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Casalvera A, Goodwin M, Lynch KG, Teferi M, Patel M, Grillon C, Ernst M, Balderston NL. Threat of shock increases distractor susceptibility during the short-term maintenance of visual information. Soc Cogn Affect Neurosci 2024; 19:nsae036. [PMID: 38809714 PMCID: PMC11173208 DOI: 10.1093/scan/nsae036] [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: 02/02/2024] [Revised: 04/18/2024] [Accepted: 05/29/2024] [Indexed: 05/31/2024] Open
Abstract
Elevated arousal in anxiety is thought to affect attention control. To test this, we designed a visual short-term memory (VSTM) task to examine distractor suppression during periods of threat and no-threat. We hypothesized that threat would impair performance when subjects had to filter out large numbers of distractors. The VSTM task required subjects to attend to one array of squares while ignoring a separate array. The number of target and distractor squares varied systematically, with high (four squares) and low (two squares) target and distractor conditions. This study comprised two separate experiments. Experiment 1 used startle responses and white noise as to directly measure threat-induced anxiety. Experiment 2 used BOLD to measure brain responses. For Experiment 1, subjects showed significantly larger startle responses during threat compared to safe period, supporting the validity of the threat manipulation. For Experiment 2, we found that accuracy was affected by threat, such that the distractor load negatively impacted accuracy only in the threat condition. We also found threat-related differences in parietal cortex activity. Overall, these findings suggest that threat affects distractor susceptibility, impairing filtering of distracting information. This effect is possibly mediated by hyperarousal of parietal cortex during threat.
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Affiliation(s)
- Abigail Casalvera
- Center for Neuromodulation in Depression and Stress, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
| | - Madeline Goodwin
- Section on the Neurobiology of Fear and Anxiety, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - Kevin G Lynch
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
| | - Marta Teferi
- Center for Neuromodulation in Depression and Stress, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
| | - Milan Patel
- Center for Neuromodulation in Depression and Stress, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
| | - Christian Grillon
- Section on the Neurobiology of Fear and Anxiety, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - Monique Ernst
- Section on the Neurobiology of Fear and Anxiety, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - Nicholas L Balderston
- Center for Neuromodulation in Depression and Stress, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
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2
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Teferi M, Gura H, Patel M, Casalvera A, Lynch KG, Makhoul W, Deng ZD, Oathes DJ, Sheline YI, Balderston NL. Intermittent theta-burst stimulation to the right dorsolateral prefrontal cortex may increase potentiated startle in healthy individuals. Neuropsychopharmacology 2024:10.1038/s41386-024-01871-w. [PMID: 38740902 DOI: 10.1038/s41386-024-01871-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 04/16/2024] [Accepted: 04/16/2024] [Indexed: 05/16/2024]
Abstract
Repetitive transcranial magnetic stimulation (rTMS) treatment protocols targeting the right dlPFC have been effective in reducing anxiety symptoms comorbid with depression. However, the mechanism behind these effects is unclear. Further, it is unclear whether these results generalize to non-depressed individuals. We conducted a series of studies aimed at understanding the link between anxiety potentiated startle and the right dlPFC, following a previous study suggesting that continuous theta burst stimulation (cTBS) to the right dlPFC can make people more anxious. Based on these results we hypothesized that intermittent TBS (iTBS), which is thought to have opposing effects on plasticity, may reduce anxiety when targeted at the same right dlPFC region. In this double-blinded, cross-over design, 28 healthy subjects underwent 12 study visits over a 4-week period. During each of their 2 stimulation weeks, they received four 600 pulse iTBS sessions (2/day), with a post-stimulation testing session occurring 24 h following the final iTBS session. One week they received active stimulation, one week they received sham. Stimulation weeks were separated by a 1-week washout period and the order of active/sham delivery was counterbalanced across subjects. During the testing session, we induced anxiety using the threat of unpredictable shock and measured anxiety potentiated startle. Contrary to our initial hypothesis, subjects showed increased startle reactivity following active compared to sham stimulation. These results replicate work from our two previous trials suggesting that TMS to the right dlPFC increases anxiety potentiated startle, independent of both the pattern of stimulation and the timing of the post stimulation measure. Although these results confirm a mechanistic link between right dlPFC excitability and startle, capitalizing upon this link for the benefit of patients will require future exploration.
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Affiliation(s)
- Marta Teferi
- Center for Neuromodulation in Depression and Stress Department of Psychiatry University of Pennsylvania, Philadelphia, PA, USA
| | - Hannah Gura
- Center for Neuromodulation in Depression and Stress Department of Psychiatry University of Pennsylvania, Philadelphia, PA, USA
- Neuroscience Graduate Group Perelman School of Medicine University of Pennsylvania, Philadelphia, PA, USA
| | - Milan Patel
- Center for Neuromodulation in Depression and Stress Department of Psychiatry University of Pennsylvania, Philadelphia, PA, USA
| | - Abigail Casalvera
- Center for Neuromodulation in Depression and Stress Department of Psychiatry University of Pennsylvania, Philadelphia, PA, USA
| | - Kevin G Lynch
- Department of Psychiatry University of Pennsylvania, Philadelphia, PA, USA
| | - Walid Makhoul
- Center for Neuromodulation in Depression and Stress Department of Psychiatry University of Pennsylvania, Philadelphia, PA, USA
| | - Zhi-De Deng
- Noninvasive Neuromodulation Unit Experimental Therapeutics and Pathophysiology Branch National Institute of Mental Health National Institutes of Health Bethesda, Bethesda, MD, USA
| | - Desmond J Oathes
- Center for Neuromodulation in Depression and Stress Department of Psychiatry University of Pennsylvania, Philadelphia, PA, USA
- Center for Brain Imaging and Stimulation Department of Psychiatry University of Pennsylvania, Philadelphia, PA, USA
- Penn Brain Science, Translation, Innovation, and Modulation Center University of Pennsylvania, Philadelphia, PA, USA
| | - Yvette I Sheline
- Center for Neuromodulation in Depression and Stress Department of Psychiatry University of Pennsylvania, Philadelphia, PA, USA
| | - Nicholas L Balderston
- Center for Neuromodulation in Depression and Stress Department of Psychiatry University of Pennsylvania, Philadelphia, PA, USA.
- Center for Brain Imaging and Stimulation Department of Psychiatry University of Pennsylvania, Philadelphia, PA, USA.
- Penn Brain Science, Translation, Innovation, and Modulation Center University of Pennsylvania, Philadelphia, PA, USA.
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Seo D, Balderston NL, Berenbaum H, Hur J. The interactive effects of different facets of threat uncertainty and cognitive load in shaping fear and anxiety responses. Psychophysiology 2023; 60:e14404. [PMID: 37559195 DOI: 10.1111/psyp.14404] [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: 12/30/2022] [Revised: 06/15/2023] [Accepted: 07/04/2023] [Indexed: 08/11/2023]
Abstract
A large body of research indicates that exaggerated response to uncertainty of a future threat is at the core of anxiety and related disorders, underscoring the need for a better understanding of the underlying mechanisms. Although behavioral and neuroimaging studies have suggested a close relationship between uncertainty responses and cognitive control, little is known about what elements of uncertainty are more or less vulnerable to cognitive modulation in shaping aversive responses. Leveraging a novel paradigm, an n-back working memory task embedded within a modified threat-of-shock paradigm, we examined how the influences of different facets of uncertainty (i.e., occurrence and timing) on psychophysiological responses were modulated by cognitive load. Psychophysiological responses were assessed using the acoustic startle reflex. Replicating prior work, the effects of cognitive load and temporal unpredictability of threat on startle responses were evident. The effect of occurrence unpredictability appears to depend on other factors. Under low cognitive load, startle response was potentiated when both the occurrence and the timing of threat were predictable. Under high cognitive load, startle response was significantly reduced, especially when a threat context involves uncertainty in both temporal and probability domains. These observations provide a framework for refining the model of fear and anxiety and for understanding the etiology of psychological disorders characterized by maladaptive uncertainty responses.
