Executive function and PTSD: disengaging from trauma.

Aupperle, Robin L.; Melrose, Andrew J.; Stein, Murray B.; Paulus, Martin P.

doi:10.1016/j.neuropharm.2011.02.008

Cited by 657Posttraumatic Stress Disorder ResearchTraumatic Brain Injury ResearchPsychoanalysis and Psychopathology Research

Executive function and PTSD: disengaging from trauma.

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Aupperle, Robin L., Melrose, Andrew J., Stein, Murray B., Paulus, Martin P.·2012·Neuropharmacology

DOI 10.1016/j.neuropharm.2011.02.008PMC PMC4719148

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Abstract

Neuropsychological approaches represent an important avenue for identifying susceptibility and resiliency factors relating to the development and maintenance of posttraumatic stress disorder (PTSD) symptoms post-trauma. This review will summarize results from prospective longitudinal and retrospective cross-sectional studies investigating executive function associated with PTSD. This research points specifically towards subtle impairments in response inhibition and attention regulation that may predate trauma exposure, serve as risk factors for the development of PTSD, and relate to the severity of symptoms. These impairments may be exacerbated within emotional or trauma-related contexts, and may relate to dysfunction within dorsal prefrontal networks. A model is presented concerning how such impairments may contribute to the clinical profile of PTSD and lead to the use of alternative coping styles such as avoidance. Further neuropsychological research is needed to identify the effects of treatment on cognitive function and to potentially characterize mechanisms of current PTSD treatments. Knowledge gained from cognitive and neuroscientific research may prove valuable for informing the future development of novel, more effective, treatments for PTSD. This article is part of a Special Issue entitled 'Post-Traumatic Stress Disorder'.

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Individuals with PTSD have shown impairments in executive dysfunction that can be traced to the prefrontal cortex.
“Finally, individuals with PTSD have shown impairments in executive dysfunction that can be traced to the prefrontal cortex (Shin et al., 2006; Hopper et al., 2007; Aupperle et al., 2012; Swick et al., 2013; DeGutis et al., 2015; Fenster et al., 2018; Holmes et al., 2018; Lebois et al., 2020).”
From How Processing of Sensory Information From the Internal and External Worlds Shape the Perception and Engagement With the World in the Aftermath of Trauma: Implications for PTSD (2021) · cites this paper as Aupperle et al., 2012
The Abstract reports subtle impairments in response inhibition and attention regulation in PTSD and says they may relate to dysfunction in dorsal prefrontal networks. The Discussion likewise describes altered prefrontal activation during relevant tasks, but does not establish that the impairments can definitively be traced to the prefrontal cortex. (LLM, conf=0.83)
Experimental — accuracy not yet measured
PTSD has been linked to impaired attention regulation and inhibitory control.
“PTSD has been linked to impaired attention regulation and inhibitory control [[13], [14], [15], [16]].”
From A randomized controlled trial of yoga vs nonaerobic exercise for veterans with PTSD: Understanding efficacy, mechanisms of change, and mode of delivery (2021) · cites this paper as [13]
Individuals with post traumatic stress disorder do experience inhibition deficits.
“However, a review of the literature including a wider range of inhibition tasks suggests that individuals with PTSD do experience inhibition deficits (Aupperle et al., 2012).”
From Advancing understanding of executive function impairments and psychopathology: bridging the gap between clinical and cognitive approaches (2015) · cites this paper as Aupperle et al., 2012
There is inconsistent evidence for planning deficits associated with post traumatic stress disorder.
“Finally, there is inconsistent evidence for planning deficits associated with PTSD (Aupperle et al., 2012).”
From Advancing understanding of executive function impairments and psychopathology: bridging the gap between clinical and cognitive approaches (2015) · cites this paper as Aupperle et al., 2012
Semantic verbal fluency is impaired in individuals with bipolar disorders (medium effect sizes), obsessive compulsive disorder (small effect sizes), and attention deficit hyperactivity disorder (small effect sizes), while there is inconsistent evidence for verbal fluency in individuals with post traumatic stress disorder.
“Semantic verbal fluency is also impaired in individuals with BD (medium effect sizes), OCD (small effect sizes), and ADHD (small effect sizes), while there is inconsistent evidence for verbal fluency in individuals with PTSD (Aupperle et al., 2012).”
From Advancing understanding of executive function impairments and psychopathology: bridging the gap between clinical and cognitive approaches (2015) · cites this paper as Aupperle et al., 2012

