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Richson BN, Abber SR, Wierenga CE. Conceptualizing avoidant/restrictive food intake disorder via an executive functioning lens. Int J Eat Disord 2024. [PMID: 38804560 DOI: 10.1002/eat.24233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 05/14/2024] [Accepted: 05/15/2024] [Indexed: 05/29/2024]
Abstract
Avoidant/restrictive food intake disorder (ARFID) is a heterogeneous disorder wherein restrictive eating is primarily attributed to non-shape/weight-based reasons (e.g., sensory sensitivity) that empirical research continues to explore. Mounting evidence suggests that ARFID often presents alongside neurodevelopmental diagnoses (NDs) or divergent neurodevelopment broadly. Executive functioning (EF) differences often characterize divergent neurodevelopmental trajectories. Additionally, restrictive eating in anorexia nervosa has been conceptualized as related to EF factors (e.g., set shifting). Given the neurodevelopmental phenotype that may be associated with ARFID and the role of EF in anorexia nervosa, this paper proposes EF as a potentially important, yet understudied factor in ARFID pathology. We posit that various observed ARFID behavioral/cognitive tendencies can be conceptualized in relation to EF differences. We contextualize commonly observed ARFID presentations within "core" EF components (i.e., cognitive flexibility, working memory, inhibitory control), leading to hypotheses about EF in ARFID. Finally, we offer additional considerations/directions for future research on EF in ARFID. Increased research on EF in ARFID is needed to consider this potential common factor in the etiology and maintenance of this heterogeneous disorder. We aim to promote further consideration of EF in ARFID etiology, maintenance, and treatment-outcome research. PUBLIC SIGNIFICANCE: This article proposes that aspects of executive functioning (EF) may play a role in the onset and maintenance of avoidant/restrictive food intake disorder (ARFID), although this notion is largely untested by existing research. Further research on the role of EF in ARFID may assist with refining models and treatments for this heterogeneous disorder.
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Affiliation(s)
- Brianne N Richson
- Sanford Center for Biobehavioral Research, Sanford Research, Fargo, North Dakota, USA
- Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, Fargo, North Dakota, USA
| | - Sophie R Abber
- Department of Psychology, Florida State University, Tallahassee, Florida, USA
| | - Christina E Wierenga
- Department of Psychiatry, University of California San Diego Eating Disorders Center for Treatment and Research, San Diego, California, USA
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Caudle MM, Dugas N, Stout DM, Ball TM, Bomyea J. Adjunctive cognitive training with exposure enhances fear and neural outcomes in social anxiety. Psychiatry Res 2023; 327:115416. [PMID: 37604041 DOI: 10.1016/j.psychres.2023.115416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 07/26/2023] [Accepted: 08/11/2023] [Indexed: 08/23/2023]
Abstract
Exposure-based cognitive behavioral therapy (CBT) is the gold standard for treating social anxiety disorder (SAD), yet response is not universal. CBT is thought to operate via extinction-related learning during exposure, which in turn relies on cognitive processes such as working memory. The present proof-of-concept study investigates the potential for training working memory to improve anxiety related outcomes following exposure. Thirty-three adults with elevated social anxiety were randomized to complete a working memory training or sham training condition. Post-training, participants completed a working memory assessment, speech exposure session, and two fMRI tasks. Participants who received working memory training demonstrated lower distress ratings by the end of the speech exposures and better performance on the fMRI working memory task than those in sham. Working memory training completers had greater neural activation in frontoparietal regions during an in-scanner working memory task and exhibited less neural activation in the fusiform gyrus in response to an emotional face processing task than those in sham. Adding working memory training to exposure procedures could strengthen functioning of frontoparietal regions and alter emotional processing - key mechanisms implicated in extinction learning. Findings provide preliminary evidence that training working memory in conjunction with exposure may enhance exposure success.
