Regional cerebral blood flow correlated with flashback intensity in patients with posttraumatic stress disorder
Abstract
Background Nuclear imaging studies have examined cerebral blood flow (rCBF) in subjects with posttraumatic stress disorder (PTSD) using symptom evocation paradigms. To date, no such studies have investigated rCBF as related to subjects' reports of flashback intensity.Methods Subjects with varying traumatic histories and longstanding PTSD were studied using [15O]-H2O positron emission tomography with an auditory script of their traumatic event. Eight subjects had three resting scans followed by their script and additional scans. Heart rate responses as well as the presence of flashbacks and their intensity were recorded. rCBF was correlated with flashback intensity in each subject's scan. Combined analysis of all subjects' data yielded common regions related to the flashback experience.Results rCBF correlated directly with flashback intensity in the brainstem, lingula, bilateral insula, right putamen and left hippocampal and perihippocampal, somatosensory and cerebellar regions. Inverse correlations with rCBF were found in bilateral dorsolateral prefrontal, right fusiform and right medial temporal cortices.Conclusions This study correlated flashback intensity and rCBF in a group of patients with chronic PTSD suggesting involvement of brainstem, and areas associated with motor control, complex visual/spatial cues and memory.
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The insula is related to body awareness and associated with both mindfulness training and traumatic re-experiencing.
“The insula is related to body awareness and associated with both mindfulness training [58–60], and traumatic re-experiencing [61–63].”
From Childhood trauma and subclinical PTSD symptoms predict adverse effects and worse outcomes across two mindfulness-based programs for active depression (2025) · cites this paper as [62]
Insula responsivity to negative images in individuals with PTSD has been shown to be positively correlated with hyperarousal symptoms, re-experiencing symptoms and flashback intensity.
“Indeed, insula responsivity to negative images in individuals with PTSD has previously been shown to be positively correlated with hyperarousal symptoms,19 re-experiencing symptoms63 and flashback intensity.64”
From Altered resting-state amygdala functional connectivity in men with posttraumatic stress disorder (2012) · cites this paper as [63]
Cites
Statistical parametric maps in functional imaging: A general linear approach
Friston, K. J., Holmes, A. P., Worsley, K. J., Poline, J. ‐., Frith, C. D., & Frackowiak, R. S. J. (1994) · Human Brain Mapping · doi:10.1002/hbm.460020402 · Cited by 9,688 · see citing works
Assessing the significance of focal activations using their spatial extent
Friston, K. J., Worsley, K. J., Frackowiak, R. S. J., Mazziotta, J. C., & Evans, A. C. (1994) · Human Brain Mapping · doi:10.1002/hbm.460010306 · Cited by 1,907 · see citing works
Rauch, S. L., Whalen, P. J., Shin, L. M., McInerney, S. C., Macklin, M. L., Lasko, N. B., Orr, S. P., & Pitman, R. K. (2000) · Biological Psychiatry · doi:10.1016/s0006-3223(00)00828-3 · Cited by 1,111 · see citing works
Rauch, S. L. (1996) · Archives of General Psychiatry · doi:10.1001/archpsyc.1996.01830050014003 · Cited by 1,056 · see citing works
Brain blood flow measured with intravenous H2(15)O. II. Implementation and validation.
Raichle, M. E., Martin, W. R. W., Herscovitch, P., Mintun, M. A., & Markham, J. (1983) · PubMed · Cited by 1,015 · see citing works
Self-citationThe Relationship between Global and Local Changes in PET Scans
Friston, K. J., Frith, C., Liddle, P. F., Dolan, R. J., Lammertsma, A. A., & Frackowiak, R. S. J. (1990) · Journal of Cerebral Blood Flow & Metabolism · doi:10.1038/jcbfm.1990.88 · Cited by 858 · see citing works
Brain blood flow measured with intravenous H2(15)O. I. Theory and error analysis.
