Isabel A. David

Is there tonic immobility in humans? Biological evidence from victims of traumatic stress.

Tonic immobility, characterized by profound motor inhibition, is elicited under inescapable threat in many species. To fully support the existence of tonic immobility in humans, our aim was to elicit this reaction in a laboratory setting and measure it objectively. To mimic exposure to life-threatening events in the lab, trauma-exposed participants with PTSD (n=18) and without PTSD (n=15) listened to the script of their autobiographical trauma. Posturography and electrocardiography were employed. Reports of script-induced immobility were associated with restricted area of body sway and were correlated with accelerated heart rate and diminished heart rate variability, implying that tonic immobility is preserved in humans as an involuntary defensive strategy. Immobility reports seemed more evident in PTSD, suggesting that, in some patients, tonic immobility may be elicited during re-experiencing episodes in daily life. This study provided a measure of tonic immobility, a peritraumatic reaction for which cumulative clinical evidence had linked to the severity of PTSD.

EEG correlates of the severity of posttraumatic stress symptoms: A systematic review of the dimensional PTSD literature

BACKGROUND Considering the Research Domain Criteria (RDoC) framework, it is crucial to investigate posttraumatic stress disorder (PTSD) as a spectrum that ranges from normal to pathological. This dimensional approach is especially important to aid early PTSD detection and to guide better treatment options. In recent years, electroencephalography (EEG) has been used to investigate PTSD; however, reviews regarding EEG data related to PTSD are lacking, especially considering the dimensional approach. This systematic review examined the literature regarding EEG alterations in trauma-exposed people with posttraumatic stress symptoms (PTSS) to identify putative EEG biomarkers of PTSS severity. METHOD A systematic review of EEG studies of trauma-exposed participants with PTSS that reported dimensional analyses (e.g., correlations or regressions) between PTSS and EEG measures was performed. RESULTS The literature search yielded 1178 references, of which 34 studies were eligible for inclusion. Despite variability among the reviewed studies, the PTSS severity was often associated with P2, P3-family event-related potentials (ERPs) and alpha rhythms. LIMITATIONS The search was limited to articles published in English; no information about non-published studies or studies reported in other languages was obtained. Another limitation was the heterogeneity of studies, which made meta-analysis challenging. CONCLUSIONS EEG provides promising candidates to act as biomarkers, although further studies are required to confirm the findings. Thus, EEG, in addition to being cheaper and easier to implement than other central techniques, has the potential to reveal biomarkers of PTSS severity.

Implicit motivational impact of pictorial health warning on cigarette packs.

Objective The use of pictorial warning labels on cigarette packages is one of the provisions included in the first ever global health treaty by the World Health Organization against the tobacco epidemic. There is substantial evidence demonstrating the effectiveness of graphic health warning labels on intention to quit, thoughts about health risks and engaging in cessation behaviors. However, studies that address the implicit emotional drives evoked by such warnings are still underexplored. Here, we provide experimental data for the use of pictorial health warnings as a reliable strategy for tobacco control. Methods Experiment 1 pre-tested nineteen prototypes of pictorial warnings to screen for their emotional impact. Participants (n = 338) were young adults balanced in gender, smoking status and education. Experiment 2 (n = 63) tested pictorial warnings (ten) that were stamped on packs. We employed an innovative set-up to investigate the impact of the warnings on the ordinary attitude of packs’ manipulation, and quantified judgments of warnings’ emotional strength and efficacy against smoking. Findings Experiment 1 revealed that women judged the warning prototypes as more aversive than men, and smokers judged them more aversive than non-smokers. Participants with lower education judged the prototypes more aversive than participants with higher education. Experiment 2 showed that stamped warnings antagonized the appeal of the brands by imposing a cost to manipulate the cigarette packs, especially for smokers. Additionally, participants’ judgments revealed that the more aversive a warning, the more it is perceived as effective against smoking. Conclusions Health warning labels are one of the key components of the integrated approach to control the global tobacco epidemic. The evidence presented in this study adds to the understanding of how implicit responses to pictorial warnings may contribute to behavioral change.

