Disrupted prefrontal activity during emotion processing in complicated grief: An fMRI investigation.

Complicated Grief, marked by a persistent and intrusive grief lasting beyond the expected period of adaptation, is associated with a relative inability to disengage from idiographic loss-relevant stimuli (O'Connor and Arizmendi, 2014). In other populations, functional magnetic resonance imaging (fMRI) studies investigating the neural networks associated with this bias consistently implicate the anterior cingulate cortex (ACC) during emotion regulation. In the present study, twenty-eight older adults were categorized into three groups based on grief severity: Complicated Grief (n=8), Non-Complicated Grief (n=9), and Nonbereaved, married controls (n=11). Using a block design, all participants completed 8 blocks (20 stimuli per block) of the ecStroop task during fMRI data acquisition. Differences in neural activity during grief-related (as opposed to neutral) stimuli across groups were examined. Those with Complicated Grief showed an absence of increased rostral ACC (rACC) and fronto-cortical recruitment relative to Nonbereaved controls. Activity in the orbitofrontal cortex (x=6, y=54, z=-10) was significantly elevated in the Non-Complicated Grief group when compared to Nonbereaved controls. Post hoc analysis evidenced activity in the dorsal ACC in the Complicated Grief and Nonbereaved groups late in the task. These findings, supported by behavioral data, suggest a relative inability to recruit the regions necessary for successful completion of this emotional task in those with Complicated Grief. This deficit was not observed in recruitment of the orbitofrontal cortex and the rACC during processing of idiographic semantic stimuli in Non-Complicated Grief.

Development and validation of the trauma-specific emotional counting Stroop paradigm for fMRI study.

BACKGROUND: The emotional-counting Stroop (ecStroop) is a cognitive task to evaluate emotional information processing. This study aimed to develop a trauma-specific ecStroop protocol for firefighters and assess its validity as a functional magnetic resonance imaging (fMRI) activation paradigm. METHODS: To develop the ecStroop protocol, trauma-related words for firefighters were selected from previous studies, and general negative and neutral words were matched corresponding to the number of letters and syllables, parts of speech, and frequency in the Korean language. The negative emotional valence of whole words was investigated in 520 healthy participants. To compare brain activation between three categories, 25 healthy individuals underwent fMRI during the ecStroop task. RESULTS: Eight trauma-related words, eight general negative words, and sixteen neutral words were selected by emotional valence scores. The general negative words were related to increased activation in the right inferior and middle temporal gyrus, right medial frontal gyrus, and left superior frontal gyrus compared to the neutral words. When exposed to the trauma-related words, participants' brain activation was increased in the right inferior temporal gyrus, right medial frontal gyrus, left superior temporal gyrus, and left inferior frontal gyrus as compared to when exposed to the neutral words. LIMITATIONS: The fact that all participants in the phase 2 fMRI study were male could limit generalization to all genders. CONCLUSIONS: These findings suggest that the ecStroop paradigm successfully activated the brain regions for emotional processing. This paradigm could be valuable in assessing the trauma-specific neural changes in firefighters.