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Lei L, Lai CSW, Lee TMC, Lam CLM. The effect of transcranial direct current and magnetic stimulation on fear extinction and return of fear: A meta-analysis and systematic review. J Affect Disord 2024; 362:263-286. [PMID: 38908557 DOI: 10.1016/j.jad.2024.06.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 05/31/2024] [Accepted: 06/17/2024] [Indexed: 06/24/2024]
Abstract
BACKGROUND We conducted a meta-analysis and qualitative review on the randomized controlled trials investigating the effects of transcranial direct current stimulation and transcranial magnetic stimulation on fear extinction and the return of fear in non-primate animals and humans. METHODS The meta-analysis was conducted by searching PubMed, Web of science, PsycINFO, and Cochrane Library and extracting fear response in the active and sham groups in the randomized controlled trials. The pooled effect size was quantified by Hedges' g using a three-level meta-analytic model in R. RESULTS We identified 18 articles on the tDCS effect and 5 articles on the TMS effect, with 466 animal subjects and 621 human subjects. Our findings show that tDCS of the prefrontal cortex significantly inhibit fear retrieval in animal models (Hedges' g = -0.50). In human studies, TMS targeting the dorsolateral/ventromedial prefrontal cortex has an inhibiting effect on the return of fear (Hedges' g = -0.24). LIMITATIONS The limited number of studies and the heterogeneous designs of the selected studies made cross-study and cross-species comparison difficult. CONCLUSIONS Our findings shed light on the optimal non-invasive brain stimulation protocols for targeting the neural circuitry of threat extinction in humans.
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Affiliation(s)
- Letian Lei
- The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong, China; Laboratory of Clinical Psychology and Affective Neuroscience, The University of Hong Kong, Hong Kong, China
| | - Cora S W Lai
- The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong, China; School of Biomedical Sciences, LKS Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong, China; Advanced Biomedical Instrumentation Centre, Hong Kong Science Park, Shatin, New Territories, Hong Kong SAR, China
| | - Tatia M C Lee
- The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong, China; Laboratory of Neuropsychology and Human Neuroscience, The University of Hong Kong, Hong Kong, China
| | - Charlene L M Lam
- The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong, China; Laboratory of Clinical Psychology and Affective Neuroscience, The University of Hong Kong, Hong Kong, China.
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Boehme S, Herrmann MJ, Mühlberger A. Good moments to stimulate the brain - A randomized controlled double-blinded study on anodal transcranial direct current stimulation of the ventromedial prefrontal cortex on two different time points in a two-day fear conditioning paradigm. Behav Brain Res 2024; 460:114804. [PMID: 38103872 DOI: 10.1016/j.bbr.2023.114804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 11/30/2023] [Accepted: 12/06/2023] [Indexed: 12/19/2023]
Abstract
It is assumed that extinction learning is a suitable model for understanding the mechanisms underlying exposure therapy. Furthermore, there is evidence that non-invasive brain stimulation (NIBS) can elevate extinction learning by enhancing frontal brain activity and therefore NIBS can augment symptom reduction during exposure therapy in phobias. But, the underlying processes are still not well established. Open questions arise from NIBS time points and electrode placement, among others. Therefore, we investigated in a 2-day fear conditioning experiment, whether anodal transcranial direct current stimulation (tDCS) of the ventromedial prefrontal cortex (vmPFC) modulates either fear memory consolidation or dampened fear reaction during fear extinction. Sixty-six healthy participants were randomly assigned either to a group that received tDCS after fear acquisition (and before fear memory consolidation), to a group that received tDCS directly before fear extinction, or to a control group that never received active stimulation (sham). Differential skin conductance response (SCR) to CS+ vs. CS- was significantly decreased in both tDCS-groups compared to sham group. Our region of interest, the vmPFC, was stimulated best focally with a lateral anode position and a cathode on the contralateral side. But this comes along with a slightly lateral stimulation of vmPFC depending on whether anode is placed left or right. To avoid unintended effects of stimulated sides the two electrode montages (anode left or right) were mirror-inverted which led to differential effects in SCR and electrocortical (mainly late positive potential [LPP]) data in our exploratory analyses. Results indicated that tDCS-timing is relevant for fear reactions via disturbed fear memory consolidation as well as fear expression, and this depends on whether vmPFC is stimulated with either left- or right-sided anode electrode montage. Electrocortical data can shed more light on the underlying neural correlates and exaggerated LPP seems to be associated with disturbed fear memory consolidation and dampened SCR to CS+ vs. CS-, but solely in the right anode electrode montage. Further open questions addressing where and when to stimulate the prefrontal brain in the course of augmenting fear extinction are raised.
