Open Peer Review Any reports and responses or comments on the article can be found at the end of the article. RESEARCH ARTICLE Does fMRI neurofeedback in the context of stress influence mood and arousal? A randomised controlled trial with parallel group design [version 1; peer review: awaiting peer review] Angelo Belardi , Jong-Hwan Lee , Hyun-Chul Kim , Esther Stalujanis , Eun Kyung Jung , Minkyung Oh , Seung-Schik Yoo , Jens C. Pruessner , Marion Tegethoff , Gunther Meinlschmidt 3,6,7* Division of Clinical Psychology and Psychiatry, Department of Psychology, University of Basel, Basel, Switzerland Department of Brain and Cognitive Engineering, Korea University, Seoul, South Korea Division of Clinical Psychology and Cognitive Behavioral Therapy, International Psychoanalytic University, Berlin, Germany Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, USA Department of Psychology, University of Konstanz, Konstanz, Germany Division of Clinical Psychology and Epidemiology, Department of Psychology, University of Basel, Basel, Switzerland Department of Psychosomatic Medicine, University Hospital Basel and University of Basel, Basel, Switzerland Equal contributors Abstract Stress-related mental and physical health issues burden Background: modern societies. New treatment opportunities could help to lessen long-term detrimental consequences of stress. To investigate whether real-time functional magnetic resonance Objective: imaging neurofeedback (rtfMRInf), aimed at modulating brain activity associated with a stressor, affects subjective mood and arousal. In total, 30 males participated in a randomised controlled trial Methods: with parallel-group design. rtfMRInf was the intervention, sham-neurofeedback the control condition, and the Stroop task the stressor. We instructed participants to modulate their stress response to the Stroop task via feedback from their anterior cingulate cortex and their insular cortex, concomitantly applying mental strategies. We assessed mood with the Multidimensional Mood State Questionnaire (dimensions: good/bad, GB; awake/tired, AT; and calm/nervous, CN), and subjective arousal with Self-Assessment Manikins (SAM). : We found significantly higher subjective arousal after Results neurofeedback phases in the experimental condition as compared to the control condition [t(26.6) = −2.216, 95%CI [−2.188,−0.083], p = 0.035; t(27.9) = −3.252, 95%CI [−2.685,−0.609], p = 0.003], but no significant differences between the conditions regarding mood [GB: b = 0.4, 95%CI [−0.67, 1.47], p = 0.467; AT: b = 0.769, 95%CI [−0.319, 1.857], p = 0.177; CN: b = 0.5, 95%CI [−0.53, 1.53], p = 0.352]. In both conditions, there was significantly worse and more tired mood after the fMRI session as compared to before [GB:b = −0.77, 95% CI [−1.31, 0.23], p = 0.009; AT: b = 1 2 2 1,3 2 2 4 5 1* 3,6,7* 1 2 3 4 5 6 7 * Reviewer Status AWAITING PEER REVIEW 09 Jul 2019, :1031 ( First published: 8 ) https://doi.org/10.12688/f1000research.19403.1 09 Jul 2019, :1031 ( Latest published: 8 ) https://doi.org/10.12688/f1000research.19403.1 v1 Page 1 of 12 F1000Research 2019, 8:1031 Last updated: 09 JUL 2019