Abstract
Affective disorders are associated with maladaptive emotion regulation strategies. In particular, the left more than the right ventrolateral prefrontal cortex (vlPFC) may insufficiently regulate emotion processing, e.g., in the amygdala. A double-blind cross-over study investigated NF-supported cognitive reappraisal training in major depression (n = 42) and age- and gender-matched controls (n = 39). In a randomized order, participants trained to upregulate either the left or the right vlPFC during cognitive reappraisal of negative images on two separate days. We wanted to confirm regional specific NF effects with improved learning for left compared to right vlPFC (ClinicalTrials.gov NCT03183947). Brain responses and connectivity were studied with respect to training progress, gender, and clinical outcomes in a 4-week follow-up. Increase of vlPFC activity was stronger after NF training from the left- than the right-hemispheric ROI. This regional-specific NF effect during cognitive reappraisal was present across patients with depression and controls and supports a central role of the left vlPFC for cognitive reappraisal. Further, the activity in the left target region was associated with increased use of cognitive reappraisal strategies (r = 0.48). In the 4-week follow-up, 75% of patients with depression reported a successful application of learned strategies in everyday life and 55% a clinically meaningful symptom improvement suggesting clinical usability.
Highlights
In everyday life we are frequently challenged by situations that evoke negative emotions
RtfMRI-NF is a novel technique by which individuals with psychiatric disorders can learn to voluntarily self-regulate their brain signal in areas amongst others involved in the neural circuitry of emotion regulation and thereby induce changes in neural plasticity [9,10,11,12,13]
Our findings support a central role of the left ventrolateral prefrontal cortex (vlPFC) for the process of cognitive reappraisal
Summary
In everyday life we are frequently challenged by situations that evoke negative emotions. Increased selective attention and fMRI Neurofeedback-Enhanced Reappraisal Training processing of negative mood-congruent stimuli as well as maladaptive emotional responses may propel the development and recurrence of depressive episodes [2,3,4]. A recent metaanalysis indicates that patients with depression show abnormal recruitment of the emotion regulation brain network during cognitive reappraisal of negative images [5]. A recent study by [8] has shown that even a single session of real-time functional magnetic imaging neurofeedback (rtfMRI-NF) could enhance the transfer of skills learned by patients with depression during CBT to real-world situations. Providing NF can inform neuroscience-based interventions for emotion dysregulation and may offer a more specific clinical tool for augmenting selfregulation in patients with depression by strengthening the monitoring within the emotion regulation process [7, 14]
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