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Real-Time fMRI Neurofeedback: How It Works, The Research, & Benefits

MRI (Magnetic Resonance Imaging) is a brain scanning technique that incorporates both magnetic fields and radio waves.  It is currently considered the most advanced form of neuroimaging technology and can be used to detect traumatic brain injuries, strokes, and/or tumors.  The MRI was invented in the early 1970s by Paul C. Laurterbur, but has since improved in resolution and processing speed since its earliest days; this trend is expected to continue with some projecting handheld-size MRI scanners by the late 2050s.

In recent years, some researchers have investigated the potential of devising MRI neurofeedback protocols to treat mental illness.  Neurofeedback is a process by which an individual gets feedback from a sensor or device telling them what is occurring within their brain, followed by learning to consciously correct faulty brain activity.  The most common type of neurofeedback is EEG neurofeedback, which involves hooking electrodes to a person’s scalp, determining brain wave abnormalities, and training a person to consciously correct them.

Since fMRI scanners are now capable of providing “real time” instantaneous feedback, researchers have investigated their potential for neurofeedback.  The goal of using real-time fMRI neurofeedback is to determine abnormal neural connectivity, and train the individual to change it by giving them feedback.  Preliminary evidence suggests that this technique could revolutionize treatment for mental illnesses such as: ADHD, anxiety, and depression.

What is real time fMRI neurofeedback?

Many researchers consider real time functional magnetic resonance imaging (rtfMRI) to be a cutting edge technology.  It allows experts to non-invasively analyze a person’s neural functioning in real time.  The technique has significant potential to be used for diagnosing diseases, monitoring the severity, and tracking efficacy of therapeutic interventions.

In addition to the aforementioned potential uses, real time fMRI scans can be utilized to correct faulty neural connectivity or activation that contributes to mental disorders.  As an example, let’s say that a person with OCD struggles with excessive “hand washing.”  A real time fMRI scan may suggest that the individual has an overactive right caudate nucleus.

A training protocol would then be devised to train a patient to decrease activation in this area, while possibly simultaneously increasing activation in another region.  When a patient successfully decreases activity in the problematic region, they receive positive feedback such as a “green light.”  When activity remains problematic, they may get either no feedback or see a “red light” signaling they’re off track.

Over time, a person can be trained to control unconscious processes within the brain such as the activation of certain neural correlates associated with a disorder.  The therapeutic potential of this technique is based on the concept of self-directed neuroplasticity or the brain’s ability to change itself.  While this intervention may not fully cure a person of their disease, it has significant potential to improve their ability to cope and/or function.

How Real Time fMRI Neurofeedback Works…

Real-time fMRI neurofeedback was invented in 1995.  It attempts to correct faulty neural activation and/or connectivity.  Below is a step-by-step description of how the process works.

1. Real time fMRI scan

A person will lie under a rtfMRI scanner so that experts can analyze their brain activity.  The scans will occur in real time and will allow researchers to determine how the brain functions in homeostasis.  The initial scan may not show any significant abnormalities in activation, but experts may have a general idea of how regional connectivity may be contributing to their disorder.

2. Determine neural abnormalities

Next, experts (e.g. neurologists) will attempt to pinpoint significant abnormalities in terms of regional activation.  While most people with a condition like arachnophobia tend to have the same regions of the brain activated when they think of spiders, it cannot be assumed that everyone’s brain activation is the exact same.  Therefore experts may “prime” the individual to envision, imagine, or think of a spider crawling on them.

They will then determine the areas of the brain (neural correlates) that are abnormally activated or deactivated.  The experts will likely notice significant changes in regional connectivity that are contributing to the arachnophobia.  Keep in mind that while there are likely general neural correlates associated with certain conditions (e.g. specific phobias), the rtfMRI scans allow experts to target individual-specific neural abnormalities as well.

3. Devising a protocol

Let’s say you suffer from extreme hoarding and a real-time fMRI scan revealed excess activity in your left precentral gyrus and right orbitofrontal cortex (the neural correlates of hoarding behavior).  Experts would then devise a neurofeedback protocol targeted to downtrain (decrease) activity in these regions and/or uptrain (increase) activity in other regions associated with non-hoarding behaviors.  The goal of the protocol would be to train you to consciously decrease activity in overactive problematic regions and possibly increase activity in other areas.

