title: Treatment effects on insular and anterior cingulate cortex activation during classic and emotional Stroop interference in child abuse-related complex post-traumatic stress disorder.
abstract: BACKGROUND
  Functional neuroimaging studies have shown increased Stroop interference coupled with altered anterior cingulate cortex (ACC) and insula activation in post-traumatic stress disorder (PTSD). These brain areas are associated with error detection and emotional arousal. There is some evidence that treatment can normalize these activation patterns.
  
  
  METHODS
  At baseline, we compared classic and emotional Stroop performance and blood oxygenation level-dependent responses (functional magnetic resonance imaging) of 29 child abuse-related complex PTSD patients with 22 non-trauma-exposed healthy controls. In 16 of these patients, we studied treatment effects of psycho-educational and cognitive behavioural stabilizing group treatment (experimental treatment; EXP) added to treatment as usual (TAU) versus TAU only, and correlations with clinical improvement.
  
  
  RESULTS
  At baseline, complex PTSD patients showed a trend for increased left anterior insula and dorsal ACC activation in the classic Stroop task. Only EXP patients showed decreased dorsal ACC and left anterior insula activation after treatment. In the emotional Stroop contrasts, clinical improvement was associated with decreased dorsal ACC activation and decreased left anterior insula activation.
  
  
  CONCLUSIONS
  We found further evidence that successful treatment in child abuse-related complex PTSD is associated with functional changes in the ACC and insula, which may be due to improved selective attention and lower emotional arousal, indicating greater cognitive control over PTSD symptoms.
authors.affiliation: GGZ InGeest/Department of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: K
authors.initials: K
authors.lastname: Thomaes
authors.affiliation: GGZ InGeest/Department of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: E
authors.initials: E
authors.lastname: Dorrepaal
authors.affiliation: GGZ InGeest/Department of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: N
authors.initials: N
authors.lastname: Draijer
authors.affiliation: AMC Academic Psychiatric Center, AIAR, Amsterdam, The Netherlands.
authors.forename: M B
authors.initials: MB
authors.lastname: de Ruiter
authors.affiliation: Department of Clinical and Health Psychology, Leiden University, Leiden, The Netherlands.
authors.forename: B M
authors.initials: BM
authors.lastname: Elzinga
authors.affiliation: GGZ InGeest/Department of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: A J
authors.initials: AJ
authors.lastname: van Balkom
authors.affiliation: GGZ InGeest/Department of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: J H
authors.initials: JH
authors.lastname: Smit
authors.affiliation: GGZ InGeest/Department of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: D J
authors.initials: DJ
authors.lastname: Veltman
mesh_terms: D000328:Adult; D002540:Cerebral Cortex / Q000503:physiopathology*; D002648:Child; D002649:Child Abuse / Q000523:psychology / Q000534:rehabilitation; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D004644:Emotions / Q000502:physiology*; D056344:Executive Function / Q000502:physiology*; D005260:Female; D006179:Gyrus Cinguli / Q000503:physiopathology; D006801:Humans; D013313:Stress Disorders, Post-Traumatic / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D057190:Stroop Test; D016896:Treatment Outcome