# Neural Correlates of Mentalizing Altered in Childhood Trauma and Cocaine Use Disorder

## TL;DR

The study explores how childhood trauma and cocaine use disorder affect brain activity related to social thinking, revealing altered neural patterns linked to social functioning.

## Contribution

The study identifies neural correlates of mentalizing altered by childhood trauma and cocaine use disorder, showing how trauma severity modulates these effects.

## Key findings

- iCUD participants performed worse on mentalizing tasks than healthy controls.
- High-trauma individuals showed increased frontal pole activation linked to mentalizing accuracy and social anxiety.
- Precuneus activity in CUD participants varied with trauma severity, affecting social function.

## Abstract

Childhood trauma is highly prevalent among individuals with cocaine use disorder (iCUD), and both entail social cognition deficits, including impaired mentalizing (social inference) capacity. Here we sought to examine the neuro-circuits underlying these associations using task-based neuroimaging. We hypothesized that childhood trauma and CUD would show altered brain activation of the mentalizing network, related to deficits in real-world social capacities.

Participants (45 iCUD and 34 healthy controls (HC), with high/low trauma) performed the validated Why/How fMRI task, probing Why versus How photographed naturalistic behaviors are performed. Whole-brain analyses used a Why > How contrast at the first level, followed by group comparisons at the second level, with cluster-level family-wise error correction (pFWE < .05). Social functioning and clinical measures were obtained using validated self-report instruments.

Mentalizing task behavior outcomes were worse in iCUD than HC (F(1,75) = 4.45, p < .05), with no effect of trauma severity on accuracy. A significant interaction was observed in the precuneus, with greater BOLD responses in iCUD-low than HC-low, and lower responses in iCUD-high than HC-high. High-trauma individuals showed increased frontal pole activation, correlating positively with mentalizing accuracy (r(39) >= .24, p < .05) and social anxiety (r(79) = .29, p = .01), and negatively with resilience (r(39) <= −.37, p < .001).

Greater frontal activation in high-trauma individuals may support task accuracy but is linked to poorer real-world social functioning. Additionally, the link between CUD diagnosis and precuneus activity depends on trauma severity, offering neural insights into how trauma history may influence CUD and social function.