Neural basis of positive and negative emotion regulation in remitted depression

Healthcare professionals' perceptions of system preparedness during public health emergencies: a path analysis of mental health impacts

Background

The easing of COVID-19 policies in China appears to have been inadequately prepared, leading to a profound shift in the mental wellbeing of healthcare professionals following the lifting of these measures. Our study aims to investigate the pathways underlying negative emotions experienced by healthcare professionals due to perceived inadequate system preparedness, aiming to enhance their mental health protection and facilitate more effective responses during future large-scale public health crises.

Methods

A total of 826 healthcare professionals were enrolled. Depression symptoms, anxiety symptoms, perceived stress, resilience, perceived inadequate system preparedness were measured in our research.

Results

The prevalence of depression and anxiety symptoms among healthcare professionals were 32.1 and 16.2%, respectively, during the concentrated outbreak of COVID-19 in China after easing policy. The chain mediation analysis reveals that perceived inadequate system preparedness significantly directly predicts depression or anxiety symptoms among healthcare professionals, indirectly through the mediating role of stress, as well as via the chain mediation of stress and resilience. However, it does not predict these symptoms through the mediator of resilience alone. Furthermore, contracting COVID-19 directly predicts depression symptoms.

Conclusions

Perceived inadequate system preparedness can have a detrimental impact on negative emotions through various channels. When facing the potential outbreak of a large-scale public health event in the future, it is crucial to implement measures such as providing psychological counseling, increasing risk allowances, and ensuring an adequate supply of personal protective equipment to be better prepared. Additionally, psychosocial interventions should be implemented to enhance the resilience of healthcare professionals and safeguard the mental wellbeing of those infected with COVID-19, etc.

Longitudinal bidirectional association between psychosocial function and depression in Chinese patients with clinically remitted depression: a cross-lagged panel model analysis

BACKGROUND

Major depressive disorder (MDD) imposes serious effect on patient's psychosocial function, which hinders the full recovery from the disease and increases the risk of recurrence, although the participants had achieved clinical remission. To understand the relationship between psychosocial function and depressive symptoms could facilitate recurrence prevention. Therefore, the purpose of this study was to analyze the relation among psychosocial function and BDI score in Chinese patients with clinically cured depression within 1 year follow-up.

METHODS

One hundred nineteen valid participants were assessed at baseline(t1), months 6(t2) and months 12(t3). Beck Depression Inventory-II (BDI-II) was used to assess depressive symptoms and indicate the possibility of depression level. Generic Quality of Life Inventory (GQOLI) was used to assessed the participants' psychosocial function(F), including body function (BF), psychological function (PF) and social function (SF). The application of a cross-lagged panel model (CLPM) approach revealed an association between BDI and psychosocial function.

RESULT

The CLPM results showed total average score of psychosocial function have reciprocal influence on BDI score. The model analyzed by structural equation modeling satisfied all indices of goodness-of-fit (chi-square = 10.306, TLI = 0.959, CFI = 0.988 RMSEA = 0.115). And body function, psychological function, social function and BDI score also affect each other. Depressive symptoms and psychosocial function could predict scores of each other 6 months later. By comparing standardized cross-lagged path, only social function has a more pronounced impact on depressive symptoms, since the absolute effect of SFt1 → BDIt2 is larger than that of BDIt1 → SFt2 (a1 vs. b1 = -.267, SE = .108, P < 0.05, 95%CI[-.485,-.063]) and the absolute effect of SFt2 → BDIt3 is larger than that of BDIt2 → SFt3 (a2 vs. b2 = -.317, SE = .096, P < 0.01,95%CI[-.508,-.129]).

CONCLUSION

The current study showed a significant bidirectional association between depressive level and psychosocial function, and the social function exerted more effect on the depression.

The effects of an acute Tai Chi on emotional memory and prefrontal cortex activation: a fNIRS study

Objective

Acute exercise has the potential to influence emotional memory and cortical hemodynamics, but the specific effects depend on the type of exercise. This study aimed to determine whether acute Tai Chi practice enhances emotional memory and prefrontal cortex activation compared to cycling and a control condition.

Methods

Using a within-subjects crossover design, 36 healthy university students completed three interventions: Tai Chi, cycling, and a resting control condition. Emotional memory performance was assessed before and after each intervention, and cortical hemodynamics were measured using functional near-infrared spectroscopy (fNIRS). The correlation between oxyhemoglobin (Oxy-Hb) concentration in the prefrontal cortex and emotional memory accuracy was analyzed.

