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Yu JX, Hussein A, Mah L, Jean Chen J. The associations among glycemic control, heart variability, and autonomic brain function in healthy individuals: Age- and sex-related differences. Neurobiol Aging 2024; 142:41-51. [PMID: 39128180 DOI: 10.1016/j.neurobiolaging.2024.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 05/08/2024] [Accepted: 05/11/2024] [Indexed: 08/13/2024]
Abstract
INTRODUCTION The purpose of this study was to clarify the relationships between glycemia and function of the autonomic nervous system (ANS), assessed via resting-state functional connectivity (FC) and heart-rate variability (HRV). METHODS Data for this study were extracted from the Leipzig Study for Mind-Body-Emotion Interactions, including 146 healthy adults (114 young, 32 older). Variables of interest were glycated hemoglobin (HbA1c), resting-state FC in the salience aspect of the central-autonomic (S-CAN) and salience network (SN) and HRV (RMSSD and high-frequency HRV (HF-HRV)). RESULTS HbA1c was inversely correlated with FC in the S-CAN but not SN. HbA1c was inversely correlated with HRV. Both RMSSD and log(HF-HRV) were correlated with FC in the S-CAN and SN. Age- (not sex-related) differences were observed in the Hb1Ac-FC associations (stronger in older adults) while sex- (not age-related) differences were observed in the HRV-FC (stronger in females). CONCLUSIONS These findings extend the diabetes literature to healthy adults in relating glycemia and brain function. The age- and sex-related differences in these relationships highlight the need to account for the potential effects of age and sex in future investigations.
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Affiliation(s)
- Jeffrey X Yu
- Rotman Research Institute, Baycrest Health Sciences, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Ahmad Hussein
- Rotman Research Institute, Baycrest Health Sciences, Toronto, ON, Canada
| | - Linda Mah
- Rotman Research Institute, Baycrest Health Sciences, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - J Jean Chen
- Rotman Research Institute, Baycrest Health Sciences, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada; Department of Biomedical Engineering, University of Toronto, Toronto, ON, Canada.
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Li HP, Cheng HL, Ding K, Zhang Y, Gao F, Zhu G, Zhang Z. New recognition of the heart-brain axis and its implication in the pathogenesis and treatment of PTSD. Eur J Neurosci 2024; 60:4661-4683. [PMID: 39044332 DOI: 10.1111/ejn.16445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Accepted: 06/04/2024] [Indexed: 07/25/2024]
Abstract
Post-traumatic stress disorder (PTSD) is a complex psychological disorder provoked by distressing experiences, and it remains without highly effective intervention strategies. The exploration of PTSD's underlying mechanisms is crucial for advancing diagnostic and therapeutic approaches. Current studies primarily explore PTSD through the lens of the central nervous system, investigating concrete molecular alterations in the cerebral area and neural circuit irregularities. However, the body's response to external stressors, particularly the changes in cardiovascular function, is often pronounced, evidenced by notable cardiac dysfunction. Consequently, examining PTSD with a focus on cardiac function is vital for the early prevention and targeted management of the disorder. This review undertakes a comprehensive literature analysis to detail the alterations in brain and heart structures and functions associated with PTSD. It also synthesizes potential mechanisms of heart-brain axis interactions relevant to the development of PTSD. Ultimately, by considering cardiac function, this review proposes novel perspectives for PTSD's prophylaxis and therapy.
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Affiliation(s)
- Hai-Peng Li
- Anhui University of Chinese Medicine, Hefei, China
| | - Hong-Liang Cheng
- The Affiliated Hospital of Acupuncture and Moxibustion, Anhui University of Chinese Medicine, Hefei, Anhui Province, China
| | - Keke Ding
- Anhui University of Chinese Medicine, Hefei, China
| | - Yang Zhang
- Anhui University of Chinese Medicine, Hefei, China
| | - Fang Gao
- Anhui University of Chinese Medicine, Hefei, China
| | - Guoqi Zhu
- Anhui University of Chinese Medicine, Hefei, China
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3
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Seligowski AV, Harnett NG, Ellis RA, Grasser LR, Hanif M, Wiltshire C, Ely TD, Lebois LAM, van Rooij SJH, House SL, 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, Swor RA, Hudak LA, Pascual JL, Seamon MJ, Harris E, Pearson C, Peak DA, Merchant RC, Domeier RM, Rathlev NK, O'Neil BJ, Sergot P, Sanchez LD, Bruce SE, Harte SE, Koenen KC, Kessler RC, McLean SA, Ressler KJ, Stevens JS, Jovanovic T. Probing the neurocardiac circuit in trauma and posttraumatic stress. J Psychiatr Res 2024; 176:173-181. [PMID: 38875773 PMCID: PMC11283955 DOI: 10.1016/j.jpsychires.2024.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 05/20/2024] [Accepted: 06/04/2024] [Indexed: 06/16/2024]
Abstract
The neurocardiac circuit is integral to physiological regulation of threat and trauma-related responses. However, few direct investigations of brain-behavior associations with replicable physiological markers of PTSD have been conducted. The current study probed the neurocardiac circuit by examining associations among its core regions in the brain (e.g., insula, hypothalamus) and the periphery (heart rate [HR], high frequency heart rate variability [HF-HRV], and blood pressure [BP]). We sought to characterize these associations and to determine whether there were differences by PTSD status. Participants were N = 315 (64.1 % female) trauma-exposed adults enrolled from emergency departments as part of the prospective AURORA study. Participants completed a deep phenotyping session (e.g., fear conditioning, magnetic resonance imaging) two weeks after emergency department admission. Voxelwise analyses revealed several significant interactions between PTSD severity 8-weeks posttrauma and psychophysiological recordings on hypothalamic connectivity to the prefrontal cortex (PFC), insula, superior temporal sulcus, and temporoparietaloccipital junction. Among those with PTSD, diastolic BP was directly correlated with right insula-hypothalamic connectivity, whereas the reverse was found for those without PTSD. PTSD status moderated the association between systolic BP, HR, and HF-HRV and hypothalamic connectivity in the same direction. While preliminary, our findings may suggest that individuals with higher PTSD severity exhibit compensatory neural mechanisms to down-regulate autonomic imbalance. Additional study is warranted to determine how underlying mechanisms (e.g., inflammation) may disrupt the neurocardiac circuit and increase cardiometabolic disease risk in PTSD.
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Affiliation(s)
- Antonia V Seligowski
- Massachusetts General Hospital, Boston, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
| | - Nathaniel G Harnett
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA; Division of Depression and Anxiety, McLean Hospital, Belmont, MA, USA
| | - Robyn A Ellis
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA; Division of Depression and Anxiety, McLean Hospital, Belmont, MA, USA
| | - Lana R Grasser
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, MI, USA
| | - Mubeena Hanif
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, MI, USA
| | - Charis Wiltshire
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, MI, USA
| | - Timothy D Ely
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Lauren A M Lebois
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA; Division of Depression and Anxiety, McLean Hospital, Belmont, MA, USA
| | - Sanne J H van Rooij
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Stacey L House
- Department of Emergency Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Francesca L Beaudoin
- Department of Epidemiology, Brown University, Providence, RI, USA; Department of Emergency Medicine, Brown University, Providence, RI, USA
| | - Xinming An
- Institute for Trauma Recovery, Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Thomas C Neylan
- Departments of Psychiatry and Neurology, University of California San Francisco, San Francisco, CA, USA
| | - Gari D Clifford
- Department of Biomedical Informatics, Emory University School of Medicine, Atlanta, GA, USA; Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA
| | - Sarah D Linnstaedt
- Institute for Trauma Recovery, Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Laura T Germine
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA; Institute for Technology in Psychiatry, McLean Hospital, Belmont, MA, USA; The Many Brains Project, Belmont, MA, USA
| | - Kenneth A Bollen
- Department of Psychology and Neuroscience & Department of Sociology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Scott L Rauch
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA; Institute for Technology in Psychiatry, McLean Hospital, Belmont, MA, USA; Department of Psychiatry, McLean Hospital, Belmont, MA, USA
| | - John P Haran
- Department of Emergency Medicine, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Alan B Storrow
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Paul I Musey
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Phyllis L Hendry
- Department of Emergency Medicine, University of Florida College of Medicine -Jacksonville, Jacksonville, FL, USA
| | - Sophia Sheikh
- Department of Emergency Medicine, University of Florida College of Medicine -Jacksonville, Jacksonville, FL, USA
| | - Christopher W Jones
- Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, NJ, USA
| | - Brittany E Punches
- Department of Emergency Medicine, Ohio State University College of Medicine, Columbus, OH, USA; Ohio State University College of Nursing, Columbus, OH, USA
| | - Robert A Swor
- Department of Emergency Medicine, Oakland University William Beaumont School of Medicine, Rochester, MI, USA
| | - Lauren A Hudak
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Jose L Pascual
- Department of Surgery, Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA, USA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Mark J Seamon
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Department of Surgery, Division of Traumatology, Surgical Critical Care and Emergency Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Erica Harris
- Department of Emergency Medicine, Einstein Medical Center, Philadelphia, PA, USA
| | - Claire Pearson
- Department of Emergency Medicine, Wayne State University, Ascension St. John Hospital, Detroit, MI, USA
| | - David A Peak
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Roland C Merchant
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Robert M Domeier
- Department of Emergency Medicine, Trinity Health-Ann Arbor, Ypsilanti, MI, USA
| | - Niels K Rathlev
- Department of Emergency Medicine, University of Massachusetts Medical School-Baystate, Springfield, MA, USA
| | - Brian J O'Neil
- Department of Emergency Medicine, Wayne State University, Detroit Receiving Hospital, Detroit, MI, USA
| | - Paulina Sergot
- Department of Emergency Medicine, McGovern Medical School at UTHealth, Houston, TX, USA
| | - Leon D Sanchez
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, USA; Department of Emergency Medicine, Harvard Medical School, Boston, MA, USA
| | - Steven E Bruce
- Department of Psychological Sciences, University of Missouri - St. Louis, St. Louis, MO, USA
| | - Steven E Harte
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, USA; Department of Internal Medicine-Rheumatology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Karestan C Koenen
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Ronald C Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Samuel A McLean
- Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Institute for Trauma Recovery, Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Kerry J Ressler
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA; Division of Depression and Anxiety, McLean Hospital, Belmont, MA, USA
| | - Jennifer S Stevens
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Tanja Jovanovic
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, MI, USA
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Quirin M, Malekzad F, Jais M, Kehr H, Ennis M. Heart rate variability and psychological health: The key role of trait emotional awareness. Acta Psychol (Amst) 2024; 246:104252. [PMID: 38677024 DOI: 10.1016/j.actpsy.2024.104252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 03/19/2024] [Accepted: 04/08/2024] [Indexed: 04/29/2024] Open
Abstract
Studies have shown that Trait Emotional Awareness (TEA) - the ability to recognize one's emotions - and Heart Rate Variability (HRV) are both negatively associated with psychological disorders. Although these studies imply that TEA is related to HRV and may explain the association between HRV and psychological disorders, there is limited research investigating this implication. Such investigation is essential to illuminate the psychophysiological processes linked to psychological disorders. The present study aims to investigate a) the association between TEA and HRV, b) the association between HRV and psychological disorders, and c) whether TEA explains the association between HRV and psychological disorders. A sample of 41 German students completed self-report questionnaires as indicators of psychological disorders, including the Hospital Anxiety and Depression Scale (HADS; Snaith & Zigmond, 1983) for anxiousness and depressiveness, as well as the somatization scale of the Hopkins Symptom Checklist (HSCL; Derogatis et al., 1976) for physical complaints. HRV was measured at baseline (resting HRV) and during exposure to a fear-provoking movie clip (reactive HRV). As hypothesized, a) TEA showed a positive association with reactive HRV, b) HRV showed negative associations with anxiousness and physical complaints, and c) TEA explained the relationships between reactive HRV and anxiousness, as well as physical complaints. Contrary to our hypothesis, we did not find any association between HRV and depressiveness. We discussed the contribution of TEA to psychophysiological health, limited generalizability of the current study, and direct future research to explore the underlying mechanisms linking TEA to health.
