Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany.
Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany; Department of Child and Adolescent Psychiatry and Psychotherapy and Psychosomatics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
J Affect Disord. 2024 Jan 15;345:32-42. doi: 10.1016/j.jad.2023.10.036. Epub 2023 Oct 16.
Adolescents with increased callous unemotional traits (CU traits) in the context of disruptive behavior disorder (DBD) show a persistent pattern of antisocial behavior with shallow affect and a lack of empathy or remorse. The amygdala and insula as regions commonly associated with emotion processing, empathy and arousal are implicated in DBD with high CU traits. While behavioral therapies for DBD provide significant but small effects, individualized treatments targeting the implicated brain regions are missing.
In this explorative randomized controlled trial we randomly assigned twenty-seven adolescents with DBD to individualized real-time functional magnetic resonance neurofeedback (rtfMRI-NF) or behavioral treatment as usual (TAU). Visual feedback of either amygdala or insula activity was provided during rtfMRI-NF by gauges and included a simple and concurrent video run plus a transfer run. A linear mixed model (LMM) was applied to determine improvement of self-regulation. Specificity was assessed by correlating individual self-regulation improvement with clinical outcomes.
The rtfMRI-NF (n = 11) and TAU (n = 10) completers showed comparable and significant clinical improvement indicating neither superiority nor inferiority of rtfMRI-NF. The exploratory LMM revealed successful learning of self-regulation along the course of training for participants who received feedback from the amygdala. A significant exploratory correlation between individual target region activity in the simple run and clinical improvement was found for one dimension of DBD.
This exploratory study demonstrated feasibility and suggests clinical efficacy of individualized rtfMRI-NF comparable to active TAU for adolescents with DBD and increased CU traits. Further studies are needed to confirm efficacy, specificity and to clarify underlying learning mechanisms.
在破坏性行为障碍 (DBD) 背景下，具有较高冷酷无情特质 (CU 特质) 的青少年表现出持续的反社会行为模式，情感淡薄，缺乏同理心或悔恨。杏仁核和岛叶作为与情绪处理、同理心和唤醒相关的常见区域，与具有高 CU 特质的 DBD 有关。虽然针对 DBD 的行为疗法提供了显著但较小的效果，但针对受影响的大脑区域的个体化治疗方法仍有待研究。
在这项探索性随机对照试验中，我们将 27 名患有 DBD 的青少年随机分配到个体化实时功能磁共振神经反馈 (rtfMRI-NF) 或行为治疗常规 (TAU)。在 rtfMRI-NF 期间，通过仪表提供杏仁核或岛叶活动的视觉反馈，并包括一个简单的、同时进行的视频运行和一个转移运行。应用线性混合模型 (LMM) 来确定自我调节的改善。通过将个体自我调节的改善与临床结果相关联来评估特异性。
rtfMRI-NF (n=11) 和 TAU (n=10) 完成者表现出可比的、显著的临床改善，表明 rtfMRI-NF 既不优越也不劣于 TAU。探索性 LMM 显示，接受杏仁核反馈的参与者在训练过程中成功地学习了自我调节。在简单运行中个体目标区域活动与临床改善之间存在显著的探索性相关性，这与 DBD 的一个维度有关。
这项探索性研究表明，个体化 rtfMRI-NF 对于患有 DBD 和较高 CU 特质的青少年来说，具有可行性和临床疗效，可与积极的 TAU 相媲美。需要进一步的研究来确认疗效、特异性，并阐明潜在的学习机制。
