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Lasogga L, Gramegna C, Müller D, Habel U, Mehler DMA, Gur RC, Weidler C. Meta-analysis of variance in tDCS effects on response inhibition. Sci Rep 2024; 14:19197. [PMID: 39160262 DOI: 10.1038/s41598-024-70065-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2024] [Accepted: 08/12/2024] [Indexed: 08/21/2024] Open
Abstract
Deficiencies in response inhibition are associated with numerous mental health conditions, warranting innovative treatments. Transcranial direct current stimulation (tDCS), a non-invasive brain stimulation technique, modulates cortical excitability and has shown promise in improving response inhibition. However, tDCS effects on response inhibition often yield contradictory findings. Previous research emphasized the importance of inter-individual factors that are mostly ignored in conventional meta-analyses of mean effects. We aimed to fill this gap and promote the complementary use of the coefficient of variation ratio and standardized mean effects. The systematic literature search included single-session and sham-controlled tDCS studies utilizing stop-signal task or Go-NoGo tasks, analyzing 88 effect sizes from 53 studies. Considering the impact of inter-individual factors, we hypothesized that variances increase in the active versus sham tDCS. However, the results showed that variances between both groups did not differ. Additionally, analyzing standardized mean effects supported previous research showing an improvement in the stop-signal task but not in the Go-NoGo task following active tDCS. These findings suggest that inter-individual differences do not increase variances in response inhibition, implying that the heterogeneity cannot be attributed to higher variance in response inhibition during and after active tDCS. Furthermore, methodological considerations are crucial for tDCS efficacy.
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Affiliation(s)
- Luca Lasogga
- Department of Psychiatry, Psychotherapy and Psychosomatics, Faculty of Medicine, RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, North Rhine-Westphalia, Germany.
- , Office 117, Wendlingweg 2, 52074, Aachen, Germany.
| | - Chiara Gramegna
- PhD Program in Neuroscience, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Dario Müller
- Department of Psychiatry, Psychotherapy and Psychosomatics, Faculty of Medicine, RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, North Rhine-Westphalia, Germany
| | - Ute Habel
- Department of Psychiatry, Psychotherapy and Psychosomatics, Faculty of Medicine, RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, North Rhine-Westphalia, Germany
- Institute of Neuroscience and Medicine, JARA-Institute Brain Structure Function Relationship (INM 10), Research Center Jülich, Wilhelm-Johnen-Straße, 52438, Jülich, Germany
| | - David M A Mehler
- Department of Psychiatry, Psychotherapy and Psychosomatics, Faculty of Medicine, RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, North Rhine-Westphalia, Germany
- Institute for Translational Psychiatry, University of Münster, 48149, Münster, Germany
- Cardiff University Brain Research Imaging Centre (CUBRIC), School of Psychology, Cardiff University, Cardiff, CF24 4HQ, UK
| | - Ruben C Gur
- Brain Behavior Laboratories, Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, USA
| | - Carmen Weidler
- Department of Psychiatry, Psychotherapy and Psychosomatics, Faculty of Medicine, RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, North Rhine-Westphalia, Germany
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Wang Y, Wu D, Sun K, Zhu Y, Chen X, Xiao W. The Effect of Rhythmic Audio-Visual Stimulation on Inhibitory Control: An ERP Study. Brain Sci 2024; 14:506. [PMID: 38790484 PMCID: PMC11119230 DOI: 10.3390/brainsci14050506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2024] [Revised: 05/13/2024] [Accepted: 05/15/2024] [Indexed: 05/26/2024] Open
Abstract
Inhibitory control, as an essential cognitive ability, affects the development of higher cognitive functions. Rhythmic perceptual stimulation has been used to improve cognitive abilities. It is unclear, however, whether it can be used to improve inhibitory control. This study used the Go/NoGo task and the Stroop task to assess various levels of inhibitory control using rhythmic audio-visual stimuli as the stimulus mode. Sixty subjects were randomly divided into three groups to receive 6 Hz, 10 Hz, and white noise stimulation for 30 min. Two tasks were completed by each subject both before and after the stimulus. Before and after the task, closed-eye resting EEG data were collected. The results showed no differences in behavioral and EEG measures of the Go/NoGo task among the three groups. While both 6 Hz and 10 Hz audio-visual stimulation reduced the conflict effect in the Stroop task, only 6 Hz audio-visual stimulation improved the amplitude of the N2 component and decreased the conflict score. Although rhythmic audio-visual stimulation did not enhance response inhibition, it improved conflict inhibition.
