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Poplin T, Ironside M, Kuplicki R, Aupperle RL, Guinjoan SM, Khalsa SS, Stewart JL, Victor TA, Paulus MP, Kirlic N. The unique face of anxious depression: Increased sustained threat circuitry response during fear acquisition. bioRxiv 2023:2023.10.17.562565. [PMID: 37905149 PMCID: PMC10614928 DOI: 10.1101/2023.10.17.562565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
Background Sensitivity to threat with dysregulation of fear learning is thought to contribute to the development of psychiatric disorders, including anxiety disorders (AD) and major depressive disorder (MDD). However, fewer studies have examined fear learning in MDD than in AD. Nearly half of individuals with MDD have an AD and the comorbid diagnosis has worse outcomes. The current study used propensity matching to examine the hypothesis that AD+MDD shows greater neural correlates of fear learning than MDD, suggesting that the co-occurrence of AD+MDD is exemplified by exaggerated defense related processes. Methods 195 individuals with MDD (N = 65) or AD+MDD (N=130) were recruited from the community and completed multi-level assessments, including a Pavlovian fear learning task during functional imaging. Results MDD and AD+MDD showed significantly different patterns of activation for [CSplus-CSminus] in the medial amygdala (ηp2=0.009), anterior insula (ηp2=0.01), dorsolateral prefrontal cortex (ηp2=0.002), dorsal anterior cingulate cortex (ηp2=0.01), mid-cingulate cortex (ηp2=0.01) and posterior cingulate cortex (ηp2=0.02). These differences were driven by greater activation to the CS+ in late conditioning phases in ADD+MDD relative to MDD. Conclusions AD+MDD showed a pattern of increased sustained activation in regions identified with fear learning. Effects were consistently driven by the threat condition, further suggesting fear signaling as the emergent target process. Differences emerged in regions associated with salience processing, attentional orienting/conflict, and self-relevant processing.These findings help to elucidate the fear signaling mechanisms involved in the pathophysiology of comorbid anxiety and depression, thereby highlighting promising treatment targets for this prevalent treatment group.
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Affiliation(s)
- Tate Poplin
- Laureate Institute for Brain Research, 6655 South Yale Avenue, Tulsa, OK 74136, USA
| | - Maria Ironside
- Laureate Institute for Brain Research, 6655 South Yale Avenue, Tulsa, OK 74136, USA
- University of Tulsa, 800 South Tucker Drive, Tulsa, OK 74104, USA
| | - Rayus Kuplicki
- Laureate Institute for Brain Research, 6655 South Yale Avenue, Tulsa, OK 74136, USA
| | - Robin L. Aupperle
- Laureate Institute for Brain Research, 6655 South Yale Avenue, Tulsa, OK 74136, USA
- University of Tulsa, 800 South Tucker Drive, Tulsa, OK 74104, USA
| | - Salvador M. Guinjoan
- Laureate Institute for Brain Research, 6655 South Yale Avenue, Tulsa, OK 74136, USA
- University of Tulsa, 800 South Tucker Drive, Tulsa, OK 74104, USA
| | - Sahib S. Khalsa
- Laureate Institute for Brain Research, 6655 South Yale Avenue, Tulsa, OK 74136, USA
- University of Tulsa, 800 South Tucker Drive, Tulsa, OK 74104, USA
| | - Jennifer L. Stewart
- Laureate Institute for Brain Research, 6655 South Yale Avenue, Tulsa, OK 74136, USA
- University of Tulsa, 800 South Tucker Drive, Tulsa, OK 74104, USA
| | - Teresa A. Victor
- Laureate Institute for Brain Research, 6655 South Yale Avenue, Tulsa, OK 74136, USA
| | - Martin P. Paulus
- Laureate Institute for Brain Research, 6655 South Yale Avenue, Tulsa, OK 74136, USA
- University of Tulsa, 800 South Tucker Drive, Tulsa, OK 74104, USA
| | - Namik Kirlic
- Laureate Institute for Brain Research, 6655 South Yale Avenue, Tulsa, OK 74136, USA
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Kirlic N, Akeman E, DeVille DC, Yeh HW, Cosgrove KT, McDermott TJ, Touthang J, Clausen A, Paulus MP, Aupperle RL. A machine learning analysis of risk and protective factors of suicidal thoughts and behaviors in college students. J Am Coll Health 2023; 71:1863-1872. [PMID: 34292856 PMCID: PMC8782938 DOI: 10.1080/07448481.2021.1947841] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 05/27/2021] [Accepted: 06/20/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To identify robust and reproducible factors associated with suicidal thoughts and behaviors (STBs) in college students. METHODS 356 first-year university students completed a large battery of demographic and clinically-relevant self-report measures during the first semester of college and end-of-year (n = 228). Suicide Behaviors Questionnaire-Revised (SBQ-R) assessed STBs. A machine learning (ML) pipeline using stacking and nested cross-validation examined correlates of SBQ-R scores. RESULTS 9.6% of students were identified at significant STBs risk by the SBQ-R. The ML algorithm explained 28.3% of variance (95%CI: 28-28.5%) in baseline SBQ-R scores, with depression severity, social isolation, meaning and purpose in life, and positive affect among the most important factors. There was a significant reduction in STBs at end-of-year with only 1.8% of students identified at significant risk. CONCLUSION Analyses replicated known factors associated with STBs during the first semester of college and identified novel, potentially modifiable factors including positive affect and social connectedness.
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Affiliation(s)
- Namik Kirlic
- Laureate Institute for Brain Research, Tulsa, OK, USA
| | | | - Danielle C. DeVille
- Laureate Institute for Brain Research, Tulsa, OK, USA
- Department of Psychology, University of Tulsa, Tulsa, OK, USA
| | - Hung-Wen Yeh
- Health Services & Outcomes Research, Children’s Mercy Hospital, Kansas City, MO, USA
| | - Kelly T. Cosgrove
- Laureate Institute for Brain Research, Tulsa, OK, USA
- Department of Psychology, University of Tulsa, Tulsa, OK, USA
| | - Timothy J. McDermott
- Laureate Institute for Brain Research, Tulsa, OK, USA
- Department of Psychology, University of Tulsa, Tulsa, OK, USA
| | | | - Ashley Clausen
- Education and Clinical Center, VA Mid-Atlantic Mental Illness Research, Durham, NC, USA
- Duke University Brain Imaging and Analysis Center, Durham, NC, USA
| | | | - Robin L. Aupperle
- Laureate Institute for Brain Research, Tulsa, OK, USA
- School of Community Medicine, University of Tulsa, Tulsa, OK, USA
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3
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Berg H, Akeman E, McDermott TJ, Cosgrove KT, Kirlic N, Clausen A, Cannon M, Yeh HW, White E, Thompson WK, Choquette EM, Sturycz-Taylor CA, Cochran G, Ramirez S, Martell CR, Wolitzky-Taylor KB, Craske MG, Abelson JL, Paulus MP, Aupperle RL. A randomized clinical trial of behavioral activation and exposure-based therapy for adults with generalized anxiety disorder. J Mood Anxiety Disord 2023; 1:100004. [PMID: 38384390 PMCID: PMC10881118 DOI: 10.1016/j.xjmad.2023.100004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/23/2024]
Abstract
Objective Exposure-based therapy (EXP) and behavioral activation (BA) are empirically-supported behavioral intervention techniques that target avoidance and approach behavior to alleviate symptoms. Although EXP is an established treatment for generalized anxiety disorder (GAD), the effectiveness of BA for GAD has not been directly tested or compared with that of EXP. This study examined the efficacy of EXP and BA for adults with GAD. Method In a randomized clinical trial (clinicaltrials.gov: NCT02807480) with partial blinding in Tulsa, OK, 102 adults with GAD were allocated to manualized, 10-session EXP or BA between April 2016-April 2021. Primary analyses were intention-to-treat and included the 94 (46 EXP, 48 BA) participants who started treatment. The GAD-7 self-report scale was the primary outcome measure. Results Similar GAD-7 declines were observed at post-treatment for EXP (d=-0.97 [95% CI -1.40 to -0.53]) and BA (d=-1.14 [95% CI -1.57 to -0.70]), and were maintained through 6-month follow-up (EXP: d=-2.13, BA: d=-1.98). Compared to EXP, BA yielded more rapid declines in anxiety and depression scores during therapy (d=0.75-0.77), as well as lower anxiety and depression scores (d=0.13-0.14) and greater participant-rated improvement (d=0.64) at post-treatment. Bayesian analyses indicated 74-99% probability of greater change in BA than EXP at post-treatment. Conclusions BA and EXP are both effective in treating GAD, and BA may confer greater benefit during treatment. Future research is warranted to inform personalized treatment approaches.
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Affiliation(s)
- Hannah Berg
- Laureate Institute for Brain Research, 6655 South Yale Ave., Tulsa, OK 74136, USA
| | - Elisabeth Akeman
- Laureate Institute for Brain Research, 6655 South Yale Ave., Tulsa, OK 74136, USA
| | - Timothy J. McDermott
- Laureate Institute for Brain Research, 6655 South Yale Ave., Tulsa, OK 74136, USA
- Department of Psychology, University of Tulsa, 800 South Tucker Drive, Tulsa, OK 74104, USA
| | - Kelly T. Cosgrove
- Laureate Institute for Brain Research, 6655 South Yale Ave., Tulsa, OK 74136, USA
- Department of Psychology, University of Tulsa, 800 South Tucker Drive, Tulsa, OK 74104, USA
| | - Namik Kirlic
- Laureate Institute for Brain Research, 6655 South Yale Ave., Tulsa, OK 74136, USA
| | - Ashley Clausen
- St. Vincent Hospital, Billings, 1233 N 30th St, Billings, MT 59101, USA
| | - Mallory Cannon
- Laureate Institute for Brain Research, 6655 South Yale Ave., Tulsa, OK 74136, USA
| | - Hung-Wen Yeh
- Health Services & Outcomes Research, Children’s Mercy Hospital, 2401 Gillham Road, Kansas City, MO 64108, USA
- Department of Pediatrics, School of Medicine, University of Missouri-Kansas City, 2411 Holmes Street, Kansas City, MO 64108, USA
| | - Evan White
- Laureate Institute for Brain Research, 6655 South Yale Ave., Tulsa, OK 74136, USA
- Department of Community Medicine, University of Tulsa, 1215 South Boulder Ave W, Tulsa, OK 74119, USA
| | - Wesley K. Thompson
- Family Medicine and Public Health, UC San Diego, 9500 Gilman Dr., La Jolla, CA 92093, USA
| | - Emily M. Choquette
- Laureate Institute for Brain Research, 6655 South Yale Ave., Tulsa, OK 74136, USA
| | | | - Gabe Cochran
- Laureate Institute for Brain Research, 6655 South Yale Ave., Tulsa, OK 74136, USA
| | - Sam Ramirez
- Laureate Institute for Brain Research, 6655 South Yale Ave., Tulsa, OK 74136, USA
| | - Christopher R. Martell
- Department of Psychological and Brain Sciences, University of Massachusetts–Amherst, 135 Hicks Way, Amherst, MA 01003, USA
| | - Kate B. Wolitzky-Taylor
- Psychology, Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, 405 Hilgard Avenue, Los Angeles, CA 90077, USA
| | - Michelle G. Craske
- Psychology, Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, 405 Hilgard Avenue, Los Angeles, CA 90077, USA
| | - James L. Abelson
- Department of Psychiatry, University of Michigan, 1500 E Medical Center Dr, Ann Arbor, MI 48109, USA
| | - Martin P. Paulus
- Laureate Institute for Brain Research, 6655 South Yale Ave., Tulsa, OK 74136, USA
- Department of Community Medicine, University of Tulsa, 1215 South Boulder Ave W, Tulsa, OK 74119, USA
| | - Robin L. Aupperle
- Laureate Institute for Brain Research, 6655 South Yale Ave., Tulsa, OK 74136, USA
- Department of Community Medicine, University of Tulsa, 1215 South Boulder Ave W, Tulsa, OK 74119, USA
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Modlin NL, Miller TM, Rucker JJ, Kirlic N, Lennard-Jones M, Schlosser D, Aaronson ST. Optimizing outcomes in psilocybin therapy: Considerations in participant evaluation and preparation. J Affect Disord 2023; 326:18-25. [PMID: 36707036 DOI: 10.1016/j.jad.2023.01.077] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 01/11/2023] [Accepted: 01/21/2023] [Indexed: 01/26/2023]
Abstract
Recent studies have demonstrated the promise of psilocybin therapies in creating positive changes for those with poor mental health across multiple diagnostic categories, including major depressive disorder (MDD), end-of-life anxiety, and obsessive-compulsive disorder (OCD). While there may be a large population that is eligible to participate in psilocybin therapy based on psychiatric diagnosis and medical clearance, little attention has been given to intrapersonal and interpersonal factors that might influence patient's readiness (i.e., eligibility and capacity) for psychedelic interventions. This paper proposes that readiness assessment includes both intrapersonal and interpersonal factors in order to improve safety, patient care, and treatment outcomes. While at the present time a reliable and valid instrument has not been developed, we propose that three specific areas of focus - patient presentation, therapeutic alliance, and patient safety - may be used to establish a patient's readiness for psilocybin therapy, thus increasing therapy optimization and personalization.
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Affiliation(s)
- Nadav Liam Modlin
- The Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Tammy M Miller
- Institute for Advanced Therapeutics and Diagnostics, Sheppard Pratt, Towson, MD, United States of America
| | - James J Rucker
- Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology, and Neuroscience, London, United Kingdom; South London and Maudsley National Health Service Foundation Trust, Bethlem Royal Hospital, Beckenham, United Kingdom
| | | | | | - Danielle Schlosser
- Compass Pathfinder Ltd, London, United Kingdom; Weill Institute for Neurosciences, University of California, San Francisco, United States of America
| | - Scott T Aaronson
- Institute for Advanced Therapeutics and Diagnostics, Sheppard Pratt, Towson, MD, United States of America; University of Maryland School of Medicine, Department of Psychiatry, 701 West Pratt Street, Baltimore, MD 21201, United States of America.
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5
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Cochran G, Cohen ZP, Paulus MP, Tsuchiyagaito A, Kirlic N. Sustained increase in depression and anxiety among psychiatrically healthy adolescents during late stage COVID-19 pandemic. Front Psychiatry 2023; 14:1137842. [PMID: 37009105 PMCID: PMC10063786 DOI: 10.3389/fpsyt.2023.1137842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 02/24/2023] [Indexed: 03/19/2023] Open
Abstract
Background Adolescents have experienced increases in anxiety, depression, and stress during the COVID-19 pandemic and may be at particular risk for suffering from long-term mental health consequences because of their unique developmental stage. This study aimed to determine if initial increases in depression and anxiety in a small sample of healthy adolescents after the onset of the COVID-19 pandemic were sustained at follow-up during a later stage of the pandemic. Methods Fifteen healthy adolescents completed self-report measures at three timepoints (pre-pandemic [T1], early pandemic [T2], and later pandemic [T3]). The sustained effect of COVID-19 on depression and anxiety was examined using linear mixed-effect analyses. An exploratory analysis was conducted to investigate the relationship between difficulties in emotion regulation during COVID-19 at T2 and increases in depression and anxiety at T3. Results The severity of depression and anxiety was significantly increased at T2 and sustained at T3 (depression: Hedges' g [T1 to T2] = 1.04, g [T1 to T3] = 0.95; anxiety: g [T1 to T2] = 0.79, g [T1 to T3] = 0.80). This was accompanied by sustained reductions in positive affect, peer trust, and peer communication. Greater levels of difficulties in emotion regulation at T2 were related to greater symptoms of depression and anxiety at T3 (rho = 0.71 to 0.80). Conclusion Increased symptoms of depression and anxiety were sustained at the later stage of the pandemic in healthy adolescents. Replication of these findings with a larger sample size would be required to draw firm conclusions.
