Neural Correlates of Psychotherapeutic Treatment of Post-traumatic Stress Disorder: A Systematic Literature Review

Abstract

ObjectivesPost-traumatic stress disorder (PTSD) is a common psychiatric disease with changes in neural circuitries. Neurobiological models conceptualize the symptoms of PTSD as correlates of a dysfunctional stress reaction to traumatic events. Functional imaging studies showed an increased amygdala and a decreased prefrontal cortex response in PTSD patients. As psychotherapeutic approaches represent the gold standard for PTSD treatment, it is important to examine its underlying neurobiological correlates.MethodsStudies published until August 2016 were selected through systematic literature research in the databases PubMed, PsychInfo, and Cochrane Library’s Central Register of Controlled Trials or were identified manually by searching reference lists of selected articles. Search terms were “neural correlates” OR “fMRI” OR “SPECT,” AND “therapy” AND “PTSD.” A total of 19 articles were included in the present review whereof 15 studies compared pre-to-post-therapy signal changes, six studies related pre-treatment activity to pre-to-post-symptom improvement, and four studies compared neural correlates of responders versus non-responders. The disposed therapy forms were cognitive behavioral therapy (CBT), eye movement desensitization and reprocessing, cognitive therapy, exposure therapy, mindfulness-based intervention, brief eclectic psychotherapy, and unspecified therapy.ResultsSuccessful psychotherapy of PTSD was repeatedly shown to be accompanied by decreased activity in the amygdala and the insula as well as increased activity in the dorsal anterior cingulate cortex (dACC) and hippocampus. Elevated dACC activity prior to treatment was related to subsequent treatment success and a positive predictor for treatment response. Elevated amygdala and insula pre-treatment activities were related to treatment failure.DiscussionDecreased activity in limbic brain regions and increased activity in frontal brain areas in PTSD patients after successful psychotherapeutic treatment might reflect regained top-down control over previously impaired bottom-up processes.

Emotional remodeling with oxytocin durably rescues trauma-induced behavioral and neuro-morphological changes in rats: a promising treatment for PTSD

“…Intriguingly, vulnerable rats exhibited less BLA and PL activation compared to resilient rats. Indeed, hypo-activation of the mPFC has been extensively reported in PTSD patients and animal models [48][49][50][51][52] , whereas hypo-activation of the BLA is very discrepant with the main stream of the literature 53 . However, protocols ranging from script-driven imagery in PTSD patients 54 or exposure to cat odor 41 or SPS in rats 43 , have shown that the amygdala is not systematically activated upon re-exposure of vulnerable subjects to trauma-related cues.…”

Neurobiological features and response to eye movement desensitization and reprocessing treatment of posttraumatic stress disorder in patients with breast cancer

“…Neuroimaging has also disclosed neurobiological changes associated with the outcome of evidencebased psychotherapeutic PTSD treatments, such as Trauma Focused-Cognitive Behavioural Therapy (TF-CBT) and Eye Movement Desensitization and Reprocessing therapy (EMDR) (Malejko, Abler, Plener, & Straub, 2017;Pagani, Högberg, Fernandez, & Siracusano, 2013). The latter was found effective in promoting a post-treatment reversal of prefrontal and limbic alterations associated with long-lasting clinical improvements (Högberg et al, 2008;Pagani et al, 2012).…”

Neural Response to Trauma-Related and Trauma-Unrelated Negative Stimuli in Remitted and Persistent Pediatric Posttraumatic Stress Disorder

“…Malejko et al recently reviewed 19 longitudinal studies of PTSD (17 adult and 2 youth) and found that the remittance of PTSD was related to decreased activities of the insula and amygdala and increased activities of the prefrontal/anterior cingulate cortex (PFC/ACC) and hippocampus. (Malejko, Abler, Plener, & Straub, 2017) Based on the ratio of the above studies, there has been relatively little PTSD-remittance research on youths. In 2016, Cisler et al applied trauma-unrelated emotional stimuli to female adolescents with PTSD ('direct physical assault/sexual assault/witnessed violence') and found several ndings.…”

“…1. Adolescents with less symptom reduction were characterized by less threat-safety discrimination before treatment (i.e., greater amygdala activation to both threat and neutral images), whereas adolescents with greater symptom reduction were characterized by amygdala activation only to threat images (Cisler et al, 2015) (included in the aforementioned review (Malejko et al, 2017)). 2.…”

“…2. The recovery of adolescent PTSD was positively related to the functional connectivity between the right amygdala and insula and the left amygdala and posterior cingulate gyrus (Cisler, Sigel, Steele, et al, 2016) (included in the aforementioned review (Malejko et al, 2017)). 3.…”