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Affiliation(s)
- Markus Quirin
- Technical University of Munich, Germany; PFH Göttingen, Germany.
| | - Farhood Malekzad
- Technical University of Munich, Germany; PFH Göttingen, Germany.
| | | | - Hugo Kehr
- Technical University of Munich, Germany.
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5
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Malandrone F, Catrambone V, Carletto S, Rossini PG, Coletti Moja M, Oliva F, Pagani M, Valenza G, Ostacoli L. Restoring bottom-up communication in brain-heart interplay after trauma-focused psychotherapy in breast cancer patients with post-traumatic stress disorder. J Affect Disord 2024; 351:143-150. [PMID: 38281599 DOI: 10.1016/j.jad.2024.01.172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 05/18/2023] [Accepted: 01/17/2024] [Indexed: 01/30/2024]
Abstract
BACKGROUND The psychological impact of breast cancer (BC) is substantial, with a significant number of patients (up to 32 %) experiencing post-traumatic stress disorder (PTSD). Exploring the emotional aspects of PTSD through the functional brain-heart interplay (BHI) offers valuable insights into the condition. BHI examines the functional interactions between cortical and sympathovagal dynamics. This study aims to investigate changes in functional directional BHI after trauma-focused (TF) psychotherapy, specifically Eye Movement Desensitization and Reprocessing (EMDR), in comparison to treatment as usual (TAU) among BC patients with PTSD. To our knowledge, this study represents the first examination of such changes. METHODS We enrolled thirty BC patients who met the criteria for a PTSD diagnosis, with fourteen receiving EMDR and fifteen receiving TAU over a two- to three-month period. We analyzed changes in the emotional response during a script-driven imagery setting. Quantification of the functional interplay between EEG and sympathovagal dynamics was achieved using the synthetic data generation model (SDG) on electroencephalographic (EEG) and heartbeat series. Our focus was on the difference in the BHI index extracted at baseline and post-treatment. RESULTS We found statistically significant higher coupling in the heart-to-brain direction in patients treated with EMDR compared to controls. This suggests that the flow of information from the autonomic nervous system to the central nervous system is restored following EMDR-induced recovery from PTSD. Furthermore, we observed a significant correlation between improvements in PTSD symptoms and an increase in functional BHI after EMDR treatment. CONCLUSIONS TF psychotherapy, particularly EMDR, appears to facilitate the restoration of the bottom-up flow of interoceptive information, which is dysfunctional in patients with PTSD. The application of BHI analysis to the study of PTSD not only aids in identifying biomarkers of the disorder but also enhances our understanding of the changes brought about by TF treatments.
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Affiliation(s)
- F Malandrone
- Department of Clinical and Biological Sciences, University of Turin, Italy
| | - V Catrambone
- NeuroCardiovascular Intelligence Lab, Department of Information Engineering & Research Centre "E. Piaggio", School of Engineering, University of Pisa, Italy
| | - S Carletto
- Department of Clinical and Biological Sciences, University of Turin, Italy.
| | - P G Rossini
- Department of Clinical and Biological Sciences, University of Turin, Italy
| | - M Coletti Moja
- Neurology Department, Ospedale degli Infermi, Ponderano, Italy
| | - F Oliva
- Department of Clinical and Biological Sciences, University of Turin, Italy
| | - M Pagani
- Institute of Cognitive Sciences and Technologies, Consiglio Nazionale delle Ricerche, Rome, Italy
| | - G Valenza
- NeuroCardiovascular Intelligence Lab, Department of Information Engineering & Research Centre "E. Piaggio", School of Engineering, University of Pisa, Italy
| | - L Ostacoli
- Department of Clinical and Biological Sciences, University of Turin, Italy
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6
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Ibanez A, Northoff G. Intrinsic timescales and predictive allostatic interoception in brain health and disease. Neurosci Biobehav Rev 2024; 157:105510. [PMID: 38104789 PMCID: PMC11184903 DOI: 10.1016/j.neubiorev.2023.105510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 11/29/2023] [Accepted: 12/12/2023] [Indexed: 12/19/2023]
Abstract
The cognitive neuroscience of brain diseases faces challenges in understanding the complex relationship between brain structure and function, the heterogeneity of brain phenotypes, and the lack of dimensional and transnosological explanations. This perspective offers a framework combining the predictive coding theory of allostatic interoceptive overload (PAIO) and the intrinsic neural timescales (INT) theory to provide a more dynamic understanding of brain health in psychiatry and neurology. PAIO integrates allostasis and interoception to assess the interaction between internal patterns and environmental stressors, while INT shows that different brain regions operate on different intrinsic timescales. The allostatic overload can be understood as a failure of INT, which involves a breakdown of proper temporal integration and segregation. This can lead to dimensional disbalances between exteroceptive/interoceptive inputs across brain and whole-body levels (cardiometabolic, cardiovascular, inflammatory, immune). This approach offers new insights, presenting novel perspectives on brain spatiotemporal hierarchies and interactions. By integrating these theories, the paper opens innovative paths for studying brain health dynamics, which can inform future research in brain health and disease.
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Affiliation(s)
- Agustin Ibanez
- Global Brain Health Institute (GBHI), University of California San Francisco (UCSF), CA, USA; Latin American Brain Health (BrainLat), Universidad Adolfo Ibáñez, Santiago, Chile; Cognitive Neuroscience Center (CNC), Universidad de San Andrés, Buenos Aires, Argentina; Trinity College Dublin, Dublin, Ireland.
| | - Georg Northoff
- Mental Health Center, Zhejiang University School of Medicine, Hangzhou, Zhejiang, People's Republic of China; Center for Cognition and Brain Disorders, The Affiliated Hospital of Hangzhou Normal University, Hangzhou, People's Republic of China; Mind, Brain Imaging and Neuroethics, Institute of Mental Health Research, University of Ottawa, Ottawa, Canada.
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7
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Schoeller F, Horowitz AH, Jain A, Maes P, Reggente N, Christov-Moore L, Pezzulo G, Barca L, Allen M, Salomon R, Miller M, Di Lernia D, Riva G, Tsakiris M, Chalah MA, Klein A, Zhang B, Garcia T, Pollack U, Trousselard M, Verdonk C, Dumas G, Adrien V, Friston K. Interoceptive technologies for psychiatric interventions: From diagnosis to clinical applications. Neurosci Biobehav Rev 2024; 156:105478. [PMID: 38007168 DOI: 10.1016/j.neubiorev.2023.105478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 11/16/2023] [Accepted: 11/19/2023] [Indexed: 11/27/2023]
Abstract
Interoception-the perception of internal bodily signals-has emerged as an area of interest due to its implications in emotion and the prevalence of dysfunctional interoceptive processes across psychopathological conditions. Despite the importance of interoception in cognitive neuroscience and psychiatry, its experimental manipulation remains technically challenging. This is due to the invasive nature of existing methods, the limitation of self-report and unimodal measures of interoception, and the absence of standardized approaches across disparate fields. This article integrates diverse research efforts from psychology, physiology, psychiatry, and engineering to address this oversight. Following a general introduction to the neurophysiology of interoception as hierarchical predictive processing, we review the existing paradigms for manipulating interoception (e.g., interoceptive modulation), their underlying mechanisms (e.g., interoceptive conditioning), and clinical applications (e.g., interoceptive exposure). We suggest a classification for interoceptive technologies and discuss their potential for diagnosing and treating mental health disorders. Despite promising results, considerable work is still needed to develop standardized, validated measures of interoceptive function across domains and before these technologies can translate safely and effectively to clinical settings.
