The causal role of prefrontal hemispheric asymmetry in valence processing of words – Insights from a combined cTBS-MEG study

Tinnitus-on the interplay between emotion and cognition

Subjective tinnitus (hereafter tinnitus) is often considered and studied as a perceptual phenomenon. Accordingly, various abnormalities in the area of cognitive processing have been reported in patients with tinnitus. At the same time, the disorder is characterized by considerable emotional distress, which is associated with a high comorbidity of affective disorders. Here, we aim to outline the close link between cognition and emotion, and how current research from the field of cognitive neuroscience examines the processing and acquisition of emotional stimuli. The emotional valence of stimuli can be acquired after brief exposure to learning, leading from neutral to appetitive or aversive evaluation. In contrast to neutral stimuli, emotional stimuli attract attention very early (about 100 ms) during processing, leading to deeper processing and corresponding memory effects. The involved subcortical and cortical network encompasses limbic and sensory areas. In particular, prefrontal regions are involved in the acquisition and evaluation of emotional stimuli as also shown in studies of patients with affect disorders. The interplay of cognitive and emotional processes seems to be central to the development, maintenance, and treatment of tinnitus.

Excitatory stimulation of the ventromedial prefrontal cortex reduces cognitive gambling biases via improved feedback learning

Humans are subject to a variety of cognitive biases, such as the framing-effect or the gambler's fallacy, that lead to decisions unfitting of a purely rational agent. Previous studies have shown that the ventromedial prefrontal cortex (vmPFC) plays a key role in making rational decisions and that stronger vmPFC activity is associated with attenuated cognitive biases. Accordingly, dysfunctions of the vmPFC are associated with impulsive decisions and pathological gambling. By applying a gambling paradigm in a between-subjects design with 33 healthy adults, we demonstrate that vmPFC excitation via transcranial direct current stimulation (tDCS) reduces the framing-effect and the gambler's fallacy compared to sham stimulation. Corresponding magnetoencephalographic data suggest improved inhibition of maladaptive options after excitatory vmPFC-tDCS. Our analyses suggest that the underlying mechanism might be improved reinforcement learning, as effects only emerge over time. These findings encourage further investigations of whether excitatory vmPFC-tDCS has clinical utility in treating pathological gambling or other behavioral addictions.

[Tinnitus-on the interplay between emotion and cognition. German version]

Subjective tinnitus (hereafter tinnitus) is often considered and studied as a perceptual phenomenon. Accordingly, various abnormalities in the area of cognitive processing have been reported in patients with tinnitus. At the same time, the disorder is characterized by considerable emotional distress, which is associated with a high comorbidity of affective disorders. Here, we aim to outline the close link between cognition and emotion, and how current research from the field of cognitive neuroscience examines the processing and acquisition of emotional stimuli. The emotional valence of stimuli can be acquired after brief exposure to learning, leading from neutral to appetitive or aversive evaluation. In contrast to neutral stimuli, emotional stimuli attract attention very early (about 100 ms) during processing, leading to deeper processing and corresponding memory effects. The involved subcortical and cortical network encompasses limbic and sensory areas. In particular, prefrontal regions are involved in the acquisition and evaluation of emotional stimuli as also shown in studies of patients with affect disorders. The interplay of cognitive and emotional processes seems to be central to the development, maintenance, and treatment of tinnitus.

Tinnitus at the Junction of Traditional Medicine and Modern Technology

The WHO estimated that 430 million people worldwide suffer from moderate-to-severe hearing loss [...].

A systematic review of transcranial direct current stimulation on eye movements and associated psychological function

