Webber, Eve Cathryn Rachael; (2024) Psychological Trauma and Affective Processing: Neural Insights From Childhood to Adulthood. Doctoral thesis (D.Clin.Psy), UCL (University College London).

Text Eve_Webber_complete version - Thesis_final_volume1_Webber.pdf - Accepted Version Access restricted to UCL open access staff until 1 November 2025. Download (1MB)

Abstract

Aims: The prevailing neurocircuitry model of post-traumatic stress disorder (PTSD) implicates circuits involved in fear conditioning in the brain, such as the amygdala, hippocampus and prefrontal cortex (PFC), whereby abnormalities in neurocircuitry are hypothesised to underpin PTSD symptomology, namely cognitive and emotion regulation difficulties. Whereas symptom provocation literature using affective (emotional), socially salient face paradigms is more expansive, less literature exists on non-social, visual emotional word processing and whether it corroborates extant cognitive and neurocircuitry models of PTSD. Furthermore, extant reviews of affective processing have described mixed findings, likely due to the type of neuropsychological task, content salience of emotional stimuli and the stimuli type itself. The current review aimed to evaluate emotional word processing functional magnetic resonance imaging (fMRI) studies across attentional and memory-based domains to evaluate their contributions to understanding the behavioural and neural mechanisms of PTSD. Methods: The PROSPERO ID for this review is CRD42023455719. An electronic search was executed on the PsycINFO (via OVID), MEDLINE (via OVID), EMBASE (via OVID) and Web of Science (Core Collection) databases for papers published up until 21 September 2023. A narrative synthesis approach was applied to 14 studies (n = 564) that met the criteria for the review. Results: Results indicated that reaction times (RTs) to emotional words were longer overall in individuals diagnosed with PTSD, compared to controls, which was not always dependent on word type. A dissociation between error rates (ERs) was observed; whereas individuals with PTSD performed poorer overall on attentional Stroop-based tasks, ER performance was mixed on memory-based tasks, supporting prior task-specific observations. Greater activation of the dorsal anterior cingulate cortex (dACC) and amygdala in individuals with PTSD relative to controls constituted the most robust findings. Conclusion: Findings offered mixed support for PTSD cognitive and neurocircuitry models. Stroop-based tasks better identified differences in the behavioural performance of individuals with PTSD. Individuals with PTSD exhibited altered brain activation and connectivity, specifically whilst processing trauma-related words, with greater dACC activation indicating greater cognitive load and enhanced, awareness-dependent amygdala activity indicating heightened sensitivity to emotionally salient words. Findings point to the potential of written visual information as a form of exposure therapy alongside more traditional imaginal/talking PTSD exposure therapies.

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