Effects of bright light therapy for depression during pregnancy: a randomised, double-blind controlled trial.

OBJECTIVES: Approximately 11%-13% of pregnant women suffer from depression. Bright light therapy (BLT) is a promising treatment, combining direct availability, sufficient efficacy, low costs and high safety for both mother and child. Here, we examined the effects of BLT on depression during pregnancy. DESIGN: Randomised, double-blind controlled trial. SETTING: Primary and secondary care in The Netherlands, from November 2016 to March 2019. PARTICIPANTS: 67 pregnant women (12-32 weeks gestational age) with a DSM-5 diagnosis of depressive disorder (Diagnostic and Statistical Manual of Mental Disorders). INTERVENTIONS: Participants were randomly allocated to treatment with either BLT (9000 lux, 5000 K) or dim red light therapy (DRLT, 100 lux, 2700 K), which is considered placebo. For 6 weeks, both groups were treated daily at home for 30 min on awakening. Follow-up took place weekly during the intervention, after 6 weeks of therapy, 3 and 10 weeks after treatment and 2 months postpartum. PRIMARY AND SECONDARY OUTCOME MEASURES: Depressive symptoms were measured primarily with the Structured Interview Guide for the Hamilton Depression Scale-Seasonal Affective Disorder. Secondary measures were the Hamilton Rating Scale for Depression and the Edinburgh Postnatal Depression Scale. Changes in rating scale scores of these questionnaires over time were analysed using generalised linear mixed models. RESULTS: Median depression scores decreased by 40.6%-53.1% in the BLT group and by 50.9%-66.7% in the DRLT group. We found no statistically significant difference in symptom change scores between BLT and DRLT. Sensitivity and post-hoc analyses did not change our findings. CONCLUSIONS: Depressive symptoms of pregnant women with depression improved in both treatment arms. More research is necessary to determine whether these responses represent true treatment effects, non-specific treatment responses, placebo effects or a combination hereof. TRIAL REGISTRATION NUMBER: NTR5476.

Spectral Tuning of White Light Allows for Strong Reduction in Melatonin Suppression without Changing Illumination Level or Color Temperature.

Studies with monochromatic light stimuli have shown that the action spectrum for melatonin suppression exhibits its highest sensitivity at short wavelengths, around 460 to 480 nm. Other studies have demonstrated that filtering out the short wavelengths from white light reduces melatonin suppression. However, this filtering of short wavelengths was generally confounded with reduced light intensity and/or changes in color temperature. Moreover, it changed the appearance from white light to yellow/orange, rendering it unusable for many practical applications. Here, we show that selectively tuning a polychromatic white light spectrum, compensating for the reduction in spectral power between 450 and 500 nm by enhancing power at even shorter wavelengths, can produce greatly different effects on melatonin production, without changes in illuminance or color temperature. On different evenings, 15 participants were exposed to 3 h of white light with either low or high power between 450 and 500 nm, and the effects on salivary melatonin levels and alertness were compared with those during a dim light baseline. Exposure to the spectrum with low power between 450 and 500 nm, but high power at even shorter wavelengths, did not suppress melatonin compared with dim light, despite a large difference in illuminance (175 vs. <5 lux). In contrast, exposure to the spectrum with high power between 450 and 500 nm (also 175 lux) resulted in almost 50% melatonin suppression. For alertness, no significant differences between the 3 conditions were observed. These results open up new opportunities for lighting applications that allow for the use of electrical lighting without disturbance of melatonin production.

Acute alerting effects of light: A systematic literature review.

Periodic, well timed exposure to light is important for our health and wellbeing. Light, in particular in the blue part of the spectrum, is thought to affect alertness both indirectly, by modifying circadian rhythms, and directly, giving rise to acute effects. We performed a systematic review of empirical studies on direct, acute effects of light on alertness to evaluate the reliability of these effects. In total, we identified 68 studies in which either light intensity, spectral distribution, or both were manipulated, and evaluated the effects on behavioral measures of alertness, either subjectively or measured in reaction time performance tasks. The results show that increasing the intensity of polychromatic white light has been found to increase subjective ratings of alertness in a majority of studies, though a substantial proportion of studies failed to find significant effects, possibly due to small sample sizes or high baseline light intensities. The effect of the color temperature of white light on subjective alertness is less clear. Some studies found increased alertness with higher color temperatures, but other studies reported no detrimental effects of filtering out the short wavelengths from the spectrum. Similarly, studies that used monochromatic light exposure showed no systematic pattern for the effects of blue light compared to longer wavelengths. Far fewer studies investigated the effects of light intensity or spectrum on alertness as measured with reaction time tasks and of those, very few reported significant effects. In general, the small sample sizes used in studies on acute alerting effects of light make it difficult to draw definitive conclusions and better powered studies are needed, especially studies that allow for the construction of dose-response curves.

