1
|
Wang HY, Zhang L, Guan BY, Wang SY, Zhang CH, Ni MF, Miao YW, Zhang BW. Resting-state cortico-limbic functional connectivity pattern in panic disorder: Relationships with emotion regulation strategy use and symptom severity. J Psychiatr Res 2024; 169:97-104. [PMID: 38007890 DOI: 10.1016/j.jpsychires.2023.11.007] [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] [Received: 08/15/2023] [Revised: 11/10/2023] [Accepted: 11/15/2023] [Indexed: 11/28/2023]
Abstract
Cognitive reappraisal is an effective emotion regulation strategy involving prefrontal cortex (PFC) control of the amygdala. Its aberrant functioning is closely associated with panic disorder (PD). However, the resting-state functional connectivity (rsFC) between the PFC, implicated in cognitive reappraisal, and the amygdala in PD has not been studied. Thus, this study aims to investigate the rsFC patterns and their association with cognitive reappraisal and PD. This study involved 51 participants, including 26 untreated patients with PD and 25 healthy controls (HC). We evaluated the habit of cognitive reappraisal assessment and the severity of PD using neuropsychological and clinical measures. Resting-state fMRI was utilized to evaluate the rsFC pattern between the PFC, engaged in cognitive reappraisal, and the amygdala. Mediation analysis was performed to explore the role of this rsFC in the relationship between cognitive reappraisal and PD severity. PD patients showed reduced rsFC between the PFC and the amygdala compared to HC. This weakened rsFC was associated with the severity of PD symptoms. Moreover, cognitive reappraisal was negatively correlated with PD severity, and mediation analysis indicated that the rsFC of the PFC-amygdala played a mediating role in this association. Abnormal PFC-amygdala rsFC may play a pivotal role in PD development and/or manifestation and mediate the association between cognitive reappraisal and PD severity, potentially serving as a clinical indicator for monitoring and intervention.
Collapse
Affiliation(s)
- Hai-Yang Wang
- Department of Neurology, Jining No. 1 People's Hospital, Shandong First Medical University, Jining, 272000, China
| | - Lin Zhang
- Medical Equipment Department, First Affiliated Hospital of Dalian Medical University, Dalian, 116011, China
| | - Bei-Yan Guan
- Department of Neurology and Psychiatry, First Affiliated Hospital of Dalian Medical University, Dalian, 116011, China
| | - Shi-Yao Wang
- Department of Neurology and Psychiatry, First Affiliated Hospital of Dalian Medical University, Dalian, 116011, China
| | - Cui-Hong Zhang
- Department of Neurology, Huizhou Third People's Hospital, Guangzhou Medical University, Huizhou, 516000, China
| | - Ming-Fei Ni
- Department of Radiology, First Affiliate Hospital of Dalian Medical University, Dalian, 116011, China
| | - Yan-Wei Miao
- Department of Radiology, First Affiliate Hospital of Dalian Medical University, Dalian, 116011, China
| | - Bing-Wei Zhang
- Department of Neurology and Psychiatry, First Affiliated Hospital of Dalian Medical University, Dalian, 116011, China; Department of Psychology, Dalian Medical University, Dalian, 116044, China.
| |
Collapse
|
2
|
Denny BT, Jungles ML, Goodson PN, Dicker EE, Chavez J, Jones JS, Lopez RB. Unpacking reappraisal: a systematic review of fMRI studies of distancing and reinterpretation. Soc Cogn Affect Neurosci 2023; 18:nsad050. [PMID: 37757486 PMCID: PMC10561539 DOI: 10.1093/scan/nsad050] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 06/29/2023] [Accepted: 09/19/2023] [Indexed: 09/29/2023] Open
Abstract
In recent decades, a substantial volume of work has examined the neural mechanisms of cognitive reappraisal. Distancing and reinterpretation are two frequently used tactics through which reappraisal can be implemented. Theoretical frameworks and prior evidence have suggested that the specific tactic through which one employs reappraisal entails differential neural and psychological mechanisms. Thus, we were motivated to assess the neural mechanisms of this distinction by examining the overlap and differentiation exhibited by the neural correlates of distancing (specifically via objective appraisal) and reinterpretation. We analyzed 32 published functional magnetic resonance imaging (fMRI) studies in healthy adults using multilevel kernel density analysis. Results showed that distancing relative to reinterpretation uniquely recruited right bilateral dorsolateral PFC (DLPFC) and left posterior parietal cortex, previously associated with mentalizing, selective attention and working memory. Reinterpretation relative to distancing uniquely recruited left bilateral ventrolateral PFC (VLPFC), previously associated with response selection and inhibition. Further, distancing relative to reinterpretation was associated with greater prevalence of bilateral amygdala attenuation during reappraisal. Finally, a behavioral meta-analysis showed efficacy for both reappraisal tactics. These results are consistent with prior theoretical models for the functional neural architecture of reappraisal via distancing and reinterpretation and suggest potential future applications in region-of-interest specification and neural network analysis in studies focusing on specific reappraisal tactics.
Collapse
Affiliation(s)
- Bryan T Denny
- Department of Psychological Sciences, Rice University, Houston, TX 77005, USA
| | - Mallory L Jungles
- Department of Psychological Sciences, Rice University, Houston, TX 77005, USA
| | - Pauline N Goodson
- Department of Psychological Sciences, Rice University, Houston, TX 77005, USA
| | - Eva E Dicker
- Department of Psychology, Seattle University, Seattle, WA 98122, USA
| | - Julia Chavez
- Department of Psychological Sciences, Rice University, Houston, TX 77005, USA
| | - Jenna S Jones
- Department of Psychological Sciences, Rice University, Houston, TX 77005, USA
| | - Richard B Lopez
- Department of Psychological & Cognitive Sciences, Worcester Polytechnic Institute, Worcester, MA 01609, USA
| |
Collapse
|
3
|
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.
Collapse
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
| |
Collapse
|
4
|
Capitão LP, Chapman R, Filippini N, Wright L, Murphy SE, James A, Cowen PJ, Harmer CJ. Acute neural effects of fluoxetine on emotional regulation in depressed adolescents. Psychol Med 2023; 53:4799-4810. [PMID: 35903009 PMCID: PMC10388313 DOI: 10.1017/s0033291722001805] [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: 06/06/2020] [Revised: 02/16/2022] [Accepted: 05/30/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Adolescent major depressive disorder (MDD) is associated with disrupted processing of emotional stimuli and difficulties in cognitive reappraisal. Little is known however about how current pharmacotherapies act to modulate the neural mechanisms underlying these key processes. The current study therefore investigated the neural effects of fluoxetine on emotional reactivity and cognitive reappraisal in adolescent depression. METHODS Thirty-one adolescents with MDD were randomised to acute fluoxetine (10 mg) or placebo. Seventeen healthy adolescents were also recruited but did not receive any treatment for ethical reasons. During functional magnetic resonance imaging (fMRI), participants viewed aversive images and were asked to either experience naturally the emotional state elicited ('Maintain') or to reinterpret the content of the pictures to reduce negative affect ('Reappraise'). Significant activations were identified using whole-brain analysis. RESULTS No significant group differences were seen when comparing Reappraise and Maintain conditions. However, when compared to healthy controls, depressed adolescents on placebo showed reduced visual activation to aversive pictures irrespective of the condition. The depressed adolescent group on fluoxetine showed the opposite pattern, i.e. increased visuo-cerebellar activity in response to aversive pictures, when compared to depressed adolescents on placebo. CONCLUSIONS These data suggest that depression in adolescence may be associated with reduced visual processing of aversive imagery and that fluoxetine may act to reduce avoidance of such cues. This could reflect a key mechanism whereby depressed adolescents engage with negative cues previously avoided. Future research combining fMRI with eye-tracking is nonetheless needed to further clarify these effects.
Collapse
Affiliation(s)
- Liliana P. Capitão
- Oxford University Department of Psychiatry and Oxford Health Biomedical Research Centre, Oxford, UK
- Oxford Health NHS Foundation Trust, Oxford, UK
| | - Robert Chapman
- Oxford University Department of Psychiatry and Oxford Health Biomedical Research Centre, Oxford, UK
- Oxford Health NHS Foundation Trust, Oxford, UK
| | | | - Lucy Wright
- Oxford University Department of Psychiatry and Oxford Health Biomedical Research Centre, Oxford, UK
- Oxford Health NHS Foundation Trust, Oxford, UK
| | - Susannah E. Murphy
- Oxford University Department of Psychiatry and Oxford Health Biomedical Research Centre, Oxford, UK
- Oxford Health NHS Foundation Trust, Oxford, UK
| | - Anthony James
- Oxford University Department of Psychiatry and Oxford Health Biomedical Research Centre, Oxford, UK
- Oxford Health NHS Foundation Trust, Oxford, UK
| | - Philip J. Cowen
- Oxford University Department of Psychiatry and Oxford Health Biomedical Research Centre, Oxford, UK
- Oxford Health NHS Foundation Trust, Oxford, UK
| | - Catherine J. Harmer
- Oxford University Department of Psychiatry and Oxford Health Biomedical Research Centre, Oxford, UK
- Oxford Health NHS Foundation Trust, Oxford, UK
| |
Collapse
|
5
|
Oussi A, Hamid K, Bouvet C. Managing emotions in panic disorder: A systematic review of studies related to emotional intelligence, alexithymia, emotion regulation, and coping. J Behav Ther Exp Psychiatry 2023; 79:101835. [PMID: 36680910 DOI: 10.1016/j.jbtep.2023.101835] [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: 03/21/2022] [Revised: 12/05/2022] [Accepted: 01/09/2023] [Indexed: 01/13/2023]
Abstract
BACKGROUND AND OBJECTIVES Panic disorder is defined by recurring and unexpected panic attacks, accompanied by anticipatory anxiety about future attacks and their consequences. This generally involves avoiding situations and behaviors that can produce panic attacks (American Psychiatric Association [APA], 2013). Among anxiety disorders, panic disorder is associated with some of the greatest burdens in terms of personal suffering, occupational disability, and societal cost. The objective of this article is to systematically identify and review the empirical literature on emotional management processes and strategies associated with panic disorder, with the aim of evaluating their role in the development and maintenance of panic disorder, in order to better understand the pathogenesis of the disorder and guide clinicians to improve their current treatments. METHODS Four databases were searched for studies which were based on self-reported questionnaires or a methodology based on an experimental procedure. RESULTS Of the 1719 articles identified, 61 referred to different aspects of emotional management. People living with PD are characterized by low emotional intelligence levels, excessive use of suppression, impaired cognitive reappraisal, high levels of alexithymia and maladaptive coping strategies. LIMITATIONS Most of the reviewed studies used measures of emotional management in cross-sectional models and were based on self-assessment reports. CONCLUSIONS Improving emotional intelligence levels is key to increasing emotion regulation flexibility for people living with PD. Automatic cognitive reappraisal impairment in these people indicates low importance of cognitive restructuring in psychotherapeutic treatment.
