Advances in biofeedback and neurofeedback studies on smoking

Integrated use of biofeedback and neurofeedback techniques in treating pathological conditions and improving performance: a narrative review

In recent years, the scientific community has begun tо explore the efficacy оf an integrated neurofeedback + biofeedback approach іn various conditions, both pathological and non-pathological. Although several studies have contributed valuable insights into its potential benefits, this review aims tо further investigate its effectiveness by synthesizing current findings and identifying areas for future research. Our goal іs tо provide a comprehensive overview that may highlight gaps іn the existing literature and propose directions for subsequent studies. The search for articles was conducted on the digital databases PubMed, Scopus, and Web of Science. Studies to have used the integrated neurofeedback + biofeedback approach published between 2014 and 2023 and reviews to have analyzed the efficacy of neurofeedback and biofeedback, separately, related to the same time interval and topics were selected. The search identified five studies compatible with the objectives of the review, related to several conditions: nicotine addiction, sports performance, Autism Spectrum Disorder (ASD), and Attention Deficit Hyperactivity Disorder (ADHD). The integrated neurofeedback + biofeedback approach has been shown to be effective in improving several aspects of these conditions, such as a reduction in the presence of psychiatric symptoms, anxiety, depression, and withdrawal symptoms and an increase in self-esteem in smokers; improvements in communication, imitation, social/cognitive awareness, and social behavior in ASD subjects; improvements in attention, alertness, and reaction time in sports champions; and improvements in attention and inhibitory control in ADHD subjects. Further research, characterized by greater methodological rigor, is therefore needed to determine the effectiveness of this method and the superiority, if any, of this type of training over the single administration of either. This review іs intended tо serve as a catalyst for future research, signaling promising directions for the advancement оf biofeedback and neurofeedback methodologies.

Resting-state electroencephalography theta predicts neurofeedback treatment 4-month follow-up response in nicotine addiction

Background

The high rate of long-term relapse is a major cause of smoking cessation failure. Recently, neurofeedback training has been widely used in the treatment of nicotine addiction; however, approximately 30% of subjects fail to benefit from this intervention. Our previous randomised clinical trial (RCT) examined cognition-guided neurofeedback and demonstrated a significant decrease in daily cigarette consumption at the 4-month follow-up. However, significant individual differences were observed in the 4-month follow-up effects of decreased cigarette consumption. Therefore, it is critical to identify who will benefit from pre-neurofeedback.

Aims

We examined whether the resting-state electroencephalography (EEG) characteristics from pre-neurofeedback predicted the 4-month follow-up effects and explored the possible mechanisms.

Methods

This was a double-blind RCT. A total of 60 participants with nicotine dependence were randomly assigned to either the real-feedback or yoked-feedback group. They underwent 6 min closed-eye resting EEG recordings both before and after two neurofeedback sessions. A follow-up assessment was conducted after 4 months.

Results

The frontal resting-state theta power spectral density (PSD) was significantly altered in the real-feedback group after two neurofeedback visits. Higher theta PSD in the real-feedback group before neurofeedback was the only predictor of decreased cigarette consumption at the 4-month follow-up. Further reliability analysis revealed a significant positive correlation between theta PSD pre-neurofeedback and post-neurofeedback. A leave-one-out cross-validated linear regression of the theta PSD pre-neurofeedback demonstrated a significant correlation between the predicted and observed reductions in cigarette consumption at the 4-month follow-up. Finally, source analysis revealed that the brain mechanisms of the theta PSD predictor were located in the orbital frontal cortex.

Conclusions

Our study demonstrated changes in the resting-state theta PSD following neurofeedback training. Moreover, the resting-state theta PSD may serve as a prognostic marker of neurofeedback effects. A higher resting-state theta PSD predicts a better long-term response to neurofeedback treatment, which may facilitate the selection of individualised interventions.

Trial registration number

ChiCTR-IPR-17011710.

