Evaluating the effect of action-like video game play and of casual video game play on anxiety in adolescents with elevated anxiety: protocol for a multi-center, parallel group, assessor-blind, randomized controlled trial.

BACKGROUND: Adolescence is a critical period for the onset and maintenance of anxiety disorders, which raises the importance of intervening early; one possibility of doing so is via digital interventions. Within that research field, at least two important research paths have been explored in the past years. On the one hand, the anxiolytic effect of casual video games has been tested as such gaming activity may distract away from anxious thoughts through the induction of flow and redirection of attention toward the game and thus away of anxious thoughts. On the other hand, the bidirectional link between weak attentional control and higher anxiety has led to the design of interventions aiming at improving attentional control such as working memory training studies. Taking stock that another genre of gaming, action video games, improves attentional control, game-based interventions that combines cognitive training and action-like game features would seem relevant. This three-arm randomized controlled trial aims to evaluate the feasibility and the efficacy of two video game interventions to document how each may potentially alleviate adolescent anxiety-related symptoms when deployed fully on-line. METHODS: The study aims to recruit 150 individuals, 12 to 14 years of age, with high levels of anxiety as reported by the parents' online form of the Screen for Child Anxiety Related Disorders questionnaire. This trial contrasts a child-friendly, "action-like" video game designed to improve attentional control abilities in a progressive and stepwise manner (Eco-Rescue), a casual puzzle video game selected to act as a positive distraction tool (Bejeweled) and finally a control group with no assigned training intervention to control for possible test-retest effects (No-training). Participants will be assigned randomly to one of the three study arms. They will be assessed for main (anxiety) and secondary outcomes (attentional control, affective working memory) at three time points, before training (T1), one week after the 6-week training (T2) and four months after completing the training (T3). DISCUSSION: The results will provide evidence for the feasibility and the efficacy of two online video game interventions at improving mental health and emotional well-being in adolescents with high levels of anxiety. This project will contribute unique knowledge to the field, as few studies have examined the effects of video game play in the context of digital mental health interventions for adolescents. TRIAL REGISTRATION: The trial is registered on ClinicalTrials.gov (NCT05923944, June 20, 2023).

A video-game-based method to induce states of high and low flow.

Flow has been defined as a state of full immersion that may emerge when the skills of a person match the challenge of an activity. It is a special case of being on task, as during flow, keeping focused on the task feels effortless. Most experimental investigations of the neural or physiological correlates of flow contrast conditions with different levels of challenge. Yet comparing different levels of challenge that are too distant may trigger states where the participant is off task, such as boredom or frustration. Thus, it remains unclear whether previously observed differences ascribed to flow may rather reflect differences in how much participants were on task-trying their best-across the contrasted conditions. To remedy this, we introduce a method to manipulate flow by contrasting two video game play conditions at personalized levels of difficulty calibrated such that participants similarly tried their best in both conditions. Across three experiments (> 90 participants), higher flow was robustly reported in our high-flow than in our low-flow condition (mean effect size d = 1.31). Cardiac, respiratory, and skin conductance measures confirmed the known difference between a period of rest and the two on-task conditions of high and low flow, but failed to distinguish between these latter two. In light of the conflicting findings regarding the physiological correlates of flow, we discuss the importance of ensuring a low-flow baseline condition that maintains participants on task, and propose that the present method provides a methodological advance toward that goal.

Disrespect during childbirth and postpartum mental health: a French cohort study.

