Ruth Lanius

Western University · Department of Psychiatry

Introduction Les thérapeutes respiratoires ont été confrontés à des situations moralement difficiles tout au long de la pandémie de COVID-19, en particulier le fait d’avoir peu de ressources pour effectuer leur travail ou encore la participation à des appels vidéo avec les familles de patients mourants. La détresse morale est associée à une foule d...

Introduction Respiratory therapists (RTs) faced morally distressing situations throughout the COVID-19 pandemic, including working with limited resources and facilitating video calls for families of dying patients. Moral distress is associated with a host of adverse psychological and functional outcomes (e.g. depression, anxiety, symptoms of posttr...

Direct eye contact is essential to understanding others’ thoughts and feelings in social interactions. However, those with post-traumatic stress disorder (PTSD) and exposure to moral injury (MI) may exhibit altered theory-of-mind (ToM)/mentalizing processes and experience shame which precludes one’s capacity for direct eye contact. We investigated...

Healthcare providers (HCPs) have described the onset of shame- and trust-violation-related moral injuries (MI) throughout the COVID-19 pandemic. Previous research suggests that HCPs may turn to various coping methods and supports, such as spirituality/religiosity, substance use, friends/family or organizational support, to manage workplace stress....

The dissociative subtype of post-traumatic stress disorder (PTSD) is a distinct PTSD phenotype characterized by trauma-related dissociation, alongside unique patterns of functional connectivity. However, disparate findings across multiple scales of investigation have highlighted the need for a cohesive understanding of dissociative neurobiology. We...

Background: Advanced neuroscientific insights surrounding post-traumatic stress disorder (PTSD) and its associated symptomatology should beget psychotherapeutic treatments that integrate these insights into practice. Deep Brain Reorienting (DBR) is a neuroscientifically-guided psychotherapeutic intervention that targets the brainstem-level neuroph...

Neural representations of sensory percepts and motor responses constitute key elements of autobiographical memory. However, these representations may remain as unintegrated sensory and motor fragments in traumatic memory, thus contributing toward re-experiencing and reliving symptoms in trauma-related conditions such as post-traumatic stress disord...

Collective research has identified a key electroencephalogram (EEG) signature in patients with posttraumatic stress disorder (PTSD), consisting of abnormally reduced alpha (8-12 Hz) rhythms. We conducted a 20-session, double-blind, randomized controlled trial of alpha-desynchronizing neurofeedback in patients with PTSD over 20-weeks. Our objective...

Background: Healthcare providers (HCPs) may be at elevated risk for moral injury due to increased exposure to potentially morally injurious events (PMIEs) throughout the COVID-19 pandemic. Identifying PMIEs experienced during the COVID-19 pandemic is a critical first step for understanding moral injury in HCPs. Accordingly, the purpose of the pres...

Introduction: Healthcare professionals (HCPs) appear to be at increased risk for negative psychological outcomes [e.g. depression, anxiety, post-traumatic stress disorder (PTSD), moral distress] and associated impacts on functioning throughout the COVID-19 pandemic. HCPs working on designated COVID-19 units may be further impacted than their collea...

Background: Alterations within large-scale brain networks-namely, the default mode (DMN) and salience networks (SN)-are present among individuals with posttraumatic stress disorder (PTSD). Previous real-time functional magnetic resonance imaging (fMRI) and electroencephalography neurofeedback studies suggest that regulating posterior cingulate cor...

Throughout the COVID-19 pandemic, healthcare workers (HCWs) have been exposed to highly stressful situations, including increased workloads and exposure to mortality, thus posing a risk for adverse psychological outcomes, including acute stress, moral injury, and depression or anxiety symptoms. Although several reports have sought to identify the t...

Background: Systemic oppression, particularly towards sexual minorities, continues to be deeply rooted in the bedrock of many societies globally. Experiences with minority stressors (e.g. discrimination, hate-crimes, internalized homonegativity, rejection sensitivity, and microaggressions or everyday indignities) have been consistently linked to a...