Collapse
Affiliation(s)
- Abdellah Oussi
- CLIPSYD Research Unit, UFR SPSE, Paris Nanterre University, 200 avenue de la République, 92001, Nanterre Cedex, France.
| | | | - Cyrille Bouvet
- CLIPSYD Research Unit, UFR SPSE, Paris Nanterre University, 200 avenue de la République, 92001, Nanterre Cedex, France.
| |
Collapse
|
6
|
McAleer J, Stewart L, Shepard R, Sheena M, Kabir S, Swank I, Stange JP, Leow A, Klumpp H, Ajilore O. Differential effects of transcranial current type on heart rate variability during emotion regulation in internalizing psychopathologies. J Affect Disord 2023; 327:7-14. [PMID: 36738996 DOI: 10.1016/j.jad.2023.01.102] [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: 05/21/2022] [Revised: 01/23/2023] [Accepted: 01/27/2023] [Indexed: 02/05/2023]
Abstract
BACKGROUND Internalizing psychopathologies (IPs) are characterized by disruptions in emotion regulation (ER). A potential target for ER modulation in individuals with IPs is the theta band. We hypothesized that offset theta-tACS (transcranial alternating current stimulation) would result in more enhanced ER, indexed by greater increase in heart rate variability (HRV), than transcranial direct current stimulation (tDCS) in participants with IPs. METHODS This pilot study utilized a double-blind, pseudo-counterbalanced design. Participants with internalizing psychopathologies (anxiety and depression) were randomly assigned to receive either offset theta-tACS (n = 14) or tDCS (n = 15) and underwent four sessions of stimulation (two sham). In both arms, there were alternating iterations of an emotion regulation task (ERT) during or immediately after stimulation and rest. Heart rate data were collected during each ERT and rest iteration, and analyses were completed using high-frequency (HF) and root mean square of successive differences (RMSSD) HRV metrics. RESULTS tACS participants consistently displayed increases in both HRV metrics from Time 1 to Time 4. Participants receiving tDCS displayed few significant changes in HF-HRV and no significant changes in RMSSD-HRV. LIMITATIONS Due to the small sample size, analyses were limited. Additionally, the lack of a baseline ERT makes it difficult to determine overall ER improvement. CONCLUSIONS tACS appears to increase ER capacity as reflected in increased HRV in individuals with internalizing psychopathologies, particularly after two sessions of stimulation. This study adds validity to the use of tACS as a neuromodulatory technique in cognitive and clinical research. Additional research is required to better understand potential carry-over effects of multiple sessions of stimulation.
Collapse
Affiliation(s)
- Jessica McAleer
- Department of Psychiatry, University of Illinois Chicago, Chicago, IL, USA
| | - Lindsey Stewart
- Department of Psychiatry, University of Illinois Chicago, Chicago, IL, USA
| | - Robert Shepard
- Department of Psychiatry, University of Illinois Chicago, Chicago, IL, USA
| | - Michelle Sheena
- Department of Psychiatry, University of Illinois Chicago, Chicago, IL, USA
| | - Sarah Kabir
- Department of Psychiatry, University of Illinois Chicago, Chicago, IL, USA
| | - Isabella Swank
- Department of Psychiatry, University of Illinois Chicago, Chicago, IL, USA
| | - Jonathan P Stange
- Department of Psychiatry, University of Illinois Chicago, Chicago, IL, USA
| | - Alex Leow
- Department of Psychiatry, University of Illinois Chicago, Chicago, IL, USA
| | - Heide Klumpp
- Department of Psychiatry, University of Illinois Chicago, Chicago, IL, USA
| | - Olusola Ajilore
- Department of Psychiatry, University of Illinois Chicago, Chicago, IL, USA.
| |
Collapse
|
7
|
Schneck N, Herzog S, Lu J, Yttredahl A, Ogden RT, Galfalvy H, Burke A, Stanley B, Mann JJ, Ochsner KN. The Temporal Dynamics of Emotion Regulation in Subjects With Major Depression and Healthy Control Subjects. Biol Psychiatry 2023; 93:260-267. [PMID: 36567086 DOI: 10.1016/j.biopsych.2022.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 07/28/2022] [Accepted: 09/01/2022] [Indexed: 12/27/2022]
Abstract
BACKGROUND Emotion regulation (ER) processes help support well-being, but ineffective ER is implicated in several psychiatric disorders. Engaging ER flexibly by going online and offline as needs and capacities shift may be more effective than engaging ER rigidly across time. Here, we sought to observe the neural temporal dynamics of an ER process, reappraisal, during regulation of responses to negative memories in healthy control subjects (n = 33) and subjects with major depressive disorder (n = 36). METHODS To track the temporal dynamics of reappraisal neural systems, we used a functional magnetic resonance imaging neural decoding approach. In task 1, subjects explicitly engaged reappraisal on instruction in response to aversive images, and we used this task to develop the decoder for detecting reappraisal. In task 2, subjects experienced negative autobiographical memories from a distant (third person, ER condition) or immersed (first person, control condition) perspective. RESULTS The neural decoder, trained to detect reappraisal in task 1, predicted greater reappraisal occurring during the task 2 distance versus immerse trials and was engaged more intensely during memories that were rated as being more negative. Across time, decoder output manifested a temporal dynamic of early engagement followed by disengagement. These results were replicated in an independent subject dataset (n = 59). Relative to healthy control subjects, subjects with major depressive disorder had a comparable initial increase in decoder engagement at the beginning of the trial but an attenuated decrease at the end. CONCLUSIONS Subjects with major depressive disorder evidenced a more rigid neural dynamic of reappraisal compared with healthy control subjects. Rigid ER may indicate diminished ability to flexibly and effectively regulate emotion.
Collapse
Affiliation(s)
- Noam Schneck
- Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York; Molecular Imaging and Neuropathology Division, The New York State Psychiatric Institute, New York, New York.
| | - Sarah Herzog
- Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York; Molecular Imaging and Neuropathology Division, The New York State Psychiatric Institute, New York, New York
| | - Jun Lu
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, Illinois
| | - Ashley Yttredahl
- Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York; Molecular Imaging and Neuropathology Division, The New York State Psychiatric Institute, New York, New York
| | - R Todd Ogden
- Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York; Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York; Molecular Imaging and Neuropathology Division, The New York State Psychiatric Institute, New York, New York
| | - Hanga Galfalvy
- Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York; Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York
| | - Ainsley Burke
- Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York; Molecular Imaging and Neuropathology Division, The New York State Psychiatric Institute, New York, New York
| | - Barbara Stanley
- Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York; Molecular Imaging and Neuropathology Division, The New York State Psychiatric Institute, New York, New York
| | - J John Mann
- Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York; Molecular Imaging and Neuropathology Division, The New York State Psychiatric Institute, New York, New York
| | - Kevin N Ochsner
- Department of Psychology, Columbia University, New York, New York
| |
Collapse
|
8
|
Tsai CF, Chuang CH, Wang YP, Lin YB, Tu PC, Liu PY, Wu PS, Lin CY, Lu CL. Differences in gut microbiota correlate with symptoms and regional brain volumes in patients with late-life depression. Front Aging Neurosci 2022; 14:885393. [PMID: 35966787 PMCID: PMC9365093 DOI: 10.3389/fnagi.2022.885393] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 07/08/2022] [Indexed: 11/13/2022] Open
Abstract
Depression is associated with gut dysbiosis that disrupts a gut-brain bidirectional axis. Gray matter volume changes in cortical and subcortical structures, including prefrontal regions and the hippocampus, have also been noted in depressive disorders. However, the link between gut microbiota and brain structures in depressed patients remains elusive. Neuropsychiatric measures, stool samples, and structural brain images were collected from 36 patients with late-life depression (LLD) and 17 healthy controls. 16S ribosomal RNA (rRNA) gene sequencing was used to profile stool microbial communities for quantitation of microbial composition, abundance, and diversity. T1-weighted brain images were assessed with voxel-based morphometry to detect alterations in gray matter volume between groups. Correlation analysis was performed to identify the possible association between depressive symptoms, brain structures and gut microbiota. We found a significant difference in the gut microbial composition between patients with late-life depression (LLD) and healthy controls. The genera Enterobacter and Burkholderia were positively correlated with depressive symptoms and negatively correlated with brain structural signatures in regions associated with memory, somatosensory integration, and emotional processing/cognition/regulation. Our study purports the microbiota-gut-brain axis as a potential mechanism mediating the symptomatology of LLD patients, which may facilitate the development of therapeutic strategies targeting gut microbes in the treatment of elderly depressed patients.
Collapse
Affiliation(s)
- Chia-Fen Tsai
- Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan
| | | | - Yen-Po Wang
- Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Endoscopy Center for Diagnosis and Treatment, Taipei Veterans General Hospital, Taipei, Taiwan
- Division of Gastroenterology, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Ya-Bo Lin
- Institute of Information Science, Academia Sinica, Taipei, Taiwan
| | - Pei-Chi Tu
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Philosophy of Mind and Cognition, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Pei-Yi Liu
- Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Endoscopy Center for Diagnosis and Treatment, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Po-Shan Wu
- Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Dietetics and Nutrition, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chung-Yen Lin
- Institute of Information Science, Academia Sinica, Taipei, Taiwan
| | - Ching-Liang Lu
- Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Endoscopy Center for Diagnosis and Treatment, Taipei Veterans General Hospital, Taipei, Taiwan
- Division of Gastroenterology, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- *Correspondence: Ching-Liang Lu ;
| |
Collapse
|
9
|
Neural basis of positive and negative emotion regulation in remitted depression. Neuroimage Clin 2022; 34:102988. [PMID: 35298997 PMCID: PMC8924423 DOI: 10.1016/j.nicl.2022.102988] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 02/16/2022] [Accepted: 03/10/2022] [Indexed: 11/24/2022]
Abstract
RRMDD patients show deviant uninstructed neural emotion regulation. This is reflected in residual problems in daily strategy use. RRMDD patients are capable to engage frontolimbic areas upon instructed reappraisal. Neural regulation capacity is related to inadequate rumination. Positive, next to negative, affect is highly relevant for understanding vulnerability.
The recurrent nature of Major Depressive Disorder (MDD) necessitates a better understanding of mechanisms facilitating relapse. MDD has often been associated with abnormal emotion regulation, underpinned by aberrant interactions between the prefrontal cortex and subcortical areas. We assessed whether neural regulation abnormalities remain after remission and relate to emotion regulation problems in daily life. At the baseline measurement of a randomized controlled trial, an emotion regulation task was performed during fMRI scanning by 46 remitted recurrent (rrMDD) patients and 24 healthy controls. We assessed both fMRI peak activity and the temporal dynamics of the neural response during passive attendance and explicit regulation of positive and negative emotions. Furthermore, we assessed regulation strategy use in daily life using questionnaires, and attentional biases using a modified attentional dot-probe task. RrMDD patients showed lower activation and different temporal dynamics in occipital, parietal, and prefrontal brain regions during passive attendance of emotional material compared to healthy controls. During explicit downregulation of negative emotions, no group differences were found. However, during explicit upregulation of positive emotions, rrMDD patients showed a different neural response over time in the insula. Behaviourally, rrMDD patients were characterized by dysfunctional regulation strategies in daily life. Within rrMDD patients, rumination was associated with activation within a limbic- prefrontal network. After remission, immediate emotional processing seems unaffected, but regulatory abnormalities remain, especially uninstructed and in daily life. Abnormal insula activation during positive upregulation suggests decreased monitoring of positive emotions. The relation between inadequate rumination and brain activity during emotion regulation suggests that regulation of both positive and negative affect is important in understanding neurocognitive underpinnings of resilience.
