADB, Simmons AN. Expectation of pain and relief: A dynamical model of the neural basis for pain-trauma co-morbidity. Neurosci Biobehav Rev 2024; 163:105750. [PMID: 38849067 DOI: 10.1016/j.neubiorev.2024.105750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 05/30/2024] [Accepted: 06/02/2024] [Indexed: 06/09/2024]
Abstract
Posttraumatic Stress Disorder (PTSD) is highly co-morbid with chronic pain conditions. When present, PTSD significantly worsens chronic pain outcomes. Likewise, pain contributes to a more severe PTSD as evidenced by greater disability, more frequent use of harmful opioid analgesics and increased pain severity. The biomechanism behind this comorbidity is incompletely understood, however recent work strongly supports the widely-accepted role of expectation, in the entanglement of chronic pain and trauma symptoms. This work has shown that those with trauma have a maladaptive brain response while expecting stress and pain, whereas those with chronic pain may have a notable impairment in brain response while expecting pain relief. This dynamical expectation model of the interaction between neural systems underlying expectation of pain onset (traumatic stress) and pain offset (chronic pain) is biologically viable and may provide a biomechanistic insight into pain-trauma comorbidity. These predictive mechanisms work through interoceptive pathways in the brain critically the insula cortex. Here we highlight how the neural expectation-related mechanisms augment the existing models of pain and trauma to better understand the dynamics of pain and trauma comorbidity. These ideas will point to targeted complementary clinical approaches, based on mechanistically separable neural biophenotypes for the entanglement of chronic pain and trauma symptoms.
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Affiliation(s)
- Irina A Strigo
- Emotion and Pain Laboratory, San Francisco Veterans Affairs Health Care Center, 4150 Clement Street, San Francisco, CA 94121, USA; Department of Psychiatry, University of California San Francisco, 401 Parnassus Ave, San Francisco, CA 94143, USA.
| | | | - Alan N Simmons
- Center of Excellence in Stress and Mental Health, San Diego Veterans Affairs Health Care Center, 3350 La Jolla Village Dr, San Diego, CA 92161, USA; Stress and Neuroimaging Laboratory, San Diego Veterans Affairs Health Care Center, 3350 La Jolla Village Drive, MC 151-B, San Diego, CA 92161, USA; Department of Psychiatry, University of California San Diego, 9500 Gilman Dr, La Jolla, CA 92093, USA
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2
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Aarts I, Thorsen AL, Vriend C, Planting C, van den Heuvel OA, Thomaes K. Effects of psychotherapy on brain activation during negative emotional processing in patients with posttraumatic stress disorder: a systematic review and meta-analysis. Brain Imaging Behav 2024; 18:444-455. [PMID: 38049598 DOI: 10.1007/s11682-023-00831-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2023] [Indexed: 12/06/2023]
Abstract
Post-traumatic stress disorder (PTSD) is a debilitating condition which has been related to problems in emotional regulation, memory and cognitive control. Psychotherapy has a non-response rate of around 50% and understanding the neurobiological working mechanisms might help improve treatment. To integrate findings from multiple smaller studies, we performed the first meta-analysis of changes in brain activation with a specific focus on emotional processing after psychotherapy in PTSD patients. We performed a meta-analysis of brain activation changes after treatment during emotional processing for PTSD with seed-based d mapping using a pre-registered protocol (PROSPERO CRD42020211039). We analyzed twelve studies with 191 PTSD patients after screening 3700 studies. We performed systematic quality assessment both for the therapeutic interventions and neuroimaging methods. Analyses were done in the full sample and in a subset of studies that reported whole-brain results. We found decreased activation after psychotherapy in the left amygdala, (para)hippocampus, medial temporal lobe, inferior frontal gyrus, ventrolateral prefrontal cortex, right pallidum, anterior cingulate cortex, bilateral putamen, and insula. Decreased activation in the left amygdala and left ventrolateral PFC was also found in eight studies that reported whole-brain findings. Results did not survive correction for multiple comparisons. There is tentative support for decreased activation in the fear and cognitive control networks during emotional processing after psychotherapy for PTSD. Future studies would benefit from adopting a larger sample size, using designs that control for confounding variables, and investigating heterogeneity in symptom profiles and treatment response.
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Affiliation(s)
- Inga Aarts
- Sinai Centrum, Arkin, Amstelveen, The Netherlands.
- Department of Psychiatry, Amsterdam UMC location Vrije Universiteit Amsterdam, Boelelaan 1117, Amsterdam, The Netherlands.
- Department of Anatomy and Neurosciences, Amsterdam UMC location Vrije Universiteit Amsterdam, Boelelaan 1117, Amsterdam, The Netherlands.
| | - A L Thorsen
- Bergen Center for Brain Plasticity, Haukeland University Hospital, Bergen, Norway
- Center for Crisis Psychology, University of Bergen, Bergen, Norway
| | - C Vriend
- Department of Psychiatry, Amsterdam UMC location Vrije Universiteit Amsterdam, Boelelaan 1117, Amsterdam, The Netherlands
- Department of Anatomy and Neurosciences, Amsterdam UMC location Vrije Universiteit Amsterdam, Boelelaan 1117, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Compulsivity, Impulsivity & Attention program, Amsterdam, The Netherlands
| | - C Planting
- GGZ inGeest Specialized Mental Health Care, Amsterdam, The Netherlands
- Vrije Universiteit Amsterdam, University Library, Amsterdam, The Netherlands
| | - O A van den Heuvel
- Department of Psychiatry, Amsterdam UMC location Vrije Universiteit Amsterdam, Boelelaan 1117, Amsterdam, The Netherlands
- Department of Anatomy and Neurosciences, Amsterdam UMC location Vrije Universiteit Amsterdam, Boelelaan 1117, Amsterdam, The Netherlands
- Bergen Center for Brain Plasticity, Haukeland University Hospital, Bergen, Norway
- Amsterdam Neuroscience, Compulsivity, Impulsivity & Attention program, Amsterdam, The Netherlands
| | - K Thomaes
- Sinai Centrum, Arkin, Amstelveen, The Netherlands
- Department of Psychiatry, Amsterdam UMC location Vrije Universiteit Amsterdam, Boelelaan 1117, Amsterdam, The Netherlands
- Department of Anatomy and Neurosciences, Amsterdam UMC location Vrije Universiteit Amsterdam, Boelelaan 1117, Amsterdam, The Netherlands
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3
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Fang A, Baran B, Feusner JD, Phan KL, Beatty CC, Crane J, Jacoby RJ, Manoach DS, Wilhelm S. Self-focused brain predictors of cognitive behavioral therapy response in a transdiagnostic sample. J Psychiatr Res 2024; 171:108-115. [PMID: 38266332 PMCID: PMC10922639 DOI: 10.1016/j.jpsychires.2024.01.018] [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: 09/03/2023] [Revised: 01/09/2024] [Accepted: 01/15/2024] [Indexed: 01/26/2024]
Abstract
BACKGROUND Effective biomarkers of cognitive behavioral therapy (CBT) response provide information beyond available behavioral or self-report measures and may optimize treatment selection for patients based on likelihood of benefit. No single biomarker reliably predicts CBT response. In this study, we evaluated patterns of brain connectivity associated with self-focused attention (SFA) as biomarkers of CBT response for anxiety and obsessive-compulsive disorders. We hypothesized that pre-treatment as well as pre-to post-treatment changes in functional connectivity would be associated with improvement during CBT in a transdiagnostic sample. METHODS Twenty-seven patients with primary social anxiety disorder (n = 14) and primary body dysmorphic disorder (n = 13) were scanned before and after 12 sessions of CBT targeting their primary disorder. Eligibility was based on elevated trait SFA scores on the Public Self-Consciousness Scale. Seed-based resting state functional connectivity associated with symptom improvement was computed using a seed in the posterior cingulate cortex of the default mode network. RESULTS At pre-treatment, stronger positive connectivity of the seed with the cerebellum, and stronger negative connectivity with the putamen, were associated with greater clinical improvement. Between pre-to post-treatment, greater anticorrelation between the seed and postcentral gyrus, extending into the inferior parietal lobule and precuneus/superior parietal lobule was associated with clinical improvement, although this did not survive thresholding. CONCLUSIONS Pre-treatment functional connectivity with the default mode network was associated with CBT response. Behavioral and self-report measures of SFA did not contribute to predictions, thus highlighting the value of neuroimaging-based measures of SFA. CLINICAL TRIALS REGISTRATION ClinicalTrials.gov Identifier: NCT02808702 https://clinicaltrials.gov/ct2/show/NCT02808702.
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Affiliation(s)
- Angela Fang
- Department of Psychology, University of Washington, Seattle, WA, 98195-1525, USA.
| | - Bengi Baran
- Department of Psychological and Brain Sciences, University of Iowa, Iowa City, IA, 52242-1407, USA
| | - Jamie D Feusner
- Centre for Addiction and Mental Health, Brain Imaging Health Center, Ontario, Toronto, Canada, M5T1R8; Department of Psychiatry, University of Toronto, Ontario, Toronto, Canada, M5T1R8; Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - K Luan Phan
- Department of Psychiatry and Behavioral Health, Ohio State University Wexner Medical Center, Columbus, OH, 43210-1240, USA
| | - Clare C Beatty
- Department of Psychology, Stony Brook University, Stony Brook, NY, 11794-2500, USA
| | - Jessica Crane
- Department of Psychology, University of Washington, Seattle, WA, 98195-1525, USA
| | - Ryan J Jacoby
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114-2696, USA
| | - Dara S Manoach
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114-2696, USA; Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, 02129-2020, USA
| | - Sabine Wilhelm
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114-2696, USA
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4
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Liu J, Roberts AL, Lawn RB, Jha SC, Sampson L, Sumner JA, Kang JH, Rimm EB, Grodstein F, Liang L, Haneuse S, Kubzansky LD, Koenen KC, Chibnik LB. Post-traumatic stress disorder symptom remission and cognition in a large cohort of civilian women. Psychol Med 2024; 54:419-430. [PMID: 37577959 PMCID: PMC10947504 DOI: 10.1017/s0033291723001915] [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] [Indexed: 08/15/2023]
Abstract
BACKGROUND Post-traumatic stress disorder (PTSD) is associated with cognitive impairments. It is unclear whether problems persist after PTSD symptoms remit. METHODS Data came from 12 270 trauma-exposed women in the Nurses' Health Study II. Trauma and PTSD symptoms were assessed using validated scales to determine PTSD status as of 2008 (trauma/no PTSD, remitted PTSD, unresolved PTSD) and symptom severity (lifetime and past-month). Starting in 2014, cognitive function was assessed using the Cogstate Brief Battery every 6 or 12 months for up to 24 months. PTSD associations with baseline cognition and longitudinal cognitive changes were estimated by covariate-adjusted linear regression and linear mixed-effects models, respectively. RESULTS Compared to women with trauma/no PTSD, women with remitted PTSD symptoms had a similar cognitive function at baseline, while women with unresolved PTSD symptoms had worse psychomotor speed/attention and learning/working memory. In women with unresolved PTSD symptoms, past-month PTSD symptom severity was inversely associated with baseline cognition. Over follow-up, both women with remitted and unresolved PTSD symptoms in 2008, especially those with high levels of symptoms, had a faster decline in learning/working memory than women with trauma/no PTSD. In women with remitted PTSD symptoms, higher lifetime PTSD symptom severity was associated with a faster decline in learning/working memory. Results were robust to the adjustment for sociodemographic, biobehavioral, and health factors and were partially attenuated when adjusted for depression. CONCLUSION Unresolved but not remitted PTSD was associated with worse cognitive function assessed six years later. Accelerated cognitive decline was observed among women with either unresolved or remitted PTSD symptoms.
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Affiliation(s)
- Jiaxuan Liu
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Andrea L. Roberts
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Rebecca B. Lawn
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Shaili C. Jha
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Laura Sampson
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Jennifer A. Sumner
- Department of Psychology, University of California, Los Angeles, CA, Los Angeles, CA, USA
| | - Jae H. Kang
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Eric B. Rimm
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Francine Grodstein
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, IL, USA
| | - Liming Liang
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Sebastien Haneuse
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Laura D Kubzansky
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Karestan C. Koenen
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Psychiatric and Neurodevelopmental Genetics Unit, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Lori B. Chibnik
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Neurology, Massachusetts General Hospital, Boston MA, USA
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5
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Bremner JD, Ortego RA, Campanella C, Nye JA, Davis LL, Fani N, Vaccarino V. Neural correlates of PTSD in women with childhood sexual abuse with and without PTSD and response to paroxetine treatment: A placebo-controlled, double-blind trial. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2023; 14:100615. [PMID: 38088987 PMCID: PMC10715797 DOI: 10.1016/j.jadr.2023.100615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2024] Open
Abstract
Objective Childhood sexual abuse is the leading cause of posttraumatic stress disorder (PTSD) in women, and is a prominent cause of morbidity and loss of function for which limited treatments are available. Understanding the neurobiology of treatment response is important for developing new treatments. The purpose of this study was to assess neural correlates of personalized traumatic memories in women with childhood sexual abuse with and without PTSD, and to assess response to treatment. Methods Women with childhood sexual abuse with (N = 28) and without (N = 17) PTSD underwent brain imaging with High-Resolution Positron Emission Tomography scanning with radiolabeled water for brain blood flow measurements during exposure to personalized traumatic scripts and memory encoding tasks. Women with PTSD were randomized to paroxetine or placebo followed by three months of double-blind treatment and repeat imaging with the same protocol. Results Women with PTSD showed decreases in areas involved in the Default Mode Network (DMN), a network of brain areas usually active when the brain is at rest, hippocampus and visual processing areas with exposure to traumatic scripts at baseline while women without PTSD showed increased activation in superior frontal gyrus and other areas (p < 0.005). Treatment of women with PTSD with paroxetine resulted in increased anterior cingulate activation and brain areas involved in the DMN and visual processing with scripts compared to placebo (p < 0.005). Conclusion PTSD related to childhood sexual abuse in women is associated with alterations in brain areas involved in memory and the stress response and treatment with paroxetine results in modulation of these areas.
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Affiliation(s)
- J. Douglas Bremner
- Department of Psychiatry & Behavioral Sciences, Emory University School of Medicine, Atlanta, GA
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA
- Atlanta VA Medical Center, Decatur, GA
| | - Rebeca Alvarado Ortego
- Department of Psychiatry & Behavioral Sciences, Emory University School of Medicine, Atlanta, GA
| | - Carolina Campanella
- Department of Psychiatry & Behavioral Sciences, Emory University School of Medicine, Atlanta, GA
| | - Jonathon A. Nye
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA
| | - Lori L. Davis
- Department of Psychiatry, University of Alabama School of Medicine, Birmingham, AL
- Tuscaloosa VA Medical Center, Tuscaloosa AL
| | - Negar Fani
- Department of Psychiatry & Behavioral Sciences, Emory University School of Medicine, Atlanta, GA
| | - Viola Vaccarino
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta GA
- Department of Medicine (Cardiology), Emory University School of Medicine, Atlanta, GA
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6
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Fang A, Baran B, Feusner JD, Phan KL, Beatty CC, Crane J, Jacoby RJ, Manoach DS, Wilhelm S. Self-Focused Brain Predictors of Cognitive Behavioral Therapy Response in a Transdiagnostic Sample. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.08.30.23294878. [PMID: 37693433 PMCID: PMC10491350 DOI: 10.1101/2023.08.30.23294878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Abstract
Background Effective biomarkers of cognitive behavioral therapy (CBT) response provide information beyond available behavioral or self-report measures and may optimize treatment selection for patients based on likelihood of benefit. No single biomarker reliably predicts CBT response. In this study, we evaluated patterns of brain connectivity associated with self-focused attention (SFA) as biomarkers of CBT response for anxiety and obsessive-compulsive disorders. We hypothesized that pre-treatment as well as pre- to post-treatment changes in functional connectivity would be associated with improvement during CBT in a transdiagnostic sample. Methods Twenty-seven patients with primary social anxiety disorder (n=14) and primary body dysmorphic disorder (n=13) were scanned before and after 12 sessions of CBT targeting their primary disorder. Eligibility was based on elevated trait SFA scores on the Public Self-Consciousness Scale. Seed-based resting state functional connectivity associated with symptom improvement was computed using a seed in the posterior cingulate cortex/precuneus that delineated a self-other functional network. Results At pre-treatment, stronger positive connectivity of the seed with the cerebellum, insula, middle occipital gyrus, postcentral gyrus, and precuneus/superior parietal lobule, and stronger negative connectivity with the putamen, were associated with greater clinical improvement. Between pre- to post-treatment, greater anticorrelation between the seed and precuneus/superior parietal lobule was associated with clinical improvement, although this did not survive thresholding. Conclusions Pre-treatment functional connectivity between regions involved in attentional salience, self-generated thoughts, and external attention predicted greater CBT response. Behavioral and self-report measures of SFA did not contribute to predictions, thus highlighting the value of neuroimaging-based measures of SFA. Clinical Trials Registration ClinicalTrials.gov Identifier: NCT02808702 https://clinicaltrials.gov/ct2/show/NCT02808702.
