Awareness, expression, and response to emotion in posttraumatic stress disorder.

摘要

Emotional awareness (EA) and expression are examined in relation to trauma-related psychopathology, in particular posttraumatic stress disorder (PTSD). In the first study, low EA (as measured by alexithymia) predicts individual differences in PTSD symptom dimensions, retrospectively reported childhood abuse and neglect, and the neural correlates of response to script-driven imagery of traumatic memories, including within anterior cingulate, medial prefrontal, posterior cingulate, and insular cortex. In the second study, low EA and its clinical correlates in PTSD are further examined using a multi-measure approach. Correlated dimensions include emotional numbing, anhedonia, differences in attentional allocation toward cognitive and somatic states, and negative emotional interference of response to positive events and emotional expressivity. The third and fourth studies investigate self-report experiential and neural responses during script-driven imagery of standardized events varying in terms of arousal (high versus low), valence (positive versus negative), and sociality (interpersonal versus intrapersonal). Women with PTSD show increased negative emotional responding to negative events, negative emotional responding to positive events, increased emotional avoidance and numbing, and associations between the priming of emotional memories and affective responses. Women with PTSD also show altered neural responding primarily during imagery of positive events, which were found to correlate with negative self-reported emotional responses to these events including within medial prefrontal cortex, insula, and amygdala. Clinical and theoretical implications and future research directions are discussed.;Keywords. Emotional Awareness, Emotion Regulation, Alexithymia, Posttraumatic Stress Disorder, Medial Prefrontal Cortex, Neuroimaging, fMRI.