title: Self-Regulation of Anterior Insula with Real-Time fMRI and Its Behavioral Effects in Obsessive-Compulsive Disorder: A Feasibility Study.
abstract: BACKGROUND
  Obsessive-compulsive disorder (OCD) is a common and chronic condition that can have disabling effects throughout the patient's lifespan. Frequent symptoms among OCD patients include fear of contamination and washing compulsions. Several studies have shown a link between contamination fears, disgust over-reactivity, and insula activation in OCD. In concordance with the role of insula in disgust processing, new neural models based on neuroimaging studies suggest that abnormally high activations of insula could be implicated in OCD psychopathology, at least in the subgroup of patients with contamination fears and washing compulsions.
  
  
  METHODS
  In the current study, we used a Brain Computer Interface (BCI) based on real-time functional magnetic resonance imaging (rtfMRI) to aid OCD patients to achieve down-regulation of the Blood Oxygenation Level Dependent (BOLD) signal in anterior insula. Our first aim was to investigate whether patients with contamination obsessions and washing compulsions can learn to volitionally decrease (down-regulate) activity in the insula in the presence of disgust/anxiety provoking stimuli. Our second aim was to evaluate the effect of down-regulation on clinical, behavioural and physiological changes pertaining to OCD symptoms. Hence, several pre- and post-training measures were performed, i.e., confronting the patient with a disgust/anxiety inducing real-world object (Ecological Disgust Test), and subjective rating and physiological responses (heart rate, skin conductance level) of disgust towards provoking pictures.
  
  
  RESULTS
  Results of this pilot study, performed in 3 patients (2 females), show that OCD patients can gain self-control of the BOLD activity of insula, albeit to different degrees. In two patients positive changes in behaviour in the EDT were observed following the rtfMRI trainings. Behavioural changes were also confirmed by reductions in the negative valence and in the subjective perception of disgust towards symptom provoking images.
  
  
  CONCLUSIONS
  Although preliminary, results of this study confirmed that insula down-regulation is possible in patients suffering from OCD, and that volitional decreases of insula activation could be used for symptom alleviation in this disorder.
authors: Graduate School of Neural & Behavioural Sciences, International Max Planck Research School, University of Tübingen, Tuebingen, Germany; Institute for Medical Psychology and Behavioural Neurobiology, University of Tuebingen, Tuebingen, Germany.
authors: Korhan
authors: K
authors: Buyukturkoglu
authors: Department of Psychiatry and Psychotherapy, Philipps-University Marburg, Marburg, Germany.
authors: Hans
authors: H
authors: Roettgers
authors: Department of Psychiatry and Psychotherapy, Philipps-University Marburg, Marburg, Germany.
authors: Jens
authors: J
authors: Sommer
authors: Graduate School of Neural & Behavioural Sciences, International Max Planck Research School, University of Tübingen, Tuebingen, Germany; Institute for Medical Psychology and Behavioural Neurobiology, University of Tuebingen, Tuebingen, Germany; Department of Biomedical Engineering, University of Florida, Gainesville, Florida, United States of America.
authors: Mohit
authors: M
authors: Rana
authors: Department of Psychiatry and Psychotherapy, Philipps-University Marburg, Marburg, Germany.
authors: Leonie
authors: L
authors: Dietzsch
authors: Department of Psychiatry and Psychotherapy, Philipps-University Marburg, Marburg, Germany.
authors: Ezgi Belkis
authors: EB
authors: Arikan
authors: Institute for Medical Psychology and Behavioural Neurobiology, University of Tuebingen, Tuebingen, Germany.
authors: Ralf
authors: R
authors: Veit
authors: Graduate School of Neural & Behavioural Sciences, International Max Planck Research School, University of Tübingen, Tuebingen, Germany; Institute for Medical Psychology and Behavioural Neurobiology, University of Tuebingen, Tuebingen, Germany.
authors: Rahim
authors: R
authors: Malekshahi
authors: Department of Psychiatry and Psychotherapy, Philipps-University Marburg, Marburg, Germany.
authors: Tilo
authors: T
authors: Kircher
authors: Institute for Medical Psychology and Behavioural Neurobiology, University of Tuebingen, Tuebingen, Germany; Ospedale San Camillo, Istituto di Ricovero e Cura a Carattere Scientifico, Venezia, Italy.
authors: Niels
authors: N
authors: Birbaumer
authors: Institute for Medical Psychology and Behavioural Neurobiology, University of Tuebingen, Tuebingen, Germany; Department of Biomedical Engineering, University of Florida, Gainesville, Florida, United States of America.
authors: Ranganatha
authors: R
authors: Sitaram
authors: Institute for Medical Psychology and Behavioural Neurobiology, University of Tuebingen, Tuebingen, Germany; Departamento de Psiquiatría, Escuela de Medicina, Centro Interdisciplinario de Neurociencia, Pontificia Universidad Católica de Chile, Santiago, Chile.
authors: Sergio
authors: S
authors: Ruiz
mesh_terms: D000328:Adult; D001007:Anxiety / Q000503:physiopathology* / Q000523:psychology; D002540:Cerebral Cortex / Q000000981:diagnostic imaging / Q000503:physiopathology*; D004644:Emotions / Q000502:physiology; D005239:Fear / Q000502:physiology* / Q000523:psychology; D005240:Feasibility Studies; D005260:Female; D006339:Heart Rate; D006801:Humans; D007858:Learning / Q000502:physiology; D008279:Magnetic Resonance Imaging; D008297:Male; D059906:Neuroimaging; D009771:Obsessive-Compulsive Disorder / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000523:psychology; D011859:Radiography; D000068356:Self-Control; D012879:Skin Physiological Phenomena; D014796:Visual Perception / Q000502:physiology