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Sun H, Yu Y, Peng C. Shyness and academic procrastination among Chinese adolescents: a moderated mediation model of self-regulation and self-focused attention. Front Psychol 2024; 15:1352342. [PMID: 38577126 PMCID: PMC10993869 DOI: 10.3389/fpsyg.2024.1352342] [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: 12/08/2023] [Accepted: 02/19/2024] [Indexed: 04/06/2024] Open
Abstract
Academic procrastination is a common concern among adolescents, but the correlation between shyness and academic procrastination and the internal mechanisms have not yet been thoroughly investigated. Based on a questionnaire survey with 1,279 Chinese middle school students, this study examined the effect of shyness on academic procrastination and its underlying mechanism of self-regulation and self-focused attention. Results revealed that: (1) shyness significantly predicted academic procrastination. (2) Self-regulation mediated the relationship between shyness and academic procrastination. (3) Self-focused attention played a moderating role in the first half of this mediation process. Specifically, higher level of self-focused attention strengthened the predictive effect of shyness on self-regulation. These results underscored the latent risks and protective factors associated with shyness, self-regulation, and self-focused attention in adolescent academic procrastination. In future research and interventions, attention may be directed towards improving individual internal factors to assist adolescents in effectively addressing issues related to academic procrastination.
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Affiliation(s)
- Hong Sun
- College of Teacher Education, Taishan University Shandong Province, Tai’an, China
| | - Yang Yu
- College of Teacher Education, Taishan University Shandong Province, Tai’an, China
| | - Chao Peng
- Shandong Provincial Qianfoshan Hospital, Jinan, China
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Noble SC, Woods E, Ward T, Ringwood JV. Accelerating P300-based neurofeedback training for attention enhancement using iterative learning control: a randomised controlled trial. J Neural Eng 2024; 21:026006. [PMID: 38394680 DOI: 10.1088/1741-2552/ad2c9e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 02/23/2024] [Indexed: 02/25/2024]
Abstract
Objective. Neurofeedback (NFB) training through brain-computer interfacing has demonstrated efficacy in treating neurological deficits and diseases, and enhancing cognitive abilities in healthy individuals. It was previously shown that event-related potential (ERP)-based NFB training using a P300 speller can improve attention in healthy adults by incrementally increasing the difficulty of the spelling task. This study aims to assess the impact of task difficulty adaptation on ERP-based attention training in healthy adults. To achieve this, we introduce a novel adaptation employing iterative learning control (ILC) and compare it against an existing method and a control group with random task difficulty variation.Approach. The study involved 45 healthy participants in a single-blind, three-arm randomised controlled trial. Each group underwent one NFB training session, using different methods to adapt task difficulty in a P300 spelling task: two groups with personalised difficulty adjustments (our proposed ILC and an existing approach) and one group with random difficulty. Cognitive performance was evaluated before and after the training session using a visual spatial attention task and we gathered participant feedback through questionnaires.Main results. All groups demonstrated a significant performance improvement in the spatial attention task post-training, with an average increase of 12.63%. Notably, the group using the proposed iterative learning controller achieved a 22% increase in P300 amplitude during training and a 17% reduction in post-training alpha power, all while significantly accelerating the training process compared to other groups.Significance. Our results suggest that ERP-based NFB training using a P300 speller effectively enhances attention in healthy adults, with significant improvements observed after a single session. Personalised task difficulty adaptation using ILC not only accelerates the training but also enhances ERPs during the training. Accelerating NFB training, while maintaining its effectiveness, is vital for its acceptability by both end-users and clinicians.
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Affiliation(s)
- S-C Noble
- Department of Electronic Engineering, Maynooth University, Maynooth, Ireland
| | - E Woods
- Discipline of Physiology, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - T Ward
- Insight SFI Research Centre for Data Analytics, Dublin City University, Dublin, Ireland
| | - J V Ringwood
- Department of Electronic Engineering, Maynooth University, Maynooth, Ireland
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Wimmer J, Rösch SA, Schmidt R, Hilbert A. Neurofeedback strategies in binge-eating disorder as predictors of EEG-neurofeedback regulation success. Front Hum Neurosci 2023; 17:1234085. [PMID: 38021247 PMCID: PMC10645064 DOI: 10.3389/fnhum.2023.1234085] [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: 06/03/2023] [Accepted: 10/09/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Treatment options such as neurofeedback (NF) that directly target the link between aberrant brain activity patterns and dysfunctional eating behaviors in binge-eating disorder (BED) are emerging. However, virtually nothing is known about mental strategies used to modulate food-specific brain activity and the associated brain-based or subjective success of specific strategies. This study firstly investigated the use of mental strategies in response to individually appetitive food cues in adults with BED and overweight or obesity based on a randomized-controlled trial providing electroencephalography (EEG)- or real-time functional near-infrared spectroscopy (rtfNIRS)-NF to BED. Methods Strategy reports written by participants were classified with qualitative content analysis. Additionally, the mental strategies employed by the N = 23 patients who received EEG-NF targeting the reduction of fronto-central high beta activity were analyzed quantitatively through their link with subjective and EEG-NF regulation success. Results The following eight categories, ordered by frequency in descending order, were found: "Behavior," "Imagination," "Emotion," "Distraction," "Thought," "Concentration," "Self-Talk" and "No Strategy." Linear mixed models revealed "Imagination," "Behavior," and "Thought" strategies as positive predictors of EEG-NF regulation success (defined as high beta activity during regulation beneath the baseline), and "Concentration" as a negative predictor of subjective (i.e., self-reported) NF regulation success. Discussion In conclusion, our study offers a classification system that may be used in future studies assessing strategy use for regulating food-related responses in patients with BED and associated overweight/obesity, providing valuable information on potential benefits of specific strategies and transferability to situations outside the NF treatment.
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Affiliation(s)
- Jytte Wimmer
- Integrated Research and Treatment Center Adiposity Diseases, Behavioral Medicine Research Unit, Leipzig University Medical Center, Leipzig, Germany
| | - Sarah Alica Rösch
- Integrated Research and Treatment Center Adiposity Diseases, Behavioral Medicine Research Unit, Leipzig University Medical Center, Leipzig, Germany
- International Max Planck Research School NeuroCom, Leipzig, Germany
| | - Ricarda Schmidt
- Integrated Research and Treatment Center Adiposity Diseases, Behavioral Medicine Research Unit, Leipzig University Medical Center, Leipzig, Germany
| | - Anja Hilbert
- Integrated Research and Treatment Center Adiposity Diseases, Behavioral Medicine Research Unit, Leipzig University Medical Center, Leipzig, Germany
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Kober SE, Buchrieser F, Wood G. Neurofeedback on twitter: Evaluation of the scientific credibility and communication about the technique. Heliyon 2023; 9:e18931. [PMID: 37600360 PMCID: PMC10432958 DOI: 10.1016/j.heliyon.2023.e18931] [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: 02/24/2023] [Revised: 07/31/2023] [Accepted: 08/02/2023] [Indexed: 08/22/2023] Open
Abstract
Neurofeedback is a popular technique to induce neuroplasticity with a controversial reputation. The public discourse on neurofeedback, as a therapeutic and neuroenhancement technique, encompasses scientific communication, therapeutic expectations and outcomes, as well as complementary and alternative practices. We investigated twitter publications from 2010 to 2022 on the keyword "neurofeedback". A total of over 138 k tweets were obtained, which originated from over 42 k different users. The communication flow in the neurofeedback community is mainly unidirectional and non-interactive. Analysis of hashtags revealed application fields, therapy provider and neuroenhancement to be the most popular contents in neurofeedback communication. A group of 1221 productive users was identified, in which clinicians, entrepreneurs, broadcasters, and scientists contribute. We identified reactions to critical publications in the twitter traffic and an increase in the number of tweets by academic users which suggest an increase in the interest on the scientific credibility of neurofeedback. More intense scientific communication on neurofeedback in twitter may contribute to promote a more realistic view on challenges and advances regarding good scientific practice of neurofeedback.
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Kalokairinou L, Specker Sullivan L, Wexler A. Neurofeedback as placebo: a case of unintentional deception? JOURNAL OF MEDICAL ETHICS 2022; 48:1037-1042. [PMID: 34521768 PMCID: PMC9205641 DOI: 10.1136/medethics-2021-107435] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 08/18/2021] [Indexed: 05/27/2023]
Abstract
The use of placebo in clinical practice has been the topic of extensive debate in the bioethics literature, with much scholarship focusing on concerns regarding deception. While considerations of placebo without deception have largely centred on open-label placebo, this paper considers a different kind of ethical quandary regarding placebo without an intent to deceive-one where the provider believes a treatment is effective due to a direct physiological mechanism, even though that belief may not be supported by rigorous scientific evidence. This is often the case with complementary and alternative medicine (CAM) techniques and also with some mainstream therapies that have not proven to be better than sham. Using one such CAM technique as a case study-electroencephalography (EEG) neurofeedback for attention-deficit/hyperactivity disorder (ADHD)-this paper explores the ethics of providing therapies that may have some beneficial effect, although one that is likely due to placebo effect. First, we provide background on EEG neurofeedback for ADHD and its evidence base, showing how it has proven to be equivalent to-but not better than-sham neurofeedback. Subsequently, we explore whether offering therapies that are claimed to work via specific physical pathways, but may actually work due to the placebo effect, constitute deception. We suggest that this practice may constitute unintentional deception regarding mechanism of action. Ultimately, we argue that providers have increased information provision obligations when offering treatments that diverge from standard of care and we make recommendations for mitigating unintentional deception.
