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Parsaei M, Hasehmi SM, Seyedmirzaei H, Cattarinussi G, Sambataro F, Brambilla P, Delvecchio G. Microstructural white matter alterations associated with social anxiety disorders: A systematic review. J Affect Disord 2024; 350:78-88. [PMID: 38220105 DOI: 10.1016/j.jad.2024.01.118] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 12/04/2023] [Accepted: 01/09/2024] [Indexed: 01/16/2024]
Abstract
BACKGROUND Social anxiety disorder (SAD) is a psychiatric condition characterized by impaired social functioning that negatively impacts individuals' quality of life. Previous neuroimaging studies have revealed morphological and functional changes in various brain regions associated with SAD. Recent advances in diffusion tensor imaging (DTI) and diffusion-weighted imaging (DWI) have enabled the investigation of microstructural white matter (WM) alterations in SAD. This study aims to provide an overview of DTI/DWI studies exploring WM microstructure changes in SAD. METHODS A systematic search on PubMed, Scopus, Web of Science, and PsycINFO was conducted for relevant records on July 8, 2023. An exploratory meta-analysis was also performed. RESULTS Eight studies were reviewed. Consistent findings indicated reduced fractional anisotropy and increased diffusivity measures in different WM tracts in SAD patients compared to healthy controls. These alterations were mostly observed within regions of the fronto-limbic network, like uncinate fasciculus (UF) and superior and inferior longitudinal fasciculi (SLF and ILF). Finally, our exploratory meta-analysis on four studies utilizing a voxel-wise analytic approach yielded no significant differences between SAD patients and controls. LIMITATIONS Limited number of studies, small sample sizes, and heterogeneity in analysis methods. CONCLUSIONS Patients with SAD exhibited altered WM integrity, particularly in the UF, SLF, and ILF, compared to healthy controls. However, due to the limited number of included studies, our meta-analysis yielded no significant differences between SAD patients and controls. Therefore, future research is crucial to unravel the link between altered WM structure and the involvement of other limbic and cortical structures in SAD pathogenesis.
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Affiliation(s)
- Mohammadamin Parsaei
- Maternal, Fetal & Neonatal Research Center, Family Health Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Homa Seyedmirzaei
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran; Interdisciplinary Neuroscience Research Program Tehran University of Medical Sciences, Tehran, Iran
| | - Giulia Cattarinussi
- Department of Neuroscience (DNS), Padua Neuroscience Center, University of Padova, Padua, Italy; Padua Neuroscience Center, University of Padova, Padua, Italy
| | - Fabio Sambataro
- Department of Neuroscience (DNS), Padua Neuroscience Center, University of Padova, Padua, Italy; Padua Neuroscience Center, University of Padova, Padua, Italy
| | - Paolo Brambilla
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy; Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giuseppe Delvecchio
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
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Fricke S, Seinsche RJ, Neudert MK, Schäfer A, Zehtner RI, Stark R, Hermann A. Neural correlates of context-dependent extinction recall in social anxiety disorder: relevance of intrusions in response to aversive social experiences. Psychol Med 2024; 54:548-557. [PMID: 37553977 DOI: 10.1017/s0033291723002179] [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] [Indexed: 08/10/2023]
Abstract
BACKGROUND There are phenomenological similarities between social anxiety disorder (SAD) and posttraumatic stress disorder, such as a provoking aversive event, posttraumatic stress symptoms (e.g. intrusions) in response to these events and deficient (context-dependent) fear conditioning processes. This study investigated the neural correlates of context-dependent extinction recall and fear renewal in SAD, specifically in patients with intrusions in response to an etiologically relevant aversive social event. METHODS During functional magnetic resonance imaging a two-day context-dependent fear conditioning paradigm was conducted in 54 patients with SAD and 54 healthy controls (HC). This included fear acquisition (context A) and extinction learning (context B) on one day, and extinction recall (context B) as well as fear renewal (contexts C and A) one day later. The main outcome measures were blood oxygen level-dependent responses in regions of interest and skin conductance responses. RESULTS Patients with SAD showed reduced differential conditioned amygdala activation during extinction recall in the safe extinction context and during fear renewal in the acquisition context compared to HC. Patients with clinically relevant intrusions moreover exhibited hypoactivation of the ventromedial prefrontal cortex (vmPFC) during extinction learning, extinction recall, and fear renewal in a novel context, while amygdala activation more strongly decreased during extinction learning and increased during fear renewal in the acquisition context compared with patients without intrusions. CONCLUSIONS Our study provides first evidence that intrusions in SAD are associated with similar deficits in context-dependent regulation of conditioned fear via the vmPFC as previously demonstrated in posttraumatic stress disorder.
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Affiliation(s)
- Susanne Fricke
- Department of Psychotherapy and Systems Neuroscience, Justus Liebig University Giessen, Giessen, Germany
- Bender Institute of Neuroimaging, Justus Liebig University Giessen, Giessen, Germany
| | - Rosa J Seinsche
- Department of Psychotherapy and Systems Neuroscience, Justus Liebig University Giessen, Giessen, Germany
- Bender Institute of Neuroimaging, Justus Liebig University Giessen, Giessen, Germany
| | - Marie K Neudert
- Department of Psychotherapy and Systems Neuroscience, Justus Liebig University Giessen, Giessen, Germany
- Bender Institute of Neuroimaging, Justus Liebig University Giessen, Giessen, Germany
| | - Axel Schäfer
- Bender Institute of Neuroimaging, Justus Liebig University Giessen, Giessen, Germany
- Center for Mind, Brain and Behavior, Phillips University Marburg and Justus Liebig University Giessen, Giessen, Germany
| | - Raphaela I Zehtner
- Department of Psychotherapy and Systems Neuroscience, Justus Liebig University Giessen, Giessen, Germany
- Bender Institute of Neuroimaging, Justus Liebig University Giessen, Giessen, Germany
| | - Rudolf Stark
- Department of Psychotherapy and Systems Neuroscience, Justus Liebig University Giessen, Giessen, Germany
- Bender Institute of Neuroimaging, Justus Liebig University Giessen, Giessen, Germany
- Center for Mind, Brain and Behavior, Phillips University Marburg and Justus Liebig University Giessen, Giessen, Germany
| | - Andrea Hermann
- Department of Psychotherapy and Systems Neuroscience, Justus Liebig University Giessen, Giessen, Germany
- Bender Institute of Neuroimaging, Justus Liebig University Giessen, Giessen, Germany
- Center for Mind, Brain and Behavior, Phillips University Marburg and Justus Liebig University Giessen, Giessen, Germany
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Liu J, Xie S, Hu Y, Ding Y, Zhang X, Liu W, Zhang L, Ma C, Kang Y, Jin S, Xia Y, Hu Z, Liu Z, Cheng W, Yang Z. Age-dependent alterations in the coordinated development of subcortical regions in adolescents with social anxiety disorder. Eur Child Adolesc Psychiatry 2024; 33:51-64. [PMID: 36542201 DOI: 10.1007/s00787-022-02118-z] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 12/02/2022] [Indexed: 12/24/2022]
Abstract
Subcortical brain regions play essential roles in the pathology of social anxiety disorder (SAD). While adolescence is the peak period of SAD, the relationships between altered development of the subcortical regions during this period and SAD are still unclear. This study investigated the age-dependent alterations in structural co-variance among subcortical regions and between subcortical and cortical regions, aiming to reflect aberrant coordination during development in the adolescent with SAD. High-resolution T1-weighted images were obtained from 76 adolescents with SAD and 67 healthy controls (HC), ranging from 11 to 17.9 years. Symptom severity was evaluated with the Social Anxiety Scale for Children (SASC) and the Depression Self Rating Scale for Children (DSRS-C). Structural co-variance and sliding age-window analyses were used to detect age-dependent group differences in inter-regional coordination patterns among subcortical regions and between subcortical and cortical regions. The volume of the striatum significantly correlated with SAD symptom severity. The SAD group exhibited significantly enhanced structural co-variance among key regions of the striatum (putamen and caudate). While the co-variance decreased with age in healthy adolescents, the co-variance in SAD adolescents stayed high, leading to more apparent group differences in middle adolescence. Moreover, the striatum's mean structural co-variance with cortical regions decreased with age in HC but increased with age in SAD. Adolescents with SAD suffer aberrant developmental coordination among the key regions of the striatum and between the striatum and cortical regions. The degree of incoordination is age-dependent, which may represent a neurodevelopmental trait of SAD.
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Affiliation(s)
- Jingjing Liu
- Laboratory of Psychological Health and Imaging, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, No. 600 South Wanping Road, Shanghai, 200013, China
| | - Shuqi Xie
- Laboratory of Psychological Health and Imaging, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, No. 600 South Wanping Road, Shanghai, 200013, China
| | - Yang Hu
- Laboratory of Psychological Health and Imaging, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, No. 600 South Wanping Road, Shanghai, 200013, China
| | - Yue Ding
- Laboratory of Psychological Health and Imaging, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, No. 600 South Wanping Road, Shanghai, 200013, China
| | - Xiaochen Zhang
- Laboratory of Psychological Health and Imaging, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, No. 600 South Wanping Road, Shanghai, 200013, China
| | - Wenjing Liu
- Department of Child and Adolescent Psychiatry, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, No. 600 South Wanping Road, Shanghai, 200013, China
| | - Lei Zhang
- Laboratory of Psychological Health and Imaging, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, No. 600 South Wanping Road, Shanghai, 200013, China
| | - Changminghao Ma
- Department of Child and Adolescent Psychiatry, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, No. 600 South Wanping Road, Shanghai, 200013, China
| | - Yinzhi Kang
- Laboratory of Psychological Health and Imaging, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, No. 600 South Wanping Road, Shanghai, 200013, China
| | - Shuyu Jin
- Laboratory of Psychological Health and Imaging, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, No. 600 South Wanping Road, Shanghai, 200013, China
| | - Yufeng Xia
- Laboratory of Psychological Health and Imaging, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, No. 600 South Wanping Road, Shanghai, 200013, China
| | - Zhishan Hu
- Laboratory of Psychological Health and Imaging, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, No. 600 South Wanping Road, Shanghai, 200013, China
| | - Zhen Liu
- Department of Child and Adolescent Psychiatry, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, No. 600 South Wanping Road, Shanghai, 200013, China
| | - Wenhong Cheng
- Department of Child and Adolescent Psychiatry, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, No. 600 South Wanping Road, Shanghai, 200013, China.
| | - Zhi Yang
- Laboratory of Psychological Health and Imaging, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, No. 600 South Wanping Road, Shanghai, 200013, China.
- Institute of Psychological and Behavioral Sciences, Shanghai Jiao Tong University, Shanghai, China.
- Brain Science and Technology Research Center, Shanghai Jiao Tong University, Shanghai, China.
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Liang J, Yu Q, Liu Y, Qiu Y, Tang R, Yan L, Zhou P. Gray matter abnormalities in patients with major depressive disorder and social anxiety disorder: a voxel-based meta-analysis. Brain Imaging Behav 2023; 17:749-763. [PMID: 37725323 PMCID: PMC10733224 DOI: 10.1007/s11682-023-00797-z] [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] [Subscribe] [Scholar Register] [Accepted: 08/30/2023] [Indexed: 09/21/2023]
Abstract
BACKGROUND Major depressive and social anxiety disorders have a high comorbidity rate and similar cognitive patterns. However, their unique and shared neuroanatomical characteristics have not been fully identified. METHODS Voxel-based morphometric studies comparing gray matter volume between patients with major depressive disorder/social anxiety disorder and healthy controls were searched using 4 electronic databases from the inception to March 2022. Stereotactic data were extracted and subsequently tested for convergence and differences using activation likelihood estimation. In addition, based on the result of the meta-analysis, behavioral analysis was performed to assess the functional roles of the regions affected by major depressive disorder and/or social anxiety disorder. RESULTS In total, 34 studies on major depressive disorder with 2873 participants, and 10 studies on social anxiety disorder with 1004 subjects were included. Gray matter volume conjunction analysis showed that the right parahippocampal gyrus region, especially the amygdala, was smaller in patients compared to healthy controls. The contrast analysis of major depressive disorder and social anxiety disorder revealed lower gray matter volume in the right lentiform nucleus and medial frontal gyrus in social anxiety disorder and lower gray matter volume in the left parahippocampal gyrus in major depressive disorder. Behavioral analysis showed that regions with lower gray matter volume in social anxiety disorder are strongly associated with negative emotional processes. CONCLUSIONS The shared and unique patterns of gray matter volume abnormalities in patients with major depressive and social anxiety disorder may be linked to the underlying neuropathogenesis of these mental illnesses and provide potential biomarkers. PROSPERO registration number: CRD42021277546.
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Affiliation(s)
- Junquan Liang
- Shenzhen Bao'an Chinese Medicine Hospital, The Seventh Clinical Medical School of Guangzhou University of Chinese Medicine, Shenzhen, 518101, Guangdong, China
- The Brain Cognition and Brain Disease Institute (BCBDI), Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences (CAS), Shenzhen-Hong Kong Institute of Brain Science-Shenzhen Fundamental Research Institutions, Shenzhen, Guangdong, China
- University of Chinese Academy of Sciences, Beijing, China
| | - Qiaoyun Yu
- Jingzhou Traditional Chinese Medicine Hospital, Jingzhou, Hubei, China
| | - Yuchen Liu
- Shenzhen Luohu District Hospital of TCM, Shenzhen, Guangdong, China
| | - Yidan Qiu
- Centre for the Study of Applied Psychology, Guangdong Key Laboratory of Mental Health and Cognitive Science, School of Psychology, Institute for Brain Research and Rehabilitation, South China Normal University, Guangzhou, Guangdong, China
| | - Rundong Tang
- Shenzhen Bao'an Chinese Medicine Hospital, The Seventh Clinical Medical School of Guangzhou University of Chinese Medicine, Shenzhen, 518101, Guangdong, China
| | - Luda Yan
- Shenzhen Bao'an Chinese Medicine Hospital, The Seventh Clinical Medical School of Guangzhou University of Chinese Medicine, Shenzhen, 518101, Guangdong, China
| | - Peng Zhou
- Shenzhen Bao'an Chinese Medicine Hospital, The Seventh Clinical Medical School of Guangzhou University of Chinese Medicine, Shenzhen, 518101, Guangdong, China.
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Jamieson AJ, Harrison BJ, Delahoy R, Schmaal L, Felmingham KL, Phillips L, Davey CG. A brain model of altered self-appraisal in social anxiety disorder. Transl Psychiatry 2023; 13:344. [PMID: 37951951 PMCID: PMC10640593 DOI: 10.1038/s41398-023-02644-7] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 10/23/2023] [Accepted: 10/30/2023] [Indexed: 11/14/2023] Open
Abstract
The brain's default mode network has a central role in the processing of information concerning oneself. Dysfunction in this self-referential processing represents a key component of multiple mental health conditions, particularly social anxiety disorder (SAD). This case-control study aimed to clarify alterations to network dynamics present during self-appraisal in SAD participants. A total of 38 adolescents and young adults with SAD and 72 healthy control participants underwent a self-referential processing fMRI task. The task involved two primary conditions of interest: direct self-appraisal (thinking about oneself) and reflected self-appraisal (thinking about how others might think about oneself). Dynamic causal modeling and parametric empirical Bayes were then used to explore differences in the effective connectivity of the default mode network between groups. We observed connectivity differences between SAD and healthy control participants in the reflected self-appraisal but not the direct self-appraisal condition. Specifically, SAD participants exhibited greater excitatory connectivity from the posterior cingulate cortex (PCC) to medial prefrontal cortex (MPFC) and greater inhibitory connectivity from the inferior parietal lobule (IPL) to MPFC. In contrast, SAD participants exhibited reduced intrinsic connectivity in the absence of task modulation. This was illustrated by reduced excitatory connectivity from the PCC to MPFC and reduced inhibitory connectivity from the IPL to MPFC. As such, participants with SAD showed changes to afferent connections to the MPFC which occurred during both reflected self-appraisal as well as intrinsically. The presence of connectivity differences in reflected and not direct self-appraisal is consistent with the characteristic fear of negative social evaluation that is experienced by people with SAD.