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Affiliation(s)
- Stephanie Boehme
- Department of Psychology, Chair for Clinical Psychology and Psychotherapy, Technische Universität Chemnitz, Wilhelm-Raabe-Straße 43, D-09120 Chemnitz, Germany; Department of Psychology, Clinical Psychology and Psychotherapy, University of Regensburg, Universitätsstraße 31, D-93053 Regensburg, Germany.
| | - Martin J Herrmann
- Center of Mental Health, Dept. of Psychiatry, Psychosomatics, and Psychotherapy, University Hospital of Wuerzburg, Margarete-Hoeppel-Platz 1, D-97080 Wuerzburg, Germany
| | - Andreas Mühlberger
- Department of Psychology, Clinical Psychology and Psychotherapy, University of Regensburg, Universitätsstraße 31, D-93053 Regensburg, Germany
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Adams TG, Kelmendi B, George JR, Forte J, Hubert TJJ, Wild H, Rippey CS, Pittenger C. Frontopolar multifocal transcranial direct current stimulation reduces conditioned fear reactivity during extinction training: A pilot randomized controlled trial. Neurobiol Learn Mem 2023; 205:107825. [PMID: 37699439 PMCID: PMC10872945 DOI: 10.1016/j.nlm.2023.107825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 08/16/2023] [Accepted: 09/03/2023] [Indexed: 09/14/2023]
Abstract
Exposure-based therapies for anxiety and related disorders are believed to depend on fear extinction learning and corresponding changes in extinction circuitry. Frontopolar multifocal transcranial direct current stimulation (tDCS) has been shown to improve therapeutic safety learning during in vivo exposure and may modulate functional connectivity of networks implicated in fear processing and inhibition. A pilot randomized controlled trial was completed to determine the effects of frontopolar tDCS on extinction learning and memory. Community volunteers (n = 35) completed a 3-day fear extinction paradigm with measurement of electrodermal activity. Participants were randomized (single-blind) to 20-min of sham (n = 17, 30 s. ramp in/out) or active (n = 18) frontopolar (anode over Fpz, 10-10 EEG) multifocal tDCS (20-min, 1.5 mA) prior to extinction training. Mixed ANOVAs revealed a significant group*trial effect on skin conductance response (SCR) to the conditioned stimulus (CS + ) during extinction training (p = 0.007, Cohen's d = 0.55). The effects of frontopolar tDCS were greatest during the first two extinction trials, suggesting that tDCS may have promoted fear inhibition prior to safety learning. Return of fear to the CS + during tests were comparable across conditions (ps > 0.50). These findings suggest that frontopolar tDCS may modulate the processing of threat cues and associated circuitry or promote the inhibition of fear. This has clear implications for the treatment of anxiety and related disorders with therapeutic exposure.
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Affiliation(s)
- Thomas G Adams
- Department of Psychology, University of Kentucky, United States; Department of Psychiatry, Yale University School of Medicine, United States.
| | - Benjamin Kelmendi
- Department of Psychiatry, Yale University School of Medicine, United States; Clinical Neuroscience Division of the National Center for PTSD, West Haven VA Medical Center, United States
| | - Jamilah R George
- Department of Psychiatry, Yale University School of Medicine, United States; Department of Psychological Sciences, University of Connecticut, United States
| | - Jennifer Forte
- Department of Psychiatry, Yale University School of Medicine, United States; Department of Psychology, Binghamton University, United States
| | - Troy J J Hubert
- Department of Psychology, University of Kentucky, United States
| | - Hannah Wild
- Department of Psychology, University of Kentucky, United States
| | - Colton S Rippey
- Department of Psychology, University of Kentucky, United States
| | - Christopher Pittenger
- Department of Psychiatry, Yale University School of Medicine, United States; Child Study Center, Yale University, United States; Department of Psychology, Center for Brain and Mind Health, Yale University, United States
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Tortora F, Hadipour AL, Battaglia S, Falzone A, Avenanti A, Vicario CM. The Role of Serotonin in Fear Learning and Memory: A Systematic Review of Human Studies. Brain Sci 2023; 13:1197. [PMID: 37626553 PMCID: PMC10452575 DOI: 10.3390/brainsci13081197] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Revised: 08/07/2023] [Accepted: 08/08/2023] [Indexed: 08/27/2023] Open
Abstract
Fear is characterized by distinct behavioral and physiological responses that are essential for the survival of the human species. Fear conditioning (FC) serves as a valuable model for studying the acquisition, extinction, and expression of fear. The serotonin (5-hydroxytryptamine, 5-HT) system is known to play a significant role in emotional and motivational aspects of human behavior, including fear learning and expression. Accumulating evidence from both animal and human studies suggests that brain regions involved in FC, such as the amygdala, hippocampus, and prefrontal cortex, possess a high density of 5-HT receptors, implicating the crucial involvement of serotonin in aversive learning. Additionally, studies exploring serotonin gene polymorphisms have indicated their potential influence on FC. Therefore, the objective of this work was to review the existing evidence linking 5-HT with fear learning and memory in humans. Through a comprehensive screening of the PubMed and Web of Science databases, 29 relevant studies were included in the final review. These studies investigated the relationship between serotonin and fear learning using drug manipulations or by studying 5-HT-related gene polymorphisms. The results suggest that elevated levels of 5-HT enhance aversive learning, indicating that the modulation of serotonin 5-HT2A receptors regulates the expression of fear responses in humans. Understanding the role of this neurochemical messenger in associative aversive learning can provide insights into psychiatric disorders such as anxiety and post-traumatic stress disorder (PTSD), among others.