Herscovitch, P., Markham, J., & Raichle, M. E. (1983) · PubMed · Cited by 835 · see citing works
Self-citationBremner, J. D., Staib, L. H., Kaloupek, D. G., Southwick, S. M., Soufer, R., & Charney, D. S. (1999) · Biological Psychiatry · doi:10.1016/s0006-3223(98)00297-2 · Cited by 704 · see citing works
Bremner, J. D., Narayan, M., Staib, L. H., Southwick, S. M., McGlashan, T., & Charney, D. S. (1999) · American Journal of Psychiatry · doi:10.1176/ajp.156.11.1787 · Cited by 701 · see citing works
Functional anatomical studies of explicit and implicit memory retrieval tasks
Buckner, R. L., Petersen, S., Ojemann, J. G., Miezin, F. M., Squire, L., & Raichle, M. E. (1995) · Journal of Neuroscience · doi:10.1523/jneurosci.15-01-00012.1995 · Cited by 678 · see citing works
Shin, L. M., McNally, R. J., Kosslyn, S. M., Thompson, W. L., Rauch, S. L., Alpert, N. M., Metzger, L. J., Lasko, N. B., Orr, S. P., & Pitman, R. K. (1999) · American Journal of Psychiatry · doi:10.1176/ajp.156.4.575 · Cited by 647 · see citing works
Brain activation in PTSD in response to trauma-related stimuli
Liberzon, I., Taylor, S. F., Amdur, R., Jung, T. D., Chamberlain, K. R., Minoshima, S., Koeppe, R. A., & Fig, L. M. (1999) · Biological Psychiatry · doi:10.1016/s0006-3223(98)00246-7 · Cited by 635 · see citing works
A Stereotactic Method of Anatomical Localization for Positron Emission Tomography
Fox, P. T., Perlmutter, J. S., & Raichle, M. E. (1985) · Journal of Computer Assisted Tomography · doi:10.1097/00004728-198501000-00025 · Cited by 576 · see citing works
Visual Imagery and Perception in Posttraumatic Stress Disorder
Shin, L. M. (1997) · Archives of General Psychiatry · doi:10.1001/archpsyc.1997.01830150057010 · Cited by 446 · see citing works
Rauch, S. L., Savage, C. R., Alpert, N. M., Fischman, A. J., & Jenike, M. A. (1997) · Biological Psychiatry · doi:10.1016/s0006-3223(97)00145-5 · Cited by 393 · see citing works
A Functional Anatomy of Anticipatory Anxiety
Chua, P. M.-L., Krams, M., Toni, I., Passingham, R. E., & Dolan, R. J. (1999) · NeuroImage · doi:10.1006/nimg.1999.0407 · Cited by 339 · see citing works
Nakamura, K. (2000) · Brain · doi:10.1093/brain/123.9.1903 · Cited by 325 · see citing works
Bremner, J. D. (1997) · Archives of General Psychiatry · doi:10.1001/archpsyc.1997.01830150070011 · Cited by 299 · see citing works
Regional cerebral metabolism associated with anxiety symptoms in affective disorder patients
Osuch, E. A., Ketter, T. A., Kimbrell, T. A., George, M. S., Benson, B. E., Herscovitch, M. W. W., & Post, R. M. (2000) · Biological Psychiatry · doi:10.1016/s0006-3223(00)00920-3 · Cited by 196 · see citing works
Self-citationBrain blood flow in anxiety disorders
Lucey, J. V., Costa, D. C., Adshead, G. M. J., Deahl, M., Busatto, G. F., Gacinovic, S., Travis, M. J., Pilowsky, L. S., Ell, P. J., Marks, I. M., et al. (1997) · The British Journal of Psychiatry · doi:10.1192/bjp.171.4.346 · Cited by 151 · see citing works
Medial frontal cortex involvement in PTSD symptoms: a spect study
Zubieta, J., Chinitz, J. A., Lombardi, U., Fig, L. M., Cameron, O. G., & Liberzon, I. (1999) · Journal of Psychiatric Research · doi:10.1016/s0022-3956(98)00060-0 · Cited by 132 · see citing works
Semple, W. E., Goyer, P. F., McCormick, R., Compton-Toth, B. A., Morris, E. D., Donovan, B. S., Muswick, G. J., Nelson, D. P., Garnett, M. L., Sharkoff, J., et al. (1996) · Psychiatry Research Neuroimaging · doi:10.1016/0925-4927(96)02735-7 · Cited by 88 · see citing works
Ketter, T. A., Kimbrell, T. A., George, M. S., Willis, M. W., Benson, B. E., Danielson, A., Frye, M. A., Herscovitch, P., & Post, R. M. (1999) · Biological Psychiatry · doi:10.1016/s0006-3223(99)00210-3 · Cited by 70 · see citing works
