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Schmaußer M, Raab M, Laborde S. The dynamic role of the left dlPFC in neurovisceral integration: Differential effects of theta burst stimulation on vagally mediated heart rate variability and cognitive-affective processing. Psychophysiology 2024; 61:e14606. [PMID: 38867447 DOI: 10.1111/psyp.14606] [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: 10/13/2023] [Revised: 03/06/2024] [Accepted: 04/22/2024] [Indexed: 06/14/2024]
Abstract
Adapting to the ever-changing demands of the environment requires a complex interplay between cognitive-affective, neuronal, and autonomic processes. Vagally mediated heart rate variability (vmHRV) is positively associated with both cognitive-affective functioning and prefrontal cortex (PFC) activity. Accordingly, the Neurovisceral Integration Model has posited a shared role of the PFC in the regulation of cognitive-affective processes and autonomic nervous system (ANS) activity. While there are numerous correlational findings in this regard, no study so far has investigated whether the manipulation of PFC activity induces changes in vmHRV and cognitive-affective processing in an inter-dependent manner. In a sample of 64 participants, we examined the effects of continuous (cTBS; n = 21) and intermittent theta-burst stimulation (iTBS; n = 20) compared to sham stimulation (n = 23) over the left dorsolateral PFC (dlPFC) on vmHRV and cognitive-affective processing within an emotional stop-signal task (ESST). Our results revealed that both resting vmHRV and vmHRV reactivity predicted cognitive-affective processing. Furthermore, we found a dampening effect of cTBS on resting and on-task vmHRV, as well as an enhancing effect of iTBS on ESST performance. Our results show no direct association between vmHRV changes and ESST performance alterations following stimulation. We interpret our results in the light of a hierarchical model of neurovisceral integration, suggesting a dynamical situation-dependent recruitment of higher-order cortical areas like the dlPFC in the regulation of the ANS. In conclusion, our results highlight the complex interplay between PFC activity, autonomic regulation, and cognitive-affective processing, emphasizing the need for further research to understand the causal dynamics of the underlying neural mechanisms.
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Affiliation(s)
- Maximilian Schmaußer
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
- Performance Psychology Department, Institute of Psychology, German Sport University, Cologne, Germany
| | - Markus Raab
- Performance Psychology Department, Institute of Psychology, German Sport University, Cologne, Germany
| | - Sylvain Laborde
- Performance Psychology Department, Institute of Psychology, German Sport University, Cologne, Germany
- UFR STAPS, Université de Caen Normandie, Caen, France
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2
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Zhu M, Huang S, Chen W, Pan G, Zhou Y. The effect of transcranial magnetic stimulation on cognitive function in post-stroke patients: a systematic review and meta-analysis. BMC Neurol 2024; 24:234. [PMID: 38969994 PMCID: PMC11225150 DOI: 10.1186/s12883-024-03726-9] [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: 06/27/2023] [Accepted: 06/12/2024] [Indexed: 07/07/2024] Open
Abstract
BACKGROUND AND OBJECTIVE Transcranial magnetic stimulation (TMS) is considered as a promising treatment option for post-stroke cognitive impairment (PSCI).Some meta-analyses have indicated that TMS can be effective in treating cognitive decline in stroke patients, but the quality of the studies included and the methodologies employed were less than satisfactory. Thus, this meta-analysis aimed to evaluate the efficacy and safety of TMS for treating post-stroke cognitive impairment. METHODS We searched online databases like PubMed, Embase, Cochrane Library, and Web of Science to retrieve randomized controlled trials (RCTs) of TMS for the treatment of patients with PSCI. Two independent reviewers identified relevant literature, extracted purpose-specific data, and the Cochrane Risk of Bias Assessment Scale was utilized to assess the potential for bias in the literature included in this study. Stata 17.0 software was used for data analysis. RESULTS A total of 10 studies involving 414 patients were included. The results of the meta-analysis showed that TMS was significantly superior to the control group for improving the overall cognitive function of stroke patients (SMD = 1.17, 95% CI [0.59, 1.75], I2 = 86.1%, P < 0.001). Subgroup analyses revealed that high-frequency rTMS (HF-rTMS), low-frequency rTMS (LF-rTMS), and intermittent theta burst stimulation (iTBS) all have a beneficial effect on the overall cognitive function of stroke patients. However, another subgroup analysis failed to demonstrate any significant advantage of TMS over the control group in terms of enhancing scores on the Loewenstein Occupational Therapy Cognitive Assessment (LOTCA) and Rivermead Behavioral Memory Test (RBMT) scales. Nonetheless, TMS demonstrated the potential to enhance the recovery of activities of daily living in stroke patients, as indicated by the Modified Barthel Index (MBI) (SMD = 0.76; 95% CI [0.22, 1.30], I2 = 52.6%, P = 0.121). CONCLUSION This meta-analysis presents evidence supporting the safety and efficacy of TMS as a non-invasive neural modulation tool for improving global cognitive abilities and activities of daily living in stroke patients. However, given the limited number of included studies, further validation of these findings is warranted through large-scale, multi-center, double-blind, high-quality randomized controlled trials. PROSPERO REGISTRATION NUMBER CRD42022381034.
