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Krause F, Linden DEJ, Hermans EJ. Getting stress-related disorders under control: the untapped potential of neurofeedback. Trends Neurosci 2024:S0166-2236(24)00150-4. [PMID: 39261131 DOI: 10.1016/j.tins.2024.08.007] [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: 02/29/2024] [Revised: 07/05/2024] [Accepted: 08/16/2024] [Indexed: 09/13/2024]
Abstract
Stress-related disorders are among the biggest global health challenges. Despite significant progress in understanding their neurocognitive basis, the promise of applying insights from fundamental research to prevention and treatment remains largely unfulfilled. We argue that neurofeedback - a method for training voluntary control over brain activity - has the potential to fill this translational gap. We provide a contemporary perspective on neurofeedback as endogenous neuromodulation that can target complex brain network dynamics, is transferable to real-world scenarios outside a laboratory or treatment facility, can be trained prospectively, and is individually adaptable. This makes neurofeedback a prime candidate for a personalized preventive neuroscience-based intervention strategy that focuses on the ecological momentary neuromodulation of stress-related brain networks in response to actual stressors in real life.
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Affiliation(s)
- Florian Krause
- Donders Institute for Brain, Cognition and Behaviour, Radboud university medical center, Nijmegen, The Netherlands.
| | - David E J Linden
- Faculty of Health, Medicine and Life Sciences, Mental Health and Neuroscience Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Erno J Hermans
- Donders Institute for Brain, Cognition and Behaviour, Radboud university medical center, Nijmegen, The Netherlands
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Kong CH, Min HS, Jeon M, Kang WC, Park K, Kim MS, Jung SY, Bae HJ, Park SJ, Shin HK, Seo CS, Ryu JH. Cheonwangbosimdan mitigates post-traumatic stress disorder-like behaviors through GluN2B-containing NMDA receptor antagonism in mice. JOURNAL OF ETHNOPHARMACOLOGY 2024; 330:118270. [PMID: 38685368 DOI: 10.1016/j.jep.2024.118270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 04/23/2024] [Accepted: 04/27/2024] [Indexed: 05/02/2024]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Cheonwangbosimdan (CWBSD), a herbal medicine traditionally used for anxiety, insomnia, depression, and heart palpitations, has been reported to have anti-anxiety, antidepressant, cognitive improvement, and neuroprotective effects. AIM OF THE STUDY The purpose of this study was to determine if CWBSD could affect post-traumatic stress disorder (PTSD)-like behaviors because it has prioritized clinical use over mechanism study. MATERIALS AND METHODS A single prolonged stress (SPS) mouse model, a well-established animal model of PTSD, was used to investigate whether standardized CWBSD could mitigate PTSD-like behaviors through robust behavioral tests, including the elevated plus-maze test and marble burying test for measuring anxiety-like behaviors, the splash test, forced swimming test, and tail suspension test for evaluating depression-like behaviors, and the Y-maze test and novel object recognition test for assessing cognitive function. Additionally, a fear extinction test was employed to determine whether CWBSD might reverse fear memory extinction deficits. Amygdala tissue was isolated from SPS-treated mouse brain and subjected to Western blotting or quantitative PCR to explore mechanisms by which CWBSD could mitigate PTSD-like behaviors. RESULTS CWBSD ameliorated emotional impairments and cognitive dysfunction in an SPS-induced PTSD-like mouse model. It also mitigated deficits in abnormal fear memory extinction. Protein expression levels of N-methyl-D-aspartate (NMDA) receptor subunit 2B (GluN2B) and phosphorylation levels of Ca2+/calmodulin-dependent protein kinase II in the amygdala were increased in SPS model mice and normalized by CWBSD. Additionally, co-administration of CWBSD and GluN2B-containing NMDA receptor antagonist, ifenprodil, at each sub-effective dose promoted fear memory extinction. CONCLUSIONS CWBSD can alleviate SPS-induced PTSD-like behaviors by normalizing GluN2B-containing NMDA receptor activity in the amygdala. Therefore, CWBSD could be a promising candidate for PTSD treatment with fewer adverse effects and better efficacy than existing therapies.
