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Cognitive and neuropsychopharmacological processes in human drug craving
Franken, I.H.A.
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Franken, I. H. A. (2003). Cognitive and neuropsychopharmacological processes in human drug craving s.l.: s.n.
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Download date: 31 Jul 2017
Chapterr 10
Neurophysiologicall Evidence for Abnormal Cognitive
Processingg of Drug Cues in Heroin Dependence
Recentt studies provide evidence for abnormal information processing in
addictivee disorders. The present study employs Event Related Potentials
(ERPs)) to investigate heroin related visual information processing. Neutrall and heroin related pictures were presented to 19 male abstinent
heroinn dependent patients and 14 male healthy controls. Patients exhibitedd larger Slow Positive Wave (SPW) components of the ERP on heroin
relatedd pictures than on neutral pictures. Within healthy control subjectss there was no difference on the SPW between neutral and heroin
pictures.. Within heroin dependent patients, mean SPW response to
heroinn pictures was correlated with post-experiment craving. This study
providess neurophysiological evidence that information processing of
drug-relatedd information is abnormal in heroin dependent patients. The
resultss provide further evidence for the cognitive and neurobiological
accountss of substance dependence such as the Incentive-Sensitization
theory. .
Ingmarr HA Franken, Cornells J Stam, Vincent M Hendriks, Wim van
denn Brink. Submitted.
Introduction n
Recently,, it has become clear that substancee dependence is associated with a
cognitivee processing bias. Studies indicate
thatt individuals with heroin, cocaine, nicotine,, and/or alcohol dependence process
substancee related stimuli in an abnormal
way 11 \ One of the cognitive processes that
iss changed is the excessive attentional focusingg on drug-related cues: attentional
bias.. Attentional bias is regarded as a cognitivee component of craving or may even be
responsiblee for craving 5 . Craving is one of
thee hallmarks of addiction and is partly responsiblee for relapse in drug use after a periodd of abstinence 6 . In previous studies, attentionall bias has been demonstrated using
paradigmss that employ behavioral measures
(reactionn time) as index of these cognitive
biases.. However, event-related potentials
(ERPs)) of the electroencephalogram (EEG)
offerr a more direct measure to study informationn processing and cognitive biases.
Comparedd to behavioral measures, the advantagess of ERPs measures are that they includee information on the spatial resolution
off the cognitive response, although this is
ratherr limited compared to other measures
ass functional Magnetic Resonance Imaging
(fMRI).. For example, EEGs provide informa-
tionn on the lateralization of emotional informationn processing. More importantly, the
ERPP measures have an extended temporal
rangee compared to behavioral measures.
Whilee typical reaction times are measured
withinn a time-frame of a second, the cognitivee processing of stimuli can be measured
withinn 6 seconds or longer.
Moree traditionally, the waves of interestt within emotionally elicited ERP are P3
andd P3-alike waves. The P3 component reflectss basic cognitive processes such as attentionn allocation and activation of immediatee memory 7 . The P3 is also influenced by
fluctuationss in the arousal state of subjects7.
Thiss evidence has resulted in the use of the
P33 amplitude as a tool for studying the cognitivee and affective processing of emotional
information.. In general, emotional stimuli
elicitt a more positive wave in the P3 area
thann neutral stimuli 811 . In addition, the P3
componentt has been investigated in the
fieldd of psychopathology. It has been found
thatt aversive disorder-related information
resultss in enhanced P3's in panic disorder
patients 12 ' 33 and post-traumatic stress patients'3"16.. In addition to enhanced P3's on
aversivee stimuli in avoidance-oriented disorderss such as anxiety, positive related informationn in approach related disorders also
elicitt an enhanced P3. Hermann and col89 9
Chapterr 10
leaguess found that cue elicited P3 was enhancedd in alcoholics 1 ' 18 , suggesting an enhancedd attentional processing of alcohol
cues.. In smokers, a similar effect of smoking
cuess on a P3 related component of the ERP,
thee P412, has been found' 9 .
