Dysfunctional regulation of mood and emotion is a key component of major depressive disorder and leads to sustained negative feelings. Using functional MRI (fMRI), we investigated the temporal dynamics of emotion regulation in patients with major depressive disorder and in healthy controls, testing for acute and sustained neural effects of active emotion regulation. Moderately depressed individuals (n ϭ 17) and never-depressed healthy control subjects (n ϭ 17) underwent fMRI during performance of an active cognitive emotion regulation task while viewing emotionally arousing pictures. In a second task, completed 15 min later, subjects were presented with the same stimuli in a passive viewing task. Whole-brain analyses and connectivity measures were used to determine acute and sustained effects of emotion regulation on brain activation and coupling between regions. On the group level, patients were able to downregulate negative emotions and corresponding amygdala activation, but this ability decreased with increasing symptom severity. Moreover, only healthy control subjects showed a sustained regulation effect in the amygdala after a 15 min delay, whereas depressed patients did not. Finally, patients exhibited diminished prefrontal activation and reduced prefrontolimbic coupling during active regulation. Although emotion regulation capacity in medicated depressive patients appears to be preserved depending on symptom severity, the effect is not sustained. Correlational analyses provide evidence that this diminished sustained-regulation effect might be related to reduced prefrontal activation during regulation.
Neuroimaging studies have identified the anterior paracingulate cortex (PCC) as the key prefrontal region subserving theory of mind. We adopt an evolutionary perspective hypothesizing that, in response to the pressures of social complexity, a mechanism for manipulating information concerning social interaction has emerged in the anterior PCC. To date, neuroimaging studies have not properly distinguished between intentions of persons involved in social interactions and intentions of an isolated person. In two separate fMRI experiments, we demonstrated that the anterior PCC is not necessarily involved in the understanding of other people's intentions per se, but primarily in the understanding of the intentions of people involved in social interaction. Moreover, this brain region showed activation when a represented intention implies social interaction and therefore had not yet actually occurred. This result suggests that the anterior PCC is also involved in our ability to predict future intentional social interaction, based on an isolated agent's behavior. We conclude that distinct areas of the neural system underlying theory of mind are specialized in processing distinct classes of social stimuli.
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