Using Neurobiological Measures to Predict and Assess Treatment Outcome of Psychotherapy in Posttraumatic Stress Disorder: Systematic Review

Abstract

Background: Trauma-focused cognitive-behavioral therapy (TF-CBT) and eye movement desensitization and reprocessing (EMDR) are effective treatments for posttraumatic stress disorder. However, little is known about their neurobiological effects. The usefulness of neurobiological measures to predict the treatment outcome of psychotherapy also has yet to be determined. Methods: Systematic review of randomized controlled trials (RCTs) focused on neurobiological treatment effects of TF-CBT or EMDR and trials with neurobiological measures as predictors of treatment response. Results: We included 23 publications reporting on 16 separate trials. TF-CBT was compared with a waitlist in most trials. TF-CBT was associated with a decrease in heart rate and blood pressure and changes in activity but not in volume of frontal brain structures and the amygdala. Neurobiological changes correlated with changes in symptom severity. EMDR was only tested against other active treatments in included trials. We did not find a difference in neurobiological treatment effects between EMDR and other treatments. Publications on neurobiological predictors of treatment response showed ambiguous results. Conclusion: TF-CBT was associated with a reduction of physiological reactivity. There is some preliminary evidence that TF-CBT influences brain regions involved in fear conditioning, extinction learning and possibly working memory and attention regulation; however, these effects could be nonspecific psychotherapeutic effects. Future trials should use paradigms aimed specifically at these brain regions and physiological reactivity. There are concerns regarding the risk of bias in some of the RCTs, indicating that methodologically more rigorous trials are required. Trials with neurobiological measures as predictors of treatment outcome render insufficient results to be useful in clinical practice.

Listening to the heart: A meta-analysis of cognitive behavior therapy impact on the heart rate of patients with anxiety disorders

“…Gonçalves et al (2011) investigated potential CBT biomarkers of efficacy in the treatment of PTSD and found results consistent with this meta-analysis regarding heart rate. In a recent systematic review (Zantvoord et al, 2013), also in patients with PTSD, reduced physiological reactivity was found in line with the decrease in symptoms after treatment with CBT. It is known that heart rate is increased in PTSD patients (but see exceptions below) in a wide variety of methodologies, including resting baseline studies, startle studies, standardized trauma cue studies, and idiographic trauma cue studies (Pole, 2007).…”

The Effects of Psychotherapy on Brain Function — Major Depressive Disorder

“…The change in the brain function was analyzed before and after PDT, and the results of the control and pharmacotherapy groups were compared. [101] However, the difference in the methodologies of the studies makes their comparison difficult. For example, Buchheim suggested that PDT was very effective in patients with subgenual ACC overactive depression [100], whereas CBT did not show any relevance.…”

Effects of Psychotherapy on DNA Strand Break Accumulation Originating from Traumatic Stress

“…A few studies have focused on endocrinological changes; however, results remain inconsistent and both an increase in cortisol and DHEA [31] as well as a decrease in cortisol [32] has been found after psychotherapeutic treatment. Additionally, a systematic review demonstrated a decrease in heart rate and blood pressure as well as changes in the activity of frontal brain structures and the amygdala through trauma-focused treatment [33]. Nevertheless, nothing is known about how psychotherapy changes altered levels of catecholamines and cytokines or DNA damage and DNA repair in PTSD.…”