Althoughh the study of P3 components in the
ERPP has advanced the knowledge on informationn processing in psychopathological
disorders,, the early ERP reactions do not
capturee the continuation of allocating attentionall resources that result in behavior seen
inn real life. Little is known about the continuationn of the processing of disorderrelatedd information after 400 ms. In real life,
w h e nn emotional or disorder-related cues
aree able to modify behavior they should
elicitt cognitive processes that last longer
andd should be measurable beyond 400 ms.
Forr example, it is demonstrated that drugrelatedd cues can elicit a cognitivemotivationall state that results in relapse
w i t h i nn in drug addicted subjects20. Slow
positivee waves of the ERP may reflect this
continuedd processing21. Recent studies
demonstratee that slow positive waves (positivityy after 400 ms) are adequate indicators
off selective cognitive processing, reflecting
ann activation of a motivational system in the
brain 9 .. These properties make Slow Waves
usefull for investigating the cognitive processingg of drug cue elicited responses.
Althoughh reaction time paradigms have
demonstratedd that processing biases are
presentt in addiction, their relationship with
drugg craving is relative unclear. In previous
research,, we found a relation between cravingg and attentional bias in cocaine 2 and
heroinn dependent patients'. Furthermore, a
relationn was found between memory bias
andd alcohol craving 22 .
Ass far as we know, no study addressed the
neurophysiologicall evidence for abnormal
cognitivee processing in heroin dependent
subjects.. The main hypothesis of the present
studyy is that heroin dependent patients have
largerr slow positive voltage change on heroinn pictures compared to neutral pictures.
Accordingg to the attentional bias theory,
thiss effect should not be present in healthy
90 0
controll subjects. In addition to Slow Waves,
thee differences on earlier components of the
ERPP are investigated. In addition, the hemisphericc distribution of this effect is investigated.. If the heroin stimuli represent appetitivee emotional value, left hemisphere
shouldd be more activated 23 . In contrast, if
heroinn stimuli represent aversive emotional
value,, right hemisphere should be more activated.. Furthermore, the correlation betweenn the magnitude of the mean amplitudee of the slow positive waves and the
magnitudee of subjective experience of heroinn craving is examined.
Methodss And Materials
Participants Participants
Twenty-threee eligible male heroin dependentt subjects were recruited from a detoxificationn unit of a substance abuse program
(Parnassiaa Mental Health Care). All participantss had been abstaining from illicit drug
usee (including heroin and cocaine) for a
minimumm of 2 weeks. At the time of testing
nonee of the subjects was taking prescribed
orr non-prescribed medications. Fifteen
healthyy control subjects who never used
opiatess were recruited from treatment staff.
Thiss group was chosen in order to control
forr familiarity effects on the ERP measure,
ass it is likely that treatment staff is frequentlyy exposed to heroin related cues and
heroinn related problems. Data from one
controll subject and four heroin dependent
subjectss were excluded from the analyses
becausee of excessive artifacts in the EEGsignal,, resulting in a final group of 19 heroinn dependent subjects and 14 healthy controll subjects. Candidates were excluded
fromm the study if one of the following conditionss was present: withdrawal symptoms,
lifetimee use of neuroleptic medication,
schizophrenia,, affective disorder, mental
retardation,, significant somatic disorders
suchh as Parkinson disease (or symptoms).
Alll subjects were male in order to rule out
genderr effects.
Thee heroin dependent group consisted of
100 subjects with lower education, 7 subjectss with middle education and 2 subjects
w i t hh higher education (according to the
Dutchh educational system). For the control
Chapterr 10
groupp these numbers were 3, 5, and 6, respectively.. Chi-square analysis showed that
thee educational level was not different for
bothh groups [^=5.47, yt?=ns]. The mean age
off the heroin dependent group was 33.5
yearss {SD=7.7) and of the control group
33.77 years (5£*=9.0), M31) =.08, p=r\s\.
