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PTSD Psychotherapy Outcome Predicted by Brain Activation During Emotional Reactivity and Regulation.

ABSTRACT: Exposure therapy is an effective treatment for posttraumatic stress disorder (PTSD), but many patients do not respond. Brain functions governing treatment outcome are not well characterized. The authors examined brain systems relevant to emotional reactivity and regulation, constructs that are thought to be central to PTSD and exposure therapy effects, to identify the functional traits of individuals most likely to benefit from treatment.Individuals with PTSD underwent functional MRI (fMRI) while completing three tasks assessing emotional reactivity and regulation. Participants were then randomly assigned to immediate prolonged exposure treatment (N=36) or a waiting list condition (N=30). A random subset of the prolonged exposure group (N=17) underwent single-pulse transcranial magnetic stimulation (TMS) concurrent with fMRI to examine whether predictive activation patterns reflect causal influence within circuits. Linear mixed-effects modeling in line with the intent-to-treat principle was used to examine how baseline brain function moderated the effect of treatment on PTSD symptoms.At baseline, individuals with larger treatment-related symptom reductions (compared with the waiting list condition) demonstrated 1) greater dorsal prefrontal activation and 2) less left amygdala activation, both during emotion reactivity; 3) better inhibition of the left amygdala induced by single TMS pulses to the right dorsolateral prefrontal cortex; and 4) greater ventromedial prefrontal/ventral striatal activation during emotional conflict regulation. Reappraisal-related activation was not a significant moderator of the treatment effect.Capacity to benefit from prolonged exposure in PTSD is gated by the degree to which prefrontal resources are spontaneously engaged when superficially processing threat and adaptively mitigating emotional interference, but not when deliberately reducing negative emotionality.

SUBMITTER: Fonzo GA

PROVIDER: S-EPMC5711543 | biostudies-literature | 2017 Dec

REPOSITORIES: biostudies-literature

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PTSD Psychotherapy Outcome Predicted by Brain Activation During Emotional Reactivity and Regulation.

Fonzo Gregory A GA Goodkind Madeleine S MS Oathes Desmond J DJ Zaiko Yevgeniya V YV Harvey Meredith M Peng Kathy K KK Weiss M Elizabeth ME Thompson Allison L AL Zack Sanno E SE Lindley Steven E SE Arnow Bruce A BA Jo Booil B Gross James J JJ Rothbaum Barbara O BO Etkin Amit A

The American journal of psychiatry 20170718 12

<h4>Objective</h4>Exposure therapy is an effective treatment for posttraumatic stress disorder (PTSD), but many patients do not respond. Brain functions governing treatment outcome are not well characterized. The authors examined brain systems relevant to emotional reactivity and regulation, constructs that are thought to be central to PTSD and exposure therapy effects, to identify the functional traits of individuals most likely to benefit from treatment.<h4>Method</h4>Individuals with PTSD und ...[more]

PMID: 28715908

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Project description:ContextSocial anxiety disorder is thought to involve emotional hyperreactivity, cognitive distortions, and ineffective emotion regulation. While the neural bases of emotional reactivity to social stimuli have been described, the neural bases of emotional reactivity and cognitive regulation during social and physical threat, and their relationship to social anxiety symptom severity, have yet to be investigated.ObjectiveTo investigate behavioral and neural correlates of emotional reactivity and cognitive regulation in patients and controls during processing of social and physical threat stimuli.DesignParticipants were trained to implement cognitive-linguistic regulation of emotional reactivity induced by social (harsh facial expressions) and physical (violent scenes) threat while undergoing functional magnetic resonance imaging and providing behavioral ratings of negative emotion experience.SettingAcademic psychology department.ParticipantsFifteen adults with social anxiety disorder and 17 demographically matched healthy controls.Main outcome measuresBlood oxygen level-dependent signal and negative emotion ratings.ResultsBehaviorally, patients reported greater negative emotion than controls during social and physical threat but showed equivalent reduction in negative emotion following cognitive regulation. Neurally, viewing social threat resulted in greater emotion-related neural responses in patients than controls, with social anxiety symptom severity related to activity in a network of emotion- and attention-processing regions in patients only. Viewing physical threat produced no between-group differences. Regulation during social threat resulted in greater cognitive and attention regulation-related brain activation in controls compared with patients. Regulation during physical threat produced greater cognitive control-related response (ie, right dorsolateral prefrontal cortex) in patients compared with controls.ConclusionsCompared with controls, patients demonstrated exaggerated negative emotion reactivity and reduced cognitive regulation-related neural activation, specifically for social threat stimuli. These findings help to elucidate potential neural mechanisms of emotion regulation that might serve as biomarkers for interventions for social anxiety disorder.

Dataset Information

PTSD Psychotherapy Outcome Predicted by Brain Activation During Emotional Reactivity and Regulation.

Publications

PTSD Psychotherapy Outcome Predicted by Brain Activation During Emotional Reactivity and Regulation.

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