1
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Dekel S, Orr SP. Establishing the validity of a diagnostic questionnaire for childbirth-related posttraumatic stress disorder: a reply. Am J Obstet Gynecol 2024; 230:e102. [PMID: 38158073 DOI: 10.1016/j.ajog.2023.12.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 12/18/2023] [Indexed: 01/03/2024]
Affiliation(s)
- Sharon Dekel
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, 120 Second Avenue, Charlestown, MA 02129.
| | - Scott P Orr
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, 120 Second Avenue, Charlestown, MA 02129
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2
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Beucke JC, Diez I, Sepulcre J, Mundorf A, Kaufmann C, Orr SP, Pitman RK, Shin LM. A late-life neurogenetic signature of exposure to combat stress - A monozygotic discordant twin study. J Psychiatr Res 2024; 171:230-237. [PMID: 38316103 DOI: 10.1016/j.jpsychires.2024.01.032] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 01/09/2024] [Accepted: 01/15/2024] [Indexed: 02/07/2024]
Abstract
Animal models suggest that experiencing high-stress levels induces changes in amygdalar circuitry and gene expression. In humans, combat exposure has been shown to alter amygdalar responsivity and connectivity, but abnormalities have been indicated to normalize at least partially upon the termination of stress exposure. In contrast, other evidence suggests that combat exposure continues to exert influence on exposed individuals well beyond deployment and homecoming, as indicated by longitudinal psychosocial evidence from veterans, and observation of greater health decline in veterans late in life. Accordingly, the experience of combat stress early in life may affect amygdalar responsivity late in life, a possibility requiring careful consideration of the confounding effects of aging, genetic factors, and symptoms of post-traumatic stress disorder. Here, we investigated amygdalar responsivity in a unique sample of 16 male monozygotic (MZ) twin pairs in their sixties, where one but not the other sibling had been exposed to combat stress in early adulthood. Forty years after combat experience, a generally blunted amygdalar response was observed in combat-exposed veterans compared to their non-exposed twin siblings. Spatial associations between these phenotypical changes and patterns of gene expression in the brain were found for genes involved in the synaptic organization and chromatin structure. Protein-protein interactions among the set of identified genes pointed to histone modification mechanisms. We conclude that exposure to combat stress early in life continues to impact brain function beyond the termination of acute stress and appears to exert prolonged effects on amygdalar function later in life via neurogenetic mechanisms.
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Affiliation(s)
- Jan C Beucke
- Institute for Systems Medicine, Department of Human Medicine, MSH Medical School Hamburg, Hamburg, Germany; Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany.
| | - Ibai Diez
- Gordon Center for Medical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA
| | - Jorge Sepulcre
- Gordon Center for Medical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA
| | - Annakarina Mundorf
- Institute for Systems Medicine, Department of Human Medicine, MSH Medical School Hamburg, Hamburg, Germany
| | - Christian Kaufmann
- Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Scott P Orr
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Roger K Pitman
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Lisa M Shin
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Tufts University, Medford, MA, USA
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3
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Leibovitz SE, Sevinc G, Greenberg J, Hölzel B, Gard T, Calahan T, Vangel M, Orr SP, Milad MR, Lazar SW. Mindfulness training and exercise differentially impact fear extinction neurocircuitry. Psychol Med 2024; 54:835-846. [PMID: 37655520 DOI: 10.1017/s0033291723002593] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
BACKGROUND The ability to extinguish a maladaptive conditioned fear response is crucial for healthy emotional processing and resiliency to aversive experiences. Therefore, enhancing fear extinction learning has immense potential emotional and health benefits. Mindfulness training enhances both fear conditioning and recall of extinguished fear; however, its effects on fear extinction learning are unknown. Here we investigated the impact of mindfulness training on brain mechanisms associated with fear-extinction learning, compared to an exercise-based program. METHODS We investigated BOLD activations in response to a previously learned fear-inducing cue during an extinction paradigm, before and after an 8-week mindfulness-based stress reduction program (MBSR, n = 49) or exercise-based stress management education program (n = 27). RESULTS The groups exhibited similar reductions in stress, but the MBSR group was uniquely associated with enhanced activation of salience network nodes and increased hippocampal engagement. CONCLUSIONS Our results suggest that mindfulness training increases attention to anticipatory aversive stimuli, which in turn facilitates decreased aversive subjective responses and enhanced reappraisal of the memory.
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Affiliation(s)
- Shaked E Leibovitz
- College of Faculty of Arts and Sciences, Harvard University, Cambridge, MA 02138, USA
| | - Gunes Sevinc
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Jonathan Greenberg
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Britta Hölzel
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
- Department of Neuroradiology, Klinikum rechts der Isar, Technical University of Munich, Munich 81675, Germany
| | - Tim Gard
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Thomas Calahan
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Mark Vangel
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Scott P Orr
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Mohammed R Milad
- Psychiatry Department, New York University Grossman School of Medicine, New York, NY 10016, USA
| | - Sara W Lazar
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
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4
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Arora IH, Woscoboinik GG, Mokhtar S, Quagliarini B, Bartal A, Jagodnik KM, Barry RL, Edlow AG, Orr SP, Dekel S. Establishing the validity of a diagnostic questionnaire for childbirth-related posttraumatic stress disorder. Am J Obstet Gynecol 2023:S0002-9378(23)02031-8. [PMID: 37981091 DOI: 10.1016/j.ajog.2023.11.1229] [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: 08/08/2023] [Revised: 11/07/2023] [Accepted: 11/09/2023] [Indexed: 11/21/2023]
Abstract
BACKGROUND Labor and delivery can entail complications and severe maternal morbidities that threaten a woman's life or cause her to believe that her life is in danger. Women with these experiences are at risk for developing posttraumatic stress disorder. Postpartum posttraumatic stress disorder, or childbirth-related posttraumatic stress disorder, can become an enduring and debilitating condition. At present, validated tools for a rapid and efficient screen for childbirth-related posttraumatic stress disorder are lacking. OBJECTIVE We examined the diagnostic validity of the Posttraumatic Stress Disorder Checklist for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, for detecting posttraumatic stress disorder among women who have had a traumatic childbirth. This Checklist assesses the 20 Diagnostic and Statistical Manual of Mental Disorders, posttraumatic stress disorder symptoms and is a commonly used patient-administrated screening instrument. Its diagnostic accuracy for detecting childbirth-related posttraumatic stress disorder is unknown. STUDY DESIGN The sample included 59 patients who reported a traumatic childbirth experience determined in accordance with the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, posttraumatic stress disorder criterion A for exposure involving a threat or potential threat to the life of the mother or infant, experienced or perceived, or physical injury. The majority (66%) of the participants were less than 1 year postpartum (for full sample: median, 4.67 months; mean, 1.5 years) and were recruited via the Mass General Brigham's online platform, during the postpartum unit hospitalization or after discharge. Patients were instructed to complete the Posttraumatic Stress Disorder Checklist for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, concerning posttraumatic stress disorder symptoms related to childbirth. Other comorbid conditions (ie, depression and anxiety) were also assessed. They also underwent a clinician interview for posttraumatic stress disorder using the gold-standard Clinician-Administered PTSD Scale for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. A second administration of the checklist was performed in a subgroup (n=43), altogether allowing an assessment of internal consistency, test-retest reliability, and convergent and diagnostic validity of the Checklist. The diagnostic accuracy of the Posttraumatic Stress Disorder Checklist for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, in reference to the Clinician-Administered PTSD Scale for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, was determined using the area under the receiver operating characteristic curve; an optimal cutoff score was identified using the Youden's J index. RESULTS One-third of the sample (35.59%) met the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, criteria for a posttraumatic stress disorder diagnosis stemming from childbirth. The Posttraumatic Stress Disorder Checklist for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, symptom severity score was strongly correlated with the Clinician-Administered PTSD Scale for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, total score (ρ=0.82; P<.001). The area under the receiver operating characteristic curve was 0.93 (95% confidence interval, 0.87-0.99), indicating excellent diagnostic performance of the Posttraumatic Stress Disorder Checklist for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. A cutoff value of 28 maximized the sensitivity (0.81) and specificity (0.90) and correctly diagnosed 86% of women. A higher value (32) identified individuals with more severe posttraumatic stress disorder symptoms (specificity, 0.95), but with lower sensitivity (0.62). Checklist scores were also stable over time (intraclass correlation coefficient, 0.73), indicating good test-retest reliability. Posttraumatic Stress Disorder Checklist for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, scores were moderately correlated with the depression and anxiety symptom scores (Edinburgh Postnatal Depression Scale: ρ=0.58; P<.001 and the Brief Symptom Inventory, anxiety subscale: ρ=0.51; P<.001). CONCLUSION This study demonstrates the validity of the Posttraumatic Stress Disorder Checklist for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, as a screening tool for posttraumatic stress disorder among women who had a traumatic childbirth experience. The instrument may facilitate screening for childbirth-related posttraumatic stress disorder on a large scale and help identify women who might benefit from further diagnostics and services. Replication of the findings in larger, postpartum samples is needed.
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Affiliation(s)
- Isha Hemant Arora
- Postpartum Traumatic Stress (Dekel) Laboratory, Division of Neuroscience, Department of Psychiatry, Massachusetts General Hospital, Boston, MA
| | - Georgia G Woscoboinik
- Postpartum Traumatic Stress (Dekel) Laboratory, Division of Neuroscience, Department of Psychiatry, Massachusetts General Hospital, Boston, MA
| | - Salma Mokhtar
- Postpartum Traumatic Stress (Dekel) Laboratory, Division of Neuroscience, Department of Psychiatry, Massachusetts General Hospital, Boston, MA
| | - Beatrice Quagliarini
- Postpartum Traumatic Stress (Dekel) Laboratory, Division of Neuroscience, Department of Psychiatry, Massachusetts General Hospital, Boston, MA
| | - Alon Bartal
- The School of Business Administration, Bar-Ilan University, Ramat Gan, Israel
| | - Kathleen M Jagodnik
- Postpartum Traumatic Stress (Dekel) Laboratory, Division of Neuroscience, Department of Psychiatry, Massachusetts General Hospital, Boston, MA; Department of Psychiatry, Harvard Medical School, Boston MA
| | - Robert L Barry
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA; Harvard Medical School, Boston, MA; Harvard-Massachusetts Institute of Technology Health Sciences & Technology, Cambridge, MA
| | - Andrea G Edlow
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Massachusetts General Hospital and Harvard Medical School, Boston MA; Vincent Center for Reproductive Biology, Massachusetts General Hospital, Boston MA
| | - Scott P Orr
- Department of Psychiatry, Harvard Medical School, Boston MA; Division of Neuroscience, Department of Psychiatry, Massachusetts General Hospital, Boston, MA
| | - Sharon Dekel
- Postpartum Traumatic Stress (Dekel) Laboratory, Division of Neuroscience, Department of Psychiatry, Massachusetts General Hospital, Boston, MA; Department of Psychiatry, Harvard Medical School, Boston MA.
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5
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Mäder T, Oliver KI, Daffre C, Kim S, Orr SP, Lasko NB, Seo J, Kleim B, Pace-Schott EF. Autonomic activity, posttraumatic and nontraumatic nightmares, and PTSD after trauma exposure. Psychol Med 2023; 53:731-740. [PMID: 34127168 PMCID: PMC9121310 DOI: 10.1017/s0033291721002075] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND Nightmares are a hallmark symptom of posttraumatic stress disorder (PTSD). This strong association may reflect a shared pathophysiology in the form of altered autonomic activity and increased reactivity. Using an acoustic startle paradigm, we investigated the interrelationships of psychophysiological measures during wakefulness and PTSD diagnosis, posttraumatic nightmares, and nontraumatic nightmares. METHODS A community sample of 122 trauma survivors were presented with a series of brief loud tones, while heart rate (HRR), skin conductance (SCR), and orbicularis oculi electromyogram (EMGR) responses were measured. Prior to the tone presentations, resting heart rate variability (HRV) was assessed. Nightmares were measured using nightmare logs. Three dichotomous groupings of participants were compared: (1) current PTSD diagnosis (n = 59), no PTSD diagnosis (n = 63), (2) those with (n = 26) or without (n = 96) frequent posttraumatic nightmares, and (3) those with (n = 22) or without (n = 100) frequent nontraumatic nightmares. RESULTS PTSD diagnosis was associated with posttraumatic but not with nontraumatic nightmares. Both PTSD and posttraumatic nightmares were associated with a larger mean HRR to loud tones, whereas nontraumatic nightmare frequency was associated with a larger SCR. EMGR and resting HRV were not associated with PTSD diagnosis or nightmares. CONCLUSIONS Our findings suggest a shared pathophysiology between PTSD and posttraumatic nightmares in the form of increased HR reactivity to startling tones, which might reflect reduced parasympathetic tone. This shared pathophysiology could explain why PTSD is more strongly related to posttraumatic than nontraumatic nightmares, which could have important clinical implications.
