Post‐traumatic stress disorder: evolving conceptualization and evidence, and future research directions

World Psychiatry, Journal Year: 2025, Volume and Issue: 24(1), P. 52 - 80

Published: Jan. 15, 2025

The understanding of responses to traumatic events has been greatly influenced by the introduction diagnosis post‐traumatic stress disorder (PTSD). In this paper we review initial versions diagnostic criteria for condition and associated epidemiological findings, including sociocultural differences. We consider evidence reactions occurring in multiple contexts not previously defined as traumatic, implications that these observations have diagnosis. More recent developments such DSM‐5 dissociative subtype ICD‐11 complex PTSD are reviewed, adding there several distinct phenotypes. describe psychological foundations PTSD, involving disturbances memory well identity. A broader focus on identity may be able accommodate group communal influences experience trauma impact resource loss. then summarize current concerning biological with a particular genetic neuroimaging studies. Whereas progress prevention disappointing, is now an extensive supporting efficacy variety treatments established trauma‐focused interventions – cognitive behavior therapy (TF‐CBT) eye movement desensitization reprocessing (EMDR) non‐trauma‐focused therapies, which also include some emerging identity‐based approaches present‐centered compassion‐focused therapies. Additionally, promising neither nor pharmacological, or combine pharmacological approach, 3,4‐methylenedioxymethamphetamine (MDMA)‐assisted psychotherapy. advances priority areas adapting resource‐limited settings across cultural contexts, community‐based approaches. conclude identifying future directions work mental health.

Language: Английский

---

The brain-body disconnect: A somatic sensory basis for trauma-related disorders

Frontiers in Neuroscience, Journal Year: 2022, Volume and Issue: 16

Published: Nov. 21, 2022

Although the manifestation of trauma in body is a phenomenon well-endorsed by clinicians and traumatized individuals, neurobiological underpinnings this remain unclear. The notion somatic sensory processing, which encompasses vestibular somatosensory processing relates to systems concerned with how physical exists space, introduced as major contributor overall regulatory, social-emotional, self-referential functioning. From phylogenetically ontogenetically informed perspective, trauma-related symptomology conceptualized be grounded brainstem-level dysfunction its cascading influences on physiological arousal modulation, affect regulation, higher-order capacities. Lastly, we introduce novel hierarchical model bridging processes limbic neocortical mechanisms regulating an individual’s emotional experience sense relational, agentive self. This provides working framework for neurobiologically assessment treatment conditions from perspective.

Language: Английский

---

The memory and identity theory of ICD-11 complex posttraumatic stress disorder.

Psychological Review, Journal Year: 2023, Volume and Issue: 130(4), P. 1044 - 1065

Published: June 20, 2023

The 11th version of the International Classification Diseases (ICD-11) includes complex posttraumatic stress disorder (CPTSD) as a separate diagnostic entity alongside (PTSD).ICD-11 CPTSD is defined by six sets symptoms, three that are shared with PTSD (reexperiencing in here and now, avoidance, sense current threat) (affective dysregulation, negative selfconcept, disturbances relationships) representing pervasive "disturbances self-organization" (DSO).There considerable evidence supporting construct validity ICD-11 CPTSD, but no theoretical account its development has thus far been presented.A theory needed to explain several phenomena especially relevant such role played prolonged repeated trauma exposure, functional independence between DSO heterogeneity following exposure.The memory identity states single multiple exposure occur context individual vulnerability which interact give rise intrusive, sensation-based traumatic memories identities which, together, produce symptoms define CPTSD.The model emphasizes two major related causal processes intrusive exist on continuum from prereflective experience full self-awareness.Theoretically derived implications for assessment treatment discussed, well areas future research testing.

