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Neural Correlates of Levels of Emotional Awareness During Trauma Script-Imagery in Posttraumatic Stress Disorder

Frewen, Paul MA; Lane, Richard D. MD, PhD; Neufeld, Richard W.J. PhD; Densmore, Maria BSc; Stevens, Todd MSc; Lanius, Ruth MD, PhD

doi: 10.1097/PSY.0b013e31815f66d4
Original Articles

Objective: To examine individual differences in levels of emotional awareness as a predictor of the blood oxygenation level dependent (BOLD) response to trauma script-driven imagery in trauma-exposed individuals with (n = 25) and without (n = 16) posttraumatic stress disorder (PTSD).

Methods: Participants completed the Levels of Emotional Awareness Scale (LEAS) and a functional magnetic resonance imaging trauma script-driven imagery paradigm.

Results: Patients with PTSD exhibited lower LEAS scores in comparison with the control group. LEAS scores correlated positively with BOLD activity during trauma script-imagery in the ventral anterior cingulate cortex (vACC) in healthy controls, whereas LEAS scores correlated negatively with activation of vACC in individuals with PTSD.

Conclusion: Patients with PTSD exhibit lower than average levels of emotional awareness. Levels of emotional awareness are differentially associated with vACC response during trauma script-driven imagery in healthy controls versus individuals with PTSD.

PTSD = posttraumatic stress disorder; LEAS = Levels of Emotional Awareness Scale; vACC = ventral anterior cingulate cortex; dACC = dorsal anterior cingulate cortex; mPFC = medial prefrontal cortex; BA = Brodmann Area; DSM-IV = Diagnostic and Statistical Manual—4th Edition; BOLD = blood oxygenation level dependent; SVC = small volume corrected; fMRI = functional magnetic resonance imaging.

From the Departments of Psychology (P.F., Ri.L., R.W.J.N.), Psychiatry (Ri.L., R.W.J.N., M.D., Ru.L.), Neuroscience (Ri.L., Ru.L.) and Medical Biophysics (T.S.), University of Western Ontario, London, Ontario, Canada (R.W.J.N.); University of Arizona, Arizona Health Sciences Center (Ri.L.), Tucson, Arizona; Imaging Research Laboratories (T.S.), Robarts Research Institute, London Ontario, Canada.

Address correspondence and reprint requests to Ruth A. Lanius, London Health Sciences Centre, 339 Windermere Road, London, Ontario, Canada, N6A 5A5. E-mail:

Received for publication January 30, 2007; revision received July 26, 2007.

Copyright © 2008 by American Psychosomatic Society
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