The dorsal prefrontal cortex is critical for multisensory integration and its activation is necessary for carrying out additional executive functioning tasks, including emotion regulation.
“As described above, the dorsal prefrontal cortex is thought to be critical for multisensory integration (Aupperle et al., 2012; Picó-Pérez et al., 2017) and its activation is necessary for carrying out additional executive functioning tasks, including emotion regulation (Menon, 2011; Cromheeke and Mueller, 2014).”
From How Processing of Sensory Information From the Internal and External Worlds Shape the Perception and Engagement With the World in the Aftermath of Trauma: Implications for PTSD (2021) · cites this paper as Aupperle et al., 2012
Aupperle et al. is cited for the sentence’s first clause, concerning multisensory integration; the later claim about executive functioning and emotion regulation has different citations. Section 4 discusses dorsal prefrontal regions in attention, working memory and inhibition, but the passages found do not address multisensory integration (searched: “multisensory integration” and “integration of sensory modalities”). Page numbers were not available in our copy. (LLM, conf=0.72)
Experimental — accuracy not yet measured
At the center of the cognitive control disturbance in PTSD is difficulty disengaging attention from salient stimuli that may be interpreted as potentially threatening, even if neutral or positively valenced.
“At the center of the cognitive control disturbance is difficulty disengaging attention from salient stimuli that may be interpreted as potentially threatening, even if neutral or positively valenced”
From Exercise Intervention in PTSD: A Narrative Review and Rationale for Implementation (2019) · cites this paper as [75]
The resulting intrusions and arousal can contribute to deficits in neuropsychological functions such as concentration, sustained attention, executive control, and working memory.
“The resulting intrusions and arousal can contribute to the welldocumented deficits in neuropsychological functions such as concentration, sustained attention, executive control, and working memory 111 .”
From Post‐traumatic stress disorder: a state‐of‐the‐art review of evidence and challenges (2019) · cites this paper as [111]

