Role of social cognition in post-traumatic stress disorder: A review and meta-analysis

Abstract

Social functioning is a key component of recovery after a potentially traumatic experience, and the buffering role of the social support in trauma resilience and recovery has been very well documented. Factors contributing to resilience and recovery are notable because although most people will experience a traumatic event during their lifetimes, only 6% to 10% are diagnosed with post-traumatic stress disorder (PTSD). The relationship between an individual and their social environment is determined both by the quality of the social environment itself, and by the individual's perception and understanding of information conveyed by the other people around them. However, little research has considered the contribution of these internal social cognitive processes to PTSD risk or resilience. The current review draws on the existing literature on social cognitive functioning in trauma exposure and PTSD, identifying key questions and themes for future research. We utilized a meta-analytic approach to assess the evidence for alterations in social cognition in PTSD, finding a consistent large deficit in social cognitive performance in PTSD groups relative to trauma-exposed and healthy controls. We then reviewed the literature on the interaction of genes and the social environment, supporting the hypothesis that social cognitive deficits are a preexisting risk factor for PTSD. Finally, we reviewed relevant neuroimaging findings, which suggest that alterations in social cognition affect the perception of threat cues in PTSD. Overall, research on social cognition and PTSD is still emerging, but existing findings suggest this is an important and understudied area for the understanding of PTSD.

Keywords: G × SE; PTSD; fMRI; face stimuli; genetic risk; meta-analysis; neuroimaging; social brain; social cognition; trauma exposure.

Figure 1.

Summary of effect sizes for group differences in performance on social cognitive tasks, comparing PTSD, trauma-exposed control (TC), and healthy control (HC) groups. Panel A shows the summary across all studies, and Panel B shows the effect sizes broken down by type of trauma exposure for the populations examined in each study. Because only a few studies examined specific trauma types, the results of Panel B are illustrative only, and a statistical comparison of these groups was not performed.

Figure 2.

An extensive human neuroimaging literature has demonstrated a set of brain regions consistently engaged by social stimuli. To provide a schematic example of key brain regions involved in social cognition, we created a brain map using the text-based meta-analytic tool Neurosynth. The search term “social” aggregated findings from the 1000 published papers in the database containing the term, and compared the results against findings of all papers not containing the word “social.” Thresholded maps for this analysis are shown above (p<.01, FDR-corrected).