Characteristics and Training of Neural Responding in BPD
Final Report Abstract
This project established neural training for down-regulation of amygdala activation, with the aim to contribute an effective brain-derived treatment of dysregulated emotion. Brain activations become visible with live-feedback from neuroimaging, named neurofeedback. Neurofeedback empowers patients to self-regulate the amygdala, which is a neural center of emotion processing. A requirement to practice down-regulation is sustained activation of the target brain region. It was demonstrated in this project that the amygdala shows the critical sustained response when persons are exposed to negative emotional scenes for eighteen seconds. The literature suggests that the amygdala response is inflated in patients with Borderline Personality Disorder (BPD). Amygdala hyper-responding is supposed to underlie emotional hyper-reactivity. It was shown that fMRI neurofeedback training is feasible, is well accepted by patients and alters connectivity in critical neural networks of emotion processing and regulation. Affective instability, which is hallmark symptom of BPD, was reduced and emotion regulation improved. Changes were demonstrated in the brain, in psychophysiological measures and in behavior, including ecological momentary assessment. Future studies with placebo control are needed to confirm that the clinical improvements demonstrated in this project are due to amygdala modulation.
Publications
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(2014). Down-regulation of amygdala activation with real-time fMRI neurofeedback in a healthy female sample. Frontiers in Behavioral Neuroscience, 8(299)
Paret, C., Kluetsch, R., Ruf, M., Demirakca, T., Hoesterey, S., Ende, G., & Schmahl, C.
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(2014). Transient and sustained BOLD signal time courses affect the detection of emotion-related brain activation in fMRI. NeuroImage, 103, 522-532
Paret, C., Kluetsch, R., Ruf, M., Demirakca, T., Kalisch, R., Schmahl, C., & Ende, G.
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(2016). Alterations of amygdala-prefrontal connectivity with real-time fMRI neurofeedback in BPD patients. Social Cognitive and Affective Neuroscience, 11(6), 952-960
Paret, C., Kluetsch, R., Zaehringer, J., Ruf, M., Demirakca, T., Bohus, M., . . . Schmahl, C.
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(2016). fMRI neurofeedback of amygdala response to aversive stimuli enhances prefrontal– limbic brain connectivity. NeuroImage, 125, 182-188
Paret, C., Ruf, M., Gerchen, M. F., Kluetsch, R., Demirakca, T., Jungkunz, M., . . . Ende, G.
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(2016). Meta-analysis of real-time fMRI neurofeedback studies using individual participant data: How is brain regulation mediated? NeuroImage, 124, 806-812
Emmert, K., Kopel, R., Sulzer, J., Brühl, A. B., Berman, B. D., Linden, D. E. J., . . . Haller, S.
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(2017). The neurobiology of emotion regulation in posttraumatic stress disorder: Amygdala downregulation via real-time fMRI neurofeedback. Human Brain Mapping, 38(1), 541-560
Nicholson, A. A., Rabellino, D., Densmore, M., Frewen, P. A., Paret, C., Kluetsch, R., . . . Lanius, R. A.
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(2018). Emotion-modulated startle reflex during reappraisal: Probe timing and behavioral correlates. Behavioral Neuroscience, 132(6), 573-579
Zaehringer, J., Schmahl, C., Ende, G., & Paret, C.
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(2018). Intrinsic connectivity network dynamics in PTSD during amygdala downregulation using real-time fMRI neurofeedback: A preliminary analysis. Human Brain Mapping, 39(11), 4258-4275
Nicholson, A. A., Rabellino, D., Densmore, M., Frewen, P. A., Paret, C., Kluetsch, R., . . . Lanius, R. A.
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(2018). Monitoring and control of amygdala neurofeedback involves distributed information processing in the human brain. Human Brain Mapping, 39(7), 3018-3031
Paret, C., Zähringer, J., Ruf, M., Gerchen, M. F., Mall, S., Hendler, T., . . . Ende, G
