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Tenekedjieva LT, McCalley DM, Goldstein-Piekarski AN, Williams LM, Padula CB. Transdiagnostic Mood, Anxiety and Trauma Symptom Factors in Alcohol Use Disorder: Neural Correlates Across Three Brain Networks. BIOLOGICAL PSYCHIATRY. COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2024:S2451-9022(24)00064-8. [PMID: 38432622 DOI: 10.1016/j.bpsc.2024.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 01/29/2024] [Accepted: 01/29/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND Alcohol use disorder (AUD) is associated with high rates of trauma, mood, and anxiety disorders. Individual symptoms highly overlap across diagnoses, highlighting the need for a transdiagnostic approach. Further, there is limited research on how transdiagnostic psychopathology impacts the neural correlates of AUD. Thus, we aimed to identify symptom factors spanning diagnoses and how they relate to the neurocircuitry of addiction. METHODS Eighty-six Veterans with AUD completed self-report measures and reward, incentive salience and cognitive control fMRI tasks. Factor analysis was performed on self-reported trauma, depression, anxiety, and stress symptoms to obtain transdiagnostic symptom compositions. Neural correlates with a-priori-defined regions of interest in the three networks were assessed. Independent samples t-tests compared the same nodes by DSM-5 diagnosis. RESULTS Four symptom factors were identified: trauma distress, negative affect, hyperarousal, and somatic anxiety. Trauma distress score was associated with increased cognitive control activity regions during response inhibition (dACC). Negative affect related to lower activation in reward regions (R.Caudate) but higher activation in cognitive control regions during response inhibition (L.dlPFC). Hyperarousal related to lower reward activity during monetary reward anticipation (L.Caudate, R.Caudate) Somatic anxiety was not significantly associated with brain activation. No difference in neural activity was found by PTSD, MDD or GAD diagnosis CONCLUSION: These preliminary, hypothesis-generating findings offer transdiagnostic symptom factors that are differentially associated with neural function and could guide us towards a brain-based classification of psychiatric dysfunction in AUD. Results warrant further investigation of transdiagnostic approaches to symptoms in addiction.
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Affiliation(s)
- Lea-Tereza Tenekedjieva
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA; Mental Illness Research Education and Clinical Center, VA Palo Alto Health Care System, Palo Alto, CA, USA.
| | - Daniel M McCalley
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA; Mental Illness Research Education and Clinical Center, VA Palo Alto Health Care System, Palo Alto, CA, USA
| | - Andrea N Goldstein-Piekarski
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA; Mental Illness Research Education and Clinical Center, VA Palo Alto Health Care System, Palo Alto, CA, USA
| | - Leanne M Williams
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA; Mental Illness Research Education and Clinical Center, VA Palo Alto Health Care System, Palo Alto, CA, USA
| | - Claudia B Padula
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA; Mental Illness Research Education and Clinical Center, VA Palo Alto Health Care System, Palo Alto, CA, USA
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2
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Guerra LTL, Rocha JM, Osório FDL, Bouso JC, Hallak JEC, Dos Santos RG. Biases in affective attention tasks in posttraumatic stress disorder patients: A systematic review of neuroimaging studies. Biol Psychol 2023; 183:108660. [PMID: 37597766 DOI: 10.1016/j.biopsycho.2023.108660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 07/24/2023] [Accepted: 08/16/2023] [Indexed: 08/21/2023]
Abstract
INTRODUCTION Posttraumatic stress disorder (PTSD) is characterized by alterations in emotional and cognitive processing. The current neurobiological model of PTSD posits that amygdala and prefrontal cortex functioning impairment underpins symptoms, such as altered emotional and cognitive processing. Additionally, these structures are key components of emotional and attention regulation. AIM This review sought to evaluate studies comparing PTSD group to non-PTSD controls performance in affective attention tasks during neuroimaging. RESULTS PTSD group behavioral performance when responding to affective stimuli differed from controls only in stroop-based tasks. However, neuroimaging techniques were able to identify brain activation differences even when behavioral differences were not present. Amygdala hyperactivation in PTSD patients was confirmed in most cases, but cortical networks results were not as consistent. More than a general reduction in activity, PTSD group data points out to impaired recruitment of ventral cortical structures and increased reliance on dorsal cortical structures during task performance. CONCLUSION Stroop-based tasks seem to be better at identifying differences in behavioral performance of PTSD individuals. PTSD individuals seems to present an altered brain activation pattern in affective attention tasks when compared to controls, where PTSD individuals seem to present enhanced amygdala activation and rely more on dorsal anterior cingulate cortex and posterior insula activation during tasks. The PROSPERO ID for this study is CRD42022355471.
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Affiliation(s)
- Lorena T L Guerra
- Department of Neurosciences and Behavior, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil.
| | - Juliana M Rocha
- Department of Neurosciences and Behavior, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil.
| | - Flávia de L Osório
- Department of Neurosciences and Behavior, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil; National Institute of Science and Technology Translational Medicine, Brazil.
| | - José C Bouso
- Department of Neurosciences and Behavior, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil; ICEERS Foundation, International Center for Ethnobotanical Education, Research and Services, Barcelona, Spain; Medical Anthopology Research Center, Universitat Rovira i Virgili, Tarragona, Spain.
| | - Jaime E C Hallak
- Department of Neurosciences and Behavior, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil; National Institute of Science and Technology Translational Medicine, Brazil; ICEERS Foundation, International Center for Ethnobotanical Education, Research and Services, Barcelona, Spain.
| | - Rafael G Dos Santos
- Department of Neurosciences and Behavior, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil; National Institute of Science and Technology Translational Medicine, Brazil; ICEERS Foundation, International Center for Ethnobotanical Education, Research and Services, Barcelona, Spain.
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Goldenthal HJ, Gouze K, Russo J, Raviv T, Holley C, Cicchetti C. Potentially Traumatic Events, Socioemotional and Adaptive Functioning: Associations with Self-Regulatory Skills in a Community Sample of Primarily Black and Latinx 3-5-year-olds. Child Psychiatry Hum Dev 2023:10.1007/s10578-023-01595-w. [PMID: 37646985 DOI: 10.1007/s10578-023-01595-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/15/2023] [Indexed: 09/01/2023]
Abstract
Early childhood is a heightened risk period for exposure to potentially traumatic events (PTEs) and a critical period for the development of foundational self-regulatory competencies that have potential cascading effects on future socioemotional functioning. This cross-sectional study examined associations between PTE exposure and socioemotional and adaptive functioning, and self-regulatory skills, in a community-based sample of 280 primarily Black and Latinx 3-5-year-olds. Results supported direct relations between PTE exposure and socioemotional and adaptive functioning. Attentional regulation was associated with PTEs and internalizing behaviors, externalizing behaviors, and adaptive behaviors. There was also a significant association of emotional regulation on the relationship between PTEs and internalizing and externalizing behaviors, but not adaptive functioning. Findings have implications for early intervention and educational and public policy, including the importance of scaffolding the development of self-regulatory skills among preschoolers with high PTE exposure.
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Affiliation(s)
- Hayley J Goldenthal
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago Medicine, Chicago, IL, USA.
- Department of Pediatrics, Michigan Medicine, Ann Arbor, MI, USA.
| | - Karen Gouze
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Pritzker Department of Psychiatry and Behavioral Sciences, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Jaclyn Russo
- School of Education and Human Development, Center for Advanced Study of Teaching and Learning, University of Virginia, Charlottesville, VA, USA
| | - Tali Raviv
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Pritzker Department of Psychiatry and Behavioral Sciences, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Carmen Holley
- Pritzker Department of Psychiatry and Behavioral Sciences, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Colleen Cicchetti
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Pritzker Department of Psychiatry and Behavioral Sciences, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
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Norbury A, Seeley SH, Perez-Rodriguez MM, Feder A. Functional neuroimaging of resilience to trauma: convergent evidence and challenges for future research. Psychol Med 2023; 53:3293-3305. [PMID: 37264949 DOI: 10.1017/s0033291723001162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Resilience is broadly defined as the ability to adapt successfully following stressful life events. Here, we review functional MRI studies that investigated key psychological factors that have been consistently linked to resilience to severe adversity and trauma exposure. These domains include emotion regulation (including cognitive reappraisal), reward responsivity, and cognitive control. Further, we briefly review functional imaging evidence related to emerging areas of study that may potentially facilitate resilience: namely social cognition, active coping, and successful fear extinction. Finally, we also touch upon ongoing issues in neuroimaging study design that will need to be addressed to enable us to harness insight from such studies to improve treatments for - or, ideally, guard against the development of - debilitating post-traumatic stress syndromes.
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Affiliation(s)
- Agnes Norbury
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Queen Square Institute of Neurology and Mental Health Neuroscience Department, Applied Computational Psychiatry Lab, Max Planck Centre for Computational Psychiatry and Ageing Research, University College London, London, UK
| | - Saren H Seeley
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Adriana Feder
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Zukerman G, Pinhas M, Icht M. Hypervigilance or shutdown? Electrophysiological processing of trauma-unrelated aversive stimuli after traumatic life events. Exp Brain Res 2023; 241:1185-1197. [PMID: 36847844 DOI: 10.1007/s00221-023-06578-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 02/17/2023] [Indexed: 03/01/2023]
Abstract
Post-Traumatic Stress Disorder (PTSD) research indicates that hyper-reactivity to trauma-related stimuli reflects reduced prefrontal cortex (PFC) modulation of amygdala reactivity. However, other studies indicate a dissociative "shutdown" reaction to overwhelming aversive stimuli, possibly reflecting PFC over-modulation. To explore this, we used an Event-Related Potential (ERP) oddball paradigm to study P3 responses in the presence of the following: 1. Trauma-unrelated morbid distractors (e.g., "injured bear") related to the Rorschach inkblot test, and 2. Negative distractors (e.g., "significant failure"), among participants with high post-traumatic stress symptoms (PTS; n = 20), low PTS (n = 17), and controls (n = 15). Distractors were presented at 20% frequency amongst the more frequent (60%) neutral standard stimuli (e.g., "desk lamp") and the equally frequent (20%) neutral trauma-unrelated target stimulus ("golden fish"). P3 amplitudes were high in the presence of morbid distractors and low in the presence of negative distractors only amongst the control group. Possible mechanisms underlying the lack of P3 amplitude modulation after trauma are discussed.
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Affiliation(s)
- Gil Zukerman
- Department of Communication Disorders, School of Health Sciences, Ariel University, 40700, Ariel, Israel.
| | - Michal Pinhas
- Department of Psychology, Ariel University, Ariel, Israel
| | - Michal Icht
- Department of Communication Disorders, School of Health Sciences, Ariel University, 40700, Ariel, Israel
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Keller AS, Sydnor VJ, Pines A, Fair DA, Bassett DS, Satterthwaite TD. Hierarchical functional system development supports executive function. Trends Cogn Sci 2023; 27:160-174. [PMID: 36437189 PMCID: PMC9851999 DOI: 10.1016/j.tics.2022.11.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 11/01/2022] [Accepted: 11/03/2022] [Indexed: 11/26/2022]
Abstract
In this perspective, we describe how developmental improvements in youth executive function (EF) are supported by hierarchically organized maturational changes in functional brain systems. We first highlight evidence that functional brain systems are embedded within a hierarchical sensorimotor-association axis of cortical organization. We then review data showing that functional system developmental profiles vary along this axis: systems near the associative end become more functionally segregated, while those in the middle become more integrative. Developmental changes that strengthen the hierarchical organization of the cortex may support EF by facilitating top-down information flow and balancing within- and between-system communication. We propose a central role for attention and frontoparietal control systems in the maturation of healthy EF and suggest that reduced functional system differentiation across the sensorimotor-association axis contributes to transdiagnostic EF deficits.
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Affiliation(s)
- Arielle S Keller
- Penn Lifespan Informatics and Neuroimaging Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Valerie J Sydnor
- Penn Lifespan Informatics and Neuroimaging Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Adam Pines
- Penn Lifespan Informatics and Neuroimaging Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Damien A Fair
- Masonic Institute for the Developing Brain, Institute of Child Development, College of Education and Human Development, Department of Pediatrics, Medical School, University of Minnesota, Minneapolis, MN 55414, USA
| | - Dani S Bassett
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; Department of Bioengineering, University of Pennsylvania, Philadelphia, PA 19104, USA; Department of Electrical & Systems Engineering, University of Pennsylvania, Philadelphia, PA 19104, USA; Department of Physics & Astronomy, University of Pennsylvania, Philadelphia, PA 19104, USA; Department of Neurology, University of Pennsylvania, Philadelphia, PA 19104, USA; Santa Fe Institute, Santa Fe, NM 87501, USA
| | - Theodore D Satterthwaite
- Penn Lifespan Informatics and Neuroimaging Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; Lifespan Brain Institute, Children's Hospital of Philadelphia and Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA.
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7
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Stopyra MA, Simon JJ, Rheude C, Nikendei C. Pathophysiological aspects of complex PTSD - a neurobiological account in comparison to classic posttraumatic stress disorder and borderline personality disorder. Rev Neurosci 2023; 34:103-128. [PMID: 35938987 DOI: 10.1515/revneuro-2022-0014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Accepted: 06/25/2022] [Indexed: 01/11/2023]
Abstract
Despite a great diagnostic overlap, complex posttraumatic stress disorder (CPTSD) has been recognised by the ICD-11 as a new, discrete entity and recent empirical evidence points towards a distinction from simple posttraumatic stress disorder (PTSD) and borderline personality disorder (BPD). The development and maintenance of these disorders is sustained by neurobiological alterations and studies using functional magnetic resonance imaging (fMRI) may further contribute to a clear differentiation of CPTSD, PTSD and BPD. However, there are no existing fMRI studies directly comparing CPTSD, PTSD and BPD. In addition to a summarization of diagnostic differences and similarities, the current review aims to provide a qualitative comparison of neuroimaging findings on affective, attentional and memory processing in CPTSD, PTSD and BPD. Our narrative review alludes to an imbalance in limbic-frontal brain networks, which may be partially trans-diagnostically linked to the degree of trauma symptoms and their expression. Thus, CPTSD, PTSD and BPD may underlie a continuum where similar brain regions are involved but the direction of activation may constitute its distinct symptom expression. The neuronal alterations across these disorders may conceivably be better understood along a symptom-based continuum underlying CPTSD, PTSD and BPD. Further research is needed to amend for the heterogeneity in experimental paradigms and sample criteria.
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Affiliation(s)
- Marion A Stopyra
- Department of General Internal Medicine and Psychosomatics, Centre for Psychosocial Medicine, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
| | - Joe J Simon
- Department of General Internal Medicine and Psychosomatics, Centre for Psychosocial Medicine, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
| | - Christiane Rheude
- Department of General Internal Medicine and Psychosomatics, Centre for Psychosocial Medicine, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
| | - Christoph Nikendei
- Department of General Internal Medicine and Psychosomatics, Centre for Psychosocial Medicine, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
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8
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Jiang W, Tian Y, Fan F, Fu F, Wei D, Tang S, Chen J, Li Y, Zhu R, Wang L, Shi Z, Wang D, Zhang XY. Effects of comorbid posttraumatic stress disorder on cognitive dysfunction in Chinese male methamphetamine patients. Prog Neuropsychopharmacol Biol Psychiatry 2022; 119:110611. [PMID: 35907518 DOI: 10.1016/j.pnpbp.2022.110611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 07/21/2022] [Accepted: 07/23/2022] [Indexed: 10/16/2022]
Abstract
OBJECTIVES Cognitive dysfunction and posttraumatic stress disorder (PTSD) are common in methamphetamine patients. However, few studies have investigated the cognitive performance of methamphetamine patients with PTSD. The purpose of this study was to investigate the impact of comorbid PTSD on cognitive function in Chinese male methamphetamine patients. METHODS We analyzed 464 methamphetamine patients and 156 healthy volunteers. The PTSD Screening Scale (PCL-5) was used to assess PTSD and the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) was used to assess cognitive function. RESULTS Compared with healthy controls, methamphetamine patients had more cognitive dysfunction in immediate memory, visuospatial/constructional, language, attention and delayed memory. Moreover, methamphetamine patients with PTSD had less cognitive dysfunction in immediate memory, attention, and delayed memory than methamphetamine patients without PTSD. Further stepwise regression analysis showed that PTSD alterations in arousal and reactivity cluster were risk predictors for language, and PTSD negative alteration in cognition and mood cluster were risk predictors for delayed memory. CONCLUSIONS Our results indicate that methamphetamine patients without PTSD have poorer cognitive dysfunction than those with PTSD. Some demographic and PTSD symptom clusters are protective or risk factors for cognitive dysfunction in methamphetamine patients.
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Affiliation(s)
- Wei Jiang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Yang Tian
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Fusheng Fan
- Xin Hua Drug Rehabilitation Center, Sichuan, China
| | - Fabing Fu
- Xin Hua Drug Rehabilitation Center, Sichuan, China
| | - Dejun Wei
- Xin Hua Drug Rehabilitation Center, Sichuan, China
| | | | - Jiajing Chen
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Yuqing Li
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Rongrong Zhu
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Li Wang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Zhanbiao Shi
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China.
| | - Dongmei Wang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China.
| | - Xiang-Yang Zhang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China.
