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456. Neural Correlates of Implicit Emotion Processing in Pediatric Anxiety: Changes with and Predictors of Treatment Response
Biological Psychiatry
Friday Abstracts
(i.e., ‘reappraisal’) and more frequent use of maladaptive regulation (i.e., ‘suppression’) in daily life. The late positive potential (LPP) reflects emotional reactivity, which is expected to decrease during successful ER. It is unclear whether LPP in ER tracks self-reported ER tendencies in anxiety disorder. This study attempts to address this gap. Methods: Electroencephalography was recorded during an emotion regulation task (ERT) in 54 patients (42 social phobia, 9 generalized anxiety disorder, 3 panic disorder) and 28 healthy controls. In the ERT, participants used a cognitive approach (i.e., reappraise) to reduce emotional reactivity to aversive images, which was contrasted with looking at aversive images. LPP was evaluated along early, middle, and late time windows. The Emotion Regulation Questionnaire (ERQ) assessed self-reported reappraisal/suppression. Two 2 (group) x 2 (condition) x 3 (time windows) ANCOVAs were conducted, with self-reported reappraisal (ERQ-R) and suppression (ERQ-S) entered as covariates of interest, respectively. Results: Healthy controls reported more frequent reappraisal use than patients (p,.001); no group effects emerged for suppression (p5.08). The ERQ-R ANCOVA yielded null results. ERQ-S analysis revealed a time, condition, and regulation interaction (p5.01). Followup analyses revealed a positive correlation between ERQ-S and late LPP when viewing negative images. Conclusions: Greater tendency to use suppression was associated with greater sustained LPP when attending to negative images across participants. Thus, individual differences in suppression are predictive of sustained emotional reactivity to negative stimuli. Supported By: MH093679 Keywords: Anxiety Disorders, late positive potential, Emotion Regulation, Emotional Suppression, Cognitive Reappraisal
456. Neural Correlates of Implicit Emotion Processing in Pediatric Anxiety: Changes with and Predictors of Treatment Response Katie Burkhouse1, Autumn Kujawa2, Heide Klumpp3, Kate Fitzgerald4, Christopher Monk4, and K. Luan Phan3 1
University of Illinois at Chicago Department of Psychiatry, Penn State College of Medicine, 3University of Illinois at Chicago, 4University of Michigan
2
Background: The current study examined the neural correlates of directing attention toward (explicit emotion processing) and away (implicit emotion processing) from emotional faces in relation to pediatric anxiety treatment response. Based on findings that patients with anxiety disorders exhibit less anterior cingulate cortex (ACC) recruitment in the presence of emotional face distractors, we expected that recruitment of the ACC during implicit emotion processing would influence treatment response. Secondary analyses were conducted to determine whether ACC activation during implicit emotion processing changed pre-to-post treatment. Methods: 62 youth (age 7-18 years) with and without anxiety disorders completed a task matching emotional faces (explicit emotion processing) or matching shapes in the context of emotional face distractors (implicit emotion processing) during fMRI. Anxious youth were enrolled in 10 weeks of treatment, consisting of either SSRI medication or cognitive behavior therapy (CBT). Following 10 weeks, the youth repeated the
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emotional-attention task. Treatment response was assessed via the Pediatric Anxiety Rating Scale. Results: Reduced activation in the dorsal ACC during implicit fear processing predicted a greater reduction in anxiety severity preto-post treatment, t-value53.47, p5.03. Recruitment of the rostral ACC in response to implicit threat processing also increased following both CBT and SSRI treatments among anxious youth, F-value54.19, p5.04, but not among healthy youth. Conclusions: The current findings are the first to demonstrate that reduced recruitment of the ACC during attentional control appears to resolve following treatment and is predictive of treatment response, possibly reflecting an improvement in attentional control processes following treatment with CBT and SSRIs. Supported By: R01-MH086517; T32- MH067631 Keywords: pediatric anxiety, Prediction of Treatment Outcome, Neuroimaging, Attention, emotional face processing
