Oxytocin, but not vasopressin, decreases willingness to harm others by promoting moral emotions of guilt and shame

Prosocial and moral behaviors have overlapping neural systems and can both be affected in a number of psychiatric disorders, although whether they involve similar neurochemical systems is unclear. In the current registered randomized placebo-controlled trial on 180 adult male and female subjects, we investigated the effects of intranasal administration of oxytocin and vasopressin, which play key roles in influencing social behavior, on moral emotion ratings for situations involving harming others and on judgments of moral dilemmas where others are harmed for a greater good. Oxytocin, but not vasopressin, enhanced feelings of guilt and shame for intentional but not accidental harm and reduced endorsement of intentionally harming others to achieve a greater good. Neither peptide influenced arousal ratings for the scenarios. Effects of oxytocin on guilt and shame were strongest in individuals scoring lower on the personal distress subscale of trait empathy. Overall, findings demonstrate for the first time that oxytocin, but not vasopressin, promotes enhanced feelings of guilt and shame and unwillingness to harm others irrespective of the consequences. This may reflect associations between oxytocin and empathy and vasopressin with aggression and suggests that oxytocin may have greater therapeutic potential for disorders with atypical social and moral behavior.

Specific Patterns of Endogenous Functional Connectivity Are Associated With Harm Avoidance in Obsessive-Compulsive Disorder

BACKGROUND

Individuals with obsessive-compulsive disorder (OCD) show persistent avoidance behaviors, often in the absence of actual threat. Quality-of-life costs and heterogeneity support the need for novel brain-behavior intervention targets. Informed by mechanistic and anatomical studies of persistent avoidance in rodents and nonhuman primates, our goal was to test whether connections within a hypothesized persistent avoidance-related network predicted OCD-related harm avoidance (HA), a trait measure of persistent avoidance. We hypothesized that 1) HA, not an OCD diagnosis, would be associated with altered endogenous connectivity in at least one connection in the network; 2) HA-specific findings would be robust to comorbid symptoms; and 3) reliable findings would replicate in a holdout testing subsample.

METHODS

Using resting-state functional connectivity magnetic resonance imaging, cross-validated elastic net for feature selection, and Poisson generalized linear models, we tested which connections significantly predicted HA in our training subsample (n = 73; 71.8% female; healthy control group n = 36, OCD group n = 37); robustness to comorbidities; and replicability in a testing subsample (n = 30; 56.7% female; healthy control group n = 15, OCD group n = 15).

RESULTS

Stronger inverse connectivity between the right dorsal anterior cingulate cortex and right basolateral amygdala and stronger positive connectivity between the right ventral anterior insula and left ventral striatum were associated with greater HA across groups. Network connections did not discriminate OCD diagnostic status or predict HA-correlated traits, suggesting sensitivity to trait HA. The dorsal anterior cingulate cortex-basolateral amygdala relationship was robust to controlling for comorbidities and medication in individuals with OCD and was also predictive of HA in our testing subsample.

CONCLUSIONS

Stronger inverse dorsal anterior cingulate cortex-basolateral amygdala connectivity was robustly and reliably associated with HA across groups and in OCD. Results support the relevance of a cross-species persistent avoidance-related network to OCD, with implications for precision-based approaches and treatment.

Can immorality be contracted? Appraisals of moral disgust and contamination fear

While extant research underlines the role of disgust in obsessive-compulsive disorder (OCD) with contamination fear, less research attention has been devoted to moral disgust. This study endeavored to examine the types of appraisals that are elicited by moral disgust in comparison to core disgust, and to examine their associations with both contact and mental contamination symptoms. In a within-participants design, 148 undergraduate students were exposed to core disgust, moral disgust, and anxiety control elicitors via vignettes, and provided appraisal ratings of sympathetic magic, thought-action fusion and mental contamination, as well as compulsive urges. Measures of both contact and mental contamination symptoms were administered. Mixed modeling analyses indicated that core disgust and moral disgust elicitors both provoked greater appraisals of sympathetic magic and compulsive urges than anxiety control elicitors. Further, moral disgust elicitors elicited greater thought-action fusion and mental contamination appraisals than all other elicitors. Overall, these effects were greater in those with higher contamination fear. This study demonstrates how a range of contagion beliefs are evoked by the presence of 'moral contaminants', and that such beliefs are positively associated with contamination concerns. These results shed light on moral disgust as an important target in the treatment of contamination fear.

Aberrant functional connectivity of neural circuits associated with thought-action fusion in patients with obsessive-compulsive disorder

BACKGROUND

Cognitive theories of obsessive-compulsive disorder (OCD) stress the importance of dysfunctional beliefs in the development and maintenance of the disorder. However, a neurobiological understanding of these cognitive models, including thought-action fusion (TAF), is surprisingly lacking. Thus, this functional magnetic resonance imaging study aimed to investigate whether altered functional connectivity (FC) is associated with the TAF paradigm in OCD patients.

METHODS

Forty-one OCD patients and 47 healthy controls (HCs) participated in a functional magnetic resonance imaging study using a TAF task, in which they were asked to read the name of a close or a neutral person in association with positive and negative statements.

RESULTS

The conventional TAF condition (negative statements/close person) induced significant FC between the regions of interest (ROIs) identified using multivoxel pattern analysis and the visual association areas, default mode network subregions, affective processing, and several subcortical regions in both groups. Notably, sparser FC was observed in OCD patients. Further analysis confined to the cortico-striato-thalamo-cortical (CSTC) and affective networks demonstrated that OCD patients exhibited reduced ROI FC with affective regions and greater ROI FC with CSTC components in the TAF condition compared to HCs. Within the OCD patients, middle cingulate cortex-insula FC was correlated with TAF and responsibility scores.