Drugg use characteristics of the heroin dependentt group are summarized in table 1.
Mostt heroin dependent subjects (n=1 7) had
aa history of additional cocaine use andd most
subjectss had ever been in a methadone
maintenancee program (n=12).The study was
approvedd by the Ethical Committee of the
institutionn in which the work was performed. .
StimulusStimulus materials
Fromm the 36 color pictures (18 neutral, 18
heroin)) that were relevant for the present
studyb,, the neutral pictures were selected
fromm the international affective picture systemm (2190, 2200, 5500, 7000, 7010, 7020,
7050,, 7080, 7090, 7100, 7130, 7150,
7160,, 7170, 7180, 7500, 7550, 7700)24. In
addition,, 18 heroin related color pictures
consistingg of digital photographs of heroin
use,, and heroin paraphernalia were produced.. All pictures appeared on an IBMG544 monitor for 6000 ms in random order.
Thee inter-stimulus interval was a random
timee between 2 and 6 seconds in 3 blocks
off pictures. Before the pictures were shown,
twoo neutral pictures (7233, 71 75) served as
practicee trials.
Procedure Procedure
Eligiblee subjects were asked to participate
inn a study concerning the processing of
heroinn pictures. They were informed that
participationn involved EEG measurements
andd viewing pictures of heroin use. Both the
patientss and control subjects received a remunerationn of 20 euro. All subjects providedd written informed consent. The experimentt started with a short explanation of
thee procedure and informed consent was
obtained.. Personal data and history of drug
usee were recorded by the experimenter.
Thenn the subject completed the preexposuree questionnaires. After completion
thee subject was seated in the EEG chair and
electrodess were attached. Instructions were
too sit relaxed and still, and to attend to all
picturess without employing distracting fantasies.. Then the task was started. After the
picturee viewing, electrodes were removed
andd the heroin dependent group completed
aa post-exposure craving questionnaire. In
addition,, both groups rated the pictures o n
theirr arousal and valence properties. After
havingg completed the experiment, subjects
receivedd their financial compensation and
theree was a check by the experiment-leader
whetherr the craving levels in the heroin dependentt group were not unacceptable high.
Iff so, a cool-down-talk was provided until
cravingg levels were decreased to an acceptablee level.
Self-reportSelf-report measures
Demographicc data were self-reported (age,
education,, and length of treatment). Instant
cravingg was measured by the 14-item Desiree for Drug Questionnaire <DDQ)25. This
questionnairee was adapted from the Desires
forr Alcohol Questionnaire (DAQ) 26 for use
inn heroin addicts. It measures instant (now)
cravingg and consists of three subscales. The
threee subscales are: desire and intention to
usee drugs, negative reinforcement (the relief
off negative states), and perceived control
overr drug-use. The three subscales have
goodd reliability and concurrent validity 25 .
Drugg use severity was assessed by means of
thee Drug Use scale of the Addiction Severityy Index (ASI)27. Questions in this scale refer
too the different types of drugs used, the
numberss of days used, and duration of use.
Valencee and arousal properties of the picturess were assessed by the 2-item Self Assessmentt Manikin (SAM; Bradley & Lang28).
Thee SAM was used in order to quickly assesss reports of affective response on the a l coholl pictures. The SAM is a non-verbal
pictoriall assessment technique that directly
measuress the valence and arousal associatedd with a person's affective reaction to
emotionall stimuli.
bb Other pictures were used, however not reportedd here.
91 1
Chapterr 10
PhysiologicalPhysiological
measures
EEGG
was
measured
with
a
digital
Schwartzerr
amplifier
using
Electrocap
Ag/AgCll electrodes at the 21 scalp sites accordingg to the International 1 0 / 2 0 System,
rightt and left mastoid locations. Data were
recordedd using the Cz-channel as reference
andd off-line re-referenced to linked mastoid.
