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Mark VW. Functional neurological disorder: Extending the diagnosis to other disorders, and proposing an alternate disease term—Attentionally-modifiable disorder. NeuroRehabilitation 2022; 50:179-207. [DOI: 10.3233/nre-228003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND: The term “functional neurological disorder,” or “FND,” applies to disorders whose occurrence of neurological symptoms fluctuate with the patient’s attention to them. However, many other disorders that are not called “FND” nonetheless can also follow this pattern. Consequently, guidelines are unclear for diagnosing “FND.” OBJECTIVE: To review the neurological conditions that follow this pattern, but which have not so far been termed “FND,” to understand their overlap with conditions that have been termed “FND,” and to discuss the rationale for why FND has not been diagnosed for them. METHOD: A systematic review of the PubMed literature registry using the terms “fluctuation,” “inconsistency,” or “attention” did not yield much in the way of these candidate disorders. Consequently, this review instead relied on the author’s personal library of peer-reviewed studies of disorders that have resembled FND but which were not termed this way, due to his longstanding interest in this problem. Consequently, this approach was not systematic and was subjective regarding disease inclusion. RESULTS: This review identified numerous, diverse conditions that generally involve fluctuating neurological symptoms that can vary with the person’s attention to them, but which have not been called “FND.” The literature was unclear for reasons for not referring to “FND” in these instances. CONCLUSION: Most likely because of historical biases, the use of the term “FND” has been unnecessarily restricted. Because at its core FND is an attentionally-influenced disorder that can respond well to behavioral treatments, the field of neurological rehabilitation could benefit by extending the range of conditions that could be considered as “FND” and referred for similar behavioral treatments. Because the term “FND” has been viewed unfavorably by some patients and clinical practitioners and whose treatment is not implied, the alternative term attentionally-modifiable disorder is proposed.
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Affiliation(s)
- Victor W. Mark
- Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, Birmingham, AL, USA
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA
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2
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Hinze J, Röder A, Menzie N, Müller U, Domschke K, Riemenschneider M, Noll-Hussong M. Spider Phobia: Neural Networks Informing Diagnosis and (Virtual/Augmented Reality-Based) Cognitive Behavioral Psychotherapy-A Narrative Review. Front Psychiatry 2021; 12:704174. [PMID: 34504447 PMCID: PMC8421596 DOI: 10.3389/fpsyt.2021.704174] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Accepted: 07/26/2021] [Indexed: 11/30/2022] Open
Abstract
Recent fMRI studies on specific animal phobias, particularly spider phobia (arachnophobia), have identified a large variety of specific brain regions involved in normal and disturbed fear processing. Both functional and structural brain abnormalities have been identified among phobic patients. Current research suggests that both conscious and subconscious fear processing play a crucial role in phobic disorders. Cognitive behavioral therapy has been identified as an effective treatment for specific phobias and has been associated with neuroplastic effects which can be evaluated using current neuroimaging techniques. Recent research suggests that new approaches using virtual (VR) or augmented reality (AR) tend to be similarly effective as traditional "in vivo" therapy methods and could expand treatment options for different medical or individual scenarios. This narrative review elaborates on neural structures and particularities of arachnophobia. Current treatment options are discussed and future research questions are highlighted.
