Associations between resting-state functional connectivity and treatment response in a randomized clinical trial for posttraumatic stress disorder

Jony Sheynin, Elizabeth R. Duval, Anthony P. King, Mike Angstadt, K. Luan Phan, Naomi M. Simon, Sheila A.M. Rauch, Israel Liberzon

Research output: Contribution to journalArticle

Abstract

Background: Alterations in resting-state functional connectivity (rsFC) have been reported in posttraumatic stress disorder (PTSD). Here, we examined pre- and post-treatment rsFC during a randomized clinical trial to characterize alterations and examine predictors of treatment response. Methods: Sixty-four combat veterans with PTSD were randomly assigned to prolonged exposure (PE) plus placebo, sertraline plus enhanced medication management, or PE plus sertraline. Symptom assessment and resting-state functional magnetic resonance imaging (fMRI) scans occurred before and after treatment. Twenty-nine trauma-exposed combat veterans without PTSD served as a control group at intake. Seed-based and region of interest (ROI)-to-ROI connectivities, as well as an exploratory connectome-based approach were used to analyze rsFC patterns. Based on previously reported findings, analyses focused on Salience Network (SN) and Default-Mode Network (DMN). Results: At intake, patients with PTSD showed greater DMN–dorsal attention network (DAN) connectivity (between ventromedial prefrontal cortex and superior parietal lobule; family-wise error corrected p =.011), greater SN–DAN connectivity (between insula and middle frontal gyrus; corrected p =.003), and a negative correlation between re-experiencing symptoms and within-DMN connectivity (between posterior cingulate cortex (PCC) and middle temporal gyrus; corrected p <.001). We also found preliminary evidence for associations between rsFC and treatment response. Specifically, high responders (≥50% PTSD symptom improvement), compared with low responders, had greater SN–DMN segregation (i.e., less pre-treatment amygdala–PCC connectivity; p =.011) and lower pre-treatment global centrality (p =.042). Conclusions: Our findings suggest neural abnormalities in PTSD and may inform future research examining neural biomarkers of PTSD treatment response.

Original languageEnglish (US)
Pages (from-to)1037-1046
Number of pages10
JournalDepression and Anxiety
Volume37
Issue number10
DOIs
StatePublished - Oct 1 2020

Keywords

  • PTSD
  • fMRI
  • functional connectivity
  • prolonged exposure
  • resting state
  • sertraline

ASJC Scopus subject areas

  • Clinical Psychology
  • Psychiatry and Mental health

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