Department of Psychology, UCLA, Los Angeles, California, USA.
RIKEN Center for Brain Science, Wako, Japan.
Psychiatry Clin Neurosci. 2024 Nov;78(11):678-686. doi: 10.1111/pcn.13726. Epub 2024 Sep 2.
A new closed-loop functional magnetic resonance imaging method called multivoxel neuroreinforcement has the potential to alleviate the subjective aversiveness of exposure-based interventions by directly inducing phobic representations in the brain, outside of conscious awareness. The current study seeks to test this method as an intervention for specific phobia.
In a randomized, double-blind, controlled single-university trial, individuals diagnosed with at least two (one target, one control) animal subtype-specific phobias were randomly assigned (1:1:1) to receive one, three, or five sessions of multivoxel neuroreinforcement in which they were rewarded for implicit activation of a target animal representation. Amygdala response to phobic stimuli was assessed by study staff blind to target and control animal assignments. Pretreatment to posttreatment differences were analyzed with a two-way repeated-measures anova.
A total of 23 participants (69.6% female) were randomized to receive one (n = 8), three (n = 7), or five (n = 7) sessions of multivoxel neuroreinforcement. Eighteen (n = 6 each group) participants were analyzed for our primary outcome. After neuroreinforcement, we observed an interaction indicating a significant decrease in amygdala response for the target phobia but not the control phobia. No adverse events or dropouts were reported as a result of the intervention.
Results suggest that multivoxel neuroreinforcement can specifically reduce threat signatures in specific phobia. Consequently, this intervention may complement conventional psychotherapy approaches with a nondistressing experience for patients seeking treatment. This trial sets the stage for a larger randomized clinical trial to replicate these results and examine the effects on real-life exposure.
The now-closed trial was prospectively registered at ClinicalTrials.gov with ID NCT03655262.
一种新的闭环功能磁共振成像方法，称为多体神经强化，有可能通过直接在大脑中诱导恐惧症的表现，而无需意识参与，从而减轻基于暴露的干预措施的主观厌恶感。本研究旨在测试该方法作为特定恐惧症的干预措施。
在一项随机、双盲、对照的单中心试验中，诊断为至少两种（一种目标，一种对照）动物亚型特异性恐惧症的个体被随机分配（1:1:1）接受一次、三次或五次多体神经强化治疗，他们因目标动物代表的内隐激活而获得奖励。研究人员对杏仁核对恐惧刺激的反应进行评估，而不知道目标和对照动物的分配。采用双向重复测量方差分析分析预处理后与后处理的差异。
共有 23 名参与者（69.6%为女性）被随机分配接受一次（n=8）、三次（n=7）或五次（n=7）多体神经强化治疗。18 名（n=6 名/组）参与者接受了我们的主要结局分析。在神经强化后，我们观察到一个交互作用，表明目标恐惧症的杏仁核反应显著降低，但对照恐惧症没有。没有因干预而报告不良反应或退出。
结果表明，多体神经强化可以特异性地降低特定恐惧症的威胁特征。因此，这种干预可能会为寻求治疗的患者提供一种非痛苦的体验，补充传统的心理治疗方法。这项试验为更大规模的随机临床试验奠定了基础，以复制这些结果并研究对现实暴露的影响。
现已关闭的试验在 ClinicalTrials.gov 上进行了前瞻性注册，ID 为 NCT03655262。
