Jarred Younger

A change of heart: cardiovascular correlates of forgiveness in response to interpersonal conflict.

This study sought to examine the psychophysiological correlates of forgiveness in response to interpersonal conflict. One hundred eight college students (44 males and 64 females) participated in two interviews about times of interpersonal betrayal, one about a parent and one about a friend/partner. Measures of forgiving personality and state forgiveness were collected, as well as stress, hostility, empathy, and self-reported illness symptoms. During baseline, interviews and recovery periods, repeated measures were taken of blood pressure, heart rate, frontalis EMG, and skin conductance. Trait forgiveness was associated with lower levels of blood pressure. State forgiveness was associated with lower blood pressure levels, heart rate, and rate pressure product. Acute, stress-induced reactivity was also linked to forgiveness: state forgiveness was associated with diastolic and mean arterial pressure and rate pressure product reactivity during the parent interview. Increased blood pressure recovery after stress was also linked to trait forgiveness. Forgiveness may produce beneficial effects directly by reducing allostatic load associated with betrayal and conflict, and indirectly through reductions in perceived stress.

The Unique Effects of Forgiveness on Health: An Exploration of Pathways

The relationship of forgiveness, both state and trait, to health was assessed. Eighty-one community adults completed a packet of questionnaires and participated in a laboratory interview about a time of hurt or betrayal. Heart rate and blood pressure were recorded during a 10 min baseline, the interview and during a recovery period; interviews were structured around a framework of questions and videotaped. Four measures of forgiveness were all statistically associated with five measures of health (physical symptoms, medications used, sleep quality, fatigue, and somatic complaints). Trait forgiveness was associated with decreased reactivity (rate-pressure product) to the interview, but sympathetic reactivity did not account for the trait forgiveness–health association. Four mechanisms or pathways by which forgiveness could lead to fewer physical symptoms were examined: spirituality, social skills, reduction in negative affect, and reduction in stress. All factors either partially or fully mediated the effect of forgiveness on health; however, the strongest mediator for both state and trait forgiveness was reduction in negative affect. For state forgiveness, the second strongest mediator was reduction in stress; for trait forgiveness, both conflict management and reduction in stress were strong contributors.

Viewing Pictures of a Romantic Partner Reduces Experimental Pain: Involvement of Neural Reward Systems

The early stages of a new romantic relationship are characterized by intense feelings of euphoria, well-being, and preoccupation with the romantic partner. Neuroimaging research has linked those feelings to activation of reward systems in the human brain. The results of those studies may be relevant to pain management in humans, as basic animal research has shown that pharmacologic activation of reward systems can substantially reduce pain. Indeed, viewing pictures of a romantic partner was recently demonstrated to reduce experimental thermal pain. We hypothesized that pain relief evoked by viewing pictures of a romantic partner would be associated with neural activations in reward-processing centers. In this functional magnetic resonance imaging (fMRI) study, we examined fifteen individuals in the first nine months of a new, romantic relationship. Participants completed three tasks under periods of moderate and high thermal pain: 1) viewing pictures of their romantic partner, 2) viewing pictures of an equally attractive and familiar acquaintance, and 3) a word-association distraction task previously demonstrated to reduce pain. The partner and distraction tasks both significantly reduced self-reported pain, although only the partner task was associated with activation of reward systems. Greater analgesia while viewing pictures of a romantic partner was associated with increased activity in several reward-processing regions, including the caudate head, nucleus accumbens, lateral orbitofrontal cortex, amygdala, and dorsolateral prefrontal cortex – regions not associated with distraction-induced analgesia. The results suggest that the activation of neural reward systems via non-pharmacologic means can reduce the experience of pain.

An alternative approach for achieving cardiovascular baseline : Viewing an aquatic video

Due to the importance of baseline and recovery levels in the computation of reactivity, two studies were conducted to determine an alternative method to traditional rest for achieving baseline and recovery levels of cardiovascular measurements. Watching a relaxing, aquatic video was compared with a traditional resting baseline to determine the better method for achieving low baseline levels. In addition, watching the video was compared with traditional rest during 5-min post-task recovery periods. Systolic (SBP) and diastolic blood pressure (DBP) decreased more during the baseline period when subjects viewed the video than when subjects rested quietly. Similarly, subjects displayed greater recovery following the mental tasks when they watched a video than when they merely sat quietly. It is recommended that researchers standardize baseline procedures by showing a relaxing video before administering tasks for the assessment of cardiovascular reactivity.

