"Listen to your heart": A novel interoceptive strategy for real-time fMRI neurofeedback training of anterior insula activity

Yuan Zhang; Qiong Zhang; Jiayuan Wang; Menghan Zhou; Yanan Qing; Haochen Zou; Jianfu Li; Chenghui Yang; Benjamin Becker; Keith M Kendrick; Shuxia Yao

doi:10.1016/j.neuroimage.2023.120455

"Listen to your heart": A novel interoceptive strategy for real-time fMRI neurofeedback training of anterior insula activity

Neuroimage. 2023 Dec 15:284:120455. doi: 10.1016/j.neuroimage.2023.120455. Epub 2023 Nov 10.

Authors

Affiliations

¹ The Center of Psychosomatic Medicine, Sichuan Provincial Center for Mental Health, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu 611731, China; The MOE Key Laboratory for Neuroinformation, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu 611731, China.
² The MOE Key Laboratory for Neuroinformation, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu 611731, China.
³ The Center of Psychosomatic Medicine, Sichuan Provincial Center for Mental Health, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu 611731, China.
⁴ The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Pokfulam, Hong Kong, China; Department of Psychology, The University of Hong Kong, Pokfulam, Hong Kong, China.
⁵ The Center of Psychosomatic Medicine, Sichuan Provincial Center for Mental Health, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu 611731, China; The MOE Key Laboratory for Neuroinformation, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu 611731, China. Electronic address: yaoshuxia@uestc.edu.cn.

PMID: 37952779
DOI: 10.1016/j.neuroimage.2023.120455

Abstract

Real-time fMRI (rt-fMRI) neurofeedback (NF) training is a novel non-invasive technique for volitional brain modulation. Given the important role of the anterior insula (AI) in human cognitive and affective processes, it has become one of the most investigated regions in rt-fMRI studies. Most rt-fMRI insula studies employed emotional recall/imagery as the regulation strategy, which may be less effective for psychiatric disorders characterized by altered emotional processing. The present study thus aimed to examine the feasibility of a novel interoceptive strategy based on heartbeat detection in rt-fMRI guided AI regulation and its associated behavioral changes using a randomized double-blind, sham feedback-controlled between-subject design. 66 participants were recruited and randomly assigned to receive either NF from the left AI (LAI) or sham feedback from a control region while using the interoceptive strategy. N = 57 participants were included in the final data analyses. Empathic and interoceptive pre-post training changes were collected as behavioral measures of NF training effects. Results showed that participants in the NF group exhibited stronger LAI activity than the control group with LAI activity being positively correlated with interoceptive accuracy following NF training, although there were no significant increases of LAI activity over training sessions. Importantly, ability of LAI regulation could be maintained in a transfer session without feedback. Successful LAI regulation was associated with strengthened functional connectivity of the LAI with cognitive control, memory and learning, and salience/interoceptive networks. The present study demonstrated for the first time the efficacy of a novel regulation strategy based on interoceptive processing in up-regulating LAI activity. Our findings also provide proof of concept for the translational potential of this strategy in rt-fMRI AI regulation of psychiatric disorders characterized by altered emotional processing.

Keywords: Anterior insula; Interoception; Neurofeedback; Real-time fMRI; Regulation strategy.

Publication types

Randomized Controlled Trial

MeSH terms

Brain / physiology
Brain Mapping / methods
Emotions / physiology
Empathy
Humans
Magnetic Resonance Imaging* / methods
Neurofeedback* / methods