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Jin Y, Zhang L, Chen W, Zheng X. Early Safety Discrimination Under Uncertainty in Trait Anxiety: An Event-Related Potential Study. Front Hum Neurosci 2022; 16:896211. [PMID: 35860399 PMCID: PMC9290664 DOI: 10.3389/fnhum.2022.896211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 06/06/2022] [Indexed: 11/25/2022] Open
Abstract
Detection of safety-threat signals during uncertainty is an important mechanism of developmental anxiety disorder (AD). Although extensive research has focused on the detection of uncertain threat signals in anxious individuals, relatively little attention has been given to the identification of safety signals during uncertainty, which is an important way to relieve anxiety in individuals with AD. To investigate this phenomenon, 16 subjects with high trait anxiety (HTA) and 16 with low trait anxiety (LTA) completed a modified cue-target task in certain and uncertain stimulus blocks. In the uncertain block, the cue was followed by a threat picture or safety picture in 20% of trials, respectively; in the certain block, the cue could be followed by a threat picture or a safety picture on 100% of trials. Behavioral responses and event-related potentials (ERPs) were recorded. The ERP results demonstrated that LTA participants exhibited larger P2 amplitudes in the detection of safety cues than of threat cues during the uncertain block, whereas HTA participants showed significant P2 amplitudes between the safety and threat cues during the certain block, impairing the detection of safety stimuli during uncertainty. However, all participants exhibited greater N2 amplitudes following threat cues in certainty or uncertainty conditions. These findings pertaining to the P2 amplitude suggested distinctive attentional biases between HTA and LTA individuals, whereas the N2 amplitude showed association learning in uncertain conditions, compensating for safety-threat detection in HTA individuals.
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Affiliation(s)
- Yan Jin
- School of Education Sciences, Huizhou University, Huizhou, China
| | - Lei Zhang
- School of Education Sciences, Huizhou University, Huizhou, China
| | - Wei Chen
- Department of Psychology, South China Normal University, Guangzhou, China
| | - Xifu Zheng
- Department of Psychology, South China Normal University, Guangzhou, China
- *Correspondence: Xifu Zheng,
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2
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Manzler CA, Radoman M, Khorrami KJ, Gorka SM. Association between startle reactivity to uncertain threats and structural brain volume. Psychophysiology 2022; 59:e14074. [PMID: 35579909 PMCID: PMC10080733 DOI: 10.1111/psyp.14074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 01/03/2022] [Accepted: 01/10/2022] [Indexed: 11/29/2022]
Abstract
Sensitivity to uncertain threat (U-threat) is a clinically important individual difference factor in multiple psychopathologies. Recent studies have implicated a specific frontolimbic circuit as a key network involved in the anticipation of aversive stimuli. In particular, the insula, thalamus, and dorsal anterior cingulate cortex (dACC) have recently been found to be robustly activated by anticipation of U-threat. However, no study to date has examined the association between U-threat reactivity and structural brain volume. In the present study, we utilized a pooled sample of 186 young adult volunteers who completed a structural MRI scan and the well-validated No-Predictable-Unpredictable (NPU) threat of electric shock task. Startle eyeblink potentiation was collected during the NPU task as an objective index of aversive reactivity. ROI-based analyses revealed that increased startle reactivity to U-threat was associated with reduced gray matter volume in the right insula and bilateral thalamus, but not the dACC. These results add to a growing literature implicating the insula and thalamus as core nodes involved in individual differences in U-threat reactivity.
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Affiliation(s)
- Charles A Manzler
- Department of Psychiatry and Behavioral Health, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Milena Radoman
- Department of Psychiatry, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Kia J Khorrami
- Department of Psychiatry and Behavioral Health, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Stephanie M Gorka
- Department of Psychiatry and Behavioral Health, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.,Institute for Behavioral Medicine Research, The Ohio State University, Columbus, Ohio, USA
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3
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Lerman I, Klaming R, Spadoni A, Baker DG, Simmons AN. Non-invasive cervical vagus nerve stimulation effects on reaction time and valence image anticipation response. Brain Stimul 2022; 15:946-956. [PMID: 35738468 PMCID: PMC9721369 DOI: 10.1016/j.brs.2022.06.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 05/28/2022] [Accepted: 06/10/2022] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Norepinephrine (NE) driven noninvasive vagus nerve stimulation (nVNS), which improves attention and reduces reaction time, augments learning. Equally important, endogenous NE mediated arousal is highly dependent on the valence (positive or negative) of the exogenous stimulus. But to date, no study has measured valence specific effects of nVNS on both functional magnetic resonance imaging (fMRI) anticipation task response and reaction time in healthy individuals. Therefore, the aim of this pilot study was to assess whether nVNS vs sham modulates valence cortical anticipation task response and reaction time in a normative sample. METHODS Participants received right sided transcutaneous cervical nVNS (N = 12) or sham (N = 12) stimulation during a 3T fMRI scan. Subjects first performed a continuous performance task (CPT) and then a cued anticipation task to images of positively and negatively valenced events during fMRI. Reaction times to cues and Blood oxygen level dependent (BOLD) response were examined over phase to identify effects of nVNS/sham over time. RESULTS nVNS reduced reaction time for all valenced image anticipation trials. With the fMRI anticipation task, we observed a valence-specific effect; nVNS increased responsivity to images with negative valence and decreased responsivity to images with positive valence, whereas sham showed an inverse valence response. CONCLUSIONS nVNS was linked to reduced reaction time during the anticipation task. In tandem, nVNS consistently enhanced responsivity to negatively valenced images and diminished responsivity to positively valenced images, suggesting specific nVNS driven endogenous neurotransmitter signaling may contribute.
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Affiliation(s)
- Imanuel Lerman
- VA Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, La Jolla, CA, United States; Department of Anesthesiology, Center for Pain Medicine, University of California San Diego School of Medicine, La Jolla, CA, United States; Department of Electrical and Computer Engineering, University of California San Diego, La Jolla, CA, United States.
| | - Ruth Klaming
- VA Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, La Jolla, CA, United States; Department of Psychiatry University of California San Diego School of Medicine, La Jolla, CA, United States
| | - Andrea Spadoni
- VA Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, La Jolla, CA, United States; Department of Psychiatry University of California San Diego School of Medicine, La Jolla, CA, United States
| | - Dewleen G Baker
- VA Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, La Jolla, CA, United States; Department of Psychiatry University of California San Diego School of Medicine, La Jolla, CA, United States
| | - Alan N Simmons
- VA Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, La Jolla, CA, United States; Department of Psychiatry University of California San Diego School of Medicine, La Jolla, CA, United States
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4
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Young DA, Chao LL, Zhang H, Metzler T, Ross J, Richards A, O'Donovan A, Inslicht SS, Neylan TC. Ventromedial and insular cortical volume moderates the relationship between BDNF Val66Met and threat sensitivity. J Psychiatr Res 2021; 142:337-344. [PMID: 34425486 PMCID: PMC9526516 DOI: 10.1016/j.jpsychires.2021.08.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 08/04/2021] [Accepted: 08/15/2021] [Indexed: 11/17/2022]
Abstract
While the BDNF Val66Met polymorphism has been linked to various trauma and anxiety - related psychiatric disorders, limited focus has been on the neural structures that might modulate its relationship with objective measures of threat sensitivity. Therefore, we assessed whether there was an interaction of Val66Met polymorphism with brain area volumes previously associated with anxiety and PTSD, such as the ventromedial prefrontal cortex (vmPFC), insular cortex (IC), and dorsal and ventral anterior cingulate cortices (dACC and vACC), in predicting fear-potentiated psychophysiological response in a clinical sample of Veterans. 110 participants engaged in a fear-potentiated acoustic startle paradigm and provided genetic and imaging data. Fear conditions included no, ambiguous, and high threat conditions (shock). Psychophysiological response measures included electromyogram (EMG), skin conductance response (SCR), and heart rate (HR). PTSD status, trauma history, and demographics were also assessed. There was an interaction of Met allele carrier status with vmPFC, IC, dACC, and vACC volumes for predicting SCR (p < 0.001 for all regions). However, only vmPFC and IC significantly moderated the relationship between Val66Met and psychophysiological response (SCR). The Val66met polymorphism may increase susceptibility to PTSD and anxiety disorders via an interaction with reduced vmPFC and IC volume. Future research should examine whether these relationships might be associated with a differential course of illness longitudinally or response to treatments.