Correlated colour temperature of morning light influences alertness and body temperature.

Though several studies have reported human alertness to be affected by the intensity and spectral composition of ambient light, the mechanism behind this effect is still largely unclear, especially for daytime exposure. Alerting effects of nocturnal light exposure are correlated with melatonin suppression, but melatonin levels are generally low during the day. The aim of this study was to explore the alerting effect of light in the morning for different correlated colour temperature (CCT) values, as well as its interaction with ambient temperature. Body temperature and perceived comfort were included in the study as possible mediating factors. In a randomized crossover design, 16 healthy females participated in two sessions, once under 2700K and once under 6500K light (both 55lx). Each session consisted of a baseline, a cool, a neutral and a warm thermal environment. Alertness as measured in a reaction time task was lower for the 6500K exposure, while subjective sleepiness was not affected by CCT. Also, core body temperature was higher under 6500K. Skin temperature parameters and perceived comfort were positively correlated with subjective sleepiness. Reaction time correlated with heat loss, but this association did not explain why the reaction time was improved for 2700K.

Reading "sun" and looking up: the influence of language on saccadic eye movements in the vertical dimension.

Traditionally, language processing has been attributed to a separate system in the brain, which supposedly works in an abstract propositional manner. However, there is increasing evidence suggesting that language processing is strongly interrelated with sensorimotor processing. Evidence for such an interrelation is typically drawn from interactions between language and perception or action. In the current study, the effect of words that refer to entities in the world with a typical location (e.g., sun, worm) on the planning of saccadic eye movements was investigated. Participants had to perform a lexical decision task on visually presented words and non-words. They responded by moving their eyes to a target in an upper (lower) screen position for a word (non-word) or vice versa. Eye movements were faster to locations compatible with the word's referent in the real world. These results provide evidence for the importance of linguistic stimuli in directing eye movements, even if the words do not directly transfer directional information.

Velocity-dependent dynamic curvature gain for redirected walking.

Redirected walking techniques allow people to walk in a larger virtual space than the physical extents of the laboratory. We describe two experiments conducted to investigate human sensitivity to walking on a curved path and to validate a new redirected walking technique. In a psychophysical experiment, we found that sensitivity to walking on a curved path was significantly lower for slower walking speeds (radius of 10 m versus 22 m). In an applied study, we investigated the influence of a velocity-dependent dynamic gain controller and an avatar controller on the average distance that participants were able to freely walk before needing to be reoriented. The mean walked distance was significantly greater in the dynamic gain controller condition, as compared to the static controller (22 m versus 15 m). Our results demonstrate that perceptually motivated dynamic redirected walking techniques, in combination with reorientation techniques, allow for unaided exploration of a large virtual city model.

Integration of vestibular and proprioceptive signals for spatial updating.

Spatial updating during self-motion typically involves the appropriate integration of both visual and non-visual cues, including vestibular and proprioceptive information. Here, we investigated how human observers combine these two non-visual cues during full-stride curvilinear walking. To obtain a continuous, real-time estimate of perceived position, observers were asked to continuously point toward a previously viewed target in the absence of vision. They did so while moving on a large circular treadmill under various movement conditions. Two conditions were designed to evaluate spatial updating when information was largely limited to either proprioceptive information (walking in place) or vestibular information (passive movement). A third condition evaluated updating when both sources of information were available (walking through space) and were either congruent or in conflict. During both the passive movement condition and while walking through space, the pattern of pointing behavior demonstrated evidence of accurate egocentric updating. In contrast, when walking in place, perceived self-motion was underestimated and participants always adjusted the pointer at a constant rate, irrespective of changes in the rate at which the participant moved relative to the target. The results are discussed in relation to the maximum likelihood estimation model of sensory integration. They show that when the two cues were congruent, estimates were combined, such that the variance of the adjustments was generally reduced. Results also suggest that when conflicts were introduced between the vestibular and proprioceptive cues, spatial updating was based on a weighted average of the two inputs.

