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Lin Y, White ML, Wu D, Viravan N, Braver TS. Distinct Mindfulness States Produce Dissociable Effects on Neural Markers of Emotion Processing: Evidence From the Late Positive Potential. BIOLOGICAL PSYCHIATRY GLOBAL OPEN SCIENCE 2024; 4:100357. [PMID: 39183744 PMCID: PMC11342101 DOI: 10.1016/j.bpsgos.2024.100357] [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: 02/15/2024] [Revised: 06/12/2024] [Accepted: 06/13/2024] [Indexed: 08/27/2024] Open
Abstract
Background Mindfulness has long been theorized to benefit emotion regulation, but despite the ubiquity of the claim, there is little empirical evidence demonstrating how mindfulness modulates the neurophysiology of emotion processing. The current study aimed to fill this gap in knowledge by leveraging a novel research approach capable of discretizing mindfulness into distinct states of open monitoring (OM) and focused attention (FA) to distinguish their influence on multimodal subjective and objective measures of emotion processing. Methods Utilizing a fully within-participant picture viewing state induction protocol (N = 30), we compared the effects of OM and FA, rigorously contrasted against an active control, on the visually evoked late positive potential (LPP), a neural index of motivated attention. Bayesian mixed modeling was used to distinguish OM versus FA effects on the early and late sustained LPP while evaluating the influence of subjective arousal ratings as a within-participant moderator of the state inductions. Results When negative picture trials were retrospectively rated as more subjectively arousing, the OM induction reduced the late sustained LPP response, whereas the FA induction enhanced the LPP. Conclusions Acute manipulation of OM and FA states may reduce and enhance motivated attention to aversive stimuli during conditions of high subjective arousal, respectively. Functional distinctions between different mindfulness states on emotion processing may be most dissociable after accounting for within-participant variability in how stimuli are appraised. These results support the future potential of the state induction protocol for parsing the neural affective mechanisms that underlie mindfulness training programs and interventions.
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Affiliation(s)
- Yanli Lin
- Department of Psychological and Brain Sciences, Washington University in St. Louis, St. Louis, Missouri
| | - Marne L. White
- Department of Psychological and Brain Sciences, Washington University in St. Louis, St. Louis, Missouri
| | - Deanna Wu
- Department of Psychological and Brain Sciences, Washington University in St. Louis, St. Louis, Missouri
| | - Natee Viravan
- Department of Psychiatry, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Todd S. Braver
- Department of Psychological and Brain Sciences, Washington University in St. Louis, St. Louis, Missouri
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Woodhams J, Duran F. A model for secondary traumatic stress following workplace exposure to traumatic material in analytical staff. COMMUNICATIONS PSYCHOLOGY 2024; 2:13. [PMID: 39242898 PMCID: PMC11332005 DOI: 10.1038/s44271-024-00060-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 01/29/2024] [Indexed: 09/09/2024]
Abstract
Analytical professionals working in criminal justice and in social media companies are exposed to aversive details of traumatic events. Albeit indirect, exposure in these roles is repeated and can be extreme, including exposure to material containing lethal violence, sexual assault, and serious self-harm, leading to post-traumatic stress disorder and Secondary Traumatic Stress reactions. Incorporating relevant empirical research, this article considers the mechanisms that may contribute to post-exposure post-traumatic stress disorder and Secondary Traumatic Stress reactions in these roles. Building on the Ehlers and Clark model, subsequent extensions, and the authors' experience of working as, and conducting research with, law enforcement professionals, a new model is proposed to explain post-exposure post-traumatic stress disorder/Secondary Traumatic Stress reactions.
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Affiliation(s)
- Jessica Woodhams
- School of Psychology, University of Birmingham, Birmingham, United Kingdom.
| | - Fazeelat Duran
- School of Psychology, University of Birmingham, Birmingham, United Kingdom
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van der Kolk BA, Wang JB, Yehuda R, Bedrosian L, Coker AR, Harrison C, Mithoefer M, Yazar-Klosinki B, Emerson A, Doblin R. Effects of MDMA-assisted therapy for PTSD on self-experience. PLoS One 2024; 19:e0295926. [PMID: 38198456 PMCID: PMC10781106 DOI: 10.1371/journal.pone.0295926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 11/28/2023] [Indexed: 01/12/2024] Open
Abstract
INTRODUCTION There is a resurgence of interest in the therapeutic potential of psychedelic substances such as 3,4-methylenedioxymethamphetamine (MDMA). Primary findings from our randomized, double-blind, placebo-controlled, multi-site Phase 3 clinical trial of participants with severe PTSD (NCT03537014) showed that MDMA-assisted therapy induced significant attenuation in the Clinician-Administered PTSD Scale for DSM-5 compared to Therapy with placebo. Deficits in emotional coping skills and altered self-capacities constitute major obstacles to successful completion of available treatments. The current analysis evaluated the differential effects of MDMA-assisted therapy and Therapy with placebo on 3 transdiagnostic outcome measures and explored the contribution of changes in self-experience to improvement in PTSD scores. METHODS Participants were randomized to receive manualized therapy with either MDMA or placebo during 3 experimental sessions in combination with 3 preparation and 9 integration therapy visits. Symptoms were measured at baseline and 2 months after the last experimental session using the 20-item Toronto Alexithymia Scale (TAS-20), the 26-item Self Compassion Scale (SCS), and the 63-item Inventory of Altered Self-Capacities (IASC). RESULTS 90 participants were randomized and dosed (MDMA-assisted therapy, n = 46; Therapy with placebo, n = 44); 84.4% (76/90) had histories of developmental trauma, and 87.8% (79/90) had suffered multiple traumas. MDMA-assisted therapy facilitated statistically significant greater improvement on the TAS-20, the SCS, and most IASC factors of interpersonal conflicts; idealization disillusionment; abandonment concerns; identity impairment; self-awareness; susceptibility to influence; affect dysregulation; affect instability; affect skill deficit; tension reduction activities; the only exception was identity diffusion. CONCLUSION Compared with Therapy with placebo, MDMA-assisted therapy had significant positive effects on transdiagnostic mental processes of self-experience which are often associated with poor treatment outcome. This provides a possible window into understanding the psychological capacities facilitated by psychedelic agents that may result in significant improvements in PTSD symptomatology.
