Neural Correlates of Procedural Variants in Cognitive-Behavioral Therapy: A Randomized, Controlled Multicenter fMRI Study
Neural Correlates of Procedural Variants in Cognitive-Behavioral Therapy: A Randomized, Controlled Multicenter fMRI Study
复制标题
认知行为治疗中程序变异的神经相关性：一项随机、受控的多中心功能磁共振成像研究
DOI：
10.1159/000359955
复制
发表时间：
2014
影响因子：
22.8
通讯作者：
Kircher T
中科院分区：
文献类型：
--
作者：
Straube B;Lueken U;Jansen A;Konrad C;Gloster AT;Gerlach AL;Ströhle A;Wittmann A;Pfleiderer B;Gauggel S;Wittchen HU;Arolt V;Kircher T
背景认知行为疗法（CBT）是治疗广场恐怖症（PD/AG）的有效方法。目前尚不清楚CBT的变体如何不同地调节PD/AG中涉及的大脑网络。本研究旨在评估治疗师引导（T+）与自我引导（T-）暴露对PD/AG患者恐惧条件反射神经相关因子的影响。方法在一项随机、对照的多中心临床试验中，对无药物治疗的PD/AG患者进行12次手动CBT治疗，在CBT前（t1）和CBT后（t2）的恐惧调节期间使用功能磁共振成像（fMRI）。获得42例患者和42例健康受试者（HS）的质量控制fMRI数据。患者被随机分配到两种CBT变体（T+, n= 22, T-, n= 20）。结果诊断（PD/AG、HS）、治疗组（T+、T-）、时间点（t1、t2）和刺激类型（条件刺激：有、无）的交互作用显示左侧海马和坐骨颞叶皮层活化。T+组在t2 （t2> t1）海马激活增加，这与治疗结果呈正相关，并且随着时间的推移，左侧额下回与左侧海马之间的连通性下降（t1> t2）。结论在T+暴露后，与后海马相关的事件编码过程被增强，并且与左侧额下回的过程更加分离，而这些过程先前被证明在PD/AG中被功能障碍激活。将单一的程序变异与神经基质联系起来，为有针对性的心理治疗干预措施的优化提供了信息。
BackgroundCognitive behavioral therapy (CBT) is an effective treatment for panic disorder with agoraphobia (PD/AG). It is unknown, how variants of CBT differentially modulate brain networks involved in PD/AG. This study was aimed to evaluate the effects of therapist-guided (T+) versus self-guided (T-) exposure on the neural correlates of fear conditioning in PD/AG.MethodIn a randomized, controlled multicenter clinical trial in medication-free patients with PD/AG who were treated with 12 sessions of manualized CBT, functional magnetic resonance imaging (fMRI) was used during fear conditioning before (t1) and after CBT (t2). Quality-controlled fMRI data from 42 patients and 42 healthy subjects (HS) were obtained. Patients were randomized to two variants of CBT (T+, n= 22, and T-, n= 20).ResultsThe interaction of diagnosis (PD/AG, HS), treatment group (T+, T-), time point (t1, t2) and stimulus type (conditioned stimulus: yes, no) revealed activation in the left hippocampus and the occipitotemporal cortex. The T+ group demonstrated increased activation of the hippocampus at t2 (t2> t1), which was positively correlated with treatment outcome, and a decreased connectivity between the left inferior frontal gyrus and the left hippocampus across time (t1> t2).ConclusionAfter T+ exposure, contingency-encoding processes related to the posterior hippocampus are augmented and more decoupled from processes of the left inferior frontal gyrus, previously shown to be dysfunctionally activated in PD/AG. Linking single procedural variants to neural substrates offers the potential to inform about the optimization of targeted psychotherapeutic interventions.
登录
查看更多内容
影响因子：
4.1
作者：
Lissek S;Rabin SJ;McDowell DJ;Dvir S;Bradford DE;Geraci M;Pine DS;Grillon C
通讯作者：
Grillon C
影响因子：
3.2
作者：
Chen J;Shi S
通讯作者：
Shi S
认知行为疗法或抗抑郁药物治疗惊恐障碍时脑部代谢（18 FDG PET）的变化
影响因子：
5.7
作者：
J. Prasko;J. Horáček;R. Záleský;M. Kopeček;T. Novák;B. Pasková;L. Skrdlantová;O. Belohlávek;C. Höschl
通讯作者：
C. Höschl
影响因子：
3.7
作者：
Leger M;Quiedeville A;Paizanis E;Natkunarajah S;Freret T;Boulouard M;Schumann-Bard P
通讯作者：
Schumann-Bard P
DOI：
10.3758/s13415-012-0089-7
发表时间：
2012-09
期刊：
Cognitive, affective & behavioral neuroscience
影响因子：
--
作者：
van Well S;Visser RM;Scholte HS;Kindt M
通讯作者：
Kindt M