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Review
. 2022 Jan;52(2):201-216.
doi: 10.1017/S0033291721004396. Epub 2021 Nov 15.

Efficacy of bio- and neurofeedback for depression: a meta-analysis

J Fernández-Alvarez  1   2 , M Grassi  3   4 , D Colombo  2 , C Botella  5 , P Cipresso  6   7 , G Perna  3   4   8   9 , G Riva  1   6
Affiliations
Review

Efficacy of bio- and neurofeedback for depression: a meta-analysis

J Fernández-Alvarez et al. Psychol Med. 2022 Jan.

Abstract

Background: For many years, biofeedback and neurofeedback have been implemented in the treatment of depression. However, the effectiveness of these techniques on depressive symptomatology is still controversial. Hence, we conducted a meta-analysis of studies extracted from PubMed, Scopus, Web of Science and Embase.

Methods: Two different strings were considered for each of the two objectives of the study: A first group comprising studies patients with major depressive disorder (MDD) and a second group including studies targeting depressive symptomatology reduction in other mental or medical conditions.

Results: In the first group of studies including patients with MDD, the within-group analyses yielded an effect size of Hedges' g = 0.717, while the between-group analysis an effect size of Hedges' g = 1.050. Moderator analyses indicate that treatment efficacy is only significant when accounting for experimental design, in favor of randomized controlled trials (RCTs) in comparison to non RCTs, whereas the type of neurofeedback, trial design, year of publication, number of sessions, age, sex and quality of study did not influence treatment efficacy. In the second group of studies, a small but significant effect between groups was found (Hedges' g = 0.303) in favor of bio- and neurofeedback against control groups. Moderator analyses revealed that treatment efficacy was not moderated by any of the sociodemographic and clinical variables.

Conclusions: Heart rate variability (HRV) biofeedback and neurofeedback are associated with a reduction in self-reported depression. Despite the fact that the field has still a large room for improvement in terms of research quality, the results presented in this study suggests that both modalities may become relevant complementary strategies for the treatment of MDD and depressive symptomatology in the coming years.

Keywords: Depression; biofeedback; fMRI neurofeedback; heart rate variability; heart rate variability biofeedback; meta-analysis; neurofeedback.

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Figures

Fig. 1.
Fig. 1.
Flowchart of included studies in the meta-analysis.
Fig. 2.
Fig. 2.
Pre-post between-group effect sizes in level 1.
Fig. 3.
Fig. 3.
Funnel plot between analyses in level 1.
Fig. 4.
Fig. 4.
Pre-post within-group effect sizes in level 1.
Fig. 5.
Fig. 5.
Funnel plot within analyses in level 1.
Fig. 6.
Fig. 6.
Pre-post between-group effect sizes in level 2.
Fig. 7.
Fig. 7.
Funnel plot between analyses in level 2.
See this image and copyright information in PMC

References

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