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Affiliation(s)
- Thomas Mäder
- Department of Psychology, University of Zurich, Zurich, Switzerland
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
| | - Katelyn I. Oliver
- Department of Psychiatry, Massachusetts General Hospital, Charlestown, MA, USA
- Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, USA
| | - Carolina Daffre
- Department of Psychiatry, Massachusetts General Hospital, Charlestown, MA, USA
- Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, USA
| | - Sophie Kim
- Department of Psychiatry, Massachusetts General Hospital, Charlestown, MA, USA
- Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, USA
| | - Scott P. Orr
- Department of Psychiatry, Massachusetts General Hospital, Charlestown, MA, USA
- Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, USA
- Department of Psychiatry, Harvard Medical School, Charlestown, MA, USA
| | - Natasha B. Lasko
- Department of Psychiatry, Massachusetts General Hospital, Charlestown, MA, USA
- Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, USA
- Department of Psychiatry, Harvard Medical School, Charlestown, MA, USA
| | - Jeehye Seo
- Department of Psychiatry, Massachusetts General Hospital, Charlestown, MA, USA
- Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, USA
- Department of Psychiatry, Harvard Medical School, Charlestown, MA, USA
- Department of Psychological & Brain Sciences, University of Massachusetts, Amherst, MA, USA
| | - Birgit Kleim
- Department of Psychology, University of Zurich, Zurich, Switzerland
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
- Neuroscience Centre Zurich, University of Zurich, Zurich, Switzerland
| | - Edward Franz Pace-Schott
- Department of Psychiatry, Massachusetts General Hospital, Charlestown, MA, USA
- Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, USA
- Department of Psychiatry, Harvard Medical School, Charlestown, MA, USA
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6
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Daffre C, Oliver KI, Nazareno JRS, Mäder T, Seo J, Dominguez JP, Gannon K, Lasko NB, Orr SP, Pace-Schott EF. Rapid eye movement sleep parasympathetic activity predicts wake hyperarousal symptoms following a traumatic event. J Sleep Res 2023; 32:e13685. [PMID: 35915961 PMCID: PMC9851935 DOI: 10.1111/jsr.13685] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 06/09/2022] [Accepted: 06/17/2022] [Indexed: 02/03/2023]
Abstract
Heart rate variability (HRV) can be used to assess changes in output of the parasympathetic nervous system (PNS). Considering that patients with post-traumatic stress disorder (PTSD) often experience disturbances in sleep, arousal, and autonomic functioning, we sought to explore the association of PNS activity during sleep with hyperarousal symptoms of PTSD. Because a broad literature supports the importance of rapid eye movement (REM) sleep in PTSD, REM-sleep features were specifically examined as predictors of PTSD symptom severity. A total of 90 participants, primarily civilian and female, aged 18-40 years who had experienced a traumatic event in the last 2 years, underwent an ambulatory polysomnography (PSG) acclimation night followed by a second PSG night from which sleep physiological measures were computed. Participants underwent an ambulatory polysomnography (PSG) acclimation night followed by a second PSG night from which sleep physiological measures were computed. PTSD severity was measured using the PTSD Checklist for the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (PCL-5). Dependent variables were total PCL-5 score as well as its hyperarousal symptom subscore. Predictors included REM latency, percentage, density, segment length, and an index of parasympathetic tone (root mean square of the successive differences in the R-R interval or RMSSD). Hierarchical regression models were conducted to analyse the association of REM features with PCL-5 total and hyperarousal subscales. Using hierarchical regression, REM-sleep RMSSD accounted for a significant proportion of the variation in outcome variables, even when accounting for other REM-sleep features. The present findings support hypothesised relationships between PTSD symptomatology and REM-sleep physiology and, specifically, that lowered parasympathetic tone in REM may be an important associate of the hyperarousal symptom cluster in PTSD.
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Affiliation(s)
- Carolina Daffre
- Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA
- Department of Psychiatry, Massachusetts General Hospital, Charlestown, MA
| | - Katelyn I. Oliver
- Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA
- Department of Psychiatry, Massachusetts General Hospital, Charlestown, MA
| | - Jovi R. S. Nazareno
- Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA
- Department of Psychiatry, Massachusetts General Hospital, Charlestown, MA
| | - Thomas Mäder
- Department of Psychology, University of Zurich, Switzerland
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Switzerland
| | - Jeehye Seo
- Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA
- Department of Psychiatry, Massachusetts General Hospital, Charlestown, MA
- Korea University, Department of Brain & Cognitive Engineering, Seongbuk-gu, Seoul, KR
| | - Jarrod P. Dominguez
- Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA
- Department of Psychiatry, Massachusetts General Hospital, Charlestown, MA
| | - Karen Gannon
- Department of Neurology, Massachusetts General Hospital, Charlestown, MA
| | - Natasha B. Lasko
- Department of Psychiatry, Massachusetts General Hospital, Charlestown, MA
- Department of Psychiatry, Harvard Medical School, Charlestown, MA
| | - Scott P. Orr
- Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA
- Department of Psychiatry, Massachusetts General Hospital, Charlestown, MA
- Department of Psychiatry, Harvard Medical School, Charlestown, MA
| | - Edward F. Pace-Schott
- Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA
- Department of Psychiatry, Massachusetts General Hospital, Charlestown, MA
- Department of Psychiatry, Harvard Medical School, Charlestown, MA
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7
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Hinojosa CA, VanElzakker MB, Hughes KC, Offringa R, Sangermano LM, Spaulding IG, Staples-Bradley LK, Whitman ET, Lasko NB, Rauch SL, Orr SP, Pitman RK, Shin LM. Exaggerated amygdala activation to ambiguous facial expressions is a familial vulnerability factor for posttraumatic stress disorder. J Psychiatr Res 2022; 156:451-459. [PMID: 36332360 PMCID: PMC9742331 DOI: 10.1016/j.jpsychires.2022.10.049] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 09/14/2022] [Accepted: 10/17/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Previous research has reported hyperresponsivity in the amygdala and hyporesponsivity in ventral portions of the medial prefrontal cortex to threat-related stimuli in posttraumatic stress disorder (PTSD). Whether such findings generalize to more ambiguous stimuli and whether such brain activation abnormalities reflect familial vulnerabilities, trauma-exposure, or acquired characteristics of PTSD remain unclear. In this study, we measured brain responses to emotionally ambiguous stimuli (i.e., surprised facial expressions) in identical twin pairs discordant for trauma exposure to elucidate the origin of brain activation abnormalities. METHODS Participants with PTSD (n = 12) and their trauma-unexposed identical cotwins (n = 12), as well as trauma-exposed participants without PTSD (n = 15) and their trauma-unexposed identical cotwins (n = 15), passively viewed surprised and neutral facial expressions during functional magnetic resonance imaging (fMRI). Afterward, participants labeled and rated each facial expression on valence and arousal. RESULTS Amygdala activation to Surprised and Neutral facial expressions (versus Fixation) was greater in the participants with PTSD and their trauma-unexposed identical cotwins without PTSD, compared to the control twin pairs. In contrast, medial frontal gyrus (MFG) activation to Surprised facial expressions (versus Fixation) was diminished in the PTSD group relative to the other three groups. CONCLUSIONS Amygdala hyperresponsivity to emotionally ambiguous facial expressions may be a familial vulnerability factor that increases the likelihood of developing PTSD after experiencing a traumatic event. In contrast, MFG hyporesponsivity may be an acquired characteristic of the disorder.
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Affiliation(s)
- Cecilia A Hinojosa
- Department of Psychology, Tufts University, Medford, MA, USA; Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA, USA
| | - Michael B VanElzakker
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA, USA
| | - Katherine C Hughes
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Reid Offringa
- Department of Psychology, Tufts University, Medford, MA, USA
| | - Lisa M Sangermano
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA, USA
| | - Isabella G Spaulding
- Section on Development and Affective Neuroscience, Emotion and Development Branch, National Institute of Mental Health, Bethesda, MD, USA
| | - Lindsay K Staples-Bradley
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA, USA
| | - Ethan T Whitman
- Department of Psychology & Neuroscience, Duke University, Durham, NC, USA
| | - Natasha B Lasko
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA, USA
| | - Scott L Rauch
- Department of Psychiatry, McLean Hospital, Belmont, MA, USA
| | - Scott P Orr
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA, USA
| | - Roger K Pitman
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA, USA
| | - Lisa M Shin
- Department of Psychology, Tufts University, Medford, MA, USA; Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA, USA.
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8
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Chan SJ, Thiel F, Kaimal AJ, Pitman RK, Orr SP, Dekel S. Validation of childbirth-related posttraumatic stress disorder using psychophysiological assessment. Am J Obstet Gynecol 2022; 227:656-659. [PMID: 35640702 PMCID: PMC9529868 DOI: 10.1016/j.ajog.2022.05.051] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [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: 03/17/2022] [Revised: 05/16/2022] [Accepted: 05/25/2022] [Indexed: 11/19/2022]
Abstract
Women with posttraumatic stress disorder (PTSD) related to traumatic childbirth show similarly elevated psychophysiological responses as individuals with PTSD related to other traumatic events.
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Affiliation(s)
- Sabrina J Chan
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA
| | - Freya Thiel
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA
| | - Anjali J Kaimal
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA; Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston, MA
| | - Roger K Pitman
- Department of Psychiatry, Massachusetts General Hospital, 120 2nd Ave., Boston, MA 02129; Department of Psychiatry, Harvard Medical School, Boston, MA
| | - Scott P Orr
- Department of Psychiatry, Massachusetts General Hospital, 120 2nd Ave., Boston, MA 02129; Department of Psychiatry, Harvard Medical School, Boston, MA
| | - Sharon Dekel
- Department of Psychiatry, Massachusetts General Hospital, 120 2nd Ave., Boston, MA 02129; Department of Psychiatry, Harvard Medical School, Boston, MA.
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9
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Gold AK, Kredlow MA, Orr SP, Hartley CA, Otto MW. Skin conductance levels and responses in Asian and White participants during fear conditioning ✰. Physiol Behav 2022; 251:113802. [PMID: 35398091 DOI: 10.1016/j.physbeh.2022.113802] [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: 02/02/2022] [Revised: 04/02/2022] [Accepted: 04/04/2022] [Indexed: 11/24/2022]
Abstract
Fear conditioning paradigms are frequently used in the translational study of anxiety and fear-related disorders. Accordingly, it is important to understand whether the measurement of fear conditioning responses is systematically influenced by an individual's race. Studies have found increased pain sensitivity and smaller physiological startle responses in Asian individuals, compared to White individuals; to our knowledge, no studies have evaluated whether skin conductance response (SCR) outcomes differ between Asian and White individuals. In a series of secondary data analyses, we investigated potential differences in skin conductance level (SCL), orienting SCR, unconditioned SCR, SCR to CS+ and CS-, differential SCR, and differential SCR non-responder status. In sample 1, Asian participants (n = 97) demonstrated a significantly smaller mean differential SCR compared to White participants (n = 86). No other between group differences were observed. In sample 2, there was no difference in mean differential SCR between Asian (n = 52) and White (n = 62) participants, although more Asian participants failed to show adequate skin conductance levels for study entry. To our knowledge, this is the first study to evaluate differences between Asian and White samples using skin conductance outcomes in a fear conditioning paradigm. We detected only subtle evidence for SCR differences between Asian and White samples, unlikely to reach significance outside large studies.
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Affiliation(s)
- Alexandra K Gold
- Department of Psychological and Brain Sciences, Boston University, 900 Commonwealth Avenue, 2nd Floor, Boston, MA 02215, United States of America.
| | - M Alexandra Kredlow
- Department of Psychology, Harvard University, 52 Oxford Street, Cambridge, MA 02138, United States of America
| | - Scott P Orr
- Department of Psychiatry, Massachusetts General Hospital, Building 120-2nd Avenue, Charlestown, MA 02129, United States of America; Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, United States of America
| | - Catherine A Hartley
- Department of Psychology, New York University, 6 Washington Place, New York, NY, 10003, United States of America
| | - Michael W Otto
- Department of Psychological and Brain Sciences, Boston University, 900 Commonwealth Avenue, 2nd Floor, Boston, MA 02215, United States of America
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10
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Sanders JJ, Caponigro E, Ericson JD, Dubey M, Duane JN, Orr SP, Pirl W, Tulsky JA, Blanch-Hartigan D. Virtual environments to study emotional responses to clinical communication: A scoping review. Patient Educ Couns 2021; 104:2922-2935. [PMID: 34020839 DOI: 10.1016/j.pec.2021.04.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 04/06/2021] [Accepted: 04/22/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE This scoping review explores the potential for virtual environments (VE) to evaluate emotional outcomes in clinical communication research. Authors representing multiple disciplines use review results to propose potential research opportunities and considerations. METHODS We utilized a structured framework for scoping reviews. We searched four literature databases for relevant articles. We applied multidisciplinary perspectives to synthesize relevant potential opportunities for emotion-focused communications research using VE. RESULTS Twenty-one articles met inclusion criteria. They applied different methodological approaches, including a range of VE technologies and diverse emotional outcome measures, such as psychophysiological arousal, emotional valence, or empathy. Major research topics included use of virtual reality to provoke and measure emotional responses, train clinicians in communication skills, and increase clinician empathy. CONCLUSION Researchers may leverage VE technologies to ethically and systematically examine how characteristics of clinical interactions, environments, and communication impact emotional reactions and responses among patients and clinicians. Variability exists in how VE technologies are employed and reported in published literature, and this may limit the internal and external validity of the research. However, virtual reality can provide a low-cost, low-risk, experimentally controlled, and ecologically valid approach for studying clinician-patient communication. PRACTICE IMPLICATIONS Future research should leverage psychophysiological measures to further examine emotional responses during clinical communication scenarios and clearly report virtual environment characteristics to support evaluation of study conclusions, study replicability, and meta-analyses.
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Affiliation(s)
- Justin J Sanders
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, 450 Brookline Avenue Boston, MA 02215, USA; Harvard Medical School, 25 Shattuck St, Boston, MA 02215, USA.
| | - Emma Caponigro
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, 450 Brookline Avenue Boston, MA 02215, USA; University of North Carolina Gillings School of Public Health, 135 Dauer Drive, Chapel Hill, NC 27599, USA.
| | - Jonathan D Ericson
- Department of Information Design & Corporate Communication, Bentley University, 175 Forest Street, Waltham, MA 02452, USA.
| | - Manisha Dubey
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, 450 Brookline Avenue Boston, MA 02215, USA; University of North Carolina Gillings School of Public Health, 135 Dauer Drive, Chapel Hill, NC 27599, USA.
| | - Ja-Nae Duane
- Department of Information and Process Management, Bentley University, 175 Forest Street, Waltham, MA 02452, USA.
| | - Scott P Orr
- Harvard Medical School, 25 Shattuck St, Boston, MA 02215, USA; Massachusetts General Hospital, 55 Fruit St, Boston, MA 02214, USA.
| | - William Pirl
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, 450 Brookline Avenue Boston, MA 02215, USA; Harvard Medical School, 25 Shattuck St, Boston, MA 02215, USA.
| | - James A Tulsky
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, 450 Brookline Avenue Boston, MA 02215, USA; Harvard Medical School, 25 Shattuck St, Boston, MA 02215, USA.
| | - Danielle Blanch-Hartigan
- Department of Natural and Applied Sciences, Bentley University, 175 Forest Street, Waltham, MA 02452, USA.
