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Specific alterations in electroencephalography (EEG)-based brain activity have recently been linked to binge-eating disorder (BED), generating interest in treatment options targeting these neuronal processes. This randomized-controlled pilot study examined the effectiveness and feasibility of two EEG neurofeedback paradigms in the reduction of binge eating, eating disorder and general psychopathology, executive functioning, and EEG activity. Adults with BED and overweight (N = 39) were randomly assigned to either a food-specific EEG neurofeedback paradigm, aiming at reducing fronto-central beta activity and enhancing theta activity after viewing highly palatable food pictures, or a general EEG neurofeedback paradigm training the regulation of slow cortical potentials. In both conditions, the study design included a waiting period of 6 weeks, followed by 6 weeks EEG neurofeedback (10 sessions à 30 min) and a 3-month follow-up period. Both EEG neurofeedback paradigms significantly reduced objective binge-eating episodes, global eating disorder psychopathology, and food craving. Approximately one third of participants achieved abstinence from objective binge-eating episodes after treatment without any differences between treatments. These results were stable at 3-month follow-up. Among six measured executive functions, only decision making improved at posttreatment in both paradigms, and cognitive flexibility was significantly improved after food-specific neurofeedback only. Both EEG neurofeedback paradigms were equally successful in reducing relative beta and enhancing relative theta power over fronto-central regions. The results highlight EEG neurofeedback as a promising treatment option for individuals with BED. Future studies in larger samples are needed to determine efficacy and treatment mechanisms.

Real-time functional magnetic resonance imaging neurofeedback (rtfMRI NFB) is a promising method for targeted regulation of pathological brain processes in mental disorders. But most NFB approaches so far have used relatively restricted regional activation as a target, which might not address the complexity of the underlying network changes. Aiming towards advancing novel treatment tools for disorders like schizophrenia, we developed a large-scale network functional connectivity-based rtfMRI NFB approach targeting dorsolateral prefrontal cortex and anterior cingulate cortex connectivity with the striatum. In a double-blind randomized yoke-controlled single-session feasibility study with N ​= ​38 healthy controls, we identified strong associations between our connectivity estimates and physiological parameters reflecting the rate and regularity of breathing. These undesired artefacts are especially detrimental in rtfMRI NFB, where the same data serves as an online feedback signal and offline analysis target. To evaluate ways to control for the identified respiratory artefacts, we compared model-based physiological nuisance regression and global signal regression (GSR) and found that GSR was the most effective method in our data. Our results strongly emphasize the need to control for physiological artefacts in connectivity-based rtfMRI NFB approaches and suggest that GSR might be a useful method for online data correction for respiratory artefacts.

•Neurofeedback (NF) training specifically enhances prefrontal theta oscillations during NF tasks and subsequent emotion regulation tasks.•NF training targeting prefrontal theta oscillations improves emotion regulation, as evidenced by reduced negative emotional ratings and decreased late positive potential amplitudes.•NF-induced enhancements in prefrontal theta power partially mediated the relationship between training efficiency and emotion regulation benefits. Prefrontal theta oscillations play a critical role in cognitive control processes that facilitate emotion regulation. However, causal evidence linking their modulation to improved emotion regulation outcomes remains limited. Using a double-blind, randomized controlled design, this study demonstrates that EEG neurofeedback (NF) targeting prefrontal theta oscillations significantly enhances emotion regulation abilities. Participants in the experimental group exhibited specific upregulation of prefrontal theta power during NF training, leading to reduced negative emotional ratings and diminished late positive potential (LPP) amplitudes. Mediation analysis further revealed that NF-induced enhancements in prefrontal theta power partially mediated the relationship between training efficiency and emotion regulation benefits. These findings underscore the theoretical significance of prefrontal theta oscillations as a core mechanism of cognitive control in emotional contexts. This study advances our understanding of the neural underpinnings of emotion regulation and highlights theta-NF as a promising, non-invasive intervention for enhancing emotional resilience.

