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Lei L, Lai CSW, Lee TMC, Lam CLM. The effect of transcranial direct current and magnetic stimulation on fear extinction and return of fear: A meta-analysis and systematic review. J Affect Disord 2024; 362:263-286. [PMID: 38908557 DOI: 10.1016/j.jad.2024.06.060] [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: 10/12/2023] [Revised: 05/31/2024] [Accepted: 06/17/2024] [Indexed: 06/24/2024]
Abstract
BACKGROUND We conducted a meta-analysis and qualitative review on the randomized controlled trials investigating the effects of transcranial direct current stimulation and transcranial magnetic stimulation on fear extinction and the return of fear in non-primate animals and humans. METHODS The meta-analysis was conducted by searching PubMed, Web of science, PsycINFO, and Cochrane Library and extracting fear response in the active and sham groups in the randomized controlled trials. The pooled effect size was quantified by Hedges' g using a three-level meta-analytic model in R. RESULTS We identified 18 articles on the tDCS effect and 5 articles on the TMS effect, with 466 animal subjects and 621 human subjects. Our findings show that tDCS of the prefrontal cortex significantly inhibit fear retrieval in animal models (Hedges' g = -0.50). In human studies, TMS targeting the dorsolateral/ventromedial prefrontal cortex has an inhibiting effect on the return of fear (Hedges' g = -0.24). LIMITATIONS The limited number of studies and the heterogeneous designs of the selected studies made cross-study and cross-species comparison difficult. CONCLUSIONS Our findings shed light on the optimal non-invasive brain stimulation protocols for targeting the neural circuitry of threat extinction in humans.
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Affiliation(s)
- Letian Lei
- The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong, China; Laboratory of Clinical Psychology and Affective Neuroscience, The University of Hong Kong, Hong Kong, China
| | - Cora S W Lai
- The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong, China; School of Biomedical Sciences, LKS Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong, China; Advanced Biomedical Instrumentation Centre, Hong Kong Science Park, Shatin, New Territories, Hong Kong SAR, China
| | - Tatia M C Lee
- The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong, China; Laboratory of Neuropsychology and Human Neuroscience, The University of Hong Kong, Hong Kong, China
| | - Charlene L M Lam
- The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong, China; Laboratory of Clinical Psychology and Affective Neuroscience, The University of Hong Kong, Hong Kong, China.
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2
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Qi L, Wang S, Li X, Yu Y, Wang W, Li Q, Tian Y, Bai T, Wang K. Non-invasive brain stimulation in the treatment of generalized anxiety disorder: A systematic review and meta-analysis. J Psychiatr Res 2024; 178:378-387. [PMID: 39208534 DOI: 10.1016/j.jpsychires.2024.07.046] [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: 01/16/2024] [Revised: 07/26/2024] [Accepted: 07/29/2024] [Indexed: 09/04/2024]
Abstract
BACKGROUND Non-invasive brain stimulation (NIBS), including repetitive transcranial magnetic stimulation (rTMS), continuous theta-burst stimulation (cTBS), and transcranial direct current stimulation (tDCS), is an emerging intervention that has been used to treat various mental illnesses. However, previous studies have not comprehensively compared the efficacies of various NIBS modalities in alleviating anxiety symptoms among patients with generalized anxiety disorder (GAD). Therefore, this study conducted a systematic review and meta-analysis to assess the efficacy of NIBS for patients with GAD. METHODS A systematic search of four major bibliographic databases (Embase, PubMed, Web of Science and The Cochrane Library) was conducted from inception dates to November 26, 2023 to identify eligible studies. The data were analyzed using a random-effects model. RESULTS Seven randomized controlled trials (RCTs) were included in the meta-analysis. Significant differences were found in changes in Hamilton anxiety rating scale (HARS) scores, study-defined response, and remission between the intervention and control groups. Moreover, the intervention groups experienced a significantly higher frequency of headaches. CONCLUSION The results revealed that interventions improved GAD compared to control groups. cTBS and rTMS exhibited better treatment efficacy than tDCS, which did not appear to have a significant therapeutic effect. Longer follow-up periods and larger sample sizes are required in future RCTs. TRIAL REGISTRATION This meta-analysis was conducted in accordance with PRISMA guidelines and registered at PROSPERO (https://www.crd.york.ac.uk/PROSPERO/, CRD42023466285).
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Affiliation(s)
- Li Qi
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022, China
| | - Shaoyang Wang
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022, China
| | - Xiaoming Li
- The School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, 230032, China
| | - Yue Yu
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022, China
| | - Wenjia Wang
- Department of Neurology, The Second Affiliated Hospital of Anhui Medical University, Hefei, 230601, China
| | - Qianqian Li
- Department of Psychology and Sleep Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei, 230601, China
| | - Yanghua Tian
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022, China; The School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, 230032, China; Department of Psychology and Sleep Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei, 230601, China.
| | - Tongjian Bai
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022, China.
| | - Kai Wang
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022, China; Department of Neurology, The Second Affiliated Hospital of Anhui Medical University, Hefei, 230601, China; Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, 230032, China.
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Manassero E, Concina G, Caraig MCC, Sarasso P, Salatino A, Ricci R, Sacchetti B. Medial anterior prefrontal cortex stimulation downregulates implicit reactions to threats and prevents the return of fear. eLife 2024; 13:e85951. [PMID: 38913410 PMCID: PMC11196108 DOI: 10.7554/elife.85951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 06/11/2024] [Indexed: 06/25/2024] Open
Abstract
Downregulating emotional overreactions toward threats is fundamental for developing treatments for anxiety and post-traumatic disorders. The prefrontal cortex (PFC) is critical for top-down modulatory processes, and despite previous studies adopting repetitive transcranial magnetic stimulation (rTMS) over this region provided encouraging results in enhancing extinction, no studies have hitherto explored the effects of stimulating the medial anterior PFC (aPFC, encompassing the Brodmann area 10) on threat memory and generalization. Here we showed that rTMS over the aPFC applied before threat memory retrieval immediately decreases implicit reactions to learned and novel stimuli in humans. These effects enduringly persisted 1 week later in the absence of rTMS. No effects were detected on explicit recognition. Critically, rTMS over the aPFC resulted in a more pronounced reduction of defensive responses compared to rTMS targeting the dorsolateral PFC. These findings reveal a previously unexplored prefrontal region, the modulation of which can efficiently and durably inhibit implicit reactions to learned threats. This represents a significant advancement toward the long-term deactivation of exaggerated responses to threats.
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Affiliation(s)
- Eugenio Manassero
- Rita Levi-Montalcini Department of Neurosciences, University of TurinTurinItaly
| | - Giulia Concina
- Rita Levi-Montalcini Department of Neurosciences, University of TurinTurinItaly
| | | | | | | | | | - Benedetto Sacchetti
- Rita Levi-Montalcini Department of Neurosciences, University of TurinTurinItaly
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Boehme S, Herrmann MJ, Mühlberger A. Good moments to stimulate the brain - A randomized controlled double-blinded study on anodal transcranial direct current stimulation of the ventromedial prefrontal cortex on two different time points in a two-day fear conditioning paradigm. Behav Brain Res 2024; 460:114804. [PMID: 38103872 DOI: 10.1016/j.bbr.2023.114804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 11/30/2023] [Accepted: 12/06/2023] [Indexed: 12/19/2023]
Abstract
It is assumed that extinction learning is a suitable model for understanding the mechanisms underlying exposure therapy. Furthermore, there is evidence that non-invasive brain stimulation (NIBS) can elevate extinction learning by enhancing frontal brain activity and therefore NIBS can augment symptom reduction during exposure therapy in phobias. But, the underlying processes are still not well established. Open questions arise from NIBS time points and electrode placement, among others. Therefore, we investigated in a 2-day fear conditioning experiment, whether anodal transcranial direct current stimulation (tDCS) of the ventromedial prefrontal cortex (vmPFC) modulates either fear memory consolidation or dampened fear reaction during fear extinction. Sixty-six healthy participants were randomly assigned either to a group that received tDCS after fear acquisition (and before fear memory consolidation), to a group that received tDCS directly before fear extinction, or to a control group that never received active stimulation (sham). Differential skin conductance response (SCR) to CS+ vs. CS- was significantly decreased in both tDCS-groups compared to sham group. Our region of interest, the vmPFC, was stimulated best focally with a lateral anode position and a cathode on the contralateral side. But this comes along with a slightly lateral stimulation of vmPFC depending on whether anode is placed left or right. To avoid unintended effects of stimulated sides the two electrode montages (anode left or right) were mirror-inverted which led to differential effects in SCR and electrocortical (mainly late positive potential [LPP]) data in our exploratory analyses. Results indicated that tDCS-timing is relevant for fear reactions via disturbed fear memory consolidation as well as fear expression, and this depends on whether vmPFC is stimulated with either left- or right-sided anode electrode montage. Electrocortical data can shed more light on the underlying neural correlates and exaggerated LPP seems to be associated with disturbed fear memory consolidation and dampened SCR to CS+ vs. CS-, but solely in the right anode electrode montage. Further open questions addressing where and when to stimulate the prefrontal brain in the course of augmenting fear extinction are raised.
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Affiliation(s)
- Stephanie Boehme
- Department of Psychology, Chair for Clinical Psychology and Psychotherapy, Technische Universität Chemnitz, Wilhelm-Raabe-Straße 43, D-09120 Chemnitz, Germany; Department of Psychology, Clinical Psychology and Psychotherapy, University of Regensburg, Universitätsstraße 31, D-93053 Regensburg, Germany.
| | - Martin J Herrmann
- Center of Mental Health, Dept. of Psychiatry, Psychosomatics, and Psychotherapy, University Hospital of Wuerzburg, Margarete-Hoeppel-Platz 1, D-97080 Wuerzburg, Germany
| | - Andreas Mühlberger
- Department of Psychology, Clinical Psychology and Psychotherapy, University of Regensburg, Universitätsstraße 31, D-93053 Regensburg, Germany
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McDonald MA, Meckes SJ, Shires J, Berryhill ME, Lancaster CL. Augmenting Virtual Reality Exposure Therapy for Social and Intergroup Anxiety With Transcranial Direct Current Stimulation. J ECT 2024; 40:51-60. [PMID: 38009966 PMCID: PMC10920400 DOI: 10.1097/yct.0000000000000967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
OBJECTIVES Exposure therapy is a cornerstone of social anxiety treatment, yet not all patients respond. Symptoms in certain social situations, including intergroup (ie, out-group) contexts, may be particularly resistant to treatment. Exposure therapy outcomes may be improved by stimulating neural areas associated with safety learning, such as the medial prefrontal cortex (mPFC). The mPFC also plays an important role in identifying others as similar to oneself. We hypothesized that targeting the mPFC during exposure therapy would reduce intergroup anxiety and social anxiety. METHODS Participants (N = 31) with the public speaking subtype of social anxiety received active (anodal) or sham transcranial direct current stimulation (tDCS) targeting the mPFC during exposure therapy. Exposure therapy consisted of giving speeches to audiences in virtual reality. To target intergroup anxiety, half of the public speaking exposure trials were conducted with out-group audiences, defined in this study as audiences of a different ethnicity. RESULTS Contrary to hypotheses, tDCS did not facilitate symptom reduction. Some evidence even suggested that tDCS temporarily increased in-group favoritism, although these effects dissipated at 1-month follow-up. In addition, collapsing across all participants, we found reductions across time for public speaking anxiety and intergroup anxiety. CONCLUSIONS The data provide evidence that standard exposure therapy techniques for social anxiety can be adapted to target intergroup anxiety. Transcranial direct current stimulation targeting the mPFC may boost safety signaling, but only in contexts previously conditioned to signal safety, such as an in-group context.
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Zugman A, Winkler AM, Qamar P, Pine DS. Current and Future Approaches to Pediatric Anxiety Disorder Treatment. Am J Psychiatry 2024; 181:189-200. [PMID: 38425255 PMCID: PMC11256210 DOI: 10.1176/appi.ajp.20231037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
This overview critically appraises the literature on the treatment of pediatric anxiety disorders. The two established treatments for these conditions comprise cognitive-behavioral therapy (CBT) and antidepressant medications. Many youths receiving these treatments fail to achieve remission, which creates a need for new treatments. After summarizing the literature on CBT and currently available medications, the authors describe research that lays a foundation for improvements in the treatment of pediatric anxiety disorders. This foundation leverages neuroscientific investigations, also described in the overview, which provide insights on mechanisms of successful treatment.
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Affiliation(s)
- Andre Zugman
- Section on Development and Affective Neuroscience (SDAN), Emotion and Development Branch (EDB), National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland, United States
| | - Anderson M. Winkler
- Section on Development and Affective Neuroscience (SDAN), Emotion and Development Branch (EDB), National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland, United States
- Division of Human Genetics, School of Medicine, The University of Texas Rio Grande Valley, Brownsville, Texas, United States
| | - Purnima Qamar
- Section on Development and Affective Neuroscience (SDAN), Emotion and Development Branch (EDB), National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland, United States
| | - Daniel S. Pine
- Section on Development and Affective Neuroscience (SDAN), Emotion and Development Branch (EDB), National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland, United States
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Schellen SJ, Zeidan P, Ernst TM, Thieme A, Nicksirat SA, Merz CJ, Nitsche MA, Yavari F, Timmann D, Batsikadze G. Absence of modulatory effects of 6Hz cerebellar transcranial alternating current stimulation on fear learning in men. Front Hum Neurosci 2024; 17:1328283. [PMID: 38264350 PMCID: PMC10803490 DOI: 10.3389/fnhum.2023.1328283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 12/18/2023] [Indexed: 01/25/2024] Open
Abstract
Fear is a vital defense mechanism to potential threats, which is influenced by the cerebellum. While the cerebellum's role in acquiring fear responses is well understood, limited knowledge exists about its involvement in fear extinction. In this study, we investigated the effects of cerebellar theta band transcranial alternating current stimulation (ctACS) administered during fear extinction training, based on previous evidence from animal studies suggesting a role of cerebellar theta oscillations in associative memory formation. To this end, thirty-seven healthy right-handed male participants were recruited for a two-day differential fear renewal paradigm. On day 1, they underwent acquisition training in context A followed by extinction training in context B. On day 2, recall was tested in contexts A and B. One group of participants received ctACS in the theta band (6 Hz) during extinction training. The other group received sham ctACS. Although both groups demonstrated the ability to recall previously learned fear and distinguish between low and high threat stimuli, no significant differences were observed between the ctACS and sham groups, indicating that ctACS at this theta frequency range did not impact extinction and recall of previously acquired fear in this study. Nevertheless, using ctACS could still be useful in future research, including brain imaging studies, to better understand how the cerebellum is involved in fear and extinction processes.
