Competition Effects in Visual Cortex Between Emotional Distractors and a Primary Task in Remitted Depression

AttentionCARE: replicability of a BCI for the clinical application of augmented reality-guided EEG-based attention modification for adolescents at high risk for depression

Affect-biased attention is the phenomenon of prioritizing attention to emotionally salient stimuli and away from goal-directed stimuli. It is thought that affect-biased attention to emotional stimuli is a driving factor in the development of depression. This effect has been well-studied in adults, but research shows that this is also true during adolescence, when the severity of depressive symptoms are correlated with the magnitude of affect-biased attention to negative emotional stimuli. Prior studies have shown that trainings to modify affect-biased attention may ameliorate depression in adults, but this research has also been stymied by concerns about reliability and replicability. This study describes a clinical application of augmented reality-guided EEG-based attention modification ("AttentionCARE") for adolescents who are at highest risk for future depressive disorders (i.e., daughters of depressed mothers). Our results (n = 10) indicated that the AttentionCARE protocol can reliably and accurately provide neurofeedback about adolescent attention to negative emotional distractors that detract from attention to a primary task. Through several within and cross-study replications, our work addresses concerns about the lack of reliability and reproducibility in brain-computer interface applications, offering insights for future interventions to modify affect-biased attention in high-risk adolescents.

A Comprehensive Overview of the Role of Visual Cortex Malfunction in Depressive Disorders: Opportunities and Challenges

Major depressive disorder (MDD) is a highly heterogeneous mental disorder, and its complex etiology and unclear mechanism are great obstacles to the diagnosis and treatment of the disease. Studies have shown that abnormal functions of the visual cortex have been reported in MDD patients, and the actions of several antidepressants coincide with improvements in the structure and synaptic functions of the visual cortex. In this review, we critically evaluate current evidence showing the involvement of the malfunctioning visual cortex in the pathophysiology and therapeutic process of depression. In addition, we discuss the molecular mechanisms of visual cortex dysfunction that may underlie the pathogenesis of MDD. Although the precise roles of visual cortex abnormalities in MDD remain uncertain, this undervalued brain region may become a novel area for the treatment of depressed patients.

Attentional biases for sad faces in offspring of mothers with a history of major depression: trajectories of change from childhood to adolescence

BACKGROUND

Theorists have proposed that the way children process social-emotional information may serve as a mechanism of risk for the intergenerational transmission of depression. There is growing evidence that infants and children of mothers with a history of major depressive disorder (MDD) during the child's life exhibit attentional avoidance of sad faces, which has been proposed as an early emerging emotion regulation strategy. In contrast, there is clear evidence that at-risk and depressed adolescents and adults exhibit difficulty disengaging attention from sad faces.

METHODS

Seeking to link these two literatures, the current U.S.-based study used eye tracking within the context of an accelerated longitudinal design to assess attentional biases in 8-14-year-old offspring of mothers with a history MDD during the child's life (n = 123) or no history of MDD (n = 119) every six months for two years, allowing us to map trajectories of attention from age 8 to 16.

RESULTS

Mother MDD history moderated age-based changes in children's gaze duration to sad (t[240] = 2.44, p = .02), but not happy (t[240] = 0.11, p = .91) or angry (t[240] = 0.67, p = .50), faces. Consistent our hypotheses, offspring of mothers with MDD exhibited significantly less attention to sad faces than offspring of never depressed mothers before age 8.5 but significantly more attention to sad faces after age 14.5, which was due to an increase in gaze duration to sad faces from childhood to adolescence among offspring of mothers with MDD (t[122] = 5.44, p < .001) but not among offspring of never depressed mothers (t[118] = 1.49, p = .14).

CONCLUSIONS

It appears that the form, and perhaps function, of attentional bias may shift across development in at-risk youth. To the extent that this is true, it has significant implications not only for theories of the intergenerational transmission of depression risk but also for prevention and early intervention efforts designed to reduce this risk.

Anxiety as a disorder of uncertainty: implications for understanding maladaptive anxiety, anxious avoidance, and exposure therapy

In cognitive-behavioral conceptualizations of anxiety, exaggerated threat expectancies underlie maladaptive anxiety. This view has led to successful treatments, notably exposure therapy, but is not consistent with the empirical literature on learning and choice alterations in anxiety. Empirically, anxiety is better described as a disorder of uncertainty learning. How disruptions in uncertainty lead to impairing avoidance and are treated with exposure-based methods, however, is unclear. Here, we integrate concepts from neurocomputational learning models with clinical literature on exposure therapy to propose a new framework for understanding maladaptive uncertainty functioning in anxiety. Specifically, we propose that anxiety disorders are fundamentally disorders of uncertainty learning and that successful treatments, particularly exposure therapy, work by remediating maladaptive avoidance from dysfunctional explore/exploit decisions in uncertain, potentially aversive situations. This framework reconciles several inconsistencies in the literature and provides a path forward to better understand and treat anxiety.

