Table 3.
gives information on the reviewed studies analyzing morphological alterations following treatment. Only results and sample of subjects are mentioned who completed treatment and the second MRI scan. Only significant results (p<0.05) are reported
|
Morphological analyses | |||||||||
| Study | Sample size (n) of (R=remitted) patients, number of male subjects, and type of trauma event | Sample size (n) and type of control subjects |
Pre-CAPS scores Mean (and SD) of total CAPS scores |
Post-CAPS scores Mean (and SD) of total scores |
Psychotropic medication in patient group (in subsample size or in percent) | Type & duration of treatment | Type of paradigm within (f)MRI scans | Neuronal alterations from pre- to post-treatment |
Correlation analysis between symptom improvement (reduction in CAPS scores) & neuronal changes ↑ means pos. correlation ↓ means neg. correlation |
| Levy-Gigi et al. (2013) | 39 (9 male) mainly environmental disaster, accident, violent crime |
H-Res=31 (11 male) |
62.4 (12.8) | 40.4 (20.3) | Benzodiazepine: 16 (< 4 weeks) no antidepressants |
CBT 12 weekly 1.5-hour sessions |
Volume change | Group-by-time interaction (Tukey’s HSD): PTSD patients (not in controls): ↑ hippocampal volumes at the second assessment relative to the first (p<.05) |
↑ total hippocampal volume (r=.52, p<.005) |
| Van Rooij et al. (2015b) | R=22 (all male) veterans |
Non-R=22 H-Res=23 H=25 |
R: 66.5 (12.3) Non-R: 76.3 (12.5) |
R: 25.0 (14.2) Non-R: 66.4 (15.2) |
R (Pre/Post): SSRI/SARI: 4/4 Benzodiazepine: 6/6 Antipsychotics/other: 3/1 Non-R (Pre/Post): SSRI/SARI: 9/13 Benzodiazepine: 4/2 Antipsychotics/other: 2/3 |
Trauma-focused CBT and/or EMDR mean session R: 9.2 (SD:6.5) Non-R: 10.0 (4.6) |
Volume change | No sign. time-by-group interaction effect. | No correlations with change in hippocampal volume. |
| Rubin et al., (2016) | R=23 (22% male) mainly accident, sexual/physical assault, natural disaster |
Non-R=17 H-Res=36 |
R: 81.3 (16.4) Non-R: 81.0 (14.5) |
R: 23.0 (20.4) Non-R: 68.0 (10.8) |
No medication usagee four weeks prior to participation | PE 10 weeks |
Volume change | No sign. time-by-group interaction effect. | |
| Laugharne et al. (2016) | EMDR=10 PE=10 (6 males) mainly adult sexual assault, witnessing death/injury |
(both treatment groups) | EMDR: 87.60 (20.92) PE: 80.70 (18.50) |
EMDR: 28.40 (27.85) PE: 22.30 (19.17) |
PE/EMDR: No psychotropic medication: 4/3 Antidepressant: 6/6 Benzodiazepine: 1/0. Antipsychotics: 0/3 |
EMDR or PE Twice-weekly for 12 sessions |
Volume change | Time-by-side-by-treatment interaction: after EMDR: ↑ left amygdala volume (p<.04) |
|
| Helpman et al. (2016b) | R=11 (2 males) mainly accidents, sexual/physical assault, witnessing death/injury |
H-Res=25 Non-R=14 |
R + Non-R: Total: 80.63 (15.58) |
R: <20 | Exclusion criteria: use of any psychotropic medication 4 weeks prior to participation (6 weeks for fluoxetine) | PE 10 weeks |
Volume change | Time-by-remission status-interaction effect: R (vs. Non-R): ↓ volume reduction & cortical thinning in left rACC |
|
| Bossini et al. (2017) | 19 (10 male) mainly assault/robbery, sudden death of a family member, terrorist attack |
H=19 | 75.8 (21.8) | 19.3 (15.5) | No medication | EMDR 12 sessions over 3 months |
Volume change | Group-by-time interaction for grey matter volume: Patients after treatment (vs. H): ↑ left parahippocampal gyrus (F(1,35)=11.237; p=.001, k=246), ↓ left thalamus (F(1,35)=9.432; p=.002, k=168) |
|
| Kennis et al. (2015) | R=16 (all male) veterans |
Non-R=23 H-Res=22 |
R: 63.25 (10.55) Non-R: 73.00 (14.37) |
R: 22.56 (14.63) Non-R: 58.91 (15.75) |
R (Pre/Post): SSRI/SARI: 4/3 Benzodiazepine: 5/3 Antipsychotics/other: 2/0 Non-R (Pre/Post): SSRI/SARI: 5/7 Benzodiazepine: 4/1 Antipsychotics/other: 2/4 |
Trauma-focused CBT with exposure and/or EMDR R/Non-R (mean): 9.33/9.35 |
White matter alteration using DTI (FA) | Tract-Based Analyses: Group-by-time interaction: Non-R: ↑ FA of left dorsal cingulum (p=.026) compared to R and H-Res → FA increase over treatment in Non-R Whole-brain analyses: Group-by-time interaction: R: ↓ FA H-Res: ↑ FA in two clusters: left posterior corona radiate (k=218, p=.004) superior longitudinal fasciculus (k=16, p=.049) ROIs: dorsal and hippocampal cingulum bundle, stria terminalis, fornix |
Voxel-wise analysis: posterior corona radiata (change in FA correlated with change in CAPS, Pearson’s r=.451, p=.004) |
Abbreviations: ACC=anterior cingulate cortex, CAPS=Clinician-Administered PTSD Scale for DSM-IV, CBT=Cognitive Behavioral Therapy, DTI=diffusion tensor imaging, EMDR=Eye Movement Desensitization and Reprocessing, FA=fractional anisotropy, H=healthy, trauma-unexposed subjects (without traumatic event in the past), H-Res=healthy, resilient controls (healthy, trauma-exposed subjects), k=cluster size, Non-R=non-responder, mPFC=medial prefrontal cortex, PE=Prolonged exposure therapy, R=responder, rACC=rostral ACC, ROI=region of interest, SD=standard deviation, ↑=significant increase (of morphological alteration) in mentioned region, ↓=decrease in mentioned region.