Neurocognitive Effects of Neurofeedback: A Systematic Review of the Applicability and Therapeutic Effect in Patients with Schizophrenia Spectrum Disorders, Psychosis or Clinical High Risks for Psychosis

Schizophrenia Spectrum Disorders are complex mental health conditions that significantly impact cognitive function and quality of life. While pharmacological and psychotherapeutic interventions are available, their effectiveness remains limited, particularly for negative symptoms and cognitive impairments. These limitations, alongside drug side effects and adherence difficulties, highlight the need for new treatments. Cognitive remediation strategies like Neurofeedback show promise by harnessing neuroplasticity. This systematic review aims to evaluate the neurocognitive and humoral changes induced by Neurofeedback and its therapeutic effects in patients with schizophrenia spectrum disorders. Our review was conducted following PRISMA guidelines. Databases including EMBASE, ScienceDirect, Scopus, PsycINFO, and MEDLINE were searched for relevant studies: 14 studies, 10 RCTs, and 4 Clinical trials were selected. Inclusion criteria encompassed studies involving patients with schizophrenia spectrum disorders, Neurofeedback interventions, and outcomes related to neurocognitive and humoral changes. The Cochrane Risk-of-Bias Tool for randomized trials (RoB 2) was used to assess the quality of included studies. The reviewed studies suggest that Neurofeedback shows promise in addressing various aspects of schizophrenia spectrum disorders. Improvements were observed in processing speed, social functioning, working memory, and emotional regulation. Several studies reported successful modulation of brain activity in regions associated with auditory hallucinations. Neurofeedback training also led to increased functional connectivity between language networks and the default mode network. Some studies found improvements in brain-derived neurotrophic factor (BDNF) levels, self-efficacy, and clinical symptoms in schizophrenia patients. Future research should focus on personalizing Neurofeedback approaches and exploring their mechanisms of action in the context of schizophrenia pathophysiology.