Pulling the lever in a hurry: the influence of impulsivity and sensitivity to reward on moral decision-making under time pressure.

BACKGROUND: Making timely moral decisions can save a life. However, literature on how moral decisions are made under time pressure reports conflicting results. Moreover, it is unclear whether and how moral choices under time pressure may be influenced by personality traits like impulsivity and sensitivity to reward and punishment. METHODS: To address these gaps, in this study we employed a moral dilemma task, manipulating decision time between participants: one group (N = 25) was subjected to time pressure (TP), with 8 s maximum time for response (including the reading time), the other (N = 28) was left free to take all the time to respond (noTP). We measured type of choice (utilitarian vs. non-utilitarian), decision times, self-reported unpleasantness and arousal during decision-making, and participants' impulsivity and BIS-BAS sensitivity. RESULTS: We found no group effect on the type of choice, suggesting that time pressure per se did not influence moral decisions. However, impulsivity affected the impact of time pressure, in that individuals with higher cognitive instability showed slower response times under no time constraint. In addition, higher sensitivity to reward predicted a higher proportion of utilitarian choices regardless of the time available for decision. CONCLUSIONS: Results are discussed within the dual-process theory of moral judgement, revealing that the impact of time pressure on moral decision-making might be more complex and multifaceted than expected, potentially interacting with a specific facet of attentional impulsivity.

Temperament Based Personality Types in Community-Dwelling Older Adults: A Latent Profile Analysis.

Three adaptive trait-based personality types have been replicated across ages, cultures, clinical problems and clustering methods: Resilient, Undercontrolled and Overcontrolled type (RUO). Recently there is growing interest in and importance of biopsychosocial transdiagnostic factors underlying personality types, such as temperamental reactivity and self-regulation. Latter can be understood in terms of Behavioural Inhibition (BIS), Behavioural Activation Systems (BAS) and Effortful Control (EC). The occurrence of temperament based RUO types has not yet been confirmed in older adults with or without a mental disorder. Therefore, based on a person-centered approach, the current study investigates whether RUO types can be corroborated in older adults based on the aforementioned temperamental factors. Latent profile analysis yielded two distinct personality profiles in community-dwelling over-60s, which we tentatively labeled a resilient (n = 167) and overcontrolled/inhibited type (n = 241). Compared to the resilient type, the overcontrolled/inhibited type scored lower on EC and higher on BIS. We could not corroborate an undercontrolled type (profiles scored equally on BAS). Group comparisons revealed that overcontrolled/inhibited older adults demonstrated significantly more clinical symptoms, higher emotional instability, lower scores on adaptive traits, less resilience and were significantly more likely to use passive and avoidant coping styles, compared to resilient older adults.

Approachability and Credibility of Virtual Character Faces: The Role of the Horizontal Viewing Angle.

OBJECTIVE: The present work explores how the horizontal viewing angle of a virtual character's face influences perceptions of credibility and approachability. BACKGROUND: When encountering virtual characters, people rely both on credibility and approachability judgments to form a first impression of the depicted virtual character. Research shows that certain perceptions are preferred either on frontal or tilted faces, but not how approachability or credibility judgments relate to horizontal viewing angles in finer granularity between 0° and 45°. METHOD: 52 participants performed a two-alternative forced choice (2AFC) task rating 240 pairwise comparisons of 20 virtual character faces shown in four horizontal viewing angles (0°, 15°, 30°, and 45°) on approachability and credibility. They also rated scales on individual differences based on the BIS-BAS framework (behavioral inhibition system, drive, and reward responsiveness), self-esteem, and personality traits (neuroticism, loneliness). RESULTS: Both approachability and credibility were negatively related to the horizontal viewing angle, but the negative relationship was less pronounced for approachability. Notably, 15° tilted faces were associated with higher approachability than frontal faces by people scoring high in reward responsiveness, drive, and self-esteem, and scoring low in neuroticism and loneliness. CONCLUSION: Our findings highlight the conditions under which showing a virtual character's face is preferred in a horizontally 15° tilted over a frontal position. APPLICATION: The differential impact of the horizontal viewing angle on approachability and credibility should be considered when displaying virtual character faces.