Collapse
|
10
|
Bas‐Hoogendam JM, Groenewold NA, Aghajani M, Freitag GF, Harrewijn A, Hilbert K, Jahanshad N, Thomopoulos SI, Thompson PM, Veltman DJ, Winkler AM, Lueken U, Pine DS, van der Wee NJA, Stein DJ. ENIGMA-anxiety working group: Rationale for and organization of large-scale neuroimaging studies of anxiety disorders. Hum Brain Mapp 2022; 43:83-112. [PMID: 32618421 PMCID: PMC8805695 DOI: 10.1002/hbm.25100] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 05/09/2020] [Accepted: 06/08/2020] [Indexed: 12/11/2022] Open
Abstract
Anxiety disorders are highly prevalent and disabling but seem particularly tractable to investigation with translational neuroscience methodologies. Neuroimaging has informed our understanding of the neurobiology of anxiety disorders, but research has been limited by small sample sizes and low statistical power, as well as heterogenous imaging methodology. The ENIGMA-Anxiety Working Group has brought together researchers from around the world, in a harmonized and coordinated effort to address these challenges and generate more robust and reproducible findings. This paper elaborates on the concepts and methods informing the work of the working group to date, and describes the initial approach of the four subgroups studying generalized anxiety disorder, panic disorder, social anxiety disorder, and specific phobia. At present, the ENIGMA-Anxiety database contains information about more than 100 unique samples, from 16 countries and 59 institutes. Future directions include examining additional imaging modalities, integrating imaging and genetic data, and collaborating with other ENIGMA working groups. The ENIGMA consortium creates synergy at the intersection of global mental health and clinical neuroscience, and the ENIGMA-Anxiety Working Group extends the promise of this approach to neuroimaging research on anxiety disorders.
Collapse
Affiliation(s)
- Janna Marie Bas‐Hoogendam
- Department of Developmental and Educational PsychologyLeiden University, Institute of PsychologyLeidenThe Netherlands
- Department of PsychiatryLeiden University Medical CenterLeidenThe Netherlands
- Leiden Institute for Brain and CognitionLeidenThe Netherlands
| | - Nynke A. Groenewold
- Department of Psychiatry & Mental HealthUniversity of Cape TownCape TownSouth Africa
| | - Moji Aghajani
- Department of PsychiatryAmsterdam UMC / VUMCAmsterdamThe Netherlands
- Department of Research & InnovationGGZ inGeestAmsterdamThe Netherlands
| | - Gabrielle F. Freitag
- National Institute of Mental Health, Emotion and Development BranchBethesdaMarylandUSA
| | - Anita Harrewijn
- National Institute of Mental Health, Emotion and Development BranchBethesdaMarylandUSA
| | - Kevin Hilbert
- Department of PsychologyHumboldt‐Universität zu BerlinBerlinGermany
| | - Neda Jahanshad
- University of Southern California Keck School of MedicineImaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics InstituteLos AngelesCaliforniaUSA
| | - Sophia I. Thomopoulos
- University of Southern California Keck School of MedicineImaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics InstituteLos AngelesCaliforniaUSA
| | - Paul M. Thompson
- University of Southern California Keck School of MedicineImaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics InstituteLos AngelesCaliforniaUSA
| | - Dick J. Veltman
- Department of PsychiatryAmsterdam UMC / VUMCAmsterdamThe Netherlands
| | - Anderson M. Winkler
- National Institute of Mental Health, Emotion and Development BranchBethesdaMarylandUSA
| | - Ulrike Lueken
- Department of PsychologyHumboldt‐Universität zu BerlinBerlinGermany
| | - Daniel S. Pine
- National Institute of Mental Health, Emotion and Development BranchBethesdaMarylandUSA
| | - Nic J. A. van der Wee
- Department of PsychiatryLeiden University Medical CenterLeidenThe Netherlands
- Leiden Institute for Brain and CognitionLeidenThe Netherlands
| | - Dan J. Stein
- Department of Psychiatry & Mental HealthUniversity of Cape TownCape TownSouth Africa
- University of Cape TownSouth African MRC Unit on Risk & Resilience in Mental DisordersCape TownSouth Africa
- University of Cape TownNeuroscience InstituteCape TownSouth Africa
| |
Collapse
|
11
|
Khodadadifar T, Soltaninejad Z, Ebneabbasi A, Eickhoff CR, Sorg C, Van Eimeren T, Vogeley K, Zarei M, Eickhoff SB, Tahmasian M. In search of convergent regional brain abnormality in cognitive emotion regulation: A transdiagnostic neuroimaging meta-analysis. Hum Brain Mapp 2021; 43:1309-1325. [PMID: 34826162 PMCID: PMC8837597 DOI: 10.1002/hbm.25722] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 10/29/2021] [Accepted: 11/01/2021] [Indexed: 01/28/2023] Open
Abstract
Ineffective use of adaptive cognitive strategies (e.g., reappraisal) to regulate emotional states is often reported in a wide variety of psychiatric disorders, suggesting a common characteristic across different diagnostic categories. However, the extent of shared neurobiological impairments is incompletely understood. This study, therefore, aimed to identify the transdiagnostic neural signature of disturbed reappraisal using the coordinate‐based meta‐analysis (CBMA) approach. Following the best‐practice guidelines for conducting neuroimaging meta‐analyses, we systematically searched PubMed, ScienceDirect, and Web of Science databases and tracked the references. Out of 1,608 identified publications, 32 whole‐brain neuroimaging studies were retrieved that compared brain activation in patients with psychiatric disorders and healthy controls during a reappraisal task. Then, the reported peak coordinates of group comparisons were extracted and several activation likelihood estimation (ALE) analyses were performed at three hierarchical levels to identify the potential spatial convergence: the global level (i.e., the pooled analysis and the analyses of increased/decreased activations), the experimental‐contrast level (i.e., the analyses of grouped data based on the regulation goal, stimulus valence, and instruction rule) and the disorder‐group level (i.e., the analyses across the experimental‐contrast level focused on increasing homogeneity of disorders). Surprisingly, none of our analyses provided significant convergent findings. This CBMA indicates a lack of transdiagnostic convergent regional abnormality related to reappraisal task, probably due to the complex nature of cognitive emotion regulation, heterogeneity of clinical populations, and/or experimental and statistical flexibility of individual studies.
Collapse
Affiliation(s)
- Tina Khodadadifar
- School of Cognitive Sciences, Institute for Research in Fundamental Sciences, Tehran, Iran
| | - Zahra Soltaninejad
- Institute of Medical Science and Technology, Shahid Beheshti University, Tehran, Iran.,Cognitive and Brain Science Institute, Shahid Beheshti University, Tehran, Iran
| | - Amir Ebneabbasi
- Institute of Medical Science and Technology, Shahid Beheshti University, Tehran, Iran
| | - Claudia R Eickhoff
- Institute of Neuroscience and Medicine, Brain and Behaviour (INM-7), Research Center Jülich, Jülich, Germany.,Institute of Clinical Neuroscience and Medical Psychology, Heinrich Heine University Düsseldorf, Düsseldorf, Germany.,Institute of Neuroscience and Medicine, Structural and functional organization of the brain (INM-1), Research Center Jülich, Jülich, Germany
| | - Christian Sorg
- TUM-Neuroimaging Center (TUM-NIC), Klinikum Rechts der Isar, Technische Universität München, Munich, Germany.,Department of Neuroradiology, Klinikum Rechts der Isar, Technische Universität München, Munich, Germany.,Department of Psychiatry and Psychotherapy, Klinikum Rechts der Isar, Technische Universität München, Munich, Germany
| | - Thilo Van Eimeren
- Multimodal Neuroimaging Group, Department of Nuclear Medicine, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany.,Department of Neurology, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Kai Vogeley
- Department of Psychiatry and Psychotherapy, University Hospital Cologne, Cologne, Germany.,Cognitive Neuroscience (INM-3), Institute of Neuroscience and Medicine, Research Center Jülich, Jülich, Germany
| | - Mojtaba Zarei
- Institute of Medical Science and Technology, Shahid Beheshti University, Tehran, Iran
| | - Simon B Eickhoff
- Institute of Neuroscience and Medicine, Brain and Behaviour (INM-7), Research Center Jülich, Jülich, Germany.,Institute for Systems Neuroscience, Medical Faculty, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
| | - Masoud Tahmasian
- Institute of Medical Science and Technology, Shahid Beheshti University, Tehran, Iran.,Institute of Neuroscience and Medicine, Brain and Behaviour (INM-7), Research Center Jülich, Jülich, Germany.,Institute for Systems Neuroscience, Medical Faculty, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
| |
Collapse
|
12
|
Wu Y, Zhong Y, Zheng G, Liu Y, Pang M, Xu H, Ding H, Wang C, Zhang N. Disrupted fronto-temporal function in panic disorder: a resting-state connectome study. Brain Imaging Behav 2021; 16:888-898. [PMID: 34668168 DOI: 10.1007/s11682-021-00563-z] [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] [Accepted: 09/21/2021] [Indexed: 12/21/2022]
Abstract
Recent neuroimaging studies have identified alterations in activity and connectivity among many brain regions as potential biomarkers for panic disorder. However, the functional connectome of panic disorder is not well understood. Therefore, a graph-theoretical approach was applied in this study to construct functional networks of patients and healthy controls in order to discover topological changes in panic disorder. 31 patients and 33 age and sex matched healthy controls underwent resting-state functional magnetic resonance imaging. Brain networks for each participant were structured using nodes from the Anatomical Automatic Labeling template and edges from connectivity matrices. Then, topological organizations of networks were calculated. Network-based statistical analysis was conducted, and global and nodal properties were compared between patients and controls. Unlike controls, patients with panic disorder displayed a small-world network. Patients also revealed decreased nodal efficiency in right superior frontal gyrus (SFG), middle frontal gyrus (MFG), right superior temporal gyrus (STG), and left middle temporal gyrus (MTG). Decreased functional connectivity was found in panic disorder between right MTG and extensive temporal regions. Among these disrupted regions, the decreased nodal efficiency of SFG showed a positive correlation with clinical symptoms while nodal betweenness centrality in angular gyrus showed a negative correlation. Our results indicated decreased function of global and regional information transmission in panic disorder and emphasized the role of temporal regions in its pathology.
