Trauma-focused psychotherapy response in youth with posttraumatic stress disorder is associated with changes in insula volume

• Published in: Journal of psychiatric research 2021-01, Vol.132, p.207-214
• Main Authors: Zantvoord, Jasper B., Zhutovsky, Paul, Ensink, Judith B.M., Op den Kelder, Rosanne, van Wingen, Guido A., Lindauer, Ramon J.L.
• Format: Article
• Language: English
• Subjects: Adolescent; Brain; Cerebral Cortex - diagnostic imaging; Child; Female; Humans; Insula; Magnetic Resonance Imaging; MRI; Neuroimaging; Psychotherapy; PTSD; Stress Disorders, Post-Traumatic - diagnostic imaging; Stress Disorders, Post-Traumatic - therapy
• ISSN: 0022-3956; 1879-1379
• DOI: 10.1016/j.jpsychires.2020.10.037

Randomized controlled trials have shown efficacy of trauma-focused psychotherapies in youth with posttraumatic stress disorder (PTSD), but little is known about the relationship between treatment response and alternations in brain structures associated with PTSD. In this study, we longitudinally examined the association between treatment response and pre-to posttreatment changes in structural magnetic resonance imaging (MRI) scans using a voxel-based morphometry approach. We analyzed MRI scans of 35 patients (ages 8–18 years, 21 female) with PTSD (80%) or partial PTSD (20%) before and after eight weekly sessions of trauma-focused psychotherapy. PTSD severity was assessed longitudinally using the Clinician-Administered PTSD scale for Children and Adolescents to divide participants into responders and non-responders. Group by time interaction analysis showed significant differences in grey-matter volume in the bilateral insula due to volume reductions over time in non-responders compared to responders. Despite the significant group by time interaction, there were no significant group differences at baseline or follow-up. As typical development is associated with insula volume increase, these longitudinal MRI findings suggest that treatment non-response is associated with atypical neurodevelopment of the insula, which may underlie persistence of PTSD in youth. The absence of structural MRI changes in treatment responders, while in need of replication, suggest that successful trauma-focused psychotherapy may not directly normalize brain abnormalities associated with PTSD. •Few studies have investigated the association between psychotherapy response and changes in brain structure in youth with PTSD.•Our study shows that non-response to trauma-focused psychotherapy is associated with bilateral insula volume decrease over time.•This suggests a relationship between PTSD persistence after treatment and ongoing atypical neurodevelopment.•Responders showed no MRI changes, indicating that successful trauma-focused psychotherapy might not directly normalize PTSD related brain abnormalities.•Future long-term studies should aim to determine if changes in MRI measurements related to treatment response are expressed later in development.