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Proverbio AM, Cesati F. Neural correlates of recalled sadness, joy, and fear states: a source reconstruction EEG study. Front Psychiatry 2024; 15:1357770. [PMID: 38638416 PMCID: PMC11024723 DOI: 10.3389/fpsyt.2024.1357770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 03/18/2024] [Indexed: 04/20/2024] Open
Abstract
Introduction The capacity to understand the others' emotional states, particularly if negative (e.g. sadness or fear), underpins the empathic and social brain. Patients who cannot express their emotional states experience social isolation and loneliness, exacerbating distress. We investigated the feasibility of detecting non-invasive scalp-recorded electrophysiological signals that correspond to recalled emotional states of sadness, fear, and joy for potential classification. Methods The neural activation patterns of 20 healthy and right-handed participants were studied using an electrophysiological technique. Analyses were focused on the N400 component of Event-related potentials (ERPs) recorded during silent recall of subjective emotional states; Standardized weighted Low-resolution Electro-magnetic Tomography (swLORETA) was employed for source reconstruction. The study classified individual patterns of brain activation linked to the recollection of three distinct emotional states into seven regions of interest (ROIs). Results Statistical analysis (ANOVA) of the individual magnitude values revealed the existence of a common emotional circuit, as well as distinct brain areas that were specifically active during recalled sad, happy and fearful states. In particular, the right temporal and left superior frontal areas were more active for sadness, the left limbic region for fear, and the right orbitofrontal cortex for happy affective states. Discussion In conclusion, this study successfully demonstrated the feasibility of detecting scalp-recorded electrophysiological signals corresponding to internal and subjective affective states. These findings contribute to our understanding of the emotional brain, and have potential applications for future BCI classification and identification of emotional states in LIS patients who may be unable to express their emotions, thus helping to alleviate social isolation and sense of loneliness.
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Affiliation(s)
- Alice Mado Proverbio
- Cognitive Electrophysiology Lab, Department of Psychology, University of Milano-Bicocca, Milan, Italy
- NEURO-MI Milan Center for Neuroscience, Milan, Italy
| | - Federico Cesati
- Cognitive Electrophysiology Lab, Department of Psychology, University of Milano-Bicocca, Milan, Italy
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2
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Leehr EJ, Seeger FR, Böhnlein J, Gathmann B, Straube T, Roesmann K, Junghöfer M, Schwarzmeier H, Siminski N, Herrmann MJ, Langhammer T, Goltermann J, Grotegerd D, Meinert S, Winter NR, Dannlowski U, Lueken U. Association between resting-state connectivity patterns in the defensive system network and treatment response in spider phobia-a replication approach. Transl Psychiatry 2024; 14:137. [PMID: 38453896 PMCID: PMC10920691 DOI: 10.1038/s41398-024-02799-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 01/15/2024] [Accepted: 01/18/2024] [Indexed: 03/09/2024] Open
Abstract
Although highly effective on average, exposure-based treatments do not work equally well for all patients with anxiety disorders. The identification of pre-treatment response-predicting patient characteristics may enable patient stratification. Preliminary research highlights the relevance of inhibitory fronto-limbic networks as such. We aimed to identify pre-treatment neural signatures differing between exposure treatment responders and non-responders in spider phobia and to validate results through rigorous replication. Data of a bi-centric intervention study comprised clinical phenotyping and pre-treatment resting-state functional connectivity (rsFC) data of n = 79 patients with spider phobia (discovery sample) and n = 69 patients (replication sample). RsFC data analyses were accomplished using the Matlab-based CONN-toolbox with harmonized analyses protocols at both sites. Treatment response was defined by a reduction of >30% symptom severity from pre- to post-treatment (Spider Phobia Questionnaire Score, primary outcome). Secondary outcome was defined by a reduction of >50% in a Behavioral Avoidance Test (BAT). Mean within-session fear reduction functioned as a process measure for exposure. Compared to non-responders and pre-treatment, results in the discovery sample seemed to indicate that responders exhibited stronger negative connectivity between frontal and limbic structures and were characterized by heightened connectivity between the amygdala and ventral visual pathway regions. Patients exhibiting high within-session fear reduction showed stronger excitatory connectivity within the prefrontal cortex than patients with low within-session fear reduction. Whereas these results could be replicated by another team using the same data (cross-team replication), cross-site replication of the discovery sample findings in the independent replication sample was unsuccessful. Results seem to support negative fronto-limbic connectivity as promising ingredient to enhance response rates in specific phobia but lack sufficient replication. Further research is needed to obtain a valid basis for clinical decision-making and the development of individually tailored treatment options. Notably, future studies should regularly include replication approaches in their protocols.
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Affiliation(s)
- Elisabeth J Leehr
- Institute for Translational Psychiatry, University of Münster, Münster, Germany.
| | - Fabian R Seeger
- Department of Psychiatry, Psychosomatics, and Psychotherapy, Center for Mental Health, University Hospital of Würzburg, Würzburg, Germany
- Department of General Psychiatry, University of Heidelberg, Heidelberg, Germany
| | - Joscha Böhnlein
- Institute for Translational Psychiatry, University of Münster, Münster, Germany
| | - Bettina Gathmann
- Institute of Medical Psychology and Systems Neuroscience, University of Münster, Münster, Germany
| | - Thomas Straube
- Institute of Medical Psychology and Systems Neuroscience, University of Münster, Münster, Germany
- Otto-Creutzfeld Center for Cognitive and Behavioral Neuroscience, University of Münster, Münster, Germany
| | - Kati Roesmann
- Otto-Creutzfeld Center for Cognitive and Behavioral Neuroscience, University of Münster, Münster, Germany
- Institute for Clinical Psychology and Psychotherapy, University of Siegen, Siegen, Germany
- Institute for Biomagnetism and Biosignalanalysis, University of Münster, Münster, Germany
- Institute of Psychology, Unit of Clinical Psychology and Psychotherapy in Childhood and Adolescence, University of Osnabrück, Osnabrück, Germany
| | - Markus Junghöfer
- Otto-Creutzfeld Center for Cognitive and Behavioral Neuroscience, University of Münster, Münster, Germany
- Institute for Biomagnetism and Biosignalanalysis, University of Münster, Münster, Germany
| | - Hanna Schwarzmeier
- Department of Psychiatry, Psychosomatics, and Psychotherapy, Center for Mental Health, University Hospital of Würzburg, Würzburg, Germany
| | - Niklas Siminski
- Department of Psychiatry, Psychosomatics, and Psychotherapy, Center for Mental Health, University Hospital of Würzburg, Würzburg, Germany
| | - Martin J Herrmann
- Department of Psychiatry, Psychosomatics, and Psychotherapy, Center for Mental Health, University Hospital of Würzburg, Würzburg, Germany
| | - Till Langhammer
- Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Janik Goltermann
- Institute for Translational Psychiatry, University of Münster, Münster, Germany
| | - Dominik Grotegerd
- Institute for Translational Psychiatry, University of Münster, Münster, Germany
| | - Susanne Meinert
- Institute for Translational Psychiatry, University of Münster, Münster, Germany
| | - Nils R Winter
- Institute for Translational Psychiatry, University of Münster, Münster, Germany
| | - Udo Dannlowski
- Institute for Translational Psychiatry, University of Münster, Münster, Germany
| | - Ulrike Lueken
- Department of Psychiatry, Psychosomatics, and Psychotherapy, Center for Mental Health, University Hospital of Würzburg, Würzburg, Germany
- Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany
- German Center for Mental Health (DZPG), partner site Berlin/Potsdam, Berlin, Germany
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3
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Borkar CD, Stelly CE, Fu X, Dorofeikova M, Le QSE, Vutukuri R, Vo C, Walker A, Basavanhalli S, Duong A, Bean E, Resendez A, Parker JG, Tasker JG, Fadok JP. Top-down control of flight by a non-canonical cortico-amygdala pathway. Nature 2024; 625:743-749. [PMID: 38233522 PMCID: PMC10878556 DOI: 10.1038/s41586-023-06912-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 11/29/2023] [Indexed: 01/19/2024]
Abstract
Survival requires the selection of appropriate behaviour in response to threats, and dysregulated defensive reactions are associated with psychiatric illnesses such as post-traumatic stress and panic disorder1. Threat-induced behaviours, including freezing and flight, are controlled by neuronal circuits in the central amygdala (CeA)2; however, the source of neuronal excitation of the CeA that contributes to high-intensity defensive responses is unknown. Here we used a combination of neuroanatomical mapping, in vivo calcium imaging, functional manipulations and electrophysiology to characterize a previously unknown projection from the dorsal peduncular (DP) prefrontal cortex to the CeA. DP-to-CeA neurons are glutamatergic and specifically target the medial CeA, the main amygdalar output nucleus mediating conditioned responses to threat. Using a behavioural paradigm that elicits both conditioned freezing and flight, we found that CeA-projecting DP neurons are activated by high-intensity threats in a context-dependent manner. Functional manipulations revealed that the DP-to-CeA pathway is necessary and sufficient for both avoidance behaviour and flight. Furthermore, we found that DP neurons synapse onto neurons within the medial CeA that project to midbrain flight centres. These results elucidate a non-canonical top-down pathway regulating defensive responses.
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Affiliation(s)
- Chandrashekhar D Borkar
- Department of Psychology, Tulane University, New Orleans, LA, USA
- Tulane Brain Institute, Tulane University, New Orleans, LA, USA
| | - Claire E Stelly
- Department of Psychology, Tulane University, New Orleans, LA, USA
- Tulane Brain Institute, Tulane University, New Orleans, LA, USA
- Department of Psychological Sciences, Loyola University, New Orleans, LA, USA
| | - Xin Fu
- Tulane Brain Institute, Tulane University, New Orleans, LA, USA
- Neuroscience Program, Tulane University, New Orleans, LA, USA
| | - Maria Dorofeikova
- Department of Psychology, Tulane University, New Orleans, LA, USA
- Tulane Brain Institute, Tulane University, New Orleans, LA, USA
| | - Quan-Son Eric Le
- Tulane Brain Institute, Tulane University, New Orleans, LA, USA
- Neuroscience Program, Tulane University, New Orleans, LA, USA
| | - Rithvik Vutukuri
- Tulane Brain Institute, Tulane University, New Orleans, LA, USA
- Neuroscience Program, Tulane University, New Orleans, LA, USA
| | - Catherine Vo
- Tulane Brain Institute, Tulane University, New Orleans, LA, USA
- Neuroscience Program, Tulane University, New Orleans, LA, USA
| | - Alex Walker
- Tulane Brain Institute, Tulane University, New Orleans, LA, USA
- Neuroscience Program, Tulane University, New Orleans, LA, USA
| | - Samhita Basavanhalli
- Tulane Brain Institute, Tulane University, New Orleans, LA, USA
- Neuroscience Program, Tulane University, New Orleans, LA, USA
| | - Anh Duong
- Tulane Brain Institute, Tulane University, New Orleans, LA, USA
- Neuroscience Program, Tulane University, New Orleans, LA, USA
| | - Erin Bean
- Tulane Brain Institute, Tulane University, New Orleans, LA, USA
- Neuroscience Program, Tulane University, New Orleans, LA, USA
| | - Alexis Resendez
- Department of Psychology, Tulane University, New Orleans, LA, USA
- Tulane Brain Institute, Tulane University, New Orleans, LA, USA
| | - Jones G Parker
- Department of Neuroscience, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Jeffrey G Tasker
- Tulane Brain Institute, Tulane University, New Orleans, LA, USA
- Department of Cell and Molecular Biology, Tulane University, New Orleans, LA, USA
| | - Jonathan P Fadok
- Department of Psychology, Tulane University, New Orleans, LA, USA.
