Emotion and Cognition - The Zurich Depression Studies IAPS- Valence Rating IAPS- Valence Rating IAPS

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  • Emotion and Cognition - The Zurich Depression Studies

    Prof. Dr. med. H. Böker Clinic of Affective Disorders and General Psychiatry Zurich East

    SFI International Symposium 2011 Chronic Depression - Clinical, Conceptual and Empirical Research

    University Frankfurt, Campus Bockenheim, 28. - 30.10.2011

  • 1.  Introduction: The empirical basis for neuro-psychodynamic hypotheses

    2.  The Problem of depressive inhibition

    2.1 Negative affective bias

    2.2 Psychomotoric disorders

    3.  Single-case research in depressed patients

    4.  Results from combined fMRI/MRS and neuropsychological studies

    Emotion and Cognition - The Zurich Depression Studies

  • 5.  A neuro-psychodynamic model for the disturbed emotional self-reference in depressed patients

    6.  Future steps in anhedonia research

    7.  The Zurich Neuroimaging Study on Psychodynamic Psychotherapy in Depressed Patients

    8.  Conclusion: Scientific implications

    Emotion and Cognition - The Zurich Depression Studies

  • Emotion, Cognition and Actions in Depressed Patients

    - Clinical Observations -

    Ø  Why do negative thoughts get locked into place in depression?

    Ø  Neurophysiological correlates of inhibition/blockade: „My right foot is on the accelerator, my left one on the brakes“

  • Negative affective Bias

    •  Cognitive triad (Beck 1974) •  Network models for depression (Segle et al. 1996)

    •  Negative emotions are over-represented in semantic networks •  Basic shift of the emotional assessment of new und early experiences

    •  Mood congruent recall •  Memories from the respective emotional situation are recalled more easily

    (Blaney 1986) •  The cognitive-affective spiral of depression promotes negative thoughts

    and negative associations (Teasdale 1988, Ackermann-Engel, De Rubeis 1993)

    •  Therapeutic implications!

  • Experiencing extremely intensive and uncontrollable emotions: “Numb with fear”

    Depressive Stupor as a Psychomotoric Syndrome

    Böker et al. Psychiat. Prax. 2000 Northoff, Böker et al. Neuro-Psychoanalysis 2003

    -  Single-case approach: (Landfield categories)

    •  Lack of social contact •  „Low“ self-esteem •  „Low“ emotional arousal

  • Self-image and Object Relationships in Depressed Patients

    Ø  Qualitative personality studies (depressed subjects in remission)

    -  Negative self-image

    -  Idealising significant others

    -  Significance of the inter-personal dimension

    Boeker 1999 Boeker et al., J. Affect. Disord., 2000

  • Emotional Experience and Decision-Making

    2.Step: Decision-making

    1. Step: Experience and judgement of emotions

    Aristoteles

    Result: Catatonics and depressed subjects unable to take action (blockade)

  • Healthy Subjects Catatonics

    Catatonia/Stupor: VMPFC and Emotional Experience

    Northoff et al. 2004 Northoff u. Böker 2005 Böker u. Northoff 2005

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    catatonics (n=6) psychiatric controls (n=5) healthy controls (n=11) a*,b*

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    Signal

    Catatonics Psychiat. Cont. Healthy Cont.

    • Healthy subjects: Activation in VMPFC

    • Subjects previously with depression and stupor: Low activation (particularly after negative stimuli)

  • Emotional Experience: Correlation with Actions/IGT

    Connection between emotional experience, the VMPFC and decision- making

    Northoff und Böker 2003 Böker und Northoff 2005 Northoff et al. 2005

    The more activity in the VMPFC, the better the decision-making

    → Healthy subjects: In the long-term more successful low-risk cards → Previous stupor: No change in decision-making despite negative consequenses

  • Subjective Emotional Experience

    Journal of Consciousness Studies, 1014-48, 2003

    Correlation between experience data and fMRI data concerning emotions

    Emotional stimulation in the fMRT with pictures

    Visual analogue scales for emotional experience

  • International Affective Picture System (IAPS, Lang 1999)

  • Expectancy: Emotional judgement: 8 - 11.5 sec

    Emotional judgement: 4 sec

    Fixation cross: 6 - 8 sec

    Expectancy: Emotional perception: 8-11.5 sec -

    Emotional perception: 4 sec

    Fixation cross: 6 - 8 se c

    A Emotional judgement:

    4 sec Fixation cross:

    6 - 8 sec

    Emotional perception: 4 sec

    Fixation cross: 6 - 8 sec

    A/A

    A/A E

    C

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    A/A

    Emotionale perception Fixation cross Emotional perception Fixation cross

    B

    J J P/N

    P/N

    Emotional judgemeng Fixation cross

    Emotional judgement

    0 8 12 18 22 28 s

    Fixation cross Expectancy period

    Expectancy period

  • Brain activation during “Experience” and “Judgement”

    (in Healthy Subjects)

    Grimm et al. 2006, 2007

    Neural activity in the VMPFC is correlated with negative emotional experience

    VMPFC: Ventromedial prefrontal Cortex

    Neural activity in the DLPFC is correlated with positive emotional judgement

    DLPFC: Dorsolateral prefrontal Cortex

  • VMPFC: Depressed > Healthy

    Hyperactivity in the VMPFC = Abnormal negative experience

    DLPFC: Healthy > Depressed

    Hypoactivity in the DLPFC = Abnormal negative judgement

    Brain activity during “Experience” and “Judgement”

    Comparison between Depressed and Healthy Subjects

  • Left DLPFC Hypofunction: Negative cognitions

    VMPFC Hyperactivity: Negative emotional perception Right DLPFC Hyperfunction: Attention/

    expectation of negative emotions

    Severity of depression (BDI, HAMD) correlates with activation in the right amygdala and in the VMPFC

    Northoff et al. 2004 Böker u. Northoff 2005 Northoff und Böker 2007

    Psychiatry Research, 141(1):1-13, 2006

    Depression: Abnormal reciprocal Modulation between the VMPFC/ACC and left and right DLPFC

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    VMPFC left DLPFC right DLPFC

    In patients with no symptoms brain activity unchanged in medial and right forehead region, but pattern of activity normalised in left forehead area. Activity in left forehead region normalised following successful treatment of depression. Lasting changes in brain activity in right and medial forehead region despite improvement of depression: Sustained attention, executive function and working memory

    Ventromedial hyperactivation and dorsolateral hypoactivation connected to neuropsychological deficits

    Cognitive and psychopathological symptoms become dissociated in the course of the illness!

    controls

    acute patients remitted patients

    Inhibition phenomena and disruption of emotional self-reference in depressed patients:

    Brain activity after improvement of depression

    Boeker and Grimm, submitted

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    Grimm et al. 2008, Biological Psychiatry

    BDI

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    ,2 ,1 ,0 - ,1 - ,2 - ,3 r= 0.66**

    In emotional processing healthy subjetcts show more activation in the left DLPFC, depressed subjects in the right DLPFC

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