Changes in Brain Volume Associated with Trauma‐Focused Cognitive Behavioral Therapy Among Youth with Posttraumatic Stress Disorder

Journal of Traumatic Stress, vol. 34, pp. 744–756

Abstract

Abstract This study investigated group differences and longitudinal changes in brain volume before and after trauma‐focused cognitive behavioral therapy (TF‐CBT) in 20 unmedicated youth with maltreatment‐related posttraumatic stress disorder (PTSD) and 20 non–trauma‐exposed healthy control (HC) participants. We collected MRI scans of brain anatomy before and after 5 months of TF‐CBT or the same time interval for the HC group. FreeSurfer software was used to segment brain images into 95 cortical and subcortical volumes, which were submitted to optimal scaling regression with lasso variable selection. The resulting model of group differences at baseline included larger right medial orbital frontal and left posterior cingulate corticies and smaller right midcingulate and right precuneus corticies in the PTSD relative to the HC group, R2 = .67. The model of group differences in pre‐ to posttreatment change included greater longitudinal changes in right rostral middle frontal, left pars triangularis, right entorhinal, and left cuneus corticies in the PTSD relative to the HC group, R2 = .69. Within the PTSD group, pre‐ to posttreatment symptom improvement was modeled by longitudinal decreases in the left posterior cingulate cortex, R2 = .45, and predicted by baseline measures of a smaller right isthmus (retrosplenial) cingulate and larger left caudate, R2 = .77. In sum, treatment was associated with longitudinal changes in brain regions that support executive functioning but not those that discriminated PTSD from HC participants at baseline. Additionally, results confirm a role for the posterior/retrosplenial cingulate as a correlate of PTSD symptom improvement and predictor of treatment outcome.

Authors 12

1. Amy S. Garrett corresponding

   The University of Texas at San Antonio Health Science Center

   Affiliation as printed

   Department of Psychiatry & Behavioral Sciences University of Texas Health Science Center San Antonio Texas USA

   Research Imaging Institute, University of Texas Health Science Center San Antonio Texas USA

   Department of Psychiatry & Behavioral Sciences, University of Texas Health Science Center, San Antonio, Texas, USA

   Research Imaging Institute, University of Texas Health Science Center, San Antonio, Texas, USA

2. Leen Abazid

   The University of Texas at San Antonio Health Science Center

   Affiliation as printed

   Research Imaging Institute, University of Texas Health Science Center San Antonio Texas USA

   Research Imaging Institute, University of Texas Health Science Center, San Antonio, Texas, USA

3. Judith Ann Cohen

   Allegheny Health Network · Drexel University

   Affiliation as printed

   Department of Psychiatry Drexel University College of Medicine, Allegheny Health Network Pittsburg Pennsylvania USA

   Department of Psychiatry, Drexel University College of Medicine, Allegheny Health Network, Pittsburg, Pennsylvania, USA

4. Anita J. van der Kooij Aachen Institute of Psychology Division of Methodology and Statistics

   Leiden University

   Affiliation as printed

   Institute of Psychology, Division of Methodology and Statistics, University of Leiden Leiden The Netherlands

   Institute of Psychology, Division of Methodology and Statistics, University of Leiden, Leiden, The Netherlands

5. Victor G. Carrión

   Stanford Medicine · Stanford University

   Affiliation as printed

   Department of Psychiatry & Behavioral Sciences Stanford University School of Medicine Stanford California USA

   Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, California, USA

6. Wei Zhang

   The University of Texas at San Antonio Health Science Center

   Affiliation as printed

   Research Imaging Institute, University of Texas Health Science Center San Antonio Texas USA

   Research Imaging Institute, University of Texas Health Science Center, San Antonio, Texas, USA

7. Booil Jo

   Stanford Medicine · Stanford University

   Affiliation as printed

   Department of Psychiatry & Behavioral Sciences Stanford University School of Medicine Stanford California USA

   Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, California, USA

8. Crystal G. Franklin

   The University of Texas at San Antonio Health Science Center

   Affiliation as printed

   Research Imaging Institute, University of Texas Health Science Center San Antonio Texas USA

   Research Imaging Institute, University of Texas Health Science Center, San Antonio, Texas, USA

9. Joseph C. Blader

   The University of Texas at San Antonio Health Science Center

   Affiliation as printed

   Department of Psychiatry & Behavioral Sciences University of Texas Health Science Center San Antonio Texas USA

   Department of Psychiatry & Behavioral Sciences, University of Texas Health Science Center, San Antonio, Texas, USA

10. Sanno Zack

    Stanford Medicine · Stanford University

    Affiliation as printed

    Department of Psychiatry & Behavioral Sciences Stanford University School of Medicine Stanford California USA

    Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, California, USA

11. Allan L. Reiss

    Stanford Medicine · Stanford University

    Affiliation as printed

    Department of Psychiatry & Behavioral Sciences Stanford University School of Medicine Stanford California USA

    Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, California, USA

12. W. Stewart Agras

    Stanford Medicine · Stanford University

    Affiliation as printed

    Department of Psychiatry & Behavioral Sciences Stanford University School of Medicine Stanford California USA

    Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, California, USA