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Tamman AJF, Abdallah CG, Dunsmoor JE, Cisler JM. Neural differentiation of emotional faces as a function of interpersonal violence among adolescent girls. J Psychiatr Res 2024; 172:90-101. [PMID: 38368703 DOI: 10.1016/j.jpsychires.2024.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 01/29/2024] [Accepted: 02/02/2024] [Indexed: 02/20/2024]
Abstract
Interpersonal violence (IV) is associated with altered neural threat processing and risk for psychiatric disorder. Representational similarity analysis (RSA) is a multivariate approach examining the extent to which differences between stimuli correspond to differences in multivoxel activation patterns to these stimuli within each ROI. Using RSA, we examine overlap in neural patterns between threat and neutral faces in youth with IV. Participants were female adolescents aged 11-17 who had a history of IV exposure (n = 77) or no history of IV, psychiatric diagnoses, nor psychiatric medications (n = 37). Participants completed a facial emotion processing task during fMRI. Linear mixed models indicated that increasing hippocampal differentiation of fear and neutral faces was associated with increasing IV severity. Increased neural differentiation of these facial stimuli in the left and right hippocampus was associated with increasing physical abuse severity. Increased differentiation by the dACC correlated with increasing physical assault severity. RSA for most ROIs were not significantly associated with univariate activity, except for a positive association between amygdala RSA and activity to fear faces. Differences in statistically significant ROIs for physical assault and physical abuse may highlight distinct effects of trauma type on encoding of threat vs. neutral faces. Null associations between RSA and univariate activation in most ROIs suggest unique contributions of RSA for understanding IV compared to traditional activation. Implications include understanding mechanisms of risk in IV and trauma-specific treatment selection. Future work should replicate these findings in longitudinal studies and identify sensitive periods for neural alterations in RSA.
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Affiliation(s)
- Amanda J F Tamman
- Baylor College of Medicine, Menninger Department of Psychiatry and Behavioral Sciences, Houston, TX 77030, USA.
| | - Chadi G Abdallah
- Baylor College of Medicine, Menninger Department of Psychiatry and Behavioral Sciences, Houston, TX 77030, USA; Yale School of Medicine, New Haven, CT 06510, USA; Michael E. DeBakey VA Medical Center, Houston, TX 77030, USA; US Department of Veterans Affairs, National Center for PTSD - Clinical Neurosciences Division, VA Connecticut, West Haven, CT 06516, USA; Core for Advanced Magnetic Resonance Imaging (CAMRI), Baylor College of Medicine, Houston, TX 77030, USA
| | - Joseph E Dunsmoor
- Institute for Neuroscience, University of Texas at Austin, Austin, TX 78712, USA; Center for Learning and Memory, Department of Neuroscience, University of Texas at Austin, Austin, TX 78712, USA; Department of Psychiatry and Behavioral Sciences, Dell Medical School, University of Texas at Austin, Austin, TX 78712, USA
| | - Josh M Cisler
- Institute for Neuroscience, University of Texas at Austin, Austin, TX 78712, USA; Department of Psychiatry and Behavioral Sciences, Dell Medical School, University of Texas at Austin, Austin, TX 78712, USA; Institute for Early Life Adversity Research, The University of Texas at Austin, Dell Medical School, Department of Psychiatry and Behavioral Sciences, Austin, TX 78712, USA
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2
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Rowland GE, Roeckner A, Ely TD, Lebois LAM, van Rooij SJH, Bruce SE, Jovanovic T, House SL, Beaudoin FL, An X, Neylan TC, Clifford GD, Linnstaedt SD, Germine LT, Rauch SL, Haran JP, Storrow AB, Lewandowski C, Musey PI, Hendry PL, Sheikh S, Jones CW, Punches BE, Kurz MC, Gentile NT, Hudak LA, Pascual JL, Seamon MJ, Harris E, Pearson C, Merchant RC, Domeier RM, Rathlev NK, Sergot P, Sanchez LD, Miller MW, Pietrzak RH, Joormann J, Pizzagalli DA, Sheridan JF, Smoller JW, Harte SE, Elliott JM, Kessler RC, Koenen KC, McLean SA, Ressler KJ, Stevens JS, Harnett NG. Prior Sexual Trauma Exposure Impacts Posttraumatic Dysfunction and Neural Circuitry Following a Recent Traumatic Event in the AURORA Study. BIOLOGICAL PSYCHIATRY GLOBAL OPEN SCIENCE 2023; 3:705-715. [PMID: 37881578 PMCID: PMC10593890 DOI: 10.1016/j.bpsgos.2023.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 02/02/2023] [Accepted: 02/06/2023] [Indexed: 02/17/2023] Open
Abstract
Background Prior sexual trauma (ST) is associated with greater risk for posttraumatic stress disorder after a subsequent traumatic event; however, the underlying neurobiological mechanisms remain opaque. We investigated longitudinal posttraumatic dysfunction and amygdala functional dynamics following admission to an emergency department for new primarily nonsexual trauma in participants with and without previous ST. Methods Participants (N = 2178) were recruited following acute trauma exposure (primarily motor vehicle collision). A subset (n = 242) completed magnetic resonance imaging that included a fearful faces task and a resting-state scan 2 weeks after the trauma. We investigated associations between prior ST and several dimensions of posttraumatic symptoms over 6 months. We further assessed amygdala activation and connectivity differences between groups with or without prior ST. Results Prior ST was associated with greater posttraumatic depression (F1,1120 = 28.35, p = 1.22 × 10-7, ηp2 = 0.06), anxiety (F1,1113 = 17.43, p = 3.21 × 10-5, ηp2 = 0.05), and posttraumatic stress disorder (F1,1027 = 11.34, p = 7.85 × 10-4, ηp2 = 0.04) severity and more maladaptive beliefs about pain (F1,1113 = 8.51, p = .004, ηp2 = 0.02) but was not related to amygdala reactivity to fearful versus neutral faces (all ps > .05). A secondary analysis revealed an interaction between ST and lifetime trauma load on the left amygdala to visual cortex connectivity (peak Z value: -4.41, corrected p < .02). Conclusions Findings suggest that prior ST is associated with heightened posttraumatic dysfunction following a new trauma exposure but not increased amygdala activity. In addition, ST may interact with lifetime trauma load to alter neural circuitry in visual processing regions following acute trauma exposure. Further research should probe the relationship between trauma type and visual circuitry in the acute aftermath of trauma.
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Affiliation(s)
- Grace E Rowland
- Division of Depression and Anxiety, McLean Hospital, Belmont, Massachusetts
| | - Alyssa Roeckner
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Timothy D Ely
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Lauren A M Lebois
- Division of Depression and Anxiety, McLean Hospital, Belmont, Massachusetts
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Sanne J H van Rooij
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Steven E Bruce
- Department of Psychological Sciences, University of Missouri - St. Louis, St. Louis, Missouri
| | - Tanja Jovanovic
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, Michigan
| | - Stacey L House
- Department of Emergency Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Francesca L Beaudoin
- Department of Epidemiology, Brown University, Providence, Rhode Island
- Department of Emergency Medicine, Brown University, Providence, Rhode Island
| | - Xinming An
- Institute for Trauma Recovery, Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Thomas C Neylan
- Department of Psychiatry, University of California, San Francisco, San Francisco, California
- Department of Neurology, University of California, San Francisco, San Francisco, California
| | - Gari D Clifford
- Department of Biomedical Informatics, Emory University School of Medicine, Atlanta, Georgia
- Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Georgia
| | - Sarah D Linnstaedt
- Institute for Trauma Recovery, Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Laura T Germine
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
- Institute for Technology in Psychiatry, McLean Hospital, Belmont, Massachusetts
- TheMany Brains Project, Belmont, Massachusetts
| | - Scott L Rauch
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
- Institute for Technology in Psychiatry, McLean Hospital, Belmont, Massachusetts
- Department of Psychiatry, McLean Hospital, Belmont, Massachusetts
| | - John P Haran
- Department of Emergency Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts
| | - Alan B Storrow
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Paul I Musey
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Phyllis L Hendry
- Department of Emergency Medicine, University of Florida College of Medicine-Jacksonville, Jacksonville, Florida
| | - Sophia Sheikh
- Department of Emergency Medicine, University of Florida College of Medicine-Jacksonville, Jacksonville, Florida
| | - Christopher W Jones
- Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, New Jersey
| | - Brittany E Punches
- Department of Emergency Medicine, Ohio State University College of Medicine, Columbus, Ohio
- Ohio State University College of Nursing, Columbus, Ohio
| | - Michael C Kurz
- Department of Emergency Medicine, University of Alabama School of Medicine, Birmingham, Alabama
- Division of Acute Care Surgery, Department of Surgery, University of Alabama School of Medicine, Birmingham, Alabama
- Center for Injury Science, University of Alabama at Birmingham, Birmingham, Alabama
| | - Nina T Gentile
- Department of Emergency Medicine, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
| | - Lauren A Hudak
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Jose L Pascual
- Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Mark J Seamon
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- Division of Traumatology, Department of Surgery, Surgical Critical Care and Emergency Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Erica Harris
- Einstein Medical Center, Philadelphia, Pennsylvania
| | - Claire Pearson
- Department of Emergency Medicine, Wayne State University, Ascension St. John Hospital, Detroit, Michigan
| | - Roland C Merchant
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Robert M Domeier
- Department of Emergency Medicine, Saint Joseph Mercy Hospital, Ypsilanti, Michigan
| | - Niels K Rathlev
- Department of Emergency Medicine, University of Massachusetts Medical School-Baystate, Springfield, Massachusetts
| | - Paulina Sergot
- Department of Emergency Medicine, McGovern Medical School at UTHealth, Houston, Texas
| | - Leon D Sanchez
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts
- Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts
| | - Mark W Miller
- National Center for PTSD, Behavioral Science Division, VA Boston Healthcare System, Boston, Massachusetts
- Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts
| | - Robert H Pietrzak
- National Center for PTSD, Clinical Neurosciences Division, VA Connecticut Healthcare System, West Haven, Connecticut
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
| | - Jutta Joormann
- Department of Psychology, Yale University, New Haven, Connecticut
| | - Diego A Pizzagalli
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
- Division of Depression and Anxiety, McLean Hospital, Belmont, Massachusetts
| | - John F Sheridan
- Division of Biosciences, Ohio State University College of Dentistry, Columbus, Ohio
- Institute for Behavioral Medicine Research, OSU Wexner Medical Center, Columbus, Ohio
| | - Jordan W Smoller
- Department of Psychiatry, Psychiatric and Neurodevelopmental Genetics Unit, Massachusetts General Hospital, Boston, Massachusetts
- Stanley Center for Psychiatric Research, Broad Institute, Cambridge, Massachusetts
| | - Steven E Harte
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, Michigan
- Department of Internal Medicine-Rheumatology, University of Michigan Medical School, Ann Arbor, Michigan
| | - James M Elliott
- Kolling Institute, University of Sydney, St. Leonards, New South Wales, Sydney, Australia
- Faculty of Medicine and Health, University of Sydney, Northern Sydney Local Health District, New South Wales, Sydney, Australia
- Physical Therapy & Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Ronald C Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Karestan C Koenen
- Department of Epidemiology, Harvard TH Chan School of Public Health, Harvard University, Boston, Massachusetts
| | - Samuel A McLean
- Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
- Department of Psychiatry, Institute for Trauma Recovery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Kerry J Ressler
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
- Division of Depression and Anxiety, McLean Hospital, Belmont, Massachusetts
| | - Jennifer S Stevens
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Nathaniel G Harnett
- Division of Depression and Anxiety, McLean Hospital, Belmont, Massachusetts
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
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Hinojosa CA, VanElzakker MB, Kaur N, Felicione JM, Charney ME, Bui E, Marques L, Summergrad P, Rauch SL, Simon NM, Shin LM. Pre-treatment amygdala activation and habituation predict symptom change in post-traumatic stress disorder. Front Behav Neurosci 2023; 17:1198244. [PMID: 37492481 PMCID: PMC10363634 DOI: 10.3389/fnbeh.2023.1198244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 06/13/2023] [Indexed: 07/27/2023] Open
Abstract
Trauma-focused psychotherapy approaches are the first-line treatment option for post-traumatic stress disorder (PTSD); however, up to a third of patients remain symptomatic even after completion of the treatment. Predicting which patients will respond to a given treatment option would support personalized treatments and improve the efficiency of healthcare systems. Although previous neuroimaging studies have examined possible pre-treatment predictors of response to treatment, the findings have been somewhat inconsistent, and no other study has examined habituation to stimuli as a predictor. In this study, 16 treatment-seeking adults (MAge = 43.63, n = 10 women) with a primary diagnosis of PTSD passively viewed pictures of emotional facial expressions during functional magnetic resonance imaging (fMRI). After scanning, participants rated facial expressions on both valence and arousal. Participants then completed eight weekly sessions of prolonged exposure (PE) therapy. PTSD symptom severity was measured before and after treatment. Overall, participants showed symptomatic improvement with PE. Consistent with hypotheses, lesser activation in the amygdala and greater activation in the ventromedial prefrontal cortex during the presentation of fearful vs. happy facial expressions, as well as a greater decline in amygdala activation across blocks of fearful facial expressions at baseline, were associated with greater reduction of PTSD symptoms. Given that the repeated presentation of emotional material underlies PE, changes in brain responses with repeated stimulus presentations warrant further studies as potential predictors of response to exposure therapies.
