Dr. Andrey Laugman

01/04/2026

A New Neurocognitive Model of Complex PTSD Places the Insula at the Centre — and Explains Why Some Therapies Work

Key Findings

- Proposes a neurocognitive model of Complex PTSD based on active inference, positioning the insula as the central hub for understanding how C-PTSD disrupts self-identity, emotional regulation, and relationships
- Integrates limbic, salience, and prefrontal system dysfunction into a unified framework — moving beyond separate symptom cluster explanations
- Argues that MDMA-assisted therapy may work specifically because it modulates insular processing — reducing threat-based self-modelling and allowing new self-representations to form
- Provides a mechanistic rationale for why different therapies target different C-PTSD components: somatic approaches (interoception/insula), EMDR (salience network), and CBT (prefrontal regulation)

Complex PTSD has a diagnostic category (ICD-11) but not a unified neurocognitive model. We know which brain regions are involved — amygdala, prefrontal cortex, anterior cingulate. But we lack a framework that explains how prolonged trauma produces the three distinctive features of C-PTSD: affective dysregulation, negative self-concept, and disturbed relationships. This European Journal of Psychotraumatology paper proposes one, and it centres on the insula.

Proposes a neurocognitive model of Complex PTSD based on active inference, positioning the insula as the central hub for understanding how C-PTSD disrupts self-identity, emotional regulation, and relationships

31/03/2026

Slow Tapering Plus Therapy Prevents Relapse as Well as Staying on

Key Findings

- Network meta-analysis of 76 RCTs (17,379 participants, mean age 45.2) compared five antidepressant deprescribing strategies with and without adjunctive psychological support
- Slow tapering (>4 weeks) combined with psychological support (MBCT, CBT) prevented relapse as effectively as continuing antidepressants at standard doses
- The combined strategy could prevent relapse in 1 out of 5 patients compared to abrupt or rapid discontinuation
- Abrupt discontinuation and fast tapering (≤4 weeks) showed significantly higher relapse rates regardless of psychological support

The question every prescribing clinician faces eventually: when and how to stop antidepressants in a remitted patient. This Lancet Psychiatry network meta-analysis of 76 trials provides the first head-to-head comparison of deprescribing strategies — and the answer is not simply "taper slowly." The answer is taper slowly and add therapy.

Network meta-analysis of 76 RCTs (17,379 participants, mean age 45.2) compared five antidepressant deprescribing strategies with and without adjunctive psychological support

28/03/2026

A MONOLOGUE FROM YOUR SURVIVAL MODE

I have been with you for a long time. Longer than you realise.

I arrived when you needed protection. I did not ask permission - there was no time. I simply switched on and began to work. Quietly. Without explanation. As an emergency response system should.

I directed your attention to threats - even when the threats were gone. I removed joy - it distracted from vigilance. I scanned everyone in the room before you had time to take off your coat. I took apart the tone of a voice before you had even heard the words. I made you watchful, quick, ready. Always ready.

You wanted to live - I gave you survival. You wanted to love - I put an alarm on every act of closeness. You wanted to trust - I immediately showed you how that usually ends. You wanted to rest - I said: not yet.

I was there when someone said something kind - and you could not take it in. You waited for the catch. You looked for what was really behind it. I was there when you woke at three in the morning, your heart already alert to danger before you understood you had been asleep. I was there on the first date that was going well - and for exactly that reason, you found a way to ruin it.

I would not let you receive a hug - your body stiffened before you had decided whether you wanted it. I would not let you accept a compliment - I was already looking for what they wanted from you. I would not let you sit with your back to the door. I would not let you unwind on holiday. I would not let you sit in silence - silence was suspicious. I would not let you stay somewhere good - because good, I registered as a trap.

You look at these years and see emptiness. I see a completed assignment. Every year - I was at my post. I simply did not know the assignment had long since changed.
There is one thing that frightens me: if you work out what happened - I will become unnecessary. I do not know how to be unnecessary. I only know how to work.

