The sense of self in the aftermath of trauma: lessons from the default mode network in posttraumatic stress disorder

Ruth A Lanius, Braeden A Terpou, Margaret C McKinnon, Ruth A Lanius, Braeden A Terpou, Margaret C McKinnon

Abstract

Trauma can profoundly affect the sense of self, where both cognitive and somatic disturbances to the sense of self are reported clinically by individuals with posttraumatic stress disorder (PTSD). These disturbances are captured eloquently by clinical accounts, such as, 'I do not know myself anymore,' 'I will never be able to experience normal emotions again,' and, 'I feel dead inside.' Self-related thoughts and experiences are represented neurobiologically by a large-scale, cortical network located along the brain's mid-line and referred to as the default mode network (DMN). Recruited predominantly during rest in healthy participants, the DMN is also active during self-referential and autobiographical memory processing - processes which, collectively, are thought to provide the foundation for a stable sense of self that persists across time and may be available for conscious access. In participants with PTSD, however, the DMN shows substantially reduced resting-state functional connectivity as compared to healthy individuals, with greater reductions associated with heightened PTSD symptom severity. Critically, individuals with PTSD describe frequently that their traumatic experiences have become intimately linked to their perceived sense of self, a perception which may be mediated, in part, by alterations in the DMN. Accordingly, identification of alterations in the functional connectivity of the DMN during rest, and during subliminal, trauma-related stimulus conditions, has the potential to offer critical insight into the dynamic interplay between trauma- and self-related processing in PTSD. Here, we discuss DMN-related alterations during these conditions, pointing further towards the clinical significance of these findings in relation to past- and present-centred therapies for the treatment of PTSD.

Keywords: MDMA; PTSD; default mode network; medial prefrontal cortex; past-centred; posterior cingulate cortex; present-centred treatment; sense of self; somatic; trauma; treatment; • Trauma may impact significantly an individual's sense of self.• The default mode network is thought to confer a stable sense of self.• We discuss alterations in connectivity in this network in PTSD and their clinical significance..

Conflict of interest statement

No potential conflict of interest was reported by the authors.

© 2020 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.

Figures

Figure 1.
Figure 1.
Images show the functional connectivity of the DMN in healthy controls (left) and in participants with PTSD (right) under different conditions. Top and bottom images depict within-group patterns in functional connectivity during rest and during trauma-related stimulus processing, respectively. Whereas resting-state functional connectivity is depicted in relation to the time series of the posterior cingulate cortex (PCC), trauma-related functional connectivity is depicted in relation to the time series of the periaqueductal grey (PAG). Figure 1 is an adaptation from two previous findings, where resting-state and threat-related functional connectivity are related to results by Bluhm et al. (2009) and Terpou et al. (2019a), respectively

References

    1. Akiki, T. J., Averill, C. L., & Abdallah, C. G. (2017). A network-based neurobiological model of PTSD: Evidence from structural and functional neuroimaging studies. Current Psychiatry Reports, 19(11), 1–11.
    1. Akiki, T. J., Averill, C. L., Wrocklage, K. M., Scott, J. C., Averill, L. A., Schweinsburg, B., & Abdallah, C. G. (2018). Default mode network abnormalities in posttraumatic stress disorder: A novel network-restricted topology approach. NeuroImage, 176, 489–498.
    1. Allen, J. G. (1995). Coping with trauma: A guide to self-understanding. Washington, DC: American Psychiatric Association.
    1. American Psychiatric Association . (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author.
    1. Barredo, J., Aiken, E., Van ’T Wout-Frank, M., Greenberg, B. D., Carpenter, L. L., & Philip, N. S. (2018). Network functional architecture and aberrant functional connectivity in post-traumatic stress disorder: A clinical application of network convergence. Brain Connectivity, 8(9), 549–557.
    1. Bernstein, E. M., & Putnam, F. W. (1986). Development, reliability, and validity of a dissociation scale. The Journal of Nervous and Mental Disease, 174(12), 727–735.
