Love and positive emotions as a therapeutic target

Can some cases of schizophrenia be seen as a neurodevelopmental deficiency of love and a pathological dominance of fear? Can the cultivation of healthy relationships towards one’s self and others and boosting feelings of love beneficially alter brain architecture in schizophrenia?

Love-related changes in the brain: a resting-state functional magnetic resonance imaging study.

Romantic love is a motivational state associated with a desire to enter or maintain a close relationship with a specific other person. Functional magnetic resonance imaging (fMRI) studies have found activation increases in brain regions involved in the processing of reward, motivation and emotion regulation, when romantic lovers view photographs of their partners. However, not much is known about whether romantic love affects the brain’s functional architecture during rest. In the present study, resting state functional magnetic resonance imaging (rsfMRI) data was collected to compare the regional homogeneity (ReHo) and functional connectivity (FC) across an “in-love” group (LG, N = 34, currently intensely in love), an “ended-love” group (ELG, N = 34, ended romantic relationship recently), and a “single” group (SG, N = 32, never fallen in love). Results show that: (1) ReHo of the left dorsal anterior cingulate cortex (dACC) was significantly increased in the LG (in comparison to the ELG and the SG); (2) ReHo of the left dACC was positively correlated with length of time in love in the LG, and negatively correlated with the lovelorn duration since breakup in the ELG; (3) FC within the reward, motivation, and emotion regulation network (dACC, insula, caudate, amygdala, and nucleus accumbens) as well as FC in the social cognition network [temporo-parietal junction (TPJ), posterior cingulate cortex (PCC), medial prefrontal cortex (MPFC), inferior parietal, precuneus, and temporal lobe] was significantly increased in the LG (in comparison to the ELG and SG); (4) in most regions within both networks FC was positively correlated with the duration of love in the LG but negatively correlated with the lovelorn duration of time since breakup in the ELG. This study provides first empirical evidence of love-related alterations in brain functional architecture. Furthermore, the results shed light on the underlying neural mechanisms of romantic love, and demonstrate the possibility of applying a resting-state fMRI approach for investigating romantic love.

“The between-group comparison results of functional connectivity (FC) showed that the in love group (in comparison to the single group) had significantly increased FC between the dACC seed and insula, NAC, and amygdala; between the insula seed and NAC, caudate nucleus, and amygdala; between the caudate seed and dACC, and insula; between the TPJ seed and ventromedial prefrontal cortex (vMPFC), and dorsal medial prefrontal cortex (dMPFC); and between the posterior cingulate cortex (PCC) seed and the inferior parietal lobe, MPFC, precuneus, and temporal lobe”

Schizophrenia, positive emotions, even love?

Loving-kindness can be cultivated and may be an intriguing treatment option [1, 2]

The neural mediators of kindness-based meditation: a theoretical model.

Model Neural systems involved
Perceptual/motor Amygdala* (↑)
Inferior frontal gyrus*
Affective Anterior insula
Anterior cingulate cortex
Cognitive Dorsomedial PFC*
Temporoparietal junction
Emotion regulation Amygdala (↑* or ↓)
Dorsolateral PFC*
Vagus nerve*
Self/other distinction Temporoparietal junction
Neuromodulatory backdrop
Oxytocin system (↑)
Pro-inflammatory immune system (↓)*
Compassion VTA*
Medial OFC*
Septal nuclei

Asterisk indicate regions of the brain that have been shown to be affected by loving-kindness or compassion meditation training.

