@article{785838ed953448839ea949bb9a677ab9,
title = "Neural correlates of emotional reactivity and regulation associated with treatment response in a randomized clinical trial for posttraumatic stress disorder",
abstract = "Posttraumatic Stress Disorder (PTSD) is a debilitating condition often associated with difficulty in emotion regulation, including reappraising negative emotions. This study assessed neural mechanisms associated with emotion regulation in veterans prior to and following treatment for PTSD. Participants with PTSD and combat exposed controls (CC) completed diagnostic evaluation and underwent fMRI scanning while completing Emotion Regulation Task (ERT) and Emotional Faces Assessment Task (EFAT). Participants with PTSD were randomly assigned to Prolonged Exposure plus placebo (PE+PLB), Sertraline plus enhanced medication management (SERT+EMM), or PE plus SERT (PE+SERT) and repeated diagnostic evaluation and MRI scanning following treatment. The amygdala, dmPFC, and dlPFC were examined as regions of interest. On ERT, veterans with PTSD showed significantly less dmPFC activation than CCs during reappraisal vs emotional maintenance. Within the PTSD group, results demonstrated a significant association between less activation in the dmPFC during emotion reappraisal vs maintenance trials before treatment and greater reductions in symptoms from pre- to post-treatment. During the EFAT, there were no group differences between participants with PTSD and CCs in brain activation, and no relationships between brain function and PTSD symptoms. These findings suggest that less emotional reactivity might potentially reflect less need for recruitment of prefrontal regions when reappraising negative emotion, and is an individual factor associated with better treatment outcome.",
keywords = "Amygdala, Dorsomedial prefrontal cortex, Medial prefrontal cortex, Prolonged Exposure, SSRI, Veterans, fMRI",
author = "Joshi, {Sonalee A.} and Duval, {Elizabeth R.} and Jony Sheynin and King, {Anthony P.} and Phan, {K. Luan} and Brian Martis and Porter, {Katherine E.} and Israel Liberzon and Rauch, {Sheila A.M.}",
note = "Funding Information: This work was supported by the U.S. Department of Defense through the U.S. Army Medical Research and Materiel Command (MRMC; Randomized Controlled Trial of Sertraline, Prolonged Exposure Therapy, and Their Combination in OEF/OIF Combat Veterans with PTSD; Grant # W81XWH-11-1-0073 ); the National Center for Advancing Translational Sciences of the National Institutes of Health (Grant # UL1TR000433 ). This material is also the result of work supported with resources and the use of facilities at Massachusetts General Hospital, the VA Ann Arbor Healthcare System, Ralph H. Johnson VA Medical Center, and VA San Diego Healthcare System. Funding Information: Dr. Duval reports in past 24 months funding from NIH , the Michigan Institute for Clinical Health Research , Cohen Veterans Bioscience , and One Mind Institute . Dr. King reports in past 24 months funding from NIH and the Michigan Institute for Clinica Health Research . Dr. Liberzon reports in past 24 months speaking or consulting with: Department of Defense, NIH, VA, Cohen Veteran Bioscience, ARMGO Pharma Inc., Sunovion Pharmaceuticals Inc. Aptinyx Inc., Heptares Therapeutics Ltd., Nobilis Therapeutics, Inc., Astrotide, Inc. Dr. Rauch reports in past 24 months speaking or consulting with Department of Defense, NIH, VA, Woodruff Foundation, McCormick Foundation, Wounded Warrior Project, Cohen Veteran Bioscience, and The Pennsylvania State University. Dr. Rauch receives royalties from Oxford University Press. Ms. Joshi and Drs. Sheynin, Phan, Martis, and Porter report no disclosures. The views expressed in this article are solely those of the authors and do not reflect an endorsement by or the official policy of the Department of Veterans Affairs, or the U.S. Government. Funding Information: Dr. Duval reports in past 24 months funding from NIH, the Michigan Institute for Clinical Health Research, Cohen Veterans Bioscience, and One Mind Institute. Dr. King reports in past 24 months funding from NIH and the Michigan Institute for Clinica Health Research. Dr. Liberzon reports in past 24 months speaking or consulting with: Department of Defense, NIH, VA, Cohen Veteran Bioscience, ARMGO Pharma Inc., Sunovion Pharmaceuticals Inc. Aptinyx Inc., Heptares Therapeutics Ltd., Nobilis Therapeutics, Inc., Astrotide, Inc. Dr. Rauch reports in past 24 months speaking or consulting with Department of Defense, NIH, VA, Woodruff Foundation, McCormick Foundation, Wounded Warrior Project, Cohen Veteran Bioscience, and The Pennsylvania State University. Dr. Rauch receives royalties from Oxford University Press. Ms. Joshi and Drs. Sheynin, Phan, Martis, and Porter report no disclosures. The views expressed in this article are solely those of the authors and do not reflect an endorsement by or the official policy of the Department of Veterans Affairs, or the U.S. Government.We would like to thank all members of the PROGrESS study team, especially Murray Stein, MD, MPH for assistance with project development and execution, Margaret Venners, MPH, MSW for project management, Nita Patel BS, for MRI scanning, Sean Ma, PhD for data collection and organization, Mike Angstadt, MS, for MRI analysis consultation and support, and Mariam Reda BS, for assistance with imaging processing. We thank all of the veterans who participated in this study. Symposium presented at the Anxiety and Depression Association of America Annual Meeting, Chicago, IL (2019). Poster presented at the Association of Psychological Sciences Annual Meeting, Washington, DC (2019). This work was supported by the U.S. Department of Defense through the U.S. Army Medical Research and Materiel Command (MRMC; Randomized Controlled Trial of Sertraline, Prolonged Exposure Therapy, and Their Combination in OEF/OIF Combat Veterans with PTSD; Grant #W81XWH-11-1-0073); the National Center for Advancing Translational Sciences of the National Institutes of Health (Grant #UL1TR000433). This material is also the result of work supported with resources and the use of facilities at Massachusetts General Hospital, the VA Ann Arbor Healthcare System, Ralph H. Johnson VA Medical Center, and VA San Diego Healthcare System. Publisher Copyright: {\textcopyright} 2020 Elsevier B.V.",
year = "2020",
month = may,
day = "30",
doi = "10.1016/j.pscychresns.2020.111062",
language = "English (US)",
volume = "299",
journal = "Psychiatry Research - Neuroimaging",
issn = "0925-4927",
publisher = "Elsevier Ireland Ltd",
}