Does transcranial direct current stimulation to the prefrontal cortex affect social behavior? A meta-analysis

Non-Invasive Brain Stimulation for the Modulation of Aggressive Behavior-A Systematic Review of Randomized Sham-Controlled Studies

INTRO

Aggressive behavior represents a significant public health issue, with relevant social, political, and security implications. Non-invasive brain stimulation (NIBS) techniques may modulate aggressive behavior through stimulation of the prefrontal cortex.

AIMS

To review research on the effectiveness of NIBS to alter aggression, discuss the main findings and potential limitations, consider the specifics of the techniques and protocols employed, and discuss clinical implications.

METHODS

A systematic review of the literature available in the PubMed database was carried out, and 17 randomized sham-controlled studies investigating the effectiveness of NIBS techniques on aggression were included. Exclusion criteria included reviews, meta-analyses, and articles not referring to the subject of interest or not addressing cognitive and emotional modulation aims.

CONCLUSIONS

The reviewed data provide promising evidence for the beneficial effects of tDCS, conventional rTMS, and cTBS on aggression in healthy adults, forensic, and clinical samples. The specific stimulation target is a key factor for the success of stimulation on aggression modulation. rTMS and cTBS showed opposite effects on aggression compared with tDCS. However, due to the heterogeneity of stimulation protocols, experimental designs, and samples, we cannot exclude other factors that may play a confounding role.

Hostility bias or sadness bias in excluded individuals: does anodal transcranial direct current stimulation of right VLPFC vs. left DLPFC have a mitigating effect?

Exclusion has multiple adverse effects on individual's well-being. It induces anger and hostile cognitions leading to aggressive behavior. The purpose of this study was to test whether exclusion would affect recognition of anger on ambivalent faces of the excluders. We hypothesized that exclusion would elicit more anger encoding (hostility bias) than inclusion, but this effect would be mitigated by anodal tDCS of right VLPFC or left DLPFC-regions engaged in negative affect regulation. Participants (N = 96) were recognizing emotions (anger, sadness, happiness) on ambiguous faces of individuals who-as they were told-liked them or not. Results showed that exclusion induced more sadness bias. tDCS to VLPFC decreased anger and increased sadness recognition on excluders' faces compared with includers' faces, expressing a mixture of these two emotions. Additionally, stimulation to VLPFC and DLPFC decreased latencies for faces expressing sadness (sad-angry and happy-sad) but increased for happy-angry faces. Stimulation to VLPFC also increased reaction time to excluders faces while stimulation of DLPFC decreased reaction latency to includers faces. Results were discussed with the reference to the form of exclusion, motivational mechanism affected by disliking but also to lateralization (valence vs. arousal theory) and cortical regions engaged in encoding sadness after a threat to belonging.

Combinatorial approaches for treating neuropsychiatric social impairment

Social behaviour is an essential component of human life and deficits in social function are seen across multiple psychiatric conditions with high morbidity. However, there are currently no FDA-approved treatments for social dysfunction. Since social cognition and behaviour rely on multiple signalling processes acting in concert across various neural networks, treatments aimed at social function may inherently require a combinatorial approach. Here, we describe the social neurobiology of the oxytocin and endocannabinoid signalling systems as well as translational evidence for their use in treating symptoms in the social domain. We leverage this systems neurobiology to propose a network-based framework that involves pharmacology, psychotherapy, non-invasive brain stimulation and social skills training to combinatorially target trans-diagnostic social impairment. Lastly, we discuss the combined use of oxytocin and endocannabinoids within our proposed framework as an illustrative strategy to treat specific aspects of social function. Using this framework provides a roadmap for actionable treatment strategies for neuropsychiatric social impairment. This article is part of the theme issue 'Interplays between oxytocin and other neuromodulators in shaping complex social behaviours'.

More focal, less heterogeneous? Multi-level meta-analysis of cathodal high-definition transcranial direct current stimulation effects on language and cognition

High-definition transcranial direct current stimulation (HD-tDCS) is a relatively focal, novel non-invasive brain stimulation method with the potential to investigate the causal contributions of specific cortical brain regions to language and cognition. Studies with HD-tDCS typically employ a 4 × 1 electrode design with a single central target electrode surrounded by four return electrodes, among which return current intensity is evenly distributed. With cathodal HD-tDCS, neural excitability in the target region is assumed to be reduced, which offers interesting perspectives for neuropsychological research and interventions. This multi-level meta-analysis compiles published studies using cathodal HD-tDCS in 4 × 1 configuration to modulate cognition and behavior. Regarding HD-tDCS, 77 effect sizes were gathered from 11 eligible reports. We extended this database with 52 effect sizes from 11 comparable reports using conventional tDCS with cathodal polarity. We observed no significant overall effect and no moderation by within-study and between-study variables in HD. In the extended analysis, results suggested a non-linear moderation of cathodal tDCS effects by intensity, driven by negative effect sizes at 1.5 mA. However, studies varied tremendously in task parameters, outcomes, and even technical parameters. Interestingly, within-study heterogeneity exceeded between-study heterogeneity in the present sample, and moderators hardly reduced the residual heterogeneity. Across domains and configurations, both positive and negative effect sizes are possible. We discuss the findings in relation to conventional cathodal tDCS and the framework of polarity specificity. Fundamental aspects of cathodal HD-tDCS are still to be addressed in future research.

