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Lanters LR, Öhlmann H, Langhorst J, Theysohn N, Engler H, Icenhour A, Elsenbruch S. Disease-specific alterations in central fear network engagement during acquisition and extinction of conditioned interoceptive fear in inflammatory bowel disease. Mol Psychiatry 2024:10.1038/s41380-024-02612-7. [PMID: 38802508 DOI: 10.1038/s41380-024-02612-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 05/10/2024] [Accepted: 05/14/2024] [Indexed: 05/29/2024]
Abstract
Interoceptive fear, which is shaped by associative threat learning and memory processes, plays a central role in abnormal interoception and psychiatric comorbidity in conditions of the gut-brain axis. Although animal and human studies support that acute inflammation induces brain alterations in the central fear network, mechanistic knowledge in patients with chronic inflammatory conditions remains sparse. We implemented a translational fear conditioning paradigm to elucidate central fear network reactivity in patients with quiescent inflammatory bowel disease (IBD), compared to patients with irritable bowel syndrome (IBS) and healthy controls (HC). Using functional magnetic resonance imaging, conditioned differential neural responses within regions of the fear network were analyzed during acquisition and extinction learning. In contrast to HC and IBS, IBD patients demonstrated distinctly altered engagement of key regions of the central fear network, including amygdala and hippocampus, during differential interoceptive fear learning, with more pronounced responses to conditioned safety relative to pain-predictive cues. Aberrant hippocampal responses correlated with chronic stress exclusively in IBD. During extinction, differential engagement was observed in IBD compared to IBS patients within amygdala, ventral anterior insula, and thalamus. No group differences were found in changes of cue valence as a behavioral measure of fear acquisition and extinction. Together, the disease-specific alterations in neural responses during interoceptive fear conditioning in quiescent IBD suggest persisting effects of recurring intestinal inflammation on central fear network reactivity. Given the crucial role of interoceptive fear in abnormal interoception, these findings point towards inflammation-related brain alterations as one trajectory to bodily symptom chronicity and psychiatric comorbidity. Patients with inflammatory conditions of the gut-brain axis may benefit from tailored treatment approaches targeting maladaptive interoceptive fear.
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Affiliation(s)
- Laura R Lanters
- Department of Neurology, Center for Translational Neuro- and Behavioral Sciences, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Hanna Öhlmann
- Department of Medical Psychology and Medical Sociology, Ruhr University Bochum, Bochum, Germany
| | - Jost Langhorst
- Department for Internal and Integrative Medicine, Sozialstiftung Bamberg, Bamberg, Germany
- Department for Integrative Medicine, Medical Faculty, University of Duisburg-Essen, Essen, Germany
| | - Nina Theysohn
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Harald Engler
- Institute of Medical Psychology and Behavioral Immunobiology, Center for Translational Neuro- and Behavioral Sciences, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Adriane Icenhour
- Department of Medical Psychology and Medical Sociology, Ruhr University Bochum, Bochum, Germany
| | - Sigrid Elsenbruch
- Department of Neurology, Center for Translational Neuro- and Behavioral Sciences, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.
- Department of Medical Psychology and Medical Sociology, Ruhr University Bochum, Bochum, Germany.
