Neural correlates of psychotic-like experiences during spiritual-trance state.

Recent studies indicate high levels of psychotic experiences in the general population. Here, we report a functional imaging study with 8 mentally healthy spiritual mediums and 8 matched controls. The mediums entered a mediumistic-trance state using a standardized manner by closing their eyes and actively seeking to ignore external and internal stimuli to achieve a 'state of emptiness'; in a control condition, they were instructed to re-enact the same mediumistic experience that they had during the mediumistic-trance condition but in a non-trance state (imaginative-trance). Both mediums and controls took part in a resting state session. The results indicate stronger activation in the lateral occipital cortex, posterior cingulate cortex (PCC), temporal pole, middle temporal gyrus and orbitofrontal cortex during the mediumistic-trance state. We also observe increased functional connectivity within auditory and sensorimotor Resting State Networks (RSN) during mediumistic-trance compared to resting and imaginative-trance conditions. Comparing spiritual mediums and controls, no differences in RSN were found. These data show preserved engagement of prefrontal cortex and connectivity of the default-mode network that indicate maintained introspective control over non-pathological psychotic-like experiences.

Neuroimagem na dependência de jogos eletrônicos: uma revisão sistemática / Neuroimaging in video game addiction: a systematic review

Objetivo: Realizar revisão sistemática de manuscritos que utilizaram a neuroimagem no estudo da dependência de jogos eletrônicos, a fim de identificar as principais regiões cerebrais alteradas. Métodos: Foram realizadas buscas nos seguintes bancos de dados: ScieELO, BVS, Lilacs, Science Direct On Line e PubMed. Não houve data mínima para a pesquisa, sendo considerados os artigos encontrados até julho de 2013. Os descritores utilizados para a presente revisão sistemática da literatura foram: “PET”, “SPECT”, “MRI”, “DTI”, “EEG”, “imaging”, “neuroimaging”, “spectroscopy”, “functional magnetic ressonance”, “structural magnetic ressonance”, “tractography”, “voxel” e “brain”, individualmente cruzados com os descritores “gaming” e “video game addiction”. Resultados: Dos 52 artigos encontrados, 16 foram selecionados: nove usaram fMRI, quatro usaram sRMI, um usou PET e dois usaram EEG. Em relação às alterações funcionais e estruturais, elas foram mais observadas no lobo frontal (córtex pré-frontal dorsolateral, córtex orbitofrontal, giro pré-frontal, giro frontal médio), parietal, temporal (giro para-hipocampal), núcleos da base, tálamo, ínsula e cerebelo. Conclusão: A despeito dos métodos utilizados, os estudos apontaram convergências quanto às reciprocidades cerebrais. Essas alterações neurais são semelhantes às observadas em pacientes dependentes de substâncias e de internet, especialmente durante o estado de fissura. Apesar de apenas recentemente pesquisas de neuroimagem em dependentes de jogos eletrônicos terem sido realizadas, contamos no momento com achados significativos alinhados à ...

Objective: To perform a systematic review of manuscripts that used neuroimage to study the video game addiction in order to identify the main altered brain regions. Methods: Searches were realized in the following databases: ScieELO, BVS, Lilacs, Science Direct On Line and PubMed. There was no minimum date for the research, being considered articles founded until July 2013. The descriptors used for this systematic review were: “PET”, “SPECT”, “MRI”, “DTI”, “EEG”, “imaging”, “neuroimaging”, “spectroscopy”, “functional magnetic resonance”, “structural magnetic resonance”, “tractography”, “voxel” and “brain”, individually crossed with descriptors “gaming” and “video game addiction”. Results: Of the 52 articles founded, 16 were selected: nine used fMRI, four used sRMI, one used PET and two used EEG. In relation of the functional and structural changes, they were more often observed in the frontal lobe (dorsolateral prefrontal cortex, orbitofrontal cortex, prefrontal gyrus, middle frontal gyrus), parietal, temporal (parahippocampal gyrus), basal ganglia, thalamus, insula and cerebellum. Conclusion: Regardless the methods utilized, the studies pointed convergences regarding reciprocity brain. These neural changes are similar to those observed in patients with substance addiction and internet addiction, especially during craving. Although only recently neuroimaging researches on game addicts were realized, we count at the moment with significant findings aligned with the understanding of the neural mechanisms associated with video game addiction and its inclusion as a nosological category in psychiatric scope. .

