Abstract
Impaired cognitive–motivational functioning is present in many psychiatric disorders, including alcohol use disorder (AUD). Emotion regulation is a key intermediate factor, relating to the (cognitive) regulation of emotional and motivational states, such as in regulation of craving or negative emotions that may lead to relapse in alcohol use. These cognitive–motivational functions, including emotion regulation, are a target in cognitive behavioral therapy and may possibly be improved by neurostimulation techniques. The present between-subjects, single-blind study assesses the effects of sham-controlled high-frequency neuronavigated repetitive transcranial magnetic stimulation (10 Hz) of the right dorsolateral prefrontal cortex (dlPFC) on several aspects relevant for emotion regulation (emotion processing and reappraisal abilities) and related brain activity, as well as self-reported craving in a sample of alcohol use disorder patients (AUD; n = 39) and healthy controls (HC; n = 36). During the emotion reappraisal task, participants were instructed to either attend or reappraise their emotions related to the negative, positive, neutral, and alcohol-related images, after which they rated their experienced emotions. We found that repetitive transcranial magnetic stimulation (rTMS) reduces self-reported experienced emotions in response to positive and negative images in AUD patients, whereas experienced emotions were increased in response to neutral and positive images in HCs. In the functional magnetic resonance imaging (fMRI) analyses, we found that rTMS reduces right dlPFC activity during appraisal of affective images relative to sham stimulation only in AUD patients. We could not confirm our hypotheses regarding the effect of rTMS craving levels, or on reappraisal related brain function, since no significant effects of rTMS on craving or reappraisal related brain function were found. These findings imply that rTMS can reduce the emotional impact of images as reflected in blood oxygenation level-dependent (BOLD) response, especially in AUD patients. Future studies should replicate and expand the current study, for instance, by assessing the effect of multiple stimulation sessions on both explicit and implicit emotion regulation paradigms and craving, and assess the effect of rTMS within subgroups with specific addiction-relevant image preferences.Clinical Trial Registration: www.ClinicalTrials.gov, identifier NCT02557815.
Highlights
Harmful alcohol consumption ranks among the top five worldwide contributors of disease, disability, and death [1,2,3], and alcohol use disorder (AUD) is a common mental health disorder with a 12-month prevalence of 2–3% in the United States [4, 5] and 4% in Europe [6].AUD is often described as a dual process disorder with reduced cognitive control and alterations in the brain reward system [7,8,9]
In our previous study within this special issue, we showed that explicit emotion regulation abilities and related brain functioning were similar in alcohol use disorder (AUD) patients and healthy controls (HCs), but that in AUD patients compared to HCs, reduced brain activity during implicit emotion processing was present (Jansen et al, submitted)
Analyses were not corrected for these differences, because depression, anxiety, and alexithymia levels are well known to be elevated in AUD [60,61,62] and are related to emotion processing and reappraisal, and correction for these factors could results in falsenegative findings
Summary
Harmful alcohol consumption ranks among the top five worldwide contributors of disease, disability, and death [1,2,3], and alcohol use disorder (AUD) is a common mental health disorder with a 12-month prevalence of 2–3% in the United States [4, 5] and 4% in Europe [6].AUD is often described as a dual process disorder with reduced cognitive control and alterations in the brain reward system [7,8,9]. Alterations in the reward circuitry include hypersensitivity to addiction relevant cues, in combination with hyposensitivity to natural rewards. Brain alterations related to cognitive control include impaired (response) inhibition and emotion regulation [12], resulting in diminished ability to effectively control the emotional impact of certain thoughts or stimuli [13, 14]. These changes in the reward circuitry and diminished control over emotions increase alcohol craving and relapse in remitted patients [15,16,17]
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