PTSD and the Insular Cortex

The Effect Meditation and Yoga have on the Insular Cortex and How it Can Be Used

to Treat PTSD in Combat Veterans

Jerri StephensonAdvanced Cognitive Psychology

Insular Cortex• The insular cortex is located in both hemispheres and is a portion of the cerebral

cortex folded within the fissure separating the temporal lobe from the parietal and frontal lobes.

• The insulae are involved in consciousness and functions such as emotion, perception, motor control, self-awareness, cognitive functioning, and interpersonal experience as well as regulation of the body's homeostasis.

• The right anterior insula aids in interoceptive awareness of the body, such as the ability to time one's own heart beat.

• More right anterior insular gray matter volume correlates with improved accuracy in sensing the inner body and with negative emotional experience.

• It is also involved in the control of blood pressure, especially during and after exercise. Its activity varies with the amount of effort a person believes they are exerting.

• The insular cortex also is where the sensation of pain is judged as to its degree.• The insula is where a person imagines pain when looking at images of painful

events while thinking about them happening to one's own body.• Those with irritable bowel syndrome have abnormal processing of visceral pain in

the insular cortex related to dysfunctional inhibition of pain within the brain.• The insular perceives the degree of nonpainful warmth or nonpainful coldness of

a skin sensation. • A full bladder activates the insular cortex.

Cool Insular Cortex Facts

Dysfunctions in the Insular Cortex• Mood Disorders• Anxiety Disorders• PTSD• Obsessive-compulsive Disorders• Eating Disorders• Schizophrenia

According to the Department of Veterans Affairs, as many as 20% of veterans that served in Operation Iraqi Freedom and Operation Enduring Freedom have PTSD...

Over 2.1 million American men and women have served in the wars in Iraq and Afghanistan since 2001

It is estimated as many as 400,000 combat veterans have post traumatic stress disorder

Post traumatic stress disorder (PTSD) is an anxiety disorder characterized by the re-experiencing of an extremely traumatic event.

PTSD is a pervasive disorder than can affect the lives of those with the disorder in many aspects including career achievement, health and wellness, and familial and social interactions.

Individuals with PTSD often describe painful guilt feelings about surviving when others did not.

PTSD symptoms may include difficulty falling or staying asleep due to recurring nightmares reliving the traumatic event, hyper-vigilance, and easily startled.

Some other symptoms that may occur include self-destructive and impulsive behavior, feelings of shame, ineffectiveness, despair or hopelessness.

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Some with PTSD report irritability or anger outbursts, trouble concentrating or completing tasks.

PTSD is associated with persistent symptoms of anxiety or increased arousal that were not present before the trauma.

In 2012, 349 servicemembers died by suicide in 2012, exceeding the 295 combat-related deaths.

The VA estimates that an average of 18 veterans per day commit suicide, or 1 out of 5 suicides in the U.S.

Deployed service members who were exposed to combat situations are at great risk for binge drinking.



Those with PTSD or depression were more likely than those without PTSD or depression to have developed or experience continued alcohol-related problems.

http://youtu.be/diOMzSpH87A



The Unique Brain Anatomy of Meditation Practitioners: Alterations in Cortical Gyrificationby Eileen Luders (2007)

• Found that long-term meditators have larger amounts of gyrification ("folding" of the cortex, which may allow the brain to process information faster) than people who do not meditate.

• 49 recruited subjects, the researchers took MRI scans of 23 meditators and compared them to 16 control subjects matched for age, handedness and sex.

• They found heightened levels of gyrification in active meditation practitioners across the cortex, including the left precentral gyrus, the left and right anterior dorsal insula, the right fusiform gyrus and the right cuneus.

• Most interesting was the positive correlation between the number of meditation years and the amount of insular gyrification.

• Positive correlation between gyrification and the number of practice years supports the idea that meditation enhances regional gyrification.

• “Meditators are known to be masters in introspection and awareness as well as emotional control and self-regulation, so the findings make sense that the longer someone has meditated, the higher the degree of folding in the insula”

Investigation of mindfulness meditation practitioners with voxel-based morphometryby Britta K. Hozel (2007)

• Using voxel-based morphometry, this study investigated MRI brain images of 20 mindfulness (Vipassana) meditators (mean practice 8.6 years; 2 h daily) and compared the regional gray matter concentration to that of non-meditators matched for sex, age, education and handedness.

