Neural correlates of emotional reactivity and regulation associated with treatment response in a randomized clinical trial for posttraumatic stress disorder.
Neural correlates of emotional reactivity and regulation associated with treatment response in a randomized clinical trial for posttraumatic stress disorder.
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DOI：
10.1016/j.pscychresns.2020.111062
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发表时间：
2020-05-30
期刊：
影响因子：
--
通讯作者：
Rauch SAM
中科院分区：
文献类型：
--
作者：
Joshi SA;Duval ER;Sheynin J;King AP;Phan KL;Martis B;Porter KE;Liberzon I;Rauch SAM
创伤后应激障碍（PTSD）是一种使人衰弱的疾病，通常与情绪调节困难有关，包括重新评估负面情绪。本研究评估了退伍军人PTSD治疗前后情绪调节相关的神经机制。创伤后应激障碍和战斗暴露对照组（CC）在完成情绪调节任务（ERT）和情绪面孔评估任务（EFAT）的同时完成诊断评估和功能磁共振成像（fMRI）扫描。PTSD患者被随机分配到延长暴露加安慰剂组（PE+PLB）、Sertraline加强化药物管理组（SERT+EMM）或PE加SERT组（PE+SERT），治疗后反复进行诊断评估和MRI扫描。杏仁核、dmPFC和dlPFC作为感兴趣的区域进行了检查。在ERT测试中，PTSD退伍军人在重新评估和情绪维持时的dmPFC激活显著低于cc。在创伤后应激障碍组中，结果表明，在治疗前的情绪重新评估和维持试验中，dmPFC的激活程度较低，与治疗前和治疗后的症状明显减轻之间存在显著关联。在EFAT期间，PTSD和cc参与者在脑激活方面没有组间差异，脑功能和PTSD症状之间也没有关系。这些发现表明，在重新评估负面情绪时，较少的情绪反应可能潜在地反映了较少的前额叶区域招募需求，并且是与更好的治疗结果相关的个体因素。
Posttraumatic Stress Disorder (PTSD) is a debilitating condition often associated with difficulty in emotion regulation, including reappraising negative emotions. This study assessed neural mechanisms associated with emotion regulation in veterans prior to and following treatment for PTSD. Participants with PTSD and combat exposed controls (CC) completed diagnostic evaluation and underwent fMRI scanning while completing Emotion Regulation Task (ERT) and Emotional Faces Assessment Task (EFAT). Participants with PTSD were randomly assigned to Prolonged Exposure plus placebo (PE+PLB), Sertraline plus enhanced medication management (SERT+EMM), or PE plus SERT (PE+SERT) and repeated diagnostic evaluation and MRI scanning following treatment. The amygdala, dmPFC, and dlPFC were examined as regions of interest. On ERT, veterans with PTSD showed significantly less dmPFC activation than CCs during reappraisal vs emotional maintenance. Within the PTSD group, results demonstrated a significant association between less activation in the dmPFC during emotion reappraisal vs maintenance trials before treatment and greater reductions in symptoms from pre- to post-treatment. During the EFAT, there were no group differences between participants with PTSD and CCs in brain activation, and no relationships between brain function and PTSD symptoms. These findings suggest that less emotional reactivity might potentially reflect less need for recruitment of prefrontal regions when reappraising negative emotion, and is an individual factor associated with better treatment outcome.
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