Biofeedback as a placebo: anxiety reduction facilitated by training in either suppression or enhancement of alpha brainwaves

Distinguishing Voluntarily Upregulation of Localized Central Alpha from Widespread Posterior Alpha

Neurofeedback (NF) training based on alpha upregulation has been widely used on patient and healthy populations. However, active voluntary modulation of central or widespread posterior alpha in response to central alpha feedback is still ambiguous. The objective of this study is to confirm whether patients learn to truly increase alpha power and to determine if patients modulate central or widespread alpha power when alpha feedback is provided from central brain region. This EEG-based NF study was conducted on seven paraplegic patients with same injury type, pain location, and sensitization to ensure homogeneity. In addition to routine NF training sessions, various experiments were performed to compare alpha NF modulation received from C4 with alpha shift during cognitive tasks, occipital or parieto-occipital cortex, and Laplacian montage which is expected to separate localized alpha from widespread alpha, to attain objectives. Moreover, imaginary coherence analysis in alpha band was also performed to check whether C4 training site is coupled with other brain regions and to confirm whether activity at training site leads/lags the activity of other brain regions. The results indicate widespread alpha modulation in patients during regular NF sessions (p < 0.05) with large effect size (> 0.8), sufficiently high statistical power (> 80%), and a narrower confidence interval (CI) in response to NF provided from the central brain region reflecting less uncertainty and higher precision. However, small effect size obtained with Laplacian montage require patients to be trained with Laplacian feedback to achieve a reliable conclusion regarding localized alpha modulation. The outcomes of this study are not only limited to validate true alpha modulation in response to central alpha feedback but also to explore the mechanism of central alpha NF training.

Efficacy, Trainability, and Neuroplasticity of SMR vs. Alpha Rhythm Shooting Performance Neurofeedback Training

Previous literature on shooting performance neurofeedback training (SP-NFT) to enhance performance usually focused on changes in behavioral indicators, but research on the physiological features of SP-NFT is lacking. To explore the effects of SP-NFT on trainability and neuroplasticity, we conducted a study in which 45 healthy participants were randomly divided into three groups: based on sensory-motor rhythm of C3, Cz and C4 (SMR group), based on alpha rhythm of T3 and T4 (Alpha group), and no NFT (control group). The training was performed for six sessions for 3 weeks. Before and after the SP-NFT, we evaluated changes in shooting performance and resting electroencephalography (EEG) frequency power, participant's subjective task appraisal, neurofeedback trainability score, and EEG feature. Statistical analysis showed that the shooting performance of the participants in the SMR group improved significantly, the participants in the Alpha group decreased, and that of participants in the control group have no change. Meanwhile, the resting EEG power features of the two NFT groups changed specifically after training. The training process data showed that the training difficulty was significantly lower in the SMR group than in the Alpha group. Both NFT groups could improve the neurofeedback trainability scores and change the feedback features by means of their mind strategy. These results may provide evidence of trainability and neuroplasticity for SP-NFT, suggesting that the SP-NFT is effective in brain regulation and thus provide a potential method to improve shooting performance.

Placebo in Surgical Research: A Case-Based Ethical Analysis and Practical Consequences

Placebo is a form of simulated medical treatment intended to deceive the patient/subject who believes that he/she received an active therapy. In clinical medicine, the use of placebo is allowed in particular circumstances to assure a patient that he is taken care of and that he/she receives an active drug, even if this is not the case. In clinical research placebo is widely used, as it allows a baseline comparison for the active intervention. If the use of placebo is highly regulated in pharmacological trials, surgery studies have a series of particularities that make its use extremely problematic and regarded less favorably. The purpose of this paper is to present three famous cases of placebo use in surgical trials and to perform an ethical analysis of their acceptability using the Declaration of Helsinki as a main regulatory source.