Evidence for elevated cortical hyperexcitability and its association with out-of-body experiences in the non-clinical population: New findings from a pattern-glare task

A symptom network model of misophonia: From heightened sensory sensitivity to clinical comorbidity

OBJECTIVES

Misophonia-an unusually strong intolerance of certain sounds-can cause significant distress and disruption to those who have it but is an enigma in terms of our scientific understanding. A key challenge for explaining misophonia is that, as with other disorders, it is likely to emerge from an interaction of traits that also occur in the general population (e.g., sensory sensitivity and anxiety) and that are transdiagnostic in nature (i.e., shared with other disorders).

METHODS

In this preregistered study with a large sample of participants (N = 1430), we performed a cluster analysis (based on responses to questions relating to misophonia) and identified two misophonia subgroups differing in severity, as well as a third group without misophonia. A subset of this sample (N = 419) then completed a battery of measures designed to assess sensory sensitivity and clinical comorbidities.

RESULTS

Clinical symptoms were limited to the most severe group of misophonics (including autistic traits, migraine with visual aura, anxiety sensitivity, obsessive-compulsive traits). Both the moderate and severe groups showed elevated attention-to-detail and hypersensitivity (across multiple senses). A novel symptom network model of the data shows the presence of a central hub linking misophonia to sensory sensitivity which, in turn, connects to other symptoms in the network (relating to autism, anxiety, etc.).

CONCLUSION

The core features of misophonia are sensory-attentional in nature with severity linked strongly to comorbidities.

Prevalence of visual snow and relation to attentional absorption

Visual snow is a condition of unclear prevalence characterized by tiny flickering dots throughout the entire visual field. It appears to result from visual cortex hyperactivity and possibly correlates with propensity to be engrossed in sensory and imaginary experiences (absorption). The prevalence and correlates of visual snow, and emotional reactions to it, were explored in the general Portuguese population with three studies with online surveys. In Study 1, 564 participants were shown an animated graphic simulation of visual snow and asked to rate how frequently they have similar percepts on a scale anchored by 0% and 100% of their waking time. They also reported their degree of distress and fascination resulting from visual snow. Absorption was measured with the Modified Tellegen Absorption Scale. 44% of respondents reported they see visual snow at least 10% of the time, and 20% reported seeing it between 80% and 100% of the time. Similar to findings in clinical samples, the frequency of visual snow correlated with tinnitus frequency and entoptic phenomena, but not with ophthalmologic problems. It was confirmed that visual snow is related to absorption. Although distress caused by visual snow was generally absent or minimal in our samples, a substantial minority (28%) reported moderate to high levels of distress. High fascination with visual snow was reported by 9%. In Studies 2 and 3, visual snow was measured by means of verbal descriptions without graphic simulation (“visual field full of tiny dots of light” and “world seen with many dots of light”, respectively). The results were similar to those in Study 1, but seeing visual snow 80%-100% of the time was less frequent (6.5% in Study 2 and 3.6% in Study 3). Visual snow has been insufficiently investigated. More research is needed to uncover underlying neurophysiological mechanisms and psychological and behavioral correlates.

Insights from a dyslexia simulation font: Can we simulate reading struggles of individuals with dyslexia?

Individuals with dyslexia struggle at explaining what it is like to have dyslexia and how they perceive letters and words differently. This led the designer Daniel Britton to create a font that aims to simulate the perceptual experience of how effortful reading can be for individuals with dyslexia (http://danielbritton.info/dyslexia). This font removes forty percent of each character stroke with the aim of increasing reading effort, and in turn empathy and understanding for individuals with dyslexia. However, its efficacy has not yet been empirically tested. In the present study, we compared participants without dyslexia reading texts in the dyslexia simulation font to a group of individuals with dyslexia reading the same texts in Times New Roman font. Results suggest that the simulation font amplifies the struggle of reading, surpassing that experienced by adults with dyslexia-as reflected in increased reading time and overall number of eye movements in the majority of typical readers reading in the simulation font. Future research could compare the performance of the Daniel Britton simulation font against a sample of beginning readers with dyslexia as well as seek to design and empirically test an adapted simulation font with an increased preserved percentage of letter strokes [Correction added on 10 December 2021, after initial online publication. Abstract has been added].

