Real-time fMRI neurofeedback as a new treatment for psychiatric disorders: a systematic review

Abstract

Background: Neurofeedback using real-time functional MRI (RT-fMRI-NF) is an innovative technique that allows to voluntarily modulating a targeted brain response and its associated behavior. Despite promising results in the current literature, its effectiveness on symptoms’ management in psychiatric disorders is not yet clearly demonstrated. This review aims to evaluate the effectiveness of RT-fMRI-NF in the treatment of psychiatric disorders and to provide methodological suggestions for future studies. Methods: Web of Science and PubMed databases were searched using the keywords: neurofeedback AND (fMRI OR “functional magnetic resonance imag*” OR “functional MRI”) AND (“real-time” OR “real time”). Twenty-six clinical trials focusing on psychiatric disorders were included and categorized according to the diagnostic categories. The RT-fMRI-NF efficacy was assessed by reporting changes in clinical endpoints before vs. after NF training and before or after NF training vs. follow-up. Results: Among the 26 studies, 18 were controlled trials, of which five showed significant clinical improvement in the experimental vs. control group after the training. Eight studies found an effect at follow-up on ADHD symptoms, emotion dysregulation, depressive symptoms, hallucinations, psychotic symptoms and specific fear. Limitations: Here, we only focused our review on fMRI-based NF training. Conclusion: The use of RT-fMRI-NF as a treatment for psychiatric symptoms is promising. However, further double blind, randomized-controlled trials are warranted.