NeuroSuitUp: System Architecture and Validation of a Motor Rehabilitation Wearable Robotics and Serious Game Platform

BACKGROUND

This article presents the system architecture and validation of the NeuroSuitUp body-machine interface (BMI). The platform consists of wearable robotics jacket and gloves in combination with a serious game application for self-paced neurorehabilitation in spinal cord injury and chronic stroke.

METHODS

The wearable robotics implement a sensor layer, to approximate kinematic chain segment orientation, and an actuation layer. Sensors consist of commercial magnetic, angular rate and gravity (MARG), surface electromyography (sEMG), and flex sensors, while actuation is achieved through electrical muscle stimulation (EMS) and pneumatic actuators. On-board electronics connect to a Robot Operating System environment-based parser/controller and to a Unity-based live avatar representation game. BMI subsystems validation was performed using exercises through a Stereoscopic camera Computer Vision approach for the jacket and through multiple grip activities for the glove. Ten healthy subjects participated in system validation trials, performing three arm and three hand exercises (each 10 motor task trials) and completing user experience questionnaires.

RESULTS

Acceptable correlation was observed in 23/30 arm exercises performed with the jacket. No significant differences in glove sensor data during actuation state were observed. No difficulty to use, discomfort, or negative robotics perception were reported.

CONCLUSIONS

Subsequent design improvements will implement additional absolute orientation sensors, MARG/EMG based biofeedback to the game, improved immersion through Augmented Reality and improvements towards system robustness.

Does combined training of biofeedback and neurofeedback affect smoking status, behavior, and longitudinal brain plasticity?

Introduction: Investigations of biofeedback (BF) and neurofeedback (NF) training for nicotine addiction have been long documented to lead to positive gains in smoking status, behavior and to changes in brain activity. We aimed to: (a) evaluate a multi-visit combined BF/NF intervention as an alternative smoking cessation approach, (b) validate training-induced feedback learning, and (c) document effects on resting-state functional connectivity networks (rsFCN); considering gender and degree of nicotine dependence in a longitudinal design. Methods: We analyzed clinical, behavioral, and electrophysiological data from 17 smokers who completed five BF and 20 NF sessions and three evaluation stages. Possible neuroplastic effects were explored comparing whole-brain rsFCN by phase-lag index (PLI) for different brain rhythms. PLI connections with significant change across time were investigated according to different resting-state networks (RSNs). Results: Improvements in smoking status were observed as exhaled carbon monoxide levels, Total Oxidative Stress, and Fageström scores decreased while Vitamin E levels increased across time. BF/NF promoted gains in anxiety, self-esteem, and several aspects of cognitive performance. BF learning in temperature enhancement was observed within sessions. NF learning in theta/alpha ratio increase was achieved across baselines and within sessions. PLI network connections significantly changed across time mainly between or within visual, default mode and frontoparietal networks in theta and alpha rhythms, while beta band RSNs mostly changed significantly after BF sessions. Discussion: Combined BF/NF training positively affects the clinical and behavioral status of smokers, displays benefit in smoking harm reduction, plays a neuroprotective role, leads to learning effects and to positive reorganization of RSNs across time. Clinical Trial Registration: https://clinicaltrials.gov/ct2/show/NCT02991781.

Prevalence of depressive symptoms among dental students is influenced by sex, academic performance, smoking exposure, and sexual orientation

