Multi-modal Virtual scenario enhances neurofeedback learning

In the past decade neurofeedback (NF) has become the focus of a growing body of research. With real-time functional magnetic resonance imaging (fMRI) enabling online monitoring of emotion-related areas, such as the amygdala, many have begun testing its therapeutic benefits. However, most existing NF procedures still use monotonic uni-modal interfaces, thus possibly limiting user engagement and weakening learning efficiency. The current study tested a novel multi-sensory NF animated scenario (AS) aimed at enhancing user experience and improving learning. We examined whether relative to a simple uni-modal 2D interface, learning via an interface of complex multi-modal 3D scenario will result in improved NF learning. As a neural-probe, we used the recently developed fMRI-inspired EEG model of amygdala activity ("amygdala-EEG finger print"; amygdala-EFP), enabling low-cost and mobile limbic NF training. Amygdala-EFP was reflected in the AS by the unrest level of a hospital waiting room in which virtual characters become impatient, approach the admission desk and complain loudly. Successful downregulation was reflected as an ease in the room unrest level. We tested whether relative to a standard uni-modal 2D graphic thermometer (TM) interface, this AS could facilitate more effective learning and improve the training experience. Thirty participants underwent two separated NF sessions (1 week apart) practicing downregulation of the amygdala-EFP signal. In the first session, half trained via the AS and half via a TM interface. Learning efficiency was tested by three parameters: (a) effect size of the change in amygdala-EFP following training, (b) sustainability of the learned downregulation in the absence of online feedback, and (c) transferability to an unfamiliar context. Comparing amygdala-EFP signal amplitude between the last and the first NF trials revealed that the AS produced a higher effect size. In addition, NF via the AS showed better sustainability, as indicated by a no-feedback trial conducted in session 2 and better transferability to a new unfamiliar interface. Lastly, participants reported that the AS was more engaging and more motivating than the TM. Together, these results demonstrate the promising potential of integrating realistic virtual environments in NF to enhance learning and improve user's experience.