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Petri-Romão P, Engen H, Rupanova A, Puhlmann L, Zerban M, Neumann RJ, Malyshau A, Ahrens KF, Schick A, Kollmann B, Wessa M, Walker H, Plichta MM, Reif A, Chmitorz A, Tuescher O, Basten U, Kalisch R. Self-report assessment of Positive Appraisal Style (PAS): Development of a process-focused and a content-focused questionnaire for use in mental health and resilience research. PLoS One 2024; 19:e0295562. [PMID: 38306328 PMCID: PMC10836662 DOI: 10.1371/journal.pone.0295562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 11/23/2023] [Indexed: 02/04/2024] Open
Abstract
Positive Appraisal Style Theory of Resilience posits that a person's general style of evaluating stressors plays a central role in mental health and resilience. Specifically, a tendency to appraise stressors positively (positive appraisal style; PAS) is theorized to be protective of mental health and thus a key resilience factor. To this date no measures of PAS exist. Here, we present two scales that measure perceived positive appraisal style, one focusing on cognitive processes that lead to positive appraisals in stressful situations (PASS-process), and the other focusing on the appraisal contents (PASS-content). For PASS-process, the items of the existing questionnaires Brief COPE and CERQ-short were analyzed in exploratory and confirmatory factor analyses (EFA, CFA) in independent samples (N = 1157 and N = 1704). The resulting 10-item questionnaire was internally consistent (α = .78, 95% CI [.86, .87]) and showed good convergent and discriminant validity in comparisons with self-report measures of trait optimism, neuroticism, urgency, and spontaneity. For PASS-content, a newly generated item pool of 29 items across stressor appraisal content dimensions (probability, magnitude, and coping potential) were subjected to EFA and CFA in two independent samples (N = 1174 and N = 1611). The resulting 14-item scale showed good internal consistency (α = .87, 95% CI [.86, .87]), as well as good convergent and discriminant validity within the nomological network. The two scales are a new and reliable way to assess self-perceived positive appraisal style in large-scale studies, which could offer key insights into mechanisms of resilience.
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Affiliation(s)
| | - Haakon Engen
- Neuroimaging Center (NIC), Focus Program Translational Neuroscience (FTN), Johannes Gutenberg University Medical Center, Mainz, Germany
| | - Anna Rupanova
- Leibniz Institute for Resilience Research (LIR), Mainz, Germany
- Neuroimaging Center (NIC), Focus Program Translational Neuroscience (FTN), Johannes Gutenberg University Medical Center, Mainz, Germany
| | - Lara Puhlmann
- Leibniz Institute for Resilience Research (LIR), Mainz, Germany
| | - Matthias Zerban
- Neuroimaging Center (NIC), Focus Program Translational Neuroscience (FTN), Johannes Gutenberg University Medical Center, Mainz, Germany
| | - Rebecca J Neumann
- Department of Psychiatry, University Hospital, Psychosomatic Medicine and Psychotherapy, Goethe University Frankfurt, Frankfurt, Germany
| | - Aliaksandr Malyshau
- Department of Psychiatry, University Hospital, Psychosomatic Medicine and Psychotherapy, Goethe University Frankfurt, Frankfurt, Germany
| | - Kira F Ahrens
- Department of Psychiatry, University Hospital, Psychosomatic Medicine and Psychotherapy, Goethe University Frankfurt, Frankfurt, Germany
| | - Anita Schick
- Medical Faculty Mannheim, Department of Public Mental Health, Central Institute of Mental Health (CIMH), Heidelberg University, Mannheim, Germany
| | - Bianca Kollmann
- Leibniz Institute for Resilience Research (LIR), Mainz, Germany
- Department of Psychiatry and Psychotherapy, Johannes Gutenberg University Medical Center, Mainz, Germany
| | - Michèle Wessa
- Leibniz Institute for Resilience Research (LIR), Mainz, Germany
- Department of Clinical Psychology and Neuropsychology, Institute of Psychology, Johannes Gutenberg University, Mainz, Germany
| | - Henrik Walker
- Department of Psychiatry & Psychotherapy, Division of Mind and Brain Research, Campus Charité Mitte, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Berlin School of Mind and Brain, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Michael M Plichta
- Department of Psychiatry, University Hospital, Psychosomatic Medicine and Psychotherapy, Goethe University Frankfurt, Frankfurt, Germany
| | - Andreas Reif
- Department of Psychiatry, University Hospital, Psychosomatic Medicine and Psychotherapy, Goethe University Frankfurt, Frankfurt, Germany
| | - Andrea Chmitorz
- Faculty of Social Work, Health Care and Nursing, Esslingen University of Applied Sciences, Esslingen, Germany
| | - Oliver Tuescher
- Leibniz Institute for Resilience Research (LIR), Mainz, Germany
- Department of Psychiatry and Psychotherapy, Johannes Gutenberg University Medical Center, Mainz, Germany
| | - Ulrike Basten
- Department of Psychology, University of Kaiserslautern-Landau, Landau, Germany
| | - Raffael Kalisch
- Leibniz Institute for Resilience Research (LIR), Mainz, Germany
- Neuroimaging Center (NIC), Focus Program Translational Neuroscience (FTN), Johannes Gutenberg University Medical Center, Mainz, Germany
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Marciniak MA, Shanahan L, Yuen KSL, Veer IM, Walter H, Tuescher O, Kobylińska D, Kalisch R, Hermans E, Binder H, Kleim B. Burst versus continuous delivery design in digital mental health interventions: Evidence from a randomized clinical trial. Digit Health 2024; 10:20552076241249267. [PMID: 38698832 PMCID: PMC11064753 DOI: 10.1177/20552076241249267] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 04/08/2024] [Indexed: 05/05/2024] Open
Abstract
Objective Digital mental health interventions delivered via smartphone-based apps effectively treat various conditions; however, optimizing their efficacy while minimizing participant burden remains a key challenge. In this study, we investigated the potential benefits of a burst delivery design (i.e. interventions delivered only in pre-defined time intervals) in comparison to the continuous delivery of interventions. Methods We randomly assigned 93 participants to the continuous delivery (CD) or burst delivery (BD) group. The CD group engaged in ReApp, a mobile app that increases positive cognitive reappraisal with a consistent delivery schedule that provides five prompts per day throughout the 3-week-long study, while the BD group received five daily prompts only in the first and third weeks of the study. Results No significant differences were found between the groups in terms of adherence, mental health outcomes (specifically depressive and anxiety symptoms), level of perceived stress, and perceived helpfulness of intervention. The BD group showed a significantly decreased perceived difficulty of intervention over time. Conclusions The results suggest that the burst delivery may be as suitable for digital mental health interventions as the continuous delivery. The perceived difficulty of the intervention declined more steeply for the BD group, indicating that it improved the feasibility of the positive cognitive reappraisal intervention without hurting its efficacy. This outcome may inform the design of less burdensome interventions with improved outcomes in future research.