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Affiliation(s)
| | - Julie B. Wang
- MAPS Public Benefit Corporation (MAPS PBC), San Jose, CA, United States of America
| | - Rachel Yehuda
- James J. Peters Veterans Affairs Medical Center, Bronx, NY, United States of America
- Center for Psychedelic Psychotherapy and Trauma Research, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Leah Bedrosian
- MAPS Public Benefit Corporation (MAPS PBC), San Jose, CA, United States of America
| | - Allison R. Coker
- University of California, San Francisco, San Francisco, CA, United States of America
- Multidisciplinary Association for Psychedelic Studies (MAPS), San Jose, CA, United States of America
| | - Charlotte Harrison
- MAPS Public Benefit Corporation (MAPS PBC), San Jose, CA, United States of America
| | - Michael Mithoefer
- MAPS Public Benefit Corporation (MAPS PBC), San Jose, CA, United States of America
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, United States of America
| | - Berra Yazar-Klosinki
- MAPS Public Benefit Corporation (MAPS PBC), San Jose, CA, United States of America
| | - Amy Emerson
- MAPS Public Benefit Corporation (MAPS PBC), San Jose, CA, United States of America
| | - Rick Doblin
- Multidisciplinary Association for Psychedelic Studies (MAPS), San Jose, CA, United States of America
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Smith PJ, Whitson HE, Merwin RM, O’Hayer CV, Strauman TJ. Engineering Virtuous health habits using Emotion and Neurocognition: Flexibility for Lifestyle Optimization and Weight management (EVEN FLOW). Front Aging Neurosci 2023; 15:1256430. [PMID: 38076541 PMCID: PMC10702760 DOI: 10.3389/fnagi.2023.1256430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 10/20/2023] [Indexed: 02/12/2024] Open
Abstract
Interventions to preserve functional independence in older adults are critically needed to optimize 'successful aging' among the large and increasing population of older adults in the United States. For most aging adults, the management of chronic diseases is the most common and impactful risk factor for loss of functional independence. Chronic disease management inherently involves the learning and adaptation of new behaviors, such as adopting or modifying physical activity habits and managing weight. Despite the importance of chronic disease management in older adults, vanishingly few individuals optimally manage their health behavior in the service of chronic disease stabilization to preserve functional independence. Contemporary conceptual models of chronic disease management and health habit theory suggest that this lack of optimal management may result from an underappreciated distinction within the health behavior literature: the behavioral domains critical for initiation of new behaviors (Initiation Phase) are largely distinct from those that facilitate their maintenance (Maintenance Phase). Psychological factors, particularly experiential acceptance and trait levels of openness are critical to engagement with new health behaviors, willingness to make difficult lifestyle changes, and the ability to tolerate aversive affective responses in the process. Cognitive factors, particularly executive function, are critical to learning new skills, using them effectively across different areas of life and contextual demands, and updating of skills to facilitate behavioral maintenance. Emerging data therefore suggests that individuals with greater executive function are better able to sustain behavior changes, which in turn protects against cognitive decline. In addition, social and structural supports of behavior change serve a critical buffering role across phases of behavior change. The present review attempts to address these gaps by proposing a novel biobehavioral intervention framework that incorporates both individual-level and social support system-level variables for the purpose of treatment tailoring. Our intervention framework triangulates on the central importance of self-regulatory functioning, proposing that both cognitive and psychological mechanisms ultimately influence an individuals' ability to engage in different aspects of self-management (individual level) in the service of maintaining independence. Importantly, the proposed linkages of cognitive and affective functioning align with emerging individual difference frameworks, suggesting that lower levels of cognitive and/or psychological flexibility represent an intermediate phenotype of risk. Individuals exhibiting self-regulatory lapses either due to the inability to regulate their emotional responses or due to the presence of executive functioning impairments are therefore the most likely to require assistance to preserve functional independence. In addition, these vulnerabilities will be more easily observable for individuals requiring greater complexity of self-management behavioral demands (e.g. complexity of medication regimen) and/or with lesser social support. Our proposed framework also intuits several distinct intervention pathways based on the profile of self-regulatory behaviors: we propose that individuals with intact affect regulation and impaired executive function will preferentially respond to 'top-down' training approaches (e.g., strategy and process work). Individuals with intact executive function and impaired affect regulation will respond to 'bottom-up' approaches (e.g., graded exposure). And individuals with impairments in both may require treatments targeting caregiving or structural supports, particularly in the context of elevated behavioral demands.
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Affiliation(s)
- Patrick J. Smith
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Heather E. Whitson
- Department of Medicine, Duke University Medical Center, Durham, NC, United States
- Department of Medicine, Durham Veterans Affairs Medical Center, Durham, NC, United States
| | - Rhonda M. Merwin
- Department of Psychiatry, Duke University Medical Center, Durham, NC, United States
| | - C. Virginia O’Hayer
- Department of Psychiatry and Human Behavior, Thomas Jefferson University, Philadelphia, PA, United States
| | - Timothy J. Strauman
- Department of Psychiatry, Duke University Medical Center, Durham, NC, United States
- Department of Psychology and Neuroscience, Duke University, Durham, NC, United States
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Mohajerin B, Lynn SJ, Cassiello-Robbins C. Unified Protocol vs Trauma-Focused Cognitive Behavioral Therapy Among Adolescents With PTSD. Behav Ther 2023; 54:823-838. [PMID: 37597960 PMCID: PMC10060014 DOI: 10.1016/j.beth.2023.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 02/27/2023] [Accepted: 03/02/2023] [Indexed: 03/31/2023]
Abstract
Harmful consequences of COVID-19, such as prolonged quarantine, lack of social contact, and especially loss of parents or friends, can negatively impact children and adolescents' mental health in diverse ways, including engendering posttraumatic stress symptoms. Our study is the first to compare the transdiagnostic Unified Protocol for the Treatment of Emotional Disorders in Adolescents (UP-A; Ehrenreich et al., 2009; Ehrenreich-May et al., 2017) with Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) in terms of outcomes related to PTSD symptoms (COVID-19-related vs. COVID-19 unrelated PTSD) and comorbid symptoms (i.e., anxiety, depression) and other measures (i.e., emotion regulation, self-injury, anger). Individuals diagnosed with PTSD were randomly assigned to the UP-A (n = 46) or TF-CBT group (n = 47), administered the SCID-5 and a battery of measures and followed up posttreatment and then after 3, 6, and 9 months. Ninety-three adolescents with PTSD were enrolled, 45% boys and 61% COVID-19-related PTSD. We adopted an intention-to-treat approach. At the initial post-intervention assessment, except for emotion regulation and unexpressed angry feelings, in which UP-A participants reported greater reductions, no significant differences in other variables were secured between the UP-A and TF-CBT. However, at follow-up assessments, the UP-A evidenced significantly better outcomes than TF-CBT. We found support for the UP-A compared with TF-CBT in treating adolescents with PTSD, regardless of COVID-19-related PTSD status, in maintaining treatment effectiveness over time.
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Bauer EA, Wilson KA, Phan KL, Shankman SA, MacNamara A. A Neurobiological Profile Underlying Comorbidity Load and Prospective Increases in Dysphoria in a Focal Fear Sample. Biol Psychiatry 2023; 93:352-361. [PMID: 36280453 PMCID: PMC10866641 DOI: 10.1016/j.biopsych.2022.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 08/09/2022] [Accepted: 08/10/2022] [Indexed: 01/21/2023]
Abstract
BACKGROUND Knowledge of the neural mechanisms underlying increased disease burden in anxiety disorders that is unaccounted for by individual categorical diagnoses could lead to improved clinical care. Here, we tested the utility of a joint functional magnetic resonance imaging-electroencephalography neurobiological profile characterized by overvaluation of negative stimuli (amygdala) in combination with blunted elaborated processing of these same stimuli (the late positive potential [LPP], an event-related potential) in predicting increased psychopathology across a 2-year period in people with anxiety disorders. METHODS One hundred ten participants (64 female, 45 male, 1 other) including 78 participants with phobias who varied in the extent of their internalizing comorbidity and 32 participants who were free from psychopathology viewed negative and neutral pictures during separate functional magnetic resonance imaging blood oxygen level-dependent and electroencephalogram recordings. Dysphoria was assessed at baseline and 2 years later. RESULTS Participants with both heightened amygdala activation and blunted LPPs to negative pictures showed the greatest increases in dysphoria 2 years later. Cross-sectionally, participants with higher comorbidity load (≥2 additional diagnoses, n = 34) showed increased amygdala activation to negative pictures compared with participants with lower comorbidity load (≤1 additional diagnosis, n = 44) and compared with participants free from psychopathology. In addition, high comorbid participants showed reduced LPPs to negative pictures compared with low comorbid participants. CONCLUSIONS Heightened amygdala in response to negative stimuli in combination with blunted LPPs could indicate overvaluation of threatening stimuli in the absence of elaborated processing that might otherwise help regulate threat responding. This brain profile could underlie the worsening and maintenance of internalizing psychopathology over time.
