Cisler Josh M, Sigel Benjamin A, Kramer Teresa L, Smitherman Sonet, Vanderzee Karin, Pemberton Joy, Kilts Clinton D
Brain Imaging Research Center, Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, Arkansas, 72205, United States of America.
PLoS One. 2016 Aug 9;11(8):e0159620. doi: 10.1371/journal.pone.0159620. eCollection 2016.
Posttraumatic stress disorder (PTSD) is often chronic and disabling across the lifespan. The gold standard treatment for adolescent PTSD is Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT), though treatment response is variable and mediating neural mechanisms are not well understood. Here, we test whether PTSD symptom reduction during TF-CBT is associated with individual differences in large-scale brain network organization during emotion processing. Twenty adolescent girls, aged 11-16, with PTSD related to assaultive violence completed a 12-session protocol of TF-CBT. Participants completed an emotion processing task, in which neutral and fearful facial expressions were presented either overtly or covertly during 3T fMRI, before and after treatment. Analyses focused on characterizing network properties of modularity, assortativity, and global efficiency within an 824 region-of-interest brain parcellation separately during each of the task blocks using weighted functional connectivity matrices. We similarly analyzed an existing dataset of healthy adolescent girls undergoing an identical emotion processing task to characterize normative network organization. Pre-treatment individual differences in modularity, assortativity, and global efficiency during covert fear vs neutral blocks predicted PTSD symptom reduction. Patients who responded better to treatment had greater network modularity and assortativity but lesser efficiency, a pattern that closely resembled the control participants. At a group level, greater symptom reduction was associated with greater pre-to-post-treatment increases in network assortativity and modularity, but this was more pronounced among participants with less symptom improvement. The results support the hypothesis that modularized and resilient brain organization during emotion processing operate as mechanisms enabling symptom reduction during TF-CBT.
创伤后应激障碍（PTSD）通常是慢性的，会在整个生命周期中导致功能障碍。青少年PTSD的金标准治疗方法是创伤聚焦认知行为疗法（TF-CBT），尽管治疗反应存在差异，且介导的神经机制尚未得到充分了解。在这里，我们测试TF-CBT过程中PTSD症状的减轻是否与情绪处理过程中大规模脑网络组织的个体差异有关。20名年龄在11至16岁之间、因攻击性暴力而患有PTSD的青春期女孩完成了为期12节的TF-CBT治疗方案。参与者在治疗前后完成了一项情绪处理任务，即在3T功能磁共振成像（fMRI）期间，以公开或隐蔽的方式呈现中性和恐惧的面部表情。分析重点是在每个任务块期间，使用加权功能连接矩阵，分别在一个824个感兴趣区域的脑图谱中表征模块化、聚类系数和全局效率的网络属性。我们同样分析了一组正在进行相同情绪处理任务的健康青春期女孩的现有数据集，以表征正常的网络组织。隐蔽恐惧与中性块期间的模块化、聚类系数和全局效率的治疗前个体差异预测了PTSD症状的减轻。对治疗反应更好的患者具有更高的网络模块化和聚类系数，但效率较低，这一模式与对照组参与者非常相似。在组水平上，更大程度的症状减轻与治疗前到治疗后网络聚类系数和模块化的更大增加相关，但这在症状改善较少的参与者中更为明显。结果支持这样的假设，即情绪处理过程中模块化且有弹性的大脑组织作为一种机制，能够在TF-CBT期间减轻症状。