Does parents' perceived style of setting limits to gaming matter? The interplay between profiles of parental mediation and BIS/BAS sensitivity in problematic gaming and online gambling.

INTRODUCTION: Parents try to prevent possible negative outcomes associated with gaming by setting rules on their adolescent's gaming behavior (i.e., restrictive mediation). Parents can use either more autonomy-supportive or more controlling styles to communicate those rules. Using a person-centered approach, this study aims to, first, identify profiles of parents' perceived degree of restrictive mediation in gaming and styles of communicating these rules (i.e., autonomy-supportive and controlling); second, to examine how adolescents in different profiles differ in terms of maladaptive gaming outcomes (i.e., problematic gaming, simulated, and online gambling); third, to investigate the moderating role of gaming frequency and adolescents' personality (i.e., behavioral inhibition system [BIS] sensitivity and behavioral activation system [BAS] sensitivity) in the associations between the parental profiles and the outcomes. METHODS: The study used quantitative, cross-sectional survey data from Belgian adolescents (N = 1651, mean age = 14.00 years, 51.2% boys), collected between November 2021 and February 2022 in schools. RESULTS: Cluster analysis yielded four profiles of perceived restrictive mediation: an exclusively controlling one, an autonomy-supportive one, one where parents used a perceived mix of both communication styles, and one where there was an overall perceived lack of restrictive mediation. Adolescents in the controlling profile displayed the most maladaptive outcomes. Some of the associations between the parental profiles and the outcomes were stronger for more frequent gamers and for adolescents scoring higher on both BIS and BAS sensitivity. CONCLUSION: Associations between the parental profiles and gaming outcomes were theoretically meaningful, yet small in terms of effect size.

Association of polymorphisms rs4680 of the Catechol-O-Methyltransferase gene and rs6265 of the brain derived neurotrophic factor gene with the behavioral inhibition and behavioral activation systems.

Background: The Behavioral Inhibition System (BIS) comprises limbic circuitry implicated in avoidance behaviors. Its increased activation has been identified as a risk factor for anxiety and depressive disorders. In addition, both Catechol-O-Methyltransferase (COMT) and Brain Derived Neurotrophic Factor (BDNF) have been postulated as candidate genes that constitute a vulnerability for the onset of anxiety and depressive disorders. The aim of this study was to evaluate the possible association between the rs4680 polymorphism of the COMT gene and the rs6265 polymorphism of the BDNF gene with the BIS and the Behavioral Activation System (BAS) in a population sample from Colombia. Methods: Genetic information was obtained by extracting DNA from blood samples of 80 participants and using Taqman probes designed for each polymorphism. In addition, participants completed a BIS/BAS scale in order to establish a neuropsychological classification. Results: The frequency of the Met allele of the BDNF gene was greater in the group with BIS sensitivity compared to the group with BAS sensitivity. On the contrary, the frequency of the Met allele of the COMT gen did not show a significant association with the BIS. Conclusions: The rs6265 polymorphism of BDNF gene is associated with the BIS which in turn constitutes a risk factor for anxiety and depression.

Chronotype and sensory-processing sensitivity: A cross-sectional survey.

Here we examined the possibility of a relationship of sensory processing sensitivity (SPS) with chronotype in a German-speaking sample of N = 1807 (1008 female, 799 male) with a mean age of 47.75 ± 14.41 y (range: 18-97 y). The data were collected using an anonymous online questionnaire (Chronotype: one item of the Morning-Evening-Questionnaire, as well as typical bedtimes on weekdays and weekends; SPS: German version of the three-factor model ; Big Five: NEO-FFI-30) between 21 and 27 April 2021. Results. We found morningness to correlate with the SPS facet low sensory threshold (LST), while eveningness correlated to aesthetic sensitivity (AES) and marginally significant to ease of excitation (EOE). Discussion: The results show that the correlations between chronotype and the Big Five personality traits are not consistent with the direction of the correlations between chronotype and the SPS facets. The reason for this could be different genes that are responsible for the individual traits influence each other differently depending on their expression.

