Poster No:
547
Submission Type:
Abstract Submission
Authors:
Soo-Eun Lee1, Anna Zilverstand2, Tim Hendrickson2, Kelsey Hagan1, Bryon Mueller2, Carol Peterson2, Ann Haynos1
Institutions:
1Virginia Commonwealth University, Richmond, VA, 2University of Minnesota, Minneapolis, MN
First Author:
Soo-Eun Lee
Virginia Commonwealth University
Richmond, VA
Co-Author(s):
Ann Haynos
Virginia Commonwealth University
Richmond, VA
Introduction:
Anorexia nervosa (AN) is a serious eating disorder characterized by emotion regulation difficulties and excessive self-control (Haynos & Fruzzetti, 2011; Pauligk et al., 2021). Real-time fMRI neurofeedback (rt-fMRI NF) is a novel brain-based tool that allows individuals to view and purposefully alter their neural activity, thus improving their emotion regulation skills (Emmert et al., 2016). Our group conducted a study comparing the effects of rt-fMRI NF targeting amygdala downregulation to sham feedback on emotion regulation and eating pathology among individuals with AN. In our previous findings, participants receiving rt-fMRI NF did not differ from sham feedback group in amygdala regulation but demonstrated less DLPFC engagement when instructed to regulate emotions. Further, the rt-fMRI NF group exhibited a linear pattern of decreasing negative affect, whereas the sham group exhibited a quadratic pattern of negative affect that initially declined and then later rebounded. Following these previous results, the current study explored the clinical implications of regional brain activity patterns in both groups. Specifically, we observed whether increased DLPFC activity in the sham group might signify a momentarily effective, but ultimately dysfunctional strategy for regulating emotions in individuals with AN.
Methods:
Participants with acute or weight-restored AN (n=23) were randomized to participate in rt-fMRI neurofeedback (n=11) or a sham condition (n=12) and completed one or two scanning sessions. During fMRI sessions, participants engaged in an emotion regulation task which presented with negative pictures and instructed to either 1) regulate their emotional responses (regulate condition) or 2) simply view the images (view condition). In the regulate condition, NF participants received real-time feedback for their amygdala activation, while the sham group received non-contingent feedback linked to previous participants' activation patterns. Before and after the scans, participants completed self-reported assessments measuring positive and negative affect (PANAS), emotion dysregulation (S-DERS), state-trait anxiety (STAI), and eating disorders symptoms (CHEDS). Pearson's correlation analysis was employed to examine the relationship between DLPFC brain activity and these clinical variables both before (time 1) and after (time 2) the initial fMRI scan.
Results:
In the sham group, increased activation in the right DLPFC during the regulate condition was significantly correlated with lower emotion dysregulation (r= -0.664, p= .013) and anxiety (r= -0.752, p= .003) at time 1 and lower anxiety at time 2 (r= -0.780, p= .002). Notably, there were no significant correlations between DLPFC activation and clinical variables observed for the NF group (ps > .05), suggesting that the consistent decrease in negative affect previously observed in the NF group likely involves different neural and psychological mechanisms than those associated with DLPFC activity and associated cognitive control.
Conclusions:
Individuals with AN demonstrate an inclination toward excessive control over their negative emotions (Pauligk et al., 2021). Our findings for the sham group align with this pattern, suggesting that the tendency toward over-control (i.e., heightened engagement of the DLPFC) may yield short-term effects. However, based on our prior findings demonstrating a subsequent rebound of negative affect in the sham group, the positive short-term effects of cognitive control in AN may lead to longer-term negative consequences. Conversely, rt-fMRI NF targeting down-regulation of the amygdala appears to divert individuals from employing their typical over-control strategy of involving the DLPFC and may introduce alternative emotion regulation mechanisms, such as enhancing emotional or interoceptive awareness. Future studies should further investigate how neurofeedback introduces alternative mechanisms for emotion regulation and their potential efficacy for individuals with AN.
Disorders of the Nervous System:
Psychiatric (eg. Depression, Anxiety, Schizophrenia) 1
Higher Cognitive Functions:
Executive Function, Cognitive Control and Decision Making
Novel Imaging Acquisition Methods:
BOLD fMRI 2
Keywords:
Eating Disorders
Emotions
FUNCTIONAL MRI
Psychiatric Disorders
Other - Neurofeedback
1|2Indicates the priority used for review
Provide references using author date format
Emmert, K., Kopel, R., Sulzer, J., Brühl, A. B., Berman, B. D., Linden, D. E., Horovitz, S. G., Breimhorst, M., Caria, A., & Frank, S. (2016). Meta-analysis of real-time fMRI neurofeedback studies using individual participant data: How is brain regulation mediated? Neuroimage, 124, 806-812.
Haynos, A. F., & Fruzzetti, A. E. (2011). Anorexia nervosa as a disorder of emotion dysregulation: Evidence and treatment implications. Clinical Psychology: Science and Practice, 18(3), 183.
Pauligk, S., Seidel, M., Fürtjes, S., King, J. A., Geisler, D., Hellerhoff, I., Roessner, V., Schmidt, U., Goschke, T., & Walter, H. (2021). The costs of over-control in anorexia nervosa: evidence from fMRI and ecological momentary assessment. Translational Psychiatry, 11(1), 304.