Neurofeedback interventions for obsessive-compulsive and related disorders: Current evidence and future directions

Area of Science:

• Neuroscience
• Psychiatry
• Neuromodulation

Background:

• Obsessive-compulsive and related disorders (OCRDs) present significant treatment challenges, with many patients showing insufficient response or relapse with conventional therapies.
• Neurofeedback (NF) is an emerging non-invasive neuromodulation technique allowing real-time self-regulation of neural activity.
• Current NF applications in obsessive-compulsive disorder (OCD) show potential but are limited by target heterogeneity and modest clinical effects.

Purpose of the Study:

• To review existing empirical evidence of neurofeedback (NF) for obsessive-compulsive and related disorders (OCRDs).
• To highlight decoded neurofeedback (DecNef) as a potential next-generation NF method for OCRDs.
• To discuss how DecNef can overcome limitations of traditional NF and its translational applications.

Main Methods:

• A narrative review synthesizing empirical evidence from neurofeedback (NF) studies in OCRDs.
• Analysis of conventional electroencephalogram-based (EEG-NF) and functional magnetic resonance imaging-based (fMRI-NF) protocols.
• Exploration of decoded neurofeedback (DecNef) principles, including multivoxel pattern analysis for reinforcing neural representations.

Main Results:

• Conventional EEG-NF and fMRI-NF have demonstrated patients' ability to regulate brain activity, with some reporting symptom improvements in OCD.
• Limitations such as target heterogeneity, lack of personalization, and modest clinical outcomes hinder the efficacy and scalability of current NF methods.
• DecNef offers enhanced precision and personalization by leveraging distributed neural representations, potentially enabling interventions without explicit symptom exposure.

Conclusions:

• Neurofeedback (NF) is a promising neuromodulation strategy for OCRDs, but traditional methods face limitations.
• Decoded neurofeedback (DecNef) represents a significant advancement, offering greater precision and personalization for circuit-level interventions.
• DecNef holds potential for broader translational applications across the OCRD spectrum, advancing precision psychiatry for these conditions.