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Affiliation(s)
- Gabe Cochran
- Laureate Institute for Brain Research, Tulsa, OK, United States
| | - Zsofia P. Cohen
- Department of Psychology, Oklahoma State University, Stillwater, OK, United States
| | | | - Aki Tsuchiyagaito
- Laureate Institute for Brain Research, Tulsa, OK, United States
- Oxley College of Health Sciences, The University of Tulsa, Tulsa, OK, United States
- Research Center for Child Mental Development, Chiba University, Chiba, Japan
| | - Namik Kirlic
- Laureate Institute for Brain Research, Tulsa, OK, United States
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6
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White EJ, Demuth MJ, Nacke M, Kirlic N, Kuplicki R, Spechler PA, McDermott TJ, DeVille DC, Stewart JL, Lowe J, Paulus MP, Aupperle RL. Neural processes of inhibitory control in American Indian peoples are associated with reduced mental health problems. Soc Cogn Affect Neurosci 2023; 18:nsac045. [PMID: 35801628 PMCID: PMC9949499 DOI: 10.1093/scan/nsac045] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 06/17/2022] [Accepted: 07/07/2022] [Indexed: 11/13/2022] Open
Abstract
American Indians (AI) experience disproportionately high prevalence of suicide and substance use disorders (SUD). However, accounting for risk burden (e.g. historical trauma and discrimination), the likelihood of mental health disorders or SUD is similar or decreased compared with the broader population. Such findings have spurred psychological research examining the protective factors, but no studies have investigated its potential neural mechanisms. Inhibitory control is one of the potential neurobehavioral construct with demonstrated protective effects, but has not been examined in neuroimaging studies with AI populations specifically. We examined the incidence of suicidal thoughts and behaviors (STB) and SUD among AI (n = 76) and propensity matched (sex, age, income, IQ proxy and trauma exposure) non-Hispanic White (NHW) participants (n = 76). Among the AI sample, functional magnetic resonance imaging (fMRI) data recorded during the stop-signal task (SST) was examined in relation to STB and SUDs. AIs relative to NHW subjects displayed lower incidence of STB. AIs with no reported STBs showed greater activity in executive control regions during the SST compared with AI who endorsed STB. AI without SUD demonstrated lower activity relative to those individual reporting SUD. Results are consistent with a growing body of literature demonstrating the high level of risk burden driving disparate prevalence of mental health concerns in AI. Furthermore, differential activation during inhibitory control processing in AI individuals without STB may represent a neural mechanism of protective effects against mental health problems in AI. Future research is needed to elucidate sociocultural factors contributing protection against mental health outcomes in AIs and further delineate neural mechanisms with respect to specific concerns (e.g. SUD vs STB).
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Affiliation(s)
- Evan J White
- Laureate Institute for Brain Research, Tulsa, OK 74136, USA
- Oxley School of Community Medicine, University of Tulsa, Tulsa, OK 74119, USA
| | - Mara J Demuth
- Laureate Institute for Brain Research, Tulsa, OK 74136, USA
| | - Mariah Nacke
- Laureate Institute for Brain Research, Tulsa, OK 74136, USA
| | - Namik Kirlic
- Laureate Institute for Brain Research, Tulsa, OK 74136, USA
| | - Rayus Kuplicki
- Laureate Institute for Brain Research, Tulsa, OK 74136, USA
| | | | - Timothy J McDermott
- Laureate Institute for Brain Research, Tulsa, OK 74136, USA
- Department of Psychology, University of Tulsa, Tulsa, OK 74104, USA
| | - Danielle C DeVille
- Laureate Institute for Brain Research, Tulsa, OK 74136, USA
- Department of Psychology, University of Tulsa, Tulsa, OK 74104, USA
| | - Jennifer L Stewart
- Laureate Institute for Brain Research, Tulsa, OK 74136, USA
- Oxley School of Community Medicine, University of Tulsa, Tulsa, OK 74119, USA
| | - John Lowe
- School of Nursing, University of Texas at Austin, Austin, TX 78712, USA
| | - Martin P Paulus
- Laureate Institute for Brain Research, Tulsa, OK 74136, USA
- Oxley School of Community Medicine, University of Tulsa, Tulsa, OK 74119, USA
| | - Robin L Aupperle
- Laureate Institute for Brain Research, Tulsa, OK 74136, USA
- Oxley School of Community Medicine, University of Tulsa, Tulsa, OK 74119, USA
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7
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Tsuchiyagaito A, Misaki M, Kirlic N, Yu X, Sánchez SM, Cochran G, Stewart JL, Smith R, Fitzgerald KD, Rohan ML, Paulus MP, Guinjoan SM. Real-Time fMRI Functional Connectivity Neurofeedback Reducing Repetitive Negative Thinking in Depression: A Double-Blind, Randomized, Sham-Controlled Proof-of-Concept Trial. Psychother Psychosom 2023:1-14. [PMID: 36630946 DOI: 10.1159/000528377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 11/10/2022] [Indexed: 01/13/2023]
Abstract
INTRODUCTION Repetitive negative thinking (RNT) is a cognitive process focusing on self-relevant and negative experiences, leading to a poor prognosis of major depressive disorder (MDD). We previously identified that connectivity between the precuneus/posterior cingulate cortex (PCC) and right temporoparietal junction (rTPJ) was positively correlated with levels of RNT. OBJECTIVE In this double-blind, randomized, sham-controlled, proof-of-concept trial, we employed real-time functional magnetic resonance imaging neurofeedback (rtfMRI-nf) to delineate the neural processes that may be causally linked to RNT and could potentially become treatment targets for MDD. METHODS MDD-affected individuals were assigned to either active (n = 20) or sham feedback group (n = 19). RNT was measured by the Ruminative Response Scale-brooding subscale (RRS-B) before and 1 week after the intervention. RESULTS Individuals in the active but not in the sham group showed a significant reduction in the RRS-B; however, a greater reduction in the PCC-rTPJ connectivity was unrelated to a greater reduction in the RRS-B. Exploratory analyses revealed that a greater reduction in the retrosplenial cortex (RSC)-rTPJ connectivity yielded a more pronounced reduction in the RRS-B in the active but not in the sham group. CONCLUSIONS RtfMRI-nf was effective in reducing RNT. Considering the underlying mechanism of rtfMIR-nf, the RSC and rTPJ could be part of a network (i.e., default mode network) that might collectively affect the intensity of RNT. Understanding the relationship between the functional organization of targeted neural changes and clinical metrics, such as RNT, has the potential to guide the development of mechanism-based treatment of MDD.
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Affiliation(s)
- Aki Tsuchiyagaito
- Laureate Institute for Brain Research, Tulsa, Oklahoma, USA.,Oxley College of Health Sciences, The University of Tulsa, Tulsa, Oklahoma, USA.,Research Center for Child Mental Development, Chiba University, Chiba, Japan
| | - Masaya Misaki
- Laureate Institute for Brain Research, Tulsa, Oklahoma, USA
| | - Namik Kirlic
- Laureate Institute for Brain Research, Tulsa, Oklahoma, USA
| | - Xiaoqian Yu
- Laureate Institute for Brain Research, Tulsa, Oklahoma, USA
| | | | - Gabe Cochran
- Laureate Institute for Brain Research, Tulsa, Oklahoma, USA
| | - Jennifer L Stewart
- Laureate Institute for Brain Research, Tulsa, Oklahoma, USA.,Oxley College of Health Sciences, The University of Tulsa, Tulsa, Oklahoma, USA
| | - Ryan Smith
- Laureate Institute for Brain Research, Tulsa, Oklahoma, USA.,Oxley College of Health Sciences, The University of Tulsa, Tulsa, Oklahoma, USA
| | - Kate D Fitzgerald
- Department of Psychiatry, Columbia University, New York, New York, USA
| | | | | | - Salvador M Guinjoan
- Laureate Institute for Brain Research, Tulsa, Oklahoma, USA.,Department of Psychiatry, Oklahoma University Health Sciences Center at Tulsa, Tulsa, Oklahoma, USA
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Savitz J, Ford BN, Yeh HW, Akeman E, Cosgrove K, Clausen AN, Martell C, Kirlic N, Santiago J, Teague TK, Irwin MR, Paulus MP, Aupperle RL. Behavioral activation therapy for depression is associated with a reduction in the concentration of circulating quinolinic acid. Psychol Med 2022; 52:2500-2509. [PMID: 33234171 PMCID: PMC8144244 DOI: 10.1017/s0033291720004389] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND An inflammation-induced imbalance in the kynurenine pathway (KP) has been reported in major depressive disorder but the utility of these metabolites as predictive or therapeutic biomarkers of behavioral activation (BA) therapy is unknown. METHODS Serum samples were provided by 56 depressed individuals before BA therapy and 29 of these individuals also provided samples after 10 weeks of therapy to measure cytokines and KP metabolites. The PROMIS Depression Scale (PROMIS-D) and the Sheehan Disability Scale were administered weekly and the Beck depression inventory was administered pre- and post-therapy. Data were analyzed with linear mixed-effect, general linear, and logistic regression models. The primary outcome for the biomarker analyses was the ratio of kynurenic acid to quinolinic acid (KynA/QA). RESULTS BA decreased depression and disability scores (p's < 0.001, Cohen's d's > 0.5). KynA/QA significantly increased at post-therapy relative to baseline (p < 0.001, d = 2.2), an effect driven by a decrease in QA post-therapy (p < 0.001, uncorrected, d = 3.39). A trend towards a decrease in the ratio of kynurenine to tryptophan (KYN/TRP) was also observed (p = 0.054, uncorrected, d = 0.78). Neither the change in KynA/QA, nor baseline KynA/QA were associated with response to BA therapy. CONCLUSION The current findings together with previous research show that electronconvulsive therapy, escitalopram, and ketamine decrease concentrations of the neurotoxin, QA, raise the possibility that a common therapeutic mechanism underlies diverse forms of anti-depressant treatment but future controlled studies are needed to test this hypothesis.
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Affiliation(s)
- Jonathan Savitz
- Laureate Institute for Brain Research, Tulsa, OK
- Oxley College of Health Sciences, The University of Tulsa, Tulsa OK
| | - Bart N. Ford
- Laureate Institute for Brain Research, Tulsa, OK
| | | | | | - Kelly Cosgrove
- Laureate Institute for Brain Research, Tulsa, OK
- Department of Psychology, The University of Tulsa, Tulsa OK
| | - Ashley N. Clausen
- Kansas City VA Healthcare System, Kansas City, MO
- Department of Psychiatry and Behavioral Sciences, University of Kansas Medical Center, Kansas City, MO
| | - Christopher Martell
- Department of Psychological and Brain Sciences, University of Massachusetts Amherst
| | - Namik Kirlic
- Laureate Institute for Brain Research, Tulsa, OK
| | | | - T. Kent Teague
- Department of Surgery, University of Oklahoma School of Community Medicine, Tulsa, OK
- Department of Psychiatry, University of Oklahoma School of Community Medicine, Tulsa, OK
- Department of Pharmaceutical Sciences, University of Oklahoma College of Pharmacy, Tulsa, OK
| | - Michael R. Irwin
- Cousins Center for Psychoneuroimmunology at UCLA, Semel Institute for Neuroscience and UCLA David Geffen School of Medicine, Los Angeles, CA, USA
| | - Martin P. Paulus
- Laureate Institute for Brain Research, Tulsa, OK
- Oxley College of Health Sciences, The University of Tulsa, Tulsa OK
| | - Robin L. Aupperle
- Laureate Institute for Brain Research, Tulsa, OK
- Oxley College of Health Sciences, The University of Tulsa, Tulsa OK
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9
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Savitz J, Ford BN, Yeh HW, Akeman E, Cosgrove K, Clausen AN, Martell C, Kirlic N, Santiago J, Teague TK, Irwin MR, Paulus MP, Aupperle RL. Behavioral activation therapy for depression is associated with a reduction in the concentration of circulating quinolinic acid - Erratum. Psychol Med 2022; 52:2846. [PMID: 34247661 DOI: 10.1017/s0033291721002683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Jonathan Savitz
- Laureate Institute for Brain Research, Tulsa, OK, USA
- Oxley College of Health Sciences, The University of Tulsa,Tulsa, OK, USA
| | - Bart N Ford
- Laureate Institute for Brain Research, Tulsa, OK, USA
| | | | | | - Kelly Cosgrove
- Laureate Institute for Brain Research, Tulsa, OK, USA
- Department of Psychology, The University of Tulsa, Tulsa, OK, USA
| | - Ashley N Clausen
- Kansas City VA Healthcare System, Kansas City, MO, USA
- Department of Psychiatry and Behavioral Sciences, University of Kansas Medical Center, Kansas City, MO, USA
| | - Christopher Martell
- Department of Psychological and Brain Sciences, University of Massachusetts Amherst, Amherst, MO, USA
| | - Namik Kirlic
- Laureate Institute for Brain Research, Tulsa, OK, USA
| | | | - T Kent Teague
- Department of Surgery, University of Oklahoma School of Community Medicine, Tulsa, OK, USA
- Department of Psychiatry, University of Oklahoma School of Community Medicine, Tulsa, OK, USA
- Department of Pharmaceutical Sciences, University of Oklahoma College of Pharmacy, Tulsa, OK, USA
| | - Michael R Irwin
- Cousins Center for Psychoneuroimmunology at UCLA, Semel Institute for Neuroscience and UCLA David Geffen School of Medicine, Los Angeles, CA, USA
| | - Martin P Paulus
- Laureate Institute for Brain Research, Tulsa, OK, USA
- Oxley College of Health Sciences, The University of Tulsa,Tulsa, OK, USA
| | - Robin L Aupperle
- Laureate Institute for Brain Research, Tulsa, OK, USA
- Oxley College of Health Sciences, The University of Tulsa,Tulsa, OK, USA
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10
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McDermott TJ, Berg H, Touthang J, Akeman E, Cannon MJ, Santiago J, Cosgrove KT, Clausen AN, Kirlic N, Smith R, Craske MG, Abelson JL, Paulus MP, Aupperle RL. Striatal reactivity during emotion and reward relates to approach-avoidance conflict behaviour and is altered in adults with anxiety or depression. J Psychiatry Neurosci 2022; 47:E311-E322. [PMID: 36223130 PMCID: PMC9448414 DOI: 10.1503/jpn.220083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 06/24/2022] [Accepted: 06/28/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND We have previously reported activation in reward, salience and executive control regions during functional MRI (fMRI) using an approach-avoidance conflict (AAC) decision-making task with healthy adults. Further investigations into how anxiety and depressive disorders relate to differences in neural responses during AAC can inform their understanding and treatment. We tested the hypothesis that people with anxiety or depression have altered neural activation during AAC. METHODS We compared 118 treatment-seeking adults with anxiety or depression and 58 healthy adults using linear mixed-effects models to examine group-level differences in neural activation (fMRI) during AAC decision-making. Correlational analyses examined relationships between behavioural and neural measures. RESULTS Adults with anxiety or depression had greater striatal engagement when reacting to affective stimuli (p = 0.008, d = 0.31) regardless of valence, and weaker striatal engagement during reward feedback (p = 0.046, d = -0.27) regardless of the presence of monetary reward. They also had blunted amygdala activity during decision-making (p = 0.023, d = -0.32) regardless of the presence of conflict. Across groups, approach behaviour during conflict decision-making was inversely correlated with striatal activation during affective stimuli (p < 0.001, r = -0.28) and positively related to striatal activation during reward feedback (p < 0.001, r = 0.27). LIMITATIONS Our transdiagnostic approach did not allow for comparisons between specific anxiety disorders, and our cross-sectional approach did not allow for causal inference. CONCLUSION Anxiety and depression were associated with altered neural responses to AAC. Findings were consistent with the role of the striatum in action selection and reward responsivity, and they point toward striatal reactivity as a future treatment target. Blunting of amygdala activity in anxiety or depression may indicate a compensatory response to inhibit affective salience and maintain approach.
