Salivary Testosterone Is Consistently and Positively Associated with Extraversion: Results from The Netherlands Study of Depression and Anxiety

BACKGROUND

Testosterone has been postulated as a 'social' hormone, but the relationship between testosterone and personality traits linked with socially oriented behaviors such as extraversion remains unclear. The objective of our study was to investigate the association between baseline salivary testosterone levels and the Big Five personality traits.

METHODS

We studied the relationship between salivary testosterone (morning and evening) and NEO-FFI (Five-Factor Inventory) personality traits in 1,611 participants with lifetime or current depression and/or anxiety and 482 participants without depression/anxiety of the Netherlands Study of Depression and Anxiety (NESDA).

RESULTS

The personality domain of extraversion was independently associated with higher salivary testosterone, both in healthy subjects (β = 0.094; p = 0.04) and in subjects with lifetime or current depression and/or anxiety (β = 0.092; p < 0.001). In multivariable adjusted analyses, extraversion remained the only personality trait that was positively associated with salivary testosterone (β = 0.079; p = 0.006).

CONCLUSION

We conclude that salivary testosterone is consistently and positively related to extraversion, supporting the notion of a hormonal basis of this personality trait, which may be linked to the tendency to strive for and maintain social status. © 2015 S. Karger AG, Basel.

Attention and postural control in patients with conversion paresis

OBJECTIVE

Current theories of conversion disorder (CD) propose that motor symptoms are related to heightened self-monitoring and excessive cognitive control of movements. We tested this hypothesis using quantification of performance on a continuous perceptuo-motor task involving quiet standing.

METHODS

Twelve CD patients and matched controls maintained static balance on a force platform under various attention conditions: (1) with eyes open; (2) with eyes closed (requiring enhanced attention to proprioceptive information to regulate posture); and (3) while performing an attention demanding cognitive task.

RESULTS

Compared to controls, CD patients displayed a greater decrease in postural stability in the 'eyes-closed' versus 'eyes-open' condition. In contrast, cognitive distraction led to a normalization of balance in CD. Moreover, sensitivity to the balance interventions correlated significantly with trauma reports and dissociative symptoms.

CONCLUSION

These results indicate that attention plays a crucial role in postural control in CD. More specifically, patients seem to inadvertently use deliberate control of posture (i.e., cognitive investment) of an otherwise nearly automatized perceptuo-motor task. Attentional distraction resulted in a temporary normalization of balance, which may be used to train individuals with CD to guide their attention in a more effective way.

Neural sensitivity to social reward and punishment anticipation in social anxiety disorder

An imbalance in the neural motivational system may underlie Social Anxiety Disorder (SAD). This study examines social reward and punishment anticipation in SAD, predicting a valence-specific effect: increased striatal activity for punishment avoidance compared to obtaining a reward. Individuals with SAD (n = 20) and age, gender, and education case-matched controls (n = 20) participated in a functional magnetic resonance imaging (fMRI) study. During fMRI scanning, participants performed a Social Incentive Delay (SID) task to measure the anticipation of social reward and punishment. The left putamen (part of the striatum) showed a valence-specific interaction with group after correcting for medication use and comorbidity. The control group showed a relatively stronger activation for reward vs. punishment trials, compared to the social anxiety group. However, post-hoc pairwise comparisons were not significant, indicating that the effect is driven by a relative difference. A connectivity analysis (Psychophysiological interaction) further revealed a general salience effect: SAD patients showed decreased putamen-ACC connectivity compared to controls for both reward and punishment trials. Together these results suggest that the usual motivational preference for social reward is absent in SAD. In addition, cortical control processes during social incentive anticipation may be disrupted in SAD. These results provide initial evidence for altered striatal involvement in both valence-specific and valence-nonspecific processing of social incentives, and stress the relevance of taking motivational processes into account when studying social anxiety.

Individual differences in bodily freezing predict emotional biases in decision making

Instrumental decision making has long been argued to be vulnerable to emotional responses. Literature on multiple decision making systems suggests that this emotional biasing might reflect effects of a system that regulates innately specified, evolutionarily preprogrammed responses. To test this hypothesis directly, we investigated whether effects of emotional faces on instrumental action can be predicted by effects of emotional faces on bodily freezing, an innately specified response to aversive relative to appetitive cues. We tested 43 women using a novel emotional decision making task combined with posturography, which involves a force platform to detect small oscillations of the body to accurately quantify postural control in upright stance. On the platform, participants learned whole body approach-avoidance actions based on monetary feedback, while being primed by emotional faces (angry/happy). Our data evidence an emotional biasing of instrumental action. Thus, angry relative to happy faces slowed instrumental approach relative to avoidance responses. Critically, individual differences in this emotional biasing effect were predicted by individual differences in bodily freezing. This result suggests that emotional biasing of instrumental action involves interaction with a system that controls innately specified responses. Furthermore, our findings help bridge (animal and human) decision making and emotion research to advance our mechanistic understanding of decision making anomalies in daily encounters as well as in a wide range of psychopathology.

Alleviating social avoidance: effects of single dose testosterone administration on approach-avoidance action

Testosterone is an important regulator of social-motivational behavior and is known for its dominance-enhancing and social-anxiolytic properties. However, to date no studies have systematically investigated the causal effect of testosterone on actual social approach-avoidance behavior in humans. The present study sets out to test the effects of testosterone administration in healthy female volunteers using an objective implicit measure of social motivational behavior: the social Approach-Avoidance Task, a reaction time task requiring participants to approach or avoid visually presented emotional (happy, angry, and neutral) faces. Participants showed significantly diminished avoidance tendencies to angry faces after testosterone administration. Testosterone did not affect approach-avoidance tendencies to social affiliation (happy) faces. Thus, a single dose testosterone administration reduces automatic avoidance of social threat and promotes relative increase of threat approach tendencies in healthy females. These findings further the understanding of the neuroendocrine regulation of social motivational behavior and may have direct treatment implications for social anxiety, characterized by persistent social avoidance.

