Neurofeedback, Self-Regulation, and Brain Imaging: Clinical Science and Fad in the Service of Mental Disorders

Abstract

Neurofeedback draws on multiple techniques that propel both healthy and patient populations to self-regulate neural activity. Since the 1970s, numerous accounts have promoted electroencephalography-neurofeedback as a viable treatment for a host of mental disorders.Today, while the number of health care providers referring patients to neurofeedback practitioners increases steadily, substantial methodological and conceptual caveats continue to pervade empirical reports. And yet, nascent imaging technologies (e.g., real-time functional magnetic resonance imaging) and increasingly rigorous protocols are paving the road towards more effective applications and better scientific understanding of the underlying mechanisms.Here we outline common neurofeedback methods, illuminate the tenuous state of the evidence, and sketch out future directions to further unravel the potential merits of this contentious therapeutic prospect.

Real‐time fMRI neurofeedback in adolescents with attention deficit hyperactivity disorder

“…Hence, both common and group‐specific underlying processes could have accounted for their clinical improvements. The activation of a bilateral DLPFC/IFG‐insular‐striato‐cerebellar cognitive control network, and not just of rIFG, in the active group, extends prior evidence for network activation in ROI based rtfMRI‐NF [Emmert et al, 2016; Thibault et al, 2015] and may have been underlying the transfer effects, the attentional performance and the inhibitory fMRI activation improvements that were specific to the rIFG group.…”

“…However, this is unlikely for the active group, given that the clinical improvements correlated with the trained brain activation changes in their ROI. While the active control condition controlled for region‐specificity, which is rarely addressed in rtfMRI‐NF [Thibault et al, 2015, 2016] or EEG‐NF [Holtmann et al, 2014] studies, the inclusion of a sham‐rtfMRI‐NF condition would have enabled us to rule out potential placebo effects (but not nonspecific learning effects [Baumeister et al, 2016]).…”

“…Studies in psychiatric/neurological disorders highlight the clinical potential of rtfMRI‐NF [Thibault et al, 2015, 2016], showing generalization to NF‐free transfer runs and longer‐term beneficial effects of up to several months [Zilverstand et al, 2015]. Importantly, by learning to self‐upregulate isolated regions, participants learn to co‐regulate other areas interconnected with the target region, suggesting modulation of entire networks [Emmert et al, 2016; Thibault et al, 2016].…”

The self-regulating brain and neurofeedback: Experimental science and clinical promise

“…Beyond EEG-nf, the advent of new technologies for imaging the living human brain has vastly expanded the scope of neurofeedback, which today includes more novel methods such as functional magnetic resonance imaging (fMRI), functional near infrared spectroscopy (fNIRS), and magnetoencephalography (MEG) (TIMELINE and Table 1). Thus, current-day neurofeedback draws on diverse imaging methods to help drive volitional control over electromagnetic and hemodynamic alterations in brain activity (Cannon, 2015;Hammond, 2011;Thibault, Lifshitz, Birbaumer, & Raz, 2015). Within each imaging modality, moreover, researchers have developed distinct neurofeedback protocols that target different brain signals and their concomitant physiological processes (Hammond, 2011;Sulzer, Haller, et al, 2013).…”

“…While EEG-nf proponents purport to effectively treat a range of psychological and neurological disorders (Arns, Heinrich, & Strehl, 2014;Cannon, 2015;Hammond, 2011;Tan et al, 2009), it appears that influences other than the feedback itself bring about improvements in clinical endpoints across a range of disorders (Thibault, Lifshitz, Birbaumer, et al, 2015). For example, in the most researched application of EEG-nf -treatment of attention deficit hyperactivity disorder (ADHD) -all double-blind (Arnold et al, 2013;Lansbergen et al, 2011;Vollebregt, van Dongen-Boomsma, Buitelaar, et al, 2014), and multiple single-blind (PerreauLinck et al, 2010;Van Dongen-Boomsma et al, 2013), sham-controlled studies demonstrate comparable clinical outcomes in patients receiving veritable-feedback compared with shamfeedback.…”