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11
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Cao J, Tu Y, Orr SP, Wilson G, Kong J. Modulatory Effects of Actual and Imagined Acupuncture on the Functional Connectivity of the Periaqueductal Gray and Ventral Tegmental Area. Psychosom Med 2021; 83:870-879. [PMID: 34292206 PMCID: PMC8490288 DOI: 10.1097/psy.0000000000000984] [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] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Both acupuncture and guided imagery hold promise for treating pain. The mechanisms underlying these alternative interventions remain unclear. The reported study aimed to comparatively investigate the modulation effect of actual and imagined acupuncture on the functional connectivity of descending pain modulation system and reward network. METHODS Twenty-four healthy participants (mean [standard error], 25.21 [0.77] years of age; 66.67% female) completed a crossover study that included five sessions, a training session and four intervention sessions administered in randomized order. We investigated the modulation effect of real acupuncture, sham acupuncture, video-guided acupuncture imagery treatment (VGAIT) and VGAIT control on the resting-state functional connectivity (rsFC) of periaqueductal gray (PAG) and ventral tegmental area (VTA). These are key regions of the descending pain modulatory system and dopaminergic reward system, respectively. RESULTS Compared with sham acupuncture, real acupuncture produced decreased PAG-precuneus (Pcu) rsFC and increased VTA-amygdala/hippocampus rsFC. Heat pain threshold changes applied on the contralateral forearm were significantly associated with the decreased PAG-Pcu (r = 0.49, p = .016) and increased VTA-hippocampus rsFC (r = -0.77, p < .001). Compared with VGAIT control, VGAIT produced decreased PAG-paracentral lobule/posterior cingulate cortex/Pcu, middle cingulate cortex (MCC), and medial prefrontal cortex rsFC, and decreased VTA-caudate and MCC rsFC. Direct comparison between real acupuncture and VGAIT showed that VGAIT decreased rsFC in PAG-paracentral lobule/MCC, VTA-caudate/anterior cingulate cortex/nucleus accumbens, and VTA-MCC. CONCLUSIONS Results suggest that both actual and imagined acupuncture can modulate key regions in the descending pain modulatory system and reward networks, but through different pathways. Identification of different pain relief mechanisms may facilitate the development of new pain management methods.
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Affiliation(s)
- Jin Cao
- Department of Psychiatry, Massachusetts General Hospital,
Harvard Medical School, Charlestown, MA, USA
| | - Yiheng Tu
- Department of Psychiatry, Massachusetts General Hospital,
Harvard Medical School, Charlestown, MA, USA
| | - Scott P. Orr
- Department of Psychiatry, Massachusetts General Hospital,
Harvard Medical School, Charlestown, MA, USA
| | - Georgia Wilson
- Department of Psychiatry, Massachusetts General Hospital,
Harvard Medical School, Charlestown, MA, USA
| | - Jian Kong
- Department of Psychiatry, Massachusetts General Hospital,
Harvard Medical School, Charlestown, MA, USA
- Martinos Brain Imaging Center, Massachusetts General
Hospital, Harvard Medical School, Charlestown, MA, USA
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12
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Jellestad L, Zeffiro T, Piccirelli M, Malamud J, Klimke BBM, Rauen K, Rufer M, Orr SP, Mueller-Pfeiffer C. Interfering with fear memories by eye movement desensitization and reprocessing. Int J Psychophysiol 2021; 166:9-18. [PMID: 33901511 DOI: 10.1016/j.ijpsycho.2021.04.006] [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: 10/06/2020] [Revised: 04/16/2021] [Accepted: 04/19/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Pharmacologic and behavioral interventions that block reconsolidation of reactivated fear memory have demonstrated only limited success in modifying stronger and long-standing fear memories. Given the efficacy of Eye Movement Desensitization and Reprocessing (EMDR) in treating PTSD, pursuit eye movements are a promising and novel intervention for studies of human memory reconsolidation. Here, we examined the efficacy of pursuit eye movements in interfering with reconsolidation of conditioned fear memories. METHODS We conducted a 3-day differential Pavlovian fear conditioning procedure in healthy adults, using videos of biologically prepared stimuli (tarantulas), partly reinforced with electrical shocks while recording skin conductance response (SCR) as a measure of autonomic conditioned responses. Fear conditioning was performed on Day 1. On Day 2, 38 participants were randomized into groups performing pursuit eye movements either immediately after fear memory reactivation, when the fear memory was stable, or 10 min later, when the fear memory was assumed to be more labile. On Day 3, fear memory strength was assessed by SCR to both reactivated and nonreactivated fear memories. RESULTS Strong differential conditioning to the spider stimuli were observed during both fear acquisition and fear memory reactivation. Reactivated fear memory conditioned responses of participants performing pursuit eye movements after a 10-min delay were significantly smaller in the reinstatement phase (0.16 μS; 95% CI [0.02, 0.31]). CONCLUSIONS Pursuit eye movements were effective in reducing fear-conditioned SCR in reinstatement. This result supports the theoretical proposition that EMDR can interfere with reactivated fear memory reconsolidation.
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Affiliation(s)
- Lena Jellestad
- Department of Consultation- Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Thomas Zeffiro
- Department of Consultation- Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland; Neurometrika, Potomac, MD, USA; University of Maryland School of Medicine, Baltimore, MD, USA
| | - Marco Piccirelli
- Department of Neuroradiology, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Jolanda Malamud
- Department of Consultation- Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Benedikt B M Klimke
- Department of Consultation- Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Katrin Rauen
- Department of Geriatric Psychiatry, Psychiatric Hospital Zurich & Institute for Regenerative Medicine, University of Zurich, Switzerland
| | - Michael Rufer
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
| | - Scott P Orr
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Christoph Mueller-Pfeiffer
- Department of Consultation- Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
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13
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14
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Sevinc G, Greenberg J, Hölzel BK, Gard T, Calahan T, Brunsch V, Hashmi JA, Vangel M, Orr SP, Milad MR, Lazar SW. Hippocampal circuits underlie improvements in self-reported anxiety following mindfulness training. Brain Behav 2020; 10:e01766. [PMID: 32700828 PMCID: PMC7507558 DOI: 10.1002/brb3.1766] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 04/28/2020] [Accepted: 07/04/2020] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Mindfulness meditation has successfully been applied to cultivate skills in self-regulation of emotion, as it employs the unbiased present moment awareness of experience. This heightened attention to and awareness of sensory experience has been postulated to create an optimal therapeutic exposure condition and thereby improve extinction learning. We recently demonstrated increased connectivity in hippocampal circuits during the contextual retrieval of extinction memory following mindfulness training. METHODS Here, we examine the role of structural changes in hippocampal subfields following mindfulness training in a randomized controlled longitudinal study using a two-day fear-conditioning and extinction protocol. RESULTS We demonstrate an association between mindfulness training-related increases in subiculum and decreased hippocampal connectivity to lateral occipital regions during contextual retrieval of extinguished fear. Further, we demonstrate an association between decreased connectivity and decreases in self-reported anxiety following mindfulness training. CONCLUSIONS The results highlight the role of the subiculum in gating interactions with contextual stimuli during memory retrieval and, also, the mechanisms through which mindfulness training may foster resilience.
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Affiliation(s)
- Gunes Sevinc
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Jonathan Greenberg
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Britta K Hölzel
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Department of Neuroradiology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Tim Gard
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Thomas Calahan
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Vincent Brunsch
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Javeria A Hashmi
- Department of Anesthesia, Pain Management & Perioperative Medicine, Dalhousie University, Halifax, NS, Canada
| | - Mark Vangel
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Scott P Orr
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Mohammed R Milad
- Psychiatry Department, New York University Grossman School of Medicine, New York, NY, USA
| | - Sara W Lazar
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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15
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Cao J, Tu Y, Wilson G, Orr SP, Kong J. Characterizing the analgesic effects of real and imagined acupuncture using functional and structure MRI. Neuroimage 2020; 221:117176. [PMID: 32682992 DOI: 10.1016/j.neuroimage.2020.117176] [Citation(s) in RCA: 12] [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] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 07/14/2020] [Indexed: 01/25/2023] Open
Abstract
Acupuncture and imagery interventions for pain management have a long history. The present study comparatively investigated whether acupuncture and video-guided acupuncture imagery treatment (VGAIT, watching a video of acupuncture on the participant's own body while imagining it being applied) could modulate brain regional connectivity to produce analgesic effects. The study also examined whether pre-intervention brain functional and structural features could be used to predict the magnitude of analgesic effects. Twenty-four healthy participants were recruited and received four different interventions (real acupuncture, sham acupuncture, VGAIT, and VGAIT control) in random order using a cross-over design. Pain thresholds and magnetic resonance imaging (MRI) data were collected before and after each intervention. We first compared the modulatory effects of real acupuncture and VGAIT on intra- and inter-regional intrinsic brain connectivity and found that real acupuncture decreased regional homogeneity (ReHo) and functional connectivity (FC) in sensorimotor areas, whereas VGAIT increased ReHo in basal ganglia (BG) (i.e., putamen) and FC between the BG subcortical network and default mode network. The altered ReHo and FC were associated with changes in pain threshold after real acupuncture and VGAIT, respectively. A multimodality fusion approach with pre-intervention ReHo and gray matter volume (GMV) as features was used to explore the brain profiles underlying individual variability of pain threshold changes by real acupuncture and VGAIT. Variability in acupuncture responses was associated with ReHo and GMV in BG, whereas VGAIT responses were associated with ReHo and GMV in the anterior insula. These results suggest that, through different pathways, both real acupuncture and VGAIT can modulate brain systems to produce analgesic effects.
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Affiliation(s)
- Jin Cao
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, United States
| | - Yiheng Tu
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, United States
| | - Georgia Wilson
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, United States
| | - Scott P Orr
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, United States
| | - Jian Kong
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, United States; Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, United States.
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16
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Pineles SL, Nillni YI, Pinna G, Webb A, Arditte Hall KA, Fonda JR, Irvine J, King MW, Hauger RL, Resick PA, Orr SP, Rasmusson AM. Associations between PTSD-Related extinction retention deficits in women and plasma steroids that modulate brain GABA A and NMDA receptor activity. Neurobiol Stress 2020; 13:100225. [PMID: 32490055 PMCID: PMC7256058 DOI: 10.1016/j.ynstr.2020.100225] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 04/14/2020] [Accepted: 04/25/2020] [Indexed: 12/25/2022] Open
Abstract
Several studies have demonstrated poor retention of extinction learning among individuals with posttraumatic stress disorder (PTSD). Gonadal hormone signaling in brain appears to influence the retention of extinction learning differently in women with and without PTSD. Women with PTSD, compared to trauma-exposed women without PTSD, show relative deficits in extinction retention during the mid-luteal phase (mLP) of the menstrual cycle, compared to the early follicular phase (eFP). A PTSD-related reduction in conversion of progesterone to its GABAergic metabolites allopregnanolone (Allo) and pregnanolone (PA) may contribute to these findings. The current study in trauma-exposed women with (n = 9) and without (n = 9) PTSD investigated associations between extinction retention and plasma Allo + PA levels, as well as the ratio of Allo + PA to 5α-dihydroprogesterone (5α-DHP), the immediate steroid precursor for Allo. The study also investigated the relationship between extinction retention and the ratio of Allo + PA to dehydroepiandrosterone (DHEA), an adrenally-derived GABAA receptor antagonist. Study participants completed differential fear-conditioning during both the eFP and mLP of the menstrual cycle. Analyses revealed a strong positive relationship between resting plasma Allo + PA levels and extinction retention during the mLP in the women with, but not without, PTSD (e.g., diagnosis X Allo + PA interaction controlling for early extinction: β = −.0008, p = .003). A similar pattern emerged for the Allo + PA to 5α-DHP ratio (β = -.165, p = .071), consistent with a PTSD-related block in production of Allo and PA at the enzyme 3α-hydroxysteroid dehydrogenase. The ratio of Allo + PA to DHEA appeared to influence extinction retention only during the eFP when Allo + PA and DHEA levels are comparable and thus may compete for effects on GABAA receptor function. This study aligns with male rodent PTSD models linking experimental reductions in brain Allo levels to deficits in extinction retention and suggests that targeting PTSD-related deficits in GABAergic neurosteroid synthesis may be therapeutic.
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Affiliation(s)
- Suzanne L Pineles
- National Center for PTSD Women's Health Sciences Division at VA Boston Healthcare System, Boston, MA, 02130, USA.,Department of Psychiatry, Boston University School of Medicine, Boston, MA, 02118, USA
| | - Yael I Nillni
- National Center for PTSD Women's Health Sciences Division at VA Boston Healthcare System, Boston, MA, 02130, USA.,Department of Psychiatry, Boston University School of Medicine, Boston, MA, 02118, USA
| | - Graziano Pinna
- The Psychiatric Institute, Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, 60612, USA
| | - Andrea Webb
- The Charles Stark Draper Laboratory, Inc., Cambridge, MA, 02139, USA
| | | | - Jennifer R Fonda
- Translational Research Center for TBI and Stress Disorders (TRACTS) and Geriatric Research, Education and Clinical Center (GRECC), VA Boston Healthcare System Boston, MA, 02130, USA.,Department of Epidemiology, Boston University School of Public Health, Boston, MA, 02118, USA
| | - John Irvine
- The MITRE Corporation, Bedford, MA, 01730, USA
| | - Matthew W King
- National Center for PTSD Women's Health Sciences Division at VA Boston Healthcare System, Boston, MA, 02130, USA.,Department of Psychiatry, Boston University School of Medicine, Boston, MA, 02118, USA
| | - Richard L Hauger
- Center of Excellence for Stress and Mental Health, San Diego VA Healthcare System, San Diego, CA, 9216, USA.,Department of Psychiatry, School of Medicine, University of California, San Diego, La Jolla, CA, 92093, USA
| | - Patricia A Resick
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, 27701, USA
| | - Scott P Orr
- Psychiatry Department, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA, 02129, USA
| | - Ann M Rasmusson
- National Center for PTSD Women's Health Sciences Division at VA Boston Healthcare System, Boston, MA, 02130, USA.,Department of Psychiatry, Boston University School of Medicine, Boston, MA, 02118, USA
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17
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Robinaugh DJ, Ward MJ, Toner ER, Brown ML, Losiewicz OM, Bui E, Orr SP. Assessing vulnerability to panic: a systematic review of psychological and physiological responses to biological challenges as prospective predictors of panic attacks and panic disorder. Gen Psychiatr 2020; 32:e100140. [PMID: 31922089 PMCID: PMC6936969 DOI: 10.1136/gpsych-2019-100140] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 11/08/2019] [Accepted: 11/17/2019] [Indexed: 12/04/2022] Open
Abstract
Background Cognitive–behavioural theories of panic disorder posit that panic attacks arise from a positive feedback loop between arousal-related bodily sensations and perceived threat. In a recently developed computational model formalising these theories of panic attacks, it was observed that the response to a simulated perturbation to arousal provided a strong indicator of vulnerability to panic attacks and panic disorder. In this review, we evaluate whether this observation is borne out in the empirical literature that has examined responses to biological challenge (eg, CO2 inhalation) and their relation to subsequent panic attacks and panic disorder. Method We searched PubMed, Web of Science and PsycINFO using keywords denoting provocation agents (eg, sodium lactate) and procedures (eg, infusion) combined with keywords relevant to panic disorder (eg, panic). Articles were eligible if they used response to a biological challenge paradigm to prospectively predict panic attacks or panic disorder. Results We identified four eligible studies. Pooled effect sizes suggest that there is biological challenge response has a moderate prospective association with subsequent panic attacks, but no prospective relationship with panic disorder. Conclusions These findings provide support for the prediction derived from cognitive–behavioural theories and some preliminary evidence that response to a biological challenge may have clinical utility as a marker of vulnerability to panic attacks pending further research and development. Trial registration number 135908.
