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Zopfs M, Jindrová M, Gurevitch G, Keynan JN, Hendler T, Baumeister S, Aggensteiner PM, Cornelisse S, Brandeis D, Schmahl C, Paret C. Amygdala-related electrical fingerprint is modulated with neurofeedback training and correlates with deep-brain activation: proof-of-concept in borderline personality disorder. Psychol Med 2024; 54:1651-1660. [PMID: 38131344 DOI: 10.1017/s0033291723003549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
BACKGROUND The modulation of brain circuits of emotion is a promising pathway to treat borderline personality disorder (BPD). Precise and scalable approaches have yet to be established. Two studies investigating the amygdala-related electrical fingerprint (Amyg-EFP) in BPD are presented: one study addressing the deep-brain correlates of Amyg-EFP, and a second study investigating neurofeedback (NF) as a means to improve brain self-regulation. METHODS Study 1 combined electroencephalography (EEG) and simultaneous functional magnetic resonance imaging to investigate the replicability of Amyg-EFP-related brain activation found in the reference dataset (N = 24 healthy subjects, 8 female; re-analysis of published data) in the replication dataset (N = 16 female individuals with BPD). In the replication dataset, we additionally explored how the Amyg-EFP would map to neural circuits defined by the research domain criteria. Study 2 investigated a 10-session Amyg-EFP NF training in parallel to a 12-weeks residential dialectical behavior therapy (DBT) program. Fifteen patients with BPD completed the training, N = 15 matched patients served as DBT-only controls. RESULTS Study 1 replicated previous findings and showed significant amygdala blood oxygenation level dependent activation in a whole-brain regression analysis with the Amyg-EFP. Neurocircuitry activation (negative affect, salience, and cognitive control) was correlated with the Amyg-EFP signal. Study 2 showed Amyg-EFP modulation with NF training, but patients received reversed feedback for technical reasons, which limited interpretation of results. CONCLUSIONS Recorded via scalp EEG, the Amyg-EFP picks up brain activation of high relevance for emotion. Administering Amyg-EFP NF in addition to standardized BPD treatment was shown to be feasible. Clinical utility remains to be investigated.
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Affiliation(s)
- Malte Zopfs
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - Miroslava Jindrová
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - Guy Gurevitch
- Sagol Brain Institute, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Jackob N Keynan
- Brain Stimulation Lab, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Talma Hendler
- Sagol Brain Institute, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
- School of Psychological Sciences and Sagol School of Neuroscience, Tel-Aviv University, Tel-Aviv, Israel
| | - Sarah Baumeister
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - Pascal-M Aggensteiner
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - Sven Cornelisse
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - Daniel Brandeis
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital of Psychiatry, University of Zurich, Zurich, Switzerland
- Neuroscience Center Zurich, University of Zurich and ETH Zurich, Zurich, Switzerland
| | - Christian Schmahl
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - Christian Paret
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
- Sagol Brain Institute, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
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Torres CB, Barona EJG, Molina MG, Sánchez MEGB, Manso JMM. A systematic review of EEG neurofeedback in fibromyalgia to treat psychological variables, chronic pain and general health. Eur Arch Psychiatry Clin Neurosci 2024; 274:981-999. [PMID: 37179502 PMCID: PMC11127810 DOI: 10.1007/s00406-023-01612-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 04/11/2023] [Indexed: 05/15/2023]
Abstract
This paper is the first up-to-date review of the various EEG-neurofeedback treatments for fibromyalgia patients and their psychological, physiological and general health consequences. Searches were made of the PubMed, PsycNet, Google Scholar and Scopus databases according to PRISMA guidelines for empirical peer-reviewed articles on EEG-neurofeedback treatment of fibromyalgia, yielding a final selection of 17 studies that met the inclusion criteria: (1) published articles and doctoral theses; (2) conducted between 2000 and 2022; (3) reporting empirical and quantitative data. These articles show that there is a wide range of protocols with different designs and procedures to treat fibromyalgia using EEG-neurofeedback techniques. The main symptoms that showed improvement were anxiety, depression, pain, general health and symptom severity, whilst the most commonly used method was traditional EEG neurofeedback based on a sensorimotor rhythm protocol. It may be concluded from the review that the lack of consistency and uniqueness of the protocols makes it very difficult to generalise results, despite the individual improvements identified. This review provides instructions and information that could guide future research and clinical practise, with the data extracted helping to gain a deeper understanding of the state of the art and the needs of the technique for this population group.
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Ubeda Matzilevich E, Daniel PL, Little S. Towards therapeutic electrophysiological neurofeedback in Parkinson's disease. Parkinsonism Relat Disord 2024; 121:106010. [PMID: 38245382 DOI: 10.1016/j.parkreldis.2024.106010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 01/10/2024] [Accepted: 01/12/2024] [Indexed: 01/22/2024]
Abstract
Neurofeedback (NF) techniques support individuals to self-regulate specific features of brain activity, which has been shown to impact behavior and potentially ameliorate clinical symptoms. Electrophysiological NF (epNF) may be particularly impactful for patients with Parkinson's disease (PD), as evidence mounts to suggest a central role of pathological neural oscillations underlying symptoms in PD. Exaggerated beta oscillations (12-30 Hz) in the basal ganglia-cortical network are linked to motor symptoms (e.g., bradykinesia, rigidity), and beta is reduced by successful therapy with dopaminergic medication and Deep Brain Stimulation (DBS). PD patients also experience non-motor symptoms related to sleep, mood, motivation, and cognitive control. Although less is known about the mechanisms of non-motor symptoms in PD and how to successfully treat them, low frequency neural oscillations (1-12 Hz) in the basal ganglia-cortical network are particularly implicated in non-motor symptoms. Here, we review how cortical and subcortical epNF could be used to target motor and non-motor specific oscillations, and potentially serve as an adjunct therapy that enables PD patients to endogenously control their own pathological neural activities. Recent studies have demonstrated that epNF protocols can successfully support volitional control of cortical and subcortical beta rhythms. Importantly, this endogenous control of beta has been linked to changes in motor behavior. epNF for PD, as a casual intervention on neural signals, has the potential to increase understanding of the neurophysiology of movement, mood, and cognition and to identify new therapeutic approaches for motor and non-motor symptoms.
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Affiliation(s)
- Elena Ubeda Matzilevich
- Movement Disorders and Neuromodulation Division, Department of Neurology, University of California San Francisco, CA, USA
| | - Pria Lauren Daniel
- Movement Disorders and Neuromodulation Division, Department of Neurology, University of California San Francisco, CA, USA; Department of Psychology, University of California San Diego, CA, USA.
| | - Simon Little
- Movement Disorders and Neuromodulation Division, Department of Neurology, University of California San Francisco, CA, USA
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Fruchter E, Goldenthal N, Adler LA, Gross R, Harel EV, Deutsch L, Nacasch N, Grinapol S, Amital D, Voigt JD, Marmar CR. Amygdala-derived-EEG-fMRI-pattern neurofeedback for the treatment of chronic post-traumatic stress disorder. A prospective, multicenter, multinational study evaluating clinical efficacy. Psychiatry Res 2024; 333:115711. [PMID: 38325159 DOI: 10.1016/j.psychres.2023.115711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Revised: 12/26/2023] [Accepted: 12/30/2023] [Indexed: 02/09/2024]
Abstract
We conducted a prospective, single arm, multisite, multinational, open label trial assessing the safety and efficacy of a novel amygdala derived neurofeedback treatment, designated Amygdala-Derived-EFP, for chronic PTSD. Participants, including veterans and civilians, underwent screening, training, 15 neurofeedback sessions over 8 weeks and; baseline, termination (8 weeks) and 3 month post treatment assessments with validated measures. The primary endpoint was more than 50 % of the participants demonstrating a Minimally Clinically Important Difference (MCID) defined as a 6-point reduction, on the Clinician Administered PTSD Scale (CAPS-5) total score at 3 months. Secondary measures included the PCL-5, ERQ, PHQ-9, and CGI. Statistical analyses were performed using SAS®V9.4. The primary endpoint was met, with a CAPS-5 MCID response rate of 66.7 %. The average reduction in CAPS-5 total scores at 3 month follow up was 13.5 points, more than twice the MCID. Changes from baseline in CAPS-5, PCL-5, PHQ-9 scores at 8 weeks and the 3 month follow-up demonstrated statistically significant improvements in response and; demonstrated effect sizes ranging from 0.46 to 1.07. Adverse events were mild and resolved after treatment. This study builds on prior research demonstrating similar outcomes using amygdala-derived neurofeedback. Positive attributes of this therapy include monitoring by non-physician personnel, affordability, accessibility, and tolerability.
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Affiliation(s)
- Eyal Fruchter
- Rambam Medical Center, Bruss Rapaport Faculty of Medicine - Technicon - Haifa, Haifa, Israel
| | - Nadav Goldenthal
- Division of Psychiatry, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Lenard A Adler
- Department Psychiatry, New York University Grossman School of Medicine, NY, NY, United States
| | - Raz Gross
- Department of Epidemiology, School of Public Health and Department of Psychiatry, School of Medicine, Tel Aviv University, Sheba Medical Center, Tel Aviv, Isreal
| | - Eiran V Harel
- Be'er Ya'akov Mental Health Center, Tel Aviv, Israel
| | | | - Nitsa Nacasch
- Division of Psychiatry, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Shulamit Grinapol
- Department of Community Mental Health, University of Haifa, Haifa, Israel
| | - Daniela Amital
- Division of Psychology, Barzilai Medical Center, Ashkelon, Israel
| | | | - Charles R Marmar
- Department Psychiatry, New York University Grossman School of Medicine, NY, NY, United States
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Adler LA, Anbarasan D, Leon T, Sardoff T, Descorbeth O, Cho D, Stern Y, Kraft O, Hendler T, Marmar CR. Pilot Study of Prism EFP NeuroFeedback in Adult ADHD. J Atten Disord 2024; 28:905-912. [PMID: 38152997 DOI: 10.1177/10870547231215283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2023]
Abstract
OBJECTIVE A pilot study to preliminarily examine the effects of Prism EFP NeuroFeedback (NF) in adult ADHD. METHOD Prism EFP NF is a form of NF specifically designed to target emotional dysregulation (ED) through down regulation of amygdala activity. Prism EFP NF has been shown to improve other disorders with significant ED. Nine participants with adult ADHD received an open trial of Prism EFP NF consisting of fifteen sessions over 8 weeks; all completed at least 5 weeks of treatment with seven completing all 8 weeks. Outcomes were assessed by change in ADHD symptoms from baseline to End of Treatment. RESULTS About two-third reduction was seen in total DSM ADHD symptom scores (primary outcome measure) with improvement observed in all other clinical measures. No significant adverse events were seen. CONCLUSION This preliminary trial found substantial effects of Prism EFP NF on ADHD/ED symptoms and global impairment.
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Affiliation(s)
| | | | - Terry Leon
- NYU Grossman School of Medicine, New York, NY, USA
| | | | | | - Dayeon Cho
- NYU Grossman School of Medicine, New York, NY, USA
| | | | | | - Talma Hendler
- GrayMatters Health, Haifa, Israel
- Tel Aviv University, Israel
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Fine NB, Neuman Fligelman E, Carlton N, Bloch M, Hendler T, Helpman L, Seligman Z, Armon DB. Integration of limbic self-neuromodulation with psychotherapy for complex post-traumatic stress disorder: treatment rationale and case study. Eur J Psychotraumatol 2024; 15:2256206. [PMID: 38166532 PMCID: PMC10769120 DOI: 10.1080/20008066.2023.2256206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 07/24/2023] [Indexed: 01/04/2024] Open
Abstract
Treatment Rationale: Exposure to repeated sexual trauma, particularly during childhood, often leads to protracted mental health problems. Childhood adversity is specifically associated with complex posttraumatic stress disorder (PTSD) presentation, which is particularly tenacious and treatment refractory, and features severe emotion dysregulation. Augmentation approaches have been suggested to enhance treatment efficacy in PTSD thus integrating first-line psychotherapy with mechanistically informed self-neuromodulation procedures (i.e. neurofeedback) may pave the way to enhanced clinical outcomes. A central neural mechanism of PTSD and emotion dysregulation involves amygdala hyperactivity that can be volitionally regulated by neurofeedback. We outline a treatment rationale that includes a detailed justification for the potential of combining psychotherapy and NF and delineate mechanisms of change. We illustrate key processes of reciprocal interactions between neurofeedback engagement and therapeutic goals.Case Study: We describe a clinical case of a woman with complex PTSD due to early and repetitive childhood sexual abuse using adjunctive neurofeedback as an augmentation to an ongoing, stable, traditional treatment plan. The woman participated in (a) ten sessions of neurofeedback by the use of an fMRI-inspired EEG model of limbic related activity (Amygdala Electrical-Finger-Print; AmygEFP-NF), (b) traditional weekly individual psychotherapy, (c) skills group. Before and after NF training period patient was blindly assessed for PTSD symptoms, followed by a 1, 3- and 6-months self-report follow-up. We demonstrate mechanisms of change as well as the clinical effectiveness of adjunctive treatment as indicated by reduced PTSD symptoms and improved daily functioning within this single case.Conclusions: We outline an integrative neuropsychological framework for understanding the unique mechanisms of change conferring value to conjoining NF applications with trauma-focused psychotherapy in complex PTSD.
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Affiliation(s)
- Naomi B. Fine
- Faculty of Social Sciences, School of Psychological Sciences, Tel-Aviv University, Tel-Aviv, Israel
- Sagol Brain Institute Tel-Aviv, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Ellie Neuman Fligelman
- Lotem Center for Treatment of Sexual Trauma, Department of Psychiatry, Sourasky Medical Center, Tel Aviv, Israel
| | - Nora Carlton
- Lotem Center for Treatment of Sexual Trauma, Department of Psychiatry, Sourasky Medical Center, Tel Aviv, Israel
| | - Miki Bloch
- Psychiatric Department, Tel Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Talma Hendler
- Faculty of Social Sciences, School of Psychological Sciences, Tel-Aviv University, Tel-Aviv, Israel
- Sagol Brain Institute Tel-Aviv, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Sagol School of Neuroscience, Tel-Aviv University, Tel-Aviv, Israel
| | - Liat Helpman
- Psychiatric Department, Tel Aviv Sourasky Medical Center, Tel-Aviv, Israel
- Department of Counseling and Human Development, University of Haifa, Haifa, Israel
| | - Zivya Seligman
- Lotem Center for Treatment of Sexual Trauma, Department of Psychiatry, Sourasky Medical Center, Tel Aviv, Israel
| | - Daphna Bardin Armon
- Lotem Center for Treatment of Sexual Trauma, Department of Psychiatry, Sourasky Medical Center, Tel Aviv, Israel
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Fine NB, Helpman L, Armon DB, Gurevitch G, Sheppes G, Seligman Z, Hendler T, Bloch M. Amygdala-related electroencephalogram neurofeedback as add-on therapy for treatment-resistant childhood sexual abuse posttraumatic stress disorder: feasibility study. Psychiatry Clin Neurosci 2024; 78:19-28. [PMID: 37615935 DOI: 10.1111/pcn.13591] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 08/14/2023] [Accepted: 08/21/2023] [Indexed: 08/25/2023]
Abstract
AIM Childhood sexual abuse (CSA) among women is an alarmingly prevalent traumatic experience that often leads to debilitating and treatment-refractory posttraumatic stress disorder (PTSD), raising the need for novel adjunctive therapies. Neuroimaging investigations systematically report that amygdala hyperactivity is the most consistent and reliable neural abnormality in PTSD and following childhood abuse, raising the potential of implementing volitional neural modulation using neurofeedback (NF) aimed at down-regulating amygdala activity. This study aimed to reliably probe limbic activity but overcome the limited applicability of functional magnetic resonance imaging (fMRI) NF by using a scalable electroencephalogram NF probe of amygdala-related activity, termed amygdala electrical-finger-print (amyg-EFP) in a randomized controlled trial. METHOD Fifty-five women with CSA-PTSD who were in ongoing intensive trauma-focused psychotherapy for a minimum of 1 year but still met Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) PTSD criteria were randomized to either 10 add-on sessions of amyg-EFP-NF training (test group) or continuing psychotherapy (control group). Participants were blindly assessed for PTSD symptoms before and after the NF training period, followed by self-reported clinical follow-up at 1, 3, and 6 months, as well as one session of amygdala real-time fMRI-NF before and after NF training period. RESULTS Participants in the test group compared with the control group demonstrated a marginally significant immediate reduction in PTSD symptoms, which progressively improved during the follow-up period. In addition, successful neuromodulation during NF training was demonstrated. CONCLUSION This feasibility study for patients with treatment-resistant CSA-PTSD indicates that amyg-EFP-NF is a viable and efficient intervention.
