Brain activation during script-driven imagery induced dissociative responses in PTSD: a functional magnetic resonance imaging investigation

Lanius, Ruth A.; Williamson, Peter C.; Boksman, Kristine; Densmore, Maria; Gupta, Madhulika A.; Neufeld, Richard W. J.; Gati, Joseph S.; Menon, Ravi S.

doi:10.1016/s0006-3223(02)01367-7

Cited by 470 publications

(373 citation statements)

References 31 publications

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“…Consequently, our data are discussed here in the context of literature on the psychophysiology of dissociative stress reactions in general. Our observations are in line with the observation of ‘physiological non-responders’ in PTSD patients (30% of PTSD patients) (Orr et al, 2002; Orr & Roth, 2000) and the ‘dissociative subtype’ of PTSD (30% of PTSD patients) (Lanius et al, 2006, 2002) showing a blunted heart rate reaction in a trauma script paradigm. Furthermore, our results extend previous work by Sack et al (2012) reporting a positive correlation between acute dissociative symptoms and a reduced psychophysiological arousal.…”

Section: Discussionsupporting

confidence: 91%

“…Most of these studies did not assess for sympathetic and parasympathetic drive simultaneously. When exposed to a trauma script, 30% of PTSD patients, who usually display psychophysiological hyperarousal under stressful conditions, exhibit blunted autonomic reactivity and are thus classified as ‘physiological non-responders’ (Orr, Metzger, & Pitman, 2002; Orr & Roth, 2000) or ‘dissociative subtype’ of PTSD (Lanius, Bluhm, Lanius, & Pain, 2006; Lanius et al, 2002). Similarly, research by Sierra et al (2002, 2006) reported on blunted autonomic reactivity (skin conductance level) to unpleasant stimuli and unpleasant emotions in patients affected by Depersonalization-Derealization Disorder.…”

Section: Introductionmentioning

confidence: 99%

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The enemy in the mirror: self-perception-induced stress results in dissociation of psychological and physiological responses in patients with dissociative disorder

Schäflein

Sattel

Schmidt

et al. 2018

European Journal of Psychotraumatology

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Background: Patients suffering from dissociative disorders (DD) are characterized by an avoidance of aversive stimuli. Clinical experience has shown that DD patients typically avoid the confrontation with their own faces in a mirror (CFM). Objective: To investigate potential CFM-associated self-reported and psychophysiological stress reactions of DD patients, which most likely inform on the still unknown pathophysiology of dysfunctional self-perception in DD. Method: Eighteen DD patients and 18 healthy controls (HCs) underwent CFM. They were assessed for CFM-induced subjective self-reported stress, acute dissociative symptoms and sympathetic and parasympathetic drive using impedance cardiography. Results: DD patients experienced more subjective stress and acute dissociation than HCs upon CFM. Their psychological stress response did not activate the sympathetic and parasympathetic nervous system. Conclusions: In DD patients, CFM constitutes serious self-reported stress and is associated with a blunted autonomic reactivity. Therapeutic approaches promoting self-perception and self-compassion, in particular by using CFM, might serve as goal-oriented diagnostic and therapeutic tools in DD.

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Section: Discussionsupporting

confidence: 91%

Section: Introductionmentioning

confidence: 99%

The enemy in the mirror: self-perception-induced stress results in dissociation of psychological and physiological responses in patients with dissociative disorder

Schäflein

Sattel

Schmidt

et al. 2018

European Journal of Psychotraumatology

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“…Such a hypothesis was recently supported by a series of studies on posttraumatic stress disorder (PTSD) showing that a specific increase of MPFC activity is present in dissociative and hypoemotional PTSD patients compared to hyperaroused PTSD patients. 57,58 With regards to this hypothesis, it is possible that the VMPFC activation in anhedonic non-clinical individuals reflects such corticolimbic inhibitory process that would be specific to positively valenced stimuli. This idea is supported by the fact that MPFC activity was no longer significantly correlated with trait anhedonia during the processing of negative information (see Figure 3b).…”

