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Cardiac Control of Fear in Brain

Final Report Summary - CCFIB (Cardiac Control of Fear in Brain)

This grant accelerated the work of the Critchley laboratory on understanding how bodily arousal influences the way we think and feel. The research programme was based on our discovery that the way the brain’s processing of threatening / fear stimuli (e.g. facial expressions of fear) is ‘gated’ by the occurrence of individual heartbeats: Fear stimuli presented when the heart has just made a beat are processed more effectively than at other times. They are seen as being more fearful and are detected more readily. We termed this effect the Cardiac Control of Fear in Brain (CCFIB). The grant aimed to better characterize this effect and explore its practical application in clinical settings and inhuman machine interactions. Over the four-year course of the grant, we achieved the core objectives of the work, through a set of clinical, neuroimaging pharmacological and behavioural studies. These were organized along specific work-packages, described below. Local and national ethical committee approvals were followed for all the research, and an independent ethical advisory committee met over the course of the study to evaluate the progress of the work and write a report on the potential of the work for mission creep.
We first sought to refine knowledge about the CCFIB effect. Here we characterized how CCFIB was influenced differentially by blood pressure drugs (Losartan and Propanolol), anxiolytic medication (Pregabalin) and the ‘prosocial’ hormone (Oxytocin), We also tested the extent to which CCFIB only applied to visual depictions of fear, by examining heart timing effects to other stimulus types including. emotional scenes and noises, pictures of painful and non-painful situations (empathy for pain), words and face-name learning, stimuli at the edge of conscious perception, and on ‘stop’ and ‘go’ signals in reaction time experiments. Broadly, these studies demonstrated the facilitation by heartbeats of action, and selective inhibition of non-fear/threat stimuli. Significant cross disciplinary outputs from this work include the illustration with collaborators of a strong cardiac arousal influence on racial bias and perceived racial threat. We used brain imaging to dissect the neural substrates and interoceptive / affective pathways supporting CCFIB. These extended to novel studies of empathy, manipulations of peripheral physiological state, and pharmacological interventions. Clinically, we developed CCFIB for patient screening, validating its use in over 300 mental health outpatients, to show the amplification of CCFIB across anxiety patient groups and as interesting marked disruption of CCFIB in patients with schizophrenia. We are now mining follow-up data on over 200 patients for predictors of treatment outcome. We showed in behavioural fear conditioning) and a clinical study of phobia that heart/timing (CCFIB) can be exploited to enhance exposure therapy and fear extinction. Lastly, in a more exploratory part of the study we showed that hear timing influences responses to ballistic threats and have instigated this same effect in a driving simulator, to test how naturalistically the physiological state of the body at each heartbeat can affect safety-related human machine interactions.
The CCFIB Grant formed the basis if two subsequent grant successes; an ERC Proof of Concept Grant to develop the heartbeat detection / CCFIB tools for clinical screening and a grants from the mental health charity MQ to extend these screening tool toward psychological / behavioural training interventions to manage anxiety and performance. Knowledge and technology transfer is integral to both these follow-on research projects. Overall we consider the grant to be a major success and are grateful to the ERC through the University of Sussex for the transformative opportunities for ground-breaking research this support has afforded. The impact will continue through the publication of our wealth of findings.