Increased recruitment of cognitive control in the presence of traumatic stimuli in complex PTSD

Abstract

A neurocircuitry model of post-traumatic stress disorder (PTSD) suggests increased amygdala responses to emotional stimuli, coupled with hypoactivation of prefrontal regions associated with cognitive control. However, results are heterogenous across different subsamples of PTSD as well as different paradigms. We investigated cognitive control in a classic and emotional Stroop task in 28 female patients with complex PTSD (cPTSD), 28 female trauma-exposed healthy controls (TCs) and 28 female non-trauma-exposed healthy controls (HCs) using functional neuroimaging. Afterwards, we assessed memory function in a spontaneous free recall and recognition task. Patients with cPTSD displayed significantly greater Stroop interference with trauma-related words (as reflected in slower reaction times and increased errors) compared to the other conditions and compared to the TC and HC groups. Moreover, patients with cPTSD showed increased activation in the context of trauma-related words in brain regions associated with cognitive control (dlPFC, vmPFC, dACC) compared to both control groups, and a trend for increased activation in the insula compared to the HC group. Increased recruitment of regions contributing to cognitive control in patients with cPTSD, together with a lack of amygdala response may point to efforts to compensate for emotional distraction caused by the trauma-related words.

Emotional Memory in Post-traumatic Stress Disorder: A Systematic PRISMA Review of Controlled Studies

“…Finally, Moradi et al (2000) observed that their PTSD group recalled an equal amount of negative words compared to HC, but fewer positive and neutral words. On the contrary, two studies did not report any differences: more emotional words (trauma-related or threat-related words) were remembered across all groups (Zoellner et al, 2003; Herzog et al, 2017).…”

“…Among studies involving tasks with word stimuli: two studies used recognition words after an emotional Stroop task (Vrana et al, 1995; Herzog et al, 2017); two studies used word-pair tasks (Bremner et al, 2003; Golier et al, 2003); four studies used a verbal declarative memory task with free recall and/or recognition (Chemtob et al, 1999; Moradi et al, 2000; Tapia et al, 2012; Thomaes et al, 2013); two others used an item-cued directed forgetting task (McNally et al, 1998; Zoellner et al, 2003), one study used cued recall (Zeitlin and McNally, 1991) and two studies used word stem completion (Zeitlin and McNally, 1991; Golier et al, 2003).…”

“…Sixteen studies included only adult PTSD patients, and two studies included only adolescent and/or child PTSD patients (Moradi et al, 2000; Guillery-Girard et al, 2013). Eleven studies involved patients with one or two specific types of traumatic event (Zeitlin and McNally, 1991; Vrana et al, 1995; McNally et al, 1998; Chemtob et al, 1999; Moradi et al, 2000; Bremner et al, 2003; Golier et al, 2003; Zoellner et al, 2003; Baumann et al, 2013; Thomaes et al, 2013; Herzog et al, 2017), six studies involved patients with different traumatic events (Whalley et al, 2009; Brohawn et al, 2010; Mickley Steinmetz et al, 2012; Tapia et al, 2012; Nicholson et al, 2014; Patel et al, 2016), and one study did not specify (Guillery-Girard et al, 2013).…”

Adverse Childhood Experiences and the Consequences on Neurobiological, Psychosocial, and Somatic Conditions Across the Lifespan

“…Moreover, preliminary results suggest that hyperactivation of the amygdala may predict the likelihood of future symptomatology ( 67 , 73 , 74 ). In contrast, several studies reported no differences or even reduced amygdala activity in individuals with ACE compared to control groups when exposed to negative/trauma-related stimuli ( 75 – 77 ). This pattern of hypo-activity to threat-related cues has repeatedly been found in patients with PTSD and severe dissociative symptomatology, pointing toward a specific dissociative subtype in PTSD [for further details please see for example: ( 78 )].…”

“…The anterior insula is associated with the detection of salient stimuli and is assumed to be important for effective modulation of attention in the presence of emotional stimuli ( 79 ). Like the amygdala, hyperactivity in the anterior insula to trauma-related stimuli has been found in several mental disorders, such as in social anxiety, specific phobia ( 72 ) and PTSD ( 75 ). Additionally, a recent meta-analysis of 20 studies of emotion processing in maltreatment individuals, revealed that ACE was (next to hyperactivation in the amygdala and insula), associated with hyperactivation in the superior temporal gyrus, and the parahippocampal gyrus ( 70 ).…”