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The effects of swLORETA Z-score neurofeedback for patients comorbid with major depressive disorder and anxiety symptoms

BACKGROUND

Patients with major depressive disorder (MDD) exhibit atypical brain activities in the frontal, temporal, and parietal lobes. The study aimed to investigate the effects of standardized weighted low-resolution electromagnetic tomography Z-score neurofeedback (swLZNFB) on symptoms of depression and anxiety, electroencephalography (EEG) parameters, and deep brain activities in patients with MDD.

METHOD

Forty-eight patients with MDD comorbid with anxiety symptoms were assigned to the swLZNFB group and the control group. Participants completed the Beck Depression Inventory-II (BDI-II) and Beck Anxiety Inventory (BAI) and a 5-minute resting EEG at the pre-and post-tests. The swLZNFB group received ten sessions of one-hour treatment twice weekly. The control group received treatment as usual. The scores for BDI-II and BAI, number of EEG abnormalities, percentage of EEG abnormalities, and current source density (CSD) measured in the prefrontal cortex (PFC), anterior cingulate cortex (ACC), posterior cingulate cortex (PCC), and amygdala were compared at pre-and post-tests between the two groups.

RESULTS

There were decreased scores of BDI-II and BAI, number of EEG abnormalities, and percentage of EEG abnormalities at post-test compared with pre-test in the swLZNFB group, and lower scores of BDI-II and BAI at post-test in the swLZNFB group compared with the control group. Moreover, decreased CSD of beta1 and beta3 in the PFC, ACC, PCC, and amygdala at post-test compared to pre-test in the swLZNFB group.

LIMITATIONS

Not a randomized controlled trial.

CONCLUSION

Ten sessions of swLZNFB reduced clinical symptoms and atypical brain activities, it serves as a potential psychological intervention for patients with MDD.

Psychosocial interventions for survivors of rape and sexual assault experienced during adulthood

BACKGROUND

Exposure to rape, sexual assault and sexual abuse has lifelong impacts for mental health and well-being. Prolonged Exposure (PE), Cognitive Processing Therapy (CPT) and Eye Movement Desensitisation and Reprocessing (EMDR) are among the most common interventions offered to survivors to alleviate post-traumatic stress disorder (PTSD) and other psychological impacts. Beyond such trauma-focused cognitive and behavioural approaches, there is a range of low-intensity interventions along with new and emerging non-exposure based approaches (trauma-sensitive yoga, Reconsolidation of Traumatic Memories and Lifespan Integration). This review presents a timely assessment of international evidence on any type of psychosocial intervention offered to individuals who experienced rape, sexual assault or sexual abuse as adults.

OBJECTIVES

To assess the effects of psychosocial interventions on mental health and well-being for survivors of rape, sexual assault or sexual abuse experienced during adulthood.

SEARCH METHODS

In January 2022, we searched CENTRAL, MEDLINE, Embase, 12 other databases and three trials registers. We also checked reference lists of included studies, contacted authors and experts, and ran forward citation searches.

SELECTION CRITERIA

Any study that allocated individuals or clusters of individuals by a random or quasi-random method to a psychosocial intervention that promoted recovery and healing following exposure to rape, sexual assault or sexual abuse in those aged 18 years and above compared with no or minimal intervention, usual care, wait-list, pharmacological only or active comparison(s). We classified psychosocial interventions according to Cochrane Common Mental Disorders Group's psychological therapies list.

DATA COLLECTION AND ANALYSIS

We used the standard methodological procedures expected by Cochrane.

