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Heart Rate Responsivity to Script-Driven Imagery in Posttraumatic Stress Disorder: Specificity of Response and Effects of Psychotherapy

From the Centre for Psychological Trauma, Department of Psychiatry (R.J.L.L., E.P.M.v.M., M.J., M.O., B.P.R.G.), de Bascule and Department of Child and Adolescent Psychiatry, Academic Medical Centre (R.J.L.L.), University of Amsterdam, Amsterdam, The Netherlands; Graduate School Neurosciences, Amsterdam, The Netherlands (R.J.L.L.); and Centre for Work-Related Mental Disorders, Altrecht Institute for Mental Health Care, Utrecht, The Netherlands (I.V.E.C.).

Address correspondence and reprint requests to Ramón J. L. Lindauer, MA, MD, Academic Medical Centre, Department of Child and Adolescent Psychiatry, Tafelbergweg 25, 1105 BC Amsterdam, The Netherlands. E-mail: R.J.Lindauer{at}amc.uva.nl; RJL.Lindauer{at}12move.nl

Objective: Previous psychophysiological studies of posttraumatic stress disorder (PTSD) have found heightened physiological responsivity to trauma-specific stimuli, but mostly in combat veterans with high comorbidity rates and with psychiatric medication. Our aim was to investigate psychophysiological responses in two new populations while excluding those confounding influences and to assess the effects of psychotherapy on such responses.

Methods: Thirty-nine subjects with PTSD (24 civilian outpatients and 15 police officers) and 15 trauma-exposed, non-PTSD control subjects underwent psychophysiological assessment while listening to neutral, stressful, and trauma scripts. Psychophysiological measures were heart rate (HR) and blood pressure in combination with subjective anxiety ratings. In a randomized clinical trial, 20 of the civilians were then assigned to treatment or waitlist groups. Psychophysiological assessment was repeated on them after the treatment stage.

Results: Both civilians and police with PTSD showed significantly higher HR responses to trauma scripts than the control subjects. After successful psychotherapy with the civilians, HR responsivity to the trauma scripts was significantly reduced, and it correlated positively with PTSD clinical symptoms.

Conclusions: We confirmed previous findings of heightened psychophysiological responses in PTSD for two new populations while minimizing comorbidity and medication as confounding factors. Successful psychotherapy normalized HR response to trauma imagery.

Key Words: posttraumatic stress disorder • psychophysiology • script-driven imagery • randomized clinical trial • psychotherapy

Abbreviations: BEP = brief eclectic psychotherapy; DBP = diastolic blood pressure; EMDR = eye movement desensitization and reprocessing; EMG = electromyographic; HR = heart rate; M = mean; MANOVA = multivariate analysis of variance; PLES = Police Life Event Scale; PTSD = posttraumatic stress disorder; SBP = systolic blood pressure; SCID = Structured Clinical Interview for DSM-IV; SD = standard deviation; SI-PTSD = Structured Interview for Posttraumatic Stress Disorder; STAI = State-Trait Anxiety Inventory; TG = treatment group; WG = waitlist group.