Psychological and Brain Connectivity Changes Following Trauma-Focused CBT and EMDR Treatment in Single-Episode PTSD Patients.

Emiliano Santarnecchi,Alberto Siracusano,Patrizia La Porta,Simone Rossi,Giampaolo Vatti,Andrea Fagiolini,Giorgio Di Lorenzo,Alessandro Rossi,Letizia Bossini

doi:10.3389/fpsyg.2019.00129

Abstract

Among the different therapeutic alternatives for post-traumatic stress disorder (PTSD), Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT) and Eye Movement Desensitization and Reprocessing (EMDR) Therapy have shown promising results in helping patients cope with PTSD symptoms. However, given the different theoretical and methodological substrate of TF-CBT and EMDR, a potentially different impact on the brain for the two interventions could be hypothesized, as well as an interaction between trauma-specific PTSD symptomatology and response to a given psychotherapy. In this study, we monitored psychological and spontaneous functional connectivity fMRI patterns in two groups of PTSD patients who suffered by the same traumatic event (i.e., natural disaster), before and after a cycle of psychotherapy sessions based on TF-CBT and EMDR. Thirty-seven (37) PTSD patients were enrolled from a larger sample of people exposed to a single, acute psychological stress (i.e., 2002 earthquake in San Giuliano di Puglia, Italy). Patients were randomly assigned to TF-CBT (n = 14) or EMDR (n = 17) psychotherapy. Clinical assessment was performed using the Clinician-Administered PTSD Scale (CAPS), the Davidson Trauma Scale (DTS) and the Work and Social Adjustment Scale (WSAS), both at baseline and after treatment. All patients underwent a fMRI data acquisition session before and after treatment, aimed at characterizing their functional connectivity (FC) profile at rest, as well as potential connectivity changes associated with the clinical impact of psychotherapy. Both EMDR and TF-CBT induced statistically significant changes in clinical scores, with no difference in the clinical impact of the two treatments. Specific changes in FC correlated with the improvement at the different clinical scores, and differently for EMDR and TF-CBT. However, a similarity in the connectivity changes associated with changes in CAPS in both groups was also observed. Specifically, changes at CAPS in the entire sample correlated with an (i) increase in connectivity between the bilateral superior medial frontal gyrus and right temporal pole, and a (ii) decrease in connectivity between left cuneus and left temporal pole. Results point to a similar, beneficial psychological impact of EMDR and TF-CBT for treatment of natural-disaster PTSD patients. Neuroimaging data suggest a similar neurophysiological substrate for clinical improvement following EMDR and TF-CBT, involving changes affecting bilateral temporal pole connectivity.

Highlights

Posttraumatic stress disorder (PTSD) is a psychiatric illness caused by traumatic events, usually developed after exposure to trauma such as physical or sexual assault, injury, combatrelated trauma, natural disaster or death, and after witnessing or indirect exposure (APA Association, 2013, October 3, 2013)
We focused on assessing the impact of both trauma-focused cognitive behavioral therapy (TF-CBT) and eye movement desensitization and reprocessing (EMDR) on patterns of functional connectivity (FC) as those measured via resting-state fMRI analysis
We investigated whether two psychotherapeutic approaches, EMDR and TF-CBT, might induce significant clinical benefit in a group of PTSD patients affected by the same trauma

Summary

Introduction

Posttraumatic stress disorder (PTSD) is a psychiatric illness caused by traumatic events, usually developed after exposure to trauma such as physical or sexual assault, injury, combatrelated trauma, natural disaster or death, and after witnessing or indirect exposure (APA Association, 2013, October 3, 2013). PTSD is configured as a complex syndrome with pathognomonic symptomatology that includes re-experiencing of trauma-related aspects (i.e., flashbacks), avoidance of trauma-related situations, hyperarousal and emotional numbing, together with cognitive symptoms including impoverished auto-biographical memory for positive events (Harvey et al, 1998), attention and working memory deficits (Scott et al, 2015), enhanced arousal induced by traumarelated stimuli (Karl et al, 2006), as well as decreased social functioning (Fontana and Rosenheck, 2010) These features highlight the need for understanding the neurobiological basis of stress vulnerability (Brunetti et al, 2017), the impact of PTSD on the brain as well as the neural effect of treatment interventions. The neurophysiological mechanism(s) behind the effect of saccadic movements is not clear, with hypotheses spanning from an unspecific, generalized relaxation achieved through activation of the parasympathetic system (followed by conditioning-based association with traumatic memories), to a decoupling between external attention and internal reprocessing of traumatic memories, which prevents patients from feeling overwhelmed (Davidson and Parker, 2001; Herkt et al, 2014)

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Discussion

Conclusion