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Uemura M, Katagiri Y, Imai E, Kawahara Y, Otani Y, Ichinose T, Kondo K, Kowa H. Dorsal Anterior Cingulate Cortex Coordinates Contextual Mental Imagery for Single-Beat Manipulation during Rhythmic Sensorimotor Synchronization. Brain Sci 2024; 14:757. [PMID: 39199452 PMCID: PMC11352649 DOI: 10.3390/brainsci14080757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2024] [Revised: 07/17/2024] [Accepted: 07/23/2024] [Indexed: 09/01/2024] Open
Abstract
Flexible pulse-by-pulse regulation of sensorimotor synchronization is crucial for voluntarily showing rhythmic behaviors synchronously with external cueing; however, the underpinning neurophysiological mechanisms remain unclear. We hypothesized that the dorsal anterior cingulate cortex (dACC) plays a key role by coordinating both proactive and reactive motor outcomes based on contextual mental imagery. To test our hypothesis, a missing-oddball task in finger-tapping paradigms was conducted in 33 healthy young volunteers. The dynamic properties of the dACC were evaluated by event-related deep-brain activity (ER-DBA), supported by event-related potential (ERP) analysis and behavioral evaluation based on signal detection theory. We found that ER-DBA activation/deactivation reflected a strategic choice of motor control modality in accordance with mental imagery. Reverse ERP traces, as omission responses, confirmed that the imagery was contextual. We found that mental imagery was updated only by environmental changes via perceptual evidence and response-based abductive reasoning. Moreover, stable on-pulse tapping was achievable by maintaining proactive control while creating an imagery of syncopated rhythms from simple beat trains, whereas accuracy was degraded with frequent erroneous tapping for missing pulses. We conclude that the dACC voluntarily regulates rhythmic sensorimotor synchronization by utilizing contextual mental imagery based on experience and by creating novel rhythms.
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Affiliation(s)
- Maho Uemura
- Department of Rehabilitation Science, Kobe University Graduate School of Health Sciences, Kobe 654-0142, Japan; (Y.O.); (H.K.)
- School of Music, Mukogawa Women’s University, Nishinomiya 663-8558, Japan;
| | - Yoshitada Katagiri
- Department of Bioengineering, School of Engineering, The University of Tokyo, Tokyo 113-8655, Japan;
| | - Emiko Imai
- Department of Biophysics, Kobe University Graduate School of Health Sciences, Kobe 654-0142, Japan;
| | - Yasuhiro Kawahara
- Department of Human life and Health Sciences, Division of Arts and Sciences, The Open University of Japan, Chiba 261-8586, Japan;
| | - Yoshitaka Otani
- Department of Rehabilitation Science, Kobe University Graduate School of Health Sciences, Kobe 654-0142, Japan; (Y.O.); (H.K.)
- Faculty of Rehabilitation, Kobe International University, Kobe 658-0032, Japan
| | - Tomoko Ichinose
- School of Music, Mukogawa Women’s University, Nishinomiya 663-8558, Japan;
| | | | - Hisatomo Kowa
- Department of Rehabilitation Science, Kobe University Graduate School of Health Sciences, Kobe 654-0142, Japan; (Y.O.); (H.K.)
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2
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Smit D, Dapor C, Koerts J, Tucha OM, Huster RJ, Enriquez-Geppert S. Long-term improvements in executive functions after frontal-midline theta neurofeedback in a (sub)clinical group. Front Hum Neurosci 2023; 17:1163380. [PMID: 37362947 PMCID: PMC10290172 DOI: 10.3389/fnhum.2023.1163380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 05/23/2023] [Indexed: 06/28/2023] Open
Abstract
Impairments in executive functions (EFs) are common across disorders and can greatly affect daily functioning. Frontal-midline (FM) theta neurofeedback (NF) has been shown effective in enhancing EFs in healthy adults, prompting interest in exploring its potential as an alternative treatment for EFs in (sub)clinical samples. This study aims to determine the effects of FM theta NF on EFs in a sample of 58 adults (aged 20-60 years) with pronounced subjective EF complaints in daily life. Using a pre/post/follow-up design with a sham NF group, the present study assessed upregulation of FM theta in an eight-session individualized FM theta NF training and its immediate and long-term transfer effects on objective and subjective measures of EFs. These included behavioral performance on EF tasks assessing working memory updating (N-back task), set-shifting (Switching task), conflict monitoring (Stroop task), and response inhibition (Stop-signal task), as well as FM theta power during these tasks, and subjective EFs in daily life (BRIEF-A). The results indicate that there are only differences in FM theta self-upregulation between the NF group and sham group when non-responders are excluded from the analysis. Regarding behavioral transfer effects, NF-specific improvements are found in working memory updating reaction time (RT) and conflict monitoring RT variability at 6-month follow-up, but not immediately after the NF training. The effects on FM theta power during the EF tasks and subjective changes in EFs in daily life were not specific to the NF training. As a next step, research should identify the best predictors to stratify NF training, as well as explore ways to improve NF responsiveness, for instance by increasing neuroplasticity.
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Affiliation(s)
- Diede Smit
- Department of Clinical and Developmental Neuropsychology, University of Groningen, Groningen, Netherlands
- Research School of Behavioural and Cognitive Neurosciences, University of Groningen, Groningen, Netherlands
| | - Cecilia Dapor
- Department of Psychology and Cognitive Science, University of Trento, Trento, Italy
| | - Janneke Koerts
- Department of Clinical and Developmental Neuropsychology, University of Groningen, Groningen, Netherlands
- Research School of Behavioural and Cognitive Neurosciences, University of Groningen, Groningen, Netherlands
| | - Oliver M. Tucha
- Department of Clinical and Developmental Neuropsychology, University of Groningen, Groningen, Netherlands
- Department of Psychiatry and Psychotherapy, University Medical Center Rostock, Rostock, Germany
- Department of Psychology, National University of Ireland, Maynooth, Irleand
| | - Rene J. Huster
- Department of Psychology, University of Oslo, Oslo, Norway
| | - Stefanie Enriquez-Geppert
- Department of Clinical and Developmental Neuropsychology, University of Groningen, Groningen, Netherlands
- Department of Biomedical Sciences of Cells and Systems, University Medical Center Groningen, Groningen, Netherlands
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3
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Markiewicz-Gospodarek A, Markiewicz R, Borowski B, Dobrowolska B, Łoza B. Self-Regulatory Neuronal Mechanisms and Long-Term Challenges in Schizophrenia Treatment. Brain Sci 2023; 13:brainsci13040651. [PMID: 37190616 DOI: 10.3390/brainsci13040651] [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: 03/30/2023] [Revised: 04/04/2023] [Accepted: 04/11/2023] [Indexed: 05/17/2023] Open
Abstract
Schizophrenia is a chronic and relapsing disorder that is characterized not only by delusions and hallucinations but also mainly by the progressive development of cognitive and social deficits. These deficits are related to impaired synaptic plasticity and impaired neurotransmission in the nervous system. Currently, technological innovations and medical advances make it possible to use various self-regulatory methods to improve impaired synaptic plasticity. To evaluate the therapeutic effect of various rehabilitation methods, we reviewed methods that modify synaptic plasticity and improve the cognitive and executive processes of patients with a diagnosis of schizophrenia. PubMed, Scopus, and Google Scholar bibliographic databases were searched with the keywords mentioned below. A total of 555 records were identified. Modern methods of schizophrenia therapy with neuroplastic potential, including neurofeedback, transcranial magnetic stimulation, transcranial direct current stimulation, vagus nerve stimulation, virtual reality therapy, and cognitive remediation therapy, were reviewed and analyzed. Since randomized controlled studies of long-term schizophrenia treatment do not exceed 2-3 years, and the pharmacological treatment itself has an incompletely estimated benefit-risk ratio, treatment methods based on other paradigms, including neuronal self-regulatory and neural plasticity mechanisms, should be considered. Methods available for monitoring neuroplastic effects in vivo (e.g., fMRI, neuropeptides in serum), as well as unfavorable parameters (e.g., features of the metabolic syndrome), enable individualized monitoring of the effectiveness of long-term treatment of schizophrenia.
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Affiliation(s)
| | - Renata Markiewicz
- Department of Neurology, Neurological and Psychiatric Nursing, Medical University of Lublin, 20-093 Lublin, Poland
| | - Bartosz Borowski
- Students Scientific Association at the Department of Human Anatomy, Medical University of Lublin, 20-090 Lublin, Poland
| | - Beata Dobrowolska
- Department of Holistic Care and Management in Nursing, Medical University of Lublin, 20-081 Lublin, Poland
| | - Bartosz Łoza
- Department of Psychiatry, Medical University of Warsaw, 02-091 Warsaw, Poland
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Orth L, Meeh J, Gur RC, Neuner I, Sarkheil P. Frontostriatal circuitry as a target for fMRI-based neurofeedback interventions: A systematic review. Front Hum Neurosci 2022; 16:933718. [PMID: 36092647 PMCID: PMC9449529 DOI: 10.3389/fnhum.2022.933718] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 08/08/2022] [Indexed: 11/19/2022] Open
Abstract
Dysregulated frontostriatal circuitries are viewed as a common target for the treatment of aberrant behaviors in various psychiatric and neurological disorders. Accordingly, experimental neurofeedback paradigms have been applied to modify the frontostriatal circuitry. The human frontostriatal circuitry is topographically and functionally organized into the "limbic," the "associative," and the "motor" subsystems underlying a variety of affective, cognitive, and motor functions. We conducted a systematic review of the literature regarding functional magnetic resonance imaging-based neurofeedback studies that targeted brain activations within the frontostriatal circuitry. Seventy-nine published studies were included in our survey. We assessed the efficacy of these studies in terms of imaging findings of neurofeedback intervention as well as behavioral and clinical outcomes. Furthermore, we evaluated whether the neurofeedback targets of the studies could be assigned to the identifiable frontostriatal subsystems. The majority of studies that targeted frontostriatal circuitry functions focused on the anterior cingulate cortex, the dorsolateral prefrontal cortex, and the supplementary motor area. Only a few studies (n = 14) targeted the connectivity of the frontostriatal regions. However, post-hoc analyses of connectivity changes were reported in more cases (n = 32). Neurofeedback has been frequently used to modify brain activations within the frontostriatal circuitry. Given the regulatory mechanisms within the closed loop of the frontostriatal circuitry, the connectivity-based neurofeedback paradigms should be primarily considered for modifications of this system. The anatomical and functional organization of the frontostriatal system needs to be considered in decisions pertaining to the neurofeedback targets.
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Affiliation(s)
- Linda Orth
- Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, Aachen, Germany
| | - Johanna Meeh
- Department of Psychiatry and Psychotherapy, University of Münster, Münster, Germany
| | - Ruben C. Gur
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Irene Neuner
- Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, Aachen, Germany
- Institute of Neuroscience and Medicine 4, Forschungszentrum Jülich, Jülich, Germany
| | - Pegah Sarkheil
- Department of Psychiatry and Psychotherapy, University of Münster, Münster, Germany
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Lubianiker N, Paret C, Dayan P, Hendler T. Neurofeedback through the lens of reinforcement learning. Trends Neurosci 2022; 45:579-593. [PMID: 35550813 DOI: 10.1016/j.tins.2022.03.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 02/11/2022] [Accepted: 03/24/2022] [Indexed: 11/29/2022]
Abstract
Despite decades of experimental and clinical practice, the neuropsychological mechanisms underlying neurofeedback (NF) training remain obscure. NF is a unique form of reinforcement learning (RL) task, during which participants are provided with rewarding feedback regarding desired changes in neural patterns. However, key RL considerations - including choices during practice, prediction errors, credit-assignment problems, or the exploration-exploitation tradeoff - have infrequently been considered in the context of NF. We offer an RL-based framework for NF, describing different internal states, actions, and rewards in common NF protocols, thus fashioning new proposals for characterizing, predicting, and hastening the course of learning. In this way we hope to advance current understanding of neural regulation via NF, and ultimately to promote its effectiveness, personalization, and clinical utility.
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Affiliation(s)
- Nitzan Lubianiker
- School of Psychological Sciences, Gershon H. Gordon Faculty of Social Sciences, Tel Aviv University, Tel Aviv, Israel; Sagol Brain Institute, Wohl Institute for Advanced Imaging, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
| | - Christian Paret
- School of Psychological Sciences, Gershon H. Gordon Faculty of Social Sciences, Tel Aviv University, Tel Aviv, Israel; Sagol Brain Institute, Wohl Institute for Advanced Imaging, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - Peter Dayan
- Max Planck Institute for Biological Cybernetics, Tübingen, Germany; University of Tübingen, Tübingen, Germany
| | - Talma Hendler
- School of Psychological Sciences, Gershon H. Gordon Faculty of Social Sciences, Tel Aviv University, Tel Aviv, Israel; 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; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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6
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Zweerings J, Sarasjärvi K, Mathiak KA, Iglesias-Fuster J, Cong F, Zvyagintsev M, Mathiak K. Data-Driven Approach to the Analysis of Real-Time FMRI Neurofeedback Data: Disorder-Specific Brain Synchrony in PTSD. Int J Neural Syst 2021; 31:2150043. [PMID: 34551675 DOI: 10.1142/s012906572150043x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Brain-computer interfaces (BCIs) can be used in real-time fMRI neurofeedback (rtfMRI NF) investigations to provide feedback on brain activity to enable voluntary regulation of the blood-oxygen-level dependent (BOLD) signal from localized brain regions. However, the temporal pattern of successful self-regulation is dynamic and complex. In particular, the general linear model (GLM) assumes fixed temporal model functions and misses other dynamics. We propose a novel data-driven analyses approach for rtfMRI NF using intersubject covariance (ISC) analysis. The potential of ISC was examined in a reanalysis of data from 21 healthy individuals and nine patients with post-traumatic stress-disorder (PTSD) performing up-regulation of the anterior cingulate cortex (ACC). ISC in the PTSD group differed from healthy controls in a network including the right inferior frontal gyrus (IFG). In both cohorts, ISC decreased throughout the experiment indicating the development of individual regulation strategies. ISC analyses are a promising approach to reveal novel information on the mechanisms involved in voluntary self-regulation of brain signals and thus extend the results from GLM-based methods. ISC enables a novel set of research questions that can guide future neurofeedback and neuroimaging investigations.
