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

• Published in: Psychological medicine Vol. 38; no. 4; pp. 555 - 561
• Main Authors: Bryant, R. A., Felmingham, K., Kemp, A., Das, P., Hughes, G., Peduto, A., Williams, L.
• Format: Journal Article
• Language: English
• Published: Cambridge, UK Cambridge University Press 01.04.2008
• Subjects: Adult; Adult and adolescent clinical studies; Amygdala - physiopathology; Anxiety disorders. Neuroses; Arousal - physiology; Behavior; Behavior therapy. Cognitive therapy; Biological and medical sciences; Cognitive behaviour therapy; Cognitive Therapy; Desensitization, Psychologic; Dominance, Cerebral - physiology; Drug therapy; Facial Expression; Fear; Fear - physiology; Female; Females; fMRI; Gyrus Cinguli - physiopathology; Humans; Image Processing, Computer-Assisted; Magnetic Resonance Imaging; Male; Medical imaging; Medical sciences; Mental depression; Middle Aged; Neurological disorders; Pattern Recognition, Visual - physiology; Post-traumatic stress disorder; Posttraumatic stress disorder; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Sample size; Stress; Stress Disorders, Post-Traumatic - physiopathology; Stress Disorders, Post-Traumatic - therapy; Studies; Trauma; Treatment Outcome; treatment prediction; Treatments; fMRI; treatment prediction; Cognitive behaviour therapy; post-traumatic stress disorder; Cognitive therapy; Posttraumatic syndrome; Amygdala; Central nervous system; Anxiety disorder; Basal ganglion; Activation; Posttraumatic stress disorder; Stress; Encephalon; Treatment; Cingulate cortex; Behavior therapy; Predictive factor; Amygdaloid nucleus
• ISSN: 0033-2917; 1469-8978
• DOI: 10.1017/S0033291707002231

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. 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. 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. 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.