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Fauver M, Clark EM, Schwartz CE. A new framework for understanding stress and disease: the developmental model of stress as applied to multiple sclerosis. Front Integr Neurosci 2024; 18:1365672. [PMID: 38957213 PMCID: PMC11218666 DOI: 10.3389/fnint.2024.1365672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 05/17/2024] [Indexed: 07/04/2024] Open
Abstract
This paper proposes a new model of stress that integrates earlier models and adds insights from developmental psychology. Previous models describe the behavioral and physical effects of stress events, but have not explained the translation of experiences into stress itself. The Developmental Model of Stress shows how psychosocial developmental challenges in childhood create persistent negative beliefs and behaviors that increase threat perception and maladaptive stress responses. These developmental challenges produce early psychological and physiological predispositions for increased stress responses over time. Ongoing stress leads to dysregulation of physical stress-response systems (allostatic load), which is associated with multiple diseases. High allostatic load provides the necessary preconditions for the diathesis-stress model, which says the addition of an acute stressor to a weakened or predisposed system can lead to disease development. The paper also documents the evolving measurement of stress to better understand the stress-disease relationship, helping to resolve conflicting results between studies. The Developmental Model of Stress was combined with clinician insight and patient reports to build an integrative framework for understanding the role of stress in the development and progression of multiple sclerosis (MS). It includes the first mapping of maladaptive beliefs and behaviors arising from developmental challenges that are common to people with MS. An initial comparison shows these may be distinct from those of people with other chronic diseases. These beliefs and behaviors form the predisposing factors and contribute to the triggering factors, which are the acute stressors triggering disease onset. These often took two forms, a prolonged incident experienced as feeling trapped or stuck, and threat of a breach in a relationship. The reinforcing factors add the stress of a chronic disease with a poor prognosis and seemingly random symptom fluctuation, still managed with the same beliefs and behaviors developed in childhood, increasing physiological dysregulation and symptom severity. A pilot study is described in which these three categories of stress factors in MS were explicitly addressed. This study noted clinically important improvements in physical and mental well-being, providing preliminary support for the Developmental Model. Future research might expand on the pilot using a more robust sample and design.
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Affiliation(s)
- Michelle Fauver
- Integral Health Program, California Institute for Human Science, Encinitas, CA, United States
| | - Eva M. Clark
- MIND based Healing, Santa Cruz, CA, United States
| | - Carolyn E. Schwartz
- DeltaQuest Foundation, Inc., Concord, MA, United States
- Department of Medicine and Departments of Orthopaedic Surgery, Tufts University Medical School, Boston, MA, United States
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Gbahabo DD, Duma SE. I did not scream. i could not; i was terrified. i just followed them. . .i blocked my mind. then they all raped me: A narrative inquiry on the onset of tonic immobility among women rape victims in Nigeria. PLoS One 2024; 19:e0278810. [PMID: 38315681 PMCID: PMC10843104 DOI: 10.1371/journal.pone.0278810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 10/30/2023] [Indexed: 02/07/2024] Open
Abstract
Tonic immobility (TI) is a common uncontrollable autonomic mammalian response to an extremely fearful situation. It is one of the most immediate devastating consequences of rape and remains poorly understood. While controversies over its definition persist among researchers, this also reflects on the care for and support to victims. The study aimed to explore and describe the onset of TI and the meaning attached to the experience among women raped victims in Nigeria. The study design was the qualitative narrative inquiry approach. Criterion and purposive sampling were conducted across four post-rape care facilities in Lagos, Nigeria, to recruit 13 participants. In-depth face-to-face interviews were conducted using a semi-structured interview guide to generate data that were thematically analysed. The findings of the study revealed five themes relating to the onset of TI as follows: the first two focused on the experience of TI: (1) the onset of TI prior to rape due to perceived imminent danger, (2) the onset of TI as a self-protection mechanism from further harm) while the last three relate to the meaning-making of the experience of TI (3) self-loathing as a meaning attached to TI, (4) suicidal ideations as a meaning attached to TI, and (5) divine intervention as a meaning attached to TI. Conclusion: The findings underscore the experiences and meanings that participants attach to TI following rape. There is a strong likelihood that tonic-immobility is not an uncommon experience amongst rape victims, but that in the absence of research, specialized care on the condition, and its associated consequences will haunt many women, affecting their psychological well-being and their entire quality of life. Describing the phenomenon as it is experienced by the participants is critical because understanding the condition is the first step toward effective appropriate management.
