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Fulton T, Lathan EC, Karkare MC, Guelfo A, Eghbalzad L, Ahluwalia V, Ely TD, Turner JA, Turner MD, Currier JM, Mekawi Y, Fani N. Civilian Moral Injury and Amygdala Functional Connectivity During Attention to Threat. BIOLOGICAL PSYCHIATRY. COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2024; 9:112-120. [PMID: 37487958 PMCID: PMC10803642 DOI: 10.1016/j.bpsc.2023.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 06/27/2023] [Accepted: 07/06/2023] [Indexed: 07/26/2023]
Abstract
BACKGROUND Moral injury references emotional and spiritual/existential suffering that may emerge following psychological trauma. Despite being linked to adverse mental health outcomes, little is known about the neurophysiological mechanisms of this phenomenon. In this study, we examined neural correlates of moral injury exposure and distress using the Moral Injury Exposure and Symptom Scale for Civilians. We also examined potential moderation of these effects by race (Black vs. White individuals) given the likely intersection of race-related stress with moral injury. METHODS Forty-eight adults ages 18 to 65 years (mean age = 30.56, SD = 11.93) completed the Moral Injury Exposure and Symptom Scale for Civilians and an affective attentional control measure, the affective Stroop task (AS), during functional magnetic resonance imaging; the AS includes presentation of threat-relevant and neutral distractor stimuli. Voxelwise functional connectivity of the bilateral amygdala was examined in response to threat-relevant versus neutral AS distractor trials. RESULTS Functional connectivity between the right amygdala and left postcentral gyrus/primary somatosensory cortex was positively correlated with the Moral Injury Exposure and Symptom Scale for Civilians exposure score (voxelwise p < .001, cluster false discovery rate-corrected p < .05) in response to threat versus neutral AS distractor trials. Follow-up analyses revealed significant effects of race; Black but not White participants demonstrated this significant pattern of amygdala-left somatosensory cortex connectivity. CONCLUSIONS Increased exposure to potentially morally injurious events may lead to emotion-somatosensory pathway disruptions during attention to threat-relevant stimuli. These effects may be most potent for individuals who have experienced multilayered exposure to morally injurious events, including racial trauma. Moral injury appears to have a distinct neurobiological signature that involves abnormalities in connectivity of emotion-somatosensory paths, which may be amplified by race-related stress.
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Affiliation(s)
- Travis Fulton
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia; Molecular and Systems Pharmacology PhD Program, Emory University, Atlanta, Georgia
| | - Emma C Lathan
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Maya C Karkare
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Alfonsina Guelfo
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Leyla Eghbalzad
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Vishwadeep Ahluwalia
- Center for Advanced Brain Imaging, Georgia Institute of Technology, Atlanta, Georgia
| | - Timothy D Ely
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia
| | | | | | - Joseph M Currier
- Department of Psychology, University of South Alabama, Mobile, Alabama
| | - Yara Mekawi
- Department of Psychological and Brain Sciences, University of Louisville, Louisville, Kentucky
| | - Negar Fani
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia.
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Andrews K, Lloyd CS, Densmore M, Kearney BE, Harricharan S, McKinnon MC, Théberge J, Jetly R, Lanius RA. 'I am afraid you will see the stain on my soul': Direct gaze neural processing in individuals with PTSD after moral injury recall. Soc Cogn Affect Neurosci 2023; 18:nsad053. [PMID: 37897804 PMCID: PMC10612569 DOI: 10.1093/scan/nsad053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 07/20/2023] [Accepted: 10/19/2023] [Indexed: 10/30/2023] Open
Abstract
Direct eye contact is essential to understanding others' thoughts and feelings in social interactions. However, those with post-traumatic stress disorder (PTSD) and exposure to moral injury (MI) may exhibit altered theory-of-mind (ToM)/mentalizing processes and experience shame which precludes one's capacity for direct eye contact. We investigated blood oxygenation level-dependent (BOLD) responses associated with direct vs averted gaze using a virtual reality paradigm in individuals with PTSD (n = 28) relative to healthy controls (n = 18) following recall of a MI vs a neutral memory. Associations between BOLD responses and clinical symptomatology were also assessed. After MI recall, individuals with PTSD showed greater activation in the right temporoparietal junction as compared to controls (T = 4.83; pFDR < 0.001; k = 237) during direct gaze. No significant activation occurred during direct gaze after neutral memory recall. Further, a significant positive correlation was found between feelings of distress and right medial superior frontal gyrus activation in individuals with PTSD (T = 5.03; pFDR = 0.049; k = 123). These findings suggest that direct gaze after MI recall prompts compensatory ToM/mentalizing processing. Implications for future interventions aimed at mitigating the effects of PTSD on social functioning are discussed.
