Adding to the neuroimmune network model: A commentary on Nusslock et al. (2024)

Work by many groups demonstrate links between peripheral markers of inflammation and symptoms of depression. Here, Nusslock and colleagues present an update to their neuroimmune network model to incorporate a developmental lens. They propose that specific neural circuits may be responsible for causing heightened inflammation. One principal circuit includes the amygdala and prefrontal cortex and is proposed to be involved in threat detection. Thus, heightened threat sensitivity resulting from early life stress is suggested to cause increases in inflammatory signaling. Second, the authors suggest that reward circuits, including the striatum, may be targets of increased inflammation leading to symptoms of anhedonia. In this commentary, I add context to the model proposed by Nusslock et al., suggesting that taking a learning perspective and considering additional circuits, including the hippocampus and midline structures may be necessary to more fully account for the phenomena described by the authors.

Familism, family cohesion, and health-related quality of life in Hispanic prostate cancer survivors

BACKGROUND

Familism, the cultural value that emphasizes feelings of loyalty and dedication to one's family, has been related to both positive and negative outcomes in Hispanic cancer survivors. One potential source of observed inconsistencies may be limited attention to the family environment, as familism may be protective in a cohesive family whereas it can exacerbate distress in a conflictive family.

PURPOSE

The current study explored the associations of familism with general and disease-specific health-related quality of life (HRQoL) in Hispanic men who completed prostate cancer (PC) treatment, and whether family cohesion may help explain these relationships.

METHODS

Hispanic men treated for localized PC (e.g., radiation, surgery) were enrolled in a randomized controlled stress management trial and assessed prior to randomization. Familism (familial obligation) was assessed using Sabogal's Familism Scale and family cohesion was measured using the Family Environment Scale (ranging from high to low). The sexual, urinary incontinence, and urinary obstructive/irritative domains of the Expanded Prostate Cancer Index Composite - Short Form measured disease-specific HRQoL. The physical, emotional, and functional well-being subscales of the Functional Assessment of Cancer Therapy - General captured general HRQoL. Hierarchical linear regression and the SPSS PROCESS macro were used to conduct moderation analyses, while controlling for relevant covariates.

RESULTS

Participants were 202 older men on average 65.7 years of age (SD = 8.0) who had been diagnosed with PC an average of 22 months prior to enrollment. Familism was not directly associated with general and disease-specific HRQoL. Moderation analyses revealed that greater familism was related to poorer urinary functioning in the incontinence (p = .03) and irritative/obstructive domains (p = .01), and lower emotional well-being (p = .02), particularly when family cohesion was low.

CONCLUSIONS

These findings underscore the importance of considering contextual factors, such as family cohesion, in understanding the influence of familism on general and disease-specific HRQoL among Hispanic PC patients. The combined influence of familism and family cohesion predicts clinically meaningful differences in urinary functioning and emotional well-being during the posttreatment phase. Culturally sensitive psychosocial interventions to boost family cohesion and leverage the positive impact of familistic attitudes are needed to enhance HRQoL outcomes in this population.

Depression is associated with blunted affective responses to naturalistic reward prediction errors

BACKGROUND

Depression is characterized by abnormalities in emotional processing, but the specific drivers of such emotional abnormalities are unknown. Computational work indicates that both surprising outcomes (prediction errors; PEs) and outcomes (values) themselves drive emotional responses, but neither has been consistently linked to affective disturbances in depression. As a result, the computational mechanisms driving emotional abnormalities in depression remain unknown.

METHODS

Here, in 687 individuals, one-third of whom qualify as depressed via a standard self-report measure (the PHQ-9), we use high-stakes, naturalistic events - the reveal of midterm exam grades - to test whether individuals with heightened depression display a specific reduction in emotional response to positive PEs.

RESULTS

Using Bayesian mixed effects models, we find that individuals with heightened depression do not affectively benefit from surprising, good outcomes - that is, they display reduced affective responses to positive PEs. These results were highly specific: effects were not observed to negative PEs, value signals (grades), and were not related to generalized anxiety. This suggests that the computational drivers of abnormalities in emotion in depression may be specifically due to positive PE-based emotional responding.

CONCLUSIONS

Affective abnormalities are core depression symptoms, but the computational mechanisms underlying such differences are unknown. This work suggests that blunted affective reactions to positive PEs are likely mechanistic drivers of emotional dysregulation in depression.

The affective benefits of real-world exploration during the COVID-19 pandemic

Increasing daily exploration is linked to improvements in affective well-being. However, COVID-19 elevated uncertainty when leaving the home, altering the risk-reward of balance of geospatial novelty. To this end, we simultaneously collected real-world geospatial tracking and experience sampling of emotion, prior to and during the first year of the pandemic in 630 individuals. COVID-19 reduced exploration and subjective well-being. Yet, despite the health risks of exploring during the pandemic, the days of highest affective well-being were those when individuals explored the most. However, this was not true for everyone: during the first months of the pandemic, at the height of the uncertainty surrounding the transmissibility and prognosis of a COVID-19 infection, more anxious individuals experienced no affective benefit to leaving home. Taken together, real-world exploration improved well-being regardless of the presence of real-world threat, but anxiety mitigated these benefits. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Greater perceived stress management skills and heightened brain metabolic activity in cortical and subcortical stress processing regions in metastatic breast cancer patients

PURPOSE

Emotional distress and adversity can contribute to negative health outcomes in women with breast cancer. Individual differences in perceived stress management skills such as cognitive reframing and relaxation for coping with adversity have been shown to predict less distress and better psychological and physiological adaptation. Prior work shows that more distressed breast cancer patients reveal less metabolic activity in brain regions such as the insula, thalamus, ventromedial and lateral prefrontal cortices. This led us to pose the hypothesis that breast cancer patients with greater stress management skills (e.g., ability to reframe stressors and use relaxation) may conversely show greater activation in these brain regions and thereby identify brain activity that may be modifiable through stress management interventions. The main objective of this study was to examine the association of perceived stress management skill efficacy with the metabolism of 9 key stress-implicated brain regions in women diagnosed with metastatic breast cancer.

