Christiane Hermann

Brain circuits involved in emotional learning in antisocial behavior and social phobia in humans

While psychopaths (PP) lack anticipatory fear, social phobics (SP) are characterized by excessive fear. Criminal PP, SP and healthy controls (HC) participated in differential aversive delay conditioning with neutral faces as conditioned (CS) and painful pressure as unconditioned stimuli. Functional magnetic resonance imaging revealed differential activation in the limbic-prefrontal circuit (orbitofrontal cortex, insula, anterior cingulate, amygdala) in the HC. By contrast, the PP displayed brief amygdala, but no further brain activation. The SP showed increased activity to the faces in the amygdala and orbitofrontal cortex already during habituation. Thus, a hypoactive frontolimbic circuit may represent the neural correlate of psychopathic behavior, whereas an overactive frontolimbic system may underly social fear.

Long-term alteration of pain sensitivity in school-aged children with early pain experiences.

&NA; While animal studies suggest that neonatal pain experiences induce long‐term alterations in pain sensitivity, no such data exist in humans. Changes in pain sensitivity in school‐aged children (9–14 years) who were born preterm or fullterm, had been hospitalized for a prolonged period of time after birth and had undergone repeated painful procedures while being treated in a Neonatal Intensive Care Unit (NICU) were determined. A retrospective cohort study of 19 preterm (≤31 weeks gestational age) and 20 fullterm children (≥37 weeks gestational age) treated at least 3 days in a NICU at a University Hospital and 20 fullterm control children without NICU experience was performed. Perceptual sensitization to tonic heat and repetitive mechanical stimuli as well as heat pain and mechanical pain thresholds were obtained at the thenar and a trigeminal site. Length of hospitalization and NICU treatment was significantly higher in preterm than fullterm children. Nonetheless, both preterm and fullterm children with NICU experience showed greater perceptual sensitization to tonic heat and elevated heat pain thresholds at both sites. Mechanical pain threshold and perceptual sensitization did not differ between groups. Consistent with findings in animals, repeated pain experiences during the neonatal period were associated with alterations in thermal pain responsivity in school‐aged preterm and fullterm children that was characterized by enhanced perceptual sensitization to prolonged painful stimulation and hypoalgesia to brief heat pain stimuli. Our findings suggest that repeated pain experiences in neonates may induce activity‐induced changes in the functioning of pain pathways that persist well beyond infancy.

Aversive Pavlovian conditioning in psychopaths: Peripheral and central correlates

Differential aversive Pavlovian conditioning with a foul odor as unconditioned stimulus (US) and neutral faces as conditioned stimuli (CS) was compared between 9 noncriminal psychopaths as defined by the Hare Psychopathy Checklist Revised and 12 healthy controls. Event-related potentials (ERP), heart rate, skin conductance response, corrugator EMG, and startle response potentiation as well as valence, arousal, and contingency of the CS were assessed. Whereas the healthy controls (HC) showed significant CS +/CS- differentiation, the psychopaths (PP) failed to exhibit a conditioned response although unconditioned responses were comparable between the groups. N100, P200, and P300 to the CSs revealed that psychopaths were not deficient in information processing and showed even better anticipatory responding than the HC group indicated by the terminal contingent negative variation (tCNV), that lacked, however, CS+ and CS- differentiation. These data indicate a deficit in association formation in psychopaths that may be related to deficient interaction of limbic-subcortical and cortical structures.

