Gray matter reduction associated with emotion regulation in female outpatients with major depressive disorder: A voxel-based morphometry study

Objective

Though emotion dysregulation is the key feature in major depressive disorder, and structural changes in brain areas of depressed patients have been found, it is unknown how these regional volume alterations correlate with the ability to regulate emotion in the depressed population.

Method

We examined the gray matter concentration (GMC) and volume (GMV) in 17 depressed patients and 17 healthy volunteers using a voxel-based morphometry (VBM) study. Images were acquired using a 1.5 T MRI scanner, and were spatially normalized and segmented. Statistical comparisons were performed using the general linear model. The identified volumetric alterations in the depressed participants were correlated with their performance on an emotion regulation task that involved reduction of positive or negative emotions to emotional pictures that were selected according to their individual ratings.

Results

The depressed participants showed specific difficulty in regulating negative emotion, though not positive emotion, which was associated with reduced GMV and concentration in the anterior cingulate cortex (ACC) and the inferior orbitofrontal cortex (OFC). Decreased GMC in the superior temporal cortex was also found in people with major depressive disorder.

Conclusions

Abnormal structures in the ACC and OFC and the dysregulation of negative emotion may relate to the pathology of major depressive disorder.     

The contribution of threat probability estimates to reexperiencing symptoms: a prospective analog study

Background and objectives

Individuals with posttraumatic stress disorder (PTSD) are hypothesized to have a “sense of current threat.” Perceived threat from the environment (i.e., external threat), can lead to overestimating the probability of the traumatic event reoccurring (Ehlers &; Clark, 2000). However, it is unclear if external threat judgments are a pre-existing vulnerability for PTSD or a consequence of trauma exposure. We used trauma analog methodology to prospectively measure probability estimates of a traumatic event, and investigate how these estimates were related to cognitive processes implicated in PTSD development.

Methods

151 participants estimated the probability of being in car-accident related situations, watched a movie of a car accident victim, and then completed a measure of data-driven processing during the movie. One week later, participants re-estimated the probabilities, and completed measures of reexperiencing symptoms and symptom appraisals/reactions.

Results

Path analysis revealed that higher pre-existing probability estimates predicted greater data-driven processing which was associated with negative appraisals and responses to intrusions. Furthermore, lower pre-existing probability estimates and negative responses to intrusions were both associated with a greater change in probability estimates. Reexperiencing symptoms were predicted by negative responses to intrusions and, to a lesser degree, by greater changes in probability estimates.

Limitations

The undergraduate student sample may not be representative of the general public. The reexperiencing symptoms are less severe than what would be found in a trauma sample.

Conclusions

Threat estimates present both a vulnerability and a consequence of exposure to a distressing event. Furthermore, changes in these estimates are associated with cognitive processes implicated in PTSD.     

Is the association between various emotion-regulation skills and mental health mediated by the ability to modify emotions? Results from two cross-sectional studies

Background and objectives

In order to clarify mechanisms underlying the association between emotion regulation and psychopathology, we tested whether the ability to modify negative emotions mediates the associations of other emotion-regulation skills with psychopathological symptoms in two studies.

Methods

The first study included 151 college students; the second included 121 psychiatric inpatients. Bootstrapping-enhanced mediation analyses were utilized to assess associations between self-reports of emotion-regulation skills and psychopathology, as well as potential mediation effects.

Results

In both samples, the ability to modify emotions completely mediated the association between symptoms and skills for most skills, but not for the skill of accepting/tolerating negative emotions.

Limitations

Major limitations include the use of a cross-sectional design as well as exclusive use of self-report data.

Conclusions

The ability to modify negative emotions may be the common pathway by which many emotion-regulation skills exert their influence on mental health; however, the skill of accepting/tolerating negative emotions may be beneficial to mental health regardless of whether or not it facilitates modification of emotions.     

Contextual representations increase analogue traumatic intrusions: evidence against a dual-representation account of peri-traumatic processing

Background and objectives

Information processing accounts of post-traumatic stress disorder (PTSD) state that intrusive memories emerge due to a lack of integration between perceptual and contextual trauma representations in autobiographical memory. This hypothesis was tested experimentally using an analogue trauma paradigm in which participants viewed an aversive film designed to elicit involuntary recollections.

