Cardiac defense in response to imminent threat in women with multiple trauma and severe <scp>PTSD</scp>

Schalinski, Inga; Elbert, Thomas; Schauer, Maggie

doi:10.1111/psyp.12051

Cited by 19 publications

(17 citation statements)

References 51 publications

(67 reference statements)

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“…Generally, individuals with PTSD who experience single‐event traumas display hyperarousal responses preferentially in the presence of a current threat (Ehring & Quack, ; Kudielka & Kirschbaum, ; Lanius, Bluhm, Lanius, & Pain, ; Meiser‐Stedman, Smith, Glucksman, Yule, & Dalgleish, ; Riggs, Rothbaum, & Foa, ; Schalinkski et al, ). Hyperarousal is associated with sympathoexcitation and the activation of motor pathways—similar to active defensive responses (Bandler et al, ; Idiaquez et al, ; Lang, ; for a review, see Kozlowska et al, ).…”

Section: Introductionmentioning

confidence: 99%

The effects of trauma on brain and body: A unifying role for the midbrain periaqueductal gray

Terpou

Harricharan

McKinnon

et al. 2019

J of Neuroscience Research

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Post-traumatic stress disorder (PTSD), a diagnosis that may follow the experience of trauma, has multiple symptomatic phenotypes. Generally, individuals with PTSD display symptoms of hyperarousal and of hyperemotionality in the presence of fearful stimuli. A subset of individuals with PTSD; however, elicit dissociative symptomatology (i.e., depersonalization, derealization) in the wake of a perceived threat. This pattern of response characterizes the dissociative subtype of the disorder, which is often associated with emotional numbing and hypoarousal. Both symptomatic phenotypes exhibit attentional threat biases, where threat stimuli are processed preferentially leading to a hypervigilant state that is thought to promote defensive behaviors during threat processing. Accordingly, PTSD and its dissociative subtype are thought to differ in their proclivity to elicit active (i.e., fight, flight) versus passive (i.e., tonic immobility, emotional shutdown) defensive responses, which are characterized by the increased and the decreased expression of the sympathetic nervous system, respectively. Moreover, active and passive defenses are accompanied by primarily endocannabinoid-and opioid-mediated analgesics, respectively. Through critical review of the literature, we apply the defense cascade model to better understand the pathological presentation of defensive responses in PTSD with a focus on the functioning of lower-level midbrain and extended brainstem systems. K E Y W O R D Sbrainstem, dissociation, periaqueductal gray, PTSD, trauma | INTRODUC TI ONIn this review, we integrate literature from trauma experiences, the defense cascade, and the threat-response neurocircuitry within a framework of post-traumatic stress disorder (PTSD). We begin by introducing the concepts of the hypothalamic-pituitary-adrenal (HPA) axis, general PTSD, and defensive responses. Following these primers, we discuss the influences of trauma onset and prolonged exposure to trauma and their effects on the development of PTSD and the dissociative subtype of PTSD. Next, we introduce the defense cascade model and its underlying neurocircuitry as described in the animal literature and relate it to PTSD. In addition, we discuss the current state of the neuroimaging literature, which Edited by Sandra Chanraud.All peer review communications can be found with the online version of the article. | 1111TERPOU ET al. suggests that functional alterations are detectable in the midbrain of individuals with PTSD and its dissociative subtype as compared to healthy controls. We conclude by presenting directions for future research and the clinical implications for treatment of persons with PTSD that arise from this review of the extant literature.

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Section: Introductionmentioning

confidence: 99%

The effects of trauma on brain and body: A unifying role for the midbrain periaqueductal gray

Terpou

Harricharan

McKinnon

et al. 2019

J of Neuroscience Research

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“…Manifestation of the complex of long-latency HR acceleration and BP rise in the reflex phase of DCR also involves the presence of a fully defined cognitive-emotional threat strategy for coping with threats in highly reactive individuals. In fact, published data indicate that this is indeed seen: increased scanning of surrounding space for threats, with a predominance of the defensive component over the orientational [38], an increased tendency to learned fear and the formation of resistance to its quenching, and increases in emotional lability and negative emotionality in the formation of anxious restlessness [30,38]. Furthermore, the present study provides the first evidence that individuals with long-latency BP reactivity show increased readiness to anger as a personality trait realized in conditions of frustration or as a reaction to a negative evaluation.…”

Section: Discussionmentioning

confidence: 92%

The Oscillatory Systems of the Brain and Individual Variability of the Defensive Cardiac Reflex in Humans

