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Real-time self-regulation of emotion networks in patients with depression.

Linden DE, Habes I, Johnston SJ, Linden S, Tatineni R, Subramanian L, Sorger B, Healy D, Goebel R - PLoS ONE (2012)

Bottom Line: In a proof-of-concept study, eight patients with depression learned to upregulate brain areas involved in the generation of positive emotions (such as the ventrolateral prefrontal cortex (VLPFC) and insula) during four neurofeedback sessions.Their clinical symptoms, as assessed with the 17-item Hamilton Rating Scale for Depression (HDRS), improved significantly.A control group that underwent a training procedure with the same cognitive strategies but without neurofeedback did not improve clinically.

View Article: PubMed Central - PubMed

Affiliation: Institute of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, Cardiff, United Kingdom. LindenD@cardiff.ac.uk

ABSTRACT
Many patients show no or incomplete responses to current pharmacological or psychological therapies for depression. Here we explored the feasibility of a new brain self-regulation technique that integrates psychological and neurobiological approaches through neurofeedback with functional magnetic resonance imaging (fMRI). In a proof-of-concept study, eight patients with depression learned to upregulate brain areas involved in the generation of positive emotions (such as the ventrolateral prefrontal cortex (VLPFC) and insula) during four neurofeedback sessions. Their clinical symptoms, as assessed with the 17-item Hamilton Rating Scale for Depression (HDRS), improved significantly. A control group that underwent a training procedure with the same cognitive strategies but without neurofeedback did not improve clinically. Randomised blinded clinical trials are now needed to exclude possible placebo effects and to determine whether fMRI-based neurofeedback might become a useful adjunct to current therapies for depression.

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Neurofeedback produced clinical improvement that was not seen in the control group.Patients in the neurofeedback (NF) treatment group, but not those in the imagery (IM) control group, improved significantly on the 17-item Hamilton Depression Rating scale, a standard clinical measure of depression severity and treatment effects. Lower values denote clinical improvement (error bars: standard errors).
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pone-0038115-g003: Neurofeedback produced clinical improvement that was not seen in the control group.Patients in the neurofeedback (NF) treatment group, but not those in the imagery (IM) control group, improved significantly on the 17-item Hamilton Depression Rating scale, a standard clinical measure of depression severity and treatment effects. Lower values denote clinical improvement (error bars: standard errors).

Mentions: The NF group showed significant clinical improvement on the HDRS-17 (Fig. 3). A repeated-measures ANOVA with the factors Time (pre/post-intervention) and Group (NF/IM) yielded a significant interaction (F[1], [14] = 10.15, p = 007). To rule out an effect of gender imbalance across groups the same analysis was repeated with the factor Gender included as covariate, and similar results were obtained (F[1], [13] = 9.36, p = 009). The HDRS-17 scores of patients in the NF group decreased significantly (4.13 points (SD = 2.75) from a mean of 14.38 to 10.25, t(7) = 4.24, p = .004), but the change in the IM group (from 13.88 to 14.88) was not significant, t(7) = −0.78, p = 46). The effect size (Cohen’s d) of the improvement from treatment in the NF group was 1.5. Before the intervention, all patients had scores >8, but after the intervention, two of the NF patients had remitted (HDRS-17<8 [26]), and three additional NF patients (and one patient in the IM group) had scores of 8, thus fulfilling the criterion used in CBT trials for full treatment response [27]. Whereas clinical improvement was confined to the NF group, both groups showed within-session improvement in current mood on the POMS. This effect was supported by a significant intercept in a 2-way repeated-measures ANOVA performed on the difference scores (F[1], [14] = 21.7, p<001). After correcting for Gender and TMD baseline (TMD pre-test session 4– session 1) no significant effects (ps>1) were found apart from a significant Session x TMD baseline interaction (F[3], [36] = 6.60, p = 001), indicating that the size of TMD improvement decreased over sessions and with reduced TMD baseline scores. On PANAS NA difference scores, the NF group was significantly lower than the IM group (F[1], [14] = 16.18, p<001), indicating that the NF group decreased their NA scores more than the IM group. However, neither the Session effect nor the Group x Session interaction was significant (ps>7). The inclusion of Gender and PANAS NA baseline (PANAS NA pre-test session 4– session 1) as covariates did not alter any of these results (Group effect (F[1], [12] = 17.95, p = 001), Session effect (ps>4), Group x Session interaction (ps>5)). A significant interaction was found between Session and PANAS NA baseline (F[3], [36] = 13.66, p<001). An ANOVA yielded no significant effects for the PA scores (ps>2), and adding Gender and PANAS PA baseline (PANAS PA pre-test session 4– session 1) as covariates only returned a significant Session x PANAS PA baseline interaction (F[3], [36] = 40.29, p<001).


Real-time self-regulation of emotion networks in patients with depression.