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Affiliation(s)
- Dmitri A Young
- San Francisco VA Health Care System, 4150 Clement St. (116P), San Francisco, CA, 94121, USA; Northern California Institute for Research and Education (NCIRE), The Veterans Health Research Institute, San Francisco, CA, 94121, USA; Department of Psychiatry, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA, 94143, USA.
| | - Linda L Chao
- San Francisco VA Health Care System, 4150 Clement St. (116P), San Francisco, CA, 94121, USA; Northern California Institute for Research and Education (NCIRE), The Veterans Health Research Institute, San Francisco, CA, 94121, USA; Department of Psychiatry, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA, 94143, USA; Department of Radiology & Biomedical Imaging, University of California San Francisco, San Francisco, CA, 94143, USA.
| | - Huaiyu Zhang
- Department of Psychiatry, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA, 94143, USA.
| | - Thomas Metzler
- San Francisco VA Health Care System, 4150 Clement St. (116P), San Francisco, CA, 94121, USA; Northern California Institute for Research and Education (NCIRE), The Veterans Health Research Institute, San Francisco, CA, 94121, USA; Department of Psychiatry, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA, 94143, USA.
| | - Jessica Ross
- Department of Psychiatry, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA, 94143, USA.
| | - Anne Richards
- San Francisco VA Health Care System, 4150 Clement St. (116P), San Francisco, CA, 94121, USA; Northern California Institute for Research and Education (NCIRE), The Veterans Health Research Institute, San Francisco, CA, 94121, USA; Department of Psychiatry, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA, 94143, USA.
| | - Aoife O'Donovan
- San Francisco VA Health Care System, 4150 Clement St. (116P), San Francisco, CA, 94121, USA; Northern California Institute for Research and Education (NCIRE), The Veterans Health Research Institute, San Francisco, CA, 94121, USA; Department of Psychiatry, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA, 94143, USA.
| | - Sabra S Inslicht
- San Francisco VA Health Care System, 4150 Clement St. (116P), San Francisco, CA, 94121, USA; Northern California Institute for Research and Education (NCIRE), The Veterans Health Research Institute, San Francisco, CA, 94121, USA; Department of Psychiatry, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA, 94143, USA.
| | - Thomas C Neylan
- San Francisco VA Health Care System, 4150 Clement St. (116P), San Francisco, CA, 94121, USA; Northern California Institute for Research and Education (NCIRE), The Veterans Health Research Institute, San Francisco, CA, 94121, USA; Department of Psychiatry, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA, 94143, USA; Department of Neurology, University of California San Francisco, San Francisco, CA, 94143, USA.
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Lee MS, Anumagalla P, Pavuluri MN. Individuals with the post-traumatic stress disorder process emotions in subcortical regions irrespective of cognitive engagement: a meta-analysis of cognitive and emotional interface. Brain Imaging Behav 2021; 15:941-957. [PMID: 32710332 DOI: 10.1007/s11682-020-00303-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Post-traumatic stress disorder (PTSD) manifests as emotional suffering and problem-solving impairments under extreme stress. This meta-analysis aimed to pool the findings from all the studies examining emotion and cognition in individuals with PTSD to develop a robust mechanistic understanding of the related brain dysfunction. We identified primary studies through a comprehensive literature search of the MEDLINE and PsychINFO databases. The GingerALE software (version 2.3.6) from the BrainMap Project was used to conduct activation likelihood estimation meta-analyses of the eligible studies for cognition, emotion and interface of both. Relative to the non-clinical (NC) group, the PTSD group showed greater activation during emotional tasks in the amygdala and parahippocampal gyrus. In contrast, the NC group showed significantly greater activation in the bilateral anterior cingulate cortex (ACC) than did the PTSD group in the emotional tasks. When both emotional and cognitive processing were evaluated, the PTSD group showed significantly greater activation in the striatum than did the NC group. No differences in activation between the PTSD and NC groups were noted when only the cognitive systems were examined. Individuals with PTSD exhibited overactivity in the subcortical regions, i.e., amygdala and striatum, when processing emotions. Underactivity in the emotional and cognitive processing intermediary cortex, i.e., the ACC, was especially prominent in individuals with PTSD relative to the NC population following exposure to emotional stimuli. These findings may explain the trauma-related fear, irritability, and negative effects as well as the concentration difficulties during cognitive distress associated with emotional arousal, that are commonly observed in individuals with PTSD.
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Affiliation(s)
- Moon-Soo Lee
- Department of adult, adolescent and child psychiatry, Brain and Wellness Institute, 1500 N. Halsted St, Chicago, IL, 60642, USA.,Department of Psychiatry, Korea University Guro hospital, Guro-gu, Seoul, 08308, Republic of Korea
| | - Purnima Anumagalla
- Department of adult, adolescent and child psychiatry, Brain and Wellness Institute, 1500 N. Halsted St, Chicago, IL, 60642, USA
| | - Mani N Pavuluri
- Department of adult, adolescent and child psychiatry, Brain and Wellness Institute, 1500 N. Halsted St, Chicago, IL, 60642, USA.
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6
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Harlé KM, Simmons AN, Norman SB, Spadoni AD. Neural affective mechanisms associated with treatment responsiveness in veterans with PTSD and comorbid alcohol use disorder. Psychiatry Res Neuroimaging 2020; 305:111172. [PMID: 32927371 PMCID: PMC8486287 DOI: 10.1016/j.pscychresns.2020.111172] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 08/16/2020] [Accepted: 08/19/2020] [Indexed: 10/23/2022]
Abstract
Post-traumatic stress disorder (PTSD) is associated with neuro-physiological abnormalities reflecting increased anticipatory anxiety and reactivity to traumatic cues. It remains unclear whether neural mechanisms associated with PTSD treatment responsiveness, i.e. hyperactivation of the affective salience network in the brain, extend to a comorbid PTSD and substance use disorder population. Thirty-one Veterans with PTSD and co-occurring alcohol use disorder (AUD) were randomly assigned to either prolonged exposure or a non-exposure based treatment. They completed an affective anticipation task while undergoing fMRI, immediately prior and after completing treatment. After controlling for type and length of treatment, larger reduction of PTSD symptoms was associated with decreased anticipatory activation to negative trauma-related cues in the right pre-Supplementary Motor Area (pre-SMA), a region associated with emotion regulation. Smaller reduction in PTSD severity was associated with enhanced anticipatory activation to those cues within the right para-hippocampal region, an affective processing region. Our findings suggest that post-treatment reductions in anticipatory reactivity to trauma-related cues in the pre-SMA and para-hippocampal area are associated with larger PTSD symptom reduction in individuals with co-occurring PTSD and AUD. These results may offer neurofeedback training targets as an alternative to or enhancement of other PTSD treatment modalities in this population.
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Affiliation(s)
- Katia M Harlé
- VA San Diego Healthcare System, San Diego, CA, United States; Department of Psychiatry, University of California San Diego, La Jolla, CA, United States.
| | - Alan N Simmons
- VA San Diego Healthcare System, San Diego, CA, United States; Department of Psychiatry, University of California San Diego, La Jolla, CA, United States
| | - Sonya B Norman
- VA San Diego Healthcare System, San Diego, CA, United States; Department of Psychiatry, University of California San Diego, La Jolla, CA, United States
| | - Andrea D Spadoni
- VA San Diego Healthcare System, San Diego, CA, United States; Department of Psychiatry, University of California San Diego, La Jolla, CA, United States
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7
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Grillon C, Ernst M. A way forward for anxiolytic drug development: Testing candidate anxiolytics with anxiety-potentiated startle in healthy humans. Neurosci Biobehav Rev 2020; 119:348-354. [PMID: 33038346 DOI: 10.1016/j.neubiorev.2020.09.024] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 09/23/2020] [Accepted: 09/24/2020] [Indexed: 12/14/2022]
Abstract
This review introduces a research strategy that may radically transform the pursuit of new anxiolytics, via the use of human models of anxiety in healthy individuals. Despite enormous investments in developing novel pharmacological treatments for anxiety disorders, pharmacotherapy for these conditions remains suboptimal. Most candidate anxiolytics from animal studies fail in clinical trials. We propose an additional screening step to help select candidate anxiolytics before launching clinical trials. This intermediate step moves the evidence for the potential anxiolytic property of candidate drugs from animals to humans, using experimental models of anxiety in healthy individuals. Anxiety-potentiated startle is a robust translational model of anxiety. The review of its face, construct, and predictive validity as well as its psychometric properties in humans establishes it as a promising tool for anxiolytic drug development. In conclusion, human models of anxiety may stir a faster, more efficient path for the development of clinically effective anxiolytics.