CONCLUSIONS

Our TAF paradigm revealed altered context-dependent engagement of the CSTC and affective networks in OCD patients. These findings suggest that the neurobiology of cognitive models corresponds to current neuroanatomical models of OCD. Further, they elucidate the underlying neurobiological mechanisms of OCD at the circuit-based level.

Reconciliation of Two Cognitive Models in Obsessive-Compulsive Disorder: An fMRI Study

OBJECTIVE

Although cognitive models of obsessive-compulsive disorder (OCD) fall into two categories: cognitive deficit models and dysfunctional belief models, these approaches have their own ways and have hardly been reconciled. Therefore, this study aimed to investigate the potential relationships between cognitive deficit (using the Wisconsin Card Sorting Task, WCST) and dysfunctional belief (measured by scales of dysfunctional beliefs) mediated by neural activity in OCD patients.

METHODS

Thirty OCD patients and 30 healthy participants performed the WCST condition and a baseline MATCH condition during the 3T-functional magnetic resonance imaging (fMRI) acquisition.

RESULTS

Engagement of additional frontoparietal networks with poorer performance of WCST was found during the fMRI scan in OCD patients. Selected regions of interest from activated regions have positive relationships with dysfunctional beliefs and with the unacceptable thoughts symptom dimension in the OCD group.

CONCLUSION

Findings suggest that alteration in frontoparietal networks related to cognitive deficits can be associated with dysfunctional beliefs while performing conventional neurocognitive tasks and this association with dysfunctional beliefs may be pronounced in the unacceptable thoughts domain-dominant OCD patients.

Feelings of shame and guilt are associated with distinct neural activation in youth

Shame and guilt are moral emotions that play an important role in social functioning. There is limited knowledge about the neural underpinnings of these emotions, particularly in young people. In the current study, 36 healthy females (mean age 18.8 ± 1.9 years) underwent functional Magnetic Resonance Imaging, during which they reflected on their decisions about social moral dilemmas, and subsequently received negative or positive peer feedback. Ratings of shame and guilt were used as parametric modulators of brain activity. Shame was associated with decreased activity in the superior temporal sulcus and precentral gyrus during reflection. Guilt was associated with decreased activity in the precuneus during positive feedback, and in the hippocampus and supramarginal gyrus during negative feedback. Results suggest that shame and guilt are associated with activity in brain regions involved in social cognition and emotion regulation; however, they have distinct underlying neural circuitry that may be differentiated based on social evaluation.

Functional Brain Imaging and OCD

In the last 20 years, functional magnetic resonance imaging (fMRI) has been extensively used to investigate system-level abnormalities in the brain of patients with obsessive-compulsive disorder (OCD). In this chapter, we start by reviewing the studies assessing regional brain differences between patients with OCD and healthy controls in task-based fMRI. Specifically, we review studies on executive functioning and emotional processing, protocols in which these patients have been described to show alterations at the behavioral level, as well as research using symptom provocation protocols. Next, we review studies on brain connectivity alterations, focusing on resting-state studies evaluating disruptions in fronto-subcortical functional connectivity and in cortical networks. Likewise, we also review research on effective connectivity, which, different from functional connectivity, allows for ascertaining the directionality of inter-regional connectivity alterations. We conclude by reviewing the most significant findings on a topic of translational impact, such as the use of different fMRI measurements to predict response across a variety of treatment approaches. Overall, results suggest that there exists a pattern of regions, involving, but not limited to, different nodes of the cortico-striatal-thalamo-cortical circuits, showing robust evidence of functional alteration across studies, although the nature of the alterations critically depends on the specific tasks and their particular demands. Moreover, such findings have been, to date, poorly translated into clinical practice. It is suggested that this may be partially accounted for by the difficulty to integrate into a common framework results obtained under a wide variety of analysis approaches.

Moral Cognition About Harm in Anxiety Disorders: The Importance of Experienced Emotion

Recent work has shown that emotional arousal influences decision-making in sacrificial moral dilemmas, with heightened levels of arousal associated with increased aversion to committing moral transgressions to maximize utilitarian outcomes. Patients with anxiety disorders experience pathologically heightened states of arousal and thus may be expected to exhibit reduced utilitarian responding on such dilemmas. Extant evidence has been mixed, however, regarding whether anxious patients differ in their moral decisions from controls, and no study has conducted a careful examination of emotions experienced during decision-making. We administered sacrificial moral dilemmas to a cohort of 95 patients from across the spectrum of anxiety disorders to test whether they differed from matched controls on a) utilitarian decision-making, and b) ratings of experienced emotion during the moral deliberative process. Results showed no group differences between patients and controls on endorsement of utilitarian sacrificial action or on reported experience of emotionality during the experiment. Additionally, exploratory analysis revealed that specific emotions were correlated with utilitarian judgments. These results are in line with the Dual Process Theory model's prediction that decreased utilitarian responding will be concomitant with an increased emotional arousal. Our findings support past work indicating that moral cognition is intact in anxiety disorders despite the emotional dysregulation characteristic of anxious psychopathology. Future work would benefit from the use of process-dissociation techniques to further clarify whether emotional or cognitive processes may differ in anxiety disorders during moral cognition.

