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Raab HA, Goldway N, Foord C, Hartley CA. Adolescents flexibly adapt action selection based on controllability inferences. Learn Mem 2024; 31:a053901. [PMID: 38527752 PMCID: PMC11000582 DOI: 10.1101/lm.053901.123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Received: 11/13/2023] [Accepted: 02/19/2024] [Indexed: 03/27/2024]
Abstract
From early in life, we encounter both controllable environments, in which our actions can causally influence the reward outcomes we experience, and uncontrollable environments, in which they cannot. Environmental controllability is theoretically proposed to organize our behavior. In controllable contexts, we can learn to proactively select instrumental actions that bring about desired outcomes. In uncontrollable environments, Pavlovian learning enables hard-wired, reflexive reactions to anticipated, motivationally salient events, providing "default" behavioral responses. Previous studies characterizing the balance between Pavlovian and instrumental learning systems across development have yielded divergent findings, with some studies observing heightened expression of Pavlovian learning during adolescence and others observing a reduced influence of Pavlovian learning during this developmental stage. In this study, we aimed to investigate whether a theoretical model of controllability-dependent arbitration between learning systems might explain these seemingly divergent findings in the developmental literature, with the specific hypothesis that adolescents' action selection might be particularly sensitive to environmental controllability. To test this hypothesis, 90 participants, aged 8-27, performed a probabilistic-learning task that enables estimation of Pavlovian influence on instrumental learning, across both controllable and uncontrollable conditions. We fit participants' data with a reinforcement-learning model in which controllability inferences adaptively modulate the dominance of Pavlovian versus instrumental control. Relative to children and adults, adolescents exhibited greater flexibility in calibrating the expression of Pavlovian bias to the degree of environmental controllability. These findings suggest that sensitivity to environmental reward statistics that organize motivated behavior may be heightened during adolescence.
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Affiliation(s)
- Hillary A Raab
- Department of Psychology, New York University, New York, New York 10003, USA
| | - Noam Goldway
- Department of Psychology, New York University, New York, New York 10003, USA
| | - Careen Foord
- Center for Neural Science, New York University, New York, New York 10003, USA
| | - Catherine A Hartley
- Department of Psychology, New York University, New York, New York 10003, USA
- Center for Neural Science, New York University, New York, New York 10003, USA
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2
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Tene O, Bleich Cohen M, Helpman L, Fine N, Halevy A, Goldway N, Perry D, Bary P, Aisenberg Romano G, Ben-Zion Z, Hendler T, Bloch M. Limbic self-neuromodulation as a novel treatment option for emotional dysregulation in premenstrual dysphoric disorder (PMDD); a proof-of-concept study. Psychiatry Clin Neurosci 2023; 77:550-558. [PMID: 37354437 DOI: 10.1111/pcn.13574] [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: 02/01/2023] [Revised: 06/07/2023] [Accepted: 06/19/2023] [Indexed: 06/26/2023]
Abstract
AIM To assess the efficacy of a novel neurofeedback (NF) method, targeting limbic activity, to treat emotional dysregulation related to premenstrual dysphoric disorder (PMDD). METHODS We applied a NF probe targeting limbic activity using a functional magnetic resonance imaging-inspired electroencephalogram model (termed Amyg-EFP-NF) in a double-blind randomized controlled trial. A frontal alpha asymmetry probe (AAS-NF), served as active control. Twenty-seven participants diagnosed with PMDD (mean age = 33.57 years, SD = 5.67) were randomly assigned to Amyg-EFP-NF or AAS-NF interventions with a 2:1 ratio, respectively. The treatment protocol consisted of 11 NF sessions through three menstrual cycles, and a follow-up assessment 3 months thereafter. The primary outcome measure was improvement in the Revised Observer Version of the Premenstrual Tension Syndrome Rating Scale (PMTS-OR). RESULTS A significant group by time effect was observed for the core symptom subscale of the PMTS-OR, with significant improvement observed at follow-up for the Amyg-EFP group compared with the AAS group [F(1, 15)=4.968, P = 0.042]. This finding was specifically robust for reduction in anger [F(1, 15) = 22.254, P < 0.001]. A significant correlation was found between learning scores and overall improvement in core symptoms (r = 0.514, P = 0.042) suggesting an association between mechanism of change and clinical improvement. CONCLUSION Our preliminary findings suggest that Amyg-EFP-NF may serve as an affordable and accessible non-invasive treatment option for emotional dysregulation in women suffering from PMDD. Our main limitations were the relatively small number of participants and the lack of a sham-NF placebo arm.
