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de Souza Junior S, Monteiro Fabricio Gama C, Menezes Gonçalves R, Lorrany Campos Guerra T, Volchan E, Erthal FS, Mocaiber I, de Paula Antunes David I, Catarina Lima Portugal L, Mendlowicz MV, Berger W, de Oliveira L, Garcia Pereira M. Tonic immobility triggered by COVID-19-related trauma is associated with long-term PTSD symptoms. J Anxiety Disord 2024; 105:102894. [PMID: 38959538 DOI: 10.1016/j.janxdis.2024.102894] [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: 12/14/2023] [Revised: 05/01/2024] [Accepted: 06/18/2024] [Indexed: 07/05/2024]
Abstract
During the COVID-19 pandemic healthcare workers were repeatedly exposed to traumatic experiences. Facing life-threatening events and repeated exposure to traumatic duty-related situations may cause posttraumatic stress disorder (PTSD). While tonic immobility has been considered a key vulnerability factor for PTSD, little is known about this relationship in the long term. In this study, we aimed to determine whether peritraumatic tonic immobility triggered by COVID-19-related trauma predicts PTSD symptom severity six to twelve months later. We conducted an online longitudinal survey using the PTSD Checklist for the DSM-5 (PCL-5) and the Tonic Immobility Scale to assess PTSD symptoms and the tonic immobility response, respectively. Multivariate regression models revealed a significant association between tonic immobility and PTSD symptoms. Each one-unit increase in the tonic immobility score was associated with a 1.5 % increase in the average PTSD symptom score six to twelve months after the traumatic event that triggered the tonic immobility. Furthermore, participants who showed significant or extreme levels of tonic immobility were 3.5 times or 7.3 times more likely to have a probable PTSD diagnosis, respectively. Hence, peritraumatic tonic immobility seems to have a lasting deleterious effect on mental health. Psychological treatment for health care professionals is urgent, and psychoeducation about the involuntary, biological nature of tonic immobility is essential to reduce suffering.
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Affiliation(s)
- Sérgio de Souza Junior
- Departamento de Fisiologia e Farmacologia, Instituto Biomédico, Universidade Federal Fluminense, Rua Hernani Pires de Mello, 101, São Domingos, Niterói, RJ 24210-130, Brazil; Programa de Pós-graduação em Ciências Biomédicas (Fisiologia e Farmacologia), Universidade Federal Fluminense, Niterói, RJ Brazil
| | - Camila Monteiro Fabricio Gama
- Departamento de Fisiologia e Farmacologia, Instituto Biomédico, Universidade Federal Fluminense, Rua Hernani Pires de Mello, 101, São Domingos, Niterói, RJ 24210-130, Brazil; Programa de Pós-graduação em Ciências Biomédicas (Fisiologia e Farmacologia), Universidade Federal Fluminense, Niterói, RJ Brazil
| | - Raquel Menezes Gonçalves
- Departamento de Fisiologia e Farmacologia, Instituto Biomédico, Universidade Federal Fluminense, Rua Hernani Pires de Mello, 101, São Domingos, Niterói, RJ 24210-130, Brazil; Programa de Pós-graduação em Ciências Biomédicas (Fisiologia e Farmacologia), Universidade Federal Fluminense, Niterói, RJ Brazil
| | - Thayssa Lorrany Campos Guerra
- Departamento de Fisiologia e Farmacologia, Instituto Biomédico, Universidade Federal Fluminense, Rua Hernani Pires de Mello, 101, São Domingos, Niterói, RJ 24210-130, Brazil
| | - Eliane Volchan
- Laboratório de Neurobiologia, Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Av. Carlos Chagas Filho 373, Cidade Universitária, Rio de Janeiro, RJ 21941-902, Brazil; Instituto de Psiquiatria da UFRJ, Departamento de Psiquiatria e Saúde Mental, Universidade Federal do Rio de Janeiro, Avenida Venceslau Brás, 71, Fundos, Botafogo, Rio de Janeiro, RJ 22290140, Brazil
| | - Fátima Smith Erthal
- Laboratório de Neurobiologia, Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Av. Carlos Chagas Filho 373, Cidade Universitária, Rio de Janeiro, RJ 21941-902, Brazil; Instituto de Psiquiatria da UFRJ, Departamento de Psiquiatria e Saúde Mental, Universidade Federal do Rio de Janeiro, Avenida Venceslau Brás, 71, Fundos, Botafogo, Rio de Janeiro, RJ 22290140, Brazil
| | - Izabela Mocaiber
- Laboratório de Psicofisiologia Cognitiva, Departamento de Ciências da Natureza, Instituto de Humanidades e Saúde, Universidade Federal Fluminense, Rua Recife s/nº, Jardim Bela Vista, Rio das Ostras, RJ 28890-000, Brazil; Programa de pós-graduação em Medicina (Neurologia/Neurociências), Universidade Federal Fluminense, Niterói, Brasil; Programa de Pós-graduação em Ciências Biomédicas (Fisiologia e Farmacologia), Universidade Federal Fluminense, Niterói, RJ Brazil
| | - Isabel de Paula Antunes David
- Departamento de Fisiologia e Farmacologia, Instituto Biomédico, Universidade Federal Fluminense, Rua Hernani Pires de Mello, 101, São Domingos, Niterói, RJ 24210-130, Brazil; Programa de Pós-graduação em Ciências Biomédicas (Fisiologia e Farmacologia), Universidade Federal Fluminense, Niterói, RJ Brazil
| | - Liana Catarina Lima Portugal
- Departamento de Ciências Fisiológicas, Instituto de Biologia Roberto Alcantara Gomes, Centro Biomédico, Universidade do Estado do Rio de Janeiro, Avenida Professor Manuel de Abreu 444, 5º Andar, Vila Isabel, Rio de Janeiro, RJ 20550-170, Brazil
| | - Mauro Vitor Mendlowicz
- Instituto de Psiquiatria da UFRJ, Departamento de Psiquiatria e Saúde Mental, Universidade Federal do Rio de Janeiro, Avenida Venceslau Brás, 71, Fundos, Botafogo, Rio de Janeiro, RJ 22290140, Brazil
| | - William Berger
- Instituto de Psiquiatria da UFRJ, Departamento de Psiquiatria e Saúde Mental, Universidade Federal do Rio de Janeiro, Avenida Venceslau Brás, 71, Fundos, Botafogo, Rio de Janeiro, RJ 22290140, Brazil
| | - Leticia de Oliveira
- Departamento de Fisiologia e Farmacologia, Instituto Biomédico, Universidade Federal Fluminense, Rua Hernani Pires de Mello, 101, São Domingos, Niterói, RJ 24210-130, Brazil; Programa de Pós-graduação em Ciências Biomédicas (Fisiologia e Farmacologia), Universidade Federal Fluminense, Niterói, RJ Brazil.
