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Li HP, Cheng HL, Ding K, Zhang Y, Gao F, Zhu G, Zhang Z. New recognition of the heart-brain axis and its implication in the pathogenesis and treatment of PTSD. Eur J Neurosci 2024; 60:4661-4683. [PMID: 39044332 DOI: 10.1111/ejn.16445] [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: 03/28/2024] [Accepted: 06/04/2024] [Indexed: 07/25/2024]
Abstract
Post-traumatic stress disorder (PTSD) is a complex psychological disorder provoked by distressing experiences, and it remains without highly effective intervention strategies. The exploration of PTSD's underlying mechanisms is crucial for advancing diagnostic and therapeutic approaches. Current studies primarily explore PTSD through the lens of the central nervous system, investigating concrete molecular alterations in the cerebral area and neural circuit irregularities. However, the body's response to external stressors, particularly the changes in cardiovascular function, is often pronounced, evidenced by notable cardiac dysfunction. Consequently, examining PTSD with a focus on cardiac function is vital for the early prevention and targeted management of the disorder. This review undertakes a comprehensive literature analysis to detail the alterations in brain and heart structures and functions associated with PTSD. It also synthesizes potential mechanisms of heart-brain axis interactions relevant to the development of PTSD. Ultimately, by considering cardiac function, this review proposes novel perspectives for PTSD's prophylaxis and therapy.
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Affiliation(s)
- Hai-Peng Li
- Anhui University of Chinese Medicine, Hefei, China
| | - Hong-Liang Cheng
- The Affiliated Hospital of Acupuncture and Moxibustion, Anhui University of Chinese Medicine, Hefei, Anhui Province, China
| | - Keke Ding
- Anhui University of Chinese Medicine, Hefei, China
| | - Yang Zhang
- Anhui University of Chinese Medicine, Hefei, China
| | - Fang Gao
- Anhui University of Chinese Medicine, Hefei, China
| | - Guoqi Zhu
- Anhui University of Chinese Medicine, Hefei, China
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2
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Worden BL, Tolin DF, Stevens MC. An exploration of neural predictors of treatment compliance in cognitive-behavioral group therapy for hoarding disorder. J Affect Disord 2024; 345:410-418. [PMID: 38706461 PMCID: PMC11068362 DOI: 10.1016/j.jad.2023.10.148] [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] [Indexed: 05/07/2024]
Abstract
A persistent and influential barrier to effective cognitive-behavioral therapy (CBT) for patients with hoarding disorder (HD) is treatment retention and compliance. Recent research has suggested that HD patients have abnormal brain activity identified by functional magnetic resonance (fMRI) in regions often engaged for executive functioning (e.g., right superior frontal gyrus, anterior insula, and anterior cingulate), which raises questions about whether these abnormalities could relate to patients' ability to attend, understand, and engage in HD treatment. We examined data from 74 HD-diagnosed adults who completed fMRI-measured brain activity during a discarding task designed to elicit symptom-related brain dysfunction, exploring which regions' activity might predict treatment compliance variables, including treatment engagement (within-session compliance), homework completion (between-session compliance), and treatment attendance. Brain activity that was significantly related to within- and between-session compliance was found largely in insula, parietal, and premotor areas. No brain regions were associated with treatment attendance. The results add to findings from prior research that have found prefrontal, cingulate, and insula activity abnormalities in HD by suggesting that some aspects of HD brain dysfunction might play a role in preventing the engagement needed for therapeutic benefit.
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Affiliation(s)
| | - David F Tolin
- Institute of Living/ Hartford Hospital, Hartford, CT
- Yale University School of Medicine, New Haven, CT
| | - Michael C Stevens
- Institute of Living/ Hartford Hospital, Hartford, CT
- Yale University School of Medicine, New Haven, CT
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3
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Zhang X, Zhang L, Yu F, Zhang W. Can Brain Activities of Guided Metaphorical Restructuring Predict Therapeutic Changes? Neuroscience 2023; 531:39-49. [PMID: 37689232 DOI: 10.1016/j.neuroscience.2023.08.031] [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: 02/27/2023] [Revised: 07/27/2023] [Accepted: 08/24/2023] [Indexed: 09/11/2023]
Abstract
The present study examined whether brain activities of metaphorical restructuring could predict improvements in emotion and general self-efficacy (GSES). Sixty-two anxious graduates were randomly assigned to either the metaphor group (n = 31) or the literal group (n = 31). After completing the pretest (T1), the participants were first presented with micro-counseling dialogues (MCD) to guide metaphorical or literal restructuring, and their functional brain activities were simultaneously recorded. They then completed the posttest (T2) and 1 week's follow-up (T3). It was found that (1) compared with the literal group, the metaphor group had more insightful experiences, a greater increase in positive affect and GSES at T2, and a greater decrease in psychological distress at T2 and T3; (2) the metaphor group showed a greater activation in the left inferior frontal gyrus (IFG) and bilateral temporal gyrus, and further activation in the left hippocampus positively predicted T2 GSES scores while that in the IFG and left hippocampus positively predicted the reduction slope of distress over the three time points. One important limitation is that the results should be interpreted with caution when generalizing to clinical anxiety samples due to the participants were graduate students with anxiety symptoms rather than clinical sample. These results indicated that metaphor restructuring produced greater symptom improvements, and activation in the hippocampus and IFG could predict these symptom improvements. This suggests that the activation of the two regions during the restructuring intervention may be a neural marker for symptom improvements.
