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Lieberman JM, Rabellino D, Densmore M, Frewen PA, Steyrl D, Scharnowski F, Théberge J, Neufeld RWJ, Schmahl C, Jetly R, Narikuzhy S, Lanius RA, Nicholson AA. Posterior cingulate cortex targeted real-time fMRI neurofeedback recalibrates functional connectivity with the amygdala, posterior insula, and default-mode network in PTSD. Brain Behav 2023; 13:e2883. [PMID: 36791212 PMCID: PMC10013955 DOI: 10.1002/brb3.2883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 12/07/2022] [Accepted: 12/12/2022] [Indexed: 02/17/2023] Open
Abstract
BACKGROUND Alterations within large-scale brain networks-namely, the default mode (DMN) and salience networks (SN)-are present among individuals with posttraumatic stress disorder (PTSD). Previous real-time functional magnetic resonance imaging (fMRI) and electroencephalography neurofeedback studies suggest that regulating posterior cingulate cortex (PCC; the primary hub of the posterior DMN) activity may reduce PTSD symptoms and recalibrate altered network dynamics. However, PCC connectivity to the DMN and SN during PCC-targeted fMRI neurofeedback remains unexamined and may help to elucidate neurophysiological mechanisms through which these symptom improvements may occur. METHODS Using a trauma/emotion provocation paradigm, we investigated psychophysiological interactions over a single session of neurofeedback among PTSD (n = 14) and healthy control (n = 15) participants. We compared PCC functional connectivity between regulate (in which participants downregulated PCC activity) and view (in which participants did not exert regulatory control) conditions across the whole-brain as well as in a priori specified regions-of-interest. RESULTS During regulate as compared to view conditions, only the PTSD group showed significant PCC connectivity with anterior DMN (dmPFC, vmPFC) and SN (posterior insula) regions, whereas both groups displayed PCC connectivity with other posterior DMN areas (precuneus/cuneus). Additionally, as compared with controls, the PTSD group showed significantly greater PCC connectivity with the SN (amygdala) during regulate as compared to view conditions. Moreover, linear regression analyses revealed that during regulate as compared to view conditions, PCC connectivity to DMN and SN regions was positively correlated to psychiatric symptoms across all participants. CONCLUSION In summary, observations of PCC connectivity to the DMN and SN provide emerging evidence of neural mechanisms underlying PCC-targeted fMRI neurofeedback among individuals with PTSD. This supports the use of PCC-targeted neurofeedback as a means by which to recalibrate PTSD-associated alterations in neural connectivity within the DMN and SN, which together, may help to facilitate improved emotion regulation abilities in PTSD.
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Affiliation(s)
- Jonathan M Lieberman
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada.,Imaging, Lawson Health Research Institute, London, Ontario, Canada
| | - Daniela Rabellino
- Imaging, Lawson Health Research Institute, London, Ontario, Canada.,Department of Neuroscience, Western University, London, Ontario, Canada
| | - Maria Densmore
- Imaging, Lawson Health Research Institute, London, Ontario, Canada.,Department of Psychiatry, Western University, London, Ontario, Canada
| | - Paul A Frewen
- Department of Neuroscience, Western University, London, Ontario, Canada.,Department of Psychology, Western University, London, Ontario, Canada
| | - David Steyrl
- Department of Cognition, Emotion, and Methods in Psychology, University of Vienna, Vienna, Austria
| | - Frank Scharnowski
- Department of Cognition, Emotion, and Methods in Psychology, University of Vienna, Vienna, Austria
| | - Jean Théberge
- Imaging, Lawson Health Research Institute, London, Ontario, Canada.,Department of Psychiatry, Western University, London, Ontario, Canada.,Department of Medical Biophysics, Western University, London, Ontario, Canada.,Department of Diagnostic Imaging, St. Joseph's Healthcare, London, Ontario, Canada
| | - Richard W J Neufeld
- Department of Neuroscience, Western University, London, Ontario, Canada.,Department of Psychiatry, Western University, London, Ontario, Canada.,Department of Psychology, Western University, London, Ontario, Canada.,Department of Psychology, University of British Columbia, Okanagan, Kelowna, British Columbia, Canada
| | - Christian Schmahl
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health Mannheim, Heidelberg University, Heidelberg, Germany
| | - Rakesh Jetly
- The Institute of Mental Health Research, University of Ottawa, Royal Ottawa Hospital, Ontario, Canada