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Affiliation(s)
- Sarah Johanna Schellen
- Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University Hospital Essen, Essen, Germany
| | - Philip Zeidan
- Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University Hospital Essen, Essen, Germany
| | - Thomas M. Ernst
- Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University Hospital Essen, Essen, Germany
| | - Andreas Thieme
- Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University Hospital Essen, Essen, Germany
| | - Seyed Ali Nicksirat
- Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University Hospital Essen, Essen, Germany
| | - Christian J. Merz
- Department of Cognitive Psychology, Faculty of Psychology, Institute of Cognitive Neuroscience, Ruhr University Bochum, Bochum, Germany
| | - Michael A. Nitsche
- Department of Psychology and Neurosciences, Leibniz Research Center for Working Environment and Human Factors, Dortmund, Germany
- German Center for Mental Health (DZPG), Bochum, Germany
| | - Fatemeh Yavari
- Department of Psychology and Neurosciences, Leibniz Research Center for Working Environment and Human Factors, Dortmund, Germany
| | - Dagmar Timmann
- Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University Hospital Essen, Essen, Germany
| | - Giorgi Batsikadze
- Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University Hospital Essen, Essen, Germany
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8
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Yang D, Ghafoor U, Eggebrecht AT, Hong KS. Effectiveness assessment of repetitive transcranial alternating current stimulation with concurrent EEG and fNIRS measurement. Health Inf Sci Syst 2023; 11:35. [PMID: 37545487 PMCID: PMC10397167 DOI: 10.1007/s13755-023-00233-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 07/11/2023] [Indexed: 08/08/2023] Open
Abstract
Transcranial alternating current stimulation (tACS) exhibits the capability to interact with endogenous brain oscillations using an external low-intensity sinusoidal current and influences cerebral function. Despite its potential benefits, the physiological mechanisms and effectiveness of tACS are currently a subject of debate and disagreement. The aims of our study are to (i) evaluate the neurological and behavioral impact of tACS by conducting repetitive sham-controlled experiments and (ii) propose criteria to evaluate effectiveness, which can serve as a benchmark to determine optimal individual-based tACS protocols. In this study, 15 healthy adults participated in the experiment over two visiting: sham and tACS (i.e., 5 Hz, 1 mA). During each visit, we used multimodal recordings of the participants' brain, including simultaneous electroencephalography (EEG) and functional near-infrared spectroscopy (fNIRS), along with a working memory (WM) score to quantify neurological effects and cognitive changes immediately after each repetitive sham/tACS session. Our results indicate increased WM scores, hemodynamic response strength, and EEG power in theta and delta bands both during and after the tACS period. Additionally, the observed effects do not increase with prolonged stimulation time, as the effects plateau towards the end of the experiment. In conclusion, our proposed closed-loop scheme offers a promising advance for evaluating the effectiveness of tACS during the stimulation session. Specifically, the assessment criteria use participant-specific brain-based signals along with a behavioral output. Moreover, we propose a feedback efficacy score that can aid in determining the optimal stimulation duration based on a participant-specific brain state, thereby preventing the risk of overstimulation.
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Affiliation(s)
- Dalin Yang
- School of Mechanical Engineering, Pusan National University, Busan, 46241 Republic of Korea
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO 63100 USA
| | - Usman Ghafoor
- School of Mechanical Engineering, Pusan National University, Busan, 46241 Republic of Korea
| | - Adam Thomas Eggebrecht
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO 63100 USA
- Department of Biomedical Engineering, Washington University, St. Louis, MO 63130 USA
| | - Keum-Shik Hong
- School of Mechanical Engineering, Pusan National University, Busan, 46241 Republic of Korea
- Institute for Future, School of Automation, Qingdao University, Qingdao, 266071 Shandong China
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Adams TG, Kelmendi B, George JR, Forte J, Hubert TJJ, Wild H, Rippey CS, Pittenger C. Frontopolar multifocal transcranial direct current stimulation reduces conditioned fear reactivity during extinction training: A pilot randomized controlled trial. Neurobiol Learn Mem 2023; 205:107825. [PMID: 37699439 PMCID: PMC10872945 DOI: 10.1016/j.nlm.2023.107825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 08/16/2023] [Accepted: 09/03/2023] [Indexed: 09/14/2023]
Abstract
Exposure-based therapies for anxiety and related disorders are believed to depend on fear extinction learning and corresponding changes in extinction circuitry. Frontopolar multifocal transcranial direct current stimulation (tDCS) has been shown to improve therapeutic safety learning during in vivo exposure and may modulate functional connectivity of networks implicated in fear processing and inhibition. A pilot randomized controlled trial was completed to determine the effects of frontopolar tDCS on extinction learning and memory. Community volunteers (n = 35) completed a 3-day fear extinction paradigm with measurement of electrodermal activity. Participants were randomized (single-blind) to 20-min of sham (n = 17, 30 s. ramp in/out) or active (n = 18) frontopolar (anode over Fpz, 10-10 EEG) multifocal tDCS (20-min, 1.5 mA) prior to extinction training. Mixed ANOVAs revealed a significant group*trial effect on skin conductance response (SCR) to the conditioned stimulus (CS + ) during extinction training (p = 0.007, Cohen's d = 0.55). The effects of frontopolar tDCS were greatest during the first two extinction trials, suggesting that tDCS may have promoted fear inhibition prior to safety learning. Return of fear to the CS + during tests were comparable across conditions (ps > 0.50). These findings suggest that frontopolar tDCS may modulate the processing of threat cues and associated circuitry or promote the inhibition of fear. This has clear implications for the treatment of anxiety and related disorders with therapeutic exposure.
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Affiliation(s)
- Thomas G Adams
- Department of Psychology, University of Kentucky, United States; Department of Psychiatry, Yale University School of Medicine, United States.
| | - Benjamin Kelmendi
- Department of Psychiatry, Yale University School of Medicine, United States; Clinical Neuroscience Division of the National Center for PTSD, West Haven VA Medical Center, United States
| | - Jamilah R George
- Department of Psychiatry, Yale University School of Medicine, United States; Department of Psychological Sciences, University of Connecticut, United States
| | - Jennifer Forte
- Department of Psychiatry, Yale University School of Medicine, United States; Department of Psychology, Binghamton University, United States
| | - Troy J J Hubert
- Department of Psychology, University of Kentucky, United States
| | - Hannah Wild
- Department of Psychology, University of Kentucky, United States
| | - Colton S Rippey
- Department of Psychology, University of Kentucky, United States
| | - Christopher Pittenger
- Department of Psychiatry, Yale University School of Medicine, United States; Child Study Center, Yale University, United States; Department of Psychology, Center for Brain and Mind Health, Yale University, United States
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Deng J, Lin X, Zheng Y, Su S, Liu X, Yuan K, Shi L, Bao Y, Lu L. Manipulating critical memory periods to treat psychiatry disorders. Sci Bull (Beijing) 2023; 68:2477-2486. [PMID: 37689533 DOI: 10.1016/j.scib.2023.08.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 08/10/2023] [Accepted: 08/27/2023] [Indexed: 09/11/2023]
Abstract
The persistence of pathological memory is the basis of several psychiatric disorders. Memory retrieval induces "reconsolidation", a time interval during which the original memory becomes labile and destabilized. Time- and retrieval-dependent processes and memory reconsolidation are critical periods for memory interference. Modulating memory reconsolidation has received considerable research attention as a treatment protocol for several psychiatric conditions such as posttraumatic stress disorder, addiction, anxiety, and trauma-related disorders. This specific time window provides an opportunity for intervention regarding mental diseases. This article reviews the effect of modulating memory reconsolidation using behavioral-, brain stimulation-, and pharmacological-based interventions, which may help bridge the gap between intervention in laboratories and application in clinical practice. The potential advantages, limitations, challenges, and opportunities for memory reconsolidation manipulations were discussed.
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Affiliation(s)
- Jiahui Deng
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing 100191, China
| | - Xiao Lin
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing 100191, China
| | - Yongbo Zheng
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing 100191, China; Peking-Tsinghua Center for Life Sciences and PKU-IDG/McGovern Institute for Brain Research, Peking University, Beijing 100871, China
| | - Sizhen Su
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing 100191, China
| | - Xiaoxing Liu
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing 100191, China
| | - Kai Yuan
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing 100191, China
| | - Le Shi
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing 100191, China
| | - Yanping Bao
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing 100191, China; School of Public Health, Peking University, Beijing 100191, China; Institute of Brain Science and Brain-inspired Research, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan 250117, China.
| | - Lin Lu
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing 100191, China; Peking-Tsinghua Center for Life Sciences and PKU-IDG/McGovern Institute for Brain Research, Peking University, Beijing 100871, China; National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing 100191, China.
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11
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Chang SH, Chen HY, Shaw FZ, Shyu BC. Early- and late-phase changes of brain activity and early-phase neuromodulation in the posttraumatic stress disorder rat model. Neurobiol Stress 2023; 26:100554. [PMID: 37576348 PMCID: PMC10415797 DOI: 10.1016/j.ynstr.2023.100554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 06/21/2023] [Accepted: 07/03/2023] [Indexed: 08/15/2023] Open
Abstract
Posttraumatic stress disorder (PTSD) is a complex syndrome that may occur after life-threatening events. Fear memory abnormalities may play vital roles in the pathogenesis of PTSD. Previous work has found that fear memories are not rigid; the retrieval of fear memories may change over time. Furthermore, prior studies suggest that theta wave (4 Hz) activity is highly correlated with fear expression in an animal model. However, the relationship between pathological fear memory and potential brain wave features in PTSD remains largely uncharacterized. Here, we hypothesized that after traumatic stress exposure, the longitudinal dynamics of abnormal fears in PTSD animal models could be reflected by the measurement of local field potentials (LFPs). Using a well-established modified single-prolonged stress and footshock (SPS & FS) PTSD rat model, animals were restrained for 2 h and subsequently subjected to 20 min of forced swimming, then exposed to diethyl ether until they lost consciousness and placed in a conditioning chamber for fear conditioning. To characterize the temporal changes, we characterized freezing behavior brain wave features during the conditioning chamber re-exposure in the early (10 and 30 min; 2, 4, and 6 h) and late (day 1, 3, 7, and 14) phases after traumatic stress exposure. Our results indicate that SPS & FS rats showed co-morbid PTSD phenotypes including significantly higher levels of anxiety-, depression-, and anhedonia-like behaviors, and impaired fear extinction. Delta wave (0.5-4 Hz) suppression in the medial prefrontal cortex, amygdala, and ventral hippocampus occurred 10 and 30 min after traumatic stress, followed by continuous delta wave activity from 2 h to day 14, correlating with fear levels. tDCS reduced delta activity and alleviated PTSD-like phenotypes in the SPS & FS group. In this study, profiling abnormal fears with brain wave correlates may improve our understanding of time-dependent pathological fear memory retrieval in PTSD and facilitate the development of effective intervention strategies.
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Affiliation(s)
- Shao-Han Chang
- Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan
- Department of Psychology, National Cheng Kung University, Tainan, Taiwan
- Taiwan International Graduate Program in Interdisciplinary Neuroscience, National Cheng Kung University and Academia Sinica, Taipei, Taiwan
| | - Huan-Yuan Chen
- Inflammation Core Facility, Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan
| | - Fu-Zen Shaw
- Department of Psychology, National Cheng Kung University, Tainan, Taiwan
| | - Bai-Chuang Shyu
- Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan
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12
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Silva BA, Gräff J. Face your fears: attenuating remote fear memories by reconsolidation-updating. Trends Cogn Sci 2023; 27:404-416. [PMID: 36813591 DOI: 10.1016/j.tics.2023.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 01/22/2023] [Accepted: 01/23/2023] [Indexed: 02/22/2023]
Abstract
Traumatic events generate some of the most enduring memories, yet little is known about how long-lasting fear memories can be attenuated. In this review, we collect the surprisingly sparse evidence on remote fear memory attenuation from both animal and human research. What is becoming apparent is twofold: although remote fear memories are more resistant to change compared with recent ones, they can nevertheless be attenuated when interventions are targeted toward the period of memory malleability instigated by memory recall, the reconsolidation window. We describe the physiological mechanisms underlying remote reconsolidation-updating approaches and highlight how they can be enhanced through interventions promoting synaptic plasticity. By capitalizing on an intrinsically relevant phase of memory, reconsolidation-updating harbors the potential to permanently alter remote fear memories.
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Affiliation(s)
- Bianca A Silva
- National Research Council of Italy, Institute of Neuroscience, Milan, Italy; IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Johannes Gräff
- Laboratory of Neuroepigenetics, Brain Mind Institute, School of Life Sciences, Ecole Polytechnique Fédérale Lausanne (EPFL), Switzerland.
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13
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Couto Pereira NDS, Klippel Zanona Q, Pastore Bernardi M, Alves J, Dalmaz C, Calcagnotto ME. Aversive memory reactivation: A possible role for delta oscillations in the hippocampus-amygdala circuit. J Neurosci Res 2023; 101:48-69. [PMID: 36128957 DOI: 10.1002/jnr.25127] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 08/25/2022] [Accepted: 09/09/2022] [Indexed: 02/03/2023]
Abstract
Memory labilization, the process by which memories become susceptible to update, is essential for memory reconsolidation and has been a target for novel therapies for traumatic memory-associated disorders. Maternal separation (MS) in male rats produced memories resistant to labilization in adulthood. Based on previous results, we hypothesized that temporal desynchronization between the dorsal hippocampus (DHc) and the basolateral amygdala (BLA), during memory retrieval, could be responsible for this impairment. Our goal was to investigate possible differences in oscillatory activity and synchrony between the DHc and BLA during fear memory reactivation, between MS and non-handled (NH) rats. We used male adult Wistar rats, NH or MS, with electrodes for local field potential (LFP) recordings implanted in the DHc and BLA. Animals were submitted to aversive memory reactivation by exposure to the conditioned context (Reat) or to pseudo-reactivation in a neutral context (pReat), and LFP was recorded. Plasticity markers linked to reconsolidation were evaluated one hour after reactivation. The power of delta oscillations and DHc-BLA synchrony in Reat animals was increased, during freezing. Besides, delta modulation of gamma oscillations amplitude in the BLA was associated with the increase in DHc Zif268 levels, an immediate early gene specifically associated with reconsolidation. Concerning early life stress, we found lower power of delta and strength of delta-gamma oscillations coupling in MS rats, compared to NH, which could explain the low Zif268 levels in a subgroup of MS animals. These results suggest a role for delta oscillations in memory reactivation that should be further investigated.
