Transcript Slide 1

Neuroimage
2008
Vol.42, 969 – 972
Presented by:
Antony Au
Craving love? Enduring grief
activates brain’s reward center
Mary-Frances O’Connor, David K. Wellisch, Annette L. Stanton, Naomi I.
Eisenberger, Michael R. Irwin, Matthew D. Lieberman.
Pathways
 Reward pathway:
 Mesolimbic pathway (dopaminergic)
 Nucleus accumbens (NA)
 Pain pathway:
 Dorsal anterior cingulate cortex (dACC)
 Insula
 Periaqueductal gray (PAG)
This study revolves around...
 Complicated Grief (CG)
 Chronic / traumatic grief
 Unresolved
 Prolonged sense of mourning (i.e. Stuck)
 Non-complicated grief (NCG)
 Set of criteria considered to be in DSM-V
 Symptoms of CG distinctly different than those in
major depressive disorder (DSM-IV)
Research Purpose
 Investigates whether the CG group has
greater activity occurrence in brain’s reward
or pain networks than the NCG group
through a fMRI study
Participants
 11 CG, 12 NCG women
 Death of mother/sister to breast cancer in past 5 yrs
 Excluded those with DSM-IV Axis I disorder
 Axis I = clinical disorders
 Clinical interview
 CG/NCG diagnosed in structural clinical
interview
Procedure
 15 grief-related words and 15
neutral words matched with 15 photos
 Photo:
 Participant’s deceased love one matched with stranger
 Grief words:
 Chosen from provided autobiographical narrative
 Total of 60 composites
 Viewed through goggles in randomized order
Results
 CG vs. NCG NA
activity in response to
grief-related than
neutral words:
 CG: more
 NCG: less
Only NA more
significantly active
Results
 While both CG and NCG exhibited activity in
ACC, insula, PAG:
 NCG > CG activity in both:
 Words: grief-related than neutral
 Pictures: deceased than stranger
 In summary:
 NCG: more pain, less reward
 CG: less pain, more reward
Theories out there...
 Two opposing models of grief:
 Detachment model
 Grief helps acceptance of death
 NA activity should reduce over time
 NCG supports this
 Reunion Model
 Grief conflicts the separation of deceased
 NA activity continue over time
 CG supports this
...an Addiction?
 CG seem to be “stuck”
 Activation of reward pathway?
 Compared to NCG: more reward than pain
 May explain why it is hard to “let go”
 Research
therapy
 Selective serotonin reuptake inhibitor (SSRI)
 Used because CG symptoms under major depressive
disorder ones
 Effectiveness for CG?
 Dopaminergic drugs
Opinions, opinions, opinions.
Strengths
 Examination of both reward + pain pathways
Limitations
 Lack of male participants
 Cannot generalize to public
 No discussion on physical vs. social pain
For the future:
 Other cues to invoke grief
 Neurocognitive similarities / differences
 To what extent is NA associated in emotion
regulation
 Therapy
 Behavioural modification
 Medicine
References
Boelon, P.A., & van den Bout, J. (2005). Complicated grief, depression and anxiety as distinct postloss
syndromes: a confirmatory factor analysis study, Am. J. Psychiatry, 162, 2175-2177.
Bowlby, J. (1980). Attachment and loss. Loss, Sadness and Depression, vol.3, Basic Books, New York.
Knuston, B., Adams, C.M., Fong, G.W., & Hommer, D. (2001). Anticipation of increasing monetary
reward selectively recruits nucleus accumbens, J. Neurosci., 21, RC159.
Shear, K., Frank, E., Houck, P.R., Reynolds III, C.F. (2005). Treatment of complicated grief: a
randomized controlled trial, J. Am. Med. Assoc., 293, 2601-2608.
Zygmont, M., Prigerson, H., Houck, P., Miller, M., Shear, M. J, & Jacobs, S. (1998). A post hoc
comparison of paroxetine and nortriptyline for symptoms of traumatic grief, J. Clin. Psychiatry, 59,
241-245.
Thanks for listening (:
Questions?