Reappraisal-related neural predictors of treatment response to cognitive behavior therapy for post-traumatic stress disorder.

Autor:	Bryant RA; University of New South Wales, School, Sydney, Australia.; Brain Dynamics Centre, Westmead Institute for Medical Research, University of Sydney, Westmead, Australia., Erlinger M; Brain Dynamics Centre, Westmead Institute for Medical Research, University of Sydney, Westmead, Australia., Felmingham K; Department of Psychological Medicine, University of Melbourne, Melbourne, Australia., Klimova A; Brain Dynamics Centre, Westmead Institute for Medical Research, University of Sydney, Westmead, Australia., Williams LM; Department of Psychiatry and Behavioral Sciences, Stanford University, San Francisco, USA.; Sierra-Pacific Mental Illness Research, Education, and Clinical Center (MIRECC) VA Palo Alto Health Care System, San Francisco, USA., Malhi G; Department of Psychiatry, University of Sydney, Sydney, Australia., Forbes D; Phoenix Australia, University of Melbourne, Melbourne, Australia., Korgaonkar MS; Brain Dynamics Centre, Westmead Institute for Medical Research, University of Sydney, Westmead, Australia.; Department of Psychiatry, University of Sydney, Sydney, Australia.
Jazyk:	angličtina
Zdroj:	Psychological medicine [Psychol Med] 2021 Oct; Vol. 51 (14), pp. 2454-2464. Date of Electronic Publication: 2020 May 05.
DOI:	10.1017/S0033291720001129
Abstrakt:	Background: Although trauma-focused cognitive behavior therapy (TF-CBT) is the frontline treatment for post-traumatic stress disorder (PTSD), one-third of patients are treatment non-responders. To identify neural markers of treatment response to TF-CBT when participants are reappraising aversive material. Methods: This study assessed PTSD patients (n = 37) prior to TF-CBT during functional magnetic brain resonance imaging (fMRI) when they reappraised or watched traumatic images. Patients then underwent nine sessions of TF-CBT, and were then assessed for symptom severity on the Clinician-Administered PTSD Scale. FMRI responses for cognitive reappraisal and emotional reactivity contrasts of traumatic images were correlated with the reduction of PTSD severity from pretreatment to post-treatment. Results: Symptom improvement was associated with decreased activation of the left amygdala during reappraisal, but increased activation of bilateral amygdala and hippocampus during emotional reactivity prior to treatment. Lower connectivity of the left amygdala to the subgenual anterior cingulate cortex, pregenual anterior cingulate cortex, and right insula, and that between the left hippocampus and right amygdala were also associated with symptom improvement. Conclusions: These findings provide evidence that optimal treatment response to TF-CBT involves the capacity to engage emotional networks during emotional processing, and also to reduce the engagement of these networks when down-regulating emotions.
Databáze:	MEDLINE
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