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Executive function and PTSD: disengaging from trauma.
Open accessAbstract
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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“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
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“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]
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“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
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“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
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“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
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“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
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“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]
In the citing paper
“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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“…that patients with PTSD show disrupted recruitment of regions implicated in topdown attention (lateral frontal cortices and parietal cortices; Aupperle et al., 2012; Esterman et al., 2013), particularly in the presence of emotional distracters (Blair et al., 2013; New et al., 2009;…”
BackgroundAshley, V., Honzel, N., Larsen, J., Justus, T. C., & Diane Swick, A. (2013) · BMC Psychiatry · doi:10.1186/1471-244x-13-86 · Cited by 97
Clausen, A. N., Francisco, A. J., Thelen, J., Bruce, J. M., Martin, L. E., McDowd, J. M., Simmons, W. K., & Aupperle, R. L. (2017) · Depression and Anxiety · doi:10.1002/da.22613 · Cited by 84
“Related to executive functioning, cognitive inhibition (the ability to disregard distracting information) has face validity concerning its importance for emotion regulation after trauma (Aupperle et al., 2012).”
BackgroundResultSelf-citationNicholson, A. A., Densmore, M., McKinnon, M. C., Neufeld, R. W. J., Frewen, P. A., Théberge, J., Jetly, R., Richardson, J. D., & Lanius, R. A. (2019) · Psychological Medicine · doi:10.1017/s0033291718002866 · Cited by 79
“…and is hypothesized to be related to a disruption of normal interoceptive processing (Nicholson et al ., 2016 b ), where altered insula activation has also been found between PTSD patients and controls (Etkin and Wager, 2007; Aupperle et al ., 2012; Pitman et al ., 2012; Mazza et al ., 2013).”
BackgroundChronicity of Posttraumatic Stress Disorder and Risk of Disability in Older Persons
Byers, A. L., Covinsky, K. E., Neylan, T. C., & Yaffe, K. S. (2014) · JAMA Psychiatry · doi:10.1001/jamapsychiatry.2014.5 · Cited by 78
Atypical visual processing in posttraumatic stress disorder
Mueller‐Pfeiffer, C., Schick, M., Schulte-Vels, T., Tuura, R., Michels, L., Martin-Söelch, C., Blair, J., Rufer, M., Schnyder, U., Zeffiro, T. A., et al. (2013) · NeuroImage Clinical · doi:10.1016/j.nicl.2013.08.009 · Cited by 79
“In agreement with our behavioral results, many previous studies employing visual selective or sustained attention tasks, reported impaired performance including higher reaction times in PTSD (e.g., Jenkins et al., 2000) (for a review, see Aupperle et al., 2012).”
ResultLazarov, A., Suarez‐Jimenez, B., Abend, R., Naim, R., Shvil, E., Helpman, L., Zhu, X., Papini, S., Durosky, A., Rom, R., et al. (2018) · Psychological Medicine · doi:10.1017/s0033291718003367 · Cited by 78
“, 2000; Brewin and Holmes, 2003), including biased attention for threat- and trauma-related information (Chemtob et al., 1988; Foa et al., 1989; Litz and Keane, 1989; Foa et al., 1991; Foa and Rothbaum, 1998; Ehlers and Clark, 2000; Aupperle et al., 2012).”
BackgroundWrocklage, K. M., Schweinsburg, B. C., Krystal, J. H., Trejo, M., Roy, A. M., Weisser, V. D., Moore, T. M., Southwick, S. M., & Scott, J. C. (2016) · Journal of the International Neuropsychological Society · doi:10.1017/s1355617716000059 · Cited by 81
Marin, M.-F., Song, H., VanElzakker, M. B., Staples-Bradley, L. K., Linnman, C., Pace-Schott, E. F., Lasko, N. B., Shin, L. M., & Milad, M. R. (2016) · American Journal of Psychiatry · doi:10.1176/appi.ajp.2015.14111460 · Cited by 74
Improving cognitive control in adolescents with post-traumatic stress disorder (PTSD)
Schweizer, S., Samimi, Z., Hasani, J., Moradi, A., Mirdoraghi, F., & Khaleghi, M. (2017) · Behaviour Research and Therapy · doi:10.1016/j.brat.2017.03.017 · Cited by 80
The Unpredictive Brain Under Threat: A Neurocomputational Account of Anxious Hypervigilance
Cornwell, B. R., Garrido, M. I., Overstreet, C. M., Pine, D. S., & Grillon, C. (2017) · Biological Psychiatry · doi:10.1016/j.biopsych.2017.06.031 · Cited by 73
“Indeed, exaggerated sensory-perceptual responding is considered a central component of hyperarousal in PTSD (3), which likely increases distractibility and disrupts higher cognitive processes (4).”