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Affiliation(s)
- Dooshima Dorothy Gbahabo
- Discipline of Nursing, School of Nursing & Public Health, College of Health Sciences, University of KwaZulu-Natal, Howard College Campus, Durban, South Africa
| | - Sinegugu Evidence Duma
- Discipline of Nursing, School of Nursing & Public Health, College of Health Sciences, University of KwaZulu-Natal, Howard College Campus, Durban, South Africa
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Kearney BE, Lanius RA. The brain-body disconnect: A somatic sensory basis for trauma-related disorders. Front Neurosci 2022; 16:1015749. [PMID: 36478879 PMCID: PMC9720153 DOI: 10.3389/fnins.2022.1015749] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 10/14/2022] [Indexed: 08/16/2023] Open
Abstract
Although the manifestation of trauma in the body is a phenomenon well-endorsed by clinicians and traumatized individuals, the neurobiological underpinnings of this manifestation remain unclear. The notion of somatic sensory processing, which encompasses vestibular and somatosensory processing and relates to the sensory systems concerned with how the physical body exists in and relates to physical space, is introduced as a major contributor to overall regulatory, social-emotional, and self-referential functioning. From a phylogenetically and ontogenetically informed perspective, trauma-related symptomology is conceptualized to be grounded in brainstem-level somatic sensory processing dysfunction and its cascading influences on physiological arousal modulation, affect regulation, and higher-order capacities. Lastly, we introduce a novel hierarchical model bridging somatic sensory processes with limbic and neocortical mechanisms regulating an individual's emotional experience and sense of a relational, agentive self. This model provides a working framework for the neurobiologically informed assessment and treatment of trauma-related conditions from a somatic sensory processing perspective.
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Affiliation(s)
- Breanne E. Kearney
- Department of Neuroscience, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Ruth A. Lanius
- Department of Neuroscience, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
- Department of Psychiatry, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
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Hagenaars MA, Hagenaars JAP. Tonic immobility predicts poorer recovery from posttraumatic stress disorder. J Affect Disord 2020; 264:365-369. [PMID: 32056773 DOI: 10.1016/j.jad.2019.11.027] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Revised: 06/07/2019] [Accepted: 11/08/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Tonic immobility (TI; a state of motor arrest during threat) and has been found to be associated with the development of psychopathology. It also hindered recovery from posttraumatic stress disorder (PTSD) after pharmacological treatment. The present study investigated the role of TI in recovery from PTSD in a large representative community sample with mixed traumas outside an exclusive treatment context. METHODS Participants with PTSD from the panel for Longitudinal Internet Studies for the Social Sciences (LISS) completed measures for trauma, PTSD symptoms, and peritraumatic responses (fear, dissociation, and TI) in two subsequent years. Traumatized participants with PTSD were selected for the analyses (N = 262). RESULTS TI was a relevant predictor for increased PTSD symptoms in year 2 after controlling for peritraumatic fear, peritraumatic dissociation, and PTSD symptoms in year 1, especially in abuse victims. Peritraumatic fear and dissociation no longer predicted PTSD in year 2 after entering TI in the model. CONCLUSIONS Our results indicate that TI may indeed hinder recovery from PTSD. TI may thus be a relevant factor to take into account after trauma and in treatment. The effects of TI may be especially negative for abuse victims.
