Skottnik Leon, Linden David E J
School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands.
Front Psychiatry. 2019 Oct 30;10:779. doi: 10.3389/fpsyt.2019.00779. eCollection 2019.
Mental imagery is a promising tool and mechanism of psychological interventions, particularly for mood and anxiety disorders. In parallel developments, neuromodulation techniques have shown promise as add-on therapies in psychiatry, particularly non-invasive brain stimulation for depression. However, these techniques have not yet been combined in a systematic manner. One novel technology that may be able to achieve this is neurofeedback, which entails the self-regulation of activation in specific brain areas or networks (or the self-modulation of distributed activation patterns) by the patients themselves, through real-time feedback of brain activation (for example, from functional magnetic resonance imaging). One of the key mechanisms by which patients learn such self-regulation is mental imagery. Here, we will first review the main mental imagery approaches in psychotherapy and the implicated brain networks. We will then discuss how these networks can be targeted with neuromodulation (neurofeedback or non-invasive or invasive brain stimulation). We will review the clinical evidence for neurofeedback and discuss possible ways of enhancing it through systematic combination with psychological interventions, with a focus on depression, anxiety disorders, and addiction. The overarching aim of this perspective paper will be to open a debate on new ways of developing neuropsychotherapies.
心理意象是一种很有前景的心理干预工具和机制，尤其适用于情绪和焦虑障碍。与此同时，神经调节技术已显示出作为精神病学辅助治疗手段的潜力，特别是用于治疗抑郁症的非侵入性脑刺激。然而，这些技术尚未以系统的方式结合起来。一种可能实现这一目标的新技术是神经反馈，它要求患者通过脑激活的实时反馈（例如来自功能磁共振成像），对特定脑区或神经网络中的激活进行自我调节（或对分布式激活模式进行自我调制）。患者学习这种自我调节的关键机制之一就是心理意象。在此，我们将首先回顾心理治疗中的主要心理意象方法以及相关的脑网络。然后，我们将讨论如何通过神经调节（神经反馈或非侵入性或侵入性脑刺激）来针对这些网络。我们将回顾神经反馈的临床证据，并讨论通过与心理干预系统结合来增强其效果的可能方法，重点关注抑郁症、焦虑障碍和成瘾问题。这篇观点性文章的总体目标是开启一场关于开发神经心理治疗新方法的辩论。