- Tulane Brain Institute, Tulane University, New Orleans, LA, USA.
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4
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Abuso ABV, Hashmi M, Hashmi H, Khoo A, Parsaik A. Overcoming Fear of Flying: A Combined Approach of Psychopharmacology and Gradual Exposure Therapy. Cureus 2023; 15:e39773. [PMID: 37398715 PMCID: PMC10312254 DOI: 10.7759/cureus.39773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2023] [Indexed: 07/04/2023] Open
Abstract
Aviophobia, the fear of flying, is a prevalent type of situational-specific phobia categorized under anxiety disorders in The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Patients with aviophobia experience intense, irrational fear when traveling by air. Active avoidance of the phobic stimulus is a diagnostic feature that affects one's quality of life and commonly leads to significant functional limitations. Virtual reality based gradual exposure therapy is a treatment option for aviophobia due to its easy accessibility and low cost, but it may not be very effective. This case reports the effectiveness of using psychopharmacologic treatment in combination with real-life gradual exposure therapy to successfully treat a patient with aviophobia. Written consent from the patient was obtained prior to the writing and submission of this case report.
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Affiliation(s)
| | - Muneeb Hashmi
- Department of Computer Science & Engineering, Texas A&M University, College Station, USA
| | - Hamdaan Hashmi
- Department of Entomology, Texas A&M University, College Station, USA
| | - Anselm Khoo
- Department of Clinical Services, Westpark Springs Behavioral Hospital, Richmond, USA
| | - Ajay Parsaik
- Department of Psychiatry, Marshfield Clinic Health System, Marshfield, USA
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5
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Bas‐Hoogendam JM, Groenewold NA, Aghajani M, Freitag GF, Harrewijn A, Hilbert K, Jahanshad N, Thomopoulos SI, Thompson PM, Veltman DJ, Winkler AM, Lueken U, Pine DS, van der Wee NJA, Stein DJ. ENIGMA-anxiety working group: Rationale for and organization of large-scale neuroimaging studies of anxiety disorders. Hum Brain Mapp 2022; 43:83-112. [PMID: 32618421 PMCID: PMC8805695 DOI: 10.1002/hbm.25100] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 05/09/2020] [Accepted: 06/08/2020] [Indexed: 12/11/2022] Open
Abstract
Anxiety disorders are highly prevalent and disabling but seem particularly tractable to investigation with translational neuroscience methodologies. Neuroimaging has informed our understanding of the neurobiology of anxiety disorders, but research has been limited by small sample sizes and low statistical power, as well as heterogenous imaging methodology. The ENIGMA-Anxiety Working Group has brought together researchers from around the world, in a harmonized and coordinated effort to address these challenges and generate more robust and reproducible findings. This paper elaborates on the concepts and methods informing the work of the working group to date, and describes the initial approach of the four subgroups studying generalized anxiety disorder, panic disorder, social anxiety disorder, and specific phobia. At present, the ENIGMA-Anxiety database contains information about more than 100 unique samples, from 16 countries and 59 institutes. Future directions include examining additional imaging modalities, integrating imaging and genetic data, and collaborating with other ENIGMA working groups. The ENIGMA consortium creates synergy at the intersection of global mental health and clinical neuroscience, and the ENIGMA-Anxiety Working Group extends the promise of this approach to neuroimaging research on anxiety disorders.
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Affiliation(s)
- Janna Marie Bas‐Hoogendam
- Department of Developmental and Educational PsychologyLeiden University, Institute of PsychologyLeidenThe Netherlands
- Department of PsychiatryLeiden University Medical CenterLeidenThe Netherlands
- Leiden Institute for Brain and CognitionLeidenThe Netherlands
| | - Nynke A. Groenewold
- Department of Psychiatry & Mental HealthUniversity of Cape TownCape TownSouth Africa
| | - Moji Aghajani
- Department of PsychiatryAmsterdam UMC / VUMCAmsterdamThe Netherlands
- Department of Research & InnovationGGZ inGeestAmsterdamThe Netherlands
| | - Gabrielle F. Freitag
- National Institute of Mental Health, Emotion and Development BranchBethesdaMarylandUSA
| | - Anita Harrewijn
- National Institute of Mental Health, Emotion and Development BranchBethesdaMarylandUSA
| | - Kevin Hilbert
- Department of PsychologyHumboldt‐Universität zu BerlinBerlinGermany
| | - Neda Jahanshad
- University of Southern California Keck School of MedicineImaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics InstituteLos AngelesCaliforniaUSA
| | - Sophia I. Thomopoulos
- University of Southern California Keck School of MedicineImaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics InstituteLos AngelesCaliforniaUSA
| | - Paul M. Thompson
- University of Southern California Keck School of MedicineImaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics InstituteLos AngelesCaliforniaUSA
| | - Dick J. Veltman
- Department of PsychiatryAmsterdam UMC / VUMCAmsterdamThe Netherlands
| | - Anderson M. Winkler
- National Institute of Mental Health, Emotion and Development BranchBethesdaMarylandUSA
| | - Ulrike Lueken
- Department of PsychologyHumboldt‐Universität zu BerlinBerlinGermany
| | - Daniel S. Pine
- National Institute of Mental Health, Emotion and Development BranchBethesdaMarylandUSA
| | - Nic J. A. van der Wee
- Department of PsychiatryLeiden University Medical CenterLeidenThe Netherlands
- Leiden Institute for Brain and CognitionLeidenThe Netherlands
| | - Dan J. Stein
- Department of Psychiatry & Mental HealthUniversity of Cape TownCape TownSouth Africa
- University of Cape TownSouth African MRC Unit on Risk & Resilience in Mental DisordersCape TownSouth Africa
- University of Cape TownNeuroscience InstituteCape TownSouth Africa
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6
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Siminski N, Borgmann L, Becker MPI, Hofmann D, Gathmann B, Leehr EJ, Böhnlein J, Seeger FR, Schwarzmeier H, Roesmann K, Junghöfer M, Dannlowski U, Lueken U, Straube T, Herrmann MJ. Centromedial amygdala is more relevant for phobic confrontation relative to the bed nucleus of stria terminalis in patients with spider phobia. J Psychiatr Res 2021; 143:268-275. [PMID: 34530337 DOI: 10.1016/j.jpsychires.2021.09.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 08/24/2021] [Accepted: 09/01/2021] [Indexed: 01/31/2023]
Abstract
Recent studies indicate differential involvement of the centromedial amygdala (CM) and the bed nucleus of the stria terminalis (BNST) during processing (anticipation and confrontation) of threat stimuli. Here, temporal predictability was shown to be a relevant factor. In this study, we want to investigate the relevance of these effects, which were found in healthy subjects, for anxiety disorders. Therefore, we investigated the differential involvement of CM and BNST in the anticipation and confrontation of phobic stimuli under variation of temporal predictability in spider phobia. 21 patients with spider phobia and 21 healthy controls underwent a temporally predictable/unpredictable phobic and neutral anticipation and confrontation paradigm using functional magnetic resonance imaging (fMRI) and ROI analyses. During the anticipation phase, healthy controls showed higher CM and BNST activity during the predictable compared with the unpredictable condition compared with the anxiety patients. During a confrontation phase that followed the anticipation phase, CM was more activated than BNST during the phobic compared with the neutral confrontation. While this effect was independent of threat predictability in patients, healthy controls showed higher activation in the CM compared with the BNST only during the predictable spider confrontation compared with the predictable bird confrontation. The results contribute to a better understanding of the separate roles of the CM and BNST during phobic processes. The CM was found to be more relevant to phobic confrontation in patients with spider phobia compared with the BNST.
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Affiliation(s)
- N Siminski
- Center of Mental Health, Dept. of Psychiatry, Psychosomatics, and Psychotherapy, University Hospital of Wuerzburg, Wuerzburg, Germany
| | - L Borgmann
- Institute of Medical Psychology and Systems Neuroscience, University of Muenster, Germany
| | - M P I Becker
- Institute of Medical Psychology and Systems Neuroscience, University of Muenster, Germany
| | - D Hofmann
- Institute of Medical Psychology and Systems Neuroscience, University of Muenster, Germany
| | - B Gathmann
- Institute of Medical Psychology and Systems Neuroscience, University of Muenster, Germany
| | - E J Leehr
- Institute for Translational Psychiatry, University of Münster, Germany
| | - J Böhnlein
- Institute for Translational Psychiatry, University of Münster, Germany
| | - F R Seeger
- Center of Mental Health, Dept. of Psychiatry, Psychosomatics, and Psychotherapy, University Hospital of Wuerzburg, Wuerzburg, Germany; Department of General Psychiatry, University of Heidelberg, Heidelberg, Germany
| | - H Schwarzmeier
- Center of Mental Health, Dept. of Psychiatry, Psychosomatics, and Psychotherapy, University Hospital of Wuerzburg, Wuerzburg, Germany
| | - K Roesmann
- Institute for Biomagnetism and Biosignalanalysis, University of Münster, Germany; Institute for Clinical Psychology and Psychotherapy, University of Siegen, Germany
| | - M Junghöfer
- Institute for Biomagnetism and Biosignalanalysis, University of Münster, Germany
| | - U Dannlowski
- Institute for Translational Psychiatry, University of Münster, Germany
| | - U Lueken
- Center of Mental Health, Dept. of Psychiatry, Psychosomatics, and Psychotherapy, University Hospital of Wuerzburg, Wuerzburg, Germany; Department of Psychology, Humboldt-Universität zu Berlin, Germany
| | - T Straube
- Institute of Medical Psychology and Systems Neuroscience, University of Muenster, Germany
| | - M J Herrmann
- Center of Mental Health, Dept. of Psychiatry, Psychosomatics, and Psychotherapy, University Hospital of Wuerzburg, Wuerzburg, Germany.
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7
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Clinical predictors of treatment response towards exposure therapy in virtuo in spider phobia: A machine learning and external cross-validation approach. J Anxiety Disord 2021; 83:102448. [PMID: 34298236 DOI: 10.1016/j.janxdis.2021.102448] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 04/07/2021] [Accepted: 07/06/2021] [Indexed: 12/29/2022]
Abstract
While being highly effective on average, exposure-based treatments are not equally effective in all patients. The a priori identification of patients with a poor prognosis may enable the application of more personalized psychotherapeutic interventions. We aimed at identifying sociodemographic and clinical pre-treatment predictors for treatment response in spider phobia (SP). N = 174 patients with SP underwent a highly standardized virtual reality exposure therapy (VRET) at two independent sites. Analyses on group-level were used to test the efficacy. We applied a state-of-the-art machine learning protocol (Random Forests) to evaluate the predictive utility of clinical and sociodemographic predictors for a priori identification of individual treatment response assessed directly after treatment and at 6-month follow-up. The reliability and generalizability of predictive models was tested via external cross-validation. Our study shows that one session of VRET is highly effective on a group-level and is among the first to reveal long-term stability of this treatment effect. Individual short-term symptom reductions could be predicted above chance, but accuracies dropped to non-significance in our between-site prediction and for predictions of long-term outcomes. With performance metrics hardly exceeding chance level and the lack of generalizability in the employed between-site replication approach, our study suggests limited clinical utility of clinical and sociodemographic predictors. Predictive models including multimodal predictors may be more promising.