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Affiliation(s)
- Deachul Seo
- Department of Psychology, Yonsei University, Seoul, South Korea
| | - Nicholas L Balderston
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Howard Berenbaum
- Department of Psychology, University of Illinois Urbana-Champaign, Urbana-Champaign, Illinois, USA
| | - Juyoen Hur
- Department of Psychology, Yonsei University, Seoul, South Korea
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Hou T, Xie Y, Zhang J, Sun Z, Yin Q, Li Z, Cai W, Dong W, Deng G, Mao X. Avoidance-motivational intensity modulated the effect of negative emotion on working memory. ROYAL SOCIETY OPEN SCIENCE 2023; 10:221128. [PMID: 37293363 PMCID: PMC10245204 DOI: 10.1098/rsos.221128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 05/10/2023] [Indexed: 06/10/2023]
Abstract
Although many studies have explored the association between negative emotion and working memory, the findings remain controversial. The present study investigated the role of avoidance-motivational intensity in modulating the effect of negative emotion on different processes (maintenance versus manipulation) of verbal and spatial working memory. Two experiments employed the modified delayed match-to-sample paradigms to separate the two processes of verbal and spatial working memory under different emotional states, respectively. In Experiment 1, participants were asked to perform the delayed match-to-sample task with or without reordering the characters (manipulation process of verbal working memory). In Experiment 2, mental rotation was used as the manipulation process of spatial working memory. The results showed that negative emotion only affected the manipulation process, but not the maintenance process. Relative to neutral and low avoidance-motivated negative conditions, the manipulation processes of both types of working memory were impaired under the high avoidance-motivated negative condition. No significant difference was observed between low avoidance-motivated negative condition and neutral condition. Our results are discussed in relation to efficiency processing theory and motivational dimensional model of affect. We conclude that negative emotional states with high avoidance-motivational intensity impair the manipulation process of verbal and spatial working memory.
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Affiliation(s)
- Tianya Hou
- Faculty of Psychology, Naval Medical University, Shanghai 200433, People's Republic of China
| | - Yawei Xie
- Faculty of Psychology, Naval Medical University, Shanghai 200433, People's Republic of China
| | - Jianguo Zhang
- Faculty of Psychology, Naval Medical University, Shanghai 200433, People's Republic of China
| | - Zhuoer Sun
- Faculty of Psychology, Naval Medical University, Shanghai 200433, People's Republic of China
| | - Qianlan Yin
- Faculty of Psychology, Naval Medical University, Shanghai 200433, People's Republic of China
| | - Ziqiang Li
- Faculty of Psychology, Naval Medical University, Shanghai 200433, People's Republic of China
| | - Wenpeng Cai
- Faculty of Psychology, Naval Medical University, Shanghai 200433, People's Republic of China
| | - Wei Dong
- Faculty of Psychology, Naval Medical University, Shanghai 200433, People's Republic of China
| | - Guanghui Deng
- Faculty of Psychology, Naval Medical University, Shanghai 200433, People's Republic of China
| | - Xiaofei Mao
- Faculty of Psychology, Naval Medical University, Shanghai 200433, People's Republic of China
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White LK, Makhoul W, Teferi M, Sheline YI, Balderston NL. The role of dlPFC laterality in the expression and regulation of anxiety. Neuropharmacology 2023; 224:109355. [PMID: 36442650 PMCID: PMC9790039 DOI: 10.1016/j.neuropharm.2022.109355] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 11/07/2022] [Accepted: 11/23/2022] [Indexed: 11/27/2022]
Abstract
Anxiety disorders are the most common mental health disorder. Therefore, elucidating brain mechanisms implicated in anxiety disorders is important avenue for developing novel treatments and improving care. The dorsolateral prefrontal cortex (dlPFC) is thought to be critically involved in working memory processes (i.e. maintenance, manipulation, suppression, etc.). In addition, there is evidence that this region is involved in anxiety regulation. However, it is unclear how working memory related dlPFC processes contribute to anxiety regulation. Furthermore, we know that laterality plays an important role in working memory related dlPFC processing, however there is no current model of dlPFC mediated anxiety regulation that accounts for potential laterality effects. To address this gap, we propose a potential framework where the dlPFC contributes to emotion regulation via working memory processing. According to this framework, working memory is a fundamental process executed by the dlPFC. However, the domain of content differs across the left and right dlPFC, with the left dlPFC sensitive to primarily verbal content, and the right dlPFC sensitive to primarily non-verbal (affective content). Critically, working memory processes allow for both the retention and suppression of affective information in working memory and the overall net effect of processing on mood will depend on the balance of retention and suppression, the valence of the information being processed (positive vs. negative), and the domain of the information (verbal vs. non-verbal). If accurate, the proposed framework predicts that effects of neuromodulation targeting the dlPFC may be dependent upon the context during which the stimulation is presented. This article is part of the Special Issue on 'Fear, Anxiety and PTSD'.
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Affiliation(s)
- Lauren K White
- Lifespan Brain Institute Children's Hospital of Philadelphia and Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Walid Makhoul
- Center for Neuromodulation in Depression and Stress Department of Psychiatry University of Pennsylvania, Philadelphia, PA, USA
| | - Marta Teferi
- Center for Neuromodulation in Depression and Stress Department of Psychiatry University of Pennsylvania, Philadelphia, PA, USA
| | - Yvette I Sheline
- Center for Neuromodulation in Depression and Stress Department of Psychiatry University of Pennsylvania, Philadelphia, PA, USA
| | - Nicholas L Balderston
- Center for Neuromodulation in Depression and Stress Department of Psychiatry University of Pennsylvania, Philadelphia, PA, USA.
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van Dillen LF, Hofmann W. Room for Feelings: A “Working Memory” Account of Affective Processing. EMOTION REVIEW 2023. [DOI: 10.1177/17540739221150233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
In the past decades, affective science has overwhelmingly demonstrated the unique properties of affective information to bias our attention, memory, and decisions. At the same time, accumulating evidence suggests that neutral and affective representations rely on the same working memory substrates for the selection and computation of information and that they are therefore restricted by the same capacity limitations that these substrates impose. Here, we integrate these insights into a working memory model of affective processing (WMAP). Drawing on competitive access models of working memory, we discuss its role in the various stages of affective processing, from attentional selection to maintenance and memory storage, and resulting feelings and actions. We end our overview with some open questions and future directions.
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Affiliation(s)
| | - Wilhelm Hofmann
- Department of Psychology, Ruhr University Bochum, Bochum, Germany
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Saggar M, Bruno J, Gaillard C, Claudino L, Ernst M. Neural resources shift under Methylphenidate: A computational approach to examine anxiety-cognition interplay. Neuroimage 2022; 264:119686. [PMID: 36273770 PMCID: PMC9772074 DOI: 10.1016/j.neuroimage.2022.119686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 10/11/2022] [Accepted: 10/13/2022] [Indexed: 11/09/2022] Open
Abstract
The reciprocal interplay between anxiety and cognition is well documented. Anxiety negatively impacts cognition, while cognitive engagement can down-regulate anxiety. The brain mechanisms and dynamics underlying such interplay are not fully understood. To study this question, we experimentally and orthogonally manipulated anxiety (using a threat of shock paradigm) and cognition (using methylphenidate; MPH). The effects of these manipulations on the brain and behavior were evaluated in 50 healthy participants (25 MPH, 25 placebo), using an n-back working memory fMRI task (with low and high load conditions). Behaviorally, improved response accuracy was observed as a main effect of the drug across all conditions. We employed two approaches to understand the neural mechanisms underlying MPH-based cognitive enhancement in safe and threat conditions. First, we performed a hypothesis-driven computational analysis using a mathematical framework to examine how MPH putatively affects cognitive enhancement in the face of induced anxiety across two levels of cognitive load. Second, we performed an exploratory data analysis using Topological Data Analysis (TDA)-based Mapper to examine changes in spatiotemporal brain activity across the entire cortex. Both approaches provided converging evidence that MPH facilitated greater differential engagement of neural resources (brain activity) across low and high working memory load conditions. Furthermore, load-based differential management of neural resources reflects enhanced efficiency that is most powerful during higher load and induced anxiety conditions. Overall, our results provide novel insights regarding brain mechanisms that facilitate cognitive enhancement under MPH and, in future research, may be used to help mitigate anxiety-related cognitive underperformance.
