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

Abstract

Neurofeedback, one of the primary examples of self-regulation, designates a collection of techniques that train the brain and help to improve its function. Since coming on the scene in the 1960s, electroencephalography-neurofeedback has become a treatment vehicle for a host of mental disorders; however, its clinical effectiveness remains controversial. Modern imaging technologies of the living human brain (e.g., real-time functional magnetic resonance imaging) and increasingly rigorous research protocols that utilize such methodologies begin to shed light on the underlying mechanisms that may facilitate more effective clinical applications. In this paper we focus on recent technological advances in the field of human brain imaging and discuss how these modern methods may influence the field of neurofeedback. Toward this end, we outline the state of the evidence and sketch out future directions to further explore the potential merits of this contentious therapeutic prospect.

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

“…It has also been argued, however, that the short‐ and longer‐term benefits of NF are not exclusively due to improving specific neural mechanisms but may be mediated or moderated by (potentially compensatory) cognitive–behavioral (feelings of self‐efficacy, achievement motivation or the development of effective mental strategies) and social (social reinforcement) interacting mechanisms [Gevensleben et al, 2014; Thibault et al, 2016]. …”

“…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]).…”

“…Real‐time functional magnetic resonance imaging‐NF (rtfMRI‐NF) teaches subjects to self‐regulate blood‐oxygen level‐dependent (BOLD) response in specific brain regions based on real‐time feedback of this response. The BOLD self‐regulation can be achieved in less than 40 min [Thibault et al, 2016] in healthy adults. While more sessions may be needed to achieve clinical efficacy in patient groups like ADHD, the ability to learn to self‐regulate brain activation appears to be much faster with rtfMRI‐NF than EEG‐NF [Thibault et al, 2016].…”

“…The BOLD self‐regulation can be achieved in less than 40 min [Thibault et al, 2016] in healthy adults. While more sessions may be needed to achieve clinical efficacy in patient groups like ADHD, the ability to learn to self‐regulate brain activation appears to be much faster with rtfMRI‐NF than EEG‐NF [Thibault et al, 2016]. The faster learning may be due to brain baroreceptors informing on blood flow but not on electrical activity [Dworkin, 1988; Thibault et al, 2016], and/or superior signal/contrast to noise ratio and superior spatial localization specificity of the fMRI signal.…”

“…While more sessions may be needed to achieve clinical efficacy in patient groups like ADHD, the ability to learn to self‐regulate brain activation appears to be much faster with rtfMRI‐NF than EEG‐NF [Thibault et al, 2016]. The faster learning may be due to brain baroreceptors informing on blood flow but not on electrical activity [Dworkin, 1988; Thibault et al, 2016], and/or superior signal/contrast to noise ratio and superior spatial localization specificity of the fMRI signal. Furthermore, EEG‐NF cannot modulate activation in key underfunctioning regions in ADHD found in fMRI meta‐analyses, such as right inferior frontal gyrus (rIFG) or basal ganglia [Hart et al, 2013; Norman et al, 2016; Rubia, 2011, 2017; Rubia et al, 1999, 2005, 2008, 2014a].…”