Christian Paret1, Matthias Ruf1, Traute demirakca1, Christian Schmahl2, and Gabriele Ende1
1Neuroimaging, Central Institute of Mental Health, Mannheim, Germany, 2Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Mannheim, Germany
Synopsis
fMRI neurofeedback on
emotion-related brain activation via a brain-computer interface can improve
brain self-regulation. We could show that neurofeedback is associated with
amygdala down-regulation and alterations in frontolimbic functional
connectivity in healthy female participants and female patients with borderline
personality disorder. Real-time fMRI neurofeedback may in future help patients
with severe emotion dysregulation to improve control over emotion-related brain
networks.Purpose
Real-time fMRI neurofeedback is a
new and quickly developing field with interesting implications for the
treatment of mental disorders such as borderline personality disorder (BPD).
There
is evidence that an improved regulation of disturbed brain circuits supported
by neurofeedback training may yield therapeutic benefits (1,2). Providing feedback on emotion-related brain activation via a brain-computer
interface can improve brain self-regulation. It was hypothesized, that
neurofeedback is associated with amygdala down-regulation (3) and alterations in
frontolimbic functional connectivity in healthy participants and patients with
BPD.
Methods
From
an amygdala ROI, the BOLD signal was calculated in a continuous EPI protocol
(TR=2s) and displayed to participants via a thermometer to the left and right
side of an emotional picture with negative valence. Healthy females participated
in one session (852 volumes) of amygdala feedback (experimental group, N=16) or
feedback from a control region (N=16). BPD patients (N=8) completed four
sessions. After each
session, a transfer run was applied to assess amygdala regulation without the
presentation of feedback. Before each session, a resting-state scan was acquired. Ratings of
dissociation-tension and emotion regulation difficulties were collected. After
standard preprocessing of fMRI images with SPM8, ROI and PPI analyses were performed
to assess neural effects of neurofeedback and transfer.
Results
Down-regulation of the amygdala was
achieved by healthy females and patients, lending initial support to the
feasibility of training. Amygdala
regulation in the transfer run was observed in the experimental group but not
in the control group. BPD patients did not transfer learning, indicating the
importance to optimize training. Altered amygdala-ventromedial
prefrontal connectivity was related to receiving amygdala neurofeedback in healthy
females and BPD patients, and was not observed
in the control group. In
addition, resting-state amygdala-dorsolateral prefrontal connectivity was
altered in BPD patients. Evidence was gathered for changes in perceived
emotion dysregulation and dissociation in patients.
Conclusion
Real-time fMRI neurofeedback may in future help patients with severe
emotion dysregulation to improve control over emotion-related brain networks. A
randomized controlled trial is currently prepared.
Acknowledgements
No acknowledgement found.References
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2. Stoeckel, L.E., Garrison, K.A., Ghosh, S.,Wighton, P., Hanlon, C.A., Gilman, J.M., et al., 2014. 581Optimizing real time fMRI neurofeedback for therapeutic discovery and develop- 582ment. Neuroimage Clin. 5, 245–255.
3. Paret, C., Kluetsch, R., Ruf, M., Demirakca, T., Hoesterey, S., Ende, G., et al., 2014. Down- 551regulation of amygdala activation with real-time fMRI neurofeedback in a healthy fe- 552male sample. Front. Behav. Neurosci. 8, 299