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Diotaiuti P, Corrado S, Tosti B, Spica G, Di Libero T, D’Oliveira A, Zanon A, Rodio A, Andrade A, Mancone S. Evaluating the effectiveness of neurofeedback in chronic pain management: a narrative review. Front Psychol 2024; 15:1369487. [PMID: 38770259 PMCID: PMC11104502 DOI: 10.3389/fpsyg.2024.1369487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 03/28/2024] [Indexed: 05/22/2024] Open
Abstract
The prevalence and impact of chronic pain in individuals worldwide necessitate effective management strategies. This narrative review specifically aims to assess the effectiveness of neurofeedback, an emerging non-pharmacological intervention, on the management of chronic pain. The methodology adopted for this review involves a meticulous search across various scientific databases. The search was designed to capture a broad range of studies related to neurofeedback and chronic pain management. To ensure the quality and relevance of the included studies, strict inclusion and exclusion criteria were applied. These criteria focused on the study design, population, intervention type, and reported outcomes. The review synthesizes the findings from a diverse array of studies, including randomized controlled trials, observational studies, and case reports. Key aspects evaluated include the types of neurofeedback used (such as EEG biofeedback), the various chronic pain conditions addressed (like fibromyalgia, neuropathic pain, and migraines), and the methodologies employed in these studies. The review highlights the underlying mechanisms by which neurofeedback may influence pain perception and management, exploring theories related to neural plasticity, pain modulation, and psychological factors. The results of the review reveal a positive correlation between neurofeedback interventions and improved pain management. Several studies report significant reductions on pain intensity, improved quality of life, and decreased reliance on medication following neurofeedback therapy. The review also notes variations in the effectiveness of different neurofeedback protocols and individual responses to treatment. Despite the promising results, the conclusion of the review emphasizes the need for further research. It calls for larger, well-designed clinical trials to validate the findings, to understand the long-term implications of neurofeedback therapy, and to optimize treatment protocols for individual patients.
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Affiliation(s)
- Pierluigi Diotaiuti
- Department of Human Sciences, Society and Health, University of Cassino and Southern Lazio, Cassino, Lazio, Italy
| | - Stefano Corrado
- Department of Human Sciences, Society and Health, University of Cassino and Southern Lazio, Cassino, Lazio, Italy
| | - Beatrice Tosti
- Department of Human Sciences, Society and Health, University of Cassino and Southern Lazio, Cassino, Lazio, Italy
| | - Giuseppe Spica
- Department of Human Sciences, Society and Health, University of Cassino and Southern Lazio, Cassino, Lazio, Italy
| | - Tommaso Di Libero
- Department of Human Sciences, Society and Health, University of Cassino and Southern Lazio, Cassino, Lazio, Italy
| | - Anderson D’Oliveira
- Department of Physical Education, CEFID, Santa Catarina State University, Florianopolis, Santa Catarina, Brazil
| | - Alessandra Zanon
- Department of Human Sciences, Society and Health, University of Cassino and Southern Lazio, Cassino, Lazio, Italy
| | - Angelo Rodio
- Department of Human Sciences, Society and Health, University of Cassino and Southern Lazio, Cassino, Lazio, Italy
| | - Alexandro Andrade
- Department of Physical Education, CEFID, Santa Catarina State University, Florianopolis, Santa Catarina, Brazil
| | - Stefania Mancone
- Department of Human Sciences, Society and Health, University of Cassino and Southern Lazio, Cassino, Lazio, Italy
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Kleih SC, Botrel L. Inconclusive results of slow cortical potential neurofeedback for the treatment of chronic post-stroke attention deficits. Front Hum Neurosci 2024; 18:1301622. [PMID: 38646162 PMCID: PMC11026669 DOI: 10.3389/fnhum.2024.1301622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 03/06/2024] [Indexed: 04/23/2024] Open
Abstract
Introduction Individuals who have suffered a stroke may experience long-lasting cognitive impairments that can worsen if left untreated. We investigated whether voluntary control of slow cortical potentials (SCP) through neurofeedback would help alleviate chronic post-stroke symptoms of impaired attention. Methods The study initially enrolled twenty-eight participants, but due to a high drop-out rate, only sixteen participants completed eight SCP neurofeedback training sessions within three to four weeks. During these sessions, we gave feedback to the participants on their ability to regulate SCPs on a computer screen. Results Our findings showed a non-significant increase in SCP regulation towards cortical negativity. On the behavioral level, we found improved test values in the divided attention and attentional flexibility subtests of the test battery for attention performance. However, we cannot eliminate the possibility that nonspecific effects influenced or caused our results. We have not observed any improvement regarding the effects of attention deficits on participants' daily lives. We identified five individuals who could gain SCP control successfully and consistently towards negativity. In this group of responders, we observed an improvement in the test results related to divided attention but no other attention-related improvements. Discussion Based on our observations, results of SCP neurofeedback training for the treatment of attention deficits after a stroke are inconclusive. More research is necessary to determine the effectiveness of SCP neurofeedback in helping stroke survivors cope with attention-related challenges in their daily lives.
