Neural oscillations while remembering traumatic memories in post-traumatic stress disorder.

OBJECTIVE: The current study investigated the oscillatory brain activity of PTSD patients during directed and imaginal exposure to the traumatic memory using magnetoencephalography (MEG), in a paradigm resembling exposure therapy. METHODS: Brain activity of healthy trauma-exposed controls and PTSD participants was measured with MEG as they listened to individualized trauma narratives as well as to a neutral narrative and as they imagined the narrative in detail. Source localization analysis by frequency bands was conducted in order to map neural generators of oscillatory activity. RESULTS: Elicitation of traumatic memories resulted in a distinct neural pattern in PTSD patients compared to healthy trauma-exposed individuals. In response to trauma scripts PTSD patients showed increases in high-gamma band power in visual areas, increased frontal and temporal theta as well as prefrontal alpha and medial temporal beta power relative to neutral scripts. CONCLUSIONS: Results suggest that when recollecting and imagining traumatic memories PTSD patients attempt to engage control or inhibition mechanisms. However, these are either not successfully recruited or inefficient leading to heightened responses and recollection. SIGNIFICANCE: Investigating the oscillatory neural dynamics of PTSD patients can help us better understand the processes underlying trauma re-experiencing.

Hypnotically induced somatosensory alterations: Toward a neurophysiological understanding of hypnotic anaesthesia.

Whereas numerous studies have investigated hypnotic analgesia, few have investigated hypnotic anaesthesia. Using magnetoencephalography (MEG) we investigated and localized brain responses (event-related fields and oscillatory activity) during sensory processing under hypnotic anaesthesia. Nineteen right handed neurotypical individuals with moderate-to-high hypnotizability received 100 vibrotactile stimuli to right and left index fingers in a random sequence. Thereafter a hypnotic state was induced, in which anaesthetic suggestion was applied to the left hand only. Once anaesthetic suggestion was achieved, a second, identical, session of vibrotactile stimuli was commenced. We found greater brain activity in response to the stimuli delivered to the left (attenuated) hand before hypnotic anaesthesia, than under hypnotic anaesthesia, in both the beta and alpha bands. In the beta band, the reduction of activity under hypnotic anaesthesia was found around 214-413ms post-stimuli and was located mainly in the right insula. In the alpha band, it was found around 253-500ms post-stimuli and was located mainly in the left inferior frontal gyrus. In a second experiment, attention modulation per se was ruled out as the underlying cause of the effects found. These findings may suggest that the brain mechanism underlying hypnotic anaesthesia involves top-down somatosensory inhibition and, therefore, a reduction of somatosensory awareness. The result of this mechanism is a mental state in which individuals lose bodily sensation.

Methylphenidate facilitates hypnotizability in adults with ADHD: a naturalistic cohort study.

Impaired attention may impede learning of adaptive skills in ADHD. While manipulations that reduce competition between attentional processes, including hypnosis, could boost learning, their feasibility in ADHD is unknown. Because hypnotic phenomena rely on attentional mechanisms, the authors aimed to assess whether stimulants could enhance hypnotizability in ADHD. In the current study, stimulant-naïve patients seeking treatment for ADHD-related symptoms were assessed with the Stanford Hypnotic Susceptibility Scale (SHSS) at baseline and during methylphenidate treatment. Methylphenidate dose and SHSS increase were negatively correlated with baseline SHSS scores. Upon reaching effective doses, mean SHSS scores increased significantly. All patients who had been poorly hypnotizable at baseline demonstrated moderate-to-high hypnotizability at follow-up. The data support methylphenidate enhancement of hypnotizability in ADHD, thus highlighting novel treatment approaches for this disabling disorder.

[Use of hypnosis in the treatment of combat post traumatic stress disorder (PTSD)].

Clinical reports and observations going back almost two centuries consistently indicate that hypnotherapy is an effective modality for the treatment of post traumatic stress disorder (PTSD). Pierre Janet was the first clinician to describe the successful initiation of stepwise hypnotic techniques in PTSD symptom reduction. Hypnotherapy may accelerate the formation of a therapeutic alliance and contribute to a positive treatment outcome. Hypnotic techniques may be valuable for patients with PTSD who exhibit symptoms such as anxiety, dissociation, widespread somatoform pain complaints and sleep disturbances. Hypnotic techniques may also facilitate the arduous tasks of working through traumatic memories, increasing coping skills, and promoting a sense of competency. In this review we will present guidelines for the stepwise implementation of hypnotherapy in PTSD. Since most data regarding the use of hypnotherapy in PTSD has been gathered from uncontrolled clinical observations, methodologically sound research demonstrating the efficacy of hypnotic techniques in PTSD is required for hypnotherapy to be officially added to the therapeutic armamentarium for this disorder.

Brain activation and heart rate during script-driven traumatic imagery in PTSD: preliminary findings.

Patients with posttraumatic stress disorder (PTSD) experience psychological and physiological distress. However, imaging research has mostly focused on the psychological aspects of the disorder. Considered an expression of distress, heart rate (HR) in PTSD is often elevated. In the current study, we sought to identify brain regions associated with increased HR in PTSD. Nine patients with PTSD and six healthy trauma survivors were scanned while resting, clenching teeth, and listening to neutral and traumatic scripts. Brain function was evaluated using H2O15 positron emission tomography (PET). HR was monitored by electrocardiogram. Data were analyzed using statistical parametric mapping (SPM). Subjects with PTSD exhibited a significant increase in HR upon exposure to traumatic scripts, while trauma survivors did not. Correlations between regional cerebral blood flow and HR were found only in patients with PTSD, in orbitofrontal, precentral and occipital regions. Neither group showed correlation between rCBF and HR in the amygdala or hippocampus. These preliminary results indicate that "top down" central nervous system regulation of autonomic stress response in PTSD may involve associative, sensory and motor areas in addition to regions commonly implicated in fear conditioning.

