Investigating the Neural Basis of Shame and Guilt in Veterans with Posttraumatic Stress Disorder

调查患有创伤后应激障碍的退伍军人羞耻和内疚的神经基础

• 批准号: 9868198
• 负责人: RAJENDRA A MOREY
• 金额: --
• 依托单位: DURHAM VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-04-01 至 2023-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9868198
• 关键词: Affect; Age; Anatomy; Animal Model; Anterior; Anxiety; Belief; Brain; Brain region; Cessation of life; Chronic; Clinical; Cognition; Communities; Complex; Control Groups; DSM-V; Development; Dorsal; Emotional; Emotions; Environment; Ethics; Exhibits; Feeling; Fright; Functional Magnetic Resonance Imaging; Future; Goals; Guilt; Individual; Inferior; Inferior frontal gyrus; Injury; Intervention; Knowledge; Learning; Libraries; Light; Literature; Matched Group; Medial; Military Personnel; Mind; Modeling; Morals; Neurobiology; Neurosciences; Parietal Lobe; Patient Self-Report; Patients; Perception; Physiological Processes; Post-Traumatic Stress Disorders; Prefrontal Cortex; Process; Refractory; Research; Resistance; Severities; Shame; Soldier; Standardization; Stimulus; Structure of superior temporal sulcus; Structure of supramarginal gyrus; Subgroup; Symptoms; System; Therapeutic Intervention; Time; Transcranial magnetic stimulation; Trauma; Veterans; base; behavior measurement; cognitive control; cognitive process; combat; combat trauma; combat veteran; design; experience; neural circuit; neurofeedback; post-traumatic symptoms; relating to nervous system; response; theories; trauma exposure; traumatic event

ABSTRACT Abnormally regulated fear and threat perception are widely regarded as the core patho- physiological process in posttraumatic stress disorder (PTSD). As a result, associative fear learning models have dominated research on the neuroscience of PTSD. However, shame, guilt, and moral injury, rather than fear, are dominant cognitive processes among individuals with PTSD, which often develops following military combat trauma. Very little is known about how PTSD affects the brain circuits associated with shame and guilt, in part due to the lack of animal models. The first goal of this proposal is to develop experimental paradigms that are suitable to the fMRI setting for investigating shame and guilt neurocircuits in PTSD. We will begin by developing a library of short vignettes highlighting dominant themes of trauma-related shame and guilt. Creating a trauma-relevant stimulus set to study shame and guilt will greatly enhance our ability, and that of the broader scientific community, to investigate the neuroscience of shame and guilt in PTSD from combat trauma. Three groups (1) patients with PTSD having prominent shame and guilt symptoms, (2) patients with PTSD without shame or guilt, and (3) combat-trauma exposed control subjects will be presented vignettes evocative of shame and guilt along with matched neutral vignettes in the fMRI environment. We hypothesize that the shame and guilt prominent PTSD group will exhibit greater activation than the other groups in canonical shame and guilt processing brain regions (self-referential) consistent with greater negative self-attribution. In addition, the functional organization of the brain will be characterized from temporally correlated activity between anatomically distinct brain regions obtained from task-related fMRI activity. We predict that self-reported shame or guilt in patients with PTSD will be associated with a disruption of functional brain networks in prominent self- referential brain regions. Behavioral measures of guilt and shame will be used to study whether PTSD modulates the association between brain activity/organization and the subjective experience of shame/guilt. The knowledge gained from the proposed research will advance the neurobiology of PTSD, and in the future with more research, shed light on treatments that engage neural targets implicated in shame and guilt. Transcranial magnetic stimulation (TMS), transcranial direct current stimulation (tDCS), and real-time fMRI neurofeedback are potential interventions that could be applied in the future to directly modulate these newly discovered targets.

抽象的 异常调节的恐惧和威胁感知被广泛认为是核心病态。 创伤后应激障碍（PTSD）的生理过程。结果，联想恐惧 学习模型主导了创伤后应激障碍（PTSD）神经科学的研究。然而，羞耻的是， 内疚和道德伤害，而不是恐惧，是个体中占主导地位的认知过程 创伤后应激障碍（PTSD），通常在军事战斗创伤后出现。人们知之甚少 创伤后应激障碍如何影响与羞耻和内疚相关的大脑回路，部分原因是缺乏 动物模型。该提案的第一个目标是开发实验范式 适合用于研究 PTSD 中羞耻和内疚神经回路的功能磁共振成像设置。我们将 首先开发一个短文库，突出与创伤相关的主导主题 羞耻和内疚。创建一个与创伤相关的刺激组来研究羞耻和内疚将极大地 增强我们以及更广泛的科学界的能力，以调查 战争创伤造成的创伤后应激障碍（PTSD）中羞耻和内疚的神经科学。三组 (1) 患者 具有显着羞耻感和内疚症状的 PTSD，（2）无羞耻感或无羞耻感的 PTSD 患者 (3) 遭受过战斗创伤的对照对象将被呈现出令人想起的小插曲 羞耻和内疚以及功能磁共振成像环境中匹配的中性小插图。我们假设 羞耻感和内疚感突出的创伤后应激障碍（PTSD）群体会比其他群体表现出更大的激活作用 典型的羞耻和内疚处理大脑区域（自我参照）的群体与 更大的负面自我归因。此外，大脑的功能组织将 以解剖学上不同的大脑区域之间的时间相关活动为特征 从任务相关的功能磁共振成像活动中获得。我们预测患者会自我报告羞耻感或内疚感 创伤后应激障碍 (PTSD) 与显着的自我认知功能性大脑网络的破坏有关。 参考大脑区域。内疚和羞耻的行为测量将用于研究是否 PTSD 调节大脑活动/组织与主观意识之间的关联 羞耻/内疚的经历。从拟议研究中获得的知识将推动 PTSD 的神经生物学，以及未来更多的研究，揭示了治疗方法 参与与羞耻和内疚有关的神经目标。经颅磁刺激（TMS）， 经颅直流电刺激 (tDCS) 和实时功能磁共振成像神经反馈是潜在的 未来可以应用的干预措施来直接调节这些新发现的 目标。