Neurofeedback for Binge-Eating Disorder: Neurophysiological Outcome Predictors and Rapid Response

Pioneer studies suggested the effectiveness of food-specific electroencephalography (EEG) and real-time functional near-infrared spectroscopy (rtfNIRS) neurofeedback (NF) trainings in the treatment of binge-eating disorder (BED). These trainings aim to improve participants' neurophysiological self-regulation. However, pretreatment neurophysiological activity, a supposed key predictor of NF outcomes, remains unexplored.

This preregistered analysis (https://osf.io/xsrj3) used data from a randomized-controlled trial (DRKS00014752) on 47 adults (47 ± 13 years, 81% women) with interview-assessed BED having undergone food-specific EEG- or rtfNIRS-NF (12 sessions, over 8 weeks). Bayesian linear models explored pretreatment fronto-central high beta power (23-28 Hz; indicating increased attention) in EEG, pretreatment prefrontal oxygenation in fNIRS (indicating increased cognitive control), and rapid response (RR; early reductions in binge eating) as predictors of treatment outcomes reflecting mental and physical health at posttreatment and 6-month follow-up.

Higher high beta power during passive viewing of food pictures, lower high beta power, and less oxygenation during regulatory NF tasks, as well as RR predicted more favorable primary outcomes, including reduced objective binge-eating episodes and increased abstinence from binge eating. Overall, neurophysiological predictors-especially EEG activity-showed greater predictive value than RR.

The preliminary findings suggest the relevance of neurophysiological activity in the prediction of NF treatment outcomes in BED. While patients with increased involuntary attention in response to food stimuli profited most from EEG-NF, those with greater difficulties in voluntary recruitment of food-related cognitive control profited most from rtfNIRS-NF. The predictors identified could guide future treatment allocation and represent a first step toward more individualized therapy approaches.