Method

Participants viewed scenes from the film either paired with contextual information or with the contextual information omitted. After viewing the film participants were asked to record for one week any involuntary intrusions for the film using a provided intrusions diary.

Results

The results revealed a significant increase in analogue intrusions for the film when viewed with contextual information in comparison to when the film was viewed with the contextual information omitted. In contrast there was no effect of contextual information on valence ratings or voluntary memory for the film, or on the reported vividness and emotionality of the intrusions.

Limitations

The analogue trauma paradigm may have failed to reproduce the effect of extreme stress on encoding that is postulated to occur during PTSD.

Conclusions

The findings have potential implications for trauma intervention as they suggest that the contextual understanding of a scene during encoding can be integral to the subsequent occurrence of traumatic intrusions. The pattern of results found in the study are inconsistent with dual-representation accounts of intrusive memory formation, and instead provide new evidence that contextual representations play a casual role in increasing the frequency of involuntary intrusions for traumatic material.     

How effective are acceptance strategies? A meta-analytic review of experimental results

Background and objectives

Experimental research on psychological acceptance strategies revealed discrepant results regarding superiority of these strategies compared to other emotion regulation strategies. A review examining results of experimental comparisons between acceptance and other emotion regulation strategies (e.g. suppression, distraction, reappraisal) is still missing. The present meta-analytic approach aims to fill this gap.

Method

A literature search was performed using PsychInfo and PubMed and effect sizes (ES; Hedge's g) were calculated.

Results

The search identified 30 relevant studies. Many studies reported that acceptance strategies were superior when compared to other emotion regulation strategies for the outcomes of pain tolerance, negative affect and believability of thoughts. Meta-analytic results replicate findings of primary studies for pain tolerance: A small to medium between-group ES was found favoring acceptance strategies (g = 0.43, p < 0.01, 95% CI[0.12, 0.73]). With respect to pain intensity and negative affect, meta-analysis did not show any significant differences between acceptance and other emotion regulation strategies.In sum, acceptance strategies proved to be superior to other emotion regulation strategies with respect to pain tolerance but not for pain intensity and negative affect.

Limitations

Future research should address which characteristics of participants lead to respond to either acceptance or to other emotion regulation strategies.

Conclusions

Acceptance strategies are at least as useful in treatments for chronic pain and depression as other emotion regulation strategies.     

Overgeneral memory in asylum seekers and refugees

Background and objectives

Studies in western samples have shown that post-traumatic stress disorder (PTSD) and depression are associated with overgeneral autobiographical memory retrieval. This study assesses whether this association extends to asylum seekers and refugees from diverse cultural backgrounds. We discuss implications for those providing testimony of their experiences when seeking asylum.

Method

38 asylum seekers and refugees were recruited through clinics and community groups. Clinical interviews assessed PTSD and depression and participants completed a test of autobiographical memory specificity.

Results

When accounting for omissions, participants with PTSD and depression recalled a lower proportion of specific memories. Those with PTSD also failed more frequently to report any memory.

Limitations

The sample did not permit separate evaluation of the effects of PTSD and depression on specificity.

Conclusions

Lower memory specificity observed in people experiencing PTSD and depression in western populations extends to asylum seekers and refugees from diverse cultural backgrounds. This study adds to the literature suggesting that being recognised as a refugee fleeing persecution is more difficult for those with post-traumatic symptoms and depression.     

Intrusive trauma recollections is associated with impairment of interference inhibition and psychomotor speed in PTSD

Background

Intrusive cognitions that enter consciousness involuntarily are prominent symptoms of posttraumatic stress disorder (PTSD). The present study aimed to identify neuropsychological mechanisms involved.

Method

Fifty PTSD outpatients and 50 healthy controls were tested using Finger Tapping, Simple and Choice Reaction Times and Stroop Tasks, to measure motor, psychomotor speed, response selection, and interference inhibition ability respectively.

Results

PTSD patients performed poorly in all tests, presumably owing to their generalized slowness of information processing and motor reaction. Psychomotor speed was a predictor of slowness and high error rate during the Stroop. Impaired inhibition, as measured by the interference index of the Stroop task, explained 9.7% of the predicated variance in frequency of re-experiencing PTSD symptoms and 23.5% of the predicated variance in augmentation of the interference response time.

