Effective psychological treatment for PTSD changes the dynamics of specific large-­‐scale brain networks

Abstract

Very little is known about the role of effective cognitive therapy in reversing imbalances in brain activity after trauma. We hypothesised that exaggerated threat perception characteristic of post-­‐traumatic stress disorder (PTSD), and subsequent recovery from this disorder, are underpinned by changes in the dynamics of large-­‐scale brain networks. Here, we use a novel data-­‐driven approach with high temporal precision to find recurring brain networks from fMRI data and estimate when these networks become active during exposure to either trauma reminders or neutral pictures. We found that PTSD patients spend less time in two default mode sub-­‐networks in contrast to trauma-­‐exposed healthy controls, and that PTSD symptom severity correlates positively with time spent in the salience network during exposure to trauma reminders. The former are important for different aspects of self-­‐ referential processing and the latter for detection of threat. Importantly, the decreased time in the default mode sub-­‐networks is rebalanced after successful cognitive therapy for PTSD. Our results show that remittance of PTSD through trauma-­‐focused cognitive therapy is associated with the successful reinstatement of a healthy balance in self-­‐referential and threat detection brain networks.