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Affiliation(s)
- Mingjin Zhu
- Department of Rehabilitation Medicine, Tongde Hospital of Zhejiang Province, Hangzhou, China
| | - Siyu Huang
- Graduate School, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Wenjun Chen
- Department of Pharmacy, Xixi Hospital of Hangzhou, Hangzhou, 310023, China
| | - Guoyuan Pan
- Department of Rehabilitation Medicine, Tongde Hospital of Zhejiang Province, Hangzhou, China
| | - Yibo Zhou
- Department of Rehabilitation Medicine, Tongde Hospital of Zhejiang Province, Hangzhou, China.
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De Smet S, Int-Veen I, Vanhollebeke G, Pulopulos MM, Barth B, Pasche S, Baeken C, Nuerk HC, Plewnia C, Nieratschker V, Jochen Fallgatter A, Ehlis AC, Vanderhasselt MA, Rosenbaum D. Trait-dependent effects of theta burst stimulation after psychosocial stress: a sham-controlled study in healthy individuals. Clin Neurophysiol 2024; 162:235-247. [PMID: 38556367 DOI: 10.1016/j.clinph.2024.03.016] [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: 05/08/2023] [Revised: 01/11/2024] [Accepted: 03/05/2024] [Indexed: 04/02/2024]
Abstract
OBJECTIVE Previous studies suggest that theta burst stimulation (TBS), a form of repetitive transcranial magnetic stimulation (rTMS), applied to the left dorsolateral prefrontal cortex (DLPFC) might be a promising approach to modulate stress-reactive rumination and the associated psychophysiological stress response. Crucially, individuals showing higher levels of trait rumination might benefit more from prefrontal stimulation. METHODS In this sham-controlled study, 127 healthy individuals, with varying ruminative tendencies, received a single-session of intermittent TBS (iTBS), continuous TBS (cTBS) or sham TBS (sTBS) over the left DLPFC before being confronted with a Trier Social Stress Test. RESULTS Results showed significant TBS effects on salivary cortisol as a function of trait rumination. cTBS, as compared to sTBS and iTBS, resulted in an attenuated stress-induced cortisol response in high compared to low trait ruminators. Although independent of trait rumination levels, cTBS showed positive effects on stress-related changes in mood and, both cTBS and iTBS (versus sham) presented an enhanced heart rate recovery following the stressor. We found no evidence for (trait rumination-dependent) TBS effects on stress-reactive rumination, negative affect, subjective stress or heart rate variability. CONCLUSIONS cTBS shows beneficial effects on certain measures of stress, especially in high trait ruminators. SIGNIFICANCE These findings highlight the importance of accounting for individual differences when examining TBS effects.
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Affiliation(s)
- Stefanie De Smet
- Department of Head and Skin, Psychiatry and Medical Psychology, Ghent University Hospital, Ghent University, Ghent, Belgium; Ghent Experimental Psychiatry (GHEP) Lab, Ghent, Belgium; Brain Stimulation and Cognition (BSC) Lab, Department of Cognitive Neuroscience, Faculty of Psychology & Neuroscience, Maastricht University, Maastricht, The Netherlands.