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Affiliation(s)
- Elizabeth A Bauer
- Department of Psychological and Brain Sciences, Texas A&M University, College Station, Texas.
| | - Kayla A Wilson
- Department of Psychological and Brain Sciences, Texas A&M University, College Station, Texas
| | - K Luan Phan
- Department of Psychiatry and Behavioral Health, Ohio State University, Columbus, Ohio
| | - Stewart A Shankman
- Department of Psychiatry and Behavioral Sciences, Northwestern University, Evanston, Illinois
| | - Annmarie MacNamara
- Department of Psychological and Brain Sciences, Texas A&M University, College Station, Texas
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Chakravarthi B, Ng SC, Ezilarasan MR, Leung MF. EEG-based emotion recognition using hybrid CNN and LSTM classification. Front Comput Neurosci 2022; 16:1019776. [PMID: 36277613 PMCID: PMC9585893 DOI: 10.3389/fncom.2022.1019776] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 09/20/2022] [Indexed: 11/13/2022] Open
Abstract
Emotions are a mental state that is accompanied by a distinct physiologic rhythm, as well as physical, behavioral, and mental changes. In the latest days, physiological activity has been used to study emotional reactions. This study describes the electroencephalography (EEG) signals, the brain wave pattern, and emotion analysis all of these are interrelated and based on the consequences of human behavior and Post-Traumatic Stress Disorder (PTSD). Post-traumatic stress disorder effects for long-term illness are associated with considerable suffering, impairment, and social/emotional impairment. PTSD is connected to subcortical responses to injury memories, thoughts, and emotions and alterations in brain circuitry. Predominantly EEG signals are the way of examining the electrical potential of the human feelings cum expression for every changing phenomenon that the individual faces. When going through literature there are some lacunae while analyzing emotions. There exist some reliability issues and also masking of real emotional behavior by the victims. Keeping this research gap and hindrance faced by the previous researchers the present study aims to fulfill the requirements, the efforts can be made to overcome this problem, and the proposed automated CNN-LSTM with ResNet-152 algorithm. Compared with the existing techniques, the proposed techniques achieved a higher level of accuracy of 98% by applying the hybrid deep learning algorithm.
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Affiliation(s)
- Bhuvaneshwari Chakravarthi
- School of Computing and Information Science, Faculty of Science and Engineering, Anglia Ruskin University, Cambridge, United Kingdom
| | - Sin-Chun Ng
- School of Computing and Information Science, Faculty of Science and Engineering, Anglia Ruskin University, Cambridge, United Kingdom
- *Correspondence: Sin-Chun Ng,
| | - M. R. Ezilarasan
- Department of Electronics and Communication Engineering, Vel Tech Rangarajan Dr. Sagunthala R&D Institute of Science and Technology, Chennai, India
| | - Man-Fai Leung
- School of Computing and Information Science, Faculty of Science and Engineering, Anglia Ruskin University, Cambridge, United Kingdom
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Yun JY, Jin MJ, Kim S, Lee SH. Stress-related cognitive style is related to volumetric change of the hippocampus and FK506 binding protein 5 polymorphism in post-traumatic stress disorder. Psychol Med 2022; 52:1243-1254. [PMID: 32892762 DOI: 10.1017/s0033291720002949] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Patients with post-traumatic stress disorder (PTSD) show a different stress-related cognitive style compared with healthy controls (HC). The FK506 binding protein 5 gene (FKBP5), one of the PTSD known risk factors, is involved in the stress response through the hypothalamic-pituitary-adrenal axis and brain volumetric alterations. The present study aimed to uncover the neural correlates of stress-related cognitive styles through the analysis of the regional brain volumes and FKBP5 genotype in patients with PTSD compared with HC. METHODS In this study, 51 patients with PTSD and 94 HC were assessed for stress-related cognitive styles, PTSD symptoms severity, and genotype of FKBP5 single nucleotide polymorphisms, and underwent T1-weighted structural magnetic resonance imaging. Diagnosis-by-genotype interaction for regional brain volumes was examined in 16 brain regions of interest. RESULTS Patients with PTSD showed significantly higher levels of catastrophizing, ruminative response, and repression, and reduced distress aversion and positive reappraisal compared with HC (p < 0.001). Significant diagnosis-by-genotype interactions for regional brain volumes were observed for bilateral hippocampi and left frontal operculum. A significant positive correlation between the severity of the repression and left hippocampal volume was found in a subgroup of patients with PTSD with FKBP5 rs3800373 (AA genotype) or rs1360780 (CC genotype). CONCLUSIONS The present study showed the influences of FKBP5 genotype on the distorted cognitive styles in PTSD by measuring the volumetric alteration of hippocampal regions, providing a possible role of the hippocampus and left frontal operculum as significant neurobiological correlates of PTSD.
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Affiliation(s)
- Je-Yeon Yun
- Seoul National University Hospital, Seoul, Republic of Korea
- Yeongeon Student Support Center, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Min Jin Jin
- Department of Psychiatry, Wonkwang University Hospital, Iksan, Republic of Korea
- Institute of General Education, Kongju National University, Gongju, Republic of Korea
| | - Sungkean Kim
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, FL, USA
| | - Seung-Hwan Lee
- Clinical Emotion and Cognition Research Clinical Emotion and Cognition Research Laboratory, Inje University, Goyang, Republic of Korea
- Department of Psychiatry, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Republic of Korea
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Emotional processing prospectively modulates the impact of anxiety on COVID-19 pandemic-related post-traumatic stress symptoms: an ERP study. J Affect Disord 2022; 303:245-254. [PMID: 35172175 PMCID: PMC8842094 DOI: 10.1016/j.jad.2022.02.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 02/01/2022] [Accepted: 02/12/2022] [Indexed: 12/03/2022]
Abstract
BACKGROUND Considering that the elevated distress caused by the COVID-19 pandemic, in some cases, led to post-traumatic stress symptoms (PTSS), it has been proposed as a specific traumatic event. The present longitudinal study investigated pre-pandemic motivated attention to emotional stimuli, as indexed by Late Positive Potential (LPP) amplitude, in relation with the potential differential role of anxiety and depressive symptoms in predicting PTSS severity related to the COVID-19 pandemic. METHODS A total of 79 university students initially completed self-report measures of depression and anxiety along with a passive viewing task of emotional (pleasant, unpleasant) and neutral pictures while electroencephaloghic activity was recorded. In December 2020, 57 participants completed a questionnaire assessing PTSS. RESULTS Significant interactions between anxiety and LPP emerged in predicting pandemic-related PTSS, where greater anxiety symptoms predicted PTSS only in individuals with greater LPP to unpleasant or with reduced LPP to pleasant stimuli. LIMITATIONS The prevalence of the female sex, the relatively young age of the participants, as well as the fact that they were all enrolled in a University course might not allow the generalization of the findings. CONCLUSIONS Taken together, the present longitudinal study provided novel evidence on EEG predictors of pandemic-related PTSS that might be useful for the prevention and treatment of PTSS. Indeed, assessing anxiety symptoms and pre-trauma LPP to emotional stimuli might be a useful target for identifying individuals that are more vulnerable to the development of PTSS during times of crisis.
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Fitzgerald JM, Webb EK, Weis CN, Huggins AA, Bennett KP, Miskovich TA, Krukowski JL, deRoon-Cassini TA, Larson CL. Hippocampal Resting-State Functional Connectivity Forecasts Individual Posttraumatic Stress Disorder Symptoms: A Data-Driven Approach. BIOLOGICAL PSYCHIATRY. COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2022; 7:139-149. [PMID: 34478884 PMCID: PMC8825698 DOI: 10.1016/j.bpsc.2021.08.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 07/18/2021] [Accepted: 08/22/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Posttraumatic stress disorder (PTSD) is a debilitating disorder, and there is no current accurate prediction of who develops it after trauma. Neurobiologically, individuals with chronic PTSD exhibit aberrant resting-state functional connectivity (rsFC) between the hippocampus and other brain regions (e.g., amygdala, prefrontal cortex, posterior cingulate), and these aberrations correlate with severity of illness. Previous small-scale research (n < 25) has also shown that hippocampal rsFC measured acutely after trauma is predictive of future severity using a region-of-interest-based approach. While this is a promising biomarker, to date, no study has used a data-driven approach to test whole-brain hippocampal FC patterns in forecasting the development of PTSD symptoms. METHODS A total of 98 adults at risk of PTSD were recruited from the emergency department after traumatic injury and completed resting-state functional magnetic resonance imaging (8 min) within 1 month; 6 months later, they completed the Clinician-Administered PTSD Scale for DSM-5 for assessment of PTSD symptom severity. Whole-brain rsFC values with bilateral hippocampi were extracted (using CONN) and used in a machine learning kernel ridge regression analysis (PRoNTo); a k-folds (k = 10) and 70/30 testing versus training split approach were used for cross-validation (1000 iterations to bootstrap confidence intervals for significance values). RESULTS Acute hippocampal rsFC significantly predicted Clinician-Administered PTSD Scale for DSM-5 scores at 6 months (r = 0.30, p = .006; mean squared error = 120.58, p = .006; R2 = 0.09, p = .025). In post hoc analyses, hippocampal rsFC remained significant after controlling for demographics, PTSD symptoms at baseline, and depression, anxiety, and stress severity at 6 months (B = 0.59, SE = 0.20, p = .003). CONCLUSIONS Findings suggest that functional connectivity of the hippocampus across the brain acutely after traumatic injury is associated with prospective PTSD symptom severity.