METHODS

Sixty women (mean age 59.86 ± 10.04) with a diagnosis of mBC underwent 18F-fluorodeoxyglucose positron emission tomography. Perceived stress management skill efficacy was assessed with the Measure of Current Status Scale.

RESULTS

Greater perceived stress management skill efficacy related significantly to higher metabolic activity in the insula, thalamus, ventromedial and lateral prefrontal cortices, and basal ganglia; this network of regions overlaps with those previously shown to be under-activated with greater level of distress in this same sample of metastatic breast cancer patients.

CONCLUSION

This is the first study to demonstrate in metastatic cancer patients that greater perceptions of stress management skill efficacy are associated with metabolic activity in key brain regions and paves the way for future studies tracking neural mechanisms sensitive to change following stress management interventions for this population.

Negative interpretation bias connects to real-world daily affect: A multistudy approach

Negative interpretation bias, the tendency to appraise ambiguous stimuli as threatening, shapes our emotional lives. Various laboratory tasks, which differ in stimuli features and task procedures, can quantify negative interpretation bias. However, it is unknown whether these tasks globally predict individual differences in real-world negative (NA) and positive (PA) affect. Across two studies, we tested whether different lab-based negative interpretation bias tasks predict daily NA and PA, measured via mobile phone across months. To quantify negative interpretation bias, Study 1 (N = 69) used a verbal, self-referential task whereas Study 2 (N = 110) used a perceptual, emotional image task with faces and scenes. Across tasks, negative interpretation bias was linked to heightened daily NA. However, only negative interpretation bias in response to ambiguous faces was related to decreased daily PA. These results illustrate the ecological validity of negative interpretation bias tasks and highlight converging and unique relationships between distinct tasks and naturalistic emotion. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Individual differences in naturalistic learning link negative emotionality to the development of anxiety

Organisms learn from prediction errors (PEs) to predict the future. Laboratory studies using small financial outcomes find that humans use PEs to update expectations and link individual differences in PE-based learning to internalizing disorders. Because of the low-stakes outcomes in most tasks, it is unclear whether PE learning emerges in naturalistic, high-stakes contexts and whether individual differences in PE learning predict psychopathology risk. Using experience sampling to assess 625 college students' expected exam grades, we found evidence of PE-based learning and a general tendency to discount negative PEs, an "optimism bias." However, individuals with elevated negative emotionality, a personality trait linked to the development of anxiety disorders, displayed a global pessimism and learning differences that impeded accurate expectations and predicted future anxiety symptoms. A sensitivity to PEs combined with an aversion to negative PEs may result in a pessimistic and inaccurate model of the world, leading to anxiety.

Identification of careless responding in ecological momentary assessment research: From posthoc analyses to real-time data monitoring

With the emerging ubiquity of cell phones, ecological momentary assessment (EMA) as a set of methods enable researchers to study momentary social, psychological, and affective responses to everyday life. Additionally, EMA enables researchers to acquire longitudinal data without the need for multiple lab visits. As the use of EMA in research increases, so too does the necessity of determining what constitutes valid or careless individual EMA responses to ensure validity and replicability of findings. Currently, EMA studies solely consider the response rate of a participant for exclusion. Yet, other features of an assessment can help to determine whether a response is careless or implausible. Here, we examined over 18,000 EMA text message responses of individual affect items to derive a data-driven model of what constitutes a "careless response." Results from this study indicate that an overly fast time to complete items (≤ 1 s), an overly narrow within assessment response variance (SD ≤ 5), and the percentage of items that fall at the mode (≥ 60%) are independent and reliable indicators of a careless response. Excluding careless responses such as these remove implausible positive correlations among psychometric antonyms (e.g., relaxed and anxious). Further, by identifying and removing careless responses, we also identify careless responders, participants who could be removed from group analyses. We use these results to develop and introduce an R package, EMAeval, so EMA researchers may similarly identify careless responses and responders either online during data collection or posthoc, after data collection has completed. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Real-World Exploration Increases Across Adolescence and Relates to Affect, Risk Taking, and Social Connectivity

Cross-species research suggests that exploratory behaviors increase during adolescence and relate to the social, affective, and risky behaviors characteristic of this developmental stage. However, how these typical adolescent behaviors manifest and relate in real-world settings remains unclear. Using geolocation tracking to quantify exploration—variability in daily movement patterns—over a 3-month period in 58 adolescents and adults (ages 13–27) in New York City, we investigated whether daily exploration varied with age and whether exploration related to social connectivity, risk taking, and momentary positive affect. In our cross-sectional sample, we found an association between daily exploration and age, with individuals near the transition to legal adulthood exhibiting the highest exploration levels. Days of higher exploration were associated with greater positive affect irrespective of age. Higher mean exploration was associated with greater social connectivity in all participants but was linked to higher risk taking selectively among adolescents. Our results highlight the interplay of exploration and socioemotional behaviors across development and suggest that societal norms may modulate their expression in naturalistic contexts.