| | - Isabell Int-Veen
- Tübingen Center for Mental Health (TüCMH), Department of Psychiatry and Psychotherapy, University Hospital of Tuebingen, Tuebingen, Germany
| | - Gert Vanhollebeke
- Department of Head and Skin, Psychiatry and Medical Psychology, Ghent University Hospital, Ghent University, Ghent, Belgium; Ghent Experimental Psychiatry (GHEP) Lab, Ghent, Belgium; Department of Electronics and Information Systems, Ghent University, Belgium; Medical Imaging and Signal Processing (MEDISIP) Group, Ghent, Belgium
| | - Matias M Pulopulos
- Department of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium
| | - Beatrix Barth
- Tübingen Center for Mental Health (TüCMH), Department of Psychiatry and Psychotherapy, University Hospital of Tuebingen, Tuebingen, Germany; German Center for Mental Health (DZPG), Germany
| | - Sarah Pasche
- Tübingen Center for Mental Health (TüCMH), Department of Psychiatry and Psychotherapy, University Hospital of Tuebingen, Tuebingen, Germany; German Center for Mental Health (DZPG), Germany
| | - Chris Baeken
- Department of Head and Skin, Psychiatry and Medical Psychology, Ghent University Hospital, Ghent University, Ghent, Belgium; Ghent Experimental Psychiatry (GHEP) Lab, Ghent, Belgium; Department of Psychiatry, University Hospital (UZBrussel), Brussels, Belgium; Eindhoven University of Technology, Department of Electrical Engineering, Eindhoven, the Netherlands
| | | | - Christian Plewnia
- Tübingen Center for Mental Health (TüCMH), Department of Psychiatry and Psychotherapy, University Hospital of Tuebingen, Tuebingen, Germany; German Center for Mental Health (DZPG), Germany
| | - Vanessa Nieratschker
- Tübingen Center for Mental Health (TüCMH), Department of Psychiatry and Psychotherapy, University Hospital of Tuebingen, Tuebingen, Germany; German Center for Mental Health (DZPG), Germany
| | - Andreas Jochen Fallgatter
- Tübingen Center for Mental Health (TüCMH), Department of Psychiatry and Psychotherapy, University Hospital of Tuebingen, Tuebingen, Germany; German Center for Mental Health (DZPG), Germany
| | - Ann-Christine Ehlis
- Tübingen Center for Mental Health (TüCMH), Department of Psychiatry and Psychotherapy, University Hospital of Tuebingen, Tuebingen, Germany; German Center for Mental Health (DZPG), Germany
| | - Marie-Anne Vanderhasselt
- Department of Head and Skin, Psychiatry and Medical Psychology, Ghent University Hospital, Ghent University, Ghent, Belgium; Ghent Experimental Psychiatry (GHEP) Lab, Ghent, Belgium
| | - David Rosenbaum
- Tübingen Center for Mental Health (TüCMH), Department of Psychiatry and Psychotherapy, University Hospital of Tuebingen, Tuebingen, Germany
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Wang Y, Zhang J, Li Y, Qi S, Zhang F, Ball LJ, Duan H. Preventing prefrontal dysfunction by tDCS modulates stress-induced creativity impairment in women: an fNIRS study. Cereb Cortex 2023; 33:10528-10545. [PMID: 37585735 DOI: 10.1093/cercor/bhad301] [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: 04/26/2023] [Revised: 07/25/2023] [Accepted: 07/26/2023] [Indexed: 08/18/2023] Open
Abstract
Stress is a major external factor threatening creative activity. The study explored whether left-lateralized activation in the dorsolateral prefrontal cortex manipulated through transcranial direct current stimulation could alleviate stress-induced impairment in creativity. Functional near-infrared spectroscopy was used to explore the underlying neural mechanisms. Ninety female participants were randomly assigned to three groups that received stress induction with sham stimulation, stress induction with true stimulation (anode over the left and cathode over the right dorsolateral prefrontal cortex), and control manipulation with sham stimulation, respectively. Participants underwent the stress or control task after the transcranial direct current stimulation manipulation, and then completed the Alternative Uses Task to measure creativity. Behavioral results showed that transcranial direct current stimulation reduced stress responses in heart rate and anxiety. The functional near-infrared spectroscopy results revealed that transcranial direct current stimulation alleviated dysfunction of the prefrontal cortex under stress, as evidenced by higher activation of the dorsolateral prefrontal cortex and frontopolar cortex, as well as stronger inter-hemispheric and intra-hemispheric functional connectivity within the prefrontal cortex. Further analysis demonstrated that the cortical regulatory effect prevented creativity impairment induced by stress. The findings validated the hemispheric asymmetry hypothesis regarding stress and highlighted the potential for brain stimulation to alleviate stress-related mental disorders and enhance creativity.