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Affiliation(s)
- Muriel A Hagenaars
- Department of Clinical Psychology, Utrecht University, Utrecht, the Netherlands.
| | - Jacques A P Hagenaars
- Department of Methodology and Statistics, Tilburg University, Tilburg, the Netherlands
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Terpou BA, Harricharan S, McKinnon MC, Frewen P, Jetly R, Lanius RA. The effects of trauma on brain and body: A unifying role for the midbrain periaqueductal gray. J Neurosci Res 2019; 97:1110-1140. [PMID: 31254294 DOI: 10.1002/jnr.24447] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 04/09/2019] [Accepted: 05/06/2019] [Indexed: 12/18/2022]
Abstract
Post-traumatic stress disorder (PTSD), a diagnosis that may follow the experience of trauma, has multiple symptomatic phenotypes. Generally, individuals with PTSD display symptoms of hyperarousal and of hyperemotionality in the presence of fearful stimuli. A subset of individuals with PTSD; however, elicit dissociative symptomatology (i.e., depersonalization, derealization) in the wake of a perceived threat. This pattern of response characterizes the dissociative subtype of the disorder, which is often associated with emotional numbing and hypoarousal. Both symptomatic phenotypes exhibit attentional threat biases, where threat stimuli are processed preferentially leading to a hypervigilant state that is thought to promote defensive behaviors during threat processing. Accordingly, PTSD and its dissociative subtype are thought to differ in their proclivity to elicit active (i.e., fight, flight) versus passive (i.e., tonic immobility, emotional shutdown) defensive responses, which are characterized by the increased and the decreased expression of the sympathetic nervous system, respectively. Moreover, active and passive defenses are accompanied by primarily endocannabinoid- and opioid-mediated analgesics, respectively. Through critical review of the literature, we apply the defense cascade model to better understand the pathological presentation of defensive responses in PTSD with a focus on the functioning of lower-level midbrain and extended brainstem systems.
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Affiliation(s)
- Braeden A Terpou
- Department of Neuroscience, 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
| | - Paul Frewen
- Department of Psychology, Western University, London, Ontario, Canada
| | - Rakesh Jetly
- Canadian Forces, Health Services, Ottawa, Canada
| | - Ruth A Lanius
- Department of Neuroscience, Western University, London, Ontario, Canada.,Department of Psychiatry, Western University, London, Ontario, Canada
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Lloyd CS, Lanius RA, Brown MF, Neufeld RJ, Frewen PA, McKinnon MC. Assessing Post-Traumatic Tonic Immobility Responses: The Scale for Tonic Immobility Occurring Post-Trauma. CHRONIC STRESS (THOUSAND OAKS, CALIF.) 2019; 3:2470547018822492. [PMID: 32440591 PMCID: PMC7219877 DOI: 10.1177/2470547018822492] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Accepted: 12/04/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND Peri-traumatic tonic immobility has been associated with the development and course of post-traumatic stress disorder. Despite serving as an adaptive late-stage defense response, tonic immobility that continues in response to post-traumatic reminders may lead to reduced functioning and a diminished sense of well-being. At present, no validated self-report measures assess post-traumatic tonic immobility responses specifically. METHODS The primary objective of the present study was to evaluate the Scale for Tonic immobility Occurring Post-trauma (STOP), the first self-report measure developed to assess for the presence and severity of tonic immobility responses that persist following trauma exposure as part of post-traumatic symptomatology. Trauma-exposed clinical and non-clinical participants (N = 462) with a history of tonic immobility completed a demographic questionnaire, the STOP, and measures of post-traumatic symptoms, dissociation, anxiety, and depression. RESULTS STOP assessed four latent constructs, which were interpreted following the human defense cascade model. Together, these factors capture the sensorimotor and perceptual alterations, and dissociative experiences, associated with post-traumatic tonic immobility as a trauma-related altered state. Residual symptoms and the experience of negative affect following this response (including guilt and shame) are also represented. STOP scores demonstrated excellent reliability, as well as good construct and convergent validity, with other measures of dissociation and post-traumatic stress disorder. Results from the present study suggest tonic immobility is most consistent with other dissociative post-traumatic symptomatology. CONCLUSIONS STOP demonstrates excellent preliminary psychometric properties and may be useful for researchers and clinicians wishing to assess chronic forms of tonic immobility across trauma-exposed, clinical and community samples.
