Lack of cortisol response in patients with posttraumatic stress disorder (PTSD) undergoing a diagnostic interview

Background: According to DSM-IV, the diagnosis of posttraumatic stress disorder (PTSD) requires the experience of a traumatic event during which the person's response involved intense fear, helplessness, or horror. In order to diagnose PTSD, clinicians must interview the person in depth about his/her previous experiences and determine whether the individual has been traumatized by a specific event or events. However, asking questions about traumatic experiences can be stressful for the traumatized individual and it has been cautioned that subsequent "re-traumatization" could occur. This study investigated the cortisol response in traumatized refugees with PTSD during a detailed and standardized interview about their personal war and torture experiences. Methods: Participants were male refugees with severe PTSD who solicited an expert opinion in the Psychological Research Clinic for Refugees of the University of Konstanz. 17 patients were administered the Vivo Checklist of War, Detention, and Torture Events, a standardized interview about traumatic experiences, and 16 subjects were interviewed about absorption behavior. Self-reported measures of affect and arousal, as well as saliva cortisol were collected at four points. Before and after the experimental intervention, subjects performed a Delayed Matching-to-Sample (DMS) task for distraction. They also rated the severity of selected PTSD symptoms, as well as the level of intrusiveness of traumatic memories at that time. Results: Cortisol excretion diminished in the course of the interview and showed the same pattern for both groups. No specific response was detectable after the supposed stressor. Correspondingly, ratings of subjective well-being, memories of the most traumatic event(s) and PTSD symptoms did not show any significant difference between groups. Those in the presumed stress condition did not perform worse than persons in the control condition after the stressor. However, both groups performed poorly in the DMS task, which is consistent with memory and concentration problems demonstrated in patients with PTSD. Conclusion: A comprehensive diagnostic interview including questions about traumatic events does not trigger an HPA-axis based alarm response or changes in psychological measures, even for persons with severe PTSD, such as survivors of torture. Thus, addressing traumatic experiences within a safe and empathic environment appears to impose no unacceptable additional load to the patient

Perception of Workload and Task Importance During Complex and Dual Task Conditions

Background • cognitive processes and movement need to occur concurrently as part of social engagement; voluntary movement is not wholly automatic and when movement occurs, it leads to changing cognitive demands. (McIsaac et al, 2015) • Current practice for creating dual-task challenges in the clinic include serial subtraction and carrying a glass of water (complex walking task) however these do not always translate to a patient\u27s individualized challenges and goals • Research has shown that a patient\u27s engagement and performance improves when the task they are performing is meaningful in their lives. (McIsaac et al, 2015) • Would including items that assess various aspects of patient perception be beneficial to augment how we create task demands in clinic

Neuroendokrinologische und hirnstrukturelle Veränderungen bei Posttraumatischer Belastungsstörung (PTBS)

A neurobiological model of posttraumatic stress disorder (PTSD) associates its specific symptoms with a memory network that is mainly composed of amygdala, hippocampus and medial prefrontal cortex. According to that framework, a core problem in PTSD consists in the excessive formation of amygdaloid fear networks that cannot be sufficiently inhibited by hippocampus and prefrontal cortex. A reason for this disturbed inhibition was suggested in the cortisol-mediated atrophy of hippocampal tissue. However, there is still no entirely unambiguous empirical support for this theory. Particularly methodological differences between studies have been discussed as potential reason for existing inconsistencies.Study 1: Potential PTSD-associated differences in basal cortisol levels were elucidated within an investigation of the diurnal cortisol release of highly traumatized, Rwandese refugees. Both, the study design and the choice of the population allowed a maximal control of methodological confounds. Notwithstanding, no PTSD-related alterations in cortisol profiles were revealed. Study 2: Potential brain structural alterations of regions associated with episodic memory networks were investigated in a sample of traumatized refugees with and without PTSD. Specific volume changes were revealed in the right inferior parietal cortex, the bilateral later prefrontal cortex and the bilateral isthmus of the cingulate. Study 3: The specific role of hippocampus and insula in the pathophysiology of PTSD was clarified in a combined volumetry/spectroscopy investigation of the same sample. In both structures neither volume reductions nor changes in neuronal density were revealed. An association between left hippocampal metabolite concentration and the occurrence of negative childhood experiences suggests that these experiences might have a particular influence on hippocampal integrity.In light of the present results, it seems unlikely that PTSD-related alterations in cortisol release might result in atrophies within hippocampal tissue. Morphological alterations in this structure might rather be the consequence of negative childhood experiences or develop secondary to other factors, as e.g. excessive alcohol abuse. Moreover, an extension of the conventional neurobiological model of PTSD seems reasonable. Particularly cortical regions that have been associated with the volitional control of memory processes and the regulation of emotional conditions showed PTSD-specific structural volume reductions. The contribution of these structures in the pathophysiology of PTSD should be the focus of future research

