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Borst B, Jovanovic T, House SL, Bruce SE, Harnett NG, Roeckner AR, Ely TD, Lebois LAM, Young D, Beaudoin FL, An X, Neylan TC, Clifford GD, Linnstaedt SD, Germine LT, Bollen KA, Rauch SL, Haran JP, Storrow AB, Lewandowski C, Musey PI, Hendry PL, Sheikh S, Jones CW, Punches BE, Hudak LA, Pascual JL, Seamon MJ, Datner EM, Pearson C, Peak DA, Domeier RM, Rathlev NK, O'Neil BJ, Sergot P, Sanchez LD, Harte SE, Koenen KC, Kessler RC, McLean SA, Ressler KJ, Stevens JS, van Rooij SJH. Sex Differences in Response Inhibition-Related Neural Predictors of Posttraumatic Stress Disorder in Civilians With Recent Trauma. BIOLOGICAL PSYCHIATRY. COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2024:S2451-9022(24)00080-6. [PMID: 38522649 DOI: 10.1016/j.bpsc.2024.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 03/05/2024] [Accepted: 03/07/2024] [Indexed: 03/26/2024]
Abstract
BACKGROUND Females are more likely to develop posttraumatic stress disorder (PTSD) than males. Impaired inhibition has been identified as a mechanism for PTSD development, but studies on potential sex differences in this neurobiological mechanism and how it relates to PTSD severity and progression are relatively rare. Here, we examined sex differences in neural activation during response inhibition and PTSD following recent trauma. METHODS Participants (n = 205, 138 female sex assigned at birth) were recruited from emergency departments within 72 hours of a traumatic event. PTSD symptoms were assessed 2 weeks and 6 months posttrauma. A Go/NoGo task was performed 2 weeks posttrauma in a 3T magnetic resonance imaging scanner to measure neural activity during response inhibition in the ventromedial prefrontal cortex, right inferior frontal gyrus, and bilateral hippocampus. General linear models were used to examine the interaction effect of sex on the relationship between our regions of interest and the whole brain, PTSD symptoms at 6 months, and symptom progression between 2 weeks and 6 months. RESULTS Lower response inhibition-related ventromedial prefrontal cortex activation 2 weeks posttrauma predicted more PTSD symptoms at 6 months in females but not in males, while greater response inhibition-related right inferior frontal gyrus activation predicted lower PTSD symptom progression in males but not females. Whole-brain interaction effects were observed in the medial temporal gyrus and left precentral gyrus. CONCLUSIONS There are sex differences in the relationship between inhibition-related brain activation and PTSD symptom severity and progression. These findings suggest that sex differences should be assessed in future PTSD studies and reveal potential targets for sex-specific interventions.
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Affiliation(s)
- Bibian Borst
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia; Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Tanja Jovanovic
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, Michigan
| | - Stacey L House
- Department of Emergency Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Steven E Bruce
- Department of Psychological Sciences, University of Missouri St. Louis, St. Louis, Missouri
| | - Nathaniel G Harnett
- Division of Depression and Anxiety, McLean Hospital, Belmont, Massachusetts; Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Alyssa R Roeckner
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Timothy D Ely
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Lauren A M Lebois
- Division of Depression and Anxiety, McLean Hospital, Belmont, Massachusetts; Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Dmitri Young
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco, California
| | - Francesca L Beaudoin
- Department of Epidemiology, Brown University, Rehabilitation International, Providence, Rhode Island; Department of Emergency Medicine, Brown University, Providence, Rhode Island
| | - Xinming An
- Institute for Trauma Recovery, Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Thomas C Neylan
- Departments of Psychiatry and Neurology, University of California San Francisco, San Francisco, California
| | - Gari D Clifford
- Department of Biomedical Informatics, Emory University School of Medicine, Atlanta, Georgia; Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Georgia
| | - Sarah D Linnstaedt
- Institute for Trauma Recovery, Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Laura T Germine
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts; Institute for Technology in Psychiatry, McLean Hospital, Belmont, Massachusetts; Many Brains Project, Belmont, Massachusetts
| | - Kenneth A Bollen
- Department of Psychology and Neuroscience & Department of Sociology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Scott L Rauch
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts; Institute for Technology in Psychiatry, McLean Hospital, Belmont, Massachusetts; Department of Psychiatry, McLean Hospital, Belmont, Massachusetts
| | - John P Haran
- Department of Emergency Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts
| | - Alan B Storrow
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Paul I Musey
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Phyllis L Hendry
- Department of Emergency Medicine, University of Florida College of Medicine, Jacksonville, Jacksonville, Florida
| | - Sophia Sheikh
- Department of Emergency Medicine, University of Florida College of Medicine, Jacksonville, Jacksonville, Florida
| | - Christopher W Jones
- Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, New Jersey
| | - Brittany E Punches
- Department of Emergency Medicine, Ohio State University College of Medicine, Columbus, Ohio; Ohio State University College of Nursing, Columbus, Ohio
| | - Lauren A Hudak
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Jose L Pascual
- Department of Surgery, Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Mark J Seamon
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Surgery, Division of Traumatology, Surgical Critical Care and Emergency Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Elizabeth M Datner
- Department of Emergency Medicine, Jefferson Einstein Hospital, Jefferson Health, Philadelphia, Pennsylvania; Department of Emergency Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Claire Pearson
- Department of Emergency Medicine, Wayne State University, Ascension St. John Hospital, Detroit, Michigan
| | - David A Peak
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Robert M Domeier
- Department of Emergency Medicine, Trinity Health, Ann Arbor, Ypsilanti, Michigan
| | - Niels K Rathlev
- Department of Emergency Medicine, University of Massachusetts Medical School-Baystate, Springfield, Massachusetts
| | - Brian J O'Neil
- Department of Emergency Medicine, Wayne State University, Detroit Receiving Hospital, Detroit, Michigan
| | - Paulina Sergot
- Department of Emergency Medicine, McGovern Medical School at UTHealth, Houston, Texas
| | - Leon D Sanchez
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts; Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts
| | - Steven E Harte
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, Michigan; Department of Internal Medicine-Rheumatology, University of Michigan Medical School, Ann Arbor, Michigan
| | - Karestan C Koenen
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts
| | - Ronald C Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Samuel A McLean
- Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Institute for Trauma Recovery, Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Kerry J Ressler
- Division of Depression and Anxiety, McLean Hospital, Belmont, Massachusetts; Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Jennifer S Stevens
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Sanne J H van Rooij
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia.