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Affiliation(s)
- Alec J Jamieson
- Department of Psychiatry, The University of Melbourne, Parkville, VIC, Australia.
| | - Ben J Harrison
- Department of Psychiatry, The University of Melbourne, Parkville, VIC, Australia
| | - Rebekah Delahoy
- Department of Psychiatry, The University of Melbourne, Parkville, VIC, Australia
| | - Lianne Schmaal
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Kim L Felmingham
- Melbourne School of Psychological Sciences, The University of Melbourne, Parkville, VIC, Australia
| | - Lisa Phillips
- Melbourne School of Psychological Sciences, The University of Melbourne, Parkville, VIC, Australia
| | - Christopher G Davey
- Department of Psychiatry, The University of Melbourne, Parkville, VIC, Australia.
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Zhang X, Yang X, Wu B, Pan N, He M, Wang S, Kemp GJ, Gong Q. Large-scale brain functional network abnormalities in social anxiety disorder. Psychol Med 2023; 53:6194-6204. [PMID: 36330833 PMCID: PMC10520603 DOI: 10.1017/s0033291722003439] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 09/06/2022] [Accepted: 10/11/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Although aberrant brain regional responses are reported in social anxiety disorder (SAD), little is known about resting-state functional connectivity at the macroscale network level. This study aims to identify functional network abnormalities using a multivariate data-driven method in a relatively large and homogenous sample of SAD patients, and assess their potential diagnostic value. METHODS Forty-six SAD patients and 52 demographically-matched healthy controls (HC) were recruited to undergo clinical evaluation and resting-state functional MRI scanning. We used group independent component analysis to characterize the functional architecture of brain resting-state networks (RSNs) and investigate between-group differences in intra-/inter-network functional network connectivity (FNC). Furtherly, we explored the associations of FNC abnormalities with clinical characteristics, and assessed their ability to discriminate SAD from HC using support vector machine analyses. RESULTS SAD patients showed widespread intra-network FNC abnormalities in the default mode network, the subcortical network and the perceptual system (i.e. sensorimotor, auditory and visual networks), and large-scale inter-network FNC abnormalities among those high-order and primary RSNs. Some aberrant FNC signatures were correlated to disease severity and duration, suggesting pathophysiological relevance. Furthermore, intrinsic FNC anomalies allowed individual classification of SAD v. HC with significant accuracy, indicating potential diagnostic efficacy. CONCLUSIONS SAD patients show distinct patterns of functional synchronization abnormalities both within and across large-scale RSNs, reflecting or causing a network imbalance of bottom-up response and top-down regulation in cognitive, emotional and sensory domains. Therefore, this could offer insights into the neurofunctional substrates of SAD.
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Affiliation(s)
- Xun Zhang
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, China
- Functional & Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, China
- Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, Chengdu, Sichuan 610041, China
| | - Xun Yang
- School of Public Affairs, Chongqing University, Chongqing 400044, China
| | - Baolin Wu
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, China
- Functional & Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, China
- Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, Chengdu, Sichuan 610041, China
| | - Nanfang Pan
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, China
- Functional & Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, China
- Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, Chengdu, Sichuan 610041, China
| | - Min He
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, China
- Functional & Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, China
- Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, Chengdu, Sichuan 610041, China
| | - Song Wang
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, China
- Functional & Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, China
- Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, Chengdu, Sichuan 610041, China
| | - Graham J. Kemp
- Liverpool Magnetic Resonance Imaging Centre (LiMRIC) and Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool L69 3BX, UK
| | - Qiyong Gong
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, China
- Department of Radiology, West China Xiamen Hospital of Sichuan University, Xiamen, Fujian 361000, China
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Lin H, Bruchmann M, Straube T. Altered Putamen Activation for Social Comparison-Related Feedback in Social Anxiety Disorder: A Pilot Study. Neuropsychobiology 2023; 82:359-372. [PMID: 37717563 DOI: 10.1159/000531762] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 06/13/2023] [Indexed: 09/19/2023]
Abstract
INTRODUCTION Social anxiety disorder (SAD) is characterized by abnormal processing of performance-related social stimuli. Previous studies have shown altered emotional experiences and activations of different sub-regions of the striatum during processing of social stimuli in patients with SAD. However, whether and to what extent social comparisons affect behavioural and neural responses to feedback stimuli in patients with SAD is unknown. MATERIALS AND METHODS To address this issue, emotional ratings and functional magnetic resonance imaging (fMRI) responses were assessed while patients suffering from SAD and healthy controls (HC) were required to perform a choice task and received performance feedback (correct, incorrect, non-informative) that varied in relation to the performance of fictitious other participants (a few, half, or most of others had the same outcome). RESULTS Across all performance feedback conditions, fMRI analyses revealed reduced activations in bilateral putamen when feedback was assumed to be received by only a few compared to half of the other participants in patients with SAD. Nevertheless, analysis of rating data showed a similar modulation of valence and arousal ratings in patients with SAD and HC depending on social comparison-related feedback. CONCLUSIONS This suggests altered neural processing of performance feedback depending on social comparisons in patients with SAD.
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Affiliation(s)
- Huiyan Lin
- Laboratory for Behavioral and Regional Finance, Guangdong University of Finance, Guangzhou, China
- Institute of Applied Psychology, Guangdong University of Finance, Guangzhou, China
| | - Maximilian Bruchmann
- Institute of Medical Psychology and Systems Neuroscience, University of Münster, Münster, Germany
- Otto Creutzfeldt Center for Cognitive and Behavioral Neuroscience, University of Münster, Münster, Germany
| | - Thomas Straube
- Institute of Medical Psychology and Systems Neuroscience, University of Münster, Münster, Germany
- Otto Creutzfeldt Center for Cognitive and Behavioral Neuroscience, University of Münster, Münster, Germany
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Koban L, Andrews-Hanna JR, Ives L, Wager TD, Arch JJ. Brain mediators of biased social learning of self-perception in social anxiety disorder. Transl Psychiatry 2023; 13:292. [PMID: 37660045 PMCID: PMC10475036 DOI: 10.1038/s41398-023-02587-z] [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: 03/16/2023] [Revised: 08/12/2023] [Accepted: 08/15/2023] [Indexed: 09/04/2023] Open
Abstract
Social anxiety disorder (SAD) is characterized by an excessive fear of social evaluation and a persistently negative view of the self. Here we test the hypothesis that negative biases in brain responses and in social learning of self-related information contribute to the negative self-image and low self-esteem characteristic of SAD. Adult participants diagnosed with social anxiety (N = 21) and matched controls (N = 23) rated their performance and received social feedback following a stressful public speaking task. We investigated how positive versus negative social feedback altered self-evaluation and state self-esteem and used functional Magnetic Resonance Imaging (fMRI) to characterize brain responses to positive versus negative feedback. Compared to controls, participants with SAD updated their self-evaluation and state self-esteem significantly more based on negative compared to positive social feedback. Responses in the frontoparietal network correlated with and mirrored these behavioral effects, with greater responses to positive than negative feedback in non-anxious controls but not in participants with SAD. Responses to social feedback in the anterior insula and other areas mediated the effects of negative versus positive feedback on changes in self-evaluation. In non-anxious participants, frontoparietal brain areas may contribute to a positive social learning bias. In SAD, frontoparietal areas are less recruited overall and less attuned to positive feedback, possibly reflecting differences in attention allocation and cognitive regulation. More negatively biased brain responses and social learning could contribute to maintaining a negative self-image in SAD and other internalizing disorders, thereby offering important new targets for interventions.
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Affiliation(s)
- Leonie Koban
- Lyon Neuroscience Research Center (CRNL), CNRS, INSERM, Université Claude Bernard Lyon 1, Bron, France.
| | | | - Lindsay Ives
- Department of Psychology and Neuroscience, University of Colorado, Boulder, CO, USA
| | - Tor D Wager
- Department of Cognitive and Brain Sciences, Dartmouth College, Hanover, NH, USA
| | - Joanna J Arch
- Department of Psychology and Neuroscience, University of Colorado, Boulder, CO, USA
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Zhang X, Lai H, Li Q, Yang X, Pan N, He M, Kemp GJ, Wang S, Gong Q. Disrupted brain gray matter connectome in social anxiety disorder: a novel individualized structural covariance network analysis. Cereb Cortex 2023; 33:9627-9638. [PMID: 37381581 DOI: 10.1093/cercor/bhad231] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Revised: 05/11/2023] [Accepted: 06/10/2023] [Indexed: 06/30/2023] Open
Abstract
Phenotyping approaches grounded in structural network science can offer insights into the neurobiological substrates of psychiatric diseases, but this remains to be clarified at the individual level in social anxiety disorder (SAD). Using a recently developed approach combining probability density estimation and Kullback-Leibler divergence, we constructed single-subject structural covariance networks (SCNs) based on multivariate morphometry (cortical thickness, surface area, curvature, and volume) and quantified their global/nodal network properties using graph-theoretical analysis. We compared network metrics between SAD patients and healthy controls (HC) and analyzed the relationship to clinical characteristics. We also used support vector machine analysis to explore the ability of graph-theoretical metrics to discriminate SAD patients from HC. Globally, SAD patients showed higher global efficiency, shorter characteristic path length, and stronger small-worldness. Locally, SAD patients showed abnormal nodal centrality mainly involving left superior frontal gyrus, right superior parietal lobe, left amygdala, right paracentral gyrus, right lingual, and right pericalcarine cortex. Altered topological metrics were associated with the symptom severity and duration. Graph-based metrics allowed single-subject classification of SAD versus HC with total accuracy of 78.7%. This finding, that the topological organization of SCNs in SAD patients is altered toward more randomized configurations, adds to our understanding of network-level neuropathology in SAD.
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Affiliation(s)
- Xun Zhang
- Department of Radiology and Huaxi MR Research Center (HMRRC), Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu 610041, China
- Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, Chengdu 610041, China
| | - Han Lai
- Department of Medical Psychology, Army Medical University, Chongqing 400038, China
| | - Qingyuan Li
- Department of Radiology and Huaxi MR Research Center (HMRRC), Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu 610041, China
- Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, Chengdu 610041, China
| | - Xun Yang
- School of Public Affairs, Chongqing University, Chongqing 400044, China
| | - Nanfang Pan
- Department of Radiology and Huaxi MR Research Center (HMRRC), Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu 610041, China
- Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, Chengdu 610041, China
| | - Min He
- Department of Radiology and Huaxi MR Research Center (HMRRC), Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu 610041, China
- Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, Chengdu 610041, China
| | - Graham J Kemp
- Liverpool Magnetic Resonance Imaging Centre (LiMRIC) and Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool L69 3BX, United Kingdom
| | - Song Wang
- Department of Radiology and Huaxi MR Research Center (HMRRC), Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu 610041, China
- Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, Chengdu 610041, China
| | - Qiyong Gong
- Department of Radiology and Huaxi MR Research Center (HMRRC), Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu 610041, China
- Department of Radiology, West China Xiamen Hospital of Sichuan University, Xiamen 361000, China
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10
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Carlton CN, Antezana L, Richey JA. Associations between resting-state neural connectivity and positive affect in social anxiety disorder. Brain Behav 2023; 13:e3006. [PMID: 37062915 PMCID: PMC10275543 DOI: 10.1002/brb3.3006] [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: 08/17/2022] [Revised: 03/10/2023] [Accepted: 03/20/2023] [Indexed: 04/18/2023] Open
Abstract
INTRODUCTION Social anxiety disorder (SAD) has been characterized by deficits in social motivation and lack of reactivity to pleasurable stimuli (i.e., positive affect; [PA]). Recent neuroimaging work has shifted toward examining positively valenced motivational systems in SAD focused on reward responses. However, little is known about the associations of reward connectivity and PA in individuals with SAD. As such, the purpose of the current study was to determine whether connectivity among key units of reward neurocircuitry meaningfully relate to PA and whether these key units are more heterogeneous in SAD as compared to controls. METHODS Thirty-one participants who met diagnostic criteria for SAD and 33 control participants were included (Mage = 24.8, SD = 6.9; 55% cisgender man). Seed-based timeseries correlations were conducted in NiTime to extract region of interest (ROI) coupling correlation strength values. ANOVAs were carried out to assess whether individuals with SAD differed in ROI-to-ROI connectivity strength as compared to controls. Correlations and variance analyses were also conducted to examine the relationship between ROI-to-ROI connectivity strength and PA, as well as heterogeneity in connectivity strength and PA expression. RESULTS Weaker connectivity between the left and right orbital frontal cortex was observed when comparing the SAD to the control group. Within the SAD group, PA was associated with several reward-related ROI couplings; however, these links were not observed among controls. Results further demonstrated that individuals with SAD had significantly more variability in reward connectivity strength as compared to controls. CONCLUSION Overall, these results provide emergent evidence for the association between reward regions and PA in individuals with SAD. Additionally, these findings show that individuals with SAD demonstrate greater heterogeneity in reward connectivity.
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Affiliation(s)
| | | | - John A. Richey
- Department of PsychologyVirginia TechBlacksburgVirginia
- Department of PsychiatryUniversity of Pittsburgh School of MedicinePittsburghPennsylvania
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11
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Zhu X, Lazarov A, Dolan S, Bar-Haim Y, Dillon DG, Pizzagalli DA, Schneier F. Resting state connectivity predictors of symptom change during gaze-contingent music reward therapy of social anxiety disorder. Psychol Med 2023; 53:3115-3123. [PMID: 35314008 PMCID: PMC9612546 DOI: 10.1017/s0033291721005171] [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: 06/12/2021] [Revised: 11/10/2021] [Accepted: 11/29/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND Social anxiety disorder (SAD) is common, first-line treatments are often only partially effective, and reliable predictors of treatment response are lacking. Here, we assessed resting state functional connectivity (rsFC) at pre-treatment and during early treatment as a potential predictor of response to a novel attention bias modification procedure, gaze-contingent music reward therapy (GC-MRT). METHODS Thirty-two adults with SAD were treated with GC-MRT. rsFC was assessed with multi-voxel pattern analysis of fMRI at pre-treatment and after 2-3 weeks. For comparison, 20 healthy control (HC) participants without treatment were assessed twice for rsFC over the same time period. All SAD participants underwent clinical evaluation at pre-treatment, early-treatment (week 2-3), and post-treatment. RESULTS SAD and depressive symptoms improved significantly from pre-treatment to post-treatment. After 2-3 weeks of treatment, decreased connectivity between the executive control network (ECN) and salience network (SN), and increased connectivity within the ECN predicted improvement in SAD and depressive symptoms at week 8. Increased connectivity between the ECN and default mode network (DMN) predicted greater improvement in SAD but not depressive symptoms at week 8. Connectivity within the DMN decreased significantly after 2-3 weeks of treatment in the SAD group, while no changes were found in HC over the same time interval. CONCLUSION We identified early changes in rsFC during a course of GC-MRT for SAD that predicted symptom change. Connectivity changes within the ECN, ECN-DMN, and ECN-SN may be related to mechanisms underlying the clinical effects of GC-MRT and warrant further study in controlled trials.
