Functional reorganization of neural networks during repeated exposure to the traumatic memory in posttraumatic stress disorder: an exploratory fMRI study
Open accessAbstract
Background Repeated exposure to the traumatic memory (RETM) is a common component of treatments for posttraumatic stress disorder (PTSD). This treatment is based on a fear extinction model; however, the degree to which this treatment actually engages and modifies neural networks mediating fear extinction is unknown. Therefore, the purpose of the current exploratory study was to define the dynamic changes in neural processing networks while participants completed a novel adaptation of RETM.Method Participants were adult women (N = 16) with PTSD related to physical or sexual assault. Prior to scanning, participants provided written narratives of a traumatic event related to their PTSD as well as a neutral control event. RETM during fMRI consisted of 5 sequential presentations of the blocked narrative types, lasting three minutes each. Self-reported anxiety was assessed after each presentation.Results Relative to changes in functional connectivity during the neutral control script, RETM was associated with strengthened functional connectivity of the right amygdala with the right hippocampus and right anterior insular cortex, left amygdala with the right insular cortex, medial PFC with right anterior insula, left hippocampus with striatum and dorsal cingulate cortex, and right hippocampus with striatum and orbitofrontal cortex. Greater PTSD severity generally led to less changes in functional connectivity with the right insular cortex.Conclusions These results provide evidence that RETM engages and modifies functional connectivity pathways with neural regions implicated in fear extinction. The results also implicate the engagement of the right insular cortex and striatum during RETM and suggest their importance in human fear extinction to trauma memories. However, comorbidity in the sample and the lack of a control group limit inferences regarding RETM with PTSD populations specifically.
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Increased connectivity between the insula, mPFC, striatum, and dorsal ACC occurs during symptom provocation in PTSD.
“Another study also found increased connectivity between the insula, mPFC, striatum and dorsal ACC during symptom provocation (Cisler et al., 2014).”
From Cortico-striatal-thalamic loop circuits of the salience network: A central pathway in psychiatric disease and treatment (2016) · cites this paper as Cisler et al., 2014
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- Authors
- Cisler, J. M., Steele, J. S., Lenow, J. K., Smitherman, S., Everett, B., Messias, E., & Kilts, C. D.
- Affiliations
- University of Arkansas for Medical Sciences (US)
- Corresponding author
- Cisler, Josh M.
- Venue
- Journal of Psychiatric Research
- Publisher
- Elsevier BV
- Published
- 2014-01
- Volume
- 48
- Issue
- 1
- Pages
- 47-55
- ISSN
- 0022-3956 (ISSN-L)
- PMC
- PMC4019667
- OpenAlex
- W1995740716
- Cited by
- 100
- References
- 62
- Citations by year
- 2026: 7 · 2025: 1 · 2024: 6 · 2023: 4 · 2022: 7 · 2021: 10 · 2020: 9 · 2019: 6 · 2018: 9 · 2017: 7 · 2016: 16 · 2015: 11 · 2014: 7
- FWCI
- 12.60
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of Psychiatric Research (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health
- National Institute of Mental Health (R21MH097784)
- National Institute on Drug Abuse (R21DA025243, R01DA019999, T32DA022981)
- National Center for Research Resources (KL2RR029883, UL1RR029884)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
- Life Sciences › Neuroscience › Cognitive Neuroscience › Memory and Neural Mechanisms
- Life Sciences › Neuroscience › Cognitive Neuroscience › Memory Processes and Influences
- Keywords
- post-traumatic stress disorder, traumatic memory, fear extinction, functional connectivity, amygdala, hippocampus, insula, striatum, medial prefrontal cortex, PTSD symptom severity, sexual assault, physical assault
- MeSH terms
- Adult, Brain, Brain Mapping, Female, Humans, Image Processing, Computer-Assisted, Magnetic Resonance Imaging, Memory Disorders, Oxygen, Stress Disorders, Post-Traumatic, Young Adult
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