1
|
Hart H, Lim L, Mehta MA, Simmons A, Mirza KAH, Rubia K. Altered fear processing in adolescents with a history of severe childhood maltreatment: an fMRI study. Psychol Med 2018; 48:1092-1101. [PMID: 29429419 PMCID: PMC6088776 DOI: 10.1017/s0033291716003585] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Revised: 12/08/2016] [Accepted: 12/15/2016] [Indexed: 11/21/2022]
Abstract
BACKGROUND Children with a history of maltreatment suffer from altered emotion processing but the neural basis of this phenomenon is unknown. This pioneering functional magnetic resonance imaging (fMRI) study investigated the effects of severe childhood maltreatment on emotion processing while controlling for psychiatric conditions, medication and substance abuse. METHOD Twenty medication-naive, substance abuse-free adolescents with a history of childhood abuse, 20 psychiatric control adolescents matched on psychiatric diagnoses but with no maltreatment and 27 healthy controls underwent a fMRI emotion discrimination task comprising fearful, angry, sad happy and neutral dynamic facial expressions. RESULTS Maltreated participants responded faster to fearful expressions and demonstrated hyper-activation compared to healthy controls of classical fear-processing regions of ventromedial prefrontal cortex (vmPFC) and anterior cingulate cortex, which survived at a more lenient threshold relative to psychiatric controls. Functional connectivity analysis, furthermore, demonstrated reduced connectivity between left vmPFC and insula for fear in maltreated participants compared to both healthy and psychiatric controls. CONCLUSIONS The findings show that people who have experienced childhood maltreatment have enhanced fear perception, both at the behavioural and neurofunctional levels, associated with enhanced fear-related ventromedial fronto-cingulate activation and altered functional connectivity with associated limbic regions. Furthermore, the connectivity adaptations were specific to the maltreatment rather than to the developing psychiatric conditions, whilst the functional changes were only evident at trend level when compared to psychiatric controls, suggesting a continuum. The neurofunctional hypersensitivity of fear-processing networks may be due to childhood over-exposure to fear in people who have been abused.
Collapse
Affiliation(s)
- H. Hart
- Department of Child & Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - L. Lim
- Department of Child & Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - M. A. Mehta
- Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - A. Simmons
- NIHR Biomedical Research Centre at South London and Maudsley Foundation NHS Trust and King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | | | - K. Rubia
- Department of Child & Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| |
Collapse
|
2
|
Zhu X, Helpman L, Papini S, Schneier F, Markowitz JC, Van Meter PE, Lindquist MA, Wager TD, Neria Y. Altered resting state functional connectivity of fear and reward circuitry in comorbid PTSD and major depression. Depress Anxiety 2017; 34:641-650. [PMID: 28030757 PMCID: PMC5667358 DOI: 10.1002/da.22594] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [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: 06/28/2016] [Revised: 11/22/2016] [Accepted: 11/26/2016] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Individuals with comorbid posttraumatic stress disorder and major depressive disorder (PTSD-MDD) often exhibit greater functional impairment and poorer treatment response than individuals with PTSD alone. Research has not determined whether PTSD-MDD is associated with different network connectivity abnormalities than PTSD alone. METHODS We used functional magnetic resonance imaging (fMRI) to measure resting state functional connectivity (rs-FC) patterns of brain regions involved in fear and reward processing in three groups: patients with PTSD-alone (n = 27), PTSD-MDD (n = 21), and trauma-exposed healthy controls (TEHCs, n = 34). Based on previous research, seeds included basolateral amygdala (BLA), centromedial amygdala (CMA), and nucleus accumbens (NAcc). RESULTS Regardless of MDD comorbidity, PTSD was associated with decreased connectivity of BLA-orbitalfrontal cortex (OFC) and CMA-thalamus pathways, key to fear processing, and fear expression, respectively. PTSD-MDD, compared to PTSD-alone and TEHC, was associated with decreased connectivity across multiple amygdala and striatal-subcortical pathways: BLA-OFC, NAcc-thalamus, and NAcc-hippocampus. Further, while both the BLA-OFC and the NAcc-thalamus pathways were correlated with MDD symptoms, PTSD symptoms correlated with the amygdala pathways (BLA-OFC; CMA-thalamus) only. CONCLUSIONS Comorbid PTSD-MDD may be associated with multifaceted functional connectivity alterations in both fear and reward systems. Clinical implications are discussed.