4. Use rtfMRI neurofeedback to train the brain

The devised protocol would be implemented within a computer program devised to give you feedback regarding regional activation.  You’d get scanned by a rtfMRI and the scans would communicate with a computer program, letting it know whether activity is increasing or decreasing in problematic areas.  If activity is decreasing in problematic areas, you may get feedback of a “green light” on a computer screen signaling that you’re doing the right thing.

If activity is increasing in problematic areas, you may see feedback of a “red light” on the computer program signaling that you’re doing the wrong thing.  It may take awhile for some people to figure out how to change their regional activation, but with enough training and feedback, eventually they get better at it.

5. Repeated practice

Just like learning how to ride a bike takes practice, so does changing the way your brain works.  If it is stuck in a faulty pattern of activation, it can take awhile to override the faulty connectivity with healthier patterns.  Some people may experience benefit from just one session of rtfMRI neurofeedback, but most people require several sessions to really get the hang of it.

With repeated practice, a person will eventually master the ability to consciously regulate an unconscious process (brain activity).  Assuming the correct neural correlates were targeted in the devised protocol, an individual should feel significantly better than before they started.  Reverting back to the “hoarding” example, a person properly trained with rtfMRI neurofeedback may no longer have the urge to hoard, or when they do, they can easily counteract it by consciously tuning down activity in the problematic region.

6. Learned ability to correct faulty neural activation

The practice of rtfMRI neurofeedback translates into a learned ability to regulate neural activity.  Some research suggests that this ability results in significant connectivity changes within the brain and strengthens activation associated with healthy brains.  With enough practice, a person learns a new skill that they can maintain – potentially over a long period of time.

The duration over which the learned ability to regulate neural activation lasts is unknown.  Preliminary evidence suggests that it may last longer than many people think.  In fact, some could argue that consistent, repetitive practice of an optimal training protocol may result in a permanent rewiring of the brain.

Real Time fMRI Neurofeedback (The Research)

Despite the fact that real-time fMRI was invented in 1995, little research had been conducted in early years in regards to neurofeedback.  In recent years there has been a growing interest in the therapeutic potential of real time fMRI neurofeedback and an increase in the number of studies.  As technology continues to improve in capacity and decrease in cost, research in the realm of rtfMRI neurofeedback will expand.

2015: A study published in 2015 tested whether real-time fMRI neurofeedback could manipulate region-specific brain activity.  Using real-time fMRI neurofeedback, researchers trained participants to control existing brain activity in regions associated with motor and memory functions.  They specifically targeted the supplementary motor area and parahippocampal cortex.

Participants learned how to voluntarily control these regions, and researchers noted specific behavioral changes including: reduced motor reaction times and improved ability to encode memories.  Authors of the study suggest that real-time fMRI neurofeedback has significant potential to improve cognitive efficiency.  They also note that the technique could train people to consciously increase activity in brain regions associated with a particular task to derive specific behavioral and/or cognitive outcomes.

This suggests that fMRI neurofeedback has potential to teach people how to control regional functioning within their brain.  They may be able to learn how to switch from activating areas of the brain associated with heightened concentration to activating areas of the brain associated with relaxation or motivation.  The uses of real-time fMRI neurofeedback are therefore not limited to correcting faulty circuitry, but may also be beneficial for increasing functional efficiency of healthy brains.

  • Source: http://www.ncbi.nlm.nih.gov/pubmed/25796342

2014: Advances in fMRI scans allow researchers to pinpoint tiny areas of neural activation the size of millimeters.  Researchers reported in 2014 that real-time fMRI neurofeedback studies have shown promise in teaching individuals to self-regulate these tiny areas of neural activation.  For example, a person could be taught how to change their emotional processing, language, motor control, or even perceptual experience with enough training.

In most real-time fMRI neurofeedback research, participants are trained to modulate one targeted area.  A new study was conducted in which researchers trained participants to modulate interhemispheric activity between the left and right visual cortex.  They were able to train participants to modulate interhemispheric activity by utilizing a training protocol devised to account for imbalances in activity between the left and right visual cortex.