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Affiliation(s)
- Angela Fang
- Department of Psychology, University of Washington, Seattle, WA, 98195-1525
| | - Bengi Baran
- Department of Psychological and Brain Sciences, University of Iowa, Iowa City, IA, 52242-1407
| | - Jamie D. Feusner
- Centre for Addiction and Mental Health, Brain Imaging Health Center, Ontario, Toronto, Canada, M5T1R8
- Department of Psychiatry, University of Toronto, Ontario, Toronto, Canada, M5T1R8
- Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
| | - K. Luan Phan
- Department of Psychiatry and Behavioral Health, Ohio State University Wexner Medical Center, Columbus, OH, 43210-1240
| | - Clare C. Beatty
- Department of Psychology, Stony Brook University, Stony Brook, NY, 11794-2500
| | - Jessica Crane
- Department of Psychology, University of Washington, Seattle, WA, 98195-1525
| | - Ryan J. Jacoby
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114-2696
| | - Dara S. Manoach
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114-2696
- Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, 02129-2020
| | - Sabine Wilhelm
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114-2696
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7
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Korgaonkar MS, Felmingham KL, Malhi GS, Williamson TH, Williams LM, Bryant RA. Changes in neural responses during affective and non-affective tasks and improvement of posttraumatic stress disorder symptoms following trauma-focused psychotherapy. Transl Psychiatry 2023; 13:85. [PMID: 36894538 PMCID: PMC9998447 DOI: 10.1038/s41398-023-02375-9] [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: 03/19/2022] [Revised: 02/07/2023] [Accepted: 02/20/2023] [Indexed: 03/11/2023] Open
Abstract
At least one-third posttraumatic stress disorder (PTSD) patients do not respond to trauma-focused psychotherapy (TF-psychotherapy), which is the treatment of choice for PTSD. To clarify the change mechanisms that may be associated with treatment response, this study examined changes in neural activations during affective and non-affective processing that occur with improvement of symptoms after TF-psychotherapy. This study assessed PTSD treatment-seeking patients (n = 27) prior to and after TF-psychotherapy using functional magnetic resonance imaging when they completed three tasks: (a) passive viewing of affective faces, (b) cognitive reappraisal of negative images, and (c) non-affective response inhibition. Patients then underwent 9 sessions of TF-psychotherapy, and were assessed on the Clinician-Administered PTSD Scale following treatment. Changes in neural responses in affect and cognitive processing regions-of-interest for each task were correlated with reduction of PTSD severity from pretreatment to posttreatment in the PTSD cohort. Data from 21 healthy controls was used for comparison. Improvement of symptoms in PTSD were associated with increased activation of left anterior insula, reductions in the left hippocampus and right posterior insula during viewing of supraliminally presented affective images, and reduced connectivity between the left hippocampus with the left amygdala and rostral anterior cingulate. Treatment response was also associated with reduced activation in the left dorsolateral prefrontal cortex during reappraisal of negative images. There were no associations between response and activation change during response inhibition. This pattern of findings indicates that improvement of PTSD symptoms following TF-psychotherapy is associated with changes in affective rather than non-affective processes. These findings accord with prevailing models that TF-psychotherapy promotes engagement and mastery of affective stimuli.Clinical Trials Registration: Trial Registration: Prospectively registered at Australian and New Zealand Clinical Trials Registry, ACTRN12612000185864 and ACTRN12609000324213. https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=83857.
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Affiliation(s)
- Mayuresh S Korgaonkar
- Brain Dynamics Centre, Westmead Institute for Medical Research, The University of Sydney, Westmead, Australia. .,Department of Psychiatry, University of Sydney, Westmead, Australia.
| | - Kim L Felmingham
- Discipline of Psychological Science, University of Melbourne, Melbourne, Australia
| | - Gin S Malhi
- Department of Psychiatry, University of Sydney, Westmead, Australia
| | - Thomas H Williamson
- Brain Dynamics Centre, Westmead Institute for Medical Research, The University of Sydney, Westmead, Australia.,School of Psychology, University of New South Wales, Kensington, Australia
| | - Leanne M Williams
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, USA.,Sierra-Pacific Mental Illness Research, Education, and Clinical Center (MIRECC) VA Palo Alto Health Care System, Palo Alto, USA
| | - Richard A Bryant
- Brain Dynamics Centre, Westmead Institute for Medical Research, The University of Sydney, Westmead, Australia. .,School of Psychology, University of New South Wales, Kensington, Australia.
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Pierce ZP, Johnson ER, Kim IA, Lear BE, Mast AM, Black JM. Therapeutic interventions impact brain function and promote post-traumatic growth in adults living with post-traumatic stress disorder: A systematic review and meta-analysis of functional magnetic resonance imaging studies. Front Psychol 2023; 14:1074972. [PMID: 36844333 PMCID: PMC9948410 DOI: 10.3389/fpsyg.2023.1074972] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 01/20/2023] [Indexed: 02/11/2023] Open
Abstract
Introduction The present systematic review and meta-analysis explores the impacts of cognitive processing therapy (CPT), eye movement desensitization and reprocessing (EMDR), and prolonged exposure (PE) therapy on neural activity underlying the phenomenon of post-traumatic growth for adult trauma survivors. Methods We utilized the following databases to conduct our systematic search: Boston College Libraries, PubMed, MEDLINE, and PsycINFO. Our initial search yielded 834 studies for initial screening. We implemented seven eligibility criteria to vet articles for full-text review. Twenty-nine studies remained for full-text review after our systematic review process was completed. Studies were subjected to several levels of analysis. First, pre-and post- test post-traumatic growth inventory (PTGI) scores were collected from all studies and analyzed through a forest plot using Hedges' g. Next, Montreal Neurological Institute (MNI) coordinates and t-scores were collected and analyzed using an Activation Likelihood Estimation (ALE) to measure brain function. T-scores and Hedges' g values were then analyzed using Pearson correlations to determine if there were any relationships between brain function and post-traumatic growth for each modality. Lastly, all studies were subjected to a bubble plot and Egger's test to assess risk of publication bias across the review sample. Results Forest plot results indicated that all three interventions had a robust effect on PTGI scores. ALE meta-analysis results indicated that EMDR exhibited the largest effect on brain function, with the R thalamus (t = 4.23, p < 0.001) showing robust activation, followed closely by the R precuneus (t = 4.19, p < 0.001). Pearson correlation results showed that EMDR demonstrated the strongest correlation between increased brain function and PTGI scores (r = 0.910, p < 0.001). Qualitative review of the bubble plot indicated no obvious traces of publication bias, which was corroborated by the results of the Egger's test (p = 0.127). Discussion Our systematic review and meta-analysis showed that CPT, EMDR, and PE each exhibited a robust effect on PTG impacts across the course of treatment. However, when looking closer at comparative analyses of neural activity (ALE) and PTGI scores (Pearson correlation), EMDR exhibited a more robust effect on PTG impacts and brain function than CPT and PE.
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Affiliation(s)
- Zachary P. Pierce
- School of Social Work, Boston College, Chestnut Hill, MA, United States
- The Cell to Society Laboratory, Chestnut Hill, MA, United States
| | - Emily R. Johnson
- School of Social Work, Boston College, Chestnut Hill, MA, United States
- The Cell to Society Laboratory, Chestnut Hill, MA, United States
| | - Isabelle A. Kim
- The Cell to Society Laboratory, Chestnut Hill, MA, United States
- Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States
| | - Brianna E. Lear
- The Cell to Society Laboratory, Chestnut Hill, MA, United States
| | - A. Michaela Mast
- School of Social Work, Boston College, Chestnut Hill, MA, United States
- The Cell to Society Laboratory, Chestnut Hill, MA, United States
| | - Jessica M. Black
- School of Social Work, Boston College, Chestnut Hill, MA, United States
- The Cell to Society Laboratory, Chestnut Hill, MA, United States
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9
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Stout DM, Harlé KM, Norman SB, Simmons AN, Spadoni AD. Resting-state connectivity subtype of comorbid PTSD and alcohol use disorder moderates improvement from integrated prolonged exposure therapy in Veterans. Psychol Med 2023; 53:332-341. [PMID: 33926595 PMCID: PMC10880798 DOI: 10.1017/s0033291721001513] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD) are highly comorbid and are associated with significant functional impairment and inconsistent treatment outcomes. Data-driven subtyping of this clinically heterogeneous patient population and the associated underlying neural mechanisms are highly needed to identify who will benefit from psychotherapy. METHODS In 53 comorbid PTSD/AUD patients, resting-state functional magnetic resonance imaging was collected prior to undergoing individual psychotherapy. We used a data-driven approach to subgroup patients based on directed connectivity profiles. Connectivity subgroups were compared on clinical measures of PTSD severity and heavy alcohol use collected at pre- and post-treatment. RESULTS We identified a subgroup of patients associated with improvement in PTSD symptoms from integrated-prolonged exposure therapy. This subgroup was characterized by lower insula to inferior parietal cortex (IPC) connectivity, higher pregenual anterior cingulate cortex (pgACC) to posterior midcingulate cortex connectivity and a unique pgACC to IPC path. We did not observe any connectivity subgroup that uniquely benefited from integrated-coping skills or subgroups associated with change in alcohol consumption. CONCLUSIONS Data-driven approaches to characterize PTSD/AUD subtypes have the potential to identify brain network profiles that are implicated in the benefit from psychological interventions - setting the stage for future research that targets these brain circuit communication patterns to boost treatment efficacy.
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Affiliation(s)
- Daniel M. Stout
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego, CA, USA
- Research Service, VA San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Katia M. Harlé
- Research Service, VA San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Sonya B. Norman
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego, CA, USA
- Research Service, VA San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
- National Center for PTSD, White River Junction, Vermont, USA
| | - Alan N. Simmons
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego, CA, USA
- Research Service, VA San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Andrea D. Spadoni
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego, CA, USA
- Research Service, VA San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
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10
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Gonda X, Dome P, Erdelyi-Hamza B, Krause S, Elek LP, Sharma SR, Tarazi FI. Invisible wounds: Suturing the gap between the neurobiology, conventional and emerging therapies for posttraumatic stress disorder. Eur Neuropsychopharmacol 2022; 61:17-29. [PMID: 35716404 DOI: 10.1016/j.euroneuro.2022.05.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 05/19/2022] [Accepted: 05/20/2022] [Indexed: 11/26/2022]
Abstract
A sharp increase in the prevalence of neuropsychiatric disorders, including major depression, anxiety, substance use disorders and posttraumatic stress disorder (PTSD) has occurred due to the traumatic nature of the persisting COVID-19 global pandemic. PTSD is estimated to occur in up to 25% of individuals following exposure to acute or chronic trauma, and the pandemic has inflicted both forms of trauma on much of the population through both direct physiological attack as well as an inherent upheaval to our sense of safety. However, despite significant advances in our ability to define and apprehend the effects of traumatic events, the neurobiology and neuroanatomical circuitry of PTSD, one of the most severe consequences of traumatic exposure, remains poorly understood. Furthermore, the current psychotherapies or pharmacological options for treatment have limited efficacy, durability, and low adherence rates. Consequently, there is a great need to better understand the neurobiology and neuroanatomy of PTSD and develop novel therapies that extend beyond the current limited treatments. This review summarizes the neurobiological and neuroanatomical underpinnings of PTSD and discusses the conventional and emerging psychotherapies, pharmacological and combined psychopharmacological therapies, including the use of psychedelic-assisted psychotherapies and neuromodulatory interventions, for the improved treatment of PTSD and the potential for their wider applications in other neuropsychiatric disorders resulting from traumatic exposure.
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Affiliation(s)
- Xenia Gonda
- Department of Psychiatry and Psychotherapy, Semmelweis University, Hungary; NAP-2-SE New Antidepressant Target Research Group, Semmelweis University, Hungary; International Centre for Education and Research in Neuropsychiatry, Samara State Medical University, Russia.
| | - Peter Dome
- Department of Psychiatry and Psychotherapy, Semmelweis University, Hungary; National Institute of Mental Health, Neurology and Neurosurgery - Nyiro Gyula Hospital, Hungary
| | - Berta Erdelyi-Hamza
- Department of Psychiatry and Psychotherapy, Semmelweis University, Hungary; Doctoral School of Mental Health Sciences, Semmelweis University, Hungary
| | - Sandor Krause
- National Institute of Mental Health, Neurology and Neurosurgery - Nyiro Gyula Hospital, Hungary; Doctoral School of Mental Health Sciences, Semmelweis University, Hungary; Department of Pharmacodynamics, Semmelweis University, Hungary
| | - Livia Priyanka Elek
- Department of Psychiatry and Psychotherapy, Semmelweis University, Hungary; Department of Clinical Psychology, Semmelweis University, Hungary
| | - Samata R Sharma
- Department of Psychiatry, Harvard Medical School, Brigham and Women's Hospital, Boston, MA 02115, USA
| | - Frank I Tarazi
- Department of Psychiatry and Neuroscience, Harvard Medical School, McLean Hospital, Belmont, MA 02478, USA
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11
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Leroy A, Very E, Birmes P, Yger P, Szaffarczyk S, Lopes R, Outteryck O, Faure C, Duhem S, Grandgenèvre P, Warembourg F, Vaiva G, Jardri R. Intrusive experiences in posttraumatic stress disorder: Treatment response induces changes in the directed functional connectivity of the anterior insula. Neuroimage Clin 2022; 34:102964. [PMID: 35189456 PMCID: PMC8861823 DOI: 10.1016/j.nicl.2022.102964] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 01/27/2022] [Accepted: 02/08/2022] [Indexed: 11/18/2022]
Abstract
Many causal paths were less influenced by the AI after effective therapy for PTSD. Insular influences over the rest of the brain were found to be positively correlated with re-experiencing. Re-experiencing was linked with changes in intrinsic networks’ spatial stability after treatment.
Background One of the core features of posttraumatic stress disorder (PTSD) is re-experiencing trauma. The anterior insula (AI) has been proposed to play a crucial role in these intrusive experiences. However, the dynamic function of the AI in re-experiencing trauma and its putative modulation by effective therapy need to be specified. Methods Thirty PTSD patients were enrolled and exposed to traumatic memory reactivation therapy. Resting-state functional magnetic resonance imaging (fMRI) scans were acquired before and after treatment. To explore AI-directed influences over the rest of the brain, we referred to a mixed model using pre-/posttreatment Granger causality analysis seeded on the AI as a within-subject factor and treatment response as a between-subject factor. To further identify correlates of re-experiencing trauma, we investigated how intrusive severity affected (i) causality maps and (ii) the spatial stability of other intrinsic brain networks. Results We observed changes in AI-directed functional connectivity patterns in PTSD patients. Many within- and between-network causal paths were found to be less influenced by the AI after effective therapy. Insular influences were found to be positively correlated with re-experiencing symptoms, while they were linked with a stronger default mode network (DMN) and more unstable central executive network (CEN) connectivity. Conclusion We showed that directed changes in AI signaling to the DMN and CEN at rest may underlie the degree of re-experiencing symptoms in PTSD. A positive response to treatment further induced changes in network-to-network anticorrelated patterns. Such findings may guide targeted neuromodulation strategies in PTSD patients not suitably improved by conventional treatment.