| | - Mirtes Garcia Pereira
- Departamento de Fisiologia e Farmacologia, Instituto Biomédico, Universidade Federal Fluminense, Rua Hernani Pires de Mello, 101, São Domingos, Niterói, RJ 24210-130, Brazil; Programa de pós-graduação em Medicina (Neurologia/Neurociências), Universidade Federal Fluminense, Niterói, Brasil; Programa de Pós-graduação em Ciências Biomédicas (Fisiologia e Farmacologia), Universidade Federal Fluminense, Niterói, RJ Brazil.
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Morabito DM, Schmidt NB. Efficacy of a brief web-based tonic immobility psychoeducation intervention among trauma-exposed adults: A randomized clinical trial. J Trauma Stress 2023; 36:896-906. [PMID: 37467150 DOI: 10.1002/jts.22955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 04/21/2023] [Accepted: 05/06/2023] [Indexed: 07/21/2023]
Abstract
Tonic immobility (TI) is a defensive response that may occur during traumatic events. Although TI is adaptive in certain circumstances, it has been shown to contribute to increased trauma-related symptoms and poorer recovery. However, current frontline treatments for posttraumatic stress disorder (PTSD) have not focused significant attention on the experience of TI. Thus, the aim of this study was to develop and test the impact of a brief TI-focused psychoeducation (TIP) intervention on posttraumatic cognitions and PTSD symptoms relative to a health education control intervention. The sample included 46 adults with elevated PTSD symptoms who endorsed prior TI episodes. After providing informed consent, participants were randomly assigned to either the active or control intervention and completed self-report questionnaires including the tonic immobility questionnaire (TIQ-R), Life Events Checklist for DSM-5 (LEC-5), Posttraumatic Stress Checklist for DSM-5 (PCL-5), Posttraumatic Cognitions Inventory (PTCI), and Positive and Negative Affect Schedule (PANAS) at baseline, 1-week, and 1-month follow-up assessments. Results from linear mixed effects models indicated that participants in the TIP condition reported significantly larger reductions in posttraumatic cognitions and PTSD symptoms at 1-week, ds = 0.48 and 0.84, respectively, and 1-month, ds = 0.67 and 0.74. The findings suggest that TIP is a promising intervention that may be used to reduce posttraumatic cognitions and PTSD symptoms associated with TI. Given the ease of access, TIP could be used as a standalone intervention or as an add-on to existing evidence-based treatments for PTSD.
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Affiliation(s)
- Danielle M Morabito
- Department of Psychology, Florida State University, Tallahassee, Florida, USA
| | - Norman B Schmidt
- Department of Psychology, Florida State University, Tallahassee, Florida, USA
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Coimbra BM, Hoeboer CM, van Zuiden M, Williamson RE, D'Elia AT, Mello AF, Mello MF, Olff M. The relationship between tonic immobility and the development, severity, and course of posttraumatic stress disorder: Systematic and meta-analytic literature review. J Anxiety Disord 2023; 97:102730. [PMID: 37229971 DOI: 10.1016/j.janxdis.2023.102730] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 05/10/2023] [Accepted: 05/18/2023] [Indexed: 05/27/2023]
Abstract
BACKGROUND Tonic immobility (TI) is a reflexive, involuntary response that causes motor inhibition, vocal suppression, and analgesia. TI is elicited by extreme fear and perception of entrapment in a life-threatening situation. Research suggests that TI is a frequent peritraumatic response and may be related to subsequent posttraumatic stress disorder (PTSD). However, findings are mixed and, as of yet, no systematic or meta-analytic review examining associations between TI and PTSD has been published. OBJECTIVE We systematically and meta-analytically reviewed the literature and investigated whether TI is associated with the development, severity, and course of PTSD. Additionally, we evaluated whether different types of traumatic events are differentially associated with TI, and whether TI severity differs according to sex. METHODS A systematic literature search was conducted using Embase, PubMed, PsycINFO, and Scopus. Meta-analyses were performed on the included articles. RESULTS We identified 27 eligible articles. We found a significant association between TI and PTSD symptom severity (r = 0.39, 95% CI: 0.34-0.44; p < .0001). TI was more severe among females (Cohen's d=0.37, 95% CI: 0.25-0.48; p < .0001) and was more often elicited in situations involving interpersonal violence. We found limited longitudinal data to perform a meta-analysis of the association between TI and the development and/or course of PTSD. However, the literature available seems to support the role of TI in both the development and course of PTSD. CONCLUSIONS Peritraumatic TI is associated with PTSD symptom severity, occurs more often during interpersonal violence, and is more severe among females. More longitudinal research is needed to investigate the role of TI in psychopathology development and course.
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Affiliation(s)
- Bruno Messina Coimbra
- Amsterdam UMC, University of Amsterdam, Department of Psychiatry, Amsterdam Public Health Research Institute and Amsterdam Neuroscience Research Institute, Amsterdam, the Netherlands; Program for Research and Care on Violence and PTSD (PROVE), Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil.