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Affiliation(s)
- Oren Tene
- Department of Psychiatry and Sagol Brain Institute, Wohl Institute for Advanced Imaging, Tel Aviv Sourasky Medical Center, Tel-Aviv, Israel
- Sackler Faculty of Medicine, Sagol School of Neuroscience and Faculty of Social Sciences, Tel-Aviv University, Tel-Aviv, Israel
| | - Maya Bleich Cohen
- Department of Psychiatry and Sagol Brain Institute, Wohl Institute for Advanced Imaging, Tel Aviv Sourasky Medical Center, Tel-Aviv, Israel
- Sackler Faculty of Medicine, Sagol School of Neuroscience and Faculty of Social Sciences, Tel-Aviv University, Tel-Aviv, Israel
| | - Liat Helpman
- Department of Psychiatry and Sagol Brain Institute, Wohl Institute for Advanced Imaging, Tel Aviv Sourasky Medical Center, Tel-Aviv, Israel
- Department of Counseling and Human Development, Faculty of Education, University of Haifa, Haifa, Israel
| | - Naomi Fine
- Department of Psychiatry and Sagol Brain Institute, Wohl Institute for Advanced Imaging, Tel Aviv Sourasky Medical Center, Tel-Aviv, Israel
- Sackler Faculty of Medicine, Sagol School of Neuroscience and Faculty of Social Sciences, Tel-Aviv University, Tel-Aviv, Israel
| | - Anat Halevy
- Baruch Ivcher School of Psychology, Reichman University, Herzliya, Israel
| | - Noam Goldway
- Department of Psychiatry and Sagol Brain Institute, Wohl Institute for Advanced Imaging, Tel Aviv Sourasky Medical Center, Tel-Aviv, Israel
- Sackler Faculty of Medicine, Sagol School of Neuroscience and Faculty of Social Sciences, Tel-Aviv University, Tel-Aviv, Israel
- Department of Psychology, New York University, New York City, New York, USA
| | - Daniella Perry
- Department of Psychiatry and Sagol Brain Institute, Wohl Institute for Advanced Imaging, Tel Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Plia Bary
- Department of Psychiatry and Sagol Brain Institute, Wohl Institute for Advanced Imaging, Tel Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Gabi Aisenberg Romano
- Department of Psychiatry and Sagol Brain Institute, Wohl Institute for Advanced Imaging, Tel Aviv Sourasky Medical Center, Tel-Aviv, Israel
- Sackler Faculty of Medicine, Sagol School of Neuroscience and Faculty of Social Sciences, Tel-Aviv University, Tel-Aviv, Israel
| | - Ziv Ben-Zion
- Department of Psychiatry and Sagol Brain Institute, Wohl Institute for Advanced Imaging, Tel Aviv Sourasky Medical Center, Tel-Aviv, Israel
- Sackler Faculty of Medicine, Sagol School of Neuroscience and Faculty of Social Sciences, Tel-Aviv University, Tel-Aviv, Israel
- Departments of Comparative Medicine and Psychiatry, Yale School of Medicine, Yale University, New Haven, Connecticut, USA
- Clinical Neuroscience Division, US Department of Veterans Affairs National Center for PTSD, VA Connecticut Healthcare System, West Haven, Connecticut, USA
| | - Talma Hendler
- Department of Psychiatry and Sagol Brain Institute, Wohl Institute for Advanced Imaging, Tel Aviv Sourasky Medical Center, Tel-Aviv, Israel
- Sackler Faculty of Medicine, Sagol School of Neuroscience and Faculty of Social Sciences, Tel-Aviv University, Tel-Aviv, Israel
| | - Miki Bloch
- Department of Psychiatry and Sagol Brain Institute, Wohl Institute for Advanced Imaging, Tel Aviv Sourasky Medical Center, Tel-Aviv, Israel
- Sackler Faculty of Medicine, Sagol School of Neuroscience and Faculty of Social Sciences, Tel-Aviv University, Tel-Aviv, Israel
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Goldway N, Eldar E, Shoval G, Hartley CA. Computational Mechanisms of Addiction and Anxiety: A Developmental Perspective. Biol Psychiatry 2023; 93:739-750. [PMID: 36775050 PMCID: PMC10038924 DOI: 10.1016/j.biopsych.2023.02.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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] [Received: 10/20/2022] [Revised: 02/05/2023] [Accepted: 02/07/2023] [Indexed: 02/12/2023]
Abstract
A central goal of computational psychiatry is to identify systematic relationships between transdiagnostic dimensions of psychiatric symptomatology and the latent learning and decision-making computations that inform individuals' thoughts, feelings, and choices. Most psychiatric disorders emerge prior to adulthood, yet little work has extended these computational approaches to study the development of psychopathology. Here, we lay out a roadmap for future studies implementing this approach by developing empirically and theoretically informed hypotheses about how developmental changes in model-based control of action and Pavlovian learning processes may modulate vulnerability to anxiety and addiction. We highlight how insights from studies leveraging computational approaches to characterize the normative developmental trajectories of clinically relevant learning and decision-making processes may suggest promising avenues for future developmental computational psychiatry research.
