Disrupted prefrontal activity during emotion processing in complicated grief: An fMRI investigation

•We examined functional activity during emotion processing in bereaved adults.•We compared three groups: Complicated Grief (CG), Non-Complicated Grief (NCG), and Nonbereaved.•CG individuals showed an absence of increased fronto-cortical recruitment relative to controls.•Activity in orbitofrontal cortex was elevated in the NCG group compared to Nonbereaved.•CG individuals show relative inability to recruit regions for grief-related emotion processing.

Complicated Grief, marked by a persistent and intrusive grief lasting beyond the expected period of adaptation, is associated with a relative inability to disengage from idiographic loss-relevant stimuli (O'Connor and Arizmendi, 2014). In other populations, functional magnetic resonance imaging (fMRI) studies investigating the neural networks associated with this bias consistently implicate the anterior cingulate cortex (ACC) during emotion regulation. In the present study, twenty-eight older adults were categorized into three groups based on grief severity: Complicated Grief (n = 8), Non-Complicated Grief (n = 9), and Nonbereaved, married controls (n = 11). Using a block design, all participants completed 8 blocks (20 stimuli per block) of the ecStroop task during fMRI data acquisition. Differences in neural activity during grief-related (as opposed to neutral) stimuli across groups were examined. Those with Complicated Grief showed an absence of increased rostral ACC (rACC) and fronto-cortical recruitment relative to Nonbereaved controls. Activity in the orbitofrontal cortex (x = 6, y = 54, z = − 10) was significantly elevated in the Non-Complicated Grief group when compared to Nonbereaved controls. Post hoc analysis evidenced activity in the dorsal ACC in the Complicated Grief and Nonbereaved groups late in the task. These findings, supported by behavioral data, suggest a relative inability to recruit the regions necessary for successful completion of this emotional task in those with Complicated Grief. This deficit was not observed in recruitment of the orbitofrontal cortex and the rACC during processing of idiographic semantic stimuli in Non-Complicated Grief.