Neurofeedback Treatment of Negative Symptoms in Schizophrenia: Two Case Reports

Cognitive effects of brief and intensive neurofeedback treatment in schizophrenia: a single center pilot study

Background

Schizophrenia is characterized by significant cognitive impairments and affects up to 98% of patients. Neurofeedback (NF) offers a means to modulate neural network function through cognitive processes such as learning and memorization, with documented structural changes in the brain, most notably an increase in grey matter volume in targeted regions.

Methods

The present 2-week, open-label, preliminary study aims to evaluate the efficacy on cognition of an adjunctive short and intensive (8 daily sessions lasting 30 minutes) alpha/theta NF training in a sample of subjects affected by schizophrenia on stabilized treatment with atypical antipsychotic drugs. The efficacy was measured at baseline and at the end of the study by the Brief Neuropsychological Examination 2 (ENB 2), the Mini Mental State Examination (MMSE), and the Stroop color-word interference test; the clinical symptoms were assessed using the Positive and Negative Syndrome Scale (PANSS).

Results

A final sample of nine patients completed the study. Regarding the cognitive performance, at the final assessment (week 2), the NF treatment significantly improved the performance in the "Story Recall Immediate" (p = 0.024), "Story Recall Delayed" (p = 0.007), "Interference Memory 30 s" (p = 0.024), "Clock Test" (p = 0.014) sub-tests, and the ENB2 Total Score (p = 0.007). Concerning the clinical symptoms, no significant changes were observed in the PANSS subscales and the PANSS Total score.

Conclusions

NF could represent an adjunctive treatment strategy in the therapeutic toolbox for schizophrenia cognitive symptoms.

A Systematic Review of the Effects of EEG Neurofeedback on Patients with Schizophrenia

Schizophrenia is a neuropsychiatric disorder affecting approximately 1 in 300 people worldwide. It is characterized by a range of symptoms, including positive symptoms (delusions, hallucinations, and formal thought disorganization), negative symptoms (anhedonia, alogia, avolition, asociality, and blunted affect), and cognitive impairments (impaired memory, attention, executive function, and processing speed). Current treatments, such as psychopharmacology and psychotherapy, often do not fully address these symptoms, leading to impaired everyday functionality. In recent years, there has been a growing interest in neuromodulation due to computer and engineering science making extraordinary computational advances. Those put together have reinitiated the spark in the field of neurofeedback (NF) as a means for self-regulation and neuromodulation with the potential to alleviate the daily burden of schizophrenia. We review, in a systematic way, the primary reports of electroencephalogram (EEG)-based NF as a therapeutical tool for schizophrenia. The main body of research consists mostly of case studies and case reports. The results of a few randomized controlled studies, combined with case studies/series, underscore the potential use of NF as an add-on treatment option for improving the lives of suffering individuals, being sustained by the changes in brain function and symptomatology improvement. We aim to provide important evidence of neuromodulation using NF in patients with schizophrenia, summarizing the effects and conclusions found in several clinical trials.

Review of EEG-based neurofeedback as a therapeutic intervention to treat depression

Depression, or major depressive disorder, is a common mental disorder that affects individuals' behavior, mood, and physical health, and its prevalence has increased during the lockdowns implemented to curb the COVID-19 pandemic. There is an urgent need to update the treatment recommendations for mental disorders during such crises. Conventional interventions to treat depression include long-term pharmacotherapy and cognitive behavioral therapy. Electroencephalogram-neurofeedback (EEG-NF) training has been suggested as a non-invasive option to treat depression with minimal side effects. In this systematic review, we summarize the recent literature on EEG-NF training for treating depression. The 12 studies included in our final sample reported that despite several issues related to EEG-NF practices, patients with depression showed significant cognitive, clinical, and neural improvements following EEG-NF training. Given its low cost and the low risk of side effects due to its non-invasive nature, we suggest that EEG-NF is worth exploring as an augmented tool for patients who already receive standard medications but remain symptomatic, and that EEG-NF training may be an effective intervention tool that can be utilized as a supplementary treatment for depression. We conclude by providing some suggestions related to experimental designs and standards to improve current EEG-NF training practices for treating depression.

Application of electroencephalographic (EEG) biofeedback therapy in the rehabilitation of patients with chronic diseases

Schizophrenia is one of the chronic mental disorders characterized by disturbances in thought, emotion, language, perception, and behavior. There is no cure for this disease, and most of the current treatments are palliative. In this study, we aimed to analyze the application of electroencephalographic (EEG) biofeedback therapy, an adjunctive treatment used for many psychiatric disorders, in the rehabilitation of schizophrenic patients. Schizophrenic patients were selected as the experimental subjects, and the initial diagnosis criteria were set accordingly. A primary and a secondary efficacy index was then developed for the evaluation of EEG biofeedback therapy rather than traditional drug treatment. Lastly, the effects of the two methods were compared. The findings indicate that traditional drugs could be used in the treatment of mild schizophrenia, but showed poor results for severe and moderate schizophrenia. EEG biofeedback therapy was effective for the treatment of various degrees of schizophrenia and improved patients' sleep quality and anxiety. These findings have significant practical implications for the rehabilitation of schizophrenic patients and patients with chronic diseases in general.

A Systematic Review of the Potential Use of Neurofeedback in Patients With Schizophrenia

Schizophrenia (SCZ) is a neurodevelopmental disorder characterized by positive symptoms (hallucinations and delusions), negative symptoms (anhedonia, social withdrawal) and marked cognitive deficits (memory, executive function, and attention). Current mainstays of treatment, including medications and psychotherapy, do not adequately address cognitive symptoms, which are essential for everyday functioning. However, recent advances in computational neurobiology have rekindled interest in neurofeedback (NF), a form of self-regulation or neuromodulation, in potentially alleviating cognitive symptoms in patients with SCZ. Therefore, we conducted a systematic review of the literature for NF studies in SCZ to identify lessons learned and to identify steps to move the field forward. Our findings reveal that NF studies to date consist mostly of case studies and small sample, single-group studies. Despite few randomized clinical trials, the results suggest that NF is feasible and that it leads to measurable changes in brain function. These findings indicate early proof-of-concept data that needs to be followed up by larger, randomized clinical trials, testing the efficacy of NF compared to well thought out placebos. We hope that such an undertaking by the field will lead to innovative solutions that address refractory symptoms and improve everyday functioning in patients with SCZ.

The Contribution of Biofeedback Brain Boy Method to the Treatment of Anxiety Disorders

Introduction:

Anxiety management is one of the most important health issues which is being faced by humans today. Biofeedback, as a method of neurophysiology, has been added to the methods recommended for this purpose.

Aim:

The aim of the study was to measure the effectiveness of biofeedback method by using Brain Boy Universal Professional in the treatment of anxiety disorders.

Methods:

The sample of this research study consisted of 50 individuals, suffering from symptoms of anxiety, who underwent biofeedback therapy. For the purposes of this study, the self-administered questionnaire Hamilton Rating Scale for Anxiety was completed by the individuals both before the initiation of the therapy and after individuals had completed ten sessions of treatment with biofeedback.

Results:

Prior to biofeedback, 26% of the participants showed mild to moderate anxiety, 12% a medium severity of anxiety and the remaining 62% severe anxiety. After the completion of 10 sessions of biofeedback, 78% of the participants was found to experience mild to moderate anxiety, 12% a medium severity of anxiety and only 10% of severe anxiety.

Conclusion:

Biofeedback can be a therapeutic method for the treatment of anxiety disorders, giving treatment to patients who do not respond to drugs but also to patients who want to apply to undergo such treatment alongside other therapeutic methods including drugs.