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Single prolonged stress impairs social and object novelty recognition in rats
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Direct suppression as a mechanism for controlling unpleasant memories in daily life.
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How Processing of Sensory Information From the Internal and External Worlds Shape the Perception and Engagement With the World in the Aftermath of Trauma: Implications for PTSD
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Executive function in posttraumatic stress disorder (PTSD) and the influence of comorbid depression
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Using fMRI connectivity to define a treatment-resistant form of post-traumatic stress disorder
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A review of the relation between dissociation, memory, executive functioning and social cognition in military members and civilians with neuropsychiatric conditions
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“…et al., 2011), MDD (Marazziti et al., 2010; Millan et al., 2012; Rock et al., 2014), bipolar disorder (Lee et al., 2014; Millan et al., 2012), OCD (Shin et al., 2014), and both civilian and combat-related PTSD (Aupperle et al., 2012; Millan et al., 2012; Polak et al., 2012; Scott et al., 2014).”
The effectiveness of an attention bias modification program as an adjunctive treatment for Post-Traumatic Stress Disorder
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Dispositional negativity, cognition, and anxiety disorders: An integrative translational neuroscience framework
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Classifying heterogeneous presentations of PTSD via the default mode, central executive, and salience networks with machine learning
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Posttraumatic Psychological Symptoms are Associated with Reduced Inhibitory Control, not General Executive Dysfunction
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A Double-Blind, Randomized, Controlled Pilot Trial of N-Acetylcysteine in Veterans With Posttraumatic Stress Disorder and Substance Use Disorders
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Individual differences in resting heart rate variability and cognitive control in posttraumatic stress disorder
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The Computational, Pharmacological, and Physiological Determinants of Sensory Learning under Uncertainty
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PTSD symptom severity is associated with increased recruitment of top-down attentional control in a trauma-exposed sample
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Attentional bias for trauma-related words: exaggerated emotional Stroop effect in Afghanistan and Iraq war veterans with PTSD
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PTSD and cognitive symptoms relate to inhibition-related prefrontal activation and functional connectivity
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Machine learning multivariate pattern analysis predicts classification of posttraumatic stress disorder and its dissociative subtype: a multimodal neuroimaging approach
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Chronicity of Posttraumatic Stress Disorder and Risk of Disability in Older Persons
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Atypical visual processing in posttraumatic stress disorder
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Bias-contingent attention bias modification and attention control training in treatment of PTSD: a randomized control trial
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Neuropsychological Functioning in Veterans with Posttraumatic Stress Disorder: Associations with Performance Validity, Comorbidities, and Functional Outcomes
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Association of Resting Metabolism in the Fear Neural Network With Extinction Recall Activations and Clinical Measures in Trauma-Exposed Individuals
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Improving cognitive control in adolescents with post-traumatic stress disorder (PTSD)
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The Unpredictive Brain Under Threat: A Neurocomputational Account of Anxious Hypervigilance
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The Cognitive Impact of Sexual Abuse and PTSD in Children: A Neuropsychological Study
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Adverse Life Experiences and Brain Function
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Peripersonal Space and Bodily Self-Consciousness: Implications for Psychological Trauma-Related Disorders
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Relationships Between Maternal Emotion Regulation, Parenting, and Children’s Executive Functioning in Families Exposed to Intimate Partner Violence
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Circuit dysregulation and circuit-based treatments in posttraumatic stress disorder
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“, attention, inhibitory function) that are often seen in PTSD also relate to dysfunction within dorsal prefrontal networks and are exacerbated within emotional or trauma-related context [60].”
Background
The effects of exposure to traumatic stressors on inhibitory control in police officers: A dense electrode array study using a Go/NoGo continuous performance task
Covey, T. J., Shucard, J. L., Violanti, J. M., Lee, J., & Shucard, D. W. (2013) · International Journal of Psychophysiology · doi:10.1016/j.ijpsycho.2013.03.009 · Cited by 67 · see citing works
Neural systems for cognitive and emotional processing in posttraumatic stress disorder.
Brown, V. M., & Morey, R. A. (2012) · Frontiers in Psychology · doi:10.3389/fpsyg.2012.00449 · Cited by 67 · see citing works
Improving mental health by training the suppression of unwanted thoughts
Mamat, Z., & Anderson, M. C. (2023) · Science Advances · doi:10.1126/sciadv.adh5292 · Cited by 65 · see citing works
Executive Dysfunctions: The Role in Attention Deficit Hyperactivity and Post-traumatic Stress Neuropsychiatric Disorders
Martínez, L., Sarmiento, E. L. P., Satler, C. E., Tavares, M. C. H., & Tomaz, C. A. B. (2016) · Frontiers in Psychology · doi:10.3389/fpsyg.2016.01230 · Cited by 68 · see citing works
Increased response variability as a marker of executive dysfunction in veterans with post-traumatic stress disorder
Diane Swick, A., Honzel, N., Larsen, J., & Ashley, V. (2013) · Neuropsychologia · doi:10.1016/j.neuropsychologia.2013.10.008 · Cited by 64 · see citing works
Interference control training for PTSD: a randomized controlled trial of a novel computer-based intervention
Bomyea, J., Stein, M. B., & Lang, A. J. (2015) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2015.05.010 · Cited by 61 · see citing works
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Prefrontal responses to digit span memory phases in patients with post-traumatic stress disorder (PTSD): A functional near infrared spectroscopy study
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Alteration of BDNF in the medial prefrontal cortex and the ventral hippocampus impairs extinction of avoidance
Rosas-Vidal, L. E., Lozada-Miranda, V., Cantres-Rosario, Y. M., Vega-Medina, A., Meléndez, L. M., & Quirk, G. J. (2018) · Neuropsychopharmacology · doi:10.1038/s41386-018-0176-8 · Cited by 62 · see citing works
Worse baseline executive functioning is associated with dropout and poorer response to trauma-focused treatment for veterans with PTSD and comorbid traumatic brain injury
Crocker, L. D., Jurick, S. M., Thomas, K. R., Keller, A. V., Sanderson‐Cimino, M. E., Boyd, B. L., Rodgers, C. S., Twamley, E. W., & Jak, A. J. (2018) · Behaviour Research and Therapy · doi:10.1016/j.brat.2018.07.004 · Cited by 59 · see citing works
Information Processing in PTSD: Evidence for Biased Attentional, Interpretation, and Memory Processes
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Intrinsic connectivity network dynamics in PTSD during amygdala downregulation using real‐time fMRI neurofeedback: A preliminary analysis
Nicholson, A., Rabellino, D., Densmore, M., Frewen, P., Paret, C., Kluetsch, R., Schmahl, C., Théberge, J., Ros, T., Neufeld, R., et al. (2018) · Human Brain Mapping · doi:10.1002/hbm.24244 · Cited by 54 · see citing works
Alterations in cognitive flexibility in a rat model of post-traumatic stress disorder
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Neurobiological indicators of disinhibition in posttraumatic stress disorder
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Effects of MDMA-assisted therapy for PTSD on self-experience
van der Kolk, B. A., Wang, J. B., Yehuda, R., Bedrosian, L., Coker, A. R., Harrison, C., Mithoefer, M., Yazar-Klosinki, B., Emerson, A., & Doblin, R. (2024) · PLoS ONE · doi:10.1371/journal.pone.0295926 · Cited by 55 · see citing works
“Multiple studies have shown that reduced self-capacities interfere with successful completion of psychotherapy for PTSD [19, 20].”
Background
Connectome-wide investigation of altered resting-state functional connectivity in war veterans with and without posttraumatic stress disorder
Misaki, M., Phillips, R., Zotev, V. S., Wong, C. K., Wurfel, B. E., Krüeger, F., Feldner, M. T., & Bodurka, J. (2017) · NeuroImage Clinical · doi:10.1016/j.nicl.2017.10.032 · Cited by 56 · see citing works
Cognitive Risks in Developmental Psychopathology
Hankin, B., Snyder, H. R., & Gulley, L. D. (2016) · Wiley eBooks · doi:10.1002/9781119125556.devpsy308 · Cited by 58 · see citing works
Neurocognitive Correlates of Successful Treatment of PTSD in Female Veterans
Haaland, K. Y., Sadek, J. R., Keller, J. E., & Castillo, D. T. (2016) · Journal of the International Neuropsychological Society · doi:10.1017/s1355617716000424 · Cited by 55 · see citing works
Posttraumatic stress disorder and positive memories: Clinical considerations
Contractor, A. A., Brown, L. A., Caldas, S. V., Banducci, A. N., Taylor, D. J., Armour, C., & Shea, M. T. (2018) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2018.06.007 · Cited by 54 · see citing works
BDNF Val66Met polymorphism and posttraumatic stress symptoms in U.S. military veterans: Protective effect of physical exercise
Pitts, B. L., Whealin, J. M., Harpaz‐Rotem, I., Duman, R. S., Krystal, J. H., Southwick, S. M., & Pietrzak, R. H. (2018) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2018.10.011 · Cited by 56 · see citing works
Prolonged periods of waiting for an asylum decision and the risk of psychiatric diagnoses: a 22-year longitudinal cohort study from Denmark
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A Systematic Review of Childhood Adversity and Executive Functions Outcomes among Adults
Lund, J. I., Boles, K., Radford, A., Toombs, E., & Mushquash, C. J. (2022) · Archives of Clinical Neuropsychology · doi:10.1093/arclin/acac013 · Cited by 53 · see citing works
Intimate partner violence, trauma, and mental health need among female community college students
Schrag, R. V., & Edmond, T. E. (2018) · Journal of American College Health · doi:10.1080/07448481.2018.1456443 · Cited by 53 · see citing works
Clinically significant cognitive dysfunction in OEF/OIF/OND veterans: Prevalence and clinical associations.
Riley, E., Mitko, A., Stumps, A. D., Robinson, M. E., Milberg, W., McGlinchey, R. E., Esterman, M. S., & Degutis, J. M. (2019) · Neuropsychology · doi:10.1037/neu0000529 · Cited by 53 · see citing works
The Electrical Aftermath: Brain Signals of Posttraumatic Stress Disorder Filtered Through a Clinical Lens
Butt, M., Espinal, E., Aupperle, R. L., Nikulina, V., & Stewart, J. L. (2019) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2019.00368 · Cited by 52 · see citing works
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Attentional processes in posttraumatic stress disorder and the associated changes in neural functioning
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ATTENTIONAL BIAS TEMPORAL DYNAMICS PREDICT POSTTRAUMATIC STRESS SYMPTOMS: A PROSPECTIVE-LONGITUDINAL STUDY AMONG SOLDIERS
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Prefrontal responses to Stroop tasks in subjects with post-traumatic stress disorder assessed by functional near infrared spectroscopy
Yennu, A. S., Tian, F., Smith‐Osborne, A., Gatchel, R. J., Woon, F. L. M., & Liu, H. (2016) · Scientific Reports · doi:10.1038/srep30157 · Cited by 51 · see citing works

