1
|
Hinojosa CA, George GC, Ben-Zion Z. Neuroimaging of posttraumatic stress disorder in adults and youth: progress over the last decade on three leading questions of the field. Mol Psychiatry 2024:10.1038/s41380-024-02558-w. [PMID: 38632413 DOI: 10.1038/s41380-024-02558-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 04/04/2024] [Accepted: 04/08/2024] [Indexed: 04/19/2024]
Abstract
Almost three decades have passed since the first posttraumatic stress disorder (PTSD) neuroimaging study was published. Since then, the field of clinical neuroscience has made advancements in understanding the neural correlates of PTSD to create more efficacious treatment strategies. While gold-standard psychotherapy options are available, many patients do not respond to them, prematurely drop out, or never initiate treatment. Therefore, elucidating the neurobiological mechanisms that define the disorder can help guide clinician decision-making and develop individualized mechanisms-based treatment options. To this end, this narrative review highlights progress made in the last decade in adult and youth samples on three outstanding questions in PTSD research: (1) Which neural alterations serve as predisposing (pre-exposure) risk factors for PTSD development, and which are acquired (post-exposure) alterations? (2) Which neural alterations can predict treatment outcomes and define clinical improvement? and (3) Can neuroimaging measures be used to define brain-based biotypes of PTSD? While the studies highlighted in this review have made progress in answering the three questions, the field still has much to do before implementing these findings into clinical practice. Overall, to better answer these questions, we suggest that future neuroimaging studies of PTSD should (A) utilize prospective longitudinal designs, collecting brain measures before experiencing trauma and at multiple follow-up time points post-trauma, taking advantage of multi-site collaborations/consortiums; (B) collect two scans to explore changes in brain alterations from pre-to-post treatment and compare changes in neural activation between treatment groups, including longitudinal follow up assessments; and (C) replicate brain-based biotypes of PTSD. By synthesizing recent findings, this narrative review will pave the way for personalized treatment approaches grounded in neurobiological evidence.
Collapse
Affiliation(s)
- Cecilia A Hinojosa
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA.
| | - Grace C George
- Department of Psychiatry, McLean Hospital, Belmont, MA, USA
| | - Ziv Ben-Zion
- Department of Comparative Medicine, Yale University School of Medicine, New Haven, CT, USA
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- US Department of Veterans Affairs National Center for PTSD, VA Connecticut Healthcare System, West Haven, CT, USA
| |
Collapse
|
2
|
Gottfredson RK, Becker WJ. How past trauma impacts emotional intelligence: Examining the connection. Front Psychol 2023; 14:1067509. [PMID: 37275697 PMCID: PMC10234103 DOI: 10.3389/fpsyg.2023.1067509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 05/02/2023] [Indexed: 06/07/2023] Open
Abstract
Backed by both research and practice, the organizational psychology field has come to value emotional intelligence (EI) as being vital for leader and employee effectiveness. While this field values EI, it has paid little attention to the antecedents of emotional intelligence, leaving the EI domain without clarity on (1) why EI might vary across individuals, and (2) how to best develop EI. In this article, we rely on neuroscience and psychology research to make the case that past psychological trauma impacts later EI capabilities. Specifically, we present evidence that psychological trauma impairs the brain areas and functions that support EI. Establishing psychological trauma has valuable theoretical and practical implications that include providing an explanation of why EI might vary across individuals and providing a focus for improving EI: healing from past trauma. Further theoretical and practical implications for the field of organizational psychology are provided.
Collapse
Affiliation(s)
- Ryan K Gottfredson
- Department of Management, College of Business and Economics, California State University, Fullerton, CA, United States
| | - William J Becker
- Department of Management, Pamplin College of Business, Virginia Tech, Blacksburg, VA, United States
| |
Collapse
|
3
|
Garrett AS, Zhang W, Price LR, Cross J, Gomez-Guiliani N, van Hoof MJ, Carrion V, Cohen JA. Structural equation modeling of treatment-related changes in neural connectivity for youth with PTSD. J Affect Disord 2023; 334:50-59. [PMID: 37127117 DOI: 10.1016/j.jad.2023.04.066] [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: 11/20/2022] [Revised: 04/06/2023] [Accepted: 04/16/2023] [Indexed: 05/03/2023]
Abstract
BACKGROUND Previous studies suggest that improvement in symptoms of posttraumatic stress disorder (PTSD) is accompanied by changes in neural connectivity, however, few studies have investigated directional (effective) connectivity. The current study assesses treatment-related changes in effective connectivity in youth with PTSD undergoing Trauma-Focused Cognitive Behavioral Therapy (TF-CBT). METHODS Functional MRI scans before and after 16 weeks of TF-CBT for 20 youth with PTSD, or the same time interval for 20 healthy controls (HC) were included in the analysis. Structural equation modeling was used to model group differences in directional connectivity at baseline, and changes in connectivity from pre- to post-treatment. RESULTS At baseline, the PTSD group, relative to the HC group, had significantly greater connectivity in the path from dorsal cingulate to anterior cingulate and from dorsal cingulate to posterior cingulate corticies. From pre- to post-treatment, connectivity in these paths decreased significantly in the PTSD group, as did connectivity from right hippocampus to left superior temporal gyrus. Connectivity from the left amygdala to the lateral orbital frontal cortex was significantly lower in PTSD vs HC at baseline, but did not change from pre- to post-treatment. CONCLUSION Although based on a small sample, these results converge with previous studies in suggesting a central role for the dorsal cingulate cortex in PTSD symptoms. The direction of this connectivity suggests that the dorsal cingulate is the source of modulation of anterior and posterior cingulate cortex during trauma-focused cognitive behavioral therapy.
Collapse
Affiliation(s)
- Amy S Garrett
- Department of Psychiatry & Behavioral Sciences, University of Texas Health Science Center San Antonio, United States of America; Research Imaging Institute, University of Texas Health Science Center San Antonio, United States of America.