Social embodiment in directional stepping behavior

Embodiment theories emphasize the role played by sensory and motor processes in psychological states, such as social information processing. Motivated by this idea, we examined how whole-body postural behaviors couple to social affective cues, viz., pictures of smiling and angry faces. We adopted a Simon-like paradigm, whereby healthy female volunteers were asked to select and initiate a forward or backward step on a force plate in response to the gender of the poser (male/female), regardless of emotion. Detailed analysis of the spatiotemporal unfolding of the body center of pressure during the steps revealed that task-irrelevant emotion had no effect on the initiation times of the steps, i.e., there was no evidence of an affective Simon effect. An unexpected finding was that steps were initiated relatively slow in response to female angry faces. This Stroop-like effect suggests that postural behavior is influenced by whether certain stimulus features match or mismatch.

Emotional signals from faces, bodies and scenes influence observers' face expressions, fixations and pupil-size

We receive emotional signals from different sources, including the face, the whole body, and the natural scene. Previous research has shown the importance of context provided by the whole body and the scene on the recognition of facial expressions. This study measured physiological responses to face-body-scene combinations. Participants freely viewed emotionally congruent and incongruent face-body and body-scene pairs whilst eye fixations, pupil-size, and electromyography (EMG) responses were recorded. Participants attended more to angry and fearful vs. happy or neutral cues, independent of the source and relatively independent from whether the face body and body scene combinations were emotionally congruent or not. Moreover, angry faces combined with angry bodies and angry bodies viewed in aggressive social scenes elicited greatest pupil dilation. Participants' face expressions matched the valence of the stimuli but when face-body compounds were shown, the observed facial expression influenced EMG responses more than the posture. Together, our results show that the perception of emotional signals from faces, bodies and scenes depends on the natural context, but when threatening cues are presented, these threats attract attention, induce arousal, and evoke congruent facial reactions.

Testosterone Inhibits Trust but Promotes Reciprocity

The steroid hormone testosterone has been associated with behavior intended to obtain or maintain high social status. Although such behavior is typically characterized as aggressive and competitive, it is clear that high social status is achieved and maintained not only through antisocial behavior but also through prosocial behavior. In the present experiment, we investigated the impact of testosterone administration on trust and reciprocity using a double-blind randomized control design. We found that a single dose of 0.5 mg of testosterone decreased trust but increased generosity when repaying trust. These findings suggest that testosterone may mediate different types of status-seeking behavior. It may increase competitive, potentially aggressive, and antisocial behavior when social challenges and threats (i.e., abuse of trust and betrayal) need to be considered; however, it may promote prosocial behavior in the absence of these threats, when high status and good reputation may be best served by prosocial behavior.

Aversive disinhibition of behavior and striatal signaling in social avoidance

Social avoidance is a major factor contributing to the development and maintenance of anxiety and depressive symptoms. Converging evidence suggests that social avoidance is associated with abnormal aversive processing and hyperactive amygdala signaling. However, what are the consequences of such abnormal aversive processing for action and for the neural mechanisms implementing action is unclear. Existing literature is conflicting, pointing at either enhanced or reduced action inhibition. We investigated the interaction between aversion and action in social avoidance by comparing the effects of aversive vs appetitive faces on a go/no-go task and associated striatal signals in 42 high and low socially avoidant individuals. We combined fMRI with a novel probabilistic learning task, in which emotional valence (angry and happy faces) and optimal response (go- and no-go-responses) were manipulated independently. High compared with low socially avoidant individuals showed reduced behavioral inhibition (proportion no-go-responses) for angry relative to happy faces. This behavioral disinhibition correlated with greater striatal signal during no-go-responses for angry relative to happy faces. The results suggest that social avoidant coping style is accompanied by disinhibition of action and striatal signal in the context of social threat. The findings concur with recent theorizing about aversive disinhibition and affective disorders.

Amygdala activation and its functional connectivity during perception of emotional faces in social phobia and panic disorder

Social phobia (SP) and panic disorder (PD) have been associated with aberrant amygdala responses to threat-related stimuli. The aim of the present study was to examine amygdala function and its connectivity with medial prefrontal cortex (mPFC) during emotional face perception in PD and SP, and the role of illness severity. Blood oxygen level dependent responses while perceiving emotional facial expressions were compared in 14 patients with PD, 17 patients with SP, 8 patients with comorbid PD and SP, and 16 healthy controls. We found that PD, but not SP, was associated with amygdala and lingual gyrus hypoactivation during perception of angry, fearful, happy and neutral faces, compared to healthy participants. No significant effect of PD and SP diagnoses was found on amygdala-mPFC connectivity. A positive correlation of anxiety symptom severity was found on amygdala-dorsal anterior cingulate and dorsal mPFC connectivity during perception of fearful faces. Amygdala hypoactivation suggests reduced responsiveness to positive and negative emotional faces in PD. Symptom severity, but not the presence of PD and SP diagnosis per se, explains most of the abnormalities in amygdala-mPFC connectivity during perception of fearful faces.