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Sheynin J, Lokshina Y, Ahrari S, Nickelsen T, Duval ER, Ben-Zion Z, Shalev AY, Hendler T, Liberzon I. Greater Early Posttrauma Activation in the Right Inferior Frontal Gyrus Predicts Recovery From Posttraumatic Stress Disorder Symptoms. BIOLOGICAL PSYCHIATRY. COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2024; 9:91-100. [PMID: 37451548 PMCID: PMC10787040 DOI: 10.1016/j.bpsc.2023.07.002] [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: 03/10/2023] [Revised: 06/30/2023] [Accepted: 07/03/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Posttraumatic stress disorder (PTSD) has been associated with altered emotion processing and modulation in specific brain regions, i.e., the amygdala, insula, and medial prefrontal and anterior cingulate cortices. Functional alterations in these regions, recorded shortly after trauma exposure, may predict changes in PTSD symptoms. METHODS Survivors (N = 104) of a traumatic event, predominantly a motor vehicle accident, were included. Functional magnetic resonance imaging was used to assess brain activation 1, 6, and 14 months after trauma exposure (T1, T2, and T3, respectively). Participants performed the Shifted-attention Emotional Appraisal Task, which probes 3 affective processes: implicit emotional processing (of emotional faces), emotion modulation by attention shifting (away from these faces), and emotion modulation by appraisal (of the participants' own emotional response to these faces). We defined regions of interest based on task-related activations, extracted beta weights from these regions of interest, and submitted them to a series of analyses to examine relationships between neural activation and PTSD severity over the 3 time points. RESULTS At T1, a regression model containing activations in the left dorsolateral prefrontal cortex, bilateral inferior frontal gyrus (IFG), and medial prefrontal cortex during emotion modulation by appraisal significantly predicted change in PTSD symptoms. More specifically, greater right IFG activation at T1 was associated with greater reduction in symptom severity (T1-T3). Exploratory analysis also found that activation of the right IFG increased from T1 to T3. CONCLUSIONS The results suggest that greater early posttrauma activation during emotion appraisal in the right IFG, a region previously linked to cognitive control in PTSD, predicts recovery from PTSD symptoms.
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Affiliation(s)
- Jony Sheynin
- Department of Psychiatry and Behavioral Science, Texas A&M University Health Science Center, Bryan, Texas
| | - Yana Lokshina
- Department of Psychiatry and Behavioral Science, Texas A&M University Health Science Center, Bryan, Texas; Department of Psychological & Brain Sciences, Texas A&M University, College Station, Texas; Texas A&M Institute for Neuroscience, Texas A&M University, College Station, Texas
| | - Samira Ahrari
- Department of Psychiatry and Behavioral Science, Texas A&M University Health Science Center, Bryan, Texas
| | - Tetiana Nickelsen
- Department of Psychiatry and Behavioral Science, Texas A&M University Health Science Center, Bryan, Texas
| | - Elizabeth R Duval
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan
| | - Ziv Ben-Zion
- Departments of Comparative Medicine and Psychiatry, Yale School of Medicine, Yale University, New Haven, Connecticut; Sagol Brain Institute Tel-Aviv, Wohl Institute for Advanced Imaging, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel; Sagol School of Neuroscience, Tel-Aviv University, Tel-Aviv, Israel; United States Department of Veterans Affairs National Center for PTSD Clinical Neuroscience Division, Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut
| | - Arieh Y Shalev
- Department of Psychiatry, New York University Grossman School of Medicine, New York, New York
| | - Talma Hendler
- Sagol Brain Institute Tel-Aviv, Wohl Institute for Advanced Imaging, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel; Sagol School of Neuroscience, Tel-Aviv University, Tel-Aviv, Israel
| | - Israel Liberzon
- Department of Psychiatry and Behavioral Science, Texas A&M University Health Science Center, Bryan, Texas; Department of Psychological & Brain Sciences, Texas A&M University, College Station, Texas; Texas A&M Institute for Neuroscience, Texas A&M University, College Station, Texas.
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Bloch MS, Høgenhaug SS, Bols Thomsen JB. Attachment and mentalization among survivors of sexual abuse: A questionnaire survey. Bull Menninger Clin 2024; 88:3-28. [PMID: 38527105 DOI: 10.1521/bumc.2024.88.1.3] [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: 03/27/2024]
Abstract
Knowledge of the long-term consequences of child sexual abuse (CSA) is crucial to further develop preventive strategies and treatment programs. The aim of this study is to investigate attachment and mentalizing ability in people who have experienced CSA. Attachment style, measured with the Experiences in Close Relationships-Relationship Structures Questionnaire (ECR-RS), and mentalization, measured with the Reflective Functioning Questionnaire (RFQ), were examined through a quantitative questionnaire survey in a sample of 49 individuals who had experienced CSA, and a control group of 612 with no history of CSA. The CSA group was, to a greater extent, identified with insecure attachment style. In addition, participants with insecure attachment were more likely to use hypomentalizing compared to individuals identified with a secure attachment. No significant association was found between attachment style and the relationship between the victim and the offender or the length of traumatic episodes.
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Affiliation(s)
| | - Stine Steen Høgenhaug
- Outpatient Clinic of Anxiety Disorders and Personality Disorders, Brønderslev Psychiatric Hospital, Brønderslev, Denmark
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Iqbal J, Huang GD, Xue YX, Yang M, Jia XJ. The neural circuits and molecular mechanisms underlying fear dysregulation in posttraumatic stress disorder. Front Neurosci 2023; 17:1281401. [PMID: 38116070 PMCID: PMC10728304 DOI: 10.3389/fnins.2023.1281401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 10/13/2023] [Indexed: 12/21/2023] Open
Abstract
Post-traumatic stress disorder (PTSD) is a stress-associated complex and debilitating psychiatric disorder due to an imbalance of neurotransmitters in response to traumatic events or fear. PTSD is characterized by re-experiencing, avoidance behavior, hyperarousal, negative emotions, insomnia, personality changes, and memory problems following exposure to severe trauma. However, the biological mechanisms and symptomatology underlying this disorder are still largely unknown or poorly understood. Considerable evidence shows that PTSD results from a dysfunction in highly conserved brain systems involved in regulating stress, anxiety, fear, and reward circuitry. This review provides a contemporary update about PTSD, including new data from the clinical and preclinical literature on stress, PTSD, and fear memory consolidation and extinction processes. First, we present an overview of well-established laboratory models of PTSD and discuss their clinical translational value for finding various treatments for PTSD. We then highlight the research progress on the neural circuits of fear and extinction-related behavior, including the prefrontal cortex, hippocampus, and amygdala. We further describe different molecular mechanisms, including GABAergic, glutamatergic, cholinergic, and neurotropic signaling, responsible for the structural and functional changes during fear acquisition and fear extinction processes in PTSD.
