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Changes in Brain Electrical Activity After Cognitive Behavioral Therapy for Posttraumatic Stress Disorder in Patients Injured in Motor Vehicle Accidents

From the Biopsychology (S.R., A.K.), Dresden University of Technology, Dresden, Germany; Saxonian Hospital Groβschweidnitz, Germany; Roseneck Hospital (T.Z.), Prien am Chiemsee, Germany; Personality Psychology (A.B.), University of the Federal Armed Forces, Hamburg, Germany; Department of Abnormal Psychology (A.M.), University of Zurich, Zurich, Switzerland; School of Psychology (A.K.), University of Southampton, Southhampton, UK.

Address correspondence and reprint requests to Anke Karl, School of Psychology, University of Southampton, Southampton, SO171BJ, UK. E-mail: karl{at}soton.ac.uk

Objective: To explore changes for the first time in neural processing due to effective cognitive behavioral therapy (CBT) in posttraumatic stress disorder (PTSD) after severe motor vehicle accidents. Recent studies have highlighted the role of right hemisphere activation during withdrawal-related emotions (e.g., anxiety). There has been little research on changes in brain function due to cognitive-behavioral interventions in anxiety disorders.

Methods: We conducted a randomized, controlled trial comparing cognitive-behavioral therapy with an assessment-only Wait-list condition. Spontaneous electroencephalographic activity was recorded from left and right anterior and posterior regions in participants with PTSD/subsyndromal PTSD receiving CBT (n = 17) before and after a CBT program. Wait-list controls (n = 18) were investigated before and after 3 months.

Results: At the pretreatment assessment, a pattern of increased right-sided activation during exposure to a trauma-related picture (relative to a neutral picture) was observed in both CBT and Wait-list participants. At posttreatment, there was a greater reduction of right anterior activation in the CBT group as compared with Wait-list controls. Across both groups, PTSD symptom reduction was significantly positively correlated with a decrease in right anterior activation to the trauma stimulus.

Conclusions: These findings suggest that effective CBT treatment of PTSD may be accompanied by adaptive changes in asymmetrical brain function. Future studies are needed to confirm our findings.

Key Words: cognitive-behavioral therapy • posttraumatic stress disorder • electroencephalography • alpha • asymmetry

Abbreviations: CBT = cognitive behavioral therapy; PTSD = posttraumatic stress disorder; EEG = electroencephalography; MDD = major depression; CAPS = Clinician Administered PTSD Scale; PANAS = Positive and Negative Affective Scale; MANOVA = multivariate analysis of variance.