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Affiliation(s)
- Marta Anna Marciniak
- Department of Psychology, University of Zurich, Zurich, Switzerland
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital (PUK), University of Zurich, Zurich, Switzerland
| | - Lilly Shanahan
- Department of Psychology, University of Zurich, Zurich, Switzerland
- Jacobs Center for Productive Youth Development, University of Zurich, Zurich, Switzerland
| | - Kenneth S L Yuen
- Leibniz Institute for Resilience Research (LIR), Mainz, Germany
- Neuroimaging Center (NIC), Focus Program Translational Neuroscience (FTN), Johannes Gutenberg University Medical Center, Mainz, Germany
| | - Ilya Milos Veer
- Department of Developmental Psychology, University of Amsterdam, Amsterdam, The Netherlands; Research Division of Mind and Brain, Department of Psychiatry and Psychotherapy CCM
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Henrik Walter
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Oliver Tuescher
- Leibniz Institute for Resilience Research (LIR), Mainz, Germany
- Neuroimaging Center (NIC), Focus Program Translational Neuroscience (FTN), Johannes Gutenberg University Medical Center, Mainz, Germany
- Institute for Molecular Biology (IMB), Mainz, Germany
| | | | - Raffael Kalisch
- Leibniz Institute for Resilience Research (LIR), Mainz, Germany
- Neuroimaging Center (NIC), Focus Program Translational Neuroscience (FTN), Johannes Gutenberg University Medical Center, Mainz, Germany
| | - Erno Hermans
- Radboud University Medical Center, Donders Institute for Brain, Cognition, and Behaviour, Nijmegen, The Netherlands
| | - Harald Binder
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
- Freiburg Center for Data Analysis and Modelling, University of Freiburg, Freiburg, Germany
| | - Birgit Kleim
- Freiburg Center for Data Analysis and Modelling, University of Freiburg, Freiburg, Germany
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von Wulffen C, Marciniak MA, Rohde J, Kalisch R, Binder H, Tuescher O, Kleim B. German Version of the Mobile Agnew Relationship Measure: Translation and Validation Study. J Med Internet Res 2023; 25:e43368. [PMID: 37955952 PMCID: PMC10682917 DOI: 10.2196/43368] [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] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 07/03/2023] [Accepted: 07/27/2023] [Indexed: 11/14/2023] Open
Abstract
BACKGROUND The mobile Agnew Relationship Measure (mARM) is a self-report questionnaire for the evaluation of digital mental health interventions and their interactions with users. With the global increase in digital mental health intervention research, translated measures are required to conduct research with local populations. OBJECTIVE The aim of this study was to translate and validate the original English version of the mARM into a German version (mARM-G). METHODS A total of 2 native German speakers who spoke English as their second language conducted forward translation of the original items. This version was then back translated by 2 native German speakers with a fluent knowledge of English. An independent bilingual reviewer then compared these drafts and created a final German version. The mARM-G was validated by 15 experts in the field of mobile app development and 15 nonexperts for content validity and face validity; 144 participants were recruited to conduct reliability testing as well as confirmatory factor analysis. RESULTS The content validity index of the mARM-G was 0.90 (expert ratings) and 0.79 (nonexperts). The face validity index was 0.89 (experts) and 0.86 (nonexperts). Internal consistency for the entire scale was Cronbach α=.91. Confirmatory factor analysis results were as follows: the chi-square statistic to df ratio was 1.66. Comparative Fit Index was 0.87 and the Tucker-Lewis Index was 0.86. The root mean square error of approximation was 0.07. CONCLUSIONS The mARM-G is a valid and reliable tool that can be used for future studies in German-speaking countries.
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Affiliation(s)
- Clemens von Wulffen
- Department of Psychology, University of Zurich, Zürich, Switzerland
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital, University of Zurich, Zurich, Switzerland
| | - Marta Anna Marciniak
- Department of Psychology, University of Zurich, Zürich, Switzerland
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital, University of Zurich, Zurich, Switzerland
| | - Judith Rohde
- Department of Psychology, University of Zurich, Zürich, Switzerland
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital, University of Zurich, Zurich, Switzerland
| | - Raffael Kalisch
- Leibniz Institute for Resilience Research, Mainz, Germany
- Neuroimaging Center, Focus Program Translational Neuroscience, Johannes Gutenberg University Medical Center, Mainz, Germany
| | - Harald Binder
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
- Freiburg Center for Data Analysis and Modelling, University of Freiburg, Freiburg, Germany
| | - Oliver Tuescher
- Leibniz Institute for Resilience Research, Mainz, Germany
- Department of Psychiatry and Psychotherapy, University Medical Center, University Johannes Gutenberg University, Mainz, Germany
| | - Birgit Kleim
- Department of Psychology, University of Zurich, Zürich, Switzerland
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital, University of Zurich, Zurich, Switzerland
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Marciniak MA, Shanahan L, Rohde J, Schulz A, Wackerhagen C, Kobylińska D, Tuescher O, Binder H, Walter H, Kalisch R, Kleim B. Standalone Smartphone Cognitive Behavioral Therapy-Based Ecological Momentary Interventions to Increase Mental Health: Narrative Review. JMIR Mhealth Uhealth 2020; 8:e19836. [PMID: 33180027 PMCID: PMC7691088 DOI: 10.2196/19836] [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] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 08/25/2020] [Accepted: 09/14/2020] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND A growing number of psychological interventions are delivered via smartphones with the aim of increasing the efficacy and effectiveness of these treatments and providing scalable access to interventions for improving mental health. Most of the scientifically tested apps are based on cognitive behavioral therapy (CBT) principles, which are considered the gold standard for the treatment of most mental health problems. OBJECTIVE This review investigates standalone smartphone-based ecological momentary interventions (EMIs) built on principles derived from CBT that aim to improve mental health. METHODS We searched the MEDLINE, PsycINFO, EMBASE, and PubMed databases for peer-reviewed studies published between January 1, 2007, and January 15, 2020. We included studies focusing on standalone app-based approaches to improve mental health and their feasibility, efficacy, or effectiveness. Both within- and between-group designs and studies with both healthy and clinical samples were included. Blended interventions, for example, app-based treatments in combination with psychotherapy, were not included. Selected studies were evaluated in terms of their design, that is, choice of the control condition, sample characteristics, EMI content, EMI delivery characteristics, feasibility, efficacy, and effectiveness. The latter was defined in terms of improvement in the primary outcomes used in the studies. RESULTS A total of 26 studies were selected. The results show that EMIs based on CBT principles can be successfully delivered, significantly increase well-being among users, and reduce mental health symptoms. Standalone EMIs were rated as helpful (mean 70.8%, SD 15.3; n=4 studies) and satisfying for users (mean 72.6%, SD 17.2; n=7 studies). CONCLUSIONS Study quality was heterogeneous, and feasibility was often not reported in the reviewed studies, thus limiting the conclusions that can be drawn from the existing data. Together, the studies show that EMIs may help increase mental health and thus support individuals in their daily lives. Such EMIs provide readily available, scalable, and evidence-based mental health support. These characteristics appear crucial in the context of a global crisis such as the COVID-19 pandemic but may also help reduce personal and economic costs of mental health impairment beyond this situation or in the context of potential future pandemics.
