The efficacy of real-time functional magnetic resonance imaging neurofeedback for psychiatric illness: A meta-analysis of brain and behavioral outcomes

Abstract

Real-time functional magnetic resonance imaging neurofeedback (rtfMRI-NF) has gained popularity as an experimental treatment for a variety of psychiatric illnesses. However, there has yet to be a quantitative review regarding its efficacy. Here, we present the first meta-analysis of rtfMRI-NF for psychiatric disorders, evaluating its impact on brain and behavioral outcomes. Our literature review identified 17 studies and 105 effect sizes across brain and behavioral outcomes. We find that rtfMRI-NF produces a medium-sized effect on neural activity during training (g\u2009=\u2009.59, 95% CI [.44, .75], p\u2009<\u2009.0001), a large-sized effect after training when no neurofeedback is provided (g\u2009=\u2009.84, 95% CI [.37, 1.31], p\u2009=\u2009.005), and small-sized effects for behavioral outcomes (symptoms g\u2009=\u2009.37, 95% CI [.16, .58], p\u2009=\u2009.002; cognition g\u2009=\u2009.23, 95% CI [-.33, .78], p\u2009=\u2009.288). Mixed-effects analyses revealed few moderators. Together, these data suggest a positive impact of rtfMRI-NF on brain and behavioral outcomes, although more research is needed to determine how rtfMRI-NF works, for whom, and under what circumstances.