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Affiliation(s)
- Arnaud Leroy
- Univ Lille, INSERM, CHU Lille, Lille Neuroscience & Cognition Centre (U-1172), Plasticity & SubjectivitY Team, CURE Platform, 59000 Lille, France; CHU Lille, Fontan Hospital, General Psychiatry Dpt., 59037 Lille Cedex, France; Centre National de Ressources et Résilience pour les psychotraumatismes (CN2R Lille - Paris), 59000 Lille, France.
| | - Etienne Very
- CHU Toulouse, Purpan Hospital, Psychiatry Department, 31059 Toulouse Cedex, France; ToNIC, Toulouse NeuroImaging Center, INSERM U-1214, UPS, France
| | - Philippe Birmes
- ToNIC, Toulouse NeuroImaging Center, INSERM U-1214, UPS, France
| | - Pierre Yger
- Univ Lille, INSERM, CHU Lille, Lille Neuroscience & Cognition Centre (U-1172), Plasticity & SubjectivitY Team, CURE Platform, 59000 Lille, France; Institut de la Vision, Sorbonne Université, Inserm S968, CNRS UMR7210, Paris, France
| | - Sébastien Szaffarczyk
- Univ Lille, INSERM, CHU Lille, Lille Neuroscience & Cognition Centre (U-1172), Plasticity & SubjectivitY Team, CURE Platform, 59000 Lille, France
| | - Renaud Lopes
- Univ Lille, INSERM, CHU Lille, Lille Neuroscience & Cognition Centre (U-1772), Degenerative & Vascular Cognitive Disorders Team, 59000 Lille, France; Univ Lille, CNRS, INSERM, CHU Lille, Institut Pasteur de Lille, US 41 - UMS 2014 - PLBS, 59000 Lille, France
| | - Olivier Outteryck
- Univ Lille, INSERM, CHU Lille, Lille Neuroscience & Cognition Centre (U-1772), Degenerative & Vascular Cognitive Disorders Team, 59000 Lille, France; CHU Lille, Department of Neuroradiology, Roger Salengro Hospital, 59037 Lille Cedex, France
| | - Cécile Faure
- Univ Lille, INSERM, CHU Lille, Lille Neuroscience & Cognition Centre (U-1172), Plasticity & SubjectivitY Team, CURE Platform, 59000 Lille, France
| | - Stéphane Duhem
- CHU Lille, Fontan Hospital, General Psychiatry Dpt., 59037 Lille Cedex, France; Centre National de Ressources et Résilience pour les psychotraumatismes (CN2R Lille - Paris), 59000 Lille, France; Université de Lille, Inserm, CHU Lille, CIC 1403 - Clinical Investigation Center, 59000 Lille, France
| | - Pierre Grandgenèvre
- Univ Lille, INSERM, CHU Lille, Lille Neuroscience & Cognition Centre (U-1172), Plasticity & SubjectivitY Team, CURE Platform, 59000 Lille, France; CHU Lille, Fontan Hospital, General Psychiatry Dpt., 59037 Lille Cedex, France
| | | | - Guillaume Vaiva
- Univ Lille, INSERM, CHU Lille, Lille Neuroscience & Cognition Centre (U-1172), Plasticity & SubjectivitY Team, CURE Platform, 59000 Lille, France; CHU Lille, Fontan Hospital, General Psychiatry Dpt., 59037 Lille Cedex, France; Centre National de Ressources et Résilience pour les psychotraumatismes (CN2R Lille - Paris), 59000 Lille, France
| | - Renaud Jardri
- Univ Lille, INSERM, CHU Lille, Lille Neuroscience & Cognition Centre (U-1172), Plasticity & SubjectivitY Team, CURE Platform, 59000 Lille, France; CHU Lille, Fontan Hospital, Child & Adolescent Psychiatry Dpt., 59037 Lille Cedex, France
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12
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Strigo IA, Spadoni AD, Simmons AN. Understanding Pain and Trauma Symptoms in Veterans From Resting-State Connectivity: Unsupervised Modeling. FRONTIERS IN PAIN RESEARCH 2022; 3:871961. [PMID: 35620636 PMCID: PMC9127988 DOI: 10.3389/fpain.2022.871961] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 04/07/2022] [Indexed: 01/19/2023] Open
Abstract
Trauma and posttraumatic stress are highly comorbid with chronic pain and are often antecedents to developing chronic pain conditions. Pain and trauma are associated with greater utilization of medical services, greater use of psychiatric medication, and increased total cost of treatment. Despite the high overlap in the clinic, the neural mechanisms of pain and trauma are often studied separately. In this study, resting-state functional magnetic resonance imaging (rs-fMRI) scans were completed among a diagnostically heterogeneous sample of veterans with a range of back pain and trauma symptoms. Using Group Iterative Multiple Model Estimation (GIMME), an effective functional connectivity analysis, we explored an unsupervised model deriving subgroups based on path similarity in a priori defined regions of interest (ROIs) from brain regions implicated in the experience of pain and trauma. Three subgroups were identified by patterns in functional connection and differed significantly on several psychological measures despite similar demographic and diagnostic characteristics. The first subgroup was highly connected overall, was characterized by functional connectivity from the nucleus accumbens (NAc), the anterior cingulate cortex (ACC), and the posterior cingulate cortex (PCC) to the insula and scored low on pain and trauma symptoms. The second subgroup did not significantly differ from the first subgroup on pain and trauma measures but was characterized by functional connectivity from the ACC and NAc to the thalamus and from ACC to PCC. The third subgroup was characterized by functional connectivity from the thalamus and PCC to NAc and scored high on pain and trauma symptoms. Our results suggest that, despite demographic and diagnostic similarities, there may be neurobiologically dissociable biotypes with different mechanisms for managing pain and trauma. These findings may have implications for the determination of appropriate biotype-specific interventions that target these neurological systems.
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Affiliation(s)
- Irina A. Strigo
- Emotion and Pain Laboratory, San Francisco Veterans Affairs Health Care Center, San Francisco, CA, United States
- Department of Psychiatry, University of California, San Francisco, San Francisco, CA, United States
| | - Andrea D. Spadoni
- Stress and Neuroimaging Laboratory, San Diego Veterans Affairs Health Care Center, San Francisco, CA, United States
- Center of Excellence in Stress and Mental Health, San Diego Veterans Affairs Health Care Center, San Diego, CA, United States
- Department of Psychiatry, University of California, San Diego, San Diego, CA, United States
| | - Alan N. Simmons
- Stress and Neuroimaging Laboratory, San Diego Veterans Affairs Health Care Center, San Francisco, CA, United States
- Center of Excellence in Stress and Mental Health, San Diego Veterans Affairs Health Care Center, San Diego, CA, United States
- Department of Psychiatry, University of California, San Diego, San Diego, CA, United States
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13
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Lerman I, Klaming R, Spadoni A, Baker DG, Simmons AN. Non-invasive cervical vagus nerve stimulation effects on reaction time and valence image anticipation response. Brain Stimul 2022; 15:946-956. [PMID: 35738468 PMCID: PMC9721369 DOI: 10.1016/j.brs.2022.06.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 05/28/2022] [Accepted: 06/10/2022] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Norepinephrine (NE) driven noninvasive vagus nerve stimulation (nVNS), which improves attention and reduces reaction time, augments learning. Equally important, endogenous NE mediated arousal is highly dependent on the valence (positive or negative) of the exogenous stimulus. But to date, no study has measured valence specific effects of nVNS on both functional magnetic resonance imaging (fMRI) anticipation task response and reaction time in healthy individuals. Therefore, the aim of this pilot study was to assess whether nVNS vs sham modulates valence cortical anticipation task response and reaction time in a normative sample. METHODS Participants received right sided transcutaneous cervical nVNS (N = 12) or sham (N = 12) stimulation during a 3T fMRI scan. Subjects first performed a continuous performance task (CPT) and then a cued anticipation task to images of positively and negatively valenced events during fMRI. Reaction times to cues and Blood oxygen level dependent (BOLD) response were examined over phase to identify effects of nVNS/sham over time. RESULTS nVNS reduced reaction time for all valenced image anticipation trials. With the fMRI anticipation task, we observed a valence-specific effect; nVNS increased responsivity to images with negative valence and decreased responsivity to images with positive valence, whereas sham showed an inverse valence response. CONCLUSIONS nVNS was linked to reduced reaction time during the anticipation task. In tandem, nVNS consistently enhanced responsivity to negatively valenced images and diminished responsivity to positively valenced images, suggesting specific nVNS driven endogenous neurotransmitter signaling may contribute.
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Affiliation(s)
- Imanuel Lerman
- VA Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, La Jolla, CA, United States; Department of Anesthesiology, Center for Pain Medicine, University of California San Diego School of Medicine, La Jolla, CA, United States; Department of Electrical and Computer Engineering, University of California San Diego, La Jolla, CA, United States.
| | - Ruth Klaming
- VA Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, La Jolla, CA, United States; Department of Psychiatry University of California San Diego School of Medicine, La Jolla, CA, United States
| | - Andrea Spadoni
- VA Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, La Jolla, CA, United States; Department of Psychiatry University of California San Diego School of Medicine, La Jolla, CA, United States
| | - Dewleen G Baker
- VA Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, La Jolla, CA, United States; Department of Psychiatry University of California San Diego School of Medicine, La Jolla, CA, United States
| | - Alan N Simmons
- VA Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, La Jolla, CA, United States; Department of Psychiatry University of California San Diego School of Medicine, La Jolla, CA, United States
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14
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Jin S, Shin C, Han C, Kim YK, Lee J, Jeon SW, Lee SH, Ko YH. Changes in Brain Electrical Activity According to Post-traumatic Stress Symptoms in Survivors of the Sewol Ferry Disaster: A 1-year Longitudinal Study. CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE 2021; 19:537-544. [PMID: 34294623 PMCID: PMC8316658 DOI: 10.9758/cpn.2021.19.3.537] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 11/03/2020] [Accepted: 11/04/2020] [Indexed: 11/25/2022]
Abstract
Objective The pathology of post-traumatic stress disorder (PTSD) is associated with changes in brain structure and function, especially in the amygdala, medial prefrontal cortex, hippocampus, and insula. Survivors of tragic accidents often experience psychological stress and develop post-traumatic stress symptoms (PTSS), regardless of the diagnosis of PTSD. This study aimed to evaluate electroencephalographic changes according to PTSS in victims of a single traumatic event. Methods This study enrolled 60 survivors of the Sewol ferry disaster that occurred in 2014 from Danwon High School and collected electroencephalographic data through 19 channels twice for each person in 2014 and 2015 (mean 451.88 [standard deviation 25.77] days of follow-up). PTSS was assessed using the PTSD Checklist-Civilian Version (PCL-C) and the participants were divided into two groups according to the differences in PCL-C scores between 2014 and 2015. Electroencephalographic data were converted to three-dimensional data to perform low-resolution electrical tomographic analysis. Results Significant electroencephalographic changes over time were observed. The group of participants with worsened PCL-C score showed an increased change of delta slow waves in Brodmann areas 13 and 44, with the largest difference in the insula region, compared to those with improved PCL-C scores. Conclusion Our findings suggests that the electrophysiological changes in the insula are associated with PTSS changes.
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Affiliation(s)
- Sehee Jin
- Department of Psychiatry, Korea University College of Medicine, Seoul, Korea
| | - Cheolmin Shin
- Department of Psychiatry, Korea University College of Medicine, Seoul, Korea
| | - Changsu Han
- Department of Psychiatry, Korea University College of Medicine, Seoul, Korea
| | - Yong-Ku Kim
- Department of Psychiatry, Korea University College of Medicine, Seoul, Korea
| | - Jongha Lee
- Department of Psychiatry, Korea University College of Medicine, Seoul, Korea
| | - Sang Won Jeon
- Department of Psychiatry, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seung-Hoon Lee
- Department of Psychiatry, Veterans Health Service Medical Center, Seoul, Korea
| | - Young-Hoon Ko
- Department of Psychiatry, Korea University College of Medicine, Seoul, Korea
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15
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Fonzo GA, Goodkind MS, Oathes DJ, Zaiko YV, Harvey M, Peng KK, Weiss ME, Thompson AL, Zack SE, Lindley SE, Arnow BA, Jo B, Rothbaum BO, Etkin A. Amygdala and Insula Connectivity Changes Following Psychotherapy for Posttraumatic Stress Disorder: A Randomized Clinical Trial. Biol Psychiatry 2021; 89:857-867. [PMID: 33516458 PMCID: PMC8052256 DOI: 10.1016/j.biopsych.2020.11.021] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 11/06/2020] [Accepted: 11/23/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Exposure-based psychotherapy is a first-line treatment for posttraumatic stress disorder (PTSD), but its mechanisms are poorly understood. Functional brain connectivity is a promising metric for identifying treatment mechanisms and biosignatures of therapeutic response. To this end, we assessed amygdala and insula treatment-related connectivity changes and their relationship to PTSD symptom improvements. METHODS Individuals with a primary PTSD diagnosis (N = 66) participated in a randomized clinical trial of prolonged exposure therapy (n = 36) versus treatment waiting list (n = 30). Task-free functional magnetic resonance imaging was completed prior to randomization and 1 month following cessation of treatment/waiting list. Whole-brain blood oxygenation level-dependent responses were acquired. Intrinsic connectivity was assessed by subregion in the amygdala and insula, limbic structures key to the disorder pathophysiology. Dynamic causal modeling assessed evidence for effective connectivity changes in select nodes informed by intrinsic connectivity findings. RESULTS The amygdala and insula displayed widespread patterns of primarily subregion-uniform intrinsic connectivity change, including increased connectivity between the amygdala and insula; increased connectivity of both regions with the ventral prefrontal cortex and frontopolar and sensory cortices; and decreased connectivity of both regions with the left frontoparietal nodes of the executive control network. Larger decreases in amygdala-frontal connectivity and insula-parietal connectivity were associated with larger PTSD symptom reductions. Dynamic causal modeling evidence suggested that treatment decreased left frontal inhibition of the left amygdala, and larger decreases were associated with larger symptom reductions. CONCLUSIONS PTSD psychotherapy adaptively attenuates functional interactions between frontoparietal and limbic brain circuitry at rest, which may reflect a potential mechanism or biosignature of recovery.
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Affiliation(s)
- Gregory A Fonzo
- Department of Psychiatry, University of Texas at Austin Dell Medical School, Austin, Texas
| | | | - Desmond J Oathes
- Center for Neuromodulation in Depression and Stress, Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Yevgeniya V Zaiko
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California; Wu Tsai Neurosciences Institute, Stanford University, Stanford, California; Veterans Affairs Palo Alto Healthcare System and Sierra Pacific Mental Illness, Research, Education, and Clinical Center, Palo Alto, California
| | - Meredith Harvey
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California; Wu Tsai Neurosciences Institute, Stanford University, Stanford, California; Veterans Affairs Palo Alto Healthcare System and Sierra Pacific Mental Illness, Research, Education, and Clinical Center, Palo Alto, California
| | - Kathy K Peng
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California; Wu Tsai Neurosciences Institute, Stanford University, Stanford, California; Veterans Affairs Palo Alto Healthcare System and Sierra Pacific Mental Illness, Research, Education, and Clinical Center, Palo Alto, California
| | - M Elizabeth Weiss
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California; Wu Tsai Neurosciences Institute, Stanford University, Stanford, California; Veterans Affairs Palo Alto Healthcare System and Sierra Pacific Mental Illness, Research, Education, and Clinical Center, Palo Alto, California
| | - Allison L Thompson
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California
| | - Sanno E Zack
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California
| | - Steven E Lindley
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California; Veterans Affairs Palo Alto Healthcare System and Sierra Pacific Mental Illness, Research, Education, and Clinical Center, Palo Alto, California
| | - Bruce A Arnow
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California
| | - Booil Jo
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California
| | - Barbara O Rothbaum
- Trauma and Anxiety Recovery Program, Department of Psychiatry, Emory University School of Medicine, Atlanta, Georgia
| | - Amit Etkin
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California; Wu Tsai Neurosciences Institute, Stanford University, Stanford, California; Alto Neuroscience, Los Altos, California.
