How understanding the neurobiology of complex post-traumatic stress disorder can inform clinical practice: a social cognitive and affective neuroscience approach: Neurobiology of PTSD and clinical practice
Abstract
OBJECTIVE: In this review, we examine the relevance of the social cognitive and affective neuroscience (SCAN) paradigm for an understanding of the psychology and neurobiology of complex post-traumatic stress disorder (PTSD) and its effective treatment. METHOD: The relevant literature pertaining to SCAN and PTSD was reviewed. RESULTS: We suggest that SCAN offers a novel theoretical paradigm for understanding psychological trauma and its numerous clinical outcomes, most notably problems in emotional/self-awareness, emotion regulation, social emotional processing and self-referential processing. A core set of brain regions appear to mediate these collective psychological functions, most notably the cortical midline structures, the amygdala, the insula, posterior parietal cortex and temporal poles, suggesting that problems in one area (e.g. emotional awareness) may relate to difficulties in another (e.g. self-referential processing). We further propose, drawing on clinical research, that the experiences of individuals with PTSD related to chronic trauma often reflect impairments in multiple social cognitive and affective functions. CONCLUSION: It is important that the assessment and treatment of individuals with complex PTSD not only addresses traumatic memories but also takes a SCAN-informed approach that focuses on the underlying deficits in emotional/self-awareness, emotion regulation, social emotional processing and self-referential processing.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Poor social or interpersonal functioning is a hallmark of many psychiatric disorders, including PTSD, mood disorders, and schizophrenia, and is associated with reduced treatment efficacy.
“Poor social or interpersonal functioning is a hallmark of many psychiatric disorders, including PTSD (Charuvastra and Cloitre, 2008;Lanius et al., 2011;Olatunji et al., 2007), mood disorders (Romera et al., 2010;Wells et al., 1989), and schizophrenia (Couture, 2006;Fett et al., 2011) and is associated with reduced treatment efficacy (Sotsky et al., 1991).”
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., 2011
Cites
<i>The Brain's Default Network</i>: <i>Anatomy, Function, and Relevance to Disease</i>
Buckner, R. L., Andrews‐Hanna, J. R., & Schacter, D. L. (2008) · Annals of the New York Academy of Sciences · doi:10.1196/annals.1440.011 · Cited by 9,761 · see citing works
Using Self-Report Assessment Methods to Explore Facets of Mindfulness
Baer, R. A., Smith, G. T., Hopkins, J., Krietemeyer, J., & Toney, L. (2006) · Assessment · doi:10.1177/1073191105283504 · Cited by 7,511 · cited 1× · see citing works
“When I m walking, I deliberately notice the sensations of my body moving ; I notice changes in my body, such as whether my breathing slows down or speeds up (48, 49)], the more activation was observed within the dorsomedial prefrontal cortex (see Fig.”
BackgroundHow do you feel — now? The anterior insula and human awareness
(Bud) Craig, A. D. (2009) · Nature Reviews Neuroscience · doi:10.1038/nrn2555 · Cited by 6,657 · see citing works
Functional connectivity in the resting brain: a network analysis of the default mode hypothesis
Greicius, M. D., Krasnow, B., Reiss, A. L., & Menon, V. (2003) · Proceedings of the National Academy of Sciences · doi:10.1073/pnas.0135058100 · Cited by 6,358 · see citing works
How do you feel? Interoception: The sense of the physiological condition of the body
Craig, A. D. (2002) · Nature Reviews Neuroscience · doi:10.1038/nrn894 · Cited by 6,006 · see citing works
Bagby, R. M., Parker, J. D. A., & Taylor, G. J. (1994) · Journal of Psychosomatic Research · doi:10.1016/0022-3999(94)90005-1 · Cited by 5,293 · see citing works
Gross, J. J. (1998) · Journal of Personality and Social Psychology · doi:10.1037//0022-3514.74.1.224 · Cited by 4,671 · cited 1× · see citing works
“The term emotion dysregulation will be used in this review to collectively refer to disturbances in a variety of emotional responses and to the process by which we influence how much emotion we have and when we have it as outlined by Gross (64).”