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8
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Dysregulation of threat neurociruitry during fear extinction: the role of anhedonia. Neuropsychopharmacology 2021; 46:1650-1657. [PMID: 33833400 PMCID: PMC8280223 DOI: 10.1038/s41386-021-01003-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 01/20/2021] [Accepted: 03/12/2021] [Indexed: 01/31/2023]
Abstract
Dimensional models of anxiety and depression highlight common and distinct symptom clusters that are thought to reflect disruptions in underlying functional processes. The current study investigated how functioning of threat neurocircuitry relates to symptom dimensions of anxiety and depression. Participants were aged 18-19 years (n = 229, 158 female) and were selected to ensure a range of scores on symptom measures. Symptom dimensions of "General Distress" (common to anxiety disorders and depression), "Fears" (more specific to anxiety disorders), and "Anhedonia-apprehension" (more specific to depression) were evaluated. Participants underwent functional magnetic resonance imaging during a Pavlovian fear conditioning paradigm. Multilevel modeling analyses estimated relationships between symptom dimensions and activation in threat neural circuitry. Exploratory whole brain analyses were also conducted. Threat-related neural activity was not associated with General Distress or Fears. Anhedonia-apprehension was associated with activation of bilateral amygdala, anterior insula and dACC during late extinction. We found no evidence to support an association between symptom dimensions of General Distress or Fears with threat circuitry activation in a large sample of young adults. We did, however, find that the symptom dimension of Anhedonia-apprehension was significantly associated with threat-related neural activation during fear extinction. This effect requires replication in future work but may reflect anhedonic impairments in learning when contingencies are altered, possibly linked to the rewarding relief of an unexpectedly absent threat.
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9
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Pang M, Zhong Y, Hao Z, Xu H, Wu Y, Teng C, Li J, Xiao C, Fox PT, Zhang N, Wang C. Resting-state causal connectivity of the bed nucleus of the stria terminalis in panic disorder. Brain Imaging Behav 2021; 15:25-35. [PMID: 31833015 DOI: 10.1007/s11682-019-00229-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Panic disorder (PD) is associated with anticipatory anxiety, a sustained threat response that appears to be related to the bed nucleus of the stria terminalis (BNST). Individuals with panic disorder may demonstrate significant differences in causal connectivity of the BNST in comparison to healthy controls. To test this hypothesis, resting-state functional magnetic resonance imaging (fMRI) was used to identify aberrant causal connectivity of the BNST in PD patients. 19 PD patients and 18 healthy controls (HC) matched for gender, age and education were included. Granger causality analysis (GCA) utilizing the BNST as a seed region was used to investigate changes in directional connectivity. Relative to healthy controls, PD patients displayed abnormal directional connectivity of the BNST including enhanced causal connectivity between the left parahippocampal gyrus and left BNST, the right insula and the right BNST, the left BNST and the right dorsolateral prefrontal cortex (dlPFC) and right BNST to the left and right dlPFC. Furthermore, PD patients displayed weakened causal connectivity between the right dlPFC and the left BNST, the left dlPFC and the right BNST, the left BNST and the left dorsomedial prefrontal cortex (dmPFC), right insula, right fusiform, and right BNST to the right insula. The results suggest that PD strongly correlates with increased causal connectivity between emotional processing regions and the BNST and enhanced causal connectivity between the BNST and cognitive control regions.
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Affiliation(s)
- Manlong Pang
- Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing, Jiangsu, China.,School of Psychology, Nanjing Normal University, Nanjing, Jiangsu, China.,Functional Brain Imaging Institute of Nanjing Medical University, Nanjing, Jiangsu, China.,Cognitive Behavioral Therapy Institute of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Yuan Zhong
- School of Psychology, Nanjing Normal University, Nanjing, Jiangsu, China.,Jiangsu Key Laboratory of Mental Health and Cognitive Science, Nanjing Normal University, Nanjing, Jiangsu, China
| | - Ziyu Hao
- School of Psychology, Nanjing Normal University, Nanjing, Jiangsu, China
| | - Huazhen Xu
- Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing, Jiangsu, China.,Functional Brain Imaging Institute of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Yun Wu
- Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing, Jiangsu, China.,School of Psychology, Nanjing Normal University, Nanjing, Jiangsu, China.,Functional Brain Imaging Institute of Nanjing Medical University, Nanjing, Jiangsu, China.,Cognitive Behavioral Therapy Institute of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Changjun Teng
- Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing, Jiangsu, China.,School of Psychology, Nanjing Normal University, Nanjing, Jiangsu, China.,Functional Brain Imaging Institute of Nanjing Medical University, Nanjing, Jiangsu, China.,Cognitive Behavioral Therapy Institute of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Jian Li
- School of Psychology, Nanjing Normal University, Nanjing, Jiangsu, China
| | - Chaoyong Xiao
- Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing, Jiangsu, China.,Functional Brain Imaging Institute of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Peter T Fox
- Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing, Jiangsu, China.,Functional Brain Imaging Institute of Nanjing Medical University, Nanjing, Jiangsu, China.,Cognitive Behavioral Therapy Institute of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Ning Zhang
- Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing, Jiangsu, China.,School of Psychology, Nanjing Normal University, Nanjing, Jiangsu, China.,Functional Brain Imaging Institute of Nanjing Medical University, Nanjing, Jiangsu, China.,Cognitive Behavioral Therapy Institute of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Chun Wang
- Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing, Jiangsu, China. .,School of Psychology, Nanjing Normal University, Nanjing, Jiangsu, China. .,Functional Brain Imaging Institute of Nanjing Medical University, Nanjing, Jiangsu, China. .,Cognitive Behavioral Therapy Institute of Nanjing Medical University, Nanjing, Jiangsu, China.
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10
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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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11
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Hulsman AM, Terburg D, Roelofs K, Klumpers F. Roles of the bed nucleus of the stria terminalis and amygdala in fear reactions. HANDBOOK OF CLINICAL NEUROLOGY 2021; 179:419-432. [PMID: 34225979 DOI: 10.1016/b978-0-12-819975-6.00027-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The bed nucleus of the stria terminalis (BNST) plays a critical modulatory role in driving fear responses. Part of the so-called extended amygdala, this region shares many functions and connections with the substantially more investigated amygdala proper. In this chapter, we review contributions of the BNST and amygdala to subjective, behavioral, and physiological aspects of fear. Despite the fact that both regions are together involved in each of these aspects of fear, they appear complimentary in their contributions. Specifically, the basolateral amygdala (BLA), through its connections to sensory and orbitofrontal regions, is ideally poised for fast learning and controlling fear reactions in a variety of situations. The central amygdala (CeA) relies on BLA input and is particularly important for adjusting physiological and behavioral responses under acute threat. In contrast, the BNST may profit from more extensive striatal and dorsomedial prefrontal connections to drive anticipatory responses under more ambiguous conditions that allow more time for planning. Thus current evidence suggests that the BNST is ideally suited to play a critical role responding to distant or ambiguous threats and could thereby facilitate goal-directed defensive action.
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Affiliation(s)
- Anneloes M Hulsman
- Experimental Psychopathology & Treatment, Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands; Affective Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Centre for Cognitive Neuroimaging, Radboud University, Nijmegen, The Netherlands
| | - David Terburg
- Department of Experimental Psychology, Utrecht University, Utrecht, The Netherlands; Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Karin Roelofs
- Experimental Psychopathology & Treatment, Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands; Affective Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Centre for Cognitive Neuroimaging, Radboud University, Nijmegen, The Netherlands
| | - Floris Klumpers
- Experimental Psychopathology & Treatment, Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands; Affective Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Centre for Cognitive Neuroimaging, Radboud University, Nijmegen, The Netherlands.
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12
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Rosenbaum D, Leehr EJ, Kroczek A, Rubel JA, Int-Veen I, Deutsch K, Maier MJ, Hudak J, Fallgatter AJ, Ehlis AC. Neuronal correlates of spider phobia in a combined fNIRS-EEG study. Sci Rep 2020; 10:12597. [PMID: 32724128 PMCID: PMC7387441 DOI: 10.1038/s41598-020-69127-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 06/29/2020] [Indexed: 11/08/2022] Open
Abstract
Specific phobia is associated with aberrant brain activation in confrontation paradigms with phobic stimuli. In previous EEG research enhanced event-related potentials (ERPs) in the late-positive potential (LPP) window have been observed. Further, studies with functional near-infrared spectroscopy (fNIRS) and fMRI suggest that spider phobia is associated with enhanced activation within cortical and subcortical areas. In the current study we investigated the neuronal correlates of spider phobia in a combined fNIRS-EEG study. To this end, 37 spider phobic patients (PP) and 32 healthy controls (HC) underwent a symptom provocation paradigm during which subjects watched video clips of spiders and domestic animals (confrontation phase) after being primed on the content of the video (anticipation phase). Simultaneously, fNIRS, EEG, electromyography (EMG), electrocardiography and behavioral measures were assessed. Results showed increased LPP amplitudes, increased hemodynamic responses in the cognitive control network, and increased EMG activity and heart rate during spider conditions in PP in comparison to HC. Furthermore, in behavioral ratings PP showed higher emotional distress and avoidance. Behavioral ratings, fNIRS and EEG data showed positive correlations on a between-subject as well as on a within-subject level. Our results merge the existing data on neurophysiological correlates of phobic stimulus processing in hemodynamic and electrophysiological research and extend those of static visual material (pictures) to dynamic visual material (videos).
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Affiliation(s)
- David Rosenbaum
- Department of Psychiatry and Psychotherapy, University Hospital of Tuebingen, Calwerstraße 14, 72076, Tübingen, Germany.
| | | | - Agnes Kroczek
- Department of Psychiatry and Psychotherapy, University Hospital of Tuebingen, Calwerstraße 14, 72076, Tübingen, Germany
| | - Julian A Rubel
- Department of Psychotherapy Research, Justus-Liebig-University Giessen, Giessen, Germany
| | - Isabell Int-Veen
- Department of Psychiatry and Psychotherapy, University Hospital of Tuebingen, Calwerstraße 14, 72076, Tübingen, Germany
| | - Kira Deutsch
- Department of Psychiatry and Psychotherapy, University Hospital of Tuebingen, Calwerstraße 14, 72076, Tübingen, Germany
| | - Moritz J Maier
- Department of Psychiatry and Psychotherapy, University Hospital of Tuebingen, Calwerstraße 14, 72076, Tübingen, Germany
| | - Justin Hudak
- Center on Mindfulness and Integrative Health Intervention Development, University of Utah, Salt Lake City, UT, 84112, USA
| | - Andreas J Fallgatter
- Department of Psychiatry and Psychotherapy, University Hospital of Tuebingen, Calwerstraße 14, 72076, Tübingen, Germany
- LEAD Graduate School and Research Network, University of Tuebingen, Tuebingen, Germany
| | - Ann-Christine Ehlis
- Department of Psychiatry and Psychotherapy, University Hospital of Tuebingen, Calwerstraße 14, 72076, Tübingen, Germany
- LEAD Graduate School and Research Network, University of Tuebingen, Tuebingen, Germany
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13
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Schwarzmeier H, Leehr EJ, Böhnlein J, Seeger FR, Roesmann K, Gathmann B, Herrmann MJ, Siminski N, Junghöfer M, Straube T, Grotegerd D, Dannlowski U. Theranostic markers for personalized therapy of spider phobia: Methods of a bicentric external cross-validation machine learning approach. Int J Methods Psychiatr Res 2020; 29:e1812. [PMID: 31814209 PMCID: PMC7301283 DOI: 10.1002/mpr.1812] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 09/18/2019] [Accepted: 10/08/2019] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES Embedded in the Collaborative Research Center "Fear, Anxiety, Anxiety Disorders" (CRC-TRR58), this bicentric clinical study aims at identifying biobehavioral markers of treatment (non-)response by applying machine learning methodology with an external cross-validation protocol. We hypothesize that a priori prediction of treatment (non-)response is possible in a second, independent sample based on multimodal markers. METHODS One-session virtual reality exposure treatment (VRET) with patients with spider phobia was conducted on two sites. Clinical, neuroimaging, and genetic data were assessed at baseline, post-treatment and after 6 months. The primary and secondary outcomes defining treatment response are as follows: 30% reduction regarding the individual score in the Spider Phobia Questionnaire and 50% reduction regarding the individual distance in the behavioral avoidance test. RESULTS N = 204 patients have been included (n = 100 in Würzburg, n = 104 in Münster). Sample characteristics for both sites are comparable. DISCUSSION This study will offer cross-validated theranostic markers for predicting the individual success of exposure-based therapy. Findings will support clinical decision-making on personalized therapy, bridge the gap between basic and clinical research, and bring stratified therapy into reach. The study is registered at ClinicalTrials.gov (ID: NCT03208400).
