Abstract
Posttraumatic stress disorder (PTSD) is often chronic and disabling across the lifespan. The gold standard treatment for adolescent PTSD is Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT), though treatment response is variable and mediating neural mechanisms are not well understood. Here, we test whether PTSD symptom reduction during TF-CBT is associated with individual differences in large-scale brain network organization during emotion processing. Twenty adolescent girls, aged 11–16, with PTSD related to assaultive violence completed a 12-session protocol of TF-CBT. Participants completed an emotion processing task, in which neutral and fearful facial expressions were presented either overtly or covertly during 3T fMRI, before and after treatment. Analyses focused on characterizing network properties of modularity, assortativity, and global efficiency within an 824 region-of-interest brain parcellation separately during each of the task blocks using weighted functional connectivity matrices. We similarly analyzed an existing dataset of healthy adolescent girls undergoing an identical emotion processing task to characterize normative network organization. Pre-treatment individual differences in modularity, assortativity, and global efficiency during covert fear vs neutral blocks predicted PTSD symptom reduction. Patients who responded better to treatment had greater network modularity and assortativity but lesser efficiency, a pattern that closely resembled the control participants. At a group level, greater symptom reduction was associated with greater pre-to-post-treatment increases in network assortativity and modularity, but this was more pronounced among participants with less symptom improvement. The results support the hypothesis that modularized and resilient brain organization during emotion processing operate as mechanisms enabling symptom reduction during TF-CBT.
Highlights
Life assaultive violence exposure is a potent risk factor for pediatric posttraumatic stress disorder (PTSD), among girls [1,2]
The purpose of the present investigation was to identify modes of functional connectivity of large-scale brain networks associated with individual variation in PTSD symptom reduction during Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT) among adolescent girls with assault-related PTSD
We demonstrated that the large-scale network organization indices of modularity, assortativity, and global efficiency all differed significantly from random networks (S3–S5 Figs), providing support for the validity of these indices applied to task data
Summary
Life assaultive violence exposure is a potent risk factor for pediatric posttraumatic stress disorder (PTSD), among girls [1,2]. The current gold standard treatment for pediatric PTSD is Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT) [5,6,7], which is a manualized treatment typically delivered in 12–16 weekly sessions and includes modules addressing psychoeducation about trauma and PTSD; parenting skills; affect regulation skills; and developing a narrative of the traumatic event and cognitive processing of associated thoughts and feelings. Numerous clinical trials have demonstrated efficacy for TF-CBT in reducing PTSD symptoms, depression, anxiety, and behavior problems among traumatized youth [8]. In a recent TF-CBT clinical trial, the mean decrease in total number of PTSD symptom from pre-to-post treatment was 3.3 with a standard deviation of 3.48, indicating significant individual differences in treatment response [7]. The purpose of the present study was to identify modes of functional organization of neural processing networks as predictors of individual variation in treatment response towards the larger goal of elucidating for whom TF-CBT is most likely to work and through what brain organization principles it produces clinical outcomes
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