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Affiliation(s)
- Louiza Kalokairinou
- Department of Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | - Anna Wexler
- Department of Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Additive effects of EEG neurofeedback on medications for ADHD: a systematic review and meta-analysis. Sci Rep 2022; 12:20401. [PMID: 36437272 PMCID: PMC9701807 DOI: 10.1038/s41598-022-23015-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Accepted: 10/21/2022] [Indexed: 11/29/2022] Open
Abstract
To elucidate possible additive effects of electroencephalogram-based neurofeedback (EEG-NF) on medications against the core symptoms of attention-deficit/hyperactivity disorder (ADHD), randomized controlled trials (RCTs) were retrieved from electronic databases including PubMed, EMBASE, ClinicalKey, Cochrane CENTRAL, ScienceDirect, and ClinicalTrials.gov from inception to March 2022. The primary outcomes were changes in ADHD symptoms (i.e., global, inattention, hyperactivity/impulsivity) assessed with validated rating scales, while secondary outcome was all-cause discontinuation rate. Meta-analysis of five RCTs involving 305 participants [Median age = 9.285 years (range 8.6-11.05)] with a median follow-up of 12 weeks showed additive effects of EEG-NF on medications from parents' observations against ADHD global symptoms (Hedges' g = 0.2898, 95%CI [0.0238; 0.5557]) and inattention symptoms (Hedges' g = 0.3274, 95%CI [0.0493; 0.6055]). However, additive effects failed to sustain six months after EEG-NF intervention. Besides, there was no difference in improvement of hyperactivity/impulsivity from parents' observation, attentional performance, and all-cause discontinuation rate between the two groups. Our results supported additional benefits of combining EEG-NF with medications compared to medication alone in treating global symptoms and symptoms of inattention in ADHD patients. Nevertheless, given a lack of evidence showing a correlation between underlying physiological changes and small effect sizes in our preliminary results, further studies are warranted to support our findings.
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González Méndez PP, Rodino Climent J, Stanley JA, Sitaram R. Real-Time fMRI Neurofeedback Training as a Neurorehabilitation Approach on Depressive Disorders: A Systematic Review of Randomized Control Trials. J Clin Med 2022; 11:jcm11236909. [PMID: 36498484 PMCID: PMC9737316 DOI: 10.3390/jcm11236909] [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: 10/17/2022] [Revised: 11/02/2022] [Accepted: 11/10/2022] [Indexed: 11/25/2022] Open
Abstract
Real-time functional magnetic resonance imaging neurofeedback (rt-fMRI-nf) training is an emerging intervention for neurorehabilitation. However, its translation into clinical use on participants with clinical depression is unclear, the effect estimates from randomized control trials and the certainty of the supporting evidence on the effect estimates are unknown. As the number of studies on neurofeedback increases every year, and better quality evidence becomes available, we evaluate the evidence of all randomized control trials available on the clinical application of rt-fMRI-nf training on participants with clinical depression. We performed electronic searches in Pubmed, Embase, CENTRAL, rtFIN database, Epistemonikos, trial registers, reference lists, other systematic reviews, conference abstracts, and cross-citation in Google Scholar. Reviewers independently selected studies, extracted data and evaluated the risk of bias. The certainty of the evidence was judged using the GRADE framework. This review complies with PRISMA guidelines and was submitted to PROSPERO registration. We found 435 results. After the selection process, we included 11 reports corresponding to four RCTs. The effect of rt-fMRI-nf on improving the severity of clinical depression scores demonstrated a tendency to favor the intervention; however, the general effect was not significant. At end of treatment, SMD (standardized mean difference): -0.32 (95% CI -0.73 to 0.10). At follow-up, SMD: -0.33 (95% CI -0.91, 1.25). All the studies showed changes in BOLD fMRI activation after training; however, only one study confirmed regulation success during a transfer run. Whole-brain analyses suggests that rt-fMRI nf may alter activity patterns in brain networks. More studies are needed to evaluate quality of life, acceptability, adverse effects, cognitive tasks, and physiology measures. We conclude that the current evidence on the effect of rt-fMRI-nf training for decision-making outcomes in patients with clinical depression is still based on low certainty of the evidence.
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Affiliation(s)
- Pamela P. González Méndez
- Department of Psychiatry, School of Medicine, Pontificia Universidad Católica de Chile, Santiago 8331150, Chile
- Correspondence: (P.P.G.M.); (R.S.)
| | - Julio Rodino Climent
- Brain Dynamics Laboratory, School of Biomedical Engineering, Universidad de Valparaíso, Valparaíso 2362905, Chile
| | - Jeffrey A. Stanley
- Department of Psychiatry and Behavioral Neurosciences, School of Medicine, Wayne State University, Detroit, MI 48202, USA
| | - Ranganatha Sitaram
- Diagnostic Imaging Department, St. Jude Children’s Research Hospital, Memphis, TN 38105, USA
- Correspondence: (P.P.G.M.); (R.S.)
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Perez TM, Glue P, Adhia DB, Navid MS, Zeng J, Dillingham P, Smith M, Niazi IK, Young CK, De Ridder D. Infraslow closed-loop brain training for anxiety and depression (ISAD): a protocol for a randomized, double-blind, sham-controlled pilot trial in adult females with internalizing disorders. Trials 2022; 23:949. [DOI: 10.1186/s13063-022-06863-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 10/22/2022] [Indexed: 11/18/2022] Open
Abstract
Abstract
Background
The core intrinsic connectivity networks (core-ICNs), encompassing the default-mode network (DMN), salience network (SN) and central executive network (CEN), have been shown to be dysfunctional in individuals with internalizing disorders (IDs, e.g. major depressive disorder, MDD; generalized anxiety disorder, GAD; social anxiety disorder, SOC). As such, source-localized, closed-loop brain training of electrophysiological signals, also known as standardized low-resolution electromagnetic tomography (sLORETA) neurofeedback (NFB), targeting key cortical nodes within these networks has the potential to reduce symptoms associated with IDs and restore normal core ICN function. We intend to conduct a randomized, double-blind (participant and assessor), sham-controlled, parallel-group (3-arm) trial of sLORETA infraslow (<0.1 Hz) fluctuation neurofeedback (sLORETA ISF-NFB) 3 times per week over 4 weeks in participants (n=60) with IDs. Our primary objectives will be to examine patient-reported outcomes (PROs) and neurophysiological measures to (1) compare the potential effects of sham ISF-NFB to either genuine 1-region ISF-NFB or genuine 2-region ISF-NFB, and (2) assess for potential associations between changes in PRO scores and modifications of electroencephalographic (EEG) activity/connectivity within/between the trained regions of interest (ROIs). As part of an exploratory analysis, we will investigate the effects of additional training sessions and the potential for the potentiation of the effects over time.
Methods
We will randomly assign participants who meet the criteria for MDD, GAD, and/or SOC per the MINI (Mini International Neuropsychiatric Interview for DSM-5) to one of three groups: (1) 12 sessions of posterior cingulate cortex (PCC) ISF-NFB up-training (n=15), (2) 12 sessions of concurrent PCC ISF up-training and dorsal anterior cingulate cortex (dACC) ISF-NFB down-training (n=15), or (3) 6 sessions of yoked-sham training followed by 6 sessions genuine ISF-NFB (n=30). Transdiagnostic PROs (Hospital Anxiety and Depression Scale, HADS; Inventory of Depression and Anxiety Symptoms – Second Version, IDAS-II; Multidimensional Emotional Disorder Inventory, MEDI; Intolerance of Uncertainty Scale – Short Form, IUS-12; Repetitive Thinking Questionnaire, RTQ-10) as well as resting-state neurophysiological measures (full-band EEG and ECG) will be collected from all subjects during two baseline sessions (approximately 1 week apart) then at post 6 sessions, post 12 sessions, and follow-up (1 month later). We will employ Bayesian methods in R and advanced source-localisation software (i.e. exact low-resolution brain electromagnetic tomography; eLORETA) in our analysis.
Discussion
This protocol will outline the rationale and research methodology for a clinical pilot trial of sLORETA ISF-NFB targeting key nodes within the core-ICNs in a female ID population with the primary aims being to assess its potential efficacy via transdiagnostic PROs and relevant neurophysiological measures.
Trial registration
Our study was prospectively registered with the Australia New Zealand Clinical Trials Registry (ANZCTR; Trial ID: ACTRN12619001428156). Registered on October 15, 2019.
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Kalokairinou L, Choi R, Nagappan A, Wexler A. Opportunity Cost or Opportunity Lost: An Empirical Assessment of Ethical Concerns and Attitudes of EEG Neurofeedback Users. NEUROETHICS-NETH 2022; 15:28. [PMID: 36249541 PMCID: PMC9555209 DOI: 10.1007/s12152-022-09506-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 09/15/2022] [Indexed: 10/14/2022]
Abstract
Background Electroencephalography (EEG) neurofeedback is a type of biofeedback that purportedly teaches users how to control their brainwaves. Although neurofeedback is currently offered by thousands of providers worldwide, its provision is contested, as its effectiveness beyond a placebo effect is unproven. While scholars have voiced numerous ethical concerns about neurofeedback-regarding opportunity cost, physical and psychological harms, financial cost, and informed consent-to date these concerns have remained theoretical. This pilot study aimed to provide insights on whether these issues were supported by empirical data from the experiences of neurofeedback users. Methods Semi-structured telephone interviews were conducted with individuals who had used EEG neurofeedback for themselves and/or for a child. Results The majority of respondents (N = 36) were female (75%), white (92%), and of higher socioeconomic status relative to the U.S. population. Among adult users (n = 33), most (78.8%) resorted to neurofeedback after having tried other therapies and were satisfied with treatment (81.8%). The majority paid for neurofeedback out-of-pocket (72.7%) and considered it to be good value for money (84.8%). More than half (57.6%) considered neurofeedback to be a scientifically well-established therapy. However, of those, 78.9%were using neurofeedback for indications not adequately supported by scientific evidence. Conclusion Concerns regarding opportunity cost, physical and psychological harms, and financial cost are not substantiated by our findings. Our results partially support concerns regarding insufficient understanding of limitations. This study underlines the disconnect between some of the theoretical concerns raised by scholars regarding the use of non-validated therapies and the lived experiences of users.