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Affiliation(s)
| | - Lilly Shanahan
- Jacobs Centre of Productive Youth Development, University of Zurich, Zurich, Switzerland
| | - Judith Rohde
- University of Zurich, Psychiatric University Hospital, Zurich, Switzerland
| | - Ava Schulz
- University of Zurich, Psychiatric University Hospital, Zurich, Switzerland
| | | | | | | | - Harald Binder
- Institute for Medical Biometry and Statistics, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | | | | | - Birgit Kleim
- University of Zurich, Psychiatric University Hospital, Zurich, Switzerland
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Schaaf J, Sedlmayr M, Prokosch HU, Ganslandt T, Schade-Brittinger C, von Wagner M, Kadioglu D, Schubert K, Lee-Kirsch MA, Kraemer BK, Winner B, Mueller T, Schaefer JR, Wagner TOF, Bruckner-Tuderman L, Tuescher O, Boeker M, Storf H. The Status Quo of Rare Diseases Centres for the Development of a Clinical Decision Support System - A Cross-Sectional Study. Stud Health Technol Inform 2020; 271:176-183. [PMID: 32578561 DOI: 10.3233/shti200094] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Clinical decision support systems (CDSS) help to improve the diagnostics and treatment of rare diseases (RD). As one of four funded consortia of the Medical Informatics Initiative supported by the Federal Ministry of Education and Research (BMBF, Germany), MIRACUM develops a clinical decision support system (CDSS) for RD based on distributed data of ten university hospitals. The CDSS will be developed at the Rare Diseases Centres (RDC) of the MIRACUM consortium. Since it is essential to deliver decision support at the right time and place in the clinician's workflow, this study aimed to capture relevant information of the RDCs regarding patient admission and diagnostic process. Additionally, we investigated how patient documentation and digitalisation is performed at the centres. Therefore, we conducted a cross-sectional survey involving experts in the RDs domain to capture relevant information for the further development of a CDSS in RD. For each centre, one expert on RDs participated in the study (n=8). The survey identified several challenges regarding the reuse of patient data, e.g. the paper-based documentation of a patientâĂŹs medical history and coding of diagnoses using ICD-10. However, we noticed a relevant use of current software diagnosis support and a similarly performed diagnostic process in all RDC. Further studies are needed to get more detailed insights and to define specific requirements.
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Affiliation(s)
- Jannik Schaaf
- Medical Informatics Group, University Hospital Frankfurt, Frankfurt, Germany
| | - Martin Sedlmayr
- Institute for Medical Informatics and Biometry, Carl Gustav Carus Faculty of Medicine, Technical University of Dresden, Dresden, Germany
| | - Hans-Ulrich Prokosch
- Chair of Medical Informatics, Department of Medical Informatics, Biometrics and Epidemiology, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Thomas Ganslandt
- Heinrich-Lanz-Centre for Digital Health, Department of Biomedical Informatics, University Medicine Mannheim, Mannheim, Germany
| | - Carmen Schade-Brittinger
- Chair of the Coordinating Centre for Clinical Trials, Philipps University Marburg, Marburg, Germany
| | - Michael von Wagner
- Executive Department for Medical IT-Systems and Digitalisation, University Hospital Frankfurt, Frankfurt, Germany
| | - Dennis Kadioglu
- Medical Informatics Group, University Hospital Frankfurt, Frankfurt, Germany
| | - Katharina Schubert
- Central German Competence Network for Rare Diseases, University Hospitals Magdeburg & Halle, Germany
| | - Min Ae Lee-Kirsch
- University Centre for Rare Diseases, University Hospital Carl Gustav Carus Dresden, Dresden, Germany
| | - Bernhard K Kraemer
- Mannheim Centre for Rare Diseases, University Medicine Mannheim, Medical Faculty Mannheim of the University of Heidelberg, Mannheim, Germany
| | - Beate Winner
- Centre for Rare Diseases Erlangen, University Hospital Erlangen, Erlangen, Germany
| | - Tobias Mueller
- Centre for undiagnosed and rare diseases, University Hospital Gießen and Marburg, Marburg, Germany
| | - Juergen R Schaefer
- Centre for undiagnosed and rare diseases, University Hospital Gießen and Marburg, Marburg, Germany
| | - Thomas O F Wagner
- Frankfurt Reference Centre for Rare Diseases, University Hospital Frankfurt, Frankfurt, Germany
| | - Leena Bruckner-Tuderman
- Freiburg Centre for Rare Diseases, Medical Faculty and Medical Centre - University of Freiburg, Freiburg, Germany
| | - Oliver Tuescher
- Centre for Rare Diseases of the Nervous System, University Medicine Mainz, Mainz, Germany
| | - Martin Boeker
- Institute of Medical Biometry and Statistics, Medical Faculty and Medical Centre - University of Freiburg, Freiburg, Germany
| | - Holger Storf
- Medical Informatics Group, University Hospital Frankfurt, Frankfurt, Germany
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Hassa T, de Jel E, Tuescher O, Schmidt R, Schoenfeld MA. Functional networks of motor inhibition in conversion disorder patients and feigning subjects. Neuroimage Clin 2016; 11:719-727. [PMID: 27330971 PMCID: PMC4900693 DOI: 10.1016/j.nicl.2016.05.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Revised: 04/24/2016] [Accepted: 05/16/2016] [Indexed: 11/24/2022]
Abstract
The neural correlates of motor inhibition leading to paresis in conversion disorder are not well known. The key question is whether they are different of those of normal subjects feigning the symptoms. Thirteen conversion disorder patients with hemiparesis and twelve healthy controls were investigated using functional magnetic resonance tomography under conditions of passive motor stimulation of the paretic/feigned paretic and the non-paretic hand. Healthy controls were also investigated in a non-feigning condition. During passive movement of the affected right hand conversion disorder patients exhibited activations in the bilateral triangular part of the inferior frontal gyri (IFG), with a left side dominance compared to controls in non-feigning condition. Feigning controls revealed for the same condition a weak unilateral activation in the right triangular part of IFG and an activity decrease in frontal midline areas, which couldn't be observed in patients. The results suggest that motor inhibition in conversion disorder patients is mediated by the IFG that was also involved in inhibition processes in normal subjects. The activity pattern in feigning controls resembled that of conversion disorder patients but with a clear difference in the medial prefrontal cortex. Healthy controls showed decreased activity in this region during feigning compared to non-feigning conditions suggesting a reduced sense of self-agency during feigning. Remarkably, no activity differences could be observed in medial prefrontal cortex for patients vs healthy controls in feigning or non-feigning conditions suggesting self-agency related activity in patients to be in between those of non-feigning and feigning healthy subjects.
