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Individualized rTMS Treatment for Depression using an fMRI-Based Targeting Method
Published on: August 2, 2021
Self-blame in major depression: a randomised pilot trial comparing fMRI neurofeedback with self-guided psychological
Tanja Jaeckle1, Steven C R Williams2, Gareth J Barker2
1Department of Psychological Medicine, Centre for Affective Disorders, London, UK.
Background:
Overgeneralised self-blame and worthlessness are key symptoms of major depressive disorder (MDD) and have previously been associated with self-blame-selective changes in connectivity between right superior anterior temporal lobe (rSATL) and subgenual frontal cortices. Another study showed that remitted MDD patients were able to modulate this neural signature using functional magnetic resonance imaging (fMRI) neurofeedback training, thereby increasing their self-esteem. The feasibility and potential of using this approach in symptomatic MDD were unknown.
Method:
This single-blind pre-registered randomised controlled pilot trial probed a novel self-guided psychological intervention with and without additional rSATL-posterior subgenual cortex (BA25) fMRI neurofeedback, targeting self-blaming emotions in people with insufficiently recovered MDD and early treatment-resistance (n = 43, n = 35 completers). Participants completed three weekly self-guided sessions to rebalance self-blaming biases.
Results:
As predicted, neurofeedback led to a training-induced reduction in rSATL-BA25 connectivity for self-blame v. other-blame. Both interventions were safe and resulted in a 46% reduction on the Beck Depression Inventory-II, our primary outcome, with no group differences. Secondary analyses, however, revealed that patients without DSM-5-defined anxious distress showed a superior response to neurofeedback compared with the psychological intervention, and the opposite pattern in anxious MDD. As predicted, symptom remission was associated with increases in self-esteem and this correlated with the frequency with which participants employed the psychological strategies in daily life.
Conclusions:
These findings suggest that self-blame-rebalance neurofeedback may be superior over a solely psychological intervention in non-anxious MDD, although further confirmatory studies are needed. Simple self-guided strategies tackling self-blame were beneficial, but need to be compared against treatment-as-usual in further trials. https://doi.org/10.1186/ISRCTN10526888.
Insights
This study found that neurofeedback targeting self-blame improved major depressive disorder (MDD) symptoms. While both interventions helped, neurofeedback was more effective for non-anxious MDD patients, increasing self-esteem.
Area of Science:
- Neuroscience
- Psychiatry
- Psychology
Background:
- Major depressive disorder (MDD) is characterized by overgeneralized self-blame and worthlessness.
- Connectivity between the right superior anterior temporal lobe (rSATL) and subgenual frontal cortices is altered in MDD.
- Previous studies showed remitted MDD patients could modulate this neural signature with fMRI neurofeedback, improving self-esteem.
Purpose of the Study:
- To investigate the feasibility and efficacy of a self-guided psychological intervention with and without fMRI neurofeedback for symptomatic MDD.
- To target self-blaming emotions and rebalance neural connectivity in individuals with treatment-resistant MDD.
Main Methods:
- A single-blind, randomized controlled pilot trial involving 43 participants with insufficiently recovered MDD.
- Interventions included a self-guided psychological approach with or without rSATL-posterior subgenual cortex (BA25) fMRI neurofeedback.
- Participants underwent three weekly sessions to address self-blaming biases.
Main Results:
- Neurofeedback successfully reduced rSATL-BA25 connectivity associated with self-blame.
- Both interventions yielded a 46% reduction in depression symptoms (Beck Depression Inventory-II), with no significant group differences.
- Patients without anxious distress responded better to neurofeedback, while those with anxious MDD showed a better response to the psychological intervention alone.
Conclusions:
- Self-blame-rebalance neurofeedback may offer advantages over purely psychological interventions for non-anxious MDD patients.
- Simple self-guided strategies for self-blame are beneficial but require comparison with standard treatments.
- Further research is necessary to confirm these findings and explore broader clinical applications.
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