Abstract
Posttraumatic stress disorder (PTSD) is widely associated with deficits in implicit emotion regulation. Recently, adaptive fMRI neurofeedback (A-NF) has been developed as a methodology that offers a unique probe of brain networks that mediate implicit emotion regulation and their impairment in PTSD. We designed an A-NF paradigm in which difficulty of an emotional conflict task (i.e., embedding trauma distractors onto a neutral target stimulus) was controlled by a whole-brain classifier trained to differentiate attention to the trauma distractor vs. target. We exploited this methodology to test whether PTSD was associated with: (1) an altered brain state that differentiates attention towards vs. away from trauma cues; and (2) an altered ability to use concurrent feedback about brain states during an implicit emotion regulation task. Adult women with a current diagnosis of PTSD (n = 10) and healthy control (n = 9) women participated in this task during 3T fMRI. During two initial non-feedback runs used to train a whole-brain classifier, we observed: (1) poorer attention performance in PTSD; and (2) a linear relationship between brain state discrimination and attention performance, which was significantly attenuated among the PTSD group when the task contained trauma cues. During the A-NF phase, the PTSD group demonstrated poorer ability to regulate brain states as per attention instructions, and this poorer ability was related to PTSD symptom severity. Further, PTSD was associated with the heightened encoding of feedback in the insula and hippocampus. These results suggest a novel understanding of whole-brain states and their regulation that underlie emotion regulation deficits in PTSD.
Highlights
A hallmark symptom of posttraumatic stress disorder (PTSD) is hypervigilance towards threats
We focused on addressing four research questions: (1) Is PTSD characterized by poorer large-scale brain state discrimination of attending to threat vs. attending away from the threat? (2) Is PTSD characterized by altered organization of a brain state that discriminates attention to vs. away from threat compared to controls? (3) Does neurofeedback ‘‘correct’’ the ability to engage desired brain states in PTSD? Alternatively, (4) is PTSD characterized generally by a poorer ability to use feedback to regulate brain states? Addressing these research questions would provide novel evidence regarding the large-scale network patterns associated with implicit emotion dysregulation in PTSD and provide novel targets for treatment
During training runs of the attentional bias task, participants with PTSD showed reduced behavioral performance compared to controls, especially during run 2
Summary
A hallmark symptom of posttraumatic stress disorder (PTSD) is hypervigilance towards threats. Prominent neurocircuitry models of PTSD (Rauch et al, 2006; Pitman et al, 2012; Admon et al, 2013) converge on the Adaptive Neurofeedback and PTSD explanation that biased attention towards threat is mediated jointly by the hyperactive amygdala and dorsal anterior cingulate cortex (dACC) and hypoactive medial prefrontal cortex (mPFC) These PTSD neurocircuitry conceptualizations of attentional bias towards threat correspond with more general models of implicit emotion regulation (Etkin et al, 2006, 2015), which differentiate two processes engaged during attentional biases: the detection of a salient cue and a regulatory process by which attention is disengaged from the cue and redirected towards task-relevant stimuli.
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