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MESH Headings
- Animals
- Receptors, N-Methyl-D-Aspartate/metabolism
- Receptors, N-Methyl-D-Aspartate/antagonists & inhibitors
- Stress Disorders, Post-Traumatic/drug therapy
- Stress Disorders, Post-Traumatic/psychology
- Stress Disorders, Post-Traumatic/metabolism
- Male
- Mice
- Behavior, Animal/drug effects
- Disease Models, Animal
- Mice, Inbred C57BL
- Fear/drug effects
- Amygdala/drug effects
- Amygdala/metabolism
- Drugs, Chinese Herbal/pharmacology
- Drugs, Chinese Herbal/therapeutic use
- Anxiety/drug therapy
- Anxiety/psychology
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Affiliation(s)
- Chang Hyeon Kong
- Department of Biomedical and Pharmaceutical Sciences, Kyung Hee University, Seoul, 02447, Republic of Korea
| | - Hoo Sik Min
- Department of Biomedical and Pharmaceutical Sciences, Kyung Hee University, Seoul, 02447, Republic of Korea
| | - Mijin Jeon
- Department of Biomedical and Pharmaceutical Sciences, Kyung Hee University, Seoul, 02447, Republic of Korea
| | - Woo Chang Kang
- Department of Biomedical and Pharmaceutical Sciences, Kyung Hee University, Seoul, 02447, Republic of Korea
| | - Keontae Park
- Department of Biomedical and Pharmaceutical Sciences, Kyung Hee University, Seoul, 02447, Republic of Korea
| | - Min Seo Kim
- Department of Biomedical and Pharmaceutical Sciences, Kyung Hee University, Seoul, 02447, Republic of Korea
| | - Seo Yun Jung
- Department of Biomedical and Pharmaceutical Sciences, Kyung Hee University, Seoul, 02447, Republic of Korea
| | - Ho Jung Bae
- Agriculture and Life Science Research Institute, Kangwon National University, Chuncheon 24341, Republic of Korea
| | - Se Jin Park
- School of Natural Resources and Environmental Sciences, Kangwon National University, Chuncheon, 24341, Republic of Korea
| | - Hyeon-Kyoo Shin
- KM Science Research Division, Korea Institute of Oriental Medicine, Daejeon, 305-811, Republic of Korea
| | - Chang-Seob Seo
- KM Science Research Division, Korea Institute of Oriental Medicine, Daejeon, 305-811, Republic of Korea.
| | - Jong Hoon Ryu
- Department of Biomedical and Pharmaceutical Sciences, Kyung Hee University, Seoul, 02447, Republic of Korea; Department of Oriental Pharmaceutical Science, Kyung Hee University, Seoul, 02447, Republic of Korea.
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Li HP, Cheng HL, Ding K, Zhang Y, Gao F, Zhu G, Zhang Z. New recognition of the heart-brain axis and its implication in the pathogenesis and treatment of PTSD. Eur J Neurosci 2024; 60:4661-4683. [PMID: 39044332 DOI: 10.1111/ejn.16445] [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: 03/28/2024] [Accepted: 06/04/2024] [Indexed: 07/25/2024]
Abstract
Post-traumatic stress disorder (PTSD) is a complex psychological disorder provoked by distressing experiences, and it remains without highly effective intervention strategies. The exploration of PTSD's underlying mechanisms is crucial for advancing diagnostic and therapeutic approaches. Current studies primarily explore PTSD through the lens of the central nervous system, investigating concrete molecular alterations in the cerebral area and neural circuit irregularities. However, the body's response to external stressors, particularly the changes in cardiovascular function, is often pronounced, evidenced by notable cardiac dysfunction. Consequently, examining PTSD with a focus on cardiac function is vital for the early prevention and targeted management of the disorder. This review undertakes a comprehensive literature analysis to detail the alterations in brain and heart structures and functions associated with PTSD. It also synthesizes potential mechanisms of heart-brain axis interactions relevant to the development of PTSD. Ultimately, by considering cardiac function, this review proposes novel perspectives for PTSD's prophylaxis and therapy.