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Affiliation(s)
- Xiaoyu Zhang
- Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing 100101, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing 100049, China; School of Psychology, Beijing Sport University, Beijing 100084, China
| | - Lu Zhang
- Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing 100101, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing 100049, China
| | - Fei Yu
- Department of Psychology, Hebei Normal University, Shijiazhuang 050010, China
| | - Wencai Zhang
- Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing 100101, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing 100049, China.
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4
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Reimann GM, Küppers V, Camilleri JA, Hoffstaedter F, Langner R, Laird AR, Fox PT, Spiegelhalder K, Eickhoff SB, Tahmasian M. Convergent abnormality in the subgenual anterior cingulate cortex in insomnia disorder: A revisited neuroimaging meta-analysis of 39 studies. Sleep Med Rev 2023; 71:101821. [PMID: 37481961 DOI: 10.1016/j.smrv.2023.101821] [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: 06/29/2022] [Revised: 07/13/2023] [Accepted: 07/13/2023] [Indexed: 07/25/2023]
Abstract
The neurobiological underpinnings of insomnia disorder (ID) are still poorly understood. A previous meta-analysis conducted by our research group in 2018 revealed no consistent regional alterations based on the limited number of eligible studies. Given the number of studies published during the last few years, we revisited the meta-analysis to provide an update to the field. Following the best-practice guidelines for conducting neuroimaging meta-analyses, we searched several databases (PubMed, Web of Science, and BrainMap) and identified 39 eligible structural and functional studies, reporting coordinates reflecting significant group differences between ID patients and healthy controls. A significant convergent regional alteration in the subgenual anterior cingulate cortex (sgACC) was observed using the activation likelihood estimation algorithm. Behavioural decoding using the BrainMap database indicated that this region is involved in fear-related emotional and cognitive processing. The sgACC showed robust task-based co-activation in meta-analytic connectivity modelling and task-free functional connectivity in a resting-state functional connectivity analysis with the main hubs of the salience and default mode networks, including the posterior cingulate cortex and dorsal ACC, amygdala, hippocampus, and medial prefrontal cortex. Collectively, the findings from this large-scale meta-analysis suggest a critical role of the sgACC in the pathophysiology of ID.
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Affiliation(s)
- Gerion M Reimann
- Institute of Neuroscience and Medicine, Brain and Behaviour (INM-7), Research Centre Jülich, Jülich, Germany
| | - Vincent Küppers
- Institute of Neuroscience and Medicine, Brain and Behaviour (INM-7), Research Centre Jülich, Jülich, Germany; Department of Nuclear Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Julia A Camilleri
- Institute of Neuroscience and Medicine, Brain and Behaviour (INM-7), Research Centre Jülich, Jülich, Germany; Institute of Systems Neuroscience, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Felix Hoffstaedter
- Institute of Neuroscience and Medicine, Brain and Behaviour (INM-7), Research Centre Jülich, Jülich, Germany; Institute of Systems Neuroscience, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Robert Langner
- Institute of Neuroscience and Medicine, Brain and Behaviour (INM-7), Research Centre Jülich, Jülich, Germany; Institute of Systems Neuroscience, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Angela R Laird
- Department of Physics, Florida International University, Miami, FL, USA
| | - Peter T Fox
- Research Imaging Institute, University of Texas Health Science Centre, San Antonio, TX, USA; South Texas Veterans Health Care System, San Antonio, TX, USA
| | - Kai Spiegelhalder
- Department of Psychiatry and Psychotherapy, Medical Centre, University of Freiburg - Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Simon B Eickhoff
- Institute of Neuroscience and Medicine, Brain and Behaviour (INM-7), Research Centre Jülich, Jülich, Germany; Institute of Systems Neuroscience, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Masoud Tahmasian
- Institute of Neuroscience and Medicine, Brain and Behaviour (INM-7), Research Centre Jülich, Jülich, Germany; Institute of Systems Neuroscience, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany.
