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Study Protocol

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

Impacto de la terapia cognitivo-conductual en marcadores neuronales, inflamatorios y autonómicos en una muestra con TEPT y riesgo cardiovascular: protocolo para un ensayo piloto aleatorizado y controlado.

ORCID Icon, , , , &
Article: 2378618 | Received 08 May 2024, Accepted 02 Jul 2024, Published online: 24 Jul 2024

References

  • Abdallah, C. G., Averill, C. L., Ramage, A. E., Averill, L. A., Alkin, E., Nemati, S., Krystal, J. H., Roache, J. D., Patricia, A. R., Young-McCaughan, S., Peterson, A. L., & Fox, P. (2019). Reduced salience and enhanced central executive connectivity following PTSD treatment. Chronic Stress, 3, 247054701983897. https://doi.org/10.1177/2470547019838971
  • Asmundson, G. J. G., Thorisdottir, A. S., Roden-Foreman, J. W., Baird, S. O., Witcraft, S. M., Stein, A. T., Smits, J. A. J., & Powers, M. B. (2019). A meta-analytic review of cognitive processing therapy for adults with posttraumatic stress disorder. Cognitive Behaviour Therapy, 48(1), 1–14. https://doi.org/10.1080/16506073.2018.1522371
  • Association AP. (2013). DSM-5 the diagnostic and statistical manual of mental disorders. (5th ed.). American Psychiatric Publishing.
  • Aupperle, R. L., Allard, C. B., Simmons, A. N., Flagan, T., Thorp, S. R., Norman, S. B., Paulus, M. P., & Stein, M. B. (2013). Neural responses during emotional processing before and after cognitive trauma therapy for battered women. Psychiatry Research: Neuroimaging, 214(1), 48–55. https://doi.org/10.1016/j.pscychresns.2013.05.001
  • Beck, A. T., Steer, R. A., & Brown, G. (1996). Beck Depression Inventory–II. PsycTESTS Dataset. Published online 1996.
  • Benjamin, E. J., Muntner, P., Alonso, A., Bittencourt, M. S., Callaway, C. W., Carson, A. P., Chamberlain, A. M., Chang, A. R., Cheng, S., Das, S. R., Delling, F. N., Djousse, L., Elkind, M. S. V., Ferguson, J. F., Fornage, M., Jordan, L. C., Khan, S. S., Kissela, B. M., Knutson, K. L., … Virani, S. S. (2019). Heart disease and stroke statistics—2019 update: A report from the American Heart Association. Circulation, 139(10), e56–e528. https://doi.org/10.1161/CIR.0000000000000659
  • Booth, M. (2000). Assessment of physical activity: An international perspective. Research Quarterly for Exercise and Sport, 71(Suppl 2), 114–120. https://doi.org/10.1080/02701367.2000.11082794
  • Bourassa, K. J., Hendrickson, R. C., Reger, G. M., & Norr, A. M. (2021). Posttraumatic stress disorder treatment effects on cardiovascular physiology: A systematic review and agenda for future research. Journal of Traumatic Stress, 34(2), 384–393. https://doi.org/10.1002/jts.22637
  • Brudey, C., Park, J., Wiaderkiewicz, J., Kobayashi, I., Mellman, T. A., & Marvar, P. J. (2015). Autonomic and inflammatory consequences of posttraumatic stress disorder and the link to cardiovascular disease. American Journal of Physiology-Regulatory, Integrative and Comparative Physiology, 309(4), R315–R321. https://doi.org/10.1152/ajpregu.00343.2014
  • Buckley, T. C., & Kaloupek, D. G. (2001). A meta-analytic examination of basal cardiovascular activity in posttraumatic stress disorder. Psychosomatic Medicine, 63(4), 585–594. https://doi.org/10.1097/00006842-200107000-00011
  • Buysse, D. J., Reynolds, C. F., Monk, T. H., Berman, S. R., & Kupfer, D. J. (1989). The Pittsburgh Sleep Quality Index: A new instrument for psychiatric practice and research. Psychiatry Research, 28(2), 193–213. https://doi.org/10.1016/0165-1781(89)90047-4
  • Byers, A. L., Covinsky, K. E., Neylan, T. C., & Yaffe, K. (2014). Chronicity of posttraumatic stress disorder and risk of disability in older persons. JAMA Psychiatry, 71(5), 540–546. https://doi.org/10.1001/jamapsychiatry.2014.5
  • Cecelja, M., & Chowienczyk, P. (2012). Role of arterial stiffness in cardiovascular disease. JRSM Cardiovascular Disease, 1(4), 1–10. https://doi.org/10.1258/cvd.2012.012016
  • Centers for Disease Control and Prevention, National Center for Health Statistics. (2021). About multiple cause of death, 1999–2020. CDC WONDER Online Database website.