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16
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Manthey A, Sierk A, Brakemeier EL, Walter H, Daniels JK. Does trauma-focused psychotherapy change the brain? A systematic review of neural correlates of therapeutic gains in PTSD. Eur J Psychotraumatol 2021; 12:1929025. [PMID: 34394855 PMCID: PMC8354020 DOI: 10.1080/20008198.2021.1929025] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/30/2022] Open
Abstract
BACKGROUND Meta-analytic results indicate that posttraumatic stress disorder (PTSD) is associated with hypoactivation of the medial prefrontal cortex (mPFC), hyperactivation of the amygdala, and volume reductions of the hippocampus. Effective psychotherapeutic treatments were hypothesized to normalize these neural patterns via upregulation of prefrontal structures, which in turn downregulate limbic regions. OBJECTIVE To gain a sound understanding of the effects of successful psychotherapy on the brain, neural changes from pre- to post-treatment in PTSD patients will be aggregated. METHOD A systematic literature search identified 24 original studies employing structural or functional MRI measurements both before and after treatment of patients diagnosed with PTSD. RESULTS In conjunction, the review returned little evidence of an activation increase in the mPFC/rostral anterior cingulate cortex (rACC) following successful treatment. Five out of 12 studies observed such an increase (especially during emotion processing tasks), albeit in partially non-overlapping brain regions. Conversely, neither the putative related activation decrease in the amygdala nor volumetric changes or altered activation during the resting state could be convincingly established. CONCLUSION Successful psychological treatments might potentially work via upregulation of the mPFC, which thus may be involved in symptom reduction. However, the role of the amygdala in recovery from PTSD remains unclear. There is currently no indication that the various PTSD treatment approaches employed by the reviewed studies differ regarding their action mechanisms, but further research on this topic is needed.
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Affiliation(s)
- Antje Manthey
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Anika Sierk
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Eva-Lotta Brakemeier
- Department of Clinical Psychology and Psychotherapy, Universität Greifswald, Greifswald, Germany.,Psychologische Hochschule Berlin, Berlin, Germany
| | - Henrik Walter
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Judith K Daniels
- Psychologische Hochschule Berlin, Berlin, Germany.,Department of Clinical Psychology, University of Groningen, Groningen, The Netherlands
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17
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Harlé KM, Simmons AN, Norman SB, Spadoni AD. Neural affective mechanisms associated with treatment responsiveness in veterans with PTSD and comorbid alcohol use disorder. Psychiatry Res Neuroimaging 2020; 305:111172. [PMID: 32927371 PMCID: PMC8486287 DOI: 10.1016/j.pscychresns.2020.111172] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 08/16/2020] [Accepted: 08/19/2020] [Indexed: 10/23/2022]
Abstract
Post-traumatic stress disorder (PTSD) is associated with neuro-physiological abnormalities reflecting increased anticipatory anxiety and reactivity to traumatic cues. It remains unclear whether neural mechanisms associated with PTSD treatment responsiveness, i.e. hyperactivation of the affective salience network in the brain, extend to a comorbid PTSD and substance use disorder population. Thirty-one Veterans with PTSD and co-occurring alcohol use disorder (AUD) were randomly assigned to either prolonged exposure or a non-exposure based treatment. They completed an affective anticipation task while undergoing fMRI, immediately prior and after completing treatment. After controlling for type and length of treatment, larger reduction of PTSD symptoms was associated with decreased anticipatory activation to negative trauma-related cues in the right pre-Supplementary Motor Area (pre-SMA), a region associated with emotion regulation. Smaller reduction in PTSD severity was associated with enhanced anticipatory activation to those cues within the right para-hippocampal region, an affective processing region. Our findings suggest that post-treatment reductions in anticipatory reactivity to trauma-related cues in the pre-SMA and para-hippocampal area are associated with larger PTSD symptom reduction in individuals with co-occurring PTSD and AUD. These results may offer neurofeedback training targets as an alternative to or enhancement of other PTSD treatment modalities in this population.
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Affiliation(s)
- Katia M Harlé
- VA San Diego Healthcare System, San Diego, CA, United States; Department of Psychiatry, University of California San Diego, La Jolla, CA, United States.
| | - Alan N Simmons
- VA San Diego Healthcare System, San Diego, CA, United States; Department of Psychiatry, University of California San Diego, La Jolla, CA, United States
| | - Sonya B Norman
- VA San Diego Healthcare System, San Diego, CA, United States; Department of Psychiatry, University of California San Diego, La Jolla, CA, United States
| | - Andrea D Spadoni
- VA San Diego Healthcare System, San Diego, CA, United States; Department of Psychiatry, University of California San Diego, La Jolla, CA, United States
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18
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Korgaonkar MS, Chakouch C, Breukelaar IA, Erlinger M, Felmingham KL, Forbes D, Williams LM, Bryant RA. Intrinsic connectomes underlying response to trauma-focused psychotherapy in post-traumatic stress disorder. Transl Psychiatry 2020; 10:270. [PMID: 32759938 PMCID: PMC7406502 DOI: 10.1038/s41398-020-00938-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 06/11/2020] [Accepted: 06/23/2020] [Indexed: 01/09/2023] Open
Abstract
Although trauma-focused cognitive behavior therapy (TF-CBT) is the frontline treatment for post-traumatic stress disorder (PTSD), up to one-half of patients are treatment nonresponders. To understand treatment nonresponse, it is important to understand the neural mechanisms of TF-CBT. Here, we used whole-brain intrinsic functional connectivity analysis to identify neural connectomic signatures of treatment outcome. In total, 36 PTSD patients and 36 healthy individuals underwent functional MRI at pre-treatment baseline. Patients then underwent nine sessions of TF-CBT and completed clinical and follow-up MRIs. We used an established large-scale brain network atlas to parcellate the brain into 343 brain regions. Pairwise intrinsic task-free functional connectivity was calculated and used to identify pre-treatment connectomic features that were correlated with reduction of PTSD severity from pretreatment to post treatment. We formed a composite metric of intrinsic connections associated with therapeutic outcome, and then interrogated this composite metric to determine if it distinguished PTSD treatment responders and nonresponders from healthy control status and changed post treatment. Lower pre-treatment connectivity for the cingulo-opercular, salience, default mode, dorsal attention, and frontoparietal executive control brain networks was associated with treatment improvement. Treatment responders had lower while nonresponders had significantly greater connectivity than controls at pretreatment. With therapy, connectivity significantly increased for responders and decreased for nonresponders, while controls remain unchanged over this time period. We provide evidence that the intrinsic functional architecture of the brain, specifically connectivity within and between brain networks associated with external vigilance, self-awareness, and cognitive control, may characterize a positive response to TF-CBT for PTSD.
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Affiliation(s)
- Mayuresh S. Korgaonkar
- grid.1013.30000 0004 1936 834XBrain Dynamics Centre, Westmead Institute for Medical Research, The University of Sydney, Sydney, NSW Australia ,grid.1013.30000 0004 1936 834XDepartment of Psychiatry, Faculty of Medicine and Health, University of Sydney, Sydney, NSW Australia
| | - Cassandra Chakouch
- grid.1013.30000 0004 1936 834XBrain Dynamics Centre, Westmead Institute for Medical Research, The University of Sydney, Sydney, NSW Australia
| | - Isabella A. Breukelaar
- grid.1013.30000 0004 1936 834XBrain Dynamics Centre, Westmead Institute for Medical Research, The University of Sydney, Sydney, NSW Australia ,grid.1005.40000 0004 4902 0432School of Psychology, University of New South Wales, Sydney, NSW Australia
| | - May Erlinger
- grid.1013.30000 0004 1936 834XBrain Dynamics Centre, Westmead Institute for Medical Research, The University of Sydney, Sydney, NSW Australia
| | - Kim L. Felmingham
- grid.1008.90000 0001 2179 088XSchool of Psychological Sciences, University of Melbourne, Melbourne, VIC Australia
| | - David Forbes
- Centenary of ANZAC Centre, a Department of Veterans’ Affairs funded initiative of Phoenix Australia, Carlton, VIC Australia
| | - Leanne M. Williams
- grid.168010.e0000000419368956Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA USA ,grid.280747.e0000 0004 0419 2556Sierra-Pacific Mental Illness Research, Education, and Clinical Center (MIRECC) VA Palo Alto Health Care System, Palo Alto, CA USA
| | - Richard A. Bryant
- grid.1013.30000 0004 1936 834XBrain Dynamics Centre, Westmead Institute for Medical Research, The University of Sydney, Sydney, NSW Australia ,grid.1005.40000 0004 4902 0432School of Psychology, University of New South Wales, Sydney, NSW Australia
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19
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Harlé KM, Spadoni AD, Norman SB, Simmons AN. Neurocomputational Changes in Inhibitory Control Associated With Prolonged Exposure Therapy. J Trauma Stress 2020; 33:500-510. [PMID: 31765510 PMCID: PMC8567749 DOI: 10.1002/jts.22461] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 06/17/2019] [Accepted: 06/19/2019] [Indexed: 11/08/2022]
Abstract
Posttraumatic stress disorder (PTSD) is associated with inhibitory control dysfunction that extends beyond difficulties inhibiting trauma-related intrusions. Inhibitory learning has been proposed as a potential mechanism of change underlying the effectiveness of extinction-based therapies such as prolonged exposure (PE), a first-line treatment for PTSD. To identify neurocognitive markers of change in inhibitory learning associated with PE, we applied a Bayesian learning model to the analysis of neuroimaging data collected during an inhibitory control task, both before and after PE treatment. Veterans (N = 20) with combat-related PTSD completed a stop-signal task (SST) while undergoing fMRI at time points immediately before and after PE treatment. Participants exhibited a small, significant improvement in performance on the SST, as demonstrated by longer reaction times and improved inhibition accuracy. Amplitude of neural activation associated with a signed prediction error (SPE; i.e., the discrepancy between actual outcome and model-based expectation of needing to stop) in the right caudate decreased from baseline to posttreatment assessment. Change in model-based activation was modulated by performance accuracy, with a decrease in positive SPE activation observed on successful trials, d = 0.79, and a reduction in negative SPE activation on error trials, d = 0.74. The decrease in SPE-related activation on successful stop trials was correlated with PTSD symptom reduction. These results are consistent with the notion that PE may help broadly strengthen inhibitory learning and the development of more accurate model-based predictions, which may thus facilitate change in cognitions in response to trauma-related cues and help reduce PTSD symptoms.
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Affiliation(s)
- Katia M. Harlé
- VA San Diego Healthcare System, San Diego, California, USA
- Department of Psychiatry, University of California San Diego, La Jolla, California, USA
| | - Andrea D. Spadoni
- VA San Diego Healthcare System, San Diego, California, USA
- Department of Psychiatry, University of California San Diego, La Jolla, California, USA
| | - Sonya B. Norman
- VA San Diego Healthcare System, San Diego, California, USA
- Department of Psychiatry, University of California San Diego, La Jolla, California, USA
| | - Alan N. Simmons
- VA San Diego Healthcare System, San Diego, California, USA
- Department of Psychiatry, University of California San Diego, La Jolla, California, USA
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20
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Duval ER, Sheynin J, King AP, Phan KL, Simon NM, Martis B, Porter KE, Norman SB, Liberzon I, Rauch SAM. Neural function during emotion processing and modulation associated with treatment response in a randomized clinical trial for posttraumatic stress disorder. Depress Anxiety 2020; 37:670-681. [PMID: 32306485 PMCID: PMC8010611 DOI: 10.1002/da.23022] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 02/19/2020] [Accepted: 03/27/2020] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Posttraumatic stress disorder (PTSD) has been associated with exaggerated threat processing and deficits in emotion modulation circuitry. It remains unknown how neural circuits are associated with response to evidence-based treatments for PTSD. METHOD We examined associations between PTSD symptoms and indicators of neural response in key emotion processing and modulation regions. Fifty-six military Veterans with PTSD were randomly assigned to one of three evidence-based treatments (prolonged exposure, sertraline, and PE plus sertraline) in a randomized clinical trial ("PROGrESS"; 2018, Contemp Clin Trials, 64, 128-138). Twenty-seven combat-exposed controls (CCs) served as a comparison group at pretreatment. Before and after PTSD treatment, functional magnetic resonance imaging was used to assess brain activation and connectivity during the validated Shifted Attention Emotion Appraisal Task (2003, J Neurosci, 23, 5627-5633; 2013, Biol Psychiatry, 73, 1045-1053). RESULTS Greater activation in emotion processing (anterior insula) and modulation (prefrontal cortex) regions and increased connectivity between attentional control (dorsolateral prefrontal cortex and superior parietal cortex) and emotion processing (amygdala) regions, at pretreatment, were associated with subsequent PTSD symptom improvement. CONCLUSIONS This study is one of the first to examine task-based activation and functional connectivity in a PTSD treatment trial, and provides evidence to suggest that activation in and connectivity between emotion processing and modulation regions are important predictors of treatment response.
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Affiliation(s)
- Elizabeth R. Duval
- VA Ann Arbor Healthcare System, Ann Arbor, Michigan,Department of Psychiatry, University of Michigan, Ann Arbor, Michigan
| | - Jony Sheynin
- VA Ann Arbor Healthcare System, Ann Arbor, Michigan,Department of Psychiatry, University of Michigan, Ann Arbor, Michigan,Department of Psychiatry, Texas A&M University Health Science Center, Bryan, Texas
| | - Anthony P. King
- VA Ann Arbor Healthcare System, Ann Arbor, Michigan,Department of Psychiatry, University of Michigan, Ann Arbor, Michigan
| | - K. Luan Phan
- Department of Psychiatry and Behavioral Health, The Ohio State University, Columbus, Ohio
| | - Naomi M. Simon
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts,Department of Psychiatry, New York University School of Medicine, New York, New York
| | - Brian Martis
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan,Research Service, VA San Diego Healthcare System, San Diego, California,Department of Psychiatry, University of California, San Diego School of Medicine, La Jolla, California
| | - Katherine E. Porter
- VA Ann Arbor Healthcare System, Ann Arbor, Michigan,Department of Psychiatry, University of Michigan, Ann Arbor, Michigan
| | - Sonya B. Norman
- Research Service, VA San Diego Healthcare System, San Diego, California,Department of Psychiatry, University of California, San Diego School of Medicine, La Jolla, California,Executive Division, National Center for PTSD, White River Junction, Vermont
| | - Israel Liberzon
- VA Ann Arbor Healthcare System, Ann Arbor, Michigan,Department of Psychiatry, University of Michigan, Ann Arbor, Michigan,Department of Psychiatry, Texas A&M University Health Science Center, Bryan, Texas
| | - Sheila A. M. Rauch
- Mental Health Service Line, VA Atlanta Healthcare System, Decatur, Georgia,Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia
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21
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May AC, Aupperle RL, Stewart JL. Dark Times: The Role of Negative Reinforcement in Methamphetamine Addiction. Front Psychiatry 2020; 11:114. [PMID: 32256392 PMCID: PMC7090143 DOI: 10.3389/fpsyt.2020.00114] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 02/10/2020] [Indexed: 12/01/2022] Open
Abstract
Methamphetamine use is associated with substantial adverse outcomes including poor mental and physical health, financial difficulties, and societal costs. Despite deleterious long-term consequences associated with methamphetamine, many people use drugs for short-term reduction of unpleasant physical or emotional sensations. By removing these aversive states, drug use behaviors are negatively reinforced. Abstinence from methamphetamine can then result in a return to previous aversive emotional states linked to withdrawal and craving, often contributing to an increased likelihood for relapse. This negative reinforcement cycle is hypothesized to be a motivating and maintaining factor for addiction. Thus, this review highlights the current evidence for negative reinforcement mechanisms in methamphetamine use disorder by integrating studies of subjective experience, behavior, functional magnetic resonance imaging, positron emission tomography, and event-related potentials and examining the efficacy of treatments targeting aspects of negative reinforcement. Overall, the literature demonstrates that individuals who use methamphetamine have diminished cognitive control and process emotions, loss of reward, and interoceptive information differently than non-using individuals. These differences are reflected in behavioral and subjective experiments as well as brain-based experiments which report significant differences in various frontal regions, insula, anterior cingulate cortex, and striatum. Together, the results suggest methamphetamine users have an altered experience of negative outcomes, difficulties employing effective emotion regulation, and difficulty engaging in adaptive or goal-directed decision-making. Suggestions for future research to improve our understanding of how negative reinforcement contributes to methamphetamine addiction and to develop effective interventions are provided.