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Affiliation(s)
- Timothy J McDermott
- From the Laureate Institute for Brain Research, Tulsa, OK (McDermott, Berg, Touthang, Akeman, Cannon, Santiago, Cosgrove, Clausen, Kirlic, Smith, Paulus, Aupperle); the Department of Psychology, University of Tulsa, Tulsa, OK (McDermott, Cosgrove); the Department of Psychology, University of Minnesota-Twin Cities, Minneapolis, MN (Berg); the Department of Psychology and Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA (Craske); the Department of Psychiatry, University of Michigan, Ann Arbor, MI (Abelson); the Department of Community Medicine, University of Tulsa, Tulsa, OK (Paulus, Aupperle)
| | - Hannah Berg
- From the Laureate Institute for Brain Research, Tulsa, OK (McDermott, Berg, Touthang, Akeman, Cannon, Santiago, Cosgrove, Clausen, Kirlic, Smith, Paulus, Aupperle); the Department of Psychology, University of Tulsa, Tulsa, OK (McDermott, Cosgrove); the Department of Psychology, University of Minnesota-Twin Cities, Minneapolis, MN (Berg); the Department of Psychology and Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA (Craske); the Department of Psychiatry, University of Michigan, Ann Arbor, MI (Abelson); the Department of Community Medicine, University of Tulsa, Tulsa, OK (Paulus, Aupperle)
| | - James Touthang
- From the Laureate Institute for Brain Research, Tulsa, OK (McDermott, Berg, Touthang, Akeman, Cannon, Santiago, Cosgrove, Clausen, Kirlic, Smith, Paulus, Aupperle); the Department of Psychology, University of Tulsa, Tulsa, OK (McDermott, Cosgrove); the Department of Psychology, University of Minnesota-Twin Cities, Minneapolis, MN (Berg); the Department of Psychology and Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA (Craske); the Department of Psychiatry, University of Michigan, Ann Arbor, MI (Abelson); the Department of Community Medicine, University of Tulsa, Tulsa, OK (Paulus, Aupperle)
| | - Elisabeth Akeman
- From the Laureate Institute for Brain Research, Tulsa, OK (McDermott, Berg, Touthang, Akeman, Cannon, Santiago, Cosgrove, Clausen, Kirlic, Smith, Paulus, Aupperle); the Department of Psychology, University of Tulsa, Tulsa, OK (McDermott, Cosgrove); the Department of Psychology, University of Minnesota-Twin Cities, Minneapolis, MN (Berg); the Department of Psychology and Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA (Craske); the Department of Psychiatry, University of Michigan, Ann Arbor, MI (Abelson); the Department of Community Medicine, University of Tulsa, Tulsa, OK (Paulus, Aupperle)
| | - Mallory J Cannon
- From the Laureate Institute for Brain Research, Tulsa, OK (McDermott, Berg, Touthang, Akeman, Cannon, Santiago, Cosgrove, Clausen, Kirlic, Smith, Paulus, Aupperle); the Department of Psychology, University of Tulsa, Tulsa, OK (McDermott, Cosgrove); the Department of Psychology, University of Minnesota-Twin Cities, Minneapolis, MN (Berg); the Department of Psychology and Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA (Craske); the Department of Psychiatry, University of Michigan, Ann Arbor, MI (Abelson); the Department of Community Medicine, University of Tulsa, Tulsa, OK (Paulus, Aupperle)
| | - Jessica Santiago
- From the Laureate Institute for Brain Research, Tulsa, OK (McDermott, Berg, Touthang, Akeman, Cannon, Santiago, Cosgrove, Clausen, Kirlic, Smith, Paulus, Aupperle); the Department of Psychology, University of Tulsa, Tulsa, OK (McDermott, Cosgrove); the Department of Psychology, University of Minnesota-Twin Cities, Minneapolis, MN (Berg); the Department of Psychology and Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA (Craske); the Department of Psychiatry, University of Michigan, Ann Arbor, MI (Abelson); the Department of Community Medicine, University of Tulsa, Tulsa, OK (Paulus, Aupperle)
| | - Kelly T Cosgrove
- From the Laureate Institute for Brain Research, Tulsa, OK (McDermott, Berg, Touthang, Akeman, Cannon, Santiago, Cosgrove, Clausen, Kirlic, Smith, Paulus, Aupperle); the Department of Psychology, University of Tulsa, Tulsa, OK (McDermott, Cosgrove); the Department of Psychology, University of Minnesota-Twin Cities, Minneapolis, MN (Berg); the Department of Psychology and Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA (Craske); the Department of Psychiatry, University of Michigan, Ann Arbor, MI (Abelson); the Department of Community Medicine, University of Tulsa, Tulsa, OK (Paulus, Aupperle)
| | - Ashley N Clausen
- From the Laureate Institute for Brain Research, Tulsa, OK (McDermott, Berg, Touthang, Akeman, Cannon, Santiago, Cosgrove, Clausen, Kirlic, Smith, Paulus, Aupperle); the Department of Psychology, University of Tulsa, Tulsa, OK (McDermott, Cosgrove); the Department of Psychology, University of Minnesota-Twin Cities, Minneapolis, MN (Berg); the Department of Psychology and Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA (Craske); the Department of Psychiatry, University of Michigan, Ann Arbor, MI (Abelson); the Department of Community Medicine, University of Tulsa, Tulsa, OK (Paulus, Aupperle)
| | - Namik Kirlic
- From the Laureate Institute for Brain Research, Tulsa, OK (McDermott, Berg, Touthang, Akeman, Cannon, Santiago, Cosgrove, Clausen, Kirlic, Smith, Paulus, Aupperle); the Department of Psychology, University of Tulsa, Tulsa, OK (McDermott, Cosgrove); the Department of Psychology, University of Minnesota-Twin Cities, Minneapolis, MN (Berg); the Department of Psychology and Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA (Craske); the Department of Psychiatry, University of Michigan, Ann Arbor, MI (Abelson); the Department of Community Medicine, University of Tulsa, Tulsa, OK (Paulus, Aupperle)
| | - Ryan Smith
- From the Laureate Institute for Brain Research, Tulsa, OK (McDermott, Berg, Touthang, Akeman, Cannon, Santiago, Cosgrove, Clausen, Kirlic, Smith, Paulus, Aupperle); the Department of Psychology, University of Tulsa, Tulsa, OK (McDermott, Cosgrove); the Department of Psychology, University of Minnesota-Twin Cities, Minneapolis, MN (Berg); the Department of Psychology and Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA (Craske); the Department of Psychiatry, University of Michigan, Ann Arbor, MI (Abelson); the Department of Community Medicine, University of Tulsa, Tulsa, OK (Paulus, Aupperle)
| | - Michelle G Craske
- From the Laureate Institute for Brain Research, Tulsa, OK (McDermott, Berg, Touthang, Akeman, Cannon, Santiago, Cosgrove, Clausen, Kirlic, Smith, Paulus, Aupperle); the Department of Psychology, University of Tulsa, Tulsa, OK (McDermott, Cosgrove); the Department of Psychology, University of Minnesota-Twin Cities, Minneapolis, MN (Berg); the Department of Psychology and Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA (Craske); the Department of Psychiatry, University of Michigan, Ann Arbor, MI (Abelson); the Department of Community Medicine, University of Tulsa, Tulsa, OK (Paulus, Aupperle)
| | - James L Abelson
- From the Laureate Institute for Brain Research, Tulsa, OK (McDermott, Berg, Touthang, Akeman, Cannon, Santiago, Cosgrove, Clausen, Kirlic, Smith, Paulus, Aupperle); the Department of Psychology, University of Tulsa, Tulsa, OK (McDermott, Cosgrove); the Department of Psychology, University of Minnesota-Twin Cities, Minneapolis, MN (Berg); the Department of Psychology and Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA (Craske); the Department of Psychiatry, University of Michigan, Ann Arbor, MI (Abelson); the Department of Community Medicine, University of Tulsa, Tulsa, OK (Paulus, Aupperle)
| | - Martin P Paulus
- From the Laureate Institute for Brain Research, Tulsa, OK (McDermott, Berg, Touthang, Akeman, Cannon, Santiago, Cosgrove, Clausen, Kirlic, Smith, Paulus, Aupperle); the Department of Psychology, University of Tulsa, Tulsa, OK (McDermott, Cosgrove); the Department of Psychology, University of Minnesota-Twin Cities, Minneapolis, MN (Berg); the Department of Psychology and Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA (Craske); the Department of Psychiatry, University of Michigan, Ann Arbor, MI (Abelson); the Department of Community Medicine, University of Tulsa, Tulsa, OK (Paulus, Aupperle)
| | - Robin L Aupperle
- From the Laureate Institute for Brain Research, Tulsa, OK (McDermott, Berg, Touthang, Akeman, Cannon, Santiago, Cosgrove, Clausen, Kirlic, Smith, Paulus, Aupperle); the Department of Psychology, University of Tulsa, Tulsa, OK (McDermott, Cosgrove); the Department of Psychology, University of Minnesota-Twin Cities, Minneapolis, MN (Berg); the Department of Psychology and Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA (Craske); the Department of Psychiatry, University of Michigan, Ann Arbor, MI (Abelson); the Department of Community Medicine, University of Tulsa, Tulsa, OK (Paulus, Aupperle)
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11
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Akeman E, Cannon MJ, Kirlic N, Cosgrove KT, DeVille DC, McDermott TJ, White EJ, Cohen ZP, Forthman KL, Paulus MP, Aupperle RL. Active coping strategies and less pre-pandemic alcohol use relate to college student mental health during the COVID-19 pandemic. Front Psychol 2022; 13:926697. [PMID: 35978795 PMCID: PMC9376611 DOI: 10.3389/fpsyg.2022.926697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 07/05/2022] [Indexed: 11/13/2022] Open
Abstract
Objective To further delineate risk and resilience factors contributing to trajectories of mental health symptoms experienced by college students through the pandemic. Participants n = 183 college students (67.2% female). Methods Linear mixed models examined time effects on depression and anxiety. Propensity-matched subgroups exhibiting "increased" versus "low and stable" depression symptoms from before to after the pandemic-onset were compared on pre-pandemic demographic and psychological factors and COVID-related experiences and coping strategies. Results Students experienced worsening of mental health symptoms throughout the pandemic, particularly during Fall 2020 compared with Fall 2019 (Depression scale d = -0.43 [95% CI: -0.65 to -0.21]). The propensity-matched subgroup exhibiting relative resilience ("low and stable" symptoms) reported less alcohol use prior to the pandemic, greater use of active coping strategies, and less of an impact on their college progress. Conclusions Results point to several potential targets of screening and intervention to decrease residual impacts of the pandemic.
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Affiliation(s)
| | | | - Namik Kirlic
- Laureate Institute for Brain Research, Tulsa, OK, United States
- School of Community Medicine, The University of Tulsa, Tulsa, OK, United States
| | - Kelly T. Cosgrove
- Laureate Institute for Brain Research, Tulsa, OK, United States
- Department of Psychology, The University of Tulsa, Tulsa, OK, United States
| | - Danielle C. DeVille
- Laureate Institute for Brain Research, Tulsa, OK, United States
- Department of Psychology, The University of Tulsa, Tulsa, OK, United States
| | - Timothy J. McDermott
- Laureate Institute for Brain Research, Tulsa, OK, United States
- Department of Psychology, The University of Tulsa, Tulsa, OK, United States
| | - Evan J. White
- Laureate Institute for Brain Research, Tulsa, OK, United States
- School of Community Medicine, The University of Tulsa, Tulsa, OK, United States
| | - Zsofia P. Cohen
- Laureate Institute for Brain Research, Tulsa, OK, United States
- Department of Psychology, Oklahoma State University, Stillwater, OK, United States
| | - K. L. Forthman
- Laureate Institute for Brain Research, Tulsa, OK, United States
| | - Martin P. Paulus
- Laureate Institute for Brain Research, Tulsa, OK, United States
- School of Community Medicine, The University of Tulsa, Tulsa, OK, United States
| | - Robin L. Aupperle
- Laureate Institute for Brain Research, Tulsa, OK, United States
- School of Community Medicine, The University of Tulsa, Tulsa, OK, United States
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12
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Kirlic N, Cohen ZP, Tsuchiyagaito A, Misaki M, McDermott TJ, Aupperle RL, Stewart JL, Singh MK, Paulus MP, Bodurka J. Self-regulation of the posterior cingulate cortex with real-time fMRI neurofeedback augmented mindfulness training in healthy adolescents: A nonrandomized feasibility study. Cogn Affect Behav Neurosci 2022; 22:849-867. [PMID: 35292905 PMCID: PMC9293874 DOI: 10.3758/s13415-022-00991-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 02/17/2022] [Indexed: 02/06/2023]
Abstract
Mindfulness training (MT) promotes the development of one's ability to observe and attend to internal and external experiences with objectivity and nonjudgment with evidence to improve psychological well-being. Real-time functional MRI neurofeedback (rtfMRI-nf) is a noninvasive method of modulating activity of a brain region or circuit. The posterior cingulate cortex (PCC) has been hypothesized to be an important hub instantiating a mindful state. This nonrandomized, single-arm study examined the feasibility and tolerability of training typically developing adolescents to self-regulate the posterior cingulate cortex (PCC) using rtfMRI-nf during MT. Thirty-four adolescents (mean age: 15 years; 14 females) completed the neurofeedback augmented mindfulness training task, including Focus-on-Breath (MT), Describe (self-referential thinking), and Rest conditions, across three neurofeedback and two non-neurofeedback runs (Observe, Transfer). Self-report assessments demonstrated the feasibility and tolerability of the task. Neurofeedback runs differed significantly from non-neurofeedback runs for the Focus-on-Breath versus Describe contrast, characterized by decreased activity in the PCC during the Focus-on-Breath condition (z = -2.38 to -6.27). MT neurofeedback neural representation further involved the medial prefrontal cortex, anterior cingulate cortex, dorsolateral prefrontal cortex, posterior insula, hippocampus, and amygdala. State awareness of physical sensations increased following rtfMRI-nf and was maintained at 1-week follow-up (Cohens' d = 0.69). Findings demonstrate feasibility and tolerability of rtfMRI-nf in healthy adolescents, replicates the role of PCC in MT, and demonstrate a potential neuromodulatory mechanism to leverage and streamline the learning of mindfulness practice. ( ClinicalTrials.gov identifier #NCT04053582; August 12, 2019).
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Affiliation(s)
- Namik Kirlic
- Laureate Institute for Brain Research, 6655 South Yale Avenue, Tulsa, OK, 74136, USA.
| | - Zsofia P Cohen
- Laureate Institute for Brain Research, 6655 South Yale Avenue, Tulsa, OK, 74136, USA
| | - Aki Tsuchiyagaito
- Laureate Institute for Brain Research, 6655 South Yale Avenue, Tulsa, OK, 74136, USA
| | - Masaya Misaki
- Laureate Institute for Brain Research, 6655 South Yale Avenue, Tulsa, OK, 74136, USA
| | - Timothy J McDermott
- Laureate Institute for Brain Research, 6655 South Yale Avenue, Tulsa, OK, 74136, USA
- Department of Psychology, University of Tulsa, Tulsa, OK, USA
| | - Robin L Aupperle
- Laureate Institute for Brain Research, 6655 South Yale Avenue, Tulsa, OK, 74136, USA
- School of Community Medicine, University of Tulsa, Tulsa, OK, USA
| | - Jennifer L Stewart
- Laureate Institute for Brain Research, 6655 South Yale Avenue, Tulsa, OK, 74136, USA
- School of Community Medicine, University of Tulsa, Tulsa, OK, USA
| | - Manpreet K Singh
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA, USA
| | - Martin P Paulus
- Laureate Institute for Brain Research, 6655 South Yale Avenue, Tulsa, OK, 74136, USA
- School of Community Medicine, University of Tulsa, Tulsa, OK, USA
| | - Jerzy Bodurka
- Laureate Institute for Brain Research, 6655 South Yale Avenue, Tulsa, OK, 74136, USA
- Stephenson School of Biomedical Engineering, University of Oklahoma, Norman, OK, USA
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13
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Park H, Kirlic N, Kuplicki R, Paulus M, Guinjoan S. Neural Processing Dysfunctions During Fear Learning but Not Reward-Related Processing Characterize Depressed Individuals With High Levels of Repetitive Negative Thinking. Biol Psychiatry Cogn Neurosci Neuroimaging 2022; 7:716-724. [PMID: 35065290 PMCID: PMC9271540 DOI: 10.1016/j.bpsc.2022.01.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 01/06/2022] [Accepted: 01/06/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Repetitive negative thinking (RNT) is a symptom dimension of depression that is associated with a poorer prognosis in terms of higher recurrence, treatment resistance, residual symptoms, and disability. This investigation examined whether RNT is associated with aberrant reward processing and fear learning. METHODS Very high RNT (VH-RNT) (n = 60) and high RNT (H-RNT) (n = 60) propensity-matched individuals with depression (age, sex, race/ethnicity, income/employment, body mass index, depressive and anxiety symptom severity) participated in this study along with matched healthy comparison volunteers (n = 30). This propensity-matched sample was selected from the larger Tulsa 1000 study. Participants performed two functional magnetic resonance imaging tasks: the monetary incentive delay task probing reward processing and the fear conditioning task probing aversive learning and extinction. RESULTS Both VH-RNT and H-RNT groups showed lower neural activity than healthy comparison subjects in reward circuitry, including the inferior frontal gyrus (VH-RNT: β = -1.24, H-RNT: β = -1.28) and the cerebellum (VH-RNT: β = -0.93, H-RNT: β = -1.14). However, individuals with VH-RNT exhibited lower activation than those with H-RNT in central autonomic network components during fear conditioning (β = -0.84) and continued conditioned responses during early extinction in the postcentral cortex (β = 0.71). CONCLUSIONS VH-RNT showed aberrant processing in fear conditioning during both learning and extinction phases compared with H-RNT. These findings demonstrate that dysfunctions of negative valence associated with RNT may be domain specific, which should be taken into account for identifying potential specific targets of intervention.