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Affiliation(s)
- Sonja C Kleih
- Institute of Psychology, Biological Psychology Clinical Psychology and Psychotherapy, Faculty of Human Sciences, Julius-Maximilians-Universität Würzburg, Würzburg, Germany
| | - Loic Botrel
- Institute of Psychology, Biological Psychology Clinical Psychology and Psychotherapy, Faculty of Human Sciences, Julius-Maximilians-Universität Würzburg, Würzburg, Germany
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Mediating Mindfulness-Based Interventions with Virtual Reality in Non-Clinical Populations: The State-of-the-Art. Healthcare (Basel) 2022; 10:healthcare10071220. [PMID: 35885747 PMCID: PMC9316803 DOI: 10.3390/healthcare10071220] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 06/27/2022] [Accepted: 06/27/2022] [Indexed: 11/17/2022] Open
Abstract
Mindfulness is one of the most popular psychotherapeutic techniques that help to promote good mental and physical health. Combining mindfulness with immersive virtual reality (VR) has been proven to be especially effective for a wide range of mood disorders for which traditional mindfulness has proven valuable. However, the vast majority of immersive VR-enhanced mindfulness applications have focused on clinical settings, with little evidence on healthy subjects. This narrative review evaluates the real effectiveness of state-of-the-art mindfulness interventions mediated by VR systems in influencing mood and physiological status in non-clinical populations. Only studies with an RCT study design were considered. We conclude that most studies were characterized by one single meditation experience, which seemed sufficient to induce a significant reduction in negative mood states (anxiety, anger, depression, tension) combined with increased mindfulness skills. However, physiological correlates of mindfulness practices have scarcely been investigated. The application of VR-enhanced mindfulness-based interventions in non-clinical populations is in its infancy since most studies have several limitations, such as the poor employment of the RCT study design, the lack of physiological measurements (i.e., heart rate variability), as well as the high heterogeneity in demographical data, technological devices, and VR procedures. We thus concluded that before applying mindfulness interventions mediated by VR in clinical populations, more robust and reliable methodological procedures need to be defined.
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Shtark MB, Kozlova LI, Bezmaternykh DD, Mel'nikov MY, Savelov AA, Sokhadze EM. Neuroimaging Study of Alpha and Beta EEG Biofeedback Effects on Neural Networks. Appl Psychophysiol Biofeedback 2019; 43:169-178. [PMID: 29926265 DOI: 10.1007/s10484-018-9396-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Neural networks interaction was studied in healthy men (20-35 years old) who underwent 20 sessions of EEG biofeedback training outside the MRI scanner, with concurrent fMRI-EEG scans at the beginning, middle, and end of the course. The study recruited 35 subjects for EEG biofeedback, but only 18 of them were considered as "successful" in self-regulation of target EEG bands during the whole course of training. Results of fMRI analysis during EEG biofeedback are reported only for these "successful" trainees. The experimental group (N = 23 total, N = 13 "successful") upregulated the power of alpha rhythm, while the control group (N = 12 total, N = 5 "successful") beta rhythm, with the protocol instructions being as for alpha training in both. The acquisition of the stable skills of alpha self-regulation was followed by the weakening of the irrelevant links between the cerebellum and visuospatial network (VSN), as well as between the VSN, the right executive control network (RECN), and the cuneus. It was also found formation of a stable complex based on the interaction of the precuneus, the cuneus, the VSN, and the high level visuospatial network (HVN), along with the strengthening of the interaction of the anterior salience network (ASN) with the precuneus. In the control group, beta enhancement training was accompanied by weakening of interaction between the precuneus and the default mode network, and a decrease in connectivity between the cuneus and the primary visual network (PVN). The differences between the alpha training group and the control group increased successively during training. Alpha training was characterized by a less pronounced interaction of the network formed by the PVN and the HVN, as well as by an increased interaction of the cerebellum with the precuneus and the RECN. The study demonstrated the differences in the structure and interaction of neural networks involved into alpha and beta generating systems forming and functioning, which should be taken into account during planning neurofeedback interventions. Possibility of using fMRI-guided biofeedback organized according to the described neural networks interaction may advance more accurate targeting specific symptoms during neurotherapy.
