Restoring large-scale brain networks in PTSD and related disorders: a proposal for neuroscientifically-informed treatment interventions

Three intrinsic connectivity networks in the brain, namely the central executive, salience, and default mode networks, have been identified as crucial to the understanding of higher cognitive functioning, and the functioning of these networks has been suggested to be impaired in psychopathology, including posttraumatic stress disorder (PTSD). 1) To describe three main large-scale networks of the human brain; 2) to discuss the functioning of these neural networks in PTSD and related symptoms; and 3) to offer hypotheses for neuroscientifically-informed interventions based on treating the abnormalities observed in these neural networks in PTSD and related disorders. Literature relevant to this commentary was reviewed. Increasing evidence for altered functioning of the central executive, salience, and default mode networks in PTSD has been demonstrated. We suggest that each network is associated with specific clinical symptoms observed in PTSD, including cognitive dysfunction (central executive network), increased and decreased arousal/interoception (salience network), and an altered sense of self (default mode network). Specific testable neuroscientifically-informed treatments aimed to restore each of these neural networks and related clinical dysfunction are proposed. Neuroscientifically-informed treatment interventions will be essential to future research agendas aimed at targeting specific PTSD and related symptoms.</p

Moral reasoning in women with posttraumatic stress disorder related to childhood abuse

Preliminary evidence suggests that relative to healthy controls, patients with posttraumatic stress disorder (PTSD) show deficits on several inter-related social cognitive tasks, including theory of mind, and emotion comprehension. Systematic investigations examining other aspects of social cognition, including moral reasoning, have not been conducted in PTSD stemming from childhood trauma. To conduct a comprehensive assessment of moral reasoning performance in individuals with PTSD stemming from childhood abuse. Moral reasoning performance was assessed in 28 women with PTSD related to prolonged childhood trauma and 19 matched healthy controls. Performance was assessed using 12 modified moral dilemmas and was queried in three domains: utilitarian/deontological sacrificial dilemmas (personal and impersonal), social order vs. compassion, and altruism vs. self-interest. Participants were asked whether a proposed action was morally acceptable or unacceptable and whether or not they would perform this action under the circumstances described. Women with PTSD were less likely to carry out utilitarian actions in personal, sacrificial moral dilemmas, a choice driven primarily by consequential intrapersonal disapproval. Increased concern regarding intrapersonal disapproval was related to higher symptoms of guilt in the PTSD group. Patients with PTSD demonstrated less altruistic moral reasoning, primarily associated with decreased empathic role-taking for beneficiaries. Women with PTSD due to childhood trauma show alterations in moral reasoning marked by decreased utilitarian judgment and decreased altruism. Childhood trauma may continue to impact moral choices made into adulthood. Moral judgment processing was found to be altered in women with PTSD related to chronic childhood trauma. In comparison to healthy women, women with PTSD were less likely to approve utilitarian actions when required to assume their agency in dilemmas involving the infliction of direct physical harm. Decreased likelihood of utilitarian action approval by the PTSD sample was driven by significantly enhanced endorsement of guilt and shame as consequences of such actions. Endorsement of guilt and shame in moral dilemmas was related to increased severity of current clinical symptoms of guilt.</p

sj-pdf-1-asm-10.1177_10731911211044198 – Supplemental material for Psychometric Evaluation of the Moral Injury Events Scale in Two Canadian Armed Forces Samples

Supplemental material, sj-pdf-1-asm-10.1177_10731911211044198 for Psychometric Evaluation of the Moral Injury Events Scale in Two Canadian Armed Forces Samples by Rachel A. Plouffe, Bethany Easterbrook, Aihua Liu, Margaret C. McKinnon, J. Don Richardson and Anthony Nazarov in Assessment</p

Graphical depiction of the experimental design.

<p><b>Subliminal session is depicted on the left, supraliminal session on the right. Above panels depict the block design. Below panels depict timing windows and stimulus presentation within word blocks (the trauma-related word block in this case).</b> Note: ms: milliseconds; sec: seconds; stim: stimulus.</p

Functional connectivity of each amygdala subdivision during sub- and supraliminal trauma-related word processing.

Functional connectivity of each amygdala subdivision during sub- and supraliminal trauma-related word processing.</p

CSS873663 Supplemental Material - Supplemental material for Back to the Basics: Resting State Functional Connectivity of the Reticular Activating System in PTSD and its Dissociative Subtype

Supplemental material, CSS873663 Supplemental Material for Back to the Basics: Resting State Functional Connectivity of the Reticular Activating System in PTSD and its Dissociative Subtype by Janine Thome, Maria Densmore, Georgia Koppe, Braeden Terpou, Jean Théberge, Margaret C. McKinnon and Ruth A. Lanius in Chronic Stress</p

Clinical and demographic information divided by group.

