Poster No:
351
Submission Type:
Abstract Submission
Authors:
Zhiying Zhao1, Mariela Rance2, Brian Zaboski2, Stephen Kichuk2, Emma Romaker2, William Koller2, Christopher Walsh2, Cheyenne Harris-Starling2, Suzanne Wasylink2, Thomas Adams2, Patricia Gruner2, Christopher Pittenger2, Michelle Hampson2
Institutions:
1University of Macau, Taipa, Macau, 2Yale University School of Medicine, New Haven, CT
First Author:
Co-Author(s):
Emma Romaker
Yale University School of Medicine
New Haven, CT
Thomas Adams
Yale University School of Medicine
New Haven, CT
Introduction:
Obsessive-compulsive disorder (OCD) is characterized by hyperactivity in cortico-striatal circuitry. This hyperactivity is reduced in parallel with symptom improvement after both psychotherapy and pharmacotherapy,1 particularly in the ventral frontal cortex. Thus, we are exploring whether training this region via neurofeedback can provide therapeutic benefit. We developed a neurofeedback intervention2 that proved promising in a subclinical population,3 and here describe it's application in an OCD clinical trial.
Methods:
Participants: Individuals with OCD with primary symptom dimensions of checking or contamination (ages 18-65) were recruited through the Yale OCD Research Clinic (ocd.yale.edu). No treatment or a stable (>8 weeks) regimen of SSRIs or maintenance therapy were allowed. 36 participants were randomized (18 per group).
Protocol: This randomized, double-blind trial (NCT02206945) followed methods previously described.2,3 The Yale-Brown Obsessive Compulsive Symptom Scale4,5 was collected before training and half a week, two weeks and one month after training. The scanning protocol involved four sessions. First, a baseline session to assess resting connectivity patterns and control over the target region during exposure to provocative images, followed by two feedback training sessions (real or yoked sham, depending on group), and a post-intervention assessment session to re-assess connectivity patterns and control over the target region after training.
Results:
There were significant differences between groups in symptom change, with the neurofeedback group showing greater symptom improvement than the sham group, but the symptom changes induced by neurofeedback were too small to be clinically meaningful. Control over the brain area did not improve differentially for the two groups.
Conclusions:
The improvement in symptoms in the neurofeedback relative to the sham group supports the promise of this intervention but effects must be amplified for clinical utility. Options for optimizing impact will be discussed. The measures of control over the brain area collected pre- and post-training were very noisy, possibly due to idiosyncratic levels of activation to the provocative imagery in participants. Standardized sets of provocative imagery will be replaced by personalized stimuli moving forward.
Brain Stimulation:
Non-Invasive Stimulation Methods Other 2
Disorders of the Nervous System:
Neurodevelopmental/ Early Life (eg. ADHD, autism) 1
Keywords:
FUNCTIONAL MRI
Obessive Compulsive Disorder
Treatment
Other - Neurofeedback
1|2Indicates the priority used for review
Provide references using author date format
1.van der Straten AL, et al. Sci. Rep. 2017;7(1):17464.
2.Hampson M, et al. J Vis Exp. 2012(59).
3.Scheinost D, et al. Transl Psychiatry. 2013;3:e250.
4.Goodman WK, et al. Arch. Gen. Psychiatry. 1989;46(11):1012-1016.
5.Goodman WK, et al. Arch. Gen. Psychiatry. 1989;46(11):1006-1011.