| | - Chris Maria Hoeboer
- Amsterdam UMC, University of Amsterdam, Department of Psychiatry, Amsterdam Public Health Research Institute and Amsterdam Neuroscience Research Institute, Amsterdam, the Netherlands
| | - Mirjam van Zuiden
- Department of Clinical Psychology, Utrecht University, Utrecht, the Netherlands
| | - Rachel E Williamson
- Department of Psychology, University of Montana, Missoula, MT, United States
| | - Ana Teresa D'Elia
- Program for Research and Care on Violence and PTSD (PROVE), Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Andrea Feijo Mello
- Program for Research and Care on Violence and PTSD (PROVE), Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Marcelo Feijo Mello
- Program for Research and Care on Violence and PTSD (PROVE), Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Miranda Olff
- Amsterdam UMC, University of Amsterdam, Department of Psychiatry, Amsterdam Public Health Research Institute and Amsterdam Neuroscience Research Institute, Amsterdam, the Netherlands; ARQ National Psychotrauma Centre, Diemen, the Netherlands
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Coliță CI, Olaru DG, Coliță D, Hermann DM, Coliță E, Glavan D, Popa-Wagner A. Induced Coma, Death, and Organ Transplantation: A Physiologic, Genetic, and Theological Perspective. Int J Mol Sci 2023; 24:ijms24065744. [PMID: 36982814 PMCID: PMC10059721 DOI: 10.3390/ijms24065744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Revised: 03/13/2023] [Accepted: 03/15/2023] [Indexed: 03/19/2023] Open
Abstract
In the clinic, the death certificate is issued if brain electrical activity is no longer detectable. However, recent research has shown that in model organisms and humans, gene activity continues for at least 96 h postmortem. The discovery that many genes are still working up to 48 h after death questions our definition of death and has implications for organ transplants and forensics. If genes can be active up to 48 h after death, is the person technically still alive at that point? We discovered a very interesting parallel between genes that were upregulated in the brain after death and genes upregulated in the brains that were subjected to medically-induced coma, including transcripts involved in neurotransmission, proteasomal degradation, apoptosis, inflammation, and most interestingly, cancer. Since these genes are involved in cellular proliferation, their activation after death could represent the cellular reaction to escape mortality and raises the question of organ viability and genetics used for transplantation after death. One factor limiting the organ availability for transplantation is religious belief. However, more recently, organ donation for the benefit of humans in need has been seen as “posthumous giving of organs and tissues can be a manifestation of love spreading also to the other side of death”.
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Affiliation(s)
- Cezar-Ivan Coliță
- Doctoral School, University of Medicine and Pharmacy Carol Davila, 020276 Bucharest, Romania; (C.-I.C.)
| | - Denissa-Greta Olaru
- Department of Psychiatry, University for Medicine and Pharmacy Craiova, 200349 Craiova, Romania;
| | - Daniela Coliță
- Doctoral School, University of Medicine and Pharmacy Carol Davila, 020276 Bucharest, Romania; (C.-I.C.)
| | - Dirk M. Hermann
- Chair of Vascular Neurology, Dementia and Ageing, Department of Neurology, University Hospital Essen, 45147 Essen, Germany
| | - Eugen Coliță
- Doctoral School, University of Medicine and Pharmacy Carol Davila, 020276 Bucharest, Romania; (C.-I.C.)
| | - Daniela Glavan
- Department of Psychiatry, University for Medicine and Pharmacy Craiova, 200349 Craiova, Romania;
- Correspondence: (D.G.); (A.P.-W.)
| | - Aurel Popa-Wagner
- Department of Psychiatry, University for Medicine and Pharmacy Craiova, 200349 Craiova, Romania;
- Chair of Vascular Neurology, Dementia and Ageing, Department of Neurology, University Hospital Essen, 45147 Essen, Germany
- Correspondence: (D.G.); (A.P.-W.)
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5
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deMello RAF, Coimbra BM, Pedro BDM, Benvenutti IM, Yeh MSL, Mello AF, Mello MF, Poyares DR. Peri-Traumatic Dissociation and Tonic Immobility as Severity Predictors of Posttraumatic Stress Disorder After Rape. JOURNAL OF INTERPERSONAL VIOLENCE 2023; 38:4240-4266. [PMID: 35899768 DOI: 10.1177/08862605221114151] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Some individuals show abnormal reactions to extreme fear and life-threatening situations, including tonic immobility (TI) and peri-traumatic dissociation (PTD). We aimed to investigate the association of TI and PTD with posttraumatic stress disorder (PTSD) in women who experienced sexual violence and the risk factors for PTD occurrence. We compared PTSD severity in 86 young adult women with PTSD after a sexual violence exposure grouped according to the presence of PTD and TI. In addition, we investigated whether PTD is associated with depression and anxiety symptoms and assessed potential risk factors for PTD reaction. We found a significant positive correlation between PTSD severity and PTD occurrence (R2 = .132; p = .001). PTD was also positively correlated with all clusters of PTSD symptoms except the Clinician-Administered PTSD Scale avoidance cluster (p = .058). PTD was strongly correlated with anxiety (R2 = .619; p < .001) and depressive symptoms (R2 = .547; p < .001). Multiple logistic regression showed that history of physical abuse (odds ratio [OR]: 1.386; p = .011) and sexual abuse (OR: 1.947; p = .004) during childhood were associated with PTD occurrence. Other risk factors for PTD were having less years of study (OR: 0.216; p = .016) and lower income (OR: 7.403; p = .028). TI measures were available for a subsample of 29 women. We found no association between TI and PTSD severity. PTD, but not TI, is significantly associated with more severe PTSD, depressive, and anxiety symptoms. Less-educated women with a history of childhood abuse and a lower income are at risk of PTD occurrence during a sexual violence episode.