Skill Improvement Through Learning in Therapy (SKILT): A Study Protocol for a Randomized Trial Testing the Direct Effects of Cognitive Behavioral Therapy Skill Acquisition and Role of Learning Capacity in Depression

Background

To improve psychological treatments for major depressive disorder (MDD), a better understanding on how symptoms ameliorate during treatment is essential. In cognitive behavioral therapy (CBT), it is unclear whether procedures focused on the acquisition of CBT skills play a causal role in the improvement of CBT skills. In this randomized trial, we isolate a single CBT Skill Acquisition Procedure (CBTSAP) and test its direct effects on CBT skills and related therapy processes (i.e., change in (idiosyncratic) dysfunctional thinking and reward processing). We hypothesize that the CBTSAP causes improvements in CBT skills and related therapy processes compared to an active control condition. In addition, we hypothesize that individual differences in attentional bias and memory functioning (defined as learning capacity) moderate the effects of CBTSAP on outcomes and that using mental imagery as a cognitive support strategy to strengthen the effects of the CBTSAP will be most beneficial for patients with low learning capacity.

Method

150 patients with MDD will be randomized to one of three conditions: 1. an active control condition, 2. CBTSAP, 2. CBTSAP plus mental imagery, all consisting of three sessions. Primary outcomes will be change in CBT skills, changes in (idiosyncratic) dysfunctional thoughts and behaviors, reward processing. Depressive symptoms are a secondary outcome. Measures of learning capacity will be conducted at baseline and tested as a potential moderator.

Discussion

Knowing whether and for whom the acquisition of CBT skills leads to change in therapy processes and a subsequent reduction of depressive symptoms will inform on how to personalize and optimize psychotherapy outcomes for depression.

Trial registration

The trial is registered at the German Clinical Trial Register (DKTR; registration number: DRKS00024116).

Asthma's effect on brain connectivity and cognitive decline

Objective

To investigate the changes in dynamic voxel mirror homotopy connection (dVMHC) between cerebral hemispheres in patients with asthma.

Methods

Our study was designed using a case-control method. A total of 31 subjects with BA and 31 healthy subjects with matching basic information were examined using rsfMRI. We also calculated and obtained the dVMHC value between the cerebral cortexes.

Results

Compared with the normal control group, the dVMHC of the lingual gyrus (Ling) and the calcarine sulcus (CAL), which represented the visual network (VN), increased significantly in the asthma group, while the dVMHC of the medial superior frontal gyrus (MSFG), the anterior/middle/posterior cingulate gyrus (A/M/PCG), and the supplementary motor area (SMA) of the sensorimotor network decreased significantly in the asthma group.

Conclusion

This study showed that the ability of emotion regulation and the efficiency of visual and cognitive information processing in patients with BA was lower than in those in the HC group. The dVMHC analysis can be used to sensitively evaluate oxygen saturation, visual function changes, and attention bias caused by emotional disorders in patients with asthma, as well as to predict airway hyperresponsiveness, inflammatory progression, and dyspnea.

Attentional capture by angry faces in girls who self-injure: Evidence from steady state visual evoked potentials

BACKGROUND

Non-suicidal self-injury (NSSI) is a significant public health concern, not only because of the personal and social cost of the behavior itself, but also because it increases risk for future self-injurious behaviors, including suicide attempts. NSSI is increasingly prevalent during adolescence, which highlights the need for research aimed at identifying modifiable risk factors that can be targeted to reduce future risk. Building from theoretical models that highlight interpersonal processes, this study examined whether adolescents with an NSSI history exhibit greater difficulty inhibiting attention to emotionally salient interpersonal stimuli (face), indexed via steady state visual evoked potentials (SSVEPs), which provide a direct neural index of the ability to inhibit attention to task-irrelevant stimuli.

METHODS

Adolescent girls aged 13-17 with (n = 26) and without (n = 28) an NSSI history completed a change-detection computer task during which frequency-tagged SSVEPs were used to assess adolescents' ability to inhibit attention to affectively salient stimuli from spatially superimposed targets.

RESULTS

Compared with adolescents with no NSSI history, adolescents with NSSI demonstrated difficulty inhibiting attention to angry adult faces.

CONCLUSIONS

These findings underscore specific deficits in attentional filtering among girls with an NSSI history, which, if replicated and extended, could be a promising intervention target for reducing risk for future NSSI.