Conclusion

Impaired interference control may be related to internal (re-experiencing) and external (sensory) stimuli that leads to cognitive deficits in PTSD patients.     

Perceived social support buffers the impact of PTSD symptoms on suicidal behavior: Implications into suicide resilience research

Background

A growing body of research has highlighted the importance of identifying resilience factors against suicidal behavior. However, no previous study has investigated potential resilience factors among individuals with Posttraumatic Stress Disorder (PTSD). The aim of this study was to examine whether perceived social support buffered the impact of PTSD symptoms on suicidal behavior.

Methods

Fifty-six individuals who had previously been exposed to a traumatic event and reported PTSD symptoms in the past month (n = 34, 60.7% participants met the full criteria for a current PTSD diagnosis) completed a range of self-report measures assessing PTSD symptoms, perceived social support and suicidal behavior. Hierarchical regression analyses were conducted to examine whether perceived social support moderates the effects of PTSD symptoms on suicidal behavior.

Results

The results showed that perceived social support moderated the impact of the number and severity of PTSD symptoms on suicidal behavior. For those who perceived themselves as having high levels of social support, an increased number and severity of PTSD symptoms were less likely to lead to suicidal behavior.

Conclusions

The current findings suggest that perceived social support might confer resilience to individuals with PTSD and counter the development of suicidal thoughts and behaviors. The milieu of social support potentially provides an area of further research and an important aspect to incorporate into clinical interventions for suicidal behavior in PTSD or trauma populations.     

Is there an all-embracing construct of emotion reactivity? Adaptation and validation of the emotion reactivity scale among a French-speaking community sample

Background

Emotion reactivity is defined as the extent to which an individual experiences emotions in response to a wide array of stimuli, intensely, and for a prolonged period. This construct is a key psychological factor in the development and maintenance of psychopathological disorders. The aim of the current study was to develop and validate a French version of the Emotion Reactivity Scale (ERS), which gauges three aspects of emotion reactivity: (1) emotional sensitivity, (2) emotional intensity, and (3) emotional persistence.

Method

The French ERS and both concurrent and divergent validated scales were administered to 258 participants from the community.

Results

Confirmatory factor analyses revealed good fit indices for: (1) a single-factor model, (2) a three-factor model, and (3) a hierarchical three-factor solution with a single-factor solution as a second-order latent variable for a generic construct of emotion reactivity. The French version of the Emotion Reactivity Scale also exhibits acceptable internal scale score reliability (total scale and subscales). Eventually, meaningful relationships were found between factors of emotion reactivity and depression, distinct aspects of impulsive behaviors, and maladaptive emotion regulation strategies.

Conclusion

Findings of the confirmatory factor analyses are consistent with previous studies suggesting that the ERS is mainly captured by a single major construct of emotion reactivity.     

Neural correlates of the individual emotional Stroop in borderline personality disorder

Objective

Emotional dysregulation is a key feature of borderline personality disorder (BPD) with altered inhibitory functions having suggested as being crucial. The anterior cingulate cortex and further prefrontal brain regions are crucial for response inhibition. The regulation of emotions is ensured via inhibitory control over the amygdala. The present study aimed to investigate neural correlates of response inhibition in BPD by using an emotional Stroop paradigm extending the task to word stimuli which were related to stressful life events.

Methods

Twenty BPD patients and 20 healthy controls underwent functional magnetic resonance imaging (fMRI) while performing the individual emotional Stroop task. A block design was used with the following word type conditions: neutral words, general negative words, and individual negative words. The individual negative words were recruited from a prior interview conducted with each participant.

Results

While BPD patients had overall slower reaction times in the Stroop task compared to healthy controls, there was no increased slowing with emotional interference. Controls exhibited significant fMRI blood oxygenation level-dependent signal increases in the anterior cingulate cortex as well as in frontal cortex contrasting generally negative vs. neutral and individual negative vs. neutral conditions, respectively. BPD patients did not show equivalent signal changes.