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Affiliation(s)
- Manish Saggar
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA,Corresponding author: Psychiatry and Behavioral Sciences, Stanford University, 401 Quarry Road, St 1356, Stanford, California 94305, USA. (M. Saggar)
| | - Jennifer Bruno
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - Claudie Gaillard
- Section on Neurobiology of Fear and Anxiety, National Institute of Mental Health, Bethesda, MD, USA
| | - Leonardo Claudino
- Section on Neurobiology of Fear and Anxiety, National Institute of Mental Health, Bethesda, MD, USA
| | - Monique Ernst
- Section on Neurobiology of Fear and Anxiety, National Institute of Mental Health, Bethesda, MD, USA,Corresponding author: 15K North Drive, Bethesda MD, 20892, USA, (M. Ernst)
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Recognition memory, primacy vs. recency effects, and time perception in the online version of the fear of scream paradigm. Sci Rep 2022; 12:14258. [PMID: 35995804 PMCID: PMC9395394 DOI: 10.1038/s41598-022-18124-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 08/05/2022] [Indexed: 11/08/2022] Open
Abstract
Anxiety disorders are characterized by cognitive dysfunctions which contribute to the patient’s profound disabilities. The threat of shock paradigm represents a validated psychopathological model of anxiety to measure the impact of anxiety on cognitive processes. We have developed an online version of the threat of scream paradigm (ToSP) to investigate the impact of experimental anxiety on recognition memory. Two animated passive walkthrough videos (either under threat of scream or safety conditions) were shown to healthy participants. Recognition memory, primacy vs. recency effects, and subjective estimations of the length of encoding sessions were assessed. Subjective anxiety, stress, and emotional arousal ratings indicated that experimental anxiety could successfully be induced (Safe-Threat) or reversed (Threat-Safe) between the two passive walkthrough sessions. Participants exposed to distress screams showed impaired retrieval of complex information that has been presented in an animated environment. In the threat condition, participants failed to recognize details related to the persons encountered, their spatial locations, as well as information about the temporal order and sequence of encounters. Participant groups, which received a threat announcement prior to the first walkthrough session (Threat-Threat vs. Safety-Safety and Threat-Safety vs. Safety-Threat) showed poorer recognition memory as compared to the groups that received a safety announcement (P = 0.0468 and P = 0.0426, respectively; Mann–Whitney U test, Cohen’s d = 0.5071; effect size r = 0.2458). In conclusion, experimental anxiety induced by the online version of the ToSP leads to compromised recognition memory for complex multi-dimensional information. Our results indicate that cognitive functions of vulnerable populations (with limited mobility) can be evaluated online by means of the ToSP.
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Teferi M, Makhoul W, Deng ZD, Oathes DJ, Sheline Y, Balderston NL. Continuous Theta Burst Stimulation to the Right Dorsolateral Prefrontal Cortex may increase Potentiated Startle in healthy individuals. BIOLOGICAL PSYCHIATRY GLOBAL OPEN SCIENCE 2022. [PMID: 37519467 PMCID: PMC10382694 DOI: 10.1016/j.bpsgos.2022.04.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Background Convergent neuroimaging and neuromodulation studies implicate the right dorsolateral prefrontal cortex (dlPFC) as a key region involved in anxiety-cognition interactions. However, neuroimaging data are correlational, and neuromodulation studies often lack appropriate methodological controls. Accordingly, this work was designed to explore the role of right prefrontal cognitive control mechanisms in the expression/regulation of anxiety using continuous theta-burst transcranial magnetic stimulation (cTBS) and threat of unpredictable shock. Based on prior neuromodulation studies, we hypothesized that the right dlPFC contributed to anxiety expression, and that cTBS should downregulate this expression. Methods We measured potentiated startle and performance on the Sternberg working memory paradigm in 28 healthy participants before and after 4 sessions (600 pulses/session) of active or sham cTBS. Stimulation was individualized to the right dlPFC site of maximal working memory-related activity and optimized using electric-field modeling. Results Compared with sham cTBS, active cTBS, which is thought to induce long-term depression-like synaptic changes, increased startle during threat of shock, but the effect was similar for predictable and unpredictable threat. As a measure of target (dis)engagement, we also showed that active but not sham cTBS decreased accuracy on the Sternberg task. Conclusions Counter to our initial hypothesis, cTBS to the right dlPFC made individuals more anxious, rather than less anxious. Although preliminary, these results are unlikely to be due to transient effects of the stimulation, because anxiety was measured 24 hours after cTBS. In addition, these results are unlikely to be due to off-target effects, because target disengagement was evident from the Sternberg performance data.
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10
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Voogd LD, Hermans EJ. Meta‐analytic evidence for downregulation of the amygdala during working memory maintenance. Hum Brain Mapp 2022; 43:2951-2971. [PMID: 35349194 PMCID: PMC9120562 DOI: 10.1002/hbm.25828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 01/27/2022] [Accepted: 02/10/2022] [Indexed: 11/11/2022] Open
Abstract
The amygdala is a region critically implicated in affective processes. Downregulation of the amygdala is one of the hallmarks of successful emotion regulation. Top‐down inhibition of the amygdala is thought to involve activation of the executive control network. This reciprocal relationship, however, is not exclusive to explicit emotion regulation. It has been noted that any cognitively demanding task that activates executive control network may downregulate the amygdala, including a standard working memory task. Such downregulation is likely established in a load‐dependent fashion with more cognitive demand leading to stronger deactivation. Using a coordinate‐based meta‐analysis, we examined whether a standard working memory task downregulates the amygdala similarly to cognitive reappraisal. We found that a standard 2‐back working memory task indeed systematically downregulates the amygdala and that deactivated clusters strongly overlap with those observed during a cognitive reappraisal task. This finding may have consequences for the interpretation of the underlying mechanism of cognitive reappraisal: amygdala downregulation may be related to the cognitively demanding nature of reappraisal and not per se by the act of the reappraisal itself. Moreover, it raises the possibility of applying working memory tasks in clinical settings as an alternative emotion regulation strategy.
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Affiliation(s)
- Lycia D. Voogd
- Donders Institute for Brain, Cognition, and Behavior Radboud University and Radboud University Medical Center Nijmegen The Netherlands
| | - Erno J. Hermans
- Donders Institute for Brain, Cognition, and Behavior Radboud University and Radboud University Medical Center Nijmegen The Netherlands
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11
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da Silva Castanheira K, Sharp M, Otto AR. The impact of pandemic-related worry on cognitive functioning and risk-taking. PLoS One 2021; 16:e0260061. [PMID: 34793534 PMCID: PMC8601558 DOI: 10.1371/journal.pone.0260061] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 10/30/2021] [Indexed: 12/24/2022] Open
Abstract
Here, we sought to quantify the effects of experienced fear and worry, engendered by the COVID-19 pandemic, on both cognitive abilities-speed of information processing, task-set shifting, and proactive control-as well as economic risk-taking. Leveraging a repeated-measures cross-sectional design, we examined the performance of 1517 participants, collected during the early phase of the pandemic in the US (April-June 2020), finding that self-reported pandemic-related worry predicted deficits in information processing speed and maintenance of goal-related contextual information. In a classic economic risk-taking task, we observed that worried individuals' choices were more sensitive to the described outcome probabilities of risky actions. Overall, these results elucidate the cognitive consequences of a large-scale, unpredictable, and uncontrollable stressor, which may in turn play an important role in individuals' understanding of, and adherence to safety directives both in the current crisis and future public health emergencies.