Thee vertical electro-oculogram (VEOG) was
recordedd with an Ag/AgCl electrode located
abovee the right eye, using the same reference.. The horizontal electro-oculogram
(HEOG)) was recorded bipolarly with two
Ag/AgCll electrodes located at the outer canthuss of each eye. A ground electrode was
placedd between Fz and Cz. All signals were
digitizedd without filtering on a PC using
Brainlabb (OSG, Belgium) software with a
samplee rate of 500Hz and 16-bit A/D conversion.. Off-line, the time constant was set
att 6 seconds and high frequencies were cutofff at 30 Hz (both phase shift-free Butterworthh filters; 24dB/octave slope). For all
electrodes,, impedance was kept under 10
K O h r r f \\ All physiological signals were analyzedd using BrainVision software (Brain
Products,,
Germany).
ERTS
software
(Berisoft,, Germany) run on an IBM PC was
usedd for timing and stimulus presentation.
Elevenn scalp electrodes (Cz, Pz, Fz, 02,
0 1 ,, F4, F3, C4, C3, P4, P3) were used in
thee present study.
DataData reduction and analysis
EEGG signal was measured from 200 ms beforee to 6000 ms after the onset of the visual
stimulus.. After ocular correction for blinks
withh the Gratton and Coles algorithm' 0 , all
segmentss with an EEG activity above 150
uVV or a gradient above 50 pV (more than
500 pV step / sampling point) were excluded
fromm further analysis. After baseline correctionn all segments were averaged by category.. Based on visual inspection of the
overalll grand average waveform (including
neutrall and heroin trials patient and control
groups)) three early peaks could be identified,, the N 1 , P2 and P3. The N1 was definedd as the local maximum negative peak
amplitudee in the 0-100 ms time range. The
P22 was defined as the local maximum positivee peak amplitude in the 1 50-200 ms time
92 2
range.. The P3 was defined as the local
maximumm positive peak amplitude in the
300-4000 ms time range. For the early
waves,, for each peak a repeated measurementt A N O V A with group as betweensubjectss factor and picture category and
electrodee site as within-subjects factor was
usedd to test for between- and within-group
differencess and interactions, resulting in a
111 (Electrode site) x 2 (Cue type) x 2
(Group)) repeated measurement ANOVA.
Inn contrast to the early waveforms, visuall inspection of the ERP grand average
waveformm showed that slow wave peaks
weree not pronounced (figure 1) and area
measurement,, according to Cuthbert et
al. 9,3 ',, seemed more appropriate. Since in
thee present study the same paradigm was
usedd for stimulus presentation, for replicationn purposes we used the same time windowss as Cuthbert and colleagues 9 . A windoww from 400-700 captured the extended
P33 (Ext. P3) area, a window from 700 to
10000 ms captured the slow positive wave
(SPW),, and the 1000 to 6000 window capturedd the sustained slow positive wave
(SSPW).. For the slow waves, repeated
measurementt A N O V A with group as between-subjectss factor and picture category
andd electrode site and time-domain as
within-subjectss factor resulted in a 3 (Timedomain)) x 11 (Electrode site) x 2 (Cue type)
xx 2 (Group) repeated measurement ANOVA
whichh was used to test for between- and
within-groupp differences and interactions.
Contrastt analysis was used in order to identifyy specific differences. In addition, four
separatee ANOVA's were conducted in order
too investigate laterality effects on frontal,
central,, parietal, and occipital sites. For this
ANOVA,, the site factor was replaced by the
lateralityy as within-subjects factor. For all
ANOVA'ss reported, a Greenhouse-Geisser
adjustmentt on the df's was conducted when
appropriate.. In addition, Spearman correlationn coefficients were calculated between
cravingg levels after the experiment and
meann amplitude of ERP components of responsess on neutral and heroin pictures. An
alpha-levell of 0.05 was used for all statisticall tests.
