Copyright 2012 Aileen M. Echiverri-Cohen - University of Washington

antidepressants and found that CBT involved similar brain changes as those seen with
antidepressants following treatment. They argued for the superiority of CBT in strengthening
prefrontal regions leading to the acquisition of emotion regulation skills where symptom
improvement continues long after treatment ends. In contrast, antidepressants purportedly
address amygdala hyperactivity but confer risk upon termination and may not offer protection
like CBT in maintaining treatment gains. These studies provide preliminary support for a top-
down pathway of strengthening prefrontal regions to reduce amygdala reactivity in CBT, leading
to therapeutic change. In summary, although PE and SER appear to converge on a final pathway
in reducing amygdala reactivity, which may account for increased temporal attentional inhibition
over time, PE produced earlier attentional inhibitory gains, and more sustained and stronger
changes in inhibition than SER, arguing for treatment specific effects in normalizing inhibitory
deficits in PTSD.
Using the AB paradigm, temporal attentional inhibition improved over time. Individuals
with PTSD showed increases in inhibition on AB from pre-treatment to post-treatment, with
accuracy on AB on critical inhibitory lags improving over time. Although there was this effect
of time on inhibition, as stated above, the effect of time was modified by the interaction with
treatment modality and treatment response. Nevertheless, these findings bolster the argument for
commonalities between PE and SER, particularly in light of the effectiveness of both treatments
(e.g., Foa et al., 1999; Brady et al., 2000), similar neural changes to the fear circuitry of PTSD
(Heym et al., 1998; Felmingham et al., 2007), and potential common pathways discussed above.
One alternative explanation is that time or repeated practice could lead to subsequent
improvement in inhibition as well. Time and repeated practice with attentional tasks has been
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