Post-traumatic stress disorder: review of DSM criteria and functional neuroanatomy

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria for post-traumatic stress disorder (PTSD) consist of over twenty possible symptoms that can be divided into six broad categories. These categories correlate with specific brain networks that regulate emotions, behaviors, and autonomic function. Normal functioning of these networks depends on two key regions; the prefrontal cortex and the amygdala. The prefrontal cortex provides top-down executive control over amygdala, whereas the amygdala is critical for threat detection and activation of the ‘fight or flight’ response. Events that trigger extreme and/or prolonged fear can cause persisting dysregulation within the prefrontal-amygdala circuit; resulting in PTSD symptomatology. Studies indicate that effective treatment of PTSD, either psychotherapy or medications, reverses this prefrontal-amygdala dysregulation. This review article summarizes current knowledge and theories available in the medical literature from NCBI’s PubMed database regarding the underlying brain networks involved in PTSD

Mindfulness and Pain Regulation: The Role of Acceptance and Commitment Therapy for Individuals with Chronic Pain

Chronic pain is a significant and widely prevalent health condition which requires comprehensive care to address the many facets contributing to symptomatology. In 2016, 20% of American adults (about 50 million) reported experiencing chronic pain, of which 7.4% indicated that chronic pain frequently limited their life and participation in activities within the past 3 months (CDC, 2018). As a result, many individuals with chronic pain turn to opioid-based medication for pain relief, but long-term use of opioids actually increases pain sensation (Tobin, 2019). Moreover, opioid medication is unable to target underlying mental health components which emerge as part of chronic pain conditions. Thus, non-pharmacological treatment is needed to relieve the burden of chronic pain and improve cognitive and emotional processing as well as views of self (Skelly et al., 2018). Acceptance and Commitment Therapy (ACT) is a highly effective transdiagnostic intervention used to treat chronic pain by teaching individuals coping skills through mindfulness and behavioral activation (Bai et al., 2020; Dindo et al., 2017). Based on extensive data, ACT is shown to correlate with an increase in psychological flexibility, pain acceptance, and reductions in feelings of pain-related stigma (Aytur et al., 2022; Ding & Zheng, 2022; Meier et al., 2021; Feliu-Soler, 2018). Given the necessity of remote healthcare intervention, especially relevant during the recent pandemic, there is an urgent need to evaluate the efficacy of ACT in a tele-practice delivery model which will broaden the availability of the treatment to reach far larger numbers of patients. As a complement to ACT, recreational therapy (RT) is likely efficacious for treatment of chronic pain and associated symptoms. Similar to the underlying goals of ACT, RT focuses on personal values, improved functioning, quality of life, independence, and recovery (Froutan, 2022). The purpose of this paper is to expand upon a prior pilot study assessing feasibility of a non-pharmacological approach to chronic pain treatment using a tele-practice intervention that combines ACT with RT (TeleACT-RT). Specifically, this paper will evaluate the efficacy of the TeleACT-RT intervention on improving mindfulness in participants with chronic pain. With a focus on the concept of mindfulness, this study aims to extend the previous findings from the TeleACT-RT study by quantifying the impact of ACT on metrics of mindfulness using the Five Facet Mindfulness Questionnaire (FFMQ; Baer et al., 2004, 2008). Results suggest that TeleACT-RT was associated with a significant increase in mindfulness scores after the intervention, as well as improved scores in numerous other domains (e.g., psychological flexibility, pain acceptance, and social role participation) (Roy, 2022). These findings complemented prior research suggesting that TeleACT-RT was associated with a wide range of improvements in chronic pain. (Roy, 2022). Roy et al. (2022) explored the feasibility of administering this intervention through a 6-week tele-practice TeleACT-RT modality within the context of the COVID-19 pandemic through a pilot-study. Findings from this study revealed positive behavior outcomes, encompassing increased psychological flexibility, pain acceptance, and lower extremity function, while simultaneously showing decreased feelings of pain-related stigma (Roy, 2022). Additionally, participants reported being satisfied with the tele-practice modality of delivery and provided positive feedback regarding their overall quality of life post-treatment with ACT

