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Examples of a breaking continuous flash suppression trial presentation and the putative generation of attentional bias during emotional under- and overmodulatory states a An example of a breaking continuous flash suppression (b-CFS) trial presentation. During each trial, one of six different faces (Face1–Face6; angry or neutral expressions) was presented within one of four quadrants (position1 to position4) on a frame presented to one eye, while a Mondrian-like mask was simultaneously presented on a frame to the other eye. b Each dyad consisted of one neutral face and one angry face trial with consistent face identity (e.g., Face1) and position (e.g., position1). c For each dyad, the attentional bias score was defined as the difference between the reaction time to the angry face and that to the neutral face. Positive and negative values represent attentional bias toward and away from threat, respectively. We averaged attentional bias scores of all the dyads with positive and negative values separately and defined them as ABTOWARD and ABAWAY. The standard deviations (SDs) of all the attentional bias scores in total (not split by valence) are comparable with attentional bias variability (ABV) measures used in previous studies. The averages of all the attentional bias scores in total are comparable with traditional attentional bias (TAB) measures used in previous studies. Since the biases toward and away from threat are indicative of re-experiencing and avoidance, respectively, we conceptually illustrated the putative generation of attentional bias during emotional under/overmodulatory states. That is, ABTOWARD and ABAWAY are associated with emotional under- and overmodulatory states, respectively.
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Patients with posttraumatic stress disorder (PTSD) appear to manifest two opposing tendencies in their attentional biases and symptoms. However, whether common neural mechanisms account for their opposing attentional biases and symptoms remains unknown. We here propose a model in which reciprocal inhibition between the amygdala and ventromedial pre...
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Introduction:
Non-epileptic psychogenic seizures (PNES) are a common condition but little studied in psychiatry. Our study is the first Moroccan of this topic. Our aim was to describe their clinical presentation, comorbidities and suicidality.
Method:
It was a one-year recruitment study conducted in the Department of Psychiatry at the University...
Objective: The present study aimed to evaluate the prevalence of traumatic experienced seizures (TES) and of postepileptic seizure PTSD (PS-PTSD) in patients with pharmacoresistant focal epilepsy and to explore the determining factors of TES.
Methods: We conducted an observational study enrolling 107 adult refractory epilepsy patients. We used the...
Citations
... Conversely, the PTSD dissociative subtype is characterized by a predominant state of "emotional over modulation" (e.g., depersonalization, derealization) linked to an abnormal increased activation of dACC and the MPFC, together with a concurrent shutdown of subcortical limbic regions (e.g., amygdala). Recently, Chiba and colleagues [48] have provided a partial revision suggesting a reciprocal inhibition between the amygdala and VMPFC that generates dynamic alternations between states of emotional under-and overmodulation. Extending these results [49], it has been proposed a neurobiological model of dissociative-related conditions including the PTSD and its subtypes. ...
... The current work was focused on task-dependent fMRI studies that administered emotional-eliciting stimuli. This was chosen according to well-supported emotional "under-regulation" and "over-modulation" states linked to PTSD manifestations, which are triggered by several emotional and trauma-related stimuli and considered as core features of these conditions [47,48]. ...
... i. Patients with PTSD-NR vs. controls should be mainly characterized by an altered subcortical limbic activity in response to emotional stimuli. This was assumed in A. Scalabrini et al. accordance with existing PTSD neurobiological models [47,48] that have supported dynamic alternations of emotional under-and over-modulations states at the base of PTSD clinical manifestations. This organization of brain responses might also reflect the demonstrated impacts of adverse non-relational events on the development of subcortical limbic networks and its connection with self areas [52]. ...