Results

Compared to cycling and the control group, the Tai Chi intervention showed: (1) a significantly higher accuracy of positive emotional memory; (2) a greater increase in Oxy-Hb concentration in the left dorsolateral prefrontal cortex (L-DLPFC) during positive emotional memory tasks; (3) a stronger positive correlation between Oxy-Hb concentration in the L-DLPFC and emotional memory accuracy. In contrast, cycling improved positive emotional memory accuracy to a lesser extent, while the control group showed no significant changes.

Conclusion

Tai Chi, compared to cycling and rest, significantly enhanced positive emotional memory and L-DLPFC activation. These findings highlight the unique potential of Tai Chi to improve emotional memory through increased cortical activation, suggesting its effectiveness as a cognitive-emotional intervention.

Efficacy of transcranial magnetic stimulation treatment in reducing neuropsychiatric symptomatology after traumatic brain injury

Background

Neuropsychiatric disorders are highly disabling in traumatic brain injury (TBI) patients, and psychopharmacological treatments often fail to adequately mitigate their detrimental effects. Repetitive transcranial magnetic stimulation (rTMS) is an emerging treatment in neurology and psychiatry, showing potential in treating psychiatric disorders.

Objective

This study investigates the efficacy of a novel, dual-site sequential rTMS protocol designed to treat neuropsychiatric symptoms in a TBI patient who was refractory to conventional treatments.

Methods

A 34-year-old woman with severe head trauma and complex psychopathology underwent 20 daily sessions of focal-coil rTMS, combining inhibitory stimulation (1 Hz) on the right dorsolateral prefrontal cortex (DLPFC) and excitatory (10 Hz) on the left DLPFC, guided by a neuronavigation system. Psychiatric and neurocognitive assessments were conducted at baseline and at 2, 4, and 8 weeks following the beginning of rTMS treatment.

Results

After 2 weeks of treatment, the patient showed decreased impulsivity and obsessive-compulsive symptoms, along with improvements in attention and processing speed. After 4 weeks, impulsivity further declined, though no other significant changes were noted. At 8 weeks, a persistent positive effect was observed, including enhanced positive emotions.

Discussion

These findings suggest that guided, alternating neurostimulation of the DLPFC may modulate activity within cortico-striato-thalamo-cortical circuits, providing a promising alternative for managing neuropsychiatric symptoms in TBI patients who are resistant to traditional treatments.

Flexible Regulation of Positive and Negative Emotion Expression: Reexamining the Factor Structure of the Flexible Regulation of Emotional Expression Scale (FREE) Based on Emotion Valence

The Flexible Regulation of Emotional Expression (FREE) Scale assesses individuals' ability to enhance and suppress their emotional expressions across different situations. This study investigates the optimal factor structure of the FREE and emphasizes the importance of distinguishing between the regulation abilities for positive and negative expressions. A sample of 607 undergraduates (Mage = 19.02, SD = 1.02, 72.2% female) from Mainland China completed the questionnaire survey. Confirmatory factor analyses tested eight competing models of the FREE structure. Results indicated that the second-order model, featuring two higher-order factors (expressive enhancement and suppression abilities), fit the data well. An alternative second-order model, with two different higher-order factors (positive and negative emotion expressive abilities) and the same four first-order factors, demonstrated an even better fit. Various types of expressive ability scores showed predictive validity regarding emotion regulation self-efficacy, mental health outcomes, and relationship stress. Regulation of emotional expression can be represented by either regulation type or emotion valence, with the latter providing more informative insights. Flexible regulation of positive and negative emotion expression predicted fewer symptoms of depression, anxiety, stress, and relationship stress beyond emotion regulation self-efficacy. These findings highlight the importance of considering emotional valence in understanding flexibility in expression regulation.

Altered neural activities during emotion regulation in depression: a meta-analysis

BACKGROUND

Deficient neural activities during emotion regulation have been reported in depression. We sought to conduct a meta-analysis to provide a comprehensive description of these neural alterations during use of emotion regulation strategies among patients with depression, including major depressive disorder (MDD) and bipolar disorder (BD).

METHODS

We identified neuroimaging studies of abnormal neural activities during emotion regulation in depression. We extracted the peak coordinates and effect sizes of differences in brain activity between patients and healthy controls. Using seed-based d mapping, we conducted voxel-wise meta-analyses of the neural activation pattern differences between the 2 groups across conditions involving emotion regulation and those where emotion regulation was not needed.

