Department of Speech and Hearing Sciences, University of Washington, Seattle, WA, United States.
Department of Psychology, University of Washington, Seattle, WA, United States.
Neuroimage Clin. 2018 Jun 9;19:868-875. doi: 10.1016/j.nicl.2018.06.009. eCollection 2018.
To benefit from cognitive behavioral therapy (CBT), individuals must not only learn new skills but also strategically implement them outside of session. Here, we tested a novel technique for personalizing CBT skills and facilitating their generalization to daily life. We hypothesized that showing participants the impact of specific CBT strategies on their own brain function using real-time functional magnetic imaging (rt-fMRI) neurofeedback would increase their metacognitive awareness, help them identify effective strategies, and motivate real-world use. In a within-subjects design, participants who had completed a clinical trial of a standardized course of CBT created a personal repertoire of negative autobiographical stimuli and mood regulation strategies. From each participant's repertoire, a set of experimental and control strategies were identified; only experimental strategies were practiced in the scanner. During the rt-fMRI neurofeedback session, participants used negative stimuli and strategies from their repertoire to manipulate activation in the anterior cingulate cortex, a region implicated in emotional distress. The primary outcome measures were changes in participant ratings of strategy difficulty, efficacy, and frequency of use. As predicted, ratings for unscanned control strategies were stable across observations, whereas ratings for experimental strategies changed after neurofeedback. At follow-up one month after the session, efficacy and frequency ratings for scanned strategies were predicted by neurofeedback during the rt-fMRI session. These results suggest that rt-fMRI neurofeedback created a salient and durable learning experience for patients, extending beyond the scan session to guide and motivate CBT skill use weeks later. This metacognitive approach to neurofeedback offers a promising model for increasing clinical benefits from cognitive behavioral therapy by personalizing skills and facilitating generalization.
为了从认知行为疗法（CBT）中受益，个体不仅必须学习新技能，还必须在治疗之外有策略地实施这些技能。在这里，我们测试了一种将 CBT 技能个性化并促进其泛化到日常生活中的新技术。我们假设，使用实时功能磁共振成像（rt-fMRI）神经反馈向参与者展示特定 CBT 策略对其自身大脑功能的影响，将增加他们的元认知意识，帮助他们识别有效策略，并激发现实世界的应用。在一项被试内设计中，完成标准化 CBT 课程临床试验的参与者创建了个人消极自传体刺激和情绪调节策略库。从每个参与者的库中，确定了一组实验和对照策略；只有实验策略在扫描仪中进行实践。在 rt-fMRI 神经反馈过程中，参与者使用来自他们的库的消极刺激和策略来操纵前扣带皮层的激活，该区域与情绪困扰有关。主要的结果测量是参与者对策略难度、效果和使用频率的评价的变化。正如预测的那样，未扫描对照策略的评分在整个观察过程中是稳定的，而实验策略的评分在神经反馈后发生了变化。在扫描后一个月的随访中，扫描策略的疗效和频率评分可以通过 rt-fMRI 扫描期间的神经反馈来预测。这些结果表明，rt-fMRI 神经反馈为患者创造了一个显著而持久的学习体验，超越了扫描会议，以指导和激励 CBT 技能使用数周后。这种元认知神经反馈方法为通过个性化技能和促进泛化来增加认知行为疗法的临床效益提供了一个有前途的模型。
