Epigenetics of traumatic stress : The association of NR3C1 methylation and posttraumatic stress disorder symptom changes in response to narrative exposure therapy
2023-01-19, Wilker, Sarah, Vukojevic, Vanja, Schneider, Anna, Pfeiffer, Anett, Inerle, Stefan, Pauly, Markus, Elbert, Thomas, Papassotiropoulos, Andreas, de Quervain, Dominique, Kolassa, Iris-Tatjana
Epigenetic processes allow plasticity in gene regulation in response to significant environmental events. Accumulating evidence suggests that effective psychotherapy is accompanied by epigenetic changes, rendering DNA methylation a potential biomarker of therapy success. Due to the central role of glucocorticoid dynamics in stress regulation and the alteration of aversive memories, glucocorticoid receptors are likely involved in the molecular processes that are required to successfully treat Posttraumatic Stress Disorder (PTSD). This study aimed to investigate the relationship between methylation at the glucocorticoid receptor gene ( NR3C1 ) and PTSD treatment success of evidence-based psychotherapy. A sample of N = 153 conflict survivors from Northern Uganda (98 females and 55 males) with PTSD were treated with Narrative Exposure Therapy (NET). Diagnostic interviews and saliva sampling took place at pretreatment and 4 and 10 months after treatment completion. We investigated potential associations between PTSD symptom development and methylation changes at 38 CpG sites spanning NR3C1 over the three times of measurement using the repeated measures correlation. After accounting for multiple comparisons, DNA methylation at CpG site cg25535999 remained negatively associated with PTSD symptoms. These results were followed up by mixed models as well as structural equation modelling. These analyses revealed that treatment responders had a significant cg25535999 methylation increase after treatment with NET. Furthermore, lower methylation at cg25535999 pretreatment predicted a higher symptom improvement. Our results suggest different epigenetic profile dynamics at NR3C1 cg25535999 in therapy responders compared to non-responders and underscore the central role of glucocorticoid signaling in trauma-focused therapy.
No Evidence That Cognitive and Physical Activities Are Related to Changes in EEG Markers of Cognition in Older Adults at Risk of Dementia
2021, Laptinskaya, Daria, Küster, Olivia Caroline, Fissler, Patrick, Thurm, Franka, von Arnim, Christine A. F., Kolassa, Iris-Tatjana
An active lifestyle as well as cognitive and physical training (PT) may benefit cognition by increasing cognitive reserve, but the underlying neurobiological mechanisms of this reserve capacity are not well understood. To investigate these mechanisms of cognitive reserve, we focused on electrophysiological correlates of cognitive performance, namely on an event-related measure of auditory memory and on a measure of global coherence. Both measures have shown to be sensitive markers for cognition and might therefore be suitable to investigate potential training- and lifestyle-related changes. Here, we report on the results of an electrophysiological sub-study that correspond to previously published behavioral findings. Altogether, 65 older adults with subjective or objective cognitive impairment and aged 60-88 years were assigned to a 10-week cognitive (n = 19) or a 10-week PT (n = 21) or to a passive control group (n = 25). In addition, self-reported lifestyle was assessed at baseline. We did not find an effect of both training groups on electroencephalography (EEG) measures of auditory memory decay or global coherence (ps ≥ 0.29) and a more active lifestyle was not associated with improved global coherence (p = 0.38). Results suggest that a 10-week unimodal cognitive or PT and an active lifestyle in older adults at risk for dementia are not strongly related to improvements in electrophysiological correlates of cognition.