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Affiliation(s)
- Christian Grillon
- National Institute of Mental Health, Section on the Neurobiology of Fear and Anxiety, Building 15K, Room 203, Bethesda, MD 20814 USA.
| | - Monique Ernst
- National Institute of Mental Health, Section on the Neurobiology of Fear and Anxiety, Building 15K, Room 203, Bethesda, MD 20814 USA.
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8
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Abstract
Stress-related psychiatric conditions are one of the main causes of disability in developed countries. They account for a large portion of resource investment in stress-related disorders, become chronic, and remain difficult to treat. Research on the neurobehavioral effects of stress reveals how changes in certain brain areas, mediated by a number of neurochemical messengers, markedly alter behavior. The cerebellum is connected with stress-related brain areas and expresses the machinery required to process stress-related neurochemical mediators. Surprisingly, it is not regarded as a substrate of stress-related behavioral alterations, despite numerous studies that show cerebellar responsivity to stress. Therefore, this review compiles those studies and proposes a hypothesis for cerebellar function in stressful conditions, relating it to stress-induced psychopathologies. It aims to provide a clearer picture of stress-related neural circuitry and stimulate cerebellum-stress research. Consequently, it might contribute to the development of improved treatment strategies for stress-related disorders.
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9
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Chung MC, Freh FM. The trajectory of bombing-related posttraumatic stress disorder among Iraqi civilians: Shattered world assumptions and altered self-capacities as mediators; attachment and crisis support as moderators. Psychiatry Res 2019; 273:1-8. [PMID: 30634110 DOI: 10.1016/j.psychres.2019.01.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 01/01/2019] [Accepted: 01/01/2019] [Indexed: 11/27/2022]
Abstract
This study examined the impact of bombing on posttraumatic stress disorder (PTSD) and psychiatric co-morbidity over time, whether this relationship was mediated by shattered world assumptions and altered self-capacities, and whether the mediational effects were moderated by attachment style and crisis support among Iraqi civilians. One hundred and fifty-nine Iraqi civilians completed questionnaires measuring the aforementioned psychological constructs. Bombing exposure was associated with PTSD and psychiatric co-morbidity over time; 87% and 77% met the criteria for PTSD at baseline and five months respectively. Shattered world assumptions and altered self-capacities mediated the impact of bombing exposure on PTSD and psychiatric co-morbidity over time. The mediational effect for shattered world assumptions was not moderated by attachment style and crisis support. However, the mediational effect for altered self-capacities was moderated by fearful attachment and a medium level of crisis support. To conclude, following bombing, Iraqi civilians' assumptions about the world and others can change. These changes can have long term effects on psychological distress but are not influenced by childhood attachment experiences or the amount of crisis support received. Bombing can also change civilians' perceptions of internal capacities like emotional regulation, particularly those with fearful attachment who rely on crisis support to some extent.
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Affiliation(s)
- Man Cheung Chung
- Department of Educational Psychology, Ho Tim Building, Faculty of Education, the Chinese University of Hong Kong, Shatin, NT, Hong Kong.
| | - Fuaad Mohammed Freh
- University of Anbar, College of Education for Humanities, Department of Psychology, Iraq
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10
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Kirlic N, Aupperle RL, Rhudy JL, Misaki M, Kuplicki R, Sutton A, Alvarez RP. Latent variable analysis of negative affect and its contributions to neural responses during shock anticipation. Neuropsychopharmacology 2019; 44:695-702. [PMID: 30181595 PMCID: PMC6372706 DOI: 10.1038/s41386-018-0187-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 07/11/2018] [Accepted: 08/14/2018] [Indexed: 01/04/2023]
Abstract
Negative affect is considered an important factor in the etiology of depression and anxiety, and is highly related to pain. However, negative affect is not a unitary construct. To identify specific targets for treatment development, we aimed to derive latent variables of negative affect and test their unique contributions to affective processing during anticipation of unpredictable, painful shock. Eighty-three subjects (43 with depression and anxiety spectrum disorders and 40 healthy controls) completed self-report measures of negative valence and underwent neuroimaging while exploring computer-simulated contexts with and without the threat of a painful, but tolerable, shock. Principal component analysis (PCA) extracted distinct components of general negative affect (GNA) and pain-related negative affect (PNA). While elevated GNA and PNA were both indicative of depression and anxiety disorders, greater PNA was more strongly related to task-specific anxious reactivity during shock anticipation. GNA was associated with increased precuneus and middle frontal gyrus activity, whereas PNA was related to increased bilateral anterior insula activity. Anterior insula activity mediated the relationship between PNA and task-specific anxious reactivity. In conclusion, GNA and PNA have distinct neural signatures and uniquely contribute to anxious anticipation. PNA, via insula activity, may relate to arousal in ways that could contribute to affective dysregulation, and thus may be an important treatment target.
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Affiliation(s)
- Namik Kirlic
- Laureate Institute for Brain Research, Tulsa, OK, USA.
| | - Robin L. Aupperle
- 0000 0004 0512 8863grid.417423.7Laureate Institute for Brain Research, Tulsa, OK USA ,0000 0001 2160 264Xgrid.267360.6School of Community Medicine, University of Tulsa, Tulsa, OK USA
| | - Jamie L. Rhudy
- 0000 0001 2160 264Xgrid.267360.6Department of Psychology, University of Tulsa, Tulsa, OK USA
| | - Masaya Misaki
- 0000 0004 0512 8863grid.417423.7Laureate Institute for Brain Research, Tulsa, OK USA
| | - Rayus Kuplicki
- 0000 0004 0512 8863grid.417423.7Laureate Institute for Brain Research, Tulsa, OK USA
| | - Anne Sutton
- 0000 0004 0512 8863grid.417423.7Laureate Institute for Brain Research, Tulsa, OK USA
| | - Ruben P. Alvarez
- 0000 0004 0512 8863grid.417423.7Laureate Institute for Brain Research, Tulsa, OK USA
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11
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Radoman M, Phan KL, Gorka SM. Neural correlates of predictable and unpredictable threat in internalizing psychopathology. Neurosci Lett 2019; 701:193-201. [PMID: 30825592 DOI: 10.1016/j.neulet.2019.02.031] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 02/08/2019] [Accepted: 02/20/2019] [Indexed: 11/19/2022]
Abstract
Converging lines of evidence suggest that heightened responding to unpredictable threat may be an important neurobiological marker of internalizing psychopathology (IP). Prior data also indicate that aversive responding to uncertainty may be mediated by hyperactivation of several brain regions within the frontolimbic circuit, namely the anterior insula (aINS) and the dorsal anterior cingulate cortex (dACC). To date, however, the majority of this research has been focused on individual diagnoses and it is unclear whether abnormal neural reactivity to unpredictable threat is observed within heterogeneous, transdiagnostic IP patient populations, as theory would suggest. The aim of the current study was to therefore examine the neural correlates of temporally unpredictable (U) and predictable (P) threat in a sample of healthy controls (n = 24) and patients with a broad range of IP diagnoses (n = 51). We also examined whether symptom severity measures of fear and distress/misery dimensions correlated with neural reactivity to U- and P-threat. All participants completed a modified version of a well-validated threat-of-shock task during functional magnetic resonance imaging (fMRI). Across all participants, U- and P-threat elicited heightened activation in the aINS and brainstem, while P-threat alone also activated the dACC. Relative to healthy controls, patients displayed greater activation in the right aINS during U-threat, and greater right brainstem activation during P-threat. In addition, we found that brainstem activity during U-threat correlated with fear, but not distress/misery, psychopathology. Taken together, these preliminary results suggest that exaggerated aINS reactivity during U-threat and brainstem reactivity during P-threat may have the potential to become important transdiagnostic biomarkers of IP; however, future research efforts are needed to corroborate and expand the present findings.
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Affiliation(s)
- Milena Radoman
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, United States; Department of Anatomy and Cell Biology, and the Graduate Program in Neuroscience, University of Illinois at Chicago, Chicago, IL, United States
| | - K Luan Phan
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, United States; Department of Anatomy and Cell Biology, and the Graduate Program in Neuroscience, University of Illinois at Chicago, Chicago, IL, United States; Department of Psychology, University of Illinois at Chicago, Chicago, IL, United States; Mental Health Service Line, Jesse Brown VA Medical Center, Chicago, IL, United States
| | - Stephanie M Gorka
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, United States; Department of Psychology, University of Illinois at Chicago, Chicago, IL, United States.