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5
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Mo L, Li S, Cheng S, Li Y, Xu F, Zhang D. Emotion regulation of social pain: double dissociation of lateral prefrontal cortices supporting reappraisal and distraction. Soc Cogn Affect Neurosci 2023; 18:nsad043. [PMID: 37676260 PMCID: PMC10484058 DOI: 10.1093/scan/nsad043] [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: 12/31/2022] [Revised: 07/06/2023] [Accepted: 08/30/2023] [Indexed: 09/08/2023] Open
Abstract
The dorsolateral prefrontal cortex (DLPFC) and ventrolateral prefrontal cortex (VLPFC) are both crucial regions involved in voluntary emotion regulation. However, it remains unclear whether the two regions show functional specificity for reappraisal and distraction. This study employed transcranial magnetic stimulation (TMS) to explore, in a real social interactive scenario, whether different lateral prefrontal regions play relatively specific roles in downregulating social pain via reappraisal and distraction. Participants initially took part in a social interactive game, followed by receiving either active (the DLPFC- or VLPFC-activated group, n = 100 per group) or control (the vertex-activated group, n = 100) TMS session. They were then instructed to use both distraction and reappraisal strategies to downregulate any negative emotions evoked by the social evaluation given by their peers who interacted with them previously. Results demonstrated that the TMS-activated DLPFC has a greater beneficial effect during distraction, whereas the activated VLPFC has a greater beneficial effect during reappraisal. This result investigated the direct experience of social pain and extended previous findings on empathy-related responses to affective pictures while also controlling for confounding factors such as empathic concern. Therefore, we are now confident in the double dissociation proposal of the DLPFC and VLPFC in distraction and reappraisal.
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Affiliation(s)
- Licheng Mo
- School of Psychology, Shenzhen University, Shenzhen 518060, China
| | - Sijin Li
- School of Psychology, Shenzhen University, Shenzhen 518060, China
| | - Si Cheng
- School of Psychology, Shenzhen University, Shenzhen 518060, China
| | - Yiwei Li
- School of Psychology, Shenzhen University, Shenzhen 518060, China
| | - Feng Xu
- Shenzhen Yingchi Technology Co., Ltd, Shenzhen 518057, China
| | - Dandan Zhang
- Institute of Brain and Psychological Sciences, Sichuan Normal University, Chengdu 610066, China
- China Center for Behavioral Economics and Finance, School of Economics, Southwestern University of Finance and Economics, Chengdu 611130, China
- Shenzhen-Hong Kong Institute of Brain Science, Shenzhen 518060, China
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6
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Russell B, Mussap AJ. Rumination and threat-biased interpretation mediate posttraumatic stress and growth responses to military stressors. MILITARY PSYCHOLOGY 2023; 35:451-466. [PMID: 37615560 PMCID: PMC10453989 DOI: 10.1080/08995605.2022.2127618] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 09/14/2022] [Indexed: 10/14/2022]
Abstract
We examined the role of rumination and threat-biased interpretation in stress and growth responses to military stressors. Two online surveys were completed by 183 (survey 1) and 393 (survey 2) currently serving or retired military personnel. The surveys measured exposure to potential military stressors (exposure to combat, witnessing the consequences of war, and perceived moral injury), posttraumatic stress symptomatology (PTSS), posttraumatic growth (PTG), and personal wellbeing, with survey 1 including measures of rumination, and survey 2 including a measure of threat-biased interpretation. Path analyses revealed that indirect paths from both witnessing the consequences of war and experiencing betrayal to PTSS were mediated by intrusive rumination and threat-biased interpretation, and that indirect paths from both betrayal and transgressions by others to PTG were mediated by deliberate rumination and threat-biased interpretation. The results reveal the idiosyncratic nature of military stressors, their differential involvement with cognitions that underpin rumination about past events and interpretation of current events, and their relevance to posttraumatic stress and growth in military personnel.
