Division of Neuropsychology, Institute of Psychology, University of Zurich, Switzerland; Clienia Littenheid AG, Hospital for Psychiatry and Psychotherapy, Littenheid, Switzerland.
Clienia Littenheid AG, Hospital for Psychiatry and Psychotherapy, Littenheid, Switzerland.
Neuroimage Clin. 2019;23:101807. doi: 10.1016/j.nicl.2019.101807. Epub 2019 Apr 2.
We investigated whether patients with complex interpersonal trauma engage neural networks that are commonly activated during cognitive reappraisal and responding naturally to affect-laden images. In this naturalistic study, we examined whether trauma treatment not only reduces symptoms but also changes neural networks involved in emotional control.
Before and after eight weeks of phase-oriented inpatient trauma treatment, patients (n = 28) with complex posttraumatic stress disorder (cPTSD) and complex dissociative disorders (CDD) performed a cognitive reappraisal task while electroencephalography (EEG) was registered. Patients were measured as a prototypical dissociative part that aims to fulfill daily life goals while avoiding traumatic memories and associated dissociative parts. Matched healthy controls (n = 38) were measured twice as well. We examined task-related functional connectivity and assessed self-reports of clinical symptoms and emotion regulation skills.
Prior to treatment and compared to controls, patients showed hypoconnectivity within neural networks involved in emotional downregulation while reappraising affect-eliciting pictures as well as viewing neutral and affect-eliciting pictures. Following treatment, connectivity became normalized in these networks comprising regions associated with cognitive control and memory. Additionally, patients showed a treatment-related reduction of negative but not of positive dissociative symptoms.
This is the first study demonstrating that trauma-focused treatment was associated with favorable changes in neural networks involved in emotional control. Emotional overregulation manifesting as negative dissociative symptoms was reduced but not emotional underregulation, manifesting as positive dissociative symptoms.
我们调查了患有复杂人际创伤的患者是否会激活认知重评和自然应对情感负荷图像时通常激活的神经网络。在这项自然主义研究中，我们研究了创伤治疗不仅是否可以减轻症状，还可以改变涉及情绪控制的神经网络。
在接受为期八周的面向阶段的住院创伤治疗前后，患有复杂创伤后应激障碍（cPTSD）和复杂分离障碍（CDD）的患者（n=28）在进行认知重评任务时记录脑电图（EEG）。患者被测量为一个典型的分离部分，旨在在避免创伤记忆和相关分离部分的同时实现日常生活目标。也对匹配的健康对照组（n=38）进行了两次测量。我们检查了与任务相关的功能连接，并评估了临床症状和情绪调节技能的自我报告。
在治疗前，与对照组相比，患者在重新评估引起情绪的图片以及观看中性和引起情绪的图片时，涉及情绪下调的神经网络中的连接性降低。治疗后，这些包括与认知控制和记忆相关的区域的神经网络中的连接性变得正常化。此外，患者的负面但不是积极的分离症状与治疗相关的减少。
这是第一项表明以创伤为中心的治疗与情绪控制相关的神经网络的有利变化有关的研究。表现为负面分离症状的情绪过度调节减少，但表现为积极分离症状的情绪调节不足并没有减少。