Collapse
Affiliation(s)
- Yun Wu
- Nanjing Brain Hospital Affiliated to Nanjing Medical University, No.264 Guangzhou Road, Gulou District, Nanjing, 210029, China.,Functional Brain Imaging Institute of Nanjing Medical University, Nanjing, Jiangsu, China.,Cognitive Behavioral Therapy Institute of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Yuan Zhong
- School of Psychology, Nanjing Normal University, Nanjing, Jiangsu, China.,Jiangsu Key Laboratory of Mental Health and Cognitive Science, Nanjing Normal University, Nanjing, 210097, PR China
| | - Gang Zheng
- Department of Medical Imaging, Medical School of Nanjing University, Nanjing, Jiangsu, China.,College of Civil Aviation, Nanjing University of Aeronautics and Astronautics, Nanjing, Jiangsu, China
| | - Ya Liu
- Department of Medical Imaging, Medical School of Nanjing University, Nanjing, Jiangsu, China.,College of Civil Aviation, Nanjing University of Aeronautics and Astronautics, Nanjing, Jiangsu, China
| | - Manlong Pang
- Nanjing Brain Hospital Affiliated to Nanjing Medical University, No.264 Guangzhou Road, Gulou District, Nanjing, 210029, China.,Functional Brain Imaging Institute of Nanjing Medical University, Nanjing, Jiangsu, China.,Cognitive Behavioral Therapy Institute of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Huazhen Xu
- Nanjing Brain Hospital Affiliated to Nanjing Medical University, No.264 Guangzhou Road, Gulou District, Nanjing, 210029, China.,Nanjing Medical University, Nanjing, Jiangsu, China
| | - Huachen Ding
- Nanjing Brain Hospital Affiliated to Nanjing Medical University, No.264 Guangzhou Road, Gulou District, Nanjing, 210029, China.,Nanjing Medical University, Nanjing, Jiangsu, China
| | - Chun Wang
- Nanjing Brain Hospital Affiliated to Nanjing Medical University, No.264 Guangzhou Road, Gulou District, Nanjing, 210029, China. .,Functional Brain Imaging Institute of Nanjing Medical University, Nanjing, Jiangsu, China. .,Cognitive Behavioral Therapy Institute of Nanjing Medical University, Nanjing, Jiangsu, China.
| | - Ning Zhang
- Nanjing Brain Hospital Affiliated to Nanjing Medical University, No.264 Guangzhou Road, Gulou District, Nanjing, 210029, China.,Functional Brain Imaging Institute of Nanjing Medical University, Nanjing, Jiangsu, China.,Cognitive Behavioral Therapy Institute of Nanjing Medical University, Nanjing, Jiangsu, China
| |
Collapse
|
13
|
Wang HY, Xu GQ, Ni MF, Zhang CH, Li XL, Chang Y, Sun XP, Zhang BW. Neural basis of implicit cognitive reappraisal in panic disorder: an event-related fMRI study. J Transl Med 2021; 19:304. [PMID: 34256777 PMCID: PMC8276458 DOI: 10.1186/s12967-021-02968-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 06/28/2021] [Indexed: 12/28/2022] Open
Abstract
Background Panic disorder (PD) is thought to be related with deficits in emotion regulation, especially in cognitive reappraisal. According to the cognitive model, PD patients’ intrinsic and unconscious misappraisal strategies are the cause of panic attacks. However, no studies have yet been performed to explore the underlying neuromechanism of cognitive reappraisal that occur on an unconscious level in PD patients. Methods Twenty-six patients with PD and 25 healthy controls (HC) performed a fully-verified event-block design emotional regulation task aimed at investigating responses of implicit cognitive reappraisal during an fMRI scan. Participants passively viewed negatively valanced pictures that were beforehand neutrally, positively, or adversely portrayed in the task. Results Whole-brain analysis of fMRI data showed that PD patients exhibited less activation in the right dorsolateral prefrontal cortex (dlPFC) and right dorsomedial prefrontal cortex (dmPFC) compared to HC, but presented greater activation in parietal cortex when negative pictures were preceded by positive/neutral vs negative descriptions. Simultaneously, interactive effects of Group × Condition were observed in the right amygdala across both groups. Furthermore, activation in dlPFC and dmPFC was is negatively correlated to severity of anxiety and panic in PD when negative images were preceded by non-negative vs negative descriptions. Conclusions Emotional dysregulation in PD is likely the result of deficient activation in dlPFC and dmPFC during implicit cognitive reappraisal, in line with impaired automatic top-down regulation. Correlations between severity of anxiety and panic attack and activation of right dlPFC and dmPFC suggest that the failure to engage prefrontal region during implicit cognitive reappraisal might be associated wtih the severity of anxiety and panic; such functional patterns might be the target of possible treatments.
Collapse
Affiliation(s)
- Hai-Yang Wang
- Department of Neurology, Jining No. 1 People's Hospital, Jining, 272000, China.,Department of Neurology and Psychiatry, The First Affiliated Hospital of Dalian Medical University, No.222, Zhongshan Road, Dalian, 116011, Liaoning Province, China
| | - Guo-Qing Xu
- Department of Psychology, Dalian Medical University, Dalian, 116044, China
| | - Ming-Fei Ni
- Department of Radiology, The First Affiliated Hospital of Dalian Medical University, Dalian, 116011, China
| | - Cui-Hong Zhang
- Department of Neurology and Psychiatry, The First Affiliated Hospital of Dalian Medical University, No.222, Zhongshan Road, Dalian, 116011, Liaoning Province, China.,Department of Geriatric Medicine, Huizhou Third People's Hospital, Guangzhou Medical University, Huizhou, 516000, China
| | - Xue-Lin Li
- Department of Intensive Care Unit, Jining No. 1 People's Hospital, Jining, 272000, China
| | - Yi Chang
- Department of Neurology and Psychiatry, The First Affiliated Hospital of Dalian Medical University, No.222, Zhongshan Road, Dalian, 116011, Liaoning Province, China
| | - Xiao-Pei Sun
- Department of Neurology and Psychiatry, The First Affiliated Hospital of Dalian Medical University, No.222, Zhongshan Road, Dalian, 116011, Liaoning Province, China
| | - Bing-Wei Zhang
- Department of Neurology and Psychiatry, The First Affiliated Hospital of Dalian Medical University, No.222, Zhongshan Road, Dalian, 116011, Liaoning Province, China. .,Department of Psychology, Dalian Medical University, Dalian, 116044, China.
| |
Collapse
|
14
|
Finnegan SL, Harrison OK, Harmer CJ, Herigstad M, Rahman NM, Reinecke A, Pattinson KTS. Breathlessness in COPD: linking symptom clusters with brain activity. Eur Respir J 2021; 58:13993003.04099-2020. [PMID: 33875493 PMCID: PMC8607925 DOI: 10.1183/13993003.04099-2020] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 04/04/2021] [Indexed: 11/11/2022]
Abstract
Background Current models of breathlessness often fail to explain disparities between patients' experiences of breathlessness and objective measures of lung function. While a mechanistic understanding of this discordance has thus far remained elusive, factors such as mood, attention and expectation have all been implicated as important modulators of breathlessness. Therefore, we have developed a model to better understand the relationships between these factors using unsupervised machine learning techniques. Subsequently we examined how expectation-related brain activity differed between these symptom-defined clusters of participants. Methods A cohort of 91 participants with mild-to-moderate chronic obstructive pulmonary disease (COPD) underwent functional brain imaging, self-report questionnaires and clinical measures of respiratory function. Unsupervised machine learning techniques of exploratory factor analysis and hierarchical cluster modelling were used to model brain–behaviour–breathlessness links. Results We successfully stratified participants across four key factors corresponding to mood, symptom burden and two capability measures. Two key groups resulted from this stratification, corresponding to high and low symptom burden. Compared with the high symptom burden group, the low symptom burden group demonstrated significantly greater brain activity within the anterior insula, a key region thought to be involved in monitoring internal bodily sensations (interoception). Conclusions This is the largest functional neuroimaging study of COPD to date, and is the first to provide a clear model linking brain, behaviour and breathlessness expectation. Furthermore, it was possible to stratify participants into groups, which then revealed differences in brain activity patterns. Together, these findings highlight the value of multimodal models of breathlessness in identifying behavioural phenotypes and for advancing understanding of differences in breathlessness burden. Towards individualised treatments for chronic breathlessness with functional neuroimaging: revealing the factors underlying the breathlessness experience in COPDhttps://bit.ly/3a8fXPt
Collapse
Affiliation(s)
- Sarah L Finnegan
- Wellcome Centre for Integrative Neuroimaging and Nuffield Division of Anaesthetics, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Olivia K Harrison
- Wellcome Centre for Integrative Neuroimaging and Nuffield Division of Anaesthetics, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK.,Translational Neuromodeling Unit, Institute for Biomedical Engineering, University of Zurich and ETH Zurich, Zurich, Switzerland.,School of Pharmacy, University of Otago, Dunedin, New Zealand
| | - Catherine J Harmer
- Department of Psychiatry, Medical Sciences, University of Oxford, Oxford, UK.,Oxford Health NHS foundation Trust, Warneford Hospital, Oxford, UK
| | - Mari Herigstad
- Department of Biosciences and Chemistry, Sheffield Hallam University, Sheffield, UK
| | - Najib M Rahman
- Nuffield Department of Medicine, University of Oxford, Oxford, UK.,NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Andrea Reinecke
- School of Pharmacy, University of Otago, Dunedin, New Zealand.,Department of Psychiatry, Medical Sciences, University of Oxford, Oxford, UK.,Oxford Health NHS foundation Trust, Warneford Hospital, Oxford, UK
| | - Kyle T S Pattinson
- Wellcome Centre for Integrative Neuroimaging and Nuffield Division of Anaesthetics, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| |
Collapse
|
15
|
Berboth S, Windischberger C, Kohn N, Morawetz C. Test-retest reliability of emotion regulation networks using fMRI at ultra-high magnetic field. Neuroimage 2021; 232:117917. [PMID: 33652143 DOI: 10.1016/j.neuroimage.2021.117917] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 01/29/2021] [Accepted: 02/22/2021] [Indexed: 12/12/2022] Open
Abstract
Given the importance of emotion regulation in affective disorders, emotion regulation is at the focus of attempts to identify brain biomarkers of disease risk, treatment response, and brain development. However, to be useful as an indicator for individual characteristics of brain functions - particularly as a biomarker in a clinical context - ensuring reliability is a key challenge. Here, we systematically evaluated test-retest reliability of task-based functional magnetic resonance imaging (fMRI) activity within neural networks associated with emotion generation and regulation across three sessions. Acquiring fMRI data at ultra-high field (7T), we examined region- and voxel-wise test-retest reliability of brain activity in response to a well-established emotion regulation task for predefined region-of-interests (ROIs) implicated in four neural networks. Test-retest reliability varied considerably across the emotion regulation networks and respective ROIs. However, core emotion regulation regions, including the ventrolateral and dorsolateral prefrontal cortex (vlPFC and dlPFC) as well as the middle temporal gyrus (MTG) showed high reliability. Our findings thus support the role of these prefrontal and temporal regions as promising candidates for the study of individual differences in emotion regulation as well as for neurobiological biomarkers in clinical neuroscience research.
Collapse
Affiliation(s)
- Stella Berboth
- Department of Neurology, Charité Universitätsmedizin Berlin, Germany; Department of Education and Psychology, Freie Universität Berlin, Germany; Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Austria
| | | | - Nils Kohn
- Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmengen, Netherlands
| | - Carmen Morawetz
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Austria; Institute of Psychology, University of Innsbruck, Austria.
| |
Collapse
|
16
|
Lai CH. Biomarkers in Panic Disorder. CURRENT PSYCHIATRY RESEARCH AND REVIEWS 2021. [DOI: 10.2174/2666082216999200918163245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background:
Panic disorder (PD) is a kind of anxiety disorder that impacts the life quality
and functional perspectives in patients. However, the pathophysiological study of PD seems still
inadequate and many unresolved issues need to be clarified.
