Anterior hippocampal volume predicts affect-focused psychotherapy outcome

Benjamin Suarez-Jimenez, Xi Zhu, Amit Lazarov, J. John Mann, Franklin Schneier, Andrew Gerber, Jacques P. Barber, Dianne L. Chambless, Yuval Neria, Barbara Milrod, John C. Markowitz*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Background. The hippocampus plays an important role in psychopathology and treatment outcome. While posterior hippocampus (PH) may be crucial for the learning process that exposure-based treatments require, affect-focused treatments might preferentially engage anterior hippocampus (AH). Previous studies have distinguished the different functions of these hippocampal sub-regions in memory, learning, and emotional processes, but not in treatment outcome. Examining two independent clinical trials, we hypothesized that anterior hippocampal volume would predict outcome of affect-focused treatment outcome [Interpersonal Psychotherapy (IPT); Panic-Focused Psychodynamic Psychotherapy (PFPP)], whereas posterior hippocampal volume would predict exposure-based treatment outcome [Prolonged Exposure (PE); Cognitive Behavioral Therapy (CBT); Applied Relaxation Training (ART)]. Methods. Thirty-five patients with posttraumatic stress disorder (PTSD) and 24 with panic disorder (PD) underwent structural magnetic resonance imaging (MRI) before randomization to affect-focused (IPT for PTSD; PFPP for PD) or exposure-based treatments (PE for PTSD; CBT or ART for PD). AH and PH volume were regressed with clinical outcome changes. Results: Baseline whole hippocampal volume did not predict post-treatment clinical severity scores in any treatment. For affect-focused treatments, but not exposure-based treatments, anterior hippocampal volume predicted clinical improvement. Smaller AH correlated with greater affect-focused treatment improvement. Posterior hippocampal volume did not predict treatment outcome. Conclusions. This is the first study to explore associations between hippocampal volume sub-regions and treatment outcome in PTSD and PD. Convergent results suggest that affect-focused treatment may influence the clinical outcome through the 'limbic' AH, whereas exposure-based treatments do not. These preliminary, theory-congruent, therapeutic findings require replication in a larger clinical trial.

Original languageEnglish
Pages (from-to)396-402
Number of pages7
JournalPsychological Medicine
Issue number3
StatePublished - 1 Feb 2020


  • Anterior hippocampus
  • PFPP (Panic-Focused Psychodynamic Psychotherapy)
  • PTSD
  • cognitive behavioral therapy (CBT)
  • interpersonal psychotherapy(IPT)
  • neuroimaging
  • panic disorder
  • psychodynamic psychotherapy
  • treatment


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