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

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.

Mindfulness increases recall of self-threatening information.

Previous research has suggested that we tend to show impaired memory for self-threatening information, an effect known as mnemic neglect. Mnemic neglect is believed to be due to shallow processing or inhibition of self-threatening information. Mnemic neglect, however, could also be an example of experiential avoidance and mindfulness training has been demonstrated to counteract experiential avoidance. The current study was designed to negate experiential avoidance on a memory task via mindfulness training and attempt to increase recall of self-threatening information. Participants were exposed to a short intervention, either mindfulness or unfocused attention, before being instructed to read and later recall self-referent behaviors. The findings indicated that recall of self-threatening and other self-referent information was increased following the mindfulness but not unfocused attention intervention. The utility of mindfulness as a strategy for negating the experiential avoidance normally associated with self-threatening information and increasing memory performance are discussed.