Executive Function in Posttraumatic Stress Disorder
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A meta-analysis of the relationship between symptom severity of Posttraumatic Stress Disorder and executive function
Woon, F. L. M., Farrer, T. J., Braman, C. R., Mabey, J. K., & Hedges, D. W. (2016) · Cognitive Neuropsychiatry · doi:10.1080/13546805.2016.1255603 · Cited by 61 · see citing works
Impaired executive function exacerbates neural markers of posttraumatic stress disorder
Jagger-Rickels, A. C., Stumps, A. D., Rothlein, D., Park, H., Fortenbaugh, F. C., Zuberer, A., Fonda, J. R., Fortier, C. B., Degutis, J. M., Milberg, W., et al. (2021) · Psychological Medicine · doi:10.1017/s0033291721000842 · Cited by 18 · see citing works
More than symptom reduction: Changes in executive function over the course of PTSD treatment
Walter, K. H., Palmieri, P. A., & Gunstad, J. (2010) · Journal of Traumatic Stress · doi:10.1002/jts.20506 · Cited by 83 · see citing works
Attentional networks reveal executive function deficits in posttraumatic stress disorder.
Leskin, L. P., & White, P. M. (2007) · Neuropsychology · doi:10.1037/0894-4105.21.3.275 · Cited by 210 · see citing works