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Affiliation(s)
- Donald J Robinaugh
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Meredith J Ward
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Emma R Toner
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Mackenzie L Brown
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Olivia M Losiewicz
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Eric Bui
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Scott P Orr
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
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18
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Tanev KS, Federico LE, Greenberg MS, Orr SP, Goetter EM, Resick PA, Pitman RK. Baseline Cognitive Performance and Treatment Outcomes From Cognitive-Behavioral Therapies for Posttraumatic Stress Disorder: A Naturalistic Study. J Neuropsychiatry Clin Neurosci 2020; 32:286-293. [PMID: 31948321 PMCID: PMC8887025 DOI: 10.1176/appi.neuropsych.19020032] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Approximately 5%-20% of U.S. troops returning from Iraq and Afghanistan have posttraumatic stress disorder (PTSD), and another 11%-23% have traumatic brain injury (TBI). Cognitive-behavioral therapies (CBTs) are empirically validated treatment strategies for PTSD. However, cognitive limitations may interfere with an individual's ability to adhere to as well as benefit from such therapies. Comorbid TBI has not been systematically taken into consideration in PTSD outcome research or in treatment planning guidance. The authors hypothesized that poorer pretreatment cognitive abilities would be associated with poorer treatment outcomes from CBTs for PTSD. METHODS This study was designed as a naturalistic examination of treatment as usual in an outpatient clinic that provides manualized CBTs for PTSD to military service members and veterans. Participants were 23 veterans, aged 18-50 years, with combat-related PTSD and a symptom duration of more than 1 year. Of these, 16 participants had mild TBI (mTBI). Predictor variables were well-normed objective tests of cognitive ability measured at baseline. Outcome variables were individual slopes of change of the PTSD Checklist for DSM-5 (PCL-5) and the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) over weeks of treatment, and of pretreatment-to-posttreatment change in PCL-5 and CAPS-5 (ΔPCL-5 and ΔCAPS-5, respectively). RESULTS Contrary to prediction, neither pretreatment cognitive performance nor the presence of comorbid mTBI predicted poorer response to CBTs for PTSD. CONCLUSIONS These results discourage any notion of excluding patients with PTSD and poorer cognitive ability from CBTs.
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Affiliation(s)
- Kaloyan S. Tanev
- Home Base, a Red Sox Foundation and Massachusetts General Hospital Program, Boston,Department of Psychiatry, Massachusetts General Hospital, Boston
| | - Lydia E. Federico
- Home Base, a Red Sox Foundation and Massachusetts General Hospital Program, Boston,Department of Psychiatry, Massachusetts General Hospital, Boston
| | | | - Scott P. Orr
- Department of Psychiatry, Massachusetts General Hospital, Boston
| | - Elizabeth M. Goetter
- Home Base, a Red Sox Foundation and Massachusetts General Hospital Program, Boston,Department of Psychiatry, Massachusetts General Hospital, Boston
| | - Patricia A. Resick
- Department of Psychiatry and Behavioral Sciences, Duke University Medical School, Durham, N.C
| | - Roger K. Pitman
- Department of Psychiatry, Massachusetts General Hospital, Boston
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19
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Sevinc G, Hölzel BK, Greenberg J, Gard T, Brunsch V, Hashmi JA, Vangel M, Orr SP, Milad MR, Lazar SW. Strengthened Hippocampal Circuits Underlie Enhanced Retrieval of Extinguished Fear Memories Following Mindfulness Training. Biol Psychiatry 2019; 86:693-702. [PMID: 31303261 PMCID: PMC6788973 DOI: 10.1016/j.biopsych.2019.05.017] [Citation(s) in RCA: 24] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 05/15/2019] [Accepted: 05/16/2019] [Indexed: 01/23/2023]
Abstract
BACKGROUND The role of hippocampus in context-dependent recall of extinction is well recognized. However, little is known about how intervention-induced changes in hippocampal networks relate to improvements in extinction learning. In this study, we hypothesized that mindfulness training creates an optimal exposure condition by heightening attention and awareness of present moment sensory experience, leading to enhanced extinction learning, improved emotion regulation, and reduced anxiety symptoms. METHODS We tested this hypothesis in a randomized controlled longitudinal study design using a 2-day fear conditioning and extinction protocol. The mindfulness training group included 42 participants (28 women) and the control group included 25 participants (15 women). RESULTS We show that mindfulness training is associated with differential engagement of the right supramarginal gyrus as well as hippocampal-cortical reorganization. We also report enhanced hippocampal connectivity to the primary sensory cortex during retrieval of extinguished stimuli following mindfulness training. CONCLUSIONS These findings suggest hippocampal-dependent changes in contextual retrieval as one plausible neural mechanism through which mindfulness-based interventions enhance fear extinction and foster stress resilience.
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Affiliation(s)
- Gunes Sevinc
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
| | - Britta K. Hölzel
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA,Department of Neuroradiology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Jonathan Greenberg
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Tim Gard
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Vincent Brunsch
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Javaria A. Hashmi
- Department of Anesthesia, Pain Management & Perioperative Medicine, Dalhousie University, Dalhousie University, Canada
| | - Mark Vangel
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Scott P. Orr
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Sara W. Lazar
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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20
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Cao J, Tu Y, Orr SP, Lang C, Park J, Vangel M, Chen L, Gollub R, Kong J. Analgesic Effects Evoked by Real and Imagined Acupuncture: A Neuroimaging Study. Cereb Cortex 2019; 29:3220-3231. [PMID: 30137262 PMCID: PMC7302519 DOI: 10.1093/cercor/bhy190] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [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: 02/02/2018] [Revised: 07/08/2018] [Accepted: 07/19/2018] [Indexed: 12/20/2022] Open
Abstract
Acupuncture can provide therapeutic analgesic benefits but is limited by its cost and scheduling difficulties. Guided imagery is a commonly used method for treating many disorders, such as chronic pain. The present study examined a novel intervention for pain relief that integrates acupuncture with imagery called video-guided acupuncture imagery treatment (VGAIT). A total of 27 healthy subjects were recruited for a crossover-design study that included 5 sessions administered in a randomized order (i.e., baseline and 4 different interventions). We investigated changes in pain threshold and fMRI signals modulated by: 1) VGAIT, watching a video of acupuncture previously administered on the participant's own body at baseline while imagining it being concurrently applied; 2) a VGAIT control condition, watching a video of a cotton swab touching the skin; 3) real acupuncture; and 4) sham acupuncture. Results demonstrated that real acupuncture and VGAIT significantly increased pain threshold compared with respective control groups. Imaging showed that real acupuncture produced greater activation of the insula compared with VGAIT. VGAIT produced greater deactivation at the rostral anterior cingulate cortex. Our findings demonstrate that VGAIT holds potential clinical value for pain management.
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Affiliation(s)
- Jin Cao
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA
- School of Acupuncture Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Yiheng Tu
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA
| | - Scott P Orr
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA
| | - Courtney Lang
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA
| | - Joel Park
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA
| | - Mark Vangel
- Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA
| | - Lucy Chen
- Department of Anesthesia, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA
| | - Randy Gollub
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA
- Martinos Brain Imaging Center, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA
| | - Jian Kong
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA
- Martinos Brain Imaging Center, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA
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21
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Geller DA, McGuire JF, Orr SP, Small BJ, Murphy TK, Trainor K, Porth R, Wilhelm S, Storch EA. Fear extinction learning as a predictor of response to cognitive behavioral therapy for pediatric obsessive compulsive disorder. J Anxiety Disord 2019; 64:1-8. [PMID: 30852257 PMCID: PMC7422704 DOI: 10.1016/j.janxdis.2019.02.005] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [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: 06/22/2018] [Revised: 01/22/2019] [Accepted: 02/26/2019] [Indexed: 01/18/2023]
Abstract
BACKGROUND While cognitive behavior therapy (CBT) is an effective treatment for many children and adolescents with Obsessive Compulsive Disorder (OCD), therapeutic response is variable. Fear conditioning and extinction are central constructs underlying exposure-based CBT. Fear extinction learning assessed prior to CBT may be a useful predictor of CBT response for guiding treatment decisions. METHODS Sixty-four youth who participated in a randomized placebo-controlled trial of CBT with and without d-cycloserine (DCS) completed a fear conditioning task. Skin conductance response (SCR) scores were used to measure fear acquisition and extinction to determine whether extinction learning could predict CBT response. RESULTS CBT responders and non-responders appeared to acquire conditioned fear SCRs in a similar manner. However, differences between treatment responders and non-responders emerged during the extinction phase. A responder (responder, non-responder) by conditioned stimulus type (CS+, CS-) interaction showed that CBT responders differentiated the stimulus paired with (CS+) and without (CS-) the unconditioned stimulus correctly during early and late extinction, whereas the CBT non-responders did not (p = .004). CONCLUSIONS While the small sample size makes conclusions tentative, this study supports an emerging literature that differential fear extinction may be an important factor underlying clinical correlates of pediatric OCD, including CBT response.
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Affiliation(s)
- Daniel A. Geller
- Massachusetts General Hospital, 185 Cambridge Street, Suite 2000, Boston, MA 02114,Harvard University Medical School, Boston, MA
| | - Joseph F. McGuire
- Division of Child and Adolescent Psychiatry, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Scott P. Orr
- Massachusetts General Hospital, 185 Cambridge Street, Suite 2000, Boston, MA 02114,Harvard University Medical School, Boston, MA
| | - Brent J. Small
- School of Aging Studies, University of South Florida, 13301 Bruce B Downs Blvd, Tampa FL 33620
| | - Tanya K. Murphy
- Department of Pediatrics, University of South Florida; Rothman Center for Neuropsychiatry,Department of Psychiatry & Behavioral Neurosciences, University of South Florida
| | - Kathleen Trainor
- Massachusetts General Hospital, 185 Cambridge Street, Suite 2000, Boston, MA, 02114, United States.
| | - Rachel Porth
- Massachusetts General Hospital, 185 Cambridge Street, Suite 2000, Boston, MA, 02114, United States.
| | - Sabine Wilhelm
- Massachusetts General Hospital, 185 Cambridge Street, Suite 2000, Boston, MA, 02114, United States; Harvard University Medical School, Boston, MA, United States.
| | - Eric A. Storch
- Menninger Department of Psychiatry & Behavioral Sciences, Baylor College of Medicine, 1977 Butler Blvd, Suite 400, Houston 77030 TX
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22
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Marin M, Barbey F, Rosenbaum BL, Hammoud MZ, Orr SP, Milad MR. Absence of conditioned responding in humans: A bad measure or individual differences? Psychophysiology 2019; 57:e13350. [DOI: 10.1111/psyp.13350] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 11/13/2018] [Accepted: 01/21/2019] [Indexed: 01/06/2023]
Affiliation(s)
- Marie‐France Marin
- Department of Psychology Université du Québec à Montréal, Research Center of the Montreal Mental Health University Institute Montreal Quebec
| | | | | | - Mira Z. Hammoud
- Department of Psychiatry University of Illinois at Chicago Chicago Illinois
| | - Scott P. Orr
- Department of Psychiatry Massachusetts General Hospital, Harvard Medical School Boston Massachusetts
| | - Mohammed R. Milad
- Department of Psychiatry University of Illinois at Chicago Chicago Illinois
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23
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Pineles SL, Nillni YI, Pinna G, Irvine J, Webb A, Arditte Hall KA, Hauger R, Miller MW, Resick PA, Orr SP, Rasmusson AM. PTSD in women is associated with a block in conversion of progesterone to the GABAergic neurosteroids allopregnanolone and pregnanolone measured in plasma. Psychoneuroendocrinology 2018; 93:133-141. [PMID: 29727810 DOI: 10.1016/j.psyneuen.2018.04.024] [Citation(s) in RCA: 80] [Impact Index Per Article: 13.3] [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: 11/13/2017] [Revised: 03/28/2018] [Accepted: 04/23/2018] [Indexed: 12/29/2022]
Abstract
There is a need to identify new and more effective treatments for posttraumatic stress disorder (PTSD). Allopregnanolone and its stereoisomer pregnanolone (together termed ALLO) are metabolites of progesterone that positively and allosterically modulate GABA effects at GABAA receptors, thereby reducing anxiety and depression. Previous research revealed that women with PTSD had low cerebrospinal fluid (CSF) ALLO levels and a low ratio of ALLO to the allopregnanolone precursor 5α-DHP, consistent with deficient activity of the ALLO synthetic enzyme 3α-hydroxysteroid dehydrogenase (3α-HSD). The current study examined ALLO and the ratio of ALLO to 5α-DHP in plasma at rest and in response to psychophysiological stressors in trauma-exposed, medication-free women with and without PTSD. Participants were examined twice in random order during the early follicular phase (eFP) and mid-luteal phase (mLP) of the menstrual cycle. Plasma neurosteroids were measured using gas chromatography-mass spectrometry. Results indicate that the ALLO to 5α-DHP ratio in plasma increases between the eFP and mLP. In addition, women with PTSD have a lower ratio of ALLO to 5α-DHP than trauma-exposed healthy women, as well as blunted increases in this ratio in response to a moderately stressful laboratory procedure, i.e., differential fear conditioning, across the menstrual cycle. Clinically feasible testing for 3α-HSD dysfunction is critical to translating this line of research into clinical care. Measurement of this ratio in plasma could facilitate patient stratification in clinical treatment trials, as well as precision medicine targeting of treatments that address ALLO synthesis deficits in women with PTSD.