•Neurofeedback (NF) training targeting the VLPFC enhances emotion regulation, but individual differences influence outcomes.•Efficiency in NF training is a strong predictor of improved emotion regulation performance.•Increased VLPFC activity during emotion regulation fully mediates the relationship between NF training efficiency and emotion regulation success.•Frequent use of reappraisal strategies in daily life is linked to higher NF training efficiency. The ventrolateral prefrontal cortex (VLPFC) plays a pivotal role in emotion regulation, yet the effectiveness of neurofeedback (NF) training targeting the VLPFC remains uncertain, suggesting significant individual differences in outcomes. In this study, we aimed to clarify these differences by enrolling 90 participants, randomly assigned to either an experimental group or a sham group (n = 48/42). Participants in the experimental group underwent VLPFCNF training over eight sessions across two consecutive days, while those in the sham group received random signals from functional near-infrared spectroscopy (fNIRS). To investigate individual variability, participants in the experimental group were further categorized as high or low-efficacy groups based on their training efficiency, determined by the regression slope of VLPFC activity over the sessions. Our results revealed a significant reduction in negative emotions and increased VLPFC activity during emotion regulation in the high-efficacy group, compared to both the low-efficacy group and sham group. Importantly, the benefit in emotion regulation, as reflected by decreased negativity ratings, was predicted by NF training efficiency. Furthermore, the enhancement of VLPFC activity during emotion regulation fully mediated the relationship between NF training efficiency and emotion regulation benefits. Participants with higher VLPFCNF training efficiency exhibited greater engagement of the VLPFC during emotion regulation, leading to superior emotional outcomes. Additionally, VLPFCNF training efficiency was linked to the habitual use of reappraisal strategies in daily life. This study provides novel causal evidence that VLPFCNF training can effectively enhance emotion regulation, highlighting the importance of individual differences in training outcomes. Our findings suggest that NF training targeting the VLPFC offers a promising and personalized intervention strategy for improving emotion regulation, with potential applications for treating emotional disorders. This research underscores the potential of personalized NF approaches, offering new avenues for tailored therapeutic interventions in the future.

•This study investigated the impact of SMR neurofeedback training on attentional processing in healthy adults.•Ten sessions of SMR neurofeedback resulted in increased absolute SMR power.•Increased SMR power subtends greater recruitment of neural resources during attentional tasks. Successful adaptation to our environment requires the ability to selectively attend to relevant stimuli while filtering out those that are irrelevant. Impairments in this selective processing are characteristic of many psychiatric disorders. Neurofeedback offers a promising approach for addressing deficits in attentional processing. This study aimed to test the hypothesis that enhancing sensorimotor rhythm (SMR) activity improves attentional processing in healthy individuals (N = 50), and to investigate the underlying neurophysiological mechanisms supporting this effect. Participants were randomly assigned either to the neurofeedback group receiving SMR neurofeedback training, in which they learned to voluntarily increase their sensorimotor activity within the 12–15 Hz frequency range, or to the placebo-feedback group receiving sham feedback. Attentional processing and its neural correlates were assessed through a bimodal Oddball task before (T0) and after (T1) 10 neurofeedback sessions, through the recording of event-related potentials (ERPs). Data were analyzed using ANOVAs. Compared to the placebo group, the active neurofeedback group demonstrated a higher absolute SMR (p = 0.040, d = 0.58) and Beta power (p = 0.036, d = 0.58). In addition, they demonstrated a larger amplitude of the P3b component (p = 0.044, η2p = 0.08). Participants who demonstrated an increase in SMR power following neurofeedback training also showed an increase in the neural resources recruited for attentional processing. These findings suggest that protocols enhancing SMR may benefit cognitive rehabilitation strategies for disorders involving deficits in selective attentional processing.

