We determined mediators of the real-time fMRI neurofeedback (rtfMRI-nf) amygdala training inducing PTSD symptom reduction in combat veterans. Thirty-six veterans with PTSD (25 experimental group and 11 control group receiving a feedback from a control region) completed three rtfMRI-nf training sessions in separate days. We employed a novel whole brain structural equation model mapping (SEMM) analysis to identify brain regions that mediated the effects of the rtfMRI-nf procedure on PTSD symptoms. Results revealed that PTSD symptom reduction in the experimental group was mediated by lower activation than the control group in default mode network regions during the neurofeedback training.
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