Tailoring treatments to the specific needs and biology of individual patients—personalized
medicine—requires delineation of reliable predictors of response. Unfortunately, these
have been slow to emerge, especially in neuropsychiatric disorders. We have recently
described a real-time functional magnetic resonance imaging (rt-fMRI) neurofeedback
protocol that can reduce contamination-related anxiety, a prominent symptom of many
cases of obsessive-compulsive disorder (OCD). Individual response to this intervention
is variable. Here we used patterns of brain functional connectivity, as measured by
baseline resting-state fMRI (rs-fMRI), to predict improvements in contamination anxiety
after neurofeedback training. Activity of a region of the orbitofrontal cortex (OFC) and
anterior prefrontal cortex, Brodmann area (BA) 10, associated with contamination anxiety
in each subject was measured in real time and presented as a neurofeedback signal,
permitting subjects to learn to modulate this target brain region. We have previously
reported both enhanced OFC/BA 10 control and improved anxiety in a group of subclinically
anxious subjects after neurofeedback. Five individuals with contamination-related OCD
who underwent the same protocol also showed improved clinical symptomatology. In both
groups, these behavioral improvements were strongly correlated with baseline whole-brain
connectivity in the OFC/BA 10, computed from rs-fMRI collected several days prior to
neurofeedback training. These pilot data suggest that rs-fMRI can be used to identify
individuals likely to benefit from rt-fMRI neurofeedback training to control contamination
anxiety.
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