    1. Blosnich, J. R., Dichter, M. E., Cerulli, C., Batten, S. V., & Bossarte, R. M. (2014). Disparities in adverse childhood experiences among individuals with a history of military service. JAMA Psychiatry, 71(9), 1041–1048.
    1. Bluhm, R. L., Williamson, P. C., Osuch, E. A., Frewen, P. A., Stevens, T. K., Boksman, K., & Lanius, R. A. (2009). Alterations in default network connectivity in posttraumatic stress disorder related to early-life trauma. Journal of Psychiatry and Neuroscience, 34(3), 187–194.
    1. Boyd, J. E., Lanius, R. A., & McKinnon, M. C. (2018). Mindfulness-based treatments for posttraumatic stress disorder: A review of the treatment literature and neurobiological evidence. Journal of Psychiatry & Neuroscience, 42(6), 170021.
    1. Brandão, M. L., Zanoveli, J. M., Ruiz-Martinez, R. C., Oliveira, L. C., & Landeira-Fernandez, J. (2008). Different patterns of freezing behavior organized in the periaqueductal gray of rats: Association with different types of anxiety. Behavioural Brain Research, 188(1), 1–13.
    1. Bremner, J. D., Southwick, S. M., Johnson, D. R., Yehuda, R., & Charney, D. S. (1993). Childhood physical abuse and combat-related posttraumatic stress disorder in Vietnam veterans. American Journal of Psychiatry, 150(2), 235–239.
    1. Brewin, C. R. (2015). Re-experiencing traumatic events in PTSD: New avenues in research on intrusive memories and flashbacks. European Journal of Psychotraumatology, 6. doi:10.3402/ejpt.v6.27180
    1. Briere, J., & Runtz, M. (2002). The inventory of altered self-capacities (IASC): A standardized measure of identity, affect regulation, and relationship disturbance. Assessment, 9(3), 230–239.
    1. Brown, V. M., Labar, K. S., Haswell, C. C., Gold, A. L., Beall, S. K., Van Voorhees, E., & Morey, R. A. (2014). Altered resting-state functional connectivity of basolateral and centromedial amygdala complexes in posttraumatic stress disorder. Neuropsychopharmacology, 39(2), 351–359.
    1. Bryant, R. A., Felmingham, K., Whitford, T. J., Kemp, A., Hughes, G., Peduto, A., & Williams, L. M. (2008). Rostral anterior cingulate volume predicts treatment response to cognitive-behavioural therapy for posttraumatic stress disorder. Journal of Psychiatry and Neuroscience, 33(2), 142–146.
    1. Buckner, R. L., Andrews-Hanna, J. R., & Schacter, D. L. (2008). The brain’s default network: Anatomy, function, and relevance to disease. Annals of the New York Academy of Sciences, 1124(1), 1–38.
    1. Buckner, R. L., & Carroll, D. C. (2007). Self-projection and the brain. Trends in Cognitive Sciences, 11(2), 49–57.
    1. Cabeza, R., & St Jacques, P. (2007). Functional neuroimaging of autobiographical memory. Trends in Cognitive Sciences, 11(5), 219–227.
    1. Carhart-Harris, R. L., Wall, M. B., Erritzoe, D., Kaelen, M., Ferguson, B., De Meer, I., & Nutt, D. J. (2014). The effect of acutely administered MDMA on subjective and BOLD-fMRI responses to favourite and worst autobiographical memories. International Journal of Neuropsychopharmacology, 17(4), 527–540.
    1. Cloitre, M., Scarvalone, P., & Difede, J. A. (1997). Posttraumatic stress disorder, self- and interpersonal dysfunction among sexually retraumatized women. Journal of Traumatic Stress, 10(3), 437–452.
    1. Conway, M. A., & Pleydell-Pearce, C. W. (2000). The construction of autobiographical memories in the self-memory system. Psychological Review, 107(2), 261–288.
