Functional reorganization of neural networks involved in emotion regulation following trauma therapy for complex trauma disorders

Yolanda R Schlumpf; Ellert R S Nijenhuis; Carina Klein; Lutz Jäncke; Silke Bachmann

doi:10.1016/j.nicl.2019.101807

Functional reorganization of neural networks involved in emotion regulation following trauma therapy for complex trauma disorders

Neuroimage Clin. 2019:23:101807. doi: 10.1016/j.nicl.2019.101807. Epub 2019 Apr 2.

Authors

Yolanda R Schlumpf¹, Ellert R S Nijenhuis², Carina Klein³, Lutz Jäncke⁴, Silke Bachmann⁵

Affiliations

¹ Division of Neuropsychology, Institute of Psychology, University of Zurich, Switzerland; Clienia Littenheid AG, Hospital for Psychiatry and Psychotherapy, Littenheid, Switzerland. Electronic address: y.schlumpf@psychologie.uzh.ch.
² Clienia Littenheid AG, Hospital for Psychiatry and Psychotherapy, Littenheid, Switzerland.
³ Division of Neuropsychology, Institute of Psychology, University of Zurich, Switzerland.
⁴ Division of Neuropsychology, Institute of Psychology, University of Zurich, Switzerland; Research Unit for Plasticity and Learning of the Healthy Aging Brain, University of Zurich, Switzerland.
⁵ Clienia Littenheid AG, Hospital for Psychiatry and Psychotherapy, Littenheid, Switzerland; Department of Psychiatry, Psychotherapy, and Psychosomatics, University Hospitals and University of Halle (Saale), Halle, Germany.

Abstract

Objectives: We investigated whether patients with complex interpersonal trauma engage neural networks that are commonly activated during cognitive reappraisal and responding naturally to affect-laden images. In this naturalistic study, we examined whether trauma treatment not only reduces symptoms but also changes neural networks involved in emotional control.

Methods: Before and after eight weeks of phase-oriented inpatient trauma treatment, patients (n = 28) with complex posttraumatic stress disorder (cPTSD) and complex dissociative disorders (CDD) performed a cognitive reappraisal task while electroencephalography (EEG) was registered. Patients were measured as a prototypical dissociative part that aims to fulfill daily life goals while avoiding traumatic memories and associated dissociative parts. Matched healthy controls (n = 38) were measured twice as well. We examined task-related functional connectivity and assessed self-reports of clinical symptoms and emotion regulation skills.

Results: Prior to treatment and compared to controls, patients showed hypoconnectivity within neural networks involved in emotional downregulation while reappraising affect-eliciting pictures as well as viewing neutral and affect-eliciting pictures. Following treatment, connectivity became normalized in these networks comprising regions associated with cognitive control and memory. Additionally, patients showed a treatment-related reduction of negative but not of positive dissociative symptoms.

Conclusions: This is the first study demonstrating that trauma-focused treatment was associated with favorable changes in neural networks involved in emotional control. Emotional overregulation manifesting as negative dissociative symptoms was reduced but not emotional underregulation, manifesting as positive dissociative symptoms.

Keywords: Complex trauma; Dissociation; Electroencephalography; Emotion regulation; Functional brain network; Network-based statistic; Trauma treatment.

MeSH terms

Adult
Affect / physiology
Brain / physiopathology*
Dissociative Disorders / physiopathology*
Dissociative Disorders / therapy*
Electroencephalography
Emotional Regulation / physiology*
Female
Humans
Male
Middle Aged
Neural Pathways / physiopathology
Stress Disorders, Post-Traumatic / physiopathology*
Stress Disorders, Post-Traumatic / therapy*
Treatment Outcome