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Affiliation(s)
- Brenton Russell
- School of Psychology, Deakin University, Melbourne, Australia
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7
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Hinojosa CA, VanElzakker MB, Kaur N, Felicione JM, Charney ME, Bui E, Marques L, Summergrad P, Rauch SL, Simon NM, Shin LM. Pre-treatment amygdala activation and habituation predict symptom change in post-traumatic stress disorder. Front Behav Neurosci 2023; 17:1198244. [PMID: 37492481 PMCID: PMC10363634 DOI: 10.3389/fnbeh.2023.1198244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 06/13/2023] [Indexed: 07/27/2023] Open
Abstract
Trauma-focused psychotherapy approaches are the first-line treatment option for post-traumatic stress disorder (PTSD); however, up to a third of patients remain symptomatic even after completion of the treatment. Predicting which patients will respond to a given treatment option would support personalized treatments and improve the efficiency of healthcare systems. Although previous neuroimaging studies have examined possible pre-treatment predictors of response to treatment, the findings have been somewhat inconsistent, and no other study has examined habituation to stimuli as a predictor. In this study, 16 treatment-seeking adults (MAge = 43.63, n = 10 women) with a primary diagnosis of PTSD passively viewed pictures of emotional facial expressions during functional magnetic resonance imaging (fMRI). After scanning, participants rated facial expressions on both valence and arousal. Participants then completed eight weekly sessions of prolonged exposure (PE) therapy. PTSD symptom severity was measured before and after treatment. Overall, participants showed symptomatic improvement with PE. Consistent with hypotheses, lesser activation in the amygdala and greater activation in the ventromedial prefrontal cortex during the presentation of fearful vs. happy facial expressions, as well as a greater decline in amygdala activation across blocks of fearful facial expressions at baseline, were associated with greater reduction of PTSD symptoms. Given that the repeated presentation of emotional material underlies PE, changes in brain responses with repeated stimulus presentations warrant further studies as potential predictors of response to exposure therapies.
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Affiliation(s)
- Cecilia A. Hinojosa
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, United States
| | - Michael B. VanElzakker
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Navneet Kaur
- Department of Cancer Biology, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Julia M. Felicione
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
- Department of Psychology, Tufts University, Medford, MA, United States
| | - Meredith E. Charney
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Eric Bui
- Normandie Univ, University of Caen Normandy (UNICAEN), L'Institut national de la santé et de la recherche médicale (INSERM), U1237, PhIND “Physiopathology and Imaging of Neurological Disorders”, NEUROPRESAGE Team, (Institut Blood and Brain @ Caen-Normandie), GIP Cyceron, Caen, France
- Centre Hospitalier Universitaire Caen Normandie, Caen, France
| | - Luana Marques
- Department of Psychiatry, Massachusetts General Hospital, Center for Anxiety and Traumatic Stress Disorders, Boston, MA, United States
| | - Paul Summergrad
- Department of Psychiatry, Tufts University School of Medicine, Boston, MA, United States
| | - Scott L. Rauch
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
- Institute for Technology in Psychiatry, McLean Hospital, Belmont, MA, United States
- Department of Psychiatry, McLean Hospital, Belmont, MA, United States
| | - Naomi M. Simon
- Department of Psychiatry, New York University (NYU) Grossman School of Medicine, New York, NY, United States
| | - Lisa M. Shin
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
- Department of Psychology, Tufts University, Medford, MA, United States
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8
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Yang R, Takarae Y, Adney H, Swineford C, Walker JC, Cheng P, Negash S, Wiggins JL. Neural correlates of irritability symptom relief in adolescents pre- and post-trauma-focused cognitive behavioral therapy: A pilot study on reward processing. Psychiatry Res Neuroimaging 2023; 332:111645. [PMID: 37087811 PMCID: PMC10901248 DOI: 10.1016/j.pscychresns.2023.111645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 03/23/2023] [Accepted: 04/13/2023] [Indexed: 04/25/2023]
Abstract
Despite that Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) is a first-line, evidence-based treatment for youths experiencing trauma-related symptoms, treatment responses vary and it remains unclear for whom and how this treatment works. In this context, we examined pre-treatment neural reward processing and pre- vs. post-treatment changes in neural reward processing, in relation to irritability - a transdiagnostic and dimensional feature present in multiple trauma-related syndromes, following TF-CBT. Adolescents (N = 22) with childhood trauma history completed a child-friendly monetary incentive delay task during fMRI acquisition, prior to and after the treatment, and irritability symptoms were assessed at five time points over the course of the treatment. Individual irritability slopes (i.e., irritability change rate) and intercepts (i.e., initial irritability level), generated by linear growth curve modeling, were integrated with fMRI data. Repeated ANCOVAs demonstrated that both pre-treatment neural response to reward and pre- vs. post-treatment changes in neural reward processing correlated with irritability symptom relief, such that opposite baseline neural reward processing profiles and differential changing patterns were observed in individuals showing irritability symptom relief vs. not. Together, our findings provide proof of concept that integrating brain information with clinical information has the potential to identify predictors and mechanisms of symptom relief.