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Affiliation(s)
- Cecilia A. Hinojosa
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, United States
| | - Michael B. VanElzakker
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Navneet Kaur
- Department of Cancer Biology, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Julia M. Felicione
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
- Department of Psychology, Tufts University, Medford, MA, United States
| | - Meredith E. Charney
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Eric Bui
- Normandie Univ, University of Caen Normandy (UNICAEN), L'Institut national de la santé et de la recherche médicale (INSERM), U1237, PhIND “Physiopathology and Imaging of Neurological Disorders”, NEUROPRESAGE Team, (Institut Blood and Brain @ Caen-Normandie), GIP Cyceron, Caen, France
- Centre Hospitalier Universitaire Caen Normandie, Caen, France
| | - Luana Marques
- Department of Psychiatry, Massachusetts General Hospital, Center for Anxiety and Traumatic Stress Disorders, Boston, MA, United States
| | - Paul Summergrad
- Department of Psychiatry, Tufts University School of Medicine, Boston, MA, United States
| | - Scott L. Rauch
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
- Institute for Technology in Psychiatry, McLean Hospital, Belmont, MA, United States
- Department of Psychiatry, McLean Hospital, Belmont, MA, United States
| | - Naomi M. Simon
- Department of Psychiatry, New York University (NYU) Grossman School of Medicine, New York, NY, United States
| | - Lisa M. Shin
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
- Department of Psychology, Tufts University, Medford, MA, United States
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4
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Cesari V, Frumento S, Leo A, Baroni M, Rutigliano G, Gemignani A, Menicucci D. Functional correlates of subliminal stimulation in Posttraumatic Stress Disorder: Systematic review and meta-analysis. J Affect Disord 2023:S0165-0327(23)00682-1. [PMID: 37236272 DOI: 10.1016/j.jad.2023.05.047] [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: 08/30/2022] [Revised: 05/08/2023] [Accepted: 05/15/2023] [Indexed: 05/28/2023]
Abstract
Patients with Post-traumatic stress disorder (PTSD) exposed to traumatic reminders show hyperreactivity in brain areas (e.g., amygdala) belonging or related to the Innate Alarm System (IAS), allowing the rapid processing of salient stimuli. Evidence that IAS is activated by subliminal trauma-reminders could shed a new light on the factors precipitating and perpetuating PTSD symptomatology. Thus, we systematically reviewed studies investigating neuroimaging correlates of subliminal stimulation in PTSD. Twenty-three studies were selected from the MEDLINE and Scopus® databases for a qualitative synthesis, 5 of which allowed a further meta-analysis of fMRI data. The intensity of IAS responses to subliminal trauma-related reminders ranged from a minimum in healthy controls to a maximum in the PTSD patients with the most severe (e.g., dissociative) symptoms or the least responsiveness to treatment. Comparisons with other disorders (e.g., phobias) revealed contrasting results. Our findings demonstrate the hyperactivation of areas belonging or related to IAS in response to unconscious threats that should be integrated in diagnostic as well as in therapeutic protocols.
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Affiliation(s)
- Valentina Cesari
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine University of Pisa, via Savi, 10, 56126 Pisa, Italy
| | - Sergio Frumento
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine University of Pisa, via Savi, 10, 56126 Pisa, Italy
| | - Andrea Leo
- Department of translational research and advanced technologies in medicine and surgery, University of Pisa, Via Risorgimento, 36, Pisa, Italy
| | - Marina Baroni
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine University of Pisa, via Savi, 10, 56126 Pisa, Italy; Institute of Clinical Physiology (IFC), National Research Council, via Giuseppe Moruzzi, 1, 56124, Pisa, Italy
| | - Grazia Rutigliano
- Institute of Clinical Sciences, Faculty of Medicine, Imperial College London, London, UK
| | - Angelo Gemignani
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine University of Pisa, via Savi, 10, 56126 Pisa, Italy; Clinical Psychology branch, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Danilo Menicucci
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine University of Pisa, via Savi, 10, 56126 Pisa, Italy.
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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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6
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Respiratory Sinus Arrhythmia Change during Trauma-Focused Cognitive-Behavioral Therapy: Results from a Randomized Controlled Feasibility Trial. Res Child Adolesc Psychopathol 2022; 50:1487-1499. [PMID: 35689729 PMCID: PMC9187846 DOI: 10.1007/s10802-022-00946-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2022] [Indexed: 11/22/2022]
Abstract
Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT) is a well-established treatment for pediatric posttraumatic stress disorder (PTSD). Animal-assisted therapy (AAT) has been proposed as an adjunct to TF-CBT that may improve treatment effects through enhanced targeting of affect regulation, as indexed by specific changes in the respiratory sinus arrhythmia (RSA). The current study reports results from a randomized controlled feasibility trial (N = 33; Mage = 11.79 [SD = 3.08]; 64% White; 67% female) that measured RSA during Sessions 1, 4, 8, and 12 of a twelve-session TF-CBT protocol and tested whether: 1) TF-CBT + AAT achieved higher average RSA amplitudes relative to TF-CBT alone, and 2) RSA regulation, defined as less variability around person-specific RSA slopes during treatment, explained variation in post-treatment PTSD symptoms. Multilevel modeling failed to support an effect for TF-CBT + AAT on RSA amplitudes (δ001 = 0.08, p = 0.844). However, regardless of treatment condition, greater RSA withdrawal was observed within Sessions 4 (γ11 = -.01, p < .001) and 12 (γ13 = -.01, p = .015) relative to the Session 1 baseline. The average level of RSA amplitude in Session 8 was also significantly lower compared to Session 1 (γ02 = -0.70, p = .046). Intraindividual regression models demonstrated that greater RSA regulation predicted improved PTSD symptoms at post-treatment after adjusting for pre-treatment levels (b3 = 20.00, p = .012). These preliminary results offer support for future confirmatory trials testing whether affect regulation, as indexed by changes in RSA, is a mechanism of action for TF-CBT in the treatment of pediatric PTSD.
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7
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Heilicher M, Crombie KM, Cisler JM. Test-retest reliability of fMRI during an emotion processing task: Investigating the impact of analytical approaches on ICC values. FRONTIERS IN NEUROIMAGING 2022; 1:859792. [PMID: 35782991 PMCID: PMC9245148 DOI: 10.3389/fnimg.2022.859792] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Test-retest reliability of fMRI is often assessed using the intraclass correlation coefficient (ICC), a numerical representation of reliability. Reports of low reliability at the individual level may be attributed to analytical approaches and inherent bias/error in the measures used to calculate ICC. It is unclear whether low reliability at the individual level is related to methodological decisions or if fMRI is inherently unreliable. The purpose of this study was to investigate methodological considerations when calculating ICC to improve understanding of fMRI reliability. fMRI data were collected from adolescent females (N=23) at pre- and post-cognitive behavioral therapy. Participants completed an emotion processing task during fMRI. We calculated ICC values using contrasts and β coefficients separately from voxelwise and network (ICA) analyses of the task-based fMRI data. For both voxelwise analysis and ICA, ICC values were higher when calculated using β coefficients. This work provides support for the use of β coefficients over contrasts when assessing reliability of fMRI, and the use of contrasts may underlie low reliability estimates reported in the existing literature. Continued research in this area is warranted to establish fMRI as a reliable measure to draw conclusions and utilize fMRI in clinical settings.
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Affiliation(s)
- Mickela Heilicher
- Mental Health and Incarceration Laboratory, University of
Wisconsin-Madison, School of Medicine and Public Health, Psychiatry Department,
Madison, WI, USA
| | - Kevin M. Crombie
- Neurocircuitry of Trauma and PTSD Laboratory, The
University of Texas at Austin, Dell Medical School, Department of Psychiatry and
Behavioral Sciences, Austin, TX, USA
| | - Josh M. Cisler
- Neurocircuitry of Trauma and PTSD Laboratory, The
University of Texas at Austin, Dell Medical School, Department of Psychiatry and
Behavioral Sciences, Austin, TX, USA
- Institute for Early Life Adversity Research, The University
of Texas at Austin, Dell Medical School, Department of Psychiatry and Behavioral
Sciences, Austin, TX, USA
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8
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Mo X, He M, Zhou L, Liu Y, Zhu H, Huang X, Zeng G, Zhang J, Li L. Mapping structural covariance networks in children and adolescents with post-traumatic stress disorder after earthquake. Front Psychiatry 2022; 13:923572. [PMID: 36186852 PMCID: PMC9520616 DOI: 10.3389/fpsyt.2022.923572] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 08/29/2022] [Indexed: 11/13/2022] Open
Abstract
For children and adolescents, there is a high risk of developing post-traumatic stress disorder (PTSD) after suffering from catastrophic events. Previous studies have identified brain functionally and subcortical brain volumes structurally abnormalities in this population. However, up till now, researches exploring alterations of regional cortical thickness (CTh) and brain interregional structural covariance networks (SCNs) are scarce. In this cross-sectional study, CTh measures are derived from 3-Tesla Tl-weighted MRI imaging data in a well-characterized combined group of children and adolescents with PTSD after an earthquake (N = 35) and a traumatized healthy control group (N = 24). By using surface-based morphometry (SBM) techniques, the regional CTh analysis was conducted. To map interregional SCNs derived from CTh, twenty-five altered brain regions reported in the PTSD population were selected as seeds. Whole-brain SBM analysis discovered a significant thickness reduction in the left medial orbitofrontal cortex for the subjects with PTSD. Similarly, analysis of SCNs associated with "seed" regions primarily located in default mode network (DMN), midline cortex structures, motor cortex, auditory association cortex, limbic system, and visual cortex demonstrated that children and adolescents with PTSD are associated with altered structural covariance with six key regions. This study provides evidence for distinct CTh correlates of PTSD that are present across children and adolescents, suggesting that brain cortical abnormalities related to trauma exposure are present in this population, probably by driving specific symptom clusters associated with disrupted extinction recall mechanisms for fear, episodic memory network and visuospatial attention.
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Affiliation(s)
- Xian Mo
- College of Electrical Engineering, Sichuan University, Chengdu, Sichuan, China.,Med-X Center for Informatics, Sichuan University, Chengdu, Sichuan, China
| | - Meirong He
- College of Electrical Engineering, Sichuan University, Chengdu, Sichuan, China
| | - Lijun Zhou
- College of Electrical Engineering, Sichuan University, Chengdu, Sichuan, China
| | - Yunfei Liu
- College of Electrical Engineering, Sichuan University, Chengdu, Sichuan, China
| | - Hongru Zhu
- Med-X Center for Informatics, Sichuan University, Chengdu, Sichuan, China.,Mental Health Center and Psychiatric Laboratory, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xiaoqi Huang
- West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Guojun Zeng
- West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Junran Zhang
- College of Electrical Engineering, Sichuan University, Chengdu, Sichuan, China.,Med-X Center for Informatics, Sichuan University, Chengdu, Sichuan, China
| | - Lingjiang Li
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
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9
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Eder-Moreau E, Zhu X, Fisch CT, Bergman M, Neria Y, Helpman L. Neurobiological Alterations in Females With PTSD: A Systematic Review. Front Psychiatry 2022; 13:862476. [PMID: 35770056 PMCID: PMC9234306 DOI: 10.3389/fpsyt.2022.862476] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 04/20/2022] [Indexed: 11/13/2022] Open
Abstract
Most females experience at least one traumatic event in their lives, but not all develop PTSD. Despite considerable research, our understanding of the key factors that constitute risk for PTSD among females is limited. Previous research has largely focused on sex differences, neglecting within group comparisons, thereby obviating differences between females who do and do not develop PTSD following exposure to trauma. In this systematic review, we conducted a search for the extent of existing research utilizing magnetic resonance imaging (MRI) to examine neurobiological differences among females of all ages, with and without PTSD. Only studies of females who met full diagnostic criteria for PTSD were included. Fifty-six studies were selected and reviewed. We synthesized here findings from structural MRI (sMRI), functional MRI (fMRI), diffusion tensor imaging (DTI), and resting state functional connectivity (rs-FC MRI) studies, comparing females with and without PTSD. A range of biopsychosocial constructs that may leave females vulnerable to PTSD were discussed. First, the ways timing and type of exposure to trauma may impact PTSD risk were discussed. Second, the key role that cognitive and behavioral mechanisms may play in PTSD was described, including rumination, and deficient fear extinction. Third, the role of specific symptom patterns and common comorbidities in female-specific PTSD was described, as well as sex-specific implications on treatment and parenting outcomes. We concluded by identifying areas for future research, to address the need to better understand developmental aspects of brain alterations, the differential impact of trauma types and timing, the putative role of neuroendocrine system in neurobiology of PTSD among females, and the impact of social and cultural factors on neurobiology in females with PTSD.
