Alterations of amygdala-prefrontal connectivity with real-time fMRI neurofeedback in BPD patients

Abstract

With the use of real-time functional magnetic resonance imaging neurofeedback (NF), amygdala activitiy can be visualized in real time. In this study, continuous amygdala NF was provided to patients with borderline personality disorder (BPD) with the instruction to down-regulate. During four sessions of NF training, patients viewed aversive pictures and received feedback from a thermometer display, which showed the amygdala blood oxygenation level-dependent signal. Conditions of regulation and viewing without regulation were presented. Each session started with a resting-state scan and was followed by a transfer run without NF. Amygdala regulation, task-related and resting-state functional brain connectivity were analyzed. Self-ratings of dissociation and difficulty in emotion regulation were collected. BPD patients down-regulated right amygdala activation but there were no improvements over time. Task-related amygdala-ventromedial prefrontal cortex connectivity was altered across the four sessions, with an increased connectivity when regulating vs viewing pictures. Resting-state amygdala-lateral prefrontal cortex connectivity was altered and dissociation, as well as scores for 'lack of emotional awareness', decreased with training. Results demonstrated that amygdala NF may improve healthy brain connectivity, as well as emotion regulation. A randomized-controlled trial is needed to investigate whether amygdala NF is instrumental for improving neural regulation and emotion regulation in BPD patients.

Keywords: borderline personality disorder; brain-computer interface; dissociation; prefrontal cortex; psychopathology; psychotherapy.

© The Author (2016). Published by Oxford University Press. For Permissions, please email: journals.permissions@oup.com.

Figures

Fig. 1.

Overview on the experimental procedure.

Fig. 2.

BPD patients decreased right amygdala response with neurofeedback. (A) Significant right amygdala activation was found with the ‘view>regulate’ contrast and SVC. For illustration on an axial slice (y = −1) of the canonical SPM template, a voxel threshold of P < 0.01 (uncorrected) was chosen. (B) Beta estimates from the experimental conditions (‘regulate>neutral’, ‘view>neutral’) extracted from a right amygdala anatomical mask.

Fig. 3.

Functional connectivity of right amygdala with vmPFC and dissociation is altered in BPD patients from NF training session 1 to session 4. (A) VmPFC activation detected with the ‘session 4 [regulate>view] > session 1 [regulate>view]’ contrast. Voxels are displayed on a sagittal slice of the canonical SPM template with an uncorrected voxel threshold of P < 0.01 and k > 10. Right is anterior. Crosshairs indicate coordinate of the peak voxel [P < 0.05, FWE-corrected, (−12,47,−11)]. (B) Group mean of PPI beta estimates at peak voxel from the ‘regulate>view’ contrast. Asterisk indicates significant interaction contrast. error bars = standard error of mean (SEM). (C) Group mean of within-session DSS-4 ratings,VAS, visual analogue scale. Error bars = SEM. (D) Picture arousal is correlated with amygdala-vmPFC connectivity in session four. Variance of PPI beta estimates at vmPFC peak voxel (‘regulate>view’ contrast) is predicted by arousal ratings. Line indicates linear association.

Fig. 4.

Resting-state functional connectivity from left amygdala to right dlPFC was altered in BPD patients over sessions. (A) For illustration, the amygdala mask (blue) is displayed on an anatomical template in axial view (left is left). (B) DlPFC cluster showing a linear functional connectivity increase with left amygdala. Voxels are displayed on a saggital slice (x = 45) of an anatomical template with an uncorrected voxel threshold of P < 0.05 and k > 10 for visualization purposes. Right is anterior. (C) Beta estimates from amygdala-dlPFC connectivity, extracted from the peak voxel (45,23,40). Error bars = SEM.