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Affiliation(s)
- Yifan Wang
- Key Laboratory of Modern Teaching Technology, Ministry of Education, Shaanxi Normal University, Xi'an 041000, China
| | - Jiaqi Zhang
- Key Laboratory of Modern Teaching Technology, Ministry of Education, Shaanxi Normal University, Xi'an 041000, China
| | - Yadan Li
- Key Laboratory of Modern Teaching Technology, Ministry of Education, Shaanxi Normal University, Xi'an 041000, China
| | - Senqing Qi
- Key Laboratory of Modern Teaching Technology, Ministry of Education, Shaanxi Normal University, Xi'an 041000, China
| | - Fengqing Zhang
- Department of Psychological and Brain Sciences, Drexel University, Philadelphia, PA 19104, USA
| | - Linden J Ball
- School of Psychology & Computer Science, University of Central Lancashire, Preston PR1 2HE, UK
| | - Haijun Duan
- Key Laboratory of Modern Teaching Technology, Ministry of Education, Shaanxi Normal University, Xi'an 041000, China
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Lande NM, Ask TF, Sætren SS, Lugo RG, Sütterlin S. The Role of Emotion Regulation for General Self-Efficacy in Adolescents Assessed Through Both Neurophysiological and Self-Reported Measures. Psychol Res Behav Manag 2023; 16:3373-3383. [PMID: 37650113 PMCID: PMC10464900 DOI: 10.2147/prbm.s406702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 07/28/2023] [Indexed: 09/01/2023] Open
Abstract
Background Self-efficacy, the belief in one's ability and capacity to organize and execute actions required to achieve desired results, is associated with adolescent academic achievement and reduced risk for psychopathology. Adolescent emotion regulation represents an important component in the relationship between self-efficacy and developmental outcomes, but the underlying neurophysiological mechanisms are poorly understood. It is unclear how emotion regulation strategies, which change with experience, and emotion regulation capacity, which is largely determined by genetics, contribute to the development of self-efficacy. Aim The present study aims to explore the relationship between emotion regulation and self-efficacy in adolescents. We hypothesize that neurophysiological emotion regulation capacity moderates the relationship between emotion regulation strategies and self-efficacy. Methods The present study applied a cross-sectional design. A sample of high-school students (N = 45, nfemale = 31, age = 17-18) provided answers on the General Self-Efficacy Questionnaire and the Emotion Regulation Questionnaire. Vagal tone was used as an indicator for emotion regulation capacity. Results In the initial correlational analysis, reappraisal, but not expressive suppression nor vagal tone was associated with self-efficacy. Vagal tone was not associated with any self-report measures of emotion regulation or self-efficacy. Contrary to our hypothesis, vagal tone did not moderate the relationship between emotion regulation and self-efficacy. Conclusion This is the first study assessing the relationship between neurophysiological indicators of emotion regulation and self-efficacy. Our results do not indicate that vagal tone moderates the relationship between emotion regulation strategies and general self-efficacy. Future studies should also assess the possible influence of metacognition and interoception on relationships.
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Affiliation(s)
| | - Torvald F Ask
- Department of Health, Welfare and Organization, Østfold University College, Halden, Norway
- Department of Information Security and Communication Technology, Norwegian University of Science and Technology, Gjøvik, Norway
| | - Sjur Skjørshammer Sætren
- Department for Child and Adolescent Research, Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway
- TIPS Centre for Clinical Research in Psychosis, Stavanger University Hospital, Stavanger, Norway
| | - Ricardo Gregorio Lugo
- Department of Health, Welfare and Organization, Østfold University College, Halden, Norway
- Department of Information Security and Communication Technology, Norwegian University of Science and Technology, Gjøvik, Norway
- Centre for Digital Forensics and Cybersecurity, Tallinn University of Technology, Tallinn, Estonia
| | - Stefan Sütterlin
- Department of Health, Welfare and Organization, Østfold University College, Halden, Norway
- Centre for Digital Forensics and Cybersecurity, Tallinn University of Technology, Tallinn, Estonia
- Faculty of Computer Science, Albstadt-Sigmaringen University, Sigmaringen, Germany
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6
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Vignaud P, Adam O, Palm U, Baeken C, Prieto N, Poulet E, Brunelin J. Can a single session of noninvasive brain stimulation applied over the prefrontal cortex prevent stress-induced cortisol release? Prog Neuropsychopharmacol Biol Psychiatry 2023; 121:110667. [PMID: 36273508 DOI: 10.1016/j.pnpbp.2022.110667] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 10/07/2022] [Accepted: 10/17/2022] [Indexed: 11/07/2022]
Abstract
INTRODUCTION A better understanding of how the hypothalamic-pituitary-adrenal (HPA) axis can be externally regulated is of major importance, especially because hyperreactivity to stress has been proposed as a key factor in the onset and maintenance of many psychiatric conditions. Over the past decades, numerous studies have investigated whether non-invasive brain stimulation (NIBS) can regulate HPA axis reactivity in acute stress situation. As the current results did not allow us to draw clear conclusions, we decided to conduct a systematic review of the literature investigating the effect of a single NIBS session on stress-induced cortisol release. METHODS We searched MEDLINE and Web Of Science for articles indexed through December 2021. Among the 246 articles identified, 15 fulfilled our inclusion criteria with a quality estimated between 52 and 93%. RESULTS Of the different NIBS used and targeted brain regions, stimulating the left dorsolateral prefrontal cortex, with either high frequency repetitive transcranial magnetic stimulation or anodal transcranial direct current stimulation, seems to be the most appropriate for reducing cortisol release in acute stress situations. CONCLUSIONS Despite the heterogeneity of the stimulation parameters, the characteristics of participants, the modalities of cortisol collection, the timing of the NIBS session in relation to the stressor exposure, and methodological considerations, stimulating the left dorsolateral prefrontal cortex can be efficient to modulate stress-induced cortisol release.
