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Targeting the affective brain - a randomized controlled trial of real-time fMRI neurofeedback in patients with depression

Mehler, David M. A., Sokunbi, Moses O., Habes, Isabelle, Barawi, Kali, Subramanian, Leena, Range, Maxence, Evans, John, Hood, Kerenza ORCID:, Lührs, Michael, Keedwell, Paul, Goebel, Rainer and Linden, David E. J. ORCID: 2018. Targeting the affective brain - a randomized controlled trial of real-time fMRI neurofeedback in patients with depression. Neuropsychopharmacology 43 , pp. 2578-2585. 10.1038/s41386-018-0126-5

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Functional magnetic resonance imaging neurofeedback (fMRI-NF) training of areas involved in emotion processing can reduce depressive symptoms by over 40% on the Hamilton Depression Rating Scale (HDRS). However, it remains unclear if this efficacy is specific to feedback from emotion-regulating regions. We tested in a single-blind, randomized, controlled trial if upregulation of emotion areas (NFE) yields superior efficacy compared to upregulation of a control region activated by visual scenes (NFS). Forty-three moderately to severely depressed medicated patients were randomly assigned to five sessions augmentation treatment of either NFE or NFS training. At primary outcome (week 12) no significant group mean HDRS difference was found (B = −0.415 [95% CI −4.847 to 4.016], p = 0.848) for the 32 completers (16 per group). However, across groups depressive symptoms decreased by 43%, and 38% of patients remitted. These improvements lasted until follow-up (week 18). Both groups upregulated target regions to a similar extent. Further, clinical improvement was correlated with an increase in self-efficacy scores. However, the interpretation of clinical improvements remains limited due to lack of a sham-control group. We thus surveyed effects reported for accepted augmentation therapies in depression. Data indicated that our findings exceed expected regression to the mean and placebo effects that have been reported for drug trials and other sham-controlled high-technology interventions. Taken together, we suggest that the experience of successful self-regulation during fMRI-NF training may be therapeutic. We conclude that if fMRI-NF is effective for depression, self-regulation training of higher visual areas may provide an effective alternative.

Item Type: Article
Date Type: Publication
Status: Published
Schools: Medicine
MRC Centre for Neuropsychiatric Genetics and Genomics (CNGG)
Cardiff University Brain Research Imaging Centre (CUBRIC)
Publisher: Nature Publishing Group
ISSN: 0893-133X
Funders: Medical Research Council
Date of First Compliant Deposit: 16 July 2018
Date of Acceptance: 12 June 2018
Last Modified: 01 Oct 2023 00:17

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