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Zhang C, Zhang X, Li W, Zhang T, Zhang Z, Lu L, Didonna F, Fan Q. Pallidum volume as a predictor for the effectiveness of mindfulness-based cognitive therapy and psycho-education in unmedicated patients with obsessive-compulsive disorder. Compr Psychiatry 2024; 131:152462. [PMID: 38354586 DOI: 10.1016/j.comppsych.2024.152462] [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: 10/21/2023] [Revised: 02/03/2024] [Accepted: 02/09/2024] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND Mindfulness-based cognitive therapy (MBCT) has been documented to be effective in treating obsessive-compulsive disorder (OCD). However, the neurobiological basis of MBCT remains largely elusive, which makes it clinically challenging to predict which patients are more likely to respond poorly. Hence, identifying biomarkers for predicting treatment outcomes holds both scientific and clinical values. This prognostic study aims to investigate whether pre-treatment brain morphological metrics can predict the effectiveness of MBCT, compared with psycho-education (PE) as an active placebo, among patients with OCD. METHODS A total of 32 patients with OCD were included in this prognostic study. They received magnetic resonance imaging (MRI) brain scans before treatment. Subsequently, 16 patients received 10 weeks of MBCT, while the other 16 patients underwent a 10-week PE program. The effectiveness of the treatments was primarily assessed by the reduction rate of the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) total score before and after the treatment. We investigated whether several predefined OCD-associated brain morphological metrics, selected based on prior published studies by the ENIGMA Consortium, could predict the treatment effectiveness. RESULTS Both the MBCT and PE groups exhibited substantial reductions in Y-BOCS scores over 10 weeks of treatment, with the MBCT group showing a larger reduction. Notably, the pallidum total volume was associated with treatment effectiveness, irrespective of the intervention group. Specifically, a linear regression model utilizing the pre-treatment pallidum volume to predict the treatment effectiveness suggested that a one-cubic-centimeter increase in pallidum volume corresponded to a 22.3% decrease in the Y-BOCS total score reduction rate. CONCLUSIONS Pallidum volume may serve as a promising predictor for the effectiveness of MBCT and PE, and perhaps, other treatments with the shared mechanisms by MBCT and PE, among patients with OCD.
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Affiliation(s)
- Chen Zhang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaochen Zhang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wenqing Li
- School of Psychology and Cognitive Science, East China Normal University, Shanghai, China
| | - Tianran Zhang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Department of Child Development and Education, University of Amsterdam, Amsterdam, the Netherlands
| | - Zongfeng Zhang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Department of Psychiatry, Ningbo Kangning Hospital & Affiliated Mental Health Centre, Ningbo University, Ningbo, Zhejiang, China
| | - Lu Lu
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Department of Clinical Psychology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | | | - Qing Fan
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Psychotic Disorders, Shanghai, China; Mental Health Branch, China Hospital Development Institute, Shanghai Jiao Tong University, Shanghai, China.
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Odriozola P, Kribakaran S, Cohodes EM, Zacharek SJ, McCauley S, Haberman JT, Quintela LA, Hernandez C, Spencer H, Pruessner L, Caballero C, Gee DG. Hippocampal Involvement in Safety Signal Learning Varies With Anxiety Among Healthy Adults. BIOLOGICAL PSYCHIATRY GLOBAL OPEN SCIENCE 2024; 4:155-164. [PMID: 38298801 PMCID: PMC10829678 DOI: 10.1016/j.bpsgos.2023.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 03/15/2023] [Accepted: 05/31/2023] [Indexed: 02/02/2024] Open
Abstract
Background Safety signal learning (SSL), based on conditioned inhibition of fear in the presence of learned safety, can effectively attenuate threat responses in animal models and humans. Difficulty regulating threat responses is a core feature of anxiety disorders, suggesting that SSL may provide a novel mechanism for fear reduction. Cross-species evidence suggests that SSL involves functional connectivity between the anterior hippocampus and the dorsal anterior cingulate cortex. However, the neural mechanisms supporting SSL have not been examined in relation to trait anxiety or while controlling for the effect of novelty. Methods Here, we investigated the neural mechanisms involved in SSL and associations with trait anxiety in a sample of 64 healthy (non-clinically anxious) adults (ages 18-30 years; 43 female, 21 male) using physiological, behavioral, and neuroimaging (functional magnetic resonance imaging) data collected during an SSL task. Results During SSL, compared with individuals with lower trait anxiety, individuals with higher trait anxiety showed less fear reduction as well as altered hippocampal activation and hippocampal-dorsal anterior cingulate cortex functional connectivity, and lower inferior frontal gyrus and ventrolateral prefrontal cortex activation. Importantly, the findings show that SSL reduces threat responding, across learning and over and above the effect of novelty, and involves hippocampal activation. Conclusions These findings provide new insights into the nature of SSL and suggest that there may be meaningful variation in SSL and related neural correlates as a function of trait anxiety, with implications for better understanding fear reduction and optimizing interventions for individuals with anxiety disorders.