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Affiliation(s)
- Noam Goldway
- Department of Psychology, New York University, New York, New York
| | - Eran Eldar
- Department of Psychology, The Hebrew University of Jerusalem, Jerusalem, Israel; Department of Cognitive and Brain Sciences, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Gal Shoval
- Princeton Neuroscience Institute, Princeton University, Princeton, New Jersey; Child and Adolescent Division, Geha Mental Health Center, Petah Tikva, Israel; Department of Psychiatry, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Catherine A Hartley
- Department of Psychology, New York University, New York, New York; Center for Neural Science, New York University, New York, New York.
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Jalon I, Berger A, Shofty B, Goldway N, Artzi M, Gurevitch G, Hochberg U, Tellem R, Hendler T, Gonen T, Strauss I. Lesions to both somatic and affective pain pathways lead to decreased salience network connectivity. Brain 2022; 146:2153-2162. [PMID: 36314058 DOI: 10.1093/brain/awac403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 09/30/2022] [Accepted: 10/06/2022] [Indexed: 11/13/2022] Open
Abstract
Abstract
Human pain is a salient stimulus composed of two main components: a sensory\somatic component, carrying peripheral nociceptive sensation via the spino-thalamic tract and brainstem nuclei to the thalamus and then to sensory cortical regions, and an affective (suffering) component, where information from central thalamic nuclei is carried to the anterior insula, dorsal anterior cingulate cortex and other regions. While the sensory component processes information about stimulus location and intensity, the affective component processes information regarding pain-related expectations, motivation to reduce pain, and pain unpleasantness. Unlike investigations of acute pain that are based on the introduction of real-time stimulus during brain recordings, chronic pain investigations are usually based on longitudinal and case-control studies, which are limited in their ability to infer the functional network topology of chronic pain. In the current study, we utilized the unique opportunity to target the central nervous system’s pain pathways in two different hierarchical locations to establish causality between pain relief and specific connectivity changes seen within the salience and sensorimotor networks. We examined how lesions to the affective and somatic pain pathways affect resting-state network topology in cancer patients suffering from severe intractable pain. Two procedures have been employed: percutaneous cervical cordotomy (n = 15), hypothesized to disrupt the transmission of the sensory component of pain along the spino-thalamic tract, or stereotactic cingulotomy (n = 7), which refers to bilateral intra-cranial ablation of an area in the dorsal anterior cingulate cortex and is known to ameliorate the affective component of pain. Both procedures led to immediate significant alleviation of experienced pain and decreased functional connectivity within the salience network. However, only the sensory procedure (cordotomy) led to decreased connectivity within the sensorimotor network. Thus, our results support the existence of two converging systems relaying experienced pain, showing that pain-related suffering can be either directly influenced by interfering with the affective pathway, or indirectly influenced by interfering with the ascending spino-thalamic tract.