Neuroimagem e mediunidade: uma promissora linha de pesquisa / Neuroimaging and mediumship: a promising research line

A relação mente-corpo tem despertado perguntas e debates desde os tempos das milenares tradições religiosas e dos antigos gregos até a neurociência contemporânea e, apesar de essas questões ainda não terem sido decisivamente respondidas, atualmente intervenções terapêuticas são orientadas por suposições a esse respeito. As investigações sobre os correlatos neurais da consciência e expressões mentais progrediram ao longo dos últimos 15 anos por meio do desenvolvimento de métodos de imagiologia funcional do cérebro. Essa abordagem pode abrir novas perspectivas para investigação da expressão de consciências supostamente espirituais com importantes implicações éticas, sociais e filosóficas. Propomos uma promissora nova linha de pesquisa em neurociências e discussão de algumas questões pertinentes à efetiva utilização da neuroimagem como potencial método de investigação da mediunidade para avançar a compreensão consensual a respeito da consciência, da suposta comunicação espiritual e suas relações com o cérebro. Destacamos certos aprendizados e desafios metodológicos adquiridos em nossa pesquisa neurofuncional sobre mediunidade a serem considerados em novos estudos nesse campo para formulação de hipóteses a respeito de tais fenômenos e discutimos orientações úteis para estudos de neuroimagem envolvendo experiências espirituais em geral.

The mind-body relationship has prompted debate from the times of millennial religious traditions and the ancient Greeks through to contemporary neuroscience, and although these questions have yet to be decisively answered, therapeutic interventions today are guided by assumptions made in this respect. Research on the neural correlates of consciousness and mental expressions has made progress over the last 15 years by developing functional brain imaging methods. This approach may open up new perspectives for studies of the expression of presumed instances of spiritual consciousness, which would have major ethical, social and philosophical implications. We pose a promising new line of research in the neurosciences and discuss certain issues pertaining to the effective use of neuroimaging to investigate mediumship and advance the consensus comprehension of consciousness, alleged spiritual communication and its relations with the brain. We highlight methodological challenges and lessons gleaned from our neurofunctional study of mediumship to be considered for further research in this field when formulating hypotheses to address these phenomena, and discuss useful guidelines for neuroimaging studies of spiritual experiences in general.

Neuroimaging during trance state: a contribution to the study of dissociation.

Despite increasing interest in pathological and non-pathological dissociation, few researchers have focused on the spiritual experiences involving dissociative states such as mediumship, in which an individual (the medium) claims to be in communication with, or under the control of, the mind of a deceased person. Our preliminary study investigated psychography - in which allegedly "the spirit writes through the medium's hand" - for potential associations with specific alterations in cerebral activity. We examined ten healthy psychographers - five less expert mediums and five with substantial experience, ranging from 15 to 47 years of automatic writing and 2 to 18 psychographies per month - using single photon emission computed tomography to scan activity as subjects were writing, in both dissociative trance and non-trance states. The complexity of the original written content they produced was analyzed for each individual and for the sample as a whole. The experienced psychographers showed lower levels of activity in the left culmen, left hippocampus, left inferior occipital gyrus, left anterior cingulate, right superior temporal gyrus and right precentral gyrus during psychography compared to their normal (non-trance) writing. The average complexity scores for psychographed content were higher than those for control writing, for both the whole sample and for experienced mediums. The fact that subjects produced complex content in a trance dissociative state suggests they were not merely relaxed, and relaxation seems an unlikely explanation for the underactivation of brain areas specifically related to the cognitive processing being carried out. This finding deserves further investigation both in terms of replication and explanatory hypotheses.

Cultura tecnológica e vulnerabilidade ao trauma psíquico / Technological culture and vulnerability to psychic trauma

O desenvolvimento das tecnologias de informação e comunicação (TIC), nas últimas décadas, repercutiu de maneira intensaem muitos aspectos da vida social e individual, criando outras formas de pensar, sentir e agir do homem em um novo tipode sociedade influenciada pela cultura tecnológica. O mundo virtual passa a ser cada vez mais atrativo a partir da qualidadee da quantidade de informações tecnológicas com alta resolução e miríade de cores vívidas, que seduzem naturalmenteos usuários por meio da excitação provocada pelos estímulos sensoriais. Por outro lado, os genitores estão cada vez maisocupados pelas pressões de performance em um contexto cultural da pressa e tendem a ignorar o isolamento dos filhos,aparentemente entretidos, porém com transtornos afetivos decorrentes do uso problemático das TICs. Pesquisadores revelamnovos distúrbios associados ao movimento caótico e constante de informações virtuais, que provocam o analfabetismo emocionale consequentemente a vulnerabilidade ao trauma psíquico por déficits da capacidade de processamento cognitivo.Os profissionais da saúde mental devem estar cientes das comorbidades potenciais associadas ao uso desregulado das TICs,assim como alertar e orientar sobre a necessidade de maior participação dos pais, familiares e educadores para redução eprevenção dos riscos traumatogênicos à juventude, influenciada pela prevalente cultura tecnológica em centros urbanos.(AU)