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Affiliation(s)
| | - Madeleine Sharp
- Department of Neurology and Neurosurgery, McGill University, Montreal, Canada
| | - A. Ross Otto
- Department of Psychology, McGill University, Montreal, Canada
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12
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Gaillard C, Lago TR, Gorka AX, Balderston NL, Fuchs BA, Reynolds RC, Grillon C, Ernst M. Methylphenidate modulates interactions of anxiety with cognition. Transl Psychiatry 2021; 11:544. [PMID: 34675189 PMCID: PMC8531440 DOI: 10.1038/s41398-021-01621-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 08/31/2021] [Accepted: 09/13/2021] [Indexed: 11/09/2022] Open
Abstract
While a large body of literature documents the impairing effect of anxiety on cognition, performing a demanding task was shown to be effective in reducing anxiety. Here we explored the mechanisms of this anxiolytic effect by examining how a pharmacological challenge designed to improve attentional processes influences the interplay between the neural networks engaged during anxiety and cognition. Using a double-blind between-subject design, we pharmacologically manipulated working memory (WM) using a single oral dose of 20 mg methylphenidate (MPH, cognitive enhancer) or placebo. Fifty healthy adults (25/drug group) performed two runs of a WM N-back task in a 3 T magnetic resonance imaging scanner. This task comprised a low (1-Back) and high (3-Back) WM load, which were performed in two contexts, safety or threat of shocks (induced-anxiety). Analyses revealed that (1) WM accuracy was overall improved by MPH and (2) MPH (vs. placebo) strengthened the engagement of regions within the fronto-parietal control network (FPCN) and reduced the default mode network (DMN) deactivation. These MPH effects predominated in the most difficult context, i.e., threat condition, first run (novelty of the task), and 3-Back task. The facilitation of neural activation can be interpreted as an expansion of cognitive resources, which could foster both the representation and integration of anxiety-provoking stimuli as well as the top-down regulatory processes to protect against the detrimental effect of anxiety. This mechanism might establish an optimal balance between FPCN (cognitive processing) and DMN (emotion regulation) recruitment.
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Affiliation(s)
- C. Gaillard
- grid.416868.50000 0004 0464 0574Section on Neurobiology of Fear and Anxiety, National Institute of Mental Health, Bethesda, MD USA
| | - T. R. Lago
- grid.189504.10000 0004 1936 7558Department of Psychiatry, Boston University School of Medicine, Boston, MA USA
| | - A. X. Gorka
- grid.416868.50000 0004 0464 0574Section on Neurobiology of Fear and Anxiety, National Institute of Mental Health, Bethesda, MD USA
| | - N. L. Balderston
- grid.25879.310000 0004 1936 8972Center for Neuromodulation in Depression and Stress, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA USA
| | - B. A. Fuchs
- grid.29857.310000 0001 2097 4281Department of Nutritional Sciences, The Pennsylvania State University, University Park, PA USA
| | - R. C. Reynolds
- grid.416868.50000 0004 0464 0574Scientific and Statistical Computing Core, National Institute of Mental Health, Bethesda, MD USA
| | - C. Grillon
- grid.416868.50000 0004 0464 0574Section on Neurobiology of Fear and Anxiety, National Institute of Mental Health, Bethesda, MD USA
| | - M. Ernst
- grid.416868.50000 0004 0464 0574Section on Neurobiology of Fear and Anxiety, National Institute of Mental Health, Bethesda, MD USA
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Balderston NL, Flook E, Hsiung A, Liu J, Thongarong A, Stahl S, Makhoul W, Sheline Y, Ernst M, Grillon C. Patients with anxiety disorders rely on bilateral dlPFC activation during verbal working memory. Soc Cogn Affect Neurosci 2020; 15:1288-1298. [PMID: 33150947 PMCID: PMC7759210 DOI: 10.1093/scan/nsaa146] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 10/01/2020] [Accepted: 10/22/2020] [Indexed: 01/06/2023] Open
Abstract
One of the hallmarks of anxiety disorders is impaired cognitive control, affecting working memory (WM). The dorsolateral prefrontal cortex (dlPFC) is critical for WM; however, it is still unclear how dlPFC activity relates to WM impairments in patients. Forty-one healthy volunteers and 32 anxiety (general and/or social anxiety disorder) patients completed the Sternberg WM paradigm during safety and unpredictable shock threat. On each trial, a series of letters was presented, followed by brief retention and response intervals. On low- and high-load trials, subjects retained the series (five and eight letters, respectively) in the original order, while on sort trials, subjects rearranged the series (five letters) in alphabetical order. We sampled the blood oxygenation level-dependent activity during retention using a bilateral anatomical dlPFC mask. Compared to controls, patients showed increased reaction time during high-load trials, greater right dlPFC activity and reduced dlPFC activity during threat. These results suggest that WM performance for patients and controls may rely on distinct patterns of dlPFC activity with patients requiring bilateral dlPFC activity. These results are consistent with reduced efficiency of WM in anxiety patients. This reduced efficiency may be due to an inefficient allocation of dlPFC resources across hemispheres or a decreased overall dlPFC capacity.
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Affiliation(s)
- Nicholas L Balderston
- Section on Neurobiology of Fear and Anxiety, National Institute of Mental Health National Institutes of Health, Bethesda, MD 20892, USA
- Center for Neuromodulation in Depression and Stress Department of Psychiatry, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Elizabeth Flook
- Section on Neurobiology of Fear and Anxiety, National Institute of Mental Health National Institutes of Health, Bethesda, MD 20892, USA
| | - Abigail Hsiung
- Section on Neurobiology of Fear and Anxiety, National Institute of Mental Health National Institutes of Health, Bethesda, MD 20892, USA
| | - Jeffrey Liu
- Section on Neurobiology of Fear and Anxiety, National Institute of Mental Health National Institutes of Health, Bethesda, MD 20892, USA
| | - Amanda Thongarong
- Section on Neurobiology of Fear and Anxiety, National Institute of Mental Health National Institutes of Health, Bethesda, MD 20892, USA
| | - Sara Stahl
- Section on Neurobiology of Fear and Anxiety, National Institute of Mental Health National Institutes of Health, Bethesda, MD 20892, USA
| | - Walid Makhoul
- Center for Neuromodulation in Depression and Stress Department of Psychiatry, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Yvette Sheline
- Center for Neuromodulation in Depression and Stress Department of Psychiatry, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Monique Ernst
- Section on Neurobiology of Fear and Anxiety, National Institute of Mental Health National Institutes of Health, Bethesda, MD 20892, USA
| | - Christian Grillon
- Section on Neurobiology of Fear and Anxiety, National Institute of Mental Health National Institutes of Health, Bethesda, MD 20892, USA
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14
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Fellman D, Ritakallio L, Waris O, Jylkkä J, Laine M. Beginning of the Pandemic: COVID-19-Elicited Anxiety as a Predictor of Working Memory Performance. Front Psychol 2020; 11:576466. [PMID: 33324288 PMCID: PMC7725684 DOI: 10.3389/fpsyg.2020.576466] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 10/27/2020] [Indexed: 01/08/2023] Open
Abstract
Increasing evidence indicates that the coronavirus disease 2019 (COVID-19) pandemic is associated with adverse psychological effects, including heightened levels of anxiety. This study examined whether COVID-19-related anxiety levels during the early stage of the pandemic predicted demanding working memory (WM) updating performance. Altogether, 201 healthy adults (age range, 18-50) mostly from North America and the British Isles were recruited to this study via the crowdsourcing site www.prolific.co. The results showed that higher levels of COVID-19-related anxiety during the first weeks of the pandemic outbreak were associated with poorer WM performance as measured by the n-back paradigm. Critically, the unique role of COVID-19-related anxiety on WM could not be explained by demographic factors, or other psychological factors such as state and trait anxiety or fluid intelligence. Moreover, across three assessment points spanning 5-6 weeks, COVID-19-related anxiety levels tended to decrease over time. This pattern of results may reflect an initial psychological "shock wave" of the pandemic, the cognitive effects of which may linger for some time, albeit the initial anxiety associated with the pandemic would change with habituation and increasing information. Our results contribute to the understanding of cognitive-affective reactions to a major disaster.