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Affiliation(s)
- S L Pineles
- National Center for PTSD, VA Boston Healthcare System, Boston, MA, 02130, USA; Department of Psychiatry, Boston University School of Medicine, Boston, MA, 02118, USA.
| | - Y I Nillni
- National Center for PTSD, VA Boston Healthcare System, Boston, MA, 02130, USA; Department of Psychiatry, Boston University School of Medicine, Boston, MA, 02118, USA
| | - G Pinna
- The Psychiatric Institute, Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, 60612, USA
| | - J Irvine
- The Charles Stark Draper Laboratory, Inc., Cambridge, MA, 02139, USA
| | - A Webb
- The Charles Stark Draper Laboratory, Inc., Cambridge, MA, 02139, USA
| | - K A Arditte Hall
- National Center for PTSD, VA Boston Healthcare System, Boston, MA, 02130, USA; Department of Psychiatry, Boston University School of Medicine, Boston, MA, 02118, USA
| | - R Hauger
- Center of Excellence for Stress and Mental Health, San Diego VA Healthcare System, San Diego, CA, 9216, USA; Department of Psychiatry, University of California, San Diego, La Jolla, CA, 92093, USA
| | - M W Miller
- National Center for PTSD, VA Boston Healthcare System, Boston, MA, 02130, USA; Department of Psychiatry, Boston University School of Medicine, Boston, MA, 02118, USA
| | - P A Resick
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, 27701, USA
| | - S P Orr
- Psychiatry Department, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA, 02129, USA
| | - A M Rasmusson
- National Center for PTSD, VA Boston Healthcare System, Boston, MA, 02130, USA; Department of Psychiatry, Boston University School of Medicine, Boston, MA, 02118, USA
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24
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Kredlow MA, Orr SP, Otto MW. Exploring the boundaries of post-retrieval extinction in healthy and anxious individuals. Behav Res Ther 2018; 108:45-57. [PMID: 29981938 DOI: 10.1016/j.brat.2018.06.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [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: 01/19/2018] [Revised: 06/14/2018] [Accepted: 06/25/2018] [Indexed: 01/07/2023]
Abstract
Over a dozen studies have examined the efficacy of post-retrieval extinction (PRE) in healthy adults in the fear conditioning laboratory, with a recent meta-analysis reporting an overall small-moderate effect on attenuating the return of fear compared to standard extinction. The current study was designed to extend PRE effects to a mixed sample of healthy and anxious individuals, explore potential moderators, and examine the benefit of PRE for a memory conditioned over multiple days. Healthy (n = 49) and anxious (n = 43) adults received either one day of acquisition followed by PRE, one day of acquisition followed by extinction, or three days of acquisition followed by PRE. Comparing participants who received one day of acquisition followed by PRE or extinction, no significant effect of PRE was observed on differential skin conductance response reinstatement or reactivity to the conditioned stimulus alone. Anxiety symptoms did not moderate outcomes. There was no difference in return of fear for anxious participants who received three days of acquisition followed by PRE versus one day of acquisition followed by PRE. These results further highlight the variability of findings in the PRE literature and need for further examination of individual difference factors that may moderate PRE effects.
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Affiliation(s)
- M Alexandra Kredlow
- Department of Psychological & Brain Sciences, Boston University, 648 Beacon Street, 5th Floor, Boston, MA 02215, United States.
| | - Scott P Orr
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, East Building 120 -2nd Avenue, Charlestown, MA 02129, United States.
| | - Michael W Otto
- Department of Psychological & Brain Sciences, Boston University, 648 Beacon Street, 5th Floor, Boston, MA 02215, United States.
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25
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Dahlgren MK, Laifer LM, VanElzakker MB, Offringa R, Hughes KC, Staples-Bradley LK, Dubois SJ, Lasko NB, Hinojosa CA, Orr SP, Pitman RK, Shin LM. Diminished medial prefrontal cortex activation during the recollection of stressful events is an acquired characteristic of PTSD. Psychol Med 2018; 48:1128-1138. [PMID: 28893331 PMCID: PMC5847462 DOI: 10.1017/s003329171700263x] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [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] [Indexed: 11/05/2022]
Abstract
BACKGROUND Previous research has shown relatively diminished medial prefrontal cortex activation and heightened psychophysiological responses during the recollection of personal events in post-traumatic stress disorder (PTSD), but the origin of these abnormalities is unknown. Twin studies provide the opportunity to determine whether such abnormalities reflect familial vulnerabilities, result from trauma exposure, or are acquired characteristics of PTSD. METHODS In this case-control twin study, 26 male identical twin pairs (12 PTSD; 14 non-PTSD) discordant for PTSD and combat exposure recalled and imagined trauma-unrelated stressful and neutral life events using a standard script-driven imagery paradigm during functional magnetic resonance imaging and concurrent skin conductance measurement. RESULTS Diminished activation in the medial prefrontal cortex during Stressful v. Neutral script-driven imagery was observed in the individuals with PTSD, relative to other groups. CONCLUSIONS Diminished medial prefrontal cortex activation during Stressful v. Neutral script-driven imagery may be an acquired characteristic of PTSD. If replicated, this finding could be used prospectively to inform diagnosis and the assessment of treatment response.
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Affiliation(s)
- M. Kathryn Dahlgren
- Department of Psychology, Tufts University, Medford, MA
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | | | - Michael B. VanElzakker
- Department of Psychology, Tufts University, Medford, MA
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Reid Offringa
- Department of Psychology, Tufts University, Medford, MA
| | - Katherine C. Hughes
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA
| | | | | | - Natasha B. Lasko
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Cecilia A. Hinojosa
- Department of Psychology, Tufts University, Medford, MA
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Scott P. Orr
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Roger K. Pitman
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Lisa M. Shin
- Department of Psychology, Tufts University, Medford, MA
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA
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26
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Moore KN, Seo J, Gazecki S, Kim S, Lasko NB, Orr SP, Pace-Schott EF. 0945 Sleep Architecture Predicts Hyperarousal Among Trauma-exposed Women. Sleep 2018. [DOI: 10.1093/sleep/zsy061.944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- K N Moore
- MGH/HST Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA
| | - J Seo
- MGH/HST Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA
| | - S Gazecki
- MGH/HST Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA
| | - S Kim
- MGH/HST Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA
| | - N B Lasko
- MGH/HST Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA
| | - S P Orr
- MGH/HST Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA
| | - E F Pace-Schott
- MGH/HST Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA
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27
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Tuerk PW, Wangelin BC, Powers MB, Smits JAJ, Acierno R, Myers US, Orr SP, Foa EB, Hamner MB. Augmenting treatment efficiency in exposure therapy for PTSD: a randomized double-blind placebo-controlled trial of yohimbine HCl. Cogn Behav Ther 2018; 47:351-371. [DOI: 10.1080/16506073.2018.1432679] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Peter W. Tuerk
- Ralph H. Johnson VA Medical Center, Charleston, SC, USA
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Bethany C. Wangelin
- Ralph H. Johnson VA Medical Center, Charleston, SC, USA
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Mark B. Powers
- Department of Psychology, University of Texas at Austin, Austin, TX, USA
| | - Jasper A. J. Smits
- Department of Psychology, University of Texas at Austin, Austin, TX, USA
| | - Ron Acierno
- Ralph H. Johnson VA Medical Center, Charleston, SC, USA
- College of Nursing, Medical University of South Carolina, Charleston, SC, USA
| | | | - Scott P. Orr
- Department of Psychiatry Service, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA, USA
| | - Edna B. Foa
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
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28
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Alexandra Kredlow M, Pineles SL, Inslicht SS, Marin MF, Milad MR, Otto MW, Orr SP. Assessment of skin conductance in African American and Non-African American participants in studies of conditioned fear. Psychophysiology 2017; 54:1741-1754. [PMID: 28675471 DOI: 10.1111/psyp.12909] [Citation(s) in RCA: 39] [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] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 05/22/2017] [Accepted: 05/23/2017] [Indexed: 11/30/2022]
Abstract
Skin conductance (SC) is a psychophysiological measure of sympathetic nervous system activity that is commonly used in research to assess conditioned fear responses. A portion of individuals evidence very low or unmeasurable SC levels (SCL) and/or response (SCR) during fear conditioning, which precludes the use of their SC data. The reason that some individuals do not produce measurable SCL and/or SCR is not clear; some early research suggested that race may be an influencing factor. In the current article, archival data from five fear conditioning samples collected from four different laboratories were examined to explore SCL and SCR magnitude in African American (AA) and non-African American (non-AA) participants. Across studies, the aggregate group difference for exclusion due to unmeasurable SCL or no measurable SCR to an unconditioned stimulus reflected a significant medium effect size (d = 0.54). Furthermore, 24.3% (range: 0-48.3%) of AA participants met SC exclusion criteria versus 14.3% (range: 4.3-24.2%) of non-AA participants. AA participants also displayed significantly lower SCL during habituation (d = 0.58). The low SC levels and responses in AA individuals and the consequent exclusion of their contributions to fear conditioning study results impacts the generalizability of findings across races. Given higher rates of posttraumatic stress disorder (PTSD) and chronic anxiety in AA individuals, it is important that AA individuals not be excluded from fear conditioning research, which informs the treatment of anxiety and PTSD. Examination of the basis of very low SCL and/or SCR is a potentially informative direction for future research.
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Affiliation(s)
| | - Suzanne L Pineles
- National Center for PTSD, Women's Health Sciences Division at VA Boston Healthcare System, Boston, Massachusetts.,Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts
| | - Sabra S Inslicht
- San Francisco VA Medical Center, San Francisco, California.,Department of Psychiatry, University of California, San Francisco, San Francisco, California
| | - Marie-France Marin
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Mohammed R Milad
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Michael W Otto
- Psychological and Brain Sciences, Boston University, Boston, Massachusetts
| | - Scott P Orr
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
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29
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Kim S, Bottary RM, Orr SP, Hofmann SG, Simon NM, Pace-Schott EF. 1120 EFFECTS OF POST-EXPOSURE NAPS ON CHANGE IN AUTONOMIC AROUSAL TO A SOCIAL CHALLENGE ACROSS EXPOSURE THERAPY FOR SOCIAL ANXIETY. Sleep 2017. [DOI: 10.1093/sleepj/zsx050.1119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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30
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Roth BR, Bottary RM, Orr SP, Lasko NB, Goetter EM, Baker AW, Bianchi MT, Hofmann SG, Simon NM, Pace-Schott EF. 1119 ASSOCIATIONS OF NEO-PI-R PERSONALITY DOMAINS WITH SLEEP QUALITY, CHRONOTYPE, AND OUTCOMES IN EXPOSURE THERAPY FOR SOCIAL ANXIETY DISORDER. Sleep 2017. [DOI: 10.1093/sleepj/zsx050.1118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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31
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Geller DA, McGuire JF, Orr SP, Pine DS, Britton JC, Small BJ, Murphy TK, Wilhelm S, Storch EA. Fear conditioning and extinction in pediatric obsessive-compulsive disorder. Ann Clin Psychiatry 2017; 29:17-26. [PMID: 28207912 PMCID: PMC5964984] [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] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
BACKGROUND Fear acquisition and extinction are central constructs in the cognitive-behavioral model of obsessive-compulsive disorder (OCD), which underlies exposure-based cognitive-behavioral therapy. Youths with OCD may have impairments in fear acquisition and extinction that carry treatment implications. METHODS Eighty youths (39 OCD, 41 healthy controls [HC]) completed clinical interviews, rating scales, and a differential conditioning task that included habituation, acquisition, and extinction phases. Skin conductance response (SCR) served as the primary dependent measure. RESULTS During habituation, participants with OCD exhibited a stronger orienting SCR to initial stimuli relative to HC participants. During acquisition, differential fear conditioning was observed for both groups as evidenced by larger SCRs to the visual conditioned stimulus paired with an aversive unconditioned stimulus (CS+) compared with a CS-; OCD participants exhibited a larger SCR to the CS+ relative to HC participants. The absolute magnitude of the unconditioned fear response was significantly larger in participants with OCD, compared with HC participants. During extinction, OCD participants continued to exhibit a differential SCR to the CS+ and CS-, whereas HC participants exhibited diminished SCR to both stimuli. CONCLUSIONS Participants with OCD exhibit a different pattern of fear extinction relative to HC participants, suggestive of greater fear acquisition and impaired inhibitory learning.
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Affiliation(s)
- Daniel A Geller
- General Hospital Harvard University Medical School, Boston, MA, USA. E-mail:
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32
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Etier BE, Orr SP, Antonetti J, Thomas SB, Theiss SM. Factors impacting Press Ganey patient satisfaction scores in orthopedic surgery spine clinic. Spine J 2016; 16:1285-1289. [PMID: 27084192 DOI: 10.1016/j.spinee.2016.04.007] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [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: 12/01/2015] [Revised: 03/15/2016] [Accepted: 04/07/2016] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Patient satisfaction is and will continue to become an important metric in the American health care system. To our knowledge, there is no current literature exploring the factors that impact patient satisfaction in outpatient orthopedic spine surgery clinic. PURPOSE The purpose of this study was to determine which factors impact patient satisfaction in an outpatient orthopedic spine clinic. STUDY DESIGN This is a case series, level of evidence IV. PATIENT SAMPLE We reviewed the Press Ganey Associates database to identify patients seen in an orthopedic spine surgery clinic from 2013 to 2015. OUTCOME MEASURES Outcome measures were self-reported, which included visual analog pain scores and Press Ganey satisfaction scores. METHODS Retrospective computerized Press Ganey survey review was performed to identify patient demographics and patient visit characteristics. Bivariate analysis was used by splitting the patient response into the following: 0-3 (not satisfied), 4-7 (somewhat satisfied), and 8-11 (satisfied). Kruskal-Wallis test and Fisher exact test were used to evaluate the significance of patient and visit characteristics. Any variable that had a p-value less than .20 was subjected to the Poisson regression model. RESULTS Overall, 353 patients were seen in an orthopedic spine surgery clinic and completed the Press Ganey survey. Three hundred and thirty-two patients were satisfied with their visit. Patients who were satisfied had a mean pain score of 4.02; patients who were somewhat satisfied or not satisfied had a pain score of 7 and 6, respectively (p=.009). Of 21 patients who felt the provider did not spend enough time with him or her, five (24%) patients were not satisfied with their visit. Poisson regression model confirmed significance of pain score and "provider time spent with you." Most impactful was "provider spent enough time with you" where a "yes, definitely" answer predicted a nearly 60% increase in Press Ganey overall satisfaction score. CONCLUSIONS Two patient variables that have a statistical significance on Press Ganey patient satisfaction scores were pain score and "provider spent enough time with you."