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Affiliation(s)
- Jonas Hinze
- Department of Psychiatry and Psychotherapy, Saarland University Medical Center, Homburg, Germany.,Psychosomatic Medicine and Psychotherapy, Saarland University Medical Center, Homburg, Germany
| | - Anne Röder
- Department of Psychiatry and Psychotherapy, Saarland University Medical Center, Homburg, Germany.,Psychosomatic Medicine and Psychotherapy, Saarland University Medical Center, Homburg, Germany
| | - Nicole Menzie
- Department of Psychiatry and Psychotherapy, Saarland University Medical Center, Homburg, Germany
| | - Ulf Müller
- Department of Psychiatry and Psychotherapy, Saarland University Medical Center, Homburg, Germany
| | - Katharina Domschke
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Center for Basics in NeuroModulation, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Matthias Riemenschneider
- Department of Psychiatry and Psychotherapy, Saarland University Medical Center, Homburg, Germany.,Psychosomatic Medicine and Psychotherapy, Saarland University Medical Center, Homburg, Germany
| | - Michael Noll-Hussong
- Psychosomatic Medicine and Psychotherapy, Saarland University Medical Center, Homburg, Germany
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3
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Schwab S, Federspiel A, Morishima Y, Nakataki M, Strik W, Wiest R, Heinrichs M, de Quervain D, Soravia LM. Glucocorticoids and cortical decoding in the phobic brain. Psychiatry Res Neuroimaging 2020; 300:111066. [PMID: 32244111 DOI: 10.1016/j.pscychresns.2020.111066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 03/06/2020] [Accepted: 03/06/2020] [Indexed: 11/16/2022]
Abstract
Glucocorticoids reduce phobic fear in anxiety disorders and enhance psychotherapy, possibly by reducing the retrieval of fear memories and enhancing the consolidation of new corrective memories. Glucocorticoid signaling in the basolateral amygdala can influence connected fear and memory-related cortical regions, but this is not fully understood. Previous studies investigated specific pathways moderated by glucocorticoids, for example, visual-temporal pathways; however, these analyses were limited to a-priori selected regions. Here, we performed whole-brain pattern analysis to localize phobic stimulus decoding related to the fear-reducing effect of glucocorticoids. We reanalyzed functional magnetic resonance imaging (fMRI) data from a previously published study with spider-phobic patients and healthy controls. The patients received glucocorticoids or a placebo before the exposure to spider images. There was moderate evidence that patients with phobia had higher decoding of phobic content in the anterior cingulate cortex (ACC) and the left and right anterior insula compared to controls. Decoding in the ACC and the right insula showed strong evidence for correlation with experienced fear. Patients with cortisol reported a reduction of fear by 10-13%; however, there was only weak evidence for changes in neural decoding compared to placebo which was found in the precuneus, the opercular cortex, and the left cerebellum.
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Affiliation(s)
- Simon Schwab
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Population Health, University of Oxford, United Kingdom; Translational Research Center, University Hospital of Psychiatry, University of Bern, Bern, Switzerland.
| | - Andrea Federspiel
- Translational Research Center, University Hospital of Psychiatry, University of Bern, Bern, Switzerland
| | - Yosuke Morishima
- Translational Research Center, University Hospital of Psychiatry, University of Bern, Bern, Switzerland; Japan Science and Technology Agency, PRESTO, Saitama, Japan
| | | | - Werner Strik
- Translational Research Center, University Hospital of Psychiatry, University of Bern, Bern, Switzerland
| | - Roland Wiest
- Institute for Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Markus Heinrichs
- Dept. of Psychology, Laboratory for Biological and Personality Psychology, University of Freiburg, Freiburg, Germany; Freiburg Brain Imaging Center, University Medical Center, University of Freiburg, Freiburg, Germany
| | - Dominique de Quervain
- Division of Cognitive Neuroscience, Department of Psychology, University of Basel, Basel, Switzerland
| | - Leila M Soravia
- Translational Research Center, University Hospital of Psychiatry, University of Bern, Bern, Switzerland
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4
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Rosenbaum D, Leehr EJ, Rubel J, Maier MJ, Pagliaro V, Deutsch K, Hudak J, Metzger FG, Fallgatter AJ, Ehlis AC. Cortical oxygenation during exposure therapy - in situ fNIRS measurements in arachnophobia. NEUROIMAGE-CLINICAL 2020; 26:102219. [PMID: 32135488 PMCID: PMC7052440 DOI: 10.1016/j.nicl.2020.102219] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 02/14/2020] [Accepted: 02/17/2020] [Indexed: 12/19/2022]
Abstract
This is the first study that assessed cortical hemodynamic reactions during exposure therapy in situ. During exposure patients showed increased activity in the cognitive control network (CCN) compared to a control condition. CCN activity deceased during the session. Further, CCN activity was associated with fear ratings at the beginning of the session and this relationship decreased from session to session.