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Affiliation(s)
- Javed Iqbal
- Shenzhen Graduate School, Peking University Shenzhen, Guangdong, China
- Department of Addiction Medicine, Shenzhen Engineering Research Center for Precision Psychiatric Technology, Shenzhen Clinical Research Center for Mental Disorders, Shenzhen Kangning Hospital and Shenzhen Mental Health Center; Clinical College of Mental Health, Shenzhen University Health Science Center; Affiliated Mental Health Center, Southern University of Science and Technology, Shenzhen, Guangdong, China
| | - Geng-Di Huang
- Shenzhen Graduate School, Peking University Shenzhen, Guangdong, China
- Department of Addiction Medicine, Shenzhen Engineering Research Center for Precision Psychiatric Technology, Shenzhen Clinical Research Center for Mental Disorders, Shenzhen Kangning Hospital and Shenzhen Mental Health Center; Clinical College of Mental Health, Shenzhen University Health Science Center; Affiliated Mental Health Center, Southern University of Science and Technology, Shenzhen, Guangdong, China
| | - Yan-Xue Xue
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing, China
| | - Mei Yang
- Department of Addiction Medicine, Shenzhen Engineering Research Center for Precision Psychiatric Technology, Shenzhen Clinical Research Center for Mental Disorders, Shenzhen Kangning Hospital and Shenzhen Mental Health Center; Clinical College of Mental Health, Shenzhen University Health Science Center; Affiliated Mental Health Center, Southern University of Science and Technology, Shenzhen, Guangdong, China
| | - Xiao-Jian Jia
- Department of Addiction Medicine, Shenzhen Engineering Research Center for Precision Psychiatric Technology, Shenzhen Clinical Research Center for Mental Disorders, Shenzhen Kangning Hospital and Shenzhen Mental Health Center; Clinical College of Mental Health, Shenzhen University Health Science Center; Affiliated Mental Health Center, Southern University of Science and Technology, Shenzhen, Guangdong, China
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5
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Lin ERH, Roeckner AR, Fani N, Merrill N, Gillespie CF, Ely TD, Bradley B, Michopoulos V, Powers A, Jovanovic T, Stevens JS. Association between dimensions of trauma-related psychopathology and asthma in trauma-exposed women. Front Behav Neurosci 2023; 17:1268877. [PMID: 38025383 PMCID: PMC10648896 DOI: 10.3389/fnbeh.2023.1268877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 09/22/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Exposure to traumatic events and stressful life experiences are associated with a wide range of adverse mental and physical health outcomes. Studies have found post-traumatic stress disorder (PTSD), depression, and anxiety sensitivity occurrence to be common in addition to inflammatory diseases like asthma, especially in women. Moreover, overlapping neurobiological mechanisms have been linked to both PTSD and asthma. Methods In the current study, n = 508 women reported on presence of lifetime asthma diagnosis and symptoms of trauma-related psychopathology including PTSD and depression. A separate group of female participants (n = 64) reported on asthma, PTSD, depression and anxiety sensitivity, and underwent functional MRI scans during a fearful faces task, and their anterior insula responses were analyzed. Results Overall, PTSD and depression severity were significantly higher in those with asthma versus those without asthma. There was a positive association between anterior insula response to social threat cues and depression symptoms only among individuals without a lifetime presence of asthma. Discussion These findings provide continued evidence on the interactions between stress, neural mechanisms involved in interoception and salience detection, and trauma-related psychopathology.
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Affiliation(s)
- Esther R.-H. Lin
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, United States
| | - Alyssa R. Roeckner
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, United States
| | - Negar Fani
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, United States
| | - Natalie Merrill
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, United States
| | - Charles F. Gillespie
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, United States
| | - Timothy D. Ely
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, United States
| | - Bekh Bradley
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, United States
- Atlanta VA Health Care System, Atlanta, GA, United States
| | - Vasiliki Michopoulos
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, United States
| | - Abigail Powers
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, United States
| | - Tanja Jovanovic
- Wayne State University School of Medicine, Detroit, MI, United States
| | - Jennifer S. Stevens
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, United States
- Atlanta VA Health Care System, Atlanta, GA, United States
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6
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Hinojosa CA, VanElzakker MB, Kaur N, Felicione JM, Charney ME, Bui E, Marques L, Summergrad P, Rauch SL, Simon NM, Shin LM. Pre-treatment amygdala activation and habituation predict symptom change in post-traumatic stress disorder. Front Behav Neurosci 2023; 17:1198244. [PMID: 37492481 PMCID: PMC10363634 DOI: 10.3389/fnbeh.2023.1198244] [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: 03/31/2023] [Accepted: 06/13/2023] [Indexed: 07/27/2023] Open
Abstract
Trauma-focused psychotherapy approaches are the first-line treatment option for post-traumatic stress disorder (PTSD); however, up to a third of patients remain symptomatic even after completion of the treatment. Predicting which patients will respond to a given treatment option would support personalized treatments and improve the efficiency of healthcare systems. Although previous neuroimaging studies have examined possible pre-treatment predictors of response to treatment, the findings have been somewhat inconsistent, and no other study has examined habituation to stimuli as a predictor. In this study, 16 treatment-seeking adults (MAge = 43.63, n = 10 women) with a primary diagnosis of PTSD passively viewed pictures of emotional facial expressions during functional magnetic resonance imaging (fMRI). After scanning, participants rated facial expressions on both valence and arousal. Participants then completed eight weekly sessions of prolonged exposure (PE) therapy. PTSD symptom severity was measured before and after treatment. Overall, participants showed symptomatic improvement with PE. Consistent with hypotheses, lesser activation in the amygdala and greater activation in the ventromedial prefrontal cortex during the presentation of fearful vs. happy facial expressions, as well as a greater decline in amygdala activation across blocks of fearful facial expressions at baseline, were associated with greater reduction of PTSD symptoms. Given that the repeated presentation of emotional material underlies PE, changes in brain responses with repeated stimulus presentations warrant further studies as potential predictors of response to exposure therapies.
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Affiliation(s)
- Cecilia A. Hinojosa
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, United States
| | - Michael B. VanElzakker
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Navneet Kaur
- Department of Cancer Biology, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Julia M. Felicione
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
- Department of Psychology, Tufts University, Medford, MA, United States
| | - Meredith E. Charney
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Eric Bui
- Normandie Univ, University of Caen Normandy (UNICAEN), L'Institut national de la santé et de la recherche médicale (INSERM), U1237, PhIND “Physiopathology and Imaging of Neurological Disorders”, NEUROPRESAGE Team, (Institut Blood and Brain @ Caen-Normandie), GIP Cyceron, Caen, France
- Centre Hospitalier Universitaire Caen Normandie, Caen, France
| | - Luana Marques
- Department of Psychiatry, Massachusetts General Hospital, Center for Anxiety and Traumatic Stress Disorders, Boston, MA, United States
| | - Paul Summergrad
- Department of Psychiatry, Tufts University School of Medicine, Boston, MA, United States
| | - Scott L. Rauch
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
- Institute for Technology in Psychiatry, McLean Hospital, Belmont, MA, United States
- Department of Psychiatry, McLean Hospital, Belmont, MA, United States
| | - Naomi M. Simon
- Department of Psychiatry, New York University (NYU) Grossman School of Medicine, New York, NY, United States
| | - Lisa M. Shin
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
- Department of Psychology, Tufts University, Medford, MA, United States
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Gottfredson RK, Becker WJ. How past trauma impacts emotional intelligence: Examining the connection. Front Psychol 2023; 14:1067509. [PMID: 37275697 PMCID: PMC10234103 DOI: 10.3389/fpsyg.2023.1067509] [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: 10/11/2022] [Accepted: 05/02/2023] [Indexed: 06/07/2023] Open
Abstract
Backed by both research and practice, the organizational psychology field has come to value emotional intelligence (EI) as being vital for leader and employee effectiveness. While this field values EI, it has paid little attention to the antecedents of emotional intelligence, leaving the EI domain without clarity on (1) why EI might vary across individuals, and (2) how to best develop EI. In this article, we rely on neuroscience and psychology research to make the case that past psychological trauma impacts later EI capabilities. Specifically, we present evidence that psychological trauma impairs the brain areas and functions that support EI. Establishing psychological trauma has valuable theoretical and practical implications that include providing an explanation of why EI might vary across individuals and providing a focus for improving EI: healing from past trauma. Further theoretical and practical implications for the field of organizational psychology are provided.