Coping and Conformity Motives Mediate the Joint Effects of the Behavioral Inhibition and Approach Systems on Alcohol Problems in Young Adults.

Background: Gray's original Reinforcement Sensitivity Theory (RST) posits that an oversensitive behavioral inhibition system (BIS) may increase risk for negative-reinforcement-motivated drinking, given its role in anxiety. However, existing data provides mixed support for the BIS-alcohol use association. The inconsistent evidence is not surprising, as the revised RST predicts that the behavioral approach system (BAS) should moderate the effect of the BIS on alcohol use. A strong BAS is thought to bring attention to the negatively reinforcing effects of alcohol, leading to problem drinking among those with a strong BIS. While emerging results support this interaction, we still have much to learn about the mechanisms underlying this effect on alcohol use. Accordingly, we examined motives for alcohol use as mediators of the joint associations of the BIS and the BAS on drinking behaviors. Specifically, our central hypothesis was that individuals with a strong BIS and a strong BAS would endorse increased negative reinforcement motives for drinking (coping and conformity motives), which in turn would predict heavy drinking and alcohol problems. Method: Participants (N=346; 195 women) completed study measures as part of the baseline assessment for a larger study. Results: Overall, results partially supported the hypotheses. Mediated moderation analyses showed that the indirect effect of the BIS on alcohol problems, through coping and conformity motives, was strongest at high levels of the BAS. This effect was not supported for alcohol use. Conclusions: Our findings suggest that clinical interventions should target coping and conformity reasons for drinking among anxious, reward responsive, young adults.

Measuring Personality Systems in Older Adults: Age-Neutrality of the Dutch BIS/BAS Questionnaire.

Introduction: With a rapidly aging population, age-neutrality of psychological instruments is becoming ever more important for accurate assessment of older adults. This study aims to test the age-neutrality of the Dutch Behavioral Inhibition System/Behavioral Approach System (BIS/BAS) scales by means of Differential Item Functioning (DIF) and Differential Test Functioning (DTF) analyses. Methods: DIF and DTF analyses were conducted using an odds ratio approach. Potential DIF was examined for the two primary scales and three BAS subscales in 390 Dutch-speaking participants divided over three age groups. Results: Overall, the BIS-BAS scales lacked age-neutrality when comparing older adults to young adults: eight out of 20 items (ie, 40%) displayed DIF according to the adjusted Bonferroni corrected cut-offs, which exceeds the threshold of 25% for large DIF. Thus, for 40% of the test items, items were differently endorsed by young and older adults with the same position on the construct measured by the item. Therefore, the implications of the item-level DIF on the scale level were investigated across age groups. DTF analyses revealed large DTF for all BIS and BAS scales according to the adjusted Bonferroni corrected cut-offs. Discussion: DIF found in items on the BIS scale and BAS-Drive and BAS-Fun Seeking scale can probably be explained by a difference in degree of expression across age groups. A solution could be the development of age-specific norms. DIF on BAS-Reward Responsiveness subscale could be partly due to measuring a different construct across age groups. Rephrasing or replacing such items with DIF may increase age-neutrality of the BIS/BAS Scales.

Predicting individual differences in behavioral activation and behavioral inhibition from functional networks in the resting EEG.

