Case Control Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Psychiatry. Feb 19, 2024; 14(2): 234-244
Published online Feb 19, 2024. doi: 10.5498/wjp.v14.i2.234
Impaired implicit emotion regulation in patients with panic disorder: An event-related potential study on affect labeling
Hai-Yang Wang, Li-Zhu Li, Yi Chang, Xiao-Mei Pang, Bing-Wei Zhang
Hai-Yang Wang, Department of Neurology, Jining No. 1 People's Hospital, Shandong First Medical University, Jining 272000, Shandong Province, China
Hai-Yang Wang, Li-Zhu Li, Yi Chang, Xiao-Mei Pang, Bing-Wei Zhang, Department of Neurology and Psychiatry, First Affiliated Hospital of Dalian Medical University, Dalian 116011, Liaoning Province, China
Li-Zhu Li, Department of Neurology, Sixth Peoples' Hospital of Shenyang, Shenyang 110003, Liaoning Province, China
Co-first authors: Hai-Yang Wang and Li-Zhu Li.
Author contributions: Wang HY contributed to conceptualization, visualization, initial draft writing, funding acquisition, review and editing; Li LZ contributed to investigation, data curation, review and editing; Chang Y contributed to investigation, review and editing; Pang XM contributed to investigation, review and editing; and Zhang BW contributed to review and editing, supervision, project administration, funding acquisition.
Supported by The National Natural Science Foundation of China, No. 81871080; the Key R&D Program of Jining (Major Program), No. 2023YXNS004; the National Natural Science Foundation of China, No. 81401486; the Natural Science Foundation of Liaoning Province of China, No. 20170540276; and the Medicine and Health Science Technology Development Program of Shandong Province, No. 202003070713.
Institutional review board statement: This study was approved by the Ethics Committee of the First Hospital of Dalian Medical University, No. KY2014-30.
Informed consent statement: All patients gave informed consent.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: All data generated or analyzed during this study are included in this published article.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Bing-Wei Zhang, MD, PhD, Professor, Researcher, Department of Neurology and Psychiatry, First Affiliated Hospital of Dalian Medical University, No. 222 Zhongshan Road, Dalian 116011, Liaoning Province, China. zhangbingweidoc@163.com
Received: September 30, 2023
Peer-review started: September 30, 2023
First decision: December 6, 2023
Revised: December 12, 2023
Accepted: December 29, 2023
Article in press: December 29, 2023
Published online: February 19, 2024
Abstract
BACKGROUND

Panic disorder (PD) involves emotion dysregulation, but its underlying mechanisms remain poorly understood. Previous research suggests that implicit emotion regulation may play a central role in PD-related emotion dysregulation and symptom maintenance. However, there is a lack of studies exploring the neural mechanisms of implicit emotion regulation in PD using neurophysiological indicators.

AIM

To study the neural mechanisms of implicit emotion regulation in PD with event-related potentials (ERP).

METHODS

A total of 25 PD patients and 20 healthy controls (HC) underwent clinical eva-luations. The study utilized a case-control design with random sampling, selecting participants for the case group from March to December 2018. Participants performed an affect labeling task, using affect labeling as the experimental condition and gender labeling as the control condition. ERP and behavioral data were recorded to compare the late positive potential (LPP) within and between the groups.

RESULTS

Both PD and HC groups showed longer reaction times and decreased accuracy under the affect labeling. In the HC group, late LPP amplitudes exhibited a dynamic pattern of initial increase followed by decrease. Importantly, a significant group × condition interaction effect was observed. Simple effect analysis revealed a reduction in the differences of late LPP amplitudes between the affect labeling and gender labeling conditions in the PD group compared to the HC group. Furthermore, among PD patients under the affect labeling, the late LPP was negatively correlated with disease severity, symptom frequency, and intensity.

CONCLUSION

PD patients demonstrate abnormalities in implicit emotion regulation, hampering their ability to mobilize cognitive resources for downregulating negative emotions. The late LPP amplitude in response to affect labeling may serve as a potentially valuable clinical indicator of PD severity.

Keywords: Panic disorder, Implicit, Emotion regulation, Affect labeling, Late positive potential

Core Tip: This study investigates neural mechanisms of implicit emotion regulation in panic disorder (PD) using event-related potentials. PD patients exhibit anomalies during an affect labeling task, including prolonged reaction times and reduced accuracy. Neurophysiological data indicate diminished differences in late positive potential (LPP) amplitude between affect labeling and gender labeling in PD, negatively correlating with disease severity, symptom frequency, and intensity. Resultantly, PD patients demonstrate impaired implicit emotion regulation, hindering cognitive resource mobilization for negative emotion downregulation. The late LPP amplitude in response to affect labeling may serve as a valuable clinical indicator of PD severity.