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 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 = .54) alongside an attenuation of amygdala responses (d = .33) emerged. Reduced amygdala responses during NF were associated with symptom improvement (r = -.42) and less negative affect (r = -.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 = .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.

中文翻译：

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Rt-fM​​RI 神经反馈引导的认知重评训练调节创伤后应激障碍中的杏仁核反应性

背景

创伤经历与情绪调节回路关键区域的神经功能失调有关。特别是，杏仁核对负面刺激的反应被夸大了，而前额叶调节控制区域的参与被削弱了。情绪调节 (ER) 策略的成功应用可能会抵消这种不平衡，但是，在受创伤后应激障碍 (PTSD) 折磨的个体中，在日常生活中应用学习策略会受到阻碍。我们假设，在情绪调节任务期间，单次实时功能磁共振成像 (rtfMRI) 引导前额叶区域上调可增强暴露于负面刺激期间的自我控制，并有助于将学习到的 ER 技能转移到日常生活中。

方法

在交叉设计中，根据 DSM-IV-TR 标准在单次创伤事件后诊断为 PTSD 的个体 (n = 20) 和没有正式精神病诊断的个体 (n = 21) 接受了认知重新评估培训。以随机顺序，所有参与者完成了两次针对左侧前额叶皮层 (lPFC) 的 rtfMRI 神经反馈 (NF) 运行和两次没有 NF (NoNF) 的对照运行，同时使用认知重新评估来减少他们对负面场景的情绪反应。在 NoNF 运行期间，显示两个 %% 符号而不是两位数 FB，以实现可比的视觉刺激。该项目旨在根据三个成功标志来定义培训的临床潜力：

结果

与没有反馈的重新评估相比，出现了左侧 PFC ( d = .54) 的神经反馈特异性降低以及杏仁核反应的衰减 ( d = .33)。NF 期间杏仁核反应减少与随访时症状改善 ( r = -.42) 和负面影响减少 ( r = -.63) 相关。症状评分的差异超过了最小临床重要差异的要求，对应于中等效应量 ( d = .64)。重要的是，75% 的 PTSD 患者在为期一个月的随访期间在日常生活中使用了这些策略，并认为培训是有效的。

结论

我们的研究结果表明 NF 训练的有益效果表现为杏仁核反应减少，这与 NF 训练后 4 周症状严重程度和情感状态的改善以及训练期间以患者为中心的感知控制、帮助和日常生活中策略的应用有关. 然而，前额叶受累减少是出乎意料的。该研究表明训练方案的良好耐受性和临床用于治疗 PTSD 的潜力。