Chapterr 10
domainn [fi2,30)=20.07, / x . 0 0 0 1 ] . Analysis
Results s
MainMain and interaction effects of early waves off the means indicated that the Ext-P3 had
thee largest amplitude compared to the other
Forr the N1 peak, no significant main or incategories.. Furthermore, a main effect was
teractionn
effect
could
be
observed
foundd
for picture category [/^1,31)=7.10,
[F's<3.49,[F's<3.49, ns]. For the P2 peak , only
a
p=.012].. Compared to neutral pictures,
mainn electrode site effect was found [F
wavee amplitude was more pronounced on
(10,31)=12.69,/x.0001].. Because this findheroinn pictures compared to neutral picingg was not relevant for the hypothesis, no
tures.. A main site effect revealed that amplicontrastt analysis was conducted.
tudess were not equally distributed among
thee
sites. Contrast analysis showed that the
M M SD SD
largestt positivity was found for P3, P4 and
?z?z sites [/U,31)=25.74, 7.74, 36,89] respectively.. In addition to the within-subjects
22.9 9 6.7 7
Agee of first heroin use (> 3
timess a week) (n=19)
effects,, a main between-subjects effect was
Agee of first cocaine use (> 3 20.3 3 5.6 6
foundd [F (1,31 )=10.42, p=.003]. Overall,
timess a week) (n=17)
patientss exhibited more positivity than conAgee of first methadone use (> 26.0 0 5.9 9
troll subjects.
33 times a week) (n=12)
9.0 0 6.7 7
Totall years of heroin use
(n=19) )
11.1 1 6.6 6
Totall years of cocaine use
(n=17) )
Totall years of methadone use 4.1 1 5.6 6
(n=12) )
25.8 8 9.5 5
Numberr of days of heroin
usee in month before
detoxificationn (n=19)
Numberr of days of cocai ne 24.7 7 9.8 8
usee in month before
detoxificationn (n=17)
14.5 5 13.2 2
Numberr of days of
methadonee use in month
beforee detoxification (n=12)
Czz C O N * K U PAT-neu
Tablee 1. Drug use characteristics of the heroin
dependentt group.
Forr the P3 peak, main effects were found
forr electrode site [fl10,31)=22.72, P<
.0001]]
and
Cue-type
[fi1,31)=5.09,
p=.031].p=.031]. Overall, heroin pictures elicited
largerr P3 peak amplitude than neutral pictures.. In addition, a Cue-type x Site interactionn
was
observed
[/^10,31)=7.01,
yCK.0001].. Because on neither N 1 , P2, nor
P33 the hypothesized Croup x Cue interactionn effect could be observed, no further
statisticall analyses were conducted with
Figuree 2. Average event related potentials at the
thesee early peaks.
vertexx (Cz) site for control subjects (black line)
andd heroin dependent subjects (gray line) in responsee to neutral pictures (above) and heroin
MainMain effects of slow waves
relatedd pictures (below).
Alll main effects in the A N O V A were significant.. A main effect was found for time93 3
Chapterr 10
InteractionInteraction effects of slow waves
Concerningg the main hypothesis of this
study,, a Cue type x Group interaction effect
wass found [fl1,30)=8.87, / T = . 0 0 6 ] , indicatingg that overall positivity in the heroin
group,, but not in the control group, was
moree pronounced on heroin pictures than
onn the neutral pictures. The mean amplitudess of the three slow waves are displayed
inn table 2. In addition two more significant
interactionn effects were found (time x site;
timee x site x cue). However, they are not
furtherr reported here because they are not
relevantt for the aim of the present study.
LateralityLaterality effects of slow waves
Forr frontal, occipital and parietal sites, no
significantt effect was found on laterality.
Forr central sites (C4-C3), a time-domain x
lateralityy x cue type effect was observed [F
(2,30)=13.74,, p<.000^].
