Symptom Based Treatment Affects Brain Plasticity - Cognitive Training in Patients With Affective Symptoms

NCT ID: NCT03183947

Last Updated: 2019-12-10

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

81 participants

Study Classification

INTERVENTIONAL

Study Start Date

2017-08-29

Study Completion Date

2019-12-06

Brief Summary

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The aim of the study is the examination of brain plasticity on on affective symptoms after neuromodulation with fMRI (functional magnetic resonance imaging) neurofeedback. During the fMRI neurofeedback training, patients with depression as well as patients with schizophrenia are trained to consciously regulate the activity of areas which are associated with the cognitive reappraisal of emotional stimuli.The aim is to improve the patients' subjective emotional processing and perception in everyday life as well as to investigate the impact of neurofeedback on resting-state networks in the brain. Healthy participants will be investigated as control group.

Detailed Description

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The ability to regulate emotions is a central element of mental health that is significantly affected in various psychiatric disorders. Its importance for development and maintenance of depressive symptomatology has been widely shown; e.g. patients with depression have a significantly reduced ability to regulate emotions in response to negative stimuli. However, emotion regulation abilities may pose as an important resilience factor that can counteract the development of depressive symptoms. The loss of the ability to regulate emotions is not only observed in depression, but is also a core factor in negative symptoms of schizophrenia.

Cognitive reappraisal training is an established method to improve emotion regulation. The cognitive reappraisal of a stimulus or situation works by reinterpreting the emotional stimulus or situation and can change the course of the emotional response. Over the last years this form of cognitive reappraisal training has become a standard approach in the treatment of affective disorders.

The prefrontal cortex (PFC) plays an important role in emotion regulation. In line with this it has been shown that patients with reduced emotion regulation ability display impaired functioning of the PFC. Aim of the study is to train patients to consciously upregulate activity in the PFC and thereby to increase emotion regulation ability. On the behavioral level this is expected to correlate with a reduced experience of negative mood. In order to regulate the PFC, participants are instructed to use cognitive reappraisal strategies. Cognitive reappraisal is an effective and well-investigated strategy to improve emotion regulation and is a standard cognitive-behavioral psychotherapeutic intervention. During cognitive reappraisal the meaning of a picture is reinterpreted in order to reduce the emotional reaction. Recent fMRI studies have shown that cognitive reappraisal is associated with an increase in prefrontal activity and a decrease of amygdala activation.

The new technique of real-time fMRI enables subjects to influence their brain activity in certain areas based on neurofeedback. Ongoing brain activity as measured by fMRI is reported to the participants in real time via brain computer interface (BCI). In order to influence brain activity, mental strategies are usually recommended to the participants that have been shown to increase activity in the respective area. Due to the identification of contingency between feedback and mental strategies participants are able to control their own brain activity consciously. It has been shown that psychiatric symptomatology can be improved using this non-invasive technique. In the current study it will be investigated whether neurofeedback of the PFC has a positive influence on affective symptoms in patients with depression and schizophrenia, respectively. In detail it is researched whether the upregulation of activity in the PFC can lead to an increase in subjective well-being. Two groups of patients (depression (N=40) and schizophrenia (N=40)) as well as a group of healthy participants will receive neurofeedback-training of the PFC. Aim of the study is an improvement of depressive (or negative) symptoms as well as the investigation of the impact of neurofeedback on resting-state networks in the brain.

Conditions

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Depression Schizophrenia

Keywords

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fMRI neurofeedback emotion regulation schizophrenia cognitive reappraisal depression

Study Design

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Allocation Method

NON_RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

DOUBLE

Participants Investigators

Study Groups

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fMRI Neurofeedback regulation of left PFC

Study related procedures included: PANAS, BDI-II, ERQ (questionnaires or evaluations)

Group Type EXPERIMENTAL

fMRI

Intervention Type PROCEDURE

collection of functional brain data for 1 hour per day

Neurofeedback

Intervention Type BEHAVIORAL

Task of the participants is to increase the activity in the selected brain region (left or right prefrontal cortex). After regulation they will get a feedback about the regulation success. (Patients: days 3 \& 4; controls: Days 2 \& 3)

PANAS

Intervention Type OTHER

to assess the mood before and after the fMRI and after 4 weeks during a telephone interview

BDI-II

Intervention Type OTHER

to assess depressive symptomatology before neurofeedback and 4 weeks after the intervention during telephone interview

ERQ

Intervention Type OTHER

To assess emotion regulation strategies before and after neurofeedback training (patients: day 3\&4; controls: day 2\&3) and after 4 weeks during a telephone interview

fMRI Neurofeedback of right PFC

Study related procedures included: PANAS, BDI-II, ERQ (questionnaires or evaluations)

Group Type EXPERIMENTAL

fMRI

Intervention Type PROCEDURE

collection of functional brain data for 1 hour per day

Neurofeedback

Intervention Type BEHAVIORAL

Task of the participants is to increase the activity in the selected brain region (left or right prefrontal cortex). After regulation they will get a feedback about the regulation success. (Patients: days 3 \& 4; controls: Days 2 \& 3)

PANAS

Intervention Type OTHER

to assess the mood before and after the fMRI and after 4 weeks during a telephone interview

BDI-II

Intervention Type OTHER

to assess depressive symptomatology before neurofeedback and 4 weeks after the intervention during telephone interview

ERQ

Intervention Type OTHER

To assess emotion regulation strategies before and after neurofeedback training (patients: day 3\&4; controls: day 2\&3) and after 4 weeks during a telephone interview

