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      Diminished positive affect and traumatic stress: A biobehavioral review and commentary on trauma affective neuroscience

      Neurobiology of Stress
      Trauma, Stress, Affect, Emotional numbing, Imaging, Reward

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          Post-traumatic stress manifests in disturbed affect and emotion, including exaggerated severity and frequency of negative valence emotions, e.g., fear, anxiety, anger, shame, and guilt. However, another core feature of common post-trauma psychopathologies, i.e. post-traumatic stress disorder (PTSD) and major depression, is diminished positive affect, or reduced frequency and intensity of positive emotions and affective states such as happiness, joy, love, interest, and desire/capacity for interpersonal affiliation. There remains a stark imbalance in the degree to which the neuroscience of each affective domain has been probed and characterized in PTSD, with our knowledge of post-trauma diminished positive affect remaining comparatively underdeveloped. This remains a prominent barrier to realizing the clinical breakthroughs likely to be afforded by the increasing availability of neuroscience assessment and intervention tools. In this review and commentary, the author summarizes the modest extant neuroimaging literature that has probed diminished positive affect in PTSD using reward processing behavioral paradigms, first briefly reviewing and outlining the neurocircuitry implicated in reward and positive emotion and its interrelationship with negative emotion and negative valence circuitry. Specific research guidelines are then offered to best and most efficiently develop the knowledge base in this area in a way that is clinically translatable and will exert a positive impact on routine clinical care. The author concludes with the prediction that the development of an integrated, bivalent theoretical and predictive model of how trauma impacts affective neurocircuitry to promote post-trauma psychopathology will ultimately lead to breakthroughs in how trauma treatments are conceptualized mechanistically and developed pragmatically.

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                Author and article information

                Neurobiol Stress
                Neurobiol Stress
                Neurobiology of Stress
                21 October 2018
                November 2018
                21 October 2018
                : 9
                : 214-230
                [1]Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
                [2]Stanford Neurosciences Institute, Stanford University, Stanford, CA, USA
                [3]Veterans Affairs Palo Alto Healthcare System, The Sierra-Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), Palo Alto, CA, USA
                Author notes
                []Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Sierra-Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), Veterans Affairs Palo Alto Healthcare System, 401 Quarry Road, MC 5722, Stanford, CA, 94305, USA. gfonzo@ 123456stanford.edu
                © 2018 Published by Elsevier Inc.

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                : 15 May 2018
                : 20 July 2018
                : 17 October 2018
                Articles from the Special Issue on Imaging Stress; Edited by Michael R Bruchas and Alan Simmons

                trauma,stress,affect,emotional numbing,imaging,reward
                trauma, stress, affect, emotional numbing, imaging, reward


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