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Affiliation(s)
- Brian E Etier
- University of Alabama at Birmingham, 1313 13th St South, Birmingham, AL 35205, USA.
| | - Scott P Orr
- University of Alabama at Birmingham, 1313 13th St South, Birmingham, AL 35205, USA
| | - Jonathan Antonetti
- University of Alabama at Birmingham, 1313 13th St South, Birmingham, AL 35205, USA
| | - Scott B Thomas
- University of Alabama at Birmingham, 1313 13th St South, Birmingham, AL 35205, USA
| | - Steven M Theiss
- University of Alabama at Birmingham, 1960 6th Ave South, Faculty Office Tower 960, Birmingham, AL 35233, USA
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33
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McGuire JF, Orr SP, Essoe JKY, McCracken JT, Storch EA, Piacentini J. Extinction learning in childhood anxiety disorders, obsessive compulsive disorder and post-traumatic stress disorder: implications for treatment. Expert Rev Neurother 2016; 16:1155-74. [PMID: 27275519 PMCID: PMC5967402 DOI: 10.1080/14737175.2016.1199276] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [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] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Threat conditioning and extinction play an important role in anxiety disorders, obsessive compulsive disorder (OCD), and post-traumatic stress disorder (PTSD). Although these conditions commonly affect children, threat conditioning and extinction have been primarily studied in adults. However, differences in phenomenology and neural architecture prohibit the generalization of adult findings to youth. AREAS COVERED A comprehensive literature search using PubMed and PsycInfo was conducted to identify studies that have used differential conditioning tasks to examine threat acquisition and extinction in youth. The information obtained from this review helps to clarify the influence of these processes on the etiology and treatment of youth with OCD, PTSD and other anxiety disorders. Thirty studies of threat conditioning and extinction were identified Expert commentary: Youth with anxiety disorders, OCD, and PTSD have largely comparable threat acquisition relative to unaffected controls, with some distinctions noted for youth with PTSD or youth who have suffered maltreatment. However, impaired extinction was consistently observed across youth with these disorders and appears to be consistent with deficiencies in inhibitory learning. Incorporating strategies to improve inhibitory learning may improve extinction learning within extinction-based treatments like cognitive behavioral therapy (CBT). Strategies to improve inhibitory learning in CBT are discussed.
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Affiliation(s)
- Joseph F. McGuire
- Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles
| | - Scott P. Orr
- Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | | | - James T. McCracken
- Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles
| | - Eric A. Storch
- Department of Pediatrics, University of South Florida
- Departments of Psychiatry and Behavioral Neurosciences, University of South Florida
- Department of Health Policy and Management, University of South Florida
- Rogers Behavioral Health – Tampa Bay
- All Children's Hospital, Johns Hopkins Medicine, St. Petersburg, FL
| | - John Piacentini
- Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles
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Familoni BO, Gregor KL, Dodson TS, Krzywicki AT, Lowery BN, Orr SP, Suvak MK, Rasmusson AM. Sweat pore reactivity as a surrogate measure of sympathetic nervous system activity in trauma-exposed individuals with and without posttraumatic stress disorder. Psychophysiology 2016; 53:1417-28. [PMID: 27286885 PMCID: PMC9164169 DOI: 10.1111/psyp.12681] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [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: 10/14/2015] [Accepted: 04/27/2016] [Indexed: 11/30/2022]
Abstract
Stress analysis by FLIR (forward-looking infrared) evaluation (SAFE) has been demonstrated to monitor sweat pore activation (SPA) as a novel surrogate measure of sympathetic nervous system (SNS) activity in a normal population. SNS responses to a series of 15 1-s, 82 dB, white noise bursts were measured by skin conductance (SC) and SAFE monitoring of SPA on the fingers (FiP) and face (FaP) in 10 participants with posttraumatic stress disorder (PTSD) and 16 trauma-exposed participants without PTSD (Mage = 48.92 ± 12.00 years; 26.9% female). Within participants, SC and FiP responses across trials were strongly correlated (r = .92, p < .001). Correlations between SC and FaP (r = .76, p = .001) and between FiP and FaP (r = .47, p = .005) were smaller. The habituation of SNS responses across the 15 trials was substantial (SC: d = -2.97; FiP: d = -2.34; FaP: d = -1.02). There was a strong correlation between habituation effects for SC and FiP (r = .76, p < .001), but not for SC and FaP (r = .15, p = .45) or FiP and FaP (r = .29, p = .16). Participants with PTSD showed larger SNS responses to the first loud noise than those without PTSD. PTSD reexperiencing symptoms assessed by the PTSD Checklist on the day of testing were associated with the SNS responses to the first loud noise measured by SC (d = 1.19) and FiP (d = .99), but not FaP (d = .10). This study confirms convergence of SAFE and SC as valid measures of SNS activity. SAFE FiP and SC responses were highly predictive of self-rated PTSD reexperiencing symptoms. SAFE may offer an attractive alternative for applications in PTSD and similar populations.
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Affiliation(s)
- Babajide O Familoni
- Division of Modeling and Simulation, U.S. Army RDECOM CERDEC Night Vision & Electronic Sensors Directorate, Fort Belvoir, Virginia, USA
| | - Kristin L Gregor
- VA Boston Healthcare System, National Center for PTSD, Women's Health Science Division, Boston, Massachusetts, USA
- Boston University School of Medicine, Boston, Massachusetts, USA
| | - Thomas S Dodson
- VA Boston Healthcare System, National Center for PTSD, Women's Health Science Division, Boston, Massachusetts, USA
| | - Alan T Krzywicki
- Division of Modeling and Simulation, U.S. Army RDECOM CERDEC Night Vision & Electronic Sensors Directorate, Fort Belvoir, Virginia, USA
| | | | - Scott P Orr
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Michael K Suvak
- Department of Psychology, Suffolk University, Boston, Massachusetts, USA
| | - Ann M Rasmusson
- VA Boston Healthcare System, National Center for PTSD, Women's Health Science Division, Boston, Massachusetts, USA
- Boston University School of Medicine, Boston, Massachusetts, USA
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Koch J, Flemming J, Zeffiro T, Rufer M, Orr SP, Mueller-Pfeiffer C. Effects of Posture and Stimulus Spectral Composition on Peripheral Physiological Responses to Loud Sounds. PLoS One 2016; 11:e0161237. [PMID: 27583659 PMCID: PMC5008836 DOI: 10.1371/journal.pone.0161237] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 06/25/2016] [Indexed: 11/19/2022] Open
Abstract
In the "loud-tone" procedure, a series of brief, loud, pure-tone stimuli are presented in a task-free situation. It is an established paradigm for measuring autonomic sensitization in posttraumatic stress disorder (PTSD). Successful use of this procedure during fMRI requires elicitation of brain responses that have sufficient signal-noise ratios when recorded in a supine, rather than sitting, position. We investigated the modulating effects of posture and stimulus spectral composition on peripheral psychophysiological responses to loud sounds. Healthy subjects (N = 24) weekly engaged in a loud-tone-like procedure that presented 500 msec, 95 dB sound pressure level, pure-tone or white-noise stimuli, either while sitting or supine and while peripheral physiological responses were recorded. Heart rate, skin conductance, and eye blink electromyographic responses were larger to white-noise than pure-tone stimuli (p's < 0.001, generalized eta squared 0.073-0.076). Psychophysiological responses to the stimuli were similar in the sitting and supine position (p's ≥ 0.082). Presenting white noise, rather than pure-tone, stimuli may improve the detection sensitivity of the neural concomitants of heightened autonomic responses by generating larger responses. Recording in the supine position appears to have little or no impact on psychophysiological response magnitudes to the auditory stimuli.
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Affiliation(s)
- Jennifer Koch
- Department of Psychiatry and Psychotherapy, University Hospital Zurich, Zurich, Switzerland
| | - Jan Flemming
- Department of Psychiatry and Psychotherapy, University Hospital Zurich, Zurich, Switzerland
| | - Thomas Zeffiro
- Neural Systems Group, Massachusetts General Hospital, Boston, MA, United States of America
| | - Michael Rufer
- Department of Psychiatry and Psychotherapy, University Hospital Zurich, Zurich, Switzerland
| | - Scott P. Orr
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States of America
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Fricchione J, Greenberg MS, Spring J, Wood N, Mueller-Pfeiffer C, Milad MR, Pitman RK, Orr SP. Delayed extinction fails to reduce skin conductance reactivity to fear-conditioned stimuli. Psychophysiology 2016; 53:1343-51. [DOI: 10.1111/psyp.12687] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Accepted: 05/10/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Jon Fricchione
- Department of Psychiatry; Massachusetts General Hospital and Harvard Medical School; Boston Massachusetts USA
| | - Mark S. Greenberg
- Department of Psychiatry; Massachusetts General Hospital and Harvard Medical School; Boston Massachusetts USA
| | - Justin Spring
- Department of Psychiatry; Massachusetts General Hospital and Harvard Medical School; Boston Massachusetts USA
| | - Nellie Wood
- Department of Psychiatry; Massachusetts General Hospital and Harvard Medical School; Boston Massachusetts USA
| | - Christoph Mueller-Pfeiffer
- Department of Psychiatry and Psychotherapy; University Hospital Zurich, University of Zurich; Zurich Switzerland
| | - Mohammed R. Milad
- Department of Psychiatry; Massachusetts General Hospital and Harvard Medical School; Boston Massachusetts USA
| | - Roger K. Pitman
- Department of Psychiatry; Massachusetts General Hospital and Harvard Medical School; Boston Massachusetts USA
| | - Scott P. Orr
- Department of Psychiatry; Massachusetts General Hospital and Harvard Medical School; Boston Massachusetts USA
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37
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Pineles SL, Blumenthal TD, Curreri AJ, Nillni YI, Putnam KM, Resick PA, Rasmusson AM, Orr SP. Prepulse inhibition deficits in women with PTSD. Psychophysiology 2016; 53:1377-85. [PMID: 27237725 DOI: 10.1111/psyp.12679] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [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: 11/09/2015] [Accepted: 04/27/2016] [Indexed: 10/21/2022]
Abstract
Prepulse inhibition (PPI) is an automatic and preattentive process, whereby a weak stimulus attenuates responding to a sudden and intense startle stimulus. PPI is a measure of sensorimotor filtering, which is conceptualized as a mechanism that facilitates processing of an initial stimulus and is protective from interruption by a later response. Impaired PPI has been found in (a) healthy women during the luteal phase of the menstrual cycle, and (b) individuals with types of psychopathology characterized by difficulty suppressing and filtering sensory, motor, or cognitive information. In the current study, 47 trauma-exposed women with or without posttraumatic stress disorder (PTSD) completed a PPI session during two different phases of the menstrual cycle: the early follicular phase, when estradiol and progesterone are both low, and the midluteal phase, when estradiol and progesterone are both high. Startle stimuli were 100 dB white noise bursts presented for 50 ms, and prepulses were 70 dB white noise bursts presented for 20 ms that preceded the startle stimuli by 120 ms. Women with PTSD showed deficits in PPI relative to the healthy trauma-exposed participants. Menstrual phase had no effect on PPI. These results provide empirical support for individuals with PTSD having difficulty with sensorimotor filtering. The potential utility of PPI as a Research Domain Criteria (RDoC) phenotype is discussed.
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Affiliation(s)
- Suzanne L Pineles
- National Center for PTSD, Women's Health Sciences Division, VA Boston Healthcare System, Boston, Massachusetts, USA.,Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Terry D Blumenthal
- Department of Psychology, Wake Forest University, Winston-Salem, North Carolina, USA
| | - Andrew J Curreri
- National Center for PTSD, Women's Health Sciences Division, VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Yael I Nillni
- National Center for PTSD, Women's Health Sciences Division, VA Boston Healthcare System, Boston, Massachusetts, USA.,Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Katherine M Putnam
- Department of Psychology, VA Central Western Massachusetts Healthcare System, Leeds, Massachusetts, USA
| | - Patricia A Resick
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, North Carolina, USA
| | - Ann M Rasmusson
- National Center for PTSD, Women's Health Sciences Division, VA Boston Healthcare System, Boston, Massachusetts, USA.,Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Scott P Orr
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
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38
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McGuire JF, Orr SP, Wu MS, Lewin AB, Small BJ, Phares V, Murphy TK, Wilhelm S, Pine DS, Geller D, Storch EA. FEAR CONDITIONING AND EXTINCTION IN YOUTH WITH OBSESSIVE-COMPULSIVE DISORDER. Depress Anxiety 2016; 33:229-37. [PMID: 26799264 PMCID: PMC5701569 DOI: 10.1002/da.22468] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [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: 09/26/2015] [Revised: 11/18/2015] [Accepted: 01/03/2016] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Fear acquisition and extinction are central constructs in the cognitive-behavioral model of obsessive-compulsive disorder (OCD), which underlies exposure-based cognitive-behavioral therapy (CBT). Youth with OCD may have impairments in fear acquisition and extinction that carry treatment implications. We examined these processes using a differential conditioning procedure. METHODS Forty-one youth (19 OCD, 22 community comparisons) completed a battery of clinical interviews, rating scales, and a differential conditioning task that included habituation, acquisition, and extinction phases. Skin conductance response (SCR) served as the primary dependent measure. RESULTS During habituation, no difference between groups was observed. During acquisition, differential fear conditioning was observed across participants as evidenced by larger SCRs to the CS+ compared to CS-; there were no between-group differences. Across participants, the number and frequency of OCD symptoms and anxiety severity was associated with greater reactivity to stimuli during acquisition. During extinction, a three-way interaction and follow-up tests revealed that youth with OCD showed a different pattern of SCR extinction compared to the community comparison group. CONCLUSIONS Youth with OCD exhibit a different pattern of fear extinction relative to community comparisons. This may be attributed to impaired inhibitory learning and contingency awareness in extinction. Findings suggest the potential benefit of utilizing inhibitory-learning principles in CBT for youth with OCD, and/or augmentative retraining interventions prior to CBT to reduce threat bias and improve contingency detection.
