Amygdala Reactivity and Anterior Cingulate Habituation Predict Posttraumatic Stress Disorder Symptom Maintenance After Acute Civilian Trauma

Jennifer S. Stevens, Ye Ji Kim, Isaac R. Galatzer-Levy, Renuka Reddy, Timothy D. Ely, Charles B. Nemeroff, Lauren A. Hudak, Tanja Jovanovic, Barbara O. Rothbaum, Kerry J. Ressler

Research output: Contribution to journalArticle

48 Scopus citations

Abstract

Background Studies suggest that exaggerated amygdala reactivity is a vulnerability factor for posttraumatic stress disorder (PTSD); however, our understanding is limited by a paucity of prospective, longitudinal studies. Recent studies in healthy samples indicate that, relative to reactivity, habituation is a more reliable biomarker of individual differences in amygdala function. We investigated reactivity of the amygdala and cortical areas to repeated threat presentations in a prospective study of PTSD. Methods Participants were recruited from the emergency department of a large level I trauma center within 24 hours of trauma. PTSD symptoms were assessed at baseline and approximately 1, 3, 6, and 12 months after trauma. Growth curve modeling was used to estimate symptom recovery trajectories. Thirty-one individuals participated in functional magnetic resonance imaging around the 1-month assessment, passively viewing fearful and neutral face stimuli. Reactivity (fearful > neutral) and habituation to fearful faces was examined. Results Amygdala reactivity, but not habituation, 5 to 12 weeks after trauma was positively associated with the PTSD symptom intercept and predicted symptoms at 12 months after trauma. Habituation in the ventral anterior cingulate cortex was positively associated with the slope of PTSD symptoms, such that decreases in ventral anterior cingulate cortex activation over repeated presentations of fearful stimuli predicted increasing symptoms. Conclusions Findings point to neural signatures of risk for maintaining PTSD symptoms after trauma exposure. Specifically, chronic symptoms were predicted by amygdala hyperreactivity, and poor recovery was predicted by a failure to maintain ventral anterior cingulate cortex activation in response to fearful stimuli. The importance of identifying patients at risk after trauma exposure is discussed.

Original languageEnglish (US)
Pages (from-to)1023-1029
Number of pages7
JournalBiological Psychiatry
Volume81
Issue number12
DOIs
StatePublished - Jun 15 2017

Keywords

  • Amygdala
  • Arousal
  • Fear
  • Prospective
  • Trauma
  • fMRI

ASJC Scopus subject areas

  • Biological Psychiatry

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    Stevens, J. S., Kim, Y. J., Galatzer-Levy, I. R., Reddy, R., Ely, T. D., Nemeroff, C. B., Hudak, L. A., Jovanovic, T., Rothbaum, B. O., & Ressler, K. J. (2017). Amygdala Reactivity and Anterior Cingulate Habituation Predict Posttraumatic Stress Disorder Symptom Maintenance After Acute Civilian Trauma. Biological Psychiatry, 81(12), 1023-1029. https://doi.org/10.1016/j.biopsych.2016.11.015