fMRI of Emotion Regulation in Autism

Background: Outside of autism, individuals with a range of psychiatric and childhood-onset disorders can learn to change their emotional responses to affective stimuli by “cognitive reappraisal” - the effortful alteration of emotional responses.  Cognitive reappraisal improves subjective experience as well as neural activation in key social-affective brain regions. This approach has revealed neuroplasticity in disorders previously thought to be "hard-wired" as emotionally dysregulated.  Despite clear evidence that autism is characterized by poor modulation of emotional responses to social-affective information, no research to date has examined the neuroplasticity of brain responses to social-affective information in autism.

Objectives: To examine changes in brain activation due to cognitive reappraisal while viewing social stimuli (i.e., pictures of faces) as well as stimuli related to circumscribes interests in adults with autism with fMRI. 

Methods:  Fifteen high-functioning adults with autism and fifteen matched neurotypical control adults enrolled.  Participants first completed a 30-60 minute one-on-one, structured cognitive reappraisal training session with visual supports.  During this training session, participants learned how to increase or decrease their emotional responses to pictures of faces and of objects.  After confirmation of adequate comprehension of the cognitive reappraisal training sessions, participants completed a 90-min fMRI scan session with eye-tracking.  The fMRI task involved first looking at pictures of faces or objects for 10 seconds.  During the first 4 seconds, participants viewed the images without instruction.  Next, an auditory prompt indicated whether participants were to increase or decrease their emotional response or leave their emotional response unchanged.  Following the scan session, participants viewed the same images again, this time outside of the scanner, and rated the images on the dimensions of valence and arousal both before and after cognitive reappraisal instructions.

Results: Analysis of subjective ratings revealed that cognitive reappraisal modulated subjective responses to both categories of stimuli in both groups.  Analysis of eyetracking data revealed no group differences in the proportion of time spent looking at the stimuli for any stimulus or regulation condition.  Initial analyses of fMRI patterns in the autism group suggest that cognitive reappraisal resulted in hypothesized changes in prefrontal and limbic brain activation patterns.  Additionally, groups differed in activation of amygdala and ventrolateral prefrontal responses when instructed to decrease positive emotional responses to images related to circumscribed interests and differed in nucleus accumbens and ventrolateral prefrontal cortex responses when instructed to increase positive emotional responses to images of faces.

Conclusions: Results indicate that individuals with high-functioning autism are able to learn and implement simple cognitive strategies to consciously modulate their emotional responses to social-affective stimuli.  However, the autism group showed evidence of differential activation during cognitive reappraisal in key social-affective brain regions.  This initial study suggests the potential for biobehavioral interventions to impact subjective experience and neurobiological responses to emotional challenges in individuals with autism.  An improved understanding of brain systems mediating emotion regulation in autism will be important for the generation of better etiologic models of emotion dysregulation in this disorder.