Abstract:
Written to educate both professionals and the general public, this article provides an update and overview of the field of neurofeedback (EEG biofeedback). The process of assessment and neurofeedback training is explained. Then, areas in which neurofeedback is being used as a treatment are identified and a survey of research findings is presented. Potential risks, side effects, and adverse reactions are cited and guidelines provided for selecting a legiti- mately qualified practitioner.
Abstract:
19-Channel Z-Score Neurofeedback (19ZNF) is a modality using 19-electrodes with real-time normative database z-scores, suggesting effective clinical outcomes in fewer sessions than traditional neurofeedback. Thus, monitoring treatment progression and clinical outcome is necessary. The area of focus in this study was a methodology of quantitative analysis for monitoring treatment progression and clinical outcome with 19ZNF. This methodology is noted as the Sites-of-Interest, which included repeated measures analyses of variance (rANOVA) and t-tests for z-scores; it was conducted on 10 cases in a single subject design. To avoid selection bias, the 10 sample cases were randomly selected from a pool of 17 cases that met the inclusion criteria. Available client out- come measures (including self-report) are briefly dis- cussed. The results showed 90 % of the pre-post comparisons moved in the targeted direction (z = 0) and of those, 96 % (80 % Bonferroni corrected) of the t-tests and 96 % (91 % Bonferroni corrected) of the rANOVAs were statistically significant; thus indicating a progression to- wards the mean in 15 or fewer 19ZNF sessions. All cases showed and reported improvement in all outcome measures (including quantitative electroencephalography assessment) at case termination.
Abstract:
Brain mapping works by allowing a neuropsychologist to compare diagnostic and normal databases. Are the QEEG parameters, such as frequency, amplitude, coherence, and morphology, consistent with a traumatic brain injury? Or, are they consistent with a preexisting condition like lupus, dementia, attention deficit disorder, or schizophrenia? We can determine with a high probability—more than 95 percent—whether the disorder is due to one or the other.
Abstract:
Z-Score neurofeedback has expanded to include 19-channel models (19ZNF) such that clinicians now have the option to use from 1 to 19 electrodes in a z-score neurofeedback protocol. Benefits and limitations of this new model are discussed from the clinical perspective of an early adopter of 19ZNF who has more than 4 years of experience with this modality after having several years of experience with QEEG-guided NF (QNF). Comparisons between QNF and 19ZNF are discussed. It has been suggested that 19ZNF can bring about positive clinical outcomes in fewer sessions than traditional NF, which matches the author’s experience (average of 38 with QNF vs. an average of 11 with 19ZNF). Unique implications of 19ZNF that have not yet been discussed in the literature, such as the advantage of once-per- week sessions, or questions about whether there could be times when change can occur too fast, are introduced. Directions for future research to further evaluate 19ZNF are suggested.
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Abstract:
This study aimed to compare the effectiveness of neurofeedback (NFB) plus pharmacotherapy with pharmacotherapy alone, on addiction severity, mental health, and quality of life in crystal methamphetamine- dependent (CMD) patients. The study included 100 CMD patients undergoing a medical treatment who volunteered for this randomized controlled trial. After being evaluated by a battery of questionnaires that included addiction severity index questionnaire, Symptoms Check List 90 version, and World Health Organization Quality of Life, the participants were randomly assigned to an experimental or a control group. The experimental group received thirty 50-min sessions of NFB in addition to their usual medication over a 2-month period; meanwhile, the control group received only their usual medication. In accordance with this study’s pre-test–post-test design, both study groups were evaluated again after completing their re- spective treatment regimens. Multivariate analysis of co- variance showed the experimental group to have lower severity of addiction, better psychological health, and better quality of life in than the control group. The differences between the two groups were statistically significant. These finding suggest that NFB can be used to improve the effectiveness of treatment results in CMD patients.
Abstract:
This study examined whether an EEG biofeedback protocol could improve outcome measures for a mixed substance abusing inpatient population. Method. One hundred twenty-one volunteers undergoing an inpatient substance abuse program were randomly assigned to the EEG biofeedback or control group. EEG biofeedback included training in Beta and SMR to address attentional variables, followed by an alpha-theta protocol. Subjects received a total of 40 to 50 biofeedback sessions. The control group received additional time in treatment equivalent to experimental procedure time. The Test of Variables of Attention (TOVA), and MMPI, were administered with both tester and subject blind as to group placement to obtain unbiased baseline data. Treatment retention and abstinence rates as well as psychometric and cognitive measures were compared. Results. Experimental subjects remained in treatment significantly longer than the control group(p < 0.005). Of the experimental subjects completing the protocol, 77% were abstinent at 12 months, compared to 44% for the controls. Experimental subjects demon- strated significant improvement on the TOVA (p<.005) after an average of 13 beta- SMR sessions. Following alpha-theta training, significant differences were noted on 5 of the 10 MMPI-2 scales at the p<.005 level. Conclusions. This protocol enhanced treatment retention, variables of attention, and abstinence rates one year following treatment.
Abstract:
Psychological improvements in patients with substance use disorders have been reported after neuro- feedback treatment. However, neurofeedback has not been commonly accepted as a treatment for substance depen- dence. This study was carried out to examine the effec- tiveness of this therapeutic method for opiate dependence disorder. The specific aim was to investigate whether treatment leads to any changes in mental health and sub- stance craving. In this experimental study with a pre-post test design, 20 opiate dependent patients undergoing Methadone or Buprenorphine maintenance treatment were examined and matched and randomized into two groups. While both experimental and control groups received their usual maintenance treatment, the experimental group received 30 sessions of neurofeedback treatment in addi- tion. The neurofeedback treatment consisted of sensory motor rhythm training on Cz, followed by an alpha-theta protocol on Pz. Data from the general health questionnaire and a heroin craving questionnaire were collected before and after treatment. Multivariate analysis of covariance showed that the experimental group achieved improvement in somatic symptoms, depression, and total score in general mental health; and in anticipation of positive outcome, desire to use opioid, and relief from withdrawal of craving in comparison with the control group. The study supports the effectiveness of neurofeedback training as a therapeutic method in opiate dependence disorder, in supplement to pharmacotherapy.