Different kinds of traumatic experiences like natural catastrophes vs. relational traumatic experiences (e.g., sex/physical abuse, interpersonal partner violence) are involved in the development of the self and PTSD psychopathological manifestations. Looking at a neuroscience approach, it has been proposed a nested hierarchical model of self, which identifies three neural-mental networks: (i) interoceptive; (ii) exteroceptive; (iii) mental. However, it is still unclear how the self and its related brain networks might be affected by non-relational vs relational traumatic experiences. Departing from this background, the current study aims at conducting a meta-analytic review of task-dependent fMRI studies (i.e., emotional processing task) among patients with PTSD due to non-relational (PTSD-NR) and relational (PTSD-R) traumatic experiences using two approaches: (i) a Bayesian network meta-analysis for a region-of-interest-based approach; (ii) a coordinated-based meta-analysis. Our findings suggested that the PTSD-NR mainly recruited areas ascribed to the mental self to process emotional stimuli. Whereas, the PTSD-R mainly activated regions associated with the intero-exteroceptive self. Accordingly, the PTSD-R compared to the PTSD-NR might not reach a higher symbolic capacity to process stimuli with an emotional valence. These results are also clinically relevant in support of the development of differential treatment approaches for non-relational vs. relational PTSD. Molecular Psychiatry; https://doi.
... Future research efforts should therefore incorporate assessments of emotion dysregulation (e.g., Dysregulation of Emotion Regulation Scale; Gratz and Roemer, 2004) alongside affective instability measures as well as other dimensions of affective functioning such as distress tolerance. In doing so, research efforts would better reflect transdiagnostic conceptualizations of emotional dysfunction (Watson et al., 2022), and conceptual models of PTSD that differentiate between affect overmodulation versus undermodulation (Chiba et al., 2021;Lanius et al., 2010). This would also foster the ability to examine whether there are domain-specific associations of affective functioning with increased risk for suicidal ideation, barriers to treatment response, or targets for intervention. ...
Objective: Mild traumatic brain injury (TBI) is associated with long-term consequences, including greater risk for posttraumatic stress disorder (PTSD) and suicidal ideation. Affective instability is also independently related to PTSD and suicidality, which may explain why some individuals continue to experience chronic psychiatric complaints following mild TBI. The purpose of the present study was to evaluate affective instability as a key factor for PTSD and suicidal ideation among Veterans with and without TBI.
Method: Participants (N = 299 Veterans; 86.96% male) completed the Personality Assessment Inventory (PAI) and structured clinical interviews for TBI and psychiatric diagnoses. Hierarchical linear regression was used to evaluate main and interaction effects.
Results: There were no significant differences in affective instability (p = 0.140) or suicidal ideation (p = 0.453) between Veterans with or without TBI. Individuals with TBI were more likely to have a PTSD diagnosis (p = 0.001). Analyses evaluating PTSD diagnosis as an outcome indicated a main effect of affective instability (p < 0.001), but not TBI (p = 0.619). Analyses evaluating suicidal ideation as an outcome demonstrated an interaction effect between PTSD and affective instability beyond the effects of TBI (p = 0.034).
Conclusions: Severe Affective instability appears to be a key factor in suicidal ideation among Veterans beyond TBI or PTSD history. PTSD was more strongly associated with suicidality at lower and moderate levels of affective instability. At severe levels of affective instability, however, Veterans with and without PTSD experienced suicidal ideation at similar rates. Findings suggests that high levels of affective instability not better explained by other psychiatric conditions confers similar suicidality risk to that of PTSD in a Veteran population.
... Generally, most people with PTSD experience both extremes, to some degree. Models have been proposed to explain such vacillations, including alterations in attentional biases, with reciprocal inhibition between the amygdala and vmPFC, which predict behavior and symptoms [224]. The reciprocal inhibition model predicts that when the amygdala is dominant, patients enter an emotional undermodulatory state, in which they show attentional bias toward threat and manifest re-experiencing symptoms. ...
