PROMOTINGROMOTING SOCIAL SOCIAL …

PPROMOTINGROMOTING SOCIALSOCIAL ENGAGEMENTENGAGEMENT BYBYUNDERSTANDINGUNDERSTANDING, , ANDAND ENHANCINGENHANCING, , EMOTIONALEMOTIONAL RESPONSITIVYRESPONSITIVY ININ PERSONSPERSONSWHOWHO HAVEHAVE EXPERIENCEDEXPERIENCED ABIABI

Presenters:Dawn Good, Ph.D., C. Psych.1

Julie Baker, M.A., Psych., Ph.D. Candidate1

Katie Chiappetta, BSc (Hons.) Candidate1

Angela Dzyundzyak M A Psych Ph D Candidate1Angela Dzyundzyak, M.A., Psych., Ph.D. CandidateStefon van Noordt, BA (Hons.), M.A. Candidate

Harnessing the Power2009 Provincial Acquired Brain Injury Conference

Niagara Falls, OntarioO t b 29 2009

1Neuropsychology Cognitive Research Lab, Brock University, St. Catharines, Ontario

October 29, 2009

PPSYCHOSYCHOSSOCIALOCIAL OUTCOMESOUTCOMESPPSYCHOSYCHOSSOCIALOCIAL OUTCOMESOUTCOMES& B& BRAINRAIN IINJURYNJURY

Psychosocial outcomes for individuals who have experienced an acquired brain injury (ABI) areexperienced an acquired brain injury (ABI) are more limited relative to age-appropriate cohorts.

While cognitive and physical gains have permitted return to activities and engagement when assessed 10 years later, socioemotional factors continue to influence community integration and quality of life satisfaction ( D P f d &quality of life satisfaction (e.g. Draper, Ponsford, & Schonberger, 2007; Hoofen, Gilboa, Vakil, & Donovick, 2001)

PPSYCHOSYCHOSSOCIALOCIAL OOUTCOMESUTCOMES& B& BRAINRAIN IINJURYNJURY

Individuals and others who know them report

& B& BRAINRAIN IINJURYNJURY

Individuals, and others who know them, report continuing and high rates of depression, anxiety, and loneliness; and successful socialanxiety, and loneliness; and successful social interactions and relationships are compromised as a function of social challenges, not the least of which includes the person’s aggression or anger.

PPSYCHOSYCHOSSOCIALOCIAL OOUTCOMESUTCOMES

O t di d t t th t i di id l i

& B& BRAINRAIN IINJURYNJURYOur studies demonstrate that individuals are, in fact, physiologically underaroused prior to a triggering event and are less able to interprettriggering event and are less able to interpret emotional signals from themselves or others.

As a result, social personality variables of aggression or anger are actually reactive in

t t ‘ t t ’ f b i gnature – not a ‘state’ of being.

Incompatible social responses, or reduced socialIncompatible social responses, or reduced social contact in the community arise, in part, due to a lessened ability to experience emotional responses in one’s self or detect the emotional reactions of others.

PPSYCHOSYCHOSSOCIALOCIAL OOUTCOMESUTCOMES& B& BRAINRAIN IINJURYNJURY

Social judgments and risky decisions result from limited emotional markers (e.g. Koenigs et al, 2007) that ( g g , )

typically guide behaviour to alert us to safe or less safe choices.

Improving the arousal/stress response in persons who have experienced an ABI has been shown towho have experienced an ABI has been shown to ameliorate these emotional indicators and provide us with an intervention to enhance or promote pimproved social engagement and outcomes.

TTHEHE RREALEAL WWORLDORLD

Persons with traumatic brain injury have been i d icompromised in:

Social decision making (Ciaramelli et al 2007)Social decision making (Ciaramelli et al., 2007)Moral decision making (Koenigs et al., 2007)Emotional functioning (Barbas, 2003; Stuss et al., 1992)g ( , ; , )

Also present with attenuated physiological responses (i d d )(i.e., underaroused status) (Tranel & Damasio, 1994)

All which are subserved by a complex network of brainAll which are subserved by a complex network of brain areas involved in both emotional and cognitive processes, especially the orbitofrontal cortex (OFC) regionp y ( ) g

Schematic diagrams ofSchematic diagrams of contusion most commonly affected by contusions (red) and ( )those that are occasionally affected by contusions (blue). Areas ( )that are predominantly affected by contusions include the orbitofrontal cortex, anterior temporal lobe, and posterior portion of h i lthe superior temporal

gyrus area, with the adjacent parietal

l

Coauthor(s): Orlando Diaz-Daza, MD, Assistant Professor, Department of Radiology, Ben TaubGeneral Hospital, Baylor College of Medicine; Roman Hlatky, MD, Assistant Professor, Center for

opercular area.

p , y g ; y, , ,Neurosurgical Sciences, The University of Texas Health Science Center; L Anne Hayman, MD, Director of Herbert J Frensley Center for Imaging Research, Professor, Departments of Radiology, Psychiatry, and Behavioral Sciences, Baylor College of Medicine

IINJURYNJURY TOTO THETHE FFRONTALRONTAL LLOBESOBES

Persons with injury to the OFC/VMPFC:Cognitive impairments (inflexibility, etc. )

Social deficits (poor decision making, etc.)making, etc.)