Abstract:
The category of disorders associated with substance abuse is the most common psychiatric set of conditions affecting an estimated 22 million people in this country (SAMHSA, 2004). Furthermore, the disorder is accompanied by serious impairments of cognitive, emotional and behavioral functioning. These conditions and symptoms so significantly alter a person’s brain and its functioning, that we often refer to the drug as hijacking the brain, making it very difficult to think logically and appropriately weigh the consequences of the drug related behavior.
Detoxified addicts have been shown to have significant alterations in brain electroencephalographic (EEG) patterns and children of addicts also exhibit EEG patterns that are significantly different than normal (Sokhadze et al., 2008, for review). This indicates that, not only are we dealing with the neurological consequences of drug-related behavior, but there appears to be a genetic pattern as well, that places certain people at greater risk for addictive behaviors. The complexity of these factors makes the treatment of addiction one of the most difficult areas of mental, emotional and physical rehabilitation.
Abstract:
The study compared the effects of EEG biofeedback and stimulant medication in reducing AD/HD symptoms. Stimulants are the most widely used treatment for AD/HD but have drawbacks. The most serious is that symptom reduction is only temporary unless medication is taken indefinitely. In addition, stimulants may have side effects and long term compliance with taking the medication is poor, especially among adolescents. The study compared treatment programs with 20 sessions of EEG biofeedback (n = 23) or stimulants (n = 23) as their primary components. An EEG group (EEG) was matched with a stimulant group (MED) by age, IQ, gender, and diagnosis. The Test of Variables of Attention (TOVA) was administered pre and post-treatment. Both the EEG and MED groups improved (p < .05) on TOVA measures of inattention, impulsivity, information processing, and variability but did not differ from each other (p > 0.3) on TOVA change scores. The results indicate that the EEG biofeedback program is an effective alternative to stimulants and may be the treatment of choice when medication is ineffective, has side effects, or compliance is a problem. Previous studies suggest that EEG biofeedback leads to lasting symptom reduction. This needs to be confirmed with larger samples using standardized assessment procedures.
Abstract:
Attention Deficit/Hyperactivity Disorder (ADHD) is a chronic syndrome characterized by deficits in executive functions and attentional processes. Persons diagnosed with ADHD have significant deficits in self-regulation evidenced by difficulty staying focused, controlling impulsive behaviors, and for many, restraining hyperactive motor activity. These symptoms typically create problems in academic, social, and familial contexts as well as in the planning and organization skills needed for daily functioning. Additionally, comorbid syndromes that can mimic the symptoms of ADHD and confound differential diagnosis are commonly present (e.g., anxiety, depression, learning disorders).ADHD is the most frequently diagnosed pediatric disorder with 11% of American school-aged children (and nearly 20% of teenage boys) having been medically diagnosed with ADHD according to the latest report from the Centers for Disease Control (Schwarz & Cohen, 2013). Stimulant medication (SM) and behavior therapy (BT) are the two most widely accepted treatments for ADHD, with approximately 70% of those diagnosed prescribed medication (Schwarz, 2013). Although both interventions are considered to meet the highest standards for the evidence-based treatment of ADHD, and have been recognized as such by the American Academy of Child and Adolescent Psychiatry (AACAP) and Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD), the leading ADHD advocacy group, the actual evidence is that these treatments fail to result in sustained benefit for the vast majority of children who receive them and, therefore, do not warrant being the first option for treating ADHD.
Abstract:
OBJECTIVE: To evaluate sustained improvements 6 months after a 40- session, in-school computer attention training intervention using neurofeedback or cognitive training (CT) administered to 7- to 11- year-olds with attention-deficit/hyperactivity disorder (ADHD).METHODS: One hundred four children were randomly assigned to receive neurofeedback, CT, or a control condition and were evaluated 6 months postintervention. A 3-point growth model assessed change over time across the conditions on the Conners 3–Parent Assessment Report (Conners 3-P), the Behavior Rating Inventory of Executive Function Parent Form (BRIEF), and a systematic double-blinded classroom observation (Behavioral Observation of Students in Schools). Analysis of variance assessed community-initiated changes in stimulant medication.RESULTS: Parent response rates were 90% at the 6-month follow-up. Six months postintervention, neurofeedback participants maintained significant gains on Conners 3-P (Inattention effect size [ES] = 0.34, Executive Functioning ES = 0.25, Hyperactivity/Impulsivity ES = 0.23) and BRIEF subscales including the Global Executive Composite (ES = 0.31), which remained significantly greater than gains found among children in CT and control conditions. Children in the CT condition showed delayed improvement over immediate postintervention ratings only on Conners 3- P Executive Functioning (ES = 0.18) and 2 BRIEF subscales. At the 6- month follow-up, neurofeedback participants maintained the same stimulant medication dosage, whereas participants in both CT and control conditions showed statistically and clinically significant increases (9 mg [P = .002] and 13 mg [P , .001], respectively).
CONCLUSIONS: Neurofeedback participants made more prompt and greater improvements in ADHD symptoms, which were sustained at the 6-month follow-up, than did CT participants or those in the control group. This finding suggests that neurofeedback is a promising attention training treatment for children with ADHD.
Abstract:
As documented by the eight-year long NIMH-funded MTA Cooperative study, optimal versions of stimulant medication and BT failed to result in sustained benefit for the majority of children. Surprisingly, in this study’s 22-month follow-up assessment of the currently recognized best treatments for ADHD, no sustained benefit was evident for any of these treatments as compared to those ADHD children who had simply been referred to community-based professionals and may or may not have actually followed through with treatment from them. Even after 14 months of free intensive multi-component behavior therapy combined with systematic medication management followed by referral to community-based treatment professionals for continuing care, ADHD was found to be an ongoing debilitating illness and the societal costs that are associated with it included 10.4% of such ‘optimally-treated’ children requiring psychiatric hospitalization one or more times during follow-up. The psychiatric hospitalization rate for those receiving intensive multi-component behavior therapy without medication was even higher at 12.3% compared to only 8.3% of those who had simply been referred to community-based professionals. The MTA study results dramatically demonstrate that more effective treatments for ADHD are desperately needed and as such treatments are identified, they warrant reimbursement by healthcare insurers to improve outcomes for ADHD children and their families.
