Autonomic dysregulation and the Window of Tolerance model of the effects of complex emotional trauma
Autonomic dysregulation and the Window of Tolerance model of the effects of complex emotional trauma
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DOI：
10.1177/0269881109354930
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发表时间：
2011-01-01
影响因子：
4.1
通讯作者：
Nutt, D. J.
中科院分区：
文献类型：
--
作者：
Corrigan, F. M.;Fisher, J. J.;Nutt, D. J.
本文回顾了与儿童期虐待相关的严重情感创伤的长期影响的容忍窗口模型，该模型也可以应用于严重程度足以导致创伤后应激障碍、慢性心境恶劣障碍和慢性焦虑障碍的成人创伤。功能失调的行为，如故意自残和滥用药物，被视为调节自主神经系统的努力，而自主神经系统很容易被最初的创伤事件的提醒触发到极端状态。虽然中脑区域如导水管周围灰质介导对创伤事件的即时防御反应及其记忆触发，但有人提出，上升的单胺能束与情绪和唤醒的长期变化有关。多巴胺能神经束上升的不平衡可能会导致唤醒水平以及相关情绪、驱动力和动机的快速波动。抑郁症的动物模型经常使用疼痛，孤立或社会失败的创伤性经历，以诱导中脑边缘和中皮层多巴胺系统的变化，这可能会改变前额叶皮层控制中脑防御反应。对容忍之窗药理学的关注可以提供药物治疗的进展，以促进那些患有创伤经历慢性后遗症的人的情绪调节。
This paper reviews the Window of Tolerance model of the long-term effects of the severe emotional trauma associated with childhood abuse, a model which can also be applied to adult trauma of sufficient severity to cause post-traumatic stress disorder, chronic dysthymic disorders and chronic anxiety disorders. Dysfunctional behaviours such as deliberate self-harm and substance abuse are seen as efforts to regulate an autonomic nervous system which is readily triggered into extreme states by reminders of the original traumatic events. While midbrain areas such as the periaqueductal gray mediate instant defence responses to traumatic events and their memory triggers it is proposed that ascending monoaminergic tracts are implicated in longer-term changes in mood and arousal. An imbalance of ascending dopaminergic tracts may drive rapid fluctuations in level of arousal and in the associated mood, drive and motivation. Animal models of depression frequently use traumatic experiences of pain, isolation or social defeat to induce changes in mesolimbic and mesocortical dopamine systems which may alter prefrontal cortical control of midbrain defence responses. A focus on the pharmacology of the Window of Tolerance could provide advances in drug treatments for promoting emotional regulation in those who are suffering from the chronic sequelae of traumatic experiences.