Language: Английский

---

Homeostatic normalization of alpha brain rhythms within the default-mode network and reduced symptoms in PTSD following a randomized controlled trial of EEG neurofeedback

Brain Communications, Journal Year: 2023, Volume and Issue: 5(2)

Published: March 2, 2023

Collective research has identified a key electroencephalogram signature in patients with post-traumatic stress disorder, consisting of abnormally reduced alpha (8-12 Hz) rhythms. We conducted 20-session, double-blind, randomized controlled trial desynchronizing neurofeedback disorder over 20 weeks. Our objective was to provide mechanistic evidence underlying potential clinical improvements by examining changes aberrant brain rhythms (namely, oscillations) as function treatment. randomly assigned participants primary diagnosis (n = 38) either an experimental group 20) or sham-control 18). A multichannel cap used record whole-scalp resting-state activity pre- and post-neurofeedback treatment, for both the groups. first observed significantly relative source power at baseline compared age/sex-matched neurotypical healthy controls 32), primarily within regions anterior default mode network. Post-treatment, we found that only demonstrated significant resynchronization areas displayed low baseline. In parallel, decreased severity scores only, when comparing post-treatment (Cohen's d 0.77) three-month follow-up 0.75), remission rate 60.0% follow-up. Overall, our results indicate training can rescue pathologically rhythmicity, functional biomarker repeatedly been linked symptoms hyperarousal cortical disinhibition disorder. This provides long-term suggesting 'alpha rebound effect' (i.e. homeostatic resynchronization) occurs network previously implicated

Language: Английский

---

Restoring bottom-up communication in brain-heart interplay after trauma-focused psychotherapy in breast cancer patients with post-traumatic stress disorder

Journal of Affective Disorders, Journal Year: 2024, Volume and Issue: 351, P. 143 - 150

Published: Jan. 27, 2024

The psychological impact of breast cancer (BC) is substantial, with a significant number patients (up to 32 %) experiencing post-traumatic stress disorder (PTSD). Exploring the emotional aspects PTSD through functional brain-heart interplay (BHI) offers valuable insights into condition. BHI examines interactions between cortical and sympathovagal dynamics. This study aims investigate changes in directional after trauma-focused (TF) psychotherapy, specifically Eye Movement Desensitization Reprocessing (EMDR), comparison treatment as usual (TAU) among BC PTSD. To our knowledge, this represents first examination such changes.

Language: Английский

---

What Predicts Beneficial Outcomes in Psychedelic Use? A Quantitative Content Analysis of Psychedelic Health Outcomes

Journal of Psychoactive Drugs, Journal Year: 2024, Volume and Issue: unknown, P. 1 - 10

Published: Feb. 10, 2024

Interest in psychedelics and their possible therapeutic potential has been growing. Metaphysical belief theory asserts that these benefits stem from the adoption of comforting supernatural beliefs following a mystical experience. By contrast, predictive self-binding suggests beneficial outcomes are primarily driven by psychological insights. The present study tests competing models psychedelic benefits. We conducted quantitative content analysis on unsolicited self-reports users available Erowid.org, to examine relations between insight, ego dissolution, intent, altered metaphysical belief, enduring health outcomes. randomly selected, coded, analyzed two hundred forty experience reports website. Path using structural equation modeling showed not beliefs, uniquely predicted Moreover, outcomes' positive relation dissolution intent was fully mediated insight. These findings support model over model.

Language: Английский

---

A randomized, controlled trial of alpha-rhythm EEG neurofeedback in posttraumatic stress disorder: A preliminary investigation showing evidence of decreased PTSD symptoms and restored default mode and salience network connectivity using fMRI

NeuroImage Clinical, Journal Year: 2020, Volume and Issue: 28, P. 102490 - 102490

Published: Jan. 1, 2020

The default-mode network (DMN) and salience (SN) have been shown to display altered connectivity in posttraumatic stress disorder (PTSD). Restoring aberrant within these networks with electroencephalogram neurofeedback (EEG-NFB) has previously be associated acute decreases symptoms. Here, we conducted a double-blind, sham-controlled randomized trial of alpha-rhythm EEG-NFB participants PTSD (n = 36) over 20-weeks. Our aim was provide mechanistic evidence underlying clinical improvements by examining changes via fMRI. Methods: We randomly assigned primary diagnosis either the experimental group 18) or sham-control 18). collected resting-state fMRI scans pre- post-NFB intervention, for both groups. further compared baseline brain measures pre-NFB age-matched healthy controls 36). Results: With regard outcome measure severity, found significant main effect time absence × interaction. Nevertheless, significantly decreased severity scores NFB only, when comparing (dz 0.71) 3-month follow-up 0.77) measures. Interestingly, suggest shift towards normalization DMN SN only. Both performance were correlated group. Critically, remission rates higher (61.1%) as (33.3%). Conclusion: current study shows therapeutic that are known psychopathology no patient dropouts. This preliminary investigation merits research demonstrate fully efficacy an adjunctive therapy PTSD.