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Affiliation(s)
- Mark B Shtark
- Research Institute of Molecular Biology and Biophysics, Novosibirsk, Russia, 630117.,Institute of Medicine and Psychology, Novosibirsk State University, Novosibirsk, Russia, 630090
| | - Lyudmila I Kozlova
- Research Institute of Molecular Biology and Biophysics, Novosibirsk, Russia, 630117.,Institute of Medicine and Psychology, Novosibirsk State University, Novosibirsk, Russia, 630090
| | - Dmitriy D Bezmaternykh
- Research Institute of Molecular Biology and Biophysics, Novosibirsk, Russia, 630117.,Institute of Medicine and Psychology, Novosibirsk State University, Novosibirsk, Russia, 630090
| | - Mikhail Ye Mel'nikov
- Research Institute of Molecular Biology and Biophysics, Novosibirsk, Russia, 630117.,Institute of Medicine and Psychology, Novosibirsk State University, Novosibirsk, Russia, 630090
| | - Andrey A Savelov
- International Tomography Center, Siberian Division of Russian Academy of Sciences, Novosibirsk, Russia, 630090
| | - Estate M Sokhadze
- University of South Carolina, School of Medicine-Greenville, Greenville, SC, 29605, USA. .,Department of Biomedical Sciences, University of South Carolina, School of Medicine-Greenville, 200 Patewood Dr. #A200, Greenville, SC, 29615, USA.
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Dalkner N, Unterrainer HF, Wood G, Skliris D, Holasek SJ, Gruzelier JH, Neuper C. Short-term Beneficial Effects of 12 Sessions of Neurofeedback on Avoidant Personality Accentuation in the Treatment of Alcohol Use Disorder. Front Psychol 2017; 8:1688. [PMID: 29018397 PMCID: PMC5622970 DOI: 10.3389/fpsyg.2017.01688] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 09/13/2017] [Indexed: 11/13/2022] Open
Abstract
This study evaluated the effects of alpha/theta neurofeedback on Clinical Personality Accentuations in individuals with alcohol use disorder. Twenty-five males were investigated using a pre-test/post-test design with a waiting-list control group. Participants were randomly assigned either to an experimental group (n = 13) receiving 12 sessions of neurofeedback twice a week as a treatment adjunct over a period of 6 weeks, or to a control group (n = 12) receiving treatment as usual. The Inventory of Clinical Personality Accentuations and the NEO-Five-Factor Inventory were applied at pre- and post-test. The neurofeedback protocol focused on enhancement of the EEG alpha (8-12 Hz) and theta (4-7 Hz) and used a visual feedback paradigm. Analyses of covariance showed improvements in Avoidant Personality Accentuation within the experimental group. Our data suggest that 12 sessions of this neurofeedback intervention might be effective in reducing avoidant and stress-related personality traits in patients with alcohol use disorder.