How you perceive threat determines your behavior

The prioritization of processing emotional stimuli usually produces deleterious effects on task performance when it distracts from a task. One common explanation is that brain resources are consumed by emotional stimuli, diverting resources away from executing the task. Viewing unpleasant stimuli also generates defensive reactions, and these responses may be at least partially responsible for the effect of the emotional modulation observed in various reaction time (RT) paradigms. We investigated whether modulatory effects on RT vary if we presented threat stimuli to prompt different defensive responses. To trigger different responses, we manipulated threat perception by moving the direction of threatening stimuli. Threatening or neutral stimuli were presented as distractors during a bar orientation discrimination task. The results demonstrated that threat stimuli directed toward the observer produced a decrease in RT; in contrast, threat stimuli directed away from the observer produced an increase in RT, when compared to neutral stimuli. Accelerated RT during directed toward threat stimuli was attributed to increased motor preparation resulting from strong activation of the defense response cascade. In contrast, directed away threat stimuli likely activated the defense cascade, but less intensively, prompting immobility. Different threat stimuli produced varying effects, which was interpreted as evidence that the modulation of RT by emotional stimuli represents the summation of attentional and motivational effects. Additionally, participants who had been previously exposed to diverse types of violent crime were more strongly influenced by threat stimuli directed toward the observer. In sum, our data support the concept that emotions are indeed action tendencies.

Emotion and attention interaction: a trade-off between stimuli relevance, motivation and individual differences.

Mounting evidence suggests that the neural processing of emotional stimuli is prioritized. However, whether the processing of emotional stimuli is dependent on attention remains debatable. Several studies have investigated this issue by testing the capacity of emotional distracters to divert processing resources from an attentional main task. The attentional load theory postulates that the perceptual load of the main task determines the selective processing of the distracter. Although we agree with this theory, we also suggest that other factors could be important in determining the association between the load of the main task and distracter processing, namely, (1) the relevance of the to-be ignored stimuli and (2) the engagement in the main task due to motivation. We postulate that these factors function as opposite forces to influence distracter processing. In addition, we propose that this trade-off is modulated by individual differences. In summary, we suggest that the relationship between emotion and attention is flexible rather than rigid and depends on several factors. Considering this perspective may help us to understand the divergence in the results described by several studies in this field.

Brain reactivity to unpleasant stimuli is associated with severity of posttraumatic stress symptoms.

Despite the impressive progress in the biological research of posttraumatic stress disorder (PTSD), little is known about the neurobiological correlates of emotional reactions in healthy people with posttraumatic stress symptoms (PTSS). The present study investigated whether PTSS are related to the electrocortical processing of unpleasant pictures in a sample of undergraduate students. Participants were instructed to judge whether images were unpleasant or neutral while an EEG was taken. The late positive potential (LPP) to unpleasant relative to neutral was more positive for people with high PTSS than with low PTSS. Additionally, a temporospatial principal components analysis (PCA) for the whole sample identified positivities that were directly correlated with PTSS. These results provide evidence that brain reactivity to unpleasant cues would predict PTSS intensity and thus be a biomarker of PTSS severity.

Preparing to caress: a neural signature of social bonding.

It is assumed that social bonds in humans have consequences for virtually all aspects of behavior. Social touch-based contact, particularly hand caressing, plays an important role in social bonding. Pre-programmed neural circuits likely support actions (or predispositions to act) toward caressing contacts. We searched for pre-set motor substrates toward caressing by exposing volunteers to bonding cues and having them gently stroke a very soft cloth, a caress-like movement. The bonding cues were pictures with interacting dyads and the control pictures presented non-interacting dyads. We focused on the readiness potential, an electroencephalographic marker of motor preparation that precedes movement execution. The amplitude of the readiness potential preceding the grasping of pleasant emotional-laden stimuli was previously shown to be reduced compared with neutral ones. Fingers flexor electromyography measured action output. The rationale here is that stroking the soft cloth when previously exposed to bonding cues, a compatible context, would result in smaller amplitudes of readiness potentials, as compared to the context with no such cues. Exposure to the bonding pictures increased subjective feelings of sociability and decreased feelings of isolation. Participants who more frequently engage in mutual caress/groom a “significant other” in daily life initiated the motor preparation earlier, reinforcing the caress-like nature of the task. As hypothesized, readiness potentials preceding the caressing of the soft cloth were significantly reduced under exposure to bonding as compared to control pictures. Furthermore, an increased fingers flexor electromyographic activity was identified under exposure to the former as compared to the latter pictures. The facilitatory effects are likely due to the recruitment of pre-set cortical motor repertoires related to caress-like movements, emphasizing the distinctiveness of neural signatures for caress-like movements.