Following the training, the participants were able to still maintain control over interhemispheric activity within the visual cortex.  Researchers suggest that this control may be beneficial for correcting psychological disorders associated with lateralization of activity.

  • Source: http://www.ncbi.nlm.nih.gov/pubmed/24904993

2014: One promising therapeutic application of rtfMRI neurofeedback is for the treatment of major depressive disorder.  Major depression is a growing epidemic with limited treatment options.  For this study, researchers recruited 21 individuals suffering from major depressive disorder that were not taking any medications.

Patterns of neural activation among those with major depressive disorder tend to differ from the norm.  A notable difference among those that are depressed is lack of amygdala activation when exposed to positive stimuli.  Researchers divided the 21 participants into 2 groups: one received rtfMRI neurofeedback designed to increase left-amygdala activation when exposed to positive stimuli, and the second received a sham treatment (targeting the intraparietal sulcus).

The participants that increased left-amygdala activation when exposed to positive stimuli experienced significant increases in happiness and decreases in anxiety ratings following the experiment.  The control group (receiving the sham) experienced no significant change in mood.  Post-training brain scans show that activity in the left superior temporal gyrus, temporal polar cortex, and right thalamus increased.

Authors concluded that this may be an effective intervention for the treatment of depression.  Other forms of EEG neurofeedback for depression have shown some promise, and perhaps the synergistic potential of fMRI and EEG neurofeedback may be superior to either as a standalone intervention for mood disorders.

  • Source: http://www.ncbi.nlm.nih.gov/pubmed/24523939

2014: Researchers conducted a study analyzing the effect of targeting the amygdala for the treatment of mood and anxiety disorders.  They suggested that the amygdala is often overactive and/or dysregulated among those with psychiatric conditions, but normalizes with proper therapeutic intervention.  Using real-time fMRI neurofeedback, researchers trained participants to decrease (downregulate) activity in the right amygdala while being confronted with a negative stimuli.

In this case, the negative stimuli used was “negative emotional faces” (e.g. an angry face).  Participants engaged in 4 rtfMRI neurofeedback training sessions, and were noted as having gained significant conscious control over their right amygdala.  A control group (passive viewing) didn’t gain this ability.  Results suggest that rtfMRI may have significant therapeutic potential for those with mood disorders.

  • Source: http://www.ncbi.nlm.nih.gov/pubmed/24241476

2014: Another study was conducted analyzing the effect of targeting the amygdala with rtfMRI neurofeedback to normalize brain activation among those with mood disorders.  Those with emotional disturbances tend to have either overactive or dysregulated activity in their amygdala.  With rtfMRI neurofeedback, it is possible to learn how to consciously regulate amygdala activity.

This study assigned 16 participants to receive rtfMRI neurofeedback targeting the amygdala while a control group of 32 participants targeted the basal ganglia.  All individuals were exposed to one training session of rtfMRI neurofeedback, and individuals learned how to modulate amygdala activity when exposed to aversive stimuli; the control group responded naturally to the pictures (without feedback).  Another test was conducted with no feedback to determine how well the participants learned to regulate their amygdala activity.

Results indicated that the group exposed to legitimate rtfMRI neurofeedback successfully learned to modulate right amygdala activity as a result of training.  Researchers theorize that learning to downregulate amygdala activity when exposed to aversive stimuli may help those with mood disorders.

  • Source: http://www.ncbi.nlm.nih.gov/pubmed/25278851

2014: A publication pointed out the fact that while many organizations are attempting to improve treatments for brain disorders, the development of new interventions is extremely slow.  This publication points out the potential of real-time fMRI neurofeedback as a novel intervention for those with psychiatric conditions.  Authors speculate that fMRI neurofeedback could be used for a variety of neurological disorders and increase comprehension of brain-behavior relationships.

They also point out that it could be used to correct personalized neural abnormalities; something I’ve always preached.  Clearly not everyone has the same neurophysiological footprint, even if they have the same “diagnosis” (e.g. depression).  Real-time functional MRI neurofeedback could significantly improve psychiatric treatment outcomes.