Chronic myofascial temporomandibular pain is associated with neural abnormalities in the trigeminal and limbic systems

&NA; Myofascial pain of the temporomandibular region (M‐TMD) is a common, but poorly understood chronic disorder. It is unknown whether the condition is a peripheral problem, or a disorder of the central nervous system (CNS). To investigate possible CNS substrates of M‐TMD, we compared the brain morphology of 15 women with M‐TMD to that of 15 age‐ and gender‐matched healthy controls. High‐resolution structural brain and brainstem scans were carried out using magnetic resonance imaging (MRI), and data were analyzed using a voxel‐based morphometry approach. The M‐TMD group evidenced decreased or increased gray matter volume compared to controls in several areas of the trigeminothalamocortical pathway, including brainstem trigeminal sensory nuclei, the thalamus, and the primary somatosensory cortex. In addition, M‐TMD individuals showed increased gray matter volume compared to controls in limbic regions such as the posterior putamen, globus pallidus, and anterior insula. Within the M‐TMD group, jaw pain, pain tolerance, and pain duration were differentially associated with brain and brainstem gray matter volume. Self‐reported pain severity was associated with increased gray matter in the rostral anterior cingulate cortex and posterior cingulate. Sensitivity to pressure algometry was associated with decreased gray matter in the pons, corresponding to the trigeminal sensory nuclei. Longer pain duration was associated with greater gray matter in the posterior cingulate, hippocampus, midbrain, and cerebellum. The pattern of gray matter abnormality found in M‐TMD individuals suggests the involvement of trigeminal and limbic system dysregulation, as well as potential somatotopic reorganization in the putamen, thalamus, and somatosensory cortex.

Towards a Physiology-Based Measure of Pain: Patterns of Human Brain Activity Distinguish Painful from Non-Painful Thermal Stimulation

Pain often exists in the absence of observable injury; therefore, the gold standard for pain assessment has long been self-report. Because the inability to verbally communicate can prevent effective pain management, research efforts have focused on the development of a tool that accurately assesses pain without depending on self-report. Those previous efforts have not proven successful at substituting self-report with a clinically valid, physiology-based measure of pain. Recent neuroimaging data suggest that functional magnetic resonance imaging (fMRI) and support vector machine (SVM) learning can be jointly used to accurately assess cognitive states. Therefore, we hypothesized that an SVM trained on fMRI data can assess pain in the absence of self-report. In fMRI experiments, 24 individuals were presented painful and nonpainful thermal stimuli. Using eight individuals, we trained a linear SVM to distinguish these stimuli using whole-brain patterns of activity. We assessed the performance of this trained SVM model by testing it on 16 individuals whose data were not used for training. The whole-brain SVM was 81% accurate at distinguishing painful from non-painful stimuli (p<0.0000001). Using distance from the SVM hyperplane as a confidence measure, accuracy was further increased to 84%, albeit at the expense of excluding 15% of the stimuli that were the most difficult to classify. Overall performance of the SVM was primarily affected by activity in pain-processing regions of the brain including the primary somatosensory cortex, secondary somatosensory cortex, insular cortex, primary motor cortex, and cingulate cortex. Region of interest (ROI) analyses revealed that whole-brain patterns of activity led to more accurate classification than localized activity from individual brain regions. Our findings demonstrate that fMRI with SVM learning can assess pain without requiring any communication from the person being tested. We outline tasks that should be completed to advance this approach toward use in clinical settings.

Fibromyalgia Symptoms Are Reduced by Low‐Dose Naltrexone: A Pilot Study

OBJECTIVE Fibromyalgia is a chronic pain disorder that is characterized by diffuse musculoskeletal pain and sensitivity to mechanical stimulation. In this pilot clinical trial, we tested the effectiveness of low-dose naltrexone in treating the symptoms of fibromyalgia. DESIGN Participants completed a single-blind, crossover trial with the following time line: baseline (2 weeks), placebo (2 weeks), drug (8 weeks), and washout (2 weeks). PATIENTS Ten women meeting criteria for fibromyalgia and not taking an opioid medication. INTERVENTIONS Naltrexone, in addition to antagonizing opioid receptors on neurons, also inhibits microglia activity in the central nervous system. At low doses (4.5 mg), naltrexone may inhibit the activity of microglia and reverse central and peripheral inflammation. OUTCOME MEASURES Participants completed reports of symptom severity everyday, using a handheld computer. In addition, participants visited the lab every 2 weeks for tests of mechanical, heat, and cold pain sensitivity. RESULTS Low-dose naltrexone reduced fibromyalgia symptoms in the entire cohort, with a greater than 30% reduction of symptoms over placebo. In addition, laboratory visits showed that mechanical and heat pain thresholds were improved by the drug. Side effects (including insomnia and vivid dreams) were rare, and described as minor and transient. Baseline erythrocyte sedimentation rate predicted over 80% of the variance in drug response. Individuals with higher sedimentation rates (indicating general inflammatory processes) had the greatest reduction of symptoms in response to low-dose naltrexone. CONCLUSIONS We conclude that low-dose naltrexone may be an effective, highly tolerable, and inexpensive treatment for fibromyalgia.

