School of Psychology, University of New South Wales, Sydney, NSW, Australia.
Brain Dynamics Centre, Westmead Institute for Medical Research, University of Sydney, Sydney, NSW, Australia.
Transl Psychiatry. 2021 Apr 14;11(1):218. doi: 10.1038/s41398-021-01340-8.
Although trauma-focused cognitive behavioural therapy (TF-CBT) is the frontline treatment for posttraumatic stress disorder (PTSD), up to one half of patients do not respond optimally to this treatment. Inhibitory functions are important for successful management of PTSD, yet there is a dearth of knowledge regarding the extent to which neural mechanisms unpinning response inhibition are associated with TF-CBT response. Treatment-seeking PTSD patients (n = 40) were assessed during a response inhibition task (the Go/No-Go task) while undergoing functional magnetic imaging (fMRI) and event-related potentials (ERP) in separate sessions. PTSD symptom severity was assessed with the Clinician-Administered PTSD Scale, before undergoing nine sessions of TF-CBT. They were then reassessed post-treatment to estimate reduction in fear and dysphoric symptoms of PTSD. Although neural responses during the inhibitory task did not predict overall symptom change, reduced activation in the left precuneus and the right superior parietal cortex predicted greater improvement in dysphoric symptoms. ERP responses during response inhibition indicated that lower P3 peak latency predicted greater reduction of dysphoric symptoms. There were no significant predictors of changes of fear symptoms. These findings indicate that neural activity associated with response inhibition can act as a predictive biomarker of TF-CBT response for PTSD symptoms. This pattern of findings underscores the importance of delineating the role of biomarkers to predict remission of subtypes of PTSD.
虽然创伤焦点认知行为疗法（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此治疗反应不佳。抑制功能对于成功管理 PTSD 很重要，但对于支持反应抑制的神经机制与 TF-CBT 反应的关联程度，我们知之甚少。在分别的会议中，对寻求治疗的 PTSD 患者（n=40）进行了反应抑制任务（Go/No-Go 任务）期间的功能磁共振成像（fMRI）和事件相关电位（ERP）评估。在接受九次 TF-CBT 治疗之前，使用临床医生管理的 PTSD 量表评估 PTSD 症状严重程度。然后在治疗后重新评估，以估计恐惧和苦恼症状的 PTSD 减轻程度。尽管抑制任务期间的神经反应并未预测整体症状变化，但左侧顶下小叶和右侧顶上小叶的激活减少预示着苦恼症状的改善更大。反应抑制期间的 ERP 反应表明，P3 峰潜伏期降低预示着苦恼症状的减轻更大。恐惧症状变化没有明显的预测因素。这些发现表明，与反应抑制相关的神经活动可以作为 PTSD 症状的 TF-CBT 反应的预测生物标志物。这一发现模式强调了确定生物标志物以预测 PTSD 亚型缓解的重要性。