Indignation for moral violations suppresses the tongue motor cortex: preliminary TMS evidence

We commonly label moral violations in terms of ‘disgust’, yet it remains unclear whether metaphorical expressions linking disgust and morality are genuinely shared at the cognitive/neural level. Using transcranial magnetic stimulation (TMS), we provide new insights into this debate by measuring motor-evoked potentials (MEPs) from the tongue generated by TMS over the tongue primary motor area (tM1) in a small group of healthy participants presented with vignettes of moral transgressions and non-moral vignettes. We tested whether moral indignation, felt while evaluating moral vignettes, affected tM1 excitability. Vignettes exerted a variable influence on MEPs with no net effect of the moral category. However, in accordance with our recent study documenting reduced tM1 excitability during exposure to pictures of disgusting foods or facial expressions of distaste, we found that the vignettes of highly disapproved moral violations reduced tM1 excitability. Moreover, tM1 excitability and moral indignation were linearly correlated: the higher the moral indignation, the lower the tM1 excitability. Respective changes in MEPs were not observed in a non-oral control muscle, suggesting a selective decrease of tM1 excitability. These preliminary findings provide neurophysiological evidence supporting the hypothesis that morality might have originated from the more primitive experience of oral distaste.

The neural correlates of thought-action fusion in healthy adults: A functional magnetic resonance imaging study

BACKGROUND

Thought-action fusion (TAF) represents an individual's belief that a thought is like action. Inflated TAF has been considered a central mechanism for developing obsessive thoughts. However, the neural mechanisms underlying TAF are yet unknown.

METHODS

We recruited 32 healthy men to participate in a functional magnetic resonance imaging (fMRI) study. Whereas inside the 3T MRI scanner, participants were asked to read negative statements describing the expectation of bad events associated with close persons (CPs condition) or neutral persons (NPs condition). They also completed the assessment of TAF and obsessive-compulsive (OC) symptoms.

RESULTS

Both CP and NP conditions commonly activated the lingual gyrus, caudate nucleus, precuneus, and several areas of the frontal cortex. Importantly, many of these regions were positively correlated with measures of OC symptoms, especially for the CP condition. The CP condition showed higher activation in the insula and temporal gyrus than the NP condition. In contrast, the NP condition evoked higher activation in regions associated with mentalizing, such as the medial prefrontal cortex and dorsal anterior cingulate cortex than the CP condition.

CONCLUSIONS

We introduced and validated a TAF-induction paradigm suitable for fMRI studies and characterized the neural circuits engaged during this paradigm. Further studies using this task may help us to better understand how dysfunctions in TAF neural processing may contribute to psychiatric conditions such as obsessive-compulsive disorder.

Modeling Morality in 3-D: Decision-Making, Judgment, and Inference

Humans face a fundamental challenge of how to balance selfish interests against moral considerations. Such trade-offs are implicit in moral decisions about what to do; judgments of whether an action is morally right or wrong; and inferences about the moral character of others. To date, these three dimensions of moral cognition-decision-making, judgment, and inference-have been studied largely independently, using very different experimental paradigms. However, important aspects of moral cognition occur at the intersection of multiple dimensions; for instance, moral hypocrisy can be conceived as a disconnect between moral decisions and moral judgments. Here we describe the advantages of investigating these three dimensions of moral cognition within a single computational framework. A core component of this framework is harm aversion, a moral sentiment defined as a distaste for harming others. The framework integrates economic utility models of harm aversion with Bayesian reinforcement learning models describing beliefs about others' harm aversion. We show how this framework can provide novel insights into the mechanisms of moral decision-making, judgment, and inference.

Dysfunctional beliefs in patients with obsessive-compulsive disorder and depression as assessed with the Beliefs Questionnaire (BQ)

There is an ongoing debate about the specificity of dysfunctional beliefs in patients with obsessive-compulsive disorder (OCD) as some of these beliefs seem to be relevant in depressed patients as well. The present study aimed to elucidate the specificity of dysfunctional beliefs using the newly developed Beliefs Questionnaire (BQ). A combination of an online assessment and clinical interviews was carried out. One hundred thirty OCD patients (M = 38.7 years; 68% women) were compared to 85 patients with depression (M = 36.6 years; 75% women) and 220 nonclinical controls (M = 38.9 years; 71% women) on the BQ, which contains 13 items tapping cognitive beliefs. The BQ was validated against the Obsessive Beliefs Questionnaire (OBQ). Patients with OCD and depression scored higher on the BQ compared to nonclinical controls. OCD patients displayed higher values on overestimation of threat and the fear of becoming insane. Correlation between BQ and OBQ total scores was high (r = 0.751), supporting the validity of the new scale. Our results show that two beliefs are OCD-specific. However, the BQ covers mainly transdiagnostic features and should be replicated with the inclusion of an anxiety disorder sample.

Use of an Individual-Level Approach to Identify Cortical Connectivity Biomarkers in Obsessive-Compulsive Disorder

BACKGROUND

Existing functional connectivity studies of obsessive-compulsive disorder (OCD) support a model of circuit dysfunction. However, these group-level observations have failed to yield neuroimaging biomarkers sufficient to serve as a test for the OCD diagnosis, predict current or future symptoms, or predict treatment response, perhaps because these studies failed to account for the substantial intersubject variability in structural and functional brain organization.

METHODS

We used functional regions, localized in each of 41 individual OCD patients, to identify cortical connectivity biomarkers of both global and dimension-specific symptom severity and to detect functional connections that track changes in symptom severity following intensive residential treatment.

RESULTS

Global OCD symptom severity was directly linked to dysconnectivity between large-scale intrinsic brain networks-particularly among the dorsal attention, default, and frontoparietal networks. Changes within a subset of connections among these networks were associated with symptom resolution. Additionally, distinct and nonoverlapping cortical connectivity biomarkers were identified that were significantly associated with the severity of contamination/washing and responsibility for harm/checking symptoms, highlighting the contribution of dissociable neural networks to specific OCD symptom dimensions. By contrast, when we defined functional regions conventionally, using a population-level brain atlas, we could no longer identify connectivity biomarkers of severity or improvement for any of the symptom dimensions.