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Affiliation(s)
- Philippe Vignaud
- Regional Centre for Psychotraumatic Disorders, Hôpital Edouard Herriot, F-69437 Lyon, France; Emergency Medical Service, Cellule D'urgences Medico-Psychologiques, Hôpital Edouard Herriot, F-69437 Lyon, France; INSERM U1028, CNRS UMR5292, PSYR2 Team, Lyon Neuroscience Research Center, Université Claude Bernard Lyon 1, F-69000 Lyon, France.
| | - Ondine Adam
- INSERM U1028, CNRS UMR5292, PSYR2 Team, Lyon Neuroscience Research Center, Université Claude Bernard Lyon 1, F-69000 Lyon, France; CH Le Vinatier, 95 boulevard Pinel, F-69500 Bron, France.
| | - Ulrich Palm
- Dept. of Psychiatry and Psychotherapy, Munich University Hospital, Munich, Germany; Medicalpark Chiemseeblick, Bernau-Felden, Germany.
| | - Chris Baeken
- Ghent University, Dept. of Head and Skin (UZGent), Ghent Experimental Psychiatry (GHEP) Lab, Belgium; Vrije Universiteit Brussel (VUB) Department of Psychiatry (UZBrussel), Belgium; Eindhoven University of Technology, Department of ELectrical Engineering, the Netherlands.
| | - Nathalie Prieto
- Regional Centre for Psychotraumatic Disorders, Hôpital Edouard Herriot, F-69437 Lyon, France; Emergency Medical Service, Cellule D'urgences Medico-Psychologiques, Hôpital Edouard Herriot, F-69437 Lyon, France.
| | - Emmanuel Poulet
- INSERM U1028, CNRS UMR5292, PSYR2 Team, Lyon Neuroscience Research Center, Université Claude Bernard Lyon 1, F-69000 Lyon, France; CH Le Vinatier, 95 boulevard Pinel, F-69500 Bron, France; Department of Psychiatric Emergency, Hôpital Edouard Herriot, F-69437 Lyon, France.
| | - Jérôme Brunelin
- INSERM U1028, CNRS UMR5292, PSYR2 Team, Lyon Neuroscience Research Center, Université Claude Bernard Lyon 1, F-69000 Lyon, France; CH Le Vinatier, 95 boulevard Pinel, F-69500 Bron, France.
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7
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De Smet S, Ottaviani C, Verkuil B, Kappen M, Baeken C, Vanderhasselt MA. Effects of non-invasive vagus nerve stimulation on cognitive and autonomic correlates of perseverative cognition. Psychophysiology 2023; 60:e14250. [PMID: 36683127 DOI: 10.1111/psyp.14250] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 01/03/2023] [Accepted: 01/03/2023] [Indexed: 01/24/2023]
Abstract
Perseverative cognitions can provoke psychophysiological stress in the absence of an actual stressor and are considered important transdiagnostic vulnerability factors for several (mental) health issues. These stress-related cognitive processes are reflected by both cognitive (assessed by self-reports) and autonomic inflexibility (assessed by heart rate variability; HRV), with a key role attributed to the vagus nerve. Interestingly, modulation of the afferent branches of the vagus can be achieved with transcutaneous auricular vagus nerve stimulation (taVNS), a non-invasive technique that employs a low-intensity electrical current applied to the ear. In a sample of healthy individuals, we investigated the effects of taVNS of the left concha, compared to sham (earlobe) stimulation, on the cognitive and autonomic correlates of perseverative cognition following a psychosocial stress task. Interestingly, taVNS significantly reduced cognitive rigidity, reflected by reduced subjective perseverative thinking after psychosocial stress. Although there were no direct effects on autonomic correlates of perseverative cognition, individual differences in perseverative thinking after the stressor significantly affected the effects of taVNS on HRV. Specifically, more autonomic inflexibility during the stress task (i.e., reduced HRV) was associated with increases in perseverative thinking afterward for the sham condition, but not the active taVNS condition. Additional exploratory analyses revealed no significant moderation of stimulation intensity. Overall, the study findings endorse the association between perseverative cognitions and vagus nerve functioning.