Conclusions

These results provide further evidence for a dysfunctional network of brain areas in BPD, including the ACC and frontal brain regions. These areas are crucial for the regulation of stress and emotions, the core problems of BPD patients.     

Not so close but still extremely loud: Recollection of the world trade center terror attack and previous hurricanes moderates the association between exposure to hurricane sandy and posttraumatic Stress Symptoms

Background

The present study examined whether recollections of the World Trade Center (WTC) terror attack and previous hurricanes moderated the relationship between exposure to Hurricane Sandy and related posttraumatic stress disorder (PTSD) symptoms.

Methods

An online sample of 1000 participants from affected areas completed self-report questionnaires a month after Hurricane Sandy hit the East Coast of the United States. Participants reported their exposure to Hurricane Sandy, their PTSD symptoms, and recollections of the WTC terror attack and previous hurricanes elicited due to Hurricane Sandy.

Results

Exposure to Hurricane Sandy was related to PTSD symptoms among those with high level of recollections of the WTC terror attack and past hurricanes, but not among those with low level of recollections.

Conclusions

The aftermath of exposure to Hurricane Sandy is related not only to exposure, but also to its interaction with recollections of past traumas. These findings have theoretical and practical implications for practitioners and health policy makers in evaluating and interpreting the impact of past memories on future natural disasters. This may help in intervention plans of social and psychological services.     

Biased processing of neutral facial expressions is associated with depressive symptoms and suicide ideation in individuals at risk for major depression due to affective temperaments

Background

To elucidate whether abnormal facial emotion processing represents a vulnerability factor for major depression, some studies have explored deficits in emotion processing in individuals at familial risk for depression. Nevertheless, these studies have provided mixed results. However, no studies on facial emotion processing have been conducted in at-risk samples with early or attenuated signs of depression, such as individuals with affective temperaments who are characterized by subclinical depressive moods, cognitions, and behaviors that resemble those that occur in patients with major depression.

Methods

Presence and severity of depressive symptoms, affective temperaments, death wishes, suicidal ideation, and suicide planning were explored in 231 participants with a mean age 39.9 years (SD = 14.57). Participants also completed an emotion recognition task with 80 emotional face stimuli expressing fear, angry, sad, happy, and neutral facial expressions.

Results

Participants with higher scores on affective temperamental dimensions containing a depressive component, compared to those with lower scores, reported more depressive symptoms, death wishes, suicide ideation and planning, and an increased tendency to interpret neutral facial expressions as emotional facial expressions; in particular, neutral facial expressions were interpreted more negatively, mostly as sad facial expressions. However, there were no group differences in identification and discrimination of facial expressions of happiness, sadness, fear, and anger.

Conclusions

A negative bias in interpretation of neutral facial expressions, but not accuracy deficits in recognizing emotional facial expressions, may represent a vulnerability factor for major depression. However, further research is needed.     

Serum brain-derived neurotrophic factor predicts responses to escitalopram in chronic posttraumatic stress disorder

Introduction

Some studies have found that antidepressants increase serum brain-derived neurotrophic factor (BDNF) levels in patients with major depression and the expression of BDNF mRNA in limbic structures of rats.

Objectives

This study addressed whether the SSRI escitalopram increases serum BDNF levels in subjects with PTSD and whether BDNF levels are associated with treatment response.

Methods

Medically healthy male subjects (N = 16) with chronic PTSD completed a 12 week open-label trial of flexible dose (5–20 mg/day) escitalopram monotherapy. BDNF levels were obtained at baseline, and at weeks 4, 8 and 12.

Results

PTSD symptoms significantly declined over the course of the 12 week escitalopram treatment. Despite a substantial improvement in PTSD symptoms, there was virtually no change in BDNF levels over time. Nevertheless, mean BDNF levels across the trial were strongly correlated with the slope of PTSD symptoms over the 12 weeks (r = 0.58, p = 0.018). Lower mean BDNF was associated with a greater decrease in PTSD symptoms over the course of the trial.

Conclusions

PTSD subjects with low BDNF levels demonstrated the largest treatment response from an agent with putative neurotrophic effects.     

Familiarity and face emotion recognition in patients with schizophrenia

Objective

To assess the emotion recognition in familiar and unknown faces in a sample of schizophrenic patients and healthy controls.

