***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Attention Deficit Hyperactivity Disorder ( ADHD ) is characterized by poor cognitive control/attention and hypofunctioning of the dorsal anterior cingulate cortex ( dACC ) . In the current study , we investigated for the first time whether real-time fMRI neurofeedback ( rt-fMRI ) training targeted at increasing activation levels within dACC in adults with ADHD leads to a reduction of clinical symptoms and improved cognitive functioning . An exploratory r and omized controlled treatment study with blinding of the participants was conducted . Participants with ADHD ( n = 7 in the neurofeedback group , and n = 6 in the control group ) attended four weekly MRI training sessions ( 60-min training time/session ) , during which they performed a mental calculation task at varying levels of difficulty , in order to learn how to up-regulate dACC activation . Only neurofeedback participants received continuous feedback information on actual brain activation levels within dACC . Before and after the training , ADHD symptoms and relevant cognitive functioning was assessed . Results showed that both groups achieved a significant increase in dACC activation levels over sessions . While there was no significant difference between the neurofeedback and control group in clinical outcome , neurofeedback participants showed stronger improvement on cognitive functioning . The current study demonstrates the general feasibility of the suggested rt-fMRI neurofeedback training approach as a potential novel treatment option for ADHD patients . Due to the study ’s small sample size , potential clinical benefits need to be further investigated in future studies . Trial Registration : IS RCT Many patients show no or incomplete responses to current pharmacological or psychological therapies for depression . Here we explored the feasibility of a new brain self-regulation technique that integrates psychological and neurobiological approaches through neurofeedback with functional magnetic resonance imaging ( fMRI ) . In a proof-of-concept study , eight patients with depression learned to upregulate brain areas involved in the generation of positive emotions ( such as the ventrolateral prefrontal cortex ( VLPFC ) and insula ) during four neurofeedback sessions . Their clinical symptoms , as assessed with the 17-item Hamilton Rating Scale for Depression ( HDRS ) , improved significantly . A control group that underwent a training procedure with the same cognitive strategies but without neurofeedback did not improve clinical ly . R and omised blinded clinical trials are now needed to exclude possible placebo effects and to determine whether fMRI-based neurofeedback might become a useful adjunct to current therapies for depression Background : Spider phobics show an exaggerated fear response when encountering spiders . This fear response is aggravated by negative and irrational beliefs about the feared object . Cognitive re appraisal can target these beliefs , and therefore has a fear regulating effect . The presented study investigated if neurofeedback derived from functional magnetic resonance imaging ( fMRI ) would facilitate anxiety regulation by cognitive re appraisal , using spider phobia as a model of anxiety disorders . Feedback was provided based on activation in left dorsolateral prefrontal cortex and right insula , as indicators of engagement and regulation success , respectively . Methods : Eighteen female spider phobics participated in a r and omized , controlled , single-blinded study . All participants completed a training session in the MRI scanner . Participants assigned to the neurofeedback condition were instructed to shape their regulatory strategy based on the provided feedback . Participants assigned to the control condition were asked to adapt their strategy intuitively . Results : Neurofeedback participants exhibited lower anxiety levels than the control group at the end of the training . In addition , only neurofeedback participants achieved down-regulation of insula activation levels by cognitive re appraisal . Group differences became more pronounced over time , supporting learning as a mechanism behind this effect . Importantly , within the neurofeedback group , achieved changes in insula activation levels during training predicted long-term anxiety reduction . Conclusions : The conducted study provides first evidence that fMRI neurofeedback has a facilitating effect on anxiety regulation in spider phobia If an individual can learn to directly control activation of localized regions within the brain , this approach might provide control over the neurophysiological mechanisms that mediate behavior and cognition and could potentially provide a different route for treating disease . Control over the endogenous pain modulatory system is a particularly important target because it could enable a unique mechanism for clinical control over pain . Here , we found that by using real-time functional MRI ( rtfMRI ) to guide training , subjects were able to learn to control activation in the rostral anterior cingulate cortex ( rACC ) , a region putatively involved in pain perception and regulation . When subjects deliberately induced increases or decreases in rACC fMRI activation , there was a