Single session real-time fMRI neurofeedback has a lasting impact on cognitive behavioral therapy strategies.

Abstract

To benefit from cognitive behavioral therapy (CBT), individuals must not only learn new skills but also strategically implement them outside of session. Here, we tested a novel technique for personalizing CBT skills and facilitating their generalization to daily life. We hypothesized that showing participants the impact of specific CBT strategies on their own brain function using real-time functional magnetic imaging (rt-fMRI) neurofeedback would increase their metacognitive awareness, help them identify effective strategies, and motivate real-world use. In a within-subjects design, participants who had completed a clinical trial of a standardized course of CBT created a personal repertoire of negative autobiographical stimuli and mood regulation strategies. From each participant's repertoire, a set of experimental and control strategies were identified; only experimental strategies were practiced in the scanner. During the rt-fMRI neurofeedback session, participants used negative stimuli and strategies from their repertoire to manipulate activation in the anterior cingulate cortex, a region implicated in emotional distress. The primary outcome measures were changes in participant ratings of strategy difficulty, efficacy, and frequency of use. As predicted, ratings for unscanned control strategies were stable across observations, whereas ratings for experimental strategies changed after neurofeedback. At follow-up one month after the session, efficacy and frequency ratings for scanned strategies were predicted by neurofeedback during the rt-fMRI session. These results suggest that rt-fMRI neurofeedback created a salient and durable learning experience for patients, extending beyond the scan session to guide and motivate CBT skill use weeks later. This metacognitive approach to neurofeedback offers a promising model for increasing clinical benefits from cognitive behavioral therapy by personalizing skills and facilitating generalization.

Department

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Citation

Published Version (Please cite this version)

10.1016/j.nicl.2018.06.009

Publication Info

MacDuffie, Katherine E, Jeff MacInnes, Kathryn C Dickerson, Kari M Eddington, Timothy J Strauman and R Alison Adcock (2018). Single session real-time fMRI neurofeedback has a lasting impact on cognitive behavioral therapy strategies. NeuroImage. Clinical, 19. pp. 868–875. 10.1016/j.nicl.2018.06.009 Retrieved from https://hdl.handle.net/10161/21882.

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Scholars@Duke

Dickerson

Kathryn C Dickerson

Assistant Professor in Psychiatry and Behavioral Sciences

Kathryn (Katie) Dickerson completed her B.A. in Brain and Cognitive Sciences from the University of Rochester in 2006. She then joined Dr. Mauricio Delgado's lab at Rutgers University-Newark earning her Ph.D. in Behavioral and Neural Sciences in 2011. She moved to Durham and joined the lab of Dr. Alison Adcock at Duke University where she was a post-doc from 2011-2016. She received a KL2 award in 2016 and was promoted to Assistant Professor in the Department of Psychiatry and Behavioral Sciences at Duke University.

Katie is interested in how reward and motivation influence what we learn and remember. She focuses on studying the dopamine system in healthy humans and clinical populations using a combination of behavioral, functional magnetic resonance imaging (fMRI), and real-time fMRI methods. 

Strauman

Timothy J. Strauman

Professor of Psychology and Neuroscience

FOR POTENTIAL STUDENTS (fall 2024 class): 

Dr. Timothy Strauman and Dr. Ann Brewster will be seeking to admit a student for Fall 2024 who will be an important member of their collaborative projects. Dr. Brewster is an intervention scientist and a faculty member in Duke’s Social Science Research Institute. The collaborative projects focus on creating, testing, and implementing school-based therapeutic and preventive interventions for adolescents at risk for negative academic and mental health outcomes. We are partnering with the Durham Public Schools as well as with other local school districts, and Dr. Brewster has extensive experience and expertise in developing the partnerships, working with community members, and the intervention process itself. We are especially interested in applicants with experience in community-based interventions, with interests in adolescence, and with knowledge and experience working with both behavioral and neuroimaging data.



Professor Strauman's research focuses on the psychological and neurobiological processes that enable self-regulation, conceptualized in terms of a cognitive/motivational perspective, as well as the relation between self-regulation and affect. Particular areas of emphasis include: (1) conceptualizing self-regulation in terms of brain/behavior motivational systems; (2) the role of self-regulatory cognitive processes in vulnerability to depression and other disorders; (3) the impact of treatments for depression, such as psychotherapy and medication, on self-regulatory function and dysfunction in depression; (4) how normative and non-normative socialization patterns influence the development of self-regulatory systems; (5) the contributory roles of self-regulation, affect, and psychopathology in determining immunologically-mediated susceptibility to illness; (6) development of novel multi-component treatments for depression targeting self-regulatory dysfunction; (7) utilization of brain imaging techniques to test hypotheses concerning self-regulation, including the nature and function of hypothetical regulatory systems and characterizing the breakdowns in self-regulation that lead to and accompany depression.
Adcock

Rachel Alison Adcock

Associate Professor of Psychiatry and Behavioral Sciences

Dr. Adcock received her undergraduate degree in psychology from Emory University and her MD and PhD in Neurobiology from Yale University.  She completed her psychiatry residency training at Langley Porter Psychiatric Institute at UC-San Francisco and did neurosciences research as a postdoctoral fellow at UC-SF, the San Francisco VA Medical Center, and Stanford before joining the Duke faculty in 2007. Her work has been funded by NIDA, NIMH, NSF and Alfred P. Sloan and Klingenstein Fellowships in the Neurosciences, and the Brain & Behavior Research Foundation, and honored by NARSAD awards, the 2012 National Academy of Sciences Seymour Benzer Lectureship, and the 2015 ABAI BF Skinner Lectureship. The overall goals of her research program are to understand how brain systems for motivation support learning and to use mechanistic understanding of how behavior changes biology to meet the challenge of developing new therapies appropriate for early interventions for mental illness.


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