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Affiliation(s)
- Jana Zweerings
- Department of Psychiatry, Psychotherapy and Psychosomatics, Faculty of Medicine, RWTH Aachen, Aachen Germany.,JARA-Brain, Research Center Jülich, Jülich, Germany
| | - Kiira Sarasjärvi
- Department of Psychiatry, Psychotherapy and Psychosomatics, Faculty of Medicine, RWTH Aachen, Aachen Germany.,Department of Digital Humanities, University of Helsinki, Helsinki, Finland
| | - Krystyna Anna Mathiak
- Department of Psychiatry, Psychotherapy and Psychosomatics, Faculty of Medicine, RWTH Aachen, Aachen Germany.,JARA-Brain, Research Center Jülich, Jülich, Germany
| | | | - Fengyu Cong
- School of Biomedical Engineering, Faculty of Electronic Information and Electrical Engineering, Dalian University of Technology, 116024 Dalian, P. R. China.,Faculty of Information Technology, University of Jyväskylä, 40014 Jyväskylä, Finland.,School of Artificial Intelligence, Faculty of Electronic Information and Electrical Engineering, Dalian University of Technology, 116024 Dalian, P. R. China.,Key Laboratory of Integrated Circuit and Biomedical Electronic System, Liaoning Province, Dalian University of Technology, 116024 Dalian, P. R. China
| | - Mikhail Zvyagintsev
- Department of Psychiatry, Psychotherapy and Psychosomatics, Faculty of Medicine, RWTH Aachen, Aachen Germany.,JARA-Brain, Research Center Jülich, Jülich, Germany
| | - Klaus Mathiak
- Department of Psychiatry, Psychotherapy and Psychosomatics, Faculty of Medicine, RWTH Aachen, Aachen Germany.,JARA-Brain, Research Center Jülich, Jülich, Germany
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7
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Improving Clinical, Cognitive, and Psychosocial Dysfunctions in Patients with Schizophrenia: A Neurofeedback Randomized Control Trial. Neural Plast 2021; 2021:4488664. [PMID: 34434228 PMCID: PMC8380506 DOI: 10.1155/2021/4488664] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 07/30/2021] [Accepted: 08/04/2021] [Indexed: 12/17/2022] Open
Abstract
Objectives The aim of this study was to use neurofeedback (NF) training as the add-on therapy in patients with schizophrenia to improve their clinical, cognitive, and psychosocial condition. The study, thanks to the monitoring of various conditions, quantitative electroencephalogram (QEEG) and brain-derived neurotrophic factor (BDNF), was supposed to give an insight into mechanisms underlying NF training results. Methods Forty-four male patients with schizophrenia, currently in a stable, incomplete remission, were recruited into two, 3-month rehabilitation programs, with standard rehabilitation as a control group (R) or with add-on NF training (NF). Pre- and posttherapy primary outcomes were compared: clinical (Positive and Negative Syndrome Scale (PANSS)), cognitive (Color Trails Test (CTT), d2 test), psychosocial functioning (General Self-Efficacy Scale (GSES), Beck Cognitive Insight Scale (BCIS), and Acceptance of Illness Scale (AIS)), quantitative electroencephalogram (QEEG), auditory event-related potentials (ERPs), and serum level of BDNF. Results. Both groups R and NF improved significantly in clinical ratings (Positive and Negative Syndrome Scale (PANSS)). In-between analyses unveiled some advantages of add-on NF therapy over standard rehabilitation. GSES scores improved significantly, giving the NF group of patients greater ability to cope with stressful or difficult social demands. Also, the serum-level BDNF increased significantly more in the NF group. Post hoc analyses indicated the possibility of creating a separate PANSS subsyndrome, specifically related to cognitive, psychosocial, and BDNF effects of NF therapy. Conclusions Neurofeedback can be effectively used as the add-on therapy in schizophrenia rehabilitation programs. The method requires further research regarding its clinical specificity and understanding mechanisms of action.
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8
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Keller M, Zweerings J, Klasen M, Zvyagintsev M, Iglesias J, Mendoza Quiñones R, Mathiak K. fMRI Neurofeedback-Enhanced Cognitive Reappraisal Training in Depression: A Double-Blind Comparison of Left and Right vlPFC Regulation. Front Psychiatry 2021; 12:715898. [PMID: 34497546 PMCID: PMC8419460 DOI: 10.3389/fpsyt.2021.715898] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 07/29/2021] [Indexed: 01/09/2023] Open
Abstract
Affective disorders are associated with maladaptive emotion regulation strategies. In particular, the left more than the right ventrolateral prefrontal cortex (vlPFC) may insufficiently regulate emotion processing, e.g., in the amygdala. A double-blind cross-over study investigated NF-supported cognitive reappraisal training in major depression (n = 42) and age- and gender-matched controls (n = 39). In a randomized order, participants trained to upregulate either the left or the right vlPFC during cognitive reappraisal of negative images on two separate days. We wanted to confirm regional specific NF effects with improved learning for left compared to right vlPFC (ClinicalTrials.gov NCT03183947). Brain responses and connectivity were studied with respect to training progress, gender, and clinical outcomes in a 4-week follow-up. Increase of vlPFC activity was stronger after NF training from the left- than the right-hemispheric ROI. This regional-specific NF effect during cognitive reappraisal was present across patients with depression and controls and supports a central role of the left vlPFC for cognitive reappraisal. Further, the activity in the left target region was associated with increased use of cognitive reappraisal strategies (r = 0.48). In the 4-week follow-up, 75% of patients with depression reported a successful application of learned strategies in everyday life and 55% a clinically meaningful symptom improvement suggesting clinical usability.
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Affiliation(s)
- Micha Keller
- Department of Psychiatry, Psychotherapy and Psychosomatics, School of Medicine, RWTH Aachen University, Aachen, Germany
| | - Jana Zweerings
- Department of Psychiatry, Psychotherapy and Psychosomatics, School of Medicine, RWTH Aachen University, Aachen, Germany
| | - Martin Klasen
- Department of Psychiatry, Psychotherapy and Psychosomatics, School of Medicine, RWTH Aachen University, Aachen, Germany
- Interdisciplinary Training Centre for Medical Education and Patient Safety—AIXTRA, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Mikhail Zvyagintsev
- Department of Psychiatry, Psychotherapy and Psychosomatics, School of Medicine, RWTH Aachen University, Aachen, Germany
| | - Jorge Iglesias
- Department of Cognitive Neuroscience, Cuban Center for Neuroscience, Havana, Cuba
| | | | - Klaus Mathiak
- Department of Psychiatry, Psychotherapy and Psychosomatics, School of Medicine, RWTH Aachen University, Aachen, Germany
- JARA-Brain, Research Center Jülich, Jülich, Germany
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9
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Kambeitz-Ilankovic L, Vinogradov S, Wenzel J, Fisher M, Haas SS, Betz L, Penzel N, Nagarajan S, Koutsouleris N, Subramaniam K. Multivariate pattern analysis of brain structure predicts functional outcome after auditory-based cognitive training interventions. NPJ SCHIZOPHRENIA 2021; 7:40. [PMID: 34413310 PMCID: PMC8376975 DOI: 10.1038/s41537-021-00165-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 07/07/2021] [Indexed: 02/07/2023]
Abstract
Cognitive gains following cognitive training interventions are associated with improved functioning in people with schizophrenia (SCZ). However, considerable inter-individual variability is observed. Here, we evaluate the sensitivity of brain structural features to predict functional response to auditory-based cognitive training (ABCT) at a single-subject level. We employed whole-brain multivariate pattern analysis with support vector machine (SVM) modeling to identify gray matter (GM) patterns that predicted higher vs. lower functioning after 40 h of ABCT at the single-subject level in SCZ patients. The generalization capacity of the SVM model was evaluated by applying the original model through an out-of-sample cross-validation analysis to unseen SCZ patients from an independent validation sample who underwent 50 h of ABCT. The whole-brain GM volume-based pattern classification predicted higher vs. lower functioning at follow-up with a balanced accuracy (BAC) of 69.4% (sensitivity 72.2%, specificity 66.7%) as determined by nested cross-validation. The neuroanatomical model was generalizable to an independent cohort with a BAC of 62.1% (sensitivity 90.9%, specificity 33.3%). In particular, greater baseline GM volumes in regions within superior temporal gyrus, thalamus, anterior cingulate, and cerebellum predicted improved functioning at the single-subject level following ABCT in SCZ participants. The present findings provide a structural MRI fingerprint associated with preserved GM volumes at a single baseline timepoint, which predicted improved functioning following an ABCT intervention, and serve as a model for how to facilitate precision clinical therapies for SCZ based on imaging data, operating at the single-subject level.
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Affiliation(s)
- Lana Kambeitz-Ilankovic
- grid.6190.e0000 0000 8580 3777Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany ,grid.5252.00000 0004 1936 973XDepartment of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany
| | - Sophia Vinogradov
- grid.17635.360000000419368657Department of Psychiatry, University of Minnesota, Minneapolis, MN USA
| | - Julian Wenzel
- grid.6190.e0000 0000 8580 3777Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany ,grid.5252.00000 0004 1936 973XDepartment of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany
| | - Melissa Fisher
- grid.17635.360000000419368657Department of Psychiatry, University of Minnesota, Minneapolis, MN USA
| | - Shalaila S. Haas
- grid.59734.3c0000 0001 0670 2351Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY USA
| | - Linda Betz
- grid.6190.e0000 0000 8580 3777Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Nora Penzel
- grid.6190.e0000 0000 8580 3777Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany ,grid.5252.00000 0004 1936 973XDepartment of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany ,grid.7644.10000 0001 0120 3326Department of Basic Medical Sciences, Neuroscience and Sense Organs – University of Bari Aldo Moro, Bari, Italy
| | - Srikantan Nagarajan
- grid.266102.10000 0001 2297 6811Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA USA
| | - Nikolaos Koutsouleris
- grid.5252.00000 0004 1936 973XDepartment of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany ,grid.13097.3c0000 0001 2322 6764Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK ,grid.419548.50000 0000 9497 5095Max Planck Institute of Psychiatry, Munich, Germany
| | - Karuna Subramaniam
- grid.266102.10000 0001 2297 6811Department of Psychiatry, University of California San Francisco, San Francisco, CA USA
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Dynamic Functional Network Connectivity Changes Associated with fMRI Neurofeedback of Right Premotor Cortex. Brain Sci 2021; 11:brainsci11050582. [PMID: 33946251 PMCID: PMC8147082 DOI: 10.3390/brainsci11050582] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 04/27/2021] [Accepted: 04/27/2021] [Indexed: 01/03/2023] Open
Abstract
Neurofeedback of real-time functional magnetic resonance imaging (rtfMRI) can enable people to self-regulate motor-related brain regions and lead to alteration of motor performance and functional connectivity (FC) underlying motor execution tasks. Numerous studies suggest that FCs dynamically fluctuate over time. However, little is known about the impact of neurofeedback training of the motor-related region on the dynamic characteristics of FC underlying motor execution tasks. This study aims to investigate the mechanism of self-regulation of the right premotor area (PMA) on the underlying dynamic functional network connectivity (DFNC) of motor execution (ME) tasks and reveal the relationship between DFNC, training effect, and motor performance. The results indicate that the experimental group spent less time on state 2, with overall weak connections, and more time on state 6, having strong positive connections between motor-related networks than the control group after the training. For the experimental group’s state 2, the mean dwell time after the training showed negative correlation with the tapping frequency and the amount of upregulation of PMA. The findings show that rtfMRI neurofeedback can change the temporal properties of DFNC, and the DFNC changes in state with overall weak connections were associated with the training effect and the improvement in motor performance.
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11
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Reinforcement of Self-Regulated Brain Activity in Schizophrenia Patients Undergoing Rehabilitation. BIOMED RESEARCH INTERNATIONAL 2021; 2021:8030485. [PMID: 33855083 PMCID: PMC8019363 DOI: 10.1155/2021/8030485] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 03/15/2021] [Accepted: 03/20/2021] [Indexed: 01/07/2023]
Abstract
The experiment was aimed to compare the effects of different forms of rehabilitation applied in patients with schizophrenia. Verification of the obtained results was based on the analysis of the level of cognitive and social functioning of the subjects. For this purpose, the following clinical tools were used: Positive and Negative Syndrome Scale (PANSS), Beck Cognitive Insight Scale (BCIS), Color Trial Test (CTT-1, CTT-2), d2 psychological tests, Acceptance of Illness Scale (AIS), Self-efficacy Scale (GSES), Quantitative Electroencephalogram Biofeedback (QEEG-BF), auditory event-related potentials (ERPs), and serum levels of brain-derived neurotrophic factor (BDNF). The subjects were mentally stable male schizophrenia patients who had been in remission. They were divided into two groups which received different types of rehabilitation for three months. Group 1 patients followed a standard rehabilitation and Group 2 patients received GSR Biofeedback (galvanic skin response Biofeedback, GSR-BF) training. Pretherapy and posttherapy measurements were made for each group. Experimental rehabilitation based on GSR-BF training resulted in regulatory control of neurophysiological mechanisms, and the parameters obtained demonstrated improvement in the subjects' cognitive and social function. The following therapy outcomes were observed: (1) reduce psychopathological symptoms (2) improving cognitive (concentration, attention) and social functions (3) increase in the neurotrophic factor BDNF. GSR-BF can be used as an alternative to conventional rehabilitation in schizophrenia patients.
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Kilmarx J, Oblak E, Sulzer J, Lewis-Peacock J. Towards a common template for neural reinforcement of finger individuation. Sci Rep 2021; 11:1065. [PMID: 33441742 PMCID: PMC7806844 DOI: 10.1038/s41598-020-80166-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 12/14/2020] [Indexed: 12/04/2022] Open
Abstract
The inability to individuate finger movements is a common impairment following stroke. Conventional physical therapy ignores underlying neural changes with recovery, leaving it unclear why sensorimotor function often remains impaired. Functional MRI neurofeedback can monitor neural activity and reinforce it towards a healthy template to restore function. However, identifying an individualized training template may not be possible depending on the severity of impairment. In this study, we investigated the use of functional alignment of brain data across healthy participants to create an idealized neural template to be used as a training target for new participants. We employed multi-voxel pattern analyses to assess the prediction accuracy and robustness to missing data of pre-trained functional templates corresponding to individual finger presses. We found a significant improvement in classification accuracy (p < 0.001) of individual finger presses when group data was aligned based on function (88%) rather than anatomy (46%). Importantly, we found no significant drop in performance when aligning a new participant to a pre-established template as compared to including this new participant in the creation of a new template. These results indicate that functionally aligned templates could provide an effective surrogate training target for patients following neurological injury.
