Restoring large-scale brain networks in PTSD and related disorders: a proposal for neuroscientifically-informed treatment interventions

Abstract

BackgroundThree intrinsic connectivity networks in the brain, namely the central executive, salience, and default mode networks, have been identified as crucial to the understanding of higher cognitive functioning, and the functioning of these networks has been suggested to be impaired in psychopathology, including posttraumatic stress disorder (PTSD).Objective1) To describe three main large-scale networks of the human brain; 2) to discuss the functioning of these neural networks in PTSD and related symptoms; and 3) to offer hypotheses for neuroscientifically-informed interventions based on treating the abnormalities observed in these neural networks in PTSD and related disorders.MethodLiterature relevant to this commentary was reviewed.ResultsIncreasing evidence for altered functioning of the central executive, salience, and default mode networks in PTSD has been demonstrated. We suggest that each network is associated with specific clinical symptoms observed in PTSD, including cognitive dysfunction (central executive network), increased and decreased arousal/interoception (salience network), and an altered sense of self (default mode network). Specific testable neuroscientifically-informed treatments aimed to restore each of these neural networks and related clinical dysfunction are proposed.ConclusionsNeuroscientifically-informed treatment interventions will be essential to future research agendas aimed at targeting specific PTSD and related symptoms.

Mindfulness-based treatments for posttraumatic stress disorder: a review of the treatment literature and neurobiological evidence

“…In addition, greater insular thickness has been noted among meditators, 73 and a course of MBSR was associated with increased insular thickness and reduced alexithymia in meditation-naive individuals. 74 Thus, via restoration of insular functioning, mindfulness-based approaches may be beneficial in improving body awareness and awareness of emotions, abilities that are often compromised in those with PTSD [75][76][77] and are associated with emotional overmodulation. 7,63 Emerging work has also noted neurobiological changes following a course of mindfulness-based exposure therapy (MBET) among individuals with PTSD.…”

“…Reduced DMN functional connectivity is thought to underlie impairments in self-referential processes, autobiographical memory and altered sense of self seen in patients with PTSD. 75,92 By contrast, increased resting-state functional connectivity among nodes of the SN, such as the amygdala and AI, 92,[94][95][96] as well as increased activation in SN regions at rest, including the AI, dACC and amygdala, 61,92 have been reported consistently among individuals with PTSD. Such changes in SN nodes are posited to underlie hyperarousal symptoms in patients with PTSD and overall dominance of the threat sensitivity circuit.…”

Typhoon-Related Post-Traumatic Stress Disorder and Trauma Might Lead to Functional Integration Abnormalities in Intra- and Inter-Resting State Networks: a Resting-State Fmri Independent Component Analysis

“…Currently, few researchers have analyzed brain function of PTSD patients at the brain network level [24,25], mostly by utilizing an experimental paradigm based on emotional or cognitive activation tasks. However, task stimulation may lead to increased activation of the amygdala and symptom provocation of PTSD patients [12].…”

Evaluating web-based cognitive-affective remediation in recent trauma survivors: study rationale and protocol

“…Pertinent to our work, neurocognitive impairments in PTSD might be amenable to ‘top-down’ cognitive remediation that focuses on the therapeutic activation of higher-order systems, such as executive functions, as a way to improve neurocognitive processing in PTSD and restore CEN functioning (Lanius et al, 2015). Neurofeedback, which involves training of blood oxygenation level dependent (BOLD) response in specific brain regions (Cannon et al, 2007) or enhancing EEG activity facilitating cognitive performance (Gruzelier, 2014; Vernon et al, 2003) offers other way of therapeutically targeting cognitive domains neuroplasticity.…”

“…The DMN and CEN were found to be weakly interconnected and hypoactive, hypothetically destabilized by an overactive and hyper-connected SN and a low saliency perception threshold, along with inefficient DMN-CEN modulation (Akiki, Averill, & Abdallah, 2017). Abnormalities within the CEN may underlie some of the cognitive, executive, and emotional regulatory dysfunctions in PTSD (Lanius, Frewen, Tursich, Jetly, & McKinnon, 2015). …”