Skip to main content
SpringerLink
Log in

Neuroimaging in PTSD-Related Psychotherapies

  • Chapter
  • First Online:
PET and SPECT in Psychiatry

Abstract

Neuroimaging studies conducted in PTSD patients who have undergone various psychological treatments have provided evidence of modifications in cerebral blood flow (single-photon emission computer tomography, SPECT; positron emission tomography, PET; functional magnetic resonance imaging, fMRI), neuronal volume and density (magnetic resonance imaging, MRI), and, more recently, brain electric signal (electroencephalography, EEG). The purpose of this chapter is to review the results of functional and structural changes being reported in PTSD treatments during the period from 1999 to 2019, in order to integrate the psychotherapy outcome with the essential neurobiological data.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 139.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 179.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 249.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Similar content being viewed by others

References

  • American Psychiatric Association (1994) Diagnostic and statistical manual of mental disorders, DSM IV. APA, Washington, DC

    Google Scholar 

  • Boukezzi S, El Khoury-Malhame M, Auzias G et al (2017) Grey matter density changes of structures involved in posttraumatic stress disorder (PTSD) after recovery following eye movement desensitization and reprocessing (EMDR) therapy. Psychiatry Res Neuroimaging 266:146–152

    PubMed  Google Scholar 

  • Boyd JE, Lanius RA, McKinnon MC (2018) Mindfulness-based treatments for posttraumatic stress disorder: a review of the treatment literature and neurobiological evidence. J Psychiatry Neurosci 43:7–25

    PubMed  Google Scholar 

  • Bradley R, Greene J, Russ E et al (2005) A multidimensional meta-analysis of psychotherapy for PTSD. Am J Psychiatry 162:214–227

    PubMed  Google Scholar 

  • Bremner JD (2007) Functional neuroimaging in post-traumatic stress disorder. Expert Rev Neurother 7:393–405

    PubMed  PubMed Central  Google Scholar 

  • Breslau N (2001) The epidemiology of posttraumatic stress disorder: what is the extent of the problem? J Clin Psychiatry 62:16–22

    PubMed  Google Scholar 

  • Breslau N, Davis GC, Andreski P et al (1991) Traumatic events and posttraumatic stress disorder in an urban population of young adults. Arch Gen Psychiatry 48:216–222

    CAS  PubMed  Google Scholar 

  • Bryant RA, Felmingham K, Whitford TJ et al (2008a) Rostral anterior cingulate volume predicts treatment response to cognitive-behavioural therapy for posttraumatic stress disorder. J Psychiatry Neurosci 33:142–146

    PubMed  PubMed Central  Google Scholar 

  • Bryant RA, Felmingham K, Kemp P et al (2008b) Amygdala and ventral anterior cingulate activation predicts treatment response to cognitive behaviour therapy for post-traumatic stress disorder. Psychol Med 38:555–561

    CAS  PubMed  Google Scholar 

  • Butler O, Willmund G, Gleich T et al (2018) Hippocampal gray matter increases following multimodal psychological treatment for combat-related post-traumatic stress disorder. Brain Behav 8:e00956

    PubMed  PubMed Central  Google Scholar 

  • Carletto S, Borsato T, Pagani M (2017) The role of slow wave sleep in memory pathophysiology: focus on post-traumatic stress disorder and eye movement desensitization and reprocessing. Front Psychol 8:2050

    PubMed  PubMed Central  Google Scholar 

  • Carletto S, Porcaro C, Settanta C, Vizzari V, Stanizzo M, Oliva F et al (2019) Neurobiological features and response to eye movement desensitization and reprocessing treatment of post-traumatic stress disorder in patients with breast cancer. Eur J Psychotraumatol 10:1600832

    PubMed  PubMed Central  Google Scholar 

  • Colvonen PJ, Glassman LH, Crocker LD et al (2017) Pretreatment biomarkers predicting PTSD psychotherapy outcomes: a systematic review. Neurosci Biobehav Rev 75:140–156

    PubMed  Google Scholar 

  • Corcoran KA, Maren S (2001) Hippocampal inactivation disrupts contextual retrieval of fear memory after extinction. J Neurosci 21:1720–1726

    CAS  PubMed  PubMed Central  Google Scholar 

  • Corrigan FM, Hull AM (2015a) Recognition of the neurobiological insults imposed by complex trauma and the implications for psychotherapeutic interventions. BJPsych Bull 39:79–86

    PubMed  PubMed Central  Google Scholar 

  • Corrigan FM, Hull AM (2015b) Neglect of the complex: why psychotherapy for post-traumatic clinical presentations is often ineffective. BJPsych Bull 39:86–89

