Background

Amygdala activity dysregulation plays a central role in post-traumatic stress disorder (PTSD). Hence learning to self-regulate one's amygdala activity may facilitate recovery. PTSD is further characterized by abnormal contextual processing related to the traumatic memory. Therefore, provoking the personal traumatic narrative while training amygdala down-regulation could enhance clinical efficacy. We report the results of a randomized controlled trial (NCT02544971) of a novel self-neuromodulation procedure (i.e. NeuroFeedback) for PTSD, aimed at down-regulating limbic activity while receiving feedback from an auditory script of a personal traumatic narrative. To scale-up applicability, neural activity was probed by an fMRI-informed EEG model of amygdala activity, termed Amygdala Electrical Finger-Print (AmygEFP).

Methods

Fifty-nine adults meeting DSM-5 criteria for PTSD were randomized between three groups: Trauma-script feedback interface (Trauma-NF) or Neutral feedback interface (Neutral-NF), and a control group of No-NF (to control for spontaneous recovery). Before and immediately after 15 NF training sessions patients were blindly assessed for PTSD symptoms and underwent one session of amygdala fMRI-NF for transferability testing. Follow-up clinical assessment was performed at 3- and 6-months following NF treatment.

Results

Patients in both NF groups learned to volitionally down-regulate AmygEFP signal and demonstrated a greater reduction in PTSD symptoms and improved down-regulation of the amygdala during fMRI-NF, compared to the No-NF group. The Trauma-NF group presented the largest immediate clinical improvement.

Conclusions

This proof-of-concept study indicates the feasibility of the AmygEFP-NF process-driven as a scalable intervention for PTSD and illustrates its clinical potential. Further investigation is warranted to elucidate the contribution of AmygEFP-NF beyond exposure and placebo effects.

中文翻译：

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杏仁核电指纹 (AmygEFP) 神经反馈由针对创伤后应激障碍的个体定制的创伤脚本引导：概念验证

背景

杏仁核活动失调在创伤后应激障碍 (PTSD) 中起着核心作用。因此，学习自我调节杏仁核活动可能有助于恢复。PTSD的进一步特征是与创伤记忆相关的异常上下文处理。因此，在训练杏仁核下调的同时激发个人创伤性叙述可以提高临床疗效。我们报告了一项针对 PTSD 的新型自我神经调节程序（即 NeuroFeedback）的随机对照试验 (NCT02544971) 的结果，该程序旨在下调边缘活动，同时接收来自个人创伤叙述的听觉脚本的反馈。为了扩大适用性，神经活动由杏仁核活动的功能磁共振脑电图模型探测，称为杏仁核电指纹 (AmygEFP)。

方法

59 名符合 DSM-5 PTSD 标准的成年人被随机分为三组：创伤脚本反馈接口 (Trauma-NF) 或中性反馈接口 (Neutral-NF)，以及无 NF 对照组（控制自发恢复）。在 15 次 NF 培训课程之前和之后，对患者的 PTSD 症状进行盲目评估，并接受一次杏仁核 fMRI-NF 的可转移性测试。在 NF 治疗后 3 个月和 6 个月进行随访临床评估。

结果

与无 NF 组相比，两个 NF 组的患者都学会了主动下调 AmygEFP 信号，并在 fMRI-NF 期间表现出更大程度地减少 PTSD 症状并改善杏仁核的下调。Trauma-NF 组呈现出最大的即时临床改善。

结论

这项概念验证研究表明 AmygEFP-NF 过程驱动作为 PTSD 的可扩展干预措施的可行性，并说明了其临床潜力。有必要进一步调查以阐明 AmygEFP-NF 除了暴露和安慰剂效应之外的贡献。