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Matsunaga M, Ohtsubo Y, Ishii K, Tsuboi H, Suzuki K, Takagishi H. Subjective well-being can be predicted by caudate volume and promotion focus. Brain Struct Funct 2024:10.1007/s00429-024-02830-3. [PMID: 39066916 DOI: 10.1007/s00429-024-02830-3] [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: 04/17/2024] [Accepted: 07/06/2024] [Indexed: 07/30/2024]
Abstract
It is well-known that the caudate nucleus is associated with motivational behaviors and subjective well-being. However, no longitudinal studies have examined the relationship between brain structure, behavioral orientations, and subjective well-being. This study analyzes data from our previous longitudinal study to examine whether future subjective well-being can be predicted by the volume of the caudate nucleus. We also examined whether behavioral orientation, based on the regulatory focus theory showing two orientations-promotion and prevention focus-was related to the volume of the caudate nucleus. Voxel-based morphometry analysis indicated that the left caudate volume was positively associated with rating scores for future subjective well-being and promotion orientation. Further, mediation analysis indicated that promotion orientation significantly mediated the relationship between future subjective well-being and left caudate volume. The findings indicate that future subjective well-being can be predicted by the volume of the left caudate nucleus, and that this relationship is mediated by promotion focus orientation.
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Affiliation(s)
- Masahiro Matsunaga
- Department of Health and Psychosocial Medicine, Aichi Medical University School of Medicine, Nagakute, 480-1195, Aichi, Japan.
| | - Yohsuke Ohtsubo
- Graduate School of Humanities and Sociology, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Keiko Ishii
- Department of Cognitive and Psychological Sciences, Graduate School of Informatics, Nagoya University, Nagoya, Aichi, Japan
| | - Hirohito Tsuboi
- Graduate School of Human Sciences, The University of Shiga Prefecture, Hikone, Shiga, Japan
| | - Kohta Suzuki
- Department of Health and Psychosocial Medicine, Aichi Medical University School of Medicine, Nagakute, 480-1195, Aichi, Japan
| | - Haruto Takagishi
- Brain Science Institute, Tamagawa University, Machida, Tokyo, Japan
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Dercon Q, Mehrhof SZ, Sandhu TR, Hitchcock C, Lawson RP, Pizzagalli DA, Dalgleish T, Nord CL. A core component of psychological therapy causes adaptive changes in computational learning mechanisms. Psychol Med 2024; 54:327-337. [PMID: 37288530 DOI: 10.1017/s0033291723001587] [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: 06/09/2023]
Abstract
BACKGROUND Cognitive distancing is an emotion regulation strategy commonly used in psychological treatment of various mental health disorders, but its therapeutic mechanisms are unknown. METHODS 935 participants completed an online reinforcement learning task involving choices between pairs of symbols with differing reward contingencies. Half (49.1%) of the sample was randomised to a cognitive self-distancing intervention and were trained to regulate or 'take a step back' from their emotional response to feedback throughout. Established computational (Q-learning) models were then fit to individuals' choices to derive reinforcement learning parameters capturing clarity of choice values (inverse temperature) and their sensitivity to positive and negative feedback (learning rates). RESULTS Cognitive distancing improved task performance, including when participants were later tested on novel combinations of symbols without feedback. Group differences in computational model-derived parameters revealed that cognitive distancing resulted in clearer representations of option values (estimated 0.17 higher inverse temperatures). Simultaneously, distancing caused increased sensitivity to negative feedback (estimated 19% higher loss learning rates). Exploratory analyses suggested this resulted from an evolving shift in strategy by distanced participants: initially, choices were more determined by expected value differences between symbols, but as the task progressed, they became more sensitive to negative feedback, with evidence for a difference strongest by the end of training. CONCLUSIONS Adaptive effects on the computations that underlie learning from reward and loss may explain the therapeutic benefits of cognitive distancing. Over time and with practice, cognitive distancing may improve symptoms of mental health disorders by promoting more effective engagement with negative information.
