TY - JOUR
T1 - Self-blame in major depression
T2 - a randomised pilot trial comparing fMRI neurofeedback with self-guided psychological strategies
AU - Jaeckle, Tanja
AU - Williams, Steven C R
AU - Barker, Gareth J
AU - Basilio, Rodrigo
AU - Carr, Ewan
AU - Goldsmith, Kimberley
AU - Colasanti, Alessandro
AU - Giampietro, Vincent
AU - Cleare, Anthony
AU - Young, Allan H
AU - Moll, Jorge
AU - Zahn, Roland
N1 - Funding Information:
We gratefully acknowledge the following funding sources: A NARSAD Independent Investigator Grant (24715) from the Brain & Behavior Research Foundation to RZ, the IoPPN at King's College London as well as the NIHR Biomedical Research Centre for Mental Health at the South London and Maudsley NHS Foundation Trust. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care. JM and RB were supported by the LABS-D'Or Hospital Network, Rio de Janeiro, Brazil.
Funding Information:
RB, JM, and RZ are affiliated with IDOR, which owns the IP for the neurofeedback software FRIEND, which is made freely available in keeping with its not-for-profit mission. AHY is a consultant to Johnson & Johnson and Livanova. AHY has given paid lectures and sat on advisory boards for the following companies with drugs used in affective and related disorders: Astrazenaca, Eli Lilly, Lundbeck, Sunovion, Servier, Livanova, Janssen, Allegan, Bionomics, Sumitomo Dainippon Pharma, COMPASS. AHY has received honoraria for attending advisory boards and presenting talks at meetings organised by LivaNova. AHY is the Principal Investigator of trials of Esketamine, Vagus Nerve Stimulation, and Psilocybin in Depression. AHY has received grant funding (past and present) from the following: NIMH (USA); CIHR (Canada); NARSAD (USA); Stanley Medical Research Institute (USA); MRC (UK); Wellcome Trust (UK); Royal College of Physicians (Edin); BMA (UK); UBC-VGH Foundation (Canada); WEDC (Canada); CCS Depression Research Fund (Canada); MSFHR (Canada); NIHR (UK); Janssen (UK). AHY has no shareholdings in pharmaceutical companies. In the last three years, AJC has received honoraria for speaking from Lundbeck, honoraria for consulting from Allergan, Livanova, Janssen and Lundbeck, and sponsorship for attending an academic conference from Janssen. RZ is a private psychiatrist service provider at The London Depression Institute and co-investigator on a Livanova-funded observational study of Vagus Nerve Stimulation for Depression. RZ has received honoraria for talks at medical symposia sponsored by Lundbeck as well as Janssen. He has collaborated with EMIS PLC and advises Depsee Ltd. RZ and JM are affiliated with Scients Institute, Palo Alto. KG reports grants from NIHR, Stroke Association, National Institutes of Health (US) and Juvenile Diabetes Research Foundation (US) during the conduct of the study. EC reports personal fees from NIHR during the conduct of the study. GJB receives honoraria from GE Healthcare for teaching and is a patent holder on US patent number US 9903930 ‘RF pulses for magnetic resonance’. The other authors report no competing interests.
Publisher Copyright:
© The King's College London, 2021. Published by Cambridge University Press.
PY - 2021/12/2
Y1 - 2021/12/2
N2 - Overgeneralised self-blame and worthlessness are key symptoms of major depressive disorder (MDD) and have previously been associated with self-blame-selective changes in connectivity between right superior anterior temporal lobe (rSATL) and subgenual frontal cortices. Another study showed that remitted MDD patients were able to modulate this neural signature using functional magnetic resonance imaging (fMRI) neurofeedback training, thereby increasing their self-esteem. The feasibility and potential of using this approach in symptomatic MDD were unknown. This single-blind pre-registered randomised controlled pilot trial probed a novel self-guided psychological intervention with and without additional rSATL-posterior subgenual cortex (BA25) fMRI neurofeedback, targeting self-blaming emotions in people with insufficiently recovered MDD and early treatment-resistance (n = 43, n = 35 completers). Participants completed three weekly self-guided sessions to rebalance self-blaming biases. As predicted, neurofeedback led to a training-induced reduction in rSATL-BA25 connectivity for self-blame v. other-blame. Both interventions were safe and resulted in a 46% reduction on the Beck Depression Inventory-II, our primary outcome, with no group differences. Secondary analyses, however, revealed that patients without DSM-5-defined anxious distress showed a superior response to neurofeedback compared with the psychological intervention, and the opposite pattern in anxious MDD. As predicted, symptom remission was associated with increases in self-esteem and this correlated with the frequency with which participants employed the psychological strategies in daily life. These findings suggest that self-blame-rebalance neurofeedback may be superior over a solely psychological intervention in non-anxious MDD, although further confirmatory studies are needed. Simple self-guided strategies tackling self-blame were beneficial, but need to be compared against treatment-as-usual in further trials. https://doi.org/10.1186/ISRCTN10526888.
AB - Overgeneralised self-blame and worthlessness are key symptoms of major depressive disorder (MDD) and have previously been associated with self-blame-selective changes in connectivity between right superior anterior temporal lobe (rSATL) and subgenual frontal cortices. Another study showed that remitted MDD patients were able to modulate this neural signature using functional magnetic resonance imaging (fMRI) neurofeedback training, thereby increasing their self-esteem. The feasibility and potential of using this approach in symptomatic MDD were unknown. This single-blind pre-registered randomised controlled pilot trial probed a novel self-guided psychological intervention with and without additional rSATL-posterior subgenual cortex (BA25) fMRI neurofeedback, targeting self-blaming emotions in people with insufficiently recovered MDD and early treatment-resistance (n = 43, n = 35 completers). Participants completed three weekly self-guided sessions to rebalance self-blaming biases. As predicted, neurofeedback led to a training-induced reduction in rSATL-BA25 connectivity for self-blame v. other-blame. Both interventions were safe and resulted in a 46% reduction on the Beck Depression Inventory-II, our primary outcome, with no group differences. Secondary analyses, however, revealed that patients without DSM-5-defined anxious distress showed a superior response to neurofeedback compared with the psychological intervention, and the opposite pattern in anxious MDD. As predicted, symptom remission was associated with increases in self-esteem and this correlated with the frequency with which participants employed the psychological strategies in daily life. These findings suggest that self-blame-rebalance neurofeedback may be superior over a solely psychological intervention in non-anxious MDD, although further confirmatory studies are needed. Simple self-guided strategies tackling self-blame were beneficial, but need to be compared against treatment-as-usual in further trials. https://doi.org/10.1186/ISRCTN10526888.
UR - http://www.scopus.com/inward/record.url?scp=85120653398&partnerID=8YFLogxK
U2 - 10.1017/S0033291721004797
DO - 10.1017/S0033291721004797
M3 - Article
C2 - 34852855
SN - 0033-2917
SP - 1
EP - 11
JO - Psychological Medicine
JF - Psychological Medicine
ER -