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Affiliation(s)
- Ricardo A F deMello
- Faculdade Israelita de Ciências da Saúde Albert Einstein, Instituto Israelita de Ensino e Pesquisa, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Bruno Messina Coimbra
- Program for Research and Care on Violence and PTSD (PROVE), Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
- Amsterdam UMC, location University of Amsterdam, Department of Psychiatry, Amsterdam Public Health Research Institute and Amsterdam Neuroscience Research Institute, Amsterdam, The Netherlands
| | - Bianca D M Pedro
- Faculdade Israelita de Ciências da Saúde Albert Einstein, Instituto Israelita de Ensino e Pesquisa, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Isabella M Benvenutti
- Faculdade Israelita de Ciências da Saúde Albert Einstein, Instituto Israelita de Ensino e Pesquisa, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Mary S L Yeh
- Program for Research and Care on Violence and PTSD (PROVE), Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Andrea F Mello
- Faculdade Israelita de Ciências da Saúde Albert Einstein, Instituto Israelita de Ensino e Pesquisa, Hospital Israelita Albert Einstein, São Paulo, Brazil
- Program for Research and Care on Violence and PTSD (PROVE), Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Marcelo F Mello
- Faculdade Israelita de Ciências da Saúde Albert Einstein, Instituto Israelita de Ensino e Pesquisa, Hospital Israelita Albert Einstein, São Paulo, Brazil
- Program for Research and Care on Violence and PTSD (PROVE), Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Dalva R Poyares
- Department of Psychobiology, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
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Gowda SB, Banu A, Salim S, Peker KA, Mohammad F. Serotonin distinctly controls behavioral states in restrained and freely moving Drosophila. iScience 2022; 26:105886. [PMID: 36654863 PMCID: PMC9840979 DOI: 10.1016/j.isci.2022.105886] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 11/09/2022] [Accepted: 12/22/2022] [Indexed: 12/29/2022] Open
Abstract
When trapped in a physical restraint, animals must select an escape strategy to increase their chances of survival. After falling into an inescapable trap, they react with stereotypical behaviors that differ from those displayed in escapable situations. Such behaviors involve either a wriggling response to unlock the trap or feigning death to fend off a predator attack. The neural mechanisms that regulate animal behaviors have been well characterized for escapable situations but not for inescapable traps. We report that restrained vinegar flies exhibit alternating flailing and immobility to free themselves from the trap. We used optogenetics and intersectional genetic approaches to show that, while broader serotonin activation promotes immobility, serotonergic cells in the ventral nerve cord (VNC) regulate immobility states majorly via 5-HT7 receptors. Restrained and freely moving locomotor states are controlled by distinct mechanisms. Taken together, our study has identified serotonergic switches of the VNC that promote environment-specific adaptive behaviors.
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Affiliation(s)
- Swetha B.M. Gowda
- Division of Biological and Biomedical Sciences (BBS), College of Health & Life Sciences (CHLS), Hamad Bin Khalifa University (HBKU), Doha 34110, Qatar
| | - Ayesha Banu
- Division of Biological and Biomedical Sciences (BBS), College of Health & Life Sciences (CHLS), Hamad Bin Khalifa University (HBKU), Doha 34110, Qatar
| | - Safa Salim
- Division of Biological and Biomedical Sciences (BBS), College of Health & Life Sciences (CHLS), Hamad Bin Khalifa University (HBKU), Doha 34110, Qatar
| | | | - Farhan Mohammad
- Division of Biological and Biomedical Sciences (BBS), College of Health & Life Sciences (CHLS), Hamad Bin Khalifa University (HBKU), Doha 34110, Qatar,Corresponding author
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7
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Beyond fear: Patients with posttraumatic stress disorder fail to engage in safety cues. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2022. [DOI: 10.1016/j.jadr.2022.100380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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8
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Gama CMF, de Souza Junior S, Gonçalves RM, Santos EDC, Machado AV, Portugal LCL, Passos RBF, Erthal FS, Vilete LMP, Mendlowicz MV, Berger W, Volchan E, de Oliveira L, Pereira MG. Tonic immobility is associated with posttraumatic stress symptoms in healthcare professionals exposed to COVID-19-related trauma. J Anxiety Disord 2022; 90:102604. [PMID: 35917747 PMCID: PMC9272678 DOI: 10.1016/j.janxdis.2022.102604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 07/01/2022] [Accepted: 07/04/2022] [Indexed: 11/16/2022]
Abstract
The Coronavirus Disease 2019 (COVID-19) pandemic has exposed healthcare workers (HCW) to traumatic situations that might lead to the development of posttraumatic stress disorder (PTSD). An important vulnerability factor for PTSD is the peritraumatic tonic immobility (TI) reaction, an involuntary and reflexive defensive response evoked by an intense and inescapable threat. TI is largely understudied in humans and has not been investigated during trauma related to COVID-19. For HCW, the pandemic context might be experienced as an intense and potentially inescapable threat, i.e., an overwhelming situation. Here, we investigated if TI response occurred during traumatic events related to the pandemic and its association with posttraumatic stress symptoms (PTSS). An online survey of 1001 HCW investigated COVID-19-related traumatic experiences, TI and PTSS. TI was reported for all types of traumatic events, and multivariate regression models revealed that TI was significantly associated with PTSS severity. HCW who reported high TI scores exhibited an increase of 9.08 times the probability of having a probable diagnosis of PTSD. Thus, TI was evoked by pandemic-related traumatic situations and associated with PTSS severity and higher odds of a PTSD diagnosis. Tonic immobility occurrence should be screened, and psychoeducation about its reflexive biological nature should be introduced.
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Affiliation(s)
- Camila Monteiro Fabricio Gama
- Laboratório de Neurofisiologia do Comportamento (LabNeC), Departamento de Fisiologia e Farmacologia, Instituto Biomédico, Universidade Federal Fluminense, Rua Hernani Pires de Mello, 101, São Domingos, 24210-130 Niterói, RJ, Brazil.
| | - Sérgio de Souza Junior
- Laboratório de Neurofisiologia do Comportamento (LabNeC), Departamento de Fisiologia e Farmacologia, Instituto Biomédico, Universidade Federal Fluminense, Rua Hernani Pires de Mello, 101, São Domingos, 24210-130 Niterói, RJ, Brazil.
| | - Raquel Menezes Gonçalves
- Laboratório de Neurofisiologia do Comportamento (LabNeC), Departamento de Fisiologia e Farmacologia, Instituto Biomédico, Universidade Federal Fluminense, Rua Hernani Pires de Mello, 101, São Domingos, 24210-130 Niterói, RJ, Brazil.
| | - Emmanuele da Conceição Santos
- Laboratório de Neurofisiologia do Comportamento (LabNeC), Departamento de Fisiologia e Farmacologia, Instituto Biomédico, Universidade Federal Fluminense, Rua Hernani Pires de Mello, 101, São Domingos, 24210-130 Niterói, RJ, Brazil.
| | - Arthur Viana Machado
- Laboratório de Psicofisiologia Cognitiva, de Ciencias da NaturezaDepartamento de Ciências da Natureza, Instituto de Humanidades e Saúde, Universidade Federal Fluminense, Rua Recife s/no Jardim Bela Vista, 28890-000 Rio das Ostras, RJ, Brazil.