| | - Sandhya Narikuzhy
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Ruth A Lanius
- Imaging, Lawson Health Research Institute, London, Ontario, Canada.,Department of Neuroscience, Western University, London, Ontario, Canada.,Department of Psychiatry, Western University, London, Ontario, Canada.,Homewood Research Institute, Guelph, Ontario, Canada
| | - Andrew A Nicholson
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada.,Department of Cognition, Emotion, and Methods in Psychology, University of Vienna, Vienna, Austria.,Department of Medical Biophysics, Western University, London, Ontario, Canada.,The Institute of Mental Health Research, University of Ottawa, Royal Ottawa Hospital, Ontario, Canada.,Homewood Research Institute, Guelph, Ontario, Canada.,Atlas Institute for Veterans and Families, Ottawa, Ontario, Canada.,School of Psychology, University of Ottawa, Ottawa, Canada
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Ekhtiari H, Zare-Bidoky M, Sangchooli A, Janes AC, Kaufman MJ, Oliver JA, Prisciandaro JJ, Wüstenberg T, Anton RF, Bach P, Baldacchino A, Beck A, Bjork JM, Brewer J, Childress AR, Claus ED, Courtney KE, Ebrahimi M, Filbey FM, Ghahremani DG, Azbari PG, Goldstein RZ, Goudriaan AE, Grodin EN, Hamilton JP, Hanlon CA, Hassani-Abharian P, Heinz A, Joseph JE, Kiefer F, Zonoozi AK, Kober H, Kuplicki R, Li Q, London ED, McClernon J, Noori HR, Owens MM, Paulus MP, Perini I, Potenza M, Potvin S, Ray L, Schacht JP, Seo D, Sinha R, Smolka MN, Spanagel R, Steele VR, Stein EA, Steins-Loeber S, Tapert SF, Verdejo-Garcia A, Vollstädt-Klein S, Wetherill RR, Wilson SJ, Witkiewitz K, Yuan K, Zhang X, Zilverstand A. A methodological checklist for fMRI drug cue reactivity studies: development and expert consensus. Nat Protoc 2022; 17:567-595. [PMID: 35121856 PMCID: PMC9063851 DOI: 10.1038/s41596-021-00649-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 10/21/2021] [Indexed: 12/23/2022]
Abstract
Cue reactivity is one of the most frequently used paradigms in functional magnetic resonance imaging (fMRI) studies of substance use disorders (SUDs). Although there have been promising results elucidating the neurocognitive mechanisms of SUDs and SUD treatments, the interpretability and reproducibility of these studies is limited by incomplete reporting of participants' characteristics, task design, craving assessment, scanning preparation and analysis decisions in fMRI drug cue reactivity (FDCR) experiments. This hampers clinical translation, not least because systematic review and meta-analysis of published work are difficult. This consensus paper and Delphi study aims to outline the important methodological aspects of FDCR research, present structured recommendations for more comprehensive methods reporting and review the FDCR literature to assess the reporting of items that are deemed important. Forty-five FDCR scientists from around the world participated in this study. First, an initial checklist of items deemed important in FDCR studies was developed by several members of the Enhanced NeuroImaging Genetics through Meta-Analyses (ENIGMA) Addiction working group on the basis of a systematic review. Using a modified Delphi consensus method, all experts were asked to comment on, revise or add items to the initial checklist, and then to rate the importance of each item in subsequent rounds. The reporting status of the items in the final checklist was investigated in 108 recently published FDCR studies identified through a systematic review. By the final round, 38 items reached the consensus threshold and were classified under seven major categories: 'Participants' Characteristics', 'General fMRI Information', 'General Task Information', 'Cue Information', 'Craving Assessment Inside Scanner', 'Craving Assessment Outside Scanner' and 'Pre- and Post-Scanning Considerations'. The review of the 108 FDCR papers revealed significant gaps in the reporting of the items considered important by the experts. For instance, whereas items in the 'General fMRI Information' category were reported in 90.5% of the reviewed papers, items in the 'Pre- and Post-Scanning Considerations' category were reported by only 44.7% of reviewed FDCR studies. Considering the notable and sometimes unexpected gaps in the reporting of items deemed to be important by experts in any FDCR study, the protocols could benefit from the adoption of reporting standards. This checklist, a living document to be updated as the field and its methods advance, can help improve experimental design, reporting and the widespread understanding of the FDCR protocols. This checklist can also provide a sample for developing consensus statements for protocols in other areas of task-based fMRI.
