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Haller SP, Linke JO, Grassie HL, Jones EL, Pagliaccio D, Harrewijn A, White LK, Naim R, Abend R, Mallidi A, Berman E, Lewis KM, Kircanski K, Fox NA, Silverman WK, Kalin NH, Bar-Haim Y, Brotman MA. Normalization of Fronto-Parietal Activation by Cognitive-Behavioral Therapy in Unmedicated Pediatric Patients With Anxiety Disorders. Am J Psychiatry 2024; 181:201-212. [PMID: 38263879 DOI: 10.1176/appi.ajp.20220449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
OBJECTIVE Anxiety disorders are prevalent among youths and are often highly impairing. Cognitive-behavioral therapy (CBT) is an effective first-line treatment. The authors investigated the brain mechanisms associated with symptom change following CBT. METHODS Unmedicated youths diagnosed with an anxiety disorder underwent 12 weeks of CBT as part of two randomized clinical trials testing the efficacy of adjunctive computerized cognitive training. Across both trials, participants completed a threat-processing task during functional MRI before and after treatment. Age-matched healthy comparison youths completed two scans over the same time span. The mean age of the samples was 13.20 years (SD=2.68); 41% were male (youths with anxiety disorders, N=69; healthy comparison youths, N=62). An additional sample including youths at temperamental risk for anxiety (N=87; mean age, 10.51 years [SD=0.43]; 41% male) was utilized to test the stability of anxiety-related neural differences in the absence of treatment. Whole-brain regional activation changes (thresholded at p<0.001) were examined using task-based blood-oxygen-level-dependent response. RESULTS Before treatment, patients with an anxiety disorder exhibited altered activation in fronto-parietal attention networks and limbic regions relative to healthy comparison children across all task conditions. Fronto-parietal hyperactivation normalized over the course of treatment, whereas limbic responses remained elevated after treatment. In the at-risk sample, overlapping clusters emerged between regions showing stable associations with anxiety over time and regions showing treatment-related changes. CONCLUSIONS Activation in fronto-parietal networks may normalize after CBT in unmedicated pediatric anxiety patients. Limbic regions may be less amenable to acute CBT effects. Findings from the at-risk sample suggest that treatment-related changes may not be attributed solely to the passage of time.
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Affiliation(s)
- Simone P Haller
- Emotion and Development Branch, NIMH, Bethesda, Md. (Haller, Grassie, Jones, Mallidi, Berman, Lewis, Kircanski, Brotman); Department of Psychology, University of Freiburg, Freiburg, Germany (Linke); Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, New York (Pagliaccio); Department of Psychology, Education and Child Studies, Erasmus University Rotterdam, Rotterdam, the Netherlands (Harrewijn); Department of Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia (White); Baruch Ivcher School of Psychology, Reichman University, Herzliya, Israel (Abend); Department of Human Development and Quantitative Methodology, University of Maryland, College Park (Fox); Yale Child Study Center, Yale School of Medicine, New Haven, Conn. (Silverman); Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison (Kalin); School of Psychological Sciences (Bar-Heim, Naim) and Sagol School of Neuroscience (Bar-Haim), Tel Aviv University, Tel Aviv, Israel
| | - Julia O Linke
- Emotion and Development Branch, NIMH, Bethesda, Md. (Haller, Grassie, Jones, Mallidi, Berman, Lewis, Kircanski, Brotman); Department of Psychology, University of Freiburg, Freiburg, Germany (Linke); Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, New York (Pagliaccio); Department of Psychology, Education and Child Studies, Erasmus University Rotterdam, Rotterdam, the Netherlands (Harrewijn); Department of Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia (White); Baruch Ivcher School of Psychology, Reichman University, Herzliya, Israel (Abend); Department of Human Development and Quantitative Methodology, University of Maryland, College Park (Fox); Yale Child Study Center, Yale School of Medicine, New Haven, Conn. (Silverman); Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison (Kalin); School of Psychological Sciences (Bar-Heim, Naim) and Sagol School of Neuroscience (Bar-Haim), Tel Aviv University, Tel Aviv, Israel
| | - Hannah L Grassie
- Emotion and Development Branch, NIMH, Bethesda, Md. (Haller, Grassie, Jones, Mallidi, Berman, Lewis, Kircanski, Brotman); Department of Psychology, University of Freiburg, Freiburg, Germany (Linke); Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, New York (Pagliaccio); Department of Psychology, Education and Child Studies, Erasmus University Rotterdam, Rotterdam, the Netherlands (Harrewijn); Department of Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia (White); Baruch Ivcher School of Psychology, Reichman University, Herzliya, Israel (Abend); Department of Human Development and Quantitative Methodology, University of Maryland, College Park (Fox); Yale Child Study Center, Yale School of Medicine, New Haven, Conn. (Silverman); Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison (Kalin); School of Psychological Sciences (Bar-Heim, Naim) and Sagol School of Neuroscience (Bar-Haim), Tel Aviv University, Tel Aviv, Israel
| | - Emily L Jones
- Emotion and Development Branch, NIMH, Bethesda, Md. (Haller, Grassie, Jones, Mallidi, Berman, Lewis, Kircanski, Brotman); Department of Psychology, University of Freiburg, Freiburg, Germany (Linke); Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, New York (Pagliaccio); Department of Psychology, Education and Child Studies, Erasmus University Rotterdam, Rotterdam, the Netherlands (Harrewijn); Department of Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia (White); Baruch Ivcher School of Psychology, Reichman University, Herzliya, Israel (Abend); Department of Human Development and Quantitative Methodology, University of Maryland, College Park (Fox); Yale Child Study Center, Yale School of Medicine, New Haven, Conn. (Silverman); Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison (Kalin); School of Psychological Sciences (Bar-Heim, Naim) and Sagol School of Neuroscience (Bar-Haim), Tel Aviv University, Tel Aviv, Israel
| | - David Pagliaccio
- Emotion and Development Branch, NIMH, Bethesda, Md. (Haller, Grassie, Jones, Mallidi, Berman, Lewis, Kircanski, Brotman); Department of Psychology, University of Freiburg, Freiburg, Germany (Linke); Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, New York (Pagliaccio); Department of Psychology, Education and Child Studies, Erasmus University Rotterdam, Rotterdam, the Netherlands (Harrewijn); Department of Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia (White); Baruch Ivcher School of Psychology, Reichman University, Herzliya, Israel (Abend); Department of Human Development and Quantitative Methodology, University of Maryland, College Park (Fox); Yale Child Study Center, Yale School of Medicine, New Haven, Conn. (Silverman); Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison (Kalin); School of Psychological Sciences (Bar-Heim, Naim) and Sagol School of Neuroscience (Bar-Haim), Tel Aviv University, Tel Aviv, Israel
| | - Anita Harrewijn
- Emotion and Development Branch, NIMH, Bethesda, Md. (Haller, Grassie, Jones, Mallidi, Berman, Lewis, Kircanski, Brotman); Department of Psychology, University of Freiburg, Freiburg, Germany (Linke); Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, New York (Pagliaccio); Department of Psychology, Education and Child Studies, Erasmus University Rotterdam, Rotterdam, the Netherlands (Harrewijn); Department of Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia (White); Baruch Ivcher School of Psychology, Reichman University, Herzliya, Israel (Abend); Department of Human Development and Quantitative Methodology, University of Maryland, College Park (Fox); Yale Child Study Center, Yale School of Medicine, New Haven, Conn. (Silverman); Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison (Kalin); School of Psychological Sciences (Bar-Heim, Naim) and Sagol School of Neuroscience (Bar-Haim), Tel Aviv University, Tel Aviv, Israel
| | - Lauren K White
