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Woelk SP, Garfinkel SN. Dissociative Symptoms and Interoceptive Integration. Curr Top Behav Neurosci 2024. [PMID: 38755513 DOI: 10.1007/7854_2024_480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2024]
Abstract
Dissociative symptoms and disorders of dissociation are characterised by disturbances in the experience of the self and the surrounding world, manifesting as a breakdown in the normal integration of consciousness, memory, identity, emotion, and perception. This paper aims to provide insights into dissociative symptoms from the perspective of interoception, the sense of the body's internal physiological state, adopting a transdiagnostic framework.Dissociative symptoms are associated with a blunting of autonomic reactivity and a reduction in interoceptive precision. In addition to the central function of interoception in homeostasis, afferent visceral signals and their neural and mental representation have been shown to shape emotional feeling states, support memory encoding, and contribute to self-representation. Changes in interoceptive processing and disrupted integration of interoceptive signals into wider cognition may contribute to detachment from the body and the world, blunted emotional experience, and altered subjective recall, as experienced by individuals who suffer from dissociation.A better understanding of the role of altered interoceptive integration across the symptom areas of dissociation could thus provide insights into the neurophysiological mechanisms underlying dissociative disorders. As new therapeutic approaches targeting interoceptive processing emerge, recognising the significance of interoceptive mechanisms in dissociation holds potential implications for future treatment targets.
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Affiliation(s)
- Sascha P Woelk
- Institute of Cognitive Neuroscience, University College London, London, UK.
| | - Sarah N Garfinkel
- Institute of Cognitive Neuroscience, University College London, London, UK
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2
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Stevens L, Bregulla M, Scheele D. Out of touch? How trauma shapes the experience of social touch - Neural and endocrine pathways. Neurosci Biobehav Rev 2024; 159:105595. [PMID: 38373642 DOI: 10.1016/j.neubiorev.2024.105595] [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: 09/29/2023] [Revised: 01/20/2024] [Accepted: 02/15/2024] [Indexed: 02/21/2024]
Abstract
Trauma can shape the way an individual experiences the world and interacts with other people. Touch is a key component of social interactions, but surprisingly little is known about how trauma exposure influences the processing of social touch. In this review, we examine possible neurobiological pathways through which trauma can influence touch processing and lead to touch aversion and avoidance in trauma-exposed individuals. Emerging evidence indicates that trauma may affect sensory touch thresholds by modulating activity in the primary sensory cortex and posterior insula. Disturbances in multisensory integration and oxytocin reactivity combined with diminished reward-related and anxiolytic responses may induce a bias towards negative appraisal of touch contexts. Furthermore, hippocampus deactivation during social touch may reflect a dissociative state. These changes depend not only on the type and severity of the trauma but also on the features of the touch. We hypothesise that disrupted touch processing may impair social interactions and confer elevated risk for future stress-related disorders.
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Affiliation(s)
- Laura Stevens
- Social Neuroscience, Research Center One Health Ruhr of the University Alliance Ruhr, Faculty of Medicine, Ruhr University Bochum, Germany; Department of Medical Psychology and Medical Sociology, Faculty of Medicine, Ruhr University Bochum, Germany
| | - Madeleine Bregulla
- Social Neuroscience, Research Center One Health Ruhr of the University Alliance Ruhr, Faculty of Medicine, Ruhr University Bochum, Germany; Department of Medical Psychology and Medical Sociology, Faculty of Medicine, Ruhr University Bochum, Germany
| | - Dirk Scheele
- Social Neuroscience, Research Center One Health Ruhr of the University Alliance Ruhr, Faculty of Medicine, Ruhr University Bochum, Germany; Department of Medical Psychology and Medical Sociology, Faculty of Medicine, Ruhr University Bochum, Germany.
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3
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Danböck SK, Duek O, Ben-Zion Z, Korem N, Amen SL, Kelmendi B, Wilhelm FH, Levy I, Harpaz-Rotem I. Effects of a dissociative drug on fronto-limbic resting-state functional connectivity in individuals with posttraumatic stress disorder: a randomized controlled pilot study. Psychopharmacology (Berl) 2024; 241:243-252. [PMID: 37872291 PMCID: PMC10806226 DOI: 10.1007/s00213-023-06479-4] [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: 12/13/2022] [Accepted: 10/07/2023] [Indexed: 10/25/2023]
Abstract
RATIONALE A subanesthetic dose of ketamine, a non-competitive N-methyl-D-aspartate glutamate receptor (NMDAR) antagonist, elicits dissociation in individuals with posttraumatic stress disorder (PTSD), who also often suffer from chronic dissociative symptoms in daily life. These debilitating symptoms have not only been linked to worse PTSD trajectories, but also to increased resting-state functional connectivity (RSFC) between medial prefrontal cortex (mPFC) and amygdala, supporting the conceptualization of dissociation as emotion overmodulation. Yet, as studies were observational, causal evidence is lacking. OBJECTIVES The present randomized controlled pilot study examines the effect of ketamine, a dissociative drug, on RSFC between mPFC subregions and amygdala in individuals with PTSD. METHODS Twenty-six individuals with PTSD received either ketamine (0.5mg/kg; n = 12) or the control drug midazolam (0.045mg/kg; n = 14) during functional magnetic resonance imaging (fMRI). RSFC between amygdala and mPFC subregions, i.e., ventromedial PFC (vmPFC), dorsomedial PFC (dmPFC) and anterior-medial PFC (amPFC), was assessed at baseline and during intravenous drug infusion. RESULTS Contrary to pre-registered predictions, ketamine did not promote a greater increase in RSFC between amygdala and mPFC subregions from baseline to infusion compared to midazolam. Instead, ketamine elicited a stronger transient decrease in vmPFC-amygdala RSFC compared to midazolam. CONCLUSIONS A dissociative drug did not increase fronto-limbic RSFC in individuals with PTSD. These preliminary experimental findings contrast with prior correlative findings and call for further exploration and, potentially, a more differentiated view on the neurobiological underpinning of dissociative phenomena in PTSD.
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Affiliation(s)
- Sarah K Danböck
- Department of Psychology, Paris Lodron University of Salzburg, Salzburg, Austria.
- Department of Psychiatry, School of Medicine, Yale University, New Haven, CT, USA.
- Department of Psychology, School of Social Sciences, University of Mannheim, Mannheim, Germany.
| | - Or Duek
- Department of Psychiatry, School of Medicine, Yale University, New Haven, CT, USA
- VA Connecticut Healthcare System, Clinical Neurosciences Division, National Center for Posttraumatic Stress Disorder, U.S. Department of Veterans Affairs, West Haven, CT, USA
- Department of Epidemiology, Biostatistics and Community Health Sciences, School of Public Health, Ben-Gurion University of The Negev, Be'er-Sheva, Israel
| | - Ziv Ben-Zion
- Department of Psychiatry, School of Medicine, Yale University, New Haven, CT, USA
- VA Connecticut Healthcare System, Clinical Neurosciences Division, National Center for Posttraumatic Stress Disorder, U.S. Department of Veterans Affairs, West Haven, CT, USA
- Departments of Comparative Medicine and Neuroscience, School of Medicine, Yale University, New Haven, CT, USA
| | - Nachshon Korem
- Department of Psychiatry, School of Medicine, Yale University, New Haven, CT, USA
- VA Connecticut Healthcare System, Clinical Neurosciences Division, National Center for Posttraumatic Stress Disorder, U.S. Department of Veterans Affairs, West Haven, CT, USA
| | - Shelley L Amen
- Department of Psychiatry, School of Medicine, Yale University, New Haven, CT, USA
- VA Connecticut Healthcare System, Clinical Neurosciences Division, National Center for Posttraumatic Stress Disorder, U.S. Department of Veterans Affairs, West Haven, CT, USA
| | - Ben Kelmendi
- Department of Psychiatry, School of Medicine, Yale University, New Haven, CT, USA
- VA Connecticut Healthcare System, Clinical Neurosciences Division, National Center for Posttraumatic Stress Disorder, U.S. Department of Veterans Affairs, West Haven, CT, USA
| | - Frank H Wilhelm
- Department of Psychology, Paris Lodron University of Salzburg, Salzburg, Austria
| | - Ifat Levy
- Departments of Comparative Medicine and Neuroscience, School of Medicine, Yale University, New Haven, CT, USA
- Department of Psychology, Yale University, New Haven, CT, USA
- Wu Tsai Institute, Yale University, New Haven, CT, USA
| | - Ilan Harpaz-Rotem
- Department of Psychiatry, School of Medicine, Yale University, New Haven, CT, USA
- VA Connecticut Healthcare System, Clinical Neurosciences Division, National Center for Posttraumatic Stress Disorder, U.S. Department of Veterans Affairs, West Haven, CT, USA
- Department of Psychology, Yale University, New Haven, CT, USA
- Wu Tsai Institute, Yale University, New Haven, CT, USA
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4
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Smith LJ, Wilkinson D, Bodani M, Surenthiran SS. Cognition in vestibular disorders: state of the field, challenges, and priorities for the future. Front Neurol 2024; 15:1159174. [PMID: 38304077 PMCID: PMC10830645 DOI: 10.3389/fneur.2024.1159174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 01/05/2024] [Indexed: 02/03/2024] Open
Abstract
Vestibular disorders are prevalent and debilitating conditions of the inner ear and brain which affect balance, coordination, and the integration of multisensory inputs. A growing body of research has linked vestibular disorders to cognitive problems, most notably attention, visuospatial perception, spatial memory, and executive function. However, the mechanistic bases of these cognitive sequelae remain poorly defined, and there is a gap between our theoretical understanding of vestibular cognitive dysfunction, and how best to identify and manage this within clinical practice. This article takes stock of these shortcomings and provides recommendations and priorities for healthcare professionals who assess and treat vestibular disorders, and for researchers developing cognitive models and rehabilitation interventions. We highlight the importance of multidisciplinary collaboration for developing and evaluating clinically relevant theoretical models of vestibular cognition, to advance research and treatment.