• Results confirmed greater gray matter concentration for meditators in the right anterior insula, which is involved in interoceptive awareness.

• Results suggest that meditation practice is associated with structural differences in regions that are typically activated during meditation and in regions that are relevant for the task of meditation.

Insular Cortex Mediates Increased Pain Tolerance in Yoga Practitionersby Chantal Villemure (2013)

• Investigated possible neuroanatomical underpinnings of the beneficial effects of yoga using sensory testing and magnetic resonance imaging techniques.

• North American yogis tolerated pain more than twice as long as individually matched controls and had more gray matter (GM) in multiple brain regions.

• Insular GM volume in yogis positively correlated with yoga experience, suggesting a causal relationship between yoga and insular size.

• These findings suggest that regular and long-term yoga practice improves pain tolerance in typical North Americans by teaching different ways to deal with sensory inputs and the potential emotional reactions attached to those inputs leading to a change in insular brain anatomy and connectivity.

Insular cortex involvement in declarative memory deficits in patients with post-traumatic stress disorderby Shulin Chen (2009)

• Twelve subjects with PTSD and 12 subjects without PTSD victims underwent functional magnetic resonance imaging and magnetic resonance imaging.

• Grey matter volume was significantly reduced bilaterally in the insular cortex of PTSD subjects than non-PTSD. PTSD group also had lower level of activation in insular cortex when performing word encoding and retrieval tasks than non-PTSD group.

• The study provides evidence on structural and function abnormalities of the insular cortex in patients with PTSD.



Research has shown that practicing yoga can help to alleviate the symptoms of PTSD

Double-click to enter titleSpecial breathing and meditation techniques provide relief to individuals who suffer from mood swings, physical aches and pains, compulsive thoughts or behaviors, and panic attacks

Yoga has shown to have a significant impact on mental health, especially when combined with more traditional methods such as medication and cognitive behavioral therapy.



Yoga has also been shown to be most effective in combination with traditional methods.

Yoga practice enhances flexibility and coordination, and increases strength and muscle tone.

Clinicians find that mindful yoga therapy provides the self-regulation skills that are needed to effectively engage in and benefit from trauma-processing therapies.

Veterans participating in these programs have found that mindful yoga therapy helps them sleep better, concentrate and think more clearly, manage anger and aggression more easily, and find comfort in their own skin.

Coaching-based PTSD treatment is based on solutions. Coaching takes into account all aspects of warriors to help them engage in creative problem-solving that will help them map out a route to achieving their goals.

Clinical studies show that yoga can help veterans:

• Sleep better, overcoming insomnia and nightmares• Enjoy a sense of well-being• Relieve depression and hopelessness• Cope with and even resolve anxiety and

fear• Find escape from the “fight or flight”

response that causes hyperarousal• Control anger and strong emotions• Reconnect emotionally with friends,

family and their community• Be successful in recovering from

addiction• Feel less physical pain

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There's no stigma, no "who, what, where, when and why."



Britta K., Ulrich Ott, Tim Gard, Hannes Hempel, Martin Weygandt, Katrin Morgen, and Dieter Vait. Investigation of mindfulness meditation practitioners with voxel-based morphometry. Soc Cogn Affect Neurosci (2008) 3 (1): 55-61 first published online December 3, 2007 doi:10.1093/scan/nsm038.Chantal Villemure, Marta Čeko, Valerie A. Cotton, and M. Catherine Bushnell. Insular Cortex Mediates Increased Pain Tolerance in Yoga Practitioners. Cereb. Cortex first published online May 21, 2013 doi:10.1093/cercor/bht124.Chen S, Li L, Xu B, Liu J. Insular cortex involvement in declarative memory deficits in patients with post-traumatic stress disorder. BMC Psychiatry. 2009;9:39. Luders Eileen , Florian Kurth, Emeran A. Mayer, Arthur W. Toga, Katherine L. Narr, Christian Gaser. The Unique Brain Anatomy of Meditation Practitioners: Alterations in Cortical Gyrification. Frontiers in Human Neuroscience, 2012; 6 DOI: 10.3389/fnhum.2012.00034.Nagai M. , Kishi K and Kato S. Insular cortex and neuropsychiatric disorders: A review of recent literature. European Psychiatry. 22. 2007. 387-394.

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PTSD and the Insular Cortex