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Attention training modulates resting-state neurophysiological abnormalities in posttraumatic stress disorder.

ABSTRACT: Recent research indicates the relative benefits of computerized attention control treatment (ACT) and attention bias modification treatment (ABMT) for posttraumatic stress disorder (PTSD); however, neural changes underlying these therapeutic effects remain unknown. This study examines how these two types of attention training modulate neurological dysfunction in veterans with PTSD. A community sample of 46 combat veterans with PTSD participated in a randomized double-blinded clinical trial of ACT versus ABMT and 32 of those veterans also agreed to undergo resting-state magnetoencephalography (MEG) recordings. Twenty-four veterans completed psychological and MEG assessments at pre- and post-training to evaluate treatment effects. MEG data were imaged using an advanced Bayesian reconstruction method and examined using statistical parametric mapping. In this report, we focus on the neural correlates and the differential treatment effects observed using MEG; the results of the full clinical trial have been described elsewhere. Our results indicated that ACT modulated occipital and ABMT modulated medial temporal activity more strongly than the comparative treatment. PTSD symptoms decreased significantly from pre- to post-test. These initial neurophysiological outcome data suggest that ACT modulates visual pathways, while ABMT modulates threat-processing regions, but that both are associated with normalizing aberrant neural activity in veterans with PTSD.

SUBMITTER: Badura-Brack A

PROVIDER: S-EPMC5741514 | biostudies-literature | 2018 Jan

REPOSITORIES: biostudies-literature

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Attention training modulates resting-state neurophysiological abnormalities in posttraumatic stress disorder.

Badura-Brack Amy A McDermott Timothy J TJ Becker Katherine M KM Ryan Tara J TJ Khanna Maya M MM Pine Daniel S DS Bar-Haim Yair Y Heinrichs-Graham Elizabeth E Wilson Tony W TW

Psychiatry research. Neuroimaging 20171114

Recent research indicates the relative benefits of computerized attention control treatment (ACT) and attention bias modification treatment (ABMT) for posttraumatic stress disorder (PTSD); however, neural changes underlying these therapeutic effects remain unknown. This study examines how these two types of attention training modulate neurological dysfunction in veterans with PTSD. A community sample of 46 combat veterans with PTSD participated in a randomized double-blinded clinical trial of AC ...[more]

PMID: 29174765

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Project description:BackgroundPrefrontal subregions, including the ventromedial prefrontal cortex (PFC), dorsomedial PFC, and dorsolateral PFC (DLPFC), are differentially implicated in the pathophysiology of posttraumatic stress disorder (PTSD), though few existing studies have examined subregional differences in resting-state functional connectivity (rsFC). We hypothesized that PTSD would involve weaker positive rsFC between ventromedial PFC, dorsomedial PFC, and other default mode network regions and increased negative rsFC between DLPFC and posterior default mode network regions. Additionally, we hypothesized that prefrontal regions exhibiting group differences in rsFC would be characterized by alterations in cortical thickness.MethodsParticipants included 36 healthy control subjects, 30 trauma-exposed control subjects, and 21 individuals with current DSM-IV PTSD resulting from community-acquired trauma. Participants completed the Clinician Administered PTSD Scale, questionnaires (Childhood Trauma Questionnaire, Adverse Childhood Events, Life Events Checklist, Beck Depression Inventory), structural neuroimaging, and resting-state functional magnetic resonance imaging. rsFC of DLPFC, ventromedial PFC, and dorsomedial PFC seeds was evaluated in SPM12 and CONN. Cortical thickness for regions with significant rsFC findings was assessed using FreeSurfer.ResultsRelative to both healthy control and trauma-exposed control subjects, individuals with PTSD showed increased negative rsFC between the DLPFC and a region of precuneus. This finding was associated with increased overall symptom severity but not with trauma load or childhood trauma exposure. Greater negative DLPFC-precuneus connectivity was associated with greater bilateral precuneus thickness.ConclusionsGiven participation of precuneus subregions in the central executive network, increased anticorrelation between right DLPFC and precuneus in this sample may reflect increased opposition between anterior and posterior central executive network hubs in PTSD.