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Affiliation(s)
- Quentin Dercon
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
- UCL Institute of Mental Health, University College London, London, UK
| | - Sara Z Mehrhof
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
| | - Timothy R Sandhu
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
- Department of Psychology, University of Cambridge, Cambridge, UK
| | - Caitlin Hitchcock
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia
| | - Rebecca P Lawson
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
- Department of Psychology, University of Cambridge, Cambridge, UK
| | - Diego A Pizzagalli
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Center for Depression, Anxiety, and Stress Research, McLean Hospital, Belmont, MA, USA
| | - Tim Dalgleish
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridgeshire, UK
| | - Camilla L Nord
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
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Artiach Hortelano P, Martens MAG, Pringle A, Harmer CJ. Effect of lithium administration on brain activity under an emotion regulation paradigm in healthy participants: a functional magnetic resonance imaging study. Psychopharmacology (Berl) 2023; 240:1719-1734. [PMID: 37338568 PMCID: PMC10349753 DOI: 10.1007/s00213-023-06395-7] [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: 06/27/2022] [Accepted: 05/31/2023] [Indexed: 06/21/2023]
Abstract
RATIONALE Emotion regulation (ER) difficulties have been previously described in bipolar disorder (BD). Whilst lithium has been shown to be effective in the treatment of BD, the mechanisms underlying lithium's effect on mood stabilisation remain unclear. OBJECTIVES Unravelling lithium's effect on psychological processes impaired in BD, such as ER, could address this translational gap and inform the development of new treatments. METHODS This study investigated the neural effects of lithium (800mg) on ER in 33 healthy volunteers in a double-blind between-groups design, randomised to lithium (n=17) or placebo (n=16) for 11 days. At treatment completion, participants underwent 3-Tesla fMRI scan whilst performing an ER task. RESULTS Reappraisal reduced negative affect across groups and led to the expected increase in frontal brain activity. Participants receiving lithium showed (1) decreased activation in prefrontal and posterior parietal cortices and connectivity between the fronto-limbic network (Z>2.3, p<0.05 corrected); and (2) increased activity in the right superior temporal gyrus (Z>3.1, p<0.05 corrected) and connectivity between the right medial temporal gyrus (MTG) and left middle frontal gyrus (Z>2.3, p<0.05 corrected) during reappraisal. Further effects of lithium were found in response to negative picture presentation, whereby an anticorrelation was found between the left amygdala and the frontal cortex, and greater connectivity between the right MTG and the bilateral medial prefrontal cortex extending into the paracingulate gyrus, compared to placebo (Z>2.3, p < 0.05 corrected). CONCLUSIONS These results show a potential effect of lithium on ER through its effects on activity and connectivity, and further elaborate the neural underpinnings of cognitive reappraisal. Future work should investigate longer term effects of lithium on ER in BD, ultimately benefitting the development of novel and more effective treatments.
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Affiliation(s)
| | - Marieke A G Martens
- Department of Psychiatry, University of Oxford, Oxford, UK.
- Oxford Health NHS Foundation Trust, Oxford, UK.
- Wellcome Centre for Integrative Neuroimaging, University of Oxford, Oxford, OX3 7JX, UK.
| | | | - Catherine J Harmer
- Department of Psychiatry, University of Oxford, Oxford, UK
- Oxford Health NHS Foundation Trust, Oxford, UK
- Wellcome Centre for Integrative Neuroimaging, University of Oxford, Oxford, OX3 7JX, UK
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Schumer MC, Chase HW, Rozovsky R, Eickhoff SB, Phillips ML. Prefrontal, parietal, and limbic condition-dependent differences in bipolar disorder: a large-scale meta-analysis of functional neuroimaging studies. Mol Psychiatry 2023; 28:2826-2838. [PMID: 36782061 PMCID: PMC10615766 DOI: 10.1038/s41380-023-01974-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 01/15/2023] [Accepted: 01/19/2023] [Indexed: 02/15/2023]
Abstract
BACKGROUND Over the past few decades, neuroimaging research in Bipolar Disorder (BD) has identified neural differences underlying cognitive and emotional processing. However, substantial clinical and methodological heterogeneity present across neuroimaging experiments potentially hinders the identification of consistent neural biomarkers of BD. This meta-analysis aims to comprehensively reassess brain activation and connectivity in BD in order to identify replicable differences that converge across and within resting-state, cognitive, and emotional neuroimaging experiments. METHODS Neuroimaging experiments (using fMRI, PET, or arterial spin labeling) reporting whole-brain results in adults with BD and controls published from December 1999-June 18, 2019 were identified via PubMed search. Coordinates showing significant activation and/or connectivity differences between BD participants and controls during resting-state, emotional, or cognitive tasks were extracted. Four parallel, independent meta-analyses were calculated using the revised activation likelihood estimation algorithm: all experiment types, all resting-state experiments, all cognitive experiments, and all emotional experiments. To confirm reliability of identified clusters, two different meta-analytic significance tests were employed. RESULTS 205 published studies yielding 506 individual neuroimaging experiments (150 resting-state, 134 cognitive, 222 emotional) comprising 5745 BD and 8023 control participants were included. Five regions survived both significance tests. Individuals with BD showed functional differences in the right posterior cingulate cortex during resting-state experiments, the left amygdala during emotional experiments, including those using a mixed (positive/negative) valence manipulation, and the left superior and right inferior parietal lobules during cognitive experiments, while hyperactivating the left medial orbitofrontal cortex during cognitive experiments. Across all experiments, there was convergence in the right caudate extending to the ventral striatum, surviving only one significance test. CONCLUSIONS Our findings indicate reproducible localization of prefrontal, parietal, and limbic differences distinguishing BD from control participants that are condition-dependent, despite heterogeneity, and point towards a framework for identifying reproducible differences in BD that may guide diagnosis and treatment.
