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Anterior hippocampal volume predicts affect-focused psychotherapy outcome

Published online by Cambridge University Press:  18 February 2019

Benjamin Suarez-Jimenez ,
Xi Zhu ,
Amit Lazarov ,
J. John Mann ,
Franklin Schneier ,
Andrew Gerber ,
Jacques P. Barber ,
Dianne L. Chambless ,
Yuval Neria  and
Barbara Milrod
...Show all authors
Benjamin Suarez-Jimenez
Affiliation:
Columbia University College of Physicians & Surgeons, New York, NY, USA
Xi Zhu
Affiliation:
Columbia University College of Physicians & Surgeons, New York, NY, USA
Amit Lazarov
Affiliation:
Columbia University College of Physicians & Surgeons, New York, NY, USA School of Psychological Sciences, Tel-Aviv University, Tel Aviv, Israel
J. John Mann
Affiliation:
Columbia University College of Physicians & Surgeons, New York, NY, USA New York State Psychiatric Institute, New York, NY, USA
Franklin Schneier
Affiliation:
Columbia University College of Physicians & Surgeons, New York, NY, USA New York State Psychiatric Institute, New York, NY, USA
Andrew Gerber
Affiliation:
Columbia University College of Physicians & Surgeons, New York, NY, USA Silver Hill Hospital, New Canaan, CT, USA
Jacques P. Barber
Affiliation:
Adelphi University, Garden City, NY, USA University of Pennsylvania, Philadelphia, PA, USA
Dianne L. Chambless
Affiliation:
University of Pennsylvania, Philadelphia, PA, USA
Yuval Neria
Affiliation:
Columbia University College of Physicians & Surgeons, New York, NY, USA School of Psychological Sciences, Tel-Aviv University, Tel Aviv, Israel
Barbara Milrod
Affiliation:
Weill Cornell Medical College, New York, NY, USA
John C. Markowitz*
Affiliation:
Columbia University College of Physicians & Surgeons, New York, NY, USA School of Psychological Sciences, Tel-Aviv University, Tel Aviv, Israel
*
Author for correspondence: John C. Markowitz, E-mail: [email protected]
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Abstract

Background

The hippocampus plays an important role in psychopathology and treatment outcome. While posterior hippocampus (PH) may be crucial for the learning process that exposure-based treatments require, affect-focused treatments might preferentially engage anterior hippocampus (AH). Previous studies have distinguished the different functions of these hippocampal sub-regions in memory, learning, and emotional processes, but not in treatment outcome. Examining two independent clinical trials, we hypothesized that anterior hippocampal volume would predict outcome of affect-focused treatment outcome [Interpersonal Psychotherapy (IPT); Panic-Focused Psychodynamic Psychotherapy (PFPP)], whereas posterior hippocampal volume would predict exposure-based treatment outcome [Prolonged Exposure (PE); Cognitive Behavioral Therapy (CBT); Applied Relaxation Training (ART)].

Methods

Thirty-five patients with posttraumatic stress disorder (PTSD) and 24 with panic disorder (PD) underwent structural magnetic resonance imaging (MRI) before randomization to affect-focused (IPT for PTSD; PFPP for PD) or exposure-based treatments (PE for PTSD; CBT or ART for PD). AH and PH volume were regressed with clinical outcome changes.

Results

Baseline whole hippocampal volume did not predict post-treatment clinical severity scores in any treatment. For affect-focused treatments, but not exposure-based treatments, anterior hippocampal volume predicted clinical improvement. Smaller AH correlated with greater affect-focused treatment improvement. Posterior hippocampal volume did not predict treatment outcome.

Conclusions

This is the first study to explore associations between hippocampal volume sub-regions and treatment outcome in PTSD and PD. Convergent results suggest that affect-focused treatment may influence the clinical outcome through the ‘limbic’ AH, whereas exposure-based treatments do not. These preliminary, theory-congruent, therapeutic findings require replication in a larger clinical trial.

Keywords

Anterior hippocampuscognitive behavioral therapy (CBT)interpersonal psychotherapy(IPT)neuroimagingpanic disorderPFPP (Panic-Focused Psychodynamic Psychotherapy)psychodynamic psychotherapyPTSDtreatment
Type
Original Articles
Information
Psychological Medicine , Volume 50 , Issue 3 , February 2020 , pp. 396 - 402
Copyright
Copyright © Cambridge University Press 2019

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Footnotes

*

These authors contributed equally to this paper.

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