| | - Liana Catarina Lima Portugal
- Laboratório de Neurofisiologia do Comportamento (LabNeC), Departamento de Fisiologia e Farmacologia, Instituto Biomédico, Universidade Federal Fluminense, Rua Hernani Pires de Mello, 101, São Domingos, 24210-130 Niterói, RJ, Brazil; Departamento de Ciências Fisiológicas, Instituto de Biologia Roberto Alcantara Gomes, Centro Biomédico, Universidade do Estado do Rio de Janeiro, Avenida Professor Manuel de Abreu 444, 5º andar, Vila Isabel, 20550-170 Rio de Janeiro, RJ, Brazil.
| | - Roberta Benitez Freitas Passos
- Departamento de Medicina Geral, Escola de Medicina e Cirurgia, Universidade Federal do Estado do Rio de Janeiro, Rua Mariz e Barros 775, 7a. enfermaria, Maracanã, 20270-004 Rio de Janeiro, RJ, Brazil.
| | - Fátima Smith Erthal
- Laboratório de Neurobiologia, Instituto de Biofísica Carlos Chagas Filho, Bloco G, Centro de Ciências da Saúde, Universidade Federal do Rio de Janeiro, Ilha do Fundão 21949-900, RJ, Brazil.
| | - Liliane Maria Pereira Vilete
- Instituto de Psiquiatria da UFRJ, Departamento de Psiquiatria e Saúde Mental, Universidade Federal do Rio de Janeiro, Avenida Venceslau Brás, 71, Fundos, Botafogo, 22290140 Rio de Janeiro, RJ, Brazil; Instituto de Psiquiatria da UFRJ, Universidade Federal do Rio de Janeiro, Avenida Venceslau Brás, 71, Fundos, Botafogo, 22290140 Rio de Janeiro, RJ, Brazil.
| | - Mauro Vitor Mendlowicz
- Instituto de Psiquiatria da UFRJ, Departamento de Psiquiatria e Saúde Mental, Universidade Federal do Rio de Janeiro, Avenida Venceslau Brás, 71, Fundos, Botafogo, 22290140 Rio de Janeiro, RJ, Brazil; Departamento de Psiquiatria e Saúde Mental, Universidade Federal Fluminense, Avenida Marquês de Paraná, 303, prédio anexo, 3º andar, Centro, 24030-215 Niteroi, RJ, Brazil.
| | - William Berger
- Instituto de Psiquiatria da UFRJ, Departamento de Psiquiatria e Saúde Mental, Universidade Federal do Rio de Janeiro, Avenida Venceslau Brás, 71, Fundos, Botafogo, 22290140 Rio de Janeiro, RJ, Brazil.
| | - Eliane Volchan
- Laboratório de Neurobiologia, Instituto de Biofísica Carlos Chagas Filho, Bloco G, Centro de Ciências da Saúde, Universidade Federal do Rio de Janeiro, Ilha do Fundão 21949-900, RJ, Brazil.
| | - Leticia de Oliveira
- Laboratório de Neurofisiologia do Comportamento (LabNeC), Departamento de Fisiologia e Farmacologia, Instituto Biomédico, Universidade Federal Fluminense, Rua Hernani Pires de Mello, 101, São Domingos, 24210-130 Niterói, RJ, Brazil.
| | - Mirtes Garcia Pereira
- Laboratório de Neurofisiologia do Comportamento (LabNeC), Departamento de Fisiologia e Farmacologia, Instituto Biomédico, Universidade Federal Fluminense, Rua Hernani Pires de Mello, 101, São Domingos, 24210-130 Niterói, RJ, Brazil.
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9
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Karl Umbrasas M. Victim Behavior in a Sample of Military Sexual Assault Cases. JOURNAL OF INTERPERSONAL VIOLENCE 2022; 37:1367-1383. [PMID: 32469672 DOI: 10.1177/0886260520922359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
This study explored victim responses to sexual assault within a military context. Victim behavior was identified in forensic case files of service members charged with sexual assault (N = 58) and referred for forensic evaluation or consultation. The identified victim behavior was coded and quantified for description. Of the sample 87.9% of victims were female and 12.0% of victims were male; 37.9% of the victims reported their assault in less than 1 month. Forceful resistance to the assault occurred in 15.5% of the cases. Physical injury associated with the sexual assault was absent in 96.5% of the cases. The description of victim behavior can inform forensic expert testimony on victim behavior within the military justice system while also offering empirical evidence to better understand this public health problem in the U.S. military.
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10
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Magalhaes AA, Gama CMF, Gonçalves RM, Portugal LCL, David IA, Serpeloni F, Wernersbach Pinto L, Assis SG, Avanci JQ, Volchan E, Figueira I, Vilete LMP, Luz MP, Berger W, Erthal FS, Mendlowicz MV, Mocaiber I, Pereira MG, de Oliveira L. Tonic Immobility is Associated with PTSD Symptoms in Traumatized Adolescents. Psychol Res Behav Manag 2021; 14:1359-1369. [PMID: 34512046 PMCID: PMC8420784 DOI: 10.2147/prbm.s317343] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 08/11/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose Growing evidence suggests that peritraumatic tonic immobility, an involuntary defensive response that involves extreme physical immobility and the perceived inability to escape, is a significant predictor of post-traumatic stress disorder (PTSD) symptomatology. However, this issue has not been specifically addressed in adolescents. Here, we investigated whether tonic immobility response experienced during the worst childhood or adolescent trauma is associated with PTSD symptom severity in a non-clinical student sample. Methods The sample was composed of students in 9th grade who were attending public and private schools. Symptoms of post-traumatic stress and tonic immobility were assessed using questionnaires. We performed bivariate and multivariate negative binomial regressions to examine whether tonic immobility was associated with PTSD symptomatology after controlling for confounders (peritraumatic dissociation, peritraumatic panic reactions, gender, age and time since trauma). Results We found an association between tonic immobility and PTSD symptom severity, even after controlling for confounders. Therefore, tonic immobility is associated with PTSD symptoms in trauma-exposed adolescents. Conclusion These findings highlight tonic immobility as a possible risk factor that could be used to provide direction for more targeted trauma interventions for individuals, particularly those at risk for developing PTSD. Therefore, it contributes to preventing and reducing the psychiatric burden in adolescence and later in life.