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Grignoli N, Filipponi C, Petrocchi S. Eliciting empathetic drives to prosocial behavior during stressful events. Front Psychol 2022; 13:963544. [PMID: 36337517 PMCID: PMC9632620 DOI: 10.3389/fpsyg.2022.963544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 09/30/2022] [Indexed: 11/23/2022] Open
Abstract
In the current pandemic situation, psychological science is increasingly considered by public health policy. Empathy is mainly recognized as a crucial drive for prosocial behavior. However, this rich body of evidence still lacks visibility and implementation. Effective social programs are needed, and little is known about how to elicit empathetic drives. The paper gives first a clear foundation to the role of empathy during stressful events. It provides then a comprehensive overview of innovative interventions triggering empathic response in the public such as fiction, film, and theater. Moreover, it integrates interactive ways of sharing personal views that could elicit empathetic feelings in different people. Advances deriving from this perspective could be of significant public interest in the current and future health crises and help authorities develop innovative social programs, which should be the focus of further scientific inquiry.
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Affiliation(s)
- Nicola Grignoli
- Cantonal Socio-Psychiatric Organisation, Public Health Division, Department of Health and Social Care, Repubblica e Cantone Ticino, Mendrisio, Switzerland
- Department of Internal Medicine, Regional Hospital of Bellinzona and Valleys, Ente Ospedaliero Cantonale, Bellinzona and Università della Svizzera italiana, Lugano, Switzerland
- *Correspondence: Nicola Grignoli, ; Serena Petrocchi,
| | - Chiara Filipponi
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
- Applied Research Division for Cognitive and Psychological Science, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Serena Petrocchi
- Faculty of Biomedical Sciences, Università della Svizzera italiana, Lugano, Switzerland
- Lab of Applied Psychology and Intervention, Università del Salento, Lecce, Italy
- *Correspondence: Nicola Grignoli, ; Serena Petrocchi,
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Orfei MD, Porcari DE, D’Arcangelo S, Maggi F, Russignaga D, Ricciardi E. A New Look on Long-COVID Effects: The Functional Brain Fog Syndrome. J Clin Med 2022; 11:jcm11195529. [PMID: 36233392 PMCID: PMC9573330 DOI: 10.3390/jcm11195529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 09/14/2022] [Accepted: 09/19/2022] [Indexed: 11/16/2022] Open
Abstract
Epidemiological data and etiopathogenesis of brain fog are very heterogeneous in the literature, preventing adequate diagnosis and treatment. Our study aimed to explore the relationship between brain fog, neuropsychiatric and cognitive symptoms in the general population. A sample of 441 subjects underwent a web-based survey, including the PANAS, the DASS-21, the IES-R, the Beck Cognitive Insight Scale, and a questionnaire investigating demographic information, brain fog, subjective cognitive impairments (Scc) and sleep disorders. ANOVA, ANCOVA, correlation and multiple stepwise regression analyses were performed. In our sample, 33% of participants were defined as Healthy Subjects (HS; no brain fog, no Scc), 27% as Probable Brain Fog (PBF; brain fog or Scc), and 40% as Functional Brain Fog (FBF; brain fog plus Scc). PBF and FBF showed higher levels of neuropsychiatric symptoms than HS, and FBF showed the worst psychological outcome. Moreover, worse cognitive symptoms were related to the female gender, greater neuropsychiatric symptoms, sleep disorders, and rumination/indecision. Being a woman and more severe neuropsychiatric symptoms were predictors of FBF severity. Our data pointed out a high prevalence and various levels of severity and impairments of brain fog, suggesting a classificatory proposal and a multifaceted etiopathogenic model, thus facilitating adequate diagnostic and therapeutic approaches.
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Affiliation(s)
- Maria Donata Orfei
- Molecular Mind Laboratory (MoMiLab), IMT School for Advanced Studies Lucca, Piazza S. Francesco 19, 55100 Lucca, Italy
- Correspondence:
| | - Desirée Estela Porcari
- Molecular Mind Laboratory (MoMiLab), IMT School for Advanced Studies Lucca, Piazza S. Francesco 19, 55100 Lucca, Italy
| | - Sonia D’Arcangelo
- Intesa Sanpaolo Innovation Center SpA Neuroscience Lab, Via Inghilterra 3, 10138 Turin, Italy
| | - Francesca Maggi
- Intesa Sanpaolo Innovation Center SpA Neuroscience Lab, Via Inghilterra 3, 10138 Turin, Italy
| | - Dario Russignaga
- Intesa Sanpaolo S.p.A., HSE Office, Via Lorenteggio 266, 20152 Milan, Italy
| | - Emiliano Ricciardi
- Molecular Mind Laboratory (MoMiLab), IMT School for Advanced Studies Lucca, Piazza S. Francesco 19, 55100 Lucca, Italy
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Tomas CW, Webb EK, Bennett KP, Huggins AA, Fitzgerald JM, Miskovich TA, Krukowki J, deRoon-Cassini TA, Larson CL. Neighborhood Socioeconomic Disadvantage and the Neurobiology of Uncertainty in Traumatically Injured Adults. BIOLOGICAL PSYCHIATRY GLOBAL OPEN SCIENCE 2022; 2:263-272. [PMID: 35903110 PMCID: PMC9328402 DOI: 10.1016/j.bpsgos.2022.02.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 02/04/2022] [Accepted: 02/21/2022] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Individuals residing in more socioeconomically disadvantaged neighborhoods experience greater uncertainty through insecurity of basic needs such as food, employment, and housing, compared with more advantaged neighborhoods. Although the neurobiology of uncertainty has been less frequently examined in relation to neighborhood disadvantage, there is evidence that neighborhood disadvantage is associated with widespread neural alterations. METHODS Recently traumatically injured participants (n = 90) completed a picture anticipation task in the magnetic resonance imaging scanner, in which they viewed images presented in a temporally predictable or unpredictable manner. We investigated how neighborhood disadvantage (via area deprivation index [ADI]) was related to neural activation during anticipation and presentation of negative and neutral images after accounting for individual factors (i.e., age, gender, income, acute posttraumatic stress symptoms). RESULTS There was a significant interaction during the anticipation period such that higher ADI rankings were related to greater activation of the right anterior cingulate cortex to predictable versus unpredictable neutral stimuli. Although no other robust interactions emerged related to ADI, we note several novel simple effects of ADI during anticipation and presentation periods in the hippocampus and prefrontal, cingulate, and occipital cortices. CONCLUSIONS Together, these results may represent an adaptive response to predictable and/or negative stimuli, stemming from chronic exposure to socioeconomic-based uncertainties. Although effects were modest, future work should continue to examine pretrauma context on posttrauma outcomes. To better understand trauma outcomes, it is imperative that researchers consider the broader context in which trauma survivors reside.
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Affiliation(s)
- Carissa W. Tomas
- Institute for Health and Equity, Division of Epidemiology and Social Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - E. Kate Webb
- Department of Psychology, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin
| | | | - Ashley A. Huggins
- Brain Imaging and Analysis Center, Duke University, Durham, North Carolina
| | | | | | - Jessica Krukowki
- Department of Psychology, Marquette University, Milwaukee, Wisconsin
| | - Terri A. deRoon-Cassini
- Division of Trauma and Acute Care Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Christine L. Larson
- Department of Psychology, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin
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12
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Tillman GD, Motes MA, Bass CM, Morris EE, Jones P, Kozel FA, Hart J, Kraut MA. Auditory N2 Correlates of Treatment Response in Posttraumatic Stress Disorder. J Trauma Stress 2022; 35:90-100. [PMID: 33960006 DOI: 10.1002/jts.22684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 03/18/2021] [Accepted: 03/21/2021] [Indexed: 11/06/2022]
Abstract
Emotional processing and cognitive control are implicated as being dysfunctional in posttraumatic stress disorder (PTSD) and targeted in cognitive processing therapy (CPT), a trauma-focused treatment for PTSD. The N2 event-related potential has been interpreted in the context of emotional processing and cognitive control. In this analysis of secondary outcome measures from a randomized controlled trial, we investigated the latency and amplitude changes of the N2 in responses to task-relevant target tones and task-irrelevant distractor sounds (e.g., a trauma-related gunshot and a trauma-unrelated lion's roar) and the associations between these responses and PTSD symptom changes. United States military veterans (N = 60) diagnosed with combat-related PTSD were randomized to either active or sham repetitive transcranial magnetic stimulation (rTMS) and received a CPT intervention that included a written trauma account element (CPT+A). Participants were tested before and 6 months after protocol completion. Reduction in N2 amplitude to the gunshot stimulus was correlated with reductions in reexperiencing, |r| = .445, and hyperarousal measures, |r| = .364. In addition, in both groups, the latency of the N2 event-related potential to the distractors became longer with treatment and the N2 latency to the task-relevant stimulus became shorter, ηp 2 = .064, both of which are consistent with improved cognitive control. There were no between-group differences in N2 amplitude and latency. Normalized N2 latencies, reduced N2 amplitude to threatening distractors, and the correlation between N2 amplitude reduction and PTSD symptom reduction reflect improved cognitive control, consistent with the CPT+A objective of addressing patients' abilities to respond more appropriately to trauma triggers.
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Affiliation(s)
- Gail D Tillman
- Callier Center, University of Texas at Dallas, Dallas, Texas, USA
| | - Michael A Motes
- Callier Center, University of Texas at Dallas, Dallas, Texas, USA
| | - Christina M Bass
- Callier Center, University of Texas at Dallas, Dallas, Texas, USA
| | | | - Penelope Jones
- Callier Center, University of Texas at Dallas, Dallas, Texas, USA
| | - F Andrew Kozel
- Mental Health and Behavioral Sciences, James A. Haley Veterans Administration Hospital and Clinics, Tampa, Florida, USA.,Department of Psychiatry and Behavioral Neurosciences, Morsani College of Medicine, University of South Florida, Tampa, Florida, USA
| | - John Hart
- Callier Center, University of Texas at Dallas, Dallas, Texas, USA.,Departments of Neurology & Neurotherapeutics and Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Michael A Kraut
- Departments of Neurology & Neurotherapeutics and Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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13
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Crum KI, Hwang S, Blair KS, Aloi JM, Meffert H, White SF, Tyler PM, Leibenluft E, Pope K, Blair RJR. Interaction of irritability and anxiety on emotional responding and emotion regulation: a functional MRI study. Psychol Med 2021; 51:2778-2788. [PMID: 32584213 PMCID: PMC7759590 DOI: 10.1017/s0033291720001397] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 04/17/2020] [Accepted: 04/29/2020] [Indexed: 01/14/2023]
Abstract
BACKGROUND Irritability and anxiety frequently co-occur in pediatric populations. Studies separately looking at the neural correlates of these symptoms have identified engagement of similar neural systems - particularly those implicated in emotional processing. Both irritability and anxiety can be considered negative valence emotional states that might relate to emotion dysregulation. However, previous work has not examined the neural responding during the performance of an emotion regulation task as a function of interaction between irritability and anxiety simultaneously. METHODS This fMRI study involved 155 participants (90 with significant psychopathologies and 92 male) who performed the Affective Stroop Task, designed to engage emotion regulation as a function of task demands. The Affective Reactivity Index (ARI) was used to index irritability and the Screen for Child Anxiety Related Emotional Disorders (SCARED) was used to index anxiety. RESULTS Levels of irritability, but not anxiety, was positively correlated with responses to visual images within the right rostro-medial prefrontal cortex and left anterior cingulate cortex during view trials. The second region of ventral anterior cingulate cortex showed a condition-by-emotion-by-ARI score-by-SCARED score interaction. Specifically, anxiety level was significantly correlated with a decreased differential BOLD response to negative relative to neutral view trials but only in the presence of relatively high irritability. CONCLUSIONS Atypical maintenance of emotional stimuli within the rostro-medial prefrontal cortex may exacerbate the difficulties faced by adolescents with irritability. Moreover, increased anxiety combined with significant irritability may disrupt an automatic emotional conflict-based form of emotion regulation that is particularly associated with the ventral anterior cingulate cortex.
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Affiliation(s)
- Kathleen I. Crum
- Medical University of South Carolina, Charleston, South Carolina, USA
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, Nebraska, USA
| | - Soonjo Hwang
- University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Karina S. Blair
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, Nebraska, USA
| | | | | | - Stuart F. White
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, Nebraska, USA
| | - Patrick M. Tyler
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, Nebraska, USA
| | - Ellen Leibenluft
- Emotion and Development Branch, National Institute of Mental Health, Bethesda, Maryland, USA
| | - Kayla Pope
- Medical College of Wisconsin, Northeastern Wisconsin Psychiatry Training Program, Winnebago, Wisconsin, USA
| | - R. J. R. Blair
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, Nebraska, USA
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14
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Li L, Xu Z, Chen L, Suo X, Fu S, Wang S, Lui S, Huang X, Li L, Li SJ, Biswal BB, Gong Q. Dysconnectivity of the amygdala and dorsal anterior cingulate cortex in drug-naive post-traumatic stress disorder. Eur Neuropsychopharmacol 2021; 52:84-93. [PMID: 34311210 DOI: 10.1016/j.euroneuro.2021.06.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 06/22/2021] [Accepted: 06/24/2021] [Indexed: 02/05/2023]
Abstract
Convergent studies have highlighted the amygdala-based and dorsal anterior cingulate cortex (dACC)-based circuit or network dysfunction in post-traumatic stress disorder (PTSD). However, previous studies are often complicated by various traumatic types, psychiatric comorbidities, chronic illness duration, and medication effect on brain function. Besides, little is known whether the functional integration with amygdala-dACC interaction disrupted or not in PTSD. Here, we investigated effective connectivity (EC) between the amygdala-dACC and rest of the cortex by applying psycho-physiological interaction (PPI) approach to resting-state functional magnetic resonance imaging data of 63 drug-naive PTSD patients and 74 matched trauma-exposed non-PTSD controls. Pearson correlation analysis was performed between EC values extracted from regions with between-group difference and clinical profiles in PTSD patients. We observed distinct amygdala-dACC interaction pattern between PTSD group and the control group, which is composed primarily by positive EC in the former and negative in the latter. In addition, compared with non-PTSD controls, PTSD patients showed increased EC between amygdala-dACC and the prefrontal cortex, left inferior parietal lobule, and bilateral ventral occipital cortex, and decreased EC between amygdala-dACC and the left fusiform gyrus. The EC increase between amygdala-dACC and the right middle frontal gyrus was negatively correlated with the clinician-administered PTSD scale scores in PTSD patients. Aberrent communication between amgydala-dACC and brain regions involved in central executive network and visual systems might be associated with the pathophysiology of PTSD. Further, these findings suggested that dysconnectivity of the amygdala and dACC could be adapted as a relatively early course diagnostic biomarker of PTSD.
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Affiliation(s)
- Lei Li
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, No. 37 Guo Xue Xiang, Chengdu 610041, China
| | - Zhan Xu
- Department of Biophysics, Medical College of Wisconsin, 8701 West Watertown Plank Road, Milwaukee, WI 53226, United States; Department of Imaging Physics, Univ of Texas M D Anderson Cancer Center, Houston, TX 77054, United States
| | - Lizhou Chen
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, No. 37 Guo Xue Xiang, Chengdu 610041, China
| | - Xueling Suo
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, No. 37 Guo Xue Xiang, Chengdu 610041, China
| | - Shiqin Fu
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, No. 37 Guo Xue Xiang, Chengdu 610041, China
| | - Song Wang
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, No. 37 Guo Xue Xiang, Chengdu 610041, China
| | - Su Lui
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, No. 37 Guo Xue Xiang, Chengdu 610041, China
| | - Xiaoqi Huang
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, No. 37 Guo Xue Xiang, Chengdu 610041, China
| | - Lingjiang Li
- Mental Health Institute, the Second Xiangya Hospital of Central South University, Changsha, China
| | - Shi-Jiang Li
- Department of Biophysics, Medical College of Wisconsin, 8701 West Watertown Plank Road, Milwaukee, WI 53226, United States.
| | - Bharat B Biswal
- Department of Biomedical Engineering, New Jersey Institute of Technology, Newark 07101, NJ, United States; The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation, University of Electronic Science and Technology of China, Chengdu, China
| | - Qiyong Gong
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, No. 37 Guo Xue Xiang, Chengdu 610041, China; Psychoradiology Research Unit of Chinese Academy of Medical Sciences, Chengdu, China; Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital of Sichuan University, Chengdu, China.