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Affiliation(s)
- Stefanie De Smet
- Department of Head and Skin, Psychiatry and Medical Psychology, Ghent University Hospital, Ghent University, Ghent, Belgium.,Ghent Experimental Psychiatry (GHEP) Lab, Ghent, Belgium
| | - Cristina Ottaviani
- Department of Psychology, Sapienza University of Rome, Rome, Italy.,IRCCS Santa Lucia Foundation, Rome, Italy
| | - Bart Verkuil
- Department of Clinical Psychology, Leiden University, Leiden, the Netherlands.,Leiden Institute for Brain and Cognition (LIBC), Leiden, the Netherlands
| | - Mitchel Kappen
- Department of Head and Skin, Psychiatry and Medical Psychology, Ghent University Hospital, Ghent University, Ghent, Belgium.,Ghent Experimental Psychiatry (GHEP) Lab, Ghent, Belgium
| | - Chris Baeken
- Department of Head and Skin, Psychiatry and Medical Psychology, Ghent University Hospital, Ghent University, Ghent, Belgium.,Ghent Experimental Psychiatry (GHEP) Lab, Ghent, Belgium.,Department of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium.,Department of Psychiatry, Brussels University Hospital, Brussels, Belgium.,Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Marie-Anne Vanderhasselt
- Department of Head and Skin, Psychiatry and Medical Psychology, Ghent University Hospital, Ghent University, Ghent, Belgium.,Ghent Experimental Psychiatry (GHEP) Lab, Ghent, Belgium.,Department of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium
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8
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Gu Z, Chen W, Lu Q, Dai J, Hu S, Xu K, Geng Y, Zhu Y, Xu B, Dai W, Shen Y. Anodal high-definition transcranial direct current stimulation reduces heart rate and modulates heart-rate variability in healthy young people: A randomized cross-controlled trial. Front Cardiovasc Med 2022; 9:1070157. [PMID: 36531710 PMCID: PMC9755739 DOI: 10.3389/fcvm.2022.1070157] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 11/18/2022] [Indexed: 08/12/2023] Open
Abstract
OBJECTIVE To investigate whether anodal high-definition transcranial current stimulation (HD-tDCS) over the left dorsolateral pre-frontal cortex (DLPFC) could modulate the heart rate (HR) and heart-rate variability (HRV) in healthy young people. METHODS Forty healthy young people were enrolled in this randomized crossover trial. The participants were randomized to receive anodal HD-tDCS (n = 20) or sham HD-tDCS (n = 20) over the left DLPFC with a washout period of 1 week. Electrocardiogram (ECG) data were continuously recorded 20 min before the stimulation, during the session (20 min), and 20 min after the session. HR and the time- and frequency-domain indices of the HRV were measured to investigate the activity of the sympathetic and parasympathetic nervous systems. RESULTS Anodal HD-tDCS over the left DLPFC induced a significant decrease in HR and a significant increase in the average of normal-to-normal intervals (AVG NN), low-frequency (LF) power, total power (TP), and LF/high-frequency (HF) ratio in comparison with the sham stimulation and the baseline. However, sham HD-tDCS over the left DLPFC had no significant effect on HR or HRV. CONCLUSIONS Anodal HD-tDCS over the left DLPFC could reduce HR and modulate the HRV in healthy young people. HD-tDCS may show some potential for acutely modulating cardiovascular function.
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Affiliation(s)
- Zhongke Gu
- Department of Sport and Health Sciences, Nanjing Sport Institute, Nanjing, China
| | - Wenxiang Chen
- Department of Rehabilitation, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Qian Lu
- Department of Rehabilitation Medicine, The Affiliated Jiangsu Shengze Hospital of Nanjing Medical University, Suzhou, China
| | - Jiansong Dai
- Department of Sport and Health Sciences, Nanjing Sport Institute, Nanjing, China
| | - Shugang Hu
- Department of Rehabilitation, The Affiliated Jiangning Hospital With Nanjing Medical University, Nanjing, China
| | - Kai Xu
- Department of Sport and Health Sciences, Nanjing Sport Institute, Nanjing, China
| | - Yao Geng
- Rehabilitation Medicine Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Ye Zhu
- Rehabilitation Medicine Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Boqing Xu
- Rehabilitation Medicine Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Wenjun Dai
- Rehabilitation Medicine Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Ying Shen
- Rehabilitation Medicine Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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9
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Schmaußer M, Hoffmann S, Raab M, Laborde S. The effects of noninvasive brain stimulation on heart rate and heart rate variability: A systematic review and meta-analysis. J Neurosci Res 2022; 100:1664-1694. [PMID: 35582757 DOI: 10.1002/jnr.25062] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 04/25/2022] [Accepted: 04/30/2022] [Indexed: 12/30/2022]
Abstract
Noninvasive brain stimulation (NIBS) techniques such as transcranial magnetic stimulation and transcranial direct current stimulation are widely used to test the involvement of specific cortical regions in various domains such as cognition and emotion. Despite the capability of stimulation techniques to test causal directions, this approach has been only sparsely used to examine the cortical regulation of autonomic nervous system (ANS) functions such as heart rate (HR) and heart rate variability (HRV) and to test current models in this regard. In this preregistered (PROSPERO) systematic review and meta-analysis, we aimed to investigate, based on meta-regression, whether NIBS represents an effective method for modulating HR and HRV measures, and to evaluate whether the ANS is modulated by cortical mechanisms affected by NIBS. Here we have adhered to the PRISMA guidelines. In a series of four meta-analyses, a total of 131 effect sizes from 35 sham-controlled trials were analyzed using robust variance estimation random-effects meta-regression technique. NIBS was found to effectively modulate HR and HRV with small to medium effect sizes. Moderator analyses yielded significant differences in effects between stimulation of distinct cortical areas. Our results show that NIBS is a promising tool to investigate the cortical regulation of ANS, which may add to the existing brain imaging and animal study literature. Future research is needed to identify further factors modulating the size of effects. As many of the studies reviewed were found to be at high risk of bias, we recommend that methods to reduce potential risk of bias be used in the design and conduct of future studies.
