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As a fundamental attention function, sustained attention plays a critical role in general cognitive abilities and is closely linked to EEG alpha oscillations. Neurofeedback training (NFT) of alpha activity on different aspects of attention has been studied previously. However, it remains unclear how NFT with up- or down-regulation directions modulates sustained attention. Here we employed a counterbalanced single-blind sham-controlled crossover design, in which healthy young adults underwent one NFT session of alpha up-regulation, one NFT session of alpha down-regulation, and one sham-control NFT session over the posterior area. The session order was counterbalanced with a 7-day interval between each session. After each NFT session, the participants completed a visual continuous temporal expectancy task (vCTET) to assess their sustained attention performance. The results showed that compared to sham-control NFT, successful learning of alpha up-regulation resulted in increased reaction time at the beginning of the attention task but a slower increase over vCTET blocks. On the other hand, successful learning of alpha down-regulation had no impact on attention performance compared to sham-control NFT. These findings suggest that successful learning of alpha up-regulation through NFT could impair initial attention performance but slow down visual attention deterioration over time, i.e., alpha enhancement by NFT stabilizing visual attention., Competing Interests: Declaration of competing interest The authors declare no competing interests., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Objective . Neurofeedback (NFB) training through brain-computer interfacing has demonstrated efficacy in treating neurological deficits and diseases, and enhancing cognitive abilities in healthy individuals. It was previously shown that event-related potential (ERP)-based NFB training using a P300 speller can improve attention in healthy adults by incrementally increasing the difficulty of the spelling task. This study aims to assess the impact of task difficulty adaptation on ERP-based attention training in healthy adults. To achieve this, we introduce a novel adaptation employing iterative learning control (ILC) and compare it against an existing method and a control group with random task difficulty variation. Approach . The study involved 45 healthy participants in a single-blind, three-arm randomised controlled trial. Each group underwent one NFB training session, using different methods to adapt task difficulty in a P300 spelling task: two groups with personalised difficulty adjustments (our proposed ILC and an existing approach) and one group with random difficulty. Cognitive performance was evaluated before and after the training session using a visual spatial attention task and we gathered participant feedback through questionnaires. Main results . All groups demonstrated a significant performance improvement in the spatial attention task post-training, with an average increase of 12.63%. Notably, the group using the proposed iterative learning controller achieved a 22% increase in P300 amplitude during training and a 17% reduction in post-training alpha power, all while significantly accelerating the training process compared to other groups. Significance . Our results suggest that ERP-based NFB training using a P300 speller effectively enhances attention in healthy adults, with significant improvements observed after a single session. Personalised task difficulty adaptation using ILC not only accelerates the training but also enhances ERPs during the training. Accelerating NFB training, while maintaining its effectiveness, is vital for its acceptability by both end-users and clinicians., (Creative Commons Attribution license.)

Despite extensive clinical research on neurofeedback (NF) in attention-deficit/hyperactivity disorder (ADHD), few studies targeted the optimization of attention performance in healthy children. As a crucial component of attention networks, the executive control network, involved in resolving response conflicts and allocating cognitive resources, is closely linked to theta activity. Here, we aimed to answer whether theta down-regulating NF can enhance healthy children's attention performance, especially the executive control network. Sixty children aged 6-12 years were randomly assigned to the NF and waitlist control groups. The NF group received theta down-regulation NF training for five days (a total of 100 mins), and the attention performance of both groups was measured by the attention network test (ANT) in the pre, post-NF, and 7-day follow-up. The electroencephalographic (EEG) results demonstrated a significant decrease in resting-state theta amplitude within sessions. For the behavioral results, the NF group exhibited significant improvements in overall attention performance and the efficiency of the executive control network relative to the control group in the post-NF and follow-up assessment, whereas the alerting and orienting networks remained unchanged. These findings proved the feasibility of theta down-regulating NF and its positive effect on attention in the healthy children population. In particular, the facilitation of the efficiency of the executive control network and the unaltered performance of the other two attention networks in the NF group may support the causality between theta rhythm and the executive control network., Competing Interests: Declaration of competing interest The authors have no conflict of interest., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Brain-Computer Interface (BCI) and Neurofeedback (NF) both rely on the technology to capture brain activity. However, the literature lacks a clear distinction between the two, with some scholars categorizing NF as a special case of BCI while others view BCI as a natural extension of NF, or classify them as fundamentally different entities. This ambiguity hinders the flow of information and expertise among scholars and can cause confusion. To address this issue, we conducted a study comparing BCI and NF from two perspectives: the background and context within which BCI and NF developed, and their system design. We utilized Functional Flow Block Diagram (FFBD) as a system modelling approach to visualize inputs, functions, and outputs to compare BCI and NF at a conceptual level. Our analysis revealed that while NF is a subset of the biofeedback method that requires data from the brain to be extracted and processed, the device performing these tasks is a BCI system by definition. Therefore, we conclude that NF should be considered a specific application of BCI technology. By clarifying the relationship between BCI and NF, we hope to facilitate better communication and collaboration among scholars in these fields., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Background: Limited research exists regarding the effectiveness of electroencephalogram (EEG) neurofeedback training for children with cerebral palsy (CP) and co-occurring attention deficits (ADs), despite the increasing prevalence of these dual conditions. This study aimed to fill this gap by examining the impact of neurofeedback training on the attention levels of children with CP and AD., Methods: Nineteen children with both CP and co-occurring ADs were randomly assigned to either a neurofeedback or control group. The neurofeedback group received 20 sessions of training, lasting approximately 1 h per day, twice a week. Theta/beta ratios of the quantitative electroencephalography (QEEG) recordings were measured pre-training and post-training in the resting state. The Continuous Performance Test (CPT), the Test of Visual Perceptual Skills-3rd Version (TVPS-3) and the Conners' Parent Rating Scale (CPRS) were measured at pre- and post-training., Results: The neurofeedback group showed both decreased theta/beta ratios compared with control group (p = 0.04) at post-training and a within-group improvement during training (p = 0.02). Additionally, the neurofeedback group had a trend of decreased omission rates of the CPT (p = 0.08) and the visual sequential memory and the visual closure subscores in the TVPS-3, compared with the control group (p = 0.02 and p = 0.01, respectively)., Conclusions: The results suggested that children with CP and co-occurring AD may benefit from neurofeedback training in their attention level. Further research is needed to explore long-term effects and expand its application in this population., (© 2024 John Wiley & Sons Ltd.)

Background: Binge-eating disorder (BED) co-occurs with neurobehavioral alterations in the processing of disorder-relevant content such as visual food stimuli. Whether neurofeedback (NF) directly targeting them is suited for treatment remains unclear. This study sought to determine feasibility and estimate effects of individualized, functional near-infrared spectroscopy-based real-time NF (rtfNIRS-NF) and high-beta electroencephalography-based NF (EEG-NF), assuming superiority over waitlist (WL)., Methods: Single-center, assessor-blinded feasibility study with randomization to rtfNIRS-NF, EEG-NF, or WL and assessments at baseline ( t 0), postassessment ( t 1), and 6-month follow-up ( t 2). NF comprised 12 60-min food-specific rtfNIRS-NF or EEG-NF sessions over 8 weeks. Primary outcome was the binge-eating frequency at t 1 assessed interview-based. Secondary outcomes included feasibility, eating disorder symptoms, mental and physical health, weight management-related behavior, executive functions, and brain activity at t 1 and t 2., Results: In 72 patients (intent-to-treat), the results showed feasibility of NF regarding recruitment, attrition, adherence, compliance, acceptance, and assessment completion. Binge eating improved at t 1 by -8.0 episodes, without superiority of NF v. WL (-0.8 episodes, 95% CI -2.4 to 4.0), but with improved estimates in NF at t 2 relative to t 1. NF was better than WL for food craving, anxiety symptoms, and body mass index, but overall effects were mostly small. Brain activity changes were near zero., Conclusions: The results show feasibility of food-specific rtfNIRS-NF and EEG-NF in BED, and no posttreatment differences v. WL, but possible continued improvement of binge eating. Confirmatory and mechanistic evidence is warranted in a double-blind randomized design with long-term follow-up, considering dose-response relationships and modes of delivery.

