VA San Diego Healthcare System, San Diego, CA, USA.
Psychiatry Res. 2013 Oct 30;214(1):48-55. doi: 10.1016/j.pscychresns.2013.05.001. Epub 2013 Aug 2.
Therapy for combat and accident-related posttraumatic stress disorder (PTSD) has been reported to influence amygdala and anterior cingulate cortex (ACC) response during emotional processing. It is not yet understood how therapy influences different phases of emotional processing, and whether previous findings generalize to other PTSD populations. We hypothesized that cognitive trauma therapy for battered women (CTT-BW) would alter insula, amygdala, and cingulate responses during anticipation and presentation of emotional images. Fourteen female patients with PTSD related to domestic violence completed the Clinician Administered PTSD Scale (CAPS) and functional magnetic resonance imaging (fMRI) before and after CTT-BW. The fMRI task involved cued anticipation followed by presentation of positive versus negative affective images. CTT-BW was associated with decreases in CAPS score, enhanced ACC and decreased anterior insula activation during anticipation, and decreased dorsolateral prefrontal cortex and amygdala response during image presentation (negative-positive). Pre-treatment ACC activation during anticipation and image presentation exhibited positive and negative relationships to treatment response, respectively. Results suggest that CTT-BW enhanced efficiency of neural responses during preparation for upcoming emotional events in a way that reduced the need to recruit prefrontal-amygdala responses during the occurrence of the event. Results also suggest that enhancing ACC function during anticipation may be beneficial for PTSD treatment.
针对与战斗和事故相关的创伤后应激障碍（PTSD）的治疗方法被报道可以影响情绪处理过程中的杏仁核和前扣带皮层（ACC）的反应。目前还不清楚治疗方法如何影响情绪处理的不同阶段，以及之前的发现是否适用于其他 PTSD 患者群体。我们假设针对受虐妇女的认知创伤疗法（CTT-BW）会改变岛叶、杏仁核和扣带的反应，从而在情绪图像的预期和呈现过程中产生影响。14 名患有与家庭暴力相关 PTSD 的女性患者在接受 CTT-BW 治疗前后完成了临床医生管理的 PTSD 量表（CAPS）和功能性磁共振成像（fMRI）。fMRI 任务包括提示性预期，然后呈现积极与消极的情感图像。CTT-BW 与 CAPS 评分降低、预期时 ACC 和前岛叶激活增强以及图像呈现时背外侧前额叶皮质和杏仁核反应减少（负性-正性）相关。治疗前的 ACC 在预期和图像呈现过程中的激活与治疗反应呈正相关和负相关。结果表明，CTT-BW 增强了对即将到来的情绪事件的准备过程中的神经反应效率，从而减少了在事件发生时需要募集前额叶-杏仁核反应的需求。结果还表明，在预期阶段增强 ACC 功能可能对 PTSD 的治疗有益。
