title: Resting state functional connectivity predicts neurofeedback response.
abstract: Tailoring treatments to the specific needs and biology of individual patients-personalized medicine-requires delineation of reliable predictors of response. Unfortunately, these have been slow to emerge, especially in neuropsychiatric disorders. We have recently described a real-time functional magnetic resonance imaging (rt-fMRI) neurofeedback protocol that can reduce contamination-related anxiety, a prominent symptom of many cases of obsessive-compulsive disorder (OCD). Individual response to this intervention is variable. Here we used patterns of brain functional connectivity, as measured by baseline resting-state fMRI (rs-fMRI), to predict improvements in contamination anxiety after neurofeedback training. Activity of a region of the orbitofrontal cortex (OFC) and anterior prefrontal cortex, Brodmann area (BA) 10, associated with contamination anxiety in each subject was measured in real time and presented as a neurofeedback signal, permitting subjects to learn to modulate this target brain region. We have previously reported both enhanced OFC/BA 10 control and improved anxiety in a group of subclinically anxious subjects after neurofeedback. Five individuals with contamination-related OCD who underwent the same protocol also showed improved clinical symptomatology. In both groups, these behavioral improvements were strongly correlated with baseline whole-brain connectivity in the OFC/BA 10, computed from rs-fMRI collected several days prior to neurofeedback training. These pilot data suggest that rs-fMRI can be used to identify individuals likely to benefit from rt-fMRI neurofeedback training to control contamination anxiety.
authors.affiliation: Magnetic Resonance Research Center (MRRC), Department of Diagnostic Radiology, Yale School of Medicine New Haven, CT, USA.
authors.forename: Dustin
authors.initials: D
authors.lastname: Scheinost
authors.affiliation: Magnetic Resonance Research Center (MRRC), Department of Diagnostic Radiology, Yale School of Medicine New Haven, CT, USA.
authors.forename: Teodora
authors.initials: T
authors.lastname: Stoica
authors.affiliation: Department of Psychiatry, Yale School of Medicine New Haven, CT, USA.
authors.forename: Suzanne
authors.initials: S
authors.lastname: Wasylink
authors.affiliation: Department of Psychiatry, Yale School of Medicine New Haven, CT, USA.
authors.forename: Patricia
authors.initials: P
authors.lastname: Gruner
authors.affiliation: Department of Psychiatry, Yale School of Medicine New Haven, CT, USA.
authors.forename: John
authors.initials: J
authors.lastname: Saksa
authors.affiliation: Department of Psychiatry, Yale School of Medicine New Haven, CT, USA ; Department of Psychology, Yale University New Haven, CT, USA ; Child Study Center, Yale School of Medicine New Haven, CT, USA.
authors.forename: Christopher
authors.initials: C
authors.lastname: Pittenger
authors.affiliation: Magnetic Resonance Research Center (MRRC), Department of Diagnostic Radiology, Yale School of Medicine New Haven, CT, USA.
authors.forename: Michelle
authors.initials: M
authors.lastname: Hampson
keywords: neurofeedback; obsessive-compulsive disorder; orbitofrontal cortex; real-time fMRI; resting state connectivity