Neural connectivity before and after each of the three treatment phases of trauma-focused therapy for adolescent posttraumatic stress

项目总结 青春期创伤后应激障碍(PTSD)对潜在的大脑网络的负面影响 认知、社交和情感功能。早期干预对于减轻长期影响很重要，但 大约20%的年轻人在目前的方法下没有得到足够的改善。通过鉴定神经生物学 有效治疗的机制，我们促进新的或个性化治疗的发展 青少年创伤后应激障碍的治疗方法。然而，在识别神经的进展有限。 使用神经成像治疗的机制，部分原因是大多数研究仅收集神经成像数据 基线和治疗结束，它崩溃在治疗过程的多个部分。目标是 这项拟议的研究的目的是采取一种新的方法，通过确定与特定的 青少年创伤后应激障碍的创伤治疗阶段。我们的中心假设是，每个阶段都会产生特定的 大脑的变化反映了在这一阶段中所获得的技能和经验。创伤- 聚焦认知行为疗法(TF-CBT)是以循证为基础的，被广泛用于治疗儿童和 患有创伤后应激障碍的青少年。它由3个定义明确的阶段组成，为检验我们的假设提供了机会 对于神经成像：执行控制网络的变化将发生在技能阶段，边缘的变化 叙述阶段的网络，以及合并阶段默认模式网络的变化。 为了验证这些假设，我们将招募N=180名12-17岁的男孩和女孩，他们患有创伤后应激障碍 人际关系创伤，如身体虐待、性虐待或目击暴力。我们将使用随机化的 对照试验设计，将参与者分配到TF-CBT(由满足以下条件的研究团队临床医生提供 并接受治疗开发商朱迪思·科恩博士的咨询)或治疗 通常(TAU；在社区中提供，不遵循分阶段结构)。我们将收集功能 磁共振成像(FMRI)在TF-CBT三期扫描前后或同一时间的数据 TAU的间隔。年龄、性别、分离亚型、症状严重程度和其他变量的个体差异 将作为与相位相关的神经变化的协变量进行研究。分析将确定Tf-的物相- 对于CBT，TF-CBT组的大脑区域和网络发生变化，但TAU组没有变化。我们还将确定 最能预测治疗结束症状改善的阶段(S)。探索性分析将使用 神经解剖学和脑白质弥散率扫描，以确定大脑结构的共同变化。这个 拟议的创新性研究将提供有关神经生物学和认知机制的新信息。 与创伤后应激障碍青少年的创伤治疗过程相关。 1

PROJECT SUMMARY Posttraumatic stress disorder (PTSD) during adolescence negatively impacts brain networks underlying cognitive, social, and emotional function. Early intervention is important for mitigating long-term effects, but about 20% of youth do not improve sufficiently with current approaches. By identifying the neurobiological mechanisms of effective therapies, we facilitate the development of novel or personalized treatment approaches for youth with PTSD. However, there has been limited progress in identifying the neural mechanisms of treatment using neuroimaging, partly because most studies collect neuroimaging data at only baseline and end-of-treatment, which collapses across multiple parts of the therapeutic process. The objective of the proposed study is to take a new approach by identifying neural mechanisms associated with specific phases of trauma therapy for youth with PTSD. Our central hypothesis is that each phase produces specific brain changes that reflect the acquisition of skills and experiences occurring during that phase. Trauma- Focused Cognitive Behavioral Therapy (TF-CBT) is evidence-based and widely-used to treat children and adolescents with PTSD. It consists of 3 well-defined phases, providing an opportunity to test our hypotheses with neuroimaging: changes in executive control networks will occur during the skills phase, changes in limbic networks during the narrative phase, and changes in default mode networks during the consolidation phase. To test these hypotheses, we will recruit N=180 girls and boys, ages 12-17, who have PTSD following interpersonal trauma, such as physical abuse, sexual abuse, or witnessing violence. We will use a randomized controlled trial design to assign participants to either TF-CBT (provided by study team clinicians who meet fidelity standards and receive consultation from Dr. Judith Cohen, the treatment developer) or Treatment as Usual (TAU; provided in the community and does not follow a phased structure). We will collect functional magnetic resonance imaging (fMRI) data before and after each of the 3 phases of TF-CBT or the same time intervals of TAU. Individual differences in age, sex, dissociative subtype, symptom severity and other variables will be investigated as covariates of phase-related neural changes. Analyses will identify the phases of TF- CBT for which brain regions and networks change for the TF-CBT but not the TAU group. We will also identify the phase(s) that best predict end-of-treatment symptom improvement. Exploratory analyses will use neuroanatomical and white matter diffusivity scans to identify co-occurring changes in brain structure. The proposed innovative study will provide novel information on the neurobiological and cognitive mechanisms associated with the process of trauma therapy for youth with PTSD. 1