  • Source: http://www.ncbi.nlm.nih.gov/pubmed/25161891

2013: Researchers noted that the ability to self-regulate amygdala activity among healthy individuals during rtfMRI neurofeedback was associated with increased connectivity between the left amygdala and various regions of the prefrontal cortex.  The specific regions of the prefrontal cortex were analyzed and discussed for their role in the self-regulation process via rtfMRI neurofeedback.

They discovered that the rACC region helps modulate the amygdala and four other regions.  Authors note that the rACC played a significant role in processing and regulating emotion.  Due to the fact that the rACC region was able to modulate many processes, it may be a region to target along with the amygdala in those with mood disorders such as PTSD.  With continued usage of fMRI neurofeedback, researchers will get a better understanding of how the brain works.

  • Source: http://www.ncbi.nlm.nih.gov/pubmed/24223175

2013: Authors of a 2013 study suggested that most real-time fMRI neurofeedback has been limited to targeting a “region of interest” (ROI) or specific area of the brain.  In their study, they were able to devise a training protocol that expanded rtfMRI neurofeedback targets beyond one specific region.  To overcome this, they used a concept called “dynamic causal modeling” which allowed them to get feedback on connectivity between brain regions as opposed to activity from a single location.

The researchers used a visual-spatial attention model and demonstrated that participants could exert voluntary modulation of feedback signals based on connectivity between prespecified regions.  This new approach allows researchers to target entire brain networks for rtfMRI neurofeedback training rather than one region.

  • Source: http://www.ncbi.nlm.nih.gov/pubmed/23668967

2013: In this publication, researchers posit that fMRI neurofeedback may be advantageous over EEG neurofeedback for the fact that it resolution continues to improve.  MRI scans also allow researchers to attain clear imagery of cortical and subcortical brain regions.  Using an fMRI also may offer superior computer algorithmic protocols to EEG-based protocols for the optimization of brain activity (neuromodulation).

Researchers created an interface called “FRIEND” which acts as a user-friendly, graphic-oriented interface specifically for rtfMRI neurofeedback.  The FRIEND interface allows for real-time imagery, regionally-targeted feedback, and brain decoding-based feedback.  It should be thought that this advance in software for fMRI neurofeedback could help expedite research, especially since it is free for non-commercial use and open-source.

  • Source: http://www.ncbi.nlm.nih.gov/pubmed/24312569

2013: A report published in 2013 documented the first ever international conference on rtfMRI neurofeedback in Switzerland.  The conference was held at the Swiss Federal Institute of Technology.  Progress in the field of rtfMRI neurofeedback, debates, questions, and perspectives were shared at the gathering.  This report discussed possibilities for study designs, potential applications of the technology, and hypothesized future advancements.

  • Source: http://www.ncbi.nlm.nih.gov/pubmed/23541800

2012: In 2012, researchers discussed possible applications of real-time fMRI.  One of the suggested applications was incorporating rtfMRI to consciously alter neural patterns in the brain in the form of neurofeedback.  This allows an individual to manipulate regional activation within the brain using a non-invasive method.

Authors of this report document the concept of using rtfMRI to self-regulate brain activity and also to get a better understanding of functional processes within the brain.  This wasn’t an actual study using rtfMRI neurofeedback, but suggested that the technique may help us understand how activation or modulation of certain regions influences human behavior.

  • Source: http://www.ncbi.nlm.nih.gov/pubmed/21652587

1995: It wasn’t until 1995 that real-time fMRIs were invented.  Technology continued to improve since the 1970s and allowed for instantaneous neuroimaging in “real time.”  Since the 1990s, the abilities of fMRI have continued to improve in terms of resolution and magnification.  The study cited below describes the details of the fist rtfMRI set-up.

  • Source: http://www.ncbi.nlm.nih.gov/pubmed/7707914

Benefits of Real-Time fMRI Neurofeedback

There are many potential benefits and uses associated with real-time fMRI neurofeedback.