Exposure therapy is a well-studied and highly efficacious treatment for phobic disorders. Although the neurobiological model of fear is well underpinned by various studies, the mechanisms of exposure therapy are still under discussion. Partly, this is due to the fact that most neurophysiological methods like fMRI are not able to be used in the natural therapeutic settings. The current study used in situ measurements of cortical blood oxygenation (O2Hb) during exposure therapy by means of functional near-infrared spectroscopy. 37 subjects (N = 30 completers) underwent exposure therapy during 5 adapted sessions in which subjects were exposed to Tegenaria Domestica (domestic house spider – experimental condition) and Dendrobaena Veneta/ Eisenaia hortensis (red earthworm – control condition). Compared to the control condition, patients showed higher O2Hb levels in the anticipation and exposure phase of spider exposure in areas of the cognitive control network (CCN). Further, significant decreases in O2Hb were observed during the session accompanied by reductions in fear related symptoms. However, while symptoms decreased in a linear quadratic manner, with higher reductions in the beginning of the session, CCN activity decreased linearly. Further, higher anxiety at the beginning of session one was associated with increased O2Hb in the CCN. This association decreased within the following sessions. The current study sheds light on the neuronal mechanisms of exposure therapy. The results are discussed in light of a phase model of exposure therapy that posits a role of cognitive control in the beginning and routine learning at the end of the therapy session.
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Affiliation(s)
- David Rosenbaum
- Department of Psychiatry and Psychotherapy, University Hospital of Tuebingen, Tuebingen, Germany.
| | | | - Julian Rubel
- Psychotherapy Research Lab, Psychology and Sport Sciences, Justus-Liebig-University Giessen, Giessen, Germany
| | - Moritz J Maier
- Fraunhofer IAO
- Center for Responsible Research and Innovation, Berlin, Germany
| | - Valeria Pagliaro
- Department of Psychiatry and Psychotherapy, University Hospital of Tuebingen, Tuebingen, Germany
| | - Kira Deutsch
- Department of Psychiatry and Psychotherapy, University Hospital of Tuebingen, Tuebingen, Germany
| | - Justin Hudak
- Department of Psychiatry and Psychotherapy, University Hospital of Tuebingen, Tuebingen, Germany; Center on Mindfulness and Integrative Health Intervention Development, University of Utah, Salt Lake City, UT 84112, United States
| | - Florian G Metzger
- Department of Psychiatry and Psychotherapy, University Hospital of Tuebingen, Tuebingen, Germany
| | - Andreas J Fallgatter
- Department of Psychiatry and Psychotherapy, University Hospital of Tuebingen, Tuebingen, Germany; LEAD Graduate School & Research Network, University of Tuebingen, Tuebingen, Germany
| | - Ann-Christine Ehlis
- Department of Psychiatry and Psychotherapy, University Hospital of Tuebingen, Tuebingen, Germany; LEAD Graduate School & Research Network, University of Tuebingen, Tuebingen, Germany
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5
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Soravia LM, Schwab S, Weber N, Nakataki M, Wiest R, Strik W, Heinrichs M, de Quervain D, Federspiel A. Glucocorticoid administration restores salience network activity in patients with spider phobia. Depress Anxiety 2018; 35:925-934. [PMID: 30099829 DOI: 10.1002/da.22806] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 06/07/2018] [Accepted: 06/13/2018] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Glucocorticoids reduce phobic fear in patients with anxiety disorders. Although the neurobiology of anxiety disorders is not fully understood, convergent structural and functional neuroimaging studies have identified abnormalities in various brain regions, including those in the salience network (SN) and default mode network (DMN). Here, we examine the effects of glucocorticoid administration on SN and DMN activity during the processing of phobic stimuli. METHODS We use functional magnetic resonance imaging to record brain activity in 24 female patients with spider phobia who were administered either 20 mg of cortisol or placebo while viewing pictures of spiders. Fourteen healthy female participants were tested with the same task but without substance administration. Independent component analysis (ICA) performed during stimulus encoding identified the SN and DMN as exhibiting synchronized activation in diverse brain regions; thus, we examined the effects of cortisol on these networks. Furthermore, participants had to rate their level of fear at various time points. RESULTS Glucocorticoids reduced phobic fear in patients with spider phobia. The ICA performed during stimulus encoding revealed that activity in the SN and DMN was reduced in placebo-treated patients versus healthy controls. Brain activity in the SN, but not the DMN, was altered in cortisol- versus placebo-treated patients to a level that was similar to that observed in healthy controls. CONCLUSIONS Activity in both the SN and DMN was reduced in patients with spider phobia. Cortisol administration altered the SN activity to a level that was comparable to that found in healthy controls. This alteration in SN activity might reflect the fear-reducing effects of glucocorticoids in phobia.