The development of information and communication technologies (ICTs) in the last few decades had intense effects in many aspectsof social and individual life, creating other human ways of thinking, feeling and acting in a new kind of society influencedby technological culture. The so-called virtual world is ever more attractive due to the quality and the amount of technologicalinformation with high resolution and a myriad of lively colors, which no doubt seduce users by means of excitation provokedby sensorial stimuli. On the other hand, parents are ever busier due to pressures for a good performance in a cultural contextmarked by haste and tend to ignore the isolation of their apparently entertained children, but with affective disturbances causedby the problematic use of ICTs. Researchers disclose new problems associated to the chaotic and constant movement of virtualinformation, which causes emotional illiteracy and consequently vulnerability to psychic trauma due to cognitive processingdeficits. Mental health professionals must be aware of potential comorbidities associated to the unregulated use of ICTs, as theymust counsel and guide about the necessity of more participation of parents, family members and educators in the reduction andprevention of traumatogenic risks to youths influenced by the prevalent technological culture in urban centers.(AU)

Cultura tecnológica e vulnerabilidade ao trauma psíquico / Technological culture and vulnerability to psychic trauma

O desenvolvimento das tecnologias de informação e comunicação (TIC), nas últimas décadas, repercutiu de maneira intensa em muitos aspectos da vida social e individual, criando outras formas de pensar, sentir e agir do homem em um novo tipo de sociedade influenciada pela cultura tecnológica. O mundo virtual passa a ser cada vez mais atrativo a partir da qualidade e da quantidade de informações tecnológicas com alta resolução e miríade de cores vívidas, que seduzem naturalmente os usuários por meio da excitação provocada pelos estímulos sensoriais. Por outro lado, os genitores estão cada vez mais ocupados pelas pressões de performance em um contexto cultural da pressa e tendem a ignorar o isolamento dos filhos,aparentemente entretidos, porém com transtornos afetivos decorrentes do uso problemático das TICs. Pesquisadores revelam novos distúrbios associados ao movimento caótico e constante de informações virtuais, que provocam o analfabetismo emocional e consequentemente a vulnerabilidade ao trauma psíquico por déficits da capacidade de processamento cognitivo.Os profissionais da saúde mental devem estar cientes das comorbidades potenciais associadas ao uso desregulado das TICs, assim como alertar e orientar sobre a necessidade de maior participação dos pais, familiares e educadores para redução e prevenção dos riscos traumatogênicos à juventude, influenciada pela prevalente cultura tecnológica em centros urbanos.

The development of information and communication technologies (ICTs) in the last few decades had intense effects in many aspects of social and individual life, creating other human ways of thinking, feeling and acting in a new kind of society influenced by technological culture. The so-called virtual world is ever more attractive due to the quality and the amount of technological information with high resolution and a myriad of lively colors, which no doubt seduce users by means of excitation provoked by sensorial stimuli. On the other hand, parents are ever busier due to pressures for a good performance in a cultural context marked by haste and tend to ignore the isolation of their apparently entertained children, but with affective disturbances caused by the problematic use of ICTs. Researchers disclose new problems associated to the chaotic and constant movement of virtual information, which causes emotional illiteracy and consequently vulnerability to psychic trauma due to cognitive processing deficits. Mental health professionals must be aware of potential comorbidities associated to the unregulated use of ICTs, as they must counsel and guide about the necessity of more participation of parents, family members and educators in the reduction and prevention of traumatogenic risks to youths influenced by the prevalent technological culture in urban centers.

Should psychotherapy consider reincarnation?

There is increasing recognition of the need to take into account the cultural environment and belief systems of psychotherapy patients because these values reflect basic assumptions about man's nature and the cognitive references used to cope with psychological difficulties. Currently accepted psychotherapeutic approaches take no account of the belief in life after death held by most of the world's population. The World Values Survey (http://www.worldvaluessurvey.org) showed that there are large numbers of reincarnationists around the world, and whatever the reasons for believing in reincarnation, psychotherapeutic approaches should not ignore this significant group of people. Respect for patient opinions and subjective realities is a therapeutic need and an ethical duty, even though therapists may not share the same beliefs. Guidelines are suggested for professionals to develop collaborative models that help patients mobilize their intrinsic intelligence to find solutions to their complaints.

