Regulation in acute stress experience through functional near-infrared spectroscopy neurofeedback of the prefrontal cortex.

BACKGROUND: Acute stress plays a key role in mental health, and there is a pressing need for accessible, brain-based interventions that strengthen stress regulation by directly targeting the underlying brain mechanisms. We therefore developed a real-time functional near-infrared spectroscopy (fNIRS)-informed neurofeedback training targeting a prefrontal region involved in cognitive emotion regulation (left lateral prefrontal cortex, PFC) and evaluated its potential to enhance stress regulation using the socially evaluated cold pressor test, an acute stress paradigm that combines physical and social stressors. METHODS: In a randomized double-blind, sham yoked feedback-controlled parallel-group trial, 60 young healthy adults underwent pretraining of cognitive emotion regulation with reappraisal strategies, then completed four neurofeedback runs applying reappraisal strategies to drive regulation, preceded and followed by baseline and maintenance runs without feedback. The training combined continuous neurofeedback from individualized lateral PFC channels to guide neurofunctional control. The primary outcome assessed activity at trained channels, while secondary outcomes assessed stress and pain regulation during the socially evaluated cold pressor test. RESULTS: Neurofeedback significantly promoted upregulation of lateral PFC activity throughout the training runs. Participants in the training group exhibited lower subjective stress - yet not pain - experience during the cold pressor test, as well as reduced post-training anxiety, reflecting a successful and domain-specific transfer of regulatory control. CONCLUSIONS: This study demonstrates the efficacy of real-time fNIRS lateral PFC neurofeedback in facilitating adaptive learning of regulatory skills, which transferred robustly to regulation of subjective stress under acute stressors. These findings point to neurofeedback training as a promising translational strategy for enhancing stress regulation.