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Affiliation(s)
- Elizabeth Eder-Moreau
- New York State Psychiatric Institute, Columbia University Irving Medical Center, New York, NY, United States
| | - Xi Zhu
- New York State Psychiatric Institute, Columbia University Irving Medical Center, New York, NY, United States.,Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, United States
| | - Chana T Fisch
- New York State Psychiatric Institute, Columbia University Irving Medical Center, New York, NY, United States
| | - Maja Bergman
- New York State Psychiatric Institute, Columbia University Irving Medical Center, New York, NY, United States
| | - Yuval Neria
- New York State Psychiatric Institute, Columbia University Irving Medical Center, New York, NY, United States.,Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, United States
| | - Liat Helpman
- Department of Counseling and Human Development, Faculty of Education, University of Haifa, Haifa, Israel.,Psychiatric Research Unit, Tel Aviv Medical Center, Tel Aviv, Israel
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10
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Földi T, Lőrincz ML, Berényi A. Temporally Targeted Interactions With Pathologic Oscillations as Therapeutical Targets in Epilepsy and Beyond. Front Neural Circuits 2021; 15:784085. [PMID: 34955760 PMCID: PMC8693222 DOI: 10.3389/fncir.2021.784085] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 11/10/2021] [Indexed: 11/13/2022] Open
Abstract
Self-organized neuronal oscillations rely on precisely orchestrated ensemble activity in reverberating neuronal networks. Chronic, non-malignant disorders of the brain are often coupled to pathological neuronal activity patterns. In addition to the characteristic behavioral symptoms, these disturbances are giving rise to both transient and persistent changes of various brain rhythms. Increasing evidence support the causal role of these "oscillopathies" in the phenotypic emergence of the disease symptoms, identifying neuronal network oscillations as potential therapeutic targets. While the kinetics of pharmacological therapy is not suitable to compensate the disease related fine-scale disturbances of network oscillations, external biophysical modalities (e.g., electrical stimulation) can alter spike timing in a temporally precise manner. These perturbations can warp rhythmic oscillatory patterns via resonance or entrainment. Properly timed phasic stimuli can even switch between the stable states of networks acting as multistable oscillators, substantially changing the emergent oscillatory patterns. Novel transcranial electric stimulation (TES) approaches offer more reliable neuronal control by allowing higher intensities with tolerable side-effect profiles. This precise temporal steerability combined with the non- or minimally invasive nature of these novel TES interventions make them promising therapeutic candidates for functional disorders of the brain. Here we review the key experimental findings and theoretical background concerning various pathological aspects of neuronal network activity leading to the generation of epileptic seizures. The conceptual and practical state of the art of temporally targeted brain stimulation is discussed focusing on the prevention and early termination of epileptic seizures.
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Affiliation(s)
- Tamás Földi
- MTA-SZTE "Momentum" Oscillatory Neuronal Networks Research Group, Department of Physiology, University of Szeged, Szeged, Hungary.,Neurocybernetics Excellence Center, University of Szeged, Szeged, Hungary.,HCEMM-USZ Magnetotherapeutics Research Group, University of Szeged, Szeged, Hungary.,Child and Adolescent Psychiatry, Department of the Child Health Center, University of Szeged, Szeged, Hungary
| | - Magor L Lőrincz
- MTA-SZTE "Momentum" Oscillatory Neuronal Networks Research Group, Department of Physiology, University of Szeged, Szeged, Hungary.,Neurocybernetics Excellence Center, University of Szeged, Szeged, Hungary.,Department of Physiology, Anatomy and Neuroscience, Faculty of Sciences University of Szeged, Szeged, Hungary.,Neuroscience Division, Cardiff University, Cardiff, United Kingdom
| | - Antal Berényi
- MTA-SZTE "Momentum" Oscillatory Neuronal Networks Research Group, Department of Physiology, University of Szeged, Szeged, Hungary.,Neurocybernetics Excellence Center, University of Szeged, Szeged, Hungary.,HCEMM-USZ Magnetotherapeutics Research Group, University of Szeged, Szeged, Hungary.,Neuroscience Institute, New York University, New York, NY, United States
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11
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Ross MC, Heilicher M, Cisler JM. Functional imaging correlates of childhood trauma: A qualitative review of past research and emerging trends. Pharmacol Biochem Behav 2021; 211:173297. [PMID: 34780877 DOI: 10.1016/j.pbb.2021.173297] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 10/22/2021] [Accepted: 11/08/2021] [Indexed: 12/12/2022]
Abstract
Childhood trauma exposure is common and is associated with poor clinical outcomes in adolescence along with mental health and sociodemographic challenges in adulthood. While many strategies exist to investigate the biological imprint of childhood trauma exposure, functional neuroimaging is a robust and growing technology for non-invasive studies of brain activity following traumatic experience and the relationship of childhood trauma exposure with psychopathology, cognition, and behavior. In this review, we discuss three popular approaches for discerning functional neural correlates to early life trauma, including regional activation, bivariate functional connectivity, and network-based connectivity. The breadth of research in each method is discussed, followed by important limitations and considerations for future research. We close by considering emerging trends in functional neuroimaging research of childhood trauma, including the use of complex decision-making tasks to mimic clinically-relevant behaviors, data-driven techniques such as multivariate pattern analysis and whole-brain network topology, and the applications of real-time neurofeedback for treatment of trauma-related mental disorders. We aim for this review to provide a framework for understanding the relationship between atypical neural functioning and adverse outcomes following childhood trauma exposure, with a focus on improving consistency in research methods and translatability of research findings for clinical settings.
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Affiliation(s)
- Marisa C Ross
- Northwestern Neighborhood & Network Initiative, Institute for Policy Research, Northwestern University, United States of America.
| | | | - Josh M Cisler
- University of Texas at Austin, Department of Psychiatry
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12
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Fineberg SK. Disentangling Amygdala Response After Early-Life Trauma: Reactivity, Habituation, and Symptom Profiles. BIOLOGICAL PSYCHIATRY: COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2021; 6:1036-1037. [PMID: 34753608 DOI: 10.1016/j.bpsc.2021.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 08/04/2021] [Indexed: 10/19/2022]
Affiliation(s)
- Sarah K Fineberg
- Department of Psychiatry, Yale University, New Haven, Connecticut.
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13
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Wiener SJ, Fitzgerald S, Einhorn H. A trauma-informed guide to caring for adolescents following sexual assault. Curr Opin Pediatr 2021; 33:354-360. [PMID: 34039900 DOI: 10.1097/mop.0000000000001030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Sexual assault is common among adolescents worldwide. Survivors of sexual assault may experience various immediate and long-term effects on their physical and mental health. It is important that pediatric healthcare providers (HCPs) are aware of the high prevalence of sexual assault and recognize the impact on their adolescent patients. The aim of this update is to discuss how pediatric HCPs can embody a trauma-informed approach when caring for survivors of sexual assault across various settings. RECENT FINDINGS All adolescent patients should be screened for sexual assault during routine clinical visits; in responding to a disclosure, providers should exhibit compassion, express validation, and help connect the patient to resources to aid in healing. Caring for survivors of sexual assault should ideally be multidisciplinary, involving treatment of the medical complications (including the possibility of pregnancy or infection) and mental health sequelae (including increased likelihood of depression, posttraumatic symptoms, and suicidality). SUMMARY A trauma-informed approach can be applied to all aspects of caring for survivors of sexual assault, from screening for sexual assault and responding to disclosure, to providing acute and longitudinal care following sexual assault.
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Affiliation(s)
- Susan J Wiener
- Division of Adolescent/Young Adult Medicine, Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA
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14
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Garner A, Yogman M. Preventing Childhood Toxic Stress: Partnering With Families and Communities to Promote Relational Health. Pediatrics 2021; 148:peds.2021-052582. [PMID: 34312296 DOI: 10.1542/peds.2021-052582] [Citation(s) in RCA: 114] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
By focusing on the safe, stable, and nurturing relationships (SSNRs) that buffer adversity and build resilience, pediatric care is on the cusp of a paradigm shift that could reprioritize clinical activities, rewrite research agendas, and realign our collective advocacy. Driving this transformation are advances in developmental sciences as they inform a deeper understanding of how early life experiences, both nurturing and adverse, are biologically embedded and influence outcomes in health, education, and economic stability across the life span. This revised policy statement on childhood toxic stress acknowledges a spectrum of potential adversities and reaffirms the benefits of an ecobiodevelopmental model for understanding the childhood origins of adult-manifested disease and wellness. It also endorses a paradigm shift toward relational health because SSNRs not only buffer childhood adversity when it occurs but also promote the capacities needed to be resilient in the future. To translate this relational health framework into clinical practice, generative research, and public policy, the entire pediatric community needs to adopt a public health approach that builds relational health by partnering with families and communities. This public health approach to relational health needs to be integrated both vertically (by including primary, secondary, and tertiary preventions) and horizontally (by including public service sectors beyond health care). The American Academy of Pediatrics asserts that SSNRs are biological necessities for all children because they mitigate childhood toxic stress responses and proactively build resilience by fostering the adaptive skills needed to cope with future adversity in a healthy manner.
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Affiliation(s)
- Andrew Garner
- Partners in Pediatrics, Westlake, Ohio.,School of Medicine, Case Western Reserve University, Cleveland, Ohio
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15
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Ross MC, Dvorak D, Sartin-Tarm A, Botsford C, Cogswell I, Hoffstetter A, Putnam O, Schomaker C, Smith P, Stalsberg A, Wang Y, Xiong M, Cisler JM. Gray matter volume correlates of adolescent posttraumatic stress disorder: A comparison of manual intervention and automated segmentation in FreeSurfer. Psychiatry Res Neuroimaging 2021; 313:111297. [PMID: 33962164 PMCID: PMC8205994 DOI: 10.1016/j.pscychresns.2021.111297] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 03/24/2021] [Accepted: 04/22/2021] [Indexed: 01/08/2023]
Abstract
Exposure to early life trauma is common and confers risk for psychological disorders in adolescence, including posttraumatic stress disorder (PTSD). Trauma exposure and PTSD are also consistently linked to alterations in gray matter volume (GMV). Despite the quantity of structural neuroimaging research in trauma-exposed populations, little consensus exists amongst research groups on best practices for image processing method and manual editing procedures. The purpose of this report is to evaluate the utility of manual editing of magnetic resonance (MR) images for detecting PTSD-related group differences in GMV. Here, T1-weighted MR images from adolescent girls aged 11-17 were obtained and analyzed. Two datasets were created from the FreeSurfer reconall pipeline, one of which was manually edited by trained research assistants. Gray matter regions of interest were selected and total volume estimates were entered into linear mixed effects models with method (manual edits or automated) as a within-subjects factor and group dummy-coded with PTSD as the reference group. Consistent with prior literature, individuals with PTSD demonstrated reduced GMV of the amygdala compared to trauma-exposed and non-trauma exposed controls, independent of editing method. Our results demonstrate that amygdala GMV reductions in PTSD are robust to certain methodological choices and do not suggest a benefit to the time-intensive manual editing pipeline in FreeSurfer for quantifying PTSD-related GMV.