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Affiliation(s)
- Ryan K Gottfredson
- Department of Management, College of Business and Economics, California State University, Fullerton, CA, United States
| | - William J Becker
- Department of Management, Pamplin College of Business, Virginia Tech, Blacksburg, VA, United States
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8
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White LK, Makhoul W, Teferi M, Sheline YI, Balderston NL. The role of dlPFC laterality in the expression and regulation of anxiety. Neuropharmacology 2023; 224:109355. [PMID: 36442650 PMCID: PMC9790039 DOI: 10.1016/j.neuropharm.2022.109355] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 11/07/2022] [Accepted: 11/23/2022] [Indexed: 11/27/2022]
Abstract
Anxiety disorders are the most common mental health disorder. Therefore, elucidating brain mechanisms implicated in anxiety disorders is important avenue for developing novel treatments and improving care. The dorsolateral prefrontal cortex (dlPFC) is thought to be critically involved in working memory processes (i.e. maintenance, manipulation, suppression, etc.). In addition, there is evidence that this region is involved in anxiety regulation. However, it is unclear how working memory related dlPFC processes contribute to anxiety regulation. Furthermore, we know that laterality plays an important role in working memory related dlPFC processing, however there is no current model of dlPFC mediated anxiety regulation that accounts for potential laterality effects. To address this gap, we propose a potential framework where the dlPFC contributes to emotion regulation via working memory processing. According to this framework, working memory is a fundamental process executed by the dlPFC. However, the domain of content differs across the left and right dlPFC, with the left dlPFC sensitive to primarily verbal content, and the right dlPFC sensitive to primarily non-verbal (affective content). Critically, working memory processes allow for both the retention and suppression of affective information in working memory and the overall net effect of processing on mood will depend on the balance of retention and suppression, the valence of the information being processed (positive vs. negative), and the domain of the information (verbal vs. non-verbal). If accurate, the proposed framework predicts that effects of neuromodulation targeting the dlPFC may be dependent upon the context during which the stimulation is presented. This article is part of the Special Issue on 'Fear, Anxiety and PTSD'.
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Affiliation(s)
- Lauren K White
- Lifespan Brain Institute Children's Hospital of Philadelphia and Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Walid Makhoul
- Center for Neuromodulation in Depression and Stress Department of Psychiatry University of Pennsylvania, Philadelphia, PA, USA
| | - Marta Teferi
- Center for Neuromodulation in Depression and Stress Department of Psychiatry University of Pennsylvania, Philadelphia, PA, USA
| | - Yvette I Sheline
- Center for Neuromodulation in Depression and Stress Department of Psychiatry University of Pennsylvania, Philadelphia, PA, USA
| | - Nicholas L Balderston
- Center for Neuromodulation in Depression and Stress Department of Psychiatry University of Pennsylvania, Philadelphia, PA, USA.
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Brewerton TD. Mechanisms by which adverse childhood experiences, other traumas and PTSD influence the health and well-being of individuals with eating disorders throughout the life span. J Eat Disord 2022; 10:162. [PMID: 36372878 PMCID: PMC9661783 DOI: 10.1186/s40337-022-00696-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 11/09/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Multiple published sources from around the world have confirmed an association between an array of adverse childhood experiences (ACEs) and other traumatic events with eating disorders (EDs) and related adverse outcomes, including higher morbidity and mortality. METHODS In keeping with this Special Issue's goals, this narrative review focuses on the ACEs pyramid and its purported mechanisms through which child maltreatment and other forms of violence toward human beings influence the health and well-being of individuals who develop EDs throughout the life span. Relevant literature on posttraumatic stress disorder (PTSD) is highlighted when applicable. RESULTS At every level of the pyramid, it is shown that EDs interact with each of these proclaimed escalating mechanisms in a bidirectional manner that contributes to the predisposition, precipitation and perpetuation of EDs and related medical and psychiatric comorbidities, which then predispose to early death. The levels and their interactions that are discussed include the contribution of generational embodiment (genetics) and historical trauma (epigenetics), social conditions and local context, the ACEs and other traumas themselves, the resultant disrupted neurodevelopment, subsequent social, emotional and cognitive impairment, the adoption of health risk behaviors, and the development of disease, disability and social problems, all resulting in premature mortality by means of fatal complications and/or suicide. CONCLUSIONS The implications of these cascading, evolving, and intertwined perspectives have important implications for the assessment and treatment of EDs using trauma-informed care and trauma-focused integrated treatment approaches. This overview offers multiple opportunities at every level for the palliation and prevention of EDs and other associated trauma-related conditions, including PTSD.
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Affiliation(s)
- Timothy D Brewerton
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA.
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10
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Leroy A, Very E, Birmes P, Yger P, Szaffarczyk S, Lopes R, Outteryck O, Faure C, Duhem S, Grandgenèvre P, Warembourg F, Vaiva G, Jardri R. Intrusive experiences in posttraumatic stress disorder: Treatment response induces changes in the directed functional connectivity of the anterior insula. Neuroimage Clin 2022; 34:102964. [PMID: 35189456 PMCID: PMC8861823 DOI: 10.1016/j.nicl.2022.102964] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 01/27/2022] [Accepted: 02/08/2022] [Indexed: 11/18/2022]
Abstract
Many causal paths were less influenced by the AI after effective therapy for PTSD. Insular influences over the rest of the brain were found to be positively correlated with re-experiencing. Re-experiencing was linked with changes in intrinsic networks’ spatial stability after treatment.
Background One of the core features of posttraumatic stress disorder (PTSD) is re-experiencing trauma. The anterior insula (AI) has been proposed to play a crucial role in these intrusive experiences. However, the dynamic function of the AI in re-experiencing trauma and its putative modulation by effective therapy need to be specified. Methods Thirty PTSD patients were enrolled and exposed to traumatic memory reactivation therapy. Resting-state functional magnetic resonance imaging (fMRI) scans were acquired before and after treatment. To explore AI-directed influences over the rest of the brain, we referred to a mixed model using pre-/posttreatment Granger causality analysis seeded on the AI as a within-subject factor and treatment response as a between-subject factor. To further identify correlates of re-experiencing trauma, we investigated how intrusive severity affected (i) causality maps and (ii) the spatial stability of other intrinsic brain networks. Results We observed changes in AI-directed functional connectivity patterns in PTSD patients. Many within- and between-network causal paths were found to be less influenced by the AI after effective therapy. Insular influences were found to be positively correlated with re-experiencing symptoms, while they were linked with a stronger default mode network (DMN) and more unstable central executive network (CEN) connectivity. Conclusion We showed that directed changes in AI signaling to the DMN and CEN at rest may underlie the degree of re-experiencing symptoms in PTSD. A positive response to treatment further induced changes in network-to-network anticorrelated patterns. Such findings may guide targeted neuromodulation strategies in PTSD patients not suitably improved by conventional treatment.
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Affiliation(s)
- Arnaud Leroy
- Univ Lille, INSERM, CHU Lille, Lille Neuroscience & Cognition Centre (U-1172), Plasticity & SubjectivitY Team, CURE Platform, 59000 Lille, France; CHU Lille, Fontan Hospital, General Psychiatry Dpt., 59037 Lille Cedex, France; Centre National de Ressources et Résilience pour les psychotraumatismes (CN2R Lille - Paris), 59000 Lille, France.
