Therapeutic interventions impact brain function and promote post-traumatic growth in adults living with post-traumatic stress disorder: A systematic review and meta-analysis of functional magnetic resonance imaging studies

Abstract

IntroductionThe present systematic review and meta-analysis explores the impacts of cognitive processing therapy (CPT), eye movement desensitization and reprocessing (EMDR), and prolonged exposure (PE) therapy on neural activity underlying the phenomenon of post-traumatic growth for adult trauma survivors.MethodsWe utilized the following databases to conduct our systematic search: Boston College Libraries, PubMed, MEDLINE, and PsycINFO. Our initial search yielded 834 studies for initial screening. We implemented seven eligibility criteria to vet articles for full-text review. Twenty-nine studies remained for full-text review after our systematic review process was completed. Studies were subjected to several levels of analysis. First, pre-and post- test post-traumatic growth inventory (PTGI) scores were collected from all studies and analyzed through a forest plot using Hedges’ g. Next, Montreal Neurological Institute (MNI) coordinates and t-scores were collected and analyzed using an Activation Likelihood Estimation (ALE) to measure brain function. T-scores and Hedges’ g values were then analyzed using Pearson correlations to determine if there were any relationships between brain function and post-traumatic growth for each modality. Lastly, all studies were subjected to a bubble plot and Egger’s test to assess risk of publication bias across the review sample.ResultsForest plot results indicated that all three interventions had a robust effect on PTGI scores. ALE meta-analysis results indicated that EMDR exhibited the largest effect on brain function, with the R thalamus (t = 4.23, p < 0.001) showing robust activation, followed closely by the R precuneus (t = 4.19, p < 0.001). Pearson correlation results showed that EMDR demonstrated the strongest correlation between increased brain function and PTGI scores (r = 0.910, p < 0.001). Qualitative review of the bubble plot indicated no obvious traces of publication bias, which was corroborated by the results of the Egger’s test (p = 0.127).DiscussionOur systematic review and meta-analysis showed that CPT, EMDR, and PE each exhibited a robust effect on PTG impacts across the course of treatment. However, when looking closer at comparative analyses of neural activity (ALE) and PTGI scores (Pearson correlation), EMDR exhibited a more robust effect on PTG impacts and brain function than CPT and PE.

Correlating stress reduction and eye movement patterns in a world famous Kyoto Japanese garden

“…After its initial discovery other sensory domains such as sound and touch have been added (Shapiro, 1999). The technique is widely used, especially to treat the persistent stress associated with traumatic events (e.g., PTSD), but its neurological basis is not understood (Pierce et al, 2023;Valiente-Gomez et al, 2017;Zarghi et al, 2013). The success of the technique has been suggested to be due in part to the strong bilateral nature of the visual stimuli used and some authors have noted its relationship to the REM phase of sleep (Stickgold, 2002).…”

Introducing the Theory of Neurosocial Interdependence

“…With recent research into complex PTSD, it has been observed how these impacts can occur in reverse as well; namely, that single events can produce complex PTSD, and individuals who experience chronic exposure can produce PTSD (Cloitre, 2020). While some research has been conducted into the neural substrates implicated in resilience and post-traumatic growth (Pierce et al, 2023), more work is needed to understand how environmental impacts of trauma lead to different mental health challenges.…”

“…Unfortunately, this trigger caused Michael to experience an episode of dissociation, where he was perceptually transported to the day of his close friend's tragic passing. Then, Michael's limbic system activates and causes his body to tense up, produce sweat, and experience harrowing feelings of panic (Pierce & Black, 2023a, 2023bPierce et al, 2023;Sherin, 2011).…”

“…Efferent and afferent reciprocity likewise dovetail with interventions designed for individuals living with PTSD, such as cognitive processing therapy (CPT), eye movement desensitization (EMDR), and prolonged exposure (PE). These interventions, among others, help individuals manage the sense of overwhelm associated with traumatic stress symptoms and rebuild their sense of self after a traumatic event has occurred (Gallagher & Resick, 2012;Hendriks et al, 2018;Pierce et al, 2023;Valiente-Gomez et al, 2017). Concepts undergirding the theory of neurosocial interdependence explore how the human brain impacts, and is impacted by, one's environments.…”

“…Theories of trauma have also begun to incorporate insights about the function of the amygdala in the human fear response, ANS dysregulation, and volumetric alteration of the hippocampus to help individuals conceptualize and moderate the physiological impacts of traumatic stress (Levine, 2015). In social work research, human neuroscience has been used as a tool to compare brain area activity during the implementation of different trauma therapies (Pierce & Black, 2023b;Pierce et al, 2023). Additionally, human neuroscience has aided social workers with identifying optimal interventions for children with different math performance and reading challenges (Ashkenazi et al, 2013).…”