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Affiliation(s)
- Marisa C Ross
- Department of Psychiatry, University of Wisconsin-Madison, Madison, WI United States; Neuroscience and Public Policy Program, University of Wisconsin-Madison, Madison, WI United States.
| | - Delaney Dvorak
- Department of Psychiatry, University of Wisconsin-Madison, Madison, WI United States
| | - Anneliis Sartin-Tarm
- Department of Psychology, University of Nebraska-Lincoln, Lincoln, NE United States
| | - Chloe Botsford
- Department of Psychiatry, University of Wisconsin-Madison, Madison, WI United States
| | - Ian Cogswell
- Institute for Health Metrics and Evaluation, Seattle, WA United States
| | - Ashley Hoffstetter
- Department of Psychiatry, University of Wisconsin-Madison, Madison, WI United States
| | - Olivia Putnam
- Department of Psychology, Northwestern University, Evanston, IL United States
| | - Chloe Schomaker
- Department of Psychiatry, University of Wisconsin-Madison, Madison, WI United States
| | - Penda Smith
- Department of Psychiatry, University of Wisconsin-Madison, Madison, WI United States
| | - Anna Stalsberg
- Department of Sociology, University of Minnesota- Twin Cities, Minneapolis, MN United States
| | - Yunling Wang
- Department of Psychiatry, University of Wisconsin-Madison, Madison, WI United States
| | - Megan Xiong
- Department of Psychiatry, University of Wisconsin-Madison, Madison, WI United States
| | - Josh M Cisler
- Department of Psychiatry, University of Wisconsin-Madison, Madison, WI United States
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16
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Wang P, Peng Z, Liu L, An L, Liu Y, Cao Q, Sun L, Ji N, Chen Y, Yang B, Wang Y. Neural response to trauma-related and trauma-unrelated negative stimuli in remitted and persistent pediatric post-traumatic stress disorder. Brain Behav 2021; 11:e02173. [PMID: 34076367 PMCID: PMC8323042 DOI: 10.1002/brb3.2173] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Revised: 04/06/2021] [Accepted: 04/23/2021] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION Most youths who suffer from post-traumatic stress disorder (PTSD) lose their diagnosis in the first 1-2 years. However, there are few studies on this brain mechanism, and the heterogeneity of the findings is partially due to the different stimuli applied and the mixed trauma history. Therefore, the use of trauma-related/unrelated stimuli to study the remittance mechanism of earthquake-induced PTSD could advance our knowledge of PTSD and inspire future treatment. METHODS Thirteen youths with PTSD, 18 remitted participants, and 18 control participants underwent functional magnetic resonance imaging (fMRI), while viewing trauma-related pictures, trauma-unrelated negative pictures, and scrambled pictures. RESULTS Under trauma-unrelated condition, the neural activity of the left hippocampus in the remitted group was between the two other groups. Under trauma-related condition, the PTSD and the remitted group exhibited higher neural activity in the right middle occipital gyrus than controls. The remitted group showed higher neural activity in the right parahippocampal gyrus and right lingual gyrus under trauma-related condition than trauma-unrelated condition, while no significant difference was found in PTSD group. CONCLUSION PTSD status-related group differences are mainly reflected in the left hippocampus under the trauma-unrelated condition, while the hyperactivity in the right middle occipital gyrus under trauma-related condition could be an endophenotype for PTSD.
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Affiliation(s)
- Peng Wang
- Sixth Hospital/Institute of Mental HealthPeking UniversityBeijingChina
- National Clinical Research Center for Mental Disorders & The Key Laboratory of Mental HealthMinistry of Health (Peking University)BeijingChina
- Shenzhen Children's HospitalShenzhenChina
- Cardiac Rehabilitation Center, Fuwai Hospital CAMS&PUMCBeijingChina
| | - Zu‐Lai Peng
- Sixth Hospital/Institute of Mental HealthPeking UniversityBeijingChina
- National Clinical Research Center for Mental Disorders & The Key Laboratory of Mental HealthMinistry of Health (Peking University)BeijingChina
| | - Lu Liu
- Sixth Hospital/Institute of Mental HealthPeking UniversityBeijingChina
- National Clinical Research Center for Mental Disorders & The Key Laboratory of Mental HealthMinistry of Health (Peking University)BeijingChina
| | - Li An
- Sixth Hospital/Institute of Mental HealthPeking UniversityBeijingChina
- National Clinical Research Center for Mental Disorders & The Key Laboratory of Mental HealthMinistry of Health (Peking University)BeijingChina
| | - Yu‐Xin Liu
- Sixth Hospital/Institute of Mental HealthPeking UniversityBeijingChina
- National Clinical Research Center for Mental Disorders & The Key Laboratory of Mental HealthMinistry of Health (Peking University)BeijingChina
| | - Qing‐Jiu Cao
- Sixth Hospital/Institute of Mental HealthPeking UniversityBeijingChina
- National Clinical Research Center for Mental Disorders & The Key Laboratory of Mental HealthMinistry of Health (Peking University)BeijingChina
| | - Li Sun
- Sixth Hospital/Institute of Mental HealthPeking UniversityBeijingChina
- National Clinical Research Center for Mental Disorders & The Key Laboratory of Mental HealthMinistry of Health (Peking University)BeijingChina
| | - Ning Ji
- Sixth Hospital/Institute of Mental HealthPeking UniversityBeijingChina
- National Clinical Research Center for Mental Disorders & The Key Laboratory of Mental HealthMinistry of Health (Peking University)BeijingChina
| | - Yun Chen
- Sixth Hospital/Institute of Mental HealthPeking UniversityBeijingChina
- National Clinical Research Center for Mental Disorders & The Key Laboratory of Mental HealthMinistry of Health (Peking University)BeijingChina
| | | | - Yu‐Feng Wang
- Sixth Hospital/Institute of Mental HealthPeking UniversityBeijingChina
- National Clinical Research Center for Mental Disorders & The Key Laboratory of Mental HealthMinistry of Health (Peking University)BeijingChina
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17
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Aarts I, Vriend C, Snoek A, van den End A, Blankers M, Beekman ATF, Dekker J, van den Heuvel OA, Thomaes K. Neural correlates of treatment effect and prediction of treatment outcome in patients with PTSD and comorbid personality disorder: study design. Borderline Personal Disord Emot Dysregul 2021; 8:13. [PMID: 33947471 PMCID: PMC8097786 DOI: 10.1186/s40479-021-00156-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 04/09/2021] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND Neural alterations related to treatment outcome in patients with both post-traumatic stress disorder (PTSD) and comorbid personality disorder are unknown. Here we describe the protocol for a neuroimaging study of treatment of patients with PTSD and comorbid borderline (BPD) or cluster C (CPD) personality disorder traits. Our specific aims are to 1) investigate treatment-induced neural alterations, 2) predict treatment outcome using structural and functional magnetic resonance imaging (MRI) and 3) study neural alterations associated with BPD and CPD in PTSD patients. We hypothesize that 1) all treatment conditions are associated with normalization of limbic and prefrontal brain activity and hyperconnectivity in resting-state brain networks, with additional normalization of task-related activation in emotion regulation brain areas in the patients who receive trauma-focused therapy and personality disorder treatment; 2) Baseline task-related activation, together with structural brain measures and clinical variables predict treatment outcome; 3) dysfunction in task-related activation and resting-state connectivity of emotion regulation areas is comparable in PTSD patients with BPD or CPD, with a hypoconnected central executive network in patients with PTSD+BPD. METHODS We aim to include pre- and post-treatment 3 T-MRI scans in 40 patients with PTSD and (sub) clinical comorbid BPD or CPD. With an expected attrition rate of 50%, at least 80 patients will be scanned before treatment. MRI scans for 30 matched healthy controls will additionally be acquired. Patients with PTSD and BPD were randomized to either EMDR-only or EMDR combined with Dialectical Behaviour Therapy. Patients with PTSD and CPD were randomized to Imaginary Rescripting (ImRs) or to ImRs combined with Schema Focused Therapy. The scan protocol consists of a T1-weighted structural scan, resting state fMRI, task-based fMRI during an emotional face task and multi-shell diffusion weighted images. For data analysis, multivariate mixed-models, regression analyses and machine learning models will be used. DISCUSSION This study is one of the first to use neuroimaging measures to predict and better understand treatment response in patients with PTSD and comorbid personality disorders. A heterogeneous, naturalistic sample will be included, ensuring generalizability to a broad group of treatment seeking PTSD patients. TRIAL REGISTRATION Clinical Trials, NCT03833453 & NCT03833531 . Retrospectively registered, February 2019.
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Affiliation(s)
- Inga Aarts
- Sinai Centrum, Amstelveen, The Netherlands.
- Department of Anatomy and Neurosciences, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan, 1117, Amsterdam, Netherlands.
- Department of Psychiatry, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan, 1117, Amsterdam, Netherlands.
| | - Chris Vriend
- Department of Anatomy and Neurosciences, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan, 1117, Amsterdam, Netherlands
- Department of Psychiatry, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan, 1117, Amsterdam, Netherlands
| | - Aishah Snoek
- Sinai Centrum, Amstelveen, The Netherlands
- Department of Psychiatry, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan, 1117, Amsterdam, Netherlands
| | - Arne van den End
- Sinai Centrum, Amstelveen, The Netherlands
- Department of Psychiatry, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan, 1117, Amsterdam, Netherlands
| | - Matthijs Blankers
- Arkin Research, Amsterdam, the Netherlands
- Trimbos Institute, Institute of Mental Health and Addiction, Utrecht, the Netherlands
| | - Aartjan T F Beekman
- Department of Psychiatry, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan, 1117, Amsterdam, Netherlands
- GGZinGeest, Department of Psychiatry, Amsterdam, The Netherlands
| | - Jack Dekker
- Arkin Research, Amsterdam, the Netherlands
- VU University, Faculty of Behavioural and Movement Sciences, Amsterdam, The Netherlands
| | - Odile A van den Heuvel
- Department of Anatomy and Neurosciences, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan, 1117, Amsterdam, Netherlands
- Department of Psychiatry, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan, 1117, Amsterdam, Netherlands
| | - Kathleen Thomaes
- Sinai Centrum, Amstelveen, The Netherlands
- Department of Anatomy and Neurosciences, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan, 1117, Amsterdam, Netherlands
- Department of Psychiatry, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan, 1117, Amsterdam, Netherlands
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18
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van Rooij SJ, Sippel LM, McDonald WM, Holtzheimer PE. Defining focal brain stimulation targets for PTSD using neuroimaging. Depress Anxiety 2021; 38:10.1002/da.23159. [PMID: 33876868 PMCID: PMC8526638 DOI: 10.1002/da.23159] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 03/17/2021] [Accepted: 04/02/2021] [Indexed: 02/02/2023] Open
Abstract
INTRODUCTION Focal brain stimulation has potential as a treatment for posttraumatic stress disorder (PTSD). In this review, we aim to inform selection of focal brain stimulation targets for treating PTSD by examining studies of the functional neuroanatomy of PTSD and treatment response. We first briefly review data on brain stimulation interventions for PTSD. Although published data suggest good efficacy overall, the neurobiological rationale for each stimulation target is not always clear. METHODS Therefore, we assess pre- and post-treatment (predominantly psychotherapy) functional neuroimaging studies in PTSD to determine which brain changes seem critical to treatment response. Results of these studies are presented within a previously proposed functional neural systems model of PTSD. RESULTS While not completely consistent, research suggests that downregulating the fear learning and threat and salience detection circuits (i.e., amygdala, dorsal anterior cingulate cortex and insula) and upregulating the emotion regulation and executive function and contextual processing circuits (i.e., prefrontal cortical regions and hippocampus) may mediate PTSD treatment response. CONCLUSION This literature review provides some justification for current focal brain stimulation targets. However, the examination of treatment effects on neural networks is limited, and studies that include the stimulation targets are lacking. Further, additional targets, such as the cingulate, medial prefrontal cortex, and inferior parietal lobe, may also be worth investigation, especially when considering how to achieve network level changes. Additional research combining PTSD treatment with functional neuroimaging will help move the field forward by identifying and validating novel targets, providing better rationale for specific treatment parameters and personalizing treatment for PTSD.
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Affiliation(s)
- Sanne J.H. van Rooij
- Emory University School of Medicine, Department of Psychiatry and Behavioral Sciences, Atlanta, GA
| | - Lauren M. Sippel
- National Center for PTSD, U.S. Department of Veterans Affairs, White River Junction, VT
- Geisel School of Medicine at Dartmouth, Hanover, NH
| | - William M. McDonald
- Emory University School of Medicine, Department of Psychiatry and Behavioral Sciences, Atlanta, GA
| | - Paul E. Holtzheimer
- National Center for PTSD, U.S. Department of Veterans Affairs, White River Junction, VT
- Geisel School of Medicine at Dartmouth, Hanover, NH
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19
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Purcell JB, Goodman AM, Harnett NG, Davis ES, Wheelock MD, Mrug S, Elliott MN, Emery ST, Schuster MA, Knight DC. Stress-elicited neural activity in young adults varies with childhood sexual abuse. Cortex 2021; 137:108-123. [PMID: 33609897 PMCID: PMC8044018 DOI: 10.1016/j.cortex.2020.12.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 10/25/2020] [Accepted: 12/18/2020] [Indexed: 01/17/2023]
Abstract
OBJECTIVE Childhood physical and sexual abuse are stressful experiences that may alter the emotional response to future stressors. Stress-related emotional function is supported by brain regions that include the prefrontal cortex (PFC), hippocampus, and amygdala. The present study investigated whether childhood physical and sexual abuse are associated with stress-elicited brain activity in young adulthood. METHODS Participants (N = 300; Mage = 20.0; 151 female) completed a psychosocial stress task during functional magnetic resonance imaging (fMRI). Measures of physical and sexual abuse were included in a linear mixed effects model to estimate the unique relationship each type of childhood abuse had with stress-elicited brain activity. RESULTS Stress-elicited dorsolateral PFC, ventromedial PFC, and hippocampal activity decreased as the frequency of childhood sexual abuse increased. There were no regions in which stress-elicited activation varied with physical abuse. CONCLUSIONS The present findings suggest there is a unique relationship between childhood sexual abuse and the stress-elicited PFC and hippocampal activity of young adults that is not observed following childhood physical abuse. SIGNIFICANCE These findings may have important implications for understanding the mechanisms by which childhood sexual abuse impacts the development of future psychopathology.