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Affiliation(s)
- Laura J. Smith
- Centre for Preventative Neurology, Wolfson Institute of Population Health, Queen Mary University of London, London, United Kingdom
- School of Psychology, Keynes College, University of Kent, Kent, United Kingdom
| | - David Wilkinson
- School of Psychology, Keynes College, University of Kent, Kent, United Kingdom
| | - Mayur Bodani
- School of Psychology, Keynes College, University of Kent, Kent, United Kingdom
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Rabellino D, Thome J, Densmore M, Théberge J, McKinnon MC, Lanius RA. The Vestibulocerebellum and the Shattered Self: a Resting-State Functional Connectivity Study in Posttraumatic Stress Disorder and Its Dissociative Subtype. CEREBELLUM (LONDON, ENGLAND) 2023; 22:1083-1097. [PMID: 36121553 PMCID: PMC10657293 DOI: 10.1007/s12311-022-01467-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/22/2022] [Indexed: 06/15/2023]
Abstract
The flocculus is a region of the vestibulocerebellum dedicated to the coordination of neck, head, and eye movements for optimal posture, balance, and orienting responses. Despite growing evidence of vestibular and oculomotor impairments in the aftermath of traumatic stress, little is known about the effects of chronic psychological trauma on vestibulocerebellar functioning. Here, we investigated alterations in functional connectivity of the flocculus at rest among individuals with post-traumatic stress disorder (PTSD) and its dissociative subtype (PTSD + DS) as compared to healthy controls. Forty-four healthy controls, 57 PTSD, and 32 PTSD + DS underwent 6-min resting-state MRI scans. Seed-based functional connectivity analyses using the right and left flocculi as seeds were performed. These analyses revealed that, as compared to controls, PTSD and PTSD + DS showed decreased resting-state functional connectivity of the left flocculus with cortical regions involved in bodily self-consciousness, including the temporo-parietal junction, the supramarginal and angular gyri, and the superior parietal lobule. Moreover, as compared to controls, the PTSD + DS group showed decreased functional connectivity of the left flocculus with the medial prefrontal cortex, the precuneus, and the mid/posterior cingulum, key regions of the default mode network. Critically, when comparing PTSD + DS to PTSD, we observed increased functional connectivity of the right flocculus with the right anterior hippocampus, a region affected frequently by early life trauma. Taken together, our findings point toward the crucial role of the flocculus in the neurocircuitry underlying a coherent and embodied self, which can be compromised in PTSD and PTSD + DS.
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Affiliation(s)
- Daniela Rabellino
- Department of Psychiatry, Western University, University Hospital, (Room C3-103), 339 Windermere Road, London, ON, N6A 5A5, Canada.
- Imaging, Lawson Health Research Institute, London, ON, Canada.
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada.
| | - Janine Thome
- Department of Theoretical Neuroscience, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
- Clinic for Psychiatry and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
| | - Maria Densmore
- Department of Psychiatry, Western University, University Hospital, (Room C3-103), 339 Windermere Road, London, ON, N6A 5A5, Canada
- Imaging, Lawson Health Research Institute, London, ON, Canada
| | - Jean Théberge
- Department of Psychiatry, Western University, University Hospital, (Room C3-103), 339 Windermere Road, London, ON, N6A 5A5, Canada
- Imaging, Lawson Health Research Institute, London, ON, Canada
- Department of Medical Biophysics, Western University, London, ON, Canada
| | - Margaret C McKinnon
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
- Homewood Research Institute, Guelph, ON, Canada
- Mood Disorders Program and Anxiety Treatment and Research Centre, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
| | - Ruth A Lanius
- Department of Psychiatry, Western University, University Hospital, (Room C3-103), 339 Windermere Road, London, ON, N6A 5A5, Canada
- Imaging, Lawson Health Research Institute, London, ON, Canada
- Department of Neuroscience, Western University, London, ON, Canada
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Laricchiuta D, Garofalo C, Mazzeschi C. Trauma-related disorders and the bodily self: current perspectives and future directions. Front Psychol 2023; 14:1166127. [PMID: 37275691 PMCID: PMC10235635 DOI: 10.3389/fpsyg.2023.1166127] [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: 02/14/2023] [Accepted: 04/28/2023] [Indexed: 06/07/2023] Open
Abstract
Trauma-related disorders are debilitating psychiatric conditions that influence people who have directly or indirectly witnessed adversities. Dramatic brain/body transformations and altered person's relationship with self, others, and the world occur when experiencing multiple types of traumas. In turn, these unfortunate modifications may contribute to predisposition to trauma-related vulnerability conditions, such as externalizing (aggression, delinquency, and conduct disorders) problems. This mini-review analyzes the relations between traumatic experiences (encoded as implicit and embodied procedural memories) and bodily self, sense of safety for the own body, and relationship with others, also in the presence of externalizing conducts. Furthermore, an emerging research area is also considered, highlighting principles and techniques of body-oriented and sensorimotor therapies designed to remodel bodily self-aspects in the presence of trauma, discussing their potential application with individuals showing externalizing problems.
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Rountree-Harrison D, Berkovsky S, Kangas M. Heart and brain traumatic stress biomarker analysis with and without machine learning: A scoping review. Int J Psychophysiol 2023; 185:27-49. [PMID: 36720392 DOI: 10.1016/j.ijpsycho.2023.01.009] [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: 06/14/2022] [Revised: 01/22/2023] [Accepted: 01/25/2023] [Indexed: 01/31/2023]
Abstract
The enigma of post-traumatic stress disorder (PTSD) is embedded in a complex array of physiological responses to stressful situations that result in disruptions in arousal and cognitions that characterise the psychological disorder. Deciphering these physiological patterns is complex, which has seen the use of machine learning (ML) grow in popularity. However, it is unclear to what extent ML has been used with physiological data, specifically, the electroencephalogram (EEG) and electrocardiogram (ECG) to further understand the physiological responses associated with PTSD. To better understand the use of EEG and ECG biomarkers, with and without ML, a scoping review was undertaken. A total of 124 papers based on adult samples were identified comprising 19 ML studies involving EEG and ECG. A further 21 studies using EEG data, and 84 studies employing ECG meeting all other criteria but not employing ML were included for comparison. Identified studies indicate classical ML methodologies currently dominate EEG and ECG biomarkers research, with derived biomarkers holding clinically relevant diagnostic implications for PTSD. Discussion of the emerging trends, algorithms used and their success is provided, along with areas for future research.
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Affiliation(s)
- Darius Rountree-Harrison
- Macquarie University, Balaclava Road, Macquarie Park, New South Wales 2109, Australia; New South Wales Service for the Rehabilitation and Treatment of Torture and Trauma Survivors (STARTTS), 152-168 The Horsley Drive Carramar, New South Wales 2163, Australia.
| | - Shlomo Berkovsky
- Macquarie University, Balaclava Road, Macquarie Park, New South Wales 2109, Australia
| | - Maria Kangas
- Macquarie University, Balaclava Road, Macquarie Park, New South Wales 2109, Australia
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Kearney BE, Corrigan FM, Frewen PA, Nevill S, Harricharan S, Andrews K, Jetly R, McKinnon MC, Lanius RA. A randomized controlled trial of Deep Brain Reorienting: a neuroscientifically guided treatment for post-traumatic stress disorder. Eur J Psychotraumatol 2023; 14:2240691. [PMID: 37581275 PMCID: PMC10431732 DOI: 10.1080/20008066.2023.2240691] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 06/07/2023] [Accepted: 06/16/2023] [Indexed: 08/16/2023] Open
Abstract
BACKGROUND Advanced neuroscientific insights surrounding post-traumatic stress disorder (PTSD) and its associated symptomatology should beget psychotherapeutic treatments that integrate these insights into practice. Deep Brain Reorienting (DBR) is a neuroscientifically-guided psychotherapeutic intervention that targets the brainstem-level neurophysiological sequence that transpired during a traumatic event. Given that contemporary treatments have non-response rates of up to 50% and high drop-out rates of >18%, DBR is investigated as a putative candidate for effective treatment of some individuals with PTSD. OBJECTIVE To conduct an interim evaluation of the effectiveness of an eight-session clinical trial of videoconference-based DBR versus waitlist (WL) control for individuals with PTSD. METHOD Fifty-four individuals with PTSD were randomly assigned to DBR (N = 29) or WL (N = 25). At baseline, post-treatment, and three-month follow-up, participants' PTSD symptom severity was assessed using the Clinician Administered PTSD Scale (CAPS-5). This is an interim analysis of a clinical trial registered with the U. S. National Institute of Health (NCT04317820). RESULTS Significant between-group differences in CAPS-total and all subscale scores (re-experiencing, avoidance, negative alterations in cognitions/mood, alterations in arousal/reactivity) were found at post-treatment (CAPS-total: Cohen's d = 1.17) and 3-month-follow-up (3MFU) (CAPS-total: Cohen's d = 1.18). Significant decreases in CAPS-total and all subscale scores were observed within the DBR group pre - to post-treatment (36.6% CAPS-total reduction) and pre-treatment to 3MFU (48.6% CAPS-total reduction), whereas no significant decreases occurred in the WL group. After DBR, 48.3% at post-treatment and 52.0% at 3MFU no longer met PTSD criteria. Attrition was minimal with one participant not completing treatment; eight participants were lost to 3MFU. CONCLUSIONS These findings provide emerging evidence for the effectiveness of DBR as a well-tolerated treatment that is based on theoretical advances highlighting alterations to subcortical mechanisms in PTSD and associated symptomatology. Additional research utilizing larger sample sizes, neuroimaging data, and comparisons or adjacencies with other psychotherapeutic approaches is warranted.Trial registration: ClinicalTrials.gov identifier: NCT04317820..
