International Society for Traumatic Stress Studies

ISTSS Members' Reflections upon Winning Award from the French Psychiatric Association: Looking at How Dissociation Affects Brain Activity and Behavior of Mothers of Young Children

Posted 1 December 2014 in StressPoints by Daniel S. Schechter, MD

We were happy to hear that our paper was selected by the French Psychiatric Association to receive a "Prix de la Meilleure Publication du Congrès Français de Psychiatrie 2014" (Best Scientific Paper Prize of the French Psychiatric Association) at their 2014 Annual Meeting:

Moser DA, Aue T, Wang Z, Rusconi-Serpa S, Favez N., Peterson BS, Schechter DS (2014). Comorbid dissociation dampens limbic activation in violence-exposed mothers with PTSD who are exposed to video-clips of their child during separation. Stress, 16(5):493-502.

Dominik Moser, a doctoral student in our lab, was one of six prize winners to accept the award at the CFP Annual Meeting in Nantes, France on November 26, 2014. The study reported in the paper was part of my NIMH K-23 Research Career Award program of research conducted at Columbia University Department of Psychiatry.

The first neuroimaging paper from this work (Schechter et al., 2012), focused on the relationship of maternal PTSD to neural activation in response to stressful versus non-stressful video stimuli involving mother-child interactions. I had the idea to go back and re-examine the effects of comorbid dissociation on maternal neural activity in response to these stimuli, given clinical phenomena that I had observed and the work of Ruth Lanius' group supporting a dissociative subtype of PTSD (Lanius et al., 2010). Dominik Moser in Geneva took the lead on the prize-winning paper with funding from the Swiss National Science Foundation NCCR-SYNAPSY.

Based on previous observations in related fields, we hypothesized that more severe comorbid dissociation in IPV-PTSD would be associated with lower limbic system activation and greater neural activity in regions of the emotion regulation circuit such as the medial prefrontal cortex and dorsolateral prefrontal cortex (dlPFC).

This study included twenty mothers (of children aged 12-42 months), with and without IPV-PTSD, who watched epochs showing their child during separation and play while undergoing functional magnetic resonance imaging (fMRI). Multiple regression indicated that when mothers diagnosed with IPV-PTSD watched their children during separation compared to play, dissociative symptom severity was indeed linked to lowered activation within the limbic system; while greater IPV-PTSD symptom severity was associated with heightened limbic activity.

With respect to emotion regulation areas, we found significant neural activation associated to dissociation in the right dlPFC. We concluded that these results likely represent a neural correlate of the affected mothers' reduced capacity for sensitive responsiveness to their young child following exposure to interpersonal stress. This reduced capacity we and others have described in previous papers as related to the affected mothers' having to turn her energy towards to self-regulation in the service of survival at the expense of mutual regulation of emotion and arousal with her very young child. Infants and young children depend on their primary caregivers' engagement in mutual regulation of emotion and arousal towards their own development of self-regulation particularly within the sensitve period during ages 10-48 months.

Our research group is currently working on the development of a manualized videofeedback exposure intervention that is designed to help mothers with IPV-PTSD with and without comorbid dissociative symptoms, who have infants and young children in this age group. The technique upon which this is based is called the "Clinician Assisted Videofeedback Exposure Session(s)" or "CAVES" and is described further in two publications (Schechter et al., 2006; Schechter et al., 2014).

The technique involves modeling and supporting existing mentalization that enhances maternal capacity for emotion and arousal regulation. This occurs during the semi-structured intervention when the clinician directs joint attention with mother to video excerpts of stressful moments of mother-child interaction that many traumatized mothers would otherwise avoid looking at and wondering about (i.e. separation in the lab that triggers child states of helplessness and distress). This videofeedback exposure technique is done within a supportive framework that first examines what mothers remember about those interactions without video prompting and that also jointly focuses on positive moments of play interaction that show the most joy, reciprocity and mutuality prior to laboratory stressors such as parent-child separation.

About the Author

Daniel S. Schechter, MD, is currently Senior Lecturer in Psychiatry at the University of Geneva Faculty of Medicine and Director of the Pediatric Consult-Liaison Unit at the University of Geneva Hospitals, Switzerland. He received his medical and post-graduate training in child, adolescent and adult psychiatry, as well as his research training in developmental psychobiology at the Columbia University College of Physicians & Surgeons and New York State Psychiatric Institute.
 

References

Lanius R, Vermetten E, Loewenstein RJ, Brand B, Schmahl C, Bremner JD, Spiegel D (2010).   Emotion modulation in PTSD:  clinical and neurobiological evidence for a dissociative subtype. American Journal of Psychiatry 167, 640-647.

Moser DA, Aue T, Wang Z, Rusconi-Serpa S, Favez N., Peterson BS, Schechter DS (2014). Comorbid dissociation dampens limbic activation in violence-exposed mothers with PTSD who are exposed to video-clips of their child during separation. Stress. 16(5):493-502.

Schechter DS, Moser DA, Reliford A, McCaw JE, Coates SW, Turner JB, Rusconi S, Willheim E (2014 epub Feb 20). Negative and distorted attributions towards child, self, and primary attachment figure, among posttraumatically stressed mothers: What changes with Clinical Assisted Videofeedback Exposure Sessions (CAVES)? Child Psychiatry and Human Development.

Schechter DS, Moser D, Wang Z, Marsh R, Hao XJ, Duan Y, Yu S, Gunter B, Murphy D, McCaw J, Kangarlu A, Willheim E, Myers M, Hofer M, Peterson BS (2012 epub 22.10.11). An fMRI study of the brain responses of traumatized mothers to viewing their toddlers during separation and play. Journal of Social, Cognitive and Affective Neuroscience,7(8), 969-79.