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Affiliation(s)
- Francesco Tortora
- Dipartimento di Scienze Cognitive, Psicologiche, Pedagogiche e Degli Studi Culturali, Università Degli Studi di Messina, Via Concezione 6, 98121 Messina, Italy; (F.T.); (A.F.)
| | - Abed L. Hadipour
- Dipartimento di Scienze Cognitive, Psicologiche, Pedagogiche e Degli Studi Culturali, Università Degli Studi di Messina, Via Concezione 6, 98121 Messina, Italy; (F.T.); (A.F.)
| | - Simone Battaglia
- Centro Studi e Ricerche in Neuroscienze Cognitive, Dipartimento di Psicologia “Renzo Canestrari”, Campus di Cesena, Alma Mater Studiorum Università di Bologna, Viale Rasi e Spinelli 176, 47521 Cesena, Italy;
| | - Alessandra Falzone
- Dipartimento di Scienze Cognitive, Psicologiche, Pedagogiche e Degli Studi Culturali, Università Degli Studi di Messina, Via Concezione 6, 98121 Messina, Italy; (F.T.); (A.F.)
| | - Alessio Avenanti
- Centro Studi e Ricerche in Neuroscienze Cognitive, Dipartimento di Psicologia “Renzo Canestrari”, Campus di Cesena, Alma Mater Studiorum Università di Bologna, Viale Rasi e Spinelli 176, 47521 Cesena, Italy;
- Centro de Investigación en Neuropsicología y Neurociencias Cognitivas, Universidad Católica Del Maule, Talca 3460000, Chile
| | - Carmelo M. Vicario
- Dipartimento di Scienze Cognitive, Psicologiche, Pedagogiche e Degli Studi Culturali, Università Degli Studi di Messina, Via Concezione 6, 98121 Messina, Italy; (F.T.); (A.F.)
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Sergi A, Messina A, Vicario CM, Martino G. A Quantum-Classical Model of Brain Dynamics. ENTROPY (BASEL, SWITZERLAND) 2023; 25:e25040592. [PMID: 37190380 PMCID: PMC10138112 DOI: 10.3390/e25040592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 03/27/2023] [Accepted: 03/28/2023] [Indexed: 05/17/2023]
Abstract
The study of the human psyche has elucidated a bipartite structure of logic reflecting the quantum-classical nature of the world. Accordingly, we posited an approach toward studying the brain by means of the quantum-classical dynamics of a mixed Weyl symbol. The mixed Weyl symbol can be used to describe brain processes at the microscopic level and, when averaged over an appropriate ensemble, can provide a link to the results of measurements made at the meso and macro scale. Within this approach, quantum variables (such as, for example, nuclear and electron spins, dipole momenta of particles or molecules, tunneling degrees of freedom, and so on) can be represented by spinors, whereas the electromagnetic fields and phonon modes can be treated either classically or semi-classically in phase space by also considering quantum zero-point fluctuations. Quantum zero-point effects can be incorporated into numerical simulations by controlling the temperature of each field mode via coupling to a dedicated Nosé-Hoover chain thermostat. The temperature of each thermostat was chosen in order to reproduce quantum statistics in the canonical ensemble. In this first paper, we introduce a general quantum-classical Hamiltonian model that can be tailored to study physical processes at the interface between the quantum and the classical world in the brain. While the approach is discussed in detail, numerical calculations are not reported in the present paper, but they are planned for future work. Our theory of brain dynamics subsumes some compatible aspects of three well-known quantum approaches to brain dynamics, namely the electromagnetic field theory approach, the orchestrated objective reduction theory, and the dissipative quantum model of the brain. All three models are reviewed.
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Affiliation(s)
- Alessandro Sergi
- Dipartimento di Scienze Matematiche e Informatiche, Scienze Fisiche e Scienze della Terra, Università degli Studi di Messina, viale F. Stagno d'Alcontres 31, 98166 Messina, Italy
- Institute of Systems Science, Durban University of Technology, P.O. Box 1334, Durban 4000, South Africa
| | - Antonino Messina
- Dipartimento di Matematica ed Informatica, Università degli Studi di Palermo, Via Archirafi 34, 90123 Palermo, Italy
| | - Carmelo M Vicario
- Dipartimento di Scienze Cognitive, Psicologiche, Pedagogiche e degli Studi Culturali, Università degli Studi di Messina, Via Concezione 6, 98121 Messina, Italy
| | - Gabriella Martino
- Dipartimento di Medicina e Clinica Sperimentale, Università degli Studi di Messina, A.O.U. "G. Martino", Via Consolare Valeria, 98125 Messina, Italy
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Becker CR, Milad MR. Contemporary Approaches Toward Neuromodulation of Fear Extinction and Its Underlying Neural Circuits. Curr Top Behav Neurosci 2023; 64:353-387. [PMID: 37658219 DOI: 10.1007/7854_2023_442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/03/2023]
Abstract