MAIN RESULTS

We included 36 studies (1991 to 2021) with 3992 participants randomly assigned to 60 experimental groups (3014; 76%) and 23 inactive comparator conditions (978, 24%). The experimental groups consisted of: 32 Cognitive Behavioural Therapy (CBT); 10 behavioural interventions; three integrative therapies; three humanist; five other psychologically oriented interventions; and seven other psychosocial interventions. Delivery involved 1 to 20 (median 11) sessions of traditional face-to-face (41) or other individual formats (four); groups (nine); or involved computer-only interaction (six). Most studies were conducted in the USA (n = 26); two were from South Africa; two from the Democratic Republic of the Congo; with single studies from Australia, Canada, the Netherlands, Spain, Sweden and the UK. Five studies did not disclose a funding source, and all disclosed sources were public funding. Participants were invited from a range of settings: from the community, through the media, from universities and in places where people might seek help for their mental health (e.g. war veterans), in the aftermath of sexual trauma (sexual assault centres and emergency departments) or for problems that accompany the experience of sexual violence (e.g. sexual health/primary care clinics). Participants randomised were 99% women (3965 participants) with just 27 men. Half were Black, African or African-American (1889 participants); 40% White/Caucasian (1530 participants); and 10% represented a range of other ethnic backgrounds (396 participants). The weighted mean age was 35.9 years (standard deviation (SD) 9.6). Eighty-two per cent had experienced rape or sexual assault in adulthood (3260/3992). Twenty-two studies (61%) required fulfilling a measured PTSD diagnostic threshold for inclusion; however, 94% of participants (2239/2370) were reported as having clinically relevant PTSD symptoms at entry. The comparison of psychosocial interventions with inactive controls detected that there may be a beneficial effect at post-treatment favouring psychosocial interventions in reducing PTSD (standardised mean difference (SMD) -0.83, 95% confidence interval (CI) -1.22 to -0.44; 16 studies, 1130 participants; low-certainty evidence; large effect size based on Cohen's D); and depression (SMD -0.82, 95% CI -1.17 to -0.48; 12 studies, 901 participants; low-certainty evidence; large effect size). Psychosocial interventions, however, may not increase the risk of dropout from treatment compared to controls, with a risk ratio of 0.85 (95% CI 0.51 to 1.44; 5 studies, 242 participants; low-certainty evidence). Seven of the 23 studies (with 801 participants) comparing a psychosocial intervention to an inactive control reported on adverse events, with 21 events indicated. Psychosocial interventions may not increase the risk of adverse events compared to controls, with a risk ratio of 1.92 (95% CI 0.30 to 12.41; 6 studies; 622 participants; very low-certainty evidence). We conducted an assessment of risk of bias using the RoB 2 tool on a total of 49 reported results. A high risk of bias affected 43% of PTSD results; 59% for depression symptoms; 40% for treatment dropout; and one-third for adverse events. The greatest sources of bias were problems with randomisation and missing outcome data. Heterogeneity was also high, ranging from I2 = 30% (adverse events) to I2 = 87% (PTSD).

AUTHORS' CONCLUSIONS

Our review suggests that survivors of rape, sexual violence and sexual abuse during adulthood may experience a large reduction in post-treatment PTSD symptoms and depressive symptoms after experiencing a psychosocial intervention, relative to comparison groups. Psychosocial interventions do not seem to increase dropout from treatment or adverse events/effects compared to controls. However, the number of dropouts and study attrition were generally high, potentially missing harms of exposure to interventions and/or research participation. Also, the differential effects of specific intervention types needs further investigation. We conclude that a range of behavioural and CBT-based interventions may improve the mental health of survivors of rape, sexual assault and sexual abuse in the short term. Therefore, the needs and preferences of individuals must be considered in selecting suitable approaches to therapy and support. The primary outcome in this review focused on the post-treatment period and the question about whether benefits are sustained over time persists. However, attaining such evidence from studies that lack an active comparison may be impractical and even unethical. Thus, we suggest that studies undertake head-to-head comparisons of different intervention types; in particular, of novel, emerging therapies, with one-year plus follow-up periods. Additionally, researchers should focus on the therapeutic benefits and costs for subpopulations such as male survivors and those living with complex PTSD.

The Resting State of Taiwan EEG Normative Database: Z-Scores of Patients with Major Depressive Disorder as the Cross-Validation

This study referred to the standard of electroencephalography (EEG) collection of normative databases and collected the Taiwan normative database to examine the reliability and validation of the Taiwan EEG normative database. We included 260 healthy participants and divided them into five groups in 10-year age-group segments and calculated the EEG means, standard deviation, and z-scores. Internal consistency reliability was verified at different frequencies between the three electrode locations in the Taiwan normative database. We recruited 221 major depressive disorder (MDD) patients for cross-validation between the Taiwan and NeuroGuide normative databases. There were high internal consistency reliabilities for delta, theta, alpha, beta, and high-beta at C3, Cz, and C4 in the HC group. There were high correlations between the two z-scores of the Taiwan and NeuroGuide normative databases in the frontal, central, parietal, temporal, and occipital lobes from MDD patients. The beta z-scores in the frontal lobe and central area, and the high-beta z-scores in the frontal, central, parietal, temporal, and occipital lobes were greater than one for MDD patients; in addition, the beta and high-beta absolute value z-scores in the whole brain were greater than the ones of MDD patients. The Taiwan EEG normative database has good psychometric characteristics of internal consistency reliability and cross-validation.

Biofeedback as an intervention for persistent post-concussive symptoms: A randomized feasibility trial

Background

Case reports indicate that low-resolution electromagnetic tomography neurofeedback and heart rate variability biofeedback may improve physiological functioning in individuals with persistent post-concussive symptoms. However, it is unclear whether larger-scale studies are feasible.

Purpose

To evaluate the feasibility of a combined low-resolution electromagnetic tomography neurofeedback and heart rate variability biofeedback intervention for individuals with persistent post-concussive symptoms.

