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Brain activation during script-driven imagery induced dissociative responses in PTSD: a functional magnetic resonance imaging investigation
Abstract
Background The goal of this study was to examine the neuronal circuitry underlying dissociative responses to traumatic script-driven imagery in sexual-abuse-related posttraumatic stress disorder (PTSD). Pilot studies in our laboratory have shown that PTSD patients had very different responses to traumatic script-driven imagery. Approximately 70% of patients relived their traumatic experience and showed an increase in heart rate while recalling the traumatic memory. The other 30% of patients had a dissociative response with no concomitant increase in heart rate. This article focuses on the latter group.Methods The neuronal circuitry underlying dissociative responses in PTSD was studied using the traumatic script-driven symptom provocation paradigm adapted to functional magnetic resonance imaging (fMRI) at a 4 Tesla field strength in 7 subjects with sexual-abuse-related PTSD and 10 control subjects.Results Compared with control subjects, PTSD patients in a dissociative state showed more activation in the superior and middle temporal gyri (BA 38), the inferior frontal gyrus (BA 47), the occipital lobe (BA 19), the parietal lobe (BA 7), the medial frontal gyrus (BA 10), the medial cortex (BA 9), and the anterior cingulate gyrus (BA 24 and 32).Conclusions These findings suggest that prefrontal and limbic structures underlie dissociative responses in PTSD. Differences observed clinically, psychophysiologically, and neurobiologically between patients who respond to traumatic script-driven imagery with dissociative versus nondissociative responses may suggest different neuronal mechanisms underlying these two distinct reactions.
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“The majority of patients (∼70%) reported marked re-experiencing symptoms and showed a substantial increase in heart rate during the script.”
From Dissociation and Alterations in Brain Function and Structure: Implications for Borderline Personality Disorder (2017) · cites this paper as [57]
In the citing paper
“In a smaller patient group (∼30%), however, this heart rate increase was not observed—instead, these patients showed stronger activity in the medial frontal gyrus, anterior and medial cingulate, middle temporal gyri (BA38), precuneus, occipital areas, and inferior frontal gyrus (IFG), compared to a control group of traumatized persons who had not developed PTSD [57].”
From Dissociation and Alterations in Brain Function and Structure: Implications for Borderline Personality Disorder (2017) · cites this paper as [57]
In the citing paper
“The VLPAG receives signals from deep somatic (muscle, joint) or visceral tissues via the dorsal horn of the spinal cord, from the parabrachial nucleus,25,94,95 and from the vagal sensory nucleus (the solitary track nucleus).28,96”
From Fear and the Defense Cascade (2015) · cites this paper as [95]
In the citing paper
“These findings are consistent with previous reports of an absence of heart-rate increase in response to traumatic scripts among patients with PTSD and comorbid dissociative symptoms (Lanius et al., 2002), and of depressed skin conductance and heart rate when recalling a trauma among rape victims high in peri-traumatic dissociation (Griffin et al., 1997).”
From A review of the relation between dissociation, memory, executive functioning and social cognition in military members and civilians with neuropsychiatric conditions (2016) · cites this paper as Lanius et al., 2002
In the citing paper
“Further research by Lanius and colleagues (Lanius et al., 2002; Lanius et al., 2005; Lanius et al., 2006) employing trauma memory recall supports the idea of two different PTSD profiles”
From Trauma-related dissociation and the autonomic nervous system: a systematic literature review of psychophysiological correlates of dissociative experiencing in PTSD patients (2022) · cites this paper as Lanius et al., 2002
In the citing paper
“The initial pilot studies describing alternating physiological reactions to individualized trauma scripts in chronic PTSD patients (Lanius et al., 2001; Lanius et al., 2002) interpreted the data as supportive for two distinct subtypes ‘each representing unique pathways to chronic stress- related psychopathology’ (Lanius et al., 2006, p. 710).”
From Trauma-related dissociation and the autonomic nervous system: a systematic literature review of psychophysiological correlates of dissociative experiencing in PTSD patients (2022) · cites this paper as Lanius et al., 2002
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“[41–43] The script-driven imagery symptomprovocation paradigm involves patients constructing a narrative of their traumatic experience including asmany sensory details as possible.”
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“In the study of Lanius et al. (2002) PTSD subjects who experienced dissociative responses to traumatic script-driven imagery reported that ‘‘I was looking down at myself from above,’’ ‘‘I was detached from my body,’’ ‘‘I was completely zoned out and floating,’’ or ‘‘I was emotionless’’ during the…”
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“All within- and between subject analyses employed random effects analyses using SPM2, in contrast to previous studies, which have employed fixed effects analyses [Bremner et al., 1999a; Lanius et al., 2002, 2003].”