Differential emotional ffarousal via disrupted reciprocal connectivity between subcortical and OFC strucutersOFC strucuters

possible differential autonomic responsivity (dysregulation)

See Wallis (2007) for review

PPHYSIOLOGICALHYSIOLOGICAL FFEEDBACKEEDBACK

And these behaviours are likely all reflective of OFC connectivity:y

e.g. limits on decision making may reflect lack of physiological/emotive feedback indicating ‘caution’

i.e. the relationship between

“Gut Reaction”/Arousal and the decision ‘not’ to do somethingg

(Bechara, Damasio, &Damasio, 2000)

CCONSEQUENCESONSEQUENCES OFOF PFCPFC//OFCOFC INJURYINJURY::CCONSEQUENCESONSEQUENCES OFOF PFCPFC//OFCOFC INJURYINJURY: : KNOWINGKNOWING VERSUSVERSUS DOINGDOING

Global intellect intact, but unable to apply social knowledge (e g Phineas Gage - Harlow 1848)knowledge (e.g., Phineas Gage Harlow, 1848).

Cognitively competent but in vivo decision-makingCognitively competent, but in vivo decision-making impaired (e.g., E.V.R. - Eslinger et al., 1985; Saver et al., 1991).)

Understand problem and possible solutions, but p p ,inability to execute properly (Robertson et al., 2008).

Prevalence of Prevalence of head Injury head Injury Globally 57 million hospitalizations per yearGlobally, 57 million hospitalizations per year

(Langlois et al., 2006)

1/3 sustain injury before 25 (McKinlay et al 2008)1/3 sustain injury before 25 (McKinlay et al., 2008)

70-90% classified as ‘mild’ (Cassidy et al., 2004)

PPATHOPHYSIOLOGICALATHOPHYSIOLOGICALCCONSEQUENCESONSEQUENCES OFOF IINJURYNJURYCCONSEQUENCESONSEQUENCES OFOF IINJURYNJURY

Diffuse Axonal Injury (DAI)

•Extracellular K+

levels increase•Indiscriminate

Excitatory Neurotransmission •Energy

demands of b•Tissue

deformation/ion channel opening

Cell

•Indiscriminate release of glutamate

•Expulsion of K+

and Ca+ influx

membrane pumps to restore homeostasis

Cell Depolarization

and Ca influx Hyperglycolysis

•Lactate impairs oxidative metabolism •Residual effects of

Depressed Neural Activity ‘biomechanical force’

metabolism •ATP production

compromisedNeural

Alterations

attenuated neural activity

•Atypical receptor functioning Alterations

(Giza et al., 2001; Gurkoff et al., 2006; Hayes et al., 1994; Siesjo et al., 1996)

MMILDILD HHEADEAD IINJURYNJURY

Kay et al. (1993): ay e a . ( 993):

physical trauma to the head p yvia biomechanical force sufficient to produce an alteration inalteration in consciousness (e.g., dizziness, dazed, disoriented)

loss of consciousness not required

Previous studies have ev o s s es aveshown the prevalence of MHI in university students yto be ~37% (Chuah et al., 2004; Segalowitz & Lawson, 1995)

Sustained MHI primarily due to:due to:

Accidental fallsSports activitiespMotor Vehicle Collisions(Belanger & Vanderploeg, 2005; Cassidy et al 2004)Cassidy et al., 2004)

MMILDILD HHEADEAD IINJURYNJURY & P& PERSONALITYERSONALITY

Interpersonal relationships rely on personality


Interpersonal relationships rely on personalityPersonality factors:

Socially unacceptable behavioursy pAggressionImpulsivity

Research questionIs mild head injury associated with maladaptive personality characteristics? If yes then which ones?

MHI IMHI INDICATORNDICATOR

Questionnaire:QDemographics

Have you ever had a head injury resulting in an altered state of consciousness (including: vomiting, dizziness, seeing stars, confusion)?


