Emotion regulation before and after transcranial magnetic stimulation in obsessive compulsive disorder

• Published in: Psychological medicine Vol. 45; no. 14; pp. 3059 - 3073
• Main Authors: de Wit, S. J., van der Werf, Y. D., Mataix-Cols, D., Trujillo, J. P., van Oppen, P., Veltman, D. J., van den Heuvel, O. A.
• Format: Journal Article
• Language: English
• Published: Cambridge, UK Cambridge University Press 01.10.2015
• Subjects: Adult; Amygdala; Amygdala - physiopathology; Brain activity; Brain mapping; Case-Control Studies; Cognition; Cognitive ability; Cortex (frontal); Emotional regulation; Emotions; Female; Functional magnetic resonance imaging; Humans; Information processing; Magnetic fields; Magnetic Resonance Imaging; Male; Middle Aged; Netherlands; Neural networks; Neuroimaging; Neuropsychological Tests; NMR; Nuclear magnetic resonance; Obsessive compulsive disorder; Obsessive-Compulsive Disorder - therapy; Original Articles; Prefrontal cortex; Prefrontal Cortex - physiopathology; Provocation; Psychiatric Status Rating Scales; Psychological distress; Reactivity; Responsiveness; Self Report; Simulation; Studies; Transcranial Magnetic Stimulation; Netherlands; Dorsolateral prefrontal cortex; emotion regulation; transcranial magnetic stimulation; obsessive compulsive disorder; functional magnetic resonance imaging
• ISSN: 0033-2917; 1469-8978; 1469-8978
• DOI: 10.1017/S0033291715001026

Impaired emotion regulation may underlie exaggerated emotional reactivity in patients with obsessive compulsive disorder (OCD), yet instructed emotion regulation has never been studied in the disorder. This study aimed to assess the neural correlates of emotion processing and regulation in 43 medication-free OCD patients and 38 matched healthy controls, and additionally test if these can be modulated by stimulatory (patients) and inhibitory (controls) repetitive transcranial magnetic stimulation (rTMS) over the left dorsolateral prefrontal cortex (dlPFC). Participants performed an emotion regulation task during functional magnetic resonance imaging before and after a single session of randomly assigned real or sham rTMS. Effect of group and rTMS were assessed on self-reported distress ratings and brain activity in frontal-limbic regions of interest. Patients had higher distress ratings than controls during emotion provocation, but similar rates of distress reduction after voluntary emotion regulation. OCD patients compared with controls showed altered amygdala responsiveness during symptom provocation and diminished left dlPFC activity and frontal-amygdala connectivity during emotion regulation. Real v. sham dlPFC stimulation differentially modulated frontal-amygdala connectivity during emotion regulation in OCD patients. We propose that the increased emotional reactivity in OCD may be due to a deficit in emotion regulation caused by a failure of cognitive control exerted by the dorsal frontal cortex. Modulatory rTMS over the left dlPFC may influence automatic emotion regulation capabilities by influencing frontal-limbic connectivity.