A neurocognitive account of complex PTSD: self-modelling, affective dysregulation, and implications for MDMA-assisted and targeted psychotherapies.
Level 5 - mechanism / opinion, no new human data
Narrative review and theoretical mechanism-based reasoning with no primary empirical data
PubMed 41853928 · doi:10.1080/20008066.2026.2631358
What was done
This narrative review synthesized clinical, neurobiological, and theoretical literature to construct a hypothesis-generating neurocognitive model of complex post-traumatic stress disorder (C-PTSD) grounded in predictive processing and active inference frameworks. The authors conceptualized PTSD and C-PTSD along a continuum of regulatory stability, focusing on insula-mediated self-modelling processes, and examined MDMA-assisted psychotherapy as an illustrative intervention targeting affective salience, interpersonal trust, and self-referential cognition.
What was found
The abstract reports no numerical or quantitative empirical data. It presents a theoretical framework linking insular dysfunction across interoception, affective experience, salience processing, and self-referential cognition to maladaptive predictive regulation under prolonged interpersonal adversity. The model conceptually differentiates PTSD and C-PTSD in terms of symptom generalization, relational threat processing, and affective stability, outlining potential mechanisms through which MDMA-assisted psychotherapy may modulate self-modelling.
Why it matters
The paper provides a unifying neurocognitive framework linking predictive processing to the core identity and affective disturbances in C-PTSD, offering specific testable hypotheses to guide future mechanistic neuroimaging and clinical intervention studies.
Limits
This is a theoretical narrative review without original human experimental data, clinical trial outcomes, or systematic literature search methodology. All proposed insula-mediated active inference mechanisms and MDMA treatment pathways are conceptual hypotheses that require empirical verification.
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- context Changing a patient's self-esteem and sense of being through psychotherapy improves treatment-refractory depression and PTSD.