Real-time fMRI and its application to neurofeedback.

Real-time fMRI (rtfMRI) allows immediate access to experimental results by analyzing data as fast as they are acquired. It was devised soon after the inception of fMRI and has undergone a rapid development since then. The availability of results during the ongoing experiment facilitates a variety of applications such as quality assurance or fast functional localization. RtfMRI can also be used as a brain-computer interface (BCI) with high spatial resolution and whole-brain coverage, overcoming limitations of EEG based BCIs. This review will focus on the application of rtfMRI BCIs to neurofeedback, i.e., the online feedback of the blood oxygen level dependent (BOLD) response. I will motivate its development and place its beginnings into the contemporary scientific context by providing an account of our early work at the University of Tübingen, followed by a review of the accomplishments and the current state of rtfMRI neurofeedback. RtfMRI neurofeedback has been used to train self-regulation of the local BOLD response in various different brain areas and to study consequential behavioral effects. Behavioral effects such as modulation of pain, reaction time, linguistic or emotional processing have been shown in healthy and/or patient populations. RtfMRI neurofeedback presents a new paradigm for studying the relation between brain behavior and physiology, because the latter can be regarded as the independent variable (unlike in conventional neuroimaging studies where behavior is the independent variable). The initial results in patient populations improving pain, tinnitus, depression or modulating perception in schizophrenia are encouraging and merit further controlled clinical studies.