Abstract:
Two functional magnetic resonance imaging (fMRI) experiments were undertaken to measure the effect of neurofeedback training (NFT), in AD/HD children, on the neural substrates of selective attention and response inhibition. Twenty unmedicated AD/HD children participated to these experiments. Fifteen children were randomly assigned to the Experimental (EXP) group whereas the other five children were randomly assigned to the Control (CON) group. Only subjects in the EXP group underwent NFT. EXP subjects were trained to enhance the amplitude of the SMR (12-15 Hz) and beta 1 activity (15-18 Hz), and decrease the amplitude of theta activity (4-7 Hz). Subjects from both groups were scanned one week before the beginning of NFT (Time 1) and 1 week after the end of NFT (Time 2), while they performed a “Counting Stroop” task (Experiment 1) and a Go/No-Go task (Experiment 2). At Time 1, in both groups, the Counting Stroop task was associated with significant activation in the left superior parietal lobule. For the Go/No-Go task, no significant activity was detected in the EXP and CON groups. At Time 2, in both groups, the Counting Stroop task was associated with significant activation of the left superior parietal lobule. This time, however, there were significant loci of activation, in the EXP group, in the right ACC, left caudate nucleus, and left substantia nigra. No such activation loci were seen in CON subjects. For the Go/No-Go task, significant loci of activation were noted, in the EXP group, in the right ventrolateral prefrontal cortex, right ACcd, left thalamus, left caudate nucleus, and left substantia nigra. No significant activation of these brain regions was measured in CON subjects. These results suggest that NFT has the capacity to functionally normalize the brain systems mediating selective attention and response inhibition in AD/HD children.
Abstract:
This case study explores the efficacy of low-resolution electromagnetic-tomographic (LORETA) neurofeedback (LNFB) in the right anterior cingulate cortex (ACC) as a method for addiction treatment and examines the frequency specific effects of this training in eight other regions of the cortex identified as playing an important role in substance use disorders. Methods. This case study was completed with one right-handed, 28-year-old female partici- pant with 3 years of continuous abstinence from polysubstance abuse; her drugs of choice were heroin and alcohol, and she reported an 8-year history of alcohol abuse and a 4-year history of heroin use (IV). She completed 25 sessions of LNFB training in which she increased 14–18 Hz activity in the right ACC. We utilized electrophysiological measures to assess the increase or decrease in eight regions of interest (ROI): the right hippocampus, the right amygdaloid com- plex, the right orbitofrontal cortex (OFC), the right occipital lobe, the right insular cortex, the right uncus, and two regions in the left prefrontal cortex and compared them using complex linear mixed model and partial correlation procedures. Results. The data indicate significant associations between these limbic and cortical regions. The linear increase in the right ACC was in the desired direction; however, this will require more than 25 sessions to reach significance. The effects of training in the right ACC show significant increase and decrease for all frequencies in specific regions of interest. Conclusion. This is the first study of its kind to explore the relationship between these nine ROI as influenced by LNFB in the right ACC. The data suggest that these regions may play an intricate role in behaviors and characteristics involved in addiction; specific changes in the alpha frequency in limbic regions and increases in associations between regions in the theta frequency may influence personality and other behaviors associated with addictive traits. This case study illustrates the possible neural mechanisms involved in the negative self-reference associated with addiction even after a significant period of abstinence and possibly offers insight into antecedents to the onset of substance use disorders.
Abstract:
Compelling evidence exists for a neurophysiologic basis for obsessive-com- pulsive disorder (OCD). A large number of positron emission tomographic and single photon emission computed tomographic studies have found increased blood flow and metabolism in the mediofrontal, anterior cingulate, right frontal, or orbitofrontal areas [1–14], which implicates a cortico-striato-thalamocortical network. Functional abnormalities also have been documented in a large num- ber of quantitative EEG (qEEG) studies [15–22] and evoked potential studies [23–27]. OCD seems to be somewhat heterogeneous, however, with at least two qEEG subtypes that have been found [17–21]. Prichep et al [20] and Kuskowski et al [15] found a group with excess alpha brain waves throughout most of the head, with frontal excess beta, whereas another subgroup has an excess of theta activity, particularly in frontal and posterior temporal areas. Clinical experience in conducting qEEG assessment with patients with OCD also has shown that excess beta activity is often found along the midline, in cortical areas approximately over the anterior cingulate.
Abstract:
INTRODUCTION: Brain/Computer Interaction (BCI) devices are designed to alter neural signals and, thereby, mental activity. This study was a randomized, waitlist (TAU) controlled trial of a BCI, EEG neurofeedback training (NF), in patients with chronic PTSD to explore the capacity of NF to reduce PTSD symptoms and increase affect regulation capacities.
STUDY DESIGN: 52 individuals with chronic PTSD were randomized to either NF (n = 28) or waitlist (WL) (n = 24). They completed four evaluations, at baseline (T1), after week 6 (T2), at post-treatment (T3), and at one month follow up (T4). Assessment measures were:1. Traumatic Events Screening Inventory (T1); 2. the Clinician Administered PTSD Scale (CAPS; T1, T3, T4); 3. the Davidson Trauma Scale (DTS; T1-T4) and 4. the Inventory of Altered Self-Capacities (IASC; T1-T4). NF training occurred two times per week for 12 weeks and involved a se- quential placement with T4 as the active site, P4 as the reference site.
RESULTS: Participants had experienced an average of 9.29 (SD = 2.90) different traumatic events. Post- treatment a significantly smaller proportion of NF (6/22, 27.3%) met criteria for PTSD than the WL condition (15/22, 68.2%), χ2 (n = 44, df = 1) = 7.38, p = .007. There was a significant treatment condition x time interaction (b = -10.45, t = -5.10, p< .001). Measures of tension reduction activities, affect dysregulation, and affect instability exhibited a significant Time x Condition interaction. The effect sizes of NF (d = -2.33 within, d = – 1.71 between groups) are comparable to those reported for the most effective evidence based treatments for PTSD. DISCUSSION: Compared with the control group NF produced significant PTSD symptom improvement in individuals with chronic PTSD, as well as in affect regulation capacities. NF deserves further investigation for its potential to ameliorate PTSD and to improve affect regulation, and to clarify its mechanisms of action.