The behavioral activation system (BAS) and behavioral inhibition system (BIS) are thought to underly affective dispositions and self-regulatory processes. The BAS is sensitive to reward and involved in approach behaviors, and the BIS is sensitive to punishment and involved in avoidance behaviors. Trait BAS and BIS relate to distinct behavioral profiles and neural activity, but little is known about how trait BAS and BIS relate to functional networks in EEG. We applied a data-driven method called connectome predictive modeling (CPM) to identify networks relating to trait BAS and BIS and tested whether the strength of those networks predicted trait BAS and BIS in novel subjects using a leave-one-out cross-validation procedure. Adult participants (N = 107) completed a resting state task with eyes closed and eyes open, and trait BAS and BIS were measured via Carver and White's (1994) BIS and BAS scales. We hypothesized distinct positive (more synchronization) and negative (less synchronization) networks would relate to trait BAS and BIS. For eyes closed, we identified two negative networks, one in theta and one in alpha predicted BIS. We identified three positive networks, one in theta and one in beta predicted Fun Seeking and one in theta predicted Drive. For eyes open, negative theta and alpha networks predicted BIS, a positive theta network predicted Fun Seeking, and a negative gamma network predicted mean BAS. Visualization of the networks are presented. Discussion centers on the observed networks and how to advance application of CPM to EEG, including with clinical implications.

Construct validity of questionnaires for the original and revised reinforcement sensitivity theory.

This study highlights psychometric properties and evidence of construct validity on parcel-level for questionnaires on the original and revised reinforcement sensitivity theory. Our data (N = 1,076) suggest good to very good psychometric properties and moderate to excellent internal consistencies. Confirmatory factor analysis (CFA) models suggest a very good model fit for the first-order, four factor models of the Carver-White BIS/BAS scales, Reinforcement Sensitivity Theory - Personality Questionnaire (RST-PQ), the two-factor model of revised Reinforcement Sensitivity Theory-Questionnaire (rRST-Q) and for the bifactor model of the Conflict Monitoring Questionnaire (CMQ-44). The CMQ-44 extends the psychometric measurement of previous trait-(r)BIS and trait-BAS scales. Factor scores of CMQ-44 cognitive demand correlate positively with factor scores of Carver-White BIS and all Carver-White BAS subfactors except RST-PQ-Impulsivity suggesting that CMQ-44 cognitive demand addresses Carver-White trait-BIS specifically and more generally the trait-BAS core. CMQ-44 anticipation of negative consequences and response adaptation correlate negatively with trait-BAS, whereas the second-order factor performance monitoring extends the rRST trait-space and correlates positively with trait-BAS.

The roles of trait and process resilience in relation of BIS/BAS and depressive symptoms among adolescents.

Background: Extensive literature revealed the relations of depression with behavioral inhibition system (BIS) and behavioral activation system (BAS) as vulnerability and with resilience separately. Besides, the concept of resilience is still broad and ambiguous. Thus, this study aimed to reveal the mediation of two aspects of resilience: trait and process, in the relations of BIS and BAS to depression among adolescents. Methods: The data set used in this study was a cross-sectional survey among 965 adolescents. The obtained data from the self-reported questionnaires used in this study were as below: Depression Serf-Rating Scale for Children (DSRS-C), Behavioral Inhibition and Behavioral Activation System Scale (BIS/BASS), and Bidimensional Resilience Scale (BRS). Structural equation modeling (SEM) was conducted to verify the hypothesized relations among BIS/BAS, trait and behavior resilience, and depressive symptoms. Results: The obtained indices of fit from SEM were good or sufficient (χ 2 = 562.911, df = 96, p < 0.001; CFI = 0.925; NFI = 0.913; RMSEA = 0.073, 90% CI [0.067, 0.079]; SRMR = 0.066). And the modeling showed that both BIS/BAS directly and indirectly influenced to depression. The indirect effects of BIS/BAS were mediated only trait resilience except the indirect effect of BIS via behavioral resilience. Discussion: Our results suggested that trait resilience played a significant mediation role in the relationships between BIS/BAS and depression. Trait but not process resilience could be considered suitable as an intervention target in line with decreasing depression.

Self-construal and behavioral motivation systems among patients with depression in Indonesia: A hospital-based study.