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Affiliation(s)
- Maya C Schumer
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
| | - Henry W Chase
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Renata Rozovsky
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Simon B Eickhoff
- Institute of Systems Neuroscience, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- Institute of Neuroscience and Medicine, Brain & Behaviour (INM-7), Research Centre Jülich, Jülich, Germany
| | - Mary L Phillips
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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Abnormal Brain Networks Related to Drug and Nondrug Reward Anticipation and Outcome Processing in Stimulant Use Disorder: A Functional Connectomics Approach. BIOLOGICAL PSYCHIATRY. COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2022; 8:560-571. [PMID: 36108930 DOI: 10.1016/j.bpsc.2022.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 08/25/2022] [Accepted: 08/29/2022] [Indexed: 01/21/2023]
Abstract
BACKGROUND Drug addiction is associated with blunted neural responses to nondrug rewards, such as money, but heightened responses to drug cues that predict drug-reward outcomes. This dissociation underscores the role of incentive context in the attribution of motivational salience, which may reflect a narrowing toward drug-related goals. This hypothesis, however, has scarcely been investigated. METHODS To address this important scientific gap, the current study performed an empirical assessment of differences in salience attribution by comparing patients with stimulant use disorder (SUD) (n = 41) with control participants (n = 48) on network connectivity related to anticipation and outcome processing using a modified monetary incentive delay task. We hypothesized increased task-related activation and connectivity to drug rewards in patients with SUD, and reduced task-related activation and connectivity to monetary rewards during incentive processing across brain networks. RESULTS In the presence of behavioral and regional brain activation similarities, we found that patients with SUD showed significantly less connectivity involving three separate distributed networks during monetary reward anticipation, and drug and monetary reward outcome processing. No group connectivity differences for drug reward anticipation were identified. Additional graph theory analyses revealed that patients with SUD had longer path lengths across these networks, all of which positively correlated with the duration of stimulant drug use. CONCLUSIONS Specific disruptions in connectivity in networks related to the anticipation of nondrug reward together with more general dysconnectivity in the processing of rewarding outcomes suggest an insensitivity to consequences. These observations support the notion of a predominance of habitual control in patients with SUD.
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Ishikawa M, Senju A, Kato M, Itakura S. Physiological arousal explains infant gaze following in various social contexts. ROYAL SOCIETY OPEN SCIENCE 2022; 9:220592. [PMID: 35991332 PMCID: PMC9382202 DOI: 10.1098/rsos.220592] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 07/27/2022] [Indexed: 05/06/2023]
Abstract
Gaze following (GF) is fundamental to central aspects of human sociocognitive development, such as acquiring language and cultural learning. Studies have shown that infant GF is not a simple reflexive orientation to an adult's eye movement. By contrast, infants adaptively modulate GF behaviour depending on the social context. However, arguably, the neurophysiological mechanisms underlying contextual modulation of GF remain somewhat unexplored. In this study, we tested the proposition about whether the contextual modulation of infant GF is mediated by the infant's heart rate (HR), which indicates the infant's physiological arousal. Forty-one 6- to 9-month-old infants participated in this study, and infants observed either a reliable face, which looked towards the location of an object, or an unreliable face, which looked away from the location of an object. Thereafter, the infants watched a video of the same model making eye contact or not making any ostensive signals, before shifting their gaze towards one of the two objects. We revealed that reliability and eye contact acted independently to increase HR, which then fully mediates the effects of these social cues on the frequency of GF. Results suggest that each social cue independently enhances physiological arousal, which then accumulatively predicts the likelihood of infant GF behaviour.
