A new paper published in Biological Psychiatry suggests that cognitive behavioral therapy for posttraumatic stress disorder (PTSD) not only reduces symptoms but also affects the underlying biology of this disorder.

The researchers, led by Dr. Szabolcs Kéri at the National Institute of Psychiatry and Addictions and University of Szeged in Hungary, recruited 39 individuals diagnosed with PTSD to participate in the study. For a comparison group, they also included 31 individuals who had been exposed to trauma, but who did not develop PTSD. The individuals with PTSD then received 12 weeks of cognitive behavioral therapy, whereas the non-PTSD group received no therapy.

Before and after the 12 weeks, the researchers measured the volumes of certain brain regions using magnetic resonance imaging. They also collected blood samples to measure changes in expression of a specific gene, FKBP5, which has been implicated in the risk for developing PTSD and plays a role in regulating stress hormones.

Before therapy, compared with the control group, patients had lower FKBP5 gene expression and smaller hippocampal and medial orbitofrontal cortex volumes, important brain regions involved in learning, memory, and emotion regulation.

At the follow-up appointment 12 weeks later, the PTSD patients showed higher expression of FKBP5 and increased hippocampal volume. More importantly, these changes were directly associated with clinical improvement among the patients. The increased FKBP5 expression, and to a lesser degree the increased hippocampal volume, actually predicted improvement in their PTSD symptoms.

“The results show that structural changes in the brain, such as the shrinkage of the hippocampus, are reversible in trauma victims. Talk therapy may help normalize these alterations and improve symptoms,” explained Kéri. “Furthermore, the regeneration of hippocampus correlated with the expression of a gene that balances the activity of the stress hormone cortisol at the level of cells.”

“This study helps to link the alleviation of PTSD symptoms to improvement in stress-related alterations in the body and brain,” said Dr. John Krystal, Editor of Biological Psychiatry.

Why are these results important? The findings suggest that talk therapy may modulate fundamental biological factors: changes in gene expression, brain structure, and psychological improvement may be closely interrelated. These conclusions highlight even further the importance of early invention in PTSD development and treatment.

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The article is “Association Among Clinical Response, Hippocampal Volume, and FKBP5 Gene Expression in Individuals with Posttraumatic Stress Disorder Receiving Cognitive Behavioral Therapy” by Einat Levy-Gigi, Csilla Szabó, Oguz Kelemen, and Szabolcs Kéri (doi: 10.1016/j.biopsych.2013.05.017). The article appears in Biological Psychiatry, Volume 74, Issue 11 (December 1, 2013), published by Elsevier.

Notes for editors

Full text of the article is available to credentialed journalists upon request; contact Rhiannon Bugno at +1 214 648 0880 or .(JavaScript must be enabled to view this email address). Journalists wishing to interview the authors may contact Szabolcs Kéri at +36 20 448 3530 or .(JavaScript must be enabled to view this email address).

The authors’ affiliations, and disclosures of financial and conflicts of interests are available in the article.

John H. Krystal, M.D., is Chairman of the Department of Psychiatry at the Yale University School of Medicine, Chief of Psychiatry at Yale-New Haven Hospital, and a research psychiatrist at the VA Connecticut Healthcare System. His disclosures of financial and conflicts of interests are available here.

About Biological Psychiatry

Biological Psychiatry is the official journal of the Society of Biological Psychiatry, whose purpose is to promote excellence in scientific research and education in fields that investigate the nature, causes, mechanisms and treatments of disorders of thought, emotion, or behavior. In accord with this mission, this peer-reviewed, rapid-publication, international journal publishes both basic and clinical contributions from all disciplines and research areas relevant to the pathophysiology and treatment of major psychiatric disorders.

The journal publishes novel results of original research which represent an important new lead or significant impact on the field, particularly those addressing genetic and environmental risk factors, neural circuitry and neurochemistry, and important new therapeutic approaches. Reviews and commentaries that focus on topics of current research and interest are also encouraged.

Biological Psychiatry is one of the most selective and highly cited journals in the field of psychiatric neuroscience. It is ranked 4th out of 135 Psychiatry titles and 13th out of 251 Neurosciences titles in the Journal Citations Reports® published by Thomson Reuters. The 2012 Impact Factor score for Biological Psychiatry is 9.247.

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Rhiannon Bugno
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214-648-0880
Elsevier