Does the Broaden-and-Build Theory Explain Reduction in Social Disruption After a Brief Relaxation Intervention for Women With Breast Cancer Undergoing Treatment?

Women with breast cancer experience social disruption during and after treatment. Brief cognitive-behavioral (CBT) and relaxation (RT) interventions may improve social disruption by increasing positive affect. Using the Broaden-and-Build Theory as a framework, this study examined whether short-term CBT- and RT-related increases in positive affect mediate long-term reductions in social disruption in women with breast cancer undergoing treatment (N = 183). This secondary analysis used latent change score and growth models to test 6- and 12-month intervention effects on positive affect and social disruption, respectively; a parallel-process model assessed mediation. RT demonstrated larger reductions in social disruption across 12 months compared to CBT and a health education control. Six-month latent change in positive affect was significant but not driven by condition. There was a significant direct effect linking the latent slopes of positive affect and social disruption but meditation was not observed. These preliminary findings hint at the value of promoting positive affect and inform the development of brief behavioral interventions that aim to augment social functioning among women surviving breast cancer.

Identifying real-world affective correlates of cognitive risk factors for internalizing disorders

Cognitive risk factors are key in the vulnerability for internalizing disorders. Cognitive risk factors modulate the way individuals process information from the environment which in turn impacts the day-to-day affective experience. In 296 young adults, we assessed two transdiagnostic, general risk factors-repetitive negative thinking (RNT) and anxiety sensitivity in a high-RNT subsample (N = 119). We also assessed disorderand content-specific risk factors including worry, rumination, and three facets of anxiety sensitivity (cognitive, social, physical). To determine the day-to-day affective experience, we used cell-phone-based ecological momentary assessment to assess the mean and variability of positive and negative affect (PA; NA) over 3-4 months. Two multilevel multivariate Bayesian models were used to predict PA and NA mean and variability from (1) general and (2) specific cognitive risk factors. Mean NA was a nonspecific correlate of cognitive risk across both models, while mean PA was most strongly related to RNT and rumination. NA variability was most strongly related to RNT, rumination, and the physiological facet of anxiety sensitivity. PA variability was a specific correlate of RNT. Results highlight that cognitive risk factors for internalizing disorders manifest in unique patterns of day-to-day emotional experience. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Temporal dynamics of affect in the brain: Evidence from human imaging and animal models

Emotions are time-varying internal states that promote survival in the face of dynamic environments and shifting homeostatic needs. Research in non-human organisms has recently afforded specific insights into the neural mechanisms that support the emergence, persistence, and decay of affective states. Concurrently, a separate affective neuroscience literature has begun to dissect the neural bases of affective dynamics in humans. However, the circuit-level mechanisms identified in animals lack a clear mapping to the human neuroscience literature. As a result, critical questions pertaining to the neural bases of affective dynamics in humans remain unanswered. To address these shortcomings, the present review integrates findings from humans and non-human organisms to highlight the neural mechanisms that govern the temporal features of emotional states. Using the theory of affective chronometry as an organizing framework, we describe the specific neural mechanisms and modulatory factors that arbitrate the rise-time, intensity, and duration of emotional states.

The distribution of daily affect distinguishes internalizing and externalizing spectra and subfactors

There has been increasing recognition that classically defined psychiatric disorders cluster hierarchically. However, the degree to which this hierarchical taxonomy manifests in the distribution of one's daily affective experience is unknown. In 462 young adults, we assessed psychiatric symptoms across internalizing and externalizing disorders and then used cell-phone-based ecological momentary assessment (EMA) to assess the distribution (mean, standard deviation, skew, kurtosis) of one's positive and negative affect over 3-4 months. Psychiatric symptoms were modeled using a higher-order factor model that estimated internalizing and externalizing spectra as well as specific disorders. Individualized factor loadings were extracted, and path models assessed associations between spectra and syndromes, and daily affect. Internalizing and externalizing spectra displayed broad differences in the distribution of affective experiences, while within the internalizing spectrum, syndromes loading onto fear and distress subfactors were associated with distinct patterns of affective experiences. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Linking Amygdala Persistence to Real-World Emotional Experience and Psychological Well-Being

Neural dynamics in response to affective stimuli are linked to momentary emotional experiences. The amygdala, in particular, is involved in subjective emotional experience and assigning value to neutral stimuli. Because amygdala activity persistence following aversive events varies across individuals, some may evaluate subsequent neutral stimuli more negatively than others. This may lead to more frequent and long-lasting momentary emotional experiences, which may also be linked to self-evaluative measures of psychological well-being (PWB). Despite extant links between daily affect and PWB, few studies have directly explored the links between amygdala persistence, daily affective experience, and PWB. To that end, we examined data from 52 human adults (67% female) in the Midlife in the United States study who completed measures of PWB, daily affect, and functional MRI (fMRI). During fMRI, participants viewed affective images followed by a neutral facial expression, permitting quantification of individual differences in the similarity of amygdala representations of affective stimuli and neutral facial expressions that follow. Using representational similarity analysis, neural persistence following aversive stimuli was operationalized as similarity between the amygdala activation patterns while encoding negative images and the neutral facial expressions shown afterward. Individuals demonstrating less persistent activation patterns in the left amygdala to aversive stimuli reported more positive and less negative affect in daily life. Further, daily positive affect served as an indirect link between left amygdala persistence and PWB. These results clarify important connections between individual differences in brain function, daily experiences of affect, and well-being.SIGNIFICANCE STATEMENT At the intersection of affective neuroscience and psychology, researchers have aimed to understand how individual differences in the neural processing of affective events map onto to real-world emotional experiences and evaluations of well-being. Using a longitudinal dataset from 52 adults in the Midlife in the United States (MIDUS) study, we provide an integrative model of affective functioning: less amygdala persistence following negative images predicts greater positive affect (PA) in daily life, which in turn predicts greater psychological well-being (PWB) seven years later. Thus, day-to-day experiences of PA comprise a promising intermediate step that links individual differences in neural dynamics to complex judgements of PWB.

