Functional connectivity changes in the delta frequency band following trauma treatment in complex trauma and dissociative disorder patients

Yolanda R Schlumpf, Ellert R S Nijenhuis, Carina Klein, Lutz Jäncke, Silke Bachmann, Yolanda R Schlumpf, Ellert R S Nijenhuis, Carina Klein, Lutz Jäncke, Silke Bachmann

Abstract

Objective: Phase-oriented trauma treatment is efficacious in the treatment of complex trauma and dissociative disorder patients. However, the neural correlates of this therapeutic effect are not yet well-understood. In the current study we investigated whether patients show a strengthening in functional network connectivity in the delta frequency band (1-3.5 Hz) over the course of phase-oriented inpatient trauma treatment while they performed an emotion regulation task. Further, we examined whether neural changes were associated with symptom reduction and improvement in emotion regulation skills.

Methods: Before and after 8 weeks of treatment, electroencephalography (EEG) was acquired in patients (n = 28) with a complex posttraumatic stress disorder (cPTSD) or complex dissociative disorder (CDD). They also completed clinical and emotion regulation questionnaires. To delimit data variability, patients participated as one dissociative part that is referred to as Apparently Normal Part (ANP). Patients' data were compared to a matched healthy control croup (n = 38), also measured twice.

Results: Prior to treatment, functional connectivity was significantly lower in patients compared to controls during cognitive reappraisal of unpleasant pictures and passive viewing of unpleasant and neutral pictures. These hypoconnected networks largely overlapped with networks typically activated during the recall of (emotional) autobiographical memories. Functional connectivity strength within these networks significantly increased following treatment and was comparable to controls. Patients showed symptom reduction across various clinical domains and improvement in the use of cognitive reappraisal as emotion regulation strategy. Treatment-related network normalizations were not related to changes in questionnaire data.

Conclusion: Phase-oriented treatment may strengthen connections between regions that are activated during autobiographical recall. These findings encourage further investigation of this circuitry as a therapeutic target in cPTSD and CDD patients.

Clinial trial registration: www.ClinicalTrials.gov, identifier: NCT02459340, https://www.kofam.ch/de/studienportal/suche/149284/studie/26681.

Keywords: complex trauma; dissociation; electroencephalography; functional connectivity; trauma treatment.

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Copyright © 2022 Schlumpf, Nijenhuis, Klein, Jäncke and Bachmann.

Figures

Figure 1
Figure 1
Schematic representation of an example trial in each condition. A horizontal arrow or a vertical arrow pointing downwards indicate that the individual has to naturally respond to or to reduce the emotional reaction to an upcoming picture, respectively. (A) Depicts trials that use unpleasant images, (B) depicts trials that use neutral object or neutral human pictures. From “Functional reorganization of neural networks involved in emotion regulation following trauma therapy for complex trauma disorders” by Schlumpf et al. (27). CC BY-NC-ND 4.0.
Figure 2
Figure 2
Functional connectivity increase in the delta frequency band over the course of treatment within the initially reduced network in the patient group (group x time point interaction) in the (A) NeutralObjectNatural, (B) NeutralHumanNatural, (C) UnpleasantNatural, and (D) UnpleasantDownregulation condition. Red dots display nodes, the gray lines correspond to the connections (edges). The thickness of a line expresses the significance (t-value) of a connection (p < 0.05, FWE corrected). Inter- and intrahemispheric connections are shown in left, right, horizontal, and coronal slices. A, anterior; L, left; R, right.

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