Neurocomputational Changes in Inhibitory Control Associated With Prolonged Exposure Therapy.
Neurocomputational Changes in Inhibitory Control Associated With Prolonged Exposure Therapy.
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DOI：
10.1002/jts.22461
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发表时间：
2020-08
影响因子：
3.3
通讯作者：
Simmons AN
中科院分区：
文献类型：
--
作者：
Harlé KM;Spadoni AD;Norman SB;Simmons AN
创伤后应激障碍（PTSD）与抑制控制功能障碍有关，这种功能障碍超出了抑制创伤相关入侵的困难。抑制性学习被认为是基于灭绝的疗法（如延长暴露（PE））有效性的潜在变化机制，这是创伤后应激障碍的一线治疗方法。为了确定与PE相关的抑制性学习变化的神经认知标志物，我们应用贝叶斯学习模型来分析PE治疗前后在抑制控制任务期间收集的神经影像学数据。患有战斗相关创伤后应激障碍的退伍军人（N = 20）在PE治疗前后立即进行fMRI时完成了停止信号任务（SST）。参与者在SST上表现出了小而显著的改善，表现为更长的反应时间和更高的抑制准确性。与有符号预测误差（SPE，即实际结果与基于模型的需要停止的预期之间的差异）相关的右侧尾状核的神经激活幅度从基线到治疗后评估有所下降。基于模型的激活的变化受到性能准确性的调节，成功试验中观察到的正SPE激活减少，d = 0.79，错误试验中观察到的负SPE激活减少，d = 0.74。成功停止试验时spe相关激活的减少与PTSD症状的减轻相关。这些结果与PE可能有助于广泛加强抑制性学习和发展更准确的基于模型的预测的概念是一致的，这可能因此促进对创伤相关线索的认知变化，并有助于减少创伤后应激障碍症状。
Posttraumatic stress disorder (PTSD) is associated with inhibitory control dysfunction that extends beyond difficulties inhibiting trauma-related intrusions. Inhibitory learning has been proposed as a potential mechanism of change underlying the effectiveness of extinction-based therapies such as prolonged exposure (PE), a first-line treatment for PTSD. To identify neurocognitive markers of change in inhibitory learning associated with PE, we applied a Bayesian learning model to the analysis of neuroimaging data collected during an inhibitory control task, both before and after PE treatment. Veterans (N = 20) with combat-related PTSD completed a stop-signal task (SST) while undergoing fMRI at time points immediately before and after PE treatment. Participants exhibited a small, significant improvement in performance on the SST, as demonstrated by longer reaction times and improved inhibition accuracy. Amplitude of neural activation associated with a signed prediction error (SPE; i.e., the discrepancy between actual outcome and model-based expectation of needing to stop) in the right caudate decreased from baseline to posttreatment assessment. Change in model-based activation was modulated by performance accuracy, with a decrease in positive SPE activation observed on successful trials, d = 0.79, and a reduction in negative SPE activation on error trials, d = 0.74. The decrease in SPE-related activation on successful stop trials was correlated with PTSD symptom reduction. These results are consistent with the notion that PE may help broadly strengthen inhibitory learning and the development of more accurate model-based predictions, which may thus facilitate change in cognitions in response to trauma-related cues and help reduce PTSD symptoms.
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