A Meta-analysis of Randomized Controlled Trials of Functional Magnetic Resonance Imaging Neurofeedback for Training of Attention and Related Cognitive Functions

Abstract

Objective This meta-analysis investigated the effects of functional magnetic resonance imaging neurofeedback (fMRI-NF) on inattention and cognitive dysfunctions. Methods Using the keywords “fMRI neurofeedback” and “attention,” randomized controlled trials were identified from major electronic databases from inception to June 2024. Outcomes were expressed as standardized mean differences (SMDs) with 95% confidence intervals (CIs). Results Five studies including 214 participants (mean age = 16.8 years) were analyzed. The median number of fMRI-NF sessions was four (range 3−15), and the median follow-up duration was three weeks (range 1−10 weeks). Stimulation sites included the right inferior frontal gyrus (n = 2), right anterior insular cortex (n = 1), dorsal anterior cingulate cortex (n = 1), and an individualized approach (n = 1). The primary analysis showed no significant difference in inattention improvement between the fMRI-NF and control groups (SMD = 0.17, 95% CI −0.15 to 0.49, p = 0.30; four studies, 153 participants). Secondary outcomes also showed no significant intergroup differences, including vigilance (SMD = 0.08, 95% CI −0.49 to 0.65, p = 0.79), inhibition (SMD = −0.68, 95% CI −2.11 to 0.74, p = 0.35), and processing speed (SMD = −0.56, 95% CI −1.38 to 0.27, p = 0.19). Heterogeneity was greater for the secondary outcomes than for the primary outcome, with I2 values of 49% for vigilance, 90% for inhibition, and 79% for processing speed, compared with 0% for the primary outcome. Conclusion Given the limited evidence available to date, current evidence remains insufficient to draw robust conclusions regarding the therapeutic effectiveness of fMRI-NF.