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Resting-state connectivity subtype of comorbid PTSD and alcohol use disorder moderates improvement from integrated prolonged exposure therapy in Veterans

Published online by Cambridge University Press:  30 April 2021

Daniel M. Stout ,
Katia M. Harlé ,
Sonya B. Norman ,
Alan N. Simmons  and
Andrea D. Spadoni
Daniel M. Stout*
Affiliation:
Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego, CA, USA Research Service, VA San Diego Healthcare System, San Diego, CA, USA Department of Psychiatry, University of California San Diego, San Diego, CA, USA
Katia M. Harlé
Affiliation:
Research Service, VA San Diego Healthcare System, San Diego, CA, USA Department of Psychiatry, University of California San Diego, San Diego, CA, USA
Sonya B. Norman
Affiliation:
Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego, CA, USA Research Service, VA San Diego Healthcare System, San Diego, CA, USA Department of Psychiatry, University of California San Diego, San Diego, CA, USA National Center for PTSD, White River Junction, Vermont, USA
Alan N. Simmons
Affiliation:
Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego, CA, USA Research Service, VA San Diego Healthcare System, San Diego, CA, USA Department of Psychiatry, University of California San Diego, San Diego, CA, USA
Andrea D. Spadoni
Affiliation:
Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego, CA, USA Research Service, VA San Diego Healthcare System, San Diego, CA, USA Department of Psychiatry, University of California San Diego, San Diego, CA, USA
*
Author for correspondence: Daniel M. Stout, E-mail: dastout@health.ucsd.edu
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Abstract

Background

Posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD) are highly comorbid and are associated with significant functional impairment and inconsistent treatment outcomes. Data-driven subtyping of this clinically heterogeneous patient population and the associated underlying neural mechanisms are highly needed to identify who will benefit from psychotherapy.

Methods

In 53 comorbid PTSD/AUD patients, resting-state functional magnetic resonance imaging was collected prior to undergoing individual psychotherapy. We used a data-driven approach to subgroup patients based on directed connectivity profiles. Connectivity subgroups were compared on clinical measures of PTSD severity and heavy alcohol use collected at pre- and post-treatment.

Results

We identified a subgroup of patients associated with improvement in PTSD symptoms from integrated-prolonged exposure therapy. This subgroup was characterized by lower insula to inferior parietal cortex (IPC) connectivity, higher pregenual anterior cingulate cortex (pgACC) to posterior midcingulate cortex connectivity and a unique pgACC to IPC path. We did not observe any connectivity subgroup that uniquely benefited from integrated-coping skills or subgroups associated with change in alcohol consumption.

Conclusions

Data-driven approaches to characterize PTSD/AUD subtypes have the potential to identify brain network profiles that are implicated in the benefit from psychological interventions – setting the stage for future research that targets these brain circuit communication patterns to boost treatment efficacy.

Keywords

Alcohol use disorderbiomarkersfMRInetwork connectivityPTSDtreatment prediction
Type
Original Article
Information
Psychological Medicine , Volume 53 , Issue 2 , January 2023 , pp. 332 - 341
Creative Commons
This is a work of the US Government and is not subject to copyright protection within the United States. Published by Cambridge University Press
Copyright
Copyright © United States Department of Veterans Affairs, 2021

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