Neural correlates of reexperiencing, avoidance, and dissociation in PTSD: Symptom dimensions and emotion dysregulation in responses to script-driven trauma imagery

Authors

  • James W. Hopper,

    Corresponding author
    1. Behavioral Psychopharmacology Research Laboratory, Department of Psychiatry, Harvard Medical School and McLean Hospital, Belmont, MA, and Department of Psychiatry, School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
    • Behavioral Psychopharmacology Research Laboratory, Department of Psychiatry, Harvard Medical School and McLean Hospital, 115 Mill Street, Belmont, MA 02478.
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  • Paul A. Frewen,

    1. Department of Psychology, University of Western Ontario, London, Ontario, Canada
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  • Bessel A. van der Kolk,

    1. Department of Psychiatry, Boston University School of Medicine and The Trauma Center, Brookline, MA
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  • Ruth A. Lanius

    1. Department of Psychiatry, School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
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Abstract

Research suggests that responses to script-driven trauma imagery in posttraumatic stress disorder (PTSD) include reexperiencing and dissociative symptom subtypes. This functional magnetic resonance imaging (fMRI) study employed a dimensional approach to characterizing script-driven imagery responses, using the Responses to Script-Driven Imagery Scale and correlational analyses of relationships between severity of state posttraumatic symptoms and neural activation. As predicted, state reexperiencing severity was associated positively with right anterior insula activity and negatively with right rostral anterior cingulate cortex (rACC). Avoidance correlated negatively with rACC and subcallosal anterior cingulate activity. In addition, as predicted, dissociation correlated positively with activity in the left medial prefrontal and right superior temporal cortices, and negatively with the left superior temporal cortex. Theoretical and clinical implications are discussed, particularly with respect to an emotion-dysregulation account of PTSD.

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