Attentional Bias to Reminders of the Deceased as Compared With a Living Attachment in Grieving

Abstract

Background: Grieving individuals demonstrate attentional bias toward reminders of the deceased versus neutral stimuli. We sought to assess bias toward reminders of the deceased versus a living attachment figure and to evaluate similarities and differences in the neural correlates of deceased- and living-related attention. We also sought to identify grief process variables associated with deceased-related attentional bias.

Methods: Twenty-five subjects grieving the death of a first-degree relative or partner within 14 months performed an emotional Stroop task, using words related to a deceased or a living attachment figure, and a standard Stroop task, to identify general selective attention, during functional magnetic resonance imaging. Subjects rated word sadness, complicated grief symptoms, depression severity, attachment style, emotional pain, nonacceptance, yearning, and intrusions.

Results: We identified an attentional bias to deceased-related versus living-related words, independent of age, depression severity/history, loss type, word sadness, medication use, and time since loss. Attentional bias correlated with complicated grief severity and intrusive thinking. A conjunction analysis identified joint activation in the fusiform gyrus, posterior cingulate, and temporal parietal junction across living- and deceased-related attention versus general selective attention. Insecure-avoidant attachment style correlated with decreased engagement of this network in deceased-related attention.

Conclusions: We have demonstrated an attentional bias to reminders of the deceased versus a living attachment in grieving. Overlapping neural circuits related to living- and deceased-related attention suggest that the bereaved employ similar processes in attending to the deceased as they do in attending to the living. Deceased-related attentional bias appears to be linked primarily to intrusive thinking about the loss.

Keywords: Attachment; Attention bias; Complicated grief; Fusiform; Grieving; Intrusive thinking.

Figure 1. Design of emotional and cognitive Stroop task

Stimuli were presented using a mixed block-event design presenting words of each condition in a unified block with inter-trial jitter allowing for trial level analyses. Deceased and living-related trials presented reminders of the deceased and a living attachment figure p rovided a week before the scan by the subject. Color congruent and incongruent trials comprised standard Stroop conditions.

Figure 2. Intrusive thinking interacts with condition type in predicting reaction time

Simple slopes display the relationship between deceased and living-related condition and average log transformed reaction time (log-RT) across high and low levels of grief process variables as well as complicated grief severity. For the sake of presentation high and low intrusive thinking, emotional pain, non-acceptance, yearning and complicated grief are presented as above and below respective medians of intrusions=2.25, emotional pain=3.6, non-acceptance 3.33, yearning=8, complicated grief (ICG)=26. The difference between reaction time to deceased and living-related conditions is greater for those with high as compared to low intrusive thinking. No such effect is observed for other process variables.

Figure 3

Figure 3A. Conjunction analysis of deceased and living-related attention. Activity in lateral occipital cortex, fusiform gyrus (XYZ=54,31,35), temporal parietal juncture, (XYZ=17,34,30) and posterior cingulate (XYZ=46,39,44) is observed. All analyses thresholded at voxel-p<0.001, cluster-p <0.05 and controlled for button pressing, general selective attention and word reading. 3B. Subjects with a more secure as opposed to avoidant attachment style showed greater engagement of the conjoint deceased and living-related attention network during deceased related trials. Engagement of conjoint network during deceased related trials corresponds to subject level z-score of the correlation between BOLD activity in the conjunction mask and deceased-related attention.