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Review
. 2021 Sep;58(9):e13874.
doi: 10.1111/psyp.13874. Epub 2021 Jun 12.

EEG-neurofeedback and executive function enhancement in healthy adults: A systematic review

Giada Viviani  1 , Antonino Vallesi  1   2
Affiliations
Review

EEG-neurofeedback and executive function enhancement in healthy adults: A systematic review

Giada Viviani et al. Psychophysiology. 2021 Sep.

Abstract

Electroencephalographic (EEG)-neurofeedback training (NFT) is a promising technique that supports individuals in learning to modulate their brain activity to obtain cognitive and behavioral improvements. EEG-NFT is gaining increasing attention for its potential "peak performance" applications on healthy individuals. However, evidence for clear cognitive performance enhancements with healthy adults is still lacking. In particular, whether EEG-NFT represents an effective technique for enhancing healthy adults' executive functions is still controversial. Therefore, the main objective of this systematic review is to assess whether the existing EEG-NFT studies targeting executive functions have provided reliable evidence for NFT effectiveness. To this end, we conducted a qualitative analysis of the literature since the limited number of retrieved studies did not allow us meta-analytical comparisons. Moreover, a second aim was to identify optimal frequencies as NFT targets for specifically improving executive functions. Overall, our systematic review provides promising evidence for NFT effectiveness in boosting healthy adults' executive functions. However, more rigorous NFT studies are required in order to overcome the methodological weaknesses that we encountered in our qualitative analysis.

Keywords: brain oscillatory activity; electroencephalogram; executive functions; neurofeedback training; task-switching; working memory.

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Figures

FIGURE 1
FIGURE 1
PRISMA flow diagram of the studies screened, assessed for eligibility and included in the review
FIGURE 2
FIGURE 2
Risk of bias assessment with ROBINS–I (Sterne et al., 2016). The risk ok bias of each study in the seven domains was evaluated and then the overall risk of bias judgment was formulated. Notes: D1, bias due to confounding; D2, bias in selection of participants into the study; D3, bias in classification of interventions; D4, bias due to deviations from intended interventions; D5, bias due to missing data; D6, bias in measurement of outcomes; D7, bias in selections of the reported results; green, low risk of bias; yellow, moderate risk of bias; orange, serious risk of bias; red, critical risk of bias. * = Studies with older adults only
FIGURE 3
FIGURE 3
Assessment of neurofeedback training (NFT) protocol quality with CRED–nf checklist (Ros et al., 2020). We assessed whether the included studies satisfied the criteria for well‐designed NFT protocols by answering with “yes” or “no” to each essential item. Y, yes; N, no; *, studies including older adults only
FIGURE 4
FIGURE 4
Comparison of the percentages of success ratio (SR) for the three neurofeedback training (NFT) protocols, divided into different ages (younger adults and older adults). Success ratio was calculated as the number of successful studies out of the total number of studies included in each protocol type
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