Cerebral processing of pain in school-aged children with neonatal nociceptive input: An exploratory fMRI study

&NA; Due to maturation‐related plasticity of the developing nociceptive system, neonatal nociceptive input, as induced by medical procedures in the neonatal intensive care unit (NICU), may cause long‐term alterations in pain processing. Using functional magnetic resonance imaging, this study investigated the cerebral pain response in school‐aged children and adolescents (11–16 yr) with experience in a NICU after preterm (≤31 weeks gestational age, N = 9) or fullterm birth (≥37 weeks gestational age, N = 9) as compared to fullterm control children without early hospitalization (N = 9). NICU children had been recruited retrospectively among former patients of the Childrens University Hospital Mannheim. All children had participated in our previous studies [46,49] entailing psychophysical measurements. In response to tonic (30 s) heat stimuli of individually adjusted moderate pain intensity, which were of comparable temperature across groups, the preterm but not the fullterm NICU children exhibited significant activations in a number of brain regions (thalamus, anterior cingulate cortex, cerebellum, basal ganglia, and periaquaeductal gray) that were not significantly activated in controls. The preterms showed significantly higher activations than controls in primary somatosensory cortex, anterior cingulate cortex, and insula. This exaggerated brain response was pain‐specific and was not observed during non‐painful warmth stimulation. Preterms’ continuous pain ratings revealed a tendency for increased sensitization within and a lack of habituation across trials. In highly vulnerable children such as preterms, neonatal nociceptive input may, aside from other neurodevelopmental consequences, persistently increase the gain within pain pathways.

Self-stigma in Women With Borderline Personality Disorder and Women With Social Phobia

Little is known about how women with borderline personality disorder (BPD) and women with social phobia react to mental illness stigma. The goal of this study was to assess empirically self-stigma and its correlates in these groups. Self-stigma and related constructs were measured by self-report questionnaires among 60 women with BPD and 30 women with social phobia. Self-stigma was inversely related to self-esteem, self-efficacy, and quality of life and predicted low self-esteem after controlling for depression and shame-proneness. Stereotype awareness was not significantly correlated with self-esteem or quality of life. While there was no difference in stereotype awareness between women with BPD and women with social phobia, women with BPD showed higher self-stigma than women with social phobia. Self-stigma is associated with low self-esteem and other indices of poor psychological well-being. In comparison to women with social phobia, women with BPD suffer from more self-stigma. This may reflect intense labeling processes as being mentally ill due to repeated hospitalizations, frequent interpersonal difficulties, and visible scars.

Responses to pain in school-aged children with experience in a neonatal intensive care unit: cognitive aspects and maternal influences.

Previously, it was shown that school‐aged (9–14yr) preterm and fullterm children with neonatal pain exposure exhibit elevated heat pain thresholds and heightened perceptual sensitization to tonic painful heat when tested under standard conditions [Hermann C, Hohmeister J, Demirakca S, Zohsel K, Flor H. Long‐term alteration of pain sensitivity in school‐aged children with early pain experiences. Pain 2006;125:278–85]. Here, changes in the psychosocial context of pain responses in these children, who had been hospitalized ≥7 days after birth including ≥3 days of treatment in a neonatal intensive care unit (NICU), are reported. Nineteen preterm (≤31 weeks gestational age) and 20 fullterm children (≥37 weeks gestational age) with NICU experience, recruited retrospectively and selected based on strict exclusion criteria, and 20 fullterm control children participated. Preterm NICU children endorsed more pain catastrophizing as compared to controls. Mothers of preterm children, who had been more severely ill and had been hospitalized longer than fullterm NICU children, were more likely to engage in solicitous pain‐related behavior. Maternal influence was also assessed by comparing heat pain thresholds and perceptual sensitization to tonic painful heat obtained in the presence versus absence (i.e. standard testing conditions) of the mother. In all three groups, maternal presence was associated with increased heat pain thresholds. Control children habituated significantly more to tonic heat when their mother was present. The NICU children showed overall significantly less habituation than the controls; there was no modulating effect of maternal presence. Especially in highly vulnerable children such as preterms, neonatal pain exposure and prolonged hospitalization may, aside from neuronal plasticity, promote maladaptive pain‐related cognitions and foster parental behavior that reinforces the childs pain response.