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Affiliation(s)
- Ruiyu Yang
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, United States; Department of Psychology, San Diego State University, United States.
| | - Yukari Takarae
- Department of Psychology, San Diego State University, United States
| | - Hailey Adney
- Department of Psychology, San Diego State University, United States
| | - Conner Swineford
- Department of Psychology, San Diego State University, United States
| | - Johanna C Walker
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, United States; Department of Psychology, San Diego State University, United States
| | - Philip Cheng
- Thomas Roth Sleep Disorders and Research Center, Henry Ford Hospital, United States
| | - Sesen Negash
- Department of Counseling & School Psychology, San Diego State University, United States
| | - Jillian Lee Wiggins
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, United States; Department of Psychology, San Diego State University, United States
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9
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Picó-Pérez M, Fullana MA, Albajes-Eizagirre A, Vega D, Marco-Pallarés J, Vilar A, Chamorro J, Felmingham KL, Harrison BJ, Radua J, Soriano-Mas C. Neural predictors of cognitive-behavior therapy outcome in anxiety-related disorders: a meta-analysis of task-based fMRI studies. Psychol Med 2023; 53:3387-3395. [PMID: 35916600 DOI: 10.1017/s0033291721005444] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Cognitive-behavior therapy (CBT) is a well-established first-line intervention for anxiety-related disorders, including specific phobia, social anxiety disorder, panic disorder/agoraphobia, generalized anxiety disorder, obsessive-compulsive disorder, and posttraumatic stress disorder. Several neural predictors of CBT outcome for anxiety-related disorders have been proposed, but previous results are inconsistent. METHODS We conducted a systematic review and meta-analysis of task-based functional magnetic resonance imaging (fMRI) studies investigating whole-brain predictors of CBT outcome in anxiety-related disorders (17 studies, n = 442). RESULTS Across different tasks, we observed that brain response in a network of regions involved in salience and interoception processing, encompassing fronto-insular (the right inferior frontal gyrus-anterior insular cortex) and fronto-limbic (the dorsomedial prefrontal cortex-dorsal anterior cingulate cortex) cortices was strongly associated with a positive CBT outcome. CONCLUSIONS Our results suggest that there are robust neural predictors of CBT outcome in anxiety-related disorders that may eventually lead (probably in combination with other data) to develop personalized approaches for the treatment of these mental disorders.
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Affiliation(s)
- Maria Picó-Pérez
- Life and Health Sciences Research Institute (ICVS), University of Minho, Braga, Portugal
- ICVS/3B's, PT Government Associate Laboratory, Braga/Guimarães, Portugal
- Clinical Academic Center - Braga, Braga, Portugal
| | - Miquel A Fullana
- Adult Psychiatry and Psychology Department, Institute of Neurosciences, Hospital Clinic, Barcelona, Spain
- Imaging of Mood- and Anxiety-Related Disorders (IMARD) Group, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), CIBERSAM, Barcelona, Spain
| | - Anton Albajes-Eizagirre
- Imaging of Mood- and Anxiety-Related Disorders (IMARD) Group, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), CIBERSAM, Barcelona, Spain
- Opticks Security, Barcelona, Spain
| | - Daniel Vega
- Psychiatry and Mental Health Department, Consorci Sanitari de l'Anoia & Fundació Sanitària d'Igualada, Igualada, Barcelona, Spain
- Unitat de Psicologia Mèdica, Departament de Psiquiatria i Medicina Legal & Institut de Neurociències, Universitat Autònoma de Barcelona, Bellaterra, Barcelona, Spain
| | - Josep Marco-Pallarés
- Department of Cognition, Development and Educational Psychology, Institute of Neurosciences, University of Barcelona, Barcelona, Spain
- Cognition and Brain Plasticity Unit, Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain
| | - Ana Vilar
- Institut de Neuropsiquiatria i Addiccions, Hospital de Dia Infanto Juvenil Litoral Mar, Parc de Salut Mar, Barcelona, Spain
| | - Jacobo Chamorro
- Anxiety Unit, Institute of Neuropsychiatry and Addictions, Parc de Salut Mar, Barcelona, Spain
| | - Kim L Felmingham
- School of Psychological Sciences, University of Melbourne, Melbourne, Australia
| | - Ben J Harrison
- Department of Psychiatry, Melbourne Neuropsychiatry Centre, The University of Melbourne and Melbourne Health, Carlton, Victoria, Australia
| | - Joaquim Radua
- Imaging of Mood- and Anxiety-Related Disorders (IMARD) Group, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), CIBERSAM, Barcelona, Spain
- Department of Clinical Neuroscience, Centre for Psychiatric Research and Education, Karolinska Institutet, Stockholm, Sweden
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Carles Soriano-Mas
- Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
- CIBERSAM, Barcelona, Spain
- Department of Psychobiology and Methodology of Health Sciences, Universitat Autònoma de Barcelona, Barcelona, Spain
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10
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Korgaonkar MS, Felmingham KL, Malhi GS, Williamson TH, Williams LM, Bryant RA. Changes in neural responses during affective and non-affective tasks and improvement of posttraumatic stress disorder symptoms following trauma-focused psychotherapy. Transl Psychiatry 2023; 13:85. [PMID: 36894538 PMCID: PMC9998447 DOI: 10.1038/s41398-023-02375-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Revised: 02/07/2023] [Accepted: 02/20/2023] [Indexed: 03/11/2023] Open
Abstract
