A study of brainspotting therapy in PTSD using 18FDG brain PET scan to evaluate glucose metabolism changes

Mariana Foo; Ryan Yudistiro

doi:10.24036/02022114121548-0-00

A study of brainspotting therapy in PTSD using 18FDG brain PET scan to evaluate glucose metabolism changes

Mariana Foo⁽¹⁾, Ryan Yudistiro⁽²⁾,
(1) University Pelita Harapan

Indonesia
(2) Siloam Hospitals

Indonesia

Corresponding Author
Copyright (c) 2023 Mariana Foo, Ryan Yudistiro

DOI : https://doi.org/10.24036/02022114121548-0-00

Full Text:

Language : en

Abstract

Post Traumatic Stress Disorder (PTSD) is a psychiatric and neurological disorder characterized by repeating experiences, avoidance, and hyperarousal. Brainspotting therapy (BSP) is a new body and brain treatment that claims to be effective in treating trauma and providing access to the brain. However, limited trials using neuroimaging have been done. A single-subject pretest-posttest design was applied in this study with two subjects (n = 1 PTSD; n = 1 Healthy Control; HC). Thirty sessions with online BSP were given to the PTSD subjects. 18FDG PET measurements and clinical assessment using HAM-A, DASS, and PCL-5 were taken for both subjects before and after treatment. The SDMAC value of brain 18FDG PET derived from NeuroQTMsoftware was used quantitatively between the PTSD and HC subjects to evaluate the glucose metabolism level of the mid-frontal cortex (MFC) and medial temporal cortex(MTC), which is associated with PTSD. Measurements taken post-treatment for clinical assessment exhibited a reduction in PTSD symptoms while PET scans demonstrated varied results. The findings of this study indicate that online BSP is effective for improving PTSD symptoms and has various effects on brain glucose metabolism. The limitations and suggestions of the study are discussed for further research.

Keywords

18FDG-PET Scan; Brainspotting Therapy; Medial Temporal Cortex; Mid Frontal Cortex; Post Traumatic Stress Disorder

References

Amodio, D. M., & Frith, C. D. (2006). Meeting of minds: the medial frontal cortex and social cognition. Nature Reviews Neuroscience, 7(4), 268–277. https://doi.org/10.1038/nrn1884

Benjet, C., Bromet, E., Karam, E. G., Kessler, R. C., McLaughlin, K. A., Ruscio, A. M., Shahly, V., Stein, D. J., Petukhova, M., Hill, E., Alonso, J., Atwoli, L., Bunting, B., Bruffaerts, R., Caldas-de-Almeida, J. M., de Girolamo, G., Florescu, S., Gureje, O., Huang, Y., & Lepine, J. P. (2016). The epidemiology of traumatic event exposure worldwide: results from the World Mental Health Survey Consortium. Psychological Medicine, 46(02), 327–343. https://doi.org/10.1017/s0033291715001981

Berle, D., Hilbrink, D., Russell-Williams, C., Kiely, R., Hardaker, L., Garwood, N., Gilchrist, A., & Steel, Z. (2018). Personal wellbeing in posttraumatic stress disorder (PTSD): association with PTSD symptoms during and following treatment. BMC Psychology, 6(1). https://doi.org/10.1186/s40359-018-0219-2

Bird, C. M., & Burgess, N. (2008). The hippocampus and memory: insights from spatial processing. Nature Reviews Neuroscience, 9(3), 182–194. https://doi.org/10.1038/nrn2335

Blanchard, E. B., Jones-Alexander, J., Buckley, T. C., & Forneris, C. A. (1996). Psychometric properties of the PTSD checklist (PCL). Behaviour Research and Therapy, 34(8), 669–673. https://doi.org/10.1016/0005-7967(96)00033-2

Bremner, J. D. (1997). Positron Emission Tomography Measurement of Cerebral Metabolic Correlates of Yohimbine Administration in Combat-Related Posttraumatic Stress Disorder. Archives of General Psychiatry, 54(3), 246. https://doi.org/10.1001/archpsyc.1997.01830150070011

Bremner, J. D. (2003). Functional neuroanatomical correlates of traumatic stress revisited 7 years later, this time with data. Psychopharmacology Bulletin, 37(2), 6–25. https://pubmed.ncbi.nlm.nih.gov/14566211/

Bremner, J. D. (2006). Traumatic stress: effects on the brain. Dialogues in Clinical Neuroscience, 8(4), 445–461. https://doi.org/10.31887/dcns.2006.8.4/jbremner

