心理治疗对创伤后应激障碍前额叶皮质功能的选择性影响
Selective Effects of Psychotherapy on Frontopolar Cortical Function in PTSD.
作者信息
Fonzo Gregory A, Goodkind Madeleine S, Oathes Desmond J, Zaiko Yevgeniya V, Harvey Meredith, Peng Kathy K, Weiss M Elizabeth, Thompson Allison L, Zack Sanno E, Mills-Finnerty Colleen E, Rosenberg Benjamin M, Edelstein Raleigh, Wright Rachael N, Kole Carena A, Lindley Steven E, Arnow Bruce A, Jo Booil, Gross James J, Rothbaum Barbara O, Etkin Amit
机构信息
From the Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, Calif.; the Stanford Neurosciences Institute, Stanford University, Stanford; the Veterans Affairs Palo Alto Healthcare System and the Sierra Pacific Mental Illness, Research, Education, and Clinical Center (MIRECC), Palo Alto, Calif.; the New Mexico Veterans Affairs Healthcare System, Albuquerque; the Center for Neuromodulation in Depression and Stress, Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia; and the Department of Psychiatry, Emory University School of Medicine, Atlanta.
出版信息
Am J Psychiatry. 2017 Dec 1;174(12):1175-1184. doi: 10.1176/appi.ajp.2017.16091073. Epub 2017 Jul 18.
OBJECTIVE
Exposure therapy is an effective treatment for posttraumatic stress disorder (PTSD), but a comprehensive, emotion-focused perspective on how psychotherapy affects brain function is lacking. The authors assessed changes in brain function after prolonged exposure therapy across three emotional reactivity and regulation paradigms.
METHOD
Individuals with PTSD underwent functional MRI (fMRI) at rest and while completing three tasks assessing emotional reactivity and regulation. Individuals were then randomly assigned to immediate prolonged exposure treatment (N=36) or a waiting list condition (N=30) and underwent a second scan approximately 4 weeks after the last treatment session or a comparable waiting period, respectively.
RESULTS
Treatment-specific changes were observed only during cognitive reappraisal of negative images. Psychotherapy increased lateral frontopolar cortex activity and connectivity with the ventromedial prefrontal cortex/ventral striatum. Greater increases in frontopolar activation were associated with improvement in hyperarousal symptoms and psychological well-being. The frontopolar cortex also displayed a greater variety of temporal resting-state signal pattern changes after treatment. Concurrent transcranial magnetic stimulation and fMRI in healthy participants demonstrated that the lateral frontopolar cortex exerts downstream influence on the ventromedial prefrontal cortex/ventral striatum.
CONCLUSIONS
Changes in frontopolar function during deliberate regulation of negative affect is one key mechanism of adaptive psychotherapeutic change in PTSD. Given that frontopolar connectivity with ventromedial regions during emotion regulation is enhanced by psychotherapy and that the frontopolar cortex exerts downstream influence on ventromedial regions in healthy individuals, these findings inform a novel conceptualization of how psychotherapy works, and they identify a promising target for stimulation-based therapeutics.
目的
暴露疗法是治疗创伤后应激障碍（PTSD）的有效方法，但目前缺乏关于心理治疗如何影响大脑功能的全面、以情绪为重点的观点。作者评估了在三种情绪反应和调节范式下进行延长暴露疗法后大脑功能的变化。
方法
患有PTSD的个体在静息状态下以及完成三项评估情绪反应和调节的任务时接受功能磁共振成像（fMRI）检查。然后，个体被随机分配到立即接受延长暴露治疗组（N = 36）或等待名单组（N = 30），并分别在最后一次治疗 session 后约4周或类似的等待期后接受第二次扫描。
结果
仅在对负面图像进行认知重评期间观察到特定于治疗的变化。心理治疗增加了外侧额极皮层的活动以及与腹内侧前额叶皮层/腹侧纹状体的连接。额极激活的更大增加与过度唤醒症状的改善和心理健康相关。治疗后，额极皮层在静息状态下的时间信号模式变化也更多样化。在健康参与者中同时进行经颅磁刺激和fMRI表明，外侧额极皮层对腹内侧前额叶皮层/腹侧纹状体产生下游影响。
结论
在故意调节负面影响期间额极功能的变化是PTSD适应性心理治疗变化的一个关键机制。鉴于心理治疗增强了情绪调节期间额极与腹内侧区域的连接，并且额极皮层在健康个体中对腹内侧区域产生下游影响，这些发现为心理治疗的工作方式提供了一种新的概念化，并确定了基于刺激的治疗方法的一个有前景的靶点。
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