The Impact of Neurofeedback on Schizophrenia: Managing Positive and Negative Symptoms

Schizophrenia, affecting nearly 1% of the global population, is a complex mental health disorder marked by positive symptoms (hallucinations, delusions) and negative symptoms (apathy, emotional withdrawal). While antipsychotic medications remain the standard treatment, up to 50% of patients continue to experience persistent symptoms. Against this backdrop, neurofeedback (NF)—a technique that enables individuals to self-regulate their brain activity—is drawing growing interest for managing the challenging symptoms of schizophrenia.

This systematic review investigates the effectiveness of neurofeedback in schizophrenia, evaluating its impact on both positive and negative symptoms. The authors examined 13 studies that used various NF modalities, including EEG and real-time functional MRI (fMRI), aiming to help patients modulate brain activity linked to key symptoms. The review presents promising findings, while also emphasizing the need for further research to refine and validate neurofeedback protocols for clinical use.

Methods

Researchers conducted an in-depth review following PRISMA guidelines, searching multiple databases up to April 2023 to identify relevant studies. They focused on studies assessing the effects of neurofeedback on schizophrenia, particularly targeting improvements in positive and negative symptoms. Thirteen studies were included, comprising 279 participants (209 with schizophrenia and 70 controls) from various regions, including Europe, the U.S., and Asia.

Each study applied different neurofeedback techniques—primarily EEG and functional MRI (fMRI), but also hemoencephalography (HEG) and functional near-infrared spectroscopy (fNIRS). EEG neurofeedback aimed to train patients to regulate their brainwave patterns, while fMRI protocols provided real-time feedback from brain areas involved in emotional and cognitive processing. Most studies were small-scale, including case reports and single-group studies, underscoring the need for more rigorous clinical trials.

Results

Overall, the studies suggest that neurofeedback can produce measurable changes in brain function and reduce both positive and negative symptoms of schizophrenia. Key findings include:

• EEG Neurofeedback: Several studies using EEG neurofeedback reported improvements in emotional regulation and symptom severity. For example, one study showed significant symptom reduction in 51 patients following EEG training. Other studies indicated that targeting specific EEG bands (such as alpha and theta) enhanced attention and mood regulation.

• fMRI Neurofeedback: Five studies employed fMRI neurofeedback, often targeting brain areas like the anterior cingulate cortex (ACC) or superior temporal gyrus (STG), which are associated with emotional processing and auditory hallucinations. Patients demonstrated improved self-regulation of these regions, resulting in reductions in hallucination severity and better emotion recognition. While effective, fMRI neurofeedback faces challenges due to cost and limited accessibility.

• HEG and fNIRS Neurofeedback: Although less commonly used, HEG and fNIRS studies also reported beneficial effects on cognitive deficits and symptom severity. For example, fNIRS neurofeedback targeting auditory areas led to reduced auditory hallucinations, suggesting a promising approach for managing difficult-to-treat symptoms.

Despite these positive results, the review also highlighted some limitations, including small sample sizes and methodological variability, which limit the generalizability of the findings.

Brendan’s Perspective

The results suggest that neurofeedback may offer a promising complementary treatment for schizophrenia, especially in addressing aspects of the disorder that standard medications struggle to manage. In practice, neurofeedback could provide patients with a new tool to better regulate symptoms such as auditory hallucinations or emotional blunting.

Neurofeedback can empower patients with a sense of control over their symptoms, reducing their reliance on medication alone. Those with persistent symptoms—especially negative ones—might benefit from this non-invasive technique that actively involves them in their recovery journey. The variety of available neurofeedback methods, such as EEG and fMRI, offers flexibility to tailor treatment to individual needs, although practical implementation may be constrained by access to equipment and trained professionals.

Given the limited efficacy of standard pharmacological treatments—particularly for negative symptoms—neurofeedback presents a compelling alternative. EEG and fMRI-based NF treatments target brain areas involved in cognitive and emotional deficits, opening up new intervention pathways that could complement existing therapies. While neurofeedback is not yet widely available or fully accepted in mainstream medical settings, it shows potential for driving meaningful changes in cognitive function, social engagement, and overall quality of life. A multidisciplinary approach incorporating NF could further enhance treatment outcomes, although larger clinical trials are crucial to establish its efficacy.

This review supports the idea that specific, individualized neurofeedback protocols could be beneficial in treating schizophrenia. Many protocols targeted deviations in alpha and theta activity based on qEEG evaluations, and were associated with symptom reductions—suggesting these protocols can be adapted to individual brain patterns. fMRI neurofeedback targeting anterior cingulate cortex (ACC) activation showed benefits for emotional regulation and cognitive function, offering a relevant protocol for practitioners working with patients with predominant cognitive and negative symptoms. Meanwhile, the efficacy of HEG and fNIRS in improving cognitive control merits further exploration, given their potential for shorter training durations and lower technical demands.

Conclusion

Current research suggests that neurofeedback offers hope for individuals with schizophrenia, and large-scale randomized controlled trials (or other suitable designs for this type of intervention) are essential to confirm its effectiveness. Future studies should prioritize robust methodologies to better demonstrate NF’s clinical utility. Additionally, exploring hybrid approaches that combine multiple NF modalities or integrate NF with standard therapies could optimize treatment protocols for broader use.

Ultimately, as neurofeedback technologies continue to evolve, they may become a valuable component of schizophrenia care—providing a non-pharmacological option that directly engages brain function. This research highlights the possibility of a more holistic, brain-centered, and human-centered treatment approach, one that could better serve patients with treatment-resistant schizophrenia symptoms.

Reference

Kakeri, F., Teimouri, M., Davarinezhad, O., Omidi, R., & Yazdani, M. (2024). The Efficacy of Neurofeedback Treatment on Positive and Negative Symptoms in Schizophrenia: A Systematic Review. Tabari Biomedical Studies and Research Journal, 6(3), 74–85. https://doi.org/10.22034/6.3.74