Tonic immobility differentiates stress responses in <scp>PTSD</scp>

Fragkaki, Iro; Stins, John F.; Roelofs, Karin; Jongedijk, Ruud A.; Hagenaars, Muriel A.

doi:10.1002/brb3.546

Cited by 18 publications

(24 citation statements)

References 46 publications

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“…The initiation of a tonic immobile state is mediated by multisensory feedback from proprioceptive, tactile, and sensory nerves, in combination with immense fear, in animals (Fleischmann & Urca, ; Porro & Carli, ; Webster et al, ; for a review, see Kozlowska et al, ). To date, however, there are few reports of experimentally induced tonic immobility in humans (Azevedo et al, ; de Kleine et al, ; Fiszman et al, ; Fragkaki et al, ; for a review, see Volchan et al, ). Nonetheless, subjective reports of trauma experiences that include a condition of restraint often point toward a sensation of paralysis akin to tonic immobility (Abrams et al, ; Fusé et al, ; Gallup, Nash, & Ellison, ; Heidt et al, ; Volchan et al, ).…”

Section: Tonic Immobilitymentioning

confidence: 99%

“…Both dissociation and tonic immobility correlate significantly with PTSD symptom severity—a strong indicator of the dissociative subtype (Bovin, Jager‐Hyman, Gold, Marx, & Sloan, ; Rocha‐Rego et al, ). Although the literature on experimentally induced tonic immobility in humans is limited (Azevedo et al, ; de Kleine, Hagenaars, & Minnen, ; Fiszman et al, ; Fragkaki, Stins, Roelofs, Jongedijk, & Hagenaars, ; Roelofs, Hagenaars, & Stins, ; for a review, see Volchan et al, ), animal models of PTSD exposed to an inescapable threat via physical restraint reliably produce states of tonic immobility (Koolhaas et al, ; Nijenhuis, Spinhoven, Dyck, Hart, & Vanderlinden, ; Webster, Lanthorn, Dewsbury, & Meyer, ). The continuities across the animal kingdom in defensive responding, as well as the extant evidence reviewed here, suggest that humans do engage in passive responses during conditions of inescapable threat (de Kleine et al, ; Fragkaki et al, ; Fusé, Forsyth, Marx, Gallup, & Weaver, ; Galliano, Noble, Travis, & Puechl, ; Heidt, Marx, & Forsyth, ; Kalaf et al, ; Marx, Forsyth, Gallup, Fusé, & Lexington, ; Nijenhuis, Vanderlinden, et al, ; TeBockhorst, O'Halloran, & Nyline, ; Volchan et al, ; for a review, see Hagenaars et al, ; Volchan et al, ).…”

Section: Introductionmentioning

confidence: 99%

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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: Tonic Immobilitymentioning

confidence: 99%

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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show abstract

“…5,16,17 Consistent with this notion, prior TI experiences have been recently linked to increased TI proneness in both healthy controls and individuals with PTSD during stressful stimuli presentation. 18 TI proneness has also been related to prior adverse experience and insecure childhood attachment in samples of healthy female and adolescent participants. 19,20 Here, TI may serve as a defensive response that persists following initial (or repeated) trauma exposure.…”

Section: Introductionmentioning

confidence: 99%

Assessing Post-Traumatic Tonic Immobility Responses: The Scale for Tonic Immobility Occurring Post-Trauma

et al. 2019

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Background: Peri-traumatic tonic immobility has been associated with the development and course of post-traumatic stress disorder. Despite serving as an adaptive late-stage defense response, tonic immobility that continues in response to posttraumatic reminders may lead to reduced functioning and a diminished sense of well-being. At present, no validated selfreport measures assess post-traumatic tonic immobility responses specifically. Methods: The primary objective of the present study was to evaluate the Scale for Tonic immobility Occurring Post-trauma (STOP), the first self-report measure developed to assess for the presence and severity of tonic immobility responses that persist following trauma exposure as part of post-traumatic symptomatology. Trauma-exposed clinical and non-clinical participants (N ¼ 462) with a history of tonic immobility completed a demographic questionnaire, the STOP, and measures of post-traumatic symptoms, dissociation, anxiety, and depression. Results: STOP assessed four latent constructs, which were interpreted following the human defense cascade model. Together, these factors capture the sensorimotor and perceptual alterations, and dissociative experiences, associated with post-traumatic tonic immobility as a trauma-related altered state. Residual symptoms and the experience of negative affect following this response (including guilt and shame) are also represented. STOP scores demonstrated excellent reliability, as well as good construct and convergent validity, with other measures of dissociation and post-traumatic stress disorder. Results from the present study suggest tonic immobility is most consistent with other dissociative post-traumatic symptomatology. Conclusions: STOP demonstrates excellent preliminary psychometric properties and may be useful for researchers and clinicians wishing to assess chronic forms of tonic immobility across trauma-exposed, clinical and community samples.

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“… 91 Cue in CTX-ITI N/A ✓ ✓ ✓ ✓ Grillon et al . 73 Cue in CTX-ITI N/A ✓ ✓ Paradigm: CTX = context conditioning, conditioning paradigm where no other cues signal the onset of the unconditioned stimulus. Cue in CTX = cue in context, paradigm where specific cues signal the onset of the unconditioned stimulus dependent on the context in which they occur.…”

Section: Introductionmentioning

confidence: 99%

Context conditioning in humans using commercially available immersive Virtual Reality

Kroes

Dunsmoor

Mackey

et al. 2017

Sci Rep

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Despite a wealth of knowledge on how humans and nonhuman animals learn to associate meaningful events with cues in the environment, far less is known about how humans learn to associate these events with the environment itself. Progress on understanding spatiotemporal contextual processes in humans has been slow in large measure by the methodological constraint of generating and manipulating immersive spatial environments in well-controlled laboratory settings. Fortunately, immersive Virtual Reality (iVR) technology has improved appreciably and affords a relatively straightforward methodology to investigate the role of context on learning, memory, and emotion while maintaining experimental control. Here, we review context conditioning literature in humans and describe challenges to study contextual learning in humans. We then provide details for a novel context threat (fear) conditioning paradigm in humans using a commercially available VR headset and a cross-platform game engine. This paradigm resulted in the acquisition of subjective threat, threat-conditioned defensive responses, and explicit threat memory. We make the paradigm publicly available and describe obstacles and solutions to optimize future studies of context conditioning using iVR. As computer technology advances to replicate the sensation of realistic environments, there are increasing opportunities to bridge the translational gap between rodent and human research on how context modulates cognition, which may ultimately lead to more optimal treatment strategies for anxiety- and stress-related disorders.

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Tonic immobility differentiates stress responses in PTSD

Cited by 18 publications

References 46 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

Assessing Post-Traumatic Tonic Immobility Responses: The Scale for Tonic Immobility Occurring Post-Trauma

Context conditioning in humans using commercially available immersive Virtual Reality

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