Executive function deficits, common in psychiatric disorders, hinder daily activities and may be linked to diminished neural plasticity, affecting treatment and training responsiveness. In this pioneering study, we evaluated the feasibility and preliminary efficacy of psilocybin-assisted frontal-midline theta neurofeedback (NF), a neuromodulation technique leveraging neuroplasticity, to improve executive functions (EFs). Thirty-seven eligible participants were randomized into an experimental group (n = 18) and a passive control group (n = 19). The experimental group underwent three microdose sessions and then three psilocybin-assisted NF sessions, without requiring psychological support, demonstrating the approach's feasibility. NF learning showed a statistical trend for increases in frontal-midline theta from session to session with a large effect size and non-significant but medium effect size dynamical changes within sessions. Placebo effects were consistent across groups, with no tasks-based EF improvements, but significant self-reported gains in daily EFs-working memory, shifting, monitoring and inhibition-showing medium and high effect sizes. The experimental group's significant gains in their key training goals underscored the approach's external relevance. A thorough study with regular sessions and an active control group is crucial to evaluate EFs improvement and their specificity in future. Psilocybin-enhanced NF could offer significant, lasting benefits across diagnoses, improving daily functioning. This article is part of the theme issue 'Neurofeedback: new territories and neurocognitive mechanisms of endogenous neuromodulation'.

Academic Unit of Neurology Trinity Biomedical Sciences Institute School of Medicine Trinity College Dublin The University of Dublin Dublin Ireland

Department of Biomedical Sciences of Cells and Systems University Medical Center Groningen Groningen Netherlands

Department of Clinical and Developmental Neuropsychology University of Groningen Groningen Netherlands

Department of Medicine Faculty of Science and Medicine University of Fribourg Fribourg Switzerland

Department of Psychiatry Faculty of Medicine Masaryk University and University Hospital Brno Brno Czech Republic

Trinity College Institute of Neuroscience School of Medicine Trinity College Dublin The University of Dublin Dublin Ireland

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Psilocybin-assisted neurofeedback for the improvement of executive functions: a randomized semi-naturalistic-lab feasibility study