Quevedo Karina, Yuan Teoh Jia, Engstrom Maggie, Wedan Riley, Santana-Gonzalez Carmen, Zewde Betanya, Porter David, Cohen Kadosh Kathrin
Department of Psychiatry, Medical School, University of Minnesota, Minneapolis, MN, United States.
Minnesota Supercomputing Institute, University of Minnesota, Minneapolis, MN, United States.
Front Behav Neurosci. 2020 Jul 22;14:110. doi: 10.3389/fnbeh.2020.00110. eCollection 2020.
Typical adolescents have increased limbic engagement unchecked by regulatory medial prefrontal cortex (PFC) activity as well as heightened self-focus. The resulting emotion dysregulation and self-focused rumination make adolescents more susceptible to depression and suicide attempts. Heightened self-focus converges with mental illness among depressed adolescents, who deploy exaggerated attention to negative self-relevant stimuli and neglect positive ones as part of depression's phenomenology. This results in rigid negative self-representations during an identity formative period with potential lifetime repercussions. Current empirically supported treatments fail to allay recurrent depression. Evidence-based interventions for illnesses linked to suicide ideation and attempts (e.g., depression) underperform across the lifespan. This could be because current treatments are not successful in altering pervasive negative self-representations and affect dysregulation, which is known to be a risk factor of chronic depression. This study departs from the premise that increasing positive self-processing might be protective against chronic depression particularly during adolescence. The present research is a novel investigation of neurofeedback as a potential treatment alternative for adolescent depression. To enhance positive self-processing, we used the happy self-face as a cue to initiate neurofeedback from the bilateral amygdala and hippocampus and adolescents attempted to upregulate that limbic activity through the recall of positive autobiographical memories. We identified limbic functional circuitry engaged during neurofeedback and links to short-term symptoms' change in depression and rumination. We found that depressed youth showed greater right amygdala to right frontocortical connectivity and lower left amygdala to right frontocortical connectivity compared to healthy controls during neurofeedback vs. control conditions. Depressed youth also showed significant symptom reduction. Connectivity between the right amygdala and frontocortical regions was positively correlated with rumination and depression change, but connectivity between frontocortical regions and the left amygdala was negatively correlated with depression change. The results suggest that depressed youth might engage implicit emotion regulation circuitry while healthy youth recruit explicit emotion regulation circuits during neurofeedback. Our findings support a compensatory approach (i.e., target the right amygdala) during future neurofeedback interventions in depressed youth. Future work ought to include a placebo condition or group.
典型的青少年边缘系统活动增强，不受内侧前额叶皮质（PFC）调节活动的控制，且自我关注增强。由此产生的情绪调节障碍和自我专注的反刍思维使青少年更容易患抑郁症和尝试自杀。增强的自我关注与抑郁青少年的精神疾病相互交织，这些青少年会过度关注与自我相关的负面刺激，而忽视正面刺激，这是抑郁症现象学的一部分。这导致在身份形成期出现僵化的负面自我表征，可能产生终身影响。目前经验证有效的治疗方法无法缓解复发性抑郁症。针对与自杀意念和自杀企图相关疾病（如抑郁症）的循证干预措施在整个生命周期中的效果都不佳。这可能是因为目前的治疗方法未能成功改变普遍存在的负面自我表征和情感调节障碍，而这是慢性抑郁症的一个危险因素。本研究基于这样一个前提，即增加积极的自我加工可能对慢性抑郁症具有保护作用，尤其是在青少年时期。本研究是对神经反馈作为青少年抑郁症潜在治疗替代方法的一项新调查。为了增强积极的自我加工，我们使用快乐的自我面孔作为线索，启动来自双侧杏仁核和海马体的神经反馈，青少年试图通过回忆积极的自传体记忆来上调边缘系统活动。我们确定了神经反馈过程中涉及的边缘系统功能回路以及与抑郁症和反刍思维短期症状变化的联系。我们发现，与健康对照组相比，在神经反馈与对照条件下，抑郁青年在神经反馈过程中右侧杏仁核与右侧额叶皮质的连接性更强，而左侧杏仁核与右侧额叶皮质的连接性更低。抑郁青年的症状也有显著减轻。右侧杏仁核与额叶皮质区域之间的连接性与反刍思维和抑郁症变化呈正相关，但额叶皮质区域与左侧杏仁核之间的连接性与抑郁症变化呈负相关。结果表明，抑郁青年在神经反馈过程中可能会启用内隐情绪调节回路，而健康青年则会调用外显情绪调节回路。我们的研究结果支持在未来对抑郁青年进行神经反馈干预时采用一种补偿方法（即针对右侧杏仁核）。未来的研究应该包括一个安慰剂条件或对照组。
