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Emotion regulation before and after transcranial magnetic stimulation in obsessive compulsive disorder

Published online by Cambridge University Press:  01 June 2015

S. J. de Wit ,
Y. D. van der Werf ,
D. Mataix-Cols ,
J. P. Trujillo ,
P. van Oppen ,
D. J. Veltman  and
O. A. van den Heuvel
S. J. de Wit*
Affiliation:
Department of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands Neuroscience Campus Amsterdam, The Netherlands
Y. D. van der Werf
Affiliation:
Neuroscience Campus Amsterdam, The Netherlands Department of Anatomy and Neurosciences, VU University Medical Center, Amsterdam, The Netherlands
D. Mataix-Cols
Affiliation:
Department of Clinical Neuroscience, Centre for Psychiatric Research and Education, Karolinska Institutet, Stockholm, Sweden
J. P. Trujillo
Affiliation:
Department of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands Department of Anatomy and Neurosciences, VU University Medical Center, Amsterdam, The Netherlands
P. van Oppen
Affiliation:
Department of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands
D. J. Veltman
Affiliation:
Department of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands Neuroscience Campus Amsterdam, The Netherlands
O. A. van den Heuvel
Affiliation:
Department of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands Neuroscience Campus Amsterdam, The Netherlands Department of Anatomy and Neurosciences, VU University Medical Center, Amsterdam, The Netherlands
*
*Address for correspondence: S. J. de Wit, MD, Department of Psychiatry, VU University Medical Center, Medical Faculty, Room MF-G102, van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands. (Email: st.dewit@vumc.nl)
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Abstract

Background.

Impaired emotion regulation may underlie exaggerated emotional reactivity in patients with obsessive compulsive disorder (OCD), yet instructed emotion regulation has never been studied in the disorder.

Method.

This study aimed to assess the neural correlates of emotion processing and regulation in 43 medication-free OCD patients and 38 matched healthy controls, and additionally test if these can be modulated by stimulatory (patients) and inhibitory (controls) repetitive transcranial magnetic stimulation (rTMS) over the left dorsolateral prefrontal cortex (dlPFC). Participants performed an emotion regulation task during functional magnetic resonance imaging before and after a single session of randomly assigned real or sham rTMS. Effect of group and rTMS were assessed on self-reported distress ratings and brain activity in frontal-limbic regions of interest.

Results.

Patients had higher distress ratings than controls during emotion provocation, but similar rates of distress reduction after voluntary emotion regulation. OCD patients compared with controls showed altered amygdala responsiveness during symptom provocation and diminished left dlPFC activity and frontal-amygdala connectivity during emotion regulation. Real v. sham dlPFC stimulation differentially modulated frontal-amygdala connectivity during emotion regulation in OCD patients.

Conclusions.

We propose that the increased emotional reactivity in OCD may be due to a deficit in emotion regulation caused by a failure of cognitive control exerted by the dorsal frontal cortex. Modulatory rTMS over the left dlPFC may influence automatic emotion regulation capabilities by influencing frontal-limbic connectivity.

Keywords

Dorsolateral prefrontal cortexemotion regulationfunctional magnetic resonance imagingobsessive compulsive disordertranscranial magnetic stimulation
Type
Original Articles
Information
Psychological Medicine , Volume 45 , Issue 14 , October 2015 , pp. 3059 - 3073
Copyright
Copyright © Cambridge University Press 2015 

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