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Affiliation(s)
- Leila Maria Soravia
- Division of Systems Neuroscience of Psychopathology, University Hospital of Psychiatry, University of Bern, Bern, Switzerland
| | - Simon Schwab
- Division of Systems Neuroscience of Psychopathology, University Hospital of Psychiatry, University of Bern, Bern, Switzerland.,Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, United Kingdom
| | - Nico Weber
- Division of Systems Neuroscience of Psychopathology, University Hospital of Psychiatry, University of Bern, Bern, Switzerland
| | - Masahito Nakataki
- Division of Systems Neuroscience of Psychopathology, University Hospital of Psychiatry, University of Bern, Bern, Switzerland.,Department of Psychiatry, University of Tokushima, Tokushima, Japan
| | - Roland Wiest
- Department of Diagnostic and Interventional Neuroradiology, Inselspital, University Hospital of Bern, Bern, Switzerland
| | - Werner Strik
- Division of Systems Neuroscience of Psychopathology, University Hospital of Psychiatry, University of Bern, Bern, Switzerland
| | - Markus Heinrichs
- Laboratory for Biological and Personality Psychology, Department of Psychology, University of Freiburg, Freiburg, Germany.,Freiburg Brain Imaging Center, University Medical Center, University of Freiburg, Freiburg, Germany
| | - Dominique de Quervain
- Division of Cognitive Neuroscience, Department of Psychology, University of Basel, Basel, Switzerland
| | - Andrea Federspiel
- Division of Systems Neuroscience of Psychopathology, University Hospital of Psychiatry, University of Bern, Bern, Switzerland
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6
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Schäfer SK, Ihmig FR, Lara H KA, Neurohr F, Kiefer S, Staginnus M, Lass-Hennemann J, Michael T. Effects of heart rate variability biofeedback during exposure to fear-provoking stimuli within spider-fearful individuals: study protocol for a randomized controlled trial. Trials 2018; 19:184. [PMID: 29548298 PMCID: PMC5857097 DOI: 10.1186/s13063-018-2554-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Accepted: 02/15/2018] [Indexed: 02/24/2023] Open
Abstract
Background Specific phobias are among the most common anxiety disorders. Exposure therapy is the treatment of choice for specific phobias. However, not all patients respond equally well to it. Hence, current research focuses on therapeutic add-ons to increase and consolidate the effects of exposure therapy. One potential therapeutic add-on is biofeedback to increase heart rate variability (HRV). A recent meta-analysis shows beneficial effects of HRV biofeedback interventions on stress and anxiety symptoms. Therefore, the purpose of the current trial is to evaluate the effects of HRV biofeedback, which is practiced before and utilized during exposure, in spider-fearful individuals. Further, this trial is the first to differentiate between the effects of a HRV biofeedback intervention and those of a low-load working memory (WM) task. Methods Eighty spider-fearful individuals participate in the study. All participants receive a training session in which they practice two tasks (HRV biofeedback and a motor pseudo-biofeedback task or two motor pseudo-biofeedback tasks). Afterwards, they train both tasks at home for 6 days. One week later, during the exposure session, they watch 16 1-min spider video clips. Participants are divided into four groups: group 1 practices the HRV biofeedback and one motor pseudo-task before exposure and utilizes HRV biofeedback during exposure. Group 2 receives the same training, but continues the pseudo-biofeedback task during exposure. Group 3 practices two pseudo-biofeedback tasks and continues one of them during exposure. Group 4 trains in two pseudo-biofeedback tasks and has no additional task during exposure. The primary outcome is fear of spiders (measured by the Fear of Spiders Questionnaire and the Behavioral Approach Test). Secondary outcomes are physiological measures based on electrodermal activity, electrocardiogram and respiration. Discussion This RCT is the first one to investigate the effects of using a pre-trained HRV biofeedback during exposure in spider-fearful individuals. The study critically contrasts the effects of the biofeedback intervention with those of pseudo-tasks, which also require WM capacity, but which do not have a physiological base. If HRV biofeedback is effective in reducing fear of spiders, it would represent an easy-to-use tool to improve exposure-therapy outcomes. Trial registration Deutsches Register Klinischer Studien, DRKS00012278. Registered on 23 May 2017, amendment on 5 October 2017. Electronic supplementary material The online version of this article (10.1186/s13063-018-2554-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sarah K Schäfer