Neuroscience and neuroimaging research have now identified brain nodes that are involved in the acquisition, storage, and expression of conditioned fear and its extinction. These brain regions include the ventromedial prefrontal cortex (vmPFC), dorsal anterior cingulate cortex (dACC), amygdala, insular cortex, and hippocampus. Psychiatric neuroimaging research shows that functional dysregulation of these brain regions might contribute to the etiology and symptomatology of various psychopathologies, including anxiety disorders and post traumatic stress disorder (PTSD) (Barad et al. Biol Psychiatry 60:322-328, 2006; Greco and Liberzon Neuropsychopharmacology 41:320-334, 2015; Milad et al. Biol Psychiatry 62:1191-1194, 2007a, Biol Psychiatry 62:446-454, b; Maren and Quirk Nat Rev Neurosci 5:844-852, 2004; Milad and Quirk Annu Rev Psychol 63:129, 2012; Phelps et al. Neuron 43:897-905, 2004; Shin and Liberzon Neuropsychopharmacology 35:169-191, 2009). Combined, these findings indicate that targeting the activation of these nodes and modulating their functional interactions might offer an opportunity to further our understanding of how fear and threat responses are formed and regulated in the human brain, which could lead to enhancing the efficacy of current treatments or creating novel treatments for PTSD and other psychiatric disorders (Marin et al. Depress Anxiety 31:269-278, 2014; Milad et al. Behav Res Ther 62:17-23, 2014). Device-based neuromodulation techniques provide a promising means for directly changing or regulating activity in the fear extinction network by targeting functionally connected brain regions via stimulation patterns (Raij et al. Biol Psychiatry 84:129-137, 2018; Marković et al. Front Hum Neurosci 15:138, 2021). In the past ten years, notable advancements in the precision, safety, comfort, accessibility, and control of administration have been made to the established device-based neuromodulation techniques to improve their efficacy. In this chapter we discuss ten years of progress surrounding device-based neuromodulation techniques-Electroconvulsive Therapy (ECT), Transcranial Magnetic Stimulation (TMS), Magnetic Seizure Therapy (MST), Transcranial Focused Ultrasound (TUS), Deep Brain Stimulation (DBS), Vagus Nerve Stimulation (VNS), and Transcranial Electrical Stimulation (tES)-as research and clinical tools for enhancing fear extinction and treating PTSD symptoms. Additionally, we consider the emerging research, current limitations, and possible future directions for these techniques.
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Affiliation(s)
- Claudia R Becker
- Department of Psychiatry, NYU Grossman School of Medicine, New York, NY, USA
| | - Mohammed R Milad
- Department of Psychiatry, NYU Grossman School of Medicine, New York, NY, USA.
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Han J, Choi KM, Yang C, Kim HS, Park SS, Lee SH. Treatment efficacy of tDCS and predictors of treatment response in patients with post-traumatic stress disorder. J Affect Disord 2022; 318:357-363. [PMID: 36055537 DOI: 10.1016/j.jad.2022.08.111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 05/31/2022] [Accepted: 08/26/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Although transcranial direct stimulation (tDCS) has been proposed as an alternative treatment option for various psychiatric disorders, there is inconsistent information regarding the treatment effects of tDCS for patients with post-traumatic stress disorder (PTSD). This study aimed to investigate the tDCS efficacy and identify predictors of treatment response to tDCS in patients with PTSD. METHOD Fifty-one patients received 10 sessions of tDCS involving the position of the anode over the F3 area and cathode over the F4 as a condition of 2.0 mA and 20 min duration. Digit span test and 10 questionnaires (Clinician-Administered PTSD Scale (CAPS), Cognitive Emotion Regulation Questionnaire (CERQ), Multidimensional Experiential Avoidance Questionnaire (MEAQ), etc.) were used to measure tDCS effects on PTSD symptoms and identify predictors of response to tDCS. RESULTS 1) 50.9 % of patients had a significant reduction in the frequency and severity of PTSD symptoms, 2) PTSD-related symptoms such as depression, anxiety, rumination, and quality of life were significantly improved, 3) baseline scores on rumination and digit span test significantly predicted treatment response to tDCS. LIMITATIONS This study was open design without a sham control group. Also, the patients' medications were not controlled. CONCLUSION This study highlighted the efficacy of frontal tDCS for the treatment of patients with PTSD and identified rumination and digit span as favorable predictive factors for the outcomes of tDCS.
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Affiliation(s)
- Jungwon Han
- Clinical Emotion and Cognition Research Laboratory, Inje University, Goyang, Republic of Korea; Department of Psychology, Sogang University, Seoul, Republic of Korea
| | - Kang-Min Choi
- Clinical Emotion and Cognition Research Laboratory, Inje University, Goyang, Republic of Korea; School of Electronic Engineering, Hanyang University, Seoul, Republic of Korea
| | - Chaeyeon Yang
- Clinical Emotion and Cognition Research Laboratory, Inje University, Goyang, Republic of Korea; Department of Psychology, Sogang University, Seoul, Republic of Korea
| | - Hyang Sook Kim
- Department of Psychology, Sogang University, Seoul, Republic of Korea
| | | | - Seung-Hwan Lee
- Clinical Emotion and Cognition Research Laboratory, Inje University, Goyang, Republic of Korea; Department of Psychiatry, Inje University, Ilsan-Paik Hospital, Goyang, Republic of Korea; Bwave Inc., Juhwa-ro, Goyang 10380, Republic of Korea..