Using Neurofeedback from Steady-State Visual Evoked Potentials to Target Affect-Biased Attention in Augmented Reality

Biases in attention to emotional stimuli (i.e., affect-biased attention) contribute to the development and mainte-nance of depression and anxiety and may be a promising target for intervention. Past attempts to therapeutically modify affect-biased attention have been unsatisfactory due to issues with reliability and precision. Electroencephalogram (EEG)-derived steady-state visual evoked potentials (SSVEPS) provide a temporally-sensitive biological index of attention to competing visual stimuli at the level of neuronal populations in the visual cortex. SSVEPS can potentially be used to quantify whether affective distractors vs. task-relevant stimuli have "won" the competition for attention at a trial-by-trial level during neuro-feedback sessions. This study piloted a protocol for a SSVEP-based neurofeedback training to modify affect-biased attention using a portable augmented-reality (AR) EEG interface. During neurofeedback sessions with five healthy participants, signifi-cantly greater attention was given to the task-relevant stimulus (a Gabor patch) than to affective distractors (negative emotional expressions) across SSVEP indices (p<0.000l). SSVEP indices exhibited excellent internal consistency as evidenced by a maximum Guttman split-half coefficient of 0.97 when comparing even to odd trials. Further testing is required, but findings suggest several SSVEP neurofeedback calculation methods most deserving of additional investigation and support ongoing efforts to develop and implement a SSVEP-guided AR-based neurofeedback training to modify affect-biased attention in adolescent girls at high risk for depression.

Shared and distinct brain fMRI response during performance of working memory tasks in adult patients with schizophrenia and major depressive disorder

Working memory (WM) impairments are common features of psychiatric disorders. A systematic meta-analysis was performed to determine common and disorder-specific brain fMRI response during performance of WM tasks in patients with SZ and patients with MDD relative to healthy controls (HC). Thirty-four published fMRI studies of WM in patients with SZ and 18 published fMRI studies of WM in patients with MDD, including relevant HC, were included in the meta-analysis. In both SZ and MDD there was common stronger fMRI response in right medial prefrontal cortex (MPFC) and bilateral anterior cingulate cortex (ACC), which are part of the default mode network (DMN). The effects were of greater magnitude in SZ than MDD, especially in prefrontal-temporal-cingulate-striatal-cerebellar regions. In addition, a disorder-specific weaker fMRI response was observed in right middle frontal gyrus (MFG) in MDD, relative to HC. For both SZ and MDD a significant correlation was observed between the severity of clinical symptoms and lateralized fMRI response relative to HC. These findings indicate that there may be common and distinct anomalies in brain function underlying deficits in WM in SZ and MDD, which may serve as a potential functional neuroimaging-based diagnostic biomarker with value in supporting clinical diagnosis, measuring illness severity and assessing the efficacy of treatments for SZ and MDD at the brain level.

Asthma-Specific Temporal Variability Reveals the Effect of Group Cognitive Behavior Therapy in Asthmatic Patients

Background: Group cognitive behavior therapy (GCBT) is a successful therapy for asthma. However, the neural biomarker of GCBT which could be used in clinic remains unclear. The temporal variability is a novel concept to characterize the dynamic functional connectivity (FC), which has many advantages as biomarker. Therefore, the aim of this study is to explore the potential difference of temporal variability between asthmatic patients and healthy controls, then determine the different patterns of temporal variability between pre- and post-treatment group and reveal the relationship between the variability and the symptoms improvement reduced by GCBT. Methods: At baseline, 40 asthmatic patients and 40 matched controls received resting-state functional magnetic resonance imaging (fMRI) scans and clinical assessments. After 8 weeks of GCBT treatment, 17 patients received fMRI scans, and assessments again. Temporal variability at baseline and post-treatment were calculated for further analysis. Results: Compared with controls, asthmatic patients showed widespread decreases in temporal variability. Moreover, the variability in both right caudate and left putamen were positively correlated with asthma control level. After GCBT, asthma control level and depression of patients were improved. Meanwhile, compared with pre-GCBT, patients after treatment showed lower variability in left opercular of Rolandic, right parahippocampal gyrus and right lingual gyrus, as well as higher variability in left temporal pole. Variability in regions which were found abnormal at baseline did not exhibit significant differences between post-GCBT and controls. Conclusions: Asthma-specific changes of dynamic functional connectivity may serve as promising underpinnings of GCBT for asthma. Clinical Trial Registration: http://www.chictr.org.cn/index.aspx, identifier: Chi-CTR-15007442.

Desynchronized Functional Activities Between Brain White and Gray Matter in Major Depression Disorder

BACKGROUND

Alterations in gray matter (GM) have been recognized as playing an important role in the neurobiological mechanism underlying major depressive disorder (MDD) and antidepressant responses. However, little is known about white matter (WM) connectivity in MDD, leaving an incomplete understanding of the pathophysiology of the disorder.