Objectives:
In this review article of biomarkers in PD, the investigator will focus on the findings of
magnetic resonance imaging (MRI) of the brain in the pathophysiology study. The MRI biomarkers
would be divided into several categories, on the basis of structural and functional perspectives.
Methods:
The structural category would include the gray matter and white matter tract studies. The
functional category would consist of functional MRI (fMRI), resting-state fMRI (Rs-fMRI), and
magnetic resonance spectroscopy (MRS). The PD biomarkers revealed by the above methodologies
would be discussed in this article.
Results:
For the gray matter perspectives, the PD patients would have alterations in the volumes of
fear network structures, such as the amygdala, parahippocampal gyrus, thalamus, anterior cingulate
cortex, insula, and frontal regions. For the white matter tract studies, the PD patients seemed to have
alterations in the fasciculus linking the fear network regions, such as the anterior thalamic radiation,
uncinate fasciculus, fronto-occipital fasciculus, and superior longitudinal fasciculus. For the fMRI
studies in PD, the significant results also focused on the fear network regions, such as the amygdala,
hippocampus, thalamus, insula, and frontal regions. For the Rs-fMRI studies, PD patients seemed to
have alterations in the regions of the default mode network and fear network model. At last, the
MRS results showed alterations in neuron metabolites of the hippocampus, amygdala, occipital
cortex, and frontal regions.
Conclusion:
The MRI biomarkers in PD might be compatible with the extended fear network model
hypothesis in PD, which included the amygdala, hippocampus, thalamus, insula, frontal regions, and
sensory-related cortex.
Collapse
Affiliation(s)
- Chien-Han Lai
- Department of Psychiatry, Institute of Biophotonics, National Yang-Ming University, Taipei, Taiwan
| |
Collapse
|
17
|
Månsson KNT, Lueken U, Frick A. Enriching CBT by Neuroscience: Novel Avenues to Achieve Personalized Treatments. Int J Cogn Ther 2020. [DOI: 10.1007/s41811-020-00089-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
AbstractAlthough cognitive behavioral therapy (CBT) is an established and efficient treatment for a variety of common mental disorders, a considerable number of patients do not respond to treatment or relapse after successful CBT. Recent findings and approaches from neuroscience could pave the way for clinical developments to enhance the outcome of CBT. Herein, we will present how neuroscience can offer novel perspectives to better understand (a) the biological underpinnings of CBT, (b) how we can enrich CBT with neuroscience-informed techniques (augmentation of CBT), and (c) why some patients may respond better to CBT than others (predictors of therapy outcomes), thus paving the way for more personalized and effective treatments. We will introduce some key topics and describe a selection of findings from CBT-related research using tools from neuroscience, with the hope that this will provide clinicians and clinical researchers with a brief and comprehensible overview of the field.
Collapse
|
18
|
Zaehringer J, Jennen-Steinmetz C, Schmahl C, Ende G, Paret C. Psychophysiological Effects of Downregulating Negative Emotions: Insights From a Meta-Analysis of Healthy Adults. Front Psychol 2020; 11:470. [PMID: 32372993 PMCID: PMC7177019 DOI: 10.3389/fpsyg.2020.00470] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Accepted: 02/28/2020] [Indexed: 12/23/2022] Open
Abstract
Assessing psychophysiological responses of emotion regulation is a cost-efficient way to quantify emotion regulation and to complement subjective report that may be biased. Previous studies have revealed inconsistent results complicating a sound interpretation of these findings. In the present study, we summarized the existing literature through a systematic search of articles. Meta-analyses were used to evaluate effect sizes of instructed downregulation strategies on common autonomic (electrodermal, respiratory, cardiovascular, and pupillometric) and electromyographic (corrugator activity, emotion-modulated startle) measures. Moderator analyses were conducted, with moderators including study design, emotion induction, control instruction and trial duration. We identified k = 78 studies each contributing multiple sub-samples and performed 23 meta-analyses for combinations of emotion regulation strategy and psychophysiological measure. Overall, results showed that effects of reappraisal and suppression on autonomic measures were highly inconsistent across studies with rather small mean effect sizes. Electromyography (startle and corrugator activity) showed medium effect sizes that were consistent across studies. Our findings highlight the diversity as well as the low level of standardization and comparability of research in this area. Significant moderation of effects by study design, trial duration, and control condition emphasizes the need for better standardization of methods. In addition, the small mean effect sizes resulting from our analyses on autonomic measures should be interpreted with caution. Findings corroborate the importance of multi-channel approaches.
Collapse
Affiliation(s)
- Jenny Zaehringer
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.,Department Neuroimaging, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Christine Jennen-Steinmetz
- Department of Biostatistics, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Christian Schmahl
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.,Department of Psychiatry, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Gabriele Ende
- Department Neuroimaging, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Christian Paret
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.,Sagol Brain Institute, Wohl Institute for Advanced Imaging, Tel-Aviv Sourasky Medical Centre, Tel-Aviv, Israel
| |
Collapse
|
19
|
Reinecke A, Nickless A, Browning M, Harmer CJ. Neurocognitive processes in d-cycloserine augmented single-session exposure therapy for anxiety: A randomized placebo-controlled trial. Behav Res Ther 2020; 129:103607. [PMID: 32229324 DOI: 10.1016/j.brat.2020.103607] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Revised: 02/10/2020] [Accepted: 03/13/2020] [Indexed: 10/24/2022]
Abstract
Drugs targeting N-methyl-d-aspartate (NMDA) receptors and the ability to learn new associations have been proposed as adjunct treatments to boost the success of exposure therapy for anxiety disorders. However, the effects of the NMDA partial agonist d-cycloserine on psychological treatment have been mixed. We investigated potential neurocognitive mechanisms underlying the clinical effects of d-cycloserine-augmented exposure, to inform the optimal combination of this and similar agents with psychological treatment. Panic disorder patients were randomised to single-dose d-cycloserine (250 mg; N = 17) or matching placebo (N = 16) 2hrs before one session of exposure therapy. Neurocognitive markers were assessed one day after treatment, including reaction-time based threat bias for fearful faces (primary outcome) and amygdala response to threat (secondary outcome). Clinical symptom severity was measured the day before and after treatment, and at 1- and 6-months follow-up (secondary outcome). d-cycloserine was associated with greater clinical recovery at 1-month follow-up than placebo (d-cyloserine 71% vs placebo 25%), with the placebo group matching the clinical gains of the d-cycloserine group during 6-months follow-up (d-cycloserine 71% vs placebo 44%). One day after treatment, threat bias for fearful faces and amygdala threat response was lower in the drug compared to placebo group. Lower amygdala magnitude predicted greater clinical improvement during follow-up across groups. While this experimental study is of a preliminary nature due to the limited sample size, these findings highlight a neurocognitive potential mechanism by which d-cycloserine may exert its augmentative effects on psychological treatment and bring forward a marker that may help understand and facilitate development of combination treatments for anxiety. (d-cycloserine Augmented CBT for Panic Disorder; clinicaltrials.gov; NCT01680107).
Collapse
Affiliation(s)
| | - Alecia Nickless
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK; School of Chemistry, University of Bristol, Bristol, UK
| | - Michael Browning
- Department of Psychiatry, University of Oxford, Oxford, UK; Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - Catherine J Harmer
- Department of Psychiatry, University of Oxford, Oxford, UK; Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| |
Collapse
|
20
|
Task MRI-Based Functional Brain Network of Anxiety. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2020; 1191:3-20. [PMID: 32002919 DOI: 10.1007/978-981-32-9705-0_1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Magnetic resonance imaging (MRI) is a good tool for researchers to understand the biological mechanisms and pathophysiology of the brain due to the translational characteristics of MRI methods. For the psychiatric illness, this kind of mental disorders usually have minor alterations when compared to traditional neurological disorders. Therefore the functional study, such as functional connectivity, would play a significant role for understanding the pathophysiology of mental disorders. This chapter would focus on the discussion of task MRI-based functional network studies in anxiety. For social anxiety disorder, the limbic system, such as the temporal lobe, amygdala, and hippocampus, would show alterations in the functional connectivity with frontal regions, such as anterior cingulate, prefrontal, and orbitofrontal cortices. PD has anterior cingulate cortex-amygdala alterations in fear conditioning, frontoparietal alterations in attention network task, and limbic-prefrontal alterations in emotional task. A similar amygdala-based aberrant functional connectivity in specific phobia is observed. The mesocorticolimbic and limbic-prefrontal functional alterations are found in generalized anxiety disorder. The major components of task MRI-based functional connectivity in anxiety include limbic and frontal regions which might play a vital role for the origination of anxiety under different scenarios and tasks.
Collapse
|
21
|
Gechter J, Liebscher C, Geiger MJ, Wittmann A, Schlagenhauf F, Lueken U, Wittchen HU, Pfleiderer B, Arolt V, Kircher T, Straube B, Deckert J, Weber H, Herrmann MJ, Reif A, Domschke K, Ströhle A. Association of NPSR1 gene variation and neural activity in patients with panic disorder and agoraphobia and healthy controls. Neuroimage Clin 2019; 24:102029. [PMID: 31734525 PMCID: PMC6854061 DOI: 10.1016/j.nicl.2019.102029] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 08/06/2019] [Accepted: 10/02/2019] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The neurobiological mechanisms behind panic disorder with agoraphobia (PD/AG) are not completely explored. The functional A/T single nucleotide polymorphism (SNP) rs324981 in the neuropeptide S receptor gene (NPSR1) has repeatedly been associated with panic disorder and might partly drive function respectively dysfunction of the neural "fear network". We aimed to investigate whether the NPSR1 T risk allele was associated with malfunctioning in a fronto-limbic network during the anticipation and perception of agoraphobia-specific stimuli. METHOD 121 patients with PD/AG and 77 healthy controls (HC) underwent functional magnetic resonance imaging (fMRI) using the disorder specific "Westphal-Paradigm". It consists of neutral and agoraphobia-specific pictures, half of the pictures were cued to induce anticipatory anxiety. RESULTS Risk allele carriers showed significantly higher amygdala activation during the perception of agoraphobia-specific stimuli than A/A homozygotes. A linear group x genotype interaction during the perception of agoraphobia-specific stimuli showed a strong trend towards significance. Patients with the one or two T alleles displayed the highest and HC with the A/A genotype the lowest activation in the inferior orbitofrontal cortex (iOFC). DISCUSSION The study demonstrates an association of the NPSR1rs324981 genotype and the perception of agoraphobia-specific stimuli. These results support the assumption of a fronto-limbic dysfunction as an intermediate phenotype of PD/AG.
