Tonic immobility triggered by COVID-19-related trauma is associated with long-term PTSD symptoms.

During the COVID-19 pandemic healthcare workers were repeatedly exposed to traumatic experiences. Facing life-threatening events and repeated exposure to traumatic duty-related situations may cause posttraumatic stress disorder (PTSD). While tonic immobility has been considered a key vulnerability factor for PTSD, little is known about this relationship in the long term. In this study, we aimed to determine whether peritraumatic tonic immobility triggered by COVID-19-related trauma predicts PTSD symptom severity six to twelve months later. We conducted an online longitudinal survey using the PTSD Checklist for the DSM-5 (PCL-5) and the Tonic Immobility Scale to assess PTSD symptoms and the tonic immobility response, respectively. Multivariate regression models revealed a significant association between tonic immobility and PTSD symptoms. Each one-unit increase in the tonic immobility score was associated with a 1.5 % increase in the average PTSD symptom score six to twelve months after the traumatic event that triggered the tonic immobility. Furthermore, participants who showed significant or extreme levels of tonic immobility were 3.5 times or 7.3 times more likely to have a probable PTSD diagnosis, respectively. Hence, peritraumatic tonic immobility seems to have a lasting deleterious effect on mental health. Psychological treatment for health care professionals is urgent, and psychoeducation about the involuntary, biological nature of tonic immobility is essential to reduce suffering.

Threat directionality modulates defensive reactions in humans: cardiac and electrodermal responses.

Features of threatening cues and the associated context influence the perceived imminence of threat and the defensive responses evoked. To provide additional knowledge about how the directionality of a threat (i.e. directed-towards or away from the viewer) might impact defensive responses in humans, participants were shown pictures of a man carrying a gun (threat) or nonlethal object (neutral) directed-away from or towards the participant. Cardiac and electrodermal responses were collected. Compared to neutral images, threatening images depicting a gun directed-towards the participant induced sustained bradycardia and an increased electrodermal response, interpreted as immobility under attack. This defensive immobility reaction is evoked by high perceived threat and inescapable situations and indicates intense action preparation. Pictures of guns directed-away from the participant induced shorter bradycardia and no significant modulation of the electrodermal response compared to neutral pictures, which might be consistent with the perception of a less threatening situation. The results show that the directionality of threat stimuli is a key factor that prompts different patterns of defensive responses.

Changes on risky drinking after the COVID-19 outbreak in Brazil: results from three consecutive web surveys.

INTRODUCTION: Risky drinking (RD) is associated with an increased risk of chronic and infectious diseases, injuries, and violence. This study aimed to assess changes in risky drinking (RD) in Brazil after COVID-19 outbreak, both overall and among individuals with self-reported chronic diseases and mental health disorders. METHODS: We conducted three independent, anonymous web surveys in Brazil including adult participants: S1 (April/2020, n=19,257), S2 (August/2020, n=1,590), and S3 (January/2021, n=859). Participants were recruited through adapted snowball sampling and sponsored social network advertisements. RD was assessed using the Alcohol Use Disorder Identification Test-Concise, designed to identify individuals at risk of alcohol-related problems. Logistic regression analyses with bootstrapping (B=2,000) were performed, with stratification by sex, age, education, employment, household size, and the presence of chronic and mental health conditions, as well as lifestyle factors, to address sample imbalances. RESULTS: The estimated prevalence of RD was 45.8% [95%CI 45.5, 46.1] in S1, 35.3% [95%CI 34.9, 35.6] in S2, and 33.7% [95%CI 33.3, 34.0] in S3. Participants with chronic diseases consistently presented lower RD prevalence across all three surveys, compared to those without such conditions. Conversely, individuals with mental health disorders presented higher RD prevalence than those without such diagnoses in S1 and S2, but not in S3. DISCUSSION: Despite the decrease in RD prevalence, monitoring of alcohol consumption trends remains essential for shaping effective public health policies. Additionally, the observed variations among individuals reporting chronic and mental health disorders highlight the need for targeted interventions in future crises.

Machine learning applied to fMRI patterns of brain activation in response to mutilation pictures predicts PTSD symptoms.