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Affiliation(s)
- Juliann B Purcell
- University of Alabama at Birmingham, Department of Psychology, Birmingham, AL, USA.
| | - Adam M Goodman
- University of Alabama at Birmingham, Department of Psychology, Birmingham, AL, USA.
| | - Nathaniel G Harnett
- University of Alabama at Birmingham, Department of Psychology, Birmingham, AL, USA.
| | - Elizabeth S Davis
- University of Alabama at Birmingham, Department of Psychology, Birmingham, AL, USA.
| | - Muriah D Wheelock
- University of Alabama at Birmingham, Department of Psychology, Birmingham, AL, USA.
| | - Sylvie Mrug
- University of Alabama at Birmingham, Department of Psychology, Birmingham, AL, USA.
| | | | - Susan Tortolero Emery
- The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Houston, TX, USA.
| | - Mark A Schuster
- Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
| | - David C Knight
- University of Alabama at Birmingham, Department of Psychology, Birmingham, AL, USA.
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Alpert E, Hayes AM, Yasinski C, Webb C, Deblinger E. Processes of Change in Trauma-Focused Cognitive Behavioral Therapy for Youth: An Emotional Processing Theory Informed Approach. Clin Psychol Sci 2021; 9:270-283. [PMID: 33758692 DOI: 10.1177/2167702620957315] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
This study examines processes of change in trauma-focused cognitive behavioral therapy (TF-CBT) delivered to a community sample of 81 youth. Emotional processing theory (EPT) is used as an organizational framework. EPT highlights activating and changing pathological trauma-related responses and increasing adaptive responses across cognitive, emotional, behavioral, and physiological domains. We coded sessions during the trauma processing phase of TF-CBT to examine the extent to which pathological and adaptive trauma-related responses were activated across domains. Higher scores indicate that more domains (0-4) were activated at a threshold of moderate to high intensity. Curvilinear change (inverted U, increase then decrease) in multimodal negative response scores across sessions predicted improvement in internalizing and PTSD symptoms at posttreatment. Linear increases in multimodal positive responses predicted improvement in externalizing symptoms. Findings suggest value in activating and changing both pathological and adaptive trauma responses across multiple domains and examining nonlinear patterns of change.
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Affiliation(s)
- Elizabeth Alpert
- University of Delaware, Department of Psychological and Brain Sciences
| | - Adele M Hayes
- University of Delaware, Department of Psychological and Brain Sciences
| | - Carly Yasinski
- Emory University, Department of Psychiatry and Behavioral Sciences
| | - Charles Webb
- State of Delaware Division of Prevention and Behavioral Health Services
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La Buissonniere-Ariza V, Fitzgerald K, Meoded A, Williams LL, Liu G, Goodman WK, Storch EA. Neural correlates of cognitive behavioral therapy response in youth with negative valence disorders: A systematic review of the literature. J Affect Disord 2021; 282:1288-1307. [PMID: 33601708 DOI: 10.1016/j.jad.2020.12.182] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 11/25/2020] [Accepted: 12/24/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Cognitive-behavioral therapy (CBT) is the gold-standard psychotherapeutic treatment for pediatric negative valence disorders. However, some youths do not respond optimally to treatment, which may be due to variations in neural functioning. METHODS We systematically reviewed functional magnetic resonance imaging studies in youths with negative valence disorders to identify pre- and post-treatment neural correlates of CBT response. RESULTS A total of 21 studies were identified, of overall weak to moderate quality. The most consistent findings across negative valence disorders consisted of associations of treatment response with pre- and post-treatment task-based activation and/or functional connectivity within and between the prefrontal cortex, the medial temporal lobe, and other limbic regions. Associations of CBT response with baseline and/or post-treatment activity in the striatum, precentral and postcentral gyri, medial and posterior cingulate cortices, and parietal cortex, connectivity within and between the default-mode, cognitive control, salience, and frontoparietal networks, and metrics of large-scale brain network organization, were also reported, although less consistently. LIMITATIONS The poor quality and limited number of studies and the important heterogeneity of study designs and results considerably limit the conclusions that can be drawn from this literature. CONCLUSIONS Despite these limitations, these findings provide preliminary evidence suggesting youths presenting certain patterns of brain function may respond better to CBT, whereas others may benefit from alternative or augmented forms of treatment.
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Affiliation(s)
- Valerie La Buissonniere-Ariza
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, One Baylor Plaza - BCM350, Houston, TX, 77030, USA.
| | - Kate Fitzgerald
- Department of Psychiatry, University of Michigan, Rachel Upjohn Building, 4250 Plymouth Road, Ann Arbor, MI, 48109, USA
| | - Avner Meoded
- Edward B. Singleton Department of Radiology, Texas Children's Hospital and Baylor College of Medicine, Houston, TX, USA
| | - Laurel L Williams
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, One Baylor Plaza - BCM350, Houston, TX, 77030, USA
| | - Gary Liu
- Department of Neuroscience, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA
| | - Wayne K Goodman
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, One Baylor Plaza - BCM350, Houston, TX, 77030, USA
| | - Eric A Storch
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, One Baylor Plaza - BCM350, Houston, TX, 77030, USA
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Cisler JM, Herringa RJ. Posttraumatic Stress Disorder and the Developing Adolescent Brain. Biol Psychiatry 2021; 89:144-151. [PMID: 32709416 PMCID: PMC7725977 DOI: 10.1016/j.biopsych.2020.06.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 05/30/2020] [Accepted: 06/01/2020] [Indexed: 02/07/2023]
Abstract
Posttraumatic stress disorder (PTSD) in adolescents is common and debilitating. In contrast to adult PTSD, relatively little is known about the neurobiology of adolescent PTSD, nor about how current treatments may alter adolescent neurodevelopment to allow recovery from PTSD. Improving our understanding of biological mechanisms of adolescent PTSD, taken in the context of neurodevelopment, is crucial for developing novel and personalized treatment approaches. In this review, we highlight prevailing constructs of PTSD and current findings on these domains in adolescent PTSD. Notably, little data exist in adolescent PTSD for prominent adult PTSD constructs, including threat learning and attentional threat bias. Most work to date has examined general threat processing, emotion regulation, and their neural substrates. These studies suggest that adolescent PTSD, while phenomenologically similar to adult PTSD, shows unique neurodevelopmental substrates that may impair recovery but could also be targeted in the context of adolescent neuroplasticity to improve outcomes. Both cross-sectional and longitudinal data suggest abnormal frontolimbic development compared with typically developing youths, a pattern that may differ from resilient youths. Whether current treatments such as trauma-focused psychotherapy engage these targets and restore healthy neurodevelopment remains an open question. We end our review by highlighting emerging areas and knowledge gaps that could be addressed to better characterize the biology underlying adolescent PTSD. Emerging studies in computational modeling of decision making, caregiver-related transmission of traumatic stress, and other areas may offer new targets that could harness adolescent neurobehavioral plasticity to improve resilience and recovery for some of our most vulnerable youths.
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Weisholtz D, Silbersweig D, Pan H, Cloitre M, LeDoux J, Stern E. Correlation Between Rostral Dorsomedial Prefrontal Cortex Activation by Trauma-Related Words and Subsequent Response to CBT for PTSD. J Neuropsychiatry Clin Neurosci 2021; 33:116-123. [PMID: 33108951 PMCID: PMC8772163 DOI: 10.1176/appi.neuropsych.20030058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Trauma-focused cognitive-behavioral therapy (CBT) is an important component of evidence-based treatment for posttraumatic stress disorder (PTSD), but the efficacy of treatment varies from individual to individual. It is hypothesized that some of this variability is derived from interindividual differences in the brain's intrinsic response to trauma-related stimuli and in activity of executive functional regions. The authors sought to characterize these differences using functional MRI (fMRI) in patients about to undergo CBT for PTSD. METHODS Blood-oxygenation-level-dependent signal was measured in 12 individuals with PTSD related to sexual and/or physical trauma while they read words with positive, neutral, and negative content. Some negative words had PTSD-related themes, while others did not. It was hypothesized that PTSD-related words would evoke emotional processes likely to be engaged by the CBT process and would be most likely to activate brain circuitry important for CBT success. RESULTS A group-level analysis showed that the rostral dorsomedial prefrontal cortex (rdmPFC) was activated to a greater degree in response to PTSD-related words compared with other word types. This activation was strongest among patients with the best CBT responses, particularly in the latter part of the task, when differences between individuals were most pronounced. CONCLUSIONS The rdmPFC activation observed in this study may reflect the engagement of neural processes involved in introspection and self-reflection. CBT may be more effective for individuals with a greater ability to engage these processes.
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Affiliation(s)
- Daniel Weisholtz
- Departments of Neurology (Weisholtz) and Psychiatry (Silbersweig), Brigham and Women’s Hospital, Boston; Departments of Neurology (Weisholtz) and Psychiatry (Silbersweig), Harvard Medical School, Boston; Ceretype Neuromedicine, Cambridge, Mass. (Pan, Stern); Department of Psychiatry, New York University, Langone Medical Center, New York (Cloitre); and Center for Neural Science, New York University (LeDoux)
| | - David Silbersweig
- Departments of Neurology (Weisholtz) and Psychiatry (Silbersweig), Brigham and Women’s Hospital, Boston; Departments of Neurology (Weisholtz) and Psychiatry (Silbersweig), Harvard Medical School, Boston; Ceretype Neuromedicine, Cambridge, Mass. (Pan, Stern); Department of Psychiatry, New York University, Langone Medical Center, New York (Cloitre); and Center for Neural Science, New York University (LeDoux)
| | - Hong Pan
- Departments of Neurology (Weisholtz) and Psychiatry (Silbersweig), Brigham and Women’s Hospital, Boston; Departments of Neurology (Weisholtz) and Psychiatry (Silbersweig), Harvard Medical School, Boston; Ceretype Neuromedicine, Cambridge, Mass. (Pan, Stern); Department of Psychiatry, New York University, Langone Medical Center, New York (Cloitre); and Center for Neural Science, New York University (LeDoux)
| | - Marylene Cloitre
- Departments of Neurology (Weisholtz) and Psychiatry (Silbersweig), Brigham and Women’s Hospital, Boston; Departments of Neurology (Weisholtz) and Psychiatry (Silbersweig), Harvard Medical School, Boston; Ceretype Neuromedicine, Cambridge, Mass. (Pan, Stern); Department of Psychiatry, New York University, Langone Medical Center, New York (Cloitre); and Center for Neural Science, New York University (LeDoux)
| | - Joseph LeDoux
- Departments of Neurology (Weisholtz) and Psychiatry (Silbersweig), Brigham and Women’s Hospital, Boston; Departments of Neurology (Weisholtz) and Psychiatry (Silbersweig), Harvard Medical School, Boston; Ceretype Neuromedicine, Cambridge, Mass. (Pan, Stern); Department of Psychiatry, New York University, Langone Medical Center, New York (Cloitre); and Center for Neural Science, New York University (LeDoux)
| | - Emily Stern
- Departments of Neurology (Weisholtz) and Psychiatry (Silbersweig), Brigham and Women’s Hospital, Boston; Departments of Neurology (Weisholtz) and Psychiatry (Silbersweig), Harvard Medical School, Boston; Ceretype Neuromedicine, Cambridge, Mass. (Pan, Stern); Department of Psychiatry, New York University, Langone Medical Center, New York (Cloitre); and Center for Neural Science, New York University (LeDoux)
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Brown EJ, Cohen JA, Mannarino AP. Trauma-Focused Cognitive-Behavioral Therapy: The role of caregivers. J Affect Disord 2020; 277:39-45. [PMID: 32791391 DOI: 10.1016/j.jad.2020.07.123] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 06/06/2020] [Accepted: 07/27/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND Childhood trauma exposure is unfortunately common and is associated with the development of posttraumatic stress disorder (PTSD) as well as a number of other serious medical and mental and health disorders. After experiencing trauma, children depend on their non-offending parents to believe and support them, reframe the meaning of the trauma, and to keep them safe from future harm. Parents are often negatively impacted by their child's trauma which may contribute to the child's risk for developing PTSD and related problems. Including parents in treatment may enhance child outcomes. METHODS Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT) is an evidence-based child and adolescent trauma treatment model that integrally includes non-offending parents or caregivers throughout treatment (hereafter referred to as "caregivers"). This article describes TF-CBT's underlying concepts, principles and core components, as well as the role of caregiver inclusion in this model, and evaluates the extant evidence for caregiver factors in predicting TF-CBT outcomes. RESULTS Several studies suggest that inclusion of non-offending caregivers is associated with TF-CBT outcomes, and that this may occur through enhancing caregiver support of the child and/or reducing caregivers' trauma-related maladaptive cognitions. LIMITATIONS Few studies have evaluated whether caregiver factors served as formal treatment mediators. CONCLUSIONS Including non-offending caregivers in TF-CBT can improve youth outcomes.
