Rostral anterior cingulate volume predicts treatment response to cognitive-behavioural therapy for posttraumatic stress disorder

Rostral anterior cingulate volume predicts treatment response to cognitive-behavioural therapy for posttraumatic stress disorder

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J Psychiatry Neurosci 2008;33(2):142-6

Richard A. Bryant, PhD; Kim Felmingham, PhD; Thomas J. Whitford, PhD; Andrew Kemp, PhD; Gerard Hughes, Dip MRS; Anthony Peduto, MB, BS; Leanne M. Williams, PhD

Bryant, Felmingham, Whitford, Kemp, Williams — Brain Dynamics Centre, Westmead Hospital; Bryant, Felmingham — School of Psychology, University of New South Wales; Hughes, Peduto — Department of Radiology, Westmead Hospital, Sydney, Australia

Abstract

Objective: To index the extent to which treatment response in posttraumatic stress disorder (PTSD) is predicted by rostral anterior cingulate cortex (rACC) volume.

Method: We used structural magnetic resonance imaging in a 1.5 T scanner to examine subjects with PTSD (n = 13), traumatized control subjects (n = 13) and nontraumatized control subjects (n = 13). Subjects with PTSD then participated in 8 sessions of cognitive-behavioural therapy, after which we reassessed them for PTSD.

Results: According to voxel-based morphometry, treatment responders had larger rACC volume than nonresponders. Further, symptom reduction was associated with larger rACC volume.

Conclusion: Consistent with evidence for the neural bases of extinction learning, PTSD patients with larger rACC volume may be better able to regulate fear during cognitive-behavioural therapy and thus achieve greater treatment gains.

Résumé

Objectif : Indexer la mesure dans laquelle la réponse au traitement du trouble du stress posttraumatique (TSPT) est prédite par le volume du cortex cingulaire antérieur rostral (CCAr).

Méthode : Nous avons utilisé l’imagerie par résonance magnétique structurelle dans un appareil de 1,5 T pour examiner des sujets atteints de TSPT (n = 13), des sujets témoins traumatisés (n = 13) et des sujets témoins non traumatisés (n = 13). Les sujets atteints de TSPT ont participé ensuite à huit séances de thérapie cognitivocomportementale à la suite desquelles nous avons réévalué leur TSPT.

Résultats : Selon la morphométrie voxel, les sujets qui ont répondu au traitement avaient un CCAr plus volumineux que ceux qui n’ont pas réagi. De plus, on a associé la réduction des symptômes à un CCAr plus volumineux.

Conclusion : Conformément aux données probantes relatives au fondements neuraux de l’apprentissage par extinction, les patients atteints de TSPT qui ont un CCAr plus volumineux sont peut-être mieux en mesure de contrôler la peur pendant une thérapie cognitivocomportementale et de tirer ainsi de plus grands avantages du traitement.


Medical subject headings: stress disorders, post-traumatic; magnetic resonance imaging; cognitive therapy.

Competing interests: None declared.

Submitted July 9, 2007; Revised Sept. 2, 2007; Oct. 1, 2007; Accepted Oct. 1, 2007

Contributors: Drs. Bryant, Felmingham and Williams designed the study. Drs. Bryant, Felmingham, Kemp and Williams, and Mr. Hughes and Mr. Peduto acquired the data, which Drs. Bryant, Felmingham, Kemp and Williams and Mr. Whitford analyzed. All authors participated in the writing of the article and Drs. Bryant, Felmingham, Kemp and Williams, and Mr. Whitford and Mr. Peduto revised it. All authors gave final approval for the article to be published.

Acknowledgements: This study was funded by an ARC Linkage Grant (LP0212048) and a NHMRC Program Grant (300304).

Correspondence to: Prof. R.A. Bryant, School of Psychology, University of New South Wales, Sydney, Australia NSW 2052; fax 61 2 93853641; r.bryant@unsw.edu.au