Attentional control abnormalities in posttraumatic stress disorder: Functional, behavioral, and structural correlates

• Published in: Journal of affective disorders 2019-06, Vol.253, p.343-351
• Main Authors: Fani, Negar, King, Tricia Z., Clendinen, Cherita, Hardy, Raven A., Surapaneni, Sindhuja, Blair, James R., White, Stuart F., Powers, Abigail, Ely, Tim D., Jovanovic, Tanja, Ressler, Kerry J., Bradley, Bekh
• Format: Article
• Language: English
• Subjects: Adult; Attention; Attention - physiology; Brain - diagnostic imaging; Brain - physiopathology; Case-Control Studies; Cognition; Diffusion Tensor Imaging; DTI; Emotions - physiology; Female; fMRI; Gyrus Cinguli - physiopathology; Humans; Magnetic Resonance Imaging - methods; Middle Aged; PTSD; Reference Values; Stress Disorders, Post-Traumatic - psychology; Stroop; Structure; White Matter - physiopathology; Young Adult
• ISSN: 0165-0327; 1573-2517
• DOI: 10.1016/j.jad.2019.04.098

•Attentional disruptions are common in posttraumatic stress disorder (PTSD), but few studies have used a multi-method approach to examine them.•We combined behavioral data with clinical, structural and functional MRI data to investigate the nature of these problems in PTSD.•We found that people with PTSD showed worse performance on an attentional control task under emotional, but not neutral conditions, compared to traumatized people without PTSD.•People with PTSD also showed differences in brain structure and function within attentional control and emotion regulation brain networks, as compared to controls. Attentional disruptions are common in PTSD, but findings across neuropsychological and neuroimaging studies have been variable. Few PTSD studies have investigated abnormalities in attention networks using a multi-modal imaging approach and attentional tasks that include emotionally-salient images. This study combined a behavioral task that included these images (emotional Stroop) with functional and structural neuroimaging (fMRI and diffusion tensor imaging; DTI) methods to comprehensively investigate attentional control abnormalities in a highly-traumatized civilian sample. 48 traumatized women with and without PTSD received clinical assessments, fMRI and DTI. During fMRI, the Affective Stroop (AS), an attentional control task that includes emotionally-salient distractor images (trauma-relevant, positive, neutral) and variable task demands, was administered. In response to more difficult AS trials, participants with PTSD demonstrated lower activation in the dorsal and rostral anterior cingulate cortex and greater activation in the insula. This group also showed comparatively poorer performance on positive AS distractor trials, even after adjusting for trauma exposure. Performance on these trials inversely correlated with structural integrity of the cingulum bundle and uncinate fasciculus. Even after adjusting for trauma exposure, participants with PTSD showed worse performance on an attentional control task in the context of emotional stimuli. They also showed relatively lower cognitive control network activation and greater salience network activation. Fronto-parietal and fronto-limbic white matter connectivity corresponded with AS performance. Our findings indicate that attentional control impairments in PTSD are most evident in the context of emotional cues, and are related to decrements in function and structure of cognitive control and salience n