Abstract:
Posttraumatic stress disorder (PTSD) in veterans differs when compared with the isolated, traumatic incidents that civilians experience (Carmichael, 2009; Tanielian, 2009; Wilson, 2009). Generally, PTSD is classified as an anxiety disorder that develops after an individual is exposed to or witnesses another individual experiencing a life-threatening situation and responds with intense fear, helplessness, or horror (Foa, Keane, & Friedman, 2000; National Institutes of Health [NIH], 2010). Combat-related PTSD, formerly known as “battle fatigue” (Solomon, Weisenberg, Schwarzwald, & Mikulincer, 1988, p. 365) or “shell shock” (Mosse, 2000, p. 101), refers to experiencing posttraumatic stress as a result of exposure to trauma on a battlefield or in a war zone. Distinctions of combat-related PTSD include not only the type of trauma experienced but also the course of its development, how it is experienced (Alford, Mahone, & Fielstein, 1988; Eisenhart, 1975; Tanielian, 2009), and psychosocial barriers to treatment (Hoge, Auchterlonie, & Milliken, 2006; Sullivan, 2012; Tanielian, 2009; Wright et al., 2009). Unfortunately, these components of combat-related PTSD are not always acknowledged. Counselors should be cognizant of these differences to effectively tailor and deliver services to veterans.
Abstract:
EEG Biofeedback (also known as neurofeed- back) has been in use as a clinical intervention for well over 30 years; however, it has made very little impact on clinical care. One reason for this has been the difficulty in designing research to measure clinical change in the real world. While substantial evidence exists for its efficacy in treating attention deficit/hyperactivity disorder, relatively little evidence exists for its utility in other disorders including posttraumatic stress disorder (PTSD). The current study represents a ‘‘proof-of-concept’’ pilot for the use of neurofeedback with multiply-traumatized individuals with treatment-resistant PTSD. Participants completed 40 sessions of neurofeedback training two times per week with sensors randomly assigned (by the study coordinator, who was not blind to condition) to sensor placements of either T4-P4 or T3-T4. We found that neurofeedback significantly reduced PTSD symptoms (Davidson Trauma Scale scores averaged 69.14 at baseline to 49.26 at termination), and preceded gains in affect regulation (Inventory of Altered Self-Capacities-Affect Dysregulation scores aver- aged 23.63 at baseline to 17.20 at termination). We discuss a roadmap for future research.
Abstract:
The literature regarding neurofeedback treatment of anxiety associated with post traumatic stress disorder (PTSD) is reviewed. The results of quantitative electroencephalograph (QEEG) guided neurofeedback training for anxiety in nineteen PTSD patients is analyzed, along with the change in anxiety in four control patients who did not do neurofeedback. Those who did neurofeedback training experienced clinically significant reductions in anxiety, whereas there was no significant change in anxiety in the control group. QEEG-guided neurofeedback appears to be effective in a higher percentage of patients than non– QEEG-guided training in increasing alpha and theta, based on results in the published literature.
Abstract:
Autism is a neurodevelopmental disorder noticeable in childhood characterized by impaired communication skills and difficulty forming relationships or bonds with others. Those with autism may lack empathy, dislike physical contact, and may be especially sensitive to loud noises, bright lights, or certain smells. Currently there is no cure for autism, and many individuals diagnosed with autism spectrum disorder (ASD) respond poorly to pharmaceutical treatments.
An intervention that has shown promise in treating symptoms of autism is EEG neurofeedback. This is a non-invasive technique that focuses on pinpointing neuroelectrical (brain wave) abnormalities and training an individual to consciously correct them with “feedback.” It is thought that by correcting neuroelectrical abnormalities, many of the severe symptoms associated with autism could significantly diminish or subside.
Understand that while autism is largely influenced by genetics, various interventions such as neurofeedback to alter brain waves may help improve communication skills, learning abilities, and reduce sensory sensitivities. Perhaps the greatest benefit derived from neurofeedback is that it can have long- lasting effects. Once an individual has completed enough training, they are able to normalize their brain wave activity “at will.”
Abstract:
Background: Research reviewing the epidemiology of Autism (Medical Research Council, 2001) indicated that approximately 60 per 10,000 children (1/166) are diagnosed with Autistic Spectrum Disorder (ASD). Jarusiewicz (2002) published the only controlled study documenting the effectiveness of neurofeedback for Autism based on one outcome measure. The present study extended these findings with a larger sample size, broader range of assessments, and physiological measures of brain functioning.Methods: Assessment-guided neurofeedback was conducted in 20 sessions for 37 patients with ASD. The experimental and control groups were matched for age, gender, race, handedness, other treatments, and severity of ASD.Results: Improved ratings of ASD symptoms reflected an 89% success rate. Statistical analyses revealed significant improvement in Autistics who received Neurofeedback compared to a wait list control group. Other major findings included a 40% reduction in core ASD symptomatology (indi- cated by ATEC Total Scores), and 76% of the experimental group had decreased hyper- connectivity. Reduced cerebral hyperconnectivity was associated with positive clinical outcomes in this population. In all cases of reported improvement in ASD symptomatology, positive treat- ment outcomes were confirmed by neuropsychological and neurophysiological assessment.Conclusions: Evidence from multiple measures has demonstrated that neurofeedback can be an effective treatment for ASD. In this population, a crucial factor in explaining improved clinical outcomes in the experimental group may be the use of assessment-guided neurofeedback to reduce cerebral hyperconnectivity. Implications of these findings are discussed.
Abstract:
Majordepressivedisorder(MDD) is a common mental illness af- fecting approximately 2.5% of the general population. MDD is one of the leading causes of disability; it is projected to have the second highest burden of disease (measured in disability-adjusted life years) by 2020 (WHO). MDD has negative social consequences in terms of reduced employment and psychosocial impairment (Anderson et al. 2011). The pathophysiology of depression involves both external social stressors and internal genetic vulnerability.
