Abstract
Regulation of emotions is necessary for successful attainment of short-term and long-term goals. However, over-regulation may also have its costs. In anorexia nervosa (AN), forgoing food intake despite emaciation and endocrine signals that promote eating is an example of “too much” self-control. Here we investigated whether voluntary emotion regulation in AN patients comes with associated disorder-relevant costs. Thirty-five patients with acute AN and thirty-five age-matched healthy controls (HCs) performed an established emotion regulation paradigm during functional magnetic resonance imaging after an overnight fast. The task required reducing emotions induced by positively valenced pictures via distancing. We calculated a neural regulation score from responses recorded in a reward-related brain region of interest (ventral striatum; VS) by subtracting activation measured on “positive distance” trials from that elicited under the “positive watch” (baseline) condition. Complementing the imaging data, we used ecological momentary assessment (EMA) to probe disorder-related rumination and affect six times/day for 2 weeks following the scanning session. The neural regulation score indicating reduced VS activation during emotion regulation was used as a predictor in hierarchical linear models with EMA measures as outcomes. No group differences in neural activity were found for the main contrasts of the task. However, regulation of VS activity was associated with increased body-related rumination and increased negative affect in AN, but not in HC. In line with this finding, correlational analysis with longitudinal BMI measurements revealed a link between greater VS regulation and poorer treatment outcome after 60 and 90 days. Together, these results identify a neural correlate of altered emotion regulation in AN, which seems to be detrimental to psychological well-being and may interfere with recovery.
Highlights
Effective behavioral and emotional self-regulation is critical for the success of everyday functioning and health[1,2,3,4]
Examining the association between self-reported emotion regulation strategies (ERQ) and ventral striatum (VS) neural regulation score, we found a positive association between the neural regulation score and self-reported habitual use of suppression in patients only (AN: r = 0.49. p = 0.003; healthy controls (HCs): r = −0.14, n.s.)
The interaction between neural regulation and diagnostic group for affect was driven by a larger neural regulation score being associated with higher negative affect in the anorexia nervosa (AN) sample (p = 0.034; Fig. 3b) and a larger regulation score being associated with higher positive affect (p = 0.018; Fig. 3b) and lower tension (p = 0.015; Fig. S4) in HC over 2 weeks post scanning. The goal of this combined fMRI/ecological momentary assessment (EMA) study was to investigate whether regulation of positive emotions as gauged by the reduction of hemodynamic activity in a reward-related brain region (VS) was associated with negative consequences for AN patients in their everyday lives as measured by EMA
Summary
Effective behavioral and emotional self-regulation is critical for the success of everyday functioning and health[1,2,3,4]. One of the most puzzling questions is how patients are able to abstain from food intake despite extreme low body weight and endocrine signals that promote eating[7,8]. One hypothesis is that AN patients downregulate their responses to rewarding stimuli, which would be in line with reward-centered models of AN13–15 and a growing body of literature implicating alterations in activity and connectivity of reward-related mesolimbic. Seidel et al Translational Psychiatry (2018)8:28 brain structures such as the ventral striatum (VS) in AN16–18. Complementing these observations, some fMRI studies have found alterations in frontoparietal networks involved in cognitive control and executive functions[19,20,21,22,23]
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