Psychiatry research. Neuroimaging · 2025
Real-time fMRI neurofeedback modulates auditory cortex activity and connectivity in schizophrenia patients with auditory hallucinations: A controlled study.
СтатьяРандомизированное исследованиеНазвание и аннотация: Перевод в очереди
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Bauer Clemens C C, Zhang Jiahe, Morfini Francesca, Hinds Oliver, Wighton Paul, Lee Yoonji, Stone Lena, Awad Angelina, Okano Kana, Hwang Melissa, Hammoud Jude, Nestor Paul, Whitfield-Gabrieli Susan, Shinn Ann K, Niznikiewicz Margaret A
Аннотация
BACKGROUND AND HYPOTHESIS: Auditory hallucinations (AHs) affect 60-80 % of schizophrenia patients and often resist antipsychotic treatment. AHs involve superior temporal gyrus (STG) hyperactivity and disrupted auditory-cognitive control connectivity. Real-time fMRI neurofeedback (NFB) enables voluntary modulation of targeted brain regions. We previously showed STG-targeted NFB with mindfulness meditation reduced STG activation and AHs in one session. However, whether effects are specific to hallucination-related regions versus placebo, and whether NFB modulates broader networks, remained unclear.
STUDY DESIGN: This randomized, sham-controlled trial examined NFB specificity and network effects. Twenty-three adults with schizophrenia/schizoaffective disorder and medication-resistant hallucinations practiced mindfulness meditation while receiving neurofeedback from either STG (n = 10, Real-NFB) or motor cortex (n = 13, Sham-NFB control). Sham participants subsequently received Real-NFB, providing within-subject comparison.
STUDY RESULTS: Both groups showed reduced AHs post-NFB without group differences. However, compared to Sham-NFB, Real-NFB produced greater reductions in secondary auditory cortex activation and connectivity between auditory cortex and cognitive control regions (dorsolateral prefrontal cortex and anterior cingulate). These connectivity reductions persisted in the Real-after-Sham condition. Both groups showed reduced primary auditory cortex activation, suggesting mindfulness meditation independently regulates bottom-up hallucination processes.
CONCLUSIONS: Region-specific NFB targeting produces distinct neural changes beyond symptom reduction. STG-targeted NFB differentially modulates auditory-cognitive control networks, potentially restoring the disrupted balance between bottom-up sensory processing and top-down control in AHs. These findings highlight the importance of anatomically-informed NFB targets and provide mechanistic insights for developing precision interventions for treatment-resistant psychiatric symptoms.
STUDY DESIGN: This randomized, sham-controlled trial examined NFB specificity and network effects. Twenty-three adults with schizophrenia/schizoaffective disorder and medication-resistant hallucinations practiced mindfulness meditation while receiving neurofeedback from either STG (n = 10, Real-NFB) or motor cortex (n = 13, Sham-NFB control). Sham participants subsequently received Real-NFB, providing within-subject comparison.
STUDY RESULTS: Both groups showed reduced AHs post-NFB without group differences. However, compared to Sham-NFB, Real-NFB produced greater reductions in secondary auditory cortex activation and connectivity between auditory cortex and cognitive control regions (dorsolateral prefrontal cortex and anterior cingulate). These connectivity reductions persisted in the Real-after-Sham condition. Both groups showed reduced primary auditory cortex activation, suggesting mindfulness meditation independently regulates bottom-up hallucination processes.
CONCLUSIONS: Region-specific NFB targeting produces distinct neural changes beyond symptom reduction. STG-targeted NFB differentially modulates auditory-cognitive control networks, potentially restoring the disrupted balance between bottom-up sensory processing and top-down control in AHs. These findings highlight the importance of anatomically-informed NFB targets and provide mechanistic insights for developing precision interventions for treatment-resistant psychiatric symptoms.