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Treatment effects on insular and anterior cingulate cortex activation during classic and emotional Stroop interference in child abuse-related complex post-traumatic stress disorder

Published online by Cambridge University Press:  22 March 2012

K. Thomaes ,
E. Dorrepaal ,
N. Draijer ,
M. B. de Ruiter ,
B. M. Elzinga ,
A. J. van Balkom ,
J. H. Smit  and
D. J. Veltman
K. Thomaes*
Affiliation:
GGZ InGeest/Department of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands Neuroscience Campus, Amsterdam, The Netherlands
E. Dorrepaal
Affiliation:
GGZ InGeest/Department of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands EMGO Institute, VU University Medical Center, Amsterdam, The Netherlands PsyQ, ParnassiaBavogroep, Den Haag, The Netherlands
N. Draijer
Affiliation:
GGZ InGeest/Department of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands EMGO Institute, VU University Medical Center, Amsterdam, The Netherlands
M. B. de Ruiter
Affiliation:
AMC Academic Psychiatric Center, AIAR, Amsterdam, The Netherlands
B. M. Elzinga
Affiliation:
Department of Clinical and Health Psychology, Leiden University, Leiden, The Netherlands
A. J. van Balkom
Affiliation:
GGZ InGeest/Department of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands EMGO Institute, VU University Medical Center, Amsterdam, The Netherlands
J. H. Smit
Affiliation:
GGZ InGeest/Department of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands Neuroscience Campus, Amsterdam, The Netherlands
D. J. Veltman
Affiliation:
GGZ InGeest/Department of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands Neuroscience Campus, Amsterdam, The Netherlands AMC Academic Psychiatric Center, AIAR, Amsterdam, The Netherlands
*
*Address for correspondence: K. Thomaes, M.D., GGZ InGeest, A. J. Ernststraat 1187, 1081 HL Amsterdam, The Netherlands. (Email: k.thomaes@vumc.nl).
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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.

Method

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.

Keywords

Child abusecognitive behavioural treatmentcomplex post-traumatic stress disorderfunctional MRIStroop task.
Type
Original Articles
Information
Psychological Medicine , Volume 42 , Issue 11 , November 2012 , pp. 2337 - 2349
Copyright
Copyright © Cambridge University Press 2012

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