Regulating Pathological Neural Connectivity in Posttraumatic Stress Disorder

ended

Posttraumatic stress disorder (PTSD) is a debilitating and prevalent psychiatric illness that develops after exposure to a traumatic event, and involves symptoms of severe intrusive recollections and flashbacks related to the trauma, hyperarousal and reactivity, avoidance, and negative alterations in cognitions and mood. Indeed, patients with PTSD are characterized by decreased prefrontal cortex (PFC) regulation on hyperactive emotion generation regions, such as the amygdala and brainstem. Real-time fMRI neurofeedback allows for brain regions to be self-regulated through neuroimaging signal feedback. Recently, the experienced researcher has shown that learning to decrease amygdala activation via real-time fMRI neurofeedback leads to a normalization of pathological neural circuitry maintaining PTSD, which was negatively correlated to symptoms. Critically, however, an intervention has not yet been developed to directly target suboptimal connectivity between emotion regulation regions (PFC) and emotion generation regions (amygdala and brainstem), where an urgent need for novel treatment interventions exists particularly among individuals suffering from PTSD. The objective of the current proposal is to determine the treatment efficacy of increasing the strength of connectivity from the PFC to the amygdala and brainstem via a real-time fMRI neurofeedback randomized clinical trial (RCT). Here, connectivity signals will be relayed back to the participant in the scanner as a simple thermometer that changes as directed connectivity between brain regions-of-interest fluctuate. Participants will be asked to self-regulate the neural signal displayed by the thermometer in real-time during PTSD emotion induction paradigms. The proposed study has the potential to develop into a novel treatment for PTSD, and is in line with current European research trends and societal needs to decrease the economic resources required to support mental health treatment.