Abstract
Anxiety is a core human emotion but can become pathologically dysregulated. We used functional magnetic resonance imaging (fMRI) neurofeedback (NF) to noninvasively alter patterns of brain connectivity, as measured by resting-state fMRI, and to reduce contamination anxiety. Activity of a region of the orbitofrontal cortex associated with contamination anxiety was measured in real time and provided to subjects with significant but subclinical anxiety as a NF signal, permitting them to learn to modulate the target brain region. NF altered network connectivity of brain regions involved in anxiety regulation: subjects exhibited reduced resting-state connectivity in limbic circuitry and increased connectivity in the dorsolateral prefrontal cortex. NF has been shown to alter brain connectivity in other contexts, but it has been unclear whether these changes persist; critically, we observed changes in connectivity several days after the completion of NF training, demonstrating that such training can lead to lasting modifications of brain functional architecture. Training also increased subjects' control over contamination anxiety several days after the completion of NF training. Changes in resting-state connectivity in the target orbitofrontal region correlated with these improvements in anxiety. Matched subjects undergoing a sham feedback control task showed neither a reorganization of resting-state functional connectivity nor an improvement in anxiety. These data suggest that NF can enable enhanced control over anxiety by persistently reorganizing relevant brain networks and thus support the potential of NF as a clinically useful therapy.
Highlights
Normal and pathological patterns of behavior and thought correspond to the activity of particular brain circuits
We demonstrate that Realtime functional magnetic resonance imaging (rt-fMRI) NF can modulate intrinsic brain connectivity patterns associated with anxiety control, thereby enhancing control over contamination anxiety
These results extend previous applications of rt-fMRI NF in two critical ways
Summary
Normal and pathological patterns of behavior and thought correspond to the activity of particular brain circuits. Interventions that alter patterns of behavior and thought must act on the organization of the underlying circuits; some clinical interventions, such as deep brain stimulation, do so explicitly through anatomically targeted manipulations of brain function.[1] The ability to manipulate targeted brain circuits of relevance to particular behavior patterns in a non-invasive manner would be of immense interest and clinical utility. Contamination anxiety, in particular, is prevalent in the healthy population and is a common symptom in obsessive-compulsive disorder (OCD).[2] Pharmacological and behavioral interventions are widely used in the treatment of anxiety and of OCD, but for many individuals these are of little efficacy or are associated with troublesome side effects. Invasive anatomically targeted interventions are sometimes used for OCD and can be effective.[1]
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