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Affiliation(s)
- Chantelle S. Lloyd
- Department of Psychology, Neuroscience,
and Behaviour, McMaster University, Hamilton, ON, Canada
- Department of Psychiatry, Western
University, London, ON, Canada
- Mood Disorders Program, St. Joseph’s
Healthcare Hamilton, Hamilton, ON, Canada
| | - Ruth A. Lanius
- Department of Psychiatry, Western
University, London, ON, Canada
- Department of Neuroscience, Western
University, London, ON, Canada
| | - Matthew F. Brown
- Department of Psychology, Western
University, London, ON, Canada
| | - Richard J. Neufeld
- Department of Psychiatry, Western
University, London, ON, Canada
- Department of Neuroscience, Western
University, London, ON, Canada
- Department of Psychology, Western
University, London, ON, Canada
| | - Paul A. Frewen
- Department of Psychiatry, Western
University, London, ON, Canada
- Department of Neuroscience, Western
University, London, ON, Canada
- Department of Psychology, Western
University, London, ON, Canada
| | - Margaret C. McKinnon
- Mood Disorders Program, St. Joseph’s
Healthcare Hamilton, Hamilton, ON, Canada
- Department of Psychiatry and Behavioural
Neurosciences, McMaster University, Hamilton, ON, Canada
- Homewood Research Institute, Guelph, ON,
Canada
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Tonic immobility during re-experiencing the traumatic event in posttraumatic stress disorder. Psychiatry Res 2018; 270:1105-1109. [PMID: 30041894 DOI: 10.1016/j.psychres.2018.06.051] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 04/11/2018] [Accepted: 06/20/2018] [Indexed: 11/20/2022]
Abstract
Tonic Immobility (TI) is an evolved defence response, characterized by physical immobility. Peritraumatic TI has been linked to posttraumatic stress disorder (PTSD). However, samples sizes in clinical studies have been small, and little is known about TI reactions post trauma, for instance during trauma reminders. The prevalence of peritraumatic TI and TI during re-experiencing the traumatic event was examined by self-report in 184 patients with chronic PTSD. Moderate peritraumatic TI was reported by 26.6% of the participants (n = 49) and extreme peritraumatic TI by 52.2% (n = 96). During re-experiencing the traumatic event, 35.3% (n = 65) reported moderate TI, and 37.0% (n = 68) extreme TI. Peritraumatic TI was related to PTSD symptom severity and TI during re-experiencing mediated this relationship. In line with previous findings, reports of peritraumatic TI were high among PTSD patients. In addition, we showed that it often re-occurred during re-experiencing the traumatic event. The prevalence of TI at different stages post trauma warrants future study.
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Stoffels M, Nijs M, Spinhoven P, Mesbah R, Hagenaars MA. Emotion avoidance and fear bradycardia in patients with borderline personality disorder and healthy controls. J Behav Ther Exp Psychiatry 2017; 57:6-13. [PMID: 28235636 DOI: 10.1016/j.jbtep.2017.02.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 01/15/2017] [Accepted: 02/10/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND OBJECTIVES Exaggerated emotional reactivity is supposed to be essential in the etiology of borderline personality disorder (BPD). More specifically, models of defensive behavior would predict reduced freezing behavior -indicated by fear bradycardia-in response to threat. This study examined automatic fear bradycardia responses in BPD versus healthy controls and the role of emotion dysregulation, more specifically tendencies to avoid emotions. METHODS Patients with BPD (n = 23) and healthy controls (n = 18) completed questionnaires and then watched neutral, pleasant and unpleasant pictures while heart rate was assessed. RESULTS Emotion avoidance interacted with group: it was associated with distinct autonomic responses in healthy controls but not in BPD patients. Controls with lower emotion avoidance tendencies showed bradycardia in response to unpleasant pictures, while controls with higher emotion avoidance tendencies did not. BPD patients showed no bradycardia, irrespective of their emotion avoidance tendencies. LIMITATIONS This study is limited by a small sample size. Comorbidity or medication intake were not controlled for. CONCLUSIONS The results may suggest impaired automatic defense responses in BPD. Further understanding of the regulation of distress and defense responses might improve BPD treatment.