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Affiliation(s)
- Louiza Kalokairinou
- Department of Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Rebekah Choi
- Department of Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ashwini Nagappan
- Department of Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Anna Wexler
- Department of Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Patil AU, Madathil D, Fan YT, Tzeng OJL, Huang CM, Huang HW. Neurofeedback for the Education of Children with ADHD and Specific Learning Disorders: A Review. Brain Sci 2022; 12:brainsci12091238. [PMID: 36138974 PMCID: PMC9497239 DOI: 10.3390/brainsci12091238] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 09/03/2022] [Accepted: 09/07/2022] [Indexed: 12/02/2022] Open
Abstract
Neurofeedback (NF) is a type of biofeedback in which an individual’s brain activity is measured and presented to them to support self-regulation of ongoing brain oscillations and achieve specific behavioral and neurophysiological outcomes. NF training induces changes in neurophysiological circuits that are associated with behavioral changes. Recent evidence suggests that the NF technique can be used to train electrical brain activity and facilitate learning among children with learning disorders. Toward this aim, this review first presents a generalized model for NF systems, and then studies involving NF training for children with disorders such as dyslexia, attention-deficit/hyperactivity disorder (ADHD), and other specific learning disorders such as dyscalculia and dysgraphia are reviewed. The discussion elaborates on the potential for translational applications of NF in educational and learning settings with details. This review also addresses some issues concerning the role of NF in education, and it concludes with some solutions and future directions. In order to provide the best learning environment for children with ADHD and other learning disorders, it is critical to better understand the role of NF in educational settings. The review provides the potential challenges of the current systems to aid in highlighting the issues undermining the efficacy of current systems and identifying solutions to address them. The review focuses on the use of NF technology in education for the development of adaptive teaching methods and the best learning environment for children with learning disabilities.
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Affiliation(s)
- Abhishek Uday Patil
- Department of Biological Science and Technology, National Yang Ming Chiao Tung University, Hsinchu 300093, Taiwan
| | - Deepa Madathil
- Jindal Institute of Behavioural Sciences, O.P. Jindal Global University, Haryana 131001, India
| | - Yang-Tang Fan
- Graduate Institute of Medicine, Yuan Ze University, Taoyuan 320315, Taiwan
| | - Ovid J. L. Tzeng
- Department of Biological Science and Technology, National Yang Ming Chiao Tung University, Hsinchu 300093, Taiwan
- Centre for Intelligent Drug Systems and Smart Bio-Devices (IDSB), National Yang Ming Chiao Tung University, Hsinchu 300093, Taiwan
- College of Humanities and Social Sciences, Taipei Medical University, Taipei 106339, Taiwan
- Department of Educational Psychology and Counseling, National Taiwan Normal University, Taipei 106308, Taiwan
- Hong Kong Institute for Advanced Studies, City University of Hong Kong, Hong Kong
| | - Chih-Mao Huang
- Department of Biological Science and Technology, National Yang Ming Chiao Tung University, Hsinchu 300093, Taiwan
- Centre for Intelligent Drug Systems and Smart Bio-Devices (IDSB), National Yang Ming Chiao Tung University, Hsinchu 300093, Taiwan
| | - Hsu-Wen Huang
- Department of Linguistics and Translation, City University of Hong Kong, Hong Kong
- Correspondence: ; Tel.: +852-3442-2579
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Berger LM, Wood G, Kober SE. Effects of virtual reality-based feedback on neurofeedback training performance—A sham-controlled study. Front Hum Neurosci 2022; 16:952261. [PMID: 36034118 PMCID: PMC9411512 DOI: 10.3389/fnhum.2022.952261] [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: 05/24/2022] [Accepted: 07/13/2022] [Indexed: 11/21/2022] Open
Abstract
Electroencephalography-neurofeedback (EEG-NF) has become a valuable tool in the field of psychology, e.g., to improve cognitive function. Nevertheless, a large percentage of NF users seem to be unable to control their own brain activation. Therefore, the aim of this study was to examine whether a different kind of visual feedback could positively influence NF performance after one training session. Virtual reality (VR) seems to have beneficial training effects and has already been reported to increase motivational training aspects. In the present study, we tested 61 young healthy adults (mean age: 23.48 years; 28 female) to investigate, whether 3D VR-based NF training has a more beneficial effect on the sensorimotor rhythm (SMR, 12–15 Hz) power increase than a mere 2D conventional NF paradigm. In the 3D group, participants had to roll a ball along a predefined path in an immersive virtual environment, whereas the 2D group had to increase the height of a bar. Both paradigms were presented using VR goggles. Participants completed one baseline and six feedback runs with 3 min each, in which they should try to increase SMR power over Cz. Half of the participants received real feedback whereas the other half received sham feedback. Participants receiving 3D VR-based feedback showed a linear increase in SMR power over the feedback runs within one training session. This was the case for the real as well as for the sham 3D feedback group and might be related to more general VR-related effects. The 2D group receiving the conventional bar feedback showed no changes in SMR power over the feedback runs. The present study underlines that the visual feedback modality has differential effects on the NF training performance and that 3D VR-based feedback has advantages over conventional 2D feedback.
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Affiliation(s)
- Lisa M. Berger
- Institute of Psychology, University of Graz, Graz, Austria
- *Correspondence: Lisa M. Berger,
| | - Guilherme Wood
- Institute of Psychology, University of Graz, Graz, Austria
- BioTechMed-Graz, Graz, Austria
| | - Silvia E. Kober
- Institute of Psychology, University of Graz, Graz, Austria
- BioTechMed-Graz, Graz, Austria
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Russo GM, Balkin RS, Lenz AS. A meta‐analysis of neurofeedback for treating anxiety‐spectrum disorders. JOURNAL OF COUNSELING AND DEVELOPMENT 2022. [DOI: 10.1002/jcad.12424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- G. Michael Russo
- Department of Counselor Education Boise State University Boise Idaho USA
- Institute for the Study of Behavioral Health and Addiction Boise State University Boise Idaho USA
| | - Richard S. Balkin
- Department of Leadership and Counselor Education The University of Mississippi Oxford Mississippi USA
| | - A. Stephen Lenz
- Department of Counseling Health and Kinesiology Texas A&M University–San Antonio San Antonio Texas USA
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Farkhondeh Tale Navi F, Heysieattalab S, Ramanathan DS, Raoufy MR, Nazari MA. Closed-loop Modulation of the Self-regulating Brain: A Review on Approaches, Emerging Paradigms, and Experimental Designs. Neuroscience 2021; 483:104-126. [PMID: 34902494 DOI: 10.1016/j.neuroscience.2021.12.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 11/30/2021] [Accepted: 12/06/2021] [Indexed: 11/27/2022]
Abstract
Closed-loop approaches, setups, and experimental designs have been applied within the field of neuroscience to enhance the understanding of basic neurophysiology principles (closed-loop neuroscience; CLNS) and to develop improved procedures for modulating brain circuits and networks for clinical purposes (closed-loop neuromodulation; CLNM). The contents of this review are thus arranged into the following sections. First, we describe basic research findings that have been made using CLNS. Next, we provide an overview of the application, rationale, and therapeutic aspects of CLNM for clinical purposes. Finally, we summarize methodological concerns and critics in clinical practice of neurofeedback and novel applications of closed-loop perspective and techniques to improve and optimize its experiments. Moreover, we outline the theoretical explanations and experimental ideas to test animal models of neurofeedback and discuss technical issues and challenges associated with implementing closed-loop systems. We hope this review is helpful for both basic neuroscientists and clinical/ translationally-oriented scientists interested in applying closed-loop methods to improve mental health and well-being.
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Affiliation(s)
- Farhad Farkhondeh Tale Navi
- Department of Cognitive Neuroscience, Faculty of Education and Psychology, University of Tabriz, Tabriz, Iran
| | - Soomaayeh Heysieattalab
- Department of Cognitive Neuroscience, Faculty of Education and Psychology, University of Tabriz, Tabriz, Iran
| | | | - Mohammad Reza Raoufy
- Department of Physiology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Mohammad Ali Nazari
- Department of Cognitive Neuroscience, Faculty of Education and Psychology, University of Tabriz, Tabriz, Iran; Department of Neuroscience, Faculty of Advanced Technologies in Medicine, Iran University of Medical Sciences, Tehran, Iran.
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14
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Liu S, Hao X, Liu X, He Y, Zhang L, An X, Song X, Ming D. Sensorimotor rhythm neurofeedback training relieves anxiety in healthy people. Cogn Neurodyn 2021; 16:531-544. [DOI: 10.1007/s11571-021-09732-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 08/12/2021] [Accepted: 09/02/2021] [Indexed: 10/19/2022] Open
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Taschereau-Dumouchel V, Cortese A, Lau H, Kawato M. Conducting decoded neurofeedback studies. Soc Cogn Affect Neurosci 2021; 16:838-848. [PMID: 32367138 PMCID: PMC8343564 DOI: 10.1093/scan/nsaa063] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 02/13/2020] [Accepted: 04/27/2020] [Indexed: 12/20/2022] Open
Abstract
Closed-loop neurofeedback has sparked great interest since its inception in the late 1960s. However, the field has historically faced various methodological challenges. Decoded fMRI neurofeedback may provide solutions to some of these problems. Notably, thanks to the recent advancements of machine learning approaches, it is now possible to target unconscious occurrences of specific multivoxel representations. In this tools of the trade paper, we discuss how to implement these interventions in rigorous double-blind placebo-controlled experiments. We aim to provide a step-by-step guide to address some of the most common methodological and analytical considerations. We also discuss tools that can be used to facilitate the implementation of new experiments. We hope that this will encourage more researchers to try out this powerful new intervention method.
