Christian E. Salas

Inside-out: Comparing internally generated and externally generated basic emotions.

A considerable number of mood induction (MI) procedures have been developed to elicit emotion in normal and clinical populations. Although external procedures (e.g., film clips, pictures) are widely used, a number of experiments elicit emotion by using self-generated procedures (e.g., recalling an emotional personal episode). However, no study has directly compared the effectiveness of two types of internal versus external MI across multiple discrete emotions. In the present experiment, 40 undergraduate students watched film clips (external procedure) and recalled personal events (internal procedure) inducing 4 basic emotions (fear, anger, joy, sadness) and later completed a self-report questionnaire. Remarkably, both internal and external procedures elicited target emotions selectively, compared with nontarget emotions. When contrasting the intensity of target emotions, both techniques showed no significant differences, with the exception of Joy, which was more intensely elicited by the internal procedure. Importantly, when considering the overall level of intensity, it was always greater in the internal procedure, for each stimulus. A more detailed investigation of the data suggest that recalling personal events (a type of internal procedure) generates more negative and mixed blends of emotions, which might account for the overall higher intensity of the internal mood induction.

Concrete behaviour and reappraisal deficits after a left frontal stroke: A case study

Concrete behaviour, the inability to disengage from immediate experience in order to manipulate ideas and thoughts, has long been understood to be a common problem after frontal lobe lesions. However, there has been little consideration of the impact that concreteness may have on emotional functioning, specifically in the use of thinking to manipulate emotional responses. One widely studied emotion regulation strategy is reappraisal, which depends on several frontal lobe related cognitive control processes. While there have been numerous neuroimaging findings on reappraisal, no study has used brain injured patients to investigate this issue. The present case study is the first to describe the capacity to generate reappraisals in a patient (Mrs M), whose behaviour became concrete after a left prefrontal stroke. Using a picture-based reappraisal paradigm, her performance was compared to non-concrete brain-lesioned patients, and neurologically healthy controls. Although Mrs M showed relatively preserved overall cognitive function, she was completely unable to spontaneously generate reappraisals. In striking contrast, once external support was offered, in the form of prompts, her capacity to reappraise dramatically improved. The results are analysed in terms of three neuropsychological capacities – all compromised in Mrs M – previously proposed as reappraisal components: response inhibition, abstraction, and verbal fluency. A number of implications for rehabilitation are discussed, including how the use of prompting may facilitate reappraisal capacity.

Reappraisal generation after acquired brain damage: The role of laterality and cognitive control

In the past decade, there has been growing interest in the neuroanatomical and neuropsychological bases of reappraisal. Findings suggest that reappraisal activates a set of areas in the left hemisphere (LH), which are commonly associated with language abilities and verbally mediated cognitive control. The main goal of this study was to investigate whether individuals with focal damage to the LH (n = 8) were more markedly impaired on a reappraisal generation task than individuals with right hemisphere lesions (RH, n = 8), and healthy controls (HC, n = 14). The reappraisal generation task consisted of a set of ten pictures from the IAPS, depicting negative events of different sorts. Participants were asked to quickly generate as many positive reinterpretations as possible for each picture. Two scores were derived from this task, namely difficulty and productivity. A second goal of this study was to explore which cognitive control processes were associated with performance on the reappraisal task. For this purpose, participants were assessed on several measures of cognitive control. Findings indicated that reappraisal difficulty – defined as the time taken to generate a first reappraisal – did not differ between LH and RH groups. However, differences were found between patients with brain injury (LH + RH) and HC, suggesting that brain damage in either hemisphere influences reappraisal difficulty. No differences in reappraisal productivity were found across groups, suggesting that neurological groups and HC are equally productive when time constraints are not considered. Finally, only two cognitive control processes inhibition and verbal fluency- were inversely associated with reappraisal difficulty. Implications for the neuroanatomical and neuropsychological bases of reappraisal generation are discussed, and implications for neuro-rehabilitation are considered.

