Can PTSD Change the Brain?

Summary: Yes, PTSD can change the brain. New research identifies several brain areas affected by the presence of PTSD and exposure to traumatic experiences.

Key Points:

• Post-traumatic stress disorder (PTSD) can develop after an individual experiences a traumatic event.
• Symptoms may appear right away, or they may appear months or even years after the initial trauma.
• Untreated PTSD is associated with a wide range of negative physical, emotional, social, and functional problems.
• Effective treatment for PTSD is available.
• Outcome of new brain imaging research may allow providers to offer targeted treatment before full PTSD symptoms develop.

New Technology, New Insight: fMRI, the Brain, and PTSD

The authors of the study “Brain Network Alterations in Trauma and Post-Traumatic Stress Disorder: A Systematic Review” recognize that a growing body of evidence indicates that PTSD and trauma can change both the structure and function of the human brain. To explore, confirm, and expand this evidence base, the research team conducted a large-scale review and meta-analysis with the following goal:

“This systematic review investigates the neurobiological correlates of trauma by synthesizing neuroimaging findings on resting-state activity in PTSD and trauma-exposed participants.”

A distinguishing feature of this study is its focus on results from neuroimaging techniques, specifically functional magnetic resonance imaging (fMRI) that allow us to actually see what’s happening inside the brain while it’s working. While fMRI is not brand new, our ability to observe the structure and function of the brain while humans engage in both complex and mundane is nothing short of revolutionary, compared to what we could observe and quantify just 50 years ago.

We’ll look at their results in moment. First, we’ll review the basic facts about PTSD.

Post-Traumatic Stress Disorder: What You Should Know

Experts define PTSD as follows:

“… a mental health condition that’s triggered by a terrifying event — either experiencing it or witnessing it. Symptoms may include flashbacks, nightmares, and severe anxiety, as well as uncontrollable thoughts about the event.”

A study on the prevalence of PTSD including data from over 20 countries shows the current rates of PTSD worldwide:

• Overall: 3.9%
• High average income: 5.0%
• Middle average income: 2.3%
• Low average income: 2.1%

Here in the U.S., the Department of Veterans Affairs and National Center for PTSD report the following rates of PTSD:

• Currently have PTSD: 5%
• Previous/any PTSD: 6%
  • Women: 8%
  • Men: 4%

Studies show the most effective clinical treatments for PTSD include:

• Cognitive behavioral therapy (CBT)
• Cognitive processing therapy (CPT)
• Cognitive therapy (CT)
• Prolonged exposure therapy (PE)

Presence of PTSD can be life changing and lead to significant disruption in the following areas of life:

• Ability to fully engage in work and school
• Family and relationships
• Memory and decision-making
• Social participation
• Mental health and wellbeing
• Physical health and wellbeing

That’s why we need to earn more about PTSD: it impacts daily functioning and overall quality of life for millions of people in the U.S. and around the world. Now let’s take a look at the results of the new study we introduce above.

PTSD and the Brain: What Changes?

To learn about exactly how PTSD can change the brain, the research team analyzed 17 studies with data from over 1,200 participants.

Results showed the presence of PTSD and trauma has a direct – and negative – impact on several brain areas and networks.

PTSD and the Brain: fMRI Results

• Plays a key role in learning, memory and emotion.
  • Results showed decreases in functional connectivity between the amygdala and brain areas associated with emotion and decision-making.
• Plays a primary role in memory and learning.
  • Results showed changes in connectivity between hippocampus and areas associated with emotion and learning, as well as decreased activity in areas associated with emotion.
• Prefrontal cortex (PFC). Associated with attention, impulse control, decision making, and emotion regulation.
  • Results showed changes in connectivity and function of the PfC, with changes associated with increased symptom severity and cognitive dysfunction.
• Cingulate cortex. Plays a key role in pain and the connection between emotion and pain.
  • Results showed increased activity in the cingulate cortex, with increased activity associated with increased PTSD symptom severity.
• Contains over half the nerve cells in the human body and plays a primary functional role in processing, regulating, and coordinating multiple physical and cognitive processes.
  • Results showed decreased activity and decreased functional connectivity to brain regions that regulate depressive symptoms such as rumination.
• Insular cortex. Plays a coordinating role in cognitive control, regulating behavior, and processing emotions.
  • Results showed increased activity in the insular cortex, associated with dysfunctional connection between cognition and emotion.
• Default mode network (DMN), salience network (SN), central executive network connectivity (CEN). The DMN regulates our bodies when we’re not paying attention and is associated with self-reflection, the SN helps us identify what’s important among the external stimuli we experience, and the CEN is a central network central to monitoring ongoing external stimuli, managing emotion, making decisions, and processing memories and sensory stimuli.
  • Results showed decreased functional activity and connectivity between the CEN and the SN and the CEN and DMN in people with PTSD, compared to controls without PTSD.

We’ll discuss these results below.

How This Data Helps Our Clients

Here’s how the study authors characterize these results:

“The findings underscore that PTSD is characterized by widespread alterations in functional brain networks, extending beyond the traditionally emphasized fear circuits to involve a broader set of regions critical for emotion regulation, self-referential processing, and cognitive control.”

The alterations in brain structure and function – while different from study to study – coalesced around connections between the DMN (monitoring external stimuli, self-reflection) and the amygdala (emotion, learning, and memory). These alterations may be connected to – and may illuminate the origin of – disruptive PTSD symptoms associated with hypervigilance, emotion regulation, and the connection between emotion and memory.

In addition, the researchers noted changes in trauma exposed individuals with no PTSD diagnosis, indicating that the brain processes associated with disruptive PTSD symptoms may begin to accumulate soon after experiencing trauma but well in advance of a PTSD diagnosis. Therefore, these observations may become functional neurological benchmarks we can observe in people with a history of trauma, allowing us to help patients address and process traumatic memories before they cause the development of disruptive symptoms.

Having objective benchmarks for PTSD-related brain structure and function could both improve PTSD treatment and reduce the development of PTSD after trauma exposure. Improving treatment and preventing PTSD onset could dramatically improve the lives of people already diagnosed with PTSD, as well as prevent disruption and emotional distress for people exposed to trauma by reducing their risk of developing clinical PTSD.