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Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT) is the gold standard treatment for pediatric PTSD. Nonetheless, clinical outcomes in TF-CBT are highly variable, indicating a need to identify reliable predictors that allow forecasting treatment response. Here, we test the hypothesis that functional neuroimaging correlates of emotion processing predict PTSD symptom reduction during Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT) among adolescent girls with PTSD. Thirty-four adolescent girls with PTSD related to physical or sexual assault were enrolled in TF-CBT, delivered in an approximately 12 session format, in an open trial. Prior to treatment, they were engaged in an implicit threat processing task during 3T fMRI, during which they viewed faces depicting fearful or neutral expressions. Among adolescent girls completing TF-CBT (n=23), slopes of PTSD symptom trajectories during TF-CBT were significantly related to pre-treatment degree of bilateral amygdala activation while viewing fearful vs neutral images. Adolescents with less symptom reduction were characterized by greater amygdala activation to both threat and neutral images (i.e., less threat-safety discrimination), whereas adolescents with greater symptom reduction were characterized by amygdala activation only to threat images. These clinical outcome relationships with pre-treatment bilateral amygdala activation remained when controlling for possible confounding demographic or clinical variables (e.g., concurrent psychotropic medication, comorbid diagnoses). While limited by a lack of a control group, these preliminary results suggest that pre-treatment amygdala reactivity to fear stimuli, a component of neurocircuitry models of PTSD, positively predicts symptom reduction during TF-CBT among * To whom correspondence should be directed: Brain Imaging Research Center, Psychiatric Research Institute, University of Arkansas for Medical Sciences, 4301 W. Markham, #554, Little Rock, AR 72205, jcisler@uams.edu, phone: (501) 526-8343. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. Financial DisclosuresAll authors report no financial conflicts of interest. ContributionsBen Sigel and Teresa Kramer were involved in study design, interpretation, and manuscript writing. Karin Vanderzee and Joy Pemberton were data collection, interpretation, and manuscript writing. Sonet Smitherman was involved in study design, data collection, and analysis. Clint Kilts was involved in study design, interpretation, and manuscript writing. Josh Cisler was involved in study design, analysis, interpretation, and manuscript writin...

The purpose of this study was to explore large-scale initiatives and dissemination models in the United States to promote Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT), an evidence-based practice (EBP) for childhood Post-Traumatic Stress Disorder (PTSD). Individuals from 17 statewide TF-CBT dissemination projects across the nation were interviewed about their projects. Data were collected and analyzed on dissemination model used, facilitating factors, approximate overall cost, and approximate number of therapists trained. Approximate total costs, approximate number of therapists trained, and duration of training and consultation ranged considerably across projects. Differences between two dissemination models in duration of training and approximate number of trained therapists were noted; however, approximate funding per year, and approximate total costs did not differ between the two models. Results are discussed in light of recent efforts to engage states in the development of traumafocused interventions and future directions for research.

These preliminary results suggest the neurocircuitry mechanisms through which TF-CBT produces clinical outcomes, providing putative brain targets for augmenting TF-CBT response.