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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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References

APA (2000). Diagnostic and Statistical Manual of Mental Disorders IV – Text Revision (DSM-IV-TR). American Psychiatric Press Incorporated: Washington, DC.Google Scholar
Arntz, A, van den Hoorn, M, Cornelis, J, Verheul, R, van den Bosch, WM, de Bie, AJ (2003). Reliability and validity of the borderline personality disorder severity index. Journal of Personality Disorder 17, 45–59.CrossRefGoogle ScholarPubMed
Bar-Haim, Y, Lamy, D, Pergamin, L, Bakermans-Kranenburg, MJ, Van IJzendoorn, MH (2007). Threat-related attentional bias in anxious and nonanxious individuals: a meta-analytic study. Psychological Bulletin 133, 1–24.CrossRefGoogle ScholarPubMed
Beck, AT, Steer, RA, Garbin, MG (1998). Psychometric properties of the Beck Depression Inventory. Clinical Psychology Review 42, 841–865.Google Scholar
Bernstein, EM, Putnam, FW (1986). Development, reliability, and validity of a dissociation scale. Journal of Nervous and Mental Disease 174, 727–735.CrossRefGoogle ScholarPubMed
Blake, DD, Weathers, FW, Nagy, LM, Kaloupek, DG, Gusman, FD, Charney, DS, Keane, TM (1995). The development of a clinician-administered PTSD scale. Journal of Traumatic Stress 8, 75–90.Google ScholarPubMed
Bremner, JD, Vermetten, E, Vythilingam, M, Afzal, N, Schmahl, C, Elzinga, B, Charney, DS (2004). Neural correlates of the classic color and emotional Stroop in women with abuse-related posttraumatic stress disorder. Biological Psychiatry 55, 612–620.CrossRefGoogle ScholarPubMed
Bryant, RA, Harvey, AG (1995). Processing threatening information in posttraumatic stress disorder. Journal of Abnormal Psychology 104, 537–541.CrossRefGoogle ScholarPubMed
Buckley, TC, Blanchard, EB, Neill, WT (2000). Information processing and PTSD: a review of the empirical literature. Clinical Psychology Review 20, 1041–1065.CrossRefGoogle ScholarPubMed
Carey, PD, Warwick, J, Niehaus, DJ, van der Linden, G, van Heerden, BB, Harvey, BH, Seedat, S, Stein, DJ (2004). Single photon emission computed tomography (SPECT) of anxiety disorders before and after treatment with citalopram. BMC Psychiatry 4, 30.CrossRefGoogle ScholarPubMed
Carter, CS, van Veen, V (2007). Anterior cingulate cortex and conflict detection: an update of theory and data. Cognitive, Affective, and Behavioral Neuroscience 7, 367–379.CrossRefGoogle ScholarPubMed
Cloitre, M, Koenen, KC, Cohen, LR, Han, H (2002). Skills training in affective and interpersonal regulation followed by exposure: a phase-based treatment for PTSD related to childhood abuse. Journal of Consulting and Clinical Psychology 70, 1067–1074.CrossRefGoogle ScholarPubMed
Cloitre, M, Stovall-McClough, KC, Nooner, K, Zorbas, P, Cherry, S, Jackson, CL, Gan, W, Petkova, E (2010). Treatment for PTSD related to childhood abuse: a randomized controlled trial. American Journal of Psychiatry 167, 915–924.CrossRefGoogle ScholarPubMed
Devineni, T, Blanchard, EB, Hickling, EJ, Buckley, TC (2004). Effect of psychological treatment on cognitive bias in motor vehicle accident-related posttraumatic stress disorder. Journal of Anxiety Disorders 18, 211–231.CrossRefGoogle ScholarPubMed
Dorrepaal, E, Thomaes, K, Smit, JH, van Balkom, AJ, Veltman, DJ, Hoogendoorn, AW, Draijer, N (in press). Stabilizing group treatment for complex posttraumatic stress disorder related to child abuse based on psychoeducation and cognitive behavioural therapy: a multisite randomized controlled trial. Psychotherapy and Psychosomatics.Google Scholar