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Affiliation(s)
| | | | | | | | | | - Wei Xiao
- Department of Military Medical Psychology, Air Force Medical University, Xi’an 710032, China; (Y.W.); (D.W.); (K.S.); (Y.Z.); (X.C.)
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Tapia JL, Aras LM, Duñabeitia JA. Enhancing Executive Functions in Pediatric Epilepsy: Feasibility and Efficacy of a Computerized Cognitive Training Program. CHILDREN (BASEL, SWITZERLAND) 2024; 11:484. [PMID: 38671701 PMCID: PMC11049550 DOI: 10.3390/children11040484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 04/15/2024] [Accepted: 04/17/2024] [Indexed: 04/28/2024]
Abstract
Epilepsy, a prevalent neurological disorder characterized by recurrent seizures, significantly impacts individuals' neurobiological, cognitive, and social lives. This report presents a feasibility study investigating the effects of a computerized cognitive training program on enhancing executive functions, particularly inhibitory control, in children and adolescents with epilepsy. Employing a pre-test-intervention-post-test design, the study involved 26 participants with diverse epileptic syndromes, focusing on those without severe intellectual disabilities. The intervention, based on the CogniFit Inc. platform, consisted of personalized tasks aiming to improve participants' inhibitory skills over 16 weeks, with an average of 40 sessions completed per participant. Results indicated significant improvements in reaction times and error rates in an anti-saccade task, demonstrating enhanced inhibitory control and general performance post-intervention. These findings suggest that targeted cognitive training is a feasible approach to bolster executive functions in young individuals with epilepsy, potentially improving their academic performance, employability, and social interactions. The study underscores the importance of early cognitive interventions in epilepsy management, highlighting the potential for computerized programs to aid in mitigating cognitive deficits associated with the condition.
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Affiliation(s)
- José Luis Tapia
- Centro de Investigación Nebrija en Cognición (CINC), Universidad Nebrija, 28043 Madrid, Spain;
| | | | - Jon Andoni Duñabeitia
- Centro de Investigación Nebrija en Cognición (CINC), Universidad Nebrija, 28043 Madrid, Spain;
- Department of Languages and Culture, UiT The Arctic University of Norway, 9019 Tromsø, Norway
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Surani Z, Turesky TK, Sullivan E, Shama T, Haque R, Islam N, Kakon SH, Yu X, Petri WA, Nelson C, Gaab N. Examining the relationship between psychosocial adversity and inhibitory control: an fMRI study of children growing up in extreme poverty. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.02.05.578942. [PMID: 38370839 PMCID: PMC10871278 DOI: 10.1101/2024.02.05.578942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/20/2024]
Abstract
Exposure to psychosocial adversity (PA) is associated with poor behavioral, physical, and mental health outcomes in adulthood. Growing evidence suggests that deficits in executive functions may in part moderate these outcomes, with inhibitory control as an example of such a putative moderator. However, much of the literature examining the development of inhibitory control has been based on children in higher resource environments, and little is known how growing up in a low resource setting might exacerbate the link between inhibitory control and health outcomes. In this context we collected fMRI data during a Go/No-Go inhibitory control task and PA variables for 68 children 5 to 7 years of age living in Dhaka, Bangladesh, an area with a high prevalence of PA. The children's mothers completed behavioral questionnaires to assess the child's PA and their own PA. Whole-brain activation underlying inhibitory control was examined using the No-Go versus Go contrast, and associations with PA variables were assessed using whole-brain regressions. Childhood neglect was associated with weaker activation in the right posterior cingulate, whereas greater family conflict, economic stress, and maternal PA factors were associated with greater activation in the left medial frontal gyrus, right superior and middle frontal gyrus, and left cingulate gyrus. These data suggest that neural networks supporting inhibitory control processes may vary as a function of exposure to different types of PA, particularly between those related to threat and deprivation. Furthermore, increased activation in children with greater PA may serve as a compensatory mechanism, allowing them to maintain similar behavioral task performance.