Background and Objective : Existing evidence indicates the potential benefits of electroencephalography neurofeedback (NFB) training for cognitive function. This study aims to comprehensively review all available evidence investigating the effectiveness of NFB on working memory (WM) and episodic memory (EM) in the elderly population. Material and Methods : A systematic search was conducted across five databases to identify clinical trials examining the impact of NFB on memory function in healthy elderly individuals or those with mild cognitive impairment (MCI). The co-primary outcomes focused on changes in WM and EM. Data synthesis was performed using a random-effects meta-analysis. Results : Fourteen clinical trials ( n = 284) were included in the analysis. The findings revealed that NFB was associated with improved WM (k = 11, reported as Hedges' g = 0.665, 95% confidence [CI] = 0.473 to 0.858, p < 0.001) and EM (k = 12, 0.595, 0.333 to 0.856, p < 0.001) in the elderly, with moderate effect sizes. Subgroup analyses demonstrated that NFB had a positive impact on both WM and EM, not only in the healthy population (WM: k = 7, 0.495, 0.213 to 0.778, p = 0.001; EM: k = 6, 0.729, 0.483 to 0.976, p < 0.001) but also in those with MCI (WM: k = 6, 0.812, 0.549 to 1.074, p < 0.001; EM: k = 6, 0.503, 0.088 to 0.919, p = 0.018). Additionally, sufficient training time (totaling more than 300 min) was associated with a significant improvement in WM (k = 6, 0.743, 0.510 to 0.976, p < 0.001) and EM (k = 7, 0.516, 0.156 to 0.876, p = 0.005); however, such benefits were not observed in groups with inadequate training time. Conclusions : The results suggest that NFB is associated with enhancement of both WM and EM in both healthy and MCI elderly individuals, particularly when adequate training time (exceeding 300 min) is provided. These findings underscore the potential of NFB in dementia prevention or rehabilitation.

Background: The human body is exposed to stressors on a daily basis. Short-term exposure to a particular stressor can cause the release of inflammatory markers - including c-reactive protein (CRP). EEG neurofeedback is a noninvasive form of therapy that aims to improve brain function. Neurofeedback is a type of feedback based on brain activity., Methods: The research process was performed by a group of 80 men who were divided into 2 research groups and 2 control groups. In the first research group and the first control group, the stressor of high temperature was applied, while in the second research group and the second control group, the stressor was physical exertion to refusal. Meanwhile, blood samples were taken to visualize inflammatory markers. These were taken before and after the stressor, as well as before and after the application of EEG neurofeedback., Results: In research group after EEG neurofeedback intervention, the level of CRP significantly dropped in the measurement after stressor implementation. Analysis of the SMK test revealed a significant influence of both factors (time F = 13.525, P = .035; state F = 10.658, P = .047) and their interaction (F = 16.709, P = .026). Same statically significant decrease was observed in the level of rect. abdom. EMG was after physical work after neurofeedback. In all tests, a decrease in the EMG amplitude of upper trap. was observed after physical work before neurofeedback with its further increase after neurofeedback. After neurofeedback training, the results of the 3 tested parameters of the sensorimotor coordination test performed after the second heat stressor improved statistically insignificantly compared to the values obtained before., Conclusion: This article shows the effect of EGG neurofeedback on reducing the negative effects of stress exposure in humans. The study showed that the level and a pattern of EEG neurofeedback influence and significance is different depending on the applied stressor. Furthermore, the level of EEG neurofeedback influence and significance in decreasing the stressor effect is different depending on the examined sphere., Competing Interests: The authors have no funding and conflicts of interest to disclose., (Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.)

Introduction: Adolescents with increased callous unemotional traits (CU traits) in the context of disruptive behavior disorder (DBD) show a persistent pattern of antisocial behavior with shallow affect and a lack of empathy or remorse. The amygdala and insula as regions commonly associated with emotion processing, empathy and arousal are implicated in DBD with high CU traits. While behavioral therapies for DBD provide significant but small effects, individualized treatments targeting the implicated brain regions are missing., Methods: In this explorative randomized controlled trial we randomly assigned twenty-seven adolescents with DBD to individualized real-time functional magnetic resonance neurofeedback (rtfMRI-NF) or behavioral treatment as usual (TAU). Visual feedback of either amygdala or insula activity was provided during rtfMRI-NF by gauges and included a simple and concurrent video run plus a transfer run. A linear mixed model (LMM) was applied to determine improvement of self-regulation. Specificity was assessed by correlating individual self-regulation improvement with clinical outcomes., Results: The rtfMRI-NF (n = 11) and TAU (n = 10) completers showed comparable and significant clinical improvement indicating neither superiority nor inferiority of rtfMRI-NF. The exploratory LMM revealed successful learning of self-regulation along the course of training for participants who received feedback from the amygdala. A significant exploratory correlation between individual target region activity in the simple run and clinical improvement was found for one dimension of DBD., Conclusions: This exploratory study demonstrated feasibility and suggests clinical efficacy of individualized rtfMRI-NF comparable to active TAU for adolescents with DBD and increased CU traits. Further studies are needed to confirm efficacy, specificity and to clarify underlying learning mechanisms., Competing Interests: Declaration of competing interest D. Brandeis served as an unpaid scientific consultant for an EU-funded neurofeedback trial. T. Banaschewski served in an advisory or consultancy role for eye level, Infectopharm, Lundbeck, Medice, Neurim Pharmaceuticals, Oberberg GmbH, Roche, and Takeda. He received conference support or speaker’s fee by Janssen, Medice and Takeda. He received royalties from Hogrefe, Kohlhammer, CIP Medien, and Oxford University Press., (Copyright © 2023. Published by Elsevier B.V.)

Objective: To compare the effectiveness of neurofeedback (NFB) at infra-low and alpha frequencies in the treatment of cognitive impairment in patients with early cerebral small vessel disease (cSVD)., Material and Methods: The study included 71 patients (average age 52.8±6.3 years, men 15%, women 85%) with early cSVD and 21 healthy volunteers (average age 53.2±4.8 years, men 29%, women 71%). All participants were assessed for clinical manifestations and cognitive functions, brain MRI, and EEG. cSVD patients were randomized by an envelope method with double-blind placebo control. Three groups of neurofeedback were formed: infra-low waves ( n =25), alpha waves ( n =22), simulated neurofeedback using EEG (placebo) ( n =24). Fifteen sessions of 30 minutes were conducted 2-5 times a week. The cognitive profile and EEG were assessed immediately and 6-8 weeks after completion of the neurofeedback course., Results: Patients with early cSVD had subjective (65%) and moderate (35%) cognitive impairment with predominant deviations in the components of executive brain functions (EBF). Neurofeedback using infra-low waves significantly improved EBF in the components of productivity, switching and inhibition, non-verbal delayed memory immediately after the course, maintaining the effect for at least 6-8 weeks, which was accompanied by an increase in the power (μB2) of the alpha rhythm in the occipital regions. Neurofeedback using alpha waves showed improvement in the Stroop test (interference index) in the delayed period., Conclusion: In patients with early cSVD and deterioration of EBF, it is preferable to conduct biofeedback neurotraining at infra-low frequencies to treat cognitive impairment and create a cognitive reserve. An increase in the power of the alpha rhythm in the occipital regions during the course can be considered a prognostic marker of its effectiveness.

Robotic systems, such as Lokomat® have shown promising results in people with severe motor impairments, who suffered a stroke or other neurological damage. Robotic devices have also been used by people with more challenging damages, such as Spinal Cord Injury (SCI), using feedback strategies that provide information about the brain activity in real-time. This study proposes a novel Motor Imagery (MI)-based Electroencephalogram (EEG) Visual Neurofeedback (VNFB) system for Lokomat® to teach individuals how to modulate their own μ (8-12 Hz) and β (15-20 Hz) rhythms during passive walking. Two individuals with complete SCI tested our VNFB system completing a total of 12 sessions, each on different days. For evaluation, clinical outcomes before and after the intervention and brain connectivity were analyzed. As findings, the sensitivity related to light touch and painful discrimination increased for both individuals. Furthermore, an improvement in neurogenic bladder and bowel functions was observed according to the American Spinal Injury Association Impairment Scale, Neurogenic Bladder Symptom Score, and Gastrointestinal Symptom Rating Scale. Moreover, brain connectivity between different EEG locations significantly ( [Formula: see text]) increased, mainly in the motor cortex. As other highlight, both SCI individuals enhanced their μ rhythm, suggesting motor learning. These results indicate that our gait training approach may have substantial clinical benefits in complete SCI individuals.

