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. 2023 Mar;13(3):e2883.
doi: 10.1002/brb3.2883. Epub 2023 Feb 15.

Posterior cingulate cortex targeted real-time fMRI neurofeedback recalibrates functional connectivity with the amygdala, posterior insula, and default-mode network in PTSD

Jonathan M Lieberman  1   2 , Daniela Rabellino  2   3 , Maria Densmore  2   4 , Paul A Frewen  3   5 , David Steyrl  6 , Frank Scharnowski  6 , Jean Théberge  2   4   7   8 , Richard W J Neufeld  3   4   5   9 , Christian Schmahl  10 , Rakesh Jetly  11 , Sandhya Narikuzhy  1 , Ruth A Lanius  2   3   4   12 , Andrew A Nicholson  1   6   7   11   12   13   14
Affiliations

Posterior cingulate cortex targeted real-time fMRI neurofeedback recalibrates functional connectivity with the amygdala, posterior insula, and default-mode network in PTSD

Jonathan M Lieberman et al. Brain Behav. 2023 Mar.

Abstract

Background: Alterations within large-scale brain networks-namely, the default mode (DMN) and salience networks (SN)-are present among individuals with posttraumatic stress disorder (PTSD). Previous real-time functional magnetic resonance imaging (fMRI) and electroencephalography neurofeedback studies suggest that regulating posterior cingulate cortex (PCC; the primary hub of the posterior DMN) activity may reduce PTSD symptoms and recalibrate altered network dynamics. However, PCC connectivity to the DMN and SN during PCC-targeted fMRI neurofeedback remains unexamined and may help to elucidate neurophysiological mechanisms through which these symptom improvements may occur.

Methods: Using a trauma/emotion provocation paradigm, we investigated psychophysiological interactions over a single session of neurofeedback among PTSD (n = 14) and healthy control (n = 15) participants. We compared PCC functional connectivity between regulate (in which participants downregulated PCC activity) and view (in which participants did not exert regulatory control) conditions across the whole-brain as well as in a priori specified regions-of-interest.

Results: During regulate as compared to view conditions, only the PTSD group showed significant PCC connectivity with anterior DMN (dmPFC, vmPFC) and SN (posterior insula) regions, whereas both groups displayed PCC connectivity with other posterior DMN areas (precuneus/cuneus). Additionally, as compared with controls, the PTSD group showed significantly greater PCC connectivity with the SN (amygdala) during regulate as compared to view conditions. Moreover, linear regression analyses revealed that during regulate as compared to view conditions, PCC connectivity to DMN and SN regions was positively correlated to psychiatric symptoms across all participants.

Conclusion: In summary, observations of PCC connectivity to the DMN and SN provide emerging evidence of neural mechanisms underlying PCC-targeted fMRI neurofeedback among individuals with PTSD. This supports the use of PCC-targeted neurofeedback as a means by which to recalibrate PTSD-associated alterations in neural connectivity within the DMN and SN, which together, may help to facilitate improved emotion regulation abilities in PTSD.

Keywords: default mode network; fMRI neurofeedback; posterior cingulate cortex; posttraumatic stress disorder.

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Conflict of interest statement

All authors declare no financial interests or potential conflicts of interest with regard to the current study.

