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Self-Regulation of Anterior Insula with Real-Time fMRI and Its Behavioral Effects in Obsessive-Compulsive Disorder: A Feasibility Study.

Buyukturkoglu K, Roettgers H, Sommer J, Rana M, Dietzsch L, Arikan EB, Veit R, Malekshahi R, Kircher T, Birbaumer N, Sitaram R, Ruiz S - PLoS ONE (2015)

Bottom Line: Obsessive-compulsive disorder (OCD) is a common and chronic condition that can have disabling effects throughout the patient's lifespan.Behavioural changes were also confirmed by reductions in the negative valence and in the subjective perception of disgust towards symptom provoking images.Although preliminary, results of this study confirmed that insula down-regulation is possible in patients suffering from OCD, and that volitional decreases of insula activation could be used for symptom alleviation in this disorder.

View Article: PubMed Central - PubMed

Affiliation: Graduate School of Neural & Behavioural Sciences, International Max Planck Research School, University of Tübingen, Tuebingen, Germany; Institute for Medical Psychology and Behavioural Neurobiology, University of Tuebingen, Tuebingen, Germany.

ABSTRACT

Introduction: Obsessive-compulsive disorder (OCD) is a common and chronic condition that can have disabling effects throughout the patient's lifespan. Frequent symptoms among OCD patients include fear of contamination and washing compulsions. Several studies have shown a link between contamination fears, disgust over-reactivity, and insula activation in OCD. In concordance with the role of insula in disgust processing, new neural models based on neuroimaging studies suggest that abnormally high activations of insula could be implicated in OCD psychopathology, at least in the subgroup of patients with contamination fears and washing compulsions.

Methods: In the current study, we used a Brain Computer Interface (BCI) based on real-time functional magnetic resonance imaging (rtfMRI) to aid OCD patients to achieve down-regulation of the Blood Oxygenation Level Dependent (BOLD) signal in anterior insula. Our first aim was to investigate whether patients with contamination obsessions and washing compulsions can learn to volitionally decrease (down-regulate) activity in the insula in the presence of disgust/anxiety provoking stimuli. Our second aim was to evaluate the effect of down-regulation on clinical, behavioural and physiological changes pertaining to OCD symptoms. Hence, several pre- and post-training measures were performed, i.e., confronting the patient with a disgust/anxiety inducing real-world object (Ecological Disgust Test), and subjective rating and physiological responses (heart rate, skin conductance level) of disgust towards provoking pictures.

Results: Results of this pilot study, performed in 3 patients (2 females), show that OCD patients can gain self-control of the BOLD activity of insula, albeit to different degrees. In two patients positive changes in behaviour in the EDT were observed following the rtfMRI trainings. Behavioural changes were also confirmed by reductions in the negative valence and in the subjective perception of disgust towards symptom provoking images.

Conclusion: Although preliminary, results of this study confirmed that insula down-regulation is possible in patients suffering from OCD, and that volitional decreases of insula activation could be used for symptom alleviation in this disorder.

No MeSH data available.


Related in: MedlinePlus

Differential brain activations during the down-regulation condition in Patient 2 on the first and second days of rtfMRI-neurofeedback training.Colors red-yellow: increased activity on the second day as compared to the first day. Blue-white: decreased activation the second day as compared to the first day. The colored functional maps were overlaid on T1-weighted structural images of four representative axial brain sections covering insula, which is delineated by the green rectangle. Statistical significance was based on z-statistic threshold of -2.3 and 2.3 followed by multiple comparisons correction at the cluster level using Family-Wise Error (FWE) at p < 0.05.
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pone.0135872.g006: Differential brain activations during the down-regulation condition in Patient 2 on the first and second days of rtfMRI-neurofeedback training.Colors red-yellow: increased activity on the second day as compared to the first day. Blue-white: decreased activation the second day as compared to the first day. The colored functional maps were overlaid on T1-weighted structural images of four representative axial brain sections covering insula, which is delineated by the green rectangle. Statistical significance was based on z-statistic threshold of -2.3 and 2.3 followed by multiple comparisons correction at the cluster level using Family-Wise Error (FWE) at p < 0.05.

Mentions: Fig 6 shows comparison of brain activity for the down-regulation condition between the 1st and 2nd days of the rtfMRI-neurofeedback training.


