Brain Dynamics Centre, Westmead Institute for Medical Research, The University of Sydney, Sydney, NSW, Australia.
Department of Psychiatry, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.
Transl Psychiatry. 2020 Aug 5;10(1):270. doi: 10.1038/s41398-020-00938-8.
Although trauma-focused cognitive behavior therapy (TF-CBT) is the frontline treatment for post-traumatic stress disorder (PTSD), up to one-half of patients are treatment nonresponders. To understand treatment nonresponse, it is important to understand the neural mechanisms of TF-CBT. Here, we used whole-brain intrinsic functional connectivity analysis to identify neural connectomic signatures of treatment outcome. In total, 36 PTSD patients and 36 healthy individuals underwent functional MRI at pre-treatment baseline. Patients then underwent nine sessions of TF-CBT and completed clinical and follow-up MRIs. We used an established large-scale brain network atlas to parcellate the brain into 343 brain regions. Pairwise intrinsic task-free functional connectivity was calculated and used to identify pre-treatment connectomic features that were correlated with reduction of PTSD severity from pretreatment to post treatment. We formed a composite metric of intrinsic connections associated with therapeutic outcome, and then interrogated this composite metric to determine if it distinguished PTSD treatment responders and nonresponders from healthy control status and changed post treatment. Lower pre-treatment connectivity for the cingulo-opercular, salience, default mode, dorsal attention, and frontoparietal executive control brain networks was associated with treatment improvement. Treatment responders had lower while nonresponders had significantly greater connectivity than controls at pretreatment. With therapy, connectivity significantly increased for responders and decreased for nonresponders, while controls remain unchanged over this time period. We provide evidence that the intrinsic functional architecture of the brain, specifically connectivity within and between brain networks associated with external vigilance, self-awareness, and cognitive control, may characterize a positive response to TF-CBT for PTSD.
虽然创伤聚焦认知行为疗法(TF-CBT)是创伤后应激障碍(PTSD)的一线治疗方法,但多达一半的患者对治疗无反应。为了了解治疗无反应,了解 TF-CBT 的神经机制很重要。在这里,我们使用全脑内在功能连接分析来确定治疗结果的神经连接组学特征。共有 36 名 PTSD 患者和 36 名健康个体在治疗前基线进行了功能磁共振成像。然后,患者接受了九次 TF-CBT 治疗,并完成了临床和随访 MRI。我们使用了一个成熟的大规模大脑网络图谱将大脑分为 343 个脑区。计算了成对的内在无任务功能连接,并用于识别与 PTSD 严重程度从治疗前到治疗后降低相关的治疗前连接组特征。我们形成了一个与治疗结果相关的内在连接的综合指标,然后检查这个综合指标,以确定它是否能区分 PTSD 治疗的反应者和非反应者与健康对照的状态,并在治疗后发生变化。扣带前扣带、突显、默认模式、背侧注意和额顶执行控制大脑网络的预处理连接性较低与治疗改善相关。治疗反应者的预处理连接性较低,而非反应者的连接性显著高于对照组。随着治疗,反应者的连接性显著增加,而非反应者的连接性显著减少,而对照组在此期间保持不变。我们提供的证据表明,大脑的内在功能结构,特别是与外部警觉、自我意识和认知控制相关的大脑网络内和网络间的连接性,可能是 PTSD 对 TF-CBT 产生积极反应的特征。