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Affiliation(s)
| | - Sven Hoffmann
- Institute of Psychology, University of Hagen, Hagen, Germany
| | - Markus Raab
- Institute of Psychology, German Sport University, Cologne, Germany.,School of Applied Sciences, London South Bank University, London, UK
| | - Sylvain Laborde
- Institute of Psychology, German Sport University, Cologne, Germany.,UFR STAPS, EA 4260, Université de Caen Normandie, Caen, France
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Teed AR, Feinstein JS, Puhl M, Lapidus RC, Upshaw V, Kuplicki RT, Bodurka J, Ajijola OA, Kaye WH, Thompson WK, Paulus MP, Khalsa SS. Association of Generalized Anxiety Disorder With Autonomic Hypersensitivity and Blunted Ventromedial Prefrontal Cortex Activity During Peripheral Adrenergic Stimulation: A Randomized Clinical Trial. JAMA Psychiatry 2022; 79:323-332. [PMID: 35107563 PMCID: PMC8811711 DOI: 10.1001/jamapsychiatry.2021.4225] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
IMPORTANCE β-Adrenergic stimulation elicits heart palpitations and dyspnea, key features of acute anxiety and sympathetic arousal, yet no neuroimaging studies have examined how the pharmacologic modulation of interoceptive signals is associated with fear-related neurocircuitry in individuals with generalized anxiety disorder (GAD). OBJECTIVE To examine the neural circuitry underlying autonomic arousal induced via isoproterenol, a rapidly acting, peripheral β-adrenergic agonist akin to adrenaline. DESIGN, SETTING, AND PARTICIPANTS This crossover randomized clinical trial of 58 women with artifact-free data was conducted from January 1, 2017, to November 31, 2019, at the Laureate Institute for Brain Research in Tulsa, Oklahoma. EXPOSURES Functional magnetic resonance imaging was used to assess neural responses during randomized intravenous bolus infusions of isoproterenol (0.5 and 2.0 μg) and saline, each administered twice in a double-blind fashion. MAIN OUTCOMES AND MEASURES Blood oxygen level-dependent responses across the whole brain during isoproterenol administration in patients with GAD vs healthy comparators. Cardiac and respiratory responses, as well as interoceptive awareness and anxiety, were also measured during the infusion protocol. RESULTS Of the 58 female study participants, 29 had GAD (mean [SD] age, 26.9 [6.8] years) and 29 were matched healthy comparators (mean [SD] age, 24.4 [5.0] years). During the 0.5-μg dose of isoproterenol, the GAD group exhibited higher heart rate responses (b = 5.34; 95% CI, 2.06-8.61; P = .002), higher intensity ratings of cardiorespiratory sensations (b = 8.38; 95% CI, 2.05-14.71; P = .01), higher levels of self-reported anxiety (b = 1.04; 95% CI, 0.33-1.76; P = .005), and significant hypoactivation in the ventromedial prefrontal cortex (vmPFC) that was evident throughout peak response (Cohen d = 1.55; P < .001) and early recovery (Cohen d = 1.52; P < .001) periods. Correlational analysis of physiological and subjective indexes and percentage of signal change extracted during the 0.5-μg dose revealed that vmPFC hypoactivation was inversely correlated with heart rate (r56 = -0.51, adjusted P = .001) and retrospective intensity of both heartbeat (r56 = -0.50, adjusted P = .002) and breathing (r56 = -0.44, adjusted P = .01) sensations. Ventromedial prefrontal cortex hypoactivation correlated inversely with continuous dial ratings at a trend level (r56 = -0.38, adjusted P = .051), whereas anxiety (r56 = -0.28, adjusted P = .27) and chronotropic dose 25 (r56 = -0.14, adjusted P = .72) showed no such association. CONCLUSIONS AND RELEVANCE In this crossover randomized clinical trial, women with GAD exhibited autonomic hypersensitivity during low levels of adrenergic stimulation characterized by elevated heart rate, heightened interoceptive awareness, increased anxiety, and a blunted neural response localized to the vmPFC. These findings support the notion that autonomic hyperarousal may be associated with regulatory dysfunctions in the vmPFC, which could serve as a treatment target to help patients with GAD more appropriately appraise and regulate signals of sympathetic arousal. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02615119.