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Affiliation(s)
- Elissa J Brown
- Professor of Psychology, St. John's University, 8000 Utopia Parkway, Queens, NY 11439, United States.
| | - Judith A Cohen
- Professor of Psychiatry, Drexel University College of Medicine, Allegheny Health Network/Allegheny General Hospital, 4 Allegheny Center, 8th Floor, Pittsburgh, PA 15212, United States.
| | - Anthony P Mannarino
- Professor and Vice ChairDepartment of Psychiatry, Allegheny General Hospital, Allegheny Health Network, Drexel University College of Medicine, 4 Allegheny Center, 8th Floor, Pittsburgh, PA 15212, United States.
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McDermott TJ, Kirlic N, Akeman E, Touthang J, Cosgrove KT, DeVille DC, Clausen AN, White EJ, Kuplicki R, Aupperle RL. Visual cortical regions show sufficient test-retest reliability while salience regions are unreliable during emotional face processing. Neuroimage 2020; 220:117077. [PMID: 32574806 DOI: 10.1016/j.neuroimage.2020.117077] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 06/16/2020] [Accepted: 06/17/2020] [Indexed: 01/14/2023] Open
Abstract
Functional magnetic resonance imaging studies frequently use emotional face processing tasks to probe neural circuitry related to psychiatric disorders and treatments with an emphasis on regions within the salience network (e.g., amygdala). Findings across previous test-retest reliability studies of emotional face processing have shown high variability, potentially due to differences in data analytic approaches. The present study comprehensively examined the test-retest reliability of an emotional faces task utilizing multiple approaches to region of interest (ROI) analysis and by examining voxel-wise reliability across the entire brain for both neural activation and functional connectivity. Analyses included 42 healthy adult participants who completed an fMRI scan concurrent with an emotional faces task on two separate days with an average of 25.52 days between scans. Intraclass correlation coefficients (ICCs) were calculated for the 'FACES-SHAPES' and 'FACES' (compared to implicit baseline) contrasts across the following: anatomical ROIs identified from a publicly available brain atlas (i.e., Brainnetome), functional ROIs consisting of 5-mm spheres centered on peak voxels from a publicly available meta-analytic database (i.e., Neurosynth), and whole-brain, voxel-wise analysis. Whole-brain, voxel-wise analyses of functional connectivity were also conducted using both anatomical and functional seed ROIs. While group-averaged neural activation maps were consistent across time, only one anatomical ROI and two functional ROIs showed good or excellent individual-level reliability for neural activation. The anatomical ROI was the right medioventral fusiform gyrus for the FACES contrast (ICC = 0.60). The functional ROIs were the left and the right fusiform face area (FFA) for both FACES-SHAPES and FACES (Left FFA ICCs = 0.69 & 0.79; Right FFA ICCs = 0.68 & 0.66). Poor reliability (ICCs < 0.4) was identified for almost all other anatomical and functional ROIs, with some exceptions showing fair reliability (ICCs = 0.4-0.59). Whole-brain voxel-wise analysis of neural activation identified voxels with good (ICCs = 0.6-0.74) to excellent reliability (ICCs > 0.75) that were primarily located in visual cortex, with several clusters in bilateral dorsal lateral prefrontal cortex (DLPFC). Whole-brain voxel-wise analyses of functional connectivity for amygdala and fusiform gyrus identified very few voxels with good to excellent reliability using both anatomical and functional seed ROIs. Exceptions included clusters in right cerebellum and right DLPFC that showed reliable connectivity with left amygdala (ICCs > 0.6). In conclusion, results indicate that visual cortical regions demonstrate good reliability at the individual level for neural activation, but reliability is generally poor for salience regions often focused on within psychiatric research (e.g., amygdala). Given these findings, future clinical neuroimaging studies using emotional faces tasks to examine individual differences might instead focus on visual regions and their role in psychiatric disorders.
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Affiliation(s)
- Timothy J McDermott
- Laureate Institute for Brain Research, Tulsa, OK, United States; Department of Psychology, University of Tulsa, Tulsa, OK, United States
| | - Namik Kirlic
- Laureate Institute for Brain Research, Tulsa, OK, United States
| | | | - James Touthang
- Laureate Institute for Brain Research, Tulsa, OK, United States
| | - Kelly T Cosgrove
- Laureate Institute for Brain Research, Tulsa, OK, United States; Department of Psychology, University of Tulsa, Tulsa, OK, United States
| | - Danielle C DeVille
- Laureate Institute for Brain Research, Tulsa, OK, United States; Department of Psychology, University of Tulsa, Tulsa, OK, United States
| | - Ashley N Clausen
- Laureate Institute for Brain Research, Tulsa, OK, United States; VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham VA Health Care System, Durham, NC, USA; Duke University Brain Imaging and Analysis Center, Durham, NC, USA
| | - Evan J White
- Laureate Institute for Brain Research, Tulsa, OK, United States
| | - Rayus Kuplicki
- Laureate Institute for Brain Research, Tulsa, OK, United States; Department of Community Medicine, University of Tulsa, Tulsa, OK, 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.
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Acute Posttrauma Resting-State Functional Connectivity of Periaqueductal Gray Prospectively Predicts Posttraumatic Stress Disorder Symptoms. BIOLOGICAL PSYCHIATRY: COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2020; 5:891-900. [PMID: 32389746 DOI: 10.1016/j.bpsc.2020.03.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 03/04/2020] [Accepted: 03/08/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND Posttraumatic stress disorder (PTSD) is characterized by hyperarousal, avoidance, and intrusive/re-experiencing symptoms. The periaqueductal gray (PAG), which generates behavioral responses to physical and psychological stressors, is also implicated in threat processing. Distinct regions of the PAG elicit opposing responses to threatening or stressful stimuli; the ventrolateral PAG evokes passive coping strategies (e.g., analgesia), whereas the dorsolateral PAG (dlPAG) promotes active responses (e.g., fight or flight). We investigated whether altered PAG resting-state functional connectivity (RSFC) prospectively predicted PTSD symptoms. METHODS A total of 48 trauma-exposed individuals underwent an RSFC scan 2 weeks posttraumatic injury. Self-report measures, including the visual analog scale for pain and the Impact of Event Scale, were collected at 2 weeks and 6 months posttrauma. We analyzed whether acute bilateral PAG RSFC was a marker of risk for total 6-month symptom severity and specific symptom clusters. In an exploratory analysis, we investigated whether dlPAG RSFC predicted PTSD symptoms. RESULTS After adjusting for physical pain ratings, greater acute posttrauma PAG-frontal pole and PAG-posterior cingulate cortex connectivity was positively associated with 6-month total PTSD symptoms. Weaker dlPAG-superior/inferior parietal lobule connectivity predicted both higher hyperarousal and higher intrusive symptoms, while weaker dlPAG-supramarginal gyrus RSFC was associated with only hyperarousal symptoms. CONCLUSIONS Altered connectivity of the PAG 2 weeks posttrauma prospectively predicted PTSD symptoms. These findings suggest that aberrant PAG function may serve as a marker of risk for chronic PTSD symptoms, possibly by driving specific symptom clusters, and more broadly that connectivity of specific brain regions may underlie specific symptom profiles.
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Kirlic N, Cohen ZP, Singh MK. Is There an Ace Up Our Sleeve? A Review of Interventions and Strategies for Addressing Behavioral and Neurobiological Effects of Adverse Childhood Experiences in Youth. ADVERSITY AND RESILIENCE SCIENCE 2020; 1:5-28. [PMID: 34278327 PMCID: PMC8281391 DOI: 10.1007/s42844-020-00001-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Exposure to early life adversity (ELA) is a major public health crisis posing as a significant risk of immediate and sustained mental and physical health consequences. While a remarkable body of knowledge has been amassed showing psychological, cognitive, social, developmental, and neurobiological consequences of ELA exposure, little has been done to improve the long-term mental and physical health outcomes for youth exposed to ELA. Furthermore, neurobiological processes underlying poor outcomes in this population have been largely left out of prevention and intervention target efforts. In this review, we first describe ELA-related alterations across psychological and neurobiological systems in children and adolescents. Next, we describe existing evidence-based interventions targeting ELA-related outcomes. We then turn to experimental studies examining individual differences in mechanistic functioning consequent to ELA exposure, and strategies that target these mechanisms and modulate disrupted functioning. Finally, we highlight areas of future research that may be promising in engaging behavioral and neurobiological targets through novel preventive interventions or augmentation of existing interventions, thereby reducing negative mental and physical health outcomes later in life.
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Affiliation(s)
- Namik Kirlic
- Laureate Institute for Brain Research, 6655 South Yale Ave., Tulsa, OK 74136, USA
| | - Zsofia P. Cohen
- Laureate Institute for Brain Research, 6655 South Yale Ave., Tulsa, OK 74136, USA
| | - Manpreet K. Singh
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
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Sellnow K, Sartin-Tarm A, Ross MC, Weaver S, Cisler JM. Biotypes of functional brain engagement during emotion processing differentiate heterogeneity in internalizing symptoms and interpersonal violence histories among adolescent girls. J Psychiatr Res 2020; 121:197-206. [PMID: 31864159 DOI: 10.1016/j.jpsychires.2019.12.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 11/08/2019] [Accepted: 12/05/2019] [Indexed: 12/25/2022]
Abstract
Youth exposed to early life interpersonal violence (IPV) demonstrate heterogeneous clinical symptoms. Studies based on univariate methods suggest that neurocircuitry related to emotion processing explains heterogeneity in internalizing symptoms. Here, we use a multivariate, data-driven method of identifying distinct functional brain activation profiles (i.e., "biotypes") and test whether these biotypes differentiate internalizing symptoms among IPV-exposed youth. 114 adolescent girls (n = 38 with no IPV exposure or psychopathology; n = 76 with IPV exposure and heterogeneous internalizing symptoms), aged 11-17, completed an emotion processing task during fMRI. To identify distinct biotypes of brain engagement profiles, data-driven clustering analysis was applied to patterns of voxel activation, constrained within a mask of distributed regions implicated in emotion processing. Resulting biotypes (BT1-3) were compared on measures of IPV exposure and internalizing symptoms, as well as symptom reduction during Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) among a subset of participants (n = 21). Cluster analyses identified three biotypes, differentiated by engagement of medial prefrontal, anterior insula, hippocampus, parietal, and ventral visual cortex during emotion processing. BT1 exhibited low levels of IPV exposure and internalizing symptoms. BT2 exhibited elevated levels of IPV, except sexual assault, and demonstrated moderate severity across internalizing symptom domains. BT3 exhibited elevated severity across all IPV and internalizing symptom domains. Greater symptom reduction during TF-CBT was associated with increased pre-to post-treatment changes in similarity with BT1. These results demonstrate distinct profiles of emotion processing neurocircuitry that differentiate heterogeneity in internalizing symptoms in IPV-exposed adolescent girls.
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Affiliation(s)
- Kyrie Sellnow
- University of Wisconsin Madison, Department of Psychiatry, USA
| | | | - Marisa C Ross
- University of Wisconsin Madison, Department of Psychiatry, USA
| | - Shelby Weaver
- University of Wisconsin Madison, Department of Psychiatry, USA
| | - Josh M Cisler
- University of Wisconsin Madison, Department of Psychiatry, USA.