Surviving Catastrophic Reaction after Brain Injury: The Use of Self- Regulation and Self-Other Regulation

Catastrophic reactions are usually observed after brain injury. Although Kurt Goldstein described this concept more than fifty years ago, it has not been adequately incorporated in the theoretical and clinical field of neuropsychological rehabilitation. In the following article a number of cases where patients experience catastrophic reactions are illustrated, as well as the intrapersonal and interpersonal mechanisms that facilitate the regulation and reorganization of the self. It is proposed that catastrophic reaction activates attachment mechanisms by default, mobilizing the patient to look for a significant other to regulate him/herself from outside. This article also describes how high levels of arousal, triggered by a catastrophic reaction during interpersonal conflict, impact on mentalizing, which is a self-regulatory function that generates representations of our own and other’s mental states. Finally, it is suggested that lesions to different brain areas might impair specific self-regulatory and self-other regulatory components, requiring the adaptation of psychotherapeutic technique to these particular profiles. Examples of the modification of psychotherapeutic technique with the patient and the family are provided.

Opening an emotional dimension in me: Changes in emotional reactivity and emotion regulation in a case of executive impairment after left fronto-parietal damage

Dysexecutive impairment is a common problem after brain injury, particularly after damage to the lateral surface of the frontal lobes. There is a large literature describing the cognitive deficits associated with executive impairment after dorsolateral damage; however, little is known about its impact on emotional functioning. This case study describes changes in a 72-year-old man (Professor F) who became markedly dysexecutive after a left fron-to-parietal stroke. Professor Fs case is remarkable in that, despite exhibiting typical executive impairments, abstraction and working memory capacities were spared. Such preservation of insight-related capacities allowed him to offer a detailed account of his emotional changes. Quantitative and qualitative tools were used to explore changes in several well-known emotional processes. The results suggest that Professor Fs two main emotional changes were in the domain of emotional reactivity (increased experience of both positive and negative emotions) and emotion regulation (down-regulation of sadness). Professor F related both changes to difficulties in his thinking process, especially a difficulty generating and manipulating thoughts during moments of negative arousal. These results are discussed in relation to the literature on executive function and emotion regulation. The relevance of these findings for neuropsychological rehabilitation and for the debate on the neural basis of emotional processes is addressed.

Revisiting the left convexity hypothesis: changes in the mental apparatus after left dorso-medial prefrontal damage

It has been 15 years since Kaplan-Solms and Solms published their Clinical Studies in Neuropsychoanalysis, where they proposed a neuroanatomy of the mental apparatus. One of their main observations was that damage to certain areas of the left prefrontal cortex (PFC), particularly those related to expressive language (Broca’s area), did not generate changes in the mental apparatus. However, a limitation of their model was that it did not include patients with damage to other areas of the left PFC. The main goal of this paper is to update Kaplan-Solms and Solms’ model through the description of id, ego and superego changes in a case of left dorso-medial prefrontal damage (Professor F). Data from a 7-year psychoanalytic psychotherapy with Professor F were collected through the review of clinical notes and session voice recordings. This material was analyzed under the light of existing evidence on the neuropsychological functions supported by the left dorso-medial PFC. Results from this analysis support the hypothesis that damage to other areas of the left PFC, beyond Broca’s area, can in fact generate deep changes in the mental apparatus. The most remarkable change observed here was a modification of the dynamic functions of the ego, as an inability to regulate affect via preconscious verbal thinking. This transformation impacted the baseline arrangement between ego and id, with somatic states becoming more salient. Finally, changes in the superego were also observed, particularly in relation to its flexibility during moments of conflict, or the silencing of superego voices outside moments of negative arousal.