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Affiliation(s)
- Itamar Jalon
- Department of Psychology, Tel Aviv University , Tel Aviv , Israel
- Sagol Brain Institute, Tel Aviv Medical Center , Tel Aviv , Israel
| | - Assaf Berger
- Department of Neurosurgery, Tel Aviv Medical Center , Tel Aviv , Israel
- Department of Neurosurgery, NYU Langone Medical Center, New York University , New York , USA
| | - Ben Shofty
- Department of Neurosurgery, Tel Aviv Medical Center , Tel Aviv , Israel
- Department of Neurosurgery, Baylor College of Medicine , Houston, Texas , USA
| | - Noam Goldway
- Department of Psychology, New York University , New York, NY
| | - Moran Artzi
- Sagol Brain Institute, Tel Aviv Medical Center , Tel Aviv , Israel
- Sackler School of Medicine, Tel Aviv University , Tel Aviv , Israel
| | - Guy Gurevitch
- Sagol Brain Institute, Tel Aviv Medical Center , Tel Aviv , Israel
- Sackler School of Medicine, Tel Aviv University , Tel Aviv , Israel
| | - Uri Hochberg
- Sackler School of Medicine, Tel Aviv University , Tel Aviv , Israel
- Institute of Pain Medicine, Tel Aviv Medical Center , Tel Aviv , Israel
| | - Rotem Tellem
- Sackler School of Medicine, Tel Aviv University , Tel Aviv , Israel
- The Palliative Care Service, Tel Aviv Medical Center , Tel Aviv , Israel
| | - Talma Hendler
- Department of Psychology, Tel Aviv University , Tel Aviv , Israel
- Sagol Brain Institute, Tel Aviv Medical Center , Tel Aviv , Israel
- Sackler School of Medicine, Tel Aviv University , Tel Aviv , Israel
- Sagol School of Neuroscience Tel Aviv University , Israel
| | - Tal Gonen
- Sagol Brain Institute, Tel Aviv Medical Center , Tel Aviv , Israel
| | - Ido Strauss
- Department of Neurosurgery, Tel Aviv Medical Center , Tel Aviv , Israel
- Sackler School of Medicine, Tel Aviv University , Tel Aviv , Israel
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5
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Goldway N, Jalon I, Keynan JN, Hellrung L, Horstmann A, Paret C, Hendler T. Feasibility and utility of amygdala neurofeedback. Neurosci Biobehav Rev 2022; 138:104694. [PMID: 35623447 DOI: 10.1016/j.neubiorev.2022.104694] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 04/12/2022] [Accepted: 05/11/2022] [Indexed: 10/18/2022]
Abstract
Amygdala NeuroFeedback (NF) have the potential of being a valuable non-invasive intervention tool in many psychiatric disporders. However, the feasibility and best practices of this method have not been systematically examined. The current article presents a review of amygdala-NF studies, an analytic summary of study design parameters, and examination of brain mechanisms related to successful amygdala-NF performance. A meta-analysis of 33 publications showed that real amygdala-NF facilitates learned modulation compared to control conditions. In addition, while variability in study dsign parameters is high, these design choices are implicitly organized by the targeted valence domain (positive or negative). However, in most cases the neuro-behavioral effects of targeting such domains were not directly assessed. Lastly, re-analyzing six data sets of amygdala-fMRI-NF revealed that successful amygdala down-modulation is coupled with deactivation of the posterior insula and nodes in the Default-Mode-Network. Our findings suggest that amygdala self-modulation can be acquired using NF. Yet, additional controlled studies, relevant behavioral tasks before and after NF intervention, and neural 'target engagement' measures are critically needed to establish efficacy and specificity. In addition, the fMRI analysis presented here suggest that common accounts regarding the brain network involved in amygdala NF might reflect unsuccessful modulation attempts rather than successful modulation.
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Affiliation(s)
- Noam Goldway
- Sagol Brain Institute, Wohl Institute for Advanced Imaging, Tel-Aviv Sourasky Medical Centre, Tel-Aviv, Israel; Sagol School of Neuroscience, Tel Aviv University, Tel-Aviv, Israel; Department of Psychology, New York University, New York, USA
| | - Itamar Jalon
- Sagol Brain Institute, Wohl Institute for Advanced Imaging, Tel-Aviv Sourasky Medical Centre, Tel-Aviv, Israel; School of Psychological Sciences, Tel Aviv University, Tel-Aviv, Israel
| | - Jackob N Keynan
- Sagol Brain Institute, Wohl Institute for Advanced Imaging, Tel-Aviv Sourasky Medical Centre, Tel-Aviv, Israel; Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA; Wu Tsai Neurosciences Institute, Stanford University, Stanford, CA, USA
| | - Lydia Hellrung
- Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany; Laboratory for Social and Neural Systems Research, Department of Economics, University of Zurich, Zurich, Switzerland
| | - Annette Horstmann
- Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany; Faculty of Medicine, University of Leipzig, Leipzig, Germany; Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Christian Paret
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Germany
| | - Talma Hendler
- Sagol Brain Institute, Wohl Institute for Advanced Imaging, Tel-Aviv Sourasky Medical Centre, Tel-Aviv, Israel; Sagol School of Neuroscience, Tel Aviv University, Tel-Aviv, Israel; School of Psychological Sciences, Tel Aviv University, Tel-Aviv, Israel; Sackler School of Medicine, Tel Aviv University, Tel-Aviv, Israel.
