Limbic self-neuromodulation as a novel treatment option for emotional dysregulation in premenstrual dysphoric disorder (PMDD); a proof-of-concept study

Oren Tene, Maya Bleich Cohen, Liat Helpman, Naomi Fine, Anat Halevy, Noam Goldway, Daniella Perry, Plia Bary, Gabi Aisenberg Romano, Ziv Ben-Zion, Talma Hendler, Miki Bloch

Research output: Contribution to journalArticlepeer-review


Aim: To assess the efficacy of a novel neurofeedback (NF) method, targeting limbic activity, to treat emotional dysregulation related to premenstrual dysphoric disorder (PMDD). Methods: We applied a NF probe targeting limbic activity using a functional magnetic resonance imaging-inspired electroencephalogram model (termed Amyg-EFP-NF) in a double-blind randomized controlled trial. A frontal alpha asymmetry probe (AAS-NF), served as active control. Twenty-seven participants diagnosed with PMDD (mean age = 33.57 years, SD = 5.67) were randomly assigned to Amyg-EFP-NF or AAS-NF interventions with a 2:1 ratio, respectively. The treatment protocol consisted of 11 NF sessions through three menstrual cycles, and a follow-up assessment 3 months thereafter. The primary outcome measure was improvement in the Revised Observer Version of the Premenstrual Tension Syndrome Rating Scale (PMTS-OR). Results: A significant group by time effect was observed for the core symptom subscale of the PMTS-OR, with significant improvement observed at follow-up for the Amyg-EFP group compared with the AAS group [F(1, 15)=4.968, P = 0.042]. This finding was specifically robust for reduction in anger [F(1, 15) = 22.254, P < 0.001]. A significant correlation was found between learning scores and overall improvement in core symptoms (r = 0.514, P = 0.042) suggesting an association between mechanism of change and clinical improvement. Conclusion: Our preliminary findings suggest that Amyg-EFP-NF may serve as an affordable and accessible non-invasive treatment option for emotional dysregulation in women suffering from PMDD. Our main limitations were the relatively small number of participants and the lack of a sham-NF placebo arm.

Original languageEnglish
JournalPsychiatry and Clinical Neurosciences
Early online date24 Jun 2023
StateE-pub ahead of print - 24 Jun 2023

Bibliographical note

Funding Information:
This study was partially funded by the Tel Aviv Sourasky Medical Center Brain Research Consortium. The funding source did not participate, influence, or intervene in any way in any stage of this study or the preparation of this paper.

Publisher Copyright:
© 2023 The Authors. Psychiatry and Clinical Neurosciences published by John Wiley & Sons Australia, Ltd on behalf of Japanese Society of Psychiatry and Neurology.


  • amygdala electrical fingerprint
  • emotional dysregulation
  • neurofeedback
  • premenstrual dysphoric disorder

ASJC Scopus subject areas

  • Neuroscience (all)
  • Neurology
  • Clinical Neurology
  • Psychiatry and Mental health


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