How are OCD patients and their families coping with the COVID-19 pandemic? A qualitative study.

Patients with obsessive-compulsive disorder (OCD) are likely to be affected by the COVID-19 crisis since fear of contamination is highly prevalent in this illness and disease reminders are omnipresent during this crisis. The current study aimed to investigate the impact of the pandemic and the lockdown on the mental health, well-being and coping abilities of OCD patients and their families in order to increase our understanding of the underlying mechanisms of the disorder. Twenty-two patients and 13 family members were interviewed one-to-one about their experiences and challenges caused by the pandemic and home-confinement directives. Verbatim transcripts of the interviews were analyzed using inductive thematic analysis. Five overarching themes were identified: (1) changing point of reference: confusion and legitimization of OCD behavior, (2) coping strategies were challenged: too much or too little exposure to obsessional concerns, (3) distress but also relief in some areas, (4) developing a new equilibrium within the family, (5) changes in accessibility and nature of therapy: perils and merits of online treatment. These findings make clear the importance of the accessibility of mental health services during this pandemic through direct patient contacts or in a remote format. In therapy therapists should focus on challenging the changing point of reference, providing practical advice on coping, stimulating to engage in exposure and encouraging patients to seek social support. Furthermore, it is important to involve family members in therapy to support and coach them to be validating, supportive and encouraging, without accommodating to the OCD behaviour.

How are OCD Patients and Family Members Dealing with the Waxing and Waning Pattern of the COVID-19 Pandemic? Results of a Longitudinal Observational Study.

The current study aimed to investigate the impact of the COVID-19 pandemic on the mental health of people with OCD and the degree of family accommodation (FA) by live-in family members across phases of the lockdown measures imposed by the Belgian government. Forty-nine OCD patients and 26 live-in family members participated in the study. We assessed OCD symptom severity and FA of the live-in family members, as well as depressive symptoms, anxiety and stress levels and COVID-19 related psychological distress of patients and family members at four different timepoints: one month after the start of the lockdown (T1), during the gradual relaxation (T2), between the two waves (T3) and during the second wave (T4). Results showed that although COVID-19 related stress increased and decreased in accordance with the waxing and waning pattern of the pandemic, OCD symptoms showed an initial slight increase followed by a decrease at T3 and again at T4. Changes in family members' accommodation of symptoms followed the same course as the OCD symptoms. Furthermore, OCD symptoms correlated with depressive symptoms, anxiety and stress levels and COVID-19 related distress at all timepoints. It is important to involve family members in the treatment of OCD even during a pandemic. Clinicians should also pay attention to symptoms of depression, anxiety and stress during OCD treatment. Further research is necessary to entangle the causal relationship between OCD symptoms, FA and symptoms of depression, anxiety and stress.

Effects of repetitive transcranial magnetic stimulation of the dorsolateral prefrontal cortex on the attentional processing of emotional information in major depression: a pilot study.

Repetitive transcranial magnetic stimulation (rTMS) is as a promising therapeutic tool for major depressive disorder. However, the degree of clinical improvement following rTMS treatment still remains questionable. This pilot study aimed at investigating potential working mechanisms of rTMS by examining the effects on attentional processing towards negative information, a proposed underlying cognitive vulnerability factor for depression. The antidepressant effect of high-frequency (10 Hz) rTMS over the left dorsolateral prefrontal cortex and possible effects on the inhibitory processing of emotional information was assessed in a sample of 14 depressed patients immediately after the first stimulation session and at the end of a 2-week treatment period. One session of rTMS caused neither significant self-reported mood changes, nor improvements in inhibitory control towards negative information. After a 10-day treatment period, nine out of our 14 patients demonstrated significant mood improvements, as indexed by a reduction of more than 50% on the Hamilton depression rating scale. Responders also demonstrated significant improvements in the inhibitory processing of negative information. This study contributed to the existing evidence of the antidepressant effect of rTMS in the treatment of depression and additionally was able to demonstrate improvements in underlying deficiencies in inhibitory processes towards negative information.

Attention for emotional facial expressions in dysphoria: an eye-movement registration study.