Look at the cost. The conversation you could not finish - because something inside had already shut down. The relationships where you were present in body and absent in everything else. The work you left when it started going well - because success felt more dangerous than failure. The people who wanted to stay - and never understood why you pushed them away. The moments you were not in - even though your body was standing right there.

You thought that was you. It was me.

This is not about blame - it is about mechanism. I did precisely what I was built to do. The assignment was temporary. I was not.

Survival mode activates for protection - and stays until it receives a signal that the threat has passed. That signal does not arrive on its own. If you feel that years are going into simply holding on - I know where a different question begins.

25/03/2026

THE QUESTION BEHIND THE SYMPTOM

Chronic symptoms are chronic questions. The body asks something it has not yet received an answer to. Pain that returns is not relapse. It is repetition of an unheard inquiry. The symptom persists because the question persists.

From my clinical experience, one of the most consistent patterns I encounter - across diagnoses, across years of prior treatment, across modalities - is this: the presenting symptom is rarely the actual problem. It is the signal. And signals exist to communicate something that has not yet been received.

This distinction matters clinically. A person who has managed panic attacks for eight years through breathing techniques, grounding protocols, and cognitive reframing has not had eight years of failed treatment. They have had eight years of sophisticated signal management. The alarm keeps sounding not because the coping is inadequate, but because the circuit it points to has never been examined. You can recalibrate a smoke detector without ever locating the fire.

Kroenke et al. (2006) documented that a significant proportion of patients presenting with chronic somatic complaints - pain, fatigue, functional gastrointestinal symptoms - show no identifiable organic pathology. The body is structurally intact. The symptom remains. The conventional response is to treat the symptom more precisely. The more productive clinical question is: what does the persistence of this signal indicate about what remains unresolved at a deeper structural level?

In trauma work specifically, van der Kolk (1994) articulated this with precision: traumatic experience does not store itself as narrative. It stores as somatic state, as physiological readiness, as implicit memory that the nervous system continues to act upon as though the original event is still present. The hypervigilance is not irrational. It is the nervous system's answer to a question that was never closed: are you still in danger? Until that question receives a genuine response - not suppression, not habituation, but actual resolution - the symptom has no reason to stop.

The clinical implication is significant. When we orient treatment exclusively toward symptom reduction, we are, in effect, asking the client's nervous system to stop signalling before we have addressed what it is signalling about. Some clients tolerate this well enough. Many do not - which is why therapy that produces short-term relief so often produces long-term return.

What changes when we follow the signal rather than silence it is the direction of the work. Instead of managing the output, we locate the source. Instead of teaching the client to live alongside the symptom, we examine what the symptom is still trying to answer.
The body does not produce chronic symptoms out of habit. It produces them out of unresolved necessity. Change the necessity, and the signal changes with it.

If you have spent years managing symptoms that keep returning, the question is not what you are doing wrong. The question is what question has not yet been heard. That is exactly where the work begins - and where it can, when approached correctly, actually end.



References
Kroenke, K., Sharpe, M., & Sykes, R. (2006). Revising the classification of somatoform disorders: Key questions and preliminary recommendations. Psychosomatics, 48(4), 277-285. https://doi.org/10.1176/appi.psy.48.4.277
van der Kolk, B. A. (1994). The body keeps the score: Memory and the evolving psychobiology of posttraumatic stress. Harvard Review of Psychiatry, 1(5), 253-265.

24/03/2026

THE VIGILANCE YOU MISTOOK FOR YOURSELF HOOK

Your nervous system is speaking for you.

Hypervigilance rarely looks like fear - it looks like personality traits. For years you think: "I am just like this - cautious, controlling, perceptive, complicated." In reality, your nervous system has long been operating in an emergency mode, signaling a constant threat.

Here are five forms that look like "this is just who I am," but actually describe the functioning of a biological system.

Hypervigilance is one of the most exhausting modes because it looks like the norm. You do not know any other way - which means you do not realize how much of your resource goes into simply maintaining this mode.

