Tschentscher Nadja, Tafelmaier Julia C, Woll Christian F J, Pogarell Oliver, Maywald Maximilian, Vierl Larissa, Breitenstein Katrin, Karch Susanne
Section of Clinical Psychology and Psychophysiology, Department of Psychiatry and Psychotherapy, LMU University Hospital, LMU Munich, Nußbaumstr. 7, 80336 Munich, Germany.
Section of Clinical Psychology of Children and Adolescents, Department of Psychology and Educational Sciences, Ludwig Maximilian University of Munich, Leopoldstr. 13, 80802 Munich, Germany.
Brain Sci. 2024 Jul 12;14(7):700. doi: 10.3390/brainsci14070700.
Emotion dysregulation has long been considered a key symptom in multiple psychiatric disorders. Difficulties in emotion regulation have been associated with neural dysregulation in fronto-limbic circuits. Real-time fMRI-based neurofeedback (rt-fMRI-NFB) has become increasingly popular as a potential treatment for emotional dysregulation in psychiatric disorders, as it is able to directly target the impaired neural circuits. However, the clinical impact of these rt-fMRI-NFB protocols in psychiatric populations is still largely unknown. Here we provide a comprehensive overview of primary studies from 2010 to 2023 that used rt-fMRI-NFB to target emotion regulation. We assessed 41 out of 4001 original studies for methodological quality and risk of bias and synthesised concerning the frequency of significant rt-fMRI-NFB-related effects on the neural and behaviour level. Successful modulation of brain activity was reported in between 25 and 50 percent of study samples, while neural effects in clinical samples were more diverse than in healthy samples. Interestingly, the frequency of rt-fMRI-NFB-related behavioural improvement was over 75 percent in clinical samples, while healthy samples showed behavioural improvements between 0 and 25 percent. Concerning clinical subsamples, rt-fMRI-NFB-related behavioural improvement was observed in up to 100 percent of major depressive disorder (MDD) and post-traumatic stress disorder (PTSD) samples. Substance use samples showed behavioural benefits ranging between 50 and 75 percent. Neural effects appeared to be less frequent than behavioural improvements: most neural outcomes ranged between 25 and 50 percent for MDD and substance use and between 0 and 25 percent for PTSD. Using multiple individualised regions of interest (ROIs) for rt-fMRI-NFB training resulted in more frequent behavioural benefits than rt-fMRI-NFB solely based on the amygdala or the prefrontal cortex. While a significant improvement in behavioural outcomes was reported in most clinical studies, the study protocols were heterogeneous, which limits the current evaluation of rt-fMRI-NFB as a putative treatment for emotional dysregulation.
情绪调节障碍长期以来一直被视为多种精神疾病的关键症状。情绪调节困难与前额叶 - 边缘回路的神经调节异常有关。基于实时功能磁共振成像的神经反馈（rt - fMRI - NFB）作为一种治疗精神疾病中情绪调节障碍的潜在方法越来越受欢迎，因为它能够直接针对受损的神经回路。然而，这些rt - fMRI - NFB方案在精神疾病人群中的临床影响仍然很大程度上未知。在此，我们全面概述了2010年至2023年使用rt - fMRI - NFB来针对情绪调节的主要研究。我们对4001项原始研究中的41项进行了方法学质量和偏倚风险评估，并综合了关于rt - fMRI - NFB对神经和行为水平的显著相关效应的频率。在25%至50%的研究样本中报告了大脑活动的成功调节，而临床样本中的神经效应比健康样本更多样化。有趣的是，在临床样本中，与rt - fMRI - NFB相关的行为改善频率超过75%，而健康样本中的行为改善率在0%至25%之间。关于临床亚样本，在高达100%的重度抑郁症（MDD）和创伤后应激障碍（PTSD）样本中观察到了与rt - fMRI - NFB相关的行为改善。物质使用样本的行为益处率在50%至75%之间。神经效应似乎比行为改善的频率更低：MDD和物质使用的大多数神经结果在25%至50%之间，而PTSD的神经结果在0%至25%之间。使用多个个体化的感兴趣区域（ROI）进行rt - fMRI - NFB训练比仅基于杏仁核或前额叶皮层的rt - fMRI - NFB产生更频繁的行为益处。虽然大多数临床研究报告了行为结果的显著改善，但研究方案存在异质性，这限制了目前对rt - fMRI - NFB作为情绪调节障碍推定治疗方法的评估。
