Enhanced efficacy of CBT following augmentation with amygdala rtfMRI neurofeedback in depression

• Published in: Journal of affective disorders 2023-10, Vol.339, p.495-501
• Main Authors: Compère, Laurie, Siegle, Greg J., Riley, Emily, Lazzaro, Sair, Strege, Marlene, Pacoe, Elizabeth, Canovali, Gia, Barb, Scott, Huppert, Theodore, Young, Kymberly
• Format: Article
• Language: English
• Subjects: Adult; Amygdala; Amygdala - diagnostic imaging; Autobiographical memory; Cognitive behavioral therapy; Depression; Depressive Disorder, Major - diagnostic imaging; Depressive Disorder, Major - therapy; Emotion: fMRI neurofeedback: Major depressive disorder; Humans; Image Processing, Computer-Assisted; Magnetic Resonance Imaging - methods; Neurofeedback - methods
• ISSN: 0165-0327; 1573-2517; 1573-2517
• DOI: 10.1016/j.jad.2023.07.063

Despite cognitive behavioral therapy (CBT) being a standard treatment in major depressive disorder (MDD), nearly half of patients do not respond. As one of the predictors of CBT's efficacy is amygdala reactivity to positive information, which is often decreased in MDD, we explored whether real-time fMRI neurofeedback (rtfMRI-nf) training to increase amygdala responses during positive memory recall prior CBT would enhance its efficacy. In a double-blind, placebo controlled, randomized clinical trial, 35 adults with MDD received two sessions of rtfMRI-nf training to increase their amygdala (experimental group, n = 16) or parietal (control group, n = 19) responses during positive memory neurofeedback prior to receiving 10 CBT sessions. Depressive symptomatology was monitored between the rtfMRI sessions, the first three, 9th and 10th sessions of CBT and at 6 months and 1 year follow-up. Participants in the experimental group showed decreased depressive symptomatology and higher remission rates at 6 months and 1 year follow-up than the control group. Analysis of CBT content highlighted that participants in the experimental group focused more on positive thinking and behaviors than the control group. The study was relatively small and not sufficiently powered to detect small effects. CBT, when combined with amygdala neurofeedback, results in sustained clinical changes and leads to long-lasting clinical improvement, potentially by increasing focus on positive memories and cognitions. •Amygdala rtfMRI-nf prior to CBT enable sustained clinical improvement.•Amygdala neurofeedback is independently effective and enhance the effects of CBT.•Efficacity of rtfMRI-nf is dependent of receiving training but not performance.•rtfMRI-nf facilitated participants to reflect about positive emotions during CBT.