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Affiliation(s)
- Natividade de Sá Couto Pereira
- Neurophysiology and Neurochemistry of Neuronal Excitability and Synaptic Plasticity Laboratory (NNNESP Lab.), Department of Biochemistry, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Graduate Program in Neuroscience, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Querusche Klippel Zanona
- Neurophysiology and Neurochemistry of Neuronal Excitability and Synaptic Plasticity Laboratory (NNNESP Lab.), Department of Biochemistry, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Graduate Program in Neuroscience, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Marcelo Pastore Bernardi
- Neurophysiology and Neurochemistry of Neuronal Excitability and Synaptic Plasticity Laboratory (NNNESP Lab.), Department of Biochemistry, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Joelma Alves
- Neurobiology of Stress Laboratory, Department of Biochemistry, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Graduate Program in Biological Sciences: Biochemistry, Department of Biochemistry, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Carla Dalmaz
- Graduate Program in Neuroscience, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Neurobiology of Stress Laboratory, Department of Biochemistry, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Graduate Program in Biological Sciences: Biochemistry, Department of Biochemistry, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Maria Elisa Calcagnotto
- Neurophysiology and Neurochemistry of Neuronal Excitability and Synaptic Plasticity Laboratory (NNNESP Lab.), Department of Biochemistry, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Graduate Program in Neuroscience, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Graduate Program in Biological Sciences: Biochemistry, Department of Biochemistry, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
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14
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Lee D, Guiomar R, Gonçalves ÓF, Almeida J, Ganho-Ávila A. Effects of transcranial direct current stimulation on neural activity and functional connectivity during fear extinction. Int J Clin Health Psychol 2023; 23:100342. [PMID: 36299490 PMCID: PMC9578989 DOI: 10.1016/j.ijchp.2022.100342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 09/28/2022] [Indexed: 11/07/2022] Open
Abstract
Background/Objective Anxiety disorders are highly prevalent and negatively impact daily functioning and quality of life. Transcranial direct current stimulation (tDCS) targeting the dorsolateral prefrontal cortex (dlPFC), especially in the right hemisphere impacts extinction learning; however, the underlying neural mechanisms are elusive. Therefore, we aimed to investigate the effects of cathodal tDCS stimulation to the right dlPFC on neural activity and connectivity patterns during delayed fear extinction in healthy participants. Methods We conducted a two-day fear conditioning and extinction procedure. On the first day, we collected fear-related self-reports, clinical questionnaires, and skin conductance responses during fear acquisition. On the second day, participants in the tDCS group (n = 16) received 20-min offline tDCS before fMRI and then completed the fear extinction session during fMRI. Participants in the control group (n = 18) skipped tDCS and directly underwent fMRI to complete the fear extinction procedure. Whole-brain searchlight classification and resting-state functional connectivity analyses were performed. Results Whole-brain searchlight classification during fear extinction showed higher classification accuracy of threat and safe cues in the left anterior dorsal and ventral insulae and hippocampus in the tDCS group than in the control group. Functional connectivity derived from the insula with the dlPFC, ventromedial prefrontal cortex, and inferior parietal lobule was increased after tDCS. Conclusion tDCS over the right dlPFC may function as a primer for information exchange among distally connected areas, thereby increasing stimulus discrimination. The current study did not include a sham group, and one participant of the control group was not randomized. Therefore, to address potential allocation bias, findings should be confirmed in the future with a fully randomized and sham controlled study.
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Key Words
- ACC, anterior cingulate cortex
- CS, conditioned stimulus
- EPI, echo-planar imaging
- FOV, field of view
- Fear extinction
- GLM, general linear model
- HC, hippocampus
- IPL, inferior parietal lobule
- PFC, prefrontal cortex
- Resting-state functional connectivity
- SCR, skin conductance response
- TE, echo time
- TR, repetition time
- US, unconditioned stimulus
- Whole-brain searchlight classification
- dAI, dorsal anterior insula
- dlPFC, dorsolateral prefrontal cortex
- fMRI, functional magnetic resonance imaging
- tDCS
- tDCS, transcranial direct current stimulation
- vAI, ventral anterior insula
- vmPFC, ventromedial prefrontal cortex
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Affiliation(s)
- Dongha Lee
- Cognitive Science Research Group, Korea Brain Research Institute, 61 Cheomdan-ro, Dong-gu, Daegu, Republic of Korea,Corresponding author at: Cognitive Science Research Group, Korea Brain Research Institute, 61 Cheomdan-ro, Dong-gu, Daegu, Republic of Korea 41062.
| | - Raquel Guiomar
- Center for Research in Neuropsychology and Cognitive Behavioral Intervention, Faculty of Psychology and Educational Sciences, University of Coimbra, Rua do Colégio Novo 3000-115, Coimbra, Portugal
| | - Óscar F. Gonçalves
- Proaction Laboratory, Center for Research in Neuropsychology and Cognitive Behavioral Intervention, Faculty of Psychology and Educational Sciences, University of Coimbra, Rua do Colégio Novo 3001-802 Coimbra, Portugal
| | - Jorge Almeida
- Proaction Laboratory, Center for Research in Neuropsychology and Cognitive Behavioral Intervention, Faculty of Psychology and Educational Sciences, University of Coimbra, Rua do Colégio Novo 3001-802 Coimbra, Portugal
| | - Ana Ganho-Ávila
- Center for Research in Neuropsychology and Cognitive Behavioral Intervention, Faculty of Psychology and Educational Sciences, University of Coimbra, Rua do Colégio Novo 3000-115, Coimbra, Portugal,Corresponding author at: Faculty of Psychology and Educational Sciences, University of Coimbra, 3000-115 Coimbra, Portugal.
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15
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Becker CR, Milad MR. Contemporary Approaches Toward Neuromodulation of Fear Extinction and Its Underlying Neural Circuits. Curr Top Behav Neurosci 2023; 64:353-387. [PMID: 37658219 DOI: 10.1007/7854_2023_442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/03/2023]
Abstract
Neuroscience and neuroimaging research have now identified brain nodes that are involved in the acquisition, storage, and expression of conditioned fear and its extinction. These brain regions include the ventromedial prefrontal cortex (vmPFC), dorsal anterior cingulate cortex (dACC), amygdala, insular cortex, and hippocampus. Psychiatric neuroimaging research shows that functional dysregulation of these brain regions might contribute to the etiology and symptomatology of various psychopathologies, including anxiety disorders and post traumatic stress disorder (PTSD) (Barad et al. Biol Psychiatry 60:322-328, 2006; Greco and Liberzon Neuropsychopharmacology 41:320-334, 2015; Milad et al. Biol Psychiatry 62:1191-1194, 2007a, Biol Psychiatry 62:446-454, b; Maren and Quirk Nat Rev Neurosci 5:844-852, 2004; Milad and Quirk Annu Rev Psychol 63:129, 2012; Phelps et al. Neuron 43:897-905, 2004; Shin and Liberzon Neuropsychopharmacology 35:169-191, 2009). Combined, these findings indicate that targeting the activation of these nodes and modulating their functional interactions might offer an opportunity to further our understanding of how fear and threat responses are formed and regulated in the human brain, which could lead to enhancing the efficacy of current treatments or creating novel treatments for PTSD and other psychiatric disorders (Marin et al. Depress Anxiety 31:269-278, 2014; Milad et al. Behav Res Ther 62:17-23, 2014). Device-based neuromodulation techniques provide a promising means for directly changing or regulating activity in the fear extinction network by targeting functionally connected brain regions via stimulation patterns (Raij et al. Biol Psychiatry 84:129-137, 2018; Marković et al. Front Hum Neurosci 15:138, 2021). In the past ten years, notable advancements in the precision, safety, comfort, accessibility, and control of administration have been made to the established device-based neuromodulation techniques to improve their efficacy. In this chapter we discuss ten years of progress surrounding device-based neuromodulation techniques-Electroconvulsive Therapy (ECT), Transcranial Magnetic Stimulation (TMS), Magnetic Seizure Therapy (MST), Transcranial Focused Ultrasound (TUS), Deep Brain Stimulation (DBS), Vagus Nerve Stimulation (VNS), and Transcranial Electrical Stimulation (tES)-as research and clinical tools for enhancing fear extinction and treating PTSD symptoms. Additionally, we consider the emerging research, current limitations, and possible future directions for these techniques.
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Affiliation(s)
- Claudia R Becker
- Department of Psychiatry, NYU Grossman School of Medicine, New York, NY, USA
| | - Mohammed R Milad
- Department of Psychiatry, NYU Grossman School of Medicine, New York, NY, USA.
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16
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Feasibility of Combining Transcranial Direct Current Stimulation and Active Fully Embodied Virtual Reality for Visual Height Intolerance: A Double-Blind Randomized Controlled Study. J Clin Med 2022; 11:jcm11020345. [PMID: 35054039 PMCID: PMC8779186 DOI: 10.3390/jcm11020345] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 01/02/2022] [Accepted: 01/05/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Transcranial Direct Current Stimulation (tDCS) and Virtual Reality Exposure Therapy (VRET) are individually increasingly used in psychiatric research. OBJECTIVE/HYPOTHESIS Our study aimed to investigate the feasibility of combining tDCS and wireless 360° full immersive active and embodied VRET to reduce height-induced anxiety. METHODS We carried out a pilot randomized, double-blind, controlled study associating VRET (two 20 min sessions with a 48 h interval, during which, participants had to cross a plank at rising heights in a building in construction) with online tDCS (targeting the ventromedial prefrontal cortex) in 28 participants. The primary outcomes were the sense of presence level and the tolerability. The secondary outcomes were the anxiety level (Subjective Unit of Discomfort) and the salivary cortisol concentration. RESULTS We confirmed the feasibility of the association between tDCS and fully embodied VRET associated with a good sense of presence without noticeable adverse effects. In both groups, a significant reduction in the fear of height was observed after two sessions, with only a small effect size of add-on tDCS (0.1) according to the SUD. The variations of cortisol concentration differed in the tDCS and sham groups. CONCLUSION Our study confirmed the feasibility of the association between wireless online tDCS and active, fully embodied VRET. The optimal tDCS paradigm remains to be determined in this context to increase effect size and then adequately power future clinical studies assessing synergies between both techniques.
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17
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Alexandra Kredlow M, Fenster RJ, Laurent ES, Ressler KJ, Phelps EA. Prefrontal cortex, amygdala, and threat processing: implications for PTSD. Neuropsychopharmacology 2022; 47:247-259. [PMID: 34545196 PMCID: PMC8617299 DOI: 10.1038/s41386-021-01155-7] [Citation(s) in RCA: 89] [Impact Index Per Article: 44.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 08/03/2021] [Accepted: 08/06/2021] [Indexed: 02/08/2023]
Abstract
Posttraumatic stress disorder can be viewed as a disorder of fear dysregulation. An abundance of research suggests that the prefrontal cortex is central to fear processing-that is, how fears are acquired and strategies to regulate or diminish fear responses. The current review covers foundational research on threat or fear acquisition and extinction in nonhuman animals, healthy humans, and patients with posttraumatic stress disorder, through the lens of the involvement of the prefrontal cortex in these processes. Research harnessing advances in technology to further probe the role of the prefrontal cortex in these processes, such as the use of optogenetics in rodents and brain stimulation in humans, will be highlighted, as well other fear regulation approaches that are relevant to the treatment of posttraumatic stress disorder and involve the prefrontal cortex, namely cognitive regulation and avoidance/active coping. Despite the large body of translational research, many questions remain unanswered and posttraumatic stress disorder remains difficult to treat. We conclude by outlining future research directions related to the role of the prefrontal cortex in fear processing and implications for the treatment of posttraumatic stress disorder.
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Affiliation(s)
- M. Alexandra Kredlow
- grid.38142.3c000000041936754XDepartment of Psychology, Harvard University, Cambridge, MA USA
| | - Robert J. Fenster
- grid.38142.3c000000041936754XDivision of Depression and Anxiety, McLean Hospital; Department of Psychiatry, Harvard Medical School, Cambridge, MA USA
| | - Emma S. Laurent
- grid.38142.3c000000041936754XDepartment of Psychology, Harvard University, Cambridge, MA USA
| | - Kerry J. Ressler
- grid.38142.3c000000041936754XDivision of Depression and Anxiety, McLean Hospital; Department of Psychiatry, Harvard Medical School, Cambridge, MA USA
| | - Elizabeth A. Phelps
- grid.38142.3c000000041936754XDepartment of Psychology, Harvard University, Cambridge, MA USA
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18
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Adams TG, Cisler JM, Kelmendi B, George JR, Kichuk SA, Averill CL, Anticevic A, Abdallah CG, Pittenger C. Transcranial direct current stimulation targeting the medial prefrontal cortex modulates functional connectivity and enhances safety learning in obsessive-compulsive disorder: Results from two pilot studies. Depress Anxiety 2022; 39:37-48. [PMID: 34464485 PMCID: PMC8732293 DOI: 10.1002/da.23212] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 06/29/2021] [Accepted: 07/09/2021] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Exposed-based psychotherapy is a mainstay of treatment for obsessive-compulsive disorder (OCD) and anxious psychopathology. The medial prefrontal cortex (mPFC) and the default mode network (DMN), which is anchored by the mPFC, promote safety learning. Neuromodulation targeting the mPFC might augment therapeutic safety learning and enhance response to exposure-based therapies. METHODS To characterize the effects of mPFC neuromodulation on functional connectivity, 17 community volunteers completed resting-state functional magnetic resonance imaging scans before and after 20 min of frontopolar anodal multifocal transcranial direct current stimulation (tDCS). To examine the effects of tDCS on therapeutic safety learning, 24 patients with OCD completed a pilot randomized clinical trial; they were randomly assigned (double-blind, 50:50) to receive active or sham frontopolar tDCS before completing an in vivo exposure and response prevention (ERP) challenge. Changes in subjective emotional distress during the ERP challenge were used to index therapeutic safety learning. RESULTS In community volunteers, frontal pole functional connectivity with the middle and superior frontal gyri increased, while connectivity with the anterior insula and basal ganglia decreased (ps < .001, corrected) after tDCS; functional connectivity between DMN and salience network also decreased after tDCS (ps < .001, corrected). OCD patients who received active tDCS exhibited more rapid therapeutic safety learning (ps < .05) during the ERP challenge than patients who received sham tDCS. CONCLUSIONS Frontopolar tDCS may modulate mPFC and DMN functional connectivity and can accelerate therapeutic safety learning. Though limited by small samples, these findings motivate further exploration of the effects of frontopolar tDCS on neural and behavioral targets associated with exposure-based psychotherapies.