  • Chen, Y., Shen, Q., Lichtenstein, P., Gradus, J. L., Arnberg, F. K., Larsson, H., D’Onofrio, B. M., Fang, F., Song, H., & Valdimarsdottir, U. A. (2024). Incidence trajectories of psychiatric disorders after assault, injury, and bereavement. JAMA Psychiatry, 81(4), 374–385. https://doi.org/10.1001/jamapsychiatry.2023.5156
  • Dickstein, B. D., Walter, K. H., Schumm, J. A., & Chard, K. M. (2013). Comparing response to cognitive processing therapy in military veterans with subthreshold and threshold posttraumatic stress disorder. Journal of Traumatic Stress, 26(6), 703–709. https://doi.org/10.1002/jts.21869
  • Edmondson, D., & Cohen, B. E. (2013). Posttraumatic stress disorder and cardiovascular disease. Progress in Cardiovascular Diseases, 55(6), 548–556. https://doi.org/10.1016/j.pcad.2013.03.004
  • Edmondson, D., & Känel, R. (2017). Post-traumatic stress disorder and cardiovascular disease. The Lancet Psychiatry, 4(4), 320–329. https://doi.org/10.1016/S2215-0366(16)30377-7
  • Ehlers, A., Suendermann, O., Boellinghaus, I., Vossbeck-Elsebusch, A., Gamer, M., Briddon, E., Martin, M. W., & Glucksman, E. (2010). Heart rate responses to standardized trauma-related pictures in acute posttraumatic stress disorder. International Journal of Psychophysiology, 78(1), 27–34. https://doi.org/10.1016/j.ijpsycho.2010.04.009
  • Emami, H., Singh, P., & MacNabb, M. (2015). Splenic metabolic activity predicts risk of future cardiovascular events. JACC: Cardiovascular Imaging, 8(2), 121–130. https://doi.org/10.1016/j.jcmg.2014.10.009
  • Finley, E. P., Mader, M., Haro, E. K., Noël, P. H., Bernardy, N., Rosen, C. S., Bollinger, M., Garcia, H. A., Sherrieb, K., & Pugh, M. J. V. (2019). Use of guideline-recommended treatments for PTSD among community-based providers in Texas and Vermont: Implications for the veterans choice program. The Journal of Behavioral Health Services & Research, 46(2), 217–233. https://doi.org/10.1007/s11414-018-9613-z
  • Foa, E. B., Hembree, E., & Rothbaum, B. (2007). Prolonged exposure therapy for PTSD: Therapist guide: Emotional processing of traumatic experiences. Oxford University Press. https://doi.org/10.1093/med:psych/9780195308501.001.0001
  • Gan, W., Buxton, J., Scheuermeyer, F., Palis, H., Zhao, B., Desai, R., Janjua, N. Z., & Slaunwhite, A. K. (2021). Risk of cardiovascular diseases in relation to substance use disorders. Drug and Alcohol Dependence, 229, 109132. https://doi.org/10.1016/j.drugalcdep.2021.109132
  • Ge, F., Yuan, M., Li, Y., & Zhang, W. (2020). Posttraumatic stress disorder and alterations in resting heart rate variability: A systematic review and meta-analysis. Psychiatry Investigation, 17(1), 9–20. https://doi.org/10.30773/pi.2019.0112
  • Gharios, C., Van Leent, M. M. T., Chang, H. L., Abohashem, S., O’Connor, D., Osborne, M. T., Tang, C. Y., Kaufman, A. E., Robson, P. M., Ramachandran, S., Calcagno, C., Mani, V., Trivieri, M. G., Seligowski, A. V., Dekel, S., Mulder, W. J. M., Murrough, J. W., Shin, L. M., Tawakol, A., & Fayad, Z. A. (2024). Cortico-limbic interactions and carotid atherosclerotic burden during chronic stress exposure. European Heart Journal, 45(19), 1753–1764. https://doi.org/10.1093/eurheartj/ehae149