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Guo Z, Qiu R, Qiu H, Lu H, Zhu X. Long-term effects of repeated multitarget high-definition transcranial direct current stimulation combined with cognitive training on response inhibition gains. Front Neurosci 2023; 17:1107116. [PMID: 36968503 PMCID: PMC10033537 DOI: 10.3389/fnins.2023.1107116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 02/24/2023] [Indexed: 03/11/2023] Open
Abstract
BackgroundFew studies have investigated the effects of repeated sessions of transcranial direct current stimulation (tDCS) combined with concurrent cognitive training on improving response inhibition, and the findings have been heterogeneous in the limited research. This study investigated the long-lasting and transfer effects of 10 consecutive sessions of multitarget anodal HD-tDCS combined with concurrent cognitive training on improving response inhibition compared with multitarget stimulation or training alone.MethodsNinety-four healthy university students aged 18–25 were randomly assigned to undergo different interventions, including real stimulation combined with stop-signal task (SST) training, real stimulation, sham stimulation combined with SST training, and sham stimulation. Each intervention lasted 20 min daily for 10 consecutive days, and the stimulation protocol targeted right inferior frontal gyrus (rIFG) and pre-supplementary motor area (pre-SMA) simultaneously with a total current intensity of 2.5 mA. Performance on SST and possible transfer effects to Stroop task, attention network test, and N-back task were measured before and 1 day and 1 month after completing the intervention course.ResultsThe main findings showed that the combined protocol and the stimulation alone significantly reduced stop-signal reaction time (SSRT) in the post-intervention and follow-up tests compared to the pre-intervention test. However, training alone only decreased SSRT in the post-test. The sham control exhibited no changes. Subgroup analysis revealed that the combined protocol and the stimulation alone induced a decrease in the SSRT of the low-performance subgroup at the post-test and follow-up test compared with the pre-test. However, only the combined protocol, but not the stimulation alone, improved the SSRT of the high-performance subgroup. The transfer effects were absent.ConclusionThis study provides supportive evidence for the synergistic effect of the combined protocol, indicating its superiority over the single intervention method. In addition, the long-term after-effects can persist for up to at least 1 month. Our findings also provide insights into the clinical application and strategy for treating response inhibition deficits.
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Guida P, Foffani G, Obeso I. The Supplementary Motor Area and Automatic Cognitive Control: Lack of Evidence from Two Neuromodulation Techniques. J Cogn Neurosci 2023; 35:439-451. [PMID: 36603037 DOI: 10.1162/jocn_a_01954] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The SMA is fundamental in planning voluntary movements and execution of some cognitive control operations. Specifically, the SMA has been known to play a dominant role in controlling goal-directed actions as well as those that are highly predicted (i.e., automatic). Yet, the essential contribution of SMA in goal-directed or automatic control of behavior is scarce. Our objective was to test the possible direct role of SMA in automatic and voluntary response inhibition. We separately applied two noninvasive brain stimulation (NIBS) inhibitory techniques over SMA: either continuous theta-burst stimulation using repetitive transcranial magnetic stimulation or transcranial static magnetic field stimulation. Each NIBS technique was performed in a randomized, crossover, sham-controlled design. Before applying NIBS, participants practiced a go/no-go learning task where associations between stimulus and stopping behaviors were created (initiation and inhibition). After applying each NIBS, participants performed a go/no-go task with reversed associations (automatic control) and the stop signal task (voluntary control). Learning associations between stimuli and response initiation/inhibition was achieved by participants and therefore automatized during training. However, no significant differences between real and sham NIBS were found in either automatic (go/no-go learning task) or voluntary inhibition (stop signal task), with Bayesian statistics providing moderate evidence of absence. In conclusion, our results are compatible with a nondirect involvement of SMA in automatic control of behavior. Further studies are needed to prove a noncausal link between prior neuroimaging findings relative to SMA controlling functions and the observed behavior.
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Affiliation(s)
- Pasqualina Guida
- Hospital Universitario HM Puerta del Sur, HM Hospitales, Madrid, Spain.,Autonoma de Madrid University-Cajal Institute, Madrid, Spain
| | - Guglielmo Foffani
- Hospital Universitario HM Puerta del Sur, HM Hospitales, Madrid, Spain.,Instituto Carlos III, Madrid, Spain.,Hospital Nacional de Parapléjicos, SESCAM, Toledo, Spain
| | - Ignacio Obeso
- Hospital Universitario HM Puerta del Sur, HM Hospitales, Madrid, Spain.,Complutense University of Madrid, Spain
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Menu I, Rezende G, Le Stanc L, Borst G, Cachia A. Inhibitory control training on executive functions of children and adolescents: A latent change score model approach. COGNITIVE DEVELOPMENT 2022. [DOI: 10.1016/j.cogdev.2022.101231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Menu I, Rezende G, Le Stanc L, Borst G, Cachia A. A network analysis of executive functions before and after computerized cognitive training in children and adolescents. Sci Rep 2022; 12:14660. [PMID: 36038599 PMCID: PMC9424216 DOI: 10.1038/s41598-022-17695-x] [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: 09/30/2021] [Accepted: 07/29/2022] [Indexed: 11/09/2022] Open
Abstract
Executive functions (EFs) play a key role in cognitive and socioemotional development. Factor analyses have revealed an age dependent structure of EFs spanning from a single common factor in early childhood to three factors in adults corresponding to inhibitory control (IC), switching and updating. IC performances change not only with age but also with cognitive training. Surprisingly, few studies have investigated training-related changes in EFs structure. We used the regularized partial correlation network model to analyze EFs structure in 137 typically developing children (9-10 years) and adolescents (15-17 years) before and after computerized cognitive training. Network models (NMs) -a graph theory-based approach allowing us to describe the structure of complex systems- can provide a priori free insight into EFs structures. We tested the hypothesis that training-related changes may mimic developmental-related changes. Quantitative and qualitative changes were detected in the EFs network structure with age and also with cognitive training. Of note, the EFs network structure in children after training was more similar to adolescents' networks than before training. This study provided the first evidence of structural changes in EFs that are age and training-dependent and supports the hypothesis that training could accelerate the development of some structural aspects of EFs. Due to the sample size, these findings should be considered preliminary before replication in independent larger samples.