Modes can be rewired - this is not a consolation, it is a clinical reality with a workable mechanism. There is a method that works directly with the root. Recognition is the first step, but it must be followed by structural work.

If you recognized yourself in these five points - this is already an entry point, not just information. When you are ready to work with the mechanism, rather than managing the signals one by one - I am here.

23/03/2026

22/03/2026

THE METAPHOR THAT MATTERS IS THEIRS

A client begins with a wall in their chest. Twenty minutes later, they mention a window. Do not let this pass. Ask: "And when there is this window, what happens to the wall?" Track the transformation. Metaphors do not shift randomly. They shift because something inside is reorganising. Your job is to notice, to name, to ask what happens next. The client's unconscious is already solving. Follow it.

From years of clinical practice with trauma and PTSD, the most significant moments in any session have rarely arrived through my words. They arrived through the client's. A woman who described her grief as "a stone sewn inside the chest." A veteran who spoke of rage as "a fire in a locked room." These were not poetic devices. They were the most accurate diagnostic signal available - compressed, specific, and impossible to replicate from the outside. Kopp (1995) demonstrated that client-generated metaphors carry the cognitive and emotional architecture of lived experience in ways therapist-offered ones simply cannot. When a therapist substitutes their own metaphor - however well-intended - they are not clarifying. They are overwriting.

This is exactly where Mental Engineering operates as a clinically coherent framework. Rather than interpreting, paraphrasing, or building on the client's metaphor with the therapist's own associations, the therapist asks questions using only the client's exact words. "And when there is a stone sewn inside the chest, whereabouts is that stone?" The client is not steered toward a resolution the therapist has pre-imagined. They are guided deeper into their own symbolic landscape - which, in my clinical experience, almost always already contains the movement the client needs. McMullen and Tay (2023) confirm this across modalities: client-generated metaphors carry greater therapeutic utility precisely because the client's metaphor already contains both the problem and the resources for resolving it.

The instinct to interpret is strong, and professionally understandable. We are trained to see patterns, offer frameworks, make connections. But in metaphor work, this instinct frequently functions as interference in the signal. Sullivan and Rees (2008) note that therapist-imposed language activates resistance because it introduces something foreign into a deeply personal symbolic system. Whigham (2010) makes the same point in trauma specifically: asking the client to translate their metaphor on the therapist's terms removes the protective function the metaphor was serving.

The therapist's role is not to provide meaning. It is to hold the space in which the client finds their own - and to stay sufficiently out of the way for that to happen.

When a client speaks in metaphors, they are not being vague. They are being precise about the only level at which the experience currently exists for them. Follow that precision. The work begins there. If years of therapy have given you other people's explanations instead of your own answers - that is worth examining. The map and the territory are not the same thing. Let's look at yours.

22/03/2026

WHAT THE BODY KNOWS NOW

In the middle of suffering, one question cuts through: "What is happening in your body right now?" Not what happened yesterday. Not what usually happens. Right now. This precision anchors attention.

The present moment is smaller than the accumulated weight of all moments. What is happening now can be witnessed, described, named. The body in the present tense is manageable. The body across all time is not.

22/03/2026

WHY THE FEMALE BRAIN STOPS TURNING OFF ANXIETY: THE NEUROBIOLOGY OF PTSD AND ESTRADIOL

It seems that the trauma was left in the past long ago, yet the body continues to treacherously react to every rustle, causing the heart to freeze with unfounded terror.

For years, many women blame themselves for excessive emotionality, weakness of character, or an inability to "pull themselves together," completely unaware that their core problem lies in a profound systemic hormonal failure. This is not your fault, nor is it banal suspiciousness — it is a scientifically documented biological mechanism that critically breaks down after severe stress, turning your own nervous system into a minefield.

A team of scientists from Emory University School of Medicine conducted a unique study to find out why women are twice as likely as men to become victims of post-traumatic stress disorder (Stevens et al., 2025). In a large-scale experiment, 110 women with completely different traumatic backgrounds underwent functional MRI. Researchers observed in real-time how the ovarian hormone estradiol controls the brain's response to danger.