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Affiliation(s)
- Joseph F. McGuire
- Semel Institute of Neuroscience and Human Behavior, University of California Los Angeles
| | - Scott P. Orr
- Massachusetts General Hospital and Harvard Medical School
| | - Monica S. Wu
- Department of Psychology, University of South Florida,Department of Pediatrics, University of South Florida
| | - Adam B. Lewin
- Department of Psychology, University of South Florida,Department of Pediatrics, University of South Florida,Departments of Psychiatry and Behavioral Neuroscience, University of South Florida,All Children's Hospital, Johns Hopkins Medicine
| | | | - Vicky Phares
- Department of Psychology, University of South Florida
| | - Tanya K. Murphy
- Department of Pediatrics, University of South Florida,Departments of Psychiatry and Behavioral Neuroscience, University of South Florida,All Children's Hospital, Johns Hopkins Medicine
| | - Sabine Wilhelm
- Massachusetts General Hospital and Harvard Medical School
| | | | - Daniel Geller
- Massachusetts General Hospital and Harvard Medical School
| | - Eric A. Storch
- Department of Psychology, University of South Florida,Department of Pediatrics, University of South Florida,Departments of Psychiatry and Behavioral Neuroscience, University of South Florida,All Children's Hospital, Johns Hopkins Medicine,Rogers Behavioral Health – Tampa Bay,Department of Health Policy and Management, University of South Florida
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Egorova N, Park J, Orr SP, Kirsch I, Gollub RL, Kong J. Not seeing or feeling is still believing: conscious and non-conscious pain modulation after direct and observational learning. Sci Rep 2015; 5:16809. [PMID: 26578164 PMCID: PMC4649469 DOI: 10.1038/srep16809] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Accepted: 10/01/2015] [Indexed: 12/14/2022] Open
Abstract
Our experience with the world is shaped not only directly through personal exposure but also indirectly through observing others and learning from their experiences. Using a conditioning paradigm, we investigated how directly and observationally learned information can affect pain perception, both consciously and non-consciously. Differences between direct and observed cues were manifest in higher pain ratings and larger skin conductance responses to directly experienced cues. However, the pain modulation effects produced by conditioning were of comparable magnitude for direct and observational learning. These results suggest that social observation can induce positive and negative pain modulation. Importantly, the fact that cues learned by observation and activated non-consciously still produced a robust conditioning effect that withstood extinction highlights the role of indirect exposure in placebo and nocebo effects.
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Affiliation(s)
- Natalia Egorova
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Charlestown, MA, USA
| | - Joel Park
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Charlestown, MA, USA
| | - Scott P. Orr
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Charlestown, MA, USA
| | - Irving Kirsch
- Program in Placebo Studies and Therapeutic Encounter, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA, USA
| | - Randy L. Gollub
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Charlestown, MA, USA
| | - Jian Kong
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Charlestown, MA, USA
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Pace-Schott EF, Rubin ZS, Tracy LE, Spencer RM, Orr SP, Verga PW. Emotional trait and memory associates of sleep timing and quality. Psychiatry Res 2015; 229:999-1010. [PMID: 26257092 PMCID: PMC4568156 DOI: 10.1016/j.psychres.2015.05.069] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [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: 11/21/2014] [Revised: 05/07/2015] [Accepted: 05/20/2015] [Indexed: 10/23/2022]
Abstract
Poor ability to remember the extinction of conditioned fear, elevated trait anxiety, and delayed or disrupted nocturnal sleep are reported in anxiety disorders. The current study examines the interrelationship of these factors in healthy young-adult males. Skin-conductance response was conditioned to two differently colored lamps. One color but not the other was then extinguished. After varying delays, both colors were presented to determine extinction recall and generalization. Questionnaires measured sleep quality, morningness-eveningness, neuroticism and trait anxiety. A subset produced a mean 7.0 nights of actigraphy and sleep diaries. Median split of mean sleep midpoint defined early- and late-"sleep timers". Extinction was more rapidly learned in the morning than evening only in early timers who also better generalized extinction recall. Extinction recall was greater with higher sleep efficiency. Sleep efficiency and morningness were negatively associated with neuroticism and anxiety. However, neuroticism and anxiety did not predict extinction learning, recall or generalization. Therefore, neuroticism/anxiety and deficient fear extinction, although both associated with poor quality and late timing of sleep, are not directly associated with each other. Elevated trait anxiety, in addition to predisposing directly to anxiety disorders, may thus also indirectly promote such disorders by impairing sleep and, consequently, extinction memory.
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Affiliation(s)
- Edward F. Pace-Schott
- Department of Psychiatry, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA,Corresponding Author: Edward F. Pace-Schott, Ph.D.. Harvard Medical School, Massachusetts General Hospital – East. CNY 149 13th Street Room 2510, Charlestown, MA 02129. Phone: 508-523-4288. Fax: 617-726-4078,
| | - Zoe S. Rubin
- Department of Psychiatry, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | - Lauren E. Tracy
- Department of Psychiatry, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | | | - Scott P. Orr
- Department of Psychiatry, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | - Patrick W. Verga
- Department of Psychology, University of Massachusetts, Amherst, MA, USA
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41
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Pachas GN, Gilman J, Orr SP, Hoeppner B, Carlini SV, Grasser EB, Loebl T, Nino J, Pitman RK, Evins AE. Erratum to: Single dose propranolol does not affect physiologic or emotional reactivity to smoking cues. Psychopharmacology (Berl) 2015; 232:2029. [PMID: 25877745 DOI: 10.1007/s00213-015-3930-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Gladys N Pachas
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
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Pachas GN, Gilman J, Orr SP, Hoeppner B, Carlini SV, Loebl T, Nino J, Pitman RK, Evins AE. Single dose propranolol does not affect physiologic or emotional reactivity to smoking cues. Psychopharmacology (Berl) 2015; 232:1619-28. [PMID: 25413896 PMCID: PMC4404704 DOI: 10.1007/s00213-014-3797-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [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: 02/16/2014] [Accepted: 10/27/2014] [Indexed: 12/19/2022]
Abstract
BACKGROUND Smoking cue exposure reactivates salient smoking-related memories, triggering craving to smoke, a phenomenon associated with maintenance of smoking behavior and relapse after periods of abstinence. Acute β-adrenergic blockade with propranolol reduces physiologic reactivity during subsequent recollection of traumatic events by inhibiting reconsolidation of reactivated memories in a process called memory reconsolidation blockade. OBJECTIVE The objective of this study is to determine whether a single dose of propranolol prior to retrieval of smoking-related memories reduces subsequent physiologic reactivity to personally salient smoking imagery scripts in current smokers. METHODS Fifty-four overnight-abstinent, adult smokers received a single-dose propranolol or placebo prior to reactivation of smoking-related memories in a randomized, double-blind, placebo-controlled trial and resumed smoking afterward. One week later, skin conductance (SC), heart rate (HR), left corrugator electromyogram (EMG), self-reported emotional state, and craving were assessed following script-driven imagery with neutral and personalized smoking-related scripts. RESULTS Smoking scripts were associated with increased physiologic activation (SC, HR, EMG), craving, and negative emotional state compared with neutral scripts. Propranolol did not moderate the effect of script type on any outcome. CONCLUSION Personalized smoking script-driven imagery robustly increased physiologic activation, negative emotional state, and craving, and a single dose of propranolol prior to memory reactivation did not moderate this effect.
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Affiliation(s)
- Gladys N. Pachas
- Department of Psychiatry, Massachusetts General Hospital, Boston Massachusetts
- Harvard Medical School, Boston Massachusetts
| | - Jodi Gilman
- Department of Psychiatry, Massachusetts General Hospital, Boston Massachusetts
- Harvard Medical School, Boston Massachusetts
| | - Scott P. Orr
- Department of Psychiatry, Massachusetts General Hospital, Boston Massachusetts
- Harvard Medical School, Boston Massachusetts
| | - Bettina Hoeppner
- Department of Psychiatry, Massachusetts General Hospital, Boston Massachusetts
- Harvard Medical School, Boston Massachusetts
| | - Sara V. Carlini
- Department of Psychiatry, Massachusetts General Hospital, Boston Massachusetts
| | - Tsafrir Loebl
- Department of Psychiatry, Massachusetts General Hospital, Boston Massachusetts
| | - Johanna Nino
- Department of Psychiatry, Massachusetts General Hospital, Boston Massachusetts
| | - Roger K. Pitman
- Department of Psychiatry, Massachusetts General Hospital, Boston Massachusetts
- Harvard Medical School, Boston Massachusetts
| | - A. Eden Evins
- Department of Psychiatry, Massachusetts General Hospital, Boston Massachusetts
- Harvard Medical School, Boston Massachusetts
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43
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Wood NE, Rosasco ML, Suris AM, Spring JD, Marin MF, Lasko NB, Goetz JM, Fischer AM, Orr SP, Pitman RK. Pharmacological blockade of memory reconsolidation in posttraumatic stress disorder: three negative psychophysiological studies. Psychiatry Res 2015; 225:31-39. [PMID: 25441015 DOI: 10.1016/j.psychres.2014.09.005] [Citation(s) in RCA: 125] [Impact Index Per Article: 13.9] [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: 01/24/2014] [Revised: 08/15/2014] [Accepted: 09/08/2014] [Indexed: 01/25/2023]
Abstract
Posttraumatic stress disorder (PTSD) may involve over-consolidated emotional memories of the traumatic event. Reactivation (RP) can return a memory to an unstable state, from which it must be restabilized (reconsolidated) if it is to persist. Pharmacological agents administered while the memory is unstable have been shown to impair reconsolidation. The N-methyl-d-aspartate (NMDA) partial agonist d-cycloserine (DCS) may promote memory destabilization. In the three studies reported here, we investigated whether the β-adrenergic blocker propranolol or the glucocorticoid (GR) antagonist mifepristone, given at the time of traumatic memory reactivation, could reduce PTSD symptoms and physiological responding during subsequent traumatic imagery. Individuals with PTSD were randomized as follows: Study One: propranolol with memory reactivation (n=10) or without reactivation (n=8); Study Two: reactivation mifepristone (n=13), non-reactivation (NRP) mifepristone (n=15), or double placebo (PL) (n=15); Study Three: reactivation mifepristone plus d-cycloserine (n=16), or two placebos (n=15). Subjects underwent memory retrieval by describing their traumatic event. A week later they engaged in script-driven traumatic mental imagery, while heart rate (HR), skin conductance (SC), and facial electromyogram (EMG) responses were measured. There were no significant group differences in physiological responsivity or change in PTSD symptoms in any of the studies. These results do not support successful blockade of reconsolidation of traumatic memories in PTSD.
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Affiliation(s)
- Nellie E Wood
- Tufts University School of Medicine, Boston, MA, USA
| | - Maria L Rosasco
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Alina M Suris
- VA North Texas Health Care System, and Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | | | - Marie-France Marin
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, 120 Second Ave, Charlestown, Boston, MA 02129, USA
| | - Natasha B Lasko
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, 120 Second Ave, Charlestown, Boston, MA 02129, USA
| | - Jared M Goetz
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, 120 Second Ave, Charlestown, Boston, MA 02129, USA
| | | | - Scott P Orr
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, 120 Second Ave, Charlestown, Boston, MA 02129, USA
| | - Roger K Pitman
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, 120 Second Ave, Charlestown, Boston, MA 02129, USA.
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Anastasides N, Beck KD, Pang KC, Servatius RJ, Gilbertson MW, Orr SP, Myers CE. Increased generalization of learned associations is related to re-experiencing symptoms in veterans with symptoms of post-traumatic stress. Stress 2015; 18:484-9. [PMID: 26372003 PMCID: PMC4583812 DOI: 10.3109/10253890.2015.1053450] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [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] [Indexed: 11/13/2022] Open
Abstract
One interpretation of re-experiencing symptoms in post-traumatic stress disorder (PTSD) is that memories related to emotional information are stored strongly, but with insufficient specificity, so that stimuli which are minimally related to the traumatic event are sufficient to trigger recall. If so, re-experiencing symptoms may reflect a general bias against encoding background information during a learning experience, and this tendency might not be limited to learning about traumatic or even autobiographical events. To test this possibility, we administered a discrimination-and-transfer task to 60 Veterans (11.2% female, mean age 54.0 years) self-assessed for PTSD symptoms in order to examine whether re-experiencing symptoms were associated with increased generalization following associative learning. The discrimination task involved learning to choose the rewarded object from each of six object pairs; each pair differed in color or shape but not both. In the transfer phase, the irrelevant feature in each pair was altered. Regression analysis revealed no relationships between re-experiencing symptoms and initial discrimination learning. However, re-experiencing symptom scores contributed to the prediction of transfer performance. Other PTSD symptom clusters (avoidance/numbing, hyperarousal) did not account for significant additional variance. The results are consistent with an emerging interpretation of re-experiencing symptoms as reflecting a learning bias that favors generalization at the expense of specificity. Future studies will be needed to determine whether this learning bias may pre-date and confer risk for, re-experiencing symptoms in individuals subsequently exposed to trauma, or emerges only in the wake of trauma exposure and PTSD symptom development.
