Executive function and PTSD: Disengaging from trauma

Department of Psychiatry, University of California, San Diego (UCSD), 8939 Villa La Jolla Dr., Suite 200, La Jolla, CA 92037, USA.
Neuropharmacology (Impact Factor: 5.11). 02/2011; 62(2):686-94. DOI: 10.1016/j.neuropharm.2011.02.008
Source: PubMed


Neuropsychological approaches represent an important avenue for identifying susceptibility and resiliency factors relating to the development and maintenance of posttraumatic stress disorder (PTSD) symptoms post-trauma. This review will summarize results from prospective longitudinal and retrospective cross-sectional studies investigating executive function associated with PTSD. This research points specifically towards subtle impairments in response inhibition and attention regulation that may predate trauma exposure, serve as risk factors for the development of PTSD, and relate to the severity of symptoms. These impairments may be exacerbated within emotional or trauma-related contexts, and may relate to dysfunction within dorsal prefrontal networks. A model is presented concerning how such impairments may contribute to the clinical profile of PTSD and lead to the use of alternative coping styles such as avoidance. Further neuropsychological research is needed to identify the effects of treatment on cognitive function and to potentially characterize mechanisms of current PTSD treatments. Knowledge gained from cognitive and neuroscientific research may prove valuable for informing the future development of novel, more effective, treatments for PTSD. This article is part of a Special Issue entitled 'Post-Traumatic Stress Disorder'.

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Available from: Robin L Aupperle, Sep 02, 2014
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    • "Proposals on the taxonomy of inhibitionrelated processes typically distinguish between response inhibition, which involves control of an automatic or dominant motor response, and interference control or resistance to distractor interference, which involve the ability to resolve conflicting information [e.g., Nigg, 2000; Friedman and Miyake, 2004]. In regards to PTSD, impaired inhibitory processes have been identified as both a potential vulnerability for the development of the disorder and implicated in the maintenance of posttraumatic stress reactions over time [Aupperle et al., 2012; Jovanovic and Ressler, 2010; Verwoerd et al., 2009]. For example, diminished control of cognitive, emotional, and behavioral reactions to traumarelated stimuli have been linked to reexperiencing symptoms (e.g., failure to suppress intrusive trauma-related memories) [Verwoerd et al., 2009] and hyperarousal symptoms (e.g., failure to suppress fear responses in the presence of safety cues) [Jovanovic and Ressler, 2010]. "
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    ABSTRACT: Deficits in impulse control are increasingly recognized in association with posttraumatic stress disorder (PTSD). To our further understanding of the neurobiology of PTSD-related disinhibition, we examined alterations in brain morphology and network connectivity associated with response inhibition failures and PTSD severity. The sample consisted of 189 trauma-exposed Operation Enduring Freedom/Operation Iraqi Freedom veterans (89% male, ages 19-62) presenting with a range of current PTSD severity. Disinhibition was measured using commission errors on a Go/No-Go (GNG) task with emotional stimuli, and PTSD was assessed using a measure of current symptom severity. Whole-brain vertex-wise analyses of cortical thickness revealed two clusters associated with PTSD-related disinhibition (Monte Carlo cluster corrected P < 0.05). The first cluster included portions of right inferior and middle frontal gyri and frontal pole. The second cluster spanned portions of left medial orbital frontal, rostral anterior cingulate, and superior frontal gyrus. In both clusters, commission errors were associated with reduced cortical thickness at higher (but not lower) levels of PTSD symptoms. Resting-state functional magnetic resonance imaging analyses revealed alterations in the functional connectivity of the right frontal cluster. Together, study findings suggest that reductions in cortical thickness in regions involved in flexible decision-making, emotion regulation, and response inhibition contribute to impulse control deficits in PTSD. Furthermore, aberrant coupling between frontal regions and networks involved in selective attention, memory/learning, and response preparation suggest disruptions in functional connectivity may also play a role. Hum Brain Mapp, 2015. © 2015 Wiley Periodicals, Inc. © 2015 Wiley Periodicals, Inc.
    Human Brain Mapping 05/2015; 36(8). DOI:10.1002/hbm.22829 · 5.97 Impact Factor
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    • "Successful treatment was associated with improving selective attention and normalization of the arousal level, indicating greater inhibition control over PTSD symptoms [15]. It is possible that " interference control " [16] partially inhibits intrusive recollection of trauma episodes [17]. The Stroop Color–Word Test (Stroop, 1935) is the most popular task for detection of interference control impairments [18]. "
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    ABSTRACT: Background Intrusive cognitions that enter consciousness involuntarily are prominent symptoms of Posttraumatic Stress Disorder (PTSD). The present study aimed to identify neuropsychological mechanisms involved. Method 50 PTSD outpatients and 50 healthy controls were tested using Finger Tapping, Simple and Choice Reaction Times and Stroop Tasks, to measure motor, psychomotor speed, response selection, and interference inhibition ability respectively. Results PTSD patients performed poorly in all tests, presumably owing to their generalized slowness of information processing and motor reaction. Psychomotor speed was a predictor of slowness and high error rate during the Stroop. Impaired inhibition, as measured by the interference index of the Stroop task, explained 9.7% of the predicated variance in frequency of re-experiencing PTSD symptoms and 23.5% of the predicated variance in augmentation of the interference response time. Conclusion Impaired interference control may be related to internal (re-experiencing) and external (sensory) stimuli that leads to cognitive deficits in PTSD patients.
    Comprehensive Psychiatry 10/2014; 55(7). DOI:10.1016/j.comppsych.2014.05.004 · 2.25 Impact Factor
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    • "In light of these findings, researchers have begun to investigate whether PTSD may be best characterized by deficits in specific cognitive control functions, rather than widespread cognitive impairment (Leskin and White, 2007; Aupperle et al., 2012). Relative to other aspects of cognitive control, deficits in inhibitory control have been most consistently observed among individuals with PTSD (Aupperle et al., 2012). For example, Leskin and White (2007) found that while college undergraduates with PTSD were less able to inhibit their attention to irrelevant distractors relative to trauma-exposed controls, the groups performed similarly on tasks assessing attentional set-shifting, alerting, and orienting. "
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    ABSTRACT: Post-traumatic stress disorder (PTSD) is characterized by deficits in cognitive functioning, particularly cognitive control. Moreover, these deficits are thought to play a critical role in the etiology and maintenance of core PTSD symptoms such as intrusive thoughts and memories. However, the psychophysiological concomitants of cognitive control remain largely unexamined. In this article, we suggest that individual differences in heart rate variability (HRV), a physiological index of self-regulatory capacity, may underlie the association between cognitive control ability and intrusive cognitions in PTSD. We review evidence showing that individual differences in HRV at rest are related to prefrontal cortical activity and performance on a broad range of cognitive control tasks. We highlight the importance of inhibition as a mechanism by which HRV promotes successful cognitive control. In addition, we summarize recent research linking individual differences in HRV to performance on laboratory tasks that assess the ability to control unwanted memories and intrusive thoughts. We conclude by suggesting that future studies should examine the role of low HRV as a risk factor for developing PTSD.
    Frontiers in Psychology 07/2014; 5:758. DOI:10.3389/fpsyg.2014.00758 · 2.80 Impact Factor
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