Human freezing in response to affective films

Human freezing has been objectively assessed using a passive picture viewing paradigm as an analog for threat. These results should be replicated for other stimuli in order to determine their stability and generalizability. Affective films are used frequently to elicit affective responses, but it is unknown whether they also elicit freezing-like defense responses. To test whether this is the case, 50 participants watched neutral, pleasant and unpleasant film fragments while standing on a stabilometric platform and wearing a polar band to assess heart rate. Freezing-like responses (indicated by overall reduced body sway and heart rate deceleration) were observed for the unpleasant film only. The unpleasant film also elicited early reduced body sway (1-2 s after stimulus onset). Heart rate and body sway were correlated during the unpleasant film only. The results suggest that ecologically valid stimuli like films are adequate stimuli in evoking defense responses. The results also underscore the importance of including time courses in human experimental research on defense reactions in order to delineate different stages in the defense response.

Acting on Anger

Oxytocin attenuates responses to stress and threat (e.g., by fostering social approach in animals), but direct investigations of whether the hormone also facilitates approach-related social behaviors in humans are lacking. To assess approach-avoidance tendencies, we had participants respond to images of happy and angry faces with direct or averted gaze by either pulling a joystick toward themselves (approach) or pushing it away from themselves (avoidance). When given a placebo, participants’ action tendencies were typical, with happy faces eliciting approach responses and angry faces eliciting avoidance responses. However, 24 IU of oxytocin moderated these tendencies, with the inclination to approach angry faces with direct gaze being negatively related to social anxiety. The results demonstrate that oxytocin facilitates approach in humans in response to social threat, which verifies its anxiolytic potential. Moreover, they underscore the moderating role of dispositional factors reported in endocrine research and their therapeutic implications.

Cortisol reactivity and distress-induced emotional eating

Animal studies suggest a relationship between blunted HPA-axis stress reactivity and increased stress-induced food intake in chronically stressed animals. Such a relationship can potentially explain the underlying mechanisms of emotional eating in humans. However, no studies have experimentally tested the relationship between stress-induced cortisol responses and acute food intake in high and low emotional eaters. We studied these effects in 46 female students that were preselected on the basis of extremely high (HEE) or low (LEE) scores on an emotional eating questionnaire. Using a within subject design we measured the difference of actual food intake after a control or a stress task (Trier Social Stress Test). The HEE and LEE groups did not differ in their cortisol stress reactivity but emotional eating significantly moderated the relationship between cortisol stress reactivity and the difference of food intake after stress vs control. Whereas HEE participants with a blunted cortisol stress response ate more food after distress than those with an elevated cortisol stress response, LEE participants showed no such relationship. These findings support the relevance of an animal based model on the relationship between a blunted cortisol stress response and increased stress-induced food intake for human high emotional eaters.

Perception of face and body expressions using electromyography, pupillometry and gaze measures

Traditional emotion theories stress the importance of the face in the expression of emotions but bodily expressions are becoming increasingly important as well. In these experiments we tested the hypothesis that similar physiological responses can be evoked by observing emotional face and body signals and that the reaction to angry signals is amplified in anxious individuals. We designed three experiments in which participants categorized emotional expressions from isolated facial and bodily expressions and emotionally congruent and incongruent face-body compounds. Participants’ fixations were measured and their pupil size recorded with eye-tracking equipment and their facial reactions measured with electromyography. The results support our prediction that the recognition of a facial expression is improved in the context of a matching posture and importantly, vice versa as well. From their facial expressions, it appeared that observers acted with signs of negative emotionality (increased corrugator activity) to angry and fearful facial expressions and with positive emotionality (increased zygomaticus) to happy facial expressions. What we predicted and found, was that angry and fearful cues from the face or the body, attracted more attention than happy cues. We further observed that responses evoked by angry cues were amplified in individuals with high anxiety scores. In sum, we show that people process bodily expressions of emotion in a similar fashion as facial expressions and that the congruency between the emotional signals from the face and body facilitates the recognition of the emotion.

Recent advances in the brain imaging of social anxiety disorder

Social anxiety disorder (SAD) is one of the most common and disabling anxiety disorders, yet much remains to be learned about its psychobiology. Although functional imaging has emphasized the role of the amygdala and other limbic structures in the neurobiology of SAD, structural and connectivity imaging techniques have emphasized the possibility of abnormalities in other regions and in whole-brain networks. The involvement of a broad range of networks in SAD is consistent with current understandings of the neuroanatomy of emotion and of social processing.

Psychopaths lack the automatic avoidance of social threat: relation to instrumental aggression

Psychopathy (PP) is associated with marked abnormalities in social emotional behaviour, such as high instrumental aggression (IA). A crucial but largely ignored question is whether automatic social approach-avoidance tendencies may underlie this condition. We tested whether offenders with PP show lack of automatic avoidance tendencies, usually activated when (healthy) individuals are confronted with social threat stimuli (angry faces). We applied a computerized approach-avoidance task (AAT), where participants pushed or pulled pictures of emotional faces using a joystick, upon which the faces decreased or increased in size, respectively. Furthermore, participants completed an emotion recognition task which was used to control for differences in recognition of facial emotions. In contrast to healthy controls (HC), PP patients showed total absence of avoidance tendencies towards angry faces. Interestingly, those responses were related to levels of instrumental aggression and the (in)ability to experience personal distress (PD). These findings suggest that social performance in psychopaths is disturbed on a basic level of automatic action tendencies. The lack of implicit threat avoidance tendencies may underlie their aggressive behaviour.

Endogenous and exogenous attention in patients with conversion paresis

Endogenous and exogenous attention of patients with conversion paresis was investigated using Posner's 'covert orienting of visual attention' task. In the light of previous evidence showing that inhibition of higher-level control functions plays a role in conversion paralysis (e.g., Marshall, Halligan, Fink, Wade, & Frackowiak, 1997), patients were expected to display weaker cue effects in the endogenous condition and weaker inhibition of return (IOR) in the exogenous condition. Eight patients with conversion paresis in one or more limbs and eight healthy controls were administered the attention task in a verbal response condition and in a limb response condition in which subjects responded with each limb separately. When responding verbally, patients showed relatively weakened endogenous cue effects on a 150-ms stimulus onset asynchronicity (SOA) and no IOR in the exogenous condition. Comparable effects emerged when patients responded with affected limbs but not when they responded with unaffected limbs. The findings suggest impairment in voluntary attention. High-level inhibition is suggested to interfere with the orientation to stimuli that prime responses with affected limbs. The fact that similar results were found for verbal responses is interpreted as supporting the view that attention deficits are manifested on a high, abstract level of cognitive processing.

