Resilience Or PTSD – Regulating Emotion After Sexual Assault
After exposure to extreme life stresses, what distinguishes the individuals who do and do not develop posttraumatic stress disorder (PTSD)?
A new (f)MRI study suggests that it has something to do with the way that we control the activity of the prefrontal cortex, a brain region thought to orchestrate our thoughts and actions.
Researchers at the Mount Sinai School of Medicine examined women who had been the victims of violent sexual assault, some of whom developed PTSD and others who did not develop any serious emotional symptoms afterwards. Using a brain imaging technique, they evaluated the ability of these women to voluntarily modify their own responses to unpleasant emotional stimuli and found that it was the trauma history itself, not how well they endured this sort of trauma, that influenced their ability to dampen subsequent emotional responses.
Surprisingly, however, the ability of the subjects to amplify their emotional responses to unpleasant stimuli was related to psychological outcome after the sexual assault. The resilient individuals, that is, those who endured sexual assault without developing emotional symptoms, were able to enhance the activation of emotional brain circuitry in response to unpleasant stimuli more than either those with PTSD or healthy controls who had never experienced a serious sexual assault.
Corresponding author Dr. Antonia New explained the findings: “This raises the possibility that the ability to focus on negative emotions permits the engagement of cognitive strategies for extinguishing negative emotional responses, and that this ability might be related to resilience. This is important, since it has implications for how we might enhance resilience.”
These findings suggest that exposure to extremely stressful situations may leave an “emotional scar” that may influence the capacity to be resilient to the impact of subsequent stressors, even when one does not develop PTSD. “These data seem to support an idea that has emerged from clinical descriptions of resilient people, i.e., that people who are resilient are able to be flexible in the way that they respond to changing emotional contexts. It would be helpful to know how we can enhance the flexible activation of these prefrontal cortex networks in people with compromised resilience,” commented Dr. John Krystal, Editor of Biological Psychiatry.
Dr. New agrees, adding that “perhaps the enrichment of the broad capacity to tolerate negative emotional experiences might be helpful in promoting resilience. Further work needs to be done on whether the feature of this capacity that relates to resilience is about the ability to tolerate one’s one responses, or whether it is the ability to respond distress in others.”
Biological Psychiatry, Volume 66, Issue 7, Pages 656-664
Functional Magnetic Resonance Imaging Study of Deliberate Emotion Regulation in Resilience and Posttraumatic Stress Disorder
A. New, J. Fan, J. Murrough, X. Liu, R. Liebman, K. Guise, C. Tang, D. Charney
Background Sexual violence is an important public health problem in the United States, with 13% to 26% of women reporting a history of sexual assault. While unfortunately common, there is substantial individual variability in response to sexual assault. Approximately half of rape victims develop posttraumatic stress disorder (PTSD), while others develop no psychopathology (e.g., trauma-exposed non-PTSD). In this project, we examined the neural mechanisms underlying differences in response to sexual violence, focusing specifically on the deliberate modification of emotional responses to negative stimuli.
Methods Using functional magnetic resonance imaging (fMRI) blood oxygenation level-dependent (BOLD) response, we examined the neural circuitry underlying effortful modification of emotional responses to negative pictures in 42 women: 14 with PTSD after sexual trauma, 14 with no psychiatric diagnosis after sexual trauma, and 14 nontraumatized control subjects.
Results In response to deliberate attempts to downregulate emotional responses, nontraumatized healthy control subjects were more successful than either trauma-exposed group (PTSD or non-PTSD) in downregulating responses to the negative pictures as measured by subjective rating and BOLD response in regions of prefrontal cortex (PFC). In contrast, after deliberate attempts to upregulate emotional responses, regions of PFC were activated by trauma-exposed non-PTSD subjects more than by healthy control subjects or PTSD subjects.
Conclusions Successful downregulation of emotional responses to negative stimuli appears to be impaired by trauma exposure. In contrast, the ability to upregulate emotional responses to negative stimuli may be a protective factor in the face of trauma exposure and associated with resilience.
Key Words: Alexithymia, PTSD, resilience, sexual assault, trauma