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Affiliation(s)
| | - Frank M. Corrigan
- Trauma Psychotherapy Scotland, Newton Terrace, Glasgow, UK
- Department of Psychiatry, Western University, London, Canada
| | - Paul A. Frewen
- Departments of Neuroscience and Psychology, Western University, London, Canada
| | | | - Sherain Harricharan
- Department of Psychology, Neuroscience, and Behaviour, McMaster University, Hamilton, Canada
| | - Krysta Andrews
- Offord Centre for Child Studies, Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Canada
| | - Rakesh Jetly
- Institute of Mental Health Research, University of Ottawa, Ottawa, Canada
| | - Margaret C. McKinnon
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Canada
| | - Ruth A. Lanius
- Departments of Neuroscience and Psychology, Western University, London, Canada
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Kearney BE, Lanius RA. The brain-body disconnect: A somatic sensory basis for trauma-related disorders. Front Neurosci 2022; 16:1015749. [PMID: 36478879 PMCID: PMC9720153 DOI: 10.3389/fnins.2022.1015749] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 10/14/2022] [Indexed: 08/16/2023] Open
Abstract
Although the manifestation of trauma in the body is a phenomenon well-endorsed by clinicians and traumatized individuals, the neurobiological underpinnings of this manifestation remain unclear. The notion of somatic sensory processing, which encompasses vestibular and somatosensory processing and relates to the sensory systems concerned with how the physical body exists in and relates to physical space, is introduced as a major contributor to overall regulatory, social-emotional, and self-referential functioning. From a phylogenetically and ontogenetically informed perspective, trauma-related symptomology is conceptualized to be grounded in brainstem-level somatic sensory processing dysfunction and its cascading influences on physiological arousal modulation, affect regulation, and higher-order capacities. Lastly, we introduce a novel hierarchical model bridging somatic sensory processes with limbic and neocortical mechanisms regulating an individual's emotional experience and sense of a relational, agentive self. This model provides a working framework for the neurobiologically informed assessment and treatment of trauma-related conditions from a somatic sensory processing perspective.
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Affiliation(s)
- Breanne E. Kearney
- Department of Neuroscience, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Ruth A. Lanius
- Department of Neuroscience, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
- Department of Psychiatry, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
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10
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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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11
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Bao W, Gao Y, Cao L, Li H, Liu J, Liang K, Hu X, Zhang L, Hu X, Gong Q, Huang X. Alterations in large-scale functional networks in adult posttraumatic stress disorder: A systematic review and meta-analysis of resting-state functional connectivity studies. Neurosci Biobehav Rev 2021; 131:1027-1036. [PMID: 34688728 DOI: 10.1016/j.neubiorev.2021.10.017] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 10/12/2021] [Accepted: 10/18/2021] [Indexed: 02/08/2023]
Abstract
Posttraumatic stress disorder (PTSD) is associated with dysfunction in large-scale brain functional networks, as revealed by resting-state functional connectivity studies. However, it remains unclear which networks have been most consistently affected and, more importantly, what role disease and trauma may play in the disrupted functional networks. We performed a systematic review of studies exploring network alterations using seed-based functional connectivity analysis, comparing individuals with PTSD to controls in general as well as trauma-exposed or nonexposed controls specifically, and quantitative meta-analysis was conducted when the number of studies was appropriately high. We found that hypoconnectivity within the default-mode network (DMN) as well as between the affective network (AN) and DMN were specifically associated with traumatic experience. Additionally, hyperconnectivity between the AN and somatomotor network (SMN) and between the DMN and SMN were specifically related to PTSD. Our results emphasize the effect of trauma itself on alterations in intrinsic brain networks and highlight disease-associated network alterations, which may help us better understand the neural mechanisms of trauma and PTSD.
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Affiliation(s)
- Weijie Bao
- Huaxi MR Research Center (HMRRC), Functional and Molecular Imaging Key Laboratory of Sichuan Province, Department of Radiology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Yingxue Gao
- Huaxi MR Research Center (HMRRC), Functional and Molecular Imaging Key Laboratory of Sichuan Province, Department of Radiology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Lingxiao Cao
- Huaxi MR Research Center (HMRRC), Functional and Molecular Imaging Key Laboratory of Sichuan Province, Department of Radiology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Hailong Li
- Huaxi MR Research Center (HMRRC), Functional and Molecular Imaging Key Laboratory of Sichuan Province, Department of Radiology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Jing Liu
- Huaxi MR Research Center (HMRRC), Functional and Molecular Imaging Key Laboratory of Sichuan Province, Department of Radiology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Kaili Liang
- Huaxi MR Research Center (HMRRC), Functional and Molecular Imaging Key Laboratory of Sichuan Province, Department of Radiology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Xinyue Hu
- Huaxi MR Research Center (HMRRC), Functional and Molecular Imaging Key Laboratory of Sichuan Province, Department of Radiology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Lianqing Zhang
- Huaxi MR Research Center (HMRRC), Functional and Molecular Imaging Key Laboratory of Sichuan Province, Department of Radiology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Xinyu Hu
- Huaxi MR Research Center (HMRRC), Functional and Molecular Imaging Key Laboratory of Sichuan Province, Department of Radiology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Qiyong Gong
- Huaxi MR Research Center (HMRRC), Functional and Molecular Imaging Key Laboratory of Sichuan Province, Department of Radiology, West China Hospital, Sichuan University, Chengdu 610041, China; Psychoradiology Research Unit of the Chinese Academy of Medical Sciences (2018RU011), West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Xiaoqi Huang
- Huaxi MR Research Center (HMRRC), Functional and Molecular Imaging Key Laboratory of Sichuan Province, Department of Radiology, West China Hospital, Sichuan University, Chengdu 610041, China; Psychoradiology Research Unit of the Chinese Academy of Medical Sciences (2018RU011), West China Hospital of Sichuan University, Chengdu, Sichuan, China.
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12
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Chronic Central Vestibulopathies for the Otolaryngologist. Otolaryngol Clin North Am 2021; 54:939-948. [PMID: 34538359 DOI: 10.1016/j.otc.2021.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Central vestibulopathies involve disorders of the central nervous system that lead to problems with balance, often manifested as dizziness, vertigo, and gait difficulty. Central vestibulopathies can be distinguished from peripheral vestibulopathies with the use of certain tests, including nystagmography and posturography. The neuroanatomy of individuals with central vestibulopathies can reveal structural abnormalities in the posterior cerebrum or cerebellum. Various medications can be used to manage central vestibulopathies, including vestibular migraine.
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13
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Jin S, Shin C, Han C, Kim YK, Lee J, Jeon SW, Lee SH, Ko YH. Changes in Brain Electrical Activity According to Post-traumatic Stress Symptoms in Survivors of the Sewol Ferry Disaster: A 1-year Longitudinal Study. CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE 2021; 19:537-544. [PMID: 34294623 PMCID: PMC8316658 DOI: 10.9758/cpn.2021.19.3.537] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 11/03/2020] [Accepted: 11/04/2020] [Indexed: 11/25/2022]
Abstract
Objective The pathology of post-traumatic stress disorder (PTSD) is associated with changes in brain structure and function, especially in the amygdala, medial prefrontal cortex, hippocampus, and insula. Survivors of tragic accidents often experience psychological stress and develop post-traumatic stress symptoms (PTSS), regardless of the diagnosis of PTSD. This study aimed to evaluate electroencephalographic changes according to PTSS in victims of a single traumatic event. Methods This study enrolled 60 survivors of the Sewol ferry disaster that occurred in 2014 from Danwon High School and collected electroencephalographic data through 19 channels twice for each person in 2014 and 2015 (mean 451.88 [standard deviation 25.77] days of follow-up). PTSS was assessed using the PTSD Checklist-Civilian Version (PCL-C) and the participants were divided into two groups according to the differences in PCL-C scores between 2014 and 2015. Electroencephalographic data were converted to three-dimensional data to perform low-resolution electrical tomographic analysis. Results Significant electroencephalographic changes over time were observed. The group of participants with worsened PCL-C score showed an increased change of delta slow waves in Brodmann areas 13 and 44, with the largest difference in the insula region, compared to those with improved PCL-C scores. Conclusion Our findings suggests that the electrophysiological changes in the insula are associated with PTSS changes.