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15
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Crum KI, Flanagan JC, Vaughan B, Aloi J, Moran-Santa Maria MM, Back SE, Brady KT, Joseph JE. Oxytocin, PTSD, and sexual abuse are associated with attention network intrinsic functional connectivity. Psychiatry Res Neuroimaging 2021; 316:111345. [PMID: 34371478 PMCID: PMC8478844 DOI: 10.1016/j.pscychresns.2021.111345] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 07/23/2021] [Accepted: 07/26/2021] [Indexed: 11/24/2022]
Abstract
Childhood maltreatment is linked to Posttraumatic Stress Disorder (PTSD) in adulthood. Neural attention network function contributes to resilience against PTSD following maltreatment; oxytocin administration alters functional connectivity differentially among resilient to PTSD groups. The present study examined intrinsic connectivity between ventral and dorsal neural attention networks (VAN and DAN) to clarify the nature of dysfunction versus resilience in the context of maltreatment-related PTSD, and to explore differential dysfunction related to varied aspects of maltreatment. Oxytocin administration was examined as a factor in these relationships. Resting-state functional connectivity data were collected from 39 adults with maltreatment histories, with and without PTSD, who were randomly assigned to receive oxytocin or placebo. We found that PTSD and sexual abuse (SA) were associated with reduced VAN-DAN connectivity. There were no significant effects with regard to physical abuse. Oxytocin was associated with greater VAN-DAN connectivity strength. These preliminary findings suggest dysfunction within attentional systems in PTSD, as well as following SA. Further, oxytocin may help ameliorate attentional neurocircuitry dysfunction in individuals with PTSD and those with maltreatment histories.
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Affiliation(s)
- Kathleen I Crum
- Department of Neuroscience, Medical University of South Carolina, Charleston, SC, USA; Department of Psychiatry, Indiana University School of Medicine, 1002 Wishard Blvd, Suite 4110, Indianapolis, 46202, IN, USA.
| | - Julianne C Flanagan
- Department of Psychiatry, Medical University of South Carolina, Charleston, SC, USA; Ralph H. Johnson Veteran's Affairs Medical Center, Charleston, SC, USA
| | - Brandon Vaughan
- Department of Neuroscience, Medical University of South Carolina, Charleston, SC, USA
| | - Joseph Aloi
- Department of Psychiatry, Indiana University School of Medicine, 1002 Wishard Blvd, Suite 4110, Indianapolis, 46202, IN, USA; Center for Neurobehavioral Research, Boys Town National Research Hospital, Omaha, NE, USA; MD/PhD Scholars Program, University of Nebraska Medical Center, Omaha, NE, USA
| | | | - Sudie E Back
- Department of Psychiatry, Medical University of South Carolina, Charleston, SC, USA; Ralph H. Johnson Veteran's Affairs Medical Center, Charleston, SC, USA
| | - Kathleen T Brady
- Department of Psychiatry, Medical University of South Carolina, Charleston, SC, USA
| | - Jane E Joseph
- Department of Neuroscience, Medical University of South Carolina, Charleston, SC, USA
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16
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Clarke PJF, Todd J. Lessons unlearned: A conceptual review and meta-analysis of the relationship between the Attention Control Scale and Objective Attention Control. Cogn Emot 2021; 35:1447-1459. [PMID: 34672869 DOI: 10.1080/02699931.2021.1987861] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Attention control is central to many models of emotion. Among the most common measures of attention, control is the Attention Control Scale (ACS), which has exerted considerable influence in terms of the volume and breadth of research findings, with its use in cognitive-experimental research continuing to increase in recent years. However, there are growing concerns about whether the ACS genuinely indexes attention control. The present paper considers the context and development of the ACS, reviews and meta-analyses the available evidence regarding its association with objective measures of attention control. Meta-analytic results from nine studies (total n = 1274) indicated that the full-scale ACS was not significantly associated with behavioural measures of attentional control (r = .067, p = .093, N = 1274, 95% CI: -.011, .145). Findings indicated likely missing studies with lower correlations suggesting the true association may be smaller. Limited evidence of shared variance between subjective and objective measures of attention control contrasts with considerable evidence that the scale is closely correlated with dispositional traits (e.g. anxiety, agreeableness) that could plausibly influence responding. Thus, on the balance of current findings, we conclude that there is little compelling evidence that responding on the ACS reflects genuine attention control abilities.
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Affiliation(s)
- Patrick J F Clarke
- Affective, Behavioural, and Cognitive Neuroscience Group, Curtin University, Bentley, WA, Australia
| | - Jemma Todd
- Clinical Psychology Unit, School of Psychology, University of Sydney, Camperdown, NSW, Australia
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17
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Espeleta HC, Taylor DL, Kraft JD, Grant DM. Child maltreatment and cognitive vulnerabilities: Examining the link to posttraumatic stress symptoms. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2021; 69:759-766. [PMID: 31944931 DOI: 10.1080/07448481.2019.1706538] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 11/18/2019] [Accepted: 12/12/2019] [Indexed: 06/10/2023]
Abstract
Research attempting to identify pathways from childhood maltreatment to adulthood posttraumatic stress symptoms (PTSS) implicates cognitive vulnerabilities that may increase risk for mental health concerns. The present study examined two cognitive vulnerabilities and their relation to PTSS amongst individuals with and without childhood maltreatment histories: attentional control and repetitive negative thinking (RNT). This research surveyed college students (N = 376) on constructs of interest. Results revealed that attentional control and RNT demonstrated significant indirect effects on PTSS (95% CI =.0003, .0336 and 95% CI =.0643, .1857, respectively). Findings suggest that childhood maltreatment severity was related to decreased attentional control and increased RNT, which were then both related to increased PTSS. Interventions for increasing attentional control and decreasing RNT should be implemented and evaluated for young adults with early adversity currently experiencing PTSS.
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Affiliation(s)
- Hannah C Espeleta
- Department of Psychology, Oklahoma State University, Stillwater, OK, USA
| | - Danielle L Taylor
- Department of Psychology, Oklahoma State University, Stillwater, OK, USA
| | - Jacob D Kraft
- Department of Psychology, Oklahoma State University, Stillwater, OK, USA
| | - DeMond M Grant
- Department of Psychology, Oklahoma State University, Stillwater, OK, USA
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18
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Breukelaar IA, Bryant RA, Korgaonkar MS. The functional connectome in posttraumatic stress disorder. Neurobiol Stress 2021; 14:100321. [PMID: 33912628 PMCID: PMC8065342 DOI: 10.1016/j.ynstr.2021.100321] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 02/15/2021] [Accepted: 03/18/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Previous fMRI studies of posttraumatic stress disorder (PTSD) have investigated region-specific alterations in intrinsic connectivity but connectome-wide changes in connectivity are yet to be characterized. Understanding the neurobiology of this is important to develop novel treatment interventions for PTSD. This study aims to identify connectome-wide disruptions in PTSD to provide a more comprehensive analysis of nseural networks in this disorder. METHODS A functional MRI scan was completed by 138 individuals (67 PTSD and 71 non-trauma-exposed healthy controls [HC]). For every individual, inter-regional intrinsic functional connectivity was estimated between 436 brain regions, comprising intra and inter-network connectivity of eight large-scale brain networks. Group-wise differences between PTSD and HC were investigated using network-based statistics at a family-wise error rate of p < 0.05. Significant network differences were then further investigated in 27 individuals with trauma exposure but no PTSD [TC]). RESULTS Compared to HC, PTSD displayed lower intrinsic functional connectivity in a network of 203 connections between 420 regions within and between mid-posterior default mode, central executive, limbic, visual and somatomotor regions. Additionally, PTSD displayed higher connectivity across a network of 50 connections from thalamic and limbic to sensory and default-mode regions. Connectivity in TC in both these networks was intermediate and significantly different to PTSD and HC. CONCLUSION A large-scale imbalance between hypoconnectivity of higher-order cortical networks and hyperconnectivity of emotional and arousal response systems seems to occur on a sliding scale from trauma exposure to clinical manifestation as PTSD. Novel interventions that target this systemic functional imbalance could provide potential mitigation of PTSD.
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Affiliation(s)
- Isabella A. Breukelaar
- Brain Dynamics Centre, Westmead Institute for Medical Research, University of Sydney, Westmead, NSW, Australia
- School of Psychology, University of New South Wales, Sydney, Australia
| | - Richard A. Bryant
- Brain Dynamics Centre, Westmead Institute for Medical Research, University of Sydney, Westmead, NSW, Australia
- School of Psychology, University of New South Wales, Sydney, Australia
| | - Mayuresh S. Korgaonkar
- Brain Dynamics Centre, Westmead Institute for Medical Research, University of Sydney, Westmead, NSW, Australia
- Discipline of Psychiatry, Sydney Medical School, Westmead, NSW, Australia
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
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19
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Lee MS, Anumagalla P, Pavuluri MN. Individuals with the post-traumatic stress disorder process emotions in subcortical regions irrespective of cognitive engagement: a meta-analysis of cognitive and emotional interface. Brain Imaging Behav 2021; 15:941-957. [PMID: 32710332 DOI: 10.1007/s11682-020-00303-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Post-traumatic stress disorder (PTSD) manifests as emotional suffering and problem-solving impairments under extreme stress. This meta-analysis aimed to pool the findings from all the studies examining emotion and cognition in individuals with PTSD to develop a robust mechanistic understanding of the related brain dysfunction. We identified primary studies through a comprehensive literature search of the MEDLINE and PsychINFO databases. The GingerALE software (version 2.3.6) from the BrainMap Project was used to conduct activation likelihood estimation meta-analyses of the eligible studies for cognition, emotion and interface of both. Relative to the non-clinical (NC) group, the PTSD group showed greater activation during emotional tasks in the amygdala and parahippocampal gyrus. In contrast, the NC group showed significantly greater activation in the bilateral anterior cingulate cortex (ACC) than did the PTSD group in the emotional tasks. When both emotional and cognitive processing were evaluated, the PTSD group showed significantly greater activation in the striatum than did the NC group. No differences in activation between the PTSD and NC groups were noted when only the cognitive systems were examined. Individuals with PTSD exhibited overactivity in the subcortical regions, i.e., amygdala and striatum, when processing emotions. Underactivity in the emotional and cognitive processing intermediary cortex, i.e., the ACC, was especially prominent in individuals with PTSD relative to the NC population following exposure to emotional stimuli. These findings may explain the trauma-related fear, irritability, and negative effects as well as the concentration difficulties during cognitive distress associated with emotional arousal, that are commonly observed in individuals with PTSD.
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Affiliation(s)
- Moon-Soo Lee
- Department of adult, adolescent and child psychiatry, Brain and Wellness Institute, 1500 N. Halsted St, Chicago, IL, 60642, USA.,Department of Psychiatry, Korea University Guro hospital, Guro-gu, Seoul, 08308, Republic of Korea
| | - Purnima Anumagalla
- Department of adult, adolescent and child psychiatry, Brain and Wellness Institute, 1500 N. Halsted St, Chicago, IL, 60642, USA
| | - Mani N Pavuluri
- Department of adult, adolescent and child psychiatry, Brain and Wellness Institute, 1500 N. Halsted St, Chicago, IL, 60642, USA.
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20
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Wermuth K, Ülsmann D, Borngräber J, Gallinat J, Schulte-Herbrüggen O, Kühn S. Structural signature of trauma: white matter volume in right inferior frontal gyrus is positively associated with use of expressive suppression in recently traumatized individuals. Eur J Psychotraumatol 2021; 12:1837512. [PMID: 33505636 PMCID: PMC7817216 DOI: 10.1080/20008198.2020.1837512] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
Background: Differences in grey and white matter structure have been found between trauma-exposed individuals with and without PTSD. Yet, it remains unclear which functional processes are underlying these volumetric changes. Avoidance- and suppression-based emotion regulation strategies are candidates of interest since they play an important role in the development and maintenance of PTSD. Method: We used voxel-based morphometry to examine differences in brain structure in 20 recently trauma-exposed individuals and 20 healthy controls in respect of their relation to emotion regulation. Results: We found a significantly larger white matter volume close to the right inferior frontal gyrus (rIFG) in patients compared to healthy controls. White matter volume close to the rIFG was positively correlated with expressive suppression. Conclusion: The region of volumetric white matter difference in our study overlaps with brain regions previously associated with executive functioning and inhibitory control, functions that are known to be impaired in PTSD. Our findings support the idea that impaired executive functions in PTSD might be compensated by suppression-based emotion regulation strategies.
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Affiliation(s)
- Katharina Wermuth
- Max Planck Institute for Human Development, Center for Lifespan Psychology, Berlin, Germany.,St. Hedwig-Krankenhaus, Clinic for Psychiatry and Psychotherapy, Charité University Medicine, Berlin, Germany
| | - Dominik Ülsmann
- Friedrich Von Bodelschwingh-Klinik Clinic for Psychiatry, Psychotherapy and Psychosomatic Medicine, Berlin, Germany
| | - Janine Borngräber
- St. Hedwig-Krankenhaus, Clinic for Psychiatry and Psychotherapy, Charité University Medicine, Berlin, Germany
| | - Jürgen Gallinat
- St. Hedwig-Krankenhaus, Clinic for Psychiatry and Psychotherapy, Charité University Medicine, Berlin, Germany.,University Clinic Hamburg-Eppendorf, Clinic and Policlinic for Psychiatry and Psychotherapy, Hamburg, Germany
| | - Olaf Schulte-Herbrüggen
- St. Hedwig-Krankenhaus, Clinic for Psychiatry and Psychotherapy, Charité University Medicine, Berlin, Germany.,Friedrich Von Bodelschwingh-Klinik Clinic for Psychiatry, Psychotherapy and Psychosomatic Medicine, Berlin, Germany
| | - Simone Kühn
- Max Planck Institute for Human Development, Center for Lifespan Psychology, Berlin, Germany.,University Clinic Hamburg-Eppendorf, Clinic and Policlinic for Psychiatry and Psychotherapy, Hamburg, Germany
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21
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Clarke PJF, Marinovic W, Todd J, Basanovic J, Chen NTM, Notebaert L. What is attention bias variability? Examining the potential roles of attention control and response time variability in its relationship with anxiety. Behav Res Ther 2020; 135:103751. [PMID: 33070010 DOI: 10.1016/j.brat.2020.103751] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 09/25/2020] [Accepted: 10/04/2020] [Indexed: 12/24/2022]
Abstract
The present study examined the underlying role of attention control and response time variability in explaining the relationship between anxiety and two commonly computed measures of attention bias variability: 'moving average' and 'trial-level bias score' measures. Participants (final n = 195) completed measures of anxiety symptomatology, antisaccade performance (attention control), a stand-alone measure of response-time variability, and a probe task measure of attention bias. Average bias and moving average bias variability measures both recorded significant, but low split-half reliability. Both attention bias variability measures and average attention bias were associated with anxiety, and attention control. Both attention bias variability measures correlated with response time variability. Neither attention bias variability measure correlated with average attention bias. Attention control was the single significant mediator of the relationship between anxiety and the trial-level bias score measure of attention bias variability. Neither response time variability nor attention control significantly mediated the relationship between anxiety and the moving average measure of attention bias variability. No evidence was found for the mediating role of response time variability. The present findings suggest that the relationships observed between anxiety and the trial-level bias score measure of attention bias variability in particular may be attributable to the over-arching role of attention control.
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Affiliation(s)
| | | | - Jemma Todd
- School of Psychology, University of Sydney, Camperdown, Australia
| | - Julian Basanovic
- School of Psychological Science, University of Western Australia, Crawley, Australia
| | - Nigel T M Chen
- School of Psychology, Curtin University, Bentley, Australia
| | - Lies Notebaert
- School of Psychological Science, University of Western Australia, Crawley, Australia
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22
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Golde S, Wingenfeld K, Riepenhausen A, Schröter N, Fleischer J, Prüssner J, Grimm S, Fan Y, Hellmann-Regen J, Beck A, Gold SM, Otte C. Healthy women with severe early life trauma show altered neural facilitation of emotion inhibition under acute stress. Psychol Med 2020; 50:2075-2084. [PMID: 31462343 PMCID: PMC7525789 DOI: 10.1017/s0033291719002198] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 02/15/2019] [Accepted: 07/31/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Across psychopathologies, trauma-exposed individuals suffer from difficulties in inhibiting emotions and regulating attention. In trauma-exposed individuals without psychopathology, only subtle alterations of neural activity involved in regulating emotions have been reported. It remains unclear how these neural systems react to demanding environments, when acute (non-traumatic but ordinary) stress serves to perturbate the system. Moreover, associations with subthreshold clinical symptoms are poorly understood. METHODS The present fMRI study investigated response inhibition of emotional faces before and after psychosocial stress situations. Specifically, it compared 25 women (mean age 31.5 ± 9.7 years) who had suffered severe early life trauma but who did not have a history of or current psychiatric disorder, with 25 age- and education-matched trauma-naïve women. RESULTS Under stress, response inhibition related to fearful faces was reduced in both groups. Compared to controls, trauma-exposed women showed decreased left inferior frontal gyrus (IFG) activation under stress when inhibiting responses to fearful faces, while activation of the right anterior insula was slightly increased. Also, groups differed in brain-behaviour correlations. Whereas stress-induced false alarm rates on fearful stimuli negatively correlated with stress-induced IFG signal in controls, in trauma-exposed participants, they positively correlated with stress-induced insula activation. CONCLUSION Neural facilitation of emotion inhibition during stress appears to be altered in trauma-exposed women, even without a history of or current psychopathology. Decreased activation of the IFG in concert with heightened bottom-up salience of fear related cues may increase vulnerability to stress-related diseases.
