One MRI-compatible tDCS session attenuates ventromedial cortical perfusion when exposed to verbal criticism: The role of perceived criticism

Unraveling how the adolescent brain deals with criticism using dynamic causal modeling

Sensitivity to criticism, which can be defined as a negative evaluation that a person receives from someone else, is considered a risk factor for the development of psychiatric disorders in adolescents. They may be more vulnerable to social evaluation than adults and exhibit more inadequate emotion regulation strategies such as rumination. The neural network involved in dealing with criticism in adolescents may serve as a biomarker for vulnerability to depression. However, the directions of the functional interactions between the brain regions within this neural network in adolescents are still unclear. In this study, 64 healthy adolescents (aged 14 to 17 years) were asked to listen to a series of self-referential auditory segments, which included negative (critical), positive (praising), and neutral conditions, during fMRI scanning. Dynamic Causal Modeling (DCM) with Parametric Empirical Bayesian (PEB) analysis was performed to map the interactions within the neural network that was engaged during the processing of these segments. Three regions were identified to form the interaction network: the left pregenual anterior cingulate cortex (pgACC), the left dorsolateral prefrontal cortex (DLPFC), and the right precuneus (preCUN). We quantified the modulatory effects of exposure to criticism and praise on the effective connectivity between these brain regions. Being criticized was found to significantly inhibit the effective connectivity from the preCUN to the DLPFC. Adolescents who scored high on the Perceived Criticism Measure (PCM) showed less inhibition of the preCUN-to-DLPFC connectivity when being criticized, which may indicate that they required more engagement of the Central Executive Network (which includes the DLPFC) to sufficiently disengage from negative self-referential processing. Furthermore, the inhibitory connectivity from the DLPFC to the pgACC was strengthened by exposure to praise as well as criticism, suggesting a recruitment of cognitive control over emotional responses when dealing with positive and negative evaluative feedback. Our novel findings contribute to a more profound understanding of how criticism affects the adolescent brain and can help to identify potential biomarkers for vulnerability to develop mood disorders before or during adulthood.

Parental criticism affects adolescents' mood and ruminative state: Self-perception appears to influence their mood response

Feeling and/or being criticized is a known risk factor for various psychiatric disorders in adolescents. However, the link between the experience of social stressors and the development of psychopathological symptoms is not yet fully understood. Identifying which adolescent subgroups are more vulnerable to parental criticism could be of great clinical relevance. In this study, 90 nondepressed 14- to 17-year-old adolescents were exposed to a sequence of auditory segments with a positive, neutral, and finally negative valence, mirroring parental criticism. Their mood and ruminative states were assessed before and after exposure to criticism. We observed an overall increase in mood disturbance and ruminative thoughts. Self-perception appeared to influence these mood changes, whereas no significant influence by perceived criticism, self-worth, or the general tendency to ruminate was found. Emotional awareness seemed to account for some of the variance in positive mood state changes. These findings point to the importance of adolescent self-perception (and emotional awareness) in dealing with parental criticism.

The default mode network and rumination in individuals at risk for depression

The default mode network (DMN) is a network of brain regions active during rest and self-referential thinking. Individuals with major depressive disorder (MDD) show increased or decreased DMN activity relative to controls. DMN activity has been linked to a tendency to ruminate in MDD. It is unclear if individuals who are at risk for, but who have no current or past history of depression, also show differential DMN activity associated with rumination. We investigated whether females with high levels of neuroticism with no current or lifetime mood or anxiety disorders (n = 25) show increased DMN activation, specifically when processing negative self-referential information, compared with females with average levels of neuroticism (n = 28). Participants heard criticism and praise during functional magnetic resonance imaging (MRI) scans in a 3T Siemens Prisma scanner. The at-risk group showed greater activation in two DMN regions, the medial prefrontal cortex and the inferior parietal lobule (IPL), after hearing criticism, but not praise (relative to females with average levels of neuroticism). Criticism-specific activation in the IPL was significantly correlated with rumination. Individuals at risk for depression may, therefore, have an underlying neurocognitive vulnerability to use a brain network typically involved in thinking about oneself to preferentially ruminate about negative, rather than positive, information.

