Amygdala response predicts trajectory of symptom reduction during Trauma-Focused Cognitive-Behavioral Therapy among adolescent girls with PTSD

被引:42
作者
Cisler, Josh M. [1 ]
Sigel, Benjamin A. [1 ]
Kramer, Teresa L. [1 ]
Smitherman, Sonet [1 ]
Vanderzee, Karin [1 ]
Pemberton, Joy [1 ]
Kilts, Clinton D. [1 ]
机构
[1] Univ Arkansas Med Sci, Inst Psychiat Res, Brain Imaging Res Ctr, Little Rock, AR 72205 USA
关键词
Adolescence; PTSD; Cognitive-Behavioral Therapy; Neuroimaging; POSTTRAUMATIC-STRESS-DISORDER; EMOTION REGULATION SCALE; FMRI; DYSREGULATION; DIFFICULTIES; SALIENCY; CHILDREN;
D O I
10.1016/j.jpsychires.2015.09.011
中图分类号
R749 [精神病学];
学科分类号
100205 ;
摘要
Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT) is the gold standard treatment for pediatric PTSD. Nonetheless, clinical outcomes in TF-CBT are highly variable, indicating a need to identify reliable predictors that allow forecasting treatment response. Here, we test the hypothesis that functional neuroimaging correlates of emotion processing predict PTSD symptom reduction during Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT) among adolescent girls with PTSD. Thirty-four adolescent girls with PTSD related to physical or sexual assault were enrolled in TF-CBT, delivered in an approximately 12 session format, in an open trial. Prior to treatment, they were engaged in an implicit threat processing task during 3T fMRI, during which they viewed faces depicting fearful or neutral expressions. Among adolescent girls completing TF-CBT (n = 23), slopes of PTSD symptom trajectories during TF-CBT were significantly related to pre-treatment degree of bilateral amygdala activation while viewing fearful vs neutral images. Adolescents with less symptom reduction were characterized by greater amygdala activation to both threat and neutral images (i.e., less threat-safety discrimination), whereas adolescents with greater symptom reduction were characterized by amygdala activation only to threat images. These clinical outcome relationships with pre-treatment bilateral amygdala activation remained when controlling for possible confounding demographic or clinical variables (e.g., concurrent psychotropic medication, comorbid diagnoses). While limited by a lack of a control group, these preliminary results suggest that pre-treatment amygdala reactivity to fear stimuli, a component of neurocircuitry models of PTSD, positively predicts symptom reduction during TF-CBT among assaulted adolescent girls, providing support for an objective measure for forecasting treatment response in this vulnerable population. (c) 2015 Elsevier Ltd. All rights reserved.
引用
收藏
页码:33 / 40
页数:8
相关论文
共 45 条
[1]   A causal model of post-traumatic stress disorder: disentangling predisposed from acquired neural abnormalities [J].
Admon, Roee ;
Milad, Mohammed R. ;
Hendler, Telma .
TRENDS IN COGNITIVE SCIENCES, 2013, 17 (07) :337-347
[2]  
Angold A, 1995, INT J METHOD PSYCH, V5, P237
[3]   Neural responses during emotional processing before and after cognitive trauma therapy for battered women [J].
Aupperle, Robin L. ;
Allard, Carolyn B. ;
Simmons, Alan N. ;
Flagan, Taru ;
Thorp, Steven R. ;
Norman, Sonya B. ;
Paulus, Martin P. ;
Stein, Murray B. .
PSYCHIATRY RESEARCH-NEUROIMAGING, 2013, 214 (01) :48-55
[4]   An Examination of the Latent Structure of the Difficulties in Emotion Regulation Scale [J].
Bardeen, Joseph R. ;
Fergus, Thomas A. ;
Orcutt, Holly K. .
JOURNAL OF PSYCHOPATHOLOGY AND BEHAVIORAL ASSESSMENT, 2012, 34 (03) :382-392
[5]  
Blakemore S.J., 2012, DEV SOCIAL BRAIN ADO, P111
[6]  
Brownell R., 2000, RECEPTIVE ONE WORD P
[7]  
Bryant R. A., 2008, ENHANCED AMYGDALA ME, P517
[8]  
Bryant R.A., 2008, AMYGDALA VENTRAL ANT, P555
[9]   The data behind the dissemination: A systematic review of trauma-focused cognitive behavioral therapy for use with children and youth [J].
Cary, Colleen E. ;
McMillen, J. Curtis .
CHILDREN AND YOUTH SERVICES REVIEW, 2012, 34 (04) :748-757
[10]  
Cisler J. M., 2012, EXPOSURE INTERPERSON, P33