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Affiliation(s)
- Nina Dalkner
- Institute of Psychology, Karl-Franzens University of Graz, Graz, Austria.,Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Human F Unterrainer
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria.,Center for Integrative Addiction Research (Grüner Kreis Society), Vienna, Austria
| | - Guilherme Wood
- Institute of Psychology, Karl-Franzens University of Graz, Graz, Austria
| | - Dimitris Skliris
- Institute of Psychology, Karl-Franzens University of Graz, Graz, Austria
| | - Sandra J Holasek
- Institute of Pathophysiology and Immunology, Medical University of Graz, Graz, Austria
| | - John H Gruzelier
- Department of Psychology, Goldsmiths, University of London, London, United Kingdom
| | - Christa Neuper
- Institute of Psychology, Karl-Franzens University of Graz, Graz, Austria
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A Randomized Trial of Comparing the Efficacy of Two Neurofeedback Protocols for Treatment of Clinical and Cognitive Symptoms of ADHD: Theta Suppression/Beta Enhancement and Theta Suppression/Alpha Enhancement. BIOMED RESEARCH INTERNATIONAL 2017; 2017:3513281. [PMID: 28321406 PMCID: PMC5340952 DOI: 10.1155/2017/3513281] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/21/2016] [Revised: 11/18/2016] [Accepted: 01/19/2017] [Indexed: 11/17/2022]
Abstract
Introduction. Neurofeedback (NF) is an adjuvant or alternative therapy for children with Attention Deficit Hyperactivity Disorder (ADHD). This study intended to compare the efficacy of two different NF protocols on clinical and cognitive symptoms of ADHD. Materials and Methods. In this clinical trial, sixty children with ADHD aged 7 to 10 years old were randomly grouped to receive two different NF treatments (theta suppression/beta enhancement protocol and theta suppression/alpha enhancement protocol). Clinical and cognitive assessments were conducted prior to and following the treatment and also after an eight-week follow-up. Results. Both protocols alleviated the symptoms of ADHD in general (p < 0.001), hyperactivity (p < 0.001), inattention (p < 0.001), and omission errors (p < 0.001); however, they did not affect the oppositional and impulsive scales nor commission errors. These effects were maintained after an eight-week intervention-free period. The only significant difference between the two NF protocols was that high-frequency alpha enhancement protocol performed better in suppressing omission errors (p < 0.001). Conclusion. The two NF protocols with theta suppression/beta enhancement and theta suppression/alpha enhancement have considerable and comparable effect on clinical symptoms of ADHD. Alpha enhancement protocol was more effective in suppressing omission errors.
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Wang Y, Sokhadze EM, El-Baz AS, Li X, Sears L, Casanova MF, Tasman A. Relative Power of Specific EEG Bands and Their Ratios during Neurofeedback Training in Children with Autism Spectrum Disorder. Front Hum Neurosci 2016; 9:723. [PMID: 26834615 PMCID: PMC4712412 DOI: 10.3389/fnhum.2015.00723] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 12/24/2015] [Indexed: 11/13/2022] Open
Abstract
Neurofeedback is a mode of treatment that is potentially useful for improving self-regulation skills in persons with autism spectrum disorder. We proposed that operant conditioning of EEG in neurofeedback mode can be accompanied by changes in the relative power of EEG bands. However, the details on the change of the relative power of EEG bands during neurofeedback training course in autism are not yet well explored. In this study, we analyzed the EEG recordings of children diagnosed with autism and enrolled in a prefrontal neurofeedback treatment course. The protocol used in this training was aimed at increasing the ability to focus attention, and the procedure represented the wide band EEG amplitude suppression training along with upregulation of the relative power of gamma activity. Quantitative EEG analysis was completed for each session of neurofeedback using wavelet transform to determine the relative power of gamma and theta/beta ratio, and further to detect the statistical changes within and between sessions. We found a linear decrease of theta/beta ratio and a liner increase of relative power of gamma activity over 18 weekly sessions of neurofeedback in 18 high functioning children with autism. The study indicates that neurofeedback is an effective method for altering EEG characteristics associated with the autism spectrum disorder. Also, it provides information about specific changes of EEG activities and details the correlation between changes of EEG and neurofeedback indexes during the course of neurofeedback. This pilot study contributes to the development of more effective approaches to EEG data analysis during prefrontal neurofeedback training in autism.