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Affiliation(s)
- Naomi B Fine
- School of Psychological Sciences, Faculty of Social Sciences, Tel-Aviv University, Tel Aviv, Israel
- Sagol Brain Institute Tel-Aviv, Wohl Institute for Advanced Imaging, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Liat Helpman
- Womens' Reproductive Mental Health research Unit, Psychiatric Department, Tel Aviv Sourasky Medical Center, Tel-Aviv, Israel
- Department of Counseling and Human Development, University of Haifa, Haifa, Israel
| | - Daphna Bardin Armon
- Lotem Center for Treatment of Sexual Trauma, Department of Psychiatry, Tel Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Guy Gurevitch
- Sagol Brain Institute Tel-Aviv, Wohl Institute for Advanced Imaging, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Gal Sheppes
- School of Psychological Sciences, Faculty of Social Sciences, Tel-Aviv University, Tel Aviv, Israel
- Sagol School of Neuroscience, Tel-Aviv University, Tel-Aviv, Israel
| | - Zivya Seligman
- Lotem Center for Treatment of Sexual Trauma, Department of Psychiatry, Tel Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Talma Hendler
- School of Psychological Sciences, Faculty of Social Sciences, Tel-Aviv University, Tel Aviv, Israel
- Sagol Brain Institute Tel-Aviv, Wohl Institute for Advanced Imaging, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Sagol School of Neuroscience, Tel-Aviv University, Tel-Aviv, Israel
| | - Miki Bloch
- Womens' Reproductive Mental Health research Unit, Psychiatric Department, Tel Aviv Sourasky Medical Center, Tel-Aviv, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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Fleury M, Figueiredo P, Vourvopoulos A, Lécuyer A. Two is better? combining EEG and fMRI for BCI and neurofeedback: a systematic review. J Neural Eng 2023; 20:051003. [PMID: 37879343 DOI: 10.1088/1741-2552/ad06e1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 10/25/2023] [Indexed: 10/27/2023]
Abstract
Electroencephalography (EEG) and functional magnetic resonance imaging (fMRI) are two commonly used non-invasive techniques for measuring brain activity in neuroscience and brain-computer interfaces (BCI).Objective. In this review, we focus on the use of EEG and fMRI in neurofeedback (NF) and discuss the challenges of combining the two modalities to improve understanding of brain activity and achieve more effective clinical outcomes. Advanced technologies have been developed to simultaneously record EEG and fMRI signals to provide a better understanding of the relationship between the two modalities. However, the complexity of brain processes and the heterogeneous nature of EEG and fMRI present challenges in extracting useful information from the combined data.Approach. We will survey existing EEG-fMRI combinations and recent studies that exploit EEG-fMRI in NF, highlighting the experimental and technical challenges.Main results. We made a classification of the different combination of EEG-fMRI for NF, we provide a review of multimodal analysis methods for EEG-fMRI features. We also survey the current state of research on EEG-fMRI in the different existing NF paradigms. Finally, we also identify some of the remaining challenges in this field.Significance. By exploring EEG-fMRI combinations in NF, we are advancing our knowledge of brain function and its applications in clinical settings. As such, this review serves as a valuable resource for researchers, clinicians, and engineers working in the field of neural engineering and rehabilitation, highlighting the promising future of EEG-fMRI-based NF.
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Affiliation(s)
- Mathis Fleury
- Univ Rennes, Inria, CNRS, Inserm, Empenn ERL U1228 Rennes, France
- ISR-Lisboa/LARSyS and Department of Bioengineering, Instituto Superior Técnico, Universidade de Lisboa, Lisbon, Portugal
| | - Patrícia Figueiredo
- ISR-Lisboa/LARSyS and Department of Bioengineering, Instituto Superior Técnico, Universidade de Lisboa, Lisbon, Portugal
| | - Athanasios Vourvopoulos
- ISR-Lisboa/LARSyS and Department of Bioengineering, Instituto Superior Técnico, Universidade de Lisboa, Lisbon, Portugal
| | - Anatole Lécuyer
- Univ Rennes, Inria, CNRS, Inserm, Empenn ERL U1228 Rennes, France
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Tene O, Bleich Cohen M, Helpman L, Fine N, Halevy A, Goldway N, Perry D, Bary P, Aisenberg Romano G, Ben-Zion Z, Hendler T, Bloch M. Limbic self-neuromodulation as a novel treatment option for emotional dysregulation in premenstrual dysphoric disorder (PMDD); a proof-of-concept study. Psychiatry Clin Neurosci 2023; 77:550-558. [PMID: 37354437 DOI: 10.1111/pcn.13574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 06/07/2023] [Accepted: 06/19/2023] [Indexed: 06/26/2023]
Abstract
AIM To assess the efficacy of a novel neurofeedback (NF) method, targeting limbic activity, to treat emotional dysregulation related to premenstrual dysphoric disorder (PMDD). METHODS We applied a NF probe targeting limbic activity using a functional magnetic resonance imaging-inspired electroencephalogram model (termed Amyg-EFP-NF) in a double-blind randomized controlled trial. A frontal alpha asymmetry probe (AAS-NF), served as active control. Twenty-seven participants diagnosed with PMDD (mean age = 33.57 years, SD = 5.67) were randomly assigned to Amyg-EFP-NF or AAS-NF interventions with a 2:1 ratio, respectively. The treatment protocol consisted of 11 NF sessions through three menstrual cycles, and a follow-up assessment 3 months thereafter. The primary outcome measure was improvement in the Revised Observer Version of the Premenstrual Tension Syndrome Rating Scale (PMTS-OR). RESULTS A significant group by time effect was observed for the core symptom subscale of the PMTS-OR, with significant improvement observed at follow-up for the Amyg-EFP group compared with the AAS group [F(1, 15)=4.968, P = 0.042]. This finding was specifically robust for reduction in anger [F(1, 15) = 22.254, P < 0.001]. A significant correlation was found between learning scores and overall improvement in core symptoms (r = 0.514, P = 0.042) suggesting an association between mechanism of change and clinical improvement. CONCLUSION Our preliminary findings suggest that Amyg-EFP-NF may serve as an affordable and accessible non-invasive treatment option for emotional dysregulation in women suffering from PMDD. Our main limitations were the relatively small number of participants and the lack of a sham-NF placebo arm.
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Affiliation(s)
- Oren Tene
- Department of Psychiatry and Sagol Brain Institute, Wohl Institute for Advanced Imaging, Tel Aviv Sourasky Medical Center, Tel-Aviv, Israel
- Sackler Faculty of Medicine, Sagol School of Neuroscience and Faculty of Social Sciences, Tel-Aviv University, Tel-Aviv, Israel
| | - Maya Bleich Cohen
- Department of Psychiatry and Sagol Brain Institute, Wohl Institute for Advanced Imaging, Tel Aviv Sourasky Medical Center, Tel-Aviv, Israel
- Sackler Faculty of Medicine, Sagol School of Neuroscience and Faculty of Social Sciences, Tel-Aviv University, Tel-Aviv, Israel
| | - Liat Helpman
- Department of Psychiatry and Sagol Brain Institute, Wohl Institute for Advanced Imaging, Tel Aviv Sourasky Medical Center, Tel-Aviv, Israel
- Department of Counseling and Human Development, Faculty of Education, University of Haifa, Haifa, Israel
| | - Naomi Fine
- Department of Psychiatry and Sagol Brain Institute, Wohl Institute for Advanced Imaging, Tel Aviv Sourasky Medical Center, Tel-Aviv, Israel
- Sackler Faculty of Medicine, Sagol School of Neuroscience and Faculty of Social Sciences, Tel-Aviv University, Tel-Aviv, Israel
| | - Anat Halevy
- Baruch Ivcher School of Psychology, Reichman University, Herzliya, Israel
| | - Noam Goldway
- Department of Psychiatry and Sagol Brain Institute, Wohl Institute for Advanced Imaging, Tel Aviv Sourasky Medical Center, Tel-Aviv, Israel
- Sackler Faculty of Medicine, Sagol School of Neuroscience and Faculty of Social Sciences, Tel-Aviv University, Tel-Aviv, Israel
- Department of Psychology, New York University, New York City, New York, USA
| | - Daniella Perry
- Department of Psychiatry and Sagol Brain Institute, Wohl Institute for Advanced Imaging, Tel Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Plia Bary
- Department of Psychiatry and Sagol Brain Institute, Wohl Institute for Advanced Imaging, Tel Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Gabi Aisenberg Romano
- Department of Psychiatry and Sagol Brain Institute, Wohl Institute for Advanced Imaging, Tel Aviv Sourasky Medical Center, Tel-Aviv, Israel
- Sackler Faculty of Medicine, Sagol School of Neuroscience and Faculty of Social Sciences, Tel-Aviv University, Tel-Aviv, Israel
| | - Ziv Ben-Zion
- Department of Psychiatry and Sagol Brain Institute, Wohl Institute for Advanced Imaging, Tel Aviv Sourasky Medical Center, Tel-Aviv, Israel
- Sackler Faculty of Medicine, Sagol School of Neuroscience and Faculty of Social Sciences, Tel-Aviv University, Tel-Aviv, Israel
- Departments of Comparative Medicine and Psychiatry, Yale School of Medicine, Yale University, New Haven, Connecticut, USA
- Clinical Neuroscience Division, US Department of Veterans Affairs National Center for PTSD, VA Connecticut Healthcare System, West Haven, Connecticut, USA
| | - Talma Hendler
- Department of Psychiatry and Sagol Brain Institute, Wohl Institute for Advanced Imaging, Tel Aviv Sourasky Medical Center, Tel-Aviv, Israel
- Sackler Faculty of Medicine, Sagol School of Neuroscience and Faculty of Social Sciences, Tel-Aviv University, Tel-Aviv, Israel
| | - Miki Bloch
- Department of Psychiatry and Sagol Brain Institute, Wohl Institute for Advanced Imaging, Tel Aviv Sourasky Medical Center, Tel-Aviv, Israel
- Sackler Faculty of Medicine, Sagol School of Neuroscience and Faculty of Social Sciences, Tel-Aviv University, Tel-Aviv, Israel
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Singer N, Poker G, Dunsky-Moran N, Nemni S, Reznik Balter S, Doron M, Baker T, Dagher A, Zatorre RJ, Hendler T. Development and validation of an fMRI-informed EEG model of reward-related ventral striatum activation. Neuroimage 2023; 276:120183. [PMID: 37225112 PMCID: PMC10300238 DOI: 10.1016/j.neuroimage.2023.120183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 04/06/2023] [Accepted: 05/22/2023] [Indexed: 05/26/2023] Open
Abstract
Reward processing is essential for our mental-health and well-being. In the current study, we developed and validated a scalable, fMRI-informed EEG model for monitoring reward processing related to activation in the ventral-striatum (VS), a significant node in the brain's reward system. To develop this EEG-based model of VS-related activation, we collected simultaneous EEG/fMRI data from 17 healthy individuals while listening to individually-tailored pleasurable music - a highly rewarding stimulus known to engage the VS. Using these cross-modal data, we constructed a generic regression model for predicting the concurrently acquired Blood-Oxygen-Level-Dependent (BOLD) signal from the VS using spectro-temporal features from the EEG signal (termed hereby VS-related-Electrical Finger Print; VS-EFP). The performance of the extracted model was examined using a series of tests that were applied on the original dataset and, importantly, an external validation dataset collected from a different group of 14 healthy individuals who underwent the same EEG/FMRI procedure. Our results showed that the VS-EFP model, as measured by simultaneous EEG, predicted BOLD activation in the VS and additional functionally relevant regions to a greater extent than an EFP model derived from a different anatomical region. The developed VS-EFP was also modulated by musical pleasure and predictive of the VS-BOLD during a monetary reward task, further indicating its functional relevance. These findings provide compelling evidence for the feasibility of using EEG alone to model neural activation related to the VS, paving the way for future use of this scalable neural probing approach in neural monitoring and self-guided neuromodulation.
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Affiliation(s)
- Neomi Singer
- Montreal Neurological Institute, McGill University, 3801 Rue University, Montréal, QC H3A 2B4, Canada; Sagol Brain Institute, Tel-Aviv Sourasky Medical Center, 6 Weizman St. Tel Aviv, 64239, Israel; Sagol school of Neuroscience, Tel-Aviv University, PO Box 39040, Tel Aviv 6997801, Israel
| | - Gilad Poker
- Sagol Brain Institute, Tel-Aviv Sourasky Medical Center, 6 Weizman St. Tel Aviv, 64239, Israel
| | - Netta Dunsky-Moran
- Sagol Brain Institute, Tel-Aviv Sourasky Medical Center, 6 Weizman St. Tel Aviv, 64239, Israel; Sagol school of Neuroscience, Tel-Aviv University, PO Box 39040, Tel Aviv 6997801, Israel
| | - Shlomi Nemni
- Sagol school of Neuroscience, Tel-Aviv University, PO Box 39040, Tel Aviv 6997801, Israel; School of Psychological Sciences, Tel-Aviv University, PO Box 39040, Tel Aviv 6997801, Israel
| | - Shira Reznik Balter
- Sagol Brain Institute, Tel-Aviv Sourasky Medical Center, 6 Weizman St. Tel Aviv, 64239, Israel
| | - Maayan Doron
- Montreal Neurological Institute, McGill University, 3801 Rue University, Montréal, QC H3A 2B4, Canada; Sackler School of Medicine, Tel-Aviv University, PO Box 39040, Tel Aviv 6997801, Israel
| | - Travis Baker
- Montreal Neurological Institute, McGill University, 3801 Rue University, Montréal, QC H3A 2B4, Canada; Center for Molecular and Behavioral Neuroscience, Rutgers University, Newark, NJ, USA
| | - Alain Dagher
- Montreal Neurological Institute, McGill University, 3801 Rue University, Montréal, QC H3A 2B4, Canada
| | - Robert J Zatorre
- Montreal Neurological Institute, McGill University, 3801 Rue University, Montréal, QC H3A 2B4, Canada; International Laboratory for Brain, Music, and Sound Research (BRAMS), Canada
| | - Talma Hendler
- Sagol Brain Institute, Tel-Aviv Sourasky Medical Center, 6 Weizman St. Tel Aviv, 64239, Israel; Sagol school of Neuroscience, Tel-Aviv University, PO Box 39040, Tel Aviv 6997801, Israel; School of Psychological Sciences, Tel-Aviv University, PO Box 39040, Tel Aviv 6997801, Israel; Sackler School of Medicine, Tel-Aviv University, PO Box 39040, Tel Aviv 6997801, Israel.
