Real-Time fMRI Neurofeedback for Auditory Hallucinations in Schizophrenia Reduces Aberrant Auditory Cortex Activity and Connectivity with the Default Mode Network

Francesca Morfini, PhD Student

McLean Hospital,VA Boston Healthcare System, Northeastern University – PhD Student

Scientific Abstract


Auditory hallucinations (AH) are a core and distressing symptom of schizophrenia that do not respond to medication in ~30% of patients. More effective interventions are needed. According to the Northoff hypothesis, AH arise from hyperconnectivity between the auditory cortex (superior temporal gyrus, STG) and the anterior hub of the default mode network (medial prefrontal cortex, mPFC), and hyperactivity in the auditory cortex. We showed AH reduction after real-time functional magnetic resonance imaging neurofeedback (NF) from the STG, a technique in which participants learn to modulate their STG activity. In this randomized sham-controlled study, we investigated the effect of real NF from the STG (NFR) vs sham NF from the motor cortex (NFS) on STG activity and STG-mPFC connectivity in schizophrenia patients with AH. We hypothesized that NFR but not NFS would reduce STG activity and STG-mPFC connectivity.


Schizophrenia patients with frequent AH received either NFR (n=12) or NFS (n=13). During NF runs, patients listened to pre-recorded voices and were instructed to upregulate their brain activity by attending to voices spoken in their own voice and to downregulate it by ignoring sentences spoken in a stranger’s voice. Before and after NF runs, patients performed the same task but without receiving NF (transfer runs), and also underwent resting state runs. Transfer runs were analyzed to investigate pre-post NF changes in STG activity, and resting state runs for STG-mPFC connectivity changes. 


Paired, pre-post NF, t-test analyses of transfer runs showed reduction in STG activation in the NFR group, p<0.002, but not in the NFS group, p<0.19. NF resulted in a reduction in resting state mPFC-STG connectivity in the NFR t(11)=5.57, p<0.001, but not in the NFS group t(12)=1.41, p<0.18. The reduction in mPFC-STG connectivity post- vs pre-NF was observed in all NFR patients.


Our results provide preliminary support to the resting state hypothesis of AH and suggest that STG-directed real NF may be effective in decreasing the abnormally elevated STG activity and mPFC-STG connectivity that have been proposed to underlie the experience of AH in individuals with schizophrenia.

Live Zoom Session – March 9th

research Areas


Francesca Morfini, MA, Jiahe Zhang, PhD, Clemens Bauer, PhD, Ann K. Shinn, MD, MPH, Yoon Lee, BS, Angelina Awad, BS, Lena M. D. Stone, BS, Georg Northoff, PhD, Margaret Niznikiewicz, PhD, Susan Whitfield-Gabrieli, PhD

Principal Investigator

Margaret Niznikiewicz, PhD