Real-time fMRI Biofeedback Targeting the Orbitofrontal Cortex for Contamination Anxiety

Abstract

We present a method for training subjects to control activity in a region of their orbitofrontal cortex associated with contamination anxiety using biofeedback of real-time functional magnetic resonance imaging (rt-fMRI) data. Increased activity of this region is seen in relationship with contamination anxiety both in control subjects and in individuals with obsessive-compulsive disorder (OCD), a relatively common and often debilitating psychiatric disorder involving contamination anxiety. Although many brain regions have been implicated in OCD, abnormality in the orbitofrontal cortex (OFC) is one of the most consistent findings. Furthermore, hyperactivity in the OFC has been found to correlate with OCD symptom severity and decreases in hyperactivity in this region have been reported to correlate with decreased symptom severity. Therefore, the ability to control this brain area may translate into clinical improvements in obsessive-compulsive symptoms including contamination anxiety. Biofeedback of rt-fMRI data is a new technique in which the temporal pattern of activity in a specific region (or associated with a specific distributed pattern of brain activity) in a subject's brain is provided as a feedback signal to the subject. Recent reports indicate that people are able to develop control over the activity of specific brain areas when provided with rt-fMRI biofeedback. In particular, several studies using this technique to target brain areas involved in emotion processing have reported success in training subjects to control these regions. In several cases, rt-fMRI biofeedback training has been reported to induce cognitive, emotional, or clinical changes in subjects. Here we illustrate this technique as applied to the treatment of contamination anxiety in healthy subjects. This biofeedback intervention will be a valuable basic research tool: it allows researchers to perturb brain function, measure the resulting changes in brain dynamics and relate those to changes in contamination anxiety or other behavioral measures. In addition, the establishment of this method serves as a first step towards the investigation of fMRI-based biofeedback as a therapeutic intervention for OCD. Given that approximately a quarter of patients with OCD receive little benefit from the currently available forms of treatment, and that those who do benefit rarely recover completely, new approaches for treating this population are urgently needed.

Orbitofrontal cortex neurofeedback produces lasting changes in contamination anxiety and resting-state connectivity

“…Our rt-fMRI NF protocol has been described in detail in a methods publication 16 using the system described in Scheinost et al 17 We provide here a general description but refer the reader there for more specific information. Briefly, the experimental paradigm consisted of four MRI scanning sessions, spaced roughly half a week apart.…”

“…The sets of contamination and neutral images used at different time points in the protocol were balanced for induced anxiety, as described previously. 16 …”

Real-time functional magnetic resonance imaging in obsessive-compulsive disorder

“…The rtfMRI regulation of contamination symptoms in a healthy sample was also addressed in a study by Scheinost et al as part of a research program on the use of rtfMRI with OCD, tic disorder, and posttraumatic stress disorder 63–65. This time, the OFC was the brain ROIs 64.…”

A Graphics Processing Unit Accelerated Motion Correction Algorithm and Modular System for Real-time fMRI

“…A second example of different front-end components is written in Matlab and the feedback provided to the subject includes multiple stimuli shown simultaneously (Figure 3b). This biofeedback display was designed for a study in which subjects were trained to control a region of the orbitofrontal cortex involved in contamination anxiety while viewing anxiety-provoking stimuli (Hampson et al, 2011b). At the top of the display, a large image presents scenes that are either neutral or designed to provoke contamination anxiety.…”

“…Recently, rt-fMRI has received increased interest with several published studies in the past two years (Caria et al, 2011; Caria et al, 2010; Cusack et al, 2011; Goebel et al, 2011; Hamilton et al, 2011; Hampson et al, 2011a; Hampson et al, 2011b; Hinds et al, 2011; LaConte, 2011; Lee et al, 2011; McCaig et al, 2011; Rota et al, 2011; Sander and Kandrot, 2010; Shibata et al, 2011; Sitaram et al, 2010; Zotev et al, 2011). However, compared to standard fMRI experiments, rt-fMRI is still limited by processing speed and available software.…”