BACKGROUND: While the World Health Organisation (WHO) warned about mistreatment, disrespect and/or abuse during childbirth as early as 2014. This same year a social media movement with #payetonuterus brought to light the problematic of obstetrical violence in French speaking countries, and more specifically on issues of disrespect. The experience of care is an integral part of the quality of care, and perception on inadequate support during labour and loss of control in labour are some of the most frequently reported risk factors for childbirth-related post-traumatic stress disorder (CB-PTSD). Therefore, it seems crucial to study the associations between disrespect during childbirth and the mental well-being of mothers. METHODS: We performed a multicentered cohort study using auto-questionnaires within a French perinatal network. The main outcome was women's report of disrespect during childbirth measured by the Behavior of the Mother's Caregivers - Satisfaction Questionnaire (BMC-SQ) 3 days and 2 months after childbirth. CB-PTSD and Postpartum Depression (PPD) were assessed 2 months after childbirth using respectively the Post-Traumatic Checklist Scale (PCLS) and the Edinburgh Postnatal Depression Scale (EPDS). RESULTS: This study followed 123 mothers from childbirth to 2 months postpartum. Among them, 8.13% (n = 10/123) reported disrespect during childbirth at 3 days after childbirth. With retrospect, 10.56% (n = 13/123) reported disrespect during childbirth at 2 months postpartum, i.e. an increase of 31%. Some 10.56% (n = 13/123) of mothers suffered from postpartum depression, and 4.06% (n = 5/123) were considered to have CB-PTSD at 2 months after childbirth. Reported disrespect during childbirth 3 days after birth was significantly associated with higher CB-PTSD 2 months after birth (R2 = 0.11, F(1,117) = 15.14, p < 0.001 and ß = 9.11, p = 0.006), PPD at 2 months after childbirth was positively associated to reported disrespect in the birth room, 3 days after birth (R2 = 0.04, F(1, 117) = 6.28, p = 0.01 and ß = 3.36, p = 0.096). Meanwhile, PPD and CB-PTSD were significantly associated 2 months after childbirth (R2 = 0.41, F=(1,117) = 82.39, p < 0.01 and ß = 11.41, p < 0.001). CONCLUSIONS: Disrespect during childbirth was associated with poorer mental health during the postpartum period. Given the high prevalence of mental health problems and the increased susceptibility to depression during the postpartum period, these correlational results highlight the importance of gaining a deeper awareness of healthcare professionals about behaviours or attitudes which might be experienced as disrespectful during childbirth.

Pregnancy, Mental Well-Being and Lockdown: A Nationwide Online Survey in France.

The objective of this study was to compare the mental well-being of French women who were and were not pregnant during the first COVID-19 pandemic lockdown. We performed a nationwide online quantitative survey including all women between 18 and 45 years of age during the second and third weeks of global lockdown (25 March-7 April 2020). The main outcome measure was mental well-being measured by the Warwick-Edinburgh Mental Well-Being Scale (WEMWBS). This study analysed 275 responses from pregnant women and compared them with those from a propensity score-matched sample of 825 non-pregnant women. In this French sample, the median WEMWBS score was 49.0 and did not differ by pregnancy status. Women living in urban areas reported better well-being, while those with sleep disorders or who spent more than an hour a day watching the news reported poorer well-being. During the first lockdown in France, women had relatively low mental well-being scores, with no significant difference between pregnant and non-pregnant women. More than ever, health-care workers need to find a way to maintain their support for women's well-being. Minor daily annoyances of pregnancy, such as insomnia, should not be trivialised because they are a potential sign of poor well-being.

Emotion perception in habitual players of action video games.

Action video game players (AVGPs) display superior performance in various aspects of cognition, especially in perception and top-down attention. The existing literature has examined these performance almost exclusively with stimuli and tasks devoid of any emotional content. Thus, whether the superior performance documented in the cognitive domain extend to the emotional domain remains unknown. We present 2 cross-sectional studies contrasting AVGPs and nonvideo game players (NVGPs) in their ability to perceive facial emotions. Under an enhanced perception account, AVGPs should outperform NVGPs when processing facial emotion. Yet, alternative accounts exist. For instance, under some social accounts, exposure to action video games, which often contain violence, may lower sensitivity for empathy-related expressions such as sadness, happiness, and pain while increasing sensitivity to aggression signals. Finally, under the view that AVGPs excel at learning new tasks (in contrast to the view that they are immediately better at all new tasks), the use of stimuli that participants are already experts at predicts little to no group differences. Study 1 uses drift-diffusion modeling and establishes that AVGPs are comparable to NVGPs in every decision-making stage mediating the discrimination of facial emotions, despite showing group difference in aggressive behavior. Study 2 uses the reverse inference technique to assess the mental representation of facial emotion expressions, and again documents no group differences. These results indicate that the perceptual benefits associated with action video game play do not extend to overlearned stimuli such as facial emotion, and rather indicate equivalent facial emotion skills in AVGPs and NVGPs. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

The role of the subgenual anterior cingulate cortex in dorsomedial prefrontal-amygdala neural circuitry during positive-social emotion regulation.

