Neural correlates of an introductory cognitive behavioral intervention with mindfulness in strengthening resilience to post-traumatic stress injuries among public safety personnel
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The term “post-traumatic stress injuries (PTSI)” means highly prevalent mental disorders among public safety personnel (PSP) which can be developed as a result of repeated exposure to different traumatic events as a part of their job. PTSI is associated with a range of negative outcomes and its underlying neurophysiological mechanisms are still not well understood. Cognitive behavioral therapies (CBT) are the ‘gold standard’ interventions for the treatment of PTSD. Cognitive Behavioral Therapy with Mindfulness (CBTm) is a brief intervention that introduces introductory cognitive behavioral strategies and mindfulness meditation. Preliminary evidence suggests that CBTm may be effective in mitigating subthreshold PTSD symptoms in PSP who do not meet diagnostic criteria for the condition. There is little research on the neurological mechanisms of PTSI resiliency. Previous studies showed that the posterior cingulate cortex (PCC; including the precuneus) of the Default Mode Network (DMN) is associated with preventing and treating PTSI. We have conducted a functional magnetic resonance imaging (fMRI) study to investigate the neural mechanisms of the resilience in PSP who underwent CBTm with a particular interest on PCC connectivity. Twenty-five PSP individuals with no or low symptoms of common mental disorders completed the current randomized neuroimaging study. 11 participants underwent the 5-week CBTm intervention, and 14 participants were waitlisted as control group. All participants were assessed by self-report measures, resting-state fMRI (measuring functional connectivity (FC)), and pseudo-continuous arterial spin labeling (pCASL; measuring cerebral blood flow) at baseline, 5-week and 12-week follow-up. The benefits of CBTm observed with self-report measures were accompanied with increased FC between the PCC and the left vlPFC at 5-week and 12-week follow-up, and decreased CBF in the left vlPFC at 12 weeks. At baseline, the CBF of PCC and vlPFC were correlated with self-reported psychological resilience as assessed by the Connor-Davidson Resilience Scale (CD-RISC), while FC between the two regions was a dominant predictor for the CD-RISC at 12-weeks. This finding suggests that the PCC and the left vlPFC play an important role in resilience against PTSI, and the benefit of CBTm may be associated with FC changes between the two regions.