The last decades have seen a rise in the use of transcranial direct current stimulation (tDCS) approaches to modulate brain activity and associated behavior. Concurrently, eye tracking (ET) technology has improved to allow more precise quantitative measurement of gaze behavior, offering a window into the mechanisms of vision and cognition. When combined, tDCS and ET provide a powerful system to probe brain function and measure the impact on visual function, leading to an increasing number of studies that utilize these techniques together. The current pre-registered, systematic review seeks to describe the literature that integrates these approaches with the goal of changing brain activity with tDCS and measuring associated changes in eye movements with ET. The literature search identified 26 articles that combined ET and tDCS in a probe-and-measure model and are systematically reviewed here. All studies implemented controlled interventional designs to address topics related to oculomotor control, cognitive processing, emotion regulation, or cravings in healthy volunteers and patient populations. Across these studies, active stimulation typically led to changes in the number, duration, and timing of fixations compared to control stimulation. Notably, half the studies addressed emotion regulation, each showing hypothesized effects of tDCS on ET metrics, while tDCS targeting the frontal cortex was widely used and also generally produced expected modulation of ET. This review reveals promising evidence of the impact of tDCS on eye movements and associated psychological function, offering a framework for effective designs with recommendations for future studies.

Dual-Brain Psychology: A novel theory and treatment based on cerebral laterality and psychopathology

Dual-Brain Psychology is a theory and its clinical applications that come out of the author's clinical observations and from the Split-brain Studies. The theory posits, based on decades of rigorous, peer-reviewed experiments and clinical reports, that, in most patients, one brain's cerebral hemisphere (either left or right) when stimulated by simple lateral visual field stimulation, or unilateral transcranial photobiomodulation, reveals a dramatic change in personality such that stimulating one hemisphere evokes, as a trait, a personality that is more childlike and more presently affected by childhood maltreatments that are usually not presently appreciated but are the proximal cause of the patient's symptoms. The personality associated with the other hemisphere is much more mature, less affected by the traumas, and less symptomatic. The theory can be applied to in-depth psychotherapy in which the focus is on helping the troubled side to bear and process the traumas with the help of the therapist and the healthier personality. A person's symptoms can be evoked to aid the psychotherapy with hemispheric stimulation and the relationship between the dual personalities can be transformed from conflicted and sabotaging to cooperating toward overall health. Stimulating the positive hemisphere in most therapy patients rapidly relieves symptoms such as anxiety, depression, or substance cravings. Two randomized controlled trials used unilateral transcranial photobiomodulation to the positive hemisphere as a stand-alone treatment for opioid cravings and both revealed high effect sizes. The theory is supported by brain imaging and rTMS studies. It is the first psychological theory and application that comes out of and is supported by rigorous peer-reviewed experimentation.

Systems Medicine Approach for Tinnitus with Comorbid Disorders

Despite the fact that chronic diseases usually occur together with a spectrum of possible comorbidities that may differ strongly between patients, they are classically still viewed as distinct disease entities and, consequently, are often treated with uniform therapies. Unfortunately, such an approach does not take into account that different combinations of symptoms and comorbidities may result from different pathological (e.g., environmental, genetic, dietary, etc.) factors, which require specific and individualised therapeutic strategies. In this opinion paper, we aim to put forward a more differentiated, systems medicine approach to disease and patient treatment. To elaborate on this concept, we focus on the interplay of tinnitus, depression, and chronic pain. In our view, these conditions can be characterised by a variety of phenotypes composed of variable sets of symptoms and biomarkers, rather than distinct disease entities. The knowledge of the interplay of such symptoms and biomarkers will provide the key to a deeper, mechanistic understanding of disease pathologies. This paves the way for prediction and prevention of disease pathways, including more personalised and effective treatment strategies.

Individual Differences in Hemispheric Emotional Valence by Computerized Test Correlate with Lateralized Differences in Nucleus Accumbens, Hippocampal and Amygdala Volumes

Purpose

Conventional theories of hemispheric emotional valence (HEV) postulate fixed hemispheric differences in emotional processing. Schiffer’s dual brain psychology proposes that there are prominent individual differences with a substantial subset showing a reversed laterality pattern. He further proposed that hemispheric differences were more akin to differences in personality than in emotional processing. This theory is supported by findings that unilateral treatments, such as transcranial magnetic stimulation, are effective if they accurately target individual differences in laterality. The aim of this paper was to assess if a computer test of hemispheric emotional valence (CTHEV) could effectively identify individual differences in HEV and to ascertain if these individual differences were associated with underlying differences in brain structure and connectivity.