Collapse
Affiliation(s)
- Xi Zhu
- Department of Psychiatry, Columbia University, New York, NY, USA,New York State Psychiatric Institute, New York, NY, USA
| | - Liat Helpman
- Department of Psychiatry, Columbia University, New York, NY, USA,New York State Psychiatric Institute, New York, NY, USA
| | - Santiago Papini
- Department of Psychology and Institute for Mental Health Research, The University of Texas at Austin, Austin, TX, USA
| | - Franklin Schneier
- Department of Psychiatry, Columbia University, New York, NY, USA,New York State Psychiatric Institute, New York, NY, USA
| | - John C. Markowitz
- Department of Psychiatry, Columbia University, New York, NY, USA,New York State Psychiatric Institute, New York, NY, USA
| | | | | | - Tor D. Wager
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, CO, USA
| | - Yuval Neria
- Department of Psychiatry, Columbia University, New York, NY, USA,New York State Psychiatric Institute, New York, NY, USA
| |
Collapse
|
3
|
Soravia LM, Orosz A, Schwab S, Nakataki M, Wiest R, Federspiel A. CBT reduces CBF: cognitive-behavioral therapy reduces cerebral blood flow in fear-relevant brain regions in spider phobia. Brain Behav 2016; 6:e00510. [PMID: 27688940 PMCID: PMC5036433 DOI: 10.1002/brb3.510] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [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: 01/21/2016] [Revised: 05/10/2016] [Accepted: 05/11/2016] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Imaging studies have provided evidence that cognitive-behavioral therapy (CBT) is able to change brain activation in phobic patients in response to threatening stimuli. The changes occurred in both emotion-generating and modulatory regions. In this study, we use a data-driven approach to explore resting state cerebral blood flow (CBF) measured by arterial spin labeling (ASL), before and after CBT. METHODS Eight female patients with spider phobia were scanned before and 1 month after an exposure-based group therapy for spider phobia. Each MRI session consisted of an ASL resting state measurement acquired before and after a symptom provocation task involving the showing of spider pictures in the scanner. The first ASL acquisition measured anticipatory anxiety and the second measured postprocessing of phobia-relevant stimuli. RESULTS Cognitive-behavioral therapy significantly reduced spider phobic symptoms in all patients. Symptom reduction during anticipatory anxiety was accompanied by reduced bilateral CBF in the parahippocampal gyrus, ventral anterior thalamus, Brodmann area 8, and the anterior cingulate cortex. During postprocessing of phobia-relevant stimuli, patients showed reduced CBF in the bilateral insula, components of the motor cortex, and areas associated with language functions. CONCLUSIONS Longitudinal CBF dynamics following CBT were in concordance with results from several studies using BOLD fMRI to investigate the effects of psychotherapy on brain activity. CBF can be quantified by ASL, with the principal advantage of sensitivity to slow variations in neural activity and task independence. Therefore, ASL may be a suitable method for monitoring and evaluating the efficacy of psychotherapy or pharmacotherapy approaches.
Collapse
Affiliation(s)
- Leila M Soravia
- Division of Systems Neuroscience of Psychopathology University Hospital of Psychiatry University of Bern Bolligenstrasse 111 3000 Bern Switzerland
| | - Ariane Orosz
- Division of Systems Neuroscience of Psychopathology University Hospital of Psychiatry University of Bern Bolligenstrasse 111 3000 Bern Switzerland
| | - Simon Schwab
- Division of Systems Neuroscience of Psychopathology University Hospital of Psychiatry University of Bern Bolligenstrasse 111 3000 Bern Switzerland
| | - Masahito Nakataki
- Division of Systems Neuroscience of Psychopathology University Hospital of Psychiatry University of Bern Bolligenstrasse 111 3000 Bern Switzerland; Department of Psychiatry University of Tokushima 3-18-15 Kuramoto-cho Tokushima 770-8503 Japan
| | - Roland Wiest
- Department of Diagnostic and Interventional Neuroradiology Inselspital University Hospital of Bern Freiburgstrasse 4 3010 Bern Switzerland
| | - Andrea Federspiel
- Division of Systems Neuroscience of Psychopathology University Hospital of Psychiatry University of Bern Bolligenstrasse 111 3000 Bern Switzerland
| |
Collapse
|
4
|
Abstract
As presently defined, post-traumatic stress disorder (PTSD) is an amalgam of symptoms falling into: re-experiencing of the trauma, avoidance of reminders of it, emotional numbing and hyperarousal. PTSD has a well-known proximate cause, commonly occurring after a life-threatening event that induces a response of intense fear, horror, and helplessness. Much of the advancement in understanding of the neurobiology of PTSD has emerged from conceptualizing the disorder as one that involves substantial dysfunction in fear processing. This article reviews recent knowledge of fear processing markers in PTSD. A systematic search was performed of reports within the specific three-year publication time period of January 2010 to December 2012. We identified a total of 31 studies reporting fear processing markers in PTSD. We further categorized them according to the following classification: (1) neural-activation markers (n=10), (2) psychophysiological markers (n=14), and (3) behavioral markers (n=7). Across most studies reviewed here, significant differences between individuals with PTSD and healthy controls were shown. Methodological, theoretical and clinical implications were discussed.