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Affiliation(s)
- Hanna Schwarzmeier
- Department of Psychiatry, Psychosomatics, and Psychotherapy, Center for Mental HealthUniversity Hospital of WürzburgWürzburgGermany
| | | | - Joscha Böhnlein
- Department of Psychiatry and PsychotherapyUniversity of MünsterMünsterGermany
| | - Fabian Reinhard Seeger
- Department of Psychiatry, Psychosomatics, and Psychotherapy, Center for Mental HealthUniversity Hospital of WürzburgWürzburgGermany
| | - Kati Roesmann
- Institute for Biomagnetism and BiosignalanalysisUniversity of MünsterMünsterGermany
- Otto‐Creutzfeld Center for Cognitive and Behavioral NeuroscienceUniversity of MünsterMünsterGermany
| | - Bettina Gathmann
- Institute of Medical Psychology and Systems NeuroscienceUniversity of MünsterMünsterGermany
| | - Martin J. Herrmann
- Department of Psychiatry, Psychosomatics, and Psychotherapy, Center for Mental HealthUniversity Hospital of WürzburgWürzburgGermany
| | - Niklas Siminski
- Department of Psychiatry, Psychosomatics, and Psychotherapy, Center for Mental HealthUniversity Hospital of WürzburgWürzburgGermany
| | - Markus Junghöfer
- Institute for Biomagnetism and BiosignalanalysisUniversity of MünsterMünsterGermany
- Otto‐Creutzfeld Center for Cognitive and Behavioral NeuroscienceUniversity of MünsterMünsterGermany
| | - Thomas Straube
- Institute of Medical Psychology and Systems NeuroscienceUniversity of MünsterMünsterGermany
- Otto‐Creutzfeld Center for Cognitive and Behavioral NeuroscienceUniversity of MünsterMünsterGermany
| | - Dominik Grotegerd
- Department of Psychiatry and PsychotherapyUniversity of MünsterMünsterGermany
| | - Udo Dannlowski
- Department of Psychiatry and PsychotherapyUniversity of MünsterMünsterGermany
- Otto‐Creutzfeld Center for Cognitive and Behavioral NeuroscienceUniversity of MünsterMünsterGermany
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14
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Jenks SK, Zhang S, Li CSR, Hu S. Threat bias and resting state functional connectivity of the amygdala and bed nucleus stria terminalis. J Psychiatr Res 2020; 122:54-63. [PMID: 31927266 PMCID: PMC7010552 DOI: 10.1016/j.jpsychires.2019.12.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 12/23/2019] [Accepted: 12/30/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Previous research has distinguished the activations of the amygdala and bed nucleus of stria terminalis (BNST) during threat-related contingencies. However, how intrinsic connectivities of the amygdala and BNST relate to threat bias remains unclear. Here, we investigated how resting state functional connectivity (rsFC) of the amygdala and BNST in healthy controls (HC) and patients with anxiety-related disorders (PAD) associate with threat bias in a dot-probe task. METHODS Imaging and behavioral data of 30 PAD and 83 HC were obtained from the Nathan Kline Institute - Rockland sample and processed according to published routines. All imaging results were evaluated at voxel p < 0.001 and cluster p < 0.05, FWE corrected in SPM. RESULTS PAD and HC did not show differences in whole brain rsFC with either the amygdala or BNST. In linear regressions threat bias was positively correlated with amygdala-thalamus/anterior cingulate cortex (ACC) rsFC in HC but not PAD, and with BNST-caudate rsFC in PAD but not HC. Slope tests confirmed group differences in the correlations between threat bias and amygdala-thalamus/ACC as well as BNST-caudate rsFC. LIMITATIONS As only half of the patients included were diagnosed with comorbid anxiety, the current findings need to be considered with the clinical heterogeneity and require replication in populations specifically with anxiety disorders. CONCLUSIONS Together, these results suggest amygdala and BNST connectivities as new neural markers of anxiety disorders. Whereas amygdala-thalamus/ACC rsFC support adaptive regulation of threat response in the HC, BNST-caudate rsFC may reflect maladaptive neural processes that are dominated by anticipatory anxiety.
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Affiliation(s)
- Samantha K. Jenks
- Department of Psychology, State University of New York at Oswego, Oswego, NY 13126
| | - Sheng Zhang
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06519
| | - Chiang-shan R. Li
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06519,Department of Neuroscience, Yale University School of Medicine, New Haven, CT 06520,Interdepartmental Neuroscience Program, Yale University, New Haven, CT 06520
| | - Sien Hu
- Department of Psychology, State University of New York at Oswego, Oswego, NY, 13126, USA.
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15
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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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16
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Clauss JA, Avery SN, Benningfield MM, Blackford JU. Social anxiety is associated with BNST response to unpredictability. Depress Anxiety 2019; 36:666-675. [PMID: 30953446 PMCID: PMC6679811 DOI: 10.1002/da.22891] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 02/04/2019] [Accepted: 03/02/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Anxiety disorders are highly prevalent and cause substantial suffering and impairment. Whereas the amygdala has well-established contributions to anxiety, evidence from rodent and nonhuman primate models suggests that the bed nucleus of the stria terminalis (BNST) may play a critical, and possibly distinct, role in human anxiety disorders. The BNST mediates hypervigilance and anticipatory anxiety in response to an unpredictable or ambiguous threat, core symptoms of social anxiety, yet little is known about the BNST's role in social anxiety. METHODS Functional magnetic resonance imaging was used to measure neural responses during a cued anticipation task with an unpredictable, predictable threat, and predictable neutral cues followed by threat or neutral images. Social anxiety was examined using a dimensional approach (N = 44 adults). RESULTS For unpredictable cues, higher social anxiety was associated with lower BNST-amygdala connectivity. For unpredictable images, higher social anxiety was associated with greater connectivity between the BNST and both the ventromedial prefrontal cortex and the posterior cingulate cortex and lower connectivity between the BNST and postcentral gyrus. Social anxiety moderated the BNST-amygdala dissociation for unpredictable images; higher social anxiety was associated with BNST > amygdala response to unpredictable threat relative to unpredictable neutral images. CONCLUSIONS Social anxiety was associated with alterations in BNST responses to unpredictability, particularly in the BNST's interactions with other brain regions, including the amygdala and prefrontal cortex. To our knowledge, these findings provide the first evidence for the BNST's role in social anxiety, which may be a potential new target for prevention and intervention.
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Affiliation(s)
- Jacqueline A Clauss
- Massachusetts General and McLean Hospitals, Harvard Medical School, Boston, MA
| | - Suzanne N Avery
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN
| | - Margaret M Benningfield
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN
| | - Jennifer Urbano Blackford
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN,Department of Psychology, Vanderbilt University, Nashville, TN,Research Service, Research and Development, Department of Veterans Affairs Medical Center, Nashville, TN
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17
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Velasco ER, Florido A, Milad MR, Andero R. Sex differences in fear extinction. Neurosci Biobehav Rev 2019; 103:81-108. [PMID: 31129235 PMCID: PMC6692252 DOI: 10.1016/j.neubiorev.2019.05.020] [Citation(s) in RCA: 70] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 03/08/2019] [Accepted: 05/19/2019] [Indexed: 12/18/2022]
Abstract
Despite the exponential increase in fear research during the last years, few studies have included female subjects in their design. The need to include females arises from the knowledge gap of mechanistic processes underlying the behavioral and neural differences observed in fear extinction. Moreover, the exact contribution of sex and hormones in relation to learning and behavior is still largely unknown. Insights from this field could be beneficial as fear-related disorders are twice as prevalent in women compared to men. Here, we review an up-to-date summary of animal and human studies in adulthood that report sex differences in fear extinction from a structural and functional approach. Furthermore, we describe how these factors could contribute to the observed sex differences in fear extinction during normal and pathological conditions.
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Affiliation(s)
- E R Velasco
- Institut de Neurociències, Universitat Autònoma de Barcelona, Spain
| | - A Florido
- Institut de Neurociències, Universitat Autònoma de Barcelona, Spain
| | - M R Milad
- Department of Psychiatry, University of Illinois at Chicago, USA
| | - R Andero
- Institut de Neurociències, Universitat Autònoma de Barcelona, Spain; CIBERSAM, Corporació Sanitaria Parc Taulí, Sabadell, Spain; Department of Psychobiology and Methodology of Health Sciences, Universitat Autònoma de Barcelona, Spain.
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18
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Radoman M, Phan KL, Gorka SM. Neural correlates of predictable and unpredictable threat in internalizing psychopathology. Neurosci Lett 2019; 701:193-201. [PMID: 30825592 PMCID: PMC6476657 DOI: 10.1016/j.neulet.2019.02.031] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 02/08/2019] [Accepted: 02/20/2019] [Indexed: 11/19/2022]
Abstract
Converging lines of evidence suggest that heightened responding to unpredictable threat may be an important neurobiological marker of internalizing psychopathology (IP). Prior data also indicate that aversive responding to uncertainty may be mediated by hyperactivation of several brain regions within the frontolimbic circuit, namely the anterior insula (aINS) and the dorsal anterior cingulate cortex (dACC). To date, however, the majority of this research has been focused on individual diagnoses and it is unclear whether abnormal neural reactivity to unpredictable threat is observed within heterogeneous, transdiagnostic IP patient populations, as theory would suggest. The aim of the current study was to therefore examine the neural correlates of temporally unpredictable (U) and predictable (P) threat in a sample of healthy controls (n = 24) and patients with a broad range of IP diagnoses (n = 51). We also examined whether symptom severity measures of fear and distress/misery dimensions correlated with neural reactivity to U- and P-threat. All participants completed a modified version of a well-validated threat-of-shock task during functional magnetic resonance imaging (fMRI). Across all participants, U- and P-threat elicited heightened activation in the aINS and brainstem, while P-threat alone also activated the dACC. Relative to healthy controls, patients displayed greater activation in the right aINS during U-threat, and greater right brainstem activation during P-threat. In addition, we found that brainstem activity during U-threat correlated with fear, but not distress/misery, psychopathology. Taken together, these preliminary results suggest that exaggerated aINS reactivity during U-threat and brainstem reactivity during P-threat may have the potential to become important transdiagnostic biomarkers of IP; however, future research efforts are needed to corroborate and expand the present findings.
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Affiliation(s)
- Milena Radoman
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, United States; Department of Anatomy and Cell Biology, and the Graduate Program in Neuroscience, University of Illinois at Chicago, Chicago, IL, United States
| | - K Luan Phan
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, United States; Department of Anatomy and Cell Biology, and the Graduate Program in Neuroscience, University of Illinois at Chicago, Chicago, IL, United States; Department of Psychology, University of Illinois at Chicago, Chicago, IL, United States; Mental Health Service Line, Jesse Brown VA Medical Center, Chicago, IL, United States
| | - Stephanie M Gorka
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, United States; Department of Psychology, University of Illinois at Chicago, Chicago, IL, United States.