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Affiliation(s)
- Thomas G Adams
- Department of Psychology, University of Kentucky, Lexington, Kentucky, USA
- Department of Psychiatry, School of Medicine, Yale University, New Haven, Connecticut, USA
- Clinical Neuroscience Division of the National Center for PTSD, West Haven VA Medical Center, Yale University, New Haven, Connecticut, USA
| | - Josh M Cisler
- Department of Psychiatry, University of Wisconsin, Madison, Wisconsin, USA
- Department of Psychiatry & Behavioral Sciences, Dell Medical School, University of Texas, Austin, Texas, USA
| | - Benjamin Kelmendi
- Department of Psychiatry, School of Medicine, Yale University, New Haven, Connecticut, USA
- Clinical Neuroscience Division of the National Center for PTSD, West Haven VA Medical Center, Yale University, New Haven, Connecticut, USA
| | - Jamilah R George
- Department of Psychiatry, School of Medicine, Yale University, New Haven, Connecticut, USA
- Department of Psychological Sciences, University of Connecticut, Mansfield, Connecticut, USA
| | - Stephen A Kichuk
- Department of Psychiatry, School of Medicine, Yale University, New Haven, Connecticut, USA
| | - Christopher L Averill
- Department of Psychiatry, School of Medicine, Yale University, New Haven, Connecticut, USA
- Clinical Neuroscience Division of the National Center for PTSD, West Haven VA Medical Center, Yale University, New Haven, Connecticut, USA
- Michael E. DeBakey VA Medical Center, Houston, Texas, USA
- Menninger Department of Psychiatry, Baylor College of Medicine, Houston, Texas, USA
| | - Alan Anticevic
- Department of Psychiatry, School of Medicine, Yale University, New Haven, Connecticut, USA
| | - Chadi G Abdallah
- Department of Psychiatry, School of Medicine, Yale University, New Haven, Connecticut, USA
- Clinical Neuroscience Division of the National Center for PTSD, West Haven VA Medical Center, Yale University, New Haven, Connecticut, USA
- Michael E. DeBakey VA Medical Center, Houston, Texas, USA
- Menninger Department of Psychiatry, Baylor College of Medicine, Houston, Texas, USA
| | - Christopher Pittenger
- Department of Psychiatry, School of Medicine, Yale University, New Haven, Connecticut, USA
- Child Study Center, Yale University, New Haven, Connecticut, USA
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19
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Abend R, Ruiz SG, Bajaj MA, Harrewijn A, Linke JO, Atlas LY, Winkler AM, Pine DS. Threat imminence reveals links among unfolding of anticipatory physiological response, cortical-subcortical intrinsic functional connectivity, and anxiety. Neurobiol Stress 2022; 16:100428. [PMID: 35036479 PMCID: PMC8749274 DOI: 10.1016/j.ynstr.2022.100428] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 12/20/2021] [Accepted: 01/03/2022] [Indexed: 12/12/2022] Open
Abstract
Excessive expression of fear responses in anticipation of threat occurs in anxiety, but understanding of underlying pathophysiological mechanisms is limited. Animal research indicates that threat-anticipatory defensive responses are dynamically organized by threat imminence and rely on conserved circuitry. Insight from basic neuroscience research in animals on threat imminence could guide mechanistic research in humans mapping abnormal function in this circuitry to aberrant defensive responses in pathological anxiety. 50 pediatric anxiety patients and healthy-comparisons (33 females) completed an instructed threat-anticipation task whereby cues signaled delivery of painful (threat) or non-painful (safety) thermal stimulation. Temporal changes in skin-conductance indexed anxiety effects on anticipatory responding as function of threat imminence. Multivariate network analyses of resting-state functional connectivity data from a subsample were used to identify intrinsic-function correlates of anticipatory-response dynamics, within a specific, distributed network derived from translational research on defensive responding. By considering threat imminence, analyses revealed specific anxiety effects. Importantly, pathological anxiety was associated with excessive deployment of anticipatory physiological response as threat, but not safety, outcomes became more imminent. Magnitude of increase in threat-anticipatory physiological responses corresponded with magnitude of intrinsic connectivity within a cortical-subcortical circuit. Moreover, more severe anxiety was associated with stronger associations between anticipatory physiological responding and connectivity that ventromedial prefrontal cortex showed with hippocampus and basolateral amygdala, regions implicated in animal models of anxiety. These findings link basic and clinical research, highlighting variations in intrinsic function in conserved defensive circuitry as a potential pathophysiological mechanism in anxiety.
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Affiliation(s)
- Rany Abend
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Sonia G. Ruiz
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, 20892, USA
- Department of Psychology, Yale University, New Haven, CT, 06511, USA
| | - Mira A. Bajaj
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Anita Harrewijn
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, 20892, USA
- Department of Psychology, Education and Child Studies, Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - Julia O. Linke
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Lauren Y. Atlas
- National Center for Complementary and Integrative Health, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Anderson M. Winkler
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Daniel S. Pine
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, 20892, USA
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20
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Duran JM, Sierra RO, Corredor K, Cardenas FP. Cathodal transcranial direct current stimulation on the prefrontal cortex applied after reactivation attenuates fear memories and prevent reinstatement after extinction. J Psychiatr Res 2021; 145:213-221. [PMID: 34929471 DOI: 10.1016/j.jpsychires.2021.12.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 12/04/2021] [Accepted: 12/11/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND In the last decade, pharmacological strategies targeting reconsolidation after memory retrieval have shown promising efforts to attenuate persistent memories and overcome fear recovery. However, most reconsolidation inhibiting agents have not been approved for human testing. While non-invasive neuromodulation can be considered an alternative approach to pharmacological treatments, there is a lack of evidence about the efficacy of these technologies when modifying memory traces via reactivation/reconsolidation mechanism. OBJECTIVE In this study, we evaluate the effect of cathodal (c-tDCS) and anodal (a-DCS) transcranial direct current stimulation applied after memory reactivation and extinction in rats. METHODS Male Wistar rats were randomly assigned into three groups: one sham group, one anodal tDCS group, and one cathodal tDCS group (500 μA, 20 min). Reconsolidation and extinction of fear memories were evaluated using a contextual fear conditioning. RESULTS Our results showed that c-tDCS and a-tDCS after memory reactivation can attenuate mild fear memories. However, only c-tDCS stimulation prevented both fear expression under strong fear learning and fear recovery after a reinstatement protocol without modification of learning rate or extinction retrieval. Nevertheless, the remote memories were resistant to modification through this type of neuromodulation. Our results are discussed considering the interaction between intrinsic excitability promoted by learning and memory retrieval and the electric field applied during tDCS. CONCLUSION These results point out some of the boundary conditions influencing the efficacy of tDCS in fear attenuation and open new ways for the development of noninvasive interventions aimed to control fear-related disorders via reconsolidation.
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Affiliation(s)
- Johanna M Duran
- Laboratory of Neuroscience and Behavior, Department of Psychology, Universidad de Los Andes, Colombia.
| | | | - Karen Corredor
- Laboratory of Neuroscience and Behavior, Department of Psychology, Universidad de Los Andes, Colombia
| | - Fernando P Cardenas
- Laboratory of Neuroscience and Behavior, Department of Psychology, Universidad de Los Andes, Colombia.
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21
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Faucher CR, Doherty RA, Philip NS, Harle ASM, Cole JJE, van ’t Wout-Frank M. Is there a neuroscience-based, mechanistic rationale for transcranial direct current stimulation as an adjunct treatment for posttraumatic stress disorder? Behav Neurosci 2021; 135:702-713. [PMID: 34338547 PMCID: PMC8648962 DOI: 10.1037/bne0000487] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
It is well-known that there is considerable variation in the effectiveness of evidence-based treatments for psychiatric disorders, and a continued need to improve the real-world effectiveness of these treatments. In the last 20+ years the examination of noninvasive brain stimulation techniques for psychiatric treatment has increased dramatically. However, in order to test these techniques for effective therapeutic use, it is critical to understand (a) (what are) the key neural circuits to engage for specific disorders or clusters of symptoms, and (b) (how) can these circuits be reached effectively using neurostimulation? Here we focus on the research toward the application of transcranial direct current stimulation (tDCS) for posttraumatic stress disorder (PTSD). tDCS is a portable and inexpensive technique that lends itself well to be combined with, and thus potentially augment, exposure-based treatment for PTSD. In this review, we discuss the behavioral model of threat and safety learning and memory as it relates to PTSD, the underlying neurobiology of PTSD, as well as the current understandings of tDCS action, including its limitations and opportunities. Through this lens, we summarize the research on the application of tDCS to modulated threat and safety learning and memory to date, and propose new directions for its future research. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Affiliation(s)
- C. R. Faucher
- Department of Psychiatry and Human Behavior, Warren Alpert Brown Medical School, Providence
- VA RR&D Center for Neurorestoration and Neurotechnology, VA Providence Healthcare System, Providence
- COBRE Center for Neuromodulation, Butler Hospital, Providence
| | - R. A. Doherty
- Department of Psychiatry and Human Behavior, Warren Alpert Brown Medical School, Providence
- VA RR&D Center for Neurorestoration and Neurotechnology, VA Providence Healthcare System, Providence
- COBRE Center for Neuromodulation, Butler Hospital, Providence
| | - N. S. Philip
- Department of Psychiatry and Human Behavior, Warren Alpert Brown Medical School, Providence
- VA RR&D Center for Neurorestoration and Neurotechnology, VA Providence Healthcare System, Providence
- COBRE Center for Neuromodulation, Butler Hospital, Providence
| | - A. S. M Harle
- Department of Psychiatry and Human Behavior, Warren Alpert Brown Medical School, Providence
- VA RR&D Center for Neurorestoration and Neurotechnology, VA Providence Healthcare System, Providence
- COBRE Center for Neuromodulation, Butler Hospital, Providence
| | - J. J. E. Cole
- Department of Psychiatry and Human Behavior, Warren Alpert Brown Medical School, Providence
- VA RR&D Center for Neurorestoration and Neurotechnology, VA Providence Healthcare System, Providence
- COBRE Center for Neuromodulation, Butler Hospital, Providence
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22
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Ghafoor U, Yang D, Hong KS. Neuromodulatory effects of HD-tACS/tDCS on the prefrontal cortex: A resting-state fNIRS-EEG study. IEEE J Biomed Health Inform 2021; 26:2192-2203. [PMID: 34757916 DOI: 10.1109/jbhi.2021.3127080] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Transcranial direct and alternating current stimulation (tDCS and tACS, respectively) can modulate human brain dynamics and cognition. However, these modalities have not been compared using multiple imaging techniques concurrently. In this study, 15 participants participated in an experiment involving two sessions with a gap of 10 d. In the first and second sessions, tACS and tDCS were administered to the participants. The anode for tDCS was positioned at point FpZ, and four cathodes were positioned over the left and right prefrontal cortices (PFCs) to target the frontal regions simultaneously. tDCS was administered with 1 mA current. tACS was supplied with a current of 1 mA (zero-to-peak value) at 10 Hz frequency. Stimulation was applied concomitantly with functional near-infrared spectroscopy and electroencephalography acquisitions in the resting-state. The statistical test showed significant alteration (p < 0.001) in the mean hemodynamic responses during and after tDCS and tACS periods. Between-group comparison revealed a significantly less (p < 0.001) change in the mean hemodynamic response caused by tACS compared with tDCS. As hypothesized, we successfully increased the hemodynamics in both left and right PFCs using tDCS and tACS. Moreover, a significant increase in alpha-band power (p < 0.01) and low beta band power (p < 0.05) due to tACS was observed after the stimulation period. Although tDCS is not frequency-specific, it increased but not significantly (p > 0.05) the powers of most bands including delta, theta, alpha, low beta, high beta, and gamma. These findings suggest that both hemispheres can be targeted and that both tACS and tDCS are equally effective in high-definition configurations, which may be of clinical relevance.
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23
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Offline tDCS modulates prefrontal-cortical-subcortical-cerebellar fear pathways in delayed fear extinction. Exp Brain Res 2021; 240:221-235. [PMID: 34694466 DOI: 10.1007/s00221-021-06248-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 10/15/2021] [Indexed: 11/27/2022]
Abstract
Transcranial direct current stimulation (tDCS) has been studied to enhance extinction-based treatments for anxiety disorders. However, the field shows conflicting results about its anxiolytic effect and only a few studies have observed the extinction of consolidated memories. We looked to study the effect of offline 1 mA tDCS over the right dorsolateral pre-frontal cortex across the fear pathways, in consolidated fear response during delayed extinction. Participants (N = 34 women) underwent in a two-day fear conditioning procedure. On day 1, participants were assigned to the control group (N = 18) or the tDCS group (N = 16) and went through a fear acquisition procedure. On day 2, the tDCS group received 20 min tDCS before extinction and while inside the MRI scanner. The control group completed the extinction procedure only. The tDCS session (for the tDCS group) and the fMRI scan (for both groups) were completed just on the second day. Univariate fMRI analysis showed stimulation-dependent activity during late extinction with the tDCS group showing decreased neural activity during the processing of threat cues (CS +) and increased activity during the processing of safety cues (CS -), in prefrontal, postcentral and paracentral regions, during late extinction. ROI to whole-brain psychophysiological interaction (PPI) analysis showed the tDCS effect on the connectivity between the left dorsolateral prefrontal cortex three cortical-amygdalo-hippocampal-cerebellar pathway clusters during the processing of the CS + in late extinction (TFCE corrected; p < 0.05). Increased neuronal activity during the processing of safety cues and stronger coupling during the processing of threat cues might be the mechanisms by which tDCS contributes to stimuli discrimination.
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24
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Roesmann K, Kroker T, Hein S, Rehbein M, Winker C, Leehr EJ, Klucken T, Junghöfer M. Transcranial Direct Current Stimulation of the Ventromedial Prefrontal Cortex Modulates Perceptual and Neural Patterns of Fear Generalization. BIOLOGICAL PSYCHIATRY: COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2021; 7:210-220. [PMID: 34403785 DOI: 10.1016/j.bpsc.2021.08.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 07/15/2021] [Accepted: 08/02/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Overgeneralization of fear is a pathogenic marker of anxiety and stress-related disorders and has been linked with perceptual discrimination deficits, reduced fear inhibition, and prefrontal hyporeactivity to safety-signaling stimuli. We aimed to examine whether behavioral and neural patterns of fear generalization are influenced by the fear-inhibiting ventromedial prefrontal cortex (vmPFC). METHODS Three groups of healthy participants received excitatory (n = 27), inhibitory (n = 26), or sham (n = 26) transcranial direct current stimulation of the vmPFC after a fear conditioning phase and before a fear generalization phase. We obtained, as dependent variables, fear ratings and unconditioned stimulus-expectancy ratings, perceptual aspects of fear generalization (perceptual discrimination), pupil dilations, and source estimations of event-related fields elicited by conditioned and generalization stimuli. RESULTS After inhibitory (compared with excitatory and sham) vmPFC stimulation, we observed reduced performance in perceptual discrimination and less negative inhibitory gradients in frontal structures at midlatency and late time intervals. Fear and unconditioned stimulus-expectancy ratings as well as pupil dilation remained unaffected by stimulation. CONCLUSIONS These findings reveal a causal contribution of vmPFC reactivity to generalization patterns and suggest that vmPFC hyporeactivity consequent on inhibitory vmPFC stimulation may serve as a model for pathological processes of fear generalization (reduced discrimination, impaired fear inhibition via frontal brain structures). This encourages further basic and clinical research on the potential of targeted brain stimulation to modulate fear generalization and overgeneralization.