Internal consistency and test-retest reliability of an affective task-switching paradigm

Affective flexibility refers to the flexible adaptation of behavior or thought given emotionally relevant stimuli, tasks, or contexts, and has been associated with the efficiency of emotion regulation and dealing with stress and adversity. Experimentally, individual differences in affective flexibility have been measured as behavioral costs (response times, errors rates) of switching between affective and neutral tasks. However, behavioral task measures can only be treated as trait-like characteristics if they have sufficient psychometric quality. We report an analysis of the test-retest reliability (interval two weeks) as well as internal consistencies of behavioral switch costs measured in an affective task switching paradigm. This paradigm elicits strong response time switch costs for both tasks, but higher when switching to the emotion than to the gender task. These ‘asymmetric switch costs’ suggest dominance of the emotional task rule. Reliability analyses indicated excellent internal consistency estimates (Spearman-Brown corrected r = .92 for both switch directions) and good test-retest reliabilities (ICC(2,1) of .78 and .82, respectively) for response time-based switch costs. Effect sizes and reliability estimates were substantially lower for switch costs calculated from error rates, which is consistent with previous literature discussing the psychometric properties of task-based cognitive measures. Reliability measures were lower but still acceptable for valence-specific response time-based switch costs, potentially due to lower trial numbers per cell when increasing granularity of the analysis. In conclusion, our results indicate that response time-based affective switch costs are well-suited as individual differences measure, and thus may be a valuable proxy for assessing affective flexibility

Cognitive, affective, and feedback-based flexibility – disentangling shared and different aspects of three facets of psychological flexibility

Cognitive flexibility – the ability to adjust one ́s behavior to changing environmental demands – is crucial for controlled behavior. However, the term ‘cognitive flexibility’ is used heterogeneously, and associations between cognitive flexibility and other facets of flexible behavior have only rarely been studied systematically. To resolve some of these conceptual uncertainties, we directly compared cognitive flexibility (cue-instructed switching between two affectively neutral tasks), affective flexibility (switching between a neutral and an affective task using emotional stimuli), and feedback-based flexibility (non-cued, feedback-dependent switching between two neutral tasks). Three experimental paradigms were established that share as many procedural features (in terms of stimuli and/or task rules) as possible and administered in a pre-registered study plan (N=100). Correlation analyses revealed significant associations between the efficiency of cognitive and affective task switching (response time switch costs). Feedback-based flexibility (measured as mean number of errors after rule reversals) did not correlate with task switching efficiency in the other paradigms, but selectively with the effectiveness of affective switching (error rate costs when switching from neutral to emotion task). While preregistered confirmatory factor analysis (CFA) provided no clear evidence for a shared factor underlying the efficiency of switching in all three domains of flexibility, an exploratory CFA suggested commonalities regarding switching effectiveness (accuracy-based switch costs). We propose shared mechanisms controlling the efficiency of cue-dependent task switching across domains, while the relationship to feedback-based flexibility may depend on mechanisms controlling switching effectiveness. Our results call for a more stringent conceptual differentiation between different variants of psychological flexibility

Individual differences in resilience to stress are associated with affective flexibility

