Functional reorganization of neural networks during repeated exposure to the traumatic memory in posttraumatic stress disorder: An exploratory fMRI study

Cisler, Josh M.; Steele, J. Scott; Lenow, Jennifer K.; Smitherman, Sonet; Everett, Betty; Messias, Erick; Kilts, Clinton D.

doi:10.1016/j.jpsychires.2013.09.013

Cited by 79 publications

(76 citation statements)

References 52 publications

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“…In line with our findings, the hippocampus has been found to be relevant also for other anxiety disorders [62,63], conditioning paradigms [35,49,64,65,66,67,68,69] and seems to be sensitive to exposure [70], CBT treatment [30,71,72], therapy response [30] or recovery in general [73]. Furthermore, the hippocampus has been discussed with regard to the potential contribution to acquisition of irregularities in PD [15] and the optimization of exposure therapy and related learning processes [26].…”

Section: Discussionsupporting

confidence: 89%

Neural Correlates of Procedural Variants in Cognitive-Behavioral Therapy: A Randomized, Controlled Multicenter fMRI Study

Straube¹,

Lueken²,

Jansen³

et al. 2014

Psychother Psychosom

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Background: Cognitive behavioral therapy (CBT) is an effective treatment for panic disorder with agoraphobia (PD/AG). It is unknown, how variants of CBT differentially modulate brain networks involved in PD/AG. This study was aimed to evaluate the effects of therapist-guided (T+) versus self-guided (T-) exposure on the neural correlates of fear conditioning in PD/AG. Method: In a randomized, controlled multicenter clinical trial in medication-free patients with PD/AG who were treated with 12 sessions of manualized CBT, functional magnetic resonance imaging (fMRI) was used during fear conditioning before (t1) and after CBT (t2). Quality-controlled fMRI data from 42 patients and 42 healthy subjects (HS) were obtained. Patients were randomized to two variants of CBT (T+, n = 22, and T-, n = 20). Results: The interaction of diagnosis (PD/AG, HS), treatment group (T+, T-), time point (t1, t2) and stimulus type (conditioned stimulus: yes, no) revealed activation in the left hippocampus and the occipitotemporal cortex. The T+ group demonstrated increased activation of the hippocampus at t2 (t2 > t1), which was positively correlated with treatment outcome, and a decreased connectivity between the left inferior frontal gyrus and the left hippocampus across time (t1 > t2). Conclusion: After T+ exposure, contingency-encoding processes related to the posterior hippocampus are augmented and more decoupled from processes of the left inferior frontal gyrus, previously shown to be dysfunctionally activated in PD/AG. Linking single procedural variants to neural substrates offers the potential to inform about the optimization of targeted psychotherapeutic interventions.

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Section: Discussionsupporting

confidence: 89%

Neural Correlates of Procedural Variants in Cognitive-Behavioral Therapy: A Randomized, Controlled Multicenter fMRI Study

Straube¹,

Lueken²,

Jansen³

et al. 2014

Psychother Psychosom

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“…The demonstrated association between the extent of insular activity reduction and better clinical outcome at 8 years of follow-up is in agreement with previous studies finding similar associations in the short term [4,5]. The anterior insula has been implicated in extinction learning [6], the neural process upon which exposure therapy relies.…”

Section: Figsupporting

confidence: 90%

Brain and Behavior Changes following Exposure Therapy Predict Outcome at 8-Year Follow-Up

Lange

Goossens²,

Leibold³

et al. 2016

Psychother Psychosom

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“…Finally, given that the amygdala clusters extend dorsally into the striatum, we tested the effect specifically in the bilateral amygdala by using independently selected coordinates for bilateral amygdala taken from our previous study among adult women with PTSD (Cisler et al 2014b) and again found significant bilateral clusters of activity related to PTSD symptom slopes (Supplemental Material and Supplemental Figure 3). …”

Section: Resultsmentioning

confidence: 99%

Amygdala response predicts trajectory of symptom reduction during Trauma-Focused Cognitive-Behavioral Therapy among adolescent girls with PTSD

Cisler

Sigel

Kramer

et al. 2015

Journal of Psychiatric Research

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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...

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Functional reorganization of neural networks during repeated exposure to the traumatic memory in posttraumatic stress disorder: An exploratory fMRI study

Cited by 79 publications

References 52 publications

Neural Correlates of Procedural Variants in Cognitive-Behavioral Therapy: A Randomized, Controlled Multicenter fMRI Study

Neural Correlates of Procedural Variants in Cognitive-Behavioral Therapy: A Randomized, Controlled Multicenter fMRI Study

Brain and Behavior Changes following Exposure Therapy Predict Outcome at 8-Year Follow-Up

Amygdala response predicts trajectory of symptom reduction during Trauma-Focused Cognitive-Behavioral Therapy among adolescent girls with PTSD

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