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Objectives: Few studies have assessed the neural mechanisms of the effects of unconscious emotional distracter on cognition in posttraumatic stress disorder (PTSD) patients. Thus, this study used functional magnetic resonance imaging (fMRI) to investigate the effects of unconscious emotional distraction involving fear during conscious working memory (WM) maintenance in patients with PTSD. Methods: This study included 10 patients with PTSD and positive early trauma inventory diagnosed based on Diagnostic and Statistical Manual of Mental Disorders fourth edition-text revision criteria, and 10 matched healthy controls. Event-related fMRI data were obtained while the participants performed a WM task (face recognition) with neutral and unconscious emotional distracters. Results: Patients with PTSD may have sought to maintain WM function during the presentation of task-irrelevant emotional distractors that induced interruption and required attention. Compared to healthy controls, the PTSD patients exhibited significantly increased activity in the superior frontal gyrus, middle frontal gyrus, superior temporal gyrus, middle temporal gyrus, and lingual gyrus in a delayed-response WM task when presented with unconscious emotional and fearful stimuli relative to neutral distracters. Conclusion: This study identified specific brain areas associated with the interaction between emotional regulation and cognitive functioning during unconscious emotional distracters presented while patients with PTSD performed a WM maintenance task. There was no difference in brain activation between the two groups at the conscious level of neutral distractors, but under the unconscious emotional distracters, PTSD patients showed a specific activation of the brain. Psychoanalysis 2019;30(4):114-123

psychoanalysis/jeongsin bunseog

Effects of Unconscious Emotional Distracters on Conscious Working Memory Maintenance in Patients with Posttraumatic Stress Disorder and Early Childhood Trauma: A Preliminary Functional Magnetic Resonance Imaging Study