RESULTS

We included 33 studies reporting 34 data sets, including 23 involving MDD (571 people with MDD and 578 matched controls) and 11 involving BD (358 people with BD and 369 matched controls). Overall, compared with controls, patients with depression showed hyperactivity in the insula and postcentral gyrus, and hypoactivity in the prefrontal part of the inferior, middle, and superior frontal gyrus, the middle temporal gyrus, and the supplementary motor area. In subgroup analyses, data from patients with MDD and studies focused on decreasing negative emotions or using the emotional strategy of reappraisal reported specific hypoactivity in the middle cerebellar peduncles.

LIMITATIONS

Given limited studies involving patients with BD, we were unable to detect the common and distinct abnormalities in neural activation between MDD and BD. We did not conduct any meta-regression analyses because of limited information.

CONCLUSION

In this meta-analysis, we identified hyperactivity in brain regions associated with emotional experience and hypoactivity in brain regions associated with cognitive control during emotion regulation among patients with depression, relative to healthy controls. These findings could help indicate a target for future interventions aimed at increasing emotion regulation capacity for patients with depression.

Bidirectional temporal associations between sleep and affect and cognitive symptoms among community-dwelling stroke survivors: An ecological momentary assessment study

INTRODUCTION

Sleep plays a critical role in daily functioning and stroke recovery but receives little attention in stroke rehabilitation. Sleep disturbances are linked to affective and cognitive impairments, but temporal associations between sleep and affect and cognitive symptoms are less clear. Understanding these temporal associations may inform new directions in intervention and prevention to support continued stroke recovery.

OBJECTIVE

To examine the bidirectional temporal associations between sleep and affect and cognitive symptoms among community-dwelling stroke survivors.

DESIGN

A secondary analysis of a longitudinal observational study involving 7 days of ecological momentary assessment (EMA), during which participants completed eight EMA surveys and a sleep diary per day. Multilevel modeling was used to analyze data.

SETTING

Community.

PARTICIPANTS

Community-dwelling stroke survivors (N = 40).

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

EMA measures of depressed affect, cheerful affect, and cognitive symptoms. Sleep quality and duration as measured using a sleep diary.

RESULTS

Between-person sleep quality was negatively associated with next-day depressed affect (B = -.16; p = .028) and positively associated with next-day cheerful affect (B = .63; p < .001). Inversely, between-person depressed affect was negatively associated with next night sleep quality (B = -.77; p = .015), and vice versa for cheerful affect (between-person: B = .45; p < .001; within-person: B = .09; p = .008). Long sleep (>9 hours) was positively associated with next-day cognitive symptoms (B = .13; p = .002), whereas cognitive symptoms were associated with a higher odds of long sleep the following night (odds ratio [OR] = 0.25; p = .047).

CONCLUSIONS

This study identified the bidirectional associations of sleep with affect and cognitive symptoms in the context of the everyday life of stroke survivors. The findings suggest that interventions addressing sleep quality and duration may impact affect and cognitive symptoms, and vice versa.

Meta-Analysis of Brain Volumetric Abnormalities in Patients with Remitted Major Depressive Disorder

Although patients with major depressive disorder (MDD) achieve remission after antidepressant treatment, >90% of those in remission have at least one residual depressive symptom, which may be due to neural damage linked with MDD. To better understand the structural impairments in patients with remitted MDD, we conducted a meta-analysis comparing grey matter volume (GMV) abnormalities between patients with remitted MDD and healthy controls (HCs). There were 11 cross-sectional datasets that investigated 275 patients with remitted MDD versus 437 HCs, and 7 longitudinal datasets that investigated 167 patients with remitted MDD. We found that GMV in the left insula, inferior parietal gyri, amygdala, and right superior parietal gyrus was decreased in patients with remitted MDD than in HCs. Additionally, patients with remitted MDD had lower GMV in the bilateral gyrus rectus than those in the nonremission state. Moreover, increased GMV in the bilateral anterior cingulate cortex, right striatum, middle temporal gyrus, and superior frontal gyrus was observed in patients with remitted MDD than in HCs. Furthermore, patients with remitted MDD had a larger GMV in the bilateral median cingulate/paracingulate gyri, left striatum, putamen, amygdala, hippocampus, and parahippocampal gyrus at follow-up than at baseline. Based on the brain morphological abnormalities in patients with remitted MDD after electroconvulsive therapy and pharmacological treatment, we proposed a schematic diagram of targeted intervention approaches for residual symptoms. In summary, our findings provide neurobiology-based evidence for multitarget treatment of depression to reduce residual symptoms and improve social function in patients with MDD.