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Affiliation(s)
- Xi Zhu
- Department of Psychiatry, Columbia University Irving Medical Center, New York, USA
- New York State Psychiatric Institute, New York, USA
| | - Amit Lazarov
- Department of Psychiatry, Columbia University Irving Medical Center, New York, USA
- School of Psychological Sciences, Tel-Aviv University, Tel-Aviv, Israel
| | - Sarah Dolan
- New York State Psychiatric Institute, New York, USA
| | - Yair Bar-Haim
- School of Psychological Sciences, Tel-Aviv University, Tel-Aviv, Israel
| | - Daniel G Dillon
- Department of Psychiatry, McLean Hospital/Harvard Medical School, Belmont, MA, USA
| | - Diego A Pizzagalli
- Department of Psychiatry, McLean Hospital/Harvard Medical School, Belmont, MA, USA
| | - Franklin Schneier
- Department of Psychiatry, Columbia University Irving Medical Center, New York, USA
- New York State Psychiatric Institute, New York, USA
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12
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Wlad M, Frick A, Engman J, Hjorth O, Hoppe JM, Faria V, Wahlstedt K, Björkstrand J, Månsson KN, Hultberg S, Alaie I, Rosén J, Fredrikson M, Furmark T, Gingnell M. Dorsal anterior cingulate cortex activity during cognitive challenge in social anxiety disorder. Behav Brain Res 2023; 442:114304. [PMID: 36681164 DOI: 10.1016/j.bbr.2023.114304] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 01/16/2023] [Accepted: 01/17/2023] [Indexed: 01/19/2023]
Abstract
BACKGROUND Social anxiety disorder (SAD) is associated with aberrant emotional information processing while little is known about non-emotional cognitive processing biases. The dorsal anterior cingulate cortex (dACC) has been implicated in SAD neuropathology and is activated both by emotional and non-affective cognitive challenges like the Multisource Interference Task (MSIT). METHODS Here, we used fMRI to compare dACC activity and test performance during MSIT in 69 SAD patients and 38 healthy controls. In addition to patient-control comparisons, we examined whether neural activity in the dACC correlated with social anxiety, trait anxiety or depression levels. RESULTS The MSIT activated the dACC as expected but with no differences in task performance or neural reactivity between SAD patients and controls. There were no significant correlations between dACC activity and social or trait anxiety symptom severity. In patients, there was a significant negative correlation between dACC activity and depressive symptoms. CONCLUSIONS In absence of affective challenge, we found no disorder-related cognitive profile in SAD patients since neither MSIT task performance nor dACC neural activity deviated in patients relative to controls.
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Affiliation(s)
- Magdalena Wlad
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
| | - Andreas Frick
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
| | - Jonas Engman
- Department of Psychology, Uppsala University, Uppsala, Sweden.
| | - Olof Hjorth
- Department of Psychology, Uppsala University, Uppsala, Sweden.
| | - Johanna M Hoppe
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
| | - Vanda Faria
- Department of Psychology, Uppsala University, Uppsala, Sweden; Brain and Eye Pain Imaging Lab, Pain and Affective Neuroscience Center, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA; Department of Otorhinolaryngology, Smell & Taste Clinic, TU Dresden, Dresden, Germany.
| | - Kurt Wahlstedt
- Department of Psychology, Uppsala University, Uppsala, Sweden.
| | | | - Kristoffer Nt Månsson
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
| | - Sara Hultberg
- Department of Psychology, Uppsala University, Uppsala, Sweden.
| | - Iman Alaie
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden; Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
| | - Jörgen Rosén
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
| | - Mats Fredrikson
- Department of Psychology, Uppsala University, Uppsala, Sweden.
| | - Tomas Furmark
- Department of Psychology, Uppsala University, Uppsala, Sweden.
| | - Malin Gingnell
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden; Department of Psychology, Uppsala University, Uppsala, Sweden.
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13
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Chen Y, Yang X, Zhang X, Cao H, Gong Q. Altered single-subject gray matter structural networks in social anxiety disorder. Cereb Cortex 2023; 33:3311-3317. [PMID: 36562992 DOI: 10.1093/cercor/bhac498] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 11/23/2022] [Accepted: 11/24/2022] [Indexed: 12/24/2022] Open
Abstract
Previous fMRI studies have reported more random brain functional graph configurations in social anxiety disorder (SAD). However, it is still unclear whether the same configurations would occur in gray matter (GM) graphs. Structural MRI was performed on 49 patients with SAD and on 51 age- and gender-matched healthy controls (HC). Single-subject GM networks were obtained based on the areal similarities of GM, and network topological properties were analyzed using graph theory. Group differences in each topological metric were compared, and the structure-function coupling was examined. These network measures were further correlated with the clinical characteristics in the SAD group. Compared with controls, the SAD patients demonstrated globally decreased clustering coefficient and characteristic path length. Altered topological properties were found in the fronto-limbic and sensory processing systems. Altered metrics were associated with the illness duration of SAD. Compared with the HC group, the SAD group exhibited significantly decreased structural-functional decoupling. Furthermore, structural-functional decoupling was negatively correlated with the symptom severity in SAD. These findings highlight less-optimized topological configuration of the brain structural networks in SAD, which may provide insights into the neural mechanisms underlying the excessive fear and avoidance of social interactions in SAD.
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Affiliation(s)
- Ying Chen
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu 640041, China
- Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, Chengdu, Sichuan 640041, China
| | - Xun Yang
- School of Public Affairs, Chongqing University, Chongqing 400044, China
| | - Xun Zhang
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu 640041, China
- Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital of Sichuan University, Chengdu, Sichuan 640041, China
| | - Hengyi Cao
- Center for Psychiatric Neuroscience, Feinstein Institute for Medical Research, Manhasset, NY, United States
- Division of Psychiatry Research, Zucker Hillside Hospital, Glen Oaks, NY, United States
| | - Qiyong Gong
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu 640041, China
- Department of Radiology, West China Xiamen Hospital of Sichuan University, Xiamen, Fujian 361000, China
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14
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Bomyea J, Sweet A, Davey DK, Boland M, Paulus MP, Stein MB, Taylor CT. Randomized controlled trial of computerized approach/avoidance training in social anxiety disorder: Neural and symptom outcomes. J Affect Disord 2023; 324:36-45. [PMID: 36549342 DOI: 10.1016/j.jad.2022.12.054] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 12/10/2022] [Accepted: 12/14/2022] [Indexed: 12/23/2022]
Abstract
Social anxiety is associated with diminished automatic approach toward positive social cues that may limit the ability to connect with others. This diminished approach bias may be a modifiable treatment target. We evaluated the effects of an approach avoidance training procedure on positive emotions, social relationship outcomes, clinical symptoms, and neural indices of social approach and reward processing. Forty-five individuals with social anxiety disorder were randomized (parallel 1:1 randomization) to complete computerized Approach Positive training (n = 21) or Balanced training(n = 24). Sessions included a standardized social interaction task. Participants were blind to training group. Participants completed clinical outcome measures and functional magnetic resonance imaging at baseline and post intervention with an MRI-compatible AAT and the social incentive delay task (SID). Both groups displayed significant improvements of similar magnitude on the primary outcome of social connectedness (between group post-treatment d = -0.21) but not positive affect (d = -0.09), from before to after treatment, persisting through follow-up. Groups demonstrated significant improvements on additional outcomes including anxiety, depression, and anhedonia symptoms. Participants in Approach Positive AAT demonstrated increased activation in the thalamus and medial prefrontal cortex during social versus neutral- approach relative to Balanced AAT during the fMRI AAT. Participants in Balanced AAT showed increased activation in regions within an a priori-defined striatum region of interest mask during anticipation of social reward (vs. baseline) in the SID relative to Approach Positive AAT. At a neural processing level AAT may influence the valuation and motivations associated with positive social cues regulated by the mPFC and thalamus. NCT02136212, NIMH R00MH090243.
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Affiliation(s)
- Jessica Bomyea
- VA San Diego Center of Excellence for Stress and Mental Health, United States of America; University of California San Diego, United States of America
| | - Alison Sweet
- University of California San Diego, United States of America
| | - Delaney K Davey
- VA San Diego Center of Excellence for Stress and Mental Health, United States of America; University of California San Diego, United States of America
| | - Matthew Boland
- University of Nevada Reno, United States of America; University of Nevada School of Medicine
| | - Martin P Paulus
- University of California San Diego, United States of America; Laureate Institute for Brain Research, United States of America
| | - Murray B Stein
- University of California San Diego, United States of America
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15
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Zhang Q, Li B, Jin S, Liu W, Liu J, Xie S, Zhang L, Kang Y, Ding Y, Zhang X, Cheng W, Yang Z. Comparing the Effectiveness of Brain Structural Imaging, Resting-state fMRI, and Naturalistic fMRI in Recognizing Social Anxiety Disorder in Children and Adolescents. Psychiatry Res Neuroimaging 2022; 323:111485. [PMID: 35567906 DOI: 10.1016/j.pscychresns.2022.111485] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 04/07/2022] [Accepted: 04/16/2022] [Indexed: 01/11/2023]
Abstract
Social anxiety disorder (SAD) is a common anxiety disorder in childhood and adolescence. Studies on SAD in adults have reported both structural and functional aberrancies of the brain at the group level. However, evidence has shown differences in anxiety-related brain abnormalities between adolescents and adults. Since children and adolescents can afford limited scan time, optimizing the scan tasks is essential for SAD research in children and adolescents. Thus, we need to address whether brain structure, resting-state fMRI, and naturalistic imaging enable individualized identification of SAD in children and adolescents, which measurement is more effective, and whether pooling multi-modal features can improve the identification of SAD. We comprehensively addressed these questions by building machine learning models based on parcel-wise brain features. We found that naturalistic fMRI yielded higher classification accuracy (69.17%) than the other modalities and the classification performance showed dependence on the contents of the movie. The classification models also identified contributing brain regions, some of which exhibited correlations with the symptoms scores of SAD. However, pooling brain features from the three modalities did not help enhance the classification accuracy. These results support the application of carefully designed naturalistic imaging in recognizing children and adolescents at risk of SAD.
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Affiliation(s)
- Qinjian Zhang
- School of Computer Science and Technology, University of Chinese Academy of Sciences, Beijing, China
| | - Baobin Li
- School of Computer Science and Technology, University of Chinese Academy of Sciences, Beijing, China
| | - Shuyu Jin
- Laboratory of Psychological Health and Imaging, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wenjing Liu
- Department of Child and Adolescent Psychiatry, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jingjing Liu
- Laboratory of Psychological Health and Imaging, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shuqi Xie
- Laboratory of Psychological Health and Imaging, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lei Zhang
- Laboratory of Psychological Health and Imaging, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yinzhi Kang
- Laboratory of Psychological Health and Imaging, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yue Ding
- Laboratory of Psychological Health and Imaging, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaochen Zhang
- Laboratory of Psychological Health and Imaging, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wenhong Cheng
- Department of Child and Adolescent Psychiatry, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Zhi Yang
- Laboratory of Psychological Health and Imaging, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Institute of Psychological and Behavioral Science, Shanghai Jiao Tong University, Shanghai, China.
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16
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Zhang X, Suo X, Yang X, Lai H, Pan N, He M, Li Q, Kuang W, Wang S, Gong Q. Structural and functional deficits and couplings in the cortico-striato-thalamo-cerebellar circuitry in social anxiety disorder. Transl Psychiatry 2022; 12:26. [PMID: 35064097 PMCID: PMC8782859 DOI: 10.1038/s41398-022-01791-7] [Citation(s) in RCA: 35] [Impact Index Per Article: 17.5] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Revised: 12/21/2021] [Accepted: 01/07/2022] [Indexed: 02/07/2023] Open
Abstract
Although functional and structural abnormalities in brain regions involved in the neurobiology of fear and anxiety have been observed in patients with social anxiety disorder (SAD), the findings have been heterogeneous due to small sample sizes, demographic confounders, and methodological differences. Besides, multimodal neuroimaging studies on structural-functional deficits and couplings are rather scarce. Herein, we aimed to explore functional network anomalies in brain regions with structural deficits and the effects of structure-function couplings on the SAD diagnosis. High-resolution structural magnetic resonance imaging (MRI) and resting-state functional MRI images were obtained from 49 non-comorbid patients with SAD and 53 demography-matched healthy controls. Whole-brain voxel-based morphometry analysis was conducted to investigate structural alterations, which were subsequently used as seeds for the resting-state functional connectivity analysis. In addition, correlation and mediation analyses were performed to probe the potential roles of structural-functional deficits in SAD diagnosis. SAD patients had significant gray matter volume reductions in the bilateral putamen, right thalamus, and left parahippocampus. Besides, patients with SAD demonstrated widespread resting-state dysconnectivity in cortico-striato-thalamo-cerebellar circuitry. Moreover, dysconnectivity of the putamen with the cerebellum and the right thalamus with the middle temporal gyrus/supplementary motor area partially mediated the effects of putamen/thalamus atrophy on the SAD diagnosis. Our findings provide preliminary evidence for the involvement of structural and functional deficits in cortico-striato-thalamo-cerebellar circuitry in SAD, and may contribute to clarifying the underlying mechanisms of structure-function couplings for SAD. Therefore, they could offer insights into the neurobiological substrates of SAD.
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Affiliation(s)
- Xun Zhang
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, 610041, China
- Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, Chengdu, 610041, China
- Functional & Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Xueling Suo
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, 610041, China
- Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, Chengdu, 610041, China
- Functional & Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Xun Yang
- School of Public Affairs, Chongqing University, Chongqing, 400044, China
| | - Han Lai
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, 610041, China
- Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, Chengdu, 610041, China
- Functional & Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Nanfang Pan
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, 610041, China
- Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, Chengdu, 610041, China
- Functional & Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Min He
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, 610041, China
- Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, Chengdu, 610041, China
- Functional & Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Qingyuan Li
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, 610041, China
- Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, Chengdu, 610041, China
- Functional & Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Weihong Kuang
- Department of Psychiatry, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Song Wang
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, 610041, China.
- Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, Chengdu, 610041, China.
- Functional & Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital of Sichuan University, Chengdu, 610041, China.
| | - Qiyong Gong
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, 610041, China.
- Department of Radiology, West China Xiamen Hospital of Sichuan University, Xiamen, 361000, China.
