Predicting Treatment Outcome in PTSD: A Longitudinal Functional MRI Study on Trauma-Unrelated Emotional Processing
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In about 30-50% of patients with posttraumatic stress disorder (PTSD), symptoms persist after treatment. Although neurobiological research has advanced our understanding of PTSD, little is known about the neurobiology underlying persistence of PTSD. Two functional MRI scans were collected from 72 war veterans with and without PTSD over a 6- to 8-month interval, during which PTSD patients received trauma-focused therapy. All participants performed a trauma-unrelated emotional processing task in the scanner. Based on post-treatment symptom severity, a distinction was made between remitted and persistent patients. Behavioral and imaging measures of trauma-unrelated emotional processing were compared between the three groups (remitted patients, N=21; persistent patients, N=22; and combat controls, N=25) with repeated-measures (pre- and post-treatment) analyses. Second, logistic regression was used to predict treatment outcome. Before and after treatment, persistent patients showed a higher dorsal anterior cingulate cortex (dACC) and insula response to negative pictures compared with remitted patients and combat controls. Before treatment, persistent patients showed increased amygdala activation in response to negative pictures compared with remitted patients. The remitted patients and combat controls did not differ on the behavioral or imaging measures. Finally, higher dACC, insula, and amygdala activation before treatment were significant predictors of symptom persistence. Our results highlight a pattern of brain activation that may predict poor response to PTSD treatment. These findings can contribute to the development of alternative or additional therapies. Further research is needed to elucidate the heterogeneity within PTSD and describe how differences in neural function are related to treatment outcome. Such approaches are critical for defining parameters to customize PTSD treatment and improve treatment response rates.
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Higher amygdala (and dACC and insula) reactivity toward negative emotional pictures prior to treatment predicted persistence of PTSD symptoms after treatment.
“In addition, higher amygdala (and dACC and insula) reactivity toward negative emotional pictures prior to treatment predicted persistence of PTSD symptoms after treatment (van Rooij et al, 2015).”
From Intranasal oxytocin administration dampens amygdala reactivity towards emotional faces in male and female PTSD patients (2016) · cites this paper as van Rooij et al, 2015
In PTSD, greater amygdala reactivity to fearful faces and negative pictures before treatment predicted worse treatment outcome.
“In PTSD, greater amygdala reactivity to fearful faces (Bryant et al, 2008) and negative pictures (van Rooij et al, 2015) before treatment predicted worse treatment outcome.”
From Intranasal oxytocin administration dampens amygdala reactivity towards emotional faces in male and female PTSD patients (2016) · cites this paper as van Rooij et al, 2015
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- Authors
- van Rooij, S. J. H., Kennis, M., Vink, M., & Geuze, E.
- Affiliations
- University Medical Center Utrecht (NL)
- Venue
- Neuropsychopharmacology
- Published
- 2015-08-20
- Volume
- 41
- Issue
- 4
- Pages
- 1156-1165
- ISSN
- 0893-133X (ISSN-L)
- 1740-634X
- PMC
- PMC4748440
- OpenAlex
- W1199377154
- Cited by
- 122
- References
- 60
- Citations by year
- 2026: 4 · 2025: 4 · 2024: 6 · 2023: 15 · 2022: 8 · 2021: 15 · 2020: 31 · 2019: 11 · 2018: 8 · 2017: 12 · 2016: 5 · 2015: 3
- FWCI
- 11.57
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Neuropsychopharmacology (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Utrecht University Repository (Utrecht University) (submittedVersion)
- Funders
- Ministerie van Defensie
- Topics
- Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
- Health Sciences › Medicine › Epidemiology › Traumatic Brain Injury Research
- Social Sciences › Psychology › Clinical Psychology › Psychoanalysis and Psychopathology Research
- Keywords
- post-traumatic stress disorder, treatment outcome prediction, dorsal anterior cingulate cortex, insula, amygdala, negative emotional stimuli, war veterans, trauma-focused psychotherapy, treatment response heterogeneity, symptom remission
- MeSH terms
- Adult, Amygdala, Brain, Brain Mapping, Cerebral Cortex, Emotions, Gyrus Cinguli, Humans, Longitudinal Studies, Magnetic Resonance Imaging, Male, Psychotherapy, Stress Disorders, Post-Traumatic, Veterans, Treatment Outcome
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