Objective: To validate Indonesian versions of two social/cultural psychological scales: the Self-Construal Scale (SCS) that measures independent and interdependent cultural values, and the Behavioral Inhibition (Avoidance) System and Behavioral Approach System (BIS/BAS) that measures motivation focus. We also explored the cultural background for the rising prevalence of depression in Indonesia. Design: Case (hospital)-control (population) study. Setting: Hasanuddin University Hospital (cases) and Makassar city region (controls), Indonesia. Participants: Participants (N = 369) were 165 patients with depression recruited from a university hospital, and 204 healthy controls without a history of mental disorders recruited from locations within a 30-minute walk from the hospital. Outcome measures: Depression was diagnosed by psychiatrists with reference to Indonesian mental disorder guidelines (Pedoman Penggolongan dan Diagnosa Gangguan Jiwa edisi 3). Participants' independent and interdependent cultural values, and neural motivational systems were measured with the SCS and BIS/BAS. Results: Exploratory and confirmatory factor analyses showed that our revised 12-item SCS and the 13-item, three-factor BIS/BAS had a good model fit for the Indonesian population. MANCOVA showed that the SCS Independent subscale and the BAS subscales were significantly associated with depression after adjustment for age, sex, religion, education, and occupation. Conclusion: These findings may guide provision of appropriate treatment for patients based on their social and cultural environment. In addition, this study contributes to understanding underlying reasons for the increasing prevalence of depression in Indonesia, where society is changing from traditional collectivism to global individualism.

A Reinforcement Sensitivity Theory of Violent Extremist Propaganda: The Motivational Pathways Underlying Movement Toward and Away From Violent Extremist Action.

Anecdotal evidence supports than engaging with violent extremist content online facilitates the radicalization process. However, there is a consistent lack of empirically grounded research to provide insight into the psychological process through which this influence occurs (if at all). As such, most theories often fail to accommodate both the multifinality (the concept that many people are exposed to violent extremist material, yet never engage in violent extremism), and equifinality (the concept that people can view a range violent extremist content, yet all end up engaging in violent extremism) that naturally is observed in those who engage with violent extremist content online and those who engage in violent extremist behavior. This paper presents Reinforcement Sensitivity Theory (RST) as a theoretical framework to inform understanding of the process that governs the interaction between violent extremist material online and engaging with violent extremism. RST is a motivational theory which has been applied to a range of benevolent and deviant behaviors. Specifically, we argue that RST is suitable to explain the effect of violent extremist content online because (1) it outlines multiple differentiated motivational pathways that can account for multifinality and equifinality observed in those who engage in violent extremist behavior and (2) the extant neurological and psychophysiological research using RST provides a empirically supported framework for developing both research methods and verifiable hypotheses to advance our understanding of how, if at all, violent extremist content online contributes to the process of radicalization.

Toward Linguistic Recognition of Generalized Anxiety Disorder.

Background: Generalized anxiety disorder (GAD) refers to extreme, uncontrollable, and persistent worry and anxiety. The disorder is known to affect the social functioning and well-being of millions of people, but despite its prevalence and burden to society, it has proven difficult to identify unique behavioral markers. Interestingly, the worrying behavior observed in GAD is argued to stem from a verbal linguistic process. Therefore, the aim of the present study was to investigate if GAD can be predicted from the language people use to put their anxious worries into words. Given the importance of avoidance sensitivity (a higher likelihood to respond anxiously to novel or unexpected triggers) in GAD, this study also explored if prediction accuracy increases when individual differences in behavioral avoidance and approach sensitivity are taken into account. Method: An expressive writing exercise was used to explore whether GAD can be predicted from linguistic characteristics of written narratives. Specifically, 144 undergraduate student participants were asked to recall an anxious experience during their university life, and describe this experience in written form. Clinically validated behavioral measures for GAD and self-reported sensitivity in behavioral avoidance/inhibition (BIS) and behavioral approach (BAS), were collected. A set of classification experiments was performed to evaluate GAD predictability based on linguistic features, BIS/BAS scores, and a concatenation of the two. Results: The classification results show that GAD can, indeed, be successfully predicted from anxiety-focused written narratives. Prediction accuracy increased when differences in BIS and BAS were included, which suggests that, under those conditions, negatively valenced emotion words and words relating to social processes could be sufficient for recognition of GAD. Conclusions: Undergraduate students with a high GAD score can be identified based on their written recollection of an anxious experience during university life. This insight is an important first step toward development of text-based digital health applications and technologies aimed at remote screening for GAD. Future work should investigate the extent to which these results uniquely apply to university campus populations or generalize to other demographics.