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Affiliation(s)
- Andressa A Magalhaes
- Biomedical Institute, Fluminense Federal University, Niterói, RJ, 24210-130, Brazil
| | - Camila M F Gama
- Biomedical Institute, Fluminense Federal University, Niterói, RJ, 24210-130, Brazil
| | - Raquel M Gonçalves
- Biomedical Institute, Fluminense Federal University, Niterói, RJ, 24210-130, Brazil
| | - Liana C L Portugal
- Department of Physiological Sciences, State University of Rio de Janeiro, Rio de Janeiro, RJ, 20550-170, Brazil
| | - Isabel A David
- Biomedical Institute, Fluminense Federal University, Niterói, RJ, 24210-130, Brazil
| | - Fernanda Serpeloni
- Department of Violence and Health Studies, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, 21040-900, Brazil
| | - Liana Wernersbach Pinto
- Department of Violence and Health Studies, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, 21040-900, Brazil
| | - Simone G Assis
- Department of Violence and Health Studies, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, 21040-900, Brazil.,The Neurology Postgraduate Program, Hospital Gaffrée and Guinle, Unirio, RJ, 20270-901, Brazil
| | - Joviana Q Avanci
- Department of Violence and Health Studies, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, 21040-900, Brazil
| | - Eliane Volchan
- Institute of Biophysics Carlos Chagas Filho, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, 21941-902, Brazil
| | - Ivan Figueira
- Psychiatry Institute, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, 22290-140, Brazil
| | - Liliane M P Vilete
- Psychiatry Institute, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, 22290-140, Brazil
| | - Mariana P Luz
- Psychiatry Institute, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, 22290-140, Brazil
| | - William Berger
- Psychiatry Institute, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, 22290-140, Brazil
| | - Fatima S Erthal
- Institute of Biophysics Carlos Chagas Filho, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, 21941-902, Brazil
| | - Mauro V Mendlowicz
- Department of Psychiatry and Mental Health, Fluminense Federal University, Niterói, RJ, 24030-215, Brazil
| | - Izabela Mocaiber
- Institute of Humanities and Health, Federal Fluminense University, Rio das Ostras, RJ, 28890-000, Brazil
| | - Mirtes G Pereira
- Biomedical Institute, Fluminense Federal University, Niterói, RJ, 24210-130, Brazil
| | - Leticia de Oliveira
- Biomedical Institute, Fluminense Federal University, Niterói, RJ, 24210-130, Brazil
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11
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Peinkhofer C, Martial C, Cassol H, Laureys S, Kondziella D. The evolutionary origin of near-death experiences: a systematic investigation. Brain Commun 2021; 3:fcab132. [PMID: 34240053 PMCID: PMC8260963 DOI: 10.1093/braincomms/fcab132] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 04/18/2021] [Accepted: 05/05/2021] [Indexed: 11/28/2022] Open
Abstract
Near-death experiences are known from all parts of the world, various times and
numerous cultural backgrounds. This universality suggests that near-death
experiences may have a biological origin and purpose. Adhering to a
preregistered protocol, we investigate the hypothesis that thanatosis, aka
death-feigning, a last-resort defense mechanism in animals, is the evolutionary
origin of near-death experiences. We first show that thanatosis is a highly
preserved survival strategy occurring at all major nodes in a cladogram ranging
from insects to humans. We then show that humans under attack by animal, human
and ‘modern’ predators can experience both thanatosis and
near-death experiences, and we further show that the phenomenology and the
effects of the two overlap. In summary, we build a line of evidence suggesting
that thanatosis is the evolutionary foundation of near-death experiences and
that their shared biological purpose is the benefit of survival. We propose that
the acquisition of language enabled humans to transform these events from
relatively stereotyped death-feigning under predatory attacks into the rich
perceptions that form near-death experiences and extend to non-predatory
situations.
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Affiliation(s)
- Costanza Peinkhofer
- Department of Neurology, Rigshospitalet, Copenhagen University Hospital, Copenhagen 2100, Denmark
| | - Charlotte Martial
- Coma Science Group, GIGA-Consciousness, University of Liège, Liège 4000, Belgium
| | - Helena Cassol
- Coma Science Group, GIGA-Consciousness, University of Liège, Liège 4000, Belgium
| | - Steven Laureys
- Coma Science Group, GIGA-Consciousness, University of Liège, Liège 4000, Belgium
| | - Daniel Kondziella
- Department of Neurology, Rigshospitalet, Copenhagen University Hospital, Copenhagen 2100, Denmark
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12
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Haltigan JD, Del Giudice M, Khorsand S. Growing points in attachment disorganization: looking back to advance forward. Attach Hum Dev 2021; 23:438-454. [PMID: 33890555 DOI: 10.1080/14616734.2021.1918454] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
In this special issue paper we reflect on the next generation of attachment research with a focus on disorganization, a central but still poorly understood topic in this area. We suggest that progress will be facilitated by a return to attachment theory's evolutionary roots, and to the emphasis on biological function that inspired Bowlby's original thinking. Increased interdisciplinary cross-fertilization and collaborations would enable novel and generative research on some of the long-standing questions surrounding attachment disorganization. Accordingly, we present an agenda for future research that encompasses contributions of modern ethology and neurobiology, novel hypotheses based on the concept of adaptive decanalization, connections with neurodevelopmental vulnerability and risk for mental disorders such as schizophrenia, and the possibility of sex differences in the behavioral manifestations of attachment disorganization. We believe that these avenues of theory and research offer exciting potential for innovative work in attachment disorganization in the years ahead.