Association between real-world experiential diversity and positive affect relates to hippocampal-striatal functional connectivity

Experiential diversity promotes well-being in animal models. Here, using geolocation tracking, experience sampling and neuroimaging, we found that daily variability in physical location was associated with increased positive affect in humans. This effect was stronger for individuals who exhibited greater functional coupling of the hippocampus and striatum. These results link diversity in real-world daily experiences to fluctuations in positive affect and identify a hippocampal-striatal circuit associated with this bidirectional relationship.

Negative affect and stress-related brain metabolism in patients with metastatic breast cancer

BACKGROUND

Cancer and its treatment represent major stressors requiring that patients make multiple adaptations. Despite evidence that poor adaptation to stressors is associated with more distress and negative affect (NA), neuroimmune dysregulation and poorer health outcomes, current understanding is very limited of how NA covaries with central nervous system changes to account for these associations.

METHODS

NA was correlated with brain metabolic activity using ¹⁸ F-fluorodeoxyglucose positron emission tomography/computed tomography (¹⁸ F-FDG PET/CT) in several regions of interest in 61 women with metastatic breast cancer. Patients underwent ¹⁸ F-FDG PET/CT and completed an assessment of NA using the Brief Symptom Inventory.

RESULTS

Regression analyses revealed that NA was significantly negatively correlated with the standardized uptake value ratio of the insula, thalamus, hypothalamus, ventromedial prefrontal cortex, and lateral prefrontal cortex. Voxel-wise correlation analyses within these 5 regions of interest demonstrated high left-right symmetry and the highest NA correlations with the anterior insula, thalamus (medial and ventral portion), lateral prefrontal cortex (right Brodmann area 9 [BA9], left BA45, and right and left BA10 and BA8), and ventromedial prefrontal cortex (bilateral BA11).

CONCLUSIONS

The regions of interest most strongly negatively associated with NA represent key areas for successful adaptation to stressors and may be particularly relevant in patients with metastatic breast cancer who are dealing with multiple challenges of cancer and its treatment.

Temporal dynamics of real-world emotion are more strongly linked to prediction error than outcome

Primarily based on laboratory studies, theories of affect propose that emotions are driven by the valence of outcomes as well as the difference between the outcome itself and the expected outcome (i.e., the prediction error [PE]). Yet no work has assessed the drivers of emotion using real-world, personally meaningful events on timescales over which human emotion unfolds. We developed an event-triggered, ecological momentary assessment procedure measuring positive and negative affect (PA and NA, respectively) in university students as they received exam grades for which they had made predictions. We split data into exploratory and confirmatory samples, and built computational models predicting the time course of PA and NA and demonstrate that a model incorporating both exam grade and grade PE accounted for the time course of PA and NA better than a model solely using exam grades. Further, grade PEs were stronger predictors of the time course of PA and NA than the grades themselves. Similarly, the effects of PEs also persisted longer for NA than PA. These data indicate that deviations from expectations are critical determinants of the temporal dynamics of real-world emotion. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

From Conditioning to Emotion: Translating Animal Models of Learning to Human Psychopathology

Emotional responses are not static but change as a consequence of learning. Organisms adapt to emotional events and these adaptations influence the way we think, behave, and feel when we encounter similar situations in the future. Integrating recent work from rodent models and research on human psychopathology, this article lays out a model describing how affective events cause learning and can lead to anxiety and depression: affective events are linked to conditioned stimuli and contexts. Affective experiences entrain oscillatory synchrony across distributed neural circuits, including the prefrontal cortex, hippocampus, amygdala, and nucleus accumbens, which form associations that constitute the basis of emotional memories. Consolidation of these experiences appears to be supported by replay in the hippocampus—a process by which hippocampal firing patterns recreate the firing pattern that occurred previously. Generalization of learning occurs to never before experienced contexts when associations form across distinct but related conditioned stimuli. The process of generalization, which requires cortical structures, can cause memories to become abstracted. During abstraction, the latent, overlapping features of the learned associations remain and result in the formation of schemas. Schemas are adaptive because they facilitate the rapid processing of conditioned stimuli and prime behavioral, cognitive, and affective responses that are the manifestations of the accumulation of an individual’s conditioned experiences. However, schemas can be maladaptive when the generalization of aversive emotional responses are applied to stimuli and contexts in which affective reactions are unnecessary. I describe how this process can lead to not only mood and anxiety disorders but also psychotherapeutic treatment.

Model-based learning and individual differences in depression: The moderating role of stress

Inflexible decision-making has been proposed as a transdiagnostic risk factor for mood disorders. Evidence suggests that inflexible decision-making may emerge only when individuals are experiencing increased negative affect or stress. 151 participants completed symptom measures of depression and anxiety, followed by a two-stage decision-making task that distinguishes between habitual and goal-directed choice. An experimental manipulation to induce stress was introduced halfway through the task. Individuals with higher depression levels became less model-based after the manipulation than those with lower depression levels. There was no relationship between trait anxiety and the impact of the manipulation on decision-making. Controlling for main effects of anxiety did not attenuate the association between depression and impact of stress. Anhedonia was associated with the impact of the manipulation on model-based decision-making. These results suggest that risk for depression is associated with reflexive decision-making, but these effects may only emerge under conditions of stress.

