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

项目摘要 青春期的创伤后应激障碍（PTSD）对大脑网络产生负面影响， 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%的青年人在目前的方法下没有得到充分的改善。通过识别神经生物学 有效疗法的机制，我们促进开发新的或个性化的治疗 治疗创伤后应激障碍的方法然而，在识别神经元方面的进展有限。 使用神经成像的治疗机制，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，这在治疗过程的多个部分中崩溃。客观 这项研究的目的是采取一种新的方法， 创伤后应激障碍青少年的创伤治疗阶段。我们的中心假设是，每个阶段产生特定的 大脑的变化反映了在这一阶段获得的技能和经验。创伤- 聚焦认知行为疗法（TF-CBT）是以证据为基础的，广泛用于治疗儿童和 青少年创伤后应激障碍它由3个定义明确的阶段组成，为检验我们的假设提供了机会 与神经成像：执行控制网络的变化将发生在技能阶段，边缘系统的变化， 在叙事阶段的网络，和默认模式的网络在巩固阶段的变化。 为了验证这些假设，我们将招募N=180名12-17岁的患有PTSD的女孩和男孩， 人际创伤，如身体虐待、性虐待或目睹暴力。我们将使用随机 对照试验设计，将受试者分配至TF-CBT（由满足以下条件的研究团队临床医生提供 保真度标准，并接受咨询博士朱迪思科恩，治疗开发商）或治疗作为 社区卫生服务（TAU;在社区提供，不遵循分阶段的结构）。我们将收集功能 TF-CBT的3个阶段中的每个阶段之前和之后或相同时间的磁共振成像（fMRI）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 将作为相位相关神经变化的协变量进行研究。分析将确定TF的阶段- 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 最能预测治疗结束时症状改善的阶段。探索性分析将使用 神经解剖学和白色物质扩散率扫描，以识别脑结构中共同发生的变化。的 提出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有关。 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