    1. Cox, K. S., Resnick, H. S., & Kilpatrick, D. G. (2014). Prevalence and correlates of posttrauma distorted beliefs: Evaluating DSM-5 PTSD expanded cognitive symptoms in a national sample. Journal of Traumatic Stress, 27(3), 299–306.
    1. Daniels, J. K., Frewen, P., McKinnon, M. C., & Lanius, R. A. (2011). Default mode alterations in posttraumatic stress disorder related to early-life trauma: A developmental perspective. Journal of Psychiatry and Neuroscience, 36(1), 56–59.
    1. Dannlowski, U., Stuhrmann, A., Beutelmann, V., Zwanzger, P., Lenzen, T., Grotegerd, D., & Kugel, H. (2012). Limbic scars: Long-term consequences of childhood maltreatment revealed by functional and structural magnetic resonance imaging. Biological Psychiatry, 71(4), 286–293.
    1. De Oca, B. M., DeCola, J. P., Maren, S., & Fanselow, M. S. (1998). Distinct regions of the periaqueductal gray are involved in the acquisition and expression of defensive responses. Journal of Neuroscience, 18(9), 3426–3432.
    1. Di, Q. L., Wang, Z., Sun, Y. W., Wan, J. Q., Su, S. S., Zhou, Y., & Xu, J. R. (2012). A preliminary study of alterations in default network connectivity in post-traumatic stress disorder patients following recent trauma. Brain Research, 1484, 50–56.
    1. Diedrichsen, J. (2006). A spatially unbiased atlas template of the human cerebellum. NeuroImage, 33(1), 127–138.
    1. DiGangi, J. A., Tadayyon, A., Fitzgerald, D. A., Rabinak, C. A., Kennedy, A., Klumpp, H., & Phan, K. L. (2016). Reduced default mode network connectivity following combat trauma. Neuroscience Letters, 615, 37–43.
    1. Fair, D. A., Cohen, A. L., Dosenbach, N. U. F., Church, J. A., Miezin, F. M., Barch, D. M., & Schlaggar, B. L. (2008). The maturing architecture of the brain’s default network. Proceedings of the National Academy of Sciences of the USA, 105(10), 4028–4032.
    1. Felmingham, K., Kemp, A. H., Williams, L., Falconer, E., Olivieri, G., Peduto, A., & Bryant, R. (2008). Dissociative responses to conscious and non-conscious fear impact underlying brain function in post-traumatic stress disorder. Psychological Medicine, 38(12), 1771–1780.
    1. Fenster, R. J., Lebois, L. A. M., Ressler, K. J., & Suh, J. (2018). Brain circuit dysfunction in post-traumatic stress disorder: From mouse to man. Nature Reviews Neuroscience, 19(9), 535–551.
    1. Foa, E. B., Hembree, E. A., & Rothbaum, B. O. (2007). Prolonged exposure therapy for PTSD: Emotional processing of traumatic experiences: Therapist guide. Oxford University Press. doi:10.1093/med:psych/9780195308501.001.0001
    1. Foa, E. B., Tolin, D. F., Ehlers, A., Clark, D. M., & Orsillo, S. M. (1999). The posttraumatic cognitions inventory (PTCI): Development and validation. Psychological Assessment, 11(3), 303–314.
    1. Fragkaki, I., Thomaes, K., & Sijbrandij, M. (2016). Posttraumatic stress disorder under ongoing threat: A review of neurobiological and neuroendocrine findings. European Journal of Psychotraumatology, 7(1), 30915.
    1. Fransson, P. (2005). Spontaneous low-frequency BOLD signal fluctuations: An fMRI investigation of the resting-state default mode of brain function hypothesis. Human Brain Mapping, 26(1), 15–29.
    1. Freeman, T. W., Hart, J., Kimbrell, T., & Ross, E. D. (2009). Comprehension of affective prosody in veterans with chronic posttraumatic stress disorder. Journal of Neuropsychiatry and Clinical Neurosciences, 21(1), 52–58.
