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 = .59, 95 % CI [.44, .75], p < .0001), a large-sized effect after training when no neurofeedback is provided (g = .84, 95 % CI [.37, 1.31], p = .005), and small-sized effects for behavioral outcomes (symptoms g = .37, 95 % CI [.16, .58], p = .002; cognition g = .23, 95 % CI [-.33, .78], p = .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.

Keywords: Functional magnetic resonance imaging; Intervention; Meta-analysis; Neurofeedback; Neuromodulation; Psychiatric illness; Psychopathology; Real-time fMRI.

Figure 1.

Depiction of the rtfMRI-NF protocol with statistics from the studies included in our analysis. RtfMRI-NF software image depicts OpenNFT software.

Figure 2.

Flow diagram of study selection following PRISMA criteria (Moher et al., 2009).

Figure 3.

Forest plots of the brain outcomes. A) Hedges’ g effect sizes with 95% confidence intervals comparing post-training neural activity between active and control groups. B) Hedges’ g effect sizes with 95% confidence intervals comparing transfer effects between active and control groups. ACC = anterior cingulate cortex; ADHD = attention deficit hyperactivity disorder; ATL = anterior temporal lobe; BA = Brodmann area; dACC = dorsal anterior cingulate cortex; DLPFC = dorsolateral prefrontal cortex; LA = left amygdala; MDD = major depressive disorder; MPFC = medial prefrontal cortex; PFC = prefrontal cortex; PTSD = posttraumatic stress disorder; rIFG = right inferior frontal gyrus; SCC = subgenual cingulate cortex; SMA = supplementary motor

Figure 4.

Forest plot depicting Hedges’ g effect sizes with 95% confidence intervals comparing post-training psychiatric symptoms between active and control groups. area; SZ = schizophrenia. ADHD = attention deficit hyperactivity disorder; MDD = major depressive disorder; PTSD = posttraumatic stress disorder; ND = nicotine dependence; SZ = schizophrenia.

Figure 5.

Forest plot depicting Hedges’ g effect sizes with 95% confidence intervals comparing post-training cognition between active and control groups. ADHD = attention deficit hyperactivity disorder; MDD = major depressive disorder.