Brockie, T. N., Dana-Sacco, G., Wallen, G. R., Wilcox, H. C., & Campbell, J. C. (2015). The Relationship of Adverse Childhood Experiences to PTSD, Depression, Poly-Drug Use and Suicide Attempt in Reservation-Based Native American Adolescents and Young Adults. American Journal of Community Psychology, 55(3-4), 411–421. https://doi.org/10.1007/s10464-015-9721-3

Brown, T. A., Chorpita, B. F., Korotitsch, W., & Barlow, D. H. (1997). Psychometric properties of the Depression Anxiety Stress Scales (DASS) in clinical samples. Behaviour Research and Therapy, 35(1), 79–89. https://doi.org/10.1016/s0005-7967(96)00068-x

Chen, S., Xia, W., Li, L., Liu, J., He, Z., Zhang, Z., Yan, L., Zhang, J., & Hu, D. (2006). Gray matter density reduction in the insula in fire survivors with posttraumatic stress disorder: A voxel-based morphometric study. Psychiatry Research: Neuroimaging, 146(1), 65–72. https://doi.org/10.1016/j.pscychresns.2005.09.006

Corrigan, F., & Grand, D. (2013). Brainspotting: Recruiting the midbrain for accessing and healing sensorimotor memories of traumatic activation. Medical Hypotheses, 80(6), 759–766. https://doi.org/10.1016/j.mehy.2013.03.005

Cottraux, J., Lecaignard, F., Yao, S.-N. ., De Mey-Guillard, C., Haour, F., Delpuech, C., & Servan-Schreiber, D. (2015). Enregistrement magnéto-encéphalographique (MEG) de réminiscences du trauma chez des femmes souffrant de stress post-traumatique : une étude pilote. L’Encéphale, 41(3), 202–208. https://doi.org/10.1016/j.encep.2014.03.002

Creamer, M., Burgess, P., & McFarlane, A. C. (2001). Post-traumatic stress disorder: findings from the Australian National Survey of Mental Health and Well-being. Psychological Medicine, 31(07). https://doi.org/10.1017/s0033291701004287

Dahm, J., Wong, D., & Ponsford, J. (2013). Validity of the Depression Anxiety Stress Scales in assessing depression and anxiety following traumatic brain injury. Journal of Affective Disorders, 151(1), 392–396. https://doi.org/10.1016/j.jad.2013.06.011

Eichenbaum, H., Yonelinas, A. P., & Ranganath, C. (2007). The Medial Temporal Lobe and Recognition Memory. Annual Review of Neuroscience, 30(1), 123–152. https://doi.org/10.1146/annurev.neuro.30.051606.094328

Engel, A., Roelfsema, P. R., Fries, P., Brecht, M., & Singer, W. (1997). Role of the temporal domain for response selection and perceptual binding. Cerebral Cortex, 7(6), 571–582. https://doi.org/10.1093/cercor/7.6.571

Etkin, A., Egner, T., & Kalisch, R. (2010). Emotional processing in anterior cingulate and medial prefrontal cortex. Trends in Cognitive Sciences, 15(2), 85–93. https://doi.org/10.1016/j.tics.2010.11.004

Fitzgerald, P. B., Laird, A. R., Maller, J., & Daskalakis, Z. J. (2008). A meta-analytic study of changes in brain activation in depression. Human Brain Mapping, 29(6), 683–695. https://doi.org/10.1002/hbm.20426

Frieden, T. R., Degutis, L. C., Spivak, H. R., Black, M. C., Basile, K. C., Breiding, M. J., Smith, S. G., & Walters, M. L. (2011). National Intimate Partner and Sexual Violence Survey: 2010 Summary Report. https://www.cdc.gov/ViolencePrevention/pdf/NISVS_Report2010-a.pdf

Gehring, W. J., & Fencsik, D. E. (2001). Functions of the Medial Frontal Cortex in the Processing of Conflict and Errors. The Journal of Neuroscience, 21(23), 9430–9437. https://doi.org/10.1523/jneurosci.21-23-09430.2001

Grand, D. (2009). Phase One Training Manual Brainspotting Training Manual -Phase One. Brainspotting Trainings Inc. https://www.nancytung.com/uploads/2/5/0/3/25033896/bsp_phase1_manual_david_grand_2.pdf

Grand, D. (2011). Brainspotting. Ein neues duales Regulationsmodell für den psychotherapeutischen Prozess [Brainspotting, a new brain-based psychotherapy approach]. Trauma & Gewalt, 5(3), 276–285. https://elibrary.klett-cotta.de/article/99.120130/tg-5-3-276?pid=99.120130

Grand, D. (2013). Brainspotting : the revolutionary new therapy for rapid and effective change. Sounds True.