Collapse
Affiliation(s)
- Johanna Gechter
- Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Germany.
| | - Carolin Liebscher
- Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Germany
| | - Maximilian J Geiger
- Epilepsy Center, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - André Wittmann
- Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Germany
| | - Florian Schlagenhauf
- Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Germany
| | - Ulrike Lueken
- Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Hans-Ulrich Wittchen
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | - Bettina Pfleiderer
- Department of Clinical Radiology, Medical Faculty - University of Muenster, and University Hospital Muenster, Muenster, Germany
| | - Volker Arolt
- Department of Psychiatry, University of Münster, Münster, Germany
| | - Tilo Kircher
- Department of Psychiatry and Psychotherapy & Center for Mind, Brain and Behavior - MCMBB, Philipps-University Marburg, Marburg, Germany
| | - Benjamin Straube
- Department of Psychiatry and Psychotherapy & Center for Mind, Brain and Behavior - MCMBB, Philipps-University Marburg, Marburg, Germany
| | - Jürgen Deckert
- Center of Mental Health, Department of Psychiatry, Psychosomatics and Psychotherapy, University Hospital of Wuerzburg, Wuerzburg, Germany
| | - Heike Weber
- Center of Mental Health, Department of Psychiatry, Psychosomatics and Psychotherapy, University Hospital of Wuerzburg, Wuerzburg, Germany; Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University of Frankfurt, Frankfurt, Germany
| | - Martin J Herrmann
- Center of Mental Health, Department of Psychiatry, Psychosomatics and Psychotherapy, University Hospital of Wuerzburg, Wuerzburg, Germany
| | - Andreas Reif
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University of Frankfurt, Frankfurt, Germany
| | - Katharina Domschke
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Andreas Ströhle
- Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Germany
| |
Collapse
|
22
|
Kaldewaij R, Reinecke A, Harmer CJ. A lack of differentiation in amygdala responses to fearful expression intensity in panic disorder patients. Psychiatry Res Neuroimaging 2019; 291:18-25. [PMID: 31357097 DOI: 10.1016/j.pscychresns.2019.07.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 07/01/2019] [Accepted: 07/08/2019] [Indexed: 11/29/2022]
Abstract
Patients with panic disorder show abnormalities in threat processing and regulation, both on a behavioural and neural level. Better understanding of the underlying mechanisms could help to develop new treatment strategies. In this study, we investigated brain region activation in 18 patients with untreated panic disorder (PD) and 17 healthy controls (HC) during the processing of emotional faces with fearful, happy and neutral expressions, using functional MRI. The intensity of the expressions was either prototypically high, medium or low. PD patients showed significantly increased activity in the dorso-medial prefrontal cortex (dmPFC) in response to faces in general and specifically for happy faces. While HC showed a decreased amygdala response to medium/low fearful versus high fearful faces, this effect was not present in PD: amygdala activation was stable across all fearful faces in this group. Psycho-physiological interaction analyses indicated more negative connectivity between the amygdala and prefrontal areas in the PD group during the task. Amygdala activation in panic patients appears to be less sensitive to decreasing intensities of fearful facial expressions and salience monitoring areas were less active during fearful faces in general in this group. This suggests PD patients might avoid more extensive processing of fearful faces.
Collapse
Affiliation(s)
- Reinoud Kaldewaij
- Department of Psychiatry, University of Oxford, United Kingdom; Currently at Donders Institute for Brain, Cognition and Behaviour, Donders Centre for Cognitive Neuro-imaging, Radboud University Nijmegen, the Netherlands.
| | - Andrea Reinecke
- Department of Psychiatry, University of Oxford, United Kingdom; Oxford Health NHS foundation Trust, Warneford Hospital, United Kingdom
| | - Catherine J Harmer
- Department of Psychiatry, University of Oxford, United Kingdom; Oxford Health NHS foundation Trust, Warneford Hospital, United Kingdom
| |
Collapse
|
23
|
Picó-Pérez M, Alemany-Navarro M, Dunsmoor J, Radua J, Albajes-Eizagirre A, Vervliet B, Cardoner N, Benet O, Harrison B, Soriano-Mas C, Fullana M. Common and distinct neural correlates of fear extinction and cognitive reappraisal: A meta-analysis of fMRI studies. Neurosci Biobehav Rev 2019; 104:102-115. [DOI: 10.1016/j.neubiorev.2019.06.029] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 05/22/2019] [Accepted: 06/20/2019] [Indexed: 12/25/2022]
|
24
|
Sojka P, Lošák J, Lamoš M, Bareš M, Kašpárek T, Brázdil M, Baláž M, Světlák M, Kočvarová J, Fialová J. Processing of Emotions in Functional Movement Disorder: An Exploratory fMRI Study. Front Neurol 2019; 10:861. [PMID: 31474926 PMCID: PMC6703143 DOI: 10.3389/fneur.2019.00861] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 07/25/2019] [Indexed: 11/13/2022] Open
Abstract
Background: Affective dysregulation and impaired cognitive control are implicated in the pathology of functional neurological disorders (FNDs). However, voluntary regulation of emotions has seldom been researched in this group of patients. We hypothesized that patients with FNDs use inefficient voluntary emotion regulation strategies and regulate emotional reactions via increased motor activation. Methods: Fifteen patients with functional movement disorder (FMD) and fifteen healthy subjects matched by age, sex, and education underwent an emotion regulation task in fMRI. For stimuli, we used neutral and negative pictures from the International Affective Picture System. There was no restriction on their emotion regulation strategy. Both patients and healthy subjects were asked about the strategies they had used in a post-scanning interview. Participant levels of depression, trait anxiety, and alexithymia were assessed. Results: There were no significant differences in the emotion regulation strategies used by patients and healthy subjects, nor in levels of reported alexithymia and depression. However, patients showed increased activation in several brain areas when observing negative pictures, notably in the post-central gyrus, precuneus, posterior cingulate cortex (PCC) and cerebellar vermis, and also in their emotion regulation condition, particularly in the precuneus and post-central gyrus. Alexithymia was negatively associated with left insular activation during the observation of unpleasant stimuli only in the patient group. Conclusions: Our findings may implicate areas associated with self-referential processing in voluntary emotional regulation and lower emotional awareness as having a role in patients with functional movement disorders. However, our findings must be replicated with larger sample.
Collapse
Affiliation(s)
- Petr Sojka
- Department of Neurology, Faculty of Medicine, Masaryk University and St. Anne's University Hospital Brno, Brno, Czechia.,Department of Psychology and Psychosomatics, Faculty of Medicine, Masaryk University and University Hospital Brno, Brno, Czechia
| | - Jan Lošák
- Department of Psychology and Psychosomatics, Faculty of Medicine, Masaryk University and University Hospital Brno, Brno, Czechia.,Department of Psychiatry, Faculty of Medicine, Masaryk University and University Hospital Brno, Brno, Czechia
| | - Martin Lamoš
- Multimodal and Functional Neuroimaging, CEITEC, Masaryk University, Brno, Czechia
| | - Martin Bareš
- Department of Neurology, Faculty of Medicine, Masaryk University and St. Anne's University Hospital Brno, Brno, Czechia.,Department of Psychiatry, Faculty of Medicine, Masaryk University and University Hospital Brno, Brno, Czechia
| | - Tomáš Kašpárek
- Department of Psychiatry, Faculty of Medicine, Masaryk University and University Hospital Brno, Brno, Czechia
| | - M Brázdil
- Department of Neurology, Faculty of Medicine, Masaryk University and St. Anne's University Hospital Brno, Brno, Czechia
| | - M Baláž
- Department of Neurology, Faculty of Medicine, Masaryk University and St. Anne's University Hospital Brno, Brno, Czechia
| | - Miroslav Světlák
- Department of Psychology and Psychosomatics, Faculty of Medicine, Masaryk University and University Hospital Brno, Brno, Czechia
| | - J Kočvarová
- Department of Neurology, Faculty of Medicine, Masaryk University and St. Anne's University Hospital Brno, Brno, Czechia
| | - J Fialová
- Department of Public Health, Faculty of Medicine, Masaryk University, Brno, Czechia
| |
Collapse
|
25
|
Strauss AY, Kivity Y, Huppert JD. Emotion Regulation Strategies in Cognitive Behavioral Therapy for Panic Disorder. Behav Ther 2019; 50:659-671. [PMID: 31030881 DOI: 10.1016/j.beth.2018.10.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 10/07/2018] [Accepted: 10/09/2018] [Indexed: 11/29/2022]
Abstract
Emotion regulation (ER) has been incorporated into many models of psychopathology, but it has not been examined directly in cognitive behavioral therapy (CBT) for panic disorder with agoraphobia (PD/A). In this study, a preliminary model of ER in CBT for PD/A is proposed based on existing theories, and several propositions of the model are tested. We hypothesized that increases in cognitive reappraisal would precede decreases in biased cognitions, decreases in expressive suppression would follow decreases in biased cognitions, and a reduction in symptom severity would follow decreases in expressive suppression. Twenty-nine patients who received CBT for PD/A completed weekly self-report measures of symptom severity, anxiety sensitivity, reappraisal and expressive suppression. In addition, patients were compared to a matched normal sample. Cross-lagged analyses partially supported the hypotheses. Reappraisal did not change until late stages of therapy and was generally not associated with treatment outcome. Suppression decreased significantly and exhibited a reciprocal relationship with biased cognitions. Symptom reduction followed decreases in suppression as hypothesized. However, patients did not differ in ER from matched controls at either pre- or posttreatment. Results suggest the important distinction between reappraisal and appraisal, and stress the role of session-by-session decreases in suppression as a predictor of symptom reduction.
Collapse
|
26
|
Unconscious cognitive dysfunction in emotion dysregulation and psychopathology of panic disorder: evidence from the late positive potential. Neuroreport 2019; 29:6-7. [PMID: 29194323 DOI: 10.1097/wnr.0000000000000913] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
27
|
Reinecke A, Thilo KV, Croft A, Harmer CJ. Early effects of exposure-based cognitive behaviour therapy on the neural correlates of anxiety. Transl Psychiatry 2018; 8:225. [PMID: 30341276 PMCID: PMC6195621 DOI: 10.1038/s41398-018-0277-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 08/16/2018] [Accepted: 09/10/2018] [Indexed: 11/22/2022] Open
Abstract
Exposure-based cognitive-behaviour therapy (CBT) for anxiety disorders is an effective intervention, but the brain mechanisms driving recovery are largely unknown. In this experimental medicine study, we investigated to what degree CBT affects neural markers of anxiety at an early stage of treatment, to identify dynamic mechanistic changes which might be crucial in the process of recovery as opposed to those seen following full treatment completion. In a randomised controlled trial, unmedicated patients with panic disorder either received four weekly sessions of exposure-based CBT (N = 14) or were allocated to a waiting group (N = 14). Symptom severity was measured before and after the intervention. During functional magnetic resonance imaging (fMRI), patients performed an emotion regulation task, either viewing negative images naturally, or intentionally down-regulating negative affect using previously taught strategies. Four-session CBT led to marked reductions in symptoms and 71% of patients reached recovery status (versus 7% in the control group). This intervention normalised brain hyperactivation previously seen in panic disorder, particularly in areas linked to threat monitoring, fear memory, and maladaptive emotion regulation, such as amygdala, dorsomedial and dorsolateral prefrontal cortex, and temporal gyrus. Our findings suggest that optimal treatment doses for panic disorder might be much lower than previously thought. Furthermore, this is the first study to show that neural markers of anxiety change very early during CBT, highlighting potential neural mechanisms that might drive clinical recovery. Such knowledge is important for the development of more compact combination treatments targeting these mechanisms more effectively. (Neural Effects of Cognitive-behaviour Therapy in Panic Disorder; clinicaltrials.gov; NCT03251235).