Aim: Childhood sexual abuse (CSA) among women is an alarmingly prevalent traumatic experience that often leads to debilitating and treatment-refractory posttraumatic stress disorder (PTSD), raising the need for novel adjunctive therapies. Neuroimaging investigations systematically report that amygdala hyperactivity is the most consistent and reliable neural abnormality in PTSD and following childhood abuse, raising the potential of implementing volitional neural modulation using neurofeedback (NF) aimed at down-regulating amygdala activity. This study aimed to reliably probe limbic activity but overcome the limited applicability of functional magnetic resonance imaging (fMRI) NF by using a scalable electroencephalogram NF probe of amygdala-related activity, termed amygdala electrical-finger-print (amyg-EFP) in a randomized controlled trial., Method: Fifty-five women with CSA-PTSD who were in ongoing intensive trauma-focused psychotherapy for a minimum of 1 year but still met Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) PTSD criteria were randomized to either 10 add-on sessions of amyg-EFP-NF training (test group) or continuing psychotherapy (control group). Participants were blindly assessed for PTSD symptoms before and after the NF training period, followed by self-reported clinical follow-up at 1, 3, and 6 months, as well as one session of amygdala real-time fMRI-NF before and after NF training period., Results: Participants in the test group compared with the control group demonstrated a marginally significant immediate reduction in PTSD symptoms, which progressively improved during the follow-up period. In addition, successful neuromodulation during NF training was demonstrated., Conclusion: This feasibility study for patients with treatment-resistant CSA-PTSD indicates that amyg-EFP-NF is a viable and efficient intervention., (© 2023 The Authors. Psychiatry and Clinical Neurosciences published by John Wiley & Sons Australia, Ltd on behalf of Japanese Society of Psychiatry and Neurology.)

Treatment Rationale: Exposure to repeated sexual trauma, particularly during childhood, often leads to protracted mental health problems. Childhood adversity is specifically associated with complex posttraumatic stress disorder (PTSD) presentation, which is particularly tenacious and treatment refractory, and features severe emotion dysregulation. Augmentation approaches have been suggested to enhance treatment efficacy in PTSD thus integrating first-line psychotherapy with mechanistically informed self-neuromodulation procedures (i.e. neurofeedback) may pave the way to enhanced clinical outcomes. A central neural mechanism of PTSD and emotion dysregulation involves amygdala hyperactivity that can be volitionally regulated by neurofeedback. We outline a treatment rationale that includes a detailed justification for the potential of combining psychotherapy and NF and delineate mechanisms of change. We illustrate key processes of reciprocal interactions between neurofeedback engagement and therapeutic goals. Case Study: We describe a clinical case of a woman with complex PTSD due to early and repetitive childhood sexual abuse using adjunctive neurofeedback as an augmentation to an ongoing, stable, traditional treatment plan. The woman participated in (a) ten sessions of neurofeedback by the use of an fMRI-inspired EEG model of limbic related activity (Amygdala Electrical-Finger-Print; AmygEFP-NF), (b) traditional weekly individual psychotherapy, (c) skills group. Before and after NF training period patient was blindly assessed for PTSD symptoms, followed by a 1, 3- and 6-months self-report follow-up. We demonstrate mechanisms of change as well as the clinical effectiveness of adjunctive treatment as indicated by reduced PTSD symptoms and improved daily functioning within this single case. Conclusions: We outline an integrative neuropsychological framework for understanding the unique mechanisms of change conferring value to conjoining NF applications with trauma-focused psychotherapy in complex PTSD.

Objective: The purpose of this study was to examine the effect of neurofeedback (NF) based on quantitative electroencephalography (QEEG) and SmartMind game on the time perception, attention, and working memory of children with Attention Deficit/Hyperactivity Disorder (ADHD) through an experimental design., Method: Using a purposive sampling method, 32 male students diagnosed with ADHD were selected and then randomly assigned to an experimental group and a control group. The experimental group received the treatment (NF + SmartMind) for 30 weekly sessions. Children's performances on a time perception test, a Continuous Performance Test (CPT), and a Wechsler working memory test (WISC) were examined before and after the intervention., Results: A significant difference was observed between the mean scores of the pretest and post-test for the experimental group, implying that NF training improved short-time perception and long-time perception attention in CPT test: omission error component, Correct Response component, and working memory: Visual forward component. However, the treatment did not have a significant effect on the commission error component (CPT), working memory in terms of the visual reverse, auditory reverse, and auditory forward components., Conclusion: NF combined with computer cognitive games (CCGs) can improve time perception, attention, and working memory in children with ADHD.

Sensorimotor rhythm (SMR) activity has been associated with automaticity and flow in motor execution. Studies have revealed that neurofeedback training (NFT) of the SMR can improve sports performance; however, few studies have adequately explored the effects of a single session of such NFT or examined the possible mechanisms underlying these effects on sports performance. This study recruited 44 professional golfers to address these gaps in the literature. A crossover design was employed to determine the order of the participation in the NFT and no-training control conditions. The participants were asked to perform 60 10-foot putts while electroencephalograms (EEGs) were recorded before and after the tasks. In pre-and post-tests, visual analog scales were used to assess the psychological states associated with SMR activities including the levels of attention engagement, conscious motor control, and physical relaxation. The results revealed that a single NFT session effectively increased SMR power and improved putting performance compared with the control condition. The subjective assessments also revealed that the participants reported lower attention engagement, less conscious control of the motor details and were more relaxed in the putting task, suggesting that SMR NFT promoted effortless and quiescent mental states during motor preparation for a putting task. This study aligns with theoretical hypotheses and extends current knowledge by revealing that a single session of SMR NFT can effectively enhance SMR power and improve putting performance in professional golfers. It also provides preliminary evidence of the possible underlying mechanisms that drive the effect of SMR NFT on putting performances., (© 2023 The Authors. Scandinavian Journal of Medicine & Science In Sports published by John Wiley & Sons Ltd.)

Improving neurocognitive functions through remote interventions has been a promising approach to developing new treatments for attention-deficit/hyperactivity disorder (AD/HD). Remote neurocognitive interventions may address the shortcomings of the current prevailing pharmacological therapies for AD/HD, e.g., side effects and access barriers. Here we review the current options for remote neurocognitive interventions to reduce AD/HD symptoms, including cognitive training, EEG neurofeedback training, transcranial electrical stimulation, and external cranial nerve stimulation. We begin with an overview of the neurocognitive deficits in AD/HD to identify the targets for developing interventions. The role of neuroplasticity in each intervention is then highlighted due to its essential role in facilitating neuropsychological adaptations. Following this, each intervention type is discussed in terms of the critical details of the intervention protocols, the role of neuroplasticity, and the available evidence. Finally, we offer suggestions for future directions in terms of optimizing the existing intervention protocols and developing novel protocols., Competing Interests: Declaration of Competing Interest None., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Real-time fMRI (rt-fMRI) neurofeedback (NF) training is a novel non-invasive technique for volitional brain modulation. Given the important role of the anterior insula (AI) in human cognitive and affective processes, it has become one of the most investigated regions in rt-fMRI studies. Most rt-fMRI insula studies employed emotional recall/imagery as the regulation strategy, which may be less effective for psychiatric disorders characterized by altered emotional processing. The present study thus aimed to examine the feasibility of a novel interoceptive strategy based on heartbeat detection in rt-fMRI guided AI regulation and its associated behavioral changes using a randomized double-blind, sham feedback-controlled between-subject design. 66 participants were recruited and randomly assigned to receive either NF from the left AI (LAI) or sham feedback from a control region while using the interoceptive strategy. N = 57 participants were included in the final data analyses. Empathic and interoceptive pre-post training changes were collected as behavioral measures of NF training effects. Results showed that participants in the NF group exhibited stronger LAI activity than the control group with LAI activity being positively correlated with interoceptive accuracy following NF training, although there were no significant increases of LAI activity over training sessions. Importantly, ability of LAI regulation could be maintained in a transfer session without feedback. Successful LAI regulation was associated with strengthened functional connectivity of the LAI with cognitive control, memory and learning, and salience/interoceptive networks. The present study demonstrated for the first time the efficacy of a novel regulation strategy based on interoceptive processing in up-regulating LAI activity. Our findings also provide proof of concept for the translational potential of this strategy in rt-fMRI AI regulation of psychiatric disorders characterized by altered emotional processing., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 The Author(s). Published by Elsevier Inc. All rights reserved.)

Several studies have examined whether electroencephalography neurofeedback (EEG-NF), a self-regulatory technique where an individual receives real-time feedback on a pattern of brain activity that is theoretically linked to a target behaviour, can enhance episodic memory. The aim of this research was to i) provide a qualitative overview of the literature, and ii) conduct a meta-analysis of appropriately controlled studies to determine whether EEG-NF can enhance episodic memory. The literature search returned 46 studies, with 21 studies (44 effect sizes) meeting the inclusion criteria for the meta-analysis. The qualitative overview revealed that, across EEG-NF studies on both healthy and clinical populations, procedures and protocols vary considerably and many studies were insufficiently powered with inadequate design features. The meta-analysis, conducted on studies with an active control, revealed a small-size, significant positive effect of EEG-NF on episodic memory performance (g = 0.31, p = 0.003), moderated by memory modality and EEG-NF self-regulation success. These results are discussed with a view towards optimising EEG-NF training and subsequent benefits to episodic memory., Competing Interests: Declaration of Competing Interest None., (Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.)