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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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Tyler P, White SF, Thompson RW, Blair R. Applying a Cognitive Neuroscience Perspective to Disruptive Behavior Disorders: Implications for Schools. Dev Neuropsychol 2019; 44:17-42. [PMID: 29432037 PMCID: PMC6283690 DOI: 10.1080/87565641.2017.1334782] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
A cognitive neuroscience perspective seeks to understand behavior, in this case disruptive behavior disorders (DBD), in terms of dysfunction in cognitive processes underpinned by neural processes. While this type of approach has clear implications for clinical mental health practice, it also has implications for school-based assessment and intervention with children and adolescents who have disruptive behavior and aggression. This review articulates a cognitive neuroscience account of DBD by discussing the neurocognitive dysfunction related to emotional empathy, threat sensitivity, reinforcement-based decision-making, and response inhibition. The potential implications for current and future classroom-based assessments and interventions for students with these deficits are discussed.
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Affiliation(s)
- Patrick Tyler
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Omaha, Nebraska, USA
- Boys Town National Research Institute, Boys Town, Nebraska, USA
| | - Stuart F. White
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Omaha, Nebraska, USA
| | | | - R.J.R. Blair
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Omaha, Nebraska, USA
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Flanagan JC, Sippel LM, Santa Maria MMM, Hartwell KJ, Brady KT, Joseph JE. Impact of Oxytocin on the neural correlates of fearful face processing in PTSD related to childhood Trauma. Eur J Psychotraumatol 2019; 10:1606626. [PMID: 31105906 PMCID: PMC6508045 DOI: 10.1080/20008198.2019.1606626] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 03/25/2019] [Accepted: 03/28/2019] [Indexed: 01/04/2023] Open
Abstract
Background: Posttraumatic stress disorder (PTSD) related to exposure to abuse and neglect during childhood is associated with particularly severe and persistent deleterious outcomes. Amygdala hyperreactivity has been observed in childhood trauma survivors and implicated in symptoms of PTSD. Objective: The neuropeptide oxytocin holds promise as a potential treatment for PTSD due to its ability to attenuate amygdala response to threat cues. However, the effect of oxytocin on amygdala reactivity in individuals with childhood trauma-related PTSD has not been investigated. Method: We employed a double-blind, randomized, placebo-controlled crossover design to examine the effects of intranasal oxytocin (24 IU) versus placebo on amygdala reactivity to fearful faces among childhood-trauma exposed individuals with PTSD (n = 17) and without PTSD (control group; n = 16). Results: Region-of-interest based amygdala fMRI signal magnitude did not differ by group, drug, or group x drug interaction. Self-report of childhood trauma exposure severity was negatively associated with the oxytocin-related change in left amygdala response in the PTSD group, but not in the control group. Supplementary and exploratory whole-brain analyses conducted separately in each group revealed that left amygdala reactivity to fearful faces was absent on placebo but increased on oxytocin in the control group. The PTSD group showed right amygdala activation to fearful faces in both the oxytocin and placebo conditions, but the left amygdala response observed in the placebo condition was diminished on oxytocin. Conclusions: Findings extend the literature pertaining to the potential for oxytocin to attenuate neural correlates of PTSD to a childhood trauma-related PTSD sample.
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Affiliation(s)
- Julianne C Flanagan
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Lauren M Sippel
- National Center for PTSD, White River Junction, VT, USA.,Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Megan M Moran Santa Maria
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Karen J Hartwell
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA.,Ralph H. Johnson VAMC, Charleston, SC, USA
| | - Kathleen T Brady
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA.,Ralph H. Johnson VAMC, Charleston, SC, USA
| | - Jane E Joseph
- Department of Neuroscience, Medical University of South Carolina, Charleston, SC, USA
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Differential Roles of the Salience Network During Prediction Error Encoding and Facial Emotion Processing Among Female Adolescent Assault Victims. BIOLOGICAL PSYCHIATRY: COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2018; 4:371-380. [PMID: 30343131 DOI: 10.1016/j.bpsc.2018.08.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 08/13/2018] [Accepted: 08/25/2018] [Indexed: 12/31/2022]
Abstract
BACKGROUND Early-life assaultive violence exposure is a potent risk factor for posttraumatic stress disorder (PTSD) and other mood and anxiety disorders. Neurocircuitry models posit that increased risk is mediated by heightened emotion processing in a salience network including the dorsal anterior cingulate cortex, anterior insula, and amygdala. However, the processes of reinforcement learning (RL) also engage the salience network and are implicated in responses to early-life trauma and PTSD. To define their relative roles in response to early-life trauma and PTSD symptoms, the current study compared engagement of the salience network during emotion processing and RL as a function of early-life assault exposure. METHODS Adolescent girls (n = 30 girls who had previously been physically or sexually assaulted; n = 30 healthy girls for comparison) 11 to 17 years of age completed two types of tasks during functional magnetic resonance imaging: a facial emotion processing task and an RL task using either social or nonsocial stimuli. Independent component analysis was used to identify a salience network and characterize its engagement in response to emotion processing and prediction error encoding during the RL tasks. RESULTS Assault was related to greater reactivity of the salience network during emotion processing. By contrast, we found lesser encoding of negative prediction errors in the salience network, particularly during the social RL task, in girls who had been assaulted. The dysfunction of salience network activity during emotion processing and prediction error encoding was not associated with PTSD symptoms. CONCLUSIONS These results suggest that hyper- versus hypoactivity of the salience network among trauma-exposed youths depends on the cognitive-affective domain.
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Perceptions of Neighborhood Mediate the Relationship Between PTSD Symptoms and Coping in a Neighborhood-Matched Substance-Using Sample. J Addict Med 2018; 11:440-448. [PMID: 28885301 DOI: 10.1097/adm.0000000000000343] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES People with substance use problems living in neighborhoods with high levels of disorder are disproportionately likely to experience trauma and develop PTSD symptoms. We sought to evaluate the relationships between objective neighborhood disorder, perceptions of neighborhood, and the use of maladaptive coping behaviors among both non-substance-using and substance-using participants with and without PTSD symptoms. METHODS Participants (255 non-drug users [NDUs], 168 marijuana and/or alcohol users [MAUs], and 273 opioid and/or stimulant users) completed the Addiction Severity Index, PTSD Checklist-Civilian Version, The COPE Inventory, and the Perceived Neighborhood Scale. The Neighborhood Inventory for Environmental Typology (NIfETy) was used to objectively assess neighborhood disorder at participants' home addresses. Regression modeling was used to assess within-group predictors of PTSD and test for mediation in the relationships between PTSD, perceptions of neighborhood, and coping behaviors. RESULTS In NDUs, lower sense of community partially mediated the relationship between PTSD symptoms and using mental disengagement to cope. In MAUs, higher levels of perceived crime partially mediated the individual relationships between PTSD symptoms and using mental disengagement, focusing on and venting emotions, and using substances to cope. Opioid and/or stimulant users with PTSD symptoms reported using higher levels of mental disengagement, focusing on and venting emotions, and substances to cope and perceived a higher degree of crime; no mediation was inferred. CONCLUSION Perceptions of community and crime may be more predictive of PTSD symptoms than objectively measured neighborhood disorder. These perceptions partially mediate the relationship between maladaptive coping behaviors and PTSD symptoms.
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Schultz IZ, Sepehry AA, Greer SC. Impact of Common Mental Health Disorders on Cognition: Depression and Posttraumatic Stress Disorder in Forensic Neuropsychology Context. PSYCHOLOGICAL INJURY & LAW 2018. [DOI: 10.1007/s12207-018-9322-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Bina RW, Langevin JP. Closed Loop Deep Brain Stimulation for PTSD, Addiction, and Disorders of Affective Facial Interpretation: Review and Discussion of Potential Biomarkers and Stimulation Paradigms. Front Neurosci 2018; 12:300. [PMID: 29780303 PMCID: PMC5945819 DOI: 10.3389/fnins.2018.00300] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 04/18/2018] [Indexed: 01/06/2023] Open
Abstract
The treatment of psychiatric diseases with Deep Brain Stimulation (DBS) is becoming more of a reality as studies proliferate the indications and targets for therapies. Opinions on the initial failures of DBS trials for some psychiatric diseases point to a certain lack of finesse in using an Open Loop DBS (OLDBS) system in these dynamic, cyclical pathologies. OLDBS delivers monomorphic input into dysfunctional brain circuits with modulation of that input via human interface at discrete time points with no interim modulation or adaptation to the changing circuit dynamics. Closed Loop DBS (CLDBS) promises dynamic, intrinsic circuit modulation based on individual physiologic biomarkers of dysfunction. Discussed here are several psychiatric diseases which may be amenable to CLDBS paradigms as the neurophysiologic dysfunction is stochastic and not static. Post-Traumatic Stress Disorder (PTSD) has several peripheral and central physiologic and neurologic changes preceding stereotyped hyper-activation behavioral responses. Biomarkers for CLDBS potentially include skin conductance changes indicating changes in the sympathetic nervous system, changes in serum and central neurotransmitter concentrations, and limbic circuit activation. Chemical dependency and addiction have been demonstrated to be improved with both ablation and DBS of the Nucleus Accumbens and as a serendipitous side effect of movement disorder treatment. Potential peripheral biomarkers are similar to those proposed for PTSD with possible use of environmental and geolocation based cues, peripheral signs of physiologic arousal, and individual changes in central circuit patterns. Non-substance addiction disorders have also been serendipitously treated in patients with OLDBS for movement disorders. As more is learned about these behavioral addictions, DBS targets and effectors will be identified. Finally, discussed is the use of facial recognition software to modulate activation of inappropriate responses for psychiatric diseases in which misinterpretation of social cues feature prominently. These include Autism Spectrum Disorder, PTSD, and Schizophrenia-all of which have a common feature of dysfunctional interpretation of facial affective clues. Technological advances and improvements in circuit-based, individual-specific, real-time adaptable modulation, forecast functional neurosurgery treatments for heretofore treatment-resistant behavioral diseases.
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Affiliation(s)
- Robert W Bina
- Division of Neurosurgery, Banner University Medical Center, Tucson, AZ, United States
| | - Jean-Phillipe Langevin
- Neurosurgery Service, VA Greater Los Angeles Healthcare System, Los Angeles, CA, United States.,Department of Neurosurgery, University of California, Los Angeles, Los Angeles, CA, United States
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Cisler JM, Privratsky A, Smitherman S, Herringa RJ, Kilts CD. Large-scale brain organization during facial emotion processing as a function of early life trauma among adolescent girls. NEUROIMAGE-CLINICAL 2017. [PMID: 29527485 PMCID: PMC5842665 DOI: 10.1016/j.nicl.2017.12.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background A wealth of research has investigated the impact of early life trauma exposure on functional brain activation during facial emotion processing and has often demonstrated amygdala hyperactivity and weakened connectivity between amygdala and medial PFC (mPFC). There have been notably limited investigations linking these previous node-specific findings into larger-scale network models of brain organization. Method To address these gaps, we applied graph theoretical analyses to fMRI data collected during a facial emotion processing task among 88 adolescent girls (n = 59 exposed to direct physical or sexual assault; n = 29 healthy controls), aged 11-17, during fMRI. Large-scale organization indices of modularity, assortativity, and global efficiency were calculated for stimulus-specific functional connectivity using an 883 region-of-interest parcellation. Results Among the entire sample, more severe early life trauma was associated with more modular and assortative, but less globally efficient, network organization across all stimulus categories. Among the assaulted girls, severity of early life trauma and PTSD diagnoses were both simultaneously related to increased modular brain organization. We also found that more modularized network organization was related both to amygdala hyperactivation and weakened connectivity between amygdala and medial PFC. Conclusions These results demonstrate that early life trauma is associated with enhanced brain organization during facial emotion processing and that this pattern of brain organization might explain the commonly observed association between childhood trauma and amygdala hyperactivity and weakened connectivity with mPFC. Implications of these results for neurocircuitry models are discussed.