| | - Wei Zhang
- Research Imaging Institute, University of Texas Health Science Center San Antonio, United States of America
| | - Larry R Price
- Department of Methodology, Measurement & Statistical Analysis, Texas State University, United States of America
| | - Jeremyra Cross
- Department of Psychiatry & Behavioral Sciences, University of Texas Health Science Center San Antonio, United States of America
| | - Natalia Gomez-Guiliani
- Department of Psychiatry & Behavioral Sciences, University of Texas Health Science Center San Antonio, United States of America
| | - Marie-Jose van Hoof
- Department of Child and Adolescent Psychiatry, Amsterdam University Medical Center, the Netherlands; Department of Developmental and Educational Psychology, Leiden University, the Netherlands
| | - Victor Carrion
- Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, United States of America
| | - Judith A Cohen
- Department of Psychiatry, Drexel University College of Medicine, Allegheny Health Network, United States of America
| |
Collapse
|
4
|
Pierce ZP, Johnson ER, Kim IA, Lear BE, Mast AM, Black JM. Therapeutic interventions impact brain function and promote post-traumatic growth in adults living with post-traumatic stress disorder: A systematic review and meta-analysis of functional magnetic resonance imaging studies. Front Psychol 2023; 14:1074972. [PMID: 36844333 PMCID: PMC9948410 DOI: 10.3389/fpsyg.2023.1074972] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 01/20/2023] [Indexed: 02/11/2023] Open
Abstract
Introduction The present systematic review and meta-analysis explores the impacts of cognitive processing therapy (CPT), eye movement desensitization and reprocessing (EMDR), and prolonged exposure (PE) therapy on neural activity underlying the phenomenon of post-traumatic growth for adult trauma survivors. Methods We utilized the following databases to conduct our systematic search: Boston College Libraries, PubMed, MEDLINE, and PsycINFO. Our initial search yielded 834 studies for initial screening. We implemented seven eligibility criteria to vet articles for full-text review. Twenty-nine studies remained for full-text review after our systematic review process was completed. Studies were subjected to several levels of analysis. First, pre-and post- test post-traumatic growth inventory (PTGI) scores were collected from all studies and analyzed through a forest plot using Hedges' g. Next, Montreal Neurological Institute (MNI) coordinates and t-scores were collected and analyzed using an Activation Likelihood Estimation (ALE) to measure brain function. T-scores and Hedges' g values were then analyzed using Pearson correlations to determine if there were any relationships between brain function and post-traumatic growth for each modality. Lastly, all studies were subjected to a bubble plot and Egger's test to assess risk of publication bias across the review sample. Results Forest plot results indicated that all three interventions had a robust effect on PTGI scores. ALE meta-analysis results indicated that EMDR exhibited the largest effect on brain function, with the R thalamus (t = 4.23, p < 0.001) showing robust activation, followed closely by the R precuneus (t = 4.19, p < 0.001). Pearson correlation results showed that EMDR demonstrated the strongest correlation between increased brain function and PTGI scores (r = 0.910, p < 0.001). Qualitative review of the bubble plot indicated no obvious traces of publication bias, which was corroborated by the results of the Egger's test (p = 0.127). Discussion Our systematic review and meta-analysis showed that CPT, EMDR, and PE each exhibited a robust effect on PTG impacts across the course of treatment. However, when looking closer at comparative analyses of neural activity (ALE) and PTGI scores (Pearson correlation), EMDR exhibited a more robust effect on PTG impacts and brain function than CPT and PE.
Collapse
Affiliation(s)
- Zachary P. Pierce
- School of Social Work, Boston College, Chestnut Hill, MA, United States
- The Cell to Society Laboratory, Chestnut Hill, MA, United States
| | - Emily R. Johnson
- School of Social Work, Boston College, Chestnut Hill, MA, United States
- The Cell to Society Laboratory, Chestnut Hill, MA, United States
| | - Isabelle A. Kim
- The Cell to Society Laboratory, Chestnut Hill, MA, United States
- Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States
| | - Brianna E. Lear
- The Cell to Society Laboratory, Chestnut Hill, MA, United States
| | - A. Michaela Mast
- School of Social Work, Boston College, Chestnut Hill, MA, United States
- The Cell to Society Laboratory, Chestnut Hill, MA, United States
| | - Jessica M. Black
- School of Social Work, Boston College, Chestnut Hill, MA, United States
- The Cell to Society Laboratory, Chestnut Hill, MA, United States
| |
Collapse
|
5
|
Lin Y, Lv W, Xu J, Jiang Y, Chen Z. Effectiveness of Cognitive Behavior Therapy Combined with Eye Movement Desensitization and Reprocessing on Psychological Problems and Life Quality in Patients' Postfacial Trauma. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:7822847. [PMID: 36118833 PMCID: PMC9473919 DOI: 10.1155/2022/7822847] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 08/22/2022] [Accepted: 08/26/2022] [Indexed: 11/22/2022]
Abstract
Objective To investigate the effectiveness of cognitive behavior therapy (CBT) combined with eye movement desensitization and reprocessing (EMDR) on the esteem, anxiety, depression, posttrauma stress disorder (PTSD), and posttraumatic growth in patients with facial trauma. Methods A total of 92 facial trauma patients in Wenzhou People's Hospital from January 2017 to December 2019 were enrolled in this study. The patients were randomly divided into control group (n = 46) and intervention group (n = 46). Both of the control group and the intervention group received routine treatment, while the intervention group further received CBT combined with EMDR. Questionnaires were used to explore and record the general patient information. The Self-Esteem Scale (SES), Self-Anxiety Scale (SAS), Self-Depression Scale (SDS), Posttraumatic Stress Disorder Checklist Civilian Version (PCL-C), Posttraumatic Growth Inventory (PTGI), and World Health Organization Quality of Life-brief (WHOQOL-BREF) scores between the two groups were compared. Results After CBT combined with EMDR intervention, the SDS and SAS scores in the intervention group were significantly decreased compared with the scores before intervention with statistically significance (P < 0.001). Furthermore, the PCL-C score in the intervention group showed significant decrease in comparison with the control group (P < 0.001), while the PTGI score in the intervention group was significantly higher than the control group (P < 0.001). The WHOQOL-BREF scores were increased after treatment in the two groups compared with the scores before treatment, and the scores in the intervention group were higher than those in the control group after treatment (P < 0.01). Conclusion Psychological intervention therapy can effectively alleviate the anxiety, depression, and PTSD and improve the life quality and the recovery of facial trauma patients.
