Childhood Trauma And Emotion Processing Neurocircuitry

Childhood trauma is one of the strongest risk factors for a range of common and debilitating neuropsychiatric disorders, including anxiety, depression, and posttraumatic stress disorder (PTSD). These emotion-related disorders have their roots in childhood and adolescence, underscoring a critical need to understand their biological bases in early life. In this dissertation, we evaluate how childhood trauma impacts emotion processing neurocircuitry in a sample of high-risk urban youth, ages 7-15. In four inter-related studies, we test neural function and functional connectivity of core emotion processing regions, including the amygdala, insula, and pregenual/subgenual anterior cingulate cortex (pgACC/sgACC). To examine the relevance of observed neurological changes, we evaluate behavioral performance on emotion processing neuropsychological tasks, as well as specific dimensions of subjective affective experience. Results indicate that, relative to matched comparison youth, trauma-exposed youth have (1) increased neural response to salient emotional cues in amygdala and insula, (2) reduced functional connectivity between amygdala and pgACC/sgACC, a pathway critical for emotion regulation, and (3) altered within- and between-network connectivity of the salience network, involved in detecting and orienting attention to salient emotional stimuli. These neurological changes are accompanied by behavioral alterations: trauma-exposed youth have a lower ability to ignore distracting emotional information, and to automatically regulate emotion. Additionally, observed neurobehavioral changes relate to a specific dimension of affective experience – reward sensitivity (RS), rather than negative affect. Moreover, trauma-exposed youth with the greatest neurobehavioral impairment report lower RS, suggesting reduced positive environmental engagement. These results suggest that RS may be a marker of stress susceptibility, a notion supported by emerging basic and clinical research. Based on our neurobehavioral findings, we discuss potential implications for intervention, and relay an emerging framework that dissociates neurological effects of different trauma types (i.e., threat/victimization vs. deprivation/neglect). In closing, we discuss future directions, including longitudinal research and evaluating the modulation of learned fear – a neurobehavioral mechanism that depends on emotion processing neurocircuitry, but has yet to be tested in trauma-exposed youth

Sleep Timing and Neurocognitive Networks in Youth

Sleep timing, particularly later midpoint of sleep, has been linked to emotion dysregulation and psychopathology. Prior adult studies link poor sleep (e.g., shorter duration, later midpoint), to altered resting-state functional connectivity (rs-FC) within and between key neurocognitive networks, particularly the default mode network (DMN), which is involved in internal thought and rumination. Importantly, many psychiatric disorders begin during adolescence, a period of shifted sleep schedules. We explored associations between midpoint of sleep and rs-FC of the DMN and other core neurocognitive networks in youth. Sleep timing was measured in 3,798 youth (11.9±0.6 years, 47.5% female) from the Adolescent Brain Cognitive Development study using Fitbit watches (over 13.1±6.5 days). Internalizing symptoms were measured using self-report and rs-FC was measured between the DMN and three neurocognitive networks: dorsal attention network (DAN), frontoparietal network (FPN), and salience network (SN). Associations between sleep timing and rs-FC were measured using linear regressions adjusting for age, sex, race, parental education, family income, puberty, and head motion. Average midpoint of sleep was 3:35 AM (range: 12:34 AM-11:27 PM). Later midpoint of sleep was associated with increased self-reported depressive symptoms. Later midpoint of sleep was associated with lower DMN-DAN rs-FC. There were no associations between midpoint of sleep and DMN-DMN, DMN-FPN, or DMN-SN network rs-FC. These results add to and extend prior studies in youth by incorporating objective measures of sleep timing (Fitbit data), and in a large national sample. Additionally, our findings may have implications for the consideration of sleep timing when designing behavioral-health interventions in youth

A virtual reality martial arts-based intervention reduces pain, drug craving, and stress in patients with opioid use disorder