Although the manifestation of trauma in the body is a phenomenon well-endorsed by clinicians and traumatized individuals, the neurobiological underpinnings of this manifestation remain unclear. The notion of somatic sensory processing, which encompasses vestibular and somatosensory processing and relates to the sensory systems concerned with how th...

Background: In 2012, a dissociative subtype of post-traumatic stress disorder (PTSD) was introduced into the DSM based on emerging clinical and neurobiological evidence of a distinct PTSD phenotype characterized by trauma-related dissociation. Ten years later, considerable research has demonstrated unique small-scale (i.e., node-based) and large-sc...

Objective: To explore care aide perceptions of caring for residents who aides perceived had past psychological trauma. Methods: Through cognitive interviews, we developed a definition of trauma for four survey questions about caring for residents with psychological trauma. We added these questions to our routine care aide survey in 91 care homes...

The flocculus is a region of the vestibulocerebellum dedicated to the coordination of neck, head, and eye movements for optimal posture, balance, and orienting responses. Despite growing evidence of vestibular and oculomotor impairments in the aftermath of traumatic stress, little is known about the effects of chronic psychological trauma on vestib...

Even seasoned clinicians can feel deskilled when trying to help to highly traumatized and dissociative patients. Together, this book and its accompanying workbook for patients (The Finding Solid Ground Program Workbook: Overcoming Obstacles in Trauma Recovery) provide an evidence-informed, pragmatic, and compassionate approach to the stabilization...

Challenges involving boundary management, the therapeutic frame, and interpersonal patterns repeatedly emerge in trauma treatment. These issues emerge out of the lessons that patients learned via abusive relationships about control and others’ unreliability and abusiveness. This chapter discusses methods for recognizing and resolving trauma-based i...

Microstates offer a promising framework to study fast-scale brain dynamics in the resting-state electroencephalogram (EEG). However, microstate dynamics have yet to be investigated in post-traumatic stress disorder (PTSD), despite research demonstrating resting-state alterations in PTSD. We performed microstate-based segmentation of resting-state E...

You can heal, recover from trauma, and grow, and this workbook can guide you through this important, meaningful work, step by step, at a pace that feels safe for you. If you’ve experienced trauma, life may sometimes feel hopeless, full of feeling too much or too little. You may feel that the world is a terrifying and dangerous place. You may even f...

This chapter reviews research about treatment for trauma-related disorders (TRDs) and discusses the functions of risky, unhealthy behaviors in TRDs. Teaching patients four core skills that provide safer ways to meet these functions promotes stabilization: grounding, separating past from present, self-compassionate emotion regulation, and getting he...

This chapter offers guidance on how to use the Finding Solid Ground Program Workbook ’s information sheets and exercises in individual and group contexts. The Finding Solid Ground program provides complex trauma patients with a coherent, comprehensive approach to trauma treatment rooted in an understanding of the neurobiological impacts of trauma....

You can heal, recover from trauma, and grow, and this workbook can guide you through this important, meaningful work, step by step, at a pace that feels safe for you. If you’ve experienced trauma, life may sometimes feel hopeless, full of feeling too much or too little. You may feel that the world is a terrifying and dangerous place. You may even f...

You can heal, recover from trauma, and grow, and this workbook can guide you through this important, meaningful work, step by step, at a pace that feels safe for you. If you’ve experienced trauma, life may sometimes feel hopeless, full of feeling too much or too little. You may feel that the world is a terrifying and dangerous place. You may even f...

Traumatized individuals often become triggered and overwhelmed without noticing they are ungrounded. They typically do not yet know how to safely self-regulate. When dysregulated, patients cannot integrate new information or work productively in therapy. Therefore, it is crucial that clinicians are skilled in detecting signs of dysregulation and kn...

You can heal, recover from trauma, and grow, and this workbook can guide you through this important, meaningful work, step by step, at a pace that feels safe for you. If you’ve experienced trauma, life may sometimes feel hopeless, full of feeling too much or too little. You may feel that the world is a terrifying and dangerous place. You may even f...

