Q&A: Susan Whitfield-Gabrieli on Managing Anxiety and Depression with Mindfulness-Based fMRI Neurofeedback

Gary Boas

In a paper recently published in Molecular Psychiatry, Martinos affiliated faculty member Susan Whitfield-Gabrieli and colleagues describe a mindfulness-based fMRI neurofeedback approach they have developed and highlight its potential in treating adolescents with a history of anxiety and depression.

In the Q&A below, Whitfield-Gabrieli discusses the work, which was done in collaboration with center researcher Anastasia Yendiki and the Martinos-based Boston Adolescent Neuroimaging of Depression and Anxiety (BANDA) study, and the impact it could have on the management of anxiety and depression.

What motivated the study?

In adolescents, rates of depression and anxiety (which are highly comorbid with ADHD) have been rising over the past decade, with the COVID-19 pandemic exacerbating these alarming trends. As a result, the American Academy of Pediatrics, American Academy of Child and Adolescent Psychiatry, Children’s Hospital Association and the U.S. Surgeon General have recently declared a national state of emergency for youth mental health.

Strategies for supporting these populations are inadequate and unequitable: large-cohort studies have shown that a majority of patients are initially prescribed ineffective pharmacological treatments, and it frequently takes years of trial and error to get to an effective therapy. As currently implemented, both pharmacological and behavioral interventions are effective for only about 50% of patients.

In what ways are the strategies inequitable?

Both pharmacological treatments and behavioral treatments can be expensive — and they are especially difficult to access now because there is a dramatic shortage of available therapists. Not everyone has the financial resources to support such interventions. For example, a primary barrier is the lack of health insurance, which prevents families from being able to afford standard treatments. However, mindfulness meditation is free and can be done by anyone, anywhere and anytime.

How does the approach you and colleagues have described work? How does it help address the need for more effective and more equitable strategies?

Depression, at the neural level, is consistently characterized by hyperactivation and hyperconnectivity among a set of regions belonging to the ‘default mode network’ (DMN), including key nodes in the medial prefrontal cortex (MPFC) and the posterior cingulate (PCC). The DMN, an intrinsic brain network associated with our inner mental lives, becomes engaged during mental time travel — such as reminiscing about the past or planning for future. It is over-engaged in patients suffering from depression/anxiety — reminiscing about the past may become ruminating or rehashing the past and planning for the future may become obsessively worrying about the future.

In depression, the DMN “ropes in” the subgenual anterior cingulate (sgACC) which is known to be an effective direct, or associated target, in stimulation-based treatment options such as deep brain stimulation and transcranial magnetic stimulation.

Instead of relying on externally delivered neurostimulation that may require invasive surgery and/or can only be performed at a clinic, we aim to teach patients how to modulate their DMN, via mindfulness meditation augmented with real-time fMRI neurofeedback, with the goal of teaching them how to volitionally modulate their brain networks and mitigate symptoms in a context specific manner.

In what ways would you like to implement the approach?

Ultimately, we are hoping to leverage the power of real-time fMRI triggered experience sampling and neurofeedback to inform highly individualized behavioral therapies and rebalance patterns of aberrant brain network activity that underlie a broad range of mental disorders (e.g., psychosis, depression, anxiety, ADHD).

Our vision is to create a technology-based training platform that supports individuals suffering from mental illness, ultimately enabling them to (1) recognize the onset of negative mental states (e.g., repetitive negative thinking [RNT] such as rumination, worry) in real-time in their daily lives; (2) initiate context-/symptom-specific interventions (e.g., mindfulness meditation, exercise) that are targeted to their own precise neural architecture and activity patterns, and (3) create brain network dynamics that are conducive to positive mental health.

Also, as part of our efforts to disseminate the technique, I will be leading a session — “Workshop on Combining fMRI-Based Modalities: Resting State Data, Task-Based Data, and Real-Time Feedback and Event-Triggered Tasks” — during Robert Savoy’s Connectivity Course: Structural and Functional Brain Connectivity via MRI and fMRI to be held at the Martinos Center this fall.