Association of Generalized Anxiety Disorder With Autonomic Hypersensitivity and Blunted Ventromedial Prefrontal Cortex Activity During Peripheral Adrenergic Stimulation

Teed, Adam R.; Feinstein, Justin S.; Puhl, Maria; Lapidus, Rachel C.; Upshaw, Valerie; Kuplicki, Rayus; Bodurka, Jerzy; Ajijola, Olujimi A.; Kaye, Walter H.; Thompson, Wesley K.; Paulus, Martin P.; Khalsa, Sahib S.

doi:10.1001/jamapsychiatry.2021.4225

Cited by 48 publications

(45 citation statements)

References 82 publications

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“…*Values averaged across two runs as there was no Group × Timepoint interaction. **vmPFC ROIs from Teed et al ( 2022 ). Bolded values represent a significant difference between the groups at p <= 0.05.…”

Section: Resultsmentioning

confidence: 99%

“…Regions of interest (ROIs) from within the insula were chosen as these are typical regions evoked by this task (see above citations). The vmPFC was also examined following our recent findings showing reduced vmPFC activation was related to differences in interoception between individuals with generalized anxiety disorder compared to healthy comparisons (Teed et al, 2022 ). This was also regarded as an exploratory analysis to assess any differences in neural signals underlying interoceptive attention in non-threatening settings.…”

Section: Methodsmentioning

confidence: 99%

“…In this view, the co-activation of regions such as the anterior insula and anterior cingulate cortex (ACC) during emotion processing (Thielscher and Pessoa, 2007 ) and across psychiatric disorders (McTeague et al, 2020 ) is consistent with the view that an emotional experience involves body states detected via interoceptive processes that may be altered in psychopathology. It follows from this that functional neuroimaging tasks which specifically perturb interoception can elucidate the neural circuits underlying interoceptive psychopathology (Smith et al, 2021 ; Teed et al, 2022 ). Furthermore, the anatomical overlap between circuits associated with fear conditioning (Maren and Quirk, 2004 ) and the central autonomic network (Thayer and Lane, 2000 ; Smith et al, 2017 ) includes the ventromedial prefrontal cortex (vmPFC), cingulate cortex, insula, and amygdala.…”

Section: Introductionmentioning

confidence: 99%

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The unique face of comorbid anxiety and depression: increased interoceptive fearfulness and reactivity

Ironside

DeVille

Kuplicki

et al. 2023

Front. Behav. Neurosci.

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Anxiety and depression commonly co-occur, yet the underlying brain and behavioral processes are poorly understood. Here we examined the hypothesis that individuals with comorbid anxiety and depression would show increased fearful reactivity to an aversive interoceptive perturbation relative to depressed-only individuals. One-hundred and eighty anxious and/or depressed participants from the Tulsa 1000 study completed multi-level behavioral or functional magnetic resonance imaging assessments of interoception and nociception including breath-hold and cold-pressor challenges, and heartbeat perception and interoceptive attention tasks. One-hundred and four individuals with comorbid depression and anxiety disorders (Dep+Anx) were propensity matched with 52 individuals with depression-only (Dep). Data were analyzed using mixed-effects linear regression. The Dep+Anx group showed significantly greater self-reported fear of suffocation during breath holding (Wilcoxon r = 0.23) and reduced cold pain tolerance (R2 = 0.027) signified by hand removal during immersion. However, these groups did not differ with respect to neutrally-valenced behavioral indices of heartbeat perception or neural indices of interoceptive attention. Individuals with comorbid depression and anxiety, vs. those with only depression, show increased respiratory fearfulness and nociceptive reactivity during perturbations of these signals, whilst showing similar interoceptive awareness in the absence of perturbation. Our findings suggest that individuals with comorbid anxiety and depression process aversive interoceptive and nociceptive signals differently than those with depression alone, providing support for a process model of increased threat sensitivity and hyperarousal in anxious depression.

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Section: Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The unique face of comorbid anxiety and depression: increased interoceptive fearfulness and reactivity

Ironside

DeVille

Kuplicki

et al. 2023

Front. Behav. Neurosci.