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12
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Stout DM, Buchsbaum MS, Spadoni AD, Risbrough VB, Strigo IA, Matthews SC, Simmons AN. Multimodal canonical correlation reveals converging neural circuitry across trauma-related disorders of affect and cognition. Neurobiol Stress 2018; 9:241-250. [PMID: 30450388 PMCID: PMC6234282 DOI: 10.1016/j.ynstr.2018.09.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 07/02/2018] [Accepted: 09/14/2018] [Indexed: 11/30/2022] Open
Abstract
Trauma-related disorders of affect and cognition (TRACs) are associated with a high degree of diagnostic comorbidity, which may suggest that these disorders share a set of underlying neural mechanisms. TRACs are characterized by aberrations in functional and structural circuits subserving verbal memory and affective anticipation. Yet, it remains unknown how the neural circuitry underlying these multiple mechanisms contribute to TRACs. Here, in a sample of 47 combat Veterans, we measured affective anticipation using functional magnetic resonance imaging (fMRI), verbal memory with fluorodeoxyglucose positron emission tomography (FDG-PET), and grey matter volume with structural magnetic resonance imaging (sMRI). Using a voxel-based multimodal canonical correlation analysis (mCCA), the set of neural measures were statistically integrated, or fused, with a set of TRAC symptom measures including mild traumatic brain injury (mTBI), posttraumatic stress, and depression severity. The first canonical correlation pair revealed neural convergence in clusters encompassing the middle frontal gyrus and supplemental motor area, regions implicated in top-down cognitive control and affect regulation. These results highlight the potential of leveraging multivariate neuroimaging analysis for linking neurobiological mechanisms associated with TRACs, paving the way for transdiagnostic biomarkers and targets for treatment.
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Affiliation(s)
- Daniel M Stout
- Center of Excellence in Stress and Mental Health, San Diego VA Health Care System, USA.,Department of Psychiatry, University of California, San Diego, USA
| | - Monte S Buchsbaum
- Department of Psychiatry, University of California, San Diego, USA.,Department of Radiology, University of California, San Diego, USA
| | - Andrea D Spadoni
- Center of Excellence in Stress and Mental Health, San Diego VA Health Care System, USA.,Department of Psychiatry, University of California, San Diego, USA
| | - Victoria B Risbrough
- Center of Excellence in Stress and Mental Health, San Diego VA Health Care System, USA.,Department of Psychiatry, University of California, San Diego, USA
| | - Irina A Strigo
- Department of Psychiatry, University of California, San Francisco, & San Francisco VA Health Care System, USA
| | - Scott C Matthews
- Center of Excellence in Stress and Mental Health, San Diego VA Health Care System, USA.,Department of Psychiatry, University of California, San Diego, USA
| | - Alan N Simmons
- Center of Excellence in Stress and Mental Health, San Diego VA Health Care System, USA.,Department of Psychiatry, University of California, San Diego, USA
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13
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Schreurs BG, Smith-Bell CA, Burhans LB. Delayed unpaired extinction as a treatment for hyperarousal of the rabbit nictitating membrane response and its implications for treating PTSD. J Psychiatr Res 2018; 99:1-9. [PMID: 29407282 PMCID: PMC5849523 DOI: 10.1016/j.jpsychires.2018.01.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Revised: 12/08/2017] [Accepted: 01/11/2018] [Indexed: 11/15/2022]
Abstract
Treatment for PTSD (Post-traumatic stress disorder) is rarely available immediately after trauma and often delayed for weeks or months after an event. In a rabbit eyeblink conditioning model of PTSD, we have previously shown that presentations of a tone conditioned stimulus (CS) and shock unconditioned stimulus (US) in an explicitly unpaired manner known as unpaired extinction is effective in reducing CS responding and US hyperarousal even if shock intensity is reduced eight-fold and elicits only minimal responding. Here we determined if delayed delivery of unpaired extinction would still be effective in extinguishing hyperarousal. Rabbits were tested for sensitivity to shock before CS-US pairings and after six days of unpaired extinction presented a day, a week or a month after CS-US pairings. Hyperarousal was extinguished a day and a week after conditioning but not after a month suggesting a significant delay in "treatment" can make hyperarousal persist. We next assessed if this persistence of hyperarousal was associative by comparing rabbits given CS-US pairings to those given explicitly unpaired CS and US presentations, measuring hyperarousal a day and a month later, followed by unpaired extinction and hyperarousal assessment. After four weeks, there was an increase in responding for all rabbits but only rabbits receiving CS-US pairings showed a significant increase in associatively-mediated hyperarousal. Importantly, both paired and unpaired groups showed increased levels of responding after unpaired extinction suggesting treatment delayed for too long may no longer be effective and could cause generalized hyperarousal.
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Affiliation(s)
- Bernard G. Schreurs
- Blanchette Rockefeller Neurosciences Institute, West Virginia University,Department of Physiology, Pharmacology and Neuroscience, West Virginia University,Corresponding author: Bernard G. Schreurs, 1024 BRNI Building, 8 Medical Center Drive, Morgantown, WV 26505
| | - Carrie A. Smith-Bell
- Blanchette Rockefeller Neurosciences Institute, West Virginia University,Department of Physiology, Pharmacology and Neuroscience, West Virginia University
| | - Lauren B. Burhans
- Blanchette Rockefeller Neurosciences Institute, West Virginia University,Department of Physiology, Pharmacology and Neuroscience, West Virginia University
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14
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Ran G, Cao X, Chen X. Emotional prediction: An ALE meta-analysis and MACM analysis. Conscious Cogn 2017; 58:158-169. [PMID: 29128283 DOI: 10.1016/j.concog.2017.10.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 10/21/2017] [Accepted: 10/30/2017] [Indexed: 11/26/2022]
Abstract
The prediction of emotion has been explored in a variety of functional brain imaging and neurophysiological studies. However, an overall picture of the areas involved this process remains unexploited. Here, we quantitatively summarized the published literature on emotional prediction using activation likelihood estimation (ALE) in functional magnetic resonance imaging (fMRI). Furthermore, the current study employed a meta-analytic connectivity modeling (MACM) to map the meta-analytic coactivation maps of regions of interest (ROIs). Our ALE analysis revealed significant convergent activations in some vital brain areas involved in emotional prediction, including the dorsolateral prefrontal cortex (DLPFC), ventrolateral prefrontal cortex (VLPFC), orbitofrontal cortex (OFC) and medial prefrontal cortex (MPFC). For the MACM analysis, we identified that the DLPFC, VLPFC and OFC were the core areas in the coactivation network of emotional prediction. Overall, the results of ALE and MACM indicated that prefrontal brain areas play critical roles in emotional prediction.
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Affiliation(s)
- Guangming Ran
- Department of Psychology, Institute of Education, China West Normal University, Nanchong 637002, China.
| | - Xiaojun Cao
- Department of Psychology, Institute of Education, China West Normal University, Nanchong 637002, China
| | - Xu Chen
- Faculty of Psychology, Southwest University, Chongqing 400715, China
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15
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Gorka SM, Lieberman L, Klumpp H, Kinney KL, Kennedy AE, Ajilore O, Francis J, Duffecy J, Craske MG, Nathan J, Langenecker S, Shankman SA, Phan KL. Reactivity to unpredictable threat as a treatment target for fear-based anxiety disorders. Psychol Med 2017; 47:2450-2460. [PMID: 28436351 DOI: 10.1017/s0033291717000964] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Heightened reactivity to unpredictable threat (U-threat) is a core individual difference factor underlying fear-based psychopathology. Little is known, however, about whether reactivity to U-threat is a stable marker of fear-based psychopathology or if it is malleable to treatment. The aim of the current study was to address this question by examining differences in reactivity to U-threat within patients before and after 12-weeks of selective serotonin reuptake inhibitors (SSRIs) or cognitive-behavioral therapy (CBT). METHODS Participants included patients with principal fear (n = 22) and distress/misery disorders (n = 29), and a group of healthy controls (n = 21) assessed 12-weeks apart. A well-validated threat-of-shock task was used to probe reactivity to predictable (P-) and U-threat and startle eyeblink magnitude was recorded as an index of defensive responding. RESULTS Across both assessments, individuals with fear-based disorders displayed greater startle magnitude to U-threat relative to healthy controls and distress/misery patients (who did not differ). From pre- to post-treatment, startle magnitude during U-threat decreased only within the fear patients who received CBT. Moreover, within fear patients, the magnitude of decline in startle to U-threat correlated with the magnitude of decline in fear symptoms. For the healthy controls, startle to U-threat across the two time points was highly reliable and stable. CONCLUSIONS Together, these results indicate that startle to U-threat characterizes fear disorder patients and is malleable to treatment with CBT but not SSRIs within fear patients. Startle to U-threat may therefore reflect an objective, psychophysiological indicator of fear disorder status and CBT treatment response.