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Affiliation(s)
- Vincent Taschereau-Dumouchel
- Department of Decoded Neurofeedback, ATR Computational Neuroscience Laboratories, Kyoto 619-0288, Japan
- Department of Psychology, UCLA, Los Angeles, CA 90095, USA
| | - Aurelio Cortese
- Department of Decoded Neurofeedback, ATR Computational Neuroscience Laboratories, Kyoto 619-0288, Japan
| | - Hakwan Lau
- Department of Decoded Neurofeedback, ATR Computational Neuroscience Laboratories, Kyoto 619-0288, Japan
- Department of Psychology, UCLA, Los Angeles, CA 90095, USA
- State Key Laboratory of Brain and Cognitive Sciences, University of Hong Kong, Hong Kong
- Brain Research Institute, UCLA, Los Angeles, CA 90095, USA
- Department of Psychology, University of Hong Kong, Pokfulam, Hong Kong
| | - Mitsuo Kawato
- Department of Decoded Neurofeedback, ATR Computational Neuroscience Laboratories, Kyoto 619-0288, Japan
- RIKEN Center for Advanced Intelligence Project, ATR Institute International, Kyoto, Japan
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16
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Paslakis G, Scholz-Hehn AD, Sommer LM, Kühn S. Implicit bias to food and body cues in eating disorders: a systematic review. Eat Weight Disord 2021; 26:1303-1321. [PMID: 32770476 PMCID: PMC8128803 DOI: 10.1007/s40519-020-00974-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 07/27/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Rigid, restrictive eating patterns, fear of gaining weight, body image concerns, but also binge eating episodes with loss of control leading to overweight, at times followed by compensatory measures to control weight, are typical symptoms in eating disorders (EDs). The regulation of food intake in EDs may underlie explicit processes that require cognitive insight and conscious control or be steered by implicit mechanisms that are mostly automatic, rapid, and associated with affective-rather than cognitive-processing. While introspection is not capable of assessing implicit responses, so-called indirect experimental tasks can assess implicit responses underlying a specific behavior by-passing the participant's consciousness. Here, we aimed to present the current evidence regarding studies on implicit biases to food and body cues in patients with EDs. METHODS We performed a systematic review (PRISMA guidelines). We included controlled studies performed in clinical ED cohorts (vs. healthy control subjects or another control condition, e.g., restrictive vs. binge/purge AN) and using at least one indirect assessment method of interest. RESULTS Out of 115 screened publications, we identified 29 studies fulfilling the eligibility criteria, and present a synthesis of the essential findings and future directions. CONCLUSION In this emerging field of research, the present work provides cornerstones of evidence highlighting aspects of implicit regulation in eating disorders. Applying both direct (e.g., self-reports) and indirect measures for the assessment of both explicit and implicit responses is necessary for a comprehensive investigation of the interplay between these different regulatory mechanisms and eating behavior. Targeted training of implicit reactions is already in use and represents a useful future tool as an add-on to standard psychotherapeutic treatments in the battle against eating disorders. EVIDENCE LEVEL 1 (systematic review).
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Affiliation(s)
- Georgios Paslakis
- Toronto General Hospital, University Health Network, Toronto, ON, M5G 2C4, Canada. .,Department of Psychiatry, University of Toronto, Toronto, ON, M5T 1R8, Canada. .,Department of Psychosomatic Medicine and Psychotherapy, Christian-Albrechts-University, Niemannsweg 147, 24105, Kiel, Germany.
| | - Anne Deborah Scholz-Hehn
- University Medical Center, Hamburg-Eppendorf, Clinic and Policlinic for Psychiatry and Psychotherapy, Martinistraße 52, 20246, Hamburg, Germany
| | - Laura Marie Sommer
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital of Erlangen, Schwabachanlage 6, 91054, Erlangen, Germany
| | - Simone Kühn
- University Medical Center, Hamburg-Eppendorf, Clinic and Policlinic for Psychiatry and Psychotherapy, Martinistraße 52, 20246, Hamburg, Germany
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Nagappan A, Kalokairinou L, Wexler A. Ethical and Legal Considerations of Alternative Neurotherapies. AJOB Neurosci 2021; 12:257-269. [PMID: 33759705 DOI: 10.1080/21507740.2021.1896601] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Neurotherapies for diagnostics and treatment-such as electroencephalography (EEG) neurofeedback, single-photon emission computerized tomography (SPECT) imaging for neuropsychiatric evaluation, and off-label/experimental uses of brain stimulation-are continuously being offered to the public outside mainstream healthcare settings. Because these neurotherapies share many key features of complementary and alternative medicine (CAM) techniques-and meet the definition of CAM as set out in Kaptchuk and Eisenberg-here we refer to them as "alternative neurotherapies." By explicitly linking these alternative neurotherapy practices under a common conceptual framework, this paper draws attention to, and critically considers, the cross-cutting ethical and legal issues related to the provision of these services. The first section of this paper provides an updated empirical overview of uses of SPECT neuropsychiatric evaluations, EEG neurofeedback, and experimental/off-label forms of brain stimulation. Next, drawing on CAM bioethics scholarship, we highlight the pertinent ethical issues in the alternative neurotherapy context, including the truthful representation of evidence base, marketing to vulnerable populations, potential harms, provider competency, and conflicts of interest. Finally, we consider the principal legal issues at stake for the provision of alternative neurotherapies in the U.S., namely those related to licensing and scope-of-practice considerations. We conclude with recommendations for future research in this domain.
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18
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Skalski S. Impact of placebo-related instruction on HEG biofeedback outcomes in children with ADHD. APPLIED NEUROPSYCHOLOGY-CHILD 2020; 11:383-390. [PMID: 33349043 DOI: 10.1080/21622965.2020.1861546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Studies to date have not revealed any differences between biofeedback (BFB) methods vs. placebo treatment in reducing ADHD symptoms. The purpose of this randomized controlled study was to assess the impact of placebo expectations on gain in hemoencephalographic (HEG) BFB. The final cohort consisted of 33 children with ADHD aged 9-14. Individuals were assigned to one of two groups (with standard active training instruction vs. placebo-related instruction) and were subjected to five HEG BFB sessions. Children with standard instruction exhibited higher growth of regional cerebral blood oxygenation during the HEG BFB session as well as better results in cognitive tests (vigilance and visual search) at the end of the experiment compared to children with placebo-related instruction. The data obtained indicate the difficulty in designing studies assessing BFB efficacy. Placebo expectation may adversely affect HEG BFB outcomes in children with ADHD.
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He S, Mostofi A, Syed E, Torrecillos F, Tinkhauser G, Fischer P, Pogosyan A, Hasegawa H, Li Y, Ashkan K, Pereira E, Brown P, Tan H. Subthalamic beta-targeted neurofeedback speeds up movement initiation but increases tremor in Parkinsonian patients. eLife 2020; 9:e60979. [PMID: 33205752 PMCID: PMC7695453 DOI: 10.7554/elife.60979] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Accepted: 11/16/2020] [Indexed: 12/17/2022] Open
Abstract
Previous studies have explored neurofeedback training for Parkinsonian patients to suppress beta oscillations in the subthalamic nucleus (STN). However, its impacts on movements and Parkinsonian tremor are unclear. We developed a neurofeedback paradigm targeting STN beta bursts and investigated whether neurofeedback training could improve motor initiation in Parkinson's disease compared to passive observation. Our task additionally allowed us to test which endogenous changes in oscillatory STN activities are associated with trial-to-trial motor performance. Neurofeedback training reduced beta synchrony and increased gamma activity within the STN, and reduced beta band coupling between the STN and motor cortex. These changes were accompanied by reduced reaction times in subsequently cued movements. However, in Parkinsonian patients with pre-existing symptoms of tremor, successful volitional beta suppression was associated with an amplification of tremor which correlated with theta band activity in STN local field potentials, suggesting an additional cross-frequency interaction between STN beta and theta activities.
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Affiliation(s)
- Shenghong He
- MRC Brain Network Dynamics Unit at the University of OxfordOxfordUnited Kingdom
- Nuffield Department of Clinical Neurosciences, University of OxfordOxfordUnited Kingdom
| | - Abteen Mostofi
- Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, St George’s University of LondonLondonUnited Kingdom
| | - Emilie Syed
- MRC Brain Network Dynamics Unit at the University of OxfordOxfordUnited Kingdom
| | - Flavie Torrecillos
- MRC Brain Network Dynamics Unit at the University of OxfordOxfordUnited Kingdom
- Nuffield Department of Clinical Neurosciences, University of OxfordOxfordUnited Kingdom
| | - Gerd Tinkhauser
- MRC Brain Network Dynamics Unit at the University of OxfordOxfordUnited Kingdom
- Department of Neurology, Bern University Hospital and University of BernBernSwitzerland
| | - Petra Fischer
- MRC Brain Network Dynamics Unit at the University of OxfordOxfordUnited Kingdom
- Nuffield Department of Clinical Neurosciences, University of OxfordOxfordUnited Kingdom
| | - Alek Pogosyan
- MRC Brain Network Dynamics Unit at the University of OxfordOxfordUnited Kingdom
- Nuffield Department of Clinical Neurosciences, University of OxfordOxfordUnited Kingdom
| | - Harutomo Hasegawa
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, King's Health PartnersLondonUnited Kingdom
| | - Yuanqing Li
- School of Automation Science and Engineering, South China University of TechnologyGuangzhouChina
| | - Keyoumars Ashkan
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, King's Health PartnersLondonUnited Kingdom
| | - Erlick Pereira
- Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, St George’s University of LondonLondonUnited Kingdom
| | - Peter Brown
- MRC Brain Network Dynamics Unit at the University of OxfordOxfordUnited Kingdom
- Nuffield Department of Clinical Neurosciences, University of OxfordOxfordUnited Kingdom
| | - Huiling Tan
- MRC Brain Network Dynamics Unit at the University of OxfordOxfordUnited Kingdom
- Nuffield Department of Clinical Neurosciences, University of OxfordOxfordUnited Kingdom
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Tursic A, Eck J, Lührs M, Linden DEJ, Goebel R. A systematic review of fMRI neurofeedback reporting and effects in clinical populations. Neuroimage Clin 2020; 28:102496. [PMID: 33395987 PMCID: PMC7724376 DOI: 10.1016/j.nicl.2020.102496] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 10/29/2020] [Accepted: 11/02/2020] [Indexed: 12/22/2022]
Abstract
Real-time fMRI-based neurofeedback is a relatively young field with a potential to impact the currently available treatments of various disorders. In order to evaluate the evidence of clinical benefits and investigate how consistently studies report their methods and results, an exhaustive search of fMRI neurofeedback studies in clinical populations was performed. Reporting was evaluated using a limited number of Consensus on the reporting and experimental design of clinical and cognitive-behavioral neurofeedback studies (CRED-NF checklist) items, which was, together with a statistical power and sensitivity calculation, used to also evaluate the existing evidence of the neurofeedback benefits on clinical measures. The 62 found studies investigated regulation abilities and/or clinical benefits in a wide range of disorders, but with small sample sizes and were therefore unable to detect small effects. Most points from the CRED-NF checklist were adequately reported by the majority of the studies, but some improvements are suggested for the reporting of group comparisons and relations between regulation success and clinical benefits. To establish fMRI neurofeedback as a clinical tool, more emphasis should be placed in the future on using larger sample sizes determined through a priori power calculations and standardization of procedures and reporting.
