PTSD Affect Labeling Study
Condition: Post-traumatic Stress Disorder; Post-Traumatic Stress Disorder, Chronic
MeSH terms: Stress Disorders, Traumatic; Stress Disorders, Post-Traumatic
Study type: Interventional

Summary: 
      The overall goal of this study is to use fMRI and psychophysiological measures to investigate
      a novel strategy involving "Affect Labeling" for improving emotion regulation in PTSD that
      could lead to a new treatment regimen for PTSD.

      Our project has two specific aims. First, the investigators aim to identify a novel neural
      target for possible PTSD intervention by verifying that RVLPFC-based inhibitory processing is
      impaired in PTSD. Second, the investigators will examine whether repeated practice with a
      simple cognitive-emotional task that requires inhibitory processing, namely, affect labeling,
      can strengthen the RVLPFC's ability to down-regulate emotional responses and physiological
      reactivity in PTSD and thereby form the basis of a novel treatment strategy to be developed
      in future studies. Secondary objectives are to examine the extent to which RVLPFC-based
      inhibitory impairments in PTSD are specific to trauma-relevant emotional processing (i.e.,
      trauma-related distress) or extend to other types of inhibitory regulation in general, which
      would have implications for the future study of inhibitory-enhancement-based interventions
      for PTSD.
    

Detailed description: 
      Previous research suggests that individuals with PTSD have impaired RVLPFC- based inhibitory
      regulation. Such deficits would appear to contribute to poor inhibitory regulation of
      emotional responses when faced with trauma-reminders, which represents a core pathological
      mechanism of PTSD.

      However, no previous studies have directly examined RVLPFC-based inhibitory deficits of
      emotional responses in PTSD. Affect labeling is a simple process that involves linguistic
      processing of emotional responses, for example, verbally labeling current feelings as
      "anxious" or "angry", and is an established form of affective inhibitory regulation involving
      RVLPFC down-regulation of amygdala-based affective responses. Therefore, the investigators
      will test whether PTSD is associated with impaired RVLPFC-based emotional inhibitory
      processing compared to healthy control participants by performing fMRI scan while they use
      affect labeling to label their own emotional responses to emotionally-evocative images
      relevant to their trauma. The investigators will then test whether repeated practice with
      affect labeling will "repair" the impaired RVLPFC inhibitory control in PTSD, by
      strengthening the capacity of the RVLPFC to down-regulate amygdala responses. In support of
      this idea, the investigators have previously demonstrated that exposure therapy augmented
      with affect labeling was more effective in reducing fear responses than exposure alone in
      specific phobia (Kircanski et al., 2013). In the present study, following the initial
      baseline fMRI scan mentioned above, participants with PTSD will complete three weeks of
      affect labeling training and then undergo a second fMRI scan to again assess inhibitory
      regulation capacity.

      The investigators hypothesize that, compared to healthy (without PTSD) subjects, participants
      with PTSD will exhibit less RVLPFC activity, more amygdala activity (i.e., less amygdala
      deactivation), as well as less inverse correlation between the RVLPFC and the amygdala at
      baseline, reflecting impaired inhibitory regulation. In addition, the investigators
      hypothesize that participants will exhibit increased physiological reactivity compared to
      healthy control subjects.

      The investigators also hypothesize that affect labeling training will lead to increased
      inhibitory regulation success, which will be reflected by increased RVLPFC activity,
      decreased amygdala activity, increased inverse connectivity between RVLPFC and amygdala from
      pre to post training. The results from this initial effort will form the foundation for
      future studies examining affect labeling training as a bona fide treatment strategy for PTSD.
    

Intervention name(s): Affect Labeling Training
Intervention type(s): Behavioral
Intervention description(s): (1) Participants will view combat-relevant images and then label the image or how they feel while viewing the image. (2) Participants will view facial expressions and then label the image. (3) Participants will view negative combat- irrelevant images (such as snakes or spiders) and then label the image or how they feel while viewing the image. (4) Participants will complete Go-NoGo trials similar to the fMRI Go-NoGo task described above. Participants will receive all four types of inhibitory training.
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Basic Science