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Affiliation(s)
- April C. May
- Joint Doctoral Program in Clinical Psychology, San Diego State University and University of California, San Diego, San Diego, CA, United States
| | - Robin L. Aupperle
- Laureate Institute for Brain Research, Tulsa, OK, United States
- Department of Community Medicine, University of Tulsa, Tulsa, OK, United States
| | - Jennifer L. Stewart
- Laureate Institute for Brain Research, Tulsa, OK, United States
- Department of Community Medicine, University of Tulsa, Tulsa, OK, United States
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22
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Szeszko PR, Yehuda R. Magnetic resonance imaging predictors of psychotherapy treatment response in post-traumatic stress disorder: A role for the salience network. Psychiatry Res 2019; 277:52-57. [PMID: 30755338 DOI: 10.1016/j.psychres.2019.02.005] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 02/01/2019] [Accepted: 02/02/2019] [Indexed: 01/21/2023]
Abstract
The earliest neuroimaging studies in post-traumatic stress disorder (PTSD) utilized positron emission tomography (PET) to examine the brain's response to glucocorticoid administration given predominant neurobiological models of the stress response focusing on that neuroendocrine system. This work revealed that the anterior cingulate cortex and amygdala, which is now considered part of the salience network, play a role in treatment response, and set the stage for subsequent magnetic resonance (MR) imaging studies focused on understanding the role of the salience network in the neurobiology of treatment response in PTSD. This selective review discusses magnetic resonance (MR) imaging studies that have been used to predict treatment response to cognitive-behavioral therapy (CBT) or prolonged exposure (PE) in PTSD, which have demonstrated abnormalities in processing involving the salience network, including the amygdala, anterior cingulate cortex and insula. Increased attention to environmental cues may signal alarm resulting in hypervigilance and overactive action-monitoring for the detection of threatening stimuli and an inability to integrate concomitant emotional and sensory functions in PTSD. Successful psychotherapy treatment response in PTSD appears to involve the ability to downregulate amygdala activity to trauma-related stimuli through improved regulation of attention by the anterior cingulate cortex and concomitant internal emotional states mediated by the insula. In addition, the ability to better modulate (normalize) the salience network following psychotherapy in PTSD may be associated with better crosstalk between untargeted inner thought (i.e., task-negative network) and the ability to focus attention on stimulus-dependent demands (i.e., task positive network).
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Affiliation(s)
- Philip R Szeszko
- James J. Peters VA Medical Center, Bronx, NY, United States; Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, United States.
| | - Rachel Yehuda
- James J. Peters VA Medical Center, Bronx, NY, United States; Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, United States
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23
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Jak AJ, Crocker LD, Aupperle RL, Clausen A, Bomyea J. Neurocognition in PTSD: Treatment Insights and Implications. Curr Top Behav Neurosci 2019; 38:93-116. [PMID: 28025811 DOI: 10.1007/7854_2016_62] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Post-traumatic stress disorder (PTSD) is classified as a traumatic stress-related condition and is most often discussed in terms of emotional dysfunction. However, given that cognitive and emotional processes are intricately intertwined, implemented by overlapping brain networks, and effectively integrated in at least some of the same regions (e.g., prefrontal cortex, for a review, see Crocker et al. 2013), an abundance of literature now highlights the key role that cognitive functioning plays in both the development and maintenance (or exacerbation) of PTSD symptoms (Aupperle et al. 2012a; Verfaellie et al. 2012). Findings from this body of work detail objective impairment in neuropsychological function in those with PTSD (Brandes et al. 2002; Hayes et al. 2012a; Koenen et al. 2001). Yet despite the impact of neurocognition on PTSD treatment engagement and success (e.g., Haaland et al. 2016; Nijdam et al. 2015) and conversely, the role of PTSD treatment in normalizing cognitive dysfunction, a much smaller literature exists on neurocognitive changes following treatment for PTSD. Even aside from its role in treatment, cognitive functioning in PTSD has significant implications for daily functioning for individuals with this disorder, as cognition is predictive of school achievement, obtaining and maintaining employment, job advancement, maintaining relationships, greater wealth, and better health and quality of life (e.g., Diamond and Ling 2016).
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Affiliation(s)
- Amy J Jak
- VA San Diego Healthcare System, San Diego, CA, USA.
- University of California, San Diego, La Jolla, CA, USA.
| | | | - Robin L Aupperle
- Laureate Institute for Brain Research, Tulsa, OK, USA
- University of Tulsa, Tulsa, OK, USA
| | - Ashley Clausen
- Laureate Institute for Brain Research, Tulsa, OK, USA
- University of Tulsa, Tulsa, OK, USA
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24
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Spadoni AD, Huang M, Simmons AN. Emerging Approaches to Neurocircuits in PTSD and TBI: Imaging the Interplay of Neural and Emotional Trauma. Curr Top Behav Neurosci 2019; 38:163-192. [PMID: 29285732 PMCID: PMC8896198 DOI: 10.1007/7854_2017_35] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Posttraumatic stress disorder (PTSD) and traumatic brain injury (TBI) commonly co-occur in general and military populations and have a number of overlapping symptoms. While research suggests that TBI is risk factor for PTSD and that PTSD may mediate TBI-related outcomes, the mechanisms of these relationships are not well understood. Neuroimaging may help elucidate patterns of neurocircuitry both specific and common to PTSD and TBI and thus help define the nature of their interaction, refine diagnostic classification, and may potentially yield opportunities for targeted treatments. In this review, we provide a summary of some of the most common and the most innovative neuroimaging approaches used to characterize the neural circuits associated with PTSD, TBI, and their comorbidity. We summarize the state of the science for each disorder and describe the few studies that have explicitly attempted to characterize the neural substrates of their shared and dissociable influence. While some promising targets in the medial frontal lobes exist, there is not currently a comprehensive understanding of the neurocircuitry mediating the interaction of PTSD and TBI. Future studies should exploit innovative neuroimaging approaches and longitudinal designs to specifically target the neural mechanisms driving PTSD-TBI-related outcomes.
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Affiliation(s)
- Andrea D Spadoni
- Research Service, VA San Diego Healthcare System, San Diego, CA, USA.
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA.
| | - Mingxiong Huang
- Radiology and Research Services, VA San Diego Healthcare System, San Diego, CA, USA
- Department of Radiology, University of California, San Diego, La Jolla, CA, USA
| | - Alan N Simmons
- Research Service, VA San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
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25
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Schubert CF, Schreckenbach M, Kirmeier T, Gall-Kleebach DJ, Wollweber B, Buell DR, Uhr M, Rosner R, Schmidt U. PTSD psychotherapy improves blood pressure but leaves HPA axis feedback sensitivity stable and unaffected: First evidence from a pre-post treatment study. Psychoneuroendocrinology 2019; 100:254-263. [PMID: 30391833 DOI: 10.1016/j.psyneuen.2018.10.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Revised: 10/15/2018] [Accepted: 10/15/2018] [Indexed: 01/05/2023]
Abstract
Although key to development of tailored drugs for augmentation treatment of psychotherapy for posttraumatic stress disorder (PTSD), the biological correlates of PTSD remission are still unknown, probably because pre-post treatment studies searching for them are rare. Not even the feedback sensitivity of the otherwise well-studied hypothalamic-pituitary-adrenal (HPA) axis nor arterial blood pressure (BP), which was previously reported to be elevated in PTSD patients, have so far been analyzed during PTSD treatment. To narrow this knowledge gap, we first performed an overnight dexamethasone suppression test (DST) in a mixed-sex cohort of 25 patients with severe PTSD vs. 20 non-traumatized healthy controls (nt-HC). In addition to hormones, BP and heart rate (HR) were measured at each of the four assessment points (APs). Second, the same parameters were assessed again in 16 of these patients after 12 sessions of integrative trauma-focused cognitive behavioral therapy (iTF-CBT). In relation to nt-HC, PTSD patients showed a significant elevation in HR and diastolic BP while their systolic BP, DST outcomes and basal serum cortisol levels (BSCL) were not significantly altered. In response to iTF-CBT, PTSD symptoms and dysfunctional stress coping strategies improved significantly in PTSD patients. Most important, also their systolic and diastolic BP levels ameliorated at distinct APs while their DST outcomes and BSCL remained unchanged. To our knowledge, this is the first pre-post treatment study assessing the stability of the DST outcome and BP levels during PTSD treatment. Our results provide first evidence for a non-involvement of HPA axis feedback sensitivity in PTSD symptom improvement and, furthermore, suggest a possible role for BP-regulating pathways such as the sympathetic nervous system in PTSD remission. Limitations arise from the small sample size, the lack of an untreated patient group and drug treatment of patients.
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Affiliation(s)
- Christine F Schubert
- Max Planck Institute of Psychiatry, Department of Translational Psychiatry, RG Molecular Psychotraumatology, Kraepelinstrasse 10, 80804 Munich, Germany; Catholic University of Eichstätt-Ingolstadt, Ostenstraße 25, 85072 Eichstätt, Germany; Ludwig Maximilians University, Department of Psychology, Leopoldstraße 44, 80802 Munich, Germany
| | - Monika Schreckenbach
- Max Planck Institute of Psychiatry, Department of Translational Psychiatry, RG Molecular Psychotraumatology, Kraepelinstrasse 10, 80804 Munich, Germany
| | | | - Dominique J Gall-Kleebach
- Max Planck Institute of Psychiatry, Department of Translational Psychiatry, RG Molecular Psychotraumatology, Kraepelinstrasse 10, 80804 Munich, Germany; Verein für Klinische Verhaltenstherapie (VFKV) - Ausbildungsinstitut München gGmbH, Lindwurmstr. 117, 80337 München, Germany
| | - Bastian Wollweber
- Max Planck Institute of Psychiatry, Department of Translational Psychiatry, RG Molecular Psychotraumatology, Kraepelinstrasse 10, 80804 Munich, Germany
| | - Dominik R Buell
- Max Planck Institute of Psychiatry, Department of Translational Psychiatry, RG Molecular Psychotraumatology, Kraepelinstrasse 10, 80804 Munich, Germany
| | - Manfred Uhr
- Max Planck Institute of Psychiatry, Clinical Department, Kraepelinstrasse 10, 80804 Munich, Germany
| | - Rita Rosner
- Catholic University of Eichstätt-Ingolstadt, Ostenstraße 25, 85072 Eichstätt, Germany
| | - Ulrike Schmidt
- Max Planck Institute of Psychiatry, Department of Translational Psychiatry, RG Molecular Psychotraumatology, Kraepelinstrasse 10, 80804 Munich, Germany; University Medical Center Göttingen (UMG), Department of Psychiatry and Psychotherapy, Psychotrauma Treatment Unit & RG Stress Modulation of Neurodegeneration, Göttingen, Germany; Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, the Netherlands.
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26
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Zuj DV, Norrholm SD. The clinical applications and practical relevance of human conditioning paradigms for posttraumatic stress disorder. Prog Neuropsychopharmacol Biol Psychiatry 2019; 88:339-351. [PMID: 30134147 DOI: 10.1016/j.pnpbp.2018.08.014] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 07/31/2018] [Accepted: 08/15/2018] [Indexed: 01/17/2023]
Abstract
The classical conditioning paradigm of fear learning has spawned a number of experimental variations for the explanation of posttraumatic stress disorder (PTSD) etiology. These paradigms include extinction learning and recall, fear inhibition, fear generalization, and conditioned avoidance. As such, each of these paradigms have significant applications for understanding the development, maintenance, treatment, and relapse of the fear-related features of PTSD. In the present review, we describe each of these conditioning-based paradigms with reference to the clinical applications, and supported by case examples from patients with severe PTSD symptoms. We also review the neurobiological models of conditioning and extinction in animals, psychiatrically healthy humans, and PTSD patients, and discuss the current balance of evidence suggesting a number of biological, behavioral, and cognitive mechanisms/moderators of the conditioning and extinction process in experimental and clinical contexts.
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Affiliation(s)
- Daniel V Zuj
- Department of Psychology, Swansea University, UK
| | - Seth Davin Norrholm
- Atlanta Veterans Affairs Medical Center, Mental Health Service Line, USA; Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, USA.
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27
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Abstract
Positioning "incentive hope" in a general model of behavioral control systems removes artificial boundaries between mechanisms of incentive motivation in foraging behavior and other functions of the striatum and connected systems. Specifically, incentive hope may involve mechanisms of anticipation of both reward and threat, explaining why anxious individuals show stronger potentiation of incentive motivation under conditions of reward uncertainty.
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28
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Zhu X, Suarez-Jimenez B, Lazarov A, Helpman L, Papini S, Lowell A, Durosky A, Lindquist MA, Markowitz JC, Schneier F, Wager TD, Neria Y. Exposure-based therapy changes amygdala and hippocampus resting-state functional connectivity in patients with posttraumatic stress disorder. Depress Anxiety 2018; 35:974-984. [PMID: 30260530 PMCID: PMC6168398 DOI: 10.1002/da.22816] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 04/19/2018] [Accepted: 05/29/2018] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Recent research suggests that posttraumatic stress disorder (PTSD) is associated with altered amygdala and hippocampal resting-state functional connectivity (rsFC). However, less research has examined whether Prolonged Exposure (PE), a first line exposure-based treatment for PTSD, has the potential to alter resting state neural networks. METHODS A total of 24 patients with PTSD and 26 matched trauma-exposed healthy controls (TEHCs) underwent resting-state functional magnetic resonance imaging (fMRI) at baseline. PTSD patients were scanned a second time after completing 10-session PE in which patients narrated a detailed trauma account (imaginal exposure) and confronted trauma reminders (in vivo exposure) to extinguish trauma-related fear responses. TEHC were scanned again following a 10-week waiting period. Seed regions of interest (ROIs) included centromedial amygdala (CMA), basolateral amygdala (BLA), and the hippocampus. RESULTS Post- versus pretreatment comparisons indicated increased rsFC of the BLA and CMA with the orbitofrontal cortex (OFC), and hippocampus-medial prefrontal cortex (mPFC) among patients with PTSD, but not among TEHC participants. CONCLUSIONS Enhanced amygdala and hippocampus rsFC with prefrontal cortical regions following PE could underlie improved capacity for inhibition and re-evaluation of threat, and heightened memory encoding and retrieval ability, respectively. These findings encourage further investigation of this circuitry as a therapeutic target in PTSD.
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Affiliation(s)
- Xi Zhu
- Columbia University, Department of Psychiatry, New York, NY,New York State Psychiatric Institute, New York, NY
| | - Benjamin Suarez-Jimenez
- Columbia University, Department of Psychiatry, New York, NY,New York State Psychiatric Institute, New York, NY
| | - Amit Lazarov
- Columbia University, Department of Psychiatry, New York, NY,New York State Psychiatric Institute, New York, NY
| | - Liat Helpman
- Columbia University, Department of Psychiatry, New York, NY,New York State Psychiatric Institute, New York, NY
| | - Santiago Papini
- The University of Texas at Austin, Department of Psychology and Institute for Mental Health Research, TX
| | - Ari Lowell
- Columbia University, Department of Psychiatry, New York, NY,New York State Psychiatric Institute, New York, NY
| | | | | | - John C. Markowitz
- Columbia University, Department of Psychiatry, New York, NY,New York State Psychiatric Institute, New York, NY
| | - Franklin Schneier
- Columbia University, Department of Psychiatry, New York, NY,New York State Psychiatric Institute, New York, NY
| | - Tor D. Wager
- University of Colorado Boulder, Department of Psychology and Neuroscience, CO
| | - Yuval Neria
- Columbia University, Department of Psychiatry, New York, NY,New York State Psychiatric Institute, New York, NY
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29
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Nicholson AA, Rabellino D, Densmore M, Frewen PA, Paret C, Kluetsch R, Schmahl C, Théberge J, Ros T, Neufeld RWJ, McKinnon MC, Reiss JP, Jetly R, Lanius RA. Intrinsic connectivity network dynamics in PTSD during amygdala downregulation using real-time fMRI neurofeedback: A preliminary analysis. Hum Brain Mapp 2018; 39:4258-4275. [PMID: 30004602 DOI: 10.1002/hbm.24244] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 05/23/2018] [Accepted: 05/29/2018] [Indexed: 01/01/2023] Open
Abstract
Posttraumatic stress disorder (PTSD) has been associated with a disturbance in neural intrinsic connectivity networks (ICN), including the central executive network (CEN), default mode network (DMN), and salience network (SN). Here, we conducted a preliminary investigation examining potential changes in ICN recruitment as a function of real-time fMRI neurofeedback (rt-fMRI-NFB) during symptom provocation where we targeted the downregulation of neural response within the amygdala-a key region-of-interest in PTSD neuropathophysiology. Patients with PTSD (n = 14) completed three sessions of rt-fMRI-NFB with the following conditions: (a) regulate: decrease activation in the amygdala while processing personalized trauma words; (b) view: process trauma words while not attempting to regulate the amygdala; and (c) neutral: process neutral words. We found that recruitment of the left CEN increased over neurofeedback runs during the regulate condition, a finding supported by increased dlPFC activation during the regulate as compared to the view condition. In contrast, DMN task-negative recruitment was stable during neurofeedback runs, albeit was the highest during view conditions and increased (normalized) during rest periods. Critically, SN recruitment was high for both the regulate and the view conditions, a finding potentially indicative of CEN modality switching, adaptive learning, and increasing threat/defense processing in PTSD. In conclusion, this study provides provocative, preliminary evidence that downregulation of the amygdala using rt-fMRI-NFB in PTSD is associated with dynamic changes in ICN, an effect similar to those observed using EEG modalities of neurofeedback.
