Real-time fMRI training of functional connectivity and adaptive self-awareness

Awareness of one's thoughts and feelings represents one of the highest mental processes in humans. Its dysregulation leads to rumination, which involves repetitively focusing on negative experiences and mental events. Rumination is consistently and strongly related to depression as both a precursor and a symptom, and therefore has important treatment implications. Given the high rates of relapse and treatment dropout in depressed individuals, a need exists for ongoing and immediate feedback in cognitive therapies that could facilitate learning and treatment compliance, and thereby improve clinical outcomes in people with depression. Real-time functional magnetic resonance imaging (fMRI), can add ongoing and immediate feedback to mindfulness-based cognitive therapy to increase its effectiveness. Mindfulness, a relatively successful treatment for depression, is an adaptive moment-to-moment awareness of mental events without controlling or elaborating (i.e. ruminating), and recruits both the anterior prefrontal cortex (PFC), (associated with cognitive and emotional self-awareness and self-regulation), and the anterior insula (associated with awareness of the self in the present moment). Previous studies show that people can successfully use real-time fMRI feedback along with awareness of their thoughts and emotions to modulate activation in the anterior PFC and the anterior insula separately. Melissa Ellamil is using real-time fMRI to examine whether it can help increase a person’s modulation ability over the functional connectivity between their anterior PFC and insular cortex and thereby improve the outcome of the strategies taught in mindfulness-based cognitive therapy. Ms. Ellamil's research complements ongoing investigations using real-time fMRI to define functions and interactions of various regions of the brain. Her results could fine-tune the real-time fMRI feedback and self-awareness strategies and thereby enhance and prolong the results of cognitive treatments for depression.