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17
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Ergül C, Yildiz ÇU, Kurt E, Kiçik A, Tükel R. Evaluation of Resting-State Functional Magnetic Resonance Imaging Findings of Patients with Social Anxiety Disorder. Turk Psikiyatri Derg 2022; 33:73-81. [PMID: 35730507 DOI: 10.5080/u25991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVE The most prominent functional magnetic resonance imaging findings about social anxiety disorder are increased activity in emotional regulation areas (amygdala, insula, hippocampus, dorsal anterior cingulate cortex) and fear circuit, and altered activity in prefrontal cortex. This study aims to investigate network abnormalities during resting state. METHOD Resting state functional magnetic resonance images of 21 drug-free patients with social anxiety disorder and 21 healthy controls (matched on age, gender, and years of education) were recorded. Resting state functional connectivity networks were obtained with independent component analysis, and were compared by using the voxel based t-test between the two groups. RESULTS Patients with social anxiety disorder displayed decreased intrinsic functional connectivity in the anterior component of the salience network (left orbitofrontal cortex) and increased intrinsic functional connectivity in the posterior component of the salience network (left supramarginal gyrus). CONCLUSION Most of the studies about social anxiety disorder mainly focused on fear circuit and emotional regulation areas by using anxiety provoking tasks or by using seed based analysis of functional connectivity. By applying a whole-brain independent component analysis, we found altered functional connectivity in the salience network, but no significant difference was found in the fear circuit areas. Our results suggest that abnormal connectivity in the salience network might play a crucial role in the neurobiology of social anxiety disorder.
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18
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Hjorth OR, Frick A, Gingnell M, Hoppe JM, Faria V, Hultberg S, Alaie I, Månsson KNT, Rosén J, Reis M, Wahlstedt K, Jonasson M, Lubberink M, Antoni G, Fredrikson M, Furmark T. Expectancy effects on serotonin and dopamine transporters during SSRI treatment of social anxiety disorder: a randomized clinical trial. Transl Psychiatry 2021; 11:559. [PMID: 34732695 PMCID: PMC8566580 DOI: 10.1038/s41398-021-01682-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 09/14/2021] [Accepted: 10/19/2021] [Indexed: 12/16/2022] Open
Abstract
It has been extensively debated whether selective serotonin reuptake inhibitors (SSRIs) are more efficacious than placebo in affective disorders, and it is not fully understood how SSRIs exert their beneficial effects. Along with serotonin transporter blockade, altered dopamine signaling and psychological factors may contribute. In this randomized clinical trial of participants with social anxiety disorder (SAD) we investigated how manipulation of verbally-induced expectancies, vital for placebo response, affect brain monoamine transporters and symptom improvement during SSRI treatment. Twenty-seven participants with SAD (17 men, 10 women), were randomized, to 9 weeks of overt or covert treatment with escitalopram 20 mg. The overt group received correct treatment information whereas the covert group was treated deceptively with escitalopram, described as an active placebo in a cover story. Before and after treatment, patients underwent positron emission tomography (PET) assessments with the [11C]DASB and [11C]PE2I radiotracers, probing brain serotonin (SERT) and dopamine (DAT) transporters. SAD symptoms were measured by the Liebowitz Social Anxiety Scale. Overt was superior to covert SSRI treatment, resulting in almost a fourfold higher rate of responders. PET results showed that SERT occupancy after treatment was unrelated to anxiety reduction and equally high in both groups. In contrast, DAT binding decreased in the right putamen, pallidum, and the left thalamus with overt SSRI treatment, and increased with covert treatment, resulting in significant group differences. DAT binding potential changes in these regions correlated negatively with symptom improvement. Findings support that the anxiolytic effects of SSRIs involve psychological factors contingent on dopaminergic neurotransmission while serotonin transporter blockade alone is insufficient for clinical response.
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Affiliation(s)
- Olof R Hjorth
- Department of Psychology, Uppsala University, Uppsala, Sweden.
| | - Andreas Frick
- Department of Psychology, Uppsala University, Uppsala, Sweden
- The Beijer Laboratory, Department of Neuroscience, Psychiatry, Uppsala University, Uppsala, Sweden
| | - Malin Gingnell
- Department of Psychology, Uppsala University, Uppsala, Sweden
- Department of Neuroscience, Psychiatry, Uppsala University, Uppsala, Sweden
| | - Johanna M Hoppe
- Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Vanda Faria
- Department of Psychology, Uppsala University, Uppsala, Sweden
- Center for Pain and the Brain, Department of Anesthesiology Perioperative and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
- Smell & Taste Clinic, Department of Otorhinolaryngology, TU Dresden, Dresden, Germany
| | - Sara Hultberg
- Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Iman Alaie
- Department of Neuroscience, Child and Adolescent Psychiatry, Uppsala University, Uppsala, Sweden
| | - Kristoffer N T Månsson
- Center for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Center for Lifespan Psychology, Max Planck Institute for Human Development, Berlin, Germany
- Max Planck UCL Center for Computational Psychiatry and Ageing Research, Berlin/London, UK
| | - Jörgen Rosén
- Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Margareta Reis
- Department of Biomedical And Clinical Sciences, Linköping University, Linköping, Sweden
- Department of Clinical Chemistry and Pharmacology, Skåne University hospital, Lund, Sweden
| | - Kurt Wahlstedt
- Department of Psychology, Uppsala University, Uppsala, Sweden
| | - My Jonasson
- Department of of Surgical Sciences/Nuclear Medicine and PET, Uppsala University, Uppsala, Sweden
| | - Mark Lubberink
- Department of of Surgical Sciences/Nuclear Medicine and PET, Uppsala University, Uppsala, Sweden
| | - Gunnar Antoni
- Department of Medicinal Chemistry, Uppsala University, Uppsala, Sweden
| | - Mats Fredrikson
- Department of Psychology, Uppsala University, Uppsala, Sweden
- Center for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Tomas Furmark
- Department of Psychology, Uppsala University, Uppsala, Sweden
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Yu X, Ruan Y, Zhang Y, Wang J, Liu Y, Zhang J, Zhang L. Cognitive Neural Mechanism of Social Anxiety Disorder: A Meta-Analysis Based on fMRI Studies. Int J Environ Res Public Health 2021; 18:ijerph18115556. [PMID: 34067468 PMCID: PMC8196988 DOI: 10.3390/ijerph18115556] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 04/07/2021] [Revised: 05/13/2021] [Accepted: 05/19/2021] [Indexed: 11/16/2022]
Abstract
Objective: The present meta-analysis aimed to explore the cognitive and neural mechanism of social anxiety disorder (SAD) from a whole-brain view, and compare the differences in brain activations under different task paradigms. Methods: We searched Web of Science Core Collection and other databases with the keywords related to social anxiety, social phobia, and functional magnetic resonance imaging (fMRI) for comparing persons with SAD to healthy controls and used the activation likelihood estimation method. Thirty-seven papers met the inclusion criteria, including 15 with emotional faces as stimuli, 8 presenting specific situations as stimuli, and 14 using other types of tasks as stimuli. Among these papers, 654 participants were in the SAD group and 594 participants were in the control group with 335 activation increase points and 115 activation decrease points. Results: Whole-brain analysis showed that compared with healthy controls, persons with SAD showed significantly lower activation of the left anterior cingulate gyrus (MNI coordinate: x = −6, y = 22, z = 38; p 0.001). Sub-group analysis based on task indicated that when performing tasks with emotional faces as stimuli, persons with SAD showed significantly lower activation of the left cerebellar slope and fusiform gyrus (MNI coordinate: x = −26, y = −68, z = −12; p 0.001), and significantly higher activation of the right supramarginal gyrus and angular gyrus, than healthy controls (MNI coordinate: x = 58, y = −52, z = 30; p 0.001). Conclusion: Individuals with social anxiety disorder show abnormal activation in the cingulate gyrus, which is responsible for the process of attention control, and task type can influence the activation pattern.
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Affiliation(s)
- Xianglian Yu
- Department of Education, Jianghan University, Wuhan 430056, China; (X.Y.); (J.W.); (Y.L.)
- Key Laboratory of Adolescent Cyberpsychology and Behavior, Ministry of Education, Key Laboratory of Human Development and Mental Health of Hubei Province, School of Psychology, Central China Normal University, Wuhan 430056, China
| | - Yijun Ruan
- Department of Psychology, The Chinese University of Hong Kong, Hong Kong 999077, China;
| | - Yawen Zhang
- Department of Medical Psychology, School of Health Humanities, Peking University, Beijing 100191, China;
| | - Jiayi Wang
- Department of Education, Jianghan University, Wuhan 430056, China; (X.Y.); (J.W.); (Y.L.)
| | - Yuting Liu
- Department of Education, Jianghan University, Wuhan 430056, China; (X.Y.); (J.W.); (Y.L.)
| | - Jibiao Zhang
- Department of Education, Jianghan University, Wuhan 430056, China; (X.Y.); (J.W.); (Y.L.)
- Correspondence: (J.Z.); (L.Z.); Tel.: +86-151-1631-9551 (J.Z.); Tel.: +86-186-2215-2329 (L.Z.)
| | - Lin Zhang
- Key Laboratory of Adolescent Cyberpsychology and Behavior, Ministry of Education, Key Laboratory of Human Development and Mental Health of Hubei Province, School of Psychology, Central China Normal University, Wuhan 430056, China
- Correspondence: (J.Z.); (L.Z.); Tel.: +86-151-1631-9551 (J.Z.); Tel.: +86-186-2215-2329 (L.Z.)
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20
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Sheng L, Ma H, Yao L, Dai Z, Hu J. Consistent brain grey matter volume alterations in adult patients with panic disorder and social anxiety disorder revisited. J Affect Disord 2021; 286:120-122. [PMID: 33721738 DOI: 10.1016/j.jad.2021.02.079] [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] [Received: 12/28/2020] [Revised: 02/22/2021] [Accepted: 02/26/2021] [Indexed: 11/20/2022]
Affiliation(s)
- LiQin Sheng
- Department of Neurology, Kunshan Hospital of Traditional Chinese Medicine, Kunshan, PR China
| | - HaiRong Ma
- Department of Neurology, Kunshan Hospital of Traditional Chinese Medicine, Kunshan, PR China
| | - LiZheng Yao
- Department of Radiology, The Yancheng School of Clinical Medicine of Nanjing Medical University, Yancheng, PR China
| | - ZhenYu Dai
- Department of Radiology, The Yancheng School of Clinical Medicine of Nanjing Medical University, Yancheng, PR China
| | - JianBin Hu
- Department of Radiology, The Yancheng School of Clinical Medicine of Nanjing Medical University, Yancheng, PR China.
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21
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Finlayson-Short L, Harrison BJ, Davey C. Self-other referential neural processing in social anxiety disorder and major depressive disorder. Neuroimage Clin 2021; 30:102669. [PMID: 34215143 PMCID: PMC8102806 DOI: 10.1016/j.nicl.2021.102669] [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] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 02/09/2021] [Accepted: 04/07/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Social anxiety disorder (SAD) and major depressive disorder (MDD) are highly comorbid and share impairments in self-referential and social processing. Many naturalistic judgements activate these processes concurrently, which can be referred to as "self-other referential processing". We sought to examine its neural correlates in young people with SAD and MDD using a novel experimental task. METHODS Fifty six young people aged 16 to 25 with diagnoses of SAD and/or MDD (15 with SAD [M = 20.3 years, 60% female], 17 with MDD [M = 19.8 years, 53% female], 24 with comorbid SAD and MDD [M = 19.8 years, 67% female]) and 76 age and gender-matched healthy controls (HCs; M = 20.7 years, 66% female) completed a novel self-other referential processing fMRI task that involved rating how much one related to emotional faces in active conditions and judging how far apart each person's eyes were in control conditions. RESULTS Participants with SAD had more and those with MDD had less activity in social cognitive areas than HCs when processing social information across all conditions and emotion types. Participants with comorbid SAD-MDD exhibited a distinct pattern of neural activity to patients with single diagnoses. Across the whole sample, the activation of reward system areas (the medial orbitofrontal cortex and caudate) in response to increasing relatedness correlated positively with a dimensional measure of social anxiety. CONCLUSIONS Young people with SAD, MDD and comorbid SAD-MDD showed deficits in social processing, but they were not specifically related to self-other referential processing. Dimensional social anxiety symptoms were correlated with reward system activation, suggesting that such symptoms are associated with an overestimation of the hedonic value of social stimuli. These novel findings have implications for our understanding of the neural correlates of SAD and MDD, suggesting that alterations in social processing and reward functioning underlie the impairments in self and social processing that characterize both disorders.
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Affiliation(s)
- Laura Finlayson-Short
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne and Melbourne Health, Melbourne, Australia; Orygen, Melbourne, Australia; Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia.
| | - Ben J Harrison
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne and Melbourne Health, Melbourne, Australia
| | - Christopher Davey
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne and Melbourne Health, Melbourne, Australia
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22
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Kir Y, Sayar-Akaslan D, Agtas-Ertan E, Kusman A, Baskak N, Baran Z, Munir K, Baskak B. Cortical activity during social acceptance and rejection task in social anxiety disorder: A controlled functional near infrared spectroscopy study. Prog Neuropsychopharmacol Biol Psychiatry 2021; 104:110012. [PMID: 32553940 DOI: 10.1016/j.pnpbp.2020.110012] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 05/30/2020] [Accepted: 06/09/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND The cognitive and emotional vulnerability of individuals with social anxiety disorder (SAD) and their response to repeated experiences of social rejection and social acceptance are important factors for the emergence and maintenance of symptoms of the disorder. Functional neuroimaging studies of SAD reveal hyperactivity in regions involved in the fear circuit such as amygdala, insula, anterior cingulate, and prefrontal cortices (PFC) in response to human faces with negative emotions. Observation of brain activity, however, involving studies of responses to standardized human interaction of social acceptance and social rejection have been lacking. METHODS We compared a group of index subjects with SAD (N = 22, mean age:26.3 ± 5.4, female/male: 7/15) (SADG) with a group of healthy controls (CG) (N = 21, mean age:28.7 ± 4.5, female/male: 14/7) in measures of cortical activity during standardized experiences of human interaction involving social acceptance (SA) and social rejection (SR) video-simulated handshaking tasks performed by real actors. In a third, control condition (CC), the subjects were expected to press a switch button in an equivalent space. Subjects with a concurrent mood episode were excluded and the severity of subclinical depressive symptoms was controlled. 52-channel functional near-infrared spectroscopy (fNIRS) was used to measure cortical activity. RESULTS Activity was higher in the SAD subjects compared to healthy controls, in particular in channels that project to middle and superior temporal gyri (STG), frontal eye fields (FEF) and dorsolateral prefrontal cortex (DLPFC) in terms of both SA and SR conditions. Cortical activity during the CC was not different between the groups. Only in the SAD-group, activity in the pre-motor and supplementary motor cortices, inferior and middle temporal gyri and fronto-polar area was higher during the rejection condition than the other two conditions. Anxiety scores were correlated with activity in STG, DLPFC, FEF and premotor cortex, while avoidance scores were correlated with activity in STG and FEF. CONCLUSIONS SA and SR are represented differently in terms of cortical activity in SAD subjects compared to healthy controls. Higher activity in both social conditions in SAD subjects compared to controls may imply biological sensitivity to these experiences and may underscore the importance of increased cortical activity during social interaction experiences as a putative mediator of vulnerability to SAD. Higher cortical activity in the SADG may possibly indicate stronger need for inhibitory control mechanisms and higher recruitment of theory of mind functions during social stress. Higher activity during the SR compared to the SA condition in the SAD subjects may also suggest distinct processing of social cues, whether they involve acceptance or rejection.