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Vicario CM, Martino G. Psychology and technology: how Virtual Reality can boost psychotherapy and neurorehabilitation. AIMS Neurosci 2022; 9:454-459. [PMID: 36660073 PMCID: PMC9826745 DOI: 10.3934/neuroscience.2022025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 11/09/2022] [Indexed: 11/16/2022] Open
Affiliation(s)
- C. M. Vicario
- COSPECS Department, University of Messina, 98122 Messina, Italy,* Correspondence:
| | - G. Martino
- Department of Clinical and Experimental Medicine, University of Messina, 98122 Messina, Italy,* Correspondence:
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9
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Stimulation of the ventromedial prefrontal cortex blocks the return of subcortically mediated fear responses. Transl Psychiatry 2022; 12:394. [PMID: 36127327 PMCID: PMC9489865 DOI: 10.1038/s41398-022-02174-8] [Citation(s) in RCA: 3] [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: 04/20/2022] [Revised: 09/07/2022] [Accepted: 09/09/2022] [Indexed: 11/08/2022] Open
Abstract
The ventromedial prefrontal cortex (vmPFC) mediates the inhibition of defensive responses upon encounters of cues, that had lost their attribute as a threat signal via previous extinction learning. Here, we investigated whether such fear extinction recall can be facilitated by anodal transcranial direct current stimulation (tDCS). Extinction recall was tested twenty-four hours after previously acquired fear was extinguished. Either anodal tDCS or sham stimulation targeting the vmPFC was applied during this test. After stimulation ceased, we examined return of fear after subjects had been re-exposed to aversive events. Fear was assessed by reports of threat expectancy and modulations of autonomic (skin conductance, heart rate) and protective reflex (startle potentiation) measures, the latter of which are mediated by subcortical defense circuits. While tDCS did not affect initial extinction recall, it abolished the return of startle potentiation and autonomic components of the fear response. Results suggest hierarchical multi-level vmPFC functions in human fear inhibition and indicate, that its stimulation might immunize against relapses into pathological subcortically mediated defensive activation.
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Lucifora C, Grasso GM, Nitsche MA, D'Italia G, Sortino M, Salehinejad MA, Falzone A, Avenanti A, Vicario CM. Enhanced fear acquisition in individuals with evening chronotype. A virtual reality fear conditioning/extinction study. J Affect Disord 2022; 311:344-352. [PMID: 35561887 DOI: 10.1016/j.jad.2022.05.033] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 04/09/2022] [Accepted: 05/05/2022] [Indexed: 11/18/2022]
Abstract
Circadian rhythms have received increasing attention within the context of mental disorders. Evening chronotype has been associated with enhanced risk to develop anxiety and post-traumatic stress disorder (PTSD). The classical fear conditioning paradigm is a powerful tool to reveal key mechanisms of anxiety and PTSD. We used this paradigm to study the neurocognitive basis of the association between chronotype and fear responses in healthy humans. 20 participants with evening chronotype and 20 controls (i.e., intermediate chronotype) completed a 2-day Pavlovian fear learning and extinction virtual reality task. Participants received fear conditioning, and extinction learning on day 1. Extinction memory recall was tested on day 2. To address interactions between chronotype and time of day of the fear conditioning, and extinction performance, half of the participants were tested in the morning, and the other half in the evening. Skin conductance response (SCR) and subjective fear ratings were measured as primary outcomes. Chronotype was established via the morningness-eveningness questionnaire (MEQ). We found an overall higher SCR for fear acquisition in participants with the evening chronotype profile, compared to controls. Moreover, the higher the MEQ scores -indicative of less eveningness - the lower the SCR was. No effects of chronotype were found for extinction and extinction recall. The higher vulnerability of the evening chronotype for anxiety and related disorders may thus be explained by enhanced fear acquisition of this group.
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Affiliation(s)
- Chiara Lucifora
- Dipartimento di Scienze Cognitive, Psicologiche, Pedagogiche e Degli Studi Culturali, Università Degli Studi di Messina, 98121 Messina, Italy
| | - Giorgio M Grasso
- Dipartimento di Scienze Cognitive, Psicologiche, Pedagogiche e Degli Studi Culturali, Università Degli Studi di Messina, 98121 Messina, Italy
| | - Michael A Nitsche
- Department of Psychology and Neurosciences, Leibniz Research Center for Working Environment and Human Factors, Ardeystr. 67, 44139 Dortmund, Germany
| | - Giovanni D'Italia
- Dipartimento di Scienze Cognitive, Psicologiche, Pedagogiche e Degli Studi Culturali, Università Degli Studi di Messina, 98121 Messina, Italy
| | - Mauro Sortino
- Dipartimento di Scienze Cognitive, Psicologiche, Pedagogiche e Degli Studi Culturali, Università Degli Studi di Messina, 98121 Messina, Italy
| | - Mohammad A Salehinejad
- Department of Psychology and Neurosciences, Leibniz Research Center for Working Environment and Human Factors, Ardeystr. 67, 44139 Dortmund, Germany
| | - Alessandra Falzone
- Dipartimento di Scienze Cognitive, Psicologiche, Pedagogiche e Degli Studi Culturali, Università Degli Studi di Messina, 98121 Messina, Italy
| | - Alessio Avenanti
- Centro Studi e Ricerche in Neuroscienze Cognitive, Dipartimento di Psicologia, Alma Mater Studiorum - Università di Bologna, Campus di Cesena, 47521 Cesena, Italy; Centro de Investigación en Neuropsicología y Neurociencias Cognitivas, Universidad Católica Del Maule, 346000 Talca, Chile
| | - Carmelo M Vicario
- Dipartimento di Scienze Cognitive, Psicologiche, Pedagogiche e Degli Studi Culturali, Università Degli Studi di Messina, 98121 Messina, Italy.
