Longitudinal changes in brain function associated with symptom improvement in youth with PTSD

Abstract

Background: Previous studies indicate that youth with posttraumatic stress disorder (PTSD) have abnormal activation in brain regions important for emotion processing. It is unknown whether symptom improvement is accompanied by normative changes in these regions. This study identified neural changes associated with symptom improvement with the long-term goal of identifying malleable targets for interventions.Methods: A total of 80 functional magnetic resonance imaging (fMRI) scans were collected, including 20 adolescents with PTSD (ages 9-17) and 20 age-and sex-matched healthy control subjects, each scanned before and after a 5-month period. Trauma-focused cognitive behavioral therapy was provided to the PTSD group to ensure improvement in symptoms. Whole brain voxelwise activation and region of interest analyses of facial expression task data were conducted to identify abnormalities in the PTSD group versus HC at baseline (BL), and neural changes correlated with symptom improvement from BL to EOS of study (EOS).Results: At BL, the PTSD group had abnormally elevated activation in the cingulate cortex, hippocampus, amygdala, and medial frontal cortex compared to HC. From BL to EOS, a PTSD symptoms improved an average of 39%. Longitudinal improvement in symptoms of PTSD was associated with decreasing activation in posterior cingulate, mid-cingulate, and hippocampus, while improvement in dissociative symptoms was correlated with decreasing activation in the amygdala.Conclusions: Abnormalities in emotion-processing brain networks in youth with PTSD normalize when symptoms improve, demonstrating neural plasticity of these regions in young patients and the importance of early intervention.

Is neuroticism really bad for you? Dynamics in personality and limbic reactivity prior to, during and following real-life combat stress

“…With respect to MCC, its function has been linked to response selection and feedback-guided decision making in a wide variety of task manipulations ( Vogt, 2016 , 2019 ). In the context of stress, MCC activation was found to be positively correlated with posttraumatic stress disorder (PTSD) symptom severity ( Etkin and Wager, 2007 ), and longitudinal reduction in PTSD symptom severity following therapy was associated with decreased MCC activation ( Garrett et al, 2019 ). These results point towards reduced MCC reactivity during stress as a potentially adaptive response, which in here was associated with elevated neuroticism.…”

Changes in Brain Volume Associated with Trauma‐Focused Cognitive Behavioral Therapy Among Youth with Posttraumatic Stress Disorder

“…Characteristics of the sample have been previously reported in a functional magnetic resonance imaging (fMRI) study (Garrett et al., 2019). The Stanford University Institutional Review Board approved this study and informed assent or consent was obtained from all youth and caregiver participants, respectively.…”

Neural response to trauma‐related and trauma‐unrelated negative stimuli in remitted and persistent pediatric post‐traumatic stress disorder

“…In a serial of studies, Cisler et al applied trauma‐unrelated emotional stimuli to female adolescents with PTSD and had several findings: (a) Adolescents with less symptom reduction were characterized by less threat‐safety discrimination before treatment (i.e., greater amygdala activation to both threat and neutral images), whereas adolescents with greater symptom reduction were characterized by amygdala activation only to threat images (Cisler et al., 2015 ); (b) The recovery of adolescent PTSD was positively related to the functional connectivity between the right amygdala and insula, and between the left amygdala and posterior cingulate gyrus (Cisler, Sigel, Steele, et al., 2016 ); and (c) The remittance of PTSD was related to the high modularity and assortativity of the whole‐brain network (Cisler, Sigel, Kramer, et al., 2016 ). Another study, which was performed on youths with PTSD due to interpersonal traumas and a control group without trauma experience, used a facial expression task (trauma‐unrelated) and found that the remittance was related to reduced activation of the posterior cingulate, mid‐cingulate and hippocampus (Garrett et al., 2019 ).…”

“…Moreover, it also makes it possible to apply a unified trauma‐related stimulus across all participants, including trauma‐exposed controls. Most of the adult studies and all of the youth studies on PTSD‐remittance mechanisms used trauma‐unrelated stimuli (Garrett et al., 2019 ; Malejko et al., 2017 ). However, trauma‐related/unrelated stimuli should have different meanings.…”