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Affiliation(s)
- Felix Schoeller
- Fluid Interfaces Group, Media Lab, Massachusetts Institute of Technology, USA; Institute for Advanced Consciousness Studies, Santa Monica, CA, USA; Department Cognitive Sciences, University of Haifa, Israel.
| | - Adam Haar Horowitz
- Fluid Interfaces Group, Media Lab, Massachusetts Institute of Technology, USA; Center for Sleep and Cognition, Beth Israel Deaconess Medical Center, Harvard Medical School, USA
| | - Abhinandan Jain
- Fluid Interfaces Group, Media Lab, Massachusetts Institute of Technology, USA
| | - Pattie Maes
- Fluid Interfaces Group, Media Lab, Massachusetts Institute of Technology, USA
| | - Nicco Reggente
- Institute for Advanced Consciousness Studies, Santa Monica, CA, USA
| | | | - Giovanni Pezzulo
- Institute of Cognitive Sciences and Technologies, National Research Council, Rome, Italy
| | - Laura Barca
- Institute of Cognitive Sciences and Technologies, National Research Council, Rome, Italy
| | - Micah Allen
- Center of Functionally Integrative Neuroscience, Aarhus University, Denmark; Cambridge Psychiatry, University of Cambridge, UK
| | - Roy Salomon
- Department Cognitive Sciences, University of Haifa, Israel
| | - Mark Miller
- Center for Human Nature, Artificial Intelligence and Neuroscience, Hokkaido University, Japan
| | - Daniele Di Lernia
- Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy; Applied Technology for Neuro- Psychology Laboratory, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Giuseppe Riva
- Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy; Applied Technology for Neuro- Psychology Laboratory, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Manos Tsakiris
- The Warburg Institute, School of Advanced Study, University of London, UK; Department of Psychology, Royal Holloway, University of London, UK; Department of Behavioural and Cognitive Sciences, University of Luxembourg, Luxembourg
| | - Moussa A Chalah
- EA 4391, Excitabilité Nerveuse et Thérapeutique, Université Paris-Est Créteil, Créteil, France; Service de Physiologie - Explorations Fonctionnelles, Hôpital Henri Mondor, Créteil, France
| | - Arno Klein
- Child Mind Institute, New York City, USA
| | - Ben Zhang
- Institute for Advanced Consciousness Studies, Santa Monica, CA, USA
| | - Teresa Garcia
- Institute for Advanced Consciousness Studies, Santa Monica, CA, USA
| | - Ursula Pollack
- Institute for Advanced Consciousness Studies, Santa Monica, CA, USA
| | - Marion Trousselard
- Institut de Recherche Biomédicale des Armées, Place Général Valérie André, 91220 Brétigny-sur-Orge, France
| | - Charles Verdonk
- Institut de Recherche Biomédicale des Armées, Place Général Valérie André, 91220 Brétigny-sur-Orge, France
| | | | - Vladimir Adrien
- Infrastructure for Clinical Research in Neurosciences (iCRIN) Psychiatry, Paris Brain Institute, Paris, France; Department of Psychiatry, Hôpital Saint-Antoine, AP-HP, Sorbonne Université, 75012 Paris, France
| | - Karl Friston
- Queen Sq, Institute of Neurology, UCL, London WC1N 3AR, UK
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8
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Beutler S, Croy I. Psychophysiological reactions during the trauma-film paradigm and their predictive value for intrusions. Eur J Psychotraumatol 2023; 14:2281753. [PMID: 38059504 PMCID: PMC10990446 DOI: 10.1080/20008066.2023.2281753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 10/12/2023] [Indexed: 12/08/2023] Open
Abstract
Background: Adequate adaptation of the autonomic nervous system (ANS) is crucial in potentially life-threatening situations. The defence cascade provides a descriptive model of progressing dominant physiological reactions in such situations, including cardiovascular parameters and body mobility. The empirical evidence for this model is scarce, and the influence of physiological reactions in this model for predicting trauma-induced intrusions is unresolved.Objectives: Using a trauma-film paradigm, we aimed to test physiological reactions to a highly stressful film as an analogue to a traumatic event along the defence cascade model. We also aimed to examine the predictive power of physiological activity for subsequent intrusive symptoms.Method: Forty-seven healthy female participants watched a stressful and a neutral film in randomized order. Heart rate (HR), heart rate variability (HRV), and body sway were measured. Participants tracked frequency, distress, and quality of subsequent intrusions in a diary for 7 consecutive days.Results: For the stressful film, we observed an initial decrease in HR, followed by an increase, before the HR stabilized at a high level, which was not found during the neutral film. No differences in HRV were observed between the two films. Body sway and trembling frequency were heightened during the stressful film. Neither HR nor HRV predicted subsequent intrusions, whereas perceived distress during the stressful film did.Conclusions: Our results suggest that the physiological trauma-analogue response is characterized by an orientation response and subsequent hyperarousal, reaching a high physiological plateau. In contrast to the assumptions of the defence cascade model, the hyperarousal was not followed by downregulation. Potential explanations are discussed. For trauma-associated intrusions in the subsequent week, psychological distress during the film seems to be more important than physiological distress. Understanding the interaction between physiological and psychological responses during threat informs the study of ANS imbalances in mental disorders such as post-traumatic stress disorder.
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Affiliation(s)
- Sarah Beutler
- Department of Psychotherapy and Psychosomatic Medicine, Medical Faculty, Technische Universität Dresden, Dresden, Germany
- Department of Psychology, Friedrich Schiller University of Jena, Jena, Germany
| | - Ilona Croy
- Department of Psychotherapy and Psychosomatic Medicine, Medical Faculty, Technische Universität Dresden, Dresden, Germany
- Department of Psychology, Friedrich Schiller University of Jena, Jena, Germany
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Lathan EC, Powers A, Kottakis A, Guelfo A, Siegle GJ, Turner JA, Turner MD, Yakkanti V, Jain J, Mekawi Y, Teer AP, Currier JM, Fani N. Civilian moral injury: associations with trauma type and high-frequency heart rate variability in two trauma-exposed community-based samples. Psychol Med 2023; 53:5136-5145. [PMID: 37650341 PMCID: PMC10476056 DOI: 10.1017/s003329172200215x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 06/13/2022] [Accepted: 06/22/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Moral injury exposure (MIE) and distress (MID) may indirectly affect the relationship between trauma exposure and alterations in autonomic regulation [assessed via high-frequency heart rate variability (hfHRV)] in civilians, but this has not been tested in prior research. We conducted two exploratory studies to examine trauma types' associations with MIE and MID among civilian medical patients (Study 1) and explore how these facets may indirectly affect the relationship between trauma type and hfHRV among civilians seeking mental health services (Study 2). METHODS Participants recruited from a public hospital and/or community advertisements (Study 1, n = 72, 87.5% Black, 83.3% women; Study 2, n = 46, 71.7% Black, 97.8% women) completed measures assessing trauma type, MIE, and MID. In Study 1, trauma types that emerged as significant correlates of MIE and MID were entered into separate linear regression analyses. Trauma types identified were included as predictors in indirect effects models with MIE or MID as the mediator and resting hfHRV (assayed via electrocardiography) as the outcome. RESULTS Childhood sexual abuse emerged as the only significant predictor of MIE, b = 0.38, p < 0.001; childhood sexual abuse, b = 0.26, p < 0.05, and adulthood sexual assault, b = 0.23, p < 0.05 were significant predictors of MID. Participants with greater MIE and MID demonstrated lower hfHRV. Adulthood sexual assault showed an indirect effect on hfHRV through MID, B = -0.10, s.e. = 0.06, 95%CI (-0.232 to -0.005). CONCLUSIONS Moral injury was uniquely associated with sexual violence and lower hfHRV in civilians. Data highlight moral injury as a pathway through which autonomic dysregulation may emerge and its salience for trauma treatment selection.
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Affiliation(s)
- Emma C. Lathan
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Abigail Powers
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Anna Kottakis
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Alfonsina Guelfo
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Greg J. Siegle
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Jessica A. Turner
- Department of Psychology, Georgia State University, Atlanta, GA, USA
| | - Matthew D. Turner
- Department of Psychology, Georgia State University, Atlanta, GA, USA
| | - Vijwala Yakkanti
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Jahnvi Jain
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Yara Mekawi
- Department of Psychological and Brain Sciences, University of Louisville, Louisville, KY, USA
| | - Andrew P. Teer
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Joseph M. Currier
- Department of Psychology, University of South Alabama, Mobile, AL, USA
| | - Negar Fani
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
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10
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Cesari V, Frumento S, Leo A, Baroni M, Rutigliano G, Gemignani A, Menicucci D. Functional correlates of subliminal stimulation in Posttraumatic Stress Disorder: Systematic review and meta-analysis. J Affect Disord 2023:S0165-0327(23)00682-1. [PMID: 37236272 DOI: 10.1016/j.jad.2023.05.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 05/08/2023] [Accepted: 05/15/2023] [Indexed: 05/28/2023]
Abstract
Patients with Post-traumatic stress disorder (PTSD) exposed to traumatic reminders show hyperreactivity in brain areas (e.g., amygdala) belonging or related to the Innate Alarm System (IAS), allowing the rapid processing of salient stimuli. Evidence that IAS is activated by subliminal trauma-reminders could shed a new light on the factors precipitating and perpetuating PTSD symptomatology. Thus, we systematically reviewed studies investigating neuroimaging correlates of subliminal stimulation in PTSD. Twenty-three studies were selected from the MEDLINE and Scopus® databases for a qualitative synthesis, 5 of which allowed a further meta-analysis of fMRI data. The intensity of IAS responses to subliminal trauma-related reminders ranged from a minimum in healthy controls to a maximum in the PTSD patients with the most severe (e.g., dissociative) symptoms or the least responsiveness to treatment. Comparisons with other disorders (e.g., phobias) revealed contrasting results. Our findings demonstrate the hyperactivation of areas belonging or related to IAS in response to unconscious threats that should be integrated in diagnostic as well as in therapeutic protocols.
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Affiliation(s)
- Valentina Cesari
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine University of Pisa, via Savi, 10, 56126 Pisa, Italy
| | - Sergio Frumento
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine University of Pisa, via Savi, 10, 56126 Pisa, Italy
| | - Andrea Leo
- Department of translational research and advanced technologies in medicine and surgery, University of Pisa, Via Risorgimento, 36, Pisa, Italy
| | - Marina Baroni
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine University of Pisa, via Savi, 10, 56126 Pisa, Italy; Institute of Clinical Physiology (IFC), National Research Council, via Giuseppe Moruzzi, 1, 56124, Pisa, Italy
| | - Grazia Rutigliano
- Institute of Clinical Sciences, Faculty of Medicine, Imperial College London, London, UK
| | - Angelo Gemignani
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine University of Pisa, via Savi, 10, 56126 Pisa, Italy; Clinical Psychology branch, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Danilo Menicucci
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine University of Pisa, via Savi, 10, 56126 Pisa, Italy.