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Affiliation(s)
- Hai-Peng Li
- Anhui University of Chinese Medicine, Hefei, China
| | - Hong-Liang Cheng
- The Affiliated Hospital of Acupuncture and Moxibustion, Anhui University of Chinese Medicine, Hefei, Anhui Province, China
| | - Keke Ding
- Anhui University of Chinese Medicine, Hefei, China
| | - Yang Zhang
- Anhui University of Chinese Medicine, Hefei, China
| | - Fang Gao
- Anhui University of Chinese Medicine, Hefei, China
| | - Guoqi Zhu
- Anhui University of Chinese Medicine, Hefei, China
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Voigt JD, Mosier M, Tendler A. Systematic review and meta-analysis of neurofeedback and its effect on posttraumatic stress disorder. Front Psychiatry 2024; 15:1323485. [PMID: 38577405 PMCID: PMC10993781 DOI: 10.3389/fpsyt.2024.1323485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 02/09/2024] [Indexed: 04/06/2024] Open
Abstract
Background To date, only one systematic review and meta-analysis of randomized controlled trials (RCTs) has evaluated the effect of neurofeedback in PTSD, which included only four studies and found an uncertainty of the effect of EEG-NF on PTSD symptoms. This meta-analysis is an update considering that numerous studies have since been published. Additionally, more recent studies have included fMRI-NF as well as fMRI-guided or -inspired EEG NF. Methods Systematic literature searches for RCTs were conducted in three online databases. Additional hand searches of each study identified and of systematic reviews and meta-analyses published were also undertaken. Outcomes evaluated the effect of neurofeedback vs. a control (active, sham, and waiting list) on their effects in reducing PTSD symptoms using various health instruments. Meta-analytical methods used were inverse variance random-effects models measuring both mean and standardized mean differences. Quality and certainty of the evidence were assessed using GRADE. Adverse events were also evaluated. Results A total of 17 studies were identified evaluating a total of 628 patients. There were 10 studies used in the meta-analysis. Results from all studies identified favored neurofeedback's effect on reducing PTSD symptoms including BDI pretest-posttest [mean difference (MD): 8.30 (95% CI: 3.09 to 13.52; P = 0.002; I 2 = 0%)]; BDI pretest-follow-up (MD: 8.75 (95% CI: 3.53 to 13.97; P < 0.00001; I 2 = 0%); CAPS-5 pretest-posttest [MD: 7.01 (95% CI: 1.36 to 12.66; P = 0.02; I 2 = 86%)]; CAPS-5 pretest-follow-up (MD: 10 (95% CI: 1.29 to 21.29; P = 0.006; I 2 = 77%); PCL-5 pretest-posttest (MD: 7.14 (95% CI: 3.08 to 11.2; P = 0.0006; I 2 = 0%); PCL-5 pretest-follow-up (MD: 14.95 (95% CI: 7.95 to 21.96; P < 0.0001; I 2 = 0%). Other studies reported improvements using various other instruments. GRADE assessments of CAPS, PCL, and BDI demonstrated a moderate/high level in the quality of the evidence that NF has a positive clinical effect. Conclusion Based on newer published studies and the outcomes measured, NF has demonstrated a clinically meaningful effect size, with an increased effect size at follow-up. This clinically meaningful effect appears to be driven by newer fMRI-guided NF and deeper brain derivates of it.