Project description:BackgroundTraumatic experiences are associated with neurofunctional dysregulations in key regions of the emotion regulation circuits. In particular, amygdala responsivity to negative stimuli is exaggerated while engagement of prefrontal regulatory control regions is attenuated. Successful application of emotion regulation (ER) strategies may counteract this disbalance, however, application of learned strategies in daily life is hampered in individuals afflicted by posttraumatic stress disorder (PTSD). We hypothesized that a single session of real-time fMRI (rtfMRI) guided upregulation of prefrontal regions during an emotion regulation task enhances self-control during exposure to negative stimuli and facilitates transfer of the learned ER skills to daily life.MethodsIn a cross-over design, individuals with a PTSD diagnosis after a single traumatic event (n = 20) according to DSM-IV-TR criteria and individuals without a formal psychiatric diagnosis (n = 21) underwent a cognitive reappraisal training. In randomized order, all participants completed two rtfMRI neurofeedback (NF) runs targeting the left lateral prefrontal cortex (lPFC) and two control runs without NF (NoNF) while using cognitive reappraisal to reduce their emotional response to negative scenes. During the NoNF runs, two %%-signs were displayed instead of the two-digit feedback (FB) to achieve a comparable visual stimulation. The project aimed at defining the clinical potential of the training according to three success markers: (1) NF induced changes in left lateral prefrontal cortex and bilateral amygdala activity during the regulation of aversive scenes compared to cognitive reappraisal alone (primary registered outcome), (2) associated changes on the symptomatic and behavioral level such as indicated by PTSD symptom severity and affect ratings, (3) clinical utility such as indicated by perceived efficacy, acceptance, and transfer to daily life measured four weeks after the training.ResultsIn comparison to the reappraisal without feedback, a neurofeedback-specific decrease in the left lateral PFC (d = 0.54) alongside an attenuation of amygdala responses (d = 0.33) emerged. Reduced amygdala responses during NF were associated with symptom improvement (r = -0.42) and less negative affect (r = -0.63) at follow-up. The difference in symptom scores exceeds requirements for a minimal clinically important difference and corresponds to a medium effect size (d = 0.64). Importantly, 75% of individuals with PTSD used the strategies in daily life during a one-month follow-up period and perceived the training as efficient.ConclusionOur findings suggest beneficial effects of the NF training indicated by reduced amygdala responses that were associated with improved symptom severity and affective state four weeks after the NF training as well as patient-centered perceived control during the training, helpfulness and application of strategies in daily life. However, reduced prefrontal involvement was unexpected. The study suggests good tolerability of the training protocol and potential for clinical use in the treatment of PTSD.

Project description:ObjectiveResting-state functional magnetic resonance imaging (rs-fMRI) studies of adult posttraumatic stress disorder (PTSD) have identified default-mode network (DMN) abnormalities, including reduced within-network connectivity and reduced anticorrelation between the DMN and task-positive network (TPN). However, no prior studies have specifically examined DMN connectivity in pediatric PTSD, which may differ due to neurodevelopmental factors.MethodA total of 29 youth with PTSD and 30 nontraumatized healthy youth of comparable age and sex completed rs-fMRI. DMN properties were examined using posterior cingulate cortex (PCC) seed-based connectivity and independent component analysis (ICA).ResultsContrary to findings in adult studies, youth with PTSD displayed increased connectivity within the DMN, including increased PCC-inferior parietal gyrus connectivity, and age-related increases in PCC-ventromedial prefrontal cortex connectivity. Strikingly, youth with PTSD also displayed greater anticorrelation between the PCC and multiple nodes within salience and attentional control networks of the TPN. ICA revealed greater anticorrelation between the entire DMN and TPN networks in youth with PTSD. Furthermore, DMN and TPN connectivity strength were positively and negatively associated, respectively, with re-experiencing symptoms of PTSD.ConclusionPediatric PTSD is characterized by heightened within-DMN connectivity, which may contribute to re-experiencing symptoms of PTSD and is consistent with the role of the DMN in autobiographical memory. At the same time, greater anticorrelation between the DMN and attentional control networks may represent compensatory mechanisms aimed at suppressing trauma-related thought, a notion supported by the inverse relationship between TPN strength and re-experiencing. These findings provide new insights into large-scale network abnormalities underlying pediatric PTSD, which could serve as biomarkers of illness and treatment response.

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Attention training modulates resting-state neurophysiological abnormalities in posttraumatic stress disorder.

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Attention training modulates resting-state neurophysiological abnormalities in posttraumatic stress disorder.

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