This chapter defines dissociation and trauma-related disorders (TRD), discusses the etiology of TRD, and describes the prevalence and complex symptom presentations of individuals who have experienced complex trauma. Despite being at least as prevalent as many other types of mental illness, complex TRDs are underrecognized. Consequently, most of the...

You can heal, recover from trauma, and grow, and this workbook can guide you through this important, meaningful work, step by step, at a pace that feels safe for you. If you’ve experienced trauma, life may sometimes feel hopeless, full of feeling too much or too little. You may feel that the world is a terrifying and dangerous place. You may even f...

This chapter offers a framework for understanding and stabilizing risky, unhealthy, and unsafe behaviors. Topics discussed include the importance of approaching this work in a collaborative, trauma-informed way that emphasizes the patient’s autonomy; recognizing risky, unhealthy, and unsafe behaviors as attempts to self-regulate; and providing trai...

You can heal, recover from trauma, and grow, and this workbook can guide you through this important, meaningful work, step by step, at a pace that feels safe for you. If you’ve experienced trauma, life may sometimes feel hopeless, full of feeling too much or too little. You may feel that the world is a terrifying and dangerous place. You may even f...

Even seasoned clinicians can feel deskilled when trying to help to highly traumatized and dissociative patients. Together, this book and its accompanying workbook for patients provide an evidence-informed, pragmatic, and compassionate approach to the stabilization and treatment of complex trauma and dissociation. These books will help clinicians im...

You can heal, recover from trauma, and grow, and this workbook can guide you through this important, meaningful work, step by step, at a pace that feels safe for you. If you’ve experienced trauma, life may sometimes feel hopeless, full of feeling too much or too little. You may feel that the world is a terrifying and dangerous place. You may even f...

You can heal, recover from trauma, and grow, and this workbook can guide you through this important, meaningful work, step by step, at a pace that feels safe for you. If you’ve experienced trauma, life may sometimes feel hopeless, full of feeling too much or too little. You may feel that the world is a terrifying and dangerous place. You may even f...

This chapter summarizes the common neurobiological pathways underpinning the wide range of symptoms seen in trauma-related disorders and provides helpful language for psychoeducation that can instill hope in the brain’s capacity to heal. This chapter reviews the triune brain model and highlights the role of more primitive brain areas in carrying ou...

You can heal, recover from trauma, and grow, and this workbook can guide you through this important, meaningful work, step by step, at a pace that feels safe for you. If you’ve experienced trauma, life may sometimes feel hopeless, full of feeling too much or too little. You may feel that the world is a terrifying and dangerous place. You may even f...

The assessment of trauma-related disorders (TRD) and dissociative disorders (DD) is not widely taught. Accurate assessment of dissociative symptoms can be challenging without adequate training. Clinicians who have not been trained in assessing TRD may mistakenly attribute TRD and DD symptoms to psychosis, bipolar disorder, borderline personality di...

You can heal, recover from trauma, and grow, and this workbook can guide you through this important, meaningful work, step by step, at a pace that feels safe for you. If you’ve experienced trauma, life may sometimes feel hopeless, full of feeling too much or too little. You may feel that the world is a terrifying and dangerous place. You may even f...

Recent meta-analyses highlight alterations in cognitive functioning among individuals with major depressive disorder (MDD), with performance deficits observed across multiple cognitive domains including executive functioning, memory, and attention. Moreover, impaired concentration is a formal diagnostic criterion for a major depressive episode. Not...

Healthcare workers (HCWs) and public safety personnel (PSP) across the globe have continued to face ethically and morally challenging situations during the COVID-19 pandemic that increase their risk for the development of moral distress (MD) and moral injury (MI). To date, however, the global circumstances that confer risk for MD and MI in these co...

Background Increasing evidence points toward the need to extend the neurobiological conceptualization of posttraumatic stress disorder (PTSD) to include evolutionarily conserved neurocircuitries centered on the brainstem and the midbrain. The reticular activating system (RAS) helps to shape the arousal state of the brain, acting as a bridge between...