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Affiliation(s)
- Daniel Fellman
- Department of Applied Educational Science, Umeå University, Umeå, Sweden.,Department of Psychology, Åbo Akademi University, Turku, Finland.,Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Liisa Ritakallio
- Department of Psychology, Åbo Akademi University, Turku, Finland
| | - Otto Waris
- Department of Psychology, Åbo Akademi University, Turku, Finland.,Department of Child Psychiatry, University of Turku and Turku University Hospital, Turku, Finland.,INVEST Research Flagship Center, University of Turku, Turku, Finland
| | - Jussi Jylkkä
- Department of Psychology, Åbo Akademi University, Turku, Finland
| | - Matti Laine
- Department of Psychology, Åbo Akademi University, Turku, Finland.,Turku Brain and Mind Center, Turku, Finland
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15
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Balderston NL, Roberts C, Beydler EM, Deng ZD, Radman T, Luber B, Lisanby SH, Ernst M, Grillon C. A generalized workflow for conducting electric field-optimized, fMRI-guided, transcranial magnetic stimulation. Nat Protoc 2020; 15:3595-3614. [PMID: 33005039 PMCID: PMC8123368 DOI: 10.1038/s41596-020-0387-4] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 07/22/2020] [Indexed: 12/27/2022]
Abstract
Transcranial magnetic stimulation (TMS) is a noninvasive method to stimulate the cerebral cortex that has applications in psychiatry, such as in the treatment of depression and anxiety. Although many TMS targeting methods that use figure-8 coils exist, many do not account for individual differences in anatomy or are not generalizable across target sites. This protocol combines functional magnetic resonance imaging (fMRI) and iterative electric-field (E-field) modeling in a generalized approach to subject-specific TMS targeting that is capable of optimizing the stimulation site and TMS coil orientation. To apply this protocol, the user should (i) operationally define a region of interest (ROI), (ii) generate the head model from the structural MRI data, (iii) preprocess the functional MRI data, (iv) identify the single-subject stimulation site within the ROI, and (iv) conduct E-field modeling to identify the optimal coil orientation. In comparison with standard targeting methods, this approach demonstrates (i) reduced variability in the stimulation site across subjects, (ii) reduced scalp-to-cortical-target distance, and (iii) reduced variability in optimal coil orientation. Execution of this protocol requires intermediate-level skills in structural and functional MRI processing. This protocol takes ~24 h to complete and demonstrates how constrained fMRI targeting combined with iterative E-field modeling can be used as a general method to optimize both the TMS coil site and its orientation.
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Affiliation(s)
- Nicholas L Balderston
- Section on Neurobiology of Fear and Anxiety, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA.
- Center for Neuromodulation in Depression and Stress, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA.
| | - Camille Roberts
- Section on Neurobiology of Fear and Anxiety, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - Emily M Beydler
- Section on Neurobiology of Fear and Anxiety, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - Zhi-De Deng
- Noninvasive Neuromodulation Unit, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - Thomas Radman
- Noninvasive Neuromodulation Unit, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - Bruce Luber
- Noninvasive Neuromodulation Unit, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - Sarah H Lisanby
- Noninvasive Neuromodulation Unit, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - Monique Ernst
- Section on Neurobiology of Fear and Anxiety, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - Christian Grillon
- Section on Neurobiology of Fear and Anxiety, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
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16
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Sarigiannidis I, Kirk PA, Roiser JP, Robinson OJ. Does overloading cognitive resources mimic the impact of anxiety on temporal cognition? J Exp Psychol Learn Mem Cogn 2020; 46:1828-1835. [PMID: 32378938 PMCID: PMC7872305 DOI: 10.1037/xlm0000845] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 03/11/2020] [Accepted: 03/22/2020] [Indexed: 12/21/2022]
Abstract
Anxiety alters how we perceive the world and can alter aspects of cognitive performance. Prominent theories of anxiety suggest that the effect of anxiety on cognition is due to anxious thoughts "overloading" limited cognitive resources, competing with other processes. If this is so, then a cognitive load manipulation should impact performance of a task in the same way as induced anxiety. Thus, we examined the impact of a load manipulation on a time perception task that we have previously shown to be reliably impacted by anxiety. In contrast with our prediction, across 3 studies we found that time perception was insensitive to our load manipulation. Our results do not therefore support the idea that anxiety impacts temporal cognition by overloading limited cognitive resources, at least as induced by a commonly used load manipulation. Thus, anxiety might affect temporal cognition in a unique way, via an evolutionary-preserved defense survival system, as suggested by animal-inspired theories of anxiety, rather than competing for limited attentional resources. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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17
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Gayete S, Giné A, Miret M, Ayuso-Mateos JL, Haro JM, Olaya B. Cognitive function associated with different diagnoses of anxiety disorders over the lifespan: Results from a Spanish representative sample. J Anxiety Disord 2020; 75:102296. [PMID: 32866758 DOI: 10.1016/j.janxdis.2020.102296] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 08/04/2020] [Accepted: 08/14/2020] [Indexed: 01/17/2023]
Abstract
BACKGROUND Previous research suggests an association between anxiety disorders and worse cognitive function. However, this association may vary depending on the type of disorder and age. We analysed the association of panic attack, 12-month and lifetime panic disorder (PD), and generalized anxiety disorder (GAD), with cognitive function in a representative sample of Spanish adults, and compared three age groups (18-49, 50-64, and 65+). METHODS Some 4,582 participants were interviewed with an adapted CIDI interview. Unadjusted and adjusted linear regression models were calculated by age group, using T scores of verbal fluency and episodic memory as the outcomes. RESULTS In young adults, 12-month GAD was associated with significantly lower scores of memory performance and verbal fluency, and 12-month PD with worse verbal fluency. In middle-aged participants, lifetime panic attack was related to better performance in verbal fluency, whereas having a diagnosis of lifetime PD was associated with lower scores. However, only participants aged 18-49 with 12-month GAD showed lower memory and verbal fluency, at almost one standard deviation below participants without 12-month GAD. LIMITATIONS Low prevalence rates of anxiety disorder could have led to biased results. CONCLUSIONS In young adults, a concurrent GAD might be particularly associated with memory and verbal fluency deficits, whereas only verbal fluency is affected in middle-aged adults with a history of PD, although this association is small. In older adults, anxiety disorders are not clearly associated with worse cognition, probably because in this age group other confounder variables might be attenuating this link. Overall, our findings suggest that cognitive interventions for anxiety disorders may be relevant, especially for young and middle-aged adults.