Self-citationNeural correlates of semantic associative encoding in episodic memory
Lepage, M., Habib, R., Cormier, H. C., Houle, S., & McIntosh, A. R. (2000) · Cognitive Brain Research · doi:10.1016/s0926-6410(00)00005-7 · Cited by 67 · see citing works
Semple, W. E., Goyer, P. F., McCormick, R., Morris, E. D., Compton-Toth, B. A., Muswick, G. J., Nelson, D. P., Donovan, B. S., Leisure, G., Berridge, M. S., et al. (1993) · Biological Psychiatry · doi:10.1016/0006-3223(93)90264-e · Cited by 60 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
The Neurocircuitry of Fear, Stress, and Anxiety Disorders
Shin, L. M., & Liberzon, I. (2010) · Neuropsychopharmacology · doi:10.1038/npp.2009.83 · Cited by 2,083 · see citing works
Amygdala, medial prefrontal cortex, and hippocampal function in PTSD
SHIN, L. M., RAUCH, S. L., & PITMAN, R. K. (2006) · Annals of the New York Academy of Sciences · doi:10.1196/annals.1364.007 · Cited by 1,203 · see citing works
Shin, L. M., Orr, S. P., Carson, M. A., Rauch, S. L., Macklin, M. L., Lasko, N. B., Peters, P. M., Metzger, L. J., Dougherty, D. D., Cannistraro, P. A., et al. (2004) · Archives of General Psychiatry · doi:10.1001/archpsyc.61.2.168 · Cited by 790 · see citing works
The functional neuroanatomy of PTSD: a critical review
Liberzon, I., & Sripada, C. S. (2007) · Progress in Brain Research · doi:10.1016/s0079-6123(07)67011-3 · Cited by 594 · see citing works
Crippa, J. A. S., Derenusson, G. N., Ferrari, T. B., Wichert-Ana, L., Duran, F. L., Martin-Santos, R., Simões, M. V., Bhattacharyya, S., Fusar-Poli, P., Atakan, Z., et al. (2011) · Journal of Psychopharmacology · doi:10.1177/0269881110379283 · Cited by 535 · see citing works
Lanius, R. A., Williamson, P. C., Boksman, K., Densmore, M., Gupta, M., Neufeld, R. W. J., Gati, J. S., & Menon, R. S. (2002) · Biological Psychiatry · doi:10.1016/s0006-3223(02)01367-7 · Cited by 505 · see citing works
Brain circuit dysfunction in post-traumatic stress disorder: from mouse to man
Fenster, R. J., Lebois, L. A. M., Ressler, K. J., & Suh, J. (2018) · Nature Reviews Neuroscience · doi:10.1038/s41583-018-0039-7 · Cited by 456 · see citing works
Altered resting-state amygdala functional connectivity in men with posttraumatic stress disorder
Sripada, R. K., King, A. P., Garfinkel, S. N., Wang, X., Sripada, C. S., Welsh, R. C., & Liberzon, I. (2012) · Journal of Psychiatry and Neuroscience · doi:10.1503/jpn.110069 · Cited by 352 · see citing works
Banich, M. T., Mackiewicz, K. L., Depue, B. E., Whitmer, A. J., Miller, G. A., & Heller, W. (2009) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2008.09.010 · Cited by 343 · see citing works
Effects of cannabidiol (CBD) on regional cerebral blood flow
Crippa, J. A. D. S., Zuardi, A. W., Garrido, G. E. J., Wichert-Ana, L., Guarnieri, R., Ferrari, L., Azevedo-Marques, P. M., Hallak, J. E. C., McGuire, P. K., & Busatto, G. F. (2004) · Neuropsychopharmacology · doi:10.1038/sj.npp.1300340 · Cited by 307 · see citing works
Functional neuroimaging studies of post-traumatic stress disorder
Hughes, K. C., & Shin, L. M. (2011) · Expert Review of Neurotherapeutics · doi:10.1586/ern.10.198 · Cited by 290 · see citing works
Waiting for spiders: Brain activation during anticipatory anxiety in spider phobics
Straube, T., Mentzel, H.-J., & Miltner, W. H. R. (2007) · NeuroImage · doi:10.1016/j.neuroimage.2007.06.023 · Cited by 282 · see citing works
Corticolimbic blood flow in posttraumatic stress disorder during script-driven imagery
Britton, J. C., Phan, K. L., Taylor, S. F., Fig, L. M., & Liberzon, I. (2005) · Biological Psychiatry · doi:10.1016/j.biopsych.2004.12.025 · Cited by 265 · see citing works
Lanius, R. A., Williamson, P. C., Bluhm, R. L., Densmore, M., Boksman, K., Neufeld, R. W. J., Gati, J. S., & Menon, R. S. (2005) · Biological Psychiatry · doi:10.1016/j.biopsych.2005.01.011 · Cited by 260 · see citing works
