Amygdala response predicts trajectory of symptom reduction during Trauma-Focused Cognitive-Behavioral Therapy among adolescent girls with PTSD

Abstract

Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT) is the gold standard treatment for pediatric PTSD. Nonetheless, clinical outcomes in TF-CBT are highly variable, indicating a need to identify reliable predictors that allow forecasting treatment response. Here, we test the hypothesis that functional neuroimaging correlates of emotion processing predict PTSD symptom reduction during Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT) among adolescent girls with PTSD. Thirty-four adolescent girls with PTSD related to physical or sexual assault were enrolled in TF-CBT, delivered in an approximately 12 session format, in an open trial. Prior to treatment, they were engaged in an implicit threat processing task during 3T fMRI, during which they viewed faces depicting fearful or neutral expressions. Among adolescent girls completing TF-CBT (n=23), slopes of PTSD symptom trajectories during TF-CBT were significantly related to pre-treatment degree of bilateral amygdala activation while viewing fearful vs neutral images. Adolescents with less symptom reduction were characterized by greater amygdala activation to both threat and neutral images (i.e., less threat-safety discrimination), whereas adolescents with greater symptom reduction were characterized by amygdala activation only to threat images. These clinical outcome relationships with pre-treatment bilateral amygdala activation remained when controlling for possible confounding demographic or clinical variables (e.g., concurrent psychotropic medication, comorbid diagnoses). While limited by a lack of a control group, these preliminary results suggest that pre-treatment amygdala reactivity to fear stimuli, a component of neurocircuitry models of PTSD, positively predicts symptom reduction during TF-CBT among * To whom correspondence should be directed: Brain Imaging Research Center, Psychiatric Research Institute, University of Arkansas for Medical Sciences, 4301 W. Markham, #554, Little Rock, AR 72205, jcisler@uams.edu, phone: (501) 526-8343. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. Financial DisclosuresAll authors report no financial conflicts of interest. ContributionsBen Sigel and Teresa Kramer were involved in study design, interpretation, and manuscript writing. Karin Vanderzee and Joy Pemberton were data collection, interpretation, and manuscript writing. Sonet Smitherman was involved in study design, data collection, and analysis. Clint Kilts was involved in study design, interpretation, and manuscript writing. Josh Cisler was involved in study design, analysis, interpretation, and manuscript writin...

Is There an Ace Up Our Sleeve? A Review of Interventions and Strategies for Addressing Behavioral and Neurobiological Effects of Adverse Childhood Experiences in Youth

“…Additionally, few studies have examined other neurobiological outcomes, mainly cortisol responses. Cisler et al, (2015Cisler et al, ( , 2016a examined neural correlates of TF-CBT in adolescent girls exposed to maltreatment. First, they found that PTSD symptom trajectories during TF-CBT were significantly related to pre-treatment bilateral amygdala activation during threat processing (Cisler, Sigel, Kramer, Smitherman, Vanderzee, Pemberton, & Kilts, 2015).…”

“…Cisler et al, (2015Cisler et al, ( , 2016a examined neural correlates of TF-CBT in adolescent girls exposed to maltreatment. First, they found that PTSD symptom trajectories during TF-CBT were significantly related to pre-treatment bilateral amygdala activation during threat processing (Cisler, Sigel, Kramer, Smitherman, Vanderzee, Pemberton, & Kilts, 2015). Greater amygdala activation to threatening and safe stimuli predicted poorer symptom improvement (suggesting impairment in discrimination), whereas adolescents with greater symptom improvement were characterized by amygdala activation only to threat images.…”

Victimización Sexual en la Infancia e Intervención Basada en la Evidencia:

“…Es por esto, y por el abordaje integral que el modelo TF-CBT ofrece, que se presenta como la opción más efectiva para trabajar con niños, niñas y adolescentes que han vivido experiencias de victimización sexual en la infancia (Cisler et al, 2015;Cohen et al, 2004a;Cohen et al, 2004b;Deblinger et al, 2011;King et al, 2000;Mannarino, Cohen, Deblinger, Runyon, y Steer, 2012;Saywitz et al, 2000).…”

“…Teniendo en cuenta los cuatro factores traumatogénicos propuestos por Finkelhor y Browne (1985) para la victimización sexual, se observa que el trabajo que se realiza desde el modelo TF-CBT apunta a combatir la presencia de los mismos, trabajando sobre las cogniciones erróneas y las emociones negativas. La utilización de esta técnica de intervención en casos de victimización sexual ha sido estudiada y ha mostrado ser efectiva, incluso en aquellos casos que presentaban complejidad sintomática (Cisler et al, 2015;Cohen et al, 2004a;Cohen et al, 2004b;Deblinger et al, 2011;Mannarino, Cohen, Deblinger, Runyon y Steer, 2012). Por ejemplo, se ha observado que en las víctimas de abuso sexual se muestra como una terapia eficaz sobre otras técnicas utilizadas (e.g., terapia centrada en el niño, la psicoterapia de padres y niños, o la psicoterapia estructurada para adolescentes en respuesta al estrés crónico) (Cohen et al, 2004b;Cohen et al, 2005; Weiner, Schneider y Lyons, Figura 1.…”

Perceptions of Neighborhood Mediate the Relationship Between PTSD Symptoms and Coping in a Neighborhood-Matched Substance-Using Sample

“…Perceived threat and risk of harm of a single trauma is a greater risk factor for PTSD symptom severity than having multiple exposures to trauma (Lancaster et al, 2016). Furthermore, intractability of PTSD symptoms in treatment has been associated with deficits in discriminating non-threatening stimuli from threatening stimuli (Cisler et al, 2015). We postulate that it is likely that PTSD symptoms are maintained by having negative perceptions of crime and community, as opposed to living in objectively disordered neighborhoods, due to deficits in accurately identifying threat, risk of harm, and likelihood of receiving help.…”