Executive function moderates the relationship between temperament and psychological difficulties in middle childhood.

The current study examined the possible moderating influence of hot and cool executive function (EF) on the relationship between temperament and psychological difficulties in middle childhood. One hundred and twenty-six children and their parents (n = 105) participated. Children aged between 5 and 12 years completed three hot (motivational decision-making on the Cambridge Gambling Task (CGT), delayed gratification, and Theory of Mind [ToM]) and three cool EF (working memory, inhibition, and attentional set shifting) measures. Children's parents completed the Behavioral Inhibition Sensitivity (BIS) and Behavioral Approach Sensitivity (BAS) Scale and the Strengths and Difficulties Questionnaire. Hot EF (CGT, ToM) exacerbated the relationship between BAS and externalizing problems. Neither hot nor cool EF moderated the relationship between BIS and internalizing problems. The current findings provide further evidence of a hot-cool distinction in EF in middle childhood, suggesting that these constructs should be investigated separately when assessing EF. In addition, by considering potential interactions between temperament and EF, clinicians/researchers may be able to predict broad categories of psychological problems in middle childhood.

Hypnotherapy for complex regional pain syndrome.

Complex Regional Pain Syndrome (CRPS) is a chronic, disabling condition with prolonged or excessive pain persisting in a limb usually following a triggering injury or trauma to an extremity. The subjective expression of pain is disproportionate to what would be objectively expected from the initial injury. It may also be accompanied by a variety of autonomic disturbances and trophic abnormalities such as swelling in the affected area and changes in skin color and temperature. Understanding the pathophysiology of CRPS remains a medical challenge, along with making the diagnosis and devising an effective treatment plan. There are limited randomized controlled trials and definitive treatment is yet to evolve for this life-altering condition. This case study illustrates the safe, cost-effective addition and efficacious use of hypnosis in the integrative treatment plan for a teenager with CRPS.

Is irregular time estimation a common factor in smoking behavior and delay discounting?

INTRODUCTION: Smoking is known to be associated with steeper delay discounting which is a widely used measure of externalizing behavior. This study investigates individual aspects of time estimation and the extent to which these are associated with differences in delay discounting and smoking behavior. METHODS: The study was conducted as an online experiment in a sample of undergraduate students (N = 495), including 51 smokers. Participants completed a serial time estimation, delay discounting task (MCQ), BIS/BAS questionnaire, Fagerstrom test for nicotine dependence and an alcohol use assessment (QFV). RESULTS: Smoking, heavy drinking and delay discounting were associated with faster estimation of time. Furthermore, smoking and delay discounting were associated with differences in autocorrelation. Fun seeking was associated with smoking and alcohol use, but not with time estimation or delay discounting. CONCLUSIONS: This study provides evidence for the hypothesis that an acceleration of the internal clock might lead to time over-estimation which could lead towards delayed consequence sensitivity and addiction. The study also found further evidence for the hypothesis that distortions in time estimation (i.e., autocorrelation) may be related to delay discounting and smoking. Smoking and delay discounting were associated with faster estimations of time and differences in autocorrelation.

Motivational mediation between coping and post-traumatic growth in previously bullied college students.

