SUFU 2020: Functional MRI Detected Changes in Brain Attentional Networks: Association with Hypnotherapy for Treatment of Urgency Urinary Incontinence

Scottsdale, Arizona ( In this presentation the authors hypothesized that hypnotherapy and medication groups would differ in post-treatment brain activation during bladder filling and in brain resting functional connectivity (FC). The randomized control trial (RCT) recently showed a similar efficacy of hypnotherapy and medications for the treatment of urgency urinary incontinence (UUI).1

There was a subgroup of women recruited from the RCT who underwent functional MRI pre-treatment eight weeks after treatment began. The average activation during the bladder filling task was compared using 2 × 2 (therapy [hypnotherapy vs. medications] × time [pre vs. post]) ANOVAs in regions of interest (ROI)s, based on prior work (n=64).2 ROIs included the interoceptive cortex (dorsal anterior cingulate cortex, [dACC]), ventral attention (temporoparietal junction [TPJ]) and dorsal attention networks (dorsolateral prefrontal cortex, dlPFC). ROIs also served as seed points for 2 × 2 voxel-wise analyses, performed with the bladder empty (n=60) and filled to 0.5 x strong urge to void (n=52). Significant therapy × time interactions in task-related activation or resting FC were further evaluated using one-way ANOVAs of changes over time (post-pre) with pre-treatment activation as a covariate.

The results revealed that the main effect of time for the left TPJ was activation diminishing in both groups following treatment (p = 0.01). No therapy × time interaction remained significant after controlling for baseline differences voxel-wise FC analyses with the bladder partially filled showed a therapy × time interaction between the dACC and the left dlPFC, connectivity increasing post-treatment in the hyp compared to medications group. This difference remained significant after controlling for baseline connectivity (p<.001) (Figure).

post treatment connectivity hyp vs medications

The authors at the end concluded that the improvement in UUI with both hypnotherapy and medication treatment was associated with decreased ventral “bottom-up” attentional network activation. Activation decreased after hypnotherapy in the absence of medication that could decrease bladder afferent stimuli to this network. Hypnotherapy, but not medication, was associated with increased resting FC between the interoceptive and dorsal, “top-down” attentional network. The latter interacts with the ventral network in the selection of endogenous stimuli that warrant a response. Findings suggest that effective treatment of UUI with hypnotherapy compared to medications may alter attentional activation by affecting top-down attentional control.

Presented by: Loren Ketai, MD, Professor, Department of Radiology, School of Medicine Research Director, Department of Radiology, School of Medicine Chief, Cardiothoracic Imaging, Department of Radiology, University of New Mexico Health Science Center, Albuquerque, New Mexico

Co-Authors: Yuko Komesu, MD, Clinician Ed-Professor, Division of Urogynecology, Department of Obstetrics & Gynecology, University of New Mexico Health Science Center, Albuquerque, New Mexico; Andrew Mayer, PhD, Vice President of Interdisciplinary Science, Professor of Translational Neuroscience, The Mind Research Network, Adjunct Assistant Professor of Neurology, University of New Mexico Health Science Center, Albuquerque, New Mexico; Andrew Dodd, MS, The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Albuquerque, New Mexico; Ron Schrader, PhD, University of New Mexico Clinical and Translational Center; Robert Sapien, MD, Department of Emergency Medicine, Emergency Medical Services Academy, Pediatric Emergency Medicine, University of New Mexico Health Science Center, Albuquerque, New Mexico; Rebecca Rogers, MD, Associate Chair, Clinical Integration and Operations, Department of Women's Health, Professor, Department of Women's Health, Dell Medical School, University of Texas at Austin, Austin, Texas

Written by: Bilal Farhan, MD, Assistant Professor, Division of Urology, University of Texas, Medical Branch, Texas; Twitter: @BilalfarhanMD, at the Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction Winter Meeting, SUFU 2020, February 25 - 29, 2020, Scottsdale, AZ


1. Komesu, Yuko M., Ronald M. Schrader, Rebecca G. Rogers, Robert E. Sapien, Andrew R. Mayer, and Loren H. Ketai. "Hypnotherapy or medications: a randomized noninferiority trial in urgency urinary incontinent women." American journal of obstetrics and gynecology 222, no. 2 (2020): 159-e1.

2. Ketai, Loren H., Yuko M. Komesu, Andrew B. Dodd, Rebecca G. Rogers, Josef M. Ling, and Andrew R. Mayer. "Urgency urinary incontinence and the interoceptive network: a functional magnetic resonance imaging study." American journal of obstetrics and gynecology 215, no. 4 (2016): 449-e1.