Impaired implicit emotion regulation in patients with panic disorder: An event-related potential study on affect labeling

Abstract

Background: Panic disorder (PD) involves emotion dysregulation, but its underlying mechanisms remain poorly understood. Previous research suggests that implicit emotion regulation may play a central role in PD-related emotion dysregulation and symptom maintenance. However, there is a lack of studies exploring the neural mechanisms of implicit emotion regulation in PD using neurophysiological indicators.

Aim: To study the neural mechanisms of implicit emotion regulation in PD with event-related potentials (ERP).

Methods: A total of 25 PD patients and 20 healthy controls (HC) underwent clinical eva-luations. The study utilized a case-control design with random sampling, selecting participants for the case group from March to December 2018. Participants performed an affect labeling task, using affect labeling as the experimental condition and gender labeling as the control condition. ERP and behavioral data were recorded to compare the late positive potential (LPP) within and between the groups.

Results: Both PD and HC groups showed longer reaction times and decreased accuracy under the affect labeling. In the HC group, late LPP amplitudes exhibited a dynamic pattern of initial increase followed by decrease. Importantly, a significant group × condition interaction effect was observed. Simple effect analysis revealed a reduction in the differences of late LPP amplitudes between the affect labeling and gender labeling conditions in the PD group compared to the HC group. Furthermore, among PD patients under the affect labeling, the late LPP was negatively correlated with disease severity, symptom frequency, and intensity.

Conclusion: PD patients demonstrate abnormalities in implicit emotion regulation, hampering their ability to mobilize cognitive resources for downregulating negative emotions. The late LPP amplitude in response to affect labeling may serve as a potentially valuable clinical indicator of PD severity.

Keywords: Affect labeling; Emotion regulation; Implicit; Late positive potential; Panic disorder.

Figure 1

Task design. In the left panel, participants engage in affect labeling trials by selecting the suitable affect label that best describes the facial expression of the target face. In contrast, the right panel demonstrates gender labeling (control) trials, where participants are tasked with selecting the name corresponding to the gender-appropriate category of the target face.

Figure 2

Early late positive potential amplitude. A: Illustrates the early late positive potential amplitudes of each electrode site for the healthy control and panic disorder groups under the affect labeling and gender labeling conditions. There were no significant main effects of group, condition, or electrode, and no significant interaction effects were observed (P > 0.05 for all comparisons); B: Displays the topographic maps of the two groups under the two conditions. PD: Panic disorder; HC: Healthy control; Fz: Frontal midline; FCz: Frontocentral midline; Cz: Central midline; CPz: Centroparietal midline; Pz: Parietal midline.

Figure 3

Late positive potential amplitude. A: Illustrates the early late positive potential (LPP) amplitudes at each electrode site for the healthy controls (HC) and panic disorder (PD) groups under affect labeling and gender labeling conditions. Firstly, a 2 × 2 × 5 repeated measures analysis of variance (350-630 ms) revealed significant main effects of electrode (P < 0.001) and a significant group × condition interaction effect (P = 0.02). Post-hoc comparisons indicated that the HC group exhibited higher LPP amplitudes in the affect labeling condition compared to the gender labeling condition (P = 0.044), while there was no significant difference in the PD group (P > 0.05). Secondly, no significant effects of electrode, condition, group, or interactions were observed in the 630-1000 ms time window (P > 0.05 for all comparisons); B: Presents topographic maps of the two groups under the two conditions; C: Demonstrates negative correlations between LPP amplitudes at the CZ site during affect labeling and Panic Disorder Severity Scale scores as well as Panic-Associated Symptom Scale scores in PD patients (P = 0.029, P = 0.035, respectively). PD: Panic disorder; HC: Healthy control; PDSS: Panic Disorder Severity Scale; PASS: Panic-Associated Symptom Scale; Fz: Frontal midline; FCz: Frontocentral midline; Cz: Central midline; CPz: Centroparietal midline; Pz: Parietal midline.