Background: Some individuals with opioid use disorder (OUD) report high levels of pain, anxiety, stress and drug craving that may occasion relapse, reduce adherence to treatment, and reduce quality of life. This pilot study evaluated whether a novel martial arts-based intervention can lower self-reported and physiological markers of pain, anxiety, stress and opioid craving in individuals with OUD undergoing methadone maintenance treatment (MMT). Methods: 15 MMT patients (11 females) completed a 12-week ‘Heroes Circle’ intervention that involved twice-weekly 30-min sessions centering around martial arts-based breathing and meditative techniques using therapist-assisted virtual reality (VR). Patients self-reported on five measures (pain, drug craving, anxiety, depression, anger) using a 0-10 scale before (pre) and after (post) each session. Salivary markers of inflammation (C-reactive protein [CRP]) and stress (cortisol) were collected before and after several sessions (baseline, weeks 4, 8, and 12). Results: There were significant pre-post session reductions in rated pain, drug craving, anxiety and depression, and saliva cortisol (ps\u3c0.05). For opioid craving, there was also an effect of week such that craving decreased from weeks 1-6, increased from 7-9, and decreased again from 10-12 (ps\u3c0.05); there was also a session x week interaction such that the pre-post reduction in craving reached significance in weeks 1-3 only. There were no significant main effects or interactions for anger or CRP (ps\u3e0.05). Conclusions: These preliminary results suggest VR-based, martial-arts meditative intervention is a promising approach for reducing pain, anxiety, stress and craving levels among individuals with OUD. Further controlled studies are warranted

A novel martial arts-based virtuality reality intervention modulates pain and the pain neuromatrix in patients with opioid use disorder

Background: Standard-of-care for opioid use disorder (OUD) includes medication and counseling. However, there is an unmet need for complementary approaches to treat OUD patients coping with pain; furthermore, few studies have probed neurobiological features of pain or its management during OUD treatment. This preliminary study examines neurobiological and behavioral effects of a martial arts-based intervention in patients undergoing methadone maintenance treatment (MMT). Methods: Fifteen (11 female) MMT patients completed a virtual reality, therapist-guided martial arts intervention that included breathing and relaxation exercises; sessions were scheduled twice weekly. Assessments included functional magnetic resonance imaging (fMRI) of pain neuromatrix activation and connectivity (pre- and post-intervention), saliva cortisol and C-reactive protein (CRP) at baseline and weeks 4, 8 and 12; and self-reported pain and affective symptoms before and after each intervention session. Results: After each intervention session (relative to pre-session), ratings of pain, opioid craving, anxiety and depression (but not anger) decreased. Saliva cortisol (but not CRP) levels decreased from pre- to post-session. From pre- to post-intervention fMRI assessments, pain task-related left postcentral gyrus (PCG) activation decreased. Higher baseline cortisol levels were associated with greater post-intervention pain task-related insular activation. At baseline, PCG showed positive connectivity with other regions of the pain neuromatrix, but this pattern changed post-intervention. Conclusions: These preliminary findings demonstrate feasibility, therapeutic promise, and brain basis of a martial arts-based intervention for OUD patients undergoing MMT

Study protocol of an investigation of attention and prediction error as mechanisms of action for latent inhibition of dental fear in humans

Background Evidence suggests that dental anxiety and phobia are frequently the result of direct associative fear conditioning but that pre-exposure to dental stimuli prior to conditioning results in latent inhibition of fear learning. The mechanisms underlying the pre-exposure effect in humans, however, are poorly understood. Moreover, pain sensitivity has been linked to dental fear conditioning in correlational investigations and theory suggests it may moderate the latent inhibition effect, but this hypothesis has not been directly tested. These gaps in our understanding are a barrier to the development of evidence-based dental phobia prevention efforts. Methods Healthy volunteers between the ages of 6 and 35 years will be enrolled across two sites. Participants will complete a conditioning task in a novel virtual reality environment, allowing for control over pre-exposure and the examination of behaviour. A dental startle (a brief, pressurized puff of air to a tooth) will serve as the unconditioned stimulus. Using a within-subjects experimental design, participants will experience a pre-exposed to-be conditioned stimulus, a non-pre-exposed to-be conditioned stimulus, and a neutral control stimulus. Two hypothesized mechanisms, changes in prediction errors and attention, are expected to mediate the association between stimulus condition and fear acquisition, recall, and retention. To ascertain the involvement of pain sensitivity, this construct will be measured through self-report and the cold pressor task. Discussion Dental phobia negatively affects the dental health and overall health of individuals. This study aims to determine the mechanisms through which pre-exposure retards conditioned dental fear acquisition, recall, and retention. A randomized control trial will be used to identify these mechanisms so that they can be precisely targeted and maximally engaged in preventative efforts

Toward understanding the impact of trauma on the early developing human brain

Boletín informativo que reseña un paisaje seleccionado entre los inscritos en el Registro de Paisajes de Interés Cultural de Andalucía y ofrece información en materia de Paisaje Cultural