CONCLUSIONS

Our findings would seem to encourage the use of individual-level approaches to connectivity analyses to better delineate the cortical and subcortical networks underlying symptom severity and improvement at the dimensional level in OCD patients.

The effect of hunger and satiety in the judgment of ethical violations

Human history is studded with instances where instinctive motivations take precedence over ethical choices. Nevertheless, the evidence of any linking between motivational states and morality has never been systematically explored. Here we addressed this topic by testing a possible linking between appetite and moral judgment. We compared moral disapproval ratings (MDR) for stories of ethical violations in participants under fasting and after having eaten a snack. Our results show that subjective hunger, measured via self-reported rating, reduces MDR for ethical violations. Moreover, the higher the disgust sensitivity the higher the MDR for ethical violations. This study adds new insights to research on physiological processes influencing morality by showing that appetite affects moral disapproval of ethical violations.

The Multifaceted Role of the Ventromedial Prefrontal Cortex in Emotion, Decision Making, Social Cognition, and Psychopathology

The ventromedial prefrontal cortex (vmPFC) has been implicated in a variety of social, cognitive, and affective functions that are commonly disrupted in mental illness. In this review, we summarize data from a diverse array of human and animal studies demonstrating that the vmPFC is a key node of cortical and subcortical networks that subserve at least three broad domains of psychological function linked to psychopathology. One track of research indicates that the vmPFC is critical for the representation of reward- and value-based decision making, through interactions with the ventral striatum and amygdala. A second track of research demonstrates that the vmPFC is critical for the generation and regulation of negative emotion, through its interactions with the amygdala, bed nucleus of the stria terminalis, periaqueductal gray, hippocampus, and dorsal anterior cingulate cortex. A third track of research shows the importance of the vmPFC in multiple aspects of social cognition, such as facial emotion recognition, theory-of-mind ability, and processing self-relevant information, through its interactions with the posterior cingulate cortex, precuneus, dorsomedial PFC, and amygdala. We then present meta-analytic data revealing distinct subregions within the vmPFC that correspond to each of these three functions, as well as the associations between these subregions and specific psychiatric disorders (depression, posttraumatic stress disorder, addiction, social anxiety disorder, bipolar disorder, schizophrenia, and attention-deficit/hyperactivity disorder). We conclude by describing several translational possibilities for clinical studies of vmPFC-based circuits, including neuropsychological assessment of transdiagnostic functions, anatomical targets for intervention, predictors of treatment response, markers of treatment efficacy, and subtyping within disorders.

Decoding moral emotions in obsessive-compulsive disorder

Background

Patients with obsessive-compulsive disorder (OCD) exhibit abnormal neural responses when they experience particular emotions or when they evaluate stimuli with emotional value. Whether these brain responses are sufficiently distinctive to discriminate between OCD patients and healthy controls is unknown. The present study is the first to investigate the discriminative power of multivariate pattern analysis of regional fMRI responses to moral and non-moral emotions.

Method

To accomplish this goal, we performed a searchlight-based multivariate pattern analysis to unveil brain regions that could discriminate 18 OCD patients from 18 matched healthy controls during provoked guilt, disgust, compassion, and anger. We also investigated the existence of distinctive neural patterns while combining those four emotions (herein termed multiemotion analysis).

Results

We found that different frontostriatal regions discriminated OCD patients from controls based on individual emotional experiences. Most notably, the left nucleus accumbens (NAcc) discriminated OCD patients from controls during both disgust and the multiemotion analysis. Among other regions, the angular gyrus responses to anger and the lingual and the middle temporal gyri in the multi-emotion analysis were highly discriminant between samples. Additional BOLD analyses supported the directionality of these findings.

Conclusions

In line with previous studies, differential activity in regions beyond the frontostriatal circuitry differentiates OCD from healthy volunteers. The finding that the response of the left NAcc to different basic and moral emotions is highly discriminative for a diagnosis of OCD confirms current pathophysiological models and points to new venues of research.

Symptom dimensions in obsessive-compulsive disorder as predictors of neurobiology and treatment response

Purpose of review

Specific symptom dimensions of obsessive-compulsive disorder (OCD) have been suggested as an approach to reduce the heterogeneity of obsessive-compulsive disorder, predict treatment outcome, and relate to brain structure and function. Here, we review studies addressing these issues.

Recent findings

The contamination and symmetry/ordering dimensions have not been reliably associated with treatment outcome. Some studies found that greater severity of sexual/aggressive/religious symptoms predicted a worse outcome after cognitive behavioral therapy (CBT) and a better outcome after serotonin reuptake inhibitors (SRIs). Contamination symptoms have been related to increased amygdala and insula activation in a few studies, while sexual/aggressive/religious symptoms have also been related to more pronounced alterations in the function and structure of the amygdala. Increased pre-treatment limbic responsiveness has been related to better outcomes of CBT, but most imaging studies show important limitations and replication in large-scale studies is needed. We review possible reasons for the strong limbic involvement of the amygdala in patients with more sexual/aggressive/religious symptoms, in relation to their sensitivity to CBT.

Summary

Symptom dimensions may predict treatment outcome, and patients with sexual/religious/aggressive symptoms are at a greater risk of not starting or delaying treatment. This is likely partly due to more shame and perceived immorality which is also related to stronger amygdala response. Competently delivered CBT is likely to help these patients improve to the same degree as patients with other symptoms.

Emotional Processing in Obsessive-Compulsive Disorder: A Systematic Review and Meta-analysis of 25 Functional Neuroimaging Studies

BACKGROUND

Patients with obsessive-compulsive disorder (OCD) experience aversive emotions in response to obsessions, motivating avoidance and compulsive behaviors. However, there is considerable ambiguity regarding the brain circuitry involved in emotional processing in OCD, especially whether activation is altered in the amygdala.