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Affiliation(s)
- Heekyeong Park
- Laureate Institute for Brain Research, Tulsa, Oklahoma; Department of Psychology, University of North Texas at Dallas, Dallas, Texas
| | - Namik Kirlic
- Laureate Institute for Brain Research, Tulsa, Oklahoma
| | | | - Martin Paulus
- Laureate Institute for Brain Research, Tulsa, Oklahoma
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14
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Yu X, Cohen ZP, Tsuchiyagaito A, Cochran G, Aupperle RL, Stewart JL, Singh MK, Misaki M, Bodurka J, Paulus MP, Kirlic N. Neurofeedback-Augmented Mindfulness Training Elicits Distinct Responses in the Subregions of the Insular Cortex in Healthy Adolescents. Brain Sci 2022; 12:brainsci12030363. [PMID: 35326319 PMCID: PMC8946655 DOI: 10.3390/brainsci12030363] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 02/25/2022] [Accepted: 03/03/2022] [Indexed: 02/05/2023] Open
Abstract
Mindfulness training (MT) reduces self-referential processing and promotes interoception, the perception of sensations from inside the body, by increasing one’s awareness of and regulating responses to them. The posterior cingulate cortex (PCC) and the insular cortex (INS) are considered hubs for self-referential processing and interoception, respectively. Although MT has been consistently found to decrease PCC, little is known about how MT relates to INS activity. Understanding links between mindfulness and interoception may be particularly important for informing mental health in adolescence, when neuroplasticity and emergence of psychopathology are heightened. We examined INS activity during real-time functional magnetic resonance imaging neurofeedback-augmented mindfulness training (NAMT) targeting the PCC. Healthy adolescents (N = 37; 16 female) completed the NAMT task, including Focus-on-Breath (MT), Describe (self-referential processing), and Rest conditions, across three neurofeedback runs and two non-neurofeedback runs (Observe, Transfer). Regression coefficients estimated from the generalized linear model were extracted from three INS subregions: anterior (aINS), mid (mINS), and posterior (pINS). Mixed model analyses revealed the main effect of run for Focus-on-Breath vs. Describe contrast in aINS [R2 = 0.39] and pINS [R2 = 0.33], but not mINS [R2 = 0.34]. Post hoc analyses revealed greater aINS activity and reduced pINS activity during neurofeedback runs, and such activities were related to lower self-reported life satisfaction and less pain behavior, respectively. These findings revealed the specific involvement of insula subregions in rtfMRI-nf MT.
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Affiliation(s)
- Xiaoqian Yu
- Laureate Institute for Brain Research, Tulsa, OK 74136, USA; (X.Y.); (Z.P.C.); (A.T.); (G.C.); (R.L.A.); (J.L.S.); (M.M.); (M.P.P.)
| | - Zsofia P. Cohen
- Laureate Institute for Brain Research, Tulsa, OK 74136, USA; (X.Y.); (Z.P.C.); (A.T.); (G.C.); (R.L.A.); (J.L.S.); (M.M.); (M.P.P.)
| | - Aki Tsuchiyagaito
- Laureate Institute for Brain Research, Tulsa, OK 74136, USA; (X.Y.); (Z.P.C.); (A.T.); (G.C.); (R.L.A.); (J.L.S.); (M.M.); (M.P.P.)
| | - Gabriella Cochran
- Laureate Institute for Brain Research, Tulsa, OK 74136, USA; (X.Y.); (Z.P.C.); (A.T.); (G.C.); (R.L.A.); (J.L.S.); (M.M.); (M.P.P.)
| | - Robin L. Aupperle
- Laureate Institute for Brain Research, Tulsa, OK 74136, USA; (X.Y.); (Z.P.C.); (A.T.); (G.C.); (R.L.A.); (J.L.S.); (M.M.); (M.P.P.)
- Department of Community Medicine, University of Tulsa, Tulsa, OK 74104, USA
| | - Jennifer L. Stewart
- Laureate Institute for Brain Research, Tulsa, OK 74136, USA; (X.Y.); (Z.P.C.); (A.T.); (G.C.); (R.L.A.); (J.L.S.); (M.M.); (M.P.P.)
- Department of Community Medicine, University of Tulsa, Tulsa, OK 74104, USA
| | - Manpreet K. Singh
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA 94305, USA;
| | - Masaya Misaki
- Laureate Institute for Brain Research, Tulsa, OK 74136, USA; (X.Y.); (Z.P.C.); (A.T.); (G.C.); (R.L.A.); (J.L.S.); (M.M.); (M.P.P.)
| | - Jerzy Bodurka
- Laureate Institute for Brain Research, Tulsa, OK 74136, USA; (X.Y.); (Z.P.C.); (A.T.); (G.C.); (R.L.A.); (J.L.S.); (M.M.); (M.P.P.)
| | - Martin P. Paulus
- Laureate Institute for Brain Research, Tulsa, OK 74136, USA; (X.Y.); (Z.P.C.); (A.T.); (G.C.); (R.L.A.); (J.L.S.); (M.M.); (M.P.P.)
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA 94305, USA;
| | - Namik Kirlic
- Laureate Institute for Brain Research, Tulsa, OK 74136, USA; (X.Y.); (Z.P.C.); (A.T.); (G.C.); (R.L.A.); (J.L.S.); (M.M.); (M.P.P.)
- Correspondence: ; Tel.: +1-918-502-5747
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15
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May AC, Davis C, Kirlic N, Stewart JL. Mindfulness-Based Interventions for the Treatment of Aberrant Interoceptive Processing in Substance Use Disorders. Brain Sci 2022; 12:brainsci12020279. [PMID: 35204042 PMCID: PMC8870441 DOI: 10.3390/brainsci12020279] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 02/04/2022] [Accepted: 02/09/2022] [Indexed: 12/24/2022] Open
Abstract
Altered interoception, or the processing of bodily signals, has been argued to play a role in the development and maintenance of substance use disorders (SUD). Therefore, interoceptive interventions focusing on bodily awareness, such as mindfulness meditation, may improve treatment outcomes for individuals with SUD. Here we review: (1) subjective, behavioral and brain evidence for altered interoceptive processing in SUD, focusing on insular and anterior cingulate cortices (INS, ACC), key regions for interoceptive processing; (2) research highlighting links between mindfulness and brain function; and (3) extant brain research investigating mindfulness-based interventions in SUD. SUD tend to be characterized by heightened INS and ACC responses to drug cues but blunted interoceptive awareness and attenuated INS and ACC responses during tasks involving bodily attention and/or perturbations. In contrast, mindfulness interventions in healthy individuals are linked to enhanced INS and ACC responses and heightened interoceptive awareness. It is crucial for future research to identify: (1) whether mindfulness-based treatments are efficacious across substance classes; (2) what particular approaches and dosages show the largest effect sizes in enhancing INS and ACC function to non-drug stimuli and reducing responsivity to substance cues, thereby improving SUD treatment outcomes (reducing drug craving and relapse).
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Affiliation(s)
- April C. May
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA 92037, USA
- Correspondence:
| | - Chrysantha Davis
- Laureate Institute for Brain Research, Tulsa, OK 74136, USA; (C.D.); (N.K.); (J.L.S.)
| | - Namik Kirlic
- Laureate Institute for Brain Research, Tulsa, OK 74136, USA; (C.D.); (N.K.); (J.L.S.)
| | - Jennifer L. Stewart
- Laureate Institute for Brain Research, Tulsa, OK 74136, USA; (C.D.); (N.K.); (J.L.S.)
- Department of Community Medicine, University of Tulsa, Tulsa, OK 74104, USA
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Cardenas GE, White EJ, Kirlic N, Paulus MP, Guinjoan SM. Repetitive negative thinking is associated with impaired verbal learning but not executive functioning in individuals with eating disorders. Pers Med Psychiatry 2022; 31-32:100090. [PMID: 35967880 PMCID: PMC9374070 DOI: 10.1016/j.pmip.2021.100090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Objective Repetitive negative thinking (RNT) is an important symptom in the development and maintenance of eating disorders (EDs). RNT Research on RNT's effect on cognition in EDs is scarce. This investigation focused on associations between RNT and cognition in individuals with EDs. Methods Ruminative Response Scale (RRS) was used from Tulsa-1000 study (T-1000) data (eating disorders-ED, Major Depressive Disorder-MDD, and healthy subjects) who were propensity matched to examine associations with cognitive performance. RNT was examined across groups and we quantified the associations between scores for RNT, depression, executive function, and learning/memory from the T-1000 study. A linear regression analysis was conducted to determine predictors of disability. Results RNT was similar in ED and MDD participants, and more intense than in controls. RNT was significantly correlated with verbal learning/memory in the control (r = 0.514, p = 0.006) and ED groups (r = -0.447, p = 0.020), but this relationship had opposite slopes in either group. Increased RNT was associated with decreased verbal learning/memory ability in ED participants while in controls, increased RNT was associated with increased ability. Comorbid depression in the ED group acted as a potential moderator of the above relationship between RNT and EF. Among ED patients, depressive symptom severity was the best predictor of disability. Discussion The differential association of RNT with cognitive abilities in ED and MDD patients suggests depression is not a mediator of RNT-mediated cognitive dysfunction in EDs. This necessitates a better understanding of the mechanistic relationship between RNT and diverse types of cognitive functioning.
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White EJ, Nacke M, Akeman E, Cannon MJ, Mayeli A, Touthang J, Zoubi OA, McDermott TJ, Kirlic N, Santiago J, Kuplicki R, Bodurka J, Paulus MP, Craske MG, Wolitzky-Taylor K, Abelson J, Martell C, Clausen A, Stewart JL, Aupperle RL. P300 amplitude during a monetary incentive delay task predicts future therapy completion in individuals with major depressive disorder. J Affect Disord 2021; 295:873-882. [PMID: 34706458 PMCID: PMC8554135 DOI: 10.1016/j.jad.2021.08.106] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 07/24/2021] [Accepted: 08/28/2021] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Treatment effectiveness for major depressive disorder (MDD) is often affected by client non-adherence, dropout, and non-response. Identification of client characteristics predicting successful treatment completion and/or response (i.e., symptom reduction) may be an important tool to increase intervention effectiveness. It is unclear whether neural attenuations in reward processing associated with MDD predict behavioral treatment outcome. METHODS This study aimed to determine whether blunted neural responses to reward at baseline differentiate MDD (n = 60; 41 with comorbid anxiety) and healthy control (HC; n = 40) groups; and predict MDD completion of and response to 7-10 sessions of behavior therapy. Participants completed a monetary incentive delay (MID) task. The N200, P300, contingent negative variation (CNV) event related potentials (ERPs) and behavioral responses (reaction time [RT], correct hits) were quantified and extracted for cross-sectional group analyses. ERPs and behavioral responses demonstrating group differences were then used to predict therapy completion and response within MDD. RESULTS MDD exhibited faster RT and smaller P300 amplitudes than HC across conditions. Within the MDD group, treatment completers (n = 37) exhibited larger P300 amplitudes than non-completers (n = 21). LIMITATIONS This study comprises secondary analyses of EEG data; thus task parameters are not optimized to examine feedback ERPs from the paradigm. We did not examine heterogenous presentations of MDD; however, severity and comorbidity did not influence findings. CONCLUSIONS Previous studies suggest that P300 is an index of motivational salience and stimulus resource allocation. In sum, individuals who deploy greater neural resources to task demands are more likely to persevere in behavioral therapy.
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Affiliation(s)
- Evan J White
- Laureate Institute for Brain Research, Tulsa, OK, United States.
| | - Mariah Nacke
- Laureate Institute for Brain Research, Tulsa, OK, United States
| | | | | | - Ahmad Mayeli
- Laureate Institute for Brain Research, Tulsa, OK, United States; Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, United States
| | - James Touthang
- Laureate Institute for Brain Research, Tulsa, OK, United States
| | - Obada Al Zoubi
- Laureate Institute for Brain Research, Tulsa, OK, United States; Department of Psychiatry, Harvard Medical School/McLean Hospital, Boston MA, United States
| | - Timothy J McDermott
- Laureate Institute for Brain Research, Tulsa, OK, United States; Department of Psychology, University of Tulsa, Tulsa, OK, United States
| | - Namik Kirlic
- Laureate Institute for Brain Research, Tulsa, OK, United States
| | | | - Rayus Kuplicki
- Laureate Institute for Brain Research, Tulsa, OK, United States
| | - Jerzy Bodurka
- Laureate Institute for Brain Research, Tulsa, OK, United States; Stephenson School of Biomedical Engineering, University of Oklahoma, Tulsa, OK, United States
| | - Martin P Paulus
- Laureate Institute for Brain Research, Tulsa, OK, United States; Department of Community Medicine, University of Tulsa, Tulsa, OK, United States
| | - Michelle G Craske
- Department of Psychology, University of California Los Angeles, Los Angeles, CA, United States; Department of Psychiatry and Biobehavioral science, University of California Los Angeles, Los Angeles, CA, United States
| | - Kate Wolitzky-Taylor
- Department of Psychiatry and Biobehavioral science, University of California Los Angeles, Los Angeles, CA, United States
| | - James Abelson
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States
| | - Christopher Martell
- Department of Psychological and Brain Sciences, University of Massachusetts- Amherst, Amherst, MA United States
| | - Ashley Clausen
- Kansas City VA Medical Center, Kansas City, MO, United States; Department of Psychiatry and Behavioral Science, University of Kansas Medical Center, Kansas City, Kansas United States
| | - Jennifer L Stewart
- Laureate Institute for Brain Research, Tulsa, OK, United States; Department of Community Medicine, University of Tulsa, Tulsa, OK, United States
| | - Robin L Aupperle
- Laureate Institute for Brain Research, Tulsa, OK, United States; Department of Community Medicine, University of Tulsa, Tulsa, OK, United States
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18
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Kirlic N, Colaizzi JM, Cosgrove KT, Cohen ZP, Yeh HW, Breslin F, Morris AS, Aupperle RL, Singh MK, Paulus MP. Extracurricular Activities, Screen Media Activity, and Sleep May Be Modifiable Factors Related to Children's Cognitive Functioning: Evidence From the ABCD Study ®. Child Dev 2021; 92:2035-2052. [PMID: 33900639 PMCID: PMC8478798 DOI: 10.1111/cdev.13578] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
This study used a machine learning framework in conjunction with a large battery of measures from 9,718 school-age children (ages 9-11) from the Adolescent Brain Cognitive DevelopmentSM (ABCD) Study to identify factors associated with fluid cognitive functioning (FCF), or the capacity to learn, solve problems, and adapt to novel situations. The identified algorithm explained 14.74% of the variance in FCF, replicating previously reported socioeconomic and mental health contributors to FCF, and adding novel and potentially modifiable contributors, including extracurricular involvement, screen media activity, and sleep duration. Pragmatic interventions targeting these contributors may enhance cognitive performance and protect against their negative impact on FCF in children.