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11
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Neural and functional validation of fMRI-informed EEG model of right inferior frontal gyrus activity. Neuroimage 2023; 266:119822. [PMID: 36535325 DOI: 10.1016/j.neuroimage.2022.119822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 11/17/2022] [Accepted: 12/15/2022] [Indexed: 12/23/2022] Open
Abstract
The right inferior frontal gyrus (rIFG) is a region involved in the neural underpinning of cognitive control across several domains such as inhibitory control and attentional allocation process. Therefore, it constitutes a desirable neural target for brain-guided interventions such as neurofeedback (NF). To date, rIFG-NF has shown beneficial ability to rehabilitate or enhance cognitive functions using functional Magnetic Resonance Imaging (fMRI-NF). However, the utilization of fMRI-NF for clinical purposes is severely limited, due to its poor scalability. The present study aimed to overcome the limited applicability of fMRI-NF by developing and validating an EEG model of fMRI-defined rIFG activity (hereby termed "Electrical FingerPrint of rIFG"; rIFG-EFP). To validate the computational model, we employed two experiments in healthy individuals. The first study (n = 14) aimed to test the target engagement of the model by employing rIFG-EFP-NF training while simultaneously acquiring fMRI. The second study (n = 41) aimed to test the functional outcome of two sessions of rIFG-EFP-NF using a risk preference task (known to depict cognitive control processes), employed before and after the training. Results from the first study demonstrated neural target engagement as expected, showing associated rIFG-BOLD signal changing during simultaneous rIFG-EFP-NF training. Target anatomical specificity was verified by showing a more precise prediction of the rIFG-BOLD by the rIFG-EFP model compared to other EFP models. Results of the second study suggested that successful learning to up-regulate the rIFG-EFP signal through NF can reduce one's tendency for risk taking, indicating improved cognitive control after two sessions of rIFG-EFP-NF. Overall, our results confirm the validity of a scalable NF method for targeting rIFG activity by using an EEG probe.
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Goldway N, Jalon I, Keynan JN, Hellrung L, Horstmann A, Paret C, Hendler T. Feasibility and utility of amygdala neurofeedback. Neurosci Biobehav Rev 2022; 138:104694. [PMID: 35623447 DOI: 10.1016/j.neubiorev.2022.104694] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 04/12/2022] [Accepted: 05/11/2022] [Indexed: 10/18/2022]
Abstract
Amygdala NeuroFeedback (NF) have the potential of being a valuable non-invasive intervention tool in many psychiatric disporders. However, the feasibility and best practices of this method have not been systematically examined. The current article presents a review of amygdala-NF studies, an analytic summary of study design parameters, and examination of brain mechanisms related to successful amygdala-NF performance. A meta-analysis of 33 publications showed that real amygdala-NF facilitates learned modulation compared to control conditions. In addition, while variability in study dsign parameters is high, these design choices are implicitly organized by the targeted valence domain (positive or negative). However, in most cases the neuro-behavioral effects of targeting such domains were not directly assessed. Lastly, re-analyzing six data sets of amygdala-fMRI-NF revealed that successful amygdala down-modulation is coupled with deactivation of the posterior insula and nodes in the Default-Mode-Network. Our findings suggest that amygdala self-modulation can be acquired using NF. Yet, additional controlled studies, relevant behavioral tasks before and after NF intervention, and neural 'target engagement' measures are critically needed to establish efficacy and specificity. In addition, the fMRI analysis presented here suggest that common accounts regarding the brain network involved in amygdala NF might reflect unsuccessful modulation attempts rather than successful modulation.
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Affiliation(s)
- Noam Goldway
- Sagol Brain Institute, Wohl Institute for Advanced Imaging, Tel-Aviv Sourasky Medical Centre, Tel-Aviv, Israel; Sagol School of Neuroscience, Tel Aviv University, Tel-Aviv, Israel; Department of Psychology, New York University, New York, USA
| | - Itamar Jalon
- Sagol Brain Institute, Wohl Institute for Advanced Imaging, Tel-Aviv Sourasky Medical Centre, Tel-Aviv, Israel; School of Psychological Sciences, Tel Aviv University, Tel-Aviv, Israel
| | - Jackob N Keynan
- Sagol Brain Institute, Wohl Institute for Advanced Imaging, Tel-Aviv Sourasky Medical Centre, Tel-Aviv, Israel; Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA; Wu Tsai Neurosciences Institute, Stanford University, Stanford, CA, USA
| | - Lydia Hellrung
- Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany; Laboratory for Social and Neural Systems Research, Department of Economics, University of Zurich, Zurich, Switzerland
| | - Annette Horstmann
- Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany; Faculty of Medicine, University of Leipzig, Leipzig, Germany; Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Christian Paret
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Germany
| | - Talma Hendler
- Sagol Brain Institute, Wohl Institute for Advanced Imaging, Tel-Aviv Sourasky Medical Centre, Tel-Aviv, Israel; Sagol School of Neuroscience, Tel Aviv University, Tel-Aviv, Israel; School of Psychological Sciences, Tel Aviv University, Tel-Aviv, Israel; Sackler School of Medicine, Tel Aviv University, Tel-Aviv, Israel.
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13
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Kvamme TL, Ros T, Overgaard M. Can neurofeedback provide evidence of direct brain-behavior causality? Neuroimage 2022; 258:119400. [PMID: 35728786 DOI: 10.1016/j.neuroimage.2022.119400] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 06/13/2022] [Accepted: 06/17/2022] [Indexed: 01/01/2023] Open
Abstract
Neurofeedback is a procedure that measures brain activity in real-time and presents it as feedback to an individual, thus allowing them to self-regulate brain activity with effects on cognitive processes inferred from behavior. One common argument is that neurofeedback studies can reveal how the measured brain activity causes a particular cognitive process. The causal claim is often made regarding the measured brain activity being manipulated as an independent variable, similar to brain stimulation studies. However, this causal inference is vulnerable to the argument that other upstream brain activities change concurrently and cause changes in the brain activity from which feedback is derived. In this paper, we outline the inference that neurofeedback may causally affect cognition by indirect means. We further argue that researchers should remain open to the idea that the trained brain activity could be part of a "causal network" that collectively affects cognition rather than being necessarily causally primary. This particular inference may provide a better translation of evidence from neurofeedback studies to the rest of neuroscience. We argue that the recent advent of multivariate pattern analysis, when combined with implicit neurofeedback, currently comprises the strongest case for causality. Our perspective is that although the burden of inferring direct causality is difficult, it may be triangulated using a collection of various methods in neuroscience. Finally, we argue that the neurofeedback methodology provides unique advantages compared to other methods for revealing changes in the brain and cognitive processes but that researchers should remain mindful of indirect causal effects.
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Affiliation(s)
- Timo L Kvamme
- Cognitive Neuroscience Research Unit, CFIN/MINDLab, Aarhus University, Universitetsbyen 3, Aarhus, Denmark; Centre for Alcohol and Drug Research (CRF), Aarhus University, Aarhus, Denmark.
| | - Tomas Ros
- Departments of Neuroscience and Psychiatry, University of Geneva, Campus Biotech, Geneva, Switzerland
| | - Morten Overgaard
- Cognitive Neuroscience Research Unit, CFIN/MINDLab, Aarhus University, Universitetsbyen 3, Aarhus, Denmark
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14
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Taschereau-Dumouchel V, Cushing C, Lau H. Real-Time Functional MRI in the Treatment of Mental Health Disorders. Annu Rev Clin Psychol 2022; 18:125-154. [DOI: 10.1146/annurev-clinpsy-072220-014550] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Multiple mental disorders have been associated with dysregulation of precise brain processes. However, few therapeutic approaches can correct such specific patterns of brain activity. Since the late 1960s and early 1970s, many researchers have hoped that this feat could be achieved by closed-loop brain imaging approaches, such as neurofeedback, that aim to modulate brain activity directly. However, neurofeedback never gained mainstream acceptance in mental health, in part due to methodological considerations. In this review, we argue that, when contemporary methodological guidelines are followed, neurofeedback is one of the few intervention methods in psychology that can be assessed in double-blind placebo-controlled trials. Furthermore, using new advances in machine learning and statistics, it is now possible to target very precise patterns of brain activity for therapeutic purposes. We review the recent literature in functional magnetic resonance imaging neurofeedback and discuss current and future applications to mental health. Expected final online publication date for the Annual Review of Clinical Psychology, Volume 18 is May 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.
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Affiliation(s)
- Vincent Taschereau-Dumouchel
- Department of Psychiatry and Addictology, Université de Montréal, Montréal, Québec, Canada
- Centre de Recherche de l'Institut Universitaire en Santé Mentale de Montréal, Montréal, Québec, Canada
| | - Cody Cushing
- Department of Psychology, University of California, Los Angeles, California, USA
| | - Hakwan Lau
- RIKEN Center for Brain Science, Wakoshi, Saitama, Japan
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15
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Stirner M, Gurevitch G, Lubianiker N, Hendler T, Schmahl C, Paret C. An Investigation of Awareness and Metacognition in Neurofeedback with the Amygdala Electrical Fingerprint. Conscious Cogn 2022; 98:103264. [PMID: 35026688 DOI: 10.1016/j.concog.2021.103264] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 11/24/2021] [Accepted: 12/15/2021] [Indexed: 11/16/2022]
Abstract
Awareness theory posits that individuals connected to a brain-computer interface can learn to estimate and discriminate their brain states. We used the amygdala Electrical Fingerprint (amyg-EFP) - a functional Magnetic Resonance Imaging-inspired Electroencephalogram surrogate of deep brain activation - to investigate whether participants could accurately estimate their own brain activation. Ten participants completed up to 20 neurofeedback runs and estimated their amygdala-EFP activation (depicted as a thermometer) and confidence in this rating during each trial. We analysed data using multilevel models, predicting the real thermometer position with participant rated position and adjusted for activation during the previous trial. Hypotheses on learning regulation and improvement of estimation were not confirmed. However, participant ratings were significantly associated with the amyg-EFP signal. Higher rating accuracy also predicted higher subjective confidence in the rating. This proof-of-concept study introduces an approach to study awareness with fMRI-informed neurofeedback and provides initial evidence for metacognition in neurofeedback.
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Affiliation(s)
- Madita Stirner
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Germany
| | - Guy Gurevitch
- Sagol Brain Institute, Wohl Institute for Advanced Imaging, Tel-Aviv Sourasky Medical Center and School of Psychological Sciences, Tel-Aviv University, Israel; Department of Physiology and Pharmacology, Sackler Faculty of Medicine, Tel-Aviv University, Israel
| | - Nitzan Lubianiker
- Sagol Brain Institute, Wohl Institute for Advanced Imaging, Tel-Aviv Sourasky Medical Center and School of Psychological Sciences, Tel-Aviv University, Israel; School of Psychological Sciences, Gershon H. Gordon Faculty of Social Sciences, Tel-Aviv University, Israel
| | - Talma Hendler
- Sagol Brain Institute, Wohl Institute for Advanced Imaging, Tel-Aviv Sourasky Medical Center and School of Psychological Sciences, Tel-Aviv University, Israel; Department of Physiology and Pharmacology, Sackler Faculty of Medicine, Tel-Aviv University, Israel; School of Psychological Sciences, Gershon H. Gordon Faculty of Social Sciences, Tel-Aviv University, Israel
| | - Christian Schmahl
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Germany
| | - Christian Paret
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Germany; Sagol Brain Institute, Wohl Institute for Advanced Imaging, Tel-Aviv Sourasky Medical Center and School of Psychological Sciences, Tel-Aviv University, Israel.
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16
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Zabcikova M, Koudelkova Z, Jasek R, Navarro JJL. Recent Advances and Current Trends in Brain-Computer Interface (BCI) Research and Their Applications. Int J Dev Neurosci 2021; 82:107-123. [PMID: 34939217 DOI: 10.1002/jdn.10166] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 11/16/2021] [Accepted: 12/18/2021] [Indexed: 11/06/2022] Open
Abstract
Brain-Computer Interface (BCI) provides direct communication between the brain and an external device. BCI systems have become a trendy field of research in recent years. These systems can be used in a variety of applications to help both disabled and healthy people. Concerning significant BCI progress, we may assume that these systems are not very far from real-world applications. This review has taken into account current trends in BCI research. In this survey, one hundred most cited articles from the WOS database were selected over the last four years. This survey is divided into several sectors. These sectors are Medicine, Communication and Control, Entertainment, and Other BCI applications. The application area, recording method, signal acquisition types, and countries of origin have been identified in each article. This survey provides an overview of the BCI articles published from 2016 to 2020 and their current trends and advances in different application areas.
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Affiliation(s)
- Martina Zabcikova
- Department of Informatics and Artificial Intelligence, Faculty of Applied Informatics, Tomas Bata University in Zlin, Zlin, Czech Republic
| | - Zuzana Koudelkova
- Department of Informatics and Artificial Intelligence, Faculty of Applied Informatics, Tomas Bata University in Zlin, Zlin, Czech Republic
| | - Roman Jasek
- Department of Informatics and Artificial Intelligence, Faculty of Applied Informatics, Tomas Bata University in Zlin, Zlin, Czech Republic
| | - José Javier Lorenzo Navarro
- Departamento de Informática y Sistemas, Instituto Universitario de Sistemas Inteligentes y Aplicaciones Numéricas en Ingeniería, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
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EEG Neurofeedback for Anxiety Disorders and Post-Traumatic Stress Disorders: A Blueprint for a Promising Brain-Based Therapy. Curr Psychiatry Rep 2021; 23:84. [PMID: 34714417 DOI: 10.1007/s11920-021-01299-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/05/2021] [Indexed: 12/12/2022]
Abstract
PURPOSE OF REVIEW This review provides an overview of current knowledge and understanding of EEG neurofeedback for anxiety disorders and post-traumatic stress disorders. RECENT FINDINGS The manifestations of anxiety disorders and post-traumatic stress disorders (PTSD) are associated with dysfunctions of neurophysiological stress axes and brain arousal circuits, which are important dimensions of the research domain criteria (RDoC). Even if the pathophysiology of these disorders is complex, one of its defining signatures is behavioral and physiological over-arousal. Interestingly, arousal-related brain activity can be modulated by electroencephalogram-based neurofeedback (EEG NF), a non-pharmacological and non-invasive method that involves neurocognitive training through a brain-computer interface (BCI). EEG NF is characterized by a simultaneous learning process where both patient and computer are involved in modifying neuronal activity or connectivity, thereby improving associated symptoms of anxiety and/or over-arousal. Positive effects of EEG NF have been described for both anxiety disorders and PTSD, yet due to a number of methodological issues, it remains unclear whether symptom improvement is the direct result of neurophysiological changes targeted by EEG NF. Thus, in this work we sought to bridge current knowledge on brain mechanisms of arousal with past and present EEG NF therapies for anxiety and PTSD. In a nutshell, we discuss the neurophysiological mechanisms underlying the effects of EEG NF in anxiety disorder and PTSD, the methodological strengths/weaknesses of existing EEG NF randomized controlled trials for these disorders, and the neuropsychological factors that may impact NF training success.
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18
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Fruchtman-Steinbok T, Keynan JN, Cohen A, Jaljuli I, Mermelstein S, Drori G, Routledge E, Krasnoshtein M, Playle R, Linden DEJ, Hendler T. Amygdala electrical-finger-print (AmygEFP) NeuroFeedback guided by individually-tailored Trauma script for post-traumatic stress disorder: Proof-of-concept. NEUROIMAGE-CLINICAL 2021; 32:102859. [PMID: 34689055 PMCID: PMC8551212 DOI: 10.1016/j.nicl.2021.102859] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 10/12/2021] [Accepted: 10/13/2021] [Indexed: 12/21/2022]
Abstract
Randomized clinical trial with a novel self-neuromodulation training in PTSD. Demonstration of feasibility of an fMRI-informed EEG model of Amygdala modulation (AmygEFP). Individually-tailored trauma-related content as the training feedback interface. Results showed reduction of PTSD symptoms following AmygEFP trauma-related feedback training.