Methods

Face emotion recognition of 18 outpatients diagnosed with schizophrenia (DSM-IVTR) and 18 healthy volunteers was assessed with two Emotion Recognition Tasks using familiar faces and unknown faces. Each subject was accompanied by 4 familiar people (parents, siblings or friends), which were photographed by expressing the 6 Ekman’s basic emotions. Face emotion recognition in familiar faces was assessed with this ad hoc instrument. In each case, the patient scored (from 1 to 10) the subjective familiarity and affective valence corresponding to each person.

Results

Patients with schizophrenia not only showed a deficit in the recognition of emotions on unknown faces (p = .01), but they also showed an even more pronounced deficit on familiar faces (p = .001). Controls had a similar success rate in the unknown faces task (mean: 18 +/− 2.2) and the familiar face task (mean: 17.4 +/− 3). However, patients had a significantly lower score in the familiar faces task (mean: 13.2 +/− 3.8) than in the unknown faces task (mean: 16 +/− 2.4; p < .05). In both tests, the highest number of errors was with emotions of anger and fear. Subjectively, the patient group showed a lower level of familiarity and emotional valence to their respective relatives (p < .01).

Conclusions

The sense of familiarity may be a factor involved in the face emotion recognition and it may be disturbed in schizophrenia.     

A feasibility pilot study on the use of text messages to track PTSD symptoms after a traumatic injury

Objective

Monitoring posttraumatic stress disorder (PTSD) symptoms after a traumatic injury is beneficial for patients and providers. Text messages can be used to automatically monitor symptoms and impose minimal burden to patients and providers. The present study piloted such a strategy with traumatic injury patients.

Method

An automated daily text message was piloted to evaluate PTSD symptoms after discharge from the hospital. Twenty-nine patients who experienced a traumatic injury received 15 daily texts and were then followed up at 1-month and 3-months after discharge.

Results

82.8% of the sample responded at least once and the average response rate per participant was 63.1%. Response rates were correlated with PTSD symptoms at baseline but not at any other time. Patient satisfaction with this approach was high.

Conclusion

Text messages are a viable method to monitor PTSD symptoms after a traumatic injury. Such an approach should be evaluated on a larger scale as part of a more comprehensive early intervention for traumatic stress.     

Altered spontaneous neuronal activity of visual cortex and medial anterior cingulate cortex in treatment-naïve posttraumatic stress disorder

Background

Although no more traumatic stimuli exists, a variety of symptoms are persisting in chronic Posttraumatic Stress Disorder (PTSD) patients. It is therefore necessary to explore the spontaneous brain activity of treatment-naïve PTSD patients during resting-state.

Method

Seventeen treatment-naïve PTSD patients and twenty traumatized controls were recruited and underwent a resting functional magnetic resonance imaging (Rs-fMRI) scan. The differences of regional brain spontaneous activity between the participants with and without PTSD were measured by Amplitude of Low-frequency fluctuation (ALFF). The relationship between the altered brain measurements and the symptoms of PTSD were analyzed.

Result

Compared to traumatized controls, the PTSD group showed significantly altered ALFF in many emotion-related brain regions, such as the medial anterior cingulate cortex (MACC), dorsolateral prefrontal cortex (DLPFC), insular (IC), middle temporal gyrus (MTG), and ventral posterior cingulate cortex (VPCC). Interestingly this is the first report of a hyperactive visual cortex (V1/V2) during resting-state in treatment-naïve PTSD patients. There were significant positive correlations between ALFF values in the bilateral visual cortex and re-experiencing or avoidance in PTSD. Negative correlation was observed between ALFF values in MACC and avoidance.

Conclusion

This study suggested that the visual cortex and the MACC may be involved in the characteristic symptoms of chronic PTSD, such as re-experiencing and avoidance. Future studies that focus on these areas of the brain are required, as alteration of these areas may act as a biomarker and could be targeted in future treatments for PTSD.     

Predicting post-traumatic stress disorder in veterans: Interaction of traumatic load with COMT gene variation

Background

Because post-traumatic stress disorder (PTSD) by definition can occur only after exposure to a traumatic event, military veterans who are at high risk for trauma exposure are a particularly relevant population for studying the interaction of trauma with genetic factors that may predispose for the disorder. A number of studies have implicated specific genes as possible risk factors in developing PTSD, including the catechol-O-methyltransferase gene (COMT).