Participants


p87 undergraduate university students (70% women)47 reported sustaining a mild head injury (54%)On average 20 years old for both groups

No MHI MHI TotalMenWomen

9 (21%)34 (79%)

18 (38%)29 (62%)

2763

Total 43 47 90Total 43 47 90

Chi-Square = 3.23, p > .05C Squa e 3. 3, p .05


Personality


yAggression Questionnaire (Buss & Perry, 1992)

Physical aggression, Verbal aggression, Hostility, AngerSRP Checklist (Paulhus et al., in press)

Erratic lifestyle, Socially unacceptable behaviours, Callous affect, Interpersonal manipulationp p

Barratt’s Impulsiveness Scale (Patton, Stanford, & Barratt, 1995)

Attentional impulsivity, Non-planning, DisinhibitionDelay discounting/gratification task (Kirby, Petry, & Bickel, 1999)1999)

MMILDILD HHEADEAD IINJURYNJURY & P& PERSONALITYERSONALITYMMILDILD HHEADEAD IINJURYNJURY & P& PERSONALITYERSONALITY

Executive functionReasoning

CTONI (1996)Cognitive flexibility

T il (DKEFS 2002)Trails (DKEFS, 2002)Sustained attention

NEPSY (NEPSY-2nd Ed., 2007)( , )Working memory

Mental Control (WMS-III, 1997)L b i (WMS III 997)Letter number sequencing (WMS-III, 1997)

MMHIHI ANDAND PPERSONALITYERSONALITY: E: EXPECTATIONSXPECTATIONS

Gender differences

Neurocognitive differences(Executive Functioning)

MHI Status

Personality Differences

MHI status would predict personality differences even after gender and executive functioning differences have b t k i t id tibeen taken into consideration

Higher levels socially unacceptable behaviour and erratic lifestyleHigher levels of reactive aggressiong f ggHigher levels of disinhibition (impulsivity)

MMHIHI ANDAND PPERSONALITYERSONALITY: R: RESULTSESULTS

O l i lif l d i ll blOnly erratic lifestyle and socially unacceptable behaviour were associated with MHI

60MHI

40

50 No MHI

Erratic Lifestyle: R2=.26,F (8,78) = 3.37, p=.002

20

30

Scor

e

10

20

0Callous Affect Erratic

LifestyleInterpersonal Manipulation

Antisocial Behaviour

Antisocial behaviour: R2=.26, F (8,78) = 3.33, p=.002

SRP scale

MMHIHI ANDAND PPERSONALITYERSONALITY: R: RESULTSESULTSImpulsivity:

Only behavioural disinhibition was predicted by MHI

35 MHI

25

30MHI

No MHI Behavioural Disihibition: R2=.22,F (8,78) = 2.72, p=.011

0 08

0.10 MHI15

20

25

S Sc

ore

0.04

0.06

0.08

ore

No MHI

10

15

BIS

0 02

0.00

0.02

DD

Sco

0

5

Non Planning Disihbibition AttentionDisinhibition

-0.04

-0.02

Delay Discounting Task

Non Planning Disihbibition Attention

Barrat's Impulsiveness ScaleDisinhibition

MMHIHI ANDAND PPERSONALITYERSONALITY: R: RESULTSESULTSMMHIHI ANDAND PPERSONALITYERSONALITY: R: RESULTSESULTSAggression:

Only physical aggression was predicted by MHI y p y gg p y

35 MHI

25

30

35 MHINo MHI

15

20

25

core

R2 417 F (8 78) 6 97

10

15Sc R2=.417, F (8,78) = 6.97, p<.001

0

5

Physical Verbal Anger HostilityPhysical Verbal Anger Hostility

Aggression Questionnaire

SS II PP60 No MHI

SSEVERITYEVERITY OFOF IINJURYNJURY ANDAND PPERSONALITYERSONALITY

50

cale

MHI/No ConcussionMHI/Concussion

40

e Su

b-sc MHI/Concussion

20

30

e on

the

10Scor

0Disinhibition Physical

AggressionErratic Lifestyle Antisocial

behaviourgg

NNUMBERUMBER OFOF IINJURIESNJURIES ANDAND PPERSONALITYERSONALITY

70No MHI

NNUMBERUMBER OFOF IINJURIESNJURIES ANDAND PPERSONALITYERSONALITY

60

ale

No MHI

1 MHI

2 or more MHI

40

50

e Su

bsca

30

e on

the

10

20

Scor

e

0Disinhibition Physical

AggressionErratic Lifestyle Antisocial

behaviourAggression behaviour

MMHIHI ANDAND PPERSONALITYERSONALITY: S: SUMMARYUMMARY

Mild head injury was associated withHigher levels of behavioural disinhibition but not other types of impulsivityHigher levels of physical aggression but not other types ofHigher levels of physical aggression but not other types of aggressionMore socially unacceptable behaviour and erratic lifestyle