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Affiliation(s)
- Yao Wang
- State Key Laboratory of Cognitive Neuroscience and Learning & IDG/McGovern Institute for Brain Research, Beijing Normal UniversityBeijing, China
- Center for Collaboration and Innovation in Brain and Learning Sciences, Beijing Normal UniversityBeijing, China
| | - Estate M. Sokhadze
- Department of Bioengineering, J.B Speed School of Engineering, University of LouisvilleLouisville, KY, USA
- Greenville Health System, Departments of Pediatrics and Biomedical Sciences, University of South Carolina School of Medicine GreenvilleGreenville, SC, USA
- Department of Psychiatry and Behavioral Sciences, University of Louisville School of MedicineLouisville, KY, USA
| | - Ayman S. El-Baz
- Department of Bioengineering, J.B Speed School of Engineering, University of LouisvilleLouisville, KY, USA
| | - Xiaoli Li
- State Key Laboratory of Cognitive Neuroscience and Learning & IDG/McGovern Institute for Brain Research, Beijing Normal UniversityBeijing, China
- Center for Collaboration and Innovation in Brain and Learning Sciences, Beijing Normal UniversityBeijing, China
| | - Lonnie Sears
- Department of Pediatrics, University of Louisville School of MedicineLouisville, KY, USA
| | - Manuel F. Casanova
- Greenville Health System, Departments of Pediatrics and Biomedical Sciences, University of South Carolina School of Medicine GreenvilleGreenville, SC, USA
- Department of Psychiatry and Behavioral Sciences, University of Louisville School of MedicineLouisville, KY, USA
| | - Allan Tasman
- Department of Psychiatry and Behavioral Sciences, University of Louisville School of MedicineLouisville, KY, USA
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Sokhadze EM, El-Baz AS, Tasman A, Sears LL, Wang Y, Lamina EV, Casanova MF. Neuromodulation integrating rTMS and neurofeedback for the treatment of autism spectrum disorder: an exploratory study. Appl Psychophysiol Biofeedback 2014; 39:237-57. [PMID: 25267414 PMCID: PMC4221494 DOI: 10.1007/s10484-014-9264-7] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Autism spectrum disorder (ASD) is a pervasive developmental disorder characterized by deficits in social interaction, language, stereotyped behaviors, and restricted range of interests. In previous studies low frequency repetitive transcranial magnetic stimulation (rTMS) has been used, with positive behavioral and electrophysiological results, for the experimental treatment in ASD. In this study we combined prefrontal rTMS sessions with electroencephalographic (EEG) neurofeedback (NFB) to prolong and reinforce TMS-induced EEG changes. The pilot trial recruited 42 children with ASD (~14.5 years). Outcome measures included behavioral evaluations and reaction time test with event-related potential (ERP) recording. For the main goal of this exploratory study we used rTMS-neurofeedback combination (TMS-NFB, N = 20) and waitlist (WTL, N = 22) groups to examine effects of 18 sessions of integrated rTMS-NFB treatment or wait period) on behavioral responses, stimulus and response-locked ERPs, and other functional and clinical outcomes. The underlying hypothesis was that combined TMS-NFB will improve executive functions in autistic patients as compared to the WTL group. Behavioral and ERP outcomes were collected in pre- and post-treatment tests in both groups. Results of the study supported our hypothesis by demonstration of positive effects of combined TMS-NFB neurotherapy in active treatment group as compared to control WTL group, as the TMS-NFB group showed significant improvements in behavioral and functional outcomes as compared to the WTL group.
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Affiliation(s)
- Estate M Sokhadze
- University of Louisville, 401 E Chestnut Street, Suite 600, Louisville, KY, 40202, USA,
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Simkin DR, Thatcher RW, Lubar J. Quantitative EEG and neurofeedback in children and adolescents: anxiety disorders, depressive disorders, comorbid addiction and attention-deficit/hyperactivity disorder, and brain injury. Child Adolesc Psychiatr Clin N Am 2014; 23:427-64. [PMID: 24975621 DOI: 10.1016/j.chc.2014.03.001] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
This article explores the science surrounding neurofeedback. Both surface neurofeedback (using 2-4 electrodes) and newer interventions, such as real-time z-score neurofeedback (electroencephalogram [EEG] biofeedback) and low-resolution electromagnetic tomography neurofeedback, are reviewed. The limited literature on neurofeedback research in children and adolescents is discussed regarding treatment of anxiety, mood, addiction (with comorbid attention-deficit/hyperactivity disorder), and traumatic brain injury. Future potential applications, the use of quantitative EEG for determining which patients will be responsive to medications, the role of randomized controlled studies in neurofeedback research, and sensible clinical guidelines are considered.
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Affiliation(s)
- Deborah R Simkin
- Committee on Integrative Medicine, American Academy of Child and Adolescent Psychiatry, Attention, Memory and Cognition Center, 4641 Gulfstarr Drive, Suite 106, Destin, FL 32541, USA; Department of Psychiatry, Emory University Medical School, Atlanta, Georgia.