This narrative state-of-the-art review paper describes the progress in the understanding and treatment of Posttraumatic Stress Disorder (PTSD). Over the last four decades, the scientific landscape has matured, with many interdisciplinary contributions to understanding its diagnosis, etiology, and epidemiology. Advances in genetics, neurobiology, stress pathophysiology, and brain imaging have made it apparent that chronic PTSD is a systemic disorder with high allostatic load. The current state of PTSD treatment includes a wide variety of pharmacological and psychotherapeutic approaches, of which many are evidence-based. However, the myriad challenges inherent in the disorder, such as individual and systemic barriers to good treatment outcome, comorbidity, emotional dysregulation, suicidality, dissociation, substance use, and trauma-related guilt and shame, often render treatment response suboptimal. These challenges are discussed as drivers for emerging novel treatment approaches, including early interventions in the Golden Hours, pharmacological and psychotherapeutic interventions, medication augmentation interventions, the use of psychedelics, as well as interventions targeting the brain and nervous system. All of this aims to improve symptom relief and clinical outcomes. Finally, a phase orientation to treatment is recognized as a tool to strategize treatment of the disorder, and position interventions in step with the progression of the pathophysiology. Revisions to guidelines and systems of care will be needed to incorporate innovative treatments as evidence emerges and they become mainstream. This generation is well-positioned to address the devastating and often chronic disabling impact of traumatic stress events through holistic, cutting-edge clinical efforts and interdisciplinary research.
... Subsequently, we compared these DTW-based clusters to the original subscale structure of the IES-R. We hypothesized that the DTW-based clusters would at least include an intrusion and an avoidance cluster, as these symptom groups may represent different states of PTSD (Chiba et al., 2021) and may therefore be less likely to co-vary. ...
Background: After the Great East Japan Earthquake [GEJE], approximately 70,000 Japan Ground Self Defense Force [JGSDF] personnel were deployed, risking Post-Traumatic Stress Disorder [PTSD]. The network approach to psychopathology suggests that symptoms may cause and exacerbate each other, resulting in the emergence and maintenance of disorders, including PTSD. It is therefore important to further explore the temporal interplay between symptoms. Most studies assessing the factor structure of the Impact of Event Scale-Revised [IES-R] have used cross-sectional designs. In this study, the structure of the IES-R was re-evaluated while incorporating the temporal interplay between symptoms.Methods: Using Dynamic Time Warping [DTW] the distances between PTSD symptoms on the IES-R were modelled in 1120 JGSDF personnel. Highly correlated symptoms were clustered at the group level using Distatis three-way principal component analyses of the distance matrices. The resulting clusters were compared to the original three subscales of the IES-R using a Confirmatory Factor Analysis (CFA).Results: The DTW analysis yielded four symptom clusters: Intrusion (five items), Hyperarousal (six items), Avoidance (six items), and Dissociation (five items). CFA yielded better fit estimates for this four-factor solution (RMSEA = 0.084, CFI = 0.918, TLI = 0.906), compared to the original three subscales of the IES-R (RMSEA = 0.103, CFI = 0.873, TLI = 0.858).Conclusions: DTW offers a new method of modelling the temporal relationships between symptoms. It yielded four IES-R symptom clusters, which may facilitate understanding of PTSD as a complex dynamic system.
... Un nouveau modèle cognitif récemment développé pourrait éclairer nos connaissances sur les facteurs impliqués dans les changements fonctionnels qui affectent la mémoire épisodique et autobiographique des personnes atteintes de TSPT. Selon ce modèle, ces changements seraient en partie provoqués par des modifications de connectivité corticale influencées par la symptomatologie du trouble (Chiba et al., 2021). Deux groupes de symptômes pourraient avoir des implications sur la manière dont de nouvelles expériences seraient encodées en mémoire en raison de leur influence sur le traitement émotionnel et attentionnel : l'hypervigilance et la dissociation. ...
... l'état d'alerte) (Bardeen & Orcutt, 2011 ;Krans et al., 2012). La dissociation, quant à elle, définit une suppression des réactions émotionnelles en situation de menace (Chiba et al., 2021) qu'il est possible de rapprocher d'un évitement des stimuli potentiellement menaçants et négatifs (Coll et al., 2022). Dans le cas d'une réponse émotionnelle de type hypervigilance, une augmentation exagérée de l'activité amygdalienne et de l'expression de peur résultante se produirait (Yehuda et al., 2015), ce qui entraînerait une suractivation des réponses perceptives d'ordre émotionnel (e.g. ...