The nature of traumatic memories: a 4-T FMRI functional connectivity analysis
Lanius, R. A., Williamson, P. C., Densmore, M., Boksman, K., Neufeld, R. W., Gati, J. S., & Menon, R. S. (2004) · American Journal of Psychiatry · doi:10.1176/appi.ajp.161.1.36 · Cited by 262 · see citing works
Autobiographical memory for trauma: update on four controversies
Brewin, C. R. (2007) · Memory · doi:10.1080/09658210701256423 · Cited by 242 · see citing works
Altered amygdala resting-state functional connectivity in post-traumatic stress disorder
Rabinak, C. A., Angstadt, M., Welsh, R. C., Kenndy, A. E., Lyubkin, M., Martis, B., & Phan, K. L. (2011) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2011.00062 · Cited by 230 · see citing works
Functional connectivity of the prefrontal cortex and the amygdala in posttraumatic stress disorder
Gilboa, A., Shalev, A. Y., Laor, L., Lester, H., Louzoun, Y., Chisin, R., & Bonne, O. (2004) · Biological Psychiatry · doi:10.1016/j.biopsych.2003.08.004 · Cited by 213 · see citing works
PTSD and stress sensitisation: A tale of brain and body
Stam, R. (2007) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2006.11.010 · Cited by 211 · see citing works
Neuroimaging Studies of Emotional Responses in PTSD
LIBERZON, I., & MARTIS, B. (2006) · Annals of the New York Academy of Sciences · doi:10.1196/annals.1364.009 · Cited by 198 · see citing works
Carrion, V. G., Garrett, A., Menon, V., Weems, C. F., & Reiss, A. L. (2008) · Depression and Anxiety · doi:10.1002/da.20346 · Cited by 185 · see citing works
Brewin, C. R. (2015) · European Journal of Psychotraumatology · doi:10.3402/ejpt.v6.27180 · Cited by 181 · see citing works
Clinical and neural correlates of alexithymia in posttraumatic stress disorder.
Frewen, P. A., Lanius, R. A., Dozois, D. J. A., Neufeld, R. W. J., Pain, C., Hopper, J. W., Densmore, M., & Stevens, T. K. (2008) · Journal of Abnormal Psychology · doi:10.1037/0021-843x.117.1.171 · Cited by 168 · see citing works
Neural correlates of attention bias to threat in post-traumatic stress disorder
Fani, N., Jovanovic, T., Ely, T. D., Bradley, B., Gutman, D., Tone, E. B., & Ressler, K. J. (2012) · Biological Psychology · doi:10.1016/j.biopsycho.2012.03.001 · Cited by 150 · see citing works
Lindauer, R. J. L., Booij, J., Habraken, J. B. A., van Meijel, E. P. M., Uylings, H. B. M., Olff, M., Carlier, I. V. E., den Heeten, G. J., van Eck-Smit, B. L. F., & Gersons, B. P. R. (2008) · Psychological Medicine · doi:10.1017/s0033291707001432 · Cited by 131 · see citing works
Harricharan, S., Rabellino, D., Frewen, P. A., Densmore, M., Théberge, J., McKinnon, M. C., Schore, A. N., & Lanius, R. A. (2016) · Brain and Behavior · doi:10.1002/brb3.579 · Cited by 127 · see citing works
Lanius, R. A. (2015) · European Journal of Psychotraumatology · doi:10.3402/ejpt.v6.27905 · Cited by 127 · see citing works
The Neural Correlates of Emotional Memory in Posttraumatic Stress Disorder
Brohawn, K. H., Offringa, R., Pfaff, D. L., Hughes, K. C., & Shin, L. M. (2010) · Biological Psychiatry · doi:10.1016/j.biopsych.2010.07.018 · Cited by 127 · see citing works
Lanius, R. A., Frewen, P. A., Girotti, M., Neufeld, R. W. J., Stevens, T. K., & Densmore, M. (2007) · Psychiatry Research: Neuroimaging · doi:10.1016/j.pscychresns.2006.11.006 · Cited by 126 · see citing works
Lindauer, R. J. L., Booij, J., Habraken, J. B. A., Uylings, H. B. M., Olff, M., Carlier, I. V. E., den Heeten, G. J., van Eck-Smit, B. L. F., & Gersons, B. P. R. (2004) · Biological Psychiatry · doi:10.1016/j.biopsych.2004.08.003 · Cited by 119 · see citing works
Regional differences of the prefrontal cortex in pediatric PTSD: an MRI study