    PubMed  PubMed Central  Google Scholar 

  • Darves-Bornoz JM, Alonso J, de Girolamo G et al (2008) Main traumatic events in Europe: PTSD in the European study of the epidemiology of mental disorders survey. J Trauma Stress 21:455–462

    PubMed  Google Scholar 

  • Davidson PR, Parker KC (2001) Eye movement desensitization and reprocessing (EMDR): a meta-analysis. J Consult Clin Psychol 69:305–316

    CAS  PubMed  Google Scholar 

  • Davidson JRT, Tharwani HM, Connor KM (2002) Davidson trauma scale (DTS): normative scores in the general population and effect sizes in placebo-controlled SSRI trials. Depress Anxiety 15:75–78

    PubMed  Google Scholar 

  • Davis M, Whalen P (2001) The amygdala: vigilance and emotion. Mol Psychiatry 6:13–34

    CAS  PubMed  Google Scholar 

  • Eichenbaum H (2000) A cortical-hippocampal system for declarative memory. Nat Rev Neurosci 1:41–50

    CAS  PubMed  Google Scholar 

  • First MB, Gibbon M, Spitzer RL et al (1997) Structured clinical interview for DSM-IV axis I disorders (SCID-I) clinician booklet. APA, Washington DC

    Google Scholar 

  • Francati V, Vermetten E, Bremner JD (2007) Functional neuroimaging studies in posttraumatic stress disorder: review of current methods and findings. Depress Anxiety 24:202–218

    CAS  PubMed  PubMed Central  Google Scholar 

  • Helpman L, Papini S, Chhetry BT et al (2016) PTSD remission after prolonged exposure treatment is associated with anterior cingulate cortex thinning and volume reduction. Depress Anxiety 33:384–391

    PubMed  PubMed Central  Google Scholar 

  • Högberg G, Pagani M, Sundin O et al (2007) On treatment with eye movement desensitization and reprocessing of chronic post-traumatic stress disorder in public transportation workers—a randomized controlled trial. Nord J Psychiatry 61:54–61

    PubMed  Google Scholar 

  • Högberg G, Pagani M, Sundin O et al (2008) Treatment of post-traumatic stress disorder with eye movement desensitization and reprocessing: outcome is stable in 35-month follow-up. Psychiatry Res 159:101–108

    PubMed  Google Scholar 

  • Karatzias T, Murphy P, Cloitre M et al (2019) Psychological interventions for ICD-11 complex PTSD symptoms: systematic review and meta-analysis. Psychol Med 12:1–15

    Google Scholar 

  • Kessler RC (2000) Posttraumatic stress disorder: the burden to the individual and to society. J Clin Psychiatry 61:4–12

    PubMed  Google Scholar 

  • Lansing K, Amen DG, Hanks C et al (2005) High–resolution brain SPECT imaging and eye movement desensitization and reprocessing in police officers with PTSD. J Neuropsychiatry Clin Neurosci 17:526–532

    PubMed  Google Scholar 

  • LeDoux JE (2000) Emotion circuits in the brain. Annu Rev Neurosci 23:155–184

    CAS  PubMed  Google Scholar 

  • 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. J Anxiety Disord 13:159–172

    CAS  PubMed  Google Scholar 

  • Liberzon I, Taylor SF, Amdur R et al (1999) Brain activation in PTSD in response to trauma-related stimuli. Biol Psychiatry 45:817–826

    CAS  PubMed  Google Scholar 

  • Lindauer RJ, Booij J, Habraken JB et al (2004) Cerebral blood flow changes during script-driven imagery in police officers with posttraumatic stress disorder. Biol Psychiatry 56:853–861

    PubMed  Google Scholar 

  • Lindauer RJ, Vlieger EJ, Jalink M et al (2005) Effects of psychotherapy on hippocampal volume in out-patients with post-traumatic stress disorder: a MRI investigation. Psychol Med 35:1421–1431

    PubMed  Google Scholar 

  • Lindauer RJ, Booij J, Habraken JB et al (2008) Effects of psychotherapy on regional cerebral blood flow during trauma imagery in patients with post-traumatic stress disorder: a randomized clinical trial. Psychol Med 38:543–554

    CAS  PubMed  Google Scholar 

  • Looi JC, Lindberg O, Liberg B et al (2008) Volumetrics of the caudate nucleus: reliability and validity of a new manual tracing protocol. Psychiatry Res 163:279–288

    PubMed  Google Scholar 

  • Looi JC, Maller JJ, Pagani M et al (2009) Caudate volumes in public transportation workers exposed to trauma in the Stockholm train system. Psychiatry Res 171:138–143

