Concrete behaviour and reappraisal deficits after a left frontal stroke: A case study

Abstract

Concrete behaviour, the inability to disengage from immediate experience in order to manipulate ideas and thoughts, has long been understood to be a common problem after frontal lobe lesions. However, there has been little consideration of the impact that concreteness may have on emotional functioning, specifically in the use of thinking to manipulate emotional responses. One widely studied emotion regulation strategy is reappraisal, which depends on several frontal lobe related cognitive control processes. While there have been numerous neuroimaging findings on reappraisal, no study has used brain injured patients to investigate this issue. The present case study is the first to describe the capacity to generate reappraisals in a patient (Mrs M), whose behaviour became concrete after a left prefrontal stroke. Using a picture-based reappraisal paradigm, her performance was compared to non-concrete brain-lesioned patients, and neurologically healthy controls. Although Mrs M showed relatively preserved overall cognitive function, she was completely unable to spontaneously generate reappraisals. In striking contrast, once external support was offered, in the form of prompts, her capacity to reappraise dramatically improved. The results are analysed in terms of three neuropsychological capacities - all compromised in Mrs M - previously proposed as reappraisal components: response inhibition, abstraction, and verbal fluency. A number of implications for rehabilitation are discussed, including how the use of prompting may facilitate reappraisal capacity.

Detaching from the negative by reappraisal: the role of right superior frontal gyrus (BA9/32)

“…Moreover, the ROI group not only showed deficits in REAPPself, but was also the group with most inhibition failures (number of errors) during Go/NoGo tasks. This is of particular interest, as one case study reported that inhibition impairments after a left frontoparietal lesion generated difficulties to spontaneously generate reappraisals (Salas et al, 2013). As previously shown in lesion studies, patients with right PFC lesions typically show inhibition difficulties, reflected by increased error rates in the interference condition of the Stroop task (Vendrell et al, 1995).…”

“…Inhibition performance, which is supposed to be a right lateralized function (Garavan et al, 1999), might influence the ability of decreasing automatic negative appraisals, thus constituting a corner pillar for the architecture of reappraisal and especially, REAPPself (Salas et al, 2013, 2014). However, we cannot rule out the influences of depression symptoms, particularly on the down-regulation of valence.…”

“…However, to date there have been only two studies investigating reappraisal performance after acquired brain damage. One recent case-study showed that emotional reappraisal is impaired after a left PFC stroke lesion (Salas et al, 2013). Another recently published study of the same author investigated behavioral data of reappraisal difficulty and productivity in brain injured patients.…”

Emotion Regulation: Current Status and Future Prospects

“…For example, in one study, Feeser and colleagues (Feeser, Prehn, Kazzer, Mungee, & Bajbouj, 2014) found that transcranial direct current stimulation to the dorsolateral prefrontal cortex enhanced participants' ability to engage in reappraisal. Other studies have examined the impact of brain damage on emotion regulation (Anderson, Barrash, Bechara, & Tranel, 2006;Salas, Gross, Rafal, Vinas-Guasch, & Turnbull, 2013). Further studies are required to better understand how different brain systems are engaged in the course of successful reappraisal and what goes wrong when regulation fails.…”

“Opening an emotional dimension in me”: Changes in emotional reactivity and emotion regulation in a case of executive impairment after left fronto-parietal damage

“…Professor F's capacity to recognize accurately, and label, basic emotions is preserved for all emotions except disgust. When compared to a sample of 15 ageand education-matched healthy controls (Salas, Gross, Rafal, Viñas-Guasch, & Turnbull, 2013), he does not present significant differences in the total score [t (14) Emotional expressivity (BEQ). Professor F's capacity to express negative and positive emotions, as well as the intensity of his emotional reactions, appears to be in the normal range.…”