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Amygdala and ventral anterior cingulate activation predicts treatment response to cognitive behaviour therapy for post-traumatic stress disorder

Published online by Cambridge University Press:  16 November 2007

R. A. Bryant ,
K. Felmingham ,
A. Kemp ,
P. Das ,
G. Hughes ,
A. Peduto  and
L. Williams
R. A. Bryant*
Affiliation:
Brain Dynamics Centre, Westmead Hospital, Sydney, NSW, Australia School of Psychology, University of New South Wales, Sydney, NSW, Australia
K. Felmingham
Affiliation:
Brain Dynamics Centre, Westmead Hospital, Sydney, NSW, Australia School of Psychology, University of New South Wales, Sydney, NSW, Australia
A. Kemp
Affiliation:
Brain Dynamics Centre, Westmead Hospital, Sydney, NSW, Australia
P. Das
Affiliation:
Brain Dynamics Centre, Westmead Hospital, Sydney, NSW, Australia Neuroscience Institute of Schizophrenia and Allied Disorders (NISAD), NSW, Australia
G. Hughes
Affiliation:
Department of Radiology, Westmead Hospital, Sydney, NSW, Australia
A. Peduto
Affiliation:
Department of Radiology, Westmead Hospital, Sydney, NSW, Australia
L. Williams
Affiliation:
Brain Dynamics Centre, Westmead Hospital, Sydney, NSW, Australia
*
*Address for correspondence: Dr R. A. Bryant, School of Psychology, University of New South Wales, Sydney, NSW 2052, Australia. (Email: r.bryant@unsw.edu.au)
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Abstract

Background

Although cognitive behaviour therapy (CBT) is the treatment of choice for post-traumatic stress disorder (PTSD), approximately half of patients do not respond to CBT. No studies have investigated the capacity for neural responses during fear processing to predict treatment response in PTSD.

Method

Functional magnetic resonance imaging (fMRI) responses of the brain were examined in individuals with PTSD (n=14). fMRI was examined in response to fearful and neutral facial expressions presented rapidly in a backwards masking paradigm adapted for a 1.5 T scanner. Patients then received eight sessions of CBT that comprised education, imaginal and in vivo exposure, and cognitive therapy. Treatment response was assessed 6 months after therapy completion.

Results

Seven patients were treatment responders (defined as a reduction of 50% of pretreatment scores) and seven were non-responders. Poor improvement after treatment was associated with greater bilateral amygdala and ventral anterior cingulate activation in response to masked fearful faces.

Conclusions

Excessive fear responses in response to fear-eliciting stimuli may be a key factor in limiting responses to CBT for PTSD. This excessive amygdala response to fear may reflect difficulty in managing anxiety reactions elicited during CBT, and this factor may limit optimal response to therapy.

Keywords

Cognitive behaviour therapyfMRIpost-traumatic stress disordertreatment prediction
Type
Original Articles
Information
Psychological Medicine , Volume 38 , Issue 4 , April 2008 , pp. 555 - 561
Copyright
Copyright © Cambridge University Press 2007

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