- Emotion and Development Branch, NIMH, Bethesda, Md. (Haller, Grassie, Jones, Mallidi, Berman, Lewis, Kircanski, Brotman); Department of Psychology, University of Freiburg, Freiburg, Germany (Linke); Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, New York (Pagliaccio); Department of Psychology, Education and Child Studies, Erasmus University Rotterdam, Rotterdam, the Netherlands (Harrewijn); Department of Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia (White); Baruch Ivcher School of Psychology, Reichman University, Herzliya, Israel (Abend); Department of Human Development and Quantitative Methodology, University of Maryland, College Park (Fox); Yale Child Study Center, Yale School of Medicine, New Haven, Conn. (Silverman); Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison (Kalin); School of Psychological Sciences (Bar-Heim, Naim) and Sagol School of Neuroscience (Bar-Haim), Tel Aviv University, Tel Aviv, Israel
| | - Reut Naim
- Emotion and Development Branch, NIMH, Bethesda, Md. (Haller, Grassie, Jones, Mallidi, Berman, Lewis, Kircanski, Brotman); Department of Psychology, University of Freiburg, Freiburg, Germany (Linke); Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, New York (Pagliaccio); Department of Psychology, Education and Child Studies, Erasmus University Rotterdam, Rotterdam, the Netherlands (Harrewijn); Department of Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia (White); Baruch Ivcher School of Psychology, Reichman University, Herzliya, Israel (Abend); Department of Human Development and Quantitative Methodology, University of Maryland, College Park (Fox); Yale Child Study Center, Yale School of Medicine, New Haven, Conn. (Silverman); Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison (Kalin); School of Psychological Sciences (Bar-Heim, Naim) and Sagol School of Neuroscience (Bar-Haim), Tel Aviv University, Tel Aviv, Israel
| | - Rany Abend
- Emotion and Development Branch, NIMH, Bethesda, Md. (Haller, Grassie, Jones, Mallidi, Berman, Lewis, Kircanski, Brotman); Department of Psychology, University of Freiburg, Freiburg, Germany (Linke); Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, New York (Pagliaccio); Department of Psychology, Education and Child Studies, Erasmus University Rotterdam, Rotterdam, the Netherlands (Harrewijn); Department of Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia (White); Baruch Ivcher School of Psychology, Reichman University, Herzliya, Israel (Abend); Department of Human Development and Quantitative Methodology, University of Maryland, College Park (Fox); Yale Child Study Center, Yale School of Medicine, New Haven, Conn. (Silverman); Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison (Kalin); School of Psychological Sciences (Bar-Heim, Naim) and Sagol School of Neuroscience (Bar-Haim), Tel Aviv University, Tel Aviv, Israel
| | - Ajitha Mallidi
- Emotion and Development Branch, NIMH, Bethesda, Md. (Haller, Grassie, Jones, Mallidi, Berman, Lewis, Kircanski, Brotman); Department of Psychology, University of Freiburg, Freiburg, Germany (Linke); Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, New York (Pagliaccio); Department of Psychology, Education and Child Studies, Erasmus University Rotterdam, Rotterdam, the Netherlands (Harrewijn); Department of Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia (White); Baruch Ivcher School of Psychology, Reichman University, Herzliya, Israel (Abend); Department of Human Development and Quantitative Methodology, University of Maryland, College Park (Fox); Yale Child Study Center, Yale School of Medicine, New Haven, Conn. (Silverman); Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison (Kalin); School of Psychological Sciences (Bar-Heim, Naim) and Sagol School of Neuroscience (Bar-Haim), Tel Aviv University, Tel Aviv, Israel
| | - Erin Berman
- Emotion and Development Branch, NIMH, Bethesda, Md. (Haller, Grassie, Jones, Mallidi, Berman, Lewis, Kircanski, Brotman); Department of Psychology, University of Freiburg, Freiburg, Germany (Linke); Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, New York (Pagliaccio); Department of Psychology, Education and Child Studies, Erasmus University Rotterdam, Rotterdam, the Netherlands (Harrewijn); Department of Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia (White); Baruch Ivcher School of Psychology, Reichman University, Herzliya, Israel (Abend); Department of Human Development and Quantitative Methodology, University of Maryland, College Park (Fox); Yale Child Study Center, Yale School of Medicine, New Haven, Conn. (Silverman); Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison (Kalin); School of Psychological Sciences (Bar-Heim, Naim) and Sagol School of Neuroscience (Bar-Haim), Tel Aviv University, Tel Aviv, Israel
| | - Krystal M Lewis
- Emotion and Development Branch, NIMH, Bethesda, Md. (Haller, Grassie, Jones, Mallidi, Berman, Lewis, Kircanski, Brotman); Department of Psychology, University of Freiburg, Freiburg, Germany (Linke); Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, New York (Pagliaccio); Department of Psychology, Education and Child Studies, Erasmus University Rotterdam, Rotterdam, the Netherlands (Harrewijn); Department of Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia (White); Baruch Ivcher School of Psychology, Reichman University, Herzliya, Israel (Abend); Department of Human Development and Quantitative Methodology, University of Maryland, College Park (Fox); Yale Child Study Center, Yale School of Medicine, New Haven, Conn. (Silverman); Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison (Kalin); School of Psychological Sciences (Bar-Heim, Naim) and Sagol School of Neuroscience (Bar-Haim), Tel Aviv University, Tel Aviv, Israel
| | - Katharina Kircanski
- Emotion and Development Branch, NIMH, Bethesda, Md. (Haller, Grassie, Jones, Mallidi, Berman, Lewis, Kircanski, Brotman); Department of Psychology, University of Freiburg, Freiburg, Germany (Linke); Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, New York (Pagliaccio); Department of Psychology, Education and Child Studies, Erasmus University Rotterdam, Rotterdam, the Netherlands (Harrewijn); Department of Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia (White); Baruch Ivcher School of Psychology, Reichman University, Herzliya, Israel (Abend); Department of Human Development and Quantitative Methodology, University of Maryland, College Park (Fox); Yale Child Study Center, Yale School of Medicine, New Haven, Conn. (Silverman); Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison (Kalin); School of Psychological Sciences (Bar-Heim, Naim) and Sagol School of Neuroscience (Bar-Haim), Tel Aviv University, Tel Aviv, Israel
| | - Nathan A Fox
- Emotion and Development Branch, NIMH, Bethesda, Md. (Haller, Grassie, Jones, Mallidi, Berman, Lewis, Kircanski, Brotman); Department of Psychology, University of Freiburg, Freiburg, Germany (Linke); Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, New York (Pagliaccio); Department of Psychology, Education and Child Studies, Erasmus University Rotterdam, Rotterdam, the Netherlands (Harrewijn); Department of Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia (White); Baruch Ivcher School of Psychology, Reichman University, Herzliya, Israel (Abend); Department of Human Development and Quantitative Methodology, University of Maryland, College Park (Fox); Yale Child Study Center, Yale School of Medicine, New Haven, Conn. (Silverman); Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison (Kalin); School of Psychological Sciences (Bar-Heim, Naim) and Sagol School of Neuroscience (Bar-Haim), Tel Aviv University, Tel Aviv, Israel
| | - Wendy K Silverman
- Emotion and Development Branch, NIMH, Bethesda, Md. (Haller, Grassie, Jones, Mallidi, Berman, Lewis, Kircanski, Brotman); Department of Psychology, University of Freiburg, Freiburg, Germany (Linke); Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, New York (Pagliaccio); Department of Psychology, Education and Child Studies, Erasmus University Rotterdam, Rotterdam, the Netherlands (Harrewijn); Department of Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia (White); Baruch Ivcher School of Psychology, Reichman University, Herzliya, Israel (Abend); Department of Human Development and Quantitative Methodology, University of Maryland, College Park (Fox); Yale Child Study Center, Yale School of Medicine, New Haven, Conn. (Silverman); Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison (Kalin); School of Psychological Sciences (Bar-Heim, Naim) and Sagol School of Neuroscience (Bar-Haim), Tel Aviv University, Tel Aviv, Israel
| | - Ned H Kalin