- Division of Clinical Psychology and Psychotherapy, Department of Psychology, Saarland University, Building A 1.3, 66123, Saarbrücken, Germany
| | - Frank R Ihmig
- Department of Biomedical Microsystems, Fraunhofer-Institut fuer Biomedizinische Technik (IBMT), Sulzbach, Saar, Germany
| | - Karen A Lara H
- Department of Biomedical Microsystems, Fraunhofer-Institut fuer Biomedizinische Technik (IBMT), Sulzbach, Saar, Germany
| | - Frank Neurohr
- Department of Biomedical Microsystems, Fraunhofer-Institut fuer Biomedizinische Technik (IBMT), Sulzbach, Saar, Germany
| | - Stephan Kiefer
- Department of Biomedical Microsystems, Fraunhofer-Institut fuer Biomedizinische Technik (IBMT), Sulzbach, Saar, Germany
| | - Marlene Staginnus
- Division of Clinical Psychology and Psychotherapy, Department of Psychology, Saarland University, Building A 1.3, 66123, Saarbrücken, Germany
| | - Johanna Lass-Hennemann
- Division of Clinical Psychology and Psychotherapy, Department of Psychology, Saarland University, Building A 1.3, 66123, Saarbrücken, Germany
| | - Tanja Michael
- Division of Clinical Psychology and Psychotherapy, Department of Psychology, Saarland University, Building A 1.3, 66123, Saarbrücken, Germany.
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7
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Oliveira ÍAF, Guimarães TM, Souza RM, Dos Santos AC, Machado-de-Sousa JP, Hallak JEC, Leoni RF. Brain functional and perfusional alterations in schizophrenia: an arterial spin labeling study. Psychiatry Res Neuroimaging 2018; 272:71-78. [PMID: 29229240 DOI: 10.1016/j.pscychresns.2017.12.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 11/30/2017] [Accepted: 12/01/2017] [Indexed: 01/10/2023]
Abstract
Schizophrenia is a severe mental disorder that affects the anatomy and function of the brain, with an impact on one's thoughts, feelings, and behavior. The purpose of the study was to investigate cerebral blood flow (CBF) and brain connectivity in a group of patients with schizophrenia. Pseudo-continuous arterial spin labeling (pCASL) images were acquired from 28 patients in treatment and 28 age-matched healthy controls. Mean CBF and connectivity patterns were assessed. Schizophrenia patients had decreased CBF in the bilateral frontal pole and superior frontal gyrus, right medial frontal gyrus, triangular and opercular parts of the inferior frontal gyrus, posterior division of the left supramarginal gyrus, superior and inferior divisions of the left lateral occipital cortex, and bilateral occipital pole. Moreover, through different methods to assess connectivity, our results showed abnormal connectivity patterns in regions involved in motor, sensorial, and cognitive functions. Using pCASL, a non-invasive technique, we found CBF deficits and altered functional organization of the brain in schizophrenia patients that are associated with the symptoms and characteristics of the disorder.
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Affiliation(s)
- Ícaro A F Oliveira
- Inbrain Lab, Department of Physics, FFCLRP, University of Sao Paulo, Ribeirao Preto, Brazil
| | - Tiago M Guimarães
- Department of Neuroscience and Behavior, FMRP, University of Sao Paulo, Ribeirao Preto, Brazil
| | - Roberto M Souza
- Department of Neuroscience and Behavior, FMRP, University of Sao Paulo, Ribeirao Preto, Brazil
| | - Antônio C Dos Santos
- Department of Medical Clinic, FMRP, University of Sao Paulo, Ribeirao Preto, Brazil
| | - João Paulo Machado-de-Sousa
- Department of Neuroscience and Behavior, FMRP, University of Sao Paulo, Ribeirao Preto, Brazil; National Institute of Science and Technology - Translational Medicine (INCT-TM), CNPq, Brazil
| | - Jaime E C Hallak
- Department of Neuroscience and Behavior, FMRP, University of Sao Paulo, Ribeirao Preto, Brazil; National Institute of Science and Technology - Translational Medicine (INCT-TM), CNPq, Brazil
| | - Renata F Leoni
- Inbrain Lab, Department of Physics, FFCLRP, University of Sao Paulo, Ribeirao Preto, Brazil.