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11
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Lawrence HR, Siegle GJ, Schwartz-Mette RA. Reimagining rumination? The unique role of mental imagery in adolescents' affective and physiological response to rumination and distraction. J Affect Disord 2023; 329:460-469. [PMID: 36813044 DOI: 10.1016/j.jad.2023.02.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 02/04/2023] [Accepted: 02/15/2023] [Indexed: 02/23/2023]
Abstract
Rumination is associated with increased risk for depression whereas distraction helps draw attention away from negative experiences, lowering risk. Many individuals who ruminate do so in the form of mental imagery and imagery-based rumination is more highly associated with depressive symptom severity than ruminating in the form of verbal thoughts. We do not yet understand why imagery-based rumination may be especially problematic nor how to intervene to reduce imagery-based rumination, however. Adolescents (N = 145) underwent a negative mood induction followed by experimental induction of rumination or distraction in the form of mental imagery or verbal thought while affective, high-frequency heart rate variability, and skin conductance response data were collected. Rumination was associated with similar affective, high-frequency heart rate variability, and skin conductance response regardless of whether adolescents were induced to ruminate in the form of mental imagery or verbal thought. Distraction led to greater affective improvement and greater increases in high-frequency heart rate variability, but similar skin conductance responses when adolescents were inducted to distract themselves in the form of mental imagery compared with verbal thought. Findings emphasize the importance of considering mental imagery in clinical contexts when assessing rumination and when intervening using distraction.
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Affiliation(s)
- Hannah R Lawrence
- School of Psychological Science, Oregon State University, Corvallis, OR, United States of America.
| | - Greg J Siegle
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States of America
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12
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Korgaonkar MS, Felmingham KL, Malhi GS, Williamson TH, Williams LM, Bryant RA. Changes in neural responses during affective and non-affective tasks and improvement of posttraumatic stress disorder symptoms following trauma-focused psychotherapy. Transl Psychiatry 2023; 13:85. [PMID: 36894538 PMCID: PMC9998447 DOI: 10.1038/s41398-023-02375-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Revised: 02/07/2023] [Accepted: 02/20/2023] [Indexed: 03/11/2023] Open
Abstract
At least one-third posttraumatic stress disorder (PTSD) patients do not respond to trauma-focused psychotherapy (TF-psychotherapy), which is the treatment of choice for PTSD. To clarify the change mechanisms that may be associated with treatment response, this study examined changes in neural activations during affective and non-affective processing that occur with improvement of symptoms after TF-psychotherapy. This study assessed PTSD treatment-seeking patients (n = 27) prior to and after TF-psychotherapy using functional magnetic resonance imaging when they completed three tasks: (a) passive viewing of affective faces, (b) cognitive reappraisal of negative images, and (c) non-affective response inhibition. Patients then underwent 9 sessions of TF-psychotherapy, and were assessed on the Clinician-Administered PTSD Scale following treatment. Changes in neural responses in affect and cognitive processing regions-of-interest for each task were correlated with reduction of PTSD severity from pretreatment to posttreatment in the PTSD cohort. Data from 21 healthy controls was used for comparison. Improvement of symptoms in PTSD were associated with increased activation of left anterior insula, reductions in the left hippocampus and right posterior insula during viewing of supraliminally presented affective images, and reduced connectivity between the left hippocampus with the left amygdala and rostral anterior cingulate. Treatment response was also associated with reduced activation in the left dorsolateral prefrontal cortex during reappraisal of negative images. There were no associations between response and activation change during response inhibition. This pattern of findings indicates that improvement of PTSD symptoms following TF-psychotherapy is associated with changes in affective rather than non-affective processes. These findings accord with prevailing models that TF-psychotherapy promotes engagement and mastery of affective stimuli.Clinical Trials Registration: Trial Registration: Prospectively registered at Australian and New Zealand Clinical Trials Registry, ACTRN12612000185864 and ACTRN12609000324213. https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=83857.
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Affiliation(s)
- Mayuresh S Korgaonkar
- Brain Dynamics Centre, Westmead Institute for Medical Research, The University of Sydney, Westmead, Australia. .,Department of Psychiatry, University of Sydney, Westmead, Australia.
| | - Kim L Felmingham
- Discipline of Psychological Science, University of Melbourne, Melbourne, Australia
| | - Gin S Malhi
- Department of Psychiatry, University of Sydney, Westmead, Australia
| | - Thomas H Williamson
- Brain Dynamics Centre, Westmead Institute for Medical Research, The University of Sydney, Westmead, Australia.,School of Psychology, University of New South Wales, Kensington, Australia
| | - Leanne M Williams
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, USA.,Sierra-Pacific Mental Illness Research, Education, and Clinical Center (MIRECC) VA Palo Alto Health Care System, Palo Alto, USA
| | - Richard A Bryant
- Brain Dynamics Centre, Westmead Institute for Medical Research, The University of Sydney, Westmead, Australia. .,School of Psychology, University of New South Wales, Kensington, Australia.
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13
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Sánchez MAA, González JA, Sánchez Fonseca JD, Calderón NP, Cárdenas-Poveda DC, López JML. Analysis of EEG and ECG in women with intimate partner violence experience during an emotional task. Int J Psychophysiol 2023; 183:148-158. [PMID: 36502937 DOI: 10.1016/j.ijpsycho.2022.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 11/17/2022] [Accepted: 12/02/2022] [Indexed: 12/13/2022]
Abstract
Intimate Partner Violence (IPV) has been associated with cognitive, emotional, physical and physiological alterations, and with the presence of anxiety disorders. There is not enough research on this problem from an interdisciplinary approach despite the above. Therefore, this research compared the emotion perception and electrophysiological responses, elicited by an emotional task, in women who had experienced IPV and women who had not (WIPV). Forty-five participants (22 with and 23 without IPV experience) were presented with nine images from the International Affective Picture System (IAPS) database and performed a self-report using the Self-Assessment Manikin (SAM). In parallel, electrophysiological signals (ECG and EEG) were acquired, for the analysis of emotional response. In the between-group analysis, the IPV group showed lower perceived dominance and greater central asymmetry in the alpha band than the WIPV group; additionally, the IPV group exhibited a significant positive correlation between the valence of the images and the alpha band power in central areas. In the within-group analysis, the WIPV group showed greater activation in the alpha band and alpha/beta ratio in frontal areas during the emotional elicitation, as compared to baseline. Furthermore, the ECG analysis showed that, for the IPV group, there was a decrease in the power of the high-frequency (HF) band and an increase in the power of the very-low-frequency (VLF) band of heart rate variability (HRV) during the elicitation stage. It is hypothesized that the IPV group could present higher stress levels and greater physiological activity during emotional stimuli than the WIPV group. Possible changes in emotional regulation and anxiety levels due to IPV experiences are discussed.
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Affiliation(s)
- Miguel Angel Angulo Sánchez
- Corporación Universitaria Minuto de Dios Uniminuto, Psychology Program, CRA 73 A 81B-70, Bogotá 111021, Bogotá D.C, Colombia.
| | - Juan Andrés González
- Escuela Colombiana de Ingeniería Julio Garavito, Biomedical Engineering Program, Av. CRA 40 205-59, Bogotá 111166, Bogotá D.C, Colombia
| | - Jessica D Sánchez Fonseca
- Escuela Colombiana de Ingeniería Julio Garavito, Biomedical Engineering Program, Av. CRA 40 205-59, Bogotá 111166, Bogotá D.C, Colombia
| | - Natalia Perea Calderón
- Escuela Colombiana de Ingeniería Julio Garavito, Biomedical Engineering Program, Av. CRA 40 205-59, Bogotá 111166, Bogotá D.C, Colombia
| | - D Carolina Cárdenas-Poveda
- Corporación Universitaria Minuto de Dios Uniminuto, Psychology Program, CRA 73 A 81B-70, Bogotá 111021, Bogotá D.C, Colombia
| | - Juan Manuel López López
- Escuela Colombiana de Ingeniería Julio Garavito, Biomedical Engineering Program, Av. CRA 40 205-59, Bogotá 111166, Bogotá D.C, Colombia
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14
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Thome J, Densmore M, Terpou BA, Théberge J, McKinnon MC, Lanius RA. Contrasting Associations Between Heart Rate Variability and Brainstem-Limbic Connectivity in Posttraumatic Stress Disorder and Its Dissociative Subtype: A Pilot Study. Front Behav Neurosci 2022; 16:862192. [PMID: 35706833 PMCID: PMC9190757 DOI: 10.3389/fnbeh.2022.862192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 04/21/2022] [Indexed: 11/23/2022] Open
Abstract
Background Increasing evidence points toward the need to extend the neurobiological conceptualization of posttraumatic stress disorder (PTSD) to include evolutionarily conserved neurocircuitries centered on the brainstem and the midbrain. The reticular activating system (RAS) helps to shape the arousal state of the brain, acting as a bridge between brain and body. To modulate arousal, the RAS is closely tied to the autonomic nervous system (ANS). Individuals with PTSD often reveal altered arousal patterns, ranging from hyper- to blunted arousal states, as well as altered functional connectivity profiles of key arousal-related brain structures that receive direct projections from the RAS. Accordingly, the present study aims to explore resting state functional connectivity of the RAS and its interaction with the ANS in participants with PTSD and its dissociative subtype. Methods Individuals with PTSD (n = 57), its dissociative subtype (PTSD + DS, n = 32) and healthy controls (n = 40) underwent a 6-min resting functional magnetic resonance imaging and pulse data recording. Resting state functional connectivity (rsFC) of a central node of the RAS – the pedunculopontine nuclei (PPN) – was investigated along with its relation to ANS functioning as indexed by heart rate variability (HRV). HRV is a prominent marker indexing the flexibility of an organism to react adaptively to environmental needs, with higher HRV representing greater effective adaptation. Results Both PTSD and PTSD + DS demonstrated reduced HRV as compared to controls. HRV measures were then correlated with rsFC of the PPN. Critically, participants with PTSD and participants with PTSD + DS displayed inverse correlations between HRV and rsFC between the PPN and key limbic structures, including the amygdala. Whereas participants with PTSD displayed a positive relationship between HRV and PPN rsFC with the amygdala, participants with PTSD + DS demonstrated a negative relationship between HRV and PPN rsFC with the amygdala. Conclusion The present exploratory investigation reveals contrasting patterns of arousal-related circuitry among participants with PTSD and PTSD + DS, providing a neurobiological lens to interpret hyper- and more blunted arousal states in PTSD and PTSD + DS, respectively.