Global EEG coherence as a marker for cognition in older adults at risk for dementia
2020-04, Laptinskaya, Daria, Fissler, Patrick, Küster, Olivia Caroline, Wischniowski, Jakob, Thurm, Franka, Elbert, Thomas, von Arnim, Christine A. F., Kolassa, Iris-Tatjana
Quantitative electroencephalography (EEG) provides useful information about neurophysiological health of the aging brain. Current studies investigating EEG coherence and power for specific brain areas and frequency bands have yielded inconsistent results. This study assessed EEG coherence and power indices at rest measured over the whole skull and for a wide frequency range as global EEG markers for cognition in a sample at risk for dementia. Since global markers are more reliable and less error‐prone than region‐ and frequency‐specific indices they might help to overcome previous inconsistencies. Global EEG coherence (1–30 Hz) and an EEG slowing score were assessed. The EEG slowing score was calculated by low‐frequency power (1–8 Hz) divided by high‐frequency power (9–30 Hz). In addition, the prognostic value of the two EEG indices for cognition and cognitive decline was assessed in a 5‐year follow‐up pilot study. Baseline global coherence correlated positively with cognition at baseline, but not with cognitive decline or with cognition at the 5‐year follow‐up. The EEG slowing ratio showed no significant association, neither with cognition at baseline or follow‐up, nor with cognitive decline over a period of 5 years. The results indicate that the resting state global EEG coherence might be a useful and easy to assess electrophysiological correlate for neurocognitive health in older adults at risk for dementia. Because of the small statistical power for the follow‐up analyses, the prognostic value of global coherence could not be determined in the present study. Future studies should assess its prognostic value with larger sample sizes.
Emotion Regulation in Rescue Workers : Differential Relationship With Perceived Work-Related Stress and Stress-Related Symptoms
2019-01-10, Gärtner, Anne, Behnke, Alexander, Conrad, Daniela, Kolassa, Iris-Tatjana, Rojas, Roberto
Rescue workers are exposed to enduring emotional distress, as they are confronted with (potentially) traumatic mission events and chronic work-related stress. Thus, regulating negative emotions seems to be crucial to withstand the work-related strain. This cross-sectional study investigated the influence of six emotion regulation strategies (i.e., rumination, suppression, avoidance, reappraisal, acceptance, and problem solving) on perceived work-related stress and stress-related depressive, post-traumatic, and somatic symptoms in a representative sample of 102 German rescue workers. Multiple regression analyses identified rumination and suppression to be associated with more work-related stress and stress-related symptoms. Acceptance was linked to fewer symptoms and, rather unexpectedly, avoidance was linked to less work-related stress. No effects were observed for reappraisal and problem solving. Our findings confirm the dysfunctional role of rumination and suppression for the mental and physical health of high-risk populations and advance the debate on the context-specific efficacy of emotion regulation strategies.
Expression of DNA repair genes and its relevance for DNA repair in peripheral immune cells of patients with posttraumatic stress disorder
2022-11-04, Behnke, Alexander, Mack, Matthias, Fieres, Judy, Christmann, Markus, Bürkle, Alexander, Moreno-Villanueva, Maria, Kolassa, Iris-Tatjana
Posttraumatic stress disorder (PTSD) involves elevated levels of cellular oxidative stress which jeopardizes the integrity of essential cell compartments. Previously, we demonstrated higher levels of DNA lesions in peripheral blood mononuclear cells (PBMCs) in PTSD. Retaining vital levels of DNA integrity requires cells to mobilize compensatory efforts in elevating their DNA-repair capacity. Accordingly, we hypothesized to find increased expression rates of the DNA-repair genes X-ray repair cross complementing 1 (XRCC1), poly (ADP-ribose) polymerase 1 (PARP1), and polymerase β (Polβ) in PBMCs of PTSD patients as compared to controls, leading to functionally relevant changes in DNA-repair kinetics. In a cohort of 14 refugees with PTSD and 15 without PTSD, we found significantly higher XRCC1 expression in PTSD patients than controls (U = 161.0, p = 0.009, Cohen's r = 0.49), and positive correlations between the severity of PTSD symptoms and the expression of XRCC1 (rS = 0.57, p = 0.002) and PARP1 (rS = 0.43, p = 0.022). Higher XRCC1 (F = 2.39, p = 0.010, η2p = 0.10) and PARP1 (F = 2.15, p = 0.022, η2p = 0.09) expression accounted for slower repair of experimentally X-ray irradiation-induced DNA damage, highlighting the possible physiological relevance of altered DNA-repair gene expression in PTSD. Our study provides first evidence for a compensatory regulation of DNA-repair mechanisms in PTSD. We discuss the implications of increased DNA damage and altered DNA-repair mechanisms in immune senescence, premature aging, and increased physical morbidity in PTSD.
Does cumulative exposure to traumatic stressors predict treatment outcome of community-implemented exposure-based therapy for PTSD?
