Neurofeedback in Psychiatry: A Decade of Clinical and Neuroimaging Insights

Background Neurofeedback (NF) has emerged as a promising neuromodulation therapy in psychiatry, offering real-time feedback to help patients self-regulate brain activity. Over the past decade, NF applications across psychiatric disorders have been extensively studied. Objective We systematically reviewed NF research in psychiatry (2015–2025), including all study types, to evaluate clinical outcomes, mechanisms, training protocols, and neuroimaging findings in ADHD, depression, anxiety disorders, PTSD, and schizophrenia. Methods A comprehensive literature search identified clinical studies using EEG, fMRI, or other modalities. We included randomized trials, open-label studies, case series, and meta-analyses. Data on NF protocols, symptom outcomes, and neurophysiological measures were synthesized. Results Across disorders, NF was generally associated with symptom improvements. In ADHD, randomized trials and meta-analyses report moderate improvements in attention and impulsivity that often persist at follow-up. Depression studies using EEG and real-time fMRI show symptom reductions, though sample sizes remain modest. Anxiety-spectrum disorders, including PTSD, demonstrate significant symptom reductions, with meta-analytic effect sizes nearing one standard deviation. PTSD shows robust evidence, with a meta-analysis of 17 studies supporting sustained improvements. Schizophrenia studies suggest NF can reduce positive and negative symptoms, particularly using SMR and beta protocols. Neuroimaging confirms NF-induced brain activity and connectivity changes paralleling symptom improvements. Conclusions NF shows durable clinical benefits with minimal adverse effects, supporting its potential as an adjunctive treatment. However, methodological variability warrants further rigorous studies optimizing protocols, controls, and mechanistic investigations.