Methods

Individuals with persistent post-concussive symptoms were randomized into intervention and control groups, and their baseline and post-test assessments were compared to a healthy control group. Outcomes included self-report questionnaires, resting electroencephalograph and electrocardiograph recordings, and a driving simulation task. Participants in the intervention group completed three 20 min low-resolution electromagnetic tomography neurofeedback sessions per week and at-home heart rate variability biofeedback training every morning and night for 8 weeks. Feasibility was evaluated according to recruitment capability and sample characteristics, data collection procedures, suitability of the intervention and study procedures, management and implementation of the study intervention, and preliminary participant responses to the intervention.

Results

Thirty-three individuals were recruited and 24 completed this study (seven intervention participants, nine persistent post-concussive symptoms control participants, and eight healthy control participants). One-quarter of participants (four intervention participants and three persistent post-concussive symptoms control participants) experienced simulator sickness during the driving simulator task and had to withdraw from the study. Intervention participants had an 88% and 86% compliance rate for the low-resolution electromagnetic tomography neurofeedback and heart rate variability biofeedback sessions, respectively. Low-resolution electromagnetic tomography neurofeedback sessions took approximately 1 h to complete per participant. Preliminary analysis indicated that the intervention reduced electroencephalograph z-score deviation with a very large effect size ( d = 1.36) compared to the other study groups.

Conclusions

Pilot studies evaluating the efficacy of low-resolution electromagnetic tomography neurofeedback and heart rate variability biofeedback should be performed to confirm these preliminary findings. However, the protocol should be modified to reduce participant fatigue and withdrawal. This trial was registered with Clinicialtrials.gov (NCT03338036; https://clinicaltrials.gov/ct2/show/NCT03338036?term=03338036&draw=2&rank=1 ).

Neurofeedback for insomnia: Current state of research

BACKGROUND

Chronic insomnia affects about 6%-13% of the Canadian population. Although treatments already exist, they each have their own issues. Neurofeedback is a neuromodulation technique that specifically targets abnormal brain activity and is gaining attention as a possible insomnia treatment.

AIM

To review the latest studies pertaining to the use of neurofeedback in the treatment of insomnia.

METHODS

In this non-systematic review, only experimental studies assessing the effects of neurofeedback on patients with insomnia were targeted across four bibliographic databases.

RESULTS

A total of 12 studies were retained. All neurofeedback studies included in this study showed a clear improvement of subjective sleep. However, data concerning objective improvement are contradictory. Most studies regarding surface and z-score neurofeedback show that neurofeedback targeting the sensorimotor rhythm in the sensorimotor cortex may help improve subjective sleep. A placebo effect seems also to be present in some studies. Several limitations were present in each study.

CONCLUSION

While studies concerning neurofeedback as a treatment for insomnia are encouraging, many methodological barriers remain to be resolved to prove its efficacy unequivocally. More studies using robust design parameters, as well as the replication of existing studies, are necessary to support neurofeedback as an effective treatment for insomnia.

Brain Activation Imaging in Emotional Decision Making and Mental Health: A Review-Part 1

In part 1 of this article, we describe an approach and methodology that bridges 2 worlds: the internal, subjective experience of emotions and thoughts, and the external world of brain electrical activity. Using a novel event-related brain activation imaging method, we demonstrate that within single trials, short-term mental processes, on the order of 100 ms, can be clearly related to observed brain activation in controlled experiments. We use an ipsative assessment validation process that combines self-report with real-time EEG recordings to provide a combined picture of both the mental and the brain activity, during short-term reactions, emotions, and decisions regarding controlled information. Part 2 provides a detailed description of the emerging emotional decision-making model.

19 Channel Z-Score and LORETA Neurofeedback: Does the Evidence Support the Hype?

Neurofeedback is a well-investigated treatment for ADHD and epilepsy, especially when restricted to standard protocols such as theta/beta, slow cortical potentials and sensori-motor rhythm neurofeedback. Advances in any field are welcome and other techniques are being pursued. Manufacturers and clinicians are marketing ‘superior’ neurofeedback approaches including 19 channel Z-score neurofeedback (ZNFB) and 3-D LORETA neurofeedback (with or without Z-scores; LNFB). We conducted a review of the empirical literature to determine if such claims were warranted. This review included the above search terms in Pubmed, Google scholar and any references that met our criteria from the ZNFB publication list and was restricted to group based studies examining improvement in a clinical population that underwent peer review (book chapters, magazine articles or conference presentations are not included since these are not peer reviewed). Fifteen relevant studies emerged with only six meeting our criterion. Based on review of these studies it was concluded that empirical validation of these approaches is sorely lacking. There is no empirical data that supports the notion that 19-channel z-score neurofeedback is effective or superior. The quality of studies for LNFB was better compared to ZNFB and some suggestion for efficacy was demonstrated for ADHD and Tinnitus distress. However, these findings need to be replicated, extended to other populations and have yet to show any “superiority.” Our conclusions continue to emphasize the pervasive lack of evidence supporting these approaches to neurofeedback and the implications of this are discussed.