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Affiliation(s)
- Silvia Gayete
- Research, Innovation and Teaching Unit, Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Sant Boi de Llobregat, Spain
| | - Anna Giné
- Research, Innovation and Teaching Unit, Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Sant Boi de Llobregat, Spain
| | - Marta Miret
- Department of Psychiatry, Universidad Autonoma de Madrid, Madrid, Spain; Instituto de Salud Carlos III, CIBER of Mental Health (CIBERSAM), Madrid, Spain; Department of Psychiatry, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Madrid, Spain
| | | | - Josep Maria Haro
- Research, Innovation and Teaching Unit, Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Sant Boi de Llobregat, Spain; Instituto de Salud Carlos III, CIBER of Mental Health (CIBERSAM), Madrid, Spain
| | - Beatriz Olaya
- Research, Innovation and Teaching Unit, Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Sant Boi de Llobregat, Spain; Instituto de Salud Carlos III, CIBER of Mental Health (CIBERSAM), Madrid, Spain.
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18
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Scult MA, Knodt AR, Radtke SR, Brigidi BD, Hariri AR. Prefrontal Executive Control Rescues Risk for Anxiety Associated with High Threat and Low Reward Brain Function. Cereb Cortex 2020; 29:70-76. [PMID: 29161340 DOI: 10.1093/cercor/bhx304] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Accepted: 10/19/2017] [Indexed: 01/06/2023] Open
Abstract
Compared with neural biomarkers of risk for mental illness, little is known about biomarkers of resilience. We explore if greater executive control-related prefrontal activity may function as a resilience biomarker by "rescuing" risk associated with higher threat-related amygdala and lower reward-related ventral striatum activity. Functional MRI was used to assay baseline threat-related amygdala, reward-related ventral striatum, and executive control-related prefrontal activity in 120 young adult volunteers. Participants provided self-reported mood and anxiety ratings at baseline and follow-up. A moderation model revealed a significant three-way interaction wherein higher amygdala and lower ventral striatum activity predicted increases in anxiety in those with average or low but not high prefrontal activity. This effect was specific to anxiety, with the neural biomarkers explaining ~10% of the variance in change over time, above and beyond baseline symptoms, sex, age, IQ, presence or absence of DMS-IV diagnosis, and both early and recent stress. Our findings are consistent with the importance of top-down executive control in adaptive regulation of negative emotions, and highlight a unique combination of neural biomarkers that may identify at-risk individuals for whom the adoption of strategies to improve executive control of negative emotions may prove particularly beneficial.
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Affiliation(s)
- Matthew A Scult
- Laboratory of NeuroGenetics, Department of Psychology & Neuroscience, Duke University, Durham, NC, USA
| | - Annchen R Knodt
- Laboratory of NeuroGenetics, Department of Psychology & Neuroscience, Duke University, Durham, NC, USA
| | - Spenser R Radtke
- Laboratory of NeuroGenetics, Department of Psychology & Neuroscience, Duke University, Durham, NC, USA
| | - Bartholomew D Brigidi
- Laboratory of NeuroGenetics, Department of Psychology & Neuroscience, Duke University, Durham, NC, USA
| | - Ahmad R Hariri
- Laboratory of NeuroGenetics, Department of Psychology & Neuroscience, Duke University, Durham, NC, USA
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19
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Mechanistic link between right prefrontal cortical activity and anxious arousal revealed using transcranial magnetic stimulation in healthy subjects. Neuropsychopharmacology 2020; 45:694-702. [PMID: 31791039 PMCID: PMC7021903 DOI: 10.1038/s41386-019-0583-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 10/08/2019] [Accepted: 11/19/2019] [Indexed: 02/07/2023]
Abstract
Much of the mechanistic research on anxiety focuses on subcortical structures such as the amygdala; however, less is known about the distributed cortical circuit that also contributes to anxiety expression. One way to learn about this circuit is to probe candidate regions using transcranial magnetic stimulation (TMS). In this study, we tested the involvement of the dorsolateral prefrontal cortex (dlPFC), in anxiety expression using 10 Hz repetitive TMS (rTMS). In a within-subject, crossover experiment, the study measured anxiety in healthy subjects before and after a session of 10 Hz rTMS to the right dorsolateral prefrontal cortex (dlPFC). It used threat of predictable and unpredictable shock to induce anxiety and anxiety potentiated startle to assess anxiety. Counter to our hypotheses, results showed an increase in anxiety-potentiated startle following active but not sham rTMS. These results suggest a mechanistic link between right dlPFC activity and physiological anxiety expression. This result supports current models of prefrontal asymmetry in affect, and lays the groundwork for further exploration into the cortical mechanisms mediating anxiety, which may lead to novel anxiety treatments.
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20
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Loos E, Schicktanz N, Fastenrath M, Coynel D, Milnik A, Fehlmann B, Egli T, Ehrler M, Papassotiropoulos A, de Quervain DJF. Reducing Amygdala Activity and Phobic Fear through Cognitive Top-Down Regulation. J Cogn Neurosci 2020; 32:1117-1129. [PMID: 32013687 DOI: 10.1162/jocn_a_01537] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
The amygdala is critically involved in emotional processing, including fear responses, and shows hyperactivity in anxiety disorders. Previous research in healthy participants has indicated that amygdala activity is down-regulated by cognitively demanding tasks that engage the PFC. It is unknown, however, if such an acute down-regulation of amygdala activity might correlate with reduced fear in anxious participants. In an fMRI study of 43 participants (11 men) with fear of snakes, we found reduced amygdala activity when visual stimuli were processed under high cognitive load, irrespective of whether the stimuli were of neutral or phobic content. Furthermore, dynamic causal modeling revealed that this general reduction in amygdala activity was partially mediated by a load-dependent increase in dorsolateral PFC activity. Importantly, high cognitive load also resulted in an acute decrease in perceived phobic fear while viewing the fearful stimuli. In conclusion, our data indicate that a cognitively demanding task results in a top-down regulation of amygdala activity and an acute reduction of fear in phobic participants. These findings may inspire the development of novel psychological intervention approaches aimed at reducing fear in anxiety disorders.
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21
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Torrisi S, Alvarez GM, Gorka AX, Fuchs B, Geraci M, Grillon C, Ernst M. Resting-state connectivity of the bed nucleus of the stria terminalis and the central nucleus of the amygdala in clinical anxiety. J Psychiatry Neurosci 2019; 44:313-323. [PMID: 30964612 PMCID: PMC6710087 DOI: 10.1503/jpn.180150] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2018] [Revised: 12/11/2018] [Accepted: 01/16/2019] [Indexed: 01/06/2023] Open
Abstract
Background The central nucleus of the amygdala and bed nucleus of the stria terminalis are involved primarily in phasic and sustained aversive states. Although both structures have been implicated in pathological anxiety, few studies with a clinical population have specifically focused on them, partly because of their small size. Previous work in our group used high-resolution imaging to map the restingstate functional connectivity of the bed nucleus of the stria terminalis and the central nucleus of the amygdala in healthy subjects at 7 T, confirming and extending structural findings in humans and animals, while providing additional insight into cortical connectivity that is potentially unique to humans. Methods In the current follow-up study, we contrasted resting-state functional connectivity in the bed nucleus of the stria terminalis and central nucleus of the amygdala at 7 T between healthy volunteers (n = 30) and patients with generalized and/or social anxiety disorder (n = 30). Results Results revealed significant voxel-level group differences. Compared with healthy volunteers, patients showed stronger resting-state functional connectivity between the central nucleus of the amygdala and the lateral orbitofrontal cortex and superior temporal sulcus. They also showed weaker resting-state functional connectivity between the bed nucleus of the stria terminalis and the dorsolateral prefrontal cortex and occipital cortex. Limitations These findings depart from a previous report of resting-state functional connectivity in the central nucleus of the amygdala and bed nucleus of the stria terminalis under sustained threat of shock in healthy volunteers. Conclusion This study provides functional MRI proxies of the functional dissociation of the bed nucleus of the stria terminalis and central nucleus of the amygdala, and suggests that resting-state functional connectivity of key structures in the processing of defensive responses do not recapitulate changes related to induced state anxiety. Future work needs to replicate and further probe the clinical significance of these findings.
