fMRI neurofeedback for disorders of emotion regulation

This chapter reviews existing work on fMRI neurofeedback in disorders of emotion regulation such as depression, posttraumatic stress disorder, borderline personality disorder, and anxiety disorders. We present a framework of what to target (disturbed or compensatory functions) as well as how to target (what interface to use and whether to up or downregulate). Considering what to target we suggest the following distinction: (a) targeting disturbed processes which aims to restore neural functions that are aberrant compared to the level of that seen in healthy controls, and (b) targeting compensatory functions which are aimed at leveraging what patients are already using to perform some task/function. With regard to targeting disturbed processes: in major depressive disorder this includes increasing amygdala responses to positive stimuli and decreasing salience network responses to negative stimuli. In posttraumatic stress disorder and borderline personality disorder this includes decreasing limbic brain activity including that of the amygdala. With regard to targeting compensatory processes: in major depressive disorder this involves increasing responses to positive stimuli in prefrontal regions in order to compensate for the lack of limbic and salience network activation. These approaches require identifying neural substrates that may compensate for disturbed functions. In addition to an overview of results in these populations using these approaches, we also discuss major issues in clinical application of neurofeedback for emotion regulation including what and how to target and how to measure training outcome.