Background Amygdala activity dysregulation plays a central role in post-traumatic stress disorder (PTSD). Hence learning to self-regulate one's amygdala activity may facilitate recovery. PTSD is further characterized by abnormal contextual processing related to the traumatic memory. Therefore, provoking the personal traumatic narrative while training amygdala down-regulation could enhance clinical efficacy. We report the results of a randomized controlled trial (NCT02544971) of a novel self-neuromodulation procedure (i.e. NeuroFeedback) for PTSD, aimed at down-regulating limbic activity while receiving feedback from an auditory script of a personal traumatic narrative. To scale-up applicability, neural activity was probed by an fMRI-informed EEG model of amygdala activity, termed Amygdala Electrical Finger-Print (AmygEFP). Methods Fifty-nine adults meeting DSM-5 criteria for PTSD were randomized between three groups: Trauma-script feedback interface (Trauma-NF) or Neutral feedback interface (Neutral-NF), and a control group of No-NF (to control for spontaneous recovery). Before and immediately after 15 NF training sessions patients were blindly assessed for PTSD symptoms and underwent one session of amygdala fMRI-NF for transferability testing. Follow-up clinical assessment was performed at 3- and 6-months following NF treatment. Results Patients in both NF groups learned to volitionally down-regulate AmygEFP signal and demonstrated a greater reduction in PTSD symptoms and improved down-regulation of the amygdala during fMRI-NF, compared to the No-NF group. The Trauma-NF group presented the largest immediate clinical improvement. Conclusions This proof-of-concept study indicates the feasibility of the AmygEFP-NF process-driven as a scalable intervention for PTSD and illustrates its clinical potential. Further investigation is warranted to elucidate the contribution of AmygEFP-NF beyond exposure and placebo effects.
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Affiliation(s)
- Tom Fruchtman-Steinbok
- Sagol Brain Institute, Tel-Aviv Medical Center, Tel-Aviv, Israel; School of Psychological Sciences, Gershon H. Gordon Faculty of Social Sciences, Tel-Aviv University, Tel-Aviv, Israel
| | - Jackob N Keynan
- Sagol Brain Institute, Tel-Aviv Medical Center, Tel-Aviv, Israel; Department of Psychiatry & Behavioral Science, Stanford University School of Medicine, Stanford, CA, USA
| | - Avihay Cohen
- Sagol Brain Institute, Tel-Aviv Medical Center, Tel-Aviv, Israel; School of Psychological Sciences, Gershon H. Gordon Faculty of Social Sciences, Tel-Aviv University, Tel-Aviv, Israel
| | - Iman Jaljuli
- Department of Statistics and Operations Research, School of Mathematical Sciences, Tel-Aviv University, Tel-Aviv, Israel
| | | | - Gadi Drori
- Sagol Brain Institute, Tel-Aviv Medical Center, Tel-Aviv, Israel; Sagol School of Neuroscience, Tel-Aviv University, Tel-Aviv, Israel
| | - Efrat Routledge
- Sagol Brain Institute, Tel-Aviv Medical Center, Tel-Aviv, Israel
| | | | - Rebecca Playle
- Center for Trials Research, College of Biomedical & Life Sciences, Cardiff University, Cardiff, UK
| | - David E J Linden
- Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, UK
| | - Talma Hendler
- Sagol Brain Institute, Tel-Aviv Medical Center, Tel-Aviv, Israel; School of Psychological Sciences, Gershon H. Gordon Faculty of Social Sciences, Tel-Aviv University, Tel-Aviv, Israel; Sagol School of Neuroscience, Tel-Aviv University, Tel-Aviv, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
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19
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20
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The Current Evidence Levels for Biofeedback and Neurofeedback Interventions in Treating Depression: A Narrative Review. Neural Plast 2021; 2021:8878857. [PMID: 33613671 PMCID: PMC7878101 DOI: 10.1155/2021/8878857] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Revised: 12/28/2020] [Accepted: 01/25/2021] [Indexed: 12/22/2022] Open
Abstract
This article is aimed at showing the current level of evidence for the usage of biofeedback and neurofeedback to treat depression along with a detailed review of the studies in the field and a discussion of rationale for utilizing each protocol. La Vaque et al. criteria endorsed by the Association for Applied Psychophysiology and Biofeedback and International Society for Neuroregulation & Research were accepted as a means of study evaluation. Heart rate variability (HRV) biofeedback was found to be moderately supportable as a treatment of MDD while outcome measure was a subjective questionnaire like Beck Depression Inventory (level 3/5, “probably efficacious”). Electroencephalographic (EEG) neurofeedback protocols, namely, alpha-theta, alpha, and sensorimotor rhythm upregulation, all qualify for level 2/5, “possibly efficacious.” Frontal alpha asymmetry protocol also received limited evidence of effect in depression (level 2/5, “possibly efficacious”). Finally, the two most influential real-time functional magnetic resonance imaging (rt-fMRI) neurofeedback protocols targeting the amygdala and the frontal cortices both demonstrate some effectiveness, though lack replications (level 2/5, “possibly efficacious”). Thus, neurofeedback specifically targeting depression is moderately supported by existing studies (all fit level 2/5, “possibly efficacious”). The greatest complication preventing certain protocols from reaching higher evidence levels is a relatively high number of uncontrolled studies and an absence of accurate replications arising from the heterogeneity in protocol details, course lengths, measures of improvement, control conditions, and sample characteristics.
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21
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Mathiak K, Keller M. Clinical Application of Real-Time fMRI-Based Neurofeedback for Depression. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2021; 1305:275-293. [PMID: 33834405 DOI: 10.1007/978-981-33-6044-0_15] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
Real-time functional magnetic resonance imaging-based neurofeedback (rt-fMRI NF) is a recent technique used to train self-regulation of circumscribed brain areas or networks. For clinical applications in depression, NF training targets brain areas with disturbed activation patterns, such as heightened reactivity of amygdala in response to negative stimuli, in order to normalize the neurophysiology and their behavioral correlates. Recent studies have targeted emotion processing areas such as the amygdala, the salience network, and top-down control areas such as the lateral prefrontal cortex. Different methods of rt-fMRI-based NF in depression, their potential for clinical improvement, and most recent advancements of this technology are discussed considering their role for future clinical applications. Initial findings of randomized controlled trials show promising results. However, for lasting treatment effects, clinical efficiency and optimal target regions, tasks, control conditions, and duration of training need to be established.
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Affiliation(s)
- Klaus Mathiak
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical School, RWTH Aachen University, Aachen, Germany.
| | - Micha Keller
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical School, RWTH Aachen University, Aachen, Germany
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22
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Priluck J, Fedio A. Factors associated with utilization of emotion and personality instruments among neuropsychologists. APPLIED NEUROPSYCHOLOGY-ADULT 2020; 29:1112-1121. [PMID: 33950753 DOI: 10.1080/23279095.2020.1852238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Historically, assessment of emotion and personality functioning was not emphasized by clinical neuropsychologists, who instead focused almost exclusively on the evaluation of cognitive functioning. This study examined current practices regarding clinical neuropsychologists' usage of instruments for assessing emotion and personality, along with factors that may mediate their choice of measures and their beliefs about evaluating emotion and personality. Participants were 117 board-certified neuropsychologists as recognized by the American Board of Professional Psychology (ABPP-CN), many of whom had been practicing for over 20 years (39%). Participants generally indicated that examining emotion and personality is essential to evaluations. There was variability among participants as to whether assessment of emotion and personality functioning is challenging, as well as whether or not clinical interview was better suited than instruments. Patients' lack of self-awareness, purposeful over- and under-exaggeration, and lack of sensitivity and specificity of the assessment instruments for neurologic disorders/conditions were identified as the greatest challenges in this area of assessment. Results of the survey suggest that further advancement in the construction and availability of emotion/personality instruments is necessary.
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Affiliation(s)
- Jacob Priluck
- Department of Clinical Psychology, The Chicago School of Professional Psychology - Washington DC Campus, Washington, USA
| | - Alison Fedio
- Department of Clinical Psychology, The Chicago School of Professional Psychology - Washington DC Campus, Washington, USA
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23
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Haugg A, Sladky R, Skouras S, McDonald A, Craddock C, Kirschner M, Herdener M, Koush Y, Papoutsi M, Keynan JN, Hendler T, Cohen Kadosh K, Zich C, MacInnes J, Adcock RA, Dickerson K, Chen N, Young K, Bodurka J, Yao S, Becker B, Auer T, Schweizer R, Pamplona G, Emmert K, Haller S, Van De Ville D, Blefari M, Kim D, Lee J, Marins T, Fukuda M, Sorger B, Kamp T, Liew S, Veit R, Spetter M, Weiskopf N, Scharnowski F. Can we predict real-time fMRI neurofeedback learning success from pretraining brain activity? Hum Brain Mapp 2020; 41:3839-3854. [PMID: 32729652 PMCID: PMC7469782 DOI: 10.1002/hbm.25089] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 05/18/2020] [Accepted: 05/26/2020] [Indexed: 12/31/2022] Open
Abstract
Neurofeedback training has been shown to influence behavior in healthy participants as well as to alleviate clinical symptoms in neurological, psychosomatic, and psychiatric patient populations. However, many real-time fMRI neurofeedback studies report large inter-individual differences in learning success. The factors that cause this vast variability between participants remain unknown and their identification could enhance treatment success. Thus, here we employed a meta-analytic approach including data from 24 different neurofeedback studies with a total of 401 participants, including 140 patients, to determine whether levels of activity in target brain regions during pretraining functional localizer or no-feedback runs (i.e., self-regulation in the absence of neurofeedback) could predict neurofeedback learning success. We observed a slightly positive correlation between pretraining activity levels during a functional localizer run and neurofeedback learning success, but we were not able to identify common brain-based success predictors across our diverse cohort of studies. Therefore, advances need to be made in finding robust models and measures of general neurofeedback learning, and in increasing the current study database to allow for investigating further factors that might influence neurofeedback learning.
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Affiliation(s)
- Amelie Haugg
- Psychiatric University Hospital ZurichUniversity of ZurichZürichSwitzerland
- Faculty of PsychologyUniversity of ViennaViennaAustria
| | - Ronald Sladky
- Faculty of PsychologyUniversity of ViennaViennaAustria
| | - Stavros Skouras
- Department of Biological and Medical PsychologyUniversity of BergenBergenNorway
| | - Amalia McDonald
- Department of PsychologyUniversity of VirginiaCharlottesvilleVirginia
| | - Cameron Craddock
- Department of Diagnostic MedicineThe University of Texas at Austin Dell Medical SchoolAustinTexas
| | - Matthias Kirschner
- Psychiatric University Hospital ZurichUniversity of ZurichZürichSwitzerland
- McConnell Brain Imaging CentreMontréal Neurological Institute, McGill UniversityMontrealCanada
| | - Marcus Herdener
- Psychiatric University Hospital ZurichUniversity of ZurichZürichSwitzerland
| | - Yury Koush
- Magnetic Resonance Research Center, Department of Radiology & Biomedical ImagingYale UniversityNew HavenConnecticut
| | - Marina Papoutsi
- UCL Huntington's Disease CentreInstitute of Neurology, University College LondonLondonEngland
| | - Jackob N. Keynan
- Functional Brain CenterWohl Institute for Advanced Imaging, Tel‐Aviv Sourasky Medical Center, Tel‐Aviv UniversityTel AvivIsrael
| | - Talma Hendler
- Functional Brain CenterWohl Institute for Advanced Imaging, Tel‐Aviv Sourasky Medical Center, Tel‐Aviv UniversityTel AvivIsrael
| | | | - Catharina Zich
- Wellcome Centre for Integrative Neuroimaging, FMRIB, Nuffield Department of Clinical NeurosciencesUniversity of OxfordOxfordEngland
| | - Jeff MacInnes
- Institute for Learning and Brain SciencesUniversity of WashingtonSeattleWashington
| | - R. Alison Adcock
- Department of Psychiatry and Behavioral SciencesDuke UniversityDurhamNorth Carolina
| | - Kathryn Dickerson
- Department of Psychiatry and Behavioral SciencesDuke UniversityDurhamNorth Carolina
| | - Nan‐Kuei Chen
- Department of Biomedical EngineeringUniversity of ArizonaTucsonArizona
| | - Kymberly Young
- Department of Psychiatry, School of MedicineUniversity of PittsburghPittsburghPennsylvania
| | | | - Shuxia Yao
- Clinical Hospital of Chengdu the Brain Science Institute, MOE Key Laboratory for NeuroinformationUniversity of Electronic Science and Technology of ChinaChengduChina
| | - Benjamin Becker
- Clinical Hospital of Chengdu the Brain Science Institute, MOE Key Laboratory for NeuroinformationUniversity of Electronic Science and Technology of ChinaChengduChina
| | - Tibor Auer
- School of PsychologyUniversity of SurreyGuildfordEngland
| | - Renate Schweizer
- Functional Imaging LaboratoryGerman Primate CenterGöttingenGermany
| | - Gustavo Pamplona
- Hôpital and Ophtalmique Jules GoninUniversity of LausanneLausanneSwitzerland
| | - Kirsten Emmert
- Department of NeurologyUniversity Medical Center Schleswig‐Holstein, Kiel UniversityKielGermany
| | - Sven Haller
- Radiology‐Department of Surgical SciencesUppsala UniversityUppsalaSweden
| | - Dimitri Van De Ville
- Center for NeuroprostheticsEcole Polytechnique Féderale de LausanneLausanneSwitzerland
- Department of Radiology and Medical Informatics, Faculty of MedicineUniversity of GenevaGenevaSwitzerland
| | - Maria‐Laura Blefari
- Center for NeuroprostheticsEcole Polytechnique Féderale de LausanneLausanneSwitzerland
| | - Dong‐Youl Kim
- Department of Brain and Cognitive EngineeringKorea UniversitySeoulKorea
| | - Jong‐Hwan Lee
- Department of Brain and Cognitive EngineeringKorea UniversitySeoulKorea
| | - Theo Marins
- D'Or Institute for Research and Education (IDOR)Rio de JaneiroBrazil
| | - Megumi Fukuda
- School of Fundamental Science and EngineeringWaseda UniversityTokyoJapan
| | - Bettina Sorger
- Department Cognitive Neuroscience, Faculty of Psychology and NeuroscienceMaastricht UniversityMaastrichtThe Netherlands
| | - Tabea Kamp
- Department Cognitive Neuroscience, Faculty of Psychology and NeuroscienceMaastricht UniversityMaastrichtThe Netherlands
| | - Sook‐Lei Liew
- Division of Occupational Science and Occupational TherapyUniversity of Southern CaliforniaLos AngelesCalifornia
| | - Ralf Veit
- Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Center MunichUniversity of TübingenTübingenGermany
| | - Maartje Spetter
- School of PsychologyUniversity of BirminghamBirminghamEngland
| | - Nikolaus Weiskopf
- Max Planck Institute for Human Cognitive and Brain SciencesLeipzigGermany
| | - Frank Scharnowski
- Psychiatric University Hospital ZurichUniversity of ZurichZürichSwitzerland
- Faculty of PsychologyUniversity of ViennaViennaAustria
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24
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Bu J, Young KD, Hong W, Ma R, Song H, Wang Y, Zhang W, Hampson M, Hendler T, Zhang X. Effect of deactivation of activity patterns related to smoking cue reactivity on nicotine addiction. Brain 2020; 142:1827-1841. [PMID: 31135053 DOI: 10.1093/brain/awz114] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 01/24/2019] [Accepted: 02/24/2019] [Indexed: 02/04/2023] Open
Abstract
With approximately 75% of smokers resuming cigarette smoking after using the Gold Standard Programme for smoking cessation, investigation into novel therapeutic approaches is warranted. Typically, smoking cue reactivity is crucial for smoking behaviour. Here we developed a novel closed-loop, smoking cue reactivity patterns EEG-based neurofeedback protocol and evaluated its therapeutic efficacy on nicotine addiction. During an evoked smoking cue reactivity task participants' brain activity patterns corresponding to smoking cues were obtained with multivariate pattern analysis of all EEG channels data, then during neurofeedback the EEG activity patterns of smoking cue reactivity were continuously deactivated with adaptive closed-loop training. In a double-blind, placebo-controlled, randomized clinical trial, 60 nicotine-dependent participants were assigned to receive two neurofeedback training sessions (∼1 h/session) either from their own brain (n = 30, real-feedback group) or from the brain activity pattern of a matched participant (n = 30, yoked-feedback group). Cigarette craving and craving-related P300 were assessed at pre-neurofeedback and post-neurofeedback. The number of cigarettes smoked per day was assessed at baseline, 1 week, 1 month, and 4 months following the final neurofeedback visit. In the real-feedback group, participants successfully deactivated EEG activity patterns of smoking cue reactivity. The real-feedback group showed significant decrease in cigarette craving and craving-related P300 amplitudes compared with the yoked-feedback group. The rates of cigarettes smoked per day at 1 week, 1 month and 4 months follow-up decreased 30.6%, 38.2%, and 27.4% relative to baseline in the real-feedback group, compared to decreases of 14.0%, 13.7%, and 5.9% in the yoked-feedback group. The neurofeedback effects on craving change and smoking amount at the 4-month follow-up were further predicted by neural markers at pre-neurofeedback. This novel neurofeedback training approach produced significant short-term and long-term effects on cigarette craving and smoking behaviour, suggesting the neurofeedback protocol described herein is a promising brain-based tool for treating addiction.