The relationship between mindfulness and ambiguity tolerance

While ambiguity may be a universal experience, it fluctuates depending on the circumstances. As there is no single definition of ambiguity, its manifestations range from role uncertainty to chaos to simple process issues. Because it is impractical and undesirable to completely eliminate ambiguity, an increased ability to tolerate ambiguity plays an important role in allowing individuals to cope with ambiguity in productive ways. Among the previously studied coping mechanism is mindfulness. The purpose of this study is to examine whether there is a relationship between individuals who self-report high levels of mindfulness and an increased ability to tolerate with ambiguity. A convenience sample of eight employees were interviewed and took a measure on mindfulness and ambiguity tolerance. Key findings were that there is a probable relationship between a higher level of mindfulness and an increased ability to tolerate ambiguity, which is consistent with other research findings

Amygdala-prefrontal connectivity during emotion regulation: A meta-analysis of psychophysiological interactions

Given the importance of emotion regulation as a transdiagnostic factor in the development of psychopathology, a myriad of neuroimaging studies has investigated its neural underpinnings. However, single studies usually provide limited insight into the function of specific brain regions. Hence, to better understand the interaction between key regions involved in emotion generation and regulation, we performed a coordinate-based meta-analysis on functional magnetic resonance imaging (fMRI) studies that examined emotion regulation-modulated connectivity of the amygdala using psychophysiological interaction (PPI) analysis. We analyzed fifteen PPI studies using the activation likelihood estimation (ALE) algorithm. Investigating emotion regulation-modulated connectivity independent of regulation strategy and goal revealed convergent connectivity between the amygdala and the left ventrolateral prefrontal cortex (vlPFC), which was primarily driven by PPI studies implementing reappraisal as a regulation strategy. A more focused analysis testing for effective coupling during the downregulation of emotions by using reappraisal specifically revealed convergent connectivity between the amygdala and the right dorsolateral prefrontal cortex (dlPFC), the left ventrolateral prefrontal cortex (vlPFC), and the dorsomedial prefrontal cortex (dmPFC). These prefrontal regions have been implicated in emotion regulatory processes such as working memory (dlPFC), language processes (vlPFC), and the attribution of mental states (dmPFC). Our findings suggest not only a dynamic modulation of connectivity between emotion generative and regulatory systems during the cognitive control of emotions, but also highlight the robustness of task-modulated prefrontal-amygdala coupling, thereby informing neurally-derived models of emotion regulation

Post-traumatic stress disorder: review of DSM criteria and functional neuroanatomy

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria for post-traumatic stress disorder (PTSD) consist of over twenty possible symptoms that can be divided into six broad categories. These categories correlate with specific brain networks that regulate emotions, behaviors, and autonomic function. Normal functioning of these networks depends on two key regions; the prefrontal cortex and the amygdala. The prefrontal cortex provides top-down executive control over amygdala, whereas the amygdala is critical for threat detection and activation of the ‘fight or flight’ response. Events that trigger extreme and/or prolonged fear can cause persisting dysregulation within the prefrontal-amygdala circuit; resulting in PTSD symptomatology. Studies indicate that effective treatment of PTSD, either psychotherapy or medications, reverses this prefrontal-amygdala dysregulation. This review article summarizes current knowledge and theories available in the medical literature from NCBI’s PubMed database regarding the underlying brain networks involved in PTSD

The Development of an Expressive Arts Method to Promote Emotional Regulation through the use of Breath in a CBAT facility, ages 4 - 17

Arts-based practices can support individuals in groups to stay centered, aligned, present, and alert in the moment. Expressive Arts Therapies serve as an opportunity to create a therapeutic attunement or alliance. This thesis explores the development of an expressive arts-based method that promotes emotional regulation through the use of breath for ages 4-17 in a Community Based Acute Treatment (CBAT) facility. The techniques in this thesis reflect the lens of theory and practice through play, attunement, mindfulness, meditation, all centering around the importance of breathing to promote emotional regulation in a CBAT population age 4 – 17. As anticipated, the focus and implementation of breath work in the therapeutic alliance increased engagement and participation in therapeutic groups

Psychobiological mechanisms underlying the mood benefits of meditation: A narrative review

Psychological stressors can lead to distress and result in autonomic arousal and activation of a stress response. Ongoing or persistent stress can disrupt the stress response feedback mechanisms and result in elevated cortisol and pro-inflammatory cytokines which can cause damage to brain regions involved in the regulation of mood and emotion. We propose that the magnitude of the stress response experienced in response to psychological stressors depends on a number of modifiable psychological processes including an individual’s level of self-compassion, dispositional mindfulness, tendency to ruminate and attentional bias. We further propose that the stress response elected by psychological stressors can be meditated by influencing these modifiable psychological processes, and that meditation practices can decrease stress and improve mood by decreasing stress reactivity on a psychological, physiological and neurobiological level. We explore this in a narrative review