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Affiliation(s)
- Janine Thome
- Department of Psychiatry, Western University, London, ON, Canada
- Department of Theoretical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Maria Densmore
- Department of Psychiatry, Western University, London, ON, Canada
- Imaging Division, Lawson Health Research Institute, London, ON, Canada
| | - Braeden A. Terpou
- Homewood Research Institute, Guelph, ON, Canada
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Jean Théberge
- Department of Psychiatry, Western University, London, ON, Canada
- Imaging Division, Lawson Health Research Institute, London, ON, Canada
- Department of Medical Biophysics, Western University, London, ON, Canada
| | - Margaret C. McKinnon
- Homewood Research Institute, Guelph, ON, Canada
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
- Mood Disorders Programs, St. Joseph’s Healthcare Hamilton, Hamilton, ON, Canada
| | - Ruth A. Lanius
- Department of Psychiatry, Western University, London, ON, Canada
- Imaging Division, Lawson Health Research Institute, London, ON, Canada
- Homewood Research Institute, Guelph, ON, Canada
- Department of Neuroscience, Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON, Canada
- *Correspondence: Ruth A. Lanius,
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15
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McIntosh R, Lobo JD, Carvalho N, Ironson G. Learning to forget: Hippocampal-amygdala connectivity partially mediates the effect of sexual trauma severity on verbal recall in older women undiagnosed with posttraumatic stress disorder. J Trauma Stress 2022; 35:631-643. [PMID: 35156236 PMCID: PMC11021133 DOI: 10.1002/jts.22778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 08/30/2021] [Accepted: 08/31/2021] [Indexed: 11/08/2022]
Abstract
Verbal learning deficits are common among sexually traumatized women who have not been formally diagnosed with posttraumatic stress disorder (PTSD). Aberrant resting-state functional connectivity (rsFC) of the amygdala and hippocampus are implicated in PTSD and verbal memory impairment. We tested rsFC between bilateral dentate gyrus (DG) and both centromedial (CM) and basolateral (BL) nuclei of the amygdala as statistical mediators for the effect of sexual trauma-related symptom severity on delayed verbal recall performance in 63 older women (age: 60-85 years) undiagnosed with PTSD. Participant data were drawn from the NKI-Rockland Study. Individuals completed a 10-min resting-state scan, Rey Auditory Verbal Learning Test (RAVLT), and the Sexual Abuse Trauma Index (SATI) from the Trauma Symptom Checklist. Z-scores indicating rsFC of DG with BL and CM amygdala seeds were evaluated in two separate mediation models. Higher SATI scores were associated with lower RAVLT after controlling for age, β = -.23, 95% CI [.48, .03], p = .039. This effect was negated upon adding a negative path from SATI to rsFC of left DG and right CM, β = -.29, 95% CI [-.52, -.02], p = .022, and a positive path from that seed pair to RAVLT List A recall, β = .28, 95% CI [.03, 0.48], p = .015. Chi-square fit indices supported partial mediation by this seed pair, p = .762. In the absence of PTSD sexual trauma symptoms partially relate to verbal learning deficits as a function of aberrant rsFC between left hippocampus DG and right amygdala CM nuclei.
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Affiliation(s)
- Roger McIntosh
- Department of Psychology, University of Miami, Coral Gables, Florida, USA
| | - Judith D Lobo
- Department of Psychology, University of Miami, Coral Gables, Florida, USA
| | - Nicole Carvalho
- Department of Psychology, University of Miami, Coral Gables, Florida, USA
| | - Gail Ironson
- Department of Psychology, University of Miami, Coral Gables, Florida, USA
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16
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Gazi AH, Wittbrodt MT, Harrison AB, Sundararaj S, Gurel NZ, Nye JA, Shah AJ, Vaccarino V, Bremner JD, Inan OT. Robust Estimation of Respiratory Variability Uncovers Correlates of Limbic Brain Activity and Transcutaneous Cervical Vagus Nerve Stimulation in the Context of Traumatic Stress. IEEE Trans Biomed Eng 2022; 69:849-859. [PMID: 34449355 PMCID: PMC8853700 DOI: 10.1109/tbme.2021.3108135] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Variations in respiration patterns are a characteristic response to distress due to underlying neurorespiratory couplings. Yet, no work to date has quantified respiration pattern variability (RPV) in the context of traumatic stress and studied its functional neural correlates - this analysis aims to address this gap. METHODS Fifty human subjects with prior traumatic experiences (24 with posttraumatic stress disorder (PTSD)) completed a ∼3-hr protocol involving personalized traumatic scripts and active/sham (double-blind) transcutaneous cervical vagus nerve stimulation (tcVNS). High-resolution positron emission tomography functional neuroimages, electrocardiogram (ECG), and respiratory effort (RSP) data were collected during the protocol. Supplementing the RSP signal with ECG-derived respiration for quality assessment and timing extraction, RPV metrics were quantified and analyzed. Specifically, correlation analyses were performed using neuroactivity in selected limbic regions, and responses to active and sham tcVNS were compared. RESULTS The single-lag unscaled autocorrelation of respiration rate correlated negatively with left amygdala activity and positively with right rostromedial prefrontal cortex (rmPFC) activity for non-PTSD; it also correlated negatively with left and right insulae activity and positively with right rmPFC activity for PTSD. The single-lag unscaled autocorrelation of expiration time was greater following active stimulation for non-PTSD. CONCLUSION Quantifying RPV is of demonstrable importance to assessing trauma-induced changes in neural function and tcVNS effects on respiratory physiology. SIGNIFICANCE This is the first demonstration of RPV's pertinence to traumatic stress- and tcVNS-induced neurorespiratory responses. The open-source processing pipeline elucidated herein uniquely includes both RSP and ECG-derived respiration signals for quality assessment, timing estimation, and RPV extraction.
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17
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Out-of-step: brain-heart desynchronization in anxiety disorders. Mol Psychiatry 2021; 26:1726-1737. [PMID: 33504952 DOI: 10.1038/s41380-021-01029-w] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 12/30/2020] [Accepted: 01/12/2021] [Indexed: 12/11/2022]
Abstract
Imaging studies in anxiety disorders (AD) show abnormal functional connectivity primarily in the salience network (SN), somatomotor network (SMN), and default mode network (DMN). However, it is not clear how precisely these network changes occur including their relation to psychopathological symptoms. Here, we show that the functional networks affected in AD overlap with cortical regions that receive visceral inputs (the so-called central/visceral autonomic network). Focusing on cardiac afferents, we suggest that network changes in AD may be due to reduced phase synchronization between ongoing neural and cardiac activity. This neuro-cardiac desynchronization occurs due to the abnormal phase resetting of neural activity at the onset of each heartbeat, as measured by a lower intertrial coherence and heartbeat-evoked potential. Biochemically, cardiac afferents reach subcortical serotonergic raphe nuclei and noradrenergic locus coeruleus (among others) which, in turn, are known to reciprocally modulate the DMN and SMN/SN on the cortical level. Consistent with the network changes in AD, decreases in serotonergic and noradrenergic activity are known to increase connectivity in both SMN and SN while, at the same time, they decrease DMN connectivity. SMN and SN increases, in turn, lead to increased emotional arousal/anxiety and bodily awareness whereas decreased DMN connectivity leads to an unstable sense-of-self in AD. Finally, we integrate our proposal with interoceptive predictive processing models suggesting neuro-cardiac desynchronization as a mechanism for "noisy" bottom-up information leading to a persistently uncertain bodily state in top-down models. In sum, integrating theories on active interference and hyperarousal, we propose a precise neuro-cardiac and biochemically -driven mechanisms for key psychopathological symptoms of AD.
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18
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Campbell AA, Wisco BE. Respiratory sinus arrhythmia reactivity in anxiety and posttraumatic stress disorder: A review of literature. Clin Psychol Rev 2021; 87:102034. [PMID: 33930767 DOI: 10.1016/j.cpr.2021.102034] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 02/24/2021] [Accepted: 04/14/2021] [Indexed: 12/24/2022]
Abstract
Respiratory sinus arrhythmia (RSA) reactivity is thought to indicate how adaptively one responds to stress. RSA reactivity has been examined across anxiety disorders and posttraumatic stress disorder (PTSD), to better understand the psychophysiological stress response of these disorders. The current state of the literature is mixed, and the association between RSA reactivity and PTSD/anxiety is unclear. This review examines RSA reactivity in response to laboratory stressor tasks across samples with anxiety and PTSD. Results indicated a complex literature that may suggest an association between anxiety/PTSD and RSA reactivity. There is evidence to suggest a pattern of heightened RSA withdrawal in PTSD and trait anxious samples. There was little evidence to suggest a heightened RSA withdrawal pattern in other anxiety disorders. This review also highlights methodological considerations which may allow for clearer interpretations of RSA reactivity. The current literature includes heterogeneity across stressor tasks, RSA measures, and comorbidities that complicates interpretation of results. Studies using samples with comorbid depression produce more consistent evidence of heightened RSA withdrawal in anxiety/PTSD. Future directions for understanding the contribution of these variables (i.e., stressor tasks, RSA measures, comorbid depression) and mechanisms contributing to the possible association between RSA reactivity and anxiety/PTSD are considered.
