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Real-time fMRI Biofeedback Targeting the Orbitofrontal Cortex for Contamination Anxiety
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Changes in Psychological States During Instrumented Biofeedback for Dyssynergic Defaecation and Fecal Incontinence
Michael P Jones1, Yoav Mazor2,3, Alissa Beath1,4
1School of Psychological Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia.
Neurogastroenterology and Motility
|May 11, 2026
Summary
Biofeedback therapy for chronic constipation and fecal incontinence improves quality of life by enhancing psychological factors like cognitive function and emotion regulation. These changes suggest psychological processes are key to biofeedback
Area of Science:
- Gastroenterology
- Psychology
- Rehabilitation Medicine
Background:
- Chronic constipation and fecal incontinence (FI) significantly reduce quality of life.
- Instrumented anorectal biofeedback is effective but its mechanism, potentially involving cognitive and motivational pathways, lacks empirical evidence.
- This study investigated psychological changes as mediators of biofeedback efficacy.
Purpose of the Study:
- To explore evidence of changes in psychological processes during biofeedback therapy.
- To identify central psychological mediators of biofeedback treatment efficacy for constipation and FI.
Main Methods:
- 135 patients with constipation due to dyssynergic defecation and/or FI were recruited.
- Psychological traits (cognitive processes, emotion regulation) and patient outcomes were measured pre- and post-therapy.
- Changes in psychological traits were correlated with changes in quality of life and other outcomes.
Main Results:
- Constipation improvement correlated with reduced external locus of control and acceptance in emotion regulation.
- FI improvement correlated with reduced acceptance, enhanced executive function, cognitive flexibility, and emotional regulation.
- Statistical significance (p < 0.05) was observed for key correlations.
Conclusions:
- Improvements in constipation and FI during biofeedback are linked to changes in psychological processes.
- Psychological factors are important mediators in the mechanism of action for biofeedback therapy.
- Findings support the role of cognitive and emotional regulation in treatment success.
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