Posttraumatic stress and alcohol use among veterans: Amygdala and anterior cingulate activation to emotional cues.

Abstract

This fMRI study tested a model of combat trauma, posttraumatic stress symptoms (PTSS), alcohol use, and behavioral and neural responses to emotional cues in 100 OIF/OEF/OND veterans. Multilevel structural equation models were tested for left and right dorsal ACC (dACC), rostral ACC (rACC), and amygdala blood-oxygen- level dependent responses during the emotional counting Stroop test and masked faces task. In the Stroop task, combat exposure moderated the effect of combat stimuli resulting in hyperactivation in the rACC and dACC. Activation in the left amygdala also increased in response to combat stimuli, but effects did not vary as a function of combat severity. In the masked faces task, activation patterns did not vary as a function of stimulus. However, at the between-person level, amygdala activation during the masked faces task was inversely associated with PTSS. In respect to behavioral outcomes, higher PTSS were associated with a stronger Stroop effect, suggesting greater interference associated with combat words. Results are consistent with the premise that combat trauma results in hyperactivation in the ACC in response to combat stimuli, and, via its effect on PTSS, is associated with deficits in cognitive performance in the presence of combat stimuli. Across tasks, predeployment drinking was inversely associated with activation in the dACC but not the rACC or amygdala. Drinking may be a buffering factor, or negatively reinforcing in part because of its effects on normalizing brain response following trauma exposure. Alternatively, drinking may undermine adaptive functioning of the dACC when responding to traumatic stress cues. (PsycINFO Database Record

PTSD symptoms and alcohol-related problems among veterans: Temporal associations and vulnerability.

“…Each item was rated on a 5-point anchored rating scale (1 = Not at all true, 5 = Very true). These subscales load on a replicable latent factor of poor behavioral control in previous research (Simons et al, 2017; Simons, Wills, et al, 2016; Wills, Pokhrel, Morehouse, & Fenster, 2011). Construct validity is supported by expected associations with theoretically related constructs and criterion variables (e.g., behavioral activation, self-control, substance use and associated problems; Emery & Simons, 2017; Wills, Simons, & Gibbons, 2015).…”

“…Trait disinhibition may be expected to exacerbate this process. In this regard, disinhibition and related constructs moderate within-person associations between drinking and alcohol-related problems (Neal & Carey, 2007; Simons, Gaher, Oliver, Bush, & Palmer, 2005; Simons, Simons, Maisto, Hahn, & Walters, 2018; Simons, Wills, et al, 2016).…”

Neural substrates of the emotion-word and emotional counting Stroop tasks in healthy and clinical populations: A meta-analysis of functional brain imaging studies

“…These findings together implicate a general dysfunction in the neural circuit consisting of prefrontal and parietal regions, which may traverse both clinical populations and task domains. Hyper-activation in the prefrontal and parietal circuits may reflect an over-engagement of the cognitive control networks to modulate the impact of emotional distractors among patients (Dresler et al, 2012;Kaiser et al, 2015;Passarotti et al, 2010;Pavuluri et al, 2010;Sadeh et al, 2011;Simons et al, 2016). In particular, the exaggerated recruitment of cognitive control regions may represent an unsuccessful attempt to compensate disrupted functional couplings between control systems and emotion processing regions (Britton et al, 2009;Sadeh et al, 2011;Szekely et al, 2017;Zimmermann et al, 2017).…”

Etiopathogenesis of Suicide: A Conceptual Analysis of Risk and Prevention Within a Comprehensive, Deterministic Model

“…We must accept that we may be incapable of predicting the exact situation an individual may confront at any given time, but that the response to a situation will be based on the current state of neurological functioning that stems from complex interactions between every preceding moment in time. For example, the amygdala and dorsal anterior cingulate cortex (dACC) are shown to be hyperactive in fMRI studies on combat veterans (van Wingen et al, 2012; Simons et al, 2016). In these cases, impulsive and risky behaviors such as substance use are common (Gilpin et al, 2014) and point toward the unavailability of certain options that would be implied by personal agency – choosing to abstain rather than suppress craving or reward.…”