# Self-regulation of real-time fMRI brain activity in chronic pain: A potential neurobiological mechanism of cognitive behavioral therapy

> **NIH NIH R21** · SPAULDING REHABILITATION HOSPITAL · 2024 · $409,612

## Abstract

Project Summary/Abstract
Self-regulation is the ability to manage one’s thoughts, emotions, and behaviors to achieve desired goals
through a variety of cognitive and emotional processes. It is an important aspect of self-management, which
plays a primary role in the efficacious treatment mechanisms of chronic pain, such as fibromyalgia.
Fibromyalgia is a chronic pain disorder characterized by widespread pain, impaired sleep, fatigue, and
depression. While non-pharmacologic treatment, such as Cognitive-Behavioral Therapy (CBT), has shown
efficacy in improving fibromyalgia-related symptoms via self-management skills, little is known about the
underlying neurobiological mechanisms of these benefits. Reduction of negative cognitive and emotional
processes, such as pain catastrophizing—which involves helplessness, rumination, and magnification of pain
complaints—via self-regulation, has been suggested as one of the central mechanistic pathways supporting
the benefits following CBT. In fact, many studies have shown that pain catastrophizing is the most consistent
psychosocial factor predicting treatment prognosis in chronic musculoskeletal pain, such as fibromyalgia. Thus,
we propose investigating the neural correlates of self-regulation, their association with catastrophizing, and the
role of changes in self-regulatory capacity in contributing to CBT’s benefits. Neural mechanisms during self-
regulation can be investigated and assessed using real-time functional magnetic resonance imaging (fMRI)
neurofeedback, which allows observing and regulating one’s brain activity. The neural target in our study is
defined from our published study demonstrating that the ventral posterior cingulate cortex (vPCC) and
retrosplenial cortex (RSC)—key nodes of the brain’s default mode network—encode pain catastrophizing.
Thus, our study will apply fMRI neurofeedback as a probe to elucidate the neurobiological mechanisms
underlying the self-regulation of pain catastrophizing. Specifically, our Aims will: (1) Evaluate the effect of CBT
on neural mechanisms of catastrophizing self-regulation, assessed with real-time fMRI neurofeedback and (2)
Predict clinical improvement following CBT with baseline brain response during pain catastrophizing self-
regulation. Furthering our understanding of the neural mechanisms underlying self-regulation of pain
catastrophizing in chronic pain will enable clinicians to boost the efficacy of CBT and facilitate the development
of multimodal treatment packages, while patients gain control over their cognitive and emotional processes.

## Key facts

- **NIH application ID:** 10870558
- **Project number:** 1R21AR084246-01
- **Recipient organization:** SPAULDING REHABILITATION HOSPITAL
- **Principal Investigator:** ROBERT R EDWARDS
- **Activity code:** R21 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $409,612
- **Award type:** 1
- **Project period:** 2024-09-24 → 2026-07-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10870558

## Citation

> US National Institutes of Health, RePORTER application 10870558, Self-regulation of real-time fMRI brain activity in chronic pain: A potential neurobiological mechanism of cognitive behavioral therapy (1R21AR084246-01). Retrieved via AI Analytics 2026-05-25 from https://api.ai-analytics.org/grant/nih/10870558. Licensed CC0.

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