The main question was: can severe trauma not just frighten a person, but literally "break" this crucial hormonal defense at the level of neural connections?

The results turned out to be clinically striking. In physiologically healthy women, normal levels of estradiol worked as a powerful endogenous sedative, gently suppressing the activity of the amygdala — our primary evolutionary center of fear.

However, in severe patients with PTSD, this saving hormone completely lost its inhibitory effect. Prolonged trauma literally "deafened" the brain's receptors, making it immune to its own regulatory mechanism.

Imagine a broken thermostat: no matter how much coolant (estradiol) is supplied, the engine (the amygdala) continues to heat up to a critical limit at the slightest threat. In such a heightened physiological state, the brain chronically loses its baseline ability to exit the mode of permanent survival on its own.

These data brilliantly explain why surface-level treatment methods so often fail in chronic forms of complex trauma. Standard cognitive-behavioral therapy (CBT) conversations or potent psychotropic medications work exclusively with physical symptoms, attempting to "drown out" the triggered cascading panic reaction through logic or chemical suppression. They work effectively with surface consequences, but organically cannot fix the deep root of the problem — the fact that the brain has, de facto, catastrophically unlearned how to respond to the body's natural hormonal brakes. This is exactly why many patients inevitably return to exhausting anxiety immediately after stopping the medication.

To finally exit this somatic labyrinth, a fundamentally different approach is required, such as Mental Engineering, which is specifically aimed at reassembling the very architecture of the endured traumatic experience. Instead of long conversations about the panic on the surface, we confidently descend to the fundamental level where the dangerous dysregulation of the nervous system has taken painful root.

When systemic work deals directly with the root — with how the endured traumatic experience pathologically rebuilt your defensive response system — we re-create the conditions to teach your brain to adequately read safety.

Attempts to cope alone with a severe hormonal and somatic failure using simple affirmations, meditations, or iron willpower only exhaust the depleted psyche, inevitably leading to burnout. If what is described resonates completely with your personal experience of struggle — we can discuss the situation in detail.

Have you noticed how powerful anxiety suddenly begins to live a completely separate physiological life of its own, crudely ignoring the rational arguments of the mind? And at what exact stage did you finally realize that the usual persuasions to "calm down" had stopped working forever?

References:
Stevens, J. S., Harnett, N. G., Lebois, L. A. M., van Rooij, S. J. H., Ely, T. D., ... & Ressler, K. J. (2025). Estradiol modulates amygdala activity to threat in women with trauma exposure and posttraumatic stress disorder. Proceedings of the National Academy of Sciences, 123(1), e2515000123. https://doi.org/10.1073/pnas.2515000123

21/03/2026

THE DEAFENING COST OF CONSTANT VIGILANCE

A Mechanical Error: Why Rest Does Not Recharge Your Battery

Your battery is draining while at rest.

I regularly observe highly intelligent clients who blame themselves for internal weakness and unsuccessfully attempt to cure their exhaustion with long hours of sleep. They ignore the basic physics of their condition: their internal security system is constantly operating like a radar at maximum capacity, burning through resources before they even finish their first cup of coffee.

But when we begin to dismantle the machinery of their daily life gear by gear, a hidden background process becomes entirely obvious. Scanning the environment for potential threats 24/7, relentlessly reading the most minute changes in a business partner's intonation, constantly anticipating the worst-case scenario — all of this requires a colossal expenditure of energy.

This is not a battery failure. This is an alarm system stuck on, burning your resources while you are simply sitting and drinking coffee. You are exhausted not by what you actually do during the day, but by the fact that your security system never enters sleep mode for a single second.

It is impossible to fully invest your energy into the present when the lion's share of it is spent servicing the neural routes of the past.

The wear and tear on the system can only be stopped by structurally rebooting its baseline circuitry of predictability. If this background exhaustion is familiar to you — I know exactly how we can transform it.

Reach out, and we will map it out.

17/03/2026