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Affiliation(s)
- John D Haltigan
- Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Marco Del Giudice
- Department of Psychology, University of New Mexico, Albuquerque, NM, USA
| | - Soha Khorsand
- Faculty of Science, Western University, London, Canada
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13
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Terpou BA, Harricharan S, McKinnon MC, Frewen P, Jetly R, Lanius RA. The effects of trauma on brain and body: A unifying role for the midbrain periaqueductal gray. J Neurosci Res 2019; 97:1110-1140. [PMID: 31254294 DOI: 10.1002/jnr.24447] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 04/09/2019] [Accepted: 05/06/2019] [Indexed: 12/18/2022]
Abstract
Post-traumatic stress disorder (PTSD), a diagnosis that may follow the experience of trauma, has multiple symptomatic phenotypes. Generally, individuals with PTSD display symptoms of hyperarousal and of hyperemotionality in the presence of fearful stimuli. A subset of individuals with PTSD; however, elicit dissociative symptomatology (i.e., depersonalization, derealization) in the wake of a perceived threat. This pattern of response characterizes the dissociative subtype of the disorder, which is often associated with emotional numbing and hypoarousal. Both symptomatic phenotypes exhibit attentional threat biases, where threat stimuli are processed preferentially leading to a hypervigilant state that is thought to promote defensive behaviors during threat processing. Accordingly, PTSD and its dissociative subtype are thought to differ in their proclivity to elicit active (i.e., fight, flight) versus passive (i.e., tonic immobility, emotional shutdown) defensive responses, which are characterized by the increased and the decreased expression of the sympathetic nervous system, respectively. Moreover, active and passive defenses are accompanied by primarily endocannabinoid- and opioid-mediated analgesics, respectively. Through critical review of the literature, we apply the defense cascade model to better understand the pathological presentation of defensive responses in PTSD with a focus on the functioning of lower-level midbrain and extended brainstem systems.
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Affiliation(s)
- Braeden A Terpou
- Department of Neuroscience, Western University, London, Ontario, Canada
| | | | - Margaret C McKinnon
- Mood Disorders Program, St. Joseph's Healthcare, Hamilton, Ontario, Canada.,Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada.,Homewood Research Institute, Guelph, Ontario, Canada
| | - Paul Frewen
- Department of Psychology, Western University, London, Ontario, Canada
| | - Rakesh Jetly
- Canadian Forces, Health Services, Ottawa, Canada
| | - Ruth A Lanius
- Department of Neuroscience, Western University, London, Ontario, Canada.,Department of Psychiatry, Western University, London, Ontario, Canada
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14
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Norte CE, Volchan E, Vila J, Mata JL, Arbol JR, Mendlowicz M, Berger W, Luz MP, Rocha-Rego V, Figueira I, de Souza GGL. Tonic Immobility in PTSD: Exacerbation of Emotional Cardiac Defense Response. Front Psychol 2019; 10:1213. [PMID: 31178810 PMCID: PMC6543833 DOI: 10.3389/fpsyg.2019.01213] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Accepted: 05/08/2019] [Indexed: 01/26/2023] Open
Abstract
Among defensive behaviors, tonic immobility (TI) is considered the last defensive resort when life is at extreme risk. Post-Traumatic Stress Disorder (PTSD) is the main psychiatric consequence resulting from exposure to traumatic events. Increasing evidence indicate an association between peritraumatic tonic immobilility and severity of PTSD. Cardiac defense response, a reactivity to perceived danger or threat, has been studied by recording heart rate changes that follows the presentation of an unpredictable intense auditory aversive stimulus. The aim of this study was to investigate potential distinctiveness in cardiac defense response among PTSD patients who presented – compared to those that did not – TI reaction in the laboratory setting. Patients (N = 17) completed the TI questionnaire for signs of immobility elicited by passive listening to their autobiographical trauma script. After a while, they were exposed to an intense white noise, while electrocardiogram was recorded. The heart rate during the 80 s after the noise, subtracted from baseline, was analyzed. Higher reports of TI to the trauma script were associated with stronger and sustained heart rate accelerations after the noise. The effects on cardiac defense response add to increasing evidence that some PTSD patients are prone to repeated re-experiences of TI, which may implicate in a potentially distinct pathophysiology and even a new PTSD subtype.
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Affiliation(s)
- Carlos Eduardo Norte
- Institute of Psychology, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Eliane Volchan
- Institute of Biophysics Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Jaime Vila
- Department of Clinical Psychology, Universidad de Granada, Granada, Spain
| | - Jose Luis Mata
- Department of Clinical Psychology, Universidad de Granada, Granada, Spain
| | - Javier R Arbol
- Department of Clinical Psychology, Universidad de Granada, Granada, Spain
| | - Mauro Mendlowicz
- Department of Psychiatry and Mental Health, Universidade Federal Fluminense, Niterói, Brazil
| | - William Berger
- Institute of Psychiatry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Mariana Pires Luz
- Institute of Psychiatry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Vanessa Rocha-Rego
- Institute of Biophysics Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Ivan Figueira
- Institute of Psychiatry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
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15
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Tonic immobility during re-experiencing the traumatic event in posttraumatic stress disorder. Psychiatry Res 2018; 270:1105-1109. [PMID: 30041894 DOI: 10.1016/j.psychres.2018.06.051] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 04/11/2018] [Accepted: 06/20/2018] [Indexed: 11/20/2022]
Abstract
Tonic Immobility (TI) is an evolved defence response, characterized by physical immobility. Peritraumatic TI has been linked to posttraumatic stress disorder (PTSD). However, samples sizes in clinical studies have been small, and little is known about TI reactions post trauma, for instance during trauma reminders. The prevalence of peritraumatic TI and TI during re-experiencing the traumatic event was examined by self-report in 184 patients with chronic PTSD. Moderate peritraumatic TI was reported by 26.6% of the participants (n = 49) and extreme peritraumatic TI by 52.2% (n = 96). During re-experiencing the traumatic event, 35.3% (n = 65) reported moderate TI, and 37.0% (n = 68) extreme TI. Peritraumatic TI was related to PTSD symptom severity and TI during re-experiencing mediated this relationship. In line with previous findings, reports of peritraumatic TI were high among PTSD patients. In addition, we showed that it often re-occurred during re-experiencing the traumatic event. The prevalence of TI at different stages post trauma warrants future study.