BACKGROUND: The present study aimed to apply multivariate pattern recognition methods to predict posttraumatic stress symptoms from whole-brain activation patterns during two contexts where the aversiveness of unpleasant pictures was manipulated by the presence or absence of safety cues. METHODS: Trauma-exposed participants were presented with neutral and mutilation pictures during functional magnetic resonance imaging (fMRI) collection. Before the presentation of pictures, a text informed the subjects that the pictures were fictitious ("safe context") or real-life scenes ("real context"). We trained machine learning regression models (Gaussian process regression (GPR)) to predict PTSD symptoms in real and safe contexts. RESULTS: The GPR model could predict PTSD symptoms from brain responses to mutilation pictures in the real context but not in the safe context. The brain regions with the highest contribution to the model were the occipito-parietal regions, including the superior parietal gyrus, inferior parietal gyrus, and supramarginal gyrus. Additional analysis showed that GPR regression models accurately predicted clusters of PTSD symptoms, nominal intrusion, avoidance, and alterations in cognition. As expected, we obtained very similar results as those obtained in a model predicting PTSD total symptoms. CONCLUSION: This study is the first to show that machine learning applied to fMRI data collected in an aversive context can predict not only PTSD total symptoms but also clusters of PTSD symptoms in a more aversive context. Furthermore, this approach was able to identify potential biomarkers for PTSD, especially in occipitoparietal regions.

Tonic immobility is associated with posttraumatic stress symptoms in healthcare professionals exposed to COVID-19-related trauma.

The Coronavirus Disease 2019 (COVID-19) pandemic has exposed healthcare workers (HCW) to traumatic situations that might lead to the development of posttraumatic stress disorder (PTSD). An important vulnerability factor for PTSD is the peritraumatic tonic immobility (TI) reaction, an involuntary and reflexive defensive response evoked by an intense and inescapable threat. TI is largely understudied in humans and has not been investigated during trauma related to COVID-19. For HCW, the pandemic context might be experienced as an intense and potentially inescapable threat, i.e., an overwhelming situation. Here, we investigated if TI response occurred during traumatic events related to the pandemic and its association with posttraumatic stress symptoms (PTSS). An online survey of 1001 HCW investigated COVID-19-related traumatic experiences, TI and PTSS. TI was reported for all types of traumatic events, and multivariate regression models revealed that TI was significantly associated with PTSS severity. HCW who reported high TI scores exhibited an increase of 9.08 times the probability of having a probable diagnosis of PTSD. Thus, TI was evoked by pandemic-related traumatic situations and associated with PTSS severity and higher odds of a PTSD diagnosis. Tonic immobility occurrence should be screened, and psychoeducation about its reflexive biological nature should be introduced.

Tonic Immobility is Associated with PTSD Symptoms in Traumatized Adolescents.

PURPOSE: Growing evidence suggests that peritraumatic tonic immobility, an involuntary defensive response that involves extreme physical immobility and the perceived inability to escape, is a significant predictor of post-traumatic stress disorder (PTSD) symptomatology. However, this issue has not been specifically addressed in adolescents. Here, we investigated whether tonic immobility response experienced during the worst childhood or adolescent trauma is associated with PTSD symptom severity in a non-clinical student sample. METHODS: The sample was composed of students in 9th grade who were attending public and private schools. Symptoms of post-traumatic stress and tonic immobility were assessed using questionnaires. We performed bivariate and multivariate negative binomial regressions to examine whether tonic immobility was associated with PTSD symptomatology after controlling for confounders (peritraumatic dissociation, peritraumatic panic reactions, gender, age and time since trauma). RESULTS: We found an association between tonic immobility and PTSD symptom severity, even after controlling for confounders. Therefore, tonic immobility is associated with PTSD symptoms in trauma-exposed adolescents. CONCLUSION: These findings highlight tonic immobility as a possible risk factor that could be used to provide direction for more targeted trauma interventions for individuals, particularly those at risk for developing PTSD. Therefore, it contributes to preventing and reducing the psychiatric burden in adolescence and later in life.

Facing Racism and Sexism in Science by Fighting Against Social Implicit Bias: A Latina and Black Woman's Perspective.

The editors of several major journals have recently asserted the importance of combating racism and sexism in science. This is especially relevant now, as the COVID-19 pandemic may have led to a widening of the gender and racial/ethnicity gaps. Implicit bias is a crucial component in this fight. Negative stereotypes that are socially constructed in a given culture are frequently associated with implicit bias (which is unconscious or not perceived). In the present article, we point to scientific evidence that shows the presence of implicit bias in the academic community, contributing to strongly damaging unconscious evaluations and judgments of individuals or groups. Additionally, we suggest several actions aimed at (1) editors and reviewers of scientific journals (2) people in positions of power within funding agencies and research institutions, and (3) members of selection committees to mitigate this effect. These recommendations are based on the experience of a group of Latinx American scientists comprising Black and Latina women, teachers, and undergraduate students who participate in women in science working group at universities in the state of Rio de Janeiro, Brazil. With this article, we hope to contribute to reflections, actions, and the development of institutional policies that enable and consolidate diversity in science and reduce disparities based on gender and race/ethnicity.

