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Cruz LN, Walker NC, Rehman SS, McNerney MW, Madore MR. Examination of Congruity between Subjective and Objective Working Memory in Veterans with Mild TBI and Relation to Psychiatric Symptoms and Childhood Trauma. Behav Sci (Basel) 2024; 14:932. [PMID: 39457804 PMCID: PMC11504902 DOI: 10.3390/bs14100932] [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: 09/17/2024] [Revised: 10/06/2024] [Accepted: 10/08/2024] [Indexed: 10/28/2024] Open
Abstract
OBJECTIVES There is conflicting evidence regarding congruence between subjective cognitive decline and objective cognitive performance for individuals with a history of mild traumatic brain injury (mTBI). The current study investigated the congruity between subjective and objective cognition, particularly working memory, among veterans with an mTBI history, accounting for post-traumatic stress disorder (PTSD) and childhood trauma. METHODS Participants included 35 veterans with a history of mTBI sustained during deployment. Participants completed measures of subjective [i.e., Behavioral Inventory Rating of Executive Functioning (BRIEF)] and objective working memory (i.e., WAIS-IV working memory index). Congruity between subjective and objective working memory was examined using linear regression. Bonferroni-corrected correlations were run to explore relationships among working memory, psychiatric symptoms, mTBI severity, and childhood trauma. RESULTS Among Veterans with mTBI, subjective working memory and objective working memory performance were not significantly related (p > 0.05); however, the overall model was significant (p < 0.0001), and childhood trauma was a notable predictor (p = 0.02). Greater PTSD, depression, and sleep symptoms were significantly related to increased subjective working memory concerns, even after Bonferroni adjustments (ps < 0.0001). Better objective working memory was significantly related to a fewer number of childhood traumatic events; however, this did not sustain corrections. The majority of individuals (67%) endorsed significant working memory complaints, despite objectively performing within normal limits (within 1 SD and above). CONCLUSIONS Subjective-objective working memory congruity among veterans with mTBI was limited. Subjective, but not objective, working memory concerns were associated with greater PTSD, depression, and sleep symptoms. Childhood trauma was a notable factor that contributed to both subjective and objective cognitive concerns. There remains clinical value in assessing subjective cognitive concerns given the strong relationships with psychiatric problems and, hence, a focus for intervention.
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Affiliation(s)
- Lisa N. Cruz
- Mental Illness Research, Education, and Clinical Center, VA Palo Alto Healthcare System, Palo Alto, CA 94304, USA; (L.N.C.)
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Nicole C. Walker
- Mental Illness Research, Education, and Clinical Center, VA Palo Alto Healthcare System, Palo Alto, CA 94304, USA; (L.N.C.)
| | | | - M. Windy McNerney
- Mental Illness Research, Education, and Clinical Center, VA Palo Alto Healthcare System, Palo Alto, CA 94304, USA; (L.N.C.)
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Michelle R. Madore
- Mental Illness Research, Education, and Clinical Center, VA Palo Alto Healthcare System, Palo Alto, CA 94304, USA; (L.N.C.)
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305, USA
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Shalev A, Cho D, Marmar CR. Neurobiology and Treatment of Posttraumatic Stress Disorder. Am J Psychiatry 2024; 181:705-719. [PMID: 39086292 DOI: 10.1176/appi.ajp.20240536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/02/2024]
Abstract
The recent worldwide surge of warfare and hostilities exposes increasingly large numbers of individuals to traumatic events, placing them at risk of developing posttraumatic stress disorder (PTSD) and challenging both clinicians and service delivery systems. This overview summarizes and updates the core knowledge of the genetic, molecular, and neural circuit features of the neurobiology of PTSD and advances in evidence-based psychotherapy, pharmacotherapy, neuromodulation, and digital treatments. While the complexity of the neurobiology and the biological and clinical heterogeneity of PTSD have challenged clinicians and researchers, there is an emerging consensus concerning the underlying mechanisms and approaches to diagnosis, treatment, and prevention of PTSD. This update addresses PTSD diagnosis, prevalence, course, risk factors, neurobiological mechanisms, current standard of care, and innovations in next-generation treatment and prevention strategies. It provides a comprehensive summary and concludes with areas of research for integrating advances in the neurobiology of the disorder with novel treatment and prevention targets.