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6
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Goldway N, Petro NM, Ablin J, Keil A, Ben Simon E, Zamir Y, Weizman L, Greental A, Hendler T, Sharon H. Abnormal Visual Evoked Responses to Emotional Cues Correspond to Diagnosis and Disease Severity in Fibromyalgia. Front Behav Neurosci 2022; 16:852133. [PMID: 35600994 PMCID: PMC9116473 DOI: 10.3389/fnbeh.2022.852133] [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: 01/10/2022] [Accepted: 04/07/2022] [Indexed: 11/20/2022] Open
Abstract
Background Chronic pain disorders are often associated with cognitive-emotional dysregulation. However, the relations between such dysregulation, underlying brain processes, and clinical symptom constellations, remain unclear. Here, we aimed to characterize the abnormalities in cognitive-emotional processing involved in fibromyalgia syndrome (FMS) and their relation to disease severity. Methods Fifty-eight participants, 39 FMS patients (35F), and 19 healthy control subjects (16F) performed an EEG-based paradigm assessing attention allocation by extracting steady-state visually evoked potentials (ssVEP) in response to affective distractors presented during a cognitive task. Patients were also evaluated for pain severity, sleep quality, depression, and anxiety. Results EEG ssVEP measurement indicated that, compared to healthy controls, FMS patients displayed impaired affective discrimination, and sustained attention to negative distractors. Moreover, patients displayed decreased task-related fronto-occipital EEG connectivity. Lack of adaptive attentional discrimination, measured via EEG, was predictive of pain severity, while impairments in fronto-occipital connectivity were predictive of impaired sleep. Conclusions FMS patients display maladaptive affective attention modulation, which predicts disease symptoms. These findings support the centrality of cognitive-emotional dysregulation in the pathophysiology of chronic pain.
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Affiliation(s)
- Noam Goldway
- Sagol Brain Institute, Wohl Institute for Advanced Imaging, Tel-Aviv Sourasky Medical Centre, Tel Aviv-Yafo, Israel
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv-Yafo, Israel
- Department of Psychology, New York University, New York, NY, United States
| | - Nathan M. Petro
- Institute for Human Neuroscience, Boys Town National Research Hospital, Boys Town, NE, United States
| | - Jacob Ablin
- Sackler School of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
- Department of Internal Medicine, Tel Aviv Sourasky Medical Centre, Tel Aviv-Yafo, Israel
| | - Andreas Keil
- Department of Psychology, Center for the Study of Emotion and Attention, University of Florida, Gainesville, FL, United States
| | - Eti Ben Simon
- Department of Psychology, University of California, Berkeley, Berkeley, CA, United States
| | - Yoav Zamir
- Sagol Brain Institute, Wohl Institute for Advanced Imaging, Tel-Aviv Sourasky Medical Centre, Tel Aviv-Yafo, Israel
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv-Yafo, Israel
| | - Libat Weizman
- Sagol Brain Institute, Wohl Institute for Advanced Imaging, Tel-Aviv Sourasky Medical Centre, Tel Aviv-Yafo, Israel
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv-Yafo, Israel
| | - Ayam Greental
- Sagol Brain Institute, Wohl Institute for Advanced Imaging, Tel-Aviv Sourasky Medical Centre, Tel Aviv-Yafo, Israel
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv-Yafo, Israel
| | - Talma Hendler
- Sagol Brain Institute, Wohl Institute for Advanced Imaging, Tel-Aviv Sourasky Medical Centre, Tel Aviv-Yafo, Israel
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv-Yafo, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
- School of Psychological Sciences, Tel Aviv University, Tel Aviv-Yafo, Israel
| | - Haggai Sharon
- Sagol Brain Institute, Wohl Institute for Advanced Imaging, Tel-Aviv Sourasky Medical Centre, Tel Aviv-Yafo, Israel
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv-Yafo, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
- Department of Anesthesiology and Critical Care Medicine, Institute of Pain Medicine, Tel Aviv Sourasky Medical Centre, Tel Aviv-Yafo, Israel
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7
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Mirelman D, Waissengrin B, Goldway N, Sharon H, Brill S, Wolf I. Use of medical cannabis: perceptions of Israeli oncologists. Lancet Oncol 2020; 20:475-477. [PMID: 30942172 DOI: 10.1016/s1470-2045(19)30077-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 02/10/2019] [Accepted: 02/11/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Dan Mirelman
- Institute of Oncology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Barliz Waissengrin
- Institute of Oncology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Noam Goldway
- Sagol Brain Institute, Wohl Institute for Advanced Imaging, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | - Haggai Sharon
- Sagol Brain Institute, Wohl Institute for Advanced Imaging, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Institute of Pain Medicine, Department of Anesthesiology and Critical Care Medicine, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Silviu Brill