    PubMed  Google Scholar 

  • Malejko K, Abler B, Plener PL et al (2017) Neural correlates of psychotherapeutic treatment of post-traumatic stress disorder: a systematic literature review. Front Psych 8:85

    Google Scholar 

  • Mazard A, Mazoyer B, Etard O et al (2002) Impact of fMRI acoustic noise on the functional anatomy of visual mental imagery. J Cogn Neurosci 14:172–186

    CAS  PubMed  Google Scholar 

  • Morris JS, Ohman A, Dolan RJ (1998) Conscious and unconscious emotional learning in the human amygdala. Nature 393:467–470

    CAS  PubMed  Google Scholar 

  • Nardo D, Högberg G, Looi JC et al (2010) Gray matter density in limbic and paralimbic cortices is associated with trauma load and EMDR outcome in PTSD patients. J Psychiatr Res 44:477–485

    PubMed  Google Scholar 

  • Nardo D, Högberg G, Flumeri F et al (2011) Self-rating scales assessing subjective well-being and distress correlate with rCBF in PTSD-sensitive regions. Psychol Med 41:2549–2561

    CAS  PubMed  Google Scholar 

  • Oh DH, Choi J (2007) Changes in the regional cerebral perfusion after eye movement desensitization and reprocessing: a SPECT study of two cases. J EMDR Pract Res 1:24–30

    Google Scholar 

  • Orr SP, Metzger LJ, Lasko NB et al (2000) De novo conditioning in traumaexposed individuals with and without posttraumatic stress disorder. J Abnorm Psychol 109:290–298

    CAS  PubMed  Google Scholar 

  • Pagani M, Högberg G, Salmaso D et al (2005) Regional cerebral blood flow during auditory recall in 47 subjects exposed to assaultive and non-assaultive trauma and developing or not posttraumatic stress disorder. Eur Arch Psychiatry Clin Neurosci 255:359–365

    PubMed  Google Scholar 

  • Pagani M, Högberg G, Salmaso D et al (2007) Effects of EMDR psychotherapy on 99mTc-HMPAO distribution in occupation-related post-traumatic stress disorder. Nucl Med Commun 28:757–765

    PubMed  Google Scholar 

  • Pagani M, Di Lorenzo G, Verardo AR et al (2011) Pre- intra- and post-treatment EEG imaging of EMDR—methodology and preliminary results from a single case. J EMDR Pract Res 5:42–56

    Google Scholar 

  • Pagani M, Di Lorenzo G, Verardo AR et al (2012) Neurobiological correlates of EMDR monitoring—an EEG study. PLoS One 7:e45753. https://doi.org/10.1371/journal.pone.0045753

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Pagani M, Hogberg G, Fernandez I et al (2013) Correlates of EMDR therapy in functional and structural neuroimaging—a critical summary of recent findings. J EMDR Pract Res 7:29–38

    Google Scholar 

  • Pagani M, Di Lorenzo G, Monaco L et al (2015) Neurobiological response to EMDR therapy in clients with different psychological traumas. Front Psychol 6:1614

    PubMed  PubMed Central  Google Scholar 

  • Pagani M, Amann BL, Landin-Romero R et al (2017) Eye movement desensitization and reprocessing and slow wave sleep: a putative mechanism of action. Front Psychol 8:1935

    PubMed  PubMed Central  Google Scholar 

  • Pagani M, Carletto S, Ostacoli L (2019) PET and SPECT in psychiatry: the past and the future. Eur J Nuc Med Mol Imaging 46:1985–1987

    Google Scholar 

  • Pavic L, Gregurek R, Petrović R et al (2003) Alterations in brain activation in posttraumatic stress disorder patients with severe hyperarousal symptoms and impulsive aggressiveness. Eur Arch Psychiatry Clin Neurosci 253:80–83

    PubMed  Google Scholar 

  • Peres JF, Newberg AB, Mercante JP et al (2007) Cerebral blood flow changes during retrieval of traumatic memories before and after psychotherapy: a SPECT study. Psychol Med 37:1481–1491

    PubMed  Google Scholar 

  • Perez JF, Foerster B, Santana LG et al (2011) Police officers under attack: resilience implications of an fMRI study. J Psychiat Res 45:727–734

    Google Scholar 

  • Peri T, Ben-Shakhar G, Orr SP et al (2000) Psychophysiologic assessment of aversive conditioning in posttraumatic stress disorder. Biol Psychiatry 47:512–519

    CAS  PubMed  Google Scholar 

  • Roffman JL, Marci CD, Glick DM et al (2005) Neuroimaging and the functional neuroanatomy of psychotherapy. Psychol Med 35:1385–1398