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Affiliation(s)
- Yagmur Kir
- Ankara University, Department of Psychiatry, Brain Research Center, Ankara, Turkey
| | - Damla Sayar-Akaslan
- Ankara University, Department of Psychiatry, Brain Research Center, Ankara, Turkey
| | - Ece Agtas-Ertan
- Ankara University, Department of Psychiatry, Brain Research Center, Ankara, Turkey
| | - Adnan Kusman
- Ankara University, Department of Psychiatry, Brain Research Center, Ankara, Turkey
| | - Nilay Baskak
- Yenimahalle Hospital, Department of Psychiatry, Ankara, Turkey
| | - Zeynel Baran
- Hacettepe University, Department of Psychology, Ankara, Turkey
| | - Kerim Munir
- Harvard Medical School, Developmental Medicine Center, Boston Children's Hospital, Boston, USA
| | - Bora Baskak
- Ankara University, Department of Psychiatry, Brain Research Center, Ankara, Turkey; Neuroscience and Neurotechnology Center of Excellence (NÖROM), Ankara, Turkey.
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23
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Savage HS, Davey CG, Fullana MA, Harrison BJ. Threat and safety reversal learning in social anxiety disorder - an fMRI study. J Anxiety Disord 2020; 76:102321. [PMID: 33099070 DOI: 10.1016/j.janxdis.2020.102321] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 09/14/2020] [Accepted: 09/27/2020] [Indexed: 02/06/2023]
Abstract
Social anxiety disorder (SAD) has been linked to maladaptive forms of fear regulation, including flexibly distinguishing between learned threat and safety signals. Few studies have examined this in young, unmedicated SAD patients, including its neural basis. We aimed to characterize the neural, subjective, and autonomic correlates of reversal learning in patients with SAD and compare them to matched patients with major depressive disorder and to healthy control participants. All participants completed a threat-safety reversal learning task during functional magnetic resonance imaging. Successful threat-safety updating was associated with significant activation of primary regions of interest (anterior cingulate, insula and ventromedial prefrontal cortex), however, no significant differences were observed between them, consistent with subjective reports of task-evoked anxiety and affect. Contrary to expectations, we did not observe threat and safety reversal learning to be significantly impaired in young people with SAD.
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Affiliation(s)
- Hannah S Savage
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne & Melbourne Health, VIC, Australia.
| | | | - Miquel A Fullana
- Adult Psychiatry and Psychology Department, Institute of Neurosciences, Hospital Clinic, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer, CIBERSAM, Barcelona, Spain
| | - Ben J Harrison
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne & Melbourne Health, VIC, Australia.
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24
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Zhang Y, Liu W, Lebowitz ER, Zhang F, Hu Y, Liu Z, Yang H, Wu J, Wang Y, Silverman WK, Yang Z, Cheng W. Abnormal asymmetry of thalamic volume moderates stress from parents and anxiety symptoms in children and adolescents with social anxiety disorder. Neuropharmacology 2020; 180:108301. [PMID: 32910952 DOI: 10.1016/j.neuropharm.2020.108301] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 07/24/2020] [Accepted: 09/04/2020] [Indexed: 02/07/2023]
Abstract
Social anxiety disorder (SAD) usually onsets in childhood or adolescence and is associated with brain development and chronic family stress during this period. As an information hub, the thalamus plays a crucial role in the development of emotion processing and stress regulation. Its structural and functional lateralization have been related to mental disorders. This study examined the age-dependent asymmetry of the thalamic volume in children and adolescents with SAD. We further examined the role of the thalamic asymmetry in moderating the relationships between parental alienation, which is a main source of familial stress for children and adolescents, and anxiety symptoms in this population. Fifty-three medication-free children and adolescents with SAD and 53 typical developing controls (age: 8-17) were included. Anxiety severity was measured using the Screen for Child Anxiety-Related Emotional Disorders (SCARED). We estimated the bilateral thalamic volume and examined diagnosis effect and age-group difference on the thalamic asymmetry. We further examined the moderation of the thalamic asymmetry on the associations between scores on the parental alienation, social phobia, and total SCARED. Compared with controls, the SAD group exhibited significantly abnormal asymmetry in thalamic volume. This asymmetry became more evident in the older age group. Furthermore, this asymmetry significantly weakened the relationships between parental attachment and total SCARED score. The asymmetry of the thalamic volume and its age-group difference provide novel evidence to support brain developmental abnormalities in children and adolescents with SAD. The findings further revealed interactions between physiological and chronic stress in children and adolescents with SAD. This article is part of the special issue on 'Stress, Addiction and Plasticity'.
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Affiliation(s)
- Yiwen Zhang
- Laboratory of Psychological Health and Imaging, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wenjing Liu
- Department of Child and Adolescent Psychiatry, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | | | - Fang Zhang
- Department of Psychological Medicine, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yang Hu
- Laboratory of Psychological Health and Imaging, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhen Liu
- Department of Child and Adolescent Psychiatry, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hanshu Yang
- Department of Child and Adolescent Psychiatry, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jingyi Wu
- Department of Child and Adolescent Psychiatry, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yunyi Wang
- Department of Psychological Medicine, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | | | - Zhi Yang
- Laboratory of Psychological Health and Imaging, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Institute of Psychological and Behavioral Sciences, Shanghai Jiao Tong University, Shanghai, China; Brain Science and Technology Research Center, Shanghai Jiao Tong University, Shanghai, China.
| | - Wenhong Cheng
- Department of Child and Adolescent Psychiatry, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Department of Psychological Medicine, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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Zhang X, Luo Q, Wang S, Qiu L, Pan N, Kuang W, Lui S, Huang X, Yang X, Kemp GJ, Gong Q. Dissociations in cortical thickness and surface area in non-comorbid never-treated patients with social anxiety disorder. EBioMedicine 2020; 58:102910. [PMID: 32739867 PMCID: PMC7393569 DOI: 10.1016/j.ebiom.2020.102910] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 06/30/2020] [Accepted: 07/10/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Abnormalities of functional activation and cortical volume in brain regions involved in the neurobiology of fear and anxiety have been implicated in the pathophysiology of social anxiety disorder (SAD). However, few studies have performed separate measurements of cortical thickness (CT) and cortical surface area (CSA) which reflect different neurobiological processes. Thus, we aimed to explore the cortical morphological anomaly separately in SAD using FreeSurfer. METHODS High-resolution structural magnetic resonance images were obtained from 32 non-comorbid never-treated adult SAD patients and 32 demography-matched healthy controls. Cortical morphometry indices including CT and CSA were separately determined by FreeSurfer and compared between the two groups via whole-brain vertex-wise analysis, while partial correlation analysis using age and gender as covariates were conducted. FINDINGS The patients with SAD showed decreased CT but increased CSA near-symmetrically in the bilateral prefrontal cortex (PFC) of the dorsolateral, dorsomedial, and ventromedial subdivisions, as well as the right lateral orbitofrontal cortex; increased CSA in the left superior temporal gyrus (STG) was also observed in SAD. The CSA in the left PFC was negatively correlated with the disease duration. INTERPRETATION As the balloon model hypothesis suggests that the tangentially stretched cortex may cause dissociations in cortical morphometry and affect the cortical capacity for information processing, our findings of dissociated morphological alterations in the PFC and cortical expansion in the STG may reflect the morphological alterations of the functional reorganization in those regions, and highlight the important role of those structures in the pathophysiology and neurobiology of SAD. FUNDING This study was funded by the National Natural Science Foundation of China (Grant Nos. 31700964, 31800963, 81621003, and 81820108018).
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Affiliation(s)
- Xun Zhang
- Huaxi MR Research Center (HMRRC), Functional and Molecular Imaging Key Laboratory of Sichuan Province, Department of Radiology, West China Hospital of Sichuan University, Chengdu 610041, Sichuan, China; Psychoradiology Research Unit of Chinese Academy of Medical Sciences (2018RU011), West China Hospital of Sichuan University, Chengdu 610041, China
| | - Qiang Luo
- Huaxi MR Research Center (HMRRC), Functional and Molecular Imaging Key Laboratory of Sichuan Province, Department of Radiology, West China Hospital of Sichuan University, Chengdu 610041, Sichuan, China; Psychoradiology Research Unit of Chinese Academy of Medical Sciences (2018RU011), West China Hospital of Sichuan University, Chengdu 610041, China
| | - Song Wang
- Huaxi MR Research Center (HMRRC), Functional and Molecular Imaging Key Laboratory of Sichuan Province, Department of Radiology, West China Hospital of Sichuan University, Chengdu 610041, Sichuan, China; Psychoradiology Research Unit of Chinese Academy of Medical Sciences (2018RU011), West China Hospital of Sichuan University, Chengdu 610041, China
| | - Lihua Qiu
- Huaxi MR Research Center (HMRRC), Functional and Molecular Imaging Key Laboratory of Sichuan Province, Department of Radiology, West China Hospital of Sichuan University, Chengdu 610041, Sichuan, China; Psychoradiology Research Unit of Chinese Academy of Medical Sciences (2018RU011), West China Hospital of Sichuan University, Chengdu 610041, China; Department of Radiology, The Second People's Hospital of Yibin, Yibin 644000, China
| | - Nanfang Pan
- Huaxi MR Research Center (HMRRC), Functional and Molecular Imaging Key Laboratory of Sichuan Province, Department of Radiology, West China Hospital of Sichuan University, Chengdu 610041, Sichuan, China; Psychoradiology Research Unit of Chinese Academy of Medical Sciences (2018RU011), West China Hospital of Sichuan University, Chengdu 610041, China
| | - Weihong Kuang
- Department of Psychiatry, State Key Lab of Biotherapy, West China Hospital of Sichuan University, Chengdu 610041, PR, China
| | - Su Lui
- Huaxi MR Research Center (HMRRC), Functional and Molecular Imaging Key Laboratory of Sichuan Province, Department of Radiology, West China Hospital of Sichuan University, Chengdu 610041, Sichuan, China; Psychoradiology Research Unit of Chinese Academy of Medical Sciences (2018RU011), West China Hospital of Sichuan University, Chengdu 610041, China
| | - Xiaoqi Huang
- Huaxi MR Research Center (HMRRC), Functional and Molecular Imaging Key Laboratory of Sichuan Province, Department of Radiology, West China Hospital of Sichuan University, Chengdu 610041, Sichuan, China; Psychoradiology Research Unit of Chinese Academy of Medical Sciences (2018RU011), West China Hospital of Sichuan University, Chengdu 610041, China
| | - Xun Yang
- School of Public Affairs, Chongqing University, Chongqing 400044, China.
| | - Graham J Kemp
- Liverpool Magnetic Resonance Imaging Centre (LiMRIC) and Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Qiyong Gong
- Huaxi MR Research Center (HMRRC), Functional and Molecular Imaging Key Laboratory of Sichuan Province, Department of Radiology, West China Hospital of Sichuan University, Chengdu 610041, Sichuan, China; Psychoradiology Research Unit of Chinese Academy of Medical Sciences (2018RU011), West China Hospital of Sichuan University, Chengdu 610041, China; Department of Psychology, School of Public Administration, Sichuan University, Chengdu 610041, China.
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26
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Abstract
BACKGROUND Reappraisal, an adaptive emotion regulation strategy, is associated with frontal engagement. In internalizing psychopathologies (IPs) such as anxiety and depression frontal activity is atypically reduced suggesting impaired regulation capacity. Yet, successful reappraisal is often demonstrated at the behavioral level. A data-driven approach was used to clarify brain and behavioral relationships in IPs. METHODS During functional magnetic resonance imaging, anxious [general anxiety disorder (n = 43), social anxiety disorder (n = 72)] and depressed (n = 47) patients reappraised negative images to reduce negative affect ('ReappNeg') and viewed negative images ('LookNeg'). After each trial, the affective state was reported. A cut-point (i.e. values <0 based on ΔReappNeg-LookNeg) demarcated successful reappraisers. Neural activity for ReappNeg-LookNeg, derived from 37 regions of interest, was submitted to Principal Component Analysis (PCA) to identify unique components of reappraisal-related brain response. PCA factors, symptom severity, and self-reported habitual reappraisal were submitted to discriminant function analysis and linear regression to examine whether these data predicted successful reappraisal (yes/no) and variance in reappraisal ability. RESULTS Most patients (63%) were successful reappraisers according to the behavioral criterion (values<0; ΔReappNeg-LookNeg). Discriminant function analysis was not significant for PCA factors, symptoms, or habitual reappraisal. For regression, more activation in a factor with high loadings for frontal regions predicted better reappraisal facility. Results were not significant for other variables. CONCLUSIONS At the individual level, more activation in a 'frontal' factor corresponded with better reappraisal facility. However, neither brain nor behavioral variables classified successful reappraisal (yes/no). Findings suggest individual differences in regions strongly implicated in reappraisal play a role in on-line reappraisal capability.
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Affiliation(s)
- Heide Klumpp
- Departments of Psychiatry and Psychology (HK, KLK), University of Illinois at Chicago, Chicago, IL, USA
| | - Kerry L. Kinney
- Departments of Psychiatry and Psychology (HK, KLK), University of Illinois at Chicago, Chicago, IL, USA
| | - Runa Bhaumik
- Department of Psychiatry (RB), University of Illinois at Chicago, Chicago, IL, USA
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Torrisi S, Alvarez GM, Gorka AX, Fuchs B, Geraci M, Grillon C, Ernst M. Resting-state connectivity of the bed nucleus of the stria terminalis and the central nucleus of the amygdala in clinical anxiety. J Psychiatry Neurosci 2019; 44:313-323. [PMID: 30964612 PMCID: PMC6710087 DOI: 10.1503/jpn.180150] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [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: 09/02/2018] [Revised: 12/11/2018] [Accepted: 01/16/2019] [Indexed: 01/06/2023] Open
Abstract
Background The central nucleus of the amygdala and bed nucleus of the stria terminalis are involved primarily in phasic and sustained aversive states. Although both structures have been implicated in pathological anxiety, few studies with a clinical population have specifically focused on them, partly because of their small size. Previous work in our group used high-resolution imaging to map the restingstate functional connectivity of the bed nucleus of the stria terminalis and the central nucleus of the amygdala in healthy subjects at 7 T, confirming and extending structural findings in humans and animals, while providing additional insight into cortical connectivity that is potentially unique to humans. Methods In the current follow-up study, we contrasted resting-state functional connectivity in the bed nucleus of the stria terminalis and central nucleus of the amygdala at 7 T between healthy volunteers (n = 30) and patients with generalized and/or social anxiety disorder (n = 30). Results Results revealed significant voxel-level group differences. Compared with healthy volunteers, patients showed stronger resting-state functional connectivity between the central nucleus of the amygdala and the lateral orbitofrontal cortex and superior temporal sulcus. They also showed weaker resting-state functional connectivity between the bed nucleus of the stria terminalis and the dorsolateral prefrontal cortex and occipital cortex. Limitations These findings depart from a previous report of resting-state functional connectivity in the central nucleus of the amygdala and bed nucleus of the stria terminalis under sustained threat of shock in healthy volunteers. Conclusion This study provides functional MRI proxies of the functional dissociation of the bed nucleus of the stria terminalis and central nucleus of the amygdala, and suggests that resting-state functional connectivity of key structures in the processing of defensive responses do not recapitulate changes related to induced state anxiety. Future work needs to replicate and further probe the clinical significance of these findings.
