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Updated: Sep 9, 2025
A Protocol for the Administration of Real-Time fMRI Neurofeedback Training
Published on: August 24, 2017
Real-time fMRI neurofeedback modulates auditory cortex activity and connectivity in schizophrenia patients with
Clemens C C Bauer1, Jiahe Zhang2, Francesca Morfini2
1Department of Psychology, Northeastern University, Boston, MA 02115, USA; Department of Brain and Cognitive Sciences and McGovern Institute for Brain Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA; Department of Psychiatry, Harvard Medical School, Boston, MA 02115, USA; Center for Precision Psychiatry, Massachusetts General Hospital, Boston, MA, 02114, USA.
Background And Hypothesis:
Auditory hallucinations (AHs) affect 60-80 % of schizophrenia patients and often resist antipsychotic treatment. AHs involve superior temporal gyrus (STG) hyperactivity and disrupted auditory-cognitive control connectivity. Real-time fMRI neurofeedback (NFB) enables voluntary modulation of targeted brain regions. We previously showed STG-targeted NFB with mindfulness meditation reduced STG activation and AHs in one session. However, whether effects are specific to hallucination-related regions versus placebo, and whether NFB modulates broader networks, remained unclear.
Study Design:
This randomized, sham-controlled trial examined NFB specificity and network effects. Twenty-three adults with schizophrenia/schizoaffective disorder and medication-resistant hallucinations practiced mindfulness meditation while receiving neurofeedback from either STG (n = 10, Real-NFB) or motor cortex (n = 13, Sham-NFB control). Sham participants subsequently received Real-NFB, providing within-subject comparison.
Study Results:
Both groups showed reduced AHs post-NFB without group differences. However, compared to Sham-NFB, Real-NFB produced greater reductions in secondary auditory cortex activation and connectivity between auditory cortex and cognitive control regions (dorsolateral prefrontal cortex and anterior cingulate). These connectivity reductions persisted in the Real-after-Sham condition. Both groups showed reduced primary auditory cortex activation, suggesting mindfulness meditation independently regulates bottom-up hallucination processes.
Conclusions:
Region-specific NFB targeting produces distinct neural changes beyond symptom reduction. STG-targeted NFB differentially modulates auditory-cognitive control networks, potentially restoring the disrupted balance between bottom-up sensory processing and top-down control in AHs. These findings highlight the importance of anatomically-informed NFB targets and provide mechanistic insights for developing precision interventions for treatment-resistant psychiatric symptoms.