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“… 19 While the exact mechanism by which nbGL reduces overall brain excitability is not fully understood, human electrophysiological studies show that compared to red and blue lights, nbGL generates significantly smaller electrical signals in the retina (measured by electroretinography recording) and cortex (measured by recording visual evoked potentials). Thus, it is reasonable to propose that the anxiolytic effects of nbGL may be achieved by its ability to (a) reduce neuronal excitability and responsivity in cortical (eg, prefrontal cortex) and subcortical (eg, amygdala) areas involved in the pathophysiology of GAD, 42–46 (b) alter autonomic responses to negative emotions such as stress, fear, and anxiety, 47 and (c) stimulate hypothalamic neurons that release chemicals such as oxytocin, dopamine, and GABA. 19 , 48 …”

Section: Discussionmentioning

confidence: 99%

Psychotherapy Treatment of Generalized Anxiety Disorder Improves When Conducted Under Narrow Band Green Light

Melo‐Carrillo¹,

Rodriguez²,

Ashina³

et al. 2023

PRBM

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Background and Goals Psychotherapy is one of the most highly recommended and practiced approaches for the treatment of Generalized anxiety disorder (GAD). Commonly defined as excessive worry that is uncontrollable, GAD is one of the most prevalent psychiatric disorders. Anxiety is also one of the most common associated symptoms of migraine. Exposing migraineurs to narrow band green light (nbGL) reduces their anxiety and anxiety-like physiological symptoms such as throat tightness, shortness of breath, and palpitations. Here, we sought to determine whether the reduced anxiety described by our patients was secondary to the reduced headache or independent of it. The goal of the current study was therefore to determine whether exposure to nbGL can reduce anxiety in GAD patients who are not migraineurs. Patients and Methods Included in this open-label, proof-of-concept, prospective study were 13 patients diagnosed with moderate-to-severe GAD. We used the State-Trait Anxiety Inventory Questionnaire (Y-1) to compare anxiety level before and after each 45-minutes psychotherapy session conducted in white light (WL) (intensity = 100±5 candela/m 2 ) vs nbGL (wavelength = 520±10nm (peak ± range), intensity = 10±5 candela/m 2 ). Results Here, we show that psychotherapy sessions conducted under nbGL increase positive and decrease negative feelings significantly more than psychotherapy sessions conducted under regular room light (χ 2 = 0.0001). Conclusion The findings provide initial evidence for the potential benefit of conducting psychotherapy sessions for patients suffering GAD under nbGL conditions. Given the absence of side effects or risks, we suggest that illuminating rooms used in psychotherapy with nbGL be considered an add-on to the treatment of GAD.

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“…In a crossover randomized clinical trial, fMRI blood oxygen level-dependent neural responses in 58 female participants, including 29 with GAD, were measured following boluses of isoproterenol (isoprenaline; 0.5 and 2.0 μg) and saline [17 ▪ ]. Women with GAD exhibited higher autonomic activity following adrenergic stimulation, including elevated heart rate, increased interoceptive awareness, and increased anxiety.…”

Section: Basic Clinical Sciencementioning

confidence: 99%

Interventions for generalized anxiety disorder

Byrne

2022

Current Opinion in Psychiatry

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Purpose of reviewTo provide an overview of recently published work on anxiety, focusing on generalized anxiety disorder (GAD) and its treatment.Recent findingsSelf-reported anxiety symptoms were highly prevalent during the COVID-19 global pandemic in both the general population and in selected groups. There remains divided opinion about whether internet-based cognitive behavioural therapy (CBT) is noninferior to face-to-face CBT for GAD. A systematic review of drug treatment for GAD showed efficacy for selective serotonin reuptake inhibitors (SNRIs), agomelatine, and quetiapine. There may be a place for repetitive transcranial magnetic stimulation in the treatment of GAD. There was some evidence of efficacy for complementary therapies, including physical exercise, yoga, acupuncture, and Withania somnifera (ashwagandha). However, a systematic review of cannabidiol and tetrahydrocannabinol found insufficient evidence of efficacy in anxiety disorders.SummaryAntidepressants and quetiapine show efficacy in the treatment of GAD. Internet-based psychological interventions have a place in the treatment of GAD when face-to-face treatment is inaccessible. There is increasing evidence for the use of physical exercise in the management of GAD. Some other complementary therapies, including cannabinoids, require further, methodologically sound, research.

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Association of Generalized Anxiety Disorder With Autonomic Hypersensitivity and Blunted Ventromedial Prefrontal Cortex Activity During Peripheral Adrenergic Stimulation

Cited by 48 publications

References 82 publications

The unique face of comorbid anxiety and depression: increased interoceptive fearfulness and reactivity

The unique face of comorbid anxiety and depression: increased interoceptive fearfulness and reactivity

Psychotherapy Treatment of Generalized Anxiety Disorder Improves When Conducted Under Narrow Band Green Light

Interventions for generalized anxiety disorder

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