Collapse
Affiliation(s)
- Yue Lin
- Department of Emergency, Wenzhou People's Hospital, Wenzhou, Zhejiang 325000, China
| | - Wang Lv
- Department of Emergency, Wenzhou People's Hospital, Wenzhou, Zhejiang 325000, China
| | - Jun Xu
- Department of Endoscopy Center, Wenzhou People's Hospital, Wenzhou, Zhejiang 325000, China
| | - Yingying Jiang
- Department of Emergency, Wenzhou People's Hospital, Wenzhou, Zhejiang 325000, China
| | - Zheyan Chen
- Department of Plastic Surgery, Wenzhou People's Hospital, Wenzhou, Zhejiang 325000, China
| |
Collapse
|
6
|
Tian T, Zhang G, Wang J, Liu D, Wan C, Fang J, Wu D, Zhou Y, Qin Y, Zhu H, Li Y, Li J, Zhu W. Contribution of brain network connectivity in predicting effects of polygenic risk and childhood trauma on state-trait anxiety. J Psychiatr Res 2022; 152:119-127. [PMID: 35724493 DOI: 10.1016/j.jpsychires.2022.06.027] [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: 11/11/2021] [Revised: 04/25/2022] [Accepted: 06/10/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Anxiety is usually attributed to adverse environmental factors, but it is known as a polygenic inheritance disease. Gene-environment interactions on the occurrence and severity of anxiety are still unclear. The role of brain network connectivity in the gene-environment effects on anxiety has not been explored and may be key to understanding neuropathogenesis and guiding treatment. METHODS This study recruited 177 young adults from the community that completed functional magnetic resonance imaging, Childhood Trauma Questionnaire (CTQ), state-trait anxiety scores, and whole exome sequencing. We calculated polygenic risk score (PRS) for anxiety and the sum score of CTQ, which are genetic and environmental factors that may affect anxiety, respectively. Abnormal brain network connectivity determined by the gene-environment effects and its associations with anxiety scores were then explored. RESULTS Except for the main effect of PRS or CTQ on intra-network connectivity, significant interactions were found in intra-network connectivity of visual network, default mode network, self-reference network, and sensorimotor network. Moreover, altered network connectivity was related to anxious tendency. In particular, the effect of CTQ on trait anxiety was mediated by the disrupted sensorimotor network, accompanied by a significant direct effect. However, the PRS influence on anxiety was mainly mediated through sensorimotor network paths, which exceeded the direct influence and was moderated by childhood trauma levels. CONCLUSIONS These network-specific functional changes related to individual gene-environment risks advance our understanding of psychiatric pathogenesis of anxiety and provide new insights for clinical intervention.
Collapse
Affiliation(s)
- Tian Tian
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Guiling Zhang
- Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Jian Wang
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Dong Liu
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Changhua Wan
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Jicheng Fang
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Di Wu
- Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Yiran Zhou
- Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Yuanyuan Qin
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Hongquan Zhu
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Yuanhao Li
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Jia Li
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
| | - Wenzhen Zhu
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
| |
Collapse
|
7
|
Xian-Yu CY, Deng NJ, Zhang J, Li HY, Gao TY, Zhang C, Gong QQ. Cognitive behavioral therapy for children and adolescents with post-traumatic stress disorder: meta-analysis. J Affect Disord 2022; 308:502-511. [PMID: 35460743 DOI: 10.1016/j.jad.2022.04.111] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 03/27/2022] [Accepted: 04/15/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Children and adolescents who experience traumatic events may develop post-traumatic stress disorder (PTSD), which is often associated with other psychiatric disorders, including depression and anxiety. Cognitive behavioral therapy (CBT) is widely used in psychotherapy to treat PTSD in children and adolescents. This meta-analysis evaluated previous studies on the effectiveness of CBT in the treatment of PTSD in children and adolescents. METHODS Randomized controlled trials (RCTs) published before July 25, 2021, were retrieved from seven databases. All RCTs of CBT compared to control, including conventional treatment or other treatments, in children or adolescents with PTSD. Random effect models were employed for all outcomes. Risk of bias was performed by Cochrane Collaboration's tool. The publication bias was evaluated using the Egger's regression analysis. RESULTS Nineteen RCTs were included in the meta-analysis. Compared with control, CBT was effective in reducing the symptoms of PTSD in children and adolescents, with a variety of scales used to measure the overall PTSD symptoms: CAPS (SMD = -0.41, 95%CI [-0.71, -0.12]), CPSS (SMD = -0.88, 95%CI [-1.42, -0.34]) and UCLA-PTSD RI (SMD = -1.70, 95%CI [-2.98, -0.42]). Furthermore, CBT also improved the comorbidities of depression (SMD = -0.43, 95%CI [-0.70, -0.17]) and anxiety (SMD = -0.29, 95%CI [-0.56, -0.03]) associated with PTSD. However, CBT was not effective in reducing avoidance symptoms (SMD = 0.38, 95%CI [-0.55, 1.31]). CONCLUSION CBT can reduce the severity of PTSD in children and adolescents and improve the symptoms of depression and anxiety, as evident in the treatment of PTSD victims of sexual abuse and war and in patients aged more than 7 years.
Collapse
Affiliation(s)
- Chen-Yang Xian-Yu
- Center for Evidence-Based Medicine and Clinical Research, Taihe Hospital, Hubei University of Medicine, Shiyan 442000, Hubei, China
| | - Nian-Jia Deng
- Center for Evidence-Based Medicine and Clinical Research, Taihe Hospital, Hubei University of Medicine, Shiyan 442000, Hubei, China
| | - Jin Zhang
- Department of Information Resources, Taihe Hospital, Hubei University of Medicine, Shiyan 442000, China
| | - Hao-Yang Li
- Center for Evidence-Based Medicine and Clinical Research, Taihe Hospital, Hubei University of Medicine, Shiyan 442000, Hubei, China
| | - Teng-Yu Gao
- Center for Evidence-Based Medicine and Clinical Research, Taihe Hospital, Hubei University of Medicine, Shiyan 442000, Hubei, China
| | - Chao Zhang
- Center for Evidence-Based Medicine and Clinical Research, Taihe Hospital, Hubei University of Medicine, Shiyan 442000, Hubei, China.
| | - Qin-Qin Gong
- Center for Evidence-Based Medicine and Clinical Research, Taihe Hospital, Hubei University of Medicine, Shiyan 442000, Hubei, China; Center of Women's Health Sciences, Taihe Hospital, Hubei University of Medicine, Shiyan 420000, China.