Positive-social emotions mediate one's cognitive performance, mood, well-being, and social bonds, and represent a critical variable within therapeutic settings. It has been shown that the upregulation of positive emotions in social situations is associated with increased top-down signals that stem from the prefrontal cortices (PFC) which modulate bottom-up emotional responses in the amygdala. However, it remains unclear if positive-social emotion upregulation of the amygdala occurs directly through the dorsomedial PFC (dmPFC) or indirectly linking the bilateral amygdala with the dmPFC via the subgenual anterior cingulate cortex (sgACC), an area which typically serves as a gatekeeper between cognitive and emotion networks. We performed functional MRI (fMRI) experiments with and without effortful positive-social emotion upregulation to demonstrate the functional architecture of a network involving the amygdala, the dmPFC, and the sgACC. We found that effortful positive-social emotion upregulation was associated with an increase in top-down connectivity from the dmPFC on the amygdala via both direct and indirect connections with the sgACC. Conversely, we found that emotion processes without effortful regulation increased network modulation by the sgACC and amygdala. We also found that more anxious individuals with a greater tendency to suppress emotions and intrusive thoughts, were likely to display decreased amygdala, dmPFC, and sgACC activity and stronger connectivity strength from the sgACC onto the left amygdala during effortful emotion upregulation. Analyzed brain network suggests a more general role of the sgACC in cognitive control and sheds light on neurobiological informed treatment interventions.

Higher availability of α4ß2 nicotinic receptors (nAChRs) in dorsal ACC is linked to more efficient interference control.

Nicotinic acetylcholine receptors (nAChRs) are widely distributed in the human brain and play an important role in the neuromodulation of brain networks implicated in attentional processes. Previous work in humans showed that heteromeric α4ß2 nAChRs are abundant in the cingulo-insular network underlying attentional control. It has been proposed that cholinergic neuromodulation by α4ß2 nAChRs is involved in attentional control during demanding tasks, when additional resources are needed to minimize interference from task-irrelevant stimuli and focus on task-relevant stimuli. Here we investigate the link between the availability of α4ß2 nAChRs in the cingulo-insular network and behavioral measures of interference control using two versions of the Stroop paradigm, a task known to recruit cingulo-insular areas. We used a previously published PET dataset acquired in 24 non-smoking male subjects in the context of a larger study which investigated the brain distribution of nAChRs in two clinical groups using 2-[(18)F]F-A-85380 PET. We found that higher availability of α4ß2 nAChRs in the dorsal anterior cingulate cortex (ACC) predicted better interference control independently of group and age. In line with animal models, our results support the view that the availability of α4ß2 nAChRs in the dorsal ACC is linked with more efficient attentional control.

Reducing the use of screen electronic devices in the evening is associated with improved sleep and daytime vigilance in adolescents.

The use of screen electronic devices in the evening negatively affects sleep. Yet, sleep is known to be essential for brain maturation and a key factor for good academic performance, and thus is particularly critical during childhood and adolescence. Although previous studies reported associations between screen time and sleep impairment, their causal relationship in adolescents remains unclear. Using actigraphy and daily questionnaires in a large sample of students (12 to 19 years old), we assessed screen time in the evening and sleep habits over 1 month. This included a 2 week baseline phase, followed by a 40 min sleep education workshop and a 2 week interventional phase, in which participants were asked to stop using screen devices after 9 pm during school nights. During the interventional phase, we found that the reduction of screen time after 9 pm correlated with earlier sleep onset time and increased total sleep duration. The latter led to improved daytime vigilance. These findings provide evidence that restricting screen use in the evening represents a valid and promising approach for improving sleep duration in adolescents, with potential implications for daytime functioning and health.

Brain networks for engaging oneself in positive-social emotion regulation.

