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Miedl SF, Franke LK, Danböck SK, Martini M, Hettegger S, Kronbichler M, Flor H, Wilhelm FH. Neural processing of audiovisual and painful analogue trauma and its relationship with subsequent audiovisual and pain intrusions. Eur J Psychotraumatol 2024; 15:2388429. [PMID: 39282770 PMCID: PMC11407396 DOI: 10.1080/20008066.2024.2388429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/19/2024] Open
Abstract
Background: Posttraumatic stress disorder and medically unexplained pain frequently co-occur. While pain is common during traumatic events, the processing of pain during trauma and its relation to audiovisual and pain intrusions is poorly understood.Objective: Here we investigate neural activations during painful analogue trauma, focusing on areas that have been related to threat and pain processing, and how they predict intrusion formation. We also examine the moderating role of cumulative lifetime adversity.Methods: Sixty-five healthy women were assessed using functional magnetic resonance imaging. An analogue trauma was induced by an adaptation of the trauma-film paradigm extended by painful electrical stimulation in a 2 (film: aversive, neutral) x 2 (pain: pain, no-pain) design, followed by 7-day audiovisual and pain intrusion assessment using event-based ecological momentary assessment. Intrusions were fitted with Bayesian multilevel regression and a hurdle lognormal distribution.Results: Conjunction analysis confirmed a wide network including anterior insula (AI) and dorsal anterior cingulate cortex (dACC) being active both, during aversive films and pain. Pain resulted in activation in areas amongst posterior insula and deactivation in a network around ventromedial prefrontal cortex (VMPFC). Higher AI and dACC activity during aversive>neutral film predicted greater audiovisual intrusion probability over time and predicted greater audiovisual intrusion frequency particularly for participants with high lifetime adversity. Lower AI, dACC, hippocampus, and VMPFC activity during pain>no-pain predicted greater pain intrusion probability particularly for participants with high lifetime adversity. Weak regulatory VMPFC activation was associated with both increased audiovisual and pain intrusion frequency.Conclusions: Enhanced AI and dACC processing during aversive films, poor pain vs. no-pain discrimination in AI and dACC, as well as weak regulatory VMPFC processing may be driving factors for intrusion formation, particularly in combination with high lifetime adversity. Results shed light on a potential path for the etiology of PTSD and medically unexplained pain.
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Affiliation(s)
- Stephan F Miedl
- Clinical Stress and Emotion Laboratory, Division of Clinical Psychology and Psychopathology, Department of Psychology, Paris-Lodron University Salzburg, Salzburg, Austria
| | - Laila K Franke
- Clinical Stress and Emotion Laboratory, Division of Clinical Psychology and Psychopathology, Department of Psychology, Paris-Lodron University Salzburg, Salzburg, Austria
| | - Sarah K Danböck
- Clinical Stress and Emotion Laboratory, Division of Clinical Psychology and Psychopathology, Department of Psychology, Paris-Lodron University Salzburg, Salzburg, Austria
- Department of Psychology, School of Social Sciences, University of Mannheim, Mannheim, Germany
| | - Michael Martini
- Clinical Stress and Emotion Laboratory, Division of Clinical Psychology and Psychopathology, Department of Psychology, Paris-Lodron University Salzburg, Salzburg, Austria
| | - Sabrina Hettegger
- Clinical Stress and Emotion Laboratory, Division of Clinical Psychology and Psychopathology, Department of Psychology, Paris-Lodron University Salzburg, Salzburg, Austria
| | - Martin Kronbichler
- Centre for Cognitive Neuroscience & Department of Psychology, Paris-Lodron University of Salzburg, Salzburg, Austria
- Neuroscience Institute, Christian-Doppler Medical University Hospital, Paracelsus Medical University, Salzburg, Austria
| | - Herta Flor
- Institute of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Department of Psychology, School of Social Sciences, University of Mannheim, Mannheim, Germany
| | - Frank H Wilhelm
- Clinical Stress and Emotion Laboratory, Division of Clinical Psychology and Psychopathology, Department of Psychology, Paris-Lodron University Salzburg, Salzburg, Austria
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Korem N, Hillmer AT, D'Souza DC, Bassir Nia A, Levy I, Pietrzak RH, Harpaz-Rotem I. Amygdala Cannabinoid 1 Receptor, Pain Response, and Emotional Numbing in Trauma-Exposed Individuals. JAMA Netw Open 2024; 7:e2432387. [PMID: 39250156 PMCID: PMC11385051 DOI: 10.1001/jamanetworkopen.2024.32387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/10/2024] Open
Abstract
This case-control study assesses associations of amygdala cannabinoid 1 receptor availability with amygdala response to shock-induced pain and severity of emotional numbing symptoms of veterans with posttraumatic stress disorder.
