Explicit Facial Emotion Processing in Patients With Dissociative Seizures

J Neurol Neurosurg Psychiatry

Goldstein

Perez

et al. 2018

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210

167

Functional neurological disorder (FND) is a common and highly disabling disorder, but its aetiology remains enigmatic. Conceptually, there has been reduced emphasis on the role of psychosocial stressors in recent years, with a corresponding increase in neurobiological explanations. However, a wealth of evidence supports the role of psychosocial adversities (eg, stressful life events, interpersonal difficulties) as important risk factors for FND. Therefore, there is a need to integrate psychosocial (environmental) and neurobiological factors (eg, sensorimotor and cognitive functions) in contemporary models of FND. Altered emotional processing may represent a key link between psychosocial risk factors and core features of FND. Here, we summarise and critically appraise experimental studies of emotional processing in FND using behavioural, psychophysiological and/or neuroimaging measures in conjunction with affective processing tasks. We propose that enhanced preconscious (implicit) processing of emotionally salient stimuli, associated with elevated limbic reactivity (eg, amygdala), may contribute to the initiation of basic affective/defensive responses via hypothalamic and brainstem pathways (eg, periaqueductal grey). In parallel, affect-related brain areas may simultaneously exert a disruptive influence on neurocircuits involved in voluntary motor control, awareness and emotional regulation (eg, sensorimotor, salience, central executive networks). Limbic-paralimbic disturbances in patients with FND may represent one of several neurobiological adaptations linked to early, severe and/or prolonged psychosocial adversity. This perspective integrates neurobiological and psychosocial factors in FND and proposes a research agenda, highlighting the need for replication of existing findings, multimodal sampling across emotional response domains and further examination of emotional influences on sensorimotor and cognitive functions in FND populations.

Section: Emotional Processing In Fnd: a Narrative Reviewmentioning

confidence: 96%

“…Findings include elevated salivary cortisol,34 HR,33 skin conductance levels,15 SCRs41 and lower HRV 27 33 42. In addition, potentiated startle responses have been observed in patients with FND-movt 43…”

Section: Emotional Processing In Fnd: a Narrative Reviewmentioning

confidence: 99%

Emotional processing in functional neurological disorder: a review, biopsychosocial model and research agenda

J Neurol Neurosurg Psychiatry

Goldstein

Perez

et al. 2018

Self Cite

210

167

“…All methods for acquiring, extracting, and reducing the SC variables followed recommended guidelines (Boucsein et al, 2012;Dawson, Schell, & Filion, 2000); the methods were described in full previously (Pick et al, 2016) and can be found in Data S3. Baseline SCLs were calculated from the average values obtained across the resting habituation period prior to the experiment, whereas task SCLs were calculated from the average of the values obtained during the last 5-s of each ISI in the experimental task (i.e., at rest, fixating on a single cross-hair).…”

Section: Skin Conductance Datamentioning

confidence: 99%

“…There is now substantial experimental evidence that people with DS display alterations in responsivity to social emotional stimuli, characterized by increased cognitive interference by and behavioural avoidance of emotional facial expressions (Bakvis et al, 2009;Bakvis, Spinhoven, Putman, Zitman, & Roelofs, 2010;Bakvis, Spinhoven, Zitman, & Roelofs, 2011;Gul and Ahmad, 2014) as well as deficits in 'theory of mind' (Sch€ onenberg et al, 2015) and explicit facial expression recognition (Pick, Mellers, & Goldstein, 2016). However, less is known about how people with DS respond to other, more general emotional stimuli.…”

mentioning

confidence: 99%

Autonomic and subjective responsivity to emotional images in people with dissociative seizures

Journal of Neuropsychology

Mellers

Goldstein

2017

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People with dissociative seizures (DS) report a range of difficulties in emotional functioning and exhibit altered responding to emotional facial expressions in experimental tasks. We extended this research by investigating subjective and autonomic reactivity (ratings of emotional valence, arousal and skin conductance responses [SCRs]) to general emotional images in 39 people with DS relative to 42 healthy control participants, whilst controlling for anxiety, depression, cognitive functioning and, where relevant, medication use. It was predicted that greater subjective negativity and arousal and increased SCRs in response to the affective pictures would be observed in the DS group. The DS group as a whole did not differ from controls in their subjective responses of valence and arousal. However, SCR amplitudes were greater in 'autonomic responders' with DS relative to 'autonomic responders' in the control group. A positive correlation was also observed between SCRs for highly arousing negative pictures and self-reported ictal autonomic arousal, in DS 'autonomic responders'. In the DS subgroup of autonomic 'nonresponders', differences in subjective responses were observed for some conditions, compared to control 'non-responders'. The findings indicate unaffected subjective responses to emotional images in people with DS overall. However, within the group of people with DS, there may be subgroups characterized by differences in emotional responding. One subgroup (i.e., 'autonomic responders') exhibit heightened autonomic responses but intact subjective emotional experience, whilst another subgroup (i.e., 'autonomic non-responders') seem to experience greater subjective negativity and arousal for some emotional stimuli, despite less frequent autonomic reactions. The current results suggest that therapeutic interventions targeting awareness and regulation of physiological arousal and subjective emotional experience could be of value in some people with this disorder.

“…Additionally, a limited number of experimental studies have indicated abnormalities in emotional processing in patients with DS, most commonly in responses to facial affect. Findings include impaired switching from a facial emotion categorisation task [31], exaggerated interference by facial emotion on working memory performance [37], and reduced explicit recognition and attenuated autonomic responses to facial expressions relative to controls [38]. The first experimental study of this nature [39] reported an increased attentional bias towards angry faces in patients with DS (n = 19) compared to healthy controls (n = 20) (p < .05), on an emotional Stroop test involving preconscious processing of affectively valenced facial stimuli.…”

Section: Introductionmentioning

confidence: 99%

Implicit attentional bias for facial emotion in dissociative seizures: Additional evidence

Mellers

2018

Epilepsy & Behavior

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This study sought to extend knowledge about the previously reported preconscious attentional bias (AB) for facial emotion in patients with dissociative seizures (DS) by exploring whether the finding could be replicated, while controlling for concurrent anxiety, depression, and potentially relevant cognitive impairments. Patients diagnosed with DS (n=38) were compared with healthy controls (n=43) on a pictorial emotional Stroop test, in which backwardly masked emotional faces (angry, happy, neutral) were processed implicitly. The group with DS displayed a significantly greater AB to facial emotion relative to controls; however, the bias was not specific to negative or positive emotions. The group effect could not be explained by performance on standardized cognitive tests or self-reported depression/anxiety. The study provides additional evidence of a disproportionate and automatic allocation of attention to facial affect in patients with DS, including both positive and negative facial expressions. Such a tendency could act as a predisposing factor for developing DS initially, or may contribute to triggering individuals' seizures on an ongoing basis. Psychological interventions such as Cognitive Behavioral Therapy (CBT) or AB modification might be suitable approaches to target this bias in clinical practice.