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Affiliation(s)
- Arieh Shalev
- Department of Psychiatry, NYU Grossman School of Medicine, New York
| | - Dayeon Cho
- Department of Psychiatry, NYU Grossman School of Medicine, New York
| | - Charles R Marmar
- Department of Psychiatry, NYU Grossman School of Medicine, New York
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Biscoe N, New E, Murphy D. Complex PTSD symptom clusters and executive function in UK Armed Forces veterans: a cross-sectional study. BMC Psychol 2024; 12:209. [PMID: 38622745 PMCID: PMC11020799 DOI: 10.1186/s40359-024-01713-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 04/05/2024] [Indexed: 04/17/2024] Open
Abstract
BACKGROUND Less is known about complex posttraumatic stress disorder (CPTSD) than postrraumatic stress disorder (PTSD) in military veterans, yet this population may be at greater risk of the former diagnosis. Executive function impairment has been linked to PTSD treatment outcomes. The current study therefore aimed to explore possible associations between each CPTSD symptom cluster and executive function to understand if similar treatment trajectories might be observed with the disorder. METHODS A total of 428 veterans from a national charity responded to a self-report questionnaire which measured CPTSD symptom clusters using the International Trauma Questionnaire, and executive function using the Adult Executive Function Inventory. Single and multiple linear regression models were used to analyse the relationship between CPTSD symptom clusters and executive function, including working memory and inhibition. RESULTS Each CPTSD symptom cluster was significantly associated with higher executive function impairment, even after controlling for possible mental health confounding variables. Emotion dysregulation was the CPTSD symptom cluster most strongly associated with executive function impairment. CONCLUSIONS This is the first study to explore the relationship between executive function and CPTSD symptom clusters. The study builds on previous findings and suggests that executive function could be relevant to CPTSD treatment trajectories, as is the case with PTSD alone. Future research should further explore such clinical implications.
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Affiliation(s)
| | - Emma New
- Birmingham and Solihull Mental Health NHS Foundation Trust, Birmingham, UK
| | - Dominic Murphy
- Combat Stress, Leatherhead, Surrey, KT22 0BX, UK
- King's Centre for Military Health Research, King's College London, London, SE5 9PR, UK
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Guo J, Orgeta V, Olivé I, Hoff E, Huntley J, Olff M, Sobczak S. Biomarkers associated with cognitive impairment in post-traumatic stress disorder: A systematic review of current evidence. Ageing Res Rev 2024; 95:102198. [PMID: 38237700 DOI: 10.1016/j.arr.2024.102198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 01/11/2024] [Accepted: 01/12/2024] [Indexed: 02/09/2024]
Abstract
OBJECTIVE This systematic review aimed at synthesizing current evidence on biomarkers associated with cognitive impairment (CI) in Post-Traumatic Stress Disorder (PTSD). METHODS A systematic literature search was conducted for studies assessing biomarkers associated with CI in PTSD. RESULTS Of the 10,149 titles screened, 8 studies met our inclusion criteria. In a single longitudinal study, MRI volumes, Aβ and tau accumulation were not associated with CI in PTSD. Studies on structural imaging reported no significant association between morphological changes and CI. Two studies on diffusion neuroimaging showed abnormalities in white matter tracts which were cross-sectionally associated with CI in PTSD. Similarly, lower resting-state functional connectivity in neocortical networks, and elevated tau in the neocortex were also cross sectionally associated with CI. Two single studies on biochemical biomarkers showed that sixteen novel plasma proteins and lower BDNF, indicative of genetic vulnerabilities associated with neural and synaptic dysfunctions commonly observed in neurodegeneration, were cross-sectionally associated with CI in PTSD. Overall, evidence is of low quality. CONCLUSIONS Longitudinal research utilizing large representative samples of trauma exposed populations are needed to establish the utility of specific biomarkers in monitoring cognitive decline in PTSD.