| | - Etienne Very
- CHU Toulouse, Purpan Hospital, Psychiatry Department, 31059 Toulouse Cedex, France; ToNIC, Toulouse NeuroImaging Center, INSERM U-1214, UPS, France
| | - Philippe Birmes
- ToNIC, Toulouse NeuroImaging Center, INSERM U-1214, UPS, France
| | - Pierre Yger
- Univ Lille, INSERM, CHU Lille, Lille Neuroscience & Cognition Centre (U-1172), Plasticity & SubjectivitY Team, CURE Platform, 59000 Lille, France; Institut de la Vision, Sorbonne Université, Inserm S968, CNRS UMR7210, Paris, France
| | - Sébastien Szaffarczyk
- Univ Lille, INSERM, CHU Lille, Lille Neuroscience & Cognition Centre (U-1172), Plasticity & SubjectivitY Team, CURE Platform, 59000 Lille, France
| | - Renaud Lopes
- Univ Lille, INSERM, CHU Lille, Lille Neuroscience & Cognition Centre (U-1772), Degenerative & Vascular Cognitive Disorders Team, 59000 Lille, France; Univ Lille, CNRS, INSERM, CHU Lille, Institut Pasteur de Lille, US 41 - UMS 2014 - PLBS, 59000 Lille, France
| | - Olivier Outteryck
- Univ Lille, INSERM, CHU Lille, Lille Neuroscience & Cognition Centre (U-1772), Degenerative & Vascular Cognitive Disorders Team, 59000 Lille, France; CHU Lille, Department of Neuroradiology, Roger Salengro Hospital, 59037 Lille Cedex, France
| | - Cécile Faure
- Univ Lille, INSERM, CHU Lille, Lille Neuroscience & Cognition Centre (U-1172), Plasticity & SubjectivitY Team, CURE Platform, 59000 Lille, France
| | - Stéphane Duhem
- CHU Lille, Fontan Hospital, General Psychiatry Dpt., 59037 Lille Cedex, France; Centre National de Ressources et Résilience pour les psychotraumatismes (CN2R Lille - Paris), 59000 Lille, France; Université de Lille, Inserm, CHU Lille, CIC 1403 - Clinical Investigation Center, 59000 Lille, France
| | - Pierre Grandgenèvre
- Univ Lille, INSERM, CHU Lille, Lille Neuroscience & Cognition Centre (U-1172), Plasticity & SubjectivitY Team, CURE Platform, 59000 Lille, France; CHU Lille, Fontan Hospital, General Psychiatry Dpt., 59037 Lille Cedex, France
| | | | - Guillaume Vaiva
- Univ Lille, INSERM, CHU Lille, Lille Neuroscience & Cognition Centre (U-1172), Plasticity & SubjectivitY Team, CURE Platform, 59000 Lille, France; CHU Lille, Fontan Hospital, General Psychiatry Dpt., 59037 Lille Cedex, France; Centre National de Ressources et Résilience pour les psychotraumatismes (CN2R Lille - Paris), 59000 Lille, France
| | - Renaud Jardri
- Univ Lille, INSERM, CHU Lille, Lille Neuroscience & Cognition Centre (U-1172), Plasticity & SubjectivitY Team, CURE Platform, 59000 Lille, France; CHU Lille, Fontan Hospital, Child & Adolescent Psychiatry Dpt., 59037 Lille Cedex, France
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11
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Rauch SA, Kim HM, Venners MR, Porter K, Norman SB, Simon NM, Rothbaum BO, Tuerk PW, Acierno R, Bui E, Powell C, Smith ER, Goetter E, McSweeney L. Change in posttraumatic stress disorder-related thoughts during treatment: Do thoughts drive change when pills are involved? J Trauma Stress 2022; 35:496-507. [PMID: 34973039 PMCID: PMC9446312 DOI: 10.1002/jts.22762] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 08/16/2021] [Accepted: 08/28/2021] [Indexed: 11/09/2022]
Abstract
Posttraumatic negative thoughts about one's self and the world are related to posttraumatic stress disorder (PTSD) symptom severity and change in cognitive behavioral treatment (CBT), but little is known about this association when CBT is delivered with medication. The current study presents a planned comparison of changes in negative posttraumatic thoughts during (a) prolonged exposure (PE) plus pill placebo (PE+PLB), (b) sertraline plus enhanced medication management (SERT+EMM), and (c) PE plus sertraline (PE+SERT) as part of a randomized clinical trial in a sample of 176 veterans. Lagged regression modeling revealed that change in posttraumatic negative thoughts was associated with PTSD symptom change in the conditions in which participants received sertraline, ds = 0.14-0.25, ps = 0.04-.001). However, contrary to previous research, the models that started with symptom change were also statistically significant, d = 0.23, p < .001, for the lagged effect of symptoms on negative thoughts about self in the SERT+EMM condition, indicating a bidirectional association between such thoughts and PTSD symptoms. In the PE+PLB condition, no significant association between posttraumatic thoughts and PTSD symptoms emerged in either direction. These results suggest that the previously demonstrated role of change in posttraumatic thoughts leading to PTSD symptom reduction in PE may be altered when combined with pill administration, either active or placebo.
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Affiliation(s)
- Sheila A.M. Rauch
- Atlanta VA Medical Center, 1670 Clairmont Road, Decatur, GA, 30033,Emory University School of Medicine, 12 Executive Park, 3 Floor, Atlanta, GA, 30029
| | - H. Myra Kim
- VA Ann Arbor Healthcare System, 2215 Fuller Road, Ann Arbor, MI, 48105,University of Michigan, Consulting for Statistics, Computing and Analytics Research, 3550 Rackham, 950 E. Washington Street, Ann Arbor, MI, 48109
| | | | - Katherine Porter
- VA Ann Arbor Healthcare System, 2215 Fuller Road, Ann Arbor, MI, 48105,University of Michigan, Department of Psychiatry, 4250 Plymouth Road, Ann Arbor, MI, 48109
| | - Sonya B. Norman
- National Center for PTSD, 215 N. Main Street, White River Junction, VT 05009,VA Center of Excellence for Stress and Mental Health, 3350 La Jolla Village Drive, MC116B, San Diego, CA 92161,University of California, San Diego, School of Medicine, 9500 Gilman Drive, La Jolla, CA 92037
| | - Naomi M. Simon
- Massachusetts General Hospital, Department of Psychiatry, One Bowdoin Square, 6th Floor, Boston, MA 02114,New York University Medical School, Department of Psychiatry, One Park Avenue 8 Floor, New York NY 10016
| | - Barbara O. Rothbaum
- Emory University School of Medicine, 12 Executive Park, 3 Floor, Atlanta, GA, 30029
| | - Peter W. Tuerk
- University of Virginia, Department of Human Services, 417 Emmet St. South, PO Box 400270, Charlottesville, VA 22903
| | - Ron Acierno
- Ralph H. Johnson VA Medical Center, 109 Bee Street, Charleston, SC, 29401,Medical University of South Carolina, College of Nursing, Jonathan Lucas Street, Charleston, SC 29425
| | - Eric Bui
- Massachusetts General Hospital, Department of Psychiatry, One Bowdoin Square, 6th Floor, Boston, MA 02114,University of Caen Normandy & Caen University Hospital, avenue de la Côte de Nacre, 14000 Caen, France
| | - Corey Powell
- University of Michigan, Consulting for Statistics, Computing and Analytics Research, 3550 Rackham, 950 E. Washington Street, Ann Arbor, MI, 48109
| | - Erin R. Smith
- VA Ann Arbor Healthcare System, 2215 Fuller Road, Ann Arbor, MI, 48105,University of Michigan, Department of Psychiatry, 4250 Plymouth Road, Ann Arbor, MI, 48109
| | - Elizabeth Goetter
- Massachusetts General Hospital, Department of Psychiatry, One Bowdoin Square, 6th Floor, Boston, MA 02114,Harvard Medical School, Department of Psychiatry, 25 Shattuck Street, Boston, MA 02115
| | - Lauren McSweeney
- Emory University School of Medicine, 12 Executive Park, 3 Floor, Atlanta, GA, 30029
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12
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Zhutovsky P, Zantvoord JB, Ensink JBM, Op den Kelder R, Lindauer RJL, van Wingen GA. Individual prediction of trauma-focused psychotherapy response in youth with posttraumatic stress disorder using resting-state functional connectivity. Neuroimage Clin 2022; 32:102898. [PMID: 34911201 PMCID: PMC8645516 DOI: 10.1016/j.nicl.2021.102898] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 11/15/2021] [Accepted: 11/23/2021] [Indexed: 01/23/2023]
Abstract
ML and rs-fMRI have shown promise in predicting treatment-response in adults with PTSD. Currently, no biomarkers for treatment-response are available in youth with PTSD. FC between the FPN and SMN was stronger in treatment non-responders on the group-level. A network within the bilateral STG predicted response for individual youth with 76% accuracy. Future studies should test generalizability of these findings and test if larger cohorts increase accuracy.