  • Brain-behavior relationship: By using rtfMRI neurofeedback, researchers can get a better understanding of brain-behavior relationships. In other words, they’ll get better at deciphering specific regions that may be responsible for various psychiatric and neurological disorders.  When activity in these regions is manipulated with rtfMRI neurofeedback, researchers will be able to study the behavioral outcomes.
  • Brain efficiency: There’s some evidence suggesting that one possible application of rtfMRI neurofeedback is to increase efficiency of the brain. In other words, someone may be able to train themselves to sustain activation of attention networks when they need to pay attention, and consciously shut them off when attention is no longer required.  This conscious control over brain regions would help people use their brains more efficiently rather than misdirect or overexert energy.
  • Conscious alterations: The concept behind neurofeedback is that changes in activity are made consciously. This means that a person is able to learn how to change the way their brain is working, giving their conscious mind control over a normally unconscious process.  Conscious modulation of brain circuitry or regional activation can be maintained for a long-term with proper training.
  • Cognitive enhancement: Those who want to enhance their cognitive prowess may want to consider fMRI neurofeedback. By determining specific neural correlates associated with heightened cognitive function, we can learn to strengthen activity in these regions “at will” with fMRI neurofeedback.  The potential of fMRI neurofeedback to strengthen activity within these regions may result in superhuman-esque ability.
  • Diagnostic tool: Currently there are limited ways to legitimately diagnose psychiatric conditions. While any person can subjectively report that they feel depressed, or cannot focus, there’s no definitive proof for these claims.  Real-time fMRI scans may show specific brain activity that can be used to diagnose a condition and determine those that fit legitimate diagnostic criteria vs. those that don’t.
  • Determining efficacy of treatments: Those taking psychiatric drugs like SSRIs for depression could end up feeling significantly worse from the treatment, to the point of experiencing increased depression and suicidality. To determine whether a treatment is making someone feel worse or getting a positive response from their medication, a real-time fMRI scan may provide definitive evidence.
  • Efficacy: While research involving rtfMRI neurofeedback is in early stages, preliminary results highlight significant efficacy. No long-term studies have yet been conducted, but the therapeutic responses have been significant in the studies that have been completed and published.  As of now there is no evidence suggesting lack of therapeutic efficacy for rtfMRI neurofeedback.
  • Lasting effect: There is preliminary evidence suggesting that fMRI neurofeedback may have a long-lasting therapeutic effect. In other words, once you’ve mastered how to modulate activity in a specific region or circuit, you gain a new skill.  With enough practice, it is thought that a person will have mastered the skill of regulating their brain activity; a skill that could be maintained for years (or life).
  • Low risk: There is minimal risk associated with fMRI neurofeedback assuming researchers are utilizing a therapeutic protocol. Theoretically the technique could be risky if there was an error in the protocol or computerized feedback programming algorithm. In this case, a person could theoretically worsen their condition.  Overall, neurofeedback side effects are thought to be minimal or nonexistent in most cases.
  • Mental disorders: The practice of rtfMRI neurofeedback has the potential to revolutionize treatment for mental and neurological disorders. As of now, the main treatments for severe mental disorders involve forms of psychotherapy and pharmaceutical agents.  Many fail to respond to either intervention.  Individuals struggling with addiction, attention deficit/hyperactivity disorder, anxiety disorder, chronic pain, depression, PTSD, and phobias – could derive significant therapeutic benefit from rtfMRI neurofeedback.
  • Motivation enhancement: Real-time fMRI neurofeedback could teach you how to consciously regulate motivation levels. Those that have suboptimal activation in areas of the brain such as the dorsal lateral habenula may have a tougher time summoning the motivation to work out or engage in physical exercise.  The ability to self-regulate motivation could help those with a variety of conditions and/or inherent motivational deficits.
  • Non-Invasive: The fact that fMRI neurofeedback is non-invasive is another plus. The technique can be used to correct abnormalities in activation without exerting exogenous force upon the brain.  There is no electrical shocking or force applied to the brain, you simply get feedback of how to consciously regulate internal processes.
  • Pathology assessment: To get a better understanding of pathology, the subtypes associated with a specific disorder, and understand the severity of a particular neuropsychological condition, real-time fMRI neurofeedback can be used. The real-time information will help us understand how the brain acts when severely affected by a disorder.
  • Personalized treatment: Since an fMRI is scanning your brain, researchers can determine specific regions that are likely to be causing a certain disorder or impairment. They will base this off of how normal brains look under real-time fMRI scans and compare those to the disordered brain.  It can then be determined which areas are most likely responsible for the disorder and train an individual to consciously correct them.
  • Synergistic potential: Those that derive therapeutic benefit from rtfMRI neurofeedback may find that the technique works synergistically with other interventions. For example, it could be used in conjunction with EEG neurofeedback to provide better results than either standalone intervention.  Additionally, it could work synergistically with certain medications (e.g. as an antidepressant augmentation strategy) for the treatment of various psychiatric conditions.
  • Targeting specific regions or circuits: The technique could be used to directly target specific brain regions for therapy. Targeting small regions (millimeters in size) or neural circuitry is a significant advance in the field of neuroscience.  In the past it was never contemplated that humans could exert volitional control over unconscious brain processes.
  • Understanding brain function: The practice of rtfMRI neurofeedback could help researchers get a better understanding of how the brain works. They will be able to distinguish healthy brains from those that are disordered and devise treatment strategies in effort to normalize disordered brains.
  • Wellness optimization: There’s potential that people will use rtfMRI neurofeedback in the future to optimize their wellness. Experts will be able to analyze a person’s brain activity and determine areas that could be targeted with rtfMRI neurofeedback training to improve their overall well-being.

