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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
Experimental — accuracy not yet measuredIn the citing paper
“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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Self-citationImpact of executive function on efficacy obtaining resources following intimate partner violence
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BackgroundResultNeurocomputational Changes in Inhibitory Control Associated With Prolonged Exposure Therapy
Harlé, K. M., Spadoni, A. D., Norman, S. B., & Simmons, A. N. (2019) · Journal of Traumatic Stress · doi:10.1002/jts.22461 · Cited by 13
“Such alterations generally involve impaired performance combined with hyporecruitment of ventrolateral, medial, and inferior prefrontal regions of the brain in the context of proactive control performance (e.g., cognitive reappraisal, inhibitory control tasks; Aupperle et al., 2012).”
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“The PTSD symptoms are accompanied by lower performance on neuropsychological tests of attention, memory and executive function (e.g. Vasterling et al., 1998; Bremner et al., 2004; Yehuda et al., 2005; Aupperle et al., 2012; Scott et al., 2015).”
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“One explanation for this association is that PTSD-related increases in autonomic arousal impair processes necessary for successful self-re fl ection (e.g., inhibitory control; [5, 29]).”
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“…correlates with increased top-down attentional control (White et al., 2015), whereas the behavioral data show that PTSD patients are characterized by lower levels of executive control both before and after the occurrence the traumatic stressor (Buckley, 2000; Aupperle et al., 2012).”
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“To date, studies of cognitive sequelae of PTSD point to deficits in memory, executive functioning, and attention (Aupperle et al., 2012; Golier and Yehuda, 2002; Qureshi et al., 2011; Vasterling et al., 2002) and a recent meta-analysis in children suggested that maltreatment with PTSD was associated with worse perform…”
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“Less activation of the cingulate cortex in response to trauma-related stimuli is commonly reported in trauma populations with and without PTSD (45,53).”
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“Individual differences in inhibiting unwanted memories can be explained by differences in executive control (Levy and Anderson, 2008), and although authors have yet to establish whether executive functioning disorders are a cause or a consequence of PTSD, executive functions and inhibition are particularly impaired in…”
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“Three distinct stages of altered attentional control to threatening stimuli have been identified in PTSD: (1) detection and approach toward trauma-related stimuli (attentional facilitation); (2) difficulty disengaging from threatening stimuli at the expense of task performance (attentional interference)(22,23); and (3…”
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PTSD symptoms are associated with visual retrieval performance in OEF/OIF/OND veterans
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“Executive functions are hypothesized in explanation of many disorders such as schizophrenia (6), obsessive-compulsive disorder (7), autistic disorder (8), eating disorders (9), panic disorder (10), and posttraumatic stress disorder (11).”
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“However, the causal relationship between PTS symptoms and executive function difficulties remains ambiguous in cross-sectional research designs (Aupperle et al., 2012).”
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“Researchers have suggested that EF deficits contribute to the development of PTSD symptoms due to resulting difficulties with regulating attention and inhibiting responses to emotional or trauma-related stimuli leading to the development of potentially maladaptive coping mechanisms (Aupperle et al., 2012; Ben-Zion et…”
BackgroundResultAttentional bias in post-traumatic stress symptoms or anxiety
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“Others suggest that disrupted EF is a vulnerability factor for the development or worsening of PTSD symptom severity (Aupperle et al., 2012; Jacob et al., 2019; Scott et al., 2020).”
BackgroundMethodBridging the Gap: A Review of Pediatric to Adult Transition of Care in Liver Transplantation
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“EF skills are widely recognized as integral to processing speed, planning, organization, working memory, sustained attention, inhibitory control, and cognitive flexibility [9–12].”
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“Cognitive control de fi cits are one of the core features of PTSD (7) and a signi fi cant factor in treatment resistance (8).”
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Grossman, E. S., Hoffman, Y. S. G., & Shrira, A. (2016) · Stress and Health · doi:10.1002/smi.2679 · Cited by 10
Albanese, B. J., Macatee, R. J., Boffa, J. W., Bryan, C. J., Zvolensky, M. J., & Schmidt, N. B. (2018) · Cognitive Therapy and Research · doi:10.1007/s10608-017-9883-4 · Cited by 8
“Given that cognitive dyscontrol is theorized to be a mechanism linking TBI with PTSS (Aupperle et al. 2012), a cognitive-affective factor that can modulate cognitive dyscontrol would be apt to moderate the effects of TBI on PTSS.”