Randomized controlled trials have shown efficacy of trauma-focused psychotherapies in youth with posttraumatic stress disorder (PTSD). However, response varies considerably among individuals. Currently, no biomarkers are available to assist clinicians in identifying youth who are most likely to benefit from treatment. In this study, we investigated whether resting-state functional magnetic resonance imaging (rs-fMRI) could distinguish between responders and non-responders on the group- and individual patient level. Pre-treatment rs-fMRI was recorded in 40 youth (ages 8–17 years) with (partial) PTSD before trauma-focused psychotherapy. Change in symptom severity from pre- to post-treatment was assessed using the Clinician-Administered PTSD scale for Children and Adolescents to divide participants into responders (≥30% symptom reduction) and non-responders. Functional networks were identified using meta-independent component analysis. Group-differences within- and between-network connectivity between responders and non-responders were tested using permutation testing. Individual predictions were made using multivariate, cross-validated support vector machine classification. A network centered on the bilateral superior temporal gyrus predicted treatment response for individual patients with 76% accuracy (pFWE = 0.02, 87% sensitivity, 65% specificity, area-under-receiver-operator-curve of 0.82). Functional connectivity between the frontoparietal and sensorimotor network was significantly stronger in non-responders (t = 5.35, pFWE = 0.01) on the group-level. Within-network connectivity was not significantly different between groups. This study provides proof-of-concept evidence for the feasibility to predict trauma-focused psychotherapy response in youth with PTSD at an individual-level. Future studies are required to test if larger cohorts could increase accuracy and to test further generalizability of the prediction models.
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Affiliation(s)
- Paul Zhutovsky
- Amsterdam UMC, University of Amsterdam, Department of Psychiatry, Amsterdam Neuroscience, Amsterdam, The Netherlands.
| | - Jasper B Zantvoord
- Amsterdam UMC, University of Amsterdam, Department of Psychiatry, Amsterdam Neuroscience, Amsterdam, The Netherlands; Amsterdam UMC, University of Amsterdam, Department of Child and Adolescent Psychiatry, Amsterdam Neuroscience, Amsterdam, The Netherlands.
| | - Judith B M Ensink
- Amsterdam UMC, University of Amsterdam, Department of Child and Adolescent Psychiatry, Amsterdam Neuroscience, Amsterdam, The Netherlands; Levvel, Academic Centre for Child and Adolescent Psychiatry, Amsterdam, The Netherlands.
| | - Rosanne Op den Kelder
- Levvel, Academic Centre for Child and Adolescent Psychiatry, Amsterdam, The Netherlands; Research Institute of Child Development and Education, University of Amsterdam, Amsterdam, The Netherlands.
| | - Ramon J L Lindauer
- Amsterdam UMC, University of Amsterdam, Department of Child and Adolescent Psychiatry, Amsterdam Neuroscience, Amsterdam, The Netherlands; Levvel, Academic Centre for Child and Adolescent Psychiatry, Amsterdam, The Netherlands.
| | - Guido A van Wingen
- Amsterdam UMC, University of Amsterdam, Department of Psychiatry, Amsterdam Neuroscience, Amsterdam, The Netherlands.
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13
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Edinoff AN, Hegefeld TL, Petersen M, Patterson JC, Yossi C, Slizewski J, Osumi A, Cornett EM, Kaye A, Kaye JS, Javalkar V, Viswanath O, Urits I, Kaye AD. Transcranial Magnetic Stimulation for Post-traumatic Stress Disorder. Front Psychiatry 2022; 13:701348. [PMID: 35711594 PMCID: PMC9193572 DOI: 10.3389/fpsyt.2022.701348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 05/13/2022] [Indexed: 11/17/2022] Open
Abstract
Post-traumatic stress disorder (PTSD) is a psychiatric disorder that causes significant functional impairment and is related to altered stress response and reinforced learned fear behavior. PTSD has been found to impact three functional networks in the brain: default mode, executive control, and salience. The executive control network includes the dorsolateral prefrontal cortex (DLPFC) and lateral PPC. The salience network involves the anterior cingulate cortex, anterior insula, and amygdala. This latter network has been found to have increased functional connectivity in PTSD. Transcranial Magnetic Stimulation (TMS) is a technique used in treating PTSD and involves stimulating specific portions of the brain through electromagnetic induction. Currently, high-frequency TMS applied to the left dorsolateral prefrontal cortex (DLPFC) is approved for use in treating major depressive disorder (MDD) in patients who have failed at least one medication trial. In current studies, high-frequency stimulation has been shown to be more effective in PTSD rating scales posttreatment than low-frequency stimulation. The most common side effect is headache and scalp pain treated by mild analgesics. Seizures are a rare side effect and are usually due to predisposing factors. Studies have been done to assess the overall efficacy of TMS. However, results have been conflicting, and sample sizes were small. More research should be done with larger sample sizes to test the efficacy of TMS in the treatment of PTSD. Overall, TMS is a relatively safe treatment. Currently, the only FDA- approved to treat refractory depression, but with the potential to treat many other conditions.
