Real-time fMRI neurofeedback reduces default mode network and auditory cortex functional connectivity in schizophrenia

ABSTRACT Background and Hypothesis Auditory verbal hallucinations (AHs) are a cardinal symptom of schizophrenia that can cause distress but are not always responsive to antipsychotic medications. There is a critical need to develop novel interventions that target neural mechanisms underlying AHs. We developed a real-time fMRI neurofeedback (NFB) paradigm for AHs that aims at modulating default mode network (DMN) functional connectivity. Study Design Patients with schizophrenia or schizoaffective disorders who were experiencing AHs ( N = 25) attempted to decrease brain activation while listening to sentences recorded in another person’s voice and increase brain activation while listening to sentences recorded in their own voice. Participants randomly assigned to the ‘real’ group ( n = 12) received neurofeedback based on signals from their auditory cortex in the superior temporal gyrus (STG) and those assigned to the ‘sham’ group ( n = 13) received neurofeedback based on motor cortex signals. Study Results Analyzing resting state fMRI data collected pre- and post-NFB, we found that: (1) at baseline, stronger within-DMN connectivity between the medial prefrontal cortex (MPFC) and posterior cingulate cortex was associated with higher AHs severity; (2) after NFB, participants in the real group, compared to those in the sham group, showed greater reduction in functional connectivity between the MPFC and auditory cortices in the STG and middle temporal gyrus (MTG). Notably, the reduction in MPFC-STG/MTG connectivity was found in all participants in the real group. Conclusions These findings suggest that NFB can effectively and non-invasively modulate functional connectivity in regions associated with AHs in psychosis.