METHODS

We conducted a systematic literature review and performed a meta-analysis-seed-based d mapping-of 25 whole-brain neuroimaging studies (including 571 patients and 564 healthy control subjects) using functional magnetic resonance imaging or positron emission tomography, comparing brain activation of patients with OCD and healthy control subjects during presentation of emotionally valenced versus neutral stimuli. Meta-regressions were employed to investigate possible moderators.

RESULTS

Patients with OCD, compared with healthy control subjects, showed increased activation in the bilateral amygdala, right putamen, orbitofrontal cortex extending into the anterior cingulate and ventromedial prefrontal cortex, and middle temporal and left inferior occipital cortices during emotional processing. Right amygdala hyperactivation was most pronounced in unmedicated patients. Symptom severity was related to increased activation in the orbitofrontal and anterior cingulate cortices and precuneus. Greater comorbidity with mood and anxiety disorders was associated with higher activation in the right amygdala, putamen, and insula as well as with lower activation in the left amygdala and right ventromedial prefrontal cortex.

CONCLUSIONS

Patients with OCD show increased emotional processing-related activation in limbic, frontal, and temporal regions. Previous mixed evidence regarding the role of the amygdala in OCD has likely been influenced by patient characteristics (such as medication status) and low statistical power.

Brain Structural Correlates of Subclinical Obsessive-Compulsive Symptoms in Healthy Children

OBJECTIVE

Subclinical obsessive-compulsive (OC) symptoms are frequently observed in children and have been reported to predict a subsequent diagnosis of OC disorder (OCD). Therefore, identifying the putative neurobiological signatures of such risk is crucial, because it would allow for the characterization of the underpinnings of OCD without the interfering effects of chronicity, medication, or comorbidities, especially when interpreted within the context of OCD clinical heterogeneity and taking into account normal neurodevelopmental changes. The present study aimed to identify the brain volumetric features associated with subclinical OC symptoms and the potential modulatory effects of sex and age in a large sample of healthy children.

METHOD

Two hundred fifty-five healthy children were assessed using the Obsessive-Compulsive Inventory-Child Version and underwent a brain structural magnetic resonance examination. The relation between total and symptom-specific scores and regional gray and white matter (GM and WM) volumes was evaluated. Participants were grouped according to sex and age (younger versus older) to assess the effect of these factors on symptom-brain morphometry associations.

RESULTS

Ordering symptoms were negatively related to GM volumes in the ventral caudate. Hoarding symptoms were positively associated with GM and WM volumes in the left inferior frontal gyrus, and obsessing symptoms correlated negatively with GM and WM volumes in the right temporal pole. Doubt-checking symptoms correlated positively with WM volumes in the right inferior fronto-occipital fasciculus and the corpus callosum. Sex and age modulated some of these associations.

CONCLUSION

Subclinical OC symptoms are associated with specific brain volumetric features, which could be considered potential neural signatures of increased risk for OCD.

Switching between internally and externally focused attention in obsessive-compulsive disorder: Abnormal visual cortex activation and connectivity

Obsessive-compulsive disorder (OCD) is characterized by excessive absorption with internally-generated distressing thoughts and urges, with difficulty incorporating external information running counter to their fears and concerns. In the present study, we experimentally probed this core feature of OCD through the use of a novel attention switching task that investigates transitions between internally focused (IF) and externally focused (EF) attentional states. Eighteen OCD patients and 18 controls imagined positive and negative personal event scenarios (IF state) or performed a color-word Stroop task (EF state). The IF/EF states were followed by a target detection (TD) task requiring responses to external stimuli. Compared to controls, OCD patients made significantly more errors and showed reduced activation of superior and inferior occipital cortex, thalamus, and putamen during TD following negative IF, with the inferior occipital hypoactivation being significantly greater for TD following negative IF compared to TD following the other conditions. Patients showed stronger functional connectivity between the inferior occipital region and dorsomedial prefrontal cortex. These findings point to an OCD-related impairment in the visual processing of external stimuli specifically when they follow a period of negative internal focus, and suggest that future treatments may wish to target the transition between attentional states.

Effect of Psilocybin on Empathy and Moral Decision-Making

BACKGROUND

Impaired empathic abilities lead to severe negative social consequences and influence the development and treatment of several psychiatric disorders. Furthermore, empathy has been shown to play a crucial role in moral and prosocial behavior. Although the serotonin system has been implicated in modulating empathy and moral behavior, the relative contribution of the various serotonin receptor subtypes is still unknown.

METHODS

We investigated the acute effect of psilocybin (0.215 mg/kg p.o.) in healthy human subjects on different facets of empathy and hypothetical moral decision-making using the multifaceted empathy test (n=32) and the moral dilemma task (n=24).

RESULTS

Psilocybin significantly increased emotional, but not cognitive empathy compared with placebo, and the increase in implicit emotional empathy was significantly associated with psilocybin-induced changed meaning of percepts. In contrast, moral decision-making remained unaffected by psilocybin.

CONCLUSIONS

These findings provide first evidence that psilocybin has distinct effects on social cognition by enhancing emotional empathy but not moral behavior. Furthermore, together with previous findings, psilocybin appears to promote emotional empathy presumably via activation of serotonin 2A/1A receptors, suggesting that targeting serotonin 2A/1A receptors has implications for potential treatment of dysfunctional social cognition.

