Neurofeedback for Bipolar Disorder

• Real-time fMRI Neurofeedback (Other): Neurofeedback with real-time fMRI is a recent technique that allows to record the BOLD signal from a particular brain region and to display it back in real-time to the participant. With this feedback on brain activity, subjects can learn to control the activity of selected brain areas. Trial after trial, participants develop their individual strategies to voluntarily regulate the signal. The main objective of the neurofeedback training is that the participant develops an enhanced ability to exert control over activity in the target area(s) even without feedback. By manipulating targeted brain circuits, this training can induce modifications in particular behaviors and promote selective plasticity within the corresponding brain networks.

Primary outcomes

• Changes in Montgomery-Asberg Depression Rating Scale (MADRS) Total Score [Baseline, 3 weeks.]: Evaluation of depressive symptoms. Total score ranging from 0 to 60, with higher scores indicating a greater severity of symptoms.

Secondary outcomes

• Montgomery and Asberg Depression Rating Scale (MADRS) [Baseline, 3 weeks, and 4, 8 weeks after the end of the training.]: Evaluation of depressive symptoms. Total score ranging from 0 to 60, with higher scores indicating a greater severity of symptoms.
• Young Mania Rating Scale (YMRS) [Baseline, 3 weeks, and 4, 8 weeks after the end of the training.]: Evaluation of manic symptoms. Total score ranging from 0 to 60, with higher scores indicating a greater severity of symptoms.
• Bipolar Depression Rating Scale (BDRS) [Baseline, 3 weeks, and 4, 8 weeks after the end of the training.]: Evaluation of bipolar depression. Total score ranging from 0 to 60, with higher scores indicating a greater severity of symptoms.
• State-Trait Anxiety Inventory (STAI A-B) [Baseline, 3 weeks, and 4, 8 weeks after the end of the training.]: Evaluation of trait and state anxiety. Total score ranging from 20 to 80 for both subscales, with higher scores indicating a greater severity of symptoms.
• Multidimensional Assessment of Thymic States - MAThyS [Baseline, 3 weeks, and 4, 8 weeks after the end of the training.]: Evaluation of thymic state. Total score ranging from 0 to 200, lower scores indicate general inhibition, and higher scores indicate general excitation. A more descriptive approach can be done by analysing the sub-score.
• Affective Intensity Measure - AIM [Baseline, 3 weeks, and 4, 8 weeks after the end of the training.]: Evaluation of emotion reactivity. Total score ranging from 20 to 120, with higher scores indicating higher strength or intensity of people's emotional experiences.
• Affective Lability Scale - ALS [Baseline, 3 weeks, and 4, 8 weeks after the end of the training.]: Evaluation of mood lability. Total score ranging from 0 to 162, with higher scores indicating greater affective lability.
• Cognitive Emotion Regulation Questionnaire - CERQ [Baseline, 3 weeks, and 4, 8 weeks after the end of the training.]: Evaluation of emotion regulation abilities. Subscales scores ranging from 4 to 20, with higher subscale scores indicating greater use of a specific cognitive strategy.
• Quality of life scale - QOLS [Baseline, 3 weeks, and 4, 8 weeks after the end of the training. .]: Quality of life assessment. Score ranging from 1 to 5, 5 indicating better quality of life
• Five Facets Mindfulness Questionnaire - FFMQ [Baseline, 3 weeks and 4, 8 weeks after the end of the training.]: Evaluation of trait mindfulness. Total score ranging from 39 to 195, higher scores are indicative of someone who is more mindful in their everyday life
• Global functioning assessment - GAF scale [Baseline, 3 weeks, and 4, 8 weeks after the end of the training.]: Evaluation of global functioning. Total score ranging from 0 to 100, higher scores indicating better global functioning.
• Questionnaire of Adherence to the technology [Baseline, 3 weeks.]: Evaluation of the score of the acceptability of neurofeedback. Total score ranging from 6 to 42, higher scores indicating better acceptability of the technology.
• Self-efficacy scale [Baseline, 3 weeks.]: Evaluation of personal efficiency. Total score ranging from 21 to 105, higher scores indicating stronger belief that one's actions are responsible for successful outcomes.
• The Ekman facial recognition test [Baseline, 3 weeks.]: Emotion recognition evaluation. Cognitive task
• The affective bias task [Baseline, 3 weeks.]: Evaluation of emotional bias. Cognitive task
• The Test battery for Attentional Performance (TAP) [Baseline, 3 weeks.]: Evaluation of attention. Cognitive task
• The choice reaction task [Baseline, 3 weeks.]: Evaluation of mindwandering, meta-awareness and ruminations. Cognitive task
• MRI T1-T2 weighted scan [Baseline, 3 weeks]: Evaluation of grey and white matter (micro)structure. MRI measurement
• MRI diffusion weighted scan [Baseline, 3 weeks]: Evaluation of grey and white matter (micro)structure. MRI measurement
• functional MRI resting-state scan [Baseline, 3 weeks]: Evaluation of brain functional connectivity. MRI measurement

Sex: All, ages: 18 Years to 65 Years

Inclusion Criteria:

* Patients diagnosed with bipolar disorder I or II (DSM-5 criteria);
* Aged between ≥ 18 and ≤ 65;
* Absence of major mood episode for at least 3 months before inclusion (MADRS scores < 12; YMRS score < 10);
* Presence of residual depressive symptoms, as assessed by the MADRS (score > 5);
* Stabilized dose of mood stabilizer medication for at least 3 months before inclusion.
* Written consent
* Affiliation to a social security system
* Effective contraception for women of childbearing age

Exclusion Criteria:

* Severe physical disorders that may be life-threatening;
* Major psychiatric (Axis 1) comorbidities except for anxiety disorders;
* Any current substance abuse except for tobacco or cannabis. Substance abuse will be defined by the DSM V criteria;
* Exclusion criteria applicable to MRI Panic disorder, claustrophobia, epilepsy Pace maker or neuronal stimulator, intraocular or intracerebral metallic foreign body, cochlear implant, cardiac valve or metallic surgical arterial material, non removable removable magnetizable metallic material
* Somatic disorder that may affect cognitive abilities and brain structures (e.g., HIV infection, MS, lupus, Parkinson's disease, epilepsy, dementia...);
* Ongoing non-pharmacological treatment: structured psychotherapeutic interventions (Cognitive Behavioral Therapy - CBT, Interpersonal and Social Rhythm Therapy - IPSRT) as well as brain stimulation techniques (Electroconvulsive Therapy - ECT, Transcranial Magnetic Stimulation - TMS, Deep Brain Stimulation - DBS);
* Subject included in clinical and / or therapeutic experimentation in progress.
* Patients under legal protection
* Prisoners
* Pregnancy
* Breastfeeding