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Affiliation(s)
- S M Gorka
- Department of Psychiatry,University of Illinois-Chicago,1747 West Roosevelt Road Chicago, IL 60608,USA
| | - L Lieberman
- Department of Psychology,University of Illinois-Chicago,1007 West Harrison St. (M/C 285) Chicago, IL 60607,USA
| | - H Klumpp
- Department of Psychiatry,University of Illinois-Chicago,1747 West Roosevelt Road Chicago, IL 60608,USA
| | - K L Kinney
- Department of Psychiatry,University of Illinois-Chicago,1747 West Roosevelt Road Chicago, IL 60608,USA
| | - A E Kennedy
- Department of Psychiatry,University of Illinois-Chicago,1747 West Roosevelt Road Chicago, IL 60608,USA
| | - O Ajilore
- Department of Psychiatry,University of Illinois-Chicago,1747 West Roosevelt Road Chicago, IL 60608,USA
| | - J Francis
- Department of Psychiatry,University of Illinois-Chicago,1747 West Roosevelt Road Chicago, IL 60608,USA
| | - J Duffecy
- Department of Psychiatry,University of Illinois-Chicago,1747 West Roosevelt Road Chicago, IL 60608,USA
| | - M G Craske
- Department of Psychology,University of California,Los Angeles, Franz Hall - Box 95156 Los Angeles, CA 90094,USA
| | - J Nathan
- Department of Psychiatry,University of Illinois-Chicago,1747 West Roosevelt Road Chicago, IL 60608,USA
| | - S Langenecker
- Department of Psychiatry,University of Illinois-Chicago,1747 West Roosevelt Road Chicago, IL 60608,USA
| | - S A Shankman
- Department of Psychiatry,University of Illinois-Chicago,1747 West Roosevelt Road Chicago, IL 60608,USA
| | - K L Phan
- Department of Psychiatry,University of Illinois-Chicago,1747 West Roosevelt Road Chicago, IL 60608,USA
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16
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Brinkmann L, Buff C, Neumeister P, Tupak SV, Becker MPI, Herrmann MJ, Straube T. Dissociation between amygdala and bed nucleus of the stria terminalis during threat anticipation in female post-traumatic stress disorder patients. Hum Brain Mapp 2017; 38:2190-2205. [PMID: 28070973 DOI: 10.1002/hbm.23513] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Revised: 12/15/2016] [Accepted: 01/03/2017] [Indexed: 01/21/2023] Open
Abstract
Feelings of uncontrollability and anxiety regarding possibly harmful events are key features of post-traumatic stress disorder (PTSD) symptomatology. Due to a lack of studies, the neural correlates of anticipatory anxiety in PTSD are still poorly understood. During functional magnetic resonance imaging, female PTSD patients with interpersonal violence trauma and healthy controls (HC) anticipated the temporally unpredictable presentation of aversive (human scream) or neutral sounds. Based on separate analysis models, we investigated phasic and sustained brain activations. PTSD patients reported increased anxiety during anticipation of aversive versus neutral sounds. Furthermore, we found both increased initial, phasic amygdala activation and increased sustained activation of the bed nucleus of the stria terminalis (BNST) during anticipation of aversive versus neutral sounds in PTSD patients in comparison to HC. PTSD patients as compared with HC also showed increased phasic responses in mid-cingulate cortex (MCC), posterior cingulate cortex (PCC), mid-insula and lateral prefrontal cortex (PFC) as well as increased sustained responses in MCC, PCC, anterior insula and lateral and medial PFC. Our results demonstrate a relationship between anticipatory anxiety in PTSD patients and hyperresponsiveness of brain regions that have previously been associated with PTSD symptomatology. Additionally, the dissociation between amygdala and BNST indicates distinct temporal and functional characteristics and suggests that phasic fear and sustained anxiety responses are enhanced during unpredictable anticipation of aversive stimuli in PTSD. Hum Brain Mapp 38:2190-2205, 2017. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Leonie Brinkmann
- Institute of Medical Psychology and Systems Neuroscience, University of Muenster, Von-Esmarch-Str. 52, Muenster, D-48149, Germany
| | - Christine Buff
- Institute of Medical Psychology and Systems Neuroscience, University of Muenster, Von-Esmarch-Str. 52, Muenster, D-48149, Germany
| | - Paula Neumeister
- Institute of Medical Psychology and Systems Neuroscience, University of Muenster, Von-Esmarch-Str. 52, Muenster, D-48149, Germany
| | - Sara V Tupak
- Institute of Medical Psychology and Systems Neuroscience, University of Muenster, Von-Esmarch-Str. 52, Muenster, D-48149, Germany
| | - Michael P I Becker
- Institute of Medical Psychology and Systems Neuroscience, University of Muenster, Von-Esmarch-Str. 52, Muenster, D-48149, Germany
| | - Martin J Herrmann
- Department of Psychiatry, Psychosomatics and Psychotherapy, University Hospital Wuerzburg, Margarete-Hoeppel-Platz 1, D-97080, Wuerzburg, Germany
| | - Thomas Straube
- Institute of Medical Psychology and Systems Neuroscience, University of Muenster, Von-Esmarch-Str. 52, Muenster, D-48149, Germany
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17
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Gorka SM, Lieberman L, Shankman SA, Phan KL. Startle potentiation to uncertain threat as a psychophysiological indicator of fear-based psychopathology: An examination across multiple internalizing disorders. J Abnorm Psychol 2016; 126:8-18. [PMID: 27868423 DOI: 10.1037/abn0000233] [Citation(s) in RCA: 84] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Heightened reactivity to uncertain threat (U-threat) is an important individual difference factor that may characterize fear-based internalizing psychopathologies (IPs) and distinguish them from distress/misery IPs. To date, however, the majority of existing research examining reactivity to U-threat has been within individuals with panic disorder and major depressive disorder (MDD) and no prior study has directly tested this hypothesis across multiple IPs. The current study therefore explored whether heightened reactivity to U-threat is a psychophysiological indicator of fear-based psychopathology across 5 groups: current (a) social anxiety disorder (SAD); (b) specific phobia (SP); (c) generalized anxiety disorder (GAD); (d) MDD; and (c) individuals with no history of psychopathology (controls). All 160 adults completed a well-validated threat-of-shock task designed to probe responses to predictable (P-) and U-threat. Startle eyeblink potentiation was recorded as an index of aversive arousal. Results indicated that individuals with SAD and SP evidenced greater startle potentiation to U-threat, but not P-threat, relative to individuals with GAD, MDD, and controls (who did not differ). The current findings, along with the prior panic disorder and MDD literature, suggest that heightened reactivity to U-threat is a psychophysiological indicator of fear-based disorders and could represent a neurobiological organizing principle for internalizing psychopathology. The findings also suggest that individuals with fear disorders generally display a hypersensitivity to uncertain aversive events, which could contribute to their psychopathology. (PsycINFO Database Record
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Affiliation(s)
| | | | | | - K Luan Phan
- Department of Psychiatry, University of Illinois-Chicago
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18
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Dretsch MN, Wood KH, Daniel TA, Katz JS, Deshpande G, Goodman AM, Wheelock MD, Wood KB, Denney Jr. TS, Traynham S, Knight DC. Exploring the Neurocircuitry Underpinning Predictability of Threat in Soldiers with PTSD Compared to Deployment Exposed Controls. Open Neuroimag J 2016; 10:111-124. [PMID: 27867434 PMCID: PMC5101630 DOI: 10.2174/1874440001610010111] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Revised: 10/18/2016] [Accepted: 10/19/2016] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Prior work examining emotional dysregulation observed in posttraumatic stress disorder (PTSD) has primarily been limited to fear-learning processes specific to anticipation, habituation, and extinction of threat. In contrast, the response to threat itself has not been systematically evaluated. OBJECTIVE To explore potential disruption in fear conditioning neurocircuitry in service members with PTSD, specifically in response to predictable versus unpredictable threats. METHOD In the current study, active-duty U.S. Army soldiers with (PTSD group; n = 38) and without PTSD (deployment-exposed controls; DEC; n = 40), participated in a fear-conditioning study in which threat predictability was manipulated by presenting an aversive unconditioned stimulus (UCS) that was either preceded by a conditioned stimulus (i.e., predictable) or UCS alone (i.e., unpredictable). Threat expectation, skin conductance response (SCR), and functional magnetic resonance imaging (fMRI) signal to predictable and unpredictable threats (i.e., UCS) were assessed. RESULTS Both groups showed greater threat expectancy and diminished threat-elicited SCRs to predictable compared to unpredictable threat. Significant group differences were observed within the amygdala, hippocampus, insula, and superior and middle temporal gyri. Contrary to our predictions, the PTSD group showed a diminished threat-related response within each of these brain regions during predictable compared to unpredictable threat, whereas the DEC group showed increased activation. CONCLUSION Although, the PTSD group showed greater threat-related diminution, hypersensitivity to unpredictable threat cannot be ruled out. Furthermore, pre-trauma, trait-like factors may have contributed to group differences in activation of the neurocircuitry underpinning fear conditioning.
