Presentation about Insular Cortex and Posttraumatic Stress Disorder

1. The Effect Meditation and Yoga have on
the Insular Cortex and How it Can Be Used
to Treat PTSD in Combat Veterans
Jerri Stephenson
Advanced Cognitive Psychology

2. 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.

3. •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

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

5. 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

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

7. 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.

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

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

10. 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.

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

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

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

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

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

17. http://youtu.be/diOMzSpH87A

18. The Unique Brain Anatomy of Meditation Practitioners:
Alterations in Cortical Gyrification
by 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”

19. Investigation of mindfulness meditation practitioners
with voxel-based morphometry
by 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.

20. Insular Cortex Mediates Increased Pain Tolerance
in Yoga Practitioners
by 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.

21. Insular cortex involvement in declarative memory deficits in
patients with post-traumatic stress disorder
by 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.

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

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Special breathing
and meditation
techniques provide
relief to individuals
who suffer from
mood swings,
physical aches and
pains, compulsive
thoughts or
behaviors, and
panic attacks

24. 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.

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

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

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

28. 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.

29. 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.

30. 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."

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33. 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.
References