(PS7-29) Effects of Real-time Fmri Neurofeedback on Affective Responding in Anorexia Nervosa

Introduction

Anorexia nervosa (AN) is a serious disorder associated with emotion regulation difficulties. However, existing interventions targeting emotion regulation in AN are limited. Real-time functional magnetic resonance imaging neurofeedback (rt-fMRI NF) targeting the limbic system is a biofeedback approach that enables individuals to observe and intentionally modulate their brain activity in threat regions. This approach holds promise as an intervention that may enhance emotion regulation in AN. For this reason, we conducted a randomized study comparing the impact of rt-fMRI NF focused on amygdala downregulation versus sham feedback on affect in AN.

Methods

Participants with acute or weight-restored AN were randomized to receive rt-fMRI NF (n=11) or sham feedback (n=12) across 2 scanning sessions. During fMRI, participants were instructed to either: 1) regulate their emotional responses to negative images (Regulate); 2) passively view negative images (Negative View); or 3) passively view neutral images (Neutral View). In the Regulate condition, NF participants received real-time feedback of their amygdala activation, while the sham group received non-contingent feedback. As participants viewed images in the scanner, they self-reported their emotional responses, with higher scores indicating more positive mood. Outside of fMRI, participants completed the Positive and Negative Affect Schedule (PANAS-X; Watson & Clark, 1994) to determine mood changes across study visits.

Results

On the PANAS, negative affect linearly decreased for the NF group across assessments (p=.015). In contrast, sham showed a quadratic pattern (p=.010) wherein negative affect decreased, then rebounded. Similarly, different patterns of in-scanner ratings were noted across sessions. In the first fMRI session, a significant group-by-condition interaction was noted (p=.039), in which the NF group demonstrated lower ratings than Sham in the Regulate condition (B=-.37, p=.11). However, in the second fMRI session, the NF group demonstrated higher in-scanner mood ratings than Sham overall (p=.039), with significantly higher ratings in response to the Negative View condition (B=.81, p< .001) and a trend towards higher ratings in the Regulate condition (B=.38, p=.060).

Conclusion

Our findings suggest that repeated sessions of rt-fMRI is a viable approach for improving emotional responses to negative stimuli for those with AN. The NF group had more notable improvement in affect to negative images across both in- and out- of the scanner compared to the sham group. Improvements were found in both Negative View and Regulate conditions, indicating that NF may improve responses even when individuals aren’t actively regulating their emotions. Future studies should investigate clinical applications of rt-fMRI NF for AN.