Understanding mechanisms of depression prevention: study protocol of a randomized cross-over trial to investigate mechanisms of mindfulness and positive fantasizing as intervention techniques for reducing perseverative cognition in remitted depressed individuals

BACKGROUND

Major Depressive Disorder (MDD) is one of the most prevalent psychiatric disorders, and involves high relapse rates in which persistent negative thinking and rumination (i.e., perseverative cognition [PC]) play an important role. Positive fantasizing and mindfulness are common evidence-based psychological interventions that have been shown to effectively reduce PC and subsequent depressive relapse. How the interventions cause changes in PC over time, is unknown, but likely differ between the two. Whereas fantasizing may change the valence of thought content, mindfulness may operate through disengaging from automatic thought patterns. Comparing mechanisms of both interventions in a clinical sample and a non-clinical sample can give insight into the effectivity of interventions for different individuals. The current study aims to 1) test whether momentary psychological and psychophysiological indices of PC are differentially affected by positive fantasizing versus mindfulness-based interventions, 2) test whether the mechanisms of change by which fantasizing and mindfulness affect PC differ between remitted MDD versus never-depressed (ND) individuals, and 3) explore potential moderators of the main effects of the two interventions (i.e., what works for whom).

METHODS

In this cross-over trial of fantasizing versus mindfulness interventions, we will include 50 remitted MDD and 50 ND individuals. Before the start of the measurements, participants complete several individual characteristics. Daily-life diary measures of thoughts and feelings (using an experience sampling method), behavioural measures of spontaneous thoughts (using the Sustained Attention to Response Task), actigraphy, physiological measures (impedance cardiography, electrocardiography, and electroencephalogram), and measures of depressive mood (self-report questionnaires) are performed during the week before (pre-) the interventions and the week during (peri-) the interventions. After a wash-out of at least one month, pre- and peri-intervention measures for the second intervention are repeated.

DISCUSSION

This is the first study integrating self-reports, behavioural-, and physiological measures capturing dynamics at multiple time scales to examine the differential mechanisms of change in PC by psychological interventions in individuals remitted from multiple MDD episodes and ND individuals. Unravelling how therapeutic techniques affect PC in remitted individuals might generate insights that allows development of personalised targeted relapse prevention interventions.

TRIAL REGISTRATION

ClinicalTrials.gov: NCT06145984, November 16, 2023.

Abnormal functional neurocircuitry underpinning emotional processing in fibromyalgia

Fibromyalgia, a condition characterized by chronic pain, is frequently accompanied by emotional disturbances. Here we aimed to study brain activation and functional connectivity (FC) during processing of emotional stimuli in fibromyalgia. Thirty female patients with fibromyalgia and 31 female healthy controls (HC) were included. Psychometric tests were administered to measure alexithymia, affective state, and severity of depressive and anxiety symptoms. Next, participants performed an emotion processing and regulation task during functional magnetic resonance imaging (fMRI). We performed a 2 × 2 ANCOVA to analyze main effects and interactions of the stimuli valence (positive or negative) and group (fibromyalgia or HC) on brain activation. Generalized psychophysiological interaction analysis was used to assess task-dependent FC of brain regions previously associated with emotion processing and fibromyalgia (i.e., hippocampus, amygdala, anterior insula, and pregenual anterior cingulate cortex [pACC]). The left superior lateral occipital cortex showed more activation in fibromyalgia during emotion processing than in HC, irrespective of valence. Moreover, we found an interaction effect (valence x group) in the FC between the left pACC and the precentral and postcentral cortex, and central operculum, and premotor cortex. These results suggest abnormal brain activation and connectivity underlying emotion processing in fibromyalgia, which could help explain the high prevalence of psychopathological symptoms in this condition.

Functional MRI correlates of emotion regulation in major depressive disorder related to depressive disease load measured over nine years

Major Depressive Disorder (MDD) often is a recurrent and chronic disorder. We investigated the neurocognitive underpinnings of the incremental risk for poor disease course by exploring relations between enduring depression and brain functioning during regulation of negative and positive emotions using cognitive reappraisal. We used fMRI-data from the longitudinal Netherlands Study of Depression and Anxiety acquired during an emotion regulation task in 77 individuals with MDD. Task-related brain activity was related to disease load, calculated from presence and severity of depression in the preceding nine years. Additionally, we explored task related brain-connectivity. Brain functioning in individuals with MDD was further compared to 35 controls to explore overlap between load-effects and general effects related to MDD history/presence. Disease load was not associated with changes in affect or with brain activity, but with connectivity between areas essential for processing, integrating and regulating emotional information during downregulation of negative emotions. Results did not overlap with general MDD-effects. Instead, MDD was generally associated with lower parietal activity during downregulation of negative emotions. During upregulation of positive emotions, disease load was related to connectivity between limbic regions (although driven by symptomatic state), and connectivity between frontal, insular and thalamic regions was lower in MDD (vs controls). Results suggest that previous depressive load relates to brain connectivity in relevant networks during downregulation of negative emotions. These abnormalities do not overlap with disease-general abnormalities and could foster an incremental vulnerability to recurrence or chronicity of MDD. Therefore, optimizing emotion regulation is a promising therapeutic target for improving long-term MDD course.