Linden DE, Habes I, Johnston SJ, Linden S, Tatineni R, Subramanian L, Sorger B, Healy D, Goebel R - PLoS ONE (2012)

Neurofeedback produced clinical improvement that was not seen in the control group.Patients in the neurofeedback (NF) treatment group, but not those in the imagery (IM) control group, improved significantly on the 17-item Hamilton Depression Rating scale, a standard clinical measure of depression severity and treatment effects. Lower values denote clinical improvement (error bars: standard errors).
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Related In: Results  -  Collection

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getmorefigures.php?uid=PMC3366978&req=5

pone-0038115-g003: Neurofeedback produced clinical improvement that was not seen in the control group.Patients in the neurofeedback (NF) treatment group, but not those in the imagery (IM) control group, improved significantly on the 17-item Hamilton Depression Rating scale, a standard clinical measure of depression severity and treatment effects. Lower values denote clinical improvement (error bars: standard errors).
Mentions: The NF group showed significant clinical improvement on the HDRS-17 (Fig. 3). A repeated-measures ANOVA with the factors Time (pre/post-intervention) and Group (NF/IM) yielded a significant interaction (F[1], [14] = 10.15, p = 007). To rule out an effect of gender imbalance across groups the same analysis was repeated with the factor Gender included as covariate, and similar results were obtained (F[1], [13] = 9.36, p = 009). The HDRS-17 scores of patients in the NF group decreased significantly (4.13 points (SD = 2.75) from a mean of 14.38 to 10.25, t(7) = 4.24, p = .004), but the change in the IM group (from 13.88 to 14.88) was not significant, t(7) = −0.78, p = 46). The effect size (Cohen’s d) of the improvement from treatment in the NF group was 1.5. Before the intervention, all patients had scores >8, but after the intervention, two of the NF patients had remitted (HDRS-17<8 [26]), and three additional NF patients (and one patient in the IM group) had scores of 8, thus fulfilling the criterion used in CBT trials for full treatment response [27]. Whereas clinical improvement was confined to the NF group, both groups showed within-session improvement in current mood on the POMS. This effect was supported by a significant intercept in a 2-way repeated-measures ANOVA performed on the difference scores (F[1], [14] = 21.7, p<001). After correcting for Gender and TMD baseline (TMD pre-test session 4– session 1) no significant effects (ps>1) were found apart from a significant Session x TMD baseline interaction (F[3], [36] = 6.60, p = 001), indicating that the size of TMD improvement decreased over sessions and with reduced TMD baseline scores. On PANAS NA difference scores, the NF group was significantly lower than the IM group (F[1], [14] = 16.18, p<001), indicating that the NF group decreased their NA scores more than the IM group. However, neither the Session effect nor the Group x Session interaction was significant (ps>7). The inclusion of Gender and PANAS NA baseline (PANAS NA pre-test session 4– session 1) as covariates did not alter any of these results (Group effect (F[1], [12] = 17.95, p = 001), Session effect (ps>4), Group x Session interaction (ps>5)). A significant interaction was found between Session and PANAS NA baseline (F[3], [36] = 13.66, p<001). An ANOVA yielded no significant effects for the PA scores (ps>2), and adding Gender and PANAS PA baseline (PANAS PA pre-test session 4– session 1) as covariates only returned a significant Session x PANAS PA baseline interaction (F[3], [36] = 40.29, p<001).

Bottom Line: In a proof-of-concept study, eight patients with depression learned to upregulate brain areas involved in the generation of positive emotions (such as the ventrolateral prefrontal cortex (VLPFC) and insula) during four neurofeedback sessions.Their clinical symptoms, as assessed with the 17-item Hamilton Rating Scale for Depression (HDRS), improved significantly.A control group that underwent a training procedure with the same cognitive strategies but without neurofeedback did not improve clinically.

View Article: PubMed Central - PubMed

Affiliation: Institute of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, Cardiff, United Kingdom. LindenD@cardiff.ac.uk

ABSTRACT
Many patients show no or incomplete responses to current pharmacological or psychological therapies for depression. Here we explored the feasibility of a new brain self-regulation technique that integrates psychological and neurobiological approaches through neurofeedback with functional magnetic resonance imaging (fMRI). In a proof-of-concept study, eight patients with depression learned to upregulate brain areas involved in the generation of positive emotions (such as the ventrolateral prefrontal cortex (VLPFC) and insula) during four neurofeedback sessions. Their clinical symptoms, as assessed with the 17-item Hamilton Rating Scale for Depression (HDRS), improved significantly. A control group that underwent a training procedure with the same cognitive strategies but without neurofeedback did not improve clinically. Randomised blinded clinical trials are now needed to exclude possible placebo effects and to determine whether fMRI-based neurofeedback might become a useful adjunct to current therapies for depression.

Show MeSH
Related in: MedlinePlus