Language: Английский

---

A systematic review of the neural correlates of sexual minority stress: towards an intersectional minority mosaic framework with implications for a future research agenda

European journal of psychotraumatology, Journal Year: 2022, Volume and Issue: 13(1)

Published: Feb. 28, 2022

Systemic oppression, particularly towards sexual minorities, continues to be deeply rooted in the bedrock of many societies globally. Experiences with minority stressors (e.g. discrimination, hate-crimes, internalized homonegativity, rejection sensitivity, and microaggressions or everyday indignities) have been consistently linked adverse mental health outcomes. Elucidating neural adaptations associated stress exposure will critical for furthering our understanding how minorities become disproportionately affected by burdens.

Language: Английский

---

Posterior cingulate cortex targeted real‐time fMRI neurofeedback recalibrates functional connectivity with the amygdala, posterior insula, and default‐mode network in PTSD

Brain and Behavior, Journal Year: 2023, Volume and Issue: 13(3)

Published: Feb. 15, 2023

Abstract Background Alterations within large‐scale brain networks—namely, the default mode (DMN) and salience networks (SN)—are present among individuals with posttraumatic stress disorder (PTSD). Previous real‐time functional magnetic resonance imaging (fMRI) electroencephalography neurofeedback studies suggest that regulating posterior cingulate cortex (PCC; primary hub of DMN) activity may reduce PTSD symptoms recalibrate altered network dynamics. However, PCC connectivity to DMN SN during PCC‐targeted fMRI remains unexamined help elucidate neurophysiological mechanisms through which these symptom improvements occur. Methods Using a trauma/emotion provocation paradigm, we investigated psychophysiological interactions over single session ( n = 14) healthy control 15) participants. We compared between regulate (in participants downregulated activity) view did not exert regulatory control) conditions across whole‐brain as well in priori specified regions‐of‐interest. Results During conditions, only group showed significant anterior (dmPFC, vmPFC) (posterior insula) regions, whereas both groups displayed other areas (precuneus/cuneus). Additionally, controls, significantly greater (amygdala) conditions. Moreover, linear regression analyses revealed regions was positively correlated psychiatric all Conclusion In summary, observations provide emerging evidence neural underlying PTSD. This supports use means by PTSD‐associated alterations SN, together, facilitate improved emotion regulation abilities

Language: Английский

---

How the body remembers: Examining the default mode and sensorimotor networks during moral injury autobiographical memory retrieval in PTSD

NeuroImage Clinical, Journal Year: 2023, Volume and Issue: 38, P. 103426 - 103426

Published: Jan. 1, 2023

Neural representations of sensory percepts and motor responses constitute key elements autobiographical memory. However, these may remain as unintegrated fragments in traumatic memory, thus contributing toward re-experiencing reliving symptoms trauma-related conditions such post-traumatic stress disorder (PTSD). Here, we investigated the sensorimotor network (SMN) posterior default mode (pDMN) using a group independent component analysis (ICA) by examining their functional connectivity during script-driven memory retrieval paradigm (potentially) morally injurious events individuals with PTSD healthy controls. Moral injury (MI), where an individual acts or fails to act aligned manner, is examined given its inherent ties disrupted planning mechanisms. Our findings revealed significant differences across SMN pDMN MI participants (n = 65) compared controls 25). No group-wise emerged neutral PTSD-related alterations included hyperconnectivity between pDMN, enhanced within-network premotor areas, increased recruitment supramarginal gyrus into both retrieval. In parallel neuroimaging findings, positive correlation was found severity subjective intensity ratings after These results suggest neural basis for re-experiencing, and/or re-enacting past event form occurs place retrieving complete, past-contextualized narrative put forth Brewin colleagues (1996) Conway Pleydell-Pearce (2000). have implications bottom-up treatments targeting directly motoric experiences.

Language: Английский

---