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Affiliation(s)
- Junjie Bu
- Hefei National Laboratory for Physical Sciences at the Microscale and School of Life Sciences, University of Science and Technology of China, Hefei, China
| | - Kymberly D Young
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, USA
| | - Wei Hong
- Hefei National Laboratory for Physical Sciences at the Microscale and School of Life Sciences, University of Science and Technology of China, Hefei, China
| | - Ru Ma
- Hefei National Laboratory for Physical Sciences at the Microscale and School of Life Sciences, University of Science and Technology of China, Hefei, China
| | - Hongwen Song
- School of Humanities and Social Science, University of Science and Technology of China, Hefei, China
| | - Ying Wang
- Hefei National Laboratory for Physical Sciences at the Microscale and School of Life Sciences, University of Science and Technology of China, Hefei, China
| | - Wei Zhang
- Hefei National Laboratory for Physical Sciences at the Microscale and School of Life Sciences, University of Science and Technology of China, Hefei, China
| | - Michelle Hampson
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA
| | - Talma Hendler
- Functional Brain Center, Tel-Aviv University, Tel-Aviv, Israel
| | - Xiaochu Zhang
- Hefei National Laboratory for Physical Sciences at the Microscale and School of Life Sciences, University of Science and Technology of China, Hefei, China.,School of Humanities and Social Science, University of Science and Technology of China, Hefei, China.,Hefei Medical Research Center on Alcohol Addiction, Anhui Mental Health Center, Hefei, China.,Academy of Psychology and Behaviour, Tianjin Normal University, Tianjin, China
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25
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Nicholson AA, Ros T, Jetly R, Lanius RA. Regulating posttraumatic stress disorder symptoms with neurofeedback: Regaining control of the mind. JOURNAL OF MILITARY, VETERAN AND FAMILY HEALTH 2020. [DOI: 10.3138/jmvfh.2019-0032] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Neurofeedback is emerging as a psychophysiological treatment where self-regulation is achieved through online feedback of neural states. Novel personalized medicine approaches are particularly important for the treatment of posttraumatic stress disorder (PTSD), as symptom presentation of the disorder, as well as responses to treatment, are highly heterogeneous. Learning to achieve control of specific neural substrates through neurofeedback has been shown to display therapeutic evidence in patients with a wide variety of psychiatric disorders, including PTSD. This article outlines the neural mechanisms underlying neurofeedback and examines converging evidence for the efficacy of neurofeedback as an adjunctive treatment for PTSD via both electroencephalography (EEG) and real-time functional magnetic resonance imaging (fMRI) modalities. Further, implications for the treatment of PTSD via neurofeedback in the military member and Veteran population is examined.
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Affiliation(s)
- Andrew A. Nicholson
- Department of Psychological Research and Research Methods, University of Vienna, Vienna, Austria
- Neurology and Imaging of Cognition Lab, University of Geneva, Geneva, Switzerland
- Canadian Forces Health Services Group, Department of National Defence, Government of Canada, Ottawa
- Department of Psychology, Western University, London, Ontario
| | - Tomas Ros
- Department of Psychological Research and Research Methods, University of Vienna, Vienna, Austria
- Neurology and Imaging of Cognition Lab, University of Geneva, Geneva, Switzerland
- Canadian Forces Health Services Group, Department of National Defence, Government of Canada, Ottawa
- Department of Psychology, Western University, London, Ontario
| | - Rakesh Jetly
- Department of Psychological Research and Research Methods, University of Vienna, Vienna, Austria
- Neurology and Imaging of Cognition Lab, University of Geneva, Geneva, Switzerland
- Canadian Forces Health Services Group, Department of National Defence, Government of Canada, Ottawa
- Department of Psychology, Western University, London, Ontario
| | - Ruth A. Lanius
- Department of Psychological Research and Research Methods, University of Vienna, Vienna, Austria
- Neurology and Imaging of Cognition Lab, University of Geneva, Geneva, Switzerland
- Canadian Forces Health Services Group, Department of National Defence, Government of Canada, Ottawa
- Department of Psychology, Western University, London, Ontario
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26
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Affiliation(s)
- Michelle Hampson
- Department of Radiology and Biomedical Imaging, Department of Psychiatry, and the Child Study Center, Yale University School of Medicine, New Haven, CT, USA.
| | - Sergio Ruiz
- Department of Psychiatry, Medicine School, and Laboratory for Brain-Machine Interfaces and Neuromodulation, Pontificia Universidad Católica de Chile, Santiago, Chile.
| | - Junichi Ushiba
- Department of Biosciences and Informatics, Faculty of Science and Technology, Keio University, Japan.
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27
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Current progress in real-time functional magnetic resonance-based neurofeedback: Methodological challenges and achievements. Neuroimage 2019; 202:116107. [DOI: 10.1016/j.neuroimage.2019.116107] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 07/26/2019] [Accepted: 08/16/2019] [Indexed: 12/21/2022] Open
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28
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Zaehringer J, Ende G, Santangelo P, Kleindienst N, Ruf M, Bertsch K, Bohus M, Schmahl C, Paret C. Improved emotion regulation after neurofeedback: A single-arm trial in patients with borderline personality disorder. Neuroimage Clin 2019; 24:102032. [PMID: 31795041 PMCID: PMC6978219 DOI: 10.1016/j.nicl.2019.102032] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 09/25/2019] [Accepted: 10/07/2019] [Indexed: 01/09/2023]
Abstract
Real-time functional magnetic resonance imaging (fMRI) neurofeedback training of amygdala hemodynamic activity directly targets a neurobiological mechanism, which contributes to emotion regulation problems in borderline personality disorder (BPD). However, it remains unknown which outcome measures can assess changes in emotion regulation and affective instability, associated with amygdala downregulation in a clinical trial. The current study directly addresses this question. Twenty-four female patients with a DSM-IV BPD diagnosis underwent four runs of amygdala neurofeedback. Before and after the training, as well as at a six-weeks follow-up assessment, participants completed measures of emotion dysregulation and affective instability at diverse levels of analysis (verbal report, clinical interview, ecological momentary assessment, emotion-modulated startle, heart rate variability, and fMRI). Participants were able to downregulate their amygdala blood oxygen-dependent (BOLD) response with neurofeedback. There was a decrease of BPD symptoms as assessed with the Zanarini rating scale for BPD (ZAN-BPD) and a decrease in emotion-modulated startle to negative pictures after training. Further explorative analyses suggest that patients indicated less affective instability, as seen by lower hour-to-hour variability in negative affect and inner tension in daily life. If replicated by an independent study, our results imply changes in emotion regulation and affective instability for several systems levels, including behavior and verbal report. Conclusions are limited due to the lack of a control group. A randomized controlled trial (RCT) will be needed to confirm effectiveness of the training.
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Affiliation(s)
- Jenny Zaehringer
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/University of Heidelberg, Mannheim, Germany.
| | - Gabriele Ende
- Department Neuroimaging, Central Institute of Mental Health, Medical Faculty Mannheim / University of Heidelberg, Mannheim, Germany
| | - Philip Santangelo
- Chair of Applied Psychology/Mental Health Lab, Institute of Sport and Sports Science, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - Nikolaus Kleindienst
- Institute of Psychiatric and Psychosomatic Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/University of Heidelberg, Mannheim, Germany
| | - Matthias Ruf
- Department Neuroimaging, Central Institute of Mental Health, Medical Faculty Mannheim / University of Heidelberg, Mannheim, Germany
| | - Katja Bertsch
- Department for General Psychiatry, Center of Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany; Department of Psychology, LMU Munich, Munich, Germany
| | - Martin Bohus
- Institute of Psychiatric and Psychosomatic Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/University of Heidelberg, Mannheim, Germany
| | - Christian Schmahl
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/University of Heidelberg, Mannheim, Germany
| | - Christian Paret
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/University of Heidelberg, Mannheim, Germany; Sagol Brain Institute, Wohl Institute for Advanced Imaging, Tel-Aviv Sourasky Medical Center and School of Psychological Sciences, Tel-Aviv University, Tel-Aviv, Israel.
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29
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Shanechi MM. Brain–machine interfaces from motor to mood. Nat Neurosci 2019; 22:1554-1564. [DOI: 10.1038/s41593-019-0488-y] [Citation(s) in RCA: 82] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 08/06/2019] [Indexed: 12/22/2022]
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30
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Daly I, Williams D, Hwang F, Kirke A, Miranda ER, Nasuto SJ. Electroencephalography reflects the activity of sub-cortical brain regions during approach-withdrawal behaviour while listening to music. Sci Rep 2019; 9:9415. [PMID: 31263113 PMCID: PMC6603018 DOI: 10.1038/s41598-019-45105-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 06/03/2019] [Indexed: 11/09/2022] Open
Abstract
The ability of music to evoke activity changes in the core brain structures that underlie the experience of emotion suggests that it has the potential to be used in therapies for emotion disorders. A large volume of research has identified a network of sub-cortical brain regions underlying music-induced emotions. Additionally, separate evidence from electroencephalography (EEG) studies suggests that prefrontal asymmetry in the EEG reflects the approach-withdrawal response to music-induced emotion. However, fMRI and EEG measure quite different brain processes and we do not have a detailed understanding of the functional relationships between them in relation to music-induced emotion. We employ a joint EEG – fMRI paradigm to explore how EEG-based neural correlates of the approach-withdrawal response to music reflect activity changes in the sub-cortical emotional response network. The neural correlates examined are asymmetry in the prefrontal EEG, and the degree of disorder in that asymmetry over time, as measured by entropy. Participants’ EEG and fMRI were recorded simultaneously while the participants listened to music that had been specifically generated to target the elicitation of a wide range of affective states. While listening to this music, participants also continuously reported their felt affective states. Here we report on co-variations in the dynamics of these self-reports, the EEG, and the sub-cortical brain activity. We find that a set of sub-cortical brain regions in the emotional response network exhibits activity that significantly relates to prefrontal EEG asymmetry. Specifically, EEG in the pre-frontal cortex reflects not only cortical activity, but also changes in activity in the amygdala, posterior temporal cortex, and cerebellum. We also find that, while the magnitude of the asymmetry reflects activity in parts of the limbic and paralimbic systems, the entropy of that asymmetry reflects activity in parts of the autonomic response network such as the auditory cortex. This suggests that asymmetry magnitude reflects affective responses to music, while asymmetry entropy reflects autonomic responses to music. Thus, we demonstrate that it is possible to infer activity in the limbic and paralimbic systems from pre-frontal EEG asymmetry. These results show how EEG can be used to measure and monitor changes in the limbic and paralimbic systems. Specifically, they suggest that EEG asymmetry acts as an indicator of sub-cortical changes in activity induced by music. This shows that EEG may be used as a measure of the effectiveness of music therapy to evoke changes in activity in the sub-cortical emotion response network. This is also the first time that the activity of sub-cortical regions, normally considered “invisible” to EEG, has been shown to be characterisable directly from EEG dynamics measured during music listening.
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Affiliation(s)
- Ian Daly
- Brain-Computer Interfacing and Neural Engineering Laboratory, School of Computer Science and Electronic Engineering, University of Essex, Colchester, CO4 3SQ, UK.
| | - Duncan Williams
- Digital Creativity Labs, Department of Computer Science, University of York, Heslington, YO10 5RG, UK
| | - Faustina Hwang
- Brain Embodiment Laboratory, Biomedical Sciences and Biomedical Engineering Division, School of Biological Sciences, University of Reading, Reading, RG6 6AY, UK
| | - Alexis Kirke
- Interdisciplinary Centre for Computer Music Research, University of Plymouth, Plymouth, PL4 8AA, UK
| | - Eduardo R Miranda
- Interdisciplinary Centre for Computer Music Research, University of Plymouth, Plymouth, PL4 8AA, UK
| | - Slawomir J Nasuto
- Brain Embodiment Laboratory, Biomedical Sciences and Biomedical Engineering Division, School of Biological Sciences, University of Reading, Reading, RG6 6AY, UK
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31
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Thibault RT, Lifshitz M, Raz A. The climate of neurofeedback: scientific rigour and the perils of ideology. Brain 2019; 141:e11. [PMID: 29220482 DOI: 10.1093/brain/awx330] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Robert T Thibault
- Integrated Program in Neuroscience, McGill University, Montreal, H3A 2B4, Canada.,Institute for Interdisciplinary Brain and Behavioral Sciences, Chapman University, Irvine, CA, 92618, USA
| | - Michael Lifshitz
- Integrated Program in Neuroscience, McGill University, Montreal, H3A 2B4, Canada.,Institute for Interdisciplinary Brain and Behavioral Sciences, Chapman University, Irvine, CA, 92618, USA
| | - Amir Raz
- Integrated Program in Neuroscience, McGill University, Montreal, H3A 2B4, Canada.,Institute for Interdisciplinary Brain and Behavioral Sciences, Chapman University, Irvine, CA, 92618, USA.,Departments of Psychiatry, Neurology and Neurosurgery, and Psychology, McGill University, Montreal, H3A 2B4, Canada.,The Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, H3T 1E4, Canada
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32
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Lubianiker N, Goldway N, Fruchtman-Steinbok T, Paret C, Keynan JN, Singer N, Cohen A, Kadosh KC, Linden DEJ, Hendler T. Process-based framework for precise neuromodulation. Nat Hum Behav 2019; 3:436-445. [DOI: 10.1038/s41562-019-0573-y] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 03/05/2019] [Indexed: 12/20/2022]
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33
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Neurofeedback for soldiers. Nat Hum Behav 2019; 3:16-17. [PMID: 30932046 DOI: 10.1038/s41562-018-0493-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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34
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Faller J, Cummings J, Saproo S, Sajda P. Regulation of arousal via online neurofeedback improves human performance in a demanding sensory-motor task. Proc Natl Acad Sci U S A 2019; 116:6482-6490. [PMID: 30862731 PMCID: PMC6442591 DOI: 10.1073/pnas.1817207116] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Our state of arousal can significantly affect our ability to make optimal decisions, judgments, and actions in real-world dynamic environments. The Yerkes-Dodson law, which posits an inverse-U relationship between arousal and task performance, suggests that there is a state of arousal that is optimal for behavioral performance in a given task. Here we show that we can use online neurofeedback to shift an individual's arousal from the right side of the Yerkes-Dodson curve to the left toward a state of improved performance. Specifically, we use a brain-computer interface (BCI) that uses information in the EEG to generate a neurofeedback signal that dynamically adjusts an individual's arousal state when they are engaged in a boundary-avoidance task (BAT). The BAT is a demanding sensory-motor task paradigm that we implement as an aerial navigation task in virtual reality and which creates cognitive conditions that escalate arousal and quickly results in task failure (e.g., missing or crashing into the boundary). We demonstrate that task performance, measured as time and distance over which the subject can navigate before failure, is significantly increased when veridical neurofeedback is provided. Simultaneous measurements of pupil dilation and heart-rate variability show that the neurofeedback indeed reduces arousal. Our work demonstrates a BCI system that uses online neurofeedback to shift arousal state and increase task performance in accordance with the Yerkes-Dodson law.
