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Background. Although cognitive behaviour therapy (CBT) is the treatment of choice for post-traumatic stress disorder (PTSD), approximately half of patients do not respond to CBT. No studies have investigated the capacity for neural responses during fear processing to predict treatment response in PTSD. Method. Functional magnetic resonance imaging (fMRI) responses of the brain were examined in individuals with PTSD (n=14). fMRI was examined in response to fearful and neutral facial expressions presented rapidly in a backwards masking paradigm adapted for a 1.5 T scanner. Patients then received eight sessions of CBT that comprised education, imaginal and in vivo exposure, and cognitive therapy. Treatment response was assessed 6 months after therapy completion. Results. Seven patients were treatment responders (defined as a reduction of 50% of pretreatment scores) and seven were non-responders. Poor improvement after treatment was associated with greater bilateral amygdala and ventral anterior cingulate activation in response to masked fearful faces. Conclusions. Excessive fear responses in response to fear-eliciting stimuli may be a key factor in limiting responses to CBT for PTSD. This excessive amygdala response to fear may reflect difficulty in managing anxiety reactions elicited during CBT, and this factor may limit optimal response to therapy.

Item Type:	Refereed Article
Keywords:	Cognitive behaviour therapy, fMRI, post-traumatic stress disorder, treatment prediction
Research Division:	Psychology
Research Group:	Biological psychology
Research Field:	Behavioural neuroscience
Objective Division:	Health
Objective Group:	Clinical health
Objective Field:	Clinical health not elsewhere classified
UTAS Author:	Felmingham, KL (Professor Kim Felmingham)
ID Code:	72075
Year Published:	2008
Web of Science® Times Cited:	207
Deposited By:	Psychology
Deposited On:	2011-08-19
Last Modified:	2015-02-11
Downloads:	471 View Download Statistics