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Affiliation(s)
- Krysta Andrews
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON L8N 3K7, Canada
- Homewood Research Institute, Guelph, ON N1E 6K9, Canada
| | - Chantelle S Lloyd
- Homewood Research Institute, Guelph, ON N1E 6K9, Canada
- Department of Psychiatry, Western University, London, ON N6C 0A7, Canada
- Department of Psychology, Neuroscience, and Behaviour, McMaster University, Hamilton, ON L8S 4K1, Canada
| | - Maria Densmore
- Department of Psychiatry, Western University, London, ON N6C 0A7, Canada
- Imaging Division, Lawson Health Research Institute, London, ON N6A 4V2, Canada
| | - Breanne E Kearney
- Department of Neuroscience, Western University, London, ON N6A 3K7, Canada
| | - Sherain Harricharan
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON L8N 3K7, Canada
| | - Margaret C McKinnon
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON L8N 3K7, Canada
- Homewood Research Institute, Guelph, ON N1E 6K9, Canada
- Mood Disorders Program, St. Joseph’s Healthcare Hamilton, Hamilton, ON L8N 3K7, Canada
| | - Jean Théberge
- Department of Psychiatry, Western University, London, ON N6C 0A7, Canada
- Imaging Division, Lawson Health Research Institute, London, ON N6A 4V2, Canada
- Department of Medical Biophysics, Western University, London, ON N6A 5C1, Canada
| | - Rakesh Jetly
- Canadian Forces, Health Services, Ottawa, ON K1A 0S2, Canada
- Department of Psychiatry, University of Ottawa, Ottawa, ON K1N 6N5, Canada
| | - Ruth A Lanius
- Homewood Research Institute, Guelph, ON N1E 6K9, Canada
- Department of Psychiatry, Western University, London, ON N6C 0A7, Canada
- Imaging Division, Lawson Health Research Institute, London, ON N6A 4V2, Canada
- Department of Neuroscience, Western University, London, ON N6A 3K7, Canada
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Zasiekina L, Duchyminska T, Bifulco A, Bignardi G. War trauma impacts in Ukrainian combat and civilian populations: Moral injury and associated mental health symptoms. MILITARY PSYCHOLOGY 2023:1-12. [PMID: 37486615 DOI: 10.1080/08995605.2023.2235256] [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: 03/18/2023] [Accepted: 07/05/2023] [Indexed: 07/25/2023]
Abstract
This is the first study to compare active-duty soldiers and student civilian samples during the first three months of the Ukrainian-Russian war in relation to moral injury and its association with PTSD, anxiety and depression. A total of 350 participants, including 191 active-duty soldiers of the Ukrainian Armed Force (UAF), who were on the frontline during the full-scale invasion of Russian troops in February 2022, and 159 students from different HEIs in Volyn oblast, were recruited into the study through their attendance at the Ukrainian Psychotrauma Center. Prior to the in-person group-intervention program of psychosocial support for military and civil populations at the Ukrainian Psychotrauma Center, moral injury, PTSD, depression, and anxiety were assessed. Results showed significantly higher moral injury, PTSD, depression, and anxiety scores in civilian students, with a two-way ANOVA indicating a significant impact of female gender in civilians only. A hierarchical regression indicated that moral injury is a predictor of PTSD symptoms in both active-duty and civilian student groups. However, previous family trauma of genocide is associated with PTSD symptoms in active soldiers only. The findings of the current study could contribute insights for clinical practice for combatants and civilians during the current war.
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Affiliation(s)
- Larysa Zasiekina
- Department of General and Clinical Psychology, Lesya Ukrainka Volyn National University, Lutsk, Ukraine
- Department of Psychology, University of Cambridge, Cambridge, UK
| | - Tamara Duchyminska
- Department of Applied Psychology and Psychodiagnostics, Lesya Ukrainka Volyn National University, Lutsk, Ukraine
| | - Antonia Bifulco
- The Centre for Abuse and Trauma Centre, Middlesex University, London, UK
| | - Giacomo Bignardi
- Department of Psychology, University of Cambridge, Cambridge, UK
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Kearney BE, Terpou BA, Densmore M, Shaw SB, Théberge J, Jetly R, McKinnon MC, Lanius RA. How the body remembers: Examining the default mode and sensorimotor networks during moral injury autobiographical memory retrieval in PTSD. Neuroimage Clin 2023; 38:103426. [PMID: 37207593 PMCID: PMC10206209 DOI: 10.1016/j.nicl.2023.103426] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 04/26/2023] [Accepted: 04/28/2023] [Indexed: 05/21/2023]
Abstract
Neural representations of sensory percepts and motor responses constitute key elements of autobiographical memory. However, these representations may remain as unintegrated sensory and motor fragments in traumatic memory, thus contributing toward re-experiencing and reliving symptoms in trauma-related conditions such as post-traumatic stress disorder (PTSD). Here, we investigated the sensorimotor network (SMN) and posterior default mode network (pDMN) using a group independent component analysis (ICA) by examining their functional connectivity during a script-driven memory retrieval paradigm of (potentially) morally injurious events in individuals with PTSD and healthy controls. Moral injury (MI), where an individual acts or fails to act in a morally aligned manner, is examined given its inherent ties to disrupted motor planning and thus sensorimotor mechanisms. Our findings revealed significant differences in functional network connectivity across the SMN and pDMN during MI retrieval in participants with PTSD (n = 65) as compared to healthy controls (n = 25). No such significant group-wise differences emerged during retrieval of a neutral memory. PTSD-related alterations included hyperconnectivity between the SMN and pDMN, enhanced within-network connectivity of the SMN with premotor areas, and increased recruitment of the supramarginal gyrus into both the SMN and the pDMN during MI retrieval. In parallel with these neuroimaging findings, a positive correlation was found between PTSD severity and subjective re-experiencing intensity ratings after MI retrieval. These results suggest a neural basis for traumatic re-experiencing, where reliving and/or re-enacting a past morally injurious event in the form of sensory and motor fragments occurs in place of retrieving a complete, past-contextualized narrative as put forth by Brewin and colleagues (1996) and Conway and Pleydell-Pearce (2000). These findings have implications for bottom-up treatments targeting directly the sensory and motoric elements of traumatic experiences.