Core, social and moral disgust are bounded: A review on behavioral and neural bases of repugnance in clinical disorders

Disgust is a multifaceted experience that might affect several aspects of life. Here, we reviewed research on neurological and psychiatric disorders that are characterized by abnormal disgust processing to test the hypothesis of a shared neurocognitive architecture in the representation of three disgust domains: i) personal experience of 'core disgust'; ii) social disgust, i.e., sensitivity to others' expressions of disgust; iii) moral disgust, i.e., sensitivity to ethical violations. Our review provides some support to the shared neurocognitive hypothesis and suggests that the insula might be the "hub" structure linking the three domains of disgust sensitivity, while other brain regions may subserve specific facets of the multidimensional experience. Our review also suggests a role of serotonin core and moral disgust, supporting "neo-sentimentalist" theories of morality, which posit a causal role of affect in moral judgment.

Executive functions in obsessive-compulsive disorder: An activation likelihood estimate meta-analysis of fMRI studies

OBJECTIVES

To identify activation changes assessed in functional magnetic resonance imaging (fMRI) studies of obsessive-compulsive disorder (OCD) through Activation Likelihood Estimate meta-analysis.

METHODS

We included 28 peer-reviewed standard stereotactic space studies assessing adult OCD patients (OCDpts) vs. healthy controls (HCs) with fMRI during executive task performance.

RESULTS

In within-group analyses, HCs showed task-related activations in bilateral inferior frontal gyri, right middle frontal gyrus, right inferior parietal lobule, right claustrum, bilateral cingulate gyri, and left caudate body. OCDpts showed task-related left-sided activations in the superior, medial, and inferior frontal gyri, and thalamus, and bilateral activations in the middle frontal gyri, inferior parietal lobule, and insular cortices. Subtraction analysis showed increased left middle frontal gyrus activation in OCDpts. In between-groups analyses, OCDpts hypoactivated the right caudate body, left putamen, left ACC, and right medial and middle frontal gyri. Right caudate hypoactivation persisted also after applying Family-wise error algorithms.

CONCLUSIONS

This meta-analysis confirms that during executive functioning OCDpts show a functional deficit of the right caudate body, which could represent a major neural functional correlate of their illness.

Structural covariance of neostriatal and limbic regions in patients with obsessive-compulsive disorder

BACKGROUND

Frontostriatal and frontoamygdalar connectivity alterations in patients with obsessive-compulsive disorder (OCD) have been typically described in functional neuroimaging studies. However, structural covariance, or volumetric correlations across distant brain regions, also provides network-level information. Altered structural covariance has been described in patients with different psychiatric disorders, including OCD, but to our knowledge, alterations within frontostriatal and frontoamygdalar circuits have not been explored.

METHODS

We performed a mega-analysis pooling structural MRI scans from the Obsessive-compulsive Brain Imaging Consortium and assessed whole-brain voxel-wise structural covariance of 4 striatal regions (dorsal and ventral caudate nucleus, and dorsal-caudal and ventral-rostral putamen) and 2 amygdalar nuclei (basolateral and centromedial-superficial). Images were preprocessed with the standard pipeline of voxel-based morphometry studies using Statistical Parametric Mapping software.

RESULTS

Our analyses involved 329 patients with OCD and 316 healthy controls. Patients showed increased structural covariance between the left ventral-rostral putamen and the left inferior frontal gyrus/frontal operculum region. This finding had a significant interaction with age; the association held only in the subgroup of older participants. Patients with OCD also showed increased structural covariance between the right centromedial-superficial amygdala and the ventromedial prefrontal cortex.

LIMITATIONS

This was a cross-sectional study. Because this is a multisite data set analysis, participant recruitment and image acquisition were performed in different centres. Most patients were taking medication, and treatment protocols differed across centres.

CONCLUSION

Our results provide evidence for structural network-level alterations in patients with OCD involving 2 frontosubcortical circuits of relevance for the disorder and indicate that structural covariance contributes to fully characterizing brain alterations in patients with psychiatric disorders.

Microstructural white-matter abnormalities and their relationship with cognitive dysfunction in obsessive-compulsive disorder

BACKGROUND

In recent years, diffusion tensor imaging (DTI) studies have detected subtle microstructural abnormalities of white matter (WM) in obsessive-compulsive disorder (OCD). However, findings have been inconsistent, and it is unclear whether WM abnormalities are related to cognitive processes. The aim of this study was to explore the relationship of WM alterations with cognitive variables in OCD in order to investigate the structural correlates of behaviorally relevant features of the disorder.

METHODS

We compared DTI-derived fractional anisotropy (FA), mean diffusivity (MD), and radial diffusivity (RD) measures between OCD patients (n = 16) and healthy controls (n = 18) using a whole-brain tract-based spatial statistics (TBSS) approach. We also explored the correlations of WM alterations with clinical and cognitive variables.

RESULTS

Patients with OCD demonstrated increases in MD in the bilateral posterior corona radiata; left anterior corona radiata; bilateral superior longitudinal fasciculus; genu, body, and splenium of the corpus callosum; and left posterior limb of the internal capsule. An increase in RD values was also found in some of the same tracts (right posterior corona radiata, right superior longitudinal fasciculus, left anterior corona radiata, and corpus callosum). Furthermore, increased MD value in the internal capsule was correlated with the percentage of errors made during a target detection task, which was greater in the OCD group overall.

CONCLUSIONS

These findings indicate that OCD patients show greater diffusivity in several white-matter regions. The correlation between cognitive performance and diffusivity in the internal capsule suggests that microstructural WM alternations may have functional consequences for the disorder.