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Affiliation(s)
- Iris Menu
- Laboratoire de Psychologie du Développement et de l'Education, UMR CNRS 8240, Universite Paris Cité, Paris, France
| | - Gabriela Rezende
- Laboratoire de Psychologie du Développement et de l'Education, UMR CNRS 8240, Universite Paris Cité, Paris, France
| | - Lorna Le Stanc
- Laboratoire de Psychologie du Développement et de l'Education, UMR CNRS 8240, Universite Paris Cité, Paris, France
| | - Grégoire Borst
- Laboratoire de Psychologie du Développement et de l'Education, UMR CNRS 8240, Universite Paris Cité, Paris, France.,Institut Universitaire de France, Paris, France
| | - Arnaud Cachia
- Laboratoire de Psychologie du Développement et de l'Education, UMR CNRS 8240, Universite Paris Cité, Paris, France. .,Imaging Biomarkers for Brain Development and Disorders, UMR INSERM 1266, GHU Paris psychiatrie & neurosciences, Universite Paris Cité, 75005, Paris, France.
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Guo Z, Gong Y, Lu H, Qiu R, Wang X, Zhu X, You X. Multitarget high-definition transcranial direct current stimulation improves response inhibition more than single-target high-definition transcranial direct current stimulation in healthy participants. Front Neurosci 2022; 16:905247. [PMID: 35968393 PMCID: PMC9372262 DOI: 10.3389/fnins.2022.905247] [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: 03/26/2022] [Accepted: 07/11/2022] [Indexed: 11/21/2022] Open
Abstract
Prior studies have focused on single-target anodal transcranial direct current stimulation (tDCS) over the right inferior frontal gyrus (rIFG) or pre-supplementary motor area (pre-SMA) to improve response inhibition in healthy individuals. However, the results are contradictory and the effect of multitarget anodal stimulation over both brain regions has never been investigated. The present study aimed to investigate the behavioral and neurophysiological effects of different forms of anodal high-definition tDCS (HD-tDCS) on improving response inhibition, including HD-tDCS over the rIFG or pre-SMA and multitarget HD-tDCS over both areas. Ninety-two healthy participants were randomly assigned to receive single-session (20 min) anodal HD-tDCS over rIFG + pre-SMA, rIFG, pre-SMA, or sham stimulation. Before and immediately after tDCS intervention, participants completed a stop-signal task (SST) and a go/nogo task (GNG). Their cortical activity was recorded using functional near-infrared spectroscopy (fNIRS) during the go/nogo task. The results showed multitarget stimulation produced a significant reduction in stop-signal reaction time (SSRT) relative to baseline. The pre-to-post SSRT change was not significant for rIFG, pre-SMA, or sham stimulation. Further analyses revealed multitarget HD-tDCS significantly decreased SSRT in both the high-performance and low-performance subgroups compared with the rIFG condition which decreased SSRT only in the low-performance subgroup. Only the multitarget condition significantly improved neural efficiency as indexed by lower △oxy-Hb after stimulation. In conclusion, the present study provides important preliminary evidence that multitarget HD-tDCS is a promising avenue to improve stimulation efficacy, establishing a more effective montage to enhance response inhibition relative to the commonly used single-target stimulation.