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Affiliation(s)
- Sabrina Golde
- Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Klinik für Psychiatrie und Psychotherapie, Campus Benjamin Franklin, Berlin, Germany
- Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Klinik für Psychiatrie und Psychotherapie, Campus Charité Mitte, Berlin, Germany
| | - Katja Wingenfeld
- Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Klinik für Psychiatrie und Psychotherapie, Campus Benjamin Franklin, Berlin, Germany
| | - Antje Riepenhausen
- Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Klinik für Psychiatrie und Psychotherapie, Campus Benjamin Franklin, Berlin, Germany
| | - Nina Schröter
- Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Klinik für Psychiatrie und Psychotherapie, Campus Benjamin Franklin, Berlin, Germany
| | - Juliane Fleischer
- Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Klinik für Psychiatrie und Psychotherapie, Campus Benjamin Franklin, Berlin, Germany
| | - Jens Prüssner
- Department of Psychology, University of Konstanz, Konstanz, Baden-Württemberg, Germany
| | - Simone Grimm
- Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Klinik für Psychiatrie und Psychotherapie, Campus Benjamin Franklin, Berlin, Germany
- Department of Psychiatry, Psychotherapy and Psychosomatics, Hospital of Psychiatry, University of Zurich, Zurich, Switzerland
- MSB Medical School Berlin, Berlin, Germany
| | - Yan Fan
- Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Klinik für Psychiatrie und Psychotherapie, Campus Benjamin Franklin, Berlin, Germany
| | - Julian Hellmann-Regen
- Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Klinik für Psychiatrie und Psychotherapie, Campus Benjamin Franklin, Berlin, Germany
| | - Anne Beck
- Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Klinik für Psychiatrie und Psychotherapie, Campus Charité Mitte, Berlin, Germany
| | - Stefan M. Gold
- Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Klinik für Psychiatrie und Psychotherapie, Campus Benjamin Franklin, Berlin, Germany
- Institut für Neuroimmunologie und Multiple Sklerose (INIMS), Zentrum für Molekulare Neurobiologie, Hamburg, Germany
| | - Christian Otte
- Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Klinik für Psychiatrie und Psychotherapie, Campus Benjamin Franklin, Berlin, Germany
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Fitzgerald JM, Belleau EL, Miskovich TA, Pedersen WS, Larson CL. Multi-voxel pattern analysis of amygdala functional connectivity at rest predicts variability in posttraumatic stress severity. Brain Behav 2020; 10:e01707. [PMID: 32525273 PMCID: PMC7428479 DOI: 10.1002/brb3.1707] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 04/16/2020] [Accepted: 05/15/2020] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION Resting state functional magnetic resonance imaging (rsfMRI) studies demonstrate that individuals with posttraumatic stress disorder (PTSD) exhibit atypical functional connectivity (FC) between the amygdala, involved in the generation of emotion, and regions responsible for emotional appraisal (e.g., insula, orbitofrontal cortex [OFC]) and regulation (prefrontal cortex [PFC], anterior cingulate cortex). Consequently, atypical amygdala FC within an emotional processing and regulation network may be a defining feature of PTSD, although altered FC does not seem constrained to one brain region. Instead, altered amygdala FC involves a large, distributed brain network in those with PTSD. The present study used a machine-learning data-driven approach, multi-voxel pattern analysis (MVPA), to predict PTSD severity based on whole-brain patterns of amygdala FC. METHODS Trauma-exposed adults (N = 90) completed the PTSD Checklist-Civilian Version to assess symptoms and a 5-min rsfMRI. Whole-brain FC values to bilateral amygdala were extracted and used in a relevance vector regression analysis with a leave-one-out approach for cross-validation with permutation testing (1,000) to obtain significance values. RESULTS Results demonstrated that amygdala FC predicted PCL-C scores with statistically significant accuracy (r = .46, p = .001; mean sum of squares = 130.46, p = .001; R2 = 0.21, p = .001). Prediction was based on whole-brain amygdala FC, although regions that informed prediction (top 10%) included the OFC, amygdala, and dorsolateral PFC. CONCLUSION Findings demonstrate the utility of MVPA based on amygdala FC to predict individual severity of PTSD symptoms and that amygdala FC within a fear acquisition and regulation network contributed to accurate prediction.
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Affiliation(s)
| | - Emily L Belleau
- Department of Psychiatry, McLean Hospital, Belmont, MA, USA.,Harvard Medical School, Boston, MA, USA
| | | | - Walker S Pedersen
- Center for Healthy Minds, University of Wisconsin-Madison, Madison, WI, USA
| | - Christine L Larson
- Department of Psychology, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
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Duval ER, Sheynin J, King AP, Phan KL, Simon NM, Martis B, Porter KE, Norman SB, Liberzon I, Rauch SAM. Neural function during emotion processing and modulation associated with treatment response in a randomized clinical trial for posttraumatic stress disorder. Depress Anxiety 2020; 37:670-681. [PMID: 32306485 PMCID: PMC8010611 DOI: 10.1002/da.23022] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 02/19/2020] [Accepted: 03/27/2020] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Posttraumatic stress disorder (PTSD) has been associated with exaggerated threat processing and deficits in emotion modulation circuitry. It remains unknown how neural circuits are associated with response to evidence-based treatments for PTSD. METHOD We examined associations between PTSD symptoms and indicators of neural response in key emotion processing and modulation regions. Fifty-six military Veterans with PTSD were randomly assigned to one of three evidence-based treatments (prolonged exposure, sertraline, and PE plus sertraline) in a randomized clinical trial ("PROGrESS"; 2018, Contemp Clin Trials, 64, 128-138). Twenty-seven combat-exposed controls (CCs) served as a comparison group at pretreatment. Before and after PTSD treatment, functional magnetic resonance imaging was used to assess brain activation and connectivity during the validated Shifted Attention Emotion Appraisal Task (2003, J Neurosci, 23, 5627-5633; 2013, Biol Psychiatry, 73, 1045-1053). RESULTS Greater activation in emotion processing (anterior insula) and modulation (prefrontal cortex) regions and increased connectivity between attentional control (dorsolateral prefrontal cortex and superior parietal cortex) and emotion processing (amygdala) regions, at pretreatment, were associated with subsequent PTSD symptom improvement. CONCLUSIONS This study is one of the first to examine task-based activation and functional connectivity in a PTSD treatment trial, and provides evidence to suggest that activation in and connectivity between emotion processing and modulation regions are important predictors of treatment response.
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Affiliation(s)
- Elizabeth R. Duval
- VA Ann Arbor Healthcare System, Ann Arbor, Michigan,Department of Psychiatry, University of Michigan, Ann Arbor, Michigan
| | - Jony Sheynin
- VA Ann Arbor Healthcare System, Ann Arbor, Michigan,Department of Psychiatry, University of Michigan, Ann Arbor, Michigan,Department of Psychiatry, Texas A&M University Health Science Center, Bryan, Texas
| | - Anthony P. King
- VA Ann Arbor Healthcare System, Ann Arbor, Michigan,Department of Psychiatry, University of Michigan, Ann Arbor, Michigan
| | - K. Luan Phan
- Department of Psychiatry and Behavioral Health, The Ohio State University, Columbus, Ohio
| | - Naomi M. Simon
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts,Department of Psychiatry, New York University School of Medicine, New York, New York
| | - Brian Martis
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan,Research Service, VA San Diego Healthcare System, San Diego, California,Department of Psychiatry, University of California, San Diego School of Medicine, La Jolla, California
| | - Katherine E. Porter
- VA Ann Arbor Healthcare System, Ann Arbor, Michigan,Department of Psychiatry, University of Michigan, Ann Arbor, Michigan
| | - Sonya B. Norman
- Research Service, VA San Diego Healthcare System, San Diego, California,Department of Psychiatry, University of California, San Diego School of Medicine, La Jolla, California,Executive Division, National Center for PTSD, White River Junction, Vermont
| | - Israel Liberzon
- VA Ann Arbor Healthcare System, Ann Arbor, Michigan,Department of Psychiatry, University of Michigan, Ann Arbor, Michigan,Department of Psychiatry, Texas A&M University Health Science Center, Bryan, Texas
| | - Sheila A. M. Rauch
- Mental Health Service Line, VA Atlanta Healthcare System, Decatur, Georgia,Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia
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25
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Genetic and Neuroimaging Approaches to Understanding Post-Traumatic Stress Disorder. Int J Mol Sci 2020; 21:ijms21124503. [PMID: 32599917 PMCID: PMC7352752 DOI: 10.3390/ijms21124503] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 05/12/2020] [Accepted: 05/14/2020] [Indexed: 12/15/2022] Open
Abstract
Post-traumatic stress disorder (PTSD) is a highly disabling condition, increasingly recognized as both a disorder of mental health and social burden, but also as an anxiety disorder characterized by fear, stress, and negative alterations in mood. PTSD is associated with structural, metabolic, and molecular changes in several brain regions and the neural circuitry. Brain areas implicated in the traumatic stress response include the amygdala, hippocampus, and prefrontal cortex, which play an essential role in memory function. Abnormalities in these brain areas are hypothesized to underlie symptoms of PTSD and other stress-related psychiatric disorders. Conventional methods of studying PTSD have proven to be insufficient for diagnosis, measurement of treatment efficacy, and monitoring disease progression, and currently, there is no diagnostic biomarker available for PTSD. A deep understanding of cutting-edge neuroimaging genetic approaches is necessary for the development of novel therapeutics and biomarkers to better diagnose and treat the disorder. A current goal is to understand the gene pathways that are associated with PTSD, and how those genes act on the fear/stress circuitry to mediate risk vs. resilience for PTSD. This review article explains the rationale and practical utility of neuroimaging genetics in PTSD and how the resulting information can aid the diagnosis and clinical management of patients with PTSD.
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26
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Acute Posttrauma Resting-State Functional Connectivity of Periaqueductal Gray Prospectively Predicts Posttraumatic Stress Disorder Symptoms. BIOLOGICAL PSYCHIATRY: COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2020; 5:891-900. [PMID: 32389746 DOI: 10.1016/j.bpsc.2020.03.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 03/04/2020] [Accepted: 03/08/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND Posttraumatic stress disorder (PTSD) is characterized by hyperarousal, avoidance, and intrusive/re-experiencing symptoms. The periaqueductal gray (PAG), which generates behavioral responses to physical and psychological stressors, is also implicated in threat processing. Distinct regions of the PAG elicit opposing responses to threatening or stressful stimuli; the ventrolateral PAG evokes passive coping strategies (e.g., analgesia), whereas the dorsolateral PAG (dlPAG) promotes active responses (e.g., fight or flight). We investigated whether altered PAG resting-state functional connectivity (RSFC) prospectively predicted PTSD symptoms. METHODS A total of 48 trauma-exposed individuals underwent an RSFC scan 2 weeks posttraumatic injury. Self-report measures, including the visual analog scale for pain and the Impact of Event Scale, were collected at 2 weeks and 6 months posttrauma. We analyzed whether acute bilateral PAG RSFC was a marker of risk for total 6-month symptom severity and specific symptom clusters. In an exploratory analysis, we investigated whether dlPAG RSFC predicted PTSD symptoms. RESULTS After adjusting for physical pain ratings, greater acute posttrauma PAG-frontal pole and PAG-posterior cingulate cortex connectivity was positively associated with 6-month total PTSD symptoms. Weaker dlPAG-superior/inferior parietal lobule connectivity predicted both higher hyperarousal and higher intrusive symptoms, while weaker dlPAG-supramarginal gyrus RSFC was associated with only hyperarousal symptoms. CONCLUSIONS Altered connectivity of the PAG 2 weeks posttrauma prospectively predicted PTSD symptoms. These findings suggest that aberrant PAG function may serve as a marker of risk for chronic PTSD symptoms, possibly by driving specific symptom clusters, and more broadly that connectivity of specific brain regions may underlie specific symptom profiles.
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27
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Maron-Katz A, Zhang Y, Narayan M, Wu W, Toll RT, Naparstek S, De Los Angeles C, Longwell P, Shpigel E, Newman J, Abu-Amara D, Marmar C, Etkin A. Individual Patterns of Abnormality in Resting-State Functional Connectivity Reveal Two Data-Driven PTSD Subgroups. Am J Psychiatry 2020; 177:244-253. [PMID: 31838870 DOI: 10.1176/appi.ajp.2019.19010060] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE A major challenge in understanding and treating posttraumatic stress disorder (PTSD) is its clinical heterogeneity, which is likely determined by various neurobiological perturbations. This heterogeneity likely also reduces the effectiveness of standard group comparison approaches. The authors tested whether a statistical approach aimed at identifying individual-level neuroimaging abnormalities that are more prevalent in case subjects than in control subjects could reveal new clinically meaningful insights into the heterogeneity of PTSD. METHODS Resting-state functional MRI data were recorded from 87 unmedicated PTSD case subjects and 105 war zone-exposed healthy control subjects. Abnormalities were modeled using tolerance intervals, which referenced the distribution of healthy control subjects as the "normative population." Out-of-norm functional connectivity values were examined for enrichment in cases and then used in a clustering analysis to identify biologically defined PTSD subgroups based on their abnormality profiles. RESULTS The authors identified two subgroups among PTSD cases, each with a distinct pattern of functional connectivity abnormalities with respect to healthy control subjects. Subgroups differed clinically on levels of reexperiencing symptoms and improved case-control discriminability and were detectable using independently recorded resting-state EEG data. CONCLUSIONS The results provide proof of concept for the utility of abnormality-based approaches for studying heterogeneity within clinical populations. Such approaches, applied not only to neuroimaging data, may allow detection of subpopulations with distinct biological signatures so that further clinical and mechanistic investigations can be focused on more biologically homogeneous subgroups.
