Using neuroscience to help determine the best treatment plans for patients with psychiatric conditions -- everything from depression to anxiety to bipolar disorder -- is a growing area of research in a field that is in desperately in need of better treatments for patients.
In a recent such study out of Stanford I wrote about how brain scans can help determine whether a patient with depression will respond to antidepressants, thus preventing wasted time and suffering on trying a treatment that’s not going to work.
Now, in a new pair of studies published in The American Journal of Psychiatry, Stanford researchers used brain scans to help show whether a patient with post traumatic stress disorder will respond to a method of psychotherapy often used to treat the disorder. In a press release, science writer Emma Hiolski quotes senior author Amit Etkin, MD, PhD, about the importance of these studies:
These findings put a place marker in our understanding of psychotherapy writ large. We can really put psychiatric disorders on the map in terms of hard science and help fight the stigma that surrounds these illnesses and their treatment. Within the field of PTSD, it gives a concrete sense of hope for people undergoing treatment and starts laying the groundwork for new treatments based on understanding brain circuitry.
PTSD — a mental disorder caused by traumatic events, such as those experienced in battle or through childhood trauma — is particularly difficult to treat. Patients will suffer prolonged anxiety and depression, recurring nightmares. Often, they avoid situations, noisy crowds, dark movie theaters, that trigger reminders of the traumatic events. About 7 percent of people in the U.S. will suffer from PTSD at some point, according to the National Institutes of Mental Health.
Prolonged exposure therapy, a type of psychotherapy that slowly exposes patients to these "triggers" through a series of sessions that are designed to help them revisit the traumatic events can over time allow the brain to reduce these emotional triggers. Obviously, it’s often a painful treatment that, if not helpful, most patients would rather not go through. And it doesn’t work for everyone; as Etkin says in the press release, "not all PTSD patients derive benefit from the treatment, and about a third drop out of the arduous process. About two-thirds of patients receiving prolonged exposure therapy see a 50 percent reduction in symptoms, and 40 percent of them achieve remission."
To help determine which patients will respond to the treatment, Etkin and colleagues used functional magnetic resonance imaging to measure the brain activity of 66 patients diagnosed with PTSD. After the initial brain imaging, about half the participants underwent nine to 12 sessions of prolonged exposure therapy; the remainder did not. By studying how the brain responded to emotional regulation and processing prior to treatment or no treatment, researchers were able to predict with 95.5 percent accuracy which patients found prolonged exposure therapy helpful.
One of the lead authors of the study, former Stanford postdoctoral scholar Madeleine Goodkind, PhD, commented on why the findings are exciting: "Not only could it provide a ray of hope for patients who would benefit from prolonged exposure to make it through the tough course, it means patients who wouldn’t derive a benefit wouldn’t have to start the treatment."
Previously: Using brain scans and personal history to predict best antidepressant choice, Stanford brain scientist’s quest to personalize mental health care, and Stanford bioengineer uses his experience in Iraq to improve research of tbi and PTSD
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