Contrast analysis
indicatedd that within the SPW and the
SSPVV,, heroin cues elicited larger positivity
onn the left hemisphere sites [/^1,30) = 6.07,
p=.019;; fl1,30)=18.25, / x . 0 0 0 1 ] than right
hemisphere.. However, no significant group
effectt on these analyses could be observed.
Tablee 2. Mean amplitudes of the three slow
wavess (in uV) collapsed over Fz, Cz and Pz of
bothh groups on neutral and heroin cues.
Cuee type Healthy y
controls s
MM
Heroin n
dependent t
patients s
SD D M M
SD D
Ext.. P3
Neutral l -2.24 4 6.2 2
2.8 8
6.0 0
Heroin n -4.7 7
7.7 7.7 5.6 6
5.9 9
Neutral l -.6 6
4.8 8
3.2 2
5.0 0
Heroin n -1.8 8
6.4 4
8.4 4
5.2 2
Neutral l 1.5 5
4.1 1
3.4 4
4.3 3
Heroin n -.2 2
2.5 5
8.0 0
5.2 2
SPW W
SSPW W
Self-reportedSelf-reported
valence, arousal and
waves waves
Self-reportedd valence and arousal using the
SAMM was not correlated with any of the ERP
Self-reportedSelf-reported era ving and slow wa veswavess elicited by neutral cues. Valence was
Nonee of the Ext. P3, SPWs or SSPWs elicalsoo not correlated with any of the ERP
itedd by neutral cues were significantly corwavess elicited by heroin cues. However, for
relatedd with self-reported craving [all p's >
thee central sites (C4, C3 and Cz), Ext. P3
.11].. However, a significant correlation was
amplitudee elicited by heroin cues [r=.51,
foundd between SPW amplitudes at the Fz
/^.52,, r=.49, respectively; all p<.035] and
sitee on heroin cues and the DDQ-control
SPWW amplitude elicited by heroin cues
scalee [r=-A8, p=.038]. Furthermore, signifi[^=.42,, r=.48,
r=.54,
respectively; all
cantt correlations were found between the
p<.035]] were significantly correlated with
SSPWW amplitude at the C3 site and the
self-reportedd arousal. The SSPW amplitude
D D QQ scales desire [r=.47, p=.042]
and
elicitedd by heroin cues was also correlated
negativee reinforcement craving
[^=.48,
withh self-reported arousal at Cz site [r=J7,
yC*=.039].. At the C4 site a correlation was
p<.p<. 00011.
foundd between SSPW amplitude and negativee reinforcement craving [r=.46, p=.045].
Furthermore,, a negative correlation was
foundd for the SSPW amplitude at the Pz site
andd the D D Q control scale
[r=-.50,
Z ^ . 0 3 0 ] .. The strongest correlation was
foundd between the D D Q desire scale and
thee SSPW amplitude at the Cz site \r=.b0,
/7-.006;; figure 3].
94 4
slow
Chapterr 10
10 0
coo
6
gg
0. .
mm
'SS
4-
0> >
oo
13 3
"5. .
00
1
2
3
4
5
6
7
Heroinn Craving (desire)
Figuree 3. Correlation between the amplitude of
SSPWW at Cz (in uV) and cue-elicited self-reported
heroinn craving.