Former research demonstrated that depression is associated with dysfunctional attentional processing of emotional information. Most studies examined this bias by registration of response latencies. The present study employed an ecologically valid measurement of attentive processing, using eye-movement registration. Dysphoric and non-dysphoric participants viewed slides presenting sad, angry, happy and neutral facial expressions. For each type of expression, three components of visual attention were analysed: the relative fixation frequency, fixation time and glance duration. Attentional biases were also investigated for inverted facial expressions to ensure that they were not related to eye-catching facial features. Results indicated that non-dysphoric individuals were characterised by longer fixating and dwelling on happy faces. Dysphoric individuals demonstrated a longer dwelling on sad and neutral faces. These results were not found for inverted facial expressions. The present findings are in line with the assumption that depression is associated with a prolonged attentional elaboration on negative information.

Role of the left DLPFC in endogenous task preparation: experimental repetitive transcranial magnetic stimulation study.

The precise role of the dorsolateral prefrontal cortex (DLPFC) in attentional set activation is still not entirely clear. Hence, repetitive transcranial magnetic stimulation (rTMS) can be applied to interfere with neural processing to determine whether a specific brain area is required in task performance. In this study, the influence of one session of high-frequency (HF)-rTMS of the left DLPFC on a reaction task using visual and auditory trials was investigated. Participants were instructed to pay constant attention to the visual stimuli, and they were informed that distracting auditory stimuli could also appear. Participants had to respond to both stimuli. Results indicate that after one session of HF-rTMS of the left DLPFC, performance was improved for the primary task, but not for the distracters. Specifically, we found decreased response time for an endogenous component of attentional control which embodies the online representations of task-relevant information. To conclude, the current results highlight a specific role of the left DLPFC in actively preparing for a specific task in the presence of a distracting task.

Acute effects of repetitive transcranial magnetic stimulation on attentional control are related to antidepressant outcomes.

BACKGROUND: Repetitive transcranial magnetic stimulation (rTMS) applied over the dorsolateral prefrontal cortex (DLPFC) is a new treatment procedure that holds promise of more insight into the pathophysiology of depression because the DLPFC may play an important role in the interplay between emotional and attentional information processing. We sought to investigate whether acute neurocognitive effects of rTMS are related to antidepressant outcomes. METHODS: Between January 2005 and May 2007, we examined the effects of a single session compared with 2 weeks of rTMS over the left DLPFC on cognition and mood in therapy-resistant patients with depression. We used a crossover placebo-controlled double-blind design and differentiated rTMS treatment responders and nonresponders. We used a task-switching paradigm to measure cognitive function. RESULTS: After 2 weeks of high-frequency rTMS over the left DLPFC, depressive symptoms improved in more than half (53%) of our therapy-resistant population. After a single session, mood did not improve but attentional control was increased solely within our group of treatment responders. LIMITATIONS: Our results should be interpreted as preliminary because our sample was small and because the cognitive task we used has not been tested for validity and reliability. In addition, despite minimal stimulation of the DLPFC during sham stimulation, it is possible that the stimulation was partially active. Finally, benzodiazepines may have had impairing effects on the attentional task. CONCLUSION: Cognitive reactivity after a single session of rTMS may hold promise as a predictor of beneficial treatment outcomes. Moreover, within the group of responders, attentional control appears to play an important role in the progress of mood disorders.

A single session of rTMS over the left dorsolateral prefrontal cortex influences attentional control in depressed patients.

Depressed patients are impaired in the ability to shift their focus of attention. This attentional control process is related to dysfunctions in the dorsolateral prefrontal cortex (DLPFC). It has been proposed that a dorsal circuit plays an important role in the interaction between emotional and attentional information processing. However, because the different emphasis of fundamental cognitive neuroscience research and clinical research of repetitive transcranial magnetic stimulation (rTMS) over the DLPFC, little research has been done on the effects of rTMS on cognitive functioning after a single stimulation session to explore the neural systems underlying depression. This study was conducted as a double-blind, placebo-controlled, crossover, within subjects design. Sixteen depressed patients performed a modified task switching paradigm, before and after receiving high frequency (HF) versus placebo rTMS over the left DLPFC. One session of HF-rTMS over the left DLPFC had a specific beneficial effect on task-switching performance, whereas mood remained stable. Antidepressant effects of rTMS could be related to the same neurochemical changes that underlie cognitive functioning. Therefore, task switching performance may provide a unique window into the extent of antidepressant effects which can be considered as second-order long-term effects possibly related to primary alternations in cognitive functioning.

