Changes in functional connectivity of the amygdala during cognitive reappraisal predict symptom reduction during trauma-focused cognitive–behavioral therapy among adolescent girls with post-traumatic stress disorder
While trauma-focused cognitive-behavioral therapy (TF-CBT) is the 'gold standard' treatment for pediatric post-traumatic stress disorder (PTSD), little is known about the neural mechanisms by which TF-CBT produces clinical benefit. Here, we test the hypothesis that PTSD symptom reduction d...
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Veröffentlicht in: | Psychological medicine 2016-10, Vol.46 (14), p.3013-3023 |
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description | While trauma-focused cognitive-behavioral therapy (TF-CBT) is the 'gold standard' treatment for pediatric post-traumatic stress disorder (PTSD), little is known about the neural mechanisms by which TF-CBT produces clinical benefit. Here, we test the hypothesis that PTSD symptom reduction during TF-CBT among adolescent girls with PTSD is associated with changes in patterns of brain functional connectivity (FC) with the amygdala during cognitive reappraisal.
Adolescent girls with PTSD related to physical or sexual assault (n = 34) were enrolled in TF-CBT, delivered in an approximately 12-session format, in an open trial. Before and after treatment, they were engaged in a cognitive reappraisal task, probing neural mechanisms of explicit emotion regulation, during 3 T functional magnetic resonance imaging.
Among adolescent girls completing TF-CBT with usable pre- and post-treatment scans (n = 20), improvements in self-reported emotion from pre- to post-treatment were positively related to improvements in PTSD symptoms. Adolescent girls with greater post-treatment symptom reduction were also able to suppress amygdala-insula FC while re-appraising, which was not evident in girls with less symptom reduction. Pre- to post-treatment changes in right amygdala to left insula FC that scaled with PTSD symptom reduction also scaled with improvements in emotion regulation.
These preliminary results suggest the neurocircuitry mechanisms through which TF-CBT produces clinical outcomes, providing putative brain targets for augmenting TF-CBT response. |
doi_str_mv | 10.1017/S0033291716001847 |
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Adolescent girls with PTSD related to physical or sexual assault (n = 34) were enrolled in TF-CBT, delivered in an approximately 12-session format, in an open trial. Before and after treatment, they were engaged in a cognitive reappraisal task, probing neural mechanisms of explicit emotion regulation, during 3 T functional magnetic resonance imaging.
Among adolescent girls completing TF-CBT with usable pre- and post-treatment scans (n = 20), improvements in self-reported emotion from pre- to post-treatment were positively related to improvements in PTSD symptoms. Adolescent girls with greater post-treatment symptom reduction were also able to suppress amygdala-insula FC while re-appraising, which was not evident in girls with less symptom reduction. Pre- to post-treatment changes in right amygdala to left insula FC that scaled with PTSD symptom reduction also scaled with improvements in emotion regulation.
These preliminary results suggest the neurocircuitry mechanisms through which TF-CBT produces clinical outcomes, providing putative brain targets for augmenting TF-CBT response.</description><identifier>ISSN: 0033-2917</identifier><identifier>EISSN: 1469-8978</identifier><identifier>DOI: 10.1017/S0033291716001847</identifier><identifier>PMID: 27524285</identifier><identifier>CODEN: PSMDCO</identifier><language>eng</language><publisher>Cambridge, UK: Cambridge University Press</publisher><subject>Adolescent ; Adolescent girls ; Amygdala ; Amygdala - diagnostic imaging ; Amygdala - physiopathology ; Brain ; Brain mapping ; Cerebral Cortex - diagnostic imaging ; Cerebral Cortex - physiopathology ; Child ; Child Abuse ; Clinical outcomes ; Cognitive ability ; Cognitive appraisal ; Cognitive behavioral therapy ; Cognitive Behavioral Therapy - methods ; Cognitive therapy ; Emotional regulation ; Female ; Functional connectivity ; Functional magnetic resonance imaging ; Functional Neuroimaging - methods ; Girls ; Humans ; Magnetic Resonance Imaging ; Neural networks ; Neuroimaging ; Neuropsychology ; NMR ; Nuclear magnetic resonance ; Original Articles ; Outcome Assessment (Health Care) ; Post