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8
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Young KS, Craske MG. The Cognitive Neuroscience of Psychological Treatment Action in Depression and Anxiety. Curr Behav Neurosci Rep 2018. [DOI: 10.1007/s40473-018-0137-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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9
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Luo L, Becker B, Geng Y, Zhao Z, Gao S, Zhao W, Yao S, Zheng X, Ma X, Gao Z, Hu J, Kendrick KM. Sex-dependent neural effect of oxytocin during subliminal processing of negative emotion faces. Neuroimage 2017; 162:127-137. [PMID: 28877512 DOI: 10.1016/j.neuroimage.2017.08.079] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2016] [Revised: 08/28/2017] [Accepted: 08/30/2017] [Indexed: 02/07/2023] Open
Abstract
In line with animal models indicating sexually dimorphic effects of oxytocin (OXT) on social-emotional processing, a growing number of OXT-administration studies in humans have also reported sex-dependent effects during social information processing. To explore whether sex-dependent effects already occur during early, subliminal, processing stages the present pharmacological fMRI-study combined the intranasal-application of either OXT or placebo (n = 86-43 males) with a backward-masking emotional face paradigm. Results showed that while OXT suppressed inferior frontal gyrus, dorsal anterior cingulate and anterior insula responses to threatening face stimuli in men it increased them in women. In women increased anterior cingulate reactivity during subliminal threat processing was also positively associated with trait anxiety. On the network level, sex-dependent effects were observed on amygdala, anterior cingulate and inferior frontal gyrus functional connectivity that were mainly driven by reduced coupling in women following OXT. Our findings demonstrate that OXT produces sex-dependent effects even at the early stages of social-emotional processing, and suggest that while it attenuates neural responses to threatening social stimuli in men it increases them in women. Thus in a therapeutic context OXT may potentially produce different effects on anxiety disorders in men and women.
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Affiliation(s)
- Lizhu Luo
- Key Laboratory for NeuroInformation of Ministry of Education, Center for Information in Medicine, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, Sichuan 611731, China
| | - Benjamin Becker
- Key Laboratory for NeuroInformation of Ministry of Education, Center for Information in Medicine, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, Sichuan 611731, China
| | - Yayuan Geng
- Key Laboratory for NeuroInformation of Ministry of Education, Center for Information in Medicine, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, Sichuan 611731, China
| | - Zhiying Zhao
- Key Laboratory for NeuroInformation of Ministry of Education, Center for Information in Medicine, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, Sichuan 611731, China
| | - Shan Gao
- Key Laboratory for NeuroInformation of Ministry of Education, Center for Information in Medicine, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, Sichuan 611731, China
| | - Weihua Zhao
- Key Laboratory for NeuroInformation of Ministry of Education, Center for Information in Medicine, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, Sichuan 611731, China
| | - Shuxia Yao
- Key Laboratory for NeuroInformation of Ministry of Education, Center for Information in Medicine, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, Sichuan 611731, China
| | - Xiaoxiao Zheng
- Key Laboratory for NeuroInformation of Ministry of Education, Center for Information in Medicine, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, Sichuan 611731, China
| | - Xiaole Ma
- Key Laboratory for NeuroInformation of Ministry of Education, Center for Information in Medicine, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, Sichuan 611731, China
| | - Zhao Gao
- Key Laboratory for NeuroInformation of Ministry of Education, Center for Information in Medicine, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, Sichuan 611731, China
| | - Jiehui Hu
- Key Laboratory for NeuroInformation of Ministry of Education, Center for Information in Medicine, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, Sichuan 611731, China
| | - Keith M Kendrick
- Key Laboratory for NeuroInformation of Ministry of Education, Center for Information in Medicine, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, Sichuan 611731, China.