Patients and Methods

The CTHEV was administered to 50 (18 male/32 female) right-handed participants, aged 18–19 years, enrolled in a study assessing the neurobiological effects of childhood maltreatment. Based on a literature review, we determined whether CTHEV correlated with lateralized volumes of the nucleus accumbens, amygdala, hippocampus, and subgenual anterior cingulate as well as volume of the corpus callosum.

Results

CTHEV scores correlated with laterality indices of the nucleus accumbens (p = 0.00016), amygdala (p = 0.0138) and hippocampus (p = 0.031). A positive left hemispheric valence was associated with a larger left-sided nucleus accumbens and hippocampus and a smaller left amygdala. We identified four eigenvector network centrality DTI measures that predict CTHEV, most notably the left amygdala, and found that CTHEV results correlated with total and segment-specific corpus callosal volumes.

Conclusion

Individual differences in HEV can be readily assessed by computer test and correlate with differences in brain structure and connectivity that could provide a mechanistic understanding. These findings provide further support for a revised understanding of HEV and provide a tool that could be used to guide lateralized brain treatments.

Neural correlates of fear conditioning are associated with treatment-outcomes to behavioral exposure in spider phobia - Evidence from magnetoencephalography

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Magnetoencephalographic effects of fear conditioning predict exposure outcomes.

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No associations between fear ratings of conditioned stimuli and exposure outcomes.

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Prefrontal correlates of safety processing and/or fear inhibition are treatment-relevant.

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Individual neural differences might be a promising predictor of exposure success.

Background

Models of anxiety disorders and the rationale of exposure therapy (ET) are grounded on classical fear conditioning. Yet, it is unclear whether lower fear ratings of conditioned safety versus threat cues and corresponding neural markers of safety-learning and/or fear inhibition assessed before treatment would predict better outcomes of behavioral exposure.

Methods

Sixty-six patients with spider phobia completed pre-treatment clinical and experimental fear conditioning assessments, one session of virtual reality ET, a post-treatment clinical assessment, and a 6-month follow-up assessment. Tilted Gabor gratings served as conditioned stimuli (CS) that were either paired (CS+) or remained unpaired (CS-) with an aversive phobia-related and phobia-unrelated unconditioned stimulus (UCS). CS+/CS- differences in fear ratings and magnetoencephalographic event-related fields (ERFs) were related to percentual symptom reductions from pre- to post-treatment, as assessed via spider phobia questionnaire (SPQ), behavioral avoidance test (BAT), and remission status at 6-month follow-up.

Results

We observed no associations between pre-treatment CS+/CS- differences in fear ratings and any treatment outcome. CS+/CS- differences in source estimations of ERFs revealed that higher CS- activity in bilateral dorsolateral prefrontal cortex (dlPFC) was related with SPQ- and BAT-reductions. Associations between CS+/CS- differences and treatment outcomes were also observed in left ventromedial prefrontal cortex (vmPFC) regions, which additionally revealed associations with the follow-up remission status.

Conclusions

Results provide initial evidence that neural pre-treatment CS+/CS- differences may hold predictive information regarding outcomes of behavioral exposure. Our findings highlight a key role of neural responses to safety cues with potentially inhibitory effects on affect-generating structures during fear conditioning.

Consumers in the Face of COVID-19-Related Advertising: Threat or Boost Effect?

The COVID-19 pandemic has prompted the production of a vast amount of COVID-19-themed brand commercials, in an attempt to exploit the salience of the topic to reach more effectively the consumers. However, the literature has produced conflicting findings of the effectiveness of negative emotional contents in advertisings. The present study aims at exploring the effect of COVID-19-related contents on the hemodynamic brain correlates of the consumer approach or avoidance motivation. Twenty Italian participants were randomly assigned to two different groups that watched COVID-19-related or non-COVID-19-related commercials. The hemodynamic response [oxygenated (O₂Hb) and deoxygenated hemoglobin modulations] within the left and right prefrontal cortices (PFC) was monitored with Functional Near-Infrared Spectroscopy (fNIRS) while brand commercials were presented, as the prefrontal lateralization was shown to be indicative of the attitude toward the brand and of the approach-avoidance motivation. First, the findings showed that the COVID-19-related contents were able to prompt emotional processing within the PFC to a higher extent compared to contents non-related to COVID-19. Moreover, the single-channel analysis revealed increased O₂Hb activity of the left dorsolateral PFC compared to the left pars triangularis Broca’s area in the group of participants that watched the COVID-19-related commercials, suggesting that the commercials may have driven participants to dedicate more attention toward the processing of the emotional components compared to the semantic meaning conveyed by the ad. To conclude, despite expressing unpleasant emotions, commercials referring to the highly emotional pandemic experience may benefit the advertising efficacy, increasing the capability to reach customers.