traumatic stress disorder ; Prognosis ; Sex crimes ; Stress Disorders, Post-Traumatic - therapy ; Teenagers ; Trauma ; Traumatic stress</subject><ispartof>Psychological medicine, 2016-10, Vol.46 (14), p.3013-3023</ispartof><rights>Copyright © Cambridge University Press 2016</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c439t-c40e9b4c601ec32e05644868f637e7a70242c1e23bd4f2f4dde542a9641c6beb3</citedby><cites>FETCH-LOGICAL-c439t-c40e9b4c601ec32e05644868f637e7a70242c1e23bd4f2f4dde542a9641c6beb3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.cambridge.org/core/product/identifier/S0033291716001847/type/journal_article$$EHTML$$P50$$Gcambridge$$H</linktohtml><link.rule.ids>164,314,780,784,12846,27924,27925,30999,55628</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/27524285$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Cisler, J. M.</creatorcontrib><creatorcontrib>Sigel, B. A.</creatorcontrib><creatorcontrib>Steele, J. S.</creatorcontrib><creatorcontrib>Smitherman, S.</creatorcontrib><creatorcontrib>Vanderzee, K.</creatorcontrib><creatorcontrib>Pemberton, J.</creatorcontrib><creatorcontrib>Kramer, T. L.</creatorcontrib><creatorcontrib>Kilts, C. D.</creatorcontrib><title>Changes in functional connectivity of the amygdala during cognitive reappraisal predict symptom reduction during trauma-focused cognitive–behavioral therapy among adolescent girls with post-traumatic stress disorder</title><title>Psychological medicine</title><addtitle>Psychol. Med</addtitle><description>While trauma-focused cognitive-behavioral therapy (TF-CBT) is the 'gold standard' treatment for pediatric post-traumatic stress disorder (PTSD), little is known about the neural mechanisms by which TF-CBT produces clinical benefit. Here, we test the hypothesis that PTSD symptom reduction during TF-CBT among adolescent girls with PTSD is associated with changes in patterns of brain functional connectivity (FC) with the amygdala during cognitive reappraisal.
Adolescent girls with PTSD related to physical or sexual assault (n = 34) were enrolled in TF-CBT, delivered in an approximately 12-session format, in an open trial. Before and after treatment, they were engaged in a cognitive reappraisal task, probing neural mechanisms of explicit emotion regulation, during 3 T functional magnetic resonance imaging.
Among adolescent girls completing TF-CBT with usable pre- and post-treatment scans (n = 20), improvements in self-reported emotion from pre- to post-treatment were positively related to improvements in PTSD symptoms. Adolescent girls with greater post-treatment symptom reduction were also able to suppress amygdala-insula FC while re-appraising, which was not evident in girls with less symptom reduction. Pre- to post-treatment changes in right amygdala to left insula FC that scaled with PTSD symptom reduction also scaled with improvements in emotion regulation.
These preliminary results suggest the neurocircuitry mechanisms through which TF-CBT produces clinical outcomes, providing putative brain targets for augmenting TF-CBT response.</description><subject>Adolescent</subject><subject>Adolescent girls</subject><subject>Amygdala</subject><subject>Amygdala - diagnostic imaging</subject><subject>Amygdala - physiopathology</subject><subject>Brain</subject><subject>Brain mapping</subject><subject>Cerebral Cortex - diagnostic imaging</subject><subject>Cerebral Cortex - physiopathology</subject><subject>Child</subject><subject>Child Abuse</subject><subject>Clinical outcomes</subject><subject>Cognitive ability</subject><subject>Cognitive appraisal</subject><subject>Cognitive behavioral therapy</subject><subject>Cognitive Behavioral Therapy - methods</subject><subject>Cognitive therapy</subject><subject>Emotional regulation</subject><subject>Female</subject><subject>Functional connectivity</subject><subject>Functional magnetic resonance imaging</subject><subject>Functional Neuroimaging - methods</subject><subject>Girls</subject><subject>Humans</subject><subject>Magnetic Resonance Imaging</subject><subject>Neural networks</subject><subject>Neuroimaging</subject><subject>Neuropsychology</subject><subject>NMR</subject><subject>Nuclear magnetic resonance</subject><subject>Original Articles</subject><subject>Outcome Assessment (Health Care)</subject><subject>Post traumatic stress disorder</subject><subject>Prognosis</subject><subject>Sex crimes</subject><subject>Stress Disorders, Post-Traumatic - therapy</subject><subject>Teenagers</subject><subject>Trauma</subject><subject>Traumatic