fMRI neurofeedback facilitates anxiety regulation in females with spider phobia

Abstract

Background: Spider phobics show an exaggerated fear response when encountering spiders. This fear response is aggravated by negative and irrational beliefs about the feared object. Cognitive reappraisal can target these beliefs, and therefore has a fear regulating effect. The presented study investigated if neurofeedback derived from functional magnetic resonance imaging (fMRI) would facilitate anxiety regulation by cognitive reappraisal, using spider phobia as a model of anxiety disorders. Feedback was provided based on activation in left dorsolateral prefrontal cortex and right insula, as indicators of engagement and regulation success, respectively.Methods: Eighteen female spider phobics participated in a randomized, controlled, single-blinded study. All participants completed a training session in the MRI scanner. Participants assigned to the neurofeedback condition were instructed to shape their regulatory strategy based on the provided feedback. Participants assigned to the control condition were asked to adapt their strategy intuitively.Results: Neurofeedback participants exhibited lower anxiety levels than the control group at the end of the training. In addition, only neurofeedback participants achieved down-regulation of insula activation levels by cognitive reappraisal. Group differences became more pronounced over time, supporting learning as a mechanism behind this effect. Importantly, within the neurofeedback group, achieved changes in insula activation levels during training predicted long-term anxiety reduction.Conclusions: The conducted study provides first evidence that fMRI neurofeedback has a facilitating effect on anxiety regulation in spider phobia.

Real-Time Functional Connectivity-Informed Neurofeedback of Amygdala-Frontal Pathways Reduces Anxiety

“…Within this context, the emergence of real-time functional magnetic resonance imaging neurofeedback (rt-fMRI NF) training (NFT) approaches that allow subjects to gain volitional control over regional brain activity have been considered as a putatively promising strategy [28-30]. Importantly, previous studies have confirmed this potential of rt-fMRI NF by demonstrating that training success in terms of control over regional activity can be maintained beyond the training session [31-34], and that training-induced neural activity changes can modulate emotional experience in healthy subjects [31] and patients with major depression [32-35]. …”

Real‐time fMRI neurofeedback in adolescents with attention deficit hyperactivity disorder

“…Instructions were minimal (i.e., “you can try to concentrate on the rocket” or “try any other method that works for you”) as this has been shown to be more effective than explicit instructions [Sulzer et al, 2013], and instruction‐free approaches are common in EEG‐NF for ADHD children [Gevensleben et al, 2014; Strehl et al, 2006]. However, in rtfMRI‐NF it has been shown that for some regions it appears to make no difference whether instructions are given (e.g., motor regions [Sepulveda et al, 2016]), while explicit instructions may be beneficial for the self‐regulation of specific brain areas (e.g., limbic system [Zilverstand et al, 2015]. They received continuous feedback (every repetition time (TR), i.e., 2 s), about their brain activation in their target region of interest (ROI) via the rocket video‐clip, with the direction and distance travelled in space proportional to their BOLD response.…”

“…Studies in psychiatric/neurological disorders highlight the clinical potential of rtfMRI‐NF [Thibault et al, 2015, 2016], showing generalization to NF‐free transfer runs and longer‐term beneficial effects of up to several months [Zilverstand et al, 2015]. Importantly, by learning to self‐upregulate isolated regions, participants learn to co‐regulate other areas interconnected with the target region, suggesting modulation of entire networks [Emmert et al, 2016; Thibault et al, 2016].…”

The self-regulating brain and neurofeedback: Experimental science and clinical promise

“…Interestingly, looking across experiments we find many cases of distinct protocols encouraging regulation in opposing directions. For example, many experiments train participants to up-regulate anterior insular activity to increase valence ratings (Caria, Sitaram, Veit, Begliomini, & Birbaumer, 2010;Lawrence et al, 2014;Ruiz et al, 2013;Sitaram et al, 2014), while other studies encourage down-regulation to decrease pain perception (Emmert et al, 2014;Rance, Ruttorf, Nees, Rudi Schad, & Flor, 2014) or subdue a phobia (Zilverstand, Sorger, Sarkheil, & Goebel, 2015).…”