Neurocognitive Correlates of Successful Treatment of PTSD in Female Veterans
Neurocognitive Correlates of Successful Treatment of PTSD in Female Veterans
复制标题
DOI：
10.1017/s1355617716000424
复制
发表时间：
2016-07-01
影响因子：
2.6
通讯作者：
Castillo, Diane T.
中科院分区：
文献类型：
--
作者：
Haaland, Kathleen Y.;Sadek, Joseph R.;Castillo, Diane T.
背景：心理治疗对创伤后应激障碍（PTSD）神经认知的影响尚未被系统地研究。尽管有证据表明，治疗前的学习和记忆与治疗成功有关，执行功能理论强调弱执行功能（特别是抑制/转换）与PTSD有关。目的：确定（1）较高的治疗前学习/记忆、抑制/转换或两者是否预测治疗成功;以及（2）治疗成功是否与抑制/转换的特定改善相关，而与学习/记忆或工作记忆（执行功能的另一个方面）无关。研究方法：对创伤后应激障碍的女性退伍军人进行了治疗前神经认知和神经认知变化（抑制/转换，学习/记忆，工作记忆）的检查。他们在16周的PTSD团体心理治疗前后进行了评估，其中包括三个平衡模块（认知重建治疗，暴露治疗，技能培训），并对治疗师的依从性进行了忠诚度检查。结果：只有治疗前的学习/记忆预测更好的治疗效果。治疗成功仅与抑制/转换的改善相关，即使在控制轻度创伤性脑损伤后，以及抑郁症状，工作记忆和学习/记忆的变化。结论：我们的发现，学习/记忆预测治疗成功是与以前的研究一致。我们扩展了这些研究，表明这种影响仅限于学习/记忆，这与PTSD的执行功能理论相反。相比之下，只有抑制/转换显著改善，更好的治疗成功的事实是一致的，其潜在的重要性，在维持创伤后应激障碍症状。未来的研究应该确定抑制/转换能力是否是PTSD发展和维持的风险，或者这种能力是否与PTSD症状变化有更广泛的相互关系。
Background: The influence of psychotherapy on neurocognition in post-traumatic stress disorder (PTSD) has not been examined methodically. This is despite evidence that pre-treatment learning and memory has been associated with treatment success and that executive function theories emphasize weak executive functions (especially inhibition/switching) are associated with PTSD. Objectives: To determine (1) if higher pre-treatment learning/memory, inhibition/switching, or both predict treatment success; and (2) if treatment success is associated with specific improvement in inhibition/switching and not learning/memory or working memory, another aspect of executive function. Methods: Pre-treatment neurocognition and neurocognitive changes (inhibition/switching, learning/memory, working memory) were examined in female veterans with PTSD. They were evaluated before and after 16-weeks of group psychotherapy for PTSD that included three counterbalanced modules (cognitive restructuring therapy, exposure therapy, skills training) with fidelity checks for therapist adherence. Results: Only pre-treatment learning/memory predicted better treatment outcome. Treatment success was associated with improvement in inhibition/switching only, even after controlling for mild traumatic brain injury, and changes in depressive symptoms, working memory, and learning/memory. Conclusions: Our finding that learning/memory predicted treatment success is consistent with previous studies. We extended these studies by showing that the effect was restricted to learning/memory, which is contrary to the executive function theory of PTSD. In contrast, the fact that only inhibition/switching significantly improved with better treatment success is consistent with its potential importance in maintaining PTSD symptoms. Future research should determine whether inhibition/switching abilities are a risk for development and maintenance of PTSD or whether such abilities have a broader reciprocal relationship with PTSD symptom change.