| | - Robert W Thatcher
- Neuroimaging Laboratory, Applied Neuroscience Research Institute, 7985 113th Street, Suite 210, Seminole, FL 33772, USA
| | - Joel Lubar
- University of Tennessee, Knoxville, TN, USA; Southeastern Neurofeedback Institute, Inc, 111 North Pompano Beach Boulevard, Suite 1214, Pompano Beach, FL 33062, USA; International Society for Neurofeedback and Research
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Arns M, Heinrich H, Strehl U. Evaluation of neurofeedback in ADHD: the long and winding road. Biol Psychol 2013; 95:108-15. [PMID: 24321363 DOI: 10.1016/j.biopsycho.2013.11.013] [Citation(s) in RCA: 218] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Revised: 11/11/2013] [Accepted: 11/27/2013] [Indexed: 10/25/2022]
Abstract
Among the clinical applications of neurofeedback, most research has been conducted in ADHD. As an introduction a short overview of the general history of neurofeedback will be given, while the main part of the paper deals with a review of the current state of neurofeedback in ADHD. A meta-analysis on neurofeedback from 2009 found large effect sizes for inattention and impulsivity and medium effects sizes for hyperactivity. Since 2009 several new studies, including 4 placebo-controlled studies, have been published. These latest studies are reviewed and discussed in more detail. The review focuses on studies employing (1) semi-active, (2) active, and (3) placebo-control groups. The assessment of specificity of neurofeedback treatment in ADHD is discussed and it is concluded that standard protocols such as theta/beta, SMR and slow cortical potentials neurofeedback are well investigated and have demonstrated specificity. The paper ends with an outlook on future questions and tasks. It is concluded that future controlled clinical trials should, in a next step, focus on such known protocols, and be designed along the lines of learning theory.
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Affiliation(s)
- Martijn Arns
- Research Institute Brainclinics, Nijmegen, The Netherlands; Utrecht University, Dept. Experimental Psychology, Utrecht, The Netherlands.
| | - Hartmut Heinrich
- Dept. of Child and Adolescent Mental Health, University Hospital of Erlangen, Erlangen, Germany; Heckscher-Klinikum, München, Germany
| | - Ute Strehl
- University of Tuebingen, Tuebingen, Germany
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Abstract
OBJECTIVE The intent of this manuscript was to review all published studies on slow cortical potentials (SCP) neurofeedback for the treatment of ADHD, with emphasis on neurophysiological rationale, study design, protocol, outcomes, and limitations. METHOD For review, PubMed, MEDLINE, ERIC, and Google Scholar searches identified six studies and six subsequent publications. In addition to five studies focusing on children with Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV)-diagnosed ADHD, one study reports on adults. RESULTS SCP protocols utilize unipolar-electrode placement at Cz, randomized bidirectional signal regulation, feedback/transfer trials, and discrete feedback/rewards. Results demonstrated learning of SCP self-regulation, moderate to large within group effect sizes for core ADHD symptom reduction, and enhancement of event-related potentials/electroencephalogram components. Neurophysiological and session variables were predictive of treatment outcome, but open questions of specific and nonspecific effects remain. Study limitations and future directions are discussed. CONCLUSION SCP is an efficacious and standardized neurofeedback protocol that addresses behavioral and neurophysiological deficits in ADHD.
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Kerson C. A proposed multisite double-blind randomized clinical trial of neurofeedback for ADHD: need, rationale, and strategy. J Atten Disord 2013; 17:420-36. [PMID: 23590978 DOI: 10.1177/1087054713482580] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Additional treatments with persisting benefit are needed for ADHD. Because ADHD often shows excessive theta electroencephalogram (EEG) power, low beta, and excessive theta-beta ratio (TBR), a promising treatment is neurofeedback (NF) downtraining TBR. Although several nonblind randomized clinical trials (RCTs) show a medium-large benefit for NF, a well-blinded, sham-controlled RCT is needed to differentiate specific from nonspecific effects. METHOD Experts in NF, ADHD, clinical trials, and statistics collaborated to design a double-blind multisite RCT. RESULTS/CONCLUSION At four sites, 180 children aged 7 to 10 years with rigorously diagnosed ADHD and TBR ≥ 5 will be randomized to active TBR-NF versus sham NF of equal duration, intensity, and appearance. Sham, utilizing prerecorded EEGs with participant artifacts superimposed, will keep participants and staff blind. Treatment fidelity will be trained/monitored by acknowledged NF leaders. Multidomain assessments before, during, and after treatment (follow-up to 2 years) will also include tests of blinding and sham inertness.
