Single session real-time fMRI neurofeedback has a lasting impact on cognitive behavioral therapy strategies
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Abstract
To benefit from cognitive behavioral therapy (CBT), individuals must not only learn new skills but also strategically implement them outside of session. Here, we tested a novel technique for personalizing CBT skills and facilitating their generalization to daily life. We hypothesized that showing participants the impact of specific CBT strategies on their own brain function using real-time functional magnetic imaging (rt-fMRI) neurofeedback would increase their metacognitive awareness, help them identify effective strategies, and motivate real-world use. In a within-subjects design, participants who had completed a clinical trial of a standardized course of CBT created a personal repertoire of negative autobiographical stimuli and mood regulation strategies. From each participant's repertoire, a set of experimental and control strategies were identified; only experimental strategies were practiced in the scanner. During the rt-fMRI neurofeedback session, participants used negative stimuli and strategies from their repertoire to manipulate activation in the anterior cingulate cortex, a region implicated in emotional distress. The primary outcome measures were changes in participant ratings of strategy difficulty, efficacy, and frequency of use. As predicted, ratings for unscanned control strategies were stable across observations, whereas ratings for experimental strategies changed after neurofeedback. At follow-up one month after the session, efficacy and frequency ratings for scanned strategies were predicted by neurofeedback during the rt-fMRI session. These results suggest that rt-fMRI neurofeedback created a salient and durable learning experience for patients, extending beyond the scan session to guide and motivate CBT skill use weeks later. This metacognitive approach to neurofeedback offers a promising model for increasing clinical benefits from cognitive behavioral therapy by personalizing skills and facilitating generalization.
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Rt-fMRI NF trainings have been shown to support perceived control and self-efficacy, thus potentially motivating behavioral change.
“Rt-fMRI NF trainings have been shown to support perceived control (Zweerings et al., 2018) and self-efficacy (Mehler et al., 2018), thus potentially motivating behavioral change (MacDuffie et al., 2018).”
From Rt-fMRI neurofeedback-guided cognitive reappraisal training modulates amygdala responsivity in posttraumatic stress disorder (2020) · cites this paper as MacDuffie et al., 2018
Presenting participants with information on the effects of strategies on brain activation may increase credibility and motivate application in daily life.
“Presenting participants with information on the effects of strategies on brain activation may increase credibility and motivate application in daily life (MacDuffie et al., 2018).”
From Rt-fMRI neurofeedback-guided cognitive reappraisal training modulates amygdala responsivity in posttraumatic stress disorder (2020) · cites this paper as MacDuffie et al., 2018
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- Authors
- MacDuffie, K. E., MacInnes, J., Dickerson, K. C., Eddington, K. M., Strauman, T. J., & Adcock, R. A.
- Affiliations
- University of Washington (US)
- Duke University (US)
- University of North Carolina at Greensboro (US)
- Corresponding author
- Adcock, R. Alison
- Venue
- NeuroImage Clinical
- Publisher
- Elsevier BV
- Published
- 2018
- Volume
- 19
- Pages
- 868-875
- ISSN
- 2213-1582 (ISSN-L)
- PMC
- PMC6005804
- OpenAlex
- W2950669198
- Cited by
- 74
- References
- 18
- Citations by year
- 2026: 7 · 2025: 5 · 2024: 6 · 2023: 6 · 2022: 7 · 2021: 31 · 2020: 8 · 2019: 3 · 2018: 1
- FWCI
- 14.08
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- NeuroImage Clinical (publishedVersion, cc-by-nc-nd)
- bioRxiv (Cold Spring Harbor Laboratory) (acceptedVersion, cc-by-nc-nd)
- Europe PMC (PubMed Central) (publishedVersion, cc-by-nc-nd)
- PubMed Central (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- NC Digital Online Collection of Knowledge and Scholarship (The University of North Carolina at Greensboro) (submittedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- National Center for Advancing Translational Sciences
- National Institute of Mental Health (R01MH094743)
- National Science Foundation
- National Institutes of Health (5KL2TR001115)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Life Sciences › Neuroscience › Cognitive Neuroscience › Neural and Behavioral Psychology Studies
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Keywords
- real-time fMRI neurofeedback, cognitive behavioral therapy, metacognitive awareness, strategy generalization, anterior cingulate cortex, emotion regulation, personalized treatment, medication adherence
- MeSH terms
- Adult, Brain, Depressive Disorder, Female, Humans, Magnetic Resonance Imaging, Male, Middle Aged, Cognitive Behavioral Therapy, Treatment Outcome, Neurofeedback
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