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Affiliation(s)
- Anita Tursic
- Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Oxfordlaan 55, 6229 EV Maastricht, The Netherlands; Brain Innovation B.V, Oxfordlaan 55, 6229 EV Maastricht, The Netherlands.
| | - Judith Eck
- Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Oxfordlaan 55, 6229 EV Maastricht, The Netherlands; Brain Innovation B.V, Oxfordlaan 55, 6229 EV Maastricht, The Netherlands.
| | - Michael Lührs
- Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Oxfordlaan 55, 6229 EV Maastricht, The Netherlands; Brain Innovation B.V, Oxfordlaan 55, 6229 EV Maastricht, The Netherlands.
| | - David E J Linden
- School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University, Universiteitssingel 40, 6229 ER Maastricht, The Netherlands.
| | - Rainer Goebel
- Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Oxfordlaan 55, 6229 EV Maastricht, The Netherlands; Brain Innovation B.V, Oxfordlaan 55, 6229 EV Maastricht, The Netherlands; Department of Neuroimaging and Neuromodeling, Netherlands Institute for Neuroscience, Meibergdreef 47, 1105 BA Amsterdam, the Netherlands.
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Muñoz-Moldes S, Cleeremans A. Delineating implicit and explicit processes in neurofeedback learning. Neurosci Biobehav Rev 2020; 118:681-688. [PMID: 32918947 PMCID: PMC7758707 DOI: 10.1016/j.neubiorev.2020.09.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 08/09/2020] [Accepted: 09/05/2020] [Indexed: 11/21/2022]
Abstract
Neurofeedback allows humans to self-regulate neural activity in specific brain regions and is considered a promising tool for psychiatric interventions. Recently, methods have been developed to use neurofeedback implicitly, prompting a theoretical debate on the role of awareness in neurofeedback learning. We offer a critical review of the role of awareness in neurofeedback learning, with a special focus on recently developed neurofeedback paradigms. We detail differences in instructions and propose a fine-grained categorization of tasks based on the degree of involvement of explicit and implicit processes. Finally, we review the methods used to measure awareness in neurofeedback and propose new candidate measures. We conclude that explicit processes cannot be eschewed in most current implicit tasks that have explicit goals, and suggest ways in which awareness could be better measured in the future. Investigating awareness during learning will help understand the learning mechanisms underlying neurofeedback learning and will help shape future tasks.
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Affiliation(s)
- Santiago Muñoz-Moldes
- Consciousness, Cognition and Computation group, Center for Research in Cognition & Neuroscience, Faculty of Psychology and Education, Université Libre de Bruxelles, 1050 Brussels, Belgium; Department of Psychology, University of Cambridge, Cambridge, United Kingdom.
| | - Axel Cleeremans
- Consciousness, Cognition and Computation group, Center for Research in Cognition & Neuroscience, Faculty of Psychology and Education, Université Libre de Bruxelles, 1050 Brussels, Belgium.
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22
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Criaud M, Wulff M, Alegria AA, Barker GJ, Giampietro V, Rubia K. Increased left inferior fronto-striatal activation during error monitoring after fMRI neurofeedback of right inferior frontal cortex in adolescents with attention deficit hyperactivity disorder. Neuroimage Clin 2020; 27:102311. [PMID: 32570204 PMCID: PMC7306625 DOI: 10.1016/j.nicl.2020.102311] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 05/19/2020] [Accepted: 06/08/2020] [Indexed: 12/12/2022]
Abstract
Attention Deficit/Hyperactivity Disorder (ADHD) is a self-regulation disorder, with impairments in error monitoring associated with underactivation of the related brain network(s). Psychostimulant medication improves ADHD symptoms and can upregulate brain function, but has side effects, with limited evidence for longer-term effects. Real-time functional magnetic resonance neurofeedback (fMRI-NF) has potential longer-term neuroplastic effects. We previously reported the effects of 11 runs of 8.5 min of fMRI-NF of the right inferior frontal cortex (rIFC) in adolescents with ADHD. This resulted in improvement of clinical symptom and enhanced rIFC activation post-pre treatment during response inhibition, when compared to a control group receiving fMRI-NF of the left parahippocampal gyrus (lPHG). In the current study we applied a novel analysis to the existing data by investigating the effects of fMRI-NF of rIFC in 16 adolescents with ADHD compared to fMRI-NF of lPHG in 11 adolescents with ADHD on the neurofunctional correlates of error monitoring during the same fMRI tracking stop task and potential associations with cognitive and clinical measures. We found stronger performance adjustment to errors in the rIFC-NF compared to the control lPHG-NF group. At the brain function level, fMRI-NF of rIFC compared to that of lPHG was associated with increased activation in error monitoring regions of the left IFC, premotor cortex, insula and putamen. The increased activation in left IFC-insular-striatal error monitoring regions in the rIFC-NF relative to the lPHG-NF group was furthermore trend-wise correlated with NF-induced ADHD symptom improvements. The findings of this study show, that during error monitoring, fMRI-NF training of rIFC upregulation elicited improvement in post-error behavioural adjustments and concomitant increased activation in left hemispheric fronto-insular-striatal and premotor regions mediating self-control and self-monitoring functions. This suggests that the administration of fMRI-NF of the rIFC may have had an impact on wider networks of self-regulation and self-monitoring in adolescents with ADHD.
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Affiliation(s)
- M Criaud
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
| | - M Wulff
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - A A Alegria
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - G J Barker
- Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - V Giampietro
- Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - K Rubia
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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Jensen M, Hüttenrauch E, Schmidt J, Andersson G, Chavanon ML, Weise C. Neurofeedback for tinnitus: study protocol for a randomised controlled trial assessing the specificity of an alpha/delta neurofeedback training protocol in alleviating both sound perception and psychological distress in a cohort of chronic tinnitus sufferers. Trials 2020; 21:382. [PMID: 32370767 PMCID: PMC7201543 DOI: 10.1186/s13063-020-04309-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 04/02/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Tinnitus is a particularly common condition and can have debilitating psychological consequences for certain people. Although several interventions have been helpful in teaching individuals to better cope with tinnitus, no cure exists at present. Neurofeedback is an emerging treatment modality in tinnitus. Previous studies, utilising an alpha/delta training protocol, have shown promise. However, they were characterised by small sample sizes and a lack of neurofeedback control conditions. Therefore, the aim of this study is to investigate whether an alpha/delta neurofeedback training protocol, compared to beta/theta neurofeedback or a diary control group, is effective in reducing not only the tinnitus sound perception but also the psychological symptoms associated with the condition. METHODS The study is designed as a three-armed randomised controlled trial. Participants are randomly assigned to a) an established neurofeedback protocol for tinnitus (alpha/delta training), b) an active control group (beta/theta training) or c) a diary control group. In the 4-week intervention period, participants in both neurofeedback groups undergo 10 sessions, whereas participants in the diary control group complete a bi-weekly diary. The primary outcomes are between group differences in tinnitus sound perception change, as measured with the Tinnitus Magnitude Index (TMI), and changes in tinnitus distress, measured with the Tinnitus Handicap Inventory (THI), 4 weeks after the start of the intervention. Secondary outcome measures include changes in tinnitus distress, sleep quality, depressive symptoms and whether neurofeedback leads to specific power changes in the trained frequency bands. DISCUSSION This is the first randomised controlled trial examining the efficacy of an alpha/delta neurofeedback training protocol in reducing tinnitus sound perception and the distress associated with the condition. Compared to former studies, the present study is designed to assess both the specificity of an alpha/delta neurofeedback training protocol by including an active comparator and beta/theta neurofeedback training, in addition to controlling for placebo effects by the inclusion of a diary control group. This study aims to contribute to an understanding of the influences of both specific and non-specific effects in neurofeedback treatment for tinnitus. TRIAL REGISTRATION ClinicalTrials.gov: NCT03550430. Registered on 27 May 2018.
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Affiliation(s)
- Martin Jensen
- Division of Clinical Psychology and Psychotherapy, Department of Psychology, Philipps University Marburg, Gutenbergstrasse 18, 35032, Marburg, Germany.
| | - Eva Hüttenrauch
- Division of Clinical Psychology and Psychotherapy, Department of Psychology, Philipps University Marburg, Gutenbergstrasse 18, 35032, Marburg, Germany
| | - Jennifer Schmidt
- HSD Hochschule Döpfer, University of Applied Sciences, Waidmarkt 3 und 9, DE-50676, Köln, Germany
| | - Gerhard Andersson
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden.,Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Mira-Lynn Chavanon
- Department of Psychology, Clinical Child and Adolescent Psychology, Philipps University Marburg, Marburg, Germany
| | - Cornelia Weise
- Division of Clinical Psychology and Psychotherapy, Department of Psychology, Philipps University Marburg, Gutenbergstrasse 18, 35032, Marburg, Germany
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Wexler A, Nagappan A, Kopyto D, Choi R. Neuroenhancement for sale: assessing the website claims of neurofeedback providers in the United States. JOURNAL OF COGNITIVE ENHANCEMENT 2020; 4:379-388. [PMID: 34164596 DOI: 10.1007/s41465-020-00170-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Although electroencephalographic (EEG) neurofeedback is a technique that has been in existence for many decades, it has remained controversial, largely due to questions about efficacy. Yet neurofeedback is being widely offered to the public, often at great expense. To date, however, there has not been empirical data on which providers are utilizing neurofeedback, what they are offering it for, and how they are advertising the technique. The present study aimed to fill that gap by systematically analyzing the websites of neurofeedback practitioners in the United States. To that end, we obtained data from four directories of neurofeedback providers, extracting practitioner names, geographical locations, professional training, and website URLs. Only websites offering neurofeedback services (N=371) were included in the next step, wherein two coders independently coded the websites based on a codebook developed from preliminary analyses. We found that nearly all websites (97.0%) contained claims about at least one clinical indication, most commonly anxiety, ADHD/ADD, and depression; however, only 36.0% of providers had either a medical degree (MD) or a doctoral-level degree in psychology. The majority of websites advertised neurofeedback for cognitive (90.0%) or performance (67.9%) enhancement, and roughly three-quarters utilized language related to complementary and alternative medicine (CAM). In sum, there is a considerable divergence between the scientific literature on neurofeedback and the marketing of neurofeedback services to the general public, raising concerns regarding the misrepresentation of services and misleading advertising claims.