Salivary testosterone: associations with depression, anxiety disorders, and antidepressant use in a large cohort study

OBJECTIVE

Low circulating levels of testosterone have been associated with major depression, but there is more limited evidence for differences in patients with anxiety disorders. The use of selective serotonin reuptake inhibitors (SSRIs) and other antidepressants is associated with sexual side effects, warranting testing for interactions with testosterone.

METHODS

Data are from 722 male and 1380 female participants of The Netherlands Study of Depression and Anxiety (NESDA), who were recruited from the community, general practice care, and specialized mental health care. Depressive and anxiety diagnoses were assessed using the DSM-IV Composite International Diagnostic Interview. To smooth the episodic secretion, the four morning saliva samples per participant and the two evening samples were pooled before testosterone analysis.

RESULTS

Morning median testosterone levels were 25.2 pg/ml in men and 16.2 pg/ml in women, with lower evening levels of 18.2 and 14.1 pg/ml, respectively. Significant determinants of testosterone levels were sex, age, time of the day, use of contraceptives, and smoking status. Female patients with a current (1-month) depressive disorder (effect size 0.29; P=0.002), generalized anxiety disorder (0.25; P=0.01), social phobia (0.30; P<0.001), and agoraphobia without panic disorder (0.30; P=0.02) had lower salivary testosterone levels than female controls. Higher testosterone levels were found in male and female participants using SSRIs than in non-users (effect size 0.26; P<0.001).

CONCLUSION

Salivary testosterone levels are lower in female patients with a depressive disorder, generalized anxiety disorder, social phobia, and agoraphobia as compared to female controls. SSRIs may increase salivary testosterone in men and women.

Extraversion is linked to volume of the orbitofrontal cortex and amygdala

Neuroticism and extraversion are personality factors associated with the vulnerability for developing depression and anxiety disorders, and are possibly differentially related to brain structures implicated in the processing of emotional information and the generation of mood states. To date, studies on brain morphology mainly focused on neuroticism, a dimension primarily related to negative affect, yielding conflicting findings concerning the association with personality, partially due to methodological issues and variable population samples under study. Recently, extraversion, a dimension primarily related to positive affect, has been repeatedly inversely related to with symptoms of depression and anxiety disorders. In the present study, high resolution structural T1-weighted MR images of 65 healthy adults were processed using an optimized Voxel Based Morphometry (VBM) approach. Multiple regression analyses were performed to test for associations of neuroticism and extraversion with prefrontal and subcortical volumes. Orbitofrontal and right amygdala volume were both positively related to extraversion. Extraversion was differentially related to volume of the anterior cingulate cortex in males (positive) and females (negative). Neuroticism scores did not significantly correlate with these brain regions. As extraversion is regarded a protective factor for developing anxiety disorders and depression and has been related to the generation of positive affect, the present results indicate that the reduced likelihood of developing affective disorders in individuals high on extraversion is related to modulation of emotion processing through the orbitofrontal cortex and the amygdala.

Positive and negative life events and personality traits in predicting course of depression and anxiety

OBJECTIVE

To examine the prognostic value of personality dimensions and negative and positive life events for diagnostic and symptom course trajectories in depressive and anxiety disorder.

METHOD

A total of 1209 subjects (18-65 years) with depressive and/or anxiety disorder were recruited in primary and specialized mental health care. Personality dimensions at baseline were assessed with the NEO-FFI and incidence and date of life events retrospectively with a structured interview at 2-year follow-up. DSM-IV-based diagnostic interviews as well as life chart assessments allowed course assessment at both the diagnostic and symptom trajectory level over 2 years.

RESULTS

Life events were significantly related to diagnostic and symptom course trajectories of depression and anxiety also after correcting for sociodemographic and clinical characteristics. Only negative life events prospectively predicted longer time to remission of depressive disorder. Prospective associations of neuroticism and extraversion with prognosis of anxiety and depression were greatly reduced after correcting for baseline severity and duration of index disorder. Personality traits did not moderate the effect of life events on 2-year course indicators.

CONCLUSIONS

Negative life events have an independent effect on diagnostic and symptom course trajectories of depression and to a lesser extent anxiety unconfounded by sociodemographic, clinical, and personality characteristics.

Personality, Life Events and the Course of Anxiety and Depression

Using data from the Netherlands Study of Depression and Anxiety, we examined among 1322 participants with a DSM–IV diagnosis of depression or anxiety: (i) whether positive and negative life events influence 1–year course of anxiety and depressive symptoms; (ii) whether personality traits (neuroticism and extraversion) predict symptom course and moderate the impact of life events on symptom course; and (iii) whether life events mediate relationships of neuroticism and extraversion with symptom course. Negative life events were predictive of both anxiety and depressive symptoms, while positive life events predicted the course of depressive symptoms only. Personality traits had significant predictive and moderating effects on symptom course, though these effects were rather small. Copyright © 2011 John Wiley & Sons, Ltd.