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Affiliation(s)
- Salvatore Torrisi
- From the Section on the Neurobiology of Fear and Anxiety, National Institute of Mental Health, Bethesda, MD, USA (Torrisi, Alvarez, Gorka, Fuchs, Geraci, Grillon, Ernst)
| | - Gabriella M. Alvarez
- From the Section on the Neurobiology of Fear and Anxiety, National Institute of Mental Health, Bethesda, MD, USA (Torrisi, Alvarez, Gorka, Fuchs, Geraci, Grillon, Ernst)
| | - Adam X. Gorka
- From the Section on the Neurobiology of Fear and Anxiety, National Institute of Mental Health, Bethesda, MD, USA (Torrisi, Alvarez, Gorka, Fuchs, Geraci, Grillon, Ernst)
| | - Bari Fuchs
- From the Section on the Neurobiology of Fear and Anxiety, National Institute of Mental Health, Bethesda, MD, USA (Torrisi, Alvarez, Gorka, Fuchs, Geraci, Grillon, Ernst)
| | - Marilla Geraci
- From the Section on the Neurobiology of Fear and Anxiety, National Institute of Mental Health, Bethesda, MD, USA (Torrisi, Alvarez, Gorka, Fuchs, Geraci, Grillon, Ernst)
| | - Christian Grillon
- From the Section on the Neurobiology of Fear and Anxiety, National Institute of Mental Health, Bethesda, MD, USA (Torrisi, Alvarez, Gorka, Fuchs, Geraci, Grillon, Ernst)
| | - Monique Ernst
- From the Section on the Neurobiology of Fear and Anxiety, National Institute of Mental Health, Bethesda, MD, USA (Torrisi, Alvarez, Gorka, Fuchs, Geraci, Grillon, Ernst)
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Jarcho JM, Grossman HY, Guyer AE, Quarmley M, Smith AR, Fox NA, Leibenluft E, Pine DS, Nelson EE. Connecting Childhood Wariness to Adolescent Social Anxiety through the Brain and Peer Experiences. J Abnorm Child Psychol 2019; 47:1153-1164. [PMID: 31028560 PMCID: PMC6628896 DOI: 10.1007/s10802-019-00543-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Wariness in early childhood manifests as shy, inhibited behavior in novel social situations and is associated with increased risk for developing social anxiety. In youth with childhood wariness, exposure to a potent social stressor, such as peer victimization, may potentiate brain-based sensitivity to unpredictable social contexts, thereby increasing risk for developing social anxiety. To test brain-based associations between early childhood wariness, self-reported peer victimization, and current social anxiety symptoms, we quantified neural responses to different social contexts in low- and high-victimized pre-adolescents with varying levels of early childhood wariness. Measures of early childhood wariness were obtained annually from ages 2-to-7-years. At age 11, participants were characterized as having low (N = 20) or high (N = 27) peer victimization. To index their neural responses to peer evaluation, participants completed an fMRI-based Virtual School paradigm (Jarcho et al. Developmental Cognitive Neuroscience, 13, 21-31, 2013a). In highly victimized, relative to low-victimized participants, wariness was differentially related to right amygdala response based on the valence and predictability of peer evaluation. More specifically, in highly victimized participants, wariness was associated with greater right amygdala response to unpredictably positive peer evaluation. Effects of wariness were not observed in participants who reported low levels of victimization. Moreover, in victimized participants, high wariness and right amygdala response to unpredictably positive peer evaluation was associated with more severe social anxiety symptoms. Results can be interpreted using a diathesis-stress model, which suggests that neural response to unexpectedly positive social feedback is a mechanism by which exposure to peer victimization potentiates the risk for developing social anxiety in individuals exhibiting high levels of early childhood wariness.
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Affiliation(s)
- Johanna M Jarcho
- Department of Psychology, Temple University, Weiss Hall, Philadelphia, PA, 19122, USA.
| | - Hannah Y Grossman
- Department of Counseling, School, and Educational Psychology, University of Buffalo, Stony Brook, NY, USA
| | - Amanda E Guyer
- Department of Human Ecology, University of California, Davis, CA, USA
- Center for Mind and Brain, University of California, Davis, CA, USA
| | - Megan Quarmley
- Department of Psychology, Temple University, Weiss Hall, Philadelphia, PA, 19122, USA
| | - Ashley R Smith
- National Institute of Mental Health, Emotion and Development Branch, Bethesda, MD, USA
| | - Nathan A Fox
- Department of Human Development and Quantitative Methodology, University of Maryland, College Park, College Park, MD, USA
| | - Ellen Leibenluft
- National Institute of Mental Health, Emotion and Development Branch, Bethesda, MD, USA
| | - Daniel S Pine
- National Institute of Mental Health, Emotion and Development Branch, Bethesda, MD, USA
| | - Eric E Nelson
- Center for Biobehavioral Health, Nationwide Children's Hospital, Columbus, OH, USA
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Brown LA, Young KS, Goldin PR, Torre JB, Burklund LJ, Davies CD, Niles AN, Lieberman MD, Saxbe DE, Craske MG. Self-referential processing during observation of a speech performance task in social anxiety disorder from pre- to post-treatment: Evidence of disrupted neural activation. Psychiatry Res Neuroimaging 2019; 284:13-20. [PMID: 30622047 PMCID: PMC6415528 DOI: 10.1016/j.pscychresns.2018.12.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 07/31/2018] [Revised: 11/26/2018] [Accepted: 12/31/2018] [Indexed: 01/08/2023]
Abstract
Self-referential processing is critical to understanding social anxiety disorder (SAD). This study examined neural differences in self-referential processing in healthy controls (HC) and participants with SAD at pre- and post-treatment. Participants (n = 64) underwent fMRI scanning while viewing a video of themselves ("Self") or another person ("Other"). SAD participants were randomized to cognitive behavior therapy (CBT), acceptance and commitment therapy (ACT), or waitlist, and were re-scanned at post-treatment. In SAD vs. HC, the fusiform face area (FFA) showed significantly more activation during Self vs. Other, and greater SAD severity was associated with significantly more activation during Self vs. Other in the right FFA and the left extrastriate body area (EBA). Greater reduction in SAD severity was associated with stronger connectivity between the amygdala and FFA during Self vs. Other at post-treatment, whereas the strength of connectivity during Self and Other was comparable at post-treatment for those with less SAD reduction. Thus, there were significant differences in activation and functional connectivity of brain regions implicated in self-referential processing in SAD. Change in connectivity between the amygdala and FFA were observed as a function of change in SAD severity, suggesting that improvements in SAD severity may correct this altered functional connectivity.
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Affiliation(s)
- Lily A Brown
- Department of Psychology, University of California, Los Angeles, 405 Hilgard Avenue, Los Angeles, CA, 90095, USA; Department of Psychiatry, University of Pennsylvania, 3535 Market Street Suite 600 N Philadelphia, PA 19104, USA.
| | - Katherine S Young
- Department of Psychology, University of California, Los Angeles, 405 Hilgard Avenue, Los Angeles, CA, 90095, USA; Social, Genetic and Development Psychiatry (SGDP) Centre, Institute of Psychology, Psychiatry and Neuroscience, King's College London, UK.
| | - Philippe R Goldin
- Betty Irene Moore School of Nursing, University of California, Davis, 4610 X Street Suite 4202, Sacramento, CA 95817, USA.
| | - Jared B Torre
- Department of Psychology, University of California, Los Angeles, 405 Hilgard Avenue, Los Angeles, CA, 90095, USA.
| | - Lisa J Burklund
- Department of Psychology, University of California, Los Angeles, 405 Hilgard Avenue, Los Angeles, CA, 90095, USA; NeuroGen Technologies, Inc., P.O. Box 775 Burbank, CA 91505, USA.
| | - Carolyn D Davies
- Department of Psychology, University of California, Los Angeles, 405 Hilgard Avenue, Los Angeles, CA, 90095, USA.
| | - Andrea N Niles
- Department of Psychology, University of California, Los Angeles, 405 Hilgard Avenue, Los Angeles, CA, 90095, USA.
| | - Matthew D Lieberman
- Department of Psychology, University of California, Los Angeles, 405 Hilgard Avenue, Los Angeles, CA, 90095, USA.
| | - Darby E Saxbe
- Department of Psychology, University of Southern California, 3620 South McClintock Avenue, Los Angeles, CA 90089, USA.
| | - Michelle G Craske
- Department of Psychology, University of California, Los Angeles, 405 Hilgard Avenue, Los Angeles, CA, 90095, USA.
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Ahmed-Leitao F, Rosenstein D, Marx M, Young S, Korte K, Seedat S. Posttraumatic stress disorder, social anxiety disorder and childhood trauma: Differences in hippocampal subfield volume. Psychiatry Res Neuroimaging 2019; 284:45-52. [PMID: 30684895 DOI: 10.1016/j.pscychresns.2018.12.015] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 12/14/2018] [Accepted: 12/29/2018] [Indexed: 12/22/2022]
Abstract
Volume-based hippocampal findings in Social Anxiety Disorder (SAD) and Posttraumatic Stress Disorder (PTSD) have been inconsistent, with very little investigation of hippocampal subfields. We assessed the effects of early childhood trauma on hippocampal subfields in participants with SAD with and without early childhood trauma and PTSD, compared to healthy controls. The sample comprised 26 participants SAD with early childhood trauma, 22 participants with SAD without early childhood trauma, 17 with PTSD secondary to early childhood trauma and 25 control participants. We used Freesurfer version 6 to determine hippocampal subfield volumes. Findings included significant reduction in right parasubiculum volume between the PTSD group secondary to early childhood trauma and the SAD group without early childhood trauma, as well as a significant reduction in left HATA (Hippocampal Amygdala Transition Area) volume between PTSD with early childhood trauma compared to controls, as well as compared to SAD with early childhood trauma. These findings did withstand correction for multiple resting using the false discovery rate. Our findings of an association of reduced volumes in the parasubiculum and HATA regions with PTSD secondary to childhood trauma are interesting. Further work should investigate whether parasubiculum and HATA regional volume reductions in PTSD are a specific effect of early childhood trauma or a specific manifestation of PTSD pathology. Further work should also be undertaken to determine if hippocampal subfield atrophy is associated with SAD in the setting of early childhood maltreatment.
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Affiliation(s)
- Fatima Ahmed-Leitao
- South African Research Chairs Initiative (SARChI) in Posttraumatic Stress Disorder, Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, PO Box 241, Tygerberg 8000, South Africa.
| | - David Rosenstein
- South African Research Chairs Initiative (SARChI) in Posttraumatic Stress Disorder, Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, PO Box 241, Tygerberg 8000, South Africa
| | - Melanie Marx
- South African Research Chairs Initiative (SARChI) in Posttraumatic Stress Disorder, Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, PO Box 241, Tygerberg 8000, South Africa
| | - Susanne Young
- South African Research Chairs Initiative (SARChI) in Posttraumatic Stress Disorder, Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, PO Box 241, Tygerberg 8000, South Africa
| | - Kristina Korte
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, United States
| | - Soraya Seedat
- South African Research Chairs Initiative (SARChI) in Posttraumatic Stress Disorder, Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, PO Box 241, Tygerberg 8000, South Africa
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31
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Kraus J, Frick A, Fischer H, Howner K, Fredrikson M, Furmark T. Amygdala reactivity and connectivity during social and non-social aversive stimulation in social anxiety disorder. Psychiatry Res Neuroimaging 2018; 280:56-61. [PMID: 30165271 DOI: 10.1016/j.pscychresns.2018.08.012] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 08/18/2018] [Accepted: 08/19/2018] [Indexed: 11/21/2022]
Abstract
Social anxiety disorder (SAD) is characterized by exaggerated amygdala reactivity in response to symptom provocation, but it is unclear if such hyper-reactivity is elicited by disorder-specific challenges only or characterizes reactions to aversive stimuli in general. Here, using functional magnetic resonance imaging in 14 patients with SAD, as compared to 12 healthy controls, we found that amygdala hyper-reactivity is confined to disorder-relevant social stimulation. SAD patients displayed increased amygdala reactivity to fearful as compared to neutral facial pictures, but not in response to generally aversive but mainly non-social stimulation when compared to neutral pictorial stimuli taken from the International Affective Picture System. The increased amygdala reactivity was not mediated by an altered prefrontal inhibition among SAD patients as compared to controls, suggesting increased bottom-up processes rather than attenuated top-down control. In conclusion, the enhanced amygdala reactivity in SAD seems specific to socially relevant stimuli rather than aversive stimuli in general.
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Affiliation(s)
- Jakub Kraus
- Department of Clinical Neuroscience, Karolinska Institute, Nobels väg 9, Stockholm, Sweden; Centre for Neuroscience, Central European Institute of Technology, Masaryk University, Brno, Czech Republic; Faculty of Medicine, Masaryk University, Brno, Czech Republic.
| | - Andreas Frick
- Department of Psychology, Uppsala University, Uppsala, Sweden; Department of Psychology, Stockholm University, Stockholm, Sweden
| | - Håkan Fischer
- Department of Psychology, Stockholm University, Stockholm, Sweden
| | - Katarina Howner
- Department of Clinical Neuroscience, Karolinska Institute, Nobels väg 9, Stockholm, Sweden
| | - Mats Fredrikson
- Department of Clinical Neuroscience, Karolinska Institute, Nobels väg 9, Stockholm, Sweden; Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Tomas Furmark
- Department of Psychology, Uppsala University, Uppsala, Sweden
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32
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Haller SPW, Mills KL, Hartwright CE, David AS, Cohen Kadosh K. When change is the only constant: The promise of longitudinal neuroimaging in understanding social anxiety disorder. Dev Cogn Neurosci 2018; 33:73-82. [PMID: 29960860 PMCID: PMC6969264 DOI: 10.1016/j.dcn.2018.05.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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: 03/22/2017] [Revised: 05/21/2018] [Accepted: 05/23/2018] [Indexed: 12/27/2022] Open
Abstract
Longitudinal studies offer a unique window into developmental change. Yet, most of what we know about the pathophysiology of psychiatric disorders is based on cross-sectional work. Here, we highlight the importance of adopting a longitudinal approach in order to make progress towards identifying the neurobiological mechanisms of social anxiety disorder (SAD). Using examples, we illustrate how longitudinal data can uniquely inform SAD etiology and timing of interventions. The brain's inherently adaptive quality requires that we model risk correlates of disorders as dynamic in their expression. Developmental theories regarding timing of environmental events, cascading effects and (mal)adaptations of the developing brain will be crucial components of comprehensive, integrative models of SAD. We close by discussing analytical considerations when working with longitudinal, developmental data.
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Affiliation(s)
| | | | - Charlotte E Hartwright
- Department of Experimental Psychology, University of Oxford, UK; Aston Brain Center, Aston University, UK
| | - Anthony S David
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Kathrin Cohen Kadosh
- Department of Experimental Psychology, University of Oxford, UK; School of Psychology, University of Surrey, UK.
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Abstract
BACKGROUND Social anxiety disorder (SAD) is characterized by fear of social and performance situations. The consequence of scrutiny by others for the neural processing of performance feedback in SAD is unknown. METHODS We used event-related functional magnetic resonance imaging to investigate brain activation to positive, negative, and uninformative performance feedback in patients diagnosed with SAD and age-, gender-, and education-matched healthy control subjects who performed a time estimation task during a social observation condition and a non-social control condition: while either being monitored or unmonitored by a body camera, subjects received performance feedback after performing a time estimation that they could not fully evaluate without external feedback. RESULTS We found that brain activation in ventral striatum (VS) and midcingulate cortex was modulated by an interaction of social context and feedback type. SAD patients showed a lack of social-context-dependent variation of feedback processing, while control participants showed an enhancement of brain responses specifically to positive feedback in VS during observation. CONCLUSIONS The present findings emphasize the importance of social-context processing in SAD by showing that scrutiny prevents appropriate reward-processing-related signatures in response to positive performances in SAD.
