TY - JOUR
T1 - Neural function during emotion processing and modulation associated with treatment response in a randomized clinical trial for posttraumatic stress disorder
AU - Duval, Elizabeth R.
AU - Sheynin, Jony
AU - King, Anthony P.
AU - Phan, K. Luan
AU - Simon, Naomi M.
AU - Martis, Brian
AU - Porter, Katherine E.
AU - Norman, Sonya B.
AU - Liberzon, Israel
AU - Rauch, Sheila A.M.
N1 - Publisher Copyright:
© 2020 Wiley Periodicals, Inc.
PY - 2020/7/1
Y1 - 2020/7/1
N2 - Background: Posttraumatic stress disorder (PTSD) has been associated with exaggerated threat processing and deficits in emotion modulation circuitry. It remains unknown how neural circuits are associated with response to evidence-based treatments for PTSD. Method: We examined associations between PTSD symptoms and indicators of neural response in key emotion processing and modulation regions. Fifty-six military Veterans with PTSD were randomly assigned to one of three evidence-based treatments (prolonged exposure, sertraline, and PE plus sertraline) in a randomized clinical trial (“PROGrESS”; 2018, Contemp Clin Trials, 64, 128–138). Twenty-seven combat-exposed controls (CCs) served as a comparison group at pretreatment. Before and after PTSD treatment, functional magnetic resonance imaging was used to assess brain activation and connectivity during the validated Shifted Attention Emotion Appraisal Task (2003, J Neurosci, 23, 5627–5633; 2013, Biol Psychiatry, 73, 1045–1053). Results: Greater activation in emotion processing (anterior insula) and modulation (prefrontal cortex) regions and increased connectivity between attentional control (dorsolateral prefrontal cortex and superior parietal cortex) and emotion processing (amygdala) regions, at pretreatment, were associated with subsequent PTSD symptom improvement. Conclusions: This study is one of the first to examine task-based activation and functional connectivity in a PTSD treatment trial, and provides evidence to suggest that activation in and connectivity between emotion processing and modulation regions are important predictors of treatment response.
AB - Background: Posttraumatic stress disorder (PTSD) has been associated with exaggerated threat processing and deficits in emotion modulation circuitry. It remains unknown how neural circuits are associated with response to evidence-based treatments for PTSD. Method: We examined associations between PTSD symptoms and indicators of neural response in key emotion processing and modulation regions. Fifty-six military Veterans with PTSD were randomly assigned to one of three evidence-based treatments (prolonged exposure, sertraline, and PE plus sertraline) in a randomized clinical trial (“PROGrESS”; 2018, Contemp Clin Trials, 64, 128–138). Twenty-seven combat-exposed controls (CCs) served as a comparison group at pretreatment. Before and after PTSD treatment, functional magnetic resonance imaging was used to assess brain activation and connectivity during the validated Shifted Attention Emotion Appraisal Task (2003, J Neurosci, 23, 5627–5633; 2013, Biol Psychiatry, 73, 1045–1053). Results: Greater activation in emotion processing (anterior insula) and modulation (prefrontal cortex) regions and increased connectivity between attentional control (dorsolateral prefrontal cortex and superior parietal cortex) and emotion processing (amygdala) regions, at pretreatment, were associated with subsequent PTSD symptom improvement. Conclusions: This study is one of the first to examine task-based activation and functional connectivity in a PTSD treatment trial, and provides evidence to suggest that activation in and connectivity between emotion processing and modulation regions are important predictors of treatment response.
KW - Cognitive Behavioral Therapy
KW - PTSD
KW - functional MRI
KW - pharmacotherapy
KW - trauma
KW - Brain/diagnostic imaging
KW - Magnetic Resonance Imaging
KW - Amygdala/diagnostic imaging
KW - Stress Disorders, Post-Traumatic/therapy
KW - Humans
KW - Emotions
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U2 - 10.1002/da.23022
DO - 10.1002/da.23022
M3 - Article
C2 - 32306485
AN - SCOPUS:85083508402
SN - 1091-4269
VL - 37
SP - 670
EP - 681
JO - Depression and Anxiety
JF - Depression and Anxiety
IS - 7
ER -