This article describes the protocol for a randomized, controlled clinical trial of a neurofeedback (NF) intervention for Tourette Syndrome (TS) and chronic tic disorder. The intervention involves using functional magnetic resonance imaging (fMRI) to provide feedback regarding activity in the supplementary motor area: participants practice controlling this brain area while using the feedback as a training signal. The previous version of this NF protocol was tested in a small study (n = 21) training adolescents with TS that yielded clinically promising results. Therefore, we plan a larger trial. Here we describe the background literature that motivated this work, the design of our original neurofeedback study protocol, and adaptations of the research study protocol for the new trial. We focus on those ideas incorporated into our protocol that may be of interest to others designing and running NF studies. For example, we highlight our approach for defining an unrelated brain region to be trained in the control group that is based on identifying a region with low functional connectivity to the target area. Consistent with a desire for transparency and open science, the new protocol is described in detail here prior to conducting the trial., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023. Published by Elsevier B.V.)

Neurofeedback training is a common treatment option for attention deficit hyperactivity disorder (ADHD). Given theta/beta-based neurofeedback (T/B NF) training targets at the electrophysiological characteristics of children with ADHD, benefits for attention may be expected. PsycINFO, PubMed, ScienceDirect, Scopus, and Web of Science were searched through December 31, 2020. Studies were evaluated with Risk of Bias tools. Within-group effects based on Pre- and Post-treatment comparisons of the Intervention Group, and Between-group effects based on the between-group differences from Pre-treatment to Post-treatment were calculated. Nineteen studies met selection criteria for systematic review, 12 of them were included in meta-analysis. Within-group effects were medium at Post-treatment and large at Follow-up. Between-group analyses revealed that T/B NF was superior to waitlist control and physical activities, but not stimulant medication. Results showed that T/B NF has benefits for attention in children with ADHD, however, cautions should be taken when interpreting the findings., (© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Objective: Knowledge on predictors for treatment response to psychotherapy in binge-eating disorder (BED) is mixed and not yet available for increasingly popular neurofeedback (NF) treatment targeting self-regulation of aberrant brain activity. This study examined eating disorder- and psychopathology-related predictors for NF treatment success in BED., Method: Patients with BED (N = 78) were randomized to 12 sessions of real-time functional near-infrared spectroscopy (rtfNIRS)-NF, targeting individual prefrontal cortex signal up-regulation, electroencephalography (EEG)-NF, targeting down-regulation of fronto-central beta activity, or waitlist (WL). The few studies assessing predictors for clinical outcomes after NF and evidenced predictors for psychotherapy guided the selection of baseline eating disorder-related predictors, including objective binge-eating (OBE) frequency, eating disorder psychopathology (EDP), food cravings, and body mass index (BMI), and general psychopathology-related predictors, including depressive and anxiety symptoms, impulsivity, emotion dysregulation, and self-efficacy. These questionnaire-based or objectively assessed (BMI) predictors were regressed on outcomes OBE frequency and EDP as key features of BED at post-treatment (t1) and 6-month follow-up (t2) in preregistered generalized mixed models (https://osf.io/4aktp)., Results: Higher EDP, food cravings, and BMI predicted worse outcomes across all groups at t1 and t2. General psychopathology-related predictors did not predict outcomes at t1 and t2. Explorative analyses indicated that lower OBE frequency and higher self-efficacy predicted lower OBE frequency, and lower EDP predicted lower EDP after the waiting period in WL., Discussion: Consistent with findings for psychotherapy, higher eating disorder-related predictors were associated with higher EDP and OBE frequency. The specificity of psychopathological predictors for NF treatment success warrants further examination., Public Significance: This exploratory study firstly assessed eating disorder- and psychopathology-related predictors for neurofeedback treatment outcome in binge-eating disorder and overweight. Findings showed an association between higher eating disorder symptoms and worse neurofeedback outcomes, indicating special needs to be considered in neurofeedback treatment for patients with a higher binge-eating disorder symptom burden. In general, outcomes and assignment to neurofeedback treatment may be improved upon consideration of baseline psychological variables., (© 2023 The Authors. International Journal of Eating Disorders published by Wiley Periodicals LLC.)

Objective: Despite the increasing popularity of neurofeedback (NF), aiming at voluntary modulation of dysfunctional prefrontal cortex (PFC) signals in the treatment of binge-eating disorder (BED) and/or overweight, mechanisms remain poorly understood., Methods: Based on a randomized-controlled trial offering 12 food-specific real-time functional near-infrared spectroscopy (rtfNIRS)-NF sessions to participants with BED (n = 22), this preregistered study examined (1) online regulation success as predictor for offline regulation success, defined by PFC signals during regulation versus watch, and subjective regulation success, and (2) changes in loss of control (LOC) eating after vs. before and across 12 rtfNIRS-NF-sessions., Results: Higher online regulation success expectedly predicted better subjective, but worse offline regulation success. LOC eating decreased after vs. before, but not over rtfNIRS-NF-sessions, and was not associated with subjective or offline regulation success., Conclusions: The association between online and subjective regulation success confirmed the presumed mechanism of operant conditioning underlying rtfNIRS-NF-learning. The contrary association between online and offline regulation indicated differential PFC involvement upon subtraction of automatic food-specific responses from regulation signals for offline success. Decreased LOC eating after food-specific rtfNIRS-NF-sessions suggested the potential of NF in BED treatment., Significance: Results may guide the optimization of future NF studies in larger samples with BED., Competing Interests: Conflicts of interest A. H. received: research grants on eating disorders and obesity from the German Federal Ministry of Education and Research, German Research Foundation, and Roland Ernst Foundation for Healthcare; royalties for books on the treatment of eating disorders and obesity with Hogrefe; honoraria for workshops and lectures on eating disorders and obesity and their treatment; honoraria as editor of the International Journal of Eating Disorders and the journal Psychotherapeut; honoraria as a reviewer from Mercator Research Center Ruhr, Oxford University Press, and the German Society for Nutrition; and honoraria as a consultant for WeightWatchers, Zweites Deutsches Fernsehen, and Takeda. The authors declare no conflict of interest., (Copyright © 2023 International Federation of Clinical Neurophysiology. Published by Elsevier B.V. All rights reserved.)

Police officers of the Special Forces are confronted with highly demanding situations in terms of stress, high tension and threats to their lives. Their tasks are specifically high-risk operations, such as arrests of armed suspects and anti-terror interventions. Improving the emotion regulation skills of police officers might be a vital investment, supporting them to stay calm and focused. A promising approach is training emotion regulation by using real-time (rt-) fMRI neurofeedback. Specifically, downregulating activity in key areas of the fronto-limbic emotion regulation network in the presence of threatening stimuli. Thirteen recruits of the Dutch police special forces underwent six weekly rt-fMRI sessions, receiving neurofeedback from individualized regions of their emotion regulation network. Their task was to reduce the image size of threatening images, wherein the image size represented their brain activity. A reduction in image size represented successful downregulation. Participants were free to use their preferred regulation strategy. A control group of fifteen recruits received no neurofeedback. Both groups completed behavioural tests (image rating on evoked valence and arousal, questionnaire) before and after the neurofeedback training. We hypothesized that the neurofeedback group would improve in downregulation and would score better than the control group on the behavioural tests after the neurofeedback training. Neurofeedback training resulted in a significant decrease in image size (t(12) = 2.82, p = .015) and a trend towards decreased activation in the target regions (t(10) = 1.82, p = .099) from the first to the last session. Notably, subjects achieved downregulation below the pre-stimulus baseline in the last two sessions. No relevant differences between groups were found in the behavioural tasks. Through the training of rt-fMRI neurofeedback, participants learned to downregulate the activity in individualized areas of the emotion regulation network, by using their own preferred strategies. The lack of behavioural between-group differences may be explained by floor effects. Tasks that are close to real-life situations may be needed to uncover behavioural correlates of this emotion regulation training., (Copyright © 2023. Published by Elsevier Ltd.)

Electroencephalography (EEG) and functional magnetic resonance imaging (fMRI) are two commonly used non-invasive techniques for measuring brain activity in neuroscience and brain-computer interfaces (BCI). Objective . In this review, we focus on the use of EEG and fMRI in neurofeedback (NF) and discuss the challenges of combining the two modalities to improve understanding of brain activity and achieve more effective clinical outcomes. Advanced technologies have been developed to simultaneously record EEG and fMRI signals to provide a better understanding of the relationship between the two modalities. However, the complexity of brain processes and the heterogeneous nature of EEG and fMRI present challenges in extracting useful information from the combined data. Approach . We will survey existing EEG-fMRI combinations and recent studies that exploit EEG-fMRI in NF, highlighting the experimental and technical challenges. Main results . We made a classification of the different combination of EEG-fMRI for NF, we provide a review of multimodal analysis methods for EEG-fMRI features. We also survey the current state of research on EEG-fMRI in the different existing NF paradigms. Finally, we also identify some of the remaining challenges in this field. Significance . By exploring EEG-fMRI combinations in NF, we are advancing our knowledge of brain function and its applications in clinical settings. As such, this review serves as a valuable resource for researchers, clinicians, and engineers working in the field of neural engineering and rehabilitation, highlighting the promising future of EEG-fMRI-based NF., (© 2023 IOP Publishing Ltd.)