- Emotion and Development Branch, NIMH, Bethesda, Md. (Haller, Grassie, Jones, Mallidi, Berman, Lewis, Kircanski, Brotman); Department of Psychology, University of Freiburg, Freiburg, Germany (Linke); Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, New York (Pagliaccio); Department of Psychology, Education and Child Studies, Erasmus University Rotterdam, Rotterdam, the Netherlands (Harrewijn); Department of Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia (White); Baruch Ivcher School of Psychology, Reichman University, Herzliya, Israel (Abend); Department of Human Development and Quantitative Methodology, University of Maryland, College Park (Fox); Yale Child Study Center, Yale School of Medicine, New Haven, Conn. (Silverman); Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison (Kalin); School of Psychological Sciences (Bar-Heim, Naim) and Sagol School of Neuroscience (Bar-Haim), Tel Aviv University, Tel Aviv, Israel
| | - Yair Bar-Haim
- Emotion and Development Branch, NIMH, Bethesda, Md. (Haller, Grassie, Jones, Mallidi, Berman, Lewis, Kircanski, Brotman); Department of Psychology, University of Freiburg, Freiburg, Germany (Linke); Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, New York (Pagliaccio); Department of Psychology, Education and Child Studies, Erasmus University Rotterdam, Rotterdam, the Netherlands (Harrewijn); Department of Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia (White); Baruch Ivcher School of Psychology, Reichman University, Herzliya, Israel (Abend); Department of Human Development and Quantitative Methodology, University of Maryland, College Park (Fox); Yale Child Study Center, Yale School of Medicine, New Haven, Conn. (Silverman); Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison (Kalin); School of Psychological Sciences (Bar-Heim, Naim) and Sagol School of Neuroscience (Bar-Haim), Tel Aviv University, Tel Aviv, Israel
| | - Melissa A Brotman
- Emotion and Development Branch, NIMH, Bethesda, Md. (Haller, Grassie, Jones, Mallidi, Berman, Lewis, Kircanski, Brotman); Department of Psychology, University of Freiburg, Freiburg, Germany (Linke); Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, New York (Pagliaccio); Department of Psychology, Education and Child Studies, Erasmus University Rotterdam, Rotterdam, the Netherlands (Harrewijn); Department of Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia (White); Baruch Ivcher School of Psychology, Reichman University, Herzliya, Israel (Abend); Department of Human Development and Quantitative Methodology, University of Maryland, College Park (Fox); Yale Child Study Center, Yale School of Medicine, New Haven, Conn. (Silverman); Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison (Kalin); School of Psychological Sciences (Bar-Heim, Naim) and Sagol School of Neuroscience (Bar-Haim), Tel Aviv University, Tel Aviv, Israel
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Haller SP, Archer C, Jeong A, Jaffe A, Jones EL, Harrewijn A, Naim R, Linke JO, Stoddard J, Brotman MA. Changes in Internalizing Symptoms During the COVID-19 Pandemic in a Transdiagnostic Sample of Youth: Exploring Mediators and Predictors. Child Psychiatry Hum Dev 2024; 55:206-218. [PMID: 35794298 PMCID: PMC9816351 DOI: 10.1007/s10578-022-01382-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/21/2022] [Indexed: 01/11/2023]
Abstract
The COVID-19 pandemic is a chronically stressful event, particularly for youth. Here, we examine (i) changes in mood and anxiety symtpoms, (ii) pandemic-related stress as a mediator of change in symptoms, and (ii) threat processing biases as a predictor of increased anxiety during the pandemic. A clinically well-characterized sample of 81 youth ages 8-18 years (M = 13.8 years, SD = 2.65; 40.7% female) including youth with affective and/or behavioral psychiatric diagnoses and youth without psychopathology completed pre- and during pandemic assessments of anxiety and depression and COVID-related stress. Forty-six youth also completed a threat processing fMRI task pre-pandemic. Anxiety and depression significantly increased during the pandemic (all ps < 0.05). Significant symptom change was partially mediated by pandemic stress and worries. Increased prefrontal activity in response to neutral faces pre-pandemic was associated with more intense parent-reported anxiety during the pandemic (all Fs(1.95,81.86) > 14.44, ps < 0.001). The present work extends existing knowledge on the mediating role of psychological stress on symptoms of anxiety and depression in youth.
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Affiliation(s)
- Simone P Haller
- Emotion and Development Branch, National Institutes of Mental Health, 9000 Rockville Pike, Bldg. 15K, Bethesda, MD, 20892-2670, USA.
| | - Camille Archer
- Emotion and Development Branch, National Institutes of Mental Health, 9000 Rockville Pike, Bldg. 15K, Bethesda, MD, 20892-2670, USA
| | - Annie Jeong
- Emotion and Development Branch, National Institutes of Mental Health, 9000 Rockville Pike, Bldg. 15K, Bethesda, MD, 20892-2670, USA
| | - Allison Jaffe
- Emotion and Development Branch, National Institutes of Mental Health, 9000 Rockville Pike, Bldg. 15K, Bethesda, MD, 20892-2670, USA
| | - Emily L Jones
- Emotion and Development Branch, National Institutes of Mental Health, 9000 Rockville Pike, Bldg. 15K, Bethesda, MD, 20892-2670, USA
| | - Anita Harrewijn
- Department of Psychology, Education and Child Studies, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Reut Naim
- Emotion and Development Branch, National Institutes of Mental Health, 9000 Rockville Pike, Bldg. 15K, Bethesda, MD, 20892-2670, USA
| | - Julia O Linke
- Emotion and Development Branch, National Institutes of Mental Health, 9000 Rockville Pike, Bldg. 15K, Bethesda, MD, 20892-2670, USA
| | - Joel Stoddard
- Department of Psychiatry & Neuroscience Program, Children's Hospital Colorado, Pediatric Mental Health Institute, University of Colorado, Anschutz Medical Campus, 13123 East 16th Avenue, Aurora, CO, 80045, USA
| | - Melissa A Brotman
- Emotion and Development Branch, National Institutes of Mental Health, 9000 Rockville Pike, Bldg. 15K, Bethesda, MD, 20892-2670, USA
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Harrewijn A, Ruiz SG, Abend R, Haller SP, Subar AR, Swetlitz C, Valadez EA, Brotman MA, Chen G, Chronis-Tuscano A, Leibenluft E, Bar-Haim Y, Fox NA, Pine DS. Development of Neural Mechanisms Underlying Threat Processing: Associations With Childhood Social Reticence and Adolescent Anxiety. BIOLOGICAL PSYCHIATRY GLOBAL OPEN SCIENCE 2023; 3:893-901. [PMID: 37881548 PMCID: PMC10593903 DOI: 10.1016/j.bpsgos.2023.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 01/19/2023] [Accepted: 01/25/2023] [Indexed: 02/05/2023] Open
Abstract
Background Social reticence in early childhood is characterized by shy and anxiously avoidant behavior, and it confers risk for pediatric anxiety disorders later in development. Aberrant threat processing may play a critical role in this association between early reticent behavior and later psychopathology. The goal of this longitudinal study is to characterize developmental trajectories of neural mechanisms underlying threat processing and relate these trajectories to associations between early-childhood social reticence and adolescent anxiety. Methods In this 16-year longitudinal study, social reticence was assessed from 2 to 7 years of age; anxiety symptoms and neural mechanisms during the dot-probe task were assessed at 10, 13, and 16 years of age. The sample included 144 participants: 71 children provided data at age 10 (43 girls, meanage = 10.62), 85 at age 13 (46 girls, meanage = 13.25), and 74 at age 16 (36 girls, meanage = 16.27). Results A significant interaction manifested among social reticence, anxiety symptoms, and time, on functional connectivity between the left amygdala and the left dorsolateral prefrontal cortex, voxelwise p < .001, clusterwise familywise error p < .05. Children with high social reticence showed a negative association between amygdala-dorsolateral prefrontal cortex connectivity and anxiety symptoms with age, compared to children with low social reticence, suggesting distinct neurodevelopmental pathways to anxiety. Conclusions These findings were present across all conditions, suggesting task-general effects in potential threat processing. Additionally, the timing of these neurodevelopmental pathways differed for children with high versus low social reticence, which could affect the timing of effective preventive interventions.