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Affiliation(s)
- Salvatore Torrisi
- From the Section on the Neurobiology of Fear and Anxiety, National Institute of Mental Health, Bethesda, MD, USA (Torrisi, Alvarez, Gorka, Fuchs, Geraci, Grillon, Ernst)
| | - Gabriella M. Alvarez
- From the Section on the Neurobiology of Fear and Anxiety, National Institute of Mental Health, Bethesda, MD, USA (Torrisi, Alvarez, Gorka, Fuchs, Geraci, Grillon, Ernst)
| | - Adam X. Gorka
- From the Section on the Neurobiology of Fear and Anxiety, National Institute of Mental Health, Bethesda, MD, USA (Torrisi, Alvarez, Gorka, Fuchs, Geraci, Grillon, Ernst)
| | - Bari Fuchs
- From the Section on the Neurobiology of Fear and Anxiety, National Institute of Mental Health, Bethesda, MD, USA (Torrisi, Alvarez, Gorka, Fuchs, Geraci, Grillon, Ernst)
| | - Marilla Geraci
- From the Section on the Neurobiology of Fear and Anxiety, National Institute of Mental Health, Bethesda, MD, USA (Torrisi, Alvarez, Gorka, Fuchs, Geraci, Grillon, Ernst)
| | - Christian Grillon
- From the Section on the Neurobiology of Fear and Anxiety, National Institute of Mental Health, Bethesda, MD, USA (Torrisi, Alvarez, Gorka, Fuchs, Geraci, Grillon, Ernst)
| | - Monique Ernst
- From the Section on the Neurobiology of Fear and Anxiety, National Institute of Mental Health, Bethesda, MD, USA (Torrisi, Alvarez, Gorka, Fuchs, Geraci, Grillon, Ernst)
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22
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Lago TR, Hsiung A, Leitner BP, Duckworth CJ, Balderston NL, Chen KY, Grillon C, Ernst M. Exercise modulates the interaction between cognition and anxiety in humans. Cogn Emot 2019; 33:863-870. [PMID: 30032703 PMCID: PMC6344312 DOI: 10.1080/02699931.2018.1500445] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 06/29/2018] [Accepted: 07/04/2018] [Indexed: 02/08/2023]
Abstract
Despite interest in exercise as a treatment for anxiety disorders the mechanism behind the anxiolytic effects of exercise is unclear. Two observations motivate the present work. First, engagement of attention control during increased working memory (WM) load can decrease anxiety. Second, exercise can improve attention control. Therefore, exercise could boost the anxiolytic effects of increased WM load via its strengthening of attention control. Anxiety was induced by threat of shock and was quantified with anxiety-potentiated startle (APS). Thirty-five healthy volunteers (19 male, age M = 26.11, SD = 5.52) participated in two types of activity, exercise (biking at 60-70% of heart rate reserve) and control-activity (biking at 10-20% of heart rate reserve). After each activity, participants completed a WM task (n-back) at low- and high-load during safe and threat. Results were not consistent with the hypothesis: exercise vs. control-activity increased APS in high-load (p = .03). However, this increased APS was not accompanied with threat-induced impairment in WM performance (p = .37). Facilitation of both task-relevant stimulus processing and task-irrelevant threat processing, concurrent with prevention of threat interference on cognition, suggests that exercise increases cognitive ability. Future studies should explore how exercise affects the interplay of cognition and anxiety in patients with anxiety disorders.
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Affiliation(s)
- Tiffany R. Lago
- Section on the Neurobiology of Fear and Anxiety, National Institute of Mental Health, Bethesda, MD, USA
| | - Abigail Hsiung
- Section on the Neurobiology of Fear and Anxiety, National Institute of Mental Health, Bethesda, MD, USA
| | - Brooks P. Leitner
- Energy Metabolism Section, Diabetes, Endocrinology, and Obesity Branch, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, USA
| | - Courtney J. Duckworth
- Energy Metabolism Section, Diabetes, Endocrinology, and Obesity Branch, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, USA
| | - Nicholas L. Balderston
- Section on the Neurobiology of Fear and Anxiety, National Institute of Mental Health, Bethesda, MD, USA
| | - Kong Y. Chen
- Energy Metabolism Section, Diabetes, Endocrinology, and Obesity Branch, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, USA
| | - Christian Grillon
- Section on the Neurobiology of Fear and Anxiety, National Institute of Mental Health, Bethesda, MD, USA
| | - Monique Ernst
- Section on the Neurobiology of Fear and Anxiety, National Institute of Mental Health, Bethesda, MD, USA
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23
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Balderston NL, Liu J, Roberson-Nay R, Ernst M, Grillon C. The relationship between dlPFC activity during unpredictable threat and CO 2-induced panic symptoms. Transl Psychiatry 2017; 7:1266. [PMID: 29213110 PMCID: PMC5802456 DOI: 10.1038/s41398-017-0006-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2017] [Revised: 05/11/2017] [Accepted: 05/15/2017] [Indexed: 01/08/2023] Open
Abstract
Panic disorder is characterized by sudden, repeated, and unexpected attacks of intense fear and overwhelming anxiety about when another attack may strike. Patients with panic disorder and healthy individuals with a history of panic attacks show a hypersensitivity to unpredictable threats, suggesting a possible link between panic and sustained anxiety. The purpose of this study was to determine the degree to which induced symptoms of panic relate to fear and anxiety, as well as activity in the neural systems that mediate and regulate these affective states. Psychological and physiological symptoms of panic were assessed during an 8-min 7.5% CO2 challenge task. Psychological, physiological, and neural symptoms of fear and anxiety were measured during two sessions (one psychophysiology and one functional magnetic resonance imaging where subjects experienced several blocks of no threat (N), predictable shock (P), and unpredictable shock (U; NPU threat task). We used a principle component analysis to characterize panic susceptibility (PS), and found that PS significantly predicted dorsolateral prefrontal cortex (dlPFC) activity to the unpredictable cue during the NPU threat task. When examining the weighted beta coefficients from this analysis, we observed that self-reported fear/anxiety during the CO2 challenge negatively loaded onto dlPFC activity during the NPU task. Consistent with this observation, dlPFC activity during the unpredictable cue was also negatively correlated with anxiety during the NPU sessions. Together, these results suggest that panic symptoms and anxiety are regulated by the same prefrontal cognitive control system.
