Neurosubstrates of Remission following Prolonged Exposure Therapy in Veterans with Posttraumatic Stress Disorder

Psychotherapy and Psychosomatics - Tập 82 Số 6 - Trang 382-389 - 2013
Alan N. Simmons1, Sonya B. Norman1, Andrea D. Spadoni1, Irina A. Strigo1
1VA San Diego Healthcare System, and

Tóm tắt

<b><i>Background:</i></b> 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. <b><i>Methods:</i></b> 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. <b><i>Results:</i></b> 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. <b><i>Conclusions:</i></b> 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.

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10.1001%2Fjama.295.9.1023

10.1016%2Fj.annepidem.2005.03.009

10.1176%2Fappi.ajp.162.2.214

10.1016%2Fj.biopsych.2009.09.023

10.1037%2F0021-843X.96.3.223

10.1016%2Fj.biopsych.2006.03.042

10.1016%2Fj.biopsych.2008.05.027

10.1001%2Farchgenpsychiatry.2011.1539

10.1017%2FS1461145709990149

10.1037%2F1040-3590.11.2.124

10.1192%2Fbjp.bp.106.021402

10.1097%2FPSY.0b013e3181a56ed8

10.1093%2Fcercor%2Fbhq186

10.1126%2Fscience.280.5364.747

10.1016%2Fj.neuroimage.2005.05.047

10.1016%2FS0959-4388%2803%2900090-4

10.1038%2Fnrn2555

10.1186%2F2045-5380-1-6

10.1111%2Fj.1469-7793.2000.t01-1-00259.x

10.1176%2Fappi.neuropsych.21.2.114

10.1111%2Fj.1749-6632.2010.05689.x

10.1111%2Fj.1467-9280.2007.01860.x

10.1016%2Fj.neuropsychologia.2011.02.055

10.1016%2Fj.jpsychires.2010.11.004

10.1016%2Fj.pscychresns.2005.05.012

10.2307%2F2532847

10.1016%2Fj.tics.2011.08.003

10.1006%2Fnimg.2002.1147

10.1159%2F000334112

10.1016%2Fj.neuroimage.2007.01.018

10.1016%2Fj.jpsychires.2005.07.005

10.1196%2Fannals.1301.012

10.1016%2Fj.neubiorev.2006.11.010

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Thông tin xuất bản

Psychotherapy and Psychosomatics

Tập 82 Số 6

382-389

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