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Affiliation(s)
- Sehee Jin
- Department of Psychiatry, Korea University College of Medicine, Seoul, Korea
| | - Cheolmin Shin
- Department of Psychiatry, Korea University College of Medicine, Seoul, Korea
| | - Changsu Han
- Department of Psychiatry, Korea University College of Medicine, Seoul, Korea
| | - Yong-Ku Kim
- Department of Psychiatry, Korea University College of Medicine, Seoul, Korea
| | - Jongha Lee
- Department of Psychiatry, Korea University College of Medicine, Seoul, Korea
| | - Sang Won Jeon
- Department of Psychiatry, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seung-Hoon Lee
- Department of Psychiatry, Veterans Health Service Medical Center, Seoul, Korea
| | - Young-Hoon Ko
- Department of Psychiatry, Korea University College of Medicine, Seoul, Korea
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14
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Harricharan S, McKinnon MC, Lanius RA. How Processing of Sensory Information From the Internal and External Worlds Shape the Perception and Engagement With the World in the Aftermath of Trauma: Implications for PTSD. Front Neurosci 2021; 15:625490. [PMID: 33935627 PMCID: PMC8085307 DOI: 10.3389/fnins.2021.625490] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 03/11/2021] [Indexed: 12/27/2022] Open
Abstract
Post-traumatic stress disorder (PTSD) is triggered by an individual experiencing or witnessing a traumatic event, often precipitating persistent flashbacks and severe anxiety that are associated with a fearful and hypervigilant presentation. Approximately 14–30% of traumatized individuals present with the dissociative subtype of PTSD, which is often associated with repeated or childhood trauma. This presentation includes symptoms of depersonalization and derealization, where individuals may feel as if the world or self is “dream-like” and not real and/or describe “out-of-body” experiences. Here, we review putative neural alterations that may underlie how sensations are experienced among traumatized individuals with PTSD and its dissociative subtype, including those from the outside world (e.g., touch, auditory, and visual sensations) and the internal world of the body (e.g., visceral sensations, physical sensations associated with feeling states). We postulate that alterations in the neural pathways important for the processing of sensations originating in the outer and inner worlds may have cascading effects on the performance of higher-order cognitive functions, including emotion regulation, social cognition, and goal-oriented action, thereby shaping the perception of and engagement with the world. Finally, we introduce a theoretical neurobiological framework to account for altered sensory processing among traumatized individuals with and without the dissociative subtype of PTSD.
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Affiliation(s)
- Sherain Harricharan
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada.,Homewood Research Institute, Guelph, ON, Canada
| | - Margaret C McKinnon
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada.,Homewood Research Institute, Guelph, ON, Canada.,Mood Disorders Program, St. Joseph's Healthcare, Hamilton, ON, Canada
| | - Ruth A Lanius
- Homewood Research Institute, Guelph, ON, Canada.,Department of Psychiatry, Western University, London, ON, Canada.,Department of Neuroscience, Western University, London, ON, Canada.,Imaging Division, Lawson Health Research Institute, London, ON, Canada.,The Brain and Mind Institute, London, ON, Canada
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15
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Rabellino D, Frewen PA, McKinnon MC, Lanius RA. Peripersonal Space and Bodily Self-Consciousness: Implications for Psychological Trauma-Related Disorders. Front Neurosci 2020; 14:586605. [PMID: 33362457 PMCID: PMC7758430 DOI: 10.3389/fnins.2020.586605] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 11/10/2020] [Indexed: 11/24/2022] Open
Abstract
Peripersonal space (PPS) is defined as the space surrounding the body where we can reach or be reached by external entities, including objects or other individuals. PPS is an essential component of bodily self-consciousness that allows us to perform actions in the world (e.g., grasping and manipulating objects) and protect our body while interacting with the surrounding environment. Multisensory processing plays a critical role in PPS representation, facilitating not only to situate ourselves in space but also assisting in the localization of external entities at a close distance from our bodies. Such abilities appear especially crucial when an external entity (a sound, an object, or a person) is approaching us, thereby allowing the assessment of the salience of a potential incoming threat. Accordingly, PPS represents a key aspect of social cognitive processes operational when we interact with other people (for example, in a dynamic dyad). The underpinnings of PPS have been investigated largely in human models and in animals and include the operation of dedicated multimodal neurons (neurons that respond specifically to co-occurring stimuli from different perceptive modalities, e.g., auditory and tactile stimuli) within brain regions involved in sensorimotor processing (ventral intraparietal sulcus, ventral premotor cortex), interoception (insula), and visual recognition (lateral occipital cortex). Although the defensive role of the PPS has been observed in psychopathology (e.g., in phobias) the relation between PPS and altered states of bodily consciousness remains largely unexplored. Specifically, PPS representation in trauma-related disorders, where altered states of consciousness can involve dissociation from the body and its surroundings, have not been investigated. Accordingly, we review here: (1) the behavioral and neurobiological literature surrounding trauma-related disorders and its relevance to PPS; and (2) outline future research directions aimed at examining altered states of bodily self-consciousness in trauma related-disorders.
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Affiliation(s)
- Daniela Rabellino
- Department of Psychiatry, Western University, London, ON, Canada
- Imaging Division, Lawson Health Research Institute, London, ON, Canada
| | - Paul A. Frewen
- 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
| | - Ruth A. Lanius
- Department of Psychiatry, Western University, London, ON, Canada
- Imaging Division, Lawson Health Research Institute, London, ON, Canada
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16
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Roydeva MI, Reinders AATS. Biomarkers of Pathological Dissociation: A Systematic Review. Neurosci Biobehav Rev 2020; 123:120-202. [PMID: 33271160 DOI: 10.1016/j.neubiorev.2020.11.019] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 08/20/2020] [Accepted: 11/15/2020] [Indexed: 02/06/2023]
Abstract
Pathological dissociation is a severe, debilitating and transdiagnostic psychiatric symptom. This review identifies biomarkers of pathological dissociation in a transdiagnostic manner to recommend the most promising research and treatment pathways in support of the precision medicine framework. A total of 205 unique studies that met inclusion criteria were included. Studies were divided into four biomarker categories, namely neuroimaging, psychobiological, psychophysiological and genetic biomarkers. The dorsomedial and dorsolateral prefrontal cortex, bilateral superior frontal regions, (anterior) cingulate, posterior association areas and basal ganglia are identified as neurofunctional biomarkers of pathological dissociation and decreased hippocampal, basal ganglia and thalamic volumes as neurostructural biomarkers. Increased oxytocin and prolactin and decreased tumor necrosis factor alpha (TNF-α) are identified as psychobiological markers. Psychophysiological biomarkers, including blood pressure, heart rate and skin conductance, were inconclusive. For the genetic biomarker category studies related to dissociation were limited and no clear directionality of effect was found to warrant identification of a genetic biomarker. Recommendations for future research pathways and possible clinical applicability are provided.
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Affiliation(s)
- Monika I Roydeva
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom
| | - Antje A T S Reinders
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, United Kingdom.
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17
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Lotfinia S, Soorgi Z, Mertens Y, Daniels J. Structural and functional brain alterations in psychiatric patients with dissociative experiences: A systematic review of magnetic resonance imaging studies. J Psychiatr Res 2020; 128:5-15. [PMID: 32480060 DOI: 10.1016/j.jpsychires.2020.05.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 04/15/2020] [Accepted: 05/10/2020] [Indexed: 12/16/2022]
Abstract
INTRODUCTION There is currently no general agreement on how to best conceptualize dissociative symptoms and whether they share similar neural underpinnings across dissociative disorders. Neuroimaging data could help elucidate these questions. OBJECTIVES The objective of this review is to summarize empirical evidence for neural aberrations observed in patients suffering from dissociative symptoms. METHODS A systematic literature review was conducted including patient cohorts diagnosed with primary dissociative disorders, post-traumatic stress disorder (PTSD), or borderline personality disorder. RESULTS Results from MRI studies reporting structural (gray matter and white matter) and functional (during resting-state and task-related activation) brain aberrations were extracted and integrated. In total, 33 articles were included of which 10 pertained to voxel-based morphology, 2 to diffusion tensor imaging, 10 to resting-state fMRI, and 11 to task-related fMRI. Overall findings indicated aberrations spread across diverse brain regions, especially in the temporal and frontal cortices. Patients with dissociative identity disorder and with dissociative PTSD showed more overlap in brain activation than each group showed with depersonalization/derealization disorder. CONCLUSION In conjunction, the results indicate that dissociative processing cannot be localized to a few distinctive brain regions but rather corresponds to differential neural signatures depending on the symptom constellation.
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Affiliation(s)
- Shahab Lotfinia
- Department of Clinical Psychology, Zahedan University of Medical Science, Zahedan, Iran
| | - Zohre Soorgi
- Department of Psychiatry, Zahedan University of Medical Science, Zahedan, Iran
| | - Yoki Mertens
- Department of Clinical Psychology, University of Groningen, the Netherlands
| | - Judith Daniels
- Department of Clinical Psychology, University of Groningen, the Netherlands.
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18
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Ross MC, Cisler JM. Altered large-scale functional brain organization in posttraumatic stress disorder: A comprehensive review of univariate and network-level neurocircuitry models of PTSD. Neuroimage Clin 2020; 27:102319. [PMID: 32622316 PMCID: PMC7334481 DOI: 10.1016/j.nicl.2020.102319] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 06/15/2020] [Accepted: 06/17/2020] [Indexed: 12/31/2022]
Abstract
Classical neural circuitry models of posttraumatic stress disorder (PTSD) are largely derived from univariate activation studies and implicate the fronto-limbic circuit as a main neural correlate of PTSD symptoms. Though well-supported by human neuroimaging literature, these models are limited in their ability to explain the widely distributed neural and behavioral deficits in PTSD. Emerging interest in the application of large-scale network methods to functional neuroimaging provides a new opportunity to overcome such limitations and conceptualize the neural circuitry of PTSD in the context of network patterns. This review aims to evaluate both the classical neural circuitry model and a new, network-based model of PTSD neural circuitry using a breadth of functional brain organization research in subjects with PTSD. Taken together, this literature suggests global patterns of reduced functional connectivity (FC) in PTSD groups as well as altered FC targets that reside disproportionately in canonical functional networks, especially the default mode network. This provides evidence for an integrative model that includes elements of both the classical models and network-based models to characterize the neural circuitry of PTSD.