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Affiliation(s)
- Breanne E Kearney
- Department of Neuroscience, Western University, London, Ontario, Canada
| | - Braeden A Terpou
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Maria Densmore
- Department of Psychiatry, Western University, London, Ontario, Canada; Imaging Division, Lawson Health Research Institute, London, Ontario, Canada
| | - Saurabh B Shaw
- Department of Psychiatry, Western University, 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
| | - Rakesh Jetly
- Institute of Mental Health Research, University of Ottawa, Ottawa, Ontario, Canada
| | - Margaret C McKinnon
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada; Mood Disorders Program, St. Joseph's Healthcare, 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; Imaging Division, Lawson Health Research Institute, London, Ontario, Canada; Homewood Research Institute, Guelph, Ontario, Canada.
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Thome J, Densmore M, Terpou BA, Théberge J, McKinnon MC, Lanius RA. Contrasting Associations Between Heart Rate Variability and Brainstem-Limbic Connectivity in Posttraumatic Stress Disorder and Its Dissociative Subtype: A Pilot Study. Front Behav Neurosci 2022; 16:862192. [PMID: 35706833 PMCID: PMC9190757 DOI: 10.3389/fnbeh.2022.862192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 04/21/2022] [Indexed: 11/23/2022] Open
Abstract
Background Increasing evidence points toward the need to extend the neurobiological conceptualization of posttraumatic stress disorder (PTSD) to include evolutionarily conserved neurocircuitries centered on the brainstem and the midbrain. The reticular activating system (RAS) helps to shape the arousal state of the brain, acting as a bridge between brain and body. To modulate arousal, the RAS is closely tied to the autonomic nervous system (ANS). Individuals with PTSD often reveal altered arousal patterns, ranging from hyper- to blunted arousal states, as well as altered functional connectivity profiles of key arousal-related brain structures that receive direct projections from the RAS. Accordingly, the present study aims to explore resting state functional connectivity of the RAS and its interaction with the ANS in participants with PTSD and its dissociative subtype. Methods Individuals with PTSD (n = 57), its dissociative subtype (PTSD + DS, n = 32) and healthy controls (n = 40) underwent a 6-min resting functional magnetic resonance imaging and pulse data recording. Resting state functional connectivity (rsFC) of a central node of the RAS – the pedunculopontine nuclei (PPN) – was investigated along with its relation to ANS functioning as indexed by heart rate variability (HRV). HRV is a prominent marker indexing the flexibility of an organism to react adaptively to environmental needs, with higher HRV representing greater effective adaptation. Results Both PTSD and PTSD + DS demonstrated reduced HRV as compared to controls. HRV measures were then correlated with rsFC of the PPN. Critically, participants with PTSD and participants with PTSD + DS displayed inverse correlations between HRV and rsFC between the PPN and key limbic structures, including the amygdala. Whereas participants with PTSD displayed a positive relationship between HRV and PPN rsFC with the amygdala, participants with PTSD + DS demonstrated a negative relationship between HRV and PPN rsFC with the amygdala. Conclusion The present exploratory investigation reveals contrasting patterns of arousal-related circuitry among participants with PTSD and PTSD + DS, providing a neurobiological lens to interpret hyper- and more blunted arousal states in PTSD and PTSD + DS, respectively.
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Affiliation(s)
- Janine Thome
- Department of Psychiatry, Western University, London, ON, Canada
- Department of Theoretical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Maria Densmore
- Department of Psychiatry, Western University, London, ON, Canada
- Imaging Division, Lawson Health Research Institute, London, ON, Canada
| | - Braeden A. Terpou
- Homewood Research Institute, Guelph, ON, Canada
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Jean Théberge
- Department of Psychiatry, Western University, London, ON, Canada
- Imaging Division, Lawson Health Research Institute, London, ON, Canada
- Department of Medical Biophysics, Western University, London, ON, Canada
| | - Margaret C. McKinnon
- Homewood Research Institute, Guelph, ON, Canada
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
- Mood Disorders Programs, St. Joseph’s Healthcare Hamilton, Hamilton, ON, Canada
| | - Ruth A. Lanius
- Department of Psychiatry, Western University, London, ON, Canada
- Imaging Division, Lawson Health Research Institute, London, ON, Canada
- Homewood Research Institute, Guelph, ON, Canada
- Department of Neuroscience, Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON, Canada
- *Correspondence: Ruth A. Lanius,
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