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Affiliation(s)
| | | | | | | | - Hung-Wen Yeh
- Laureate Institute for Brain Research
- Children's Mercy Hospital
| | | | - Amanda S Morris
- Laureate Institute for Brain Research
- Oklahoma State University
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19
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May AC, Burrows K, Figueroa-Hall LK, Kirlic N, White EJ, Smith R, Ekhtiari H, Paulus MP, Savitz J, Stewart JL. Erratum to "Sex differences in circulating inflammatory mediators as a function of substance use disorder" [Drug Alcohol Depend. 221 (2021) 108610]. Drug Alcohol Depend 2021; 224:108743. [PMID: 34024664 PMCID: PMC8667335 DOI: 10.1016/j.drugalcdep.2021.108743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- April C. May
- San Diego State University/University of California, San
Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA,Department of Psychiatry, University of California, San
Diego, San Diego, CA, USA,Corresponding author at: Department of Psychiatry,
University of California, San Diego, 9500 Gilman Drive, MC 0405, La Jolla, CA
92093, USA. (A.C. May)
| | | | | | - Namik Kirlic
- Laureate Institute for Brain Research, Tulsa, OK, USA
| | - Evan J. White
- Laureate Institute for Brain Research, Tulsa, OK, USA
| | - Ryan Smith
- Laureate Institute for Brain Research, Tulsa, OK, USA
| | | | - Martin P. Paulus
- Laureate Institute for Brain Research, Tulsa, OK, USA,Oxley College of Health Sciences, The University of Tulsa,
Tulsa, OK, USA
| | - Jonathan Savitz
- Laureate Institute for Brain Research, Tulsa, OK, USA,Oxley College of Health Sciences, The University of Tulsa,
Tulsa, OK, USA
| | - Jennifer L. Stewart
- Laureate Institute for Brain Research, Tulsa, OK, USA,Oxley College of Health Sciences, The University of Tulsa,
Tulsa, OK, USA
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20
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Cohen ZP, Cosgrove KT, DeVille DC, Akeman E, Singh MK, White E, Stewart JL, Aupperle RL, Paulus MP, Kirlic N. The Impact of COVID-19 on Adolescent Mental Health: Preliminary Findings From a Longitudinal Sample of Healthy and At-Risk Adolescents. Front Pediatr 2021; 9:622608. [PMID: 34169046 PMCID: PMC8217763 DOI: 10.3389/fped.2021.622608] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 04/19/2021] [Indexed: 12/24/2022] Open
Abstract
Background: The COVID-19 pandemic has brought on far-reaching consequences for adolescents. Adolescents with early life stress (ELS) may be at particular risk. We sought to examine how COVID-19 impacted psychological functioning in a sample of healthy and ELS-exposed adolescents during the pandemic. Methods: A total of 24 adolescents (15 healthy, nine ELS) completed self-report measures prior to and during the COVID-19 pandemic. The effect of COVID-19 on symptoms of depression and anxiety were explored using linear mixed-effect analyses. Results: With the onset of the pandemic, healthy but not ELS-exposed adolescents evidenced increased symptoms of depression and anxiety (ps < 0.05). Coping by talking with friends and prioritizing sleep had a protective effect against anxiety for healthy adolescents (t = -3.76, p = 0.002). Conclusions: On average, this study demonstrated large increases in depression and anxiety in adolescents who were healthy prior to the COVID-19 pandemic, while ELS-exposed adolescents evidenced high but stable symptoms over time.
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Affiliation(s)
- Zsofia P. Cohen
- Laureate Institute for Brain Research, Tulsa, OK, United States
| | - Kelly T. Cosgrove
- Laureate Institute for Brain Research, Tulsa, OK, United States
- Department of Psychology, University of Tulsa, Tulsa, OK, United States
| | - Danielle C. DeVille
- Laureate Institute for Brain Research, Tulsa, OK, United States
- Department of Psychology, University of Tulsa, Tulsa, OK, United States
| | | | - Manpreet K. Singh
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA, United States
| | - Evan White
- Laureate Institute for Brain Research, Tulsa, OK, United States
| | - Jennifer L. Stewart
- Laureate Institute for Brain Research, Tulsa, OK, United States
- School of Community Medicine, University of Tulsa, Tulsa, OK, United States
| | - Robin L. Aupperle
- Laureate Institute for Brain Research, Tulsa, OK, United States
- School of Community Medicine, University of Tulsa, Tulsa, OK, United States
| | | | - Namik Kirlic
- Laureate Institute for Brain Research, Tulsa, OK, United States
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21
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Smith R, Kirlic N, Stewart JL, Touthang J, Kuplicki R, McDermott TJ, Taylor S, Khalsa SS, Paulus MP, Aupperle RL. Long-term stability of computational parameters during approach-avoidance conflict in a transdiagnostic psychiatric patient sample. Sci Rep 2021; 11:11783. [PMID: 34083701 PMCID: PMC8175390 DOI: 10.1038/s41598-021-91308-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 05/17/2021] [Indexed: 11/16/2022] Open
Abstract
Maladaptive behavior during approach-avoidance conflict (AAC) is common to multiple psychiatric disorders. Using computational modeling, we previously reported that individuals with depression, anxiety, and substance use disorders (DEP/ANX; SUDs) exhibited differences in decision uncertainty and sensitivity to negative outcomes versus reward (emotional conflict) relative to healthy controls (HCs). However, it remains unknown whether these computational parameters and group differences are stable over time. We analyzed 1-year follow-up data from a subset of the same participants (N = 325) to assess parameter stability and relationships to other clinical and task measures. We assessed group differences in the entire sample as well as a subset matched for age and IQ across HCs (N = 48), SUDs (N = 29), and DEP/ANX (N = 121). We also assessed 2-3 week reliability in a separate sample of 30 HCs. Emotional conflict and decision uncertainty parameters showed moderate 1-year intra-class correlations (.52 and .46, respectively) and moderate to excellent correlations over the shorter period (.84 and .54, respectively). Similar to previous baseline findings, parameters correlated with multiple response time measures (ps < .001) and self-reported anxiety (r = .30, p < .001) and decision difficulty (r = .44, p < .001). Linear mixed effects analyses revealed that patients remained higher in decision uncertainty (SUDs, p = .009) and lower in emotional conflict (SUDs, p = .004, DEP/ANX, p = .02) relative to HCs. This computational modelling approach may therefore offer relatively stable markers of transdiagnostic psychopathology.
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Affiliation(s)
- Ryan Smith
- Laureate Institute for Brain Research, 6655 S Yale Ave, Tulsa, OK, 74136, USA.
| | - Namik Kirlic
- Laureate Institute for Brain Research, 6655 S Yale Ave, Tulsa, OK, 74136, USA
| | - Jennifer L Stewart
- Laureate Institute for Brain Research, 6655 S Yale Ave, Tulsa, OK, 74136, USA
| | - James Touthang
- Laureate Institute for Brain Research, 6655 S Yale Ave, Tulsa, OK, 74136, USA
| | - Rayus Kuplicki
- Laureate Institute for Brain Research, 6655 S Yale Ave, Tulsa, OK, 74136, USA
| | - Timothy J McDermott
- Laureate Institute for Brain Research, 6655 S Yale Ave, Tulsa, OK, 74136, USA
| | - Samuel Taylor
- Laureate Institute for Brain Research, 6655 S Yale Ave, Tulsa, OK, 74136, USA
| | - Sahib S Khalsa
- Laureate Institute for Brain Research, 6655 S Yale Ave, Tulsa, OK, 74136, USA
| | - Martin P Paulus
- Laureate Institute for Brain Research, 6655 S Yale Ave, Tulsa, OK, 74136, USA
| | - Robin L Aupperle
- Laureate Institute for Brain Research, 6655 S Yale Ave, Tulsa, OK, 74136, USA
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22
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McDermott TJ, Kirlic N, Akeman E, Touthang J, Clausen AN, Kuplicki R, Aupperle RL. Test-retest reliability of approach-avoidance conflict decision-making during functional magnetic resonance imaging in healthy adults. Hum Brain Mapp 2021; 42:2347-2361. [PMID: 33650761 PMCID: PMC8090786 DOI: 10.1002/hbm.25371] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 01/22/2021] [Accepted: 02/07/2021] [Indexed: 01/02/2023] Open
Abstract
Neural and behavioral mechanisms during approach-avoidance conflict decision-making are relevant across various psychiatric disorders, particularly anxiety disorders. Studies using approach-avoidance conflict paradigms in healthy adults have identified preliminary neural mechanisms, but findings must be replicated and demonstrated as reliable before further application. This study sought to replicate previous findings and examine test-retest reliability of behavioral (approach behavior, reaction time) and neural (regions of interest [ROIs]) responses during an approach-avoidance conflict task conducted during functional magnetic resonance imaging (fMRI). Thirty healthy adults completed an approach-avoidance conflict task during fMRI on two occasions (mean interval: 17 days; range: 11-32). Effects of task condition during three task phases (decision-making, affective outcome and monetary reward) and intraclass correlation coefficients (ICCs) were calculated across time points. Results replicated that approach behavior was modulated by conflict during decision-making. ROI activations were replicated such that dorsal anterior cingulate cortex (dACC) was modulated by conflict during decision-making, and dACC, striatum, and anterior insula were modulated by valence during affective outcomes (p's <.0083). Approach behavior during conflict demonstrated excellent reliability (ICCs ≥.77). Activation of dACC during conflict decision-making and anterior insula during negative outcomes demonstrated fair reliability (ICCs = .51 and .54), and dACC and striatum activation demonstrated good reliability during negative outcomes (ICCs = .63 and .69). Two additional ROIs (amygdala, left dorsolateral prefrontal cortex) showed good reliability during negative outcomes (ICCs ≥.60). These results characterize several specific behavioral and neuroimaging responses that are replicable and sufficiently reliable during approach-avoidance conflict decision-making to support future utility.
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Affiliation(s)
- Timothy J. McDermott
- Laureate Institute for Brain ResearchTulsaOklahomaUSA
- Department of PsychologyUniversity of TulsaTulsaOklahomaUSA
| | - Namik Kirlic
- Laureate Institute for Brain ResearchTulsaOklahomaUSA
| | | | | | - Ashley N. Clausen
- Laureate Institute for Brain ResearchTulsaOklahomaUSA
- Kansas City VA Medical CenterKansas CityMissouriUSA
| | | | - Robin L. Aupperle
- Laureate Institute for Brain ResearchTulsaOklahomaUSA
- Department of Community MedicineUniversity of TulsaTulsaOklahomaUSA
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23
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Cohen ZP, Cosgrove KT, Akeman E, Coffey S, Teague K, Hays-Grudo J, Paulus MP, Aupperle RL, Kirlic N. The effect of a mindfulness-based stress intervention on neurobiological and symptom measures in adolescents with early life stress: a randomized feasibility study. BMC Complement Med Ther 2021; 21:123. [PMID: 33858395 PMCID: PMC8050904 DOI: 10.1186/s12906-021-03295-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 03/31/2021] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Early life stress (ELS) has been linked to poor mental and physical health outcomes in adolescence and adulthood. Mindfulness reduces symptoms of depression and anxiety and improves cognitive and social outcomes in both youth and adults. However, little is known whether mindfulness can mitigate against the adverse neurobiological and psychological effects of ELS. This study aimed to examine the feasibility of conducting a group mindfulness intervention in adolescents with ELS and provide preliminary indication of potential effects on stress-related biomarkers and mental health symptoms. METHODS Forty adolescents were randomized to receive either eight sessions of Mindfulness-Based Stress Reduction for Teens in group format (MBSR-T; n = 21) or Treatment as Usual Control group (CTRL; n = 17). Outcomes were assessed at baseline and follow-up and included measures associated with neurobiological functioning (immune and endocrine biomarkers) and self-reported mental health (depressive) symptoms. Linear mixed effects models were used to assess the effects of group and time on these outcome measures. RESULTS Sixteen of the 21 adolescents completed the intervention, attending an average of 6.5 sessions. The model examining cortisol responses to stress induction revealed medium effects trending toward significance (Cohen's d = .56) for anticipatory cortisol levels in the MBSR-T relative to CTRL groups. No significant effects were found in models examining C-reactive protein or interleukin 6 inflammatory markers. The model examining depressive symptoms revealed a medium effect for symptom reduction (Cohen's d = .69) in the MBSR-T relative to CTRL groups. CONCLUSIONS This study demonstrated feasibility of conducting a group-based MBSR-T intervention for adolescents with ELS. There was some evidence for efficacy on a symptom level with potential subtle changes on a biological level. Future larger studies are needed to determine the efficacy of group-based mindfulness interventions in this population. TRIAL REGISTRATION Identifier # NCT03633903 , registered 16/08/2018.
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Affiliation(s)
- Zsofia P Cohen
- Laureate Institute for Brain Research, 6655 S Yale Avenue, Tulsa, OK, 74136, USA
| | - Kelly T Cosgrove
- Laureate Institute for Brain Research, 6655 S Yale Avenue, Tulsa, OK, 74136, USA
- Department of Psychology, University of Tulsa, 800 S Tucker Drive, Tulsa, OK, 74104, USA
| | - Elisabeth Akeman
- Laureate Institute for Brain Research, 6655 S Yale Avenue, Tulsa, OK, 74136, USA
| | - Sara Coffey
- Center for Health Sciences, Oklahoma State University - Tulsa, 1111 W 17th St, Tulsa, OK, 74107, USA
| | - Kent Teague
- Center for Health Sciences, Oklahoma State University - Tulsa, 1111 W 17th St, Tulsa, OK, 74107, USA
- Departments of Surgery and Psychiatry, University of Oklahoma School of Community Medicine, 4502 A 41st St, Tulsa, OK, 74135, USA
| | - Jennifer Hays-Grudo
- Center for Health Sciences, Oklahoma State University - Tulsa, 1111 W 17th St, Tulsa, OK, 74107, USA
| | - Martin P Paulus
- Laureate Institute for Brain Research, 6655 S Yale Avenue, Tulsa, OK, 74136, USA
| | - Robin L Aupperle
- Laureate Institute for Brain Research, 6655 S Yale Avenue, Tulsa, OK, 74136, USA
- Oxley College of Health Sciences, School of Community Medicine, University of Tulsa, 1215 S Boulder Ave W, Tulsa, OK, 74119, USA
| | - Namik Kirlic
- Laureate Institute for Brain Research, 6655 S Yale Avenue, Tulsa, OK, 74136, USA.
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May AC, Burrows K, Figueroa-Hall LK, Kirlic N, White EJ, Smith R, Ekhtiari H, Paulus MP, Savitz J, Stewart JL. Sex differences in circulating inflammatory mediators as a function of substance use disorder. Drug Alcohol Depend 2021; 221:108610. [PMID: 33631550 PMCID: PMC8026624 DOI: 10.1016/j.drugalcdep.2021.108610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 01/20/2021] [Accepted: 01/23/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Substance use disorders (SUD) with comorbid depression and anxiety are linked to poor treatment outcome and relapse. Although some depressed individuals exhibit elevated blood-based inflammation (interleukin-6 [IL-6] and C reactive protein [CRP]), few studies have examined whether the presence of SUD exacerbates inflammation. METHODS Treatment-seeking individuals with major depressive disorder (MDD), anxiety disorders, and/or SUD (N = 160; 80 % with MDD) recruited into the Tulsa 1000 study provided blood samples, participated in clinical interviews, and completed a questionnaire battery querying symptoms of current psychopathology and emotional processing. Analyses followed a multistep process. First, groups were created on the presence versus absence of 1+ lifetime SUD diagnoses: SUD+ (37 F, 43 M) and SUD- (60 F, 20 M). Second, a principal component analysis (PCA) of questionnaire data resulted in two factors, one indexing negative emotionality/withdrawal motivation and one measuring positive emotionality/approach motivation. Third, SUD groups, extracted PCA factors, and nuisance covariates (age, body mass index [BMI], nicotine use, psychotropic medication [and hormone/contraception use in females]) were entered as simultaneous predictors of blood-based inflammation (IL-6, IL-8, IL-10, tumor necrosis factor-α, and CRP). RESULTS Within females, SUD + exhibited higher IL-8 and IL-10 but lower CRP levels than SUD-. In contrast, SUD was not associated with biomarker levels in males. Across sexes, higher BMI was linked to higher IL-6 and CRP levels, and within the five biomarkers, IL-6 and CRP shared the most variance. CONCLUSION These findings point to sex-specific inflammatory profiles as a function of SUD that may provide new targets for intervention.