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Affiliation(s)
- Junling Guo
- Division of Psychiatry, University College London, London, United Kingdom
| | - Vasiliki Orgeta
- Division of Psychiatry, University College London, London, United Kingdom.
| | - Isadora Olivé
- Division of Psychiatry, University College London, London, United Kingdom
| | - Erik Hoff
- Department of Neurology, Zuyderland Medical Center, Heerlen, Sittard, the Netherlands
| | - Jonathan Huntley
- Division of Psychiatry, University College London, London, United Kingdom
| | - Miranda Olff
- Department of Psychiatry, Amsterdam University Medical Center, University of Amsterdam, Amsterdam Neuroscience, & Amsterdam Public Health, Amsterdam, the Netherlands; ARQ National Psychotrauma Centre, Diemen, the Netherlands
| | - Sjacko Sobczak
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands; Mondriaan Mental Health Center, Heerlen, Maastricht, the Netherlands; Rotterdam University of Applied Sciences (RUAS), Research Center Innovations in Care, Rotterdam, the Netherlands
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Cisler JM, Dunsmoor JE, Fonzo GA, Nemeroff CB. Latent-state and model-based learning in PTSD. Trends Neurosci 2024; 47:150-162. [PMID: 38212163 PMCID: PMC10923154 DOI: 10.1016/j.tins.2023.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 12/18/2023] [Accepted: 12/18/2023] [Indexed: 01/13/2024]
Abstract
Post-traumatic stress disorder (PTSD) is characterized by altered emotional and behavioral responding following a traumatic event. In this article, we review the concepts of latent-state and model-based learning (i.e., learning and inferring abstract task representations) and discuss their relevance for clinical and neuroscience models of PTSD. Recent data demonstrate evidence for brain and behavioral biases in these learning processes in PTSD. These new data potentially recast excessive fear towards trauma cues as a problem in learning and updating abstract task representations, as opposed to traditional conceptualizations focused on stimulus-specific learning. Biases in latent-state and model-based learning may also be a common mechanism targeted in common therapies for PTSD. We highlight key knowledge gaps that need to be addressed to further elaborate how latent-state learning and its associated neurocircuitry mechanisms function in PTSD and how to optimize treatments to target these processes.
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Affiliation(s)
- Josh M Cisler
- Department of Psychiatry and Behavioral Sciences, University of Texas at Austin, Austin, TX, USA; Institute for Early Life Adversity Research, University of Texas at Austin, Austin, TX, USA.
| | - Joseph E Dunsmoor
- Department of Psychiatry and Behavioral Sciences, University of Texas at Austin, Austin, TX, USA; Institute for Early Life Adversity Research, University of Texas at Austin, Austin, TX, USA
| | - Gregory A Fonzo
- Department of Psychiatry and Behavioral Sciences, University of Texas at Austin, Austin, TX, USA; Institute for Early Life Adversity Research, University of Texas at Austin, Austin, TX, USA
| | - Charles B Nemeroff
- Department of Psychiatry and Behavioral Sciences, University of Texas at Austin, Austin, TX, USA; Institute for Early Life Adversity Research, University of Texas at Austin, Austin, TX, USA
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Etzel L, Miskey HM, Webb JB, Demakis GJ, Harris HL, Shura RD. An Executive Functioning Composite Does Not Moderate the Relationship Between Combat Exposure and Posttraumatic Stress Disorder Symptom Clusters. Arch Clin Neuropsychol 2024; 39:11-23. [PMID: 37565825 DOI: 10.1093/arclin/acad055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 04/30/2023] [Accepted: 06/07/2023] [Indexed: 08/12/2023] Open
Abstract
OBJECTIVE Posttraumatic stress disorder (PTSD) is prevalent among U.S. combat Veterans, and associated with poor health and wellbeing. As combat experiences are likely to significantly modify self-, other-, and society-oriented cognitions and heighten risk for PTSD, examination of related cognitive processes may yield new treatment strategies. The cognitive model of PTSD suggests that persistent threat perceptions contribute to symptom worsening. Thus, cognitive processes of shifting perspectives or generating novel interpretations may be particularly relevant to lessen PTSD symptoms. This cross-sectional study examined executive functioning as a moderator to the relationship between combat exposure and PTSD symptom clusters among post-9/11 Veterans. METHOD Data from 168 Veterans were drawn from a larger study examining post-deployment mental health and cognitive function. An executive functioning composite derived from Wisconsin Card Sorting Test Perseveration Errors, WAIS-III Similarities, Trail Making Test B, and Stroop Color-Word Inhibition scores was computed. Path analysis was used to test the moderation model. RESULTS After accounting for age, sex, and estimated premorbid functioning, results indicated that combat exposure was associated with all symptom clusters on the PTSD Checklist-Military. Executive functioning was not significantly associated with the PTSD symptom clusters and did not moderate the relationship between combat exposure and any of the PTSD symptom clusters. CONCLUSIONS Combat exposure is an important dimension of risk related to PTSD in Veterans that warrants regular screening. Moderation by executive functioning was not observed despite theoretical support. Future work could test methodological and sampling reasons for this finding to determine if theoretical adjustment is necessary.