Unveiling the neural underpinnings of optimism: a systematic review.

Optimism is a personality trait strongly associated with physical and psychological well-being, with correlates in nonhuman species. Optimistic individuals hold positive expectancies for their future, have better physical and psychological health, recover faster after heart disease and other ailments, and cope more effectively with stress and anxiety. We performed a systematic review of neuroimaging studies focusing on neural correlates of optimism. A search identified 14 papers eligible for inclusion. Two key brain areas were linked to optimism: the anterior cingulate cortex (ACC), involved in imagining the future and processing of self-referential information; and the inferior frontal gyrus (IFG), involved in response inhibition and processing relevant cues. ACC activity was positively correlated with trait optimism and with the probability estimations of future positive events. Behavioral measures of optimistic tendencies investigated through the belief update task correlated positively with IFG activity. Elucidating the neural underpinnings of optimism may inform both the development of prevention and treatment strategies for several mental disorders negatively associated with optimism, such as depression, as well as help to foster new resilience promotion interventions targeting healthy, vulnerable, and mentally ill individuals.

Vulnerability and Protective Factors for PTSD and Depression Symptoms Among Healthcare Workers During COVID-19: A Machine Learning Approach.

Background: Healthcare workers are at high risk for developing mental health problems during the COVID-19 pandemic. There is an urgent need to identify vulnerability and protective factors related to the severity of psychiatric symptoms among healthcare workers to implement targeted prevention and intervention programs to reduce the mental health burden worldwide during COVID-19. Objective: The present study aimed to apply a machine learning approach to predict depression and PTSD symptoms based on psychometric questions that assessed: (1) the level of stress due to being isolated from one's family; (2) professional recognition before and during the pandemic; and (3) altruistic acceptance of risk during the COVID-19 pandemic among healthcare workers. Methods: A total of 437 healthcare workers who experienced some level of isolation at the time of the pandemic participated in the study. Data were collected using a web survey conducted between June 12, 2020, and September 19, 2020. We trained two regression models to predict PTSD and depression symptoms. Pattern regression analyses consisted of a linear epsilon-insensitive support vector machine (ε-SVM). Predicted and actual clinical scores were compared using Pearson's correlation coefficient (r), the coefficient of determination (r2), and the normalized mean squared error (NMSE) to evaluate the model performance. A permutation test was applied to estimate significance levels. Results: Results were significant using two different cross-validation strategies to significantly decode both PTSD and depression symptoms. For all of the models, the stress due to social isolation and professional recognition were the variables with the greatest contributions to the predictive function. Interestingly, professional recognition had a negative predictive value, indicating an inverse relationship with PTSD and depression symptoms. Conclusions: Our findings emphasize the protective role of professional recognition and the vulnerability role of the level of stress due to social isolation in the severity of posttraumatic stress and depression symptoms. The insights gleaned from the current study will advance efforts in terms of intervention programs and public health messaging.

Interactions between emotion and action in the brain.

A growing literature supports the existence of interactions between emotion and action in the brain, and the central participation of the anterior midcingulate cortex (aMCC) in this regard. In the present functional magnetic resonance imaging study, we sought to investigate the role of self-relevance during such interactions by varying the context in which threating pictures were presented (with guns pointed towards or away from the observer). Participants performed a simple visual detection task following exposure to such stimuli. Except for voxelwise tests, we adopted a Bayesian analysis framework which evaluated evidence for the hypotheses of interest, given the data, in a continuous fashion. Behaviorally, our results demonstrated a valence by context interaction such that there was a tendency of speeding up responses to targets after viewing threat pictures directed towards the participant. In the brain, interaction patterns that paralleled those observed behaviorally were observed most notably in the middle temporal gyrus, supplementary motor area, precentral gyrus, and anterior insula. In these regions, activity was overall greater during threat conditions relative to neutral ones, and this effect was enhanced in the directed towards context. A valence by context interaction was observed in the aMCC too, where we also observed a correlation (across participants) of evoked responses and reaction time data. Taken together, our study revealed the context-sensitive engagement of motor-related areas during emotional perception, thus supporting the idea that emotion and action interact in important ways in the brain.

