Published:  2023-12-27

Autonomic nervous system function before and after trauma-focused psychotherapy in youth with (partial) posttraumatic stress disorder

Authors:  Jasper B. Zantvoord, Judith B. M. Ensink, Rosanne op den Kelder, Julia Diehle, Anja Lok, Ramon J. L. Lindauer

Tags:  PTSD, adolescent, autonomic nervous system, child, psychotherapy, stress response

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While trauma-focused psychotherapies have been shown effective in youth with PTSD, the relationship between treatment response and alterations in autonomic nervous system (ANS) associated with PTSD, remains incompletely understood. During neutral and personalized trauma script imagery heart rate (HR), pre-ejection period (PEP) and respiratory sinus arrhythmia (RSA) were recorded in youth aged 8-18 with PTSD or partial PTSD (n= 76) and trauma exposed controls (TEC) (n= 27) to determine ANS activity and stress reactivity. Within the patient group, 77.6% met the full DSM-IV diagnostic criteria for PTSD, the remaining 22.4% met criteria for partial PTSD. Youth with (partial) PTSD were subsequently treated with eight sessions of either trauma-focused cognitive behavioral therapy or eye movement desensitization and reprocessing. PTSD severity was assessed using the Clinician-Administered PTSD scale for Children and Adolescents to divide patients into responders and non-responders. Youth with (partial) PTSD relative to TEC had higher overall HR during both neutral and trauma imagery (p =.05). Youth with (partial) PTSD showed RSA decrease during trauma imagery relative to neutral imagery, the reverse of TEC (p =.01). Relative to non-responders, responders demonstrated a significant baseline to posttreatment increase of RSA response to stress only when employing a ≥50% response criterion (p =.05) and not with the primary ≥30% criterion (p =.12). Our results suggest overall higher HR and sympathetic nervous system activity as well as vagal withdrawal in response to stress in youth with (partial) PTSD, and only provide partial support for normalization of the latter with successful trauma-focused psychotherapy.