Investigating biological traces of traumatic stress in changing societies: challenges and directions from the ESTSS Task Force on Neurobiology

Abstract

Traumatic stress can have severe consequences for both mental and physical health. Furthermore, both psychological and biological traces of trauma increase as a function of accumulating traumatic experiences. Neurobiological research may aid in limiting the impact of traumatic stress, by leading to advances in preventive and treatment interventions. To promote the possibility for clinical implementation of novel research findings, this brief review describes timely conceptual and methodological challenges and directions in neurobiological trauma research on behalf of the Task Force “Neurobiology of Traumatic Stress” of the European Society for Traumatic Stress Studies (ESTSS). The most important conceptual challenges are the heterogeneity of disorders and existence of subtypes across diagnostic categories: differential latent profiles and trajectories regarding symptom expression and neural correlates are being unraveled; however, similar latent classes’ approaches for treatment response and neurobiological data remain scarce thus far. The key to improving the efficacy of currently available preventive interventions and treatments for trauma-related disorders lies in a better understanding and characterization of individual differences in response to trauma and interventions. This could lead to personalized treatment strategies for trauma-related disorders, based on objective information indicating whether individuals are expected to benefit from them. The most important methodological challenge identified here is the need for large consortia and meta-analyses or, rather, mega-analyses on existent data as a first step. In addition, large multicenter studies, combining novel methods for repeated sampling with more advanced statistical modeling techniques, such as machine learning, should aim to translate identified disease mechanisms into molecular blood-based biomarker combinations to predict disorder vulnerability and treatment responses.

Top‐down and bottom‐up control of stress‐coping

“…Moreover, studies conducted in patients diagnosed with personality disorders, depression, 223 psychotic 224 and bipolar disorders 225 show that the spectrum of psychiatric disorders, which are impacted in onset and progression by trauma exposure, is much broader than formally acknowledged as trauma-related. 226…”

Trauma and trauma care in Europe

“…Although not yet implemented, other treatment innovations include hormonal enhancers (D-cycloserin, cortisol, oxytocin; e.g. Thomaes et al, 2016).…”

Neurobiological Trajectories Involving Social Isolation in PTSD: A Systematic Review

“…We present the results of the retrieved studies in terms of hypothalamic-pituitary-adrenal (HPA)-axis and endocannabinoid system function, immune reactions, neuroplasticity, novel pharmacological targets, and shortening of telomere length, which confirm a synergistic effect on a neurobiological level between the two entities.Brain Sci. 2020, 10, 173 2 of 15 studies have shown that trauma-related disorders are associated with the dysfunctioning of numerous biological systems, and that PTSD symptom severity exerts a cumulative effect on premature aging of the immune system and telomere length [8].Human functional imaging studies have identified an increased connectivity between the ventromedial prefrontal cortex (vmPFC), locus coeruleus (LC), hypothalamus, hippocampus, basolateral amygdala (BLA), and bed nucleus of the stria terminalis (BNST) in PTSD patients, while more subcortical areas like the periaqueductal gray area (PAG) and central amygdala (CeA) gradually become involved when the severity of a threatening stimulus becomes aggravated [9,10].Before the last decade, the predominant neurobiological model of PTSD concentrated on the pathway of fear conditioning involving mainly the amygdala system [11]. The preparations of the new DSM-5 broadened the criteria to include further emotionally dysregulated states like anger, guilt, shame, and symptoms of derealization and depersonalization, as well as altered self-and other-related conditions and deficits in social cognitions.…”

“…Brain Sci. 2020, 10, 173 2 of 15 studies have shown that trauma-related disorders are associated with the dysfunctioning of numerous biological systems, and that PTSD symptom severity exerts a cumulative effect on premature aging of the immune system and telomere length [8].…”