Neurodevelopmental correlates of proneness to guilt and shame in adolescence and early adulthood

Investigating how brain development during adolescence and early adulthood underlies guilt- and shame-proneness may be important for understanding risk processes for mental disorders. The aim of this study was to investigate the neurodevelopmental correlates of interpersonal guilt- and shame-proneness in healthy adolescents and young adults using structural magnetic resonance imaging (sMRI). Sixty participants (age range: 15–25) completed sMRI and self-report measures of interpersonal guilt- and shame-proneness. Independent of interpersonal guilt, higher levels of shame-proneness were associated with thinner posterior cingulate cortex (PCC) thickness and smaller amygdala volume. Higher levels of shame-proneness were also associated with attenuated age-related reductions in thickness of lateral orbitofrontal cortex (lOFC). Our findings highlight the complexities in understanding brain–behavior relationships during the adolescent/young adult period. Results were consistent with growing evidence that accelerated cortical thinning during adolescence may be associated with superior socioemotional functioning. Further research is required to understand the implications of these findings for mental disorders characterized by higher levels of guilt and shame.

Neurofunctional correlates of ethical, food-related decision-making

For consumers today, the perceived ethicality of a food’s production method can be as important a purchasing consideration as its price. Still, few studies have examined how, neurofunctionally, consumers are making ethical, food-related decisions. We examined how consumers’ ethical concern about a food’s production method may relate to how, neurofunctionally, they make decisions whether to purchase that food. Forty-six participants completed a measure of the extent to which they took ethical concern into consideration when making food-related decisions. They then underwent a series of functional magnetic resonance imaging (fMRI) scans while performing a food-related decision-making (FRDM) task. During this task, they made 56 decisions whether to purchase a food based on either its price (i.e., high or low, the “price condition”) or production method (i.e., with or without the use of cages, the “production method condition”), but not both. For 23 randomly selected participants, we performed an exploratory, whole-brain correlation between ethical concern and differential neurofunctional activity in the price and production method conditions. Ethical concern correlated negatively and significantly with differential neurofunctional activity in the left dorsolateral prefrontal cortex (dlPFC). For the remaining 23 participants, we performed a confirmatory, region-of-interest (ROI) correlation between the same variables, using an 8-mm3 volume situated in the left dlPFC. Again, the variables correlated negatively and significantly. This suggests, when making ethical, food-related decisions, the more consumers take ethical concern into consideration, the less they may rely on neurofunctional activity in the left dlPFC, possibly because making these decisions is more routine for them, and therefore a more perfunctory process requiring fewer cognitive resources.

The influence of oxytocin on volitional and emotional ambivalence

Moral decisions and social relationships are often characterized by strong feelings of ambivalence which can be a catalyst for emotional distress and several health-related problems. The anterior cingulate cortex (ACC) has been identified as a key brain region in monitoring conflicting information, but the neurobiological substrates of ambivalence processing are still widely unknown. We have conducted two randomized, double-blind, placebo-controlled, functional magnetic resonance imaging experiments involving 70 healthy male volunteers to investigate the effects of the neuropeptide oxytocin (OXT) on neural and behavioral correlates of ambivalence. We chose moral decision-making and the imagery of partner infidelity as examples to probe volitional and emotional ambivalence. In both experiments, intranasal OXT diminished neural responses in the ACC to ambivalence. Under OXT, moral dilemma vignettes also elicited a reduced activation in the orbitofrontal cortex, and the imagery of partner infidelity was rated as less arousing. Interestingly, the OXT-induced differential activation in the ACC predicted the magnitude of arousal reduction. Taken together, our findings reveal an unprecedented role of OXT in causing a domain-general decrease of neural responses to ambivalence. By alleviating emotional distress, OXT may qualify as a treatment option for psychiatric disorders with heightened ambivalence sensitivity such as schizophrenia or obsessive-compulsive disorder.

Microstructural abnormality in left nucleus accumbens predicts dysfunctional beliefs in treatment-resistant obsessive-compulsive disorder

Background

The aim of this study was to determine whether dysfunctional beliefs might predict treatment-resistance and to examine the relationship between fractional anisotropy (FA) in diffusion tensor imaging (DTI) and cognitive biases for optimal treatment choice.

Material/Methods

We recruited 11 non-resistant obsessive-compulsive disorder (OCD) patients, 11 resistant OCD patients, and 11 healthy subjects.

Results

OCD patients had higher Obsessive Beliefs Questionnaire (OBQ-87) subscale scores than subjects in non-resistant and resistant groups. A significant difference was found between non-resistant and resistant OCD patients in R-Scale and I-Scale. A significant decrease in FA was found in left dorsal frontal gyrus and left inferior parietal lobule in the non-resistant group as compared to the control group. FA also decreased significantly in left anterior cingulate cortex, putamen, and nucleus accumbens in the resistant group as compared to the control group. There was a significant decrease in FA in nucleus accumbens in the resistant group as compared to the non-resistant group. Reduced FA in left nucleus accumbens was negatively associated with OBQ-87 factor R and I and the total Yale-Brown Obsessive-Compulsive Scale (Y-BOCS).

Conclusions

Abnormalities in cortical-striatal white matter networks may contribute to the dysfunctional beliefs in patients with treatment-resistant OCD, and the left nucleus accumbens may be an important and promising target for the treatment of OCD.

Cognitive neuroscience of obsessive-compulsive disorder

Cognitive neuroscience investigates neural responses to cognitive and emotional probes, an approach that has yielded critical insights into the neurobiological mechanisms of psychiatric disorders. This article reviews some of the major findings from neuroimaging studies using a cognitive neuroscience approach to investigate obsessive-compulsive disorder (OCD). It evaluates the consistency of results and interprets findings within the context of OCD symptoms, and proposes a model of OCD involving inflexibility of internally focused cognition. Although further research is needed, this body of work probing cognitive-emotional processes in OCD has already shed considerable light on the underlying mechanisms of the disorder.

