Related Experiment Video
Updated: May 5, 2026
Simultaneous Application of Transcranial Direct Current Stimulation during Virtual Reality Exposure
Published on: January 18, 2021
Can pharmacological and psychological treatment change brain structure and function in PTSD? A systematic review
Kathleen Thomaes1, Ethy Dorrepaal2, Nel Draijer3
1GGZ InGeest/Dept. of Psychiatry, VU University Medical Center (VUmc), Amsterdam, The Netherlands; Neuroscience Campus, Amsterdam, The Netherlands.
Insights
Treatments for posttraumatic stress disorder (PTSD) can improve brain structure, like hippocampus volume. Functional brain changes differ between trauma types, with child abuse-related PTSD showing distinct patterns requiring further study.
Area of Science:
- Neuroscience
- Psychiatry
- Clinical Psychology
Background:
- Posttraumatic stress disorder (PTSD) treatment shows clinical improvement, but neural mechanisms remain unclear.
- Understanding neurophysiological changes in PTSD, particularly from child abuse, is crucial due to developmental brain vulnerability.
- Existing research lacks clarity on whether distinct neural changes occur in PTSD resulting from child abuse versus other trauma types.
Purpose of the Study:
- To systematically review studies on structural and functional brain changes following PTSD treatment.
- To investigate if neurophysiological changes differ between PTSD related to general adult trauma and PTSD specifically linked to child abuse.
- To synthesize findings on pharmacotherapy and psychotherapy effects on brain alterations in PTSD.
Main Methods:
- Systematic literature review of PubMed, EMBASE, PsycINFO, PILOTS, and Cochrane Library databases.
- Inclusion of Randomized Controlled Trials (RCTs) and pre-post design studies on adults with PTSD (partial or full), excluding case studies.
- Standardization of brain coordinates and effect sizes for comparability, with independent risk of bias assessment.
Main Results:
- Pharmacotherapy demonstrated improvement in structural abnormalities, such as increased hippocampus volume, in both adult-trauma and child abuse-related PTSD.
- Functional brain changes varied: adult-trauma PTSD showed decreased amygdala and increased dorsolateral prefrontal activation.
- Child abuse-related PTSD exhibited distinct functional changes, including decreased dorsolateral prefrontal, dorsal anterior cingulate, and insula activation, with no significant amygdala changes in one RCT.
Conclusions:
- Pharmacotherapy may ameliorate structural abnormalities in PTSD, including increased hippocampus volume.
- Psychotherapy appears to modulate neural activity, potentially decreasing amygdala activation and increasing prefrontal and hippocampus activity, linked to emotional regulation.
- Evidence suggests distinct neural activation patterns in child abuse-related PTSD, warranting further empirical investigation.
Abstract:
While there is evidence of clinical improvement of posttraumatic stress disorder (PTSD) with treatment, its neural underpinnings are insufficiently clear. Moreover, it is unknown whether similar neurophysiological changes occur in PTSD specifically after child abuse, given its enduring nature and the developmental vulnerability of the brain during childhood. We systematically reviewed PTSD treatment effect studies on structural and functional brain changes from PubMed, EMBASE, PsycINFO, PILOTS and the Cochrane Library. We included studies on adults with (partial) PTSD in Randomized Controlled Trials (RCT) or pre-post designs (excluding case studies) on pharmacotherapy and psychotherapy. Risk of bias was evaluated independently by two raters. Brain coordinates and effect sizes were standardized for comparability. We included 15 studies (6 RCTs, 9 pre-post), four of which were on child abuse. Results showed that pharmacotherapy improved structural abnormalities (i.e., increased hippocampus volume) in both adult-trauma and child abuse related PTSD (3 pre-post studies). Functional changes were found to distinguish between groups. Adult-trauma PTSD patients showed decreased amygdala and increased dorsolateral prefrontal activations post-treatment (4 RCTs, 5 pre-post studies). In one RCT, child abuse patients showed no changes in the amygdala, but decreased dorsolateral prefrontal, dorsal anterior cingulate and insula activation post-treatment. In conclusion, pharmacotherapy may reduce structural abnormalities in PTSD, while psychotherapy may decrease amygdala activity and increase prefrontal, dorsal anterior cingulate and hippocampus activations, that may relate to extinction learning and re-appraisal. There is some evidence for a distinct activation pattern in child abuse patients, which clearly awaits further empirical testing.
More Related Videos
10:43Developing Neuroimaging Phenotypes of the Default Mode Network in PTSD: Integrating the Resting State, Working Memory, and Structural Connectivity
Published on: July 1, 2014
08:29Biomarkers in an Animal Model for Revealing Neural, Hematologic, and Behavioral Correlates of PTSD
Published on: October 10, 2012
Related Concept Videos
01:27Post-traumatic Stress Disorder
Symptoms and Behavioral Manifestations
A spectrum of distressing symptoms characterizes PTSD. Recurrent flashbacks, where individuals involuntarily relive traumatic events,...
01:30Psychosurgery
Historical Development of Psychosurgery
In the 1930s, Portuguese neurologist Antonio Egas Moniz introduced a surgical procedure designed...
01:24Treatment Strategies for Psychological Disorders
Psychological therapies focus on modifying emotions, thoughts, and behaviors through talking, interpreting, listening, rewarding, challenging, and modeling. Clinical psychologists, counselors, and social workers commonly practice psychotherapy. Clinical...
01:28Drug Therapy
Antianxiety Medications
01:26Psychosis: Goals of Pharmacotherapy