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“…(ACC), precuneus, and parietal lobe in PTSD patients who exhibit dissociative responses during traumatic script-driven imagery or fear processing as compared to those who instead demonstrate re-experiencing symptoms (Felmingham et al., 2008; Hopper et al., 2007; Lanius et al., 2002; 2005; 2010a).”
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Hysterical conversion and brain function
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PTSD-related neuroimaging abnormalities in brain function, structure, and biochemistry
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“This hypothesis is consistent with prior work that found that those with the dissociative subtype of PTSD showed a smaller physiological response to emotional events compared to individuals with a more typical presentation of PTSD symptoms (Lanius et al., 2001; Lanius et al., 2002; Seligowski et al., 2019).”
ResultClinical experimental stress studies: methods and assessment
Bali, A., & Jaggi, A. S. (2015) · Reviews in the Neurosciences · doi:10.1515/revneuro-2015-0004 · Cited by 190
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“…decreased activity of the mPFC, resulting in diminished extinction, and decreased hippocampal/parahippocampal activity, resulting in overgeneralization of fear to nonthreatening stimuli and the inability to distinguish safe and threatening contexts (Lanius et al., 2002, 2003; Rauch et al., 2003).”
Resick, P. A., Suvak, M. K., Johnides, B. D., Mitchell, K. S., & Iverson, K. M. (2012) · Depression and Anxiety · doi:10.1002/da.21938 · Cited by 169
“Using functionalmagnetic resonance imaging (fMRI), several studies have found different patterns of response among participants with chronic PTSD who dissociate during script-driven imagery tasks,[3–5] compared to”
BackgroundClinical 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
“…functional brain responses with PTSD or alexithymia in previous studies of the ventral ACC–mPFC (Lanius et al., 2001), right inferior frontal cortex (Lanius et al., 2002), ventral PCC (Mantani et al., 2005), left and right anterior insula (Osuch et al., 2001), and left superior temporal cortex…”
BackgroundResultSelf-citationDissociative disorders in DSM-5
Spiegel, D., Loewenstein, R. J., Lewis-Fernández, R., Sar, V., Simeon, D., Vermetten, E., Cardeña, E., & Dell, P. F. (2011) · Depression and Anxiety · doi:10.1002/da.20923 · Cited by 162
Carrion, V. G., Weems, C. F., Watson, C., Eliez, S., Menon, V., & Reiss, A. L. (2009) · Psychiatry Research: Neuroimaging · doi:10.1016/j.pscychresns.2008.07.008 · Cited by 165
Felmingham, K., Kemp, A. H., Williams, L., Falconer, E., Olivieri, G., Peduto, A., & Bryant, R. (2008) · Psychological Medicine · doi:10.1017/s0033291708002742 · Cited by 165
“This finding replicates previous imaging findings in dissociative PTSD that used trauma narratives (Lanius et al. 2002).”
BackgroundMethodResultInfluentialCorticolimbic Blood Flow During Nontraumatic Emotional Processing in Posttraumatic Stress Disorder
Phan, K. L., Britton, J. C., Taylor, S. F., Fig, L. M., & Liberzon, I. (2006) · Archives of General Psychiatry · doi:10.1001/archpsyc.63.2.184 · Cited by 168
“This deactivation to affective salience may be PTSD specific, which is consistent with reported absent or decreased MPFC activity in PTSD patients engaged in recall and imagery of personal trauma.(9,12,13) Current observation further extends the evidence of diminished MPFC activation in PTSD beyond traumatic reexperie…”
ResultBremner, J. D. (2006) · CNS & Neurological Disorders - Drug Targets · doi:10.2174/187152706778559309 · Cited by 165
Thinner prefrontal cortex in veterans with posttraumatic stress disorder
Geuze, E., Westenberg, H. G. M., Heinecke, A., de Kloet, C. S., Goebel, R., & Vermetten, E. H. G. J. M. (2008) · NeuroImage · doi:10.1016/j.neuroimage.2008.03.007 · Cited by 168
“The right superior temporal gyrus has been linked to dissociation symptoms in patients with PTSD (Hopper et al., 2007; Lanius et al., 2002).”
BackgroundPsychobiological characteristics of dissociative identity disorder: a symptom provocation study
Reinders, A. A. T. S., Nijenhuis, E. R. S., Quak, J., Korf, J., Haaksma, J., Paans, A. M. J., Willemsen, A. T. M., & den Boer, J. A. (2006) · Biological Psychiatry · doi:10.1016/j.biopsych.2005.12.019 · Cited by 196
Boccia, M., D’Amico, S., Bianchini, F., Marano, A., Giannini, A. M., & Piccardi, L. (2015) · Brain Imaging and Behavior · doi:10.1007/s11682-015-9387-3 · Cited by 155
“Finally, many studies used Shin and co-workers' method (Shin et al. 1997) in which participants are asked to mentally generate trauma-related images (Shin et al. 1999; Lanius et al. 2002, 2003, 2004, 2005, 2007).”