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Affiliation(s)
- Lena Etzel
- Health Psychology Ph.D. Program, University of North Carolina at Charlotte, Charlotte, NC, USA
- W. G. (Bill) Hefner VA Medical Center, Research & Academic Affairs, Salisbury, NC, USA
| | - Holly M Miskey
- W. G. (Bill) Hefner VA Medical Center, Mental Health and Behavioral Sciences, Salisbury, NC, USA
- VA VISN 6 Mid Atlantic Mental Illness Research, Education and Clinical Center (MIRECC), Durham, NC, USA
- Wake Forest School of Medicine, Department of Neurology, Winston-Salem, NC, USA
- University of North Carolina at Charlotte, Department of Psychological Science, Charlotte, NC, USA
| | - Jennifer B Webb
- Health Psychology Ph.D. Program, University of North Carolina at Charlotte, Charlotte, NC, USA
- University of North Carolina at Charlotte, Department of Psychological Science, Charlotte, NC, USA
| | - George J Demakis
- Health Psychology Ph.D. Program, University of North Carolina at Charlotte, Charlotte, NC, USA
- University of North Carolina at Charlotte, Department of Psychological Science, Charlotte, NC, USA
| | - Henry L Harris
- University of North Carolina at Charlotte, Department of Counseling, Charlotte, NC, USA
| | - Robert D Shura
- W. G. (Bill) Hefner VA Medical Center, Research & Academic Affairs, Salisbury, NC, USA
- VA VISN 6 Mid Atlantic Mental Illness Research, Education and Clinical Center (MIRECC), Durham, NC, USA
- Wake Forest School of Medicine, Department of Neurology, Winston-Salem, NC, USA
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DeGutis J, Agnoli S, Bernstein JPK, Jagger-Rickels A, Evans TC, Fortier CB, McGlinchey RE, Milberg WP, Esterman M. Poorer Inhibitory Control Uniquely Contributes to Greater Functional Disability in Post-9/11 Veterans. Arch Clin Neuropsychol 2023; 38:944-961. [PMID: 36781401 PMCID: PMC10456219 DOI: 10.1093/arclin/acad012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2023] [Indexed: 02/15/2023] Open
Abstract
OBJECTIVE Post-9/11 Veterans endorse greater self-reported functional disability than 80% of the adult population. Previous studies of trauma-exposed populations have shown that increased post-traumatic stress disorder (PTSD) and depressive symptoms are consistently associated with greater disability. Additionally, poorer cognitive performance in the domain of executive functions, particularly inhibitory control, has been associated with disability, though it is unclear if this effect is independent of and/or interacts with PTSD and depression. METHOD Three overlapping samples of n = 582, 297, and 183 combat-deployed post-9/11 Veterans completed comprehensive assessments of executive functions, PTSD and depressive symptoms, and self-reported World Health Organization Disability Assessment Schedule-II (WHODAS II). RESULTS Poorer performance on measures of inhibitory control (Delis-Kaplan Executive Functioning System Color-Word Interference-CWI Test and gradual-onset Continuous Performance Test-gradCPT), but not other executive functions, were significantly associated with greater disability on the WHODAS II (ρ's = -.13 and -.13, p = .002 and .026, respectively). CWI inhibitory control measures accounted for unique variance in disability after controlling for PTSD and depressive symptoms (R2 change = 0.02, p < .001). Further, CWI significantly moderated the effect of depressive symptoms on disability, such that better inhibitory control weakened the relationship between depression and disability. CONCLUSIONS Inhibitory control deficits are uniquely associated with increased disability in combat-deployed post-9/11 Veterans, and better inhibitory control abilities may serve as a protective factor for depressive symptoms leading to increased disability. KEY POINTS
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Affiliation(s)
- Joseph DeGutis
- Translational Research Center for TBI and Stress Disorders (TRACTS) and Geriatric Research, Education and Clinical Center (GRECC), VA Boston Health Care System, Boston, MA, USA
- Boston Attention and Learning (BAL) Lab, VA Boston Health Care System, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Sam Agnoli