Draijer, N, Langeland, W (1999). Childhood trauma and perceived parental dysfunction in the etiology of dissociative symptoms in psychiatric inpatients. American Journal of Psychiatry 156, 379–385.CrossRefGoogle ScholarPubMed
Eckert, MA, Menon, V, Walczak, A, Ahlstrom, J, Denslow, S, Horwitz, A, Dubno, JR (2009). At the heart of the ventral attention system: the right anterior insula. Human Brain Mapping 30, 2530–2541.CrossRefGoogle ScholarPubMed
Farrow, TF, Hunter, MD, Wilkinson, ID, Gouneea, C, Fawbert, D, Smith, R, Lee, KH, Mason, S, Spence, SA, Woodruff, PW (2005). Quantifiable change in functional brain response to empathic and forgivability judgments with resolution of posttraumatic stress disorder. Psychiatry Research 140, 45–53.CrossRefGoogle ScholarPubMed
Felmingham, K, Kemp, A, Williams, L, Das, P, Hughes, G, Peduto, A, Bryant, R (2007). Changes in anterior cingulate and amygdala after cognitive behavior therapy of posttraumatic stress disorder. Psychological Science 18, 127–129.CrossRefGoogle ScholarPubMed
Fernandez, M, Pissiota, A, Frans, O, von Knorring, L, Fischer, H, Fredrikson, M (2001). Brain function in a patient with torture related post-traumatic stress disorder before and after fluoxetine treatment: a positron emission tomography provocation study. Neuroscience Letters 297, 101–104.CrossRefGoogle Scholar
Field, NP, Classen, C, Butler, LD, Koopman, C, Zarcone, J, Spiegel, D (2001). Revictimization and information processing in women survivors of childhood sexual abuse. Journal of Anxiety Disorders 15, 459–469.CrossRefGoogle ScholarPubMed
First, MB, Spitzer, RL, Williams, JBW, Gibbon, M (1995). Structured Clinical Interview for DSM-IV Diagnoses (SCID-I). American Psychiatric Press: Washington, DC.Google Scholar
Foa, EB, Feske, U, Murdock, TB, Kozak, MJ, McCarthy, PR (1991). Processing of threat-related information in rape victims. Journal of Abnormal Psychology 100, 156–162.CrossRefGoogle ScholarPubMed
Foa, EB, Keane, TM, Friedman, MJ (2000). Effective Treatments for PTSD. Guilford Press: New York.Google Scholar
Ford, JD, Kidd, P (1998). Early childhood trauma and disorders of extreme stress as predictors of treatment outcome with chronic posttraumatic stress disorder. Journal of Traumatic Stress 11, 743–761.CrossRefGoogle ScholarPubMed
Herman, JL (1992). Complex PTSD: a syndrome in survivors of prolonged and repeated trauma. Journal of Traumatic Stress 5, 377–391.CrossRefGoogle Scholar
Hovens, JE, van der Ploeg, HM, Klaarenbeek, MT, Bramsen, I, Schreuder, JN, Rivero, VV (1994). The assessment of posttraumatic stress disorder: with the Clinician Administered PTSD Scale: Dutch results. Journal of Clinical Psychology 50, 325–340.3.0.CO;2-M>CrossRefGoogle ScholarPubMed
Kanagaratnam, P, Asbjornsen, AE (2007). Executive deficits in chronic PTSD related to political violence. Journal of Anxiety Disorders 21, 510–525.CrossRefGoogle ScholarPubMed
Kasai, K, Yamasue, H, Gilbertson, MW, Shenton, ME, Rauch, SL, Pitman, RK (2008). Evidence for acquired pregenual anterior cingulate gray matter loss from a twin study of combat-related posttraumatic stress disorder. Biological Psychiatry 63, 550–556.CrossRefGoogle ScholarPubMed
Kessler, RC, Davis, CG, Kendler, KS (1997). Childhood adversity and adult psychiatric disorder in the US National Comorbidity Survey. Psychological Medicine 27, 1101–1119.CrossRefGoogle ScholarPubMed
Kimble, MO, Frueh, BC, Marks, L (2009). Does the modified Stroop effect exist in PTSD? Evidence from dissertation abstracts and the peer reviewed literature. Journal of Anxiety Disorders 23, 650–655.CrossRefGoogle ScholarPubMed
Lanius, RA, Brewin, CR, Bremner, JD, Daniels, JK, Friedman, MJ, Liberzon, I, McFarlane, A, Schnurr, PP, Shin, L, Stein, M, Vermetten, E (2010). Does neuroimaging research examining the pathophysiology of posttraumatic stress disorder require medication-free patients? Journal of Psychiatry and Neuroscience 35, 80–89.CrossRefGoogle ScholarPubMed