457. Fear Extinction Mechanisms and the Link to Exposure Therapy Outcome in Specific Phobia: A Pilot Study Iris Lange, Liesbet Goossens, Jindra Bakker, Stijn Michielse, Therese van Amelsvoort, and Koen Schruers Maastricht University Background: Fear extinction is the decrement in conditioned fear responses occurring with repeated presentation of a conditioned threat stimulus without reinforcement. Exposurebased treatments (ET) are thought to rely on extinction learning mechanisms. The current study provides novel unpublished data exploring whether the neurobehavioral mechanisms of fear extinction learning and extinction recall can predict exposure therapy success in specific phobia. Methods: Individuals aged 16-25 with a spider phobia (SP; n518) were included. All individuals underwent a 3-day fMRI fear conditioning, extinction and extinction recall paradigm with geometrical shapes as conditioned threat (CS1) and safety (CS-) stimuli. Generalization stimuli (GS) were additionally shown during extinction recall. Fear, valence, shock expectancy and blood-oxygen-level-dependent (BOLD) response were measured. Next, participants underwent one session of exposure therapy (n518). Before and after therapy, phobic symptoms were measured with the Fear of spiders questionnaire (FSQ) and a behavioral approach test (BAT). Results: Regression analyses showed a trend for better extinction retention predicting a higher increase in BAT from pre-to-post therapy (p5.08). Furthermore, a higher increase in BAT from pre-to-post therapy tended to be associated with higher valence ratings for GS during extinction recall (p5.08). A lower phobia score on the FSQ from pre-to-post therapy was marginally associated with a lower valence for the CS1 during extinction recall (p5.07). Neuroimaging results were found in the fear extinction network, compromising the vmPFC, hippocampus, and amygdala. Conclusions: Our results point out that exposure therapy outcome can be predicted by enhanced threat-safety identification at extinction recall.
Biological Psychiatry May 15, 2017; 81:S140–S276 www.sobp.org/journal
Friday Abstracts
(i.e., ‘reappraisal’) and more frequent use of maladaptive regulation (i.e., ‘suppression’) in daily life. The late positive potential (LPP) reflects emotional reactivity, which is expected to decrease during successful ER. It is unclear whether LPP in ER tracks self-reported ER tendencies in anxiety disorder. This study attempts to address this gap. Methods: Electroencephalography was recorded during an emotion regulation task (ERT) in 54 patients (42 social phobia, 9 generalized anxiety disorder, 3 panic disorder) and 28 healthy controls. In the ERT, participants used a cognitive approach (i.e., reappraise) to reduce emotional reactivity to aversive images, which was contrasted with looking at aversive images. LPP was evaluated along early, middle, and late time windows. The Emotion Regulation Questionnaire (ERQ) assessed self-reported reappraisal/suppression. Two 2 (group) x 2 (condition) x 3 (time windows) ANCOVAs were conducted, with self-reported reappraisal (ERQ-R) and suppression (ERQ-S) entered as covariates of interest, respectively. Results: Healthy controls reported more frequent reappraisal use than patients (p,.001); no group effects emerged for suppression (p5.08). The ERQ-R ANCOVA yielded null results. ERQ-S analysis revealed a time, condition, and regulation interaction (p5.01). Followup analyses revealed a positive correlation between ERQ-S and late LPP when viewing negative images. Conclusions: Greater tendency to use suppression was associated with greater sustained LPP when attending to negative images across participants. Thus, individual differences in suppression are predictive of sustained emotional reactivity to negative stimuli. Supported By: MH093679 Keywords: Anxiety Disorders, late positive potential, Emotion Regulation, Emotional Suppression, Cognitive Reappraisal
456. Neural Correlates of Implicit Emotion Processing in Pediatric Anxiety: Changes with and Predictors of Treatment Response Katie Burkhouse1, Autumn Kujawa2, Heide Klumpp3, Kate Fitzgerald4, Christopher Monk4, and K. Luan Phan3 1