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Affiliation(s)
| | - Elisabeth Kate Webb
- University of Wisconsin-Milwaukee, Department of Psychology, Milwaukee, WI, USA
| | - Carissa N. Weis
- University of Wisconsin-Milwaukee, Department of Psychology, Milwaukee, WI, USA
| | - Ashley A. Huggins
- Medical University of South Carolina, Department of Psychiatry, Charleston, SC, USA
| | | | | | | | - Terri A. deRoon-Cassini
- Medical College of Wisconsin, Department of Surgery, Division of Trauma & Acute Care Surgery, Milwaukee, WI, USA
| | - Christine L. Larson
- University of Wisconsin-Milwaukee, Department of Psychology, Milwaukee, WI, USA
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Diaz-Marsa M, MacDowell K, de laTorre-Luque A, Caso JR, Faya M, Gutierrez S, Soto M, Pemau A, Diaz-Carracedo P, Carrasco-Diaz A, Leza JC, Graell M, Carrasco JL. Inflammatory dysregulation in women with an eating disorder: Relationships with altered emotional reactivity. Int J Eat Disord 2021; 54:1843-1854. [PMID: 34418141 DOI: 10.1002/eat.23598] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 08/11/2021] [Accepted: 08/11/2021] [Indexed: 12/26/2022]
Abstract
BACKGROUND Some studies suggest that inflammatory signaling dysregulation may contribute to eating disorder (ED) pathophysiology. However, little is known about the influence of inflammatory response on altered processes seen among patients with ED, such as emotional processing and reactivity. OBJECTIVES The objectives were: (a) to investigate the systemic inflammatory response in ED women; and (b) to analyze the role of inflammatory markers in emotional reactivity. METHOD Concentrations of several intercellular and intracellular inflammatory mediators (cytokines, prostaglandin by-products and enzymes, TBARS, and MAPK proteins) were quantified in plasma and PBMCs from 68 women with an ED (m = 22.01 years, SD = 9.15) and 35 healthy controls (m = 18.54 years, SD = 4.21). Moreover, emotional reactivity to affective pictures (those without either food or thinness content) was studied using the adult (>18 years old) sample (n = 41). RESULTS Between-group differences were revealed for most markers (TNF-α, PGE2 , COX2, and ratio of activated MAPK proteins), pointing to increased inflammatory response in patients (p < .01). Women with ED showed heightened emotional reactivity, regardless of picture valence. Principal components derived from inflammatory markers showed an explanatory loading on patient's emotional reaction, in terms of valence and arousal. CONCLUSION This study corroborates the altered systemic inflammatory response in patients with ED. The inflammatory dysregulation may contribute to ED phenotype, as seen by its relationship with heightened emotional reactivity, even though the inflammatory markers were not evaluated throughout the emotional reactivity protocol.
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Affiliation(s)
- Marina Diaz-Marsa
- Department of Legal Medicine, Psychiatry, and Pathology, Universidad Complutense de Madrid (UCM), Madrid, Spain.,Centre for Biomedical Research in Mental Health (CIBERSAM), Madrid, Spain.,IIS Hospital Clinico San Carlos, Madrid, Spain
| | - Karina MacDowell
- Centre for Biomedical Research in Mental Health (CIBERSAM), Madrid, Spain.,Department of Pharmacology and Toxicology, School of Medicine, UCM, Madrid, Spain.,IIS Hospital 12 de Octubre, IUIN-UCM, Madrid, Spain
| | - Alejandro de laTorre-Luque
- Department of Legal Medicine, Psychiatry, and Pathology, Universidad Complutense de Madrid (UCM), Madrid, Spain.,Centre for Biomedical Research in Mental Health (CIBERSAM), Madrid, Spain
| | - Javier R Caso
- Centre for Biomedical Research in Mental Health (CIBERSAM), Madrid, Spain.,Department of Pharmacology and Toxicology, School of Medicine, UCM, Madrid, Spain.,IIS Hospital 12 de Octubre, IUIN-UCM, Madrid, Spain
| | - Mar Faya
- Child and Adolescent Psychiatry and Psychology Service, Child Hospital Niño Jesus, Madrid, Spain
| | - Silvia Gutierrez
- Child and Adolescent Psychiatry and Psychology Service, Child Hospital Niño Jesus, Madrid, Spain
| | - Marta Soto
- IIS Hospital Clinico San Carlos, Madrid, Spain
| | - Andres Pemau
- Faculty of Psychology, Universidad Complutense de Madrid, Madrid, Spain
| | | | - Alvaro Carrasco-Diaz
- Education and Psychology Faculty, Francisco de Vitoria University, Madrid, Spain
| | - Juan C Leza
- Centre for Biomedical Research in Mental Health (CIBERSAM), Madrid, Spain.,Department of Pharmacology and Toxicology, School of Medicine, UCM, Madrid, Spain.,IIS Hospital 12 de Octubre, IUIN-UCM, Madrid, Spain
| | - Montserrat Graell
- Centre for Biomedical Research in Mental Health (CIBERSAM), Madrid, Spain.,Child and Adolescent Psychiatry and Psychology Service, Child Hospital Niño Jesus, Madrid, Spain
| | - Jose L Carrasco
- Department of Legal Medicine, Psychiatry, and Pathology, Universidad Complutense de Madrid (UCM), Madrid, Spain.,Centre for Biomedical Research in Mental Health (CIBERSAM), Madrid, Spain.,IIS Hospital Clinico San Carlos, Madrid, Spain
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12
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Gromatsky M, Edwards ER, Sullivan SR, Goodman M, Hazlett EA. Distinguishing veterans with suicidal ideation from suicide attempt history: The role of emotion reactivity. Suicide Life Threat Behav 2021; 51:572-585. [PMID: 33665891 DOI: 10.1111/sltb.12744] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 09/11/2020] [Accepted: 10/02/2020] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Growing evidence suggests emotion reactivity-sensitivity and intensity of emotional experience-may represent a diathesis for suicide risk. However, our understanding of its ability to differentiate risk for suicidal ideation (SI) from suicide attempt (SA) is limited. METHOD This study compares Veterans with SI (n = 81) to Veterans with SA (n = 177) history on factors relevant to emotion reactivity to determine which variable(s) best differentiate groups. Variables examined are multimodal: (a) self-report: childhood trauma, combat exposure; (b) clinician-assessed: non-suicidal self-injury (NSSI), structured diagnostic interview of psychopathology; and (c) psychophysiological: affect-modulated startle (AMS; proxy for amygdala reactivity and emotion reactivity) to unpleasant pictures was examined in a subset (n = 90). RESULTS SA history was independently predicted by NSSI history, MDD, PTSD, and SUD diagnosis. Childhood trauma and combat exposure did not differentiate groups. The composite risk index demonstrated good accuracy (AUC=0.71, sensitivity=0.90, specificity=0.49). Only AMS independently predicted SA history when added to the model and accuracy was improved (AUC=0.82, sensitivity=0.85, specificity=0.56). CONCLUSION NSSI history, MDD, PTSD, and SUD diagnosis may be salient risk factors for this population. However, emotion reactivity is a more parsimonious predictor of SA history among Veterans suggesting it is an important treatment target among Veterans with SI.
