Amygdala and ventral anterior cingulate activation predicts treatment response to cognitive behaviour therapy for post-traumatic stress disorder
Amygdala and ventral anterior cingulate activation predicts treatment response to cognitive behaviour therapy for post-traumatic stress disorder
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DOI：
10.1017/s0033291707002231
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发表时间：
2008-04-01
影响因子：
6.9
通讯作者：
Williams, L.
中科院分区：
文献类型：
--
作者：
Bryant, R. A.;Felmingham, K.;Williams, L.
背景。尽管认知行为疗法（CBT）是创伤后应激障碍（PTSD）的首选治疗方法，但大约有一半的患者对CBT没有反应。尚无研究探讨恐惧处理过程中的神经反应能力对PTSD治疗反应的预测作用。
方法。对14名PTSD患者的大脑功能性磁共振成像（fMRI）反应进行了检测。采用适用于1.5T扫描仪的反向掩蔽范式，快速呈现恐惧和中性面部表情，然后检测fMRI反应。患者随后接受了8次CBT治疗，包括教育、想象和现场暴露以及认知疗法。在治疗完成6个月后评估治疗反应。
结果。7名患者对治疗有反应（定义为治疗前评分降低50%），7名患者无反应。治疗后改善不佳与对掩蔽恐惧面孔的双侧杏仁核和腹侧前扣带回激活增强有关。
结论。对诱发恐惧的刺激产生过度的恐惧反应可能是限制PTSD患者对CBT治疗产生反应的一个关键因素。这种对恐惧的杏仁核过度反应可能反映了在CBT治疗过程中难以控制引发的焦虑反应，并且这一因素可能限制了对治疗的最佳反应。
Background. Although cognitive behaviour therapy (CBT) is the treatment of choice for post-traumatic stress disorder (PTSD), approximately half of patients do not respond to CBT. No studies have investigated the capacity for neural responses during fear processing to predict treatment response in PTSD.Method. Functional magnetic resonance imaging (fMRI) responses of the brain were examined in individuals with PTSD (n = 14). fMRI was examined in response to fearful and neutral facial expressions presented rapidly in a backwards masking paradigm adapted for a 1.5 T scanner. Patients then received eight sessions of CBT that comprised education, imaginal and in vivo exposure, and cognitive therapy. Treatment response was assessed 6 months after therapy completion.Results. Seven patients were treatment responders (defined as a reduction of 50% of pretreatment scores) and seven were non-responders. Poor improvement after treatment was associated with greater bilateral amygdala and ventral anterior cingulate activation in response to masked fearful faces.Conclusions. Excessive fear responses in response to fear-eliciting stimuli may be a key factor in limiting responses to CBT for PTSD. This excessive amygdala response to fear may reflect difficulty in managing anxiety reactions elicited during CBT, and this factor may limit optimal response to therapy.