BackgroundMethodLanius, R. A., Frewen, P., Vermetten, E. H. G. J. M., & Yehuda, R. (2010) · European Journal of Psychotraumatology · doi:10.3402/ejpt.v1i0.5467 · Cited by 163
“…to note that even though increased amygdala response has been observed in PTSD (e.g., Liberzon et al., 1999; Shin et al., 1997, 1999, 2004, 2005; reviewed in Etkin & Wager, 2007), others have not demonstrated this effect (e.g., Bremner et al., 1999a, 1999b; Lanius et al. 2001, 2002, 2003).”
BackgroundSelf-citationNeural 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
“…in temporal regions has been previously observed in PTSD participants during presentation of trauma-related reminders (Hopper et al., 2007; Lanius et al., 2002; Osuch et al., 2001), and the presence of these findings serves as a reminder that brain structures and regions frequently…”
BackgroundAndrewes, D. G., & Jenkins, L. M. (2019) · Neuropsychology Review · doi:10.1007/s11065-019-09398-4 · Cited by 169
Neurobiological Correlates of EMDR Monitoring – An EEG Study
Pagani, M., Di Lorenzo, G., Verardo, A. R., Nicolais, G., Monaco, L., Lauretti, G., Russo, R., Niolu, C., Ammaniti, M., Fernandez, I., et al. (2012) · PLoS ONE · doi:10.1371/journal.pone.0045753 · Cited by 145
“Comparing our findings to previous studies investigating psychological traumas [41], significantly higher activations in OFC and rPFC in patients during script were found by some [13,42–44], but not by other authors [45,46].”
ResultEmotional learning during dissociative states in borderline personality disorder
Ebner-Priemer, U. W., Mauchnik, J., Kleindienst, N., Schmahl, C., Peper, M., Rosenthal, M. Z., Flor, H., & Bohus, M. (2009) · Journal of Psychiatry and Neuroscience · doi:10.1139/jpn.0929 · Cited by 147
“Similarly, individuals who had posttraumatic stress disorder (PTSD) with present-state dissociative experiences exhibited reduced heart rates and increased activation in the dorsolateral and medial frontal cortices compared with a nondissociative PTSD subgroup in a traumatic script-driven symptomprovocation paradigm.(…”
Neurodevelopmental Biology Associated with Childhood Sexual Abuse
Bellis, M. D. D., Spratt, E. G., & Hooper, S. R. (2011) · Journal of Child Sexual Abuse · doi:10.1080/10538712.2011.607753 · Cited by 151
“As stated, neuroimaging studies support the hypotheses that the medial prefrontal regions are hyporesponsive and the amygdala is hyperresponsive in adult PTSD (Bremner et al., 1999a; Bremner et al., 1999b; Lanius et al., 2002; Shin et al., 1999; Shin et al., 2004; Shin et al., 2001).”
InfluentialLindauer, 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
“…mostly victims of war (Semple et al. 1993 ; Bremner et al. 1997 ; Shin et al. 1997, 2001 ; Liberzon et al. 1999 ; Zubieta et al. 1999; Rauch et al. 2000 ; Pissiota et al. 2003) or sexual abuse (Bremner et al. 1999, 2003 ; Shin et al. 1999 ; Lanius et al. 2001, 2002, 2003 ; Osuch et al. 2001).”
Corbo, V., Clément, M.-H., Armony, J. L., Pruessner, J. C., & Brunet, A. (2005) · Biological Psychiatry · doi:10.1016/j.biopsych.2005.02.032 · Cited by 134
Morey, R. A., Petty, C. M., Cooper, D. A., LaBar, K. S., & McCarthy, G. (2008) · Psychiatry Research: Neuroimaging · doi:10.1016/j.pscychresns.2007.07.007 · Cited by 131
“, 1999), and during dissociative states induced in young adult PTSD patients (Lanius et al., 2002).”