As a significant component of executive function, goal-directed attentional control is crucial for cognitive processing and is closely linked to frontal-midline theta (FMT) rhythms. However, how up-regulation and down-regulation of FMT through neurofeedback training (NFT) impact goal-directed attention control remains unclear, especially for both short-term and long-lasting effects. Therefore, this study employed a single-blind sham-controlled between-subject design to answer this question. Forty-seven healthy adults were randomly assigned to the up-regulation, down-regulation, or sham control groups. Each group underwent one NFT session per day at the Fz electrode site for four consecutive days. All participants completed a visual search task before, immediately after the first, after the final, and one week following the last NFT session. The down-regulation group significantly reduced FMT activity during NFT and in the resting state ( p  < = 0.038), while the up-regulation group only showed an upward trend during the training phase ( r  = 0.721, p  = 0.002). The behavioral performance showed no significant improvement in any group ( p  > 0.05). Importantly, the FMT learning efficacy in the up-regulation group revealed a significantly negative correlation with the change in switch cost ( r = -0.602, p  = 0.046). These findings suggest a close link between the up-regulation efficacy of FMT rhythms and goal-directed attentional control. In educational or clinical settings, it would be desirable to improve goal-directed attention through enhancement of FMT up-regulation efficacy of NFT in future work.

Neurofeedback is a promising approach for non-invasive modulation of human brain activity with applications for treatment of mental disorders and enhancement of brain performance. Neurofeedback techniques are commonly based on either electroencephalography (EEG) or real-time functional magnetic resonance imaging (rtfMRI). Advances in simultaneous EEG–fMRI have made it possible to combine the two approaches. Here we report the first implementation of simultaneous multimodal rtfMRI and EEG neurofeedback (rtfMRI–EEG-nf). It is based on a novel system for real-time integration of simultaneous rtfMRI and EEG data streams. We applied the rtfMRI–EEG-nf to training of emotional self-regulation in healthy subjects performing a positive emotion induction task based on retrieval of happy autobiographical memories. The participants were able to simultaneously regulate their BOLD fMRI activation in the left amygdala and frontal EEG power asymmetry in the high-beta band using the rtfMRI−EEG-nf. Our proof-of-concept results demonstrate the feasibility of simultaneous self-regulation of both hemodynamic (rtfMRI) and electrophysiological (EEG) activities of the human brain. They suggest potential applications of rtfMRI–EEG-nf in the development of novel cognitive neuroscience research paradigms and enhanced cognitive therapeutic approaches for major neuropsychiatric disorders, particularly depression. •We report the first implementation of simultaneous rtfMRI and EEG neurofeedback.•A novel integration of simultaneous rtfMRI and EEG data streams is described.•Subjects can self-regulate their left amygdala fMRI activation and frontal EEG asymmetry.•Hemodynamic and electrophysiological processes can be regulated simultaneously.•rtfMRI–EEG neurofeedback holds promise for improved treatment of mental disorders.

Evaluation of mechanisms of action of EEG neurofeedback (EEG‐nf) using simultaneous fMRI is highly desirable to ensure its effective application for clinical rehabilitation and therapy. Counterbalancing training runs with active neurofeedback and sham (neuro)feedback for each participant is a promising approach to demonstrate specificity of training effects to the active neurofeedback. We report the first study in which EEG‐nf procedure is both evaluated using simultaneous fMRI and controlled via the counterbalanced active‐sham study design. Healthy volunteers (n = 18) used EEG‐nf to upregulate frontal theta EEG asymmetry (FTA) during fMRI while performing tasks that involved mental generation of a random numerical sequence and serial summation of numbers in the sequence. The FTA was defined as power asymmetry for channels F3 and F4 in [4–7] Hz band. Sham feedback was provided based on asymmetry of motion‐related artifacts. The experimental procedure included two training runs with the active EEG‐nf and two training runs with the sham feedback, in a randomized order. The participants showed significantly more positive FTA changes during the active EEG‐nf conditions compared to the sham conditions, associated with significantly higher theta EEG power changes for channel F3. Temporal correlations between the FTA and fMRI activities of prefrontal, parietal, and occipital brain regions were significantly enhanced during the active EEG‐nf conditions compared to the sham conditions. Temporal correlation between theta EEG power for channel F3 and fMRI activity of the left dorsolateral prefrontal cortex (DLPFC) was also significantly enhanced. Significant active‐vs‐sham difference in fMRI activations was observed for the left DLPFC. Our results demonstrate that mechanisms of EEG‐nf training can be reliably evaluated using the counterbalanced active‐sham study design and simultaneous fMRI. EEG neurofeedback procedure for upregulation of frontal theta EEG asymmetry during cognitive tasks is evaluated using simultaneous fMRI and controlled via the counterbalanced active‐sham study design. EEG, fMRI, and EEG‐fMRI results in healthy participants suggest that the procedure can be effective for cognitive training to enhance executive function.