<p>Clinical and demographic information divided by group.</p

Data_Sheet_2_Altered Sense of Body Ownership and Agency in Posttraumatic Stress Disorder and Its Dissociative Subtype: A Rubber Hand Illusion Study.DOCX

Traumatic experiences have been linked to the development of altered states of consciousness affecting bodily perception, including alterations in body ownership and in sense of agency, the conscious experience of the body as one's own and under voluntary control. Severe psychological trauma and prolonged distress may lead to posttraumatic stress disorder (PTSD). Together, symptoms of derealization and, related specifically to the sense of body ownership and agency, of depersonalization (where parts of the body or the entire body itself is perceived as detached and out of control), constitute the dissociative subtype (PTSD+DS). In this study, we explored the Rubber Hand Illusion, an experimental paradigm utilized to manipulate sense of body ownership in PTSD (n = 4) and PTSD+DS (n = 6) as compared to healthy controls (n = 7). Perceived finger location and self-report questionnaires were used as behavioral and subjective measures of the illusion, respectively. In addition, the correlation between the illusion's effect and sense of agency as a continuous feeling of controlling one's own body movements was explored. Here, a lower illusion effect was observed in the PTSD as compared to the control group after synchronous stimulation for both the proprioceptive drift and subjectively perceived illusion. Moreover, by both proprioceptive drift and by subjective ratings, the PTSD+DS group showed a response characterized by high variance, ranging from a very strong to a very weak effect of the illusion. Finally, sense of agency showed a trend toward a negative correlation with the strength of the illusion as subjectively perceived by participants with PTSD and PTSD+DS. These findings suggest individuals with PTSD may, at times, maintain a rigid representation of the body as an avoidance strategy, with top-down cognitive processes weakening the impact of manipulation of body ownership. By contrast, the response elicited in PTSD+DS appeared to be driven by either an increased vulnerability to manipulation of embodiment or by a dominant top-down cognitive representation of the body, with disruption of multisensory integration processes likely in both cases. Taken together, these findings further our understanding of bodily consciousness in PTSD and its dissociative subtype and highlight the supportive role played by sense of agency for the maintenance of body ownership.</p

Table_1_Contrasting Associations Between Heart Rate Variability and Brainstem-Limbic Connectivity in Posttraumatic Stress Disorder and Its Dissociative Subtype: A Pilot Study.pdf

BackgroundIncreasing evidence points toward the need to extend the neurobiological conceptualization of posttraumatic stress disorder (PTSD) to include evolutionarily conserved neurocircuitries centered on the brainstem and the midbrain. The reticular activating system (RAS) helps to shape the arousal state of the brain, acting as a bridge between brain and body. To modulate arousal, the RAS is closely tied to the autonomic nervous system (ANS). Individuals with PTSD often reveal altered arousal patterns, ranging from hyper- to blunted arousal states, as well as altered functional connectivity profiles of key arousal-related brain structures that receive direct projections from the RAS. Accordingly, the present study aims to explore resting state functional connectivity of the RAS and its interaction with the ANS in participants with PTSD and its dissociative subtype.MethodsIndividuals with PTSD (n = 57), its dissociative subtype (PTSD + DS, n = 32) and healthy controls (n = 40) underwent a 6-min resting functional magnetic resonance imaging and pulse data recording. Resting state functional connectivity (rsFC) of a central node of the RAS – the pedunculopontine nuclei (PPN) – was investigated along with its relation to ANS functioning as indexed by heart rate variability (HRV). HRV is a prominent marker indexing the flexibility of an organism to react adaptively to environmental needs, with higher HRV representing greater effective adaptation.ResultsBoth PTSD and PTSD + DS demonstrated reduced HRV as compared to controls. HRV measures were then correlated with rsFC of the PPN. Critically, participants with PTSD and participants with PTSD + DS displayed inverse correlations between HRV and rsFC between the PPN and key limbic structures, including the amygdala. Whereas participants with PTSD displayed a positive relationship between HRV and PPN rsFC with the amygdala, participants with PTSD + DS demonstrated a negative relationship between HRV and PPN rsFC with the amygdala.ConclusionThe present exploratory investigation reveals contrasting patterns of arousal-related circuitry among participants with PTSD and PTSD + DS, providing a neurobiological lens to interpret hyper- and more blunted arousal states in PTSD and PTSD + DS, respectively.</p

Aberrant Functional Connectivity of the Amygdala Complexes in PTSD during Conscious and Subconscious Processing of Trauma-Related Stimuli - Fig 2

<p><b>On the left, a) Increased (PTSD>CNTR) and decreased (CNTR>PTSD) functional connectivity of the amygdala complexes during processing of SUBLIMINAL (subconscious) trauma-related words in PTSD as compared to controls. On the right, b) Increased (PTSD>CNTR) functional connectivity of the amygdala complexes during processing of SUPRALIMINAL (conscious) trauma-related words in PTSD as compared to controls. Coordinates are reported in MNI. Color bar indicates <i>t</i> scores.</b> Note: BLA: basolateral amygdala; CMA: centromedial amygdala; CNTR: control group; L: left; PTSD: post-traumatic stress disorder group; R: right.</p