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Affiliation(s)
- Malou Stoffels
- Amstel Academy, VU Medical Centre, de Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Maurits Nijs
- Netherlands Psychiatric Association, Mercatorlaan 1200, 3528 BL Utrecht, The Netherlands
| | - Philip Spinhoven
- Institute of Psychology, Leiden University, Wassenaarseweg 52, 2333 AK, Leiden, The Netherlands; Department of Psychiatry, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Rahele Mesbah
- Institute of Psychology, Leiden University, Wassenaarseweg 52, 2333 AK, Leiden, The Netherlands; PsyQ, Lijnbaan 4, 2512 VA Den Haag, The Netherlands
| | - Muriel A Hagenaars
- Institute of Psychology, Leiden University, Wassenaarseweg 52, 2333 AK, Leiden, The Netherlands; Department of Clinical Psychology, Utrecht University, Heidelberglaan 1, 3584 CS Utrecht, The Netherlands.
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Kroes MCW, Dunsmoor JE, Mackey WE, McClay M, Phelps EA. Context conditioning in humans using commercially available immersive Virtual Reality. Sci Rep 2017; 7:8640. [PMID: 28819155 PMCID: PMC5561126 DOI: 10.1038/s41598-017-08184-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 07/05/2017] [Indexed: 11/08/2022] Open
Abstract
Despite a wealth of knowledge on how humans and nonhuman animals learn to associate meaningful events with cues in the environment, far less is known about how humans learn to associate these events with the environment itself. Progress on understanding spatiotemporal contextual processes in humans has been slow in large measure by the methodological constraint of generating and manipulating immersive spatial environments in well-controlled laboratory settings. Fortunately, immersive Virtual Reality (iVR) technology has improved appreciably and affords a relatively straightforward methodology to investigate the role of context on learning, memory, and emotion while maintaining experimental control. Here, we review context conditioning literature in humans and describe challenges to study contextual learning in humans. We then provide details for a novel context threat (fear) conditioning paradigm in humans using a commercially available VR headset and a cross-platform game engine. This paradigm resulted in the acquisition of subjective threat, threat-conditioned defensive responses, and explicit threat memory. We make the paradigm publicly available and describe obstacles and solutions to optimize future studies of context conditioning using iVR. As computer technology advances to replicate the sensation of realistic environments, there are increasing opportunities to bridge the translational gap between rodent and human research on how context modulates cognition, which may ultimately lead to more optimal treatment strategies for anxiety- and stress-related disorders.
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Affiliation(s)
- Marijn C W Kroes
- New York University, Department of Psychology, New York, NY, 10003, USA.
- New York University, Center for Neural Science, New York, NY, 10003, USA.
| | - Joseph E Dunsmoor
- University of Texas at Austin, Department of Psychiatry, Austin, TX, 78712, USA
| | - Wayne E Mackey
- New York University, Department of Psychology, New York, NY, 10003, USA
| | - Mason McClay
- Centre College, Department of Psychology, Danville, KY, 40422, USA
| | - Elizabeth A Phelps
- New York University, Department of Psychology, New York, NY, 10003, USA.
- New York University, Center for Neural Science, New York, NY, 10003, USA.
- Nathan Kline Institute, Orangeburg, NY, 10962, USA.
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Effects of Osteopathic Treatment on Postural Equilibrium Evaluated through a Stabilometric Platform: A Randomized and Controlled Study. J Funct Morphol Kinesiol 2017. [DOI: 10.3390/jfmk2020018] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
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Niermann HCM, Figner B, Roelofs K. Individual differences in defensive stress-responses: the potential relevance for psychopathology. Curr Opin Behav Sci 2017. [DOI: 10.1016/j.cobeha.2017.01.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Fragkaki I, Roelofs K, Stins J, Jongedijk RA, Hagenaars MA. Reduced Freezing in Posttraumatic Stress Disorder Patients while Watching Affective Pictures. Front Psychiatry 2017; 8:39. [PMID: 28352237 PMCID: PMC5348645 DOI: 10.3389/fpsyt.2017.00039] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 02/27/2017] [Indexed: 12/04/2022] Open
Abstract
Besides fight and flight responses, animals and humans may respond to threat with freezing, a response characterized by bradycardia and physical immobility. Risk assessment is proposed to be enhanced during freezing to promote optimal decision making. Indeed, healthy participants showed freezing-like responses to threat cues. Posttraumatic stress disorder (PTSD) patients are characterized by hypervigilance and increased threat responsiveness. We propose that threat responses will be characterized by decreased freezing in PTSD, eliminating possibilities for rejecting cognitive distortions, such as harm expectancy, and thereby contributing to the maintenance of the disorder. However, freezing responses have hardly been investigated in PTSD. Using a stabilometric platform to assess body sway as an indicator of freezing-like behavior, we examined whether veterans with PTSD would show diminished freezing responses to unpleasant versus neutral and pleasant pictures. Fourteen PTSD patients and 14 healthy matched controls watched the pictures, while body sway and heart rate (HR) were continuously assessed. Replicating previous findings, healthy controls showed decreased body sway and HR in response to unpleasant pictures, indicative of freezing-like behavior. In contrast, this response pattern was not observed in PTSD patients. The results may indicate a reduced freezing response in PTSD. As reduced freezing may hinder appropriate risk assessment, it may be an important factor in the maintenance of PTSD. Future research might clarify whether impaired freezing is a PTSD-specific or a transdiagnostic symptom, being present in threat-related disorders.
