title: Effects of psychotherapy on regional cerebral blood flow during trauma imagery in patients with post-traumatic stress disorder: a randomized clinical trial.
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.
  
  
  METHODS
  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.
authors.affiliation: Department of Psychiatry, Academic Medical Centre, Amsterdam, The Netherlands. R.J.Lindauer@amc.uva.nl
authors.forename: R J L
authors.initials: RJ
authors.lastname: Lindauer
authors.forename: J
authors.initials: J
authors.lastname: Booij
authors.forename: J B A
authors.initials: JB
authors.lastname: Habraken
authors.forename: E P M
authors.initials: EP
authors.lastname: van Meijel
authors.forename: H B M
authors.initials: HB
authors.lastname: Uylings
authors.forename: M
authors.initials: M
authors.lastname: Olff
authors.forename: I V E
authors.initials: IV
authors.lastname: Carlier
authors.forename: G J
authors.initials: GJ
authors.lastname: den Heeten
authors.forename: B L F
authors.initials: BL
authors.lastname: van Eck-Smit
authors.forename: B P R
authors.initials: BP
authors.lastname: Gersons
mesh_terms: D001931:Brain Mapping; D004292:Dominance, Cerebral / Q000502:physiology*; D005260:Female; D005625:Frontal Lobe / Q000098:blood supply* / Q000000981:diagnostic imaging; D006801:Humans; D007092:Imagination / Q000502:physiology*; D008297:Male; D011614:Psychotherapy, Brief; D012039:Regional Blood Flow / Q000502:physiology; D013313:Stress Disorders, Post-Traumatic / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000628:therapy*; D019690:Technetium Tc 99m Exametazime; D013702:Temporal Lobe / Q000098:blood supply* / Q000000981:diagnostic imaging; D015899:Tomography, Emission-Computed, Single-Photon