Hamilton, M. (1959). The Assessment of Anxiety States by Rating. British Journal of Medical Psychology, 32(1), 50–55. https://doi.org/10.1111/j.2044-8341.1959.tb00467.x

Hildebrand, A., Grand, D., & Stemmler, M. (2015). Zur Wirksamkeit von Brainspotting - Ein neues Therapieverfahren zur Behandlung von Posttraumatischen Belastungsstörungen [The efficacy of Brainspotting – a new therapy approach for the treatment of Posttraumatic Stress Disorder]. Trauma - Zeitschrift Für Psychotraumatologie Und Ihre Anwendungen, 13(1), 84–92.

Hildebrand, A., Grand, D., & Stemmler, M. (2017). Brainspotting – the efficacy of a new therapy approach for the treatment of Posttraumatic Stress Disorder in comparison to Eye Movement Desensitization and Reprocessing. Mediterranean Journal of Clinical Psychology, 5(1). https://doi.org/10.6092/2282-1619/2017.5.1376

Huda, M. A. (2021). Sexual Harassment in Indonesia: Problems and Challenges in Legal Protection. Law Research Review Quarterly, 7(3), 303–314. https://doi.org/10.15294/lrrq.v7i3.48162

Indonesia: perception on causes of sexual assaults. (2020). Statista. https://www.statista.com/statistics/1250314/indonesia-perception-on-causes-of-sexual-assaults/

Kahnt, T., Grueschow, M., Speck, O., & Haynes, J.-D. (2011). Perceptual Learning and Decision-Making in Human Medial Frontal Cortex. Neuron, 70(3), 549–559. https://doi.org/10.1016/j.neuron.2011.02.054

Kessler, R. C., Aguilar-Gaxiola, S., Alonso, J., Benjet, C., Bromet, E. J., Cardoso, G., Degenhardt, L., de Girolamo, G., Dinolova, R. V., Ferry, F., Florescu, S., Gureje, O., Haro, J. M., Huang, Y., Karam, E. G., Kawakami, N., Lee, S., Lepine, J.-P., Levinson, D., & Navarro-Mateu, F. (2017). Trauma and PTSD in the WHO World Mental Health Surveys. European Journal of Psychotraumatology, 8(sup5). https://doi.org/10.1080/20008198.2017.1353383

Kim, S. J., Lyoo, I. K., Lee, Y. S., Kim, J., Sim, M. E., Bae, S. J., Kim, H. J., Lee, J.-Y. ., & Jeong, D.-U. . (2007). Decreased cerebral blood flow of thalamus in PTSD patients as a strategy to reduce re-experience symptoms. Acta Psychiatrica Scandinavica, 116(2), 145–153. https://doi.org/10.1111/j.1600-0447.2006.00952.x

Kim, S.-Y., Chung, Y.-K., Kim, B. S., Lee, S. J., Yoon, J.-K., & An, Y.-S. (2012). Resting cerebral glucose metabolism and perfusion patterns in women with posttraumatic stress disorder related to sexual assault. Psychiatry Research: Neuroimaging, 201(3), 214–217. https://doi.org/10.1016/j.pscychresns.2011.08.007

Kummer, A., Cardoso, F., & Teixeira, A. L. (2010). Generalized anxiety disorder and the Hamilton Anxiety Rating Scale in Parkinson’s disease. Arquivos de Neuro-Psiquiatria, 68(4), 495–501. https://doi.org/10.1590/s0004-282x2010000400005

Lanius, R. A., Williamson, P. C., Densmore, M., Boksman, K., Neufeld, R. W., Gati, J. S., & Menon, R. S. (2004). The nature of traumatic memories: a 4-T FMRI functional connectivity analysis. The American Journal of Psychiatry, 161(1), 36–44. https://doi.org/10.1176/appi.ajp.161.1.36

Looi, J. C. L., Maller, J. J., Pagani, M., Högberg, G., Lindberg, O., Liberg, B., Botes, L., Engman, E.-L., Zhang, Y., Svensson, L., & Wahlund, L.-O. (2009). Caudate volumes in public transportation workers exposed to trauma in the Stockholm train system. Psychiatry Research: Neuroimaging, 171(2), 138–143. https://doi.org/10.1016/j.pscychresns.2008.03.011

