Introduction
posttraumatic stress disorder, non-affective, traumatic, affective and non-affective paradigms, PTSD
Trauma-focused psychotherapy (TF-psychotherapy) is the frontline treatment of choice for posttraumatic stress disorder, and is recommended in most treatment guidelines for PTSD [One of important lines of enquiry to study mechanisms of change in TF-psychotherapy is understand how neural functioning is associated with symptom improvement. Numerous studies of adults with PTSD have used functional magnetic resonance imaging (fMRI) during a range of tasks to map how treatment response is associated with neural changes when performing different tasks. Most studies have employed affective tasks that include fear conditioning [There are no previous studies that have employed both affective and non-affective paradigms in the same treatment study to investigate how treatment response is associated with changes in neural functioning following TF-psychotherapy in PTSD. The goal of the present study was to examine the relationship between response to TF-psychotherapy in adults with PTSD with changes in neural activity and connectivity across affective and non-affective tasks. In this sense, this study attempted to extend on most previous studies by utilizing diverse paradigms to provide a more comprehensive investigation of neural functions that may be affected by TF-psychotherapy. This study focused on passive viewing of affective stimuli, reappraisal of traumatic stimuli, and response inhibition of neutral stimuli to provide indices of distinct neural functions in the context of treatment response. We hypothesized that improvement following TF-psychotherapy will be associated with an increase in activation of the prefrontal cortical regions for both the passive viewing and reappraisal affective paradigms and this activation to be at levels expected in healthy individuals post treatment. Due to only one previous treatment study in non-affective paradigms, we tested whether the prefrontal cortical activation for response inhibition also significantly increases following TF-psychotherapy. Due to mixed previous results for the amygdala, we did not have a particular hypothesis for changes in amygdala activation for the two affective paradigms.