Psychological and Brain Connectivity Changes Following Trauma-Focused CBT and EMDR Treatment in Single-Episode PTSD Patients

Frontiers in Psychology

article

Emiliano Santarnecchi¹  Letizia Bossini³  Giampaolo Vatti¹  Andrea Fagiolini³  Patrizia La Porta⁴  Giorgio Di Lorenzo⁵  Alberto Siracusano⁵  Simone Rossi¹  Alessandro Rossi⁷ 

[1] Siena Brain Investigation & Neuromodulation Lab, Neurology and Clinical Neurophysiology Section, Department of Medicine, University of Siena;Berenson-Allen Center for Noninvasive Brain Stimulation, Beth Israel Deaconess Medical Center, Harvard Medical School, United States;Department of Psychiatry, University of Siena;EMDR Italy Association;Laboratory of Psychophysiology and Cognitive Neuroscience, Department of Systems Medicine, University of Rome “Tor Vergata”;Tor Vergata University of Rome Fondazione Policlinico Tor Vergata Roma;Department of Medicine, School of Medicine, University of Siena

关键词: EMDR;    fMRI;    PTSD;    connectivity;    psychotherapy;    MRI;    CBT;   

DOI  :  10.3389/fpsyg.2019.00129

学科分类：社会科学、人文和艺术（综合）

来源: Frontiers

【 摘 要 】

Among the different therapeutic alternatives for post-traumatic stress disorder (PTSD), Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT) and Eye Movement Desensitization and Reprocessing (EMDR) Therapy have shown promising results in helping patients cope with PTSD symptoms. However, given the different theoretical and methodological substrate of TF-CBT and EMDR, a potentially different impact on the brain for the two interventions could be hypothesized, as well as an interaction between trauma-specific PTSD symptomatology and response to a given psychotherapy. In this study, we monitored psychological and spontaneous functional connectivity fMRI patterns in two groups of PTSD patients who suffered by the same traumatic event (i.e., natural disaster), before and after a cycle of psychotherapy sessions based on TF-CBT and EMDR. Thirty-seven (37) PTSD patients were enrolled from a larger sample of people exposed to a single, acute psychological stress (i.e., 2002 earthquake in San Giuliano di Puglia, Italy). Patients were randomly assigned to TF-CBT ( n = 14) or EMDR ( n = 17) psychotherapy. Clinical assessment was performed using the Clinician-Administered PTSD Scale (CAPS), the Davidson Trauma Scale (DTS) and the Work and Social Adjustment Scale (WSAS), both at baseline and after treatment. All patients underwent a fMRI data acquisition session before and after treatment, aimed at characterizing their functional connectivity (FC) profile at rest, as well as potential connectivity changes associated with the clinical impact of psychotherapy. Both EMDR and TF-CBT induced statistically significant changes in clinical scores, with no difference in the clinical impact of the two treatments. Specific changes in FC correlated with the improvement at the different clinical scores, and differently for EMDR and TF-CBT. However, a similarity in the connectivity changes associated with changes in CAPS in both groups was also observed. Specifically, changes at CAPS in the entire sample correlated with an (i) increase in connectivity between the bilateral superior medial frontal gyrus and right temporal pole, and a (ii) decrease in connectivity between left cuneus and left temporal pole. Results point to a similar, beneficial psychological impact of EMDR and TF-CBT for treatment of natural-disaster PTSD patients. Neuroimaging data suggest a similar neurophysiological substrate for clinical improvement following EMDR and TF-CBT, involving changes affecting bilateral temporal pole connectivity.

【 授权许可】

CC BY