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Journal of Cancer Survivorship
Published in: Journal of Cancer Survivorship 1/2018

01-02-2018

Changes in cerebellar functional connectivity and autonomic regulation in cancer patients treated with the Neuro Emotional Technique for traumatic stress symptoms

Authors: Daniel A. Monti, Anna Tobia, Marie Stoner, Nancy Wintering, Michael Matthews, Chris J. Conklin, Feroze B. Mohamed, Inna Chervoneva, Andrew B. Newberg

Published in: Journal of Cancer Survivorship | Issue 1/2018

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Abstract

Purpose

A growing number of research studies have implicated the cerebellum in emotional processing and regulation, especially with regard to negative emotional memories. However, there currently are no studies showing functional changes in the cerebellum as a result of treatment for traumatic stress symptoms. The Neuro Emotional Technique (NET) is an intervention designed to help improve symptoms related to traumatic stress using an integrative approach that combines emotional, cognitive, and motor processing, with a particular focus on autonomic nervous system regulation. In this study, we evaluated whether the NET intervention alters functional connectivity in the brain of patients with traumatic stress symptoms associated with a cancer-related event. We hypothesized that the NET intervention would reduce emotional and autonomic reactivity and that this would correlate with connectivity changes between the cerebellum and limbic structures as well as the brain stem.

Methods

We enrolled patients with a prior cancer diagnosis who experienced distressing cancer-related memories associated with traumatic stress symptoms of at least 6 months in duration. Participants were randomized to either the NET intervention or a waitlist control. To evaluate the primary outcome of neurophysiological effects, all participants received resting-state functional blood oxygen level-dependent (BOLD) magnetic resonance imaging (rs-fMRI) before and after the NET intervention. In addition, autonomic reactivity was measured using heart rate response to the traumatic stimulus. Pre/post comparisons were performed between the NET and control groups.

Results

The results demonstrated significant changes in the NET group, as compared to the control group, in the functional connectivity between the cerebellum (including the vermis) and the amygdala, parahippocampus, and brain stem. Likewise, participants receiving the NET intervention had significant reductions in autonomic reactivity based on heart rate response to the traumatic stimulus compared to the control group.

Conclusions

This study is an initial step towards establishing a neurological signature of treatment effect for the NET intervention. Specifically, functional connectivity between the cerebellum and the amygdala and prefrontal cortex appear to be associated with a reduction in autonomic reactivity in response to distressing cancer-related memories.