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Affiliation(s)
- M M Caudle
- San Diego State University, University of California San Diego Joint Doctoral Program in Clinical Psychology, 6363 Alvarado Court, Suite 103, San Diego, CA 92120, United States; Department of Veteran Affairs Medical Center, 3350 La Jolla Village Dr, San Diego, CA 92161, United States; Department of Psychiatry, University of California, 9500 Gilman Dr, La Jolla, CA 92093, United States
| | - N Dugas
- Department of Veteran Affairs Medical Center, 3350 La Jolla Village Dr, San Diego, CA 92161, United States; Department of Psychiatry, University of California, 9500 Gilman Dr, La Jolla, CA 92093, United States
| | - D M Stout
- Department of Psychiatry, University of California, 9500 Gilman Dr, La Jolla, CA 92093, United States; VA San Diego Center of Excellence for Stress and Mental Health, 3350 La Jolla Village Dr, San Diego, CA 92161, United States
| | - T M Ball
- Department of Psychiatry & Behavioral Sciences, Stanford School of Medicine, 401 Quarry Road, Stanford, CA, 94305, United States
| | - J Bomyea
- Department of Psychiatry, University of California, 9500 Gilman Dr, La Jolla, CA 92093, United States; VA San Diego Center of Excellence for Stress and Mental Health, 3350 La Jolla Village Dr, San Diego, CA 92161, United States.
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Gonsalves MA, Beck QM, Fukuda AM, Tirrell E, Kokdere F, Kronenberg EF, Iadarola ND, Hagberg S, Carpenter LL, Barredo J. Mechanical Affective Touch Therapy for Anxiety Disorders: Effects on Resting State Functional Connectivity. Neuromodulation 2022; 25:1431-1442. [PMID: 35088729 PMCID: PMC9256848 DOI: 10.1016/j.neurom.2021.10.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 09/08/2021] [Accepted: 09/27/2021] [Indexed: 02/06/2023]
Abstract
OBJECTIVES Mechanical Affective Touch Therapy (MATT) is a safe, novel form of noninvasive peripheral nerve stimulation. Although mechanical stimulation activates nerves, we know little about its impact on psychiatric symptoms and their underlying cortical mechanisms. We examined the effects of open-label MATT on resting state functional connectivity (RSFC) and its relationship with anxiety and affective symptomatology (clinical results in separate report). MATERIALS AND METHODS A total of 22 adults with an Axis I anxiety disorder were recruited from the community. After two initial sessions assisted by research staff, participants self-administered 20-minute sessions of MATT at home at least twice daily for four weeks. Self-report measures of mood and anxiety severity were collected at baseline, two weeks, and four weeks. Resting state functional magnetic resonance imaging was collected before the initial MATT session (n = 20), immediately after the first session (n = 18), and following four weeks of MATT (n = 14). Seed-based whole-brain functional connectivity analyses identified brain connectivity patterns correlated with responsiveness to MATT. Seeds were based on Neurosynth meta-analytic maps for "anxiety" and "pain" given MATT's hypothesized role in anxiety symptom amelioration and potential mechanism of action through C-tactile afferents, which play an important role in detecting pain and its affective components. Connectivity results were corrected for multiple comparisons (voxel p < 0.005, cluster p-FDR < 0.05). RESULTS Baseline RSFC is predictive of symptom improvement with chronic MATT. Acute increases in insula connectivity were observed between mid-cingulate cortex and postcentral motor regions following the first MATT session. Chronic MATT was associated with increased connectivity between pain and anxiety regions of interest (ROIs) and posterior default mode network (DMN) regions involved in memory and self-reflection; the connectivity changes correlated with decreases in stress and depression symptoms. CONCLUSIONS MATT is associated with alterations in RSFC in the DMN of anxiety disorder patients both acutely and after long-term administration, and baseline RSFC is predictive of post-treatment symptom improvement.