Contributions of Body-Orientation to Mental Ball Dropping Task During Out-of-Body Experiences

Out-of-body experiences (OBEs) provide fascinating insights into our understanding of bodily self-consciousness and the workings of the brain. Studies that examined individuals with brain lesions reported that OBEs are generally characterized by participants experiencing themselves outside their physical body (i.e., disembodied feeling) (Blanke and Arzy, 2005). Based on such a characterization, it has been shown that it is possible to create virtual OBEs in immersive virtual environments (Ehrsson, 2007; Ionta et al., 2011b; Bourdin et al., 2017). However, the extent to which body-orientation influences virtual OBEs is not well-understood. Thus, in the present study, 30 participants (within group design) experienced a full-body ownership illusion (synchronous visuo-tactile stimulation only) induced with a gender-matched full-body virtual avatar seen from the first-person perspective (1PP). At the beginning of the experiment, participants performed a mental ball dropping (MBD) task, seen from the location of their virtual avatar, to provide a baseline measurement. After this, a full-body ownership illusion (embodiment phase) was induced in all participants. This was followed by the virtual OBE illusion phase of the experiment (disembodiment phase) in which the first-person viewpoint was switched to a third-person perspective (3PP), and participants' disembodied viewpoint was gradually raised to 14 m above the virtual avatar, from which altitude they repeated the MBD task. During the experiment, this procedure was conducted twice, and the participants were allocated first to the supine or the standing body position at random. Results of the MBD task showed that the participants experienced increased MBD durations during the supine condition compared to the standing condition. Furthermore, although the findings from the subjective reports confirmed the previous findings of virtual OBEs, no significant difference between the two postures was found for body ownership. Taken together, the findings of the current study make further contributions to our understanding of both the vestibular system and time perception during OBEs.

What is the Link Between Mental Imagery and Sensory Sensitivity? Insights from Aphantasia

People with aphantasia have impoverished visual imagery so struggle to form mental pictures in the mind's eye. By testing people with and without aphantasia, we investigate the relationship between sensory imagery and sensory sensitivity (i.e., hyper- or hypo-reactivity to incoming signals through the sense organs). In Experiment 1 we first show that people with aphantasia report impaired imagery across multiple domains (e.g., olfactory, gustatory etc.) rather than simply vision. Importantly, we also show that imagery is related to sensory sensitivity: aphantasics reported not only lower imagery, but also lower sensory sensitivity. In Experiment 2, we showed a similar relationship between imagery and sensitivity in the general population. Finally, in Experiment 3 we found behavioural corroboration in a Pattern Glare Task, in which aphantasics experienced less visual discomfort and fewer visual distortions typically associated with sensory sensitivity. Our results suggest for the very first time that sensory imagery and sensory sensitivity are related, and that aphantasics are characterised by both lower imagery, and lower sensitivity. Our results also suggest that aphantasia (absence of visual imagery) may be more accurately defined as a subtype of a broader imagery deficit we name dysikonesia, in which weak or absent imagery occurs across multiple senses.

Photophobia in migraine: A symptom cluster?

Photophobia is one of the most common symptoms in migraine, and the underlying mechanism is uncertain. The discovery of the intrinsically-photosensitive retinal ganglion cells which signal the intensity of light on the retina has led to discussion of their role in the pathogenesis of photophobia. In the current review, we discuss the relationship between pain and discomfort leading to light aversion (traditional photophobia) and discomfort from flicker, patterns, and colour that are also common in migraine and cannot be explained solely by the activity of intrinsically-photosensitive retinal ganglion cells. We argue that, at least in migraine, a cortical mechanism provides a parsimonious explanation for discomfort from all forms of visual stimulation, and that the traditional definition of photophobia as pain in response to light may be too restrictive. Future investigation that directly compares the retinal and cortical contributions to photophobia in migraine with that in other conditions may offer better specificity in identifying biomarkers and possible mechanisms to target for treatment.

Locus Coeruleus Malfunction Is Linked to Psychopathology in Prodromal Dementia With Lewy Bodies

Background: The locus coeruleus (LC) is a nucleus in the human brainstem with a variety of noradrenaline-driven functions involved in cognition, emotions, and perception. Dementia with Lewy bodies (DLB) constitutes a neurodegenerative disease involving deposits of alpha-synuclein, first appearing in the brainstem. The goal of this narrative review is to delineate the relationship between the expression of psychiatric symptoms as an early-onset of DLB and the degeneration of the LC's noradrenaline system.

Methods: We searched in PubMed for relevant articles concerning LC degeneration and psychiatric symptoms in prodromal DLB in this narrative review. We rely on the McKeith criteria for prodromal psychiatric DLB.

