Neural activity during response inhibition associated with improvement of dysphoric symptoms of PTSD after trauma-focused psychotherapy\u2014an EEG-fMRI study

Richard A Bryant,May Erlinger,Leanne Williams,Gin Malhi,Kim L Felmingham,Thomas Williamson,Mark Hinton,Mayuresh S Korgaonkar

doi:10.1038/s41398-021-01340-8

Abstract

Although trauma-focused cognitive behavioural therapy (TF-CBT) is the frontline treatment for posttraumatic stress disorder (PTSD), up to one half of patients do not respond optimally to this treatment. Inhibitory functions are important for successful management of PTSD, yet there is a dearth of knowledge regarding the extent to which neural mechanisms unpinning response inhibition are associated with TF-CBT response. Treatment-seeking PTSD patients (n = 40) were assessed during a response inhibition task (the Go/No-Go task) while undergoing functional magnetic imaging (fMRI) and event-related potentials (ERP) in separate sessions. PTSD symptom severity was assessed with the Clinician-Administered PTSD Scale, before undergoing nine sessions of TF-CBT. They were then reassessed post-treatment to estimate reduction in fear and dysphoric symptoms of PTSD. Although neural responses during the inhibitory task did not predict overall symptom change, reduced activation in the left precuneus and the right superior parietal cortex predicted greater improvement in dysphoric symptoms. ERP responses during response inhibition indicated that lower P3 peak latency predicted greater reduction of dysphoric symptoms. There were no significant predictors of changes of fear symptoms. These findings indicate that neural activity associated with response inhibition can act as a predictive biomarker of TF-CBT response for PTSD symptoms. This pattern of findings underscores the importance of delineating the role of biomarkers to predict remission of subtypes of PTSD.

Highlights

Trauma-focused cognitive behavior therapy (TF-CBT) is the primary frontline treatment for posttraumatic stress disorder (PTSD)
We examined brain areas making up the default mode network (DMN) and the cognitive control network (CCN) based on previous meta-analyses and studies, which have outlined the role of these networks in response inhibition processes[44,45]
This study aimed to evaluate the capacity of neural markers of inhibitory control to predict TF-CBT response by using a Go/No-Go paradigm during functional magnetic resonance imaging (fMRI) and event-related potentials (ERP) assessments

Summary

Introduction

Trauma-focused cognitive behavior therapy (TF-CBT) is the primary frontline treatment for posttraumatic stress disorder (PTSD). Despite the demonstrated success of this treatment for many patients, 30–50% of those with PTSD do not respond to this therapy[1,2] This situation has led to many attempts to understand predictors of treatment response, including neural markers that can predict who will respond to TF-CBT. Other studies have employed resting state MRI to identify neural profiles characteristic of TF-CBT responders[7] These studies have led to variable findings that have not provided consistent regions that predict TF-CBT outcome; one review indicates that there is convergence that better treatment response is associated with increased pre-treatment dorsal anterior cingulate activation and decreased amygdala and insula activation[8]. Another study employed a response inhibition task that allowed delineation of contextual processing and inhibition, and found that treatment responders had increased activation of the inferior parietal lobe during contextual processing that non-responders[21]

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