BackgroundThe Cognitive Impact of Sexual Abuse and PTSD in Children: A Neuropsychological Study
Barrera, M., Calderón, L., & Bell, V. (2013) · Journal of Child Sexual Abuse · doi:10.1080/10538712.2013.811141 · Cited by 72
“Although there is a clear connection between PTSD and difficulties with cognitive inhibition linked to prefrontal cortex function (Aupperle et al., 2012) it is notable that no difference was found between groups of sexually abused children with and without PTSD.”
BackgroundAdverse Life Experiences and Brain Function
Hosseini‐Kamkar, N., Farahani, M. V., Nikolic, M., Stewart, K., Goldsmith, S. F., Soltaninejad, M., Rajabli, R., Lowe, C. J., Nicholson, A. A., Morton, J. B., et al. (2023) · JAMA Network Open · doi:10.1001/jamanetworkopen.2023.40018 · Cited by 80
Rabellino, D., Frewen, P. A., McKinnon, M. C., & Lanius, R. A. (2020) · Frontiers in Neuroscience · doi:10.3389/fnins.2020.586605 · Cited by 69
“In numerous neuroimaging studies of individuals with PTSD, the insula appears hyper-responsive during various tasks involving trauma processing or presentation of emotional stimuli (Lanius et al., 2007; Simmons et al., 2008; Shin and Liberzon, 2010; Aupperle et al., 2012; Brinkmann et al., 2017) and its neural activit…”
BackgroundSamuelson, K. W., Krueger, C. E., & Wilson, C. K. (2012) · Journal of Interpersonal Violence · doi:10.1177/0886260512445385 · Cited by 68
Circuit dysregulation and circuit-based treatments in posttraumatic stress disorder
Sheynin, J., & Liberzon, I. (2017) · Neuroscience Letters · doi:10.1016/j.neulet.2016.11.014 · Cited by 68
“, 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].”
BackgroundCovey, 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 75
“, 1995; van der Kolk, 1987; Wolfe and Charney, 1991), and problems with executive and inhibitory functions (Aupperele et al., 2011; Falconer et al., 2008; Leskin and White, 2007; Shucard et al., 2008; Swick et al., 2012).”
BackgroundNeural 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
“COGNITIVE PROCESSING OF NON-EMOTIONAL INFORMATION Individuals with PTSD show preserved cognition in many domains, but poorer performance during sustained attention as well as memory encoding and retrieval (Vasterling et al., 2002; Aupperle et al., 2012).”