- Institute of Pain Medicine, Department of Anesthesiology and Critical Care Medicine, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ido Wolf
- Institute of Oncology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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Mirelman D, Waissengrin B, Goldway N, Sharon H, Brill S, Wolf I. Knowledge, attitude and practices regarding the use of medical cannabis: A national survey among Israeli oncologists. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.e24125] [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] [Indexed: 11/20/2022] Open
Abstract
e24125 Background: Despite lack of clinical trials reporting on beneficial effects of the cannabis plant for cancer-associated symptoms, its use is increasing worldwide. Approximately 10,000 Israeli cancer patients receive permits for the use of medical cannabis, making cannabis one of the most commonly prescribed oncology treatments in Israel and making the Israeli oncologists highly experienced with its use. The experience gained by the Israeli oncologists is therefore highly valuable. Methods: We conducted a web-based survey among all 238 Israeli oncologists, addressing personal experience; knowledge and attitudes toward the use of cannabis in oncology. Results: Response rate was 54% (n = 126), with the vast majority (87%) regularly prescribing cannabis to their patients. Anorexia, pain and nausea were the most common indications for cannabis use. While 90% of responders stated lack of sufficient knowledge regarding cannabis, its use was perceived as effective and safe. Interestingly, while most oncologists stated that opioids should be used as a first line treatment for cancer pain, most would prefer cannabis for pain relief if needed by a close relative. Oncologists who support cannabis legalization were more likely to prescribe it. Conclusions: Our findings indicate extensive use and perception of medical cannabis despite lack of knowledge, and support about efficacy and indicate a unique role for moral attitudes affecting clinical decisions. These data call for the implementation of an educational program and practical guidelines enabling more consistent and rational approach toward cannabis role in oncology.
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Affiliation(s)
| | - Barliz Waissengrin
- Tel Aviv Medical Center and Sackler School of Medicine, Tel Aviv, Israel
| | | | | | | | - Ido Wolf
- Tel Aviv Sourasky medical center, Tel Aviv, Israel
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9
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Mirelman D, Waissengrin B, Goldway N, Wolf I. Knowledge, attitude and practices regarding use of medical cannabis: A national survey among israeli oncologists. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.e23110] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e23110 Background: Despite lack of clinical trials reporting on beneficial effects of the cannabis plant for cancer-associated symptoms, its use is increasing worldwide. Approximately 10,000 Israeli cancer patients receive permits for the use of medical cannabis, making cannabis one of the most commonly prescribed oncology treatments in Israel and making the Israeli oncologists highly experienced with its use. The experience gained by the Israeli oncologists is therefore highly valuable. Materials and Methods: We conducted a web-based survey among all 238 Israeli oncologists, addressing personal experience; knowledge and attitudes toward the use of cannabis in oncology. Results: Response rate was 54% (n = 126), with the vast majority (87%) regularly prescribing cannabis to their patients. Anorexia, pain and nausea were the most common indications for cannabis use. While 90% of responders stated lack of sufficient knowledge regarding cannabis, its use was perceived as effective and safe. Interestingly, while most oncologists stated that opioids should be used as a first line treatment for cancer pain, most would prefer cannabis for pain relief if needed by a close relative. Oncologists who support cannabis legalization were more likely to prescribe it. Conclusions: Our findings indicate extensive use and perception of efficacy despite lack of knowledge, and indicate unique role for moral attitudes affecting clinical decisions. These data call for the implementation of an educational program and practical guidelines enabling more consistent and rational approach toward cannabis role in oncology.
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Affiliation(s)
| | - Barliz Waissengrin
- Tel Aviv Medical Center and Sackler School of Medicine, Tel Aviv, Israel
| | | | - Ido Wolf
- Sheba Medical Center, Or-Yehuda, Israel
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Lubianiker N, Goldway N, Fruchtman-Steinbok T, Paret C, Keynan JN, Singer N, Cohen A, Kadosh KC, Linden DEJ, Hendler T. Publisher Correction: Process-based framework for precise neuromodulation. Nat Hum Behav 2019; 3:537. [PMID: 31040437 DOI: 10.1038/s41562-019-0616-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
The original and corrected text is shown in the accompanying Publisher Correction.