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Gibson BC, Votaw VR, Stein ER, Clark VP, Claus E, Witkiewitz K. Transcranial Direct Current Stimulation Provides no Additional Benefit to Improvements in Self-Reported Craving Following Mindfulness-Based Relapse Prevention. Mindfulness (N Y) 2022; 13:92-103. [PMID: 35833199 PMCID: PMC9272998 DOI: 10.1007/s12671-021-01768-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/27/2021] [Indexed: 01/03/2023]
Abstract
Objectives Mindfulness-Based Relapse Prevention (MBRP) and transcranial direct current stimulation (tDCS) have each demonstrated efficacy in improving outcomes in those with alcohol use disorder (AUD), however a recent study that combined MBRP with tDCS found tDCS provided no additional benefit to MBRP for AUD. Differences in treatment adherence between active versus sham tDCS groups may have contributed to this result. The current study examined whether treatment adherence interacted with tDCS condition in predicting post-treatment mindfulness and craving. Methods This study was a secondary data analysis from a randomized sham-controlled trial comparing MBRP paired with tDCS. Linear regression analyses were conducted examining the interaction between tDCS condition and two measures of treatment adherence (i.e., number of groups attended, number of tDCS administrations) on post-treatment mindfulness and craving. Results There was no effect of treatment adherence by tDCS condition in predicting mindfulness, however the interaction between treatment adherence and tDCS condition significantly predicted post-treatment craving. There was a significant negative association between treatment adherence and post-treatment craving in the sham group, but there was no association in the active tDCS group. Conclusions MBRP coupled with sham stimulation led to significant reductions in self-reported craving when patients attended more sessions and received a greater number of sham tDCS administrations, while no relationship was observed between treatment adherence and craving among those who received active tDCS. This result provides tentative evidence that, rather than improve the effects of MBRP on craving, this active tDCS protocol provides no additional benefit to MBRP in reducing craving. Pre-registration This study was registered with clinicaltrials.gov (NCT02861807).
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Affiliation(s)
- Benjamin C. Gibson
- Psychology Department, University of New Mexico, Logan Hall, MSC03-2220, 1 University of New Mexico, Albuquerque, NM 87131
- The Mind Research Network, Department of Translational Neuroscience, 1101 Yale Blvd. NE, Albuquerque, NM 87106
| | - Victoria R. Votaw
- Psychology Department, University of New Mexico, Logan Hall, MSC03-2220, 1 University of New Mexico, Albuquerque, NM 87131
- Center on Alcohol, Substance use, And Addictions, 2650 Yale Blvd. SE, Albuquerque, NM 87106
| | - Elena R. Stein
- Psychology Department, University of New Mexico, Logan Hall, MSC03-2220, 1 University of New Mexico, Albuquerque, NM 87131
- Center on Alcohol, Substance use, And Addictions, 2650 Yale Blvd. SE, Albuquerque, NM 87106
| | - Vincent P. Clark
- Psychology Department, University of New Mexico, Logan Hall, MSC03-2220, 1 University of New Mexico, Albuquerque, NM 87131
- The Mind Research Network, Department of Translational Neuroscience, 1101 Yale Blvd. NE, Albuquerque, NM 87106
| | - Eric Claus
- The Mind Research Network, Department of Translational Neuroscience, 1101 Yale Blvd. NE, Albuquerque, NM 87106
- Department of Biobehavioral Health, The Pennsylvania State University, 219 Biobehavioral Health Building, University Park, PA 16802
| | - Katie Witkiewitz
- Psychology Department, University of New Mexico, Logan Hall, MSC03-2220, 1 University of New Mexico, Albuquerque, NM 87131
- Center on Alcohol, Substance use, And Addictions, 2650 Yale Blvd. SE, Albuquerque, NM 87106
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12
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Offline tDCS modulates prefrontal-cortical-subcortical-cerebellar fear pathways in delayed fear extinction. Exp Brain Res 2021; 240:221-235. [PMID: 34694466 DOI: 10.1007/s00221-021-06248-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 10/15/2021] [Indexed: 11/27/2022]
Abstract
Transcranial direct current stimulation (tDCS) has been studied to enhance extinction-based treatments for anxiety disorders. However, the field shows conflicting results about its anxiolytic effect and only a few studies have observed the extinction of consolidated memories. We looked to study the effect of offline 1 mA tDCS over the right dorsolateral pre-frontal cortex across the fear pathways, in consolidated fear response during delayed extinction. Participants (N = 34 women) underwent in a two-day fear conditioning procedure. On day 1, participants were assigned to the control group (N = 18) or the tDCS group (N = 16) and went through a fear acquisition procedure. On day 2, the tDCS group received 20 min tDCS before extinction and while inside the MRI scanner. The control group completed the extinction procedure only. The tDCS session (for the tDCS group) and the fMRI scan (for both groups) were completed just on the second day. Univariate fMRI analysis showed stimulation-dependent activity during late extinction with the tDCS group showing decreased neural activity during the processing of threat cues (CS +) and increased activity during the processing of safety cues (CS -), in prefrontal, postcentral and paracentral regions, during late extinction. ROI to whole-brain psychophysiological interaction (PPI) analysis showed the tDCS effect on the connectivity between the left dorsolateral prefrontal cortex three cortical-amygdalo-hippocampal-cerebellar pathway clusters during the processing of the CS + in late extinction (TFCE corrected; p < 0.05). Increased neuronal activity during the processing of safety cues and stronger coupling during the processing of threat cues might be the mechanisms by which tDCS contributes to stimuli discrimination.
