Trajectories of Neuroanatomical Change During Psychotherapy for Youth with PTSD

Garrett A.S., Cohen J.A., Armenta B., Zhang W., Nawrocik A., Belford A., Rodriguez G., Cross J., Fields K., Blount T. Trajectories of Neuroanatomical Change During Psychotherapy for Youth with PTSD. Biological Psychiatry. 2024; 95(10):S93.

Topic: Neuroimaging

Abstract

Background: Examining neural changes occurring during successful treatment will facilitate understanding of the mechanisms of symptom improvement. This study adds novel information by investigating the temporal sequence of neural changes predicting treatment outcomes.

Methods: Adolescent patients (mean age=14.7, 82% female) with symptoms of posttraumatic stress, received 20 weeks of psychotherapy, with an MRI scan of brain anatomy collected at 4 timepoints. A total of 148 T1 weighted anatomical images from 37 patients were processed with Freesurfer to extract 87 measures (per patient) of cortical thickness or volume. Individual subject changes per region were calculated for 3 intervals of therapy (IOT). Optimal scaling regression with LASSO regularization was used to predict symptom improvement from anatomical changes across treatment. The selected predictors were submitted to partial correlation analysis to examine structural covariance.

Results: A model including five brain changes significantly predicted symptom improvement (adjusted Rsquare=.73, p=.001). In temporal order, these included increases in pallidum volume and decreases in orbital frontal cortex (OFC) thickness during the first IOT, followed by decreases in posterior cingulate thickness during the second IOT, and decreases in OFC and inferior frontal thickness during the third IOT. Structural covariance did not change significantly between IOTs. Average symptom improvement was 48%.

Conclusions: Successful therapy requires a series of neural changes, with frontal cortex changes required both early and late in treatment, and posterior cingulate changes required during the mid-point of treatment. Decreases in cortical thickness are consistent with developmental processes as well as correlates of symptom improvement in previous studies.