Reduced Salience and Enhanced Central Executive Connectivity Following PTSD Treatment

Abstract

BACKGROUND:In soldiers with posttraumatic stress disorder (PTSD), symptom provocation was found to induce increased connectivity within the salience network, as measured by functional magnetic resonance imaging (fMRI) and global brain connectivity with global signal regression (GBCr). However, it is unknown whether these GBCr disturbances would normalize following effective PTSD treatment.METHODS: 69 US Army soldiers with (n = 42) and without PTSD (n = 27) completed fMRI at rest and during symptom provocation using subject-specific script imagery. Then, participants with PTSD received 6 weeks (12 sessions) of group cognitive processing therapy (CPT) or present-centered therapy (PCT). At week 8, all participants repeated the fMRI scans. The primary analysis used a region-of-interest approach to determine the effect of treatment on salience GBCr. A secondary analysis was conducted to explore the pattern of GBCr alterations posttreatment in PTSD participants compared to controls. RESULTS:Over the treatment period, PCT significantly reduced salience GBCr (p = .02). Compared to controls, salience GBCr was high pretreatment (PCT, p = .01; CPT, p = .03) and normalized post-PCT (p = .53), but not post-CPT (p = .006). Whole-brain secondary analysis found high GBCr within the central executive network in PTSD participants compared to controls. Post hoc exploratory analyses showed significant increases in executive GBCr following CPT treatment (p = .01). CONCLUSION:The results support previous models relating CPT to central executive network and enhanced cognitive control while unraveling a previously unknown neurobiological mechanism of PCT treatment, demonstrating treatment-specific reduction in salience connectivity during trauma recollection.

A Unique Brain Connectome Fingerprint Predates and Predicts Response to Antidepressants

“…during infusion starting at 20 min post administration) scans were acquired using 3.0 T magnets Downey et al, 2016;Greenberg et al, 2015). Brain scans from both studies underwent the same surface-based preprocessing using pipeline adapted from the HCP (https://github.com/Washington-University/HCPpipelines) (Glasser et al, 2013), as reported elsewhere (Abdallah et al, 2019a;Abdallah et al, 2019b;Abdallah et al, 2018). Briefly, the preprocessing pipeline included FreeSurfer parcellation of structural scans, slice timing correction, motion correction, intensity normalization, brain masking, and registration of fMRI images to structural MRI and standard template.…”

Associations between resting‐state functional connectivity and treatment response in a randomized clinical trial for posttraumatic stress disorder

“…As dlPFC and dACC are associated with executive control of attention, these findings could relate to more effective emotion regulation and control of mental states with treatment (King, Block, Sripada, Rauch, Porter, et al, 2016). Interestingly, Abdallah, Averill, Ramage, Averill, Alkin, et al (2019) found that in combat PTSD patients, PCT decreased connectivity within SN, whereas cognitive processing therapy increased connectivity within the Central Executive Network. In another study, X. Zhu et al (2018) reported increased rsFC in patients with PTSD between amygdala, hippocampus, and prefrontal regions following exposure therapy—a possible reflection of fear inhibition/extinction and memory processing.…”

Intrinsic connectomes underlying response to trauma-focused psychotherapy in post-traumatic stress disorder

“…While such a focused approach has been useful to identify neural regions underlying TF-CBT response, it is limited because it does not address how treatment response may be predicted by task-independent coreintrinsic connectivity within and between brain networks. The few studies investigating changes in resting-state connectivity following TF-CBT have reported increases between the amygdala and hippocampal limbic network structures with the executive top-down control prefrontal brain regions 9 , and a reduction in salience network connectivity 10 . Two recent studies have also evaluated the extent to which pre-treatment resting connectivity is associated with TF-CBT response.…”