Amygdala downregulation training using fMRI neurofeedback in post-traumatic stress disorder
Poster No:
484
Submission Type:
Abstract Submission
Authors:
Zhiying Zhao1, Or Duek2, Rebecca Seidemann2, Charles Gordon2, Christopher Walsh2, Emma Romaker2, William Koller2, Mark Horvath2, Jitendra Awasthi2, Ilan Harpaz-Rotem2, Michelle Hampson2
Institutions:
1University of Macau, Macau, Macau, 2Yale University School of Medicine, New Haven, CT
First Author:
Co-Author(s):
Introduction:
Post-traumatic stress disorder (PSTD) is a psychiatric disorder with a high prevalence worldwide [1]. Recent neuroimaging studies have revealed a relationship between PTSD symptoms and dysregulated amygdala activity and have suggested that normalizing amygdala activity may be therapeutic [2]. We explored whether fMRI NF could improve amygdala regulation by conducting a clinical trial (NCT03574974) in which PTSD patients were trained to down-regulate their amygdala activity following trauma recall.
Methods:
Individuals with PTSD symptoms were recruited and screened through the VA. They were assessed using the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5). Those eligible were assigned to receive either Real or Sham feedback. During three feedback sessions, they were instructed to downregulate the feedback signal after listening to personal trauma scripts. Participants also underwent three additional imaging sessions to assess changes in control over amygdala activity at the following timepoints: baseline, post-NF, and 30 days post-NF. During these sessions, they performed down-regulation after trauma recall in the absence of a feedback signal. This served as our primary measurement for improvement in amygdala activity control.
Results:
25 PTSD patients (14 Real, 11 Sham) completed this randomized, double-blind trial. Although the Real group showed greater improvement in amygdala control than the Sham group at the post-training time point, this difference was not significant. However, at the 30day follow-up time point, the Real group had significantly greater improvement in amygdala control than the Sham group: Cohen's d = 0.986; t17 = 2.146, p = 0.047, two-tailed. Clinical improvements were also qualitatively larger and increased over time in the Real group, although this was not significant.
Conclusions:
In this mechanistic study, we found improved control over amygdala activity after neurofeedback training. Although not significant in this small sample, the clinical changes induced were also promising. These data support the growing literature suggesting that neurofeedback of amygdala activity has therapeutic potential for PTSD [3,4].
Brain Stimulation:
Non-Invasive Stimulation Methods Other 2
Disorders of the Nervous System:
Psychiatric (eg. Depression, Anxiety, Schizophrenia) 1
Keywords:
FUNCTIONAL MRI
Limbic Systems
Psychiatric
Trauma
Treatment
1|2Indicates the priority used for review
·Real group had significantly greater improvement in down-regulating amygdala than the Sham group at 30day follow-up
·Change in CAPS-5 scores
Provide references using author date format
2.Diamond DM, et al. J Neurosci Res. 2016;94(6):437-444.
3.Fruchtman T, et al. PsyArXiv. 2019.
4.Nicholson AA, et al. HBM. 2017;38(1):541-560.