Neurofeedback and Affect Regulation Circuitry in Depressed and Healthy Adolescents

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

The manuscript entitled “Neurofeedback and Affect Regulation Circuitry in Depressed and Healthy Adolescents” examines the effect of real-time fMRI neurofeedback procedure on engaging higher-order brain networks as possible treatment for chronic depression in adolescents. The study is well-written, all the reported results are discussed, and the results are visualized. However, a sample size is small (especially, when the results are attributed to subgroups divided by medication, style of parenting, etc.).

 There are some points that have to be clarified and corrected:

 1.  Since the sample size is small, the authors have to mention this issue in Limitations.

2. Introduction is too long, I suggest to shorten it.

3. Table 1 Notes lack the explanation of how self-esteem, attributional style, parental support were measured. There should be a link to these inventories. In addition, it should be indicated if psychological and MRI-related measures were congruent with normal distribution (and the results of corresponding statistical criterion have to be placed); otherwise, median instead of mean score has to be reported in Table 1.

4. Please indicate what stands for “PsychoPy” (line 220), if it is software, give the date of use.

5. In Table 2 I suggest to use control group, count backwards and absent medication as reference groups instead of depressed group, Neurofeedback, and present medication, respectively (Models of AMYHIPPO and ACC activity). Please, report p-value for the models with these significant predictors.

6. For Table 3 please indicate what is given in bold (in Notes).

7. Please, give all the values from statistical analysis in brackets in the text. For example, line 363.

8. Finally, the manuscript has to be English checked, there are mistakes. Some letters are missed in several words.

Comments on the Quality of English Language

The manuscript has to be English checked.

Author Response

October 16, 2023

Biology-2574427

We thank the reviewers for all the helpful comments and positive feedback on our paper.

Reviewer 1

1. Since the sample size is small, the authors have to mention this issue in Limitations.

We have addressed the concerns regarding the small sample size in the Limitations subsection. However, please know that it is not infrequent for neurofeedback studies to have relatively small sample sizes.

2. Introduction is too long, I suggest to shorten it.

Thank you for your recommendation, the introduction has been condensed from 1,510 words to 1,011 words.

3. Table 1 Notes lack the explanation of how self-esteem, attributional style, parental support were measured. There should be a link to these inventories. In addition, it should be indicated if psychological and MRI-related measures were congruent with normal distribution (and the results of corresponding statistical criterion have to be placed); otherwise, median instead of mean score has to be reported in Table 1.

We have revised Table 1 by removing the data related to self-esteem and attributional style which were not pertinent to the current study. We have added details about the measurement of parental support to the methods section. Descriptive statistics now present median and interquartile range (IQR) for non-normally distributed data (e.g., puberty data for both experimental groups). In instances where one group’s data is normally distributed and the other’s isn’t, we have reported both mean with standard deviation and median with IQR combinations. These guidelines are also outline beneath the relevant table, i.e. Table 1.

4. Please indicate what stands for “PsychoPy” (line 220), if it is software, give the date of use.

Since PsychoPy is a software we used to present stimuli to participants, we cited the corresponding article as per the citation guidelines on their website (https://psychopy.org/about/index.html).

5. In Table 2 I suggest to use control group, count backwards and absent medication as reference groups instead of depressed group, Neurofeedback, and present medication, respectively (Models of AMYHIPPO and ACC activity). Please, report p-value for the models with these significant predictors.

In Table 2, we followed the common convention that any group within a dichotomous covariate whose activity was higher was reported as a positive estimate and the group with less activity is the reference group. This also makes the interpretation and synthesis of the figures’ results easier for the reader. We hope that you agree with this decision. The reference groups now are count backwards, and medication presence, and depressed as the reference groups. The depressed group is the reference group for the effect of diagnosis upon AMYHIPPO. We’ve adjusted the statistical signs accordingly, and the predictor significances are listed in the table’s last column as well as in the text.

6. For Table 3 please indicate what is given in bold (in Notes).

The rows that were bolded occurred accidentally due to the use of the Pages software during the initial document editing. We removed the bold formatting.

7. Please, give all the values from statistical analysis in brackets in the text. For example, line 363.

Thank you for noticing this, all corresponding statistics have now been inserted into the text for each line of the results.

Reviewer 2 Report

Comments and Suggestions for Authors

This article in a good form.

Comments on the Quality of English Language

Please, make a light correction of English language.

Author Response

Please see the attachment.

Author Response File: Author Response.pdf

Reviewer 3 Report

Comments and Suggestions for Authors

The work is very interesting and well thought out and presented.

Aspects to be resolved:

- They must improve the theoretical background with more updated references (preferably from the last 4 years, including 2023).

- They should provide information on the ethics committee (code or reference number of approval of the study).

- The wording does not require underlining or bolding of words. This is not appropriate in scientific texts. REVIEW

- Revise rules: when a statistic cannot exceed a value of 1, do not put 0; example p < .001.

Author Response

Please see the attachment.

Author Response File: Author Response.pdf