Richert, K. A., Carrion, V. G., Karchemskiy, A., & Reiss, A. L. (2006) · Depression and Anxiety · doi:10.1002/da.20131 · Cited by 118 · see citing works
Posttraumatic stress disorder: a theoretical model of the hyperarousal subtype
Weston, C. S. E. (2014) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2014.00037 · Cited by 114 · see citing works
An fMRI investigation of posttraumatic flashbacks
Whalley, M. G., Kroes, M. C. W., Huntley, Z., Rugg, M. D., Davis, S. W., & Brewin, C. R. (2013) · Brain and Cognition · doi:10.1016/j.bandc.2012.10.002 · Cited by 115 · see citing works
Intrusive memories to traumatic footage: the neural basis of their encoding and involuntary recall
Clark, I. A., Holmes, E. A., Woolrich, M. W., & Mackay, C. E. (2016) · Psychological Medicine · doi:10.1017/s0033291715002007 · Cited by 100 · see citing works
Nicotine modulation of fear memories and anxiety: Implications for learning and anxiety disorders
Kutlu, M. G., & Gould, T. J. (2015) · Biochemical Pharmacology · doi:10.1016/j.bcp.2015.07.029 · Cited by 97 · see citing works
Primitive mechanisms of trauma response: an evolutionary perspective on trauma-related disorders.
Baldwin, D. V. (2013) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2013.06.004 · Cited by 85 · see citing works
Rabellino, D., Frewen, P. A., McKinnon, M. C., & Lanius, R. A. (2020) · Frontiers in Neuroscience · doi:10.3389/fnins.2020.586605 · Cited by 69 · see citing works
Rabellino, D., Densmore, M., Frewen, P. A., Théberge, J., & Lanius, R. A. (2016) · Psychiatry Research: Neuroimaging · doi:10.1016/j.pscychresns.2015.12.005 · Cited by 67 · see citing works
Osuch, E. A., Willis, M. W., Bluhm, R., Ursano, R. J., & Drevets, W. C. (2008) · Biological Psychiatry · doi:10.1016/j.biopsych.2008.03.010 · Cited by 67 · see citing works
Self-citationNardo, D., Högberg, G., Flumeri, F., Jacobsson, H., Larsson, S. A., Hällström, T., & Pagani, M. (2011) · Psychological Medicine · doi:10.1017/s0033291711000912 · Cited by 41 · see citing works
Canby, N. K., Cosby, E. A., Palitsky, R., Kaplan, D. M., Lee, J., Mahdavi, G., Lopez, A. A., Goldman, R. E., Eichel, K., Lindahl, J. R., et al. (2025) · PLOS ONE · doi:10.1371/journal.pone.0318499 · Cited by 15 · see citing works
- Authors
- Osuch, E. A., Benson, B., Geraci, M., Podell, D., Herscovitch, P., McCann, U. D., & Post, R. M.
- Affiliations
- Uniformed Services University of the Health Sciences (US)
- National Institutes of Health (US)
- Johns Hopkins University (US)
- Corresponding author
- Post, Robert M
- Venue
- Biological Psychiatry
- Publisher
- Elsevier BV
- Published
- 2001-08
- Volume
- 50
- Issue
- 4
- Pages
- 246-253
- ISSN
- 0006-3223 (ISSN-L)
- OpenAlex
- W2062011348
- Cited by
- 204
- References
- 26
- Citations by year
- 2026: 2 · 2025: 5 · 2024: 12 · 2023: 7 · 2022: 7 · 2021: 4 · 2020: 13 · 2019: 12 · 2018: 8 · 2017: 10 · 2016: 8 · 2015: 8 · 2014: 10 · 2013: 9 · 2012: 9
- FWCI
- 8.86
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Biological Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
- Health Sciences › Medicine › Epidemiology › Traumatic Brain Injury Research
- Life Sciences › Neuroscience › Cognitive Neuroscience › Memory Processes and Influences
- Keywords
- post-traumatic stress disorder, flashbacks, regional cerebral blood flow, 15O-water PET, brainstem, insula, hippocampus, prefrontal cortex, somatosensory cortex, cerebellum, memory, heart rate response
- MeSH terms
- Adult, Brain, Cerebrovascular Circulation, Chronic Disease, Cues, Female, Heart Rate, Humans, Male, Middle Aged, Severity of Illness Index, Space Perception, Stress Disorders, Post-Traumatic, Tomography, Emission-Computed, Visual Perception
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