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Affiliation(s)
- Mitsuhiko Ishikawa
- Centre for Baby Science, Doshisha University, 4-1-1 Kizugawadai, Kizugawa, Kyoto 619-0295, Japan
- Centre for Brain and Cognitive Development, Birkbeck College, University of London, Malet Street, London WC1E 7HX, UK
| | - Atsushi Senju
- Centre for Brain and Cognitive Development, Birkbeck College, University of London, Malet Street, London WC1E 7HX, UK
- Research Centre for Child Mental Development, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu, Sizuoka 431-3192, Japan
| | - Masaharu Kato
- Centre for Baby Science, Doshisha University, 4-1-1 Kizugawadai, Kizugawa, Kyoto 619-0295, Japan
| | - Shoji Itakura
- Centre for Baby Science, Doshisha University, 4-1-1 Kizugawadai, Kizugawa, Kyoto 619-0295, Japan
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Ishikawa M, Senju A, Kato M, Itakura S. Physiological arousal explains infant gaze following in various social contexts. ROYAL SOCIETY OPEN SCIENCE 2022; 9:220592. [PMID: 35991332 DOI: 10.6084/m9.figshare.c.6135552] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 07/27/2022] [Indexed: 05/22/2023]
Abstract
Gaze following (GF) is fundamental to central aspects of human sociocognitive development, such as acquiring language and cultural learning. Studies have shown that infant GF is not a simple reflexive orientation to an adult's eye movement. By contrast, infants adaptively modulate GF behaviour depending on the social context. However, arguably, the neurophysiological mechanisms underlying contextual modulation of GF remain somewhat unexplored. In this study, we tested the proposition about whether the contextual modulation of infant GF is mediated by the infant's heart rate (HR), which indicates the infant's physiological arousal. Forty-one 6- to 9-month-old infants participated in this study, and infants observed either a reliable face, which looked towards the location of an object, or an unreliable face, which looked away from the location of an object. Thereafter, the infants watched a video of the same model making eye contact or not making any ostensive signals, before shifting their gaze towards one of the two objects. We revealed that reliability and eye contact acted independently to increase HR, which then fully mediates the effects of these social cues on the frequency of GF. Results suggest that each social cue independently enhances physiological arousal, which then accumulatively predicts the likelihood of infant GF behaviour.
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Affiliation(s)
- Mitsuhiko Ishikawa
- Centre for Baby Science, Doshisha University, 4-1-1 Kizugawadai, Kizugawa, Kyoto 619-0295, Japan
- Centre for Brain and Cognitive Development, Birkbeck College, University of London, Malet Street, London WC1E 7HX, UK
| | - Atsushi Senju
- Centre for Brain and Cognitive Development, Birkbeck College, University of London, Malet Street, London WC1E 7HX, UK
- Research Centre for Child Mental Development, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu, Sizuoka 431-3192, Japan
| | - Masaharu Kato
- Centre for Baby Science, Doshisha University, 4-1-1 Kizugawadai, Kizugawa, Kyoto 619-0295, Japan
| | - Shoji Itakura
- Centre for Baby Science, Doshisha University, 4-1-1 Kizugawadai, Kizugawa, Kyoto 619-0295, Japan
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Puglisi-Allegra S, Ruggieri S, Fornai F. Translational evidence for lithium-induced brain plasticity and neuroprotection in the treatment of neuropsychiatric disorders. Transl Psychiatry 2021; 11:366. [PMID: 34226487 PMCID: PMC8257731 DOI: 10.1038/s41398-021-01492-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 06/16/2021] [Accepted: 06/23/2021] [Indexed: 02/06/2023] Open
Abstract
Increasing evidence indicates lithium (Li+) efficacy in neuropsychiatry, pointing to overlapping mechanisms that occur within distinct neuronal populations. In fact, the same pathway depending on which circuitry operates may fall in the psychiatric and/or neurological domains. Li+ restores both neurotransmission and brain structure unveiling that psychiatric and neurological disorders share common dysfunctional molecular and morphological mechanisms, which may involve distinct brain circuitries. Here an overview is provided concerning the therapeutic/neuroprotective effects of Li+ in different neuropsychiatric disorders to highlight common molecular mechanisms through which Li+ produces its mood-stabilizing effects and to what extent these overlap with plasticity in distinct brain circuitries. Li+ mood-stabilizing effects are evident in typical bipolar disorder (BD) characterized by a cyclic course of mania or hypomania followed by depressive episodes, while its efficacy is weaker in the opposite pattern. We focus here on neural adaptations that may underlie psychostimulant-induced psychotic development and to dissect, through the sensitization process, which features are shared in BD and other psychiatric disorders, including schizophrenia. The multiple functions of Li+ highlighted here prove its exceptional pharmacology, which may help to elucidate its mechanisms of action. These may serve as a guide toward a multi-drug strategy. We propose that the onset of sensitization in a specific BD subtype may predict the therapeutic efficacy of Li+. This model may help to infer in BD which molecular mechanisms are relevant to the therapeutic efficacy of Li+.