Research has consistently shown that experiences of peer victimization may have long lasting negative consequences on health and academic achievement. Less attention has been paid to the association between past bullying and post-traumatic growth in college students. This cross-sectional study aims to examine the role of different motivational orientations (The Behavioral Inhibition and Behavioral Activation Systems (BIS/BAS) and regulatory focus) as potential mediators between cognitive strategies (rumination and resilient coping) and post-traumatic growth (PTG). Using a large sample of 1,134 college students, 85 were selected who were in their first year of college and had reported having previously experienced bullying. After classifying the participants acording to their the 33rd and 66th percentile scores on post-traumatic growth, a univariate analysis of variance (ANOVA) indicated significant differences between the low and high groups, with those highest in PTG showing the highest scores on drive approach, focus on promotion, and resilient coping. Conditional process analysis with these significant variables revealed that regulatory focus on promotion mediates between resilient coping and post-traumatic growth, whereas drive moderates the link between both variables. The findings shed light on the motivational mechanisms underlying PTG, which may be useful to guide interventions to prevent the consequences of bullying.

Does environmental message framing impact proportional reach and sample representativeness related to motivational characteristics?

Physical activity (PA) promotion messages are commonly used to engage target populations in PA programs. However, little is known about how recruitment messages impact program reach. Evidence suggests that framing messages to be congruent with individuals' motivational orientation can maximize effectiveness. This congruency effect has not been tested in the context of brief PA promotion messages used in a recruitment environment. It is plausible that framed messages attract certain individuals, while deterring others. The purpose of this study was to determine whether message framing influences representativeness of a sample recruited for a PA program with regards to motivational factors. Three messaging conditions (gain-framed, neutral, loss-framed) were counterbalanced across days of data collection in a primary care waiting room. Patients were asked to complete a questionnaire including surveys on personality and PA, and basic demographic questions. Respondents were offered the chance to participate in a low-burden PA program. Interested respondents were instructed to provide contact information. The proportion and representativeness, with respect to motivational orientation, of individuals volunteering for program participation was assessed using chi-squared tests, and two-way (condition × group) ANOVAs, respectively. After controlling for demographic and behavioral covariates, there was no effect of message framing on the motivational orientation of the resultant samples. Results did not support a congruency effect of a covert message-framing manipulation. More work should aim to understand how recruitment materials and strategies influence motivational characteristics of the resulting sample to maximize intervention outcomes, and target individuals who are more likely to engage in risky health behaviors.

Individual interregional perfusion between the left dorsolateral prefrontal cortex stimulation targets and the subgenual anterior cortex predicts response and remission to aiTBS treatment in medication-resistant depression: The influence of behavioral inhibition.

BACKGROUND: Accelerated intermittent Theta Burst Stimulation (aiTBS) has been put forward as an effective treatment to alleviate depressive symptoms. Baseline functional connectivity (FC) patterns between the left dorsolateral prefrontal cortex (DLPFC) and the subgenual anterior cortex (sgACC) have gained a lot of attention as a potential biomarker for response. However, arterial spin labeling (ASL) - measuring regional cerebral blood flow - may allow a more straightforward physiological interpretation of such interregional functional connections. OBJECTIVES: We investigated whether baseline covariance perfusion connectivity between the individually stimulated left DLPFC targets and sgACC could predict meaningful clinical outcome. Considering that individual characteristics may influence efficacy prediction, all patients were also assessed with the Behavioral Inhibition System/Behavioral Activation System (BIS/BAS) scale. METHODS: After baseline ASL scanning, forty-one medication-resistant depressed patients received twenty sessions of neuronavigated left DLPFC aiTBS in an accelerated sham-controlled crossover fashion, where all stimulation sessions were spread over four days (Trial registration: http://clinicaltrials.gov/show/NCT01832805). RESULTS: Stronger individual baseline interregional covariance perfusion connectivity patterns predicted response and/or remission. Furthermore, responders and remitters with higher BIS scores displayed stronger baseline interregional perfusion connections. CONCLUSIONS: Targeting the left DLPFC with aiTBS based on personal structural imaging data only may not be the most optimal method to enhance meaningful antidepressant responses. Individual baseline interregional perfusion connectivity could be an important added brain imaging method for individual optimization of more valid stimulation targets within the left DLPFC. Additional therapies dealing with behavioral inhibition may be warranted.