Post-traumatic stress disorder (PTSD) is a severe psychiatric illness that disproportionately affects military personnel, veterans, and public safety personnel (PSP). Evidence demonstrates that PTSD is significantly associated with difficulties with emotion regulation (ER) and difficulties with cognitive functioning, including difficulties with att...

Background: A moral injury occurs when a deeply held moral code has been violated, and it can lead to the development of symptoms of posttraumatic stress disorder (PTSD). However, the neural correlates that differentiate moral injury and PTSD remain largely unknown. Intrinsic connectivity networks such as the default mode network (DMN) appear to b...

The COVID-19 pandemic has resulted in a still-unfolding series of novel, potentially traumatic moral and ethical challenges that place many healthcare workers at risk of developing moral injury. Moral injury is a type of psychological response that may arise when one transgresses or witnesses another transgress deeply held moral values, or when one...

Background Adverse Childhood Experiences (ACEs) increase risk for negative mental health outcomes in adulthood; however, the mechanisms through which ACEs exert their influence on adult mental health are poorly understood. This is particularly true for Public Safety Personnel (PSP; e.g., police, firefighters, paramedics, etc.), a group with unique...

Background Intrinsic connectivity networks, including the default mode network (DMN), are frequently disrupted in individuals with posttraumatic stress disorder (PTSD). The posterior cingulate cortex (PCC) is the main hub of the posterior DMN, where the therapeutic regulation of this region with real-time fMRI neurofeedback (NFB) has yet to be expl...

Background Post-traumatic stress disorder affects 9% of individuals across their lifetime and increases nearly fourfold to 35% in Canadian public safety personnel (PSP). On-the-job experiences of PSP frequently meet criteria for traumatic events, making these individuals highly vulnerable to exposures of trauma and the negative consequences of PTSD...

Individuals who engage in criminal behavior for which they are found not criminally responsible (NCR) may be at increased vulnerability to experience moral pain and, in extreme circumstances, moral injury after regaining insight into the consequences of their behavior. Yet, almost no research exists characterizing the nature, severity, or impact of...

A growing number of studies have examined alterations in white matter organization in people with posttraumatic stress disorder (PTSD) using diffusion MRI (dMRI), but the results have been mixed which may be partially due to relatively small sample sizes among studies. Altered structural connectivity may be both a neurobiological vulnerability for,...

Individuals with posttraumatic stress disorder (PTSD) are at increased risk for the development of various forms of dementia. Nevertheless, the neuropathological link between PTSD and neurodegeneration remains unclear. Degeneration of the human basal forebrain constitutes a pathological hallmark of neurodegenerative diseases, such as Alzheimer's an...

Real-time fMRI neurofeedback is an increasingly popular neuroimaging technique that allows an individual to gain control over his/her own brain signals, which can lead to improvements in behavior in healthy participants as well as to improvements of clinical symptoms in patient populations. However, a considerably large ratio of participants underg...

LAY SUMMARY Moral injury (MI) refers to the distress experienced when people do, or do not, do something that goes against their morals or values. It can also occur when people perceive that their values have been betrayed. MI is associated with several mental health conditions, including posttraumatic stress disorder (PTSD), depression, and anxiet...

Post-traumatic stress disorder (PTSD) is triggered by an individual experiencing or witnessing a traumatic event, often precipitating persistent flashbacks and severe anxiety that are associated with a fearful and hypervigilant presentation. Approximately 14-30% of traumatized individuals present with the dissociative subtype of PTSD, which is ofte...

Background Emotions have been associated with culturally universal and distinct bodily sensation “maps”. Despite this knowledge, to date few studies have explored emotion-specific topography along clinically relevant dimensions, such as alexithymia. Objective We aimed to investigate emotion-specific topographies among individuals exposed to childh...

Background Moral injury (MI) is consistently associated with adverse mental health outcomes, including the development of posttraumatic stress disorder (PTSD) and suicidality. Methods We investigated neural activation patterns associated with MI event recall using functional magnetic resonance imaging in participants with military and public safet...

