PTSD Remission After Prolonged Exposure Treatment Is Associated With Anterior Cingulate Cortex Thinning and Volume Reduction

Abstract

Background Brain structures underlying posttraumatic stress disorder (PTSD) have been a focus of imaging studies, but associations between treatment outcome and alterations in brain structures remain largely unexamined. We longitudinally examined the relation of structural changes in the rostral anterior cingulate cortex (rACC), a previously identified key region in the PTSD fear network, to outcome of Prolonged Exposure (PE) treatment. Method The sample included 78 adults (53 women): 41 patients with PTSD and 37 trauma-exposed healthy volunteers (TE-HCs). Patients underwent a 10-week course of PE treatment and completed pre-and post-treatment assessments and magnetic resonance imaging (MRI) structural scans. TE-HCs also underwent assessment and MRI at baseline and 10 weeks later. PE remitters (n =11), non-remitters (n= 14), and TE-HCs, were compared at baseline on demographic and clinical characteristics and ACC structure. Remitters, non-remitters, and TE-HCs were compared for pre- to post-treatment clinical and structural ACC change, controlling for potential confounding variables. Results There were no baseline differences in structure between PTSD and TE-HCs or remitters and non-remitters. Following treatment, PTSD remitters exhibited cortical thinning and volume decrease in the left rACC compared with PTSD non-remitters and TE-HCs. Conclusions These results, while in need of replication, suggest that PE treatment for PTSD, by extinguishing maladaptive trauma associations, may promote synaptic plasticity and structure change in rACC. Future research should explore possible underlying mechanisms.

Exposure-based therapy changes amygdala and hippocampus resting-state functional connectivity in patients with posttraumatic stress disorder

“…We previously reported functional (Helpman, Marin, et al, 2016) and structural (Helpman, Papini, et al, 2016) PE-related changes in this sample. This report presents their rsFC findings.…”

“…Psychotherapy research in posttraumatic stress disorder (PTSD) has recently begun using neuroimaging methods to assess structural (Helpman, Papini, et al, 2016) and functional (Fonzo, Goodkind, Oathes, Zaiko, Harvey, Peng, Weiss, Thompson, Zack, Lindley, et al, 2017; Helpman, Marin, et al, 2016) neural alterations of evidence-based treatments. Prolonged Exposure (PE) therapy is a relatively brief, highly structured, exposure-based treatment, considered to be effective in treating PTSD (Bradley, Greene, Russ, Dutra, & Westen, 2005).…”

Altered resting state functional connectivity of fear and reward circuitry in comorbid PTSD and major depression

“…Although most PTSD treatments to date have focused on normalizing fear network deficits (Foa et al, 2005, Helpman et al, 2016b, our findings suggest that when PTSD patients have comorbid MDD, as is common (Neria & Bromet, 2000), they may benefit from a more comprehensive treatment approach addressing impairments in both fear and reward processing. Previous treatment studies have demonstrated efficacy in depression for treatments that putatively address reward dysfunction, such as behavioral activation (Dimidjian et al, 2006) and dopaminergic drugs (Soskin, Holt, Sacco, & Fava, 2013).…”

Cortical thickness reduction in combat exposed U.S. veterans with and without PTSD

“…Some studies demonstrated a negative correlation between cortical thickness and PTSD severity (Corbo et al, 2014; Lindemer et al, 2013; Liu et al, 2012; Sadeh et al, 2016). Greater cortical thickness was previously associated with resilience and enhanced recovery from PTSD symptoms (Dickie et al, 2013; Lyoo et al, 2011; Nilsen et al, 2016), although not without inconsistencies (Helpman et al, 2016). …”