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19
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Gentili C, Messerotti Benvenuti S, Lettieri G, Costa C, Cecchetti L. ROI and phobias: The effect of ROI approach on an ALE meta-analysis of specific phobias. Hum Brain Mapp 2019; 40:1814-1828. [PMID: 30548734 PMCID: PMC6865604 DOI: 10.1002/hbm.24492] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Revised: 11/23/2018] [Accepted: 11/28/2018] [Indexed: 12/22/2022] Open
Abstract
About 90% of fMRI findings on specific phobias (SP) include analysis of region of interest (ROI). This approach characterized by higher sensitivity may produce inflated results, particularly when findings are aggregated in meta-analytic maps. Here, we conducted a systematic review and activation likelihood estimation (ALE) meta-analysis on SP, testing the impact of the inclusion of ROI-based studies. ALE meta-analyses were carried out either including ROI-based results or focusing on whole-brain voxelwise studies exclusively. To assess the risk of bias in the neuroimaging field, we modified the Newcastle-Ottawa Scale (NOS) and measured the reliability of fMRI findings. Of the 31 selected investigations (564 patients and 485 controls) one-third did not motivate ROI selection: five studies did not report an explicit rationale, whereas four did not cite any specific reference in this regard. Analyses including ROI-based studies revealed differences between phobics and healthy subjects in several regions of the limbic circuit. However, when focusing on whole-brain analysis, only the anterior midcingulate cortex differentiated SP from controls. Notably, 13 studies were labeled with low risk of bias according to the adapted NOS. The inclusion of ROI-based results artificially inflates group differences in fMRI meta-analyses. Moreover, a priori, well-motivated selection of ROIs is desirable to improve quality and reproducibility in SP neuroimaging studies. Lastly, the use of modified NOS may represent a valuable way to assess and evaluate biases in fMRI studies: "low risk" of bias was reported for less than half of the included studies, indicating the need for better practices in fMRI.
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Affiliation(s)
- Claudio Gentili
- Department of General PsychologyUniversity of PadovaPadovaItaly
| | | | | | - Cristiano Costa
- Department of General PsychologyUniversity of PadovaPadovaItaly
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20
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Goode TD, Ressler RL, Acca GM, Miles OW, Maren S. Bed nucleus of the stria terminalis regulates fear to unpredictable threat signals. eLife 2019; 8:46525. [PMID: 30946011 PMCID: PMC6456295 DOI: 10.7554/elife.46525] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Accepted: 03/28/2019] [Indexed: 12/15/2022] Open
Abstract
The bed nucleus of the stria terminalis (BNST) has been implicated in conditioned fear and anxiety, but the specific factors that engage the BNST in defensive behaviors are unclear. Here we examined whether the BNST mediates freezing to conditioned stimuli (CSs) that poorly predict the onset of aversive unconditioned stimuli (USs) in rats. Reversible inactivation of the BNST selectively reduced freezing to CSs that poorly signaled US onset (e.g., a backward CS that followed the US), but did not eliminate freezing to forward CSs even when they predicted USs of variable intensity. Additionally, backward (but not forward) CSs selectively increased Fos in the ventral BNST and in BNST-projecting neurons in the infralimbic region of the medial prefrontal cortex (mPFC), but not in the hippocampus or amygdala. These data reveal that BNST circuits regulate fear to unpredictable threats, which may be critical to the etiology and expression of anxiety.
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Affiliation(s)
- Travis D Goode
- Department of Psychological and Brain Sciences, Institute for Neuroscience, Texas A&M University, College Station, United States
| | - Reed L Ressler
- Department of Psychological and Brain Sciences, Institute for Neuroscience, Texas A&M University, College Station, United States
| | - Gillian M Acca
- Department of Psychological and Brain Sciences, Institute for Neuroscience, Texas A&M University, College Station, United States
| | - Olivia W Miles
- Department of Psychological and Brain Sciences, Institute for Neuroscience, Texas A&M University, College Station, United States
| | - Stephen Maren
- Department of Psychological and Brain Sciences, Institute for Neuroscience, Texas A&M University, College Station, United States
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The Role of the Amygdala and the Ventromedial Prefrontal Cortex in Emotional Regulation: Implications for Post-traumatic Stress Disorder. Neuropsychol Rev 2019; 29:220-243. [DOI: 10.1007/s11065-019-09398-4] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2017] [Accepted: 02/14/2019] [Indexed: 10/27/2022]
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22
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Phasic amygdala and BNST activation during the anticipation of temporally unpredictable social observation in social anxiety disorder patients. NEUROIMAGE-CLINICAL 2019; 22:101735. [PMID: 30878610 PMCID: PMC6423472 DOI: 10.1016/j.nicl.2019.101735] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 02/17/2019] [Accepted: 02/21/2019] [Indexed: 01/05/2023]
Abstract
Anticipation of potentially threatening social situations is a key process in social anxiety disorder (SAD). In other anxiety disorders, recent research of neural correlates of anticipation of temporally unpredictable threat suggests a temporally dissociable involvement of amygdala and bed nucleus of the stria terminalis (BNST) with phasic amygdala responses and sustained BNST activation. However, the temporal profile of amygdala and BNST responses during temporal unpredictability of threat has not been investigated in patients suffering from SAD. We used functional magnetic resonance imaging (fMRI) to investigate neural activation in the central nucleus of the amygdala (CeA) and the BNST during anticipation of temporally unpredictable aversive (video camera observation) relative to neutral (no camera observation) events in SAD patients compared to healthy controls (HC). For the analysis of fMRI data, we applied two regressors (phasic/sustained) within the same model to detect temporally dissociable brain responses. The aversive condition induced increased anxiety in patients compared to HC. SAD patients compared to HC showed increased phasic activation in the CeA and the BNST for anticipation of aversive relative to neutral events. SAD patients as well as HC showed sustained activity alterations in the BNST for aversive relative to neutral anticipation. No differential activity during sustained threat anticipation in SAD patients compared to HC was found. Taken together, our study reveals both CeA and BNST involvement during threat anticipation in SAD patients. The present results point towards potentially SAD-specific threat processing marked by elevated phasic but not sustained CeA and BNST responses when compared to HC. fMRI in SAD during anticipation of temporally unpredictable aversive events. Anticipation of social observation induces increased anxiety in SAD patients. SAD patients show elevated phasic activity in fundamental anxiety network regions. Evidence of SAD-specific threat processing.
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23
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Fox AS, Shackman AJ. The central extended amygdala in fear and anxiety: Closing the gap between mechanistic and neuroimaging research. Neurosci Lett 2019; 693:58-67. [PMID: 29195911 PMCID: PMC5976525 DOI: 10.1016/j.neulet.2017.11.056] [Citation(s) in RCA: 123] [Impact Index Per Article: 24.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 09/30/2017] [Accepted: 11/26/2017] [Indexed: 12/19/2022]
Abstract
Anxiety disorders impose a staggering burden on public health, underscoring the need to develop a deeper understanding of the distributed neural circuits underlying extreme fear and anxiety. Recent work highlights the importance of the central extended amygdala, including the central nucleus of the amygdala (Ce) and neighboring bed nucleus of the stria terminalis (BST). Anatomical data indicate that the Ce and BST form a tightly interconnected unit, where different kinds of threat-relevant information can be integrated to assemble states of fear and anxiety. Neuroimaging studies show that the Ce and BST are engaged by a broad spectrum of potentially threat-relevant cues. Mechanistic work demonstrates that the Ce and BST are critically involved in organizing defensive responses to a wide range of threats. Studies in rodents have begun to reveal the specific molecules, cells, and microcircuits within the central extended amygdala that underlie signs of fear and anxiety, but the relevance of these tantalizing discoveries to human experience and disease remains unclear. Using a combination of focal perturbations and whole-brain imaging, a new generation of nonhuman primate studies is beginning to close this gap. This work opens the door to discovering the mechanisms underlying neuroimaging measures linked to pathological fear and anxiety, to understanding how the Ce and BST interact with one another and with distal brain regions to govern defensive responses to threat, and to developing improved intervention strategies.
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Affiliation(s)
- Andrew S Fox
- Department of Psychology and University of California, Davis, CA 95616, United States; California National Primate Research Center, University of California, Davis, CA 95616, United States.
| | - Alexander J Shackman
- Department of Psychology, University of Maryland, College Park, MD 20742, United States; Neuroscience and Cognitive Science Program, University of Maryland, College Park, MD 20742, United States; Maryland Neuroimaging Center, University of Maryland,College Park, MD 20742, United States.
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24
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Knight LK, Depue BE. New Frontiers in Anxiety Research: The Translational Potential of the Bed Nucleus of the Stria Terminalis. Front Psychiatry 2019; 10:510. [PMID: 31379626 PMCID: PMC6650589 DOI: 10.3389/fpsyt.2019.00510] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Accepted: 06/28/2019] [Indexed: 12/17/2022] Open
Abstract
After decades of being overshadowed by the amygdala, new perspectives suggest that a tiny basal forebrain region known as the bed nucleus of the stria terminalis (BNST) may hold key insights into understanding and treating anxiety disorders. Converging research indicates that the amygdala and BNST play complementary but distinct functional roles during threat processing, with the BNST specializing in the detection of a potential threat to maintain hypervigilance and anxiety, while the amygdala responds to the perceived presence of an aversive stimulus (i.e., fear). Therefore, given that human anxiety is largely driven by future-oriented hypothetical threats that may never occur, studies involving the BNST stand at the forefront of essential future research with the potential to bring about profound insights for understanding and treating anxiety disorders. In this article, we present a narrative review on the BNST, summarizing its roles in anxiety and the stress response and highlighting the most recent advances in the clinical realm. Furthermore, we discuss oversights in the current state of anxiety research and identify avenues for future exploration.
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Affiliation(s)
- Lindsay K Knight
- Interdisciplinary Program in Translational Neuroscience, University of Louisville, Louisville, KY, United States.,Department of Psychological and Brain Sciences, University of Louisville, Louisville, KY, United States
| | - Brendan E Depue
- Department of Psychological and Brain Sciences, University of Louisville, Louisville, KY, United States.,Department of Anatomical Sciences and Neurobiology, University of Louisville, Louisville, KY, United States
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25
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Gill BJA, Khan FA, McKhann GM. Fear Not, We Found What's Making You Anxious. Neurosurgery 2018; 83:E207-E208. [DOI: 10.1093/neuros/nyy404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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26
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Buff C, Brinkmann L, Bruchmann M, Becker MPI, Tupak S, Herrmann MJ, Straube T. Activity alterations in the bed nucleus of the stria terminalis and amygdala during threat anticipation in generalized anxiety disorder. Soc Cogn Affect Neurosci 2018; 12:1766-1774. [PMID: 28981839 PMCID: PMC5714227 DOI: 10.1093/scan/nsx103] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 08/17/2017] [Indexed: 11/14/2022] Open
Abstract
Sustained anticipatory anxiety is central to Generalized Anxiety Disorder (GAD). During anticipatory anxiety, phasic threat responding appears to be mediated by the amygdala, while sustained threat responding seems related to the bed nucleus of the stria terminalis (BNST). Although sustained anticipatory anxiety in GAD patients was proposed to be associated with BNST activity alterations, firm evidence is lacking. We aimed to explore temporal characteristics of BNST and amygdala activity during threat anticipation in GAD patients. Nineteen GAD patients and nineteen healthy controls (HC) underwent functional magnetic resonance imaging (fMRI) during a temporally unpredictable threat anticipation paradigm. We defined phasic and a systematic variation of sustained response models for blood oxygen level-dependent responses during threat anticipation, to disentangle temporally dissociable involvement of the BNST and the amygdala. GAD patients relative to HC responded with increased phasic amygdala activity to onset of threat anticipation and with elevated sustained BNST activity that was delayed relative to the onset of threat anticipation. Both the amygdala and the BNST displayed altered responses during threat anticipation in GAD patients, albeit with different time courses. The results for the BNST activation hint towards its role in sustained threat responding, and contribute to a deeper understanding of pathological sustained anticipatory anxiety in GAD.