Aim: To estimate the prevalence and associated factors of self-reported depressive symptoms in undergraduate and graduate dental students. Methods: The Depression, Anxiety and Stress Scale (DASS-21) was applied, and only the depression domain was verified. A structured questionnaire was used to collect sociodemographic, behavioral, and COVID-19 pandemic-related fear variables. Academic performance was assessed based on academic records, ranging from 0 (worst possible grade) to 10 (best possible grade). Respondents included 408 regularly enrolled dental students. Bi- and multivariate analyses were performed using Poisson regression with robust variance to verify the association between at least moderate depressive symptoms and independent variables. Results: The prevalence of at least moderate depression was 40.5% among undergraduate students and 26% among graduate students. The prevalence of fear and anxiety due to the COVID-19 pandemic was 96.1% among undergraduate students and 93.5% among graduate students. In the final multivariate analysis, being female (prevalence ratio [PR]:2.01; 95% confidence interval [95%CI]:1.36–2.96) was associated with a higher PR for depression. Conversely, no exposure to smoking (PR:0.54; 95%CI:0.36–0.82) and a final academic performance average ≥7.0 (PR:0.56; 95%CI:0.41–0.76) was associated with a lower PR for depression. Finally, among graduate students, a non-heterosexual orientation was associated with a higher PR for depression (PR:6.70; 95%CI:2.21–20.29). Conclusion: Higher rates of depression symptoms were observed in female undergraduates, students with lower academic performance and smoking exposure, and graduate dental students with a non-heterosexual orientation.

Genetically influenced externalizing and internalizing risk pathways as novel prevention targets

Objective: Risky substance use among college students is widespread, and associated with numerous adverse consequences. Current interventions focus primarily on students' current substance use; we hypothesize that shifting focus from current use to underlying risk factors is a complementary approach that may improve effectiveness of prevention/intervention programming. This approach aligns with the personalized medicine movement, which aims to harness knowledge about underlying etiological factors to provide individuals with specific information about their unique risk profiles and personalized recommendations, to motivate and enable individuals to better self-regulate their health. Method: Our group is building and evaluating an online Personalized Feedback Program (PFP) for college students that provides feedback about the individual's underlying genetically influenced externalizing and internalizing risk factors for substance use, along with personalized recommendations/resources. The project capitalizes on work from a university-wide research project (Spit for Science; S4S), in which > 12,000 students (˜70% of 5 years of incoming freshmen) are being followed longitudinally to assess substance use and related factors across the college years. In this article, we describe our foundational work to develop the PFP. Results: From the S4S data, we have identified risk factors across four domains (Sensation Seeking, Impulsivity, Extraversion, and Neuroticism) that are correlated with college students' substance use. We developed an online self-guided PFP, in collaboration with professionals from student affairs, and using feedback from students, with the ultimate goal of conducting a randomized clinical trial. Conclusion: The provision of personalized risk information represents a novel approach to complement and extend existing college substance use programming. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

The effect of biofeedback on smoking cessation-a systematic short review

Purpose

The aim of this systematic review was to focus on the effect of biofeedback on smoking cessation.

Material and methods

This review was conducted following the PRISMA guidelines. Peer-reviewed original articles including biofeedback and/or neurofeedback training as an intervention for smoking cessation were included. The PubMed, MEDLINE, Web of Science, Scopus, and Cochrane Library databases were screened for trials published up to July 2021. The effects on smoking rates and smoking behavior, and biofeedback/neurofeedback training measures are summarized here.

Results

In total, three articles fulfilled the inclusion criteria. The total Downs and Black checklist scores ranged from 11 to 23 points, showing that the articles were of poor to good methodological quality. The included studies were heterogeneous, both in terms of treatment protocols and in terms of outcome parameters. Pooling of data for a meta-analysis was not possible. Therefore, we were limited to describing the included studies. The included biofeedback study demonstrated that skin temperature training might improve the patients’ ability to raise their skin temperature aiming at stress alleviation. All three studies reported positive effects of biofeedback/neurofeedback in supporting smokers to quit. Furthermore, individualized electroencephalography neurofeedback training showed promising results in one study in modulating craving-related responses.

Conclusion

The results of the present review suggest that biofeedback/neurofeedback training might facilitate smoking cessation by changing behavioral outcomes. Although the investigated studies contained heterogeneous methodologies, they showed interesting approaches that could be further investigated and elaborated. To improve the scientific evidence, prospective randomized controlled trials are needed to investigate biofeedback/neurofeedback in clinical settings for smoking cessation.