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The present work assessed the efficacy of training volitional down-regulation of the primary auditory cortex (A1) based on real-time functional magnetic resonance imaging neurofeedback (fMRI-NFT). A1 has been shown to be hyperactive in chronic tinnitus patients, and has been implicated as a potential source for the tinnitus percept. 27 healthy volunteers with normal hearing underwent 5 fMRI-NFT sessions: 18 received real neurofeedback and 9 sham neurofeedback. Each session was composed of a simple auditory fMRI followed by 2 runs of A1 fMRI-NFT. The auditory fMRI alternated periods of no auditory with periods of white noise stimulation at 90 dB. A1 activity, defined from a region using the activity during the preceding auditory run, was continuously updated during fMRI-NFT using a simple bar plot, and was accompanied by white noise (90 dB) stimulation for the duration of the scan. Each fMRI-NFT run alternated 'relax' periods with 'lower' periods. Subjects were instructed to watch the bar during the relax condition and actively reduce the bar by decreasing A1 activation during the lower condition. Average A1 de-activation, representative of the ability to volitionally down-regulate A1, was extracted from each fMRI-NFT run. A1 de-activation was found to increase significantly across training and to be higher in those receiving real neurofeedback. A1 de-activation in sessions 2 and 5 were found to be significantly greater than session 1 in only the group receiving real neurofeedback. The most successful subjects reportedly adopted mindfulness tasks associated with directed attention. For the first time, fMRI-NFT has been applied to teach volitional control of A1 de-activation magnitude over more than 1 session. These are important findings for therapeutic development as the magnitude of A1 activity is altered in tinnitus populations and it is unlikely a single fMRI-NFT session will reverse the effects of tinnitus.


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