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

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 I 2 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.