Acquired self‐control of insula cortex modulates emotion recognition and brain network connectivity in schizophrenia

Abstract

Real-time functional magnetic resonance imaging (rtfMRI) is a novel technique that has allowed subjects to achieve self-regulation of circumscribed brain regions. Despite its anticipated therapeutic benefits, there is no report on successful application of this technique in psychiatric populations. The objectives of the present study were to train schizophrenia patients to achieve volitional control of bilateral anterior insula cortex on multiple days, and to explore the effect of learned self-regulation on face emotion recognition (an extensively studied deficit in schizophrenia) and on brain network connectivity. Nine patients with schizophrenia were trained to regulate the hemodynamic response in bilateral anterior insula with contingent rtfMRI neurofeedback, through a 2-weeks training. At the end of the training stage, patients performed a face emotion recognition task to explore behavioral effects of learned self-regulation. A learning effect in self-regulation was found for bilateral anterior insula, which persisted through the training. Following successful self-regulation, patients recognized disgust faces more accurately and happy faces less accurately. Improvements in disgust recognition were correlated with levels of self-activation of right insula. RtfMRI training led to an increase in the number of the incoming and outgoing effective connections of the anterior insula. This study shows for the first time that patients with schizophrenia can learn volitional brain regulation by rtfMRI feedback training leading to changes in the perception of emotions and modulations of the brain network connectivity. These findings open the door for further studies of rtfMRI in severely ill psychiatric populations, and possible therapeutic applications.

Multi-modal Virtual Scenario Enhances Neurofeedback Learning

“…The results showed that participants who initially trained via the AS interface were better able to regulate the amyg-EFP in the absence of online feedback (open-loop Brain-Computer Interface), indicating better learning sustainability ( Figure 4A). This "sustainability effect" in a no-feedback trial was demonstrated in previous studies, although mostly conducted immediately after one NF session (i.e., at the same day) (deCharms et al, 2004(deCharms et al, , 2005Ruiz et al, 2013;Sulzer et al, 2013a,b). In the current study, we further challenged our trainees by conducting the no-feedback trial 1 week following the initial NF session, with no refresher training in between.…”

Closed-loop brain training: the science of neurofeedback

“…This study demonstrates that neurofeedback is able not only to alter connectivity between two functionally distinct brain networks but also to exert long-term effects. Network reorganization resulting from neurofeedback training of single regions was observed in earlier studies 34,35 , whereas recent studies have attempted neurofeedback training of functional connectivity between brain regions. For example, in one study, participants were trained to be able to alter the level of interhemispheric motor cortical coherence through the use of contingent magnetoencephalography-based neurofeedback, leading to proportional changes in asynchronous finger tapping 36,37 .…”

The self-regulating brain and neurofeedback: Experimental science and clinical promise

“…As it turns out, few studies examine sustainability in neurofeedback (Thibault et al, 2015). Whereas some experiments demonstrate that participants retain control over target brain regions Mathiak et al, 2015;Robineau et al, 2014;Scharnowski et al, 2015;Zotev, Phillips, Young, et al, 2013;Zotev, Phillips, Yuan, et al, 2013;Zotev et al, 2011), other studies report no such retention (Berman, Horovitz, & Hallett, 2013;Greer et al, 2014;Hamilton et al, 2011;Ruiz et al, 2013;. Thus, the conundrums of mental strategy and sustainability still beg resolution.…”

“…According to some studies, modulating activity in the insula appears to influence the perceived valence of emotional stimuli (Caria et al, 2010;Ruiz et al, 2013); yet one of these studies had no control group and another experiment suggested that control over activity in the insula area hardly related to valence ratings (Lawrence et al, 2014).…”

“…Interestingly, looking across experiments we find many cases of distinct protocols encouraging regulation in opposing directions. For example, many experiments train participants to up-regulate anterior insular activity to increase valence ratings (Caria, Sitaram, Veit, Begliomini, & Birbaumer, 2010;Lawrence et al, 2014;Ruiz et al, 2013;Sitaram et al, 2014), while other studies encourage down-regulation to decrease pain perception (Emmert et al, 2014;Rance, Ruttorf, Nees, Rudi Schad, & Flor, 2014) or subdue a phobia (Zilverstand, Sorger, Sarkheil, & Goebel, 2015).…”