Trauma-focused psychotherapy response in youth with posttraumatic stress disorder is associated with changes in insula volume

Jasper B Zantvoord,Paul Zhutovsky,Judith B.M Ensink,Rosanne Op Den Kelder,Guido A Van Wingen,Ramon J.L Lindauer

doi:10.1016/j.jpsychires.2020.10.037

Abstract

Randomized controlled trials have shown efficacy of trauma-focused psychotherapies in youth with posttraumatic stress disorder (PTSD), but little is known about the relationship between treatment response and alternations in brain structures associated with PTSD. In this study, we longitudinally examined the association between treatment response and pre-to posttreatment changes in structural magnetic resonance imaging (MRI) scans using a voxel-based morphometry approach. We analyzed MRI scans of 35 patients (ages 8–18 years, 21 female) with PTSD (80%) or partial PTSD (20%) before and after eight weekly sessions of trauma-focused psychotherapy. PTSD severity was assessed longitudinally using the Clinician-Administered PTSD scale for Children and Adolescents to divide participants into responders and non-responders. Group by time interaction analysis showed significant differences in grey-matter volume in the bilateral insula due to volume reductions over time in non-responders compared to responders. Despite the significant group by time interaction, there were no significant group differences at baseline or follow-up. As typical development is associated with insula volume increase, these longitudinal MRI findings suggest that treatment non-response is associated with atypical neurodevelopment of the insula, which may underlie persistence of PTSD in youth. The absence of structural MRI changes in treatment responders, while in need of replication, suggest that successful trauma-focused psychotherapy may not directly normalize brain abnormalities associated with PTSD.

Highlights

Posttraumatic stress disorder (PTSD) is a common mental health disorder that develops in approximately 16% of youth exposed to traumatic events, which may include domestic violence, sexual abuse and accidents (Alisic et al, 2014)
Our results show that treatment non-responders, relative to responders are characterized by a decrease over time of grey-matter volume (GMV) in the bilateral anterior and posterior insula
The insula can be subdivided in distinct regions, each with their own set of functions: the posterior insula is involved in the detection, inter oceptive awareness and interpretation of somatosensory and autonomic stimuli

Summary

Introduction

Posttraumatic stress disorder (PTSD) is a common mental health disorder that develops in approximately 16% of youth exposed to traumatic events, which may include domestic violence, sexual abuse and accidents (Alisic et al, 2014). Youth with PTSD are troubled by frequent re-experiencing of the traumatic event, persistent avoidance, hyperarousal and negative alterations in cognition and mood (American Psychiatric Association, 2013). These symptoms can interfere with so cial functioning and school performance and have a negative effect on the quality of life of the affected youth and their families (Carrion et al, 2002). They are a crucial factor in shaping the vulnerability to depression and suicidality later in life (Molnar et al, 2001; Sunley et al, 2020).

Methods

Results

Conclusion