“…empathy is composed of basic attentional, perceptual and motor simulation processes, simulation of another’s affective body state, and slower and higher-level perspective-taking. These components are modulated by emotion regulation and self/other discrimination, and when infused with a motivational component, may become a compassionate response. At all levels in the process, neural systems are influenced by oxytocin and the pro-inflammatory immune system. Kindness-based meditation practices may influence each of these neural systems; however, to date the most consistent evidence supports the idea that Loving Kindness Meditation enhances the neural systems important for emotion regulation (dlPFC and vagal tone) and reward (VTA and mOFC), whereas Cognitively-Based Compassion Training affects the perceptual/motor and cognitive processes, perhaps in part by modulating inflammation.” [3]

Cognitively-Based Compassion Training is detailed here: Third-wave strategies for emotion regulation in early psychosis: a pilot study (2015)

Loving-kindness is first generated for oneself in order to remove negative emotions that might impede the generation of loving-kindness for others. Next, one generates feelings of loving-kindness for someone whom it is typically easy, for example, someone who is acutely suffering or a close loved one. The practitioner then progresses by extending this feeling to others for whom loving-kindness may be more challenging, first, to someone neutral, and ultimately to someone whom is challenging or difficult.

There are some differences in schizophrenia which may complicate therapy:

“It has been suggested that there is a recognition problem in schizophrenia for positive emotions, but not for negative emotions… [there is] a reduced utilization of emotion specific areas during the processing of negative emotions in schizophrenia, which is compensated by the activation of unspecific perception areas. This hypoactivity might produce recognition deficits if the emotional intensity is not adapted.

In contrast, during the recognition of positive emotions, a study found compensation in emotion specific areas. This suggests that although patients need higher intensities, the brain system for positive emotions has the capability to compensate and therefore allow an adequate processing of positive emotions. This can also be interpreted as evidence for the ability of patients with schizophrenia to experience positive emotions.

Reduced VLPFC activity associated with social anhedonia creates weak reward-representations, which then compromises goal-directed behavior. People with low social anhedonia have greater activity in the medial prefrontal cortex, specifically the rostral portion of the anterior cingulate cortex,  for positive social signals whereas people with high social anhedonia show a trend in the opposite direction.” [4]

Dowd & Barch (2012) demonstrate a pattern of largely intact responses to reward receipt throughout the brain at the group level among individuals with schizophrenia [5].

“The robust striatal responses to reward receipt among individuals with schizophrenia are consistent with recent studies demonstrating intact outcome responses in this region. However, the pattern of intact cortical responses to reward receipt seen here contrasts with other findings. A large body of data suggesting intact hedonic responses to pleasant stimuli in schizophrenia, despite clinically evident deficits in motivation. It is also consistent with the view that motivational deficits in schizophrenia are related to deficits in value representation. In order to influence goal-directed behavior, information about reward receipt must be integrated and represented in a way that makes it available to guide value-based decision-making.”

“…an inverse relationship between anticipatory activity in left ventral striatum and VMPFC and anhedonia scores has been found. This relationship is consistent with the findings of several reward prediction studies in schizophrenia showing that higher negative symptoms, particularly anhedonia and avolition, are associated with reduced striatal responses to reward-predicting cues.”

Brown et al. (2013) suggest that there could be a unique “neural signature” for each temperament dimension associated with close, love relationships. [6]

  • Curious/Energetic Scale
  • Prosocial/Empathetic Scale
  • Analytical/Tough-minded Scale
  • Cautious/Social Norm Compliant Scale

An objective of their research was to test the hypothesis that these four temperament dimensions are associated with influences of dopamine/norepinephrine, serotonin, testosterone and estrogen/oxytocin in the brain.

“Although each of the temperament dimensions use many other neurochemical systems, one or two appear to predominate in each dimension under these specific task circumstances.”

Curious/Energetic scores correlated with the region of the substantia nigra (SN) providing evidence for involvement of the predicted transmitter system dopamine.

“Scores on the Curious/Energetic scale of the FTI co-varied with activation in a region of the substantia nigra in two independent studies, providing strong evidence that the Curious/Energetic scale could measure some aspect of the dopamine system activity in people thinking about their romantic partner.”

