Facing Your Fears?: Evaluating Cognitive Behavioral Therapy With the Help of Systems Neuroscience

     For those suffering from PTSD and other related anxiety disorders, there exists a connecting theme in its therapy for those seeking treatments. A core idea in treatment of anxiety is the act of purposefully re-living/recalling the trauma that might serve as a trigger for anxiety response. Cognitive behavioral therapy (CBT) makes use of this exposure-based treatment by helping individuals process and reframe their traumatic memories in a controlled environment. But what of its efficacy?

Hardy et al.’s 2022 study focuses on the mechanisms of cognitive behavioral therapy, and whether this exposure-based treatment truly has far-reaching benefits for those who undergo it. The researchers intended to evaluate the efficacy of CBT, investigating whether the therapy is both safe and acceptable for individuals suffering from psychosis and PTSD. They also recognized the worry of potential harm being caused to those afflicted due to the nature of this exposure-based therapy, giving the opposite-intended effect. It was found that 68.8% of participants showed clinically meaningful improvements after therapy. In analyzing patients’ overall psychological, social, and occupational functioning, researchers were able to conclude that trauma-focused cognitive-behavior therapy for psychosis can be safe, acceptable, and effective when smartly integrated in routine care.

Interesting and notable connections can be made between these findings and Dr. Grella’s published article on memory modulation in the dorsal and ventral regions of the hippocampus. To summarize, Chen et al. explores the manner in which reward and fear memories in the dorsal and ventral hippocampus are able to be either enhanced or suppressed via chemogenetic and optogenetic manipulation. It is understood that dorsal and ventral regions of the hippocampus encode different information. The former is primarily responsible for encoding contextual information and cognitive aspects of an experience, and the latter for stress-related behaviors/emotional components of memory. The investigators intended to reactivate the distinct hippocampal memories along the longitudinal dorsoventral axis and observe whether context-specific behaviors can be promoted chronically, differentially, and acutely. With chronic stimulation of these fear engrams, they found a bi-directional and context-specific reduction (dorsal) or enhancement (ventral) of animal fear responses respectively. Repeated stimulation of fear memories in the dorsal hippocampus led to a long-term reduction in fear responses. This finding can add meaningful commentary to the aforementioned discussion on cognitive behavioral therapy.

The fact that chronic artificial stimulation of fear memories in the dorsal hippocampus to extinction-like effects suggests that a similar mechanism could be at play in exposure-based therapies such as cognitive behavioral therapy (CBT). Both studies suggest that through repeated/intentional exposure, whether in therapy or via neural manipulation, the emotional impact of traumatic memories can be reduced, highlighting the potential role of the dorsal hippocampus in memory modulation and CBT in therapeutic outcomes.

References:

Chen, B. K., Murawski, N. J., Cincotta, C., McKissick, O., Finkelstein, A., Hamidi, A. B., Merfeld, E., Doucette, E., Grella, S. L., Shpokayte, M., Zaki, Y., Fortin, A., & Ramirez, S. (2019). Artificially Enhancing and Suppressing Hippocampus-Mediated Memories. Current Biology, 29(11), 1885-1894.e4. https://doi.org/10.1016/j.cub.2019.04.065

Hardy, A., Good, S., Dix, J., & Longden, E. (2022). “It hurt but it helped”: A mixed methods audit of the implementation of trauma- focused cognitive-behavioral therapy for psychosis. Frontiers in Psychiatry, 13. https://doi.org/10.3389/fpsyt.2022.946615

Chen,