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Affiliation(s)
- Jeffrey D. Voigt
- Medical Device Consultants of Ridgewood, LLC, Waldwick, NJ, United States
| | - Michael Mosier
- EMB Statistical Solutions, LLC, Topeka, KS, United States
| | - Aron Tendler
- Department Life Sciences, Ben-Gurion University of the Negev, Be’er Sheva, Israel
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Sun B, Cao X, Xin M, Guan R. Treatment of Depression with Acupuncture Based on Pathophysiological Mechanism. Int J Gen Med 2024; 17:347-357. [PMID: 38314195 PMCID: PMC10838506 DOI: 10.2147/ijgm.s448031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Accepted: 01/21/2024] [Indexed: 02/06/2024] Open
Abstract
Depression is a prevalent mental disorder and has a profound impact on an individual's psychological and physical well-being. It is characterized by a persistently depressed mood, loss of interest, energy loss, and cognitive dysfunction. In recent years, more and more people have changed to mental diseases, such as depression, anxiety, mania and so on. In the incidence of depression, covering all ages, but still mainly young and middle-aged women. Traditional treatments for depression mainly rely on medication and psychotherapy, but these methods are not effective for all patients and are often accompanied by certain side effects. Therefore, finding safe and effective alternative or adjuvant treatments has become a priority. Here we highlight the research progress of acupuncture in the treatment of depression and to explore the mechanism of acupuncture in the treatment of depression. Acupuncture treatment of depression is an ancient and effective method, the mechanism involves multiple biological pathways, for example, by regulating neurotransmitter levels, regulating the neuroendocrine axis, improving neuroplasticity, anti-inflammatory and other effects, improving emotional state and play an antidepressant role. To provide evidence to support the widespread use of acupuncture in clinical practice. We hope to provide new treatment ideas and methods for patients with depression, and even reduce the incidence of depression.
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Affiliation(s)
- Bo Sun
- Neurology Department, The 962nd Hospital of the PLA Joint Logistic Support Force, Harbin, People’s Republic of China
| | - Xuewei Cao
- Cardiopulmonary Department, Jiamusi Hospital of Traditional Chinese Medicine, Harbin, People’s Republic of China
| | - Ming Xin
- Neurology Department, Xin Wanhe Acupuncture Clinic, Harbin, People’s Republic of China
| | - Ruiqian Guan
- Massage Department, The Second Affiliated Hospital of Heilongjiang University of Chinese Medicine, Harbin, People’s Republic of China
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Rance M, Zhao Z, Zaboski B, Kichuk SA, Romaker E, Koller WN, Walsh C, Harris-Starling C, Wasylink S, Adams T, Gruner P, Pittenger C, Hampson M. Neurofeedback for obsessive compulsive disorder: A randomized, double-blind trial. Psychiatry Res 2023; 328:115458. [PMID: 37722238 PMCID: PMC10695074 DOI: 10.1016/j.psychres.2023.115458] [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: 06/09/2023] [Revised: 08/28/2023] [Accepted: 08/31/2023] [Indexed: 09/20/2023]
Abstract
We aim to develop fMRI neurofeedback as a treatment for obsessive compulsive disorder (OCD). In prior work, we found that providing neurofeedback of activity in the anterior prefrontal cortex (aPFC) improved control over contamination anxiety in a subclinical population. Here, we present the results of a randomized, double-blind clinical trial (NCT02206945) testing this intervention in patients with OCD. We recruited patients with primary symptoms in the fear-of-harm/checking or contamination/washing domains. During neurofeedback, they viewed symptom provocative images and attempted to up- and down-regulate the aPFC during different blocks of time. The active group received two sessions of neurofeedback and the control group received yoked sham feedback. The primary outcome measure was the Yale-Brown Obsessive-Compulsive Symptom scale. The secondary outcome was control over aPFC. Thirty-six participants completed feedback training (18 active, 18 control). The active group had a slightly but significantly greater reduction of obsessive-compulsive symptoms after neurofeedback compared to the control group (p<.05) but no significant differences in control over the aPFC. These data demonstrate that neurofeedback targeting the aPFC can reduce symptoms in OCD. Future investigations should seek to optimize the training protocol to yield larger effects and to clarify the mechanism of action.