Positive emotions facilitate cognitive performance, and their absence is associated with burdening psychiatric disorders. However, the brain networks regulating positive emotions are not well understood, especially with regard to engaging oneself in positive-social situations. Here we report convergent evidence from a multimodal approach that includes functional magnetic resonance imaging (fMRI) brain activations, meta-analytic functional characterization, Bayesian model-driven analysis of effective brain connectivity, and personality questionnaires to identify the brain networks mediating the cognitive up-regulation of positive-social emotions. Our comprehensive approach revealed that engaging in positive-social emotion regulation with a self-referential first-person perspective is characterized by dynamic interactions between functionally specialized prefrontal cortex (PFC) areas, the temporoparietal junction (TPJ) and the amygdala. Increased top-down connectivity from the superior frontal gyrus (SFG) controls affective valuation in the ventromedial and dorsomedial PFC, self-referential processes in the TPJ, and modulate emotional responses in the amygdala via the ventromedial PFC. Understanding the brain networks engaged in the regulation of positive-social emotions that involve a first-person perspective is important as they are known to constitute an effective strategy in therapeutic settings.

Transient emotional events and individual affective traits affect emotion recognition in a perceptual decision-making task.

Both affective states and personality traits shape how we perceive the social world and interpret emotions. The literature on affective priming has mostly focused on brief influences of emotional stimuli and emotional states on perceptual and cognitive processes. Yet this approach does not fully capture more dynamic processes at the root of emotional states, with such states lingering beyond the duration of the inducing external stimuli. Our goal was to put in perspective three different types of affective states (induced affective states, more sustained mood states and affective traits such as depression and anxiety) and investigate how they may interact and influence emotion perception. Here, we hypothesized that absorption into positive and negative emotional episodes generate sustained affective states that outlast the episode period and bias the interpretation of facial expressions in a perceptual decision-making task. We also investigated how such effects are influenced by more sustained mood states and by individual affect traits (depression and anxiety) and whether they interact. Transient emotional states were induced using movie-clips, after which participants performed a forced-choice emotion classification task with morphed facial expressions ranging from fear to happiness. Using a psychometric approach, we show that negative (vs. neutral) clips increased participants' propensity to classify ambiguous faces as fearful during several minutes. In contrast, positive movies biased classification toward happiness only for those clips perceived as most absorbing. Negative mood, anxiety and depression had a stronger effect than transient states and increased the propensity to classify ambiguous faces as fearful. These results provide the first evidence that absorption and different temporal dimensions of emotions have a significant effect on how we perceive facial expressions.

Learning Control Over Emotion Networks Through Connectivity-Based Neurofeedback.

Most mental functions are associated with dynamic interactions within functional brain networks. Thus, training individuals to alter functional brain networks might provide novel and powerful means to improve cognitive performance and emotions. Using a novel connectivity-neurofeedback approach based on functional magnetic resonance imaging (fMRI), we show for the first time that participants can learn to change functional brain networks. Specifically, we taught participants control over a key component of the emotion regulation network, in that they learned to increase top-down connectivity from the dorsomedial prefrontal cortex, which is involved in cognitive control, onto the amygdala, which is involved in emotion processing. After training, participants successfully self-regulated the top-down connectivity between these brain areas even without neurofeedback, and this was associated with concomitant increases in subjective valence ratings of emotional stimuli of the participants. Connectivity-based neurofeedback goes beyond previous neurofeedback approaches, which were limited to training localized activity within a brain region. It allows to noninvasively and nonpharmacologically change interconnected functional brain networks directly, thereby resulting in specific behavioral changes. Our results demonstrate that connectivity-based neurofeedback training of emotion regulation networks enhances emotion regulation capabilities. This approach can potentially lead to powerful therapeutic emotion regulation protocols for neuropsychiatric disorders.

Influence of Temporal Expectations on Response Priming by Subliminal Faces.

Unconscious processes are often assumed immune from attention influence. Recent behavioral studies suggest however that the processing of subliminal information can be influenced by temporal attention. To examine the neural mechanisms underlying these effects, we used a stringent masking paradigm together with fMRI to investigate how temporal attention modulates the processing of unseen (masked) faces. Participants performed a gender decision task on a visible neutral target face, preceded by a masked prime face that could vary in gender (same or different than target) and emotion expression (neutral or fearful). We manipulated temporal attention by instructing participants to expect targets to appear either early or late during the stimulus sequence. Orienting temporal attention to subliminal primes influenced response priming by masked faces, even when gender was incongruent. In addition, gender-congruent primes facilitated responses regardless of attention while gender-incongruent primes reduced accuracy when attended. Emotion produced no differential effects. At the neural level, incongruent and temporally unexpected primes increased brain response in regions of the fronto-parietal attention network, reflecting greater recruitment of executive control and reorienting processes. Congruent and expected primes produced higher activations in fusiform cortex, presumably reflecting facilitation of perceptual processing. These results indicate that temporal attention can influence subliminal processing of face features, and thus facilitate information integration according to task-relevance regardless of conscious awareness. They also suggest that task-congruent information between prime and target may facilitate response priming even when temporal attention is not selectively oriented to the prime onset time.