Transcranial Direct Current Stimulation of the Ventromedial Prefrontal Cortex Modulates Perceptual and Neural Patterns of Fear Generalization

BACKGROUND

Overgeneralization of fear is a pathogenic marker of anxiety and stress-related disorders and has been linked with perceptual discrimination deficits, reduced fear inhibition, and prefrontal hyporeactivity to safety-signaling stimuli. We aimed to examine whether behavioral and neural patterns of fear generalization are influenced by the fear-inhibiting ventromedial prefrontal cortex (vmPFC).

METHODS

Three groups of healthy participants received excitatory (n = 27), inhibitory (n = 26), or sham (n = 26) transcranial direct current stimulation of the vmPFC after a fear conditioning phase and before a fear generalization phase. We obtained, as dependent variables, fear ratings and unconditioned stimulus-expectancy ratings, perceptual aspects of fear generalization (perceptual discrimination), pupil dilations, and source estimations of event-related fields elicited by conditioned and generalization stimuli.

RESULTS

After inhibitory (compared with excitatory and sham) vmPFC stimulation, we observed reduced performance in perceptual discrimination and less negative inhibitory gradients in frontal structures at midlatency and late time intervals. Fear and unconditioned stimulus-expectancy ratings as well as pupil dilation remained unaffected by stimulation.

CONCLUSIONS

These findings reveal a causal contribution of vmPFC reactivity to generalization patterns and suggest that vmPFC hyporeactivity consequent on inhibitory vmPFC stimulation may serve as a model for pathological processes of fear generalization (reduced discrimination, impaired fear inhibition via frontal brain structures). This encourages further basic and clinical research on the potential of targeted brain stimulation to modulate fear generalization and overgeneralization.

Inhibition of the occipital face area modulates the electrophysiological signals of face familiarity: A combined cTBS-EEG study

The occipital face area (OFA) is hierarchically one of the first stages of the face processing network. It has originally been thought to be involved in early, structural processing steps, but currently more and more studies challenge this view and propose that it also takes part in higher level face processing, such as identification and recognition. Here we tested whether the OFA is involved in the initial steps of recognition memory and plays a causal role in the differential processing of familiar and unfamiliar faces. We used an offline, inhibitory continuous theta-burst stimulation (cTBS) protocol over the right OFA and the vertex as control site. Electroencephalographic (EEG) recording of event-related potentials (ERPs), elicited by visually presented familiar (famous) and unfamiliar faces was performed before and after stimulation. We observed a difference in ERPs for famous and unfamiliar faces in a time-window corresponding to the N250 component. Importantly, this difference was significantly increased by cTBS of the right OFA, suggesting its causal role in the differential processing of familiar and unfamiliar faces. The enhancement occurred focally, at electrodes close to the right hemispheric cTBS site, as well as over similar occipito-temporal sites of the contralateral hemisphere. To the best of our knowledge, this is the first study showing the causal role of the rOFA in the differential processing of familiar and unfamiliar faces, using combined cTBS and EEG recording methods. These results are discussed with respect to the nature of familiar face representations, supported by an extensive, bilateral network.