When brain stimulation backfires: the effects of prefrontal cortex stimulation on impulsivity

Transcranial direct current stimulation (tDCS) can sometimes cause the opposite of its intended effect. These reverse effects may be related in part to individual differences in personality and neurochemistry. Previous studies have demonstrated that dopamine levels can impact the effects of tDCS. In the present study, 124 healthy participants took the UPPS impulsive behavior scale. Participants then underwent a single, randomized anodal or sham tDCS session on the prefrontal cortex. While the effects of tDCS were still active, they performed the Stop Signal Task, a measure of state impulsivity. tDCS was associated with increased errors on this task in people who had higher scores on the UPPS in two facets of impulsivity that correlate with dopamine levels. tDCS had no effects on people who are low in trait impulsivity. These results suggest that the reverse effects of tDCS could be associated with inter-individual differences in personality and neurochemistry.

Effects of non-invasive brain stimulation on visual perspective taking: A meta-analytic study

Visual perspective taking (VPT) is a critical ability required by complex social interaction. Non-invasive brain stimulation (NIBS) has been increasingly used to examine the causal relationship between brain activity and VPT, yet with heterogeneous results. In the current study, we conducted two meta-analyses to examine the effects of NIBS of the right temporoparietal junction (rTPJ) or dorsomedial prefrontal cortex (dmPFC) on VPT, respectively. We performed a comprehensive literature search to identify qualified studies and computed the standardized effect size (ES) for each combination of VPT level (Level-1: visibility judgment; Level-2: mental rotation) and perspective (self and other). Thirteen studies (rTPJ: 12 studies, 23 ESs; dmPFC: 4 studies, 14 ESs) were included in the meta-analyses. Random-effects models were used to generate the overall effects. Subgroup analyses for distinct VPT conditions were also performed. We found that rTPJ stimulation significantly improved participants' visibility judgment from the allocentric perspective, whereas its effects on other VPT conditions are negligible. Stimulation of dmPFC appeared to influence Level-1 performance from the egocentric perspective, although this finding was only based on a small number of studies. Notably, contrary to some theoretical models, we did not find strong evidence that these regions are involved in Level-2 VPT with a higher requirement of mental rotation. These findings not only advance our understanding of the causal roles of the rTPJ and dmPFC in VPT, but also reveal that the efficacy of NIBS on VPT is relatively small. Additionally, researchers should also be cautious about the potential publication bias and selective reporting.

Does non-invasive brain stimulation modulate emotional stress reactivity?

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, CI_95% = [−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.

High-definition transcranial direct current stimulation of the lateral occipital cortex influences figure-ground perception

Prior work has shown that the lateral occipital cortex (LO) is involved in recognition of objects and their parts, as well as segregation of that object (or "figure") from its background. No studies, though, have examined how LO's functioning is influenced by non-invasive brain stimulation, particularly during a figure-ground perception task. The present study tested whether high-definition transcranial direct current stimulation (HD-tDCS) to right LO influences the effects of familiarity on figure-ground perception. Following 20 min of offline anodal stimulation (or sham), participants viewed masked stimuli consisting of two regions separated by a vertical border and were asked to report which region they perceived as figure. One region was the "critical" region, which either depicted a portion of a familiar object ("Familiar" stimuli), or a familiar object with its parts rearranged into a novel configuration ("Part-rearranged" stimuli). Previous research using these stimuli has found higher reports of the critical region as figure for Familiar vs. Part-rearranged displays, demonstrating the effect of familiarity on figure assignment. The results of the current study showed that HD-tDCS to right LO significantly influenced this typical behavioral pattern. Specifically, stimulation (vs. sham) increased reports of the critical region as figure for Part-rearranged stimuli, bringing perception of these displays up to the level of the Familiar stimuli. We interpret this finding as evidence that stimulation of right LO increased participants' reliance on the familiarity of the parts in their figure-ground judgements-a finding consistent with and extending previous research showing that LO is indeed sensitive to object parts. This is the first study showing that HD-tDCS to LO can influence the effects of familiarity on figure-ground perception.

Transcranial electric stimulation as a neural interface to gain insight on human brain functions: current knowledge and future perspective

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.