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Affiliation(s)
- M P I Becker
- Department of Biological and Clinical Psychology,Friedrich Schiller University,D-07743 Jena,Germany
| | - D Simon
- Department of Biological and Clinical Psychology,Friedrich Schiller University,D-07743 Jena,Germany
| | - W H R Miltner
- Department of Biological and Clinical Psychology,Friedrich Schiller University,D-07743 Jena,Germany
| | - T Straube
- Department of Biological and Clinical Psychology,Friedrich Schiller University,D-07743 Jena,Germany
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Bas-Hoogendam JM, van Steenbergen H, Nienke Pannekoek J, Fouche JP, Lochner C, Hattingh CJ, Cremers HR, Furmark T, Månsson KN, Frick A, Engman J, Boraxbekk CJ, Carlbring P, Andersson G, Fredrikson M, Straube T, Peterburs J, Klumpp H, Phan KL, Roelofs K, Veltman DJ, van Tol MJ, Stein DJ, van der Wee NJ. Voxel-based morphometry multi-center mega-analysis of brain structure in social anxiety disorder. Neuroimage Clin 2017; 16:678-688. [PMID: 30140607 PMCID: PMC6103329 DOI: 10.1016/j.nicl.2017.08.001] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [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: 05/13/2017] [Accepted: 08/01/2017] [Indexed: 01/04/2023]
Abstract
Social anxiety disorder (SAD) is a prevalent and disabling mental disorder, associated with significant psychiatric co-morbidity. Previous research on structural brain alterations associated with SAD has yielded inconsistent results concerning the direction of the changes in gray matter (GM) in various brain regions, as well as on the relationship between brain structure and SAD-symptomatology. These heterogeneous findings are possibly due to limited sample sizes. Multi-site imaging offers new opportunities to investigate SAD-related alterations in brain structure in larger samples. An international multi-center mega-analysis on the largest database of SAD structural T1-weighted 3T MRI scans to date was performed to compare GM volume of SAD-patients (n = 174) and healthy control (HC)-participants (n = 213) using voxel-based morphometry. A hypothesis-driven region of interest (ROI) approach was used, focusing on the basal ganglia, the amygdala-hippocampal complex, the prefrontal cortex, and the parietal cortex. SAD-patients had larger GM volume in the dorsal striatum when compared to HC-participants. This increase correlated positively with the severity of self-reported social anxiety symptoms. No SAD-related differences in GM volume were present in the other ROIs. Thereby, the results of this mega-analysis suggest a role for the dorsal striatum in SAD, but previously reported SAD-related changes in GM in the amygdala, hippocampus, precuneus, prefrontal cortex and parietal regions were not replicated. Our findings emphasize the importance of large sample imaging studies and the need for meta-analyses like those performed by the Enhancing NeuroImaging Genetics through Meta-Analysis (ENIGMA) Consortium. Multi-center mega-analysis on gray matter (GM) in social anxiety disorder (SAD) Largest sample available for analysis to date: 174 SAD-patients vs 213 controls Larger GM volume in the right putamen in SAD-patients No SAD-related alterations in amygdala-hippocampal, prefrontal or parietal regions Results stress need for larger samples and meta-analyses - cf. ENIGMA Consortium
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Affiliation(s)
- Janna Marie Bas-Hoogendam
- Institute of Psychology, Leiden University, Leiden, The Netherlands
- Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands
- Leiden Institute for Brain and Cognition, Leiden, The Netherlands
- Corresponding author at: Institute of Psychology, Leiden University, Wassenaarseweg 52, 2333 AK Leiden, The Netherlands.
| | - Henk van Steenbergen
- Institute of Psychology, Leiden University, Leiden, The Netherlands
- Leiden Institute for Brain and Cognition, Leiden, The Netherlands
| | - J. Nienke Pannekoek
- Neuropsychopharmacology Unit, Centre for Psychiatry, Division of Brain Sciences, Imperial College London, United Kingdom
| | - Jean-Paul Fouche
- Department of Psychiatry and Mental Health, University of Cape Town, Observatory, Cape Town, South Africa
| | - Christine Lochner
- SU/UCT MRC Unit on Anxiety & Stress Disorders, South Africa
- Department of Psychiatry, Stellenbosch University, Tygerberg, South Africa
| | - Coenraad J. Hattingh
- Department of Psychiatry and Mental Health, University of Cape Town, Observatory, Cape Town, South Africa
| | - Henk R. Cremers
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Tomas Furmark
- Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Kristoffer N.T. Månsson
- Department of Psychology, Uppsala University, Uppsala, Sweden
- Department of Psychology, Stockholm University, Stockholm, Sweden
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Andreas Frick
- Department of Psychology, Uppsala University, Uppsala, Sweden
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Jonas Engman
- Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Carl-Johan Boraxbekk
- Umeå Centre for Functional Brain Imaging (UFBI), Umeå University, Umeå, Sweden
- Danish Research Centre for Magnetic Resonance (DRCMR), Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Denmark
| | - Per Carlbring
- Department of Psychology, Stockholm University, Stockholm, Sweden
| | - Gerhard Andersson
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Behavioural Sciences and Learning, Psychology, Linköping University, Linköping, Sweden
| | - Mats Fredrikson
- Department of Psychology, Uppsala University, Uppsala, Sweden
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Thomas Straube
- Institute of Medical Psychology and Systems Neuroscience, University of Münster, Münster, Germany
| | - Jutta Peterburs
- Institute of Medical Psychology and Systems Neuroscience, University of Münster, Münster, Germany
| | - Heide Klumpp
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, United States
- Department of Psychology, University of Illinois at Chicago, Chicago, IL, United States
| | - K. Luan Phan
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, United States
- Department of Psychology, University of Illinois at Chicago, Chicago, IL, United States
| | - Karin Roelofs
- Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands
| | - Dick J. Veltman
- Department of Psychiatry, Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - Marie-José van Tol
- Department of Neuroscience, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Dan J. Stein
- Department of Psychiatry and Mental Health, University of Cape Town, Observatory, Cape Town, South Africa
- SU/UCT MRC Unit on Anxiety & Stress Disorders, South Africa
| | - Nic J.A. van der Wee
- Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands
- Leiden Institute for Brain and Cognition, Leiden, The Netherlands
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Minkova L, Sladky R, Kranz GS, Woletz M, Geissberger N, Kraus C, Lanzenberger R, Windischberger C. Task-dependent modulation of amygdala connectivity in social anxiety disorder. Psychiatry Res Neuroimaging 2017; 262:39-46. [PMID: 28226306 DOI: 10.1016/j.pscychresns.2016.12.016] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Revised: 12/12/2016] [Accepted: 12/27/2016] [Indexed: 01/27/2023]
Abstract
Increased amygdala activation is consistently found in patients suffering from social anxiety disorder (SAD), a psychiatric condition characterized by an intense fear of social situations and scrutiny. Disruptions in the amygdalar-frontal network in SAD may explain the inability of frontal regions to appropriately down-regulate amygdalar hyper-activation. In this study, we measured 15 SAD patients and 15 healthy controls during an affective counting Stroop task with emotional faces to assess the interaction of affective stimuli with a cognitive task in SAD, as well as to investigate the causal interactions between the amygdala and the medial orbitofrontal cortex (OFC) using dynamic causal modeling (DCM). Here we show for the first time that differences in OFC-amygdala effective connectivity between SAD patients and healthy controls are influenced by cognitive load during task processing. In SAD patients relative to controls dysfunctional amygdala regulation was observed during passive viewing of harsh faces This could be linked to ongoing self-initiated cognitive processes (such as rumination and anticipation of negative events) that hinder successful amygdala regulation. However, between-group differences diminished during cognitive processing, suggesting that attentional load interfered with emotional processing in both patients and controls.
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Affiliation(s)
- Lora Minkova
- MR Center of Excellence, Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Austria; Department of Psychiatry and Psychotherapy, University Medical Center Freiburg, Germany; Freiburg Brain Imaging Center, University Medical Center Freiburg, Germany
| | - Ronald Sladky
- MR Center of Excellence, Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Austria
| | - Georg S Kranz
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Austria
| | - Michael Woletz
- MR Center of Excellence, Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Austria
| | - Nicole Geissberger
- MR Center of Excellence, Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Austria
| | - Christoph Kraus
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Austria
| | - Rupert Lanzenberger
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Austria
| | - Christian Windischberger
- MR Center of Excellence, Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Austria.
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Young KS, Burklund LJ, Torre JB, Saxbe D, Lieberman MD, Craske MG. Treatment for social anxiety disorder alters functional connectivity in emotion regulation neural circuitry. Psychiatry Res 2017; 261:44-51. [PMID: 28129555 PMCID: PMC5330298 DOI: 10.1016/j.pscychresns.2017.01.005] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [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: 09/09/2016] [Revised: 01/05/2017] [Accepted: 01/12/2017] [Indexed: 11/27/2022]
Abstract
Social anxiety disorder (SAD) is characterized at a neurobiological level by disrupted activity in emotion regulation neural circuitry. Previous work has demonstrated amygdala hyperreactivity and disrupted prefrontal responses to social cues in individuals with SAD (Kim et al., 2011). While exposure-based psychological treatments effectively reduce SAD symptoms, not all individuals respond to treatment. Better understanding of the neural mechanisms involved offers the potential to improve treatment efficacy. In this study, we investigated functional connectivity in emotion regulation neural circuitry in a randomized controlled treatment trial for SAD. Participants with SAD underwent fMRI scanning while performing an implicit emotion regulation task prior to treatment (n=62). Following 12 weeks of cognitive behavioral therapy, acceptance and commitment therapy, or wait-list, participants completed a second scan (n=42). Psychophysiological interaction analyses using amygdala seed regions demonstrated differences between SAD and healthy control participants (HC; n=16) in right amygdala-vmPFC connectivity. SAD participants demonstrated more negative amygdala-to-vmPFC connectivity, compared to HC participants, an effect that was correlated with SAD symptom severity. Post-treatment symptom reduction was correlated with altered amygdala-to-vm/vlPFC connectivity, independent of treatment type. Greater symptom reduction was associated with more negative amygdala-to-vm/vlPFC connectivity. These findings suggest that effective psychological treatment for SAD enhances amygdala-prefrontal functional connectivity.
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Affiliation(s)
- Katherine S Young
- Department of Psychology, University of California, 405 Hilgard Avenue, Los Angeles, CA 90095-1563, USA
| | - Lisa J Burklund
- Department of Psychology, University of California, 405 Hilgard Avenue, Los Angeles, CA 90095-1563, USA
| | - Jared B Torre
- Department of Psychology, University of California, 405 Hilgard Avenue, Los Angeles, CA 90095-1563, USA
| | - Darby Saxbe
- Department of Psychology, University of Southern California, Los Angeles, CA, USA
| | - Matthew D Lieberman
- Department of Psychology, University of California, 405 Hilgard Avenue, Los Angeles, CA 90095-1563, USA
| | - Michelle G Craske
- Department of Psychology, University of California, 405 Hilgard Avenue, Los Angeles, CA 90095-1563, USA.
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Burklund LJ, Torre JB, Lieberman MD, Taylor SE, Craske MG. Neural responses to social threat and predictors of cognitive behavioral therapy and acceptance and commitment therapy in social anxiety disorder. Psychiatry Res 2017; 261:52-64. [PMID: 28129556 PMCID: PMC5435374 DOI: 10.1016/j.pscychresns.2016.12.012] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [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: 08/20/2015] [Revised: 12/19/2016] [Accepted: 12/27/2016] [Indexed: 02/08/2023]
Abstract
Previous research has often highlighted hyperactivity in emotion regions to simple, static social threat cues in social anxiety disorder (SAD). Investigation of the neurobiology of SAD using more naturalistic paradigms can further reveal underlying mechanisms and how these relate to clinical outcomes. We used fMRI to investigate responses to novel dynamic rejection stimuli in individuals with SAD (N=70) and healthy controls (HC; N=17), and whether these responses predicted treatment outcomes following cognitive behavioral therapy (CBT) or acceptance and commitment therapy (ACT). Both HC and SAD groups reported greater distress to rejection compared to neutral social stimuli. At the neural level, HCs exhibited greater activations in social pain/rejection regions, including dorsal anterior cingulate cortex and anterior insula, to rejection stimuli. The SAD group evidenced a different pattern, with no differences in these rejection regions and relatively greater activations in the amygdala and other regions to neutral stimuli. Greater responses in anterior cingulate cortex and the amygdala to rejection vs. neutral stimuli predicted better CBT outcomes. In contrast, enhanced activity in sensory-focused posterior insula predicted ACT responses.
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Affiliation(s)
- Lisa J Burklund
- University of California Los Angeles, Department of Psychology, Los Angeles, CA 90095-1563, United States.
| | - Jared B Torre
- University of California Los Angeles, Department of Psychology, Los Angeles, CA 90095-1563, United States
| | - Matthew D Lieberman
- University of California Los Angeles, Department of Psychology, Los Angeles, CA 90095-1563, United States
| | - Shelley E Taylor
- University of California Los Angeles, Department of Psychology, Los Angeles, CA 90095-1563, United States
| | - Michelle G Craske
- University of California Los Angeles, Department of Psychology, Los Angeles, CA 90095-1563, United States
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38
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Åhs F, Gingnell M, Furmark T, Fredrikson M. Within-session effect of repeated stress exposure on extinction circuitry function in social anxiety disorder. Psychiatry Res Neuroimaging 2017; 261:85-90. [PMID: 28167379 DOI: 10.1016/j.pscychresns.2017.01.009] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Revised: 01/20/2017] [Accepted: 01/26/2017] [Indexed: 01/30/2023]
Abstract
Anxiety reduction following repeated exposure to stressful experiences is generally held to depend on neural processes involved in extinction of conditioned fear. We predicted that repeated exposure to stressful experiences would change activity throughout the circuitry serving extinction, including ventromedial prefrontal cortex (vmPFC), the hippocampus and the amygdala. To test this prediction, 36 participants diagnosed with SAD performed two successive speeches in front of an observing audience while regional cerebral blood flow (rCBF) was recorded using positron emission tomography. To control for non-anxiolytic effects of repeated exposure, rCBF was also measured during repeated presentations of neutral and angry facial expressions. Results showed that anxiety ratings and heart rate decreased from the first to the second speech, indicating an anxiolytic effect of repeated exposure. Exposure attenuated rCBF in the amygdala whereas no change in rCBF was observed in the vmPFC or hippocampus. The rCBF-reductions in the amygdala were greater following repetition of the speech task than repetition of face exposure indicating that they were specific to anxiety attenuation and not due to a reduced novelty. Our findings suggest that amygdala-related attenuation processes are key to understanding the working mechanisms of exposure therapy.
