Increased Amygdala Activations during the Emotional Experience of Death-Related Pictures in Complicated Grief: An fMRI Study.

María Inmaculada Fernández-Ávalos,Manuel Fernández-Alcántara,Juan Verdejo-Román,Francisco Cruz-Quintana,Andrés Catena-Martínez,Miguel Pérez-García,María Nieves Pérez-Marfil

doi:10.3390/jcm9030851

María Inmaculada Fernández-Ávalos, Manuel Fernández-Alcántara + Show 5 more

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https://doi.org/10.3390/jcm9030851

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Abstract

Complicated grief (CG) is associated with alterations in various components of emotional processing. The main aim of this study was to identify brain activations in individuals diagnosed with CG while they were observing positive, negative, and death-related pictures. The participants included 19 individuals with CG and 19 healthy non-bereaved (NB) individuals. Functional magnetic resonance imaging (fMRI) scans were obtained during an emotional experience task. The perception of death-related pictures differed between the CG group and the NB group, with a greater activation in the former of the amygdala, putamen, hypothalamus, middle frontal gyrus, and anterior cingulate cortex. Amygdala and putamen activations were significantly correlated with Texas Revised Inventory of Grief scores in the CG group, suggesting that the higher level of grief in this group was associated with a greater activation in both brain areas while watching death-related pictures. A significant interaction between image type and group was observed in the amygdala, midbrain, periaqueductal gray, cerebellum, and hippocampus, largely driven by the greater activation of these areas in the CG group when watching death-related pictures and the lower activation when watching positive-valence pictures. In this study, individuals with CG showed significantly distinct brain activations in response to different emotional images.

Highlights

The death of a loved one triggers emotional reactions that are generally natural and adaptive
In this line, Freed et al [17] studied avoidance and intrusiveness in an emotional Stroop task using death-related words versus neutral words. They found that activation of the dorsal part of the amygdala and the middle frontal gyrus was correlated with avoidance and that the ventral part of amygdala and the cingulate gyrus were correlated with intrusiveness [17]
In the contrast of death-related pictures with the fixation cross, between-group comparisons revealed significantly increased activation in the complicated grief (CG) versus NB group in the left amygdala, hypothalamus, right lateral middle frontal gyrus, right putamen, and dorsal anterior cingulate cortex extending to the supplementary motor area

Summary

Introduction

The death of a loved one triggers emotional reactions that are generally natural and adaptive. Greater attentional avoidance of emotional stimuli related to the deceased was observed in individuals with high levels of rumination [13,14], who were found to respond more slowly to negative or positive emotional stimuli not directly related to their loss [15,16] In this line, Freed et al [17] studied avoidance and intrusiveness in an emotional Stroop task using death-related words versus neutral words. They found that activation of the dorsal part of the amygdala and the middle frontal gyrus was correlated with avoidance and that the ventral part of amygdala and the cingulate gyrus were correlated with intrusiveness [17]

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