Abstract:
Depression and fatigue are common symptoms of multiple sclerosis (MS) and are the primary determinants of impaired quality of life in this demyelinating neurological disease. Untreated depression is associated with suicidal ideation, impaired cognitive function and poor adherence to immunomodulatory treatment. For these reasons, systematic screening and management of depressive symptoms and fatigue is recommended for all patients with MS. The objective of this study was to evaluate the effectiveness of neurofeedback in treating depression and fatigue in persons with MS. We conducted a randomized trial with 24 MS patients with primary fatigue and depression. Participants were randomized into two groups: neurofeedback training group (16 sessions of NFB) or treatment as usual. Participants were evaluated at 3 time points (baseline, end of the treatment, and 2-month follow- up) using the Fatigue Severity Scale and Depression subscale of the Hospital Anxiety and Depression Scale as outcome measures. A repeated measures analysis of variance was used to examine differences between the groups. NFB significantly reduced symptoms of depression and fatigue in patients with MS patients, compared to treatment as usual (p\.05), and these effects were maintained the 2-month follow-up (p\.05).
Abstract:
Few well-controlled studies have considered neurofeedback treatment in adult psychiatric patients. In this regard, the present study investigates the characteristics and effects of neurofeedback on adult psychiatric patients in a naturalistic setting. A total of 77 adult patients with psychiatric disorders participated in this study. Demographic data and neurofeedback states were retrospectively analyzed, and the effects of neurofeedback were evaluated using clinical global impression (CGI) and subjective self-rating scales. Depressive disorders were the most common psychiatric disorders (19; 24.7 %), followed by anxiety disorders (18; 23.4 %). A total of 69 patients (89.6 %) took medicine, and the average frequency of neurofeedback was 17.39 ± 16.64. Neurofeedback was applied to a total of 39 patients (50.6 %) more than 10 times, and 48 patients (62.3 %) received both b/SMR and a/h training. The discontinuation rate was 33.8 % (26 pa- tients). There was significant difference between pretreatment and posttreatment CGI scores (\.001), and the selfrating scale also showed significant differences in depressive symptoms, anxiety, and inattention (\.001). This is a naturalistic study in a clinical setting, and has several limitations, including the absence of a control group and a heterogenous sample. Despite these limitations, the study demonstrates the potential of neurofeedback as an effective complimentary treatment for adult patients with psychiatric disorders.
Abstract:
A robust body of research documents that there are biological predispositions that often exist for depression, anxiety, and obsessive–compulsive disorder. However, new research has shown that medication is only mildly more effective than placebo in the treatment of these problems. In treating these conditions, neurofeedback (EEG biofeedback) may offer an alternative to invasive treatments such as medication, ECT, and intense levels of transcrancial magnetic stimulation. This paper reviews the neurofeedback literature with these problems, finding particularly positive research support for the treatment of anxiety disorders. New findings on the neurofeedback treatment of depression are presented.
Abstract:
The purpose of this study was to evaluate the effect of neurofeedback on depressive symptoms and electrophysiological disturbances in patients with major depressive disorder. We recruited participants suffering from depression to evaluate efficacy of left prefrontal beta with alpha/theta training. An 8-week, prospective, open-label study was undertaken. Twenty participants were recruited. The treatment protocol was twice or three times a week training of beta at F3 with alpha/theta at Pz for 8 weeks. When every visit, patients were received beta training for 30 min, and then alpha/theta training for 30 min. Baseline, 4 and 8 week scores of; the Hamilton rating scale for Depression (HAM-D), the Hamilton rating scale for Anxiety (HAM-A), the Beck Depression Inventory (BDI)-II, the Beck Anxiety Inventory (BAI), Clinical global impression-severity (CGI-S), and pre- and post- treatment resting state EEGs were compared. Interhemispheric alpha power asymmetry (A score) was computed for homologous sites F3–F4. Pre- and post-training clinical assessments revealed significant improvements in HAM– D, HAM-A, BDI, and CGI-S scores. Cumulative response rates by HAM-D were 35.0 and 75.0 % at 4 and 8 weeks, respectively, corresponding cumulative remission rates by HAM-D were 15.0 and 55.0 %, respectively. No significant differences were found between pre- and post-treatment A score. Neurofeedback treatment could improve depressive symptoms significantly. In addition, anxiety symptoms and clinical illness severity decreased significantly after neuArofeedback treatment. Despite its several limitations, such as, small sample size and lack of a control group, this study suggested neurofeedback has significant effects in patients with major depressive disorder.
Abstract:
Background: Central neuropathic pain has a prevalence of 40 % in patients with spinal cord injury. Electroencephalography (EEG) studies showed that this type of pain has identifiable signatures, that could potentially be targeted by a neuromodulation therapy. The aim of the study was to investigate the putative mechanism of neurofeedback training on central neuropathic pain and its underlying brain signatures in patients with chronic paraplegia.
Methods: Patients’ EEG activity was modulated from the sensory-motor cortex, electrode location C3/Cz/C4/P4 in up to 40 training sessions Results. Six out of seven patients reported immediate reduction of pain during neurofeedback training. Best results were achieved with suppressing Ɵ and higher β (20–30 Hz) power and reinforcing α power at C4. Four patients reported clinically significant long-term reduction of pain (>30 %) which lasted at least a month beyond the therapy. EEG during neurofeedback revealed a wide spread modulation of power in all three frequency bands accompanied with changes in the coherence most notable in the beta band. The standardized low resolution electromagnetic tomography analysis of EEG before and after neurofeedback therapy showed the statistically significant reduction of power in beta frequency band in all tested patients. Areas with reduced power included the Dorsolateral Prefrontal Cortex, the Anterior Cingulate Cortex and the Insular Cortex.
Conclusions: Neurofeedback training produces both immediate and longer term reduction of central neuropathic pain that is accompanied with a measurable short and long term modulation of cortical activity. Controlled trials are required to confirm the efficacy of this neurofeedback protocol on treatment of pain. The study is a registered UKCRN clinical trial Nr 9824.