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Affiliation(s)
- Fredrik Åhs
- Department of Psychology, Uppsala University, Uppsala, Sweden; Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
| | - Malin Gingnell
- Department of Psychology, Uppsala University, Uppsala, Sweden; Department of Women's and Children's Health, Obstetrics and Gynaecology, Uppsala University, Uppsala, Sweden
| | - Tomas Furmark
- Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Mats Fredrikson
- Department of Psychology, Uppsala University, Uppsala, Sweden; Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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Feldker K, Heitmann CY, Neumeister P, Tupak SV, Schrammen E, Moeck R, Zwitserlood P, Bruchmann M, Straube T. Transdiagnostic brain responses to disorder-related threat across four psychiatric disorders. Psychol Med 2017; 47:730-743. [PMID: 27869064 DOI: 10.1017/s0033291716002634] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND There is an ongoing debate whether transdiagnostic neural mechanisms are shared by different anxiety-related disorders or whether different disorders show distinct neural correlates. To investigate this issue, studies controlling for design and stimuli across multiple anxiety-related disorders are needed. METHOD The present functional magnetic resonance imaging study investigated neural correlates of visual disorder-related threat processing across unmedicated patients suffering from panic disorder (n = 20), social anxiety disorder (n = 20), dental phobia (n = 16) and post-traumatic stress disorder (n = 11) relative to healthy controls (HC; n = 67). Each patient group and the corresponding HC group saw a tailor-made picture set with 50 disorder-related and 50 neutral scenes. RESULTS Across all patients, increased activation to disorder-related v. neutral scenes was found in subregions of the bilateral amygdala. In addition, activation of the lateral amygdala to disorder-related v. neutral scenes correlated positively with subjective anxiety ratings of scenes across patients. Furthermore, whole-brain analysis revealed increased responses to disorder-related threat across the four disorders in middle, medial and superior frontal regions, (para-)limbic regions, such as the insula and thalamus, as well as in the brainstem and occipital lobe. We found no disorder-specific brain responses. CONCLUSIONS The results suggest that pathologically heightened lateral amygdala activation is linked to experienced anxiety across anxiety disorders and trauma- and stressor-related disorders. Furthermore, the transdiagnostically shared activation network points to a common neural basis of abnormal responses to disorder-related threat stimuli across the four investigated disorders.
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Affiliation(s)
- K Feldker
- University Hospital Muenster, Institute of Medical Psychology and Systems Neuroscience,Muenster,Germany
| | - C Y Heitmann
- University Hospital Muenster, Institute of Medical Psychology and Systems Neuroscience,Muenster,Germany
| | - P Neumeister
- University Hospital Muenster, Institute of Medical Psychology and Systems Neuroscience,Muenster,Germany
| | - S V Tupak
- University Hospital Muenster, Institute of Medical Psychology and Systems Neuroscience,Muenster,Germany
| | - E Schrammen
- University Hospital Muenster, Institute of Medical Psychology and Systems Neuroscience,Muenster,Germany
| | - R Moeck
- University Hospital Muenster, Institute of Medical Psychology and Systems Neuroscience,Muenster,Germany
| | | | - M Bruchmann
- University Hospital Muenster, Institute of Medical Psychology and Systems Neuroscience,Muenster,Germany
| | - T Straube
- University Hospital Muenster, Institute of Medical Psychology and Systems Neuroscience,Muenster,Germany
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40
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A. Richey J, Ghane M, Valdespino A, Coffman MC, Strege MV, White SW, Ollendick TH. Spatiotemporal dissociation of brain activity underlying threat and reward in social anxiety disorder. Soc Cogn Affect Neurosci 2017; 12:81-94. [PMID: 27798252 PMCID: PMC5390704 DOI: 10.1093/scan/nsw149] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Revised: 09/12/2016] [Accepted: 10/04/2016] [Indexed: 11/26/2022] Open
Abstract
Social anxiety disorder (SAD) involves abnormalities in social motivation, which may be independent of well-documented differences in fear and arousal systems. Yet, the neurobiology underlying motivational difficulties in SAD is not well understood. The aim of the current study was to spatiotemporally dissociate reward circuitry dysfunction from alterations in fear and arousal-related neural activity during anticipation and notification of social and non-social reward and punishment. During fMRI acquisition, non-depressed adults with social anxiety disorder (SAD; N = 21) and age-, sex- and IQ-matched control subjects (N = 22) completed eight runs of an incentive delay task, alternating between social and monetary outcomes and interleaved in alternating order between gain and loss outcomes. Adults with SAD demonstrated significantly reduced neural activity in ventral striatum during the anticipation of positive but not negative social outcomes. No differences between the SAD and control groups were observed during anticipation of monetary gain or loss outcomes or during anticipation of negative social images. However, consistent with previous work, the SAD group demonstrated amygdala hyper-activity upon notification of negative social outcomes. Degraded anticipatory processing in bilateral ventral striatum in SAD was constrained exclusively to anticipation of positive social information and dissociable from the effects of negative social outcomes previously observed in the amygdala. Alterations in anticipation-related neural signals may represent a promising target for treatment that is not addressed by available evidence-based interventions, which focus primarily on fear extinction and habituation processes.
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Affiliation(s)
- John A. Richey
- Department of Psychology, Virginia Tech., 109 Williams Hall, MC0436 Blacksburg, VA 24061, USA
| | - Merage Ghane
- Department of Psychology, Virginia Tech., 109 Williams Hall, MC0436 Blacksburg, VA 24061, USA
| | - Andrew Valdespino
- Department of Psychology, Virginia Tech., 109 Williams Hall, MC0436 Blacksburg, VA 24061, USA
| | - Marika C. Coffman
- Department of Psychology, Virginia Tech., 109 Williams Hall, MC0436 Blacksburg, VA 24061, USA
| | - Marlene V. Strege
- Department of Psychology, Virginia Tech., 109 Williams Hall, MC0436 Blacksburg, VA 24061, USA
| | - Susan W. White
- Department of Psychology, Virginia Tech., 109 Williams Hall, MC0436 Blacksburg, VA 24061, USA
- Virginia Tech Child Study Center, Suite 207, Turner St, Blacksburg, VA 24061, USA
| | - Thomas H. Ollendick
- Department of Psychology, Virginia Tech., 109 Williams Hall, MC0436 Blacksburg, VA 24061, USA
- Virginia Tech Child Study Center, Suite 207, Turner St, Blacksburg, VA 24061, USA
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41
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Kawashima C, Tanaka Y, Inoue A, Nakanishi M, Okamoto K, Maruyama Y, Oshita H, Ishitobi Y, Aizawa S, Masuda K, Higuma H, Kanehisa M, Ninomiya T, Akiyoshi J. Hyperfunction of left lateral prefrontal cortex and automatic thoughts in social anxiety disorder: A near-infrared spectroscopy study. J Affect Disord 2016; 206:256-260. [PMID: 27517133 DOI: 10.1016/j.jad.2016.07.028] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Accepted: 07/17/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND Patients with social anxiety disorder (SAD) experience unusual fear in normal social situations. The verbal fluency task (VFT) was administered while subjects were undergoing near-infrared spectroscopy (NIRS) scanning. The purpose of VFT was to examine the functions of the frontal and temporal lobes. METHODS Subjects included 145 drug-naïve patients with SAD and 152 healthy controls (HCs). All subjects underwent psychological testing to determine levels of anxiety and depression and to evaluate cognition. RESULTS The scores of patients with SAD indicated significantly higher anxiety and depressive states than those in HCs on several measures: Leibowitz Social Anxiety Scale (LSAS), Profile of Mood States (POMS), Spielberger Anxiety Inventory (STAI), Beck Depression Inventory (BDI), and Social Adaptation Self-evaluation Scale (SASS). The patients with SAD also had higher scores on the future denial, threat prediction, self-denial, past denial, and interpersonal threat sections of the Depression and Anxiety Cognition Scale (DACS). NIRS scanning revealed hyperactivity in the left frontal cortex of patients with SAD. Threat prediction scores on DACS were negatively correlated with oxy-Hb responses in the right frontal cortex. LIMITATIONS Further studies with a larger sample size are required to verify our findings. CONCLUSIONS The results of this study demonstrate the different mechanisms of the right and left frontal cortex in situations of social anxiety disorder.
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Affiliation(s)
- Chiwa Kawashima
- Department of Neuropsychiatry, Oita University Faculty of Medicine, Hasama-Machi, Oita 879-5593, Japan
| | - Yoshihiro Tanaka
- Department of Neuropsychiatry, Oita University Faculty of Medicine, Hasama-Machi, Oita 879-5593, Japan
| | - Ayako Inoue
- Department of Neuropsychiatry, Oita University Faculty of Medicine, Hasama-Machi, Oita 879-5593, Japan
| | - Mari Nakanishi
- Department of Neuropsychiatry, Oita University Faculty of Medicine, Hasama-Machi, Oita 879-5593, Japan
| | - Kana Okamoto
- Department of Neuropsychiatry, Oita University Faculty of Medicine, Hasama-Machi, Oita 879-5593, Japan
| | - Yoshihiro Maruyama
- Department of Neuropsychiatry, Oita University Faculty of Medicine, Hasama-Machi, Oita 879-5593, Japan
| | - Harumi Oshita
- Department of Applied Linguistics, Oita University Faculty of Medicine, Hasama-Machi, Oita 879-5593, Japan
| | - Yoshinobu Ishitobi
- Department of Neuropsychiatry, Oita University Faculty of Medicine, Hasama-Machi, Oita 879-5593, Japan
| | - Saeko Aizawa
- Department of Neuropsychiatry, Oita University Faculty of Medicine, Hasama-Machi, Oita 879-5593, Japan
| | - Koji Masuda
- Department of Neuropsychiatry, Oita University Faculty of Medicine, Hasama-Machi, Oita 879-5593, Japan
| | - Haruka Higuma
- Department of Neuropsychiatry, Oita University Faculty of Medicine, Hasama-Machi, Oita 879-5593, Japan
| | - Masayuki Kanehisa
- Department of Neuropsychiatry, Oita University Faculty of Medicine, Hasama-Machi, Oita 879-5593, Japan
| | - Taiga Ninomiya
- Department of Neuropsychiatry, Oita University Faculty of Medicine, Hasama-Machi, Oita 879-5593, Japan
| | - Jotaro Akiyoshi
- Department of Neuropsychiatry, Oita University Faculty of Medicine, Hasama-Machi, Oita 879-5593, Japan.
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42
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Doruyter A, Lochner C, Jordaan GP, Stein DJ, Dupont P, Warwick JM. Resting functional connectivity in social anxiety disorder and the effect of pharmacotherapy. Psychiatry Res Neuroimaging 2016; 251:34-44. [PMID: 27111811 DOI: 10.1016/j.pscychresns.2016.04.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Revised: 02/11/2016] [Accepted: 04/14/2016] [Indexed: 11/28/2022]
Abstract
Neuroimaging research has reported differences in resting-state functional connectivity (RFC) between social anxiety disorder (SAD) patients and healthy controls (HCs). Limited research has examined the effect of treatment on RFC in SAD. We performed a study to identify differences in RFC between SAD and HC groups, and to investigate the effect of pharmacotherapy on RFC in SAD. Seed-based RFC analysis was performed on technetium-99m hexamethylpropylene amine oxime (Tc-99m HMPAO) SPECT scans using a cross-subject approach in SPM-12. Seeds were chosen to represent regions in a recently published network model of SAD. A second-level regression analysis was performed to further characterize the underlying relationships identified in the group contrasts. Twenty-three SAD participants were included, of which 18 underwent follow-up measures after an 8-week course of citalopram or moclobemide. Fifteen healthy control (HC) scans were included. SAD participants at baseline demonstrated several significant connectivity disturbances consistent with the existing network model as well as one previously unreported finding (increased connectivity between cerebellum and posterior cingulate cortex). After therapy, the SAD group demonstrated significant increases in connectivity with dorsal anterior cingulate cortex which may explain therapy-induced modifications in how SAD sufferers interpret emotions in others and improvements in self-related and emotional processing.
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Affiliation(s)
- Alexander Doruyter
- Division of Nuclear Medicine, Faculty of Health Sciences, Stellenbosch University, Cape Town, South Africa.
| | - Christine Lochner
- US/UCT MRC Unit for Stress and Anxiety Disorders, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Gerhard P Jordaan
- Department of Psychiatry, Faculty of Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Dan J Stein
- US/UCT MRC Unit for Stress and Anxiety Disorders, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Patrick Dupont
- Laboratory for Cognitive Neurology and Medical Imaging Centre, KU Leuven, Leuven, Belgium
| | - James M Warwick
- Division of Nuclear Medicine, Faculty of Health Sciences, Stellenbosch University, Cape Town, South Africa
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Heitmann CY, Feldker K, Neumeister P, Zepp BM, Peterburs J, Zwitserlood P, Straube T. Abnormal brain activation and connectivity to standardized disorder-related visual scenes in social anxiety disorder. Hum Brain Mapp 2016; 37:1559-72. [PMID: 26806013 PMCID: PMC6867294 DOI: 10.1002/hbm.23120] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Revised: 01/07/2016] [Accepted: 01/07/2016] [Indexed: 11/09/2022] Open
Abstract
Our understanding of altered emotional processing in social anxiety disorder (SAD) is hampered by a heterogeneity of findings, which is probably due to the vastly different methods and materials used so far. This is why the present functional magnetic resonance imaging (fMRI) study investigated immediate disorder-related threat processing in 30 SAD patients and 30 healthy controls (HC) with a novel, standardized set of highly ecologically valid, disorder-related complex visual scenes. SAD patients rated disorder-related as compared with neutral scenes as more unpleasant, arousing and anxiety-inducing than HC. On the neural level, disorder-related as compared with neutral scenes evoked differential responses in SAD patients in a widespread emotion processing network including (para-)limbic structures (e.g. amygdala, insula, thalamus, globus pallidus) and cortical regions (e.g. dorsomedial prefrontal cortex (dmPFC), posterior cingulate cortex (PCC), and precuneus). Functional connectivity analysis yielded an altered interplay between PCC/precuneus and paralimbic (insula) as well as cortical regions (dmPFC, precuneus) in SAD patients, which emphasizes a central role for PCC/precuneus in disorder-related scene processing. Hyperconnectivity of globus pallidus with amygdala, anterior cingulate cortex (ACC) and medial prefrontal cortex (mPFC) additionally underlines the relevance of this region in socially anxious threat processing. Our findings stress the importance of specific disorder-related stimuli for the investigation of altered emotion processing in SAD. Disorder-related threat processing in SAD reveals anomalies at multiple stages of emotion processing which may be linked to increased anxiety and to dysfunctionally elevated levels of self-referential processing reported in previous studies.
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Affiliation(s)
- Carina Yvonne Heitmann
- Institute of Medical Psychology and Systems Neuroscience, University of Muenster, MuensterGermany
| | - Katharina Feldker
- Institute of Medical Psychology and Systems Neuroscience, University of Muenster, MuensterGermany
| | - Paula Neumeister
- Institute of Medical Psychology and Systems Neuroscience, University of Muenster, MuensterGermany
| | - Britta Maria Zepp
- Institute of Medical Psychology and Systems Neuroscience, University of Muenster, MuensterGermany
| | - Jutta Peterburs
- Institute of Medical Psychology and Systems Neuroscience, University of Muenster, MuensterGermany
| | | | - Thomas Straube
- Institute of Medical Psychology and Systems Neuroscience, University of Muenster, MuensterGermany
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