Sensitivity to aversive stimulation, posttraumatic symptoms and migraines: what do they have in common?

Studies have suggested that the high comorbidity observed between chronic migraine and anxiety disorders can be mediated through a third factor namely increased sensitivity to aversive stimulation. This trait may predispose for both chronic migraines, through medication overuse as an avoidance response, and anxiety disorders. Additional studies have shown that hyper sensitivity to aversive stimulation, migraine chronification and anxiety disorders share other characteristics such as serotonergic mediation and personality traits. Preliminary analysis of empirical data comparing the frequency the impact of traumatic events over chronic [CM] and episodic migraine [EM] patients gives further support to this hypothesis. In spite of CM and EM did not differ in terms of the occurrence of traumatic events, CM patients that had experienced at least one traumatic event during their lives had higher scores in re-experiencing and avoidance (but not in hyperarousal) symptoms than CM patients. These observations suggest that traumatic events have greater impact over CM than over EM patients.

Police officers under attack: resilience implications of an fMRI study.

OBJECTIVE: Crime is now a top-priority public-health issue in many urban areas. Sao Paulo's state police force was the target of gunfire attack on an unprecedented scale. Several officers were killed or wounded, and many more were affected by psychological trauma. We investigated the brain activity underlying trauma, the coping effect of psychotherapy, and resilience in a highly homogenous sample that experienced the same traumatic event. The design applied was a between-group comparison of cerebral blood-oxygenation-level-dependent signals and symptom scores of police officers with and without partial Posttraumatic Stress Disorder (pPTSD). METHOD: We used functional magnetic resonance imaging (fMRI) to investigate the retrieval of traumatic memories of 36 volunteers divided in three groups: (1) pPTSD policemen submitted to psychotherapy; (2) pPTSD policemen on the wait list; and (3) symptom-free (resilient) policemen. All participants were given a baseline fMRI scan and a follow-up scan some 40 days later. Not given psychotherapy, groups 2 and 3 were controls. RESULTS: Group 1 showed 37% fewer PTSD symptoms post-psychotherapy and their scores and neural expressions were comparable to Group 3 resilient policemen. A marked increased in medial prefrontal cortex (mPFC) activity was concomitant with decreased amygdala activity during traumatic memory retrieval in both resilient and pPTSD participants (after psychotherapy) and these findings were associated with symptom attenuation. CONCLUSIONS: Our results provide neurophysiological evidence of resilience in a high-risk group for PTSD. Psychotherapy may help to build narratives and resilient integrated translations of fragmented traumatic memories via mPFC, and thus weaken their sensory content while strengthening them cognitively.

Psychological trauma in chronic pain: implications of PTSD for fibromyalgia and headache disorders.

The association of traumatic exposures with posttraumatic stress disorder (PTSD) and other mental health conditions is well known. Patients with chronic pain, particularly headache disorders and fibromyalgia (FM), associated with psychological traumas need a special management strategy. Diagnosis of headache disorders and FM in traumatized patients and collecting the clinical history of a traumatic event or diagnosing PTSD in chronic pain patients is of great importance. Psychotherapy and pharmacotherapeutic options should be started on patients with comorbid PTSD and headache disorders and/or FM.

Traumatic memories: bridging the gap between functional neuroimaging and psychotherapy.

OBJECTIVE: Neuroimaging studies have highlighted important issues related to structural and functional brain changes found in sufferers of psychological trauma that may influence their ability to synthesize, categorize, and integrate traumatic memories. METHODS: Literature review and critical analysis and synthesis. RESULTS: Traumatic memories are diagnostic symptoms of post-traumatic stress disorder (PTSD), and the dual representation theory posits separate memory systems subserving vivid re-experiencing (non-hippocampally dependent) versus declarative autobiographical memories of trauma (hippocampally dependent). But the psychopathological signs of trauma are not static over time, nor is the expression of traumatic memories. Multiple memory systems are activated simultaneously and in parallel on various occasions. Neural circuitry interaction is a crucial aspect in the development of a psychotherapeutic approach that may favour an integrative translation of the sensory fragments of the traumatic memory into a declarative memory system. CONCLUSION: The relationship between neuroimaging findings and psychological approaches is discussed for greater efficacy in the treatment of psychologically traumatized patients.

Psychotherapy and neuroscience: towards closer integration.