Parsing affective dynamics to identify risk for mood and anxiety disorders

Emotional dysregulation is thought to underlie risk for both anxiety and depressive disorders. However, despite high rates of comorbidity, anxiety and depression are phenotypically different. Apart from nosological differences (e.g., worry for anxiety, low mood for depression), it remains unclear how the emotional dysregulation inherent in individual differences in trait anxiety and depression severity present on a day-to-day basis. One approach that may facilitate addressing these questions is to utilize Ecological Momentary Assessment (EMA) using mobile phones to parse the temporal dynamics of affective experiences into specific parameters. An emerging literature in affective science suggests that risk for anxiety and depressive disorders may be associated with variation in the mean and instability/variability of emotion. Here we examine the extent to which distinct temporal dynamic parameters uniquely predict risk for anxiety versus depression. Over 10 days, 105 individuals rated their current positive and negative affective state several times each day. Using two distinct approaches to statistically assess mean and instability of positive and negative affect, we found that individual differences in trait anxiety was generally associated with increased instability of positive and negative affect whereas mean levels of positive and negative affect were generally associated with individual differences in depression. These data provide evidence that the emotional dysregulation underlying risk for mood versus anxiety disorders unfolds in distinct ways and highlights the utility in examining affective dynamics to understand psychopathology. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Resting-State Brain Signal Variability in Prefrontal Cortex Is Associated With ADHD Symptom Severity in Children

Atypical brain function in attention-deficit/hyperactivity disorder (ADHD) has been identified using both task-activation and functional connectivity fMRI approaches. Recent work highlights the potential for another measure derived from functional neuroimaging data, brain signal variability, to reveal insights into clinical conditions. Higher brain signal variability has previously been linked with optimal behavioral performance. At present, little is known regarding the relationship between resting-state brain signal variability and ADHD symptom severity. The current study examined the relationship between a measure of moment-to-moment brain signal variability called mean-square successive difference (MSSD) and ADHD symptomatology in a group of children (7–12 years old) with (n = 40) and without (n = 30) a formal diagnosis of ADHD. A categorical analysis comparing subjects with and without a clinical diagnosis of ADHD showed no differences in MSSD between groups. A dimensional analysis revealed a positive relationship between MSSD and overall ADHD symptom severity and inattention across children with and without an ADHD diagnosis. Specifically, this positive relationship was found in medial prefrontal areas comprising the default mode network. These results demonstrate a link between intrinsic brain signal variability and ADHD symptom severity that cuts across diagnostic categories, and point to a locus of dysfunction consistent with previous neuroimaging literature.

Purposeful Engagement, Healthy Aging, and the Brain

PURPOSE OF REVIEW

Research on psychological well-being in later life has identified strengths and vulnerabilities that occur with aging. We review the conceptual and philosophical foundations of a eudaimonic model of well-being and its empirical translation into six key dimensions of positive functioning. We also consider its implications for health, broadly defined.

RECENT FINDINGS

Numerous findings from national longitudinal samples of U.S. adults are described. They show declining scores on purpose in life and personal growth with aging, but also underscore the notable variability among older persons in these patterns. Recently, health benefits have been identified among older adults who maintain high levels of a particular aspect of well-being, namely, purposeful life engagement. These benefits include extended longevity, reduced risk for various disease outcomes, reduced physiological dysregulation, and gene expression linked to better inflammatory profiles. The brain mechanisms that underlie such outcomes are also examined via a focus on affective style. Adults with higher levels of purpose in life show more rapid recovery from negative stimulus provocation, whereas those with higher well-being overall show sustained activation of reward circuitry in response to positive stimuli, and this pattern is associated with lower diurnal cortisol output. Volumetric findings (right insular gray matter volume) have also been linked with eudaimonic well-being.

SUMMARY

Eudaimonic well-being predicts better health and longer lives, and thus constitutes an important direction for future research and practice. Intervention studies designed to promote well-being, including among those suffering from psychological disorders, are briefly described.

Changes in cortico-subcortical and subcortico-subcortical connectivity impact cognitive control to emotional cues across development

The capacity to suppress inappropriate thoughts, emotions and actions in favor of appropriate ones shows marked changes throughout childhood and adolescence. Most research has focused on pre-frontal circuit development to explain these changes. Yet, subcortical circuitry involving the amygdala and ventral striatum (VS) has been shown to modulate cue-triggered motivated behaviors in rodents. The nature of the interaction between these two subcortical regions in humans is less well understood, especially during development when there appears to be heightened sensitivity to emotional cues. In the current study, we tested how task-based cortico-subcortical and subcortico-subcortical functional connectivity in 155 participants ages from 5 to 32 impacted cognitive control performance on an emotional go/nogo task. Functional connectivity between the amygdala and VS was inversely correlated with age and predicted cognitive control to emotional cues, when controlling for performance to neutral cues. In contrast, increased medial pre-frontal-amygdala connectivity was associated with better cognitive control to emotional cues and this cortical-subcortical connectivity mediated the association between amygdala-VS connectivity and emotional cognitive control. These findings suggest a dissociation in how subcortical-subcortical and cortical-subcortical connectivity impact cognitive control across development.

