Neuroeconomics of Social Behavior Following Trauma Exposure

Social Withdrawal Following Trauma Exposure: a Neuroeconomic Approach

This study will use a neuroeconomic paradigm with state-of-the-art imaging protocols to probe abnormal social reward processing underlying social withdrawal in symptomatic trauma-exposed women. By also gathering self-report measures of social anhedonia, performance on non-social and social reward valuation tasks, and measures of real-world social functioning including social network size, we aim to specify how alterations in social reward processing result in social withdrawal and functional impairment.

Study Overview

• Status: Recruiting
• Conditions: Posttraumatic Stress Disorder

Detailed Description

Impaired social functioning is a frequent and disabling sequela of trauma-related disorders. PTSD is associated with a high rate of severe impairment in quality of life relative to other anxiety disorders, including panic disorder, social phobia, and OCD, with particularly marked impairment in social quality of life. Mounting evidence indicates that impairment in quality of life in PTSD is strongly related to its effect on social functioning. Such difficulties are widespread and affect multiple social networks, including marital relationships, and friendships and family relationships. Social withdrawal, defined here in terms of reduced social network size, is of particular interest because of its strong relationship with health outcomes, including increased risk of disability, reduced immune response, and increased mortality risk; most critically, poor social integration is associated with a threefold increase in suicide risk. Because women are at a 2.3-to-3-fold increased risk compared to men of developing PTSD following trauma, understanding the differential neurobiological pathways that may contribute to the development of stress-related disorders in women is particularly critical. Women are more likely than men to endorse social detachment following trauma, especially when the trauma involves exposure to violence.

In this project, we propose abnormal reward processing (anhedonia) as a specific mechanism underlying social withdrawal in trauma-exposed women, and we present a paradigm that capitalizes on advances in neuroeconomics to elucidate the neural underpinnings of social withdrawal. Additionally, we propose to identify the possible influences of a stress peptide (pituitary adenylate cyclase-activating polypeptide: PACAP) implicated in sex-specific changes in social behavior following stress exposure.

• Study Type: Observational
• Enrollment (Anticipated): 168

Contacts and Locations

• Study Contact: Name: Elizabeth Olson, PhD; Phone Number: 617-855-2268; Email: adlab@partners.org

Study Locations

• United States
  • Massachusetts
    • Belmont, Massachusetts, United States, 02478
      • Recruiting
      • McLean Hospital
      • Contact: Elizabeth Olson, PhD; Phone Number: 617-855-2268; Email: adlab@partners.org

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 45 years (Adult)
• Accepts Healthy Volunteers: Yes
• Genders Eligible for Study: Female

• Sampling Method: Non-Probability Sample

Study Population

Phase 1 will include healthy volunteers (age 18-45, n = 60).

Phase 2 will include posttraumatic spectrum-socially anhedonic women (PTS-SA, n = 36), posttraumatic spectrum-non-socially anhedonic women (PTS-nonSA), and healthy controls (HC, n = 36).

Description

Phase 1:

Inclusion Criteria:

• Age 18-45
• Self-reported healthy volunteer status

Exclusion Criteria:

• Inability to provide written informed consent in English
• Inability to see task due to visual impairment
• Participants who produce T-scores of 65 or higher on any Brief Symptom Inventory (BSI) subscales will not be eligible to remain in the Trust Task participant pool.

Phase 2:

Inclusion Criteria:

• Female
• Trauma exposure appropriate to group
• For trauma-exposed groups the index trauma is actual or threatened physical assault or sexual violence
• PCL-5 score 33 and above (for PS-SA and PS-nonSA groups)
• Right handedness
• Age 18-45
• English as a first language

Exclusion Criteria:

• History of neurological illness (including head injury with loss of consciousness > 5 minutes)
• Medical conditions that may influence neuroimaging (e.g. HIV)
• Current or past DSM-5 Axis I disorder (for HC group)
• History of bipolar disorder or schizophrenia spectrum disorder
• Contraindications for MRI
• Alcohol dependence in the past 5 years
• Substance dependence in the past 3 years
• Daily substance use in the past year
• Prescribed psychotropic medication use in the past month
• Wechsler Abbreviated Scale of Intelligence- Second Edition (WASI-II) FSIQ < 70.

Study Plan

How is the study designed?

Number of groups / cohorts

4

Cohorts and Interventions

Group / Cohort
Phase 1; Healthy control participants will provide neuroeconomic game responses to form a pool of potential responses for participants to interact with during Phase 2.
Phase 2: PTS-SA; posttraumatic spectrum-socially anhedonic
Phase 2: PTS-nonSA; posttraumatic spectrum-non-socially anhedonic
Phase 2: HC; healthy controls

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Group differences in neuroeconomic game performance	Compared to the PTS-nonSA and HC groups, the PTS-SA group will demonstrate lower investments and slower learning rates on the Trust Task than on the non-social risk task compared with PTS-nonSA and HC subjects	Measured on the day of the MRI scan
Group differences in fMRI BOLD signal	The HC and PTS-nonSA groups will show greater ventral striatum (VS), dorsal striatum (DS), and medial prefrontal cortex (mPFC) responses during the outcome phase of the trust game for 'share' versus baseline, compared to the PTS-SA group, for the real partner condition (Trust Task), but not for the risk task.	Measured on the day of the MRI scan
Correlations between behavior and fMRI BOLD signal	Because social withdrawal will occur in response to reduced social reward value, we hypothesize that across the PTS groups, reduced VS, DS, and mPFC activity during the outcome phase of the trust game for 'share' outcomes will be associated with lower Trust Task investments, greater self-reported social anhedonia, and smaller social network size.	Measured on the day of the MRI scan
PACAP correlations	Elevated PACAP levels will be associated with lower investments on the Trust Task; decreased social reward signals during the outcome phase for 'share' outcomes in the VS, DS, and mPFC; and smaller social network size.	Measured on the day of the MRI scan

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Mediation analysis	Within the PTS groups, decreased VS, DS, and mPFC response to 'share' outcomes will mediate the relationship between social anhedonia and reduced social network size.	Measured on the day of the MRI scan
Functional connectivity (psychophysiological interaction)	PTS individuals with higher self-reported social anhedonia and social withdrawal will show reduced VS-mPFC connectivity for social rewards on the Trust Task.	Measured on the day of the MRI scan

Collaborators and Investigators

• Sponsor: Mclean Hospital
• Collaborators: National Institute of Mental Health (NIMH)
• Investigators: Principal Investigator: Elizabeth Olson, PhD, McLean Hospital

Study record dates

Study Major Dates

• Study Start (Actual): November 14, 2017
• Primary Completion (Anticipated): August 31, 2022
• Study Completion (Anticipated): August 31, 2022

Study Registration Dates

• First Submitted: December 19, 2017
• First Submitted That Met QC Criteria: December 19, 2017
• First Posted (Actual): December 26, 2017

Study Record Updates

• Last Update Posted (Actual): August 31, 2022
• Last Update Submitted That Met QC Criteria: August 29, 2022
• Last Verified: August 1, 2022

More Information

Terms related to this study

• Keywords: neuroimaging; stress; fMRI; social; peptide
• Additional Relevant MeSH Terms: Mental Disorders; Trauma and Stressor Related Disorders; Stress Disorders, Traumatic; Stress Disorders, Post-Traumatic
• Other Study ID Numbers: 2017P001423; K23MH112873-01A1 (U.S. NIH Grant/Contract)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: UNDECIDED
• IPD Plan Description: We will evaluate requests for deidentified data on a case-by-case basis.

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No