Results: We found four studies that document neuronal loss, deposits of Lewy bodies and other hints for neurodegeneration in the LC in patients with DLB. Furthermore, we reviewed theories and studies on how the degenerated noradrenaline LC system contributes to psychiatric DLB's phenotype. We hypothesized how anxiety, hallucinations, delusions, and depressive symptoms might occur in DLB patients due to degenerated noradrenergic neurons entailing consecutive altered noradrenergic transmission in the LC's projection areas.

Conclusions: LC degeneration in prodromal DLB might cause psychiatric symptoms as the first and non-motor manifestation of DLB, as the LC is affected earlier by degeneration than are dopaminergic structures such as the substantia nigra, which are impaired later in the disease course.

Exploration of anomalous perceptual experiences in migraine between attacks using the Cardiff Anomalous Perceptions Scale

Distortions in sensory experiences that precede a migraine attack have been extensively documented, the most well-known being the visual aura. Distortions in the experience of other senses are also reported as part of an aura, albeit less frequently, together with changes in the perception or ownership of the body or body parts. There are many examples of differences in aspects of visual perception between migraine and control groups, between attacks, but not as much on unusual experiences involving other senses, the sense of the body or the experience of the environment. Seventy-seven migraine (33 with aura) and 74 control participants took part. Anomalous perceptions were experienced by both migraine and control groups, but more with migraine experienced them and rated them as more distressing, intrusive and frequent. Associations with reports of visual triggers of migraine and visual discomfort are presented. This study is the first to show relationships between these factors.

The Influence of Typography on Algorithms that Predict the Speed and Comfort of Reading

1. The speed with which text can be read is determined in part by the spatial regularity and similarity of vertical letter strokes as assessed by the height of the first peak in the horizontal autocorrelation of the text. The height of this peak was determined for two passages in 20 fonts. The peak was unaffected by the size of the text or its content but was influenced by the font design. Sans serif fonts usually had a lower peak than serif fonts because the presence of serifs usually (but not invariably) resulted in a more even spacing of letter strokes. There were small effects of justification and font-dependent effects of font expansion and compression. 2. The visual comfort of images can be estimated from the extent to which the Fourier amplitude spectrum conforms to 1/f. Students were asked to adjust iBooks to obtain their preferred settings of font and layout. The preference was predicted by the extent to which the Fourier amplitude spectrum approximated 1/f, which in turn was jointly affected by the design of the font, its weight and the ratio of x-height to line separation. Two algorithms based on the autocorrelation and Fourier transformation of text can be usefully applied to any orthography to estimate likely speed and comfort of reading.

Altered neural dynamics in people who report spontaneous out of body experiences

It has been suggested that individual differences in cortical excitability leading to disruption of the timing and integration of sensory information processing may explain why some people have out of body experiences (OBE) in the absence of any known pathological or psychiatric condition. Here we recorded EEG from people who either had, or had not experienced an OBE in order to investigate the neural dynamics of OBE in the non-clinical population. A screening questionnaire was completed by 551 people, 24% of whom reported having at least one OBE. Participants who were free of any psychiatric or neurological diagnoses, including migraines, were invited to take part in subsequent EEG recording. EEG data were obtained from 19 people who had had an OBE and 20 who had not. Amplitude of the visual P1 ERP deflection and consistency of alpha-band phase locking were significantly reduced in the participants who had had an OBE. We did not find any group differences in resting state power or in visually induced gamma oscillations. These results provide support for the claim that cortical differences, particularly with respect to the timing of visual information processing, may give rise to OBE in clinically healthy individuals. To our knowledge, this study is the first to compare EEG variables obtained from people who have, and have not, had an OBE.

Transcranial direct current stimulation of the right temporoparietal junction impairs third-person perspective taking

Given the current debates about the precise functional role of the right temporoparietal junction (rTPJ) in egocentric and exocentric perspective taking, in the present study we manipulated activity in the rTPJ to investigate the effects on a spatial perspective-taking task. Participants engaged in a mental body transformation task, requiring them to mentally rotate their own body to the position of an avatar, while undergoing anodal, cathodal, or sham transcranial direct current stimulation (tDCS) of the rTPJ. As a control task, participants judged the laterality of a stimulus feature with respect to a fixation cross on the screen. For the first half of the experiment (only during online tDCS), a task-selective effect of tDCS was observed, reflected in slower reaction times following anodal than following cathodal and sham tDCS for the mental body transformation task, but not for the control task. The effects of tDCS were most pronounced for stimuli implying a more difficult mental body transformation. No effects of tDCS were observed during the second half of the experiment. The effects of tDCS were most pronounced for participants scoring low on aberrant perceptual beliefs and spiritual transcendence, suggesting a relation between third-person perspective taking and bodily and perceptual experiences. The finding that anodal stimulation of the rTPJ impairs third-person perspective taking indicates a key role of this region in exocentric spatial processing.