MethodThe cognitive control of emotion
OCHSNER, K., & GROSS, J. (2005) · Trends in Cognitive Sciences · doi:10.1016/j.tics.2005.03.010 · Cited by 4,495 · see citing works
Meeting of minds: the medial frontal cortex and social cognition
Amodio, D. M., & Frith, C. D. (2006) · Nature Reviews Neuroscience · doi:10.1038/nrn1884 · Cited by 3,782 · see citing works
Etkin, A., & Wager, T. D. (2007) · American Journal of Psychiatry · doi:10.1176/appi.ajp.2007.07030504 · Cited by 3,391 · cited 4× · see citing works
“Although response within the amygdala has more often been associated with negative emotional processing, particularly of threat-related visual stimuli (79), research also implicates the amygdala in positive emotional processing [e.”
BackgroundInfluentialSelf-referential processing in our brain—A meta-analysis of imaging studies on the self
Northoff, G., Heinzel, A., de Greck, M., Bermpohl, F., Dobrowolny, H., & Panksepp, J. (2006) · NeuroImage · doi:10.1016/j.neuroimage.2005.12.002 · Cited by 2,792 · see citing works
Social cognition and the brain: A meta-analysis
Van Overwalle, F. (2009) · Human Brain Mapping · doi:10.1002/hbm.20547 · Cited by 1,792 · see citing works
Phelps, E. A., Delgado, M. R., Nearing, K. I., & LeDoux, J. E. (2004) · Neuron · doi:10.1016/j.neuron.2004.08.042 · Cited by 1,753 · see citing works
The Posttraumatic Cognitions Inventory (PTCI): development and validation
Foa, E. B., Ehlers, A., Clark, D. M., Tolin, D. F., & Orsillo, S. M. (1999) · Psychological Assessment · doi:10.1037/1040-3590.11.3.303 · Cited by 1,727 · see citing works
Disorders of extreme stress: The empirical foundation of a complex adaptation to trauma
van der Kolk, B. A., Roth, S., Pelcovitz, D., Sunday, S., & Spinazzola, J. (2005) · Journal of Traumatic Stress · doi:10.1002/jts.20047 · Cited by 1,284 · see citing works
Kim, J., & Cicchetti, D. (2010) · Journal of Child Psychology and Psychiatry · doi:10.1111/j.1469-7610.2009.02202.x · Cited by 1,229 · see citing works
Kober, H., Barrett, L. F., Joseph, J., Bliss-Moreau, E., Lindquist, K., & Wager, T. D. (2008) · NeuroImage · doi:10.1016/j.neuroimage.2008.03.059 · Cited by 1,144 · cited 1× · see citing works
“Interestingly, the perigenual anterior cingulate cortex is one of the most responsive brain regions to emotional manipulations as assessed by neuroimaging (109).”
BackgroundPsychological theories of posttraumatic stress disorder
Brewin, C. R., & Holmes, E. A. (2003) · Clinical Psychology Review · doi:10.1016/s0272-7358(03)00033-3 · Cited by 1,132 · cited 1× · see citing works
“It has been well described that psychological trauma can undermine the sense of an adaptive and agentive self, challenging one s sense of identity and life purpose [see (116, 117) for reviews].”
