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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    • "In support of the executive functioning account in PTSD, individuals with the disorder are characterized by deficits in aspects of executive functioning compared to healthy controls (Aupperle et al., 2012) and demonstrate difficulty using cognitive resources to downregulate retrieval of emotional information (Catarin et al., 2014 ). While these deficits may be partially secondary to the experience of trauma or having chronic PTSD, data suggest that poor executive functioning may be a pre-trauma risk factor for later PTSD development (e.g., Aupperle et al., 2012 ). Moreover, re-experiencing symptoms are inversely associated with executive functioning (Verwoerd et al., 2009; Bomyea et al., 2012), and ITs and re-experiencing symptoms are reduced following improvements in executive functioning in analogue and PTSD samples, respectively (Bomyea and Amir, 2011;). "
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    ABSTRACT: Background: Persistent, trauma-related intrusive thoughts are common in individuals with posttraumatic stress disorder (PTSD). Automatic aspects of cognitive functioning (including executive functioning) and maladaptive deliberate attempts at cognitive regulation have been proposed as individual difference factors that may perpetuate intrusive thoughts. The current study sought to examine the joint contribution of these two factors on intrusive thoughts in PTSD. Method: Forty-two women with PTSD completed an executive functioning assessment followed by a thought suppression task. Intrusive thoughts (frequency and duration), as well as participants' use of specific cognitive regulation strategies (avoidance-based thought regulation strategies; TRS), were measured during the task. Hierarchical linear regression was used to examine the interaction of executive functioning and TRS on intrusive thoughts. Results: Greater use of TRS was associated with greater intrusive thought persistence for those with low executive functioning, but not those with high executive functioning. Limitations: Data was collected cross-sectionally and the laboratory thought suppression task may not correspond to naturalistic thought regulation. Conclusions: Results are consistent with prior literature suggesting that certain responses deployed by individuals to control intrusive thoughts may be unhelpful, but that a higher level of cognitive capacity may mitigate this effect. Implications of these findings for recent models of cognition in PTSD are discussed.
    Full-text · Article · Mar 2016 · Journal of Affective Disorders
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    • "These can be temporally classified into pre-exposure 'vulnerability' factors, peri-traumatic factors and reactions directly related to the event, and post-exposure adversities. Preexisting vulnerability factors range from neurobiological factors , such as genetic endowment and epigenetic regulation, through environmental factors, such as prior trauma exposure, family and personal psychiatric history, lower education, and stressful, resourceless living conditions, to behavioral factors, such as impaired executive function and higher emotional reactivity[17,18]. Peri-traumatic factors include trauma intensity and type (e.g., intentional vs. unintentional), peritraumatic symptoms, physiological arousal (e.g., heart rate) and gene expression. "
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    ABSTRACT: Post-traumatic stress disorder (PTSD) is a frequent, tenacious, and disabling consequence of traumatic events. The disorder’s identifiable onset and early symptoms provide opportunities for early detection and prevention. Empirical findings and theoretical models have outlined specific risk factors and pathogenic processes leading to PTSD. Controlled studies have shown that theory-driven preventive interventions, such as cognitive behavioral therapy (CBT), or stress hormone-targeted pharmacological interventions, are efficacious in selected samples of survivors. However, the effectiveness of early clinical interventions remains unknown, and results obtained in aggregates (large groups) overlook individual heterogeneity in PTSD pathogenesis. We review current evidence of PTSD prevention and outline the need to improve the disorder’s early detection and intervention in individual-specific paths to chronic PTSD.
    Full-text · Article · Feb 2016 · Current Psychiatry Reports
    • "Nevertheless, both hyper-and hypoactivation in medial prefrontal regions have been described for PTSD patients (Shin et al., 2005;Burgmer et al., 2013;Ke et al., 2015;White et al., 2015). Anyway, the most general pattern found in PTSD is the presence of amygdalar hyperreactivity and decreased recruitment of the regions of the frontal, parietal and cingular cortex implicated in topdown attentional control such as the lateral prefrontal cortex and the ACC (Bremner et al., 2004;New et al., 2009;Simmons et al., 2011;Aupperle et al., 2012;Blair et al., 2013;Esterman et al., 2013;Stevens et al., 2013). But PTSD has not always been considered a unitary construct. "
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    ABSTRACT: Emotion regulation impairments with traumatic origins have mainly been studied from posttraumatic stress disorder (PTSD) models by studying cases of adult onset and single-incident trauma exposure. The effects of adverse traumatic experiences, however, go beyond the PTSD. Different authors have proposed that PTSD, borderline personality, dissociative, conversive and somatoform disorders constitute a full spectrum of trauma-related conditions. Therefore, a comprehensive review of the neurobiological findings covering this posttraumatic spectrum is needed in order to develop an all-encompassing model for trauma-related disorders with emotion regulation at its center. The present review has sought to link neurobiology findings concerning cortico-limbic function to the field of emotion regulation. In so doing, trauma-related disorders have been placed in a continuum between under- and over-regulation of affect strategies. Under-regulation of affect was predominant in borderline personality disorder, PTSD with re-experiencing symptoms and positive psychoform and somatoform dissociative symptoms. Over-regulation of affect was more prevalent in somatoform disorders and pathologies characterized by negative psychoform and somatoform symptoms. Throughout this continuum, different combinations between under- and over-regulation of affect strategies were also found.
    No preview · Article · Jan 2016 · Reviews in the neurosciences
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