Exploring new frontiers in brain health and neuromodulation and their policy implications
What if you could train your brain to heal itself? This is the promise of neurofeedback (NF) and non-invasive individualized neuromodulation (iNM), which capitalize on real-time brain activity to improve and decelerate the pace of neurological and psychiatric disease. While the concept might sound like science fiction, recent advancements have made it a reality, and a newly published special journal issue of the Philosophical Transactions of the Royal Society, “Neurofeedback: New Territories and Neurocognitive Mechanisms of Endogenous Neuromodulation,” offers a deep dive into the evolving landscape of neuromodulation. I’ve highlighted some of the contributions in the issue and what it means for the field at large.
Individualized neuromodulation (iNM) for enhancing visuospatial perception
My lab explored how iNM can enhance visuospatial perception (i.e. the ability to navigate the environment, such as driving, throwing a ball, reading, and many others) by targeting specific brain regions associated with visual imagery, motor planning, and a new network we discovered, selective exteroceptive interoceptive attention. This research demonstrates measurable and quantified improvements by tailoring interventions to each patient’s unique brain structure and function. It presents an exciting opportunity to support cognitive health by decelerating age-related cognitive decline and optimizing mental performance in various fields, including athletics, where enhanced navigation and decision-making could improve outcomes. We aim to test these personalized interventions to patients with cortical blindness or early cognitive impairment, as it will fill a critical gap in effective, non-invasive treatments, enhancing patients’ quality of life while potentially reducing long-term healthcare costs. Developing policies to fund such precision medicine approaches will ensure equitable access to cutting-edge neurorehabilitation technologies and the integration of iNM into subsidized healthcare programs, such as Medicare.
Psychedelic-assisted neurofeedback
Dr. Enriquez-Geppert and colleagues examined the combination of psilocybin – a serotonergic psychedelic drug – and NF to target executive functions. Their research highlighted psilocybin’s potential to enhance neuroplasticity (i.e. the brain’s ability to change and adapt) with participants showing self-reported improvements in daily executive functions like working memory and inhibition. While there weren’t objective task-based gains observed, this novel integration of neuropharmacology and NF could pave the way for innovative therapeutic approaches by integrating psilocybin-assisted neurofeedback (NF) to enhance executive functions in individuals with psychiatric conditions. Its findings may catalyze larger-scale trials to validate the approach, potentially leading to new, targeted interventions for depression and anxiety.
Unlocking the brain’s inner workings
Dr. Weiskopf and colleagues discussed the challenges that would need to be overcome by implementing mesoscopic closed-loop fMRI NF at seven ultra-high fields. By aiming to target cortical columns and layers at sub-millimeter resolution, this technique holds the potential to transform our understanding of the brain’s functional organization with unparalleled precision. Future applications could range from refining neurofeedback targets to probing the complex cortical mechanisms involved in perception, cognition and disorders like psychosis, autism and neurodegenerative diseases. However, the empirical validation of mesoscopic closed-loop fMRI is still in its infancy. Significant challenges, like achieving reliable signal-to-noise ratios, overcoming computational hurdles and advancing acquisition and analysis methods, must be addressed before their full potential can be realized. Empirical validation and resource allocation will also be required to determine its use from the bench to the clinic.
How neurofeedback can change how we perceive and remember
Dr. Turk-Browne and colleagues used NF to manipulate memory coactivation in the hippocampus. Participants were trained to activate a “competitor” memory while viewing another object, effectively inducing integration between the two. This led to blurred distinctions both in behavioral tasks and neural patterns, revealing how memories can be combined by pruning unique features. By training participants to coactivate representations of competing memories, the study demonstrates that hippocampal integration can be achieved through direct manipulation of cortical activity. This work presents numerous positive implications for policy and future applications. Policymakers might consider frameworks to encourage the development of neurofeedback-based interventions for healthcare, such as treatments for PTSD, age-related memory decline, or stroke recovery while ensuring accessibility and affordability. Additionally, the approach has potential applications in education and occupational training, enabling personalized learning strategies that strengthen memory.
Bridging the lab-real world divide with accessible brain training
Dr. Sorger and colleagues highlighted the potential to transform NF by overcoming challenges in spatial specificity and signal quality, paving the way for innovative applications like multimodal brain training, wearable AI-driven NF and social interaction enhancement through hyperfeedback, which offers NF by requiring participants to jointly regulate the specific brain area. This process has the potential to enhance empathy and foster a sense of social connection among the participants. To fully realize its potential, policies should ensure rigorous clinical validation to establish safety and efficacy, paving the way for integration into healthcare systems and, in turn, increasing accessibility and affordability for stroke patients and individuals with ADHD. As advancements in AI, smartphone integration and hyperfeedback techniques expand its possibilities, thoughtful frameworks can foster equitable access while enabling fNIRS to transform neurofeedback into a scalable and impactful tool for personal and societal well-being.