Authors: Aupperle, R. L., Melrose, A. J., Stein, M. B., & Paulus, M. P.
Affiliations: University of California San Diego (US)
Corresponding author: Aupperle, Robin L.
ORCID: Aupperle, Robin L.
Stein, Murray B.
Paulus, Martin P.
Venue: Neuropharmacology
Publisher: Elsevier BV
Published: 2012-02
Volume: 62
Issue: 2
Pages: 686-694
ISSN: 0028-3908 (ISSN-L)
DOI: 10.1016/j.neuropharm.2011.02.008
PMC: PMC4719148
OpenAlex: W2106557234
Cited by: 657
References: 147
Citations by year: 2026: 30 · 2025: 33 · 2024: 47 · 2023: 48 · 2022: 49 · 2021: 58 · 2020: 65 · 2019: 62 · 2018: 58 · 2017: 46 · 2016: 49 · 2015: 44 · 2014: 27 · 2013: 20 · 2012: 14
FWCI: 3.18
Type: journal article
Language: en
Open access: green
www.ncbi.nlm.nih.gov
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations: Neuropharmacology (publishedVersion)
PubMed (publishedVersion)
PubMed Central (acceptedVersion)
Funders: National Institute on Drug Abuse (R01DA016663)
Topics: Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
Health Sciences › Medicine › Epidemiology › Traumatic Brain Injury Research
Social Sciences › Psychology › Clinical Psychology › Psychoanalysis and Psychopathology Research
Keywords: post-traumatic stress disorder, executive function, response inhibition, attentional control, prefrontal cortex, avoidance coping, risk factors, symptom severity, trauma exposure, neuropsychological assessment, PTSD treatment
MeSH terms: Adaptation, Psychological, Attention, Humans, Inhibition, Psychological, Memory, Short-Term, Stress Disorders, Post-Traumatic, Executive Function

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Executive function and PTSD: disengaging from trauma.

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