The Persistence of Experience: Prior Attentional and Emotional State Affects Network Functioning in a Target Detection Task

Efficient, adaptive behavior relies on the ability to flexibly move between internally focused (IF) and externally focused (EF) attentional states. Despite evidence that IF cognitive processes such as event imagination comprise a significant amount of awake cognition, the consequences of internal absorption on the subsequent recruitment of brain networks during EF tasks are unknown. The present functional magnetic resonance imaging (fMRI) study employed a novel attentional state switching task. Subjects imagined positive and negative events (IF task) or performed a working memory task (EF task) before switching to a target detection (TD) task also requiring attention to external information, allowing for the investigation of neural functioning during external attention based on prior attentional state. There was a robust increase of activity in frontal, parietal, and temporal regions during TD when subjects were previously performing the EF compared with IF task, an effect that was most pronounced following negative IF. Additionally, dorsolateral prefrontal cortex was less negatively coupled with ventromedial prefrontal and posterior cingulate cortices during TD following IF compared with EF. These findings reveal the striking consequences for brain activity following immersion in an IF attentional state, which have strong implications for psychiatric disorders characterized by excessive internal focus.

Moral rigidity in obsessive-compulsive disorder: do abnormalities in inhibitory control, cognitive flexibility and disgust play a role?

BACKGROUND AND OBJECTIVES

Abnormalities in cognitive control and disgust responding are well-documented in obsessive-compulsive disorder (OCD), and also interfere with flexible, outcome-driven utilitarian moral reasoning. The current study examined whether individuals with OCD differ from healthy and anxious individuals in their use of utilitarian moral reasoning, and whether abnormalities in inhibitory control, cognitive flexibility and disgust contribute to moral rigidity.

METHODS

Individuals with OCD (n = 23), non-OCD anxiety (n = 21) and healthy participants (n = 24) gave forced-choice responses to three types of moral dilemmas: benign, impersonal, personal. Scores on measures of cognitive flexibility, inhibitory control and trait disgust were also examined.

RESULTS

Individuals with OCD gave fewer utilitarian responses to impersonal moral dilemmas compared to healthy, but not anxious, individuals. Poorer cognitive flexibility was associated with fewer utilitarian responses to impersonal dilemmas in the OCD group. Furthermore, greater trait disgust was associated with increased utilitarian responding to personal dilemmas in the OCD group, but decreased utilitarian responding to impersonal dilemmas in the anxious group.

LIMITATIONS

Although we did not find an association between inhibitory control and moral reasoning, smaller associations may be evident in a larger sample.

CONCLUSION

These data indicate that individuals with OCD use more rigid moral reasoning in response to impersonal moral dilemmas compared to healthy individuals, and that this may be associated with reduced cognitive flexibility. Furthermore, these data suggest that trait disgust may exert opposing effects on moral reasoning in individuals with OCD compared to those with other forms of anxiety.

Neural correlates of obsessive-compulsive related dysfunctional beliefs

There have been few attempts to integrate neurobiological and cognitive models of obsessive-compulsive disorder (OCD), although this might constitute a key approach to clarify the complex etiology of the disorder. Our study aimed to explore the neural correlates underlying dysfunctional beliefs hypothesized by cognitive models to be involved in the development and maintenance of OCD. We obtained a high-resolution magnetic resonance image from fifty OCD patients and 30 healthy controls, and correlated them, voxel-wise, with the severity of OC-related dysfunctional beliefs assessed by the Obsessive Beliefs Questionnaire-44. In healthy controls, significant negative correlations were observed between anterior temporal lobe (ATL) volume and scores on perfectionism/intolerance of uncertainty and overimportance/need to control thoughts. No significant correlations between OBQ-44 domains and regional gray matter volumes were observed in OCD patients. A post-hoc region-of-interest analysis detected that the ATLs was bilaterally smaller in OCD patients. On splitting subjects into high- and low-belief subgroups, we observed that such brain structural differences between OCD patients and healthy controls were explained by significantly larger ATL volumes among healthy subjects from the low-belief subgroup. Our results suggest a significant correlation between OC-related dysfunctional beliefs and morphometric variability in the anterior temporal lobe, a brain structure related to socio-emotional processing. Future studies should address the interaction of these correlations with environmental factors to fully characterize the bases of OC-related dysfunctional beliefs and to advance in the integration of biological and cognitive models of OCD.

Ethical sensitivity in obsessive-compulsive disorder and generalized anxiety disorder: the role of reversal learning

BACKGROUND AND OBJECTIVES

In obsessive-compulsive disorder (OCD), amplified moral sensitivity may be related to the orbitofrontal-striatal circuit, which is also critical in reversal learning. This study examined three questions: (1) What aspects of ethical sensitivity is altered in OCD?; (2) What is the relationship between ethical sensitivity and reversal learning?; (3) Are potential alterations in ethical sensitivity and reversal learning present in generalized anxiety disorder (GAD)?

METHODS

Participants were 28 outpatients with OCD, 21 individuals with GAD, and 30 matched healthy controls. Participants received the ethical sensitivity scale questionnaire (ESSQ), rating scales for clinical symptoms, a reversal learning task, and the Wisconsin Card Sorting Test (WCST).

RESULTS

We found higher ethical sensitivity scores in OCD compared with healthy controls in the case of generating interpretations and options and identifying the consequences of actions. Individuals with OCD displayed prolonged reaction times on probabilistic errors without shift and final reversal errors. Participants with GAD did not differ from healthy controls on the ESSQ, but they were slower on reversal learning relative to nonpatients. In OCD, reaction time on final reversal errors mediated the relationship between ethical sensitivity and compulsions. WCST performance was intact in OCD and GAD.

LIMITATIONS

Small sample size, limited neuropsychological assessment, self-rating scale for ethical sensitivity.

CONCLUSION

Prolonged reaction time at switching reinforcement contingencies is related to increased ethical sensitivity in OCD. Slow affective switching may link ethical sensitivity and compulsions.