A randomised controlled trial investigating the causal role of the medial prefrontal cortex in mediating self-agency during speech monitoring and reality monitoring.

Self-agency is being aware of oneself as the agent of one's thoughts and actions. Self agency is necessary for successful interactions with the external world (reality-monitoring). The medial prefrontal cortex (mPFC) is considered to represent one neural correlate underlying self-agency. We investigated whether mPFC activity can causally modulate self-agency on two different tasks involving speech-monitoring and reality-monitoring. The experience of self-agency is thought to result from being able to reliably predict the sensory outcomes of one's own actions. This self-prediction ability is necessary for successfully encoding and recalling one's own thoughts to enable accurate self-agency judgments during reality-monitoring tasks. This self-prediction ability is also necessary during speech-monitoring tasks where speakers compare what we hear ourselves say in auditory feedback with what we predict we will hear while speaking. In this randomised-controlled study, heathy controls (HC) are assigned to either high-frequency transcranial magnetic stimulation (TMS) to enhance mPFC excitability or TMS targeting a control site. After TMS to mPFC, HC improved self-predictions during speech-monitoring tasks that predicted improved self-agency judgments during different reality-monitoring tasks. These first-in-kind findings demonstrate the mechanisms of how mPFC plays a causal role in self-agency that results from the fundamental ability of improving self-predictions across two different tasks.