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Affiliation(s)
- Anita Harrewijn
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland
- Department of Psychology, Education and Child Studies, Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - Sonia G. Ruiz
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland
| | - Rany Abend
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland
- School of Psychology, Reichman University, Herzliya, Israel
| | - Simone P. Haller
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland
| | - Anni R. Subar
- Department of Psychology, University of Denver, Denver, Colorado
| | | | - Emilio A. Valadez
- Department of Human Development and Quantitative Methodology, University of Maryland, College Park, Maryland
| | - Melissa A. Brotman
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland
| | - Gang Chen
- Scientific and Statistical Computing Core, National Institute of Mental Health, Bethesda, Maryland
| | | | - Ellen Leibenluft
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland
| | - Yair Bar-Haim
- School of Psychological Sciences and Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | - Nathan A. Fox
- Department of Human Development and Quantitative Methodology, University of Maryland, College Park, Maryland
| | - Daniel S. Pine
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland
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Ladouceur CD, Henry T, Ojha A, Shirtcliff EA, Silk JS. Fronto-amygdala resting state functional connectivity is associated with anxiety symptoms among adolescent girls more advanced in pubertal maturation. Dev Cogn Neurosci 2023; 60:101236. [PMID: 36996571 PMCID: PMC10063408 DOI: 10.1016/j.dcn.2023.101236] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 02/21/2023] [Accepted: 03/21/2023] [Indexed: 03/30/2023] Open
Abstract
Early adolescence, with the onset of puberty, is an important period when sex differences in anxiety emerge, with girls reporting significantly higher anxiety symptoms than boys. This study examined the role of puberty on fronto-amygdala functional connectivity and risk of anxiety symptoms in 70 girls (age 11-13) who completed a resting state fMRI scan, self-report measures of anxiety symptoms and pubertal status, and provided basal testosterone levels (64 girls). Resting state fMRI data were preprocessed using fMRIPrep and connectivity indices were extracted from ventromedial prefrontal cortex (vmPFC) and amygdala regions-of-interest. We tested moderated mediation models and hypothesized that vmPFC-amygdala would mediate the relation between three indices of puberty (testosterone and adrenarcheal/gonadarcheal development) and anxiety, with puberty moderating the relation between connectivity and anxiety. Results showed a significant moderation effect of testosterone and adrenarcheal development in the right amygdala and a rostral/dorsal area of the vmPFC and of gonadarcheal development in the left amygdala and a medial area of the vmPFC on anxiety symptoms. Simple slope analyses showed that vmPFC-amygdala connectivity was negatively associated with anxiety only in girls more advanced in puberty suggesting that sensitivity to the effects of puberty on fronto-amygdala function could contribute to risk for anxiety disorders among adolescent girls.
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Todd J, Coutts-Bain D, Wilson E, Clarke P. Is attentional bias variability causally implicated in emotional vulnerability? A systematic review and meta-analysis. Neurosci Biobehav Rev 2023; 146:105069. [PMID: 36738811 DOI: 10.1016/j.neubiorev.2023.105069] [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: 08/30/2022] [Revised: 01/22/2023] [Accepted: 01/28/2023] [Indexed: 02/05/2023]
Abstract
BACKGROUND The aim of the present review was to determine whether attentional bias variability (ABV) is causally implicated in emotional vulnerability. We consider evidence examining whether ABV precedes and predicts later psychopathology, and whether modifying ABV leads to changes in psychological symptoms following an intervention. METHODS A systematic literature search located 15 studies that met the inclusion criteria (3 longitudinal, 12 intervention). Eligible intervention studies were also meta-analysed. RESULTS Preliminary evidence suggests that ABV predicts later post-traumatic stress symptomatology in interaction with number of traumatic events. The few interventions designed to reduce ABV suggest promise for improving PTSD symptoms. However, these interventions did not consistently change ABV, and where it was tested, change in ABV did not correspond to change in symptoms. CONCLUSIONS There is emerging evidence that ABV could represent a vulnerability factor for psychological symptoms, particularly for those exposed to trauma. This may indicate attentional control difficulties, although this remains to be tested. Conclusions regarding the causal status of ABV will depend on future high-quality randomised controlled trials.
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Affiliation(s)
- Jemma Todd
- School of Psychology, University of Sydney, Sydney, NSW, Australia; School of Psychological Science, University of Western Australia, Crawley, WA, Australia.
| | | | - Emily Wilson
- School of Psychology, University of Sydney, Sydney, NSW, Australia
| | - Patrick Clarke
- Discipline of Psychology, School of Population Health, Bentley, WA, Australia
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Abend R, Ruiz SG, Bajaj MA, Harrewijn A, Linke JO, Atlas LY, Winkler AM, Pine DS. Threat imminence reveals links among unfolding of anticipatory physiological response, cortical-subcortical intrinsic functional connectivity, and anxiety. Neurobiol Stress 2022; 16:100428. [PMID: 35036479 PMCID: PMC8749274 DOI: 10.1016/j.ynstr.2022.100428] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 12/20/2021] [Accepted: 01/03/2022] [Indexed: 12/12/2022] Open
Abstract
Excessive expression of fear responses in anticipation of threat occurs in anxiety, but understanding of underlying pathophysiological mechanisms is limited. Animal research indicates that threat-anticipatory defensive responses are dynamically organized by threat imminence and rely on conserved circuitry. Insight from basic neuroscience research in animals on threat imminence could guide mechanistic research in humans mapping abnormal function in this circuitry to aberrant defensive responses in pathological anxiety. 50 pediatric anxiety patients and healthy-comparisons (33 females) completed an instructed threat-anticipation task whereby cues signaled delivery of painful (threat) or non-painful (safety) thermal stimulation. Temporal changes in skin-conductance indexed anxiety effects on anticipatory responding as function of threat imminence. Multivariate network analyses of resting-state functional connectivity data from a subsample were used to identify intrinsic-function correlates of anticipatory-response dynamics, within a specific, distributed network derived from translational research on defensive responding. By considering threat imminence, analyses revealed specific anxiety effects. Importantly, pathological anxiety was associated with excessive deployment of anticipatory physiological response as threat, but not safety, outcomes became more imminent. Magnitude of increase in threat-anticipatory physiological responses corresponded with magnitude of intrinsic connectivity within a cortical-subcortical circuit. Moreover, more severe anxiety was associated with stronger associations between anticipatory physiological responding and connectivity that ventromedial prefrontal cortex showed with hippocampus and basolateral amygdala, regions implicated in animal models of anxiety. These findings link basic and clinical research, highlighting variations in intrinsic function in conserved defensive circuitry as a potential pathophysiological mechanism in anxiety.