Neural Mechanisms of Emotion Regulation in Autism Spectrum Disorder

Autism spectrum disorder (ASD) is characterized by high rates of comorbid internalizing and externalizing disorders. One mechanistic account of these comorbidities is that ASD is characterized by impaired emotion regulation (ER) that results in deficits modulating emotional responses. We assessed neural activation during cognitive reappraisal of faces in high functioning adults with ASD. Groups did not differ in looking time, pupilometry, or subjective ratings of faces during reappraisal. However, instructions to increase positive and negative emotional responses resulted in less increase in nucleus accumbens and amygdala activations (respectively) in the ASD group, and both regulation instructions resulted in less change in dorsolateral prefrontal cortex activation in the ASD group. Results suggest a potential mechanistic account of impaired ER in ASD.

Cortical-Subcortical Interactions in Depression: From Animal Models to Human Psychopathology

Depression is a debilitating disorder causing significant societal and personal suffering. Improvements in identification of major depressive disorder (MDD) and its treatment are essential to reduce its toll. Recent developments in rodent models of MDD and neuroimaging of humans suffering from the disorder provide avenues through which gains can be made towards reducing its burden. In this review, new findings, integrating across rodent models and human imaging are highlighted that have yielded new insights towards a basic understanding of the disorder. In particular, this review focuses on cortical-subcortical interactions underlying the pathophysiology of MDD. In particular, evidence is accruing that dysfunction in prefrontal-subcortical circuits including the amygdala, ventral striatum (VS), hippocampus and dorsal raphe nucleus (DRN) are associated with MDD status.

The Impact of Emotional States on Cognitive Control Circuitry and Function

Typically in the laboratory, cognitive and emotional processes are studied separately or as a stream of fleeting emotional stimuli embedded within a cognitive task. Yet in life, thoughts and actions often occur in more lasting emotional states of arousal. The current study examines the impact of emotions on actions using a novel behavioral paradigm and functional neuroimaging to assess cognitive control under sustained states of threat (anticipation of an aversive noise) and excitement (anticipation of winning money). Thirty-eight healthy adult participants were scanned while performing an emotional go/no-go task with positive (happy faces), negative (fearful faces), and neutral (calm faces) emotional cues, under threat or excitement. Cognitive control performance was enhanced during the excited state relative to a nonarousing control condition. This enhanced performance was paralleled by heightened activity of frontoparietal and frontostriatal circuitry. In contrast, under persistent threat, cognitive control was diminished when the valence of the emotional cue conflicted with the emotional state. Successful task performance in this conflicting emotional condition was associated with increased activity in the posterior cingulate cortex, a default mode network region implicated in complex processes such as processing emotions in the context of self and monitoring performance. This region showed positive coupling with frontoparietal circuitry implicated in cognitive control, providing support for a role of the posterior cingulate cortex in mobilizing cognitive resources to improve performance. These findings suggest that emotional states of arousal differentially modulate cognitive control and point to the potential utility of this paradigm for understanding effects of situational and pathological states of arousal on behavior.

When Is an Adolescent an Adult? Assessing Cognitive Control in Emotional and Nonemotional Contexts

An individual is typically considered an adult at age 18, although the age of adulthood varies for different legal and social policies. A key question is how cognitive capacities relevant to these policies change with development. The current study used an emotional go/no-go paradigm and functional neuroimaging to assess cognitive control under sustained states of negative and positive arousal in a community sample of one hundred ten 13- to 25-year-olds from New York City and Los Angeles. The results showed diminished cognitive performance under brief and prolonged negative emotional arousal in 18- to 21-year-olds relative to adults over 21. This reduction in performance was paralleled by decreased activity in fronto-parietal circuitry, implicated in cognitive control, and increased sustained activity in the ventromedial prefrontal cortex, involved in emotional processes. The findings suggest a developmental shift in cognitive capacity in emotional situations that coincides with dynamic changes in prefrontal circuitry. These findings may inform age-related social policies.

The face of negative affect: trial-by-trial corrugator responses to negative pictures are positively associated with amygdala and negatively associated with ventromedial prefrontal cortex activity

The ability to simultaneously acquire objective physiological measures of emotion concurrent with fMRI holds the promise to enhance our understanding of the biological bases of affect and thus improve our knowledge of the neural circuitry underlying psychiatric disorders. However, the vast majority of neuroimaging studies to date examining emotion have not anchored the examination of emotion-responding circuitry to objective measures of emotional processing. To that end, we acquired EMG activity of a valence-sensitive facial muscle involved in the frowning response (corrugator muscle) concurrent with fMRI while twenty-six human participants viewed negative and neutral images. Trial-by-trial increases in corrugator EMG activity to negative pictures were associated with greater amygdala activity and a concurrent decrease in ventromedial PFC activity. Thus, this study highlights the reciprocal relation between amygdalar and ventromedial PFC in the encoding of emotional valence as reflected by facial expression.

Increased prefrontal cortex activity during negative emotion regulation as a predictor of depression symptom severity trajectory over 6 months

IMPORTANCE

Emotion regulation is critically disrupted in depression, and the use of paradigms that tap into these processes may uncover essential changes in neurobiology during treatment. In addition, because neuroimaging outcome studies of depression commonly use only baseline and end-point data-which are more prone to week-to-week noise in symptomatology-we sought to use all data points over the course of a 6-month trial.

OBJECTIVE

To examine changes in neurobiology resulting from successful treatment.

