The Role of the Amygdala and the Ventromedial Prefrontal Cortex in Emotional Regulation: Implications for Post-traumatic Stress Disorder.

The importance of the amygdala as a salience detector and in emotional learning is now well accepted. The mechanisms that regulate and inhibit the amygdala, however, are less well understood. This review provides evidence from imaging and lesion studies to support the role of the ventromedial prefrontal cortex (vmPFC) as a moderator and inhibitor of the amygdala. The dual inhibition model centres on the broadly defined ventromedial prefrontal cortex (vmPFC) and the distinct role of two of its subcomponents, the rostral anterior cingulate cortex and orbitofrontal cortex. The dual inhibition model posits that these two regions, along with their associated inhibitory pathways, must interact for adequate inhibitory control of the amygdala and emotional regulation. Following a description of the model's experimental support, it is then proposed as a neuropsychological mechanism for post-traumatic stress disorder (PTSD). Flashbacks, as a defining feature of PTSD, are described in terms of a subcortical orienting network. Finally, there is a discussion of how a neuropsychological understanding of post-traumatic stress disorder (PTSD) might inform a clinician's approach to treatment and how the dual inhibition model might have a more general application to understanding emotional dysregulation.