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Affiliation(s)
- Rany Abend
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Sonia G. Ruiz
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, 20892, USA
- Department of Psychology, Yale University, New Haven, CT, 06511, USA
| | - Mira A. Bajaj
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Anita Harrewijn
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, 20892, USA
- Department of Psychology, Education and Child Studies, Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - Julia O. Linke
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Lauren Y. Atlas
- National Center for Complementary and Integrative Health, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Anderson M. Winkler
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Daniel S. Pine
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, 20892, USA
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7
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Tseng WL, Abend R, Gold AL, Brotman MA. Neural correlates of extinguished threat recall underlying the commonality between pediatric anxiety and irritability. J Affect Disord 2021; 295:920-929. [PMID: 34706463 PMCID: PMC8554134 DOI: 10.1016/j.jad.2021.08.117] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 07/28/2021] [Accepted: 08/28/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Anxiety and irritability frequently co-occur in youth and are mediated by aberrant threat responses. However, empirical evidence on neural mechanisms underlying this co-occurrence is limited. To address this, we apply data-driven latent phenotyping to data from a prior report of a well-validated threat extinction recall fMRI paradigm. METHODS Participants included 59 youth (28 anxiety disorder, 31 healthy volunteers; Mage=13.15 yrs) drawn from a transdiagnostic sample of 331 youth, in which bifactor analysis was conducted to derive latent factors representing shared vs. unique variance of dimensionally-assessed anxiety and irritability. Participants underwent threat conditioning and extinction. Approximately three weeks later, during extinction recall fMRI, participants made threat-safety discriminations under two task conditions: current threat appraisal and explicit recall of threat contingencies. Linear mixed-effects analyses examined associations of a "negative affectivity" factor reflecting shared anxiety and irritability variance with whole-brain activation and task-dependent amygdala connectivity. RESULTS During recall of threat-safety contingencies, higher negative affectivity was associated with greater prefrontal (ventrolateral/ventromedial, dorsolateral, orbitofrontal), motor, temporal, parietal, and occipital activation. During threat appraisal, higher negative affectivity was associated with greater amygdala-inferior parietal lobule connectivity to threat/safety ambiguity. LIMITATIONS Sample included only healthy youth and youth with anxiety disorders. Results may not generalize to other diagnoses for which anxiety and irritability are also common, and our negative affectivity factor should be interpreted as anxiety disorders with elevated irritability. Reliability of some subfactors was poor. CONCLUSIONS Aberrant amygdala-prefrontal-parietal circuitry during extinction recall of threat-safety stimuli may be a mechanism underlying the co-occurrence of pediatric anxiety and irritability.
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Affiliation(s)
- Wan-Ling Tseng
- Yale Child Study Center, Yale School of Medicine, Yale University, 230 S. Frontage Road, New Haven, CT 06519, USA.
| | - Rany Abend
- Emotion and Development Branch, National Institute of Mental Health, Bethesda, MD 20854, USA
| | - Andrea L Gold
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI 02912, USA
| | - Melissa A Brotman
- Emotion and Development Branch, National Institute of Mental Health, Bethesda, MD 20854, USA
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8
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Expressions of positive and negative shyness in preschool-age children: Temperamental correlates and visual attention to emotions. J Exp Child Psychol 2021; 215:105315. [PMID: 34801737 DOI: 10.1016/j.jecp.2021.105315] [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: 02/04/2021] [Revised: 10/16/2021] [Accepted: 10/16/2021] [Indexed: 11/21/2022]
Abstract
Recent empirical evidence shows heterogeneity in the expression of shyness in children. Some children tend to express their shyness displaying positive affect along with gaze aversions (positive shyness), whereas others display more negative emotional reactions accompanied by gaze aversions (negative shyness). Temperamental differences in approach-avoidance tendencies are likely to explain these differences in shyness expression in children and influence their visual attention to social stimuli, yet little empirical attention has been devoted to these associations. Our study examined the temperamental profile (approach, fear, and inhibitory control) associated with positive and negative shyness and the relation between expression of shyness and attention to social stimuli in 47 children aged 3-6 years. Children's positive and negative expressions of shyness were assessed using a performance task. Visual attention to facial emotional expressions was measured with the dot - probe task, and temperament was measured with maternal reports. Positive shyness was found to be positively associated with temperamental dimensions of approach, inhibitory control, and fear. Positive shyness was significantly associated with attentional orientation to positive facial expressions and with less attentional avoidance of threatening facial expressions. Negative shyness was positively associated only with temperamental fear, and no associations were found with attention to social stimuli. Our study provides empirical support for the association between temperament and the multidimensional character of the expression of positive shyness and adds relevant evidence regarding the connection between the expression of shyness and attention to social stimuli.
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Filippi CA, Ravi S, Bracy M, Winkler A, Sylvester CM, Pine DS, Fox NA. Amygdala Functional Connectivity and Negative Reactive Temperament at Age 4 Months. J Am Acad Child Adolesc Psychiatry 2021; 60:1137-1146. [PMID: 33385507 PMCID: PMC8239057 DOI: 10.1016/j.jaac.2020.11.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 11/18/2020] [Accepted: 12/23/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Infant amygdala connectivity correlates with maternal reports of infant temperament characterized by novelty-evoked distress and avoidance. However, no studies have examined how human infant amygdala connectivity relates to direct observations of novelty-evoked distress. This study examined the link between amygdala connectivity and infant novelty-evoked distress using direct observation of temperament. METHOD Novelty-evoked distress was assessed at 4 months of age (N = 90) using a standardized reactivity assessment and parent report. Within 3 weeks of assessment, resting-state functional magnetic resonance imaging was collected in a subset of infants (n = 34). Using a whole-brain voxelwise approach, amygdala connectivity associated with positive and negative affect during the reactivity assessment was examined. Regions where the association of amygdala connectivity with negative affect was higher than with positive affect were then examined. Associations between amygdala connectivity and parent report of temperament were also examined. RESULTS Greater amygdala-cingulate and amygdala-superior frontal gyrus connectivity was associated with lower positive affect during the reactivity assessment. Further, the association between amygdala-cingulate connectivity was greater for negative affect compared with positive affect. There were no significant associations between latency to approach novelty (as measured by parent report) and amygdala connectivity. Validation analyses conducted using a large independent longitudinal sample (N = 323) demonstrated that negative reactivity was associated with increased child-reported anxiety symptoms in adolescence. CONCLUSION These results provide novel insight into the developmental pathophysiology of novelty-evoked distress. This is consistent with research linking an altered cognitive control mechanism to temperamental risk for anxiety.
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Affiliation(s)
- Courtney A Filippi
- University of Maryland, College Park; National Institute of Mental Health (NIMH), Bethesda, Maryland.
| | | | | | | | | | - Daniel S Pine
- National Institute of Mental Health (NIMH), Bethesda, Maryland
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10
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Grasser LR, Jovanovic T. Safety learning during development: Implications for development of psychopathology. Behav Brain Res 2021; 408:113297. [PMID: 33862062 PMCID: PMC8102395 DOI: 10.1016/j.bbr.2021.113297] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 03/23/2021] [Accepted: 04/11/2021] [Indexed: 12/13/2022]
Abstract
Fear and safety learning are necessary adaptive behaviors that develop over the course of maturation. While there is a large body of literature regarding the neurobiology of fear and safety learning in adults, less is known regarding safety learning during development. Given developmental changes in the brain, there are corresponding changes in safety learning that are quantifiable; these may serve to predict risk and point to treatment targets for fear and anxiety-related disorders in children and adolescents. For healthy, typically developing youth, the main developmental variation observed is reduced discrimination between threat and safety cues in children compared to adolescents and adults, while lower expression of extinction learning is exhibited in adolescents compared to adults. Such distinctions may be related to faster maturation of the amygdala relative to the prefrontal cortex, as well as incompletely developed functional circuits between the two. Fear and anxiety-related disorders, childhood maltreatment, and behavioral problems are all associated with alterations in safety learning for youth, and this dysfunction may proceed into adulthood with corresponding abnormalities in brain structure and function-including amygdala hypertrophy and hyperreactivity. As impaired inhibition of fear to safety may reflect abnormalities in the developing brain and subsequent psychopathology, impaired safety learning may be considered as both a predictor of risk and a treatment target. Longitudinal neuroimaging studies over the course of development, and studies that query change with interventions are needed in order to improve outcomes for individuals and reduce long-term impact of developmental psychopathology.