| |
Collapse
|
8
|
Persichilli G, Grifoni J, Pagani M, Bertoli M, Gianni E, L'Abbate T, Cerniglia L, Bevacqua G, Paulon L, Tecchio F. Sensorimotor Interaction Against Trauma. Front Neurosci 2022; 16:913410. [PMID: 35774554 PMCID: PMC9238294 DOI: 10.3389/fnins.2022.913410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 05/18/2022] [Indexed: 11/16/2022] Open
Affiliation(s)
- Giada Persichilli
- Laboratory of Electrophysiology for Translational Neuroscience LET'S, Institute of Cognitive Sciences and Technologies ISTC, Consiglio Nazionale Delle Ricerche CNR, Rome, Italy
| | - Joy Grifoni
- Laboratory of Electrophysiology for Translational Neuroscience LET'S, Institute of Cognitive Sciences and Technologies ISTC, Consiglio Nazionale Delle Ricerche CNR, Rome, Italy
- Department of Neuroscience, Imaging and Clinical Sciences, University “Gabriele D'Annunzio” of Chieti-Pescara, Chieti, Italy
- Faculty of Psychology, International Telematic University Uninettuno, Rome, Italy
| | - Marco Pagani
- Laboratory of Electrophysiology for Translational Neuroscience LET'S, Institute of Cognitive Sciences and Technologies ISTC, Consiglio Nazionale Delle Ricerche CNR, Rome, Italy
| | - Massimo Bertoli
- Laboratory of Electrophysiology for Translational Neuroscience LET'S, Institute of Cognitive Sciences and Technologies ISTC, Consiglio Nazionale Delle Ricerche CNR, Rome, Italy
- Department of Neuroscience, Imaging and Clinical Sciences, University “Gabriele D'Annunzio” of Chieti-Pescara, Chieti, Italy
| | - Eugenia Gianni
- Laboratory of Electrophysiology for Translational Neuroscience LET'S, Institute of Cognitive Sciences and Technologies ISTC, Consiglio Nazionale Delle Ricerche CNR, Rome, Italy
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, University Campus Bio-Medico of Rome, Rome, Italy
| | - Teresa L'Abbate
- Laboratory of Electrophysiology for Translational Neuroscience LET'S, Institute of Cognitive Sciences and Technologies ISTC, Consiglio Nazionale Delle Ricerche CNR, Rome, Italy
- Department of Neuroscience, Imaging and Clinical Sciences, University “Gabriele D'Annunzio” of Chieti-Pescara, Chieti, Italy
| | - Luca Cerniglia
- Faculty of Psychology, International Telematic University Uninettuno, Rome, Italy
| | | | | | - Franca Tecchio
- Laboratory of Electrophysiology for Translational Neuroscience LET'S, Institute of Cognitive Sciences and Technologies ISTC, Consiglio Nazionale Delle Ricerche CNR, Rome, Italy
- *Correspondence: Franca Tecchio ; orcid.org/0000-0002-1325-5059
| |
Collapse
|
9
|
Leroy A, Very E, Birmes P, Yger P, Szaffarczyk S, Lopes R, Outteryck O, Faure C, Duhem S, Grandgenèvre P, Warembourg F, Vaiva G, Jardri R. Intrusive experiences in posttraumatic stress disorder: Treatment response induces changes in the directed functional connectivity of the anterior insula. Neuroimage Clin 2022; 34:102964. [PMID: 35189456 PMCID: PMC8861823 DOI: 10.1016/j.nicl.2022.102964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 01/27/2022] [Accepted: 02/08/2022] [Indexed: 11/18/2022]
Abstract
Many causal paths were less influenced by the AI after effective therapy for PTSD. Insular influences over the rest of the brain were found to be positively correlated with re-experiencing. Re-experiencing was linked with changes in intrinsic networks’ spatial stability after treatment.
Background One of the core features of posttraumatic stress disorder (PTSD) is re-experiencing trauma. The anterior insula (AI) has been proposed to play a crucial role in these intrusive experiences. However, the dynamic function of the AI in re-experiencing trauma and its putative modulation by effective therapy need to be specified. Methods Thirty PTSD patients were enrolled and exposed to traumatic memory reactivation therapy. Resting-state functional magnetic resonance imaging (fMRI) scans were acquired before and after treatment. To explore AI-directed influences over the rest of the brain, we referred to a mixed model using pre-/posttreatment Granger causality analysis seeded on the AI as a within-subject factor and treatment response as a between-subject factor. To further identify correlates of re-experiencing trauma, we investigated how intrusive severity affected (i) causality maps and (ii) the spatial stability of other intrinsic brain networks. Results We observed changes in AI-directed functional connectivity patterns in PTSD patients. Many within- and between-network causal paths were found to be less influenced by the AI after effective therapy. Insular influences were found to be positively correlated with re-experiencing symptoms, while they were linked with a stronger default mode network (DMN) and more unstable central executive network (CEN) connectivity. Conclusion We showed that directed changes in AI signaling to the DMN and CEN at rest may underlie the degree of re-experiencing symptoms in PTSD. A positive response to treatment further induced changes in network-to-network anticorrelated patterns. Such findings may guide targeted neuromodulation strategies in PTSD patients not suitably improved by conventional treatment.
Collapse
Affiliation(s)
- Arnaud Leroy
- Univ Lille, INSERM, CHU Lille, Lille Neuroscience & Cognition Centre (U-1172), Plasticity & SubjectivitY Team, CURE Platform, 59000 Lille, France; CHU Lille, Fontan Hospital, General Psychiatry Dpt., 59037 Lille Cedex, France; Centre National de Ressources et Résilience pour les psychotraumatismes (CN2R Lille - Paris), 59000 Lille, France.
| | - Etienne Very
- CHU Toulouse, Purpan Hospital, Psychiatry Department, 31059 Toulouse Cedex, France; ToNIC, Toulouse NeuroImaging Center, INSERM U-1214, UPS, France
| | - Philippe Birmes
- ToNIC, Toulouse NeuroImaging Center, INSERM U-1214, UPS, France
| | - Pierre Yger
- Univ Lille, INSERM, CHU Lille, Lille Neuroscience & Cognition Centre (U-1172), Plasticity & SubjectivitY Team, CURE Platform, 59000 Lille, France; Institut de la Vision, Sorbonne Université, Inserm S968, CNRS UMR7210, Paris, France
| | - Sébastien Szaffarczyk
- Univ Lille, INSERM, CHU Lille, Lille Neuroscience & Cognition Centre (U-1172), Plasticity & SubjectivitY Team, CURE Platform, 59000 Lille, France
| | - Renaud Lopes
- Univ Lille, INSERM, CHU Lille, Lille Neuroscience & Cognition Centre (U-1772), Degenerative & Vascular Cognitive Disorders Team, 59000 Lille, France; Univ Lille, CNRS, INSERM, CHU Lille, Institut Pasteur de Lille, US 41 - UMS 2014 - PLBS, 59000 Lille, France
| | - Olivier Outteryck
- Univ Lille, INSERM, CHU Lille, Lille Neuroscience & Cognition Centre (U-1772), Degenerative & Vascular Cognitive Disorders Team, 59000 Lille, France; CHU Lille, Department of Neuroradiology, Roger Salengro Hospital, 59037 Lille Cedex, France
| | - Cécile Faure
- Univ Lille, INSERM, CHU Lille, Lille Neuroscience & Cognition Centre (U-1172), Plasticity & SubjectivitY Team, CURE Platform, 59000 Lille, France
| | - Stéphane Duhem
