Selective Effects of Psychotherapy on Frontopolar Cortical Function in PTSD.
<bold>Objective: </bold>Exposure therapy is an effective treatment for posttraumatic stress disorder (PTSD), but a comprehensive, emotion-focused perspective on how psychotherapy affects brain function is lacking. The authors assessed changes in brain function after prolonged exposure therapy across...
| Published in: | American Journal of Psychiatry Vol. 174; no. 12; pp. 1175 - 1185 |
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| Main Authors: | , , , , , , , , , , , , , , , , , , , |
| Format: | journal article |
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American Psychiatric Publishing, Inc.
Dec2017
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| Subjects: | |
| Online Access: | View this record in EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ssf&AN=126519393&site=ehost-live header: @attributes: shortDbName: ssf uiTerm: 126519393 longDbName: Social Sciences Full Text (H.W. Wilson) uiTag: AN controlInfo: bkinfo: jinfo: jid: 0002953X API jtl: American Journal of Psychiatry issn: 0002953X maglogo: N pubinfo: dt: Dec2017 vid: 174 iid: 12 pid: 37323 pub: American Psychiatric Publishing, Inc. artinfo: ui: 126519393 10.1176/appi.ajp.2017.16091073 ppf: 1175 ppct: 10 formats: tig: atl: Selective Effects of Psychotherapy on Frontopolar Cortical Function in PTSD. aug: au: Fonzo, Gregory A. Goodkind, Madeleine S. Oathes, Desmond J. Zaiko, Yevgeniya V. Harvey, Meredith Peng, Kathy K. Weiss, M. Elizabeth Thompson, Allison L. Zack, Sanno E. Mills-Finnerty, Colleen E. Rosenberg, Benjamin M. Edelstein, Raleigh Wright, Rachael N. Kole, Carena A. Lindley, Steven E. Arnow, Bruce A. Jo, Booil Gross, James J. Rothbaum, Barbara O. Etkin, Amit su: Treatment of post-traumatic stress disorder Well-being Behavior therapy Emotions Post-traumatic stress disorder Randomized controlled trials Physiology Brain function localization Prefrontal cortex Hypothalamus Basal ganglia Comparative studies Frontal lobe Magnetic resonance imaging Research methodology Medical cooperation Neurologic examination Research Research funding Statistical sampling Transcranial magnetic stimulation Evaluation research Treatment effectiveness Neural pathways sug: subj: Treatment of post-traumatic stress disorder Well-being Behavior therapy Emotions Post-traumatic stress disorder Randomized controlled trials Physiology Diagnostic Imaging Centers Marketing Research and Public Opinion Polling Brain function localization Prefrontal cortex Hypothalamus Basal ganglia Comparative studies Frontal lobe Magnetic resonance imaging Research methodology Medical cooperation Neurologic examination Research Research funding Statistical sampling Transcranial magnetic stimulation Evaluation research Treatment effectiveness Neural pathways keyword: Brain Imaging Techniques Emotion Regulation Frontopolar Cortex Posttraumatic Stress Disorder Psychotherapy Transcranial Magnetic Stimulation Brain Imaging Techniques Emotion Regulation Frontopolar Cortex Posttraumatic Stress Disorder Psychotherapy Transcranial Magnetic Stimulation ab: <bold>Objective: </bold>Exposure therapy is an effective treatment for posttraumatic stress disorder (PTSD), but a comprehensive, emotion-focused perspective on how psychotherapy affects brain function is lacking. The authors assessed changes in brain function after prolonged exposure therapy across three emotional reactivity and regulation paradigms.<bold>Method: </bold>Individuals with PTSD underwent functional MRI (fMRI) at rest and while completing three tasks assessing emotional reactivity and regulation. Individuals were then randomly assigned to immediate prolonged exposure treatment (N=36) or a waiting list condition (N=30) and underwent a second scan approximately 4 weeks after the last treatment session or a comparable waiting period, respectively.<bold>Results: </bold>Treatment-specific changes were observed only during cognitive reappraisal of negative images. Psychotherapy increased lateral frontopolar cortex activity and connectivity with the ventromedial prefrontal cortex/ventral striatum. Greater increases in frontopolar activation were associated with improvement in hyperarousal symptoms and psychological well-being. The frontopolar cortex also displayed a greater variety of temporal resting-state signal pattern changes after treatment. Concurrent transcranial magnetic stimulation and fMRI in healthy participants demonstrated that the lateral frontopolar cortex exerts downstream influence on the ventromedial prefrontal cortex/ventral striatum.<bold>Conclusions: </bold>Changes in frontopolar function during deliberate regulation of negative affect is one key mechanism of adaptive psychotherapeutic change in PTSD. Given that frontopolar connectivity with ventromedial regions during emotion regulation is enhanced by psychotherapy and that the frontopolar cortex exerts downstream influence on ventromedial regions in healthy individuals, these findings inform a novel conceptualization of how psychotherapy works, and they identify a promising target for stimulation-based therapeutics. pubtype: Academic Journal doctype: journal article src: R language: English refInfo: copyright: @attributes: flag: N holdings: @attributes: islocal: N |
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