Auditory hallucinations in schizophrenia are linked to overactivity and hyperconnectivity in the default mode network and reduced anticorrelation with the central executive network. Patients were trained with real-time fMRI neurofeedback and meditation strategies to modulate these networks. The intervention reduced default mode network hyperconnectivity and increased anticorrelation between the default mode and central executive networks. Changes in individual default mode network connectivity correlated with reductions in auditory hallucination frequency and severity. This provides the first empirical evidence that meditation-enhanced neurofeedback can directly alter resting state network activity and reduce auditory hallucinations.
Auditory hallucinations affect 60-80% of schizophrenia patients and often resist antipsychotic treatment. This randomized, sham-controlled trial tested whether real-time fMRI neurofeedback targeting the superior temporal gyrus, combined with mindfulness meditation, produces specific neural changes beyond placebo. Twenty-three adults with medication-resistant hallucinations practiced mindfulness meditation while receiving neurofeedback from either the superior temporal gyrus or motor cortex. Both groups reported reduced hallucinations after neurofeedback, with no group differences in symptom reduction. However, real neurofeedback produced greater reductions in secondary auditory cortex activation and connectivity between auditory cortex and cognitive control regions (dorsolateral prefrontal cortex and anterior cingulate), which persisted in a crossover condition. Mindfulness meditation independently reduced primary auditory cortex activation. Region-specific neurofeedback targeting modulates auditory-cognitive control networks, potentially restoring the balance between bottom-up sensory processing and top-down control.