33 to 4.08). Conversely, the psychotherapy group only showed minimal improvement (12.36 to 11.08). However, the scope of this study is limited by the relatively low depression levels before treatment (a mean IIDRS score of 12 indicates mild depression and is below the conventional cutoffs for treatment trials). Furthermore, the choice of control group does not exclude the impact of nonspecific effects of neurofeedback training, for example, the gaming component, which may make the training more interesting and engaging than conventional psychotherapy. fMRI neurofeedback in depression One of the limitations of EEG-NF is its low spatial Inhibitors,research,lifescience,medical precision, which is

owed to the effects of volume conductance

and the attenuation of electrical signals on their way from the source to the scalp, and the ill-posed nature of the source Inhibitors,research,lifescience,medical localization problem.41 Although the fMRI technique provides only indirect measures of neural activity (obtained through neurovascular coupling) and has a much lower temporal resolution than the electrophysiological techniques (in the second range compared with the millisecond precision of EEG and MEG), its spatial resolution and access to deeper brain structure make it an attractive tool for network mapping in psychiatric disorders and neurofeedback.42 Our research group has designed an fMRI-NF protocol for patients with depression Inhibitors,research,lifescience,medical Inhibitors,research,lifescience,medical (Figure 2). Figure 2. Display screen of visual neurofeedback with an outline of the protocol. The patients trained to increase activity in functionally localized areas during 20-second periods, alternating with 20 second periods of rest. Overall, they did this for 20 minutes … Rather than using anatomically fixed target regions (as conventionally used in psychiatric surgery), the fMRI-NF approach gave us the opportunity to identify the relevant target areas in each training session using

a functional localizer. Localizer scans with emotionally charged pictures can identify areas involved in the processing of positive or negative affective stimuli, and from we initially Inhibitors,research,lifescience,medical showed that healthy participants can attain control over the activation levels in these areas.44,45 The “positive emotion” areas were then used as the target for fMRI-NF in a pilot study with patients with mild-tomoderate levels of depression.46 We tested eight patients, all with a longstanding history of depression. They were informed that the areas they trained to upregulate had been associated with positive emotional pictures, but no specific strategy was suggested to them. Most patients started their attempts to upregulate the target areas that, although varied in localization, mostly included areas in the ventral prefrontal cortex and limbic system, by click here imagining the pictures, which included serene landscapes and uplifting sporting scenes.