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Cited by 175Transcranial Magnetic Stimulation StudiesTreatment of Major DepressionNeural and Behavioral Psychology Studies

The DOI matches its Crossref record; 53 of the 53 references it cites were found in a registry or an index.

Targeting the affective brain—a randomized controlled trial of real-time fMRI neurofeedback in patients with depression

Open access
Mehler, David M. A., Sokunbi, Moses O., Habes, Isabelle, Barawi, Kali, Subramanian, Leena, Range, Maxence, Evans, John, Hood, Kerenza, Lührs, Michael, Keedwell, Paul, Goebel, Rainer, Linden, David E. J.·2018·Neuropsychopharmacology
DOI 10.1038/s41386-018-0126-5PMC PMC6186421
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Abstract

Functional magnetic resonance imaging neurofeedback (fMRI-NF) training of areas involved in emotion processing can reduce depressive symptoms by over 40% on the Hamilton Depression Rating Scale (HDRS). However, it remains unclear if this efficacy is specific to feedback from emotion-regulating regions. We tested in a single-blind, randomized, controlled trial if upregulation of emotion areas (NFE) yields superior efficacy compared to upregulation of a control region activated by visual scenes (NFS). Forty-three moderately to severely depressed medicated patients were randomly assigned to five sessions augmentation treatment of either NFE or NFS training. At primary outcome (week 12) no significant group mean HDRS difference was found (B = -0.415 [95% CI -4.847 to 4.016], p = 0.848) for the 32 completers (16 per group). However, across groups depressive symptoms decreased by 43%, and 38% of patients remitted. These improvements lasted until follow-up (week 18). Both groups upregulated target regions to a similar extent. Further, clinical improvement was correlated with an increase in self-efficacy scores. However, the interpretation of clinical improvements remains limited due to lack of a sham-control group. We thus surveyed effects reported for accepted augmentation therapies in depression. Data indicated that our findings exceed expected regression to the mean and placebo effects that have been reported for drug trials and other sham-controlled high-technology interventions. Taken together, we suggest that the experience of successful self-regulation during fMRI-NF training may be therapeutic. We conclude that if fMRI-NF is effective for depression, self-regulation training of higher visual areas may provide an effective alternative.

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Crossref · 10.1038/s41386-018-0126-5

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Figures

Fig. 1 CONSORT diagram of clinical trial
Fig. 1 CONSORT diagram of clinical trialCC BY · PubMed Central
Fig. 2 Main clinical outcome measure HDRS-17 for NFE and NFS groups at baseline, post-intervention, and follow up. a Mean and standard error of the mean (SEM) HDRS scores, b remission rate in %age based on HDRS, c Robust regression analysis between change in total self-efficacy scores, and residualized HDRS-17 scores at primary endpoint. *p < 0.05
Fig. 2 Main clinical outcome measure HDRS-17 for NFE and NFS groups at baseline, post-intervention, and follow up. a Mean and standard error of the mean (SEM) HDRS scores, b remission rate in %age based on HDRS, c Robust regression analysis between change in total self-efficacy scores, and residualized HDRS-17 scores at primary endpoint. *p < 0.05CC BY · PubMed Central
Fig. 3 ROI analysis. Average t-value of target ROIs for each session. Pooled mean shown, as well as means for both groups with error bars showing standard error of the mean (SEM). *p < 0.05 at FDR correction
Fig. 3 ROI analysis. Average t-value of target ROIs for each session. Pooled mean shown, as well as means for both groups with error bars showing standard error of the mean (SEM). *p < 0.05 at FDR correctionCC BY · PubMed Central
Fig. 4 Whole-brain analysis. a Probability map (PM) of the localizer. b Activity of intervention groups, shown separately for NF-emotion and NF-scene group. c Group contrast. Key areas are labeled with numbers: (1) Insular cortex/ ventrolateral prefrontal cortex, (2) parahippocampal Place area (PPA), (3) supplementary motor area, (4) lingual gyrus, (5) premotor cortex, (6) superior parietal lobule, and (7) ventrolateral prefrontal cortex. Statistical maps cluster-threshold corrected for multiple comparison (p < 0.001)
Fig. 4 Whole-brain analysis. a Probability map (PM) of the localizer. b Activity of intervention groups, shown separately for NF-emotion and NF-scene group. c Group contrast. Key areas are labeled with numbers: (1) Insular cortex/ ventrolateral prefrontal cortex, (2) parahippocampal Place area (PPA), (3) supplementary motor area, (4) lingual gyrus, (5) premotor cortex, (6) superior parietal lobule, and (7) ventrolateral prefrontal cortex. Statistical maps cluster-threshold corrected for multiple comparison (p < 0.001)CC BY · PubMed Central

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Research works printed but not linked: 1

  1. Qids S, Qids-c CR, Rush aJ, Trivedi MH, Ibrahim HM, Carmody TJ, et al. The 16-Item quick inventory of depressive. Depression. 2003;54:573–83.

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Metadata

Authors
Mehler, D. M. A., Sokunbi, M. O., Habes, I., Barawi, K., Subramanian, L., Range, M., Evans, J., Hood, K., Lührs, M., Keedwell, P., Goebel, R., & Linden, D. E. J.
Affiliations
  • Cardiff University (GB)
  • De Montfort University (GB)
  • Maastricht University (NL)
  • King's College London (GB)
Corresponding author
Linden, David E. J.
ORCID
Venue
Neuropsychopharmacology
Publisher
Springer Science and Business Media LLC
Published
2018-06-23
Volume
43
Issue
13
Pages
2578-2585
ISSN
  • 0893-133X (ISSN-L)
  • 1740-634X
DOI
10.1038/s41386-018-0126-5
PMC
PMC6186421
OpenAlex
W2808876118
Cited by
175
References
53
Citations by year
2026: 9 · 2025: 14 · 2024: 16 · 2023: 19 · 2022: 25 · 2021: 54 · 2020: 21 · 2019: 13 · 2018: 4
FWCI
10.35
Type
journal article
Language
en
Open access
Licence
Locations
  • Neuropsychopharmacology (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, other-oa)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Research Publications (Maastricht University) (publishedVersion, cc-by)
  • ORCA Online Research @Cardiff (Cardiff University) (acceptedVersion)
  • DMU Open Research Archive (De Montfort University) (submittedVersion)
  • Research Publications (Maastricht University) (submittedVersion, other-oa)
Funders
  • National Institute for Social Care and Health Research (HS/10/25)
  • Health and Care Research Wales (HS/14/20)
  • Cancer Research UK
  • European Commission (602186)
  • Medical Research Council (MR/L010305/1)
Topics
  • Life Sciences › Neuroscience › Neurology › Transcranial Magnetic Stimulation Studies
  • Health Sciences › Medicine › Pharmacology (medical) › Treatment of Major Depression
  • Life Sciences › Neuroscience › Cognitive Neuroscience › Neural and Behavioral Psychology Studies
Keywords
fMRI neurofeedback, depression, emotion regulation, real-time fMRI, visual scene processing, antidepressant augmentation, self-efficacy, placebo effect, regression to the mean, self-regulation training
MeSH terms
Adult, Brain, Computer Systems, Depressive Disorder, Female, Follow-Up Studies, Humans, Magnetic Resonance Imaging, Male, Middle Aged, Pilot Projects, Treatment Outcome, Self Efficacy, Neurofeedback

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