Furthermore:Behavioural disihibition was associated with MHI evenBehavioural disihibition was associated with MHI even after lifestyle and socially unacceptable behaviour were taken into consideration (Dzyundzyak, Good, & DeBono,

)2008)

MHIMHI ANDAND PPERSONALITYERSONALITY: S: SOO WWHATHAT??MHI MHI ANDAND PPERSONALITYERSONALITY: S: SOO WWHATHAT? ? Mild head injury is associated with inability to j y ywithhold responses and reactive physical aggression

These effects present as impulsive and aggressive personality characteristics, which in turn have a negative impact on interpersonal relationships

However, these responses are triggered by the environment and, thus, can be anticipated and

t dprevented

Social competence in terms of decision making can be a f i f OFC h hfunction of OFC through:

Arousal Arousal

Social Competence

Social Competence

Trauma or maturationOrbitofrontal

Cortex Orbitofrontal

Cortex

Arousal levels

Injury to the OFC Decision Making

(Yeates et al., 2007)

SSOCIALOCIAL DDECISIONSECISIONS: : MMORALORAL BBEHAVIOURSEHAVIOURS

Previous research demonstrates that persons who have

MMORALORAL BBEHAVIOURSEHAVIOURS

Previous research demonstrates that persons who have incurred a head injury may lack social awareness demonstrated through self-report social problem solving skills (K d ll t l 1997)(Kendall et al., 1997)

Persons who have experienced injury to the VMPFC are more likely to agree with a socially unacceptable choice relative to persons who have not incurred a head injury (Ciaramelli et al., 2007; Koenigs et al., 2007); g , )

Persons who had not incurred a head injury were more reluctant to make decisions that resulted in personalreluctant to make decisions that resulted in personal transgressions compared with impersonal, whereas persons with injury to the VMPFC took equally as long (Ciaramelli et al 2007)al., 2007)

HHYPOTHESESYPOTHESESIndividuals with MHI would rate themselves as

having similar social problem solving skills as i di id l i hindividuals with no MHI

BUTBUT…When individuals with MHI consider social/moral

decisions, we expect their performance to reflect , p pdifferent processes:

Persons with MHI will make lessPersons with MHI will make less socially acceptable choices, and be quicker to do so, compared to no q , pMHI counterparts

DDEMOGRAPHICSEMOGRAPHICS

R it d 47 U i it St d t ith dRecruited 47 University Students with andwithout MHI

No MHI MHI Total

M l 6 6 12Males 6 6 12

Females 21 14 35

Total 27 20 47

2(χ2 = .37, p = .55)

12 participants reported a loss of consciousness (60% of MHI group)p p p ( g p)8 participants reported seeking medical treatment (40% of MHI group)

MMEASURESEASURES

Moral JudgmentMoral JudgmentDemographicDemographic Social ProblemSocial ProblemMoral Judgment Task• Social

Moral Judgment Task• Social

Demographic Questionnaire • Indicator of

Demographic Questionnaire • Indicator of

Social Problem Solving Inventory

Social Problem Solving Inventory

situation• Presents a

it ti i

situation• Presents a

it ti i

head injury head injury • Describe how they believe they make

• Describe how they believe they makesituation in

which a social dilemma is

situation in which a social dilemma is

they make choices they make choices

requiredrequired

SOCIAL PROBLEMSOCIAL PROBLEM--SOLVING SOLVING INVENTORYINVENTORY REVISEDREVISED

20

INVENTORYINVENTORY-- REVISEDREVISEDNo Differences between the Groups on

1618 any of the measures of SPSI

F(1, 46) = 0.27, p = 0.61

1214

re

810 NonMHI

MHI

Scor

246

02

RELATIVERELATIVE LIKELIHOODLIKELIHOOD OFOF COMMITTINGCOMMITTING

16 15

THETHE TRANSGRESSIONTRANSGRESSION

nts

14

16 15

13

artic

ipan

10

12 11

ber o

f Pa

6

8 No-MHIMHI

Num

b

2

4 4 3

1

0

2

MI and MP are MI Greater than MP MP Greater than MI

1

(χ2 = 9.13, p = .01)

MI and MP are Equal

MI Greater than MP MP Greater than MI

TTIMEIME DDATAATA

45

50

35

40

45

seco

nds)

25

30

35No Difference

e Ti

me

(s

15

20

25No- MHIMHI

NonMHI:Ave

rage

10

15

NM < MI < MP

MHI:NM < MI = MP

0

5

N M l M l M l NM < MI = MP

(F(1,45) = 5.37, p = .03)