BackgroundInfluentialPannu Hayes, J., LaBar, K. S., Petty, C. M., McCarthy, G., & Morey, R. A. (2009) · Psychiatry Research: Neuroimaging · doi:10.1016/j.pscychresns.2008.05.005 · Cited by 130
“…provocation of trauma symptoms (Rauch et al., 1996; Bremner et al., 1999; Liberzon et al., 1999; Shin et al., 1999; Lanius et al., 2001; Lanius et al., 2002; Pissiota et al., 2002; Lanius et al., 2003a; Gilboa et al., 2004; Shin et al., 2004; Yang et al., 2004; Britton et al., 2005;…”
BackgroundResultInfluentialDissociation and emotion regulation strategies: A meta-analytic review
Cavicchioli, M., Scalabrini, A., Northoff, G., Mucci, C., Ogliari, A., & Maffei, C. (2021) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2021.09.011 · Cited by 146
The grounding of abstract concepts in the motor and visual system: An fMRI study
Harpaintner, M., Sim, E.-J., Trumpp, N. M., Martin, U., & Kiefer, M. (2019) · Cortex · doi:10.1016/j.cortex.2019.10.014 · Cited by 137
Ludäscher, P., Valerius, G., Stiglmayr, C., Mauchnik, J., Lanius, R. A., Bohus, M., & Schmahl, C. (2010) · Journal of Psychiatry and Neuroscience · doi:10.1503/jpn.090022 · Cited by 131
“Conclusion: Our results showed that the script-driven imagery method is capable of inducing dissociative states in participants with BPD with and without comorbid PTSD.”
InfluentialSelf-citationLanius, 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
Self-citationVermetten, E. H. G. J. M., MD, PhD, Schmahl, C. G., MD, Southwick, S. M., MD, Bremner, A. J. D., & MD (2025) · Psychopharmacology Bulletin · doi:10.64719/pb.4128 · Cited by 126
Strigo, I. A., Simmons, A. N., Matthews, S. C., Grimes, E. M., Allard, C. B., Reinhardt, L. E., Paulus, M. P., & Stein, M. B. (2010) · Biological Psychiatry · doi:10.1016/j.biopsych.2010.03.034 · Cited by 124
Liu, F., Xie, B., Wang, Y., Guo, W., Fouché, J., Long, Z., Wang, W., Chen, H., Li, M., Duan, X., et al. (2014) · Brain Topography · doi:10.1007/s10548-014-0386-2 · Cited by 126
“These regions have been investigated before and are thought to be associated with PTSD, including the cingulate gyrus (Lanius et al. 2002; Tuescher et al. 2011),”
BackgroundPerez, D. L., Dworetzky, B. A., Dickerson, B. C., Leung, L., Cohn, R., Baslet, G. C., & Silbersweig, D. (2014) · Clinical EEG and Neuroscience · doi:10.1177/1550059414555905 · Cited by 130
Krause-Utz, A., Frost, R., Winter, D., & Elzinga, B. M. (2017) · Current Psychiatry Reports · doi:10.1007/s11920-017-0757-y · Cited by 116
Eckart, C., Stoppel, C. M., Kaufmann, J., Tempelmann, C., Hinrichs, H., Elbert, T. R., Heinze, H., & Kolassa, I. (2011) · Journal of Psychiatry and Neuroscience · doi:10.1503/jpn.100010 · Cited by 122
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
Lanius, R. A., Bluhm, R. L., & Frewen, P. A. (2011) · Acta Psychiatrica Scandinavica · doi:10.1111/j.1600-0447.2011.01755.x · Cited by 158
Self-citation
Metadata
- Authors
- Lanius, R. A., Williamson, P. C., Boksman, K., Densmore, M., Gupta, M., Neufeld, R. W. J., Gati, J. S., & Menon, R. S.
- Affiliations
- Western University (CA)
- Robarts Research Institute (CA)
- Corresponding author
- Lanius, Ruth A
- Venue
- Biological Psychiatry
- Publisher
- Elsevier BV
- Published
- 2002-08
- Volume
- 52
- Issue
- 4
- Pages
- 305-311
- ISSN
- 0006-3223 (ISSN-L)
- OpenAlex
- W1966297906
- Cited by
- 505
- References
- 48
- Citations by year
- 2026: 7 · 2025: 11 · 2024: 10 · 2023: 17 · 2022: 23 · 2021: 18 · 2020: 24 · 2019: 24 · 2018: 12 · 2017: 25 · 2016: 17 · 2015: 23 · 2014: 27 · 2013: 28 · 2012: 25
- FWCI
- 23.40
- 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 › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
- Life Sciences › Neuroscience › Cognitive Neuroscience › Memory Processes and Influences
- Keywords
- post-traumatic stress disorder, dissociation, script-driven imagery, sexual abuse, brain activation, prefrontal cortex, limbic system, anterior cingulate cortex, temporal lobe, heart rate response
- MeSH terms
- Adult, Arousal, Brain, Brain Mapping, Child, Child Abuse, Child Abuse, Sexual, Dissociative Disorders, Female, Gyrus Cinguli, Humans, Imagination, Magnetic Resonance Imaging, Nerve Net, Mental Recall, Stress Disorders, Post-Traumatic, Temporal Lobe, Prefrontal Cortex
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