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Affiliation(s)
- Kati Roesmann
- Institute for Biomagnetism and Biosignalanalysis, University of Münster, Münster, Germany; Institute for Clinical Psychology and Psychotherapy, University of Siegen, Siegen, Germany.
| | - Thomas Kroker
- Institute for Biomagnetism and Biosignalanalysis, University of Münster, Münster, Germany
| | - Sarah Hein
- Institute for Biomagnetism and Biosignalanalysis, University of Münster, Münster, Germany
| | - Maimu Rehbein
- Institute for Biomagnetism and Biosignalanalysis, University of Münster, Münster, Germany
| | - Constantin Winker
- Institute for Biomagnetism and Biosignalanalysis, University of Münster, Münster, Germany
| | | | - Tim Klucken
- Institute for Clinical Psychology and Psychotherapy, University of Siegen, Siegen, Germany
| | - Markus Junghöfer
- Institute for Biomagnetism and Biosignalanalysis, University of Münster, Münster, Germany
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25
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Doerig N, Seinsche RJ, Moisa M, Seifritz E, Ruff CC, Kleim B. Enhancing reappraisal of negative emotional memories with transcranial direct current stimulation. Sci Rep 2021; 11:14760. [PMID: 34285247 PMCID: PMC8292314 DOI: 10.1038/s41598-021-93647-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 06/17/2021] [Indexed: 12/19/2022] Open
Abstract
Reappraisal of negative memories and experiences is central for mental health and well-being. Deficiency of reappraisal lies at the core of many psychiatric disorders and is a key target for treatment. Here we apply transcranial direct current stimulation (tDCS) to enhance reappraisal of negative emotional memories. In a randomised, sham-controlled, 2 × 2 between-subject and double-blinded study, we applied single sessions of anodal and sham tDCS over the right dorsolateral prefrontal cortex (dlPFC) of 101 healthy participants while reappraising a personal negative memory or engaging in a control task. We hypothesised that (i) reappraisal decreases negative valence, arousal and evaluations of the memory and leads to improved decision making, and (ii) tDCS leads to additional changes in these reappraisal outcomes. In line with these hypotheses, participants’ personal memories were rated as less negative and less arousing following reappraisal. Anodal tDCS during reappraisal was associated with significant short-term reductions in negative valence compared to sham stimulation. Our results indicate that tDCS may enhance some of the effects of reappraisal. If replicated, our findings suggest potential benefits elicited by tDCS stimulation that may help optimise current treatment approaches for psychiatric disorders.
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Affiliation(s)
- Nadja Doerig
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital Zurich, Lenggstrasse 31, 8032, Zurich, Switzerland.,Department of Psychology, University of Zurich, Binzmühlesatrsse 14, Box 8, 8050, Zurich, Switzerland
| | - Rosa J Seinsche
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital Zurich, Lenggstrasse 31, 8032, Zurich, Switzerland.,Department of Psychology, University of Zurich, Binzmühlesatrsse 14, Box 8, 8050, Zurich, Switzerland.,Department of Psychotherapy and Systems Neuroscience, University of Giessen, Giessen, Germany
| | - Marius Moisa
- Department of Economics, Urich Center for Neuroeconomics (ZNE), University of Zurich, Zurich, Switzerland.,Zurich Neuroscience Center (ZNZ), University of Zurich, Zurich, Switzerland
| | - Erich Seifritz
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital Zurich, Lenggstrasse 31, 8032, Zurich, Switzerland.,Zurich Neuroscience Center (ZNZ), University of Zurich, Zurich, Switzerland
| | - Christian C Ruff
- Department of Economics, Urich Center for Neuroeconomics (ZNE), University of Zurich, Zurich, Switzerland.,Zurich Neuroscience Center (ZNZ), University of Zurich, Zurich, Switzerland
| | - Birgit Kleim
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital Zurich, Lenggstrasse 31, 8032, Zurich, Switzerland. .,Department of Psychology, University of Zurich, Binzmühlesatrsse 14, Box 8, 8050, Zurich, Switzerland. .,Zurich Neuroscience Center (ZNZ), University of Zurich, Zurich, Switzerland.
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26
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Michaels TI, Stone E, Singal S, Novakovic V, Barkin RL, Barkin S. Brain reward circuitry: The overlapping neurobiology of trauma and substance use disorders. World J Psychiatry 2021; 11:222-231. [PMID: 34168969 PMCID: PMC8209534 DOI: 10.5498/wjp.v11.i6.222] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 04/14/2021] [Accepted: 05/20/2021] [Indexed: 02/06/2023] Open
Abstract
Mental health symptoms secondary to trauma exposure and substance use disorders (SUDs) co-occur frequently in both clinical and community samples. The possibility of a shared aetiology remains an important question in translational neuroscience. Advancements in genetics, basic science, and neuroimaging have led to an improved understanding of the neural basis of these disorders, their frequent comorbidity and high rates of relapse remain a clinical challenge. This project aimed to conduct a review of the field's current understanding regarding the neural circuitry underlying posttraumatic stress disorder and SUD. A comprehensive review was conducted of available published literature regarding the shared neurobiology of these disorders, and is summarized in detail, including evidence from both animal and clinical studies. Upon summarizing the relevant literature, this review puts forth a hypothesis related to their shared neurobiology within the context of fear processing and reward cues. It provides an overview of brain reward circuitry and its relation to the neurobiology, symptomology, and phenomenology of trauma and substance use. This review provides clinical insights and implications of the proposed theory, including the potential development of novel pharmacological and therapeutic treatments to address this shared neurobiology. Limitations and extensions of this theory are discussed to provide future directions and insights for this shared phenomena.
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Affiliation(s)
- Timothy I Michaels
- Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY 11004, United States
- Department of Psychiatry, The Donald and Barbara Zucker School of Medicine, Hofstra/Northwell, Glen Oaks, NY 11004, United States
| | - Emily Stone
- Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY 11004, United States
| | - Sonali Singal
- Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY 11004, United States
| | - Vladan Novakovic
- Department of Psychiatry, The Donald and Barbara Zucker School of Medicine, Hofstra/Northwell, Glen Oaks, NY 11004, United States
| | - Robert L Barkin
- Department of Anesthesiology, Rush University Medical College, Chicago, IL 60612, United States
| | - Stacy Barkin
- Private Practice, Scottsdale, AZ 85250, United States
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27
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Smits FM, Schutter DJLG, van Honk J, Geuze E. Does non-invasive brain stimulation modulate emotional stress reactivity? Soc Cogn Affect Neurosci 2021; 15:23-51. [PMID: 31993648 PMCID: PMC7171378 DOI: 10.1093/scan/nsaa011] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 12/09/2019] [Accepted: 01/08/2020] [Indexed: 12/14/2022] Open
Abstract
Excessive emotional responses to stressful events can detrimentally affect psychological functioning and mental health. Recent studies have provided evidence that non-invasive brain stimulation (NBS) targeting the prefrontal cortex (PFC) can affect the regulation of stress-related emotional responses. However, the reliability and effect sizes have not been systematically analyzed. In the present study, we reviewed and meta-analyzed the effects of repetitive transcranial magnetic (rTMS) and transcranial direct current stimulation (tDCS) over the PFC on acute emotional stress reactivity in healthy individuals. Forty sham-controlled single-session rTMS and tDCS studies were included. Separate random effects models were performed to estimate the mean effect sizes of emotional reactivity. Twelve rTMS studies together showed no evidence that rTMS over the PFC influenced emotional reactivity. Twenty-six anodal tDCS studies yielded a weak beneficial effect on stress-related emotional reactivity (Hedges’ g = −0.16, CI95% = [−0.33, 0.00]). These findings suggest that a single session of NBS is insufficient to induce reliable, clinically significant effects but also provide preliminary evidence that specific NBS methods can affect emotional reactivity. This may motivate further research into augmenting the efficacy of NBS protocols on stress-related processes.
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Affiliation(s)
- Fenne M Smits
- Brain Research & Innovation Centre, Ministry of Defence, Lundlaan 1, 3584 EZ, Utrecht, The Netherlands.,Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Dennis J L G Schutter
- Experimental Psychology, Helmholtz Institute, Utrecht University, Heidelberglaan 1, 3584 CS, Utrecht, The Netherlands
| | - Jack van Honk
- Experimental Psychology, Helmholtz Institute, Utrecht University, Heidelberglaan 1, 3584 CS, Utrecht, The Netherlands.,Department of Psychiatry and Mental Health, University of Cape Town, Observatory, 7925, Cape Town, South Africa.,Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Observatory, 7925, Cape Town, South Africa
| | - Elbert Geuze
- Brain Research & Innovation Centre, Ministry of Defence, Lundlaan 1, 3584 EZ, Utrecht, The Netherlands.,Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
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28
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Memories are not written in stone: Re-writing fear memories by means of non-invasive brain stimulation and optogenetic manipulations. Neurosci Biobehav Rev 2021; 127:334-352. [PMID: 33964307 DOI: 10.1016/j.neubiorev.2021.04.036] [Citation(s) in RCA: 58] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 03/29/2021] [Accepted: 04/29/2021] [Indexed: 11/21/2022]
Abstract
The acquisition of fear associative memory requires brain processes of coordinated neural activity within the amygdala, prefrontal cortex (PFC), hippocampus, thalamus and brainstem. After fear consolidation, a suppression of fear memory in the absence of danger is crucial to permit adaptive coping behavior. Acquisition and maintenance of fear extinction critically depend on amygdala-PFC projections. The robust correspondence between the brain networks encompassed cortical and subcortical hubs involved into fear processing in humans and in other species underscores the potential utility of comparing the modulation of brain circuitry in humans and animals, as a crucial step to inform the comprehension of fear mechanisms and the development of treatments for fear-related disorders. The present review is aimed at providing a comprehensive description of the literature on recent clinical and experimental researches regarding the noninvasive brain stimulation and optogenetics. These innovative manipulations applied over specific hubs of fear matrix during fear acquisition, consolidation, reconsolidation and extinction allow an accurate characterization of specific brain circuits and their peculiar interaction within the specific fear processing.
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29
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Marković V, Vicario CM, Yavari F, Salehinejad MA, Nitsche MA. A Systematic Review on the Effect of Transcranial Direct Current and Magnetic Stimulation on Fear Memory and Extinction. Front Hum Neurosci 2021; 15:655947. [PMID: 33828472 PMCID: PMC8019721 DOI: 10.3389/fnhum.2021.655947] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 02/25/2021] [Indexed: 12/13/2022] Open
Abstract
Anxiety disorders are among the most prevalent mental disorders. Present treatments such as cognitive behavior therapy and pharmacological treatments show only moderate success, which emphasizes the importance for the development of new treatment protocols. Non-invasive brain stimulation methods such as repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS) have been probed as therapeutic option for anxiety disorders in recent years. Mechanistic information about their mode of action, and most efficient protocols is however limited. Here the fear extinction model can serve as a model of exposure therapies for studying therapeutic mechanisms, and development of appropriate intervention protocols. We systematically reviewed 30 research articles that investigated the impact of rTMS and tDCS on fear memory and extinction in animal models and humans, in clinical and healthy populations. The results of these studies suggest that tDCS and rTMS can be efficient methods to modulate fear memory and extinction. Furthermore, excitability-enhancing stimulation applied over the vmPFC showed the strongest potential to enhance fear extinction. We further discuss factors that determine the efficacy of rTMS and tDCS in the context of the fear extinction model and provide future directions to optimize parameters and protocols of stimulation for research and treatment.
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Affiliation(s)
- Vuk Marković
- Department of Psychology and Neurosciences, Leibniz Research Centre for Working Environment and Human Factors, Dortmund, Germany
- International Graduate School of Neuroscience, Ruhr-University-Bochum, Bochum, Germany
| | | | - Fatemeh Yavari
- Department of Psychology and Neurosciences, Leibniz Research Centre for Working Environment and Human Factors, Dortmund, Germany
| | - Mohammad A. Salehinejad
- Department of Psychology and Neurosciences, Leibniz Research Centre for Working Environment and Human Factors, Dortmund, Germany
| | - Michael A. Nitsche
- International Graduate School of Neuroscience, Ruhr-University-Bochum, Bochum, Germany
- Department of Neurology, University Medical Hospital Bergmannsheil, Bochum, Germany
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30
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Abend R, Bajaj MA, Harrewijn A, Matsumoto C, Michalska KJ, Necka E, Palacios-Barrios EE, Leibenluft E, Atlas LY, Pine DS. Threat-anticipatory psychophysiological response is enhanced in youth with anxiety disorders and correlates with prefrontal cortex neuroanatomy. J Psychiatry Neurosci 2021; 46:E212-E221. [PMID: 33703868 PMCID: PMC8061736 DOI: 10.1503/jpn.200110] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 08/27/2020] [Accepted: 09/14/2020] [Indexed: 12/27/2022] Open
Abstract
Background Threat anticipation engages neural circuitry that has evolved to promote defensive behaviours; perturbations in this circuitry could generate excessive threat-anticipation response, a key characteristic of pathological anxiety. Research into such mechanisms in youth faces ethical and practical limitations. Here, we use thermal stimulation to elicit pain-anticipatory psychophysiological response and map its correlates to brain structure among youth with anxiety and healthy youth. Methods Youth with anxiety (n = 25) and healthy youth (n = 25) completed an instructed threat-anticipation task in which cues predicted nonpainful or painful thermal stimulation; we indexed psychophysiological response during the anticipation and experience of pain using skin conductance response. High-resolution brain-structure imaging data collected in another visit were available for 41 participants. Analyses tested whether the 2 groups differed in their psychophysiological cue-based pain-anticipatory and pain-experience responses. Analyses then mapped psychophysiological response magnitude to brain structure. Results Youth with anxiety showed enhanced psychophysiological response specifically during anticipation of painful stimulation (b = 0.52, p = 0.003). Across the sample, the magnitude of psychophysiological anticipatory response correlated negatively with the thickness of the dorsolateral prefrontal cortex (pFWE < 0.05); psychophysiological response to the thermal stimulation correlated positively with the thickness of the posterior insula (pFWE < 0.05). Limitations Limitations included the modest sample size and the cross-sectional design. Conclusion These findings show that threat-anticipatory psychophysiological response differentiates youth with anxiety from healthy youth, and they link brain structure to psychophysiological response during pain anticipation and experience. A focus on threat anticipation in research on anxiety could delineate relevant neural circuitry.