Aversive life events enhance human freezing responses

In the present study, we investigated the effect of prior aversive life events on freezing-like responses. Fifty healthy females were presented neutral, pleasant, and unpleasant images from the International Affective Picture System while standing on a stabilometric platform and wearing a polar band to assess body sway and heart rate. In the total sample, only unpleasant pictures elicited reduced body sway and reduced heart rate (freezing). Moreover, participants who had experienced 1 or more aversive life events showed greater reductions in heart rate for unpleasant versus pleasant pictures than those who had experienced no such event. In addition, relative to no-event participants, single-event participants showed reduced body sway to unpleasant pictures, while multiple-event participants showed reduced body sway in response to all picture categories. These results indicate that aversive life events affect automatic freezing responses and may indicate the cumulative effect of multiple trauma. The experimental paradigm presented is a promising method to study freezing as a primary defense response in trauma-related disorders.

Automatic avoidance tendencies in patients with psychogenic non-epileptic seizures

INTRODUCTION

Psychogenic Non Epileptic Seizures (PNES) have been theorized to reflect a learned pattern of avoidant behavior to deal with stressors. Although such observation may be relevant for our understanding of the etiology of PNES, evidence for this theory is largely build on self-report investigations and no studies have systematically tested actual avoidance behavior in patients with PNES. In this study, we tested automatic threat avoidance tendencies in relation to stress and cortisol levels in patients with PNES and healthy controls (HCs).

METHODS

The approach and avoidance (AA) task was administered to 12 patients with PNES and 20 matched HCs at baseline and following stress-induction using the Cold Pressor Test (CPT). The AA task requires participants to evaluate the emotional valence of pictures of angry and happy faces by making arm movements (arm flexion or extension) that are either affect-congruent (avoid-angry; approach-happy) or affect-incongruent (approach-angry; avoid-happy) with their intuitive action tendencies. Saliva cortisol was measured throughout the experiment.

RESULTS

Patients, but not HCs, showed increased approach-avoidance congruency-effects for angry faces on the AA task at baseline, with relatively slower approach of angry faces, which was overall associated with basal pre-task cortisol. This congruency-effect disappeared after the CPT.

DISCUSSION

The present findings provide an objective confirmation of previous suggestions from self-report studies indicating that PNES patients show relatively increased avoidance tendencies to social threat cues. The registering of threat avoidance behavior may prove to be a clinically valuable contribution to evaluate psychological treatment effectiveness and perhaps even PNES prognosis.

Walk to me when I smile, step back when I'm angry: emotional faces modulate whole-body approach-avoidance behaviors

Facial expressions are potent social cues that can induce behavioral dispositions, such as approach–avoidance tendencies. We studied these tendencies by asking participants to make whole-body forward (approach) or backward (avoidance) steps on a force plate in response to the valence of social cues (happy or angry faces) under affect-congruent and incongruent mappings. Posturographic parameters of the steps related to automatic stimulus evaluation, step initiation (reaction time), and step execution were determined and analyzed as a function of stimulus valence and stimulus–response mapping. The main result was that participants needed more time to initiate a forward step towards an angry face than towards a smiling face (which is evidence of a congruency effect), but with backward steps, this difference failed to reach significance. We also found a reduction in spontaneous body sway prior to the step with the incongruent mapping. The results provide a crucial empirical link between theories of socially induced action tendencies and theories of postural control and suggest a motoric basis for socially guided motivated behavior.

Effects of single cortisol administrations on human affect reviewed: Coping with stress through adaptive regulation of automatic cognitive processing

The human stress hormone cortisol may facilitate effective coping after psychological stress. In apparent agreement, administration of cortisol has been demonstrated to reduce fear in response to stressors. For anxious patients with phobias or posttraumatic stress disorder this has been ascribed to hypothetical inhibition of retrieval of traumatic memories. However, such stress-protective effects may also work via adaptive regulation of early cognitive processing of threatening information from the environment. This paper selectively reviews the available literature on effects of single cortisol administrations on affect and early cognitive processing of affectively significant information. The concluded working hypothesis is that immediate effects of high concentration of cortisol may facilitate stress-coping via inhibition of automatic processing of goal-irrelevant threatening information and through increased automatic approach-avoidance responses in early emotional processing. Limitations in the existing literature and suggestions for future directions are briefly discussed.

Endogenous testosterone modulates prefrontal-amygdala connectivity during social emotional behavior

It is clear that the steroid hormone testosterone plays an important role in the regulation of social emotional behavior, but it remains unknown which neural circuits mediate these hormonal influences in humans. We investigated the modulatory effects of endogenous testosterone on the control of social emotional behavior by applying functional magnetic resonance imaging while healthy male participants performed a social approach-avoidance task. This task operationalized social emotional behavior by having participants approach and avoid emotional faces by pulling and pushing a joystick, respectively. Affect-congruent trials mapped the automatic tendency to approach happy faces and avoid angry faces. Affect-incongruent trials required participants to override those automatic action tendencies and select the opposite response (approach-angry, avoid-happy). The social emotional control required by affect-incongruent responses resulted in longer reaction times (RTs) and increased activity at the border of the ventrolateral prefrontal cortex and frontal pole (VLPFC/FP). We show that endogenous testosterone modulates these cerebral congruency effects through 2 mechanisms. First, participants with lower testosterone levels generate larger VLPFC/FP responses during affect-incongruent trials. Second, during the same trials, endogenous testosterone modulates the effective connectivity between the VLPFC/FP and the amygdala. These results indicate that endogenous testosterone influences local prefrontal activity and interregional connectivity supporting the control of social emotional behavior.

The specificity of childhood adversities and negative life events across the life span to anxiety and depressive disorders

BACKGROUND

Although several studies have shown that life adversities play an important role in the etiology and maintenance of both depressive and anxiety disorders, little is known about the relative specificity of several types of life adversities to different forms of depressive and anxiety disorder and the concurrent role of neuroticism. Few studies have investigated whether clustering of life adversities or comorbidity of psychiatric disorders critically influence these relationships.