Unilateral Brachial Plexus Lesion Impairs Bilateral Touch Threshold.

Unilateral brachial plexus injury (BPI) impairs sensory and motor functions of the upper limb. This study aimed to map in detail brachial plexus sensory impairment both in the injured and the uninjured upper limb. Touch sensation was measured through Semmes-Weinstein monofilaments at the autonomous regions of the brachial plexus nerves, hereafter called points of exclusive innervation (PEIs). Seventeen BPI patients (31.35 years±6.9 SD) and 14 age-matched healthy controls (27.57 years±5.8 SD) were tested bilaterally at six selected PEIs (axillary, musculocutaneous, median, radial, ulnar, and medial antebrachial cutaneous [MABC]). As expected, the comparison between the control group and the brachial plexus patients' injured limb showed a robust difference for all PEIs (p ≤ 0.001). Moreover, the comparison between the control group and the brachial plexus uninjured limb revealed a difference for the median (p = 0.0074), radial (p = 0.0185), ulnar (p = 0.0404), and MABC (p = 0.0328) PEIs. After splitting the sample into two groups with respect to the dominance of the injured limb, higher threshold values were found for the uninjured side when it occurred in the right dominant limb compared to the control group at the median (p = 0.0456), radial (p = 0.0096), and MABC (p = 0.0078) PEIs. This effect was absent for the left, non-dominant arm. To assess the effect of the severity of sensory deficits observed in the injured limb upon the alterations of the uninjured limb, a K-means clustering algorithm (k = 2) was applied resulting in two groups with less or more severe sensory impairment. The less severely affected patients presented higher thresholds at the median (p = 0.0189), radial (p = 0.0081), ulnar (p = 0.0253), and MABC (p = 0.0187) PEIs in the uninjured limb in comparison with the control group, whereas higher thresholds at the uninjured limb were found only for the median PEI (p = 0.0457) in the more severely affected group. In conclusion, an expressive reduction in touch threshold was found for the injured limb allowing a precise mapping of the impairment caused by the BPI. Crucially, BPI also led to reduced tactile threshold in specific PEIs in the uninjured upper limb. These new findings suggest a superordinate model of representational plasticity occurring bilaterally in the brain after a unilateral peripheral injury.

Hands Up! Atypical Defensive Reactions in Heavy Players of Violent Video Games When Exposed to Gun-Attack Pictures.

Threatening cues and surrounding contexts trigger specific defensive response patterns. Posturography, a technique for measuring postural strategies, has been used to evaluate motor defensive reactions in humans. When exposed to gun pointed pictures, humans were shown to exhibit an immobility reaction. Short and long-term exposure to violent video games was shown to be a causal risk factor for increased violent and aggressive behavior. Assaultive violence with a gun is a major trigger for motor defensive reactions, and post-traumatic stress disorder (PTSD) is the most characteristic psychiatric sequelae. Recent studies point to links between PTSD symptoms and emotional shortfalls in non-clinical trauma-exposed samples. The present study investigated defensive reactions to gun threat and PTSD symptoms in heavy players of violent video games compared to non-players. Male university students were screened according to use of violent video games and divided in three groups: non-players, moderate players, and heavy players. Stimuli were pictures depicting a man pointing a gun directed at the participant. In matched control pictures, non-lethal objects replaced the gun. Posturography was recorded and PTSD symptoms were assessed. When exposed to the threat pictures, non-players exhibited the expected reduction in amplitude of body sway (immobility), heavy players presented atypical augmented amplitude of body sway, and moderate players showed intermediate reactivity. Heavy players presented a significant distinct reaction compared to non-players. They also scored significantly higher in PTSD symptoms than non-players. Disadvantageous defensive reactions and higher vulnerability to PTSD symptoms, revealed in the present study, add to other shortcomings for heavy players.

Stop or move: Defensive strategies in humans.