- Translational Research Center for TBI and Stress Disorders (TRACTS) and Geriatric Research, Education and Clinical Center (GRECC), VA Boston Health Care System, Boston, MA, USA
- Boston Attention and Learning (BAL) Lab, VA Boston Health Care System, Boston, MA, USA
| | - John P K Bernstein
- Translational Research Center for TBI and Stress Disorders (TRACTS) and Geriatric Research, Education and Clinical Center (GRECC), VA Boston Health Care System, Boston, MA, USA
| | - Audreyana Jagger-Rickels
- Boston Attention and Learning (BAL) Lab, VA Boston Health Care System, Boston, MA, USA
- National Center for PTSD, VA Boston Health Care System, Boston, MA, USA
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
| | - Travis C Evans
- Boston Attention and Learning (BAL) Lab, VA Boston Health Care System, Boston, MA, USA
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
| | - Catherine B Fortier
- Translational Research Center for TBI and Stress Disorders (TRACTS) and Geriatric Research, Education and Clinical Center (GRECC), VA Boston Health Care System, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Regina E McGlinchey
- Translational Research Center for TBI and Stress Disorders (TRACTS) and Geriatric Research, Education and Clinical Center (GRECC), VA Boston Health Care System, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - William P Milberg
- Translational Research Center for TBI and Stress Disorders (TRACTS) and Geriatric Research, Education and Clinical Center (GRECC), VA Boston Health Care System, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Michael Esterman
- Boston Attention and Learning (BAL) Lab, VA Boston Health Care System, Boston, MA, USA
- National Center for PTSD, VA Boston Health Care System, Boston, MA, USA
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
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8
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Evans TC, Alonso MR, Jagger-Rickels A, Rothlein D, Zuberer A, Bernstein J, Fortier CB, Fonda JR, Villalon A, Jorge R, Milberg W, McGlinchey R, DeGutis J, Esterman M. PTSD symptomatology is selectively associated with impaired sustained attention ability and dorsal attention network synchronization. Neuroimage Clin 2022; 36:103146. [PMID: 36055063 PMCID: PMC9437905 DOI: 10.1016/j.nicl.2022.103146] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 07/03/2022] [Accepted: 08/03/2022] [Indexed: 12/14/2022]
Abstract
Posttraumatic Stress Disorder (PTSD) symptomatology is associated with dysregulated sustained attention, which produces functional impairments. Performance on sustained attention paradigms such as continuous performance tasks are influenced by both the ability to sustain attention and response strategy. However, previous studies have not dissociated PTSD-related associations with sustained attention ability and strategy, which limits characterization of neural circuitry underlying PTSD-related attentional impairments. Therefore, we characterized and replicated PTSD-related associations with sustained attention ability and response strategy in trauma-exposed Veterans, which guided characterization of PTSD-related differences in neural circuit function. In Study 1, PTSD symptoms were selectively associated with reduced sustained attention ability, but not more impulsive response strategies. In Study 2, we utilized task and resting-state fMRI to characterize neural circuitry underlying PTSD-related differences in sustained attention ability. Both PTSD symptomatology and sustained attention ability exhibited converging associations with reduced dorsal attention network (DAN) synchronization to endogeneous attentional fluctuations. Post-hoc time course analyses demonstrated that PTSD symptoms were most accurately characterized by delayed, rather than globally reduced, DAN synchronization to endogenous attentional fluctuations. Together, these findings suggest that PTSD symptomatology may selectively impair sustained attention ability by disrupting proactive engagement of attentional control circuitry.