DESIGN, SETTING, AND PARTICIPANTS

Double-blind trial examining changes in the neural circuits involved in emotion regulation resulting from 1 of 2 antidepressant treatments during a 6-month trial. Twenty-one patients with major depressive disorder and without other Axis I or Axis II diagnoses were scanned before treatment and 2 and 6 months into treatment at the university's functional magnetic resonance imaging facility.

INTERVENTIONS

Venlafaxine hydrochloride extended release (with doses of up to 300 mg) or fluoxetine hydrochloride (with doses of up to 80 mg).

MAIN OUTCOMES AND MEASURES

Neural activity, as measured using functional magnetic resonance imaging during performance of an emotion regulation paradigm, as well as regular assessments of symptom severity using the Hamilton Depression Rating Scale. For use of all data points, slope trajectories were calculated for rate of change in depression severity and for rate of change in neural engagement.

RESULTS

The depressed individuals who showed the steepest decrease in depression severity over the 6-month period were the same individuals who showed the most rapid increases in activity in Brodmann area 10 and the right dorsolateral prefrontal cortex activity when regulating negative affect over the same time frame. This relationship was more robust when using only the baseline and end-point data.

CONCLUSIONS AND RELEVANCE

Changes in prefrontal cortex engagement when regulating negative affect correlate with changes in depression severity over 6 months. These results are buttressed by calculating these statistics, which are more reliable and robust to week-to-week variation than are difference scores.

Sustained striatal activity predicts eudaimonic well-being and cortisol output

Eudaimonic well-being-a sense of purpose, meaning, and engagement with life-is protective against psychopathology and predicts physical health, including lower levels of the stress hormone cortisol. Although it has been suggested that the ability to engage the neural circuitry of reward may promote well-being and mediate the relationship between well-being and health, this hypothesis has remained untested. To test this hypothesis, we had participants view positive, neutral, and negative images while fMRI data were collected. Individuals with sustained activity in the striatum and dorsolateral prefrontal cortex to positive stimuli over the course of the scan session reported greater well-being and had lower cortisol output. This suggests that sustained engagement of reward circuitry in response to positive events underlies well-being and adaptive regulation of the hypothalamic-pituitary-adrenal axis.

Relationships between changes in sustained fronto-striatal connectivity and positive affect in major depression resulting from antidepressant treatment

OBJECTIVE Deficits in positive affect and their neural bases have been associated with major depression. However, whether reductions in positive affect result solely from an overall reduction in nucleus accumbens activity and fronto-striatal connectivity or the additional inability to sustain engagement of this network over time is unknown. The authors sought to determine whether treatment-induced changes in the ability to sustain nucleus accumbens activity and fronto-striatal connectivity during the regulation of positive affect are associated with gains in positive affect. METHOD Using fMRI, the authors assessed the ability to sustain activity in reward-related networks when attempting to increase positive emotion during performance of an emotion regulation paradigm in 21 depressed patients before and after 2 months of antidepressant treatment. Over the same interval, 14 healthy comparison subjects underwent scanning as well. RESULTS After 2 months of treatment, self-reported positive affect increased. The patients who demonstrated the largest increases in sustained nucleus accumbens activity over the 2 months were those who demonstrated the largest increases in positive affect. In addition, the patients who demonstrated the largest increases in sustained fronto-striatal connectivity were also those who demonstrated the largest increases in positive affect when controlling for negative affect. None of these associations were observed in healthy comparison subjects. CONCLUSIONS Treatment-induced change in the sustained engagement of fronto-striatal circuitry tracks the experience of positive emotion in daily life. Studies examining reduced positive affect in a variety of psychiatric disorders might benefit from examining the temporal dynamics of brain activity when attempting to understand changes in daily positive affect.

Reduced right ventrolateral prefrontal cortex activity while inhibiting positive affect is associated with improvement in hedonic capacity after 8 weeks of antidepressant treatment in major depressive disorder

BACKGROUND

Anhedonia, a reduced ability to experience pleasure, is a chief symptom of major depressive disorder and is related to reduced frontostriatal connectivity when attempting to upregulate positive emotion. The present study examined another facet of positive emotion regulation associated with anhedonia-namely, the downregulation of positive affect-and its relation to prefrontal cortex (PFC) activity.

METHODS

Neuroimaging data were collected from 27 individuals meeting criteria for major depressive disorder as they attempted to suppress positive emotion during a positive emotion regulation task. Their PFC activation pattern was compared with the PFC activation pattern exhibited by 19 healthy control subjects during the same task. Anhedonia scores were collected at three time points: at baseline (time 1), 8 weeks after time 1 (i.e., time 2), and 6 months after time 1 (i.e., time 3). Prefrontal cortex activity at time 1 was used to predict change in anhedonia over time. Analyses were conducted utilizing hierarchical linear modeling software.

RESULTS

Depressed individuals who could not inhibit positive emotion-evinced by reduced right ventrolateral prefrontal cortex activity during attempts to dampen their experience of positive emotion in response to positive visual stimuli-exhibited a steeper anhedonia reduction slope between baseline and 8 weeks of treatment with antidepressant medication (p < .05). Control subjects showed a similar trend between baseline and time 3.

CONCLUSIONS

To reduce anhedonia, it may be necessary to teach individuals how to counteract the functioning of an overactive pleasure-dampening prefrontal inhibitory system.

