Psychotherapy for PTSD: Neuroimaging of Recovery Processes

Abstract

Much of the neurobiological research on posttraumatic stress disorder (PTSD) has focused on brain structures implicated in the fear circuit. Illustrated and labeled here are the locations and general extent of the amygdala (pink), hippocampus (purple), and limbic-related cerebral cortex (yellow), which includes the cingulate and parahippocampal gyri and uncus. The general region that is considered to be ventromedial prefrontal cortex (PFC) is circled. COVER and FIGURE 2. There is considerable variability across functional imaging studies assessing neural differences associated with PTSD, in part due to small sample size. Other important aspects include whether the analysis focused only on specific regions of interest or examined the whole brain and the tasks used to evoke changes in neural activity. Summarized here are the results of two recent meta-analyses that focused primarily on studies that reported whole brain analysis, used some form of symptom provocation (e.g., trauma reminders), and compared subjects with PTSD to healthy trauma exposed individuals. 1,2 Warm colors (pink, orange) indicate areas with higher activation in subjects with PTSD, and cool colors (blue, green) indicate areas with lower activation in subjects with PTSD. Both metaanalyses found hyperactivation within multiple areas in the cingulate cortex and noted the importance of this region for salience processing. Neither meta-analysis found the response of the amygdala to differ significantly between subjects with PTSD and trauma-exposed control subjects during symptom provocation. As noted in one study, this may be due to the inherent difficulty with acquiring functional imaging of this small area or may indicate that amygdala dysfunction is not as important in PTSD as previously thought. 1 FIGURE 3. Only a handful of imaging studies have assessed treatment-related changes in brain activations induced by trauma reminders in subjects with PTSD. The results of three studies that used single photon emission computed tomography (SPECT) to compare regional cerebral blood flow (CBF) in subjects who responded to treatment compared with their own baseline or subjects who did not respond to treatment are summarized. 3-5 Warm colors (pink, orange) indicate areas with higher CBF, and cool colors (blue, greens) indicate areas with lower CBF. One study reported only general areas (e.g. Brodmann areas [BA], hippocampus) and did not specify laterality, so these are indicated by large circles in both hemispheres. 3 Smaller circles mark the locations from the two studies that reported coordinates. 4,5 The only areas reported in all three studies are in dorsolateral PFC and medial temporal lobe, but the laterality and direction of change varies. Although very preliminary, these results suggest that both normalization and compensatory changes may occur.

Functional neuroimaging with default mode network regions distinguishes PTSD from TBI in a military veteran population

“…The default mode network (DMN), consisting of the inferior orbital frontal cortex, anterior cingulate gyrus, posterior cingulate gyrus, hippocampus, precuneus, superior parietal lobe, and angular gyrus (Buckner et al 2008 ), shows hyperperfusion in patients diagnosed with PTSD and hypoperfusion in patients diagnosed with TBI (Erickson et al 2014 ; Dubroff and Newberg 2008 ; Newberg and Alavi 2003 ; Newberg et al 2014 ; Liu et al 2013 ). By further elucidating the correlation between increased perfusion in DMN structures in PTSD and decreased perfusion in TBI, clinicians may be able to more reliably diagnose PTSD from TBI.…”

Future Research: Global Implications

“…research is needed to explore the degree to which successful treatment of trauma decreases the amount of high-risk and/or perpetrator behavior and deters further victimization. Additional research is also needed to explore the degree to which neurobiological changes correlated with traumatization, cognitive deficits, affective dysregulation, and perpetrator behavior (Erickson, Hurley, & Taber, 2014;Perry, 1997;Perry et al, 1995;Schore, 2001;Siegel, 2012) can be reversed with the judicious application of eye movement desensitization and reprocessing (EMDR), or any other treatment (Barsaglini, Sartori, Benetti, Pettersson-Yeo, & Mechelli, 2014;Quidé, Witteveen, El-Hage, Veltman, & Olff, 2012;Schore, Siegel, Shapiro, & Van der Kolk, 1998;Thomaes et al, 2014). It seems self-evident that the ideal way to address pressing societal needs, on both local and global levels, is by the integration of science and practice.…”

EMDR as a Treatment Approach of PTSD Complicated by Comorbid Psychiatric, Somatic, and Cognitive Disorders: A Case Report of an Older Woman With a Borderline and Avoidant Personality Disorder

“…Often, significant neurocognitive effects are associated with PTSD (Scott et al, 2015) as are premature aging and dementia (Lohr et al, 2015). In case of cognitive disorders, successful treatment of PTSD might normalize brain abnormalties (Erickson, Hurley, & Taber, 2014; Rabe, Zoellner, & Beauducel, 2008) and as a result, positively improve cognitive functioning. Research on this topic is needed.…”