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DOI: 10.1055/s-0038-1627519
Neuronale Korrelate psychotherapeutischer Behandlung bei Patienten mit posttraumatischer Belastungsstörung[*]
Neural correlates of psychotherapeutic treatment of posttraumatic stress disorderPublikationsverlauf
eingegangen am:
01. Juli 2017
angenommen am:
18. Juli 2017
Publikationsdatum:
20. Januar 2018 (online)
![](https://www.thieme-connect.de/media/10.1055-s-00034916/201709/lookinside/thumbnails/10-1055-s-0038-1627519-1.jpg)
Zusammenfassung
Posttraumatische Belastungsstörungen (PTBS) gehen mit Veränderungen der Reagibilität auf neuronaler Ebene einher. Dabei weisen Bildgebungsstudien auf eine erhöhte Aktivität in der Amygdala und eine verminderte Aktivität im präfrontalen Kortex hin. Psychotherapeutische Interventionen gelten als Goldstandard der PTBS-Behandlung. Es wurde eine systematische Literaturrecherche anhand der Datenbanken: PubMed, PsychInfo und dem zentralen Register der kontrollierten Studien der Cochrane Library mit den Suchbegriffen „neural correlates” ODER “fMRI” ODER “SPECT” UND “therapy” UND “PTSD” durchgeführt. 20 Artikel wurden eingeschlossen: 15 verglichen Signalveränderungen von vor zu nach Psychotherapie, sieben verglichen die neuronale Aktivität vor Therapie mit der Symptomreduktion von vor zu nach Therapie und vier Studien verglichen neuronale Korrelate von Therapieansprechen. Erfolgreiche PTBS-Psychotherapie führte über mehrere Studien hinweg zu einer verminderten neuronalen Aktivität in der Amygdala und Insula und zu einer erhöhten Aktivität im dorsalen anterioren zingulären Kortex sowie dem Hippocampus, was im Sinne einer wiedergewonnenen Top-down-Kontrolle interpretiert werden kann.
Summary
Patients with posttraumatic stress disorder (PTSD) show changes in neural circuitries. Particularly, functional imaging studies found an increased amygdala and a decreased prefrontal cortex response in PTSD patients. Psychotherapy represents the gold standard for PTSD treatment. Studies were selected through systematic literature research in the databases PubMed, PsychInfo and Cochrane Library’s Central Register of Controlled Trials or were identified manually by searching reference lists of selected articles. Search terms were “neural correlates” OR “fMRI” OR “SPECT”, AND “therapy” AND “PTSD”. 20 articles were included, 15 of them compared pre-to-post therapy signal changes, seven related pre-treatment activity to pre-to-post symptom improvement and four compared neural correlates of responders versus nonresponders. After psychotherapy, several neuroimaging studies consistently found decreased activity in the amygdala and the insula as well as increased activity in the dorsal anterior cingulate cortex and hippocampus, which might reflect a regained top-downcontrol.
* Die vorliegende Studie ist eine für Nervenheilkunde überarbeitete, gekürzte Fassung der englischen Originalpublikation der Evaluationsergebnisse: Malejko K, Abler B, Plener PL, Straub J. Neural correlates of psychotherapeutic treatment of post-traumatic stress disorder: A systematic literature review. Frontiers in Psychiatry 2017; 8(85).
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Literatur
- 1 Hidalgo RB, Davidson JR. Posttraumatic stress disorder: epidemiology and health-related considerations. The Journal of clinical psychiatry 2000; 61 (Suppl. 07) 5-13.
- 2 Breslau N. Epidemiologic studies of trauma, posttraumatic stress disorder, and other psychiatric disorders. Canadian journal of psychiatry Revue canadienne de psychiatrie 2002; 47 (10) 923-9.
- 3 Breslau N, Chilcoat HD, Kessler RC, Davis GC. Previous exposure to trauma and PTSD effects of subsequent trauma: results from the Detroit Area Survey of Trauma. The American journal of psychiatry 1999; 156 (06) 902-7.
- 4 Heim C, Nemeroff CB. Neurobiology of posttraumatic stress disorder. CNS spectrums 2009; 14 (1 Suppl 1): 13-24.
- 5 Sherin JE, Nemeroff CB. Post-traumatic stress disorder: the neurobiological impact of psychological trauma. Dialogues in clinical neuroscience 2011; 13 (03) 263-78.
- 6 Lanius RA, Frewen PA, Tursich M, Jetly R, McKinnon MC. Restoring large-scale brain networks in PTSD and related disorders: a proposal for neuroscientifically-informed treatment interventions. Eur J Psychotraumatol 2015; 06: 27313.