Section: Functional Correlates Of Trait Anhedoniamentioning

confidence: 99%

Individual differences in trait anhedonia: a structural and functional magnetic resonance imaging study in non-clinical subjects

et al. 2007

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Anhedonia, the reduced capacity to gain pleasure from pleasurable experiences, is a key symptom of major depression and schizophrenia. Reduced hedonic capacity can also be measured as an enduring trait in non-clinical subjects. Such altered hedonic capacity is likely the result of a basic neuropsychophysiological dysfunction and a vulnerability marker that potentially precedes and contributes to the liability of developing psychiatric disorders. The characterization of the structural and functional neural correlates of trait anhedonia in nonclinical individuals may provide new insights for the early detection of such psychiatric diseases. Twenty-nine non-clinical subjects were scanned at the Montreal Neurological Institute. Trait anhedonia was measured using the Chapman Revised Physical Anhedonia Scale. Semi-automated and automated structural MRI segmentation techniques were used to explore structural correlates of trait anhedonia. Seventeen of the 29 subjects also underwent a functional imaging task where responses to the viewing of affective stimuli were examined to identify the functional correlates of trait anhedonia. Trait anhedonia was inversely related to anterior caudate volume, but positively related to ventromedial prefrontal cortex activity during the processing of positive information. These findings may reflect a specific kind of vulnerability for the development of psychiatric affective disorders and suggest that trait anhedonia may be linked to a volumetric reduction in the basal ganglia and to a prefrontal functional abnormality during hedonic processing.

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“…In a functional magnetic resonance imaging (fMRI) study, Lanius and colleagues 16 investigated neural activation patterns during dissociative states in patients with PTSD using a script-driven imagery paradigm. By comparing the neural responses of a personalized traumatic script and an implicit baseline, this group found significant activation of the medial prefrontal cortex, anterior cingulate cortex, middle temporal gyrus, superior temporal gyrus and medial parietal lobe in PTSD patients compared with a control group, which consisted of participants who met criterion A for PTSD but had no other DSM-IV criteria for PTSD.…”

Section: Introductionmentioning

confidence: 99%

Pain sensitivity and neural processing during dissociative states in patients with borderline personality disorder with and without comorbid posttraumatic stress disorder: a pilot study

Ludäscher

Valerius

Stiglmayr

et al. 2010

jpn

109

113

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Background: Stress-induced dissociative states involving analgesia are a common feature of borderline personality disorder (BPD) and posttraumatic stress disorder (PTSD). Our aim was to investigate the psychologic, somatosensory (pain sensitivity) and neural correlates of dissociative states in patients with these disorders. Methods: We included 15 women with BPD who were not taking medication; 10 of these women had comorbid PTSD. While undergoing functional magnetic resonance imaging at 1.5 Tesla, participants were exposed to a script describing a personalized dissociation-inducing situation and a personalized script describing a neutral situation. We assessed dissociative psychopathology and pain sensitivity. Results: Dissociative psychopathology scores were significantly higher and pain sensitivity was lower after the dissociation-inducing script was read compared with the neutral script. The blood oxygen level-dependent (BOLD) signal was significantly increased in the left inferior frontal gyrus (Brodmann area [BA] 9) during the presentation of the dissociationinducing script. Regression analyses revealed positive correlations between BOLD signal and dissociative psychopathology in the left superior frontal gyrus (BA 6) and negative correlations in the right middle (BA 21) and inferior temporal gyrus (BA 20). In the subgroup of participants with comorbid PTSD, we also found increased activity in the left cingulate gyrus (BA 32) during script-driven imagery-induced dissociation, a positive correlation between dissociation scores and activity in the right and left insula (BA 13) and a negative correlation in the right parahippocampal gyrus (BA 35). Limitations: The main limitation of this pilot study is the absence of a control group. Therefore, the results may also reflect the neural correlates of non-BPD/PTSD specific dissociative states or the neural correlates of emotionally stressful or "loaded" memories. Another limitation is the uncorrected statistical level of the functional magnetic resonance imaging results. Conclusion: Our results showed that the script-driven imagery method is capable of inducing dissociative states in participants with BPD with and without comorbid PTSD. These states were characterized by reduced pain sensitivity and a fronto limbic activation pattern, which resembles the findings in participants with PTSD while in dissociative states.

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Brain activation during script-driven imagery induced dissociative responses in PTSD: a functional magnetic resonance imaging investigation

Cited by 470 publications

References 31 publications

The enemy in the mirror: self-perception-induced stress results in dissociation of psychological and physiological responses in patients with dissociative disorder

The enemy in the mirror: self-perception-induced stress results in dissociation of psychological and physiological responses in patients with dissociative disorder

Individual differences in trait anhedonia: a structural and functional magnetic resonance imaging study in non-clinical subjects

Pain sensitivity and neural processing during dissociative states in patients with borderline personality disorder with and without comorbid posttraumatic stress disorder: a pilot study

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