Functional reorganization of neural networks involved in emotion regulation following trauma therapy for complex trauma disorders

Abstract

Objectives We investigated whether patients with complex interpersonal trauma engage neural networks that are commonly activated during cognitive reappraisal and responding naturally to affect-laden images. In this naturalistic study, we examined whether trauma treatment not only reduces symptoms but also changes neural networks involved in emotional control. Methods Before and after eight weeks of phase-oriented inpatient trauma treatment, patients ( n = 28) with complex posttraumatic stress disorder (cPTSD) and complex dissociative disorders (CDD) performed a cognitive reappraisal task while electroencephalography (EEG) was registered. Patients were measured as a prototypical dissociative part that aims to fulfill daily life goals while avoiding traumatic memories and associated dissociative parts. Matched healthy controls ( n = 38) were measured twice as well. We examined task-related functional connectivity and assessed self-reports of clinical symptoms and emotion regulation skills. Results Prior to treatment and compared to controls, patients showed hypoconnectivity within neural networks involved in emotional downregulation while reappraising affect-eliciting pictures as well as viewing neutral and affect-eliciting pictures. Following treatment, connectivity became normalized in these networks comprising regions associated with cognitive control and memory. Additionally, patients showed a treatment-related reduction of negative but not of positive dissociative symptoms. Conclusions This is the first study demonstrating that trauma-focused treatment was associated with favorable changes in neural networks involved in emotional control. Emotional overregulation manifesting as negative dissociative symptoms was reduced but not emotional underregulation, manifesting as positive dissociative symptoms.

Resting‐state functional connectivity in patients with a complex PTSD or complex dissociative disorder before and after inpatient trauma treatment

“…This is an essential prerequisite for the integration of trauma memories and development of a cooperative relationship with other dissociative parts (i.e., EPs; Nijenhuis, 2015Nijenhuis, , 2017Van der Hart et al, 2006). Thus, our results might reflect a remarkable therapeutic achievement and are in line with our previously published emotion regulation functional connectivity study (Schlumpf et al, 2019) showing that patients as ANP were less depersonalized, derealized, and emotionally numbed following phase-oriented treatment.…”

“…This hypothesis is only subordinate as we do not have a control group that was presented emotionally neutral pictures only. However, it is in line with our previous EEG functional connectivity emotion regulation study (Schlumpf et al, 2019) and fMRI investigations of exposure-based treatment effects on functional networks in PTSD patients at rest (Shou et al, 2017;Zhu et al, 2018) and during confrontation with reminders of traumatic events (Cisler et al, 2014;Helpman et al, 2016).…”

“…published (Schlumpf et al, 2019). Immediately after completion of the emotion regulation task, the EEG signal was registered during both 3 min of eyes-open and 3 min of eyes-closed resting-state (see Figure 1).…”

Schematherapy in DID: treatment length and related studies on dissociative amnesia

“…Similarly, in the case of DID, differential identity reactivity on (neuro)physiological measures may be driven by their self-understanding of harbouring multiple identities. This explanation may also account for the studies on neurophysiological and behavioural reactions to subliminally presented neutral and angry faces (Schlumpf et al, 2013(Schlumpf et al, , 2014Schlumpf, Nijenhuis, Klein, Jäncke, & Bachmann, 2019) with an equivalent line of reasoning. The explanation also fits perfectly well with our conceptualization of DID in terms of erroneous meta-cognitive understanding of the self as being composed of multiple identities and erroneous meta-memory processes including the belief of amnesic barriers between these identities.…”

Maladaptive Alterations of Defensive Response Following Developmental Complex Stress in Rats

“…Researchers have studied the immediate and long-term results of complex trauma, both biologically and behaviorally. While the neural basis of these abnormalities has not been fully elucidated, previous studies have suggested an association between childhood trauma and structural and functional abnormalities of brain regions mediating emotion, such as the hippocampus, amygdala, and prefrontal cortex [19][20][21][22]. However, there are limitations in population studies, because inducing trauma to humans has ethical issues and because it is difficult to carry out well-validated behavioral and psychophysiological studies in human populations.…”