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Affiliation(s)
- Allison A Campbell
- Department of Psychology, University of North Carolina at Greensboro, United States of America.
| | - Blair E Wisco
- Department of Psychology, University of North Carolina at Greensboro, United States of America
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19
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Rab SL, Admon R. Parsing inter- and intra-individual variability in key nervous system mechanisms of stress responsivity and across functional domains. Neurosci Biobehav Rev 2020; 120:550-564. [PMID: 32941963 DOI: 10.1016/j.neubiorev.2020.09.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Revised: 08/21/2020] [Accepted: 09/03/2020] [Indexed: 12/16/2022]
Abstract
Exposure to stressful events is omnipresent in modern human life, yet people show considerable heterogeneity in the impact of stress exposure(s) on their functionality and overall health. Encounter with stressor(s) is counteracted by an intricate repertoire of nervous-system responses. This narrative review starts with a brief summary of the vast evidence that supports heart rate variability, cortisol secretion, and large-scale cortical network interactions as kay physiological, endocrinological, and neural mechanisms of stress responsivity, respectively. The second section highlights potential sources for inter-individual variability in these mechanisms, by focusing on biological, environmental, social, habitual, and psychological factors that may influence stress responsivity patterns and thus contribute to heterogeneity in the impact of stress exposure on functionality and health. The third section introduces intra-individually variability in stress responsivity across functional domains as a novel putative source for heterogeneity in the impact of stress exposure. Challenges and future directions are further discussed. Parsing inter- and intra-individual variability in nervous-system mechanisms of stress responsivity and across functional domains is critical towards potential clinical translation.
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Affiliation(s)
- Sharona L Rab
- Department of Psychology, University of Haifa, Haifa, Israel
| | - Roee Admon
- Department of Psychology, University of Haifa, Haifa, Israel; The Integrated Brain and Behavior Research Center (IBBRC), University of Haifa, Haifa, Israel.
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Northoff G, Lamme V. Neural signs and mechanisms of consciousness: Is there a potential convergence of theories of consciousness in sight? Neurosci Biobehav Rev 2020; 118:568-587. [PMID: 32783969 DOI: 10.1016/j.neubiorev.2020.07.019] [Citation(s) in RCA: 81] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 07/03/2020] [Accepted: 07/16/2020] [Indexed: 11/18/2022]
Abstract
Various theories for the neural basis of consciousness have been proposed, suggesting a diversity of neural signs and mechanisms. We ask to what extent this diversity is real, or whether many theories share the same basic ideas with a potential for convergence towards a more unified theory of the neural basis of consciousness. For that purpose, we review and compare the various neural signs, measures, and mechanisms proposed in the different theories. We demonstrate that different theories focus on neural signs and measures of distinct aspects of neural activity including stimulus-related, prestimulus, and resting state activity as well as on distinct features of consciousness. Therefore, the various mechanisms proposed in the different theories may, in part, complement each other. Together, we provide insight into the shared basis and convergences (and, in part, discrepancies) of the different theories of consciousness. We conclude that the different theories concern distinct aspects of both neural activity and consciousness which, as we suppose, may be integrated and nested within the brain's overall temporo-spatial dynamics.
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Affiliation(s)
- Georg Northoff
- Mental Health Center, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China; Mind, Brain Imaging and Neuroethics, Institute of Mental Health Research, University of Ottawa, Ottawa, Canada; Centre for Research Ethics & Bioethics, University of Uppsala, Uppsala, Sweden.
| | - Victor Lamme
- Amsterdam Brain and Cognition (ABC), Department of Psychology, University of Amsterdam, the Netherlands
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Terpou BA, Densmore M, Théberge J, Frewen P, McKinnon MC, Nicholson AA, Lanius RA. The hijacked self: Disrupted functional connectivity between the periaqueductal gray and the default mode network in posttraumatic stress disorder using dynamic causal modeling. NEUROIMAGE-CLINICAL 2020; 27:102345. [PMID: 32738751 PMCID: PMC7394966 DOI: 10.1016/j.nicl.2020.102345] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 07/07/2020] [Accepted: 07/08/2020] [Indexed: 12/21/2022]
Abstract
Posttraumatic stress disorder (PTSD) shows altered effective connectivity dynamics. Modeling between the periaqueductal gray (PAG) and the default mode network (DMN). In PTSD, stronger excitatory effective connectivity from the PAG towards the DMN. Trauma-related/neutral stimulus modulations to effective connectivity are compared. In PTSD, trauma-related stimulus modulations differ significantly to the controls.
Self-related processes define assorted self-relevant or social-cognitive functions that allow us to gather insight and to draw inferences related to our own mental conditions. Self-related processes are mediated by the default mode network (DMN), which, critically, shows altered functionality in individuals with posttraumatic stress disorder (PTSD). In PTSD, the midbrain periaqueductal gray (PAG) demonstrates stronger functional connectivity with the DMN [i.e., precuneus (PCN), medial prefrontal cortex (mPFC)] as compared to healthy individuals during subliminal, trauma-related stimulus processing. Here, we analyzed the directed functional connectivity between the PAG and the PCN, as well as between the PAG and the mPFC to more explicitly characterize the functional connectivity we have observed previously on the corresponding sample and paradigm. We evaluated three models varying with regard to context-dependent modulatory directions (i.e., bi-directional, bottom-up, top-down) among individuals with PTSD (n = 26) and healthy participants (n = 20), where Bayesian model selection was used to identify the most optimal model for each group. We then compared the effective connectivity strength for each parameter across the models and between our groups using Bayesian model averaging. Bi-directional models were found to be favoured across both groups. In PTSD, we revealed the PAG to show stronger excitatory effective connectivity to the PCN, as well as to the mPFC as compared to controls. In PTSD, we further demonstrated that PAG-mediated effective connectivity to the PCN, as well as to the mPFC were modulated more strongly during subliminal, trauma-related stimulus conditions as compared to controls. Clinical disturbances towards self-related processes are reported widely by participants with PTSD during trauma-related stimulus processing, where altered functional connectivity directed by the PAG to the DMN may elucidate experiential links between self- and trauma-related processing in traumatized individuals.
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Affiliation(s)
- Braeden A Terpou
- Department of Neuroscience, Western University, London, ON, Canada.
| | - Maria Densmore
- Imaging Division, Lawson Health Research Institute, London, ON, Canada; Department of Psychiatry, Western University, London, ON, Canada.
| | - Jean Théberge
- Imaging Division, Lawson Health Research Institute, London, ON, Canada; Department of Psychiatry, Western University, London, ON, Canada; Department of Medical Imaging, Western University, London, ON, Canada; Department of Medical Biophysics, Western University, London, ON, Canada; Department of Diagnostic Imaging, St. Joseph's Healthcare, London, ON, Canada.
| | - Paul Frewen
- Department of Neuroscience, Western University, London, ON, Canada; Department of Psychiatry, Western University, London, ON, Canada; Department of Psychology, Western University, London, ON, Canada.
| | - Margaret C McKinnon
- Mood Disorders Program, St. Joseph's Healthcare, Hamilton, ON, Canada; Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada; Homewood Research Institute, Guelph, ON, Canada.
| | - Andrew A Nicholson
- Department of Cognition, Emotion, and Methods in Psychology, University of Vienna, Wien, Austria.
| | - Ruth A Lanius
- Department of Neuroscience, Western University, London, ON, Canada; Imaging Division, Lawson Health Research Institute, London, ON, Canada; Department of Psychiatry, Western University, London, ON, Canada.
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Thome J, Terpou BA, McKinnon MC, Lanius RA. The neural correlates of trauma-related autobiographical memory in posttraumatic stress disorder: A meta-analysis. Depress Anxiety 2020; 37:321-345. [PMID: 31815346 DOI: 10.1002/da.22977] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 10/02/2019] [Accepted: 11/06/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Autobiographical memory (AM) refers to memories of events that are personally relevant and are remembered from one's own past. The AM network is a distributed brain network comprised largely by prefrontal medial and posteromedial cortical brain regions, which together facilitate AM. Autobiographical memories with high arousal and negatively valenced emotional states are thought to be retrieved more readily and re-experienced more vividly. This is critical in the case of trauma-related AMs, which are related to altered phenomenological experiences as well as aberrations to the underlying neural systems in posttraumatic stress disorder (PTSD). Critically, these alterations to the AM network have not been explored recently and have never been analyzed with consideration to the different processes of AM, them being retrieval and re-experiencing. METHODS We conducted a series of effect-size signed differential mapping meta-analyses across twenty-eight studies investigating the neural correlates of trauma-related AMs in participants with PTSD as compared with controls. Studies included either trauma-related scripts or trauma-related materials (i.e., sounds, images, pictures) implemented to evoke the recollection of a trauma-related memory. RESULTS The meta-analyses revealed that control and PTSD participants displayed greater common brain activation of prefrontal medial and posteromedial cortices, respectively. Whereby the prefrontal medial cortices are suggested to facilitate retrieval monitoring, the posteromedial cortices are thought to enable the visual imagery processes of AM. CONCLUSIONS Taken together, reduced common activation of prefrontal cortices may be interpreted as a bias toward greater re-experiencing, where the more salient elements of the traumatic memory are relived as opposed to retrieved in a controlled manner in PTSD.
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Affiliation(s)
- Janine Thome
- Department of Psychiatry, Western University, London, Ontario, Canada.,Department of Theoretical Neuroscience, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
| | - 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
| | - Ruth A Lanius
- Department of Psychiatry, Western University, London, Ontario, Canada.,Department of Neuroscience, Western University, London, Ontario, Canada
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Northoff G. Anxiety Disorders and the Brain's Resting State Networks: From Altered Spatiotemporal Synchronization to Psychopathological Symptoms. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2020; 1191:71-90. [PMID: 32002923 DOI: 10.1007/978-981-32-9705-0_5] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Anxiety disorders include a variety of different disorders including panic disorder (PD), social anxiety disorder (SAD), generalized anxiety disorder (GAD), and phobias. We here focus our review on GAD, SAD, and PD and put a specific emphasis on resting state networks and the coupling between the brain and the heart as all anxiety disorders exhibit abnormal perception of their own heartbeat in some way or the other. Resting state functional connectivity (rsFC) studies demonstrate abnormalities in default-mode network (DMN) in all anxiety disorders, e.g., mostly decreases in rsFC of DMN. In contrast, resting state fMRI shows increased rsFC in salience network (SN) (SAD, GAD) and/or somato-motor/sensory network (SMN) (PD). Since rsFC is coherence- or phase-based operating in the infraslow frequency domain (0.01-0.1 Hz), these data suggest spatiotemporal hypo- or hyper-synchronization in DMN and SMN/SN, respectively. These abnormalities in the neural network's spatiotemporal synchronization may, in turn, impact phase-based temporal synchronization of neural and cardiac activities resulting in decreased (DMN) or increased (SMN/SN) neuro-cardiac coupling in anxiety disorders. That, in turn, may be related to the various psychopathological symptoms like unstable sense of self (as based on unstable DMN showing spatiotemporal hypo-synchronization), increased emotions and specifically anxiety (as related to increased SN showing spatiotemporal hyper-synchronization), and increased bodily awareness (mediated by increased SMN with spatiotemporal hyper-synchronization) in anxiety disorders. Taken together, we here suggest altered spatiotemporal synchronization of neural and cardiac activity within the brain's resting state to underlie various psychopathological symptoms in anxiety disorders. Such spatiotemporal basis of psychopathological symptoms is well compatible with the recently suggested "Spatiotemporal Psychopathology."