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Affiliation(s)
- Rany Abend
- From the Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD (Abend, Bajaj, Harrewijn, Matsumoto, Leibenluft, Pine); the Department of Psychology, University of California Riverside, Riverside, CA (Michalaska); the 3 National Center for Complementary and Integrative Health, National Institutes of Health, Bethesda, MD (Necka, Atlas); and the 1 Department of Psychology, University of Pittsburgh, Pittsburgh, PA (Palacios-Barrios)
| | - Mira A Bajaj
- From the Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD (Abend, Bajaj, Harrewijn, Matsumoto, Leibenluft, Pine); the Department of Psychology, University of California Riverside, Riverside, CA (Michalaska); the 3 National Center for Complementary and Integrative Health, National Institutes of Health, Bethesda, MD (Necka, Atlas); and the 1 Department of Psychology, University of Pittsburgh, Pittsburgh, PA (Palacios-Barrios)
| | - Anita Harrewijn
- From the Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD (Abend, Bajaj, Harrewijn, Matsumoto, Leibenluft, Pine); the Department of Psychology, University of California Riverside, Riverside, CA (Michalaska); the 3 National Center for Complementary and Integrative Health, National Institutes of Health, Bethesda, MD (Necka, Atlas); and the 1 Department of Psychology, University of Pittsburgh, Pittsburgh, PA (Palacios-Barrios)
| | - Chika Matsumoto
- From the Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD (Abend, Bajaj, Harrewijn, Matsumoto, Leibenluft, Pine); the Department of Psychology, University of California Riverside, Riverside, CA (Michalaska); the 3 National Center for Complementary and Integrative Health, National Institutes of Health, Bethesda, MD (Necka, Atlas); and the 1 Department of Psychology, University of Pittsburgh, Pittsburgh, PA (Palacios-Barrios)
| | - Kalina J Michalska
- From the Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD (Abend, Bajaj, Harrewijn, Matsumoto, Leibenluft, Pine); the Department of Psychology, University of California Riverside, Riverside, CA (Michalaska); the 3 National Center for Complementary and Integrative Health, National Institutes of Health, Bethesda, MD (Necka, Atlas); and the 1 Department of Psychology, University of Pittsburgh, Pittsburgh, PA (Palacios-Barrios)
| | - Elizabeth Necka
- From the Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD (Abend, Bajaj, Harrewijn, Matsumoto, Leibenluft, Pine); the Department of Psychology, University of California Riverside, Riverside, CA (Michalaska); the 3 National Center for Complementary and Integrative Health, National Institutes of Health, Bethesda, MD (Necka, Atlas); and the 1 Department of Psychology, University of Pittsburgh, Pittsburgh, PA (Palacios-Barrios)
| | - Esther E Palacios-Barrios
- From the Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD (Abend, Bajaj, Harrewijn, Matsumoto, Leibenluft, Pine); the Department of Psychology, University of California Riverside, Riverside, CA (Michalaska); the 3 National Center for Complementary and Integrative Health, National Institutes of Health, Bethesda, MD (Necka, Atlas); and the 1 Department of Psychology, University of Pittsburgh, Pittsburgh, PA (Palacios-Barrios)
| | - Ellen Leibenluft
- From the Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD (Abend, Bajaj, Harrewijn, Matsumoto, Leibenluft, Pine); the Department of Psychology, University of California Riverside, Riverside, CA (Michalaska); the 3 National Center for Complementary and Integrative Health, National Institutes of Health, Bethesda, MD (Necka, Atlas); and the 1 Department of Psychology, University of Pittsburgh, Pittsburgh, PA (Palacios-Barrios)
| | - Lauren Y Atlas
- From the Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD (Abend, Bajaj, Harrewijn, Matsumoto, Leibenluft, Pine); the Department of Psychology, University of California Riverside, Riverside, CA (Michalaska); the 3 National Center for Complementary and Integrative Health, National Institutes of Health, Bethesda, MD (Necka, Atlas); and the 1 Department of Psychology, University of Pittsburgh, Pittsburgh, PA (Palacios-Barrios)
| | - Daniel S Pine
- From the Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD (Abend, Bajaj, Harrewijn, Matsumoto, Leibenluft, Pine); the Department of Psychology, University of California Riverside, Riverside, CA (Michalaska); the 3 National Center for Complementary and Integrative Health, National Institutes of Health, Bethesda, MD (Necka, Atlas); and the 1 Department of Psychology, University of Pittsburgh, Pittsburgh, PA (Palacios-Barrios)
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Van Schuerbeek A, Vanderhasselt MA, Baeken C, Pierre A, Smolders I, Van Waes V, De Bundel D. Effects of repeated anodal transcranial direct current stimulation on auditory fear extinction in C57BL/6J mice. Brain Stimul 2021; 14:250-260. [PMID: 33454396 DOI: 10.1016/j.brs.2021.01.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 01/07/2021] [Accepted: 01/08/2021] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Trauma-based psychotherapy is a first line treatment for post-traumatic stress disorder (PTSD) but not all patients achieve long-term remission. Transcranial direct current stimulation (tDCS) received considerable attention as a neuromodulation method that may improve trauma-based psychotherapy. OBJECTIVE We explored the effects of repeated anodal tDCS over the prefrontal cortex (PFC) on fear extinction in mice as a preclinical model for trauma-based psychotherapy. METHODS We performed auditory fear conditioning with moderate or high shock intensity on C57BL6/J mice. Next, mice received anodal tDCS (0.2 mA, 20 min) or sham stimulation over the PFC twice daily for five consecutive days. Extinction training was performed by repeatedly exposing mice to the auditory cue the day after the last stimulation session. Early and late retention of extinction were evaluated one day and three weeks after extinction training respectively. RESULTS We observed no significant effect of tDCS on the acquisition or retention of fear extinction in mice subjected to fear conditioning with moderate intensity. However, when the intensity of fear conditioning was high, tDCS significantly lowered freezing during the acquisition of extinction, regardless of the extinction protocol. Moreover, when tDCS was combined with a strong extinction protocol, we also observed a significant improvement of early extinction recall. Finally, we found that tDCS reduced generalized fear induced by contextual cues when the intensity of conditioning is high and extinction training limited. CONCLUSIONS Our data provide a rationale to further explore anodal tDCS over the PFC as potential support for trauma-based psychotherapy for PTSD.
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Affiliation(s)
- Andries Van Schuerbeek
- Department of Pharmaceutical Sciences, Research Group Experimental Pharmacology, Center for Neurosciences (C4N), Vrije Universiteit Brussel, Laarbeeklaan 103, 1090, Brussels, Belgium.
| | - Marie-Anne Vanderhasselt
- Department of Experimental Clinical and Health Psychology, Universiteit Gent - C, Heymanslaan 10, 9000, Gent, Belgium.
| | - Chris Baeken
- Department of Psychiatry and Medical Psychology, Ghent Experimental Psychiatry (GHEP) Lab, Universiteit Gent - C, Heymanslaan 10, 9000, Gent, Belgium; Department of Psychiatry, UZBrussel, Laarbeeklaan 103, 1090, Brussels, Belgium.
| | - Anouk Pierre
- Department of Pharmaceutical Sciences, Research Group Experimental Pharmacology, Center for Neurosciences (C4N), Vrije Universiteit Brussel, Laarbeeklaan 103, 1090, Brussels, Belgium
| | - Ilse Smolders
- Department of Pharmaceutical Sciences, Research Group Experimental Pharmacology, Center for Neurosciences (C4N), Vrije Universiteit Brussel, Laarbeeklaan 103, 1090, Brussels, Belgium.
| | - Vincent Van Waes
- Laboratory of Clinical and Integrative Neuroscience, EA481, Université Bourgogne Franche-Comté, 19 rue Ambroise Paré, 25030, Besancon, Cedex, France.
| | - Dimitri De Bundel
- Department of Pharmaceutical Sciences, Research Group Experimental Pharmacology, Center for Neurosciences (C4N), Vrije Universiteit Brussel, Laarbeeklaan 103, 1090, Brussels, Belgium.
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Ney LJ, Vicario CM, Nitsche MA, Felmingham KL. Timing matters: Transcranial direct current stimulation after extinction learning impairs subsequent fear extinction retention. Neurobiol Learn Mem 2020; 177:107356. [PMID: 33278591 DOI: 10.1016/j.nlm.2020.107356] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 11/01/2020] [Accepted: 11/29/2020] [Indexed: 02/09/2023]
Abstract
BACKGROUND Transcranial direct current stimulation (tDCS) has previously been shown to improve fear extinction learning and retention when administered prior to or during extinction learning. This study investigates whether tDCS immediately following extinction learning improves efficacy of extinction memory retention. METHODS 30 participants completed a 2-day fear learning and extinction paradigm, where they acquired fear of a stimulus conditioned to an aversive electric shock on day 1. Extinction learning occurred on day 1, with tDCS or sham tDCS administered immediately following the learning phase. Participants returned for a second day test of extinction memory recall. Skin conductance was measured as the primary outcome. RESULTS/CONCLUSIONS Participants in the tDCS group showed impaired fear extinction retention on day 2, marked by significant generalisation of fear to the safety stimulus. This contrasts with earlier studies showing improved extinction retention when stimulation occurred during encoding of extinction learning, compared to immediate consolidation as in our study. These findings may have important implications for the use of tDCS during exposure therapy for anxiety and trauma disorders.
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Affiliation(s)
- Luke J Ney
- School of Psychology, University of Tasmania, Australia.
| | - Carmelo M Vicario
- University of Messina, Department of Scienze Cognitive Della Formazione e Degli Studi Culturali, Messina, Italy.
| | - Michael A Nitsche
- Deptartment of Psychology and Neurosciences, Leibniz Research Centre for Working Environment and Human Factors, Dortmund, Germany; Department of Neurology, University Medical Hospital Bergmannsheil, Bochum, Germany
| | - Kim L Felmingham
- School of Psychological Sciences, University of Melbourne, Australia
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Galli G, Miniussi C, Pellicciari MC. Transcranial electric stimulation as a neural interface to gain insight on human brain functions: current knowledge and future perspective. Soc Cogn Affect Neurosci 2020; 17:4-14. [PMID: 32756871 DOI: 10.1093/scan/nsaa099] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 05/12/2020] [Accepted: 07/11/2020] [Indexed: 11/12/2022] Open
Abstract
The use of brain-stimulation approaches in social and affective science has greatly increased over the last two decades. The interest in social factors has grown along with technological advances in brain research. Transcranial electric stimulation (tES) is a research tool that allows scientists to establish contributory causality between brain functioning and social behaviour, therefore deepening our understanding of the social mind. Preliminary evidence is also starting to demonstrate that tES, either alone or in combination with pharmacological or behavioural interventions, can alleviate the symptomatology of individuals with affective or social cognition disorders. This review offers an overview of the application of tES in the field of social and affective neuroscience. We discuss issues and challenges related to this application and suggest avenue for future basic and translational research.
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Affiliation(s)
- Giulia Galli
- Department of Psychology, Kingston University, Penrhyn Road, Kingston Upon Thames, KT1 2EE, United Kingdom
| | - Carlo Miniussi
- Center for Mind/Brain Sciences - CIMeC, University of Trento, Corso Bettini, 31, 38068 Rovereto, TN Italy
| | - Maria Concetta Pellicciari
- UniCamillus - Saint Camillus International University of Health Sciences, via di Sant'Alessandro 8, 00131, Rome, Italy
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Abend R, Gold AL, Britton JC, Michalska KJ, Shechner T, Sachs JF, Winkler AM, Leibenluft E, Averbeck BB, Pine DS. Anticipatory Threat Responding: Associations With Anxiety, Development, and Brain Structure. Biol Psychiatry 2020; 87:916-925. [PMID: 31955915 PMCID: PMC7211142 DOI: 10.1016/j.biopsych.2019.11.006] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 10/16/2019] [Accepted: 11/07/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND While translational theories link neurodevelopmental changes in threat learning to pathological anxiety, findings from studies in patients inconsistently support these theories. This inconsistency may reflect difficulties in studying large patient samples with wide age ranges using consistent methods. A dearth of imaging data in patients further limits translational advances. We address these gaps through a psychophysiology and structural brain imaging study in a large sample of patients across the lifespan. METHODS A total of 351 participants (8-50 years of age; 209 female subjects; 195 healthy participants and 156 medication-free, treatment-seeking patients with anxiety) completed a differential threat conditioning and extinction paradigm that has been validated in pediatric and adult populations. Skin conductance response indexed psychophysiological response to conditioned (CS+, CS-) and unconditioned threat stimuli. Structural magnetic resonance imaging data were available for 250 participants. Analyses tested anxiety and age associations with psychophysiological response in addition to associations between psychophysiology and brain structure. RESULTS Regardless of age, patients and healthy comparison subjects demonstrated comparable differential threat conditioning and extinction. The magnitude of skin conductance response to both conditioned stimulus types differentiated patients from comparison subjects and covaried with dorsal prefrontal cortical thickness; structure-response associations were moderated by anxiety and age in several regions. Unconditioned responding was unrelated to anxiety and brain structure. CONCLUSIONS Rather than impaired threat learning, pathological anxiety involves heightened skin conductance response to potential but not immediately present threats; this anxiety-related potentiation of anticipatory responding also relates to variation in brain structure. These findings inform theoretical considerations by highlighting anticipatory response to potential threat in anxiety.
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Affiliation(s)
- Rany Abend
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland.
| | - Andrea L. Gold
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI; Pediatric Anxiety Research Center, Bradley Hospital, Riverside, RI
| | | | | | - Tomer Shechner
- Psychology Department, University of Haifa, Haifa, Israel
| | | | - Anderson M. Winkler
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD
| | - Ellen Leibenluft
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD
| | - Bruno B. Averbeck
- Laboratory of Neuropsychology, National Institute of Mental Health, National Institutes of
Health, Bethesda, MD
| | - Daniel S. Pine
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD
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Anodal transcranial direct current stimulation over the ventromedial prefrontal cortex enhances fear extinction in healthy humans: A single blind sham-controlled study. Brain Stimul 2020; 13:489-491. [DOI: 10.1016/j.brs.2019.12.022] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Accepted: 12/22/2019] [Indexed: 11/24/2022] Open
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tDCS increases anxiety reactivity to intentional worry. J Psychiatr Res 2020; 120:34-39. [PMID: 31629997 DOI: 10.1016/j.jpsychires.2019.10.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 10/11/2019] [Accepted: 10/11/2019] [Indexed: 12/15/2022]
Abstract
While considerable experimental research has examined the impact of transcranial direct current stimulation (tDCS) on a range of cognitive processes associated with emotional pathology, the impact of tDCS on worry has been comparatively neglected. Given that anxiety pathology is characterised by motivated engagement in worry, and that frontal tDCS has the capacity to enhance goal-oriented cognition, it is important to examine whether tDCS would increase or ameliorate the cognitive and emotional effects of worry. In the current study we examined how tDCS influenced the anxiety response to worry, and the frequency of negative intrusive thoughts. We additionally examined whether stimulation delivered in isolation, or in combination with a mindful-focus task would augment the effects of tDCS. Ninety-seven (75 female) healthy participants received either active or sham anodal tDCS to the left dorsolateral prefrontal cortex, delivered either in isolation or concurrently with a mindful task (four conditions). The frequency of negative thought intrusions was assessed before and after a period of instructed worry, and state anxiety was assessed across the study. Active tDCS was associated with significantly greater elevation in anxiety in response to the worry induction. No effects were observed on the frequency of negative thought intrusions, and the combined delivery of tDCS with the concurrent mindful task did not alter the pattern of observed effects. While inviting replication in a high anxious sample, the present results highlight the possibility that tDCS may interact with motivated engagement in negative patterns of cognition, such as worry, to produce greater emotional reactivity.