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Affiliation(s)
- Justin Kilmarx
- Department of Mechanical Engineering, The University of Texas at Austin, 2501 Wichita St, Austin, TX, 78712, USA.
| | - Ethan Oblak
- Department of Mechanical Engineering, The University of Texas at Austin, 2501 Wichita St, Austin, TX, 78712, USA
| | - James Sulzer
- Department of Mechanical Engineering, The University of Texas at Austin, 2501 Wichita St, Austin, TX, 78712, USA
| | - Jarrod Lewis-Peacock
- Department of Psychology, The University of Texas at Austin, 108 E Dean Keeton St, Austin, TX, 78712, USA
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13
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Bohaterewicz B, Sobczak AM, Podolak I, Wójcik B, Mȩtel D, Chrobak AA, Fa̧frowicz M, Siwek M, Dudek D, Marek T. Machine Learning-Based Identification of Suicidal Risk in Patients With Schizophrenia Using Multi-Level Resting-State fMRI Features. Front Neurosci 2021; 14:605697. [PMID: 33505239 PMCID: PMC7829970 DOI: 10.3389/fnins.2020.605697] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Accepted: 11/26/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Some studies suggest that as much as 40% of all causes of death in a group of patients with schizophrenia can be attributed to suicides and compared with the general population, patients with schizophrenia have an 8.5-fold greater suicide risk (SR). There is a vital need for accurate and reliable methods to predict the SR among patients with schizophrenia based on biological measures. However, it is unknown whether the suicidal risk in schizophrenia can be related to alterations in spontaneous brain activity, or if the resting-state functional magnetic resonance imaging (rsfMRI) measures can be used alongside machine learning (ML) algorithms in order to identify patients with SR. METHODS Fifty-nine participants including patients with schizophrenia with and without SR as well as age and gender-matched healthy underwent 13 min resting-state functional magnetic resonance imaging. Both static and dynamic indexes of the amplitude of low-frequency fluctuation (ALFF), the fractional amplitude of low-frequency fluctuations (fALFF), regional homogeneity as well as functional connectivity (FC) were calculated and used as an input for five machine learning algorithms: Gradient boosting (GB), LASSO, Logistic Regression (LR), Random Forest and Support Vector Machine. RESULTS All groups revealed different intra-network functional connectivity in ventral DMN and anterior SN. The best performance was reached for the LASSO applied to FC with an accuracy of 70% and AUROC of 0.76 (p < 0.05). Significant classification ability was also reached for GB and LR using fALFF and ALFF measures. CONCLUSION Our findings suggest that SR in schizophrenia can be seen on the level of DMN and SN functional connectivity alterations. ML algorithms were able to significantly differentiate SR patients. Our results could be useful in developing neuromarkers of SR in schizophrenia based on non-invasive rsfMRI.
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Affiliation(s)
- Bartosz Bohaterewicz
- Department of Cognitive Neuroscience and Neuroergonomics, Institute of Applied Psychology, Jagiellonian University, Kraków, Poland
- Department of Psychology of Individual Differences, Psychological Diagnosis, and Psychometrics, Institute of Psychology, University of Social Sciences and Humanities, Warsaw, Poland
| | - Anna M. Sobczak
- Department of Cognitive Neuroscience and Neuroergonomics, Institute of Applied Psychology, Jagiellonian University, Kraków, Poland
| | - Igor Podolak
- Institute of Computer Science, Faculty of Mathematics and Computer Science, Jagiellonian University, Kraków, Poland
| | - Bartosz Wójcik
- Institute of Computer Science, Faculty of Mathematics and Computer Science, Jagiellonian University, Kraków, Poland
| | - Dagmara Mȩtel
- Department of Community Psychiatry, Jagiellonian University Medical College, Kraków, Poland
| | - Adrian A. Chrobak
- Department of Adult Psychiatry, Jagiellonian University Medical College, Kraków, Poland
| | - Magdalena Fa̧frowicz
- Department of Cognitive Neuroscience and Neuroergonomics, Institute of Applied Psychology, Jagiellonian University, Kraków, Poland
| | - Marcin Siwek
- Department of Affective Disorders, Jagiellonian University Medical College, Kraków, Poland
| | - Dominika Dudek
- Department of Adult Psychiatry, Jagiellonian University Medical College, Kraków, Poland
| | - Tadeusz Marek
- Department of Cognitive Neuroscience and Neuroergonomics, Institute of Applied Psychology, Jagiellonian University, Kraków, Poland
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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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Tursic A, Eck J, Lührs M, Linden DEJ, Goebel R. A systematic review of fMRI neurofeedback reporting and effects in clinical populations. Neuroimage Clin 2020; 28:102496. [PMID: 33395987 PMCID: PMC7724376 DOI: 10.1016/j.nicl.2020.102496] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 10/29/2020] [Accepted: 11/02/2020] [Indexed: 12/22/2022]
Abstract
Real-time fMRI-based neurofeedback is a relatively young field with a potential to impact the currently available treatments of various disorders. In order to evaluate the evidence of clinical benefits and investigate how consistently studies report their methods and results, an exhaustive search of fMRI neurofeedback studies in clinical populations was performed. Reporting was evaluated using a limited number of Consensus on the reporting and experimental design of clinical and cognitive-behavioral neurofeedback studies (CRED-NF checklist) items, which was, together with a statistical power and sensitivity calculation, used to also evaluate the existing evidence of the neurofeedback benefits on clinical measures. The 62 found studies investigated regulation abilities and/or clinical benefits in a wide range of disorders, but with small sample sizes and were therefore unable to detect small effects. Most points from the CRED-NF checklist were adequately reported by the majority of the studies, but some improvements are suggested for the reporting of group comparisons and relations between regulation success and clinical benefits. To establish fMRI neurofeedback as a clinical tool, more emphasis should be placed in the future on using larger sample sizes determined through a priori power calculations and standardization of procedures and reporting.
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Affiliation(s)
- Anita Tursic
- Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Oxfordlaan 55, 6229 EV Maastricht, The Netherlands; Brain Innovation B.V, Oxfordlaan 55, 6229 EV Maastricht, The Netherlands.
| | - Judith Eck
- Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Oxfordlaan 55, 6229 EV Maastricht, The Netherlands; Brain Innovation B.V, Oxfordlaan 55, 6229 EV Maastricht, The Netherlands.
| | - Michael Lührs
- Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Oxfordlaan 55, 6229 EV Maastricht, The Netherlands; Brain Innovation B.V, Oxfordlaan 55, 6229 EV Maastricht, The Netherlands.
| | - David E J Linden
- School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University, Universiteitssingel 40, 6229 ER Maastricht, The Netherlands.
| | - Rainer Goebel
- Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Oxfordlaan 55, 6229 EV Maastricht, The Netherlands; Brain Innovation B.V, Oxfordlaan 55, 6229 EV Maastricht, The Netherlands; Department of Neuroimaging and Neuromodeling, Netherlands Institute for Neuroscience, Meibergdreef 47, 1105 BA Amsterdam, the Netherlands.
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16
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Zweerings J, Sarkheil P, Keller M, Dyck M, Klasen M, Becker B, Gaebler AJ, Ibrahim CN, Turetsky BI, Zvyagintsev M, Flatten G, Mathiak K. Rt-fMRI neurofeedback-guided cognitive reappraisal training modulates amygdala responsivity in posttraumatic stress disorder. NEUROIMAGE-CLINICAL 2020; 28:102483. [PMID: 33395974 PMCID: PMC7689411 DOI: 10.1016/j.nicl.2020.102483] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 10/15/2020] [Accepted: 10/21/2020] [Indexed: 12/14/2022]
Abstract
We found neurofeedback-specific attenuation of amygdala responses. Trauma symptoms and the affective state improved in patients at one-month follow-up. Reduced amygdala responses were associated with improved well-being at follow-up. 75% of individuals with PTSD used the learned strategies in daily life. Left lateral prefrontal cortex responses were reduced during neurofeedback training.
Background Traumatic experiences are associated with neurofunctional dysregulations in key regions of the emotion regulation circuits. In particular, amygdala responsivity to negative stimuli is exaggerated while engagement of prefrontal regulatory control regions is attenuated. Successful application of emotion regulation (ER) strategies may counteract this disbalance, however, application of learned strategies in daily life is hampered in individuals afflicted by posttraumatic stress disorder (PTSD). We hypothesized that a single session of real-time fMRI (rtfMRI) guided upregulation of prefrontal regions during an emotion regulation task enhances self-control during exposure to negative stimuli and facilitates transfer of the learned ER skills to daily life. Methods In a cross-over design, individuals with a PTSD diagnosis after a single traumatic event (n = 20) according to DSM-IV-TR criteria and individuals without a formal psychiatric diagnosis (n = 21) underwent a cognitive reappraisal training. In randomized order, all participants completed two rtfMRI neurofeedback (NF) runs targeting the left lateral prefrontal cortex (lPFC) and two control runs without NF (NoNF) while using cognitive reappraisal to reduce their emotional response to negative scenes. During the NoNF runs, two %%-signs were displayed instead of the two-digit feedback (FB) to achieve a comparable visual stimulation. The project aimed at defining the clinical potential of the training according to three success markers: (1) NF induced changes in left lateral prefrontal cortex and bilateral amygdala activity during the regulation of aversive scenes compared to cognitive reappraisal alone (primary registered outcome), (2) associated changes on the symptomatic and behavioral level such as indicated by PTSD symptom severity and affect ratings, (3) clinical utility such as indicated by perceived efficacy, acceptance, and transfer to daily life measured four weeks after the training. Results In comparison to the reappraisal without feedback, a neurofeedback-specific decrease in the left lateral PFC (d = 0.54) alongside an attenuation of amygdala responses (d = 0.33) emerged. Reduced amygdala responses during NF were associated with symptom improvement (r = −0.42) and less negative affect (r = −0.63) at follow-up. The difference in symptom scores exceeds requirements for a minimal clinically important difference and corresponds to a medium effect size (d = 0.64). Importantly, 75% of individuals with PTSD used the strategies in daily life during a one-month follow-up period and perceived the training as efficient. Conclusion Our findings suggest beneficial effects of the NF training indicated by reduced amygdala responses that were associated with improved symptom severity and affective state four weeks after the NF training as well as patient-centered perceived control during the training, helpfulness and application of strategies in daily life. However, reduced prefrontal involvement was unexpected. The study suggests good tolerability of the training protocol and potential for clinical use in the treatment of PTSD.
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Affiliation(s)
- Jana Zweerings
- Department of Psychiatry, Psychotherapy and Psychosomatics, Faculty of Medicine, RWTH Aachen, Aachen, Germany; Institute of Neuroscience and Medicine, JARA-Institute Brain Structure Function Relationship (INM 10), Research Center Jülich, Jülich, Germany.
| | - Pegah Sarkheil
- Department of Psychiatry, Psychotherapy and Psychosomatics, Faculty of Medicine, RWTH Aachen, Aachen, Germany; Institute of Neuroscience and Medicine, JARA-Institute Brain Structure Function Relationship (INM 10), Research Center Jülich, Jülich, Germany
| | - Micha Keller
- Department of Psychiatry, Psychotherapy and Psychosomatics, Faculty of Medicine, RWTH Aachen, Aachen, Germany; Institute of Neuroscience and Medicine, JARA-Institute Brain Structure Function Relationship (INM 10), Research Center Jülich, Jülich, Germany
| | - Miriam Dyck
- Department of Psychiatry, Psychotherapy and Psychosomatics, Faculty of Medicine, RWTH Aachen, Aachen, Germany; Novarea RPK, Aachen, Germany
| | - Martin Klasen
- Department of Psychiatry, Psychotherapy and Psychosomatics, Faculty of Medicine, RWTH Aachen, Aachen, Germany; Institute of Neuroscience and Medicine, JARA-Institute Brain Structure Function Relationship (INM 10), Research Center Jülich, Jülich, Germany
| | - Benjamin Becker
- The Clinical Hospital of the Chengdu Brain Science Institute, School of Life Science and Technology, Key Laboratory for Neuroinformation, University of Electronic Science and Technology of China, Chengdu, China
| | - Arnim J Gaebler
- Department of Psychiatry, Psychotherapy and Psychosomatics, Faculty of Medicine, RWTH Aachen, Aachen, Germany; Institute of Neuroscience and Medicine, JARA-Institute Brain Structure Function Relationship (INM 10), Research Center Jülich, Jülich, Germany
| | - Camellia N Ibrahim
- Department of Psychiatry, Psychotherapy and Psychosomatics, Faculty of Medicine, RWTH Aachen, Aachen, Germany; Institute of Neuroscience and Medicine, JARA-Institute Brain Structure Function Relationship (INM 10), Research Center Jülich, Jülich, Germany
| | - Bruce I Turetsky
- Neuropsychiatry Section, Department of Psychiatry, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA
| | - Mikhail Zvyagintsev
- Department of Psychiatry, Psychotherapy and Psychosomatics, Faculty of Medicine, RWTH Aachen, Aachen, Germany; Brain Imaging Facility, Interdisciplinary Centre for Clinical Studies (IZKF), School of Medicine, RWTH Aachen University, Germany
| | - Guido Flatten
- Euregio-Institut für Psychosomatik und Psychotraumatologie, Aachen, Germany
| | - Klaus Mathiak
- Department of Psychiatry, Psychotherapy and Psychosomatics, Faculty of Medicine, RWTH Aachen, Aachen, Germany; Institute of Neuroscience and Medicine, JARA-Institute Brain Structure Function Relationship (INM 10), Research Center Jülich, Jülich, Germany
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17
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Humpston C, Garrison J, Orlov N, Aleman A, Jardri R, Fernyhough C, Allen P. Real-Time Functional Magnetic Resonance Imaging Neurofeedback for the Relief of Distressing Auditory-Verbal Hallucinations: Methodological and Empirical Advances. Schizophr Bull 2020; 46:1409-1417. [PMID: 32740661 PMCID: PMC7707074 DOI: 10.1093/schbul/sbaa103] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Auditory-verbal hallucinations (AVH) are often associated with high levels of distress and disability in individuals with schizophrenia-spectrum disorders. In around 30% of individuals with distressing AVH and diagnosed with schizophrenia, traditional antipsychotic drugs have little or no effect. Thus, it is important to develop mechanistic models of AVH to inform new treatments. Recently a small number of studies have begun to explore the use of real-time functional magnetic resonance imaging neurofeedback (rtfMRI-NF) for the treatment of AVH in individuals with schizophrenia. rtfMRI-NF protocols have been developed to provide feedback about brain activation in real time to enable participants to progressively achieve voluntary control over their brain activity. We offer a conceptual review of the background and general features of neurofeedback procedures before summarizing and evaluating existing mechanistic models of AVH to identify feasible neural targets for the application of rtfMRI-NF as a potential treatment. We consider methodological issues, including the choice of localizers and practicalities in logistics when setting up neurofeedback procedures in a clinical setting. We discuss clinical considerations relating to the use of rtfMRI-NF for AVH in individuals distressed by their experiences and put forward a number of questions and recommendations about best practice. Lastly, we conclude by offering suggestions for new avenues for neurofeedback methodology and mechanistic targets in relation to the research and treatment of AVH.
