Impact of cognitive behavioural therapy on neural, inflammatory, & autonomic markers in a sample with PTSD and cardiovascular risk: protocol for a pilot randomised controlled trial

Figures & data

Figure 1. Mechanistic model of CVD risk in PTSD.

Note. BP = blood pressure; HR = heart rate; HRV = heart rate variability; NTS = solitary nucleus; RVLM = rostral ventrolateral medulla; SNA = stress-associated neural network activity; vmPFC = ventromedial prefrontal cortex. PTSD leads to alterations in stress-related neural activity, leading to increased inflammation and autonomic dysfunction, which both lead to cardiovascular disease.

Figure 2. Study design overview.

Participant flow through the study.

Table 1. Schedule of study assessments.

	Screener	Baseline	Treatment (12 weeks)	12-Week Visit
Clinical Interview and Medical History
Clinician Administered PTSD Scale-5th Edition (CAPS-5)	X			X
Demographics	X
Self-Report Questionnaires
Life Events Checklist		X		X
PTSD Checklist
Beck Depression Inventory
State-Trait Anxiety Inventory
Health Behavior Questions
Autonomic Function
Heart Rate		X		X
Blood Pressure
Heart Rate Variability
Inflammation
Leukopoiesis		X		X
Arterial Plaque
Inflammation
Neural Activity
Stress-Associated Neural Activity		X		X
MRI-based Brain Measurements

Note. PTSD = posttraumatic stress disorder; MRI = magnetic resonance imaging

Figure 3. Overview of imaging session.

Note. BP = Blood Pressure; ECG = electrocardiogram; FDG = 18F-fluorodeoxyglucose; PET/MRI = positron emission tomography/ magnetic resonance imaging; fMRI = functional magnetic resonance imaging; DTI = diffusion tensor imaging; all neural imaging is performed at rest besides fMRI which is performed with eyes opened with fixation cross and the Hariri task. Timeline of procedures for the 155-minute imaging session. The first 60 minutes of the session includes consent, measure of autonomic function, participant preparation and set-up followed by FDG-PET/MRI brain and peripheral imaging.

Data availability statement

Data sharing not applicable – no new data generated.