Rt-fMRI neurofeedback-guided cognitive reappraisal training modulates amygdala responsivity in posttraumatic stress disorder

Abstract

Highlights 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.

fMRI Neurofeedback-Enhanced Cognitive Reappraisal Training in Depression: A Double-Blind Comparison of Left and Right vlPFC Regulation

“…Deficient recruitment of prefrontal areas (vlPFC, dlPFC) ( 5 ) and the STG ( 40 ) as seen in patients with depression is in line with dysfunctional attentional and inhibitory capacities. Interestingly, we did not find any effects in the amygdala and therefore could neither replicate the attenuation of amygdala response during reappraisal training found in previous studies ( 70 , 71 ) nor the group difference in terms of increased amygdala response during reappraisal ( 5 ). Accordingly, findings in the current cohort may support a direct pathway hypothesis postulating that reappraisal primarily impacts cortical systems involved in cognitive appraisals and emotional evaluation and only has a minimal impact on subcortical systems ( 41 ).…”

“…During 2 days of NF training, participants trained to regulate their brain signal in the vlPFC using reappraisal strategies in response to negative pictures and guided by intermittent NF (“reappraise > view”). This paradigm has already been applied successfully in healthy individuals ( 70 ) and patients with post-traumatic stress disorder (PTSD) ( 71 ). Overall, the cognitive reappraisal evoked predicted responses within the emotion regulation network such as activations in prefrontal, motor, and subcortical areas.…”

“…The NF task was adapted from our previous study in patients with PTSD ( 71 ) and consisted of 18 blocks of picture presentation (12 s each; see Figure 1B ). The task was either to passively view a picture and to allow spontaneous thoughts and emotions to occur (“view” condition) or to upregulate the BOLD signal in the respective target region by using a cognitive reappraisal strategy to reduce negative feelings associated with the presented picture (“reappraise” condition).…”

“…For instance, Sarkheil et al ( 70 ) showed that attenuation of amygdala responses during emotion regulation training in healthy individuals could be enhanced by receiving feedback from the lateral PFC. In a similar NF-supported emotion regulation paradigm, Zweerings et al ( 71 ) found reduced amygdala responses when receiving NF vs. not receiving NF in patients with posttraumatic stress disorder. Furthermore, the level of amygdala attenuation could be associated with improved symptomatology and negative affect 4 weeks later.…”

“…Based on the reviewed fMRI and EEG literature, we hypothesized that the left compared to right vlPFC may be more important for the emotion regulation process. Therefore, the right vlPFC was chosen as active control condition as it is known to be involved in cognitive reappraisal, however, it is less consistently observed and activation levels tend to be lower ( 37 , 70 , 71 ). An active control condition can circumvent the problem of causing frustration as regulation is expected to be possible in both conditions.…”