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Post-stroke depression (PSD) is a common complication impairing recovery. This study aimed to compare standard cognitive behavioral therapy (CBT) with an enhanced version integrating functional near-infrared spectroscopy (fNIRS)-guided neurofeedback and art therapy (NF-AT+CBT) in patients with mild-to-moderate PSD. In this multicenter, assessor-blinded randomized controlled trial, 50 patients were randomly assigned (1:1) to NF-AT+CBT or standard CBT for 12 weeks (two 45–60 min sessions/week). Primary outcome was change in Hamilton Depression Rating Scale-17 (HAMD-17) score; secondary outcomes included changes in serum IL-6 and TNF-α levels. The NF-AT+CBT group showed significantly greater HAMD-17 reduction at 12 weeks (−11.4 ± 2.5 vs. −8.6 ± 2.5, P < 0.001, Cohen's d = 1.1) and higher remission rate (80% vs. 40%, P = 0.009). Reductions in IL-6 and TNF-α were also significantly larger in the NF-AT+CBT group (both P < 0.001). Treatment adherence was excellent with no serious adverse events. Integrating fNIRS-guided neurofeedback and art tasks into CBT (NF-AT+CBT) produced greater improvement in depressive symptoms and inflammatory markers than standard CBT alone in mild-to-moderate PSD, suggesting a promising, feasible, and safe enhancement strategy. Larger trials with mechanistic assessments are warranted. • A randomized controlled trial compared CBT alone with CBT combined with fNIRS-informed neurofeedback and art therapy in patients with post-stroke depression. • The combined intervention produced greater improvements in depressive symptoms than CBT alone over 12 weeks. • Participants receiving the combined intervention also showed larger reductions in circulating inflammatory markers (IL-6 and TNF-α). • The study evaluates a feasible, integrative neurofeedback–art therapy framework embedded within CBT for post-stroke depression.
Lin et al. (Mon,) studied this question.