- CHU Lille, Fontan Hospital, General Psychiatry Dpt., 59037 Lille Cedex, France; Centre National de Ressources et Résilience pour les psychotraumatismes (CN2R Lille - Paris), 59000 Lille, France; Université de Lille, Inserm, CHU Lille, CIC 1403 - Clinical Investigation Center, 59000 Lille, France
| | - Pierre Grandgenèvre
- Univ Lille, INSERM, CHU Lille, Lille Neuroscience & Cognition Centre (U-1172), Plasticity & SubjectivitY Team, CURE Platform, 59000 Lille, France; CHU Lille, Fontan Hospital, General Psychiatry Dpt., 59037 Lille Cedex, France
| | | | - Guillaume Vaiva
- Univ Lille, INSERM, CHU Lille, Lille Neuroscience & Cognition Centre (U-1172), Plasticity & SubjectivitY Team, CURE Platform, 59000 Lille, France; CHU Lille, Fontan Hospital, General Psychiatry Dpt., 59037 Lille Cedex, France; Centre National de Ressources et Résilience pour les psychotraumatismes (CN2R Lille - Paris), 59000 Lille, France
| | - Renaud Jardri
- Univ Lille, INSERM, CHU Lille, Lille Neuroscience & Cognition Centre (U-1172), Plasticity & SubjectivitY Team, CURE Platform, 59000 Lille, France; CHU Lille, Fontan Hospital, Child & Adolescent Psychiatry Dpt., 59037 Lille Cedex, France
| |
Collapse
|
10
|
Zarate-Guerrero S, Duran JM, Naismith I. How a transdiagnostic approach can improve the treatment of emotional disorders: Insights from clinical psychology and neuroimaging. Clin Psychol Psychother 2022; 29:895-905. [PMID: 34984759 DOI: 10.1002/cpp.2704] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 12/28/2021] [Accepted: 12/29/2021] [Indexed: 11/05/2022]
Abstract
Multiple psychological treatments for emotional disorders have been developed and implemented, improving the quality of life of individuals. Nevertheless, relapse and poor response to psychotherapy are common. This article argues that a greater understanding of both the psychological and neurobiological mechanisms of change in psychotherapy is essential to improve treatment for emotional disorders. It aims to demonstrate how an understanding of these mechanisms provides a basis for (i) reconceptualizing some mental disorders, (ii) refining and establishing the evidence for existing therapeutic techniques and (iii) designing new techniques that precisely target the processes that maintain these disorders. Possible future directions for researchers and practitioners working at the intersection of neuropsychology and clinical psychology are discussed.
Collapse
Affiliation(s)
- Santiago Zarate-Guerrero
- Facultad de Ciencias Sociales y Humanas, Programa Virtual de Psicología, Grupo: Psynergia, Fundación Universitaria del Área Andina, Bogotá, Colombia
- Programa de Psicología, Grupo de investigación: Mente Cerebro y Comportamiento, Universidad Sergio Arboleda, Bogotá, Colombia
| | - Johanna M Duran
- Facultad de Ciencias Sociales y Humanas, Programa de Psicología, Fundación Universitaria del Área Andina, Bogotá, Colombia
| | - Iona Naismith
- Departamento de Psicología, Universidad de los Andes, Bogota, Colombia
| |
Collapse
|
11
|
Williams MT, Khanna Roy A, MacIntyre MP, Faber S. The Traumatizing Impact of Racism in Canadians of Colour. CURRENT TRAUMA REPORTS 2022; 8:17-34. [PMID: 35345606 PMCID: PMC8943361 DOI: 10.1007/s40719-022-00225-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/11/2022] [Indexed: 01/27/2023]
Abstract
Purpose of Review While research has identified racial trauma in other contexts, it is often overlooked amongst Canadian society. Racial trauma occurs as a result of an event of racism or cumulative events over time whereby an individual experiences stress and consequent mental health sequelae. Given that the BIPOC (Black, Indigenous, and/or Person of Colour) population in Canada is increasing, it is imperative to identify racial discrimination and the subsequent stress and trauma associated with being racialized in Canada, which subjects BIPOC Canadians to various forms of racism, including microaggressions. Recent Findings This paper reviews the published literature on racism and racial discrimination that identifies or infers racial trauma as the source of the mental health implications for various groups (e.g., Indigenous people, Black Canadians, Asian Canadians, immigrants, and refugees). In addition, intersectionality of racialized persons is prominent to their psychological well-being as their psychosocial and socioeconomic position are complex. Therefore, this paper both provides insight into the Canadian experience as a person of colour and signifies the need for further research on racial trauma in a Canadian context. Summary Despite Canada’s emphasis on multiculturalism, racialized individuals are at risk for racial trauma due to prejudice and discrimination. The politicization of multiculturalism has permitted Canada to deny claims of racism, yet the historical basis of established institutions results in irrefutable systemic and systematic barriers for Canadian people of colour.
Collapse
Affiliation(s)
- Monnica T Williams
- School of Psychology, University of Ottawa, 136 Jean-Jacques Lussier, Vanier Hall, Ottawa, ON K1N 6N5 Canada.,Cellular and Molecular Medicine, University of Ottawa, Ottawa, ON Canada
| | | | - Marie-Paule MacIntyre
- School of Psychology, University of Ottawa, 136 Jean-Jacques Lussier, Vanier Hall, Ottawa, ON K1N 6N5 Canada
| | | |
Collapse
|
12
|
Wong SL. A Model for the Flash Technique Based on Working Memory and Neuroscience Research. JOURNAL OF EMDR PRACTICE AND RESEARCH 2021. [DOI: 10.1891/emdr-d-21-00048] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Research has shown that the Flash Technique (FT) appears to reduce memory-related disturbance and may reduce symptoms of posttraumatic stress disorder. This paper discusses the connections between FT and eye movement desensitization and reprocessing (EMDR) therapy. In FT, clients remind themselves of a traumatic memory without dwelling on it and focus instead on a positive engaging focus and then blink their eyes when prompted. This paper summarizes numerous models describing how the brain processes traumatic material and presents a model for how FT may work in the brain. It proposes that during the blinking, the patient's periaqueductal gray (PAG) may take over, sensing the reminder of the traumatic memory and reflexively triggering the amygdala. In Porges's neuroception model, the PAG assesses danger without going through the conscious brain. Recent fMRI data show that for patients with posttraumatic stress disorder, there is enhanced connectivity from the amygdala to the left hippocampus. Thus, triggering the amygdala may, in turn, activate the left hippocampus, which may then provide a brief access to the traumatic memory. Given the brief access, there is insufficient time for the amygdala to go into overactivation. The client remains calm while accessing the traumatic memory, thus setting up the prediction error necessary for possible memory reconsolidation. This process is repeated during blinking in FT allowing memory reconsolidation to proceed. This model requires experimental confirmation.