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Affiliation(s)
- Josef Faller
- Department of Biomedical Engineering, Columbia University, New York, NY 10027;
| | - Jennifer Cummings
- Department of Biomedical Engineering, Columbia University, New York, NY 10027
| | - Sameer Saproo
- Department of Biomedical Engineering, Columbia University, New York, NY 10027
| | - Paul Sajda
- Department of Biomedical Engineering, Columbia University, New York, NY 10027;
- Data Science Institute, Columbia University, New York, NY 10027
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35
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Barreiros AR, Almeida I, Baía BC, Castelo-Branco M. Amygdala Modulation During Emotion Regulation Training With fMRI-Based Neurofeedback. Front Hum Neurosci 2019; 13:89. [PMID: 30971906 PMCID: PMC6444080 DOI: 10.3389/fnhum.2019.00089] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2018] [Accepted: 02/25/2019] [Indexed: 11/25/2022] Open
Abstract
Available evidence suggests that individuals can enhance their ability to modulate brain activity in target regions, within the Emotion Regulation network, using fMRI-based neurofeedback. However, there is no systematic review that investigates the effectiveness of this method on amygdala modulation, a core region within this network. The major goal of this study was to systematically review and analyze the effects of real-time fMRI-Neurofeedback concerning the neuromodulation of the amygdala during Emotion Regulation training. A search was performed in PubMed, Science Direct, and Web of Science with the following key terms: ≪(“neurofeedback” or “neuro feedback” or “neuro-feedback”) and (“emotion regulation”) and (fMRI OR “functional magnetic resonance”),≫ and afterwards two additional searches were performed, replacing the term “emotion regulation” for “amygdala” and “neurofeedback” for “feedback.” Of the 531 identified articles, only 19 articles reported results of amygdala modulation during Emotional Regulation training through rtfMRI-NF, using healthy participants or patients, in original research articles. The results, systematically reviewed here, provide evidence for amygdala's modulation during rtfMRI-NF training, although studies' heterogeneity precluded a quantitative meta-analysis—the included studies relied on different outcome measures to infer the success of neurofeedback intervention. Thus, a qualitative analysis was done instead. We identified critical features influencing inference on the quality of the intervention as: the inclusion of a Practice Run, a Transfer Run and a Control Group in the protocol, and to choose adequate Emotion Regulation strategies—in particular, the effective recall of autobiographic memories. Surprisingly, the Regulated vs. Control Condition was lacking in most of the studies, precluding valid inference of amygdala neuromodulation within Session. The best controlled studies nevertheless showed positive effects. The type of stimulus/interface did not seem critical for amygdala modulation. We also identified potential effects of lateralization of amygdala responses following Up- or Down-Regulation, and the impact of fMRI parameters for data acquisition and analysis. Despite qualitative evidence for amygdala modulation during rtfMRI-NF, there are still important limitations in the design of a clear conceptual framework of NF-training research. Future studies should focus on more homogeneous guidelines concerning design, protocol structure and, particularly, harmonized outcome measures to provide quantitative estimates of neuromodulatory effects in the amygdala.
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Affiliation(s)
- Ana Rita Barreiros
- CIBIT, ICNAS-Institute of Nuclear Sciences Applied to Health-and CNC.IBILI-Faculty of Medicine, Coimbra Institute for Biomedical Imaging and Translational Research, University of Coimbra, Azinhaga de Santa Comba, Coimbra, Portugal
| | - Inês Almeida
- CIBIT, ICNAS-Institute of Nuclear Sciences Applied to Health-and CNC.IBILI-Faculty of Medicine, Coimbra Institute for Biomedical Imaging and Translational Research, University of Coimbra, Azinhaga de Santa Comba, Coimbra, Portugal
| | - Bárbara Correia Baía
- CIBIT, ICNAS-Institute of Nuclear Sciences Applied to Health-and CNC.IBILI-Faculty of Medicine, Coimbra Institute for Biomedical Imaging and Translational Research, University of Coimbra, Azinhaga de Santa Comba, Coimbra, Portugal
| | - Miguel Castelo-Branco
- CIBIT, ICNAS-Institute of Nuclear Sciences Applied to Health-and CNC.IBILI-Faculty of Medicine, Coimbra Institute for Biomedical Imaging and Translational Research, University of Coimbra, Azinhaga de Santa Comba, Coimbra, Portugal
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36
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Papo D. Neurofeedback: Principles, appraisal, and outstanding issues. Eur J Neurosci 2019; 49:1454-1469. [PMID: 30570194 DOI: 10.1111/ejn.14312] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 11/21/2018] [Accepted: 11/27/2018] [Indexed: 12/16/2022]
Abstract
Neurofeedback is a form of brain training in which subjects are fed back information about some measure of their brain activity which they are instructed to modify in a way thought to be functionally advantageous. Over the last 20 years, neurofeedback has been used to treat various neurological and psychiatric conditions, and to improve cognitive function in various contexts. However, in spite of a growing popularity, neurofeedback protocols typically make (often covert) assumptions on what aspects of brain activity to target, where in the brain to act and how, which have far-reaching implications for the assessment of its potential and efficacy. Here we critically examine some conceptual and methodological issues associated with the way neurofeedback's general objectives and neural targets are defined. The neural mechanisms through which neurofeedback may act at various spatial and temporal scales, and the way its efficacy is appraised are reviewed, and the extent to which neurofeedback may be used to control functional brain activity discussed. Finally, it is proposed that gauging neurofeedback's potential, as well as assessing and improving its efficacy will require better understanding of various fundamental aspects of brain dynamics and a more precise definition of functional brain activity and brain-behaviour relationships.
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Affiliation(s)
- David Papo
- SCALab, CNRS, Université de Lille, Villeneuve d'Ascq, France
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37
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Keynan JN, Cohen A, Jackont G, Green N, Goldway N, Davidov A, Meir-Hasson Y, Raz G, Intrator N, Fruchter E, Ginat K, Laska E, Cavazza M, Hendler T. Electrical fingerprint of the amygdala guides neurofeedback training for stress resilience. Nat Hum Behav 2018; 3:63-73. [PMID: 30932053 DOI: 10.1038/s41562-018-0484-3] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2018] [Accepted: 10/30/2018] [Indexed: 02/02/2023]
Abstract
Real-time functional magnetic resonance imaging (rt-fMRI) has revived the translational perspective of neurofeedback (NF)1. Particularly for stress management, targeting deeply located limbic areas involved in stress processing2 has paved new paths for brain-guided interventions. However, the high cost and immobility of fMRI constitute a challenging drawback for the scalability (accessibility and cost-effectiveness) of the approach, particularly for clinical purposes3. The current study aimed to overcome the limited applicability of rt-fMRI by using an electroencephalography (EEG) model endowed with improved spatial resolution, derived from simultaneous EEG-fMRI, to target amygdala activity (termed amygdala electrical fingerprint (Amyg-EFP))4-6. Healthy individuals (n = 180) undergoing a stressful military training programme were randomly assigned to six Amyg-EFP-NF sessions or one of two controls (control-EEG-NF or NoNF), taking place at the military training base. The results demonstrated specificity of NF learning to the targeted Amyg-EFP signal, which led to reduced alexithymia and faster emotional Stroop, indicating better stress coping following Amyg-EFP-NF relative to controls. Neural target engagement was demonstrated in a follow-up fMRI-NF, showing greater amygdala blood-oxygen-level-dependent downregulation and amygdala-ventromedial prefrontal cortex functional connectivity following Amyg-EFP-NF relative to NoNF. Together, these results demonstrate limbic specificity and efficacy of Amyg-EFP-NF during a stressful period, pointing to a scalable non-pharmacological yet neuroscience-based training to prevent stress-induced psychopathology.
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Affiliation(s)
- Jackob N Keynan
- Sagol Brain Institute, Wohl Institute for Advanced Imaging, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel.,The School of Psychological Sciences, Tel-Aviv University, Tel-Aviv, Israel
| | - Avihay Cohen
- Sagol Brain Institute, Wohl Institute for Advanced Imaging, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel.,The School of Psychological Sciences, Tel-Aviv University, Tel-Aviv, Israel
| | - Gilan Jackont
- Sagol Brain Institute, Wohl Institute for Advanced Imaging, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel.,The School of Psychological Sciences, Tel-Aviv University, Tel-Aviv, Israel
| | - Nili Green
- Sagol Brain Institute, Wohl Institute for Advanced Imaging, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel.,The School of Psychological Sciences, Tel-Aviv University, Tel-Aviv, Israel
| | - Noam Goldway
- Sagol Brain Institute, Wohl Institute for Advanced Imaging, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel.,Sagol School of Neuroscience, Tel-Aviv University, Tel-Aviv, Israel
| | | | | | - Gal Raz
- Sagol Brain Institute, Wohl Institute for Advanced Imaging, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel.,Sagol School of Neuroscience, Tel-Aviv University, Tel-Aviv, Israel.,The Steve Tisch School of Film and Television, Tel-Aviv University, Tel-Aviv, Israel
| | - Nathan Intrator
- Sagol School of Neuroscience, Tel-Aviv University, Tel-Aviv, Israel.,Blavatnik School of Computer Science, Tel-Aviv University, Tel-Aviv, Israel
| | - Eyal Fruchter
- The Mental Health Department, Medical Corps, IDF, Ramat-Gan, Israel
| | - Keren Ginat
- The Mental Health Department, Medical Corps, IDF, Ramat-Gan, Israel
| | - Eugene Laska
- Department of Psychiatry, New York University Langone School of Medicine, New York, NY, USA
| | - Marc Cavazza
- School of Engineering and Digital Arts, University of Kent, Canterbury, UK
| | - Talma Hendler
- Sagol Brain Institute, Wohl Institute for Advanced Imaging, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel. .,The School of Psychological Sciences, Tel-Aviv University, Tel-Aviv, Israel. .,Sagol School of Neuroscience, Tel-Aviv University, Tel-Aviv, Israel. .,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
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38
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Targeting the affective brain-a randomized controlled trial of real-time fMRI neurofeedback in patients with depression. Neuropsychopharmacology 2018; 43:2578-2585. [PMID: 29967368 PMCID: PMC6186421 DOI: 10.1038/s41386-018-0126-5] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 05/14/2018] [Accepted: 06/12/2018] [Indexed: 12/28/2022]
Abstract
Functional magnetic resonance imaging neurofeedback (fMRI-NF) training of areas involved in emotion processing can reduce depressive symptoms by over 40% on the Hamilton Depression Rating Scale (HDRS). However, it remains unclear if this efficacy is specific to feedback from emotion-regulating regions. We tested in a single-blind, randomized, controlled trial if upregulation of emotion areas (NFE) yields superior efficacy compared to upregulation of a control region activated by visual scenes (NFS). Forty-three moderately to severely depressed medicated patients were randomly assigned to five sessions augmentation treatment of either NFE or NFS training. At primary outcome (week 12) no significant group mean HDRS difference was found (B = -0.415 [95% CI -4.847 to 4.016], p = 0.848) for the 32 completers (16 per group). However, across groups depressive symptoms decreased by 43%, and 38% of patients remitted. These improvements lasted until follow-up (week 18). Both groups upregulated target regions to a similar extent. Further, clinical improvement was correlated with an increase in self-efficacy scores. However, the interpretation of clinical improvements remains limited due to lack of a sham-control group. We thus surveyed effects reported for accepted augmentation therapies in depression. Data indicated that our findings exceed expected regression to the mean and placebo effects that have been reported for drug trials and other sham-controlled high-technology interventions. Taken together, we suggest that the experience of successful self-regulation during fMRI-NF training may be therapeutic. We conclude that if fMRI-NF is effective for depression, self-regulation training of higher visual areas may provide an effective alternative.
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39
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Marino M, Liu Q, Samogin J, Tecchio F, Cottone C, Mantini D, Porcaro C. Neuronal dynamics enable the functional differentiation of resting state networks in the human brain. Hum Brain Mapp 2018; 40:1445-1457. [PMID: 30430697 DOI: 10.1002/hbm.24458] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 10/22/2018] [Indexed: 12/11/2022] Open
Abstract
Intrinsic brain activity is organized in spatial-temporal patterns, called resting-state networks (RSNs), exhibiting specific structural-functional architecture. These networks presumably reflect complex neurophysiological processes and have a central role in distinct perceptual and cognitive functions. In this work, we propose an innovative approach for characterizing RSNs according to their underlying neural oscillations. We investigated specific electrophysiological properties, including spectral features, fractal dimension, and entropy, associated with eight core RSNs derived from high-density electroencephalography (EEG) source-reconstructed signals. Specifically, we found higher synchronization of the gamma-band activity and higher fractal dimension values in perceptual (PNs) compared with higher cognitive (HCNs) networks. The inspection of this underlying rapid activity becomes of utmost importance for assessing possible alterations related to specific brain disorders. The disruption of the coordinated activity of RSNs may result in altered behavioral and perceptual states. Thus, this approach could potentially be used for the early detection and treatment of neurological disorders.