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Affiliation(s)
- Adi Maron-Katz
- Department of Bioengineering (Toll) and Department of Psychiatry and Behavioral Sciences and Wu Tsai Neurosciences Institute (Maron-Katz, Zhang, Narayan, Wu, Toll, Naparstek, De Los Angeles, Longwell, Shpigel, Etkin), Stanford University, Stanford, Calif.; VA Palo Alto Health Care System and Sierra Pacific Mental Illness Research, Education, and Clinical Center, Palo Alto, Calif. (Maron-Katz, Zhang, Narayan, Wu, Toll, Naparstek, De Los Angeles, Longwell, Shpigel, Etkin); School of Automation Science and Engineering, South China University of Technology, Guangzhou, Guangdong, China (Wu); Steven and Alexandra Cohen Veterans Center for the Study of Post-Traumatic Stress and Traumatic Brain Injury and Department of Psychiatry (Newman, Abu-Amara, Marmar), New York University Langone School of Medicine, New York
| | - Yu Zhang
- Department of Bioengineering (Toll) and Department of Psychiatry and Behavioral Sciences and Wu Tsai Neurosciences Institute (Maron-Katz, Zhang, Narayan, Wu, Toll, Naparstek, De Los Angeles, Longwell, Shpigel, Etkin), Stanford University, Stanford, Calif.; VA Palo Alto Health Care System and Sierra Pacific Mental Illness Research, Education, and Clinical Center, Palo Alto, Calif. (Maron-Katz, Zhang, Narayan, Wu, Toll, Naparstek, De Los Angeles, Longwell, Shpigel, Etkin); School of Automation Science and Engineering, South China University of Technology, Guangzhou, Guangdong, China (Wu); Steven and Alexandra Cohen Veterans Center for the Study of Post-Traumatic Stress and Traumatic Brain Injury and Department of Psychiatry (Newman, Abu-Amara, Marmar), New York University Langone School of Medicine, New York
| | - Manjari Narayan
- Department of Bioengineering (Toll) and Department of Psychiatry and Behavioral Sciences and Wu Tsai Neurosciences Institute (Maron-Katz, Zhang, Narayan, Wu, Toll, Naparstek, De Los Angeles, Longwell, Shpigel, Etkin), Stanford University, Stanford, Calif.; VA Palo Alto Health Care System and Sierra Pacific Mental Illness Research, Education, and Clinical Center, Palo Alto, Calif. (Maron-Katz, Zhang, Narayan, Wu, Toll, Naparstek, De Los Angeles, Longwell, Shpigel, Etkin); School of Automation Science and Engineering, South China University of Technology, Guangzhou, Guangdong, China (Wu); Steven and Alexandra Cohen Veterans Center for the Study of Post-Traumatic Stress and Traumatic Brain Injury and Department of Psychiatry (Newman, Abu-Amara, Marmar), New York University Langone School of Medicine, New York
| | - Wei Wu
- Department of Bioengineering (Toll) and Department of Psychiatry and Behavioral Sciences and Wu Tsai Neurosciences Institute (Maron-Katz, Zhang, Narayan, Wu, Toll, Naparstek, De Los Angeles, Longwell, Shpigel, Etkin), Stanford University, Stanford, Calif.; VA Palo Alto Health Care System and Sierra Pacific Mental Illness Research, Education, and Clinical Center, Palo Alto, Calif. (Maron-Katz, Zhang, Narayan, Wu, Toll, Naparstek, De Los Angeles, Longwell, Shpigel, Etkin); School of Automation Science and Engineering, South China University of Technology, Guangzhou, Guangdong, China (Wu); Steven and Alexandra Cohen Veterans Center for the Study of Post-Traumatic Stress and Traumatic Brain Injury and Department of Psychiatry (Newman, Abu-Amara, Marmar), New York University Langone School of Medicine, New York
| | - Russell T Toll
- Department of Bioengineering (Toll) and Department of Psychiatry and Behavioral Sciences and Wu Tsai Neurosciences Institute (Maron-Katz, Zhang, Narayan, Wu, Toll, Naparstek, De Los Angeles, Longwell, Shpigel, Etkin), Stanford University, Stanford, Calif.; VA Palo Alto Health Care System and Sierra Pacific Mental Illness Research, Education, and Clinical Center, Palo Alto, Calif. (Maron-Katz, Zhang, Narayan, Wu, Toll, Naparstek, De Los Angeles, Longwell, Shpigel, Etkin); School of Automation Science and Engineering, South China University of Technology, Guangzhou, Guangdong, China (Wu); Steven and Alexandra Cohen Veterans Center for the Study of Post-Traumatic Stress and Traumatic Brain Injury and Department of Psychiatry (Newman, Abu-Amara, Marmar), New York University Langone School of Medicine, New York
| | - Sharon Naparstek
- Department of Bioengineering (Toll) and Department of Psychiatry and Behavioral Sciences and Wu Tsai Neurosciences Institute (Maron-Katz, Zhang, Narayan, Wu, Toll, Naparstek, De Los Angeles, Longwell, Shpigel, Etkin), Stanford University, Stanford, Calif.; VA Palo Alto Health Care System and Sierra Pacific Mental Illness Research, Education, and Clinical Center, Palo Alto, Calif. (Maron-Katz, Zhang, Narayan, Wu, Toll, Naparstek, De Los Angeles, Longwell, Shpigel, Etkin); School of Automation Science and Engineering, South China University of Technology, Guangzhou, Guangdong, China (Wu); Steven and Alexandra Cohen Veterans Center for the Study of Post-Traumatic Stress and Traumatic Brain Injury and Department of Psychiatry (Newman, Abu-Amara, Marmar), New York University Langone School of Medicine, New York
| | - Carlo De Los Angeles
- Department of Bioengineering (Toll) and Department of Psychiatry and Behavioral Sciences and Wu Tsai Neurosciences Institute (Maron-Katz, Zhang, Narayan, Wu, Toll, Naparstek, De Los Angeles, Longwell, Shpigel, Etkin), Stanford University, Stanford, Calif.; VA Palo Alto Health Care System and Sierra Pacific Mental Illness Research, Education, and Clinical Center, Palo Alto, Calif. (Maron-Katz, Zhang, Narayan, Wu, Toll, Naparstek, De Los Angeles, Longwell, Shpigel, Etkin); School of Automation Science and Engineering, South China University of Technology, Guangzhou, Guangdong, China (Wu); Steven and Alexandra Cohen Veterans Center for the Study of Post-Traumatic Stress and Traumatic Brain Injury and Department of Psychiatry (Newman, Abu-Amara, Marmar), New York University Langone School of Medicine, New York
| | - Parker Longwell
- Department of Bioengineering (Toll) and Department of Psychiatry and Behavioral Sciences and Wu Tsai Neurosciences Institute (Maron-Katz, Zhang, Narayan, Wu, Toll, Naparstek, De Los Angeles, Longwell, Shpigel, Etkin), Stanford University, Stanford, Calif.; VA Palo Alto Health Care System and Sierra Pacific Mental Illness Research, Education, and Clinical Center, Palo Alto, Calif. (Maron-Katz, Zhang, Narayan, Wu, Toll, Naparstek, De Los Angeles, Longwell, Shpigel, Etkin); School of Automation Science and Engineering, South China University of Technology, Guangzhou, Guangdong, China (Wu); Steven and Alexandra Cohen Veterans Center for the Study of Post-Traumatic Stress and Traumatic Brain Injury and Department of Psychiatry (Newman, Abu-Amara, Marmar), New York University Langone School of Medicine, New York
| | - Emmanuel Shpigel
- Department of Bioengineering (Toll) and Department of Psychiatry and Behavioral Sciences and Wu Tsai Neurosciences Institute (Maron-Katz, Zhang, Narayan, Wu, Toll, Naparstek, De Los Angeles, Longwell, Shpigel, Etkin), Stanford University, Stanford, Calif.; VA Palo Alto Health Care System and Sierra Pacific Mental Illness Research, Education, and Clinical Center, Palo Alto, Calif. (Maron-Katz, Zhang, Narayan, Wu, Toll, Naparstek, De Los Angeles, Longwell, Shpigel, Etkin); School of Automation Science and Engineering, South China University of Technology, Guangzhou, Guangdong, China (Wu); Steven and Alexandra Cohen Veterans Center for the Study of Post-Traumatic Stress and Traumatic Brain Injury and Department of Psychiatry (Newman, Abu-Amara, Marmar), New York University Langone School of Medicine, New York
| | - Jennifer Newman
- Department of Bioengineering (Toll) and Department of Psychiatry and Behavioral Sciences and Wu Tsai Neurosciences Institute (Maron-Katz, Zhang, Narayan, Wu, Toll, Naparstek, De Los Angeles, Longwell, Shpigel, Etkin), Stanford University, Stanford, Calif.; VA Palo Alto Health Care System and Sierra Pacific Mental Illness Research, Education, and Clinical Center, Palo Alto, Calif. (Maron-Katz, Zhang, Narayan, Wu, Toll, Naparstek, De Los Angeles, Longwell, Shpigel, Etkin); School of Automation Science and Engineering, South China University of Technology, Guangzhou, Guangdong, China (Wu); Steven and Alexandra Cohen Veterans Center for the Study of Post-Traumatic Stress and Traumatic Brain Injury and Department of Psychiatry (Newman, Abu-Amara, Marmar), New York University Langone School of Medicine, New York
| | - Duna Abu-Amara
- Department of Bioengineering (Toll) and Department of Psychiatry and Behavioral Sciences and Wu Tsai Neurosciences Institute (Maron-Katz, Zhang, Narayan, Wu, Toll, Naparstek, De Los Angeles, Longwell, Shpigel, Etkin), Stanford University, Stanford, Calif.; VA Palo Alto Health Care System and Sierra Pacific Mental Illness Research, Education, and Clinical Center, Palo Alto, Calif. (Maron-Katz, Zhang, Narayan, Wu, Toll, Naparstek, De Los Angeles, Longwell, Shpigel, Etkin); School of Automation Science and Engineering, South China University of Technology, Guangzhou, Guangdong, China (Wu); Steven and Alexandra Cohen Veterans Center for the Study of Post-Traumatic Stress and Traumatic Brain Injury and Department of Psychiatry (Newman, Abu-Amara, Marmar), New York University Langone School of Medicine, New York
| | - Charles Marmar
- Department of Bioengineering (Toll) and Department of Psychiatry and Behavioral Sciences and Wu Tsai Neurosciences Institute (Maron-Katz, Zhang, Narayan, Wu, Toll, Naparstek, De Los Angeles, Longwell, Shpigel, Etkin), Stanford University, Stanford, Calif.; VA Palo Alto Health Care System and Sierra Pacific Mental Illness Research, Education, and Clinical Center, Palo Alto, Calif. (Maron-Katz, Zhang, Narayan, Wu, Toll, Naparstek, De Los Angeles, Longwell, Shpigel, Etkin); School of Automation Science and Engineering, South China University of Technology, Guangzhou, Guangdong, China (Wu); Steven and Alexandra Cohen Veterans Center for the Study of Post-Traumatic Stress and Traumatic Brain Injury and Department of Psychiatry (Newman, Abu-Amara, Marmar), New York University Langone School of Medicine, New York
| | - Amit Etkin
- Department of Bioengineering (Toll) and Department of Psychiatry and Behavioral Sciences and Wu Tsai Neurosciences Institute (Maron-Katz, Zhang, Narayan, Wu, Toll, Naparstek, De Los Angeles, Longwell, Shpigel, Etkin), Stanford University, Stanford, Calif.; VA Palo Alto Health Care System and Sierra Pacific Mental Illness Research, Education, and Clinical Center, Palo Alto, Calif. (Maron-Katz, Zhang, Narayan, Wu, Toll, Naparstek, De Los Angeles, Longwell, Shpigel, Etkin); School of Automation Science and Engineering, South China University of Technology, Guangzhou, Guangdong, China (Wu); Steven and Alexandra Cohen Veterans Center for the Study of Post-Traumatic Stress and Traumatic Brain Injury and Department of Psychiatry (Newman, Abu-Amara, Marmar), New York University Langone School of Medicine, New York
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Ioannidis K, Askelund AD, Kievit RA, van Harmelen AL. The complex neurobiology of resilient functioning after childhood maltreatment. BMC Med 2020; 18:32. [PMID: 32050974 PMCID: PMC7017563 DOI: 10.1186/s12916-020-1490-7] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Accepted: 01/07/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Childhood maltreatment has been associated with significant impairment in social, emotional and behavioural functioning later in life. Nevertheless, some individuals who have experienced childhood maltreatment function better than expected given their circumstances. MAIN BODY Here, we provide an integrated understanding of the complex, interrelated mechanisms that facilitate such individual resilient functioning after childhood maltreatment. We aim to show that resilient functioning is not facilitated by any single 'resilience biomarker'. Rather, resilient functioning after childhood maltreatment is a product of complex processes and influences across multiple levels, ranging from 'bottom-up' polygenetic influences, to 'top-down' supportive social influences. We highlight the complex nature of resilient functioning and suggest how future studies could embrace a complexity theory approach and investigate multiple levels of biological organisation and their temporal dynamics in a longitudinal or prospective manner. This would involve using methods and tools that allow the characterisation of resilient functioning trajectories, attractor states and multidimensional/multilevel assessments of functioning. Such an approach necessitates large, longitudinal studies on the neurobiological mechanisms of resilient functioning after childhood maltreatment that cut across and integrate multiple levels of explanation (i.e. genetics, endocrine and immune systems, brain structure and function, cognition and environmental factors) and their temporal interconnections. CONCLUSION We conclude that a turn towards complexity is likely to foster collaboration and integration across fields. It is a promising avenue which may guide future studies aimed to promote resilience in those who have experienced childhood maltreatment.
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Affiliation(s)
- Konstantinos Ioannidis
- University of Cambridge, Department of Psychiatry, 18b Trumpington Rd, Cambridge, CB2 8AH, UK.
- Cambridgeshire and Peterborough NHS Foundation Trust/S3 Eating Disorder Service, Addenbrookes Hospital, Hills Rd Cambridge, CB2 0QQ, PO Box 175, Cambridge, UK.
| | - Adrian Dahl Askelund
- University of Cambridge, Department of Psychiatry, 18b Trumpington Rd, Cambridge, CB2 8AH, UK
| | - Rogier A Kievit
- MRC Cognition And Brain Sciences Unit, 15 Chaucer Road, University of Cambridge, Cambridge, UK
| | - Anne-Laura van Harmelen
- University of Cambridge, Department of Psychiatry, 18b Trumpington Rd, Cambridge, CB2 8AH, UK.
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29
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Lago TR, Blair KS, Alvarez G, Thongdarong A, Blair JR, Ernst M, Grillon C. Threat-of-shock decreases emotional interference on affective stroop performance in healthy controls and anxiety patients. Eur J Neurosci 2019; 55:2519-2528. [PMID: 31738835 DOI: 10.1111/ejn.14624] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 11/13/2019] [Accepted: 11/15/2019] [Indexed: 11/29/2022]
Abstract
Patients with anxiety disorders suffer from impaired concentration, potentially as a result of stronger emotional interference on attention. Studies using behavioural measures provide conflicting support for this hypothesis. Elevated state anxiety may be necessary to reliably document differences in emotional interference in patients versus healthy controls. The present study examines the effect of experimentally induced state anxiety (threat-of-shock) on attention interference by emotional stimuli. Anxiety patients (n = 36) and healthy controls (n = 32) completed a modified affective Stroop task during periods of safety and threat-of-shock. Results indicated that in both patients and controls, threat decreased negative, but not positive or neutral, emotional interference on attention (both p < .001). This finding supports a threat-related narrowing of attention whereby a certain level of anxiety decreases task-irrelevant processing.
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Affiliation(s)
- Tiffany R Lago
- Section on the Neurobiology of Fear and Anxiety, National Institute of Mental Health, Bethesda, MD
| | - Karina S Blair
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, NE
| | - Gabriella Alvarez
- Section on the Neurobiology of Fear and Anxiety, National Institute of Mental Health, Bethesda, MD
| | - Amanda Thongdarong
- Section on the Neurobiology of Fear and Anxiety, National Institute of Mental Health, Bethesda, MD
| | - James R Blair
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, NE
| | - Monique Ernst
- Section on the Neurobiology of Fear and Anxiety, National Institute of Mental Health, Bethesda, MD
| | - Christian Grillon
- Section on the Neurobiology of Fear and Anxiety, National Institute of Mental Health, Bethesda, MD
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30
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Vanasse TJ, Franklin C, Salinas FS, Ramage AE, Calhoun VD, Robinson PC, Kok M, Peterson AL, Mintz J, Litz BT, Young-McCaughan S, Resick PA, Fox PT. A resting-state network comparison of combat-related PTSD with combat-exposed and civilian controls. Soc Cogn Affect Neurosci 2019; 14:933-945. [PMID: 31588508 PMCID: PMC6917024 DOI: 10.1093/scan/nsz072] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 08/09/2019] [Accepted: 08/24/2019] [Indexed: 12/30/2022] Open
Abstract
Resting-state functional connectivity (rsFC) is an emerging means of understanding the neurobiology of combat-related post-traumatic stress disorder (PTSD). However, most rsFC studies to date have limited focus to cognitively related intrinsic connectivity networks (ICNs), have not applied data-driven methodologies or have disregarded the effect of combat exposure. In this study, we predicted that group independent component analysis (GICA) would reveal group-wise differences in rsFC across 50 active duty service members with PTSD, 28 combat-exposed controls (CEC), and 25 civilian controls without trauma exposure (CC). Intranetwork connectivity differences were identified across 11 ICNs, yet combat-exposed groups were indistinguishable in PTSD vs CEC contrasts. Both PTSD and CEC demonstrated anatomically diffuse differences in the Auditory Vigilance and Sensorimotor networks compared to CC. However, intranetwork connectivity in a subset of three regions was associated with PTSD symptom severity among executive (left insula; ventral anterior cingulate) and right Fronto-Parietal (perigenual cingulate) networks. Furthermore, we found that increased temporal synchronization among visuospatial and sensorimotor networks was associated with worse avoidance symptoms in PTSD. Longitudinal neuroimaging studies in combat-exposed cohorts can further parse PTSD-related, combat stress-related or adaptive rsFC changes ensuing from combat.
