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Anterior hippocampal volume predicts affect-focused psychotherapy outcome

Published online by Cambridge University Press:  18 February 2019

Benjamin Suarez-Jimenez ,
Xi Zhu ,
Amit Lazarov ,
J. John Mann ,
Franklin Schneier ,
Andrew Gerber ,
Jacques P. Barber ,
Dianne L. Chambless ,
Yuval Neria  and
Barbara Milrod
...Show all authors
Benjamin Suarez-Jimenez
Affiliation:
Columbia University College of Physicians & Surgeons, New York, NY, USA
Xi Zhu
Affiliation:
Columbia University College of Physicians & Surgeons, New York, NY, USA
Amit Lazarov
Affiliation:
Columbia University College of Physicians & Surgeons, New York, NY, USA School of Psychological Sciences, Tel-Aviv University, Tel Aviv, Israel
J. John Mann
Affiliation:
Columbia University College of Physicians & Surgeons, New York, NY, USA New York State Psychiatric Institute, New York, NY, USA
Franklin Schneier
Affiliation:
Columbia University College of Physicians & Surgeons, New York, NY, USA New York State Psychiatric Institute, New York, NY, USA
Andrew Gerber
Affiliation:
Columbia University College of Physicians & Surgeons, New York, NY, USA Silver Hill Hospital, New Canaan, CT, USA
Jacques P. Barber
Affiliation:
Adelphi University, Garden City, NY, USA University of Pennsylvania, Philadelphia, PA, USA
Dianne L. Chambless
Affiliation:
University of Pennsylvania, Philadelphia, PA, USA
Yuval Neria
Affiliation:
Columbia University College of Physicians & Surgeons, New York, NY, USA School of Psychological Sciences, Tel-Aviv University, Tel Aviv, Israel
Barbara Milrod
Affiliation:
Weill Cornell Medical College, New York, NY, USA
John C. Markowitz*
Affiliation:
Columbia University College of Physicians & Surgeons, New York, NY, USA School of Psychological Sciences, Tel-Aviv University, Tel Aviv, Israel
*
Author for correspondence: John C. Markowitz, E-mail: [email protected]
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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.

Keywords

Anterior hippocampuscognitive behavioral therapy (CBT)interpersonal psychotherapy(IPT)neuroimagingpanic disorderPFPP (Panic-Focused Psychodynamic Psychotherapy)psychodynamic psychotherapyPTSDtreatment
Type
Original Articles
Information
Psychological Medicine , Volume 50 , Issue 3 , February 2020 , pp. 396 - 402
Copyright
Copyright © Cambridge University Press 2019

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Footnotes

*

These authors contributed equally to this paper.