Implications for cancer survivors

This study contributes to the understanding of possible mechanisms by which interventions like NET may help reduce emotional distress in cancer patients who suffer from traumatic stress symptoms.
Literature
1.
Alter CL, Pelcovitz D, Axelrod A, Goldenberg B, Harris H, Meyers B, et al. Identification of PTSD in cancer survivors. Psychosomatics. 1996;37:137–43.CrossRefPubMed
2.
Meeske KA, Ruccione K, Globe DR, Stuber ML. Posttraumatic stress, quality of life, and psychological distress in young adult survivors of childhood cancer. Oncol Nurs Forum. 2001;28:481–9.PubMed
3.
Peres JF, Newberg AB, Mercante JP, Simao M, Albuquerque VE, Peres MJ, et al. Cerebral blood flow changes during retrieval of traumatic memories before and after psychotherapy: a SPECT study. Psychol Med. 2007;37:1–11.CrossRef
4.
5.
Strata P, Scelfo B, Sacchetti B. Involvement of cerebellum in emotional behavior. Physiol Res. 2011;60(Suppl 1):S39–48.PubMed
6.
Yin Y, Li L, Jin C, Hu X, Duan L, Eyler LT, et al. Abnormal baseline brain activity in posttraumatic stress disorder: a resting-state functional magnetic resonance imaging study. Neurosci Lett. 2011;498:185–9.CrossRefPubMed
7.
Baldaçara L, Jackowski AP, Schoedl A, Pupo M, Andreoli SB, Mello MF, et al. Reduced cerebellar left hemisphere and vermal volume in adults with PTSD from a community sample. J Psychiatr Res. 2011;45:1627–33.CrossRefPubMed
8.
9.
10.
Wolpe J. The practice of behavior therapy. New York: Pergamon Press; 1973.
11.
First MB, Spitzer RL, Gibbon M, Williams JBW. Structured clinical interview for DSM-IV Axis I disorders-clinical version (SCID-CV). Washington D.C.: American Psychiatric Press; 1997.
12.
Pitman RK, Scott PO, Forgue DF, de Jong JB, Claiborn JM. Psychophysiologic assessment of post-traumatic stress disorder imagery in Vietnam combat veterans. Arch Gen Psychiatry. 1987;44:970–5.CrossRefPubMed
13.
Damasio AR, Grabowski TJ, Bechara A, Damasio H, Ponto LL, Parvisi J, et al. Subcortical and cortical brain activity during the feeling of self-generated emotions. Nat Neurosci. 2000;3:1049–56.CrossRefPubMed
14.
Schwartz MS. Biofeedback: a practitioner’s guide. 2nd ed. New York: Guilford; 1995.
15.
Flor H, Miltner W, Birbaumer N. Psychophysiological recording methods. In: Turk DC, Melzack R, editors. Handbook of pain assessment. New York: Guilford; 1992. p. 169–90.
16.
Foa EB, Ehlers A, Clark DM, Tolin DF, Orsillo SM. The posttraumatic cognitions inventory (PTCI): development and validation. Psychol Assess. 1999;11:303–14.CrossRef
17.
Horowitz MJ, Wilner NR, Alvarez W. Impact of events scale. A measure of subjective stress. Psychosom Med. 1979;41:209–18.CrossRefPubMed
18.
Spielberger CD. Manual for the state trait anxiety inventory: STAI (form Y). Palo Alto CA: Consulting Psychologists Press; 1983.
19.
Derogatis LR. Brief Symptom Inventory 18: Administration Scoring and Procedure Manual. Minnesota. NCS Pearson Inc: Minneapolis; 2001.
20.
Carlson LE, Bultz BD. Cancer distress screening: needs, methods and models. J Psychosom Res. 2003;55:403–9.CrossRefPubMed
21.
Monti DA, Sinnott J, Marchese M, et al. Muscle test comparisons of congruent and incongruent self-referential statements. Percept Mot Skills. 1999;88:1019–28.CrossRefPubMed
22.
Hommel GA. Stagewise rejective multiple test procedure based on a modified Bonferroni test. Biometrika. 1988;5:383–6.CrossRef
23.
24.
Baumann O, Mattingley JB. Functional topography of primary emotion processing in the human cerebellum. NeuroImage. 2012;61:805–11.CrossRefPubMed
25.
Park JY, Gu BM, Kang DH, Shin YW, Choi CH, Lee JM, et al. Integration of cross-modal emotional information in the human brain: an fMRI study. Cortex. 2008;46:161–9.CrossRefPubMed
26.
Ferrucci R, Giannicola G, Rosa M, Fumagalli M, Boggio PS, Hallett M, et al. Cerebellum and processing of negative facial emotions: cerebellar transcranial DC stimulation specifically enhances the emotional recognition of facial anger and sadness. Cognit Emot. 2012;26:786–99.CrossRef
27.
Stoodley CJ, Schmahmann JD. Functional topography in the human cerebellum: a meta-analysis of neuroimaging studies. NeuroImage. 2009;44:489–501.CrossRefPubMed
28.
Stoodley CJ, Schmahmann JD. Evidence for topographic organization in the cerebellum of motor control versus cognitive and affective processing. Cortex. 2010;46:831–44.CrossRefPubMedPubMedCentral
29.
Park JY, Gu BM, Kang DH, Shin YW, Choi CH, Lee JM, et al. Integration of cross-modal emotional information in the human brain: an fMRI study. Cortex. 2008;46:161–9.CrossRefPubMed
30.
Schraa-Tam CK, Rietdijk WJ, Verbeke WJ, Dietvorst RC, van den Berg WE, Bagozzi RP, et al. fMRI activities in the emotional cerebellum: a preference for negative stimuli and goal-directed behavior. Cerebellum. 2012;11:233–45.CrossRefPubMed