Lovibond, P. F., & Lovibond, S. H. (1995). The structure of negative emotional states: Comparison of the Depression Anxiety Stress Scales (DASS) with the Beck Depression and Anxiety Inventories. Behaviour Research and Therapy, 33(3), 335–343. https://doi.org/10.1016/0005-7967(94)00075-u

Maguire, E. A., Mummery, C. J., & Büchel, C. (2000). Patterns of hippocampal-cortical interaction dissociate temporal lobe memory subsystems. Hippocampus, 10(4), 475–482. https://doi.org/https://doi.org/10.1002/1098-1063(2000)10:4<475::AID-HIPO14>3.0.CO;2-X

MC Salvador. (2018). Brainspotting, Attunement, and Presence in Therapeutic Relationship. In The power of brainspotting an international anthology. Kröning Asanger Verlag.

Molina, M. E., Isoardi, R., Prado, M. N., & Bentolila, S. (2010). Basal cerebral glucose distribution in long-term post-traumatic stress disorder. The World Journal of Biological Psychiatry, 11(2-2), 493–501. https://doi.org/10.3109/15622970701472094

Moreira, S., Marques, P., & Magalhães, R. (2016). Identifying Functional Subdivisions in the Medial Frontal Cortex. The Journal of Neuroscience, 36(44), 11168–11170. https://doi.org/10.1523/jneurosci.2584-16.2016

Nimgampalle, M., Chakravarthy, H., & Devanathan, V. (2021). Glucose metabolism in the brain: An update. Recent Developments in Applied Microbiology and Biochemistry, 2, 77–88. https://doi.org/10.1016/B978-0-12-821406-0.00008-4

Noer, K. U., Chadijah, S., & Rudiatin, E. (2021). There is no trustable data: the state and data accuracy of violence against women in Indonesia. Heliyon, 7(12), e08552. https://doi.org/10.1016/j.heliyon.2021.e08552

Patel, A., & Fowler, J. B. (2019, January 28). Neuroanatomy, Temporal Lobe. Nih.gov; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK519512/

Petrie, E. C., Cross, D. J., Yarnykh, V. L., Richards, T., Martin, N. M., Pagulayan, K., Hoff, D., Hart, K., Mayer, C., Tarabochia, M., Raskind, M. A., Minoshima, S., & Peskind, E. R. (2014). Neuroimaging, Behavioral, and Psychological Sequelae of Repetitive Combined Blast/Impact Mild Traumatic Brain Injury in Iraq and Afghanistan War Veterans. Journal of Neurotrauma, 31(5), 425–436. https://doi.org/10.1089/neu.2013.2952

Pratiwi, A. M., & Niko, N. (2021). “Spilling the tea” on sexual violence. Inside Indonesia. https://www.insideindonesia.org/spilling-the-tea-on-sexual-violence

Ramage, A. E., Litz, B. T., Resick, P. A., Woolsey, M. D., Dondanville, K. A., Young-McCaughan, S., Borah, A. M., Borah, E. V., Peterson, A. L., & Fox, P. T. (2015). Regional cerebral glucose metabolism differentiates danger- and non-danger-based traumas in post-traumatic stress disorder. Social Cognitive and Affective Neuroscience, 11(2), 234–242. https://doi.org/10.1093/scan/nsv102

Rogers, M. A., Yamasue, H., Abe, O., Yamada, H., Ohtani, T., Iwanami, A., Aoki, S., Kato, N., & Kasai, K. (2009). Smaller amygdala volume and reduced anterior cingulate gray matter density associated with history of post-traumatic stress disorder. Psychiatry Research: Neuroimaging, 174(3), 210–216. https://doi.org/10.1016/j.pscychresns.2009.06.001

Shalev, A., Liberzon, I., & Marmar, C. (2017). Post-Traumatic Stress Disorder. New England Journal of Medicine, 376(25), 2459–2469. https://doi.org/10.1056/nejmra1612499

Sherin, J. E., & Nemeroff, C. B. (2011). Post-traumatic stress disorder: the neurobiological impact of psychological trauma. Trauma, Brain Injury, and Post-Traumatic Stress Disorder, 13(3), 263–278. https://doi.org/10.31887/dcns.2011.13.2/jsherin