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Affiliation(s)
- Paola Odriozola
- Department of Psychology, Yale University, New Haven, Connecticut
| | | | - Emily M. Cohodes
- Department of Psychology, Yale University, New Haven, Connecticut
| | | | - Sarah McCauley
- Department of Psychology, Yale University, New Haven, Connecticut
| | | | | | | | - Hannah Spencer
- Department of Psychology, Yale University, New Haven, Connecticut
| | - Luise Pruessner
- Department of Psychology, Yale University, New Haven, Connecticut
| | - Camila Caballero
- Department of Psychology, Yale University, New Haven, Connecticut
| | - Dylan G. Gee
- Department of Psychology, Yale University, New Haven, Connecticut
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Laing PAF, Dunsmoor JE. Pattern separation of fear extinction memory. Learn Mem 2023; 30:110-115. [PMID: 37433642 PMCID: PMC10353259 DOI: 10.1101/lm.053760.123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 06/13/2023] [Indexed: 07/13/2023]
Abstract
While fear generalizes widely, extinction is stimulus-specific. Using a hybrid conditioning/episodic memory paradigm, subjects encoded nonrepeating category exemplars during fear conditioning and extinction. Twenty-four hours later, a surprise memory test included old, similar, and novel category exemplars. Results showed strong dissociation between pattern completion (generalization) and pattern separation (discrimination) in episodic memory for items encoded during fear conditioning versus extinction, respectively. These data suggest that directly threat-conditioned stimuli are better recognized at the expense of mnemonic precision, whereas discrimination is enhanced for extinguished stimuli. Overly precise extinction memory may be a contributing factor to fear relapse.
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Affiliation(s)
- Patrick A F Laing
- Department of Psychiatry and Behavioral Sciences, Dell Medical School, University of Texas at Austin, Austin, Texas 78712, USA
- Institute for Neuroscience, University of Texas at Austin, Austin, Texas 78712, USA
| | - Joseph E Dunsmoor
- Department of Psychiatry and Behavioral Sciences, Dell Medical School, University of Texas at Austin, Austin, Texas 78712, USA
- Institute for Neuroscience, University of Texas at Austin, Austin, Texas 78712, USA
- Department of Neuroscience, University of Texas at Austin, Austin, Texas 78712, USA
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Cassaday HJ, Muir C, Stevenson CW, Bonardi C, Hock R, Waite L. From safety to frustration: The neural substrates of inhibitory learning in aversive and appetitive conditioning procedures. Neurobiol Learn Mem 2023; 202:107757. [PMID: 37044368 DOI: 10.1016/j.nlm.2023.107757] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 03/20/2023] [Accepted: 04/08/2023] [Indexed: 04/14/2023]
Abstract
Inhibitory associative learning counters the effects of excitatory learning, whether appetitively or aversively motivated. Moreover, the affective responses accompanying the inhibitory associations are of opponent valence to the excitatory conditioned responses. Inhibitors for negative aversive outcomes (e.g. shock) signal safety, while inhibitors for appetitive outcomes (e.g. food reward) elicit frustration and/or disappointment. This raises the question as to whether studies using appetitive and aversive conditioning procedures should demonstrate the same neural substrates for inhibitory learning. We review the neural substrates of appetitive and aversive inhibitory learning as measured in different procedural variants and in the context of the underpinning excitatory conditioning on which it depends. The mesocorticolimbic dopamine pathways, retrosplenial cortex and hippocampus are consistently implicated in inhibitory learning. Further neural substrates identified in some procedural variants may be related to the specific motivation of the learning task and modalities of the learning cues. Finally, we consider the translational implications of our understanding of the neural substrates of inhibitory learning, for obesity and addictions as well as for anxiety disorders.
