Dynamic causal modeling in PTSD and its dissociative subtype: Bottom–up versus top–down processing within fear and emotion regulation circuitry

Nicholson, Andrew A.; Friston, Karl J.; Zeidman, Peter; Harricharan, Sherain; McKinnon, Margaret C.; Densmore, Maria; Neufeld, Richard W. J.; Théberge, Jean; Corrigan, Frank M.; Jetly, Rakesh; Spiegel, David; Lanius, Ruth A.

doi:10.1002/hbm.23748

Cited by 119 publications

(115 citation statements)

References 49 publications

(111 reference statements)

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“…Post‐traumatic stress disorder (PTSD) is characterized by emotion dysregulation, including prominently states of reliving and of hypervigilance, which are thought to be mediated in part by decreased prefrontal inhibition on limbic (e.g., amygdala) and brainstem (e.g., periaqueductal gray) regions (Corrigan, Fisher, & Nutt, ; Fenster, Lebois, Ressler, & Suh, ; Lanius et al, ; Litz, ; Nicholson et al, ; Shalev, Liberzon, & Marmar, ; Yehuda et al, ). By contrast, the dissociative subtype of PTSD (PTSD+DS) is associated with symptoms of depersonalization, derealization and concomitant emotional detachment (Daniels, Frewen, Theberge, & Lanius, ; Lanius et al, ; Melara, Ruglass, Fertuck, & Hien, ; Sierra & Berrios, ), which are thought to be mediated by increased top‐down prefrontal inhibition on limbic and brainstem regions (Nicholson et al, ). Notably, brain connectivity patterns consistent with emotion dysregulation in PTSD and its dissociative subtype are present even at rest (Harricharan et al, ; Nicholson et al, , ; Thome et al, ).…”

Section: Introductionmentioning

confidence: 99%

“…By contrast, the dissociative subtype of PTSD (PTSD+DS) is associated with symptoms of depersonalization, derealization and concomitant emotional detachment (Daniels, Frewen, Theberge, & Lanius, ; Lanius et al, ; Melara, Ruglass, Fertuck, & Hien, ; Sierra & Berrios, ), which are thought to be mediated by increased top‐down prefrontal inhibition on limbic and brainstem regions (Nicholson et al, ). Notably, brain connectivity patterns consistent with emotion dysregulation in PTSD and its dissociative subtype are present even at rest (Harricharan et al, ; Nicholson et al, , ; Thome et al, ). Indeed, the prefrontal cortex as well as subcortical limbic and brainstem regions have been described as central to the neural underpinnings of emotion dysregulation in PTSD; however, more recent work has sought to expand this neurobiological framework through identification of other structures critical to emotion processing, including the insula (Etkin & Wager, ; Nicholson et al, ; Stark et al, ; Stein, Simmons, Feinstein, & Paulus, ).…”

Section: Introductionmentioning

confidence: 99%

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PTSD and its dissociative subtype through the lens of the insula: Anterior and posterior insula resting‐state functional connectivity and its predictive validity using machine learning

et al. 2019

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Individuals with post‐traumatic stress disorder (PTSD) typically experience states of reliving and hypervigilance; however, the dissociative subtype of PTSD (PTSD+DS) presents with additional symptoms of depersonalization and derealization. Although the insula is critical to emotion processing, its association with these contrasting symptom profiles is yet to be fully delineated. Accordingly, we investigated insula subregion resting‐state functional connectivity patterns among individuals with PTSD, PTSD+DS, and healthy controls. Using SPM12 and PRONTO software, we implemented a seed‐based resting‐state functional connectivity approach, along with multiclass Gaussian process classification machine learning, respectively, in order to evaluate unique patterns and the predictive validity of insula subregion connectivity among individuals with PTSD (n = 84), PTSD+DS (n = 49), and age‐matched healthy controls (n = 51). As compared to PTSD and PTSD+DS, healthy controls showed increased right anterior and posterior insula connectivity with frontal lobe structures. By contrast, PTSD showed increased bilateral posterior insula connectivity with subcortical structures, including the periaqueductal gray. Strikingly, as compared to PTSD and controls, PTSD+DS showed increased bilateral anterior and posterior insula connectivity with posterior cortices, including the left lingual gyrus and the left precuneus. Moreover, machine learning analyses were able to classify PTSD, PTSD+DS, and controls using insula subregion connectivity patterns with 80.4% balanced accuracy (p < .01). These findings suggest a neurobiological distinction between PTSD and its dissociative subtype with regard to insula subregion functional connectivity patterns. Furthermore, machine learning algorithms were able to utilize insula resting‐state connectivity patterns to discriminate between participant groups with high predictive accuracy.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