Humans do not have direct access to retinal flow during walking.

Perceived visual speed has been reported to be reduced during walking. This reduction has been attributed to a partial subtraction of walking speed from visual speed (F. H. Durgin & K. Gigone, 2007; F. H. Durgin, K. Gigone, & R. Scott, 2005). We tested whether observers still have access to the retinal flow before subtraction takes place. Observers performed a 2IFC visual speed discrimination task while walking on a treadmill. In one condition, walking speed was identical in the two intervals, while in a second condition walking speed differed between intervals. If observers have access to the retinal flow before subtraction, any changes in walking speed across intervals should not affect their ability to discriminate retinal flow speed. Contrary to this "direct access hypothesis," we found that observers were worse at discrimination when walking speed differed between intervals. The results therefore suggest that observers do not have access to retinal flow before subtraction. We also found that the amount of subtraction depended on the visual speed presented, suggesting that the interaction between the processing of visual input and of self-motion is more complex than previously proposed.

Walking straight into circles.

Common belief has it that people who get lost in unfamiliar terrain often end up walking in circles. Although uncorroborated by empirical data, this belief has widely permeated popular culture. Here, we tested the ability of humans to walk on a straight course through unfamiliar terrain in two different environments: a large forest area and the Sahara desert. Walking trajectories of several hours were captured via global positioning system, showing that participants repeatedly walked in circles when they could not see the sun. Conversely, when the sun was visible, participants sometimes veered from a straight course but did not walk in circles. We tested various explanations for this walking behavior by assessing the ability of people to maintain a fixed course while blindfolded. Under these conditions, participants walked in often surprisingly small circles (diameter < 20 m), though rarely in a systematic direction. These results rule out a general explanation in terms of biomechanical asymmetries or other general biases [1-6]. Instead, they suggest that veering from a straight course is the result of accumulating noise in the sensorimotor system, which, without an external directional reference to recalibrate the subjective straight ahead, may cause people to walk in circles.

Walking along curved paths of different angles: the relationship between head and trunk turning.

Walking along a curved path requires coordinated motor actions of the entire body. Here, we investigate the relationship between head and trunk movements during walking. Previous studies have found that the head systematically turns into turns before the trunk does. This has been found to occur at a constant distance rather than at a constant time before a turn. We tested whether this anticipatory head behavior is spatially invariant for turns of different angles. Head and trunk positions and orientations were measured while participants walked around obstacles in 45 degrees, 90 degrees, 135 degrees or 180 degrees turns. The radius of the turns was either imposed or left free. We found that the head started to turn into the direction of the turn at a constant distance before the obstacle (approximately 1.1 m) for turn angles up to 135 degrees . During turns, the head was consistently oriented more into the direction of the turn than the trunk. This difference increased for larger turning angles and reached its maximum later in the turn for larger turns. Walking speeds decreased monotonically for increasing turn angles. Imposing fixed turn radii only affected the point at which the trunk started to turn into a turn. Our results support the view that anticipatory head movements during turns occur in order to gather advance visual information about the trajectory and potential obstacles.

Motion perception during sinusoidal smooth pursuit eye movements: signal latencies and non-linearities.

Smooth pursuit eye movements add motion to the retinal image. To compensate, the visual system can combine estimates of pursuit velocity and retinal motion to recover motion with respect to the head. Little attention has been paid to the temporal characteristics of this compensation process. Here, we describe how the latency difference between the eye movement signal and the retinal signal can be measured for motion perception during sinusoidal pursuit. In two experiments, observers compared the peak velocity of a motion stimulus presented in pursuit and fixation intervals. Both the pursuit target and the motion stimulus moved with a sinusoidal profile. The phase and amplitude of the motion stimulus were varied systematically in different conditions, along with the amplitude of pursuit. The latency difference between the eye movement signal and the retinal signal was measured by fitting the standard linear model and a non-linear variant to the observed velocity matches. We found that the eye movement signal lagged the retinal signal by a small amount. The non-linear model fitted the velocity matches better than the linear one and this difference increased with pursuit amplitude. The results support previous claims that the visual system estimates eye movement velocity and retinal velocity in a non-linear fashion and that the latency difference between the two signals is small.