Creativity and the brain: Uncovering the neural signature of conceptual expansion

Neurophysiological studies of creativity thus far have not allowed for clear conclusions to be made regarding the specific neural underpinnings of such complex cognition due to overgeneralizations concerning the creativity construct, heterogeneity in the type of creativity tasks used, and the questionable efficacy of the employed comparison tasks. A novel experimental design was developed in the present fMRI study which rendered it possible to investigate a critical facet of creative cognition - that of conceptual expansion - as distinct from general divergent thinking, working memory, or cognitive load. Brain regions involved in the retention, retrieval and integration of conceptual knowledge such as the anterior inferior frontal gyrus, the temporal poles and the lateral frontopolar cortex were found to be selectively involved during conceptual expansion. The findings go against generic ideas that argue for the dominance of the right hemisphere during creative thinking and indicate the necessity to reconsider the functions of regions such as the anterior cingulate cortex to include more abstract facets of cognitive control. This study represents a new direction in the investigation of creativity in that it highlights the necessity to adopt a process based perspective in which the multifaceted nature of creativity can be truly grasped.

Psychophysiological and subjective indicators of aversive pavlovian conditioning in generalized social phobia

Aversive conditioning has been proposed as an important etiologic mechanism in social phobia; however, empirical evidence is scarce and has not relied on a detailed analysis of the acquisition and extinction of the conditioned emotional response. Fourteen men sustaining generalized social phobia and 19 healthy control subjects participated in differential aversive conditioning with two neutral faces as conditioned stimuli and an aversive odor as unconditioned stimulus. Subjective and peripheral physiological responses were obtained. Both groups were successfully conditioned as reflected by differential subjective (valence, arousal, subjective unconditioned stimulus expectancy) and peripheral physiological responses (skin conductance, startle response). There was no evidence for an enhanced conditionability in the social phobics; however, they showed an enhanced unconditioned stimulus expectancy, especially for the nonreinforced conditioned stimuli during acquisition, and a delayed extinction of the conditioned skin conductance response as well as a certain dissociation between subjective and physiological responses.The enhanced unconditioned stimulus expectancy during acquisition and the overall elevated subjective arousal suggest that, under threat, subjects with generalized social phobia may be more prone to associate neutral social cues and an aversive outcome. Furthermore, delayed extinction of the conditioned response seems to contribute to the etiology and maintenance of generalized social phobia.

Biofeedback in the treatment of headache and other childhood pain

Since the first biofeedback (BFB) studies on pediatric pain were published in the early 1980s, most of the studies have focused on the treatment of pediatric migraine. More recently, BFB has also been evaluated in the treatment of tension headache in children. Not surprisingly, most of what we know about the efficacy and mechanisms of BFB in the treatment of childrens pain problems concerns the treatment of childhood headache (HA). In this review, we provide a detailed summary of studies that have evaluated BFB in the treatment of childhood HAs with an emphasis on treatment outcome and maintenance of treatment success. Moreover, findings and hypotheses with regard to the mechanisms that may mediate the treatment effects of BFB are addressed. Finally, we discuss specific issues relating to the treatment of pain in children with BFB and outline future directions of research.

Heartbeat perception in social anxiety before and during speech anticipation

According to current cognitive models of social phobia, individuals with social anxiety create a distorted image of themselves in social situations, relying, at least partially, on interoceptive cues. We investigated differences in heartbeat perception as a proxy of interoception in 48 individuals high and low in social anxiety at baseline and while anticipating a public speech. Results revealed lower error scores for high fearful participants both at baseline and during speech anticipation. Speech anticipation improved heartbeat perception in both groups only marginally. Eight of nine accurate perceivers as determined using a criterion of maximum difference between actual and counted beats were high socially anxious. Higher interoceptive accuracy might increase the risk of misinterpreting physical symptoms as visible signs of anxiety which then trigger negative evaluation by others. Treatment should take into account that in socially anxious individuals perceived physical arousal is likely to be accurate rather than false alarm.