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Affiliation(s)
| | | | - Francesco Fornai
- IRCCS Neuromed, Via Atinense 18, 86077, Pozzilli (IS), Italy.
- Human Anatomy, Department of Translational Research and New technologies in Medicine and Surgery, University of Pisa, Via Roma 55, 56126, Pisa (PI), Italy.
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Barredo J, Bozzay ML, Primack JM, Schatten HT, Armey MF, Carpenter LL, Philip NS. Translating Interventional Neuroscience to Suicide: It's About Time. Biol Psychiatry 2021; 89:1073-1083. [PMID: 33820628 PMCID: PMC8603185 DOI: 10.1016/j.biopsych.2021.01.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 01/19/2021] [Accepted: 01/21/2021] [Indexed: 12/26/2022]
Abstract
Despite significant advances in psychiatric and psychological treatment over the last 30 years, suicide deaths have increased. Unfortunately, neuroscience insights have yielded few translational interventions that specifically target suicidal thoughts and behaviors. In our view, this is attributable to two factors. The first factor is our limited integration of neurocircuitry models with contemporary suicide theory. The second challenge is inherent to the variable nature of suicide risk over time. Few interventional neuroscience studies evaluate how temporal fluctuations in risk affect treatment, despite evidence that temporality is a key component distinguishing suicide phenotypes. To wit, individual variability in risk trajectories may provide different treatment targets to engage as a patient moves between suicidal ideation and attempt. Here, we first review contemporary ideation-to-action theories of suicide from a neurobiological perspective, focusing on valence and executive function circuits and the key role of state-induced (e.g., within stressful contexts) functional modulation on longitudinal risk trajectories. We then describe neural correlates of suicide reduction following various interventions, ranging from circuit specific (i.e., transcranial magnetic stimulation) to broader pharmacological (i.e., ketamine, lithium) to psychological (i.e., brief cognitive therapy). We then introduce novel strategies for tracking risk in naturalistic settings and real time using ecological momentary interventions. We provide a critical integration of the literature focusing on the intersection between targets and temporality, and we conclude by proposing novel research designs integrating real-time and biologically based interventions to generate novel strategies for future suicide reduction research.
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Affiliation(s)
- Jennifer Barredo
- VA RR&D Center for Neurorestoration and Neurotechnology, Providence VA Medical Center, Providence, Rhode Island; Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island; COBRE Center for Neuromodulation and Neuroimaging, Providence, Rhode Island.
| | - Melanie L Bozzay
- VA RR&D Center for Neurorestoration and Neurotechnology, Providence VA Medical Center, Providence, Rhode Island; Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Jennifer M Primack
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island; Psychosocial Research Program, Butler Hospital, Providence, Rhode Island; Providence VA Medical Center, Providence, Rhode Island
| | - Heather T Schatten
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island; Psychosocial Research Program, Butler Hospital, Providence, Rhode Island
| | - Michael F Armey
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island; Psychosocial Research Program, Butler Hospital, Providence, Rhode Island
| | - Linda L Carpenter
- VA RR&D Center for Neurorestoration and Neurotechnology, Providence VA Medical Center, Providence, Rhode Island; Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island; COBRE Center for Neuromodulation and Neuroimaging, Providence, Rhode Island
| | - Noah S Philip
- VA RR&D Center for Neurorestoration and Neurotechnology, Providence VA Medical Center, Providence, Rhode Island; Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island; COBRE Center for Neuromodulation and Neuroimaging, Providence, Rhode Island
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