Collapse
Affiliation(s)
- Erel Shvil
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, 1051 Riverside Drive, Unit # 69, New York, NY 10032, USA.
| | - Heather L. Rusch
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, 1051 Riverside Drive, Unit # 69, New York, NY 10032, USA
| | - Gregory M. Sullivan
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, 1051 Riverside Drive, Unit # 69, New York, NY 10032, USA,New York State Psychiatric Institute, 1051 Riverside Drive, Unit # 69, New York, NY 10032, USA
| | - Yuval Neria
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, 1051 Riverside Drive, Unit # 69, New York, NY 10032, USA,New York State Psychiatric Institute, 1051 Riverside Drive, Unit # 69, New York, NY 10032, USA,Department of Epidemiology & College of Physicians and Surgeons, Columbia University, Columbia, USA
| |
Collapse
|
5
|
Hong DS, Bray S, Haas BW, Hoeft F, Reiss AL. Aberrant neurocognitive processing of fear in young girls with Turner syndrome. Soc Cogn Affect Neurosci 2012; 9:255-64. [PMID: 23171616 DOI: 10.1093/scan/nss133] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Appraisal of fearful stimuli is an integral aspect of social cognition. Neural circuitry underlying this phenomenon has been well-described and encompasses a distributed network of affective and cognitive nodes. Interestingly, this ability to process fearful faces is impaired in Turner syndrome (TS), a genetic disorder of females in which all or part of an X chromosome is missing. However, neurofunctional correlates for this impairment have not been well-studied, particularly in young girls. Given that the core features of TS include X chromosome gene haploinsufficiency and secondary sex hormone deficiencies, investigation of fearful face processing may provide insights into the influence of X chromosome gene expression on this network. Therefore, we examined behavioral and neural responses during an explicit emotional face labeling task in 14 prepubertal girls with TS and 16 typically developing age-matched controls (6-13 years). We demonstrate that girls with TS have a specific impairment in the identification of fearful faces and show decreased activation in several cognitive control regions, including the anterior dorsal anterior cingulate cortex, dorsolateral prefrontal cortex and posterior cingulate gyrus. Our results indicate that aberrant functional activation in dorsal cognitive regions plays an integral role in appraisal of, and regulation of response to fear in TS.
Collapse
|
6
|
Bobes MA, Ostrosky F, Diaz K, Romero C, Borja K, Santos Y, Valdés-Sosa M. Linkage of functional and structural anomalies in the left amygdala of reactive-aggressive men. Soc Cogn Affect Neurosci 2012; 8:928-36. [PMID: 22956672 DOI: 10.1093/scan/nss101] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Amygdala structural and functional abnormalities have been associated to reactive aggression in previous studies. However, the possible linkage of these two types of anomalies has not been examined. We hypothesized that they would coincide in the same localizations, would be correlated in intensity and would be mediated by reactive aggression personality traits. Here violent (n = 25) and non-violent (n = 29) men were recruited on the basis of their reactive aggression. Callous-unemotional (CU) traits were also assessed. Gray matter concentration (gmC) and reactivity to fearful and neutral facial expressions were measured in dorsal and ventral amygdala partitions. The difference between responses to fearful and neutral facial expressions was calculated (F/N-difference). Violent individuals exhibited a smaller F/N-difference and gmC in the left dorsal amygdala, where a significant coincidence was found in a conjunction analysis. Moreover, the left amygdala F/N-difference and gmC were correlated to each other, an effect mediated by reactive aggression but not by CU. The F/N-difference was caused by increased reactivity to neutral faces. This suggests that anatomical anomalies within local circuitry (and not only altered input) may underlie the amygdala hyper-reactivity to social signals which is characteristic of reactive aggression.
Collapse
Affiliation(s)
- María A Bobes
- Cuban Neuroscience Center, CNEURO, Ave 25 y 158, Cubanacan, Apartado 12100, La Habana, Cuba.
| | | | | | | | | | | | | |
Collapse
|
7
|
Abstract
The current article explores the implication of the interaction of emotion and consciousness for autism. The framework that is proposed for the disorder explains that the compromised functional integrity of the amygdala is the root cause of disturbed affective consciousness. Amygdala, with its connections to various cortical and subcortical regions, helps detect a fearful facial expression at the attentional periphery and make it the focus of attention and awareness for enhanced processing. The conscious life of autistics with respect to affective objects can thus be very different from that of normal people, which leads them to perceive the world differently. They process fearful stimuli the way normal controls perceive common objects by activating areas responsible for feature based analysis rather than the amygdala and other connected areas. Conscious perception of such stimuli is important for appropriate development of emotion concepts, something that autistics lack, thus leading to impairment in the awareness of one's own emotions especially within the negative spectrum with a prominent position for fearful stimuli. Thus the interaction of emotion with consciousness is ripe for investigation and can help to throw light on the mental life of autistics.
Collapse
Affiliation(s)
- Neha Khetrapal
- Centre for Behavioural and Cognitive Sciences, University of Allahabad Allahabad, India.
| |
Collapse
|