Non-Moral Average Time

Moral Impersonal

Average Time

Moral Personal

Average Time

SSEVERITYEVERITY MMEASUREEASURE

60

50

nds)

40

e (s

econ

20

30

ge T

ime

NonMHIMHI No LOC MHI with LOC

10

20

Ave

ra

MHI with LOC

0Non Moral Moral MoralNon-Moral Moral

Impersonal Moral

Personal

SSUMMARYUMMARY

1. NonMHI and MHI approached problemapproached problem solving skills in a similar fashion

No Difference

2. MHI group made less socially acceptable NonMHI:socially acceptable choices, and were quicker to do so, compared to the

MHI

NonMHI:NM < MI < MP

MHI:nonMHI group NM < MI = MP

Persons who have incurred a MHI may have disrupted emotional feedback from the viscera and orbtiofrontal cortex, therefore, they are not interpreting or receiving social information in the same way

DDECISIONECISION MAKINGMAKING, , EMOTIONALEMOTIONAL,,MARKERSMARKERS ANDAND LEARNINGLEARNING

Emotional feedback to consequences of decisionsEmotional feedback to consequences of decisions signals a discrepancy between one’s expectation and what actually happens (Nieuwenhuis et al., 2004; Oya et al., 2005 S t t l 2009)2005; Santesso et al., 2009)

Affect (valence) associated with an outcome providesAffect (valence) associated with an outcome provides basis for adaptive learning (Bechara, 2004; Rudrauf et al., 2009) – i.e. negative feelings = learn to avoid, or anticipate the negative consequence in future situations

Anticipation of potential future consequences via somatic marker activation (Damasio 1996; Denburg et alsomatic marker activation (Damasio, 1996; Denburg et al., 2007)

CCONSEQUENCESONSEQUENCES OFOF OFC IOFC INJURYNJURY

Have the capacity to emotionally respond to theHave the capacity to emotionally respond to the environment, but have limited activation of anticipatory emotional responses

Limited affective markers compromise emotion precognition in oneself and others (Heberlein et al., 2008; Hopkins et al., 2002; Ietswaart et al., 2008)

Insensitive to the potential of future consequences to decisions (B h t l 1996 2000)decisions (Bechara et al., 1996; 2000)

HHYPOTHESESYPOTHESES

Might those with MHI, even though competent be emotionally

University students with MHI are expected to perform

OO

though competent, be emotionally uninformed when making

decisions?

are expected to perform competently on general cognitive tasksUniversity students with MHI

Do mild head injuries in university students relate to measurable differences in the

University students with MHI are expected to have attenuated physiological responses during the anticipatory stages of d i i kiability to generate and interpret

emotional signals from oneself and others?

decision-makingUniversity students with MHI are expected to be less successful in discriminating facial

How might variable physiological and neuropsychological

h i i fl i l

in discriminating facial expressions of emotionCompromise community reintegration and healthymechanisms influence social

decision making?reintegration and healthy interpersonal relationships

MMETHODSETHODS:: PPARTICIPANTSARTICIPANTS

Study 1 Study 2

OO :: CC

Study 1 Study 2

MHI Non-MHI MHI Non-MHI

n 16 (40%) 24 (60%) 18 (41%) 26 (59%)

Mean Age 19 19 20 19

n Males 9 (56%) 6 (25%) 5 (28%) 6 (23%)

n Females 7 (44%) 18 (75%) 13 (72%) 20 (77%)

Education(Yrs.)

13 13 13 13

MMETHODSETHODS:: PPARTICIPANTSARTICIPANTSStudy 1 Study 2

MHI (n = 16) MHI (n = 18)

Medical Attention 7 (44%) 7 (39%)

Stitches 4 (25%) 2 (11%)Stitches 4 (25%) 2 (11%)Loss ofConsciousness

5 (31%) 11 (61%)

Multiple MHI 8 (50%) 5 (28%)

Mean Age of Injury 15 13

MMEASURESEASURESNeuropsychological Tasks:

General cognitive abilities:Design Fluency (Delis et al 2001)Design Fluency (Delis et al., 2001).

Behavioural decision-making: A B C DBehavioural decision-making:Iowa Gambling Task (IGT; Bechara, 2007).

Emotion discrimination:Affect Recognition (Korkman et al., 2007).Affect Recognition (Korkman et al., 2007).