Effects of neuromodulation on cognitive and emotional responses to psychosocial stressors in healthy humans

Physiological and psychological stressors can exert wide-ranging effects on the human brain and behavior. Research has improved understanding of how the sympatho-adreno-medullary (SAM) and hypothalamic-pituitary-adrenocortical (HPA) axes respond to stressors and the differential responses that occur depending on stressor type. Although the physiological function of SAM and HPA responses is to promote survival and safety, exaggerated psychobiological reactivity can occur in psychiatric disorders. Exaggerated reactivity may occur more for certain types of stressors, specifically, psychosocial stressors. Understanding stressor effects and how the body regulates these responses can provide insight into ways that psychobiological reactivity can be modulated. Non-invasive neuromodulation is one way that responding to stressors may be altered; research into these interventions may provide further insights into the brain circuits that modulate stress reactivity. This review focuses on the effects of acute psychosocial stressors and how neuromodulation might be effective in altering stress reactivity. Although considerable research into stress interventions focuses on treating pathology, it is imperative to first understand these mechanisms in non-clinical populations; therefore, this review will emphasize populations with no known pathology and consider how these results may translate to those with psychiatric pathologies.

Does non-invasive brain stimulation modulate emotional stress reactivity?

Excessive emotional responses to stressful events can detrimentally affect psychological functioning and mental health. Recent studies have provided evidence that non-invasive brain stimulation (NBS) targeting the prefrontal cortex (PFC) can affect the regulation of stress-related emotional responses. However, the reliability and effect sizes have not been systematically analyzed. In the present study, we reviewed and meta-analyzed the effects of repetitive transcranial magnetic (rTMS) and transcranial direct current stimulation (tDCS) over the PFC on acute emotional stress reactivity in healthy individuals. Forty sham-controlled single-session rTMS and tDCS studies were included. Separate random effects models were performed to estimate the mean effect sizes of emotional reactivity. Twelve rTMS studies together showed no evidence that rTMS over the PFC influenced emotional reactivity. Twenty-six anodal tDCS studies yielded a weak beneficial effect on stress-related emotional reactivity (Hedges’ g = −0.16, CI_95% = [−0.33, 0.00]). These findings suggest that a single session of NBS is insufficient to induce reliable, clinically significant effects but also provide preliminary evidence that specific NBS methods can affect emotional reactivity. This may motivate further research into augmenting the efficacy of NBS protocols on stress-related processes.

Exposure to Criticism Modulates Left but Not Right Amygdala Functional Connectivity in Healthy Adolescents: Individual Influences of Perceived and Self-Criticism

Background: Frequent exposure to criticism is a known risk factor for various adult psychiatric disorders. Adolescents may be even more vulnerable to (parental) criticism, as their imbalanced brain maturation makes them prone to stronger mood changes and less effective emotional regulation. Identifying which adolescent subgroups are more vulnerable than others could be of great clinical relevance. Perceived criticism (PC) and self-criticism (SC), two related but distinct traits, could well be crucial vulnerability factors. Hypotheses: After exposure to criticism during fMRI scanning, rapid changes in amygdalar functional connectivity (FC) with other brain areas involved in emotion regulation and social cognitive processing will occur. These changes will depend on trait moderators, such as the adolescents' proneness to (a) perceive others as critical of them (PC) or (b) perceive themselves positively or negatively (SC). Methods: Sixty-four healthy 14-17-year-olds were exposed to a series of auditory comments. Changes in mood states were assessed based on the Profile of Mood States (POMS) prior to and after exposure to these segments. Pre- and post-experiment FC of the left and right amygdalae with other brain areas were also measured. Correlates between FC changes and psychometric measures-including the perceived criticism measure (PCM) and self-perception profile for adolescents (SPPA)-were assessed. Results: First, after being criticized, FC increases of the left amygdala seed region with brain areas related to sustained emotional processing were found, but no right amygdalar FC changes. Second, there was a significant positive partial correlation between individual PCM scores and FC changes between the left amygdala seed region and the left precuneus and left superior parietal cortex, both part of the default mode network. Conclusion: Exposure to criticism resulted in a rapid negative mood change accompanied by an increase in FC between the left amygdala and regions known to be involved in sustained emotional processing, but no right amygdalar FC changes. Furthermore, higher PC but not SC was correlated with stronger left amygdalar FC increases with these regions, suggesting an elevated vulnerability for disturbed emotional processing, as observed in mood disorders, in healthy adolescents with higher PCM scores.