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Affiliation(s)
- Meghan A Gonsalves
- Neuroscience Graduate Program, Department of Neuroscience, Brown University, Providence, RI, USA; Butler Hospital Mood Disorders Research Program and Neuromodulation Research Facility, Providence, RI, USA.
| | - Quincy M Beck
- Butler Hospital Mood Disorders Research Program and Neuromodulation Research Facility, Providence, RI, USA
| | - Andrew M Fukuda
- Butler Hospital Mood Disorders Research Program and Neuromodulation Research Facility, Providence, RI, USA; Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Providence, RI, USA
| | - Eric Tirrell
- Butler Hospital Mood Disorders Research Program and Neuromodulation Research Facility, Providence, RI, USA
| | - Fatih Kokdere
- Butler Hospital Mood Disorders Research Program and Neuromodulation Research Facility, Providence, RI, USA; Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Providence, RI, USA
| | - Eugenia F Kronenberg
- Butler Hospital Mood Disorders Research Program and Neuromodulation Research Facility, Providence, RI, USA
| | - Nicolas D Iadarola
- Butler Hospital Mood Disorders Research Program and Neuromodulation Research Facility, Providence, RI, USA; University of Arizona College of Medicine, Tucson, Tucson, AZ, USA
| | - Sean Hagberg
- AffectNeuro, Inc, Brooklyn, NY, USA; Department of Neurosurgery, School of Medicine, University of New Mexico, Albuquerque, NM, USA
| | - Linda L Carpenter
- Butler Hospital Mood Disorders Research Program and Neuromodulation Research Facility, Providence, RI, USA; Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Providence, RI, USA
| | - Jennifer Barredo
- Butler Hospital Mood Disorders Research Program and Neuromodulation Research Facility, Providence, RI, USA; Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Providence, RI, USA; Center for Neurorestoration and Neurotechnology, Providence VA Medical Center, Providence, RI, USA
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Iwama Y, Takamoto K, Hibi D, Nishimaru H, Matsumoto J, Setogawa T, Nishijo H. Young female participants show blunted placebo effects associated with blunted responses to a cue predicting a safe stimulus in the right dorsolateral prefrontal cortex. Front Neurosci 2022; 16:1001177. [PMID: 36263366 PMCID: PMC9574021 DOI: 10.3389/fnins.2022.1001177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 09/20/2022] [Indexed: 11/17/2022] Open
Abstract
Discrimination of cues predicting non-nociceptive/nociceptive stimuli is essential for predicting whether a non-painful or painful stimulus will be administered and for eliciting placebo/nocebo (pain reduction/pain enhancement) effects. Dysfunction of the neural system involved in placebo effects has been implicated in the pathology of chronic pain, while female sex is one of the important risk factors for development of chronic pain in young adults. The dorsolateral prefrontal cortex (dl-PFC) is suggested to be involved in placebo effects and is sensitive to sex and age. In this study, to examine the neural mechanisms by which sex and age alter placebo and nocebo effects, we analyzed cerebral hemodynamic activities in the dl-PFC in different sex and age groups during a differential conditioning task. During the training session, two different sounds were followed by low- and high-intensity electrical shocks. In the following recording session, electrical shocks, the intensity of which was mismatched to the sounds, were occasionally administered to elicit placebo and nocebo effects. In young female participants, both placebo effects and hemodynamic responses to the conditioned sounds in the right dl-PFC were significantly lower than those in elderly female participants, while there were no age differences in male participants. The hemodynamic responses to the sound paired with the safe stimulus in the right dl-PFC were significantly correlated with placebo effects, except in the young female group. These results suggest that blunted placebo effects in the young female participants are ascribed to blunted responses to the sound associated with the safe stimulus in the right dl-PFC, and that sex- and age-related factors may alter the responsiveness of the right dl-PFC to associative cues predicting a safe stimulus.