Conclusions s
Thee main finding of this study is that heroin
dependentt patients exhibited enhanced
Sloww Positive Wave amplitude elicited by
heroinn pictures compared to neutral pictures.. This difference was specific for the
groupp of abstinent heroin patients, and was
nott found within the healthy controls. The
findingg that the Slow Wave to heroin picturess is greatly enhanced in heroin dependentt patients suggests that these heroin cues
aree selected by the brain for sustained attentivee processing'. This is in accordance with
thee Incentive-Sensitization Theory of Robinsonn & Berridge32, who claim that classically
conditionedd drug related stimuli have acquiredd attention-grabbing properties. The
presentt study shows that this enhanced attentionall processing sustains during at least
aa period of 6 seconds. Although the present
studyy design does not allow for causality
speculating,, it is conceivable that this prolongedd processing bias results in increased
craving.. Although the reactivity of the Slow
Wavess was in the hypothesized direction,
wee failed to find any Group x Cue interactionn effects on the earlier (<400 ms) ERP
components.. Typically, studies using emotionall information yield mainly effects in
thee post 400 ms time-frames in contrast to
thee earlier time-frames' 2 .However, there are
previouss studies using pictures as stimuli
thatt did find differences on early ERP componentss such as the P3'?. However, in their
study,, Herrmann and colleagues did not
statisticallyy correct for multiple testing and
theirr findings were also marginally significant. .
Furthermore,, the question can be raised
whetherr early ERP components are adequatee measures when it comes to measuringg reactivity on pictorial stimuli. Probably,
earlyy components reflect rather basic stimuluss properties such as contrast, complexity
off the scene, and colors. It is conceivable
thatt early components are more useful
whenn using less complex stimuli such as
words' 2 . .
Thee finding that the amplitude of the slow
wavess of the cue elicited ERP are correlated
withh self-reported heroin craving and
arousal,, suggests that the slow wave in
thesee kinds of paradigms represent motivationall significance. This concurs with the
vieww of Schupp and colleagues" that the
latee positive potential is modulated by motivationall relevance. However, this finding
iss in contrast with Warren & McDonough' 9
whoo failed to find a relation between smokingg urge and earlier ERP components
(P412).. Together, these findings indicates
thatt slow waves may be more adequate indexess of motivational relevance than earlier
components.. Although it should be noted
thatt the correlation testing comprises multiplee significance testing, thereby inflating
Typee I errors, the correlations between the
Sloww Waves at Central sites and reported
cravingg were very consistent and large in
effectt and can therefore be considered robust. .
Inn concordance with earlier work by
Cuthbertt and colleagues 9 , we did not find
lateralityy effects. Although we did find an
indicationn that the evoked potentials responsess on the heroin pictures were more
pronouncedd in the left hemisphere than the
rightt hemisphere we failed to find any
groupp differences. It was hypothesized that
heroinn stimuli elicited more pronounced
activationn in one hemisphere compared to
controll subjects for whom the heroin picturess can be regarded as neutrally valenced.
Thee hypothesis concerning the appetiveness
')r> >
Chapterr 10
behaviourall and ERP data. Cognition
&
Emotion.Emotion. 1 995;9{5):507-523.
9..
Cuthbert BN, Schupp HT, Bradley M M ,
effectss i n the present s t u d y . As p h y s i o l o g i c a l
Birbaumerr N, Lang PJ. Brain potentials in
a l t e r n a t i v ee for self-report, m e a s u r e m e n t of
affectivee picture processing: covariation
t h ee m o d u l a t i o n o f t h e e y e - b l i n k startle rewithh autonomic arousal and affective res p o n s ee is p r o b a b l y a better w a y t o evaluate
port.. Biol Psychol. 2000;52(2):95 - 11J.
t h ee v a l e n c e of t h e p r e s e n t e d s t i m u l i than
10.. Carretie L, Martin-Loeches M, HinojosaJA,
ERPs344 35, e v e n t h o u g h t h e results o n t h e starMercadoo F. Emotion and attention interact l ee r e s p o n s e in a d d i c t i o n are n o t always
tionn studied through event-related potentials.. } Cognitive
Neuroscience.
2001;
consistent31. .
13:1109-1128. .
Researchh is n e e d e d t h a t addresses the
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Diedrich O, Naumann E, Maier S, Becker
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slides.. ) Psychophysiol. 1997;! 1:71-84.
h e r o i n ,, c o c a i n e a n d a l c o h o l c r a v i n g 1 2 2 3 1 3 6 .
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