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Affiliation(s)
- Michael N. Dretsch
- U.S. Army Aeromedical Research Laboratory, Fort Rucker, AL, USA
- Human Dimension Division, HQ TRADOC, 950 Jefferson Ave, Fort Eustis, VA 23604, USA
| | - Kimberly H. Wood
- Department of Psychology, University of Alabama at Birmingham, AL, USA
| | - Thomas A. Daniel
- Department of Psychology, Auburn University, Auburn, AL, USA
- Oak Ridge Institute for Science and Education, Oak Ridge, TN, USA
| | - Jeffrey S. Katz
- Department of Psychology, Auburn University, Auburn, AL, USA
- AU MRI Research Center, Department of Electrical and Computer Engineering, Auburn University, Auburn, AL, USA
| | - Gopikrishna Deshpande
- Department of Psychology, Auburn University, Auburn, AL, USA
- AU MRI Research Center, Department of Electrical and Computer Engineering, Auburn University, Auburn, AL, USA
| | - Adam M. Goodman
- Department of Psychology, Auburn University, Auburn, AL, USA
- Oak Ridge Institute for Science and Education, Oak Ridge, TN, USA
| | | | - Kayli B. Wood
- Department of Psychology, University of Alabama at Birmingham, AL, USA
| | - Thomas S. Denney Jr.
- Department of Psychology, Auburn University, Auburn, AL, USA
- AU MRI Research Center, Department of Electrical and Computer Engineering, Auburn University, Auburn, AL, USA
| | | | - David C. Knight
- Department of Psychology, University of Alabama at Birmingham, AL, USA
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Duan H, Wang L, Fernández G, Zhang K, Wu J. Increased anticipatory contingent negative variation in posttraumatic stress disorder. Biol Psychol 2016; 117:80-8. [DOI: 10.1016/j.biopsycho.2016.03.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Revised: 03/03/2016] [Accepted: 03/04/2016] [Indexed: 02/04/2023]
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Abstract
Discriminative fear conditioning requires learning to dissociate between safety cues and cues that predict negative outcomes yet little is known about what processes contribute to discriminative fear learning. According to attentional models of time perception, processes that distract from timing result in temporal underestimation. If discriminative fear learning only requires learning what cues predict what outcomes, and threatening stimuli distract attention from timing, then better discriminative fear learning should predict greater temporal distortion on threat trials. Alternatively, if discriminative fear learning also reflects a more accurate perceptual experience of time in threatening contexts, discriminative fear learning scores would predict less temporal distortion on threat trials, as time is perceived more veridically. Healthy young adults completed discriminative fear conditioning in which they learned to associate one stimulus (CS+) with aversive electrical stimulation and another stimulus (CS-) with non-aversive tactile stimulation and then an ordinal comparison timing task during which CSs were presented as task-irrelevant distractors Consistent with predictions, we found an overall temporal underestimation bias on CS+ relative to CS- trials. Differential skin conductance responses to the CS+ versus the CS- during conditioning served as a physiological index of discriminative fear conditioning and this measure predicted the magnitude of the underestimation bias, such that individuals exhibiting greater discriminative fear conditioning showed less underestimation on CS+ versus CS- trials. These results are discussed with respect to the nature of discriminative fear learning and the relationship between temporal distortions and maladaptive threat processing in anxiety.
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Affiliation(s)
- Jessica I Lake
- Department of Psychology, University of California-Los Angeles, Los Angeles, CA, USA; Department of Psychology & Neuroscience, Duke University, Durham, NC, USA
| | - Warren H Meck
- Department of Psychology & Neuroscience, Duke University, Durham, NC, USA
| | - Kevin S LaBar
- Department of Psychology & Neuroscience, Duke University, Durham, NC, USA
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21
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Hu H, Zhou Y, Wang Q, Su S, Qiu Y, Ge J, Wang Z, Xiao Z. Association of abnormal white matter integrity in the acute phase of motor vehicle accidents with post-traumatic stress disorder. J Affect Disord 2016; 190:714-722. [PMID: 26600413 DOI: 10.1016/j.jad.2015.09.044] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Revised: 09/08/2015] [Accepted: 09/28/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND A small portion of the Motor vehicle accidents (MVA) survivors would develop post-traumatic stress disorder (PTSD), which would cause substantial social function loss. How to identify those high-risk MVA survivors in the acute phase of the trauma is the first step to prevent the onset of PTSD. In the present study, we studied white matter integrity of subjects post to MVA by diffusional tensor imaging (DTI). METHODS To investigate whether the integrity of the white matter was impaired in the acute phase of the MVA among survivors who later develop PTSD and whether it could predict the severity of PTSD while being diagnosed. MVA Survivors were recruited to get trauma-specific clinical assessments and received DTI scan within 2 days from the MVA. These survivors were divided into 2 groups, PTSD group and trauma control (TC) group based on the clinical follow-up interview. Tract-Based Spatial Statistics (TBSS) was carried out to investigate difference in white matter integrity between 2 groups within DTI parameter maps. White matter integrity was measured by using fractional anisotropy (FA), axial diffusivity (AD), mean diffusivity (MD), and radical diffusivity (RD). RESULTS Compared with TC group, PTSD group showed lower FA value in multiple regions of both hemispheres, mainly involving anterior thalamic radiation, cortico-spinal tract, forceps minor, uncinate, inferior fronto-occipital fasciculus, inferior longitudinal fasciculus, cingulum and superior longitudinal fasciculus. Increased RD was also detected in PTSD group in the posterior part of right hemisphere, involving forceps major, inferior fronto-occipital fasciculus, inferior longitudinal fasciculus, cingulum, hippocampus and superior longitudinal fasciculus. The baseline FA and RD values correlated with Clinician-Administered PTSD Scale scores at clinical follow up. CONCLUSION MVA survivors who later developed PTSD had more abnormalities in white matter integrity in the acute phase than those non-PTSD MVA survivors. Imaging markers of white matter integrity might be helpful in early identification of MVA survivors at high risk of PTSD. LIMITATIONS Larger sample size in our extensive study is needed to confer a robust inference and image data at follow up are needed to observe the longitudinal changes of white matter integrity.
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Affiliation(s)
- Hao Hu
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China; Shanghai Key Laboratory of Psychotic Disorders, PR China
| | - Yan Zhou
- Department of Radiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, PR China
| | - Qian Wang
- Med-X Research Institute, Shanghai Jiao Tong University, Shanghai, PR China
| | - Shanshan Su
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China; Shanghai Key Laboratory of Psychotic Disorders, PR China
| | - Yongming Qiu
- Department of Neurosurgery, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, PR China
| | - Jianwei Ge
- Department of Neurosurgery, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, PR China
| | - Zhen Wang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China; Shanghai Key Laboratory of Psychotic Disorders, PR China.
| | - Zeping Xiao
- Shanghai Jiao Tong University School of Medicine, PR China.