Segal, A., Pine, D. S., & Bar‐Haim, Y. (2020) · Psychological Medicine · doi:10.1017/s0033291720004304 · Cited by 9
Memory as a cognitive representation of post-traumatic growth
Huang, S.-H., & Gan, Y. (2017) · Anxiety Stress & Coping · doi:10.1080/10615806.2017.1364730 · Cited by 8
“As such, previous research has shown that individuals who have experienced trauma have difficulty in learning and inhibitory functions (Aupperle et al., 2012).”
BackgroundHamidi, F., & Tabar, S. S. (2021) · Iranian Journal of Psychiatry and Clinical Psychology · doi:10.32598/ijpcp.26.3.3190.2 · Cited by 8
Zhang, F., Huang, C., Yan, W., Ouyang, H., & Liu, W. (2024) · Therapeutic Advances in Psychopharmacology · doi:10.1177/20451253241243260 · Cited by 9
“33 In ACT, probes appeared equally often after threatening and neutral stimuli.”
BackgroundRandomized controlled trial of computerized working memory training for Veterans with PTSD
Bomyea, J. A., Caudle, M. M., Bartolovich, A. L., Simmons, A. N., Jak, A. J., & Golshan, S. (2024) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2024.11.072 · Cited by 7
“…symptoms can be conceptualized as a type of interference, whereby trauma-related thoughts and memories intrude into active working memory storage and interfere with goal-directed cognitive activity (Aupperle et al., 2012; Bomyea and Lang, 2015; Gillie and Thayer, 2014; Levy and Anderson, 2008).”
InfluentialAlbanese, B. J., Macatee, R. J., Schmidt, N. B., Leeson, B., Clemans, T. A., Mintz, J., Rudd, M. D., & Bryan, C. J. (2017) · Cognitive Therapy and Research · doi:10.1007/s10608-017-9863-8 · Cited by 7
“It is plausible that the moderating effects of ASCC on the relationship between the number of probable TBIs and PTS arises from the amplification (high ASCC) or suppression (low ASCC) of cognitive dyscontrol symptoms, which are believed to be a mechanism by which the number of probable TBIs influences PTS (Aupperle et…”
Cenkner, D. P., Asnaani, A., DiChiara, C., Harb, G. C., Lynch, K. G., Greene, J. L., & Scott, J. C. (2021) · Frontiers in Psychology · doi:10.3389/fpsyg.2021.625669 · Cited by 7
“, 2002), and executive functioning (Aupperle et al., 2012), with the largest effects observed in immediate verbal memory (i.”
BackgroundCannabinoid use is enhanced by stress and changes conditioned stress responses
Hodebourg, R., Meyerink, M. E., Crow, A. D., Reichel, C. M., Kalivas, P. W., & García‐Keller, C. (2022) · Neuropsychopharmacology · doi:10.1038/s41386-022-01287-4 · Cited by 8
“These studies suggest that stress and drug use share common neural substrates [12, 13].”
BackgroundCueing natural event boundaries improves memory in people with post-traumatic stress disorder
Pitts, B. L., Eisenberg, M. L., Bailey, H. R., & Zacks, J. M. (2023) · Cognitive Research Principles and Implications · doi:10.1186/s41235-023-00478-x · Cited by 7
“One possibility is deficits that occur either earlier in the event processing stream, such as attention to the stimuli (Aupperle et al., 2012), or later, such as consolidation and retrieval.”
BackgroundCan Interacting with Animals Improve Executive Functions? A Systematic Review
Tepper, D. L., Shnookal, J., Howell, T. J., & Bennett, P. C. (2023) · Animals · doi:10.3390/ani13132080 · Cited by 8
“Additionally, impairments in EFs have been associated with dementia [15], mood and anxiety disorders [16,17], and posttraumatic stress disorder (PTSD) [18] as well as with neurodevelopmental conditions such as attention-deficit/hyperactivity disorder (ADHD) [19] and autism spectrum disorder (ASD) [20].”