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Affiliation(s)
- Anna Wexler
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania
| | - Ashwini Nagappan
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania
| | - Deena Kopyto
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania
| | - Rebekah Choi
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania
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Power L, Neyedli HF, Boe SG, Bardouille T. Efficacy of low-cost wireless neurofeedback to modulate brain activity during motor imagery. Biomed Phys Eng Express 2020; 6:035024. [DOI: 10.1088/2057-1976/ab872c] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Neurofeedback-Linked Suppression of Cortical β Bursts Speeds Up Movement Initiation in Healthy Motor Control: A Double-Blind Sham-Controlled Study. J Neurosci 2020; 40:4021-4032. [PMID: 32284339 PMCID: PMC7219286 DOI: 10.1523/jneurosci.0208-20.2020] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 03/10/2020] [Accepted: 03/30/2020] [Indexed: 11/30/2022] Open
Abstract
Abnormally increased β bursts in cortical-basal ganglia-thalamic circuits are associated with rigidity and bradykinesia in patients with Parkinson's disease. Increased β bursts detected in the motor cortex have also been associated with longer reaction times (RTs) in healthy participants. Here we further hypothesize that suppressing β bursts through neurofeedback training can improve motor performance in healthy subjects. Abnormally increased β bursts in cortical-basal ganglia-thalamic circuits are associated with rigidity and bradykinesia in patients with Parkinson's disease. Increased β bursts detected in the motor cortex have also been associated with longer reaction times (RTs) in healthy participants. Here we further hypothesize that suppressing β bursts through neurofeedback training can improve motor performance in healthy subjects. We conducted a double-blind sham-controlled study on 20 human volunteers (10 females) using a sequential neurofeedback-behavior task with the neurofeedback reflecting the occurrence of β bursts over sensorimotor cortex quantified in real time. The results show that neurofeedback training helps healthy participants learn to volitionally suppress β bursts in the sensorimotor cortex, with training being accompanied by reduced RT in subsequent cued movements. These changes were only significant in the real feedback group but not in the sham group, confirming the effect of neurofeedback training over simple motor imagery. In addition, RTs correlated with the rate and accumulated duration of β bursts in the contralateral motor cortex before the go-cue, but not with averaged β power. The reduced RTs induced by neurofeedback training positively correlated with reduced β bursts across all tested hemispheres. These results strengthen the link between the occurrence of β bursts in the sensorimotor cortex before the go-cue and slowed movement initiation in healthy motor control. The results also highlight the potential benefit of neurofeedback training in facilitating voluntary suppression of β bursts to speed up movement initiation. SIGNIFICANCE STATEMENT This double-blind sham-controlled study suggested that neurofeedback training can facilitate volitional suppression of β bursts in sensorimotor cortex in healthy motor control better than sham feedback. The training was accompanied by reduced reaction time (RT) in subsequent cued movements, and the reduced RT positively correlated with the level of reduction in cortical β bursts before the go-cue, but not with average β power. These results provide further evidence of a causal link between sensorimotor β bursts and movement initiation and suggest that neurofeedback training could potentially be used to train participants to speed up movement initiation.
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Omejc N, Rojc B, Battaglini PP, Marusic U. Review of the therapeutic neurofeedback method using electroencephalography: EEG Neurofeedback. Bosn J Basic Med Sci 2019; 19:213-220. [PMID: 30465705 DOI: 10.17305/bjbms.2018.3785] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 08/02/2018] [Indexed: 11/16/2022] Open
Abstract
Electroencephalographic neurofeedback (EEG-NFB) represents a broadly used method that involves a real-time EEG signal measurement, immediate data processing with the extraction of the parameter(s) of interest, and feedback to the individual in a real-time. Using such a feedback loop, the individual may gain better control over the neurophysiological parameters, by inducing changes in brain functioning and, consequently, behavior. It is used as a complementary treatment for a variety of neuropsychological disorders and improvement of cognitive capabilities, creativity or relaxation in healthy subjects. In this review, various types of EEG-NFB training are described, including training of slow cortical potentials (SCPs) and frequency and coherence training, with their main results and potential limitations. Furthermore, some general concerns about EEG-NFB methodology are presented, which still need to be addressed by the NFB community. Due to the heterogeneity of research designs in EEG-NFB protocols, clear conclusions on the effectiveness of this method are difficult to draw. Despite that, there seems to be a well-defined path for the EEG-NFB research in the future, opening up possibilities for improvement.
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Affiliation(s)
- Nina Omejc
- Department of Psychology, Faculty of Mathematics, Natural Sciences and Information Technologies, University of Primorska, Koper, Slovenia Graduate School of Neural and Behavioural Sciences, University of Tübingen, Germany.
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28
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Thibault RT, Lifshitz M, Raz A. The climate of neurofeedback: scientific rigour and the perils of ideology. Brain 2019; 141:e11. [PMID: 29220482 DOI: 10.1093/brain/awx330] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Robert T Thibault
- Integrated Program in Neuroscience, McGill University, Montreal, H3A 2B4, Canada.,Institute for Interdisciplinary Brain and Behavioral Sciences, Chapman University, Irvine, CA, 92618, USA
| | - Michael Lifshitz
- Integrated Program in Neuroscience, McGill University, Montreal, H3A 2B4, Canada.,Institute for Interdisciplinary Brain and Behavioral Sciences, Chapman University, Irvine, CA, 92618, USA
| | - Amir Raz
- Integrated Program in Neuroscience, McGill University, Montreal, H3A 2B4, Canada.,Institute for Interdisciplinary Brain and Behavioral Sciences, Chapman University, Irvine, CA, 92618, USA.,Departments of Psychiatry, Neurology and Neurosurgery, and Psychology, McGill University, Montreal, H3A 2B4, Canada.,The Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, H3T 1E4, Canada
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29
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Zhao Z, Yao S, Li K, Sindermann C, Zhou F, Zhao W, Li J, Lührs M, Goebel R, Kendrick KM, Becker B. Real-Time Functional Connectivity-Informed Neurofeedback of Amygdala-Frontal Pathways Reduces Anxiety. PSYCHOTHERAPY AND PSYCHOSOMATICS 2019; 88:5-15. [PMID: 30699438 DOI: 10.1159/000496057] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 12/03/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND Deficient emotion regulation and exaggerated anxiety represent a major transdiagnostic psychopathological marker. On the neural level these deficits have been closely linked to impaired, yet treatment-sensitive, prefrontal regulatory control over the amygdala. Gaining direct control over these pathways could therefore provide an innovative and promising intervention to regulate exaggerated anxiety. To this end the current proof-of-concept study evaluated the feasibility, functional relevance and maintenance of a novel connectivity-informed real-time fMRI neurofeedback training. METHODS In a randomized crossover sham-controlled design, 26 healthy subjects with high anxiety underwent real-time fMRI-guided neurofeedback training to enhance connectivity between the ventrolateral prefrontal cortex (vlPFC) and the amygdala (target pathway) during threat exposure. Maintenance of regulatory control was assessed after 3 days and in the absence of feedback. Training-induced changes in functional connectivity of the target pathway and anxiety ratings served as primary outcomes. RESULTS Training of the target, yet not the sham control, pathway significantly increased amygdala-vlPFC connectivity and decreased levels of anxiety. Stronger connectivity increases were significantly associated with higher anxiety reduction on the group level. At the follow-up, volitional control over the target pathway was maintained in the absence of feedback. CONCLUSIONS The present results demonstrate for the first time that successful self-regulation of amygdala-prefrontal top-down regulatory circuits may represent a novel intervention to control anxiety. As such, the present findings underscore both the critical contribution of amygdala-prefrontal circuits to emotion regulation and the therapeutic potential of connectivity-informed real-time neurofeedback.
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Affiliation(s)
- Zhiying Zhao
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Laboratory for Neuroinformation, University of Electronic Science and Technology of China, Chengdu, China
| | - Shuxia Yao
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Laboratory for Neuroinformation, University of Electronic Science and Technology of China, Chengdu, China
| | - Keshuang Li
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Laboratory for Neuroinformation, University of Electronic Science and Technology of China, Chengdu, China
| | | | - Feng Zhou
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Laboratory for Neuroinformation, University of Electronic Science and Technology of China, Chengdu, China
| | - Weihua Zhao
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Laboratory for Neuroinformation, University of Electronic Science and Technology of China, Chengdu, China
| | - Jianfu Li
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Laboratory for Neuroinformation, University of Electronic Science and Technology of China, Chengdu, China
| | - Michael Lührs
- Department of Cognitive Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Rainer Goebel
- Department of Cognitive Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Keith M Kendrick
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Laboratory for Neuroinformation, University of Electronic Science and Technology of China, Chengdu, China
| | - Benjamin Becker
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Laboratory for Neuroinformation, University of Electronic Science and Technology of China, Chengdu, China,
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30
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Li K, Jiang Y, Gong Y, Zhao W, Zhao Z, Liu X, Kendrick KM, Zhu C, Becker B. Functional near-infrared spectroscopy-informed neurofeedback: regional-specific modulation of lateral orbitofrontal activation and cognitive flexibility. NEUROPHOTONICS 2019; 6:025011. [PMID: 31930153 PMCID: PMC6951484 DOI: 10.1117/1.nph.6.2.025011] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 05/13/2019] [Indexed: 06/10/2023]
Abstract
Cognitive flexibility and reward processing critically rely on the orbitofrontal cortex (OFC). Dysregulations in these domains and orbitofrontal activation have been reported in major psychiatric disorders. Hemodynamic brain imaging-informed neurofeedback allows regional-specific control over brain activation and thus may represent an innovative intervention to regulate orbitofrontal dysfunctions. Against this background the present proof-of-concept study evaluates the feasibility and behavioral relevance of functional near-infrared spectroscopy (fNIRS)-assisted neurofeedback training of the lateral orbitofrontal cortex (lOFC). In a randomized sham-controlled between-subject design, 60 healthy participants have undergone four subsequent runs of training to enhance the lOFC activation. Training-induced changes in the lOFC, attentional set-shifting performance, and reward experience have served as primary outcomes. Feedback from the target channel significantly increases the regional-specific lOFC activation over the four training runs in comparison with sham neurofeedback. The real-time OFC neurofeedback group demonstrates a trend for faster responses during the set-shifting relative to the sham neurofeedback group. Within the real-time OFC neurofeedback group, stronger training-induced lOFC increases are associated with higher reward experience. The present results demonstrate that fNIRS-informed neurofeedback allows regional-specific regulation of lOFC activation and may have the potential to modulate the associated behavioral domains. As such fNIRS-informed neurofeedback may represent a promising strategy to regulate OFC dysfunctions in psychiatric disorders.
