![]() Hyperactivity in the posterior STG, a region sensitive to speech and human voices 9, is a particularly robust neuroimaging finding in patients with SCZ and AVH 4, 7, 8. There is now consensus that AVH are associated with a functional network of brain areas including auditory and language regions in the superior temporal gyrus (STG) and inferior parietal gyrus (IPG), and speech motor regions in the inferior prefrontal cortex/gyrus (IFG), as well as cortical midline region around the cingulate cortex and paracingulate sulcus 4, 6, 7, 8. ![]() However, over the last few decades, neuroimaging techniques have allowed researchers to identify brain regions associated with AVH 4, 5. The neural basis of AVH in patients with SCZ is not fully understood. Thus, there is a clear need for an enhanced understanding of the neural systems that underlie AVH and how function within these systems can be altered. In 30% of patients with AVH, traditional antipsychotic drugs have little or no effect 3. They are associated with high levels of distress as well as functional and occupational disability 2. These findings suggest that patients with AVH have the ability to alter activity and connectivity in speech and language regions, and raise the possibility that rtfMRI-NF training could present a novel therapeutic intervention in SCZ.Īuditory verbal hallucinations (AVH) are a cardinal feature of schizophrenia (SCZ), occurring in around 70% of patients with the illness 1. Successful down-regulation of left STG activity can increase functional connectivity between speech motor and perception regions. The speech-sensitive region of the left STG is a suitable target region for rtfMRI-NF in patients with SCZ and treatment-refractory AVH. The post-training increase in functional connectivity between the left STG and IFG was associated with a reduction in AVH symptoms over the training period. Post- training, patients showed increased functional connectivity between the left STG, the left inferior prefrontal gyrus (IFG) and the inferior parietal gyrus. Patients successfully learnt to down-regulate activity in their left STG over the rtfMRI-NF training. STG activity and functional connectivity were compared pre- and post-training. Twelve patients with SCZ and treatment-refractory AVH were recruited to participate in the study and were trained to down-regulate STG activity using rtfMRI-NF, over four MRI scanner visits during a 2-week training period. We also examined the effects of rtfMRI-NF training on functional connectivity between the STG and other speech and language regions. Here, we examined if patients with schizophrenia (SCZ) and AVH could be trained to down-regulate STG activity using real-time functional magnetic resonance imaging neurofeedback (rtfMRI-NF). Neurocognitive models and previous neuroimaging work posit that auditory verbal hallucinations (AVH) arise due to increased activity in speech-sensitive regions of the left posterior superior temporal gyrus (STG).
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