University of Illinois at Chicago Department of Psychiatry, Penn State College of Medicine, 3University of Illinois at Chicago, 4University of Michigan
2
Background: The current study examined the neural correlates of directing attention toward (explicit emotion processing) and away (implicit emotion processing) from emotional faces in relation to pediatric anxiety treatment response. Based on findings that patients with anxiety disorders exhibit less anterior cingulate cortex (ACC) recruitment in the presence of emotional face distractors, we expected that recruitment of the ACC during implicit emotion processing would influence treatment response. Secondary analyses were conducted to determine whether ACC activation during implicit emotion processing changed pre-to-post treatment. Methods: 62 youth (age 7-18 years) with and without anxiety disorders completed a task matching emotional faces (explicit emotion processing) or matching shapes in the context of emotional face distractors (implicit emotion processing) during fMRI. Anxious youth were enrolled in 10 weeks of treatment, consisting of either SSRI medication or cognitive behavior therapy (CBT). Following 10 weeks, the youth repeated the
S186
emotional-attention task. Treatment response was assessed via the Pediatric Anxiety Rating Scale. Results: Reduced activation in the dorsal ACC during implicit fear processing predicted a greater reduction in anxiety severity preto-post treatment, t-value53.47, p5.03. Recruitment of the rostral ACC in response to implicit threat processing also increased following both CBT and SSRI treatments among anxious youth, F-value54.19, p5.04, but not among healthy youth. Conclusions: The current findings are the first to demonstrate that reduced recruitment of the ACC during attentional control appears to resolve following treatment and is predictive of treatment response, possibly reflecting an improvement in attentional control processes following treatment with CBT and SSRIs. Supported By: R01-MH086517; T32- MH067631 Keywords: pediatric anxiety, Prediction of Treatment Outcome, Neuroimaging, Attention, emotional face processing
457. Fear Extinction Mechanisms and the Link to Exposure Therapy Outcome in Specific Phobia: A Pilot Study Iris Lange, Liesbet Goossens, Jindra Bakker, Stijn Michielse, Therese van Amelsvoort, and Koen Schruers Maastricht University Background: Fear extinction is the decrement in conditioned fear responses occurring with repeated presentation of a conditioned threat stimulus without reinforcement. Exposurebased treatments (ET) are thought to rely on extinction learning mechanisms. The current study provides novel unpublished data exploring whether the neurobehavioral mechanisms of fear extinction learning and extinction recall can predict exposure therapy success in specific phobia. Methods: Individuals aged 16-25 with a spider phobia (SP; n518) were included. All individuals underwent a 3-day fMRI fear conditioning, extinction and extinction recall paradigm with geometrical shapes as conditioned threat (CS1) and safety (CS-) stimuli. Generalization stimuli (GS) were additionally shown during extinction recall. Fear, valence, shock expectancy and blood-oxygen-level-dependent (BOLD) response were measured. Next, participants underwent one session of exposure therapy (n518). Before and after therapy, phobic symptoms were measured with the Fear of spiders questionnaire (FSQ) and a behavioral approach test (BAT). Results: Regression analyses showed a trend for better extinction retention predicting a higher increase in BAT from pre-to-post therapy (p5.08). Furthermore, a higher increase in BAT from pre-to-post therapy tended to be associated with higher valence ratings for GS during extinction recall (p5.08). A lower phobia score on the FSQ from pre-to-post therapy was marginally associated with a lower valence for the CS1 during extinction recall (p5.07). Neuroimaging results were found in the fear extinction network, compromising the vmPFC, hippocampus, and amygdala. Conclusions: Our results point out that exposure therapy outcome can be predicted by enhanced threat-safety identification at extinction recall.
Biological Psychiatry May 15, 2017; 81:S140–S276 www.sobp.org/journal