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Affiliation(s)
- Thomas Hassa
- Lurija Institute for Rehabilitation and Health Sciences, Allensbach, Germany; Neurological Rehabilitation Center Kliniken Schmieder, Allensbach, Germany.
| | - Esther de Jel
- Department of Psychology, University of Konstanz, Germany
| | - Oliver Tuescher
- Department of Psychiatry and Psychotherapy, University Medical Center of the Johannes Gutenberg University Mainz, Germany
| | - Roger Schmidt
- Department of Psychology, University of Konstanz, Germany; Department of Psychotherapeutic Neurology, Neurological Rehabilitation Center Kliniken Schmieder, Konstanz and Gailingen, Germany
| | - Mircea Ariel Schoenfeld
- Neurological Rehabilitation Center Kliniken Schmieder, Allensbach, Germany; Department of Neurology, Otto-von-Guericke-University Magdeburg, Germany; Leibniz-Institute for Neurobiology, Magdeburg, Germany
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7
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Perez DL, Vago DR, Pan H, Root J, Tuescher O, Fuchs BH, Leung L, Epstein J, Cain NM, Clarkin JF, Lenzenweger MF, Kernberg OF, Levy KN, Silbersweig DA, Stern E. Frontolimbic neural circuit changes in emotional processing and inhibitory control associated with clinical improvement following transference-focused psychotherapy in borderline personality disorder. Psychiatry Clin Neurosci 2016; 70:51-61. [PMID: 26289141 PMCID: PMC4718821 DOI: 10.1111/pcn.12357] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [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: 05/09/2015] [Revised: 08/03/2015] [Accepted: 08/09/2015] [Indexed: 12/30/2022]
Abstract
AIMS Borderline personality disorder (BPD) is characterized by self-regulation deficits, including impulsivity and affective lability. Transference-focused psychotherapy (TFP) is an evidence-based treatment proven to reduce symptoms across multiple cognitive-emotional domains in BPD. This pilot study aimed to investigate neural activation associated with, and predictive of, clinical improvement in emotional and behavioral regulation in BPD following TFP. METHODS BPD subjects (n = 10) were scanned pre- and post-TFP treatment using a within-subjects design. A disorder-specific emotional-linguistic go/no-go functional magnetic resonance imaging paradigm was used to probe the interaction between negative emotional processing and inhibitory control. RESULTS Analyses demonstrated significant treatment-related effects with relative increased dorsal prefrontal (dorsal anterior cingulate, dorsolateral prefrontal, and frontopolar cortices) activation, and relative decreased ventrolateral prefrontal cortex and hippocampal activation following treatment. Clinical improvement in constraint correlated positively with relative increased left dorsal anterior cingulate cortex activation. Clinical improvement in affective lability correlated positively with left posterior-medial orbitofrontal cortex/ventral striatum activation, and negatively with right amygdala/parahippocampal activation. Post-treatment improvements in constraint were predicted by pre-treatment right dorsal anterior cingulate cortex hypoactivation, and pre-treatment left posterior-medial orbitofrontal cortex/ventral striatum hypoactivation predicted improvements in affective lability. CONCLUSIONS These preliminary findings demonstrate potential TFP-associated alterations in frontolimbic circuitry and begin to identify neural mechanisms associated with a psychodynamically oriented psychotherapy.
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Affiliation(s)
- David L Perez
- Functional Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Boston, USA
| | - David R Vago
- Functional Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Boston, USA
| | - Hong Pan
- Functional Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Boston, USA.,Department of Radiology, Harvard Medical School, Brigham and Women's Hospital, Boston, USA
| | - James Root
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Oliver Tuescher
- Department of Neurology, University Medical Center Freiburg, Freiburg im Breisgau, Germany.,Department of Psychiatry and Psychotherapy, University Medical Centre Mainz, Mainz, Germany
| | - Benjamin H Fuchs
- Functional Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Boston, USA
| | - Lorene Leung
- Functional Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Boston, USA
| | - Jane Epstein
- Functional Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Boston, USA
| | - Nicole M Cain
- Weill Cornell Medical College, Department of Psychiatry, Cornell University, New York, USA
| | - John F Clarkin
- Weill Cornell Medical College, Department of Psychiatry, Cornell University, New York, USA
| | - Mark F Lenzenweger
- Weill Cornell Medical College, Department of Psychiatry, Cornell University, New York, USA.,Department of Psychology, The State University of New York at Binghamton, Binghamton, USA
| | - Otto F Kernberg
- Weill Cornell Medical College, Department of Psychiatry, Cornell University, New York, USA
| | - Kenneth N Levy
- Weill Cornell Medical College, Department of Psychiatry, Cornell University, New York, USA
| | - David A Silbersweig
- Functional Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Boston, USA.,Department of Neurology, Brigham and Women's Hospital, Boston, USA
| | - Emily Stern
- Functional Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Boston, USA.,Department of Radiology, Harvard Medical School, Brigham and Women's Hospital, Boston, USA
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8
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Perez DL, Pan H, Weisholtz DS, Root JC, Tuescher O, Fischer DB, Butler T, Vago DR, Isenberg N, Epstein J, Landa Y, Smith TE, Savitz AJ, Silbersweig DA, Stern E. Altered threat and safety neural processing linked to persecutory delusions in schizophrenia: a two-task fMRI study. Psychiatry Res 2015; 233. [PMID: 26208746 PMCID: PMC5003172 DOI: 10.1016/j.pscychresns.2015.06.002] [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] [Indexed: 12/15/2022]
Abstract
Persecutory delusions are a clinically important symptom in schizophrenia associated with social avoidance and increased violence. Few studies have investigated the neurobiology of persecutory delusions, which is a prerequisite for developing novel treatments. The aim of this two-paradigm functional magnetic resonance imaging (fMRI) study is to characterize social "real world" and linguistic threat brain activations linked to persecutory delusions in schizophrenia (n=26) using instructed-fear/safety and emotional word paradigms. Instructed-fear/safety activations correlated to persecutory delusion severity demonstrated significant increased lateral orbitofrontal cortex and visual association cortex activations for the instructed-fear vs. safety and instructed-fear vs. baseline contrasts; decreased lateral orbitofrontal cortex and ventral occipital-temporal cortex activations were observed for the instructed-safety stimuli vs. baseline contrast. The salience network also showed divergent fear and safety cued activations correlated to persecutory delusions. Emotional word paradigm analyses showed positive correlations between persecutory delusion severity and left-lateralized linguistic and hippocampal-parahippocampal activations for the threat vs. neutral word contrast. Visual word form area activations correlated positively with persecutory delusions for both threat and neutral word vs. baseline contrasts. This study links persecutory delusions to enhanced neural processing of threatening stimuli and decreased processing of safety cues, and helps elucidate systems-level activations associated with persecutory delusions in schizophrenia.