Coupling between Blood Pressure and Subarachnoid Space Width Oscillations during Slow Breathing

The precise mechanisms connecting the cardiovascular system and the cerebrospinal fluid (CSF) are not well understood in detail. This paper investigates the couplings between the cardiac and respiratory components, as extracted from blood pressure (BP) signals and oscillations of the subarachnoid space width (SAS), collected during slow ventilation and ventilation against inspiration resistance. The experiment was performed on a group of 20 healthy volunteers (12 females and 8 males; BMI =22.1±3.2 kg/m2; age 25.3±7.9 years). We analysed the recorded signals with a wavelet transform. For the first time, a method based on dynamical Bayesian inference was used to detect the effective phase connectivity and the underlying coupling functions between the SAS and BP signals. There are several new findings. Slow breathing with or without resistance increases the strength of the coupling between the respiratory and cardiac components of both measured signals. We also observed increases in the strength of the coupling between the respiratory component of the BP and the cardiac component of the SAS and vice versa. Slow breathing synchronises the SAS oscillations, between the brain hemispheres. It also diminishes the similarity of the coupling between all analysed pairs of oscillators, while inspiratory resistance partially reverses this phenomenon. BP–SAS and SAS–BP interactions may reflect changes in the overall biomechanical characteristics of the brain.

Verbal emotional memory laterality effect on amygdalohippocampectomy for refractory epilepsy

OBJECTIVES

To study the brain lateralization of the verbal emotional memory and the influence of the emotional valence, we investigated a sample composed of patients with medial temporal lobe refractory epilepsy (MTLE) treated with unilateral amygdalohippocampectomy compared to a control group.

MATERIALS & METHODS

A new task (Verbal Association) was designed and implemented to assess emotional memory performance. It was applied to 62 patients with MTLE of whom 31 have been subjected to right amygdalohippocampectomy and 31 to left amygdalohippocampectomy. These patients were compared with 31 participants with no cerebral pathology, as a control group.

RESULTS

(a) The control group obtained a higher number of recalled words than the rest of the groups, while the MTLE-right group obtained better results than the MTLE-left group. (b) In the case of positive emotional valence words, the MTLE-left group performed significantly worse than the rest of the groups; whereas for negative emotional words, the MTLE-left group presented the lowest average performance and the control group obtained a higher number of recalled words compared to MTLE-right group. In the case of neutral emotional words, no significant differences were found among the groups. (c) The MTLE-left group showed poorer performance on positive and negative words than neutral; the control group demonstrated lower average performance on positive and neutral words compared to negative; the MTLE-right group did not show any significant differences on the recall of different emotional valences.

CONCLUSIONS

Patients with MTLE show a deficit in the verbal recall which is exacerbated for information with an affective component. This deficit is more prominent in the case of patients with left unilateral resection (MTLE-left group) since they lose the benefits of the emotional information for the recall.

Neuromodulation of cursing in American English: A combined tDCS and pupillometry study

Many neurological disorders are associated with excessive and/or uncontrolled cursing. The right prefrontal cortex has long been implicated in a diverse range of cognitive processes that underlie the propensity for cursing, including non-propositional language representation, emotion regulation, theory of mind, and affective arousal. Neurogenic cursing often poses significant negative social consequences, and there is no known behavioral intervention for this communicative disorder. We examined whether right vs. left lateralized prefrontal neurostimultion via tDCS could modulate taboo word production in neurotypical adults. We employed a pre/post design with a bilateral frontal electrode montage. Half the participants received left anodal and right cathodal stimulation; the remainder received the opposite polarity stimulation at the same anatomical loci. We employed physiological (pupillometry) and behavioral (reaction time) dependent measures as participants read aloud taboo and non-taboo words. Pupillary responses demonstrated a crossover reaction, suggestive of modulation of phasic arousal during cursing. Participants in the right anodal condition showed elevated pupil responses for taboo words post stimulation. In contrast, participants in the right cathodal condition showed relative dampening of pupil responses for taboo words post stimulation. We observed no effects of stimulation on response times. We interpret these findings as supporting modulation of right hemisphere affective arousal that disproportionately impacts taboo word processing. We discuss alternate accounts of the data and future applications to neurological disorders.

