The influence of biofeedback training on functional connectivity between limbic and prefrontal brain areas in patients with major depression

• Applicant: Dr. Andy Schumann
• Subject Area: Clinical Psychiatry, Psychotherapy, Child and Adolescent Psychiatry
• Term: from 2020 to 2024
• Project identifier: Deutsche Forschungsgemeinschaft (DFG) - Project number 445564528

A large body of scientific literature demonstrated that patients with major depression (MD) have an increased risk of cardiovascular morbidity and mortality. The well-documented imbalance of the autonomic nervous system in MD patients seem to precede cardiovascular impairments. One key symptom of depression is that patients are caught in perseverative worries and negative thoughts (rumination). There is evidence that rumination contribute significantly to sympathetic arousal and autonomic imbalance. Functional brain imaging studies suggest a lack of inhibition of frontal areas upon the limbic promoting depressive rumination and sympathetic autonomic arousal. In this research proposal, we want to assess the contribution of sympathetic overactivation and parasympathetic withdrawal to autonomic imbalance in more detail as well as their relation to neural connectivity patterns and rumination levels. Furthermore, we want to compare two types of biofeedback interventions that are thought to ameliorate the autonomic imbalance and alleviate depressive rumination. In a preliminary investigation, we found that an eight-week heart rate variability (HRV) biofeedback training is accompanied by increased fronto-limbic functional brain connectivity. The biofeedback group showed a drop of heart rate by 5.5 beats/min and an increased RMSSD as a measure of HRV by 10.1ms (33%). Functional connectivity of the ventromedial prefrontal cortex increased mainly to the right anterior insula, the dorsal anterior cingulate cortex, and lateral prefrontal areas due to the intervention when compared to changes in the control group. Increased prefrontal connectivity to core regions of the limbic system suggest an impact of HRV biofeedback on emotion regulation and cognitive control. To further assess the suitability of this type of intervention in patients with depression, we want to compare HRV biofeedback that targets the parasympathetic branch of the autonomic nervous system to Skin conductance biofeedback that impacts primarily on the sympathetic branch. In this way, we want to promote the application of biofeedback interventions to decrease disease severity in MD patients.

• DFG Programme: Research Grants
• International Connection: Italy
• Co-Investigators: Professor Dr. Karl-Jürgen Bär; Dr. Feliberto De la Cruz; Dr. Stefanie Köhler
• Cooperation Partner: Professorin Dr. Cristina Ottaviani