Researchers find brain’s ‘sweet spot’ for love in neurological patient

A region deep inside the brain controls how quickly people make decisions about love, according to new research at the University of Chicago.

The finding, made in an examination of a 48-year-old man who suffered a stroke, provides the first causal clinical evidence that an area of the brain called the anterior insula “plays an instrumental role in love,” said UChicago neuroscientist Stephanie Cacioppo, lead author of the study.

In an earlier paper that analyzed research on the topic, Cacioppo and colleagues defined love as “an intentional state for intense [and long-term] longing for union with another” while lust, or sexual desire, is characterized by an intentional state for a short-term, pleasurable goal.

In this study, the patient made decisions normally about lust but showed slower reaction times when making decisions about love, in contrast to neurologically typical participants matched on age, gender and ethnicity. The findings are presented in a paper, “Selective Decision-Making Deficit in Love Following Damage to the Anterior Insula,” published in the journal Current Trends in Neurology.

“This distinction has been interpreted to mean that desire is a relatively concrete representation of sensory experiences, while love is a more abstract representation of those experiences,” said Cacioppo, a research associate and assistant professor in psychology. The new data suggest that the posterior insula, which affects sensation and motor control, is implicated in feelings of lust or desire, while the anterior insula has a role in the more abstract representations involved in love.

In the earlier paper, “The Common Neural Bases Between Sexual Desire and Love: A Multilevel Kernel Density fMRI Analysis,” Cacioppo and colleagues examined a number of studies of brain scans that looked at differences between love and lust.

The studies showed consistently that the anterior insula was associated with love, and the posterior insula was associated with lust. However, as in all fMRI studies, the findings were correlational.

“We reasoned that if the anterior insula was the origin of the love response, we would find evidence for that in brain scans of someone whose anterior insula was damaged,” she said. 

In the study, researchers examined a 48-year-old heterosexual male in Argentina, who had suffered a stroke that damaged the function of his anterior insula. He was matched with a control group of seven Argentinian heterosexual men of the same age who had healthy anterior insula.

The patient and the control group were shown 40 photographs at random of attractive, young women dressed in appealing, short and long dresses and asked whether these women were objects of sexual desire or love. The patient with the damaged anterior insula showed a much slower response when asked if the women in the photos could be objects of love.

“The current work makes it possible to disentangle love from other biological drives,” the authors wrote. Such studies also could help researchers examine feelings of love by studying neurological activity rather than subjective questionnaires.

Biomarkers may be the key that opens the door to discovery of successful initial treatment of depression

In a National Institutes of Health (NIH) funded clinical trial, researchers at Emory have discovered that specific patterns of brain activity may indicate whether a depressed patient will or will not respond to treatment with medication or psychotherapy. The study was published June 12, 2013, in JAMA Psychiatry Online First.

The choice of medication versus psychotherapy is often based on the preference of the patient or clinician, rather than objective factors. On average, only 35-40 percent of patients get well with whatever treatment they start with. 

"To be ill with depression any longer than necessary can be perilous," says Helen Mayberg,md principal investigator for the study and professor of psychiatry, neurology and radiology at Emory University School of Medicine. "This is a serious illness and the prolonged suffering resulting from an ineffective treatment can have serious medical, personal and social consequences. Our goal is not just to get patients well, but to get them well as fast as possible, using the treatment that is best for each individual."

Mayberg’s positron emission tomography (PET) studies over the years have given clues about what may be going on in the brain when people are depressed, and how different treatments affect brain activity.

These studies have also suggested that scan patterns prior to treatment might provide important clues as to which treatment to choose. In this study, the investigators used PET scans to measure brain glucose metabolism, an important index of brain functioning to test this hypothesis. 

Participants in the trial were randomly assigned to receive a 12-week course of either the SSRI medication escitalopram or cognitive behavior therapy (CBT) after first undergoing a pretreatment PET scan.

The team found that activity in one particular region of the brain, the anterior insula, could discriminate patients who recovered from those who were non-responders to the treatment assigned. Specifically, patients with low activity in the insula showed remission with CBT, but poor response to medication; patients with high activity in the insula did well with medication, and poorly with CBT.

"These data suggest that if you treat based on a patient’s brain type, you increase the chance of getting them into remission," says Mayberg.

Mayberg is quick to add that this approach needs to be replicated before it would be appropriate for routine treatment selection decisions for individual depressed patients. It is, however, a first step to better define different types of depression that can be used to select a specific treatment for a patient.

A treatment stratification approach is done routinely in the management of other medical conditions such as infections, cancer, and heart disease, notes Mayberg. “The study reported here provides important first results towards the development of brain-based treatment algorithms that match a patient to the treatment with the highest likelihood of success, while also avoiding those treatments that will be ineffective.”

Why Old People Get Scammed

Despite long experience with the ways of the world, older people are especially vulnerable to fraud. According to the Federal Trade Commission (FTC), up to 80% of scam victims are over 65. One explanation may lie in a brain region that serves as a built-in crook detector. Called the anterior insula, this structure—which fires up in response to the face of an unsavory character—is less active in older people, possibly making them less cagey than younger folks, a new study finds.

Both FTC and the Federal Bureau of Investigation have found that older people are easy marks due in part to their tendency to accentuate the positive. According to social neuroscientist Shelley Taylor of the University of California, Los Angeles, research backs up the idea that older people can put a positive spin on things—emotionally charged pictures, for example, and playing virtual games in which they risk the loss of money. “Older people are good at regulating their emotions, seeing things in a positive light, and not overreacting to everyday problems,” she says. But this trait may make them less wary.

To see if older people really are less able to spot a shyster, Taylor and colleagues showed photos of faces considered trustworthy, neutral, or untrustworthy to a group of 119 older adults (ages 55 to 84) and 24 younger adults (ages 20 to 42). Signs of untrustworthiness include averted eyes; an insincere smile that doesn’t reach the eyes; a smug, smirky mouth; and a backward tilt to the head. The participants were asked to rate each face on a scale from -3 (very untrustworthy) to 3 (very trustworthy).

In the study, appearing online in the Proceedings of the National Academy of Sciences, the “untrustworthy” faces were perceived as significantly more trustworthy by the older subjects than by the younger ones. The researchers then performed the same test on a different set of volunteers, this time imaging their brains during the process, to look for differences in brain activity between the age groups. In the younger subjects, when asked to judge whether the faces were trustworthy, the anterior insula became active; the activity increased at the sight of an untrustworthy face. The older people, however, showed little or no activation.

Listen up, doc: Empathy raises patients’ pain tolerance

A doctor-patient relationship built on trust and empathy doesn’t just put patients at ease – it actually changes the brain’s response to stress and increases pain tolerance, according to new findings from a Michigan State University research team.

Medical researchers have shown in recent studies that doctors who listen carefully have happier patients with better health outcomes, but the underlying mechanism was unknown, said Issidoros Sarinopoulos, professor of radiology at MSU.

“This is the first study that has looked at the patient-centered relationship from a neurobiological point of view,” said Sarinopoulos, the lead researcher. “It’s important for doctors and others who advocate this type of relationship with the patient to show that there is a biological basis.”

Published in the journal Patient Education and Counseling, the study was part of a broader effort at MSU, led by professor of medicine Robert Smith, to establish standards for patient-centered health care and measure its effectiveness.

“Medicine has for too long focused just on the physical dimensions of the patient,” said Smith, who co-authored the paper. “Those clinical questions are important and necessary, but we’re trying to demonstrate that when you let patients tell their story in an unfettered way, you get more satisfied patients who end up healthier.”