Healthy Clinical Trial
Official title:
Effects of Transcranial Direct Current Stimulation Over the Left Ventrolateral Prefrontal Cortex on Cognitive Reappraisal
This study aims to investigate the role of the left ventrolateral prefrontal cortex (VLPFC)
on cognitive reappraisal, using the reinterpretation strategy. For this purpose, we will
produce direct disturbance to the activity of this area through anodal and cathodal
transcranial direct current stimulation during a reinterpretation task.
A double-blind randomized sham-controlled trial will be conducted. 60 healthy volunteers will
be allocated into three groups. Each group will receive one type of stimulation (anodal,
cathodal or sham) while accomplishing a cognitive task on reinterpretation using images from
the International Affective Pictures System (IAPS). The task consists in applying a given
emotional regulation condition (downregulate, upregulate or maintain emotions) to a series of
images and ranking the intensity of the emotional arousal felt after doing this procedure to
each picture. The effects of tDCS on the subjective evaluation of emotional arousal after
reinterpretation in each group will be compared.
60 healthy graduation and post-graduation at the Federal University of Pernambuco (UFPE)
students will take part of the study. After providing written informed consent, the
volunteers will respond to four online questionnaires, received by email: a sociodemographic
questionnaire investigating eligibility conditions; the brazilian version of the
Self-Reporting Questionnaire (SRQ-20) to screen for common psychiatric disorders; the
brazilian self-report version of the Alcohol, Smoking and Substance Involvement Screening
Test (ASSIST) 3.0, to screen for drug-related disorders; and the brazilian version of the
Emotion Regulation Questionnaire (ERQ) to evaluate individual profile of habitual use of
emotion regulation strategies. They will be oriented to contact to researchers if they have
any doubts. After filling the questionnaires, the volunteers will be contacted to be informed
about eligibility. Individuals with previous history of epilepsy/ convulsions, brain tumors,
neurosurgery, or with brain metallic implants or pacemakers, as well as in current use of
psychotropic medication will be excluded from the study. The volunteers that score less than
5 point in SRQ-20 or more than 10 points for alcohol or more than 3 points for other
substances in self-report ASSIST 3.0 will also be excluded from the sample.
The selected volunteers will receive a training on the cognitive task. Firstly, they will
receive a brief explanation and examples on cognitive reappraisal, the reinterpretation
strategies and the instructions. Against the instruction MAINTAIN, they should simply look at
the pictures and maintain their emotional experience, according to their initial
interpretation of the presented situation. When facing the instruction DOWNREGULATE, they
should look to the picture and imagine that the situation is better or will become better
than initially perceived and when instructed to UPREGULATE, they should look to the picture
and imagine that the situation is worse or will become worse than initially perceived. They
will be presented on the computer screen to a series of 21 negative images preceded of a
screen containing one of instructions (7 images for each instruction) and 7 neutral images
preceded of a screen with the instruction maintain. The images will be presented randomly and
they will be asked to generate strategies to each situation. They will be guided to provide
adequate strategies to the received instructions and will receive a standardized example for
each picture. After this phase, they will be presented to the same series of images in the
same format as the experimental cognitive task. They will see 4 screens for each picture,
following uninterruptedly. The fist will contain the strategy for 2 seconds, the second will
present the picture for 8 seconds, the third will contain a visual scale from 1-7 to rank the
intensity of the emotional arousal felt after applying the strategy to the picture (1=very
weak; 7=very strong). They will be asked to press the correspondent number on a numerical
keyboard into 5 seconds. The final screen will have the instruction RELAX for 3 seconds and
they should wait and relax until the subsequent task initiate.
The experiment will be conducted 3-5 days later. Before the experiment, the participant will
respond to 2 questionnaires: the first will investigate behaviors that could influence the
results of the experiment (sleep, psychostimulant substance intake) and the second will
evaluate the current momentaneous status of the volunteer (humor, attention, fatigue). After
a brief training of the cognitive task with 6 pictures, we will proceed to the electrodes
montage. tDCS (1 mA) will be applied through a pair of saline-soaked surface sponge
electrodes connected to a battery-driven constant current stimulator and positioned according
to the 10-20 EEG system over the left VLPFC. A 4,5x4cm "active" electrode will be placed over
the crossing point between T3-Fz and F7- Cz and a 12x5cm "return" electrode will be
positioned over Fp2. The big return electrode will be used to attenuate the effects of
stimulation over that region. The stimulation will start 4 minutes before the beginning of
the cognitive task. The participants of the real stimulation groups will receive stimulation
for 20 minutes, with 10 seconds ramp-up and down periods. In the sham group, the participants
will receive the stimulation for 30 seconds.
Measures of central tendency and dispersion (mean and standard deviation) for continuous
variables and measures of frequency for the categorical variables will be used in the sample
characterization. T-test for independent samples or qui-square will be used to verify
comparability between groups for continuous and categorical variables, respectively.
Shapiro-Wilk test will be used to evaluate normality. Repeated measures analyses of variance
(ANOVAs) will be used to test for main effects and interaction with the within subjects
factors regulation condition (downregulate, upregulate, negative maintain, neutral maintain)
and the between-subjects factors (anodal, cathodal, sham stimulation) in case of normality.
Paired t-test will be used for compare intra-group differences. T-test for independent
samples will be conducted to compare inter-group differences. The sphericity will be verified
with the Mauchly's test. Greenhouse-Geisser correction will be used when necessary. If
normality is not verified, Friedman's test with post-hoc Wilcoxon test will be conducted to
detect intra-group differences and post-hoc Mann-Whitney test will be conducted for
inter-group differences. Two-tailed tests will be performed at 95% confidence interval for
all analyses. Statistical analyses will be carried out using SPSS (Statistical Package for
Social Sciences) 20.0 version for Windows (SPSS Inc, Chicago IL, USA).
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