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Affiliation(s)
- Clara Humpston
- Institute for Mental Health, School of Psychology, University of Birmingham, Birmingham, UK,Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK,To whom correspondence should be addressed; tel: +44 (0)121 414 2942, fax: +44 (0)121 414 3971, e-mail:
| | - Jane Garrison
- Department of Psychology, University of Cambridge, Cambridge, UK
| | - Natasza Orlov
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK,Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Boston, MA,Department of Radiology, Xuanwu Hospital, Capital Medical University, Beijing, China,Precision Brain Imaging Lab, Medical University of South Carolina, Charleston, SC
| | - André Aleman
- Faculty of Medical Sciences, University of Groningen, AB Groningen, The Netherlands
| | - Renaud Jardri
- University of Lille, INSERM, CHU Lille, Lille Neuroscience and Cognition Centre (U-1172), Plasticity and Subjectivity (PSY) Team, CURE Platform, Lille, France
| | | | - Paul Allen
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK,Department of Psychology, University of Roehampton, London, UK
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18
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Klöbl M, Michenthaler P, Godbersen GM, Robinson S, Hahn A, Lanzenberger R. Reinforcement and Punishment Shape the Learning Dynamics in fMRI Neurofeedback. Front Hum Neurosci 2020; 14:304. [PMID: 32792929 PMCID: PMC7393482 DOI: 10.3389/fnhum.2020.00304] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 07/08/2020] [Indexed: 12/22/2022] Open
Abstract
Introduction Neurofeedback (NF) using real-time functional magnetic resonance imaging (fMRI) has proven to be a valuable neuroscientific tool for probing cognition and promising therapeutic approach for several psychiatric disorders. Even though learning constitutes an elementary aspect of NF, the question whether certain training schemes might positively influence its dynamics has largely been neglected. Methods To address this issue, participants were trained to exert control on their subgenual anterior cingulate cortex (sgACC) blood-oxygenation-level-dependent signal, receiving either exclusively positive reinforcement (PR, “positive feedback”) or also positive punishment (PP, “negative feedback”). The temporal dynamics of the learning process were investigated by individually modeling the feedback periods and trends, offering the possibility to assess activation changes within and across blocks, runs and sessions. Results The results show faster initial learning of the PR + PP group by significantly lower deactivations of the sgACC in the first session and stronger regulation trends during the first runs. Independent of the group, significant control over the sgACC could further be shown with but not without feedback. Conclusion The beneficial effect of PP is supported by previous findings of multiple research domains suggesting that error avoidance represents an important motivational factor of learning, which complements the reward spectrum. This hypothesis warrants further investigation with respect to NF, as it could offer a way to generally facilitate the process of gaining volitional control over brain activity.
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Affiliation(s)
- Manfred Klöbl
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Paul Michenthaler
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | | | - Simon Robinson
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria.,Centre for Advanced Imaging, University of Queensland, Brisbane, QLD, Australia.,Department of Neurology, Medical University of Graz, Graz, Austria
| | - Andreas Hahn
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Rupert Lanzenberger
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
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Nelson B, Torregrossa L, Thompson A, Sass L, Park S, Hartmann J, McGorry P, Alvarez-Jimenez M. Improving treatments for psychotic disorders: beyond cognitive behaviour therapy for psychosis. PSYCHOSIS 2020; 13:78-84. [PMID: 33889197 PMCID: PMC8057716 DOI: 10.1080/17522439.2020.1742200] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Accepted: 03/10/2020] [Indexed: 02/07/2023]
Abstract
More effective treatments for people with psychotic disorders are urgently required. Here, we make three suggestions for progress: 1. Targeting the disorders' core phenomenological features ('phenomenological phenotype'), 2. Addressing social disconnection, isolation and loneliness, and 3. Leveraging 'hot' cognitions and using symptom capture approaches that combine psychotherapy with advances in technology and neuroscience.
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Affiliation(s)
- B. Nelson
- Orygen, Parkville, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
| | - L. Torregrossa
- Department of Psychology, Vanderbilt University, Nashville, USA
| | - A. Thompson
- Orygen, Parkville, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
| | - L.A. Sass
- Rutgers, the State University of New Jersey, New Jersey, USA
| | - S. Park
- Department of Psychology, Vanderbilt University, Nashville, USA
| | - J.A. Hartmann
- Orygen, Parkville, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
| | - P.D. McGorry
- Orygen, Parkville, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
| | - M. Alvarez-Jimenez
- Orygen, Parkville, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
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20
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Weiss F, Aslan A, Zhang J, Gerchen MF, Kiefer F, Kirsch P. Using mind control to modify cue-reactivity in AUD: the impact of mindfulness-based relapse prevention on real-time fMRI neurofeedback to modify cue-reactivity in alcohol use disorder: a randomized controlled trial. BMC Psychiatry 2020; 20:309. [PMID: 32546139 PMCID: PMC7298966 DOI: 10.1186/s12888-020-02717-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 06/04/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Alcohol Use Disorder is a severe mental disorder affecting the individuals concerned, their family and friends and society as a whole. Despite its high prevalence, novel treatment options remain rather limited. Two innovative interventions used for treating severe disorders are the use of real-time functional magnetic resonance imaging neurofeedback that targets brain regions related to the disorder, and mindfulness-based treatments. In the context of the TRR SFB 265 C04 "Mindfulness-based relapse prevention as an addition to rtfMRI NFB intervention for patients with Alcohol Use Disorder (MiND)" study, both interventions will be combined to a state-of-the art intervention that will use mindfulness-based relapse prevention to improve the efficacy of a real-time neurofeedback intervention targeting the ventral striatum, which is a brain region centrally involved in cue-reactivity to alcohol-related stimuli. METHODS/DESIGN After inclusion, N = 88 patients will be randomly assigned to one of four groups. Two of those groups will receive mindfulness-based relapse prevention. All groups will receive two fMRI sessions and three real-time neurofeedback sessions in a double-blind manner and will regulate either the ventral striatum or the auditory cortex as a control region. Two groups will additionally receive five sessions of mindfulness-based relapse prevention prior to the neurofeedback intervention. After the last fMRI session, the participants will be followed-up monthly for a period of 3 months for an assessment of the relapse rate and clinical effects of the intervention. DISCUSSION The results of this study will give further insights into the efficacy of real-time functional magnetic resonance imaging neurofeedback interventions for the treatment of Alcohol Use Disorder. Additionally, the study will provide further insight on neurobiological changes in the brain caused by the neurofeedback intervention as well as by the mindfulness-based relapse prevention. The outcome might be useful to develop new treatment approaches targeting mechanisms of Alcohol Use Disorder with the goal to reduce relapse rates after discharge from the hospital. TRIAL REGISTRATION This trial is pre-registered at clinicaltrials.gov (trial identifier: NCT04366505; WHO Universal Trial Number (UTN): U1111-1250-2964). Registered 30 March 2020, published 29 April 2020.
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Affiliation(s)
- Franziska Weiss
- Department of Clinical Psychology, Central Institute of Mental Health (ZI), Heidelberg University/Medical Faculty Mannheim, 68159, Mannheim, Germany.
| | - Acelya Aslan
- grid.7700.00000 0001 2190 4373Department of Addiction Behavior and Addiction Medicine, Central Institute of Mental Health, Heidelberg University/Medical Faculty Mannheim, Mannheim, Germany
| | - Jingying Zhang
- grid.7700.00000 0001 2190 4373Department of Clinical Psychology, Central Institute of Mental Health (ZI), Heidelberg University/Medical Faculty Mannheim, 68159 Mannheim, Germany
| | - Martin Fungisai Gerchen
- grid.7700.00000 0001 2190 4373Department of Clinical Psychology, Central Institute of Mental Health (ZI), Heidelberg University/Medical Faculty Mannheim, 68159 Mannheim, Germany ,grid.7700.00000 0001 2190 4373Department of Psychology, Heidelberg University, Heidelberg, Germany ,grid.455092.fBernstein Center for Computational Neuroscience Heidelberg/Mannheim, Mannheim, Germany
| | - Falk Kiefer
- grid.7700.00000 0001 2190 4373Department of Addiction Behavior and Addiction Medicine, Central Institute of Mental Health, Heidelberg University/Medical Faculty Mannheim, Mannheim, Germany
| | - Peter Kirsch
- grid.7700.00000 0001 2190 4373Department of Clinical Psychology, Central Institute of Mental Health (ZI), Heidelberg University/Medical Faculty Mannheim, 68159 Mannheim, Germany ,grid.7700.00000 0001 2190 4373Department of Psychology, Heidelberg University, Heidelberg, Germany ,grid.455092.fBernstein Center for Computational Neuroscience Heidelberg/Mannheim, Mannheim, Germany
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Weiss F, Zamoscik V, Schmidt SN, Halli P, Kirsch P, Gerchen MF. Just a very expensive breathing training? Risk of respiratory artefacts in functional connectivity-based real-time fMRI neurofeedback. Neuroimage 2020; 210:116580. [DOI: 10.1016/j.neuroimage.2020.116580] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 01/15/2020] [Accepted: 01/20/2020] [Indexed: 10/25/2022] Open
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Fede SJ, Dean SF, Manuweera T, Momenan R. A Guide to Literature Informed Decisions in the Design of Real Time fMRI Neurofeedback Studies: A Systematic Review. Front Hum Neurosci 2020; 14:60. [PMID: 32161529 PMCID: PMC7052377 DOI: 10.3389/fnhum.2020.00060] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 02/07/2020] [Indexed: 11/26/2022] Open
Abstract
Background: Although biofeedback using electrophysiology has been explored extensively, the approach of using neurofeedback corresponding to hemodynamic response is a relatively young field. Real time functional magnetic resonance imaging-based neurofeedback (rt-fMRI-NF) uses sensory feedback to operantly reinforce patterns of neural response. It can be used, for example, to alter visual perception, increase brain connectivity, and reduce depression symptoms. Within recent years, interest in rt-fMRI-NF in both research and clinical contexts has expanded considerably. As such, building a consensus regarding best practices is of great value. Objective: This systematic review is designed to describe and evaluate the variations in methodology used in previous rt-fMRI-NF studies to provide recommendations for rt-fMRI-NF study designs that are mostly likely to elicit reproducible and consistent effects of neurofeedback. Methods: We conducted a database search for fMRI neurofeedback papers published prior to September 26th, 2019. Of 558 studies identified, 146 met criteria for inclusion. The following information was collected from each study: sample size and type, task used, neurofeedback calculation, regulation procedure, feedback, whether feedback was explicitly related to changing brain activity, feedback timing, control group for active neurofeedback, how many runs and sessions of neurofeedback, if a follow-up was conducted, and the results of neurofeedback training. Results: rt-fMRI-NF is typically upregulation practice based on hemodynamic response from a specific region of the brain presented using a continually updating thermometer display. Most rt-fMRI-NF studies are conducted in healthy samples and half evaluate its effect on immediate changes in behavior or affect. The most popular control group method is to provide sham signal from another region; however, many studies do not compare use a comparison group. Conclusions: We make several suggestions for designs of future rt-fMRI-NF studies. Researchers should use feedback calculation methods that consider neural response across regions (i.e., SVM or connectivity), which should be conveyed as intermittent, auditory feedback. Participants should be given explicit instructions and should be assessed on individual differences. Future rt-fMRI-NF studies should use clinical samples; effectiveness of rt-fMRI-NF should be evaluated on clinical/behavioral outcomes at follow-up time points in comparison to both a sham and no feedback control group.
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Affiliation(s)
| | | | | | - Reza Momenan
- Clinical NeuroImaging Research Core, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD, United States
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23
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Abstract
Brain-computer interfaces (BCIs) based on functional magnetic resonance imaging (fMRI) provide an important complement to other noninvasive BCIs. While fMRI has several disadvantages (being nonportable, methodologically challenging, costly, and noisy), it is the only method providing high spatial resolution whole-brain coverage of brain activation. These properties allow relating mental activities to specific brain regions and networks providing a transparent scheme for BCI users to encode information and for real-time fMRI BCI systems to decode the intents of the user. Various mental activities have been used successfully in fMRI BCIs so far that can be classified into the four categories: (a) higher-order cognitive tasks (e.g., mental calculation), (b) covert language-related tasks (e.g., mental speech and mental singing), (c) imagery tasks (motor, visual, auditory, tactile, and emotion imagery), and (d) selective attention tasks (visual, auditory, and tactile attention). While the ultimate spatial and temporal resolution of fMRI BCIs is limited by the physiologic properties of the hemodynamic response, technical and analytical advances will likely lead to substantially improved fMRI BCIs in the future using, for example, decoding of imagined letter shapes at 7T as the basis for more "natural" communication BCIs.