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Affiliation(s)
- Josh M Cisler
- University of Wisconsin Madison, Department of Psychiatry, United States.
| | - Anthony Privratsky
- University of Arkansas for Medical Sciences, Department of Psychiatry, Brain Imaging Research Center, United States
| | - Sonet Smitherman
- University of Arkansas for Medical Sciences, Department of Psychiatry, Brain Imaging Research Center, United States
| | - Ryan J Herringa
- University of Wisconsin Madison, Department of Psychiatry, United States
| | - Clinton D Kilts
- University of Arkansas for Medical Sciences, Department of Psychiatry, Brain Imaging Research Center, United States
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van Hoof MJ, van den Bulk BG, Rombouts SARB, Rinne-Albers MAW, van der Wee NJA, van IJzendoorn MH, Vermeiren RRJM. Emotional face processing in adolescents with childhood sexual abuse-related posttraumatic stress disorder, internalizing disorders and healthy controls. Psychiatry Res Neuroimaging 2017; 264:52-59. [PMID: 28458084 DOI: 10.1016/j.pscychresns.2017.04.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2016] [Revised: 04/09/2017] [Accepted: 04/12/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Marie-José van Hoof
- Curium-LUMC, Department of Child and Adolescent Psychiatry, Leiden University Medical Center, Leiden, The Netherlands; YOEP (Yulius Onderwijs zorg Expertise Partners), Warmond, The Netherlands; Leiden Institute for Brain and Cognition (LIBC), Leiden University, Leiden, The Netherlands.
| | - Bianca G van den Bulk
- Leiden Institute for Brain and Cognition (LIBC), Leiden University, Leiden, The Netherlands; Department of Child and Family Studies, Faculty of Social Sciences, Leiden University, The Netherlands
| | - Serge A R B Rombouts
- Leiden Institute for Brain and Cognition (LIBC), Leiden University, Leiden, The Netherlands; Institute of Psychology, Leiden University, The Netherlands; Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Mirjam A W Rinne-Albers
- Curium-LUMC, Department of Child and Adolescent Psychiatry, Leiden University Medical Center, Leiden, The Netherlands
| | - Nic J A van der Wee
- Leiden Institute for Brain and Cognition (LIBC), Leiden University, Leiden, The Netherlands; Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands
| | - Marinus H van IJzendoorn
- Leiden Institute for Brain and Cognition (LIBC), Leiden University, Leiden, The Netherlands; Department of Child and Family Studies, Faculty of Social Sciences, Leiden University, The Netherlands; School of Pedagogical and Educational Sciences, Erasmus University, Rotterdam, The Netherlands
| | - Robert R J M Vermeiren
- Curium-LUMC, Department of Child and Adolescent Psychiatry, Leiden University Medical Center, Leiden, The Netherlands; Leiden Institute for Brain and Cognition (LIBC), Leiden University, Leiden, The Netherlands; VU Medical Center, Department of Child and Adolescent Psychiatry, Amsterdam, The Netherlands
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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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Cisler JM, Sigel BA, Steele JS, Smitherman S, Vanderzee K, Pemberton J, Kramer TL, Kilts CD. Changes in functional connectivity of the amygdala during cognitive reappraisal predict symptom reduction during trauma-focused cognitive-behavioral therapy among adolescent girls with post-traumatic stress disorder. Psychol Med 2016; 46:3013-3023. [PMID: 27524285 DOI: 10.1017/s0033291716001847] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND While trauma-focused cognitive-behavioral therapy (TF-CBT) is the 'gold standard' treatment for pediatric post-traumatic stress disorder (PTSD), little is known about the neural mechanisms by which TF-CBT produces clinical benefit. Here, we test the hypothesis that PTSD symptom reduction during TF-CBT among adolescent girls with PTSD is associated with changes in patterns of brain functional connectivity (FC) with the amygdala during cognitive reappraisal. METHOD Adolescent girls with PTSD related to physical or sexual assault (n = 34) were enrolled in TF-CBT, delivered in an approximately 12-session format, in an open trial. Before and after treatment, they were engaged in a cognitive reappraisal task, probing neural mechanisms of explicit emotion regulation, during 3 T functional magnetic resonance imaging. RESULTS Among adolescent girls completing TF-CBT with usable pre- and post-treatment scans (n = 20), improvements in self-reported emotion from pre- to post-treatment were positively related to improvements in PTSD symptoms. Adolescent girls with greater post-treatment symptom reduction were also able to suppress amygdala-insula FC while re-appraising, which was not evident in girls with less symptom reduction. Pre- to post-treatment changes in right amygdala to left insula FC that scaled with PTSD symptom reduction also scaled with improvements in emotion regulation. CONCLUSIONS These preliminary results suggest the neurocircuitry mechanisms through which TF-CBT produces clinical outcomes, providing putative brain targets for augmenting TF-CBT response.
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Affiliation(s)
- J M Cisler
- Department of Psychiatry,Brain Imaging Research Center,University of Arkansas for Medical Sciences,Little Rock, AR,USA
| | - B A Sigel
- Department of Psychiatry,Brain Imaging Research Center,University of Arkansas for Medical Sciences,Little Rock, AR,USA
| | - J S Steele
- Department of Psychiatry,Brain Imaging Research Center,University of Arkansas for Medical Sciences,Little Rock, AR,USA
| | - S Smitherman
- Department of Psychiatry,Brain Imaging Research Center,University of Arkansas for Medical Sciences,Little Rock, AR,USA
| | - K Vanderzee
- Department of Psychiatry,Brain Imaging Research Center,University of Arkansas for Medical Sciences,Little Rock, AR,USA
| | - J Pemberton
- Department of Psychiatry,Brain Imaging Research Center,University of Arkansas for Medical Sciences,Little Rock, AR,USA
| | - T L Kramer
- Department of Psychiatry,Brain Imaging Research Center,University of Arkansas for Medical Sciences,Little Rock, AR,USA
| | - C D Kilts
- Department of Psychiatry,Brain Imaging Research Center,University of Arkansas for Medical Sciences,Little Rock, AR,USA
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van den Bulk BG, Somerville LH, van Hoof MJ, van Lang NDJ, van der Wee NJA, Crone EA, Vermeiren RRJM. Amygdala habituation to emotional faces in adolescents with internalizing disorders, adolescents with childhood sexual abuse related PTSD and healthy adolescents. Dev Cogn Neurosci 2016; 21:15-25. [PMID: 27591712 PMCID: PMC6987649 DOI: 10.1016/j.dcn.2016.08.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2016] [Revised: 08/23/2016] [Accepted: 08/23/2016] [Indexed: 11/24/2022] Open
Abstract
A study investigating habituation patterns in the amygdala. Compares adolescents with internalizing disorders and adolescents with CSA-related PTSD. Initial heightened response and fast habituation in amygdala for the PTSD group. No habituation of amygdala response in the internalizing group. Possible difference in underlying neurobiological mechanisms for emotional face processing.
Adolescents with internalizing disorders and adolescents with childhood sexual abuse related post-traumatic stress disorder (CSA-related PTSD) show a large overlap in symptomatology. In addition, brain research indicated hyper-responsiveness and sustained activation instead of habituation of amygdala activation to emotional faces in both groups. Little is known, however, about whether the same patterns of amygdala habituation are present in these two groups. The current study examined habituation patterns of amygdala activity to emotional faces (fearful, happy and neutral) in adolescents with a DSM-IV depressive and/or anxiety disorder (N = 25), adolescents with CSA-related PTSD (N = 19) and healthy controls (N = 26). Behaviourally, the adolescents from the internalizing and CSA-related PTSD group reported more anxiety to fearful and neutral faces than adolescents from the control group and adolescents from the CSA-related PTSD group reacted slower compared to the internalizing group. At the whole brain level, there was a significant interaction between time and group within the left amygdala. Follow-up ROI analysis showed elevated initial activity in the amygdala and rapid habituation in the CSA-related PTSD group compared to the internalizing group. These findings suggest that habituation patterns of amygdala activation provide additional information on problems with emotional face processing. Furthermore, the results suggest there are differences in the underlying neurobiological mechanisms related to emotional face processing for adolescents with internalizing disorders and adolescents with CSA-related PTSD. Possibly CSA-related PTSD is characterized by a stronger primary emotional response driven by the amygdala.
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Affiliation(s)
- Bianca G van den Bulk
- Curium-LUMC, Department of Child Psychiatry, Leiden University Medical Centre, P.O. box 9600, 2300 RC Leiden, the Netherlands; Leiden Consortium on Individual Development, Department of Child and Family Studies, Leiden University, P.O. box 9555, 2300 RB Leiden, the Netherlands; Institute of Psychology, Brain and Development Lab, Leiden University, P.O. box 9555, 2300 RB Leiden, the Netherlands; Leiden Institute for Brain and Cognition, Leiden University Medical Centre, P.O. box 9600, 2300 RC Leiden, the Netherlands.
| | - Leah H Somerville
- Department of Psychology, Affective Neuroscience and Development Lab, Harvard University, 52 Oxford Street, Cambridge, MA 02138, USA
| | - Marie-José van Hoof
- Curium-LUMC, Department of Child Psychiatry, Leiden University Medical Centre, P.O. box 9600, 2300 RC Leiden, the Netherlands; Leiden Institute for Brain and Cognition, Leiden University Medical Centre, P.O. box 9600, 2300 RC Leiden, the Netherlands; GGZ Rivierduinen, Psychotraumacenter and Department of Child and Adolescent Psychiatry, P.O. box 2211, 2301 CE Leiden, the Netherlands
| | - Natasja D J van Lang
- Curium-LUMC, Department of Child Psychiatry, Leiden University Medical Centre, P.O. box 9600, 2300 RC Leiden, the Netherlands; Leiden Institute for Brain and Cognition, Leiden University Medical Centre, P.O. box 9600, 2300 RC Leiden, the Netherlands
| | - Nic J A van der Wee
- Leiden Institute for Brain and Cognition, Leiden University Medical Centre, P.O. box 9600, 2300 RC Leiden, the Netherlands; Department of Psychiatry, Leiden University Medical Centre. P.O. box 9600, 2300 RC Leiden, the Netherlands
| | - Eveline A Crone
- Institute of Psychology, Brain and Development Lab, Leiden University, P.O. box 9555, 2300 RB Leiden, the Netherlands; Leiden Institute for Brain and Cognition, Leiden University Medical Centre, P.O. box 9600, 2300 RC Leiden, the Netherlands
| | - Robert R J M Vermeiren
- Curium-LUMC, Department of Child Psychiatry, Leiden University Medical Centre, P.O. box 9600, 2300 RC Leiden, the Netherlands; Leiden Institute for Brain and Cognition, Leiden University Medical Centre, P.O. box 9600, 2300 RC Leiden, the Netherlands; Department of Child Psychiatry, VU University Medical Centre, P.O. box 303, 1115 ZG Duivendrecht, the Netherlands
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Cisler JM, Sigel BA, Kramer TL, Smitherman S, Vanderzee K, Pemberton J, Kilts CD. Modes of Large-Scale Brain Network Organization during Threat Processing and Posttraumatic Stress Disorder Symptom Reduction during TF-CBT among Adolescent Girls. PLoS One 2016; 11:e0159620. [PMID: 27505076 PMCID: PMC4978452 DOI: 10.1371/journal.pone.0159620] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Accepted: 07/06/2016] [Indexed: 11/18/2022] Open
Abstract
Posttraumatic stress disorder (PTSD) is often chronic and disabling across the lifespan. The gold standard treatment for adolescent PTSD is Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT), though treatment response is variable and mediating neural mechanisms are not well understood. Here, we test whether PTSD symptom reduction during TF-CBT is associated with individual differences in large-scale brain network organization during emotion processing. Twenty adolescent girls, aged 11–16, with PTSD related to assaultive violence completed a 12-session protocol of TF-CBT. Participants completed an emotion processing task, in which neutral and fearful facial expressions were presented either overtly or covertly during 3T fMRI, before and after treatment. Analyses focused on characterizing network properties of modularity, assortativity, and global efficiency within an 824 region-of-interest brain parcellation separately during each of the task blocks using weighted functional connectivity matrices. We similarly analyzed an existing dataset of healthy adolescent girls undergoing an identical emotion processing task to characterize normative network organization. Pre-treatment individual differences in modularity, assortativity, and global efficiency during covert fear vs neutral blocks predicted PTSD symptom reduction. Patients who responded better to treatment had greater network modularity and assortativity but lesser efficiency, a pattern that closely resembled the control participants. At a group level, greater symptom reduction was associated with greater pre-to-post-treatment increases in network assortativity and modularity, but this was more pronounced among participants with less symptom improvement. The results support the hypothesis that modularized and resilient brain organization during emotion processing operate as mechanisms enabling symptom reduction during TF-CBT.
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Affiliation(s)
- Josh M. Cisler
- Brain Imaging Research Center, Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, Arkansas, 72205, United States of America
- * E-mail:
| | - Benjamin A. Sigel
- Brain Imaging Research Center, Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, Arkansas, 72205, United States of America
| | - Teresa L. Kramer
- Brain Imaging Research Center, Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, Arkansas, 72205, United States of America
| | - Sonet Smitherman
- Brain Imaging Research Center, Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, Arkansas, 72205, United States of America
| | - Karin Vanderzee
- Brain Imaging Research Center, Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, Arkansas, 72205, United States of America
| | - Joy Pemberton
- Brain Imaging Research Center, Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, Arkansas, 72205, United States of America
| | - Clinton D. Kilts
- Brain Imaging Research Center, Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, Arkansas, 72205, United States of America
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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: 32] [Impact Index Per Article: 4.0] [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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