Pre-treatment amygdala activation and habituation predict symptom change in post-traumatic stress disorder

• Type of Material: Article
• Authors: Cecilia A Hinojosa, Emory University; Michael B VanElzakker, Harvard Medical School; Navneet Kaur, Wake Forest University School of Medicine; Julia M Felicione, Harvard Medical School; Meredith E Charney, Harvard Medical School; Eric Bui, Centre Hospitalier Universitaire Caen Normandie, Caen; Luana Marques, Massachusetts General Hospital; Paul Summergrad, Tufts University; Scott L Rauch, Harvard Medical School; Naomi M Simon, New York University; Lisa M Shin, Harvard Medical School
• Language: English
• Date: 2023-01-01
• Publisher: Emory University Libraries
• Publication Version: Final Published Version
• Copyright Statement: © 2023 Hinojosa, VanElzakker, Kaur, Felicione, Charney, Bui, Marques, Summergrad, Rauch, Simon and Shin.
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.3389/fnbeh.2023.1198244
• Title of Journal or Parent Work: Frontiers in Behavioral Neuroscience
• Volume: 17
• Grant/Funding Information: his research was supported by the Brain and Behavior Research Foundation (formally NARSAD), an award from Tufts Collaborates!, and a Faculty Research Award Committee Grant from Tufts University. The Massachusetts General Hospital Athinoula A. Martinos Imaging Center was supported by the Center for Functional Neuroimaging Technologies Grant P41RR14075. MV was supported by a National Defense Science and Engineering Graduate fellowship from the US Department of Defense. CH was supported by the Ford Foundation fellowship from the National Academies of Sciences, Engineering, and Medicine.
• Keywords: symptom change; fMRI, biomarkers; prolonged exposure therapy; post-traumatic stress disorder
• Research Categories: Psychology, Behavioral; Health Sciences, Medicine and Surgery; Psychology, Clinical; Health Sciences, Oncology

Abstract

Trauma-focused psychotherapy approaches are the first-line treatment option for post-traumatic stress disorder (PTSD); however, up to a third of patients remain symptomatic even after completion of the treatment. Predicting which patients will respond to a given treatment option would support personalized treatments and improve the efficiency of healthcare systems. Although previous neuroimaging studies have examined possible pre-treatment predictors of response to treatment, the findings have been somewhat inconsistent, and no other study has examined habituation to stimuli as a predictor. In this study, 16 treatment-seeking adults (MAge = 43.63, n = 10 women) with a primary diagnosis of PTSD passively viewed pictures of emotional facial expressions during functional magnetic resonance imaging (fMRI). After scanning, participants rated facial expressions on both valence and arousal. Participants then completed eight weekly sessions of prolonged exposure (PE) therapy. PTSD symptom severity was measured before and after treatment. Overall, participants showed symptomatic improvement with PE. Consistent with hypotheses, lesser activation in the amygdala and greater activation in the ventromedial prefrontal cortex during the presentation of fearful vs. happy facial expressions, as well as a greater decline in amygdala activation across blocks of fearful facial expressions at baseline, were associated with greater reduction of PTSD symptoms. Given that the repeated presentation of emotional material underlies PE, changes in brain responses with repeated stimulus presentations warrant further studies as potential predictors of response to exposure therapies.