Cognitive training is an emergent approach to improve cognitive functions in various neurodevelopmental and neurodegenerative diseases. However, current training programs can be relatively lengthy, making adherence potentially difficult for patients with cognitive difficulties. Previous studies suggest that providing individuals with real-time feedback about the level of brain activity (neurofeedback) can potentially help them learn to control the activation of specific brain regions. In the present study, we developed a novel task-based neurofeedback training paradigm that benefits from the effects of neurofeedback in parallel with computerized training. We focused on executive function training given its core involvement in various developmental and neurodegenerative diseases. Near-infrared spectroscopy (NIRS) was employed for providing neurofeedback by measuring changes in oxygenated hemoglobin in the prefrontal cortex. Of the twenty healthy adult participants, ten received real neurofeedback (NFB) on prefrontal activity during cognitive training, and ten were presented with sham feedback (SHAM). Compared with SHAM, the NFB group showed significantly improved executive function performance including measures of working memory after four sessions of training (100min total). The NFB group also showed significantly reduced training-related brain activity in the executive function network including right middle frontal and inferior frontal regions compared with SHAM. Our data suggest that providing neurofeedback along with cognitive training can enhance executive function after a relatively short period of training. Similar designs could potentially be used for patient populations with known neuropathology, potentially helping them to boost/recover the activity in the affected brain regions. •Significantly improved EF test scores in the NFB group compared with SHAM•Reduced post-training activity in the prefrontal regions in NFB compared with SHAM•Targeted enhancement of executive functions using task-based neurofeedback training

Attention Deficit Hyperactivity Disorder (ADHD) is associated with poor self-control, underpinned by inferior fronto-striatal deficits. We showed previously that 18 ADHD adolescents over 11 runs of 8.5 min of real-time functional magnetic resonance neurofeedback of the right inferior frontal cortex (rIFC) progressively increased activation in 2 regions of the rIFC which was associated with clinical symptom improvement. In this study, we used functional connectivity analyses to investigate whether fMRI-Neurofeedback of rIFC resulted in dynamic functional connectivity changes in underlying neural networks. Whole-brain seed-based functional connectivity analyses were conducted using the two clusters showing progressively increased activation in rIFC as seed regions to test for changes in functional connectivity before and after 11 fMRI-Neurofeedback runs. Furthermore, we tested whether the resulting functional connectivity changes were associated with clinical symptom improvements and whether they were specific to fMRI-Neurofeedback of rIFC when compared to a control group who had to self-regulate another region. rIFC showed increased positive functional connectivity after relative to before fMRI-Neurofeedback with dorsal caudate and anterior cingulate and increased negative functional connectivity with regions of the default mode network (DMN) such as posterior cingulate and precuneus. Furthermore, the functional connectivity changes were correlated with clinical improvements and the functional connectivity and correlation findings were specific to the rIFC-Neurofeedback group. The findings show for the first time that fMRI-Neurofeedback of a typically dysfunctional frontal region in ADHD adolescents leads to strengthening within fronto-cingulo-striatal networks and to weakening of functional connectivity with posterior DMN regions and that this may be underlying clinical improvement. [Display omitted]