Psychotherapy Produces Biological Changes in Post-Traumatic Stress Disorder
May 25, 2013—A new study published in the Journal of Psychotherapy and Psychosomatics examines whether treatments for post-traumatic stress disorder (PTSD) produce measureable biological changes.
Trauma-focused cognitive-behavioral therapy (TF-CBT) and eye movement desensitization and reprocessing (EMDR) are effective treatments for posttraumatic stress disorder. However, little has been known about their neurobiological effects. The usefulness of neurobiological measures to predict the treatment outcome of psychotherapy has also been undetermined.
Researcher Jasper B. Zantvoord, of the Department of Child and Adolescent Psychiatry at Amsterdam's Academic Medical Centre, along with colleagues Julia Diehle and Ramón J. L. Lindauer undertook a systematic review of 23 publications reporting on 16 randomized controlled trials of trauma therapy. The chosen papers focused on neurobiological treatment effects of TF-CBT or EMDR and trials with neurobiological measures as predictors of treatment response. TF-CBT was compared with a waitlist in most trials.
The researchers found that TF-CBT is associated with a decrease in heart rate and blood pressure and changes in activity but not in volume of frontal brain structures and the amygdala. Neurobiological changes correlated with changes in symptom severity, they noted. EMDR was only tested against other active treatments in the reviewed trials. The researchers did not find a difference in neurobiological treatment effects between EMDR and other treatments.
Publications on neurobiological predictors of treatment response showed ambiguous results, they said. TF-CBT was associated with a reduction of physiological reactivity. The review found preliminary evidence that TF-CBT influences brain regions involved in fear conditioning, extinction learning and possibly working memory and attention regulation; however, the researchers write, these effects could be nonspecific psychotherapeutic effects.
Zantvoord, Diehle and Lindauer recommend that future trials should use paradigms aimed specifically at these brain regions and physiological reactivity, and raised concerns regarding the risk of bias in some of the RCTs, suggesting that methodologically more rigorous trials are required. "Trials with neurobiological measures as predictors of treatment outcome render insufficient results to be useful in clinical practice," they said.
ARTICLE:
Zantvoord J.B., Diehle J. , Lindauer R.J.L. "Using Neurobiological Measures to Predict and Assess Treatment Outcome of Psychotherapy in Posttraumatic Stress Disorder: Systematic Review." Psychotherapy and Psychosomatics 2013; 82:142-151.
What is EMDR?
From the EMDR Institute: "EMDR therapy is an eight-phase treatment. Eye movements (or other bilateral stimulation) are used during one part of the session. After the clinician has determined which memory to target first, he asks the client to hold different aspects of that event or thought in mind and to use his eyes to track the therapist's hand as it moves back and forth across the client's field of vision. As this happens, for reasons believed by a Harvard researcher to be connected with the biological mechanisms involved in Rapid Eye Movement (REM) sleep, internal associations arise and the clients begin to process the memory and disturbing feelings. In successful EMDR therapy, the meaning of painful events is transformed on an emotional level. For instance, a rape victim shifts from feeling horror and self-disgust to holding the firm belief that, "I survived it and I am strong." Unlike talk therapy, the insights clients gain in EMDR result not so much from clinician interpretation, but from the client’s own accelerated intellectual and emotional processes."
What is TF-CBT?
From SAMHSA's National Registry of Evidence-Based Programs and Practices (NREPP): "Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) is a psychosocial treatment model designed to treat posttraumatic stress and related emotional and behavioral problems in children and adolescents. Initially developed to address the psychological trauma associated with child sexual abuse, the model has been adapted for use with children who have a wide array of traumatic experiences, including domestic violence, traumatic loss, and the often multiple psychological traumas experienced by children prior to foster care placement. The treatment model is designed to be delivered by trained therapists who initially provide parallel individual sessions with children and their parents (or guardians), with conjoint parent-child sessions increasingly incorporated over the course of treatment. The acronym PRACTICE reflects the components of the treatment model: Psychoeducation and parenting skills, Relaxation skills, Affect expression and regulation skills, Cognitive coping skills and processing, Trauma narrative, In vivo exposure (when needed), Conjoint parent-child sessions, and Enhancing safety and future development. Although TF-CBT is generally delivered in 12-16 sessions of individual and parent-child therapy, it also may be provided in the context of a longer-term treatment process or in a group therapy format."
