TY - JOUR
T1 - Auditory N2 Correlates of Treatment Response in Posttraumatic Stress Disorder
AU - Tillman, Gail D.
AU - Motes, Michael A.
AU - Bass, Christina M.
AU - Morris, Elizabeth Ellen
AU - Jones, Penelope
AU - Kozel, F. Andrew
AU - Hart, John
AU - Kraut, Michael A.
N1 - Funding Information:
This work was supported by the U.S. Department of Defense (W81XWH‐11‐2‐0132) and the Texas Health and Human Services Commission (HHSC; Contract 529‐14‐0084‐00001). The views expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the Department of Defense, the Department of Veteran Affairs, Texas HHSC, or the U.S. Government. Neither the James A. Haley Veterans Administration Hospital nor Veterans Affairs (VA) health care providers were involved with this study during VA duty time. The authors have no conflicts of interest to report.
Funding Information:
Posttraumatic stress disorder (PTSD) has been estimated to affect between 11% and 20% of U.S. veterans who have been deployed in support of recent military operations in Iraq, Afghanistan, and surrounding areas (U.S. Department of Veteran Affairs [VA], 2018). Poor physical health and interpersonal functioning (Schnurr et?al., 2009), increased rates of unemployment (Schnurr et?al., 2009), homelessness and domestic violence (Tanielian & Jaycox, 2008), and higher health care costs (Ivanova et?al., 2011) have been shown to be associated with PTSD. Thus, there is a considerable need for PTSD treatment that is reliable and accessible. The guidelines for treating PTSD published by the U.S. Department of Defense (DoD) and the VA (VA/DoD, 2017) stated that the treatments that have demonstrated the strongest evidence of efficacy are those that are trauma-focused. These include prolonged exposure therapy (Foa et?al., 2007), eye movement desensitization and reprocessing therapy (Shapiro, 1989), and cognitive processing therapy (CPT; Monson et?al., 2006; Resick & Schnick, 1992). CPT combines components of exposure therapy and cognitive therapy by focusing on the traumatic experience and the maladaptive cognitions associated with it. Patients learn to challenge their overaccommodated and overlearned assumptions based on their memory of the traumatic event and process the present environment through more balanced and accurate beliefs. The objective is to strengthen the ability to move away from a reflexive response to stimuli and toward a considered response. Although CPT is recognized as an effective treatment that reduces PTSD symptoms in military patient populations, the reported effect sizes in these populations are smaller than those reported in civilian PTSD patients (Bradley et?al., 2005; Steenkamp et?al., 2015; Watts et?al., 2013). In their review of randomized clinical trials for PTSD in military and veteran populations, Steenkamp et?al. (2015) emphasized this disparity and concluded that further refinements of existing PTSD treatments and the development of novel approaches are needed. Repetitive transcranial magnetic stimulation (rTMS) has been tested for efficacy in relieving PTSD symptoms (Kozel, 2018). The results of a meta-analysis by Berlim and Van Den Eynde (2014) demonstrated that rTMS applied to the right dorsolateral prefrontal cortex (dlPFC) resulted in lower levels of PTSD symptoms as assessed by clinicians and, to a greater extent, as reported by the PTSD patients. Osuch et?al. (2009) found that applying low-frequency rTMS to the right dlPFC during patients? imaginal exposure therapy sessions reduced symptoms of hyperarousal. Findings from other studies (e.g., Cohen et?al., 2004; Tillman et?al., 2011) have also shown that interference of right frontal lobe function via rTMS may temporarily attenuate the hyperarousal response in some PTSD patients. Some studies have reported positive effects of rTMS on cognitive domains such as attention (Rektorova et?al., 2005; Vanderhasselt et?al., 2007), processing speed (Curtin et?al., 2019), and executive function/cognitive control (Corlier et?al., 2020), although several studies have reported null and even negative findings (see Guse et?al., 2009; Patel et?al., 2020).
Publisher Copyright:
© 2021 International Society for Traumatic Stress Studies.
PY - 2022/2
Y1 - 2022/2
N2 - Emotional processing and cognitive control are implicated as being dysfunctional in posttraumatic stress disorder (PTSD) and targeted in cognitive processing therapy (CPT), a trauma-focused treatment for PTSD. The N2 event-related potential has been interpreted in the context of emotional processing and cognitive control. In this analysis of secondary outcome measures from a randomized controlled trial, we investigated the latency and amplitude changes of the N2 in responses to task-relevant target tones and task-irrelevant distractor sounds (e.g., a trauma-related gunshot and a trauma-unrelated lion's roar) and the associations between these responses and PTSD symptom changes. United States military veterans (N = 60) diagnosed with combat-related PTSD were randomized to either active or sham repetitive transcranial magnetic stimulation (rTMS) and received a CPT intervention that included a written trauma account element (CPT+A). Participants were tested before and 6 months after protocol completion. Reduction in N2 amplitude to the gunshot stimulus was correlated with reductions in reexperiencing, |r| =.445, and hyperarousal measures, |r| =.364. In addition, in both groups, the latency of the N2 event-related potential to the distractors became longer with treatment and the N2 latency to the task-relevant stimulus became shorter, ηp2 =.064, both of which are consistent with improved cognitive control. There were no between-group differences in N2 amplitude and latency. Normalized N2 latencies, reduced N2 amplitude to threatening distractors, and the correlation between N2 amplitude reduction and PTSD symptom reduction reflect improved cognitive control, consistent with the CPT+A objective of addressing patients’ abilities to respond more appropriately to trauma triggers.
AB - Emotional processing and cognitive control are implicated as being dysfunctional in posttraumatic stress disorder (PTSD) and targeted in cognitive processing therapy (CPT), a trauma-focused treatment for PTSD. The N2 event-related potential has been interpreted in the context of emotional processing and cognitive control. In this analysis of secondary outcome measures from a randomized controlled trial, we investigated the latency and amplitude changes of the N2 in responses to task-relevant target tones and task-irrelevant distractor sounds (e.g., a trauma-related gunshot and a trauma-unrelated lion's roar) and the associations between these responses and PTSD symptom changes. United States military veterans (N = 60) diagnosed with combat-related PTSD were randomized to either active or sham repetitive transcranial magnetic stimulation (rTMS) and received a CPT intervention that included a written trauma account element (CPT+A). Participants were tested before and 6 months after protocol completion. Reduction in N2 amplitude to the gunshot stimulus was correlated with reductions in reexperiencing, |r| =.445, and hyperarousal measures, |r| =.364. In addition, in both groups, the latency of the N2 event-related potential to the distractors became longer with treatment and the N2 latency to the task-relevant stimulus became shorter, ηp2 =.064, both of which are consistent with improved cognitive control. There were no between-group differences in N2 amplitude and latency. Normalized N2 latencies, reduced N2 amplitude to threatening distractors, and the correlation between N2 amplitude reduction and PTSD symptom reduction reflect improved cognitive control, consistent with the CPT+A objective of addressing patients’ abilities to respond more appropriately to trauma triggers.
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U2 - 10.1002/jts.22684
DO - 10.1002/jts.22684
M3 - Article
C2 - 33960006
AN - SCOPUS:85105145833
SN - 0894-9867
VL - 35
SP - 90
EP - 100
JO - Journal of Traumatic Stress
JF - Journal of Traumatic Stress
IS - 1
ER -