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Affiliation(s)
- Marisa C Ross
- Neuroscience and Training Program, University of Wisconsin-Madison, United States; Neuroscience and Public Policy Program, University of Wisconsin-Madison, United States.
| | - Josh M Cisler
- Neuroscience and Training Program, University of Wisconsin-Madison, United States; Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, United States
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19
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Blades R, Jordan S, Becerra S, Eusebio B, Heatwole M, Iovine J, Mahdavi K, Mamoun M, Nicodemus N, Packham H, Spivak N, Kuhn T. Treating dissociative post-traumatic stress disorder presenting as a functional movement disorder with transcranial magnetic stimulation targeting the cingulate gyrus. Neurol Sci 2020; 41:2275-2280. [DOI: 10.1007/s10072-020-04433-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 04/16/2020] [Indexed: 12/01/2022]
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20
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Nicholson AA, Harricharan S, Densmore M, Neufeld RWJ, Ros T, McKinnon MC, Frewen PA, Théberge J, Jetly R, Pedlar D, Lanius RA. Classifying heterogeneous presentations of PTSD via the default mode, central executive, and salience networks with machine learning. Neuroimage Clin 2020; 27:102262. [PMID: 32446241 PMCID: PMC7240193 DOI: 10.1016/j.nicl.2020.102262] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Revised: 04/15/2020] [Accepted: 04/16/2020] [Indexed: 01/26/2023]
Abstract
Intrinsic connectivity networks (ICNs), including the default mode network (DMN), the central executive network (CEN), and the salience network (SN) have been shown to be aberrant in patients with posttraumatic stress disorder (PTSD). The purpose of the current study was to a) compare ICN functional connectivity between PTSD, dissociative subtype PTSD (PTSD+DS) and healthy individuals; and b) to examine the use of multivariate machine learning algorithms in classifying PTSD, PTSD+DS, and healthy individuals based on ICN functional activation. Our neuroimaging dataset consisted of resting-state fMRI scans from 186 participants [PTSD (n = 81); PTSD + DS (n = 49); and healthy controls (n = 56)]. We performed group-level independent component analyses to evaluate functional connectivity differences within each ICN. Multiclass Gaussian Process Classification algorithms within PRoNTo software were then used to predict the diagnosis of PTSD, PTSD+DS, and healthy individuals based on ICN functional activation. When comparing the functional connectivity of ICNs between PTSD, PTSD+DS and healthy controls, we found differential patterns of connectivity to brain regions involved in emotion regulation, in addition to limbic structures and areas involved in self-referential processing, interoception, bodily self-consciousness, and depersonalization/derealization. Machine learning algorithms were able to predict with high accuracy the classification of PTSD, PTSD+DS, and healthy individuals based on ICN functional activation. Our results suggest that alterations within intrinsic connectivity networks may underlie unique psychopathology and symptom presentation among PTSD subtypes. Furthermore, the current findings substantiate the use of machine learning algorithms for classifying subtypes of PTSD illness based on ICNs.
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Affiliation(s)
- Andrew A Nicholson
- Department of Cognition, Emotion and Methods in Psychology, University of Vienna, Austria; Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada.
| | - Sherain Harricharan
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Maria Densmore
- Department of Psychiatry, Western University, London, ON, Canada; Imaging Division, Lawson Health Research Institute, London, ON, Canada
| | - Richard W J Neufeld
- Department of Psychiatry, Western University, London, ON, Canada; Department of Psychology, Western University, London, ON, Canada; Department of Medical Imaging, Western University, London, ON, Canada
| | - Tomas Ros
- Department of Neuroscience, University of Geneva, Switzerland
| | - Margaret C McKinnon
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada; Mood Disorders Program, St. Joseph's Healthcare, Hamilton, ON, Canada; Homewood Research Institute, Guelph, ON, Canada
| | - Paul A Frewen
- Department of Psychiatry, Western University, London, ON, Canada; Department of Neuroscience, Western University, London, ON, Canada
| | - Jean Théberge
- Department of Psychiatry, Western University, London, ON, Canada; Department of Medical Imaging, Western University, London, ON, Canada; Imaging Division, Lawson Health Research Institute, London, ON, Canada; Department of Diagnostic Imaging, St. Joseph's Health Care, London, ON, Canada
| | - Rakesh Jetly
- Canadian Forces, Health Services, Ottawa, Ontario, Canada
| | - David Pedlar
- Canadian Institute for Military and Veteran Health Research (CIMVHR), Canada
| | - Ruth A Lanius
- Department of Psychiatry, Western University, London, ON, Canada; Department of Neuroscience, Western University, London, ON, Canada; Imaging Division, Lawson Health Research Institute, London, ON, Canada
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21
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Maron-Katz A, Zhang Y, Narayan M, Wu W, Toll RT, Naparstek S, De Los Angeles C, Longwell P, Shpigel E, Newman J, Abu-Amara D, Marmar C, Etkin A. Individual Patterns of Abnormality in Resting-State Functional Connectivity Reveal Two Data-Driven PTSD Subgroups. Am J Psychiatry 2020; 177:244-253. [PMID: 31838870 DOI: 10.1176/appi.ajp.2019.19010060] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE A major challenge in understanding and treating posttraumatic stress disorder (PTSD) is its clinical heterogeneity, which is likely determined by various neurobiological perturbations. This heterogeneity likely also reduces the effectiveness of standard group comparison approaches. The authors tested whether a statistical approach aimed at identifying individual-level neuroimaging abnormalities that are more prevalent in case subjects than in control subjects could reveal new clinically meaningful insights into the heterogeneity of PTSD. METHODS Resting-state functional MRI data were recorded from 87 unmedicated PTSD case subjects and 105 war zone-exposed healthy control subjects. Abnormalities were modeled using tolerance intervals, which referenced the distribution of healthy control subjects as the "normative population." Out-of-norm functional connectivity values were examined for enrichment in cases and then used in a clustering analysis to identify biologically defined PTSD subgroups based on their abnormality profiles. RESULTS The authors identified two subgroups among PTSD cases, each with a distinct pattern of functional connectivity abnormalities with respect to healthy control subjects. Subgroups differed clinically on levels of reexperiencing symptoms and improved case-control discriminability and were detectable using independently recorded resting-state EEG data. CONCLUSIONS The results provide proof of concept for the utility of abnormality-based approaches for studying heterogeneity within clinical populations. Such approaches, applied not only to neuroimaging data, may allow detection of subpopulations with distinct biological signatures so that further clinical and mechanistic investigations can be focused on more biologically homogeneous subgroups.
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Affiliation(s)
- Adi Maron-Katz
- Department of Bioengineering (Toll) and Department of Psychiatry and Behavioral Sciences and Wu Tsai Neurosciences Institute (Maron-Katz, Zhang, Narayan, Wu, Toll, Naparstek, De Los Angeles, Longwell, Shpigel, Etkin), Stanford University, Stanford, Calif.; VA Palo Alto Health Care System and Sierra Pacific Mental Illness Research, Education, and Clinical Center, Palo Alto, Calif. (Maron-Katz, Zhang, Narayan, Wu, Toll, Naparstek, De Los Angeles, Longwell, Shpigel, Etkin); School of Automation Science and Engineering, South China University of Technology, Guangzhou, Guangdong, China (Wu); Steven and Alexandra Cohen Veterans Center for the Study of Post-Traumatic Stress and Traumatic Brain Injury and Department of Psychiatry (Newman, Abu-Amara, Marmar), New York University Langone School of Medicine, New York
| | - Yu Zhang
- Department of Bioengineering (Toll) and Department of Psychiatry and Behavioral Sciences and Wu Tsai Neurosciences Institute (Maron-Katz, Zhang, Narayan, Wu, Toll, Naparstek, De Los Angeles, Longwell, Shpigel, Etkin), Stanford University, Stanford, Calif.; VA Palo Alto Health Care System and Sierra Pacific Mental Illness Research, Education, and Clinical Center, Palo Alto, Calif. (Maron-Katz, Zhang, Narayan, Wu, Toll, Naparstek, De Los Angeles, Longwell, Shpigel, Etkin); School of Automation Science and Engineering, South China University of Technology, Guangzhou, Guangdong, China (Wu); Steven and Alexandra Cohen Veterans Center for the Study of Post-Traumatic Stress and Traumatic Brain Injury and Department of Psychiatry (Newman, Abu-Amara, Marmar), New York University Langone School of Medicine, New York
| | - Manjari Narayan
- Department of Bioengineering (Toll) and Department of Psychiatry and Behavioral Sciences and Wu Tsai Neurosciences Institute (Maron-Katz, Zhang, Narayan, Wu, Toll, Naparstek, De Los Angeles, Longwell, Shpigel, Etkin), Stanford University, Stanford, Calif.; VA Palo Alto Health Care System and Sierra Pacific Mental Illness Research, Education, and Clinical Center, Palo Alto, Calif. (Maron-Katz, Zhang, Narayan, Wu, Toll, Naparstek, De Los Angeles, Longwell, Shpigel, Etkin); School of Automation Science and Engineering, South China University of Technology, Guangzhou, Guangdong, China (Wu); Steven and Alexandra Cohen Veterans Center for the Study of Post-Traumatic Stress and Traumatic Brain Injury and Department of Psychiatry (Newman, Abu-Amara, Marmar), New York University Langone School of Medicine, New York
| | - Wei Wu
- Department of Bioengineering (Toll) and Department of Psychiatry and Behavioral Sciences and Wu Tsai Neurosciences Institute (Maron-Katz, Zhang, Narayan, Wu, Toll, Naparstek, De Los Angeles, Longwell, Shpigel, Etkin), Stanford University, Stanford, Calif.; VA Palo Alto Health Care System and Sierra Pacific Mental Illness Research, Education, and Clinical Center, Palo Alto, Calif. (Maron-Katz, Zhang, Narayan, Wu, Toll, Naparstek, De Los Angeles, Longwell, Shpigel, Etkin); School of Automation Science and Engineering, South China University of Technology, Guangzhou, Guangdong, China (Wu); Steven and Alexandra Cohen Veterans Center for the Study of Post-Traumatic Stress and Traumatic Brain Injury and Department of Psychiatry (Newman, Abu-Amara, Marmar), New York University Langone School of Medicine, New York
| | - Russell T Toll
- Department of Bioengineering (Toll) and Department of Psychiatry and Behavioral Sciences and Wu Tsai Neurosciences Institute (Maron-Katz, Zhang, Narayan, Wu, Toll, Naparstek, De Los Angeles, Longwell, Shpigel, Etkin), Stanford University, Stanford, Calif.; VA Palo Alto Health Care System and Sierra Pacific Mental Illness Research, Education, and Clinical Center, Palo Alto, Calif. (Maron-Katz, Zhang, Narayan, Wu, Toll, Naparstek, De Los Angeles, Longwell, Shpigel, Etkin); School of Automation Science and Engineering, South China University of Technology, Guangzhou, Guangdong, China (Wu); Steven and Alexandra Cohen Veterans Center for the Study of Post-Traumatic Stress and Traumatic Brain Injury and Department of Psychiatry (Newman, Abu-Amara, Marmar), New York University Langone School of Medicine, New York
