Brain Imaging of Psychotherapy for Posttraumatic Stress Disorder (PTSD)
Posttraumatic Stress Disorder (PTSD)
About this trial
This is an interventional basic science trial for Posttraumatic Stress Disorder (PTSD) focused on measuring Posttraumatic Stress Disorder (PTSD), Psychotherapy, non-medication treatment, Prolonged Exposure, Transcranial Magnetic Stimulation (TMS), Anxiety Disorders, emotion, emotion regulation, functional MRI, Affective Symptoms
Eligibility Criteria
Inclusion Criteria:
- age between 18 and 60 years;
- fMRI scanning eligibility, including no evidence of any form of metal embedded in the body (e.g., metal wires, nuts, bolts, screws, plates, sutures), as these produce artifacts when brain imaging;
- not currently involved in an exposure-based psychotherapy, in order to be able to measure and interpret the effects of PE on PTSD;
- must comprehend English well and show non-impaired intellectual abilities to ensure adequate comprehension of the fMRI task instructions and PE treatment;
- no history of neurological or cardiovascular disorders, brain surgery, electroconvulsive or radiation treatment, brain hemorrhage or tumor, stroke, seizures or epilepsy, diabetes, hypo- or hyperthyroidism, head trauma with loss of consciousness greater than thirty minutes;
- no regular use of benzodiazepine, opiate, thyroid, anticonvulsant or antipsychotic medications. Patients on stable doses of antidepressant medications will be allowed. Patients for whom antidepressant dosing is being actively titrated will be required to be on a stable dose for 1 month prior to inclusion in the study.
Exclusion Criteria:
- Any contraindication to being scanned in the 3T or 1.5T scanners at the Lucas Center or CNI such as having a pacemaker or implanted device that has not been cleared for scanning at the Lucas Center or CNI.
- Participants will be excluded from the study if there is any lifetime evidence of psychosis, mania, hypomania, or bipolar disorders. Other axis I comorbidities will not be a cause for exclusion.
In addition, subjects will be excluded if they have a significant CNS neurological condition such as stroke, seizure, tumor, hemorrhage, multiple sclerosis, etc.
Patients who have current substance dependence will be excluded from the study. A recent diagnosis of substance abuse is allowable, however, as long as subjects have been abstinent for greater than three months.
- Subjects will be excluded if they are currently in an exposure-based psychotherapy for PTSD.
Sites / Locations
- VA Palo Alto Healthcare System
- Stanford University, Department of Psychiatry
Arms of the Study
Arm 1
Arm 2
Experimental
No Intervention
Immediate Prolonged Exposure Treatment
Wait list, immediately followed by Prolonged Exposure
Intake procedures include clinician-administered diagnostic battery, cognitive testing, self-report measures of symptoms, and functional imaging scan. Participants in this arm will complete a concurrent TMS/fMRI scan before beginning Prolonged Exposure (PE). PE will be delivered in 9-12 90-minute sessions. Therapy will be delivered by PhD-level therapists at Stanford and Palo Alto VA.
Intake procedures include clinician-administered diagnostic battery, cognitive testing, self-report measures of symptoms, and functional imaging scan. NOTE: Participants in this arm receive treatment following a waitlist period of 12 weeks. After waitlist, will have a TMS/fMRI scan and then immediately begin Prolonged Exposure treatment. See above for description of Prolonged Exposure.