Interventions

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fMRI

collection of functional brain data for 1 hour per day

Intervention Type PROCEDURE

Neurofeedback

Task of the participants is to increase the activity in the selected brain region (left or right prefrontal cortex). After regulation they will get a feedback about the regulation success. (Patients: days 3 \& 4; controls: Days 2 \& 3)

Intervention Type BEHAVIORAL

PANAS

to assess the mood before and after the fMRI and after 4 weeks during a telephone interview

Intervention Type OTHER

BDI-II

to assess depressive symptomatology before neurofeedback and 4 weeks after the intervention during telephone interview

Intervention Type OTHER

ERQ

To assess emotion regulation strategies before and after neurofeedback training (patients: day 3\&4; controls: day 2\&3) and after 4 weeks during a telephone interview

Intervention Type OTHER

Other Intervention Names

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functional magnetic resonance imaging Positive And Negative Affect Scales Beck's depression inventory Emotion regulation questionnaire

Eligibility Criteria

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Inclusion Criteria

* Depression according to ICD-10 (F32.x, F33.x, F31.3 or F34.x); Schizophrenia according to ICD-10 (F2x); or healthy subjects
* Fluent German language skills

Exclusion Criteria

* any contraindication to MRI examination or claustrophobia
* pregnant or lactating women
* acute suicidal tendency
* persons incapable of giving consent
Minimum Eligible Age

18 Years

Maximum Eligible Age

75 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

Yes

Sponsors

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RWTH Aachen University

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Klaus Mathiak, Prof MD PhD

Role: PRINCIPAL_INVESTIGATOR

University Hospital RWTH Aachen, Department of Psychiatry, Psychotherapy and Psychosomatics

Locations

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University Hospital RWTH Aachen, Department of Psychiatry, Psychotherapy and Psychosomatics

Aachen, , Germany

Site Status

Countries

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Germany

References

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Buhle JT, Silvers JA, Wager TD, Lopez R, Onyemekwu C, Kober H, Weber J, Ochsner KN. Cognitive reappraisal of emotion: a meta-analysis of human neuroimaging studies. Cereb Cortex. 2014 Nov;24(11):2981-90. doi: 10.1093/cercor/bht154. Epub 2013 Jun 13.

Reference Type BACKGROUND
PMID: 23765157 (View on PubMed)

Hayes JP, Vanelzakker MB, Shin LM. Emotion and cognition interactions in PTSD: a review of neurocognitive and neuroimaging studies. Front Integr Neurosci. 2012 Oct 9;6:89. doi: 10.3389/fnint.2012.00089. eCollection 2012.

Reference Type BACKGROUND
PMID: 23087624 (View on PubMed)

Kohn N, Eickhoff SB, Scheller M, Laird AR, Fox PT, Habel U. Neural network of cognitive emotion regulation--an ALE meta-analysis and MACM analysis. Neuroimage. 2014 Feb 15;87:345-55. doi: 10.1016/j.neuroimage.2013.11.001. Epub 2013 Nov 9.

Reference Type BACKGROUND
PMID: 24220041 (View on PubMed)

Linden DE, Habes I, Johnston SJ, Linden S, Tatineni R, Subramanian L, Sorger B, Healy D, Goebel R. Real-time self-regulation of emotion networks in patients with depression. PLoS One. 2012;7(6):e38115. doi: 10.1371/journal.pone.0038115. Epub 2012 Jun 4.

Reference Type BACKGROUND
PMID: 22675513 (View on PubMed)

Ochsner KN, Bunge SA, Gross JJ, Gabrieli JD. Rethinking feelings: an FMRI study of the cognitive regulation of emotion. J Cogn Neurosci. 2002 Nov 15;14(8):1215-29. doi: 10.1162/089892902760807212.

Reference Type BACKGROUND
PMID: 12495527 (View on PubMed)

Weiskopf N, Scharnowski F, Veit R, Goebel R, Birbaumer N, Mathiak K. Self-regulation of local brain activity using real-time functional magnetic resonance imaging (fMRI). J Physiol Paris. 2004 Jul-Nov;98(4-6):357-73. doi: 10.1016/j.jphysparis.2005.09.019. Epub 2005 Nov 10.

Reference Type BACKGROUND
PMID: 16289548 (View on PubMed)

Joormann J, Gotlib IH. Emotion regulation in depression: relation to cognitive inhibition. Cogn Emot. 2010 Feb 1;24(2):281-98. doi: 10.1080/02699930903407948.

Reference Type BACKGROUND
PMID: 20300538 (View on PubMed)

Troy AS, Wilhelm FH, Shallcross AJ, Mauss IB. Seeing the silver lining: cognitive reappraisal ability moderates the relationship between stress and depressive symptoms. Emotion. 2010 Dec;10(6):783-95. doi: 10.1037/a0020262.

Reference Type BACKGROUND
PMID: 21058843 (View on PubMed)

Keller M, Zweerings J, Klasen M, Zvyagintsev M, Iglesias J, Mendoza Quinones R, Mathiak K. fMRI Neurofeedback-Enhanced Cognitive Reappraisal Training in Depression: A Double-Blind Comparison of Left and Right vlPFC Regulation. Front Psychiatry. 2021 Aug 23;12:715898. doi: 10.3389/fpsyt.2021.715898. eCollection 2021.

Reference Type DERIVED
PMID: 34497546 (View on PubMed)

Other Identifiers

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17-094

Identifier Type: -

Identifier Source: org_study_id