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Affiliation(s)
- April C May
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA; Department of Psychiatry, University of California, San Diego, San Diego, CA, USA.
| | | | | | - Namik Kirlic
- Laureate Institute for Brain Research, Tulsa, OK, USA
| | - Evan J White
- Laureate Institute for Brain Research, Tulsa, OK, USA
| | - Ryan Smith
- Laureate Institute for Brain Research, Tulsa, OK, USA
| | | | - Martin P Paulus
- Laureate Institute for Brain Research, Tulsa, OK, USA; Oxley College of Health Sciences, The University of Tulsa, Tulsa, OK, USA
| | - Jonathan Savitz
- Laureate Institute for Brain Research, Tulsa, OK, USA; Oxley College of Health Sciences, The University of Tulsa, Tulsa, OK, USA
| | - Jennifer L Stewart
- Laureate Institute for Brain Research, Tulsa, OK, USA; Oxley College of Health Sciences, The University of Tulsa, Tulsa, OK, USA
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White EJ, Kuplicki R, Stewart JL, Kirlic N, Yeh HW, Paulus MP, Aupperle RL. Latent variables for region of interest activation during the monetary incentive delay task. Neuroimage 2021; 230:117796. [PMID: 33503481 DOI: 10.1016/j.neuroimage.2021.117796] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 11/27/2020] [Accepted: 01/19/2021] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND The Monetary Incentive Delay task (MID) has been used extensively to probe anticipatory reward processes. However, individual differences evident during this task may relate to other constructs such as general arousal or valence processing (i.e., anticipation of negative versus positive outcomes). This investigation used a latent variable approach to parse activation patterns during the MID within a transdiagnostic clinical sample. METHODS Participants were drawn from the first 500 individuals recruited for the Tulsa-1000 (T1000), a naturalistic longitudinal study of 1000 participants aged 18-55 (n = 476 with MID data). We employed a multiview latent analysis method, group factor analysis, to characterize factors within and across variable sets consisting of: (1) region of interest (ROI)-based blood oxygenation level-dependent (BOLD) contrasts during reward and loss anticipation; and (2) self-report measures of positive and negative valence and related constructs. RESULTS Three factors comprised of ROI indicators emerged to accounted for >43% of variance and loaded on variables representing: (1) general arousal or general activation; (2) valence, with dissociable responses to anticipation of win versus loss; and (3) region-specific activation, with dissociable activation in salience versus perceptual brain networks. Two additional factors were comprised of self-report variables, which appeared to represent arousal and valence. CONCLUSIONS Results indicate that multiview techniques to identify latent variables offer a novel approach for differentiating brain activation patterns during task engagement. Such approaches may offer insight into neural processing patterns through dimension reduction, be useful for probing individual differences, and aid in the development of optimal explanatory or predictive frameworks.
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Affiliation(s)
- Evan J White
- Laureate Institute for Brain Research, 6655 South Yale Avenue, Tulsa, OK 74136, USA.
| | - Rayus Kuplicki
- Laureate Institute for Brain Research, 6655 South Yale Avenue, Tulsa, OK 74136, USA
| | - Jennifer L Stewart
- Laureate Institute for Brain Research, 6655 South Yale Avenue, Tulsa, OK 74136, USA; Department of Community Medicine, Oxley Health Sciences, University of Tulsa, 800 South Tucker Drive, Tulsa, OK 74104, USA
| | - Namik Kirlic
- Laureate Institute for Brain Research, 6655 South Yale Avenue, Tulsa, OK 74136, USA
| | - Hung-Wen Yeh
- Pediatrics Department, Children's Mercy Kansas City, 2401 Gilham Road, Kansas City, MO 64108, USA
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- Laureate Institute for Brain Research, 6655 South Yale Avenue, Tulsa, OK 74136, USA
| | - Martin P Paulus
- Laureate Institute for Brain Research, 6655 South Yale Avenue, Tulsa, OK 74136, USA; Department of Community Medicine, Oxley Health Sciences, University of Tulsa, 800 South Tucker Drive, Tulsa, OK 74104, USA
| | - Robin L Aupperle
- Laureate Institute for Brain Research, 6655 South Yale Avenue, Tulsa, OK 74136, USA; Department of Community Medicine, Oxley Health Sciences, University of Tulsa, 800 South Tucker Drive, Tulsa, OK 74104, USA
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Smith R, Kirlic N, Stewart JL, Touthang J, Kuplicki R, Khalsa SS, Feinstein J, Paulus MP, Aupperle RL. Greater decision uncertainty characterizes a transdiagnostic patient sample during approach-avoidance conflict: a computational modelling approach. J Psychiatry Neurosci 2021. [PMID: 33119490 DOI: 10.31234/osf.io/t2dhn] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/12/2023] Open
Abstract
BACKGROUND Imbalances in approach-avoidance conflict (AAC) decision-making (e.g., sacrificing rewards to avoid negative outcomes) are considered central to multiple psychiatric disorders. We used computational modelling to examine 2 factors that are often not distinguished in descriptive analyses of AAC: decision uncertainty and sensitivity to negative outcomes versus rewards (emotional conflict). METHODS A previously validated AAC task was completed by 478 participants, including healthy controls (n = 59), people with substance use disorders (n = 159) and people with depression and/or anxiety disorders who did not have substance use disorders (n = 260). Using an active inference model, we estimated individual-level values for a model parameter that reflected decision uncertainty and another that reflected emotional conflict. We also repeated analyses in a subsample (59 healthy controls, 161 people with depression and/or anxiety disorders, 56 people with substance use disorders) that was propensity-matched for age and general intelligence. RESULTS The model showed high accuracy (72%). As further validation, parameters correlated with reaction times and self-reported task motivations in expected directions. The emotional conflict parameter further correlated with self-reported anxiety during the task (r = 0.32, p < 0.001), and the decision uncertainty parameter correlated with self-reported difficulty making decisions (r = 0.45, p < 0.001). Compared to healthy controls, people with depression and/or anxiety disorders and people with substance use disorders showed higher decision uncertainty in the propensity-matched sample (t = 2.16, p = 0.03, and t = 2.88, p = 0.005, respectively), with analogous results in the full sample; people with substance use disorders also showed lower emotional conflict in the full sample (t = 3.17, p = 0.002). LIMITATIONS This study was limited by heterogeneity of the clinical sample and an inability to examine learning. CONCLUSION These results suggest that reduced confidence in how to act, rather than increased emotional conflict, may explain maladaptive approach-avoidance behaviours in people with psychiatric disorders.
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Affiliation(s)
- Ryan Smith
- From the Laureate Institute for Brain Research, Tulsa, OK, USA (Smith, Kirlic, Stewart, Touthang, Kuplicki, Khalsa, Feinstein, Paulus, Aupperle); and the Oxley College of Health Sciences, University of Tulsa, Tulsa, OK, USA (Stewart, Khalsa, Paulus, Aupperle)
| | - Namik Kirlic
- From the Laureate Institute for Brain Research, Tulsa, OK, USA (Smith, Kirlic, Stewart, Touthang, Kuplicki, Khalsa, Feinstein, Paulus, Aupperle); and the Oxley College of Health Sciences, University of Tulsa, Tulsa, OK, USA (Stewart, Khalsa, Paulus, Aupperle)
| | - Jennifer L Stewart
- From the Laureate Institute for Brain Research, Tulsa, OK, USA (Smith, Kirlic, Stewart, Touthang, Kuplicki, Khalsa, Feinstein, Paulus, Aupperle); and the Oxley College of Health Sciences, University of Tulsa, Tulsa, OK, USA (Stewart, Khalsa, Paulus, Aupperle)
| | - James Touthang
- From the Laureate Institute for Brain Research, Tulsa, OK, USA (Smith, Kirlic, Stewart, Touthang, Kuplicki, Khalsa, Feinstein, Paulus, Aupperle); and the Oxley College of Health Sciences, University of Tulsa, Tulsa, OK, USA (Stewart, Khalsa, Paulus, Aupperle)
| | - Rayus Kuplicki
- From the Laureate Institute for Brain Research, Tulsa, OK, USA (Smith, Kirlic, Stewart, Touthang, Kuplicki, Khalsa, Feinstein, Paulus, Aupperle); and the Oxley College of Health Sciences, University of Tulsa, Tulsa, OK, USA (Stewart, Khalsa, Paulus, Aupperle)
| | - Sahib S Khalsa
- From the Laureate Institute for Brain Research, Tulsa, OK, USA (Smith, Kirlic, Stewart, Touthang, Kuplicki, Khalsa, Feinstein, Paulus, Aupperle); and the Oxley College of Health Sciences, University of Tulsa, Tulsa, OK, USA (Stewart, Khalsa, Paulus, Aupperle)
| | - Justin Feinstein
- From the Laureate Institute for Brain Research, Tulsa, OK, USA (Smith, Kirlic, Stewart, Touthang, Kuplicki, Khalsa, Feinstein, Paulus, Aupperle); and the Oxley College of Health Sciences, University of Tulsa, Tulsa, OK, USA (Stewart, Khalsa, Paulus, Aupperle)
| | - Martin P Paulus
- From the Laureate Institute for Brain Research, Tulsa, OK, USA (Smith, Kirlic, Stewart, Touthang, Kuplicki, Khalsa, Feinstein, Paulus, Aupperle); and the Oxley College of Health Sciences, University of Tulsa, Tulsa, OK, USA (Stewart, Khalsa, Paulus, Aupperle)
| | - Robin L Aupperle
- From the Laureate Institute for Brain Research, Tulsa, OK, USA (Smith, Kirlic, Stewart, Touthang, Kuplicki, Khalsa, Feinstein, Paulus, Aupperle); and the Oxley College of Health Sciences, University of Tulsa, Tulsa, OK, USA (Stewart, Khalsa, Paulus, Aupperle)
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27
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Smith R, Kirlic N, Stewart JL, Touthang J, Kuplicki R, Khalsa SS, Feinstein J, Paulus MP, Aupperle RL. Greater decision uncertainty characterizes a transdiagnostic patient sample during approach-avoidance conflict: a computational modelling approach. J Psychiatry Neurosci 2021; 46:E74-E87. [PMID: 33119490 PMCID: PMC7955838 DOI: 10.1503/jpn.200032] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Imbalances in approach-avoidance conflict (AAC) decision-making (e.g., sacrificing rewards to avoid negative outcomes) are considered central to multiple psychiatric disorders. We used computational modelling to examine 2 factors that are often not distinguished in descriptive analyses of AAC: decision uncertainty and sensitivity to negative outcomes versus rewards (emotional conflict). METHODS A previously validated AAC task was completed by 478 participants, including healthy controls (n = 59), people with substance use disorders (n = 159) and people with depression and/or anxiety disorders who did not have substance use disorders (n = 260). Using an active inference model, we estimated individual-level values for a model parameter that reflected decision uncertainty and another that reflected emotional conflict. We also repeated analyses in a subsample (59 healthy controls, 161 people with depression and/or anxiety disorders, 56 people with substance use disorders) that was propensity-matched for age and general intelligence. RESULTS The model showed high accuracy (72%). As further validation, parameters correlated with reaction times and self-reported task motivations in expected directions. The emotional conflict parameter further correlated with self-reported anxiety during the task (r = 0.32, p < 0.001), and the decision uncertainty parameter correlated with self-reported difficulty making decisions (r = 0.45, p < 0.001). Compared to healthy controls, people with depression and/or anxiety disorders and people with substance use disorders showed higher decision uncertainty in the propensity-matched sample (t = 2.16, p = 0.03, and t = 2.88, p = 0.005, respectively), with analogous results in the full sample; people with substance use disorders also showed lower emotional conflict in the full sample (t = 3.17, p = 0.002). LIMITATIONS This study was limited by heterogeneity of the clinical sample and an inability to examine learning. CONCLUSION These results suggest that reduced confidence in how to act, rather than increased emotional conflict, may explain maladaptive approach-avoidance behaviours in people with psychiatric disorders.
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Affiliation(s)
- Ryan Smith
- From the Laureate Institute for Brain Research, Tulsa, OK, USA (Smith, Kirlic, Stewart, Touthang, Kuplicki, Khalsa, Feinstein, Paulus, Aupperle); and the Oxley College of Health Sciences, University of Tulsa, Tulsa, OK, USA (Stewart, Khalsa, Paulus, Aupperle)
| | - Namik Kirlic
- From the Laureate Institute for Brain Research, Tulsa, OK, USA (Smith, Kirlic, Stewart, Touthang, Kuplicki, Khalsa, Feinstein, Paulus, Aupperle); and the Oxley College of Health Sciences, University of Tulsa, Tulsa, OK, USA (Stewart, Khalsa, Paulus, Aupperle)
| | - Jennifer L Stewart
- From the Laureate Institute for Brain Research, Tulsa, OK, USA (Smith, Kirlic, Stewart, Touthang, Kuplicki, Khalsa, Feinstein, Paulus, Aupperle); and the Oxley College of Health Sciences, University of Tulsa, Tulsa, OK, USA (Stewart, Khalsa, Paulus, Aupperle)
| | - James Touthang
- From the Laureate Institute for Brain Research, Tulsa, OK, USA (Smith, Kirlic, Stewart, Touthang, Kuplicki, Khalsa, Feinstein, Paulus, Aupperle); and the Oxley College of Health Sciences, University of Tulsa, Tulsa, OK, USA (Stewart, Khalsa, Paulus, Aupperle)
| | - Rayus Kuplicki
- From the Laureate Institute for Brain Research, Tulsa, OK, USA (Smith, Kirlic, Stewart, Touthang, Kuplicki, Khalsa, Feinstein, Paulus, Aupperle); and the Oxley College of Health Sciences, University of Tulsa, Tulsa, OK, USA (Stewart, Khalsa, Paulus, Aupperle)
| | - Sahib S Khalsa
- From the Laureate Institute for Brain Research, Tulsa, OK, USA (Smith, Kirlic, Stewart, Touthang, Kuplicki, Khalsa, Feinstein, Paulus, Aupperle); and the Oxley College of Health Sciences, University of Tulsa, Tulsa, OK, USA (Stewart, Khalsa, Paulus, Aupperle)
| | - Justin Feinstein
- From the Laureate Institute for Brain Research, Tulsa, OK, USA (Smith, Kirlic, Stewart, Touthang, Kuplicki, Khalsa, Feinstein, Paulus, Aupperle); and the Oxley College of Health Sciences, University of Tulsa, Tulsa, OK, USA (Stewart, Khalsa, Paulus, Aupperle)
| | - Martin P Paulus
- From the Laureate Institute for Brain Research, Tulsa, OK, USA (Smith, Kirlic, Stewart, Touthang, Kuplicki, Khalsa, Feinstein, Paulus, Aupperle); and the Oxley College of Health Sciences, University of Tulsa, Tulsa, OK, USA (Stewart, Khalsa, Paulus, Aupperle)
| | - Robin L Aupperle
- From the Laureate Institute for Brain Research, Tulsa, OK, USA (Smith, Kirlic, Stewart, Touthang, Kuplicki, Khalsa, Feinstein, Paulus, Aupperle); and the Oxley College of Health Sciences, University of Tulsa, Tulsa, OK, USA (Stewart, Khalsa, Paulus, Aupperle)
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McDermott TJ, Kirlic N, Akeman E, Touthang J, Cosgrove KT, DeVille DC, Clausen AN, White EJ, Kuplicki R, Aupperle RL. Visual cortical regions show sufficient test-retest reliability while salience regions are unreliable during emotional face processing. Neuroimage 2020; 220:117077. [PMID: 32574806 DOI: 10.1016/j.neuroimage.2020.117077] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 06/16/2020] [Accepted: 06/17/2020] [Indexed: 01/14/2023] Open
Abstract
Functional magnetic resonance imaging studies frequently use emotional face processing tasks to probe neural circuitry related to psychiatric disorders and treatments with an emphasis on regions within the salience network (e.g., amygdala). Findings across previous test-retest reliability studies of emotional face processing have shown high variability, potentially due to differences in data analytic approaches. The present study comprehensively examined the test-retest reliability of an emotional faces task utilizing multiple approaches to region of interest (ROI) analysis and by examining voxel-wise reliability across the entire brain for both neural activation and functional connectivity. Analyses included 42 healthy adult participants who completed an fMRI scan concurrent with an emotional faces task on two separate days with an average of 25.52 days between scans. Intraclass correlation coefficients (ICCs) were calculated for the 'FACES-SHAPES' and 'FACES' (compared to implicit baseline) contrasts across the following: anatomical ROIs identified from a publicly available brain atlas (i.e., Brainnetome), functional ROIs consisting of 5-mm spheres centered on peak voxels from a publicly available meta-analytic database (i.e., Neurosynth), and whole-brain, voxel-wise analysis. Whole-brain, voxel-wise analyses of functional connectivity were also conducted using both anatomical and functional seed ROIs. While group-averaged neural activation maps were consistent across time, only one anatomical ROI and two functional ROIs showed good or excellent individual-level reliability for neural activation. The anatomical ROI was the right medioventral fusiform gyrus for the FACES contrast (ICC = 0.60). The functional ROIs were the left and the right fusiform face area (FFA) for both FACES-SHAPES and FACES (Left FFA ICCs = 0.69 & 0.79; Right FFA ICCs = 0.68 & 0.66). Poor reliability (ICCs < 0.4) was identified for almost all other anatomical and functional ROIs, with some exceptions showing fair reliability (ICCs = 0.4-0.59). Whole-brain voxel-wise analysis of neural activation identified voxels with good (ICCs = 0.6-0.74) to excellent reliability (ICCs > 0.75) that were primarily located in visual cortex, with several clusters in bilateral dorsal lateral prefrontal cortex (DLPFC). Whole-brain voxel-wise analyses of functional connectivity for amygdala and fusiform gyrus identified very few voxels with good to excellent reliability using both anatomical and functional seed ROIs. Exceptions included clusters in right cerebellum and right DLPFC that showed reliable connectivity with left amygdala (ICCs > 0.6). In conclusion, results indicate that visual cortical regions demonstrate good reliability at the individual level for neural activation, but reliability is generally poor for salience regions often focused on within psychiatric research (e.g., amygdala). Given these findings, future clinical neuroimaging studies using emotional faces tasks to examine individual differences might instead focus on visual regions and their role in psychiatric disorders.