Evidence-based Umbrella Review of Cognitive Effects of Prefrontal tDCS

Transcranial direct current stimulation (tDCS) is a non-invasive brain stimulation technique, which has been increasingly used as an investigational tool in neuroscience. In social and affective neuroscience research, the prefrontal cortex has been primarily targeted, since this brain region is critically involved in complex psychobiological processes subserving both Șhotș and Școldș domains. Although several studies have suggested that prefrontal tDCS can enhance neuropsychological outcomes, meta-analyses have reported conflicting results. Therefore, we aimed to assess the available evidence by performing an umbrella review of meta-analyses. We evaluated the effects of prefrontal active vs sham tDCS on different domains of cognition among healthy and neuropsychiatric individuals. A MeaSurement Tool to Assess Systematic Reviews 2 was employed to evaluate the quality of meta-analyses, and the GRADE system was employed to grade the quality of evidence of every comparison from each meta-analysis. PubMed/MEDLINE, PsycINFO and the Cochrane Database of Systematic Reviews were searched, and 11 meta-analyses were included resulting in 55 comparisons. Only 16 comparisons reported significant effects favoring tDCS, but 13 of them had either very low or low quality of evidence. Of the remaining 39 comparisons which reported non-significant effects, 38 had either very low or low quality of evidence. Meta-analyses were rated as having critically low and low quality. Among several reasons to explain these findings, the lack of consensus and reproducibility in tDCS research is discussed.

Transforming treatments for schizophrenia: Virtual reality, brain stimulation and social cognition

Schizophrenia is characterised by delusions, hallucinations, anhedonia and apathy; while impairments in social cognition are often less recognised. Poor social cognition can lead to difficulties in obtaining and maintaining employment, academic progression, interpersonal relationships, and community functioning. Current interventions are highly intensive, require significant resources and have only modest effects on functional outcomes. Virtual reality (VR) and non-invasive brain stimulation (NIBS) may have a role in addressing these limitations. VR allows treatments that are potentially more accessible, less delivery intensive, and have higher ecological validity. While NIBS is able to directly modulate activity in social brain areas in order to promote neuroplasticity, strengthen neural connections and enhance brain function related to social cognitive behaviours. Therefore, the combination of VR and NIBS may allow for more efficient and transferrable interventions than those currently available. This review will explore the potential role of these technologies in the treatment of social cognitive impairment.

Affective evaluation of others' altruistic decisions under risk and ambiguity

Gratitude arises when one is the target of an altruistic decision, particularly when this decision incurs cost to the agent. Here we examined how individuals evaluate others' altruistic decisions under risky (uncertainty with known probabilities) and ambiguous (uncertainty with unknown probabilities) costs and respond with gratitude and reciprocity. Participants played an interactive game in an fMRI scanner in which they would receive painful electric shocks. An anonymous co-player either intentionally (Human conditions) or unintentionally (Computer conditions) decided whether to help the participant reduce half of the pain by undertaking an amount of pain (i.e., cost) with varying level of uncertainty (Certain vs. Risky vs. Ambiguous). Participants could then transfer monetary points to the co-player knowing that the co-player was unaware of this transfer. Behaviorally, monetary allocation and gratitude rating increased as the uncertainty level of cost increased in Human conditions; these effects were reduced in Computer conditions. The effect of cost uncertainty on gratitude was mediated by the perceived kind intention behind the help. FMRI revealed both shared and differential neurocognitive substrates for evaluating the benefactor's altruistic decisions under risk and ambiguity: both were associated with fear- and anxiety-related processes, involving right lateral orbitofrontal cortex and anterior insula; ambiguity additionally recruited mentalizing- and conflict monitoring-related processes, involving dorsal medial prefrontal cortex and dorsal anterior cingulate cortex. These findings underscore the crucial role of social uncertainty perception in the generation of gratitude.

Both High Cognitive Load and Transcranial Direct Current Stimulation Over the Right Inferior Frontal Cortex Make Truth and Lie Responses More Similar

Deception scholars have argued that increasing the liar’s cognitive system artificially can produce deception cues. However, if too much load is imposed, the truth tellers’ performance can also be impaired. To address this issue, we designed a veracity task that incorporated a secondary task to increase cognitive load gradually. Also, because deception has been associated with activity in the inferior frontal cortex (IFC), we examined the influence of transcranial direct current stimulation (tDCS) of the IFC on performance. During stimulation, participants truthfully or deceptively indicated whether each of a number of statements shown on screen was true or not. Higher load decreased recall but not general compliance or response times (RTs). Truthful trials yielded higher compliance rates and faster RTs than deceptive trials except for the highest load level. Anodal right stimulation decreased compliance in truthful trials when participants were not overloaded. Truth telling was more vulnerable to cognitive load and tDCS than lying.