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Affiliation(s)
- Nachshon Korem
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
- Department of Comparative Medicine, Yale University School of Medicine, New Haven, Connecticut
- US Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, Connecticut
| | - Ansel T Hillmer
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut
- Department of Biomedical Engineering, Yale School of Engineering and Applied Sciences, Yale University, New Haven, Connecticut
- Wu Tsai Institute, Yale University New Haven, New Haven, Connecticut
| | - Deepak Cyril D'Souza
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
- US Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, Connecticut
| | - Anahita Bassir Nia
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
| | - Ifat Levy
- Department of Comparative Medicine, Yale University School of Medicine, New Haven, Connecticut
- Wu Tsai Institute, Yale University New Haven, New Haven, Connecticut
- Department of Psychology, Yale University, New Haven, Connecticut
- Department of Neuroscience, Yale University, New Haven, Connecticut
| | - Robert H Pietrzak
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
- US Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, Connecticut
| | - Ilan Harpaz-Rotem
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
- US Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, Connecticut
- Wu Tsai Institute, Yale University New Haven, New Haven, Connecticut
- Department of Psychology, Yale University, New Haven, Connecticut
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Oshri A, Reck AJ, Carter SE, Uddin LQ, Geier CF, Beach SRH, Brody GH, Kogan SM, Sweet LH. Racial Discrimination and Risk for Internalizing and Externalizing Symptoms Among Black Youths. JAMA Netw Open 2024; 7:e2416491. [PMID: 38865126 PMCID: PMC11170300 DOI: 10.1001/jamanetworkopen.2024.16491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 04/11/2024] [Indexed: 06/13/2024] Open
Abstract
Importance Racial discrimination is a psychosocial stressor associated with youths' risk for psychiatric symptoms. Scarce data exist on the moderating role of amygdalar activation patterns among Black youths in the US. Objective To investigate the association between racial discrimination and risk for psychopathology moderated by neuroaffective processing. Design, Setting, and Participants This cohort study used longitudinal self-report and functional magnetic resonance imaging (fMRI) data from Black youth participants in the US from the Adolescent Brain Cognitive Development (ABCD) study. Data were analyzed from January 2023 to May 2024. Exposures At time 1 of the current study (12 months after baseline), youths self-reported on their experiences of interpersonal racial discrimination and their feelings of marginalization. Amygdalar response was measured during an emotionally valenced task that included blocks of faces expressing either neutral or negative emotion. Main Outcomes and Measures At 24 and 36 months after baseline, youths reported their internalizing (anxiety and depressive symptoms) and externalizing symptoms (aggression and rule-breaking symptoms). Results A total of 1596 youths were a mean (SD) age of 10.92 (0.63) years, and 803 were female (50.3%). Families in the study had a mean annual income range of $25 000 to $34 999. Two factors were derived from factor analysis: interpersonal racial discrimination and feelings of marginalization (FoM). Using structural equation modeling in a linear regression, standardized β coefficients were obtained. Neural response to faces expressing negative emotion within the right amygdala significantly moderated the association between FoM and changes in internalizing symptoms (β = -0.20; 95% CI, -0.32 to -0.07; P < .001). The response to negative facial emotion within the right amygdala significantly moderated the association between FoM and changes in externalizing symptoms (β = 0.24; 95% CI, 0.04 to 0.43; P = .02). Left amygdala response to negative emotion significantly moderated the association between FoM and changes in externalizing symptoms (β = -0.16; 95% CI, -0.32 to -0.01; P = .04). Conclusions and Relevance In this cohort study of Black adolescents in the US, findings suggest that amygdala function in response to emotional stimuli can both protect and intensify the affective outcomes of feeling marginalized on risk for psychopathology, informing preventive interventions aimed at reducing the adverse effects of racism on internalizing and externalizing symptoms among Black youths.
