Emotion and cognition interactions in PTSD: a review of neurocognitive and neuroimaging studies
Open accessAbstract
Posttraumatic stress disorder (PTSD) is a psychiatric syndrome that develops after exposure to terrifying and life-threatening events including warfare, motor-vehicle accidents, and physical and sexual assault. The emotional experience of psychological trauma can have long-term cognitive effects. The hallmark symptoms of PTSD involve alterations to cognitive processes such as memory, attention, planning, and problem solving, underscoring the detrimental impact that negative emotionality has on cognitive functioning. As such, an important challenge for PTSD researchers and treatment providers is to understand the dynamic interplay between emotion and cognition. Contemporary cognitive models of PTSD theorize that a preponderance of information processing resources are allocated toward threat detection and interpretation of innocuous stimuli as threatening, narrowing one's attentional focus at the expense of other cognitive operations. Decades of research have shown support for these cognitive models of PTSD using a variety of tasks and methodological approaches. The primary goal of this review is to summarize the latest neurocognitive and neuroimaging research of emotion-cognition interactions in PTSD. To directly assess the influence of emotion on cognition and vice versa, the studies reviewed employed challenge tasks that included both cognitive and emotional components. The findings provide evidence for memory and attention deficits in PTSD that are often associated with changes in functional brain activity. The results are reviewed to provide future directions for research that may direct better and more effective treatments for PTSD.
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In response to trauma scripts, patients with the reexperiencing/hyperarousal response-as in PTSD-show decreased activation in anterior brain regions implicated in regulating arousal and emotion (ventromedial prefrontal cortex and rostral anterior cingulate cortex), decreased activation in the thalamus and occipital cortices, and increased activity in the amygdala and insula.
“In response to trauma scripts, patients with the reexperiencing/hyperarousal response—as in PTSD—show decreased activation in anterior brain regions implicated in regulating arousal and emotion (ventromedial prefrontal cortex and rostral anterior cingulate cortex), decreased activation in the thalamus and occipital cortices, and increased activity in the amygdala and insula.53–58”
From Fear and the Defense Cascade (2015) · cites this paper as [54]
Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
Experimental — accuracy not yet measuredNeuroimaging studies in individuals with PTSD point clearly to a decreased capacity for emotion regulation, where emotional stress may alter cognitive networks that process information about perception, salience processing and creating goal-oriented responses.
“In line with this hypothesis, neuroimaging studies in individuals with PTSD point clearly to a decreased capacity for emotion regulation, where emotional stress may alter cognitive networks that process information about perception, salience processing and creating goal-oriented responses.”
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 Hayes et al., 2012
Split into 2 atoms — 1 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
Experimental — accuracy not yet measuredAberrations at the prefrontal cortex may play a role in disrupting emotion processing among individuals with PTSD, which may shape intense reactions to traumatic reminders and lead to decreased cognitive control of behavioral responses to emotionally salient stimuli.
“This research points to aberrations at the prefrontal cortex that may play a role in disrupting emotion processing among individuals with PTSD, which may shape intense reactions to traumatic reminders (e.g., a triggering sound, sight or smell) and lead to decreased cognitive control of behavioral responses to emotionally salient stimuli (Frewen et al., 2008; Brown and Morey, 2012; Hayes et al., 2”
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 Hayes et al., 2012
For humans, the defense cascade model includes collapsed immobility, characterized by bradycardia combined with hypotonicity of skeletal muscles.
“For humans, the model includes collapsed immobility,††,7,16,35 which is characterized by bradycardia combined with hypotonicity of skeletal muscles.”
From Fear and the Defense Cascade (2015) · cites this paper as [35]
The Memory and learning section discusses heart rate as a measure of fear responsivity in PTSD, but does not describe a human defense cascade or collapsed immobility. Searches for collapsed immobility, bradycardia, skeletal-muscle hypotonicity, and the defense cascade found no passage addressing the claim in our copy; page numbers were not provided. (LLM, conf=0.76)
Experimental — accuracy not yet measuredStructural alterations in PTSD co-occur with functional brain alterations, including alterations in activation and connectivity in the amygdala, hippocampal, orbitofrontal cortex, and dorsal anterior cingulate cortex.
“These structural alterations co-occur with functional brain alterations in PTSD, which include alterations in activation and connectivity in amygdala, hippocampal, orbitofrontal cortex and dorsal anterior cingulate cortex”
From Exercise Intervention in PTSD: A Narrative Review and Rationale for Implementation (2019) · cites this paper as [3]
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“And because the insula is involved in neural representations of body state—including acute sympathetic arousal—increased activity there reflects the individual’s hyperaroused body state.(54,57,59)”
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- Authors
- Hayes, J. P., VanElzakker, M. B., & Shin, L. M.
- Affiliations
- Boston University (US)
- Tufts University (US)
- Corresponding author
- Hayes, Jasmeet P.
- Venue
- Frontiers in Integrative Neuroscience
- Publisher
- Frontiers Media SA
- Published
- 2012
- Volume
- 6
- Pages
- 89-89
- ISSN
- 1662-5145 (ISSN-L)
- PMC
- PMC3466464
- OpenAlex
- W2152791743
- Cited by
- 393
- References
- 166
- Citations by year
- 2026: 29 · 2025: 41 · 2024: 34 · 2023: 22 · 2022: 36 · 2021: 42 · 2020: 29 · 2019: 32 · 2018: 30 · 2017: 36 · 2016: 22 · 2015: 18 · 2014: 15 · 2013: 5 · 2012: 1
- FWCI
- 14.19
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- Frontiers in Integrative Neuroscience (publishedVersion, cc-by)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- National Defense Science and Engineering Graduate
- National Institute of Mental Health (K23MH084013, R01MH054636)
- 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, emotion-cognition interaction, threat detection, attentional bias, memory impairment, cognitive impairment, negative affectivity, neurocognitive model, threat interpretation
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