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Affiliation(s)
- Travis C. Evans
- Boston Attention and Learning Lab (BALLAB), VA Boston Healthcare System, USA,Department of Psychiatry, Boston University School of Medicine, USA,Corresponding author at: VA Boston Healthcare System, 150 S. Huntington Avenue, Boston, MA 02130, USA.
| | | | - Audreyana Jagger-Rickels
- Boston Attention and Learning Lab (BALLAB), VA Boston Healthcare System, USA,National Center for PTSD, VA Boston Healthcare System, USA
| | - David Rothlein
- Boston Attention and Learning Lab (BALLAB), VA Boston Healthcare System, USA,National Center for PTSD, VA Boston Healthcare System, USA
| | - Agnieszka Zuberer
- Boston Attention and Learning Lab (BALLAB), VA Boston Healthcare System, USA,Department of Psychiatry and Psychotherapy, University Hospital Jena, Germany,Department of Psychiatry and Psychotherapy, University of Tübingen, Germany
| | - John Bernstein
- Translational Research Center for TBI and Stress Disorders (TRACTS), VA Boston Healthcare System, USA
| | - Catherine B. Fortier
- Translational Research Center for TBI and Stress Disorders (TRACTS), VA Boston Healthcare System, USA,Department of Psychiatry, Harvard Medical School, USA,Geriatric Research, Education, and Clinical Center (GRECC), VA Boston Healthcare System, USA
| | - Jennifer R. Fonda
- Department of Psychiatry, Boston University School of Medicine, USA,Translational Research Center for TBI and Stress Disorders (TRACTS), VA Boston Healthcare System, USA,Department of Psychiatry, Harvard Medical School, USA,Geriatric Research, Education, and Clinical Center (GRECC), VA Boston Healthcare System, USA
| | - Audri Villalon
- Translational Research Center for TBI and Stress Disorders (TRACTS), Michael E. DeBakey VA Medical Center, Houston, TX, USA,Beth K. and Stuart C. Yudofsky Division of Neuropsychiatry, Baylor College of Medicine, USA
| | - Ricardo Jorge
- Translational Research Center for TBI and Stress Disorders (TRACTS), Michael E. DeBakey VA Medical Center, Houston, TX, USA,Beth K. and Stuart C. Yudofsky Division of Neuropsychiatry, Baylor College of Medicine, USA
| | - William Milberg
- Translational Research Center for TBI and Stress Disorders (TRACTS), VA Boston Healthcare System, USA,Department of Psychiatry, Harvard Medical School, USA,Geriatric Research, Education, and Clinical Center (GRECC), VA Boston Healthcare System, USA
| | - Regina McGlinchey
- Translational Research Center for TBI and Stress Disorders (TRACTS), VA Boston Healthcare System, USA,Department of Psychiatry, Harvard Medical School, USA,Geriatric Research, Education, and Clinical Center (GRECC), VA Boston Healthcare System, USA
| | - Joseph DeGutis
- Boston Attention and Learning Lab (BALLAB), VA Boston Healthcare System, USA,Department of Psychiatry, Harvard Medical School, USA,Geriatric Research, Education, and Clinical Center (GRECC), VA Boston Healthcare System, USA
| | - Michael Esterman
- Boston Attention and Learning Lab (BALLAB), VA Boston Healthcare System, USA,Department of Psychiatry, Boston University School of Medicine, USA,National Center for PTSD, VA Boston Healthcare System, USA,Neuroimaging Research for Veterans (NeRVe) Center, VA Boston Healthcare System, USA
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