Abstract:
Z-score LORETA neurofeedback (NFB) has been found in case reports to be an effective and promising form of neuromodulation, relieving many neuropsychiatric symptoms. The ability to identify the dysregulated structures of the brain participating in pain regulation by LORETA imaging has made it possible to design the targeted NFB therapy. In this paper, four selected cases of chronic pain are described with effective delivery of targeted LORETA neurotherapy.
Abstract:
Study lead investigator Sarah Prinsloo, Ph.D., assistant professor Palliative, Rehabilitation, and Integrative Medicine at MD Anderson, identified the location of brain activity that contributes to the physical and emotional aspects of chronic pain, which allowed patients to modify their own brain activity through electroencephalogram (EEG) biofeedback. EEG tracks and records brain wave patterns by attaching small metal discs with thin wires on the scalp, and then sending signals to a computer to record the results.
Abstract:
A significant postulate of this commentary is that all addictions create, in addition to chemical changes in the brain, anatomical and pathological changes which result in various manifestations of cerebral dysfunction collectively labeled hypofrontal syndromes. In these syndromes, the underlying defect, reduced to its simplest description, is damage to the “braking system” of the brain. They are well known to clinical neuroscientists, especially neurologists and neurosurgeons, for they are also seen with tumors, strokes, and trauma. Indeed, anatomically, loss of these frontal control systems is most apparent following trauma, exemplified by progressive atrophy of the frontal lobes seen in serial MRI scans over time.
Abstract:
Insomnia is an epidemic in the US. Neurofeedback (NFB) is a little used, psychophysiological treatment with demonstrated usefulness for treating insomnia. Our objective was to assess whether two distinct Z-Score NFB protocols, a modified sensorimotor (SMR) protocol and a sequential, quantitative EEG (sQEEG)-guided, individually designed (IND) protocol, would alleviate sleep and associated daytime dysfunctions of participants with insomnia. Both protocols used instantaneous Z scores to determine reward condition administered when awake. Twelve adults with insomnia, free of other mental and uncontrolled physical illnesses, were randomly assigned to the SMR or IND group. Eight completed this randomized, parallel group, single-blind study. Both groups received fifteen 20-min sessions of Z-Score NFB. Pre-post assessments included sQEEG, mental health, quality of life, and insomnia status. ANOVA yielded significant post-treatment improvement for the combined group on all primary insomnia scores: Insomnia Severity Index (ISI p\.005), Pittsburgh Sleep Quality Inventory (PSQI p\.0001), PSQI Sleep Efficiency (p\.007), and Quality of Life Inventory (p\.02). Binomial tests of baseline EEGs indicated a significant proportion of excessively high levels of Delta and Beta power (p\.001) which were lowered post- treatment (paired z-tests p\.001). Baseline EEGs showed excessive sleepiness and hyperarousal, which improved post-treatment. Both Z-Score NFB groups improved in sleep and daytime functioning. Post-treatment, all participants were normal sleepers. Because there were no significant differences in the findings between the two groups, our future large scale studies will utilize the less burdensome to administer Z-Score SMR protocol.
Abstract:
This is a multi-case study involving sixty-seven patients diagnosed with Traumatic Brain Injury (TBI) that were subjected to Z-score neurofeedback (NFB) therapy. Most of the patients were diagnosed with mild TBI and treated within the first year after brain injury. A few patients were diagnosed with more severe TBI and treated after one year or later following their head injury incident. Most of the patients complained of headaches and cognitive problems while some of them also suffered from dizziness and overlapping depression. Those who complained of cognitive problems were subjected to analysis with computerized cognitive testing (NeuroTrax, Inc.) before and after ten sessions of NFB. During the NFB therapy the subjective response from patients was collected in order to discern whether or not there was an improvement of their symptoms. In addition, QEEG maps were completed before each NFB session initiation in order to see an objective improvement of QEEG abnormalities. Subsequent analysis revealed that 59 out of 67 patients (88%) noticed subjective improvement of their symptoms within 10 sessions of NFB therapy, out of which most of them reported an improvement after only 1-3 NFB sessions. 54 patients also had an objective improvement of QEEG maps (80%) manifesting as reduction of excessive beta activity and/or normalization of delta or theta power.
45 patients completed prior and post NFB neurocognitive testing with 34 patients (76%) having significant cognitive enhancement (Global Cognitive Score increased between 3-30 points). These results are very encouraging and indicate high potential of Z-score LORETA NFB rehabilitation of patients suffering from TBI.
Abstract:
Schizophrenia is sometimes considered one of the most devastating of mental illnesses because its onset is early in a patient’s life and its symptoms can be destructive to the patient, the family and friends. Schizophrenia affects 1 in 100 people at some point during their lives, and while there is no cure, it is treatable with antipsychotic medications. According to the Clinical Antipsychotic Trials for Interventions Effectiveness (CATIE) about 74 % of the patients who have discontinued the first medication prescribed within a year will have a relapse afterwards. This shows an enormous need for developing better treatment methods and better ways to manage the disease, since current therapies do not have sufficient impact on negative symptoms, cognitive dysfunction, and compliance to treatment. In this clinical case series we investigate the efficacy of QEEG Guided Neurofeedback (NF) treatment in this population, and whether this method has an effect on these patients, and its effect on concurrent medical treatment.
Fifty-one subjects (25 males, 26 females) ranging from 17-54 years old (mean: 28.82y, SD: 7.94y) were included. A signed consent form was received from all the patients. Most of the subjects were previously diagnosed with chronic schizophrenia, and their symptoms did not improve with medication. All 51 patients were evaluated using QEEG, which was recorded at baseline and following treatment. Before recording the QEEG all medications were discontinued and the subjects were washed out for up to 7 half lives of the medication they were on. Recorded QEEGs were analyzed using FDA approved Nx-Link Neurometric analysis, which suggested a diagnosis of chronic schizophrenia for all the subjects tested.
