Emotion regulation before and after transcranial magnetic stimulation in obsessive compulsive disorder

Abstract

Background. Impaired emotion regulation may underlie exaggerated emotional reactivity in patients with obsessive compulsive disorder (OCD), yet instructed emotion regulation has never been studied in the disorder.Method. This study aimed to assess the neural correlates of emotion processing and regulation in 43 medication-free OCD patients and 38 matched healthy controls, and additionally test if these can be modulated by stimulatory (patients) and inhibitory (controls) repetitive transcranial magnetic stimulation (rTMS) over the left dorsolateral prefrontal cortex (dlPFC). Participants performed an emotion regulation task during functional magnetic resonance imaging before and after a single session of randomly assigned real or sham rTMS. Effect of group and rTMS were assessed on self-reported distress ratings and brain activity in frontal-limbic regions of interest.Results. Patients had higher distress ratings than controls during emotion provocation, but similar rates of distress reduction after voluntary emotion regulation. OCD patients compared with controls showed altered amygdala responsiveness during symptom provocation and diminished left dlPFC activity and frontal-amygdala connectivity during emotion regulation. Real v. sham dlPFC stimulation differentially modulated frontal-amygdala connectivity during emotion regulation in OCD patients.Conclusions. We propose that the increased emotional reactivity in OCD may be due to a deficit in emotion regulation caused by a failure of cognitive control exerted by the dorsal frontal cortex. Modulatory rTMS over the left dlPFC may influence automatic emotion regulation capabilities by influencing frontal-limbic connectivity.

The Relationship Between Behavioral Inhibition Strategies for Cognitive Regulation of Emotions and Young Adult Family of Life Events and Changes with Obsessive-Compulsive Traits in Students

“…According to the studies, when negative emotions are aroused, deficits in the ability to identify, describe, and understand emotions are related to intolerance for distress and impulsive behavior (40). Similar to the present study, some researches have shown that cognitive emotion-regulation strategies may be efficient for OCD's symptoms and its modification (11,41,42).…”

“…Patients with obsessive-compulsive disorder (OCD) may have impaired emotions that underlie exaggerated emotional reactivity. However, instructed emotion regulation has never been studied in the disorder (11). Previous studies have found that obsessive-compulsive symptom distress was significantly related to poor understanding of emotions and fear of emotions including both negative (anxiety, anger, and depressed mood), and unexpectedly, positive emotions (12)(13)(14).…”

Excessive habit formation in schedule‐induced polydipsia: Microstructural analysis of licking among rat strains and involvement of the orbitofrontal cortex

“…In support of this, previous SIP studies found hyperactivity in serotonergic and noradrenergic neurotransmission, 14 higher binding for D2 receptors 15 in the amygdala, and less myelination of the BLA 13 in HD compared with LD rats selected by the median split. 60,[73][74][75][76] The aberrant LOFC and BLA hyperactivity in CD rats might support the hypothesis that compulsivity in SIP could be due to deficits in the goal-directed system rather than an excessive build-up of stimulus-response habits. 69,70 The BLA seems to be important for the acquisition of goal-directed actions, 71 whereas the central amygdala seems to be critical for the formation of habits by its interaction with the DLS.…”

Intrinsic functional and structural connectivity of emotion regulation networks in obsessive-compulsive disorder

“…Moreover, studies have identified a general pattern of frontosubcortical (including frontoamygdalar) hyper-reactivity while anticipating and perceiving emotional stimuli; a pattern that is shared by OCD and social anxiety disorder patients (Weidt et al, 2016). Likewise, OCD patients show diminished frontoamygdala connectivity during emotion regulation (de Wit et al, 2015), although, by contrast, increased functional connectivity between the amygdala and dorsolateral prefrontal cortex (dlPFC) has been shown to account for impaired working memory performance in OCD (de Vries et al, 2014). Overall, these findings have been interpreted as suggesting that greater amygdala activation in response to emotional stimuli in OCD may interfere with information processing in cognitive control networks.…”

“…Notably, previous research on the neural correlates of emotion regulation has identified significant activations in other (mainly prefrontal) regions(Buhle et al, 2013;Kohn et al, 2014) not reported here. For example, deWit et al (2015) showed decreased activity in the left dlPFC and increased activity in the dorsomedial prefrontal cortex of OCD patients during emotion regulation. In this sense, it could be argued that we should have also identified alterations in amygdala connectivity with these other regions, but it is important to bear in mind that those findings stemmed from task-activation studies, in experimental contexts (i.e., during emotion induction), while we used a dispositional/trait measure of emotional regulation.…”