The original aim of psychology was to study and understand the spirit-from the Latin spiritus, literally "breath." The limitations of scientific methods in the past favoured psychology's aloofness in terms of studying the "intangible," while medicine developed methods of examining the body (Latin corpus: essential part). Until 20 years ago, knowledge of the localization of brain functions was limited to inferences from clinical observation of brain-lesioned patients or parallel studies of primate brains. Current neuroscience, with its integrative approach, is bringing together research from molecular through cognitive levels, and psychotherapy has benefited from these findings. Functional neuroimaging studies may make specific and more far-reaching contributions in this respect, since cerebral dynamics may be observed in vivo and in controlled situations. Methods such as single photon emission tomography, positron emission tomography, and functional magnetic resonance imaging have been able to evaluate the neural correlates involved in psychotherapy for individuals with obsessive-compulsive disorder, major depression, social phobia, specific phobia, and post-traumatic disorder. Researchers have found that psychotherapy has the potential to modify dysfunctional neural circuits associated with these disorders. However, precautions are required in constructing feasible designs for neurofunctional investigations. This article reviews the 21 studies that have been published on the subject, and sets out the main advantages and limitations of the technologies used most frequently in protocols involving psychotherapies, and prerequisites for experimental designs. We also pose ways in which the findings from neuroimaging may produce knowledge to guide psychotherapeutic interventions by specifying what should be stimulated in these individuals in order to normalize deficient neural activities.

Cerebral blood flow changes during retrieval of traumatic memories before and after psychotherapy: a SPECT study.

BACKGROUND: Traumatic memory is a key symptom in psychological trauma victims and may remain vivid for several years. Psychotherapy has shown that neither the psychopathological signs of trauma nor the expression of traumatic memories are static over time. However, few studies have investigated the neural substrates of psychotherapy-related symptom changes. METHOD: We studied 16 subthreshold post-traumatic stress disorder (PTSD) subjects by using a script-driven symptom provocation paradigm adapted for single photon emission computed tomography (SPECT) that was read aloud during traumatic memory retrieval both before and after exposure-based and cognitive restructuring therapy. Their neural activity levels were compared with a control group comprising 11 waiting-list subthreshold PTSD patients, who were age- and profile-matched with the psychotherapy group. RESULTS: Significantly higher activity was observed in the parietal lobes, left hippocampus, thalamus and left prefrontal cortex during memory retrieval after psychotherapy. Positive correlations were found between activity changes in the left prefrontal cortex and left thalamus, and also between the left prefrontal cortex and left parietal lobe. CONCLUSIONS: Neural mechanisms involved in subthreshold PTSD may share neural similarities with those underlying the fragmented and non-verbal nature of traumatic memories in full PTSD. Moreover, psychotherapy may influence the development of a narrative pattern overlaying the declarative memory neural substrates.

Espiritualidade, religiosidade e psicoterapia / Spirituality, religiousness and psychotherapy

Crenças e práticas religiosas/espirituais constituem uma parte importante da cultura e dos princípios utilizados para dar forma a julgamentos e ao processamento de informações. O conhecimento e a valorização de tais sistemas de crenças colaboram com a aderência do indivíduo à psicoterapia e promovem melhores resultados. Contudo, nem todas as abordagens encontraram um ajuste desse tema em suas intervenções e os diversos conceitos sobre religiosidade/espiritualidade dificultam essa importante interface. Neste artigo, trazemos os conceitos mais coerentes e acessíveis para facilitar o diálogo profissional no âmbito terapêutico. Discutimos o impacto da subjetividade, dos estados de consciência e das percepções influenciadas pela religiosidade/espiritualidade na saúde mental e a importância de a psicoterapia voltar-se a clientes e respectivos sistemas de crenças, desenvolvendo modelos que mobilizem esperança e potencializem suas capacidades de superação. A despeito da atual distância entre estudos controlados e práticas clínicas, discutimos a integração das dimensões espirituais/religiosas na psicoterapia com profissionalismo ético, conhecimento e habilidades para alinhar as informações coletadas ao benefício do cliente. Considerando que apenas 7,3 por cento da população brasileira não têm religião e a escassez de abordagens e psicoterapeutas que contemplem a religiosidade/espiritualidade, apontamos a relevância de investigações sobre o tema e que as propostas psicoterápicas sejam testadas em ensaios clínicos.