Neurofeedback (NF) is a promising method to self-regulate human brain activity for cognition enhancement. Due to the unclear results of alpha NF training on working memory updating as well as the impact of feedback modality on NF learning, this study aimed to understand further the underlying neural mechanism of alpha NF training effects on working memory updating, where the NF learning was also compared between visual and auditory feedback modalities. A total of 30 participants were assigned to Visual NF, Auditory NF, and Control groups. Working memory updating was evaluated by n-back (n =2,3) tasks before and after five alpha upregulation NF sessions. The result showed no significant difference in NF learning performance between the Visual and Auditory groups, indicating that the difference in feedback modality did not affect NF learning. In addition, compared to the control group, the participants who achieved successful NF learning showed a significant increase in n-back behavioral performance and P3a amplitude in 2-back and a significant decrease in P3a latency in 3-back. Our results in n-back further suggested that successful alpha NF training might improve updating performance in terms of the behavioral and related event-related potential (ERP) measures. These findings contribute to the understanding of the effect of alpha training on memory updating and the design of NF experimental protocol in terms of feedback modality selection., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Inc. All rights reserved.)

The use of neurofeedback is an important aspect of effective motor rehabilitation as it offers real-time sensory information to promote neuroplasticity. However, there is still limited knowledge about how the brain's functional networks reorganize in response to such feedback. To address this gap, this study investigates the reorganization of the brain network during motor imagery tasks when subject to visual stimulation or visual-electrotactile stimulation feedback. This study can provide healthcare professionals with a deeper understanding of the changes in the brain network and help develop successful treatment approaches for brain-computer interface-based motor rehabilitation applications. We examine individual edges, nodes, and the entire network, and use the minimum spanning tree algorithm to construct a brain network representation using a functional connectivity matrix. Furthermore, graph analysis is used to detect significant features in the brain network that might arise in response to the feedback. Additionally, we investigate the power distribution of brain activation patterns using power spectral analysis and evaluate the motor imagery performance based on the classification accuracy. The results showed that the visual and visual-electrotactile stimulation feedback induced subject-specific changes in brain activation patterns and network reorganization in the [Formula: see text] band. Thus, the visual-electrotactile stimulation feedback significantly improved the integration of information flow between brain regions associated with motor-related commands and higher-level cognitive functions, while reducing cognitive workload in the sensory areas of the brain and promoting positive emotions. Despite these promising results, neither neurofeedback modality resulted in a significant improvement in classification accuracy, compared with the absence of feedback. These findings indicate that multimodal neurofeedback can modulate imagery-mediated rehabilitation by enhancing motor-cognitive communication and reducing cognitive effort. In future interventions, incorporating this technique to ease cognitive demands for participants could be crucial for maintaining their motivation to engage in rehabilitation., (© 2023. Springer Nature Limited.)

Background: Adolescence is characterized by a heightened vulnerability for Major Depressive Disorder (MDD) onset, and currently, treatments are only effective for roughly half of adolescents with MDD. Accordingly, novel interventions are urgently needed. This study aims to establish mindfulness-based real-time fMRI neurofeedback (mbNF) as a non-invasive approach to downregulate the default mode network (DMN) in order to decrease ruminatory processes and depressive symptoms., Methods: Adolescents (N = 90) with a current diagnosis of MDD ages 13-18-years-old will be randomized in a parallel group, two-arm, superiority trial to receive either 15 or 30 min of mbNF with a 1:1 allocation ratio. Real-time neurofeedback based on activation of the frontoparietal network (FPN) relative to the DMN will be displayed to participants via the movement of a ball on a computer screen while participants practice mindfulness in the scanner. We hypothesize that within-DMN (medial prefrontal cortex [mPFC] with posterior cingulate cortex [PCC]) functional connectivity will be reduced following mbNF (Aim 1: Target Engagement). Additionally, we hypothesize that participants in the 30-min mbNF condition will show greater reductions in within-DMN functional connectivity (Aim 2: Dosing Impact on Target Engagement). Aim 1 will analyze data from all participants as a single-group, and Aim 2 will leverage the randomized assignment to analyze data as a parallel-group trial. Secondary analyses will probe changes in depressive symptoms and rumination., Discussion: Results of this study will determine whether mbNF reduces functional connectivity within the DMN among adolescents with MDD, and critically, will identify the optimal dosing with respect to DMN modulation as well as reduction in depressive symptoms and rumination., Trial Registration: This study has been registered with clinicaltrials.gov, most recently updated on July 6, 2023 (trial identifier: NCT05617495)., (© 2023. BioMed Central Ltd., part of Springer Nature.)

Frontal functional asymmetry (FA) has been proposed as a potential target for neurofeedback (NFB) training for mental disorders but most FA NFB studies used electroencephalography while the investigations of FA NFB in functional magnetic resonance imaging (fMRI) are rather limited. In this study, we aimed at identifying functional asymmetry effects in fMRI and exploring its potential as a target for fMRI NFB studies by re-analyzing an existing data set containing a resting state measurement and a sad mood induction task of n = 30 participants with remitted major depressive disorder and n = 30 matched healthy controls. We applied low-frequency fluctuations (ALFF), fractional ALFF, and regional homogeneity and estimated functional asymmetry in both a voxel-wise and regional manner. We assessed functional asymmetry during rest and negative mood induction as well as functional asymmetry changes between the phases, and associated the induced mood change with the change in functional asymmetry. Analyses were conducted within as well as between groups. Despite extensive analyses, we identified only very limited effects. While some tests showed nominal significance, our results did not contain any clear identifiable patterns of effects that would be expected if a true underlying effect would be present. In conclusion, we do not find evidence for FA effects related to negative mood in fMRI, which questions the usefulness of FA measures for real-time fMRI neurofeedback as a treatment approach for affective disorders., (© 2023. Springer Nature Limited.)

Background: Despite cognitive behavioral therapy (CBT) being a standard treatment in major depressive disorder (MDD), nearly half of patients do not respond. As one of the predictors of CBT's efficacy is amygdala reactivity to positive information, which is often decreased in MDD, we explored whether real-time fMRI neurofeedback (rtfMRI-nf) training to increase amygdala responses during positive memory recall prior CBT would enhance its efficacy., Methods: In a double-blind, placebo controlled, randomized clinical trial, 35 adults with MDD received two sessions of rtfMRI-nf training to increase their amygdala (experimental group, n = 16) or parietal (control group, n = 19) responses during positive memory neurofeedback prior to receiving 10 CBT sessions. Depressive symptomatology was monitored between the rtfMRI sessions, the first three, 9th and 10th sessions of CBT and at 6 months and 1 year follow-up., Results: Participants in the experimental group showed decreased depressive symptomatology and higher remission rates at 6 months and 1 year follow-up than the control group. Analysis of CBT content highlighted that participants in the experimental group focused more on positive thinking and behaviors than the control group., Limitations: The study was relatively small and not sufficiently powered to detect small effects., Conclusions: CBT, when combined with amygdala neurofeedback, results in sustained clinical changes and leads to long-lasting clinical improvement, potentially by increasing focus on positive memories and cognitions., Competing Interests: Declaration of competing interest Dr. Compère, Huppert, Strege, Pacoe, and Young, as Ms Riley, Canovali, and Mr. Barb, Lazzaro report no financial relationships with commercial interests. Dr. Siegle reports royalties from a patent licensed to Apollo Neuroscience, regarding a device to decrease stress during cognitive tasks., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Neurofeedback, utilizing an electroencephalogram (EEG) and/or a functional near-infrared spectroscopy (fNIRS) device, is a real-time measurement of brain activity directed toward controlling and optimizing brain function. This treatment has often been attributed to improvements in disorders such as ADHD, anxiety, depression, and epilepsy, among others. While there is evidence suggesting the efficacy of neurofeedback devices, the research is still inconclusive. The applicability of the measurements and parameters of consumer neurofeedback wearable devices has improved, but the literature on measurement techniques lacks rigorously controlled trials. This paper presents a survey and literary review of consumer neurofeedback devices and the direction toward clinical applications and diagnoses. Relevant devices are highlighted and compared for treatment parameters, structural composition, available software, and clinical appeal. Finally, a conclusion on future applications of these systems is discussed through the comparison of their advantages and drawbacks.