ELECTROPHYSIOLOGICALELECTROPHYSIOLOGICAL EQUIPMENTEQUIPMENTELECTROPHYSIOLOGICALELECTROPHYSIOLOGICAL EQUIPMENTEQUIPMENT

El t d l A ti it (EDA)Electrodermal Activity (EDA)Index of autonomic arousal through continuous measurement of

skin conductance (Lykken, 1961; 1971; Fowles et al., 1981)( y )Variations in perspiration signal sympathetic activityRepresents a measure of Emotional Arousal

Physiological E i tEquipment

Electrodermal ElectrodeFinger Pulse

Electrodermal Electrode

GGENERALENERAL CCOGNITIVEOGNITIVE AABILITYBILITY

MHI

1.5

1.8

rror

s

Non-MHI

*

0 6

0.9

1.2

Set

-Los

s Er

0

0.3

0.6

1 2 3

Mea

n

1 2 3

Condition of Design Fluency Task* p < .01

MHI (n = 18) and non-MHI (n = 25) groups perform comparably on the Design Fluency Task; with more challenging task demands resulting in more errors for both groups.demands resulting in more errors for both groups.

DDECISIONECISION--MMAKINGAKING SSUCCESSUCCESS

No difference in

100

No difference in overall decision-making performance

60

80

GT

Sco

ree

Ran

k)

performance.

40

t Tot

al I

GP

erce

ntil

e

0

20Net (P

MHI Non-MHIGroup

MHI (n = 17) and non-MHI (n = 26) groups made equally risky decisions overall.

SSEVERITYEVERITY OFOF MHI MHI ANDAND DDECISIONECISION--MMAKINGAKING SSUCCESSUCCESS

80

MMAKINGAKING SSUCCESSUCCESS

60

cisi

ons

re)

20

40

s. Po

or D

ecf R

aw S

cor

-20

0

of G

ood

vsN

et T

otal

of

-40

20

0 2 4 6 8 10 12 14

Rat

io (N

Severity of Head InjuryR2 = 0.26, n=18

Correlation between reported severity of mild head injury and net raw score on IGT, r = -.51, p = .03.

AAUTONOMICUTONOMIC AAROUSALROUSAL ––EEMOTIONALMOTIONAL PPHYSIOLOGICALHYSIOLOGICAL FFEEDBACKEEDBACK

2 MHI

EEMOTIONALMOTIONAL PPHYSIOLOGICALHYSIOLOGICAL FFEEDBACKEEDBACK

1.5

1.75

2

(inch

es)

MHINon-MHI* Individuals

reporting MHI were significantly less

0 75

1

1.25

A M

agni

tude

significantly less aroused only during the anticipation of a triggering event.

0.25

0.5

0.75

Mea

n ED

A triggering event.

0Baseline Anticipation Reward Punishment

Category of Physiological Arousal* p < .05

Comparison of mean electrodermal conductance amplitude for baseline, anticipatory, and feedback between the MHI and non-

p .

baseline, anticipatory, and feedback between the MHI and nonMHI groups.

EEMOTIONMOTION FFACIALACIAL RECOGNITIONRECOGNITION ––EEMOTIONALMOTIONAL FFEEDBACKEEDBACK FROMFROM OOTHERSTHERS

Af lli

EEMOTIONALMOTIONAL FFEEDBACKEEDBACK FROMFROM OOTHERSTHERS

3

MHI Non-MHI

After controlling for abstract and social reasoning *

2

3

an E

rror

s skills, history of MHI significantly predicted the

1

Mea

psuccess in discriminating facial expressions

0Sad Anger Neutral Fear Disgust Happy

Affective Expression

facial expressions of anger, p < .05

* 01

Comparison of mean errors made in discriminating various facial expressions of emotion between the MHI and non MHI groups

* p = .01

expressions of emotion between the MHI and non-MHI groups.

SSUMMARYUMMARY OFOF FFINDINGSINDINGS

Intact intellect emotionally responsiveIntact intellect, emotionally responsive

Self-reported MHI severity is marker of underlying metabolic/neural disruptionmetabolic/neural disruption

Limited emotional markers during anticipatory stages of decision makingdecision-making

Individuals with MHI are limited in successful emotional di i i ti ( ti l l i f )discrimination (particularly expressions of anger)

Social decision-making behaviour in the MHI group is t i d b li it ti i i i ti lconstrained by limitations in processing socio-emotional

feedback

UUNDERAROUSALNDERAROUSAL HHYPOTHESISYPOTHESIS

Students with MHI are relatively emotionally and physiologicallyemotionally and physiologically underaroused compared to no-MHI counterparts

May benefit from being activated to a higher level of arousal

Since the OFC /VMPFC manages emotional responses, disruption to this area could explain the differential pemotional and physiological arousal state