    PubMed  Google Scholar 

  • Rousseau PF, Malbos E, Verger A et al (2019) Increase of precuneus metabolism correlates with reduction of PTSD symptoms after EMDR therapy in military veterans: an 18F-FDG PET study during virtual reality exposure to war. Eur J Nucl Med Mol Imaging 46:1817–1821

    CAS  PubMed  Google Scholar 

  • Shin LM, Liberzon I (2010) The neurocircuitry of fear, stress, and anxiety disorders. Neuropsychopharmacology 35:169–191

    PubMed  Google Scholar 

  • Suarez-Jimenez B, Zhu X, Lazarov A et al (2019) Anterior hippocampal volume predicts affect-focused psychotherapy outcome. Psychol Med 18:1–7

    Google Scholar 

  • Szesko PR, Yehuda R (2019) Magnetic resonance imaging predictors of psychotherapy treatment response in post-traumatic stress disorder: a role for the salience network. Psychiatry Res 277:52–57

    Google Scholar 

  • Thomaes K, Dorrepaal E, Draijer N et al (2014) Can pharmacological and psychological treatment change brain structure and function in PTSD? A systematic review. J Psychiatr Res 50:1–15

    PubMed  Google Scholar 

  • Trentini C, Pagani M, Fania P et al (2015) Neural processing of emotions in traumatized children treated with eye movement desensitization and reprocessing therapy: a hdEEG study. Front Psychol 6:1662

    PubMed  PubMed Central  Google Scholar 

  • Van Etten ML, Taylor S (1998) Comparative efficacy of treatments for post-traumatic stress disorder: a meta-analysis. Clin Psychol Psychother 5:126–144

    Google Scholar 

  • Whalen PJ, Rauch SL, Etcoff NL et al (1998) Masked presentations of emotional facial expressions modulate amygdala activity without explicit knowledge. J Neurosci 18:411–418

    CAS  PubMed  PubMed Central  Google Scholar 

  • Zantvoord JB, Diehle J, Lindauer RJ (2013) Using neurobiological measures to predict and assess treatment outcome of psychotherapy in posttraumatic stress disorder: systematic review. Psychother Psychosom 82:142–151

    PubMed  Google Scholar 

  • Zoellner LA, Roy-Byrne PP, Mavissakalian M et al (2019) Doubly randomized preference trial of prolonged exposure versus sertraline for treatment of PTSD. Am J Psychiatry 176:287–296

    PubMed  Google Scholar 

  • Zubieta JK, Chinitz JA, Lombardi U et al (1999) Medial frontal cortex involvement in PTSD symptoms: a SPECT study. J Psychiatr Res 33:259–264

    CAS  PubMed  Google Scholar 

Download references

Acknowledgments

The authors wish to thank EMDR Italy and EMDR Research Foundation for the research grants received. They also want to thank the Department of Nuclear Medicine, Karolinska Hospital, Stockholm Sweden and the Department of Systems Medicine, University of Rome “Tor Vergata,” Rome, Italy, for the valuable collaboration in our previous studies.

Author information

Authors and Affiliations

  1. Institute of Cognitive Sciences and Technologies, CNR, Rome, Italy

    Marco Pagani

  2. Department of Nuclear Medicine, Karolinska Hospital, Stockholm, Sweden

    Marco Pagani

  3. Department of Clinical and Biological Sciences, University of Turin, Turin, Italy

    Sara Carletto

  4. eCampus University, Faculty of Psychology, Novedrate, Como, Italy

    Marco Cavallo

Authors
  1. Marco Pagani
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sara Carletto
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Marco Cavallo
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Marco Pagani .

Editor information

Editors and Affiliations

  1. Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, Groningen, The Netherlands

    Rudi A.J.O. Dierckx

  2. Faculty of Electrical Engineering, Medical Engineering and Computer Science, Offenburg University, Offenburg, Germany

    Andreas Otte

  3. Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, Groningen, The Netherlands

    Erik F. J. de Vries

  4. Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, Groningen, The Netherlands

    Aren van Waarde

  5. Biomedical Sciences of Cells and Systems, University Medical Center Groningen, Groningen, The Netherlands

    Iris E. Sommer

Rights and permissions

Reprints and permissions

Copyright information

© 2021 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Pagani, M., Carletto, S., Cavallo, M. (2021). Neuroimaging in PTSD-Related Psychotherapies. In: Dierckx, R.A., Otte, A., de Vries, E.F.J., van Waarde, A., Sommer, I.E. (eds) PET and SPECT in Psychiatry. Springer, Cham. https://doi.org/10.1007/978-3-030-57231-0_12

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-57231-0_12

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-57230-3

  • Online ISBN: 978-3-030-57231-0

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation