Real-time fMRI neurofeedback training of the amygdala activity with simultaneous EEG in veterans with combat-related PTSD
Open accessAbstract
Posttraumatic stress disorder (PTSD) is a chronic and disabling neuropsychiatric disorder characterized by insufficient top-down modulation of the amygdala activity by the prefrontal cortex. Real-time fMRI neurofeedback (rtfMRI-nf) is an emerging method with potential for modifying the amygdala-prefrontal interactions. We report the first controlled emotion self-regulation study in veterans with combat-related PTSD utilizing rtfMRI-nf of the amygdala activity. PTSD patients in the experimental group (EG, n = 20) learned to upregulate blood‑oxygenation-level-dependent (BOLD) activity of the left amygdala (LA) using the rtfMRI-nf during a happy emotion induction task. PTSD patients in the control group (CG, n = 11) were provided with a sham rtfMRI-nf. The study included three rtfMRI-nf training sessions, and EEG recordings were performed simultaneously with fMRI. PTSD severity was assessed before and after the training using the Clinician-Administered PTSD Scale (CAPS). The EG participants who completed the study showed a significant reduction in total CAPS ratings, including significant reductions in avoidance and hyperarousal symptoms. They also exhibited a significant reduction in comorbid depression severity. Overall, 80% of the EG participants demonstrated clinically meaningful reductions in CAPS ratings, compared to 38% in the CG. No significant difference in the CAPS rating changes was observed between the groups. During the first rtfMRI-nf session, functional connectivity of the LA with the orbitofrontal cortex (OFC) and the dorsolateral prefrontal cortex (DLPFC) was progressively enhanced, and this enhancement significantly and positively correlated with the initial CAPS ratings. Left-lateralized enhancement in upper alpha EEG coherence also exhibited a significant positive correlation with the initial CAPS. Reduction in PTSD severity between the first and last rtfMRI-nf sessions significantly correlated with enhancement in functional connectivity between the LA and the left DLPFC. Our results demonstrate that the rtfMRI-nf of the amygdala activity has the potential to correct the amygdala-prefrontal functional connectivity deficiencies specific to PTSD.
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Two other studies reported clinically meaningful reduction in PTSD symptoms after amygdala down-regulation training in PTSD (Gerin et al., 2016, Zotev et al., 2018).
“Two other studies reported clinically meaningful reduction in PTSD symptoms after amygdala down-regulation training in PTSD (Gerin et al., 2016, Zotev et al., 2018).”
From Rt-fMRI neurofeedback-guided cognitive reappraisal training modulates amygdala responsivity in posttraumatic stress disorder (2020) · cites this paper as Zotev et al., 2018
The Results (Psychological measures) report clinically meaningful PTSD symptom reductions in 12 of 15 experimental-group completers. But the Discussion says this study trained participants to upregulate—not downregulate—the amygdala; it describes downregulation as an approach for future work. (LLM, conf=0.90)
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- Authors
- Zotev, V., Phillips, R., Misaki, M., Wong, C. K., Wurfel, B. E., Krueger, F., Feldner, M., & Bodurka, J.
- Affiliations
- Laureate Institute for Brain Research (US)
- Laureate Psychiatric Clinic and Hospital (US)
- University of Arkansas at Fayetteville (US)
- Corresponding author
- Bodurka, Jerzy
- Venue
- NeuroImage Clinical
- Publisher
- Elsevier BV
- Published
- 2018
- Volume
- 19
- Pages
- 106-121
- ISSN
- 2213-1582 (ISSN-L)
- PMC
- PMC6051473
- OpenAlex
- W2786003115
- Cited by
- 135
- References
- 67
- Citations by year
- 2026: 8 · 2025: 12 · 2024: 16 · 2023: 20 · 2022: 22 · 2021: 20 · 2020: 17 · 2019: 16 · 2018: 4
- FWCI
- 16.71
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- NeuroImage Clinical (publishedVersion, cc-by-nc-nd)
- Europe PMC (PubMed Central) (publishedVersion, cc-by-nc-nd)
- PubMed Central (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- arXiv (Cornell University) (submittedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- arXiv (Cornell University)
- Funders
- U.S. Department of Defense
- Topics
- Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
- Life Sciences › Neuroscience › Cognitive Neuroscience › Neural and Behavioral Psychology Studies
- Life Sciences › Neuroscience › Neurology › Transcranial Magnetic Stimulation Studies
- Keywords
- real-time fMRI neurofeedback, amygdala activity, combat-related posttraumatic stress disorder, veterans, dorsolateral prefrontal cortex, orbitofrontal cortex, emotion regulation, comorbid depression, avoidance symptoms, hyperarousal
- MeSH terms
- Adult, Amygdala, Brain Mapping, Major Depressive Disorder, Emotions, Female, Humans, Image Processing, Computer-Assisted, Learning, Magnetic Resonance Imaging, Male, Middle Aged, Stress Disorders, Post-Traumatic, Neurofeedback
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