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Brain Imaging and Neurofeedback: Has Fiction Become Reality?

By Carolyn C. Meltzer, MD

Dr. Carolyn C. Meltzer is a professor at the Emory University School of Medicine Departments of Radiology and Imaging Sciences, Psychiatry and Behavioral Sciences, and Neurology. She is also a member of the AJOB Neuroscience Editorial Board.

“Power is in tearing human minds to pieces and putting them together again in new shapes of your own choosing.”

George Orwell, 1984

In the iconic geopolitical thriller “The Manchurian Candidate,” advanced mind control techniques are used on a Korean War prisoner to turn him into an assassin. As we move into an era in which functional neuroimaging may be applied in ways akin to “mind reading,” such as applied to lie detection and economic choices, this fictional work more closely mimics reality.

Functional neuroimaging tools have helped us to tease out neuronal networks and to better understand how we think and act in health and disease. With the exception of few specific instances of validated clinical use (such as mapping of exquisite cerebral cortex prior to resecting a nearby tumor), most behavioral functional imaging studies require group, rather than individual data.

New research has focused on exploiting brain-computer interfaces that address therapeutic approaches to neurological and psychiatric conditions in individualized care settings. Recording brain activity and using it to modulate behavior or motor activity – or to seek a specific therapeutic outcome – has spawned the field of neurofeedback. Initial applications have used invasive approaches, such as deep brain stimulation in movement disorders and medically intractable depression. More recently, emphasis has turned to non-invasive approaches. Florin and colleagues (2014) demonstrate how real-time magnetoencephalography (MEG) source imaging may modulate the activity of targeted specific brain regions reinforced by visual subject feedback.

There are many ethical issues to explore in the therapeutic setting of neurofeedback, including whether informed consent (autonomy) may be biased by patient desperation and/or unrealistic expectations (Hamani and Moro, 2012). An unanticipated alteration in mood or behavior (and potential alteration of identity) post-treatment may further alter the patient’s decision-making capabilities.

The ethical concerns further escalate as one contemplates current and potential future uses of neurofeedback in which the patient may not consciously consent or even be aware of its use. In a fascinating study by Monti and colleagues (2010), five of 54 brain injury patients in presumed vegetative states were shown to modulate their brain activity (using fMRI) in response to mental imagery tasks. Neurofeedback techniques using imaging signal modulation have already been attempted in conditions with law enforcement implications, such as pedophilia (Renaud et al. 2011) and drug addiction (Carter et al. 2011). Stopczynski, et al present a vision of a world in which a Smartphone Brain Scanner could track (and eventually modulate) a consumer’s emotional responses to product presentation.

Demonstration of a Smartphone Brain Scanner (Stopczynski et al 2014

Another avenue of use for neurofeedback is in national security and warfare. The Defense Advanced Research Projects Agency (DARPA) and the Department of Defense have funded neuroscience projects with relevance to deception detection, and enhanced endurance and attention capabilities of soldiers (Tennison and Moreno, 2012).

While most neurofeedback is performed for treatment of a condition, the potential exists for its use to target enhancement of mental function (2007 ethics). While some might argue that this is no different from many accepted therapies such as a cochlear implant or contact lenses, cognitive enhancement may introduce additional concerns of informed consent and the potential for undue social or economic motivators.

The BRAIN Initiative (Brain Research through Advancing Innovative Neurotechnologies), launched by President Obama on April 1, 2013 and developed by the National Institutes of Health, is a multi-decade effort to “revolutionize our understanding of the human brain.” Given the promise of further acceleration of innovation in neurofeedback tools, scientists, physicians, and policy makers need to be ready to ensure their ethical use.


Florin E, Bock E, Bailet S. Targeted reinforcement of neural oscillatory activity with real-time neuroimaging feedback. Neuroimage 2014;88:54-60.

Hamani C, Moro E. Emerging Horizons in Neuromodulation: New Frontiers in Brain and Spine Stimulation. International Review of Neurobiology. Academic Press 2012.

Monti M, Vanhaudenhuyse A, Coleman MR, Boly M, Pickard JD, Tshibanda L, Owen AM, Laureys S. Willful Modulation of Brain Activity in Disorders of Consciousness. N Engl J Med 2010; 362:579-589.

Renaud P, Joyal C, Stoleru S, Goyette M, Weiskopf N, Birbaumer N. Real-time functional magnetic imaging-brain-computer interface and virtual reality promising tools for the treatment of pedophilia. Progress in Brain Research 2011; 192:263-272.

Ethical and Legal Aspects of Neuromodulation: on the Road to Guidelines. Neuromodulation: Technology at the Neural Interface, 2007;10: 177-186.

Tennison M, Moreno JD. Neuroscience, Ethics, and National Security: The State of the Art. PLoS Biol. Mar 2012;10(3): e1001289.

Carter A, Bell E, Racine E, Hall W. Ethical Issues Raised by Proposals to Treat Addiction Using Deep Brain Stimulation. Neuroethics 2011;4:129-142.

Stopczynski A, Stahlhut C, Petersen MK, Larsen JE, Jensen CF, Ivanova MG, Andersen TS, Hansen LK. Smartphones as pocketable labs: Visions for mobile brain imaging and neurofeedback. International Journal of Psychophysiology 2014;91:54-66.

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Meltzer, C. (2014). Brain Imaging and Neurofeedback: Has Fiction Become Reality? The Neuroethics Blog. Retrieved on , from


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