BackgroundMethodInfluentialImproving mental health by training the suppression of unwanted thoughts
Mamat, Z., & Anderson, M. C. (2023) · Science Advances · doi:10.1126/sciadv.adh5292 · Cited by 75
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 71
Diane Swick, A., Honzel, N., Larsen, J., & Ashley, V. (2013) · Neuropsychologia · doi:10.1016/j.neuropsychologia.2013.10.008 · Cited by 66
Bomyea, J., Stein, M. B., & Lang, A. J. (2015) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2015.05.010 · Cited by 61
Self-citationTian, F., Yennu, A. S., Smith‐Osborne, A., Gonzalez-Lima, F., North, C. S., & Liu, H. (2014) · NeuroImage Clinical · doi:10.1016/j.nicl.2014.05.005 · Cited by 63
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 63
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 63
Bomyea, J. A., Johnson, A., & Lang, A. J. (2016) · Psychopathology Review · doi:10.5127/pr.037214 · Cited by 70
Nicholson, A. A., Rabellino, D., Densmore, M., Frewen, P., Paret, C., Kluetsch, R. C., Schmahl, C. G., Théberge, J., Ros, T., Neufeld, R. W. J., et al. (2018) · Human Brain Mapping · doi:10.1002/hbm.24244 · Cited by 63
Alterations in cognitive flexibility in a rat model of post-traumatic stress disorder
George, S. A., Rodriguez-Santiago, M., Riley, J., Abelson, J. L., Floresco, S., & Liberzon, I. (2015) · Behavioural Brain Research · doi:10.1016/j.bbr.2015.02.051 · Cited by 58
Neurobiological indicators of disinhibition in posttraumatic stress disorder
Sadeh, N., Spielberg, J. M., Miller, M. W., Milberg, W., Salat, D. H., Amick, M. M., Fortier, C. B., & McGlinchey, R. E. (2015) · Human Brain Mapping · doi:10.1002/hbm.22829 · Cited by 60
“In regards to PTSD, impaired inhibitory processes have been identified as both a potential vulnerability for the development of the disorder and implicated in the maintenance of posttraumatic stress reactions over time [Aupperle et al., 2012; Jovanovic and Ressler, 2010; Verwoerd et al., 2009].”
BackgroundEffects 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
“Multiple studies have shown that reduced self-capacities interfere with successful completion of psychotherapy for PTSD [19, 20].”
BackgroundMisaki, 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 57
“implicated in attention and working memory (Aupperle et al., 2012) as well as memory representation (Brewin, 2011; Whalley et al.”
InfluentialCognitive Risks in Developmental Psychopathology
Hankin, B. L., Snyder, H. R., & Gulley, L. D. (2016) · Wiley eBooks · doi:10.1002/9781119125556.devpsy308 · Cited by 55
“It is thus possible that individual differences in prefrontal function and resulting differences in EF predispose some people to develop psychopathology, while buffering others (Aupperle et al., 2012).”
BackgroundInfluentialNeurocognitive 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 58
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 56
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
Hvidtfeldt, C., Petersen, J. H., & Norredam, M. (2020) · International Journal of Epidemiology · doi:10.1093/ije/dyz091 · Cited by 64
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 62
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
“Previous studies have demonstrated the strong associations between experiencing trauma (including IPV and sexual assault) and deficits in short term memory, which is a key component of the learning process.(48,49) When working to develop academic safety plans with survivors, advocates and counselors in the community c…”
BackgroundRiley, 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 52
Butt, M., Espinal, E., Aupperle, R. L., Nikulina, V., & Stewart, J. L. (2019) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2019.00368 · Cited by 55
“For instance, MMN and P3a amplitudes are malleable as a function of auditory-based targeted cognitive training in individuals with schizophrenia, with ERP changes predicting verbal learning improvements and reductions in clinical symptoms (190, 191).”
BackgroundSelf-citationBlock, S. R., & Liberzon, I. (2016) · Experimental Neurology · doi:10.1016/j.expneurol.2016.05.009 · Cited by 52
Schäfer, J., Bernstein, A., Zvielli, A., Höfler, M., Wïttchen, H., & Schönfeld, S. (2016) · Depression and Anxiety · doi:10.1002/da.22526 · Cited by 58
“First, this finding challenges the assumption of theoretical accounts that AB towards threat stimuli exclusively contributes to the development[1] and maintenance[1–3] of PTS.”
BackgroundYennu, 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 56
“A recent review article on neuropsychological and neuroimaging studies of PTSD patients highlights the importance of further understanding the PTSD related attentional and inhibitory dysfunctions in order to successfully treat PTSD patients 16 .”
Metadata
- 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.
- Venue
- Neuropharmacology
- Publisher
- Elsevier BV
- Published
- 2012-02
- Volume
- 62
- Issue
- 2
- Pages
- 686-694
- ISSN
- 0028-3908 (ISSN-L)
- 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
- 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 › Clinical Neurology › 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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