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Effects of psychotherapy on regional cerebral blood flow during trauma imagery in patients with post-traumatic stress disorder: a randomized clinical trial

Published online by Cambridge University Press:  06 September 2007

R. J. L. Lindauer ,
J. Booij ,
J. B. A. Habraken ,
E. P. M. van Meijel ,
H. B. M. Uylings ,
M. Olff ,
I. V. E. Carlier ,
G. J. den Heeten ,
B. L. F. van Eck-Smit  and
B. P. R. Gersons
R. J. L. Lindauer*
Affiliation:
Centre for Psychological Trauma, Department of Psychiatry, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands De Bascule and Department of Child and Adolescent Psychiatry, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands Graduate School of Neurosciences, Amsterdam, The Netherlands
J. Booij
Affiliation:
Department of Nuclear Medicine, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
J. B. A. Habraken
Affiliation:
Department of Nuclear Medicine, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
E. P. M. van Meijel
Affiliation:
Centre for Psychological Trauma, Department of Psychiatry, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands De Bascule and Department of Child and Adolescent Psychiatry, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
H. B. M. Uylings
Affiliation:
Netherlands Institute for Neuroscience, Netherlands Institute for Neuroscience, Amsterdam, The Netherlands Royal Netherlands Academy of Arts and Sciences, Amsterdam, The Netherlands Department of Anatomy, VU Medical Centre, Amsterdam, The Netherlands
M. Olff
Affiliation:
Centre for Psychological Trauma, Department of Psychiatry, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
I. V. E. Carlier
Affiliation:
Centre for Work-Related Mental Disorders, Altrecht Institute for Mental Health Care, Utrecht, The Netherlands
G. J. den Heeten
Affiliation:
Department of Radiology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
B. L. F. van Eck-Smit
Affiliation:
Department of Nuclear Medicine, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
B. P. R. Gersons
Affiliation:
Centre for Psychological Trauma, Department of Psychiatry, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
*
*Address for correspondence: Dr R. J. L. Lindauer, M.A., M.D., Ph.D., Academic Medical Centre, Department of Child and Adolescent Psychiatry, Meibergdreef 5, 1105 AZ Amsterdam, The Netherlands. (Email: R.J.Lindauer@amc.uva.nl)
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Abstract

Background

Functional brain-imaging studies in post-traumatic stress disorder (PTSD) have suggested functional alterations in temporal and prefrontal cortical regions. Effects of psychotherapy on these brain regions have not yet been examined.

Method

Twenty civilian PTSD out-patients and 15 traumatized control subjects were assessed at baseline using psychometric ratings. Cerebral blood flow was measured using trauma script-driven imagery during 99mtechnetium hexamethyl-propylene-amine-oxime single-photon emission computed tomography scanning. All 20 out-patients were randomly assigned to treatment or wait-list conditions. Treatment was brief eclectic psychotherapy (BEP) in 16 weekly individual sessions.

Results

At baseline, greater activation was found in the right insula and right superior/middle frontal gyrus in the PTSD group than in the control group. PTSD patients treated with BEP significantly improved on all PTSD symptom clusters compared to those on the waiting list. After effective psychotherapy, lower activation was measured in the right middle frontal gyrus, compared to the PTSD patients on the waiting list. Treatment effects on PTSD symptoms correlated positively with activation in the left superior temporal gyrus, and superior/middle frontal gyrus.

Conclusions

BEP induced clinical recovery in PTSD patients, and appeared to modulate the functioning of specific PTSD-related sites in the prefrontal cortical regions.

Keywords

Brain imagingpost-traumatic stress disorderpsychotherapyrandomized clinical trial
Type
Original Articles
Information
Psychological Medicine , Volume 38 , Issue 4 , April 2008 , pp. 543 - 554
Copyright
Copyright © Cambridge University Press 2007

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