Abstract
BackgroundAmygdala 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). MethodsFifty-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. ResultsPatients 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. ConclusionsThis 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.
Highlights
Post-Traumatic Stress Disorder (PTSD), is a chronic and debilitating condition (Benjet, 2016; Karam, 2014), affecting approximately 15% of trauma-exposed individuals (Breslau et al, 1991; Santiago et al, 2013)
Learned Amygdala Electrical Finger-Print (AmygEFP) regulation was tested by a patient-repeatedmeasurements nested mixed-model analysis: Fixed effects of Group (Neutral-NF, Trauma-NF) and Time (13 weekly training sessions) and Group by Time interaction were fitted
This study introduced a personalized and scalable process-based NF intervention for post-traumatic stress disorder (PTSD), aimed at amygdala down-regulation in PTSD patients
Summary
Post-Traumatic Stress Disorder (PTSD), is a chronic and debilitating condition (Benjet, 2016; Karam, 2014), affecting approximately 15% of trauma-exposed individuals (Breslau et al, 1991; Santiago et al, 2013). Learning to regu late one’s own amygdala activity may minimize detrimental processes and facilitate recovery ones. Such regulation of amygdala activity could be obtained volitionally via a closed-loop brain-computer-interface guided procedure of reinforcement learning termed fMRIneurofeedback (fMRI-NF) (Young, 2017; Paret et al, 2014; Paret et al, 2016; Zotev et al, 2011; Herwig et al, 2019; Sitaram, 2017). 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. Further investigation is warranted to elucidate the contribution of AmygEFP-NF beyond exposure and placebo effects
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