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10
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Miller CWT. Epigenetic and Neural Circuitry Landscape of Psychotherapeutic Interventions. PSYCHIATRY JOURNAL 2017; 2017:5491812. [PMID: 29226124 PMCID: PMC5684598 DOI: 10.1155/2017/5491812] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/10/2016] [Accepted: 04/11/2017] [Indexed: 11/21/2022]
Abstract
The science behind psychotherapy has garnered considerable interest, as objective measures are being developed to map the patient's subjective change over the course of treatment. Prenatal and early life influences have a lasting impact on how genes are expressed and the manner in which neural circuits are consolidated. Transgenerationally transmitted epigenetic markers as well as templates of enhanced thought flexibility versus evasion can be passed down from parent to child. This influences gene expression/repression (impacting neuroplasticity) and kindling of neurocircuitry which can perpetuate maladaptive cognitive processing seen in a number of psychiatric conditions. Importantly, genetic factors and the compounding effects of early life adversity do not inexorably lead to certain fated outcomes. The concepts of vulnerability and resilience are becoming more integrated into the framework of "differential susceptibility," speaking to how corrective environmental factors may promote epigenetic change and reconfigure neural templates, allowing for symptomatic improvement. Psychotherapy is one such factor, and this review will focus on our current knowledge of its epigenetic and neurocircuitry impact.
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Affiliation(s)
- Christopher W. T. Miller
- University of Maryland School of Medicine, 701 W. Pratt St., 4th Floor, Baltimore, MD 21201, USA
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11
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Soravia LM, Orosz A, Schwab S, Nakataki M, Wiest R, Federspiel A. CBT reduces CBF: cognitive-behavioral therapy reduces cerebral blood flow in fear-relevant brain regions in spider phobia. Brain Behav 2016; 6:e00510. [PMID: 27688940 PMCID: PMC5036433 DOI: 10.1002/brb3.510] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Revised: 05/10/2016] [Accepted: 05/11/2016] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Imaging studies have provided evidence that cognitive-behavioral therapy (CBT) is able to change brain activation in phobic patients in response to threatening stimuli. The changes occurred in both emotion-generating and modulatory regions. In this study, we use a data-driven approach to explore resting state cerebral blood flow (CBF) measured by arterial spin labeling (ASL), before and after CBT. METHODS Eight female patients with spider phobia were scanned before and 1 month after an exposure-based group therapy for spider phobia. Each MRI session consisted of an ASL resting state measurement acquired before and after a symptom provocation task involving the showing of spider pictures in the scanner. The first ASL acquisition measured anticipatory anxiety and the second measured postprocessing of phobia-relevant stimuli. RESULTS Cognitive-behavioral therapy significantly reduced spider phobic symptoms in all patients. Symptom reduction during anticipatory anxiety was accompanied by reduced bilateral CBF in the parahippocampal gyrus, ventral anterior thalamus, Brodmann area 8, and the anterior cingulate cortex. During postprocessing of phobia-relevant stimuli, patients showed reduced CBF in the bilateral insula, components of the motor cortex, and areas associated with language functions. CONCLUSIONS Longitudinal CBF dynamics following CBT were in concordance with results from several studies using BOLD fMRI to investigate the effects of psychotherapy on brain activity. CBF can be quantified by ASL, with the principal advantage of sensitivity to slow variations in neural activity and task independence. Therefore, ASL may be a suitable method for monitoring and evaluating the efficacy of psychotherapy or pharmacotherapy approaches.
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Affiliation(s)
- Leila M Soravia
- Division of Systems Neuroscience of Psychopathology University Hospital of Psychiatry University of Bern Bolligenstrasse 111 3000 Bern Switzerland
| | - Ariane Orosz
- Division of Systems Neuroscience of Psychopathology University Hospital of Psychiatry University of Bern Bolligenstrasse 111 3000 Bern Switzerland
| | - Simon Schwab
- Division of Systems Neuroscience of Psychopathology University Hospital of Psychiatry University of Bern Bolligenstrasse 111 3000 Bern Switzerland
| | - Masahito Nakataki
- Division of Systems Neuroscience of Psychopathology University Hospital of Psychiatry University of Bern Bolligenstrasse 111 3000 Bern Switzerland; Department of Psychiatry University of Tokushima 3-18-15 Kuramoto-cho Tokushima 770-8503 Japan
| | - Roland Wiest
- Department of Diagnostic and Interventional Neuroradiology Inselspital University Hospital of Bern Freiburgstrasse 4 3010 Bern Switzerland
| | - Andrea Federspiel
- Division of Systems Neuroscience of Psychopathology University Hospital of Psychiatry University of Bern Bolligenstrasse 111 3000 Bern Switzerland
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