Resting‐state functional connectivity in patients with a complex PTSD or complex dissociative disorder before and after inpatient trauma treatment

Schlumpf, Yolanda R.; Nijenhuis, Ellert R. S.; Klein, Carina; Jäncke, Lutz; Bachmann, Silke

doi:10.1002/brb3.2200

Cited by 7 publications

(6 citation statements)

References 77 publications

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“…Given this, decreased functional connectivity between the PCC and isthmus could reflect inefficient or slowed synchronization between these regions of the brain that are critical for sensory integration, consciousness, and the physical sense of self and place. Our finding of decreased DMN connectivity is consistent with at least one EEG study of pretreatment dissociative conditions, with data suggesting increased DMN connectivity following treatment (Schlumpf et al, 2021). It is important to note that we studied trait but not state dissociation, thus this functional connectivity correlate could represent a vulnerability to derealization/depersonalization rather than (or in addition to) the neurobiology of an active dissociative state.…”

Section: Discussionsupporting

confidence: 89%

Neurobiological and genetic correlates of the dissociative subtype of posttraumatic stress disorder.

Wolf¹,

Hawn²,

Sullivan³

et al. 2023

Journal of Psychopathology and Clinical Sci

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Approximately 10%–30% of individuals with posttraumatic stress disorder (PTSD) exhibit a dissociative subtype of the condition defined by symptoms of depersonalization and derealization. This study examined the psychometric evidence for the dissociative subtype of PTSD in a sample of young, primarily male post-9/11-era Veterans (n = 374 at baseline and n = 163 at follow-up) and evaluated its biological correlates with respect to resting state functional connectivity (default mode network [DMN]; n = 275), brain morphology (hippocampal subfield volume and cortical thickness; n = 280), neurocognitive functioning (n = 337), and genetic variation (n = 193). Multivariate analyses of PTSD and dissociation items suggested a class structure was superior to dimensional and hybrid ones, with 7.5% of the sample comprising the dissociative class; this group showed stability over 1.5 years. Covarying for age, sex, and PTSD severity, linear regression models revealed that derealization/depersonalization severity was associated with: decreased DMN connectivity between bilateral posterior cingulate cortex and right isthmus (p = .015; adjusted-p [padj] = .097); increased bilateral whole hippocampal, hippocampal head, and molecular layer head volume (p = .010–.034; padj = .032–.053); worse self-monitoring (p = .018; padj = .079); and a candidate genetic variant (rs263232) in the adenylyl cyclase 8 gene (p = .026), previously associated with dissociation. Results converged on biological structures and systems implicated in sensory integration, the neural representation of spatial awareness, and stress-related spatial learning and memory, suggesting possible mechanisms underlying the dissociative subtype of PTSD.

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Section: Discussionsupporting

confidence: 89%

Neurobiological and genetic correlates of the dissociative subtype of posttraumatic stress disorder.

Wolf¹,

Hawn²,

Sullivan³

et al. 2023

Journal of Psychopathology and Clinical Sci

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“…In this line of reasoning, a strengthening in the autobiographical memory network in response to visual cues could also reflect that treatment may have helped the patients as ANP to experience and see more what is self-relevant and of affective significance to them. This interpretation is in accordance with a resting-state functional connectivity study suggesting an increased ability in ANPs to engage in self-related thinking across a phase-oriented inpatient treatment ( 80 ) and is further supported by the growing body of evidence that relates dissociation to a reduce capacity for self-reference ( 81 – 83 ). The increased functional coupling among occipital areas in the network involved in the execution of cognitive reappraisal suggests as well-that the patients experienced and perceived unpleasant pictures more intensely following treatment while they managed to reduce their emotional responses to these cues.…”

Section: Discussionsupporting

confidence: 86%

“…Thus, a continuation of treatment is required. Previous findings of relationships between alterations in questionnaire data and neural changes across treatment are inconsistent ( 27 , 80 , 87 – 90 ). In the present study, network changes were neither associated with self-reported symptom reduction, nor with improvement in emotion regulation capacities.…”

Section: Discussionmentioning

confidence: 89%

Functional connectivity changes in the delta frequency band following trauma treatment in complex trauma and dissociative disorder patients

Schlumpf

Nijenhuis²,

Klein

et al. 2022

Front. Psychiatry

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ObjectivePhase-oriented trauma treatment is efficacious in the treatment of complex trauma and dissociative disorder patients. However, the neural correlates of this therapeutic effect are not yet well-understood. In the current study we investigated whether patients show a strengthening in functional network connectivity in the delta frequency band (1–3.5 Hz) over the course of phase-oriented inpatient trauma treatment while they performed an emotion regulation task. Further, we examined whether neural changes were associated with symptom reduction and improvement in emotion regulation skills.MethodsBefore and after 8 weeks of treatment, electroencephalography (EEG) was acquired in patients (n = 28) with a complex posttraumatic stress disorder (cPTSD) or complex dissociative disorder (CDD). They also completed clinical and emotion regulation questionnaires. To delimit data variability, patients participated as one dissociative part that is referred to as Apparently Normal Part (ANP). Patients' data were compared to a matched healthy control croup (n = 38), also measured twice.ResultsPrior to treatment, functional connectivity was significantly lower in patients compared to controls during cognitive reappraisal of unpleasant pictures and passive viewing of unpleasant and neutral pictures. These hypoconnected networks largely overlapped with networks typically activated during the recall of (emotional) autobiographical memories. Functional connectivity strength within these networks significantly increased following treatment and was comparable to controls. Patients showed symptom reduction across various clinical domains and improvement in the use of cognitive reappraisal as emotion regulation strategy. Treatment-related network normalizations were not related to changes in questionnaire data.ConclusionPhase-oriented treatment may strengthen connections between regions that are activated during autobiographical recall. These findings encourage further investigation of this circuitry as a therapeutic target in cPTSD and CDD patients.Clinial trial registrationwww.ClinicalTrials.gov, identifier: NCT02459340, https://www.kofam.ch/de/studienportal/suche/149284/studie/26681.

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“…This might provide the field with more insight on the effect of timing of the exposure to the potential traumatic event. We would further like to mention that next to investigations using rs-fMRI the field has recently also studied rs-FC in individuals with PTSD using EEG, which might complement several methodological difficulties associated with rs-fMRI ( Schlumpf et al, 2021 , Heinrich et al, 2014 , Mutschler et al, 2014 ). Future investigation might therefore benefit from using a multimodal approach in studying rs-FC.…”

Section: Discussionmentioning

confidence: 99%

A longitudinal resting-state functional connectivity analysis on trauma exposure and post-traumatic stress symptoms in older individuals

Eising

Maercker

Malagurski

et al. 2022

NeuroImage: Clinical

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Resting‐state functional connectivity in patients with a complex PTSD or complex dissociative disorder before and after inpatient trauma treatment

Abstract: This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

Cited by 7 publications

References 77 publications

Neurobiological and genetic correlates of the dissociative subtype of posttraumatic stress disorder.

Neurobiological and genetic correlates of the dissociative subtype of posttraumatic stress disorder.

Functional connectivity changes in the delta frequency band following trauma treatment in complex trauma and dissociative disorder patients

A longitudinal resting-state functional connectivity analysis on trauma exposure and post-traumatic stress symptoms in older individuals

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