2020-12-31, Schneider, Anna, Pfeiffer, Anett, Conrad, Daniela, Elbert, Thomas, Kolassa, Iris-Tatjana, Wilker, Sarah
Background: Posttraumatic Stress Disorder (PTSD) is associated with high levels of functional impairments such as difficulties in academic or occupational performance and in social relationships. With an increasing number of traumatic event types experienced (trauma load), PTSD risk increases in a dose-dependent manner. Accordingly, high rates of PTSD can impair the reconstruction process in post-conflict societies. In order to meet these high needs for mental health services in societies with little access to professional care, task shifting approaches and community-based interventions have been suggested. Narrative Exposure Therapy (NET) has been developed as a short and pragmatic exposure-based PTSD treatment that can be easily trained to lay personnel. Yet, it remains unclear whether NET can be effectively provided by trained lay counsellors even at high levels of trauma load.
Objective: To investigate whether trauma load influences the treatment effectiveness of NET provided by trained and supervised local lay counsellors.
Method: Linear mixed models were calculated to investigate the influence of trauma load on treatment effectiveness in a sample of N = 323 rebel war survivors from Northern Uganda with PTSD.
Results: We found a strong reduction of PTSD symptoms following NET, which was not influenced by trauma load. However, individuals with higher levels of trauma load reported higher PTSD symptoms before therapy as well as 4 and 10 months following treatment completion compared to individuals with lower trauma load.
Conclusions: Treatment with NET by lay counsellors is effective independent of trauma load. However, individuals with higher trauma load have a higher probability to show residual symptoms, which might require additional time, sessions or treatment modules.
Integrated genetic, epigenetic, and gene set enrichment analyses identify NOTCH as a potential mediator for PTSD risk after trauma : Results from two independent African cohorts
2020-01, Conrad, Daniela, Wilker, Sarah, Schneider, Anna, Karabatsiakis, Alexander, Pfeiffer, Anett, Kolassa, Stephan, Freytag, Virginie, Vukojevic, Vanja, Elbert, Thomas, Kolassa, Iris-Tatjana
The risk of developing posttraumatic stress disorder (PTSD) increases with the number of traumatic event types experienced (trauma load) in interaction with other psychobiological risk factors. The NOTCH (neurogenic locus notch homolog proteins) signaling pathway, consisting of four different trans-membrane receptor proteins (NOTCH1-4), constitutes an evolutionarily well-conserved intercellular communication pathway (involved, e.g., in cell-cell interaction, inflammatory signaling, and learning processes). Its association with fear memory consolidation makes it an interesting candidate for PTSD research. We tested for significant associations of common genetic variants of NOTCH1-4 (investigated by microarray) and genomic methylation of saliva-derived DNA with lifetime PTSD risk in independent cohorts from Northern Uganda (N1 = 924) and Rwanda (N2 = 371), and investigated whether NOTCH-related gene sets were enriched for associations with lifetime PTSD risk. We found associations of lifetime PTSD risk with single nucleotide polymorphism (SNP) rs2074621 (NOTCH3) (puncorrected = 0.04) in both cohorts, and with methylation of CpG site cg17519949 (NOTCH3) (puncorrected = 0.05) in Rwandans. Yet, none of the (epi-)genetic associations survived multiple testing correction. Gene set enrichment analyses revealed enrichment for associations of two NOTCH pathways with lifetime PTSD risk in Ugandans: NOTCH binding (pcorrected = 0.003) and NOTCH receptor processing (pcorrected = 0.01). The environmental factor trauma load was significant in all analyses (all p < 0.001). Our integrated methodological approach suggests NOTCH as a possible mediator of PTSD risk after trauma. The results require replication, and the precise underlying pathophysiological mechanisms should be illuminated in future studies.