AAFFECTFFECT

80

50

60

70

y Pe

rcen

tile

g

30

40

50

ate

Anx

iety

Ran

king

0

10

20

Mea

n St

MHI No MHI

Presence of MHI

Persons with MHI presented with less anxiety than persons without MHI.p

St. Cyr & Good (2006; 2007)

AAROUSALROUSALAAROUSALROUSAL

84

78

80

82

84

74

76

78

e (b

pm)

68

70

72

Hea

rt R

ate

MHINo-MHI

62

64

66

60Baseline During Psychosocial

StressorAfter Stressor

Time

Jung & Good (2006)

Time

CCOGNITIONOGNITION & A& AFFECTFFECTCCOGNITIONOGNITION & A& AFFECTFFECT

40

32343638

in se

cond

s)

26283032

tchi

ng T

ime

(i

MHINo-MHI

202224

Low Anxiety High Anxiety

Swit

MHI group performed more slowly on a complex

State Anxiety

MHI group performed more slowly on a complex attentional task with lower reports of anxiety and otherwise perform comparably to their no-MHI

Jung & Good (2006)

otherwise perform comparably to their no MHI cohorts when stressed

CCOGNITIONOGNITION & A& AFFECTFFECT

50

60

racy

)

30

40

50

ive

Rec

all (

Acc

ur

MHI

No MHI

0

10

20

Mea

n N

arra

ti


State Anxiety

2.5

3n

min

s)

Overall, persons with MHI were faster and more accurate for 1

1.5

2

me

(in m

inut

es)

MHIno MHI

plet

ion

Tim

e (in

more accurate for memory tasks with higher reports of stress. 0

0.5

1


Tim

Mem

ory

Com

p

St. Cyr & Good (2007; in press1). Brain & Cognition1


State AnxietySpat

ial

PPURPOSEURPOSE: T: TOO INVESTIGATEINVESTIGATE THETHE EFFECTEFFECT OFOF AAROUSALROUSALPPURPOSEURPOSE: T: TOO INVESTIGATEINVESTIGATE THETHE EFFECTEFFECT OFOF AAROUSALROUSALMMANIPULATIONANIPULATION ININ PERSONSPERSONS WITHWITH//WITHOUTWITHOUT MHIMHI

Timed verbal Listened to and followed

Stress Relaxation

Timed verbal mathematical subtraction task

Listened to and followed instructions on a cognitive relaxation C D

Told related to i f

C.D.

Tranquil atmosphereimportant aspects of intellectual functioning

Tranquil atmosphere (dimmed lighting, restful sounds)

Male observer Aromatherapy (lavender)(adapted from Shostak & Peterson, 1990; ( )

Wymer, 1996)

Baker & Good (2009). Journal of Head Trauma Rehabilitation, 24 (5)

MMEASURESEASURESMMEASURESEASURES•• QuestionnairesQuestionnaires •• Arousal State MeasuresArousal State MeasuresQuestionnairesQuestionnaires

• Demographic information

Arousal State MeasuresArousal State Measures

• Electrophysiological Measures re: MHI History (Kay et al., 1993)

• PCSC (Gouvier et al 1992)

• EDA, HR, respiration (sympathetic activation)

PCSC (Gouvier et al., 1992)

• Verbal self-report of arousal state

•• Cognitive MeasuresCognitive Measures

M• Everyday life Stress (adapted

from Holmes & Rahe, 1967)State Trait Anxiety Inventory

• Memory • Planning/abstract

reasoningA i • State-Trait Anxiety Inventory

(Speilberger, 1983)• Attention• Subtests from: WMS-III,

WAIS-III, DKEFS and NEPSY IINEPSY-II

PPROCEDUREROCEDURE

Experimental Manipulation

Demographic & questionnaires

Additional questionnaires

Baseline

= Physiological Recordings= Cognitive Testing

DDEMOGRAPHICSEMOGRAPHICSDDEMOGRAPHICSEMOGRAPHICS

N = 91 Mean age 21 years (SD = 3.20)Males n = 28 ; females n = 63

Arousal Manipulation Condition

MHI No-MHI Total

Stress 27 18 45

Relaxation 24 22 46

Total 51 40

DDEMOGRAPHICSEMOGRAPHICS56% (n = 51) of students reported a MHI occurring around56% (n = 51) of students reported a MHI occurring around 16 years of age; ~ 5 years post-injury (mode = 2 years)

Indicators of Severity for SelfIndicators of Severity for Self--reported MHIreported MHIN = 51 n Percentage

Loss of consciousness 15 29.40

Indicators of Severity for SelfIndicators of Severity for Self reported MHIreported MHI

