Abdallah Chadi G, Averill Christopher L, Ramage Amy E, Averill Lynnette A, Alkin Evelyn, Nemati Samaneh, Krystal John H, Roache John D, Resick Patricia, Young-McCaughan Stacey, Peterson Alan L, Fox Peter
National Center for PTSD - Clinical Neurosciences Division, US Department of Veterans Affairs, West Haven, Connecticut.
Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut.
Chronic Stress (Thousand Oaks). 2019 Jan-Feb;3. doi: 10.1177/2470547019838971. Epub 2019 Apr 15.
In soldiers with posttraumatic stress disorder (PTSD), symptom provocation was found to induce increased connectivity within the salience network, as measured by functional magnetic resonance imaging (MRI) and global brain connectivity with global signal regression (GBCr). However, it is unknown whether these GBCr disturbances would normalize following effective PTSD treatment.
69 US Army soldiers with (n = 42) and without PTSD (n = 27) completed MRI at rest and during symptom provocation using subject-specific script imagery. Then, participants with PTSD received 6 weeks (12 sessions) of group cognitive processing therapy (CPT) or present-centered therapy (PCT). At week 8, all participants repeated the MRI scans. The primary analysis used a region-of-interest approach to determine the effect of treatment on salience GBCr. A secondary analysis was conducted to explore the pattern of GBCr alterations posttreatment in PTSD participants compared to controls.
Over the treatment period, PCT significantly reduced salience GBCr ( = .02). Compared to controls, salience GBCr was high pretreatment (PCT, = .01; CPT, = .03) and normalized post-PCT ( = .53), but not post-CPT ( = .006). Whole-brain secondary analysis found high GBCr within the central executive network in PTSD participants compared to controls. exploratory analyses showed significant increases in executive GBCr following CPT treatment ( = .01).
The results support previous models relating CPT to central executive network and enhanced cognitive control while unraveling a previously unknown neurobiological mechanism of PCT treatment, demonstrating treatment-specific reduction in salience connectivity during trauma recollection.
在创伤后应激障碍（PTSD）士兵中，通过功能磁共振成像（MRI）和采用全局信号回归（GBCr）的全脑连接性测量发现，症状激发会导致突显网络内的连接性增加。然而，尚不清楚这些GBCr紊乱在有效的PTSD治疗后是否会恢复正常。
69名患有（n = 42）和未患有PTSD（n = 27）的美国陆军士兵在静息状态下以及使用特定于个体的脚本意象进行症状激发期间完成了MRI检查。然后，患有PTSD的参与者接受了为期6周（12节）的团体认知加工疗法（CPT）或以当下为中心的疗法（PCT）。在第8周时，所有参与者重复进行MRI扫描。主要分析采用感兴趣区域方法来确定治疗对突显GBCr的影响。进行了一项次要分析，以探讨与对照组相比，PTSD参与者治疗后GBCr改变的模式。
在治疗期间，PCT显著降低了突显GBCr（P = 0.02）。与对照组相比，突显GBCr在PCT治疗前较高（PCT，P = 0.01；CPT，P = 0.03），且在PCT治疗后恢复正常（P = 0.53），但在CPT治疗后未恢复正常（P = 0.006）。全脑次要分析发现，与对照组相比，PTSD参与者的中央执行网络内GBCr较高。探索性分析显示，CPT治疗后执行GBCr显著增加（P = 0.01）。
结果支持了先前将CPT与中央执行网络及增强的认知控制相关联的模型，同时揭示了PCT治疗以前未知的神经生物学机制，表明在创伤回忆期间突显连接性有特定治疗效果的降低。
