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Anterior hippocampal volume predicts affect-focused psychotherapy outcome

  • Benjamin Suarez-Jimenez (a1), Xi Zhu (a1), Amit Lazarov (a1) (a2), J. John Mann (a1) (a3), Franklin Schneier (a1) (a3), Andrew Gerber (a1) (a4), Jacques P. Barber (a5) (a6), Dianne L. Chambless (a6), Yuval Neria (a1) (a2), Barbara Milrod (a7) and John C. Markowitz (a1) (a2)...

Abstract

Background

The hippocampus plays an important role in psychopathology and treatment outcome. While posterior hippocampus (PH) may be crucial for the learning process that exposure-based treatments require, affect-focused treatments might preferentially engage anterior hippocampus (AH). Previous studies have distinguished the different functions of these hippocampal sub-regions in memory, learning, and emotional processes, but not in treatment outcome. Examining two independent clinical trials, we hypothesized that anterior hippocampal volume would predict outcome of affect-focused treatment outcome [Interpersonal Psychotherapy (IPT); Panic-Focused Psychodynamic Psychotherapy (PFPP)], whereas posterior hippocampal volume would predict exposure-based treatment outcome [Prolonged Exposure (PE); Cognitive Behavioral Therapy (CBT); Applied Relaxation Training (ART)].

Methods

Thirty-five patients with posttraumatic stress disorder (PTSD) and 24 with panic disorder (PD) underwent structural magnetic resonance imaging (MRI) before randomization to affect-focused (IPT for PTSD; PFPP for PD) or exposure-based treatments (PE for PTSD; CBT or ART for PD). AH and PH volume were regressed with clinical outcome changes.

Results

Baseline whole hippocampal volume did not predict post-treatment clinical severity scores in any treatment. For affect-focused treatments, but not exposure-based treatments, anterior hippocampal volume predicted clinical improvement. Smaller AH correlated with greater affect-focused treatment improvement. Posterior hippocampal volume did not predict treatment outcome.

Conclusions

This is the first study to explore associations between hippocampal volume sub-regions and treatment outcome in PTSD and PD. Convergent results suggest that affect-focused treatment may influence the clinical outcome through the ‘limbic’ AH, whereas exposure-based treatments do not. These preliminary, theory-congruent, therapeutic findings require replication in a larger clinical trial.

Copyright

Corresponding author

Author for correspondence: John C. Markowitz, E-mail: jcm42@cumc.columbia.edu

Footnotes

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These authors contributed equally to this paper.

Footnotes

References

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Anterior hippocampal volume predicts affect-focused psychotherapy outcome

  • Benjamin Suarez-Jimenez (a1), Xi Zhu (a1), Amit Lazarov (a1) (a2), J. John Mann (a1) (a3), Franklin Schneier (a1) (a3), Andrew Gerber (a1) (a4), Jacques P. Barber (a5) (a6), Dianne L. Chambless (a6), Yuval Neria (a1) (a2), Barbara Milrod (a7) and John C. Markowitz (a1) (a2)...

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