Neurocognitive assessment tools have been proposed to optimize, maintain, and improve perceptual-cognitive performance. Here, we investigated the feasibility and efficacy of a novel neurofeedback system, neuroMoon (nM), on cognitive abilities compared with one of the most popular perceptual-cognitive training (PCT) tools both in sports and rehabilitation called NeuroTracker (NT). Thirty-one young athletes performed a comprehensive battery of cognitive tests from the Vienna Test System before and after a 12-session computer-based cognitive training program using nM (n = 11, age 22.6 ± 3.8 years), nM sham (CON, n = 10, age 20.3 ± 1.2 years) or NT (n = 10, age 20.5 ± 1.7 years) device. A series of repeated-measures ANOVA was performed to detect changes in cognitive abilities in response to the training. Participants had faster median reaction time in both the color-naming and word-reading conditions of the Stroop test (all p < 0.005), regardless of group. Regarding the task switching test, statistical analysis indicated faster working time and mean reaction time of the incongruent stimuli, repetition task, and shifting task (all p < 0.005), nevertheless, these changes were also regardless of group. In addition, we found fewer omitted (pre: 17.5 ± 8.3, post: 6.4 ± 1.5, d = 1.311) and more correct (pre: 261.6 ± 36.1, post: 278.6 ± 38.7, d = - 1.020) post-intervention answers in the determination test, regardless of group. Finally, participants in each group performed the digit span backward test with larger post (6.42 ± 1.54) vs. pre (5.55 ± 1.43) scores following the PCT (d = - 0.801). Overall, PCT with nM as compared with NT induced similar results in cognitive abilities suggesting its potential to be used to achieve and maintain better mental performance. However, considering that the sham stimulation also induced similar improvements in cognitive abilities, future studies should clearly determine the cognitive measures that could benefit from NF training., (© 2023. Springer Nature Limited.)

Emotion regulation plays a key role in human behavior and overall well-being. Neurofeedback is a non-invasive self-brain training technique used for emotion regulation to enhance brain function and treatment of mental disorders through behavioral changes. Previous neurofeedback research often focused on using activity from a single brain region as measured by fMRI or power from one or two EEG electrodes. In a new study, we employed connectivity-based EEG neurofeedback through recalling positive autobiographical memories and simultaneous fMRI to upregulate positive emotion. In our novel approach, the feedback was determined by the coherence of EEG electrodes rather than the power of one or two electrodes. We compared the efficiency of this connectivity-based neurofeedback to traditional activity-based neurofeedback through multiple experiments. The results showed that connectivity-based neurofeedback effectively improved BOLD signal change and connectivity in key emotion regulation regions such as the amygdala, thalamus, and insula, and increased EEG frontal asymmetry, which is a biomarker for emotion regulation and treatment of mental disorders such as PTSD, anxiety, and depression and coherence among EEG channels. The psychometric evaluations conducted both before and after the neurofeedback experiments revealed that participants demonstrated improvements in enhancing positive emotions and reducing negative emotions when utilizing connectivity-based neurofeedback, as compared to traditional activity-based and sham neurofeedback approaches. These findings suggest that connectivity-based neurofeedback may be a superior method for regulating emotions and could be a useful alternative therapy for mental disorders, providing individuals with greater control over their brain and mental functions., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 The Author(s). Published by Elsevier Inc. All rights reserved.)

Attention Deficit/Hyperactivity Disorder (ADHD) is a common neurodevelopmental disorder of childhood and its effects mostly continue to adulthood. Neurofeedback training has shown promising results in the treatment of ADHD. However, there is no yet consensus as to the efficacy of neurofeedback in comparison to stimulant medication. Despite a large number of meta-analyses and comparative reviews on the effects of neurofeedback in the treatment of ADHD, there is a lack of comparative reviews on the efficacy of neurofeedback protocols. This review aims at examining the effect of different training protocols on the efficacy of neurofeedback in the treatment of ADHD across specific research studies published between 2017 and 2022. Altogether, a total of 916 records were identified and 18 articles met the inclusion criteria. Findings show that the efficacy of different neurofeedback protocols has been comparable to the efficacy of stimulant medications. Nevertheless, there is still room for more clinical trials on neurofeedback protocols for ADHD since some studies suggest not using neurofeedback as a stand-alone treatment for ADHD. To my knowledge, this systematic review is the first to review neurofeedback protocols for ADHD. This study provides significant implications and directions for researchers to conduct research, on alternatives to stimulant medications for ADHD, in the future., Competing Interests: Declaration of Competing Interest I confirm that there is no conflict of interest associated with this publication, and there has been no financial support for this work that could have influenced its outcome., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Aim: To assess the efficacy of a novel neurofeedback (NF) method, targeting limbic activity, to treat emotional dysregulation related to premenstrual dysphoric disorder (PMDD)., Methods: We applied a NF probe targeting limbic activity using a functional magnetic resonance imaging-inspired electroencephalogram model (termed Amyg-EFP-NF) in a double-blind randomized controlled trial. A frontal alpha asymmetry probe (AAS-NF), served as active control. Twenty-seven participants diagnosed with PMDD (mean age = 33.57 years, SD = 5.67) were randomly assigned to Amyg-EFP-NF or AAS-NF interventions with a 2:1 ratio, respectively. The treatment protocol consisted of 11 NF sessions through three menstrual cycles, and a follow-up assessment 3 months thereafter. The primary outcome measure was improvement in the Revised Observer Version of the Premenstrual Tension Syndrome Rating Scale (PMTS-OR)., Results: A significant group by time effect was observed for the core symptom subscale of the PMTS-OR, with significant improvement observed at follow-up for the Amyg-EFP group compared with the AAS group [F(1, 15)=4.968, P = 0.042]. This finding was specifically robust for reduction in anger [F(1, 15) = 22.254, P < 0.001]. A significant correlation was found between learning scores and overall improvement in core symptoms (r = 0.514, P = 0.042) suggesting an association between mechanism of change and clinical improvement., Conclusion: Our preliminary findings suggest that Amyg-EFP-NF may serve as an affordable and accessible non-invasive treatment option for emotional dysregulation in women suffering from PMDD. Our main limitations were the relatively small number of participants and the lack of a sham-NF placebo arm., (© 2023 The Authors. Psychiatry and Clinical Neurosciences published by John Wiley & Sons Australia, Ltd on behalf of Japanese Society of Psychiatry and Neurology.)

This study aimed to investigate the effect of neurofeedback training on the executive control network of attention and dart-throwing skill performance in individuals with trait anxiety. Twenty girls (24.65 [Formula: see text] 2.83 years) participated in this study. They were divided into neurofeedback and control training groups. All participants practiced 14 sessions. The neurofeedback group performed neurofeedback training (increasing SMR wave, decreasing theta, and increasing alpha) and dart-throwing exercise, and the control group only completed the dart-throwing exercise. The post-test, including Attentional Networks Test (ANT) and dart-throwing, was conducted 48 h after the last training session. The results revealed a significant difference in the performance of the executive control network and dart-throwing skill between the neurofeedback and the control training group. In general, these findings support the effect of neurofeedback training on the neural mechanisms of the executive control network of attention, and performance in dart-throwing skill improves by improving attentional performance processes., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Objective: In attention deficit/hyperactivity disorder (ADHD), impaired response inhibition is frequently observed. A promising non-pharmacological treatment is electroencephalography (EEG)-neurofeedback (NF) training. However, the widely used theta-down/beta-up regulation (↓θ↑β) NF protocol may not be optimal for targeting these deficits. We examined how neurofeedback protocols training the upregulation of theta and/or beta power affect inhibitory control in children and adolescents with ADHD., Methods: 64 patients with ADHD took part in the three NF trainings. Aside from parent-reported ADHD symptoms and behavioural performance data, neurophysiological parameters collected via a Go/Nogo task and corrected to account for intraindividual variability were compared in a pre-post design and to an ADHD (n = 20) as well as a typically developing control group (n = 24)., Results: The examined NF protocols resulted in similar improvements in response inhibition with the neurophysiological mechanisms differing substantially. The upregulation of theta led to a specific Nogo-P3 increase, while training beta upregulation as well as the combined protocol resulted in less specific effects., Conclusions: This study shows distinct effects of different theta/beta-neurofeedback protocols on the neural mechanisms underlying improvements in response inhibition in patients with ADHD., Significance: These effects shed further light on the oscillatory dynamics underlying cognitive control in ADHD and how these may be targeted in neurofeedback treatments., Competing Interests: Submission declaration The authors confirm that work described has not been published previously, is not currently being considered for publication elsewhere, that its publication is approved by all authors and that, if accepted, it will not be published elsewhere without the written permission of the copyright holder., (Copyright © 2023 International Federation of Clinical Neurophysiology. Published by Elsevier B.V. All rights reserved.)