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Affiliation(s)
- Molly Gromatsky
- VISN 2 Mental Illness Research Education and Clinical Center (MIRECC), Bronx, NY, USA
| | - Emily R Edwards
- VISN 2 Mental Illness Research Education and Clinical Center (MIRECC), Bronx, NY, USA.,Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sarah R Sullivan
- VISN 2 Mental Illness Research Education and Clinical Center (MIRECC), Bronx, NY, USA
| | - Marianne Goodman
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,James J. Peters Veterans Affairs Medical Center, Bronx, NY, USA
| | - Erin A Hazlett
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,James J. Peters Veterans Affairs Medical Center, Bronx, NY, USA
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13
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Miller LN, Simmons JG, Whittle S, Forbes D, Felmingham K. The impact of posttraumatic stress disorder on event-related potentials in affective and non-affective paradigms: A systematic review with meta-analysis. Neurosci Biobehav Rev 2020; 122:120-142. [PMID: 33383070 DOI: 10.1016/j.neubiorev.2020.12.027] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 11/09/2020] [Accepted: 12/20/2020] [Indexed: 12/11/2022]
Abstract
Post-traumatic stress disorder (PTSD) is associated with neural processing deficits affecting early automatic and later conscious processing. Event-related Potentials (ERPs) are high resolution indices of automatic and conscious processing, but there are no meta-analyses that have examined automatic and conscious ERPs in PTSD across multiple paradigms. This systematic review examined 69 studies across affective and non-affective auditory and visual paradigms. Individuals with PTSD were compared to trauma-exposed and non-trauma controls on ERPs reflecting automatic (N1, P1, N2, P2) and conscious (P3, LPP) processing. Trauma exposure was associated with increased automatic ERP amplitudes to irrelevant auditory information. PTSD further showed increased automatic and conscious allocation of resources to affective information, reduced automatic attending and classification as well as reduced attention processing and working memory updating of non-affective information. Therefore, trauma exposure is associated with enhanced early processing of incoming stimuli, and PTSD with enhanced processing of affective stimuli and impaired processing of non-affective stimuli. This review highlights the need for longitudinal ERP studies in PTSD, adopting standardized procedures and methodological designs.
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Affiliation(s)
- Lisa N Miller
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Australia.
| | - Julian G Simmons
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Australia; Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne and Melbourne Health, Melbourne, Australia
| | - Sarah Whittle
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Australia; Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne and Melbourne Health, Melbourne, Australia
| | - David Forbes
- Department of Psychiatry, The University of Melbourne, Melbourne, Australia; Phoenix Australia, Centre for Posttraumatic Mental Health, Melbourne, Australia
| | - Kim Felmingham
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Australia
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14
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Forbes CN, Tull MT, Rapport D, Xie H, Kaminski B, Wang X. Emotion Dysregulation Prospectively Predicts Posttraumatic Stress Disorder Symptom Severity 3 Months After Trauma Exposure. J Trauma Stress 2020; 33:1007-1016. [PMID: 32529732 PMCID: PMC10691918 DOI: 10.1002/jts.22551] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 03/26/2020] [Accepted: 04/07/2020] [Indexed: 11/08/2022]
Abstract
Despite growing evidence in support of emotion dysregulation as a risk factor for the development of posttraumatic stress disorder (PTSD) following trauma exposure, few studies have examined temporal relations between emotion dysregulation and the onset and/or worsening of PTSD symptoms over time. The aim of the present study was to extend research on temporal associations between emotion dysregulation and PTSD in a sample of individuals recruited from hospital emergency departments soon after a traumatic event. Adult participants (N = 85; 62.4% female) completed self-report measures of emotion dysregulation and PTSD symptoms within 2 weeks of experiencing a traumatic event. Symptoms of PTSD were assessed approximately 3 months posttrauma. The results of a hierarchical linear regression analysis demonstrated that the inclusion of emotion dysregulation accounted for a significant amount of unique variance, β = .23, ΔR2 = .04, p = .042, in 3-month PTSD symptom severity over and above other risk factors and baseline PTSD symptoms. No specific facet of emotion dysregulation emerged as a significant predictor of 3-month PTSD symptoms when all facets were included on the same step of the model, βs = -.04-.33, ps = .133-.954. These results demonstrate that posttraumatic emotion dysregulation may predict PTSD symptoms 3 months after trauma exposure. These findings are consistent with a growing body of literature that speaks to the relevance of emotional processes to the onset and maintenance of PTSD following exposure to a traumatic event.
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Affiliation(s)
| | - Matthew T Tull
- Department of Psychology, University of Toledo, Toledo, Ohio, USA
| | - Daniel Rapport
- Department of Psychiatry, University of Toledo, Toledo, Ohio, USA
| | - Hong Xie
- Department of Neurosciences, University of Toledo, Toledo, Ohio, USA
| | - Brian Kaminski
- Department of Psychiatry, University of Toledo, Toledo, Ohio, USA
| | - Xin Wang
- Department of Psychiatry, University of Toledo, Toledo, Ohio, USA
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15
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Denk-Florea CB, Gancz B, Gomoiu A, Ingram M, Moreton R, Pollick F. Understanding and supporting law enforcement professionals working with distressing material: Findings from a qualitative study. PLoS One 2020; 15:e0242808. [PMID: 33237979 PMCID: PMC7688122 DOI: 10.1371/journal.pone.0242808] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 11/09/2020] [Indexed: 01/13/2023] Open
Abstract
This study aimed to extend previous research on the experiences and factors that impact law enforcement personnel when working with distressing materials such as child sexual abuse content. A sample of 22 law enforcement personnel working within one law enforcement organisation in England, United Kingdom participated in anonymous semi-structured interviews. Results were explored thematically and organised in the following headings: "Responses to the material", "Impact of working with distressing evidence", "Personal coping strategies" and "Risks and mitigating factors". Law enforcement professionals experienced heightened affective responses to personally relevant material, depictions of violence, victims' displays of emotions, norm violations and to various mediums. These responses dampened over time due to desensitisation. The stress experienced from exposure to the material sometimes led to psychological symptoms associated with Secondary Traumatic Stress. Job satisfaction, self-care activities, the coping strategies used when viewing evidence, detachment from work outside working hours, social support and reducing exposure to the material were found to mediate law enforcement professionals' resilience. Exposure to distressing material and the risks associated with this exposure were also influenced by specific organisational procedures implemented as a function of the funding available and workload. Recommendations for individual and organisational practices to foster resilience emerged from this research. These recommendations are relevant to all organisations where employees are required to view distressing content.
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Affiliation(s)
| | | | - Amalia Gomoiu
- Institute of Neuroscience and Psychology, The University of Glasgow, Glasgow, United Kingdom
| | - Martin Ingram
- Institute of Neuroscience and Psychology, The University of Glasgow, Glasgow, United Kingdom
| | - Reuben Moreton
- Qumodo, London, United Kingdom
- Department of Psychology, The Open University, Milton Keynes, United Kingdom
| | - Frank Pollick
- Institute of Neuroscience and Psychology, The University of Glasgow, Glasgow, United Kingdom
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16
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Zweerings J, Sarkheil P, Keller M, Dyck M, Klasen M, Becker B, Gaebler AJ, Ibrahim CN, Turetsky BI, Zvyagintsev M, Flatten G, Mathiak K. Rt-fMRI neurofeedback-guided cognitive reappraisal training modulates amygdala responsivity in posttraumatic stress disorder. NEUROIMAGE-CLINICAL 2020; 28:102483. [PMID: 33395974 PMCID: PMC7689411 DOI: 10.1016/j.nicl.2020.102483] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 10/15/2020] [Accepted: 10/21/2020] [Indexed: 12/14/2022]
Abstract
We found neurofeedback-specific attenuation of amygdala responses. Trauma symptoms and the affective state improved in patients at one-month follow-up. Reduced amygdala responses were associated with improved well-being at follow-up. 75% of individuals with PTSD used the learned strategies in daily life. Left lateral prefrontal cortex responses were reduced during neurofeedback training.
