CCN Colloquium: "Personalized Network Based Neurofeedback And Neuromodulation in Psychiatric Disorders"

The U.S. Surgeon General and leading pediatric health organizations have recently declared a national state of emergency for adolescent mental health. Demand for mental health services has broadly outstripped capacity, underscoring that the majority of affected individuals do not receive sufficient treatment. Moreover, because gold-standard treatments are effective for only ~50% of patients, developing novel, mechanistically driven, treatments is crucial for improving clinical outcomes and potentiating early preventive care. The default mode network (DMN), an intrinsic brain network associated with inner mental life, is over-engaged in patients suffering from anxiety, depression and psychosis and is positively associated with increased clinical symptoms. We hypothesize that DMN hyperconnectivity is a core transdiagnostic shared neural mechanism underlying mood and psychotic disorders. Hence, we developed a mindfulness-based real-time fMRI neurofeedback (mbNF) intervention as a novel "network therapeutic" targeting DMN. Mindfulness meditation -drawing attentional focus to the present and metacognitive awareness of ongoing thoughts - suppresses the DMN and reduces the DMN hyperconnectivity, while neurofeedback provides a mental mirror of personalized brain network modulation empowering patients agency to train their brains to tune their minds. Importantly, the reduction of DMN hyperconnectivity, post mbNF, is associated with a reduction of clinical symptoms and increased state mindfulness. Finally, we are developing a closed loop, personalized neurofeedback system designed to: a) elucidate and track personalized, intrinsic brain networks (and their electrophysiological correlates) along with their associated mental states/symptoms; b) elucidate the symptom's neural antecedents, through the use of real-time fMRI triggered experience sampling (rt-fMRI-ES); and c) trigger just-in-time adaptive neuromodulatory interventions.