- 7 Rauch SL, Shin LM, Phelps EA. Neurocircuitry models of posttraumatic stress disorder and extinction: human neuroimaging research – past, present, and future. Biol Psychiatry 2006; 60 (04) 376-82.
- 8 Shin LM, Wright CI, Cannistraro PA, Wedig MM, McMullin K, Martis B. et al. A functional magnetic resonance imaging study of amygdala and medial prefrontal cortex responses to overtly presented fearful faces in posttraumatic stress disorder. Archives of general psychiatry 2005; 62 (03) 273-81.
- 9 Disner SG, Beevers CG, Haigh EA, Beck AT. Neural mechanisms of the cognitive model of depression. Nat Rev Neurosci 2011; 12 (08) 467-77.
- 10 Patel R, Spreng RN, Shin LM, Girard TA. Neurocircuitry models of posttraumatic stress disorder and beyond: A meta-analysis of functional neuroimaging studies. Neuroscience and biobehavioral reviews 2012; 36: 2130-42.
- 11 Gillies D, Taylor F, Gray C, O’Brien L, D’Abrew N. Psychological therapies for the treatment of posttraumatic stress disorder in children and adolescents. The Cochrane database of systematic reviews 2012; 12: CD006726.
- 12 Forbes D, Creamer M, Bisson JI, Cohen JA, Crow BE, Foa EB. et al. A guide to guidelines for the treatment of PTSD and related conditions. Journal of traumatic stress 2010; 23 (05) 537-52.
- 13 Foa E, Hembree EA, Rothbaum BO. Prolonged exposure therapy for PTSD: emotional processing of traumatic experiences therapist guide. New York: Oxfod Press; 2007
- 14 Flatten G, Gast U, Hofmann A, Knaevelsrud C, Lampe A, Liebermann P. et al. S3 – Leitlinie Posttraumatische Belastungsstörung. Trauma & Gewalt 2011; 03: 202-10.
- 15 LeDoux JE. Emotion circuits in the brain. Annu Rev Neurosci 2000; 23: 155-84.
- 16 Bouton ME. Context, ambiguity, and unlearning: Sources of relapses after behavioural extinction. Biol Psychiatry 2002; 52: 976-86.
- 17 Aupperle RL, Allard CB, Simmons AN, Flagan T, Thorp SR, Norman SB. et al. Neural responses during emotional processing before and after cognitive trauma therapy for battered women. Psychiatry Research Neuroimaging 2013; 214 (01) 48-55.
- 18 Thomaes K, Dorrepaal E, Draijer N, de Ruiter MB, Elzinga BM, van Balkom AJ. et al. Treatment effects on insular and anterior cingulate cortex activation during classic and emotional Stroop interference in child abuse-related complex post-traumatic stress disorder. Psychological Medicine 2012; 42: 2337-49.
- 19 Peres JFP, Newberg AB, Mercante JP, Simao M, Albuquerque VE, Peres MJP. et al. Cerebral blood flow changes during retrieval of traumatic memories before and after psychotherapy: a SPECT study. Psychological medicine 2007; 37: 1481-91.
- 20 Cisler JM, Sigel BA, Steele JS, Smitherman S, Vanderzee K, Pemberton J. et al. Changes in functional connectivity of the amygdala during cognitive reappraisal predict symptom reduction during trauma-focused cognitive-behavioral therapy among adolescent girls with post-traumatic stress disorder. Psychological medicine 2016; 1-11.
- 21 Rooij S, Kennis M, Vink M, Geuze E. Predicting treatment outcome in PTSD: A longitudinal functional MRI study on trauma-unrelated emotional processing. Neuropsychopharmacology 2016; 41: 1156-65.
- 22 Roy MJ, Francis J, Friedlander J, Banks-Williams L, Lande RG, Taylor P. et al. Improvement in cerebral function with treatment of posttraumatic stress disorder. Annals of the New York academy of sciences 2010; 1208: 142-9.
- 23 Roy MJ, Constanzo ME, Rizzo AA. Compelling evidence that exposure therapy for PTSD normalizes brain function. Studies in health technology and informatics 2014; 199: 61-5.
- 24 Aupperle RL, Allard CB, Simmons AN, Flagan T, Thorp SR, Norman SB. et al. Neural responses during emotional processing before and after cognitive trauma therapy for battered women. Psychiatry Research Neuroimaging 2013; 214: 48-55.
- 25 King AP, Block SR, Sripada RK, Rauch S, Giardino N, Favorite T. et al. Altered default mode network (DMN) resting state functional connectivity following a mindfulness-based exposure therapy for posttraumatic stress disorder (PTSD) in combat veterans of Afghanistan and Iraq. Depression and Anxiety 2016; 33: 289-99.
