Symptom Based Treatment Affects Brain Plasticity - Cognitive Training in Patients With Affective Symptoms
Condition: Depression; Schizophrenia
MeSH terms: Depression; Schizophrenia; Affective Symptoms
Study type: Interventional

Summary: 
      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: 
      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.
    

Intervention name(s): fMRI; Neurofeedback; PANAS; BDI-II; ERQ
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 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); to assess the mood before and after the fMRI and after 4 weeks during a telephone interview; to assess depressive symptomatology before neurofeedback and 4 weeks after the intervention during telephone interview; 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
Other intervention name(s): functional magnetic resonance imaging; Positive And Negative Affect Scales; Beck's depression inventory; Emotion regulation questionnaire
Allocation: Non-Randomized
Intervention model: Parallel Assignment
Masking: Double (Participant, Investigator)
Primary purpose: Treatment
Keywords: fMRI; neurofeedback; emotion regulation; schizophrenia; cognitive reappraisal; depression