Threatening cues and surrounding contexts trigger specific defensive response patterns. Potential threat evokes attentive immobility; attack evokes flight when escape is available and immobility when escape is blocked. Tonic immobility installs when threat is overwhelming and life-risky. In humans, reduced body sway characterizes attentive and tonic immobility, the former with bradycardia, and the later with expressive tachycardia. Here, we investigate human defensive strategies in the presence or absence of an escape route. We employed pictures depicting a man carrying a gun and worked with participants exposed to urban violence. In pictures simulating more possibility of escape, the gun was directed away from the observer; in those simulating higher risk and less chance of escape, the gun was directed toward the observer. Matched control pictures depicted similar layouts, but a non-lethal object substituted the gun. Posturographic and electrocardiographic recordings were collected. Amplitude of sway and heart rate were higher for gun directed-away and lower for gun direct-toward. Compared to their respective matched controls, there was a general increase in the amplitude of sway for the gun directed-away pictures; and a reduction in back-and-forth sway and in heart rate for gun directed-toward pictures. Taken together, those measures suggest that, when exposed to threat invading their margin of safety in a context indicating possible escape route, humans, as non-human species, engage in active escape, resembling the flight stage of the defensive cascade. When facing threat indicating less possibility of escape, humans present an immobile response with bradycardia.

Amygdala responses to unpleasant pictures are influenced by task demands and positive affect trait.

The role of attention in emotional processing is still the subject of debate. Recent studies have found that high positive affect in approach motivation narrows attention. Furthermore, the positive affect trait has been suggested as an important component for determining human variability in threat reactivity. We employed functional magnetic resonance imaging to investigate whether different states of attention control would modulate amygdala responses to highly unpleasant pictures relative to neutral and whether this modulation would be influenced by the positive affect trait. Participants (n = 22, 12 male) were scanned while viewing neutral (people) or unpleasant pictures (mutilated bodies) flanked by two peripheral bars. They were instructed to (a) judge the picture content as unpleasant or neutral or (b) to judge the difference in orientation between the bars in an easy condition (0 or 90(∘) orientation difference) or (c) in a hard condition (0 or 6(∘) orientation difference). Whole brain analysis revealed a task main effect of brain areas related to the experimental manipulation of attentional control, including the amygdala, dorsolateral prefrontal cortex, and posterior parietal cortex. Region of interest analysis showed an inverse correlation (r = -0.51, p < 0.01) between left amygdala activation and positive affect level when participants viewed unpleasant stimuli and judged bar orientation in the easy condition. This result suggests that subjects with high positive affect exhibit lower amygdala reactivity to distracting unpleasant pictures. In conclusion, the current study suggests that positive affect modulates attention effect on unpleasant pictures, therefore attenuating emotional responses.

How you perceive threat determines your behavior.

The prioritization of processing emotional stimuli usually produces deleterious effects on task performance when it distracts from a task. One common explanation is that brain resources are consumed by emotional stimuli, diverting resources away from executing the task. Viewing unpleasant stimuli also generates defensive reactions, and these responses may be at least partially responsible for the effect of the emotional modulation observed in various reaction time (RT) paradigms. We investigated whether modulatory effects on RT vary if we presented threat stimuli to prompt different defensive responses. To trigger different responses, we manipulated threat perception by moving the direction of threatening stimuli. Threatening or neutral stimuli were presented as distractors during a bar orientation discrimination task. The results demonstrated that threat stimuli directed toward the observer produced a decrease in RT; in contrast, threat stimuli directed away from the observer produced an increase in RT, when compared to neutral stimuli. Accelerated RT during directed toward threat stimuli was attributed to increased motor preparation resulting from strong activation of the defense response cascade. In contrast, directed away threat stimuli likely activated the defense cascade, but less intensively, prompting immobility. Different threat stimuli produced varying effects, which was interpreted as evidence that the modulation of RT by emotional stimuli represents the summation of attentional and motivational effects. Additionally, participants who had been previously exposed to diverse types of violent crime were more strongly influenced by threat stimuli directed toward the observer. In sum, our data support the concept that emotions are indeed action tendencies.

The improvement of emotion and attention regulation after a 6-week training of focused meditation: a randomized controlled trial.

Self-regulatory trainings can be an effective complementary treatment for mental health disorders. We investigated the effects of a six-week-focused meditation training on emotion and attention regulation in undergraduates randomly allocated to a meditation, a relaxation, or a wait-list control group. Assessment comprised a discrimination task that investigates the relationship between attentional load and emotional processing and self-report measures. For emotion regulation, results showed greater reduction in emotional interference in the low attentional load condition in meditators, particularly compared to relaxation. Only meditators presented a significant association between amount of weekly practice and the reduction in emotion interference in the task and significantly reduced image ratings of negative valence and arousal, perceived anxiety and difficulty during the task, and state and trait-anxiety. For attention regulation, response bias during the task was analyzed through signal detection theory. After training, meditation and relaxation significantly reduced bias in the high attentional load condition. Importantly, there was a dose-response effect on general bias: the lowest in meditation, increasing linearly across relaxation and wait-list. Only meditators reduced omissions in a concentrated attention test. Focused meditation seems to be an effective training for emotion and attention regulation and an alternative for treatments in the mental health context.