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Affiliation(s)
- Marco Marino
- Research Center for Motor Control and Neuroplasticity, KU Leuven, Leuven, Belgium.,Department of Experimental Psychology, University of Oxford, Oxford, United Kingdom
| | - Quanying Liu
- Research Center for Motor Control and Neuroplasticity, KU Leuven, Leuven, Belgium.,Division of Engineering and Applied Science, California Institute of Technology, Pasadena, California.,Neurosciences, Huntington Medical Research Institutes, Pasadena, California
| | - Jessica Samogin
- Research Center for Motor Control and Neuroplasticity, KU Leuven, Leuven, Belgium
| | - Franca Tecchio
- ISTC-CNR, Rome, Italy.,Fondazione Policlinico Gemelli IRCCS, Rome, Italy
| | | | - Dante Mantini
- Research Center for Motor Control and Neuroplasticity, KU Leuven, Leuven, Belgium.,Functional Neuroimaging Laboratory, Fondazione Ospedale San Camillo, IRCCS, Venezia, Italy
| | - Camillo Porcaro
- Research Center for Motor Control and Neuroplasticity, KU Leuven, Leuven, Belgium.,ISTC-CNR, Rome, Italy.,Centre for Human Brain Health and School of Psychology, University of Birmingham, Birmingham, United Kingdom.,Department of Information Engineering, Università Politecnica delle Marche, Ancona, Italy.,S. Anna Institute and Research in Advanced Neurorehabilitation (RAN) Crotone, Italy
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40
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Kober SE, Witte M, Grinschgl S, Neuper C, Wood G. Placebo hampers ability to self-regulate brain activity: A double-blind sham-controlled neurofeedback study. Neuroimage 2018; 181:797-806. [DOI: 10.1016/j.neuroimage.2018.07.025] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 07/11/2018] [Accepted: 07/11/2018] [Indexed: 01/03/2023] Open
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41
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Admon R, Vaisvaser S, Erlich N, Lin T, Shapira-Lichter I, Fruchter E, Gazit T, Hendler T. The role of the amygdala in enhanced remembrance of negative episodes and acquired negativity of related neutral cues. Biol Psychol 2018; 139:17-24. [DOI: 10.1016/j.biopsycho.2018.09.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Revised: 08/15/2018] [Accepted: 09/30/2018] [Indexed: 12/15/2022]
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42
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Nicholson AA, Rabellino D, Densmore M, Frewen PA, Paret C, Kluetsch R, Schmahl C, Théberge J, Ros T, Neufeld RWJ, McKinnon MC, Reiss JP, Jetly R, Lanius RA. Intrinsic connectivity network dynamics in PTSD during amygdala downregulation using real-time fMRI neurofeedback: A preliminary analysis. Hum Brain Mapp 2018; 39:4258-4275. [PMID: 30004602 DOI: 10.1002/hbm.24244] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 05/23/2018] [Accepted: 05/29/2018] [Indexed: 01/01/2023] Open
Abstract
Posttraumatic stress disorder (PTSD) has been associated with a disturbance in neural intrinsic connectivity networks (ICN), including the central executive network (CEN), default mode network (DMN), and salience network (SN). Here, we conducted a preliminary investigation examining potential changes in ICN recruitment as a function of real-time fMRI neurofeedback (rt-fMRI-NFB) during symptom provocation where we targeted the downregulation of neural response within the amygdala-a key region-of-interest in PTSD neuropathophysiology. Patients with PTSD (n = 14) completed three sessions of rt-fMRI-NFB with the following conditions: (a) regulate: decrease activation in the amygdala while processing personalized trauma words; (b) view: process trauma words while not attempting to regulate the amygdala; and (c) neutral: process neutral words. We found that recruitment of the left CEN increased over neurofeedback runs during the regulate condition, a finding supported by increased dlPFC activation during the regulate as compared to the view condition. In contrast, DMN task-negative recruitment was stable during neurofeedback runs, albeit was the highest during view conditions and increased (normalized) during rest periods. Critically, SN recruitment was high for both the regulate and the view conditions, a finding potentially indicative of CEN modality switching, adaptive learning, and increasing threat/defense processing in PTSD. In conclusion, this study provides provocative, preliminary evidence that downregulation of the amygdala using rt-fMRI-NFB in PTSD is associated with dynamic changes in ICN, an effect similar to those observed using EEG modalities of neurofeedback.
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Affiliation(s)
- Andrew A Nicholson
- Department of Neuroscience, Western University, London, Ontario, Canada.,Department of Psychiatry, Western University, London, Ontario, Canada.,Department of Imaging, Lawson Health Research Institute, London, Ontario, Canada.,Homewood Research Institute, Guelph, Ontario, Canada
| | - Daniela Rabellino
- Department of Psychiatry, Western University, London, Ontario, Canada.,Department of Imaging, Lawson Health Research Institute, London, Ontario, Canada.,Homewood Research Institute, Guelph, Ontario, Canada
| | - Maria Densmore
- Department of Psychiatry, Western University, London, Ontario, Canada.,Department of Imaging, Lawson Health Research Institute, London, Ontario, Canada
| | - Paul A Frewen
- Department of Neuroscience, Western University, London, Ontario, Canada.,Department of Psychology, Western University, London, Ontario, Canada
| | - Christian Paret
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - Rosemarie Kluetsch
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - Christian Schmahl
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - Jean Théberge
- Department of Psychiatry, Western University, London, Ontario, Canada.,Department of Imaging, Lawson Health Research Institute, London, Ontario, Canada.,Department of Medical Imaging, Western University, London, Ontario, Canada.,Department of Medial Biophysics, Western University, London, Ontario, Canada.,Department of Diagnostic Imaging, St. Joseph's Healthcare, London, Ontario, Canada
| | - Tomas Ros
- Laboratory of Neurology and Imaging of Cognition, Department of Neuroscience, University of Geneva, Geneva, Switzerland
| | - Richard W J Neufeld
- Department of Neuroscience, Western University, London, Ontario, Canada.,Department of Psychiatry, Western University, London, Ontario, Canada.,Department of Psychology, Western University, London, Ontario, Canada
| | - Margaret C McKinnon
- Homewood Research Institute, Guelph, Ontario, Canada.,Mood Disorders Program, St. Joseph's Healthcare, Hamilton, Ontario, Canada.,Department of Psychiatry and Behavioural Neuroscience, McMaster University, Hamilton, Ontario, Canada
| | - Jeffrey P Reiss
- Department of Psychiatry, Western University, London, Ontario, Canada
| | - Rakesh Jetly
- Canadian Forces, Health Services, Ottawa, Ontario, Canada
| | - Ruth A Lanius
- Department of Neuroscience, Western University, London, Ontario, Canada.,Department of Psychiatry, Western University, London, Ontario, Canada.,Department of Imaging, Lawson Health Research Institute, London, Ontario, Canada
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43
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Shushakova A, Ohrmann P, Pedersen A. Exploring deficient emotion regulation in adult ADHD: electrophysiological evidence. Eur Arch Psychiatry Clin Neurosci 2018; 268:359-371. [PMID: 28770370 DOI: 10.1007/s00406-017-0826-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 07/24/2017] [Indexed: 12/29/2022]
Abstract
Emotional dysregulation (ED) is being increasingly recognized as a core feature of attention-deficit/hyperactivity disorder (ADHD), but the pathophysiological underpinnings remain unclear. In this study, we provide meaningful electrophysiological evidence of ED in adult patients with ADHD (n = 39) compared to healthy controls (n = 40) by exploring the electrophysiological correlates of the emotion regulation strategies reappraisal, distraction, and expressive suppression. Event-related potentials (ERPs) were recorded during passive viewing of neutral and negative images, as well as during emotion regulation. The patients with ADHD exhibited increased frontal late positive potential (LPP) amplitudes during passive viewing of the aversive images and during emotion regulation. Compared with the healthy controls, a subgroup of medication-naïve patients with ADHD (n = 25) also exhibited larger centroparietal LPP amplitudes and provided more negative ratings of the aversive and neutral images. Both the frontal and centroparietal LPP amplitudes were associated with ADHD symptom severity. However, no significant deficit in LPP modulation during emotion regulation was found. These findings strongly support the clinical observation of increased emotional responsivity toward negative stimuli and difficulty during the implementation of emotion regulation strategies and thus encourage the implementation of emotion regulation modules in the treatment of adult patients with ADHD.
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Affiliation(s)
- Anna Shushakova
- Clinical Psychology and Psychotherapy, Department of Psychology, University of Kiel, Olshausenstr. 62, 24118, Kiel, Germany.,Clinical Psychology and Psychotherapy, Department of Psychology, University of Münster, Fliednerstr. 21, 48149, Münster, Germany
| | - Patricia Ohrmann
- Department of Psychiatry, School of Medicine, University of Münster, Albert-Schweitzer-Straße 11, 48149, Münster, Germany
| | - Anya Pedersen
- Clinical Psychology and Psychotherapy, Department of Psychology, University of Kiel, Olshausenstr. 62, 24118, Kiel, Germany.
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44
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Paret C, Zähringer J, Ruf M, Gerchen MF, Mall S, Hendler T, Schmahl C, Ende G. Monitoring and control of amygdala neurofeedback involves distributed information processing in the human brain. Hum Brain Mapp 2018; 39:3018-3031. [PMID: 29602255 DOI: 10.1002/hbm.24057] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 03/06/2018] [Accepted: 03/13/2018] [Indexed: 01/28/2023] Open
Abstract
Brain-computer interfaces provide conscious access to neural activity by means of brain-derived feedback ("neurofeedback"). An individual's abilities to monitor and control feedback are two necessary processes for effective neurofeedback therapy, yet their underlying functional neuroanatomy is still being debated. In this study, healthy subjects received visual feedback from their amygdala response to negative pictures. Activation and functional connectivity were analyzed to disentangle the role of brain regions in different processes. Feedback monitoring was mapped to the thalamus, ventromedial prefrontal cortex (vmPFC), ventral striatum (VS), and rostral PFC. The VS responded to feedback corresponding to instructions while rPFC activity differentiated between conditions and predicted amygdala regulation. Control involved the lateral PFC, anterior cingulate, and insula. Monitoring and control activity overlapped in the VS and thalamus. Extending current neural models of neurofeedback, this study introduces monitoring and control of feedback as anatomically dissociated processes, and suggests their important role in voluntary neuromodulation.
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Affiliation(s)
- Christian Paret
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Heidelberg, Germany
| | - Jenny Zähringer
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Heidelberg, Germany
| | - Matthias Ruf
- Department Neuroimaging, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Heidelberg, Germany
| | - Martin Fungisai Gerchen
- Department of Clinical Psychology, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Germany and Bernstein Center for Computational Neuroscience Heidelberg/Mannheim, Heidelberg, Germany
| | - Stephanie Mall
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Heidelberg, Germany
| | - Talma Hendler
- Sagol Center for Brain Function, Wohl Institute for Advanced Imaging, Tel-Aviv Sourasky Medical Center and Sagol School of Neuroscience, School of Psychological Sciences and Faculty of Medicine, Tel-Aviv University, Tel Aviv-Yafo, Israel
| | - Christian Schmahl
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Heidelberg, Germany
| | - Gabriele Ende
- Department Neuroimaging, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Heidelberg, Germany
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45
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Jacob Y, Or-Borichev A, Jackont G, Lubianiker N, Hendler T. Network Based fMRI Neuro-Feedback for Emotion Regulation; Proof-of-Concept. COMPLEX NETWORKS & THEIR APPLICATIONS VI 2018. [DOI: 10.1007/978-3-319-72150-7_101] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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46
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MacNamara A, Rabinak CA, Kennedy AE, Phan KL. Convergence of fMRI and ERP measures of emotional face processing in combat-exposed U. S. military veterans. Psychophysiology 2017; 55. [PMID: 28881021 DOI: 10.1111/psyp.12988] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Revised: 06/21/2017] [Accepted: 08/04/2017] [Indexed: 01/14/2023]
Abstract
The late positive potential (LPP) and fMRI blood-oxygen-level dependent (BOLD) activity can provide complementary measures of the processing of affective and social stimuli. Separate lines of research using these measures have often employed the same stimuli, paradigms, and samples; however, there remains relatively little understanding of the way in which individual differences in one of these measures relates to the other, and all prior research has been conducted in psychiatrically healthy samples and using emotional scenes (not faces). Here, 32 combat-exposed U. S. military veterans with varying levels of posttraumatic stress symptomatology viewed affective social stimuli (angry, fearful, and happy faces) and geometric shapes during separate EEG and fMRI BOLD recordings. Temporospatial principal component analysis was used to quantify the face-elicited LPP in a data-driven manner, prior to conducting whole-brain correlations between resulting positivities and fMRI BOLD elicited by faces. Participants with larger positivities to fearful faces (> shapes) showed increased activation in the amygdala; larger positivities to angry and happy faces (> shapes) were associated with increased BOLD activation in the posterior fusiform gyrus and inferior temporal gyrus, respectively. Across all face types, larger positivities were associated with increased activation in the fusiform "face" area. Correlations using mean area amplitude LPPs showed an association with increased activation in the anterior insula for angry faces (> shapes). LPP-BOLD associations were not moderated by PTSD. Findings provide the first evidence of correspondence between face-elicited LPP and BOLD activation across a range of (normal to disordered) psychiatric health.
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Affiliation(s)
- Annmarie MacNamara
- Department of Psychology, Texas A&M University, College Station, Texas, USA
| | - Christine A Rabinak
- Departments of Pharmacy Practice and Psychiatry & Behavioral Neurosciences, Wayne State University, Detroit, Michigan, USA
| | - Amy E Kennedy
- Department of Psychiatry, University of Illinois at Chicago, Chicago, Illinois, USA.,Mental Health Service Line, Jesse Brown VA Medical Center, Chicago, Illinois, USA
| | - K Luan Phan
- Department of Psychiatry, University of Illinois at Chicago, Chicago, Illinois, USA.,Mental Health Service Line, Jesse Brown VA Medical Center, Chicago, Illinois, USA.,Department of Psychology, University of Illinois at Chicago, Chicago, Illinois, USA.,Department of Anatomy and Cell Biology and the Graduate Program in Neuroscience, University of Illinois at Chicago, Chicago, Illinois, USA
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47
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Yamada T, Hashimoto RI, Yahata N, Ichikawa N, Yoshihara Y, Okamoto Y, Kato N, Takahashi H, Kawato M. Resting-State Functional Connectivity-Based Biomarkers and Functional MRI-Based Neurofeedback for Psychiatric Disorders: A Challenge for Developing Theranostic Biomarkers. Int J Neuropsychopharmacol 2017; 20:769-781. [PMID: 28977523 PMCID: PMC5632305 DOI: 10.1093/ijnp/pyx059] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Accepted: 07/12/2017] [Indexed: 12/28/2022] Open
Abstract
Psychiatric research has been hampered by an explanatory gap between psychiatric symptoms and their neural underpinnings, which has resulted in poor treatment outcomes. This situation has prompted us to shift from symptom-based diagnosis to data-driven diagnosis, aiming to redefine psychiatric disorders as disorders of neural circuitry. Promising candidates for data-driven diagnosis include resting-state functional connectivity MRI (rs-fcMRI)-based biomarkers. Although biomarkers have been developed with the aim of diagnosing patients and predicting the efficacy of therapy, the focus has shifted to the identification of biomarkers that represent therapeutic targets, which would allow for more personalized treatment approaches. This type of biomarker (i.e., "theranostic biomarker") is expected to elucidate the disease mechanism of psychiatric conditions and to offer an individualized neural circuit-based therapeutic target based on the neural cause of a condition. To this end, researchers have developed rs-fcMRI-based biomarkers and investigated a causal relationship between potential biomarkers and disease-specific behavior using functional MRI (fMRI)-based neurofeedback on functional connectivity. In this review, we introduce a recent approach for creating a theranostic biomarker, which consists mainly of 2 parts: (1) developing an rs-fcMRI-based biomarker that can predict diagnosis and/or symptoms with high accuracy, and (2) the introduction of a proof-of-concept study investigating the relationship between normalizing the biomarker and symptom changes using fMRI-based neurofeedback. In parallel with the introduction of recent studies, we review rs-fcMRI-based biomarker and fMRI-based neurofeedback, focusing on the technological improvements and limitations associated with clinical use.