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Affiliation(s)
- Yudai Iwama
- System Emotional Science, Faculty of Medicine, University of Toyama, Toyama, Japan
| | - Kouichi Takamoto
- Department of Sport and Health Sciences, Faculty of Human Sciences, University of East Asia, Shimonoseki, Japan
| | - Daisuke Hibi
- Department of Anesthesiology, Faculty of Medicine, University of Toyama, Toyama, Japan
| | - Hiroshi Nishimaru
- System Emotional Science, Faculty of Medicine, University of Toyama, Toyama, Japan
- Research Center for Idling Brain Science (RCIBS), University of Toyama, Toyama, Japan
| | - Jumpei Matsumoto
- System Emotional Science, Faculty of Medicine, University of Toyama, Toyama, Japan
- Research Center for Idling Brain Science (RCIBS), University of Toyama, Toyama, Japan
| | - Tsuyoshi Setogawa
- System Emotional Science, Faculty of Medicine, University of Toyama, Toyama, Japan
- Research Center for Idling Brain Science (RCIBS), University of Toyama, Toyama, Japan
| | - Hisao Nishijo
- System Emotional Science, Faculty of Medicine, University of Toyama, Toyama, Japan
- Research Center for Idling Brain Science (RCIBS), University of Toyama, Toyama, Japan
- *Correspondence: Hisao Nishijo,
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Ward RT, Lotfi S, Stout DM, Mattson S, Lee HJ, Larson CL. Working Memory Performance for Differentially Conditioned Stimuli. Front Psychol 2022; 12:811233. [PMID: 35145464 PMCID: PMC8821888 DOI: 10.3389/fpsyg.2021.811233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 12/29/2021] [Indexed: 01/29/2023] Open
Abstract
Previous work suggests that threat-related stimuli are stored to a greater degree in working memory compared to neutral stimuli. However, most of this research has focused on stimuli with physically salient threat attributes (e.g., angry faces), failing to account for how a "neutral" stimulus that has acquired threat-related associations through differential aversive conditioning influences working memory. The current study examined how differentially conditioned safe (i.e., CS-) and threat (i.e., CS+) stimuli are stored in working memory relative to a novel, non-associated (i.e., N) stimuli. Participants (n = 69) completed a differential fear conditioning task followed by a change detection task consisting of three conditions (CS+, CS-, N) across two loads (small, large). Results revealed individuals successfully learned to distinguishing CS+ from CS- conditions during the differential aversive conditioning task. Our working memory outcomes indicated successful load manipulation effects, but no statistically significant differences in accuracy, response time (RT), or Pashler's K measures of working memory capacity between CS+, CS-, or N conditions. However, we observed significantly reduced RT difference scores for the CS+ compared to CS- condition, indicating greater RT differences between the CS+ and N condition vs. the CS- and N condition. These findings suggest that differentially conditioned stimuli have little impact on behavioral outcomes of working memory compared to novel stimuli that had not been associated with previous safe of aversive outcomes, at least in healthy populations.
