Thursday 14 October 2021
The study shows a link between post-traumatic brain activity and symptoms of anxiety and PTSD six months later.
The way a person’s brain responds to stress after a traumatic event, such as a car accident, may help predict long-term mental health outcomes, according to research supported by the National Institute of Mental Health (NIMH), part of the National. health institutes. Search published in American Journal of Psychiatry, is part of the NIMH-funded AURORA Study, a large-scale, multi-site study that followed more than 3,000 people for up to a year after experiencing a traumatic event.
Evidence from previous studies indicates that it is common for people to show a wide range of responses after a traumatic experience, such as a natural disaster or a serious accident. One person may have initial symptoms that naturally diminish over time, while another person may have long-term symptoms that make it difficult to carry out daily activities. These different responses do not fall neatly into the current diagnostic categories, and although there are known risk and resilience factors associated with mental health outcomes, researchers are not yet able to predict how a particular person will act after experiencing a traumatic event.
Using a variety of neurological, behavioral, and self-report measures, the AURORA study researchers hope to develop a comprehensive picture of the factors that play a role in the mental health of trauma survivors over time. To help advance this effort, AURORA study data will be made available to the broader research community through the NIMH Data Archive.
As part of the study, Dr. Jennifer Stevens, of Emory University in Atlanta, led an investigation of post-traumatic brain activity in an initial group of 69 AURORA participants seen in the emergency department after a motor vehicle accident. Stevens and colleagues hypothesized that different patterns of stress-related brain activity might predict long-term mental health symptoms for participants across a range of diagnoses.
Two weeks after the accident, participants’ brain activity was measured by functional magnetic resonance imaging while they completed a series of standard computer-based tasks. The tasks assessed their brain activity in response to social threat cues, reward cues, and situations that required them to block the response.
Over the next six months, participants also completed digital surveys in which they self-reported symptoms of post-traumatic stress disorder (PTSD), depression, dissociation, anxiety, and impulsivity.
Analyzes of the participants’ brain activity data revealed four distinct profiles:
- reactive / uninhibited: elevated threat and reward activity; Little activity related to response inhibition
- Low Reward/High Threat: elevated threat-related activity; Low Reward Activity
- high reward: No threat-related activity. little activity related to response inhibition; High Reward Activity
- discourage: deactivation related to the threat; some activities related to inhibition; Low Reward Activity
The researchers then performed the same analyzes with a separate group of 77 AURORA participants who were also seen in the emergency department after experiencing a range of traumatic events not limited to motor vehicle accidents. In this group, they found evidence of three of the four profiles: reactive/non-inhibitory, low-reward/high-threat, and inhibitory. These profiles were not associated with demographic, health, trauma, or location-specific characteristics.
When looking at participants’ brain activity profiles in relation to their mental health outcomes, Stevens and the co-authors found that participants with the reactive/non-inhibitory profile—those who showed high activity associated with threat and reward—reported higher levels of PTSD symptoms. and anxiety over the six-month follow-up period compared to the other profiles.
The researchers found no association between any of the features of brain activity and other mental health outcomes, such as symptoms of depression, dissociation, or impulsivity.
The association between high reward reactivity (as part of the reactive/non-inhibitor profile) and long-term symptoms was unexpected, as previous studies have suggested an association between low reward reactivity and PTSD and depression. The divergent results may be explained by the fact that the interaction of reward and threat is rarely examined together in trauma-related studies. The researchers suggest that reward interaction requires greater attention in future studies as a potential risk factor for post-traumatic stress-related symptoms.
These results are preliminary and additional research with larger samples will be needed to confirm and refine these brain-based profiles. However, these preliminary findings suggest that profiles can provide useful information about a person’s exposure to stress after experiencing a traumatic event. Creating reliable and predictive stress response profiles can improve clinical care, and help providers deliver effective interventions tailored to the individual needs and circumstances of trauma survivors.
Grant: MH110925 (NIMH and US Army Medical Research and Materials Command), MH119603, MH118467
About the National Institute of Mental Health (NIMH): NIMH’s mission is to transform the understanding and treatment of mental illness through basic and clinical research, paving the way for prevention, recovery and treatment. For more information, visit the NIMH website.
About the National Institutes of Health (NIH):NIH, the country’s medical research agency, includes 27 institutes and centers and is part of the US Department of Health and Human Services. The National Institutes of Health is the primary federal agency that conducts and supports basic, clinical, and polymedical research, investigating the causes, treatments, and treatment of both common and rare diseases. For more information about the National Institutes of Health and its programs, visit www.nih.gov.
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Stevens, J. S., Harnett, N. G., Lebois, L. A., van Rooij, S. J., Ely, T. D., Roeckner, A., Vincent, S., Beaudoin, F. L., An, X., Zeng, D., Neylan, T. C., Clifford , G. D., Linnstaedt, S. D., Germine, L. T., Rauch, S. L., Lewandowski, C., Storrow, A. B., Hendry, P. L., Sheikh, S., Musey, P. I., … Ressler, K. J. (2021). Brain-based bio-models of psychological vulnerability in the aftermath of acute trauma. American Journal of Psychiatry. DOI: 10.1176 / appi.ajp.2021.20101526