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Affiliation(s)
- Bettina Sorger
- Department of Cognitive Neuroscience, Maastricht University, Maastricht, The Netherlands; Maastricht Brain Imaging Center (M-BIC), Maastricht, The Netherlands
| | - Rainer Goebel
- Department of Cognitive Neuroscience, Maastricht University, Maastricht, The Netherlands; Maastricht Brain Imaging Center (M-BIC), Maastricht, The Netherlands.
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Gandara V, Pineda JA, Shu IW, Singh F. A Systematic Review of the Potential Use of Neurofeedback in Patients With Schizophrenia. SCHIZOPHRENIA BULLETIN OPEN 2020; 1:sgaa005. [PMID: 32803157 PMCID: PMC7418870 DOI: 10.1093/schizbullopen/sgaa005] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Schizophrenia (SCZ) is a neurodevelopmental disorder characterized by positive symptoms (hallucinations and delusions), negative symptoms (anhedonia, social withdrawal) and marked cognitive deficits (memory, executive function, and attention). Current mainstays of treatment, including medications and psychotherapy, do not adequately address cognitive symptoms, which are essential for everyday functioning. However, recent advances in computational neurobiology have rekindled interest in neurofeedback (NF), a form of self-regulation or neuromodulation, in potentially alleviating cognitive symptoms in patients with SCZ. Therefore, we conducted a systematic review of the literature for NF studies in SCZ to identify lessons learned and to identify steps to move the field forward. Our findings reveal that NF studies to date consist mostly of case studies and small sample, single-group studies. Despite few randomized clinical trials, the results suggest that NF is feasible and that it leads to measurable changes in brain function. These findings indicate early proof-of-concept data that needs to be followed up by larger, randomized clinical trials, testing the efficacy of NF compared to well thought out placebos. We hope that such an undertaking by the field will lead to innovative solutions that address refractory symptoms and improve everyday functioning in patients with SCZ.
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Affiliation(s)
- Veronica Gandara
- Department of Psychiatry, University of California at San Diego (UCSD), La Jolla, CA
| | - Jaime A Pineda
- Department of Cognitive Science, University of California at San Diego (UCSD), La Jolla, CA
| | - I-Wei Shu
- Department of Psychiatry, University of California at San Diego (UCSD), La Jolla, CA
| | - Fiza Singh
- Department of Psychiatry, University of California at San Diego (UCSD), La Jolla, CA
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Eckstein M, Zietlow AL, Gerchen MF, Schmitgen MM, Ashcroft-Jones S, Kirsch P, Ditzen B. The NeMo real-time fMRI neurofeedback study: protocol of a randomised controlled clinical intervention trial in the neural foundations of mother-infant bonding. BMJ Open 2019; 9:e027747. [PMID: 31315861 PMCID: PMC6661567 DOI: 10.1136/bmjopen-2018-027747] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 03/22/2019] [Accepted: 05/22/2019] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Most mothers feel an immediate, strong emotional bond with their newborn. On a neurobiological level, this is accompanied with the activation of the brain reward systems, including the striatum. However, approximately 10% of all mothers report difficulties to bond emotionally with their infant and display impaired reward responses to the interaction with their infant which might have long-term negative effects for the child's development. As previous studies suggest that activation of the striatal reward system can be regulated through functional MRI (fMRI)-based neurofeedback (NFB), we have designed and investigate fMRI-NFB training to treat maternal bonding difficulties. METHODS AND ANALYSIS In the planned trial, mothers will be presented pictures of their infant and real-time fMRI (rtfMRI), peripheral measures, neural, endocrine, psychophysiological and behavioural measures will be assessed. Mothers with bonding difficulties (n=68) will be randomised to one of two double-blind intervention groups at 4-6 months postpartum. They will participate in three repeated NFB training sessions with rtfMRI-NFB training to increase activation of (a) the ventral striatum or (b) the anterior cingulate. Interview data and real-time mother-infant interaction behaviour pre-intervention, post-intervention and at follow-up will serve as clinical outcome measures. ETHICS AND DISSEMINATION Study procedures are in line with the recommendations of the World Medical Association (revised Declaration of Helsinki) and were approved by the Ethics Committee of the Medical Faculty, s-450/2017, Heidelberg University. All participants will provide written informed consent after receiving a detailed oral and written explanation of all procedures and can withdraw their consent at any time without negative consequence. Results will be internationally published and disseminated, to further the discussion on non-pharmacological treatment options in complex mental disorders. TRIAL REGISTRATION NUMBER DRKS00014570; Pre-results.
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Affiliation(s)
- Monika Eckstein
- Institute of Medical Psychology in the Center for Psychosocial Medicine, UniversitatsKlinikum Heidelberg, Heidelberg, Germany
| | - Anna-Lena Zietlow
- Institute of Medical Psychology in the Center for Psychosocial Medicine, UniversitatsKlinikum Heidelberg, Heidelberg, Germany
| | - Martin Fungisai Gerchen
- Department of Clinical Psychology, Central Institute for Mental Health, Mannheim, Germany
- Bernstein Center for Computational Neuroscience, Mannheim, Germany
| | | | - Sarah Ashcroft-Jones
- Institute of Medical Psychology in the Center for Psychosocial Medicine, UniversitatsKlinikum Heidelberg, Heidelberg, Germany
| | - Peter Kirsch
- Department of Clinical Psychology, Central Institute for Mental Health, Mannheim, Germany
- Bernstein Center for Computational Neuroscience, Mannheim, Germany
| | - Beate Ditzen
- Institute of Medical Psychology in the Center for Psychosocial Medicine, UniversitatsKlinikum Heidelberg, Heidelberg, Germany
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26
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Peter F, Andrea S, Nancy A. Forty years of structural brain imaging in mental disorders: is it clinically useful or not? DIALOGUES IN CLINICAL NEUROSCIENCE 2019. [PMID: 30581287 PMCID: PMC6296397 DOI: 10.31887/dcns.2018.20.3/pfalkai] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Structural brain imaging was introduced into routine clinical practice more than 40 years ago with the hope that it would support the diagnosis and treatment of mental disorders. It is now widely used to exclude organic brain disease (eg, brain tumors, cardiovascular, and inflammatory processes) in mental disorders. However, questions have been raised about whether structural brain imaging is still needed today and whether it could also be clinically useful to apply new biostatistical methods, such as machine learning. Therefore, the current paper not only reviews structural findings in Alzheimer disease, depression, bipolar disorder, and schizophrenia but also discusses the role of structural imaging in supporting diagnostic, prognostic, and therapeutic processes in mental disorders. Thus, it attempts to answer the questions whether, after four decades of use, structural brain imaging is clinically useful in mental disorders or whether it will become so in the future.
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Affiliation(s)
- Falkai Peter
- Department of Psychiatry and Psychotherapy, University Hospital Munich, Munich, Germany
| | - Schmitt Andrea
- Department of Psychiatry and Psychotherapy, University Hospital Munich, Munich, Germany
| | - Andreasen Nancy
- Department of Psychiatry, The University of Iowa, Iowa City, USA
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27
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Neurofeedback of core language network nodes modulates connectivity with the default-mode network: A double-blind fMRI neurofeedback study on auditory verbal hallucinations. Neuroimage 2019; 189:533-542. [DOI: 10.1016/j.neuroimage.2019.01.058] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 12/16/2018] [Accepted: 01/21/2019] [Indexed: 12/11/2022] Open
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Rieger K, Rarra MH, Diaz Hernandez L, Hubl D, Koenig T. Neurofeedback-Based Enhancement of Single-Trial Auditory Evoked Potentials: Treatment of Auditory Verbal Hallucinations in Schizophrenia. Clin EEG Neurosci 2018; 49:367-378. [PMID: 29569473 DOI: 10.1177/1550059418765810] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Auditory verbal hallucinations depend on a broad neurobiological network ranging from the auditory system to language as well as memory-related processes. As part of this, the auditory N100 event-related potential (ERP) component is attenuated in patients with schizophrenia, with stronger attenuation occurring during auditory verbal hallucinations. Changes in the N100 component assumingly reflect disturbed responsiveness of the auditory system toward external stimuli in schizophrenia. With this premise, we investigated the therapeutic utility of neurofeedback training to modulate the auditory-evoked N100 component in patients with schizophrenia and associated auditory verbal hallucinations. Ten patients completed electroencephalography neurofeedback training for modulation of N100 (treatment condition) or another unrelated component, P200 (control condition). On a behavioral level, only the control group showed a tendency for symptom improvement in the Positive and Negative Syndrome Scale total score in a pre-/postcomparison ( t(4) = 2.71, P = .054); however, no significant differences were found in specific hallucination related symptoms ( t(7) = -0.53, P = .62). There was no significant overall effect of neurofeedback training on ERP components in our paradigm; however, we were able to identify different learning patterns, and found a correlation between learning and improvement in auditory verbal hallucination symptoms across training sessions ( r = 0.664, n = 9, P = .05). This effect results, with cautious interpretation due to the small sample size, primarily from the treatment group ( r = 0.97, n = 4, P = .03). In particular, a within-session learning parameter showed utility for predicting symptom improvement with neurofeedback training. In conclusion, patients with schizophrenia and associated auditory verbal hallucinations who exhibit a learning pattern more characterized by within-session aptitude may benefit from electroencephalography neurofeedback. Furthermore, independent of the training group, a significant spatial pre-post difference was found in the event-related component P200 ( P = .04).
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Affiliation(s)
- Kathryn Rieger
- 1 Translational Research Center, University Hospital of Psychiatry, University of Bern, Bern, Switzerland.,2 Center for Cognition, Learning and Memory, University of Bern, Bern, Switzerland
| | - Marie-Helene Rarra
- 1 Translational Research Center, University Hospital of Psychiatry, University of Bern, Bern, Switzerland
| | - Laura Diaz Hernandez
- 1 Translational Research Center, University Hospital of Psychiatry, University of Bern, Bern, Switzerland
| | - Daniela Hubl
- 1 Translational Research Center, University Hospital of Psychiatry, University of Bern, Bern, Switzerland
| | - Thomas Koenig
- 1 Translational Research Center, University Hospital of Psychiatry, University of Bern, Bern, Switzerland.,2 Center for Cognition, Learning and Memory, University of Bern, Bern, Switzerland
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Rieger K, Rarra MH, Moor N, Diaz Hernandez L, Baenninger A, Razavi N, Dierks T, Hubl D, Koenig T. Neurofeedback-Based Enhancement of Single Trial Auditory Evoked Potentials: Feasibility in Healthy Subjects. Clin EEG Neurosci 2018; 49:79-92. [PMID: 28516807 DOI: 10.1177/1550059417708935] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Previous studies showed a global reduction of the event-related potential component N100 in patients with schizophrenia, a phenomenon that is even more pronounced during auditory verbal hallucinations. This reduction assumingly results from dysfunctional activation of the primary auditory cortex by inner speech, which reduces its responsiveness to external stimuli. With this study, we tested the feasibility of enhancing the responsiveness of the primary auditory cortex to external stimuli with an upregulation of the event-related potential component N100 in healthy control subjects. A total of 15 healthy subjects performed 8 double-sessions of EEG-neurofeedback training over 2 weeks. The results of the used linear mixed effect model showed a significant active learning effect within sessions ( t = 5.99, P < .001) against an unspecific habituation effect that lowered the N100 amplitude over time. Across sessions, a significant increase in the passive condition ( t = 2.42, P = .03), named as carry-over effect, was observed. Given that the carry-over effect is one of the ultimate aims of neurofeedback, it seems reasonable to apply this neurofeedback training protocol to influence the N100 amplitude in patients with schizophrenia. This intervention could provide an alternative treatment option for auditory verbal hallucinations in these patients.
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Affiliation(s)
- Kathryn Rieger
- 1 Translational Research Center, University Hospital of Psychiatry, University of Bern, Bern, Switzerland.,2 Center for Cognition, Learning and Memory, University of Bern, Bern, Switzerland
| | - Marie-Helene Rarra
- 1 Translational Research Center, University Hospital of Psychiatry, University of Bern, Bern, Switzerland
| | - Nicolas Moor
- 1 Translational Research Center, University Hospital of Psychiatry, University of Bern, Bern, Switzerland
| | - Laura Diaz Hernandez
- 1 Translational Research Center, University Hospital of Psychiatry, University of Bern, Bern, Switzerland.,2 Center for Cognition, Learning and Memory, University of Bern, Bern, Switzerland
| | - Anja Baenninger
- 1 Translational Research Center, University Hospital of Psychiatry, University of Bern, Bern, Switzerland
| | - Nadja Razavi
- 1 Translational Research Center, University Hospital of Psychiatry, University of Bern, Bern, Switzerland
| | - Thomas Dierks
- 1 Translational Research Center, University Hospital of Psychiatry, University of Bern, Bern, Switzerland
| | - Daniela Hubl
- 1 Translational Research Center, University Hospital of Psychiatry, University of Bern, Bern, Switzerland
| | - Thomas Koenig
- 1 Translational Research Center, University Hospital of Psychiatry, University of Bern, Bern, Switzerland.,2 Center for Cognition, Learning and Memory, University of Bern, Bern, Switzerland
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30
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Gerchen MF, Kirsch M, Bahs N, Halli P, Gerhardt S, Schäfer A, Sommer WH, Kiefer F, Kirsch P. The SyBil-AA real-time fMRI neurofeedback study: protocol of a single-blind randomized controlled trial in alcohol use disorder. BMC Psychiatry 2018; 18:12. [PMID: 29343230 PMCID: PMC5773029 DOI: 10.1186/s12888-018-1604-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Accepted: 01/11/2018] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Alcohol Use Disorder is a highly prevalent mental disorder which puts a severe burden on individuals, families, and society. The treatment of Alcohol Use Disorder is challenging and novel and innovative treatment approaches are needed to expand treatment options. A promising neuroscience-based intervention method that allows targeting cortical as well as subcortical brain processes is real-time functional magnetic resonance imaging neurofeedback. However, the efficacy of this technique as an add-on treatment of Alcohol Use Disorder in a clinical setting is hitherto unclear and will be assessed in the Systems Biology of Alcohol Addiction (SyBil-AA) neurofeedback study. METHODS N = 100 patients with Alcohol Use Disorder will be randomized to 5 parallel groups in a single-blind fashion and receive real-time functional magnetic resonance imaging neurofeedback while they are presented pictures of alcoholic beverages. The groups will either downregulate the ventral striatum, upregulate the right inferior frontal gyrus, negatively modulate the connectivity between these regions, upregulate, or downregulate the auditory cortex as a control region. After receiving 3 sessions of neurofeedback training within a maximum of 2 weeks, participants will be followed up monthly for a period of 3 months and relapse rates will be assessed as the primary outcome measure. DISCUSSION The results of this study will provide insights into the efficacy of real-time functional magnetic resonance imaging neurofeedback training in the treatment of Alcohol Use Disorder as well as in the involved brain systems. This might help to identify predictors of successful neurofeedback treatment which could potentially be useful in developing personalized treatment approaches. TRIAL REGISTRATION The study was retrospectively registered in the German Clinical Trials Register (trial identifier: DRKS00010253 ; WHO Universal Trial Number (UTN): U1111-1181-4218) on May 10th, 2016.