Adults with autism spectrum conditions experience increased levels of anomalous perception

Autism spectrum condition (ASC) is characterised by differences in social interaction and behavioural inflexibility. In addition to these core symptoms, atypical sensory responses are prevalent in the ASC phenotype. Here we investigated anomalous perception, i.e. hallucinatory and/or out of body experiences in adults with ASC. Thirty participants with an ASC diagnosis and thirty neurotypical controls completed the Cardiff Anomalous Perception Scale (CAPS) and the Social Responsiveness Scale (SRS-2). The CAPS is a 32-item questionnaire that asks participants to indicate whether or not they experience a range of anomalous and out of body experiences, and to rate how intrusive and distressing these experiences are. The SRS-2 asks participants to rate the extent to which they identify with a series of 65 statements that describe behaviours associated with the autism phenotype. We found that total CAPS score was significantly higher in the participants with ASC (mean = 14.8, S.D. = 7.9) than the participants without ASC (mean = 3.6, S.D. = 4.1). In addition, the frequency of anomalous perception, the level of distraction and the level of distress associated with the experience were significantly increased in participants with ASC. Importantly, both the frequency of anomalous perceptual experiences and the level of distress caused by anomalous perception in this sample of adults with ASC were very similar to that reported previously in a sample of non-autistic participants who were being treated in hospital for a current psychotic episode. These data indicate that anomalous perceptual experiences are common in adults with ASC and are associated with a high level of distress. The origins of anomalous perception in ASC and the implication of this phenomenon are considered.

The Cortical Hyperexcitability Index (CHi): a new measure for quantifying correlates of visually driven cortical hyperexcitability

INTRODUCTION

Aberrations of visual experience, including visual hallucinations and visual distortions, are known to be associated with increased cortical hyperexcitability. As a consequence, the presence, intensity and frequency of certain experiences may well be indicative of an underlying increase in cortical hyperexcitability.

METHODS

The current study presents a new proxy measure of cortical hyperexcitability, the Cortical Hyperexcitability Index (CHi). Two hundred and fifty healthy participants completed the CHi with the results subjected to exploratory factor analysis (EFA).

RESULTS

The EFA revealed a three-factor model as the most parsimonious solution. The three factors were defined as: (1) heightened visual sensitivity and discomfort; (2) negative aura-type visual aberrations; and (3) positive aura-type visual aberrations. The identification of three factors suggests that multiple mechanisms underlie the notion of cortical hyperexcitability, providing researchers with new and greater precision in delineating these underlying features.

CONCLUSIONS

The factorial structure of the CHi and the increased precision could aid the interpretation of findings from neuroscientific (i.e., brain imaging/stimulation) examinations of cortical processes underlying aberrant perceptions across a host of clinical, neurological and pathological conditions. As a consequence, the CHi is a useful and comprehensive proxy measure of cortical hyperexcitability with considerable scientific and clinical utility.

[Factorial Structure of the Cardiff Anomalous Perceptions Scale (CAPS) in a Colombian Population Sample]

BACKGROUND

The continuum hypothesis of psychosis assumes that hallucinations are not exclusive of psychotic disorders. A number of psychometric tests have been developed to assess psychosis using a dimensional model.

OBJECTIVES

To determine the factorial structure of the Cardiff Anomalous Perceptions Scale (CAPS) for the Colombian population, and to contrast the fit of two factor models previously reported in the literature by conducting a confirmatory factor analysis (CFA).

METHODS

This was a cross-sectional study in which 207 subjects from the general population were assessed using the Cardiff Anomalous Perceptions Scale.

RESULTS

A two-factor structure with acceptable ordinal alpha coefficients (α=.88 and α=.87) was found. One factor gathered items related to multimodal perceptual alterations, and a second factor grouped items related with experiences linked to the temporal lobe. The analysis of the first factor indicated that it was dependent on cultural issues for the interpretation of sensations. The second factor appeared almost unchanged on diverse populations, suggesting its transcultural character. When comparing the models proposed by Bell et al. and Jaen-Moreno et al. using the data obtained from the sample, the confirmatory factor analysis conducted indicated inadequate goodness-of-fit indexes (χ(2)). However, some incremental goodness-of-fit indexes (normalized χ(2) [RMSEA]) were acceptable. The Jaén-Moreno et al. model showed the best fit to the data collected from the Colombian sample.

