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Randomized Controlled Trial
. 2011 Dec 19:12:127.
doi: 10.1186/1471-2202-12-127.

Narrative exposure therapy for PTSD increases top-down processing of aversive stimuli--evidence from a randomized controlled treatment trial

Hannah Adenauer  1 , Claudia Catani, Hannah Gola, Julian Keil, Martina Ruf, Maggie Schauer, Frank Neuner
Affiliations
Randomized Controlled Trial

Narrative exposure therapy for PTSD increases top-down processing of aversive stimuli--evidence from a randomized controlled treatment trial

Hannah Adenauer et al. BMC Neurosci. .

Abstract

Background: Little is known about the neurobiological foundations of psychotherapy for Posttraumatic Stress Disorder (PTSD). Prior studies have shown that PTSD is associated with altered processing of threatening and aversive stimuli. It remains unclear whether this functional abnormality can be changed by psychotherapy. This is the first randomized controlled treatment trial that examines whether narrative exposure therapy (NET) causes changes in affective stimulus processing in patients with chronic PTSD.

Methods: 34 refugees with PTSD were randomly assigned to a NET group or to a waitlist control (WLC) group. At pre-test and at four-months follow-up, the diagnostics included the assessment of clinical variables and measurements of neuromagnetic oscillatory brain activity (steady-state visual evoked fields, ssVEF) resulting from exposure to aversive pictures compared to neutral pictures.

Results: PTSD as well as depressive symptom severity scores declined in the NET group, whereas symptoms persisted in the WLC group. Only in the NET group, parietal and occipital activity towards threatening pictures increased significantly after therapy.

Conclusions: Our results indicate that NET causes an increase of activity associated with cortical top-down regulation of attention towards aversive pictures. The increase of attention allocation to potential threat cues might allow treated patients to re-appraise the actual danger of the current situation and, thereby, reducing PTSD symptoms. REGISTRATION OF THE CLINICAL TRIAL: Number: NCT00563888Name: "Change of Neural Network Indicators Through Narrative Treatment of PTSD in Torture Victims" ULR: http://www.clinicaltrials.gov/ct2/show/NCT00563888.

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Figures

Figure 1
Figure 1
Difference maps (PTSD minus healthy controls) of cortical activity following aversive (upper panel) and pleasant picture presentation (lower panel). The right panel indicates statistically significant brain regions revealed by permutation statistics. Cortical activity following neutral picture presentation was used for normalization. We found significantly reduced activity following aversive picture presentation in the left occipital cortex in PTSD patients compared to healthy controls. No differences of the cortical activation were found between healthy controls and PTSD subjects in following pleasant pictures.
Figure 2
Figure 2
Threat effect (cortical activation following aversive picture presentation) for all patients at pretest. Color bar indicates minimum norm source strength (left). Permutation statistics revealed no significant difference between the NET and the WLC group (right). Cortical activity following neutral picture presentation was used for normalization.
Figure 3
Figure 3
Threat effect (cortical activation following aversive picture presentation) group differences in pre to post treatment change. Color bar indicates minimum norm source strength (left). The circle marks significant interaction between the NET and WLC group and pre to post treatment time as indicated by permutation statistics (right). Cortical activity following neutral picture presentation was used for normalization.
Figure 4
Figure 4
Pre to post treatment time course of threat effect (cortical activation following aversive picture presentation) in parietal regions (left) and occipital regions (right) for NET and WLC patients. Ordinates indicate minimum norm source strength. Cortical activity following neutral picture presentation was used for normalization.
Figure 5
Figure 5
Pre to post treatment time effect for NET (left) and WLC (right) patients. Color bar indicates minimum norm source strength following aversive picture presentation. The circle marks significant difference between pre and post treatment time as indicated by permutation statistics. Cortical activity following neutral picture presentation was used for normalization.
Figure 6
Figure 6
Flowchart of study participants. NET indicates Narrative Exposure Therapy, WLC indicates waitlist control condition.
Figure 7
Figure 7
Four cycles of the 10 Hz steady state response of the 148 MEG channels for one representative participant.
See this image and copyright information in PMC

References

    1. Buckley TC, Blanchard EB, Neill WT. Information processing and PTSD: A review of the empirical literature. Clinical Psychology Review. 2000;20(8):1041–1065. doi: 10.1016/S0272-7358(99)00030-6. - DOI - PubMed
    1. Ehlers A, Clark DM. A cognitive model of posttraumatic stress disorder. Behav Res Ther. 2000;38(4):319–345. doi: 10.1016/S0005-7967(99)00123-0. - DOI - PubMed
    1. Koster EHW, Verschuere B, Crombez G, Van Damme S. Time-course of attention for threatening pictures in high and low trait anxiety. Behaviour Research and Therapy. 2005;43(8):1087–1098. doi: 10.1016/j.brat.2004.08.004. - DOI - PubMed
    1. Mogg K, Bradley BP, Miles F, Dixon R. Time course of attentional bias for threat scenes: Testing the vigilance-avoidance hypothesis. Cognition and emotion. 2004;18(5):689–700. doi: 10.1080/02699930341000158. - DOI
    1. Chen YP, Ehlers A, Clark DM, Mansell W. Patients with generalized social phobia direct their attention away from faces. Behaviour Research and Therapy. 2002;40(6):677–687. doi: 10.1016/S0005-7967(01)00086-9. - DOI - PubMed

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