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Adams T, Wesley M, Rippey C. Transcranial Electric Stimulation and the Extinction of Fear. THE CLINICAL PSYCHOLOGIST 2020; 73:5-14. [PMID: 35153300 PMCID: PMC8830604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
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Prefrontal but not cerebellar tDCS attenuates renewal of extinguished conditioned eyeblink responses. Neurobiol Learn Mem 2019; 170:107137. [PMID: 31838223 DOI: 10.1016/j.nlm.2019.107137] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 12/02/2019] [Accepted: 12/11/2019] [Indexed: 01/28/2023]
Abstract
An extended neural network is known to underlie extinction learning. As yet, comparatively little is known about the possible contribution of the cerebellum and the dorsolateral prefrontal cortex (dlPFC). In the present study, transcranial direct current stimulation (tDCS) was used to provide further evidence that the dlPFC and the cerebellum are involved in extinction-related processes. A total of 100 young and healthy human participants were randomly assigned to one of five stimulation groups: (1) anodal tDCS of the cerebellum, (2) cathodal tDCS of the cerebellum, (3) anodal tDCS of the dlPFC, (4) cathodal tDCS of the dlPFC, and (5) sham stimulation. Participants underwent delay eyeblink conditioning using an A-B-A/B renewal paradigm. Two different colors of background light (orange and blue) were used as contexts. On day 1, acquisition of conditioned eyeblink responses was performed in context A, followed by extinction in context B. tDCS was applied during extinction. On day 2, extinction recall was tested in contexts A and B with higher incidence of conditioned responses in acquisition context A compared to extinction context B indicating renewal effects. All groups showed significant effects of acquisition of conditioned eyeblink responses and significant effects of extinction. There was no significant difference in extinction between stimulation groups. During extinction recall, renewal effects were present in all groups, except the group which had received anodal tDCS of the dlPFC during extinction. In the present study, no direct effects of dlPFC or cerebellar tDCS were demonstrated on extinction. Anodal tDCS of the dlPFC, but not the cerebellum, resulted in delayed effects on context-related processes of extinction, possibly explained by shifting attention away from the context and towards the conditioned stimulus during extinction learning. Anodal tDCS of the dlPFC attenuated context-related recall of learned aversive responses. Effects of tDCS, however, were weak and need to be confirmed in future studies. Lack of cerebellar tDCS effects do not exclude a possible role of the cerebellum in extinction-related processes, and are likely explained by methodological limitations of cerebellar tDCS.
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Ganho-Ávila A, Gonçalves ÓF, Guiomar R, Boggio PS, Asthana MK, Krypotos AM, Almeida J. The effect of cathodal tDCS on fear extinction: A cross-measures study. PLoS One 2019; 14:e0221282. [PMID: 31532768 PMCID: PMC6750569 DOI: 10.1371/journal.pone.0221282] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 08/02/2019] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Extinction-based procedures are often used to inhibit maladaptive fear responses. However, because extinction procedures show efficacy limitations, transcranial direct current stimulation (tDCS) has been suggested as a promising add-on enhancer. OBJECTIVE In this study, we tested how cathodal tDCS over the right dorsolateral prefrontal cortex affects extinction and tried to unveil the processes at play that boost the effectiveness of extinction procedures and its translational potential to the treatment of anxiety disorders. METHODS We implemented a fear conditioning paradigm whereby 41 healthy women (mean age = 20.51 ± 5.0) were assigned to either cathodal tDCS (n = 27) or sham tDCS (n = 16). Fear responses were measured with self-reports, autonomic responses, and implicit avoidance tendencies. RESULTS Cathodal tDCS shows no statistically significant effect in extinction, according to self-reports, and seems to even negatively affect fear conditioned skin conductance responses. However, one to three months after the tDCS session and extinction, we found a group difference in the action tendencies towards the neutral stimuli (F (1, 41) = 12.04, p = .001, ηp2 = .227), with the cathodal tDCS group (as opposed to the sham group) showing a safety learning (a positive bias towards the CS-), with a moderate effect size. This suggests that cathodal tDCS may foster stimuli discrimination, leading to a decreased generalization effect. DISCUSSION Cathodal tDCS may have enhanced long-term distinctiveness between threatening cues and perceptively similar neutral cues through a disambiguation process of the value of the neutral stimuli-a therapeutic target in anxiety disorders. Future studies should confirm these results and extend the study of cathodal tDCS effect on short term avoidance tendencies.
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Affiliation(s)
- Ana Ganho-Ávila
- Proaction Laboratory, Cognitive and Behavior Center for Research and Intervention Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal
- Neuropsychophysiology Lab, CiPsi, School of Psychology, University of Minho, Braga, Portugal
| | - Óscar F. Gonçalves
- Neuropsychophysiology Lab, CiPsi, School of Psychology, University of Minho, Braga, Portugal
- Spaulding Neuromodulation Center, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Raquel Guiomar
- Proaction Laboratory, Cognitive and Behavior Center for Research and Intervention Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal
| | - Paulo Sérgio Boggio
- Social and Cognitive Neuroscience Laboratory and Developmental Disorders Program, Center for Health and Biological Sciences, Mackenzie Presbyterian University, São Paulo, Brazil
| | - Manish Kumar Asthana
- Social and Cognitive Neuroscience Laboratory and Developmental Disorders Program, Center for Health and Biological Sciences, Mackenzie Presbyterian University, São Paulo, Brazil
- Department of Humanities and Social Sciences, Indian Institute of Technology, Roorkee, India
| | | | - Jorge Almeida
- Proaction Laboratory, Cognitive and Behavior Center for Research and Intervention Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal
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Clancy KJ, Baisley SK, Albizu A, Kartvelishvili N, Ding M, Li W. Lasting connectivity increase and anxiety reduction via transcranial alternating current stimulation. Soc Cogn Affect Neurosci 2019; 13:1305-1316. [PMID: 30380131 PMCID: PMC6277743 DOI: 10.1093/scan/nsy096] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 10/28/2018] [Indexed: 12/12/2022] Open
Abstract
Growing evidence of transcranial alternating current stimulation (tACS) modulating intrinsic neural oscillations has spawned interest in applying tACS to treat psychiatric disorders associated with aberrant neural oscillations. The alpha rhythmic activity is known to dominate neural oscillations at the awake, restful state, while attenuated resting-state alpha activity has been implicated in anxious mood. Administering repeated alpha-frequency tACS (α-tACS; at individual peak alpha frequency; 8–12 Hz) over four consecutive days (in the experiment group, sham stimulation in the control group), we demonstrated immediate and lasting (>24 h) increases in resting-state posterior ➔frontal connectivity in the alpha frequency, quantified by Granger causality. Critically, this connectivity enhancement was accompanied by sustained reductions in both anxious arousal and negative perception of sensory stimuli. Resting-state alpha power also increased, albeit only transiently, reversing to the baseline level within 24 h after tACS. Therefore, the lasting enhancement of long-range alpha connectivity due to α-tACS differs from local alpha activity that is nonetheless conserved, highlighting the adaptability of alpha oscillatory networks. In light of increasing recognition of large-scale network dysfunctions as a transdiagnostic pathophysiology of psychiatric disorders, this enduring connectivity plasticity, along with the behavioral improvements, paves the way for tACS applications in clinical interventions of psychiatric ‘oscillopathies’.
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Affiliation(s)
- Kevin J Clancy
- Department of Psychology, Florida State University, Tallahassee, FL, USA
| | - Sarah K Baisley
- Department of Psychology, Florida State University, Tallahassee, FL, USA
| | - Alejandro Albizu
- Department of Psychology, Florida State University, Tallahassee, FL, USA
| | | | - Mingzhou Ding
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, FL, USA
| | - Wen Li
- Department of Psychology, Florida State University, Tallahassee, FL, USA
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Marques RC, Vieira L, Marques D, Cantilino A. Transcranial magnetic stimulation of the medial prefrontal cortex for psychiatric disorders: a systematic review. REVISTA BRASILEIRA DE PSIQUIATRIA (SAO PAULO, BRAZIL : 1999) 2019; 41:447-457. [PMID: 31166547 PMCID: PMC6796817 DOI: 10.1590/1516-4446-2019-0344] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 01/31/2019] [Indexed: 03/11/2023]
Abstract
OBJECTIVE The medial prefrontal cortex (mPFC) is a highly connected cortical region that acts as a hub in major large-scale brain networks. Its dysfunction is associated with a number of psychiatric disorders, such as schizophrenia, autism, depression, substance use disorder (SUD), obsessive-compulsive disorder (OCD), and anxiety disorders. Repetitive transcranial magnetic stimulation (rTMS) studies targeting the mPFC indicate that it may be a useful therapeutic resource in psychiatry due to its selective modulation of this area and connected regions. METHODS This review examines six mPFC rTMS trials selected from 697 initial search results. We discuss the main results, technical and methodological details, safety, tolerability, and localization strategies. RESULTS Six different protocols were identified, including inhibitory (1 Hz) and excitatory (5, 10, and 20 Hz) frequencies applied therapeutically to patient populations diagnosed with major depressive disorder, OCD, autistic spectrum disorder, SUD, specific phobia, and post-traumatic stress disorder (PTSD). In the OCD and acrophobia trials, rTMS significantly reduced symptoms compared to placebo. CONCLUSION These protocols were considered safe and add interesting new evidence to the growing body of mPFC rTMS literature. However, the small number and low methodological quality of the studies indicate the need for further research.
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Affiliation(s)
- Rodrigo C. Marques
- Departamento de Neuropsiquiatria, Universidade Federal de Pernambuco (UFPE), Recife, PE, Brazil
- Programa de Pós-Graduação em Neuropsiquiatria e Ciências do Comportamento, UFPE, Recife, PE, Brazil
| | - Larissa Vieira
- Programa de Pós-Graduação em Neuropsiquiatria e Ciências do Comportamento, UFPE, Recife, PE, Brazil
- Laboratório de Neurociência Aplicada, UFPE, Recife, PE, Brazil
| | - Déborah Marques
- Programa de Pós-Graduação em Neuropsiquiatria e Ciências do Comportamento, UFPE, Recife, PE, Brazil
- Laboratório de Neurociência Aplicada, UFPE, Recife, PE, Brazil
| | - Amaury Cantilino
- Departamento de Neuropsiquiatria, Universidade Federal de Pernambuco (UFPE), Recife, PE, Brazil
- Programa de Pós-Graduação em Neuropsiquiatria e Ciências do Comportamento, UFPE, Recife, PE, Brazil
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Tan SZK, Sheng V, Chan YS, Lim LW. Eternal sunshine of the neuromodulated mind: Altering fear memories through neuromodulation. Exp Neurol 2019; 314:9-19. [PMID: 30639183 DOI: 10.1016/j.expneurol.2019.01.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 12/27/2018] [Accepted: 01/09/2019] [Indexed: 11/17/2022]
Abstract
Anxiety disorders pose one of the greatest threats to mental health. Modern treatment methods exist but are hindered by relapse, toxicity, and low efficacy. The use of neuromodulation to treat anxiety disorders has shown promising results, yet its underpinning mechanisms remain poorly understood. In this review, we make the case for further development of neuromodulation techniques to alter fear memories, with particular regard to future clinical applications in treating anxiety disorders. We start by briefly summarizing the neural circuitry of fear while identifying the pros and cons of possible neuromodulation targets. We then highlight recent advances in neuromodulation techniques that have been used to alter fear memories. Next, we apply a novel network-based approach to elucidate possible mechanisms of neuromodulation which may disrupt the consolidation of fear memory. Finally, we emphasize the need for more systematic neuromodulation studies on animal models and the developing brain. Overall, we aim to provide an integrated framework for future action, identifying key research priorities that must be addressed before effective neuromodulation-based treatments can be developed for practical use.
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Affiliation(s)
- Shawn Zheng Kai Tan
- School of Biomedical Sciences, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region
| | - Victoria Sheng
- School of Biological Sciences, The University of Hong Kong, Hong Kong Special Administrative Region
| | - Ying-Shing Chan
- School of Biomedical Sciences, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region
| | - Lee Wei Lim
- School of Biomedical Sciences, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region.
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Attenuating anger and aggression with neuromodulation of the vmPFC: A simultaneous tDCS-fMRI study. Cortex 2018; 109:156-170. [PMID: 30343211 DOI: 10.1016/j.cortex.2018.09.010] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 08/20/2018] [Accepted: 09/13/2018] [Indexed: 12/22/2022]
Abstract
Angry outbursts during interpersonal provocations may lead to violence and prevails in numerous pathological conditions. In the anger-infused Ultimatum Game (aiUG), unfair monetary offers accompanied by written provocations induce anger. Rejection of such offers relates to aggression, whereas acceptance to anger regulation. We previously demonstrated the involvement of the ventro-medial prefrontal cortex (vmPFC) in accepting unfair offers and attenuating anger during an aiUG, suggestive of its role in anger regulation. Here, we aimed to enhance anger regulation by facilitating vmPFC activity during anger induction, using anodal transcranial direct current stimulation (tDCS) and simultaneously with functional Magnetic Resonance Imaging to validate modulation of vmPFC activity. In a cross-over, sham-controlled, double-blind study, participants (N = 25) were each scanned twice, counterbalancing sham and active tDCS applied during administration of the aiUG. Outcome measures included the effect of active versus sham stimulation on vmPFC activity, unfair offers' acceptance rates, self-reported anger, and aggressive behavior in a subsequent reactive aggression paradigm. Results indicate that active stimulation led to increased vmPFC activity during the processing of unfair offers, increased acceptance rates of these offers, and mitigated the increase in self-reported anger following the aiUG. We also noted a decrease in subsequent aggressive behavior following active stimulation, but only when active stimulation was conducted in the first experimental session. Finally, an exploratory finding indicated that participants with a stronger habitual tendency to use suppression as an emotion regulation strategy, reported less anger following the aiUG in the active compared to sham stimulation conditions. Findings support a potential causal link between vmPFC functionality and the experience and expression of anger, supporting vmPFC's role in anger regulation, and providing a promising avenue for reducing angry and aggressive outbursts during interpersonal provocations in various psychiatric and medical conditions.