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Hillard B, El-Baz AS, Sears L, Tasman A, Sokhadze EM. Neurofeedback training aimed to improve focused attention and alertness in children with ADHD: a study of relative power of EEG rhythms using custom-made software application. Clin EEG Neurosci 2013; 44:193-202. [PMID: 23820311 DOI: 10.1177/1550059412458262] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Neurofeedback is a nonpharmacological treatment for attention-deficit hyperactivity disorder (ADHD). We propose that operant conditioning of electroencephalogram (EEG) in neurofeedback training aimed to mitigate inattention and low arousal in ADHD, will be accompanied by changes in EEG bands' relative power. Patients were 18 children diagnosed with ADHD. The neurofeedback protocol ("Focus/Alertness" by Peak Achievement Trainer) has a focused attention and alertness training mode. The neurofeedback protocol provides one for Focus and one for Alertness. This does not allow for collecting information regarding changes in specific EEG bands (delta, theta, alpha, low and high beta, and gamma) power within the 2 to 45 Hz range. Quantitative EEG analysis was completed on each of twelve 25-minute-long sessions using a custom-made MatLab application to determine the relative power of each of the aforementioned EEG bands throughout each session, and from the first session to the last session. Additional statistical analysis determined significant changes in relative power within sessions (from minute 1 to minute 25) and between sessions (from session 1 to session 12). Analysis was of relative power of theta, alpha, low and high beta, theta/alpha, theta/beta, and theta/low beta and theta/high beta ratios. Additional secondary measures of patients' post-neurofeedback outcomes were assessed, using an audiovisual selective attention test (IVA + Plus) and behavioral evaluation scores from the Aberrant Behavior Checklist. Analysis of data computed in the MatLab application, determined that theta/low beta and theta/alpha ratios decreased significantly from session 1 to session 12, and from minute 1 to minute 25 within sessions. The findings regarding EEG changes resulting from brain wave self-regulation training, along with behavioral evaluations, will help elucidate neural mechanisms of neurofeedback aimed to improve focused attention and alertness in ADHD.
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Affiliation(s)
- Brent Hillard
- Department of Psychiatry & Behavioral Sciences, University of Louisville School of Medicine, Louisville, KY, USA
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Larsen S, Sherlin L. Neurofeedback: an emerging technology for treating central nervous system dysregulation. Psychiatr Clin North Am 2013; 36:163-8. [PMID: 23538085 DOI: 10.1016/j.psc.2013.01.005] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Neurofeedback is a machine-mediated noninvasive treatment modality based on the analysis and "feeding back" of electroencephalogram brainwaves, which has shown efficacy with a variety of central nervous system-based problems. It has special application where patients have adverse reaction to psychopharmacologic treatments and psychotherapy, cognitive behavioral therapy, and dialectical behavior therapy have proved ineffective. Treatment modalities include active forms based on operant conditioning, involving a subject's response to stimuli. Neurofeedback is strong in clinical confirmations of efficacy (case studies) and has thus far limited controlled studies in the peer-reviewed journals.
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Affiliation(s)
- Stephen Larsen
- Stone Mountain Center, 310 River Road Exd, New Paltz, NY 12561, USA
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Russell-Chapin L, Kemmerly T, Liu WC, Zagardo MT, Chapin T, Dailey D, Dinh D. The Effects of Neurofeedback in the Default Mode Network: Pilot Study Results of Medicated Children with ADHD. ACTA ACUST UNITED AC 2013. [DOI: 10.1080/10874208.2013.759017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Arns M, Kenemans JL. Neurofeedback in ADHD and insomnia: vigilance stabilization through sleep spindles and circadian networks. Neurosci Biobehav Rev 2012; 44:183-94. [PMID: 23099283 DOI: 10.1016/j.neubiorev.2012.10.006] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2012] [Revised: 06/28/2012] [Accepted: 10/11/2012] [Indexed: 12/26/2022]
Abstract
In this review article an overview of the history and current status of neurofeedback for the treatment of ADHD and insomnia is provided. Recent insights suggest a central role of circadian phase delay, resulting in sleep onset insomnia (SOI) in a sub-group of ADHD patients. Chronobiological treatments, such as melatonin and early morning bright light, affect the suprachiasmatic nucleus. This nucleus has been shown to project to the noradrenergic locus coeruleus (LC) thereby explaining the vigilance stabilizing effects of such treatments in ADHD. It is hypothesized that both Sensori-Motor Rhythm (SMR) and Slow-Cortical Potential (SCP) neurofeedback impact on the sleep spindle circuitry resulting in increased sleep spindle density, normalization of SOI and thereby affect the noradrenergic LC, resulting in vigilance stabilization. After SOI is normalized, improvements on ADHD symptoms will occur with a delayed onset of effect. Therefore, clinical trials investigating new treatments in ADHD should include assessments at follow-up as their primary endpoint rather than assessments at outtake. Furthermore, an implication requiring further study is that neurofeedback could be stopped when SOI is normalized, which might result in fewer sessions.