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Affiliation(s)
- Assaf Oshri
- Department of Human Development and Family Science, University of Georgia, Athens
| | - Ava Jane Reck
- Department of Human Development and Family Science, University of Georgia, Athens
| | | | - Lucina Q. Uddin
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles
| | - Charles F. Geier
- Department of Human Development and Family Science, University of Georgia, Athens
| | - Steven R. H. Beach
- Center of Family Research, University of Georgia, Athens
- Department of Psychology, University of Georgia, Athens
| | - Gene H. Brody
- Center of Family Research, University of Georgia, Athens
| | - Steven M. Kogan
- Department of Human Development and Family Science, University of Georgia, Athens
- Center of Family Research, University of Georgia, Athens
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Korem N, Duek O, Spiller T, Ben-Zion Z, Levy I, Harpaz-Rotem I. Emotional State Transitions in Trauma-Exposed Individuals With and Without Posttraumatic Stress Disorder. JAMA Netw Open 2024; 7:e246813. [PMID: 38625701 PMCID: PMC11022112 DOI: 10.1001/jamanetworkopen.2024.6813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 02/16/2024] [Indexed: 04/17/2024] Open
Abstract
Importance Posttraumatic stress disorder (PTSD) is marked by the contrasting symptoms of hyperemotional reactivity and emotional numbing (ie, reduced emotional reactivity). Comprehending the mechanism that governs the transition between neutral and negative emotional states is crucial for developing targeted therapeutic strategies. Objectives To explore whether individuals with PTSD experience a more pronounced shift between neutral and negative emotional states and how the intensity of emotional numbing symptoms impacts this shift. Design, Setting, and Participants This cross-sectional study used hierarchical bayesian modeling to fit a 5-parameter logistic regression to analyze the valence ratings of images. The aim was to compare the curve's slope between groups and explore its association with the severity of emotional numbing symptoms. The study was conducted online, using 35 images with a valence range from highly negative to neutral. The rating of these images was used to assess the emotional responses of the participants. The study recruited trauma-exposed individuals (witnessed or experienced life-threatening incident, violent assault, or someone being killed) between January 17 and March 8, 2023. Participants completed the PTSD Checklist for the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) (DSM-5) (PCL-5). Exposure On the basis of DSM-5 criteria (endorsing at least 1 symptom from clusters B and C and 2 from D and E), participants were categorized as having probable PTSD (pPTSD) or as trauma-exposed controls (TECs). Main Outcomes and Measures The main outcome was the slope parameter (b) of the logistic curve fitted to the valence rating. The slope parameter indicates the rate at which emotional response intensity changes with stimulus valence, reflecting how quickly the transition occurs between neutral and negatively valenced states. The secondary outcome was the association between emotional numbing (PCL-5 items 12-14) and the slope parameter. Results A total of 1440 trauma-exposed individuals were included. The pPTSD group (n = 445) was younger (mean [SD] age, 36.1 [10.9] years) compared with the TEC group (mean [SD] age, 41.5 [13.3] years; P < .001). Sex distribution (427 women in the TEC group vs 230 in the pPTSD group) did not significantly differ between groups (P = .67). The pPTSD group exhibited a steeper slope (mean slope difference, -0.255; 89% highest posterior density [HPD], -0.340 to -0.171) compared with the controls. Across all individuals (n = 1440), a robust association was found between the slope and emotional numbing severity (mean [SD] additive value, 0.100 [0.031]; 89% HPD, 0.051-0.15). Additional analysis controlling for age confirmed the association between emotional numbing and transition sharpness (mean [SD] additive value, 0.108 [0.032]; 89% HPD, 0.056-0.159), without evidence of an age-related association (mean [SD] additive value, 0.031 [0.033]; 89% HPD, -0.022 to 0.083). Conclusions and Relevance These findings support that individuals with PTSD undergo rapid transitions between neutral and negative emotional states, a phenomenon intensified by the severity of emotional numbing symptoms. Therapeutic interventions aimed at moderating these swift emotional transitions could potentially alleviate PTSD symptoms.