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Affiliation(s)
- Andrew A Nicholson
- Department of Neuroscience, Western University, London, Ontario, Canada.,Department of Psychiatry, Western University, London, Ontario, Canada.,Department of Imaging, Lawson Health Research Institute, London, Ontario, Canada.,Homewood Research Institute, Guelph, Ontario, Canada
| | - Daniela Rabellino
- Department of Psychiatry, Western University, London, Ontario, Canada.,Department of Imaging, Lawson Health Research Institute, London, Ontario, Canada.,Homewood Research Institute, Guelph, Ontario, Canada
| | - Maria Densmore
- Department of Psychiatry, Western University, London, Ontario, Canada.,Department of Imaging, Lawson Health Research Institute, London, Ontario, Canada
| | - Paul A Frewen
- Department of Neuroscience, Western University, London, Ontario, Canada.,Department of Psychology, Western University, London, Ontario, Canada
| | - Christian Paret
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - Rosemarie Kluetsch
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - Christian Schmahl
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - Jean Théberge
- Department of Psychiatry, Western University, London, Ontario, Canada.,Department of Imaging, Lawson Health Research Institute, London, Ontario, Canada.,Department of Medical Imaging, Western University, London, Ontario, Canada.,Department of Medial Biophysics, Western University, London, Ontario, Canada.,Department of Diagnostic Imaging, St. Joseph's Healthcare, London, Ontario, Canada
| | - Tomas Ros
- Laboratory of Neurology and Imaging of Cognition, Department of Neuroscience, University of Geneva, Geneva, Switzerland
| | - Richard W J Neufeld
- Department of Neuroscience, Western University, London, Ontario, Canada.,Department of Psychiatry, Western University, London, Ontario, Canada.,Department of Psychology, Western University, London, Ontario, Canada
| | - Margaret C McKinnon
- Homewood Research Institute, Guelph, Ontario, Canada.,Mood Disorders Program, St. Joseph's Healthcare, Hamilton, Ontario, Canada.,Department of Psychiatry and Behavioural Neuroscience, McMaster University, Hamilton, Ontario, Canada
| | - Jeffrey P Reiss
- Department of Psychiatry, Western University, London, Ontario, Canada
| | - Rakesh Jetly
- Canadian Forces, Health Services, Ottawa, Ontario, Canada
| | - Ruth A Lanius
- Department of Neuroscience, Western University, London, Ontario, Canada.,Department of Psychiatry, Western University, London, Ontario, Canada.,Department of Imaging, Lawson Health Research Institute, London, Ontario, Canada
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Sun D, Davis SL, Haswell CC, Swanson CA, LaBar KS, Fairbank JA, Morey RA. Brain Structural Covariance Network Topology in Remitted Posttraumatic Stress Disorder. Front Psychiatry 2018; 9:90. [PMID: 29651256 PMCID: PMC5885936 DOI: 10.3389/fpsyt.2018.00090] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Accepted: 03/05/2018] [Indexed: 01/18/2023] Open
Abstract
Posttraumatic stress disorder (PTSD) is a prevalent, chronic disorder with high psychiatric morbidity; however, a substantial portion of affected individuals experience remission after onset. Alterations in brain network topology derived from cortical thickness correlations are associated with PTSD, but the effects of remitted symptoms on network topology remain essentially unexplored. In this cross-sectional study, US military veterans (N = 317) were partitioned into three diagnostic groups, current PTSD (CURR-PTSD, N = 101), remitted PTSD with lifetime but no current PTSD (REMIT-PTSD, N = 35), and trauma-exposed controls (CONTROL, n = 181). Cortical thickness was assessed for 148 cortical regions (nodes) and suprathreshold interregional partial correlations across subjects constituted connections (edges) in each group. Four centrality measures were compared with characterize between-group differences. The REMIT-PTSD and CONTROL groups showed greater centrality in left frontal pole than the CURR-PTSD group. The REMIT-PTSD group showed greater centrality in right subcallosal gyrus than the other two groups. Both REMIT-PTSD and CURR-PTSD groups showed greater centrality in right superior frontal sulcus than CONTROL group. The centrality in right subcallosal gyrus, left frontal pole, and right superior frontal sulcus may play a role in remission, current symptoms, and PTSD history, respectively. The network centrality changes in critical brain regions and structural networks are associated with remitted PTSD, which typically coincides with enhanced functional behaviors, better emotion regulation, and improved cognitive processing. These brain regions and associated networks may be candidates for developing novel therapies for PTSD. Longitudinal work is needed to characterize vulnerability to chronic PTSD, and resilience to unremitting PTSD.
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Affiliation(s)
- Delin Sun
- Department of Veteran Affairs (VA) Mid-Atlantic Mental Illness Research, Education and Clinical Center, Durham, NC, United States.,Duke-UNC Brain Imaging and Analysis Center, Duke University, Durham, NC, United States
| | - Sarah L Davis
- Department of Veteran Affairs (VA) Mid-Atlantic Mental Illness Research, Education and Clinical Center, Durham, NC, United States.,Duke-UNC Brain Imaging and Analysis Center, Duke University, Durham, NC, United States
| | - Courtney C Haswell
- Department of Veteran Affairs (VA) Mid-Atlantic Mental Illness Research, Education and Clinical Center, Durham, NC, United States.,Duke-UNC Brain Imaging and Analysis Center, Duke University, Durham, NC, United States
| | - Chelsea A Swanson
- Department of Veteran Affairs (VA) Mid-Atlantic Mental Illness Research, Education and Clinical Center, Durham, NC, United States.,Duke-UNC Brain Imaging and Analysis Center, Duke University, Durham, NC, United States
| | | | - Kevin S LaBar
- Department of Veteran Affairs (VA) Mid-Atlantic Mental Illness Research, Education and Clinical Center, Durham, NC, United States.,Duke-UNC Brain Imaging and Analysis Center, Duke University, Durham, NC, United States.,Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, United States
| | - John A Fairbank
- Department of Veteran Affairs (VA) Mid-Atlantic Mental Illness Research, Education and Clinical Center, Durham, NC, United States.,Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, United States
| | - Rajendra A Morey
- Department of Veteran Affairs (VA) Mid-Atlantic Mental Illness Research, Education and Clinical Center, Durham, NC, United States.,Duke-UNC Brain Imaging and Analysis Center, Duke University, Durham, NC, United States.,Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, United States
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31
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Moody TD, Morfini F, Cheng G, Sheen C, Tadayonnejad R, Reggente N, O'Neill J, Feusner JD. Mechanisms of cognitive-behavioral therapy for obsessive-compulsive disorder involve robust and extensive increases in brain network connectivity. Transl Psychiatry 2017; 7:e1230. [PMID: 28872637 PMCID: PMC5639240 DOI: 10.1038/tp.2017.192] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Accepted: 06/13/2017] [Indexed: 12/28/2022] Open
Abstract
Cognitive-behavioral therapy (CBT) is effective for obsessive compulsive disorder (OCD); however, little is understood about its mechanisms related to brain network connectivity. We examined connectivity changes from resting-state functional magnetic resonance imaging data pre-to-post-CBT in 43 OCD participants, randomized to receive either 4 weeks of intensive CBT or 4 weeks waitlist followed by 4 weeks of CBT, and 24 healthy controls before and after 4 weeks of no treatment. Network-based-statistic analysis revealed large-magnitude increases in OCD connectivity in eight networks. Strongest increases involved connectivity between the cerebellum and caudate/putamen, and between the cerebellum and dorsolateral/ventrolateral prefrontal cortices. Connectivity increases were associated with increased resistance to compulsions. Mechanisms of CBT may involve enhanced cross-network integration, both within and outside of classical cortico-striatal-thalamo-cortical regions; those involving cerebellar to striatal and prefrontal regions may reflect acquisition of new non-compulsive goal-directed behaviors and thought patterns. Our findings have implications for identifying targets for enhancing treatment efficacy and monitoring treatment progress.
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Affiliation(s)
- T D Moody
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA,UCLA Semel Institute, Box 951759, Westwood Boulevard 27-465, Los Angeles, CA 90095-1759, USA. E-mail:
| | - F Morfini
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - G Cheng
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - C Sheen
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - R Tadayonnejad
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - N Reggente
- Department of Psychology, University of California Los Angeles, Los Angeles, CA, USA
| | - J O'Neill
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - J D Feusner
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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32
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Moore RC, Straus E, Dev SI, Parish SM, Sueko S, Eyler LT. Development and Pilot Randomized Control Trial of a Drama Program to Enhance Well-being Among Older Adults. ARTS IN PSYCHOTHERAPY 2017; 52:1-9. [PMID: 28503015 DOI: 10.1016/j.aip.2016.09.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Develop a novel theatre-based program and test its feasibility, tolerability, and preliminary efficacy for improving empathy/compassion and well-being among older adults. METHOD Thirteen older adults were randomized to a 6-week Drama Workshop (DW) program or time-equivalent Backstage Pass (BP) control condition. Pre- and post-treatment measures included empathy, compassion, and mood scales. Additional post-treatment measures included self-rated change in empathy/compassion, confidence, and affect. Participants also rated their mood/affect after each session. RESULTS The program was successfully completed and well-liked. No pre-to-post-treatment changes in empathy/compassion or mood symptoms were found in either group. Compared to BP, DW weekly ratings indicated higher levels of anxiety and lower happiness; however, the DW program had higher self-ratings of positive change in self-esteem, confidence, and happiness post-treatment. DISCUSSION While the DW may not promote empathy/compassion and was personally challenging during the program, engagement in dramatic exercises and rehearsing and performing a dramatic piece was seen by participants as a positive growth experience, as indicated by the post-treatment ratings of enhanced self-esteem, confidence and happiness. Thus, such a program might be useful for counteracting some of the potential negative aspects of aging, including reduced self-efficacy due to physical limitations and negative affect due to losses.
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Affiliation(s)
- Raeanne C Moore
- Department of Psychiatry, University of California, San Diego, 9500 Gilman Drive MC 0993, San Diego, CA 92103-0993 USA.,The Sam and Rose Stein Institute for Research on Aging, University of California, San Diego, 9500 Gilman Drive MC 0012, San Diego, CA 92103-0012 USA.,Veterans Administration San Diego Health Care System, San Diego, California, 3350 La Jolla Village Drive, San Diego, CA 92161 USA
| | - Elizabeth Straus
- California School of Professional Psychology, Alliant International University, San Diego, California, 10455 Pomerado Rd, San Diego, CA 92131 USA
| | - Sheena I Dev
- Department of Psychiatry, University of California, San Diego, 9500 Gilman Drive MC 0993, San Diego, CA 92103-0993 USA.,San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California, 9500 Gilman Drive MC 0993, San Diego, CA 92103-0993 USA
| | - Steven M Parish
- Department of Anthropology, University of California, San Diego, 9500 Gilman Drive MC 0532, San Diego, CA 92103-0532 USA
| | - Seema Sueko
- The Pasadena Playhouse, Pasadena, California, 39 S El Molino Avenue, Pasadena, CA 91101 USA
| | - Lisa T Eyler
- Department of Psychiatry, University of California, San Diego, 9500 Gilman Drive MC 0993, San Diego, CA 92103-0993 USA.,The Sam and Rose Stein Institute for Research on Aging, University of California, San Diego, 9500 Gilman Drive MC 0012, San Diego, CA 92103-0012 USA.,Veterans Administration San Diego Health Care System, San Diego, California, 3350 La Jolla Village Drive, San Diego, CA 92161 USA
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33
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Brinkmann L, Buff C, Neumeister P, Tupak SV, Becker MPI, Herrmann MJ, Straube T. Dissociation between amygdala and bed nucleus of the stria terminalis during threat anticipation in female post-traumatic stress disorder patients. Hum Brain Mapp 2017; 38:2190-2205. [PMID: 28070973 DOI: 10.1002/hbm.23513] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Revised: 12/15/2016] [Accepted: 01/03/2017] [Indexed: 01/21/2023] Open
Abstract
Feelings of uncontrollability and anxiety regarding possibly harmful events are key features of post-traumatic stress disorder (PTSD) symptomatology. Due to a lack of studies, the neural correlates of anticipatory anxiety in PTSD are still poorly understood. During functional magnetic resonance imaging, female PTSD patients with interpersonal violence trauma and healthy controls (HC) anticipated the temporally unpredictable presentation of aversive (human scream) or neutral sounds. Based on separate analysis models, we investigated phasic and sustained brain activations. PTSD patients reported increased anxiety during anticipation of aversive versus neutral sounds. Furthermore, we found both increased initial, phasic amygdala activation and increased sustained activation of the bed nucleus of the stria terminalis (BNST) during anticipation of aversive versus neutral sounds in PTSD patients in comparison to HC. PTSD patients as compared with HC also showed increased phasic responses in mid-cingulate cortex (MCC), posterior cingulate cortex (PCC), mid-insula and lateral prefrontal cortex (PFC) as well as increased sustained responses in MCC, PCC, anterior insula and lateral and medial PFC. Our results demonstrate a relationship between anticipatory anxiety in PTSD patients and hyperresponsiveness of brain regions that have previously been associated with PTSD symptomatology. Additionally, the dissociation between amygdala and BNST indicates distinct temporal and functional characteristics and suggests that phasic fear and sustained anxiety responses are enhanced during unpredictable anticipation of aversive stimuli in PTSD. Hum Brain Mapp 38:2190-2205, 2017. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Leonie Brinkmann
- Institute of Medical Psychology and Systems Neuroscience, University of Muenster, Von-Esmarch-Str. 52, Muenster, D-48149, Germany
| | - Christine Buff
- Institute of Medical Psychology and Systems Neuroscience, University of Muenster, Von-Esmarch-Str. 52, Muenster, D-48149, Germany
| | - Paula Neumeister
- Institute of Medical Psychology and Systems Neuroscience, University of Muenster, Von-Esmarch-Str. 52, Muenster, D-48149, Germany
| | - Sara V Tupak
- Institute of Medical Psychology and Systems Neuroscience, University of Muenster, Von-Esmarch-Str. 52, Muenster, D-48149, Germany
| | - Michael P I Becker
- Institute of Medical Psychology and Systems Neuroscience, University of Muenster, Von-Esmarch-Str. 52, Muenster, D-48149, Germany
| | - Martin J Herrmann
- Department of Psychiatry, Psychosomatics and Psychotherapy, University Hospital Wuerzburg, Margarete-Hoeppel-Platz 1, D-97080, Wuerzburg, Germany
| | - Thomas Straube
- Institute of Medical Psychology and Systems Neuroscience, University of Muenster, Von-Esmarch-Str. 52, Muenster, D-48149, Germany
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34
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Malejko K, Abler B, Plener PL, Straub J. Neural Correlates of Psychotherapeutic Treatment of Post-traumatic Stress Disorder: A Systematic Literature Review. Front Psychiatry 2017; 8:85. [PMID: 28579965 PMCID: PMC5437215 DOI: 10.3389/fpsyt.2017.00085] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Accepted: 04/28/2017] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Post-traumatic stress disorder (PTSD) is a common psychiatric disease with changes in neural circuitries. Neurobiological models conceptualize the symptoms of PTSD as correlates of a dysfunctional stress reaction to traumatic events. Functional imaging studies showed an increased amygdala and a decreased prefrontal cortex response in PTSD patients. As psychotherapeutic approaches represent the gold standard for PTSD treatment, it is important to examine its underlying neurobiological correlates. METHODS Studies published until August 2016 were selected through systematic literature research in the databases PubMed, PsychInfo, and Cochrane Library's Central Register of Controlled Trials or were identified manually by searching reference lists of selected articles. Search terms were "neural correlates" OR "fMRI" OR "SPECT," AND "therapy" AND "PTSD." A total of 19 articles were included in the present review whereof 15 studies compared pre-to-post-therapy signal changes, six studies related pre-treatment activity to pre-to-post-symptom improvement, and four studies compared neural correlates of responders versus non-responders. The disposed therapy forms were cognitive behavioral therapy (CBT), eye movement desensitization and reprocessing, cognitive therapy, exposure therapy, mindfulness-based intervention, brief eclectic psychotherapy, and unspecified therapy. RESULTS Successful psychotherapy of PTSD was repeatedly shown to be accompanied by decreased activity in the amygdala and the insula as well as increased activity in the dorsal anterior cingulate cortex (dACC) and hippocampus. Elevated dACC activity prior to treatment was related to subsequent treatment success and a positive predictor for treatment response. Elevated amygdala and insula pre-treatment activities were related to treatment failure. DISCUSSION Decreased activity in limbic brain regions and increased activity in frontal brain areas in PTSD patients after successful psychotherapeutic treatment might reflect regained top-down control over previously impaired bottom-up processes.
