PTSD, Neuroimaging and Psychotherapy: A Fruitful Encounter

Abstract

Most of us have dealt with a traumatic event of some kind such as loss, accident, or illness, or will be dealing with one at some point in our lives. Psychological trauma is closely related to the development of posttraumatic stress disorder (PTSD), involving three sets of symptoms: (i) reliving trauma (traumatic memories, nightmares, intrusive thoughts); (ii) emotional avoidance/numbness (affective distance, emotional anaesthesia); and (iii) increased arousal (irritability, insomnia and hypervigilance) (American Psychiatric Association, 1994). Lifetime prevalence of PTSD-triggering traumatic events may be as much as 50–90%, and actual prevalence in the general population is about 8% (Kessler et al., 1995; Vieweg et al., 2006), while partial PTSD (pPTSD) in an at-risk groups have been estimated at approximately 30% (Weiss et al., 1992). After noting that individuals who do not meet the full set of diagnostic criteria for PTSD may suffer from clinically significant symptoms of PTSD (Weiss et al., 1992), the concept of pPTSD or subthreshold PTSD was introduced to describe subsyndromal forms of PTSD (Blanchard et al., 1995; Stein et al. 1997). Thus, exposure to traumatic stressors and psychological trauma is widespread, with a wide range of cognitive and behavioral responses/outcomes among trauma survivors (Peres et al., 2009; 2011). One of the main psychological sequelae of traumatic experiences is conditioning of specific fears. In addition to PTSD, traumatic events can significantly influence major depression, somatoform disorders, panic and anxiety disorders, obsessive-compulsive disorders, phobic disorders, and substance abuse (Peres et al., 2009). Although traumatic events are associated with PTSD in the literature, traumatized people do not meet DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, 4th Edition) criteria for PTSD in many cases and often present a range of psychoform or somatoform symptoms. Considerable overlap in symptoms and disease comorbidity has been noted for medically unexplained symptoms in the primary care setting, such as chronic fatigue syndrome, low back pain, irritable bowel syndrome, primary headaches, fibromyalgia, temporomandibular joint disorder, major depression, panic attacks, and PTSD (Peres et al., 2009). Epidemiologic surveys increasingly point to a relation between exposure to traumatic events and more health care utilization, adverse health outcomes, onset of specific diseases, and premature death (Corrigan et al., 2005; Keane et al., 2006). Certain characteristics of traumas, particularly peritraumatic cognitive response and related cognitions, appear to heighten the risk for PTSD (Peres et al.,