This was consistent with the clinical judgment of the authors. The subjects’ symptoms were assessed by means of the Positive and Negative Syndrome Scale (PANSS). Besides the PANSS, 33 out of 51 subjects were also evaluated by the Minnesota Multiphasic Personality Inventory (MMPI) and were administered the Test of Variables of Attention (TOVA), both at baseline and following treatment. Each subject was prescribed a NF treatment protocol based on their QEEG Neurometric analysis results. Each session was 60 minutes in duration, with 1-2 sessions per day where a 30 minute rest was given between sessions, when 2 were administered during the day. Changes in the PANSS, MMPI and TOVA measures were analyzed to evaluate the effectiveness of NF treatment. The mean number of sessions completed by the subjects was 58.5 sessions within 24 days to 91 days.
Forty-seven out of 48 schizophrenic subjects showed clinical improvement after neurofeedback treatment, based on changes in their PANSS scores. The subjects who were able to take the MMPI and the TOVA showed significant improvements on these measures as well. Three out of 51 patients dropped out of treatment between 20 and 40 sessions of NF treatment and 1 out of 51 did not show response. Forty of the subjects in this study were followed up for more than 22 months, 2 were followed for 1 year, 1 was followed for 9 months and 3 were followed for between 1 and 3 months after completion of their NF treatment. Overall NF treatment was shown to be effective in this group of subjects studied.
This study provides the first evidence for positive effects of neurofeedback treatment on clinical outcome measures in schizophrenia. The results of this study encourage further research. The goal of this study was to foster further controlled studies in this methodology.
Abstract:
Few well-controlled studies have considered neurofeedback treatment in adult psychiatric patients. In this regard, the present study investigates the characteristics and effects of neurofeedback on adult psychiatric patients in a naturalistic setting. A total of 77 adult patients with psychiatric disorders participated in this study. Demographic data and neurofeedback states were retrospectively analyzed, and the effects of neurofeedback were evaluated using clinical global impression (CGI) and subjective self-rating scales. Depressive disorders were the most common psychiatric disorders (19; 24.7 %), followed by anxiety disorders (18; 23.4 %). A total of 69 patients (89.6 %) took medicine, and the average frequency of neurofeedback was 17.39 ± 16.64. Neurofeedback was applied to a total of 39 patients (50.6 %) more than 10 times, and 48 patients (62.3 %) received both b/SMR and a/h training. The discontinuation rate was 33.8 % (26 patients). There was significant difference between pretreatment and posttreatment CGI scores (\.001), and the self- rating scale also showed significant differences in depressive symptoms, anxiety, and inattention (\.001). This is a naturalistic study in a clinical setting, and has several limitations, including the absence of a control group and a heterogenous sample. Despite these limitations, the study demonstrates the potential of neurofeedback as an effective complimentary treatment for adult patients with psychiatric disorders.
Abstract:
Alzheimer s Disease (AD) is the most common form of dementia. In a qEEG, patients with AD present a greater amount of theta activity compared to normal aging individuals. An excess of delta and a decrement of alpha and beta is also observed. Little is known about the effect of neurofeedback in patients with dementia. However, it has been successfully applied in the treatment of different disorders.The objective of this study was to examine if neurofeedback has a positive effect on the cognitive performance in patients with AD. Ten patients whose qEEG met the typical pattern for patients with AD received neurofeedback training. These patients were compared with 123 AD patients who received treatment as usual (TAU). Participants were between the age of 61 and 90. All patients received a test designed to assess cognitive functioning pre- and post- treatment.The test-retest reliability of the TAU group for the total CAMCOG score was 0.84 and varied between the subscales from 0.56 to 0.78. Individual results, analyzed with a reliable change index (RCI), indicated that patients who received neurofeedback treatment had stable cognitive functions. When the groups were compared; patients with neurofeedback treatment showed an improvement in learning memory, other cognitive functions were stable. In comparison, patients with TAU had an overall decrement in cognitive functioning, with the exception of orientation in time.In sum, neurofeedback has a positive effect on the cognitive performance of patients with AD. Patients who received neurofeedback treatment had stable cognitive functions and an increase in the recognition and recall of information, whereas TAU patients showed a decrement in these functions.
Abstract:
Reducing cognitive decline in patients with Mild Cognitive Impairment (MCI) may slow their progression to develop dementia. In this 12-week single-arm intervention trial, elderly patients (n = 127, age 70.69 +/-10.53, 63% female) with a diagnosis of MCI were enrolled in a multi-disciplinary Brain Fitness Program. The main outcome measure was changes in a battery of 10 cognitive domains. Each patient received weekly personalized cognitive stimulation, neurofeedback training, and brain coaching/counseling for eating a Mediterranean diet, taking omega-3 supplements, increasing fitness, and practicing mindfulness meditation. The post-program testing showed 84% of the patients experienced statistically significant improvements in their cognitive function (p< 0.05). Among the random sample of 17 patients who had a post-program quantitative MRI, 12 patients had either no atrophy or an actual growth above the baseline volume of their hippocampus. These preliminary findings support the concept that a personalized Brain Fitness Program can improve cognitive function and either reverse or grow the volume of hippocampus in elderly with MCI.
Abstract:
Neurofeedback has been found to be effective in the treatment of a number of clinical disorders, such as attention-deficit/hyperactivity disorder (ADHD/ADD) (Lubar, 2003), obsessive-compulsive disorder (Hammond, 2003), seizures (Sternum, 2000), and substance abuse (Burkett, Cummins, Dickson, &• Skolnick, 2005; Saxby & Peniston, 1995). The benefits of neurofeedback have also been found useful in peak performance training. These benefits include improving attention!concentration, imagery, arousal level, and decreasing worry and rumination (Williams, 2006). The combination of cognitive, emotional, and psychophysiological benefits from neurofeedback results in improved performance. Due to individual differences in brain activity, as well as the large diversity o f skills required in different sports, neuro feedback for performance training is not a “one size fits all” approach (Wilson, Thompson, Thompson, & Peper, 2011). In order to obtain optimal results, neurofeedback for peak performance training begins with appropriate assessment and evaluation of an individual’s brain wave (electroencephalographic) activity. Individualized training plans are based upon the assessment findings and the specific needs of the targeted sport or activity (Wilson et al., 2011). This article will discuss the benefits and applications of neurofeedback for peak performance training and the importance o f assessment to create effective training programs.