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Affiliation(s)
- Zhihua Guo
- Department of Military Medical Psychology, Air Force Medical University, Xi’an, China
| | - Yue Gong
- School of Psychology, Shaanxi Normal University, Xi’an, China
| | - Hongliang Lu
- Department of Military Medical Psychology, Air Force Medical University, Xi’an, China
| | - Rui Qiu
- Department of Military Medical Psychology, Air Force Medical University, Xi’an, China
| | - Xinlu Wang
- Department of Military Medical Psychology, Air Force Medical University, Xi’an, China
| | - Xia Zhu
- Department of Military Medical Psychology, Air Force Medical University, Xi’an, China
- *Correspondence: Xia Zhu,
| | - Xuqun You
- School of Psychology, Shaanxi Normal University, Xi’an, China
- Xuqun You,
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Initial performance modulates the effects of cathodal transcranial direct current stimulation (tDCS) over the right dorsolateral prefrontal cortex on inhibitory control. Brain Res 2022; 1774:147722. [PMID: 34774867 DOI: 10.1016/j.brainres.2021.147722] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 10/22/2021] [Accepted: 11/06/2021] [Indexed: 11/27/2022]
Abstract
Transcranial direct current stimulation (tDCS) has received considerable attention as a new option to facilitate cognitive ability or rehabilitation in healthy populations or in individuals with neuropsychiatric disorders. However, the tDCS effect varies widely, possibly because individual differences in initial performance have frequently been ignored in previous research. Here, we aimed to examine the influence of initial performance on inhibitory control after tDCS. Fifty-six participants were randomly divided into three groups: anodal, cathodal and sham stimulation. The go/no-go task, stop-signal task and Stroop task were performed to measure inhibitory control before and immediately after tDCS. tDCS was applied to the F4 site (international 10-20 system), corresponding to the right dorsolateral prefrontal cortex (rDLPFC), for 20 min with an intensity of 1.5 mA. Neither anodal nor cathodal stimulation had significant effects on the performance of these three tasks at the group level in comparison with sham stimulation. However, the analyses at the individual level only showed a negative relationship between baseline performance and the magnitude of change in go/no-go task performance following cathodal tDCS, indicating the dependence of the change amount on initial performance, with greater gains (or losses) observed in individuals with poorer (or better) initial performance. Together, the initial performance modulates the proactive inhibitory effect of cathodal tDCS of the rDLPFC. Additionally, the rDLPFC plays a crucial role in proactive inhibition.
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Xu P, Chen Y, Wu D, Sun K, Xiao W. The influence of 'deliberate' implementation intention on medical students' risk decision task outcomes. PSYCHOL HEALTH MED 2021; 27:1805-1812. [PMID: 34256666 DOI: 10.1080/13548506.2021.1954206] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Implementation intention is a kind of behaviour choice strategy in which individuals adopt specific and definite behaviour patterns to achieve behavioural goals. The standard form is 'if something happens, then I will do something'. Previous studies have shown that implementation intention strategy is a fast and effective mental skill with notable advantages. However, adding the requirement of 'deliberate' to the implementation plan will increase the probability of decision adjustment to a certain extent. In this study, the classic Balloon Analogue Risk Task (BART) was selected as the evaluation index of risk decision-making, and the 'deliberate' implementation intention was adopted to explore the impact of this behavioural strategy on risk selection. The recruited medical students were divided into two groups: the implementation intention group (n = 37) and the control group (n = 34). The baseline assessment for the BART was performed by all participants, and the intensive training of 'deliberate' implementation intention to 'make as much money as possible' was conducted before the post-test decision-making after one week. The adjusted BART (adj BART) value and AvgIncome were significantly higher than those at baseline in the implementation intention group(adj BART value: baseline 12.63 ± 2.90, post-test: 14.78 ± 2.66, F = 15.978, p < 0.001, η 2 = 0.307; AvgIncome: baseline 12.43 ± 2.56, post-test 15.00 ± 2.57, F = 20.953, p < 0.001, η 2 = 0.368). The mixed-model ANOVAs showed that there was a significant interaction between test time and group (adj BART value: F = 4.859, p = 0.031, η 2 = 0.066; AvgIncome: F = 4.261, p = 0.043, η 2 = 0.058). Conclusion: The implementation of 'deliberate' intention can help medical students make more rational judgements in risk decision-making tasks, avoid over conservative behaviour and obtain more benefits.
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Affiliation(s)
- Pengbo Xu
- Department of Military Medical Psychology, Air Force Medical University, Xi'an, China
| | - Yuqin Chen
- Department of Military Medical Psychology, Air Force Medical University, Xi'an, China.,Second Brigade, NCO School, Army Medical University, Shijiazhuang, China
| | - Di Wu
- Department of Military Medical Psychology, Air Force Medical University, Xi'an, China
| | - Kewei Sun
- Department of Military Medical Psychology, Air Force Medical University, Xi'an, China
| | - Wei Xiao
- Department of Military Medical Psychology, Air Force Medical University, Xi'an, China
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