Rewiring addiction: how real-time brain feedback tackles gaming disorder
Dr. Oka and colleagues explored how neurofeedback can help address gaming disorder by decoding and modifying attentional bias. Using fMRI and real-time brain decoding, the researchers identify the insula as a key player in tracking and altering attentional bias, offering a novel therapeutic approach called Decoded Attentional Bias Training (DecABT). This innovative technique provides “just-in-time” interventions that could reduce cravings and improve outcomes for gaming disorders and other addiction-related conditions. It will be important for policymakers to ensure safety and efficacy standards for clinical use, safeguard neural data privacy, and prevent misuse for profit-driven purposes such as curbing addiction but also potentially enhancing gaming engagement. Ethical dilemmas may arise around the potential overmedicalization of gaming behaviors and covert cognitive manipulation in non-therapeutic contexts. New regulatory frameworks will need to be developed, enhanced data privacy laws, and ethical guidelines to ensure responsible development and use of these powerful technologies. This work has the potential to revolutionize addiction treatment over the next five years by establishing a foundation for personalized, real-time interventions that address gaming disorder and other addictive behaviors while advancing our understanding of the neural mechanisms underlying attentional bias and its dynamic nature.
The ethics of influence – regulating neurofeedback in an evolving world
Furnari and colleagues argued for proactive regulation to address the risks posed by NF’s precision and persistence, which allow it to influence mental processes subtly and enduringly. The authors warn of potential misuse in economic and political decision-making, particularly when combined with AI-driven personalization, and critique the inadequacy of existing U.S. regulatory frameworks. They discuss the need for proactive regulation, research to measure NF’s influence, and legislation to safeguard cognitive liberty. Over the next five years, NF’s expanded accessibility, integration with AI, and ethical concerns about manipulation in political and commercial contexts are likely to accelerate regulatory and research efforts. This paper could catalyze discussions on “neurorights,” inform policy development, and drive interdisciplinary research, shaping the balance between innovation and safeguarding societal and individual autonomy.
The ethical balancing act
Dr. Ruiz detailed how Chile has already included neurorights in its constitution, recognizing the unique ethical considerations of brain neuromodulation technology. This has sparked critical debates about balancing innovation and protection in neurotechnologies. Key concerns include the risk of overregulation stifling innovation and clinical treatments, particularly in vulnerable populations like those unable to provide consent, and the ambiguity in defining concepts such as “mental privacy” and “cognitive freedom.” Critics argue that fear-driven legislation, fueled by neurohype, may lead to premature laws based on speculative risks rather than scientific realities. Chile’s experience highlights the need for precise, evidence-based policies to prevent harm to scientific progress while safeguarding human rights. Ultimately, international collaboration and clear distinctions between moral values and enforceable rights are essential for addressing the ethical, legal, and societal implications of neurotechnologies. As this field continues to evolve, these discussions are critical to ensure that innovation aligns with the best interests of patients and society.
The future of brain health
As neuroscientists, psychiatrists, neuroengineers, and neurologists continue to refine NF and iNM technology and explore new applications, the possibilities seem endless. From managing cravings and improving emotion regulation to addressing chronic pain, attention deficit hyperactivity disorder, obsessive-compulsive disorder, treatment-resistant depression, chronic post-traumatic stress disorder and fostering neuroplasticity for brain health, NF and iNM offer a transformative potential across a diverse range of conditions.
This special issue demonstrates that NF and iNM are more than a therapeutic tool – they are a window into understanding how the brain functions and adapts. By combining advanced neuroimaging, machine learning, and individualized approaches, researchers are shaping a future where the brain’s resilience is harnessed to heal itself. At its core, this work isn’t just about advancing science – it’s about giving patients new options and effective treatment options without the burden of side effects. And that’s something worth celebrating.
By Dr. T. Dorina Papageorgiou, assistant professor of psychiatry, neuroscience, physical medicine and rehabilitation at Baylor College of Medicine, Principle Investigator, Investigational Targeted Brain Neurotherapeutics Laboratory, and Adjunct Assistant Professor, Electrical and Computer Engineering, Rice Neuroengineering Initiative, Rice University