| | - Sharon Naparstek
- Department of Bioengineering (Toll) and Department of Psychiatry and Behavioral Sciences and Wu Tsai Neurosciences Institute (Maron-Katz, Zhang, Narayan, Wu, Toll, Naparstek, De Los Angeles, Longwell, Shpigel, Etkin), Stanford University, Stanford, Calif.; VA Palo Alto Health Care System and Sierra Pacific Mental Illness Research, Education, and Clinical Center, Palo Alto, Calif. (Maron-Katz, Zhang, Narayan, Wu, Toll, Naparstek, De Los Angeles, Longwell, Shpigel, Etkin); School of Automation Science and Engineering, South China University of Technology, Guangzhou, Guangdong, China (Wu); Steven and Alexandra Cohen Veterans Center for the Study of Post-Traumatic Stress and Traumatic Brain Injury and Department of Psychiatry (Newman, Abu-Amara, Marmar), New York University Langone School of Medicine, New York
| | - Carlo De Los Angeles
- Department of Bioengineering (Toll) and Department of Psychiatry and Behavioral Sciences and Wu Tsai Neurosciences Institute (Maron-Katz, Zhang, Narayan, Wu, Toll, Naparstek, De Los Angeles, Longwell, Shpigel, Etkin), Stanford University, Stanford, Calif.; VA Palo Alto Health Care System and Sierra Pacific Mental Illness Research, Education, and Clinical Center, Palo Alto, Calif. (Maron-Katz, Zhang, Narayan, Wu, Toll, Naparstek, De Los Angeles, Longwell, Shpigel, Etkin); School of Automation Science and Engineering, South China University of Technology, Guangzhou, Guangdong, China (Wu); Steven and Alexandra Cohen Veterans Center for the Study of Post-Traumatic Stress and Traumatic Brain Injury and Department of Psychiatry (Newman, Abu-Amara, Marmar), New York University Langone School of Medicine, New York
| | - Parker Longwell
- Department of Bioengineering (Toll) and Department of Psychiatry and Behavioral Sciences and Wu Tsai Neurosciences Institute (Maron-Katz, Zhang, Narayan, Wu, Toll, Naparstek, De Los Angeles, Longwell, Shpigel, Etkin), Stanford University, Stanford, Calif.; VA Palo Alto Health Care System and Sierra Pacific Mental Illness Research, Education, and Clinical Center, Palo Alto, Calif. (Maron-Katz, Zhang, Narayan, Wu, Toll, Naparstek, De Los Angeles, Longwell, Shpigel, Etkin); School of Automation Science and Engineering, South China University of Technology, Guangzhou, Guangdong, China (Wu); Steven and Alexandra Cohen Veterans Center for the Study of Post-Traumatic Stress and Traumatic Brain Injury and Department of Psychiatry (Newman, Abu-Amara, Marmar), New York University Langone School of Medicine, New York
| | - Emmanuel Shpigel
- Department of Bioengineering (Toll) and Department of Psychiatry and Behavioral Sciences and Wu Tsai Neurosciences Institute (Maron-Katz, Zhang, Narayan, Wu, Toll, Naparstek, De Los Angeles, Longwell, Shpigel, Etkin), Stanford University, Stanford, Calif.; VA Palo Alto Health Care System and Sierra Pacific Mental Illness Research, Education, and Clinical Center, Palo Alto, Calif. (Maron-Katz, Zhang, Narayan, Wu, Toll, Naparstek, De Los Angeles, Longwell, Shpigel, Etkin); School of Automation Science and Engineering, South China University of Technology, Guangzhou, Guangdong, China (Wu); Steven and Alexandra Cohen Veterans Center for the Study of Post-Traumatic Stress and Traumatic Brain Injury and Department of Psychiatry (Newman, Abu-Amara, Marmar), New York University Langone School of Medicine, New York
| | - Jennifer Newman
- Department of Bioengineering (Toll) and Department of Psychiatry and Behavioral Sciences and Wu Tsai Neurosciences Institute (Maron-Katz, Zhang, Narayan, Wu, Toll, Naparstek, De Los Angeles, Longwell, Shpigel, Etkin), Stanford University, Stanford, Calif.; VA Palo Alto Health Care System and Sierra Pacific Mental Illness Research, Education, and Clinical Center, Palo Alto, Calif. (Maron-Katz, Zhang, Narayan, Wu, Toll, Naparstek, De Los Angeles, Longwell, Shpigel, Etkin); School of Automation Science and Engineering, South China University of Technology, Guangzhou, Guangdong, China (Wu); Steven and Alexandra Cohen Veterans Center for the Study of Post-Traumatic Stress and Traumatic Brain Injury and Department of Psychiatry (Newman, Abu-Amara, Marmar), New York University Langone School of Medicine, New York
| | - Duna Abu-Amara
- Department of Bioengineering (Toll) and Department of Psychiatry and Behavioral Sciences and Wu Tsai Neurosciences Institute (Maron-Katz, Zhang, Narayan, Wu, Toll, Naparstek, De Los Angeles, Longwell, Shpigel, Etkin), Stanford University, Stanford, Calif.; VA Palo Alto Health Care System and Sierra Pacific Mental Illness Research, Education, and Clinical Center, Palo Alto, Calif. (Maron-Katz, Zhang, Narayan, Wu, Toll, Naparstek, De Los Angeles, Longwell, Shpigel, Etkin); School of Automation Science and Engineering, South China University of Technology, Guangzhou, Guangdong, China (Wu); Steven and Alexandra Cohen Veterans Center for the Study of Post-Traumatic Stress and Traumatic Brain Injury and Department of Psychiatry (Newman, Abu-Amara, Marmar), New York University Langone School of Medicine, New York
| | - Charles Marmar
- Department of Bioengineering (Toll) and Department of Psychiatry and Behavioral Sciences and Wu Tsai Neurosciences Institute (Maron-Katz, Zhang, Narayan, Wu, Toll, Naparstek, De Los Angeles, Longwell, Shpigel, Etkin), Stanford University, Stanford, Calif.; VA Palo Alto Health Care System and Sierra Pacific Mental Illness Research, Education, and Clinical Center, Palo Alto, Calif. (Maron-Katz, Zhang, Narayan, Wu, Toll, Naparstek, De Los Angeles, Longwell, Shpigel, Etkin); School of Automation Science and Engineering, South China University of Technology, Guangzhou, Guangdong, China (Wu); Steven and Alexandra Cohen Veterans Center for the Study of Post-Traumatic Stress and Traumatic Brain Injury and Department of Psychiatry (Newman, Abu-Amara, Marmar), New York University Langone School of Medicine, New York
| | - Amit Etkin
- Department of Bioengineering (Toll) and Department of Psychiatry and Behavioral Sciences and Wu Tsai Neurosciences Institute (Maron-Katz, Zhang, Narayan, Wu, Toll, Naparstek, De Los Angeles, Longwell, Shpigel, Etkin), Stanford University, Stanford, Calif.; VA Palo Alto Health Care System and Sierra Pacific Mental Illness Research, Education, and Clinical Center, Palo Alto, Calif. (Maron-Katz, Zhang, Narayan, Wu, Toll, Naparstek, De Los Angeles, Longwell, Shpigel, Etkin); School of Automation Science and Engineering, South China University of Technology, Guangzhou, Guangdong, China (Wu); Steven and Alexandra Cohen Veterans Center for the Study of Post-Traumatic Stress and Traumatic Brain Injury and Department of Psychiatry (Newman, Abu-Amara, Marmar), New York University Langone School of Medicine, New York
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22
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Harricharan S, Nicholson AA, Thome J, Densmore M, McKinnon MC, Théberge J, Frewen PA, Neufeld RWJ, Lanius RA. PTSD and its dissociative subtype through the lens of the insula: Anterior and posterior insula resting‐state functional connectivity and its predictive validity using machine learning. Psychophysiology 2019; 57:e13472. [DOI: 10.1111/psyp.13472] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 06/24/2019] [Accepted: 07/29/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Sherain Harricharan
- Department of Neuroscience Western University London Ontario Canada
- Department of Psychiatry Western University London Ontario Canada
- Imaging Division Lawson Health Research Institute London Ontario Canada
| | - Andrew A. Nicholson
- Department of Psychological Research and Research Methods University of Vienna Vienna Austria
| | - Janine Thome
- Department of Psychiatry Western University London Ontario Canada
- Imaging Division Lawson Health Research Institute London Ontario Canada
| | - Maria Densmore
- Department of Psychiatry Western University London Ontario Canada
- Imaging Division Lawson Health Research Institute 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
| | - Jean Théberge
- Department of Psychiatry Western University London Ontario Canada
- Imaging Division Lawson Health Research Institute London Ontario Canada
- Department of Medical Imaging Western University London Ontario Canada
- Department of Medical Biophysics Western University London Ontario Canada
- Department of Diagnostic Imaging St. Joseph's Healthcare London Ontario Canada
| | - Paul A. Frewen
- Department of Neuroscience Western University London Ontario Canada
- Department of Psychiatry Western University London Ontario Canada
- Department of Psychology Western University London Ontario Canada
| | - Richard W. J. Neufeld
- Department of Psychiatry Western University London Ontario Canada
- Department of Psychology Western University London Ontario Canada
| | - Ruth A. Lanius
- Department of Neuroscience Western University London Ontario Canada
- Department of Psychiatry Western University London Ontario Canada
- Imaging Division Lawson Health Research Institute London Ontario Canada
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23
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Nicholson AA, Densmore M, McKinnon MC, Neufeld RWJ, Frewen PA, Théberge J, Jetly R, Richardson JD, Lanius RA. Machine learning multivariate pattern analysis predicts classification of posttraumatic stress disorder and its dissociative subtype: a multimodal neuroimaging approach. Psychol Med 2019; 49:2049-2059. [PMID: 30306886 DOI: 10.1017/s0033291718002866] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND The field of psychiatry would benefit significantly from developing objective biomarkers that could facilitate the early identification of heterogeneous subtypes of illness. Critically, although machine learning pattern recognition methods have been applied recently to predict many psychiatric disorders, these techniques have not been utilized to predict subtypes of posttraumatic stress disorder (PTSD), including the dissociative subtype of PTSD (PTSD + DS). METHODS Using Multiclass Gaussian Process Classification within PRoNTo, we examined the classification accuracy of: (i) the mean amplitude of low-frequency fluctuations (mALFF; reflecting spontaneous neural activity during rest); and (ii) seed-based amygdala complex functional connectivity within 181 participants [PTSD (n = 81); PTSD + DS (n = 49); and age-matched healthy trauma-unexposed controls (n = 51)]. We also computed mass-univariate analyses in order to observe regional group differences [false-discovery-rate (FDR)-cluster corrected p < 0.05, k = 20]. RESULTS We found that extracted features could predict accurately the classification of PTSD, PTSD + DS, and healthy controls, using both resting-state mALFF (91.63% balanced accuracy, p < 0.001) and amygdala complex connectivity maps (85.00% balanced accuracy, p < 0.001). These results were replicated using independent machine learning algorithms/cross-validation procedures. Moreover, areas weighted as being most important for group classification also displayed significant group differences at the univariate level. Here, whereas the PTSD + DS group displayed increased activation within emotion regulation regions, the PTSD group showed increased activation within the amygdala, globus pallidus, and motor/somatosensory regions. CONCLUSION The current study has significant implications for advancing machine learning applications within the field of psychiatry, as well as for developing objective biomarkers indicative of diagnostic heterogeneity.
