Department of Psychological Medicine, Centre for Affective Disorders, London, UK.
Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
Psychol Med. 2023 May;53(7):2831-2841. doi: 10.1017/S0033291721004797. Epub 2021 Dec 2.
Overgeneralised self-blame and worthlessness are key symptoms of major depressive disorder (MDD) and have previously been associated with self-blame-selective changes in connectivity between right superior anterior temporal lobe (rSATL) and subgenual frontal cortices. Another study showed that remitted MDD patients were able to modulate this neural signature using functional magnetic resonance imaging (fMRI) neurofeedback training, thereby increasing their self-esteem. The feasibility and potential of using this approach in symptomatic MDD were unknown.
This single-blind pre-registered randomised controlled pilot trial probed a novel self-guided psychological intervention with and without additional rSATL-posterior subgenual cortex (BA25) fMRI neurofeedback, targeting self-blaming emotions in people with insufficiently recovered MDD and early treatment-resistance ( = 43, = 35 completers). Participants completed three weekly self-guided sessions to rebalance self-blaming biases.
As predicted, neurofeedback led to a training-induced reduction in rSATL-BA25 connectivity for self-blame other-blame. Both interventions were safe and resulted in a 46% reduction on the Beck Depression Inventory-II, our primary outcome, with no group differences. Secondary analyses, however, revealed that patients without DSM-5-defined anxious distress showed a superior response to neurofeedback compared with the psychological intervention, and the opposite pattern in anxious MDD. As predicted, symptom remission was associated with increases in self-esteem and this correlated with the frequency with which participants employed the psychological strategies in daily life.
These findings suggest that self-blame-rebalance neurofeedback may be superior over a solely psychological intervention in non-anxious MDD, although further confirmatory studies are needed. Simple self-guided strategies tackling self-blame were beneficial, but need to be compared against treatment-as-usual in further trials. https://doi.org/10.1186/ISRCTN10526888.
过度自责和无价值感是重度抑郁症（MDD）的主要症状，先前的研究表明，这与右额上颞叶（rSATL）和亚属额皮质之间的连接的自责选择性变化有关。另一项研究表明，缓解期 MDD 患者能够使用功能磁共振成像（fMRI）神经反馈训练来调节这种神经特征，从而提高自尊心。在症状性 MDD 中使用这种方法的可行性和潜力尚不清楚。
这项单盲、预先注册的随机对照试验探索了一种新的自我引导的心理干预方法，包括和不包括额外的 rSATL-后亚属皮质（BA25）fMRI 神经反馈，针对的是恢复不足的 MDD 和早期治疗抵抗患者（n=43，n=35 完成者）的自责情绪。参与者完成了三个每周一次的自我引导课程，以重新平衡自责偏见。
正如预测的那样，神经反馈导致了 rSATL-BA25 连接对自责和他人指责的训练诱导减少。两种干预措施都是安全的，导致贝克抑郁量表第二版（BDI-II）的主要结果降低了 46%，没有组间差异。然而，二次分析显示，没有 DSM-5 定义的焦虑痛苦的患者对神经反馈的反应优于心理干预，而在焦虑性 MDD 中则相反。正如预测的那样，症状缓解与自尊心的提高相关，而自尊心的提高与参与者在日常生活中使用心理策略的频率相关。
这些发现表明，在非焦虑性 MDD 中，自我责备平衡神经反馈可能优于单纯的心理干预，尽管需要进一步的确认性研究。简单的自我引导策略处理自责是有益的，但需要在进一步的试验中与常规治疗进行比较。