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Affiliation(s)
| | - C Muir
- School of Psychology, University of Nottingham; School of Physiology, Pharmacology, and Neuroscience, University of Bristol
| | | | - C Bonardi
- School of Psychology, University of Nottingham
| | - R Hock
- School of Psychology, University of Nottingham
| | - L Waite
- School of Psychology, University of Nottingham
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Kribakaran S, Odriozola P, Cohodes EM, McCauley S, Zacharek SJ, Hodges H, Haberman JT, Pierre JC, Gee DG. Neural circuitry involved in conditioned inhibition via safety signal learning is sensitive to trauma exposure. Neurobiol Stress 2022; 21:100497. [PMID: 36532365 PMCID: PMC9755062 DOI: 10.1016/j.ynstr.2022.100497] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 10/04/2022] [Accepted: 10/14/2022] [Indexed: 11/25/2022] Open
Abstract
Exposure to trauma throughout the lifespan is prevalent and increases the likelihood for the development of mental health conditions such as anxiety and post-traumatic stress disorder (PTSD). Safety signal learning (SSL)--a form of conditioned inhibition that involves reducing fear via conditioned safety--has been shown to effectively attenuate fear responses among individuals with trauma exposure, but the association between trauma exposure and the neural mechanisms of SSL remains unknown. Adults with varied prior exposure to trauma completed a conditioned inhibition task during functional MRI scanning and collection of skin conductance response (SCR). Conditioned safety signals reduced psychophysiological reactivity (i.e., SCR) in the overall sample. Although exposure to a higher number of traumatic events was associated with elevated SCR across all task conditions, SCR did not differ between threat in the presence of conditioned safety (i.e., SSL) relative to threat alone in a trauma-related manner. At the neural level, however, higher levels of trauma exposure were associated with lower hippocampal, amygdala, and dorsolateral prefrontal cortical activation during SSL. These findings suggest that while conditioned safety signals can reduce fear in the presence of threat even among individuals exposed to higher degrees of trauma, the neural circuitry involved in SSL is in fact sensitive to trauma exposure. Future research investigating neural processes during SSL among individuals with PTSD or anxiety can further elucidate the ways in which SSL and its neural correlates may reduce fear and link trauma exposure with later mental health conditions.
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Affiliation(s)
- Sahana Kribakaran
- Department of Psychology, Yale University, New Haven, CT, USA
- Yale School of Medicine, Yale University, New Haven, CT, USA
| | - Paola Odriozola
- Department of Psychology, Yale University, New Haven, CT, USA
| | | | - Sarah McCauley
- Silberman School of Social Work at Hunter College, New York, NY, USA
| | - Sadie J. Zacharek
- Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - H.R. Hodges
- Institute of Child Development, University of Minnesota, Minneapolis, MN, USA
| | | | | | - Dylan G. Gee
- Department of Psychology, Yale University, New Haven, CT, USA
- Corresponding author. 2 Hillhouse Avenue, New Haven, CT, 06511, USA.
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Laing PAF, Felmingham KL, Davey CG, Harrison BJ. The neurobiology of Pavlovian safety learning: Towards an acquisition-expression framework. Neurosci Biobehav Rev 2022; 142:104882. [PMID: 36150453 DOI: 10.1016/j.neubiorev.2022.104882] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 09/15/2022] [Accepted: 09/16/2022] [Indexed: 11/19/2022]
Abstract
Safety learning creates associations between conditional stimuli and the absence of threat. Studies of human fear conditioning have accumulated evidence for the neural signatures of safety over various paradigms, aligning on several common brain systems. While these systems are often interpreted as underlying safety learning in a generic sense, they may instead reflect the expression of learned safety, pertaining to processes of fear inhibition, positive affect, and memory. Animal models strongly suggest these can be separable from neural circuits implicated in the conditioning process itself (or safety acquisition). While acquisition-expression distinctions are ubiquitous in behavioural science, this lens has not been applied to safety learning, which remains a novel area in the field. In this mini-review, we overview findings from prevalent safety paradigms in humans, and synthesise these with insights from animal models to propose that the neurobiology of safety learning be conceptualised along an acquisition-expression model, with the aim of stimulating richer brain-based characterisations of this important process.
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Affiliation(s)
- Patrick A F Laing
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne, Australia.
| | - Kim L Felmingham
- Melbourne School of Psychological Sciences, The University of Melbourne, Australia
| | - Christopher G Davey
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne, Australia
| | - Ben J Harrison
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne, Australia.
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