Methods

Data from Iraq War veterans (n = 236) were used to examine the interaction between COMT and traumatic experiences in predicting later development of PTSD symptoms. Subjects were assessed for exposure to traumatic events both before and during deployment.

Results

The interaction between trauma load and COMT was a significant predictor of PTSD symptoms. Those with the heterozygous genotype (Val/Met) showed fewer symptoms associated with trauma exposure compared to those with either homozygous genotype. This interaction remained significant after controlling for other risk factors for PTSD, including personality dimensions of Internalizing and Externalizing.

Conclusions

COMT genotype affects risk for development of PTSD symptoms following exposure to trauma.     

Eating disorder symptoms and comorbid psychopathology among male and female veterans

Objective

Eating disorder (ED) symptoms have gone mostly unexamined among veterans. The current study assessed rates of bulimia nervosa (BN) and binge eating disorder (BED) symptoms and diagnoses and their associations with common comorbidities among male and female veterans.

Method

Participants were US military veterans who screened positive for trauma histories and/or a probable Diagnostic and Statistical Manual of Mental Disorders 4th Edition (DSM-IV) posttraumatic stress disorder (PTSD) diagnosis (n= 499). Symptoms of PTSD were assessed using the Clinician-Administered PTSD Scale, and symptoms of EDs, mood, and substance use disorders were assessed using the Structured Clinical Interview for the DSM-IV.

Results

Lifetime rates of BN and BED diagnoses were comparable to civilian populations, and a considerable range of lifetime and current BN and BED symptoms were identified. In multivariate models, PTSD and depression severity were most consistently associated with BN and BED symptom severity, with depression most strongly associated with EDs for women.

Conclusions

Findings highlight the importance of screening for ED symptoms among male and female veterans, particularly those that present with PTSD and depression symptomatology. Future examinations of the temporal order of such relationships and the degree to which ED symptoms and associated symptoms impact veteran functioning are warranted.     

Mental health consequences of intimate partner violence in Vhembe district,South Africa

Objective

The aim of this study was to assess the contributions of different forms of intimate partner violence (physical violence, sexual violence, psychological abuse, and stalking) on symptoms of posttraumatic stress disorder (PTSD) and depression.

Methods

In all 268 women (18 years and older) consecutively receiving a protection order in the Vhembe district in South Africa were assessed by an external interviewer. Hierarchical regressions tested the unique effects of different types of intimate partner violence on PTSD and depression.

Results

In terms of PTSD symptom severity, more than half (51.9%) of the sample reported severe PTSD and 66.4% reported severe depression symptoms. Two types of intimate partner violence (physical and sexual) were significantly associated with PTSD symptoms, while only psychological violence was moderately correlated with depression symptoms. Physical abuse contributed to the prediction of PTSD and psychological abuse to depression.

Conclusions

A significant number of women with protection orders suffer from PTSD and depression. The results confirm a relationship between severity of intimate partner violence and mental health problems (PTSD and depression). Assessment of intimate partner violence should incorporate the multiple dimensions that have been identified as contributing to poor mental health.     

The impact of negative affect on reality discrimination

Background and objectives

People who experience auditory hallucinations tend to show weak reality discrimination skills, so that they misattribute internal, self-generated events to an external, non-self source. We examined whether inducing negative affect in healthy young adults would increase their tendency to make external misattributions on a reality discrimination task.

Methods

Participants (N = 54) received one of three mood inductions (one positive, two negative) and then performed an auditory signal detection task to assess reality discrimination.

Results

Participants who received either of the two negative inductions made more false alarms, but not more hits, than participants who received the neutral induction, indicating that negative affect makes participants more likely to misattribute internal, self-generated events to an external, non-self source.

Limitations

These findings are drawn from an analogue sample, and research that examines whether negative affect also impairs reality discrimination in patients who experience auditory hallucinations is required.

Conclusions

These findings show that negative affect disrupts reality discrimination and suggest one way in which negative affect may lead to hallucinatory experiences.