Increased recruitment of cognitive control in the presence of traumatic stimuli in complex PTSD

  • Julia I. HerzogEmail author
  • Inga Niedtfeld
  • Sophie Rausch
  • Janine Thome
  • Meike Mueller-Engelmann
  • Regina Steil
  • Kathlen Priebe
  • Martin Bohus
  • Christian Schmahl
Original Paper


A neurocircuitry model of post-traumatic stress disorder (PTSD) suggests increased amygdala responses to emotional stimuli, coupled with hypoactivation of prefrontal regions associated with cognitive control. However, results are heterogenous across different subsamples of PTSD as well as different paradigms. We investigated cognitive control in a classic and emotional Stroop task in 28 female patients with complex PTSD (cPTSD), 28 female trauma-exposed healthy controls (TCs) and 28 female non-trauma-exposed healthy controls (HCs) using functional neuroimaging. Afterwards, we assessed memory function in a spontaneous free recall and recognition task. Patients with cPTSD displayed significantly greater Stroop interference with trauma-related words (as reflected in slower reaction times and increased errors) compared to the other conditions and compared to the TC and HC groups. Moreover, patients with cPTSD showed increased activation in the context of trauma-related words in brain regions associated with cognitive control (dlPFC, vmPFC, dACC) compared to both control groups, and a trend for increased activation in the insula compared to the HC group. Increased recruitment of regions contributing to cognitive control in patients with cPTSD, together with a lack of amygdala response may point to efforts to compensate for emotional distraction caused by the trauma-related words.


Complex post-traumatic stress disorder Child abuse fMRI Stroop task Cognitive control 



We thank all members of the research team for their assistance and thank all participants for their collaboration. We further thank Dr. Lars Schulze for his skillful technical support during the data analyses.

Compliance with ethical standards

Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.


This work was supported by the German Ministry of Education and Research (BMBF): [RELEASE 01KR1303A].

Supplementary material

406_2017_822_MOESM1_ESM.docx (76 kb)
Supplementary material 1 (DOCX 75 kb)


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Copyright information

© Springer-Verlag GmbH Germany 2017

Authors and Affiliations

  • Julia I. Herzog
    • 1
    Email author
  • Inga Niedtfeld
    • 1
  • Sophie Rausch
    • 2
  • Janine Thome
    • 2
  • Meike Mueller-Engelmann
    • 3
  • Regina Steil
    • 3
  • Kathlen Priebe
    • 2
    • 4
  • Martin Bohus
    • 2
    • 5
  • Christian Schmahl
    • 1
    • 6
  1. 1.Department of Psychosomatic Medicine and Psychotherapy, Medical Faculty Mannheim, Central Institute of Mental Health MannheimHeidelberg UniversityMannheimGermany
  2. 2.Institute of Psychiatric and Psychosomatic Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty MannheimHeidelberg UniversityMannheimGermany
  3. 3.Department of Clinical Psychology and Intervention, Institute of PsychologyGoethe University FrankfurtFrankfurt am MainGermany
  4. 4.Department of Psychology, Faculty of Life SciencesHumboldt-Universitaet zu BerlinBerlinGermany
  5. 5.Faculty of HealthUniversity of AntwerpWilrijk, AntwerpBelgium
  6. 6.Department of Psychiatry, Schulich School of Medicine and DentistryWestern UniversityLondonCanada

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