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16
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Herzog S, DePierro J, D’Andrea W. Driven to distraction: Childhood trauma and dissociation, but not PTSD symptoms, are related to threat avoidance. EUROPEAN JOURNAL OF TRAUMA & DISSOCIATION 2018. [DOI: 10.1016/j.ejtd.2018.03.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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17
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Möller A, Söndergaard HP, Helström L. Tonic immobility during sexual assault - a common reaction predicting post-traumatic stress disorder and severe depression. Acta Obstet Gynecol Scand 2017; 96:932-938. [DOI: 10.1111/aogs.13174] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Accepted: 05/21/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Anna Möller
- Department of Clinical Science and Education; Karolinska Institute; Stockholm Sweden
| | | | - Lotti Helström
- Department of Clinical Science and Education; Karolinska Institute; Stockholm Sweden
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18
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Sexual trauma is more strongly associated with tonic immobility than other types of trauma - A population based study. J Affect Disord 2017; 215:71-76. [PMID: 28319694 DOI: 10.1016/j.jad.2017.03.009] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Revised: 01/18/2017] [Accepted: 03/05/2017] [Indexed: 11/22/2022]
Abstract
BACKGROUND Tonic immobility is an involuntary motor and vocal inhibition reaction, considered the last-ditch response of the defensive cascade model. It is elicited in context of inescapable threat and perception of entrapment. Our aim was to investigate the association between different traumatic events and peritraumatic tonic immobility (PTI) in a representative sample of the general population. METHODS This is a cross-sectional study of general population from Rio de Janeiro and São Paulo with 3231 victims of traumatic events aged 15-75 years who completed the Tonic Immobility Scale (TIS). We calculated the frequency of the different traumatic events and estimated the mean scores with 95% confidence intervals for each traumatic event, controlling for the potential confounders using multiple linear regression models. Finally, we calculated the proportion of individual scoring zero in TIS for the 16 traumatic events. RESULTS PTI scores in child sexual abuse and adult sexual violence were almost twice as high as in other types of traumatic events, even when controlled for gender and educational level. Torture and war also showed high PTI scores, but these were based on very small number of cases and need to be interpreted with caution. Furthermore, victims of sexual trauma had the lowest proportion of individuals with total absence of PTI symptoms. LIMITATIONS This is a cross-sectional study and causal inferences must be drawn with caution. CONCLUSIONS Peritraumatic tonic immobility is more strongly associated with sexual trauma, particularly in childhood, than to other types of trauma in the general population.
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19
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Lights … action: Comparison of trauma films for use in the trauma film paradigm. Behav Res Ther 2017; 93:67-77. [DOI: 10.1016/j.brat.2017.02.007] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Revised: 02/18/2017] [Accepted: 02/27/2017] [Indexed: 11/21/2022]
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20
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Volchan E, Rocha-Rego V, Bastos AF, Oliveira JM, Franklin C, Gleiser S, Berger W, Souza GGL, Oliveira L, David IA, Erthal FS, Pereira MG, Figueira I. Immobility reactions under threat: A contribution to human defensive cascade and PTSD. Neurosci Biobehav Rev 2017; 76:29-38. [PMID: 28131873 DOI: 10.1016/j.neubiorev.2017.01.025] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Revised: 01/18/2017] [Accepted: 01/21/2017] [Indexed: 01/03/2023]
Abstract
Violence exacts a burden on public health. Gun violence is a major trigger for motor defensive reactions in humans and post-traumatic stress disorder (PTSD) is its main psychiatric sequela. However, studies of the human defensive cascade, especially the motor reactions, are at an early stage. This review focuses on studies that employ stabilometry, a methodology that assesses whole body motor reactions, to address defensive behaviors to violence-related threats. Special attention is given to three reactions: "attentive immobility", "immobility under attack" and "tonic immobility", with emphasis on the latter - a peritraumatic reaction which has been strongly associated with the severity of PTSD. These reactions are characterized by reduced body sway and bradycardia, except tonic immobility that presents robust tachycardia. The advances made by investigations into the immobility reactions of the human defensive cascade contribute to helping to bridge the gap between human and non-human species. Furthermore, progresses in basic research to objectively monitor motor defensive reactions under threat can help to develop a dimensional, trans-diagnostic approach to PTSD.
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Affiliation(s)
- E Volchan
- Instituto de Biofisica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Brazil.
| | - V Rocha-Rego
- Instituto de Biofisica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Brazil; Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro, Brazil
| | - A F Bastos
- Instituto de Biofisica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Brazil
| | - J M Oliveira
- Instituto de Biofisica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Brazil; Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro, Brazil
| | - C Franklin
- Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro, Brazil
| | - S Gleiser
- Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro, Brazil
| | - W Berger
- Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro, Brazil
| | - G G L Souza
- Instituto de Ciências Exatas e Biológicas, Universidade Federal de Ouro Preto, Brazil
| | - L Oliveira
- Instituto Biomédico, Universidade Federal Fluminense, Brazil
| | - I A David
- Instituto Biomédico, Universidade Federal Fluminense, Brazil
| | - F S Erthal
- Instituto de Biofisica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Brazil
| | - M G Pereira
- Instituto Biomédico, Universidade Federal Fluminense, Brazil
| | - I Figueira
- Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro, Brazil
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21
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Shors TJ, Millon EM. Sexual trauma and the female brain. Front Neuroendocrinol 2016; 41:87-98. [PMID: 27085856 DOI: 10.1016/j.yfrne.2016.04.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Revised: 04/11/2016] [Accepted: 04/12/2016] [Indexed: 01/01/2023]
Abstract
Sexual aggression and violence against women (VAM) are not only social problems; they are mental health problems. Women who experience sexual trauma often express disruptions in emotional and cognitive processes, some of which lead to depression and post-traumatic stress disorder (PTSD). Animal models of neurogenesis and learning suggest that social yet aggressive interactions between a pubescent female and an adult male can disrupt processes of learning related to maternal care, which in turn reduce survival of new neurons in the female hippocampus. Mental and Physical (MAP) Training is a novel clinical intervention that was translated from neurogenesis research. The intervention, which combines meditation and aerobic exercise, is currently being used to help women learn to recover from traumatic life experiences, especially those related to sexual violence and abuse.
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Affiliation(s)
- Tracey J Shors
- Behavioral and Systems Neuroscience, Department of Psychology, Center for Collaborative Neuroscience, Rutgers University, 152 Frelinghuysen Road Room 201, Piscataway, NJ 08854, USA.
| | - Emma M Millon
- Behavioral and Systems Neuroscience, Department of Psychology, Center for Collaborative Neuroscience, Rutgers University, 152 Frelinghuysen Road Room 201, Piscataway, NJ 08854, USA
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