stress</subject><issn>0033-2917</issn><issn>1469-8978</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>7QJ</sourceid><sourceid>8G5</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNqNksuKFDEUhoMoTjv6AG4k4MZNaW5VSS2l8QYDLtR1kUpOVWeoSsokNUPvfAefzq1PYnq6R0UR3CSE8_3fCclB6DElzymh8sUHQjhnLZW0IYQqIe-gDRVNW6lWqrtocyhXh_oZepDSZWE4Few-OmOyZoKpeoO-bXfaj5Cw83hYvckueD1hE7yHcrhyeY_DgPMOsJ73o9WTxnaNzo-FGb0rCOAIelmidqkklwjWmYzTfl5ymEvNrjfW21iOep11NQSzJrC_LN-_fO1hp69ciEVTGka97EvTUDLahgmSAZ_x6OKU8LXLO7yElKujLjuDU46QErYuhWghPkT3Bj0leHTaz9Gn168-bt9WF-_fvNu-vKiM4G0uK4G2F6YhFAxnQOpGCNWooeESpJakPJShwHhvxcAGYS3Ugum2EdQ0PfT8HD07epcYPq-Qcje7ctVp0h7CmjpaZJxLopr_QHnNlWKKFfTpH-hlWGP5mhuKyIYwKgpFj5SJIaUIQ7dEN-u47yjpDiPS_TUiJfPkZF77GezPxO1MFICfpHruo7Mj_Nb7n9ofmBXNXw</recordid><startdate>201610</startdate><enddate>201610</enddate><creator>Cisler, J. 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M.</au><au>Sigel, B. A.</au><au>Steele, J. S.</au><au>Smitherman, S.</au><au>Vanderzee, K.</au><au>Pemberton, J.</au><au>Kramer, T. L.</au><au>Kilts, C. D.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Changes in functional connectivity of the amygdala during cognitive reappraisal predict symptom reduction during trauma-focused cognitive–behavioral therapy among adolescent girls with post-traumatic stress disorder</atitle><jtitle>Psychological medicine</jtitle><addtitle>Psychol. Med</addtitle><date>2016-10</date><risdate>2016</risdate><volume>46</volume><issue>14</issue><spage>3013</spage><epage>3023</epage><pages>3013-3023</pages><issn>0033-2917</issn><eissn>1469-8978</eissn><coden>PSMDCO</coden><abstract>While trauma-focused cognitive-behavioral therapy (TF-CBT) is the 'gold standard' treatment for pediatric post-traumatic stress disorder (PTSD), little is known about the neural mechanisms by which TF-CBT produces clinical benefit. Here, we test the hypothesis that PTSD symptom reduction during TF-CBT among adolescent girls with PTSD is associated with changes in patterns of brain functional connectivity (FC) with the amygdala during cognitive reappraisal.
Adolescent girls with PTSD related to physical or sexual assault (n = 34) were enrolled in TF-CBT, delivered in an approximately 12-session format, in an open trial. Before and after treatment, they were engaged in a cognitive reappraisal task, probing neural mechanisms of explicit emotion regulation, during 3 T functional magnetic resonance imaging.
Among adolescent girls completing TF-CBT with usable pre- and post-treatment scans (n = 20), improvements in self-reported emotion from pre- to post-treatment were positively related to improvements in PTSD symptoms. Adolescent girls with greater post-treatment symptom reduction were also able to suppress amygdala-insula FC while re-appraising, which was not evident in girls with less symptom reduction. Pre- to post-treatment changes in right amygdala to left insula FC that scaled with PTSD symptom reduction also scaled with improvements in emotion regulation.
These preliminary results suggest the neurocircuitry mechanisms through which TF-CBT produces clinical outcomes, providing putative brain targets for augmenting TF-CBT response.</abstract><cop>Cambridge, UK</cop><pub>Cambridge University Press</pub><pmid>27524285</pmid><doi>10.1017/S0033291716001847</doi><tpages>11</tpages></addata></record> |
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subjects | Adolescent Adolescent girls Amygdala Amygdala - diagnostic imaging Amygdala - physiopathology Brain Brain mapping Cerebral Cortex - diagnostic imaging Cerebral Cortex - physiopathology Child Child Abuse Clinical outcomes Cognitive ability Cognitive appraisal Cognitive behavioral therapy Cognitive Behavioral Therapy - methods Cognitive therapy Emotional regulation Female Functional connectivity Functional magnetic resonance imaging Functional Neuroimaging - methods Girls Humans Magnetic Resonance Imaging Neural networks Neuroimaging Neuropsychology NMR Nuclear magnetic resonance Original Articles Outcome Assessment (Health Care) Post traumatic stress disorder Prognosis Sex crimes Stress Disorders, Post-Traumatic - therapy Teenagers Trauma Traumatic stress |
title | Changes in functional connectivity of the amygdala during cognitive reappraisal predict symptom reduction during trauma-focused cognitive–behavioral therapy among adolescent girls with post-traumatic stress disorder |
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