Increased top-down control of emotions during symptom provocation working memory tasks following a RCT of alpha-down neurofeedback in PTSD.

Autor:	Shaw SB; Department of Psychiatry, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada; Vector Institute, Toronto, Ontario, Canada; Homewood Research Institute (HRI), Guelph, Ontario, Canada. Electronic address: sshaw62@uwo.ca., Nicholson AA; School of Psychology, University of Ottawa, Canada; Atlas Institute for Veterans and Families, Royal Ottawa Hospital, Canada; Department of Psychiatry and Behavioral Neuroscience, McMaster University, Hamilton, Ontario, Canada; Department of Medical Biophysics, Western University, London, Ontario, Canada., Ros T; Departments of Neuroscience and Psychiatry, University of Geneva, Geneva, Switzerland., Harricharan S; Homewood Research Institute (HRI), Guelph, Ontario, Canada; Department of Psychiatry and Behavioral Neuroscience, McMaster University, Hamilton, Ontario, Canada; St. Joseph's Healthcare, Hamilton, Ontario, Canada., Terpou B; Homewood Research Institute (HRI), Guelph, Ontario, Canada; Department of Psychiatry and Behavioral Neuroscience, McMaster University, Hamilton, Ontario, Canada., Densmore M; Department of Psychiatry, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada; Lawson Health Research Institute, London, Ontario, Canada., Theberge J; Department of Psychiatry, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada; Department of Medical Biophysics, Western University, London, Ontario, Canada; Lawson Health Research Institute, London, Ontario, Canada; Department of Diagnostic Imaging, St. Joseph's Healthcare, London, Ontario, Canada., Frewen P; Department of Psychiatry, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada., Lanius RA; Department of Psychiatry, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada; Homewood Research Institute (HRI), Guelph, Ontario, Canada; St. Joseph's Healthcare, Hamilton, Ontario, Canada. Electronic address: Ruth.Lanius@lhsc.on.ca.
Jazyk:	angličtina
Zdroj:	NeuroImage. Clinical [Neuroimage Clin] 2023; Vol. 37, pp. 103313. Date of Electronic Publication: 2023 Jan 03.
DOI:	10.1016/j.nicl.2023.103313
Abstrakt:	Background: Posttraumatic stress disorder (PTSD) has been found to be associated with emotion under-modulation from the prefrontal cortex and a breakdown of the top-down control of cognition and emotion. Novel adjunct therapies such as neurofeedback (NFB) have been shown to normalize aberrant neural circuits that underlie PTSD psychopathology at rest. However, little evidence exists for NFB-linked neural improvements under emotionally relevant cognitive load. The current study sought to address this gap by examining the effects of alpha-down NFB in the context of an emotional n-back task. Methods: We conducted a 20-week double-blind randomized, sham-controlled trial of alpha-down NFB and collected neuroimaging data before and after the NFB protocol. Participants performed an emotional 1-back and 2-back working memory task, with interleaved trauma-neutral and trauma-relevant cues in the fMRI scanner. Data from 35 participants with a primary diagnosis of PTSD were analyzed in this study (n = 18 in the experimental group undergoing alpha-down NFB, n = 17 in the sham-control group). Results: Firstly, within-group analyses showed clinically significant reductions in PTSD symptom severity scores at the post-intervention timepoint and 3-month follow-up for the experimental group, and not for the sham-control group. The neuroimaging analyses revealed that alpha-down NFB enhanced engagement of top-down cognitive and emotional control centers, such as the dorsolateral prefrontal cortex (dlPFC), and improved integration of the anterior and posterior parts of the default mode network (DMN). Finally, our results also indicate that increased alpha-down NFB performance correlated with increased activity in brain regions involved in top-down control and bodily consciousness/embodied processing of self (TPJ and posterior insula). Conclusion: This is the first study to provide mechanistic insights into how NFB may normalize dysfunctional brain activity and connectivity in PTSD under cognitive load with simultaneous symptom provocation, adding to a growing body of evidence supporting the therapeutic neuromodulatory effects of NFB. This preliminary study highlights the benefits of alpha-down NFB training as an adjunctive therapy for PTSD and warrants further investigation into its therapeutic effects on cognitive and emotion control in those with PTSD. Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. (Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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