Effects of psychotherapy on brain activation during negative emotional processing in patients with posttraumatic stress disorder: a systematic review and meta-analysis

• Published in: Brain imaging and behavior 2024-04, Vol.18 (2), p.444-455
• Main Authors: Aarts, Inga, Thorsen, A. L., Vriend, C., Planting, C., van den Heuvel, O. A., Thomaes, K.
• Format: Article
• Language: English
• Subjects: Activation analysis; Amygdala; Biomedical and Life Sciences; Biomedicine; Brain; Brain - diagnostic imaging; Brain - physiopathology; Brain mapping; Brain Mapping - methods; Cortex (cingulate); Cortex (frontal); Emotions; Emotions - physiology; Frontal gyrus; Globus pallidus; Heterogeneity; Humans; Magnetic Resonance Imaging - methods; Medical imaging; Mental disorders; Meta-analysis; Neuroimaging; Neuropsychology; Neuroradiology; Neurosciences; Post traumatic stress disorder; Prefrontal cortex; Psychiatry; Psychological stress; Psychotherapy; Psychotherapy - methods; Putamen; Quality assessment; Quality control; Review; Stress Disorders, Post-Traumatic - diagnostic imaging; Stress Disorders, Post-Traumatic - physiopathology; Stress Disorders, Post-Traumatic - psychology; Stress Disorders, Post-Traumatic - therapy; Systematic review; Temporal lobe; Therapeutic applications
• ISSN: 1931-7557; 1931-7565
• DOI: 10.1007/s11682-023-00831-0

Post-traumatic stress disorder (PTSD) is a debilitating condition which has been related to problems in emotional regulation, memory and cognitive control. Psychotherapy has a non-response rate of around 50% and understanding the neurobiological working mechanisms might help improve treatment. To integrate findings from multiple smaller studies, we performed the first meta-analysis of changes in brain activation with a specific focus on emotional processing after psychotherapy in PTSD patients. We performed a meta-analysis of brain activation changes after treatment during emotional processing for PTSD with seed-based d mapping using a pre-registered protocol (PROSPERO CRD42020211039). We analyzed twelve studies with 191 PTSD patients after screening 3700 studies. We performed systematic quality assessment both for the therapeutic interventions and neuroimaging methods. Analyses were done in the full sample and in a subset of studies that reported whole-brain results. We found decreased activation after psychotherapy in the left amygdala, (para)hippocampus, medial temporal lobe, inferior frontal gyrus, ventrolateral prefrontal cortex, right pallidum, anterior cingulate cortex, bilateral putamen, and insula. Decreased activation in the left amygdala and left ventrolateral PFC was also found in eight studies that reported whole-brain findings. Results did not survive correction for multiple comparisons. There is tentative support for decreased activation in the fear and cognitive control networks during emotional processing after psychotherapy for PTSD. Future studies would benefit from adopting a larger sample size, using designs that control for confounding variables, and investigating heterogeneity in symptom profiles and treatment response.