SHIN, L. M. (2006). Amygdala, Medial Prefrontal Cortex, and Hippocampal Function in PTSD. Annals of the New York Academy of Sciences, 1071(1), 67–79. https://doi.org/10.1196/annals.1364.007

Shin, L. M., Lasko, N. B., Macklin, M. L., Karpf, R. D., Milad, M. R., Orr, S. P., Goetz, J. M., Fischman, A. J., Rauch, S. L., & Pitman, R. K. (2009). Resting Metabolic Activity in the Cingulate Cortex and Vulnerability to Posttraumatic Stress Disorder. Archives of General Psychiatry, 66(10), 1099. https://doi.org/10.1001/archgenpsychiatry.2009.138

Silverman, D. H. S., Geist, C. L., Kenna, H. A., Williams, K., Wroolie, T., Powers, B., Brooks, J., & Rasgon, N. L. (2010). Differences in regional brain metabolism associated with specific formulations of hormone therapy in postmenopausal women at risk for AD. Psychoneuroendocrinology, 36(4), 502–513. https://doi.org/10.1016/j.psyneuen.2010.08.002

Squire, L. R., Stark, C. E. L., & Clark, R. E. (2004). THE MEDIAL TEMPORAL LOBE. Annual Review of Neuroscience, 27(1), 279–306. https://doi.org/10.1146/annurev.neuro.27.070203.144130

Stevens, J. S., Reddy, R., Kim, Y. J., van Rooij, S. J. H., Ely, T. D., Hamann, S., Ressler, K. J., & Jovanovic, T. (2017). Episodic memory after trauma exposure: Medial temporal lobe function is positively related to re-experiencing and inversely related to negative affect symptoms. NeuroImage : Clinical, 17, 650–658. https://doi.org/10.1016/j.nicl.2017.11.016

U.S. Department Of Veterans Affairs. (2013). PTSD Checklist for DSM-5 (PCL-5) - PTSD: National Center for PTSD. https://www.ptsd.va.gov/professional/assessment/adult-sr/ptsd-checklist.asp

Van Der Kolk, B. (2014). The body keeps the score : brain, mind, and body in the healing of trauma. Penguin Books.

Vega, A. de la, Chang, L. J., Banich, M. T., Wager, T. D., & Yarkoni, T. (2016). Large-Scale Meta-Analysis of Human Medial Frontal Cortex Reveals Tripartite Functional Organization. Journal of Neuroscience, 36(24), 6553–6562. https://doi.org/10.1523/JNEUROSCI.4402-15.2016

Whalen, P. J. (1998). Fear, Vigilance, and Ambiguity: Initial Neuroimaging Studies of the Human Amygdala. Current Directions in Psychological Science, 7(6), 177–188. https://doi.org/10.1111/1467-8721.ep10836912

Wilkins, K. C., Lang, A. J., & Norman, S. B. (2011). Synthesis of the psychometric properties of the PTSD checklist (PCL) military, civilian, and specific versions. Depression and Anxiety, 28(7), 596–606. https://doi.org/10.1002/da.20837

Yamasue, H., Kasai, K., Iwanami, A., Ohtani, T., Yamada, H., Abe, O., Kuroki, N., Fukuda, R., Tochigi, M., Furukawa, S., Sadamatsu, M., Sasaki, T., Aoki, S., Ohtomo, K., Asukai, N., & Kato, N. (2003). Voxel-based analysis of MRI reveals anterior cingulate gray-matter volume

reduction in posttraumatic stress disorder due to terrorism. Proceedings of the National Academy of Sciences of the United States of America, 100(15), 9039–9043. https://doi.org/10.1073/pnas.1530467100

Zandieh, S., Bernt, R., Knoll, P., Wenzel, T., Hittmair, K., Haller, J., Hergan, K., & Mirzaei, S. (2016). Analysis of the Metabolic and Structural Brain Changes in Patients With Torture-Related Post-Traumatic Stress Disorder (TR-PTSD) Using 18F-FDG PET and MRI. Medicine, 95(15), e3387. https://doi.org/10.1097/md.0000000000003387

Zhu, Y., Du, R., Zhu, Y., Shen, Y., Zhang, K., Chen, Y., Song, F., Wu, S., Zhang, H., & Tian, M. (2016). PET Mapping of Neurofunctional Changes in a Posttraumatic Stress Disorder Model. Journal of Nuclear Medicine, 57(9), 1474–1477. https://doi.org/10.2967/jnumed.116.173443