PTSD and its dissociative subtype through the lens of the insula: Anterior and posterior insula resting‐state functional connectivity and its predictive validity using machine learning

et al. 2019

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“…Compared with controls, the PTSD groups have widespread functional connectivity of the PAG with cortical areas such as the anterior cingulate cortex and the orbitomedial prefrontal cortex. Subsequent study of the direction of connectivity between the prefrontal cortex, the amygdala, and the PAG (Nicholson et al., ), confirmed major differences between the subgroups of PTSD. The re‐experiencing subtype has bottom‐up connectivity from the amygdala and the PAG to the ventromedial prefrontal cortex (VMPFC), whereas the dissociative subtype has the opposite pattern; enhanced top‐down connectivity from the VMPFC to the amygdala and PAG (Nicholson et al., ).…”

Section: Introductionmentioning

confidence: 91%

“…Subsequent study of the direction of connectivity between the prefrontal cortex, the amygdala, and the PAG (Nicholson et al., ), confirmed major differences between the subgroups of PTSD. The re‐experiencing subtype has bottom‐up connectivity from the amygdala and the PAG to the ventromedial prefrontal cortex (VMPFC), whereas the dissociative subtype has the opposite pattern; enhanced top‐down connectivity from the VMPFC to the amygdala and PAG (Nicholson et al., ). These findings confirm not only the importance of the PAG, but the clinical relevance of the subtype discrimination; the dissociative group has learnt to shut down the body and emotion awareness which was so painful during the developmental years.…”

Section: Introductionmentioning

confidence: 91%

The Comprehensive Resource Model^®: Overview of basic affects in adversity & effective treatment for complex reactions to trauma

Hull

Corrigan

2019

Couns and Psychother Res

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Much of the theoretical focus in post‐traumatic stress disorder has been on the role of the amygdala, the hippocampus and the prefrontal cortex. Crucially, in unresolved traumatic experiences that underlie clinical presentations, this focus misses the brain areas key to the defence responses of fight, flight and freeze—and the associated affects of anger, fear and grief. The periaqueductal gray in the midbrain, with the hypothalamus, is essential for these somatic and emotional responses to traumatic experiences. We argue that when treatment approaches thought to work at the higher brain levels have been ineffective, it is because they have failed to engage the midbrain and hypothalamic sources of the affective responses to the trauma and to the memory of it. Basic affects have been so overwhelming that dissociation, or a similarly protective neurochemical capping mechanism, has prevented full resolution of the affective content of the adversity. Treatment with the Comprehensive Resource Model® (CRM) aims to clear the clinically relevant residues of adverse experiences by resolving the emotional responses accessed through the body memories. When the trauma has led to overwhelming distress, and/or dissociation, there is a necessity for robust resourcing to be in place before the emotional intensity of that distress is accessed. Resourcing needs to be as proximal to the re‐experience as possible to promote complete resolution and in some psychotherapy modalities, the supports provided are somewhat remote from the crucial moments of processing. Therefore, we describe how the CRM seeks to have robustly resourced states present concurrently with traumatised states to avoid overwhelming emotional distress. This allows safe entry into the deepest pain residual from the traumatic event so that it is not overwhelming during processing of the memory, and does not lead to further dissociation, allowing the individual to remain fully present throughout. This “stepping into the affect” can then be so rapidly effective that we also argue that CRM is not an exposure treatment; re‐orientation to the deepest content of the experience resolves the residual distress quickly and permanently through memory reconsolidation. Re‐learning at upper brain levels will then follow from the revoking of the affective power, which has previously driven stimulus/context and response learning in the amygdala, hippocampus and prefrontal cortex.