  • Goldstein, R. B., Smith, S. M., Chou, S. P., Saha, T. D., Jung, J., Zhang, H., Pickering, R. P., Ruan, W. J., Huang, B., & Grant, B. F. (2016). The epidemiology of DSM-5 posttraumatic stress disorder in the United States: Results from the National Epidemiologic Survey on Alcohol and Related Conditions-III. Social Psychiatry and Psychiatric Epidemiology, 51(8), 1137–1148. https://doi.org/10.1007/s00127-016-1208-5
  • Hariri, A. R., Bookheimer, S. Y., & Mazziotta, J. C. (2000). Modulating emotional responses. NeuroReport, 11(1), 43. https://doi.org/10.1097/00001756-200001170-00009
  • Held, P., Coleman, J. A., & Petrey, K. (2022). A case series examining PTSD and depression symptom reductions over the course of a 2-week virtual intensive PTSD treatment program for veterans. Psychological Trauma: Theory, Research, Practice, and Policy, 14(4), 615–623. https://doi.org/10.1037/tra0001106
  • Held, P., Kovacevic, M., & Petrey, K. (2022). Treating posttraumatic stress disorder at home in a single week using 1-week virtual massed cognitive processing therapy. Journal of Traumatic Stress, 35(4), 1215–1225. https://doi.org/10.1002/jts.22831
  • Helpman, L., Marin, M. F., Papini, S., Zhu, X., Sullivan, G. M., Schneier, F., Neria, M., Shvil, E., Malaga Aragon, M. J., Markowitz, J. C., Lindquist, M. A., Wager, T. D., Milad, M. R., & Neria, Y. (2016). Neural changes in extinction recall following prolonged exposure treatment for PTSD: A longitudinal fMRI study. NeuroImage: Clinical, 12, 715–723. https://doi.org/10.1016/j.nicl.2016.10.007
  • Hendrickson, R. C., & Raskind, M. A. (2016). Noradrenergic dysregulation in the pathophysiology of PTSD. Experimental Neurology, 284, 181–195. https://doi.org/10.1016/j.expneurol.2016.05.014
  • Jovanovic, T., Norrholm, S. D., Sakoman, A. J., Esterajher, S., & Kozarić-Kovačić, D. (2009). Altered resting psychophysiology and startle response in Croatian combat veterans with PTSD. International Journal of Psychophysiology, 71(3), 264–268. https://doi.org/10.1016/j.ijpsycho.2008.10.007
  • Kessler, R. C., Sonnega, A., Bromet, E., Hughes, M., & Nelson, C. B. (1995). Posttraumatic stress disorder in the National Comorbidity Survey. Archives of General Psychiatry, 52(12), 1048–1060. https://doi.org/10.1001/archpsyc.1995.03950240066012
  • Kim, T. D., Lee, S., & Yoon, S. (2020). Inflammation in Post-Traumatic Stress Disorder (PTSD): A review of potential correlates of PTSD with a neurological perspective. Antioxidants, 9(2), 107. https://doi.org/10.3390/antiox9020107
  • Klein, A. B., Schnurr, P. P., Bovin, M. J., Friedman, M. J., Keane, T. M., & Marx, B. P. (2024). An empirical investigation of definitions of subthreshold posttraumatic stress disorder. Journal of Traumatic Stress, 37(1), 113–125. https://doi.org/10.1002/jts.22987