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Modulating what is and what could have been: The effect of transcranial direct current stimulation on the evaluation of attained and unattained decision outcomes. COGNITIVE AFFECTIVE & BEHAVIORAL NEUROSCIENCE 2018; 17:1176-1185. [PMID: 29019148 DOI: 10.3758/s13415-017-0541-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The affective evaluation of decision outcomes, whether attained (e.g., disappointment) or based on the conscious realization that a decision made differently would have led to a better or worse outcome (e.g., regret), greatly influence future decisions. Prior research has demonstrated a role of the medial and orbitofrontal cortex (M/OFC) in decision valuation and the experience of regret and relief. Here we examined whether inhibitory transcranial direct current stimulation (tDCS) could dampen the experience of decision-induced affect, with a focus on regret and relief. Thirty-eight participants completed a previously used gambling task and were asked to rate their happiness with attained outcomes of a chosen gamble before and after being shown unattained, counterfactual outcomes (i.e., what would have happened had they selected the other gamble). The difference in happiness rating before and after revealing these unattained counterfactual outcomes was taken as a measure of regret (negative shift) or relief (positive shift). During this task, 20 participants received 2 mA cathodal tDCS over EEG coordinate Fp1 for 20 minutes, and 18 participants received sham stimulation over the same location. Linear mixed-model results showed that, compared to sham, participants who received cathodal tDCS reported less intense emotions in response to attained as well as counterfactual outcomes. These findings were not due to the groups differing in the gambles they selected or attained monetary outcomes, demonstrating that tDCS can modulate decision-induced (counterfactual) affect. This may have implications for the ability to modulate value-based decision-making using brain stimulation techniques more broadly.
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Hadoush H, Al-Jarrah M, Khalil H, Al-Sharman A, Al-Ghazawi S. Bilateral anodal transcranial direct current stimulation effect on balance and fearing of fall in patient with Parkinson's disease. NeuroRehabilitation 2018; 42:63-68. [PMID: 29400676 DOI: 10.3233/nre-172212] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND A number of studies have examined the therapeutic effects of transcranial direct current stimulation (tDCS) stimulation in patients with Parkinson's disease (PD) using unilateral anodal stimulation applied either on the left or right brain hemisphere. However, PD involves the dysfunctions of both brain hemispheres. OBJECTIVES This study investigates the therapeutic effects of bilateral anodal tDCS stimulation on balance and fear of fall outcomes in patient with PD. METHODS Eighteen patients with idiopathic PD completed the study. Ten sessions of bilateral anodal tDCS stimulation were applied over the FC1 and FC2 targeting both pre-frontal and motor areas for each patient, 5 sessions per week for 2 weeks. Berg Balance Scale (BBS), Falls Efficacy Scale-International (FES-I), and 10 meters walk test (10mwt) were applied before and after the stimulation therapy. RESULTS Paired t-test showed a significant increase in the BBS scores and decrease in the FES-I scores after the bilateral tDCS compared with those scores before tDCS therapy (P < 0.05), as well improvement in the 10mwt scores. CONCLUSION Our data showed that bilateral anodal tDCS serves as an effective, safe and feasible approach for rehabilitation of patients with PD with the issues related to balance and fear of fall.
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Affiliation(s)
- Hikmat Hadoush
- Department of Rehabilitation Sciences, Faculty of Applied Medical Sciences, Jordan University of Science and Technology (JUST), Irbid, Jordan
| | - Muhammed Al-Jarrah
- Department of Rehabilitation Sciences, Faculty of Applied Medical Sciences, Jordan University of Science and Technology (JUST), Irbid, Jordan
| | - Hanan Khalil
- Department of Rehabilitation Sciences, Faculty of Applied Medical Sciences, Jordan University of Science and Technology (JUST), Irbid, Jordan
| | - Alham Al-Sharman
- Department of Rehabilitation Sciences, Faculty of Applied Medical Sciences, Jordan University of Science and Technology (JUST), Irbid, Jordan
| | - Sadik Al-Ghazawi
- Department of Neurology Faculty of Medicine, University of Science and Technology (JUST), Irbid, Jordan
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Abend R, van 't Wout M. Commentary: Augmentation of Fear Extinction by Transcranial Direct Current Stimulation (tDCS). Front Behav Neurosci 2018; 12:121. [PMID: 30002621 PMCID: PMC6031735 DOI: 10.3389/fnbeh.2018.00121] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2018] [Accepted: 06/04/2018] [Indexed: 11/13/2022] Open
Affiliation(s)
- Rany Abend
- Emotion and Development Branch, National Institute of Mental Health, Bethesda, MD, United States
| | - Mascha van 't Wout
- Department of Psychiatry and Human Behavior, Alpert Brown Medical School, Brown University, Providence, RI, United States.,Center for Neurorestoration and Neurotechnology, Providence VA Medical Center, Providence, RI, United States
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Abend R, Sar-El R, Gonen T, Jalon I, Vaisvaser S, Bar-Haim Y, Hendler T. Modulating Emotional Experience Using Electrical Stimulation of the Medial-Prefrontal Cortex: A Preliminary tDCS-fMRI Study. Neuromodulation 2018; 22:884-893. [PMID: 29741803 DOI: 10.1111/ner.12787] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Revised: 03/23/2018] [Accepted: 03/26/2018] [Indexed: 12/28/2022]
Abstract
OBJECTIVES Implicit regulation of emotions involves medial-prefrontal cortex (mPFC) regions exerting regulatory control over limbic structures. Diminished regulation relates to aberrant mPFC functionality and psychopathology. Establishing means of modulating mPFC functionality could benefit research on emotion and its dysregulation. Here, we tested the capacity of transcranial direct current stimulation (tDCS) targeting mPFC to modulate subjective emotional states by facilitating implicit emotion regulation. MATERIALS AND METHODS Stimulation was applied concurrently with functional magnetic resonance imaging to validate its neurobehavioral effect. Sixteen participants were each scanned twice, counterbalancing active and sham tDCS application, while undergoing negative mood induction (clips featuring negative vs. neutral contents). Effects of stimulation on emotional experience were assessed using subjective and neural measures. RESULTS Subjectively, active stimulation led to significant reduction in reported intensity of experienced emotions to negatively valenced (p = 0.005) clips but not to neutral clips (p > 0.99). Active stimulation further mitigated a rise in stress levels from pre- to post-induction (sham: p = 0.004; active: p = 0.15). Neurally, stimulation increased activation in mPFC regions associated with implicit emotion regulation (ventromedial-prefrontal cortex; subgenual anterior-cingulate cortex, sgACC), and in ventral striatum, a core limbic structure (all ps < 0.05). Stimulation also altered functional connectivity (assessed using whole-brain psycho-physiological interaction) between these regions, and with additional limbic regions. Stimulation-induced sgACC activation correlated with reported emotion intensity and depressive symptoms (rs > 0.64, ps < 0.018), suggesting individual differences in stimulation responsivity. CONCLUSIONS Results of this study indicate the potential capacity of tDCS to facilitate brain activation in mPFC regions underlying implicit regulation of emotion and accordingly modulate subjective emotional experiences.
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Affiliation(s)
- Rany Abend
- School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel.,Functional Brain Center, Wohl Institute for Advanced Imaging, Sourasky Medical Center, Tel Aviv, Israel.,Section on Development and Affective Neuroscience, National Institute of Mental Health, Bethesda, MD, USA
| | - Roy Sar-El
- Functional Brain Center, Wohl Institute for Advanced Imaging, Sourasky Medical Center, Tel Aviv, Israel.,Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tal Gonen
- Functional Brain Center, Wohl Institute for Advanced Imaging, Sourasky Medical Center, Tel Aviv, Israel
| | - Itamar Jalon
- Functional Brain Center, Wohl Institute for Advanced Imaging, Sourasky Medical Center, Tel Aviv, Israel.,Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | - Sharon Vaisvaser
- Functional Brain Center, Wohl Institute for Advanced Imaging, Sourasky Medical Center, Tel Aviv, Israel
| | - Yair Bar-Haim
- School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel.,Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | - Talma Hendler
- School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel.,Functional Brain Center, Wohl Institute for Advanced Imaging, Sourasky Medical Center, Tel Aviv, Israel.,Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
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Yue J, Shi L, Lin X, Khan MZ, Shi J, Lu L. Behavioral interventions to eliminate fear responses. SCIENCE CHINA-LIFE SCIENCES 2018; 61:625-632. [PMID: 29744783 DOI: 10.1007/s11427-018-9294-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 02/26/2018] [Indexed: 02/07/2023]
Abstract
Fear memory underlies anxiety-related disorders, including posttraumatic stress disorder (PTSD). PTSD is a fear-based disorder, characterized by difficulties in extinguishing the learned fear response and maintaining extinction. Currently, the first-line treatment for PTSD is exposure therapy, which forms an extinction memory to compete with the original fear memory. However, the extinguished fear often returns under numerous circumstances, suggesting that novel methods are needed to eliminate fear memory or facilitate extinction memory. This review discusses research that targeted extinction and reconsolidation to manipulate fear memory. Recent studies indicate that sleep is an active state that can regulate memory processes. We also discuss the influence of sleep on fear memory. For each manipulation, we briefly summarize the neural mechanisms that have been identified in human studies. Finally, we highlight potential limitations and future directions in the field to better translate existing interventions to clinical settings.
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Affiliation(s)
- Jingli Yue
- Peking University Sixth Hospital, Peking University Institute of Mental Health, Key of Mental Health, Ministry of Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, 100191, China
| | - Le Shi
- Peking University Sixth Hospital, Peking University Institute of Mental Health, Key of Mental Health, Ministry of Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, 100191, China.,National Institute on Drug Dependence, Peking University, Beijing, 100191, China
| | - Xiao Lin
- Peking University Sixth Hospital, Peking University Institute of Mental Health, Key of Mental Health, Ministry of Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, 100191, China.,Peking-Tsinghua Center for Life Sciences and PKU-IDG/McGovern Institute for Brain Research, Peking University, Beijing, 100871, China
| | - Muhammad Zahid Khan
- National Institute on Drug Dependence, Peking University, Beijing, 100191, China
| | - Jie Shi
- National Institute on Drug Dependence, Peking University, Beijing, 100191, China
| | - Lin Lu
- Peking University Sixth Hospital, Peking University Institute of Mental Health, Key of Mental Health, Ministry of Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, 100191, China. .,National Institute on Drug Dependence, Peking University, Beijing, 100191, China. .,Peking-Tsinghua Center for Life Sciences and PKU-IDG/McGovern Institute for Brain Research, Peking University, Beijing, 100871, China.
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Neural Oscillatory Correlates for Conditioning and Extinction of Fear. Biomedicines 2018; 6:biomedicines6020049. [PMID: 29724018 PMCID: PMC6027138 DOI: 10.3390/biomedicines6020049] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 04/23/2018] [Accepted: 04/28/2018] [Indexed: 12/27/2022] Open
Abstract
The extinction of conditioned-fear represents a hallmark of current exposure therapies as it has been found to be impaired in people suffering from post-traumatic stress disorder (PTSD) and anxiety. A large body of knowledge focusing on psychophysiological animal and human studies suggests the involvement of key brain structures that interact via neural oscillations during the acquisition and extinction of fear. Consequently, neural oscillatory correlates of such mechanisms appear relevant regarding the development of novel therapeutic approaches to counterbalance abnormal activity in fear-related brain circuits, which, in turn, could alleviate fear and anxiety symptoms. Here, we provide an account of state-of-the-art neural oscillatory correlates for the conditioning and extinction of fear, and also deal with recent translational efforts aimed at fear extinction by neural oscillatory modulation.
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Dittert N, Hüttner S, Polak T, Herrmann MJ. Augmentation of Fear Extinction by Transcranial Direct Current Stimulation (tDCS). Front Behav Neurosci 2018; 12:76. [PMID: 29922133 PMCID: PMC5996916 DOI: 10.3389/fnbeh.2018.00076] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 04/06/2018] [Indexed: 12/16/2022] Open
Abstract
Although posttraumatic stress disorder (PTSD; DSM-V 309.82) and anxiety disorders (DSM-V 300.xx) are widely spread mental disorders, the effectiveness of their therapy is still unsatisfying. Non-invasive brain-stimulation techniques like transcranial direct current stimulation (tDCS) might be an option to improve extinction learning, which is a main functional factor of exposure-based therapy for anxiety disorders. To examine this hypothesis, we used a fear conditioning paradigm with female faces as conditioned stimuli (CS) and a 95-dB female scream as unconditioned stimulus (UCS). We aimed to perform a tDCS of the ventromedial prefrontal cortex (vmPFC), which is mainly involved in the control of extinction-processes. Therefore, we applied two 4 × 4 cm electrodes approximately at the EEG-positions F7 and F8 and used a direct current of 1.5 mA. The 20-min stimulation was started during a 10-min break between acquisition and extinction and went on overall extinction-trials. The healthy participants were randomly assigned in two double-blinded process into two sham stimulation and two verum stimulation groups with opposite current flow directions. To measure the fear reactions, we used skin conductance responses (SCR) and subjective ratings. We performed a generalized estimating equations model for the SCR to assess the impact of tDCS and current flow direction on extinction processes for all subjects that showed a successful conditioning (N = 84). The results indicate that tDCS accelerates early extinction processes with a significantly faster loss of CS+/CS– discrimination. The discrimination loss was driven by a significant decrease in reaction toward the CS+ as well as an increase in reaction toward the CS– in the tDCS verum groups, whereas the sham groups showed no significant reaction changes during this period. Therefore, we assume that tDCS of the vmPFC can be used to enhance early extinction processes successfully. But before it should be tested in a clinical context further investigation is needed to assess the reason for the reaction increase on CS–. If this negative side effect can be avoided, tDCS may be a tool to improve exposure-based anxiety therapies.
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Affiliation(s)
- Natalie Dittert
- Department of Psychiatry, Psychosomatics, and Psychotherapy, Center of Mental Health, University Hospital Würzburg, Würzburg, Germany
| | - Sandrina Hüttner
- Department of Psychiatry, Psychosomatics, and Psychotherapy, Center of Mental Health, University Hospital Würzburg, Würzburg, Germany
| | - Thomas Polak
- Department of Psychiatry, Psychosomatics, and Psychotherapy, Center of Mental Health, University Hospital Würzburg, Würzburg, Germany
| | - Martin J Herrmann
- Department of Psychiatry, Psychosomatics, and Psychotherapy, Center of Mental Health, University Hospital Würzburg, Würzburg, Germany
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