31.
Dempesy CW, Tootle DM, Fontana CJ, Fitzjarrell AT, Garey RE, Heath RG. Stimulation of the paleocerebellar cortex of the cat: increased rate of synthesis and release of catecholamines at limbic sites. Biol Psychiatry. 1983;18:127–32.PubMed
32.
Marcinkiewicz M, Morcos R, Chretien MCNS. Connections with the median raphe nucleus: retrograde tracing with WGA-apoHRP-gold complex in the rat. J Comp Neurol. 1989;289:11–35.CrossRefPubMed
33.
Utz A, Thürling M, Ernst TM, Hermann A, Stark R, Wolf OT, et al. Cerebellar vermis contributes to the extinction of conditioned fear. Neurosci Lett. 2015;604:173–7.CrossRefPubMed
34.
Supple WF, Kapp BS. The anterior cerebellar vermis: essential involvement in classically conditioned bradycardia in the rabbit. J Neurosci. 1993;13:3705–11.PubMed
35.
Supple WF, Leaton RN. Lesions of the cerebellar vermis and cerebellar hemispheres: effects on heart rate conditioning in rats. Behav Neurosci. 1990;104:934–47.CrossRefPubMed
36.
Sacchetti B, Sacco T, Strata P. Reversible inactivation of amygdala, cerebellum, but not perirhinal cortex, impairs reactivated fear memories. Eur J Neurosci. 2007;25:2875–84.CrossRefPubMed
37.
Cacciola A, Milardi D, Calamuneri A, Bonanno L, Marino S, Ciolli P, et al. Constrained spherical deconvolution tractography reveals cerebello-mammillary connections in humans. Cerebellum. 2017;16:483–95.CrossRefPubMed
38.
Blatt GJ, Oblak AL, Schmahmann JD. Cerebellar connections with limbic circuits: anatomy and functional implications. Handbook of the Cerebellum and Cerebellar Disorders. New York: Springer; 2013. p. 479–96.CrossRef
39.
Seeley WW, Menon V, Schalzberg AF, Keller J, Glover GH, Kenna H, et al. Dissociable intrinsic connectivity networks for salience processing and executive control. J Neurosci. 2007;27:2349–56.CrossRefPubMedPubMedCentral
40.
Sang L, Qin W, Liu Y, Zhang Y, Jiang T, Resting-state YC. Functional connectivity of the vermal and hemispheric subregions of the cerebellum with both the cerebral cortical networks and subcortical structures. NeuroImage. 2012;61:1213–25.CrossRefPubMed
41.
Allen G, McColl R, Barnard H, Ringe WK, Fleckenstein J, Cullum CM. Magnetic resonance imaging of cerebellar-prefrontal and cerebellar-parietal functional connectivity. NeuroImage. 2005;28:39–48.CrossRefPubMed
42.
Silberman EK, Weingartner H. Hemispheric lateralization of functions related to emotion. Brain Cogn. 1986;5:322–53.CrossRefPubMed
43.
Lee GP, Meador KJ, Loring DW, Allison JD, Brown WS, Paul LK, et al. Neural substrates of emotion as revealed by functional magnetic resonance imaging. Cogn Behav Neurol. 2004;17:9–17.CrossRefPubMed
44.
Schienle A, Scharmüller W. Cerebellar activity and connectivity during the experience of disgust and happiness. Neuroscience. 2013;246:375–81.CrossRefPubMed
45.
Hou C, Liu J, Wang K, Li L, Liang M, He Z, et al. Brain responses to symptom provocation and trauma-related short-term memory recall in coal mining accident survivors with acute severe PTSD. Brain Res. 2007;1144:165–74.CrossRefPubMed
46.
Sakamoto H, Fukuda R, Okuaki T, Rogers M, Kasai K, Machida T, et al. Parahippocampal activation evoked by masked traumatic images in posttraumatic stress disorder: a functional MRI study. NeuroImage. 2005;26:813–21.CrossRefPubMed
47.
Stark EA, Parsons CE, Van Hartevelt TJ, Charquero-Ballester M, McManners H, Ehlers A, et al. Post-traumatic stress influences the brain even in the absence of symptoms: a systematic, quantitative meta-analysis of neuroimaging studies. Neurosci Biobehav Rev. 2015;56:207–21.CrossRefPubMed
48.
Buchsbaum MS, Simmons AN, DeCastro A, Farid N, Matthews SC. Clusters of low (18)F-fluorodeoxyglucose uptake voxels in combat veterans with traumatic brain injury and post-traumatic stress disorder. J Neurotrauma. 2015;32:1736–50.CrossRefPubMed
49.
Meng Y, Qiu C, Zhu H, Lama S, Lui S, Gong Q, et al. Anatomical deficits in adult posttraumatic stress disorder: a meta-analysis of voxel-based morphometry studies. Behav Brain Res. 2014;270:307–15.CrossRefPubMed
Metadata
Title
Changes in cerebellar functional connectivity and autonomic regulation in cancer patients treated with the Neuro Emotional Technique for traumatic stress symptoms
Authors
Daniel A. Monti
Anna Tobia
Marie Stoner
Nancy Wintering
Michael Matthews
Chris J. Conklin
Feroze B. Mohamed
Inna Chervoneva
Andrew B. Newberg
Publication date
01-02-2018
Publisher
Springer US
Published in
Journal of Cancer Survivorship / Issue 1/2018
Print ISSN: 1932-2259
Electronic ISSN: 1932-2267
DOI
https://doi.org/10.1007/s11764-017-0653-9

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