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Affiliation(s)
- Amber N Edinoff
- Department of Psychiatry and Behavioral Medicine, Louisiana State University Health Science Center Shreveport, Shreveport, LA, United States
| | - Tanner L Hegefeld
- Department of Psychiatry and Behavioral Medicine, Louisiana State University Health Science Center Shreveport, Shreveport, LA, United States
| | - Murray Petersen
- Department of Psychiatry and Behavioral Medicine, Louisiana State University Health Science Center Shreveport, Shreveport, LA, United States
| | - James C Patterson
- Department of Psychiatry and Behavioral Medicine, Louisiana State University Health Science Center Shreveport, Shreveport, LA, United States
| | | | - Jacob Slizewski
- Creighton University School of Medicine, Omaha, NE, United States
| | - Ashley Osumi
- Creighton University School of Medicine, Omaha, NE, United States
| | - Elyse M Cornett
- Department of Anesthesiology, Louisiana State University Shreveport, Shreveport, LA, United States
| | - Adam Kaye
- Department of Pharmacy Practice, Thomas J. Long School of Pharmacy and Health Sciences, University of the Pacific, Stockton, CA, United States
| | - Jessica S Kaye
- Department of Pharmacy Practice, Thomas J. Long School of Pharmacy and Health Sciences, University of the Pacific, Stockton, CA, United States
| | - Vijayakumar Javalkar
- Department of Neurology, Louisiana State University Shreveport, Shreveport, LA, United States
| | - Omar Viswanath
- College of Medicine-Phoenix, University of Arizona, Phoenix, AZ, United States.,Department of Anesthesiology, Creighton University School of Medicine, Omaha, NE, United States.,Valley Anesthesiology and Pain Consultants-Envision Physician Services, Phoenix, AZ, United States
| | - Ivan Urits
- Department of Anesthesiology, Louisiana State University Shreveport, Shreveport, LA, United States.,Southcoast Health, Southcoast Physicians Group Pain Medicine, Wareham, MA, United States
| | - Alan D Kaye
- Department of Anesthesiology, Louisiana State University Shreveport, Shreveport, LA, United States
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14
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van Rooij SJ, Sippel LM, McDonald WM, Holtzheimer PE. Defining focal brain stimulation targets for PTSD using neuroimaging. Depress Anxiety 2021; 38:10.1002/da.23159. [PMID: 33876868 PMCID: PMC8526638 DOI: 10.1002/da.23159] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 03/17/2021] [Accepted: 04/02/2021] [Indexed: 02/02/2023] Open
Abstract
INTRODUCTION Focal brain stimulation has potential as a treatment for posttraumatic stress disorder (PTSD). In this review, we aim to inform selection of focal brain stimulation targets for treating PTSD by examining studies of the functional neuroanatomy of PTSD and treatment response. We first briefly review data on brain stimulation interventions for PTSD. Although published data suggest good efficacy overall, the neurobiological rationale for each stimulation target is not always clear. METHODS Therefore, we assess pre- and post-treatment (predominantly psychotherapy) functional neuroimaging studies in PTSD to determine which brain changes seem critical to treatment response. Results of these studies are presented within a previously proposed functional neural systems model of PTSD. RESULTS While not completely consistent, research suggests that downregulating the fear learning and threat and salience detection circuits (i.e., amygdala, dorsal anterior cingulate cortex and insula) and upregulating the emotion regulation and executive function and contextual processing circuits (i.e., prefrontal cortical regions and hippocampus) may mediate PTSD treatment response. CONCLUSION This literature review provides some justification for current focal brain stimulation targets. However, the examination of treatment effects on neural networks is limited, and studies that include the stimulation targets are lacking. Further, additional targets, such as the cingulate, medial prefrontal cortex, and inferior parietal lobe, may also be worth investigation, especially when considering how to achieve network level changes. Additional research combining PTSD treatment with functional neuroimaging will help move the field forward by identifying and validating novel targets, providing better rationale for specific treatment parameters and personalizing treatment for PTSD.
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Affiliation(s)
- Sanne J.H. van Rooij
- Emory University School of Medicine, Department of Psychiatry and Behavioral Sciences, Atlanta, GA
| | - Lauren M. Sippel
- National Center for PTSD, U.S. Department of Veterans Affairs, White River Junction, VT
- Geisel School of Medicine at Dartmouth, Hanover, NH
| | - William M. McDonald
- Emory University School of Medicine, Department of Psychiatry and Behavioral Sciences, Atlanta, GA
| | - Paul E. Holtzheimer
- National Center for PTSD, U.S. Department of Veterans Affairs, White River Junction, VT
- Geisel School of Medicine at Dartmouth, Hanover, NH
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15
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Franceschi Biagioni A, Cellot G, Pati E, Lozano N, Ballesteros B, Casani R, Coimbra NC, Kostarelos K, Ballerini L. Graphene oxide prevents lateral amygdala dysfunctional synaptic plasticity and reverts long lasting anxiety behavior in rats. Biomaterials 2021; 271:120749. [PMID: 33714913 DOI: 10.1016/j.biomaterials.2021.120749] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 02/23/2021] [Accepted: 02/27/2021] [Indexed: 12/19/2022]
Abstract
Engineered small graphene oxide (s-GO) sheets were previously shown to reversibly down-regulate glutamatergic synapses in the hippocampus of juvenile rats, disclosing an unexpected translational potential of these nanomaterials to target selective synapses in vivo. Synapses are anatomical specializations acting in the Central Nervous System (CNS) as functional interfaces among neurons. Dynamic changes in synaptic function, named synaptic plasticity, are crucial to learning and memory. More recently, pathological mechanisms involving dysfunctional synaptic plasticity were implicated in several brain diseases, from dementia to anxiety disorders. Hyper-excitability of glutamatergic neurons in the lateral nucleus of the amygdala complex (LA) is substantially involved in the storage of aversive memory induced by stressful events enabling post-traumatic stress disorder (PTSD). Here we translated in PTSD animal model the ability of s-GO, when stereotaxically administered to hamper LA glutamatergic transmission and to prevent the behavioral response featured in long-term aversive memory. We propose that s-GO, by interference with glutamatergic plasticity, impair LA-dependent memory retrieval related to PTSD.
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Affiliation(s)
- Audrey Franceschi Biagioni
- Neuron Physiology and Technology Lab, International School for Advanced Studies (SISSA), Neuroscience, Via Bonomea 265, 34136, Trieste, Italy
| | - Giada Cellot
- Neuron Physiology and Technology Lab, International School for Advanced Studies (SISSA), Neuroscience, Via Bonomea 265, 34136, Trieste, Italy
| | - Elisa Pati
- Neuron Physiology and Technology Lab, International School for Advanced Studies (SISSA), Neuroscience, Via Bonomea 265, 34136, Trieste, Italy
| | - Neus Lozano
- Catalan Institute of Nanoscience and Nanotechnology (ICN2), CSIC and BIST, Campus UAB, Bellaterra, 08193, Barcelona, Spain
| | - Belén Ballesteros
- Catalan Institute of Nanoscience and Nanotechnology (ICN2), CSIC and BIST, Campus UAB, Bellaterra, 08193, Barcelona, Spain
| | - Raffaele Casani
- Neuron Physiology and Technology Lab, International School for Advanced Studies (SISSA), Neuroscience, Via Bonomea 265, 34136, Trieste, Italy
| | - Norberto Cysne Coimbra
- Laboratory of Neuroanatomy & Neuropsychobiology, Department of Pharmacology, Ribeirão Preto Medical School of the University of São Paulo (FMRP-USP), Av. Bandeirantes 3900, 14049-900, Ribeirão Preto, SP, Brazil
| | - Kostas Kostarelos
- Catalan Institute of Nanoscience and Nanotechnology (ICN2), CSIC and BIST, Campus UAB, Bellaterra, 08193, Barcelona, Spain; Nanomedicine Lab, National Graphene Institute and Faculty of Biology, Medicine & Health, The University of Manchester, AV Hill Building, Oxford Rd, Manchester, M13 9PL, United Kingdom
| | - Laura Ballerini
- Neuron Physiology and Technology Lab, International School for Advanced Studies (SISSA), Neuroscience, Via Bonomea 265, 34136, Trieste, Italy.
