Neurosubstrates of remission following prolonged exposure therapy in veterans with posttraumatic stress disorder.
Neurosubstrates of remission following prolonged exposure therapy in veterans with posttraumatic stress disorder.
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患有创伤后应激障碍的退伍军人经过长期暴露治疗后缓解的神经基质。
DOI：
10.1159/000348867
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发表时间：
2013
影响因子：
22.8
通讯作者：
Strigo,IrinaA
中科院分区：
文献类型：
--
作者：
Simmons,AlanN;Norman,SonyaB;Spadoni,AndreaD;Strigo,IrinaA
背景：长期暴露(PE)疗法是退伍军人创伤后应激障碍(PTSD)的一线治疗方法。创伤后应激障碍治疗效果的脑内潜在变化目前尚不清楚。方法：共31名PTSD退伍军人在基线状态下完成了执行情感预期任务的fMRI扫描，并参加了体育治疗。在这些人中，7人提前终止治疗，24人完成了PE治疗和相同的后续fMRI扫描。随访时，24例完全者中15例仍有可诊断的PTSD(NR-PTSD)，9例完全缓解(R-PTSD)，即不符合PTSD的诊断标准。具体地说，R-PTSD组在预期治疗前和治疗后的阴性图像期间表现出较低的激活，而NR-PTSD组在预期该区域出现阳性图像时表现出较高的激活。此外，脑岛功能激活的变化与该岛区与右扣带回和右后岛区的连通性增加同时发生。结论：这些发现表明，PE治疗后有效缓解PTSD症状的能力需要与生理信号相联系的能力，并缓解暴露治疗的预期焦虑的不适感。这些过程似乎是由一个网络控制的，在这个网络中，前岛叶与扣带回和中后岛相连。
Background:Prolonged exposure (PE) therapy is the first-line treatment for posttraumatic stress disorder (PTSD) in combat veterans. The underlying brain changes of treatment effect in PTSD are currently unknown.Methods:A total of 31 veterans with PTSD completed an fMRI scan performing an affective anticipation task at baseline and were enrolled in PE therapy. Of these, 7 prematurely terminated therapy, while 24 individuals completed PE therapy and an identical follow-up fMRI scan. At follow-up, 15 of the 24 completers still had diagnosable PTSD (NR-PTSD) and 9 of the 24 completers showed complete remission from PTSD (R-PTSD), i.e. they did not meet diagnostic criteria for PTSD.Results:The left anterior insula showed a significant group by scan session interaction. Specifically, the R-PTSD group showed decreased activation during anticipation of negative images from pre- to posttreatment scans, while the NR-PTSD group showed increased activation during anticipation of positive images in this region. Furthermore, the change in functional activation in the insula co-occurred with increased connectivity between this insular region and the right cingulate and right mid-posterior insular region in R-PTSD.Conclusions:These findings suggest that the capacity to effectively remit from PTSD symptoms after PE treatment requires the ability to connect with physiological signals and moderate the discomfort of anticipatory anxiety of exposure therapy. These processes appear to be controlled by a network where the anterior insula is connected with the cingulate and the mid-posterior insula.