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Cited by 120Posttraumatic Stress Disorder ResearchPsychoanalysis and Psychopathology ResearchPsychotherapy Techniques and Applications

Selective Effects of Psychotherapy on Frontopolar Cortical Function in PTSD

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Fonzo, Gregory A., Goodkind, Madeleine S., Oathes, Desmond J., Zaiko, Yevgeniya V., Harvey, Meredith, Peng, Kathy K., Weiss, M. Elizabeth, Thompson, Allison L. +12 more·2017·American Journal of Psychiatry
DOI 10.1176/appi.ajp.2017.16091073PMC PMC5711612
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Abstract

OBJECTIVE: Exposure therapy is an effective treatment for posttraumatic stress disorder (PTSD), but a comprehensive, emotion-focused perspective on how psychotherapy affects brain function is lacking. The authors assessed changes in brain function after prolonged exposure therapy across three emotional reactivity and regulation paradigms. METHOD: Individuals with PTSD underwent functional MRI (fMRI) at rest and while completing three tasks assessing emotional reactivity and regulation. Individuals were then randomly assigned to immediate prolonged exposure treatment (N=36) or a waiting list condition (N=30) and underwent a second scan approximately 4 weeks after the last treatment session or a comparable waiting period, respectively. RESULTS: Treatment-specific changes were observed only during cognitive reappraisal of negative images. Psychotherapy increased lateral frontopolar cortex activity and connectivity with the ventromedial prefrontal cortex/ventral striatum. Greater increases in frontopolar activation were associated with improvement in hyperarousal symptoms and psychological well-being. The frontopolar cortex also displayed a greater variety of temporal resting-state signal pattern changes after treatment. Concurrent transcranial magnetic stimulation and fMRI in healthy participants demonstrated that the lateral frontopolar cortex exerts downstream influence on the ventromedial prefrontal cortex/ventral striatum. CONCLUSIONS: Changes in frontopolar function during deliberate regulation of negative affect is one key mechanism of adaptive psychotherapeutic change in PTSD. Given that frontopolar connectivity with ventromedial regions during emotion regulation is enhanced by psychotherapy and that the frontopolar cortex exerts downstream influence on ventromedial regions in healthy individuals, these findings inform a novel conceptualization of how psychotherapy works, and they identify a promising target for stimulation-based therapeutics.

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  • Frontopolar connectivity with ventromedial regions during emotion regulation is a possible key mechanism of psychotherapeutic improvement in PTSD.

    “Given these findings, the authors argue that frontopolar connectivity with ventromedial regions during emotion regulation is a possible key mechanism of psychotherapeutic improvement in PTSD.”

    From Prefrontal cortex, amygdala, and threat processing: implications for PTSD (2022) · cites this paper as [168]

  • Further analysis of the Fonzo et al. study suggested that psychotherapy increased lateral frontopolar cortex activity and connectivity with the vmPFC.

    “Further analysis of this study suggested that psychotherapy increased lateral frontopolar cortex activity and connectivity with the vmPFC [168].”

    From Prefrontal cortex, amygdala, and threat processing: implications for PTSD (2022) · cites this paper as [168]

  • Greater increases in frontopolar activation were associated with improvements in hyperarousal symptoms and psychological well-being.

    “Additionally, greater increases in frontopolar activation were associated with improvements in hyperarousal symptoms and psychological well-being.”

    From Prefrontal cortex, amygdala, and threat processing: implications for PTSD (2022) · cites this paper as [168]

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Authors
Fonzo, G. A., Goodkind, M. S., Oathes, D. J., Zaiko, Y. V., Harvey, M., Peng, K. K., Weiss, M. E., Thompson, A. L., Zack, S. E., Mills-Finnerty, C. E., Rosenberg, B. M., Edelstein, R., Wright, R. N., Kole, C. A., Lindley, S. E., Arnow, B. A., Jo, B., Gross, J. J., Rothbaum, B. O., & Etkin, A.
Affiliations
  • Stanford Medicine (US)
  • From the Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, Calif.; the Stanford Neurosciences Institute, Stanford University, Stanford; the Veterans Affairs Palo Alto Healthcare System and the Sierra Pacific Mental Illness, Research, Education, and Clinical Center (MIRECC), Palo Alto, Calif.; the New Mexico Veterans Affairs Healthcare System, Albuquerque; the Center for Neuromodulation in Depression and Stress, Department of Psychiatry, University of...
ORCID
Venue
American Journal of Psychiatry
Publisher
American Psychiatric Association Publishing
Published
2017-12
Volume
174
Issue
12
Pages
1175-1184
ISSN
  • 0002-953X (ISSN-L)
  • 1535-7228
DOI
10.1176/appi.ajp.2017.16091073
PMC
PMC5711612
OpenAlex
W2739099034
Cited by
120
References
14
Citations by year
2026: 6 · 2025: 15 · 2024: 13 · 2023: 12 · 2022: 10 · 2021: 9 · 2020: 27 · 2019: 9 · 2018: 14 · 2017: 5
FWCI
18.66
Type
journal article
Language
en
Open access
Locations
  • American Journal of Psychiatry (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
National Institute of Mental Health (R01MH103324, R01MH094757, R01MH091860, T32MH019938)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
  • Social Sciences › Psychology › Clinical Psychology › Psychoanalysis and Psychopathology Research
  • Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
Keywords
post-traumatic stress disorder, prolonged exposure therapy, frontopolar cortex, emotion regulation, cognitive reappraisal, ventromedial prefrontal cortex, ventral striatum, hyperarousal, resting-state brain activity, transcranial magnetic stimulation
MeSH terms
Adolescent, Adult, Corpus Striatum, Emotions, Female, Frontal Lobe, Humans, Implosive Therapy, Magnetic Resonance Imaging, Male, Middle Aged, Neural Pathways, Stress Disorders, Post-Traumatic, Treatment Outcome, Prefrontal Cortex, Transcranial Magnetic Stimulation, Young Adult, Functional Neuroimaging

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