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Clinical applications of real-time FMRI neurofeedback training – premises, promises, and pitfalls

Mehler, David 2018. Clinical applications of real-time FMRI neurofeedback training – premises, promises, and pitfalls. PhD Thesis, Cardiff University.
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Neurofeedback training represents a form of biofeedback training with a history of over 50 years. During neurofeedback training participants aim to gain control over a feedback signal that represents the activity of a brain region or network of interest. As such, it holds promise for clinical translation as an add-on treatment for psychiatric and neurological conditions. Yet, currently available evidence for its therapeutic efficacy remains limited. Originally provided based on cortical signals measured with electroencephalography (EEG), methodological developments have allowed providing neurofeedback based on (cortical and subcortical) brain signals acquired from functional magnetic resonance imaging (fMRI). The aim of this thesis was to test the feasibility and clinical efficacy of fMRI neurofeedback (fMRI-NF) training in a psychiatric population and to develop protocols that allow translating the technique to motor rehabilitation. Specifically, this thesis summarises the clinical and neuroimaging results from a randomised controlled trial conducted in patients suffering from depression. Depression represents a leading cause of disability in adults and epidemiological data indicates that up to one third of patients remain depressed after treatment. Another focus was the development of a motor imagery-based fMRI-NF protocol in healthy participants. This work has informed a proof-of-concept study for motor rehabilitation in stroke survivors, for which the methodology was preregistered on a public platform before data collection started to increase transparency. The thesis aims to address problematic research practices that have been attributed to the replication crisis in many areas of science, including a clear separation of planned and exploratory hypotheses and the use and adaptation of alternative statistical methods. A review chapter discusses potential electrophysiological target signatures for EEG-NF to improve motor symptoms in Parkinson’s disease patients. The thesis concludes with a discussion of current premises, promises, and pitfalls in clinical applications of neurofeedback training and considerations for clinical trials development.

Item Type: Thesis (PhD)
Date Type: Submission
Status: Unpublished
Schools: Cardiff University Brain Research Imaging Centre (CUBRIC)
Subjects: B Philosophy. Psychology. Religion > BF Psychology
Funders: NISCR
Date of First Compliant Deposit: 23 November 2018
Last Modified: 29 Mar 2021 15:43

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