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Affiliation(s)
- Lana Ruvolo Grasser
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, 3901 Chrysler Dr, Tolan Park Suite 2C Room 273, Detroit, MI 48201 United States.
| | - Tanja Jovanovic
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, 3901 Chrysler Dr, Tolan Park Suite 2C, Detroit, MI 48201 United States.
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11
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Sequeira SL, Rosen DK, Silk JS, Hutchinson E, Allen KB, Jones NP, Price RB, Ladouceur CD. "Don't judge me!": Links between in vivo attention bias toward a potentially critical judge and fronto-amygdala functional connectivity during rejection in adolescent girls. Dev Cogn Neurosci 2021; 49:100960. [PMID: 33975229 PMCID: PMC8120940 DOI: 10.1016/j.dcn.2021.100960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 04/06/2021] [Accepted: 04/22/2021] [Indexed: 11/17/2022] Open
Abstract
We used innovative, ecologically valid eye-tracking and fMRI measures to examine social threat sensitivity in adolescent girls. Findings support the reliability of a novel in vivo attention bias task. Real-world attentional biases toward social threat correlated with amygdala-anterior PFC functional connectivity during social evaluation. Greater positive amygdala-anterior PFC connectivity during social evaluation could suggest disrupted prefrontal regulation of the amygdala. Disrupted prefrontal regulation of the amygdala could contribute to deployment of attention to social evaluative threat in daily life.
During adolescence, increases in social sensitivity, such as heightened attentional processing of social feedback, may be supported by developmental changes in neural circuitry involved in emotion regulation and cognitive control, including fronto-amygdala circuitry. Less negative fronto-amygdala circuitry during social threat processing may contribute to heightened attention to social threat in the environment. However, “real-world” implications of altered fronto-amygdala circuitry remain largely unknown. In this study, we used multiple novel methods, including an in vivo attention bias task implemented using mobile eye-tracking glasses and socially interactive fMRI task, to examine how functional connectivity between the amygdala and prefrontal cortex (PFC) during rejection and acceptance feedback from peers is associated with heightened attention towards potentially critical social evaluation in a real-world environment. Participants were 77 early adolescent girls (ages 11–13) oversampled for shy/fearful temperament. Results support the reliability of this in vivo attention task. Further, girls with more positive functional connectivity between the right amygdala and anterior PFC during both rejection and acceptance feedback attended more to potentially critical social evaluation during the attention task. Findings could suggest that dysfunction in prefrontal regulation of the amygdala’s response to salient social feedback supports heightened sensitivity to socially evaluative threat during adolescence.
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Affiliation(s)
| | - Dana K Rosen
- University of Pittsburgh, Department of Psychology, United States
| | - Jennifer S Silk
- University of Pittsburgh, Department of Psychology, United States
| | - Emily Hutchinson
- University of Pittsburgh, Department of Psychology, United States
| | | | - Neil P Jones
- University of Pittsburgh, Department of Psychiatry, United States
| | - Rebecca B Price
- University of Pittsburgh, Department of Psychiatry, United States
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12
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Wang M, Han B, Liu Q, Liu C, Li W, Teng S, Du H, Huang S, Kong H, Lu G, Song Y. Attentional bias of subliminal emotional faces in adolescents with obsessive-compulsive disorder. Neurocase 2021; 27:22-29. [PMID: 33378225 DOI: 10.1080/13554794.2020.1861303] [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] [Indexed: 10/22/2022]
Abstract
Attentional bias to threatening information may play a vital role in the onset and maintenance of obsessive-compulsive disorder (OCD). This study aimed to explore whether adolescents with OCD exhibited attentional bias toward faces that express disgust or fear. Participants were 27 adolescents with a first-time primary diagnosis of OCD and 27 healthy controls. To assess OCD, depression, and anxiety symptoms, all participants completed the Yale-Brown Obsessive Compulsive Scale, the Hamilton Depression Scale, and the Hamilton Anxiety Scale, respectively, followed by the modified dot probe task. Repeated measures ANOVA revealed a main effect of validity type and a significant group × validity type interaction effect. The results of one sample t-tests showed that participants in the OCD group had an attentional bias toward both disgusted and fearful faces. Further analysis indicated that adolescents in the OCD group showed facilitated attention toward the fearful faces and difficulty disengaging from disgusted faces. Adolescents with OCD exhibited facilitated attention toward threat stimuli, and when they allocated attention to threat, they experienced difficulty disengaging from it. Treatment procedures to modify the attentional bias may be effective.
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Affiliation(s)
- Miaomiao Wang
- School of Public Health, Fuyanshan Campus of Weifang Medical College, Weifang, China
| | - Bingxue Han
- School of Public Health, Fuyanshan Campus of Weifang Medical College, Weifang, China
| | - Qing Liu
- School of Computing, Heze University, Heze, China
| | - Changjin Liu
- Department of Clinical Psychology, Shandong Mental Health Center, Jinan, China
| | - Wanyu Li
- Lynch School of Education, Boston College, Chestnut Hill, USA
| | - Shuai Teng
- School of Public Health, Fuyanshan Campus of Weifang Medical College, Weifang, China
| | - He Du
- Department of Psychology, Weifang Medical University, Weifang, China
| | - Shuxia Huang
- Department of Psychology, Weifang Medical University, Weifang, China
| | - Hao Kong
- Department of Psychology, Weifang Medical University, Weifang, China
| | - Guohua Lu
- Department of Psychology, Weifang Medical University, Weifang, China
| | - Yuping Song
- Department of Psychology, Weifang Medical University, Weifang, China
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13
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Abend R, Bajaj MA, Matsumoto C, Yetter M, Harrewijn A, Cardinale EM, Kircanski K, Lebowitz ER, Silverman WK, Bar-Haim Y, Lazarov A, Leibenluft E, Brotman M, Pine DS. Converging Multi-modal Evidence for Implicit Threat-Related Bias in Pediatric Anxiety Disorders. Res Child Adolesc Psychopathol 2020; 49:227-240. [PMID: 33095373 DOI: 10.1007/s10802-020-00712-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/23/2020] [Indexed: 01/08/2023]
Abstract
This report examines the relationship between pediatric anxiety disorders and implicit bias evoked by threats. To do so, the report uses two tasks that assess implicit bias to negative-valence faces, the first by eye-gaze and the second by measuring body-movement parameters. The report contrasts task performance in 51 treatment-seeking, medication-free pediatric patients with anxiety disorders and 36 healthy peers. Among these youth, 53 completed an eye-gaze task, 74 completed a body-movement task, and 40 completed both tasks. On the eye-gaze task, patients displayed longer gaze duration on negative relative to non-negative valence faces than healthy peers, F(1, 174) = 8.27, p = .005. In contrast, on the body-movement task, patients displayed a greater tendency to behaviorally avoid negative-valence faces than healthy peers, F(1, 72) = 4.68, p = .033. Finally, implicit bias measures on the two tasks were correlated, r(38) = .31, p = .049. In sum, we found an association between pediatric anxiety disorders and implicit threat bias on two tasks, one measuring eye-gaze and the other measuring whole-body movements. Converging evidence for implicit threat bias encourages future research using multiple tasks in anxiety.