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Affiliation(s)
- Iro Fragkaki
- Behavioural Science Institute, Radboud University , Nijmegen , Netherlands
| | - Karin Roelofs
- Behavioural Science Institute and Donders Institute for Brain Cognition and Behavior, Radboud University , Nijmegen , Netherlands
| | - John Stins
- Faculty of Behaviour and Movement Sciences, Department of Human Movement Sciences, MOVE Research Institute Amsterdam, VU University , Amsterdam , Netherlands
| | - Ruud A Jongedijk
- Foundation Centrum '45, Arq Psychotrauma Expert Group , Diemen , Netherlands
| | - Muriel A Hagenaars
- Department of Clinical Psychology, Utrecht University , Utrecht , Netherlands
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Fragkaki I, Stins J, Roelofs K, Jongedijk RA, Hagenaars MA. Tonic immobility differentiates stress responses in PTSD. Brain Behav 2016; 6:e00546. [PMID: 27843699 PMCID: PMC5102644 DOI: 10.1002/brb3.546] [Citation(s) in RCA: 12] [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: 02/29/2016] [Revised: 07/06/2016] [Accepted: 07/06/2016] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Tonic immobility (TI) is a state of physical immobility associated with extreme stress and the development of posttraumatic stress disorder (PTSD). However, it is unknown whether TI is associated with a distinct actual stress response, i.e., objective immobility measured by a stabilometric platform. This study made a first step in exploring this as well as differences in body sway responses between PTSD patients and healthy controls. We hypothesized that PTSD would be related to increased body sway under stress, whereas TI would be related to decreased body sway under stress. METHODS Eye closure was selected as a PTSD-relevant stress induction procedure. Body sway and heart rate (HR) were measured in 12 PTSD patients and 12 healthy controls in four conditions: (1) maintaining a stable stance with eyes open, (2) with eyes closed, (3) during a mental arithmetic task with eyes open, and (4) with eyes closed. RESULTS As predicted, PTSD patients showed increased body sway from eyes open to eyes closed compared to controls and this effect was eliminated by executing the arithmetic task. Most importantly, retrospective self-reported TI was associated with lower body sway increases in PTSD and higher body sway decreases in controls from eyes-open to eyes-closed conditions. CONCLUSIONS These preliminary findings suggest that eye closure has a different effect on PTSD patients than controls and that high self-reported TI might indicate a distinct stress response pattern, i.e., a proneness for immobility. It may be relevant to take such individual differences in stress-response into account in PTSD treatment.
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Affiliation(s)
- Iro Fragkaki
- Behavioural Science Institute Radboud University Nijmegen Nijmegen The Netherlands
| | - John Stins
- Department of Human Movement Sciences Faculty of Behaviour and Movement Sciences MOVE Research Institute Amsterdam VU University Amsterdam Amsterdam The Netherlands
| | - Karin Roelofs
- Behavioural Science Institute and Donders Institute for Brain Cognition and Behavior Radboud University Nijmegen Nijmegen The Netherlands
| | - Ruud A Jongedijk
- Foundation Centrum '45, Arq Psychotrauma Expert Group Oegstgeest The Netherlands
| | - Muriel A Hagenaars
- Department of Clinical Psychology Utrecht University Utrecht The Netherlands
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