At least one-third posttraumatic stress disorder (PTSD) patients do not respond to trauma-focused psychotherapy (TF-psychotherapy), which is the treatment of choice for PTSD. To clarify the change mechanisms that may be associated with treatment response, this study examined changes in neural activations during affective and non-affective processing that occur with improvement of symptoms after TF-psychotherapy. This study assessed PTSD treatment-seeking patients (n = 27) prior to and after TF-psychotherapy using functional magnetic resonance imaging when they completed three tasks: (a) passive viewing of affective faces, (b) cognitive reappraisal of negative images, and (c) non-affective response inhibition. Patients then underwent 9 sessions of TF-psychotherapy, and were assessed on the Clinician-Administered PTSD Scale following treatment. Changes in neural responses in affect and cognitive processing regions-of-interest for each task were correlated with reduction of PTSD severity from pretreatment to posttreatment in the PTSD cohort. Data from 21 healthy controls was used for comparison. Improvement of symptoms in PTSD were associated with increased activation of left anterior insula, reductions in the left hippocampus and right posterior insula during viewing of supraliminally presented affective images, and reduced connectivity between the left hippocampus with the left amygdala and rostral anterior cingulate. Treatment response was also associated with reduced activation in the left dorsolateral prefrontal cortex during reappraisal of negative images. There were no associations between response and activation change during response inhibition. This pattern of findings indicates that improvement of PTSD symptoms following TF-psychotherapy is associated with changes in affective rather than non-affective processes. These findings accord with prevailing models that TF-psychotherapy promotes engagement and mastery of affective stimuli.Clinical Trials Registration: Trial Registration: Prospectively registered at Australian and New Zealand Clinical Trials Registry, ACTRN12612000185864 and ACTRN12609000324213. https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=83857.
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Affiliation(s)
- Mayuresh S Korgaonkar
- Brain Dynamics Centre, Westmead Institute for Medical Research, The University of Sydney, Westmead, Australia. .,Department of Psychiatry, University of Sydney, Westmead, Australia.
| | - Kim L Felmingham
- Discipline of Psychological Science, University of Melbourne, Melbourne, Australia
| | - Gin S Malhi
- Department of Psychiatry, University of Sydney, Westmead, Australia
| | - Thomas H Williamson
- Brain Dynamics Centre, Westmead Institute for Medical Research, The University of Sydney, Westmead, Australia.,School of Psychology, University of New South Wales, Kensington, Australia
| | - Leanne M Williams
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, USA.,Sierra-Pacific Mental Illness Research, Education, and Clinical Center (MIRECC) VA Palo Alto Health Care System, Palo Alto, USA
| | - Richard A Bryant
- Brain Dynamics Centre, Westmead Institute for Medical Research, The University of Sydney, Westmead, Australia. .,School of Psychology, University of New South Wales, Kensington, Australia.
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Pacitto R, Peters C, Iadipaolo A, Rabinak CA. Cannabinoid modulation of brain activation during volitional regulation of negative affect in trauma-exposed adults. Neuropharmacology 2022; 218:109222. [PMID: 35981598 PMCID: PMC11092923 DOI: 10.1016/j.neuropharm.2022.109222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 06/16/2022] [Accepted: 08/10/2022] [Indexed: 10/31/2022]
Abstract
Emotion dysregulation is considered a core component of posttraumatic stress disorder (PTSD). Cognitive reappraisal is one therapeutic emotion regulation strategy that has been widely studied among individuals with mood and anxiety disorders, and numerous differences in brain activation patterns have been shown between individuals with and without PTSD during tasks of cognitive reappraisal. Prior research among healthy subjects suggests that an acute, low dose of Δ9-tetrahydrocannabinol (THC) could attenuate the neurophysiological discrepancies that exist between individuals with and without PTSD during tasks of emotional processing; however, the effect of an acute, low dose of THC on corticolimbic activity during emotion regulation among individuals with PTSD has not yet been studied. The present study aimed to investigate the effect of THC on negative affect and brain activation in a priori regions of interest during cognitive reappraisal among trauma-exposed individuals with and without PTSD. Using a double-blind design, 51 individuals were randomized to receive THC or placebo (PBO) before participating in a well-established emotion regulation task during functional magnetic resonance imaging (fMRI). THC but not PBO reduced negative affect during reappraisal, and THC increased dorsomedial prefrontal cortex (dmPFC) activation in response to neutral images. Individuals with PTSD displayed less activation in the angular gyrus, overall, compared to the trauma-exposed control (TEC) group, however THC increased angular gyrus activation in the PTSD group so that there was no significant difference in angular gyrus activation between the TEC and PTSD groups that received THC. Compared to PBO, THC also increased cerebellar activation during exposure to neutral images in individuals with PTSD. Lastly, in participants that received THC, greater posterior cingulate cortex (PCC)/precuneus activation during reappraisal was associated with less self-reported negative affect following reappraisal blocks. Together these findings suggest that THC may prove to be a beneficial pharmacological adjunct to cognitive reappraisal therapy in the treatment of PTSD.