corresponding change in the perception of pain caused by an applied noxious thermal stimulus . Control experiments demonstrated that this effect was not observed after similar training conducted without rtfMRI information , or using rtfMRI information derived from a different brain region , or sham rtfMRI information derived previously from a different subject . Chronic pain patients were also trained to control activation in rACC and reported decreases in the ongoing level of chronic pain after training . These findings show that individuals can gain voluntary control over activation in a specific brain region given appropriate training , that voluntary control over activation in rACC leads to control over pain perception , and that these effects were powerful enough to impact severe , chronic clinical pain Abstract Attention Deficit Hyperactivity Disorder ( ADHD ) is associated with poor self‐control , underpinned by inferior fronto‐striatal deficits . Real‐time functional magnetic resonance neurofeedback ( rtfMRI‐NF ) allows participants to gain self‐control over dysregulated brain regions . Despite evidence for beneficial effects of electrophysiological‐NF on ADHD symptoms , no study has applied the spatially superior rtfMRI‐NF neurotherapy to ADHD . A r and omized controlled trial tested the efficacy of rtfMRI‐NF of right inferior prefrontal cortex ( rIFG ) , a key region that is compromised in ADHD and upregulated with psychostimulants , on improvement of ADHD symptoms , cognition , and inhibitory fMRI activation . To control for region‐specificity , an active control group received rtfMRI‐NF of the left parahippocampal gyrus ( lPHG ) . Thirty‐one ADHD boys were r and omly allocated and had to learn to upregulate their target brain region in an average of 11 rtfMRI‐NF runs over 2 weeks . Feedback was provided through a video‐clip of a rocket that had to be moved up into space . A transfer session without feedback tested learning retention as a proximal measure of transfer to everyday life . Both NF groups showed significant linear activation increases with increasing number of runs in their respective target regions and significant reduction in ADHD symptoms after neurotherapy and at 11‐month follow‐up . Only the group targeting rIFG , however , showed a transfer effect , which correlated with ADHD symptom reductions , improved at trend level in sustained attention , and showed increased IFG activation during an inhibitory fMRI task . This proof‐of‐concept study demonstrates for the first time feasibility , safety , and shorter‐ and longer‐term efficacy  of rtfMRI‐NF of rIFG in adolescents with ADHD . Hum Brain Mapp 38:3190–3209 , 2017 . © 2017 The Authors Human Brain Mapping Published by Wiley Periodicals , BACKGROUND Cue-induced craving plays an important role in relapse , and the neural correlates of cue-induced craving have been eluci date d using fMRI . This study examined the utility of real-time fMRI ( rtfMRI ) neurofeedback to strengthen self-regulation of craving-related neural activation and cue-reactivity in cigarette smokers . METHODS Nicotine-dependent smokers were r and omized to rtfMRI neurofeedback or to a no-feedback control group . Participants completed 3 neuroimaging visits . Within each visit , an initial run during which smoking-related cues were used to provoke craving , an individualized craving-related region of interest ( ROI ) in the prefrontal cortex or anterior cingulate cortex was identified . In the rtfMRI group , activity from the ROI was fed back via a visual display during 3 subsequent runs while participants were instructed to reduce craving during cue exposure . The control group had an identical experience with no feedback provided . RESULTS Forty-four nicotine-dependent smokers were recruited to participate in our study ; data from the 33 participants who completed a 1-week follow-up visit were included in the analysis . Subjective craving ratings and cue-induced brain activation were lower in the rtfMRI group than in the control group . LIMITATIONS As participants were not seeking treatment , clinical outcomes are lacking . CONCLUSION Nicotine-dependent smokers receiving rtfMRI feedback from an individualized ROI attenuated smoking cue-elicited neural activation and craving , relative to a control group . Further studies are needed in treatment-seeking smokers to determine if this intervention can translate into a clinical ly meaningful treatment modality Significance Real-time functional MRI allows the use of well-localized , complex network activity patterns to drive neurofeedback , rather than a simple up/down regulation of a specific cortical region . We based our feedback on differential levels of activity in two high-order visual areas but misled participants to believe the feedback was r and om . Even without being given an explicit strategy , or having any awareness or intention of learning , our results show changes in resting-state connectivity , which are correlated with the ability to implicitly modulate interactions between neural networks to positively impact feedback . This opens up numerous possibilities for research , as well as for potential clinical intervention , even in states of altered consciousness . Recent advances in blood oxygen level-dependent – functional MRI (BOLD-fMRI)-based neurofeedback reveal that participants can modulate neuronal properties . However , it is unknown whether such training effects can be introduced in the absence of participants ' awareness that they are being trained . Here , we show unconscious neurofeedback training , which consequently produced changes in functional connectivity , introduced in participants who received positive and negative rewards that were covertly coupled to activity in two category-selective visual cortex regions . The results indicate that brain networks can be modified even in the complete absence of intention and awareness of the learning situation , raising intriguing possibilities for clinical interventions Concerns about the reliability and reproducibility of biomedical research have been voiced across several arenas . In this commentary , I discuss how a poor appreciation of the role of chance in statistical inference contributes to this problem . In particular , how poor scientific design , such as low statistical power , and question able research practice s , such as post hoc hypothesizing and undisclosed flexibility in analyses , yield a high proportion of false-positive results . I discuss how the current publication and funding system perpetuates this poor practice by rewarding positive , yet often unreliable , results over rigorous methods . I conclude by discussing how scientists can prevent being fooled by chance findings by adopting well established , but often ignored , method ological best- practice . There is increasing awareness of the problem of unreliable findings across biomedical sciences ( Ioannidis , 2005 ) . Many “ l and mark ” findings could not be replicated ( Scott et al. , 2008 ; Begley and Ellis , 2012 ; Steward et al. , 2012 ) and many promising pre clinical findings have failed to translate into clinical application ( Perel et al. , 2007 ; Prinz et al. , 2011 ) , leading many to question whether science is broken ( Economist,2013 ) . Central to this problem is a poor appreciation of the role of chance in the scientific process . As neuroscience has developed over the past 50 years , many of the large , easily observable effects have been found , and the field is likely pursuing smaller and more subtle effects . The corresponding growth in computational capabilities ( Moore , 1998 ) means that research ers can run numerous tests on a single data set in a matter of minutes . The human brain processes r and omness poorly , and the huge potential for undisclosed analytical flexibility in modern data -management packages leaves research ers increasingly vulnerable to being fooled by chance . Research ers can not measure an entire population of interest , so they take sample s and use statistical inference to determine the probability that the results BACKGROUND Many studies suggest that electroencephalographic ( EEG ) neurofeedback might be beneficial in the treatment of attention-deficit hyperactivity disorder ( ADHD ) . However , numbers of well controlled studies are low and neurofeedback techniques are regarded as highly controversial . The present trial examined the efficacy ( compared with sham neurofeedback ) and efficiency ( compared with meta-cognitive therapy ) of a st and ard EEG neurofeedback protocol in adults with ADHD . METHODS We did a concurrent , triple-blind , r and omised , controlled trial using authorised deception in adults with ADHD from one centre ( University of Tübingen ) in Tübingen , Germany . Participants were eligible if they fulfilled the DSM-IV-TR criteria for ADHD , were aged between 18 years and 60 years , and had no or stable use of medication for at least 2 months with no intention to change . We excluded participants who had comorbid schizophrenia or schizoaffective disorder , bipolar disorder , borderline personality disorder , epilepsy , or traumatic brain injury ; substance abuse or dependence ; or current or planned other psychological treatment . Those eligible were r and omly assigned to three groups : a neurofeedback group which received 30 verum θ-to-β neurofeedback sessions over 15 weeks , a sham neurofeedback group which received 15 sham followed by 15 verum θ-to-β neurofeedback sessions over 15 weeks , or a meta-cognitive group therapy group which received 12 sessions over 12 weeks . Participants were assigned equally to one of the three interventions through a computerised minimisation r and omisation procedure stratified by sex , age , and baseline symptom severity of ADHD . Participants were masked as to whether they were receiving neurofeedback or sham neurofeedback , but those receiving meta-cognitive therapy were aware of their treatment . Clinical assessors ( ie , those assessing outcomes ) and 
    Output:
    
The vast majority of fMRI‐nf findings suggest that self‐regulation of specific brain signatures seems viable ; however , replication of concomitant behavioral outcomes remains sparse .
We can certainly change brain activity with fMRI‐nf .
HighlightsWe conducted a systematic review of 99 fMRI neurofeedback ( fMRI‐nf ) experiments.fMRI‐nf successfully drives BOLD regulation and behavioral change .
BOLD regulation guarantees neither neural regulation nor clinical improvement .
Psychosocial factors may contribute to regulation of BOLD signal and behavior .