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Affiliation(s)
- Rany Abend
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, 9000 Rockville Pike, Bldg 15K, MSC-2670, Bethesda, MD, 20892, USA.
| | - Mira A Bajaj
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, 9000 Rockville Pike, Bldg 15K, MSC-2670, Bethesda, MD, 20892, USA
| | - Chika Matsumoto
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, 9000 Rockville Pike, Bldg 15K, MSC-2670, Bethesda, MD, 20892, USA
| | - Marissa Yetter
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, 9000 Rockville Pike, Bldg 15K, MSC-2670, Bethesda, MD, 20892, USA
| | - Anita Harrewijn
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, 9000 Rockville Pike, Bldg 15K, MSC-2670, Bethesda, MD, 20892, USA
| | - Elise M Cardinale
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, 9000 Rockville Pike, Bldg 15K, MSC-2670, Bethesda, MD, 20892, USA
| | - Katharina Kircanski
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, 9000 Rockville Pike, Bldg 15K, MSC-2670, Bethesda, MD, 20892, USA
| | | | | | - Yair Bar-Haim
- School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Amit Lazarov
- School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Ellen Leibenluft
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, 9000 Rockville Pike, Bldg 15K, MSC-2670, Bethesda, MD, 20892, USA
| | - Melissa Brotman
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, 9000 Rockville Pike, Bldg 15K, MSC-2670, Bethesda, MD, 20892, USA
| | - Daniel S Pine
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, 9000 Rockville Pike, Bldg 15K, MSC-2670, Bethesda, MD, 20892, USA
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14
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Kryza-Lacombe M, Kiefer C, Schwartz KT, Strickland K, Wiggins JL. Attention shifting in the context of emotional faces: Disentangling neural mechanisms of irritability from anxiety. Depress Anxiety 2020; 37:645-656. [PMID: 32253797 PMCID: PMC8312255 DOI: 10.1002/da.23010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 01/31/2020] [Accepted: 02/24/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Irritability predicts concurrent and prospective psychiatric disorders across the lifespan. Anxiety commonly co-occurs with irritability, and such comorbidity complicates care. Understanding the mechanisms of comorbid traits is necessary to inform treatment decisions. This study aimed to disentangle neural mechanisms of irritability from anxiety in the context of attentional shifting toward and away from emotional faces in youths from treatment-seeking families. METHODS Youths (N = 45), mean age = 14.01 years (standard deviation = 1.89) completed a dot-probe task during functional magnetic resonance imaging acquisition. Whole-brain activation analyses evaluated the effect of irritability on neural reactivity in the context of varying attentional shifting toward and away from emotional faces, both depending on and above and beyond anxiety (i.e., with anxiety as [a] a moderator and [b] a covariate, respectively). RESULTS Higher irritability levels related to distinct task-related patterns of cuneus activation, depending on comorbid anxiety levels. Increased irritability also related to distinct task-related patterns of parietal, temporal, occipital, and cerebellar activation, controlling for anxiety. Overall, youths with higher levels of irritability evinced more pronounced fluctuations in neural reactivity across task conditions. CONCLUSION The present study contributes to a literature delineating the unique and shared neural mechanisms of overlapping symptom dimensions, which will be necessary to ultimately build a brain- and behavior-based nosology that forms the basis for more targeted and effective treatments.
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Affiliation(s)
- Maria Kryza-Lacombe
- San Diego State University/University of California, San Diego, Joint Doctoral Program in Clinical Psychology, San Diego, California
| | - Cynthia Kiefer
- Department of Psychology, San Diego State University, San Diego, California
| | - Karen T.G. Schwartz
- San Diego State University/University of California, San Diego, Joint Doctoral Program in Clinical Psychology, San Diego, California
| | - Katie Strickland
- Department of Psychology, San Diego State University, San Diego, California
| | - Jillian Lee Wiggins
- San Diego State University/University of California, San Diego, Joint Doctoral Program in Clinical Psychology, San Diego, California,Department of Psychology, San Diego State University, San Diego, California
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15
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Doyle FL, Mendoza Diaz A, Eapen V, Frick PJ, Kimonis ER, Hawes DJ, Moul C, Richmond JL, Mehta D, Sareen S, Morgan BG, Dadds MR. Mapping the Specific Pathways to Early-Onset Mental Health Disorders: The "Watch Me Grow for REAL" Study Protocol. Front Psychiatry 2020; 11:553. [PMID: 32636770 PMCID: PMC7319093 DOI: 10.3389/fpsyt.2020.00553] [Citation(s) in RCA: 6] [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: 03/21/2020] [Accepted: 05/29/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND From birth, the human propensity to selectively attend and respond to critical super-stimuli forms the basis of future socio-emotional development and health. In particular, the first super-stimuli to preferentially engage and elicit responses in the healthy newborn are the physical touch, voice and face/eyes of caregivers. From this grows selective attention and responsiveness to emotional expression, scaffolding the development of empathy, social cognition, and other higher human capacities. In this paper, the protocol for a longitudinal, prospective birth-cohort study is presented. The major aim of this study is to map the emergence of individual differences and disturbances in the system of social-Responsiveness, Emotional Attention, and Learning (REAL) through the first 3 years of life to predict the specific emergence of the major childhood mental health problems, as well as social adjustment and impairment more generally. A further aim of this study is to examine how the REAL variables interact with the quality of environment/caregiver interactions. METHODS/DESIGN A prospective, longitudinal birth-cohort study will be conducted. Data will be collected from four assessments and mothers' electronic medical records. DISCUSSION This study will be the first to test a clear developmental map of both the unique and specific causes of childhood psychopathology and will identify more precise early intervention targets for children with complex comorbid conditions.
