Craving love? Enduring grief activates brain’s reward center

Mary-Frances O’Connor, David K. Wellisch, Annette L. Stanton, Naomi I.Eisenberger, Michael R. Irwin, Matthew D. Lieberman.

Neuroimage2008Vol.42, 969 – 972

Presented by: Antony Au

Pathways Reward pathway:

Mesolimbic pathway (dopaminergic) Nucleus accumbens (NA)

Pain pathway: Dorsal anterior cingulate cortex

(dACC) Insula Periaqueductal gray (PAG)

This study revolves around...

Complicated Grief (CG) Chronic / traumatic grief Unresolved Prolonged sense of mourning (i.e. Stuck)

Non-complicated grief (NCG)

Set of criteria considered to be in DSM-V Symptoms of CG distinctly different than

those in major depressive disorder (DSM-IV)

Research Purpose

Investigates whether the CG group has greater activity occurrence in brain’s reward or pain networks than the NCG group through a fMRI study

Participants

11 CG, 12 NCG women Death of mother/sister to breast cancer in

past 5 yrs Excluded those with DSM-IV Axis I disorder

Axis I = clinical disorders Clinical interview

CG/NCG diagnosed in structural clinical interview

Procedure

15 grief-related words and 15 neutral words matched with 15 photos

Photo: Participant’s deceased love one matched with

stranger Grief words:

Chosen from provided autobiographical narrative

Total of 60 composites Viewed through goggles in randomized

order

Results CG vs. NCG NA

activity in response to grief-related than neutral words: CG: more NCG: less

Only NA more significantly active

Results

While both CG and NCG exhibited activity in ACC, insula, PAG:

NCG > CG activity in both: Words: grief-related than neutral Pictures: deceased than stranger

In summary: NCG: more pain, less reward CG: less pain, more reward

Theories out there... Two opposing models of grief:

Detachment model Grief helps acceptance of death NA activity should reduce over time NCG supports this

Reunion Model Grief conflicts the separation of deceased NA activity continue over time CG supports this

...an Addiction?

CG seem to be “stuck” Activation of reward pathway? Compared to NCG: more reward than pain May explain why it is hard to “let go”

Research therapy Selective serotonin reuptake inhibitor

(SSRI) Used because CG symptoms under major

depressive disorder ones Effectiveness for CG?

Dopaminergic drugs

Opinions, opinions, opinions.

Strengths Examination of both reward + pain

pathways

Limitations Lack of male participants Cannot generalize to public No discussion on physical vs. social

pain

For the future:

Other cues to invoke grief Neurocognitive similarities / differences

To what extent is NA associated in emotion regulation

Therapy Behavioural modification Medicine

References

Boelon, P.A., & van den Bout, J. (2005). Complicated grief, depression and anxiety as distinct postloss syndromes: a confirmatory factor analysis study, Am. J. Psychiatry, 162, 2175-2177.

Bowlby, J. (1980). Attachment and loss. Loss, Sadness and Depression, vol.3, Basic Books, New York.

Knuston, B., Adams, C.M., Fong, G.W., & Hommer, D. (2001). Anticipation of increasing monetary reward selectively recruits nucleus accumbens, J. Neurosci., 21, RC159.

Shear, K., Frank, E., Houck, P.R., Reynolds III, C.F. (2005). Treatment of complicated grief: a randomized controlled trial, J. Am. Med. Assoc., 293, 2601-2608.

Zygmont, M., Prigerson, H., Houck, P., Miller, M., Shear, M. J, & Jacobs, S. (1998). A post hoc comparison of paroxetine and nortriptyline for symptoms of traumatic grief, J. Clin. Psychiatry, 59, 241-245.

Thanks for listening (:Questions?