METHODS

Using data from the Netherlands Study of Depression and Anxiety (NESDA), we analyzed the association of childhood adversities and negative life experiences across the lifespan with lifetime DSM-IV-based diagnoses of depression or anxiety among 2288 participants with at least one affective disorder.

RESULTS

Controlling for comorbidity and clustering of adversities the association of childhood adversity with affective disorders was greater than that of negative life events across the life span with affective disorders. Among childhood adversities, emotional neglect was specifically associated with depressive disorder, dysthymia, and social phobia. Persons with a history of emotional neglect and sexual abuse were more likely to develop more than one lifetime affective disorder. Neuroticism and current affective disorder did not affect the adversity-disorder relationships found.

LIMITATIONS

Using a retrospective study design, causal interpretations of the relationships found are not warranted.

CONCLUSIONS

Emotional neglect seems to be differentially related to depression, dysthymia and social phobia. This knowledge may help to reduce underestimation of the impact of emotional abuse and lead to better recognition and treatment to prevent long-term disorders.

Facing freeze: social threat induces bodily freeze in humans

Freezing is a common defensive response in animals threatened by predators. It is characterized by reduced body motion and decreased heart rate (bradycardia). However, despite the relevance of animal defense models in human stress research, studies have not shown whether social threat cues elicit similar freeze-like responses in humans. We investigated body sway and heart rate in 50 female participants while they were standing on a stabilometric force platform and viewing cues that were socially threatening, socially neutral, and socially affiliative (angry, neutral, and happy faces, respectively). Posturographic analyses showed that angry faces (compared with neutral faces and happy faces) induced significant reductions in body sway. In addition, the reduced body sway for angry faces was accompanied by bradycardia and correlated significantly with subjective anxiety. Together, these findings indicate that spontaneous body responses to social threat cues involve freeze-like behavior in humans that mimics animal freeze responses. These findings open avenues for studying human freeze responses in relation to various sociobiological markers and social-affective disorders.

Emotional stimuli and motor conversion disorder

Conversion disorder is characterized by neurological signs and symptoms related to an underlying psychological issue. Amygdala activity to affective stimuli is well characterized in healthy volunteers with greater amygdala activity to both negative and positive stimuli relative to neutral stimuli, and greater activity to negative relative to positive stimuli. We investigated the relationship between conversion disorder and affect by assessing amygdala activity to affective stimuli. We conducted a functional magnetic resonance imaging study using a block design incidental affective task with fearful, happy and neutral face stimuli and compared valence contrasts between 16 patients with conversion disorder and 16 age- and gender-matched healthy volunteers. The patients with conversion disorder had positive movements such as tremor, dystonia or gait abnormalities. We also assessed functional connectivity between the amygdala and regions associated with motor preparation. A group by affect valence interaction was observed. Post hoc analyses revealed that whereas healthy volunteers had greater right amygdala activity to fearful versus neutral compared with happy versus neutral as expected, there were no valence differences in patients with conversion disorder. There were no group differences observed. The time course analysis also revealed greater right amygdala activity in patients with conversion disorder for happy stimuli (t = 2.96, P = 0.006) (with a trend for fearful stimuli, t = 1.81, P = 0.08) compared with healthy volunteers, with a pattern suggestive of impaired amygdala habituation even when controlling for depressive and anxiety symptoms. Using psychophysiological interaction analysis, patients with conversion disorder had greater functional connectivity between the right amygdala and the right supplementary motor area during both fearful versus neutral, and happy versus neutral 'stimuli' compared with healthy volunteers. These results were confirmed with Granger Causality Modelling analysis indicating a directional influence from the right amygdala to the right supplementary motor area to happy stimuli (P < 0.05) with a similar trend observed to fearful stimuli (P = 0.07). Our data provide a potential neural mechanism that may explain why psychological or physiological stressors can trigger or exacerbate conversion disorder symptoms in some patients. Greater functional connectivity of limbic regions influencing motor preparatory regions during states of arousal may underlie the pathophysiology of motor conversion symptoms.

Basal cortisol is positively correlated to threat vigilance in patients with psychogenic nonepileptic seizures

Previous studies have provided evidence for a vigilant attentional bias toward threat stimuli and increased basal diurnal cortisol levels in patients with psychogenic nonepileptic seizures (PNES). Because cortisol levels may be predictive of threat vigilance, we reanalyzed previous data on threat vigilance in 19 unmedicated patients with PNES and found a positive correlation between baseline cortisol levels and attentional bias scores for threat stimuli (r=0.49, P=0.035). There was no such relationship in healthy matched controls (n=20) or in patients with epileptic seizures (n=17). These findings provide the first evidence linking an endocrine stress marker to increased threat sensitivity in PNES and support new integrated psychoneurobiological models of PNES.

The role of childhood abuse in HPA-axis reactivity in Social Anxiety Disorder: a pilot study

BACKGROUND

Studies on depression have found that childhood abuse (CA) is associated with a persistent sensitization of the hypothalamic-pituitary-adrenal (HPA)-axis to stress in adulthood. So far, it is unknown whether this HPA-axis sensitization is specific to depression, or whether this is a more general outcome associated with CA in patients with mood and anxiety disorders. The aim of this study was to investigate whether CA is associated with enhanced cortisol reactivity to psychosocial stress in Social Anxiety Disorder (SAD).

METHODS

Salivary cortisol levels before, during, and after exposure to psychosocial stress (i.e., Trier Social Stress Task, TSST) in SAD patients with a history of childhood abuse (SAD+CA, n=9) were compared to cortisol levels in SAD patients without a history of childhood abuse (SAD-CA, n=9), patients with PTSD related to childhood abuse (n=16), and healthy controls without a history of childhood abuse (n=16).

