Neuroimaging the Impact of Treatment on Neural Substrates of Trust in Post-Traumatic Stress Disorder (PTSD)
Condition: Stress Disorders, Post Traumatic; Trust
MeSH terms: Stress Disorders, Traumatic; Stress Disorders, Post-Traumatic
Study type: Interventional

Summary: 
      Traumatic experiences can have a profound negative effect on the lives and well-being of both
      the people who experience them and their loved ones. For those who experience post-traumatic
      stress disorder (PTSD), their interpersonal difficulties and social support further impact
      the success of treatment such that interpersonal difficulties are associated with mistrust
      and predict poor treatment outcome. In this proposal, the investigators use functional
      neuroimaging to understand the neurobiology of trust and mistrust in people with PTSD and to
      learn more about how successful treatment can improve trust and social functioning.
    

Detailed description: 
      Substantial recent data highlight the role of social functioning as a primary moderator of
      therapeutic response in individuals with post-traumatic stress disorder (PTSD) such that
      interpersonal difficulties and mistrust significantly and negatively impact treatment
      efficacy (Forbes et al., 2003; Forbes et al., 2005; Forbes et al., 2008). In addition, ample
      evidence suggests that psychotherapy improves the social and interpersonal lives of
      psychotherapy clients through improving clients' abilities to regulate their emotions and
      reduce social isolation (Yalom & Leszcz, 2005; Foy et al., 2000). While considerable research
      has been dedicated to exploring the neurobiology of emotional dysregulation associated with
      PTSD (Rauch, Shin, & Phelps, 2006; Etkin & Wager, 2007), and increasing data suggest that
      diverse psychotherapies affect neural functioning (Beauregard 2007), very little is
      understood about the neurobehavioral pathology underlying the debilitating interpersonal
      difficulties in PTSD, or the neurobiological mechanisms accompanying the improvements in
      social functioning that occur with efficacious therapy.

      Thus, the broad goals of this project are two-fold. First, the investigators seek to examine
      the neural substrates associated with interpersonal dysfunction in PTSD using a social
      exchange game previously developed to assess interpersonal trust and cooperation in healthy
      (King-Casas et al., 2005) and psychiatric groups (Chiu et al., 2008; King-Casas et al.,
      2008). Second, the investigators seek to examine changes in neurobehavioral substrates of
      social functioning following treatment for Veterans with PTSD. Specifically, the
      investigators propose to use functional magnetic resonance imaging (fMRI) and behavior within
      a well-characterized Trust Game to examine the neural substrates associated with
      interpersonal trust and cooperation in Veterans with PTSD prior to and following empirically
      supported psychotherapy cognitive processing therapy (CPT) for PTSD.

      Thus, the broad goals of this project are two-fold. First, the investigators seek to examine
      the neural substrates associated with interpersonal dysfunction in PTSD using a social
      exchange game previously developed to assess interpersonal trust and cooperation in healthy
      (King-Casas et al., 2005) and psychiatric groups (Chiu et al., 2008; King-Casas et al.,
      2008). Second, the investigators seek to examine changes in neurobehavioral substrates of
      social functioning following treatment for veterans with PTSD. Specifically, the
      investigators propose to use functional magnetic resonance imaging (fMRI) and behavior within
      a well-characterized Trust Game to examine the neural substrates associated with
      interpersonal trust and cooperation in veterans with PTSD prior to and following empirically
      supported psychotherapy cognitive processing therapy (CPT) for PTSD.
    

Intervention name(s): Group CPT-C
Intervention type(s): Behavioral
Intervention description(s): Participants will be randomly assigned to participate in CPT-C or a 12 week waitlist control group. Waitlist control subjects will participate in CPT-C after the 12 weeks.
Allocation: Randomized
Intervention model: Crossover Assignment
Masking: None (Open Label)
Primary purpose: Basic Science
Keywords: Stress Disorders, Post Traumatic; Trust; functional Magnetic Resonance Imaging (fMRI)