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Affiliation(s)
- Kathrin Malejko
- Department of Psychiatry and Psychotherapy III, University Hospital Ulm, Ulm, Germany
| | - Birgit Abler
- Department of Psychiatry and Psychotherapy III, University Hospital Ulm, Ulm, Germany
| | - Paul L Plener
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital Ulm, Ulm, Germany
| | - Joana Straub
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital Ulm, Ulm, Germany
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35
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Mason L, Peters E, Kumari V. Functional connectivity predictors and mechanisms of cognitive behavioural therapies: A systematic review with recommendations. Aust N Z J Psychiatry 2016; 50:311-21. [PMID: 26773689 DOI: 10.1177/0004867415624970] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVE While there is now strong evidence that psychological therapies can alter the activity of individual brain regions, their impact on the functional integration between regions has not yet been systematically evaluated. This area is important given that brain dysconnectivity has been implicated across almost all psychiatric disorders. Accordingly, we sought to establish connectivity predictors and mechanisms of effective psychological therapies. We further establish whether connectivity changes represent normalisation of disorder pathophysiology or compensatory changes. METHOD We reviewed studies examining structural and functional connectivity longitudinally as either a predictor or outcome variable of successful psychological therapies across psychiatric disorders. RESULTS Fifteen studies met our inclusion criteria. All but three related to cognitive behavioural therapy. Of these, five assessed resting state, nine probed affective processing and one probed cognitive processing. Twelve studies reported evidence of functional connectivity as a significant predictor or outcome of cognitive behavioural therapy, with prefronto-limbic circuitry most commonly implicated. Only six studies included healthy participants, limiting direct inferences about normalisation as opposed to compensatory changes. Anxiety disorders were overrepresented, totalling 13 of the studies reviewed. No studies examined structural connectivity or utilised analyses allowing the directionality of functional connectivity to be inferred. CONCLUSION While the evidence base is still in its infancy for other therapy approaches, there was clearer evidence that functional connectivity both predicts and is altered by cognitive behavioural therapy. Connections from prefrontal cortex appear especially key, perhaps given their role in cognitive appraisal of lower order affective, motivational and cognitive processes. A number of recommendations are made for this rapidly developing literature.
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Affiliation(s)
- Liam Mason
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Emmanuelle Peters
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK NIHR Biomedical Research Centre for Mental Health, South London and Maudsley NHS Foundation Trust, London, UK
| | - Veena Kumari
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK NIHR Biomedical Research Centre for Mental Health, South London and Maudsley NHS Foundation Trust, London, UK
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36
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Cook IA, Abrams M, Leuchter AF. Trigeminal Nerve Stimulation for Comorbid Posttraumatic Stress Disorder and Major Depressive Disorder. Neuromodulation 2016; 19:299-305. [PMID: 26818103 DOI: 10.1111/ner.12399] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Revised: 12/27/2015] [Accepted: 12/28/2015] [Indexed: 02/02/2023]
Abstract
OBJECTIVES External stimulation of the trigeminal nerve (eTNS) is an emerging neuromodulation therapy for epilepsy and depression. Preliminary studies suggest it has an excellent safety profile and is associated with significant improvements in seizures and mood. Neuroanatomical projections of the trigeminal system suggest eTNS may alter activity in structures regulating mood, anxiety, and sleep. In this proof-of-concept trial, the effects of eTNS were evaluated in adults with posttraumatic stress disorder (PTSD) and comorbid unipolar major depressive disorder (MDD) as an adjunct to pharmacotherapy for these commonly co-occurring conditions. MATERIALS AND METHODS Twelve adults with PTSD and MDD were studied in an eight-week open outpatient trial (age 52.8 [13.7 sd], 8F:4M). Stimulation was applied to the supraorbital and supratrochlear nerves for eight hours each night as an adjunct to pharmacotherapy. Changes in symptoms were monitored using the PTSD Patient Checklist (PCL), Hamilton Depression Rating Scale (HDRS-17), Quick Inventory of Depressive Symptomatology (QIDS-C), and the Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q). RESULTS Over the eight weeks, eTNS treatment was associated with significant decreases in PCL (p = 0.003; median decrease of 15 points; effect size d 1.5), HDRS-17 (p < 0.001; 42% response rate, 25% remission; d 2.1), and QIDS-C scores (p < 0.001; d 1.8), as well as an improvement in quality of life (Q-LES-Q, p < 0.01). eTNS was well tolerated with few treatment emergent adverse events. CONCLUSIONS Significant improvements in PTSD and depression severity were achieved in the eight weeks of acute eTNS treatment. This novel approach to wearable brain stimulation may have use as an adjunct to pharmacotherapy in these disorders if efficacy and tolerability are confirmed with additional studies.
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Affiliation(s)
- Ian A Cook
- Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles, CA, USA.,Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.,Department of Bioengineering, Henry Samueli School of Engineering and Applied Sciences at UCLA, Los Angeles, CA, USA.,NeuroSigma, Inc, Los Angeles, CA, USA
| | - Michelle Abrams
- Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles, CA, USA.,Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Andrew F Leuchter
- Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles, CA, USA.,Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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37
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King AP, Block SR, Sripada RK, Rauch SAM, Porter KE, Favorite TK, Giardino N, Liberzon I. A Pilot Study of Mindfulness-Based Exposure Therapy in OEF/OIF Combat Veterans with PTSD: Altered Medial Frontal Cortex and Amygdala Responses in Social-Emotional Processing. Front Psychiatry 2016; 7:154. [PMID: 27703434 PMCID: PMC5028840 DOI: 10.3389/fpsyt.2016.00154] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Accepted: 08/25/2016] [Indexed: 01/04/2023] Open
Abstract
Combat-related posttraumatic stress disorder (PTSD) is common among returning veterans, and is a serious and debilitating disorder. While highly effective treatments involving trauma exposure exist, difficulties with engagement and early drop may lead to sub-optimal outcomes. Mindfulness training may provide a method for increasing emotional regulation skills that may improve engagement in trauma-focused therapy. Here, we examine potential neural correlates of mindfulness training and in vivo exposure (non-trauma focused) using a novel group therapy [mindfulness-based exposure therapy (MBET)] in Afghanistan (OEF) or Iraq (OIF) combat veterans with PTSD. OEF/OIF combat veterans with PTSD (N = 23) were treated with MBET (N = 14) or a comparison group therapy [Present-centered group therapy (PCGT), N = 9]. PTSD symptoms were assessed at pre- and post-therapy with Clinician Administered PTSD scale. Functional neuroimaging (3-T fMRI) before and after therapy examined responses to emotional faces (angry, fearful, and neutral faces). Patients treated with MBET had reduced PTSD symptoms (effect size d = 0.92) but effect was not significantly different from PCGT (d = 0.43). Improvement in PTSD symptoms from pre- to post-treatment in both treatment groups was correlated with increased activity in rostral anterior cingulate cortex, dorsal medial prefrontal cortex (mPFC), and left amygdala. The MBET group showed greater increases in amygdala and fusiform gyrus responses to Angry faces, as well as increased response in left mPFC to Fearful faces. These preliminary findings provide intriguing evidence that MBET group therapy for PTSD may lead to changes in neural processing of social-emotional threat related to symptom reduction.
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Affiliation(s)
- Anthony P King
- Mental Health Service, VA Ann Arbor Health System, Ann Arbor, MI, USA; Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Stefanie R Block
- Department of Psychology, University of Michigan , Ann Arbor, MI , USA
| | - Rebecca K Sripada
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA; VA Center for Clinical Management Research, Ann Arbor, MI, USA
| | - Sheila A M Rauch
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, GA, USA; Mental Health Service, Atlanta VA Medical Center, Atlanta, GA, USA
| | | | - Todd K Favorite
- Mental Health Service, VA Ann Arbor Health System, Ann Arbor, MI, USA; Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA; Mary A. Rackham Institute (MARI), University of Michigan, Ann Arbor, MI, USA
| | - Nicholas Giardino
- Department of Psychiatry, University of Michigan , Ann Arbor, MI , USA
| | - Israel Liberzon
- Mental Health Service, VA Ann Arbor Health System, Ann Arbor, MI, USA; Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
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Functional network topology associated with posttraumatic stress disorder in veterans. NEUROIMAGE-CLINICAL 2015; 10:302-9. [PMID: 26900570 PMCID: PMC4724037 DOI: 10.1016/j.nicl.2015.12.008] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Revised: 11/25/2015] [Accepted: 12/17/2015] [Indexed: 11/22/2022]
Abstract
Posttraumatic stress disorder (PTSD) is a disabling disorder associated with resting state functional connectivity alterations. However, whether specific brain regions are altered in PTSD or whether the whole brain network organization differs remains unclear. PTSD can be treated with trauma-focused therapy, although only half of the patients recover after treatment. In order to better understand PTSD psychopathology our aim was to study resting state networks in PTSD before and after treatment. Resting state functional magnetic resonance images were obtained from veterans with PTSD (n = 50) and controls (combat and civilian controls; n = 54) to explore which network topology properties (degree and clustering coefficient) of which brain regions are associated with PTSD. Then, PTSD-associated brain regions were investigated before and after treatment. PTSD patients were subdivided in persistent (n = 22) and remitted PTSD patients (n = 17), and compared with combat controls (n = 22), who were also reassessed. Prior to treatment associations with PTSD were found for the degree of orbitofrontal, and temporoparietal brain regions, and for the clustering coefficient of the anterior cingulate cortex. No significant effects were found over the course of treatment. Our results are in line with previous resting state studies, showing resting state connectivity alterations in the salience network and default mode network in PTSD, and also highlight the importance of other brain regions. However, network metrics do not seem to change over the course of treatment. This study contributes to a better understanding of the psychopathology of PTSD.
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Mahabir M, Tucholka A, Shin LM, Etienne P, Brunet A. Emotional face processing in post-traumatic stress disorder after reconsolidation impairment using propranolol: A pilot fMRI study. J Anxiety Disord 2015; 36:127-33. [PMID: 26551661 DOI: 10.1016/j.janxdis.2015.10.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Revised: 09/09/2015] [Accepted: 10/06/2015] [Indexed: 11/25/2022]
Abstract
Individuals with post-traumatic stress disorder (PTSD) exhibit exaggerated emotional reactions to threatening stimuli, which may represent deregulated fear-conditioning, associated with long-term adaptations in the sympathetic nervous system. Within a repeated measures design, functional magnetic resonance imaging (fMRI) was employed to investigate neural responses to threat in PTSD participants (N=7), during the presentation of emotional facial expressions. Scans were separated by 6 weekly reconsolidation impairment treatment sessions, consisting of traumatic memory reactivation under the influence of propranolol. Greater activation before versus after treatment emerged in the thalamus and amygdala during fearful versus neutral face processing. Furthermore, participants showed greater activation after versus before treatment in the right anterior cingulate, during fearful relative to happy face processing. PTSD symptoms significantly improved (d=1.75), post-treatment. These preliminary results suggest that aberrant emotional responding is modulated by noradrenergic plasticity within the amygdala-prefrontal cortex circuit, a neural substrate for the pharmacological treatment of PTSD.
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Affiliation(s)
- Megan Mahabir
- Department of Neurology and Neurosurgery, McGill University, 3801 University Street, Montreal, QC H3A 2B4, Canada; Douglas Mental Health University Institute, 6875 LaSalle Blvd, Verdun, QC H4H 1R3, Canada
| | - Alan Tucholka
- Department of Radiology, Hôpital Notre-Dame-Centre Hospitalier du l'Université de Montréal, 1560 Sherbrooke St. East, Montreal, QC H2L 4M1, Canada
| | - Lisa M Shin
- Department of Psychology, Tufts University, 490 Boston Avenue, Medford, MA 02155, USA
| | - Pierre Etienne
- Douglas Mental Health University Institute, 6875 LaSalle Blvd, Verdun, QC H4H 1R3, Canada; Department of Psychiatry, McGill University, 1033 Pine Avenue West Montreal, QC H3A 1A1, Canada
| | - Alain Brunet
- Department of Neurology and Neurosurgery, McGill University, 3801 University Street, Montreal, QC H3A 2B4, Canada; Douglas Mental Health University Institute, 6875 LaSalle Blvd, Verdun, QC H4H 1R3, Canada; Department of Psychiatry, McGill University, 1033 Pine Avenue West Montreal, QC H3A 1A1, Canada.
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Tursich M, Ros T, Frewen PA, Kluetsch RC, Calhoun VD, Lanius RA. Distinct intrinsic network connectivity patterns of post-traumatic stress disorder symptom clusters. Acta Psychiatr Scand 2015; 132:29-38. [PMID: 25572430 DOI: 10.1111/acps.12387] [Citation(s) in RCA: 98] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/09/2014] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Post-traumatic stress disorder (PTSD) is considered a multidimensional disorder, with distinct symptom clusters including re-experiencing, avoidance/numbing, hyperarousal, and most recently depersonalization/derealization. However, the extent of differing intrinsic network connectivity underlying these symptoms has not been fully investigated. We therefore investigated the degree of association between resting connectivity of the salience (SN), default mode (DMN), and central executive (CEN) networks and PTSD symptom severity. METHOD Using resting-state functional MRI data from PTSD participants (n = 21), we conducted multivariate analyses to test whether connectivity of extracted independent components varied as a function of re-experiencing, avoidance/numbing, hyperarousal, and depersonalization/derealization. RESULTS Hyperarousal symptoms were associated with reduced connectivity of posterior insula/superior temporal gyrus within SN [peak Montréal Neurological Institute (MNI): -44, -8, 0, t = -4.2512, k = 40]. Depersonalization/derealization severity was associated with decreased connectivity of perigenual anterior cingulate/ventromedial prefrontal cortex within ventral anterior DMN (peak MNI: 8, 40, -4; t = -3.8501; k = 15) and altered synchrony between two DMN components and between DMN and CEN. CONCLUSION Our results are consistent with prior research showing intrinsic network disruptions in PTSD and imply heterogeneous connectivity patterns underlying PTSD symptom dimensions. These findings suggest possible biomarkers for PTSD and its dissociative subtype.