BackgroundLee, H., Oh, S., Ha, E., Joo, Y., Suh, C., Kim, Y., Jeong, H. S., Lyoo, I. K., Yoon, S. J., & Hong, H. (2023) · Psychiatry Research · doi:10.1016/j.psychres.2023.115345 · Cited by 7
Post-Traumatic Stress Disorder: Evolution of Views
Kryukov, E. V., Shamrey, V. K., Марченко, А. А., Lobachev, A. V., Khabarov, I. Y., & Kolodin, S. N. (2023) · Psikhiatriya · doi:10.30629/2618-6667-2023-21-4-57-71 · Cited by 9
Edgelow, M., Brar, S., & Fecica, A. (2023) · Frontiers in Organizational Psychology · doi:10.3389/forgp.2023.1284650 · Cited by 7
Animal models of liability to post-traumatic stress disorder: going beyond fear memory
Cabib, S., Orsini, C., & Puglisi‐Allegra, S. (2019) · Behavioural Pharmacology · doi:10.1097/fbp.0000000000000475 · Cited by 7
Scotland-Coogan, D. (2019) · The Qualitative Report · doi:10.46743/2160-3715/2019.3573 · Cited by 10
“These are areas that are impaired for those with a diagnosis of PTSD (Aupperle et al., 2012).”
BackgroundNeurological Soft Signs and Post-Traumatic Stress Disorder: A Biomarker of Severity?
Belrose, C., Duffaud, A. M., Rakotoarison, E., Faget, C., Raynaud, P., Dutheil, F., Boyer, L. E., Billaud, J., & Trousselard, M. (2020) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2020.533662 · Cited by 8
Frankel, K. K., Brabeck, K. M., & García, S. A. R. (2021) · Journal of Education for Students Placed at Risk (JESPAR) · doi:10.1080/10824669.2021.1949320 · Cited by 7
Zavros-Orr, A. (2021) · Psychology of Sexualities Review · doi:10.53841/bpssex.2021.12.1.34 · Cited by 7
Rapgay, L., Ross, J. L., Petersen, O., Izquierdo, C., Harms, M., Hawa, S., Riehl, S., Gurganus, A., & Couper, G. E. (2013) · Mindfulness · doi:10.1007/s12671-013-0231-9 · Cited by 11
Duan, H., Wang, L., & Wu, J. (2018) · Scientific Reports · doi:10.1038/s41598-018-35123-x · Cited by 8
Trial-to-trial carryover effects on spatial attentional bias
Gladwin, T. E., & Figner, B. (2019) · Acta Psychologica · doi:10.1016/j.actpsy.2019.04.006 · Cited by 7
Min, D., Kwon, A., Kim, Y., Jin, M. J., Kim, Y.-W., Jeon, H., Kim, S., Jeon, H. J., & Lee, S. (2020) · Brain Topography · doi:10.1007/s10548-020-00754-9 · Cited by 9
Protopopescu, A., O’Connor, C., Cameron, D. H., Boyd, J. E., Lanius, R. A., & McKinnon, M. C. (2022) · Brain Sciences · doi:10.3390/brainsci12030377 · Cited by 11
White, E. J., Demuth, M. J., Nacke, M., Kirlić, N., Kuplicki, R., Spechler, P. A., McDermott, T. J., DeVille, D. C., Stewart, J. L., Lowe, J. R., et al. (2022) · Social Cognitive and Affective Neuroscience · doi:10.1093/scan/nsac045 · Cited by 8
“Higher levels of inhibitory control are associated with lower levels of multiple forms of psychopathology across behavioral and functional brain studies (Aupperle et al., 2012; McTeague et al., 2016; White and Grant, 2017).”