  • Kline, A. C., Cooper, A. A., Rytwinksi, N. K., & Feeny, N. C. (2018). Long-term efficacy of psychotherapy for posttraumatic stress disorder: A meta-analysis of randomized controlled trials. Clinical Psychology Review, 59, 30–40. https://doi.org/10.1016/j.cpr.2017.10.009
  • Lima, B. B., Hammadah, M., Wilmot, K., Pearce, B. D., Shah, A., & Levantsevych, O. (2019). Posttraumatic stress disorder is associated with enhanced interleukin-6 response to mental stress in subjects with a recent myocardial infarction. Brain, Behavior, and Immunity, 75, 26–33. https://doi.org/10.1016/j.bbi.2018.08.015
  • Manthey, A., Sierk, A., Brakemeier, E. L., Walter, H., & Daniels, J. K. (2021). Does trauma-focused psychotherapy change the brain? A systematic review of neural correlates of therapeutic gains in PTSD. European Journal of Psychotraumatology, 12(1), 1929025. https://doi.org/10.1080/20008198.2021.1929025
  • McCarty, R. (2016). Chapter 4 – the fight-or-flight response: A cornerstone of stress research. In G. Fink (Ed.), Stress: Concepts, cognition, emotion, and behavior (pp. 33–37). Academic Press. https://doi.org/10.1016/B978-0-12-800951-2.00004-2
  • Moon, E., Lee, S. H., Kim, D. H., & Hwang, B. (2013). Comparative study of heart rate variability in patients with schizophrenia, bipolar disorder, post-traumatic stress disorder, or major depressive disorder. Clinical Psychopharmacology and Neuroscience, 11(3), 137–143. https://doi.org/10.9758/cpn.2013.11.3.137
  • O’Donovan, A., Neylan, T. C., Metzler, T., & Cohen, B. E. (2012). Lifetime exposure to traumatic psychological stress is associated with elevated inflammation in the Heart and Soul Study. Brain, Behavior, and Immunity, 26(4), 642–649. https://doi.org/10.1016/j.bbi.2012.02.003
  • Osborne, M. T., Abohashem, S., Zureigat, H., Abbasi, T. A., & Tawakol, A. (2021). Multimodality molecular imaging: Gaining insights into the mechanisms linking chronic stress to cardiovascular disease. Journal of Nuclear Cardiology, 28(3), 955–966. https://doi.org/10.1007/s12350-020-02424-6
  • Pietrzak, R. H., Goldstein, R. B., Southwick, S. M., & Grant, B. F. (2011). Prevalence and Axis I comorbidity of full and partial posttraumatic stress disorder in the United States: Results from Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions. Journal of Anxiety Disorders, 25(3), 456–465. https://doi.org/10.1016/j.janxdis.2010.11.010
  • Radfar, A., Abohashem, S., Osborne, M. T., Wang, Y., Dar, T., Hassan, M. Z. O., Ghoneem, A., Naddaf, N., Patrich, T., Abbasi, T., Zureigat, H., Jaffer, J., Ghazi, P., Scott, J. A., Shin, L. M., Pitman, R. K., Neilan, T. G., Wood, M. J., & Tawakol, A. (2021). Stress-associated neurobiological activity associates with the risk for and timing of subsequent Takotsubo syndrome. European Heart Journal, 42(19), 1898–1908. https://doi.org/10.1093/eurheartj/ehab029
  • Resick, P. A., Monson, C. M., & Chard, K. M. (2017). Cognitive processing therapy for PTSD: A comprehensive manual. Guilford Press.
