Emotion Processing, Reappraisal, and Craving in Alcohol Dependence: A Functional Magnetic Resonance Imaging Study

Jochem M Jansen, Odile A van den Heuvel, Ysbrand D van der Werf, Stella J de Wit, Dick J Veltman, Wim van den Brink, Anna E Goudriaan, Jochem M Jansen, Odile A van den Heuvel, Ysbrand D van der Werf, Stella J de Wit, Dick J Veltman, Wim van den Brink, Anna E Goudriaan

Abstract

Alcohol dependence has long been related to impaired emotion regulation-including reappraisal-but little is known about the performance and associated neural activity of alcohol-dependent patients (ADPs) on an emotion reappraisal task. This study, therefore, compares reappraisal of negative, positive, neutral, and alcohol-related images at a behavioral and neural level between ADPs and healthy controls (HCs). Thirty-nine ADPs and 39 age-, gender-, and education-matched HCs performed an emotion reappraisal task during functional magnetic resonance imaging (fMRI), and craving was measured before and after the reappraisal task. During the emotion reappraisal task, participants were instructed to either attend or reappraise positive, negative, neutral, or alcohol-related images, and to indicate their experienced emotion on a visual analogue scale (VAS). Both ADPs and HCs completed the emotion reappraisal task successfully, showing significant differences in self-reported experienced emotion after attending versus reappraising visual stimuli and in brain activity in emotion processing/reappraisal relevant areas. ADPs were not impaired in cognitive reappraisal at a behavioral or neural level relative to HCs, nor did ADPs indicate any difference in self-reported emotion while attending emotional images. However, ADPs were different from HC in emotion processing: ADPs revealed a blunted response in the (posterior) insula, precuneus, operculum, and superior temporal gyrus while attending emotional images compared neutral images compared to HCs, and in ADPs, higher baseline craving levels were associated with a less blunted response to alcohol-related images than in HCs. These results reveal that ADPs do not show impaired reappraisal abilities when instructed, although future studies should assess voluntary reappraisal abilities in alcohol-dependent patients. Clinical Trial Registration: www.ClinicalTrials.gov, identifier NCT02557815.

Keywords: alcohol dependence; craving; emotion reappraisal; emotion regulation; functional magnetic resonance imaging.

Figures

Figure 1
Figure 1
This figure reveals the mean experienced emotion (VAS) per emotion type, instruction, and participant group. Analysis reveals no effect of participant group, but a significant interaction between emotion type and instruction for alcohol-related, neutral, positive, and negative images. Error bars reflect the standard deviation.
Figure 2
Figure 2
Craving levels per group and time point [pre/post-emotion reappraisal task (ERT)]. Error bars reflect standard deviations. Craving levels were log(x + 1) transformed and refer to self-reported Alcohol Urge Questionnaire (AUQ) scores.
Figure 3
Figure 3
Main effects of the emotion reappraisal task, presented at a threshold of k > 5, p < 0.001. Top: Brain areas activated while attending emotional images versus neutral images. Middle: activated brain areas during reappraising vs. attending images. Bottom: regions more activated during attending images vs. reappraising images.
Figure 4
Figure 4
(A) Graphical presentation of the increased activity in healthy controls (HCs) compared to alcohol-dependent patients (ADPs), during emotion processing (attending negative, positive, and alcohol-related images vs. neutral). Crosshair is pointed at the peak voxel in the posterior insula. (B) The correlation between the posterior insula and baseline craving levels for the [attend alcohol > neutral] contrast. The threshold for visualization of the results is set at k > 5, p < 0.001 uncorrected.

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