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Affiliation(s)
- Regina Pacitto
- Department of Pharmacy Practice, Wayne State University, Detroit, MI, USA
| | - Craig Peters
- Department of Pharmacy Practice, Wayne State University, Detroit, MI, USA
| | | | - Christine A Rabinak
- Department of Pharmacy Practice, Wayne State University, Detroit, MI, USA; Translational Neuroscience Program, Wayne State University, Detroit, MI, USA; Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, MI, USA; Department of Pharmaceutical Sciences, Wayne State University, Detroit, MI, USA; Merrill Palmer Skillman Institute for Child and Family Development, Wayne State University, Detroit, MI, USA.
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Klimova A, Breukelaar IA, Bryant RA, Korgaonkar MS. A comparison of the functional connectome in mild traumatic brain injury and post-traumatic stress disorder. Hum Brain Mapp 2022; 44:813-824. [PMID: 36206284 PMCID: PMC9842915 DOI: 10.1002/hbm.26101] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 08/25/2022] [Accepted: 09/07/2022] [Indexed: 01/25/2023] Open
Abstract
Post-traumatic stress disorder (PTSD) and mild traumatic brain injury (mTBI) often co-occur in the context of threat to one's life. These conditions also have an overlapping symptomatology and include symptoms of anxiety, poor concentration and memory problems. A major challenge has been articulating the underlying neurobiology of these overlapping conditions. The primary aim of this study was to compare intrinsic functional connectivity between mTBI (without PTSD) and PTSD (without mTBI). The study included functional MRI data from 176 participants: 42 participants with mTBI, 67 with PTSD and a comparison group of 66 age and sex-matched healthy controls. We used network-based statistical analyses for connectome-wide comparisons of intrinsic functional connectivity between mTBI relative to PTSD and controls. Our results showed no connectivity differences between mTBI and PTSD groups. However, we did find that mTBI had significantly reduced connectivity relative to healthy controls within an extensive network of regions including default mode, executive control, visual and auditory networks. The mTBI group also displayed hyperconnectivity between dorsal and ventral attention networks and perceptual regions. The PTSD group also demonstrated abnormal connectivity within these networks relative to controls. Connectivity alterations were not associated with severity of PTSD or post-concussive symptoms in either clinical group. Taken together, the similar profiles of intrinsic connectivity alterations in these two conditions provide neural evidence that can explain, in part, the overlapping symptomatology between mTBI and PTSD.
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Affiliation(s)
- Aleksandra Klimova
- Brain Dynamics Centre, Westmead Institute for Medical ResearchThe University of SydneyWestmeadAustralia
| | - Isabella A. Breukelaar
- Brain Dynamics Centre, Westmead Institute for Medical ResearchThe University of SydneyWestmeadAustralia,School of PsychologyUniversity of New South WalesSydneyAustralia
| | - Richard A. Bryant
- Brain Dynamics Centre, Westmead Institute for Medical ResearchThe University of SydneyWestmeadAustralia,School of PsychologyUniversity of New South WalesSydneyAustralia
| | - Mayuresh S. Korgaonkar
- Brain Dynamics Centre, Westmead Institute for Medical ResearchThe University of SydneyWestmeadAustralia,Department of Psychiatry, Faculty of Medicine and HealthUniversity of SydneyWestmeadAustralia
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Zhao Q, Guo Q, Shi Z, Cai Z, Zhang L, Li D, Chen Q, Du J, Wang K, Zhang L. Promoting gaze toward the eyes of emotional faces in individuals with high autistic traits using group cognitive behavioral therapy: An eye-tracking study. J Affect Disord 2022; 306:115-123. [PMID: 35304234 DOI: 10.1016/j.jad.2022.03.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Revised: 01/05/2022] [Accepted: 03/10/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Individuals with subclinical autistic traits exhibit a pattern of eye avoidance similar to that of typical autism. Our study aimed to test the efficacy of group cognitive behavioral therapy (G-CBT) in promoting gaze toward the eye area of facial expressions, specifically orienting to emotional faces, in individuals with high autistic traits (high AT). METHODS Twenty-six high AT individuals and 30 low AT individuals participated. High AT individuals were assigned to eight sessions of G-CBT intervention. Eye-tracking measurements were acquired before and after treatment. RESULTS We observed the following: (a) the eye avoidance in high AT individuals was prominent for all facial expressions in relative to low AT individuals; (b) G-CBT primarily improved gaze toward the eyes of happy and fearful faces but not for neutral face expressions in high AT individuals; (c) after 8 sessions of G-CBT, the fixation time on the eyes of emotional faces improved significantly. For happy faces, the fixation time on the eyes of faces was markedly increased in epochs between 500 ms and 1000 ms after the face onset; for fearful faces, the improvement in participants existed between about 1000 ms and 1500 ms after the face appeared. LIMITATION Our results may not be generalized to other patients with ASD. CONCLUSIONS Our findings demonstrate that G-CBT significantly promotes gaze toward the eyes of emotional faces in high AT individuals. These results are encouraging, and suggest that the emotional face processing in autism spectrum disorder (ASD) might stand to benefit from similar psychotherapeutic treatment.