Prescription opioid analgesics rapidly change the human brain

&NA; Chronic opioid exposure is known to produce neuroplastic changes in animals; however, it is not known if opioids used over short periods of time and at analgesic dosages can similarly change brain structure in humans. In this longitudinal, magnetic resonance imaging study, 10 individuals with chronic low back pain were administered oral morphine daily for 1 month. High‐resolution anatomical images of the brain were acquired immediately before and after the morphine administration period. Regional changes in gray matter volume were assessed on the whole brain using tensor‐based morphometry, and those significant regional changes were then independently tested for correlation with morphine dosage. Thirteen regions evidenced significant volumetric change, and degree of change in several of the regions was correlated with morphine dosage. Dosage‐correlated volumetric decrease was observed primarily in the right amygdala. Dosage‐correlated volumetric increase was seen in the right hypothalamus, left inferior frontal gyrus, right ventral posterior cingulate, and right caudal pons. Follow‐up scans that were conducted an average of 4.7 months after cessation of opioids demonstrated many of the morphine‐induced changes to be persistent. In a separate study, 9 individuals consuming blinded placebo capsules for 6 weeks evidenced no significant morphologic changes over time. The results add to a growing body of literature showing that opioid exposure causes structural and functional changes in reward‐ and affect‐processing circuitry. Morphologic changes occur rapidly in humans during new exposure to prescription opioid analgesics. Further research is needed to determine the clinical impact of those opioid‐induced gray matter changes. After 1 month of daily opioid analgesic consumption, chronic pain patients showed morphologic changes in several reward‐processing and limbic areas of the brain.

Dimensions of forgiveness: The views of laypersons

Many conceptualizations of forgiveness currently exist in the forgiveness literature. The present study adds another perspective to the forgiveness discussion by investigating lay definitions of forgiveness, as well as reasons for forgiveness and nonforgiveness. In Study 1, undergraduate students completed a questionnaire packet in which they provided three narratives of interpersonal offense: a time when they had been hurt and then forgave the offender, a time when they had been hurt and did not forgive, and a time when they had hurt someone else and were forgiven. Respondents were also asked questions about their conceptualization of forgiveness and the factors that influence their decisions to forgive or not forgive. In Study 2, community adults participated in interviews during which they described a time when they had been betrayed or hurt. Following their story, participants answered questions about their definitions of and motivations for forgiveness. A number of important themes in forgiveness definition and motivation are identified, and important similarities and differences between the under-graduate and community samples are discussed. In particular, it is noted that primary motivations for forgiveness appear to be largely self-focused, rather than altruistic.

Multivariate Classification of Structural MRI Data Detects Chronic Low Back Pain

Chronic low back pain (cLBP) has a tremendous personal and socioeconomic impact, yet the underlying pathology remains a mystery in the majority of cases. An objective measure of this condition, that augments self-report of pain, could have profound implications for diagnostic characterization and therapeutic development. Contemporary research indicates that cLBP is associated with abnormal brain structure and function. Multivariate analyses have shown potential to detect a number of neurological diseases based on structural neuroimaging. Therefore, we aimed to empirically evaluate such an approach in the detection of cLBP, with a goal to also explore the relevant neuroanatomy. We extracted brain gray matter (GM) density from magnetic resonance imaging scans of 47 patients with cLBP and 47 healthy controls. cLBP was classified with an accuracy of 76% by support vector machine analysis. Primary drivers of the classification included areas of the somatosensory, motor, and prefrontal cortices--all areas implicated in the pain experience. Differences in areas of the temporal lobe, including bordering the amygdala, medial orbital gyrus, cerebellum, and visual cortex, were also useful for the classification. Our findings suggest that cLBP is characterized by a pattern of GM changes that can have discriminative power and reflect relevant pathological brain morphology.