Bryant R A, Felmingham K, Kemp A, Das P, Hughes G, Peduto A, Williams L
School of Psychology, University of New South Wales, Sydney, NSW, Australia.
Psychol Med. 2008 Apr;38(4):555-61. doi: 10.1017/S0033291707002231. Epub 2007 Nov 16.
Although cognitive behaviour therapy (CBT) is the treatment of choice for post-traumatic stress disorder (PTSD), approximately half of patients do not respond to CBT. No studies have investigated the capacity for neural responses during fear processing to predict treatment response in PTSD.
Functional magnetic resonance imaging (fMRI) responses of the brain were examined in individuals with PTSD (n=14). fMRI was examined in response to fearful and neutral facial expressions presented rapidly in a backwards masking paradigm adapted for a 1.5 T scanner. Patients then received eight sessions of CBT that comprised education, imaginal and in vivo exposure, and cognitive therapy. Treatment response was assessed 6 months after therapy completion.
Seven patients were treatment responders (defined as a reduction of 50% of pretreatment scores) and seven were non-responders. Poor improvement after treatment was associated with greater bilateral amygdala and ventral anterior cingulate activation in response to masked fearful faces.
Excessive fear responses in response to fear-eliciting stimuli may be a key factor in limiting responses to CBT for PTSD. This excessive amygdala response to fear may reflect difficulty in managing anxiety reactions elicited during CBT, and this factor may limit optimal response to therapy.
尽管认知行为疗法（CBT）是创伤后应激障碍（PTSD）的首选治疗方法，但约有一半的患者对CBT无反应。尚无研究调查恐惧加工过程中的神经反应能力能否预测PTSD的治疗反应。
对14名PTSD患者进行大脑功能磁共振成像（fMRI）检查。采用适用于1.5T扫描仪的反向掩蔽范式，快速呈现恐惧和中性面部表情，以此来检测fMRI。患者随后接受为期八节的CBT治疗，包括教育、想象暴露和现场暴露以及认知疗法。在治疗结束6个月后评估治疗反应。
7名患者为治疗反应者（定义为治疗后得分降低50%），7名患者为无反应者。治疗后改善不佳与对掩蔽恐惧面孔的双侧杏仁核和腹侧前扣带回激活增强有关。
对引发恐惧的刺激产生过度恐惧反应可能是限制PTSD患者对CBT反应的关键因素。杏仁核对恐惧的这种过度反应可能反映出在管理CBT过程中引发的焦虑反应方面存在困难，而这一因素可能会限制对治疗的最佳反应。