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Affiliation(s)
- Takashi Yamada
- Department of Decoded Neurofeedback, ATR Brain Information Communication Research Laboratory Group, Advanced Telecommunications Research Institute International, Kyoto, Japan (Drs Yamada, Hashimoto, Yahata, and Kawato); Medical Institute of Developmental Disabilities Research, Showa University, Tokyo, Japan (Drs Yamada, Hashimoto, and Kato); Department of Language Sciences, Graduate School of Humanities (Dr Hashimoto), and Research Center for Language, Brain and Genetics (Dr Hashimoto), Tokyo Metropolitan University, Tokyo, Japan; Department of Molecular Imaging and Theranostics, National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan (Dr Yahata); Department of Youth Mental Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan (Dr Yahata); Department of Psychiatry and Neurosciences, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan (Ms Ichikawa and Dr Okamoto); Department of Psychiatry, Kyoto University Graduate School of Medicine, Kyoto, Japan (Drs Yoshihara and Takahashi)
| | - Ryu-ichiro Hashimoto
- Department of Decoded Neurofeedback, ATR Brain Information Communication Research Laboratory Group, Advanced Telecommunications Research Institute International, Kyoto, Japan (Drs Yamada, Hashimoto, Yahata, and Kawato); Medical Institute of Developmental Disabilities Research, Showa University, Tokyo, Japan (Drs Yamada, Hashimoto, and Kato); Department of Language Sciences, Graduate School of Humanities (Dr Hashimoto), and Research Center for Language, Brain and Genetics (Dr Hashimoto), Tokyo Metropolitan University, Tokyo, Japan; Department of Molecular Imaging and Theranostics, National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan (Dr Yahata); Department of Youth Mental Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan (Dr Yahata); Department of Psychiatry and Neurosciences, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan (Ms Ichikawa and Dr Okamoto); Department of Psychiatry, Kyoto University Graduate School of Medicine, Kyoto, Japan (Drs Yoshihara and Takahashi)
| | - Noriaki Yahata
- Department of Decoded Neurofeedback, ATR Brain Information Communication Research Laboratory Group, Advanced Telecommunications Research Institute International, Kyoto, Japan (Drs Yamada, Hashimoto, Yahata, and Kawato); Medical Institute of Developmental Disabilities Research, Showa University, Tokyo, Japan (Drs Yamada, Hashimoto, and Kato); Department of Language Sciences, Graduate School of Humanities (Dr Hashimoto), and Research Center for Language, Brain and Genetics (Dr Hashimoto), Tokyo Metropolitan University, Tokyo, Japan; Department of Molecular Imaging and Theranostics, National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan (Dr Yahata); Department of Youth Mental Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan (Dr Yahata); Department of Psychiatry and Neurosciences, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan (Ms Ichikawa and Dr Okamoto); Department of Psychiatry, Kyoto University Graduate School of Medicine, Kyoto, Japan (Drs Yoshihara and Takahashi)
| | - Naho Ichikawa
- Department of Decoded Neurofeedback, ATR Brain Information Communication Research Laboratory Group, Advanced Telecommunications Research Institute International, Kyoto, Japan (Drs Yamada, Hashimoto, Yahata, and Kawato); Medical Institute of Developmental Disabilities Research, Showa University, Tokyo, Japan (Drs Yamada, Hashimoto, and Kato); Department of Language Sciences, Graduate School of Humanities (Dr Hashimoto), and Research Center for Language, Brain and Genetics (Dr Hashimoto), Tokyo Metropolitan University, Tokyo, Japan; Department of Molecular Imaging and Theranostics, National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan (Dr Yahata); Department of Youth Mental Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan (Dr Yahata); Department of Psychiatry and Neurosciences, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan (Ms Ichikawa and Dr Okamoto); Department of Psychiatry, Kyoto University Graduate School of Medicine, Kyoto, Japan (Drs Yoshihara and Takahashi)
| | - Yujiro Yoshihara
- Department of Decoded Neurofeedback, ATR Brain Information Communication Research Laboratory Group, Advanced Telecommunications Research Institute International, Kyoto, Japan (Drs Yamada, Hashimoto, Yahata, and Kawato); Medical Institute of Developmental Disabilities Research, Showa University, Tokyo, Japan (Drs Yamada, Hashimoto, and Kato); Department of Language Sciences, Graduate School of Humanities (Dr Hashimoto), and Research Center for Language, Brain and Genetics (Dr Hashimoto), Tokyo Metropolitan University, Tokyo, Japan; Department of Molecular Imaging and Theranostics, National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan (Dr Yahata); Department of Youth Mental Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan (Dr Yahata); Department of Psychiatry and Neurosciences, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan (Ms Ichikawa and Dr Okamoto); Department of Psychiatry, Kyoto University Graduate School of Medicine, Kyoto, Japan (Drs Yoshihara and Takahashi)
| | - Yasumasa Okamoto
- Department of Decoded Neurofeedback, ATR Brain Information Communication Research Laboratory Group, Advanced Telecommunications Research Institute International, Kyoto, Japan (Drs Yamada, Hashimoto, Yahata, and Kawato); Medical Institute of Developmental Disabilities Research, Showa University, Tokyo, Japan (Drs Yamada, Hashimoto, and Kato); Department of Language Sciences, Graduate School of Humanities (Dr Hashimoto), and Research Center for Language, Brain and Genetics (Dr Hashimoto), Tokyo Metropolitan University, Tokyo, Japan; Department of Molecular Imaging and Theranostics, National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan (Dr Yahata); Department of Youth Mental Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan (Dr Yahata); Department of Psychiatry and Neurosciences, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan (Ms Ichikawa and Dr Okamoto); Department of Psychiatry, Kyoto University Graduate School of Medicine, Kyoto, Japan (Drs Yoshihara and Takahashi)
| | - Nobumasa Kato
- Department of Decoded Neurofeedback, ATR Brain Information Communication Research Laboratory Group, Advanced Telecommunications Research Institute International, Kyoto, Japan (Drs Yamada, Hashimoto, Yahata, and Kawato); Medical Institute of Developmental Disabilities Research, Showa University, Tokyo, Japan (Drs Yamada, Hashimoto, and Kato); Department of Language Sciences, Graduate School of Humanities (Dr Hashimoto), and Research Center for Language, Brain and Genetics (Dr Hashimoto), Tokyo Metropolitan University, Tokyo, Japan; Department of Molecular Imaging and Theranostics, National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan (Dr Yahata); Department of Youth Mental Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan (Dr Yahata); Department of Psychiatry and Neurosciences, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan (Ms Ichikawa and Dr Okamoto); Department of Psychiatry, Kyoto University Graduate School of Medicine, Kyoto, Japan (Drs Yoshihara and Takahashi)
| | - Hidehiko Takahashi
- Department of Decoded Neurofeedback, ATR Brain Information Communication Research Laboratory Group, Advanced Telecommunications Research Institute International, Kyoto, Japan (Drs Yamada, Hashimoto, Yahata, and Kawato); Medical Institute of Developmental Disabilities Research, Showa University, Tokyo, Japan (Drs Yamada, Hashimoto, and Kato); Department of Language Sciences, Graduate School of Humanities (Dr Hashimoto), and Research Center for Language, Brain and Genetics (Dr Hashimoto), Tokyo Metropolitan University, Tokyo, Japan; Department of Molecular Imaging and Theranostics, National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan (Dr Yahata); Department of Youth Mental Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan (Dr Yahata); Department of Psychiatry and Neurosciences, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan (Ms Ichikawa and Dr Okamoto); Department of Psychiatry, Kyoto University Graduate School of Medicine, Kyoto, Japan (Drs Yoshihara and Takahashi)
| | - Mitsuo Kawato
- Department of Decoded Neurofeedback, ATR Brain Information Communication Research Laboratory Group, Advanced Telecommunications Research Institute International, Kyoto, Japan (Drs Yamada, Hashimoto, Yahata, and Kawato); Medical Institute of Developmental Disabilities Research, Showa University, Tokyo, Japan (Drs Yamada, Hashimoto, and Kato); Department of Language Sciences, Graduate School of Humanities (Dr Hashimoto), and Research Center for Language, Brain and Genetics (Dr Hashimoto), Tokyo Metropolitan University, Tokyo, Japan; Department of Molecular Imaging and Theranostics, National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan (Dr Yahata); Department of Youth Mental Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan (Dr Yahata); Department of Psychiatry and Neurosciences, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan (Ms Ichikawa and Dr Okamoto); Department of Psychiatry, Kyoto University Graduate School of Medicine, Kyoto, Japan (Drs Yoshihara and Takahashi).,Correspondence: Mitsuo Kawato, PhD, 2-2-2 Hikaridai, Seika-cho, Sorakugun, Kyoto, Japan ()
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48
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Fouragnan E, Queirazza F, Retzler C, Mullinger KJ, Philiastides MG. Spatiotemporal neural characterization of prediction error valence and surprise during reward learning in humans. Sci Rep 2017; 7:4762. [PMID: 28684734 PMCID: PMC5500565 DOI: 10.1038/s41598-017-04507-w] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Accepted: 05/17/2017] [Indexed: 02/01/2023] Open
Abstract
Reward learning depends on accurate reward associations with potential choices. These associations can be attained with reinforcement learning mechanisms using a reward prediction error (RPE) signal (the difference between actual and expected rewards) for updating future reward expectations. Despite an extensive body of literature on the influence of RPE on learning, little has been done to investigate the potentially separate contributions of RPE valence (positive or negative) and surprise (absolute degree of deviation from expectations). Here, we coupled single-trial electroencephalography with simultaneously acquired fMRI, during a probabilistic reversal-learning task, to offer evidence of temporally overlapping but largely distinct spatial representations of RPE valence and surprise. Electrophysiological variability in RPE valence correlated with activity in regions of the human reward network promoting approach or avoidance learning. Electrophysiological variability in RPE surprise correlated primarily with activity in regions of the human attentional network controlling the speed of learning. Crucially, despite the largely separate spatial extend of these representations our EEG-informed fMRI approach uniquely revealed a linear superposition of the two RPE components in a smaller network encompassing visuo-mnemonic and reward areas. Activity in this network was further predictive of stimulus value updating indicating a comparable contribution of both signals to reward learning.
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Affiliation(s)
- Elsa Fouragnan
- Institute of Neuroscience & Psychology, University of Glasgow, Glasgow, UK.
- Department of Experimental Psychology, University of Oxford, Oxford, UK.
| | - Filippo Queirazza
- Institute of Neuroscience & Psychology, University of Glasgow, Glasgow, UK
| | - Chris Retzler
- Institute of Neuroscience & Psychology, University of Glasgow, Glasgow, UK
- Department of Behavioural & Social Sciences, University of Huddersfield, Huddersfield, UK
| | - Karen J Mullinger
- Sir Peter Mansfield Magnetic Resonance Center, School of Physics and Astronomy, University of Nottingham, Nottingham, UK
- Birmingham University Imaging Centre, School of Psychology, University of Birmingham, Birmingham, UK
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49
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Gilam G, Lin T, Fruchter E, Hendler T. Neural indicators of interpersonal anger as cause and consequence of combat training stress symptoms. Psychol Med 2017; 47:1561-1572. [PMID: 28052779 DOI: 10.1017/s0033291716003354] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Angry outbursts are an important feature of various stress-related disorders, and commonly lead to aggression towards other people. Findings regarding interpersonal anger have linked the ventromedial prefrontal cortex (vmPFC) to anger regulation and the locus coeruleus (LC) to aggression. Both regions were previously associated with traumatic and chronic stress symptoms, yet it is unclear if their functionality represents a consequence of, or possibly also a cause for, stress symptoms. Here we investigated the relationship between the neural trajectory of these indicators of anger and the development and manifestation of stress symptoms. METHOD A total of 46 males (29 soldiers, 17 civilians) participated in a prospective functional magnetic resonance imaging experiment in which they played a modified interpersonal anger-provoking Ultimatum Game (UG) at two-points. Soldiers were tested at the beginning and end of combat training, while civilians were tested at the beginning and end of civil service. We assumed that combat training would induce chronic stress and result in increased stress symptoms. RESULTS Soldiers showed an increase in stress symptoms following combat training while civilians showed no such change following civil service. All participants were angered by the modified UG irrespective of time point. Higher post-combat training stress symptoms were associated with lower pre-combat training vmPFC activation and with higher activation increase in the LC between pre- and post-combat training. CONCLUSIONS Results suggest that during anger-provoking social interactions, flawed vmPFC functionality may serve as a causal risk factor for the development of stress symptoms, and heightened reactivity of the LC possibly reflects a consequence of stress-inducing combat training. These findings provide potential neural targets for therapeutic intervention and inoculation for stress-related psychopathological manifestations of anger.
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Affiliation(s)
- G Gilam
- Tel Aviv Center for Brain Function,Wohl Institute for Advanced Imaging,Tel Aviv Sourasky Medical Center,Weizmann 6,Tel Aviv,64239,Israel
| | - T Lin
- Tel Aviv Center for Brain Function,Wohl Institute for Advanced Imaging,Tel Aviv Sourasky Medical Center,Weizmann 6,Tel Aviv,64239,Israel
| | - E Fruchter
- Division of Mental Health,Israeli Defense Force Medical Corp,Tel Hashomer,Military Mail 02149,Israel
| | - T Hendler
- Tel Aviv Center for Brain Function,Wohl Institute for Advanced Imaging,Tel Aviv Sourasky Medical Center,Weizmann 6,Tel Aviv,64239,Israel
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50
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Deshpande G, Rangaprakash D, Oeding L, Cichocki A, Hu XP. A New Generation of Brain-Computer Interfaces Driven by Discovery of Latent EEG-fMRI Linkages Using Tensor Decomposition. Front Neurosci 2017. [PMID: 28638316 PMCID: PMC5461249 DOI: 10.3389/fnins.2017.00246] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
A Brain-Computer Interface (BCI) is a setup permitting the control of external devices by decoding brain activity. Electroencephalography (EEG) has been extensively used for decoding brain activity since it is non-invasive, cheap, portable, and has high temporal resolution to allow real-time operation. Due to its poor spatial specificity, BCIs based on EEG can require extensive training and multiple trials to decode brain activity (consequently slowing down the operation of the BCI). On the other hand, BCIs based on functional magnetic resonance imaging (fMRI) are more accurate owing to its superior spatial resolution and sensitivity to underlying neuronal processes which are functionally localized. However, due to its relatively low temporal resolution, high cost, and lack of portability, fMRI is unlikely to be used for routine BCI. We propose a new approach for transferring the capabilities of fMRI to EEG, which includes simultaneous EEG/fMRI sessions for finding a mapping from EEG to fMRI, followed by a BCI run from only EEG data, but driven by fMRI-like features obtained from the mapping identified previously. Our novel data-driven method is likely to discover latent linkages between electrical and hemodynamic signatures of neural activity hitherto unexplored using model-driven methods, and is likely to serve as a template for a novel multi-modal strategy wherein cross-modal EEG-fMRI interactions are exploited for the operation of a unimodal EEG system, leading to a new generation of EEG-based BCIs.
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Affiliation(s)
- Gopikrishna Deshpande
- AU MRI Research Center, Department of Electrical and Computer Engineering, Auburn UniversityAuburn, AL, USA.,Department of Psychology, Auburn UniversityAuburn, AL, USA.,Alabama Advanced Imaging Consortium, Auburn University and University of Alabama at BirminghamBirmingham, AL, USA
| | - D Rangaprakash
- AU MRI Research Center, Department of Electrical and Computer Engineering, Auburn UniversityAuburn, AL, USA.,Department of Psychiatry and Biobehavioral Sciences, University of California, Los AngelesLos Angeles, CA, USA
| | - Luke Oeding
- Department of Mathematics and Statistics, Auburn UniversityAuburn, AL, USA
| | - Andrzej Cichocki
- Skolkovo Institute of Science and Technology (Skoltech)Moscow, Russia.,Nicolaus Copernicus University (UMK)Torun, Poland.,Systems Research Institute, Polish Academy of ScienceWarsaw, Poland
| | - Xiaoping P Hu
- Department of Bioengineering, University of California, RiversideRiverside, CA, USA
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