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Affiliation(s)
- Martijn Arns
- Department of Experimental Psychology, Utrecht University, Utrecht, The Netherlands; Research Institute Brainclinics, Bijleveldsingel 34, 6524 AD Nijmegen, The Netherlands.
| | - J Leon Kenemans
- Department of Experimental Psychology, Utrecht University, Utrecht, The Netherlands
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Lofthouse N, Arnold LE, Hurt E. Current status of neurofeedback for attention-deficit/hyperactivity disorder. Curr Psychiatry Rep 2012; 14:536-42. [PMID: 22890816 DOI: 10.1007/s11920-012-0301-z] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
As conventional treatments offer incomplete benefit for over 33 % of children with attention-deficit/hyperactivity disorder (ADHD) and many refuse to try them, additional treatments are needed. One of the most promising is neurofeedback (NF, EEG biofeedback), which trains the brain with real-time video/audio information about its electrical activity measured from scalp electrodes. Since 2010, data from 8 randomized controlled studies of NF have been published with overall mean effect sizes of: 0.40 (all measures), 0.42 (ADHD measures), 0.56 (inattention), and 0.54 (hyperactivity/ impulsivity). Unfortunately, the benefit reported from randomized studies has not been observed in the few small blinded studies conducted. Main study strengths include randomization, evidence-based diagnostic assessments, multi-domain treatment outcomes, use of some type of blinding, and sham control conditions. Main study limitations include lack of large samples, abnormal EEG participant selection, double-blinding, and testing of blind validity and sham inertness. Most recently, a collaborative NF research group has been planning a definitive double-blind well-controlled trial.
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Affiliation(s)
- Nicholas Lofthouse
- Department of Psychiatry, The Ohio State University, 1670 Upham Drive, Columbus, OH 43210, USA.
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Gevensleben H, Rothenberger A, Moll GH, Heinrich H. Neurofeedback in children with ADHD: validation and challenges. Expert Rev Neurother 2012; 12:447-60. [PMID: 22449216 DOI: 10.1586/ern.12.22] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Neurofeedback (NF), a type of neurobehavioral training, has gained increasing attention in recent years, especially concerning the treatment of children with ADHD. Promising results have emerged from recent randomized controlled studies, and thus, NF is on its way to becoming a valuable addition to the multimodal treatment of ADHD. In this review, we summarize the randomized controlled trials in children with ADHD that have been published within the last 5 years and discuss issues such as the efficacy and specificity of effects, treatment fidelity and problems inherent in placebo-controlled trials of NF. Directions for future NF research are outlined, which should further address specificity and help to determine moderators and mediators to optimize and individualize NF training. Furthermore, we describe methodological (tomographic NF) and technical ('tele-NF') developments that may also contribute to further improvements in treatment outcome.
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Affiliation(s)
- Holger Gevensleben
- Child & Adolescent Psychiatry, University of Göttingen, v. Siebold-Str. 5, D-37075 Göttingen, Germany.
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Myers JE, Young JS. Brain Wave Biofeedback: Benefits of Integrating Neurofeedback in Counseling. JOURNAL OF COUNSELING AND DEVELOPMENT 2012. [DOI: 10.1111/j.1556-6676.2012.00003.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Sokhadze E, Stewart CM, Tasman A, Daniels R, Trudeau D. Review of Rationale for Neurofeedback Application in Adolescent Substance Abusers with Comorbid Disruptive Behavioral Disorders. ACTA ACUST UNITED AC 2011. [DOI: 10.1080/10874208.2011.595298] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Willis WG, Weyandt LL, Lubiner AG, Schubart CD. Neurofeedback as a Treatment for Attention-Deficit/Hyperactivity Disorder: A Systematic Review of Evidence for Practice. JOURNAL OF APPLIED SCHOOL PSYCHOLOGY 2011. [DOI: 10.1080/15377903.2011.590746] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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23
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Lofthouse N, Arnold LE, Hurt E. A Comment on Sherlin, Arns, Lubar, and Sokhadze, 2010. ACTA ACUST UNITED AC 2010. [DOI: 10.1080/10874208.2010.523340] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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