BackgroundEmotion Modulation in PTSD: Clinical and Neurobiological Evidence for a Dissociative Subtype
Lanius, R. A., Vermetten, E., Loewenstein, R. J., Brand, B., Schmahl, C., Bremner, J. D., & Spiegel, D. (2010) · American Journal of Psychiatry · doi:10.1176/appi.ajp.2009.09081168 · Cited by 1,123 · cited 6× · see citing works
“Teaching PTSD patients with impairments in emotional awareness to identify their affective feelings early on in treatment may make exposure-based treatments more efficient (78, 86, 162, 163) because such therapies are dependent on a patient s judgment of their internal affect and as well as a reliable report of their…”
BackgroundInfluentialSelf-citationRaichle, M. E. (2010) · Trends in Cognitive Sciences · doi:10.1016/j.tics.2010.01.008 · Cited by 1,111 · see citing works
Cloitre, M., Koenen, K. C., Cohen, L. R., & Han, H. (2002) · Journal of Consulting and Clinical Psychology · doi:10.1037/0022-006x.70.5.1067 · Cited by 1,097 · see citing works
Role of Affective Self-Regulatory Efficacy in Diverse Spheres of Psychosocial Functioning
Bandura, A., Caprara, G. V., Barbaranelli, C., Gerbino, M., & Pastorelli, C. (2003) · Child Development · doi:10.1111/1467-8624.00567 · Cited by 1,092 · see citing works
Spreng, R. N., & Grady, C. L. (2010) · Journal of Cognitive Neuroscience · doi:10.1162/jocn.2009.21282 · Cited by 985 · see citing works
Bateman, A., & Fonagy, P. (2009) · American Journal of Psychiatry · doi:10.1176/appi.ajp.2009.09040539 · Cited by 961 · see citing works
Social Bonds and Posttraumatic Stress Disorder
Charuvastra, A., & Cloitre, M. (2008) · Annual Review of Psychology · doi:10.1146/annurev.psych.58.110405.085650 · Cited by 911 · 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
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
Treatment for PTSD Related to Childhood Abuse: a Randomized Controlled Trial
Cloitre, M., Stovall-McClough, K. C., Nooner, K., Zorbas, P., Cherry, S., Jackson, C. L., Gan, W., & Petkova, E. (2010) · American Journal of Psychiatry · doi:10.1176/appi.ajp.2010.09081247 · Cited by 642 · cited 4× · see citing works
“(78) who specifically examined the treatment of PTSD related to childhood abuse.”
BackgroundInfluentialHandbook of Mentalization‐Based Treatment
(2006) · doi:10.1002/9780470712986 · Cited by 631 · see citing works
Influence of emotional engagement and habituation on exposure therapy for PTSD
Jaycox, L. H., Foa, E. B., & Morral, A. R. (1998) · Journal of Consulting and Clinical Psychology · doi:10.1037/0022-006x.66.1.185 · Cited by 507 · 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
Self-citationDalgleish, T. (2004) · Psychological Bulletin · doi:10.1037/0033-2909.130.2.228 · Cited by 498 · see citing works
Cytology and functionally correlated circuits of human posterior cingulate areas
Vogt, B. A., Vogt, L., & Laureys, S. (2006) · NeuroImage · doi:10.1016/j.neuroimage.2005.07.048 · Cited by 484 · see citing works
What is self-specific? Theoretical investigation and critical review of neuroimaging results
Legrand, D., & Ruby, P. (2009) · Psychological Review · doi:10.1037/a0014172 · Cited by 470 · see citing works
Associations and dissociations between default and self-reference networks in the human brain
Whitfield-Gabrieli, S., Moran, J. M., Nieto-Castañón, A., Triantafyllou, C., Saxe, R., & Gabrieli, J. D. E. (2011) · NeuroImage · doi:10.1016/j.neuroimage.2010.11.048 · Cited by 394 · see citing works
FREWEN, P. A., & LANIUS, R. A. (2006) · Annals of the New York Academy of Sciences · doi:10.1196/annals.1364.010 · Cited by 306 · see citing works
Self-citationBlair, K., Shaywitz, J., Smith, B. W., Rhodes, R., Geraci, M., Jones, M., McCaffrey, D., Vythilingam, M., Finger, E., Mondillo, K., et al. (2008) · American Journal of Psychiatry · doi:10.1176/appi.ajp.2008.07071060 · Cited by 282 · see citing works
Social cognitive neuroscience: where are we heading?
