Real-time fMRI neurofeedback boosts heartbeat perception by modulating insula activation pattern during interoceptive attention.

Real-time fMRI neurofeedback (NF) has emerged as a promising method for enabling individuals to modulate specific brain regions and, consequently, their behavioural outcomes. This study examined whether the NF targeting the right insula could improve heartbeat perception ability and influence emotional response to negatively valenced stimuli, by training participants to modulate the brain activation associated with interoceptive (heartbeat-focused) and exteroceptive (visual-focused) attention. Fifty-four participants underwent a single ~40-minute NF session with contingent (NF group, n = 28) or non-contingent (Sham group, n = 26) feedback, with heartbeat perception and emotional appraisal assessed pre- and post-training. The NF group demonstrated significant improvements in heartbeat perception, with individual learning effects in neuromodulation predicting the behavioural gains. However, group-level NF scores did not differ significantly, likely reflecting variability in learnability. Despite improvements in heartbeat perception, NF training did not modulate emotional responses at either the behavioural or neural level, suggesting that targeting the insula alone is insufficient to alter affective processing within a single session. These findings provide evidence that NF can enhance heartbeat perception through targeted neuromodulation in the insular cortex.