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Ney LJ, Matthews A, Hsu CMK, Zuj DV, Nicholson E, Steward T, Nichols D, Graham B, Harrison B, Bruno R, Felmingham K. Cannabinoid polymorphisms interact with plasma endocannabinoid levels to predict fear extinction learning. Depress Anxiety 2021; 38:1087-1099. [PMID: 34151472 DOI: 10.1002/da.23170] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 05/04/2021] [Accepted: 05/07/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The endocannabinoid system is gaining increasing attention as a favorable target for improving posttraumatic stress disorder (PTSD) treatments. Exposure therapy is the gold-standard treatment for PTSD, and fear extinction learning is a key concept underlying successful exposure. METHODS This study examined the role of genetic endocannabinoid polymorphisms in a fear extinction paradigm with PTSD compared to healthy participants (N = 220). Participants provided saliva for genotyping, completed a fear conditioning and extinction task, with blood samples taken before and after the task (n = 57). Skin conductance was the outcome and was analyzed using mixed models. RESULTS Results for cannabinoid receptor type 1 polymorphisms suggested that minor alleles of rs2180619 and rs1049353 were associated with poorer extinction learning in PTSD participants. The minor allele of the fatty acid amide hydrolase (FAAH) polymorphism rs324420 was associated with worse extinction in PTSD participants. Subanalysis of healthy participants (n = 57) showed the FAAH rs324420 genotype effect was dependent on plasma arachidonoyl ethanolamide (AEA) level, but not oleoylethanolamide or 2-arachidonoyl glycerol. Specifically, higher but not lower AEA levels in conjunction with the minor allele of FAAH rs324420 were associated with better extinction learning. CONCLUSIONS These findings provide translational evidence that cannabinoid receptor 1 and AEA are involved in extinction learning in humans. FAAH rs324420's effect on fear extinction is moderated by AEA plasma level in healthy controls. These findings imply that FAAH inhibitors may be effective for targeting anxiety in PTSD, but this effect needs to be explored further in clinical populations.
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Affiliation(s)
- Luke J Ney
- School of Psychology, University of Tasmania, Hobart, Australia
| | | | | | - Daniel V Zuj
- Department of Psychology, Swansea University, Wales, United Kingdom
| | - Emma Nicholson
- School of Psychological Sciences, University of Melbourne, Melbourne, Australia
| | - Trevor Steward
- School of Psychological Sciences, University of Melbourne, Melbourne, Australia
| | - David Nichols
- Central Science Laboratory, University of Tasmania, Hobart, Australia
| | - Bronwyn Graham
- School of Psychology, The University of New South Wales, Kensington, Australia
| | - Ben Harrison
- Department of Psychiatry, Melbourne Neuropsychiatry Center, University of Melbourne & Melbourne Health, Melbourne, Australia
| | - Raimondo Bruno
- School of Psychology, University of Tasmania, Hobart, Australia
| | - Kim Felmingham
- School of Psychological Sciences, University of Melbourne, Melbourne, Australia
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Ney LJ, Matthews A, Nicholson E, Zuj D, Ken Hsu CM, Steward T, Graham B, Harrison B, Nichols D, Felmingham K. BDNF genotype Val66Met interacts with acute plasma BDNF levels to predict fear extinction and recall. Behav Res Ther 2021; 145:103942. [PMID: 34340176 DOI: 10.1016/j.brat.2021.103942] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Revised: 06/17/2021] [Accepted: 07/28/2021] [Indexed: 02/06/2023]
Abstract
Brain-derived neurotropic factor (BDNF) is a potent regulator of memory processes and is believed to influence the consolidation of fear extinction memories. No previous human study has tested the effect of unstimulated BDNF on fear extinction recall, and no study has tested the association between plasma BDNF levels and psychophysiological responding during an extinction paradigm. We tested the association between fear responses during a 2-day differential conditioning, extinction and extinction recall paradigm and Val66Met genotype in a group of healthy participants (N = 191). There were no group differences during habituation or acquisition. Met allele carriers compared to Val homozygotes displayed higher responses to the CS + compared to the CS- during extinction learning and had higher responding to both the CS+ and CS- during extinction recall. Plasma levels of BDNF protein that were collected in a sub-sample of the group (n = 56) moderated the effect of Met allele presence, such that lower BDNF level was associated with higher skin conductance response in the Met but not Val group to the CS+ during extinction learning and to both the CS+ and CS- during extinction recall. The current results extend previous observations of a Val66Met effect during fear extinction learning to extinction recall and show for the first time that these effects are moderated by plasma BDNF level.
