BACKGROUND: Prolonged exposure (PE) therapy is the first-line treatment for posttraumatic stress disorder (PTSD) in combat veterans. The underlying brain changes of treatment effect in PTSD are currently unknown. METHODS: A total of 31 veterans with PTSD completed an fMRI scan performing an affective anticipation task at baseline and were enrolled in PE therapy. Of these, 7 prematurely terminated therapy, while 24 individuals completed PE therapy and an identical follow-up fMRI scan. At follow-up, 15 of the 24 completers still had diagnosable PTSD (NR-PTSD) and 9 of the 24 completers showed complete remission from PTSD (R-PTSD), i.e. they did not meet diagnostic criteria for PTSD. RESULTS: The left anterior insula showed a significant group by scan session interaction. Specifically, the R-PTSD group showed decreased activation during anticipation of negative images from pre- to posttreatment scans, while the NR-PTSD group showed increased activation during anticipation of positive images in this region. Furthermore, the change in functional activation in the insula co-occurred with increased connectivity between this insular region and the right cingulate and right mid-posterior insular region in R-PTSD. CONCLUSIONS: These findings suggest that the capacity to effectively remit from PTSD symptoms after PE treatment requires the ability to connect with physiological signals and moderate the discomfort of anticipatory anxiety of exposure therapy. These processes appear to be controlled by a network where the anterior insula is connected with the cingulate and the mid-posterior insula.
BACKGROUND: Prolonged exposure (PE) therapy is the first-line treatment for posttraumatic stress disorder (PTSD) in combat veterans. The underlying brain changes of treatment effect in PTSD are currently unknown. METHODS: A total of 31 veterans with PTSD completed an fMRI scan performing an affective anticipation task at baseline and were enrolled in PE therapy. Of these, 7 prematurely terminated therapy, while 24 individuals completed PE therapy and an identical follow-up fMRI scan. At follow-up, 15 of the 24 completers still had diagnosable PTSD (NR-PTSD) and 9 of the 24 completers showed complete remission from PTSD (R-PTSD), i.e. they did not meet diagnostic criteria for PTSD. RESULTS: The left anterior insula showed a significant group by scan session interaction. Specifically, the R-PTSD group showed decreased activation during anticipation of negative images from pre- to posttreatment scans, while the NR-PTSD group showed increased activation during anticipation of positive images in this region. Furthermore, the change in functional activation in the insula co-occurred with increased connectivity between this insular region and the right cingulate and right mid-posterior insular region in R-PTSD. CONCLUSIONS: These findings suggest that the capacity to effectively remit from PTSD symptoms after PE treatment requires the ability to connect with physiological signals and moderate the discomfort of anticipatory anxiety of exposure therapy. These processes appear to be controlled by a network where the anterior insula is connected with the cingulate and the mid-posterior insula.
Authors: Andrew A Nicholson; Daniela Rabellino; Maria Densmore; Paul A Frewen; Christian Paret; Rosemarie Kluetsch; Christian Schmahl; Jean Théberge; Tomas Ros; Richard W J Neufeld; Margaret C McKinnon; Jeffrey P Reiss; Rakesh Jetly; Ruth A Lanius Journal: Hum Brain Mapp Date: 2018-07-13 Impact factor: 5.038
Authors: Leonie Brinkmann; Christine Buff; Paula Neumeister; Sara V Tupak; Michael P I Becker; Martin J Herrmann; Thomas Straube Journal: Hum Brain Mapp Date: 2017-01-10 Impact factor: 5.038
Authors: Xi Zhu; Benjamin Suarez-Jimenez; Amit Lazarov; Liat Helpman; Santiago Papini; Ari Lowell; Ariel Durosky; Martin A Lindquist; John C Markowitz; Franklin Schneier; Tor D Wager; Yuval Neria Journal: Depress Anxiety Date: 2018-09-10 Impact factor: 6.505
Authors: Sonya B Norman; Moira Haller; Andrea D Spadoni; Sean P A Drummond; Victoria Risbrough; Jessica L Hamblen; Ryan S Trim; Erika X Blanes Journal: Contemp Clin Trials Date: 2015-04-28 Impact factor: 2.226
Authors: Gregory A Fonzo; Madeleine S Goodkind; Desmond J Oathes; Yevgeniya V Zaiko; Meredith Harvey; Kathy K Peng; M Elizabeth Weiss; Allison L Thompson; Sanno E Zack; Steven E Lindley; Bruce A Arnow; Booil Jo; Barbara O Rothbaum; Amit Etkin Journal: Biol Psychiatry Date: 2020-12-08 Impact factor: 13.382