... augmentation du rythme cardiaque, de la pression sanguine : Blanchard et al., 1982). Cette première réponse est désignée sous le terme de sous-modulation émotionnelle, c'est-à-dire un manque de gestion des émotions (Yehuda et al., 2015 ;Chiba et al., 2021) (Figure 1) qui entraînerait des symptômes de ré-expérience, d'hypervigilance et un état émotionnel négatif de peur, de culpabilité, de colère ou de honte chez la personne. Au contraire, dans le cas d'une réponse émotionnelle de type dissociatif, une inhibition de l'activité de l'amygdale se produirait en raison de la plus grande activation des régions corticales qui la contrôlent (i.e. ...
Le Trouble de Stress Post-Traumatique (TSPT) est une pathologie qui se développe chez une personne qui a fait l’expérience d’un événement hautement stressant impliquant une confrontation à la mort ou à une menace de mort, à une blessure grave ou à des violences sexuelles. Ce trouble se caractérise par plusieurs symptômes dont les intrusions, l’évitement et l’hypervigilance. Le TSPT est associé à un déséquilibre entre une mémorisation exacerbée des aspects émotionnels et sensoriels de l’événement traumatique et un défaut de mémorisation des aspects contextuels. En conséquence, le TSPT est aujourd’hui considéré comme un trouble de la mémoire dont les retentissements s’étendent à plusieurs de ses composantes. Cet article expose les conséquences du TSPT sur la mémoire à long terme et met la focale sur deux mécanismes : l’encodage partiel de l’événement traumatique en mémoire épisodique et l’influence de cette expérience traumatique sur les souvenirs personnels en mémoire autobiographique. L’article aborde en première partie les difficultés d’encodage de certains éléments de l’événement traumatique et leurs conséquences, comprenant les reviviscences ainsi que la persistance et la généralisation de la peur à d’autres contextes plus ou moins liés à l’événement traumatique. La deuxième partie aborde la façon dont le trouble affecte la mémoire autobiographique et l’identité en occasionnant une réduction de la précision des événements du passé, des altérations de la capacité à se projeter dans des événements futurs et un encodage incomplet de nouveaux événements.
... In light of the above results, we predicted that hyperacusis would be associated with enhanced sound-evoked responses in the right SMA. This pattern of larger stimulus-evoked activity and smaller gray matter volumes has been reported for instance in war veterans who developed posttraumatic stress disorder (PTSD), showing reduced gray matter volumes in the amygdala (Morey et al., 2012;O'Doherty et al., 2015) along with enhanced amygdala BOLD response to fearful stimuli (Chiba et al., 2021). According to expectations, we found increased BOLD responses to sounds in the right SMA of participants with hyperacusis compared to controls. ...
Hyperacusis is a disorder in loudness perception characterized by increased sensitivity to ordinary environmental sounds and associated with otologic conditions, including hearing loss and tinnitus (the phantom perception of sound) as well as neurologic and neuropsychiatric conditions. Hyperacusis is believed to arise centrally in the brain; however, the underlying causes are unknown. To gain insight into differences in brain morphology associated with hyperacusis, we undertook a retrospective case-control study comparing whole-brain gray matter morphology in participants with sensorineural hearing loss and tinnitus who either scored above or below the threshold for hyperacusis based on a standard questionnaire. We found that participants reporting hyperacusis had smaller gray matter volumes and cortical sheet thicknesses in the right supplementary motor area (SMA), independent of anxiety, depression, tinnitus burden, or sex. In fact, the right SMA volumes extracted from an independently defined volume of interest could accurately classify participants. Finally, in a subset of participants where functional data were also available, we found that individuals with hyperacusis showed increased sound-evoked responses in the right SMA compared to individuals without hyperacusis. Given the role of the SMA in initiating motion, these results suggest that in hyperacusis the SMA is involved in a motor response to sounds.