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Affiliation(s)
- Christine Buff
- Institute of Medical Psychology and Systems Neuroscience, University of Muenster, 48149 Muenster, Germany
| | - Leonie Brinkmann
- Institute of Medical Psychology and Systems Neuroscience, University of Muenster, 48149 Muenster, Germany
| | - Maximilian Bruchmann
- Institute of Medical Psychology and Systems Neuroscience, University of Muenster, 48149 Muenster, Germany
| | - Michael P I Becker
- Institute of Medical Psychology and Systems Neuroscience, University of Muenster, 48149 Muenster, Germany
| | - Sara Tupak
- Institute of Medical Psychology and Systems Neuroscience, University of Muenster, 48149 Muenster, Germany
| | - Martin J Herrmann
- Department of Psychiatry, Psychosomatics and Psychotherapy, University Clinic Wuerzburg, 97080 Wuerzburg, Germany
| | - Thomas Straube
- Institute of Medical Psychology and Systems Neuroscience, University of Muenster, 48149 Muenster, Germany
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Dittert N, Hüttner S, Polak T, Herrmann MJ. Augmentation of Fear Extinction by Transcranial Direct Current Stimulation (tDCS). Front Behav Neurosci 2018; 12:76. [PMID: 29922133 PMCID: PMC5996916 DOI: 10.3389/fnbeh.2018.00076] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 04/06/2018] [Indexed: 12/16/2022] Open
Abstract
Although posttraumatic stress disorder (PTSD; DSM-V 309.82) and anxiety disorders (DSM-V 300.xx) are widely spread mental disorders, the effectiveness of their therapy is still unsatisfying. Non-invasive brain-stimulation techniques like transcranial direct current stimulation (tDCS) might be an option to improve extinction learning, which is a main functional factor of exposure-based therapy for anxiety disorders. To examine this hypothesis, we used a fear conditioning paradigm with female faces as conditioned stimuli (CS) and a 95-dB female scream as unconditioned stimulus (UCS). We aimed to perform a tDCS of the ventromedial prefrontal cortex (vmPFC), which is mainly involved in the control of extinction-processes. Therefore, we applied two 4 × 4 cm electrodes approximately at the EEG-positions F7 and F8 and used a direct current of 1.5 mA. The 20-min stimulation was started during a 10-min break between acquisition and extinction and went on overall extinction-trials. The healthy participants were randomly assigned in two double-blinded process into two sham stimulation and two verum stimulation groups with opposite current flow directions. To measure the fear reactions, we used skin conductance responses (SCR) and subjective ratings. We performed a generalized estimating equations model for the SCR to assess the impact of tDCS and current flow direction on extinction processes for all subjects that showed a successful conditioning (N = 84). The results indicate that tDCS accelerates early extinction processes with a significantly faster loss of CS+/CS– discrimination. The discrimination loss was driven by a significant decrease in reaction toward the CS+ as well as an increase in reaction toward the CS– in the tDCS verum groups, whereas the sham groups showed no significant reaction changes during this period. Therefore, we assume that tDCS of the vmPFC can be used to enhance early extinction processes successfully. But before it should be tested in a clinical context further investigation is needed to assess the reason for the reaction increase on CS–. If this negative side effect can be avoided, tDCS may be a tool to improve exposure-based anxiety therapies.
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Affiliation(s)
- Natalie Dittert
- Department of Psychiatry, Psychosomatics, and Psychotherapy, Center of Mental Health, University Hospital Würzburg, Würzburg, Germany
| | - Sandrina Hüttner
- Department of Psychiatry, Psychosomatics, and Psychotherapy, Center of Mental Health, University Hospital Würzburg, Würzburg, Germany
| | - Thomas Polak
- Department of Psychiatry, Psychosomatics, and Psychotherapy, Center of Mental Health, University Hospital Würzburg, Würzburg, Germany
| | - Martin J Herrmann
- Department of Psychiatry, Psychosomatics, and Psychotherapy, Center of Mental Health, University Hospital Würzburg, Würzburg, Germany
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28
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Optogenetic silencing of a corticotropin-releasing factor pathway from the central amygdala to the bed nucleus of the stria terminalis disrupts sustained fear. Mol Psychiatry 2018; 23:914-922. [PMID: 28439099 PMCID: PMC5656568 DOI: 10.1038/mp.2017.79] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Revised: 02/22/2017] [Accepted: 02/24/2017] [Indexed: 01/19/2023]
Abstract
The lateral central nucleus of the amygdala (CeAL) and the dorsolateral bed nucleus of the stria terminalis (BNSTDL) coordinate the expression of shorter- and longer-lasting fears, respectively. Less is known about how these structures communicate with each other during fear acquisition. One pathway, from the CeAL to the BNSTDL, is thought to communicate via corticotropin-releasing factor (CRF), but studies have yet to examine its function in fear learning and memory. Thus, we developed an adeno-associated viral-based strategy to selectively target CRF neurons with the optogenetic silencer archaerhodopsin tp009 (CRF-ArchT) to examine the role of CeAL CRF neurons and projections to the BNSTDL during the acquisition of contextual fear. Expression of our CRF-ArchT vector injected into the amygdala was restricted to CeAL CRF neurons. Furthermore, CRF axonal projections from the CeAL clustered around BNSTDL CRF cells. Optogenetic silencing of CeAL CRF neurons during contextual fear acquisition disrupted retention test freezing 24 h later, but only at later time points (>6 min) during testing. Silencing CeAL CRF projections in the BNSTDL during contextual fear acquisition produced a similar effect. Baseline contextual freezing, the rate of fear acquisition, freezing in an alternate context after conditioning and responsivity to foot shock were unaffected by optogenetic silencing. Our results highlight how CeAL CRF neurons and projections to the BNSTDL consolidate longer-lasting components of a fear memory. Our findings have implications for understanding how discrete amygdalar CRF pathways modulate longer-lasting fear in anxiety- and trauma-related disorders.
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29
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Tillman RM, Stockbridge MD, Nacewicz BM, Torrisi S, Fox AS, Smith JF, Shackman AJ. Intrinsic functional connectivity of the central extended amygdala. Hum Brain Mapp 2018; 39:1291-1312. [PMID: 29235190 PMCID: PMC5807241 DOI: 10.1002/hbm.23917] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Revised: 12/03/2017] [Accepted: 12/04/2017] [Indexed: 12/16/2022] Open
Abstract
The central extended amygdala (EAc)-including the bed nucleus of the stria terminalis (BST) and central nucleus of the amygdala (Ce)-plays a critical role in triggering fear and anxiety and is implicated in the development of a range of debilitating neuropsychiatric disorders. Although it is widely believed that these disorders reflect the coordinated activity of distributed neural circuits, the functional architecture of the EAc network and the degree to which the BST and the Ce show distinct patterns of functional connectivity is unclear. Here, we used a novel combination of imaging approaches to trace the connectivity of the BST and the Ce in 130 healthy, racially diverse, community-dwelling adults. Multiband imaging, high-precision registration techniques, and spatially unsmoothed data maximized anatomical specificity. Using newly developed seed regions, whole-brain regression analyses revealed robust functional connectivity between the BST and Ce via the sublenticular extended amygdala, the ribbon of subcortical gray matter encompassing the ventral amygdalofugal pathway. Both regions displayed coupling with the ventromedial prefrontal cortex (vmPFC), midcingulate cortex (MCC), insula, and anterior hippocampus. The BST showed stronger connectivity with the thalamus, striatum, periaqueductal gray, and several prefrontal territories. The only regions showing stronger functional connectivity with the Ce were neighboring regions of the dorsal amygdala, amygdalohippocampal area, and anterior hippocampus. These observations provide a baseline against which to compare a range of special populations, inform our understanding of the role of the EAc in normal and pathological fear and anxiety, and showcase image registration techniques that are likely to be useful for researchers working with "deidentified" neuroimaging data.
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Affiliation(s)
| | - Melissa D. Stockbridge
- Department of Hearing and Speech SciencesUniversity of MarylandCollege ParkMaryland20742
| | - Brendon M. Nacewicz
- Department of PsychiatryUniversity of Wisconsin—Madison, 6001 Research Park BoulevardMadisonWisconsin53719
| | - Salvatore Torrisi
- Section on the Neurobiology of Fear and AnxietyNational Institute of Mental HealthBethesdaMaryland20892
| | - Andrew S. Fox
- Department of PsychologyUniversity of CaliforniaDavisCalifornia95616
- California National Primate Research CenterUniversity of CaliforniaDavisCalifornia95616
| | - Jason F. Smith
- Department of PsychologyUniversity of MarylandCollege ParkMaryland20742
| | - Alexander J. Shackman
- Department of PsychologyUniversity of MarylandCollege ParkMaryland20742
- Neuroscience and Cognitive Science ProgramUniversity of MarylandCollege ParkMaryland20742
- Maryland Neuroimaging CenterUniversity of MarylandCollege ParkMaryland20742
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30
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Brinkmann L, Buff C, Feldker K, Neumeister P, Heitmann CY, Hofmann D, Bruchmann M, Herrmann MJ, Straube T. Inter-individual differences in trait anxiety shape the functional connectivity between the bed nucleus of the stria terminalis and the amygdala during brief threat processing. Neuroimage 2018; 166:110-116. [DOI: 10.1016/j.neuroimage.2017.10.054] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 09/27/2017] [Accepted: 10/25/2017] [Indexed: 12/20/2022] Open
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31
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Brinkmann L, Buff C, Feldker K, Tupak SV, Becker MPI, Herrmann MJ, Straube T. Distinct phasic and sustained brain responses and connectivity of amygdala and bed nucleus of the stria terminalis during threat anticipation in panic disorder. Psychol Med 2017; 47:2675-2688. [PMID: 28485259 DOI: 10.1017/s0033291717001192] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Panic disorder (PD) patients are constantly concerned about future panic attacks and exhibit general hypersensitivity to unpredictable threat. We aimed to reveal phasic and sustained brain responses and functional connectivity of the amygdala and the bed nucleus of the stria terminalis (BNST) during threat anticipation in PD. METHODS Using functional magnetic resonance imaging (fMRI), we investigated 17 PD patients and 19 healthy controls (HC) during anticipation of temporally unpredictable aversive and neutral sounds. We used a phasic and sustained analysis model to disentangle temporally dissociable brain activations. RESULTS PD patients compared with HC showed phasic amygdala and sustained BNST responses during anticipation of aversive v. neutral stimuli. Furthermore, increased phasic activation was observed in anterior cingulate cortex (ACC), insula and prefrontal cortex (PFC). Insula and PFC also showed sustained activation. Functional connectivity analyses revealed partly distinct phasic and sustained networks. CONCLUSIONS We demonstrate a role for the BNST during unpredictable threat anticipation in PD and provide first evidence for dissociation between phasic amygdala and sustained BNST activation and their functional connectivity. In line with a hypersensitivity to uncertainty in PD, our results suggest time-dependent involvement of brain regions related to fear and anxiety.