DNA methylation changes following narrative exposure therapy in a randomized controlled trial with female former child soldiers
2021-09-16, Carleial, Samuel, Nätt, Daniel, Unternaehrer, Eva, Elbert, Thomas, Robjant, Katy, Wilker, Sarah, Vukojevic, Vanja, Kolassa, Iris-Tatjana, Rukundo-Zeller, Anja C., Koebach, Anke
The aftermath of traumatization lives on in the neural and epigenetic traces creating a momentum of affliction in the psychological and social realm. Can psychotherapy reorganise these memories through changes in DNA methylation signatures? Using a randomised controlled parallel group design, we examined methylome-wide changes in saliva samples of 84 female former child soldiers from Eastern DR Congo before and six months after Narrative Exposure Therapy. Treatment predicted differentially methylated positions (DMPs) related to ALCAM, RIPOR2, AFAP1 and MOCOS. In addition, treatment associations overlapped at gene level with baseline clinical and social outcomes. Treatment related DMPs are involved in memory formation—the key agent in trauma focused treatments—and enriched for molecular pathways commonly affected by trauma related disorders. Results were partially replicated in an independent sample of 53 female former child soldiers from Northern Uganda. Our results suggest a molecular impact of psychological treatment in women with war-related childhood trauma.
A combination of combat experience, early abduction and severe traumatization fuels appetitive aggression and violence among abductees of rebel war in Northern Uganda
2020-11, Rukundo-Zeller, Anja C., Conrad, Daniela, Schneider, Anna, Behnke, Alexander, Pfeiffer, Annett, Blum, Gerrit, Wilker, Sarah, Elbert, Thomas, Kolassa, Iris-Tatjana
Individuals who perpetrate violence may likely perceive violence as appealing and infliction of violence to derive pleasure is termed as appetitive aggression. Individuals who were abducted as children into an armed group often experience a higher number of traumatic event types, that is traumatic load and are usually socialized in a violence-endorsing environment. This study aims to investigate the interaction between age at initial abduction with that of traumatic load, and their influence on appetitive aggression along with perpetration of violent acts by former members of an armed rebel group of both sexes. Semi-structured interviews were conducted among a target group of formerly abducted rebel-war survivors (including participants with and without combat experience) from Northern Uganda. Participants included 596 women and 570 men with N = 1,166 (Mage = 32.58, SDage = 9.76, range: 18-80 years). We conducted robust linear regression models to investigate the influence of age at initial abduction, traumatic load, combat experience, and biological sex on appetitive aggression as well as their perpetrated violent acts. Our study shows, appetitive aggression and the number of perpetrated violent acts were specifically increased in individuals who were abducted young, experienced several traumatic events in their lifetime, and with previous combat experience. For perpetrated violence men showed increased levels whereas for appetitive aggression the association was independent of biological sex. Therefore, early abducted individuals with a higher traumatic load, who have combat experience, need to be given special intervention to prevent any further violence.
Higher sense of coherence is associated with better mental and physical health in emergency medical services : results from investigations on the revised sense of coherence scale (SOC-R) in rescue workers
2019-05-20, Behnke, Alexander, Conrad, Daniela, Kolassa, Iris-Tatjana, Rojas, Roberto
As rescue workers are regularly confronted with potentially traumatising on-duty events, they have an increased risk to develop trauma-related mental and physical health impairments, including post-traumatic, depressive, and somatic symptoms. For this high-risk group, it could be of particular importance to experience their occupational burden as manageable, meaningful, and coherent. This mindset – called sense of coherence – may be a potential resilience factor against the development of mental and physical health problems. In a cross-sectional cohort of 102 rescue workers (Mdn(QD)age = 26.0 (8.5), age range: 18−61), including 36 women, we investigated whether higher values on the Revised Sense of Coherence Scale (SOC-R) predicted lower post-traumatic, depressive, and somatic symptoms. In addition, we evaluated the factor structure of the SOC-R using confirmatory factor analyses. Linear regressions indicated that higher SOC-R, but particularly manageability scores were associated with less post-traumatic (β = −.31, p = .009), depressive (β = −.44, p < .001), and somatic symptoms (β = −.36, p = .002). Furthermore, we found that all symptom scores significantly increased with occupational and private-life trauma exposure. The SOC-R’s factor structure was replicated, comprising the three subscales manageability, reflection, and balance. However, the SOC-R’s convergent factor validity was rather low in the present sample. Taken together, a high sense of coherence, and in particular a high manageability conviction, was observed as resilience factors for high-risk groups that are frequently exposed to potentially traumatic events. Future studies might investigate whether strengthening the sense of coherence could be one building block in an effective prevention program for maintaining long-term health in risk groups.