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Affiliation(s)
- Georg Northoff
- EJLB-Michael Smith Chair for Neuroscience and Mental Health, Royal Ottawa Healthcare Group, University of Ottawa Institute of Mental Health Research, Ottawa, ON, Canada.
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24
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Graham K, Searle A, Van Hooff M, Lawrence-Wood E, McFarlane A. The Value of Physical Symptoms in Screening For Posttraumatic Stress Disorder in the Military. Assessment 2019; 27:1139-1150. [PMID: 31328529 DOI: 10.1177/1073191119864662] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Physical symptoms are highly comorbid with posttraumatic stress disorder (PTSD). As PTSD is underdiagnosed, this study explored the value of self-reported physical symptoms in screening for 30-day PTSD in military personnel. Two physical symptom scales were constructed using items from a 67-item health symptom checklist, clinical interviews were used as the diagnostic reference standard, and diagnostic utility of physical symptoms was compared with the current gold standard screen, the PTSD checklist (PCL). Receiver operating characteristic analyses showed that both a 9-item and a 10-item physical symptom scale were of value in predicting PTSD (areas under the curve 0.81 and 0.85). Importantly, two thirds of PTSD positive personnel missed by the PCL were captured with physical symptoms scales, and when physical symptoms were added to the PCL, prediction was improved (areas under the curve 0.90 to 0.92). Our findings highlight the value of including assessing physical symptoms in PTSD screening.
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Affiliation(s)
- Kristin Graham
- The University of Adelaide, Adelaide, South Australia, Australia
| | - Amelia Searle
- The University of Adelaide, Adelaide, South Australia, Australia
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25
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Terpou BA, Densmore M, Thome J, Frewen P, McKinnon MC, Lanius RA. The Innate Alarm System and Subliminal Threat Presentation in Posttraumatic Stress Disorder: Neuroimaging of the Midbrain and Cerebellum. CHRONIC STRESS (THOUSAND OAKS, CALIF.) 2019; 3:2470547018821496. [PMID: 32440590 PMCID: PMC7219880 DOI: 10.1177/2470547018821496] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 11/28/2018] [Indexed: 01/01/2023]
Abstract
BACKGROUND The innate alarm system, a network of interconnected midbrain, other brainstem, and thalamic structures, serves to rapidly detect stimuli in the environment prior to the onset of conscious awareness. This system is sensitive to threatening stimuli and has evolved to process these stimuli subliminally for hastened responding. Despite the conscious unawareness, the presentation of subliminal threat stimuli generates increased activation of limbic structures, including the amygdala and insula, as well as emotionally evaluative structures, including the cerebellum and orbitofrontal cortex. Posttraumatic stress disorder (PTSD) is associated with an increased startle response and decreased extinction learning to conditioned threat. The role of the innate alarm system in the clinical presentation of PTSD, however, remains poorly understood. METHODS Here, we compare midbrain, brainstem, and cerebellar activation in persons with PTSD (n = 26) and matched controls (n = 20) during subliminal threat presentation. Subjects were presented with masked trauma-related and neutral stimuli below conscious threshold. Contrasts of subliminal brain activation for the presentation of neutral stimuli were subtracted from trauma-related brain activation. Group differences in activation, as well as correlations between clinical scores and PTSD activation, were examined. Imaging data were preprocessed utilizing the spatially unbiased infratentorial template toolbox within SPM12. RESULTS Analyses revealed increased midbrain activation in PTSD as compared to controls in the superior colliculus, periaqueductal gray, and midbrain reticular formation during subliminal threat as compared to neutral stimulus presentation. Controls showed increased activation in the right cerebellar lobule V during subliminal threat presentation as compared to PTSD. Finally, a negative correlation emerged between PTSD patient scores on the Multiscale Dissociation Inventory for the Depersonalization/Derealization subscale and activation in the right lobule V of the cerebellum during the presentation of subliminal threat as compared to neutral stimuli. CONCLUSION We interpret these findings as evidence of innate alarm system overactivation in PTSD and of the prominent role of the cerebellum in the undermodulation of emotion observed in PTSD.
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Affiliation(s)
- Braeden A. Terpou
- Department of Neuroscience, Western
University, London, Ontario, Canada
| | - Maria Densmore
- Department of Psychiatry, Western
University, London, Ontario, Canada
- Imaging Division,
Lawson
Health Research Institute, London, Ontario,
Canada
| | - Janine Thome
- Department of Psychiatry, Western
University, London, Ontario, Canada
- Department of Theoretical Neuroscience,
Central Institute of Mental Health Mannheim, Medical Faculty Mannheim, Heidelberg
University, Heidelberg, Germany
| | - Paul Frewen
- Department of Neuroscience, Western
University, London, Ontario, Canada
- Department of Psychology, Western
University, London, Ontario, Canada
| | - Margaret C. McKinnon
- Mood Disorders Program, St. Joseph’s
Healthcare, Hamilton, Ontario, Canada
- Department of Psychiatry and Behavioural
Neurosciences, McMaster University, Hamilton, Ontario, Canada
- Homewood Research Institute, Guelph,
Ontario, Canada
| | - Ruth A. Lanius
- Department of Neuroscience, Western
University, London, Ontario, Canada
- Department of Psychiatry, Western
University, London, Ontario, Canada
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26
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Thome J, Densmore M, Koppe G, Terpou B, Théberge J, McKinnon MC, Lanius RA. Back to the Basics: Resting State Functional Connectivity of the Reticular Activation System in PTSD and its Dissociative Subtype. CHRONIC STRESS (THOUSAND OAKS, CALIF.) 2019; 3:2470547019873663. [PMID: 32440600 PMCID: PMC7219926 DOI: 10.1177/2470547019873663] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 08/09/2019] [Indexed: 01/17/2023]
Abstract
BACKGROUND Brainstem and midbrain neuronal circuits that control innate, reflexive responses and arousal are increasingly recognized as central to the neurobiological framework of post-traumatic stress disorder (PTSD). The reticular activation system represents a fundamental neuronal circuit that plays a critical role not only in generating arousal but also in coordinating innate, reflexive responding. Accordingly, the present investigation aims to characterize the resting state functional connectivity of the reticular activation system in PTSD and its dissociative subtype. METHODS We investigated patterns of resting state functional connectivity of a central node of the reticular activation system, namely, the pedunculopontine nuclei, among individuals with PTSD (n = 77), its dissociative subtype (PTSD+DS; n = 48), and healthy controls (n = 51). RESULTS Participants with PTSD and PTSD+DS were characterized by within-group pedunculopontine nuclei resting state functional connectivity to brain regions involved in innate threat processing and arousal modulation (i.e., midbrain, amygdala, ventromedial prefrontal cortex). Critically, this pattern was most pronounced in individuals with PTSD+DS, as compared to both control and PTSD groups. As compared to participants with PTSD and controls, individuals with PTSD+DS showed enhanced pedunculopontine nuclei resting state functional connectivity to the amygdala and the parahippocampal gyrus as well as to the anterior cingulate and the ventromedial prefrontal cortex. No group differences emerged between PTSD and control groups. In individuals with PTSD+DS, state derealization/depersonalization was associated with reduced resting state functional connectivity between the left pedunculopontine nuclei and the anterior nucleus of the thalamus. Altered connectivity in these regions may restrict the thalamo-cortical transmission necessary to integrate internal and external signals at a cortical level and underlie, in part, experiences of depersonalization and derealization. CONCLUSIONS The present findings extend the current neurobiological model of PTSD and provide emerging evidence for the need to incorporate brainstem structures, including the reticular activation system, into current conceptualizations of PTSD and its dissociative subtype.