Common and distinct patterns of task-related neural activation abnormalities in patients with remitted and current major depressive disorder: A systematic review and coordinate-based meta-analysis

Whether remitted major depressive disorder (rMDD) and MDD present common or distinct neuropathological mechanisms remains unclear. We performed a meta-analysis of task-related whole-brain functional magnetic resonance imaging (fMRI) using anisotropic effect-size signed differential mapping software to compare brain activation between rMDD/MDD patients and healthy controls (HCs). We included 18 rMDD studies (458 patients and 476 HCs) and 120 MDD studies (3746 patients and 3863 HCs). The results showed that MDD and rMDD patients shared increased neural activation in the right temporal pole and right superior temporal gyrus. Several brain regions, including the right middle temporal gyrus, left inferior parietal, prefrontal cortex, left superior frontal gyrus and striatum, differed significantly between MDD and rMDD. Meta-regression analyses revealed that the percentage of females with MDD was positively associated with brain activity in the right lenticular nucleus/putamen. Our results provide valuable insights into the underlying neuropathology of brain dysfunction in MDD, developing more targeted and efficacious treatment and intervention strategies, and more importantly, providing potential neuroimaging targets for the early screening of MDD.

Abnormal global signal topography of self modulates emotion dysregulation in major depressive disorder

Major depressive disorder (MDD) is a complex mental disorder featured by an increased focus on the self and emotion dysregulation whose interaction remains unclear, though. At the same time, various studies observed abnormal representation of global fMRI brain activity in specifically those regions, e.g., cortical midline structure (CMS) in MDD that are associated with the self. Are the self and its impact on emotion regulation related to global brain activity unevenly represented in CMS relative to non-CMS? Addressing this yet open question is the main goal of our study. We here investigate post-acute treatment responder MDD and healthy controls in fMRI during an emotion task involving both attention and reappraisal of negative and neutral stimuli. We first demonstrate abnormal emotion regulation with increased negative emotion severity on the behavioral level. Next, focusing on a recently established three-layer topography of self, we show increased representation of global fMRI brain activity in specifically those regions mediating the mental (CMS) and exteroceptive (Right temporo-parietal junction and mPFC) self in post-acute MDD during the emotion task. Applying a complex statistical model, namely multinomial regression analyses, we show that increased global infra-slow neural activity in the regions of the mental and exteroceptive self modulates the behavioral measures of specifically negative emotion regulation (emotion attention and reappraisal/suppression). Together, we demonstrate increased representation of global brain activity in regions of the mental and exteroceptive self, including their modulation of negative emotion dysregulation in specifically the infra-slow frequency range (0.01 to 0.1 Hz) of post-acute MDD. These findings support the assumption that the global infra-slow neural basis of the increased self-focus in MDD may take on the role as basic disturbance in that it generates the abnormal regulation of negative emotions.

A behavioral and brain imaging dataset with focus on emotion regulation of women with fibromyalgia

Fibromyalgia is a chronic condition characterized by widespread pain, as well as numerous symptoms related to central sensitization such as: fatigue, cognitive disturbances, constipation/diarrhea and sensory hypersensitivity. Furthermore, depression and anxiety are prevalent comorbidities, accompanied by emotion processing and regulation difficulties. Although fibromyalgia physiopathology is still not fully understood, neuroimaging research methods have shown brain structural and functional alterations as well as neuroinflammation abnormalities. We believe that open access to data may help fibromyalgia research advance more. Here, we present an open dataset of 33 fibromyalgia female patients and 33 paired healthy controls recruited from a Mexican population. Dataset includes demographic, clinical, behavioural and magnetic resonance imaging (MRI) data. The MRI data consists of: structural (T1- and T2- weighted) and functional (task-based and resting state) sequences. The task was an emotion processing and regulation task based on visual stimuli. The MRI data contained in the repository are unprocessed, presented in Brain Imaging Data Structure (BIDS) format and available on the OpenNeuro platform for future analysis.