Classification of autistic individuals and controls using cross-task characterization of fMRI activity.

Multivariate pattern analysis (MVPA) has been applied successfully to task-based and resting-based fMRI recordings to investigate which neural markers distinguish individuals with autistic spectrum disorders (ASD) from controls. While most studies have focused on brain connectivity during resting state episodes and regions of interest approaches (ROI), a wealth of task-based fMRI datasets have been acquired in these populations in the last decade. This calls for techniques that can leverage information not only from a single dataset, but from several existing datasets that might share some common features and biomarkers. We propose a fully data-driven (voxel-based) approach that we apply to two different fMRI experiments with social stimuli (faces and bodies). The method, based on Support Vector Machines (SVMs) and Recursive Feature Elimination (RFE), is first trained for each experiment independently and each output is then combined to obtain a final classification output. Second, this RFE output is used to determine which voxels are most often selected for classification to generate maps of significant discriminative activity. Finally, to further explore the clinical validity of the approach, we correlate phenotypic information with obtained classifier scores. The results reveal good classification accuracy (range between 69% and 92.3%). Moreover, we were able to identify discriminative activity patterns pertaining to the social brain without relying on a priori ROI definitions. Finally, social motivation was the only dimension which correlated with classifier scores, suggesting that it is the main dimension captured by the classifiers. Altogether, we believe that the present RFE method proves to be efficient and may help identifying relevant biomarkers by taking advantage of acquired task-based fMRI datasets in psychiatric populations.

Cumulative activation during positive and negative events and state anxiety predicts subsequent inertia of amygdala reactivity.

Inertia, together with intensity and valence, is an important component of emotion. We tested whether positive and negative events generate lingering changes in subsequent brain responses to unrelated threat stimuli and investigated the impact of individual anxiety. We acquired fMRI data while participants watched positive or negative movie-clips and subsequently performed an unrelated task with fearful and neutral faces. We quantified changes in amygdala reactivity to fearful faces as a function of the valence of preceding movies and cumulative neural activity evoked during them. We demonstrate that amygdala responses to emotional movies spill over to subsequent processing of threat information in a valence-specific manner: negative movies enhance later amygdala activation whereas positive movies attenuate it. Critically, the magnitude of such changes is predicted by a measure of cumulative amygdala responses to the preceding positive or negative movies. These effects appear independent of overt attention, are regionally limited to amygdala, with no changes in functional connectivity. Finally, individuals with higher state anxiety displayed stronger modulation of amygdala reactivity by positive movies. These results suggest that intensity and valence of emotional events as well as anxiety levels promote local changes in amygdala sensitivity to threat, highlighting the importance of past experience in shaping future affective reactivity.

Getting the beat: entrainment of brain activity by musical rhythm and pleasantness.

Rhythmic entrainment is an important component of emotion induction by music, but brain circuits recruited during spontaneous entrainment of attention by music and the influence of the subjective emotional feelings evoked by music remain still largely unresolved. In this study we used fMRI to test whether the metric structure of music entrains brain activity and how music pleasantness influences such entrainment. Participants listened to piano music while performing a speeded visuomotor detection task in which targets appeared time-locked to either strong or weak beats. Each musical piece was presented in both a consonant/pleasant and dissonant/unpleasant version. Consonant music facilitated target detection and targets presented synchronously with strong beats were detected faster. FMRI showed increased activation of bilateral caudate nucleus when responding on strong beats, whereas consonance enhanced activity in attentional networks. Meter and consonance selectively interacted in the caudate nucleus, with greater meter effects during dissonant than consonant music. These results reveal that the basal ganglia, involved both in emotion and rhythm processing, critically contribute to rhythmic entrainment of subcortical brain circuits by music.

Responses of medial and ventrolateral prefrontal cortex to interpersonal conflict for resources.