    1. Frewen, P. A., & Lanius, R. A. (2015). Healing the traumatized self: Consciousness, neuroscience, treatment. New York: W. W. Norton & Company.
    1. Frewen, P. A., Lanius, R. A., Dozois, D. J. A., Neufeld, R. W. J., Pain, C., Hopper, J. W., & Stevens, T. K. (2008). Clinical and neural correlates of alexithymia in posttraumatic stress disorder. Journal of Abnormal Psychology, 117(1), 171–181.
    1. Frewen, P. A., Schroeter, M. L., Riva, G., Cipresso, P., Fairfield, B., Padulo, C., & Northoff, G. (2020). Neuroimaging the consciousness of self: Review, and conceptual-methodological framework. Neuroscience and Biobehavioral Reviews, 112, 164–212.
    1. Friston, K. J. (1994). Functional and effective connectivity in neuroimaging: A synthesis. Human Brain Mapping, 2(1–2), 56–78.
    1. Graham, K., Dipnall, J., Van Hooff, M., Lawrence-Wood, E., Searle, A., & AO, A. M. F. (2019). Identifying clusters of health symptoms in deployed military personnel and their relationship with probable PTSD. Journal of Psychosomatic Research, 127, 109838.
    1. Graham, K., Searle, A., Van Hooff, M., Lawrence-Wood, E., & McFarlane, A. (2019). The Associations between physical and psychological symptoms and traumatic military deployment exposures. Journal of Traumatic Stress, 32(6), 957–966.
    1. Greicius, M. D., Krasnow, B., Reiss, A. L., & Menon, V. (2003). Functional connectivity in the resting brain: A network analysis of the default mode hypothesis. Proceedings of the National Academy of Sciences of the USA, 100(1), 253–258.
    1. Herman, J. L. (1992). Complex PTSD: A syndrome in survivors of prolonged and repeated trauma. Journal of Traumatic Stress, 5(3), 377–391.
    1. Keay, K. A., & Bandler, R. (2014). Periaqueductal Gray. The Rat Nervous System: Fourth Edition, 207–221. doi:10.1016/B978-0-12-374245-2.00010-3
    1. Kennis, M., Van Rooij, S. J. H., Van den Heuvel, M. P., Kahn, R. S., & Geuze, E. (2016). Functional network topology associated with posttraumatic stress disorder in veterans. NeuroImage: Clinical, 10(2), 302–309.
    1. Kim, H. (2012). A dual-subsystem model of the brain’s default network: Self-referential processing, memory retrieval processes, and autobiographical memory retrieval. NeuroImage, 61(4), 966–977.
    1. King, A. P., Block, S. R., Sripada, R. K., Rauch, S., Giardino, N., Favorite, T., & Liberzon, I. (2016). Altered default mode network (DMN) resting state functional connectivity following a mindfulness-based exposure therapy for posttraumatic stress disorder (PTSD) in combat veterans of Afghanistan and Iraq. Depression and Anxiety, 33(4), 289–299.
    1. Kluetsch, R. C., Ros, T., Théberge, J., Frewen, P. A., Calhoun, V. D., Schmahl, C., & Lanius, R. A. (2014). Plastic modulation of PTSD resting-state networks and subjective wellbeing by EEG neurofeedback. Acta Psychiatrica Scandinavica, 130(2), 123–136.
    1. Koch, S. B. J., van Zuiden, M., Nawijn, L., Frijling, J. L., Veltman, D. J., & Olff, M. (2016). Aberrant resting-state brain activity in posttraumatic stress disorder: A meta-analysis and systematic review. Depression and Anxiety, 33(7), 592–605.
    1. Kozlowska, K., Walker, P., McLean, L., & Carrive, P. (2015). Fear and the defense cascade. Harvard Review of Psychiatry, 23(4), 263–287.