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Affiliation(s)
- Adam R. Teed
- Laureate Institute for Brain Research, Tulsa, Oklahoma
| | | | - Maria Puhl
- Laureate Institute for Brain Research, Tulsa, Oklahoma
| | | | | | | | - Jerzy Bodurka
- Laureate Institute for Brain Research, Tulsa, Oklahoma,Stephenson School for Biomedical Engineering, University of Oklahoma, Norman
| | - Olujimi A. Ajijola
- Cardiac Arrhythmia Center, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Walter H. Kaye
- Department of Psychiatry, University of California, San Diego
| | | | - Martin P. Paulus
- Laureate Institute for Brain Research, Tulsa, Oklahoma,Oxley College of Health Sciences, University of Tulsa, Tulsa, Oklahoma,Deputy Editor, JAMA Psychiatry
| | - Sahib S. Khalsa
- Laureate Institute for Brain Research, Tulsa, Oklahoma,Oxley College of Health Sciences, University of Tulsa, Tulsa, Oklahoma
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Mikellides G, Michael P, Psalta L, Stefani A, Schuhmann T, Sack AT. Accelerated Intermittent Theta Burst Stimulation in Smoking Cessation: Placebo Effects Equal to Active Stimulation When Using Advanced Placebo Coil Technology. Front Psychiatry 2022; 13:892075. [PMID: 35686190 PMCID: PMC9170940 DOI: 10.3389/fpsyt.2022.892075] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 05/04/2022] [Indexed: 12/23/2022] Open
Abstract
UNLABELLED Smoking is currently one of the main public health problems. Smoking cessation is known to be difficult for most smokers because of nicotine dependence. Repetitive transcranial magnetic stimulation (rTMS) over the left dorsolateral prefrontal cortex (DLPFC) has been shown to be effective in the reduction of nicotine craving and cigarette consumption. Here, we evaluated the efficacy of accelerated intermittent theta burst stimulation (aiTBS; four sessions per day for 5 consecutive days) over the left DLPFC in smoking cessation, and we investigated whether the exposure to smoking-related cues compared to neutral cues during transcranial magnetic stimulation (TMS) impacts treatment outcome. A double-blind, randomized, controlled study was conducted in which 89 participants (60 males and 29 females; age 45.62 ± 13.42 years) were randomly divided into three groups: the first group received active aiTBS stimulation while watching neutral videos, the second group received active aiTBS stimulation while watching smoking-related videos and the last group received sham stimulation while watching smoking-related videos. Our results suggest that aiTBS is a tolerable treatment. All treatment groups equally reduced cigarette consumption, nicotine dependence, craving and perceived stress. The effect on nicotine dependence, general craving and perceived stress lasted for at least 1 week after the end of treatment. Active aiTBS over the left DLPFC, combined with smoking related cues, is as effective as active aiTBS combined with neutral cues as well as placebo aiTBS in smoking cessation. These findings extend the results of previous studies indicating that TMS therapy is associated with considerably large placebo effects and that these placebo effects may be further increased when using advanced placebo coil technology. CLINICAL TRIAL REGISTRATION www.clinicaltrials.gov, identifier NCT05271175.
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Affiliation(s)
- Georgios Mikellides
- Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, Netherlands.,Cyprus rTMS Centre, Larnaca, Cyprus
| | | | - Lilia Psalta
- Department of Psychology, University of Cyprus, Nicosia, Cyprus.,School of Science, University of Central Lancashire, Larnaca, Cyprus
| | - Artemis Stefani
- Department of Developmental Neurosciences, Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
| | - Teresa Schuhmann
- Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, Netherlands
| | - Alexander T Sack
- Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, Netherlands.,Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNs), Brain+Nerve Centre, Maastricht University Medical Centre+ (MUMC+), Maastricht, Netherlands
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12
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Thayer JF, Mather M, Koenig J. Stress and aging: A neurovisceral integration perspective. Psychophysiology 2021; 58:e13804. [PMID: 33723899 DOI: 10.1111/psyp.13804] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 02/12/2021] [Accepted: 02/17/2021] [Indexed: 12/11/2022]
Abstract
Darwin emphasized the intimate relationship between the brain and the heart over 150 years ago. Healthy aging is associated with significant changes in both the brain and the heart. The changes between these, the two most important organs of the body, are linked via the vagus nerve. In this review, we examine the normative changes with aging and the effect that stress may have on how the brain-heart connection changes with age. We provide a framework based on the concept of neurovisceral integration and propose that stress regulation is emotion regulation. As such, studies that have investigated emotion regulation may yield insights into successful stress regulation that helps protect people from age-related decline. In addition, interventions that improve brain health also improve heart health and vice versa. We conclude by noting that significant sex and ethnic differences exist but that future studies are needed to more fully explicate how they may moderate the associations between stress and aging.
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Affiliation(s)
- Julian F Thayer
- Department of Psychological Science, University of California, Irvine, CA, USA
| | - Mara Mather
- Department of Psychology, Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA, USA.,Department of Biomedical Engineering, University of Southern California, Los Angeles, CA, USA
| | - Julian Koenig
- Section for Experimental Child and Adolescent Psychiatry, Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany.,University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
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