Sensory processing sensitivity (SPS) is a biological trait associated with enhanced awareness of and responsivity to the environment, as well as depth of cognitive processing. However, only a few studies have investigated how contextual factors impact cognition as a function of SPS. Thus, this study examined whether SPS is associated with differential changes in cognitive function resulting from participation in a 4-week app-based cognitive training program with neurofeedback (CT-NF). Participants (M age = 66 years) were randomized to either a treatment (CT-NF) or control group (Tetris). They completed a self-report measure of SPS (the Highly Sensitive Person Scale), and cognitive tests at pre- and post-intervention. Results revealed that individuals with higher levels of SPS in the treatment group showed superior improvements in memory (MEM) and visual memory (VSM), relative to other participants and other measures of cognition. These findings are consistent with theories of SPS and studies showing that enhanced visual perceptiveness and memory are associated with the trait. Moreover, they highlight the cognitive mechanisms that might be especially important for SPS. In conclusion, these findings suggest that those with high SPS may experience enhancements in MEM and VSM, resulting from a 4-week app-based CT-NF program., Competing Interests: Declaration of Competing Interest The author declares that they have no known competing financial interests or personal relationships that would have influenced the literature and work reported in this paper., (Copyright © 2023 The Authors. Published by Elsevier B.V. All rights reserved.)

Neurofeedback (NF) training is a promising preventive and therapeutic approach for brain and behavioral impairments, the dorsolateral prefrontal cortex (DL-PFC) being a relevant region of interest. Functional near-infrared spectroscopy (NIRS) has recently been applied in NF training. However, this approach is highly sensitive to extra-cerebral vascularization, which could bias measurements of cortical activity. Here, we examined the feasibility of a NF training targeting the DL-PFC and its specificity by assessing the impact of physiological confounds on NF success via short-channel offline correction under different signal filtering conditions. We also explored whether the individual mental strategies affect the NF success. Thirty volunteers participated in a single 15-trial NF session in which they had to increase the oxy-hemoglobin (HbO2) level of their bilateral DL-PFC. We found that 0.01-0.09 Hz band-pass filtering was more suited than the 0.01-0.2 Hz band-pass filter to highlight brain activation restricted to the NF channels in the DL-PFC. Retaining the 10 out of 15 best trials, we found that 18 participants (60%) managed to control their DL-PFC. This number dropped to 13 (43%) with short-channel correction. Half of the participants reported a positive subjective feeling of control, and the "cheering" strategy appeared to be more effective in men (p<0.05). Our results showed successful DL-PFC fNIRS-NF in a single session and highlighted the value of accounting for extra cortical signals, which can profoundly affect the success and specificity of NF training., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Godet et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

There is an increasing interest in non-pharmacological treatments for children with attention-deficit/hyperactivity disorder (AD/HD), especially digital techniques that can be remotely delivered, such as neurofeedback (NFT) and computerized cognitive training (CCT). In this study, a randomized controlled design was used to compare training outcomes between remotely delivered NFT, CCT, and combined NFT/CCT training approaches. A total of 121 children with AD/HD were randomly assigned to the NFT, CCT, or NFT/CCT training groups, with 80 children completing the training program. Pre- and post-training symptoms (primary outcome), executive and daily functions were measured using questionnaires as well as resting EEG during eyes-closed (EC) and eyes-open (EO) conditions. After 3 months of training, the inattentive and hyperactive/impulsive symptoms, inhibition, working memory, learning and life skills of the three groups of children were significantly improved. The objective EEG activity showed a consistent increase in the relative alpha power in the EO condition among the three training groups. Training differences were not observed between groups. There was a positive correlation between pre-training EO relative alpha power and symptom improvement scores of inattention and hyperactivity/impulsivity, as well as a negative correlation between pre-training inattention scores and change in EO relative alpha. This study verified the training effects of NFT, CCT, and combined NFT/CCT training in children with AD/HD and revealed an objective therapeutic role for individual relative alpha activity. The verified feasibility and effectiveness of home-based digital training support promotion and application of digital remote training., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.)

Objective: To determine whether in situ neurofeedback training can be used as a tool to build sustained attention in the general student population and whether gains in attention translate to more effective work habits and learning skills., Method: Students participated in attention training game-based neurofeedback in situ for a period of 35 sessions of 25 min each. The study was built as a one-group pretest-posttest quasi-experimental design., Results: This study supports that classroom-based neurofeedback may be an effective tool to build sustained attention and translate these gains into observable work habits and learning behaviors including planning and organization., Conclusion: Neurofeedback has shown specificity in the treatment of Attention Deficit Hyperactivity Disorder. Published research has not, however, focused on its efficacy in developing attentional capacities in the general population. The promising results of this exploratory investigation warrant further applied research.

Background: Major depressive disorder is a difficult-to-treat psychological disorder. Approximately 30% of patients with major depressive disorder do not respond to conventional therapies; thus, the efficacy of alternative therapies for treating major depressive disorder, such as neurofeedback, a non-invasive neuromodulation method used in the treatment of psychiatric diseases, must be investigated., Objective: We aimed to evaluate the efficacy of neurofeedback in minimizing and treating major depressive disorder and its application as a substitute to or an adjuvant with conventional therapies., Methods: We searched for experimental studies published between 1962-2021 in Scopus, PubMed, Web of Science, and Embase databases and identified 1,487 studies, among which 13 met the inclusion exclusion criteria., Results: We noted that not all patients responded to neurofeedback. Based on depression scales, major depressive disorder significantly improved in response to neurofeedback only in a few individuals. Additionally, the number of training sessions did not influence the results., Conclusion: Neurofeedback can reduce depression symptoms in patients; however, not all patients respond to the treatment. Therefore, further studies must be conducted to validate the effectiveness of neurofeedback in treating major depressive disorder.

Resting-state magnetoencephalography (MEG) data show complex but structured spatiotemporal patterns. However, the neurophysiological basis of these signal patterns is not fully known and the underlying signal sources are mixed in MEG measurements. Here, we developed a method based on the nonlinear independent component analysis (ICA), a generative model trainable with unsupervised learning, to learn representations from resting-state MEG data. After being trained with a large dataset from the Cam-CAN repository, the model has learned to represent and generate patterns of spontaneous cortical activity using latent nonlinear components, which reflects principal cortical patterns with specific spectral modes. When applied to the downstream classification task of audio-visual MEG, the nonlinear ICA model achieves competitive performance with deep neural networks despite limited access to labels. We further validate the generalizability of the model across different datasets by applying it to an independent neurofeedback dataset for decoding the subject's attentional states, providing a real-time feature extraction and decoding mindfulness and thought-inducing tasks with an accuracy of around 70% at the individual level, which is much higher than obtained by linear ICA or other baseline methods. Our results demonstrate that nonlinear ICA is a valuable addition to existing tools, particularly suited for unsupervised representation learning of spontaneous MEG activity which can then be applied to specific goals or tasks when labelled data are scarce., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 The Author(s). Published by Elsevier Inc. All rights reserved.)

Neurofeedback procedures are attracting increasing attention in the neuroscience community. Based on the principle that participants, through suitable feedback, may learn to affect specific aspects of their brain activity, neurofeedback interventions have been applied to basic research, translational, and clinical science. A large segment of the available empirical research as well as review articles have focused on the extent to which neurofeedback interventions affect mental health outcomes, cognitive capacity, aging, and other complex behaviors. Another segment has aimed to characterize the extent to which neurofeedback affects the targeted neural processes. At this time, there is no current systematic review of the effects of neurofeedback on healthy participants' performance in experimental tasks. Such a review is relevant in this rapidly evolving field because changes in experimental task performance are traditionally considered a hallmark of changing neurocognitive processes, often established in neurotypical individuals. This systematic review addresses this gap in the literature using the PRISMA method, building on earlier reviews on the same topic. Empirical studies using EEG or fMRI to alter brain processes linked to established cognitive and affective laboratory tasks were reviewed. Systematic quality assessment and z-curve analyses were also conducted. Substantial variability was found regarding the study designs used, the implementation of the feedback, and the neural targets of feedback. Importantly, only a minority of the studies reported statistically meaningful effects of neurofeedback on performance in cognitive and affective tasks. The z-curve analyses found no evidence for reporting bias or unsound research practices. Quality control and effect size analyses showed few systematic relations between study characteristics such as sample size or experimental control on the one hand and outcome on the other. Overall, the present study does not support strong effects of NFT on performance in laboratory tasks. Implications for future work are discussed., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Good emotion-regulation ability (ERA) is a vital sign of psychological health; conversely, emotion dysregulation may lead to mental or neurological disorders, such as anxiety disorders and depression. This study developed an emotion-regulation training system, Emo-regulator, fusing virtual reality (VR) and EEG-based neurofeedback to enhance subjects' ability to down-regulate negative emotions. Emo-regulator first elicited negative emotions in subjects through VR scenarios and then asked them to regulate emotions using cognitive reappraisal to change the emotional responses elicited by the VRs. Meanwhile, EEG signals from the subjects were collected and analyzed in real time by machine learning to predict the emotional states of the subjects (negative or positive). Emo-regulator changed the VR scenarios according to the prediction results and completed the feedback. Eight subjects used Emo-regulator for two weeks, and the results showed it could help the subjects improve their emotion regulation, and its usability is above average.Clinical Relevance-Emo-regulator can help subjects improve their ability to down-regulate negative emotions and increase the frequency of cognitive reappraisal use during emotion regulation.

