Restoring large-scale brain networks in PTSD and related disorders: a proposal for neuroscientifically-informed treatment interventions

Ruth A Lanius, Paul A Frewen, Mischa Tursich, Rakesh Jetly, Margaret C McKinnon, Ruth A Lanius, Paul A Frewen, Mischa Tursich, Rakesh Jetly, Margaret C McKinnon

Abstract

Background: Three intrinsic connectivity networks in the brain, namely the central executive, salience, and default mode networks, have been identified as crucial to the understanding of higher cognitive functioning, and the functioning of these networks has been suggested to be impaired in psychopathology, including posttraumatic stress disorder (PTSD).

Objective: 1) To describe three main large-scale networks of the human brain; 2) to discuss the functioning of these neural networks in PTSD and related symptoms; and 3) to offer hypotheses for neuroscientifically-informed interventions based on treating the abnormalities observed in these neural networks in PTSD and related disorders.

Methods: Literature relevant to this commentary was reviewed.

Results: Increasing evidence for altered functioning of the central executive, salience, and default mode networks in PTSD has been demonstrated. We suggest that each network is associated with specific clinical symptoms observed in PTSD, including cognitive dysfunction (central executive network), increased and decreased arousal/interoception (salience network), and an altered sense of self (default mode network). Specific testable neuroscientifically-informed treatments aimed to restore each of these neural networks and related clinical dysfunction are proposed.

Conclusions: Neuroscientifically-informed treatment interventions will be essential to future research agendas aimed at targeting specific PTSD and related symptoms.

Keywords: Intrinsic networks; PTSD; central executive network; default mode network; dissociation; insula; interoception; mindfulness; neurofeedback; salience network.

Figures

Fig. 1
Fig. 1
Neuroscientifically-informed treatment interventions in psychotraumatology: Three intrinsic networks, including the central executive network (CEN), salience network (SN), and default mode network (DMN) may be associated with specific clinical symptoms observed in PTSD, including cognitive dysfunction (CEN), hyper- and hypoarousal/interoception (SN), and an altered sense of self (DMN). Specific testable treatment interventions targeted to restore each one of these brain networks and related clinical dysfunction are suggested. Images were created using network templates available from http://findlab.stanford.edu/functional_ROIs.html (Shirer, Ryali, Rykhlevskaia, Menon, & Greicius, 2012).

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