AUTHOR=Zweerings Jana , Pflieger Eliza M. , Mathiak Krystyna A. , Zvyagintsev Mikhail , Kacela Anastasia , Flatten Guido , Mathiak Klaus 

TITLE=Impaired Voluntary Control in PTSD: Probing Self-Regulation of the ACC With Real-Time fMRI

JOURNAL=Frontiers in Psychiatry

VOLUME=9

YEAR=2018

URL=https://www.frontiersin.org/journals/psychiatry/articles/10.3389/fpsyt.2018.00219

DOI=10.3389/fpsyt.2018.00219

ISSN=1664-0640

ABSTRACT=<p><bold>Background:</bold> Post-traumatic stress disorder (PTSD) is characterized by deficits in the self-regulation of cognitions and emotions. Neural networks of emotion regulation may exhibit reduced control mediated by the anterior cingulate cortex (ACC), contributing to aberrant limbic responses in PTSD.</p><p><bold>Methods:</bold> Real-time fMRI neurofeedback (rt-fMRI NF) assessed self-regulation of the ACC in nine patients with PTSD after single trauma exposure and nine matched healthy controls. All participants were instructed to train ACC upregulation on three training days.</p><p><bold>Results:</bold> Both groups achieved regulation, which was associated with wide-spread brain activation encompassing the ACC. Compared to the controls, regulation amplitude and learning rate was lower in patients, correlating with symptom severity. In addition, a frontopolar activation cluster was associated with self-regulation efforts in patients.</p><p><bold>Conclusions:</bold> For the first time, we tested self-regulation of the ACC in patients with PTSD. The observed impairment supports models of ACC-mediated regulation deficits that may contribute to the psychopathology of PTSD. Controlled trials in a larger sample are needed to confirm our findings and to directly investigate whether training of central regulation mechanisms improves emotion regulation in PTSD.</p>