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Affiliation(s)
- David L. Perez
- Functional Neuroimaging Laboratory, Brigham and Women’s Hospital, Harvard Medical School, Department of Psychiatry, Chestnut Hill, MA, USA
| | - Hong Pan
- Functional Neuroimaging Laboratory, Brigham and Women’s Hospital, Harvard Medical School, Department of Psychiatry, Chestnut Hill, MA, USA,Brigham and Women’s Hospital, Department of Radiology, Harvard Medical School, Boston, MA, USA
| | - Daniel S. Weisholtz
- Functional Neuroimaging Laboratory, Brigham and Women’s Hospital, Harvard Medical School, Department of Psychiatry, Chestnut Hill, MA, USA,Brigham and Women’s Hospital, Department of Neurology, Boston, MA, USA
| | - James C. Root
- Memorial Sloan Kettering Cancer Center, Department of Psychiatry and Behavioral Sciences, New York, NY, USA
| | - Oliver Tuescher
- University Medical Center Freiburg, Department of Neurology, Freiburg im Breisgau, Germany,University Medical Centre Mainz, Department of Psychiatry and Psychotherapy, Mainz, Germany
| | - David B. Fischer
- Functional Neuroimaging Laboratory, Brigham and Women’s Hospital, Harvard Medical School, Department of Psychiatry, Chestnut Hill, MA, USA
| | - Tracy Butler
- Langone Medical Center, New York University School of Medicine, New York, NY, USA
| | - David R. Vago
- Functional Neuroimaging Laboratory, Brigham and Women’s Hospital, Harvard Medical School, Department of Psychiatry, Chestnut Hill, MA, USA
| | - Nancy Isenberg
- Neuroscience Institute, Virginia Mason Medical Center, Seattle, WA, USA
| | - Jane Epstein
- Functional Neuroimaging Laboratory, Brigham and Women’s Hospital, Harvard Medical School, Department of Psychiatry, Chestnut Hill, MA, USA
| | - Yulia Landa
- Weill Cornell Medical Center, Department of Psychiatry, New York, NY, USA
| | - Thomas E. Smith
- New York State Psychiatric Institute, Columbia University, New York, NY, USA
| | - Adam J. Savitz
- Weill Cornell Medical Center, Department of Psychiatry, New York, NY, USA
| | - David A. Silbersweig
- Functional Neuroimaging Laboratory, Brigham and Women’s Hospital, Harvard Medical School, Department of Psychiatry, Chestnut Hill, MA, USA,Brigham and Women’s Hospital, Department of Neurology, Boston, MA, USA
| | - Emily Stern
- Functional Neuroimaging Laboratory, Brigham and Women's Hospital, Harvard Medical School, Department of Psychiatry, 824 Boylston Street, Chestnut Hill, MA 02467, USA; Brigham and Women's Hospital, Department of Radiology, Harvard Medical School, Boston, MA, USA.
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9
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Scheel CN, Schneid EM, Tuescher O, Lieb K, Tuschen-Caffier B, Jacob GA. Effects of Shame Induction in Borderline Personality Disorder. Cogn Ther Res 2013. [DOI: 10.1007/s10608-013-9567-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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10
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Matthies S, Rüsch N, Weber M, Lieb K, Philipsen A, Tuescher O, Ebert D, Hennig J, van Elst LT. Small amygdala-high aggression? The role of the amygdala in modulating aggression in healthy subjects. World J Biol Psychiatry 2012; 13:75-81. [PMID: 22256828 DOI: 10.3109/15622975.2010.541282] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [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: 01/18/2023]
Abstract
OBJECTIVE Several lines of evidence suggest an association between the amygdala and the modulation of aggressive behaviour. Previous morphometric brain imaging studies have focused on the role of the amygdala in the context of pathologic neuropsychiatric conditions like depression, personality disorders, and dysphoric and aggressive behaviour in epilepsy. In order to better understand the physiological role of the amygdala in modulating aggressive behaviour we investigated the relationship between amygdala volumes and lifetime aggression in healthy subjects. METHODS Morphometric brain scans were obtained in 20 healthy volunteers. Amygdala volumes were measured by manually outlining the boundaries of the structure following a well established and validated protocol. Careful psychiatric and psychometric assessment was done to exclude any psychiatric disorder and to assess lifetime aggressiveness with an established and validated psychometric instrument (i.e., Life History of Aggression Assessment (LHA)). RESULTS All volunteers scored in the normal range of lifetime aggression. Volunteers with higher aggression scores displayed a 16-18% reduction of amygdala volumes. There was a highly significant negative correlation between amygdala volumes and trait aggression. CONCLUSION The extent of volumetric differences in this study is remarkable and suggests that amygdala volumes might be a surrogate marker for the personality property of aggressiveness in healthy human beings.
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Affiliation(s)
- Swantje Matthies
- Department of Psychiatry & Psychotherapy, University Medical Centre Freiburg, Freiburg, Germany
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11
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Tuescher O, Protopopescu X, Pan H, Cloitre M, Butler T, Goldstein M, Root JC, Engelien A, Furman D, Silverman M, Yang Y, Gorman J, LeDoux J, Silbersweig D, Stern E. Differential activity of subgenual cingulate and brainstem in panic disorder and PTSD. J Anxiety Disord 2011; 25:251-7. [PMID: 21075593 PMCID: PMC4096628 DOI: 10.1016/j.janxdis.2010.09.010] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.7] [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: 06/17/2010] [Revised: 08/25/2010] [Accepted: 09/10/2010] [Indexed: 01/04/2023]
Abstract
Most functional neuroimaging studies of panic disorder (PD) have focused on the resting state, and have explored PD in relation to healthy controls rather than in relation to other anxiety disorders. Here, PD patients, posttraumatic stress disorder (PTSD) patients, and healthy control subjects were studied with functional magnetic resonance imaging utilizing an instructed fear conditioning paradigm incorporating both Threat and Safe conditions. Relative to PTSD and control subjects, PD patients demonstrated significantly less activation to the Threat condition and increased activity to the Safe condition in the subgenual cingulate, ventral striatum and extended amygdala, as well as in midbrain periaquaeductal grey, suggesting abnormal reactivity in this key region for fear expression. PTSD subjects failed to show the temporal pattern of activity decrease found in control subjects.