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22
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Hong JY, Naliboff B, Labus JS, Gupta A, Kilpatrick LA, Ashe-McNalley C, Stains J, Heendeniya N, Smith SR, Tillisch K, Mayer EA. Altered brain responses in subjects with irritable bowel syndrome during cued and uncued pain expectation. Neurogastroenterol Motil 2016; 28:127-38. [PMID: 26526698 PMCID: PMC4943658 DOI: 10.1111/nmo.12710] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Accepted: 09/21/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND A majority of the subjects with irritable bowel syndrome (IBS) show increased behavioral and brain responses to expected and delivered aversive visceral stimuli during controlled rectal balloon distension, and during palpation of the sigmoid colon. We aimed to determine if altered brain responses to cued and uncued pain expectation are also seen in the context of a noxious somatic pain stimulus applied to the same dermatome as the sigmoid colon. METHODS A task-dependent functional magnetic resonance imaging technique was used to investigate the brain activity of 37 healthy controls (18 females) and 37 IBS subjects (21 females) during: (i) a cued expectation of an electric shock to the abdomen vs a cued safe condition; and (ii) an uncued cross-hair condition in which the threat is primarily based on context vs a cued safe condition. KEY RESULTS Regions within the salience, attention, default mode, and emotional arousal networks were more activated by the cued abdominal threat condition and the uncued condition than in the cued safe condition. During the uncued condition contrasted to the cued safe condition, IBS subjects (compared to healthy control subjects) showed greater brain activations in the affective (amygdala, anterior insula) and attentional (middle frontal gyrus) regions, and in the thalamus and precuneus. These disease-related differences were primarily seen in female subjects. CONCLUSIONS & INFERENCES The observed greater engagement of cognitive and emotional brain networks in IBS subjects during contextual threat may reflect the propensity of IBS subjects to overestimate the likelihood and severity of future abdominal pain.
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Affiliation(s)
- Jui-Yang Hong
- Oppenheimer Center for Neurobiology of Stress, University of California, Los Angeles, California 90095,Division of Digestive Diseases, University of California, Los Angeles, California 90095,Department of Bioengineering, University of California, Los Angeles, California 90095
| | - Bruce Naliboff
- Oppenheimer Center for Neurobiology of Stress, University of California, Los Angeles, California 90095,Pain and Interoception Imaging Network (PAIN), University of California, Los Angeles, California 90095,Department of Medicine, University of California, Los Angeles, California 90095,Brain Research Institute, University of California, Los Angeles, California 90095,Division of Digestive Diseases, University of California, Los Angeles, California 90095
| | - Jennifer S. Labus
- Oppenheimer Center for Neurobiology of Stress, University of California, Los Angeles, California 90095,Pain and Interoception Imaging Network (PAIN), University of California, Los Angeles, California 90095,Department of Medicine, University of California, Los Angeles, California 90095,Brain Research Institute, University of California, Los Angeles, California 90095,Division of Digestive Diseases, University of California, Los Angeles, California 90095
| | - Arpana Gupta
- Oppenheimer Center for Neurobiology of Stress, University of California, Los Angeles, California 90095,Department of Medicine, University of California, Los Angeles, California 90095,Division of Digestive Diseases, University of California, Los Angeles, California 90095
| | - Lisa A. Kilpatrick
- Oppenheimer Center for Neurobiology of Stress, University of California, Los Angeles, California 90095,Pain and Interoception Imaging Network (PAIN), University of California, Los Angeles, California 90095,Department of Medicine, University of California, Los Angeles, California 90095,Division of Digestive Diseases, University of California, Los Angeles, California 90095
| | - Cody Ashe-McNalley
- Oppenheimer Center for Neurobiology of Stress, University of California, Los Angeles, California 90095,Pain and Interoception Imaging Network (PAIN), University of California, Los Angeles, California 90095,Department of Medicine, University of California, Los Angeles, California 90095,Division of Digestive Diseases, University of California, Los Angeles, California 90095
| | - Jean Stains
- Oppenheimer Center for Neurobiology of Stress, University of California, Los Angeles, California 90095,Department of Medicine, University of California, Los Angeles, California 90095,Division of Digestive Diseases, University of California, Los Angeles, California 90095
| | - Nuwanthi Heendeniya
- Oppenheimer Center for Neurobiology of Stress, University of California, Los Angeles, California 90095,Department of Medicine, University of California, Los Angeles, California 90095,Division of Digestive Diseases, University of California, Los Angeles, California 90095
| | - Suzanne R. Smith
- Oppenheimer Center for Neurobiology of Stress, University of California, Los Angeles, California 90095,Department of Medicine, University of California, Los Angeles, California 90095,Division of Digestive Diseases, University of California, Los Angeles, California 90095
| | - Kirsten Tillisch
- Oppenheimer Center for Neurobiology of Stress, University of California, Los Angeles, California 90095,Pain and Interoception Imaging Network (PAIN), University of California, Los Angeles, California 90095,Department of Medicine, University of California, Los Angeles, California 90095,Division of Digestive Diseases, University of California, Los Angeles, California 90095
| | - Emeran A. Mayer
- Oppenheimer Center for Neurobiology of Stress, University of California, Los Angeles, California 90095,Pain and Interoception Imaging Network (PAIN), University of California, Los Angeles, California 90095,Department of Medicine, University of California, Los Angeles, California 90095,Brain Research Institute, University of California, Los Angeles, California 90095,Division of Digestive Diseases, University of California, Los Angeles, California 90095,Department of Psychiatry, University of California, Los Angeles, California 90095,Ahmanson Lovelace Brain Mapping Center, David Geffen School of Medicine, University of California, Los Angeles, California 90095
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23
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Stark EA, Parsons CE, Van Hartevelt TJ, Charquero-Ballester M, McManners H, Ehlers A, Stein A, Kringelbach ML. Post-traumatic stress influences the brain even in the absence of symptoms: A systematic, quantitative meta-analysis of neuroimaging studies. Neurosci Biobehav Rev 2015; 56:207-21. [PMID: 26192104 DOI: 10.1016/j.neubiorev.2015.07.007] [Citation(s) in RCA: 100] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Revised: 07/02/2015] [Accepted: 07/09/2015] [Indexed: 10/23/2022]
Abstract
Stress affects brain function, and may lead to post-traumatic stress disorder (PTSD). Considerable empirical data for the neurobiology of PTSD has been derived from neuroimaging studies, although findings have proven inconsistent. We used an activation likelihood estimation analysis to explore differences in brain activity between adults with and without PTSD in response to affective stimuli. We separated studies by type of control group: trauma-exposed and trauma-naïve. This revealed distinct patterns of differences in functional activity. Compared to trauma-exposed controls, regions of the basal ganglia were differentially active in PTSD; whereas the comparison with trauma-naïve controls revealed differential involvement in the right anterior insula, precuneus, cingulate and orbitofrontal cortices known to be involved in emotional regulation. Changes in activity in the amygdala and parahippocampal cortex distinguished PTSD from both control groups. Results suggest that trauma has a measurable, enduring effect upon the functional dynamics of the brain, even in individuals who experience trauma but do not develop PTSD. These findings contribute to the understanding of whole-brain network activity following trauma, and its transition to clinical PTSD.
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Affiliation(s)
- E A Stark
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom; The Scars of War Foundation, The Queen's College, Oxford, United Kingdom; Center of Functionally Integrative Neuroscience (CFIN), Aarhus University, Aarhus, Denmark
| | - C E Parsons
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom; The Scars of War Foundation, The Queen's College, Oxford, United Kingdom; Center of Functionally Integrative Neuroscience (CFIN), Aarhus University, Aarhus, Denmark; Center for Music in the Brain, Department of Clinical Medicine, Aarhus University & The Royal Academy of Music Aarhus/Aalborg, Denmark
| | - T J Van Hartevelt
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom; The Scars of War Foundation, The Queen's College, Oxford, United Kingdom; Center of Functionally Integrative Neuroscience (CFIN), Aarhus University, Aarhus, Denmark
| | - M Charquero-Ballester
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom; The Scars of War Foundation, The Queen's College, Oxford, United Kingdom; Center of Functionally Integrative Neuroscience (CFIN), Aarhus University, Aarhus, Denmark
| | - H McManners
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom; The Scars of War Foundation, The Queen's College, Oxford, United Kingdom
| | - A Ehlers
- Department of Experimental Psychology, University of Oxford, Oxford, United Kingdom
| | - A Stein
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - M L Kringelbach
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom; The Scars of War Foundation, The Queen's College, Oxford, United Kingdom; Center of Functionally Integrative Neuroscience (CFIN), Aarhus University, Aarhus, Denmark; Center for Music in the Brain, Department of Clinical Medicine, Aarhus University & The Royal Academy of Music Aarhus/Aalborg, Denmark.
