title: Changes in functional connectivity of the amygdala during cognitive reappraisal predict symptom reduction during trauma-focused cognitive-behavioral therapy among adolescent girls with post-traumatic stress disorder.
abstract: While trauma-focused cognitive-behavioral therapy (TF-CBT) is the 'gold standard' treatment for pediatric post-traumatic stress disorder (PTSD), little is known about the neural mechanisms by which TF-CBT produces clinical benefit. Here, we test the hypothesis that PTSD symptom reduction during TF-CBT among adolescent girls with PTSD is associated with changes in patterns of brain functional connectivity (FC) with the amygdala during cognitive reappraisal.
  
  
  
  Adolescent girls with PTSD related to physical or sexual assault (n = 34) were enrolled in TF-CBT, delivered in an approximately 12-session format, in an open trial. Before and after treatment, they were engaged in a cognitive reappraisal task, probing neural mechanisms of explicit emotion regulation, during 3 T functional magnetic resonance imaging.
  
  
  
  Among adolescent girls completing TF-CBT with usable pre- and post-treatment scans (n = 20), improvements in self-reported emotion from pre- to post-treatment were positively related to improvements in PTSD symptoms. Adolescent girls with greater post-treatment symptom reduction were also able to suppress amygdala-insula FC while re-appraising, which was not evident in girls with less symptom reduction. Pre- to post-treatment changes in right amygdala to left insula FC that scaled with PTSD symptom reduction also scaled with improvements in emotion regulation.
  
  
  
  These preliminary results suggest the neurocircuitry mechanisms through which TF-CBT produces clinical outcomes, providing putative brain targets for augmenting TF-CBT response.
authors.affiliation: Department of Psychiatry,Brain Imaging Research Center,University of Arkansas for Medical Sciences,Little Rock, AR,USA.
authors.forename: J M
authors.initials: JM
authors.lastname: Cisler
authors.affiliation: Department of Psychiatry,Brain Imaging Research Center,University of Arkansas for Medical Sciences,Little Rock, AR,USA.
authors.forename: B A
authors.initials: BA
authors.lastname: Sigel
authors.affiliation: Department of Psychiatry,Brain Imaging Research Center,University of Arkansas for Medical Sciences,Little Rock, AR,USA.
authors.forename: J S
authors.initials: JS
authors.lastname: Steele
authors.affiliation: Department of Psychiatry,Brain Imaging Research Center,University of Arkansas for Medical Sciences,Little Rock, AR,USA.
authors.forename: S
authors.initials: S
authors.lastname: Smitherman
authors.affiliation: Department of Psychiatry,Brain Imaging Research Center,University of Arkansas for Medical Sciences,Little Rock, AR,USA.
authors.forename: K
authors.initials: K
authors.lastname: Vanderzee
authors.affiliation: Department of Psychiatry,Brain Imaging Research Center,University of Arkansas for Medical Sciences,Little Rock, AR,USA.
authors.forename: J
authors.initials: J
authors.lastname: Pemberton
authors.affiliation: Department of Psychiatry,Brain Imaging Research Center,University of Arkansas for Medical Sciences,Little Rock, AR,USA.
authors.forename: T L
authors.initials: TL
authors.lastname: Kramer
authors.affiliation: Department of Psychiatry,Brain Imaging Research Center,University of Arkansas for Medical Sciences,Little Rock, AR,USA.
authors.forename: C D
authors.initials: CD
authors.lastname: Kilts
mesh_terms: D000293:Adolescent; D000679:Amygdala / Q000000981:diagnostic imaging / Q000503:physiopathology*; D002540:Cerebral Cortex / Q000000981:diagnostic imaging / Q000503:physiopathology*; D002648:Child; D002649:Child Abuse; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D005260:Female; D059907:Functional Neuroimaging / Q000379:methods*; D006801:Humans; D008279:Magnetic Resonance Imaging; D017063:Outcome Assessment, Health Care; D011379:Prognosis; D013313:Stress Disorders, Post-Traumatic / Q000628:therapy*
keywords: Adolescence; cognitive–behavioral therapy; neuroimaging; post-traumatic stress disorder