title: Cognitive and neural strategies during control of the anterior cingulate cortex by fMRI neurofeedback in patients with schizophrenia.
abstract: Cognitive functioning is impaired in patients with schizophrenia, leading to significant disabilities in everyday functioning. Its improvement is an important treatment target. Neurofeedback (NF) seems a promising method to address the neural dysfunctions underlying those cognitive impairments. The anterior cingulate cortex (ACC), a central hub for cognitive processing, is one of the brain regions known to be dysfunctional in schizophrenia. Here we conducted NF training based on real-time functional magnetic resonance imaging (fMRI) in patients with schizophrenia to enable them to control their ACC activity. Training was performed over 3 days in a group of 11 patients with schizophrenia and 11 healthy controls. Social feedback was provided in accordance with the evoked activity in the selected region of interest (ROI). Neural and cognitive strategies were examined off-line. Both groups learned to control the activity of their ACC but used different neural strategies: patients activated the dorsal and healthy controls the rostral subdivision. Patients mainly used imagination of music to elicit activity and the control group imagination of sports. In a stepwise regression analysis, the difference in neural control did not result from the differences in cognitive strategies but from diagnosis alone. Based on social reinforcers, patients with schizophrenia can learn to regulate localized brain activity. However, cognitive strategies and neural network location differ from healthy controls. These data emphasize that for therapeutic interventions in patients with schizophrenia compensatory strategies may emerge. Specific cognitive skills or specific dysfunctional networks should be addressed to train impaired skills. Social NF based on fMRI may be one method to accomplish precise learning targets.
authors.affiliation: Department of Psychiatry, Psychotherapy, and Psychosomatics, Medical School, RWTH Aachen University Aachen, Germany ; JARA-Translational Brain Medicine, RWTH Aachen University Aachen, Germany.
authors.forename: Julia S
authors.initials: JS
authors.lastname: Cordes
authors.affiliation: Department of Psychiatry, Psychotherapy, and Psychosomatics, Medical School, RWTH Aachen University Aachen, Germany ; JARA-Translational Brain Medicine, RWTH Aachen University Aachen, Germany ; Clinic for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, RWTH Aachen University Aachen, Germany.
authors.forename: Krystyna A
authors.initials: KA
authors.lastname: Mathiak
authors.affiliation: Department of Psychiatry, Psychotherapy, and Psychosomatics, Medical School, RWTH Aachen University Aachen, Germany ; JARA-Translational Brain Medicine, RWTH Aachen University Aachen, Germany.
authors.forename: Miriam
authors.initials: M
authors.lastname: Dyck
authors.affiliation: Department of Psychiatry, Psychotherapy, and Psychosomatics, Medical School, RWTH Aachen University Aachen, Germany ; JARA-Translational Brain Medicine, RWTH Aachen University Aachen, Germany.
authors.forename: Eliza M
authors.initials: EM
authors.lastname: Alawi
authors.affiliation: Department of Psychiatry, Psychotherapy, and Psychosomatics, Medical School, RWTH Aachen University Aachen, Germany ; Clinic for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, RWTH Aachen University Aachen, Germany.
authors.forename: Tilman J
authors.initials: TJ
authors.lastname: Gaber
authors.affiliation: JARA-Translational Brain Medicine, RWTH Aachen University Aachen, Germany ; Clinic for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, RWTH Aachen University Aachen, Germany ; Department of Child and Adolescent Psychiatry, School of Psychiatry and Clinical Neurosciences and School of Paediatrics and Child Health, Faculty of Medicine, Dentistry and Health Sciences, The University of Western Australia (M561) Perth, WA, Australia ; Specialised Child and Adolescent Mental Health Services (CAMHS), Department of Health in Western Australia Perth, WA, Australia.
authors.forename: Florian D
authors.initials: FD
authors.lastname: Zepf
authors.affiliation: Department of Psychiatry, Psychotherapy, and Psychosomatics, Medical School, RWTH Aachen University Aachen, Germany ; JARA-Translational Brain Medicine, RWTH Aachen University Aachen, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Klasen
authors.affiliation: Department of Psychiatry, Psychotherapy, and Psychosomatics, Medical School, RWTH Aachen University Aachen, Germany ; JARA-Translational Brain Medicine, RWTH Aachen University Aachen, Germany.
authors.forename: Mikhail
authors.initials: M
authors.lastname: Zvyagintsev
authors.affiliation: Department of Psychiatry, University of Pennsylvania Philadelphia, PA, USA.
authors.forename: Ruben C
authors.initials: RC
authors.lastname: Gur
authors.affiliation: Department of Psychiatry, Psychotherapy, and Psychosomatics, Medical School, RWTH Aachen University Aachen, Germany ; JARA-Translational Brain Medicine, RWTH Aachen University Aachen, Germany ; Institute of Psychiatry, Psychology and Neuroscience, King's College London London, UK.
authors.forename: Klaus
authors.initials: K
authors.lastname: Mathiak
keywords: brain computer interface; cognitive strategies; cognitive therapy; psychotherapy; remediation therapy; rostral and dorsal ACC; self-regulation; social reinforcement