Increasing the efficacy of exposure using a whole brain approach to real-time fMRI neurofeedback among female victims of interpersonal violence

Individuals who experience interpersonal violence (IPV) and poly-victimization have an increased likelihood of developing Posttraumatic Stress Disorder (PTSD), and statistically, women are more likely than men to be victims of IPV, experience poly-victimization, and develop PTSD. Current gold-standard PTSD treatments utilize exposure, a key mechanism of change; however, exposure-based treatments suffer from moderate remission rates. This outcome underscores the importance of utilizing knowledge of neural mechanisms to increase treatment effectiveness and PTSD remission rates. The current study used a symptom provocation paradigm, which is conceptually similar to exposure, and whole brain multivariate pattern classifiers (MVPC) to provide participants with neurofeedback on their ability to regulate their brain-states. In the MRI scanner, women (N = 21; control n = 11, PTSD n = 10) completed a symptom provocation paradigm. The MVPC was constructed during the first two runs and neurofeedback was given during the third and fourth run. During all four runs, participants were instructed to increase or decrease their emotional engagement with their stress/trauma script and during the last two runs, participants were provided visual feedback indicating their performance in regulating brain states. Skin conductance response was utilized as an independent measure of physiological arousal. Generalized linear models indicated a significant interaction effect of feedback and condition as well as feedback and group. Generalized linear models of skin conductance response largely mirrored these findings. Results indicate neurofeedback of whole brain activation can be utilized to increase engagement with trauma memories. Thus, exposure-based treatments, possibly with refractory cases of PTSD, may be improved with neurofeedback by providing the therapist and patient insight into their brain-state during exposure which may increase the effectiveness of exposure-based treatments.