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Affiliation(s)
- Oliver Tuescher
- Functional Neuroimaging Laboratory, Department of Psychiatry, Weill Medical College of Cornell University, United States.
| | - Xenia Protopopescu
- Functional Neuroimaging Laboratory, Department of Psychiatry, Weill Medical College of Cornell University, The Rockefeller University Laboratory of Neuroendocrinology
| | - Hong Pan
- Functional Neuroimaging Laboratory, Department of Psychiatry, Weill Medical College of Cornell University, Department of Psychiatry, Brigham & Women’s Hospital, Harvard University Medical School, Boston
| | - Marylene Cloitre
- NYU Child Studies Center, New York University School of Medicine
| | - Tracy Butler
- Functional Neuroimaging Laboratory, Department of Psychiatry, Weill Medical College of Cornell University
| | - Martin Goldstein
- Functional Neuroimaging Laboratory, Department of Psychiatry, Weill Medical College of Cornell University, Mount Sinai School of Medicine
| | - James C. Root
- Functional Neuroimaging Laboratory, Department of Psychiatry, Weill Medical College of Cornell University
| | - Almut Engelien
- Functional Neuroimaging Laboratory, Department of Psychiatry, Weill Medical College of Cornell University, Department of Psychiatry and IZKF Münster, University of Münster
| | - Daniella Furman
- Functional Neuroimaging Laboratory, Department of Psychiatry, Weill Medical College of Cornell University
| | - Michael Silverman
- Functional Neuroimaging Laboratory, Department of Psychiatry, Weill Medical College of Cornell University, Mount Sinai School of Medicine
| | - Yihong Yang
- Functional Neuroimaging Laboratory, Department of Psychiatry, Weill Medical College of Cornell University
| | - Jack Gorman
- Comprehensive NeuroScience, Inc., White Plains, New York
| | | | - David Silbersweig
- Functional Neuroimaging Laboratory, Department of Psychiatry, Weill Medical College of Cornell University, Department of Psychiatry, Brigham & Women’s Hospital, Harvard University Medical School, Boston
| | - Emily Stern
- Functional Neuroimaging Laboratory, Department of Psychiatry, Weill Medical College of Cornell University, Department of Psychiatry, Brigham & Women’s Hospital, Harvard University Medical School, Boston
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12
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Silbersweig D, Clarkin JF, Goldstein M, Kernberg OF, Tuescher O, Levy KN, Brendel G, Pan H, Beutel M, Pavony MT, Epstein J, Lenzenweger MF, Thomas KM, Posner MI, Stern E. Failure of Frontolimbic Inhibitory Function in the Context of Negative Emotion in Borderline Personality Disorder. FOC 2010. [DOI: 10.1176/foc.8.2.foc250] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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13
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Tuescher O, Bader K, Kamphausen S, Maier S, Sebastian A, Jacob G, van Elst LT, Lieb K. Emotional Modulation of Impulse-control in Borderline Personality Disorder. Neuroimage 2009. [DOI: 10.1016/s1053-8119(09)71995-0] [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: 10/20/2022] Open
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14
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Cunningham-Bussel AC, Root JC, Butler T, Tuescher O, Pan H, Epstein J, Weisholtz DS, Pavony M, Silverman ME, Goldstein MS, Altemus M, Cloitre M, LeDoux J, McEwen B, Stern E, Silbersweig D. Diurnal cortisol amplitude and fronto-limbic activity in response to stressful stimuli. Psychoneuroendocrinology 2009; 34:694-704. [PMID: 19135805 PMCID: PMC4250041 DOI: 10.1016/j.psyneuen.2008.11.011] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [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: 09/15/2007] [Revised: 11/25/2008] [Accepted: 11/25/2008] [Indexed: 10/21/2022]
Abstract
The development and exacerbation of many psychiatric and neurologic conditions are associated with dysregulation of the hypothalamic pituitary adrenal (HPA) axis as measured by aberrant levels of cortisol secretion. Here we report on the relationship between the amplitude of diurnal cortisol secretion, measured across 3 typical days in 18 healthy individuals, and blood oxygen level dependant (BOLD) response in limbic fear/stress circuits, elicited by in-scanner presentation of emotionally negative stimuli, specifically, images of the World Trade Center (WTC) attack. Results indicate that subjects who secrete a greater amplitude of cortisol diurnally demonstrate less brain activation in limbic regions, including the amygdala and hippocampus/parahippocampus, and hypothalamus during exposure to traumatic WTC-related images. Such initial findings can begin to link our understanding, in humans, of the relationship between the diurnal amplitude of a hormone integral to the stress response, and those neuroanatomical regions that are implicated as both modulating and being modulated by that response.
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Affiliation(s)
- Amy C. Cunningham-Bussel
- Functional Neuroimaging Laboratory, Department of Psychiatry, Box 140, Rm 1302, Weill Cornell Medical College, 1300 York Avenue, New York, NY 10065, United States,Corresponding author: Tel.: +1 212 746 8025; fax: +1 212 746 5818. (A.C. Cunningham-Bussel)
| | - James C. Root
- Functional Neuroimaging Laboratory, Department of Psychiatry, Box 140, Rm 1302, Weill Cornell Medical College, 1300 York Avenue, New York, NY 10065, United States
| | - Tracy Butler
- Functional Neuroimaging Laboratory, Department of Psychiatry, Box 140, Rm 1302, Weill Cornell Medical College, 1300 York Avenue, New York, NY 10065, United States
| | - Oliver Tuescher
- Functional Neuroimaging Laboratory, Department of Psychiatry, Box 140, Rm 1302, Weill Cornell Medical College, 1300 York Avenue, New York, NY 10065, United States,Department of Neurology, University of Freiburg, United States
| | - Hong Pan
- Functional Neuroimaging Laboratory, Department of Psychiatry, Box 140, Rm 1302, Weill Cornell Medical College, 1300 York Avenue, New York, NY 10065, United States,Department of Psychiatry, Brigham and Women’s/Faulkner Hospitals, Harvard Medical School, United States
| | - Jane Epstein
- Functional Neuroimaging Laboratory, Department of Psychiatry, Box 140, Rm 1302, Weill Cornell Medical College, 1300 York Avenue, New York, NY 10065, United States,Department of Psychiatry, Brigham and Women’s/Faulkner Hospitals, Harvard Medical School, United States
| | - Daniel S. Weisholtz
- Functional Neuroimaging Laboratory, Department of Psychiatry, Box 140, Rm 1302, Weill Cornell Medical College, 1300 York Avenue, New York, NY 10065, United States
| | - Michelle Pavony
- Functional Neuroimaging Laboratory, Department of Psychiatry, Box 140, Rm 1302, Weill Cornell Medical College, 1300 York Avenue, New York, NY 10065, United States
| | - Michael E. Silverman
- Mt. Sinai School of Medicine, One Gustave L. Levy Place, Box 1230, New York, NY 10029, United States
| | - Martin S. Goldstein
- Mt. Sinai School of Medicine, One Gustave L. Levy Place, Box 1230, New York, NY 10029, United States
| | - Margaret Altemus
- Functional Neuroimaging Laboratory, Department of Psychiatry, Box 140, Rm 1302, Weill Cornell Medical College, 1300 York Avenue, New York, NY 10065, United States
| | - Marylene Cloitre
- New York University School of Medicine, 550 First Avenue, New York, NY 10016, United States
| | - Joseph LeDoux
- Center for Neural Science, New York University, 4 Washington Place, Room 809, New York, NY 10003-6621, United States
| | - Bruce McEwen
- The Rockefeller University, 1230 York Avenue, New York, NY 10021, United States
| | - Emily Stern
- Functional Neuroimaging Laboratory, Department of Psychiatry, Box 140, Rm 1302, Weill Cornell Medical College, 1300 York Avenue, New York, NY 10065, United States,Department of Psychiatry, Brigham and Women’s/Faulkner Hospitals, Harvard Medical School, United States