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Affiliation(s)
- Luke John Ney
- School of Psychological Sciences, University of Tasmania, Australia.
| | - Allison Matthews
- School of Psychological Sciences, University of Tasmania, Australia
| | - Emma Nicholson
- School of Psychological Sciences, University of Melbourne, Australia
| | - Daniel Zuj
- Department of Psychology, Swansea University, United Kingdom
| | | | - Trevor Steward
- School of Psychological Sciences, University of Melbourne, Australia
| | - Bronwyn Graham
- School of Psychology, University of New South Wales, Australia
| | - Ben Harrison
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne & Melbourne Health, Australia
| | - David Nichols
- Central Science Laboratory, University of Tasmania, Australia
| | - Kim Felmingham
- School of Psychological Sciences, University of Melbourne, Australia
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The effects of transcranial direct current stimulation on upper-limb function post-stroke: A meta-analysis of multiple-session studies. Clin Neurophysiol 2021; 132:1897-1918. [PMID: 34157634 DOI: 10.1016/j.clinph.2021.05.015] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 04/21/2021] [Accepted: 05/10/2021] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To systematically review how patient characteristics and/or transcranial direct current stimulation (tDCS) parameters influence tDCS effectiveness in respect to upper limb function post-stroke. METHODS Three electronic databases were searched for sham-controlled randomised trials using the Fugl-Meyer Assessment for upper extremity as outcome measure. A meta-analysis and nine subgroup-analyses were performed to identify which tDCS parameters yielded the greatest impact on upper limb function recovery in stroke patients. RESULTS Eighteen high-quality studies (507 patients) were included. tDCS applied in a chronic stage yields greater results than tDCS applied in a (sub)acute stage. Additionally, patients with low baseline upper limb impairments seem to benefit more from tDCS than those with high baseline impairments. Regarding tDCS configuration, all stimulation types led to a significant improvement, but only tDCS applied during therapy, and not before therapy, yielded significant results. A positive dose-response relationship was identified for current/charge density and stimulation duration, but not for number of sessions. CONCLUSION Our results demonstrate that tDCS improves upper limb function post-stroke. However, its effectiveness depends on numerous factors. Especially chronic stroke patients improved, which is promising as they are typically least amenable to recovery. SIGNIFICANCE The current work highlights the importance of several patient-related and protocol-related factors regarding tDCS effectiveness.
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Marković V, Vicario CM, Yavari F, Salehinejad MA, Nitsche MA. A Systematic Review on the Effect of Transcranial Direct Current and Magnetic Stimulation on Fear Memory and Extinction. Front Hum Neurosci 2021; 15:655947. [PMID: 33828472 PMCID: PMC8019721 DOI: 10.3389/fnhum.2021.655947] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 02/25/2021] [Indexed: 12/13/2022] Open
Abstract
Anxiety disorders are among the most prevalent mental disorders. Present treatments such as cognitive behavior therapy and pharmacological treatments show only moderate success, which emphasizes the importance for the development of new treatment protocols. Non-invasive brain stimulation methods such as repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS) have been probed as therapeutic option for anxiety disorders in recent years. Mechanistic information about their mode of action, and most efficient protocols is however limited. Here the fear extinction model can serve as a model of exposure therapies for studying therapeutic mechanisms, and development of appropriate intervention protocols. We systematically reviewed 30 research articles that investigated the impact of rTMS and tDCS on fear memory and extinction in animal models and humans, in clinical and healthy populations. The results of these studies suggest that tDCS and rTMS can be efficient methods to modulate fear memory and extinction. Furthermore, excitability-enhancing stimulation applied over the vmPFC showed the strongest potential to enhance fear extinction. We further discuss factors that determine the efficacy of rTMS and tDCS in the context of the fear extinction model and provide future directions to optimize parameters and protocols of stimulation for research and treatment.
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Affiliation(s)
- Vuk Marković
- Department of Psychology and Neurosciences, Leibniz Research Centre for Working Environment and Human Factors, Dortmund, Germany
- International Graduate School of Neuroscience, Ruhr-University-Bochum, Bochum, Germany
| | | | - Fatemeh Yavari
- Department of Psychology and Neurosciences, Leibniz Research Centre for Working Environment and Human Factors, Dortmund, Germany
| | - Mohammad A. Salehinejad
- Department of Psychology and Neurosciences, Leibniz Research Centre for Working Environment and Human Factors, Dortmund, Germany
| | - Michael A. Nitsche
- International Graduate School of Neuroscience, Ruhr-University-Bochum, Bochum, Germany
- Department of Neurology, University Medical Hospital Bergmannsheil, Bochum, Germany
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