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Affiliation(s)
- Nicole Anastasides
- Department of Veterans Affairs, VA New Jersey Health Care System, East Orange, NJ, USA
| | - Kevin D. Beck
- Department of Veterans Affairs, VA New Jersey Health Care System, East Orange, NJ, USA
- Stress & Motivated Behavior Institute, New Jersey Medical School, Rutgers, The State University of New Jersey, Newark, NJ, USA
| | - Kevin C.H. Pang
- Department of Veterans Affairs, VA New Jersey Health Care System, East Orange, NJ, USA
- Stress & Motivated Behavior Institute, New Jersey Medical School, Rutgers, The State University of New Jersey, Newark, NJ, USA
| | - Richard J. Servatius
- Stress & Motivated Behavior Institute, New Jersey Medical School, Rutgers, The State University of New Jersey, Newark, NJ, USA
- Department of Veterans Affairs, Syracuse NY, USA
| | | | - Scott P. Orr
- Harvard Medical School and Massachusetts General Hospital, Boston, MA, USA
| | - Catherine E. Myers
- Department of Veterans Affairs, VA New Jersey Health Care System, East Orange, NJ, USA
- Stress & Motivated Behavior Institute, New Jersey Medical School, Rutgers, The State University of New Jersey, Newark, NJ, USA
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Kostek JA, Beck KD, Gilbertson MW, Orr SP, Pang KCH, Servatius RJ, Myers CE. Acquired equivalence in U.S. veterans with symptoms of posttraumatic stress: reexperiencing symptoms are associated with greater generalization. J Trauma Stress 2014; 27:717-20. [PMID: 25470729 PMCID: PMC4272630 DOI: 10.1002/jts.21974] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The severity and number of reexperiencing symptoms (e.g., flashbacks) show considerable variability across individuals with posttraumatic stress disorder (PTSD). One interpretation of reexperiencing symptoms invokes generalization: Specifically, the traumatic memory may be stored in such a way that neutral stimuli that only vaguely resemble some feature of the traumatic event are sufficient to trigger the memory. If this is the case, then individuals with higher levels of reexperiencing symptoms might show greater generalization, even in contexts unrelated to trauma. In the current study, an acquired equivalence test was used to assess associative learning and generalization in 114 U.S. veterans who were also given a test of declarative memory. PTSD symptoms were rated by the veteran. After adjusting for demographic variables, psychoactive medication use, and initial learning, regression analyses showed that the number of PTSD reexperiencing symptoms significantly improved the model for generalization (β = -.23, R(2) = .34) but not associative learning or declarative memory. The results support the idea that generalization is linked to reexperiencing symptoms, is not limited to learning about traumatic events, and can emerge even in a relatively innocuous computer-based learning task.
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Affiliation(s)
- John A. Kostek
- Department of Veterans Affairs, VA New Jersey Health Care System, East Orange, NJ, USA,Stress & Motivated Behavior Institute, New Jersey Medical School, Rutgers, The State University of New Jersey, Newark, NJ, USA
| | - Kevin D. Beck
- Department of Veterans Affairs, VA New Jersey Health Care System, East Orange, NJ, USA,Stress & Motivated Behavior Institute, New Jersey Medical School, Rutgers, The State University of New Jersey, Newark, NJ, USA
| | | | - Scott P. Orr
- Harvard Medical School and Massachusetts General Hospital, Boston, MA, USA
| | - Kevin C. H. Pang
- Department of Veterans Affairs, VA New Jersey Health Care System, East Orange, NJ, USA,Stress & Motivated Behavior Institute, New Jersey Medical School, Rutgers, The State University of New Jersey, Newark, NJ, USA
| | - Richard J. Servatius
- Department of Veterans Affairs, VA New Jersey Health Care System, East Orange, NJ, USA,Stress & Motivated Behavior Institute, New Jersey Medical School, Rutgers, The State University of New Jersey, Newark, NJ, USA
| | - Catherine E. Myers
- Department of Veterans Affairs, VA New Jersey Health Care System, East Orange, NJ, USA,Stress & Motivated Behavior Institute, New Jersey Medical School, Rutgers, The State University of New Jersey, Newark, NJ, USA
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Spring JD, Wood NE, Mueller-Pfeiffer C, Milad MR, Pitman RK, Orr SP. Prereactivation propranolol fails to reduce skin conductance reactivity to prepared fear-conditioned stimuli. Psychophysiology 2014; 52:407-15. [PMID: 25224026 DOI: 10.1111/psyp.12326] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [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: 04/17/2014] [Accepted: 07/21/2014] [Indexed: 11/30/2022]
Abstract
Pharmacologic blockade of memory reconsolidation has been demonstrated in fear-conditioned rodents and humans and may provide a means to reduce fearfulness in anxiety disorders and posttraumatic stress disorder. Studying the efficacy of potential interventions in clinical populations is challenging, creating a need for paradigms within which candidate reconsolidation-blocking interventions can be readily tested. We used videos of biologically prepared conditioned stimuli (tarantulas) to test the efficacy of propranolol in blocking reconsolidation of conditioned fear in healthy young adults. Strong differential conditioning, measured by skin conductance, was observed among a screened subset of participants during acquisition. However, subsequent propranolol failed to reduce reactivity to the reactivated conditioned stimulus. These results are consistent with other recent findings and point to a need for testing other candidate drugs.
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Affiliation(s)
- Justin D Spring
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
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47
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Pace-Schott EF, Tracy LE, Rubin Z, Mollica AG, Ellenbogen JM, Bianchi MT, Milad MR, Pitman RK, Orr SP. Interactions of time of day and sleep with between-session habituation and extinction memory in young adult males. Exp Brain Res 2014; 232:1443-58. [PMID: 24481663 PMCID: PMC4013206 DOI: 10.1007/s00221-014-3829-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [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: 08/18/2013] [Accepted: 01/05/2014] [Indexed: 12/16/2022]
Abstract
Within-session habituation and extinction learning co-occur as do subsequent consolidation of habituation (i.e., between-session habituation) and extinction memory. We sought to determine whether, as we predicted: (1) between-session habituation is greater across a night of sleep versus a day awake; (2) time-of-day accounts for differences; (3) between-session habituation predicts consolidation of extinction memory; (4) sleep predicts between-session habituation and/or extinction memory. Participants (N = 28) completed 4-5 sessions alternating between mornings and evenings over 3 successive days (2 nights) with session 1 in either the morning (N = 13) or evening (N = 15). Twelve participants underwent laboratory polysomnography. During 4 sessions, participants completed a loud-tone habituation protocol, while skin conductance response (SCR), blink startle electromyography (EMG), heart-rate acceleration and heart-rate deceleration (HRD) were recorded. For sessions 1 and 2, between-session habituation of EMG, SCR and HRD was greater across sleep. SCR and HRD were generally lower in the morning. Between-session habituation of SCR for sessions 1 and 2 was positively related to intervening (first night) slow wave sleep. In the evening before night 2, participants also underwent fear conditioning and extinction learning phases of a second protocol. Extinction recall was tested the following morning. Extinction recall was predicted only by between-session habituation of SCR across the same night (second night) and by intervening REM. We conclude that: (1) sleep augments between-session habituation, as does morning testing; (2) extinction recall is predicted by concurrent between-session habituation; and (3) both phenomena may be influenced by sleep.
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Affiliation(s)
- Edward F Pace-Schott
- Department of Psychiatry, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA,
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Brunet A, Thomas É, Saumier D, Ashbaugh AR, Azzoug A, Pitman RK, Orr SP, Tremblay J. Trauma reactivation plus propranolol is associated with durably low physiological responding during subsequent script-driven traumatic imagery. Can J Psychiatry 2014; 59:228-32. [PMID: 25007116 PMCID: PMC4079131 DOI: 10.1177/070674371405900408] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Accepted: 11/01/2013] [Indexed: 11/15/2022]
Abstract
OBJECTIVE In a previous, double-blind, placebo-controlled study, patients with posttraumatic stress disorder (PTSD) showed lower physiological response during script-driven traumatic imagery 1 week after receiving a single dose of propranolol given after the retrieval of a traumatic memory. We hypothesized that this effect would extend beyond 1 week using a modified treatment approach. METHOD Twenty-eight participants with PTSD read an account of their traumatic event once weekly for 6 consecutive weeks under the influence of open-label propranolol. One week and 4-months later, skin conductance, heart rate, and left corrugator electromyogram responses were measured while participants engaged in script-driven mental imagery of their traumatic event. Results from the 22 study participants were compared with results from treated and untreated participants in a previously published trial. RESULTS Most participants in our study were classified as non-PTSD cases at posttreatment and follow-up according to a psychophysiological discriminant function analysis. Posttreatment skin conductance and heart rate responses of the current (propranolol-treated) participants were lower than those of placebo participants from the previous study. No difference was observed between physiological responding measured posttreatment and at follow-up. CONCLUSIONS Low physiological responding during script-driven traumatic imagery after treatment extends up to 4 months, demonstrating the durability of the treatment effect's. Limitations include the absence of a placebo-controlled group and lack of physiological baseline measures. Despite these limitations, results point to the need for future trials examining the clinical efficacy of trauma reactivation plus propranolol, as it has the potential to become a novel, cost- and time-effective treatment for PTSD.
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Affiliation(s)
- Alain Brunet
- Director of the Psychosocial Research Division, Douglas Mental Health University Institute, Montreal, Quebec; Associate Professor, Department of Psychiatry, McGill University, Montreal, Quebec
| | - Émilie Thomas
- Graduate Student, Department of Psychology, Université de Montréal, Montreal, Quebec
| | - Daniel Saumier
- Research Coordinator, Douglas Mental Health University Institute, Montreal, Quebec; Associate Member, Department of Psychiatry, McGill University, Montreal, Quebec; Associate Member, Department of Neurology and Neurosurgery, McGill University, Montreal, Quebec
| | - Andrea R Ashbaugh
- Assistant Professor, Department of Psychology, University of Ottawa, Ottawa, Ontario
| | - Abdelmadjid Azzoug
- Registered Nurse, Douglas Mental Health University Institute, Montreal, Quebec
| | - Roger K Pitman
- Professor, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Scott P Orr
- Associate Professor, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Jacques Tremblay
- Researcher, Douglas Mental Health University Institute, Montreal, Quebec; Assistant Professor, Department of Psychiatry, McGill University, Montreal, Quebec
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49
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Pace-Schott EF, Spencer RM, Vijayakumar S, Ahmed N, Verga PW, Orr SP, Pitman RK, Milad MR. Extinction of conditioned fear is better learned and recalled in the morning than in the evening. J Psychiatr Res 2013; 47:1776-84. [PMID: 23992769 PMCID: PMC3791331 DOI: 10.1016/j.jpsychires.2013.07.027] [Citation(s) in RCA: 62] [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: 05/08/2013] [Revised: 07/18/2013] [Accepted: 07/25/2013] [Indexed: 01/22/2023]
Abstract
Sleep helps emotional memories consolidate and may promote generalization of fear extinction memory. We examined whether extinction learning and memory might differ in the morning and evening due, potentially, to circadian and/or sleep-homeostatic factors. Healthy men (N = 109) in 6 groups completed a 2-session protocol. In Session 1, fear conditioning was followed by extinction learning. Partial reinforcement with mild electric shock produced conditioned skin conductance responses (SCRs) to 2 differently colored lamps (CS+), but not a third color (CS-), within the computer image of a room (conditioning context). One CS+ (CS + E) but not the other (CS + U) was immediately extinguished by un-reinforced presentations in a different room (extinction context). Delay durations of 3 h (within AM or PM), 12 h (morning-to-evening or evening-to-morning) or 24 h (morning-to-morning or evening-to-evening) followed. In Session 2, extinction recall and contextual fear renewal were tested. We observed no significant effects of the delay interval on extinction memory but did observe an effect of time-of-day. Fear extinction was significantly better if learned in the morning (p = .002). Collapsing across CS + type, there was smaller morning differential SCR at both extinction recall (p = .003) and fear renewal (p = .005). Morning extinction recall showed better generalization from the CS + E to CS + U with the response to the CS + U significantly larger than to the CS + E only in the evening (p = .028). Thus, extinction is learned faster and its memory is better generalized in the morning. Cortisol and testosterone showed the expected greater salivary levels in the morning when higher testosterone/cortisol ratio also predicted better extinction learning. Circadian factors may promote morning extinction. Alternatively, evening homeostatic sleep pressure may impede extinction and favor recall of conditioned fear.
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Affiliation(s)
- Edward F. Pace-Schott
- Department of Psychiatry, Harvard Medical School, Massachusetts General Hospital, Boston, MA
| | | | | | - Nafis Ahmed
- Department of Psychology, University of Massachusetts, Amherst, MA
| | - Patrick W. Verga
- Department of Psychology, University of Massachusetts, Amherst, MA
| | - Scott P. Orr
- Department of Psychiatry, Harvard Medical School, Massachusetts General Hospital, Boston, MA
| | - Roger K. Pitman
- Department of Psychiatry, Harvard Medical School, Massachusetts General Hospital, Boston, MA
| | - Mohammed R. Milad
- Department of Psychiatry, Harvard Medical School, Massachusetts General Hospital, Boston, MA
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50
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Mueller-Pfeiffer C, Zeffiro T, O'Gorman R, Michels L, Baumann P, Wood N, Spring J, Rufer M, Pitman RK, Orr SP. Cortical and cerebellar modulation of autonomic responses to loud sounds. Psychophysiology 2013; 51:60-9. [DOI: 10.1111/psyp.12142] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2013] [Accepted: 07/19/2013] [Indexed: 12/30/2022]
Affiliation(s)
- Christoph Mueller-Pfeiffer
- Department of Psychiatry and Psychotherapy; University Hospital Zurich; Zurich Switzerland
- Center of Education and Research (COEUR); Psychiatric Services of the County of St. Gallen-North; Wil Switzerland
- Department of Psychiatry; Massachusetts General Hospital and Harvard Medical School; Boston Massachusetts USA
| | - Thomas Zeffiro
- Neural Systems Group; Massachusetts General Hospital; Boston Massachusetts USA
| | - Ruth O'Gorman
- Center for MR-Research; University Children's Hospital Zurich; Zurich Switzerland
| | - Lars Michels
- Institute of Neuroradiology; University Hospital Zurich; Zurich Switzerland
| | - Peter Baumann
- Department of Psychiatry and Psychotherapy; University Hospital Zurich; Zurich Switzerland
| | - Nellie Wood
- Department of Psychiatry; Massachusetts General Hospital and Harvard Medical School; Boston Massachusetts USA
| | - Justin Spring
- Department of Psychiatry; Massachusetts General Hospital and Harvard Medical School; Boston Massachusetts USA
| | - Michael Rufer
- Department of Psychiatry and Psychotherapy; University Hospital Zurich; Zurich Switzerland
| | - Roger K. Pitman
- Department of Psychiatry; Massachusetts General Hospital and Harvard Medical School; Boston Massachusetts USA
| | - Scott P. Orr
- Department of Psychiatry; Massachusetts General Hospital and Harvard Medical School; Boston Massachusetts USA
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