Symptom Based Treatment Affects Brain Plasticity - the Role of Verbal Auditory Hallucinations
Condition: Hallucinations, Verbal Auditory
MeSH terms: Hallucinations
Study type: Interventional

Summary: 
      The aim of the study is the examination of brain plasticity on verbal auditory hallucinations
      (AVH) after neuromodulation with fMRI (functional magnetic resonance imaging) neurofeedback.
      During the training of fMRI neurofeedback subjects are trained to regulate consciously the
      connectivity of areas which are associated with hallucinations.The aim is to improve
      perceived hallucinations' intensity in everyday life of the patients as well as investigating
      the impact of neurofeedback on resting-state networks in the brain. As control groups,
      control subjects without AVH and participants with AVH, but no psychiatric diagnosis will be
      included.
    

Detailed description: 
      This study investigates the brain plasticity after neuromodulation with fMRI neurofeedback on
      verbal auditory hallucinations (AVH). The new technique of real-time fMRI enables subjects to
      influence their brain activity in certain areas based on neurofeedback. Current brain
      activity as measured by fMRI will be reported to the participants in real time via brain
      computer interface (BCI). Due to the identification of contingency between feedback and
      mental strategies subjects are able to control their own brain activity consciously. This
      provides the opportunity to control symptoms such as AVH. Neurofeedback has been tested on
      subjects with schizophrenia, leading to conscious control of circumscribed brain areas.
      Recent studies show that, in addition to the modulation of single areas, neurofeedback can
      also modulate connectivity between different areas. Thus, it is possible to regulate not only
      single brain regions but also whole networks.

      AVH are a key symptom of schizophrenia. They limit social functions significantly and are
      resistant to the therapy with antipsychotics in 25 % of cases. AVH also occur in 6-15 % of
      the healthy population, without meeting any diagnostic criteria for schizophrenia or other
      psychiatric disorders. This study will perform a direct, not-invasive and selective
      modulation of networks underlying AVH and assess their neural, cognitive and emotional
      effects. The focus of this study is on the connectivity between auditory cortex and inferior
      frontal cortex. Various studies demonstrated that the auditory cortex exhibits an abnormal
      function in schizophrenia patients. It was shown that during AVH, auditory cortex (superior
      temporal lobe) and inferior frontal cortex synchronize spontaneously. These regions play an
      essential role in speech perception and processing. An increased synchronisation of these
      areas could lead to the development of AVH. This study will try to reduce frontotemporal
      connectivity to uncouple the regions. Increasing connectivity of both areas will serve as
      control condition and furthermore intensify the perceived control of the own brain activity
      and of the associated AVH. Thus, patients will learn which factors influence the appearance
      of their hallucinations.
    

Intervention name(s): fMRI; Neurofeedback; PANAS; AVHRS; SF36
Intervention type(s): Procedure; Behavioral; Other; Other; Other
Intervention description(s): collection of functional brain data for 1 hour per day; Task of the participants is to increase or decrease the connectivity between selected brain regions in double-blind, randomized order. After the regulation they will get a feedback about the regulation success. (Patients and controls with AVH: days 3 & 4; controls without AVH: Days 2 & 3); to assess the mood before and after the fMRI and after 1 week during a telephone interview; to assess the intensity and quality of the hallucinations before and after the fMRI and after 1 week during a telephone interview; questionnaire about life quality after 1 week during a telephone interview
Other intervention name(s): functional magnetic resonance imaging; Positive And Negative Affect Scales; Auditory Vocal Hallucinations Rating Scale
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Participant, Investigator)
Primary purpose: Treatment
Keywords: fMRI; neurofeedback; hallucination; schizophrenia