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Affiliation(s)
- L Brinkmann
- Institute of Medical Psychology and Systems Neuroscience, University of Muenster,Von-Esmarch-Str. 52, Muenster,Germany
| | - C Buff
- Institute of Medical Psychology and Systems Neuroscience, University of Muenster,Von-Esmarch-Str. 52, Muenster,Germany
| | - K Feldker
- Institute of Medical Psychology and Systems Neuroscience, University of Muenster,Von-Esmarch-Str. 52, Muenster,Germany
| | - S V Tupak
- Institute of Medical Psychology and Systems Neuroscience, University of Muenster,Von-Esmarch-Str. 52, Muenster,Germany
| | - M P I Becker
- Institute of Medical Psychology and Systems Neuroscience, University of Muenster,Von-Esmarch-Str. 52, Muenster,Germany
| | - M J Herrmann
- Department of Psychiatry, Psychosomatics and Psychotherapy,Center of Mental Health, University Hospital Wuerzburg,Margarete-Hoeppel-Platz 1, Wuerzburg,Germany
| | - T Straube
- Institute of Medical Psychology and Systems Neuroscience, University of Muenster,Von-Esmarch-Str. 52, Muenster,Germany
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Gorka SM, Lieberman L, Klumpp H, Kinney KL, Kennedy AE, Ajilore O, Francis J, Duffecy J, Craske MG, Nathan J, Langenecker S, Shankman SA, Phan KL. Reactivity to unpredictable threat as a treatment target for fear-based anxiety disorders. Psychol Med 2017; 47:2450-2460. [PMID: 28436351 DOI: 10.1017/s0033291717000964] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Heightened reactivity to unpredictable threat (U-threat) is a core individual difference factor underlying fear-based psychopathology. Little is known, however, about whether reactivity to U-threat is a stable marker of fear-based psychopathology or if it is malleable to treatment. The aim of the current study was to address this question by examining differences in reactivity to U-threat within patients before and after 12-weeks of selective serotonin reuptake inhibitors (SSRIs) or cognitive-behavioral therapy (CBT). METHODS Participants included patients with principal fear (n = 22) and distress/misery disorders (n = 29), and a group of healthy controls (n = 21) assessed 12-weeks apart. A well-validated threat-of-shock task was used to probe reactivity to predictable (P-) and U-threat and startle eyeblink magnitude was recorded as an index of defensive responding. RESULTS Across both assessments, individuals with fear-based disorders displayed greater startle magnitude to U-threat relative to healthy controls and distress/misery patients (who did not differ). From pre- to post-treatment, startle magnitude during U-threat decreased only within the fear patients who received CBT. Moreover, within fear patients, the magnitude of decline in startle to U-threat correlated with the magnitude of decline in fear symptoms. For the healthy controls, startle to U-threat across the two time points was highly reliable and stable. CONCLUSIONS Together, these results indicate that startle to U-threat characterizes fear disorder patients and is malleable to treatment with CBT but not SSRIs within fear patients. Startle to U-threat may therefore reflect an objective, psychophysiological indicator of fear disorder status and CBT treatment response.
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Affiliation(s)
- S M Gorka
- Department of Psychiatry,University of Illinois-Chicago,1747 West Roosevelt Road Chicago, IL 60608,USA
| | - L Lieberman
- Department of Psychology,University of Illinois-Chicago,1007 West Harrison St. (M/C 285) Chicago, IL 60607,USA
| | - H Klumpp
- Department of Psychiatry,University of Illinois-Chicago,1747 West Roosevelt Road Chicago, IL 60608,USA
| | - K L Kinney
- Department of Psychiatry,University of Illinois-Chicago,1747 West Roosevelt Road Chicago, IL 60608,USA
| | - A E Kennedy
- Department of Psychiatry,University of Illinois-Chicago,1747 West Roosevelt Road Chicago, IL 60608,USA
| | - O Ajilore
- Department of Psychiatry,University of Illinois-Chicago,1747 West Roosevelt Road Chicago, IL 60608,USA
| | - J Francis
- Department of Psychiatry,University of Illinois-Chicago,1747 West Roosevelt Road Chicago, IL 60608,USA
| | - J Duffecy
- Department of Psychiatry,University of Illinois-Chicago,1747 West Roosevelt Road Chicago, IL 60608,USA
| | - M G Craske
- Department of Psychology,University of California,Los Angeles, Franz Hall - Box 95156 Los Angeles, CA 90094,USA
| | - J Nathan
- Department of Psychiatry,University of Illinois-Chicago,1747 West Roosevelt Road Chicago, IL 60608,USA
| | - S Langenecker
- Department of Psychiatry,University of Illinois-Chicago,1747 West Roosevelt Road Chicago, IL 60608,USA
| | - S A Shankman
- Department of Psychiatry,University of Illinois-Chicago,1747 West Roosevelt Road Chicago, IL 60608,USA
| | - K L Phan
- Department of Psychiatry,University of Illinois-Chicago,1747 West Roosevelt Road Chicago, IL 60608,USA
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Garcia R. Neurobiology of fear and specific phobias. ACTA ACUST UNITED AC 2017; 24:462-471. [PMID: 28814472 PMCID: PMC5580526 DOI: 10.1101/lm.044115.116] [Citation(s) in RCA: 79] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 06/02/2017] [Indexed: 01/01/2023]
Abstract
Fear, which can be expressed innately or after conditioning, is triggered when a danger or a stimulus predicting immediate danger is perceived. Its role is to prepare the body to face this danger. However, dysfunction in fear processing can lead to psychiatric disorders in which fear outweighs the danger or possibility of harm. Although recognized as highly debilitating, pathological fear remains insufficiently treated, indicating the importance of research on fear processing. The neurobiological basis of normal and pathological fear reactions is reviewed in this article. Innate and learned fear mechanisms, particularly those involving the amygdala, are considered. These fear mechanisms are also distinguished in specific phobias, which can indeed be nonexperiential (implicating innate, learning-independent mechanisms) or experiential (implicating learning-dependent mechanisms). Poor habituation and poor extinction are presented as dysfunctional mechanisms contributing to persistence of nonexperiential and experiential phobias, respectively.
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Affiliation(s)
- René Garcia
- Institut de Neurosciences de la Timone, UMR7289, Aix Marseille Université & Centre National de la Recherche Scientifique, 13385 Marseille, France
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34
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Heightened extended amygdala metabolism following threat characterizes the early phenotypic risk to develop anxiety-related psychopathology. Mol Psychiatry 2017; 22:724-732. [PMID: 27573879 PMCID: PMC5332536 DOI: 10.1038/mp.2016.132] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2015] [Revised: 05/19/2016] [Accepted: 06/01/2016] [Indexed: 12/12/2022]
Abstract
Children with an anxious temperament are prone to heightened shyness and behavioral inhibition (BI). When chronic and extreme, this anxious, inhibited phenotype is an important early-life risk factor for the development of anxiety disorders, depression and co-morbid substance abuse. Individuals with extreme anxious temperament often show persistent distress in the absence of immediate threat and this contextually inappropriate anxiety predicts future symptom development. Despite its clear clinical relevance, the neural circuitry governing the maladaptive persistence of anxiety remains unclear. Here, we used a well-established nonhuman primate model of childhood temperament and high-resolution 18fluorodeoxyglucose positron emission tomography (FDG-PET) imaging to understand the neural systems governing persistent anxiety and to clarify their relevance to early-life phenotypic risk. We focused on BI, a core component of anxious temperament, because it affords the moment-by-moment temporal resolution needed to assess contextually appropriate and inappropriate anxiety. From a pool of 109 peri-adolescent rhesus monkeys, we formed groups characterized by high or low levels of BI, as indexed by freezing in response to an unfamiliar human intruder's profile. The high-BI group showed consistently elevated signs of anxiety and wariness across >2 years of assessments. At the time of brain imaging, 1.5 years after initial phenotyping, the high-BI group showed persistently elevated freezing during a 30-min 'recovery' period following an encounter with the intruder-more than an order of magnitude greater than the low-BI group-and this was associated with increased metabolism in the bed nucleus of the stria terminalis, a key component of the central extended amygdala. These observations provide a neurobiological framework for understanding the early phenotypic risk to develop anxiety-related psychopathology, for accelerating the development of improved interventions, and for understanding the origins of childhood temperament.
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Klahn AL, Klinkenberg IA, Lueken U, Notzon S, Arolt V, Pantev C, Zwanzger P, Junghoefer M. Commonalities and differences in the neural substrates of threat predictability in panic disorder and specific phobia. NEUROIMAGE-CLINICAL 2017; 14:530-537. [PMID: 28331799 PMCID: PMC5345973 DOI: 10.1016/j.nicl.2017.02.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 01/15/2017] [Accepted: 02/16/2017] [Indexed: 10/27/2022]
Abstract
Different degrees of threat predictability are thought to induce either phasic fear or sustained anxiety. Maladaptive, sustained anxious apprehension is thought to result in overgeneralization of anxiety and thereby to contribute to the development of anxiety disorders. Therefore, differences in threat predictability have been associated with pathological states of anxiety with specific phobia (SP) representing phasic fear as heightened response to predictable threat, while panic disorder (PD) is characterized by sustained anxiety (unpredictable threat) and, as a consequence, overgeneralization of fear. The present study aimed to delineate commonalities and differences in the neural substrates of the impact of threat predictability on affective processing in these two anxiety disorders. Twenty PD patients, 20 SP patients and 20 non-anxious control subjects were investigated with an adapted NPU-design (no, predictable, unpredictable threat) using whole-head magnetoencephalography (MEG). Group independent neural activity in the right dlPFC increased with decreasing threat predictability. PD patients showed a sustained hyperactivation of the vmPFC under threat and safety conditions. The magnitude of hyperactivation was inversely correlated with PDs subjective arousal and anxiety sensitivity. Both PD and SP patients revealed decreased parietal processing of affective stimuli. Findings indicate overgeneralization between threat and safety conditions and increased need for emotion regulation via the vmPFC in PD, but not SP patients. Both anxiety disorders showed decreased activation in parietal networks possibly indicating attentional avoidance of affective stimuli. Present results complement findings from fear conditioning studies and underline overgeneralization of fear, particularly in PD.
