Abstract

Trauma-focused cognitive behavior therapy (TF-CBT) is the gold standard treatment for posttraumatic stress disorder (PTSD), up to one-half of PTSD patients remain treatment non-responders. Although studies have used functional MRI to understand the neurobiology of treatment response, there is less understanding of the role of white matter brain structures in response to TF-CBT. Thirty-six treatment-seeking PTSD patients and 33 age-gender matched healthy controls completed diffusion-weighted imaging scans at baseline. Patients underwent nine sessions of TF-CBT treatment and PTSD symptom severity was assessed with the Clinician-Administered PTSD Scale before and after completing treatment. Patients were assessed to estimate the reduction in overall symptoms and also specifically fear and dysphoric symptoms of PTSD. Tract-based spatial statistical analyses were performed for the PTSD group to evaluate whole-brain correlations of fractional anisotropy (FA) with improvement in overall, fear, and dysphoric symptoms using non-parametric permutation inference testing (pFWE < 0.05). Next, we evaluated if these significant measures also characterized PTSD from controls. Greater improvement in dysphoric symptoms was found correlated with lower FA in white matter regions associated with the limbic system, frontal cortex, thalamic association and projection fibers, corpus callosum, and tracts related to the brainstem. White matter anisotropy was not found associated with either overall or fear symptoms. FA in the significant clusters was similar between PTSD and controls. White-matter related to key functional regions may also play an important role in response to TF-CBT. Our results underscore the heterogeneity of PTSD and the need to evaluate distinct symptom phenotypes in treatment studies.

Highlights

  • International treatment guidelines recommend traumafocused cognitive behavior therapy (TF-CBT) as the recommended treatment for posttraumatic stress disorder (PTSD)[1,2,3]

  • The aim of this study was to investigate the extent to which white matter fractional anisotropy (FA) prior to treatment is associated with symptom reduction in PTSD patients who receive a course of TF-CBT

  • This study investigated whether white matter FA prior to treatment is associated with symptom reduction in PTSD patients who receive a course of TF-CBT

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Summary

Introduction

International treatment guidelines recommend traumafocused cognitive behavior therapy (TF-CBT) as the recommended treatment for posttraumatic stress disorder (PTSD)[1,2,3]. There is a need to understand why some patients are more responsive than others to TF-CBT. In response to this need, a series of studies have investigated neural markers that can predict response to TF-CBT7–12. Overall, these studies have found that better response to TF-CBT is associated with higher activation in the rostral anterior cingulate and posterior cingulate cortex during emotional processing and in the inferior parietal lobe and inferior frontal cortex during inhibitory tasks. Structural imaging studies have reported that larger hippocampal and rostral anterior cingulate volume prior to treatment predicts better treatment response[14,15]

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