  • Richards, L. K., Bui, E., Charney, M., Hayes, K. C., Baier, A. L., Rauch, P. K., Allard, M., & Simon, N. M. (2017). Treating veterans and military families: Evidence based practices and training needs among community clinicians. Community Mental Health Journal, 53(2), 215–223. https://doi.org/10.1007/s10597-016-0013-7
  • Ruparelia, N., Chai, J. T., Fisher, E. A., & Choudhury, R. P. (2017). Inflammatory processes in cardiovascular disease: A route to targeted therapies. Nature Reviews Cardiology, 14(3), 133–144. https://doi.org/10.1038/nrcardio.2016.185
  • Santarnecchi, E., Bossini, L., Vatti, G., Fagiolini, A., La Porta, P., Di Lorenzo, G., Siracusano, A., Rossi, S., & Rossi, A. (2019). Psychological and brain connectivity changes following trauma-focused CBT and EMDR treatment in single-episode PTSD patients. Frontiers in Psychology, 10, 129. https://doi.org/10.3389/fpsyg.2019.00129
  • Schaefer, S. M., Abercrombie, H. C., Lindgren, K. A., Larson, C. L., Ward, R. T., Oakes, T. R., Holden, J. E., Perlman, S. B., Turski, P. A., & Davidson, R. J. (2000). Six-month test-retest reliability of MRI-defined PET measures of regional cerebral glucose metabolic rate in selected subcortical structures. Human Brain Mapping, 10(1), 1–9. https://doi.org/10.1002/(SICI)1097-0193(200005)10:1<1::AID-HBM10>3.0.CO;2-O
  • Schneider, M., & Schwerdtfeger, A. (2020). Autonomic dysfunction in posttraumatic stress disorder indexed by Heart Rate Variability: A meta-analysis. Psychological Medicine, 50(12), 1937–1948. https://doi.org/10.1017/S003329172000207X
  • Seligowski, A. V., Grewal, S. S., Abohashem, S., Zureigat, H., Qamar, I., Aldosoky, W., Gharios, C., Hanlon, E., Alani, O., Bollepalli, S. C., Armoundas, A., Fayad, Z. A., Shin, L. M., Osborne, M. T., & Tawakol, A. (2024). PTSD increases risk for major adverse cardiovascular events through neural and cardio-inflammatory pathways. Brain, Behavior, and Immunity, 117, 149–154. https://doi.org/10.1016/j.bbi.2024.01.006
  • Seligowski, A. V., Steuber, E. R., Hinrichs, R., Reda, M. H., Wiltshire, C. N., Wanna, C. P., Winters, S. J., Phillips, K. A., House, S. L., Beaudoin, F. L., An, X., Stevens, J. S., Zeng, D., Neylan, T. C., Clifford, G. D., Linnstaedt, S. D., Germine, L. T., Bollen, K. A., Guffanti, G., … Jovanovic, T. (2021). A prospective examination of sex differences in posttraumatic autonomic functioning. Neurobiology of Stress, 15, 100384. https://doi.org/10.1016/j.ynstr.2021.100384
  • Shin, L. M., Orr, S. P., Carson, M. A., Rauch, S. L., Macklin, M. L., Lasko, N. B., Peters, P. M., Metzger, L. J., Dougherty, D. D., Cannistraro, P. A., Alpert, N. M., Fischman, A. J., & Pitman, R. K. (2004). Regional cerebral blood flow in the amygdala and medial prefrontal cortex during traumatic imagery in male and female Vietnam veterans With PTSD. Archives of General Psychiatry, 61(2), 168–176. https://doi.org/10.1001/archpsyc.61.2.168
  • Shin, L. M., Wright, C. I., Cannistraro, P. A., Wedig, M. M., McMullin, K., Martis, B., Macklin, M. L., Lasko, N. B., Cavanagh, S. R., Krangel, T. S., Orr, S. P., Pitman, R. K., Whalen, P. J., & Rauch, S. L. (2005). A functional magnetic resonance imaging study of amygdala and medial prefrontal cortex responses to overtly presented fearful faces in posttraumatic stress disorder. Archives of General Psychiatry, 62(3), 273–281. https://doi.org/10.1001/archpsyc.62.3.273
  • Spielberger, C. D. (1983). State-Trait Anxiety Inventory for adults. PsycTESTS Dataset. Published online 1983.
