Neuromodulatory Enhancement of Hope in the Treatment of Suicide (NEU-Hope)

In the United States, one person dies by suicide every 11 minutes and suicide rates have increased by 22% over the past 15 years, making it of pressing concern for the field of psychiatry and a public health crisis. There is a need to identify fast-acting, targeted, non-invasive interventions to reduce suicidal ideation and attempts. Real-time functional MRI (fMRI) neurofeedback is a method of training individuals to regulate activity in the brain and has shown promise for the improvement of mental health. Episodic future thinking involves the imagining of future events and optimal engagement in positive future thinking may increase hope and reduce impulsivity. Prior work and the investigators’ preliminary data indicate (1) increased suicide risk is associated with less specificity and positivity in episodic future thinking as well as blunted ventromedial prefrontal cortex (vmPFC) activity during future thinking, (2) optimal engagement in positive future thinking relates to increased hope and reduced impulsivity, and (3) that real-time fMRI neurofeedback has the potential to improve mental health and that vmPFC-targeted neurofeedback is feasible for individuals with major depressive disorder and history of suicide attempts.

For the proposed project, our main objective is to conduct an initial, randomized controlled trial examining the potential clinical benefit of vmPFC-targeted fMRI neurofeedback for individuals diagnosed with major depressive disorder who are at risk for SA recurrence (MDD+SA). Our long-term goal is to identify neuromodulation interventions that could serve as an acute treatment alternative or augmentation for this patient population. The proposed study will accomplish the following aims: (1) Examine the acute impact of vmPFC-targeted neurofeedback, as compared to sham neurofeedback, on vmPFC activation and connectivity with patients experiencing MDD+SA, (3) Examine the clinical impact of neurofeedback-related changes in vmPFC activation for patients experiencing MDD+SA, with a primary focus on relationships between changes in vmPFC activation and changes in suicidal ideation and intent.

To accomplish these aims, we will recruit 45 participants with MDD+SA to be randomized in a 2:1 ratio to complete vmPFC-targeted fMRI neurofeedback (N=30) or sham neurofeedback (N=15). All participants will complete baseline diagnostic, behavioral and self-report surveys, followed by two real-time fMRI-based neurofeedback sessions (one week apart) and follow-up sessions two and four weeks later. Self-report and behavioral measures will be repeated at each session. Experience sampling methodology (ESM) will be implemented using daily surveys at baseline, and between each of the rtfMRI-nf and follow-up sessions. Results from the proposed study will inform future, larger randomized clinical trials to examine the effectiveness of vmPFC-targeted rtfMRI-nf for reducing SA recurrence.