Background Traumatic experiences are associated with neurofunctional dysregulations in key regions of the emotion regulation circuits. In particular, amygdala responsivity to negative stimuli is exaggerated while engagement of prefrontal regulatory control regions is attenuated. Successful application of emotion regulation (ER) strategies may counteract this disbalance, however, application of learned strategies in daily life is hampered in individuals afflicted by posttraumatic stress disorder (PTSD). We hypothesized that a single session of real-time fMRI (rtfMRI) guided upregulation of prefrontal regions during an emotion regulation task enhances self-control during exposure to negative stimuli and facilitates transfer of the learned ER skills to daily life. Methods In a cross-over design, individuals with a PTSD diagnosis after a single traumatic event (n = 20) according to DSM-IV-TR criteria and individuals without a formal psychiatric diagnosis (n = 21) underwent a cognitive reappraisal training. In randomized order, all participants completed two rtfMRI neurofeedback (NF) runs targeting the left lateral prefrontal cortex (lPFC) and two control runs without NF (NoNF) while using cognitive reappraisal to reduce their emotional response to negative scenes. During the NoNF runs, two %%-signs were displayed instead of the two-digit feedback (FB) to achieve a comparable visual stimulation. The project aimed at defining the clinical potential of the training according to three success markers: (1) NF induced changes in left lateral prefrontal cortex and bilateral amygdala activity during the regulation of aversive scenes compared to cognitive reappraisal alone (primary registered outcome), (2) associated changes on the symptomatic and behavioral level such as indicated by PTSD symptom severity and affect ratings, (3) clinical utility such as indicated by perceived efficacy, acceptance, and transfer to daily life measured four weeks after the training. Results In comparison to the reappraisal without feedback, a neurofeedback-specific decrease in the left lateral PFC (d = 0.54) alongside an attenuation of amygdala responses (d = 0.33) emerged. Reduced amygdala responses during NF were associated with symptom improvement (r = −0.42) and less negative affect (r = −0.63) at follow-up. The difference in symptom scores exceeds requirements for a minimal clinically important difference and corresponds to a medium effect size (d = 0.64). Importantly, 75% of individuals with PTSD used the strategies in daily life during a one-month follow-up period and perceived the training as efficient. Conclusion Our findings suggest beneficial effects of the NF training indicated by reduced amygdala responses that were associated with improved symptom severity and affective state four weeks after the NF training as well as patient-centered perceived control during the training, helpfulness and application of strategies in daily life. However, reduced prefrontal involvement was unexpected. The study suggests good tolerability of the training protocol and potential for clinical use in the treatment of PTSD.
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Affiliation(s)
- Jana Zweerings
- Department of Psychiatry, Psychotherapy and Psychosomatics, Faculty of Medicine, RWTH Aachen, Aachen, Germany; Institute of Neuroscience and Medicine, JARA-Institute Brain Structure Function Relationship (INM 10), Research Center Jülich, Jülich, Germany.
| | - Pegah Sarkheil
- Department of Psychiatry, Psychotherapy and Psychosomatics, Faculty of Medicine, RWTH Aachen, Aachen, Germany; Institute of Neuroscience and Medicine, JARA-Institute Brain Structure Function Relationship (INM 10), Research Center Jülich, Jülich, Germany
| | - Micha Keller
- Department of Psychiatry, Psychotherapy and Psychosomatics, Faculty of Medicine, RWTH Aachen, Aachen, Germany; Institute of Neuroscience and Medicine, JARA-Institute Brain Structure Function Relationship (INM 10), Research Center Jülich, Jülich, Germany
| | - Miriam Dyck
- Department of Psychiatry, Psychotherapy and Psychosomatics, Faculty of Medicine, RWTH Aachen, Aachen, Germany; Novarea RPK, Aachen, Germany
| | - Martin Klasen
- Department of Psychiatry, Psychotherapy and Psychosomatics, Faculty of Medicine, RWTH Aachen, Aachen, Germany; Institute of Neuroscience and Medicine, JARA-Institute Brain Structure Function Relationship (INM 10), Research Center Jülich, Jülich, Germany
| | - Benjamin Becker
- The Clinical Hospital of the Chengdu Brain Science Institute, School of Life Science and Technology, Key Laboratory for Neuroinformation, University of Electronic Science and Technology of China, Chengdu, China
| | - Arnim J Gaebler
- Department of Psychiatry, Psychotherapy and Psychosomatics, Faculty of Medicine, RWTH Aachen, Aachen, Germany; Institute of Neuroscience and Medicine, JARA-Institute Brain Structure Function Relationship (INM 10), Research Center Jülich, Jülich, Germany
| | - Camellia N Ibrahim
- Department of Psychiatry, Psychotherapy and Psychosomatics, Faculty of Medicine, RWTH Aachen, Aachen, Germany; Institute of Neuroscience and Medicine, JARA-Institute Brain Structure Function Relationship (INM 10), Research Center Jülich, Jülich, Germany
| | - Bruce I Turetsky
- Neuropsychiatry Section, Department of Psychiatry, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA
| | - Mikhail Zvyagintsev
- Department of Psychiatry, Psychotherapy and Psychosomatics, Faculty of Medicine, RWTH Aachen, Aachen, Germany; Brain Imaging Facility, Interdisciplinary Centre for Clinical Studies (IZKF), School of Medicine, RWTH Aachen University, Germany
| | - Guido Flatten
- Euregio-Institut für Psychosomatik und Psychotraumatologie, Aachen, Germany
| | - Klaus Mathiak
- Department of Psychiatry, Psychotherapy and Psychosomatics, Faculty of Medicine, RWTH Aachen, Aachen, Germany; Institute of Neuroscience and Medicine, JARA-Institute Brain Structure Function Relationship (INM 10), Research Center Jülich, Jülich, Germany
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17
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Raudales AM, Weiss NH, Schmidt NB, Short NA. The role of emotion dysregulation in negative affect reactivity to a trauma cue: Differential associations through elicited posttraumatic stress disorder symptoms. J Affect Disord 2020; 267:203-210. [PMID: 32217220 PMCID: PMC10923236 DOI: 10.1016/j.jad.2020.02.028] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 12/16/2019] [Accepted: 02/08/2020] [Indexed: 01/29/2023]
Abstract
BACKGROUND Recent research has linked emotion dysregulation with increases in subjective ratings of negative affect (NA reactivity) to trauma reminders, a central symptom of posttraumatic stress disorder (PTSD). The current study adds to this burgeoning line of research by exploring elicited PTSD symptoms as a mechanism explicating the relation between emotion dysregulation and NA reactivity following trauma cue exposure. METHODS Participants were 60 treatment-seeking marijuana users with insomnia symptoms who reported exposure to a traumatic event. Participants were administered questionnaires assessing emotion dysregulation, PTSD symptoms, and NA prior to and/or after listening to a personalized trauma script, and subsequently completed a diagnostic interview. RESULTS Results demonstrated that greater emotion dysregulation was associated with heightened NA reactivity through re-experiencing symptoms, but not avoidance or dissociation symptoms, even after accounting for past 30-day PTSD symptom severity and pre-trauma script NA. These effects were driven by the dimensions of emotion dysregulation characterized by nonacceptance of negative emotions and limited access to effective emotion regulation strategies. LIMITATIONS This study requires replication among other clinical samples, and is limited by use of self-report measures. CONCLUSIONS Findings provide novel empirical support for one mechanism through which emotion dysregulation may confer vulnerability to PTSD symptomology, and offer implications for refining PTSD treatments.