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“…In dissociative PTSD, there is excessive rather than diminished top‐down connectivity from the EN to the SN, and heightened interconnectivity of the SN and DMN (Nicholson et al., , ). Dissociative PTSD has also been found to involve heightened cortical activation and preconscious attention to negative emotion stimuli, combined with diminished cortical activation and conscious attention to positive emotion stimuli (Klimova, Bryant, Williams, & Felmingham, ).…”

Section: Ptsd Neuroimaging Research Of Relevance For Tmpmentioning

confidence: 99%

Trauma Memory Processing in Posttraumatic Stress Disorder Psychotherapy: A Unifying Framework

Ford

2018

Journal of Traumatic Stress

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Trauma memory processing (TMP) is an empirically supported approach to psychotherapy for posttraumatic stress disorder (PTSD). However, TMP is not a single, uniform intervention but instead a paradigm that can be operationalized through a variety of component procedures that have not been systematically elucidated and formally tested. Based on findings from phenomenological/structural and neuroimaging research, a central feature of PTSD is theorized to be the involuntary immersion in trauma memories with diminished awareness or negative appraisals of self and current context. Such intrusive reexperiencing—which is epitomized by, but not limited to, flashbacks—is postulated to underlie PTSD's avoidance, altered emotions and cognitions, dissociative, and hyperarousal/hypervigilance symptoms; it is thus a logical target for TMP. The varied approaches to TMP for PTSD are conceptualized as having the common goal of activation of the neural networks in the brain that underlie two key capacities disrupted by intrusive reexperiencing in PTSD: intentional self‐referential retrieval of memories and suppression of memory retrieval. Therefore, TMP is postulated to involve two core functions (purposeful reflective remembering and memory awareness in situ) and three essential types (in vivo, imaginal, and cognitive reappraisal). Several implications of this framework for clinical practice and research on TMP for PTSD are discussed.

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Dynamic causal modeling in PTSD and its dissociative subtype: Bottom–up versus top–down processing within fear and emotion regulation circuitry

Cited by 119 publications

References 49 publications

PTSD and its dissociative subtype through the lens of the insula: Anterior and posterior insula resting‐state functional connectivity and its predictive validity using machine learning

PTSD and its dissociative subtype through the lens of the insula: Anterior and posterior insula resting‐state functional connectivity and its predictive validity using machine learning

The Comprehensive Resource Model^®: Overview of basic affects in adversity & effective treatment for complex reactions to trauma

Trauma Memory Processing in Posttraumatic Stress Disorder Psychotherapy: A Unifying Framework

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Dynamic causal modeling in PTSD and its dissociative subtype: Bottom–up versus top–down processing within fear and emotion regulation circuitry

Cited by 119 publications

References 49 publications

PTSD and its dissociative subtype through the lens of the insula: Anterior and posterior insula resting‐state functional connectivity and its predictive validity using machine learning

PTSD and its dissociative subtype through the lens of the insula: Anterior and posterior insula resting‐state functional connectivity and its predictive validity using machine learning

The Comprehensive Resource Model®: Overview of basic affects in adversity & effective treatment for complex reactions to trauma

Trauma Memory Processing in Posttraumatic Stress Disorder Psychotherapy: A Unifying Framework

Contact Info

Product

Resources

About

The Comprehensive Resource Model^®: Overview of basic affects in adversity & effective treatment for complex reactions to trauma