Little is known about brain mechanisms recruited during the monitoring and appraisal of social conflicts--for instance, when individuals compete with each other for the same resources. We designed a novel experimental task inducing resource conflicts between two individuals. In an event-related functional magnetic resonance imaging (fMRI) design, participants played with another human participant or against a computer, who across trials chose either different (no-conflict) or the same tokens (conflict trials) in order to obtain monetary gains. In conflict trials, the participants could decide whether they would share the token, and the resulting gain, with the other person or instead keep all points for themselves. Behaviorally, participants shared much more often when playing with a human partner than with a computer. fMRI results demonstrated that the dorsal mediofrontal cortex was selectively activated during human conflicts. This region might play a key role in detecting situations in which self- and social interest are incompatible and require behavioral adjustment. In addition, we found a conflict-related response in the right ventrolateral prefrontal cortex that correlated with measures of social relationship and individual sharing behavior. Taken together, these findings reveal a key role of these prefrontal areas for the appraisal and resolution of interpersonal resource conflicts.

Affective and sensorimotor components of emotional prosody generation.

Although advances have been made regarding how the brain perceives emotional prosody, the neural bases involved in the generation of affective prosody remain unclear and debated. Two models have been forged on the basis of clinical observations: a first model proposes that the right hemisphere sustains production and comprehension of emotional prosody, while a second model proposes that emotional prosody relies heavily on basal ganglia. Here, we tested their predictions in two functional magnetic resonance imaging experiments that used a cue-target paradigm, which allows distinguishing affective from sensorimotor aspects of emotional prosody generation. Both experiments show that when participants prepare for emotional prosody, bilateral ventral striatum is specifically activated and connected to temporal poles and anterior insula, regions in which lesions frequently cause dysprosody. The bilateral dorsal striatum is more sensitive to cognitive and motor aspects of emotional prosody preparation and production and is more strongly connected to the sensorimotor speech network compared with the ventral striatum. Right lateralization during increased prosodic processing is confined to the posterior superior temporal sulcus, a region previously associated with perception of emotional prosody. Our data thus provide physiological evidence supporting both models and suggest that bilateral basal ganglia are involved in modulating motor behavior as a function of affective state. Right lateralization of cortical regions mobilized for prosody control could point to efficient processing of slowly changing acoustic speech parameters in the ventral stream and thus identify sensorimotor processing as an important factor contributing to right lateralization of prosody.

Persistent affective biases in human amygdala response following implicit priming with negative emotion concepts.

To what extent do past experiences shape our behaviors, perceptions, and thoughts even without explicit knowledge of these influences? Behavioral research has demonstrated that various cognitive processes can be influenced by conceptual representations implicitly primed during a preceding and unrelated task. Here we investigated whether emotion processing might also be influenced by prior incidental exposure to negative semantic material and which neural substrates would mediate these effects. During a first (priming) task, participants performed a variant of the hangman game with either negative or neutral emotion-laden words. Subsequently, they performed a second, unrelated visual task with fearful and neutral faces presented at attended or unattended locations. Participants were generally not aware of any relationships between the two tasks. We found that priming with emotional words enhanced amygdala sensitivity to faces in the subsequent visual task, while decreasing discriminative responses to threat. Furthermore, the magnitude of the induced bias in behavior and amygdala activation was predicted by the effectiveness of semantic access observed in the priming task. This demonstrates that emotional processing can be modulated by implicit influence of environmental information processed at an earlier time, independently of volitional control.

Threat prompts defensive brain responses independently of attentional control.

Negative emotional signals are known to influence task performance, but so far, investigations have focused on how emotion interacts with perceptual processes by mobilizing attentional resources. The attention-independent effects of negative emotional signals are less well understood. Here, we show that threat signals trigger defensive responses independently of what observers pay attention to. Participants were scanned using functional magnetic resonance imaging while watching short video clips of threatening actions and performed either color or emotion judgments. Seeing threatening actions interfered with performance in both tasks. Amygdala activation reflected both stimulus and task conditions. In contrast, threat stimuli prompted a constant activity in a network underlying reflexive defensive behavior (periaqueductal gray, hypothalamus, and premotor cortex). Threat stimuli also disrupted ongoing behavior and provoked motor conflict in prefrontal regions during both tasks. The present results are consistent with the view that emotions trigger adaptive action tendencies independently of task settings.