Combined transcranial direct current stimulation and psychological interventions: State of the art and promising perspectives for clinical psychology

Recent literature shows great heterogeneity in the reported efficacy of transcranial direct current stimulation (tDCS) as a stand-alone psychiatric treatment. Aiming to increase its efficacy, tDCS has been combined with psychological interventions. Our state-of-the-art overview of such combined treatment trials indicates, however, that these usually do not elicit synergistic clinical effects. We therefore explored more basic mechanisms related to the brain state-dependency of tDCS. Importantly, based on our overview, the efficacy of combined interventions may depend on whether individual patients present with endophenotypes that are implicated in the development and maintenance of psychopathology, such as prefrontal-mediated cognitive dysfunction. We discuss how future studies may contribute to the development of personally-tailored dual active treatments by adhering to the Research Domain Criteria (RDoC) framework. RDoC-based mechanistic research may reveal alternative neural circuits that should be functionally targeted by both tDCS and psychological interventions, with promising avenues for clinical psychological science and practice.

Frequency of nonsuicidal self-injury is associated with impulsive decision-making during criticism

Research indicates that nonsuicidal self-injury (NSSI) is associated with impulsive traits, but not impulsive behavior on laboratory tasks, even in the context of negative mood. However, previous studies may not have induced forms of negative affect most relevant to NSSI. For example, evidence implicates both self-criticism and feeling criticized by others in NSSI engagement. We conducted two studies examining whether negative mood related to criticism increases impulsive decision-making among individuals with NSSI histories, using a gambling task embedded with auditory critical comments; participants imagined loved ones saying these comments to them. Study 1 evaluated community adults with (n = 33) and without (n = 31) NSSI histories. Despite no group differences in task performance, we found an association between past-year NSSI frequency and more impulsive choices during criticism. This was confirmed in Study 2 using a separate sample of adults (n = 69) with more frequent and recent NSSI. In regression models including self-criticism and depressive symptoms, only task performance (i.e., decision-making while receiving critical feedback) predicted NSSI frequency across multiple measurement periods. These studies suggest that more frequent and recent NSSI is associated with neurocognitive impulsivity, specifically in negative emotional contexts involving actual or imagined criticism in close relationships.

One MRI-compatible tDCS session attenuates ventromedial cortical perfusion when exposed to verbal criticism: The role of perceived criticism

Transcranial direct current stimulation (tDCS) is a potential treatment strategy for mood and anxiety disorders, but how this application may influence emotional processes, and whether this is related to individual characteristics, is not well understood. It has been proposed that perceived criticism (PC) may represent a vulnerability factor for the development of such mental illnesses. To decipher whether neural mechanisms of action of tDCS potentially differ depending on PC status (low vs. high), we evaluated mood and brain perfusion before and after applying MRI-compatible tDCS, and after participants were exposed to verbal criticism in the scanner. Experimental design 30 healthy nondepressed females were included in a sham-controlled crossover MRI-compatible tDCS study. Brain perfusion was measured by means of arterial spin labeling (ASL) before and after tDCS applied to the left dorsolateral prefrontal cortex (DLPFC), and after hearing criticism. Before the experiment, all participants provided a rating of PC in their closest environment. Principal observations at the behavioral level, criticism made participants angrier. This was unrelated to the active or sham stimulation. After being criticized, females scoring high on PC had significantly decreased brain perfusion in the pregenual anterior cingulate cortex (pgACC) and medioprefrontal cortex (mPFC), after active tDCS but not sham. The decrease in pgACC/mPFC perfusion points to a significant impact of tDCS in brain areas related to stress responses and self-referential processes, especially in females scoring high on PC, which has been shown to be related to vulnerability for mood and anxiety disorders.