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Affiliation(s)
- Richard T. Ward
- Center for the Study of Emotion and Attention, University of Florida, Gainesville, FL, United States,Department of Psychology, University of Florida, Gainesville, FL, United States,*Correspondence: Richard T. Ward,
| | - Salahadin Lotfi
- Department of Psychology, University of Wisconsin—Milwaukee, Milwaukee, WI, United States
| | - Daniel M. Stout
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego, CA, United States,Department of Psychiatry, University of California, San Diego, San Diego, CA, United States
| | - Sofia Mattson
- Department of Psychology, University of Wisconsin—Milwaukee, Milwaukee, WI, United States
| | - Han-Joo Lee
- Department of Psychology, University of Wisconsin—Milwaukee, Milwaukee, WI, United States
| | - Christine L. Larson
- Department of Psychology, University of Wisconsin—Milwaukee, Milwaukee, WI, United States
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Laing PAF, Harrison BJ. Safety learning and the Pavlovian conditioned inhibition of fear in humans: Current state and future directions. Neurosci Biobehav Rev 2021; 127:659-674. [PMID: 34023357 DOI: 10.1016/j.neubiorev.2021.05.014] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Revised: 05/07/2021] [Accepted: 05/17/2021] [Indexed: 01/02/2023]
Abstract
Safety learning occurs when an otherwise neutral stimulus comes to signal the absence of threat, allowing organisms to use safety information to inhibit fear and anxiety in nonthreatening environments. Although it continues to emerge as a topic of relevance in biological and clinical psychology, safety learning remains inconsistently defined and under-researched. Here, we analyse the Pavlovian conditioned inhibition paradigm and its application to the study of safety learning in humans. We discuss existing studies; address outstanding theoretical considerations; and identify prospects for its further application. Though Pavlovian conditioned inhibition presents a theoretically sound model of safety learning, it has been investigated infrequently, with decade-long interims between some studies, and notable methodological variability. Consequently, we argue that the full potential of conditioned inhibition as a model for human safety learning remains untapped, and propose that it could be revisited as a framework for addressing timely questions in the behavioural and clinical sciences.
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Affiliation(s)
- Patrick A F Laing
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne, Victoria, Australia.
| | - Ben J Harrison
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne, Victoria, Australia.
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Laing PA, Vervliet B, Fullana MA, Savage HS, Davey CG, Felmingham KL, Harrison BJ. Characterizing human safety learning via Pavlovian conditioned inhibition. Behav Res Ther 2021; 137:103800. [DOI: 10.1016/j.brat.2020.103800] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 12/09/2020] [Accepted: 12/28/2020] [Indexed: 02/08/2023]
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Ney LJ, Laing PA, Steward T, Zuj DV, Dymond S, Felmingham KL. Inconsistent analytic strategies reduce robustness in fear extinction via skin conductance response. Psychophysiology 2020; 57:e13650. [DOI: 10.1111/psyp.13650] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 06/24/2020] [Accepted: 07/07/2020] [Indexed: 12/19/2022]
Affiliation(s)
- Luke John Ney
- School of Psychology University of Tasmania Hobart TAS Australia
| | - Patrick A.F. Laing
- Melbourne Neuropsychiatry Centre Department of Psychiatry University of Melbourne & Melbourne Health Carlton VIC Australia
| | - Trevor Steward
- School of Psychological Sciences University of Melbourne Carlton VIC Australia
| | - Daniel V. Zuj
- Department of Psychology Swansea University Swansea UK
| | - Simon Dymond
- Department of Psychology Swansea University Swansea UK
- Department of Psychology Reykjavik University Reykjavik Iceland
| | - Kim L. Felmingham
- School of Psychological Sciences University of Melbourne Carlton VIC Australia
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Papalini S, Beckers T, Vervliet B. Dopamine: from prediction error to psychotherapy. Transl Psychiatry 2020; 10:164. [PMID: 32451377 PMCID: PMC7248121 DOI: 10.1038/s41398-020-0814-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 04/14/2020] [Accepted: 04/21/2020] [Indexed: 02/07/2023] Open
Abstract
Dopamine, one of the main neurotransmitters in the mammalian brain, has been implicated in the coding of prediction errors that govern reward learning as well as fear extinction learning. Psychotherapy too can be viewed as a form of error-based learning, because it challenges erroneous beliefs and behavioral patterns in order to induce long-term changes in emotions, cognitions, and behaviors. Exposure therapy, for example, relies in part on fear extinction principles to violate erroneous expectancies of danger and induce novel safety learning that inhibits and therefore reduces fear in the long term. As most forms of psychotherapy, however, exposure therapy suffers from non-response, dropout, and relapse. This narrative review focuses on the role of midbrain and prefrontal dopamine in novel safety learning and investigates possible pathways through which dopamine-based interventions could be used as an adjunct to improve both the response and the long-term effects of the therapy. Convincing evidence exists for an involvement of the midbrain dopamine system in the acquisition of new, safe memories. Additionally, prefrontal dopamine is emerging as a key ingredient for the consolidation of fear extinction. We propose that applying a dopamine prediction error perspective to psychotherapy can inspire both pharmacological and non-pharmacological studies aimed at discovering innovative ways to enhance the acquisition of safety memories. Additionally, we call for further empirical investigations on dopamine-oriented drugs that might be able to maximize consolidation of successful fear extinction and its long-term retention after therapy, and we propose to also include investigations on non-pharmacological interventions with putative prefrontal dopaminergic effects, like working memory training.