    1. Lanius, R. A., Bluhm, R. L., Coupland, N. J., Hegadoren, K. M., Rowe, B., Théberge, J., & Brimson, M. (2010). Default mode network connectivity as a predictor of post-traumatic stress disorder symptom severity in acutely traumatized subjects. Acta Psychiatrica Scandinavica, 121(1), 33–40.
    1. Lanius, R. A., Bluhm, R. L., & Frewen, P. A. (2011). How understanding the neurobiology of complex post-traumatic stress disorder can inform clinical practice: A social cognitive and affective neuroscience approach. Acta Psychiatrica Scandinavica, 124(5), 331–348.
    1. Lanius, R. A., Frewen, P. A., Tursich, M., Jetly, R., & McKinnon, M. C. (2015). Restoring large-scale brain networks in PTSD and related disorders: A proposal for neuroscientifically-informed treatment interventions. European Journal of Psychotraumatology, 6(1), 1–12.
    1. Lanius, R. A., Rabellino, D., Boyd, J. E., Harricharan, S., Frewen, P. A., & McKinnon, M. C. (2017). The innate alarm system in PTSD: Conscious and subconscious processing of threat. Current Opinion in Psychology, 14, 109–115.
    1. Levine, B., Svoboda, E., Hay, J. F., Winocur, G., & Moscovitch, M. (2002). Aging and autobiographical memory: Dissociating episodic from semantic retrieval. Psychology and Aging, 17(4), 677–689.
    1. Liddell, B. J., Brown, K. J., Kemp, A. H., Barton, M. J., Das, P., Peduto, A., & Williams, L. M. (2005). A direct brainstem-amygdala-cortical “alarm” system for subliminal signals of fear. NeuroImage, 24(1), 235–243.
    1. Lu, S., Pan, F., Gao, W., Wei, Z., Wang, D., Hu, S., & Li, L. (2017). Neural correlates of childhood trauma with executive function in young healthy adults. Oncotarget, 8(45), 79843–79853.
    1. Malejko, K., Abler, B., Plener, P. L., & Straub, J. (2017). Neural correlates of psychotherapeutic treatment of post-traumatic stress disorder: A systematic literature review. Frontiers in Psychiatry, 8, 85.
    1. Miller, D. R., Hayes, S. M., Hayes, J. P., Spielberg, J. M., Lafleche, G., & Verfaellie, M. (2017). Default mode network subsystems are differentially disrupted in posttraumatic stress disorder. Biological Psychiatry: Cognitive Neuroscience and Neuroimaging, 2(4), 363–371.
    1. Mithoefer, M. C., Grob, C. S., & Brewerton, T. D. (2016). Novel psychopharmacological therapies for psychiatric disorders: Psilocybin and MDMA. The Lancet Psychiatry, 3(5), 481–488.
    1. Mithoefer, M. C., Mithoefer, A. T., Feduccia, A. A., Jerome, L., Wagner, M., Wymer, J., & Doblin, R. (2018). 3,4-methylenedioxymethamphetamine (MDMA)-assisted psychotherapy for post-traumatic stress disorder in military veterans, firefighters, and police officers: A randomised, double-blind, dose-response, phase 2 clinical trial. The Lancet Psychiatry, 5(6), 486–497.
    1. Moore, S. A., & Zoellner, L. A. (2007). Overgeneral autobiographical memory and traumatic events: An evaluative review. Psychological Bulletin, 133(3), 419–437.
    1. Nazarov, A., Frewen, P. A., Oremus, C., Schellenberg, E. G., Mckinnon, M. C., & Lanius, R. A. (2015). Comprehension of affective prosody in women with post-traumatic stress disorder related to childhood abuse. Acta Psychiatrica Scandinavica, 131(5), 342–349.
    1. Nazarov, A., Frewen, P. A., Parlar, M., Oremus, C., Macqueen, G., Mckinnon, M., & Lanius, R. A. (2014). Theory of mind performance in women with posttraumatic stress disorder related to childhood abuse. Acta Psychiatrica Scandinavica, 129(3), 193–201.