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Affiliation(s)
- Nicholas L. Balderston
- 0000 0001 2297 5165grid.94365.3dSection on Neurobiology of Fear and Anxiety, National Institute of Mental Health, National Institutes of Health, Bethesda, MD USA
| | - Jeffrey Liu
- 0000 0001 2297 5165grid.94365.3dSection on Neurobiology of Fear and Anxiety, National Institute of Mental Health, National Institutes of Health, Bethesda, MD USA
| | - Roxann Roberson-Nay
- 0000 0004 0458 8737grid.224260.0Virginia Institute for Psychiatric and Behavioral Genetics, Department of Psychiatry, Virginia Commonwealth University, Richmond, VA USA
| | - Monique Ernst
- 0000 0001 2297 5165grid.94365.3dSection on Neurobiology of Fear and Anxiety, National Institute of Mental Health, National Institutes of Health, Bethesda, MD USA
| | - Christian Grillon
- 0000 0001 2297 5165grid.94365.3dSection on Neurobiology of Fear and Anxiety, National Institute of Mental Health, National Institutes of Health, Bethesda, MD USA
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24
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Effect of Threat on Right dlPFC Activity during Behavioral Pattern Separation. J Neurosci 2017; 37:9160-9171. [PMID: 28842415 DOI: 10.1523/jneurosci.0717-17.2017] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Revised: 07/14/2017] [Accepted: 07/20/2017] [Indexed: 01/29/2023] Open
Abstract
It has long been established that individuals with anxiety disorders tend to overgeneralize attributes of fearful stimuli to nonfearful stimuli, but there is little mechanistic understanding of the neural system that supports overgeneralization. To address this gap in our knowledge, this study examined effect of experimentally induced anxiety in humans on generalization using the behavioral pattern separation (BPS) paradigm. Healthy subjects of both sexes encoded and retrieved novel objects during periods of safety and threat of unpredictable shocks while we recorded brain activity with fMRI. During retrieval, subjects were instructed to differentiate among new, old, and altered images. We hypothesized that the hippocampus and dorsolateral prefrontal cortex (dlPFC) would play a key role in the effect of anxiety on BPS. The dlPFC, but not the hippocampus, showed increased activity for altered images compared with old images when retrieval occurred during periods of threat compared with safety. In addition, accuracy for altered items retrieved during threat was correlated with dlPFC activity. Together, these results suggest that overgeneralization in anxiety patients may be mediated by an inability to recruit the dlPFC, which mediates the cognitive control needed to overcome anxiety and differentiate between old and altered items during periods of threat.SIGNIFICANCE STATEMENT Anxiety and posttraumatic stress disorder patients generalize fear to nonfearful fear stimuli, making it difficult to regulate anxiety. Understanding how anxiety affects generalization is key to understanding the overgeneralization experienced by these patients. We examined this relationship in healthy subjects by studying how threat of shock affects neural responses to previously encountered stimuli. Although previous studies point to hippocampal involvement, we found that threat affected activity in the dorsolateral prefrontal cortex (dlPFC), rather than the hippocampus, when subjects encountered slightly altered versions of the previously encountered items. Importantly, this dlPFC activity predicted performance for these items. Together, these results suggest that the dlPFC is important for discrimination during elevated anxiety and that overgeneralization may reflect a deficit in dlPFC-mediated cognitive control.
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Balderston NL, Hsiung A, Liu J, Ernst M, Grillon C. Reducing State Anxiety Using Working Memory Maintenance. J Vis Exp 2017. [PMID: 28745646 PMCID: PMC5612581 DOI: 10.3791/55727] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
The purpose of this protocol is to explain how to examine the relationship between working memory processes and anxiety by combining the Sternberg Working Memory (WM) and the threat of shock paradigms. In the Sternberg WM paradigm, subjects are required to maintain a series of letters in the WM for a brief interval and respond by identifying whether the position of a given letter in the series matches a numerical prompt. In the threat of shock paradigm, subjects are exposed to alternating blocks where they are either at risk of receiving unpredictable presentations of a mild electric shock or are safe from the shock. Anxiety is probed throughout the safe and threat blocks using the acoustic startle reflex, which is potentiated under threat (Anxiety-Potentiated Startle (APS)). By conducting the Sternberg WM paradigm during the threat of shock and probing the startle response during either the WM maintenance interval or the intertrial interval, it is possible to determine the effect of WM maintenance on APS.
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Affiliation(s)
- Nicholas L Balderston
- Section on Neurobiology of Fear and Anxiety, National Institute of Mental Health, National Institutes of Health (NIH);
| | - Abigail Hsiung
- Section on Neurobiology of Fear and Anxiety, National Institute of Mental Health, National Institutes of Health (NIH)
| | - Jeffrey Liu
- Section on Neurobiology of Fear and Anxiety, National Institute of Mental Health, National Institutes of Health (NIH)
| | - Monique Ernst
- Section on Neurobiology of Fear and Anxiety, National Institute of Mental Health, National Institutes of Health (NIH)
| | - Christian Grillon
- Section on Neurobiology of Fear and Anxiety, National Institute of Mental Health, National Institutes of Health (NIH)
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Balderston NL, Hale E, Hsiung A, Torrisi S, Holroyd T, Carver FW, Coppola R, Ernst M, Grillon C. Threat of shock increases excitability and connectivity of the intraparietal sulcus. eLife 2017; 6. [PMID: 28555565 PMCID: PMC5478270 DOI: 10.7554/elife.23608] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Accepted: 05/29/2017] [Indexed: 11/30/2022] Open
Abstract
Anxiety disorders affect approximately 1 in 5 (18%) Americans within a given 1 year period, placing a substantial burden on the national health care system. Therefore, there is a critical need to understand the neural mechanisms mediating anxiety symptoms. We used unbiased, multimodal, data-driven, whole-brain measures of neural activity (magnetoencephalography) and connectivity (fMRI) to identify the regions of the brain that contribute most prominently to sustained anxiety. We report that a single brain region, the intraparietal sulcus (IPS), shows both elevated neural activity and global brain connectivity during threat. The IPS plays a key role in attention orienting and may contribute to the hypervigilance that is a common symptom of pathological anxiety. Hyperactivation of this region during elevated state anxiety may account for the paradoxical facilitation of performance on tasks that require an external focus of attention, and impairment of performance on tasks that require an internal focus of attention. DOI:http://dx.doi.org/10.7554/eLife.23608.001 Anxiety disorders affect around one in five Americans, and in many cases people experience anxiety so intensely that they have difficulties performing day-to-day activities. To help these people, it is important to understand how anxiety works. Current research suggests that anxiety disorders are caused when the connections in the brain that control our response to threat are either excessively or inappropriately activated. However, it was not clear what causes the anxiety to last for long periods. To better understand this phenomenon, Balderston et al. studied the brains of over 30 volunteers using two types of measurements called magnetoencephalography and fMRI. In the each experiment, participants experienced periods of threat, where they could receive unpredictable electric shocks. In the first experiment, Balderston et al. measured the brain activity by recording the magnetic fields generated in the brain. In the second experiment, they used fMRI to record changes in the blood flow throughout the brain to measure how the different regions in the brain communicate. The recordings identified a single part of the brain that increased its activity and changed its communication pattern with the other regions in the brain, when people are anxious. This region in a part of the brain called parietal lobe, is also important for processing attention, which suggests that anxiety might make people also more aware of their surroundings. However, this extra awareness might also make it more difficult for people to concentrate. Future studies may be able to stimulate this area of the brain through the scalp to potentially reduce anxiety, as the affected area is close to the skull. DOI:http://dx.doi.org/10.7554/eLife.23608.002
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Affiliation(s)
- Nicholas L Balderston
- Section on Neurobiology of Fear and Anxiety, National Institute of Mental Health, National Institutes of Health, Bethesda, United States
| | - Elizabeth Hale
- Section on Neurobiology of Fear and Anxiety, National Institute of Mental Health, National Institutes of Health, Bethesda, United States
| | - Abigail Hsiung
- Section on Neurobiology of Fear and Anxiety, National Institute of Mental Health, National Institutes of Health, Bethesda, United States
| | - Salvatore Torrisi
- Section on Neurobiology of Fear and Anxiety, National Institute of Mental Health, National Institutes of Health, Bethesda, United States
| | - Tom Holroyd
- MEG Core Facility, National Institute of Mental Health, National Institutes of Health, Bethesda, United States
| | - Frederick W Carver
- MEG Core Facility, National Institute of Mental Health, National Institutes of Health, Bethesda, United States
| | - Richard Coppola
- MEG Core Facility, National Institute of Mental Health, National Institutes of Health, Bethesda, United States
| | - Monique Ernst
- Section on Neurobiology of Fear and Anxiety, National Institute of Mental Health, National Institutes of Health, Bethesda, United States
| | - Christian Grillon
- Section on Neurobiology of Fear and Anxiety, National Institute of Mental Health, National Institutes of Health, Bethesda, United States
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