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Affiliation(s)
- Nitzan Lubianiker
- Sagol Brain Institute, Tel-Aviv Medical Center, Tel-Aviv, Israel.,School of Psychological Sciences, Gershon H. Gordon Faculty of Social Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Noam Goldway
- Sagol Brain Institute, Tel-Aviv Medical Center, Tel-Aviv, Israel.,Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | - Tom Fruchtman-Steinbok
- Sagol Brain Institute, Tel-Aviv Medical Center, Tel-Aviv, Israel.,School of Psychological Sciences, Gershon H. Gordon Faculty of Social Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Christian Paret
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jacob N Keynan
- Sagol Brain Institute, Tel-Aviv Medical Center, Tel-Aviv, Israel.,School of Psychological Sciences, Gershon H. Gordon Faculty of Social Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Neomi Singer
- Sagol Brain Institute, Tel-Aviv Medical Center, Tel-Aviv, Israel.,School of Psychological Sciences, Gershon H. Gordon Faculty of Social Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Avihay Cohen
- Sagol Brain Institute, Tel-Aviv Medical Center, Tel-Aviv, Israel.,School of Psychological Sciences, Gershon H. Gordon Faculty of Social Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Kathrin Cohen Kadosh
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim / Heidelberg University, Mannheim, Germany.,Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - David E J Linden
- School of Psychology, University of Surrey, Guildford, UK.,MRC Centre for Neuropsychiatric Genetics and Genomics, School of Medicine, Cardiff University, Cardiff, UK
| | - Talma Hendler
- Sagol Brain Institute, Tel-Aviv Medical Center, Tel-Aviv, Israel. .,School of Psychological Sciences, Gershon H. Gordon Faculty of Social Sciences, Tel Aviv University, Tel Aviv, Israel. .,Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel. .,School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.
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Lubianiker N, Goldway N, Fruchtman-Steinbok T, Paret C, Keynan JN, Singer N, Cohen A, Kadosh KC, Linden DEJ, Hendler T. Process-based framework for precise neuromodulation. Nat Hum Behav 2019; 3:436-445. [DOI: 10.1038/s41562-019-0573-y] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 03/05/2019] [Indexed: 12/20/2022]
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Goldway N, Ablin J, Lubin O, Zamir Y, Keynan JN, Or-Borichev A, Cavazza M, Charles F, Intrator N, Brill S, Ben-Simon E, Sharon H, Hendler T. Volitional limbic neuromodulation exerts a beneficial clinical effect on Fibromyalgia. Neuroimage 2019; 186:758-770. [DOI: 10.1016/j.neuroimage.2018.11.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 10/03/2018] [Accepted: 11/01/2018] [Indexed: 12/18/2022] Open
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Keynan JN, Cohen A, Jackont G, Green N, Goldway N, Davidov A, Meir-Hasson Y, Raz G, Intrator N, Fruchter E, Ginat K, Laska E, Cavazza M, Hendler T. Electrical fingerprint of the amygdala guides neurofeedback training for stress resilience. Nat Hum Behav 2018; 3:63-73. [PMID: 30932053 DOI: 10.1038/s41562-018-0484-3] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2018] [Accepted: 10/30/2018] [Indexed: 02/02/2023]
Abstract
Real-time functional magnetic resonance imaging (rt-fMRI) has revived the translational perspective of neurofeedback (NF)1. Particularly for stress management, targeting deeply located limbic areas involved in stress processing2 has paved new paths for brain-guided interventions. However, the high cost and immobility of fMRI constitute a challenging drawback for the scalability (accessibility and cost-effectiveness) of the approach, particularly for clinical purposes3. The current study aimed to overcome the limited applicability of rt-fMRI by using an electroencephalography (EEG) model endowed with improved spatial resolution, derived from simultaneous EEG-fMRI, to target amygdala activity (termed amygdala electrical fingerprint (Amyg-EFP))4-6. Healthy individuals (n = 180) undergoing a stressful military training programme were randomly assigned to six Amyg-EFP-NF sessions or one of two controls (control-EEG-NF or NoNF), taking place at the military training base. The results demonstrated specificity of NF learning to the targeted Amyg-EFP signal, which led to reduced alexithymia and faster emotional Stroop, indicating better stress coping following Amyg-EFP-NF relative to controls. Neural target engagement was demonstrated in a follow-up fMRI-NF, showing greater amygdala blood-oxygen-level-dependent downregulation and amygdala-ventromedial prefrontal cortex functional connectivity following Amyg-EFP-NF relative to NoNF. Together, these results demonstrate limbic specificity and efficacy of Amyg-EFP-NF during a stressful period, pointing to a scalable non-pharmacological yet neuroscience-based training to prevent stress-induced psychopathology.