Global Image Properties Predict Ratings of Affective Pictures

Affective pictures are widely used in studies of human emotions. The objects or scenes shown in affective pictures play a pivotal role in eliciting particular emotions. However, affective processing can also be mediated by low-level perceptual features, such as local brightness contrast, color or the spatial frequency profile. In the present study, we asked whether image properties that reflect global image structure and image composition affect the rating of affective pictures. We focused on 13 global image properties that were previously associated with the esthetic evaluation of visual stimuli, and determined their predictive power for the ratings of five affective picture datasets (IAPS, GAPED, NAPS, DIRTI, and OASIS). First, we used an SVM-RBF classifier to predict high and low ratings for valence and arousal, respectively, and achieved a classification accuracy of 58–76% in this binary decision task. Second, a multiple linear regression analysis revealed that the individual image properties account for between 6 and 20% of the variance in the subjective ratings for valence and arousal. The predictive power of the image properties varies for the different datasets and type of ratings. Ratings tend to share similar sets of predictors if they correlate positively with each other. In conclusion, we obtained evidence from non-linear and linear analyses that affective pictures evoke emotions not only by what they show, but they also differ by how they show it. Whether the human visual system actually uses these perceptive cues for emotional processing remains to be investigated.

ERP Markers of Valence Coding in Emotional Speech Processing

How is auditory emotional information processed? The study's aim was to compare cerebral responses to emotionally positive or negative spoken phrases matched for structure and content. Twenty participants listened to 198 vocal stimuli while detecting filler phrases containing first names. EEG was recorded from 128 sites. Three event-related potential (ERP) components were quantified and found to be sensitive to emotional valence since 350 ms of latency. P450 and late positivity were enhanced by positive content, whereas anterior negativity was larger to negative content. A similar set of markers (P300, N400, LP) was found previously for the processing of positive versus negative affective vocalizations, prosody, and music, which suggests a common neural mechanism for extracting the emotional content of auditory information. SwLORETA applied to potentials recorded between 350 and 550 ms showed that negative speech activated the right temporo/parietal areas (BA40, BA20/21), whereas positive speech activated the left homologous and inferior frontal areas.

A Novel Treatment of Opioid Cravings With an Effect Size of .73 for Unilateral Transcranial Photobiomodulation Over Sham

BACKGROUND

Opioid use disorders (OUDs) are an epidemic causing catastrophic consequences to individuals, families, and society despite treatments including psychotherapy, substitution therapy or receptor blockers, and psychoeducation. We have developed a novel treatment that combines unilateral transcranial photobiomodulation (t-PBM) to the hemisphere with a more positive valence by Dual Brain Psychology (DBP).

METHODS

We used a randomized, double blind, placebo-controlled protocol in which 22 patients with significant opioid cravings and a history of recent or current OUD attended three 1-h weekly sessions. After baseline measures of opioid craving and other psychometrics, subjects received two unilateral t-PBM applications (810 nm CW LED, 250 mW/cm², 60 J/cm², 4 min) or a sham (foil-covered LED) at F3 or F4. Prior to any treatment we used two tests to determine which hemisphere was more associated with a negative outlook and cravings and treated that side before the more positive hemisphere. Primary outcome measure was an opioid craving scale (OCS). Secondary outcomes were weekly Hamilton Depression (HDRS) and Anxiety (HARS) Rating Scales prior to treatments and at follow-up.

RESULTS

Immediately after treatment the OCS improved significantly for both the sham and active treatments, but one week later the active treatment showed a 51.0% (SD 33.7) decrease in OCS while a week after the sham treatments there was a decrease of only 15.8% (SD 35.0) (by Wilcoxon Sign Rank Test, p = 0.004) and by a mixed model it was p = 0.0071. The effect size for the differences between active and sham was 0.73. For the active treatment from before and after treatment the effect size was 1.51 and for the sham, 0.45. The HDRS improved from a baseline of 15.1 to 8.8 (SD 10.3) a week after the active treatment and to 13.3 (SD 12.9) after the sham (p = 0.0071). HARS improved from 14.7 to 8.0 (SD 13.2) after the active treatments and to 14.3 (SD 16.0) after the sham, p = 0.08. Active treatment of the positive hemisphere after the negative hemisphere significantly improved the OCS, but there was no significant difference after the sham treatment. One patient complained of 2 h of abdominal bloating and dropped out; no other adverse effects were observed.

DISCUSSION

Unilateral t-PBM to the hemisphere with a more positive hemispheric emotional valence was an effective and safe treatment for opioid cravings as well as for depression and anxiety. Our results also lend support to the underlying premises of DBP.