The Psychophysiology of Posttraumatic Stress Disorder: A Meta-Analysis

Department of Psychology, University of Michigan, Ann Arbor, MI 48109-1109, USA.
Psychological Bulletin (Impact Factor: 14.76). 10/2007; 133(5):725-46. DOI: 10.1037/0033-2909.133.5.725
Source: PubMed


This meta-analysis of 58 resting baseline studies, 25 startle studies, 17 standardized trauma cue studies, and 22 idiographic trauma cue studies compared adults with and without posttraumatic stress disorder (PTSD) on psychophysiological variables: facial electromyography (EMG), heart rate (HR), skin conductance (SC), and blood pressure. Significant weighted mean effects of PTSD were observed for HR (r = .18) and SC (r = .08) in resting baseline studies; eyeblink EMG (r = .13), HR (r = .23), and SC habituation slope (r = .21) in startle studies; HR (r = .27) in standardized trauma cue studies; and frontalis EMG (r = .21), corrugator EMG (r = .34), HR (r = .22), and SC (r = .19) in idiographic trauma cue studies. The most robust correlates of PTSD were SC habituation slope, facial EMG during idiographic trauma cues, and HR during all study types. Overall, the results support the view that PTSD is associated with elevated psychophysiology. However, the generalizability of these findings is limited by characteristics of the published literature, including its disproportionate focus on male veterans and neglect of potential PTSD subtypes.

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    • "Returning to the integrative hierarchical model of anxiety and depression (Mineka et al., 1998), the autonomic arousal component proposed to differentiate panic disorder from other mood and anxiety disorders is less clearly identifiable as a trait dimension (Brown, Chorpita, & Barlow, 1998; Clark et al., 1994). Rather, autonomic arousal is likely to be a symptom of anxiety, particularly panic disorder (Brown et al., 1998; Clark & Watson, 1991) and PTSD (Brown & McNiff, 2009; Pole, 2007). Anxiety sensitivity, defined as the fear of anxiety signs and symptoms, stemming from beliefs that these sensations have harmful consequences, is most strongly related to generalized anxiety disorder, panic disorder, and PTSD (Naragon-Gainey, 2010). "
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    ABSTRACT: Objectives: Post-traumatic stress disorder (PTSD) and major depressive disorder (MDD) in response to trauma co-occur at high rates. A better understanding of the nature of this co-occurrence is critical to developing an accurate conceptualization of the disorders. This study examined structural relations among the PTSD and MDD constructs and trait and symptom dimensions within the framework of the integrative hierarchical model of anxiety and depression. Design: Study participants completed clinician-rated and self-report measures during a pre-treatment assessment. Methods: The sample consisted of 200 treatment-seeking individuals with a primary DSM-IV PTSD diagnosis. Structural equation modelling was used to examine the relationship between the constructs. Results: The trait negative affect/neuroticism construct had a direct effect on both PTSD and MDD. The trait positive affect/extraversion construct had a unique, negative direct effect on MDD, and PTSD had a unique, direct effect on the physical concerns symptoms construct. An alternative model with the PTSD and MDD constructs combined into an overall general traumatic stress construct produced a decrement in model fit. Conclusions: These findings provide a clearer understanding of the relationship between co-occurring PTSD and MDD as disorders with shared trait negative affect/neuroticism contributing to the overlap between them and unique trait positive affect/extraversion and physical concerns differentiating them. Therefore, PTSD and MDD in response to trauma may be best represented as two distinct, yet strongly related constructs. Practitioner points: In assessing individuals who have been exposed to trauma, practitioners should recognize that co-occurring PTSD and MDD appears to be best represented as two distinct, yet strongly related constructs. Negative affect may be the shared vulnerability directly influencing both PTSD and MDD; however, in the presence of both PTSD and MDD, low positive affect appears to be more specifically related to MDD and fear of physical sensations to PTSD, which is information that could be used by practitioners in the determination of treatment approach. Overall, these findings are clinically relevant in that they may inform assessment, treatment planning, and ultimately diagnostic classification.
    Full-text · Article · Dec 2015
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    • "). In addition, other investigators have used cardiac activity to index emotional engagement during fear processing (e.g., Pitman et al., 1996a, 1996b), and a comprehensive meta-analysis found that heart rate was more strongly related to PTSD than other physiological measures, such as skin conductance (Pole, 2007). Cardiac activity was recorded continuously, for a 5-minute baseline period and during the treatment session. "
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    ABSTRACT: Although the effectiveness of exposure therapy for PTSD is recognized, treatment mechanisms are not well understood. Emotional processing theory (EPT) posits that fear reduction within and between sessions creates new learning, but evidence is limited by self-report assessments and inclusion of treatment components other than exposure. We examined trajectories of physiological arousal and their relation to PTSD treatment outcome in a randomized controlled trial of written exposure treatment, a protocol focused on exposure to trauma memories. Hierarchical linear modeling was used to model reduction in Clinician Administered PTSD Scale score as a predictor of initial activation and within- and between-session change in physiological arousal. Treatment gains were significantly associated with initial physiological activation, but not with within- or between-session changes in physiological arousal. Treatment gains were associated with larger between-session reductions in self-reported arousal. These findings highlight the importance of multimethod arousal assessment and add to a growing literature suggesting refinements of EPT.
    Full-text · Article · Oct 2015
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    • "Our results are in agreement with studies on PTSD patients. There are two meta-analyses [14] [15] showing that PTSD patients might be characterized by higher resting SBP and DBP. Moreover, the recent analysis of data from 4008 subjects participating in the United States National Comorbidity Survey revealed that PTSD is associated with the highest rate of hypertension, independently of depression [16] [17]. "
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    ABSTRACT: Objective: It has repeatedly been found that early life traumatic events may contribute to metabolic dysregulation. Therefore, the aim of this study was to investigate the association between the history of childhood trauma and cardiovascular risk factors in first-episode schizophrenia (FES) patients. Method: The history of childhood trauma was assessed using the Early Trauma Inventory Self Report – Short Form (ETISR-SF) in 83 FES patients. Based on the ETISR-SF, patients were divided into those with positive and negative history of childhood trauma – FES(+) and FES(−) patients. Serum levels of fasting glucose lipids, homocysteine, vitamin B12 and folate, as well as anthropometric parameters, resting systolic and diastolic blood pressure (SBP and DBP) were measured. Results: The history of childhood trauma was associated with higher LDL levels, SBP and DBP after co-varying for age, gender, BMI, education and chlorpromazine equivalent. There were significant correlations between scores of distinct ETISR-SF subscales and LDL, HDL, SBP, DBP and the number of metabolic syndrome criteria. Conclusions: Results of this study indicate that traumatic events during childhood might be related to higher resting blood pressure and higher LDL levels in adult FES patients.
    Full-text · Article · Mar 2015 · General Hospital Psychiatry
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