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Affiliation(s)
- M Tursich
- Department of Psychiatry, The University of Western Ontario, London, ON, Canada
| | - T Ros
- Department of Fundamental Neurosciences, The University of Geneva, Geneva, Switzerland
| | - P A Frewen
- Department of Psychiatry, The University of Western Ontario, London, ON, Canada.,Department of Psychology, The University of Western Ontario, London, ON, Canada.,Department of Neuroscience, The University of Western Ontario, London, ON, Canada
| | - R C Kluetsch
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Mannheim, Germany
| | - V D Calhoun
- Department of Electrical and Computer Engineering, The University of New Mexico, Albuquerque, NM, USA.,The Mind Research Network, Albuquerque, NM, USA
| | - R A Lanius
- Department of Psychiatry, The University of Western Ontario, London, ON, Canada.,Department of Neuroscience, The University of Western Ontario, London, ON, Canada
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Norman SB, Haller M, Spadoni AD, Drummond SP, Risbrough V, Hamblen JL, Trim RS, Blanes EX. Maximizing the utility of a single site randomized controlled psychotherapy trial. Contemp Clin Trials 2015; 42:244-51. [DOI: 10.1016/j.cct.2015.04.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Revised: 04/18/2015] [Accepted: 04/21/2015] [Indexed: 11/16/2022]
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van Rooij SJH, Rademaker AR, Kennis M, Vink M, Kahn RS, Geuze E. Neural correlates of trauma-unrelated emotional processing in war veterans with PTSD. Psychol Med 2015; 45:575-587. [PMID: 25036523 DOI: 10.1017/s0033291714001706] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND Post-traumatic stress disorder (PTSD) is thought to be characterized by general heightened amygdala activation. However, this hypothesis is mainly based on specific studies presenting fear or trauma-related stimuli, hence, a thorough investigation of trauma-unrelated emotional processing in PTSD is needed. METHODS In this study, 31 male medication-naive veterans with PTSD, 28 male control veterans (combat controls; CC) and 25 non-military men (healthy controls; HC) were included. Participants underwent functional MRI while trauma-unrelated neutral, negative and positive emotional pictures were presented. In addition to the group analyses, PTSD patients with and without major depressive disorder (MDD) were compared. RESULTS All groups showed an increased amygdala response to negative and positive contrasts, but amygdala activation did not differ between groups. However, a heightened dorsal anterior cingulate cortex (dACC) response for negative contrasts was observed in PTSD patients compared to HC. The medial superior frontal gyrus was deactivated in the negative contrast in HC, but not in veterans. PTSD+MDD patients showed decreased subgenual ACC (sgACC) activation to all pictures compared to PTSD-MDD. CONCLUSION Our findings do not support the hypothesis that increased amygdala activation in PTSD generalizes to trauma-unrelated emotional processing. Instead, the increased dACC response found in PTSD patients implicates an attentional bias that extends to trauma-unrelated negative stimuli. Only HC showed decreased medial superior frontal gyrus activation. Finally, decreased sgACC activation was related to MDD status within the PTSD group.
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Affiliation(s)
- S J H van Rooij
- Brain Center Rudolf Magnus, Department of Psychiatry,University Medical Center Utrecht,The Netherlands
| | - A R Rademaker
- Research Centre, Military Mental Healthcare, Ministry of Defence,The Netherlands
| | - M Kennis
- Brain Center Rudolf Magnus, Department of Psychiatry,University Medical Center Utrecht,The Netherlands
| | - M Vink
- Brain Center Rudolf Magnus, Department of Psychiatry,University Medical Center Utrecht,The Netherlands
| | - R S Kahn
- Brain Center Rudolf Magnus, Department of Psychiatry,University Medical Center Utrecht,The Netherlands
| | - E Geuze
- Brain Center Rudolf Magnus, Department of Psychiatry,University Medical Center Utrecht,The Netherlands
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van Rooij SJH, Geuze E, Kennis M, Rademaker AR, Vink M. Neural correlates of inhibition and contextual cue processing related to treatment response in PTSD. Neuropsychopharmacology 2015; 40:667-75. [PMID: 25154707 PMCID: PMC4289955 DOI: 10.1038/npp.2014.220] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Revised: 08/06/2014] [Accepted: 08/15/2014] [Indexed: 11/09/2022]
Abstract
Thirty to fifty percent of posttraumatic stress disorder (PTSD) patients do not respond to treatment. Understanding the neural mechanisms underlying treatment response could contribute to improve response rates. PTSD is often associated with decreased inhibition of fear responses in a safe environment. Importantly, the mechanism of effective treatment (psychotherapy) relies on inhibition and so-called contextual cue processing. Therefore, we investigate inhibition and contextual cue processing in the context of treatment. Forty-one male war veterans with PTSD and 22 healthy male war veterans (combat controls) were scanned twice with a 6- to 8-month interval, in which PTSD patients received treatment (psychotherapy). We distinguished treatment responders from nonresponders on the base of percentage symptom decrease. Inhibition and contextual cue processing were assessed with the stop-signal anticipation task. Behavioral and functional MRI measures were compared between PTSD patients and combat controls, and between responders and nonresponders using repeated measures analyses. PTSD patients showed behavioral and neural deficits in inhibition and contextual cue processing at both time points compared with combat controls. These deficits were unaffected by treatment; therefore, they likely represent vulnerability factors or scar aspects of PTSD. Second, responders showed increased pretreatment activation of the left inferior parietal lobe (IPL) during contextual cue processing compared with nonresponders. Moreover, left IPL activation predicted percentage symptom improvement. The IPL has an important role in contextual cue processing, and may therefore facilitate the effect of psychotherapy. Hence, increased left IPL activation may represent a potential predictive biomarker for PTSD treatment response.
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Affiliation(s)
- Sanne JH van Rooij
- Brain Center Rudolf Magnus, Department of Psychiatry, University Medical Center Utrecht, Utrecht, The Netherlands
- Research Centre Military Mental Healthcare, Ministry of Defence, Utrecht, The Netherlands
| | - Elbert Geuze
- Brain Center Rudolf Magnus, Department of Psychiatry, University Medical Center Utrecht, Utrecht, The Netherlands
- Research Centre Military Mental Healthcare, Ministry of Defence, Utrecht, The Netherlands
| | - Mitzy Kennis
- Brain Center Rudolf Magnus, Department of Psychiatry, University Medical Center Utrecht, Utrecht, The Netherlands
- Research Centre Military Mental Healthcare, Ministry of Defence, Utrecht, The Netherlands
| | - Arthur R Rademaker
- Research Centre Military Mental Healthcare, Ministry of Defence, Utrecht, The Netherlands
| | - Matthijs Vink
- Brain Center Rudolf Magnus, Department of Psychiatry, University Medical Center Utrecht, Utrecht, The Netherlands
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Lanius RA, Frewen PA, Tursich M, Jetly R, McKinnon MC. Restoring large-scale brain networks in PTSD and related disorders: a proposal for neuroscientifically-informed treatment interventions. Eur J Psychotraumatol 2015; 6:27313. [PMID: 25854674 PMCID: PMC4390556 DOI: 10.3402/ejpt.v6.27313] [Citation(s) in RCA: 129] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Revised: 03/02/2015] [Accepted: 03/02/2015] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Three intrinsic connectivity networks in the brain, namely the central executive, salience, and default mode networks, have been identified as crucial to the understanding of higher cognitive functioning, and the functioning of these networks has been suggested to be impaired in psychopathology, including posttraumatic stress disorder (PTSD). OBJECTIVE 1) To describe three main large-scale networks of the human brain; 2) to discuss the functioning of these neural networks in PTSD and related symptoms; and 3) to offer hypotheses for neuroscientifically-informed interventions based on treating the abnormalities observed in these neural networks in PTSD and related disorders. METHODS Literature relevant to this commentary was reviewed. RESULTS Increasing evidence for altered functioning of the central executive, salience, and default mode networks in PTSD has been demonstrated. We suggest that each network is associated with specific clinical symptoms observed in PTSD, including cognitive dysfunction (central executive network), increased and decreased arousal/interoception (salience network), and an altered sense of self (default mode network). Specific testable neuroscientifically-informed treatments aimed to restore each of these neural networks and related clinical dysfunction are proposed. CONCLUSIONS Neuroscientifically-informed treatment interventions will be essential to future research agendas aimed at targeting specific PTSD and related symptoms.
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Affiliation(s)
- Ruth A Lanius
- Western University, London, ON, Canada.,Lawson Health Research Institute, London, ON, Canada;
| | - Paul A Frewen
- Western University, London, ON, Canada.,Lawson Health Research Institute, London, ON, Canada
| | | | - Rakesh Jetly
- Canadian Forces, Health Services, Ottawa, Ontario, Canada
| | - Margaret C McKinnon
- McMaster University, Hamilton, Hamilton, Ontario, Canada.,St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada.,Homewood Research Institute, Guelph, Ontario, Canada
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45
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Yehuda R, Bierer LM, Pratchett LC, Lehrner A, Koch EC, Van Manen JA, Flory JD, Makotkine I, Hildebrandt T. Cortisol augmentation of a psychological treatment for warfighters with posttraumatic stress disorder: Randomized trial showing improved treatment retention and outcome. Psychoneuroendocrinology 2015; 51:589-97. [PMID: 25212409 DOI: 10.1016/j.psyneuen.2014.08.004] [Citation(s) in RCA: 113] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Accepted: 08/03/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Prolonged exposure (PE) therapy for post-traumatic stress disorder (PTSD) in military veterans has established efficacy, but is ineffective for a substantial number of patients. PE is also associated with high dropout rates. We hypothesized that hydrocortisone augmentation would enhance symptom improvement and reduce drop-out rates by diminishing the distressing effects of traumatic memories retrieved during imaginal exposure. We also hypothesized that in responders, hydrocortisone augmentation would be more effective in reversing glucocorticoid indices associated with PTSD than placebo augmentation. METHOD Twenty-four veterans were randomized to receive either 30 mg oral hydrocortisone or placebo prior to PE sessions 3-10 in a double-blind protocol. Glucocorticoid receptor sensitivity was assessed in cultured peripheral blood mononuclear cells (PBMC) using the in vitro lysozyme inhibition test and was determined before and after treatment. Intent-to-treat analysis was performed using latent growth curve modeling of treatment effects on change in PTSD severity over time. Veterans who no longer met diagnostic criteria for PTSD at post-treatment were designated as responders. RESULTS Veterans randomized to hydrocortisone or placebo augmentation did not differ significantly in clinical severity or glucocorticoid sensitivity at pre-treatment. Hydrocortisone augmentation was associated with greater reduction in total PTSD symptoms compared to placebo, a finding that was explained by significantly greater patient retention in the hydrocortisone augmentation condition. A significant treatment condition by responder status interaction for glucocorticoid sensitivity indicated that responders to hydrocortisone augmentation had the highest pre-treatment glucocorticoid sensitivity (lowest lysozyme IC50-DEX) that diminished over the course of treatment. There was a significant association between decline in glucocorticoid responsiveness and improvement in PTSD symptoms among hydrocortisone recipients. CONCLUSIONS The results of this pilot study suggest that hydrocortisone augmentation of PE may result in greater retention in treatment and thereby promote PTSD symptom improvement. Further, the results suggest that particularly elevated glucocorticoid responsiveness at pre-treatment may identify veterans likely to respond to PE combined with an intervention that targets glucocorticoid sensitivity. Confirmation of these findings will suggest that pharmacologic interventions that target PTSD-associated glucocorticoid dysregulation may be particularly helpful in promoting a positive clinical response to PTSD psychotherapy.
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Affiliation(s)
- Rachel Yehuda
- James J. Peters Veterans Affairs Medical Center, Bronx, New York, United States; Traumatic Stress Studies Division, Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, United States.
| | - Linda M Bierer
- James J. Peters Veterans Affairs Medical Center, Bronx, New York, United States; Traumatic Stress Studies Division, Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Laura C Pratchett
- James J. Peters Veterans Affairs Medical Center, Bronx, New York, United States; Traumatic Stress Studies Division, Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Amy Lehrner
- James J. Peters Veterans Affairs Medical Center, Bronx, New York, United States; Traumatic Stress Studies Division, Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Erin C Koch
- James J. Peters Veterans Affairs Medical Center, Bronx, New York, United States
| | - Jaklyn A Van Manen
- James J. Peters Veterans Affairs Medical Center, Bronx, New York, United States
| | - Janine D Flory
- James J. Peters Veterans Affairs Medical Center, Bronx, New York, United States; Traumatic Stress Studies Division, Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Iouri Makotkine
- James J. Peters Veterans Affairs Medical Center, Bronx, New York, United States; Traumatic Stress Studies Division, Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Tom Hildebrandt
- Traumatic Stress Studies Division, Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, United States
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Serotonin transporter [corrected] methylation and response to cognitive behaviour therapy in children with anxiety disorders. Transl Psychiatry 2014. [PMID: 25226553 DOI: 10.1038/tp.2014.109] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Anxiety disorders that are the most commonly occurring psychiatric disorders in childhood, are associated with a range of social and educational impairments and often continue into adulthood. Cognitive behaviour therapy (CBT) is an effective treatment option for the majority of cases, although up to 35-45% of children do not achieve remission. Recent research suggests that some genetic variants may be associated with a more beneficial response to psychological therapy. Epigenetic mechanisms such as DNA methylation work at the interface between genetic and environmental influences. Furthermore, epigenetic alterations at the serotonin transporter (SERT) promoter region have been associated with environmental influences such as stressful life experiences. In this study, we measured DNA methylation upstream of SERT in 116 children with an anxiety disorder, before and after receiving CBT. Change during treatment in percentage DNA methylation was significantly different in treatment responders vs nonresponders. This effect was driven by one CpG site in particular, at which responders increased in methylation, whereas nonresponders showed a decrease in DNA methylation. This is the first study to demonstrate differences in SERT methylation change in association with response to a purely psychological therapy. These findings confirm that biological changes occur alongside changes in symptomatology following a psychological therapy such as CBT.
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Roberts S, Lester KJ, Hudson JL, Rapee RM, Creswell C, Cooper PJ, Thirlwall KJ, Coleman JRI, Breen G, Wong CCY, Eley TC. Serotonin transporter [corrected] methylation and response to cognitive behaviour therapy in children with anxiety disorders. Transl Psychiatry 2014; 4:e444. [PMID: 25226553 PMCID: PMC4203012 DOI: 10.1038/tp.2014.83] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Accepted: 07/26/2014] [Indexed: 01/19/2023] Open
Abstract
Anxiety disorders that are the most commonly occurring psychiatric disorders in childhood, are associated with a range of social and educational impairments and often continue into adulthood. Cognitive behaviour therapy (CBT) is an effective treatment option for the majority of cases, although up to 35-45% of children do not achieve remission. Recent research suggests that some genetic variants may be associated with a more beneficial response to psychological therapy. Epigenetic mechanisms such as DNA methylation work at the interface between genetic and environmental influences. Furthermore, epigenetic alterations at the serotonin transporter (SERT) promoter region have been associated with environmental influences such as stressful life experiences. In this study, we measured DNA methylation upstream of SERT in 116 children with an anxiety disorder, before and after receiving CBT. Change during treatment in percentage DNA methylation was significantly different in treatment responders vs nonresponders. This effect was driven by one CpG site in particular, at which responders increased in methylation, whereas nonresponders showed a decrease in DNA methylation. This is the first study to demonstrate differences in SERT methylation change in association with response to a purely psychological therapy. These findings confirm that biological changes occur alongside changes in symptomatology following a psychological therapy such as CBT.
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Affiliation(s)
- S Roberts
- MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, King's College London, London UK
| | - K J Lester
- MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, King's College London, London UK
| | - J L Hudson
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia
| | - R M Rapee
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia
| | - C Creswell
- Winnicott Research Unit, School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
| | - P J Cooper
- Winnicott Research Unit, School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK,Department of Psychology, Stellenbosch University, Western Cape, South Africa
| | - K J Thirlwall
- Winnicott Research Unit, School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
| | - J R I Coleman
- MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, King's College London, London UK
| | - G Breen
- MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, King's College London, London UK
| | - C C Y Wong
- MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, King's College London, London UK
| | - T C Eley
- MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, King's College London, London UK,MRC Social Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Kings College London, Box PO80, SGDP Centre, 16 De Crespigny Park, London SE5 8AF, UK. E-mail:
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