Changes in functional connectivity of the amygdala during cognitive reappraisal predict symptom reduction during trauma-focused cognitive-behavioral therapy among adolescent girls with post-traumatic stress disorder.

BACKGROUND: While trauma-focused cognitive-behavioral therapy (TF-CBT) is the 'gold standard' treatment for pediatric post-traumatic stress disorder (PTSD), little is known about the neural mechanisms by which TF-CBT produces clinical benefit. Here, we test the hypothesis that PTSD symptom reduction during TF-CBT among adolescent girls with PTSD is associated with changes in patterns of brain functional connectivity (FC) with the amygdala during cognitive reappraisal. METHOD: Adolescent girls with PTSD related to physical or sexual assault (n = 34) were enrolled in TF-CBT, delivered in an approximately 12-session format, in an open trial. Before and after treatment, they were engaged in a cognitive reappraisal task, probing neural mechanisms of explicit emotion regulation, during 3 T functional magnetic resonance imaging. RESULTS: Among adolescent girls completing TF-CBT with usable pre- and post-treatment scans (n = 20), improvements in self-reported emotion from pre- to post-treatment were positively related to improvements in PTSD symptoms. Adolescent girls with greater post-treatment symptom reduction were also able to suppress amygdala-insula FC while re-appraising, which was not evident in girls with less symptom reduction. Pre- to post-treatment changes in right amygdala to left insula FC that scaled with PTSD symptom reduction also scaled with improvements in emotion regulation. CONCLUSIONS: These preliminary results suggest the neurocircuitry mechanisms through which TF-CBT produces clinical outcomes, providing putative brain targets for augmenting TF-CBT response.

A comparison of two multidimensional measures of health status: the Nottingham Health Profile and the RAND 36-Item Health Survey 1.0.

In this study the applicability of two multidimensional instruments, the NHP and the RAND 36-item Health Survey 1.0, for measuring health status in population surveys was examined. A population sample of 1,063 persons aged over 17 years participated in the study. It was shown that, as compared with the NHP, the RAND 36-Item Health Survey 1.0 is a more reliable measure of health status. Second, within a group of subjects who scored 'zero' on the NHP, considerable dispersion in RAND 36-Item Health Survey 1.0 scores was found. For the whole group, no significant differences were found in the amount of variance explained by the corresponding scales from both instruments in the prevalence of chronic diseases. However, among subjects with a zero score on the NHP, the RAND 36-Item Health Survey 1.0 scores were still predictive of the occurrence of chronic diseases. It was concluded that, compared with the NHP, the RAND 36-Item Health Survey 1.0 seems to be a more sensitive instrument for the use in population samples.

Social comparison as a mediator between health problems and subjective health evaluations.

The role of social comparison in mediating the relation between 'objective' health status and subjective health evaluations was examined. In a random population sample (N = 361) it was shown that health problems were related to psychological distress, which in turn induced a downward comparison process. This downward comparison resulted in a perception of being better off than others in a similar situation (relative evaluation). While both health problems and psychological distress had strong direct effects on general health evaluations, relative evaluations explained further significant variance. In addition, it was found that although women reported more psychological and physical problems than men, they engaged more often in downward comparison and consistently felt more than men did that their health was better than that of most others. No gender differences in general health evaluations were found. Interestingly, social comparison had a stronger impact on the general subjective well-being of women than of men.