    1. Olff, M., Amstadter, A., Armour, C., Birkeland, M. S., Bui, E., Cloitre, M., & Thoresen, S. (2019). A decennial review of psychotraumatology: What did we learn and where are we going? European Journal of Psychotraumatology, 10(1), 1672948.
    1. Patriat, R., Birn, R. M., Keding, T. J., & Herringa, R. J. (2016). Default-mode network abnormalities in pediatric posttraumatic stress disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 55(4), 319–327.
    1. Philippi, C. L., Tranel, D., Duff, M., & Rudrauf, D. (2013). Damage to the default mode network disrupts autobiographical memory retrieval. Social Cognitive and Affective Neuroscience, 10(3), 318–326.
    1. Piolino, P., Desgranges, B., Clarys, D., Guillery-Girard, B., Taconnat, L., Isingrini, M., & Eustache, F. (2006). Autobiographical memory, autonoetic consciousness, and self-perspective in aging. Psychology and Aging, 21(3), 510–525.
    1. Qin, P., & Northoff, G. (2011). How is our self related to midline regions and the default-mode network? NeuroImage, 57(3), 1221–1233.
    1. Rabellino, D., Densmore, M., Frewen, P. A., Théberge, J., & Lanius, R. A. (2016). The innate alarm circuit in post-traumatic stress disorder: Conscious and subconscious processing of fear- and trauma-related cues. Psychiatry Research: Neuroimaging, 248, 142–150.
    1. Raichle, M. E. (2015). The brain’s default mode network. Annual Review of Neuroscience, 38(1), 433–447.
    1. Resick, P. A., & Schnicke, M. K. (1992). Cognitive processing therapy for sexual assault victims. Journal of Consulting and Clinical Psychology, 60(5), 748–756.
    1. Reuveni, I., Bonne, O., Giesser, R., Shragai, T., Lazarovits, G., Isserles, M., & Levin, N. (2016). Anatomical and functional connectivity in the default mode network of post-traumatic stress disorder patients after civilian and military-related trauma. Human Brain Mapping, 37(2), 589–599.
    1. Schore, A. N. (2003). Affect dysregulation and disorders of the self. New York: W. W. Norton & Co.
    1. Shang, J., Lui, S., Meng, Y., Zhu, H., Qiu, C., Gong, Q., & Zhang, W. (2014). Alterations in low-level perceptual networks related to clinical severity in PTSD after an earthquake: A resting-state fMRI study. PLoS ONE, 9(5), e96834.
    1. Shapiro, F. (2018). Eye movement desensitization and reprocessing (EMDR) therapy: Basic principles, protocols, and procedures (3rd ed.). New York: Guilford Press.
    1. Sherman, L. E., Rudie, J. D., Pfeifer, J. H., Masten, C. L., McNealy, K., & Dapretto, M. (2014). Development of the default mode and central executive networks across early adolescence: A longitudinal study. Developmental Cognitive Neuroscience, 10, 148–159.
    1. Spreng, R. N., Mar, R. A., & Kim, A. S. N. (2009). The common neural basis of autobiographical memory, prospection, navigation, theory of mind, and the default mode: A quantitative meta-analysis. Journal of Cognitive Neuroscience, 21(3), 489–510.
    1. Sripada, C. S., Liberzon, I., Garfinkel, S. N., Sripada, R. K., King, A. P., Wang, X., & Welsh, R. C. (2012). Neural dysregulation in posttraumatic stress disorder. Psychosomatic Medicine, 74(9), 904–911.
    1. Sripada, R. K., Swain, J. E., Evans, G. W., Welsh, R. C., & Liberzon, I. (2014). Childhood poverty and stress reactivity are associated with aberrant functional connectivity in default mode network. Neuropsychopharmacology, 39(9), 2244–2251.
    1. St Jacques, P. L., Kragel, P. A., & Rubin, D. C. (2013). Neural networks supporting autobiographical memory retrieval in posttraumatic stress disorder. Cognitive, Affective and Behavioral Neuroscience, 13(3), 554–566.