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Affiliation(s)
- Jackob N Keynan
- Sagol Brain Institute, Wohl Institute for Advanced Imaging, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel.,The School of Psychological Sciences, Tel-Aviv University, Tel-Aviv, Israel
| | - Avihay Cohen
- Sagol Brain Institute, Wohl Institute for Advanced Imaging, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel.,The School of Psychological Sciences, Tel-Aviv University, Tel-Aviv, Israel
| | - Gilan Jackont
- Sagol Brain Institute, Wohl Institute for Advanced Imaging, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel.,The School of Psychological Sciences, Tel-Aviv University, Tel-Aviv, Israel
| | - Nili Green
- Sagol Brain Institute, Wohl Institute for Advanced Imaging, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel.,The School of Psychological Sciences, Tel-Aviv University, Tel-Aviv, Israel
| | - Noam Goldway
- Sagol Brain Institute, Wohl Institute for Advanced Imaging, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel.,Sagol School of Neuroscience, Tel-Aviv University, Tel-Aviv, Israel
| | | | | | - Gal Raz
- Sagol Brain Institute, Wohl Institute for Advanced Imaging, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel.,Sagol School of Neuroscience, Tel-Aviv University, Tel-Aviv, Israel.,The Steve Tisch School of Film and Television, Tel-Aviv University, Tel-Aviv, Israel
| | - Nathan Intrator
- Sagol School of Neuroscience, Tel-Aviv University, Tel-Aviv, Israel.,Blavatnik School of Computer Science, Tel-Aviv University, Tel-Aviv, Israel
| | - Eyal Fruchter
- The Mental Health Department, Medical Corps, IDF, Ramat-Gan, Israel
| | - Keren Ginat
- The Mental Health Department, Medical Corps, IDF, Ramat-Gan, Israel
| | - Eugene Laska
- Department of Psychiatry, New York University Langone School of Medicine, New York, NY, USA
| | - Marc Cavazza
- School of Engineering and Digital Arts, University of Kent, Canterbury, UK
| | - Talma Hendler
- Sagol Brain Institute, Wohl Institute for Advanced Imaging, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel. .,The School of Psychological Sciences, Tel-Aviv University, Tel-Aviv, Israel. .,Sagol School of Neuroscience, Tel-Aviv University, Tel-Aviv, Israel. .,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
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Sharon H, Goldway N, Goor-Aryeh I, Eisenberg E, Brill S. Personal experience and attitudes of pain medicine specialists in Israel regarding the medical use of cannabis for chronic pain. J Pain Res 2018; 11:1411-1419. [PMID: 30104896 PMCID: PMC6074811 DOI: 10.2147/jpr.s159852] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Introduction The scientific study of the role of cannabis in pain medicine still lags far behind the growing use driven by public approval. Accumulated clinical experience is therefore an important source of knowledge. However, no study to date has targeted physicians who actually use cannabis in their daily practice. Methods Registered, active, board-certified pain specialists in Israel (n=79) were asked to complete a Web-based survey. The survey was developed using the Qualtrics Online Survey Software. Questions were formulated as multiple-choice questions, and these addressed three areas of interest: 1) doctors’ personal experience; 2) the role of cannabis in pain medicine; and 3) cannabis medicalization and legalization. Results Sixty-four percent of all practicing pain specialists in Israel responded. Almost all prescribe cannabis. Among them, 63% find cannabis moderately to highly effective, 56% have encountered mild or no side effects, and only 5% perceive it as significantly harmful. Common indications are neuropathic pain (65%), oncological pain (50%), arthralgias (25%), and any intractable pain (29%). Leading contraindications are schizophrenia (76%), pregnancy/breastfeeding (65%), and age <18 years (59%). Only 12% rated cannabis as more hazardous than opiates. On a personal note, 45% prefer cannabis for themselves or a family member. Lastly, 54% would like to see cannabis legalized in Israel. Conclusion In this survey, pain clinicians experienced in prescribing cannabis over prolonged periods view it as an effective and relatively safe treatment for chronic pain, based on their own experience. Their responses suggest a possible change of paradigm from using cannabis as the last resort.
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Affiliation(s)
- Haggai Sharon
- Institute of Pain Medicine, Department of Anesthesiology and Critical Care Medicine, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel, .,Center for Brain Functions, Wohl Institute for Advanced Imaging, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel, .,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel, .,Pain Management and Neuromodulation Centre, Guy's and St Thomas' Hospital, London, UK,
| | - Noam Goldway
- Center for Brain Functions, Wohl Institute for Advanced Imaging, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel,
| | | | - Elon Eisenberg
- Institute for Pain Medicine, Rambam Health Care Campus, Haifa, Israel.,Rappaport Faculty of Medicine, Technion Institute for Technology, Haifa, Israel
| | - Silviu Brill
- Institute of Pain Medicine, Department of Anesthesiology and Critical Care Medicine, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel, .,Goldman School of Medicine, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
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