Systematic Review And Meta-analysis of The Effects of EEG Neurofeedback Combined with Pharmacological Treatment on The Positive and Negative Symptoms in Patients with Schizophrenia

Yiyi DUAN ShuFan LI shuqi jia fen Yu xing wang yueyu long ^*

• Shanghai University of Sport, Shanghai, China

Objective: To evaluate the efficacy of EEG neurofeedback (EEG-NF) combined with pharmacological treatment on positive and negative symptoms in schizophrenia. Methods: Randomized controlled trials (RCTs) were searched in CNKI, Wanfang, VIP, PubMed, Web of Science, Cochrane, and Embase databases until January 25, 2025. Literature quality was assessed using the PEDro and CRED-NF checklists. Meta-analysis and publication bias tests were performed using RevMan 5.4.1 and Stata 18.0, respectively, with evidence quality evaluated via GRADEpro. Results: Fourteen studies (1371 patients) were included. EEG-NF combined with pharmacological treatment significantly improved positive (SMD=-0.87) and negative symptoms (SMD=-1.28). Subgroup analysis showed greater improvement in patients aged ≥45 years (positive: SMD=-1.05; negative: SMD=-1.64). For positive symptoms, better outcomes were observed with intervention periods ≥8 weeks, frequency ≥4 times/week, and disease duration ≥5 years (SMD=-1.04, -0.94, -0.94). For negative symptoms, better outcomes were seen with intervention periods ≥8 weeks, frequency ≥4 times/week, and disease duration <5 years (SMD=-1.34, -1.68, -1.26). Mental and emotional disorders treatment regimens targeting sensorimotor rhythm (SMR) and beta waves showed significant improvement in both positive (SMD=-0.98) and negative symptoms (SMD=-1.49). Conclusion: EEG-NF combined with pharmacological treatment effectively improves schizophrenia symptoms. A regimen of ≥4 sessions/week for ≥8 weeks, targeting SMR and beta waves, is recommended. However, publication bias may limit the generalizability of findings. Future research should prioritize larger-scale, multicenter studies to evaluate long-term efficacy and mechanisms.