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Affiliation(s)
- Frances L. Doyle
- Faculty of Science, School of Psychology, University of Sydney, Sydney, NSW, Australia
| | - Antonio Mendoza Diaz
- Faculty of Science, School of Psychology, University of Sydney, Sydney, NSW, Australia
| | - Valsamma Eapen
- Faculty of Medicine, School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
| | - Paul J. Frick
- Institute for Learning Sciences & Teacher Education, Australian Catholic University, Brisbane, QLD, Australia
- Department of Psychology, Louisiana State University, Baton Rouge, LA, United States
| | - Eva R. Kimonis
- Faculty of Science, School of Psychology, University of New South Wales, Sydney, NSW, Australia
| | - David J. Hawes
- Faculty of Science, School of Psychology, University of Sydney, Sydney, NSW, Australia
| | - Caroline Moul
- Faculty of Science, School of Psychology, University of Sydney, Sydney, NSW, Australia
| | - Jenny L. Richmond
- Faculty of Science, School of Psychology, University of New South Wales, Sydney, NSW, Australia
| | - Divya Mehta
- School of Psychology and Counselling, Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia
| | - Sinia Sareen
- Faculty of Science, School of Psychology, University of Sydney, Sydney, NSW, Australia
| | - Bronte G. Morgan
- Faculty of Science, School of Psychology, University of Sydney, Sydney, NSW, Australia
| | - Mark R. Dadds
- Faculty of Science, School of Psychology, University of Sydney, Sydney, NSW, Australia
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Smith AR, White LK, Leibenluft E, McGlade AL, Heckelman AC, Haller SP, Buzzell GA, Fox NA, Pine DS. The Heterogeneity of Anxious Phenotypes: Neural Responses to Errors in Treatment-Seeking Anxious and Behaviorally Inhibited Youths. J Am Acad Child Adolesc Psychiatry 2020; 59:759-769. [PMID: 31128266 PMCID: PMC7690456 DOI: 10.1016/j.jaac.2019.05.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 05/07/2019] [Accepted: 05/17/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Although behaviorally inhibited (BI) temperament predicts risk for anxiety, anxiety in BI may involve distinct neural responses to errors. The current study examines the relations between anxiety and neural correlates of error processing both in youths identified as BI in early childhood and in youths seeking treatment for an anxiety disorder. METHOD All participants underwent functional magnetic resonance imaging using a flanker task to assess responses to errors. A study in healthy subjects assessed test-retest reliability to inform analyses in two other samples. For one sample, a cohort of BI youths (Low BI, n = 28; High BI, n = 27) was followed into adolescence. For the other, participants were recruited based on the presence or absence of an anxiety disorder. Using identical methods in medication-free subjects, analyses compared relations between anxiety and error processing across the two samples. RESULTS Error-processing exhibited acceptable reliability. Within a ventromedial-prefrontal-cortex (vmPFC) cluster, anxiety related to error processing only in youths whose early-life BI status was known. In the high BI group, anxiety related to reduced neural response to errors. No such associations manifested in treatment-seeking youths. Other analyses mapped relations between error-processing and anxiety in each sample on its own. However, only the vmPFC cluster statistically differentiated the neural correlates of anxiety in BI. CONCLUSION BI temperament may define a unique pathway into anxiety involving perturbed neural responding to errors. Although BI is a risk factor for later anxiety, the neural and associated features of anxiety in BI youths may differ from those in treatment-seeking youths.
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Affiliation(s)
| | - Lauren K. White
- Lifespan Brain Institute, Children’s Hospital of Philadelphia, Pennsylvania
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Harrewijn A, Abend R, Linke J, Brotman MA, Fox NA, Leibenluft E, Winkler AM, Pine DS. Combining fMRI during resting state and an attention bias task in children. Neuroimage 2020; 205:116301. [PMID: 31639510 PMCID: PMC6911838 DOI: 10.1016/j.neuroimage.2019.116301] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 10/01/2019] [Accepted: 10/17/2019] [Indexed: 01/12/2023] Open
Abstract
Neuroimaging studies typically focus on either resting state or task-based fMRI data. Prior research has shown that similarity in functional connectivity between rest and cognitive tasks, interpreted as reconfiguration efficiency, is related to task performance and IQ. Here, we extend this approach from adults to children, and from cognitive tasks to a threat-based attention task. The goal of the current study was to examine whether similarity in functional connectivity during rest and an attention bias task relates to threat bias, IQ, anxiety symptoms, and social reticence. fMRI was measured during resting state and during the dot-probe task in 41 children (M = 13.44, SD = 0.70). Functional connectivity during rest and dot-probe was positively correlated, suggesting that functional hierarchies in the brain are stable. Similarity in functional connectivity between rest and the dot-probe task only related to threat bias (puncorr < .03). This effect did not survive correction for multiple testing. Overall, children who allocate more attention towards threat also may possess greater reconfiguration efficiency in switching from intrinsic to threat-related attention states. Finally, functional connectivity correlated negatively across the two conditions of the dot-probe task. Opposing patterns of modulation of functional connectivity by threat-congruent and threat-incongruent trials may reflect task-specific network changes during two different attentional processes.
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Affiliation(s)
- Anita Harrewijn
- Emotion and Development Branch, National Institute of Mental Health, 9000 Rockville Pike, Bethesda, MD, 20892, USA.
| | - Rany Abend
- Emotion and Development Branch, National Institute of Mental Health, 9000 Rockville Pike, Bethesda, MD, 20892, USA
| | - Julia Linke
- Emotion and Development Branch, National Institute of Mental Health, 9000 Rockville Pike, Bethesda, MD, 20892, USA
| | - Melissa A Brotman
- Emotion and Development Branch, National Institute of Mental Health, 9000 Rockville Pike, Bethesda, MD, 20892, USA
| | - Nathan A Fox
- Department of Human Development and Quantitative Methodology, University of Maryland, 3304 Benjamin Building, College Park, MD, 20742-1131, USA
| | - Ellen Leibenluft
- Emotion and Development Branch, National Institute of Mental Health, 9000 Rockville Pike, Bethesda, MD, 20892, USA
| | - Anderson M Winkler
- Emotion and Development Branch, National Institute of Mental Health, 9000 Rockville Pike, Bethesda, MD, 20892, USA
| | - Daniel S Pine
- Emotion and Development Branch, National Institute of Mental Health, 9000 Rockville Pike, Bethesda, MD, 20892, USA
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Abend R, Rosenfelder A, Shamai D, Pine DS, Tavor I, Assaf Y, Bar-Haim Y. Brain structure changes induced by attention bias modification training. Biol Psychol 2019; 146:107736. [PMID: 31352029 DOI: 10.1016/j.biopsycho.2019.107736] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 07/02/2019] [Accepted: 07/24/2019] [Indexed: 02/06/2023]
Abstract
Attention bias modification (ABM) therapy aims to reduce anxiety by changing threat-related attention patterns using computerized training tasks. We examined changes in brain microstructure following ABM training. Thirty-two participants were randomly assigned to one of two training conditions: active ABM training shifting attention away from threat or attention control training involving no attention modification. Participants completed six lab visits, including five training sessions and three diffusion tensor imaging scans: immediately before and after the first training session, and at the end of the training series. Indices of local and global changes in microstructure and connectivity were measured. Significant longitudinal differences in fractional anisotropy (FA) between the active and control training regimens occurred in inferior temporal cortex. Changes in FA occurred across groups within ventromedial prefrontal cortex and middle occipital gyrus. These results indicate specific effects of active ABM on brain structure. Such changes could relate to clinical effects of ABM.
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Affiliation(s)
- Rany Abend
- Section on Development and Affective Neuroscience, National Institute of Mental Health, 9000 Rockville Pike, Bethesda, MD 20892, USA.
| | - Ariel Rosenfelder
- School of Psychological Sciences, Tel Aviv University, P.O. Box 39040, Tel Aviv 69978, Israel
| | - Dana Shamai
- School of Psychological Sciences, Tel Aviv University, P.O. Box 39040, Tel Aviv 69978, Israel; Sagol School of Neuroscience, Tel Aviv University, P.O. Box 39040, Tel Aviv 69978, Israel
| | - Daniel S Pine
- Section on Development and Affective Neuroscience, National Institute of Mental Health, 9000 Rockville Pike, Bethesda, MD 20892, USA
| | - Ido Tavor
- Sagol School of Neuroscience, Tel Aviv University, P.O. Box 39040, Tel Aviv 69978, Israel; Department of Anatomy and Anthropology, Sackler Faculty of Medicine, Tel Aviv University, P.O. Box 39040, Tel Aviv 69978, Israel
| | - Yaniv Assaf
- Department of Neurobiology, George S. Wise Faculty of Life Sciences, Tel Aviv University, P.O. Box 39040, Tel Aviv 69978, Israel; Sagol School of Neuroscience, Tel Aviv University, P.O. Box 39040, Tel Aviv 69978, Israel
| | - Yair Bar-Haim
- School of Psychological Sciences, Tel Aviv University, P.O. Box 39040, Tel Aviv 69978, Israel; Sagol School of Neuroscience, Tel Aviv University, P.O. Box 39040, Tel Aviv 69978, Israel
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