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Affiliation(s)
- Andrew A Nicholson
- Department of Neuroscience, Western University, London, ON, Canada
- Department of Psychiatry, Western University, London, ON, Canada
- Department of Psychiatry and Behavioural Neuroscience, McMaster University, Hamilton, ON, Canada
- Homewood Research Institute, Guelph, ON, Canada
- Imaging, Lawson Health Research Institute, London, ON, Canada
| | - Maria Densmore
- Department of Psychiatry, Western University, London, ON, Canada
- Imaging, Lawson Health Research Institute, London, ON, Canada
| | - Margaret C McKinnon
- Department of Psychiatry and Behavioural Neuroscience, McMaster University, Hamilton, ON, Canada
- Homewood Research Institute, Guelph, ON, Canada
- Department of Mood Disorders Program, St. Joseph's Healthcare, Hamilton, ON, Canada
| | - Richard W J Neufeld
- Department of Neuroscience, Western University, London, ON, Canada
- Department of Psychiatry, Western University, London, ON, Canada
- Department of Psychology, Western University, London, ON, Canada
| | - Paul A Frewen
- Department of Neuroscience, Western University, London, ON, Canada
- Department of Psychology, Western University, London, ON, Canada
| | - Jean Théberge
- Department of Psychiatry, Western University, London, ON, Canada
- Imaging, Lawson Health Research Institute, London, ON, Canada
- Department of Medical Imaging, Western University, London, ON, Canada
- Department of Medial Biophysics, Western University, London, ON, Canada
- Department of Diagnostic Imaging, St. Joseph's Healthcare, London, ON, Canada
| | - Rakesh Jetly
- Canadian Forces, Health Services, Ottawa, Ontario, Canada
| | - J Donald Richardson
- Department of Psychiatry and Behavioural Neuroscience, McMaster University, Hamilton, ON, Canada
- Homewood Research Institute, Guelph, ON, Canada
- Department of Mood Disorders Program, St. Joseph's Healthcare, Hamilton, ON, Canada
| | - Ruth A Lanius
- Department of Neuroscience, Western University, London, ON, Canada
- Department of Psychiatry, Western University, London, ON, Canada
- Imaging, Lawson Health Research Institute, London, ON, Canada
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24
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Poppa T, Droutman V, Amaro H, Black D, Arnaudova I, Monterosso J. Sexual trauma history is associated with reduced orbitofrontal network strength in substance-dependent women. Neuroimage Clin 2019; 24:101973. [PMID: 31472330 PMCID: PMC6728879 DOI: 10.1016/j.nicl.2019.101973] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 06/29/2019] [Accepted: 08/03/2019] [Indexed: 12/19/2022]
Abstract
AIM Substance use disorders (SUDs) are highly comorbid with post-traumatic stress disorder (PTSD). PTSD-SUD comorbidity is associated with greater functional impairments and relapse risk. Women with SUDs experience markedly higher rates of trauma and PTSD compared to men with SUDs, particularly due to sexual and domestic abuse. Despite the strong association between trauma exposure and SUDs, the neurobiological correlates are understudied, particularly among females with SUDs. However, there is indication of abnormal somatic and interoceptive processing in women with PTSD. The present study examines interoception-linked differences in intrinsic brain networks in a group of women with SUDs and varying histories of trauma exposure, some of whom have a current PTSD diagnosis. METHODS Pre-intervention data were analyzed from a subset (N = 43) of women in SUD residential treatment recruited for a mindfulness-based intervention efficacy clinical trial. Participants diagnosed with PTSD (n = 14) or not (n = 29) performed a task which involved attending to the somatic and visceral sensations of the breathing cycle (interoception) while undergoing a functional MRI (fMRI) scan. FMRI analysis employed independent components analysis and dual regression. First, we assessed differences in functional connectivity of interoception-modulated functional networks among those with and without PTSD. Second, we tested associations between network strength and lifetime sexual violence exposure across all participants on networks that showed significant group differences. RESULTS PTSD diagnosis was associated with reduced functional connectivity of an orbitofrontal network with the precuneus, mid-posterior insula, lateral prefrontal cortex and angular gyrus. OFC network strength was inversely associated with sexual violence exposure over-and-above the contribution of PTSD status alone. CONCLUSIONS Our findings provide a novel network-level account of brain activity associated with PTSD among women with SUDs, which may inform treatment response in this subpopulation.
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Affiliation(s)
- Tasha Poppa
- Department of Psychology, University of Southern California, Los Angeles, United States of America.
| | - Vita Droutman
- Department of Psychology, University of Southern California, Los Angeles, United States of America
| | - Hortensia Amaro
- Herbert Wertheim College of Medicine, Robert Stempel College of Public Health and Social Work, Florida International University, Los Angeles, United States of America
| | - David Black
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, United States of America
| | - Inna Arnaudova
- Department of Psychiatry, University of California, Los Angeles, United States of America
| | - John Monterosso
- Department of Psychology, University of Southern California, Los Angeles, United States of America
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25
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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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26
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Terpou BA, Densmore M, Théberge J, Frewen P, McKinnon MC, Lanius RA. Resting-state pulvinar-posterior parietal decoupling in PTSD and its dissociative subtype. Hum Brain Mapp 2018; 39:4228-4240. [PMID: 30091811 DOI: 10.1002/hbm.24242] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 05/09/2018] [Accepted: 05/27/2018] [Indexed: 12/30/2022] Open
Abstract
Key evidence points toward alterations in the neurocircuitry of large-scale networks among patients with posttraumatic stress disorder (PTSD). The pulvinar is a thalamic region displaying reciprocal connectivity with the cortex and has been shown to modulate alpha synchrony to facilitate network communication. During rest, the pulvinar displays functional connectivity with the posterior parietal cortex (PPC), a heteromodal network of brain areas underlying multisensory integration and socioaffective functions that are shown at deficit in PTSD. Accordingly, this study seeks to reveal the resting-state functional connectivity (rsFC) patterns of individuals with PTSD, its dissociative subtype (PTSD + DS) and healthy controls. A whole-brain rsFC analysis was conducted using SPM12 and PickAtlas. Connectivity was analyzed for the left and right pulvinar across groups of individuals with PTSD (n = 81), PTSD + DS (n = 49), and controls (n = 51). As compared to PTSD, controls displayed significantly greater pulvinar rsFC with the superior parietal lobule and precuneus. Moreover, as compared to PTSD + DS, controls showed increased pulvinar connectivity with the superior parietal lobule, inferior parietal lobule and the precuneus. PTSD groups did not display stronger connectivity with any region as compared to controls. Last, PTSD had greater rsFC in the supramarginal gyrus relative to PTSD + DS. Reduced connectivity between the pulvinar and PPC may explain impairments to autobiographical memory, self-referential processing, and socioaffective domains in PTSD and PTSD + DS even at "rest." Critically, these alterations appear to be exacerbated in individuals with PTSD + DS, which may have important implications for treatment.
