Processing of Emotions in Functional Movement Disorder: An Exploratory fMRI Study, 2019, Sojka et al

[Andy]

Background: Affective dysregulation and impaired cognitive control are implicated in the pathology of functional neurological disorders (FNDs). However, voluntary regulation of emotions has seldom been researched in this group of patients. We hypothesized that patients with FNDs use inefficient voluntary emotion regulation strategies and regulate emotional reactions via increased motor activation.

Methods: Fifteen patients with functional movement disorder (FMD) and fifteen healthy subjects matched by age, sex, and education underwent an emotion regulation task in fMRI. For stimuli, we used neutral and negative pictures from the International Affective Picture System. There was no restriction on their emotion regulation strategy. Both patients and healthy subjects were asked about the strategies they had used in a post-scanning interview. Participant levels of depression, trait anxiety, and alexithymia were assessed.

Results: There were no significant differences in the emotion regulation strategies used by patients and healthy subjects, nor in levels of reported alexithymia and depression. However, patients showed increased activation in several brain areas when observing negative pictures, notably in the post-central gyrus, precuneus, posterior cingulate cortex (PCC) and cerebellar vermis, and also in their emotion regulation condition, particularly in the precuneus and post-central gyrus. Alexithymia was negatively associated with left insular activation during the observation of unpleasant stimuli only in the patient group.

Conclusions: Our findings may implicate areas associated with self-referential processing in voluntary emotional regulation and lower emotional awareness as having a role in patients with functional movement disorders. However, our findings must be replicated with larger sample.

Open access at https://www.frontiersin.org/articles/10.3389/fneur.2019.00861/full

 

[Peter T]

This might be potentially interesting.

For example I have recently been trying to get my head around why brain fog varies between cognitive tasks, and wondering if stress or distressing factors are significant issues in determining how hard different cognitive tasks feel.

However I am afraid I did not bother to read the article as I anticipate from the abstract the authors are looking for grossly over simplified answers in very complex situations. In such an example association tells us very little about causation.

Also any unquestioning acceptance of a ‘functional’ label is always very worrying.

 

[Hutan]

The authors clutch at straws.

Sample size 15 with a 'functional movement disorder', 15 healthy controls. Functional movement disorder covered a wide range of things from 'right hand tremor', to 'gait disturbance', 'non-epileptic seizures' and 'spasms'.

Turns out the groups didn't differ on ability to recognise their emotions. Self-reported measures of anxiety and depression came out a bit higher in patients. But despite including 4 patients with diagnosed depression (one of which also had diagnosed panic attacks and one of which had an anxiety disorder) only the anxiety scores were significantly higher - and then only just with a P value of 0.04.

They had three tasks related to looking at pictures - for each they had to report the strength of negative affect on a scale of 1 to 4
1. negative picture - look without emotional regulation
2. negative picture - try to regulate emotion
3. neutral picture - look without emotional regulation

Patients and controls didn't differ with the strength of negative affect or the strategies used to control emotions.

With respect to the imaging, the planned statistical analysis was

a cluster-corrected FWE correction threshold (p < 0.05)

It doesn't look as though any finding of differences between patients and controls met that threshold. The authors do refer to uncorrected differences, so they have something to talk about.

Now, I don't know whether the stats approach was appropriate, but the study looks to me as though it didn't find anything very much.

But read the conclusion...

Our study suggests an abnormal involvement of areas implicated in self-referential processing during voluntary emotional regulation efforts and limited access to emotional experience in FMD patients.

Well no, it doesn't.

Our results may indicate that emotional reactions to negative stimuli are inaccessible for conscious processing due to low emotional awareness and the implicit emotional reactions may therefore pose a difficulty for voluntary emotional regulation efforts. As a result, more bodily emotional regulation processes such as aberrant movements ma develop instead in FMD patients in order to decrease accumulated arousal.

There was no low emotional awareness problem - the mean of both the patients and controls in the TAS-20 was well below the 61 score required to diagnose alexithymia. The authors said as much in the results section.

There was no significant difference in TAS-20 between patients and HCs, suggesting low alexithymia in our sample

(low alexithymia is a good thing, the opposite of low emotional awareness)​

A similar view was postulated by Janet (10): “Action, by becoming unconscious in hysterics, by separating from consciousness…assumes an appearance that recalls the action of visceral muscles…” (s. 137).

And of course a null result just means that more studies are needed.

However, the findings presented in this study have to be considered preliminary due to the small sample size and the liberal statistical threshold used in neuroimaging analyses. Future studies should employ experimental tasks probing emotional awareness to further elucidate the role of (un)conscious emotional processing in affective dysregulation in FNDs.

It's another one of these studies where the authors appear to have written the conclusion ahead of the experiment - and then, when the results don't fit, they just paste in the conclusion anyway. I despair.

 

[Amw66]

The authors clutch at straws.

Sample size 15 with a 'functional movement disorder', 15 healthy controls. Functional movement disorder covered a wide range of things from 'right hand tremor', to 'gait disturbance', 'non-epileptic seizures' and 'spasms'.

Turns out the groups didn't differ on ability to recognise their emotions. Self-reported measures of anxiety and depression came out a bit higher in patients. But despite including 4 patients with diagnosed depression (one of which also had diagnosed panic attacks and one of which had an anxiety disorder) only the anxiety scores were significantly higher - and then only just with a P value of 0.04.

They had three tasks related to looking at pictures - for each they had to report the strength of negative affect on a scale of 1 to 4
1. negative picture - look without emotional regulation
2. negative picture - try to regulate emotion
3. neutral picture - look without emotional regulation

Patients and controls didn't differ with the strength of negative affect or the strategies used to control emotions.

With respect to the imaging, the planned statistical analysis was

It doesn't look as though any finding of differences between patients and controls met that threshold. The authors do refer to uncorrected differences, so they have something to talk about.

Now, I don't know whether the stats approach was appropriate, but the study looks to me as though it didn't find anything very much.

But read the conclusion...


Well no, it doesn't.


There was no low emotional awareness problem - the mean of both the patients and controls in the TAS-20 was well below the 61 score required to diagnose alexithymia. The authors said as much in the results section.

(low alexithymia is a good thing, the opposite of low emotional awareness)​

And of course a null result just means that more studies are needed.


It's another one of these studies where the authors appear to have written the conclusion ahead of the experiment - and then, when the results don't fit, they just paste in the conclusion anyway. I despair.

worth someone tweeting this?

 

[Mithriel]

As a result, more bodily emotional regulation processes such as aberrant movements ma develop instead in FMD patients in order to decrease accumulated arousal.

Aberrant movements are not a bodily emotional regulation process. There are many genetic movement disorders which are caused by ion channel dysfunction. There are also movement disorders caused by autoimmune problems due to certain cancers.

 

[rvallee]

So many of the concepts used are vague and any conclusions depend on interaction between those vague, unquantifiable, concepts. In addition to functional disorders being vague and a complete black box made from the god of the gaps.

Our study suggests an abnormal involvement

Based on what definition of normal? We have neither the resolution nor the understanding to define those beyond vague concepts.

Pretty obvious that it's a conclusion seeking evidence.

 

[Hutan]

worth someone tweeting this?

Actually, I think a published review of papers like this could be warranted- there's a few of them now, trying to find imaging and other evidence for this theory that FMD is the result of suppressed emotions/alexithymia. I think the problems are blatant enough that they could be easily pointed out.

@Carolyn Wilshire

 

[Jonathan Edwards]

Discussion could be: Our findings may implicate areas associated with self-referential processing in knowing that you are patient in the study rather than a control.

It has certain psychological implications I suspect - which might even show on brain scans.