Афтанас

Brak

Reva

et al. 2015

Neurosci Behav Physi

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The present study presents an analysis of the central mechanisms of the individual variation of cardiovascular stress reactivity in humans. The cardiovascular system is one of the leading effectors of motivated activity, and the nature of the obligatory "rearrangements" of hemodynamics to the chosen program of adaptive behavior is determined by the operation of psychosomatic integration mechanisms, the efficacy of which varies over a wide range in health and is impaired in arterial hypertension [4,35,36]. A new direction in studies of the question of cardiovascular reactivity is provided by analysis of the contribution of the activity of the two major motivational systems of the brain -the aversive/defensive system and the positive reinforcement system, initiating cascades of cognitive, emotional, visceral, and motor reactions -to the central mechanisms regulating cardiovascular stress reactivity [18].We report here our studies of the activity of the defensive motivational system, which, using immobilization or active defensive reactions, prepares the body to cope with threats [18]. Assessment of the reactivity of this system was based on a psychophysiological test in which presentation of a discrete stressor evokes a hemodynamic response altering the defensive cardiac reflex (DCR) [1,38]. The DCR profile includes short-and long-latency complexes of BP and HR reactivity [2]. Marked individual variability is the main distinguishing feature characteristic of the DCR and is reflected mainly in the presence or absence of a long-latency increase in BP [1,38]. The phenomenon of the long-latency increase in BP is of potential clinical interest, as it is an indicator of activation of the defense system, organizing resource mobilization and defensive coping reactions [1,2,38]. In turn, hyperactivity of the defense system can be regarded as a neuThe defensive cardiac reflex (DCR) is a reaction of the cardiovascular system with a specific profile of short-and long-latency reactivities (mainly of arterial blood pressure (BP) and heart rate (HR)). The DCR reflects activation of the defensive motivational system and defensive coping programs in humans. The aim of the present work was to evaluate the contribution of the brain oscillatory systems to the mechanisms of individual variability of the DCR. The oscillatory dynamics of multichannel (64-channel) electroencephalogram (EEG) were assessed using evoked synchronization/desynchronization in different frequency ranges and hemodynamics were assessed using simultaneously recorded beat-by-beat measures of cardiovascular reactivity (Finapres ® technology). This is the first report showing significant linkage between θ 2 (6-8 Hz) EEG activity with short-latency DCR reactivity and between α 2 (10-12 Hz) activity and long-latency reactivity. Hyperreactivity of the long-latency BP component was shown to be associated with the absence of a concomitant phase α 2 synchronization evoked. It is suggested that high-frequency θ EEG oscillations are involved in the central magnitude scaling m...

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“…These were compared to 17 Non-PTSD controls with similar ethnic backgrounds, who were recruited from the general community and from the University of Konstanz. Participants in the Non-PTSD control group and most of the patients had been examined with the Cardiac Defense Paradigm [27]. Each participant was interviewed after providing informed consent.…”

Section: Methodsmentioning

confidence: 99%

Rapid emotional processing in relation to trauma-related symptoms as revealed by magnetic source imaging

et al. 2014

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BackgroundTraumatic stress leads to functional reorganization in the brain and may trigger an alarm response. However, when the traumatic event produces severe helplessness, the predominant peri-traumatic response may instead be marked by a dissociative shutdown reaction. The neural correlates of this dissociative shutdown were investigated by presenting rapidly presented affective pictures to female participants with posttraumatic stress disorder (PTSD), and comparing responses to a Non-PTSD control group.MethodsEvent-related-magnetic-fields were recorded during rapid visual serial presentation of emotionally arousing stimuli (unpleasant or pleasant), which alternated with pictures with low affective content (neutral). Neural sources, based on the L2-surface-minimum-norm, correlated with the severity of the symptom clusters: PTSD, depression and shutdown dissociation.ResultsFor the early cortical response (60 to 110 ms), dissociation and PTSD symptom severity show similar spatial distributions of correlates for unpleasant stimuli. Cortical networks that could be involved in the relationships seem to be widespread.ConclusionWe conclude that shutdown dissociation, PTSD and depression all have distinct effects on early processing of emotional stimuli.

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Cardiac defense in response to imminent threat in women with multiple trauma and severe PTSD

Cited by 19 publications

References 51 publications

The effects of trauma on brain and body: A unifying role for the midbrain periaqueductal gray

The effects of trauma on brain and body: A unifying role for the midbrain periaqueductal gray

The Oscillatory Systems of the Brain and Individual Variability of the Defensive Cardiac Reflex in Humans

Rapid emotional processing in relation to trauma-related symptoms as revealed by magnetic source imaging

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