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Affiliation(s)
- Timothy J McDermott
- Laureate Institute for Brain Research, Tulsa, OK, United States; Department of Psychology, University of Tulsa, Tulsa, OK, United States
| | - Namik Kirlic
- Laureate Institute for Brain Research, Tulsa, OK, United States
| | | | - James Touthang
- Laureate Institute for Brain Research, Tulsa, OK, United States
| | - Kelly T Cosgrove
- Laureate Institute for Brain Research, Tulsa, OK, United States; Department of Psychology, University of Tulsa, Tulsa, OK, United States
| | - Danielle C DeVille
- Laureate Institute for Brain Research, Tulsa, OK, United States; Department of Psychology, University of Tulsa, Tulsa, OK, United States
| | - Ashley N Clausen
- Laureate Institute for Brain Research, Tulsa, OK, United States; VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham VA Health Care System, Durham, NC, USA; Duke University Brain Imaging and Analysis Center, Durham, NC, USA
| | - Evan J White
- Laureate Institute for Brain Research, Tulsa, OK, United States
| | - Rayus Kuplicki
- Laureate Institute for Brain Research, Tulsa, OK, United States; Department of Community Medicine, University of Tulsa, Tulsa, OK, United States
| | - Robin L Aupperle
- Laureate Institute for Brain Research, Tulsa, OK, United States; Department of Community Medicine, University of Tulsa, Tulsa, OK, United States.
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Kirlic N, Cohen ZP, Singh MK. Is There an Ace Up Our Sleeve? A Review of Interventions and Strategies for Addressing Behavioral and Neurobiological Effects of Adverse Childhood Experiences in Youth. Advers Resil Sci 2020; 1:5-28. [PMID: 34278327 PMCID: PMC8281391 DOI: 10.1007/s42844-020-00001-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Exposure to early life adversity (ELA) is a major public health crisis posing as a significant risk of immediate and sustained mental and physical health consequences. While a remarkable body of knowledge has been amassed showing psychological, cognitive, social, developmental, and neurobiological consequences of ELA exposure, little has been done to improve the long-term mental and physical health outcomes for youth exposed to ELA. Furthermore, neurobiological processes underlying poor outcomes in this population have been largely left out of prevention and intervention target efforts. In this review, we first describe ELA-related alterations across psychological and neurobiological systems in children and adolescents. Next, we describe existing evidence-based interventions targeting ELA-related outcomes. We then turn to experimental studies examining individual differences in mechanistic functioning consequent to ELA exposure, and strategies that target these mechanisms and modulate disrupted functioning. Finally, we highlight areas of future research that may be promising in engaging behavioral and neurobiological targets through novel preventive interventions or augmentation of existing interventions, thereby reducing negative mental and physical health outcomes later in life.
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Affiliation(s)
- Namik Kirlic
- Laureate Institute for Brain Research, 6655 South Yale Ave., Tulsa, OK 74136, USA
| | - Zsofia P. Cohen
- Laureate Institute for Brain Research, 6655 South Yale Ave., Tulsa, OK 74136, USA
| | - Manpreet K. Singh
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
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Akeman E, Kirlic N, Clausen AN, Cosgrove KT, McDermott TJ, Cromer LD, Paulus MP, Yeh HW, Aupperle RL. A pragmatic clinical trial examining the impact of a resilience program on college student mental health. Depress Anxiety 2020; 37:202-213. [PMID: 31682327 PMCID: PMC7054149 DOI: 10.1002/da.22969] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 09/20/2019] [Accepted: 10/10/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND One in three college students experience significant depression or anxiety interfering with daily functioning. Resilience programs that can be administered to all students offer an opportunity for addressing this public health problem. The current study objective was to assess the benefit of a brief, universal resilience program for first-year college students. METHOD First-year students at a private, midwestern university participated. This trial used a pragmatic design, delivering the intervention within university-identified orientation courses and was not randomized. The four-session resilience program included goal-building, mindfulness, and resilience skills. The comparison was orientation-as-usual. Primary outcomes included PROMIS® Depression and Anxiety and Connor-Davidson Resilience Scale. Secondary and exploratory outcomes included the Perceived Stress Scale, Emotion Regulation, and Cognitive Behavioral Therapy (CBT) Skills Questionnaires, and Freiburg Mindfulness Inventory. Time by treatment interactions at post-training and semester-end were examined using linear mixed models. RESULTS Analysis included 252 students, 126 who completed resilience programming and a matched comparison sample. Resilience programming did not relate to improvements in depression at post-training (CI: -2.53 to 1.02; p = .404, d =-0.08), but did at semester-end (95% CI: -4.27 to -0.72; p = .006, d = -0.25) and improvements in perceived stress were observed at post-training (CI: -3.31 to -0.44; p = .011, d = -0.24) and semester-end (CI: -3.30 to -0.41; p = .013, d = -0.24). Emotion regulation, mindfulness, and CBT skills increased, with CBT skills mediating clinical improvements. CONCLUSIONS Universal implementation of a brief, resilience intervention may be effective for improving college student mental health.
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Affiliation(s)
| | - Namik Kirlic
- Laureate Institute for Brain Research, Tulsa, Oklahoma
| | - Ashley N Clausen
- VA Mid-Atlantic Mental Illness Research, Education and Clinical Center, Durham, North Carolina.,Duke University Brain Imaging and Analysis Center, Durham, North Carolina
| | - Kelly T Cosgrove
- Laureate Institute for Brain Research, Tulsa, Oklahoma.,Department of Psychology, University of Tulsa, Tulsa, Oklahoma
| | - Timothy J McDermott
- Laureate Institute for Brain Research, Tulsa, Oklahoma.,Department of Psychology, University of Tulsa, Tulsa, Oklahoma
| | - Lisa D Cromer
- Department of Psychology, University of Tulsa, Tulsa, Oklahoma
| | | | - Hung-Wen Yeh
- Health Services & Outcomes Research, Children's Mercy Hospital, Kansas City, Missouri
| | - Robin L Aupperle
- Laureate Institute for Brain Research, Tulsa, Oklahoma.,School of Community Medicine, University of Tulsa, Tulsa, Oklahoma
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31
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Santiago J, Akeman E, Kirlic N, Clausen AN, Cosgrove KT, McDermott TJ, Mathis B, Paulus M, Craske MG, Abelson J, Martell C, Wolitzky-Taylor K, Bodurka J, Thompson WK, Aupperle RL. Protocol for a randomized controlled trial examining multilevel prediction of response to behavioral activation and exposure-based therapy for generalized anxiety disorder. Trials 2020; 21:17. [PMID: 31907032 PMCID: PMC6943897 DOI: 10.1186/s13063-019-3802-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 10/11/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Only 40-60% of patients with generalized anxiety disorder experience long-lasting improvement with gold standard psychosocial interventions. Identifying neurobehavioral factors that predict treatment success might provide specific targets for more individualized interventions, fostering more optimal outcomes and bringing us closer to the goal of "personalized medicine." Research suggests that reward and threat processing (approach/avoidance behavior) and cognitive control may be important for understanding anxiety and comorbid depressive disorders and may have relevance to treatment outcomes. This study was designed to determine whether approach-avoidance behaviors and associated neural responses moderate treatment response to exposure-based versus behavioral activation therapy for generalized anxiety disorder. METHODS/DESIGN We are conducting a randomized controlled trial involving two 10-week group-based interventions: exposure-based therapy or behavioral activation therapy. These interventions focus on specific and unique aspects of threat and reward processing, respectively. Prior to and after treatment, participants are interviewed and undergo behavioral, biomarker, and neuroimaging assessments, with a focus on approach and avoidance processing and decision-making. Primary analyses will use mixed models to examine whether hypothesized approach, avoidance, and conflict arbitration behaviors and associated neural responses at baseline moderate symptom change with treatment, as assessed using the Generalized Anxiety Disorder-7 item scale. Exploratory analyses will examine additional potential treatment moderators and use data reduction and machine learning methods. DISCUSSION This protocol provides a framework for how studies may be designed to move the field toward neuroscience-informed and personalized psychosocial treatments. The results of this trial will have implications for approach-avoidance processing in generalized anxiety disorder, relationships between levels of analysis (i.e., behavioral, neural), and predictors of behavioral therapy outcome. TRIAL REGISTRATION The study was retrospectively registered within 21 days of first participant enrollment in accordance with FDAAA 801 with ClinicalTrials.gov, NCT02807480. Registered on June 21, 2016, before results.
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Affiliation(s)
- J Santiago
- Laureate Institute for Brain Research, 6655 South Yale Avenue, Tulsa, OK, 74136, USA
| | - E Akeman
- Laureate Institute for Brain Research, 6655 South Yale Avenue, Tulsa, OK, 74136, USA
| | - N Kirlic
- Laureate Institute for Brain Research, 6655 South Yale Avenue, Tulsa, OK, 74136, USA
| | - A N Clausen
- VA Mid-Atlantic Mental Illness Research, Education and Clinical Center, Durham, NC, USA
- Duke University Brain Imaging and Analysis Center, Durham, NC, USA
| | - K T Cosgrove
- Laureate Institute for Brain Research, 6655 South Yale Avenue, Tulsa, OK, 74136, USA
- Department of Psychology, University of Tulsa, Tulsa, OK, USA
| | - T J McDermott
- Laureate Institute for Brain Research, 6655 South Yale Avenue, Tulsa, OK, 74136, USA
- Department of Psychology, University of Tulsa, Tulsa, OK, USA
| | - B Mathis
- Laureate Institute for Brain Research, 6655 South Yale Avenue, Tulsa, OK, 74136, USA
| | - M Paulus
- Laureate Institute for Brain Research, 6655 South Yale Avenue, Tulsa, OK, 74136, USA
- School of Community Medicine, University of Tulsa, Tulsa, OK, USA
| | - M G Craske
- Psychology, Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, USA
| | - J Abelson
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - C Martell
- Department of Psychological and Brain Sciences, University of Massachusetts-Amherst, Amherst, MA, USA
| | - K Wolitzky-Taylor
- Psychology, Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, USA
| | - J Bodurka
- Laureate Institute for Brain Research, 6655 South Yale Avenue, Tulsa, OK, 74136, USA
- Stephenson School of Biomedical Engineering, The University of Oklahoma, Norman, OK, USA
| | - W K Thompson
- Family Medicine and Public Health, University of California, San Diego, San Diego, CA, USA
| | - Robin L Aupperle
- Laureate Institute for Brain Research, 6655 South Yale Avenue, Tulsa, OK, 74136, USA.
- School of Community Medicine, University of Tulsa, Tulsa, OK, USA.
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Kirlic N, Aupperle RL, Rhudy JL, Misaki M, Kuplicki R, Sutton A, Alvarez RP. Latent variable analysis of negative affect and its contributions to neural responses during shock anticipation. Neuropsychopharmacology 2019; 44:695-702. [PMID: 30181595 PMCID: PMC6372706 DOI: 10.1038/s41386-018-0187-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 07/11/2018] [Accepted: 08/14/2018] [Indexed: 01/04/2023]
Abstract
Negative affect is considered an important factor in the etiology of depression and anxiety, and is highly related to pain. However, negative affect is not a unitary construct. To identify specific targets for treatment development, we aimed to derive latent variables of negative affect and test their unique contributions to affective processing during anticipation of unpredictable, painful shock. Eighty-three subjects (43 with depression and anxiety spectrum disorders and 40 healthy controls) completed self-report measures of negative valence and underwent neuroimaging while exploring computer-simulated contexts with and without the threat of a painful, but tolerable, shock. Principal component analysis (PCA) extracted distinct components of general negative affect (GNA) and pain-related negative affect (PNA). While elevated GNA and PNA were both indicative of depression and anxiety disorders, greater PNA was more strongly related to task-specific anxious reactivity during shock anticipation. GNA was associated with increased precuneus and middle frontal gyrus activity, whereas PNA was related to increased bilateral anterior insula activity. Anterior insula activity mediated the relationship between PNA and task-specific anxious reactivity. In conclusion, GNA and PNA have distinct neural signatures and uniquely contribute to anxious anticipation. PNA, via insula activity, may relate to arousal in ways that could contribute to affective dysregulation, and thus may be an important treatment target.
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Affiliation(s)
- Namik Kirlic
- Laureate Institute for Brain Research, Tulsa, OK, USA.
| | - Robin L. Aupperle
- 0000 0004 0512 8863grid.417423.7Laureate Institute for Brain Research, Tulsa, OK USA ,0000 0001 2160 264Xgrid.267360.6School of Community Medicine, University of Tulsa, Tulsa, OK USA
| | - Jamie L. Rhudy
- 0000 0001 2160 264Xgrid.267360.6Department of Psychology, University of Tulsa, Tulsa, OK USA
| | - Masaya Misaki
- 0000 0004 0512 8863grid.417423.7Laureate Institute for Brain Research, Tulsa, OK USA
| | - Rayus Kuplicki
- 0000 0004 0512 8863grid.417423.7Laureate Institute for Brain Research, Tulsa, OK USA
| | - Anne Sutton
- 0000 0004 0512 8863grid.417423.7Laureate Institute for Brain Research, Tulsa, OK USA
| | - Ruben P. Alvarez
- 0000 0004 0512 8863grid.417423.7Laureate Institute for Brain Research, Tulsa, OK USA
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McDermott TJ, Kirlic N, Aupperle RL. Roadmap for optimizing the clinical utility of emotional stress paradigms in human neuroimaging research. Neurobiol Stress 2018; 8:134-146. [PMID: 29888309 PMCID: PMC5991342 DOI: 10.1016/j.ynstr.2018.05.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 04/30/2018] [Accepted: 05/03/2018] [Indexed: 01/24/2023] Open
Abstract
The emotional stress response is relevant to a number of psychiatric disorders, including posttraumatic stress disorder (PTSD) in particular. Research using neuroimaging methods such as functional magnetic resonance imaging (fMRI) to probe stress-related neural processing have provided some insights into psychiatric disorders. Treatment providers and individual patients would benefit from clinically useful fMRI paradigms that provide information about patients' current brain state and responses to stress in order to inform the treatment selection process. However, neuroimaging has not yet made a meaningful impact on real-world clinical practice. This lack of clinical utility may be related to a number of basic psychometric properties that are often overlooked during fMRI task development. The goals of the current review are to discuss important methodological considerations for current human fMRI stress-related paradigms and to provide a roadmap for developing methodologically sound and clinically useful paradigms. This would include establishing various aspects of reliability, including internal consistency, test-retest and multi-site, as well as validity, including face, content, construct, and criterion. In addition, the establishment of standardized normative data from a large sample of participants would support our understanding of how any one individual compares to the general population. Addressing these methodological gaps will likely have a powerful effect on improving the replicability of findings and optimize our chances for improving real-world clinical outcomes.