(LOC)Less than 5 mins 14 93.33

M h 5 i b l 1 6 67More than 5 mins but less than 30 mins

1 6.67

Altered State of 36 70.59Consciousness (no LOC)Concussion 24 47.10Received medical 20 39 20Received medical treatment

20 39.20

Etiology—sports-related injury: 54.90% (n = 28) falling: 25.50% (n = 13)other (e.g., fights): 19.60% (n = 10)

UUNDERAROUSALNDERAROUSAL

7

8

9

10

sal S

tate

10)

150

175

200

225

Tot

al S

core

3

4

5

6

7

f-re

port

ed A

rous

(Sca

le fr

om 1

-

MHI

no-MHI50

75

100

125

Stre

ssor

s Sca

le

1

2

3

Stress Relaxation

Self


0

25

MHI no-MHI

Life

MHI History Arousal Manipulation Condition

14

m) 1 8

2

s)

6

8

10

12

A F

requ

ency

(cpm

11.21.41.61.8

A A

mpl

itude

(µs

0

2

4

6

Bas

elin

e E

DA

00.20.40.60.8

Bas

elin

e E

DA

0MHI No-MHI

MHI History

0MHI No-MHI

MHI History

RRESPONSIVITYESPONSIVITY TOTO AAROUSALROUSALMMMMANIPULATIONANIPULATION

8

9St

ate

ed)

5

6

7

port

ed A

rous

al S

to 1

0 ve

rystr

esse

MHI-Stress

2

3

4

Rat

ing

of S

elf-

rep

(1 v

ery

rela

xed

t MHI Stress

MHI-Relaxation

No-MHI-Stress

No-MHI-Relaxation

1

2

After Manipulation During Neuropsychological

Testing

After Neuropsychological

Testing

Final

R

22.25

2.5

e (µ

S)

Time

11.25

1.51.75

2

tivity

Am

plitu

de• Students with MHI had a diminished EDA response

00.25

0.50.75

Af M i l i D i Af Fi llect

rode

rmal

Actp

overall•No-MHI had more extreme and larger range of

t th After Manipulation During Neuropsychological

Testing

After Neuropsychological

Testing

FinalEl

Time

responses to the manipulations than MHI

CCOGNITIVEOGNITIVE PERFORMANCEPERFORMANCE

As expected, prior to arousal manipulation (baseline) students i h MHI d d f lwith MHI tended (p = .06 to .09) to perform more poorly on:

working memory (WAIS-III, 1997; DKEFS, 2002)

attentional tasks (DKEFS 2002)attentional tasks (DKEFS, 2002)

25

30

35

WA

IS-I

II)

n se

cond

s)

Trend-Cognitive Flexibility T k

10

15

20

Men

tal C

ontr

ol (W

witc

hing

Tim

e (in

MHI

No MHI

Task

Performance for students with MHI tended to be:

0

5

Stress RelaxationM Sw


MHI tended to be:Better in stress than relaxation

Whereas, for no-MHI:Better in relaxation than stress pBetter in relaxation than stress

CCOGNITIONOGNITION ASAS AA FUNCTIONFUNCTION OFOFCCOGNITIONOGNITION ASAS AA FUNCTIONFUNCTION OFOFSSEVERITYEVERITY OFOF IINJURYNJURY

24m

e

18

20

22

) Sw

itchi

ng T

im

14

16

18

ntro

l (W

AIS

-III no-MHI

MHI with Altered State of Consciousness

MHI with Loss of Consciousness

10

12

Men

tal C

on MHI with Loss of Consciousness

8Stress Relaxation


SSUMMARYUMMARY & C& CONCLUSIONSONCLUSIONS

Even individuals with mild head trauma present with a profile similar to that of persons with moderate-to-

TBIsevere TBIunderaroused (emotionally & physiologically)increased reports of life stressorspless responsive to stressors in their environmentadvantaged by increasing their arousal

Suggestive of long-lasting effects of neural disruptionMay indicate subtle disruption to OFC/VMPFC as this y pregion has been implicated in the modulation of autonomic responses (e.g., Tranel & Damasio, 1994)

THANK YOU!

A d Th k ll f h d i h NCR l b!

CONTACTING US…

And Thanks to all of the students in the NCR lab!

Email dawn good@brocku ca (Dr Dawn Good)[email protected] (Dr. Dawn Good)

Website - Neuropsychology Cognitive Research Lab –Website Neuropsychology Cognitive Research Lab Koffler Family Trauma Research Centre in the Lifespan Development Research Institute at Brock U i it ( b k )University (www.brocku.ca)

htt // b k / h/ g iti /i dhttp://www.psyc.brocku.ca/research/neurocognitive/index.html

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