‘Just can’t hide it’: a behavioral and lesion study on emotional response modulation after right prefrontal damage

INTRODUCTION Historically, emotion regulation problems have been reported as a common consequence of right prefrontal cortex (rPFC) damage. It has been proposed that the rPFC, particularly the rIFG, has a key role inhibiting prepotent reflexive actions, thus contributing to emotion regulation and self-regulation. This study is the first to directly explore this hypothesis, by testing whether damage to the rIFG compromises the voluntary modulation of emotional responses, and whether performance on inhibition tasks is associated with emotion regulation. METHOD 10 individuals with unilateral right prefrontal damage and 15 matched healthy controls were compared on a well-known response modulation task. During the task participants had to amplify and suppress their facial emotional expressions, while watching film clips eliciting amusement. Measures of executive control, emotion regulation strategies usage and symptomatology were also collected. RESULTS As a group, individuals with rPFC damage presented a significantly reduced range of response modulation compared with controls. In addition, performance in the suppression task was associated with measures of cognitive inhibition and suppression usage. Interestingly, these effects were driven primarily by a subgroup of individuals with rPFC damage, all of whom also had damage to the right posterior insula, and who presented a marked impairment in suppressing facial emotional expressions.

In Self-Defense: Disruptions in the Sense of Self, Lateralization, and Primitive Defenses

Perhaps the main appeal of Todd Feinberg’s proposal is his effort to undertake the study of one of the most avoided and controversial topics in neuroscience and psychoanalysis: the self. The difficulties that this endeavor implies are multiple, and it is our intention to engage with Feinberg’s pursuit by constructively challenging and potentially enriching his theory. Our purpose here is to examine four particular aspects of Feinberg’s argument. First, to point out the need to clarify how he understands the notion of self from a psychoanalytic and neuroscientific perspective. Second, to review the evidence regarding how purely cognitive conditions (memory disorders, aphasia, etc.) do affect the sense of self. Third, to examine his claim on how the neuropathologies of the self imply a regression to earlier stages of development, characterized by a recrudescence of patterns of thought and psychological defenses. Fourth, to comment on his theoretical suggestion that, because patients with right-sided lesions preserve immature defenses (denial, projection, splitting, fantasy), those primitive defensive processes are somehow left-lateralized, while mature defenses are right-lateralized.

“Relating through sameness”: a qualitative study of friendship and social isolation in chronic traumatic brain injury

ABSTRACT Social isolation has been described as a common problem among traumatic brain injury (TBI) survivors during the chronic phase. Due to physical, cognitive and behavioural changes, survivors become less socially active and experience a marked decrease in the number of friends. The goal of this investigation is to explore TBI survivors’ subjective account of the challenges encountered in sustaining friendships, as well as gaining insight into their particular understanding of such difficulties. Using a thematic analysis approach, 11 survivors of TBI were interviewed in relation to their experience of social isolation and friendship during the chronic stage. Four main themes emerged from the interviews: (1) The impact of long-term cognitive and behavioural problems on relationships; (2) Loss of old friends; (3) Difficulties making new friends, and (4) Relating to other survivors in order to fight social isolation (sameness). Clinical implications of these findings, as well as their relevance in the design of long-term rehabilitation programmes, are discussed. Particular emphasis is placed on the need to acknowledge the value of relating to other survivors, as a way of resisting cultural discourses about disability, and as a source of self-cohesion in the process of identity re-construction.

Emotional reactivity and awareness of task performance in Alzheimer's disease

Background:A commonmethod for assessing a person with dementia’s appraisal of their own condition is to interview them and ask direct questions. However, people with dementia can develop knowledge about their condition without it being expressed directly in terms of their own selves. Consequently, an indirect, vignette-based method can be used to measure awareness in which judgments are made about fictitious characters with dementia included in vignettes. Methods: Three vignettes were constructed which describe situations concerning early dementia, established dementia and healthy aging. The participants had to listen to the vignettes and express their viewpoints concerning the problems that the characters in the vignettes were experiencing and what advice might be given. 91 people with early dementia, including those with Alzheimer’s disease, vascular and mixed dementia were included in the study, compared to 87 carers and 80 older adults. The responses were also contrasted with awareness of their own illness or neuropsychological deficit.Results: The people with dementia were often able to identify the dementia related problems associated with the characters in the vignettes and often provide appropriate advice, although in both cases this was less than that found in carers or older adults. The ability to provide advice decreased with dementia severity and there was some association between vignette scores and awareness of illness or functional deficit. Conclusions: The vignette procedure can be used to assess indirectly knowledge concerning the effects of dementia in people with dementia. It might provide an additional tool to measuring general awareness associated with dementia in in the early stages.