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Affiliation(s)
- Silvia Papalini
- Laboratory of Biological Psychology (LBP), Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium. .,Leuven Brain Institute, KU Leuven, Leuven, Belgium.
| | - Tom Beckers
- grid.5596.f0000 0001 0668 7884Leuven Brain Institute, KU Leuven, Leuven, Belgium ,grid.5596.f0000 0001 0668 7884Centre for the Psychology of Learning and Experimental Psychopathology (CLEP), Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
| | - Bram Vervliet
- grid.5596.f0000 0001 0668 7884Laboratory of Biological Psychology (LBP), Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium ,grid.5596.f0000 0001 0668 7884Leuven Brain Institute, KU Leuven, Leuven, Belgium
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Sheynin J, Baetu I, Collins-Praino LE, Myers CE, Winwood-Smith R, Moustafa AA. Maladaptive avoidance patterns in Parkinson's disease are exacerbated by symptoms of depression. Behav Brain Res 2020; 382:112473. [PMID: 31935419 DOI: 10.1016/j.bbr.2020.112473] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 01/05/2020] [Accepted: 01/05/2020] [Indexed: 11/26/2022]
Abstract
Parkinson's disease (PD) is a chronic, progressive neurodegenerative disorder, characterized by a loss of dopaminergic neurons in the substantia nigra pars compacta. Given that dopamine is critically involved in learning and other cognitive processes, such as working memory, dopamine loss in PD has been linked both to learning abnormalities and to cognitive dysfunction more generally in the disease. It is unclear, however, whether avoidance behavior is impacted in PD. This is significant, as this type of instrumental behavior plays an important role in both decision-making and emotional (dys) function. Consequently, the aim of the present study was to examine avoidance learning and operant extinction in PD using a computer-based task. On this task, participants control a spaceship and attempt to shoot an enemy spaceship to gain points. They also learn to hide in safe areas to protect from (i.e., avoid) aversive events (on-screen explosions and point loss). The results showed that patients with PD (N = 25) acquired an avoidance response during aversive periods to the same extent as healthy age-matched controls (N = 19); however, patients demonstrated greater hiding during safe periods not associated with aversive events, which could represent maladaptive generalization of the avoidance response. Furthermore, this impairment was more pronounced during the extinction phase, and in patients who reported higher levels of depression. These results demonstrate for the first time that PD is associated with maladaptive avoidance patterns, which could possibly contribute to the emergence of depression in the disease.
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Affiliation(s)
- Jony Sheynin
- Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI, USA; Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA.
| | - Irina Baetu
- School of Psychology, University of Adelaide, Adelaide, SA, Australia
| | - Lyndsey E Collins-Praino
- Department of Medical Sciences, Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
| | - Catherine E Myers
- Department of Veterans Affairs, New Jersey Health Care System, East Orange, NJ, USA; Department of Pharmacology, Physiology & Neuroscience, New Jersey Medical School, Rutgers University, Newark, NJ, USA
| | - Robyn Winwood-Smith
- School of Social Sciences and Psychology, Western Sydney University, Sydney, NSW, Australia
| | - Ahmed A Moustafa
- School of Social Sciences and Psychology, Western Sydney University, Sydney, NSW, Australia; The MARCS Institute for Brain, Behaviour and Development, Western Sydney University, Sydney, NSW, Australia
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