The influence of rTMS over the right dorsolateral prefrontal cortex on top-down attentional processes.

Repetitive Transcranial Magnetic Stimulation (rTMS) provides a unique opportunity to study causal relationships between activity in the dorsolateral prefrontal cortex (DLPFC) and executive functioning, by modulating brain activity in SHAM controlled designs. We devised a new Stroop task paradigm in which subjects must engage in both strategic and automatic attentional processes. In the current experiment, we manipulated subjects' expectancies for incongruent stimuli. Previous research demonstrated that when subjects have a high level of expectancy that a stimulus will be incongruent, they are able to strategically adjust the relative influence of word reading on color naming. The effect of high frequency (HF) rTMS on Stroop performance of 20 right-handed healthy female volunteers was tested using a double blind within subjects design by counterbalanced crossover sham (placebo) and active rTMS over the right DLPFC. Since mood remained unchanged after rTMS, the Stroop data could be evaluated independent of mood changes. Only in the high expectancy condition, we found a decreased response time to both congruent and incongruent trials on the Stroop task performance after HF rTMS. The SHAM placebo condition yielded no effects. We conclude that high frequency stimulation over the right DLPFC has an effect on top-down attentional processes by modulating the attentional set.

The influence of rTMS over the left dorsolateral prefrontal cortex on Stroop task performance.

Several studies have demonstrated that repetitive transcranial magnetic stimulation (rTMS) can improve cognitive processing. Neuroimaging studies have shown the engagement of the left dorsolateral prefrontal cortex (DLPFC) in executive functioning, and more specifically during selective attention. In the present study, the influence of high-frequency rTMS over the left DLPFC on Stroop task performance in healthy female volunteers was investigated. As expected, reaction time on both the incongruent and congruent trials decreased significantly after stimulation, and there was no difference with regard to the Stroop interference effect. Mood remained unchanged after rTMS. Such a pattern is consistent with the role of the left DLPFC in implementing top-down attentional control.

Mood-congruent attention and memory bias in dysphoria: Exploring the coherence among information-processing biases.

Recent studies indicate that depression is characterized by mood-congruent attention bias at later stages of information-processing. Moreover, depression has been associated with enhanced recall of negative information. The present study tested the coherence between attention and memory bias in dysphoria. Stable dysphoric (n = 41) and non-dysphoric (n = 41) undergraduates first performed a spatial cueing task that included negative, positive, and neutral words. Words were presented for 250 ms under conditions that allowed or prevented elaborate processing. Memory for the words presented in the cueing task was tested using incidental free recall. Dysphoric individuals exhibited an attention bias for negative words in the condition that allowed elaborate processing, with the attention bias for negative words predicting free recall of negative words. Results demonstrate the coherence of attention and memory bias in dysphoric individuals and provide suggestions on the influence of attention bias on further processing of negative material.

Neurocognitive effects of HF-rTMS over the dorsolateral prefrontal cortex on the attentional processing of emotional information in healthy women: an event-related fMRI study.

Current evidence concerning the neurocircuitry underlying the interplay between attention and emotion is mainly correlational. We used high-frequency repetitive Transcranial Magnetic Stimulation (HF-rTMS) to experimentally manipulate activity within the right or left dorsolateral prefrontal cortex (DLPFC) of healthy women and examined changes in attentional processing of emotional information using an emotional modification of the exogenous cueing task during event-related fMRI. Right prefrontal HF-rTMS resulted in impaired disengagement from angry faces, associated with decreased activation within the right DLPFC, dorsal anterior cingulate cortex (dACC) and left superior parietal gyrus, combined with increased activity within the right amygdala. Left prefrontal HF-rTMS resulted in diminished attentional engagement by angry faces and was associated with increased activity within the right DLPFC, dACC, right superior parietal gyrus and left orbitofrontal cortex. The present observations are in line with reports of a functionally interactive network of cortical-limbic pathways that play a central role in emotion regulation.

The impact of one session of HF-rTMS on salivary cortisol in healthy female subjects.