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24
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Abstract
Empirical findings in the Cognitive Sciences on the relationship between feeling states and subjective time have led to the assumption that time perception entails emotional and interoceptive states. The perception of time would thereafter be embodied; the bodily self, the continuous input from the body is the functional anchor of phenomenal experience and the mental self. Subjective time emerges through the existence of the self across time as an enduring and embodied entity. This relation is prominently disclosed in studies on altered states of consciousness such as in meditative states, under the influence of hallucinogens as well as in many psychiatric and neurological conditions. An increased awareness of oneself coincides with an increased awareness of time. Conversely, a decreased awareness of the self is associated with diminished awareness of time. The body of empirical work within different conceptual frameworks on the intricate relationship between self and time is presented and discussed.
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Affiliation(s)
- Marc Wittmann
- Institute for Frontier Areas of Psychology and Mental Health, Freiburg, Germany.
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25
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Alvarez RP, Kirlic N, Misaki M, Bodurka J, Rhudy JL, Paulus MP, Drevets WC. Increased anterior insula activity in anxious individuals is linked to diminished perceived control. Transl Psychiatry 2015; 5:e591. [PMID: 26125154 PMCID: PMC4490294 DOI: 10.1038/tp.2015.84] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Revised: 04/25/2015] [Accepted: 05/21/2015] [Indexed: 02/07/2023] Open
Abstract
Individuals with high-trait anxiety frequently report decreased perceived control. However, it is unclear how these processes are instantiated at a neural level. Prior research suggests that individuals prone to anxiety may have exaggerated activity in the anterior insula and altered activity in the cingulate cortex during anticipation of aversive events. Thus, we hypothesized that anxiety proneness influences anterior insula activation during anticipation of unpredictable threat through decreased perceived control. Forty physically healthy adults underwent neuroimaging while they explored computer-simulated contexts associated either with or without the threat of an unpredictable shock. Skin conductance, anxiety ratings and blood oxygenation level-dependent (BOLD) functional magnetic resonance imaging were used to assess responses to threat versus no threat. Perceived control was measured using the Anxiety Control Questionnaire-Revised. Mediation analysis examined how anxiety proneness influenced BOLD activity. Anticipation of unpredictable threat resulted in increased skin conductance responses, anxiety ratings and enhanced activation in bilateral insula, anterior midcingulate cortex (aMCC) and bed nucleus of the stria terminalis. Individuals with greater anxiety proneness and less perceived control showed greater activity in dorsal anterior insula (dAI). Perceived control mediated the relationship between anxiety proneness and dAI activity. Increased dAI activity was associated with increased activity in aMCC, which correlated with increased exploratory behavior. Results provide evidence that exaggerated insula activation during the threat of unpredictable shock is directly related to low perceived control in anxiety-prone individuals. Perceived control thus may constitute an important treatment target to modulate insula activity during anxious anticipation in anxiety-disordered individuals.
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Affiliation(s)
- R P Alvarez
- Laureate Institute for Brain Research, Tulsa, OK, USA,Faculty of Community Medicine, The University of Tulsa, Tulsa, OK, USA,Laureate Institute for Brain Research, 6655 South Yale Avenue, Tulsa, OK 74136, USA. E-mail:
| | - N Kirlic
- Laureate Institute for Brain Research, Tulsa, OK, USA,Department of Psychology, The University of Tulsa, Tulsa, OK, USA
| | - M Misaki
- Laureate Institute for Brain Research, Tulsa, OK, USA
| | - J Bodurka
- Laureate Institute for Brain Research, Tulsa, OK, USA,Center for Biomedical Engineering, The University of Oklahoma, Norman, OK, USA,College of Engineering, The University of Oklahoma, Norman, OK, USA
| | - J L Rhudy
- Department of Psychology, The University of Tulsa, Tulsa, OK, USA
| | - M P Paulus
- Laureate Institute for Brain Research, Tulsa, OK, USA
| | - W C Drevets
- Janssen Research and Development, Janssen Pharmaceuticals, Titusville, NJ, USA
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26
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Shankman SA, Gorka SM, Nelson BD, Fitzgerald DA, Phan KL, O'Daly O. Anterior insula responds to temporally unpredictable aversiveness: an fMRI study. Neuroreport 2014; 25:596-600. [PMID: 24614364 DOI: 10.1097/WNR.0000000000000144] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A heightened sensitivity to unpredictable aversiveness is a key component of several anxiety disorders. Neuroimaging studies of unpredictable aversiveness have shown that the anterior region of the insula cortex (AIC) plays a central role in the anticipation of unpredictable aversiveness. The present study extended these findings by examining the role of the AIC in temporal unpredictability (i.e. not knowing when the stimulus will occur), a particularly critical aspect of unpredictability as it increases contextual anxiety and vigilance, given that the danger could happen 'at any time'. Nineteen healthy participants underwent functional MRI while anticipating either temporally unpredictable or predictable aversive (or neutral) images. Participants showed greater right AIC activation while anticipating unpredictable relative to predictable aversive images. In addition, activation in this region was correlated positively with self-reported individual differences in a key facet of intolerance of uncertainty (inhibitory behavior). Taken together, the present study suggests that the AIC plays an important role in the anticipation of temporally unpredictable aversiveness and may mediate key deficits in anxiety disorders.
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27
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Shu IW, Onton JA, Prabhakar N, O'Connell RM, Simmons AN, Matthews SC. Combat veterans with PTSD after mild TBI exhibit greater ERPs from posterior-medial cortical areas while appraising facial features. J Affect Disord 2014; 155:234-40. [PMID: 24342149 DOI: 10.1016/j.jad.2013.06.057] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2013] [Accepted: 06/14/2013] [Indexed: 10/26/2022]
Abstract
Posttraumatic stress disorder (PTSD) worsens prognosis following mild traumatic brain injury (mTBI). Combat personnel with histories of mTBI exhibit abnormal activation of distributed brain networks-including emotion processing and default mode networks. How developing PTSD further affects these abnormalities has not been directly examined. We recorded electroencephalography in combat veterans with histories of mTBI, but without active PTSD (mTBI only, n=16) and combat veterans who developed PTSD after mTBI (mTBI+PTSD, n=16)-during the Reading the Mind in the Eyes Test (RMET), a validated test of empathy requiring emotional appraisal of facial features. Task-related event related potentials (ERPs) were identified, decomposed using independent component analysis (ICA) and localized anatomically using dipole modeling. We observed larger emotional face processing ERPs in veterans with mTBI+PTSD, including greater N300 negativity. Furthermore, greater N300 negativity correlated with greater PTSD severity, especially avoidance/numbing and hyperarousal symptom clusters. This correlation was dependent on contributions from the precuneus and posterior cingulate cortex (PCC). Our results support a model where, in combat veterans with histories of mTBI, larger ERPs from over-active posterior-medial cortical areas may be specific to PTSD, and is likely related to negative self-referential activity.
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Affiliation(s)
- I-Wei Shu
- VISN-22 Mental Illness, Research, Education and Clinical Center, 3350 La Jolla Village Drive, #116A, San Diego, CA 92161, USA; Veterans Affairs San Diego Healthcare System, 3350 La Jolla Village Drive, #116A, San Diego, CA 92161, USA.
| | - Julie A Onton
- Naval Health Research Center, 140 Sylvester Rd, Department 162, San Diego, CA 92106, USA
| | - Nitin Prabhakar
- Department of Psychiatry, University of California San Diego, 9500 Gilman Drive #9116A, La Jolla, CA 92037, USA
| | - Ryan M O'Connell
- Veterans Affairs San Diego Healthcare System, 3350 La Jolla Village Drive, #116A, San Diego, CA 92161, USA; Department of Psychiatry, University of California San Diego, 9500 Gilman Drive #9116A, La Jolla, CA 92037, USA
| | - Alan N Simmons
- Veterans Affairs San Diego Healthcare System, 3350 La Jolla Village Drive, #116A, San Diego, CA 92161, USA; Veterans Affairs San Diego Healthcare System Center of Excellence for Stress and Mental Health, 3350 La Jolla Village Drive, #116A, San Diego, CA 92161, USA
| | - Scott C Matthews
- VISN-22 Mental Illness, Research, Education and Clinical Center, 3350 La Jolla Village Drive, #116A, San Diego, CA 92161, USA; Veterans Affairs San Diego Healthcare System Center of Excellence for Stress and Mental Health, 3350 La Jolla Village Drive, #116A, San Diego, CA 92161, USA
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