BackgroundSelf-citationTrastorno por estrés postraumático y cerebro
Gómez, R. S. (2013) · Revista de la Asociación Española de Neuropsiquiatría · doi:10.4321/s0211-57352013000300004 · Cited by 9
Patel, G. J., & McDowall, J. (2016) · Journal of EMDR Practice and Research · doi:10.1891/1933-3196.10.1.13 · Cited by 7
“The search for a mechanism of action for eye movements has led to the development of several varying accounts, such as the orienting response and O ne of the most successful treatments for posttraumatic stress disorder (PTSD) is eye movement desensitization and reprocessing (EMDR) with support from controlled studies…”
BackgroundResultInfluentialBunyaratavej, N., Kittimanon, N., & Boonthitikul, S. (2001) · PubMed · Cited by 7
Wu, M., Lin, L., Wu, Y., Zheng, Y., & Chen, H. (2022) · Translational Pediatrics · doi:10.21037/tp-22-289 · Cited by 6
“Patients with PTSD patients have shown significant differences in behavioral levels, including attention, executive ability, and memory (4).”
BackgroundMiller, L. N., Forbes, D., McFarlane, A., Lawrence-Wood, E., Simmons, J., & Felmingham, K. L. (2023) · Scientific Reports · doi:10.1038/s41598-023-48505-7 · Cited by 5
“This suggests high interpersonal trauma led to less resources for monitoring competing task-relevant stimuli, potentially due to difficulty allocating resources away from arousal symptoms towards processing the task at hand 4 .”
BackgroundShahrajabian, F., Hasani, J., Hodgins, D. C., & Griffiths, M. D. (2024) · Journal of Gambling Studies · doi:10.1007/s10899-024-10354-y · Cited by 8
“Disruptions in the networks mediating emotional regulation are related to deficits in cognitive control and work - ing memory (Aupperle et al., 2012 ).”
Mental health of adolescents during times of war
Lipskaya‐Velikovsky, L., Komemi, R., Gilboa, Y., & Nahum, M. (2026) · Psychiatry Research · doi:10.1016/j.psychres.2026.116957 · Cited by 6
Stolz, M. G., Rea, K. E., Cushman, G. K., Quast, L. F., Gutierrez‐Colina, A. M., Eaton, C. K., & Blount, R. L. (2021) · Pediatric Transplantation · doi:10.1111/petr.14176 · Cited by 8
Post-traumatic Stress Disorder and Working Memory: a Systematic Review
Nórte, C. E., Vargas, A. L. V., & Silveira, A. D. C. (2022) · Trends in Psychology · doi:10.1007/s43076-022-00206-2 · Cited by 7
“The findings of the pre-sent study are in accordance with the model proposed by Aupperle et al. (2012), which emphasizes the role of cognitive control in the development and maintenance of symptoms of hyperexcitability and revival through the difficulty of detaching and inhibiting responses to…”
Amir, I., Aizik-Reebs, A., Yuval, K., Hadash, Y., & Bernstein, A. (2023) · Clinical Psychological Science · doi:10.1177/21677026231164958 · Cited by 6
“The current findings support extant theory and findings implicating executive dysfunctions, and specifically deficits in CI (DeGutis et al., 2015; van der Bij et al., 2020), in posttraumatic stress (Aupperle et al., 2012) and extend these findings to trauma-affected FDP.”
BackgroundResultInfluentialDomain-specific associations between psychopathology and neurocognitive functioning
Zoupou, E., Moore, T. M., Calkins, M. E., Gur, R. E., Gur, R. C., & Scott, J. C. (2024) · Psychological Medicine · doi:10.1017/s0033291724001302 · Cited by 8
“Neurocognitive dysfunction is common in psychiatric disorders including schizophrenia (Reichenberg, 2010; Saykin et al., 1991), posttraumatic stress (Aupperle, Melrose, Stein, & Paulus, 2012; Scott et al., 2015), and mood disorders (Bredemeier, Warren, Berenbaum, Miller, & Heller, 2016; Merikangas…”
Sahragard, M., Alipour, A., Zare, H., Roshan, R., & Moodi, M. (2018) · مجله طب جانباز · doi:10.29252/ijwph.10.4.187 · Cited by 6
Sopp, M. R., Streb, M., Brueckner, A. H., Schäfer, S. K., Lass‐Hennemann, J., Mecklinger, A., & Michael, T. (2020) · Journal of Behavior Therapy and Experimental Psychiatry · doi:10.1016/j.jbtep.2020.101611 · Cited by 6
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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