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Affiliation(s)
- Hamed Ekhtiari
- Laureate Institute for Brain Research, Tulsa, OK, USA. .,Department of Psychiatry & Behavioral Sciences, University of Minnesota, Minneapolis, MN, USA.
| | - Mehran Zare-Bidoky
- Iranian National Center for Addiction Studies (INCAS), Tehran University of Medical Sciences, Tehran, Iran.,Shahid-Sadoughi University of Medical Sciences, Yazd, Iran.,These authors contributed equally: Mehran Zare-Bidoky, Arshiya Sangchooli
| | - Arshiya Sangchooli
- Iranian National Center for Addiction Studies (INCAS), Tehran University of Medical Sciences, Tehran, Iran.,These authors contributed equally: Mehran Zare-Bidoky, Arshiya Sangchooli
| | - Amy C. Janes
- Department of Psychiatry, McLean Hospital, Harvard Medical School, Belmont, MA, USA
| | - Marc J. Kaufman
- Department of Psychiatry, McLean Hospital, Harvard Medical School, Belmont, MA, USA
| | - Jason A. Oliver
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA.,TSET Health Promotion Research Center, Stephenson Cancer Center, Oklahoma City, OK, USA.,Department of Psychiatry & Behavioral Sciences, Oklahoma State University Center for Health Sciences, Tulsa, OK, USA
| | - James J. Prisciandaro
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Torsten Wüstenberg
- Department of Psychiatry and Neurosciences, Charité Campus Mitte, Charité–Universitätsmedizin Berlin, Berlin, Germany
| | - Raymond F. Anton
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Patrick Bach
- Department of Addictive Behaviour and Addiction Medicine, Central Institute of Mental Health (CIMH), Heidelberg University, Mannheim, Germany
| | - Alex Baldacchino
- Division of Population Studies and Behavioural Sciences, St Andrews University Medical School, University of St Andrews, Scotland, UK
| | - Anne Beck
- Department of Psychiatry and Neurosciences, Charité Campus Mitte, Charité–Universitätsmedizin Berlin, Berlin, Germany.,Faculty of Health, Health and Medical University, Campus Potsdam, Potsdam, Germany
| | - James M. Bjork
- Department of Psychiatry, Virginia Commonwealth University, Richmond, VA, USA
| | - Judson Brewer
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
| | - Anna Rose Childress
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Eric D. Claus
- Department of Biobehavioral Health, The Pennsylvania State University, University Park, PA, USA
| | - Kelly E. Courtney
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
| | - Mohsen Ebrahimi
- Iranian National Center for Addiction Studies (INCAS), Tehran University of Medical Sciences, Tehran, Iran
| | - Francesca M. Filbey
- Center for BrainHealth, School of Behavioral and Brain Sciences, University of Texas at Dallas, Dallas, TX, USA
| | - Dara G. Ghahremani
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, USA
| | - Peyman Ghobadi Azbari
- Iranian National Center for Addiction Studies (INCAS), Tehran University of Medical Sciences, Tehran, Iran.,Department of Biomedical Engineering, Shahed University, Tehran, Iran
| | - Rita Z. Goldstein
- Departments of Psychiatry & Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Anna E. Goudriaan
- Department of Psychiatry, Amsterdam University Medical Center, University of Amsterdam and Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Erica N. Grodin
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, USA
| | - J. Paul Hamilton
- Center for Social and Affective Neuroscience, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.,Center for Medical Image Science and Visualization, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Colleen A. Hanlon
- Department of Cancer Biology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | | | - Andreas Heinz
- Department of Psychiatry and Neurosciences, Charité Campus Mitte, Charité–Universitätsmedizin Berlin, Berlin, Germany