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Affiliation(s)
- Janine Thome
- Department of Psychiatry, Western
University, London, Ontario, Canada
- Department of Theoretical Neuroscience,
Central
Institute of Mental Health Mannheim, Medical
Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Department of Psychiatry,
Central
Institute of Mental Health Mannheim, Medical
Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Maria Densmore
- Department of Psychiatry, Western
University, London, Ontario, Canada
- Imaging Division,
Lawson
Health Research Institute, London, Ontario,
Canada
| | - Georgia Koppe
- Department of Theoretical Neuroscience,
Central
Institute of Mental Health Mannheim, Medical
Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Department of Psychiatry,
Central
Institute of Mental Health Mannheim, Medical
Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Braeden Terpou
- Department of Psychiatry, Western
University, London, Ontario, Canada
- Department of Neuroscience, Western
University, London, Ontario, Canada
| | - Jean Théberge
- Department of Psychiatry, Western
University, London, Ontario, Canada
- Imaging Division,
Lawson
Health Research Institute, London, Ontario,
Canada
- Department of Medical Biophysics,
Western University, London, Ontario, Canada
| | - Margaret C. McKinnon
- Homewood Research Institute, Guelph,
Ontario, Canada
- Mood Disorder Programs, St. Joseph's
Healthcare, Hamilton, Ontario, Canada
- Department of Psychiatry and Behavioral
Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Ruth A. Lanius
- Department of Psychiatry, Western
University, London, Ontario, Canada
- Imaging Division,
Lawson
Health Research Institute, London, Ontario,
Canada
- Department of Neuroscience, Western
University, London, Ontario, Canada
- Homewood Research Institute, Guelph,
Ontario, Canada
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27
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Vujanovic AA, Wardle MC, Bakhshaie J, Smith LJ, Green CE, Lane SD, Schmitz JM. Distress tolerance: Associations with trauma and substance cue reactivity in low-income, inner-city adults with substance use disorders and posttraumatic stress. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2018; 32:264-276. [PMID: 29771557 DOI: 10.1037/adb0000362] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Cue reactivity has great potential to advance our understanding of posttraumatic stress disorder (PTSD), substance use disorder (SUD), and PTSD/SUD comorbidity. The present investigation examined distress tolerance (DT) with regard to trauma and substance cue reactivity. Participants included 58 low-income, inner-city adults (49.1% women; Mage = 45.73, SD = 10.00) with substance dependence and at least 4 symptoms of PTSD. A script-driven cue reactivity paradigm was utilized. Four DT measures were administered, including the Distress Tolerance Scale (DTS), Mirror-Tracing Persistence Task (MTPT), Breath-Holding Task (BH), and Paced Auditory Serial Addition Task (PASAT). Lower DT, as indexed by MTPT duration, was significantly predictive of greater levels of self-reported substance cravings/urges in response to trauma cues, above and beyond covariates. Lower DTS scores predicted lower levels of self-reported control/safety ratings in response to substance cues. None of the DT indices was significantly predictive of heart rate variability. Clinical and research implications are discussed. (PsycINFO Database Record
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Affiliation(s)
| | - Margaret C Wardle
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at Houston
| | | | - Lia J Smith
- Department of Psychology, University of Houston
| | - Charles E Green
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at Houston
| | - Scott D Lane
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at Houston
| | - Joy M Schmitz
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at Houston
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Yang S, Wynn GH, Ursano RJ. A Clinician's Guide to PTSD Biomarkers and Their Potential Future Use. FOCUS: JOURNAL OF LIFE LONG LEARNING IN PSYCHIATRY 2018; 16:143-152. [PMID: 31975909 DOI: 10.1176/appi.focus.20170045] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
No clinically validated biomarkers have yet been found to assist in the diagnosis and treatment of posttraumatic stress disorder (PTSD). Innovation in clinical trial design, however, has led to the study of biomarkers as part of testing new medications and psychotherapies. There may soon be viable biomarkers to assist in diagnosis of PTSD and prediction of illness trajectory, severity, and functional outcomes; subtyping; and treatment selection. Processes for the identification and validation of biomarker findings are complex, involving several stages of clinical testing before use. The authors provide an overview of issues regarding the clinical use of PTSD biomarkers and examine a set of genetic, epigenetic, and other blood-based markers along with physiological markers currently proposed as candidate tests for PTSD. Studies that have identified candidate biomarkers with relevance to treatment selection in PTSD are discussed as a promising area of research that may lead to changes in clinical practice.
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Affiliation(s)
- Suzanne Yang
- The authors are with the Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University, Bethesda, Maryland. Dr. Yang is also with the Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland
| | - Gary H Wynn
- The authors are with the Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University, Bethesda, Maryland. Dr. Yang is also with the Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland
| | - Robert J Ursano
- The authors are with the Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University, Bethesda, Maryland. Dr. Yang is also with the Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland
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Bourla A, Mouchabac S, El Hage W, Ferreri F. e-PTSD: an overview on how new technologies can improve prediction and assessment of Posttraumatic Stress Disorder (PTSD). Eur J Psychotraumatol 2018; 9:1424448. [PMID: 29441154 PMCID: PMC5804808 DOI: 10.1080/20008198.2018.1424448] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 12/18/2017] [Indexed: 02/01/2023] Open
Abstract
Background: New technologies may profoundly change our way of understanding psychiatric disorders including posttraumatic stress disorder (PTSD). Imaging and biomarkers, along with technological and medical informatics developments, might provide an answer regarding at-risk patient's identification. Recent advances in the concept of 'digital phenotype', which refers to the capture of characteristics of a psychiatric disorder by computerized measurement tools, is one paradigmatic example. Objective: The impact of the new technologies on health professionals practice in PTSD care remains to be determined. The recent evolutions could disrupt the clinical practices and practitioners in their beliefs, ethics and representations, going as far as questioning their professional culture. In the present paper, we conducted an extensive search to highlight the articles which reflect the potential of these new technologies. Method: We conducted an overview by querying PubMed database with the terms [PTSD] [Posttraumatic stress disorder] AND [Computer] OR [Computerized] OR [Mobile] OR [Automatic] OR [Automated] OR [Machine learning] OR [Sensor] OR [Heart rate variability] OR [HRV] OR [actigraphy] OR [actimetry] OR [digital] OR [motion] OR [temperature] OR [virtual reality]. Results: We summarized the synthesized literature in two categories: prediction and assessment (including diagnostic, screening and monitoring). Two independent reviewers screened, extracted data and quality appraised the sources. Results were synthesized narratively. Conclusions: This overview shows that many studies are underway allowing researchers to start building a PTSD digital phenotype using passive data obtained by biometric sensors. Active data obtained from Ecological Momentary Assessment (EMA) could allow clinicians to assess PTSD patients. The place of connected objects, Artificial Intelligence and remote monitoring of patients with psychiatric pathology remains to be defined. These tools must be explained and adapted to the different profiles of physicians and patients. The involvement of patients, caregivers and health professionals is essential to the design and evaluation of these new tools.
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Affiliation(s)
- Alexis Bourla
- Department of Psychiatry, Sorbonne Université, AP-HP, Hôpital Saint-Antoine, Service de Psychiatrie, Paris, France
| | - Stephane Mouchabac
- Department of Psychiatry, Sorbonne Université, AP-HP, Hôpital Saint-Antoine, Service de Psychiatrie, Paris, France
| | - Wissam El Hage
- Clinique Psychiatrique Universitaire, CHRU de Tours, Université François-Rabelais de Tours, Tours, France
| | - Florian Ferreri
- Department of Psychiatry, Sorbonne Université, AP-HP, Hôpital Saint-Antoine, Service de Psychiatrie, Paris, France
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30
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Koch SBJ, Klumpers F, Zhang W, Hashemi MM, Kaldewaij R, van Ast VA, Smit AS, Roelofs K. The role of automatic defensive responses in the development of posttraumatic stress symptoms in police recruits: protocol of a prospective study. Eur J Psychotraumatol 2017; 8:1412226. [PMID: 29321826 PMCID: PMC5757225 DOI: 10.1080/20008198.2017.1412226] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Accepted: 11/20/2017] [Indexed: 12/24/2022] Open
Abstract
Background: Control over automatic tendencies is often compromised in challenging situations when people fall back on automatic defensive reactions, such as freeze-fight-flight responses. Stress-induced lack of control over automatic defensive responses constitutes a problem endemic to high-risk professions, such as the police. Difficulties controlling automatic defensive responses may not only impair split-second decisions under threat, but also increase the risk for and persistence of posttraumatic stress disorder (PTSD) symptoms. However, the significance of these automatic defensive responses in the development and maintenance of trauma-related symptoms remains unclear due to a shortage of large-scale prospective studies. Objective: The 'Police-in-Action' study is conducted to investigate the role of automatic defensive responses in the development and maintenance of PTSD symptomatology after trauma exposure. Methods: In this prospective study, 340 police recruits from the Dutch Police Academy are tested before (wave 1; pre-exposure) and after (wave 2; post-exposure) their first emergency aid experiences as police officers. The two waves of data assessment are separated by approximately 15 months. To control for unspecific time effects, a well-matched control group of civilians (n = 85) is also tested twice, approximately 15 months apart, but without being frequently exposed to potentially traumatic events. Main outcomes are associations between (changes in) behavioural, psychophysiological, endocrine and neural markers of automatic defensive responses and development of trauma-related symptoms after trauma exposure in police recruits. Discussion: This prospective study in a large group of primary responders enables us to distinguish predisposing from acquired neurobiological abnormalities in automatic defensive responses, associated with the development of trauma-related symptoms. Identifying neurobiological correlates of (vulnerability for) trauma-related psychopathology may greatly improve screening for individuals at risk for developing PTSD symptomatology and offer valuable targets for (early preventive) interventions for PTSD.
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Affiliation(s)
- Saskia B J Koch
- Donders Institute for Brain, Cognition and Behaviour, Centre for Cognitive Neuroimaging, Radboud University Nijmegen, Nijmegen, The Netherlands.,Behavioural Science Institute, Radboud University Nijmegen, Nijmegen, The Netherlands
| | - Floris Klumpers
- Donders Institute for Brain, Cognition and Behaviour, Centre for Cognitive Neuroimaging, Radboud University Nijmegen, Nijmegen, The Netherlands.,Behavioural Science Institute, Radboud University Nijmegen, Nijmegen, The Netherlands
| | - Wei Zhang
- Donders Institute for Brain, Cognition and Behaviour, Centre for Cognitive Neuroimaging, Radboud University Nijmegen, Nijmegen, The Netherlands.,Behavioural Science Institute, Radboud University Nijmegen, Nijmegen, The Netherlands
| | - Mahur M Hashemi
- Donders Institute for Brain, Cognition and Behaviour, Centre for Cognitive Neuroimaging, Radboud University Nijmegen, Nijmegen, The Netherlands.,Behavioural Science Institute, Radboud University Nijmegen, Nijmegen, The Netherlands
| | - Reinoud Kaldewaij
- Donders Institute for Brain, Cognition and Behaviour, Centre for Cognitive Neuroimaging, Radboud University Nijmegen, Nijmegen, The Netherlands.,Behavioural Science Institute, Radboud University Nijmegen, Nijmegen, The Netherlands
| | - Vanessa A van Ast
- Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Annika S Smit
- Police Academy of the Netherlands, Apeldoorn, The Netherlands
| | - Karin Roelofs
- Donders Institute for Brain, Cognition and Behaviour, Centre for Cognitive Neuroimaging, Radboud University Nijmegen, Nijmegen, The Netherlands.,Behavioural Science Institute, Radboud University Nijmegen, Nijmegen, The Netherlands
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