... Furthermore, provisional considerations suggested that compartmentalization should be viewed as the key mechanism underlying somatoform dissociative symptoms among individuals with CD and SDs. 12 PTSD shows a constellation of dissociative phenomena, including positive dissociative symptoms (e.g., reexperiencing) and negative dissociative symptoms (e.g., emotional numbing). 28,29 Referring to PTSD linked to repeated interpersonal traumatic experiences (PTSD-IT) and DDs (e.g., dissociative identity disorder [DID]), clinical literature posits at the base of these conditions a key role of a "structural dissociation." 30,31 This kind of structural dissociation is sustained by a complex system of dissociative symptoms including negative psychoform dissociative symptoms (e.g., amnesia and numbing), negative somatoform dissociative symptoms (e.g., anesthesia and sensory loss), positive psychoform dissociative symptoms (e.g., traumatic memories and nightmares), and positive somatoform dissociative symptoms (intrusions of sensorimotor aspects of traumatic reexperiences and pain). ...
... 28,55 Consistently, dissociative reactions (e.g., disengagement from the emotional content of the traumatic memory through depersonalization or derealization symptoms) among patients with PTSD has been associated with an abnormal increased activation of dorsal ACC (dACC) and the medial PFC together with a concurrent shutdown of limbic regions (e.g., amygdala). Recently, Chiba and colleagues 29 have been provided a partial revision of the previous model based on a meta-analytic review of neuroimaging and behavioral studies. The authors have suggested a reciprocal inhibition between the amygdala and ventromedial PFC that generates dynamic alternations between states of emotional undermodulation (i.e., hyperarousal, hypervigilance, reexperiencing) and overmodulation (i.e., hypoarousal, avoidance, dissociation) within the same individual affected from a trauma-related condition. ...
... Extending findings of previous reviews and meta-analyses, 28,29,56 the current study aims at quantitatively defining the involvement of the ER brain network in the context of emotion-task functional magnetic resonance imaging (fMRI) among disorders constituting the DS. First, using a well-established ER network of interest (i.e. ...
Aim:
Departing from existing neurobiological models of dissociation, the current study aims at conducting a quantitative meta-analytic review of neural responses to emotional stimuli among individuals ascribed to the dissociative spectrum (DS). Accordingly, the study explored common and specific brain mechanisms across borderline personality disorder, conversion/somatoform disorders, post-traumatic stress disorder [PTSD], PTSD related to repeated interpersonal traumatic experiences, dissociative disorders.
Methods:
The meta-analysis included studies that administered emotional stimuli during fMRI acquisition among individuals included in the DS. There were conducted 2 meta-analytic procedures: i) a Bayesian network meta-analysis for a region-of-interest (ROI)-based approach; ii) robust voxel-based approach.
Results:
Forty-four independent studies were included for a total of 1384 individuals (DS = 741 subjects). The network meta-analysis showed specific patterns of neural activity considering an extended brain network involved in emotion regulation for each condition ascribed to the DS. The voxel-based meta-analysis highlighted an increased activity of dorsal anterior cingulate cortex as a common neurological signature of the DS.
Conclusion:
The common neural feature of the DS captures an implicit appraisals of emotion-eliciting stimuli as threatening and/or noxious for mental and physical integrity of the individual together with painful subjective experiences associated to physiological emotional reactions. Specific brain responses across the DS suggested that the engagement in different mechanisms to address emotional stimuli - implicit avoidance reactions and attempts to over-control of affective states together with a disruption of integrative processes of emotional mind-body features. This article is protected by copyright. All rights reserved.