References

Abdallah, CG, Wrocklage, KM, Averill, CL, Akiki, T, Schweinsburg, B, Roy, A, Martini, B, Southwick, SM, Krystal, JH and Scott, JC (2017) Anterior hippocampal dysconnectivity in posttraumatic stress disorder: a dimensional and multimodal approach. Translational Psychiatry 7, e1045.CrossRefGoogle ScholarPubMed
Ashburner, J (2007) A fast diffeomorphic image registration algorithm. Neuroimage 38, 95–113.CrossRefGoogle ScholarPubMed
Ashburner, J and Friston, KJ (2005) Unified segmentation. Neuroimage 26, 839–851.CrossRefGoogle ScholarPubMed
Bandelow, B, Baldwin, D, Abelli, M, Altamura, C, Dell'Osso, B, Domschke, K, Fineberg, NA, Grünblatt, E, Jarema, M, Maron, E, Nutt, D, Pini, S, Vaghi, MM, Wichniak, A, Zai, G and Riederer, P (2016) Biological markers for anxiety disorders, OCD and PTSD - a consensus statement. Part I: Neuroimaging and genetics. World Journal of Biological Psychiatry 17, 321–365.CrossRefGoogle ScholarPubMed
Bandelow, B, Baldwin, D, Abelli, M, Bolea-Alamanac, B, Bourin, M, Chamberlain, SR, Cinosi, E, Davies, S, Domschke, K, Fineberg, N, Grünblatt, E, Jarema, M, Kim, YK, Maron, E, Masdrakis, V, Mikova, O, Nutt, D, Pallanti, S, Pini, S, Ströhle, A, Thibaut, F, Vaghi, MM, Won, E, Wedekind, D, Wichniak, A, Woolley, J, Zwanzger, P and Riederer, P (2017) Biological markers for anxiety disorders, OCD and PTSD: A consensus statement. Part II: Neurochemistry, neurophysiology and neurocognition. World Journal of Biological Psychiatry 18, 162–214.CrossRefGoogle ScholarPubMed
Bannerman, DM, Grubb, M, Deacon, RM, Yee, BK, Feldon, J and Rawlins, JN (2003) Ventral hippocampal lesions affect anxiety but not spatial learning. Behavioural Brain Research 139, 197–213.CrossRefGoogle Scholar
Bannerman, DM, Sprengel, R, Sanderson, DJ, McHugh, SB, Rawlins, JN, Monyer, H and Seeburg, PH (2014) Hippocampal synaptic plasticity, spatial memory and anxiety. Nature Reviews Neuroscience 15, 181–192.CrossRefGoogle ScholarPubMed
Barlow, DH and Craske, MG (2006) Mastery of Your Anxiety and Panic, 4th Edn. New York: Oxford.CrossRefGoogle Scholar
Barlow, DH, Gorman, JM, Shear, MK and Woods, SW (2000) Cognitive-behavioral therapy, imipramine, or their combination for panic disorder: a randomized controlled trial. Journal of the American Medical Association 283, 2529–2536.CrossRefGoogle ScholarPubMed
Blake, DD, Weathers, FW, Nagy, LM, Kaloupek, DG, Gusman, FD, Charney, DS and Keane, TM (1995) The development of a Clinician-Administered PTSD Scale. Journal of Traumatic Stress 8, 75–90.CrossRefGoogle ScholarPubMed
Brohawn, KH, Offringa, R, Pfaff, DL, Hughes, KC and Shin, LM (2010) The neural correlates of emotional memory in posttraumatic stress disorder. Biological Psychiatry 68, 1023–1030.CrossRefGoogle ScholarPubMed
Busch, F, Milrod, B, Singer, M and Aronson, A (2012) Panic Focused Psychodynamic Psychotherapy: Extended Range: Psychodynamic Psychotherapy for Anxiety Disorders: A Transdiagnostic Treatment Manual. New York: Taylor & Francis.Google Scholar
Cerny, JA, Klosko, J and Barlow, DH (1985) Anxiety treatment project: combined relaxation and cognitive therapy treatment manual. Unpublished manuscript, the phobia and anxiety disorders clinic. New York, Albany: State University of New York.Google Scholar
Chen, AC and Etkin, A (2013) Hippocampal network connectivity and activation differentiates post-traumatic stress disorder from generalized anxiety disorder. Neuropsychopharmacology 38, 1889–1898.CrossRefGoogle ScholarPubMed
Corcoran, KA, Desmond, TJ, Frey, KA and Maren, S (2005) Hippocampal inactivation disrupts the acquisition and contextual encoding of fear extinction. Journal of Neuroscience 25, 8978–8987.CrossRefGoogle ScholarPubMed
DiNardo, PA and Brown, TA (1995) Anxiety Disorders Interview Schedule For DSM-IV: Current Version (ADIS-IV). New York: Graywinds.Google Scholar
