The Department of Decoded Neurofeedback, Computational Neuroscience Laboratories, Advanced Telecommunications Research Institute International, Kyoto, Japan.
The Department of Psychiatry, Kobe University Graduate School of Medicine, Kobe, Japan.
Mol Psychiatry. 2021 Sep;26(9):5023-5039. doi: 10.1038/s41380-020-0827-0. Epub 2020 Jul 20.
Patients with posttraumatic stress disorder (PTSD) appear to manifest two opposing tendencies in their attentional biases and symptoms. However, whether common neural mechanisms account for their opposing attentional biases and symptoms remains unknown. We here propose a model in which reciprocal inhibition between the amygdala and ventromedial prefrontal cortex (vmPFC) predicts synchronized alternations between emotional under- and overmodulatory states at the neural, behavioral, and symptom levels within the same patients. This reciprocal inhibition model predicts that when the amygdala is dominant, patients enter an emotional undermodulatory state where they show attentional bias toward threat and manifest re-experiencing symptoms. In contrast, when the vmPFC is dominant, patients are predicted to enter an emotional overmodulatory state where they show attentional bias away from threat and avoidance symptoms. To test the model, we performed a behavioral meta-analysis (total N = 491), analyses of own behavioral study (N = 20), and a neuroimaging meta-analysis (total N = 316). Supporting the model, we found the distributions of behavioral attentional measurements to be bimodal, suggesting alternations between the states within patients. Moreover, attentional bias toward threat was related to re-experiencing symptoms, whereas attentional bias away from threat was related with avoidance symptoms. We also found that the increase and decrease of activity in the left amygdala activity was related with re-experiencing and avoidance symptoms, respectively. Our model may help elucidate the neural mechanisms differentiating nondissociative and dissociative subtypes of PTSD, which usually show differential emotional modulatory levels. It may thus provide a new venue for therapies targeting each subtype.
创伤后应激障碍（PTSD）患者的注意力偏向和症状似乎表现出两种对立的趋势。然而，它们对立的注意力偏向和症状是否由共同的神经机制引起尚不清楚。我们提出了一个模型，该模型认为杏仁核和腹内侧前额叶皮质（vmPFC）之间的相互抑制可以预测同一患者的神经、行为和症状水平上情绪调节不足和过度状态之间的同步交替。该相互抑制模型预测，当杏仁核占主导地位时，患者会进入情绪调节不足状态，表现出对威胁的注意力偏向，并表现出再体验症状。相比之下，当 vmPFC 占主导地位时，患者预计会进入情绪过度调节状态，表现出对威胁的注意力偏向和回避症状。为了检验该模型，我们进行了行为荟萃分析（总 N=491）、自身行为研究分析（N=20）和神经影像学荟萃分析（总 N=316）。支持该模型的是，我们发现行为注意力测量的分布呈双峰，表明患者内部状态的交替。此外，对威胁的注意力偏向与再体验症状有关，而对威胁的注意力偏向与回避症状有关。我们还发现，左侧杏仁核活动的增加和减少分别与再体验和回避症状有关。我们的模型可能有助于阐明区分非分离性和分离性 PTSD 亚型的神经机制，这两种亚型通常表现出不同的情绪调节水平。因此，它可能为针对每种亚型的治疗提供一个新的途径。
