School of Psychological Sciences, Faculty of Social Sciences, Tel-Aviv University, Tel Aviv, Israel.
Sagol Brain Institute Tel-Aviv, Wohl Institute for Advanced Imaging, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel.
Psychiatry Clin Neurosci. 2024 Jan;78(1):19-28. doi: 10.1111/pcn.13591. Epub 2023 Dec 22.
Childhood sexual abuse (CSA) among women is an alarmingly prevalent traumatic experience that often leads to debilitating and treatment-refractory posttraumatic stress disorder (PTSD), raising the need for novel adjunctive therapies. Neuroimaging investigations systematically report that amygdala hyperactivity is the most consistent and reliable neural abnormality in PTSD and following childhood abuse, raising the potential of implementing volitional neural modulation using neurofeedback (NF) aimed at down-regulating amygdala activity. This study aimed to reliably probe limbic activity but overcome the limited applicability of functional magnetic resonance imaging (fMRI) NF by using a scalable electroencephalogram NF probe of amygdala-related activity, termed amygdala electrical-finger-print (amyg-EFP) in a randomized controlled trial.
Fifty-five women with CSA-PTSD who were in ongoing intensive trauma-focused psychotherapy for a minimum of 1 year but still met Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) PTSD criteria were randomized to either 10 add-on sessions of amyg-EFP-NF training (test group) or continuing psychotherapy (control group). Participants were blindly assessed for PTSD symptoms before and after the NF training period, followed by self-reported clinical follow-up at 1, 3, and 6 months, as well as one session of amygdala real-time fMRI-NF before and after NF training period.
Participants in the test group compared with the control group demonstrated a marginally significant immediate reduction in PTSD symptoms, which progressively improved during the follow-up period. In addition, successful neuromodulation during NF training was demonstrated.
This feasibility study for patients with treatment-resistant CSA-PTSD indicates that amyg-EFP-NF is a viable and efficient intervention.
女性童年期性虐待（CSA）是一种普遍存在的创伤性经历，往往导致致残和治疗抵抗性创伤后应激障碍（PTSD），因此需要新的辅助治疗方法。神经影像学研究系统地报告，杏仁核过度活跃是 PTSD 及儿童期虐待后最一致和可靠的神经异常，这为使用旨在下调杏仁核活动的神经反馈（NF）实施自愿性神经调节提供了潜力。本研究旨在使用可扩展的杏仁核相关活动的脑电图 NF 探针——称为杏仁核电指纹（amyg-EFP），可靠地探测边缘系统活动，但克服功能磁共振成像（fMRI）NF 的应用局限性，从而在随机对照试验中进行。
55 名 CSA-PTSD 女性在接受至少 1 年的强化创伤聚焦心理治疗后，仍符合精神障碍诊断与统计手册（第五版）（DSM-5）PTSD 标准，被随机分为接受 10 次附加的杏仁核-EFP-NF 训练（试验组）或继续接受心理治疗（对照组）。在 NF 训练期间之前和之后，参与者接受 PTSD 症状的盲法评估，然后在 1、3 和 6 个月进行自我报告的临床随访，以及在 NF 训练前后进行一次杏仁核实时 fMRI-NF 治疗。
与对照组相比，试验组参与者的 PTSD 症状立即出现了略微显著的减轻，并且在随访期间逐渐改善。此外，还证明了 NF 训练期间的成功神经调节。
本研究对治疗抵抗性 CSA-PTSD 患者进行了可行性研究，表明 amyg-EFP-NF 是一种可行且有效的干预措施。