- 26 Felmingham K, Kemp A, Williams L, Das P, Hughes G, Peduto A. et al. Changes in anterior cingulate and amygdala after cognitive behavior therapy of posttraumatic stress disorder. Psychological Science 2007; 18 (127) 127-9.
- 27 Dickie EW, Brunet A, Akerib V, Armony JL. Neural correlates of recovery from post-traumatic stress disorder: a longitudinal fMRI investigation of memroy encoding. Neuropsychologia 2011; 49: 1771-8.
- 28 Levin P, Lazrove Svd, Kolk B. What psychological and neuroimaging tell us about the treatment of posttraumatic stress disorder by eye movement desensitization and reprocessing. Journal of Anxiety Disorders 1999; 13 (1–2): 159-72.
- 29 Lansing K, Amen DG, Hanks C, Rudy L. High-resolution brain SPECT imaging and eye movement desensitization and reprocessing in police officers with PTSD. The Journal of Neuropsychiatry and Clinical Neuroscience 2005; 17 (04) 526-32.
- 30 Lindauer RJL, Booij J, Habraken JBAv, Meijel EPM, Uylings HBM, Olff M. et al. Effects of psychotherapy on regional cerebral blood flow during trauma imagery in patients with post-traumatic stress disorder: a randomized clinical trial. Psychological medicine 2008; 38: 543-54.
- 31 Pagani M, Hoegberg G, Salmaso D, Nardo D, Sundin O, Jonsson C. et al. Effects of EMDR psychotherapy on 99mTc-HMPAO distribution in occupation-related post-traumatic stress disorder. Nuclear medicine communications 2007; 28: 257-765.
- 32 Bryant RA, Felmingham K, Kemp A, Das P, Hughes G, Peduto A. et al. Amygdala and ventral anterior cingulate activation predicts treatment response to cognitive behavior therapy for posttraumatic stress disorder. Psychological medicine 2008; 38: 555-61.
- 33 Thomaes K, Dorrepaal E, Draijer Nd, Ruiter MB, Elzinga BMv, Balkom AJ. et al. Treament effects on insular and anterior cingulate cortex activation during classic and emotional Stroop interference in child abuse-related complex post-traumatic stress disorder. Psychological medicine 2012; 42: 2337-49.
- 34 Cisler JM, Sigel BA, Kramer TL, Smitherman S, Vanderzee K, Pemberton J. et al. Amygdala response predicts trajectory of symptom reduction during trauma-focused cognitive-behavioral therapy among adolescent girls with PTSD. Journal of psychiatric research 2015; 71: 33-40.
- 35 Kennis DMPh, van Rooij DSPh, Reijnen MA, Geuze DEPh. The predictive value of dorsal cingulate activity and fractional anisotropy on longterm PTSD symptom severity. Depression and Anxiety 2017; 34 (05) 410-8.
- 36 Simmons AN, Norman SB, Spadoni AD, Strigo IA. Neurosubstrates of remission following prolonged exposure therapy in veterans with posttraumatic stress disorder. Psychotherapy and psychosomatics 2013; 82: 382-9.
- 37 van Rooij SJ, Kennis M, Sjouwerman R, van den Heuvel MP, Kahn RS, Geuze E. Smaller hippocampal volume as a vulnerability factor for the persistence of post-traumatic stress disorder. Psychological medicine 2015; 45 (13) 2737-46.
- 38 Brown RC, Witt A, Fegert JM, Keller F, Rassenhofer M, Plener PL. Psychosocial interventions for children and adolescents after man-made and natural disasters: a meta-analysis and systematic review. Psychological medicine 2011; 1-13.
- 39 Menon V, Uddin LQ. Saliency, switching, attention and control: a network model of insula function. Brain Struct Funct 2010; 214 (5–6): 655-67.
- 40 Gu X, Hof PR, Friston KJ, Fan J. Anterior insular cortex and emotional awareness. J Comp Neurol 2013; 521 (15) 3371-88.
- 41 Simmons AN, Paulus MP, Thorp SR, Matthews SC, Norman SB, Stein MB. Functional activation and neural networks in women with posttraumatic stress disorder related to intimate partner violence. Biol Psychiatry 2008; 64 (08) 681-90.
- 42 Strigo IA, Simmons AN, Matthews SC, Grimes EM, Allard CB, Reinhardt LE. et al. Neural correlates of altered pain response in women with posttraumatic stress disorder from intimate partner violence. Biol Psychiatry 2010; 68 (05) 442-50.
- 43 Aupperle RL, Allard CB, Grimes EM, Simmons AN, Flagan T, Behrooznia M. et al. Dorsolateral prefrontal cortex activation during emotional anticipation and neuropsychological performance in posttraumatic stress disorder. Archives of general psychiatry 2012; 69 (04) 360-71.
