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

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 networks than 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?