Simultaneous acquisition of corrugator electromyography and functional magnetic resonance imaging: a new method for objectively measuring affect and neural activity concurrently

The development of functional neuroimaging of emotion holds the promise to enhance our understanding of the biological bases of affect and improve our knowledge of psychiatric diseases. However, up to this point, researchers have been unable to objectively, continuously and unobtrusively measure the intensity and dynamics of affect concurrently with functional magnetic resonance imaging (fMRI). This has hindered the development and generalizability of our field. Facial electromyography (EMG) is an objective, reliable, valid, sensitive, and unobtrusive measure of emotion. Here, we report the successful development of a method for simultaneously acquiring fMRI and facial EMG. The ability to simultaneously acquire brain activity and facial physiology will allow affective neuroscientists to address theoretical, psychiatric, and individual difference questions in a more rigorous and generalizable way.

Cerebral responses to change in spatial location of unattended sounds

The neural basis of spatial processing in the auditory cortex has been controversial. Human fMRI studies suggest that a part of the planum temporale (PT) is involved in auditory spatial processing, but it was recently argued that this region is active only when the task requires voluntary spatial localization. If this is the case, then this region cannot harbor an ongoing spatial representation of the acoustic environment. In contrast, we show in three fMRI experiments that a region in the human medial PT is sensitive to background auditory spatial changes, even when subjects are not engaged in a spatial localization task, and in fact attend the visual modality. During such times, this area responded to rare location shifts, and even more so when spatial variation increased, consistent with spatially selective adaptation. Thus, acoustic space is represented in the human PT even when sound processing is not required by the ongoing task.

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.

Functional connectivity with anterior cingulate and orbitofrontal cortices during decision-making

Recent neuroscience research is beginning to discover the brain regions involved in decision-making under uncertainty, but little is known about whether or how these regions functionally interact with each other. Here, we used event-related functional magnetic resonance imaging to examine both changes in overall activity and changes in functional connectivity during risk-taking. Results showed that choosing high-risk over low-risk decisions was associated with increased activity in both anterior cingulate and orbitofrontal cortices. Connectivity analyses revealed that largely distinct, but somewhat overlapping, cortical and subcortical regions exhibited significant functional connectivity with anterior cingulate and orbitofrontal cortices. Additionally, connectivity with the anterior cingulate in some regions, including the orbitofrontal cortex and nucleus accumbens, was modulated by the decision participants chose. These findings (1) elucidate large networks of brain regions that are functionally connected with both anterior cingulate and orbitofrontal cortices during decision-making and (2) demonstrate that the roles of orbitofrontal and anterior cingulate cortices can be functionally differentiated by examining patterns of connectivity.

Antibiotic penetration in liver infection: a case of tobramycin failure responsive to moxalactam

A 23-year-old man sustained a severe liver laceration which subsequently became infected with Enterobacter aerogenes. Blood cultures were positive for this organism and the patient experienced sepsis. Over the course of 18 days, his bilirubin and serum creatinine increased from normal to 40 and 2.7 mg/dl, respectively. Tobramycin, clindamycin, and penicillin failed to control the infection despite in vitro sensitivity of the organism to tobramycin. Moxalactam was started as a last resort, and the symptoms of infection resolved in 12 h. Both hepatic and renal function returned to normal, and the patient was discharged without complications. Moxalactam concentrations in wound fluid exceeded serum concentrations and the usual minimum inhibitory concentration of the infecting organism. A likely explanation for response to moxalactam, in face of tobramycin failure, was that moxalactam was able to reach the site of infection.

Antibiotic penetration in abdominal infection: a case of tobramycin failure responsive to moxalactam

A 50-year-old male developed an Enterobacter cloacae abdominal infection as the result of gangrene of a gastric remnant after gastrectomy. Aggressive antibiotic treatment with tobramycin and clindamycin was instituted, but despite documented in vitro bacterial sensitivity and high serum tobramycin levels, the patient's clinical condition worsened. Enterobacter cloacae continued to grow in the abdominal drainage cultures. As a last resort, moxalactam therapy was started. Within 36 hours, dramatic clinical improvement was seen and Enterobacter disappeared from the abdominal fluid cultures. Antibiotic assays showed that abdominal fluid contained approximately 50 percent of the simultaneous serum moxalactam concentration, while tobramycin was present in abdominal fluid at less than 15 percent of the serum concentration. In spite of bacterial sensitivity to both drugs, it is likely that moxalactam produced better results than did tobramycin, because of better tissue penetration characteristics.

Coagulum choledocholithotomy: a preliminary report

Using the technique of coagulum pyelolithotomy, development of which was pioneered by Dees in 1943, we successfully extracted common duct stones from 17 dogs and three human beings. The canine model for pyelolithotomy was developed by producing an autogenous clot. We think Dee's technique could be applicable in common bile duct surgery.

Anxiety in asthma: panic-fear symptomatology and personality in relation to manifest anxiety

Anxiety in asthma has been measured in two ways. The MMPI Panic-Fear scale is a measure of general, nonillness specific anxiety and the Panic-Fear symptom scale of the Asthma Symptom Checklist is a measure of illness-specific anxiety focused on the asthma attack. Both measures relate to response styles in asthma which contribute to the maintenance of illness. In the present study of 140 asthmatic patients, MMPI Panic-Fear scores were highly related to trait-anxiety measured by the Taylor Manifest Anxiety Scale, even after partialling out checklist Panic-Fear symptom scores. In contrast, Panic-Fear symptomatology had a more moderate relationship to the Taylor Anxiety scores and was independent of the Taylor scores after partialling out MMPI Panic-Fear scores. The results support earlier findings suggesting that MMPI Panic-Fear measures trait anxiety. In contrast, checklist Panic-Fear symptom reports measure an illness-specific state anxiety that is not per se a measure of trait anxiety.