Translating Neurocognitive Models of Auditory-Verbal Hallucinations into Therapy: Using Real-time fMRI-Neurofeedback to Treat Voices.
Translating Neurocognitive Models of Auditory-Verbal Hallucinations into Therapy: Using Real-time fMRI-Neurofeedback to Treat Voices.
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DOI：
10.3389/fpsyt.2016.00103
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发表时间：
2016
影响因子：
4.7
通讯作者：
Jardri R
中科院分区：
文献类型：
--
作者：
Fovet T;Orlov N;Dyck M;Allen P;Mathiak K;Jardri R
听觉-言语幻觉（AVH）是常见的致残症状，在超过25%的病例中，常规精神药理学治疗可能难以治愈。脑成像的最新进展使我们能够更好地了解AVH的神经基础。这些发现加强了跨诊断神经认知模型，这些模型表征了这些频繁和致残的经历。与此同时，实时功能性磁共振成像（fMRI）的技术进步使得创新和非侵入性方法的发展成为可能，以缓解精神症状，如基于fMRI的神经反馈（fMRI-NF）。在fMRI-NF过程中，测量大脑活动并以真实的时间反馈给参与者，以帮助受试者逐渐实现对其自身神经活动的自主控制。精确定义目标脑区/网络在fMRI-NF方案中显得至关重要。在回顾了AVH的神经认知模型后，我们详细阐述了该领域的最新研究结果如何有助于制定强有力的先验策略，用于fMRI-NF靶点定位。第一种方法依赖于基于成像的"性状标记"（即，也可以在AVH的症状前和缓解阶段检测到的持久性特征或脆弱性标记）。这些策略的目标是针对AVH期间显示异常激活或已知参与补偿激活（或弹性过程）的区域。NF信号所来源的大脑区域可以基于结构MRI和神经认知知识，或在特定认知任务期间收集的功能MRI信息。由于幻觉是急性的侵入性症状，第二种策略更侧重于“状态标记”。在这种情况下，感兴趣的信号依赖于通过多变量模式识别方法对AVH发生期间表现出增加的活性的神经网络的fMRI捕获。然后，可以将伴随幻觉的细粒度活动模式反馈给患者用于治疗目的。考虑到实施fMRI-NF所需的潜在成本，迫切需要进行概念验证研究，以确定应用于AVH患者的最佳策略。这项技术有可能建立一个新的脑成像引导的心理治疗的患者，不响应传统的治疗和采取功能性神经成像的治疗应用。
Auditory-verbal hallucinations (AVHs) are frequent and disabling symptoms, which can be refractory to conventional psychopharmacological treatment in more than 25% of the cases. Recent advances in brain imaging allow for a better understanding of the neural underpinnings of AVHs. These findings strengthened transdiagnostic neurocognitive models that characterize these frequent and disabling experiences. At the same time, technical improvements in real-time functional magnetic resonance imaging (fMRI) enabled the development of innovative and non-invasive methods with the potential to relieve psychiatric symptoms, such as fMRI-based neurofeedback (fMRI-NF). During fMRI-NF, brain activity is measured and fed back in real time to the participant in order to help subjects to progressively achieve voluntary control over their own neural activity. Precisely defining the target brain area/network(s) appears critical in fMRI-NF protocols. After reviewing the available neurocognitive models for AVHs, we elaborate on how recent findings in the field may help to develop strong a priori strategies for fMRI-NF target localization. The first approach relies on imaging-based “trait markers” (i.e., persistent traits or vulnerability markers that can also be detected in the presymptomatic and remitted phases of AVHs). The goal of such strategies is to target areas that show aberrant activations during AVHs or are known to be involved in compensatory activation (or resilience processes). Brain regions, from which the NF signal is derived, can be based on structural MRI and neurocognitive knowledge, or functional MRI information collected during specific cognitive tasks. Because hallucinations are acute and intrusive symptoms, a second strategy focuses more on “state markers.” In this case, the signal of interest relies on fMRI capture of the neural networks exhibiting increased activity during AVHs occurrences, by means of multivariate pattern recognition methods. The fine-grained activity patterns concomitant to hallucinations can then be fed back to the patients for therapeutic purpose. Considering the potential cost necessary to implement fMRI-NF, proof-of-concept studies are urgently required to define the optimal strategy for application in patients with AVHs. This technique has the potential to establish a new brain imaging-guided psychotherapy for patients that do not respond to conventional treatments and take functional neuroimaging to therapeutic applications.