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Affiliation(s)
- Nachshon Korem
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
- Department of Comparative Medicine, Yale University School of Medicine, New Haven, Connecticut
- US Department of Veterans Affairs (VA) National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven
| | - Or Duek
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
- Department of Epidemiology, Biostatistics, and Community Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Tobias Spiller
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
- US Department of Veterans Affairs (VA) National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Ziv Ben-Zion
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
- Department of Comparative Medicine, Yale University School of Medicine, New Haven, Connecticut
- US Department of Veterans Affairs (VA) National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven
| | - Ifat Levy
- Department of Comparative Medicine, Yale University School of Medicine, New Haven, Connecticut
- Department of Psychology, Yale University, New Haven, Connecticut
- Department of Neuroscience, Yale University, New Haven, Connecticut
- Wu Tsai Institute, Yale University New Haven, New Haven, Connecticut
| | - Ilan Harpaz-Rotem
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
- US Department of Veterans Affairs (VA) National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven
- Department of Psychology, Yale University, New Haven, Connecticut
- Wu Tsai Institute, Yale University New Haven, New Haven, Connecticut
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Stiltner B, Fischer IC, Duek O, Polimanti R, Harpaz-Rotem I, Pietrzak RH. Functional correlates of a novel 8-factor model of PTSD in U.S. military veterans: Results from the National Health and Resilience in Veterans Study. J Psychiatr Res 2024; 171:69-74. [PMID: 38244335 DOI: 10.1016/j.jpsychires.2024.01.017] [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] [Received: 10/03/2023] [Revised: 12/21/2023] [Accepted: 01/10/2024] [Indexed: 01/22/2024]
Abstract
Emerging evidence indicates that more nuanced models of posttraumatic stress disorder (PTSD) may better capture the condition's symptom structure. Recent theoretical and empirical work suggest that an 8-factor model of PTSD with separate internally- (e.g. flashbacks) and externally- (e.g. trauma-cue related physiological reactivity) generated intrusive symptom clusters may advance understanding of PTSD and its treatment and course. However, the model's functional and clinical significance still requires evaluation. To this end, we analyzed data from the National Health and Resilience in Veterans Study, a nationally representative sample of 3847 trauma-exposed U.S. military veterans. Multivariable regressions were performed to assess the relationship between the 8 PTSD symptom clusters, assessed using the PTSD Checklist for DSM-5, and clinical and functional measures. Results revealed that externally-generated intrusions were associated with higher odds of current depression and anxiety and worse mental, cognitive, and psychosocial functioning. Anhedonia (e.g., loss of interest in enjoyable activities) symptoms were associated with all the correlates tested, while negative affect (e.g., having strong negative feelings such as fear) symptoms were associated with all measures except depression. Avoidance symptoms were associated with lower odds of current anxiety while externalizing behavior symptoms were linked to higher odds of suicidal ideation. Anxious arousal symptoms were associated with lower odds of suicidal ideation but higher odds of PTSD-related impairment/distress, while dysphoric arousal symptoms were associated with higher odds of current depression, PTSD-related impairment/distress and worse mental and cognitive functioning. Results suggest that a more nuanced 8-factor model of PTSD symptoms may help inform understanding of the clinical and functional correlates of this multi-faceted disorder.
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Affiliation(s)
- Brendan Stiltner
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA; VA Connecticut Healthcare System, West Haven, CT, USA
| | - Ian C Fischer
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA; U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, CT, USA
| | - Or Duek
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA; U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, CT, USA; Department of Epidemiology, Biostatistics and Community Health Sciences, School of Public Health, Ben-Gurion University of the Negev, Israel
| | - Renato Polimanti
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA; VA Connecticut Healthcare System, West Haven, CT, USA
| | - Ilan Harpaz-Rotem
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA; U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, CT, USA
| | - Robert H Pietrzak
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA; U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, CT, USA; Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA.
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