Blakemore, S.-J., Winston, J., & Frith, U. (2004) · Trends in Cognitive Sciences · doi:10.1016/j.tics.2004.03.012 · Cited by 224 · see citing works
Descilo, T., Vedamurtachar, A., Gerbarg, P. L., Nagaraja, D., Gangadhar, B. N., Damodaran, B., Adelson, B., Braslow, L. H., Marcus, S., & Brown, R. P. (2010) · Acta Psychiatrica Scandinavica · doi:10.1111/j.1600-0447.2009.01466.x · Cited by 210 · see citing works
Bryant, R. A., Moulds, M. L., Guthrie, R. M., Dang, S. T., Mastrodomenico, J., Nixon, R. D. V., Felmingham, K. L., Hopwood, S., & Creamer, M. (2008) · Journal of Consulting and Clinical Psychology · doi:10.1037/a0012616 · Cited by 195 · 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
Self-citation
Flagged first, then by citations
Cited by
Sorted by citations
Spreng, R. N., & Grady, C. L. (2010) · Journal of Cognitive Neuroscience · doi:10.1162/jocn.2009.21282 · Cited by 985 · see citing works
Diagnosis and classification of disorders specifically associated with stress: proposals for ICD-11
Maercker, A., Brewin, C. R., Bryant, R. A., Cloitre, M., van Ommeren, M., Jones, L. M., Humayan, A., Kagee, A., Llosa, A. E., Rousseau, C., et al. (2013) · World Psychiatry · doi:10.1002/wps.20057 · Cited by 762 · see citing works
Childhood maltreatment, emotional dysregulation, and psychiatric comorbidities
Dvir, Y., Ford, J. D., Hill, M., & Frazier, J. A. (2014) · Harvard Review of Psychiatry · doi:10.1097/hrp.0000000000000014 · Cited by 698 · see citing works
Patel, R., Spreng, R. N., Shin, L. M., & Girard, T. A. (2012) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2012.06.003 · Cited by 546 · see citing works
O'Doherty, D. C. M., Chitty, K. M., Saddiqui, S., Bennett, M. R., & Lagopoulos, J. (2015) · Psychiatry Research: Neuroimaging · doi:10.1016/j.pscychresns.2015.01.002 · Cited by 375 · see citing works
Plastic modulation of PTSD resting‐state networks and subjective wellbeing by EEG neurofeedback
Kluetsch, R. C., Ros, T., Théberge, J., Frewen, P. A., Calhoun, V. D., Schmahl, C., Jetly, R., & Lanius, R. A. (2014) · Acta Psychiatrica Scandinavica · doi:10.1111/acps.12229 · Cited by 183 · see citing works
Self-citationLanius, R. A., Terpou, B. A., & McKinnon, M. C. (2020) · European Journal of Psychotraumatology · doi:10.1080/20008198.2020.1807703 · Cited by 164 · see citing works
Self-citationThe brain-body disconnect: A somatic sensory basis for trauma-related disorders
Kearney, B. E., & Lanius, R. A. (2022) · Frontiers in Neuroscience · doi:10.3389/fnins.2022.1015749 · Cited by 154 · see citing works
Self-citationDistinct intrinsic network connectivity patterns of post‐traumatic stress disorder symptom clusters
Tursich, M., Ros, T., Frewen, P. A., Kluetsch, R. C., Calhoun, V. D., & Lanius, R. A. (2015) · Acta Psychiatrica Scandinavica · doi:10.1111/acps.12387 · Cited by 148 · see citing works
Self-citationThe neurobiological correlates of childhood adversity and implications for treatment
Tyrka, A. R., Burgers, D. E., Philip, N. S., Price, L. H., & Carpenter, L. L. (2013) · Acta Psychiatrica Scandinavica · doi:10.1111/acps.12143 · Cited by 142 · see citing works
“Decreased connectivity within this network has been linked to early-life stress and PTSD, suggesting a link between stress exposure and disrupted processing of internal experiences, which may contribute to the pathophysiology of stress-related illnesses (28, 29).”