CONCLUSIONS

The factorial structure of CAPS for the Colombian population appears to be sensitive to cultural issues, especially when describing anomalous sensorial experiences.

Stimulating the aberrant brain: Evidence for increased cortical hyperexcitability from a transcranial direct current stimulation (tDCS) study of individuals predisposed to anomalous perceptions

Findings from neurological and clinical groups have shown that increased predisposition to anomalous experience/aura reflects an elevation in aberrant neural processes in the brain. However, studies of anomalous experiences in non-clinical/non-neurological groups are less clear on this matter and are more typically confined to subjective questionnaire measures alone. The current investigation, the first to our knowledge, carried out a transcranial Direct Current Stimulation (tDCS) study of cortical hyperexcitability, and its association with anomalous experience in non-clinical/non-neurological groups. Sixty participants completed; (i) both excitatory (anodal) and inhibitory (cathodal) brain stimulation conditions of the visual cortex; (ii) a computerised pattern-glare task, where observers reported phantom visual distortions from viewing highly irritable visual patterns (a metric of cortical hyperexcitability), and; (iii) questionnaire measures of predisposition to anomalous perceptions. There were no reliable signs of cortical hyperexcitability (via pattern-glare tasks) when collapsed across the whole sample. However, a significant positive correlation between predisposition to anomalous experience and elevated signs of cortical hyperexcitability was observed. Crucially, there was a significant negative correlation between tDCS stimulatory conditions. A visual cortex that reacted more strongly to excitatory stimulation, responded less well to inhibitory suppression, and this pattern was related to predisposition to anomalous perceptions. Both findings are consistent with the presence of a hyperexcitable cortex. Collectively the present findings provide objective evidence that the brains of individuals predisposed to anomalous experiences/hallucinations can be hyperexcitable - even in the non-clinical/non-neurological population. These data are consistent with continuum models of anomalous experience and have important implications for contemporary theories of aberrations in self-consciousness.

Voluntary Out-of-Body Experience: An fMRI Study

The present single-case study examined functional brain imaging patterns in a participant that reported being able, at will, to produce somatosensory sensations that are experienced as her body moving outside the boundaries of her physical body all the while remaining aware of her unmoving physical body. We found that the brain functional changes associated with the reported extra-corporeal experience (ECE) were different than those observed in motor imagery. Activations were mainly left-sided and involved the left supplementary motor area and supramarginal and posterior superior temporal gyri, the last two overlapping with the temporal parietal junction that has been associated with out-of-body experiences. The cerebellum also showed activation that is consistent with the participant’s report of the impression of movement during the ECE. There was also left middle and superior orbital frontal gyri activity, regions often associated with action monitoring. The results suggest that the ECE reported here represents an unusual type of kinesthetic imagery.

Fractionating the unitary notion of dissociation: disembodied but not embodied dissociative experiences are associated with exocentric perspective-taking

It has been argued that hallucinations which appear to involve shifts in egocentric perspective (e.g., the out-of-body experience, OBE) reflect specific biases in exocentric perspective-taking processes. Via a newly devised perspective-taking task, we examined whether such biases in perspective-taking were present in relation to specific dissociative anomalous body experiences (ABE) - namely the OBE. Participants also completed the Cambridge Depersonalization Scale (CDS; Sierra and Berrios, 2000) which provided measures of additional embodied ABE (unreality of self) and measures of derealization (unreality of surroundings). There were no reliable differences in the level of ABE, emotional numbing, and anomalies in sensory recall reported between the OBE and control group as measured by the corresponding CDS subscales. In contrast, the OBE group did provide significantly elevated measures of derealization ("alienation from surroundings" CDS subscale) relative to the control group. At the same time we also found that the OBE group was significantly more efficient at completing all aspects of the perspective-taking task relative to controls. Collectively, the current findings support fractionating the typically unitary notion of dissociation by proposing a distinction between embodied dissociative experiences and disembodied dissociative experiences - with only the latter being associated with exocentric perspective-taking mechanisms. Our findings - obtained with an ecologically valid task and a homogeneous OBE group - also call for a re-evaluation of the relationship between OBEs and perspective-taking in terms of facilitated disembodied experiences.