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Affiliation(s)
- Keshuang Li
- University of Electronic Science and Technology of China, The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Laboratory for Neuroinformation, Chengdu, China
| | - Yihan Jiang
- Beijing Normal University, State Key Laboratory of Cognitive Neuroscience and Learning, Beijing, China
| | - Yilong Gong
- Beijing Normal University, State Key Laboratory of Cognitive Neuroscience and Learning, Beijing, China
| | - Weihua Zhao
- University of Electronic Science and Technology of China, The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Laboratory for Neuroinformation, Chengdu, China
| | - Zhiying Zhao
- University of Electronic Science and Technology of China, The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Laboratory for Neuroinformation, Chengdu, China
| | - Xiaolong Liu
- University of Electronic Science and Technology of China, The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Laboratory for Neuroinformation, Chengdu, China
| | - Keith M. Kendrick
- University of Electronic Science and Technology of China, The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Laboratory for Neuroinformation, Chengdu, China
| | - Chaozhe Zhu
- Beijing Normal University, State Key Laboratory of Cognitive Neuroscience and Learning, Beijing, China
- Beijing Normal University, IDG/McGovern Institute for Brain Research, Beijing, China
- Beijing Normal University, Center for Collaboration and Innovation in Brain and Learning Sciences, Beijing, China
| | - Benjamin Becker
- University of Electronic Science and Technology of China, The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Laboratory for Neuroinformation, Chengdu, China
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31
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Rubia K, Criaud M, Wulff M, Alegria A, Brinson H, Barker G, Stahl D, Giampietro V. Functional connectivity changes associated with fMRI neurofeedback of right inferior frontal cortex in adolescents with ADHD. Neuroimage 2019; 188:43-58. [PMID: 30513395 PMCID: PMC6414400 DOI: 10.1016/j.neuroimage.2018.11.055] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 11/28/2018] [Accepted: 11/29/2018] [Indexed: 11/21/2022] Open
Abstract
Attention Deficit Hyperactivity Disorder (ADHD) is associated with poor self-control, underpinned by inferior fronto-striatal deficits. We showed previously that 18 ADHD adolescents over 11 runs of 8.5 min of real-time functional magnetic resonance neurofeedback of the right inferior frontal cortex (rIFC) progressively increased activation in 2 regions of the rIFC which was associated with clinical symptom improvement. In this study, we used functional connectivity analyses to investigate whether fMRI-Neurofeedback of rIFC resulted in dynamic functional connectivity changes in underlying neural networks. Whole-brain seed-based functional connectivity analyses were conducted using the two clusters showing progressively increased activation in rIFC as seed regions to test for changes in functional connectivity before and after 11 fMRI-Neurofeedback runs. Furthermore, we tested whether the resulting functional connectivity changes were associated with clinical symptom improvements and whether they were specific to fMRI-Neurofeedback of rIFC when compared to a control group who had to self-regulate another region. rIFC showed increased positive functional connectivity after relative to before fMRI-Neurofeedback with dorsal caudate and anterior cingulate and increased negative functional connectivity with regions of the default mode network (DMN) such as posterior cingulate and precuneus. Furthermore, the functional connectivity changes were correlated with clinical improvements and the functional connectivity and correlation findings were specific to the rIFC-Neurofeedback group. The findings show for the first time that fMRI-Neurofeedback of a typically dysfunctional frontal region in ADHD adolescents leads to strengthening within fronto-cingulo-striatal networks and to weakening of functional connectivity with posterior DMN regions and that this may be underlying clinical improvement.
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Affiliation(s)
- K Rubia
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK.
| | - M Criaud
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - M Wulff
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - A Alegria
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - H Brinson
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - G Barker
- Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - D Stahl
- Department of Biostatistics & Health Informatics, King's College London, UK
| | - V Giampietro
- Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
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32
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Lovato N, Miller CB, Gordon CJ, Grunstein RR, Lack L. The efficacy of biofeedback for the treatment of insomnia: a critical review. Sleep Med 2018; 56:192-200. [PMID: 30846410 DOI: 10.1016/j.sleep.2018.12.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 11/26/2018] [Accepted: 12/03/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND The popularity of biofeedback as a non-pharmacological treatment option for insomnia has increased in recent times despite inconsistent empirical evidence for its therapeutic efficacy. OBJECTIVE The purpose of the current review was to systematically assess the efficacy of using biofeedback to treat insomnia. METHODS AND RESULTS A search of electronic databases (PubMED, MEDLINE, OvidSP, Ovid EMBASE, PsychInfo, The Cochrane Library including Cochrane Reviews), clinical trials databases and registries (Clinical Trials Database [US], Australian New Zealand Clinical Trials Registry [ANZCTR]) and online journal (eg, SLEEP, Sleep Medicine) identified 92 studies. Of these, 50 publications were descriptive or review papers about use of biofeedback for the treatment of insomnia, while an additional 37 did not meet the detailed inclusion criteria (ie not original research, participants do not meet the diagnostic criteria for insomnia). Six full-text articles met inclusion criteria and were included in this review. Methodological flaws including poor study design (small sample size, lack of control group) limit the validity of the body of work in this field to date and fail adequately to account for other unspecified factors likely to drive the observed changes, such as care and attention of those administering the treatment, as well as the expectations and motivations of the patient. CONCLUSION There is an urgent need for future studies to clarify the role of unspecific placebo effects when reporting biofeedback effects for the treatment of insomnia.
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Affiliation(s)
- Nicole Lovato
- Adelaide Institute for Sleep Health, A Flinders Centre of Research Excellence, Flinders University of South Australia, Australia; CRC for Alertness, Safety and Productivity, Melbourne, VIC, Australia.
| | | | - Christopher J Gordon
- CRC for Alertness, Safety and Productivity, Melbourne, VIC, Australia; CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, NSW, Australia; Sydney Nursing School, The University of Sydney, Sydney, NSW, Australia
| | - Ronald R Grunstein
- CRC for Alertness, Safety and Productivity, Melbourne, VIC, Australia; CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, NSW, Australia; Department of Respiratory Medicine, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Leon Lack
- Adelaide Institute for Sleep Health, A Flinders Centre of Research Excellence, Flinders University of South Australia, Australia; School of Psychology, Flinders University of South Australia, Australia
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Keynan JN, Cohen A, Jackont G, Green N, Goldway N, Davidov A, Meir-Hasson Y, Raz G, Intrator N, Fruchter E, Ginat K, Laska E, Cavazza M, Hendler T. Electrical fingerprint of the amygdala guides neurofeedback training for stress resilience. Nat Hum Behav 2018; 3:63-73. [PMID: 30932053 DOI: 10.1038/s41562-018-0484-3] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2018] [Accepted: 10/30/2018] [Indexed: 02/02/2023]
Abstract
Real-time functional magnetic resonance imaging (rt-fMRI) has revived the translational perspective of neurofeedback (NF)1. Particularly for stress management, targeting deeply located limbic areas involved in stress processing2 has paved new paths for brain-guided interventions. However, the high cost and immobility of fMRI constitute a challenging drawback for the scalability (accessibility and cost-effectiveness) of the approach, particularly for clinical purposes3. The current study aimed to overcome the limited applicability of rt-fMRI by using an electroencephalography (EEG) model endowed with improved spatial resolution, derived from simultaneous EEG-fMRI, to target amygdala activity (termed amygdala electrical fingerprint (Amyg-EFP))4-6. Healthy individuals (n = 180) undergoing a stressful military training programme were randomly assigned to six Amyg-EFP-NF sessions or one of two controls (control-EEG-NF or NoNF), taking place at the military training base. The results demonstrated specificity of NF learning to the targeted Amyg-EFP signal, which led to reduced alexithymia and faster emotional Stroop, indicating better stress coping following Amyg-EFP-NF relative to controls. Neural target engagement was demonstrated in a follow-up fMRI-NF, showing greater amygdala blood-oxygen-level-dependent downregulation and amygdala-ventromedial prefrontal cortex functional connectivity following Amyg-EFP-NF relative to NoNF. Together, these results demonstrate limbic specificity and efficacy of Amyg-EFP-NF during a stressful period, pointing to a scalable non-pharmacological yet neuroscience-based training to prevent stress-induced psychopathology.
