Does fMRI neurofeedback in the context of stress influence mood and arousal? A randomised controlled trial with parallel group design [version 2; peer review: 1 approved, 1 approved with reservations]

Background: Stress-related mental and physical health issues burden modern societies. New treatment opportunities could help to lessen long-term detrimental consequences of stress. Objective: To investigate whether real-time functional magnetic resonance imaging neurofeedback (rtfMRInf), aimed at modulating brain activity associated with a stressor, affects subjective mood and arousal. Methods: In total, 30 males participated in a randomised controlled trial with parallel-group design. rtfMRInf was the intervention, sham-neurofeedback the control condition, and the Stroop task the stressor. We instructed participants to modulate their stress response to the Stroop task via feedback from their anterior cingulate cortex and their insular cortex, concomitantly applying mental strategies. We assessed mood with the Multidimensional Mood State Questionnaire (dimensions: good/bad, GB; awake/tired, AT; and calm/nervous, CN), and subjective arousal with Self-Assessment Manikins (SAM). Results: We found significantly higher subjective arousal after neurofeedback phases in the experimental condition as compared to the control condition [t(26.6) = −2.216, 95%CI [−2.188,−0.083], p = 0.035; t(27.9) = −3.252, 95%CI [−2.685,−0.609], p = 0.003], but no significant differences between the conditions regarding mood [GB: b = 0.4, 95%CI [−0.67, 1.47], p = 0.467; AT: b = 0.769, 95%CI [−0.319, 1.857], p = 0.177; CN: b = 0.5, 95%CI [−0.53, 1.53], p = 0.352]. In both conditions, there was significantly worse and more tired mood after the fMRI session as compared to before [GB:b = −0.77, 95% CI [−1.31, 0.23], p = 0.009; AT: b = −0.652, 95%CI [−1.116,−0.187], p = 0.01]. Conclusions: Findings indicate that rtfMRInf led to higher arousal, which may counteract the aim to reduce stress responses. Whether the multitasking situation has triggered this neurofeedback-related arousal – and how to circumvent it – asks for further study. Trial registration: NCT01921088, ClinicalTrials.gov, 13th August 2013.