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Affiliation(s)
- Martin Fungisai Gerchen
- Department of Clinical Psychology, Central Institute of Mental Health (ZI), University of Heidelberg/Medical Faculty Mannheim, J5, 68159, Mannheim, Germany. .,Bernstein Center for Computational Neuroscience Heidelberg/Mannheim, Mannheim, Germany.
| | - Martina Kirsch
- 0000 0001 2190 4373grid.7700.0Department of Addiction Behavior and Addiction Medicine, Central Institute of Mental Health, University of Heidelberg/Medical Faculty Mannheim, Mannheim, Germany
| | - Nathalie Bahs
- 0000 0001 2190 4373grid.7700.0Department of Addiction Behavior and Addiction Medicine, Central Institute of Mental Health, University of Heidelberg/Medical Faculty Mannheim, Mannheim, Germany
| | - Patrick Halli
- 0000 0004 0477 2235grid.413757.3Department of Clinical Psychology, Central Institute of Mental Health (ZI), University of Heidelberg/Medical Faculty Mannheim, J5, 68159 Mannheim, Germany
| | - Sarah Gerhardt
- 0000 0001 2190 4373grid.7700.0Department of Addiction Behavior and Addiction Medicine, Central Institute of Mental Health, University of Heidelberg/Medical Faculty Mannheim, Mannheim, Germany
| | - Axel Schäfer
- 0000 0001 2190 4373grid.7700.0Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, University of Heidelberg/Medical Faculty Mannheim, Mannheim, Germany
| | - Wolfgang H. Sommer
- 0000 0001 2190 4373grid.7700.0Department of Addiction Behavior and Addiction Medicine, Central Institute of Mental Health, University of Heidelberg/Medical Faculty Mannheim, Mannheim, Germany ,0000 0001 2190 4373grid.7700.0Department of Psychopharmacology, Central Institute of Mental Health, University of Heidelberg/Medical Faculty Mannheim, Mannheim, Germany
| | - Falk Kiefer
- 0000 0001 2190 4373grid.7700.0Department of Addiction Behavior and Addiction Medicine, Central Institute of Mental Health, University of Heidelberg/Medical Faculty Mannheim, Mannheim, Germany
| | - Peter Kirsch
- 0000 0004 0477 2235grid.413757.3Department of Clinical Psychology, Central Institute of Mental Health (ZI), University of Heidelberg/Medical Faculty Mannheim, J5, 68159 Mannheim, Germany ,grid.455092.fBernstein Center for Computational Neuroscience Heidelberg/Mannheim, Mannheim, Germany
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Zweerings J, Pflieger EM, Mathiak KA, Zvyagintsev M, Kacela A, Flatten G, Mathiak K. Impaired Voluntary Control in PTSD: Probing Self-Regulation of the ACC With Real-Time fMRI. Front Psychiatry 2018; 9:219. [PMID: 29899712 PMCID: PMC5989618 DOI: 10.3389/fpsyt.2018.00219] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Accepted: 05/07/2018] [Indexed: 01/05/2023] Open
Abstract
Background: Post-traumatic stress disorder (PTSD) is characterized by deficits in the self-regulation of cognitions and emotions. Neural networks of emotion regulation may exhibit reduced control mediated by the anterior cingulate cortex (ACC), contributing to aberrant limbic responses in PTSD. Methods: Real-time fMRI neurofeedback (rt-fMRI NF) assessed self-regulation of the ACC in nine patients with PTSD after single trauma exposure and nine matched healthy controls. All participants were instructed to train ACC upregulation on three training days. Results: Both groups achieved regulation, which was associated with wide-spread brain activation encompassing the ACC. Compared to the controls, regulation amplitude and learning rate was lower in patients, correlating with symptom severity. In addition, a frontopolar activation cluster was associated with self-regulation efforts in patients. Conclusions: For the first time, we tested self-regulation of the ACC in patients with PTSD. The observed impairment supports models of ACC-mediated regulation deficits that may contribute to the psychopathology of PTSD. Controlled trials in a larger sample are needed to confirm our findings and to directly investigate whether training of central regulation mechanisms improves emotion regulation in PTSD.
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Affiliation(s)
- Jana Zweerings
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical School, RWTH Aachen University, Aachen, Germany
| | - Eliza M Pflieger
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical School, RWTH Aachen University, Aachen, Germany
| | - Krystyna A Mathiak
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical School, RWTH Aachen University, Aachen, Germany
| | - Mikhail Zvyagintsev
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical School, RWTH Aachen University, Aachen, Germany.,Brain Imaging Facility, Interdisciplinary Centre for Clinical Studies (IZKF), Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Anastasia Kacela
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical School, RWTH Aachen University, Aachen, Germany
| | - Guido Flatten
- Euregio-Institut für Psychosomatik und Psychotraumatologie, Aachen, Germany
| | - Klaus Mathiak
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical School, RWTH Aachen University, Aachen, Germany.,JARA-Translational Brain Medicine, Aachen, Germany
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32
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Romano A, Serviddio G, Calcagnini S, Villani R, Giudetti AM, Cassano T, Gaetani S. Linking lipid peroxidation and neuropsychiatric disorders: focus on 4-hydroxy-2-nonenal. Free Radic Biol Med 2017; 111:281-293. [PMID: 28063940 DOI: 10.1016/j.freeradbiomed.2016.12.046] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Revised: 12/27/2016] [Accepted: 12/30/2016] [Indexed: 12/25/2022]
Abstract
4-hydroxy-2-nonenal (HNE) is considered to be a strong marker of oxidative stress; the interaction between HNE and cellular proteins leads to the formation of HNE-protein adducts able to alter cellular homeostasis and cause the development of a pathological state. By virtue of its high lipid concentration, oxygen utilization, and the presence of metal ions participating to redox reactions, the brain is highly susceptible to the formation of free radicals and HNE-related compounds. A variety of neuropsychiatric disorders have been associated with elevations of HNE concentration. For example, increased levels of HNE were found in the cortex of bipolar and schizophrenic patients, while HNE plasma concentrations resulted high in patients with major depression. On the same line, high brain concentrations of HNE were found associated with Huntington's inclusions. The incidence of high HNE levels is relevant also in the brain and cerebrospinal fluid of patients suffering from Parkinson's disease. Intriguingly, in this case the increase of HNE was associated with an accumulation of iron in the substantia nigra, a brain region highly affected by the pathology. In the present review we recapitulate the findings supporting the role of HNE in the pathogenesis of different neuropsychiatric disorders to highlight the pathogenic mechanisms ascribed to HNE accumulation. The aim of this review is to offer novel perspectives both for the understanding of etiopathogenetic mechanisms that remain still unclear and for the identification of new useful biological markers. We conclude suggesting that targeting HNE-driven cellular processes may represent a new more efficacious therapeutical intervention.
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Affiliation(s)
- Adele Romano
- Department of Physiology and Pharmacology "V. Erspamer", Sapienza University of Rome, Piazzale A. Moro 5, 00185 Roma, Italy
| | - Gaetano Serviddio
- Department of Medical and Surgical Sciences, University of Foggia, Via Luigi Pinto, c/o Ospedali Riuniti, 71122 Foggia, Italy
| | - Silvio Calcagnini
- Department of Physiology and Pharmacology "V. Erspamer", Sapienza University of Rome, Piazzale A. Moro 5, 00185 Roma, Italy
| | - Rosanna Villani
- Department of Medical and Surgical Sciences, University of Foggia, Via Luigi Pinto, c/o Ospedali Riuniti, 71122 Foggia, Italy
| | - Anna Maria Giudetti
- Department of Biological and Environmental Sciences and Technologies, University of Salento, Centro Ecotekne, sp Lecce-Monteroni 73100 Lecce, Italy
| | - Tommaso Cassano
- Department of Clinical and Experimental Medicine, University of Foggia, Via Luigi Pinto, c/o Ospedali Riuniti, 71122 Foggia, Italy.
| | - Silvana Gaetani
- Department of Physiology and Pharmacology "V. Erspamer", Sapienza University of Rome, Piazzale A. Moro 5, 00185 Roma, Italy
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An Exploratory Study of Intensive Neurofeedback Training for Schizophrenia. Behav Neurol 2017; 2017:6914216. [PMID: 28701821 PMCID: PMC5497641 DOI: 10.1155/2017/6914216] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2017] [Revised: 04/23/2017] [Accepted: 05/28/2017] [Indexed: 12/01/2022] Open
Abstract
Schizophrenia is a chronic and devastating brain disorder with ongoing cognitive, behavioral, and emotional deteriorated functions. Neurofeedback training, which enables the individuals to regulate their brain activity using a real-time feedback loop, is increasingly investigated as a potential alternative intervention for schizophrenia. This study aimed to explore the effect of short but intensive neurofeedback training for schizophrenic patients with difficulty for long-time training. A middle-aged woman with chronic schizophrenia completed the intensive training of alpha/beta2 (20–30 Hz) in four consecutive days with a total training duration of 13.5 hours. The results showed that her alpha/beta2 increased over sessions, and her behavior performance including short-term memory, mood, and speech pattern was improved at the end of neurofeedback training. Importantly, a 22-month follow-up found a dramatic improvement in both positive and negative symptoms. These positive outcomes suggest that such intensive neurofeedback training may provide new insight into the treatment of schizophrenia and thus deserves further study to fully examine its scope.
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Bassett DS, Khambhati AN. A network engineering perspective on probing and perturbing cognition with neurofeedback. Ann N Y Acad Sci 2017; 1396:126-143. [PMID: 28445589 PMCID: PMC5446287 DOI: 10.1111/nyas.13338] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Network science and engineering provide a flexible and generalizable tool set to describe and manipulate complex systems characterized by heterogeneous interaction patterns among component parts. While classically applied to social systems, these tools have recently proven to be particularly useful in the study of the brain. In this review, we describe the nascent use of these tools to understand human cognition, and we discuss their utility in informing the meaningful and predictable perturbation of cognition in combination with the emerging capabilities of neurofeedback. To blend these disparate strands of research, we build on emerging conceptualizations of how the brain functions (as a complex network) and how we can develop and target interventions or modulations (as a form of network control). We close with an outline of current frontiers that bridge neurofeedback, connectomics, and network control theory to better understand human cognition.
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Affiliation(s)
- Danielle S. Bassett
- Department of BioengineeringUniversity of PennsylvaniaPhiladelphiaPennsylvania
- Department of Electrical and Systems EngineeringUniversity of PennsylvaniaPhiladelphiaPennsylvania
| | - Ankit N. Khambhati
- Department of BioengineeringUniversity of PennsylvaniaPhiladelphiaPennsylvania
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Krause F, Benjamins C, Lührs M, Eck J, Noirhomme Q, Rosenke M, Brunheim S, Sorger B, Goebel R. Real-time fMRI-based self-regulation of brain activation across different visual feedback presentations. BRAIN-COMPUTER INTERFACES 2017. [DOI: 10.1080/2326263x.2017.1307096] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Florian Krause
- Department of Cognitive Neuroscience, Maastricht University, Maastricht, the Netherlands
- Department of Research and Development, Brain Innovation B.V., Maastricht, The Netherlands
| | - Caroline Benjamins
- Department of Cognitive Neuroscience, Maastricht University, Maastricht, the Netherlands
- Department of Research and Development, Brain Innovation B.V., Maastricht, The Netherlands
| | - Michael Lührs
- Department of Cognitive Neuroscience, Maastricht University, Maastricht, the Netherlands
- Department of Research and Development, Brain Innovation B.V., Maastricht, The Netherlands
| | - Judith Eck
- Department of Cognitive Neuroscience, Maastricht University, Maastricht, the Netherlands
- Department of Research and Development, Brain Innovation B.V., Maastricht, The Netherlands
| | - Quentin Noirhomme
- Department of Cognitive Neuroscience, Maastricht University, Maastricht, the Netherlands
- Department of Research and Development, Brain Innovation B.V., Maastricht, The Netherlands
| | - Mona Rosenke
- Department of Cognitive Neuroscience, Maastricht University, Maastricht, the Netherlands
- Department of Research and Development, Brain Innovation B.V., Maastricht, The Netherlands
- Department of Psychology, Stanford University, Stanford, CA, USA
| | - Sascha Brunheim
- Department of Cognitive Neuroscience, Maastricht University, Maastricht, the Netherlands
- Department of Research and Development, Brain Innovation B.V., Maastricht, The Netherlands
- Erwin L. Hahn Institute for Magnetic Resonance Imaging, University Duisburg-Essen, Essen, Germany
| | - Bettina Sorger
- Department of Cognitive Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - Rainer Goebel
- Department of Cognitive Neuroscience, Maastricht University, Maastricht, the Netherlands
- Department of Research and Development, Brain Innovation B.V., Maastricht, The Netherlands
- Department of Neuroimaging and Neuromodeling, Royal Netherlands Academy of Arts and Sciences (KNAW), Netherlands Institute for Neuroscience, Amsterdam, The Netherlands
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Wei S, Womer F, Geng H, Jiang X, Zhou Q, Chang M, Zhou Y, Tang Y, Wang F. Similarities and differences of functional connectivity in drug-naïve, first-episode adolescent and young adult with major depressive disorder and schizophrenia. Sci Rep 2017; 7:44316. [PMID: 28287187 PMCID: PMC5347082 DOI: 10.1038/srep44316] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 02/06/2017] [Indexed: 12/27/2022] Open
Abstract
Major depressive disorder (MDD) and schizophrenia (SZ) are considered two distinct psychiatric disorders. Yet, they have considerable overlap in symptomatology and clinical features, particularly in the initial phases of illness. The amygdala and prefrontal cortex (PFC) appear to have critical roles in these disorders; however, abnormalities appear to manifest differently. In our study forty-nine drug-naïve, first-episode MDD, 45 drug-naïve, first-episode SZ, and 50 healthy control (HC) participants from 13 to 30 years old underwent resting-state functional magnetic resonance imaging. Functional connectivity (FC) between the amygdala and PFC was compared among the three groups. Significant differences in FC were observed between the amygdala and ventral PFC (VPFC), dorsolateral PFC (DLPFC), and dorsal anterior cingulated cortex (dACC) among the three groups. Further analyses demonstrated that MDD showed decreased amygdala-VPFC FC and SZ had reductions in amygdala-dACC FC. Both the diagnostic groups had significantly decreased amygdala-DLPFC FC. These indicate abnormalities in amygdala-PFC FC and further support the importance of the interaction between the amygdala and PFC in adolescents and young adults with these disorders. Additionally, the alterations in amygdala-PFC FC may underlie the initial similarities observed between MDD and SZ and suggest potential markers of differentiation between the disorders at first onset.
