Post-Traumatic Stress Disorder and Trauma-Focused Psychotherapy
Even though Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) is one of the preliminary treatment methods used frequently for Post-Traumatic Stress Disorder (PTSD), nearly half of the patients do not respond to the treatment. It is of importance to understand the neurobiological mechanisms of the Trauma-Focused Cognitive Behavioral Therapy in order to comprehend why some patients do not respond to the treatment.
- Having experienced destructive incidents, such as death, heavy injuries, or sexual assault;
- Recurring memories, dreams, physiological reactions after the incident;
- Avoidance of the reminders of the incident;
- Negative changes in mood (fear, horror, anger, guilt, shame), and in perception;
- Improper reactions to incidents (being extremely sensitive or unresponsive).
The aforementioned symptoms are associated with Post-Traumatic Stress Disorder (DSM-5).
Studies on functional magnetic resonance imaging (fMRI) have shed light on some of the neurobiological predictors of this treatment. In a study, attempts were made to determine the neural connectomic signs as a result of a Trauma-Focused Cognitive Behavioral Therapy. During the study, 36 Post-Traumatic Stress Disorder patients, and 36 healthy individuals were subjected to fMRI prior to the Trauma-Focused Cognitive Behavioral Therapy. Subsequently, nine sessions of Trauma-Focused Cognitive Behavioral Therapy, and clinical follow-up MRIs were administered on the patients.
As a result of the study, the effectiveness of the treatment was found to be associated with the pre-treatment connectivity in the cingulo-opercular, random mood, and dorsal attention-frontoparietal administrator control brain networks. Those who did not respond to the treatment, had significantly more connectivity prior to the treatment, compared to healthy individuals.
This provides an evidence regarding the fact that a positive response to the Trauma-Focused Cognitive Behavioral Therapy for Post-Traumatic Stress Disorder can be characterized by the connectivity that is associated with the vigilance, self-awareness, and cognitive control in the functional architecture of the brain. Trauma-Focused Cognitive Behavioral Therapy is shown to be increasing the amygdala and hippocampal connectivity through the orbitofrontal and medial prefrontal cerebral cortices. This increase has been associated with the improved capacity and the augmented memory skills for the prevention and reassessment of a threat.
In brief, a connectivity that is lower than the normal levels within the cerebral networks that are associated with vigilance, self-awareness, and cognitive control, can function as a key mechanism for responding to Trauma-Focused Cognitive Behavioral Therapy. Trauma-Focused Cognitive Behavioral Therapy aims to normalize the cerebral connectivity architecture of the patients.
REFERENCES:
Korgaonkar, MS, Chakouch, C., Breukelaar, IA ve diğerleri. Travma sonrası stres bozukluğunda travma odaklı psikoterapiye verilen yanıtın altında yatan içsel bağlar. Transl Psikiyatri 10, 270 (2020). https://doi.org/10.1038/s41398-020-00938-8