What’s the difference between EEG and fMRI neurofeedback?

The main difference between EEG (electroencephalograph) neurofeedback and rtfMRI (real-time functional magnetic resonance imaging) neurofeedback is that the former focuses on brain waves, while the latter focuses on specific neural activation.  With EEG neurofeedback, the goal is to correct abnormal neuroelectrical activity in specified regions of the brain.

With rtfMRI neurofeedback, the goal is to modulate specific neural activation.  Both techniques have not been well-researched.  Some speculate that the potential for treating psychiatric conditions is greater for rtfMRI-based neurofeedback than EEG-based neurofeedback – despite the fact that efficacy of each technique has not been compared.

Could fMRI and EEG Neurofeedback be combined?

It is certainly plausible that rtfMRI neurofeedback could be used on a complementary basis with EEG neurofeedback or vice-versa.  In addition, some believe that the two technologies could theoretically be “combined” although this may prove difficult.  The rtfMRI would be able to provide information regarding: blood oxygen levels, neural activity, and connectivity.

The EEG would be able to determine electrical activity via electrodes placed on the scalp.  Due to the fact that rtfMRI neurofeedback remains very expensive, some have suggested combining both EEG with rtfMRI neurofeedback to cut costs.  This would allow researchers to match electrical activity associated with the QEEG signature to neural activation with the rtfMRI.

It is thought that the training could then be conducted with an EEG neurofeedback device rather than a rtfMRI neurofeedback device to target both brain waves and specific neural connectivity.  In theory, this is possible but may prove difficult due to the fact that EEG training may not precisely align with regional activations derived from the rtfMRI.  I’m somewhat skeptical regarding whether this would work, but it’s worth an attempt.

Would you try rtfMRI Neurofeedback?

If you’ve tried rtfMRI neurofeedback or would try it, be sure to share your thoughts in the comments section below.  Do you think that rtfMRI neurofeedback will prove to be an effective intervention for certain neuropsychological disorders?  It is clear that this technique has the ability to literally train the interworkings of the brain to work to our advantage.

The major challenges associated with rtfMRI will be establishing efficacy and reducing costs to make treatment more widely available.  Should the treatment prove efficacy for any condition, it may serve as perhaps the most neurologically-targeted and personalized form of treatment on the market; plus there won’t be significant risk of side effects.

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1 thought on “Real-Time fMRI Neurofeedback: How It Works, The Research, & Benefits”

  1. Thank you for sharing this new trend of treatment for mental illness! I have suffered from severe anxiety and major Depression most of my life! I would love to volunteer for any of these studies! Please let me know, one way or another, I can participate in this research? God Bless You! Sincerest Thanks,
    Respectfully Yours, Kathryn Winfrey.


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