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Affiliation(s)
- Shengnan Wei
- Brain Function Research Section, First Affiliated Hospital, China Medical University, Shenyang, Liaoning, PR China.,Department of Radiology, First Affiliated Hospital, China Medical University, Shenyang, Liaoning, PR China
| | - Fay Womer
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Haiyang Geng
- Department of Radiology, First Affiliated Hospital, China Medical University, Shenyang, Liaoning, PR China
| | - Xiaowei Jiang
- Brain Function Research Section, First Affiliated Hospital, China Medical University, Shenyang, Liaoning, PR China.,Department of Radiology, First Affiliated Hospital, China Medical University, Shenyang, Liaoning, PR China
| | - Qian Zhou
- Department of Psychiatry, First Affiliated Hospital, China Medical University, Shenyang, Liaoning, PR China
| | - Miao Chang
- Department of Radiology, First Affiliated Hospital, China Medical University, Shenyang, Liaoning, PR China
| | - Yifang Zhou
- Department of Psychiatry, First Affiliated Hospital, China Medical University, Shenyang, Liaoning, PR China.,Department of Geriatric Medicine, First Affiliated Hospital, China Medical University, Shenyang, Liaoning, PR China
| | - Yanqing Tang
- Brain Function Research Section, First Affiliated Hospital, China Medical University, Shenyang, Liaoning, PR China.,Department of Psychiatry, First Affiliated Hospital, China Medical University, Shenyang, Liaoning, PR China.,Department of Geriatric Medicine, First Affiliated Hospital, China Medical University, Shenyang, Liaoning, PR China
| | - Fei Wang
- Brain Function Research Section, First Affiliated Hospital, China Medical University, Shenyang, Liaoning, PR China.,Department of Radiology, First Affiliated Hospital, China Medical University, Shenyang, Liaoning, PR China.,Department of Psychiatry, First Affiliated Hospital, China Medical University, Shenyang, Liaoning, PR China.,Department of Psychiatry, Yale University School of Medicine, New Haven, Conn., USA
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Soares JM, Magalhães R, Moreira PS, Sousa A, Ganz E, Sampaio A, Alves V, Marques P, Sousa N. A Hitchhiker's Guide to Functional Magnetic Resonance Imaging. Front Neurosci 2016; 10:515. [PMID: 27891073 PMCID: PMC5102908 DOI: 10.3389/fnins.2016.00515] [Citation(s) in RCA: 112] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 10/25/2016] [Indexed: 12/12/2022] Open
Abstract
Functional Magnetic Resonance Imaging (fMRI) studies have become increasingly popular both with clinicians and researchers as they are capable of providing unique insights into brain functions. However, multiple technical considerations (ranging from specifics of paradigm design to imaging artifacts, complex protocol definition, and multitude of processing and methods of analysis, as well as intrinsic methodological limitations) must be considered and addressed in order to optimize fMRI analysis and to arrive at the most accurate and grounded interpretation of the data. In practice, the researcher/clinician must choose, from many available options, the most suitable software tool for each stage of the fMRI analysis pipeline. Herein we provide a straightforward guide designed to address, for each of the major stages, the techniques, and tools involved in the process. We have developed this guide both to help those new to the technique to overcome the most critical difficulties in its use, as well as to serve as a resource for the neuroimaging community.
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Affiliation(s)
- José M. Soares
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of MinhoBraga, Portugal
- ICVS/3B's - PT Government Associate LaboratoryBraga, Portugal
| | - Ricardo Magalhães
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of MinhoBraga, Portugal
- ICVS/3B's - PT Government Associate LaboratoryBraga, Portugal
| | - Pedro S. Moreira
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of MinhoBraga, Portugal
- ICVS/3B's - PT Government Associate LaboratoryBraga, Portugal
| | - Alexandre Sousa
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of MinhoBraga, Portugal
- ICVS/3B's - PT Government Associate LaboratoryBraga, Portugal
- Department of Informatics, University of MinhoBraga, Portugal
| | - Edward Ganz
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of MinhoBraga, Portugal
- ICVS/3B's - PT Government Associate LaboratoryBraga, Portugal
| | - Adriana Sampaio
- Neuropsychophysiology Lab, CIPsi, School of Psychology, University of MinhoBraga, Portugal
| | - Victor Alves
- Department of Informatics, University of MinhoBraga, Portugal
| | - Paulo Marques
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of MinhoBraga, Portugal
- ICVS/3B's - PT Government Associate LaboratoryBraga, Portugal
| | - Nuno Sousa
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of MinhoBraga, Portugal
- ICVS/3B's - PT Government Associate LaboratoryBraga, Portugal
- Clinical Academic Center – BragaBraga, Portugal
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Föcking M, Dicker P, Lopez LM, Hryniewiecka M, Wynne K, English JA, Cagney G, Cotter DR. Proteomic analysis of the postsynaptic density implicates synaptic function and energy pathways in bipolar disorder. Transl Psychiatry 2016; 6:e959. [PMID: 27898073 PMCID: PMC5290351 DOI: 10.1038/tp.2016.224] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 09/26/2016] [Accepted: 09/28/2016] [Indexed: 12/17/2022] Open
Abstract
The postsynaptic density (PSD) contains a complex set of proteins of known relevance to neuropsychiatric disorders such as schizophrenia and bipolar disorder. We enriched for this anatomical structure in the anterior cingulate cortex of 16 bipolar disorder samples and 20 controls from the Stanley Medical Research Institute. Unbiased shotgun proteomics incorporating label-free quantitation was used to identify differentially expressed proteins. Quantitative investigation of the PSD identified 2033 proteins, among which 288 were found to be differentially expressed. Validation of expression changes of DNM1, DTNA, NDUFV2, SEPT11 and SSBP was performed by western blotting. Bioinformatics analysis of the differentially expressed proteins implicated metabolic pathways including mitochondrial function, the tricarboxylic acid cycle, oxidative phosphorylation, protein translation and calcium signaling. The data implicate PSD-associated proteins, and specifically mitochondrial function in bipolar disorder. They relate synaptic function in bipolar disorder and the energy pathways that underpin it. Overall, our findings add to a growing literature linking the PSD and mitochondrial function in psychiatric disorders generally, and suggest that mitochondrial function associated with the PSD is particularly important in bipolar disorder.
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Affiliation(s)
- M Föcking
- Department of Psychiatry, Royal College of Surgeons in Ireland, Education and Research Centre, Beaumont Hospital, Dublin, Ireland,Department of Psychiatry, Royal College of Surgeons in Ireland, Education and Research Centre, Education and Research Centre, Dublin 9, Ireland. E-mail: or
| | - P Dicker
- Departments of Epidemiology and Public Health, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - L M Lopez
- Department of Psychiatry, Royal College of Surgeons in Ireland, Education and Research Centre, Beaumont Hospital, Dublin, Ireland
| | - M Hryniewiecka
- Department of Psychiatry, Royal College of Surgeons in Ireland, Education and Research Centre, Beaumont Hospital, Dublin, Ireland
| | - K Wynne
- Proteome Research Centre, UCD Conway Institute of Biomolecular and Biomedical Research, School of Medicine and Medical Sciences, University College Dublin, Dublin, Ireland
| | - J A English
- Department of Psychiatry, Royal College of Surgeons in Ireland, Education and Research Centre, Beaumont Hospital, Dublin, Ireland
| | - G Cagney
- Proteome Research Centre, UCD Conway Institute of Biomolecular and Biomedical Research, School of Medicine and Medical Sciences, University College Dublin, Dublin, Ireland
| | - D R Cotter
- Department of Psychiatry, Royal College of Surgeons in Ireland, Education and Research Centre, Beaumont Hospital, Dublin, Ireland,Department of Psychiatry, Beaumont Hospital, Dublin, Ireland,Department of Psychiatry, Royal College of Surgeons in Ireland, Education and Research Centre, Education and Research Centre, Dublin 9, Ireland. E-mail: or
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Kinney-Lang E, Auyeung B, Escudero J. Expanding the (kaleido)scope: exploring current literature trends for translating electroencephalography (EEG) based brain–computer interfaces for motor rehabilitation in children. J Neural Eng 2016; 13:061002. [DOI: 10.1088/1741-2560/13/6/061002] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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40
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Micoulaud Franchi JA, Quiles C, Belzeaux R, Adida M, Azorin JM. [Negative symptoms of schizophrenia: from electrophysiology to electrotherapy]. Encephale 2016; 41:6S50-6. [PMID: 26776393 DOI: 10.1016/s0013-7006(16)30011-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
The aim of this review of the literature is to summarize the state of the knowledge concerning the relationship between negative symptoms in schizophrenia, electrophysiology and electrotherapy. The scientific literature search of international articles was performed during August and September 2015 using the PubMed electronic database. We used the following MeSH terms: "Negative symptoms", "Schizophrenia", "Electrophysiology", "Neurophysiology", "EEG power", "Alpha rhythm", "Transcranial magnetic stimulation", "Transcranial direct current stimulation", "Electroconvulsive therapy", "Neurofeedback", "Vagus Nerve Stimulation", "Deep Brain Stimulation", and "State dependent". Negative symptoms in schizophrenia are associated with altered activity in prefrontal cortex in functional neuroimaging studies. This is in line with electrophysiological measurements that found a change in EEG spectral power in the alpha frequency band over prefrontal brain regions. The notion of functional hypofrontality has led to hypotheses that electrotherapy applied to the prefrontal cortex may be an effective treatment of negative symptoms in schizophrenia. Repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS) were used to increase cortical activity in schizophrenia and achieve a clinical effect on negative symptoms. Three meta-analyses confirmed, with a moderate effect size, that rTMS is an effective treatment option for negative symptoms in schizophrenia. The two subsequently published prospective multicenter studies, however, found opposite results from each other. Two randomized controlled studies suggested that tDCS is an effective treatment option for negative symptoms. There is no study on the efficacy of neurofeedback, vagal nerve stimulation or deep brain stimulation on negative symptoms in schizophrenia. Additional studies are needed to confirm the efficacy of rTMS and tDCS on negative symptoms in schizophrenia. Influencing factors, related to clinical and stimulation parameters, of rTMS and tDCS on negative symptoms should be better investigated. Effects related to electrophysiological brain activity of the patient, especially in the alpha band, during the stimulation should also be better investigated. The action of electrotherapy may be state dependent, and a better understanding of electrophysiological effects of electrotherapy techniques could enable their optimization.
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Affiliation(s)
- J-A Micoulaud Franchi
- Services d'explorations fonctionnelles du système nerveux, Clinique du sommeil, CHU de Bordeaux, Place Amélie Raba-Leon, 33076 Bordeaux, France; USR CNRS 3413 SANPSY, CHU Pellegrin, Université de Bordeaux, France.
| | - C Quiles
- Université de Bordeaux, 146 rue Léo-Saignat, 33076 Bordeaux cedex, France
| | - R Belzeaux
- SHU Psychiatrie adultes, Hôpital Ste Marguerite, 13274 Marseille cedex 9, France
| | - M Adida
- SHU Psychiatrie adultes, Hôpital Ste Marguerite, 13274 Marseille cedex 9, France
| | - J-M Azorin
- SHU Psychiatrie adultes, Hôpital Ste Marguerite, 13274 Marseille cedex 9, France
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Sorger B, Kamp T, Weiskopf N, Peters JC, Goebel R. When the Brain Takes 'BOLD' Steps: Real-Time fMRI Neurofeedback Can Further Enhance the Ability to Gradually Self-regulate Regional Brain Activation. Neuroscience 2016; 378:71-88. [PMID: 27659118 PMCID: PMC5953410 DOI: 10.1016/j.neuroscience.2016.09.026] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2015] [Revised: 08/02/2016] [Accepted: 09/12/2016] [Indexed: 01/07/2023]
Abstract
Humans are able to gradually self-regulate regional brain activation by applying cognitive strategies. Providing rtfMRI neurofeedback can enhance the gradual self-regulation ability. Findings are generalizable to various mental tasks and clinical MR field strengths. Novel parametric activation paradigm enriches spectrum of rtfMRI-neurofeedback and BCI methodology.