Frame of reference transformations in motion perception during smooth pursuit eye movements.

Smooth pursuit eye movements change the retinal image velocity of objects in the visual field. In order to change from a retinocentric frame of reference into a head-centric one, the visual system has to take the eye movements into account. Studies on motion perception during smooth pursuit eye movements have measured either perceived speed or perceived direction during smooth pursuit to investigate this frame of reference transformation, but never both at the same time. We devised a new velocity matching task, in which participants matched both perceived speed and direction during fixation to that during pursuit. In Experiment 1, the velocity matches were determined for a range of stimulus directions, with the head-centric stimulus speed kept constant. In Experiment 2, the retinal stimulus speed was kept approximately constant, with the same range of stimulus directions. In both experiments, the velocity matches for all directions were shifted against the pursuit direction, suggesting an incomplete transformation of the frame of reference. The degree of compensation was approximately constant across stimulus direction. We fitted the classical linear model, the model of Turano and Massof (2001) and that of Freeman (2001) to the velocity matches. The model of Turano and Massof fitted the velocity matches best, but the differences between de model fits were quite small. Evaluation of the models and comparison to a few alternatives suggests that further specification of the potential effect of retinal image characteristics on the eye movement signal is needed.

Localization and motion perception during smooth pursuit eye movements.

We investigated the relationship between compensation for the effects of smooth pursuit eye movements in localization and motion perception. Participants had to indicate the perceived motion direction, the starting point and the end point of a vertically moving stimulus dot presented during horizontal smooth pursuit. The presentation duration of the stimulus was varied. From the indicated starting and end points, the motion direction was predicted and compared with the actual indicated directions. Both the directions predicted from localization and the indicated directions deviated from the physical directions, but the errors in the predicted directions were larger than those in the indicated directions. The results of a control experiment, in which the same tasks were performed during fixation, suggest that this difference reflects different transformations from a retinocentric to a head-centric frame of reference. This difference appears to be mainly due to an asymmetry in the effect of retinal image motion direction on localization during smooth pursuit.

Perceived motion direction during smooth pursuit eye movements.

Although many studies have been devoted to motion perception during smooth pursuit eye movements, relatively little attention has been paid to the question of whether the compensation for the effects of these eye movements is the same across different stimulus directions. The few studies that have addressed this issue provide conflicting conclusions. We measured the perceived motion direction of a stimulus dot during horizontal ocular pursuit for stimulus directions spanning the entire range of 360 degrees. The stimulus moved at either 3 or 8 degrees/s. Constancy of the degree of compensation was assessed by fitting the classical linear model of motion perception during pursuit. According to this model, the perceived velocity is the result of adding an eye movement signal that estimates the eye velocity to the retinal signal that estimates the retinal image velocity for a given stimulus object. The perceived direction depends on the gain ratio of the two signals, which is assumed to be constant across stimulus directions. The model provided a good fit to the data, suggesting that compensation is indeed constant across stimulus direction. Moreover, the gain ratio was lower for the higher stimulus speed, explaining differences in results in the literature.

Vertical object motion during horizontal ocular pursuit: compensation for eye movements increases with presentation duration.

Smooth pursuit eye movements change the retinal image motion of objects in the visual field. To enable an observer to perceive the motion of these objects veridically, the visual system has to compensate for the effects of the eye movements. The occurrence of the Filehne-illusion (illusory motion of a stationary object during smooth pursuit) shows that this compensation is not always perfect. The amplitude of the illusion appears to decrease with increasing presentation durations of the stationary object. In this study we investigated whether presentation duration has the same effect when an observer views a vertically moving object during horizontal pursuit. In this case, the pursuit eye movements cause the perceived motion path to be oblique instead of vertical; this error in perceived motion direction should decrease with higher presentation durations. In Experiment 1, we found that the error in perceived motion direction indeed decreased with increasing presentation duration, especially for higher pursuit velocities. The results of Experiment 2 showed that the error in perceived motion direction did not depend on the moment during pursuit at which the stimulus was presented, suggesting that the degree of compensation for eye movements is constant throughout pursuit. The results suggest that longer presentation durations cause the eye movement signal that is used by the visual system to increase more than the retinal signal.