RESULTS

Analyses showed that the SAD+CA group had a strongly increased cortisol reactivity (mean peak: 17.5+/-1.9 nmol/l) compared to SAD-CA (mean peak: 9.0+/-1.1 nmol/l), PTSD (mean peak: 9.0+/-1.1 nmol/l) and healthy controls (mean peak: 9.6+/-1.4 nmol/l), whereas baseline cortisol levels did not differ. The enhanced increase in the SAD+CA group was not explained by stronger anxiety in response to the TSST.

CONCLUSIONS

Consistent with the findings in depression, these results show for the first time that childhood abuse is also associated with strongly increased cortisol reactivity in SAD. When replicated in a larger sample, these findings may have important implications for the treatment of SAD.

Psychological features of patients with complex regional pain syndrome type I related dystonia

The objective of this study was to evaluate psychological features in severely affected patients with complex regional pain syndrome type I- (CRPS-I) related dystonia. Personality traits, psychopathology, dissociative experiences, the number of traumatic experiences, and quality of life were studied in 46 patients. Findings were compared with two historical psychiatric control groups [54 patients with conversion disorder (CD) and 50 patients with affective disorders (AD)] and normative population data. The CRPS-I patients showed elevated scores on the measures for somatoform dissociation, traumatic experiences, general psychopathology, and lower scores on quality of life compared with general population data, but had significantly lower total scores on the measures for personality traits, recent life events, and general psychopathology compared with the CD and AD patients. Rates of early traumatic experiences were comparable with the CD and AD patients, and the level of somatoform dissociation was comparable to the CD patients, but was elevated in comparison to the AD patients. Early traumatic experiences were reported in 87% of the CRPS-I patients and were found to be moderately related to somatoform dissociative experiences, indicating that early traumatic experiences might be a predisposing, although not a necessary factor for the development of CRPS-I-related dystonia. Although the psychological profile of the patients with CRPS-I-related dystonia shows some elevations, there does not seem to be a unique disturbed psychological profile on a group level.

Hypothalamus-pituitary-adrenal axis hyperresponsiveness is associated with increased social avoidance behavior in social phobia

BACKGROUND

Social avoidance and inhibition in animals is associated with hyperresponsiveness of the glucocorticoid stress-system. In humans, the relation between glucocorticoid stress-reactivity and social avoidance behavior remains largely unexplored. We investigated whether increased cortisol stress-responsiveness is linked to increased social avoidance behavior in patients with social anxiety disorder (SAD).

METHODS

Patients with SAD (n = 18) as well as two control groups of healthy participants (n = 22) and patients with posttraumatic stress disorder (PTSD; n = 17), respectively, performed a social approach-avoidance task (AA-task) in a baseline condition and in a social stress condition (provided by the Trier Social Stress Test). The AA-task is a computerized reaction-time task measuring the speed of manual approach and avoidance responses to visually presented social threat cues (angry faces). Salivary cortisol, blood pressure, and subjective anxiety were assessed throughout the experiment.

RESULTS

Patients with SAD showed larger cortisol responses to the social stress test, as compared with healthy and PTSD control subjects. Most crucially, these increased cortisol responses were significantly correlated to the increase in social avoidance behavior measured by the AA-task in the social stress condition in SAD. An additional regression analysis showed that the cortisol responses predicted the stress-induced increase in social avoidance tendencies over and above the effects of blood pressure and subjective anxiety.

CONCLUSIONS

These findings provide the first evidence for a direct link between increased cortisol stress-responsiveness and social avoidance behavior in patients with SAD. The results support animal models of social avoidance and inhibition and might have important treatment implications.

On the neural control of social emotional behavior

It is known that the orbitofrontal cortex (OFC) is crucially involved in emotion regulation. However, the specific role of the OFC in controlling the behavior evoked by these emotions, such as approach-avoidance (AA) responses, remains largely unexplored. We measured behavioral and neural responses (using fMRI) during the performance of a social task, a reaction time (RT) task where subjects approached or avoided visually presented emotional faces by pulling or pushing a joystick, respectively. RTs were longer for affect-incongruent responses (approach angry faces and avoid happy faces) as compared to affect-congruent responses (approach-happy; avoid-angry). Moreover, affect-incongruent responses recruited increased activity in the left lateral OFC. These behavioral and neural effects emerged only when the subjects responded explicitly to the emotional value of the faces (AA-task) and largely disappeared when subjects responded to an affectively irrelevant feature of the faces during a control (gender evaluation: GE) task. Most crucially, the size of the OFC-effect correlated positively with the size of the behavioral costs of approaching angry faces. These findings qualify the role of the lateral OFC in the voluntary control of social-motivational behavior, emphasizing the relevance of this region for selecting rule-driven stimulus-response associations, while overriding automatic (affect-congruent) stimulus-response mappings.

Diminished cortisol responses to psychosocial stress associated with lifetime adverse events a study among healthy young subjects

BACKGROUND

Animal and human studies have found that prior stressful events can result in an altered reactivity in the HPA axis. The aim of the present study was to investigate the role of adverse events in childhood on cortisol reactivity to psychosocial stress in young healthy subjects (n=80).

METHODS

Salivary cortisol levels were measured before, during and after exposure to a psychosocial stress task in healthy men and women with high (n=33) and low (n=47) exposure to adverse childhood events.

RESULTS

A significant blunted cortisol response was found in individuals with a history of adverse events compared to individuals with no adverse life events, with no differences in baseline cortisol levels. This finding appeared to be primarily driven by men. The groups did not differ on any other physiological or subjective stress measure, including heart rate, blood pressure, and subjective tension.