Self-Regulation of Anterior Insula with Real-Time fMRI and Its Behavioral Effects in Obsessive-Compulsive Disorder: A Feasibility Study.

Buyukturkoglu K, Roettgers H, Sommer J, Rana M, Dietzsch L, Arikan EB, Veit R, Malekshahi R, Kircher T, Birbaumer N, Sitaram R, Ruiz S - PLoS ONE (2015)

Differential brain activations during the down-regulation condition in Patient 2 on the first and second days of rtfMRI-neurofeedback training.Colors red-yellow: increased activity on the second day as compared to the first day. Blue-white: decreased activation the second day as compared to the first day. The colored functional maps were overlaid on T1-weighted structural images of four representative axial brain sections covering insula, which is delineated by the green rectangle. Statistical significance was based on z-statistic threshold of -2.3 and 2.3 followed by multiple comparisons correction at the cluster level using Family-Wise Error (FWE) at p < 0.05.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4547706&req=5

pone.0135872.g006: Differential brain activations during the down-regulation condition in Patient 2 on the first and second days of rtfMRI-neurofeedback training.Colors red-yellow: increased activity on the second day as compared to the first day. Blue-white: decreased activation the second day as compared to the first day. The colored functional maps were overlaid on T1-weighted structural images of four representative axial brain sections covering insula, which is delineated by the green rectangle. Statistical significance was based on z-statistic threshold of -2.3 and 2.3 followed by multiple comparisons correction at the cluster level using Family-Wise Error (FWE) at p < 0.05.
Mentions: Fig 6 shows comparison of brain activity for the down-regulation condition between the 1st and 2nd days of the rtfMRI-neurofeedback training.

Bottom Line: Obsessive-compulsive disorder (OCD) is a common and chronic condition that can have disabling effects throughout the patient's lifespan.Behavioural changes were also confirmed by reductions in the negative valence and in the subjective perception of disgust towards symptom provoking images.Although preliminary, results of this study confirmed that insula down-regulation is possible in patients suffering from OCD, and that volitional decreases of insula activation could be used for symptom alleviation in this disorder.

View Article: PubMed Central - PubMed

Affiliation: Graduate School of Neural & Behavioural Sciences, International Max Planck Research School, University of Tübingen, Tuebingen, Germany; Institute for Medical Psychology and Behavioural Neurobiology, University of Tuebingen, Tuebingen, Germany.

ABSTRACT

Introduction: Obsessive-compulsive disorder (OCD) is a common and chronic condition that can have disabling effects throughout the patient's lifespan. Frequent symptoms among OCD patients include fear of contamination and washing compulsions. Several studies have shown a link between contamination fears, disgust over-reactivity, and insula activation in OCD. In concordance with the role of insula in disgust processing, new neural models based on neuroimaging studies suggest that abnormally high activations of insula could be implicated in OCD psychopathology, at least in the subgroup of patients with contamination fears and washing compulsions.

Methods: In the current study, we used a Brain Computer Interface (BCI) based on real-time functional magnetic resonance imaging (rtfMRI) to aid OCD patients to achieve down-regulation of the Blood Oxygenation Level Dependent (BOLD) signal in anterior insula. Our first aim was to investigate whether patients with contamination obsessions and washing compulsions can learn to volitionally decrease (down-regulate) activity in the insula in the presence of disgust/anxiety provoking stimuli. Our second aim was to evaluate the effect of down-regulation on clinical, behavioural and physiological changes pertaining to OCD symptoms. Hence, several pre- and post-training measures were performed, i.e., confronting the patient with a disgust/anxiety inducing real-world object (Ecological Disgust Test), and subjective rating and physiological responses (heart rate, skin conductance level) of disgust towards provoking pictures.

Results: Results of this pilot study, performed in 3 patients (2 females), show that OCD patients can gain self-control of the BOLD activity of insula, albeit to different degrees. In two patients positive changes in behaviour in the EDT were observed following the rtfMRI trainings. Behavioural changes were also confirmed by reductions in the negative valence and in the subjective perception of disgust towards symptom provoking images.

Conclusion: Although preliminary, results of this study confirmed that insula down-regulation is possible in patients suffering from OCD, and that volitional decreases of insula activation could be used for symptom alleviation in this disorder.

No MeSH data available.


Related in: MedlinePlus