Increased anxiety during anticipation of unpredictable aversive stimuli in posttraumatic stress disorder but not in generalized anxiety disorder.

BACKGROUND: Uncontrollability and unpredictability are key concepts related to re-experiencing, avoidance, and hypervigilance symptoms of posttraumatic stress disorder (PTSD). However, little is known about the differential sensitivity of PTSD individuals to unpredictable stressors, relative to either healthy individuals or individuals with other anxiety disorders. This study tested the hypothesis that elevated anxious reactivity, specifically for unpredictable aversive events, is a psychophysiological correlate of PTSD. METHODS: Sixteen patients with PTSD (34.5 +/- 12.4 years) were compared with 18 patients with generalized anxiety disorder (GAD) (34.0 +/- 10.5 years) and 34 healthy control subjects (30.2 +/- 8.5 years). Participants were exposed to three conditions: one in which predictable aversive stimuli were signaled by a cue, a second in which aversive stimuli were administered unpredictably, and a third in which no aversive stimuli were anticipated. Startle magnitude was used to assess anxious responses to the threat cue and to contexts associated with each condition. RESULTS: Posttraumatic stress disorder and GAD patients showed normative enhancement of fear to the predictable threat cue, but the PTSD group displayed elevated anxiety during the unpredictable condition compared with participants with GAD and healthy control subjects. CONCLUSIONS: Anxious reactivity to unpredictable aversive events was heightened in PTSD but not in GAD and healthy subjects. Prior works also found signs of increased reactivity to unpredictable threat in panic disorder (PD), suggesting that PTSD and PD may involve shared vulnerability. As such, the current results inform understandings of classification, pathophysiology, and psychopharmacology of anxiety disorders, generally, and PTSD and panic disorder specifically.

Hydrocortisone impairs hippocampal-dependent trace eyeblink conditioning in post-traumatic stress disorder.

Trace eyeblink conditioning is a hippocampal-dependent associative learning task that could help evaluate hippocampal function in Post-traumatic stress disorder (PTSD). Since preclinical research has demonstrated that trace eyeblink conditioning can be pharmacologically manipulated by glucocorticoids, this task may shed light on glucocorticoid sensitivity in PTSD. This study assessed baseline and hydrocortisone-mediated changes in trace eyeblink conditioning in patients with PTSD and in healthy controls. A total of 12 patients with PTSD and 12 age- and sex-matched healthy controls participated in a trace eyeblink test 6 h following intravenous administration of 30 mg of hydrocortisone. Spontaneous blink rates were similar between PTSD patients and healthy controls. There was no significant difference in the mean conditioned response between PTSD subjects and healthy controls under placebo conditions. Following hydrocortisone administration, only the PTSD patients demonstrated a significant reduction in conditioned response in contrast to healthy subjects who did not demonstrate any change. Patients with PTSD had increased glucocorticoid sensitivity in the focal brain regions mediating trace eyeblink conditioning.

Parent-daughter discrepancies in perception of family function in bulimia nervosa.

Eating disorders have traditionally been associated with disturbed family function. Most empirical data regarding this issue, however, were gathered from eating disorders patients. Attitudes, function, and inter-personal relationships were examined within 16 families with a member suffering from bulimia nervosa (BN) and compared to 16 matched healthy families. Perception of family function was significantly more derogatory in bulimic subjects than in their parents, while in control subjects and parents, perception was largely congruent. Subjects suffering from BN perceived their families as less cohesive, adaptable, and supportive than did healthy subjects. No such difference in perception of family function was observed between parents of respective groups. This preliminary study shows that parent-daughter discrepancy in perception of family function may prove more characteristic of eating disorder families than any particular deficit. Future research should aim to replicate these findings, incorporate them into treatment paradigms, and employ them to monitor treatment outcome.

A randomized, double-blind, placebo-controlled study of classical homeopathy in generalized anxiety disorder.

BACKGROUND: Homeopathy is commonly used for the treatment of medical and psychological conditions. Such prevalent use, however, is not supported by robust, methodologically sound research. This study evaluates the effect of homeopathic treatment in generalized anxiety disorder, a prevalent mental disorder characterized by an enduring pattern of excessive apprehension and distress and by mental and bodily complaints. METHOD: Forty-four patients with DSM-IV generalized anxiety disorder participated in a randomized, double-blind, placebo-controlled 10-week trial of individually tailored homeopathic remedy. Homeopathic therapy was administered by an expert who followed the traditional routines of homeopathic diagnosis and prescription. Thirty-nine subjects completed the study (20 in the active treatment group and 19 in the placebo group). Subjects' symptoms were rated before treatment and after 5 and 10 weeks of treatment, with the Hamilton Rating Scale for Anxiety (HAM-A) as main outcome measure. Additional measures of outcome included the Brief Symptom Inventory, the Psychological General Well-Being Index, the Hamilton Rating Scale for Depression, the Beck Depression Inventory, Spielberger's State-Trait Anxiety Inventory, and a Visual Analogue Scale of subjective distress. RESULTS: Significant (p <.05) improvement in most measures, including the HAM-A, was observed in both the active treatment and placebo groups, yet no group effect was observed. CONCLUSION: The effect of homeopathic treatment on mental symptoms of patients with generalized anxiety disorder did not differ from that of placebo. The improvement in both conditions was substantial. Improvement of such magnitude may account for the current belief in the efficacy of homeopathy and the current increase in the use of this practice.