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Affiliation(s)
- Alexa M Raudales
- University of Rhode Island, Department of Psychology, 142 Flagg Road, Kingston, RI 02881 USA.
| | - Nicole H Weiss
- University of Rhode Island, Department of Psychology, 142 Flagg Road, Kingston, RI 02881 USA
| | - Norman B Schmidt
- Florida State University, Department of Psychology, 1107W. Call St., Tallahassee, FL 32306-4301 USA.
| | - Nicole A Short
- University of Rhode Island, Department of Psychology, 142 Flagg Road, Kingston, RI 02881 USA
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18
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Simons JS, Simons RM, Grimm KJ, Keith JA, Stoltenberg SF. Affective dynamics among veterans: Associations with distress tolerance and posttraumatic stress symptoms. Emotion 2020; 21:757-771. [PMID: 32191092 DOI: 10.1037/emo0000745] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
We tested a dynamic structural equation model (DSEM; Asparouhov, Hamaker, & Muthén, 2018) of positive and negative affect in 254 veterans with approximately 1.5 years of experience sampling data. The analysis provided estimates of several aspects of veteran's emotional experience including "trait" positive and negative affect (i.e., mean levels), inertia (i.e., tendency for emotions to self-perpetuate), innovation variance (conceptualized as lability, reactivity, or exposure to stressors), and cross-lagged associations between positive and negative affect. Veterans with higher trait negative affect had more negative affect inertia and innovation variance. This suggests a pattern whereby the veteran has more negative reactions, and negative emotions, in turn, tend to maintain themselves, contributing to higher trait negative affect. In contrast, veterans with higher trait positive affect exhibited more positive affect innovation variance (e.g., positive reactivity). Although veterans showed some consistency in dynamics across emotions (e.g., positive and negative reactivity were positively correlated), trait positive and negative affect were not significantly associated. Veterans with higher posttraumatic stress symptoms (PTSS) at baseline exhibited higher reactivity to negative events, less positive affect, and more negative affect during the follow-up. Veterans with higher distress tolerance reported not only lower PTSS but also a more adaptive pattern of affective experience characterized by lower inertia and reactivity in negative affect and more positive lagged associations between negative affect and subsequent positive affect. The results demonstrated that distress tolerance and PTSS in veterans were associated with dynamics of positive and negative emotion over time, suggesting specific differences in affect regulation processes. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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19
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Macatee RJ, Burkhouse KL, Afshar K, Schroth C, Aase DM, Greenstein JE, Proescher E, Phan KL. Nonlinear relations between post-traumatic stress symptoms and electrocortical reactivity during emotional face processing in combat-exposed veterans. Psychophysiology 2020; 57:e13423. [PMID: 31228269 DOI: 10.1111/psyp.13423] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 03/10/2019] [Accepted: 05/07/2019] [Indexed: 12/25/2022]
Abstract
Combat-related post-traumatic stress symptoms (PTSS) are prevalent among recently deployed veterans, making identification of biomarkers of PTSS in this population a public health priority. Given the link between threat processing neurobiology and PTSS, the threat-related late positive potential (LPP), an ERP reflective of attentional processing sensitive to emotion and its regulation, may have utility as a cost-effective biomarker. Existing PTSS/threat-related LPP findings are mixed, possibly due to variability in PTSS across samples, but this has never been explicitly tested. To address this gap, LPP amplitudes to angry, fearful, and happy emotional face stimuli were recorded among 81 combat-exposed veterans at a VA hospital. A quadratic relationship between self-reported PTSS and LPP amplitude modulation by angry faces emerged such that greater PTSS was related to a decreased LPP response to angry faces among veterans with subthreshold PTSD and an enhanced LPP response to angry faces among veterans with probable PTSD. These results suggest that prior mixed findings may be due to variability in PTSS severity. In addition, exploratory moderation analysis revealed that PTSS was positively associated with late LPP modulation for veterans reporting low cognitive reappraisal use and negatively associated with late LPP modulation for veterans reporting high cognitive reappraisal use. All results were specific to the 1,000-3,000 ms LPP time window. Thus, the functional nature of LPP modulation by direct threat cues may depend upon PTSS severity and/or related variables (e.g., cognitive reappraisal utilization).
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Affiliation(s)
- Richard J Macatee
- Department of Psychiatry, University of Illinois at Chicago, Chicago, Illinois
| | - Katie L Burkhouse
- Department of Psychiatry, University of Illinois at Chicago, Chicago, Illinois
| | - Kaveh Afshar
- Department of Psychiatry, University of Illinois at Chicago, Chicago, Illinois
| | - Christopher Schroth
- Department of Psychiatry, University of Illinois at Chicago, Chicago, Illinois
| | - Darren M Aase
- Department of Psychiatry, University of Illinois at Chicago, Chicago, Illinois
- Mental Health Service Line, Jesse Brown VA Medical Center, Chicago, Illinois
- College of Health & Human Services, Governors State University, University Park, Illinois
| | - Justin E Greenstein
- Department of Psychiatry, University of Illinois at Chicago, Chicago, Illinois
- Mental Health Service Line, Jesse Brown VA Medical Center, Chicago, Illinois
| | - Eric Proescher
- Department of Psychiatry, University of Illinois at Chicago, Chicago, Illinois
- Mental Health Service Line, Jesse Brown VA Medical Center, Chicago, Illinois
| | - K Luan Phan
- Department of Psychiatry, University of Illinois at Chicago, Chicago, Illinois
- Mental Health Service Line, Jesse Brown VA Medical Center, Chicago, Illinois
- Department of Psychology, University of Illinois at Chicago, Chicago, Illinois
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20
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Neural correlates of emotion-attention interactions: From perception, learning, and memory to social cognition, individual differences, and training interventions. Neurosci Biobehav Rev 2020; 108:559-601. [DOI: 10.1016/j.neubiorev.2019.08.017] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Revised: 07/02/2019] [Accepted: 08/21/2019] [Indexed: 12/12/2022]
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21
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Gibney KD, Kypriotakis G, Cinciripini PM, Robinson JD, Minnix JA, Versace F. Estimating statistical power for event-related potential studies using the late positive potential. Psychophysiology 2019; 57:e13482. [PMID: 31608456 DOI: 10.1111/psyp.13482] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 08/24/2019] [Accepted: 08/27/2019] [Indexed: 12/19/2022]
Abstract
The late positive potential (LPP) is a common measurement used to study emotional processes of subjects in ERP paradigms. Despite its extensive use in affective neuroscience, there is presently no gold standard for how to appropriately power ERP studies using the LPP. The present study investigates how the number of trials, number of subjects, and magnitude of the effect size affect statistical power in analyses of the LPP. Using Monte Carlo simulations of ERP experiments with varying numbers of trials, subjects, and synthetic effects of known magnitude, we measured the probability of obtaining a statistically significant effect in 1,489 experiments repeated 1,000 times each. Predictably, our results showed that statistical power increases with increasing numbers of trials and subjects and at larger effect sizes. We also found that higher levels of statistical power can be achieved with lower numbers of subjects and trials and at lower effect sizes in within-subject than in between-subjects designs. Furthermore, we found that, as subjects are added to an experiment, the slope of the relationship between effect size and statistical power increased and shifted to the left until the power asymptoted to nearly 100% at higher effect sizes. This suggests that adding more subjects greatly increases statistical power at lower effect sizes (<1 µV) compared with more robust (>1.5 µV) effect sizes. We confirmed the results from the simulations based on the synthetic effects by running a new series of simulated experiments based on real data collected while participants looked at emotional images.
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Affiliation(s)
- Kyla D Gibney
- The University of Texas MD Anderson Cancer Center UT Health Graduate School of Biomedical Sciences, Houston, Texas.,Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - George Kypriotakis
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Paul M Cinciripini
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jason D Robinson
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jennifer A Minnix
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Francesco Versace
- The University of Texas MD Anderson Cancer Center UT Health Graduate School of Biomedical Sciences, Houston, Texas.,Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, Texas
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22
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Albanese BJ, Macatee RJ, Stanley IH, Bauer BW, Capron DW, Bernat E, Joiner TE, Schmidt NB. Differentiating suicide attempts and suicidal ideation using neural markers of emotion regulation. J Affect Disord 2019; 257:536-550. [PMID: 31323595 DOI: 10.1016/j.jad.2019.07.014] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 05/24/2019] [Accepted: 07/04/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Theories of suicide posit distinct etiological pathways for suicide attempts (SA) and suicidal ideation (SI) that are marked, in part, by disruptions in the ability to regulate reactions to threat/mutilation and interpersonally-relevant emotional stimuli. However, little research has specifically tested these associations. To address this gap, the present study extracted the Late Positive Potential (LPP) during an emotion regulation task to evaluate the independent associations that SA history and SI share with initial responsivity to, and regulation of, these distinct emotional contents. METHODS A clinical sample (N = 257) were recruited based on elevations in suicide risk factors. Participants completed a picture viewing and regulation task that included threat/mutilation, reward, and neutral images from the International Affective Picture System. Immediately prior to picture onset, participants were instructed to passively view the image, increase their emotional reaction to the image, or decrease their emotional reaction to the image. RESULTS Differential patterns of LPP amplitudes only emerged in the context of attempts to regulate emotional responses such that SA history predicted a superior ability to volitionally mitigate responses to threat/mutilation while SI was related to a worse ability to increase responses to reward. Effect sizes were in the small and small-to-medium range. LIMITATIONS The present data were cross-sectional and included low trial counts. CONCLUSIONS Taken together, these findings support existing theories of suicide suggesting that distinct mechanisms underlie suicidal thoughts and behaviors. Future research should seek to determine if these mechanisms may serve as a viable intervention targets.