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Affiliation(s)
- Thomas J Vanasse
- Research Imaging Institute, University of Texas Health Science Center, San Antonio, TX 78229, USA.,Department of Radiology, University of Texas Health Science Center, San Antonio, TX 78229, USA
| | - Crystal Franklin
- Research Imaging Institute, University of Texas Health Science Center, San Antonio, TX 78229, USA
| | - Felipe S Salinas
- Research Imaging Institute, University of Texas Health Science Center, San Antonio, TX 78229, USA.,Department of Radiology, University of Texas Health Science Center, San Antonio, TX 78229, USA.,Research and Development Service, South Texas Veterans Health Care System, San Antonio, TX 78229, USA
| | - Amy E Ramage
- Department of Communication Sciences and Disorders, College of Health and Human Services, University of New Hampshire, Durham, NH 03824, USA
| | - Vince D Calhoun
- The Mind Research Network, Albuquerque, NM 87106, USA.,Department of Electrical and Computer Engineering, University of New Mexico, Albuquerque, NM 87131, USA.,Tri-institutional Center for Translational Research in Neuroimaging and Data Science (TReNDS), Georgia State University 30302, Georgia Institute of Technology, Emory University 30322, Atlanta, GA, USA
| | - Paul C Robinson
- Carl R. Darnall Army Medical Center, Fort Hood, TX 76544, USA
| | - Mitchell Kok
- Carl R. Darnall Army Medical Center, Fort Hood, TX 76544, USA
| | - Alan L Peterson
- Department of Psychiatry, University of Texas Health Science Center, San Antonio, TX 78229, USA.,Research and Development Service, South Texas Veterans Health Care System, San Antonio, TX 78229, USA.,Department of Psychology, University of Texas, San Antonio, TX 78249, USA
| | - Jim Mintz
- Department of Psychiatry, University of Texas Health Science Center, San Antonio, TX 78229, USA.,Department of Epidemiology and Biostatistics, University of Texas Health Science Center, San Antonio, TX 78229, USA
| | - Brett T Litz
- Massachusetts Veterans Epidemiological Research and Information Center, VA Boston Healthcare System, Boston, MA 02130, USA.,Department of Psychiatry, Boston University School of Medicine, Boston, MA 02118, USA.,Department of Psychological and Brain Sciences, Boston University, Boston, MA 02215, USA
| | - Stacey Young-McCaughan
- Department of Psychiatry, University of Texas Health Science Center, San Antonio, TX 78229, USA
| | - Patricia A Resick
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27707, USA
| | - Peter T Fox
- Research Imaging Institute, University of Texas Health Science Center, San Antonio, TX 78229, USA.,Department of Radiology, University of Texas Health Science Center, San Antonio, TX 78229, USA.,Department of Psychiatry, University of Texas Health Science Center, San Antonio, TX 78229, USA.,Research and Development Service, South Texas Veterans Health Care System, San Antonio, TX 78229, USA
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31
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Attentional control abnormalities in posttraumatic stress disorder: Functional, behavioral, and structural correlates. J Affect Disord 2019; 253:343-351. [PMID: 31078834 PMCID: PMC6857173 DOI: 10.1016/j.jad.2019.04.098] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 02/19/2019] [Accepted: 04/30/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND Attentional disruptions are common in PTSD, but findings across neuropsychological and neuroimaging studies have been variable. Few PTSD studies have investigated abnormalities in attention networks using a multi-modal imaging approach and attentional tasks that include emotionally-salient images. This study combined a behavioral task that included these images (emotional Stroop) with functional and structural neuroimaging (fMRI and diffusion tensor imaging; DTI) methods to comprehensively investigate attentional control abnormalities in a highly-traumatized civilian sample. METHODS 48 traumatized women with and without PTSD received clinical assessments, fMRI and DTI. During fMRI, the Affective Stroop (AS), an attentional control task that includes emotionally-salient distractor images (trauma-relevant, positive, neutral) and variable task demands, was administered. RESULTS In response to more difficult AS trials, participants with PTSD demonstrated lower activation in the dorsal and rostral anterior cingulate cortex and greater activation in the insula. This group also showed comparatively poorer performance on positive AS distractor trials, even after adjusting for trauma exposure. Performance on these trials inversely correlated with structural integrity of the cingulum bundle and uncinate fasciculus. CONCLUSIONS Even after adjusting for trauma exposure, participants with PTSD showed worse performance on an attentional control task in the context of emotional stimuli. They also showed relatively lower cognitive control network activation and greater salience network activation. Fronto-parietal and fronto-limbic white matter connectivity corresponded with AS performance. Our findings indicate that attentional control impairments in PTSD are most evident in the context of emotional cues, and are related to decrements in function and structure of cognitive control and salience networks.
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32
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Aaseth J, Roer GE, Lien L, Bjørklund G. Is there a relationship between PTSD and complicated obesity? A review of the literature. Biomed Pharmacother 2019; 117:108834. [PMID: 31177066 DOI: 10.1016/j.biopha.2019.108834] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 03/25/2019] [Accepted: 03/29/2019] [Indexed: 12/26/2022] Open
Abstract
Recent research strongly supports the hypothesis that posttraumatic stress disorder (PTSD) can be accompanied by obesity and related metabolic disturbances. The mechanisms of these associations are however still not well defined, although disturbed functions in the sympathetic-adrenergic nervous system together with the disturbed release of hormones via the endocrine HPA (hypothalamic-pituitary-adrenal) axis apparently play a role. Leptin resistance and ghrelin excesses might contribute to a disturbed hypothalamic function, and also disturb other cerebral functions, leading to dysfunctional reward signaling and uncontrolled appetite combined with a tendency to alcohol abuse. Secondarily, cortisol stimulation will contribute to the development of central obesity which is known to facilitate the development of metabolic syndrome, including slightly increased levels of inflammatory biomarkers such as C-reactive protein and fibrinogen. While previous therapeutic strategies have focused on early psychotherapeutic interventions in PTSD, the present review emphasizes the importance of better therapeutic approaches regarding the somatic correlates of the syndrome. Strict regulation of dietary meals and food composition with minimal intake of sweets and saturated fat, as well as alcohol avoidance, can provide a basic therapeutic framework. A cognitive psychotherapeutic approach with graduated desensitization toward trigging factors, combined with pharmacotherapy, is discussed in the present review.
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Affiliation(s)
- Jan Aaseth
- Research Department, Innlandet Hospital Trust, Pb 104, 2381 Brumunddal, Norway; Faculty of Health and Social Science, Inland Norway University of Applied Sciences, Elverum, Norway.
| | - Grethe Emilie Roer
- Faculty of Health and Social Science, Inland Norway University of Applied Sciences, Elverum, Norway
| | - Lars Lien
- Faculty of Health and Social Science, Inland Norway University of Applied Sciences, Elverum, Norway; Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, Ottestad, Norway
| | - Geir Bjørklund
- Council for Nutritional and Environmental Medicine, Toften 24, 8610 Mo i Rana, Norway.
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33
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Blair KS, Aloi J, Crum K, Meffert H, White SF, Taylor BK, Leiker EK, Thornton LC, Tyler PM, Shah N, Johnson K, Abdel-Rahim H, Lukoff J, Dobbertin M, Pope K, Pollak S, Blair RJ. Association of Different Types of Childhood Maltreatment With Emotional Responding and Response Control Among Youths. JAMA Netw Open 2019; 2:e194604. [PMID: 31125109 PMCID: PMC6632148 DOI: 10.1001/jamanetworkopen.2019.4604] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Accepted: 04/03/2019] [Indexed: 01/08/2023] Open
Abstract
Importance Childhood maltreatment is associated with serious developmental consequences that may be different depending on the form of maltreatment. However, relatively little research has investigated this issue despite implications for understanding the development of psychiatric disorders after maltreatment. Objective To determine the association of childhood maltreatment and potential differential associations of childhood abuse or neglect with neural responsiveness within regions of the brain implicated in emotional responding and response control. Design, Setting, and Participants In this cross-sectional study, participants aged 10 to 18 years with varying levels of prior maltreatment as indexed by the Childhood Trauma Questionnaire (CTQ) were recruited from a residential care facility and the surrounding community. Blood oxygen level-dependent response data were analyzed via 2 analyses of covariance that examined 2 (sex) × 3 (task condition [view, congruent, incongruent]) × 3 (valence [negative, neutral, positive]) with Blom-transformed covariates: (1) total CTQ score; and (2) abuse and neglect subscores. Data were collected from April 1, 2016, to June 30, 2018. Data analyses occurred from June 10, 2018, to October 31, 2018. Main Outcomes and Measures Blood oxygenation level-dependent signals in response to an Affective Stroop task were measured via functional magnetic resonance imaging. Results The sample included 116 youths (mean [SD] age, 15.0 [2.2] years; 70 [60.3%] male). Fifteen participants reported no prior maltreatment. The remaining 101 participants (87.1%) reported at least some prior maltreatment, and 55 (54.5%) reported significant maltreatment, ie, total CTQ scores were greater than the validated CTQ score threshold of 40. There were significant total CTQ score × task condition associations within the bilateral postcentral gyrus, left precentral gyrus, midcingulate cortex, middle temporal gyrus, and superior temporal gyrus (left postcentral gyrus: F = 11.73; partial η2 = 0.14; right postcentral and precentral gyrus: F = 9.81; partial η2 = 0.10; midcingulate cortex: F = 12.76; partial η2 = 0.12; middle temporal gyrus: F = 13.24; partial η2 = 0.10; superior temporal gyrus: F = 10.33; partial η2 = 0.11). In all examined regions of the brain, increased maltreatment was associated with decreased differential responsiveness to incongruent task trials compared with view trials (left postcentral gyrus: r = -0.34; 95% CI, -0.17 to -0.51; right postcentral and precentral gyrus: r = -0.31; 95% CI, -0.14 to -0.49; midcingulate cortex: r = -0.36; 95% CI, -0.18 to -0.53; middle temporal gyrus: r = -0.35; 95% CI, -0.17 to -0.52; superior temporal gyrus: r = -0.37; 95% CI, -0.20 to -0.55). These interactions were particularly associated with level of abuse rather than neglect. A second analysis of covariance revealed significant abuse × task condition (but not neglect × task) interactions within the midcingulate cortex (F = 13.96; partial η2 = 0.11), right postcentral gyrus and inferior parietal lobule (F = 15.21; partial η2 = 0.12), left postcentral and precentral gyri (F = 11.16; partial η2 = 0.12), and rostromedial frontal cortex (F = 10.36; partial η2 = 0.08)). In all examined regions of the brain, increased abuse was associated with decreased differential responsiveness to incongruent task trials compared with view trials (midcingulate cortex: partial r = -0.33; P < .001; right postcentral gyrus and inferior parietal lobule: partial r = -0.41; P < .001; left postcentral and precentral gyri: partial r = -0.40; P < .001; and rostromedial frontal cortex: partial r = -0.40; P < .001). Conclusions and Relevance These data document associations of different forms of childhood maltreatment with atypical neural response. This suggests that forms of maltreatment may differentially influence the development of psychiatric pathology.
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Affiliation(s)
- Karina S. Blair
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, Nebraska
| | - Joseph Aloi
- Department of Psychiatry, University of Nebraska Medical Center, Omaha
| | - Kathleen Crum
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston
| | | | - Stuart F. White
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, Nebraska
| | - Brittany K. Taylor
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha
| | - Emily K. Leiker
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, Nebraska
| | - Laura C. Thornton
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, Nebraska
| | - Patrick M. Tyler
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, Nebraska
| | - Niraj Shah
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, Nebraska
| | - Kimberly Johnson
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, Nebraska
| | - Heba Abdel-Rahim
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, Nebraska
| | - Jennie Lukoff
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, Nebraska
| | - Matthew Dobbertin
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, Nebraska
| | - Kayla Pope
- Department of Psychiatry, Creighton University, Omaha, Nebraska
| | - Seth Pollak
- Department of Psychology, University of Wisconsin, Madison
| | - R. James Blair
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, Nebraska
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Herzog JI, Niedtfeld I, Rausch S, Thome J, Mueller-Engelmann M, Steil R, Priebe K, Bohus M, Schmahl C. Increased recruitment of cognitive control in the presence of traumatic stimuli in complex PTSD. Eur Arch Psychiatry Clin Neurosci 2019; 269:147-159. [PMID: 28712089 DOI: 10.1007/s00406-017-0822-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Accepted: 07/09/2017] [Indexed: 12/31/2022]
Abstract
A neurocircuitry model of post-traumatic stress disorder (PTSD) suggests increased amygdala responses to emotional stimuli, coupled with hypoactivation of prefrontal regions associated with cognitive control. However, results are heterogenous across different subsamples of PTSD as well as different paradigms. We investigated cognitive control in a classic and emotional Stroop task in 28 female patients with complex PTSD (cPTSD), 28 female trauma-exposed healthy controls (TCs) and 28 female non-trauma-exposed healthy controls (HCs) using functional neuroimaging. Afterwards, we assessed memory function in a spontaneous free recall and recognition task. Patients with cPTSD displayed significantly greater Stroop interference with trauma-related words (as reflected in slower reaction times and increased errors) compared to the other conditions and compared to the TC and HC groups. Moreover, patients with cPTSD showed increased activation in the context of trauma-related words in brain regions associated with cognitive control (dlPFC, vmPFC, dACC) compared to both control groups, and a trend for increased activation in the insula compared to the HC group. Increased recruitment of regions contributing to cognitive control in patients with cPTSD, together with a lack of amygdala response may point to efforts to compensate for emotional distraction caused by the trauma-related words.
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Affiliation(s)
- Julia I Herzog
- Department of Psychosomatic Medicine and Psychotherapy, Medical Faculty Mannheim, Central Institute of Mental Health Mannheim, Heidelberg University, J5, 68159, Mannheim, Germany.
| | - Inga Niedtfeld
- Department of Psychosomatic Medicine and Psychotherapy, Medical Faculty Mannheim, Central Institute of Mental Health Mannheim, Heidelberg University, J5, 68159, Mannheim, Germany
| | - Sophie Rausch
- Institute of Psychiatric and Psychosomatic Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim, Heidelberg University, J5, 68159, Mannheim, Germany
| | - Janine Thome
- Institute of Psychiatric and Psychosomatic Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim, Heidelberg University, J5, 68159, Mannheim, Germany
| | - Meike Mueller-Engelmann
- Department of Clinical Psychology and Intervention, Institute of Psychology, Goethe University Frankfurt, Varrentrappstr. 40-42, 60486, Frankfurt am Main, Germany
| | - Regina Steil
- Department of Clinical Psychology and Intervention, Institute of Psychology, Goethe University Frankfurt, Varrentrappstr. 40-42, 60486, Frankfurt am Main, Germany
| | - Kathlen Priebe
- Institute of Psychiatric and Psychosomatic Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim, Heidelberg University, J5, 68159, Mannheim, Germany
- Department of Psychology, Faculty of Life Sciences, Humboldt-Universitaet zu Berlin, Unter den Linden 6, 10999, Berlin, Germany
| | - Martin Bohus
- Institute of Psychiatric and Psychosomatic Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim, Heidelberg University, J5, 68159, Mannheim, Germany
- Faculty of Health, University of Antwerp, Universiteitsplein 1, 2610, Wilrijk, Antwerp, Belgium
| | - Christian Schmahl
- Department of Psychosomatic Medicine and Psychotherapy, Medical Faculty Mannheim, Central Institute of Mental Health Mannheim, Heidelberg University, J5, 68159, Mannheim, Germany
- Department of Psychiatry, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
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35
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Rose EJ, Picci G, Fishbein DH. Neurocognitive Precursors of Substance Misuse Corresponding to Risk, Resistance, and Resilience Pathways: Implications for Prevention Science. Front Psychiatry 2019; 10:399. [PMID: 31258493 PMCID: PMC6586742 DOI: 10.3389/fpsyt.2019.00399] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 05/21/2019] [Indexed: 12/22/2022] Open
Abstract
Studies of substance misuse prevention generally focus on characteristics that typify risk, with the assumption that the prevalence of the problem will be optimally reduced by identifying, targeting, and reducing or eliminating risk factors. However, this risk-centered approach neglects variations in individual-level and environmental characteristics that portend differential pathways that are distinguishable by timing of substance use initiation (e.g., early versus delayed), the likelihood of use escalation versus eventual desistance, and enduring abstinence, despite exposure to significant risk factors. Considering the various underpinnings of these distinct substance use trajectories is critical to a more nuanced understanding of the effects, potency, and malleability of factors that are known to increase risk or confer protection. Here, we discuss three pathways relative to substance use patterns and predictors in the context of adversity, a well-known, highly significant influence on propensity for substance misuse. The first pathway is designated as "high risk" based on early onset of substance use, rapid escalation, and proneness to substance use disorders. Individuals who defy all odds and eventually exhibit adaptive developmental outcomes despite an initial maladaptive reaction to adversity, are referred to as "resilient." However, another categorization that has not been adequately characterized is "resistant." Resistant individuals include those who do not exhibit problematic substance use behaviors (e.g., early onset and escalation) and do not develop substance use disorders or other forms of psychopathology, despite significant exposure to factors that normally increase the propensity for such outcomes (e.g. trauma and/or adversity). In this paper, we apply this conceptualization of risk, resistance, and resilience for substance misuse to a more fine-grained analysis of substance use pathways and their corresponding patterns (e.g., non-use, initiation, escalation, desistance). The significance of the progression of neurocognitive functioning over the course of development is discussed as well as how this knowledge may be translated to make a science-based determination of intervention targets. This more encompassing theoretical model has direct implications for primary prevention and clinical approaches to disrupt risk pathways and to optimize long-term outcomes.