Previous studies in healthy volunteers reported a possible impact of high frequency repetitive transcranial magnetic stimulation (HF-rTMS) on stress hormones, like cortisol. In this sham-controlled, "single blind", crossover study, we examined whether HF-rTMS had an effect on the hypothalamic-pituitary-adrenal (HPA) axis, by analysing salivary cortisol levels. Two studies were conducted. First, HF-rTMS on the left dorsolateral prefrontal cortex (DLPFC) was performed in 28 young healthy female volunteers. Second, in a comparable, but different group of 26 healthy females, HF-rTMS was performed on the right DLPFC. Salivary cortisol levels were assessed before, immediately after and 30 min after real and sham HF-rTMS. We found no support for the hypothesis that one single session of HF-rTMS on the left or the right DLPFC has an immediate or delayed impact on the HPA-axis, as measured by salivary cortisol. Although we controlled for several methodological problems in HF-rTMS research, the hypothesis that one single session of HF-rTMS on the left or on the right DLPFC can influence the HPA-axis in healthy volunteers was not supported.

Amygdala responses to positively and negatively valenced baby faces in healthy female volunteers: influences of individual differences in harm avoidance.

Research regarding the lateralization of processing emotional visual stimuli suggests various roles for affective information-processing by the amygdalae. However, individual differences seem to influence outcome results. In this study we re-investigate this question, paying special attention to the salient nature of the mood inducing stimuli. We presented blocks of happy looking baby faces and sad looking baby faces (disfigured by severe dermatological conditions), as well as blurred isoluminescent neutral pictures to a 'homogeneous' group of 40 healthy female subjects during fMRI. We used the temperament dimension harm avoidance (HA), extracted from the Temperament and Character Inventory (TCI), to evaluate the impact of this personality feature on 'emotional' amygdala responses. HA is related to behavioral inhibition and it implies a genetically determined bias towards being cautious, apprehensive and overly pessimistic. Because emotional valence and arousal may be controlled by different neural systems, the positively and negatively valenced baby faces were selected to be equal in arousal levels. Viewing blocks of negatively valenced baby faces evoked bilateral amygdala activity, whereas viewing positively valenced ones resulted in left amygdala activity only. Globally, we found no evidence of lateralized amygdala specialization. When taking into account individual differences in HA, only in female subjects who score high on this dimension did we find predominantly left amygdala activation when viewing blocks of negatively valenced baby faces. HA did not influence amygdala activity when processing positively valenced images. Our results might indicate that personality features, such as HA, could be of importance in 'emotional' fMRI paradigms examining amygdala lateralization patterns.

Attentional biases for angry faces in unipolar depression.

BACKGROUND: Past research has demonstrated that depression is associated with dysfunctional processing of emotional information. Recent studies demonstrate that a bias in the attentional processing of negative information may be an important cognitive vulnerability factor underlying the onset and maintenance of depression. However, to date, the nature of this attentional bias is still poorly understood and further exploration of this topic to advance current knowledge of attentional biases in depression seems imperative. METHOD: This study examined attentional biases for angry facial expressions presented for 1000 ms in 20 patients with major depressive disorder (MDD) and 20 non-depressed control participants (NC) matched for age and gender using an emotional modification of the Exogenous Cueing task. RESULTS: Patients with MDD showed maintained attention for angry faces compared with neutral faces. In comparison with non-depressed participants they showed a stronger attentional engagement for angry faces. In contrast, the NC group directed attention away from angry faces, more rapidly disengaging their attention compared with neutral faces. CONCLUSIONS: This pattern of results supports the assumption that MDD is characterized by deficits in the attentional processing of negative, interpersonal information and suggests a 'protective' bias in non-depressed individuals. Implications in relation to previous research exploring cognitive and interpersonal functioning in depression are discussed.

The influence of rTMS over the right dorsolateral prefrontal cortex on intentional set switching.

High frequency (HF) repetitive transcranial magnetic stimulation (rTMS) has an excitatory effect on neurons of a specific brain area. The dorsolateral prefrontal cortex (DLPFC) has been associated with executive functions, such as task set switching. One important experimental paradigm for investigating such higher order cognitive control is the task-switching (TS) paradigm. A TS paradigm requires switching between two conditional response tasks with mutually incompatible response-selection rules. In the present study, the influence of HF rTMS over the right DLPFC in healthy female volunteers on a modified TS paradigm was investigated. As expected, reaction time on cued switching trials decreased significant after rTMS, as compared to non-cued switch trials. No changes emerged after the placebo sham condition. Mood remained unchanged after rTMS. These findings demonstrate the role of the right DLPFC in cued intentional set switch initiation.