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      Trauma-related dissociation and altered states of consciousness: a call for clinical, treatment, and neuroscience research

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          Abstract

          The primary aim of this commentary is to describe trauma-related dissociation and altered states of consciousness in the context of a four-dimensional model that has recently been proposed (Frewen & Lanius, 2015). This model categorizes symptoms of trauma-related psychopathology into (1) those that occur within normal waking consciousness and (2) those that are dissociative and are associated with trauma-related altered states of consciousness (TRASC) along four dimensions: (1) time; (2) thought; (3) body; and (4) emotion. Clinical applications and future research directions relevant to each dimension are discussed. Conceptualizing TRASC across the dimensions of time, thought, body, and emotion has transdiagnostic implications for trauma-related disorders described in both the Diagnostic Statistical Manual and the International Classifications of Diseases. The four-dimensional model provides a framework, guided by existing models of dissociation, for future research examining the phenomenological, neurobiological, and physiological underpinnings of trauma-related dissociation.

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          Most cited references104

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          Diagnostic and statistical manual of mental disorders.

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            Emotion modulation in PTSD: Clinical and neurobiological evidence for a dissociative subtype.

            In this article, the authors present evidence regarding a dissociative subtype of PTSD, with clinical and neurobiological features that can be distinguished from nondissociative PTSD. The dissociative subtype is characterized by overmodulation of affect, while the more common undermodulated type involves the predominance of reexperiencing and hyperarousal symptoms. This article focuses on the neural manifestations of the dissociative subtype in PTSD and compares it to those underlying the reexperiencing/hyperaroused subtype. A model that includes these two types of emotion dysregulation in PTSD is described. In this model, reexperiencing/hyperarousal reactivity is viewed as a form of emotion dysregulation that involves emotional undermodulation, mediated by failure of prefrontal inhibition of limbic regions. In contrast, the dissociative subtype of PTSD is described as a form of emotion dysregulation that involves emotional overmodulation mediated by midline prefrontal inhibition of the same limbic regions. Both types of modulation are involved in a dynamic interplay and lead to alternating symptom profiles in PTSD. These findings have important implications for treatment of PTSD, including the need to assess patients with PTSD for dissociative symptoms and to incorporate the treatment of dissociative symptoms into stage-oriented trauma treatment.
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              Basic Emotions, Natural Kinds, Emotion Schemas, and a New Paradigm.

              Research on emotion flourishes in many disciplines and specialties, yet experts cannot agree on its definition. Theorists and researchers use the term emotion in ways that imply different processes and meanings. Debate continues about the nature of emotions, their functions, their relations to broad affective dimensions, the processes that activate them, and their role in our daily activities and pursuits. I will address these issues here, specifically in terms of basic emotions as natural kinds, the nature of emotion schemas, the development of emotion-cognition relations that lead to emotion schemas, and discrete emotions in relation to affective dimensions. Finally, I propose a new paradigm that assumes continual emotion as a factor in organizing consciousness and as an influence on mind and behavior. The evidence reviewed suggests that a theory that builds on concepts of both basic emotions and emotion schemas provides a viable research tool and is compatible with more holistic or dimensional approaches.

                Author and article information

                Journal
                Eur J Psychotraumatol
                Eur J Psychotraumatol
                EJPT
                European Journal of Psychotraumatology
                Co-Action Publishing
                2000-8198
                2000-8066
                19 May 2015
                2015
                : 6
                : 10.3402/ejpt.v6.27905
                Affiliations
                Western University, Lawson Health Research Institute, London, ON, Canada
                Author notes
                [* ]Correspondence to: Ruth A. Lanius, Western University, 339 Windermere Road, PO Box 5339, University Hospital, London, ON N6A 5A5, Canada, Email: Ruth.Lanius@ 123456lhsc.on.ca
                Article
                27905
                10.3402/ejpt.v6.27905
                4439425
                25994026
                847abada-b0a2-47b1-9fbe-79b14525d147
                © 2015 Ruth A. Lanius

                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
                : 18 March 2015
                : 16 April 2015
                : 16 April 2015
                Categories
                Trauma and PTSD: Setting the Research Agenda

                Clinical Psychology & Psychiatry
                dissociation,consciousness,interoceptive awareness,dissociative subtype,emotion,anterior cingulate,insula,complex ptsd

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