Brain Changes in Emotion Regulation After Trauma

Frontiers in Behavioral Neuroscience | 2025, p. 1-9

Neural correlates and plasticity of explicit emotion regulation following the experience of trauma 

Annika C. Konrad; Clinical Psychology and Behavioral Neuroscience, Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany

Andrei C. Miu; Department of Psychology, Faculty of Psychology and Educational Sciences, Babeș-Bolyai University, Cluj-Napoca, Romania

Sebastian Trautmann; Institute for Clinical Psychology and Psychotherapy, Medical School Hamburg, Hamburg, Germany

Philipp Kanske; Clinical Psychology and Behavioral Neuroscience, Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany; Department of Psychology, Faculty of Psychology and Educational Sciences, Babeș-Bolyai University, Cluj-Napoca, Romania

“The experience of a traumatic event is not only deeply impactful in itself but is often followed by a range of mental health symptoms. However, only a minority of trauma-exposed individuals develop a full-blown mental disorder in the aftermath of a traumatic event. In order to identify individuals at risk, it seems crucial to investigate specific mechanisms for the development of psychopathology. In particular, difficulties in emotion regulation have been proposed as a transdiagnostic mechanism that plays a central role in various mental disorders, including post-traumatic stress disorder. Emotion regulation has been defined as the conscious or unconscious process of modifying the intensity or type of emotions. Given this definition, it is not surprising that individuals who have experienced a trauma and also show difficulties in managing negative emotions appear to be more vulnerable to developing psychopathology” (p. 1-2).

“We aim to first summarize studies reporting neural correlates of explicit emotion regulation strategies (in response to negative stimuli) in trauma-exposed samples. By including trauma-exposed individuals with and without PTSD, we aim to explore general effects of trauma exposure, while between-group differences may pinpoint alterations in emotion regulation as a specific correlate of PTSD symptoms. Second, we highlight research gaps, and third, we discuss current and future developments in the field of intervention research investigating the neural plasticity of emotion regulation. Being able to show neural plasticity of explicit emotion regulation offers a further level of evaluating the long-term effectiveness of these interventions and their underlying processes” (p. 2).

“Reappraisal has been defined as an adaptive and antecedent-focused regulatory strategy and describes the process of changing the interpretation of an event that triggers an emotional response. In healthy participants, reappraisal engages a network of regions associated with cognitive control, (prefrontal cortex; PFC), conflict monitoring (anterior cingulate cortex; ACC), and semantic processing or perspective taking (middle temporal gyrus… studies assessing neural underpinnings of reappraisal related to trauma exposure hint that specifically PTSD appears to be associated with reduced prefrontal engagement, in the dorsolateral PFC. Although there is a growing body of research assessing reappraisal, small sample sizes, lack of reported whole-brain results or between-group contrasts still make it difficult to draw final conclusions considering other brain regions” (p. 2-6).

“In contrast to reappraisal, suppression targets the response directly by attempting to inhibit or prevent the full expression of the emotion, but seems less effective. Similar to reappraisal, suppressing emotional expressions and memories engages prefrontal… none of [the] studies reported robust differences between people with and without PTSD and control groups related to emotion or memory suppression. The use of different comparisons, samples (e.g., mixed group with and without PTSD vs. each group separated), and correction methods makes it difficult to aggregate these findings, calling for more research on neural correlates of suppression in trauma-exposed people with and without PTSD compared to healthy controls” (p. 6).

“Training in adaptive explicit emotion regulation is a core component of several interventions for PTSD, utilizing strategies such as reappraisal, but also acceptance and compassion as part of third-wave cognitive-behavioral therapy. Although some previous studies indeed examined neural predictors of treatment response, studies including explicit emotion regulation tasks before and after treatment to examine neural plasticity are still scarce. Last, the field of real-time fMRI neurofeedback has emerged as potential treatment for PTSD to promote neural plasticity related to regulation of emotion-related brain activation” (p. 6-7).

“Overall, we reviewed neural underpinnings of explicit emotion regulation strategies following trauma and their neural plasticity. Based on the current body of literature, general conclusions on neural underpinnings across explicit emotion regulation strategies cannot be drawn. While reappraisal seems to be associated with a reduced activation in prefrontal brain regions specifically related to PTSD, there is still room for higher quality studies using larger samples sizes and comparing both trauma-exposed people with and without PTSD and healthy controls” (p. 7).

• Prioritize Reappraisal Training: Clients with PTSD consistently show reduced prefrontal activation during reappraisal, indicating difficulties with cognitive control of emotions. Therapeutic approaches should focus on building reappraisal skills to enhance top-down regulation.
• Use Compassion-Based Strategies: PTSD is associated with reduced neural responsiveness to compassion-related stimuli. Integrating compassion-focused or self-compassion interventions may help clients reconnect with emotional and interpersonal processes disrupted by trauma.
• Expect Neural Efficiency, Not Just Activation: Symptom improvement after treatment has been linked to both increased and decreased prefrontal activation, suggesting that efficiency—not just activation—may indicate successful emotion regulation. Clinical progress should be gauged behaviorally, not just by cognitive effort.
• Incorporate Mindfulness Thoughtfully: Preliminary evidence supports mindfulness-based interventions (including self-compassion exercises) as a way to enhance neural connectivity in emotion regulation networks. These practices may serve as a useful complement to exposure-based treatments.

“Based on this review, we identify the following challenges for future research: research could focus on strategies other than reappraisal, such as compassion, acceptance, rumination, or self-blame. Especially, the question whether there are different neural underpinnings related to different strategies would enhance our understanding of emotion dysregulation following trauma experience. For instance, in healthy participants, contrasting compassion directly to reappraisal has revealed activity in the subgenual ACC, mid-insula, and ventral striatum, but not in cognitive control regions, such as the lateral PFC. These distinct neural pathways support the idea that compassion and reappraisal target different aspects of emotion regulation. While reappraisal seems to focus on the antecedent trigger decreasing negative affect, compassion generates positive affect. Notably, explicit emotion regulation is much more than the mere use of a given strategy. The investigation of emotion regulation flexibility, strategy preference, context, and goal dependencies could enhance current research and contribute to our general understanding of emotion regulation. Moreover, studies should assess how specific symptoms, symptom clusters, and situational variation may relate to emotion dysregulation on a neural level. 

On the intervention research side, there have been promising projects assessing neural correlates of emotion regulation before and after treatment, and others demonstrating the potential of real-time fMRI neurofeedback. However, inconsistent findings related to trauma-focused exposure and lack of learning effects leave room for research. Finally, a general lack of evidence on the neural plasticity of emotion regulation through psychotherapeutic interventions and specifically through mindfulness-based trainings calls for further investigation, as the long-term training of acceptance and compassion could be a promising complement to reappraisal training” (p. 7-8).