Collapse
Affiliation(s)
| | | | - Alison Croft
- 0000 0004 0641 5119grid.416938.1Oxford Cognitive Therapy Centre, Warneford Hospital, Oxford, UK
| | - Catherine J. Harmer
- 0000 0004 1936 8948grid.4991.5Department of Psychiatry, University of Oxford, Oxford, UK
| |
Collapse
|
28
|
Haiblum-Itskovitch S, Czamanski-Cohen J, Galili G. Emotional Response and Changes in Heart Rate Variability Following Art-Making With Three Different Art Materials. Front Psychol 2018; 9:968. [PMID: 29967587 PMCID: PMC6015920 DOI: 10.3389/fpsyg.2018.00968] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 05/24/2018] [Indexed: 01/12/2023] Open
Abstract
Art therapy encourages the use of art materials to express feelings and thoughts in a supportive environment. Art materials differ in fluidity and are postulated to thus differentially enhance emotional response (the more fluid the material the more emotion elicited). Yet, to the best of our knowledge, this assumption has not been empirically tested. The current study aimed to examine the emotional and physiological responses to art-making with different art materials. We were particularly interested in vagal activity, indexed by heart rate variability (HRV), because of its association with numerous health related outcomes. In this study, 50 adults (mean age 33 ± 10.27 years, 52% males) participated in a repeated measures experiment, in which they were requested to draw with three art materials (order randomized) differing in their level of fluidity (pencil, oil-pastels, and gouache paint) intermittent with periods of music. We measured the emotional response to art-making with each material using a self-report measure and matrices of HRV using a wearable electrocardiogram device. We calculated two indices of HRV, one indicative of parasympathetic nervous system (PNS) activity, and one indicative of sympathetic nervous system (SNS) activity. Art-making with gouache paint and oil-pastels resulted in improved positive mood, while pencil did not. Art-making explained approximately 35% of the variability in parasympathetic reactivity, which may indicate changes in emotional regulation processes during the art-making task. Yet, fluidity was not sufficient to explain the reaction to art-making. Surprisingly, the largest suppression of PNS and augmentation of the SNS occurred during art-making with oil-pastels and not with Gouache. Moreover, PNS and SNS reactivity to oil-pastels were related to emotional valance, which may point to emotional engagement. We can conclude that art-making with oil-pastels, first created in Japan in 1924 to increase self-expression of students, results in a unique emotional and physiological responses. These findings might be explained by the enhanced tactile experience of art-making with oil-pastels along with their relative fluidity, triggering an arousal pattern. Further studies that take the format and presentation of the materials as well as the content of the artwork, into account, are needed.
Collapse
Affiliation(s)
- Shai Haiblum-Itskovitch
- Emili Sagol Creative Arts Therapies Research Center, School of Creative Arts Therapies, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | - Johanna Czamanski-Cohen
- Emili Sagol Creative Arts Therapies Research Center, School of Creative Arts Therapies, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
- Department of Psychiatry, Faculty of Medicine, The University of Arizona, Tucson, AZ, United States
| | - Giora Galili
- The Department of Education and Psychology, The Open University of Israel, Ra’anana, Israel
| |
Collapse
|
29
|
Wang HY, Zhang XX, Si CP, Xu Y, Liu Q, Bian HT, Zhang BW, Li XL, Yan ZR. Prefrontoparietal dysfunction during emotion regulation in anxiety disorder: a meta-analysis of functional magnetic resonance imaging studies. Neuropsychiatr Dis Treat 2018; 14:1183-1198. [PMID: 29785110 PMCID: PMC5953307 DOI: 10.2147/ndt.s165677] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Impairments in emotion regulation, and more specifically in cognitive reappraisal, are thought to play a key role in the pathogenesis of anxiety disorders. However, the available evidence on such deficits is inconsistent. To further illustrate the neurobiological underpinnings of anxiety disorder, the present meta-analysis summarizes functional magnetic resonance imaging (fMRI) findings for cognitive reappraisal tasks and investigates related brain areas. METHODS We performed a comprehensive series of meta-analyses of cognitive reappraisal fMRI studies contrasting patients with anxiety disorder with healthy control (HC) subjects, employing an anisotropic effect-size signed differential mapping approach. We also conducted a subgroup analysis of medication status, anxiety disorder subtype, data-processing software, and MRI field strengths. Meta-regression was used to explore the effects of demographics and clinical characteristics. Eight studies, with 11 datasets including 219 patients with anxiety disorder and 227 HC, were identified. RESULTS Compared with HC, patients with anxiety disorder showed relatively decreased activation of the bilateral dorsomedial prefrontal cortex (dmPFC), bilateral dorsal anterior cingulate cortex (dACC), bilateral supplementary motor area (SMA), left ventromedial prefrontal cortex (vmPFC), bilateral parietal cortex, and left fusiform gyrus during cognitive reappraisal. The subgroup analysis, jackknife sensitivity analysis, heterogeneity analysis, and Egger's tests further confirmed these findings. CONCLUSIONS Impaired cognitive reappraisal in anxiety disorder may be the consequence of hypo-activation of the prefrontoparietal network, consistent with insufficient top-down control. Our findings provide robust evidence that functional impairment in prefrontoparietal neuronal circuits may have a significant role in the pathogenesis of anxiety disorder.
Collapse
Affiliation(s)
- Hai-Yang Wang
- Department of Neurology, Jining No 1 People’s Hospital, Jining, Shandong Province, China
| | - Xiao-Xia Zhang
- Department of Neurology, Jining No 1 People’s Hospital, Jining, Shandong Province, China
| | - Cui-Ping Si
- Department of Neurology, Jining No 1 People’s Hospital, Jining, Shandong Province, China
| | - Yang Xu
- Department of Neurology, Jining No 1 People’s Hospital, Jining, Shandong Province, China
| | - Qian Liu
- Department of Neurology, Jining No 1 People’s Hospital, Jining, Shandong Province, China
| | - He-Tao Bian
- Department of Neurology, Jining No 1 People’s Hospital, Jining, Shandong Province, China
| | - Bing-Wei Zhang
- Department of Neurology and Psychiatry, First Affiliate Hospital of Dalian Medical University, Dalian, Liaoning Province, China
| | - Xue-Lin Li
- Department of Intensive Care Unit, Jining No 1 People’s Hospital, Jining, Shandong Province, China
| | - Zhong-Rui Yan
- Department of Neurology, Jining No 1 People’s Hospital, Jining, Shandong Province, China
| |
Collapse
|
30
|
MacNamara A, Jackson TB, Fitzgerald JM, Hajcak G, Phan KL. Working Memory Load and Negative Picture Processing: Neural and Behavioral Associations With Panic, Social Anxiety, and Positive Affect. BIOLOGICAL PSYCHIATRY: COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2018; 4:151-159. [PMID: 29805056 DOI: 10.1016/j.bpsc.2018.04.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 04/02/2018] [Accepted: 04/12/2018] [Indexed: 01/03/2023]
Abstract
BACKGROUND Internalizing disorders such as anxiety may be characterized by an imbalance between bottom-up (stimulus-driven) and top-down (goal-directed) attention. The late positive potential (LPP) can be used to assess these processes when task-irrelevant negative and neutral pictures are presented within a working memory paradigm. Prior work using this paradigm has found that working memory load reduces the picture-elicited LPP across participants; however, anxious individuals showed a reduced effect of working memory load on the LPP, suggesting increased distractibility. METHODS The current study assessed transdiagnostic associations between specific symptom dimensions of anxiety, the LPP, and behavior in a clinically representative, heterogeneous group of 76 treatment-seeking patients with internalizing disorders, who performed a working memory task interspersed with negative and neutral pictures. RESULTS As expected, negative pictures enhanced the LPP, and working memory load reduced the LPP. Participants with higher social anxiety showed increased LPPs to negative stimuli during early and late portions of picture presentation. Panic symptoms were associated with reduced LPPs to negative pictures compared with neutral pictures as well as a reduced effect of working memory load on the LPP during the late time window. Reduced positive affect was associated with greater behavioral interference from negative pictures. CONCLUSIONS Hypervigilance for negative stimuli was uniquely explained by social anxiety symptoms, whereas panic symptoms were associated with the opposing effect-blunted processing/avoidance of these stimuli. Panic symptoms were uniquely associated with reduced top-down control. Results reveal distinct associations between neural reactivity and anxiety symptom dimensions that transcend traditional diagnostic boundaries.
Collapse
Affiliation(s)
- Annmarie MacNamara
- Department of Psychological and Brain Sciences, Texas A&M University, College Station, Texas.
| | - T Bryan Jackson
- Department of Psychological and Brain Sciences, Texas A&M University, College Station, Texas
| | | | - Greg Hajcak
- Department of Psychology, Florida State University, Tallahassee, Florida
| | - K Luan Phan
- Department of Psychiatry, University of Illinois at Chicago, Chicago, Illinois; Department of Psychology, University of Illinois at Chicago, Chicago, Illinois; Department of Anatomy and Cell Biology, and Graduate Program in Neuroscience, University of Illinois at Chicago, Chicago, Illinois
| |
Collapse
|
31
|
Carr O, de Vos M, Saunders KEA. Heart rate variability in bipolar disorder and borderline personality disorder: a clinical review. EVIDENCE-BASED MENTAL HEALTH 2017; 21:23-30. [PMID: 29223951 PMCID: PMC5800347 DOI: 10.1136/eb-2017-102760] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 08/07/2017] [Accepted: 08/30/2017] [Indexed: 12/27/2022]
Abstract
Heart rate variability (HRV) in psychiatric disorders has become an increasing area of interest in recent years following technological advances that enable non-invasive monitoring of autonomic nervous system regulation. However, the clinical interpretation of HRV features remain widely debated or unknown. Standardisation within studies of HRV in psychiatric disorders is poor, making it difficult to reproduce or build on previous work. Recently, a Guidelines for Reporting Articles on Psychiatry and Heart rate variability checklist has been proposed to address this issue. Here we assess studies of HRV in bipolar disorder and borderline personality disorder against this checklist and discuss the implication for ongoing research in this area.
