Can Cognitive Behavioral Therapy Heal PTSD?
A study published in an issue of Biological Psychiatry suggests that cognitive-behavioral therapy (CBT) not only helps to reduce symptoms of post-traumatic stress disorder (PTSD), but also reverses the underlying biology of the disorder within the brain.
What Research Says
For the sake of understanding, let’s discuss a couple of important terms used in the study:
• PTSD: Biologically characterized by a reduced expression of FKBP5, a gene that plays a part in regulating stress response. When FKBP5 expression is reduced, prolonged stress hormone activation (cortisol response) follows any exposure to stress. In the genetic sense, people with reduced FKBP5 expression are biologically more susceptible to stress-related psychiatric disorders such as depression, anxiety, and PTSD.
• Hippocampus: Part of the brain involved with long-term memory and one of the first regions of the brain to suffer damage in Alzheimer’s disease. Smaller hippocampal volume has been documented in people with PTSD.
• Amygdala and Medial Orbitofrontal Cortex: Two additional areas of the brain that are involved in fear conditioning.
• Cognitive behavioral therapy (CBT): A type of talk therapy that helps people identify, challenge, and modify dysfunctional automatic negative thoughts and abnormal mental scenarios. People learn how to identify cognitive distortions, find evidences for and against thoughts, create alternatives, and finally reappraise their beliefs about themselves and the trauma by creating a new narrative of the traumatic event. In this study, patients received an educational session about PTSD and then learned to detect their automatic thoughts using daily monitoring and diaries.
The Study: Increased FKBP5 and Hippocampal Volume
Researchers measured FKBP5 expression and volumes of hippocampus, amygdala and medial orbitofrontal cortex (the areas of the brain involved in fear conditioning) in the following groups:
• 39 people with PTSD who participated in CBT – measured at the beginning of treatment and again after.
• 31 trauma-exposed people without PTSD who did not participate in CBT – also measured twice.
Before the Study (Baseline):
The 39 patients with PTSD showed lower FKBP5 gene expression and smaller hippocampal and medial orbitofrontal cortex, but not amygdala (volumes relative to the control group).
After 12 weeks of CBT, researchers found significantly increased FKBP5 expression and increased hippocampal volume, but did not find significant changes in the medial orbitofrontal cortex or amygdala.
You CAN Change Your Brain
The most noteworthy finding of this study was that clinical improvement during CBT in PTSD was associated with increased hippocampal size and elevated FKBP5 gene expression.
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