Enhanced attention-related alertness following right anterior insular cortex neurofeedback training

Abstract

The anterior insular cortex, a central node of the salience network, plays a critical role in cognitive control and attention. Here, we investigated the feasibility of enhancing attention using real-time fMRI neurofeedback training that targets the right anterior insular cortex (rAIC). 56 healthy adults underwent two neurofeedback training sessions. The experimental group received feedback from neural responses in the rAIC, while control groups received sham feedback from the primary visual cortex or no feedback. Cognitive functioning was evaluated before, immediately after, and three months post-training. Our results showed that only the rAIC neurofeedback group successfully increased activity in the rAIC. Furthermore, this group showed enhanced attention-related alertness up to three months after the training. Our findings provide evidence for the potential of rAIC neurofeedback as a viable approach for enhancing attention-related alertness, which could pave the way for non-invasive therapeutic strategies to address conditions characterized by attention deficits.

Keywords: Biological sciences; Neuroscience; Sensory neuroscience; Techniques in neuroscience.

Graphical abstract

Figure 1

Study overview Participants in the rAIC and V1 group took part in four sessions. The first session included questionnaires, behavioral tests and a Go/NoGo task while EEG and fMRI were recorded simultaneously. Session two and three were rt-fMRI neurofeedback training sessions. For details about ROI placement see also Figure S1. After session three, participants again performed behavioral tests. Three months after neurofeedback training, participants repeated the procedure of the first study session. Participants in the mental-rehearsal group followed the same procedure but without the three months follow-up session and we did not record EEG-fMRI during session one.

Figure 2

Schematic illustration of one session of rt-fMRI neurofeedback training for each group Participants in rAIC and V1 group performed at the beginning and at the end of each session runs without feedback (baseline/transfer). Between baseline and transfer run, they did five runs where they received neurofeedback training. Participants in the mental-rehearsal group conducted per session seven runs without feedback. For each participant, an anatomical MRI and a resting-state fMRI was recorded before the neurofeedback training.

Figure 3

Activation level within rAIC before and after neurofeedback training Activity difference in contrast values (regulation > baseline) between the first baseline run and the last transfer run. Asterisks indicate significant paired t-test results: ∗p < 0.05, ∗∗p < 0.01, ∗∗∗p < 0.001. For rAIC activity over all runs see also Figures S2 and S3.

Figure 4

Alerting effects Participants in the rAIC group showed an increased alerting effect right after rt-fMRI neurofeedback training (post-training) compared to before (∗∗p < 0.01). This effect was also evident three months later (∗p < 0.05) (upper panel A). The lower panel B shows that this effect was driven by faster reaction times for the double cue condition for the examined time intervals. Post-hoc test showed that participants in the rAIC group responded significantly faster to double cue trials immediately after training compared to before rt-fMRI neurofeedback (∗∗∗p < 0.001). RTs remained shorter during the three months FU compared to before neurofeedback training (∗∗∗p < 0.001). RTs used for this figure were cleaned for outliers (see STAR Methods part). However, additional analysis was calculated without the values marked as outliers in the boxplots and can be found in the SI Figure S5 (results remained unchanged).