Collapse
|
13
|
Zhou YG, Shang ZL, Zhang F, Wu LL, Sun LN, Jia YP, Yu HB, Liu WZ. PTSD: Past, present and future implications for China. Chin J Traumatol 2021; 24:187-208. [PMID: 33994278 PMCID: PMC8343811 DOI: 10.1016/j.cjtee.2021.04.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 03/30/2021] [Accepted: 04/18/2021] [Indexed: 02/04/2023] Open
Abstract
There has been a long history since human beings began to realize the existence of post-traumatic symptoms. Posttraumatic stress disorder (PTSD), a diagnostic category adopted in 1980 in the Diagnostic and Statistical Manual of Mental Disorders-Ⅲ, described typical clusters of psychiatric symptoms occurring after traumatic events. Abundant researches have helped deepen the understanding of PTSD in terms of epidemiological features, biological mechanisms, and treatment options. The prevalence of PTSD in general population ranged from 6.4% to 7.8% and was significantly higher among groups who underwent major public traumatic events. There has been a long way in the studies of animal models and genetic characteristics of PTSD. However, the high comorbidity with other stress-related psychiatric disorders and complexity in the pathogenesis of PTSD hindered the effort to find specific biological targets for PTSD. Neuroimage was widely used to elucidate the underlying neurophysiological mechanisms of PTSD. Functional MRI studies have showed that PTSD was linked to medial prefrontal cortex, anterior cingulate cortex and sub-cortical structures like amygdala and hippocampus, and to explore the functional connectivity among these brain areas which might reveal the possible neurobiological mechanism related to PTSD symptoms. For now, cognitive behavior therapy-based psychotherapy, including combination with adjunctive medication, showed evident treatment effects on PTSD. The emergence of more effective PTSD pharmacotherapies awaits novel biomarkers from further fundamental research. Several natural disasters and emergencies have inevitably increased the possibility of suffering from PTSD in the last two decades, making it critical to strengthen PTSD research in China. To boost PTSD study in China, the following suggestions might be helpful: (1) establishing a national psychological trauma recover project, and (2) exploring the mechanisms of PTSD with joint effort and strengthening the indigenized treatment of PTSD.
Collapse
Affiliation(s)
- Yao-Guang Zhou
- Lab for Post-traumatic Stress Disorder, Faculty of Psychology and Mental Health, Naval Medical University, Shanghai, 200433, China
| | - Zhi-Lei Shang
- The Emotion & Cognition Lab, Faculty of Psychology and Mental Health, Naval Medical University, Shanghai, 200433, China
| | - Fan Zhang
- Faculty of Psychology and Mental Health, Naval Medical University, Shanghai, 200433, China
| | - Li-Li Wu
- Lab for Post-traumatic Stress Disorder, Faculty of Psychology and Mental Health, Naval Medical University, Shanghai, 200433, China,The Emotion & Cognition Lab, Faculty of Psychology and Mental Health, Naval Medical University, Shanghai, 200433, China
| | - Lu-Na Sun
- Lab for Post-traumatic Stress Disorder, Faculty of Psychology and Mental Health, Naval Medical University, Shanghai, 200433, China,The Emotion & Cognition Lab, Faculty of Psychology and Mental Health, Naval Medical University, Shanghai, 200433, China
| | - Yan-Pu Jia
- Lab for Post-traumatic Stress Disorder, Faculty of Psychology and Mental Health, Naval Medical University, Shanghai, 200433, China,The Emotion & Cognition Lab, Faculty of Psychology and Mental Health, Naval Medical University, Shanghai, 200433, China
| | - Hai-Bo Yu
- Faculty of Psychology and Mental Health, Naval Medical University, Shanghai, 200433, China,Corresponding author.
| | - Wei-Zhi Liu
- Lab for Post-traumatic Stress Disorder, Faculty of Psychology and Mental Health, Naval Medical University, Shanghai, 200433, China,The Emotion & Cognition Lab, Faculty of Psychology and Mental Health, Naval Medical University, Shanghai, 200433, China,Corresponding author. Lab for Post-traumatic Stress Disorder, Faculty of Psychology and Mental Health, Naval Medical University, Shanghai, 200433, China.
| |
Collapse
|
14
|
Ord AS, Stranahan KR, Hurley RA, Taber KH. Stress-Related Growth: Building a More Resilient Brain. J Neuropsychiatry Clin Neurosci 2021; 32:A4-212. [PMID: 32729793 DOI: 10.1176/appi.neuropsych.20050111] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Anna S Ord
- The Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center, and the Research and Academic Affairs Service Line, W.G. Hefner Veterans Affairs Medical Center, Salisbury, N.C. (Ord, Hurley, Taber); the Mental Health Service Line, W.G. Hefner Veterans Affairs Medical Center, Salisbury, N.C. (Stranahan); the Departments of Psychiatry and Radiology, Wake Forest School of Medicine, Winston-Salem, N.C. (Hurley); the Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston (Hurley); the Division of Biomedical Sciences, Via College of Osteopathic Medicine, Blacksburg, Va. (Taber); and the Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston (Taber)
| | - Kathryn R Stranahan
- The Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center, and the Research and Academic Affairs Service Line, W.G. Hefner Veterans Affairs Medical Center, Salisbury, N.C. (Ord, Hurley, Taber); the Mental Health Service Line, W.G. Hefner Veterans Affairs Medical Center, Salisbury, N.C. (Stranahan); the Departments of Psychiatry and Radiology, Wake Forest School of Medicine, Winston-Salem, N.C. (Hurley); the Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston (Hurley); the Division of Biomedical Sciences, Via College of Osteopathic Medicine, Blacksburg, Va. (Taber); and the Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston (Taber)
| | - Robin A Hurley
- The Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center, and the Research and Academic Affairs Service Line, W.G. Hefner Veterans Affairs Medical Center, Salisbury, N.C. (Ord, Hurley, Taber); the Mental Health Service Line, W.G. Hefner Veterans Affairs Medical Center, Salisbury, N.C. (Stranahan); the Departments of Psychiatry and Radiology, Wake Forest School of Medicine, Winston-Salem, N.C. (Hurley); the Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston (Hurley); the Division of Biomedical Sciences, Via College of Osteopathic Medicine, Blacksburg, Va. (Taber); and the Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston (Taber)
| | - Katherine H Taber
- The Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center, and the Research and Academic Affairs Service Line, W.G. Hefner Veterans Affairs Medical Center, Salisbury, N.C. (Ord, Hurley, Taber); the Mental Health Service Line, W.G. Hefner Veterans Affairs Medical Center, Salisbury, N.C. (Stranahan); the Departments of Psychiatry and Radiology, Wake Forest School of Medicine, Winston-Salem, N.C. (Hurley); the Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston (Hurley); the Division of Biomedical Sciences, Via College of Osteopathic Medicine, Blacksburg, Va. (Taber); and the Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston (Taber)
| |
Collapse
|
15
|
Kasia K, Nicola G, Stephen S, Blanche S. Psychologically informed physiotherapy as part of a multidisciplinary rehabilitation program for children and adolescents with functional neurological disorder: Physical and mental health outcomes. J Paediatr Child Health 2021; 57:73-79. [PMID: 32861224 DOI: 10.1111/jpc.15122] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 07/16/2020] [Accepted: 07/27/2020] [Indexed: 01/05/2023]
Abstract
AIM Children and adolescents with functional neurological disorder (FND) present with physical impairment and mental health comorbidities. Specialist physiotherapy programs for treating FND have been developed over the last two decades. This article reports outcome data from three cohorts of children treated with a multidisciplinary rehabilitation intervention - the Mind-Body Program - in which a psychologically informed physiotherapy intervention, known as the wellness approach to physiotherapy, was a key component. METHODS For three cohorts of children (n = 57, n = 60 and n = 25, respectively) treated in the Mind-Body Program, data about functional impairment and mental health concerns were collected at presentation and at follow-up (4 years, 12 months and 18 months, respectively). RESULTS Outcome data show that FND symptoms resolved in 54/57 (95%), 51/60 (85%) and 22/25 (88%) of children in the three cohorts, and that 31/57 (61%), 32/60 (53%) and 13/25 (52%) of children returned to full health and to full-time school attendance. Changes in Global Assessment of Function (GAF) were significant (t(54) = 21.60, P < 0.001; t(55) = 9.92, P < 0.001; t(24) = 6.51, P < 0.001). Outcomes were less favourable for children with chronic FND symptoms at presentation; those whose comorbid mental health disorders or other (comorbid) functional somatic symptoms did not resolve; and those who subsequently developed chronic mental health problems. CONCLUSIONS Implementation of a multidisciplinary rehabilitation intervention - with psychologically informed physiotherapy as one of the key treatment components - resulted in resolution of FND symptoms and return to health and well-being in the large majority of patients.