Doeller, CF, King, JA and Burgess, N (2008) Parallel striatal and hippocampal systems for landmarks and boundaries in spatial memory. Proceedings of the National Academy of Sciences of the USA 105, 5915–5920.CrossRefGoogle ScholarPubMed
Driessen, M, Herrmann, J, Stahl, K, Zwaan, M, Meier, S, Hill, A, Osterheider, M and Petersen, D (2000) Magnetic resonance imaging volumes of the hippocampus and the amygdala in women with borderline personality disorder and early traumatization. Archives of General Psychiatry 57, 1115–1122.CrossRefGoogle ScholarPubMed
Etkin, A and Wager, TD (2007) Functional neuroimaging of anxiety: a meta-analysis of emotional processing in PTSD, social anxiety disorder, and specific phobia. American Journal of Psychiatry 164, 1476–1488.CrossRefGoogle ScholarPubMed
Fanselow, MS and Dong, HW (2010) Are the dorsal and ventral hippocampus functionally distinct structures? Neuron 65, 7–19.CrossRefGoogle ScholarPubMed
First, MB, Spitzer, RL, Gibbon, M and Williams, JB (1995) Structured Clinical Interview for DSM-IV Axis I Disorders -- Patient edition (SCID-I/P, Version 2.0). New York: New York State Psychiatric Institute, Biometrics Research Department.Google Scholar
Foa, EB and Rothbaum, BO (1998) Treating the Trauma of Rape: Cognitive-Behavioral Therapy for PTSD. New York: Guilford.Google Scholar
Fonagy, P and Target, M (1997) Attachment and reflective function: their role in self-organization. Developmental Psychopathology 9, 679–700.CrossRefGoogle ScholarPubMed
Hamilton, M (1960) A rating scale for depression. Journal of Neurology, Neurosurgery, and Psychiatry 23, 56–62.CrossRefGoogle Scholar
Ismaylova, E, Di Sante, J, Gouin, JP, Pomares, FB, Vitaro, F, Tremblay, RE and Booij, L (2018) Associations between daily mood states and brain gray matter volume, resting-state functional connectivity and task-based activity in healthy adults. Frontiers in Human Neuroscience 12, 168.CrossRefGoogle ScholarPubMed
Kaplan, R, Horner, AJ, Bandettini, PA, Doeller, CF and Burgess, N (2014) Human hippocampal processing of environmental novelty during spatial navigation. Hippocampus 24, 740–750.CrossRefGoogle ScholarPubMed
Kessler, RC, Sonnega, A, Bromet, E, Hughes, M and Nelson, CB (1995) Posttraumatic stress disorder in the National Comorbidity Survey. Archives of General Psychiatry 52, 1048–1060.CrossRefGoogle ScholarPubMed
Kessler, RC, Berglund, P, Demler, O, Jin, R, Merikangas, KR and Walters, EE (2005 a) Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry 62, 593–602.CrossRefGoogle ScholarPubMed
Kessler, RC, Chiu, WT, Demler, O and Walters, EE (2005 b) Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry 62, 617–627.CrossRefGoogle ScholarPubMed
Lazarov, A, Zhu, X, Suarez-Jimenez, B, Rutherford, BR and Neria, Y (2017) Resting-state functional connectivity of anterior and posterior hippocampus in posttraumatic stress disorder. Journal of Psychiatric Research 94, 15–22.CrossRefGoogle ScholarPubMed
Management of Posttraumatic Stress Disorder Work Group (2017) VA/DOD Clinical Practice Guideline for the Management of Posttraumatic Stress Disorder and Acute Stress Disorder. Version 3.0–2017. Available at https://www.healthquality.va.gov/guidelines/MH/ptsd/VADoDPTSDCPGFinal012418.pdf (Accessed 13 May 2018).Google Scholar
Markowitz, JC (2016) IPT for PTSD: Interpersonal Psychotherapy for Posttraumatic Stress Disorder. New York: Oxford University Press.Google Scholar
Markowitz, JC, Milrod, B, Bleiberg, KL and Marshall, RD (2009) Interpersonal factors in understanding and treating posttraumatic stress disorder. Journal of Psychiatric Practice 15, 133–140.CrossRefGoogle ScholarPubMed
Markowitz, JC, Petkova, E, Neria, Y, Van Meter, P, Zhao, Y, Hembree, E, Lovell, K, Biyanova, T and Marshall, RD (2015) Is exposure necessary? A randomized clinical trial of interpersonal psychotherapy for PTSD. American Journal of Psychiatry 172, 430–440.CrossRefGoogle ScholarPubMed