- 44 Etkin A, Wager TD. Functional neuroimaging of anxiety: a meta-analysis of emotional processing in PTSD, social anxiety disorder, and specific phobia. The American journal of psychiatry 2007; 164 (10) 1476-88.
- 45 Cisler JM, Sigel BA, Kramer TL, Smitherman S, Vanderzee K, Pemberton J. et al. Modes of largescale brain network organization during threat processing and posttraumatic stress disorder symptom reduction during TF-CBT among adolescent girls. Plos one 2016; 11 (08) 1-16.
- 46 LaBar KS, Gatenby JC, Gore JC, LeDoux JE, Phelps EA. Human amygdala activation during conditioned fear acquisition and extinction: a mixed-trial fMRI study. Neuron 1998; 20 (05) 937-45.
- 47 Barad M, Gean PW, Lutz B. The role of the amygdala in the extinction of conditioned fear. Biol Psychiatry 2006; 60 (04) 322-8.
- 48 Koenigs M, Grafman J. Posttraumatic stress disorder: the role of medial prefrontal cortex and amygdala. The Neuroscientist 2009; 15 (05) 540-8.
- 49 Milad MR, Pitman RK, Ellis CB, Gold AL, Shin LM, Lasko NB. et al. Neurobiological basis of failure to recall extinction memory in posttraumatic stress disorder. Biol Psychiatry 2009; 66 (12) 1075-82.
- 50 Pitman RK, Rasmusson AM, Koenen KC, Shin LM, Orr SP, Gilbertson MW. et al. Biological studies of post-traumatic stress disorder. Nat Rev Neurosci 2012; 13 (11) 769-87.
- 51 McLaughlin KA, Busso DS, Duys A, Green JG, Alves S, Way M. et al. Amygdala response to negative stimuli predicts PTSD symptom onset following a terrorist attack. Depress Anxiety 2014; 31 (10) 834-42.
- 52 Bremner JD, Randall P, Scott TM, Bronen RA, Seibyl JP, Southwick SM. et al. MRI-based measurement of hippocampal volume in patients with combat-related posttraumatic stress disorder. The American journal of psychiatry 1995; 152 (07) 973-81.
- 53 Gurvits TV, Shenton ME, Hokama H, Ohta H, Lasko NB, Gilbertson MW. et al. Magnetic resonance imaging study of hippocampal volume in chronic, combat-related posttraumatic stress disorder. Biol Psychiatry 1996; 40 (11) 1091-9.
- 54 Bremner JD, Randall P, Vermetten E, Staib L, Bronen RA, Mazure C. et al. Magnetic resonance imaging-based measurement of hippocampal volume in posttraumatic stress disorder related to childhood physical and sexual abuse – a preliminary report. Biol Psychiatry 1997; 41 (01) 23-32.
- 55 Stein MB, Koverola C, Hanna C, Torchia MG, McClarty B. Hippocampal volume in women victimized by childhood sexual abuse. Psychological medicine 1997; 27 (04) 951-9.
- 56 Fuchs E, Gould E. Mini-review: in vivo neurogenesis in the adult brain: regulation and functional implications. The European journal of neuroscience 2000; 12 (07) 2211-4.
- 57 Shin LM, Liberzon I. The neurocircuitry of fear, stress, and anxiety disorders. Neuropsychopharmacology 2010; 35 (01) 169-91.
- 58 Bremner JD, Vythilingam M, Vermetten E, Southwick SM, McGlashan T, Nazeer A. et al. MRI and PET study of deficits in hippocampal structure and function in women with childhood sexual abuse and posttraumatic stress disorder. The American journal of psychiatry 2003; 160 (05) 924-32.
- 59 Behrens TE, Hunt LT, Woolrich MW, Rushworth MF. Associative learning of social value. Nature 2008; 456 (7219): 245-9.
- 60 Beckmann M, Johansen-Berg H, Rushworth MF. Connectivity-based parcellation of human cingulate cortex and its relation to functional specialization. J Neurosci 2009; 29 (04) 1175-90.
- 61 Shin LM, Rauch SL, Pitman RK. Amygdala, medial prefrontal cortex, and hippocampal function in PTSD. Ann N Y Acad Sci 2006; 1071: 67-79.
- 62 Rauch SL, Shin LM, Segal E, Pitman RK, Carson MA, McMullin K. et al. Selectively reduced regional cortical volumes in post-traumatic stress disorder. Neuroreport 2003; 14 (07) 913-6.
- 63 Kasai K, Yamasue H, Gilbertson MW, Shenton ME, Rauch SL, Pitman RK. Evidence for acquired pregenual anterior cingulate gray matter loss from a twin study of combat-related posttraumatic stress disorder. Biol Psychiatry 2008; 63 (06) 550-6.