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Affiliation(s)
- Anna Luisa Klahn
- Department of Psychiatry and Psychotherapy, University Hospital Muenster, Germany
| | | | - Ulrike Lueken
- Department of Psychiatry, Psychosomatics and Psychotherapy, University Hospital Wuerzburg, Germany
| | - Swantje Notzon
- Department of Psychiatry and Psychotherapy, University Hospital Muenster, Germany
| | - Volker Arolt
- Department of Psychiatry and Psychotherapy, University Hospital Muenster, Germany
| | - Christo Pantev
- Institute for Biogmagnetism and Biosignalanalysis, University of Muenster, Germany
| | - Peter Zwanzger
- Department of Psychiatry and Psychotherapy, University Hospital Muenster, Germany; kbo-Inn-Salzach-Hospital, Wasserburg am Inn, Germany; Department of Psychiatry and Psychotherapy, Ludwig Maximilian University of Munich, Germany
| | - Markus Junghoefer
- Institute for Biogmagnetism and Biosignalanalysis, University of Muenster, Germany
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Brinkmann L, Buff C, Neumeister P, Tupak SV, Becker MPI, Herrmann MJ, Straube T. Dissociation between amygdala and bed nucleus of the stria terminalis during threat anticipation in female post-traumatic stress disorder patients. Hum Brain Mapp 2017; 38:2190-2205. [PMID: 28070973 DOI: 10.1002/hbm.23513] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Revised: 12/15/2016] [Accepted: 01/03/2017] [Indexed: 01/21/2023] Open
Abstract
Feelings of uncontrollability and anxiety regarding possibly harmful events are key features of post-traumatic stress disorder (PTSD) symptomatology. Due to a lack of studies, the neural correlates of anticipatory anxiety in PTSD are still poorly understood. During functional magnetic resonance imaging, female PTSD patients with interpersonal violence trauma and healthy controls (HC) anticipated the temporally unpredictable presentation of aversive (human scream) or neutral sounds. Based on separate analysis models, we investigated phasic and sustained brain activations. PTSD patients reported increased anxiety during anticipation of aversive versus neutral sounds. Furthermore, we found both increased initial, phasic amygdala activation and increased sustained activation of the bed nucleus of the stria terminalis (BNST) during anticipation of aversive versus neutral sounds in PTSD patients in comparison to HC. PTSD patients as compared with HC also showed increased phasic responses in mid-cingulate cortex (MCC), posterior cingulate cortex (PCC), mid-insula and lateral prefrontal cortex (PFC) as well as increased sustained responses in MCC, PCC, anterior insula and lateral and medial PFC. Our results demonstrate a relationship between anticipatory anxiety in PTSD patients and hyperresponsiveness of brain regions that have previously been associated with PTSD symptomatology. Additionally, the dissociation between amygdala and BNST indicates distinct temporal and functional characteristics and suggests that phasic fear and sustained anxiety responses are enhanced during unpredictable anticipation of aversive stimuli in PTSD. Hum Brain Mapp 38:2190-2205, 2017. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Leonie Brinkmann
- Institute of Medical Psychology and Systems Neuroscience, University of Muenster, Von-Esmarch-Str. 52, Muenster, D-48149, Germany
| | - Christine Buff
- Institute of Medical Psychology and Systems Neuroscience, University of Muenster, Von-Esmarch-Str. 52, Muenster, D-48149, Germany
| | - Paula Neumeister
- Institute of Medical Psychology and Systems Neuroscience, University of Muenster, Von-Esmarch-Str. 52, Muenster, D-48149, Germany
| | - Sara V Tupak
- Institute of Medical Psychology and Systems Neuroscience, University of Muenster, Von-Esmarch-Str. 52, Muenster, D-48149, Germany
| | - Michael P I Becker
- Institute of Medical Psychology and Systems Neuroscience, University of Muenster, Von-Esmarch-Str. 52, Muenster, D-48149, Germany
| | - Martin J Herrmann
- Department of Psychiatry, Psychosomatics and Psychotherapy, University Hospital Wuerzburg, Margarete-Hoeppel-Platz 1, D-97080, Wuerzburg, Germany
| | - Thomas Straube
- Institute of Medical Psychology and Systems Neuroscience, University of Muenster, Von-Esmarch-Str. 52, Muenster, D-48149, Germany
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Brinkmann L, Poller H, Herrmann MJ, Miltner W, Straube T. Initial and sustained brain responses to threat anticipation in blood-injection-injury phobia. NEUROIMAGE-CLINICAL 2016; 13:320-329. [PMID: 28066706 PMCID: PMC5200881 DOI: 10.1016/j.nicl.2016.12.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Revised: 11/03/2016] [Accepted: 12/16/2016] [Indexed: 12/20/2022]
Abstract
Blood-injection-injury (BII) phobia differs from other subtypes of specific phobia in that it is associated with elevated disgust-sensitivity as well as specific autonomic and brain responses during processing of phobia-relevant stimuli. To what extent these features play a role already during threat anticipation is unclear. In the current fMRI experiment, 16 female BII phobics and 16 female healthy controls anticipated the presentation of phobia-specific and neutral pictures. On the behavioral level, anxiety dominated the anticipatory period in BII phobics relative to controls, while both anxiety and disgust were elevated during picture presentation. By applying two different models for the analysis of brain responses to anticipation of phobia-specific versus neutral stimuli, we found initial and sustained increases of activation in anterior cingulate cortex (ACC), insula, lateral and medial prefrontal cortex (PFC), thalamus and visual areas, as well as initial activation in the amygdala for BII phobics as compared to healthy controls. These results suggest that BII phobia is characterized by activation of a typical neural defense network during threat anticipation, with anxiety as the predominant emotion.
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Affiliation(s)
- Leonie Brinkmann
- Institute of Medical Psychology and Systems Neuroscience, University of Muenster, Von-Esmarch-Str. 52, D-48149 Muenster, Germany
| | - Hendrik Poller
- Department of Biological and Clinical Psychology, Friedrich-Schiller-University Jena, Am Steiger 3, D-07743 Jena, Germany
| | - Martin J Herrmann
- Laboratory of Psychophysiology and Functional Imaging, University Hospital Wuerzburg, Fuechsleinstraße 15, D-97080 Wuerzburg, Germany
| | - Wolfgang Miltner
- Department of Biological and Clinical Psychology, Friedrich-Schiller-University Jena, Am Steiger 3, D-07743 Jena, Germany
| | - Thomas Straube
- Institute of Medical Psychology and Systems Neuroscience, University of Muenster, Von-Esmarch-Str. 52, D-48149 Muenster, Germany
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Manual segmentation of the human bed nucleus of the stria terminalis using 3T MRI. Neuroimage 2016; 146:288-292. [PMID: 27876653 DOI: 10.1016/j.neuroimage.2016.11.047] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Revised: 10/23/2016] [Accepted: 11/18/2016] [Indexed: 12/30/2022] Open
Abstract
The bed nucleus of the stria terminalis (BNST)-a small gray matter region located in the basal forebrain-has been implicated in both anxiety and addiction based on compelling evidence from rodent and non-human primate studies. However, the BNST's small size and proximity to other gray matter regions has hindered non-invasive study in human subjects using standard neuroimaging methods. While initial studies have benefitted from a BNST mask created from a single human subject using a 7T scanner, individual variability is likely-especially in patient populations-thus a manual segmentation protocol is needed. Here we report on the development of a reliable manual segmentation protocol performed on 3T MRI images using a scanning sequence that provides high gray matter/white matter/cerebrospinal fluid contrast. Inter- and intra-rater reliabilities, measured in 10 healthy individuals, demonstrate that the protocol can be reliably implemented (intra-rater Dice similarity coefficient≥0.85, inter-rater≥0.77). This BNST tracing protocol provides the necessary foundation for future 3T MRI studies of the BNST in healthy controls and patient populations.
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Halsband U, Wolf TG. Functional changes in brain activity after hypnosis in patients with dental phobia. ACTA ACUST UNITED AC 2016; 109:131-142. [PMID: 27720948 DOI: 10.1016/j.jphysparis.2016.10.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 10/04/2016] [Accepted: 10/05/2016] [Indexed: 02/07/2023]
Abstract
Visiting the dentist is often accompanied by apprehension or anxiety. People, who suffer from specific dental phobia (a disproportional fear of dental) procedures show psychological and physiological symptoms which make dental treatments difficult or impossible. For such purposes, hypnosis is often used in dental practice as an alternative for a number of treatments adjuvant or instead of sedation or general anaesthetics, as medication is often associated with risks and side effects. This is the first study to address the effects of a brief dental hypnosis on the fear processing structures of the brain in dental phobics using functional magnetic resonance imaging (fMRI). 12 dental phobics (DP; mean 34.9years) and 12 healthy controls (CO; mean 33.2years) were scanned with a 3T MRI whole body-scanner observing brain activity changes after a brief hypnotic invervention. An fMRI event-related design symptom provocation task applying animated audio-visual pseudorandomized strong phobic stimuli was presented in order to maximize the fearful reactions during scanning. Control videos showed the use of familiar electronic household equipment. In DP group, main effects of fear condition were found in the left amygdala and bilaterally in the anterior cingulate cortex (ACC), insula and hippocampu (R<L). During hypnosis DP showed a significantly reduced activation in all of these areas. Reduced neural activity patterns were also found in the control group. No amygdala activation was detected in healthy subjects in the two experimental conditions. Compared to DP, CO showed less bilateral activation in the insula and ACC in the awake condition. Findings show that anxiety-provoking stimuli such as undergoing dental surgery, endodontic treatments or insufficient anaesthetics, can be effectively reduced under hypnosis. The present study gives scientific evidence that hypnosis is a powerful and successful method for inhibiting the reaction of the fear circuitry structures.
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Affiliation(s)
- Ulrike Halsband
- Department of Psychology, Neuropsychology, University of Freiburg, Germany.
| | - Thomas Gerhard Wolf
- Department of Operative Dentistry, University Medical Center, University of Mainz, Germany
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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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Shackman AJ, Fox AS. Contributions of the Central Extended Amygdala to Fear and Anxiety. J Neurosci 2016; 36:8050-63. [PMID: 27488625 PMCID: PMC4971357 DOI: 10.1523/jneurosci.0982-16.2016] [Citation(s) in RCA: 190] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Revised: 05/30/2016] [Accepted: 06/03/2016] [Indexed: 01/01/2023] Open
Abstract
It is widely thought that phasic and sustained responses to threat reflect dissociable circuits centered on the central nucleus of the amygdala (Ce) and the bed nucleus of the stria terminalis (BST), the two major subdivisions of the central extended amygdala. Early versions of this hypothesis remain highly influential and have been incorporated into the National Institute of Mental Health Research Research Domain Criteria framework. However, new observations encourage a different perspective. Anatomical studies show that the Ce and BST form a tightly interconnected unit, where different kinds of threat-relevant information can be integrated and used to assemble states of fear and anxiety. Imaging studies in humans and monkeys show that the Ce and BST exhibit similar functional profiles. Both regions are sensitive to a range of aversive challenges, including uncertain or temporally remote threat; both covary with concurrent signs and symptoms of fear and anxiety; both show phasic responses to short-lived threat; and both show heightened activity during sustained exposure to diffusely threatening contexts. Mechanistic studies demonstrate that both regions can control the expression of fear and anxiety during sustained exposure to diffuse threat. These observations compel a reconsideration of the central extended amygdala's contributions to fear and anxiety and its role in neuropsychiatric disease.
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Affiliation(s)
- Alexander J Shackman
- Department of Psychology, Neuroscience and Cognitive Science Program, and Maryland Neuroimaging Center, University of Maryland, College Park, Maryland 20742, and
| | - Andrew S Fox
- Department of Psychology and California National Primate Research Center, University of California, Davis, California 95616
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Daldrup T, Lesting J, Meuth P, Seidenbecher T, Pape HC. Neuronal correlates of sustained fear in the anterolateral part of the bed nucleus of stria terminalis. Neurobiol Learn Mem 2016; 131:137-46. [DOI: 10.1016/j.nlm.2016.03.020] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Revised: 03/24/2016] [Accepted: 03/28/2016] [Indexed: 12/23/2022]
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Prepare for scare-Impact of threat predictability on affective visual processing in spider phobia. Behav Brain Res 2016; 307:84-91. [PMID: 27036648 DOI: 10.1016/j.bbr.2016.03.045] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Revised: 03/14/2016] [Accepted: 03/28/2016] [Indexed: 01/25/2023]
Abstract
The visual processing of emotional faces is influenced by individual's level of stress and anxiety. Valence unspecific affective processing is expected to be influenced by predictability of threat. Using a design of phasic fear (predictable threat), sustained anxiety (unpredictable threat) and safety (no threat), we investigated the magnetoencephalographic correlates and temporal dynamics of emotional face processing in a sample of phobic patients. Compared to non-anxious controls, phobic individuals revealed decreased parietal emotional attention processes during affective processing at mid-latency and late processing stages. While control subjects showed increasing parietal processing of the facial stimuli in line with decreasing threat predictability, phobic subjects revealed the opposite pattern. Decreasing threat predictability also led to increasing neural activity in the orbitofrontal and dorsolateral prefrontal cortex at mid-latency stages. Additionally, unpredictability of threat lead to higher subjective discomfort compared to predictability of threat and no threat safety condition. Our findings indicate that visual processing of emotional information is influenced by both stress induction and pathologic anxiety.
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