Markowitz, JC, Neria, Y, Lovell, K, Van Meter, PE and Petkova, E (2017) History of sexual trauma moderates psychotherapy outcome for posttraumatic stress disorder. Depression and Anxiety 34, 692–700.CrossRefGoogle ScholarPubMed
Milrod, B, Busch, F, Cooper, A and Shapiro, T (1997) Manual of Panic-Focused Psychodynamic Psychotherapy. Washington, DC: American Psychiatric Association Press.Google Scholar
Milrod, B, Chambless, DL, Gallop, R, Busch, FN, Schwalberg, M, McCarthy, KS, Gross, C, Sharpless, BA, Leon, AC and Barber, JP (2016) Psychotherapies for panic disorder: a tale of two sites. Journal of Clinical Psychiatry 77, 927–935.CrossRefGoogle ScholarPubMed
Neria, Y, Nandi, A and Galea, S (2008) Post-traumatic stress disorder following disasters: a systematic review. Psychological Medicine 38, 467–480.CrossRefGoogle ScholarPubMed
Neria, Y, DiGrande, L and Adams, BG (2011) Posttraumatic stress disorder following the September 11, 2001, terrorist attacks: a review of the literature among highly exposed populations. American Psychologist 66, 429–446.CrossRefGoogle ScholarPubMed
North, CS, Suris, AM, Davis, M and Smith, RP (2009) Toward validation of the diagnosis of posttraumatic stress disorder. American Journal of Psychiatry 166, 34–41.CrossRefGoogle Scholar
O'Doherty, DC, Chitty, KM, Saddiqui, S, Bennett, MR and Lagopoulos, J (2015) A systematic review and meta-analysis of magnetic resonance imaging measurement of structural volumes in posttraumatic stress disorder. Psychiatry Research 232, 1–33.CrossRefGoogle ScholarPubMed
Patel, R, Spreng, NR, Shin, LM and Girard, TA (2012) Neurocircuitry models of posttraumatic stress disorder and beyond: a meta-analysis of functional neuroimaging studies. Neuroscience & Biobehavioral Reviews 36, 2130–2142.CrossRefGoogle ScholarPubMed
Poppenk, J, Evensmoen, HR, Moscovitch, M and Nadel, L (2013) Long-axis specialization of the human hippocampus. Trends in Cognitive Science 17, 230–240.CrossRefGoogle ScholarPubMed
Quirk, GJ and Mueller, D (2008) Neural mechanisms of extinction learning and retrieval. Neuropsychopharmacology 33, 56–72.CrossRefGoogle ScholarPubMed
Rubin, M, Shvil, E, Papini, S, Chhetry, BT, Helpman, L, Markowitz, JC, Mann, JJ and Neria, Y (2016) Greater hippocampal volume is associated with PTSD treatment response. Psychiatry Research 252, 36–39.CrossRefGoogle ScholarPubMed
Shear, MK, Brown, TA, Barlow, DH, Money, R, Sholomskas, DE, Woods, SW, Gorman, JM and Papp, LA (1997) Multicenter collaborative panic disorder severity scale. American Journal of Psychiatry 154, 1571–1575.CrossRefGoogle ScholarPubMed
Small, SA, Schobel, SA, Buxton, RB, Witter, MP and Barnes, CA (2011) A pathophysiological framework of hippocampal dysfunction in ageing and disease. Nature Reviews Neuroscience 2011, 585–601.CrossRefGoogle Scholar
Stein, MB, Koverola, C, Hanna, C, Torchia, MG and McClarty, B (1997) Hippocampal volume in women victimized by childhood sexual abuse. Psychological Medicine 27, 951–959.CrossRefGoogle ScholarPubMed
Vythilingam, M, Heim, C, Newport, J, Miller, AH, Anderson, E, Bronen, R, Brummer, M, Staib, L, Vermetten, E, Charney, DS, Nemeroff, CB and Bremner, JD (2002) Childhood trauma associated with smaller hippocampal volume in women with major depression. American Journal of Psychiatry 159, 2072–2080.CrossRefGoogle ScholarPubMed
Weathers, FW, Keane, TM and Davidson, JRT (2001) Clinician-Administered PTSD Scale: a review of the first ten years of research. Depression and Anxiety 13, 132–156.CrossRefGoogle Scholar
Zarei, M, Beckmann, CF, Binnewijzend, MA, Schoonheim, MM, Oghabian, MA, Sanz-Arigita, EJ, Scheltens, P, Matthews, PM and Barkhof, F (2013) Functional segmentation of the hippocampus in the healthy human brain and in Alzheimer's disease. Neuroimage 66, 28–35.CrossRefGoogle ScholarPubMed
Zeidman, P and Maguire, EA (2016) Anterior hippocampus: the anatomy of perception, imagination, and episodic memory. Nature Reviews Neuroscience 17, 173–182.CrossRefGoogle ScholarPubMed