Neurofeedback training in major depressive disorder: a systematic review of clinical efficacy, study quality and reporting practices

Abstract

Major depressive disorder (MDD) is the leading cause of disability worldwide. Neurofeedback training has been suggested as a potential additional treatment option for MDD patients not reaching remission from psychopharmacology and psychotherapy. Here we systematically reviewed neurofeedback studies employing electroencephalography, or functional magnetic resonance-based protocols in depressive patients. From a total of 585 screened studies, 24 were included in our final sample (N=480 patients in experimental and N=194 in the control groups completing the primary endpoint). We evaluated the clinical efficacy across studies and explored its relationship with the number of sessions as a potential proxy for a dose-effect response. We also attempted to group studies according to the control condition categories currently used in the field that affect clinical outcomes in group comparisons. In most studies, MDD patients showed symptom improvement superior to the control group(s). However, most articles did not comply with the most stringent study quality and reporting practices. We conclude with recommendations on best practices for experimental designs and reporting standards for neurofeedback training.

Biofeedback in Clinical Psychology: Modalities and Perspectives

“…Moreover, neurofeedback training by fNIRS is also recent and has been applied to treat depression [46] and improve cognitive performance [47]. It has the advantage of being more accessible, as it involves simpler equipment and less medical environment compared to rt-fMRI.…”

Optimizing spatial specificity and signal quality in fNIRS: an overview of potential challenges and possible options for improving the reliability of real-time applications

“…On the other hand, NFB focuses on self-regulation of brain activity by providing feedback through sensory cues with the aim of improving cognitive function or alleviating symptoms (Sitaram et al, 2017;Marzbani et al, 2016;Kohl et al, 2020;Soekadar et al, 2021). NFB is widely used in clinical settings to treat conditions such as ADHD (e.g., Hudak et al, 2018;Rubia et al, 2021), anxiety (e.g., Kimmig et al, 2019;Linhartová et al, 2019;Lipp and Cohen Kadosh, 2020), depression (e.g., Trambaiolli et al, 2021), stroke (e.g., Sanders et al, 2022;Rieke et al, 2020;González Méndez et al, 2022), and Parkinson's disease (e.g., Subramanian et al, 2011;Subramanian et al, 2016;Mehler, 2022).…”