The DOI matches its Crossref record; 84 of the 85 references it cites were found in a registry or an index.
Real-Time Functional Connectivity-Informed Neurofeedback of Amygdala-Frontal Pathways Reduces Anxiety
Open accessPublished version of a preprint
Abstract
Background: Deficient emotion regulation and exaggerated anxiety represent a major transdiagnostic psychopathological marker. On the neural level these deficits have been closely linked to impaired, yet treatment-sensitive, prefrontal regulatory control over the amygdala. Gaining direct control over these pathways could therefore provide an innovative and promising intervention to regulate exaggerated anxiety. To this end the current proof-of-concept study evaluated the feasibility, functional relevance and maintenance of a novel connectivity-informed real-time fMRI neurofeedback training. Methods: In a randomized crossover sham-controlled design, 26 healthy subjects with high anxiety underwent real-time fMRI-guided neurofeedback training to enhance connectivity between the ventrolateral prefrontal cortex (vlPFC) and the amygdala (target pathway) during threat exposure. Maintenance of regulatory control was assessed after 3 days and in the absence of feedback. Training-induced changes in functional connectivity of the target pathway and anxiety ratings served as primary outcomes. Results: Training of the target, yet not the sham control, pathway significantly increased amygdala-vlPFC connectivity and decreased levels of anxiety. Stronger connectivity increases were significantly associated with higher anxiety reduction on the group level. At the follow-up, volitional control over the target pathway was maintained in the absence of feedback. Conclusions: The present results demonstrate for the first time that successful self-regulation of amygdala-prefrontal top-down regulatory circuits may represent a novel intervention to control anxiety. As such, the present findings underscore both the critical contribution of amygdala-prefrontal circuits to emotion regulation and the therapeutic potential of connectivity-informed real-time neurofeedback.
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“Moreover, despite increasing evidence for the maintenance of neural regulatory control acquired during NF trainings in the absence of feedback and for periods of several days (Rance et al., 2018, Yao et al., 2016, Zhao et al., 2019) the transfer of the acquired strategies to everyday life and the perceived efficiency have not been systematically examined in PTSD.”
From Rt-fMRI neurofeedback-guided cognitive reappraisal training modulates amygdala responsivity in posttraumatic stress disorder (2020) · cites this paper as Zhao et al., 2019
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Fu, K., Xu, S., Liu, D., Zhang, Z., Liu, Q., He, J., Xu, T., Liu, C., Wang, J., Zhang, Y., et al. (2026) · medRxiv · doi:10.64898/2026.08.11.26360155
Self-citationTsang, M. H. L., Chen, J. C., Jiang, H., & Becker, B. (2026) · Progress in Neuro-Psychopharmacology and Biological Psychiatry · doi:10.1016/j.pnpbp.2026.111918 · Cited by 2
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Metadata
- Authors
- Zhao, Z., Yao, S., Li, K., Sindermann, C., Zhou, F., Zhao, W., Li, J., Lührs, M., Goebel, R., Kendrick, K. M., & Becker, B.
- Affiliations
- University of Electronic Science and Technology of China (CN)
- Universität Ulm (DE)
- Maastricht University (NL)
- ORCID
- Venue
- Psychotherapy and Psychosomatics
- Publisher
- S. Karger AG
- Published
- 2019
- Volume
- 88
- Issue
- 1
- Pages
- 5-15
- ISSN
- 0033-3190 (ISSN-L)
- 1423-0348
- OpenAlex
- W2951709304
- Cited by
- 102
- References
- 85
- Citations by year
- 2026: 6 · 2025: 14 · 2024: 16 · 2023: 8 · 2022: 19 · 2021: 17 · 2020: 15 · 2019: 5
- FWCI
- 8.16
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Psychotherapy and Psychosomatics (publishedVersion)
- bioRxiv (Cold Spring Harbor Laboratory) (acceptedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- Research Publications (Maastricht University) (publishedVersion, other-oa)
- Research Publications (Maastricht University) (submittedVersion, other-oa)
- Funders
- National Natural Science Foundation of China (91632117, 31530032, 31700998)
- Fundamental Research Funds for the Central Universities (ZYGX2015Z002)
- Topics
- Life Sciences › Neuroscience › Cognitive Neuroscience › Neural and Behavioral Psychology Studies
- Life Sciences › Neuroscience › Cognitive Neuroscience › Functional Brain Connectivity Studies
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- real-time fMRI neurofeedback, amygdala, ventrolateral prefrontal cortex, amygdala-prefrontal connectivity, anxiety, emotion regulation, top-down control, threat exposure, self-regulation, transdiagnostic psychopathology
- MeSH terms
- Self-Control, Proof of Concept Study, Adult, Amygdala, Anxiety, Humans, Magnetic Resonance Imaging, Nerve Net, Outcome Assessment, Health Care, Prefrontal Cortex, Cross-Over Studies, Neurofeedback, Functional Neuroimaging
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