... In light of the above results, we predicted that hyperacusis would be associated with enhanced sound-evoked responses in the right SMA. This pattern of larger stimulus-evoked activity and smaller gray matter volumes has been reported for instance in war veterans who developed posttraumatic stress disorder (PTSD), showing reduced gray matter volumes in the amygdala (Morey et al., 2012;O'Doherty et al., 2015) along with enhanced amygdala BOLD response to fearful stimuli (Chiba et al., 2021). According to expectations, we found increased BOLD responses to sounds in the right SMA of participants with hyperacusis compared to controls. ...
... The negative weights within the left dlPFC highlight the reciprocal relation between this region and activity in the limbic system (i.e., amygdala and hippocampus). In this context, it is worth noting that there is debate about whether aberrant functional connectivity in PTSD reflects alterations in top-down regulation of the limbic system (e.g., amygdala) via the prefrontal cortex [34][35][36][37][38][39] or altered reciprocal regulation between these regions [108,109]. It is unclear whether the temporal resolution of fMRI (e.g., 1-2 seconds) is suitable for studying these dynamic and directional connections. ...
Assessment of brain function with functional near-infrared spectroscopy (fNIRS) is limited to the outer regions of the cortex. Previously, we demonstrated the feasibility of inferring activity in subcortical "deep brain" regions using cortical fMRI and fNIRS activity in healthy adults. Access to subcortical regions subserving emotion and arousal using affordable and portable fNIRS is likely to be transformative for clinical diagnostic and treatment planning. Here, we validate the feasibility of inferring activity in subcortical regions that are central to the pathophysiology of PTSD (i.e., amygdala and hippocampus) using cortical fMRI and simulated fNIRS activity in a sample of adolescents diagnosed with PTSD (N=20, mean age=15.3, SD=1.9 years) and age-matched healthy controls (N=20, mean age=14.5, SD=2.0 years) as they performed a facial expression task. We tested different prediction models, including linear regression, a multi-layer perceptron neural network, and a k-nearest neighbors model. Inference of subcortical fMRI activity with cortical fMRI showed high prediction performance for the amygdala (r>0.91) and hippocampus (r>0.95) in both groups. Using fNIRS simulated data, relatively high prediction performance for deep brain regions was maintained in healthy controls (r>0.79), as well as in youths with PTSD (r>0.75). The linear regression and neural network models provided the best predictions.
... Post-traumatic stress disorder (PTSD) and generalized anxiety disorder (GAD) may also have over-represented negative expectations in PFC. Notably, there is an inverse relationship between the activity in the amygdala and mPFC during the expression of opposing symptoms (approach and avoidance of threat, respectively) within individual patients (Chiba et al., 2020), suggesting that this reciprocal circuit (Ishikawa et al., 2020;Senn et al., 2014) contributes to opposing over-representations and subsequent mental states. These studies point to causal relationships between psychiatric disorder symptoms and chronic over-representation of particular fundamental decision variables that are tightly regulated by specific neural circuits. ...
The brain is organized into anatomically distinct structures consisting of a variety of projection neurons. While such evolutionarily conserved neural circuit organization underlie the innate ability of animals to swiftly adapt to environments, they can cause biased cognition and behavior. Although recent studies have begun to address the causal importance of projection-neuron types as distinct computational units, it remains unclear how projection types are functionally organized in encoding variables during cognitive tasks. This review focuses on the neural computation of decision making in the prefrontal cortex and discusses what decision variables are encoded by single neurons, neuronal populations, and projection type, alongside how specific projection types constrain decision making. We focus particularly on "over-representations" of distinct decision variables in the prefrontal cortex that reflect the biological and subjective significance of the variables for the decision makers. We suggest that task-specific over-representation in the prefrontal cortex involves the refinement of the given decision making, while generalized over-representation of fundamental decision variables is associated with suboptimal decision biases, including pathological ones such as those in patients with psychiatric disorders. Such over-representations of fundamental decision variables in the prefrontal cortex appear to be tightly constrained by afferent and efferent connections that can be optogenetically intervened on. These ideas may provide critical insights into potential therapeutic targets for psychiatric disorders, including addiction and depression.