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Affiliation(s)
- Emma Jane Rose
- Program for Translational Research on Adversity and Neurodevelopment (P-TRAN), The Edna Bennett Pierce Prevention Research Center, The Pennsylvania State University, University Park, PA, USA
| | - Giorgia Picci
- Program for Translational Research on Adversity and Neurodevelopment (P-TRAN), The Edna Bennett Pierce Prevention Research Center, The Pennsylvania State University, University Park, PA, USA
| | - Diana H Fishbein
- Program for Translational Research on Adversity and Neurodevelopment (P-TRAN), The Edna Bennett Pierce Prevention Research Center, The Pennsylvania State University, University Park, PA, USA.,Department of Human Development and Family Studies, The Pennsylvania State University, University Park, PA, USA
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36
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Selemon LD, Young KA, Cruz DA, Williamson DE. Frontal Lobe Circuitry in Posttraumatic Stress Disorder. CHRONIC STRESS (THOUSAND OAKS, CALIF.) 2019; 3:2470547019850166. [PMID: 31435577 PMCID: PMC6703563 DOI: 10.1177/2470547019850166] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 04/23/2019] [Indexed: 12/31/2022]
Abstract
Symptoms of posttraumatic stress disorder include hyperarousal, avoidance of trauma-related stimuli, re-experiencing of trauma, and mood changes. This review focuses on the frontal cortical areas that form crucial links in circuitry pertinent to posttraumatic stress disorder symptomatology: (1) the conditioned fear extinction circuit, (2) the salience circuit, and (3) the mood circuit. These frontal areas include the ventromedial prefrontal cortex (conditioned fear extinction), the dorsal anterior cingulate and insular cortices (salience), and the lateral orbitofrontal and subgenual cingulate cortices (mood). Frontal lobe structural abnormalities in posttraumatic stress disorder, including volumetric reductions in the cingulate cortices, impact all three circuits. Functional analyses of frontal cortices in posttraumatic stress disorder show abnormal activation in all three according to task demand and emotional valence. Network analyses reveal altered amygdalo-frontal connectivity and failure to suppress the default mode network during cognitive engagement. Spine shape alterations also have been detected in the medial orbito-frontal cortex in posttraumatic stress disorder postmortem brains, suggesting reduced synaptic plasticity. Importantly, frontal lobe abnormalities in posttraumatic stress disorder extend beyond emotion-related circuits to include the lateral prefrontal cortices that mediate executive functions. In conclusion, widespread frontal lobe dysfunction in posttraumatic stress disorder provides a neurobiologic basis for the core symptomatology of the disorder, as well as for executive function impairment.
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Affiliation(s)
- Lynn D. Selemon
- Department of Neuroscience, Yale School
of Medicine, Yale University, New Haven, CT, USA
| | - Keith A. Young
- Baylor Scott & White Psychiatry,
Central Texas Veterans Health Care System, Temple, TX, USA
- Department of Psychiatry, Texas A&M
College of Medicine, College Station, USA
- Department of Veterans Affairs,
VISN
17 Center of Excellence for Research on Returning War
Veterans, Waco, TX,USA
| | - Dianne A. Cruz
- Department of Psychiatry and Behavioral
Sciences,
Duke
University, Durham, NC, USA
| | - Douglas E. Williamson
- Department of Psychiatry and Behavioral
Sciences,
Duke
University, Durham, NC, USA
- Durham
VA Medical Center, Durham, NC, USA
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37
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Gaffey AE, Aranda F, Burns JW, Purim-Shem-Tov YA, Burgess HJ, Beckham JC, Bruehl S, Hobfoll SE. Race, psychosocial vulnerability and social support differences in inner-city women's symptoms of posttraumatic stress disorder. ANXIETY, STRESS, AND COPING 2019; 32:18-31. [PMID: 30306795 PMCID: PMC6269211 DOI: 10.1080/10615806.2018.1532078] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND/OBJECTIVES Inner-city Black women may be more susceptible to posttraumatic stress disorder (PTSD) than White women, although mechanisms underlying this association are unclear. Living in urban neighborhoods distinguished by higher chronic stress may contribute to racial differences in women's cognitive, affective, and social vulnerabilities, leading to greater trauma-related distress including PTSD. Yet social support could buffer the negative effects of psychosocial vulnerabilities on women's health. METHODS/DESIGN Mediation and moderated mediation models were tested with 371 inner-city women, including psychosocial vulnerability (i.e., catastrophizing, anger, social undermining) mediating the pathway between race and PTSD, and social support moderating psychosocial vulnerability and PTSD. RESULTS Despite comparable rates of trauma, Black women reported higher vulnerability and PTSD symptoms, and lower support compared to White Hispanic and non-Hispanic women. Psychosocial vulnerability mediated the pathway between race and PTSD, and social support moderated vulnerability, reducing negative effects on PTSD. When examining associations by race, the moderation effect remained significant for Black women only. CONCLUSIONS Altogether these psychosocial vulnerabilities represent one potential mechanism explaining Black women's greater risk of PTSD, although cumulative psychosocial vulnerability may be buffered by social support. Despite higher support, inner-city White women's psychosocial vulnerability may actually outweigh support's benefits for reducing trauma-related distress.
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Affiliation(s)
- Allison E. Gaffey
- Yale School of Medicine, Department of Internal Medicine 330 Cedar Street, New Haven, CT 06520
| | - Frances Aranda
- Rush University Medical Center, Dept. of Behavioral Sciences, 1645 W. Jackson Blvd., Ste. 400, Chicago, IL 60612
| | - John W. Burns
- Rush University Medical Center, Dept. of Behavioral Sciences, 1645 W. Jackson Blvd., Ste. 400, Chicago, IL 60612
| | - Yanina A. Purim-Shem-Tov
- Rush University Medical Center, Dept. of Emergency Medicine, 1653 W. Congress Parkway, Chicago, IL 60612
| | - Helen J. Burgess
- Rush University Medical Center, Dept. of Behavioral Sciences, 1645 W. Jackson Blvd., Ste. 400, Chicago, IL 60612
| | - Jean C. Beckham
- Department of Psychiatry, Duke University School of Medicine, 40 Duke Medicine Circle, Durham, NC 27710
- Durham Veterans Affairs Health System, 508 Fulton St, Durham, NC 27705
| | - Stephen Bruehl
- Department of Anesthesiology, Vanderbilt University Medical Center, 1211 Medical Center Drive, Nashville, TN 37232
| | - Stevan E. Hobfoll
- Rush University Medical Center, Dept. of Behavioral Sciences, 1645 W. Jackson Blvd., Ste. 400, Chicago, IL 60612
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38
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White SF, Costanzo ME, Thornton LC, Mobley AM, Blair JR, Roy MJ. Increased cognitive control and reduced emotional interference is associated with reduced PTSD symptom severity in a trauma-exposed sample: A preliminary longitudinal study. Psychiatry Res Neuroimaging 2018; 278:7-12. [PMID: 29935441 PMCID: PMC6433528 DOI: 10.1016/j.pscychresns.2018.06.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 06/09/2018] [Accepted: 06/10/2018] [Indexed: 10/14/2022]
Abstract
Individuals with posttraumatic stress disorder (PTSD) show deficits in recruiting neural regions associated with cognitive control. In contrast, trauma exposed individuals (TEIs) show increased recruitment of these regions. While many individuals who experience a trauma exhibit some PTSD symptoms, relatively few develop PTSD. Despite this, no work has examined the relationship between changes in PTSD symptoms and changes in neural functioning in TEIs longitudinally. This study examined the neural correlates of changing PTSD symptom levels in TEIs. Twenty-one military service members completed the affective stroop task while undergoing fMRI within 2 months of returning from deployment and a second scan 6-12 months later. Participants with PTSD or depression at baseline were excluded. PTSD symptom improvement was associated with greater increase in response to incongruent relative to congruent negative stimuli in dorsal anterior cingulate cortex and inferior frontal gyrus/anterior insula and increased BOLD response over time to emotional relative to neutral stimuli in inferior parietal cortex. Improvement in PTSD symptoms were not associated with changes in amygdala responsiveness to emotional stimuli. In short, the current data indicate that TEIs who become more able to recruit regions implicated in cognitive control show greater reductions in PTSD symptom levels.
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Affiliation(s)
- Stuart F White
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Omaha, NE, USA; National Institute of Mental Health, Bethesda, MD, USA.
| | - Michelle E Costanzo
- Uniformed Services University of the Health Sciences, Bethesda, MD, USA; Henry M. Jackson Foundation, Bethesda, MD, USA
| | - Laura C Thornton
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Omaha, NE, USA
| | - Alita M Mobley
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Omaha, NE, USA
| | - James R Blair
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Omaha, NE, USA; National Institute of Mental Health, Bethesda, MD, USA
| | - Michael J Roy
- Uniformed Services University of the Health Sciences, Bethesda, MD, USA
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Fani N, King TZ, Powers A, Hardy RA, Siegle GJ, Blair RJ, Surapaneni S, van Rooij S, Ressler KJ, Jovanovic T, Bradley B. Cognitive and neural facets of dissociation in a traumatized population. ACTA ACUST UNITED AC 2018; 19:863-875. [PMID: 30124316 DOI: 10.1037/emo0000466] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Dissociative phenomena are frequently experienced by psychologically traumatized people. However, little is known about the cognitive profiles of highly dissociative traumatized individuals, and corresponding patterns of neural connectivity when attentional networks are engaged in the context of emotion. One hundred seventeen traumatized women completed the multiscale dissociation inventory (MDI) and neuropsychological testing; MDI scores were used to classify high- and low-dissociative participants. Forty-six participants also underwent fMRI during performance of an attentional control task that incorporates emotionally distracting images (Affective Number Stroop; ANS). Compared to low-dissociative participants, high-dissociative participants demonstrated better performance on an executive functioning task (F1,111 = 4.64, p = .03), worse performance on a task of visual memory (F1,111 = 9.52, p = .003), and similar performance on all other neuropsychological measures. In addition, dissociative symptoms were negatively correlated with functional connectivity between the amygdala and right anterior insula in response to trauma-related ANS trials. These findings indicate that highly dissociative traumatized people experience difficulties with attentional control in the context of emotionally evocative stimuli, but in a neutral context, their overall cognitive profiles are similar to low-dissociative people. Highly dissociative participants also demonstrated weaker connectivity between the amygdala and insula in response to trauma-relevant images. Evocative, trauma-relevant stimuli appear to disrupt neutral networks involved with attention to salient cues and interoception in highly dissociative traumatized individuals. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Affiliation(s)
- Negar Fani
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine
| | - Tricia Z King
- Department of Psychology and the Neuroscience Institute, Georgia State University
| | - Abigail Powers
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine
| | - Raven A Hardy
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine
| | | | | | - Sindhuja Surapaneni
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine
| | - Sanne van Rooij
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine
| | - Kerry J Ressler
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine
| | - Tanja Jovanovic
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine
| | - Bekh Bradley
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine
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Terpou BA, Densmore M, Théberge J, Frewen P, McKinnon MC, Lanius RA. Resting-state pulvinar-posterior parietal decoupling in PTSD and its dissociative subtype. Hum Brain Mapp 2018; 39:4228-4240. [PMID: 30091811 DOI: 10.1002/hbm.24242] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 05/09/2018] [Accepted: 05/27/2018] [Indexed: 12/30/2022] Open
Abstract
Key evidence points toward alterations in the neurocircuitry of large-scale networks among patients with posttraumatic stress disorder (PTSD). The pulvinar is a thalamic region displaying reciprocal connectivity with the cortex and has been shown to modulate alpha synchrony to facilitate network communication. During rest, the pulvinar displays functional connectivity with the posterior parietal cortex (PPC), a heteromodal network of brain areas underlying multisensory integration and socioaffective functions that are shown at deficit in PTSD. Accordingly, this study seeks to reveal the resting-state functional connectivity (rsFC) patterns of individuals with PTSD, its dissociative subtype (PTSD + DS) and healthy controls. A whole-brain rsFC analysis was conducted using SPM12 and PickAtlas. Connectivity was analyzed for the left and right pulvinar across groups of individuals with PTSD (n = 81), PTSD + DS (n = 49), and controls (n = 51). As compared to PTSD, controls displayed significantly greater pulvinar rsFC with the superior parietal lobule and precuneus. Moreover, as compared to PTSD + DS, controls showed increased pulvinar connectivity with the superior parietal lobule, inferior parietal lobule and the precuneus. PTSD groups did not display stronger connectivity with any region as compared to controls. Last, PTSD had greater rsFC in the supramarginal gyrus relative to PTSD + DS. Reduced connectivity between the pulvinar and PPC may explain impairments to autobiographical memory, self-referential processing, and socioaffective domains in PTSD and PTSD + DS even at "rest." Critically, these alterations appear to be exacerbated in individuals with PTSD + DS, which may have important implications for treatment.
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Affiliation(s)
- Braeden A Terpou
- Department of Neuroscience, Western University, London, Ontario, Canada
| | - Maria Densmore
- Department of Psychiatry, Western University, London, Ontario, Canada.,Imaging Division, Lawson Health Research Institute, London, Ontario, Canada
| | - Jean Théberge
- Department of Psychiatry, Western University, London, Ontario, Canada.,Imaging Division, Lawson Health Research Institute, London, Ontario, Canada.,Department of Medical Biophysics, Western University, London, Ontario, Canada
| | - Paul Frewen
- Department of Neuroscience, Western University, London, Ontario, Canada.,Department of Psychology, Western University, London, Ontario, Canada
| | - Margaret C McKinnon
- Mood Disorders Program, St. Joseph's Healthcare, Hamilton, Ontario, Canada.,Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada.,Homewood Research Institute, Guelph, Ontario, Canada
| | - Ruth A Lanius
- Department of Neuroscience, Western University, London, Ontario, Canada.,Department of Psychiatry, Western University, London, Ontario, Canada
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41
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Zukerman G, Fostick L, Ben‐Itzchak E. Early automatic hyperarousal in response to neutral novel auditory stimuli among trauma‐exposed individuals with and without PTSD: An ERP study. Psychophysiology 2018; 55:e13217. [DOI: 10.1111/psyp.13217] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2017] [Revised: 05/21/2018] [Accepted: 05/22/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Gil Zukerman
- Department of Communication Disorders, School of Health SciencesAriel UniversityAriel Israel
| | - Leah Fostick
- Department of Communication Disorders, School of Health SciencesAriel UniversityAriel Israel
| | - Ester Ben‐Itzchak
- Department of Communication Disorders, School of Health SciencesAriel UniversityAriel Israel
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Aloi J, Blair KS, Crum KI, Meffert H, White SF, Tyler PM, Thornton LC, Mobley AM, Killanin AD, Adams KO, Filbey F, Pope K, Blair RJR. Adolescents show differential dysfunctions related to Alcohol and Cannabis Use Disorder severity in emotion and executive attention neuro-circuitries. NEUROIMAGE-CLINICAL 2018; 19:782-792. [PMID: 29988822 PMCID: PMC6031867 DOI: 10.1016/j.nicl.2018.06.005] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 04/27/2018] [Accepted: 06/04/2018] [Indexed: 11/20/2022]
Abstract
Alcohol and cannabis are two substances that are commonly abused by adolescents in the United States and which, when abused, are associated with negative medical and psychiatric outcomes across the lifespan. These negative psychiatric outcomes may reflect the detrimental impact of substance abuse on neural systems mediating emotion processing and executive attention. However, work indicative of this has mostly been conducted either in animal models or adults with Alcohol and/or Cannabis Use Disorder (AUD/CUD). Little work has been conducted in adolescent patients. In this study, we used the Affective Stroop task to examine the relationship in 82 adolescents between AUD and/or CUD symptom severity and the functional integrity of neural systems mediating emotional processing and executive attention. We found that AUD symptom severity was positively related to amygdala responsiveness to emotional stimuli and negatively related to responsiveness within regions implicated in executive attention and response control (i.e., dorsolateral prefrontal cortex, anterior cingulate cortex, precuneus) as a function of task performance. In contrast, CUD symptom severity was unrelated to amygdala responsiveness but positively related to responsiveness within regions including precuneus, posterior cingulate cortex, and inferior parietal lobule as a function of task performance. These data suggest differential impacts of alcohol and cannabis abuse on the adolescent brain. Alcohol and cannabis are the most widely abused substances by adolescents. AUDIT scores are related to amygdala hyperactivity to emotional stimuli. AUDIT scores are related to hypoactivity in executive attention neuro-circuitry. CUDIT scores are related to hyperactivity in executive attention neuro-circuitry.
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Affiliation(s)
- Joseph Aloi
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, NE, United States; Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, NE, United States.
| | - Karina S Blair
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, NE, United States
| | - Kathleen I Crum
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, NE, United States
| | - Harma Meffert
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, NE, United States
| | - Stuart F White
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, NE, United States
| | - Patrick M Tyler
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, NE, United States
| | - Laura C Thornton
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, NE, United States
| | - Alita M Mobley
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, NE, United States
| | - Abraham D Killanin
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, NE, United States
| | - Kathryn O Adams
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, NE, United States
| | - Francesca Filbey
- Center for BrainHealth, School of Behavioral and Brain Sciences, University of Texas at Dallas, Dallas, TX, United States
| | - Kayla Pope
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, NE, United States; Department of Psychiatry, University of Nebraska Medical Center, Omaha, NE, United States; Department of Psychiatry, Creighton University, Omaha, NE, United States
| | - R James R Blair
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, NE, United States
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Wang HY, Zhang XX, Si CP, Xu Y, Liu Q, Bian HT, Zhang BW, Li XL, Yan ZR. Prefrontoparietal dysfunction during emotion regulation in anxiety disorder: a meta-analysis of functional magnetic resonance imaging studies. Neuropsychiatr Dis Treat 2018; 14:1183-1198. [PMID: 29785110 PMCID: PMC5953307 DOI: 10.2147/ndt.s165677] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Impairments in emotion regulation, and more specifically in cognitive reappraisal, are thought to play a key role in the pathogenesis of anxiety disorders. However, the available evidence on such deficits is inconsistent. To further illustrate the neurobiological underpinnings of anxiety disorder, the present meta-analysis summarizes functional magnetic resonance imaging (fMRI) findings for cognitive reappraisal tasks and investigates related brain areas. METHODS We performed a comprehensive series of meta-analyses of cognitive reappraisal fMRI studies contrasting patients with anxiety disorder with healthy control (HC) subjects, employing an anisotropic effect-size signed differential mapping approach. We also conducted a subgroup analysis of medication status, anxiety disorder subtype, data-processing software, and MRI field strengths. Meta-regression was used to explore the effects of demographics and clinical characteristics. Eight studies, with 11 datasets including 219 patients with anxiety disorder and 227 HC, were identified. RESULTS Compared with HC, patients with anxiety disorder showed relatively decreased activation of the bilateral dorsomedial prefrontal cortex (dmPFC), bilateral dorsal anterior cingulate cortex (dACC), bilateral supplementary motor area (SMA), left ventromedial prefrontal cortex (vmPFC), bilateral parietal cortex, and left fusiform gyrus during cognitive reappraisal. The subgroup analysis, jackknife sensitivity analysis, heterogeneity analysis, and Egger's tests further confirmed these findings. CONCLUSIONS Impaired cognitive reappraisal in anxiety disorder may be the consequence of hypo-activation of the prefrontoparietal network, consistent with insufficient top-down control. Our findings provide robust evidence that functional impairment in prefrontoparietal neuronal circuits may have a significant role in the pathogenesis of anxiety disorder.