BackgroundCarhart-Harris, R. L., Wall, M. B., Erritzoe, D., Kaelen, M., Ferguson, B., De Meer, I., Tanner, M., Bloomfield, M., Williams, T. M., Bolstridge, M., et al. (2014) · The International Journal of Neuropsychopharmacology · doi:10.1017/s1461145713001405 · Cited by 108 · see citing works
Theory of mind performance in women with posttraumatic stress disorder related to childhood abuse
Nazarov, A., Frewen, P., Parlar, M., Oremus, C., MacQueen, G., McKinnon, M., & Lanius, R. (2014) · Acta Psychiatrica Scandinavica · doi:10.1111/acps.12142 · Cited by 111 · see citing works
Self-citationSteuwe, C., Daniels, J. K., Frewen, P. A., Densmore, M., Pannasch, S., Beblo, T., Reiss, J., & Lanius, R. A. (2014) · Social Cognitive and Affective Neuroscience · doi:10.1093/scan/nss105 · Cited by 107 · see citing works
Self-citationMcKinnon, M. C., Boyd, J. E., Frewen, P. A., Lanius, U. F., Jetly, R., Richardson, J. D., & Lanius, R. A. (2016) · Neuropsychologia · doi:10.1016/j.neuropsychologia.2016.07.017 · Cited by 94 · see citing works
“Poor social or interpersonal functioning is a hallmark of many psychiatric disorders, including PTSD (Charuvastra and Cloitre, 2008; Lanius et al., 2011; Olatunji et al., 2007), mood disorders (Romera et al., 2010; Wells et al., 1989), and schizophrenia (Couture, 2006; Fett et al., 2011) and is…”
Self-citationPost-traumatic stress disorder and opioid use disorder: a narrative review of conceptual models
Danovitch, I. (2016) · Journal of Addictive Diseases · doi:10.1080/10550887.2016.1168212 · Cited by 55 · see citing works
Marinova, Z., & Maercker, A. (2015) · European Journal of Psychotraumatology · doi:10.3402/ejpt.v6.25913 · Cited by 42 · see citing works
Frewen, P., Thornley, E., Rabellino, D., & Lanius, R. (2017) · European Journal of Psychotraumatology · doi:10.1080/20008198.2017.1314164 · Cited by 36 · see citing works
Self-citationKearney, B. E., Terpou, B. A., Densmore, M., Shaw, S. B., Théberge, J., Jetly, R., McKinnon, M. C., & Lanius, R. A. (2023) · NeuroImage: Clinical · doi:10.1016/j.nicl.2023.103426 · Cited by 33 · see citing works
Self-citationNazarov, A., Frewen, P., Oremus, C., Schellenberg, E. G., McKinnon, M. C., & Lanius, R. (2015) · Acta Psychiatrica Scandinavica · doi:10.1111/acps.12364 · Cited by 30 · see citing works
Self-citation
- Authors
- Lanius, R. A., Bluhm, R. L., & Frewen, P. A.
- Affiliations
- Western University (CA)
- Old Dominion University (US)
- Corresponding author
- Lanius, R. A.
- Venue
- Acta Psychiatrica Scandinavica
- Publisher
- Wiley
- Published
- 2011-08-19
- Volume
- 124
- Issue
- 5
- Pages
- 331-348
- ISSN
- 0001-690X (ISSN-L)
- OpenAlex
- W2162116497
- Cited by
- 158
- References
- 41
- Citations by year
- 2026: 8 · 2025: 6 · 2024: 6 · 2023: 7 · 2022: 6 · 2021: 10 · 2020: 9 · 2019: 14 · 2018: 28 · 2017: 12 · 2016: 10 · 2015: 9 · 2014: 12 · 2013: 12 · 2012: 5
- FWCI
- 1.57
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Acta Psychiatrica Scandinavica (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
- Social Sciences › Psychology › Clinical Psychology › Psychoanalysis and Psychopathology Research
- Health Sciences › Medicine › Epidemiology › Traumatic Brain Injury Research
- Keywords
- complex PTSD, neurobiology of trauma, emotional self-awareness, emotion regulation, social-emotional processing, self-referential processing, amygdala, insula, posterior parietal cortex, temporal pole, cortical midline structures, chronic trauma, PTSD treatment
- MeSH terms
- Affective Symptoms, Brain, Emotions, Humans, Models, Neurological, Nerve Net, Social Behavior, Stress Disorders, Post-Traumatic
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
