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      Restoring large-scale brain networks in PTSD and related disorders: a proposal for neuroscientifically-informed treatment interventions

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          Abstract

          Background

          Three intrinsic connectivity networks in the brain, namely the central executive, salience, and default mode networks, have been identified as crucial to the understanding of higher cognitive functioning, and the functioning of these networks has been suggested to be impaired in psychopathology, including posttraumatic stress disorder (PTSD).

          Objective

          1) To describe three main large-scale networks of the human brain; 2) to discuss the functioning of these neural networks in PTSD and related symptoms; and 3) to offer hypotheses for neuroscientifically-informed interventions based on treating the abnormalities observed in these neural networks in PTSD and related disorders.

          Method

          Literature relevant to this commentary was reviewed.

          Results

          Increasing evidence for altered functioning of the central executive, salience, and default mode networks in PTSD has been demonstrated. We suggest that each network is associated with specific clinical symptoms observed in PTSD, including cognitive dysfunction (central executive network), increased and decreased arousal/interoception (salience network), and an altered sense of self (default mode network). Specific testable neuroscientifically-informed treatments aimed to restore each of these neural networks and related clinical dysfunction are proposed.

          Conclusions

          Neuroscientifically-informed treatment interventions will be essential to future research agendas aimed at targeting specific PTSD and related symptoms.

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          Most cited references126

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          Functional connectivity in the resting brain: a network analysis of the default mode hypothesis.

          Michael D. Greicius, Ben Krasnow, Allan L. Reiss … (2003)
          Functional imaging studies have shown that certain brain regions, including posterior cingulate cortex (PCC) and ventral anterior cingulate cortex (vACC), consistently show greater activity during resting states than during cognitive tasks. This finding led to the hypothesis that these regions constitute a network supporting a default mode of brain function. In this study, we investigate three questions pertaining to this hypothesis: Does such a resting-state network exist in the human brain? Is it modulated during simple sensory processing? How is it modulated during cognitive processing? To address these questions, we defined PCC and vACC regions that showed decreased activity during a cognitive (working memory) task, then examined their functional connectivity during rest. PCC was strongly coupled with vACC and several other brain regions implicated in the default mode network. Next, we examined the functional connectivity of PCC and vACC during a visual processing task and show that the resultant connectivity maps are virtually identical to those obtained during rest. Last, we defined three lateral prefrontal regions showing increased activity during the cognitive task and examined their resting-state connectivity. We report significant inverse correlations among all three lateral prefrontal regions and PCC, suggesting a mechanism for attenuation of default mode network activity during cognitive processing. This study constitutes, to our knowledge, the first resting-state connectivity analysis of the default mode and provides the most compelling evidence to date for the existence of a cohesive default mode network. Our findings also provide insight into how this network is modulated by task demands and what functions it might subserve.
          Article 0 comments Cited 617 times – based on 0 reviews     Review now
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            A meta-analysis of cognitive remediation for schizophrenia: methodology and effect sizes.

            Til Wykes, Vyv Huddy, Caroline Cellard … (2011)
            Cognitive remediation therapy for schizophrenia was developed to treat cognitive problems that affect functioning, but the treatment effects may depend on the type of trial methodology adopted. The present meta-analysis will determine the effects of treatment and whether study method or potential moderators influence the estimates. Electronic databases were searched up to June 2009 using variants of the key words "cognitive," "training," "remediation," "clinical trial," and "schizophrenia." Key researchers were contacted to ensure that all studies meeting the criteria were included. This produced 109 reports of 40 studies in which ≥70% of participants had a diagnosis of schizophrenia, all of whom received standard care. There was a comparison group and allocation procedure in these studies. Data were available to calculate effect sizes on cognition and/or functioning. Data were independently extracted by two reviewers with excellent reliability. Methodological moderators were extracted through the Clinical Trials Assessment Measure and verified by authors in 94% of cases. The meta-analysis (2,104 participants) yielded durable effects on global cognition and functioning. The symptom effect was small and disappeared at follow-up assessment. No treatment element (remediation approach, duration, computer use, etc.) was associated with cognitive outcome. Cognitive remediation therapy was more effective when patients were clinically stable. Significantly stronger effects on functioning were found when cognitive remediation therapy was provided together with other psychiatric rehabilitation, and a much larger effect was present when a strategic approach was adopted together with adjunctive rehabilitation. Despite variability in methodological rigor, this did not moderate any of the therapy effects, and even in the most rigorous studies there were similar small-to-moderate effects. Cognitive remediation benefits people with schizophrenia, and when combined with psychiatric rehabilitation, this benefit generalizes to functioning, relative to rehabilitation alone. These benefits cannot be attributed to poor study methods.
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              An insular view of anxiety.

              Martin Paulus, Murray Stein (2006)
              We propose a general hypothesis that integrates affective and cognitive processing with neuroanatomy to explain anxiety pronenes. The premise is that individuals who are prone to anxiety show an altered interoceptive prediction signal, i.e., manifest augmented detection of the difference between the observed and expected body state. As a consequence, the increased prediction signal of a prospective aversive body state triggers an increase in anxious affect, worrisome thoughts and other avoidance behaviors. The anterior insula is proposed to play a key role in this process. Further testing of this model--which should include investigation of genetic and environmental influences--may lead to the development of novel treatments that attenuate this altered interoceptive prediction signal in patients with anxiety disorders.
              Article 0 comments Cited 397 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Eur J Psychotraumatol
                Journal ID (iso-abbrev): Eur J Psychotraumatol
                Journal ID (publisher-id): EJPT
                Title: European Journal of Psychotraumatology
                Publisher: Co-Action Publishing
                ISSN (Print): 2000-8198
                ISSN (Electronic): 2000-8066
                Publication date (Electronic): 31 March 2015
                Publication date Collection: 2015
                Volume: 6
                Electronic Location Identifier: 10.3402/ejpt.v6.27313
                Affiliations
                [1 ]Western University, London, ON, Canada
                [2 ]Lawson Health Research Institute, London, ON, Canada
                [3 ]Canadian Forces, Health Services, Ottawa, Ontario, Canada
                [4 ]McMaster University, Hamilton, Hamilton, Ontario, Canada
                [5 ]St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
                [6 ]Homewood Research Institute, Guelph, Ontario, Canada
                Author notes
                [* ]Correspondence to: Ruth A. Lanius, 339 Windermere Road, PO Box 5339, Western University, University Hospital, London, ON N6A 5A5, Canada, Email: Ruth.Lanius@ 123456lhsc.on.ca
                Article
                Publisher ID: 27313
                DOI: 10.3402/ejpt.v6.27313
                PMC ID: 4390556
                PubMed ID: 25854674
                SO-VID: 7f035a71-cec4-4e2a-9573-f3f1ef84f4e9
                Copyright © © 2015 Ruth A. Lanius et al.
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 International License, allowing third parties to copy and redistribute the material in any medium or format, and to remix, transform, and build upon the material, for any purpose, even commercially, under the condition that appropriate credit is given, that a link to the license is provided, and that you indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.

                History
                Date received : 16 January 2015
                Date revision received : 02 March 2015
                Date accepted : 02 March 2015
                Categories
                Subject: Review Article

                ScienceOpen disciplines: Clinical Psychology & Psychiatry
                Keywords: intrinsic networks,default mode network,salience network,central executive network,insula,ptsd,interoception,neurofeedback,mindfulness,dissociation
                Data availability:
                ScienceOpen disciplines: Clinical Psychology & Psychiatry
                Keywords: intrinsic networks, default mode network, salience network, central executive network, insula, ptsd, interoception, neurofeedback, mindfulness, dissociation

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