Collapse
Affiliation(s)
- Oliver Carr
- Institute of Biomedical Engineering, University of Oxford, Oxford, UK
| | - Maarten de Vos
- Institute of Biomedical Engineering, University of Oxford, Oxford, UK
| | - Kate E A Saunders
- University of Oxford Department of Psychiatry, Warneford Hospital, Oxford, UK.,Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| |
Collapse
|
32
|
Fitzgerald JM, Phan KL, Kennedy AE, Shankman SA, Langenecker SA, Klumpp H. Prefrontal and amygdala engagement during emotional reactivity and regulation in generalized anxiety disorder. J Affect Disord 2017; 218:398-406. [PMID: 28501740 PMCID: PMC6608590 DOI: 10.1016/j.jad.2017.05.013] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Revised: 04/10/2017] [Accepted: 05/06/2017] [Indexed: 12/21/2022]
Abstract
BACKGROUND Emotion dysregulation is prominent in generalized anxiety disorder (GAD), characterized clinically by exaggerated reactivity to negative stimuli and difficulty in down-regulating this response. Although limited research implicates frontolimbic disturbances in GAD, whether neural aberrations occur during emotional reactivity, regulation, or both is not well understood. METHODS During functional magnetic resonance imaging (fMRI), 30 individuals with GAD and 30 healthy controls (HC) completed a well-validated explicit emotion regulation task designed to measure emotional reactivity and regulation of reactivity. During the task, participants viewed negative images ('Look-Negative' condition) and, on some trials, used a cognitive strategy to reduce negative affective response ('Reappraise' condition). RESULTS Results from an Analysis of Variance corrected for whole brain multiple comparisons showed a significant group x condition interaction in the left amygdala and left inferior frontal gyrus (IFG). Results from post-hoc analyses showed that the GAD group engaged these regions to a greater extent than HCs during Look-Negative but not Reappraise. Behaviorally, the GAD group reported feeling more negative than the HC group in each condition, although both groups reported reduced negative affect following regulation. LIMITATIONS As comorbidity was permitted, the presence of concurrent disorders, like other anxiety disorders and depression, detracts our ability to classify neural engagement particular to GAD alone. CONCLUSIONS Individuals with GAD exhibited over-engagement of amygdala and frontal regions during the viewing of negative images, compared to HCs. Together, these aberrations may indicate that deficits in emotional reactivity rather than regulation contribute to emotion dysregulation in those with GAD.
Collapse
Affiliation(s)
- Jacklynn M Fitzgerald
- University of Illinois at Chicago, Department of Psychology, Chicago, IL, USA; University of Illinois at Chicago, Department of Psychiatry, Chicago, IL, USA.
| | - K Luan Phan
- University of Illinois at Chicago, Department of Psychology, Chicago, IL, USA; University of Illinois at Chicago, Department of Psychiatry, Chicago, IL, USA; University of Illinois at Chicago, Department of Anatomy and Cell Biology and the Graduate Program in Neuroscience, Chicago, IL, USA; Jesse Brown VA Medical Center, Chicago, IL, USA
| | - Amy E Kennedy
- University of Illinois at Chicago, Department of Psychiatry, Chicago, IL, USA
| | - Stewart A Shankman
- University of Illinois at Chicago, Department of Psychology, Chicago, IL, USA; University of Illinois at Chicago, Department of Psychiatry, Chicago, IL, USA
| | - Scott A Langenecker
- University of Illinois at Chicago, Department of Psychology, Chicago, IL, USA; University of Illinois at Chicago, Department of Psychiatry, Chicago, IL, USA
| | - Heide Klumpp
- University of Illinois at Chicago, Department of Psychology, Chicago, IL, USA; University of Illinois at Chicago, Department of Psychiatry, Chicago, IL, USA
| |
Collapse
|
33
|
Izadpanah S, Barnow S, Neubauer AB, Holl J. Development and Validation of the Heidelberg Form for Emotion Regulation Strategies (HFERST): Factor Structure, Reliability, and Validity. Assessment 2017; 26:880-906. [PMID: 28730850 DOI: 10.1177/1073191117720283] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The Heidelberg Form for Emotion Regulation Strategies (HFERST) was developed to complement previous emotion regulation (ER) questionnaires and addresses some of their limitations by measuring eight ER strategies. An initial item pool was developed in German following expert discussions and adaptation of the items from existing ER scales. Following a stepwise selection based on the experts' judgments, 32 items with the best content validity were chosen. Results of an exploratory factor analysis in Study 1 (N = 399) and two confirmatory factor analyses in Studies 2 (N = 715) and 3 (N = 408) supported the eight-factor structure of the HFERST and provided evidence for its internal consistency, construct and criterion validity, and clinical utility. Study 4 supported a 2-week stability of the HFERST and Study 5 showed that, following an ER intervention, the HFERST captured a reduction in dysfunctional and an improvement in functional ER strategies, which again supports the clinical utility of the HFERST.
Collapse
Affiliation(s)
| | - Sven Barnow
- 1 University of Heidelberg, Heidelberg, Germany
| | | | - Julia Holl
- 1 University of Heidelberg, Heidelberg, Germany
| |
Collapse
|
34
|
Klahn AL, Klinkenberg IA, Lueken U, Notzon S, Arolt V, Pantev C, Zwanzger P, Junghoefer M. Commonalities and differences in the neural substrates of threat predictability in panic disorder and specific phobia. NEUROIMAGE-CLINICAL 2017; 14:530-537. [PMID: 28331799 PMCID: PMC5345973 DOI: 10.1016/j.nicl.2017.02.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 01/15/2017] [Accepted: 02/16/2017] [Indexed: 10/27/2022]
Abstract
Different degrees of threat predictability are thought to induce either phasic fear or sustained anxiety. Maladaptive, sustained anxious apprehension is thought to result in overgeneralization of anxiety and thereby to contribute to the development of anxiety disorders. Therefore, differences in threat predictability have been associated with pathological states of anxiety with specific phobia (SP) representing phasic fear as heightened response to predictable threat, while panic disorder (PD) is characterized by sustained anxiety (unpredictable threat) and, as a consequence, overgeneralization of fear. The present study aimed to delineate commonalities and differences in the neural substrates of the impact of threat predictability on affective processing in these two anxiety disorders. Twenty PD patients, 20 SP patients and 20 non-anxious control subjects were investigated with an adapted NPU-design (no, predictable, unpredictable threat) using whole-head magnetoencephalography (MEG). Group independent neural activity in the right dlPFC increased with decreasing threat predictability. PD patients showed a sustained hyperactivation of the vmPFC under threat and safety conditions. The magnitude of hyperactivation was inversely correlated with PDs subjective arousal and anxiety sensitivity. Both PD and SP patients revealed decreased parietal processing of affective stimuli. Findings indicate overgeneralization between threat and safety conditions and increased need for emotion regulation via the vmPFC in PD, but not SP patients. Both anxiety disorders showed decreased activation in parietal networks possibly indicating attentional avoidance of affective stimuli. Present results complement findings from fear conditioning studies and underline overgeneralization of fear, particularly in PD.
Collapse
Affiliation(s)
- Anna Luisa Klahn
- Department of Psychiatry and Psychotherapy, University Hospital Muenster, Germany
| | | | - Ulrike Lueken
- Department of Psychiatry, Psychosomatics and Psychotherapy, University Hospital Wuerzburg, Germany
| | - Swantje Notzon
- Department of Psychiatry and Psychotherapy, University Hospital Muenster, Germany
| | - Volker Arolt
- Department of Psychiatry and Psychotherapy, University Hospital Muenster, Germany
| | - Christo Pantev
- Institute for Biogmagnetism and Biosignalanalysis, University of Muenster, Germany
| | - Peter Zwanzger
- Department of Psychiatry and Psychotherapy, University Hospital Muenster, Germany; kbo-Inn-Salzach-Hospital, Wasserburg am Inn, Germany; Department of Psychiatry and Psychotherapy, Ludwig Maximilian University of Munich, Germany
| | - Markus Junghoefer
- Institute for Biogmagnetism and Biosignalanalysis, University of Muenster, Germany
| |
Collapse
|
35
|
Godlewska BR, Clare S, Cowen PJ, Emir UE. Ultra-High-Field Magnetic Resonance Spectroscopy in Psychiatry. Front Psychiatry 2017; 8:123. [PMID: 28744229 PMCID: PMC5504194 DOI: 10.3389/fpsyt.2017.00123] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 06/26/2017] [Indexed: 12/30/2022] Open
Abstract
The advantages of ultra-high-field (UHF ≥ 7T) MR have been demonstrated in a variety of MR acquisition modalities. Magnetic resonance spectroscopy (MRS) can particularly benefit from substantial gains in signal-to-noise ratio (SNR) and spectral resolution at UHF, enabling the quantification of numerous metabolites, including glutamate, glutamine, glutathione, and γ-aminobutyric acid that are relevant to psychiatric disorders. The aim of this review is to give an overview about the advantages and advances of UHF MRS and its application to psychiatric disorders. In order to provide a practical guide for potential applications of MRS at UHF, a literature review is given, surveying advantages and disadvantages of MRS at UHF. Key concepts, emerging technologies, practical considerations, and applications of UHF MRS are provided. Second, the strength of UHF MRS is demonstrated using some examples of its application in psychiatric disorders.
Collapse
Affiliation(s)
- Beata R Godlewska
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, United Kingdom
| | - Stuart Clare
- Oxford Centre for Functional MRI of the Brain, Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom
| | - Philip J Cowen
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, United Kingdom
| | - Uzay E Emir
- Oxford Centre for Functional MRI of the Brain, Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom
| |
Collapse
|
36
|
Zilverstand A, Parvaz MA, Goldstein RZ. Neuroimaging cognitive reappraisal in clinical populations to define neural targets for enhancing emotion regulation. A systematic review. Neuroimage 2016; 151:105-116. [PMID: 27288319 DOI: 10.1016/j.neuroimage.2016.06.009] [Citation(s) in RCA: 215] [Impact Index Per Article: 26.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Revised: 05/26/2016] [Accepted: 06/06/2016] [Indexed: 02/07/2023] Open
Abstract
Reduced capacity to cognitively regulate emotional responses is a common impairment across major neuropsychiatric disorders. Brain systems supporting one such strategy, cognitive reappraisal of emotion, have been investigated extensively in the healthy population, a research focus that has led to influential meta-analyses and literature reviews. However, the emerging literature on neural substrates underlying cognitive reappraisal in clinical populations is yet to be systematically reviewed. Therefore, the goal of the current review was to summarize the literature on cognitive reappraisal and highlight common and distinct neural correlates of impaired emotion regulation in clinical populations. We performed a two-stage systematic literature search, selecting 32 studies on cognitive reappraisal in individuals with mood disorders (n=12), anxiety disorders (n=14), addiction (n=2), schizophrenia (n=2), and personality disorders (n=5). Comparing findings across these disorders allowed us to determine underlying mechanisms that were either disorder-specific or common across disorders. Results showed that across clinical populations, individuals consistently demonstrated reduced recruitment of the ventrolateral prefrontal cortex (vlPFC) and dorsolateral prefrontal cortex (dlPFC) during downregulation of negative emotion, indicating that there may be a core deficit in selection, manipulation and inhibition during reappraisal. Further, in individuals with mood disorders, amygdala responses were enhanced during downregulation of emotion, suggesting hyperactive bottom-up responses or reduced modulatory capacity. In individuals with anxiety disorders, however, emotion regulation revealed reduced activity in the dorsal anterior cingulate cortex (dACC) and inferior/superior parietal cortex, possibly indicating a deficit in allocation of attention. The reviewed studies thus provide evidence for both disorder-specific and common deficits across clinical populations. These findings highlight the role of distinct neural substrates as targets for developing/assessing novel therapeutic approaches that are geared towards cognitive regulation of emotion, as well as the importance of transdiagnostic research to identify both disorder specific and core mechanisms.
Collapse
Affiliation(s)
- Anna Zilverstand
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Muhammad A Parvaz
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Rita Z Goldstein
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| |
Collapse
|