| | - David Silbersweig
- Functional Neuroimaging Laboratory, Department of Psychiatry, Box 140, Rm 1302, Weill Cornell Medical College, 1300 York Avenue, New York, NY 10065, United States,Department of Psychiatry, Brigham and Women’s/Faulkner Hospitals, Harvard Medical School, United States
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15
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Protopopescu X, Tuescher O, Pan H, Epstein J, Root J, Chang L, Altemus M, Polanecsky M, McEwen B, Stern E, Silbersweig D. Toward a functional neuroanatomy of premenstrual dysphoric disorder. J Affect Disord 2008; 108:87-94. [PMID: 18031826 DOI: 10.1016/j.jad.2007.09.015] [Citation(s) in RCA: 88] [Impact Index Per Article: 5.5] [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] [Received: 04/17/2007] [Revised: 09/07/2007] [Accepted: 09/26/2007] [Indexed: 10/22/2022]
Abstract
BACKGROUND Premenstrual dysphoric disorder (PMDD) is a prevalent disorder in the spectrum of affective illness, and is associated with significant morbidity. The neurobiology of this underdiagnosed and undertreated illness is poorly understood. A functional magnetic resonance imaging (fMRI) probe of fronto-limbic function was used to advance understanding of PMDD pathophysiology. METHODS We applied BOLD fMRI and Statistical Parametric Mapping to study neural response to emotional words in the context of an emotional Go/NoGo inhibitory control task. We examined alterations in this response across the menstrual cycle, in the premenstrual (late luteal) phase and the postmenstrual (late follicular) phase. RESULTS In the premenstrual (vs. postmenstrual) phase, PMDD subjects, compared with asymptomatic subjects, showed an increased amygdala response to negative vs. neutral stimuli, and a decreased ventral striatum response to positive vs. neutral stimuli. PMDD subjects failed to show the asymptomatic subjects' patterns of increased medial and decreased lateral orbitofrontal cortex (OFC) response to negative vs. neutral stimuli in the premenstrual vs. postmenstrual phase. This decreased premenstrual medial OFC response to negative stimuli in PMDD subjects was further enhanced in the context of behavioral inhibition. LIMITATIONS Further studies with larger numbers of subjects are needed. CONCLUSIONS The results support a neurobiological model of enhanced negative emotional processing, diminished positive emotional processing, and diminished top-down control of limbic activity in PMDD during the premenstrual phase. These findings provide a basis for a neurocircuitry model of PMDD, and have implications for studies of mood/emotional regulation across the human menstrual cycle in health and disease.
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Affiliation(s)
- Xenia Protopopescu
- Functional Neuroimaging Laboratory, Department of Psychiatry, Weill Medical College of Cornell University, New York, NY 10021, United States.
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16
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Silbersweig D, Clarkin JF, Goldstein M, Kernberg OF, Tuescher O, Levy KN, Brendel G, Pan H, Beutel M, Pavony MT, Epstein J, Lenzenweger MF, Thomas KM, Posner MI, Stern E. Failure of frontolimbic inhibitory function in the context of negative emotion in borderline personality disorder. Am J Psychiatry 2007; 164:1832-41. [PMID: 18056238 DOI: 10.1176/appi.ajp.2007.06010126] [Citation(s) in RCA: 238] [Impact Index Per Article: 14.0] [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: 11/30/2022]
Abstract
OBJECTIVE The authors sought to test the hypothesis that in patients with borderline personality disorder, the ventromedial prefrontal cortex and associated regions would not be activated during a task requiring motor inhibition in the setting of negative emotion. Such a finding would provide a plausible neural basis for the difficulty borderline patients have in modulating their behavior during negative emotional states and a potential marker for treatment interventions. METHOD A specifically designed functional magnetic resonance imaging (fMRI) activation probe was used, with statistical parametric mapping analyses, to test hypotheses concerning decreased prefrontal inhibitory function in the context of negative emotion in patients with borderline personality disorder (N=16) and healthy comparison subjects (N=14). 3-T fMRI scanning was used to study brain activity while participants performed an emotional linguistic go/no-go task. RESULTS Analyses confirmed that under conditions associated with the interaction of behavioral inhibition and negative emotion, borderline patients showed relatively decreased ventromedial prefrontal activity (including medial orbitofrontal and subgenual anterior cingulate) compared with healthy subjects. In borderline patients, under conditions of behavioral inhibition in the context of negative emotion, decreasing ventromedial prefrontal and increasing extended amygdalar-ventral striatal activity correlated highly with measures of decreased constraint and increased negative emotion, respectively. CONCLUSIONS These findings suggest specific frontolimbic neural substrates associated with core clinical features of emotional and behavioral dyscontrol in borderline personality disorder.
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Affiliation(s)
- David Silbersweig
- Department of Psychiatry, Box 140, Weill Medical College of Cornell University, 1300 York Avenue, New York, NY 10021, USA.
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17
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Goldstein M, Brendel G, Tuescher O, Pan H, Epstein J, Beutel M, Yang Y, Thomas K, Levy K, Silverman M, Clarkin J, Posner M, Kernberg O, Stern E, Silbersweig D. Neural substrates of the interaction of emotional stimulus processing and motor inhibitory control: An emotional linguistic go/no-go fMRI study. Neuroimage 2007; 36:1026-40. [PMID: 17509899 DOI: 10.1016/j.neuroimage.2007.01.056] [Citation(s) in RCA: 136] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2006] [Revised: 12/25/2006] [Accepted: 01/24/2007] [Indexed: 10/23/2022] Open
Abstract
Neural substrates of behavioral inhibitory control have been probed in a variety of animal model, physiologic, behavioral, and imaging studies, many emphasizing the role of prefrontal circuits. Likewise, the neurocircuitry of emotion has been investigated from a variety of perspectives. Recently, neural mechanisms mediating the interaction of emotion and behavioral regulation have become the focus of intense study. To further define neurocircuitry specifically underlying the interaction between emotional processing and response inhibition, we developed an emotional linguistic go/no-go fMRI paradigm with a factorial block design which joins explicit inhibitory task demand (i.e., go or no-go) with task-unrelated incidental emotional stimulus valence manipulation, to probe the modulation of the former by the latter. In this study of normal subjects focusing on negative emotional processing, we hypothesized activity changes in specific frontal neocortical and limbic regions reflecting modulation of response inhibition by negative stimulus processing. We observed common fronto-limbic activations (including orbitofrontal cortical and amygdalar components) associated with the interaction of emotional stimulus processing and response suppression. Further, we found a distributed cortico-limbic network to be a candidate neural substrate for the interaction of negative valence-specific processing and inhibitory task demand. These findings have implications for elucidating neural mechanisms of emotional modulation of behavioral control, with relevance to a variety of neuropsychiatric disease states marked by behavioral dysregulation within the context of negative emotional processing.
