Targeting treatment-resistant auditory verbal hallucinations in schizophrenia with fMRI-based neurofeedback – exploring different cases of Schizophrenia
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Auditory verbal hallucinations (AVHs) are a hallmark of schizophrenia and can significantly impair patients' emotional, social, and occupational functioning. Despite progress in psychopharmacology, over 25% of schizophrenia patients suffer from treatment-resistant hallucinations. In the search for alternative treatment methods, neurofeedback (NF) emerges as a promising therapy tool. NF based on real-time functional magnetic resonance imaging (rt-fMRI) allows voluntarily change of the activity in a selected brain region - even in patients with schizophrenia. This study explored effects of NF on ongoing AVHs. The selected participants were trained in the self-regulation of activity in the anterior cingulate cortex (ACC), a key monitoring region involved in generation and intensity modulation of AVHs. Using rt-fMRI, three right-handed patients, suffering from schizophrenia and ongoing, treatment-resistant AVHs, learned control over ACC activity on three separate days. The effect of NF training on hallucinations' severity was assessed with the Auditory Vocal Hallucination Rating Scale (AVHRS) and on the affective state - with the Positive and Negative Affect Schedule (PANAS). All patients yielded significant upregulation of the ACC and reported subjective improvement in some aspects of AVHs (AVHRS) such as disturbance and suffering from the voices. In general, mood (PANAS) improved during NF training, though two patients reported worse mood after NF on the third day. ACC and reward system activity during NF learning and specific effects on mood and symptoms varied across the participants. None of them profited from the last training set in the prolonged three-session training. Moreover, individual differences emerged in brain networks activated with NF and in symptom changes, which were related to the patients' symptomatology and disease history. NF based on rt-fMRI seems a promising tool in therapy of AVHs. The patients, who suffered from continuous hallucinations for years, experienced symptom changes that may be attributed to the NF training. In order to assess the effectiveness of NF as a therapeutic method, this effect has to be studied systematically in larger groups; further, long-term effects need to be assessed. Particularly in schizophrenia, future NF studies should take into account the individual differences in reward processing, fatigue, and motivation to develop individualized training protocols.
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Rt-fMRI NF is a promising non-invasive approach to support voluntary modification of BOLD activation in individuals with psychiatric disorders characterized by aberrant neural activation patterns.
“Real-time fMRI neurofeedback (rt-fMRI NF) is a promising non-invasive approach to support voluntary modification of blood oxygen level dependent (BOLD) activation in individuals with psychiatric disorders characterized by aberrant neural activation patterns (Cordes et al., 2015, Dyck et al., 2016, Young et al., 2017, Zaehringer et al., 2019, Zweerings et al., 2019).”
From Rt-fMRI neurofeedback-guided cognitive reappraisal training modulates amygdala responsivity in posttraumatic stress disorder (2020) · cites this paper as Dyck et al., 2016
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- Authors
- Dyck, M. S., Mathiak, K. A., Bergert, S., Sarkheil, P., Koush, Y., Alawi, E. M., Zvyagintsev, M., Gaebler, A. J., Shergill, S. S., & Mathiak, K.
- Affiliations
- Jülich Aachen Research Alliance (DE)
- King's College London (GB)
- University of Geneva (CH)
- Corresponding author
- Mathiak, Klaus
- Venue
- Frontiers in Psychiatry
- Publisher
- Frontiers Media SA
- Published
- 2016-03-15
- Volume
- 7
- Pages
- 37-37
- ISSN
- 1664-0640 (ISSN-L)
- PMC
- PMC4791600
- OpenAlex
- W2305099475
- Cited by
- 56
- References
- 87
- Citations by year
- 2026: 4 · 2025: 7 · 2024: 2 · 2023: 2 · 2022: 5 · 2021: 9 · 2020: 10 · 2019: 3 · 2018: 6 · 2017: 7 · 2016: 1
- FWCI
- 5.04
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- Frontiers in Psychiatry (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Infoscience (Ecole Polytechnique Fédérale de Lausanne) (submittedVersion)
- Infoscience (Ecole Polytechnique Fédérale de Lausanne) (submittedVersion, cc-by-nc-nd)
- Research Portal (King's College London) (submittedVersion, cc-by)
- RWTH Publications (RWTH Aachen) (submittedVersion, other-oa)
- Funders
- Bundesministerium für Bildung und Forschung (APIC: 01EE1405B, APIC: 01EE1405C)
- Deutsche Forschungsgemeinschaft (MA 2631/6-1, BE 5328/2-1)
- Brain & Behavior Research Foundation
- RWTH Aachen University
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Life Sciences › Neuroscience › Cognitive Neuroscience › Hallucinations in medical conditions
- Life Sciences › Neuroscience › Neurology › Transcranial Magnetic Stimulation Studies
- Keywords
- auditory verbal hallucinations, schizophrenia, neurofeedback, real-time fMRI, anterior cingulate cortex, self-regulation of brain activity, reward systems, mood, individual differences, hallucination severity
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