PURPOSE

To examine the functional connectivity (FC) of WM, GM, and WM-GM in MDD patients and explore the relationship between FC and antidepressant response.

STUDY TYPE

Longitudinal study.

SUBJECTS

In all, 129 MDD patients and 89 healthy controls (HC).

FIELD STRENGTH/SEQUENCE

Whole-brain blood oxygen level-dependent (BOLD) single-shot echo planar imaging was acquired at 3.0T.

ASSESSMENT

At baseline, all participants received Hamilton depression rating scale (HAMD) assessment and an fMRI scan. After 2- and 8-week antidepressant treatment, patients completed the HAMD again. The HAMD reductive rate of 2- and 8-weeks were calculated.

STATISTICAL TESTS

The comparisons of age, education, HAMD scores, and FC values (false discovery rate correction) between patients and controls were calculated with a two-sample t-test. The chi-square test was employed to compare the differences of gender between these two groups. Correlations between FC and HAMD, as well as the reductive rate of HAMD, were analyzed with Pearson or Spearman correlation. Receiver operator curve analysis was performed to predict the antidepressant response.

RESULTS

Compared to HC, MDD patients exhibited widespread decreases in FC of WM-GM. Furthermore, 28 GM regions and 11 WM bundles had lower connectivity in MDD patients. At baseline, four FC of WM-GM showed negative correlations with the HAMD scores. Six FC of WM-GM correlated with the 2-week reductive rate of HAMD. Moreover, FC in GM, WM, and WM-GM also exhibited significantly positive correlations with an 8-week reductive rate of HAMD.

DATA CONCLUSION

The FC of WM-GM was decreased in MDD and may play a role in its pathophysiology and antidepressant responses.

LEVEL OF EVIDENCE

2.

TECHNICAL EFFICACY STAGE

2.

Pinpointing mechanisms of a mechanistic treatment: Dissociable roles for overt and covert attentional processes in acute and long-term outcomes following Attention Bias Modification

Biased patterns of attention towards threat are implicated as key mechanisms in anxiety which can be modified through automated intervention (Attention Bias Modification; ABM). Intervention refinement and personalized dissemination efforts are substantially hindered by gaps in understanding the precise attentional components that underlie ABM's effects on symptoms-particularly with respect to longer-term outcomes. Seventy adults with transdiagnostic anxiety were randomized to receive 8 sessions of active ABM (n=49) or sham training (n=21). Reaction time and eyetracking data, collected at baseline, post-training, and 1-month follow-up, dissociated multiple core attentional processes, spanning overt and covert processes of engagement and disengagement. Self-reported symptoms were collected out to 1-year follow-up. Covert disengagement bias was specifically reduced by ABM, unlike all other indices. Overt disengagement bias at baseline predicted acute post-ABM outcomes, while covert engagement bias was non-specifically predictive of symptom trajectories out to 1-year follow-up. Results suggest unique and dissociable roles for each discrete mechanism.

Towards personalized, brain-based behavioral intervention for transdiagnostic anxiety: Transient neural responses to negative images predict outcomes following a targeted computer-based intervention

OBJECTIVE

Clinical anxiety is prevalent, highly comorbid with other conditions, and associated with significant medical morbidity, disability, and public health burden. Excessive attentional deployment toward threat is a transdiagnostic dimension of anxiety seen at both initial and sustained stages of threat processing. However, group-level observations of these phenomena mask considerable within-group heterogeneity that has been linked to treatment outcomes, suggesting that a transdiagnostic, individual differences approach may capture critical, clinically relevant information.

METHOD

Seventy clinically anxious individuals were randomized to receive 8 sessions of attention bias modification (ABM; n = 41 included in analysis), a computer-based mechanistic intervention that specifically targets initial stages of threat processing, or a sham control (n = 21). Participants completed a mixed block/event-related functional MRI task optimized to discriminate transient from sustained neural responses to threat.

RESULTS

Larger transient responses across a wide range of cognitive-affective regions (e.g., ventrolateral prefrontal cortex, anterior cingulate cortex, amygdala) predicted better clinical outcomes following ABM, in both a priori anatomical regions and whole-brain analyses; sustained responses did not. A spatial pattern recognition algorithm using transient threat responses successfully discriminated the top quartile of ABM responders with 68% accuracy.

CONCLUSIONS

Neural alterations occurring on the relatively transient timescale that is specifically targeted by ABM predict favorable clinical outcomes. Results inform how to expand on the initial promise of neurocognitive treatments like ABM by fine-tuning their clinical indications (e.g., through personalized mechanistic intervention relevant across diagnoses) and by increasing the range of mechanisms that can be targeted (e.g., through synergistic treatment combinations and/or novel neurocognitive training protocols designed to tackle identified predictors of nonresponse). (PsycINFO Database Record (c) 2018 APA, all rights reserved).