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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
| | - 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
| | - 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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27
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Rabellino D, Densmore M, Théberge J, McKinnon MC, Lanius RA. The cerebellum after trauma: Resting-state functional connectivity of the cerebellum in posttraumatic stress disorder and its dissociative subtype. Hum Brain Mapp 2018; 39:3354-3374. [PMID: 29667267 PMCID: PMC6866303 DOI: 10.1002/hbm.24081] [Citation(s) in RCA: 72] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 03/28/2018] [Accepted: 04/04/2018] [Indexed: 12/25/2022] Open
Abstract
The cerebellum plays a key role not only in motor function but also in affect and cognition. Although several psychopathological disorders have been associated with overall cerebellar dysfunction, it remains unclear whether different regions of the cerebellum contribute uniquely to psychopathology. Accordingly, we compared seed-based resting-state functional connectivity of the anterior cerebellum (lobule IV-V), of the posterior cerebellum (Crus I), and of the anterior vermis across posttraumatic stress disorder (PTSD; n = 65), its dissociative subtype (PTSD + DS; n = 37), and non-trauma-exposed healthy controls (HC; n = 47). Here, we observed decreased functional connectivity of the anterior cerebellum and anterior vermis with brain regions involved in somatosensory processing, multisensory integration, and bodily self-consciousness (temporo-parietal junction, postcentral gyrus, and superior parietal lobule) in PTSD + DS as compared to PTSD and HC. Moreover, the PTSD + DS group showed increased functional connectivity of the posterior cerebellum with cortical areas related to emotion regulation (ventromedial prefrontal and orbito-frontal cortex, subgenual anterior cingulum) as compared to PTSD. By contrast, PTSD showed increased functional connectivity of the anterior cerebellum with cortical areas associated with visual processing (fusiform gyrus), interoceptive awareness (posterior insula), memory retrieval, and contextual processing (hippocampus) as compared to HC. Finally, we observed decreased functional connectivity between the posterior cerebellum and prefrontal regions involved in emotion regulation, in PTSD as compared to HC. These findings not only highlight the crucial role of each cerebellar region examined in the psychopathology of PTSD but also reveal unique alterations in functional connectivity distinguishing the dissociative subtype of PTSD versus PTSD.
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Affiliation(s)
- Daniela Rabellino
- Department of PsychiatryUniversity of Western OntarioLondonOntarioCanada
- Imaging DivisionLawson Health Research InstituteLondonOntarioCanada
| | - Maria Densmore
- Department of PsychiatryUniversity of Western OntarioLondonOntarioCanada
- Imaging DivisionLawson Health Research InstituteLondonOntarioCanada
| | - Jean Théberge
- Department of PsychiatryUniversity of Western OntarioLondonOntarioCanada
- Imaging DivisionLawson Health Research InstituteLondonOntarioCanada
- Department of Medical BiophysicsUniversity of Western OntarioLondonOntarioCanada
| | - Margaret C. McKinnon
- Mood Disorders Program, St. Joseph's HealthcareHamiltonOntarioCanada
- Department of Psychiatry and Behavioural NeurosciencesMcMaster UniversityHamiltonOntarioCanada
- Homewood Research InstituteGuelphOntarioCanada
| | - Ruth A. Lanius
- Department of PsychiatryUniversity of Western OntarioLondonOntarioCanada
- Imaging DivisionLawson Health Research InstituteLondonOntarioCanada
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28
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Sierk A, Daniels JK, Manthey A, Kok JG, Leemans A, Gaebler M, Lamke JP, Kruschwitz J, Walter H. White matter network alterations in patients with depersonalization/derealization disorder. J Psychiatry Neurosci 2018; 43:170110. [PMID: 29877178 PMCID: PMC6158023 DOI: 10.1503/jpn.170110] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 12/01/2017] [Accepted: 01/21/2018] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Depersonalization/derealization disorder (DPD) is a chronic and distressing condition characterized by detachment from oneself and/or the external world. Neuroimaging studies have associated DPD with structural and functional alterations in a variety of distinct brain regions. Such local neuronal changes might be mediated by altered interregional white matter connections. However, to our knowledge, no research on network characteristics in this patient population exists to date. METHODS We explored the structural connectome in 23 individuals with DPD and 23 matched, healthy controls by applying graph theory to diffusion tensor imaging data. Mean interregional fractional anisotropy (FA) was used to define the network weights. Group differences were assessed using network-based statistics and a link-based controlling procedure. RESULTS Our main finding refers to lower FA values within left temporal and right temporoparietal regions in individuals with DPD than in healthy controls when using a link-based controlling procedure. These links were also associated with dissociative symptom severity and could not be explained by anxiety or depression scores. Using network-based statistics, no significant results emerged. However, we found a trend for 1 subnetwork that may support the model of frontolimbic dysbalance suggested to underlie DPD symptomatology. LIMITATIONS To ensure ecological validity, patients with certain comorbidities or psychotropic medication were included in the study. Confirmatory replications are necessary to corroborate the results of this explorative investigation. CONCLUSION In patients with DPD, the structural connectivity between brain regions crucial for multimodal integration and emotion regulation may be altered. Aberrations in fibre tract communication seem to be not solely a secondary effect of local grey matter volume loss, but may present a primary pathophysiology in patients with DPD.
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Affiliation(s)
- Anika Sierk
- From the Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany (Sierk, Manthey, Lamke, Kruschwitz, Walter); the Institute of Cognitive Neuroscience, University College London, London, UK (Sierk); the Department of Clinical Psychology, University of Groningen, Groningen, The Netherlands (Daniels); the Department of Neurology, University of Groningen, University Medical Center Groningen, The Netherlands (Kok); the PROVIDI Lab, University Medical Center Utrecht, Utrecht, the Netherlands (Leemans); and the Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany (Gaebler)
| | - Judith K Daniels
- From the Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany (Sierk, Manthey, Lamke, Kruschwitz, Walter); the Institute of Cognitive Neuroscience, University College London, London, UK (Sierk); the Department of Clinical Psychology, University of Groningen, Groningen, The Netherlands (Daniels); the Department of Neurology, University of Groningen, University Medical Center Groningen, The Netherlands (Kok); the PROVIDI Lab, University Medical Center Utrecht, Utrecht, the Netherlands (Leemans); and the Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany (Gaebler)
| | - Antje Manthey
- From the Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany (Sierk, Manthey, Lamke, Kruschwitz, Walter); the Institute of Cognitive Neuroscience, University College London, London, UK (Sierk); the Department of Clinical Psychology, University of Groningen, Groningen, The Netherlands (Daniels); the Department of Neurology, University of Groningen, University Medical Center Groningen, The Netherlands (Kok); the PROVIDI Lab, University Medical Center Utrecht, Utrecht, the Netherlands (Leemans); and the Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany (Gaebler)
| | - Jelmer G Kok
- From the Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany (Sierk, Manthey, Lamke, Kruschwitz, Walter); the Institute of Cognitive Neuroscience, University College London, London, UK (Sierk); the Department of Clinical Psychology, University of Groningen, Groningen, The Netherlands (Daniels); the Department of Neurology, University of Groningen, University Medical Center Groningen, The Netherlands (Kok); the PROVIDI Lab, University Medical Center Utrecht, Utrecht, the Netherlands (Leemans); and the Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany (Gaebler)
| | - Alexander Leemans
- From the Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany (Sierk, Manthey, Lamke, Kruschwitz, Walter); the Institute of Cognitive Neuroscience, University College London, London, UK (Sierk); the Department of Clinical Psychology, University of Groningen, Groningen, The Netherlands (Daniels); the Department of Neurology, University of Groningen, University Medical Center Groningen, The Netherlands (Kok); the PROVIDI Lab, University Medical Center Utrecht, Utrecht, the Netherlands (Leemans); and the Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany (Gaebler)
| | - Michael Gaebler
- From the Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany (Sierk, Manthey, Lamke, Kruschwitz, Walter); the Institute of Cognitive Neuroscience, University College London, London, UK (Sierk); the Department of Clinical Psychology, University of Groningen, Groningen, The Netherlands (Daniels); the Department of Neurology, University of Groningen, University Medical Center Groningen, The Netherlands (Kok); the PROVIDI Lab, University Medical Center Utrecht, Utrecht, the Netherlands (Leemans); and the Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany (Gaebler)
| | - Jan-Peter Lamke
- From the Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany (Sierk, Manthey, Lamke, Kruschwitz, Walter); the Institute of Cognitive Neuroscience, University College London, London, UK (Sierk); the Department of Clinical Psychology, University of Groningen, Groningen, The Netherlands (Daniels); the Department of Neurology, University of Groningen, University Medical Center Groningen, The Netherlands (Kok); the PROVIDI Lab, University Medical Center Utrecht, Utrecht, the Netherlands (Leemans); and the Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany (Gaebler)
| | - Johann Kruschwitz
- From the Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany (Sierk, Manthey, Lamke, Kruschwitz, Walter); the Institute of Cognitive Neuroscience, University College London, London, UK (Sierk); the Department of Clinical Psychology, University of Groningen, Groningen, The Netherlands (Daniels); the Department of Neurology, University of Groningen, University Medical Center Groningen, The Netherlands (Kok); the PROVIDI Lab, University Medical Center Utrecht, Utrecht, the Netherlands (Leemans); and the Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany (Gaebler)
| | - Henrik Walter
- From the Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany (Sierk, Manthey, Lamke, Kruschwitz, Walter); the Institute of Cognitive Neuroscience, University College London, London, UK (Sierk); the Department of Clinical Psychology, University of Groningen, Groningen, The Netherlands (Daniels); the Department of Neurology, University of Groningen, University Medical Center Groningen, The Netherlands (Kok); the PROVIDI Lab, University Medical Center Utrecht, Utrecht, the Netherlands (Leemans); and the Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany (Gaebler)
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