Departments of Neurology (Weisholtz) and Psychiatry (Silbersweig), Brigham and Women's Hospital, Boston; Departments of Neurology (Weisholtz) and Psychiatry (Silbersweig), Harvard Medical School, Boston; Ceretype Neuromedicine, Cambridge, Mass. (Pan, Stern); Department of Psychiatry, New York University, Langone Medical Center, New York (Cloitre); and Center for Neural Science, New York University (LeDoux).
J Neuropsychiatry Clin Neurosci. 2021 Spring;33(2):116-123. doi: 10.1176/appi.neuropsych.20030058. Epub 2020 Oct 28.
Trauma-focused cognitive-behavioral therapy (CBT) is an important component of evidence-based treatment for posttraumatic stress disorder (PTSD), but the efficacy of treatment varies from individual to individual. It is hypothesized that some of this variability is derived from interindividual differences in the brain's intrinsic response to trauma-related stimuli and in activity of executive functional regions. The authors sought to characterize these differences using functional MRI (fMRI) in patients about to undergo CBT for PTSD.
Blood-oxygenation-level-dependent signal was measured in 12 individuals with PTSD related to sexual and/or physical trauma while they read words with positive, neutral, and negative content. Some negative words had PTSD-related themes, while others did not. It was hypothesized that PTSD-related words would evoke emotional processes likely to be engaged by the CBT process and would be most likely to activate brain circuitry important for CBT success.
A group-level analysis showed that the rostral dorsomedial prefrontal cortex (rdmPFC) was activated to a greater degree in response to PTSD-related words compared with other word types. This activation was strongest among patients with the best CBT responses, particularly in the latter part of the task, when differences between individuals were most pronounced.
The rdmPFC activation observed in this study may reflect the engagement of neural processes involved in introspection and self-reflection. CBT may be more effective for individuals with a greater ability to engage these processes.
创伤聚焦认知行为疗法（CBT）是创伤后应激障碍（PTSD）循证治疗的重要组成部分，但治疗效果因人而异。据推测，这种可变性部分源自大脑对与创伤相关刺激的固有反应以及执行功能区域活动的个体差异。作者试图通过即将接受 PTSD CBT 的患者的功能磁共振成像（fMRI）来描述这些差异。
12 名与性和/或身体创伤相关的 PTSD 患者在阅读具有积极、中性和消极内容的单词时，测量血氧水平依赖信号。一些消极单词具有 PTSD 相关主题，而另一些则没有。据推测，与 PTSD 相关的单词会引起可能被 CBT 过程所涉及的情绪过程，并且最有可能激活对 CBT 成功至关重要的大脑回路。
组水平分析显示，与其他类型的单词相比，rdmPFC（前脑岛皮层背内侧部）对 PTSD 相关单词的反应更为强烈。这种激活在 CBT 反应最佳的患者中最强，尤其是在任务的后半部分，此时个体之间的差异最为明显。
本研究中观察到的 rdmPFC 激活可能反映了参与内省和自我反思的神经过程的参与。对于能够更有效地参与这些过程的个体，CBT 可能更有效。
