A Systematic Review of the Potential Use of Neurofeedback in Patients With Schizophrenia

Abstract

Schizophrenia (SCZ) is a neurodevelopmental disorder characterized by positive symptoms (hallucinations and delusions), negative symptoms (anhedonia, social withdrawal) and marked cognitive deficits (memory, executive function, and attention). Current mainstays of treatment, including medications and psychotherapy, do not adequately address cognitive symptoms, which are essential for everyday functioning. However, recent advances in computational neurobiology have rekindled interest in neurofeedback (NF), a form of self-regulation or neuromodulation, in potentially alleviating cognitive symptoms in patients with SCZ. Therefore, we conducted a systematic review of the literature for NF studies in SCZ to identify lessons learned and to identify steps to move the field forward. Our findings reveal that NF studies to date consist mostly of case studies and small sample, single-group studies. Despite few randomized clinical trials, the results suggest that NF is feasible and that it leads to measurable changes in brain function. These findings indicate early proof-of-concept data that needs to be followed up by larger, randomized clinical trials, testing the efficacy of NF compared to well thought out placebos. We hope that such an undertaking by the field will lead to innovative solutions that address refractory symptoms and improve everyday functioning in patients with SCZ.

Psychotherapy in the Framework of Embodied Cognition—Does Interpersonal Synchrony Influence Therapy Success?

“…On the other hand, neurofeedback is already being applied and established in some fields of psychotherapy such as ADHD [see for example Enriquez-Geppert et al ( 82 ), Marx et al ( 70 ), and van Doren et al ( 74 )] and schizophrenia [see for example Gandara et al ( 83 ) and Surmeli et al ( 84 )]. Future research will show whether the framework of embodied cognition and its signatures both in the body and in the brain can help to improve psychotherapy.…”

Recent findings on neurofeedback training for auditory hallucinations in schizophrenia

“…BOLD signal, event-related potential/field, and components and/or frequency domains), and activity status (evoked or spontaneous/resting) are crucial as they can impact the overall direction of the NFB strategy and its effectiveness. In particular, spontaneous oscillatory activity (EEG/MEG) and connectivity (EEG/MEG/fMRI) that are related to AVH seem to be new targets for suppressing AVH [ 21 , 23 , 24 ]. The design of the NFB experiment (e.g.…”

“…Novel computational neuroscience approaches may shed light on such real-time computations of complex brain networks [ 9 , 56 , 57 ]. Furthermore, given the limited efficacy of the above small sample studies as well as some negative findings in NFB trainings [ 21 , 47 ▪ , 58 ▪ ], additional randomized controlled trials (RCTs) with larger samples are essential to ensure the effectiveness of NFB as a widely implemented therapeutic intervention for treatment-resistant AVH [ 58 ▪ ]. There is also the issue of cost-effectiveness.…”

“…There has been dramatic progress with the advent of functional MRI (fMRI), high-performance digital EEG systems, and magnetoencephalography (MEG) [ 18 – 20 ]. Most recent studies using NFB in patients with schizophrenia have predominantly been conducted using fMRI-NFB systems and have shown some degree of effectiveness [ 21 ]. However, EEG and MEG have a clear advantage in regard to temporal resolution in the order of milliseconds, which is crucial for real-time NFB [ 20 , 22 ].…”

Improving Clinical, Cognitive, and Psychosocial Dysfunctions in Patients with Schizophrenia: A Neurofeedback Randomized Control Trial

“…Looking for new, more effective methods of treatment and rehabilitation of schizophrenia, systematic attempts are being made to use neurofeedback (NF) [ 11 ]. NF, by allowing patients to perceive and response actively, creates brain stimulation as the cognitive target.…”