The aim of the study was to test the feasibility of visual-neurofeedback-guided motor imagery (MI) of the dominant leg, based on source analysis with real-time sLORETA derived from 44 EEG channels. Ten able-bodied participants took part in two sessions: session 1 sustained MI without feedback and session 2 sustained MI of a single leg with neurofeedback. MI was performed in 20 s on and 20 s off intervals to mimic functional magnetic resonance imaging. Neurofeedback in the form of a cortical slice presenting the motor cortex was provided from a frequency band with the strongest activity during real movements. The sLORETA processing delay was 250 ms. Session 1 resulted in bilateral/contralateral activity in the 8-15 Hz band dominantly over the prefrontal cortex while session 2 resulted in ipsi/bilateral activity over the primary motor cortex, covering similar areas as during motor execution. Different frequency bands and spatial distributions in sessions with and without neurofeedback may reflect different motor strategies, most notably a larger proprioception in session 1 and operant conditioning in session 2. Single-leg MI might be used in the early phases of rehabilitation of stroke patients. Simpler visual feedback and motor cueing rather than sustained MI might further increase the intensity of cortical activation.

The Visual Word Form Area (VWFA) is a key region of the brain's reading network and its activation has been shown to be strongly associated with reading skills. Here, for the first time, we investigated whether voluntary regulation of VWFA activation is feasible using real-time fMRI neurofeedback. 40 adults with typical reading skills were instructed to either upregulate (UP group, N = 20) or downregulate (DOWN group, N = 20) their own VWFA activation during six neurofeedback training runs. The VWFA target region was individually defined based on a functional localizer task. Before and after training, also regulation runs without feedback ("no-feedback runs") were performed. When comparing the two groups, we found stronger activation across the reading network for the UP than the DOWN group. Further, activation in the VWFA was significantly stronger in the UP group than the DOWN group. Crucially, we observed a significant interaction of group and time (pre, post) for the no-feedback runs: The two groups did not differ significantly in their VWFA activation before neurofeedback training, but the UP group showed significantly stronger activation than the DOWN group after neurofeedback training. Our results indicate that upregulation of VWFA activation is feasible and that, once learned, successful upregulation can even be performed in the absence of feedback. These results are a crucial first step toward the development of a potential therapeutic support to improve reading skills in individuals with reading impairments., (© 2023. The Author(s).)

Background and Objective: Neurofeedback (NF) is a paradigm that allows users to self-modulate patterns of brain activity. It is implemented with a closed-loop brain-computer interface (BCI) system that analyzes the user's brain activity in real-time and provides continuous feedback. This paradigm is of great interest due to its potential as a non-pharmacological and non-invasive alternative to treat non-degenerative brain disorders. Nevertheless, currently available NF frameworks have several limitations, such as the lack of a wide variety of real-time analysis metrics or overly simple training scenarios that may negatively affect user performance. To overcome these limitations, this work proposes ITACA: a novel open-source framework for the design, implementation and evaluation of NF training paradigms., Methods: ITACA is designed to be easy-to-use, flexible and attractive. Specifically, ITACA includes three different gamified training scenarios with a choice of five brain activity metrics as real-time feedback. Among them, novel metrics based on functional connectivity and network theory stand out. It is complemented with five different computerized versions of widespread cognitive assessment tests. To validate the proposed framework, a computational efficiency analysis and an NF training protocol focused on frontal-medial theta modulation were conducted., Results: Efficiency analysis proved that all implemented metrics allow an optimal feedback update rate for conducting NF sessions. Furthermore, conducted NF protocol yielded results that support the use of ITACA in NF research studies., Conclusions: ITACA implements a wide variety of features for designing, conducting and evaluating NF studies with the goal of helping researchers expand the current state-of-the-art in NF training., Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Roberto Hornero reports financial support was provided by Spain Ministry of Science and Innovation. Diego Marcos-Martínez reports administrative support was provided by Biomedical Research Network Centre of Bioengineering Biomaterials and Nanomedicine. Sergio Pérez-Velasco reports administrative support was provided by Biomedical Research Network Centre of Bioengineering Biomaterials and Nanomedicine. Víctor Martínez–Cagigal reports administrative support was provided by Biomedical Research Network Centre of Bioengineering Biomaterials and Nanomedicine. Eduardo Santamaría-Vázquez reports administrative support was provided by Biomedical Research Network Centre of Bioengineering Biomaterials and Nanomedicine. Víctor Rodríguez-González reports administrative support was provided by Biomedical Research Network Centre of Bioengineering Biomaterials and Nanomedicine. Roberto Hornero reports administrative support was provided by Biomedical Research Network Centre of Bioengineering Biomaterials and Nanomedicine. Eduardo Santamaría-Vázquez reports financial support was provided by Junta de Castilla y León Consejería de Educación. Sergio Pérez-Velasco reports financial support was provided by Junta de Castilla y León Consejería de Educación. Diego Marcos-Martínez reports financial support was provided by Junta de Castilla y León Consejería de Educación. Víctor Rodríguez-González reports financial support was provided by Universidad de Valladolid., (Copyright © 2023 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Background and Aim: Identifying EEG brain markers might yield better mechanistic insights into how chronic pain develops and could be treated. An existing longitudinal EEG study gave us the opportunity to determine whether the development of pain is accompanied by less alpha power-ie, a "relaxed" brain state-and vice versa., Methods: Five-minute resting EEG with the eyes open was measured 2 times in 95 subjects at T0 (baseline) and T1 (6 months later). Based on the Short-Form Health Survey and Brief Pain Inventory questionnaire, subjects were divided into 4 groups: staying pain-free (n = 44), developing chronic pain (n = 8), becoming pain-free (n = 15), and ongoing chronic pain (n = 28). The EEG data of 14 electrodes were analyzed by multilevel regression., Results: The group that developed chronic pain demonstrated less power in the lower-frequency bands over time during the resting state EEG, whereas the transition to a pain-free state had the opposite pattern. Thus, the a priori hypothesis was confirmed., Conclusions: Transitions in pain states are linked to a change in baseline EEG activity. Future research is needed to replicate these results in a larger study sample and in targeted clinical populations. Furthermore, these results might be beneficial in optimizing neurofeedback algorithms for the treatment of chronic pain., (© 2023 The Authors. Pain Practice published by Wiley Periodicals LLC on behalf of World Institute of Pain.)

Prior studies show that neurofeedback training (NFT) of mu rhythms improves behavior and EEG mu rhythm suppression during action observation in children with autism spectrum disorder (ASD). However, intellectually impaired persons were excluded because of their behavioral challenges. We aimed to determine if intellectually impaired children with ASD, who were behaviorally prepared to take part in a mu-NFT study using conditioned auditory reinforcers, would show improvements in symptoms and mu suppression following mu-NFT. Seven children with ASD (ages 6-8; mean IQ 70.6 ± 7.5) successfully took part in mu-NFT. Four cases demonstrated positive learning trends (hit rates) during mu-NFT (learners), and three cases did not (non-learners). Artifact-creating behaviors were present during tests of mu suppression for all cases, but were more frequent in non-learners. Following NFT, learners showed behavioral improvements and were more likely to show evidence of a short-term increase in mu suppression relative to non-learners who showed little to no EEG or behavior improvements. Results support mu-NFT's application in some children who otherwise may not have been able to take part without enhanced behavioral preparations. Children who have more limitations in demonstrating learning during NFT, or in providing data with relatively low artifact during task-dependent EEG tests, may have less chance of benefiting from mu-NFT. Improving the identification of ideal mu-NFT candidates, mu-NFT learning rates, source analyses, EEG outcome task performance, population-specific artifact-rejection methods, and the theoretical bases of NFT protocols, could aid future BCI-based, neurorehabilitation efforts., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)