Increased Amygdala Activity Associated With Cognitive Reappraisal Strategy in Functional Neurologic Disorder

Abstract

Cognitive reappraisal is an emotion regulation strategy to reduce the impact of affective stimuli. This regulation could be incomplete in patients with functional neurologic disorder (FND) resulting in an overflowing emotional stimulation perpetuating symptoms in FND patients. Here we employed functional MRI to study cognitive reappraisal in FND. A total of 24 FND patients and 24 healthy controls employed cognitive reappraisal while seeing emotional visual stimuli in the scanner. The Symptom Checklist-90-R (SCL-90-R) was used to evaluate concomitant psychopathologies of the patients. During cognitive reappraisal of negative IAPS images FND patients show an increased activation of the right amygdala compared to normal controls. We found no evidence of downregulation in the amygdala during reappraisal neither in the patients nor in the control group. The valence and arousal ratings of the IAPS images were similar across groups. However, a subgroup of patients showed a significant higher account of extreme low ratings for arousal for negative images. These low ratings correlated inversely with the item "anxiety" of the SCL-90-R. The increased activation of the amygdala during cognitive reappraisal suggests altered processing of emotional stimuli in this region in FND patients.

Keywords: amygdala; cognitive reappraisal strategy; conversion disorder; emotion regulation; fMRI; functional neurologic disorder.

Figure 1

Selection of negative and neutral IAPS images intended to achieve a high uniformity with regard to the factors “valence” and “arousal.” Blue circles: all IAPS images; green circles: selected negative images; red circles: selected neutral images. X-axis: arousal; y-axis: valence (1 = very negative, 9 = very positive).

Figure 2

Increased activation of the right amygdala in FND patients vs. healthy controls during reappraisal (contrast NegReapp patients > NegReapp controls; MNI coordinates xyz= 30 −4 −28, Z=3.96, p = 0.039 cluster level FWE, small volume corrected). The activation is displayed on the MRIcron template.

Figure 3

Time course analysis in the amygdala. (A) Mean Timecourse of Beta Values for 20 s (8 timebins à TR 2,500 ms after start of presenting the image) in the left and right amygdala: similar upregulation for NegReapp and NegW in both amygdala for patients and controls (n=24, each group). (B) Mean Beta Values with standard error of mean for all main conditions indicate as well an upregulation in both amygdala during NegReapp and a downregulation for the distraction conditions NegDistr and NeutrDistr. [main conditions: NegReapp: Reappraisal while watching negative images; NegW: watching negative images; NeutrW: watching neutral images; NegDistr: distraction condition (calculating) while watching negative images; NeutrDistr: distraction condition (calculating) while watching neutral images. TR: time repetition].