Description
Purpose: The present study aims to examine pre-treatment neural activity profile as a potential predictor of improvement and explore the neural mechanisms of change in relation to irritability in a group of youths who received Trauma-Focused Cognitive Behavioral Therapy (TF-CBT). Participants: Thirty-one participants aged 11 to 19 years old were recruited. Participants had past childhood trauma exposure and went through a 12-week TF-CBT intervention. Twenty-two participants completed more than 80 percent of the treatment sessions and were included in the final analysis. Methodology: Participants completed a child-friendly monetary incentive delay (MID) task during fMRI acquisition at pre- and post-treatment. Self-report Affective Reactivity Index (ARI) assessed irritability symptoms across five time points at pre-treatment, during treatment, and at post-treatment. Individual irritability intercepts and slopes were generated by linear growth curve modeling and integrated with fMRI data. For Aim 1, repeated ANCOVAs examined irritability changes over the course of TF-CBT (i.e., irritability slope) in relation to pre-treatment neural activity during reward anticipation and feedback, controlling for pre-treatment irritability (i.e., irritability intercept). For Aim 2, repeated ANCOVAs examined neural changes in reward anticipation and feedback at pre- vs. post-treatment in relation to irritability changes, controlling for pre-treatment irritability. Results: Paired samples t tests revealed overall improvement in irritability symptoms at pre- vs. post-treatment, with significant individual variability. Repeated ANCOVAs showed significant interactions between pre-treatment neutral reward processing and irritability changes for Aim 1, and significant associations between changes in neural reward processing and irritability for Aim 2, in brain regions associated with emotion- and reward-processing. Individuals with reduced irritability showed qualitatively different neural activity profiles compared with individuals showing no improvement. Conclusions: The present study, as a preliminary effort, showed that pre-treatment neural activity profile during reward anticipation and feedback may be a potential predictor for irritability symptom improvement following TF-CBT. Additionally, changes in reward-related neural activity might be one of the underlying mechanisms of symptom improvement in TF-CBT.
