Time course of clinical change following neurofeedback

Abstract

Neurofeedback - learning to modulate brain function through real-time monitoring of current brain state - is both a powerful method to perturb and probe brain function and an exciting potential clinical tool. For neurofeedback effects to be useful clinically, they must persist. Here we examine the time course of symptom change following neurofeedback in two clinical populations, combining data from two ongoing neurofeedback studies. This analysis reveals a shared pattern of symptom change, in which symptoms continue to improve for weeks after neurofeedback. This time course has several implications for future neurofeedback studies. Most neurofeedback studies are not designed to test an intervention with this temporal pattern of response. We recommend that new studies incorporate regular follow-up of subjects for weeks or months after the intervention to ensure that the time point of greatest effect is sampled. Furthermore, this time course of continuing clinical change has implications for crossover designs, which may attribute long-term, ongoing effects of real neurofeedback to the control intervention that follows. Finally, interleaving neurofeedback sessions with assessments and examining when clinical improvement peaks may not be an appropriate approach to determine the optimal number of sessions for an application.

A Guide to Literature Informed Decisions in the Design of Real Time fMRI Neurofeedback Studies: A Systematic Review

“…are more pronounced at follow-ups of at least 2 months (Megumi et al, 2015;Rance et al, 2018). This continued improvement after neurofeedback training has been demonstrated in as little time as 1 day (Harmelech et al, 2013).…”

“…This has also been used to downregulate craving in individuals with AUD (Karch et al, 2015) and obesity (Spetter et al, 2017), as well as smokers (Hartwell et al, 2016) and cocaine users (Kirschner et al, 2018). Other studies present individuals with stimuli that invoke anxiety, such as trauma-inducing words for patients with PTSD (Nicholson et al, 2017), contamination images for patients with OCD (Scheinost et al, 2013b;Rance et al, 2018), and pictures of spiders in females with spider phobia (Zilverstand et al, 2015). By practicing control of reactivity based on signal from the orbitofrontal cortex (OFC), dorsolateral prefrontal cortex (dlPFC), and insula, these patients had reduction in anxiety symptomology.…”

The potential of functional near-infrared spectroscopy-based neurofeedback – a systematic review and recommendations for best practice

“…Evidence of delayed effects of neurofeedback emerging after the primary endpoint of a study has been reported. Particularly when investigating clinical populations, follow-up measures may boost statistical power and should be applied where possible (Rance et al, 2018;Van Doren et al, 2019).…”

Neuromodulation of brain activation associated with addiction: A review of real-time fMRI neurofeedback studies

“…Identifying t the potential long-term effects of neurofeedback training on sustained reductions in substance use is essential in order for rtfMRI-nf to be used as a treatment modality for addiction. Emerging evidence suggests that rtfMRI-nf can indeed have lasting therapeutic effects on behavioral modification and symptom reduction ( Mehler et al, 2018 , Rance et al, 2018 ). Continued research that incorporates follow-up assessments on rtfMRI-nf learning effects is needed to validate the efficacy of neurofeedback training.…”