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

Zhiying Zhao, Shuxia Yao, Keshuang Li, Cornelia Sindermann, Feng Zhou, Weihua Zhao, Jianfu Li, Michael Luhrs, Rainer Goebel, Keith M. Kendrick, Benjamin Becker*

*Corresponding author for this work

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Abstract

Background: Deficient emotion regulation and exaggerated anxiety represent a major transdiagnostic psychopathological marker. On the neural level these deficits have been closely linked to impaired, yet treatment-sensitive, prefrontal regulatory control over the amygdala. Gaining direct control over these pathways could therefore provide an innovative and promising intervention to regulate exaggerated anxiety. To this end the current proof-of-concept study evaluated the feasibility, functional relevance and maintenance of a novel connectivity-informed real-time fMRI neurofeedback training. Methods: In a randomized crossover sham-controlled design, 26 healthy subjects with high anxiety underwent real-time fMRI-guided neurofeedback training to enhance connectivity between the ventrolateral prefrontal cortex (vlPFC) and the amygdala (target pathway) during threat exposure. Maintenance of regulatory control was assessed after 3 days and in the absence of feedback. Training-induced changes in functional connectivity of the target pathway and anxiety ratings served as primary outcomes. Results: Training of the target, yet not the sham control, pathway significantly increased amygdala-vlPFC connectivity and decreased levels of anxiety. Stronger connectivity increases were significantly associated with higher anxiety reduction on the group level. At the follow-up, volitional control over the target pathway was maintained in the absence of feedback. Conclusions: The present results demonstrate for the first time that successful self-regulation of amygdala-prefrontal top-down regulatory circuits may represent a novel intervention to control anxiety. As such, the present findings underscore both the critical contribution of amygdala-prefrontal circuits to emotion regulation and the therapeutic potential of connectivity-informed real-time neurofeedback. (C) 2019 S. Karger AG, Basel

Original languageEnglish
Pages (from-to)5-15
Number of pages11
JournalPsychotherapy and Psychosomatics
Volume88
Issue number1
DOIs
Publication statusPublished - 2019

Keywords

  • Emotion regulation
  • Real-time neurofeedback
  • Anxiety
  • Amygdala
  • Connectivity
  • Anxiolytic treatment
  • Prefrontal cortex
  • Treatment
  • Functional magnetic resonance imaging
  • Network
  • POSTTRAUMATIC-STRESS-DISORDER
  • COGNITIVE-BEHAVIORAL THERAPY
  • FMRI-BASED NEUROFEEDBACK
  • EMOTION-REGULATION
  • SOCIAL ANXIETY
  • SELF-REGULATION
  • BRAIN
  • MODULATION
  • NETWORKS
  • METAANALYSIS

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