Religious/spiritual beliefs and practices constitute an important part of culture and principles clients use to shape judgments and process information. Psychotherapists may use knowledge of these belief systems and appreciation of their potential to leverage client adherence and achieve better outcomes. However, many approaches have yet to do so and the variety of concepts of religiosity/spirituality may place obstacles to this important interface. This article raises certain concepts that we see as consistent, accessible, and capable of facilitating professional dialogue in the therapeutic sphere. We discuss the impact of subjectivity, states of consciousness and perceptions influenced by religiosity/spirituality, on mental health as well as the importance of psychotherapists actually focusing clients and their belief systems, developing models to mobilize hope, and boosting coping abilities. Despite the current distance between controlled studies and clinical practice, we discuss the integration of spiritual/religious dimensions in psychotherapy with ethical professionalism, knowledge, and the ability to align the collected information so as to benefit clients. Since only 7.3 percent of Brazilians have no religion, and very few psychotherapeutic approaches or practitioners do actually engage religiosity/spirituality, we point to the relevance of research on this issue and the importance of testing related psychotherapeutic proposals in clinical trials.

Psychological dynamics affecting traumatic memories: implications in psychotherapy.

The search to understand response to trauma has turned to the contribution of personality factors. The way people process the stressor event is critical in determining whether a trauma will be configured or not. Neuroscience shows that the brain does not store memories, but traces of information that are later used to create memories, which do not always express a completely factual picture of the past experience. Whenever an event is retrieved, it may undergo a cognitive and emotional change. Psychological dynamics--emotional interpretative tendency that affects the internal dialogue related to a meaningful event--may influence the development of positive or negative outcomes after stressor events. We postulate that therapists must see beyond the traumatic event itself and work with the internal dialogues that maintain the pathological relationship with the past episode. Thus, they may better treat traumatized patients by therapeutically rebuilding the memory. A brief clinical case is presented to show how exposure-based and cognitive restructuring therapy may help trauma victims experience psychological growth from their negative experiences, by fostering healthy psychological dynamics.

Promovendo resiliência em vítimas de trauma psicológico / Fostering resilience in psychological trauma victims

A exposição a eventos estressores e violentos ocorre com relativa freqüência em grande parte da população. A busca pela compreensão das respostas ao trauma está voltada também para a contribuição dos fatores da personalidade. A maneira como os indivíduos processam o evento estressor é crítica para a determinação ou não do trauma. O encéfalo não armazena propriamente registros factuais, mas traços de informações que serão usados para recriar memórias, as quais nem sempre expressam um retrato completamente fidedigno da experiência passada. Sempre que um evento traumático é recordado, este pode submeter-se a mudanças cognitivas e emocionais. Postulamos que os psicoterapeutas devem trabalhar, além do evento traumático em si, os diálogos internos que mantêm a relação patológica com o episódio passado. A exposição imaginária e a reestruturação cognitiva podem auxiliar as vítimas de experiências traumáticas a evoluir a partir de suas experiências negativas, com o desenvolvimento de diálogos internos saudáveis e resilientes.

Achados da neuroimagem em transtorno de estresse pós-traumático e suas implicações clínicas / Posttraumatic stress disorder neuroimaging findings and their clinical implications

Estudos com neuroimagem vêm replicando alguns achados relevantes ao entendimento de anormalidades neuroanatômicas, estruturais e funcionais associadas ao transtorno de estresse pós-traumático (TEPT). A dificuldade em sintetizar, categorizar e integrar a memória traumática em uma narrativa pode estar relacionada à relativa diminuição do volume e ativação do hipocampo, à diminuição na atividade do córtex pré-frontal, do cíngulo anterior e da área de Broca. O mecanismo deficiente de extinção da resposta ao medo e à desregulação emocional estão possivelmente relacionados à menor atividade cortical pré-frontal, implicado na atenuação do feedback negativo da atividade da amígdala. Tais memórias traumáticas não-hipocampo/pré-frontal dependentes são involuntariamente acessadas, apresentam-se fragmentadas sensorialmente, sem estrutura narrativa desenvolvida e tendem a permanecer com expressão emocional intensa e sensações vívidas. Processos psicoterapêuticos, baseados em exposição e reconstrução cognitiva, podem estimular as faculdades cognitivas e integrativas do encéfalo correspondentes às estruturas encontradas como deficitárias em indivíduos com TEPT. Nessa perspectiva, a memória poderá perder intensidade emocional, ser cognitivamente mais organizada e ainda, esvaecer-se com o tempo. Outras implicações dos achados da neuroimagem são discutidas no âmbito psicoterapêutico, assim como, as perspectivas de futuros estudos com neuroimagem no Brasil.