Lansing, K, Amen, DG, Hanks, C, Rudy, L (2005). High-resolution brain SPECT imaging and eye movement desensitization and reprocessing in police officers with PTSD. Journal of Neuropsychiatry and Clinical Neurosciences 17, 526–532.CrossRefGoogle ScholarPubMed
Leung, HC, Skudlarski, P, Gatenby, JC, Peterson, BS, Gore, JC (2000). An event-related functional MRI study of the Stroop color word interference task. Cerebral Cortex 10, 552–560.CrossRefGoogle ScholarPubMed
Levin, P, Lazrove, S, van der Kolk, B (1999). What psychological testing and neuroimaging tell us about the treatment of posttraumatic stress disorder by eye movement desensitization and reprocessing. Journal of Anxiety Disorders 13, 159–172.CrossRefGoogle ScholarPubMed
Lindauer, RJ, Booij, J, Habraken, JB, van Meijel, EP, Uylings, HB, Olff, M, Carlier, IV, Den Heeten, GJ, van Eck-Smit, BL, Gersons, BP (2008). Effects of psychotherapy on regional cerebral blood flow during trauma imagery in patients with post-traumatic stress disorder: a randomized clinical trial. Psychological Medicine 38, 543–554.CrossRefGoogle ScholarPubMed
Litz, BT, Weathers, FW, Monaco, V, Herman, DS, Wulfsohn, M, Marx, B, Keane, TM (1996). Attention, arousal, and memory in posttraumatic stress disorder. Journal of Traumatic Stress 9, 497–519.CrossRefGoogle ScholarPubMed
McDonagh, A, Friedman, M, McHugo, G, Ford, J, Sengupta, A, Mueser, K, Demment, CC, Fournier, D, Schnurr, PP, Descamps, M (2005). Randomized trial of cognitive-behavioral therapy for chronic posttraumatic stress disorder in adult female survivors of childhood sexual abuse. Journal of Consulting and Clinical Psychology 73, 515–524.CrossRefGoogle ScholarPubMed
McNally, RJ, Kaspi, SP, Riemann, BC, Zeitlin, SB (1990). Selective processing of threat cues in posttraumatic stress disorder. Journal of Abnormal Psychology 99, 398–402.CrossRefGoogle ScholarPubMed
Molnar, BE, Buka, SL, Kessler, RC (2001). Child sexual abuse and subsequent psychopathology: results from the National Comorbidity Survey. American Journal of Public Health 91, 753–760.Google ScholarPubMed
Pardo, JV, Pardo, PJ, Janer, KW, Raichle, ME (1990). The anterior cingulate cortex mediates processing selection in the Stroop attentional conflict paradigm. Proceedings of the National Academy of Sciences USA 87, 256–259.CrossRefGoogle ScholarPubMed
Pelcovitz, D, van der Kolk, B, Roth, S, Mandel, F, Kaplan, S, Resick, P (1997). Development of a criteria set and a structured interview for disorders of extreme stress (SIDES). Journal of Traumatic Stress 10, 3–16.CrossRefGoogle Scholar
Peres, JF, Newberg, AB, Mercante, JP, Simao, M, Albuquerque, VE, Peres, MJ, Nasello, AG (2007). Cerebral blood flow changes during retrieval of traumatic memories before and after psychotherapy: a SPECT study. Psychological Medicine 37, 1481–1491.CrossRefGoogle ScholarPubMed
Pfohl, N, Blum, M, Zimmerman, M (1997). Structured Interview for DSM-IV Personality (SIDP-IV). American Psychiatric Press Incorporated: Washington, DC.Google Scholar
Phan, KL, Wager, T, Taylor, SF, Liberzon, I (2002). Functional neuroanatomy of emotion: a meta-analysis of emotion activation studies in PET and fMRI. Neuroimage 16, 331–348.CrossRefGoogle ScholarPubMed
Seedat, S, Warwick, J, van Heerden, B, Hugo, C, Zungu-Dirwayi, N, Van Kradenburg, J, Stein, DJ (2004). Single photon emission computed tomography in posttraumatic stress disorder before and after treatment with a selective serotonin reuptake inhibitor. Journal of Affective Disorders 80, 45–53.CrossRefGoogle ScholarPubMed
