Cardiovascular and psychological responses to voluntary recall of trauma in posttraumatic stress disorder

Chou, Charles C.-K.; Marca, Roberto La; Steptoe, Andrew; Brewin, Chris R.

doi:10.1080/20008198.2018.1472988

Cited by 13 publications

(19 citation statements)

References 49 publications

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“…Thalamic deactivation has been proposed as a mechanism whereby dissociative symptoms can emerge during symptom provocation (Krystal et al, ). Furthermore, individuals eliciting dissociative responses across multiple disorders (i.e., PTSD, borderline personality disorder, depersonalization disorder, dissociative identity disorder) exhibit a lack of autonomic response during states of depersonalization and/or derealization, as measured by reductions in heart rate variability and decreased startle responses (Chou, Marca, Steptoe, & Brewin, , ; Lanius et al, ; Sierra et al, ; for a review, see Owens, Low, Iodice, Mathias, & Critchley, ). Although there is no experimental evidence to state conclusively that motor paralysis occurs during emotional shutdown responses in PTSD, current evidence surrounding dissociation suggests that shutdown responses can be engaged during traumatic episodes and their subsequent recall.…”

Section: Emotional Shutdownmentioning

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: Emotional Shutdownmentioning

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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“…As Janet stated more than a century ago: “mental health is characterized by a high capacity for integration” (Janet, 1889 page 460). The disintegrative processes lead to a wide range of different psychopathological phenomena depending on which mental function they compromise: from alterations of self-consciousness, such as detachment symptoms (derealization/depersonalization), to the fragmentation of self-experiences, such as compartmentalization symptoms (e.g., amnesia, motor control, and multiple personality), and even to a sudden loss of control on emotions and behavior and vegetative arousal dysregulation (Carlson et al., 2009; Farina and Liotti, 2013; Chou et al., 2018).…”

Section: Dissociation and Disintegrative Traumatic Processesmentioning

confidence: 99%

The Role of Attachment Trauma and Disintegrative Pathogenic Processes in the Traumatic-Dissociative Dimension

Farina

Liotti²,

Imperatori

2019

Front. Psychol.

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Epidemiological, clinical, and neurobiological studies of the last 30 years suggest that traumatic attachments during the early years of life are associated to specific psychopathological vulnerabilities based on dissociative pathogenic processes. It has been observed that the dissociative pathogenic processes caused by these traumatic attachments either may contribute to the genesis of well-defined mental disorders (e.g., dissociative disorders) or may variably occur in many other diagnostic categories, complicating their clinical pictures and worsening their prognosis. For this reason, we proposed to define the dimension of psychopathological outcomes linked to traumatic attachments and dissociative pathogenic processes as the “traumatic-dissociative” dimension (TDD). The clinical complexity of the TDD requires specific training to enable mental health professionals to recognize the signs of traumatic developments and to implement specific treatment strategies. The present article aims to review some crucial points about the clinical meaning and treatment strategies of the TDD, the dissociative pathogenic processes characterizing the TDD, as well as of the role of attachment trauma in the TDD. We also focused on the clinical and theoretical evidence suggesting that dissociation and dis-integration may be considered two different processes but highly correlated. The usefulness of clinical reasoning in terms of psychopathological dimensions, instead of distinct diagnostic categories, as well as several therapeutic implications of these issues was finally discussed.

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“…Like the real-life situations PTSD patients encounter, the same words and phrases tend to elicit flashbacks repeatedly, but not invariably—flashback elicitation is a probabilistic rather than a wholly predictable process. A recent study of the voluntary recall of trauma memories by a PTSD sample, mimicking what happens in exposure therapy, found that whereas heart rate gradually reduced over time, flashbacks were accompanied by momentary increases in heart rate [ 39 ].…”

Section: Memory Modelsmentioning

confidence: 99%

Memory and Forgetting

Brewin

2018

Curr Psychiatry Rep

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Purpose of ReviewI summarize recent developments in understanding the phenomenology of memory in PTSD, describe the most prominent theoretical models, and outline new forms of treatment aimed at modifying the traumatic memory.Recent FindingsIntrusive memories that have the quality of being relived in the present have been highlighted in ICD-11. Debate over whether trauma memories are disorganized has led to a distinction between global narratives that are usually well rehearsed and episodic memories of the most frightening moments when disruptions and fragmentation may occur. Attempts to prevent the initial consolidation of trauma memories have promise in prevention but face practical difficulties. Theoretical developments have led to a number of promising treatments for established PTSD including pre-retrieval propranolol and imagery rescripting.SummaryResearch has suggested real possibilities to improve the prevention and treatment of PTSD by modifying trauma recall even though the theoretical basis for these interventions remains controversial.

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Cardiovascular and psychological responses to voluntary recall of trauma in posttraumatic stress disorder

Cited by 13 publications

References 49 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 Role of Attachment Trauma and Disintegrative Pathogenic Processes in the Traumatic-Dissociative Dimension

Memory and Forgetting

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