    1. Steuwe, C., Daniels, J. K., Frewen, P. A., Densmore, M., Pannasch, S., Beblo, T., & Lanius, R. A. (2014). Effect of direct eye contact in PTSD related to interpersonal trauma: An fMRI study of activation of an innate alarm system. Social Cognitive and Affective Neuroscience, 9(1), 88–97.
    1. Supekar, K., Uddin, L. Q., Prater, K., Amin, H., Greicius, M. D., & Menon, V. (2010). Development of functional and structural connectivity within the default mode network in young children. NeuroImage, 52(1), 290–301.
    1. Svoboda, E., McKinnon, M. C., & Levine, B. (2006). The functional neuroanatomy of autobiographical memory: A meta-analysis. Neuropsychologia, 44(12), 2189–2208.
    1. Tamietto, M., & de Gelder, B. (2010). Neural bases of the non-conscious perception of emotional signals. Nature Reviews Neuroscience, 11(10), 697–709.
    1. Terpou, B. A., Densmore, M., Théberge, J., Frewen, P., McKinnon, M. C., Nicholson, A. A., & Lanius, R. A. (2020). The hijacked self: Disrupted functional connectivity between the periaqueductal gray and the default mode network in posttraumatic stress disorder using dynamic causal modeling. NeuroImage: Clinical. 27(1), 102345. 10.1016/j.nicl.2020.102345
    1. Terpou, B. A., Densmore, M., Théberge, J., Thome, J., Frewen, P., McKinnon, M. C., & Lanius, R. A. (2019a). The threatful self: Midbrain functional connectivity to cortical midline and parietal regions during subliminal trauma-related processing in PTSD. Chronic Stress, 3, 247054701987136.
    1. Terpou, B. A., Densmore, M., Thome, J., Frewen, P., McKinnon, M. C., & Lanius, R. A. (2019b). The innate alarm system and subliminal threat presentation in posttraumatic stress disorder: Neuroimaging of the midbrain and cerebellum. Chronic Stress, 3, 247054701882149.
    1. Terpou, B. A., Harricharan, S., McKinnon, M. C., Frewen, P., Jetly, R., & Lanius, R. A. (2019c). The effects of trauma on brain and body: A unifying role for the midbrain periaqueductal gray. Journal of Neuroscience Research, 97(9), 1110–1140.
    1. Tulving, E. (1985). Memory and consciousness. Canadian Psychology, 26(1), 1–12.
    1. van der Kolk, B. A. (1989). The compulsion to repeat the trauma. Re-enactment, revictimization, and masochism. Psychiatric Clinics of North America, 12(2), 389–411.
    1. van der Kolk, B. A. (2015). The body keeps the score: Brain, mind, and body in the healing of trauma. New York: Viking.
    1. van der Kolk, B. A., Roth, S., Pelcovitz, D., Sunday, S., & Spinazzola, J. (2005). Disorders of extreme stress: The empirical foundation of a complex adaptation to trauma. Journal of Traumatic Stress, 18(5), 389–399.
    1. Wang, T., Liu, J., Zhang, J., Zhan, W., Li, L., Wu, M., & Gong, Q. (2016). Altered resting-state functional activity in posttraumatic stress disorder: A quantitative meta-analysis. Scientific Reports, 6(1), 1–14.
    1. Williams, L. M., Liddell, B. J., Kemp, A. H., Bryant, R. A., Meares, R. A., Peduto, A. S., & Gordon, E. (2006). Amygdala-prefrontal dissociation of subliminal and supraliminal fear. Human Brain Mapping, 27(8), 652–661.
    1. Wu, R. Z., Zhang, J. R., Qiu, C. J., Meng, Y. J., Zhu, H. R., Gong, Q. Y., & Zhang, W. (2011). Study on resting-state default mode network in patients with posttraumatic stress disorder after the earthquake. Journal of Sichuan University (Medical Science Edition), 42(3), 397–400. Retrieved from

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