From Fear Circuit to Recovery: Neural Mechanisms and Interventions in Post-Traumatic Stress Disorder

Abstract

Post-traumatic stress disorder (PTSD) is a psychiatric condition that develops after exposure to a traumatic event. It is characterized by intrusive memories, avoidance, negative mood changes, and hyperarousal. This paper reviews the main brain mechanisms underlying PTSD and evaluates the effectiveness of current psychological and pharmacological interventions targeting these mechanisms. Diagnostic criteria for PTSD differ between the Diagnostic and Statical Manual of Mental Disorders, Fifth Edition (DSM-5) and the International Classification of Diseases, 11th Revision (ICD-11) systems. They affect how the disorder is identified across studies. At the neural level, PTSD is associated with a dysregulated fear circuit involving amygdala hyperactivity, ventromedial prefrontal cortex hypoactivity, and hippocampal dysfunction. Exposure-based psychotherapy shows strong, consistent evidence of effectiveness and appears to strengthen prefrontal regulation over the amygdala, while pharmacological intervention with propranolol shows more mixed results across individual trials though meta-analytic evidence supports a modest overall benefit. This review argues that psychological and pharmacological approaches converge on the same neural circuit through different mechanisms via gaps in long-term outcome data and treatment accessibility.