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J Psychiatr Res. 2014 Jul;54:1-10. doi: 10.1016/j.jpsychires.2014.03.016. Epub 2014 Mar 27.

The effect of trauma-focused therapy on the altered T cell distribution in individuals with PTSD: evidence from a randomized controlled trial.

Author information

1
Center of Excellence for Psychotraumatology, Clinical Psychology and Neuropsychology, University of Konstanz, Germany.
2
Clinical and Biological Psychology, Institute of Psychology and Education, University of Ulm, Albert-Einstein-Allee 47, 89069 Ulm, Germany.
3
Division of Immunology, Department of Biology, University of Konstanz, 78457 Konstanz, Germany.
4
SAP Switzerland AG, Tägerwilen, Switzerland.
5
Clinical Psychology and Psychotherapy, University of Bielefeld, Germany.
6
Division of Immunology, Department of Biology, University of Konstanz, 78457 Konstanz, Germany; Biotechnology Institute Thurgau at the University of Konstanz, 8280 Kreuzlingen, Switzerland.
7
Center of Excellence for Psychotraumatology, Clinical Psychology and Neuropsychology, University of Konstanz, Germany; Clinical and Biological Psychology, Institute of Psychology and Education, University of Ulm, Albert-Einstein-Allee 47, 89069 Ulm, Germany. Electronic address: Iris.Kolassa@uni-ulm.de.

Abstract

Posttraumatic stress disorder (PTSD) is associated with a reduced ratio of naïve cytotoxic T lymphocytes, an increased ratio of memory cytotoxic T lymphocytes, and a reduced proportion of FoxP3(+) regulatory T lymphocytes. This study investigated whether these immunological alterations are reversible through an evidence-based psychotherapeutic treatment. Therefore, 34 individuals with PTSD were randomly assigned to either a treatment condition of 12 sessions narrative exposure therapy (NET) or a waitlist control (WLC) group. PTSD symptoms were significantly reduced in the NET group, but not in the WLC group, four months post-therapy (effect size: Hedges' g = -1.61). One year after therapy, PTSD symptoms were improved even further in the NET group compared to baseline (Hedges' g = -1.96). This symptom improvement was mirrored in an increase in the originally reduced proportion of regulatory T cells (Tregs) in the NET group at the one-year follow-up, when comparing subgroups matched for baseline Treg numbers. However, no changes were found for the initially reduced proportion of CD45RA(+)CCR7(+) naïve T lymphocytes. In conclusion, NET was effective in reducing trauma-related PTSD symptoms and had a positive effect on the proportion of Tregs cells, thus demonstrating an effect of psychotherapy on an immunological level. Yet, the shift in the proportion of naïve and memory T lymphocytes in individuals with PTSD, discussed in the literature as a correlate of premature immunosenescence, was not reversible and thus might render these patients permanently more susceptible to infectious diseases.

KEYWORDS:

Narrative exposure therapy (NET); Posttraumatic stress disorder (PTSD); Psychotherapy; Regulatory T cells; T lymphocytes

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