Cautious/Social Norm Compliant dimension’s association with the serotonin system was the weakest:

“No brainstem regions rich in serotonin cells, nor forebrain regions especially rich in serotonin receptors were associated with the Cautious/Social Norm Compliant dimension. But a brain region containing serotonin receptors and associated with “social norm compliance” in other fMRI studies was correlated with that dimension*.”

* Scores on the Cautious/Social Norm Compliant scale co-varied in both studies with activation in the ventrolateral prefrontal cortex

Their results concluded that there is “Indirect evidence that the Cautious/Social Norm Compliant scale measures some aspect of the serotonin system.”

Correlations between Analytical/Tough-minded and Prosocial/Empathic dimensions with brain regions influenced by sex hormones was indirect, but functional, with evidence in support of the hypothesis. The findings were replicated in two separate studies, making them highly significant:

“Scores on the Analytical/Tough-minded scale co-varied in these two studies with activity in regions of the occipital, parietal, orbitofrontal and prefrontal cortex, regions affected by sex hormones and associated with sex differences in behavior.”

They concluded that “…the Analytical/Tough-minded scale may measure some aspect of testosterone system activity.”

The Prosocial/Empathetic scale correlated in both studies with activity in regions associated with mirror neurons and concomitant empathy [in the IFG, AI and fusiform gyrus], a trait linked with the estrogen/oxytocin systems, and brain regions structurally affected by gender.

“These findings support the hypothesis that the four broad temperament dimensions measured by the FTI are associated with separable brain systems. Because the results were replicated in two independent studies using participants of significantly different ages, these data also suggest that traits associated with these four temperament dimensions may be relatively stable across the life course.”

On the contrary, rejection in love [7] is associated with midbrain activations of the left ventral tegmental area; right ventral striatum (nucleus accumbens core), ventral globus pallidus and ventral putamen; right pulvinar. Cortical areas that showed significant group effects were the middle orbitofrontal cortex, right lateral prefrontal cortex; angular gyrus deep in the sulcus, right middle/ inferior frontal gyrus, left ventral sulcus, medial prefrontal cortex, left dorsolateral prefrontal cortex, right anterior and left posterior insular cortex, bilateral anterior cingulate, and left posterior and retrosplenial cingulate.

Struggle for life, struggle for love and recognition: the neglected self in social cognitive neuroscience

“Because much of our mental life and many of the complaints that bring patients to psychiatrists are concerned with social appraisal and its reference to the self, the critical question is to what extent the model of a narrow social cognition … can be epistemically valid and heuristically promising. Because social cognition is fundamentally intertwined with self-cognition, understanding and treating psychiatric disorders requires a model of the self and self-awareness (its construction, its identity) involving a level of integration between social perception and self-perception that none of the current neuroscience approaches have proven to be able to illuminate. An integrated approach to social/self cognition should direct efforts toward understanding inter-subjective factors in interpersonal and social-familial relationships, which are potentially implicated in the development of psychiatric disorders, beyond and in addition to risk factors of genetic nature. The adequate level of integration is precisely that of a subject with genetic vulnerability and with a history and a place assigned or imagined to be assigned by others, living in a world of representations while building a narrative about them, and coping with conflicts and dissonances at multiple levels.”

Contrary to engaging in treatment and pathologising, ‘holding space’ seems to be an important foundation from which to grow, particularly for people struggling with difficult experiences:

What it means to “hold space” for people, plus eight tips on how to do it well

What does it mean to hold space for someone else? It means that we are willing to walk alongside another person in whatever journey they’re on without judging them, making them feel inadequate, trying to fix them, or trying to impact the outcome. When we hold space for other people, we open our hearts, offer unconditional support, and let go of judgement and control.

1   Give people permission to trust their own intuition and wisdom.

2   Give people only as much information as they can handle.

3   Don’t take their power away.

4   Keep your own ego out of it.

5   Make them feel safe enough to fail

6   Give guidance and help with humility and thoughtfulness.

7   Create a container for complex emotions, fear, trauma, etc.

8   Allow them to make different decisions and to have different experiences than you would.

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