Abstract:
Aim: One of the applications of the Neurofeedback methodology is peak performance in sport. The protocols of the neurofeedback are usually based on an assessment of the spectral parameters of spontaneous EEG in resting state conditions. The aim of the paper was to study whether the intensive neurofeedback training of a well-functioning Olympic athlete who has lost his performance confidence after injury in sport, could change the brain functioning reflected in changes in spontaneous EEG and event related potentials (ERPs).Case study: The case is presented of an Olympic athlete who has lost his performance confidence after injury in sport. He wanted to resume his activities by means of neurofeedback training. His QEEG/ERP parameters were assessed before and after 4 intensive sessions of neurotherapy. Dramatic and statistically significant changes that could not be explained by error measurement were observed in the patient.Conclusion: Neurofeedback training in the subject under study increased the amplitude of the monitoring component of ERPs generated in the anterior cingulate cortex, accompanied by an increase in beta activity over the medial prefrontal cortex. Taking these changes together, it can be concluded that even a few sessions of neurofeedback in a high performance brain can significantly activate the prefrontal cortical areas associated with increasing confidence in sport performance.
Abstract:
This report describes some basic considerations and operational details for using a series of neurofeedback techniques in the pursuit of personal improvement in golf or related sports. Generally, the neurofeedback will be used in order to acquaint trainees with desirable mental states, and to help them to learn to achieve and recognize these states. Our approach to training these states is based upon the concepts of flexibility and appropriateness, and does not appeal to the notion of good vs. bad brainwaves or brain states. No particular brain state is good or bad, in its own context. What matters is being able to achieve an appropriate state at the appropriate time, and to be able to recognize it. Indeed, if we try to specifically enhance or inhibit any particular brainwaves in general, we will surely lose some of the capacity for change and flexibility that is at the very essence of being able to be a peak performer.
Abstract:
Approximately 30 % of epilepsy patients are resistant to conventional medical therapy. Therefore, alternative forms of treatment are needed to improve efficiency of these therapeutic regimens. Neurofeedback (NFB) has been becoming recognized as one of the promising therapies improving control of medically refractory epilepsy cases. This multi-case paper describes our experience with LORETA Z-score NFB as a tool for control of patients with seizures.
Abstract:
Purpose: Tinnitus, the perception of sound without the presence of a physical stimulus, provides the opportunity to study neural codes of percepts without simultaneous processing of stimuli. Previously, we have found that tinnitus is associated with enhanced delta- and reduced tau-power in temporal brain regions. By operantly modifying corresponding aspects of spontaneous EEG activity, the aim of the present study was to corroborate the assumption that tinnitus should be reduced if patterns of ongoing synchronous brain activity are normalized.
Methods: In response to different variants of neurofeedback, a total of twenty-one patients produced significant changes in EEG frequency bands.
Results: Simultaneous alteration of both frequency bands was strongly related to changes in tinnitus intensity matched before and after the intervention (r = −0.74). In those two patients with the greatest modulatory success, the tinnitus sensation resided completely in response to the treatment. Comparing the neurofeedback-treated patients with a group of patients trained with a frequency discrimination task (n = 27), the tinnitus relief in the neurofeedback group was significantly stronger.
Conclusions: This study supports the notion that altered patterns of intrinsic ongoing brain activity lead to phantom percepts and offer new routes to the treatment of tinnitus.
Abstract:
An innovative neurofeedback protocol for the treatment of problems with physical balance, incontinence, and swallowing is described. Successful case reports from four consecutively treated cases are presented. This protocol holds potential promise for work with the elderly, stroke and head injury patients, primary nocturnal enuresis, and in peak performance training where balance is important. Further con- trolled research is warranted.
Abstract:
Consistent with the 2009 Standards of the Council for Accreditation of Counseling and Related Educational Programs, counselors must understand neurobiological behavior in individuals of all developmental levels. This requires understanding the brain and strategies for applying neurobiological concepts in counseling practice, training, and research. Neurofeedback, biofeedback for the brain, is one modality based in neuroscience that empowers individuals to recognize, monitor, and self-regulate brain wave activity to create greater Wellness. Neurofeedback has significant potential in counseling preparation, research, and practice.
Abstract:
Restless leg syndrome (RLS) and periodic limb movements in sleep (PLMS) are prevalent and chronic movement disorders that result in sleep deprivation and impaired quality of life. Although there is no single pathophysiological explanation, EEG studies commonly implicate alpha activity as being involved. This article presents the first case reports of the treatment of RLS and PLMS with neurofeedback (EEG biofeedback). The encouraging results warrant further controlled research.
Abstract:
Restless leg syndrome (RLS) and periodic limb movements in sleep (PLMS) are prevalent and chronic movement disorders that result in sleep deprivation and impaired quality of life. Although there is no single pathophysiological explanation, EEG studies commonly implicate alpha activity as being involved. This article presents the first case reports of the treatment of RLS and PLMS with neurofeedback (EEG biofeedback). The encouraging results warrant further controlled research.
Abstract:
Introduction: Blinded, placebo-controlled research (e.g., Sterman, 2000) has documented the ability of brainwave biofeedback to recondition brain wave patterns. Neurofeedback has been used successfully with uncontrolled epilepsy, ADD/ADHD, learning disabilities, anxiety, and head injuries. However, nothing has been published on the treatment of obsessive-compulsive disorder (OCD) with neurofeedback.Method: Quantitative EEGs were gathered on two consecutive OCD patients who sought treatment. This assessment guided protocol selection for subsequent neurofeedback training.Results: Scores on the Yale-Brown Obsessive-Compulsive Scale and the Padua Inventory normalized following treatment. An MMPI was administered pre-post to one patient, and she showed dramatic improvements not only in OCD symptoms, but also in depression, anxiety, somatic symptoms, and in becoming extroverted rather than introverted and withdrawn.Discussion: In follow-ups of the two cases at 15 and 13 months after completion of treatment, both patients were maintaining improvements in OCD symptoms as measured by the Padua Inventory and as externally validated through contacts with family members. Since research has found that pharmacologic treatment of OCD produces only very modest improvements and behavior therapy utilizing exposure with response prevention is experienced as quite unpleasant and results in treatment dropouts, neurofeedback appears to have potential as a new treatment modality.
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