  • Stevens, J. S., Jovanovic, T., Fani, N., Ely, T. D., Glover, E. M., Bradley, B., & Ressler, K. J. (2013). Disrupted amygdala-prefrontal functional connectivity in civilian women with posttraumatic stress disorder. Journal of Psychiatric Research, 47(10), 1469–1478. https://doi.org/10.1016/j.jpsychires.2013.05.031
  • Sumner, J. A., Nishimi, K. M., Koenen, K. C., Roberts, A. L., & Kubzansky, L. D. (2020). Posttraumatic stress disorder and inflammation: Untangling issues of bidirectionality. Biological Psychiatry, 87(10), 885–897. https://doi.org/10.1016/j.biopsych.2019.11.005
  • Task Force of the European Society of Cardiology the North A E. (1996). Heart rate variability. Circulation, 93(5), 1043–1065. https://doi.org/10.1161/01.CIR.93.5.1043
  • Tawakol, A., Fayad, Z. A., Mogg, R., Alon, A., Klimas, M. T., Dansky, H., Subramanian, S. S., Abdelbaky, A., Rudd, J. H. F., Farkouh, M. E., Nunes, I. O., Beals, C. R., & Shankar, S. S. (2013). Intensification of statin therapy results in a rapid reduction in atherosclerotic inflammation. Journal of the American College of Cardiology, 62(10), 909–917. https://doi.org/10.1016/j.jacc.2013.04.066
  • Tawakol, A., Ishai, A., Takx, R. A., Figueroa, A. L., Ali, A., Kaiser, Y., Truong, Q. A., Solomon, C. J., Calcagno, C., Mani, V., Tang, C. Y., Mulder, W. J., Murrough, J. W., Hoffmann, U., Nahrendorf, M., Shin, L. M., Fayad, Z. A., & Pitman, R. K. (2017). Relation between resting amygdalar activity and cardiovascular events: A longitudinal and cohort study. The Lancet, 389(10071), 834–845. https://doi.org/10.1016/S0140-6736(16)31714-7
  • VA/DoD Clinical Practice Guideline. (2023). Management of posttraumatic stress disorder and acute stress disorder work group. U.S. Government Printing Office.
  • Watkins, L. L., LoSavio, S. T., Calhoun, P., Resick, P. A., Sherwood, A., Coffman, C. J., Kirby, A. C., Beaver, T. A., Dennis, M. F., & Beckham, J. C. (2023). Effect of cognitive processing therapy on markers of cardiovascular risk in posttraumatic stress disorder patients: A randomized clinical trial. Journal of Psychosomatic Research, 170, 111351. https://doi.org/10.1016/j.jpsychores.2023.111351
  • Watts, B. V., Schnurr, P. P., Mayo, L., Young-Xu, Y., Weeks, W. B., & Friedman, M. J. (2013). Meta-analysis of the efficacy of treatments for posttraumatic stress disorder. The Journal of Clinical Psychiatry, 74(6), e541–e550. https://doi.org/10.4088/JCP.12r08225
  • Weathers, F. W., Blake, D. D., Schnurr, P. P., Kaloupek, D. G., Marx, B. P., & Keane, T. M. (2013). The Life Events Checklist for DSM-5 (LEC-5). Instrument available from the National Center for PTSD. www.ptsd.va.gov.
  • Weathers, F. W., Blake, D. D., Schnurr, P. P., Kaloupek, D. G., Marx, B. P., & Keane, T. M. (2013). The Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) [Assessment]. Published online 2013. www.ptsd.va.gov.
  • Weathers, F. W., Litz, B. T., Keane, T. M., Palmieri, P. A., Marx, B. P., & Schnurr, P. P. (2013). The PTSD checklist for DSM-5 (PCL-5). Published online 2013. www.ptsd.va.gov.
  • Williams, L. M., Kemp, A. H., Felmingham, K., Barton, M., Olivieri, G., Peduto, A., Gordon, E., & Bryant, R. A. (2006). Trauma modulates amygdala and medial prefrontal responses to consciously attended fear. Neuroimage, 29(2), 347–357. https://doi.org/10.1016/j.neuroimage.2005.03.047
  • Zhu, X., Suarez-Jimenez, B., Lazarov, A., Helpman, L., Papini, S., Lowell, A., Durosky, A., Lindquist, M. A., Markowitz, J. C., Schneier, F., Wager, T. D., & Neria, Y. (2018). Exposure-based therapy changes amygdala and hippocampus resting-state functional connectivity in patients with posttraumatic stress disorder. Depression and Anxiety, 35(10), 974–984. https://doi.org/10.1002/da.22816