Peripersonal space (PPS) is defined as the space surrounding the body where we can reach or be reached by external entities, including objects or other individuals. PPS is an essential component of bodily self-consciousness that allows us to perform actions in the world (e.g., grasping and manipulating objects) and protect our body while interactin...

These authors contributed equally to this work. All other authors are listed in reverse alphabetical order. Neurofeedback has begun to attract the attention and scrutiny of the scientific and medical mainstream. Here, neurofeedback researchers present a consensus-derived checklist that aims to improve the reporting and experimental design standards...

Real-time fMRI neurofeedback is an increasingly popular neuroimaging technique that allows an individual to gain control over his/her own brain signals, which can lead to improvements in behavior in healthy participants as well as to improvements of clinical symptoms in patient populations. However, a considerably large ratio of participants underg...

Trauma can profoundly affect the sense of self, where both cognitive and somatic disturbances to the sense of self are reported clinically by individuals with posttraumatic stress disorder (PTSD). These disturbances are captured eloquently by clinical accounts, such as, ‘I do not know myself anymore,’ ‘I will never be able to experience normal emot...

Self-related processes define assorted self-relevant or social-cognitive functions that allow us to gather insight and to draw inferences related to our own mental conditions. Self-related processes are mediated by the default mode network (DMN), which, critically, shows altered functionality in participants with posttraumatic stress disorder (PTSD...

Across three studies, we provide a proof-of-concept evaluation of an integrative psychotherapeutic application of virtual reality (VR) technology. Study 1 (n = 36) evaluated an unguided “safe-place” imagery task, where participants were instructed “to create a safe space… [such as] a scene, item, design, or any visual representation that makes you...

Background: In 2012, a dissociative subtype of post-traumatic stress disorder (PTSD) was introduced into the DSM based on emerging clinical and neurobiological evidence of a distinct PTSD phenotype characterized by trauma-related dissociation. Ten years later, considerable research has demonstrated unique small-scale (i.e., node-based) and large-sc...

Intrinsic connectivity networks (ICNs), including the default mode network (DMN), central executive network (CEN), and salience network (SN) have been shown to be aberrant in patients with posttraumatic stress disorder (PTSD). The purpose of the current study was to a) compare ICN functional connectivity between PTSD, dissociative subtype PTSD (PTS...

Objective: Dissociative disorders (DDs) are associated with intensive, long-term treatment, suicidality, recurrent hospitalizations, and high rates of disability. However, little is known about the specifics of the economic burden associated with DDs. This worldwide, systematic review examines the results of studies in adults on direct and indirec...

Background: Functional impairment among individuals with posttraumatic stress disorder (PTSD) represents a significant factor in recovery. Critically, functional impairment appears to persist following remission of PTSD symptoms. To date, work investigating functional impairment among individuals with PTSD has focused on PTSD symptom clusters, exc...

Neurofeedback has begun to attract the attention and scrutiny of the scientific and medical mainstream. Here, neurofeedback researchers present a consensus-derived checklist that aims to improve the reporting and experimental design standards in the field.

Introduction: Recently, there has been substantial interest in exploring the heterogeneity of posttraumatic stress disorder (PTSD) on a neurobiological level, as individuals with PTSD, including military members and Veterans, vary in their presentation of symptoms. Methods: Critically, a dissociative subtype of PTSD (PTSD+DS) has been defined, wher...

Neurofeedback is emerging as a psychophysiological treatment where self-regulation is achieved through online feed­back of neural states. Novel personalized medicine approaches are particularly important for the treatment of posttrau­matic stress disorder (PTSD), as symptom presentation of the disorder, as well as responses to treatment, are highly...

Objective: The default-mode network (DMN) and salience network (SN) have been shown to display altered connectivity in posttraumatic stress disorder (PTSD). Restoring aberrant connectivity within these networks with electroencephalogram neurofeedback (EEG-NFB) has been shown previously to be associated with acute decreases in symptoms. Here, we co...