CONCLUSIONS

These findings suggest that, at least in healthy young males, adverse childhood events are associated with changes in HPA-axis functioning. Longitudinal studies are needed to investigate whether the blunted cortisol response is a risk factor in the etiology of psychiatric disorders or rather reflects resiliency with regard to the development of psychopathology.

Motor imagery: a window into the mechanisms and alterations of the motor system

Motor imagery is a widely used paradigm for the study of cognitive aspects of action control, both in the healthy and the pathological brain. In this paper we review how motor imagery research has advanced our knowledge of behavioral and neural aspects of action control, both in healthy subjects and clinical populations. Furthermore, we will illustrate how motor imagery can provide new insights in a poorly understood psychopathological condition: conversion paralysis (CP). We measured behavioral and cerebral responses with functional magnetic resonance imaging (fMRI) in seven CP patients with a lateralized paresis of the arm as they imagined moving the affected or the unaffected hand. Imagined actions were either implicitly induced by the task requirements, or explicitly instructed through verbal instructions. We previously showed that implicitly induced motor imagery of the affected limb leads to larger ventromedial prefrontal responses compared to motor imagery of the unaffected limb. We interpreted this effect in terms of greater self-monitoring of actions during motor imagery of the affected limb. Here, we report new data in support of this interpretation: inducing self-monitoring of actions of both the affected and the unaffected limb (by means of explicitly cued motor imagery) abolishes the activation difference between the affected and the unaffected hand in the ventromedial prefrontal cortex. Our results show that although implicit and explicit motor imagery both entail motor simulations, they differ in terms of the amount of action monitoring they induce. The increased self-monitoring evoked by explicit motor imagery can have profound cerebral consequences in a psychopathological condition.

Cortisol administration enhances the coupling of midfrontal delta and beta oscillations

There is increasing evidence that the strength of the relation between slow (SW) and fast (FW) wave activity in the EEG is associated with specific motivational states and their corresponding neuroendocrine patterns. Enhanced correlations between SW and FW have been related to anxiety, behavioral inhibition and high basal cortisol levels. However, the direct effects of cortisol on SW-FW coupling have not been experimentally studied yet. The present study investigated whether cortisol administration increases SW-FW coupling. Resting state EEG recordings were obtained from 40 right-handed healthy male subjects with extreme low or high scores on a behavioral inhibition scale, after placebo and cortisol (50 mg) administration. As expected, cortisol resulted in a significant increase in correlation between SW (delta) and FW (beta) activity compared to placebo. In addition, delta-beta correlation was significantly higher in high compared to low behaviorally inhibited subjects in both conditions. These results suggest that cortisol can modify brain activity, increasing a pattern associated with anxiety and behavioral inhibition. This is in line with findings associating cortisol with behavioral inhibition and anxiety.

The effects of cortisol administration on approach–avoidance behavior: An event-related potential study

We investigated the effects of cortisol administration (50 mg) on approach and avoidance tendencies in low and high trait avoidant healthy young men. Event-related brain potentials (ERPs) were measured during a reaction time task, in which participants evaluated the emotional expression of photographs of happy and angry faces by making an approaching (flexion) or avoiding (extension) arm movement. The task consisted of an affect-congruent (approach happy faces and avoid angry faces) and an affect-incongruent (reversed instruction) condition. Behavioral and ERP analyses showed that cortisol enhanced congruency effects for angry faces in highly avoidant individuals only. The ERP effects involved an increase of both early (P150) and late (P3) positive amplitudes, indicative of increased processing of the angry faces in high avoidant subjects after cortisol administration. Together, these results suggest a context-specific effect of cortisol on processing of, and adaptive responses to, motivationally significant threat stimuli, particularly in participants highly sensitive to threat signals.

Trauma and medically unexplained symptoms towards an integration of cognitive and neuro-biological accounts

Medically unexplained symptoms (MUS) are frequently associated with a history of traumatization. The first purpose of the present review paper was to investigate systematically the evidence for such relation in a subset of clinical samples with MUS presenting with functional somatization: chronic pelvic pain, irritable bowel syndrome and conversion and somatization disorder. The second purpose was to critically review three dominant models explaining the relation between trauma and MUS (i.e. dissociation, conversion and hierarchical cognitive models). The latter model in particular adequately accounts for the non-volitional and non-intentional character of MUS and explains how traumata can affect the development of MUS without assuming that previous trauma is a necessary prerequisite of MUS. The cognitive model, however, lacks integration with current neurobiological findings, indicative of central stress-and central nervous system alterations in MUS. The final purpose of the present paper was, therefore, to review current neurobiological studies focused on trauma and MUS and to formulate a research agenda to integrate these neurobiological developments with cognitive models for MUS.

Increased self-monitoring during imagined movements in conversion paralysis

Conversion paralysis is characterized by a loss of voluntary motor functioning without an organic cause. Despite its prevalence among neurological outpatients, little is known about the neurobiological basis of this motor dysfunction. We have examined whether the motor dysfunction in conversion paralysis can be linked to inhibition of the motor system, or rather to enhanced self-monitoring during motor behavior. We measured behavioral and cerebral responses (with fMRI) in eight conversion paralysis patients with a lateralized paresis of the arm as they were engaged in imagined actions of the affected and unaffected hand. We used a within-subjects design to compare cerebral activity during imagined movements of the affected and the unaffected hand. Motor imagery of the affected hand and the unaffected hand recruited comparable cerebral resources in the motor system, and generated equal behavioral performance. However, motor imagery of the affected limb recruited additional cerebral resources in the ventromedial prefrontal cortex and superior temporal cortex. These activation differences were caused by a failure to de-activate these regions during movement imagery of the affected hand. These findings lend support to the hypothesis that conversion paralysis is associated with heightened self-monitoring during actions with the affected arm.