These three networks — default mode, salience, and central executive — are sometimes called the triple network, and the framework was developed by Vinod Menon and others over the past decade. It has turned out to be one of the most useful integrative lenses for understanding psychiatric disorders. Many disorders can be understood as imbalances in the triple network.
Let me walk through the mappings.
Depression: stuck DMN. The autobiographical narrator is hyperactive and cannot disengage. The patient is locked in rumination, unable to engage external tasks or attend to the world. Treatments converge on reducing DMN dominance. SSRIs do this slowly through plasticity changes; ketamine does it rapidly through glutamatergic reset; CBT does it behaviorally by training disengagement from rumination; psychedelics do it dramatically through transient DMN disorganization.
Anxiety disorders: hyperactive salience network. Too many stimuli are flagged as important. Interoceptive signals get amplified. The patient lives in a state of heightened threat detection. Treatments include benzodiazepines (fast, blunt amygdala output), SSRIs (slow, reduce salience network reactivity), CBT (retrain salience evaluation), mindfulness (engage salience switching to disengage from automatic threat appraisal).
ADHD: difficulty switching from DMN to CEN. The patient cannot disengage from default mode and engage central executive on demand. Stimulants facilitate the switch. Behavioral interventions train switching through structure and external cues. Both can help simultaneously.
Schizophrenia: failed switching across all three networks. DMN, salience, and CEN all show abnormal activation and inappropriate switching patterns. This is part of why schizophrenia is so cognitively devastating — the basic machinery of toggling between internal narration, salience detection, and task engagement is impaired. Antipsychotics modulate the dopaminergic input to these networks; cognitive remediation works on the networks themselves; both contribute to functional recovery in different ways.
PTSD: hyperactive amygdala-salience network with weakened CEN control. Threat detection is on overdrive, executive control over emotional response is reduced. Treatments target both — SSRIs reduce amygdala-salience reactivity; trauma-focused therapy strengthens CEN-mediated regulation; prazosin reduces noradrenergic input that drives the salience overactivity.
OCD: ACC-salience network hyperactivity. The conflict monitor is firing too much. Treatments include SSRIs (reduce ACC hyperactivity over weeks), CBT with exposure and response prevention (retrain the network), and in severe cases deep brain stimulation of related circuits.
The framework is unifying because it gives common vocabulary to disorders that look superficially different. Depression and anxiety, on the surface, are different syndromes. In triple-network terms, they involve overlapping dysregulation of the same systems with different patterns of dominance. Comorbidity becomes less surprising. Treatments that help across multiple diagnoses (SSRIs, mindfulness, CBT) make mechanistic sense because they target shared underlying network dysfunction.
Hold the framework. Three networks. Many disorders. The clinical job is to identify which network imbalance dominates in this patient and which intervention most efficiently corrects it.