Shad, MU, Muddasani, S, Keshavan, MS (2006). Prefrontal subregions and dimensions of insight in first-episode schizophrenia – a pilot study. Psychiatry Research 146, 35–42.CrossRefGoogle ScholarPubMed
Shin, LM, Bush, G, Whalen, PJ, Handwerger, K, Cannistraro, PA, Wright, CI, Martis, B, Macklin, ML, Lasko, NB, Orr, SP, Pitman, RK, Rauch, SL (2007). Dorsal anterior cingulate function in posttraumatic stress disorder. Journal of Traumatic Stress 20, 701–712.CrossRefGoogle ScholarPubMed
Shin, LM, Whalen, PJ, Pitman, RK, Bush, G, Macklin, ML, Lasko, NB, Orr, SP, McInerney, SC, Rauch, SL (2001). An fMRI study of anterior cingulate function in posttraumatic stress disorder. Biological Psychiatry 50, 932–942.CrossRefGoogle ScholarPubMed
Steinberg, M, Rounsaville, B, Cicchetti, DV (1990). The Structured Clinical Interview for DSM-III-R Dissociative Disorders: preliminary report on a new diagnostic instrument. American Journal of Psychiatry 147, 76–82.Google ScholarPubMed
Taylor, KS, Seminowicz, DA, Davis, KD (2009). Two systems of resting state connectivity between the insula and cingulate cortex. Human Brain Mapping 30, 2731–2745.CrossRefGoogle ScholarPubMed
Thomaes, K, Dorrepaal, E, Draijer, N, de Ruiter, MB, Elzinga, BM, Sjoerds, Z, van Balkom, AJ, Smit, JH, Veltman, DJ (2011). Increased anterior cingulate cortex and hippocampus activation in complex PTSD during encoding of negative words. Social Cognitive and Affective Neuroscience. Published online 7 December 2011. doi:10.1093/scan/nsr084.Google ScholarPubMed
Thomaes, K, Dorrepaal, E, Draijer, N, de Ruiter, MB, van Balkom, AJ, Smit, JH, Veltman, DJ (2010). Reduced anterior cingulate and orbitofrontal volumes in child abuse-related complex PTSD. Journal of Clinical Psychiatry 71, 1636–1644.CrossRefGoogle ScholarPubMed
van der Kolk, BA, Spinazzola, J, Blaustein, ME, Hopper, JW, Hopper, EK, Korn, DL, Simpson, WB (2007). A randomized clinical trial of eye movement desensitization and reprocessing (EMDR), fluoxetine, and pill placebo in the treatment of posttraumatic stress disorder: treatment effects and long-term maintenance. Journal of Clinical Psychiatry 68, 37–46.CrossRefGoogle ScholarPubMed
van Tol, MJ, van der Wee, NJ, Demenescu, LR, Nielen, MM, Aleman, A, Renken, R, van Buchem, MA, Zitman, FG, Veltman, DJ (2011). Functional MRI correlates of visuospatial planning in out-patient depression and anxiety. Acta Psychiatrica Scandinavica 124, 273–284.CrossRefGoogle ScholarPubMed
Worsley, KJ, Marrett, S, Neelin, P, Vandal, AC, Friston, KJ, Evans, AC (1996). A unified statistical approach for determining significant signals in images of cerebral activation. Human Brain Mapping 4, 58–73.3.0.CO;2-O>CrossRefGoogle ScholarPubMed
Wright, CI, Martis, B, McMullin, K, Shin, LM, Rauch, SL (2003). Amygdala and insular responses to emotionally valenced human faces in small animal specific phobia. Biological Psychiatry 54, 1067–1076.CrossRefGoogle ScholarPubMed
Zanarini, MC, Frankenburg, FR, Dubo, ED, Sickel, AE, Trikha, A, Levin, A, Reynolds, V (1998). Axis I comorbidity of borderline personality disorder. American Journal of Psychiatry 155, 1733–1739.CrossRefGoogle ScholarPubMed
Zlotnick, C, Shea, TM, Rosen, K, Simpson, E, Mulrenin, K, Begin, A, Pearlstein, T (1997). An affect-management group for women with posttraumatic stress disorder and histories of childhood sexual abuse. Journal of Traumatic Stress 10, 425–436.CrossRefGoogle Scholar
Zlotnick, C, Warshaw, M, Shea, MT, Allsworth, J, Pearlstein, T, Keller, MB (1999). Chronicity in posttraumatic stress disorder (PTSD) and predictors of course of comorbid PTSD in patients with anxiety disorders. Journal of Traumatic Stress 12, 89–100.CrossRefGoogle ScholarPubMed
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