Neurofeedback training might help to improve the effectiveness of certain psychological interventions for patients with depression, according to new research. But the findings indicate that fMRI neurofeedback might not be effective for patients with the anxious distress subtype of depression.
The study, published in Psychological Medicine, examined a neurofeedback intervention targeting self-blaming biases in major depressive disorder
“Excessive self-blame is an important symptom and cause of depression and distinguishes depression from healthy bereavement, as Sigmund Freud pointed out,” said study author Roland Zahn, a professor at King’s College London and honorary consultant psychiatrist at Maudsley Hospital.
“Together with my colleague Jorge Moll from the D’Or Institute for Research and Education in Rio de Janeiro, my research group has started to identify the brain circuits that are important for overgeneralized self-blame in depression (e.g. ‘feeling like a total failure’ or ‘feeling guilty for everything’ or ‘loathing oneself’).”
“We previously used functional magnetic resonance imaging (fMRI) to show that whilst thinking about self-blame-evoking statements, the communication between two brain regions — the subgenual part of the frontal region and a section of the anterior temporal lobe just beneath our right temple — predicted risk of recurrent depression,” Zahn explained.
“The current study was motivated by two questions: Firstly, can we confirm our hypothesis that the connectivity between these two brain regions plays a causal role in depressive forms of overgeneralized self-blame. If there was a causal relationship then helping people to train their brain connectivity should improve their depression. Secondly, we wanted to see whether we can use this to develop a new non-invasive treatment approach for depression.”
In the study, 35 participants with recurrent major depressive disorder attended three treatment sessions where they were taught cognitive strategies to tackle self-blame. Some of these participants were randomly assigned to receive the treatment alongside additional fMRI neurofeedback training.
The neurofeedback training provided the participants with a visual representation of their brain activity, giving them information about cognitive states that would otherwise be outside of their awareness.
“Jorge Moll and his team have developed a software for our studies which allowed us to measure connectivity between brain regions directly whilst people are in an MRI scanner and update the measure every two seconds,” Zahn explained. “This was inspired by previous breakthroughs from other groups who have worked on fMRI neurofeedback, a specific type of biofeedback where you can use a signal from your brain to learn how to modify it.”
In line with their predictions, the researchers found that fMRI neurofeedback training was associated with in a decrease in functional connectivity between the posterior subgenual cortex and the right superior anterior temporal lobe. But, when it came to treatment response, the researchers found no difference between those who received fMRI neurofeedback training and those who didn’t. Both groups experienced a similar reduction in symptoms, as measured via the Beck Depression Inventory-II.
“We were unable to conclude that the fMRI neurofeedback was better than the control intervention overall,” Zahn told PsyPost. However, “when we explored our data further to see whether different types of depression showed a different pattern of response, we found a very important clue in that people with non-anxious depression benefitted much more from neurofeedback than our solely psychological control intervention, whereas in anxious depression it was the opposite.”
Depression with anxious distress is characterized by feeling tense and restless, having difficulty concentrating because of worry, fearing that something awful might happen, and having a sense that one might lose control.
“We had only a small number of non-anxious depression patients and that we did not plan this analysis, so our result is exploratory and needs to be replicated in an independent larger study before it could be recommended as a treatment in a clinical setting,” Zahn said. “But for us it was a very important step in prompting us to investigate anxious depression further, a relatively new subtype in the latest version of the American Psychiatric Association-based classification. We have learned that we need to identify specific treatment targets in different subtypes of depression and provide more tailored neurofeedback treatments.”
Despite the limitations, the findings suggest that neurofeedback training is a safe approach to managing depressive symptoms that warrants further investigation.
“We think that fMRI neurofeedback has the prospect of becoming a treatment in the next 10 or 20 years and colleagues around the world have been working on different approaches that are promising,” Zahn said. “Much more work is needed though before it can be recommended clinically.”
The study, “Self-blame in major depression: a randomised pilot trial comparing fMRI neurofeedback with self-guided psychological strategies“, was authored by Tanja Jaeckle, Steven C. R. Williams, Gareth J. Barker, Rodrigo Basilio, Ewan Carr, Kimberley Goldsmith4 Alessandro Colasanti, Vincent Giampietro, Anthony Cleare, Allan H. Young, Jorge Moll and Roland Zahn.