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16
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Elman I, Upadhyay J, Lowen S, Karunakaran K, Albanese M, Borsook D. Mechanisms Underlying Unconscious Processing and Their Alterations in Post-traumatic Stress Disorder: Neuroimaging of Zero Monetary Outcomes Contextually Framed as "No Losses" vs. "No Gains". Front Neurosci 2020; 14:604867. [PMID: 33390889 PMCID: PMC7772193 DOI: 10.3389/fnins.2020.604867] [Citation(s) in RCA: 4] [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: 09/10/2020] [Accepted: 11/24/2020] [Indexed: 11/26/2022] Open
Abstract
Although unconscious processing is a key element of mental operation, its neural correlates have not been established. Also, clinical observations suggest that unconscious processing may be involved in the pathophysiology of post-traumatic stress disorder (PTSD), but the neurobiological mechanisms underlying such impairments remain unknown. The purpose of the present study was to examine putative mechanisms underlying unconscious processing by healthy participants and to determine whether these mechanisms may be altered in PTSD patients. Twenty patients with PTSD and 27 healthy individuals were administered a validated wheel of fortune-type gambling task during functional magnetic resonance imaging (fMRI). Unconscious processing was elicited using unconscious contextual framing of the zero monetary outcomes as "no loss," "no gain" or as "neutral." Brief passive visual processing of the "no loss" vs. "no gain" contrast by healthy participants yielded bilateral frontal-, temporal- and insular cortices and striatal activations. Between-group comparison revealed smaller activity in the left anterior prefrontal-, left dorsolateral prefrontal-, right temporal- and right insular cortices and in bilateral striatum in PTSD patients with the left dorsolateral prefrontal cortex activity been more pronounced in those with greater PTSD severity. These observations implicate frontal-, temporal-, and insular cortices along with the striatum in the putative mechanisms underlying unconscious processing of the monetary outcomes. Additionally, our results support the hypothesis that PTSD is associated with primary cortical and subcortical alterations involved in the above processes and that these alterations may be related to some aspects of PTSD symptomatology.
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Affiliation(s)
- Igor Elman
- Center for Pain and the Brain, Department of Anesthesiology, Boston Children’s Hospital, Harvard Medical School, Boston, MA, United States
- Cambridge Health Alliance, Harvard Medical School, Cambridge, MA, United States
| | - Jaymin Upadhyay
- Center for Pain and the Brain, Department of Anesthesiology, Boston Children’s Hospital, Harvard Medical School, Boston, MA, United States
- Department of Psychiatry, McLean Hospital, Harvard Medical School, Belmont, MA, United States
| | | | - Keerthana Karunakaran
- Center for Pain and the Brain, Department of Anesthesiology, Boston Children’s Hospital, Harvard Medical School, Boston, MA, United States
| | - Mark Albanese
- Cambridge Health Alliance, Harvard Medical School, Cambridge, MA, United States
| | - David Borsook
- Center for Pain and the Brain, Department of Anesthesiology, Boston Children’s Hospital, Harvard Medical School, Boston, MA, United States
- Department of Psychiatry, McLean Hospital, Harvard Medical School, Belmont, MA, United States
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Harlé KM, Simmons AN, Norman SB, Spadoni AD. Neural affective mechanisms associated with treatment responsiveness in veterans with PTSD and comorbid alcohol use disorder. Psychiatry Res Neuroimaging 2020; 305:111172. [PMID: 32927371 PMCID: PMC8486287 DOI: 10.1016/j.pscychresns.2020.111172] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 08/16/2020] [Accepted: 08/19/2020] [Indexed: 10/23/2022]
Abstract
Post-traumatic stress disorder (PTSD) is associated with neuro-physiological abnormalities reflecting increased anticipatory anxiety and reactivity to traumatic cues. It remains unclear whether neural mechanisms associated with PTSD treatment responsiveness, i.e. hyperactivation of the affective salience network in the brain, extend to a comorbid PTSD and substance use disorder population. Thirty-one Veterans with PTSD and co-occurring alcohol use disorder (AUD) were randomly assigned to either prolonged exposure or a non-exposure based treatment. They completed an affective anticipation task while undergoing fMRI, immediately prior and after completing treatment. After controlling for type and length of treatment, larger reduction of PTSD symptoms was associated with decreased anticipatory activation to negative trauma-related cues in the right pre-Supplementary Motor Area (pre-SMA), a region associated with emotion regulation. Smaller reduction in PTSD severity was associated with enhanced anticipatory activation to those cues within the right para-hippocampal region, an affective processing region. Our findings suggest that post-treatment reductions in anticipatory reactivity to trauma-related cues in the pre-SMA and para-hippocampal area are associated with larger PTSD symptom reduction in individuals with co-occurring PTSD and AUD. These results may offer neurofeedback training targets as an alternative to or enhancement of other PTSD treatment modalities in this population.
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Affiliation(s)
- Katia M Harlé
- VA San Diego Healthcare System, San Diego, CA, United States; Department of Psychiatry, University of California San Diego, La Jolla, CA, United States.
| | - Alan N Simmons
- VA San Diego Healthcare System, San Diego, CA, United States; Department of Psychiatry, University of California San Diego, La Jolla, CA, United States
| | - Sonya B Norman
- VA San Diego Healthcare System, San Diego, CA, United States; Department of Psychiatry, University of California San Diego, La Jolla, CA, United States
| | - Andrea D Spadoni
- VA San Diego Healthcare System, San Diego, CA, United States; Department of Psychiatry, University of California San Diego, La Jolla, CA, United States
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Sheynin J, Duval ER, King AP, Angstadt M, Phan KL, Simon NM, Rauch SAM, Liberzon I. Associations between resting-state functional connectivity and treatment response in a randomized clinical trial for posttraumatic stress disorder. Depress Anxiety 2020; 37:1037-1046. [PMID: 32668087 PMCID: PMC7722156 DOI: 10.1002/da.23075] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 05/04/2020] [Accepted: 06/13/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Alterations in resting-state functional connectivity (rsFC) have been reported in posttraumatic stress disorder (PTSD). Here, we examined pre- and post-treatment rsFC during a randomized clinical trial to characterize alterations and examine predictors of treatment response. METHODS Sixty-four combat veterans with PTSD were randomly assigned to prolonged exposure (PE) plus placebo, sertraline plus enhanced medication management, or PE plus sertraline. Symptom assessment and resting-state functional magnetic resonance imaging (fMRI) scans occurred before and after treatment. Twenty-nine trauma-exposed combat veterans without PTSD served as a control group at intake. Seed-based and region of interest (ROI)-to-ROI connectivities, as well as an exploratory connectome-based approach were used to analyze rsFC patterns. Based on previously reported findings, analyses focused on Salience Network (SN) and Default-Mode Network (DMN). RESULTS At intake, patients with PTSD showed greater DMN-dorsal attention network (DAN) connectivity (between ventromedial prefrontal cortex and superior parietal lobule; family-wise error corrected p = .011), greater SN-DAN connectivity (between insula and middle frontal gyrus; corrected p = .003), and a negative correlation between re-experiencing symptoms and within-DMN connectivity (between posterior cingulate cortex (PCC) and middle temporal gyrus; corrected p < .001). We also found preliminary evidence for associations between rsFC and treatment response. Specifically, high responders (≥50% PTSD symptom improvement), compared with low responders, had greater SN-DMN segregation (i.e., less pre-treatment amygdala-PCC connectivity; p = .011) and lower pre-treatment global centrality (p = .042). CONCLUSIONS Our findings suggest neural abnormalities in PTSD and may inform future research examining neural biomarkers of PTSD treatment response.
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Affiliation(s)
- Jony Sheynin
- Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI, USA
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Elizabeth R. Duval
- Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI, USA
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Anthony P. King
- Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI, USA
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Mike Angstadt
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - K. Luan Phan
- Department of Psychiatry and Behavioral Health, The Ohio State University, Columbus, OH, USA
| | - Naomi M. Simon
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychiatry, New York University Medical School, New York, NY, USA
| | - Sheila A. M. Rauch
- Atlanta VA Healthcare System, Decatur, GA, USA
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Israel Liberzon
- Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI, USA
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
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