A Pilot Study of Mindfulness-Based Exposure Therapy in OEF/OIF Combat Veterans with PTSD: Altered Medial Frontal Cortex and Amygdala Responses in Social-Emotional Processing.

Anthony P King,Sheila A M Rauch,Stefanie R Block,Nicholas Giardino,Todd K Favorite,Israel Liberzon,Rebecca K Sripada,Katherine E Porter

doi:10.3389/fpsyt.2016.00154

Abstract

Combat-related posttraumatic stress disorder (PTSD) is common among returning veterans, and is a serious and debilitating disorder. While highly effective treatments involving trauma exposure exist, difficulties with engagement and early drop may lead to sub-optimal outcomes. Mindfulness training may provide a method for increasing emotional regulation skills that may improve engagement in trauma-focused therapy. Here, we examine potential neural correlates of mindfulness training and in vivo exposure (non-trauma focused) using a novel group therapy [mindfulness-based exposure therapy (MBET)] in Afghanistan (OEF) or Iraq (OIF) combat veterans with PTSD. OEF/OIF combat veterans with PTSD (N = 23) were treated with MBET (N = 14) or a comparison group therapy [Present-centered group therapy (PCGT), N = 9]. PTSD symptoms were assessed at pre- and post-therapy with Clinician Administered PTSD scale. Functional neuroimaging (3-T fMRI) before and after therapy examined responses to emotional faces (angry, fearful, and neutral faces). Patients treated with MBET had reduced PTSD symptoms (effect size d = 0.92) but effect was not significantly different from PCGT (d = 0.43). Improvement in PTSD symptoms from pre- to post-treatment in both treatment groups was correlated with increased activity in rostral anterior cingulate cortex, dorsal medial prefrontal cortex (mPFC), and left amygdala. The MBET group showed greater increases in amygdala and fusiform gyrus responses to Angry faces, as well as increased response in left mPFC to Fearful faces. These preliminary findings provide intriguing evidence that MBET group therapy for PTSD may lead to changes in neural processing of social–emotional threat related to symptom reduction.

Highlights

Posttraumatic stress disorder (PTSD) affects up to ~20% of combat veterans returning from Afghanistan (OEF) and Iraq (OIF) [1], and is associated with high levels of suffering and disability
We found that an 8-week mindfulness-based cognitive therapy (MBCT) adapted for PTSD led to improvement in avoidant symptoms in chronic PTSD patients (Vietnam veterans) [20], and recent larger randomized controlled studies of mindfulness-based stress reduction (MBSR) adapted for combat PTSD in primarily Vietnam veterans have shown similar results [21]
This pilot study of a novel mindfulness-based, group in vivo exposure therapy for combat PTSD (MBET) found improvement in PTSD symptoms from pre- to post treatment was associated with changes in brain responses to processing of angry faces, including increased activity in rostral and dorsal medial PFC, and left amygdala

Summary

Introduction

Posttraumatic stress disorder (PTSD) affects up to ~20% of combat veterans returning from Afghanistan (OEF) and Iraq (OIF) [1], and is associated with high levels of suffering and disability. There is considerable empirical support for exposurebased individual psychotherapy for PTSD involving processing of traumatic memories [e.g. prolonged exposure therapy (PE), cognitive processing therapy (CPT)] and these individual treatments show very large effect sizes in military veterans compared to baseline (pre–post Cohen’s d in the 1.0–2.0 range) and often in comparison to active therapies [2, 3]. Group therapies appear to be considerably less effective than individual therapy for PTSD symptom reduction, even when the content of the intervention was similar [e.g., individual vs group present-centered therapy (PCT), trauma-focused exposure therapy, CPT] [6,7,8]. A recent large study of women veterans (N = 272) treated with group form of CPT that was not included in the meta-analysis found pre-post effect size estimate range of 0.27–0.38 [8]

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