Attention, Executive Function, Behavior, and Electrocortical Function, Significantly Improved With 19-Channel Z-Score Neurofeedback in a Clinical Setting: A Pilot Study

OBJECTIVE

Neurofeedback (NF) is gaining recognition as an evidence-based intervention grounded in learning theory, and 19-channel z-score NF (19ZNF) is a new NF model. This pilot study sought to evaluate the efficacy of 19ZNF in a clinical setting.

METHOD

Outcome measures framed groups such that 19ZNF was evaluated, as it relates to the neuropsychological constructs of attention ( n = 10), executive function ( n = 12), behavior ( n = 14), and electrocortical functioning ( n = 21). One-tailed t tests compared pre-post difference scores.

RESULTS

For all pre-post comparisons, the direction of change was in the predicted direction, and differences were statistically significant ( p = .000 to p = .008, effect sizes 1.29 to 3.42).

CONCLUSION

Results suggest 19ZNF improved attention, executive function, behavior, and electrocortical function. This study provides beginning evidence of 19ZNF's efficacy, adds to what is known about 19ZNF, and offers an innovative approach for using quantitative electroencephalographic (QEEG) metrics as outcome measures.

Assessing the Effectiveness of Neurofeedback Training in the Context of Clinical and Social Neuroscience

Social neuroscience benefits from the experimental manipulation of neuronal activity. One possible manipulation, neurofeedback, is an operant conditioning-based technique in which individuals sense, interact with, and manage their own physiological and mental states. Neurofeedback has been applied to a wide variety of psychiatric illnesses, as well as to treat sub-clinical symptoms, and even to enhance performance in healthy populations. Despite growing interest, there persists a level of distrust and/or bias in the medical and research communities in the USA toward neurofeedback and other functional interventions. As a result, neurofeedback has been largely ignored, or disregarded within social neuroscience. We propose a systematic, empirically-based approach for assessing the effectiveness, and utility of neurofeedback. To that end, we use the term perturbative physiologic plasticity to suggest that biological systems function as an integrated whole that can be perturbed and guided, either directly or indirectly, into different physiological states. When the intention is to normalize the system, e.g., via neurofeedback, we describe it as self-directed neuroplasticity, whose outcome is persistent functional, structural, and behavioral changes. We argue that changes in physiological, neuropsychological, behavioral, interpersonal, and societal functioning following neurofeedback can serve as objective indices and as the metrics necessary for assessing levels of efficacy. In this chapter, we examine the effects of neurofeedback on functional connectivity in a few clinical disorders as case studies for this approach. We believe this broader perspective will open new avenues of investigation, especially within social neuroscience, to further elucidate the mechanisms and effectiveness of these types of interventions, and their relevance to basic research.

A Methodology of Analysis for Monitoring Treatment Progression with 19-Channel Z-Score Neurofeedback (19ZNF) in a Single-Subject Design

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 outcome measures (including self-report) are briefly discussed. 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 towards 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.

Advances in Assessment and Treatment of ADHD Using Network Analyses

The purpose of this review is to discuss how new advances in neuroimaging and functional network analyses are applied to electroencephalography (EEG) biofeedback or neurofeedback. Clinical efficacy of one or a few scalp EEG recordings used in the treatment of attention-deficit hyperactivity disorder (ADHD) has been repeatedly demonstrated over the past 34 years. However, a problem is that improved clinical outcome often requires 40 to 80 sessions, which is expensive and difficult for patient compliance. This review cites the scientific literature of direct measures of the nodes and connections between nodes in the attention and default mode networks that are correlated with ADHD using functional magnetic resonance imaging, positron emission tomography, and EEG inverse solutions such as low-resolution electromagnetic tomography. Three-dimensional EEG biofeedback that targets dysregulation in Brodmann areas of the attention and default networks provides increased specificity and can result in improved clinical outcome in fewer sessions.

Z-Score LORETA Neurofeedback as a Potential Therapy for ADHD

Attention deficit hyperactivity disorder (ADHD) is a disorder of relatively high prevalence and frequently contributes to poor school and work performance. Neurofeedback (NFB) has proven to be an effective therapeutic modality in the treatment of ADHD. Recently introduced z-score LORETA neurofeedback offers promise as a tool, and appears to provide a more efficient therapy than standard two-channel neurofeedback. This advantage is based on the ability to train 19 channels simultaneously, and the ability to directly target an electrically dysregulated area of the brain, which may be more difficult to access with standard neurofeedback therapy (areas addressed with LORETA neurofeedback include the cingulate gyrus and hippocampal structures). This paper presents our experience with Z-score LORETA neurofeedback in the treatment of ADHD.