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Affiliation(s)
- Hai-Yang Wang
- Department of Neurology, Jining No 1 People’s Hospital, Jining, Shandong Province, China
| | - Xiao-Xia Zhang
- Department of Neurology, Jining No 1 People’s Hospital, Jining, Shandong Province, China
| | - Cui-Ping Si
- Department of Neurology, Jining No 1 People’s Hospital, Jining, Shandong Province, China
| | - Yang Xu
- Department of Neurology, Jining No 1 People’s Hospital, Jining, Shandong Province, China
| | - Qian Liu
- Department of Neurology, Jining No 1 People’s Hospital, Jining, Shandong Province, China
| | - He-Tao Bian
- Department of Neurology, Jining No 1 People’s Hospital, Jining, Shandong Province, China
| | - Bing-Wei Zhang
- Department of Neurology and Psychiatry, First Affiliate Hospital of Dalian Medical University, Dalian, Liaoning Province, China
| | - Xue-Lin Li
- Department of Intensive Care Unit, Jining No 1 People’s Hospital, Jining, Shandong Province, China
| | - Zhong-Rui Yan
- Department of Neurology, Jining No 1 People’s Hospital, Jining, Shandong Province, China
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Asselmann E, Hilbert K, Hoyer J, Wittchen HU, Lieb R, Bühringer G, Beesdo-Baum K. Self-reported volitional control in adolescents and young adults from a community cohort: Associations with current, past and future mental disorders. Psychiatry Res 2018; 260:292-299. [PMID: 29223798 DOI: 10.1016/j.psychres.2017.11.046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Revised: 11/15/2017] [Accepted: 11/16/2017] [Indexed: 12/27/2022]
Abstract
Alterations in volitional control have been found for various mental disorders. However, it remains unclear to which degree such alterations vary by type of psychopathology and constitute preceding vulnerabilities or correlates of mental disorders. DSM-IV mental disorders were assessed among adolescents and young adults from the community at baseline (age 14-24) and in up to 3 follow-up assessments over 10 years (n = 2515) using a standardized diagnostic interview (DIA-X/M-CIDI). Self-reported volitional control was assessed at second follow-up (T2) when subjects were aged 17-28 using the German version of the Short Form of the Volitional Components Inventory. Linear regressions adjusted for sex, age and lifetime disorders revealed that anxiety and affective disorders were associated with widespread alterations in self-reported volitional control (lower self regulation, higher self inhibition and volitional inhibition), while substance use disorders were specifically associated with higher volitional inhibition. Logistic regressions adjusted for sex, age and prior lifetime psychopathology revealed that lower self-reported volitional control at T2 predicted incident panic, social phobia and substance use at T3 (follow-up interval M = 4.8 years). Findings point toward at least partly disorder-specific alterations in volitional control in mental disorders, which might be antecedent vulnerability factors and thus useful to guide early recognition and prevention.
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Affiliation(s)
- Eva Asselmann
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany; Behavioral Epidemiology, Technische Universität Dresden, Dresden, Germany.
| | - Kevin Hilbert
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany; Behavioral Epidemiology, Technische Universität Dresden, Dresden, Germany
| | - Jana Hoyer
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany; Behavioral Epidemiology, Technische Universität Dresden, Dresden, Germany
| | - Hans-Ulrich Wittchen
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Roselind Lieb
- Max Planck Institute of Psychiatry, Munich, Germany; Division of Clinical Psychology and Epidemiology, Department of Psychology, University of Basel, Basel, Switzerland
| | - Gerhard Bühringer
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | - Katja Beesdo-Baum
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany; Behavioral Epidemiology, Technische Universität Dresden, Dresden, Germany
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45
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Badura-Brack A, McDermott TJ, Becker KM, Ryan TJ, Khanna MM, Pine DS, Bar-Haim Y, Heinrichs-Graham E, Wilson TW. Attention training modulates resting-state neurophysiological abnormalities in posttraumatic stress disorder. Psychiatry Res 2018; 271:135-141. [PMID: 29174765 PMCID: PMC5741514 DOI: 10.1016/j.pscychresns.2017.11.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Revised: 11/02/2017] [Accepted: 11/12/2017] [Indexed: 12/12/2022]
Abstract
Recent research indicates the relative benefits of computerized attention control treatment (ACT) and attention bias modification treatment (ABMT) for posttraumatic stress disorder (PTSD); however, neural changes underlying these therapeutic effects remain unknown. This study examines how these two types of attention training modulate neurological dysfunction in veterans with PTSD. A community sample of 46 combat veterans with PTSD participated in a randomized double-blinded clinical trial of ACT versus ABMT and 32 of those veterans also agreed to undergo resting-state magnetoencephalography (MEG) recordings. Twenty-four veterans completed psychological and MEG assessments at pre- and post-training to evaluate treatment effects. MEG data were imaged using an advanced Bayesian reconstruction method and examined using statistical parametric mapping. In this report, we focus on the neural correlates and the differential treatment effects observed using MEG; the results of the full clinical trial have been described elsewhere. Our results indicated that ACT modulated occipital and ABMT modulated medial temporal activity more strongly than the comparative treatment. PTSD symptoms decreased significantly from pre- to post-test. These initial neurophysiological outcome data suggest that ACT modulates visual pathways, while ABMT modulates threat-processing regions, but that both are associated with normalizing aberrant neural activity in veterans with PTSD.
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Affiliation(s)
- Amy Badura-Brack
- Department of Psychology, Creighton University, 2500 California Plaza, Omaha, NE 68178, USA.
| | - Timothy J McDermott
- Department of Psychology, Creighton University, 2500 California Plaza, Omaha, NE 68178, USA; Center for Magnetoencephalography (MEG), University of Nebraska Medical Center (UNMC), Omaha, NE, USA
| | - Katherine M Becker
- Center for Magnetoencephalography (MEG), University of Nebraska Medical Center (UNMC), Omaha, NE, USA; Department of Psychology, Colorado State University, Fort Collins, CO, USA
| | - Tara J Ryan
- Department of Psychology, Creighton University, 2500 California Plaza, Omaha, NE 68178, USA; Department of Psychology, Simon Fraser University, Burnaby, BC, Canada
| | - Maya M Khanna
- Department of Psychology, Creighton University, 2500 California Plaza, Omaha, NE 68178, USA
| | - Daniel S Pine
- Intramural Research Program, National Institute of Mental Health, Bethesda, MD, USA
| | - Yair Bar-Haim
- School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel; The Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | - Elizabeth Heinrichs-Graham
- Center for Magnetoencephalography (MEG), University of Nebraska Medical Center (UNMC), Omaha, NE, USA; Department of Neurological Sciences, UNMC, Omaha, NE, USA
| | - Tony W Wilson
- Center for Magnetoencephalography (MEG), University of Nebraska Medical Center (UNMC), Omaha, NE, USA; Department of Neurological Sciences, UNMC, Omaha, NE, USA
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Brown VM, Zhu L, Wang JM, Frueh BC, King-Casas B, Chiu PH. Associability-modulated loss learning is increased in posttraumatic stress disorder. eLife 2018; 7:e30150. [PMID: 29313489 PMCID: PMC5760201 DOI: 10.7554/elife.30150] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Accepted: 12/02/2017] [Indexed: 11/30/2022] Open
Abstract
Disproportionate reactions to unexpected stimuli in the environment are a cardinal symptom of posttraumatic stress disorder (PTSD). Here, we test whether these heightened responses are associated with disruptions in distinct components of reinforcement learning. Specifically, using functional neuroimaging, a loss-learning task, and a computational model-based approach, we assessed the mechanistic hypothesis that overreactions to stimuli in PTSD arise from anomalous gating of attention during learning (i.e., associability). Behavioral choices of combat-deployed veterans with and without PTSD were fit to a reinforcement learning model, generating trial-by-trial prediction errors (signaling unexpected outcomes) and associability values (signaling attention allocation to the unexpected outcomes). Neural substrates of associability value and behavioral parameter estimates of associability updating, but not prediction error, increased with PTSD during loss learning. Moreover, the interaction of PTSD severity with neural markers of associability value predicted behavioral choices. These results indicate that increased attention-based learning may underlie aspects of PTSD and suggest potential neuromechanistic treatment targets.
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Affiliation(s)
- Vanessa M Brown
- Virginia Tech Carilion Research InstituteRoanokeUnited States
- Department of PsychologyVirginia TechBlacksburgUnited States
| | - Lusha Zhu
- Virginia Tech Carilion Research InstituteRoanokeUnited States
- School of Psychological and Cognitive SciencesIDG/McGovern Institute for Brain Research, Beijing Key Laboratory of Behavior and Mental Health, Peking–Tsinghua Center for Life Sciences, Peking UniversityBeijingChina
| | - John M Wang
- Virginia Tech Carilion Research InstituteRoanokeUnited States
- Department of PsychologyVirginia TechBlacksburgUnited States
| | | | - Brooks King-Casas
- Virginia Tech Carilion Research InstituteRoanokeUnited States
- Department of PsychologyVirginia TechBlacksburgUnited States
- Salem Veterans Affairs Medical CenterSalemUnited States
- School of Biomedical Engineering and SciencesVirginia Tech-Wake Forest UniversityBlacksburgUnited States
| | - Pearl H Chiu
- Virginia Tech Carilion Research InstituteRoanokeUnited States
- Department of PsychologyVirginia TechBlacksburgUnited States
- Salem Veterans Affairs Medical CenterSalemUnited States
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Del Río-Casanova L, González A, Páramo M, Van Dijke A, Brenlla J. Emotion regulation strategies in trauma-related disorders: pathways linking neurobiology and clinical manifestations. Rev Neurosci 2018; 27:385-95. [PMID: 26812780 DOI: 10.1515/revneuro-2015-0045] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Accepted: 11/29/2015] [Indexed: 01/30/2023]
Abstract
Emotion regulation impairments with traumatic origins have mainly been studied from posttraumatic stress disorder (PTSD) models by studying cases of adult onset and single-incident trauma exposure. The effects of adverse traumatic experiences, however, go beyond the PTSD. Different authors have proposed that PTSD, borderline personality, dissociative, conversive and somatoform disorders constitute a full spectrum of trauma-related conditions. Therefore, a comprehensive review of the neurobiological findings covering this posttraumatic spectrum is needed in order to develop an all-encompassing model for trauma-related disorders with emotion regulation at its center. The present review has sought to link neurobiology findings concerning cortico-limbic function to the field of emotion regulation. In so doing, trauma-related disorders have been placed in a continuum between under- and over-regulation of affect strategies. Under-regulation of affect was predominant in borderline personality disorder, PTSD with re-experiencing symptoms and positive psychoform and somatoform dissociative symptoms. Over-regulation of affect was more prevalent in somatoform disorders and pathologies characterized by negative psychoform and somatoform symptoms. Throughout this continuum, different combinations between under- and over-regulation of affect strategies were also found.
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Abstract
Posttraumatic stress disorder (PTSD) is a devastating disorder, linked to profound mental, physical, occupational, and functional impairment. In addition, it is a highly complex disorder, characterized by symptom heterogeneity across multiple domains. Nevertheless, emotion dysregulation arising from the exaggerated response to threat or from the inability to regulate negative emotional states plays a defining role in the pathophysiology of PTSD. In order to improve our understanding of how emotion dysregulation manifests in this illness, functional neuroimaging research over the past 20 years provides great insight into underlying neuroanatomy of each component of emotion dysregulation in the context of PTSD. While prior reviews exist on the topic of neuroimaging findings in PTSD, the present review synthesizes that work through the lens of emotion and its regulation. Studies that employed tasks of emotional responding and symptom provocation, implicit regulation (e.g., emotional Stroop and interference), explicit regulation (e.g., cognitive reappraisal), and fear conditioning/extinction were reviewed. Findings demonstrate that emotion dysregulation in PTSD arises from complications within a large neurocircuitry involving the amygdala, insula, hippocampus, anterior cingulate cortex, and prefrontal cortex. Although an exaggerated response in the amygdala and insula to negative emotional triggers is pervasive, PTSD is also marked by deficient appraisal, resolution, and management of negative emotional states subserved by the anterior cingulate cortex and prefrontal cortex during regulation. These findings further support the importance of studying emotion-regulation deficits in tandem with exaggerated symptom provocation in order to better understand the constellation of symptoms present in those with PTSD.
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Bolsinger J, Seifritz E, Kleim B, Manoliu A. Neuroimaging Correlates of Resilience to Traumatic Events-A Comprehensive Review. Front Psychiatry 2018; 9:693. [PMID: 30631288 PMCID: PMC6315158 DOI: 10.3389/fpsyt.2018.00693] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Accepted: 11/28/2018] [Indexed: 12/13/2022] Open
Abstract
Improved understanding of the neurobiological correlates of resilience would be an important step toward recognizing individuals at risk of developing post-traumatic stress disorder (PTSD) or other trauma-related diseases, enabling both preventative measures and individually tailored therapeutic approaches. Studies on vulnerability factors allow drawing conclusions on resilience. Structural changes of cortical and subcortical structures, as well as alterations in functional connectivity and functional activity, have been demonstrated to occur in individuals with PTSD symptoms. Relevant areas of interest are hippocampus, amygdala, insula, anterior cingulate cortex, and prefrontal cortex, as well as related brain networks, such as the default-mode, salience, and central executive network. This review summarizes the existing literature and integrates findings from cross-sectional study designs with two-group designs (trauma exposed individuals with and without PTSD), three-group designs (with an additional group of unexposed, healthy controls), twin-studies and longitudinal studies. In terms of structural findings, decreased hippocampal volume in PTSD individuals might be either a vulnerability factor or a result of trauma exposure, or both. Reduced anterior cingulate cortex and prefrontal cortex volumes seem to be predisposing factors for increased vulnerability. Regarding functional connectivity, increased amygdala connectivity has been demonstrated selectively in PTSD individuals, as well as increased default-mode-network and salience network connectivity. In terms of functional activity, increased amygdala and anterior cingulate cortex activities, and decreased prefrontal cortex activity as a response to external stimuli have been associated with higher vulnerability. Increased prefrontal cortex activity seemed to be a protective factor. Selecting adequate study designs, optimizing the diagnostic criteria, as well as differentiating between types of trauma and accounting for other factors, such as gender-specific differences, would be well-served in future research. Conclusions on potential preventative measures, as well as clinical applications, can be drawn from the present literature, but more studies are needed.
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Affiliation(s)
- Julia Bolsinger
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital, University of Zurich, Zurich, Switzerland
| | - Erich Seifritz
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital, University of Zurich, Zurich, Switzerland
| | - Birgit Kleim
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital, University of Zurich, Zurich, Switzerland.,Department of Psychology, University of Zurich, Zurich, Switzerland
| | - Andrei Manoliu
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital, University of Zurich, Zurich, Switzerland
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50
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Tingey JL, McGuire AP, Stebbins OL, Erickson TM. Moral elevation and compassionate goals predict posttraumatic growth in the context of a college shooting. JOURNAL OF POSITIVE PSYCHOLOGY 2017. [DOI: 10.1080/17439760.2017.1402077] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Jamie L. Tingey
- Department of Clinical Psychology, Seattle Pacific University, Seattle, WA, USA
| | - Adam P. McGuire
- Department of Clinical Psychology, Seattle Pacific University, Seattle, WA, USA
| | - Oxana L. Stebbins
- Department of Clinical Psychology, Seattle Pacific University, Seattle, WA, USA
| | - Thane M. Erickson
- Department of Clinical Psychology, Seattle Pacific University, Seattle, WA, USA
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