CNS 2013 Meeting: Controlling Emotional Response is Key to Treating Mental Illness

http://www.youtube.com/watch?v=y4ML5ymlCFA

Everyone attending CNS 2013’s first symposium Sunday morning on the regulation of emotion and mental illness took part in a group belly laugh when James Gross played a video to open his talk. In the clip, a newscaster nervously interviews an animal handler holding a 5-foot snake. Unbeknownst to the viewers (and perhaps the newscaster), a lizard sits quietly on the table in front of them. A moment later, it leaps and attaches itself to the newscaster’s sport coat. Completely flummoxed, he belts out a few awkward screams before collapsing to the floor in fright.

Despite the fright, the newscaster survives to see another broadcast. He stands up right away and guffaws his way through an explanation of his reaction. But that reaction is the very reason Gross, of Stanford University, chose the video: to demonstrate that emotional responses are often uncontrollable. But opportunities for understanding and treating mental illnesses lie in controlling emotional response, as the symposium’s four speakers can attest.

Gross contextualized the talks by pointing out that more than 50 percent of psychiatric disorders have some sort of emotional disruption component. For example, patients with social anxiety disorder have a heightened, negative emotional response to social situations.

More than a decade of research into what’s called “reappraisal” has examined what happens in the brain when a researcher asks a subject to respond to a negative stimulus by mulling it over and finding a new way to look at it. In healthy subjects at least, reappraisal decreases the negative impact of that stimulus. Gross and his colleagues found that patients with a mental illness such as social anxiety disorder had trouble activating the parts of their brains – primarily in the prefrontal cortex – that allow those without such afflictions to recharacterize tough situations. The upshot of these findings is that deficiencies in this system may be responsible for mental illness, and these processes provide points to treat these issues.

“As emotions unfold, we can intervene at multiple points,” Gross said. “Reappraisal is one of these points – a particularly interesting one that may play a crucial role in social anxiety.”

Regina Lapate, a graduate student at the University of Wisconsin, echoed the value of cognitive reappraisal and took its application a step further. By measuring pupil dilation and conductance in the skin as indicators of emotional response, Lapate showed that subjects’ ability to regulate their emotional responses strongly correlated with how well they could modulate their responses to physical pain. Both types of stimuli also activated the same parts of the amygdala.

Karina Blair of the National Institute of Mental Health had focused much of her research on the top-down attention carried out in the frontal and parietal cortices of the brain. Rather than just responding to external stimuli as in bottom-up attention, top-down attention is under the person’s control: the driving force for the attention comes from within and thus is important in reappraisal. Blair presented evidence that patients with anxiety disorders, as well as post-traumatic stress disorder (PTSD), had trouble energizing the portions of their brain involved in this process. Interestingly, when she and her team examined subjects who had face a serious trauma in their lives but did not develop PTSD, they found very high levels of activity in the reappraisal centers of the brain, much higher than even healthy individuals.

“This raises the very exciting possibility that perhaps with a superior top-down attentional system could actually function as a buffer – as protection against the development of PTSD,” Blair told the audience, though she acknowledged that they still hadn’t fleshed out the cause for this connection.

Richard Davidson of the University of Wisconsin rounded out the panel with a primer on the three R’s of emotion regulation – the other two being reactivity and recovery. His team’s research compared activation (and reactivation) in two parts of the brain, the amygdala and the nucleus accumbens (NAcc), in healthy individuals and those who suffer from depression. Patients with depression had trouble sustaining the activity in the NAcc found in healthy patients, but anti-depressants helped keep that activity level up.

Further research demonstrated that interventions, particularly in childhood, could strengthen the sort of attention that staves off the negative emotional responses that are characteristic of depression. Davidson pointed out that those early intercessions actually have the potential to alter not just the functions, but also the structures, of key areas of the brain, including the prefrontal cortex and the amygdala.

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More than 1,500 scientists are attending the 20th annual meeting of CNS in San Francisco, CA, from April 13 to April 16,2013. Follow the meeting on Twitter: @CogNeuroNews #CNS2013

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