Real-time fMRI neurofeedback of left dorsolateral prefrontal cortex to enhance emotional cognitive control: A randomized controlled trial.

Abstract

Real-time fMRI neurofeedback (rt-fMRI-nf) is an endogenous neuromodulation approach whereby individuals are taught to self-regulate their own neural activity in the moment. Cognitive control in emotional contexts is related to risk for or protection against mental health disorders, such as depression, anxiety, or posttraumatic stress disorder. The left dorsolateral prefrontal cortex (dlPFC) has been shown to be centrally important in facilitating emotional cognitive control (ECC). Using a double-blind randomized controlled trial design, the present study tested a novel rt-fMRI-nf protocol to increase left dlPFC activity during ECC and improve ECC measured by self-report and behavioral task performance. Seventy healthy adult participants were enrolled and randomized to either active (n = 37; left dlPFC) or sham [n = 33; left postcentral gyrus (PCG)] neurofeedback. Linear mixed effects models tested for effects of time (practice/run 1/run 2/run 3/transfer), feedback target (active/sham), and their interaction on left dlPFC activity, left PCG activity, and ECC measures (self-report and behavior). Results showed a significant time-by-feedback interaction on left dlPFC activity (p = .031). This interaction was such that active feedback led to greater left dlPFC activity in run 1 (p = .030; d = .66) and run 2 (p = .042; d = .62), but not for run 3 nor the transfer run (when no feedback was provided). There were no significant effects of feedback on ECC measures. These findings demonstrate that rt-fMRI-nf had an initial but not a sustained effect on left dlPFC activity, providing evidence of neural target engagement. However, the lack of a sustained effect on neural activity nor any observed effects on ECC highlight the complexity of identifying the optimal design and dosing for novel rt-fMRI-nf protocols.