Neural correlates of reexperiencing, avoidance, and dissociation in PTSD: Symptom dimensions and emotion dysregulation in responses to script‐driven trauma imagery

TLDR

Research suggests that responses to script‑driven trauma imagery in PTSD include reexperiencing and dissociative symptom subtypes. The study aimed to characterize script‑driven trauma‑imagery responses dimensionally in PTSD using fMRI and the Responses to Script‑Driven Imagery Scale. Using fMRI, the authors correlated severity of state posttraumatic symptoms with neural activation measured during script‑driven imagery. State reexperiencing severity correlated positively with right anterior insula activity and negatively with right rostral anterior cingulate cortex; avoidance was negatively associated with rACC and subcallosal anterior cingulate activity; dissociation showed positive correlations with left medial prefrontal and right superior temporal cortices and a negative correlation with left superior temporal cortex, supporting an emotion‑dysregulation account of PTSD.

Abstract

Research suggests that responses to script-driven trauma imagery in posttraumatic stress disorder (PTSD) include reexperiencing and dissociative symptom subtypes. This functional magnetic resonance imaging (fMRI) study employed a dimensional approach to characterizing script-driven imagery responses, using the Responses to Script-Driven Imagery Scale and correlational analyses of relationships between severity of state posttraumatic symptoms and neural activation. As predicted, state reexperiencing severity was associated positively with right anterior insula activity and negatively with right rostral anterior cingulate cortex (rACC). Avoidance correlated negatively with rACC and subcallosal anterior cingulate activity. In addition, as predicted, dissociation correlated positively with activity in the left medial prefrontal and right superior temporal cortices, and negatively with the left superior temporal cortex. Theoretical and clinical implications are discussed, particularly with respect to an emotion-dysregulation account of PTSD.