Emotion and attention interaction: a trade-off between stimuli relevance, motivation and individual differences.

Mounting evidence suggests that the neural processing of emotional stimuli is prioritized. However, whether the processing of emotional stimuli is dependent on attention remains debatable. Several studies have investigated this issue by testing the capacity of emotional distracters to divert processing resources from an attentional main task. The attentional load theory postulates that the perceptual load of the main task determines the selective processing of the distracter. Although we agree with this theory, we also suggest that other factors could be important in determining the association between the load of the main task and distracter processing, namely, (1) the relevance of the to-be ignored stimuli and (2) the engagement in the main task due to motivation. We postulate that these factors function as opposite forces to influence distracter processing. In addition, we propose that this trade-off is modulated by individual differences. In summary, we suggest that the relationship between emotion and attention is flexible rather than rigid and depends on several factors. Considering this perspective may help us to understand the divergence in the results described by several studies in this field.

Fact or fiction? An event-related potential study of implicit emotion regulation.

Emotion regulation can be achieved through a number of processes. Previous studies have investigated this issue by encouraging individuals to voluntarily change how they think about a situation in order to decrease its emotional impact. However, little is known about automatic regulation processes. The goal of the present study was to investigate whether an "implicit reappraisal strategy" would modulate the Late Positive Potential (LPP) associated to affective picture viewing. Unpleasant pictures, presented as distractors, were shown in two contexts in which a prior description presented them as taken from either movie scenes (fictitious) or real scenes. Results showed that the interference produced by unpleasant pictures under the real context, indexed by reaction time and LPP amplitude, was attenuated under the fictitious context. These results provide evidence for implicit down-regulation of the stimulus relevance during an inattention condition.

Emotion affects action: Midcingulate cortex as a pivotal node of interaction between negative emotion and motor signals.

Affective pictures drive the activity of brain networks and impact behavior. We showed previously that viewing unpleasant pictures interfered in the performance of a basic nonemotional visual detection task. In the present study, we employed functional magnetic resonance imaging to test the hypothesis that behavioral interference may result from the interaction between negatively valenced and motor-related signals in the brain. As in our previous study (Pereira et al., 2006), participants performed a simple target detection task that followed the presentation of unpleasant or neutral pictures. Our results revealed that an unpleasant emotional context modulated evoked responses in several regions engaged by the simple target detection task. In particular, the midcingulate cortex was recruited when participants performed target detection trials during the unpleasant context, and signal responses in this region closely mirrored the pattern of behavioral interference (as revealed via reaction time). Our findings suggest that the midcingulate cortex may be an important site for the interaction between negatively valenced signals and motor signals in the brain and that it may be involved in the implementation of defensive responses, such as freezing.

Regulation of negative emotions in high trait anxious individuals: an ERP study

Literature has shown that failures in the ability to down-regulate negative emotions are the core substrate of anxiety disorders. Previous studies have investigated this issue by encouraging individuals to voluntarily change how they think about a situation in order to decrease its emotional impact. The majority of studies has demonstrated that explicit instructions to reduce negative affect in anxious individuals are usually ineffective. Thus, the goal of the present study was to investigate whether an implicit regulation strategy would modulate electrophysiological activity (Late Positive Potential) associated to affective picture viewing. The Late Positive Potential (LPP) is a sustained positive deflection in the event-related potential that is larger following the presentation of emotional compared to neutral visual stimuli. Participants (low trait anxious - LTA and high trait anxious - HTA individuals) performed an attention task (bar orientation discrimination) while emotional distractive pictures were presented. The task was performed in two different contexts: in the Real context, participants were informed that the distractive pictures had been obtained from real life situations, whereas in the Fictitious context they were told that the pictures had been obtained from movie scenes. In this vein, we encouraged participants to change how they appraised the pictures. Results showed that HTA individuals exhibited larger Late Positive Potential (LPPs) when mutilation pictures were presented in the Real context. Importantly, during the Fictitious one (regulation strategy) the LPP was reduced even in HTA individuals, emphasizing its importance to psychotherapeutic interventions. The present results indicate that HTA individuals are susceptible to modifications in affective contexts.(AU)