Craving love? Enduring grief activates brain’s reward center

1. Neuroimage 2008 Vol.42, 969 – 972 Presented by: Antony Au 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.

2. Pathways • Reward pathway: • Mesolimbic pathway (dopaminergic) • Nucleus accumbens (NA) • Pain pathway: • Dorsal anterior cingulate cortex (dACC) • Insula • Periaqueductal gray (PAG)

3. 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)

4. Research Purpose • Investigates whether the CG group has greater activity occurrence in brain’s reward or pain networksthan the NCG group through a fMRI study

5. 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

6. 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

7. Results • CG vs. NCG NA activity in response to grief-related than neutral words: • CG: more • NCG: less Only NA more significantly active

8. 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

9. 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

10. ...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

11. 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

12. For the future: • Other cues to invoke grief • Neurocognitive similarities / differences • To what extent is NA associated in emotion regulation • Therapy • Behavioural modification • Medicine

13. 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.

14. Thanks for listening (:Questions?