The Combined Effectiveness of Neurofeedback and Complementary or Neuromodulatory Therapies on Adult Mental Health: A Systematic Review

Brain Res Bull. 2025 Nov 6:111623. doi: 10.1016/j.brainresbull.2025.111623. Online ahead of print.

ABSTRACT

BACKGROUND: Neurofeedback (NFB) shows promise as a non-invasive intervention for mental health. Whether combined with complementary (cognitive-behavioral therapy, mindfulness) or neuromodulatory approaches (tDCS, rTMS) enhances efficacy remains unclear.

OBJECTIVE: Synthesize empirical evidence on NFB combined with complementary and neuromodulatory therapies for adult mental health.

METHODS: Systematic review following PRISMA guidelines and PROSPERO registration (CRD42024604765). Searches of PubMed, Web of Science, Scopus, and Cochrane Library through April 2025.

INCLUSION: quantitative empirical studies combining NFB with complementary or neuromodulatory approaches in adults ≥18 years. Qualitative synthesis organized by intervention subtype.

RESULTS: Twenty-one studies met inclusion criteria. Among 18 with extractable sample size data, 77.8% enrolled <30 participants (median N=20.5). Among 15 with extractable duration, most interventions lasted ≤8 weeks; four included follow-ups ≥12 weeks, with one extending to 6 and 12 months. NFB combined with CBT or mindfulness showed preliminary improvements in depression, anxiety, and stress (p<.05-.001). Music adjuncts showed no additive benefit. tDCS and rTMS remain preliminary. All 21 studies reported positive findings. Universal absence of null or negative results, combined with small samples and short follow-up, suggests potential publication and selective reporting bias.

CONCLUSION: NFB with CBT or mindfulness shows preliminary signals warranting further investigation, particularly for depression and anxiety. However, current evidence-constrained by small samples, short follow-up, and potential publication bias-is insufficient for clinical recommendation. Large-scale, blinded, durability-focused trials with standardized protocols and dismantling designs are required before clinical implementation.

PMID:41205711 | DOI:10.1016/j.brainresbull.2025.111623