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Affiliation(s)
- Mariela Rance
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA
| | - Zhiying Zhao
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA; Centre for Cognitive and Brain Sciences, University of Macau, Macau SAR, China
| | - Brian Zaboski
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Stephen A Kichuk
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Emma Romaker
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA; Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - William N Koller
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA
| | - Christopher Walsh
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA
| | | | - Suzanne Wasylink
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Thomas Adams
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA; Department of Psychology, University of Kentucky, Lexington, KY, USA
| | - Patricia Gruner
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Christopher Pittenger
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA; Child Study Center, Yale School of Medicine, New Haven, CT, USA; Department of Psychology, Yale University, New Haven, CT, USA; Center for Brain and Mind Health, Yale School of Medicine, New Haven, CT, USA
| | - Michelle Hampson
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA; Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA; Child Study Center, Yale School of Medicine, New Haven, CT, USA; Department of Biomedical Engineering, Yale School of Engineering and Applied Science, New Haven, CT, USA.
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Dehghani A, Soltanian-Zadeh H, Hossein-Zadeh GA. Neural modulation enhancement using connectivity-based EEG neurofeedback with simultaneous fMRI for emotion regulation. Neuroimage 2023; 279:120320. [PMID: 37586444 DOI: 10.1016/j.neuroimage.2023.120320] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 08/06/2023] [Accepted: 08/10/2023] [Indexed: 08/18/2023] Open
Abstract
Emotion regulation plays a key role in human behavior and overall well-being. Neurofeedback is a non-invasive self-brain training technique used for emotion regulation to enhance brain function and treatment of mental disorders through behavioral changes. Previous neurofeedback research often focused on using activity from a single brain region as measured by fMRI or power from one or two EEG electrodes. In a new study, we employed connectivity-based EEG neurofeedback through recalling positive autobiographical memories and simultaneous fMRI to upregulate positive emotion. In our novel approach, the feedback was determined by the coherence of EEG electrodes rather than the power of one or two electrodes. We compared the efficiency of this connectivity-based neurofeedback to traditional activity-based neurofeedback through multiple experiments. The results showed that connectivity-based neurofeedback effectively improved BOLD signal change and connectivity in key emotion regulation regions such as the amygdala, thalamus, and insula, and increased EEG frontal asymmetry, which is a biomarker for emotion regulation and treatment of mental disorders such as PTSD, anxiety, and depression and coherence among EEG channels. The psychometric evaluations conducted both before and after the neurofeedback experiments revealed that participants demonstrated improvements in enhancing positive emotions and reducing negative emotions when utilizing connectivity-based neurofeedback, as compared to traditional activity-based and sham neurofeedback approaches. These findings suggest that connectivity-based neurofeedback may be a superior method for regulating emotions and could be a useful alternative therapy for mental disorders, providing individuals with greater control over their brain and mental functions.
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Affiliation(s)
- Amin Dehghani
- School of Electrical and Computer Engineering, University of Tehran, Tehran, Iran; Department of Psychological and Brain Sciences, Dartmouth College, Hanover, NH, USA.
| | - Hamid Soltanian-Zadeh
- School of Electrical and Computer Engineering, University of Tehran, Tehran, Iran; School of Cognitive Sciences, Institute for Research in Fundamental Sciences (IPM), Tehran, Iran; Departments of Radiology and Research Administration, Henry Ford Health System, Detroit, MI, USA
| | - Gholam-Ali Hossein-Zadeh
- School of Electrical and Computer Engineering, University of Tehran, Tehran, Iran; School of Cognitive Sciences, Institute for Research in Fundamental Sciences (IPM), Tehran, Iran
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