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Affiliation(s)
- Brian J Albanese
- Department of Psychology, Florida State University, Tallahassee, FL, United States.
| | - Richard J Macatee
- Department of Psychology, Auburn University, Auburn, AL, United States
| | - Ian H Stanley
- Department of Psychology, Auburn University, Auburn, AL, United States
| | - Brian W Bauer
- Department of Psychology, University of Southern Mississippi, Hattiesburg, MS, United States
| | - Daniel W Capron
- Department of Psychology, University of Southern Mississippi, Hattiesburg, MS, United States
| | - Edward Bernat
- Department of Psychology, University of Maryland, College Park, MD, United States
| | - Thomas E Joiner
- Department of Psychology, Florida State University, Tallahassee, FL, United States
| | - Norman B Schmidt
- Department of Psychology, Florida State University, Tallahassee, FL, United States
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23
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Butt M, Espinal E, Aupperle RL, Nikulina V, Stewart JL. The Electrical Aftermath: Brain Signals of Posttraumatic Stress Disorder Filtered Through a Clinical Lens. Front Psychiatry 2019; 10:368. [PMID: 31214058 PMCID: PMC6555259 DOI: 10.3389/fpsyt.2019.00368] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 05/13/2019] [Indexed: 12/14/2022] Open
Abstract
This review aims to identify patterns of electrical signals identified using electroencephalography (EEG) linked to posttraumatic stress disorder (PTSD) diagnosis and symptom dimensions. We filter EEG findings through a clinical lens, evaluating nuances in findings according to study criteria and participant characteristics. Within the EEG frequency domain, greater right than left parietal asymmetry in alpha band power is the most promising marker of PTSD symptoms and is linked to exaggerated physiological arousal that may impair filtering of environmental distractors. The most consistent findings within the EEG time domain focused on event related potentials (ERPs) include: 1) exaggerated frontocentral responses (contingent negative variation, mismatch negativity, and P3a amplitudes) to task-irrelevant distractors, and 2) attenuated parietal responses (P3b amplitudes) to task-relevant target stimuli. These findings suggest that some individuals with PTSD suffer from attention dysregulation, which could contribute to problems concentrating on daily tasks and goals in lieu of threatening distractors. Future research investigating the utility of alpha asymmetry and frontoparietal ERPs as diagnostic and predictive biomarkers or intervention targets are recommended.
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Affiliation(s)
- Mamona Butt
- Department of Psychology, Queens College, City University of New York, Flushing, NY, United States
| | - Elizabeth Espinal
- Department of Psychology, Queens College, City University of New York, Flushing, NY, United States
| | - Robin L Aupperle
- Laureate Institute for Brain Research, Tulsa, OK, United States.,Department of Community Medicine, Oxley College of Health Sciences, University of Tulsa, Tulsa, OK, United States
| | - Valentina Nikulina
- Department of Psychology, Queens College, City University of New York, Flushing, NY, United States.,Department of Psychology, The Graduate Center, City University of New York, New York, NY, United States
| | - Jennifer L Stewart
- Laureate Institute for Brain Research, Tulsa, OK, United States.,Department of Community Medicine, Oxley College of Health Sciences, University of Tulsa, Tulsa, OK, United States
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24
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Ford JD. Trauma Memory Processing in Posttraumatic Stress Disorder Psychotherapy: A Unifying Framework. J Trauma Stress 2018; 31:933-942. [PMID: 30444287 DOI: 10.1002/jts.22344] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 09/05/2018] [Accepted: 09/08/2018] [Indexed: 12/19/2022]
Abstract
Trauma memory processing (TMP) is an empirically supported approach to psychotherapy for posttraumatic stress disorder (PTSD). However, TMP is not a single, uniform intervention but instead a paradigm that can be operationalized through a variety of component procedures that have not been systematically elucidated and formally tested. Based on findings from phenomenological/structural and neuroimaging research, a central feature of PTSD is theorized to be the involuntary immersion in trauma memories with diminished awareness or negative appraisals of self and current context. Such intrusive reexperiencing-which is epitomized by, but not limited to, flashbacks-is postulated to underlie PTSD's avoidance, altered emotions and cognitions, dissociative, and hyperarousal/hypervigilance symptoms; it is thus a logical target for TMP. The varied approaches to TMP for PTSD are conceptualized as having the common goal of activation of the neural networks in the brain that underlie two key capacities disrupted by intrusive reexperiencing in PTSD: intentional self-referential retrieval of memories and suppression of memory retrieval. Therefore, TMP is postulated to involve two core functions (purposeful reflective remembering and memory awareness in situ) and three essential types (in vivo, imaginal, and cognitive reappraisal). Several implications of this framework for clinical practice and research on TMP for PTSD are discussed.
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Affiliation(s)
- Julian D Ford
- Department of Psychiatry, University of Connecticut School of Medicine, Farmington, Connecticut, USA
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25
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Zielinski MJ, Privratsky AA, Smitherman S, Kilts CD, Herringa RJ, Cisler JM. Does development moderate the effect of early life assaultive violence on resting-state networks? An exploratory study. Psychiatry Res Neuroimaging 2018; 281:69-77. [PMID: 30266022 PMCID: PMC6373177 DOI: 10.1016/j.pscychresns.2018.08.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Revised: 07/31/2018] [Accepted: 08/27/2018] [Indexed: 12/15/2022]
Abstract
Current neurocircuitry models of PTSD do not account for developmental effects, despite that early life assaultive violence is a potent risk factor for PTSD. Here, we preliminarily evaluated developmental stage as a moderator of the effect of early life assaultive violence on resting-state connectivity amongst regions associated with emotion generation and regulation using fMRI. Participants were adult women (n = 25) and adolescent girls (n = 36) who had or had not experienced early life assaultive violence. We found significant interactions between developmental stage and trauma exposure on resting-state functional connectivity (FC). Left amygdala connectivity with the left ventral anterior cingulate gyrus (BA 32) was reduced among trauma-exposed compared to control adolescents, but increased among trauma-exposed compared to control adults. A corresponding pattern of results was identified for FC between rostral anterior cingulate gyrus seed region and a similar right ventral anterior superior frontal gyrus cluster. Increased FC in both regions for assaulted adult women scaled positively with self-reported emotion regulation difficulties. Our results should be viewed tentatively due to sample limitations, but provide impetus to examine whether neurocircuitry models of PTSD may be strengthened by accounting for developmental stage.
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Affiliation(s)
- Melissa J Zielinski
- Brain Imaging Research Center, Psychiatric Research Institute, University of Arkansas for Medical Sciences, 4301 W. Markham Street, Little Rock, AR 72205, USA.
| | - Anthony A Privratsky
- Brain Imaging Research Center, Psychiatric Research Institute, University of Arkansas for Medical Sciences, 4301 W. Markham Street, Little Rock, AR 72205, USA
| | - Sonet Smitherman
- Brain Imaging Research Center, Psychiatric Research Institute, University of Arkansas for Medical Sciences, 4301 W. Markham Street, Little Rock, AR 72205, USA
| | - Clinton D Kilts
- Brain Imaging Research Center, Psychiatric Research Institute, University of Arkansas for Medical Sciences, 4301 W. Markham Street, Little Rock, AR 72205, USA
| | - Ryan J Herringa
- Department of Psychiatry, University of Wisconsin School of Medicine & Public Health, Madison, WI 53726, USA
| | - Josh M Cisler
- Brain Imaging Research Center, Psychiatric Research Institute, University of Arkansas for Medical Sciences, 4301 W. Markham Street, Little Rock, AR 72205, USA; Department of Psychiatry, University of Wisconsin School of Medicine & Public Health, Madison, WI 53726, USA
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