Exposure-based therapy changes amygdala and hippocampus resting-state functional connectivity in patients with posttraumatic stress disorder

Xi Zhu, Benjamin Suarez-Jimenez, Amit Lazarov, Liat Helpman, Santiago Papini, Ari Lowell, Ariel Durosky, Martin A. Lindquist, John C. Markowitz, Franklin Schneier, Tor D. Wager, Yuval Neria

Research output: Contribution to journalArticlepeer-review

19 Scopus citations


Background: Recent research suggests that posttraumatic stress disorder (PTSD) is associated with altered amygdala and hippocampal resting-state functional connectivity (rsFC). However, less research has examined whether Prolonged Exposure (PE), a first line exposure-based treatment for PTSD, has the potential to alter resting state neural networks. Methods: A total of 24 patients with PTSD and 26 matched trauma-exposed healthy controls (TEHCs) underwent resting-state functional magnetic resonance imaging (fMRI) at baseline. PTSD patients were scanned a second time after completing 10-session PE in which patients narrated a detailed trauma account (imaginal exposure) and confronted trauma reminders (in vivo exposure) to extinguish trauma-related fear responses. TEHC were scanned again following a 10-week waiting period. Seed regions of interest (ROIs) included centromedial amygdala (CMA), basolateral amygdala (BLA), and the hippocampus. Results: Post- versus pretreatment comparisons indicated increased rsFC of the BLA and CMA with the orbitofrontal cortex (OFC), and hippocampus-medial prefrontal cortex (mPFC) among patients with PTSD, but not among TEHC participants. Conclusions: Enhanced amygdala and hippocampus rsFC with prefrontal cortical regions following PE could underlie improved capacity for inhibition and re-evaluation of threat, and heightened memory encoding and retrieval ability, respectively. These findings encourage further investigation of this circuitry as a therapeutic target in PTSD.

Original languageEnglish (US)
Pages (from-to)974-984
Number of pages11
JournalDepression and anxiety
Issue number10
StatePublished - Oct 2018


  • PTSD
  • amygdala
  • fMRI
  • hippocampus
  • prolonged exposure treatment
  • resting-state functional connectivity

ASJC Scopus subject areas

  • Clinical Psychology
  • Psychiatry and Mental health


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