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Affiliation(s)
- Martin Goldstein
- Department of Neurology, Mount Sinai School of Medicine, One Gustave L. Levy Place, New York, NY 10021, USA.
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18
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Protopopescu X, Pan H, Tuescher O, Cloitre M, Goldstein M, Engelien A, Yang Y, Gorman J, LeDoux J, Stern E, Silbersweig D. Increased brainstem volume in panic disorder: a voxel-based morphometric study. Neuroreport 2006; 17:361-3. [PMID: 16514359 DOI: 10.1097/01.wnr.0000203354.80438.1] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Neurocircuitry models of panic disorder have hypothesized that the panic attack itself stems from loci in the brainstem including the ascending reticular system and respiratory and cardiovascular control centers. Voxel-based morphometry with acobian modulation was used to examine gray matter volume changes in 10 panic disorder patients and 23 healthy controls. The panic disorder patients had a relatively increased gray matter volume in the midbrain and rostral pons of the brainstem. Increased ventral hippocampal and decreased regional prefrontal cortex volumes were also noted at a lower significance threshold. This finding has implications for pathophysiologic models of panic disorder, and provides structural evidence for the role of the brainstem in neurocircuitry models of panic disorder.
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Affiliation(s)
- Xenia Protopopescu
- Functional Neuroimaging Laboratory, Department of Psychiatry, Weill Medical College of Cornell University, New York, New York, USA
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19
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Protopopescu X, Pan H, Altemus M, Tuescher O, Polanecsky M, McEwen B, Silbersweig D, Stern E. Orbitofrontal cortex activity related to emotional processing changes across the menstrual cycle. Proc Natl Acad Sci U S A 2005; 102:16060-5. [PMID: 16247013 PMCID: PMC1276043 DOI: 10.1073/pnas.0502818102] [Citation(s) in RCA: 161] [Impact Index Per Article: 8.5] [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: 04/05/2005] [Accepted: 09/15/2005] [Indexed: 11/18/2022] Open
Abstract
The orbitofrontal cortex (OFC) has been implicated in the representation of emotional stimuli, assignment of emotional valence/salience to stimuli, stimulus-reinforcement association learning, motivation, and socio-emotional control. Using functional magnetic resonance imaging in female subjects without premenstrual mood symptoms, we found that OFC activity to emotional linguistic stimuli varies depending on the menstrual cycle phase. Specifically, anterior-medial OFC activity for negative vs. neutral stimuli was increased premenstrually and decreased postmenstrually. The inverse pattern was seen in the lateral OFC. These findings suggest that specific subregional OFC activity to emotional stimuli is modulated across the menstrual cycle. The data also demonstrate that menstrual cycle phase is an important consideration in further studies attempting to elucidate the neural substrates of affective representation.
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Affiliation(s)
- Xenia Protopopescu
- Functional Neuroimaging Laboratory, Department of Obstetrics and Gynecology, Weill Medical College of Cornell University, New York, NY 10021, USA
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20
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Butler T, Pan H, Epstein J, Protopopescu X, Tuescher O, Goldstein M, Cloitre M, Yang Y, Phelps E, Gorman J, Ledoux J, Stern E, Silbersweig D. Fear-related activity in subgenual anterior cingulate differs between men and women. Neuroreport 2005; 16:1233-6. [PMID: 16012355 DOI: 10.1097/00001756-200508010-00020] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Functional magnetic resonance imaging in association with an instructed fear/anticipatory anxiety paradigm was used to explore sex differences in the human fear response. During anticipation of mild electrodermal stimulation, women, as compared with men, demonstrated increased activity in the subgenual anterior cingulate cortex and functionally related regions of the insula and brainstem. The subgenual anterior cingulate cortex is a region critical for emotional control implicated in the pathogenesis of psychiatric disease. Present findings suggest a contributory neural substrate for the greater susceptibility of women to anxiety and affective disorders, and emphasize the importance of considering participant sex when designing and interpreting functional neuroimaging studies.
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Affiliation(s)
- Tracy Butler
- Functional Neuroimaging Laboratory, Weill Medical College of Cornell University, New York, New York, USA.
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21
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Protopopescu X, Pan H, Tuescher O, Cloitre M, Goldstein M, Engelien W, Epstein J, Yang Y, Gorman J, LeDoux J, Silbersweig D, Stern E. Differential time courses and specificity of amygdala activity in posttraumatic stress disorder subjects and normal control subjects. Biol Psychiatry 2005; 57:464-73. [PMID: 15737660 DOI: 10.1016/j.biopsych.2004.12.026] [Citation(s) in RCA: 213] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2004] [Revised: 12/01/2004] [Accepted: 12/13/2004] [Indexed: 10/25/2022]
Abstract
BACKGROUND Previous neuroimaging studies have demonstrated exaggerated amygdala responses to negative stimuli in posttraumatic stress disorder (PTSD). The time course of this amygdala response is largely unstudied and is relevant to questions of habituation and sensitization in PTSD exposure therapy. METHODS We applied blood oxygen level dependent functional magnetic resonance imaging and statistical parametric mapping to study amygdala responses to trauma-related and nontrauma-related emotional words in sexual/physical abuse PTSD and normal control subjects. We examined the time course of this response by separate analysis of early and late epochs. RESULTS PTSD versus normal control subjects have a relatively increased initial amygdala response to trauma-related negative, but not nontrauma-related negative, versus neutral stimuli. Patients also fail to show the normal patterns of sensitization and habituation to different categories of negative stimuli. These findings correlate with measured PTSD symptom severity. CONCLUSIONS Our results demonstrate differential time courses and specificity of amygdala response to emotional and control stimuli in PTSD and normal control subjects. This has implications for pathophysiologic models of PTSD and treatment response. The results also extend previous neuroimaging studies demonstrating relatively increased amygdala response in PTSD and expand these results to a largely female patient population probed with emotionally valenced words.
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Affiliation(s)
- Xenia Protopopescu
- Functional Neuroimaging Laboratory, Weill Medical College of Cornell University, New York, NY 10021, USA
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22
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Silverman ME, Tuescher O, Pan H, Zimmerman D, Protopopescu X, Goldstein M, Stern E, Silbersweig D. Anxiety and the search for safety: An fMRI study. J Vis 2004. [DOI: 10.1167/4.8.758] [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: 11/24/2022] Open
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