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Published Online: 28 October 2020

Correlation Between Rostral Dorsomedial Prefrontal Cortex Activation by Trauma-Related Words and Subsequent Response to CBT for PTSD

Publication: The Journal of Neuropsychiatry and Clinical Neurosciences

Abstract

Objective:

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.

Methods:

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.

Results:

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.

Conclusions:

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.

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Information & Authors

Information

Published In

Go to The Journal of Neuropsychiatry and Clinical Neurosciences
Go to The Journal of Neuropsychiatry and Clinical Neurosciences
The Journal of Neuropsychiatry and Clinical Neurosciences
Pages: 116 - 123
PubMed: 33108951

History

Received: 23 March 2020
Revision received: 18 June 2020
Accepted: 29 July 2020
Published online: 28 October 2020
Published in print: Spring 2021

Keywords

  1. PTSD
  2. Functional Neuroimaging
  3. Cognitive-Behavioral Therapy
  4. Rostral Dorsomedial Prefrontal Cortex

Authors

Details

Daniel Weisholtz, M.D. [email protected]
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).
David Silbersweig, M.D.
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).
Hong Pan, Ph.D.
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).
Marylene Cloitre, Ph.D
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).
Joseph LeDoux, Ph.D.
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).
Emily Stern, M.D.
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).

Notes

Send correspondence to Dr. Weisholtz ([email protected]).

Competing Interests

The authors report no financial relationships with commercial interests.

Funding Information

Supported by NIMH (grant 5-P50MH58911).

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