Collapse
Affiliation(s)
- Kozlowska Kasia
- Department of Psychological Medicine, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.,Discipline of Psychiatry and Discipline of Child and Adolescent Health, University of Sydney Medical School, Sydney, New South Wales, Australia.,The Brain Dynamics Centre, Westmead Institute for Medical Research, Sydney, New South Wales, Australia
| | - Gray Nicola
- Department of Physiotherapy, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Scher Stephen
- Discipline of Psychiatry and Discipline of Child and Adolescent Health, University of Sydney Medical School, Sydney, New South Wales, Australia.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, United States
| | - Savage Blanche
- Department of Psychological Medicine, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| |
Collapse
|
16
|
Manthey A, Sierk A, Brakemeier EL, Walter H, Daniels JK. Does trauma-focused psychotherapy change the brain? A systematic review of neural correlates of therapeutic gains in PTSD. Eur J Psychotraumatol 2021; 12:1929025. [PMID: 34394855 PMCID: PMC8354020 DOI: 10.1080/20008198.2021.1929025] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/30/2022] Open
Abstract
BACKGROUND Meta-analytic results indicate that posttraumatic stress disorder (PTSD) is associated with hypoactivation of the medial prefrontal cortex (mPFC), hyperactivation of the amygdala, and volume reductions of the hippocampus. Effective psychotherapeutic treatments were hypothesized to normalize these neural patterns via upregulation of prefrontal structures, which in turn downregulate limbic regions. OBJECTIVE To gain a sound understanding of the effects of successful psychotherapy on the brain, neural changes from pre- to post-treatment in PTSD patients will be aggregated. METHOD A systematic literature search identified 24 original studies employing structural or functional MRI measurements both before and after treatment of patients diagnosed with PTSD. RESULTS In conjunction, the review returned little evidence of an activation increase in the mPFC/rostral anterior cingulate cortex (rACC) following successful treatment. Five out of 12 studies observed such an increase (especially during emotion processing tasks), albeit in partially non-overlapping brain regions. Conversely, neither the putative related activation decrease in the amygdala nor volumetric changes or altered activation during the resting state could be convincingly established. CONCLUSION Successful psychological treatments might potentially work via upregulation of the mPFC, which thus may be involved in symptom reduction. However, the role of the amygdala in recovery from PTSD remains unclear. There is currently no indication that the various PTSD treatment approaches employed by the reviewed studies differ regarding their action mechanisms, but further research on this topic is needed.
Collapse
Affiliation(s)
- Antje Manthey
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Anika Sierk
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Eva-Lotta Brakemeier
- Department of Clinical Psychology and Psychotherapy, Universität Greifswald, Greifswald, Germany.,Psychologische Hochschule Berlin, Berlin, Germany
| | - Henrik Walter
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Judith K Daniels
- Psychologische Hochschule Berlin, Berlin, Germany.,Department of Clinical Psychology, University of Groningen, Groningen, The Netherlands
| |
Collapse
|
17
|
Tryon VL, Garman HD, Loewy RL, Niendam TA. Links Between Human and Animal Models of Trauma and Psychosis: A Narrative Review. BIOLOGICAL PSYCHIATRY: COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2020; 6:154-165. [PMID: 33309566 DOI: 10.1016/j.bpsc.2020.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 09/08/2020] [Accepted: 09/16/2020] [Indexed: 11/26/2022]
Abstract
Traumatic experiences during development are associated with an increased risk of developing psychosis. Individuals with psychosis also report a higher rate of past trauma than healthy control subjects and worse outcomes than those who do not have these experiences. It is thought that traumatic experiences negatively impact specific neurobiological processes to confer this increased risk, and that systems affected by trauma are similarly changed in individuals with psychosis. Examining animal models of psychosis and the shared neurobiological changes in response to stressors can offer valuable insight into biological mechanisms that mediate symptoms and targets for intervention. This targeted review highlights a subset of models of psychosis across humans and animals, examines the similarities with the brain's response to stress and traumatic events, and discusses how these models may interact. Suggestions for future research are described.