Figures

FIGURE 1
FIGURE 1
Depiction of the rt‐fMRI‐NFB set‐up. While participants were inside the scanner, they were presented with a neurofeedback signal in the form of a virtual thermometer that increased/decreased in response to fluctuating activity within the neurofeedback target region (PCC). Participants completed three neurofeedback training runs, followed by a transfer run, in which they were not presented with the neurofeedback signal. Figure reproduced with permission from Nicholson et al. (2021).
FIGURE 2
FIGURE 2
(a) Event‐related BOLD activation within the neurofeedback target area (PCC) for the PTSD and healthy control groups during the three neurofeedback training runs. The red and green lines indicate PCC activation during the regulate and view conditions, respectively. As shown, both the PTSD and healthy control groups showed significantly lower PCC activation during regulate as compared to view conditions for all three neurofeedback training runs. (b) Event‐related BOLD activation within the neurofeedback target area (PCC) for the PTSD and healthy control groups during the transfer run. As with the training runs, both groups showed significantly lower PCC activation during regulate as compared to view conditions during the transfer run. The x‐axis of the graphs indicate time over the 24 s conditions; the y‐axis indicates the event‐related BOLD response (peristimulus time histogram) in the neurofeedback target area (PCC). Shaded areas adjacent to the red and green lines indicate standard error of the mean. PCC = posterior cingulate cortex, NFB = Neurofeedback. Figure reproduced with permission from Nicholson et al. (2021).
FIGURE 3
FIGURE 3
State changes in emotional experience (i.e., reliving and distress symptoms, as measured by the RSDI scale) over NFB training during a trauma/emotion provocation paradigm. Both the PTSD and healthy control groups demonstrated significant reductions in reliving symptoms. Only the PTSD group demonstrated significant reductions on distress symptoms. NFB = neurofeedback, RSDI = Response to Script Driven Imagery Scale. Figure reproduced with permission from Nicholson et al. (2021).
FIGURE 4
FIGURE 4
Within‐ and between‐group differences in functional connectivity of the PCC during the 3 neurofeedback training runs and the transfer run. Results show brain areas that were found to display increased functional connectivity with the PPI seed region (left or right PCC) during regulate as compared to view conditions. (a) The within‐healthy control group comparison revealed left and right PCC connectivity with the bilateral cuneus/precuneus during regulate as compared to view conditions for the neurofeedback training runs. (b) The within‐PTSD group comparison revealed left and right PCC connectivity with the bilateral cuneus/precuneus, left parietal/central operculum, and left posterior insula during regulate as compared to view conditions for the neurofeedback training runs. Additionally, left PCC‐dmPFC and right PCC‐vmPFC connectivity was also observed during regulate as compared to view conditions for the neurofeedback training runs. (c) The between‐group comparison revealed that the PTSD group displayed increased right PCC‐right amygdala connectivity relative to the healthy control group during regulate as compared to view conditions for the neurofeedback training runs. (d) The within‐healthy control group comparison revealed left PCC connectivity with the bilateral calcarine cortex/cuneus during regulate as compared to view conditions for the neurofeedback transfer run. All results are evaluated at the FWE‐peak corrected threshold for multiple comparisons (p < .05, k = 10). NFB = neurofeedback, PCC = posterior cingulate cortex, dmPFC = dorsomedial prefrontal cortex, vmPFC = ventromedial prefrontal cortex.
FIGURE 5
FIGURE 5
Clinical symptom correlation results across all participants over 3 combined neurofeedback training runs. Results indicate brain areas whose connectivity with the PPI seed region—the left or right PCC—are correlated with participant scores on clinical measures during regulate as compared to view conditions. (a) CAPS scores are positively correlated with connectivity between the right PCC and both the right amygdala and left anterior insula. (b) Connectivity between both PCC seeds and the right amygdala are positively correlated with BDI scores. (c) MDI scores are positively correlated with right PCC‐right amygdala connectivity. (d) Connectivity between both PCC seeds and the right amygdala are positively correlated with DERS scores. (e) CTQ scores are positively correlated with connectivity between the left PCC and both the right ventral striatum/nucleus accumbens and the dmPFC. All results are evaluated at the FWE‐peak corrected threshold for multiple comparisons (p��< .05, k = 10). NFB = neurofeedback, PCC = posterior cingulate cortex, dmPFC = dorsomedial prefrontal cortex, CAPS = Clinician‐administered PTSD Scale, BDI = Beck's Depression Inventory, MDI = Multiscale Dissociation Inventory, DERS = Difficulties in Emotion Regulation Scale, CTQ = Childhood Trauma Questionnaire.
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References

    1. Abdallah, C. G. , Southwick, S. M. , & Krystal, J. H. (2017). Neurobiology of posttraumatic stress disorder (PTSD): A path from novel pathophysiology to innovative therapeutics. Neuroscience Letters, 649, 130–132. 10.1016/j.neulet.2017.04.046 - DOI - PubMed
    1. Aghajani, M. , Veer, I. M. , Van Hoof, M. ‐. J. , Rombouts, S. A. R. B. , Van Der Wee, N. J. , & Vermeiren, R. R. J. M. (2016). Abnormal functional architecture of amygdala‐centered networks in adolescent posttraumatic stress disorder. Human Brain Mapping, 37(3), 1120–1135. 10.1002/hbm.23093 - DOI - PMC - PubMed
    1. Akiki, T. J. , Averill, C. L. , Wrocklage, K. M. , Scott, J. C. , Averill, L. A. , Schweinsburg, B. , Alexander‐Bloch, A. , Martini, B. , Southwick, S. M. , Krystal, J. H. , & Abdallah, C. G. (2018). Default mode network abnormalities in posttraumatic stress disorder: A novel network‐restricted topology approach. Neuroimage, 176, 489–498. 10.1016/j.neuroimage.2018.05.005 - DOI - PMC - PubMed
    1. Akiki, T. J. , Averill, C. L. , & Abdallah, C. G. (2017). A network‐based neurobiological model of PTSD: Evidence from structural and functional neuroimaging studies. Current Psychiatry Reports, 19(11), 81. 10.1007/s11920-017-0840-4 - DOI - PMC - PubMed
    1. Albert, K. M. , Potter, G. G. , Boyd, B. D. , Kang, H. , & Taylor, W. D. (2019). Brain network functional connectivity and cognitive performance in major depressive disorder. Journal of Psychiatric Research, 110, 51–56. 10.1016/j.jpsychires.2018.11.020 - DOI - PMC - PubMed

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