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Affiliation(s)
- Timothy J. McDermott
- Laureate Institute for Brain Research, Tulsa, OK, United States
- Department of Psychology, University of Tulsa, Tulsa, OK, United States
| | - Namik Kirlic
- Laureate Institute for Brain Research, Tulsa, OK, United States
| | - Robin L. Aupperle
- Laureate Institute for Brain Research, Tulsa, OK, United States
- Department of Community Medicine, University of Tulsa, Tulsa, OK, United States
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Kirlic N, Aupperle RL, Misaki M, Kuplicki R, Alvarez RP. Recruitment of orbitofrontal cortex during unpredictable threat among adults at risk for affective disorders. Brain Behav 2017; 7:e00757. [PMID: 28828218 PMCID: PMC5561318 DOI: 10.1002/brb3.757] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Revised: 05/01/2017] [Accepted: 06/03/2017] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Mood and anxiety disorders are characterized by altered prefrontal-amygdala function and increased behavioral inhibition (BI) in response to potential threat. Whether these alterations constitute a vulnerability or a symptom of illness remains unclear. The medial orbitofrontal cortex (mOFC) is thought to play a central role in estimating probability and cost of threat, in turn informing selection of subsequent behaviors. To better understand the behavioral and neural processes that may be associated with risk for psychopathology, we used a virtual reality paradigm to examine behavioral and neural responses of psychiatrically healthy adults with familial history of affective disorders during anticipation of unpredictable threat. METHODS Twenty psychiatrically healthy adults with high familial risk for affective disorders and 20 low-risk matched controls underwent functional magnetic resonance imaging concurrent with a paradigm in which they explored virtual contexts associated with the threat of shock or safety from shock. Subjective anxiety ratings, skin conductance, exploratory behavior, and neural responses were examined for threat versus safe conditions. RESULTS High-risk adults evidenced greater right mOFC activation, as well as greater BI, compared to low-risk adults. There were no significant group differences in subjective ratings or autonomic responses. Individuals exhibiting greater activity in the right mOFC showed greater BI and decreased skin conductance response. CONCLUSIONS These results suggest that BI and mOFC recruitment during anticipation of aversive outcomes may reflect a vulnerability for affective disorders. However, such a response may also serve as a compensatory response, protecting these high-risk individuals from negative outcomes (i.e., increased physiological arousal). These results suggest that the OFC may play a central role in driving threat-related behaviors and thus may be a target for efforts aimed at early detection or prevention.
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Affiliation(s)
- Namik Kirlic
- Laureate Institute for Brain Research Tulsa OK USA
| | - Robin L Aupperle
- Laureate Institute for Brain Research Tulsa OK USA.,Department of Community Medicine University of Tulsa Tulsa OK USA
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Kirlic N, Young J, Aupperle RL. Animal to human translational paradigms relevant for approach avoidance conflict decision making. Behav Res Ther 2017; 96:14-29. [PMID: 28495358 DOI: 10.1016/j.brat.2017.04.010] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Revised: 04/17/2017] [Accepted: 04/20/2017] [Indexed: 12/29/2022]
Abstract
Avoidance behavior in clinical anxiety disorders is often a decision made in response to approach-avoidance conflict, resulting in a sacrifice of potential rewards to avoid potential negative affective consequences. Animal research has a long history of relying on paradigms related to approach-avoidance conflict to model anxiety-relevant behavior. This approach includes punishment-based conflict, exploratory, and social interaction tasks. There has been a recent surge of interest in the translation of paradigms from animal to human, in efforts to increase generalization of findings and support the development of more effective mental health treatments. This article briefly reviews animal tests related to approach-avoidance conflict and results from lesion and pharmacologic studies utilizing these tests. We then provide a description of translational human paradigms that have been developed to tap into related constructs, summarizing behavioral and neuroimaging findings. Similarities and differences in findings from analogous animal and human paradigms are discussed. Lastly, we highlight opportunities for future research and paradigm development that will support the clinical utility of this translational work.
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Affiliation(s)
- Namik Kirlic
- Laureate Institute for Brain Research, 6655 S Yale Ave, Tulsa, OK 74136, United States.
| | - Jared Young
- Department of Psychiatry, School of Medicine, University of California San Diego, 9500 Gilman Drive MC 0804, La Jolla, CA 92093, United States; VA San Diego Healthcare System, 3350 La Jolla Village Dr, San Diego, CA 92161, United States.
| | - Robin L Aupperle
- Laureate Institute for Brain Research, 6655 S Yale Ave, Tulsa, OK 74136, United States; School of Community Medicine, University of Tulsa, 800 S Tucker Dr, Tulsa, OK 74104, United States.
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Aupperle RL, Morris AS, Silk JS, Criss MM, Judah MR, Eagleton SG, Kirlic N, Byrd-Craven J, Phillips R, Alvarez RP. Neural responses to maternal praise and criticism: Relationship to depression and anxiety symptoms in high-risk adolescent girls. Neuroimage Clin 2016; 11:548-554. [PMID: 27158587 PMCID: PMC4845388 DOI: 10.1016/j.nicl.2016.03.009] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Revised: 03/07/2016] [Accepted: 03/09/2016] [Indexed: 02/03/2023]
Abstract
Background The parent-child relationship may be an important factor in the development of adolescent depressive and anxious symptoms. In adults, depressive symptoms relate to increased amygdala and attenuated prefrontal activation to maternal criticism. The current pilot study examined how depressive and anxiety symptoms in a high-risk adolescent population relate to neural responses to maternal feedback. Given previous research relating oxytocin to maternal behavior, we conducted exploratory analyses using oxytocin receptor (OXTR) genotype. Methods Eighteen females (ages 12–16) listened to maternal praise, neutral, and critical statements during functional magnetic resonance imaging. Participants completed the Mood and Feelings Questionnaire and the Screen for Child Anxiety Related Emotional Disorders. The OXTR single nucleotide polymorphism, rs53576, was genotyped. Linear mixed models were used to identify symptom or allele (GG, AA/AG) by condition (critical, neutral, praise) interaction effects on brain activation. Results Greater symptoms related to greater right amygdala activation for criticism and reduced activation to praise. For left amygdala, greater symptoms related to reduced activation to both conditions. Anxiety symptoms related to differences in superior medial PFC activation patterns. Parental OXTR AA/AG allele related to reduced activation to criticism and greater activation to praise within the right amygdala. Conclusions Results support a relationship between anxiety and depressive symptoms and prefrontal-amygdala responses to maternal feedback. The lateralization of amygdala findings suggests separate neural targets for interventions reducing reactivity to negative feedback or increasing salience of positive feedback. Exploratory analyses suggest that parents' OXTR genetic profile influences parent-child interactions and related adolescent brain responses. Adolescent brain responses to maternal praise and criticism were examined. Anxiety related to prefrontal-amygdala response to both criticism and praise. Exploratory results support a role for the OXTR gene in parent-child interactions.
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Affiliation(s)
- Robin L Aupperle
- Laureate Institute for Brain Research, 6655 S. Yale Ave., Tulsa, OK 74136, United States; School of Community Medicine, University of Tulsa, 800 S. Tucker Dr., Tulsa, OK 74104, United States.
| | - Amanda S Morris
- Laureate Institute for Brain Research, 6655 S. Yale Ave., Tulsa, OK 74136, United States; Department of Human Development and Family Science, Oklahoma State University, 700 N. Greenwood Ave., Tulsa, OK 74106, United States
| | - Jennifer S Silk
- Department of Psychology, University of Pittsburgh, 210 South Bouquet Street, Pittsburgh, PA 15260, United States
| | - Michael M Criss
- Department of Human Development and Family Science, Oklahoma State University, 700 N. Greenwood Ave., Tulsa, OK 74106, United States; Center for Family Resilience, Oklahoma State University, 700 N. Greenwood Ave., Tulsa, OK 74106, United States
| | - Matt R Judah
- Department of Psychology, Oklahoma State University, 116 N. Murray Hall, Stillwater, OK 74078, United States
| | - Sally G Eagleton
- Department of Human Development and Family Science, Oklahoma State University, 700 N. Greenwood Ave., Tulsa, OK 74106, United States; Center for Family Resilience, Oklahoma State University, 700 N. Greenwood Ave., Tulsa, OK 74106, United States
| | - Namik Kirlic
- Laureate Institute for Brain Research, 6655 S. Yale Ave., Tulsa, OK 74136, United States; Department of Psychology, University of Tulsa, 800 S. Tucker Dr., Tulsa, OK 74104, United States
| | - Jennifer Byrd-Craven
- Department of Psychology, Oklahoma State University, 116 N. Murray Hall, Stillwater, OK 74078, United States
| | - Raquel Phillips
- Laureate Institute for Brain Research, 6655 S. Yale Ave., Tulsa, OK 74136, United States
| | - Ruben P Alvarez
- Laureate Institute for Brain Research, 6655 S. Yale Ave., Tulsa, OK 74136, United States; School of Community Medicine, University of Tulsa, 800 S. Tucker Dr., Tulsa, OK 74104, United States
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Alvarez RP, Kirlic N, Misaki M, Bodurka J, Rhudy JL, Paulus MP, Drevets WC. Increased anterior insula activity in anxious individuals is linked to diminished perceived control. Transl Psychiatry 2015; 5:e591. [PMID: 26125154 PMCID: PMC4490294 DOI: 10.1038/tp.2015.84] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Revised: 04/25/2015] [Accepted: 05/21/2015] [Indexed: 02/07/2023] Open
Abstract
Individuals with high-trait anxiety frequently report decreased perceived control. However, it is unclear how these processes are instantiated at a neural level. Prior research suggests that individuals prone to anxiety may have exaggerated activity in the anterior insula and altered activity in the cingulate cortex during anticipation of aversive events. Thus, we hypothesized that anxiety proneness influences anterior insula activation during anticipation of unpredictable threat through decreased perceived control. Forty physically healthy adults underwent neuroimaging while they explored computer-simulated contexts associated either with or without the threat of an unpredictable shock. Skin conductance, anxiety ratings and blood oxygenation level-dependent (BOLD) functional magnetic resonance imaging were used to assess responses to threat versus no threat. Perceived control was measured using the Anxiety Control Questionnaire-Revised. Mediation analysis examined how anxiety proneness influenced BOLD activity. Anticipation of unpredictable threat resulted in increased skin conductance responses, anxiety ratings and enhanced activation in bilateral insula, anterior midcingulate cortex (aMCC) and bed nucleus of the stria terminalis. Individuals with greater anxiety proneness and less perceived control showed greater activity in dorsal anterior insula (dAI). Perceived control mediated the relationship between anxiety proneness and dAI activity. Increased dAI activity was associated with increased activity in aMCC, which correlated with increased exploratory behavior. Results provide evidence that exaggerated insula activation during the threat of unpredictable shock is directly related to low perceived control in anxiety-prone individuals. Perceived control thus may constitute an important treatment target to modulate insula activity during anxious anticipation in anxiety-disordered individuals.
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Affiliation(s)
- R P Alvarez
- Laureate Institute for Brain Research, Tulsa, OK, USA,Faculty of Community Medicine, The University of Tulsa, Tulsa, OK, USA,Laureate Institute for Brain Research, 6655 South Yale Avenue, Tulsa, OK 74136, USA. E-mail:
| | - N Kirlic
- Laureate Institute for Brain Research, Tulsa, OK, USA,Department of Psychology, The University of Tulsa, Tulsa, OK, USA
| | - M Misaki
- Laureate Institute for Brain Research, Tulsa, OK, USA
| | - J Bodurka
- Laureate Institute for Brain Research, Tulsa, OK, USA,Center for Biomedical Engineering, The University of Oklahoma, Norman, OK, USA,College of Engineering, The University of Oklahoma, Norman, OK, USA
| | - J L Rhudy
- Department of Psychology, The University of Tulsa, Tulsa, OK, USA
| | - M P Paulus
- Laureate Institute for Brain Research, Tulsa, OK, USA
| | - W C Drevets
- Janssen Research and Development, Janssen Pharmaceuticals, Titusville, NJ, USA
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Kirlic N, Newman E, Lagasse LL, Derauf C, Shah R, Smith LM, Arria AM, Huestis MA, Haning W, Strauss A, Dellagrotta S, Dansereau LM, Abar B, Neal CR, Lester BM. Cortisol reactivity in two-year-old children prenatally exposed to methamphetamine. J Stud Alcohol Drugs 2013; 74:447-51. [PMID: 23490574 DOI: 10.15288/jsad.2013.74.447] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Until now, the functioning of the hypothalamic-pituitary-adrenal (HPA) axis in children with prenatal methamphetamine exposure (PME) had been unexamined. Previous research indicates that prenatal exposure to stimulant drugs is associated with dose-response alterations in neural growth and connectivity and consequent neurobehavioral deficits. In addition, children of drug-using parents are at an increased risk for exposure to chronic postnatal stress. In this preliminary study, we examined the associations of PME and postnatal environmental stress with cortisol stress reactivity in children with PME. METHOD Participants were 2-year-old children (N = 123; 55.3% male) with PME from a multicenter longitudinal Infant, Development, Environment, and Lifestyle Study. Saliva samples were obtained before and after a stress-inducing separation task. Hierarchical multiple regression analyses examined prenatal drug exposure, methodological and postnatal stress covariates, and interactions between levels of PME and postnatal stress. RESULTS Mild to moderate potential for child physical abuse moderated increased cortisol reactivity in high exposed children with PME. Blunted cortisol reactivity was associated with caregiver's postnatal alcohol use, child's behavioral dysregulation, and the interaction between higher levels of PME and caregiver's psychopathology. CONCLUSIONS Consistent with the known effects of stimulant drugs and chronically stressful environments on the HPA axis and, thus, the toxic stress and allostatic load phenomena, our results imply that elevated PME may be associated with alterations in the programming of the HPA axis reflecting hyperactivity, which under significant and chronic environmental stress then may become hypoactive.
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Affiliation(s)
- Namik Kirlic
- Department of Psychology, The University of Tulsa, Tulsa, Oklahoma, USA.
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Blood AJ, Kuster JK, Woodman SC, Kirlic N, Makhlouf ML, Multhaupt-Buell TJ, Makris N, Parent M, Sudarsky LR, Sjalander G, Breiter H, Breiter HC, Sharma N. Evidence for altered basal ganglia-brainstem connections in cervical dystonia. PLoS One 2012; 7:e31654. [PMID: 22384048 PMCID: PMC3285161 DOI: 10.1371/journal.pone.0031654] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2011] [Accepted: 01/16/2012] [Indexed: 11/18/2022] Open
Abstract
Background There has been increasing interest in the interaction of the basal ganglia with the cerebellum and the brainstem in motor control and movement disorders. In addition, it has been suggested that these subcortical connections with the basal ganglia may help to coordinate a network of regions involved in mediating posture and stabilization. While studies in animal models support a role for this circuitry in the pathophysiology of the movement disorder dystonia, thus far, there is only indirect evidence for this in humans with dystonia. Methodology/Principal Findings In the current study we investigated probabilistic diffusion tractography in DYT1-negative patients with cervical dystonia and matched healthy control subjects, with the goal of showing that patients exhibit altered microstructure in the connectivity between the pallidum and brainstem. The brainstem regions investigated included nuclei that are known to exhibit strong connections with the cerebellum. We observed large clusters of tractography differences in patients relative to healthy controls, between the pallidum and the brainstem. Tractography was decreased in the left hemisphere and increased in the right hemisphere in patients, suggesting a potential basis for the left/right white matter asymmetry we previously observed in focal dystonia patients. Conclusions/Significance These findings support the hypothesis that connections between the basal ganglia and brainstem play a role in the pathophysiology of dystonia.
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Affiliation(s)
- Anne J Blood
- Mood and Motor Control Laboratory, Massachusetts General Hospital, Charlestown, Massachusetts, United States of America.
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