Collapse
Affiliation(s)
- Valerie L Tryon
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, Davis
| | - Heather D Garman
- Department of Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, California
| | - Rachel L Loewy
- Department of Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, California
| | - Tara A Niendam
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, Davis.
| |
Collapse
|
18
|
Luyten TR, Jacquemin L, Van Looveren N, Declau F, Fransen E, Cardon E, De Bodt M, Topsakal V, Van de Heyning P, Van Rompaey V, Gilles A. Bimodal Therapy for Chronic Subjective Tinnitus: A Randomized Controlled Trial of EMDR and TRT Versus CBT and TRT. Front Psychol 2020; 11:2048. [PMID: 33013517 PMCID: PMC7511540 DOI: 10.3389/fpsyg.2020.02048] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 07/23/2020] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION To date, guidelines recommend the use of a stepped care approach to treat tinnitus. The current clinical management of tinnitus frequently consists of audiologic interventions and tinnitus retraining therapy (TRT) or cognitive behavioral therapy (CBT). Due to the high heterogeneity of the tinnitus population and comorbidity of tinnitus with insomnia, anxiety, and depression, these interventions may not be sufficient for every patient. The current study aims to determine whether a bimodal therapy for chronic, subjective tinnitus consisting of the combination of TRT and eye movement desensitization reprocessing (EMDR) results in a clinically significant different efficacy in comparison with the prevailing bimodal TRT and CBT therapy. METHODS Patients were randomized in two treatment groups. The experimental group received the bimodal therapy TRT/EMDR and the active control group received the bimodal therapy TRT/CBT. Evaluations took place at baseline (T0), at the end of the treatment (T1), and 3 months after therapy (T2). The tinnitus functional index (TFI) was used as primary outcome measurement. Secondary outcome measurements were the visual analog scale of tinnitus loudness (VASLoudness), tinnitus questionnaire (TQ), hospital anxiety and depression scale (HADS), hyperacusis questionnaire (HQ), global perceived effect (GPE), and psychoacoustic measurements. FINDINGS The TFI showed clinically significant improvement in both bimodal therapies (mean decrease 15.1 in TRT/CBT; p < 0.001 vs. 16.2 in TRT/EMDR; p < 0.001). The total score on the TQ, HADS, HQ, and VASLoudness all demonstrated significant decrease after treatment and follow-up (p < 0.001) in the experimental and the active control group. GPE-measurements revealed that more than 80% (i.e., 84% in TRT/CBT vs. 80% in TRT/EMDR) of the patients experienced substantial improvement of tinnitus at follow up. Treatment outcome remained stable after 3 month follow-up and no adverse events were observed. CONCLUSION Both psychotherapeutic protocols result in a clinically significant improvement for patients with chronic subjective tinnitus. No significant different efficacy was found for the TRT/EMDR treatment compared to the combination of TRT and CBT. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov, ID: NCT03114878. April 14, 2017.
Collapse
Affiliation(s)
- Tine Roanna Luyten
- Faculty of Medicine and Health Sciences, Department Translational Neuroscience, University of Antwerp, Antwerp, Belgium
- Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium
- Hoorzorg Van Looveren BVBA, Borsbeek, Belgium
| | - Laure Jacquemin
- Faculty of Medicine and Health Sciences, Department Translational Neuroscience, University of Antwerp, Antwerp, Belgium
- Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium
| | | | - Frank Declau
- Faculty of Medicine and Health Sciences, Department Translational Neuroscience, University of Antwerp, Antwerp, Belgium
| | - Erik Fransen
- Faculty of Medicine and Health Sciences, Department Translational Neuroscience, University of Antwerp, Antwerp, Belgium
- Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Emilie Cardon
- Faculty of Medicine and Health Sciences, Department Translational Neuroscience, University of Antwerp, Antwerp, Belgium
- Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Marc De Bodt
- Faculty of Medicine and Health Sciences, Department Translational Neuroscience, University of Antwerp, Antwerp, Belgium
- Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Vedat Topsakal
- Faculty of Medicine and Health Sciences, Department Translational Neuroscience, University of Antwerp, Antwerp, Belgium
- Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Paul Van de Heyning
- Faculty of Medicine and Health Sciences, Department Translational Neuroscience, University of Antwerp, Antwerp, Belgium
- Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Vincent Van Rompaey
- Faculty of Medicine and Health Sciences, Department Translational Neuroscience, University of Antwerp, Antwerp, Belgium
- Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Annick Gilles
- Faculty of Medicine and Health Sciences, Department Translational Neuroscience, University of Antwerp, Antwerp, Belgium
- Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium
- Faculty of Education, Health and Social Work, University College Ghent, Ghent, Belgium
| |
Collapse
|
19
|
Gainer D, Alam S, Alam H, Redding H. A FLASH OF HOPE: Eye Movement Desensitization and Reprocessing (EMDR) Therapy. INNOVATIONS IN CLINICAL NEUROSCIENCE 2020; 17:12-20. [PMID: 33520399 PMCID: PMC7839656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
DEPARTMENT EDITORS Julie P. Gentile, MD Professor and Chair, Department of Psychiatry, Wright State University, Boonshoft School of Medicine, Dayton, Ohio Allison E. Cowan, MD Associate Professor, Department of Psychiatry, Wright State University, Boonshoft School of Medicine, Dayton, Ohio EDITORS' NOTE The patient cases presented in Psychotherapy Rounds are composite cases written to illustrate certain diagnostic characteristics and to instruct on treatment techniques. The composite cases are not real patients in treatment. Any resemblance to a real patient is purely coincidental. ABSTRACT Eye movement desensitization and reprocessing (EMDR) is a specific treatment modality that utilizes bilateral stimulation to help individuals who have experienced trauma. This stimulation can occur in a variety of forms, including left-right eye movements, tapping on the knees, headphones, or handheld buzzers, known as tappers. This type of psychotherapy allows the individuals to redefine their self-assessment and responses to a given traumatic event in eight defined steps. While EMDR is relatively new type of psychotherapy, existing literature has demonstrated positive results using this form of therapy when treating patients with post-traumatic stress disorder (PTSD) by utilizing eye movements to detract from negative conceptualizations as a response to a specific trigger, while reaffirming positive self-assessments. Research indicates that EMDR could be a promising treatment for mental health issues other than PTSD, including bipolar disorder, substance use disorders, and depressive disorders. In this article, the eight fundamental processes of EMDR are illustrated through a composite case vignette and examined alongside relevant research regarding its efficacy in treating PTSD.
Collapse
Affiliation(s)
- Danielle Gainer
- Dr. Gainer, Sarah Alam, and Ms. Redding are with Wright State University Boonshoft School of Medicine in Fairborn, Ohio. Harris Alam is with University of Central Florida in Orlando, Florida
| | - Sarah Alam
- Dr. Gainer, Sarah Alam, and Ms. Redding are with Wright State University Boonshoft School of Medicine in Fairborn, Ohio. Harris Alam is with University of Central Florida in Orlando, Florida
| | - Harris Alam
- Dr. Gainer, Sarah Alam, and Ms. Redding are with Wright State University Boonshoft School of Medicine in Fairborn, Ohio. Harris Alam is with University of Central Florida in Orlando, Florida
| | - Hannah Redding
- Dr. Gainer, Sarah Alam, and Ms. Redding are with Wright State University Boonshoft School of Medicine in Fairborn, Ohio. Harris Alam is with University of Central Florida in Orlando, Florida
| |
Collapse
|