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Affiliation(s)
- Qingqing Zhao
- School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei 230032, China
| | - Qianhui Guo
- School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei 230032, China
| | - Zhulin Shi
- School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei 230032, China
| | - Zhu Cai
- School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei 230032, China
| | - Long Zhang
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, The School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, Anhui Province 230032, China
| | - Dandan Li
- School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei 230032, China
| | - Qiuyu Chen
- School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei 230032, China
| | - Jinmei Du
- School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei 230032, China
| | - Kai Wang
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, The School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, Anhui Province 230032, China; Institute of Artificial Intelligence, Hefei Comprehensive National Science Center, Hefei 230088, China; Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei 230032, China; Collaborative Innovation Center for Neuropsychiatric Disorders and Mental Health, Anhui Medical University, Hefei 230032, China.
| | - Lei Zhang
- School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei 230032, China.
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Affective neural signatures do not distinguish women with emotion dysregulation from healthy controls: A mega-analysis across three task-based fMRI studies. NEUROIMAGE: REPORTS 2021. [DOI: 10.1016/j.ynirp.2021.100019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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van Rooij SJ, Sippel LM, McDonald WM, Holtzheimer PE. Defining focal brain stimulation targets for PTSD using neuroimaging. Depress Anxiety 2021; 38:10.1002/da.23159. [PMID: 33876868 PMCID: PMC8526638 DOI: 10.1002/da.23159] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 03/17/2021] [Accepted: 04/02/2021] [Indexed: 02/02/2023] Open
Abstract
INTRODUCTION Focal brain stimulation has potential as a treatment for posttraumatic stress disorder (PTSD). In this review, we aim to inform selection of focal brain stimulation targets for treating PTSD by examining studies of the functional neuroanatomy of PTSD and treatment response. We first briefly review data on brain stimulation interventions for PTSD. Although published data suggest good efficacy overall, the neurobiological rationale for each stimulation target is not always clear. METHODS Therefore, we assess pre- and post-treatment (predominantly psychotherapy) functional neuroimaging studies in PTSD to determine which brain changes seem critical to treatment response. Results of these studies are presented within a previously proposed functional neural systems model of PTSD. RESULTS While not completely consistent, research suggests that downregulating the fear learning and threat and salience detection circuits (i.e., amygdala, dorsal anterior cingulate cortex and insula) and upregulating the emotion regulation and executive function and contextual processing circuits (i.e., prefrontal cortical regions and hippocampus) may mediate PTSD treatment response. CONCLUSION This literature review provides some justification for current focal brain stimulation targets. However, the examination of treatment effects on neural networks is limited, and studies that include the stimulation targets are lacking. Further, additional targets, such as the cingulate, medial prefrontal cortex, and inferior parietal lobe, may also be worth investigation, especially when considering how to achieve network level changes. Additional research combining PTSD treatment with functional neuroimaging will help move the field forward by identifying and validating novel targets, providing better rationale for specific treatment parameters and personalizing treatment for PTSD.
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Affiliation(s)
- Sanne J.H. van Rooij
- Emory University School of Medicine, Department of Psychiatry and Behavioral Sciences, Atlanta, GA
| | - Lauren M. Sippel
- National Center for PTSD, U.S. Department of Veterans Affairs, White River Junction, VT
- Geisel School of Medicine at Dartmouth, Hanover, NH
| | - William M. McDonald
- Emory University School of Medicine, Department of Psychiatry and Behavioral Sciences, Atlanta, GA
| | - Paul E. Holtzheimer
- National Center for PTSD, U.S. Department of Veterans Affairs, White River Junction, VT
- Geisel School of Medicine at Dartmouth, Hanover, NH
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