Immobility reactions under threat: A contribution to human defensive cascade and PTSD

HIGHLIGHTSStabilometry is a successful methodology to study the defensive cascade in humans.Human defensive reactions: attentive immobility, immobility under attack and tonic immobility parallel those proposed for other mammals.Symptom severity in PTSD is associated with peritraumatic tonic immobility, an involuntary reaction under extreme threat.Biological indicators of tonic immobility in humans are characterized by reduced body sway, tachycardia and low heart rate variability. ABSTRACT Violence exacts a burden on public health. Gun violence is a major trigger for motor defensive reactions in humans and post‐traumatic stress disorder (PTSD) is its main psychiatric sequela. However, studies of the human defensive cascade, especially the motor reactions, are at an early stage. This review focuses on studies that employ stabilometry, a methodology that assesses whole body motor reactions, to address defensive behaviors to violence‐related threats. Special attention is given to three reactions: “attentive immobility”, “immobility under attack” and “tonic immobility”, with emphasis on the latter – a peritraumatic reaction which has been strongly associated with the severity of PTSD. These reactions are characterized by reduced body sway and bradycardia, except tonic immobility that presents robust tachycardia. The advances made by investigations into the immobility reactions of the human defensive cascade contribute to helping to bridge the gap between human and non‐human species. Furthermore, progresses in basic research to objectively monitor motor defensive reactions under threat can help to develop a dimensional, trans‐diagnostic approach to PTSD.

Exposure to trauma-relevant pictures is associated with tachycardia in victims who had experienced an intense peritraumatic defensive response: the tonic immobility.

Tonic immobility is an involuntary, last-ditch defensive reaction characterized by physical inactivity in a context of inescapable threat that has been described in many species, including humans. The occurrence of this defensive response is a predictor of the severity of psychiatric disorders and may be considered as an index of an intense reaction to a traumatic event. Here, we investigated whether the retrospective reports of peritraumatic tonic immobility reaction in participants exposed to a traumatic event would modify their cardiac responses to pictures related to their trauma. Using a questionnaire of life-threating events, we selected students who experienced violent crime as their most intense trauma and students who had never experienced a violent crime trauma, but experienced other traumatic events. All participants completed a questionnaire that estimated the intensity of tonic immobility during their most intense trauma. Electrocardiographic recordings were collected during exposure to pictures. Participants viewed emotional pictures (human attack with guns) and neutral pictures. These emotional stimuli were selected to be trauma-relevant to the violent crime group and non trauma-relevant to the no violent crime trauma group. Violent crime group showed a positive correlation between heart rate changes after viewing trauma-related pictures and tonic immobility scores. We observed that low tonic immobility scores were associated with bradycardia and high scores with tachycardia in response to trauma-relevant pictures. For the no violent crime group, no significant correlation was detected. These results suggest that the relevance of the stimuli and the magnitude of the defensive response during a previous trauma event were important factors triggering more intense defensive responses.

Alcohol, emotion and attention: revisiting the Alcohol Myopia Theory

Among the known effects of alcohol on behavior, the modulation of cognitive functions (such as attention and memory), emotion, risk-taking and aggressive behavior are noteworthy. Here, we performed literature review in order to reinterpret alcohol effects on behavior according to the Alcohol Myopia Theory. According to this construct, there is a reduction of attentional resources during alcohol intoxication, which are primarily allocated to the most salient events in a given situation. The consequence is a hyperfocus directed to emotional situations when they are sufficiently relevant to grab attention, or a reduced attentional focus to emotional events in the presence of a relevant demanding task. The understanding of the mechanism mentioned above support the discussion of propositions toward the prevention of problems related to alcohol consumption. Importantly, the attentional allocation model provides inputs for a discussion on the scientifically-supported public health propositions aimed at preventing problems related to acute alcohol intoxication.