Brain-computer interfaces (BCIs) based on real-time functional magnetic resonance imaging (rtfMRI) are currently explored in the context of developing alternative (motor-independent) communication and control means for the severely disabled. In such BCI systems, the user encodes a particular intention (e.g., an answer to a question or an intended action) by evoking specific mental activity resulting in a distinct brain state that can be decoded from fMRI activation. One goal in this context is to increase the degrees of freedom in encoding different intentions, i.e., to allow the BCI user to choose from as many options as possible. Recently, the ability to voluntarily modulate spatial and/or temporal blood oxygenation level-dependent (BOLD)-signal features has been explored implementing different mental tasks and/or different encoding time intervals, respectively. Our two-session fMRI feasibility study systematically investigated for the first time the possibility of using magnitudinal BOLD-signal features for intention encoding. Particularly, in our novel paradigm, participants (n = 10) were asked to alternately self-regulate their regional brain-activation level to 30%, 60% or 90% of their maximal capacity by applying a selected activation strategy (i.e., performing a mental task, e.g., inner speech) and modulation strategies (e.g., using different speech rates) suggested by the experimenters. In a second step, we tested the hypothesis that the additional availability of feedback information on the current BOLD-signal level within a region of interest improves the gradual-self regulation performance. Therefore, participants were provided with neurofeedback in one of the two fMRI sessions. Our results show that the majority of the participants were able to gradually self-regulate regional brain activation to at least two different target levels even in the absence of neurofeedback. When provided with continuous feedback on their current BOLD-signal level, most participants further enhanced their gradual self-regulation ability. Our findings were observed across a wide variety of mental tasks and across clinical MR field strengths (i.e., at 1.5 T and 3 T), indicating that these findings are robust and can be generalized across mental tasks and scanner types. The suggested novel parametric activation paradigm enriches the spectrum of current rtfMRI-neurofeedback and BCI methodology and has considerable potential for fundamental and clinical neuroscience applications.
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Affiliation(s)
- Bettina Sorger
- Department of Cognitive Neuroscience, Maastricht University, Maastricht, The Netherlands; Maastricht Brain Imaging Center (M-BIC), Maastricht, The Netherlands.
| | - Tabea Kamp
- Department of Cognitive Neuroscience, Maastricht University, Maastricht, The Netherlands; Maastricht Brain Imaging Center (M-BIC), Maastricht, The Netherlands
| | - Nikolaus Weiskopf
- Department of Neurophysics, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany; Wellcome Trust Centre for Neuroimaging, UCL Institute of Neurology, University College London, London, United Kingdom
| | - Judith Caroline Peters
- Department of Cognitive Neuroscience, Maastricht University, Maastricht, The Netherlands; Maastricht Brain Imaging Center (M-BIC), Maastricht, The Netherlands; Department of Neuroimaging and Neuromodeling, Netherlands Institute for Neuroscience, An institute of the Royal Netherlands Academy of Arts and Sciences (KNAW), Amsterdam, The Netherlands
| | - Rainer Goebel
- Department of Cognitive Neuroscience, Maastricht University, Maastricht, The Netherlands; Maastricht Brain Imaging Center (M-BIC), Maastricht, The Netherlands; Department of Neuroimaging and Neuromodeling, Netherlands Institute for Neuroscience, An institute of the Royal Netherlands Academy of Arts and Sciences (KNAW), Amsterdam, The Netherlands
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Sherwood MS, Weisend MP, Kane JH, Parker JG. Combining Real-Time fMRI Neurofeedback Training of the DLPFC with N-Back Practice Results in Neuroplastic Effects Confined to the Neurofeedback Target Region. Front Behav Neurosci 2016; 10:138. [PMID: 27445733 PMCID: PMC4923251 DOI: 10.3389/fnbeh.2016.00138] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Accepted: 06/15/2016] [Indexed: 12/16/2022] Open
Abstract
In traditional fMRI, individuals respond to exogenous stimuli and are naïve to the effects of the stimuli on their neural activity patterns. Changes arising in the fMRI signal are analyzed post-hoc to elucidate the spatial and temporal activation of brain regions associated with the tasks performed. The advent of real-time fMRI has enabled a new method to systematically alter brain activity across space and time using neurofeedback training (NFT), providing a new tool to study internally-driven processes such as neuroplasticity. In this work, we combined n-back practice with fMRI-NFT of the left dorsolateral prefrontal cortex (DLPFC) to better understand the relationship between open- and closed-loop neuromodulation. FMRI data were acquired during both traditional n-back and NFT across five imaging sessions. Region-of-interest (ROI) and voxel-wise 2 × 2 within subjects ANOVAs were carried out to determine the effects of, and interaction between, training session and neuromodulation type. A main effect of training session was identified for only a single, highly focused cluster that shared spatial properties with the fMRI-NFT target region (left DLPFC). This finding indicates that combined open- and closed-loop neuroplastic enhancement techniques result in focal changes that are confined to the target area of NFT, and do not affect up- or down-stream network components that are normally engaged during working memory. Additionally, we identified a main effect of neuromodulation type for 15 clusters with significantly different activation between open- and closed-loop neuromodulation during training, 12 of which demonstrated higher activity during the open-loop neuromodulation. Our results, taken together with previous reports, indicate that fMRI-NFT combined with n-back practice leads to a highly focal volume exhibiting neuroplasticity without additional network effects.
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Affiliation(s)
- Matthew S Sherwood
- Wright State Research Institute, Wright State UniversityDayton, OH, USA; Department of Biomedical, Industrial, and Human Factors Engineering, Wright State UniversityDayton, OH, USA
| | | | - Jessica H Kane
- Wright State Research Institute, Wright State UniversityDayton, OH, USA; Department of Neuroscience, Cell Biology, and Physiology, Wright State UniversityDayton, OH, USA
| | - Jason G Parker
- Department of Biomedical, Industrial, and Human Factors Engineering, Wright State UniversityDayton, OH, USA; Department of Neurology, Boonshoft School of Medicine, Wright State UniversityDayton, OH, USA
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Dyck MS, Mathiak KA, Bergert S, Sarkheil P, Koush Y, Alawi EM, Zvyagintsev M, Gaebler AJ, Shergill SS, Mathiak K. Targeting Treatment-Resistant Auditory Verbal Hallucinations in Schizophrenia with fMRI-Based Neurofeedback - Exploring Different Cases of Schizophrenia. Front Psychiatry 2016; 7:37. [PMID: 27014102 PMCID: PMC4791600 DOI: 10.3389/fpsyt.2016.00037] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Accepted: 02/29/2016] [Indexed: 01/13/2023] Open
Abstract
Auditory verbal hallucinations (AVHs) are a hallmark of schizophrenia and can significantly impair patients' emotional, social, and occupational functioning. Despite progress in psychopharmacology, over 25% of schizophrenia patients suffer from treatment-resistant hallucinations. In the search for alternative treatment methods, neurofeedback (NF) emerges as a promising therapy tool. NF based on real-time functional magnetic resonance imaging (rt-fMRI) allows voluntarily change of the activity in a selected brain region - even in patients with schizophrenia. This study explored effects of NF on ongoing AVHs. The selected participants were trained in the self-regulation of activity in the anterior cingulate cortex (ACC), a key monitoring region involved in generation and intensity modulation of AVHs. Using rt-fMRI, three right-handed patients, suffering from schizophrenia and ongoing, treatment-resistant AVHs, learned control over ACC activity on three separate days. The effect of NF training on hallucinations' severity was assessed with the Auditory Vocal Hallucination Rating Scale (AVHRS) and on the affective state - with the Positive and Negative Affect Schedule (PANAS). All patients yielded significant upregulation of the ACC and reported subjective improvement in some aspects of AVHs (AVHRS) such as disturbance and suffering from the voices. In general, mood (PANAS) improved during NF training, though two patients reported worse mood after NF on the third day. ACC and reward system activity during NF learning and specific effects on mood and symptoms varied across the participants. None of them profited from the last training set in the prolonged three-session training. Moreover, individual differences emerged in brain networks activated with NF and in symptom changes, which were related to the patients' symptomatology and disease history. NF based on rt-fMRI seems a promising tool in therapy of AVHs. The patients, who suffered from continuous hallucinations for years, experienced symptom changes that may be attributed to the NF training. In order to assess the effectiveness of NF as a therapeutic method, this effect has to be studied systematically in larger groups; further, long-term effects need to be assessed. Particularly in schizophrenia, future NF studies should take into account the individual differences in reward processing, fatigue, and motivation to develop individualized training protocols.
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Affiliation(s)
- Miriam S Dyck
- Department of Psychiatry, Psychotherapy and Psychosomatics, Jülich-Aachen Research Alliance (JARA)-Brain, RWTH Aachen University, Aachen, Germany; Jülich-Aachen Research Alliance (JARA)-Translational Brain Medicine, Jülich, Aachen, Germany
| | - Krystyna A Mathiak
- Department of Psychiatry, Psychotherapy and Psychosomatics, Jülich-Aachen Research Alliance (JARA)-Brain, RWTH Aachen University, Aachen, Germany; Jülich-Aachen Research Alliance (JARA)-Translational Brain Medicine, Jülich, Aachen, Germany; Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, Aachen, Germany; Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Susanne Bergert
- Department of Psychiatry, Psychotherapy and Psychosomatics, Jülich-Aachen Research Alliance (JARA)-Brain, RWTH Aachen University, Aachen, Germany; Jülich-Aachen Research Alliance (JARA)-Translational Brain Medicine, Jülich, Aachen, Germany
| | - Pegah Sarkheil
- Department of Psychiatry, Psychotherapy and Psychosomatics, Jülich-Aachen Research Alliance (JARA)-Brain, RWTH Aachen University, Aachen, Germany; Jülich-Aachen Research Alliance (JARA)-Translational Brain Medicine, Jülich, Aachen, Germany
| | - Yury Koush
- Institute of Bioengineering, Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland; Department of Radiology and Medical Informatics, University of Geneva, Geneva, Switzerland
| | - Eliza M Alawi
- Department of Psychiatry, Psychotherapy and Psychosomatics, Jülich-Aachen Research Alliance (JARA)-Brain, RWTH Aachen University, Aachen, Germany; Jülich-Aachen Research Alliance (JARA)-Translational Brain Medicine, Jülich, Aachen, Germany
| | - Mikhail Zvyagintsev
- Department of Psychiatry, Psychotherapy and Psychosomatics, Jülich-Aachen Research Alliance (JARA)-Brain, RWTH Aachen University, Aachen, Germany; Jülich-Aachen Research Alliance (JARA)-Translational Brain Medicine, Jülich, Aachen, Germany
| | - Arnim J Gaebler
- Department of Psychiatry, Psychotherapy and Psychosomatics, Jülich-Aachen Research Alliance (JARA)-Brain, RWTH Aachen University, Aachen, Germany; Jülich-Aachen Research Alliance (JARA)-Translational Brain Medicine, Jülich, Aachen, Germany
| | - Sukhi S Shergill
- Institute of Psychiatry, Psychology and Neuroscience, King's College London , London , UK
| | - Klaus Mathiak
- Department of Psychiatry, Psychotherapy and Psychosomatics, Jülich-Aachen Research Alliance (JARA)-Brain, RWTH Aachen University, Aachen, Germany; Jülich-Aachen Research Alliance (JARA)-Translational Brain Medicine, Jülich, Aachen, Germany; Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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Fovet T, Orlov N, Dyck M, Allen P, Mathiak K, Jardri R. Translating Neurocognitive Models of Auditory-Verbal Hallucinations into Therapy: Using Real-time fMRI-Neurofeedback to Treat Voices. Front Psychiatry 2016; 7:103. [PMID: 27445865 PMCID: PMC4921472 DOI: 10.3389/fpsyt.2016.00103] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Accepted: 05/31/2016] [Indexed: 12/31/2022] Open
Abstract
Auditory-verbal hallucinations (AVHs) are frequent and disabling symptoms, which can be refractory to conventional psychopharmacological treatment in more than 25% of the cases. Recent advances in brain imaging allow for a better understanding of the neural underpinnings of AVHs. These findings strengthened transdiagnostic neurocognitive models that characterize these frequent and disabling experiences. At the same time, technical improvements in real-time functional magnetic resonance imaging (fMRI) enabled the development of innovative and non-invasive methods with the potential to relieve psychiatric symptoms, such as fMRI-based neurofeedback (fMRI-NF). During fMRI-NF, brain activity is measured and fed back in real time to the participant in order to help subjects to progressively achieve voluntary control over their own neural activity. Precisely defining the target brain area/network(s) appears critical in fMRI-NF protocols. After reviewing the available neurocognitive models for AVHs, we elaborate on how recent findings in the field may help to develop strong a priori strategies for fMRI-NF target localization. The first approach relies on imaging-based "trait markers" (i.e., persistent traits or vulnerability markers that can also be detected in the presymptomatic and remitted phases of AVHs). The goal of such strategies is to target areas that show aberrant activations during AVHs or are known to be involved in compensatory activation (or resilience processes). Brain regions, from which the NF signal is derived, can be based on structural MRI and neurocognitive knowledge, or functional MRI information collected during specific cognitive tasks. Because hallucinations are acute and intrusive symptoms, a second strategy focuses more on "state markers." In this case, the signal of interest relies on fMRI capture of the neural networks exhibiting increased activity during AVHs occurrences, by means of multivariate pattern recognition methods. The fine-grained activity patterns concomitant to hallucinations can then be fed back to the patients for therapeutic purpose. Considering the potential cost necessary to implement fMRI-NF, proof-of-concept studies are urgently required to define the optimal strategy for application in patients with AVHs. This technique has the potential to establish a new brain imaging-guided psychotherapy for patients that do not respond to conventional treatments and take functional neuroimaging to therapeutic applications.
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Affiliation(s)
- Thomas Fovet
- Univ Lille, CNRS, UMR-9193, psyCHIC team & CHU Lille, Psychiatry Dpt (CURE), Fontan Hospital , Lille , France
| | - Natasza Orlov
- Department of Psychosis Studies, Institute of Psychiatry Psychology and Neuroscience, King's College London , London , UK
| | - Miriam Dyck
- Department of Psychiatry, Psychotherapy and Psychosomatics, JARA-Brain, RWTH Aachen University , Aachen , Germany
| | - Paul Allen
- Department of Psychosis Studies, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK; Department of Psychology, University of Roehampton, London, UK
| | - Klaus Mathiak
- Department of Psychiatry, Psychotherapy and Psychosomatics, JARA-Brain, RWTH Aachen University , Aachen , Germany
| | - Renaud Jardri
- Univ Lille, CNRS, UMR-9193, psyCHIC team & CHU Lille, Psychiatry Dpt (CURE), Fontan Hospital , Lille , France
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