| | - Jane E. Joseph
- Department of Neuroscience, Medical University of South Carolina, Charleston, SC, USA
| | - Falk Kiefer
- Department of Addictive Behaviour and Addiction Medicine, Central Institute of Mental Health (CIMH), Heidelberg University, Mannheim, Germany
| | - Arash Khojasteh Zonoozi
- Iranian National Center for Addiction Studies (INCAS), Tehran University of Medical Sciences, Tehran, Iran.,Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hedy Kober
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | | | - Qiang Li
- Department of Radiology, Tangdu Hospital, Fourth Military Medical University, Xi’an, China
| | - Edythe D. London
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, USA
| | - Joseph McClernon
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA
| | - Hamid R. Noori
- International Center for Primate Brain Research, Center for Excellence in Brain Science and Intelligence Technology (CEBSIT)/Institute of Neuroscience (ION), Chinese Academy of Sciences, Shanghai, China.,McGovern Institute for Brain Research, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Max M. Owens
- Department of Psychiatry, University of Vermont, Burlington, VT, USA
| | | | - Irene Perini
- Center for Social and Affective Neuroscience, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.,Center for Medical Image Science and Visualization, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Marc Potenza
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA.,Connecticut Mental Health Center, New Haven, CT, USA.,Connecticut Council on Problem Gambling, Wethersfield, CT, USA.,Department of Neuroscience, Child Study Center and Wu Tsai Institute, Yale School of Medicine, New Haven, CT, USA
| | - Stéphane Potvin
- Centre de recherche de l’Institut Universitaire en Santé Mentale de Montréal, University of Montreal, Montreal, Canada
| | - Lara Ray
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, USA
| | | | - Dongju Seo
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Rajita Sinha
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Michael N. Smolka
- Department of Psychiatry, Technische Universität Dresden, Dresden, Germany
| | - Rainer Spanagel
- Institute of Psychopharmacology, Central Institute of Mental Health, Mannheim, Germany
| | - Vaughn R. Steele
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Elliot A. Stein
- Intramural Research Program, National Institute on Drug Abuse, Baltimore, MD, USA
| | - Sabine Steins-Loeber
- Department of Clinical Psychology and Psychotherapy, Otto-Friedrich-University of Bamberg, Bamberg, Germany
| | - Susan F. Tapert
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
| | | | - Sabine Vollstädt-Klein
- Department of Addictive Behaviour and Addiction Medicine, Central Institute of Mental Health (CIMH), Heidelberg University, Mannheim, Germany
| | - Reagan R. Wetherill
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Stephen J. Wilson
- Department of Psychology, The Pennsylvania State University, University Park, PA, USA
| | - Katie Witkiewitz
- Department of Psychology, University of New Mexico, Albuquerque, NM, USA
| | - Kai Yuan
- School of Life Science and Technology, Xidian University, Xi’an, China
| | - Xiaochu Zhang
- Department of Psychology, School of Humanities and Social Science, University of Science and Technology of China, Anhui, China.,Department of Radiology, First Affiliated Hospital of USTC, Hefei National Laboratory for Physical Science at the Microscale and School of Life Science, Division of Life Science and Medicine, University of Science and Technology of China, Anhui, China
| | - Anna Zilverstand
- Department of Psychiatry & Behavioral Sciences, University of Minnesota, Minneapolis, MN, USA
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