Cognitive flexibility, the capacity to adjust behavior to changing situational demands, is frequently linked to resilience because of its important contribution to stress regulation. In this context, particularly affective flexibility, defined as the ability to flexibly attend and disengage from affective information, may play a significant role. However, there are so far only very few empirical investigations that directly explore the link between flexibility and resilience to stress. In the present study, the relationship of cognitive and affective flexibility and resilience was examined in 100 healthy participants. Resilience was measured with three self-report questionnaires, two defining resilience as a personality trait and one focusing on resilience as an outcome in the sense of stress coping abilities. Cognitive and affective flexibility were assessed in two experimental task switching paradigms with non-affective and affective materials and tasks, respectively. The cognitive flexibility paradigm additionally included measures of cognitive stability and dispositional cognitive flexibility. In the affective flexibility paradigm, we explicitly considered the affective valence of the stimuli before and during task switching. Response time switch costs in the affective flexibility paradigm were significantly correlated to all three self-report measures of resilience. Regarding the valence of the stimuli, the correlation with resilience was not specific to costs when switching from negative to positive information or vice versa. For cognitive (i.e., non-affective) flexibility, a significant correlation of response time switch costs was found with only one of the three resilience measures. A regression analysis including both affective and cognitive switch costs as predictors of resilience indicated that only affective, but not cognitive switch costs, explained unique variance components. Furthermore, the experimental measures of cognitive stability and dispositional cognitive flexibility did not correlate with resilience scores. These findings suggest that specifically the efficiency of flexibly switching between affective and non-affective information is related to resilience

Cognitive, affective, and feedback-based flexibility : disentangling shared and different aspects of three facets of psychological flexibility

Cognitive flexibility – the ability to adjust one’s behavior to changing environmental demands – is crucial for controlled behavior. However, the term ‘cognitive flexibility’ is used heterogeneously, and associations between cognitive flexibility and other facets of flexible behavior have only rarely been studied systematically. To resolve some of these conceptual uncertainties, we directly compared cognitive flexibility (cue-instructed switching between two affectively neutral tasks), affective flexibility (switching between a neutral and an affective task using emotional stimuli), and feedback-based flexibility (non-cued, feedback-dependent switching between two neutral tasks). Three experimental paradigms were established that share as many procedural features (in terms of stimuli and/or task rules) as possible and administered in a pre-registered study plan (N = 100). Correlation analyses revealed significant associations between the efficiency of cognitive and affective task switching (response time switch costs). Feedback-based flexibility (measured as mean number of errors after rule reversals) did not correlate with task switching efficiency in the other paradigms, but selectively with the effectiveness of affective switching (error rate costs when switching from neutral to emotion task). While preregistered confirmatory factor analysis (CFA) provided no clear evidence for a shared factor underlying the efficiency of switching in all three domains of flexibility, an exploratory CFA suggested commonalities regarding switching effectiveness (accuracy-based switch costs). We propose shared mechanisms controlling the efficiency of cue-dependent task switching across domains, while the relationship to feedback-based flexibility may depend on mechanisms controlling switching effectiveness. Our results call for a more stringent conceptual differentiation between different variants of psychological flexibility

The probability of spontaneous remission from PTSD depends on the number f traumatic event types experienced

Kolassa I-T, Ertl V, Kolassa S, Onyut LP, Elbert T. The probability of spontaneous remission from PTSD depends on the number f traumatic event types experienced. Psychological Trauma: Theory, Research, Practice, and Policy (in press). In Press;2(3):169-174

No PTSD-related differences in diurnal cortisol profiles of genocide survivors

Posttraumatic stress disorder (PTSD) has been associated with reduced cortisol levels. Opposing results have been interpreted as resulting from methodological differences between studies. We investigated the diurnal profile of salivary cortisol in a population of highly traumatized adult males from Rwanda with and without PTSD, who spent the whole day of examination together under a maximally standardized schedule. Besides the detection of PTSD-related alterations in cortisol release we aimed at determining physiologically relevant effects of cumulative trauma exposure on HPA functioning in interaction with or independent of diagnosis. There were no differences in the diurnal pattern of cortisol release between subjects with and without PTSD. We observed an increasing prevalence of PTSD with increasing number of different traumatic event types experienced, replicating earlier results on a “building-block effect” of multiple traumatization. However, size of cumulative exposure was not related to any of the cortisol measures. The results suggest that besides methodological constraints also confounding factors not previously controlled for, e.g., sex differences or current life stress, might contribute to the diverging results of lowered, unchanged or enhanced cortisol secretion in PTSD. Future research should therefore closely monitor these possible confounds to optimize models for cortisol in research on stress-dependent illnesses