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Affiliation(s)
- Jackob N Keynan
- Sagol Brain Institute, Wohl Institute for Advanced Imaging, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel.,The School of Psychological Sciences, Tel-Aviv University, Tel-Aviv, Israel
| | - Avihay Cohen
- Sagol Brain Institute, Wohl Institute for Advanced Imaging, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel.,The School of Psychological Sciences, Tel-Aviv University, Tel-Aviv, Israel
| | - Gilan Jackont
- Sagol Brain Institute, Wohl Institute for Advanced Imaging, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel.,The School of Psychological Sciences, Tel-Aviv University, Tel-Aviv, Israel
| | - Nili Green
- Sagol Brain Institute, Wohl Institute for Advanced Imaging, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel.,The School of Psychological Sciences, Tel-Aviv University, Tel-Aviv, Israel
| | - Noam Goldway
- Sagol Brain Institute, Wohl Institute for Advanced Imaging, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel.,Sagol School of Neuroscience, Tel-Aviv University, Tel-Aviv, Israel
| | | | | | - Gal Raz
- Sagol Brain Institute, Wohl Institute for Advanced Imaging, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel.,Sagol School of Neuroscience, Tel-Aviv University, Tel-Aviv, Israel.,The Steve Tisch School of Film and Television, Tel-Aviv University, Tel-Aviv, Israel
| | - Nathan Intrator
- Sagol School of Neuroscience, Tel-Aviv University, Tel-Aviv, Israel.,Blavatnik School of Computer Science, Tel-Aviv University, Tel-Aviv, Israel
| | - Eyal Fruchter
- The Mental Health Department, Medical Corps, IDF, Ramat-Gan, Israel
| | - Keren Ginat
- The Mental Health Department, Medical Corps, IDF, Ramat-Gan, Israel
| | - Eugene Laska
- Department of Psychiatry, New York University Langone School of Medicine, New York, NY, USA
| | - Marc Cavazza
- School of Engineering and Digital Arts, University of Kent, Canterbury, UK
| | - Talma Hendler
- Sagol Brain Institute, Wohl Institute for Advanced Imaging, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel. .,The School of Psychological Sciences, Tel-Aviv University, Tel-Aviv, Israel. .,Sagol School of Neuroscience, Tel-Aviv University, Tel-Aviv, Israel. .,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
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Kober SE, Witte M, Grinschgl S, Neuper C, Wood G. Placebo hampers ability to self-regulate brain activity: A double-blind sham-controlled neurofeedback study. Neuroimage 2018; 181:797-806. [DOI: 10.1016/j.neuroimage.2018.07.025] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 07/11/2018] [Accepted: 07/11/2018] [Indexed: 01/03/2023] Open
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Mind-Reading or Misleading? Assessing Direct-to-Consumer Electroencephalography (EEG) Devices Marketed for Wellness and Their Ethical and Regulatory Implications. JOURNAL OF COGNITIVE ENHANCEMENT 2018. [DOI: 10.1007/s41465-018-0091-2] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Thibault RT, Veissière S, Olson JA, Raz A. Treating ADHD With Suggestion: Neurofeedback and Placebo Therapeutics. J Atten Disord 2018; 22:707-711. [PMID: 29717910 DOI: 10.1177/1087054718770012] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE We propose that clinicians can use suggestion to help treat conditions such as ADHD. METHODS We use EEG neurofeedback as a case study, alongside evidence from a recent pilot experiment utilizing a sham MRI scanner to highlight the therapeutic potential of suggestion-based treatments. RESULTS The medical literature demonstrates that many practitioners already prescribe treatments that hardly outperform placebo comparators. Moreover, the sham MRI experiment showed that, even with full disclosure of the procedure, suggestion alone can reduce the symptomatology of ADHD. CONCLUSION Non-deceptive suggestion-based treatments, especially those drawing on accessories from neuroscience, may offer a safe complement and potential alternative to current standard of care for individuals with ADHD.
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Affiliation(s)
- Robert T Thibault
- 1 McGill University, Montreal, Québec, Canada.,2 Chapman University, Irvine, CA, USA
| | | | - Jay A Olson
- 1 McGill University, Montreal, Québec, Canada
| | - Amir Raz
- 1 McGill University, Montreal, Québec, Canada.,2 Chapman University, Irvine, CA, USA
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Thibault RT, MacPherson A, Lifshitz M, Roth RR, Raz A. Neurofeedback with fMRI: A critical systematic review. Neuroimage 2018; 172:786-807. [DOI: 10.1016/j.neuroimage.2017.12.071] [Citation(s) in RCA: 93] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2017] [Revised: 12/18/2017] [Accepted: 12/21/2017] [Indexed: 10/18/2022] Open
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38
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Rubia K. Cognitive Neuroscience of Attention Deficit Hyperactivity Disorder (ADHD) and Its Clinical Translation. Front Hum Neurosci 2018; 12:100. [PMID: 29651240 PMCID: PMC5884954 DOI: 10.3389/fnhum.2018.00100] [Citation(s) in RCA: 181] [Impact Index Per Article: 30.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 03/05/2018] [Indexed: 01/01/2023] Open
Abstract
This review focuses on the cognitive neuroscience of Attention Deficit Hyperactivity Disorder (ADHD) based on functional magnetic resonance imaging (fMRI) studies and on recent clinically relevant applications such as fMRI-based diagnostic classification or neuromodulation therapies targeting fMRI deficits with neurofeedback (NF) or brain stimulation. Meta-analyses of fMRI studies of executive functions (EFs) show that ADHD patients have cognitive-domain dissociated complex multisystem impairments in several right and left hemispheric dorsal, ventral and medial fronto-cingulo-striato-thalamic and fronto-parieto-cerebellar networks that mediate cognitive control, attention, timing and working memory (WM). There is furthermore emerging evidence for abnormalities in orbital and ventromedial prefrontal and limbic areas that mediate motivation and emotion control. In addition, poor deactivation of the default mode network (DMN) suggests an abnormal interrelationship between hypo-engaged task-positive and poorly "switched off" hyper-engaged task-negative networks, both of which are related to impaired cognition. Translational cognitive neuroscience in ADHD is still in its infancy. Pattern recognition analyses have attempted to provide diagnostic classification of ADHD using fMRI data with respectable classification accuracies of over 80%. Necessary replication studies, however, are still outstanding. Brain stimulation has been tested in heterogeneously designed, small numbered proof of concept studies targeting key frontal functional impairments in ADHD. Transcranial direct current stimulation (tDCS) appears to be promising to improve ADHD symptoms and cognitive functions based on some studies, but larger clinical trials of repeated stimulation with and without cognitive training are needed to test clinical efficacy and potential costs on non-targeted functions. Only three studies have piloted NF of fMRI-based frontal dysfunctions in ADHD using fMRI or near-infrared spectroscopy, with the two larger ones finding some improvements in cognition and symptoms, which, however, were not superior to the active control conditions, suggesting potential placebo effects. Neurotherapeutics seems attractive for ADHD due to their safety and potential longer-term neuroplastic effects, which drugs cannot offer. However, they need to be thoroughly tested for short- and longer-term clinical and cognitive efficacy and their potential for individualized treatment.
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Affiliation(s)
- Katya Rubia
- Child & Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King’s College London, London, United Kingdom
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39
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Fava GA, Cosci F, Sonino N. Current Psychosomatic Practice. PSYCHOTHERAPY AND PSYCHOSOMATICS 2017; 86:13-30. [PMID: 27884006 DOI: 10.1159/000448856] [Citation(s) in RCA: 160] [Impact Index Per Article: 22.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 08/03/2016] [Indexed: 11/19/2022]
Abstract
Psychosomatic research has advanced over the past decades in dealing with complex biopsychosocial phenomena and may provide new effective modalities of patient care. Among psychosocial variables affecting individual vulnerability, course, and outcome of any medical disease, the role of chronic stress (allostatic load/overload) has emerged as a crucial factor. Assessment strategies include the Diagnostic Criteria for Psychosomatic Research. They are presented here in an updated version based on insights derived from studies carried out so far and encompass allostatic overload, type A behavior, alexithymia, the spectrum of maladaptive illness behavior, demoralization, irritable mood, and somatic symptoms secondary to a psychiatric disorder. Macroanalysis is a helpful tool for identifying the relationships between biological and psychosocial variables and the individual targets for medical intervention. The personalized and holistic approach to the patient includes integration of medical and psychological therapies in all phases of illness. In this respect, the development of a new psychotherapeutic modality, Well-Being Therapy, seems to be promising. The growth of subspecialties, such as psychooncology and psychodermatology, drives towards the multidisciplinary organization of health care to overcome artificial boundaries. There have been major transformations in health care needs in the past decades. From psychosomatic medicine, a land of innovative hypotheses and trends, many indications for changes in the current practice of medicine are now at hand. The aim of this critical review is to outline current and potential clinical applications of psychosomatic methods.
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Affiliation(s)
- Giovanni A Fava
- Department of Psychology, University of Bologna, Bologna, Italy
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40
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Gonçalves ÓF, Batistuzzo MC, Sato JR. Real-time functional magnetic resonance imaging in obsessive-compulsive disorder. Neuropsychiatr Dis Treat 2017; 13:1825-1834. [PMID: 28744133 PMCID: PMC5513821 DOI: 10.2147/ndt.s121139] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
The current literature provides substantial evidence of brain alterations associated with obsessive-compulsive disorder (OCD) symptoms (eg, checking, cleaning/decontamination, counting compulsions; harm or sexual, symmetry/exactness obsessions), and emotional problems (eg, defensive/appetitive emotional imbalance, disgust, guilt, shame, and fear learning/extinction) and cognitive impairments associated with this disorder (eg, inhibitory control, working memory, cognitive flexibility). Building on this evidence, new clinical trials can now target specific brain regions/networks. Real-time functional magnetic resonance imaging (rtfMRI) was introduced as a new therapeutic tool for the self-regulation of brain-mind. In this review, we describe initial trials testing the use of rtfMRI to target brain regions associated with specific OCD symptoms (eg, contamination), and other mind-brain processes (eg, cognitive - working memory, inhibitory control, emotional - defensive, appetitive systems, fear reduction through counter-conditioning) found impaired in OCD patients. While this is a novel topic of research, initial evidence shows the promise of using rtfMRI in training the self-regulation of brain regions and mental processes associated with OCD. Additionally, studies with healthy populations have shown that individuals can regulate brain regions associated with cognitive and emotional processes found impaired in OCD. After the initial "proof-of-concept" stage, there is a need to follow up with controlled clinical trials that could test rtfMRI innovative treatments targeting brain regions and networks associated with different OCD symptoms and cognitive-emotional impairments.
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Affiliation(s)
- Óscar F Gonçalves
- Neuropsychophysiology Lab, CIPsi, School of Psychology, University of Minho, Braga, Portugal
- Spaulding Neuromodulation Center, Department of Physical Medicine & Rehabilitation, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Social and Cognitive Neuroscience Laboratory, Center for Health and Biological Sciences, Mackenzie Presbyterian University
| | - Marcelo C Batistuzzo
- Department and Institute of Psychiatry, University of São Paulo Medical School (FMUSP)
| | - João R Sato
- Mathematics, Computing, and Cognition Center, Universidade Federal do ABC – UFABC, São Paulo, Brazil
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41
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Kober SE, Witte M, Neuper C, Wood G. Specific or nonspecific? Evaluation of band, baseline, and cognitive specificity of sensorimotor rhythm- and gamma-based neurofeedback. Int J Psychophysiol 2017; 120:1-13. [PMID: 28652143 DOI: 10.1016/j.ijpsycho.2017.06.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Revised: 06/09/2017] [Accepted: 06/23/2017] [Indexed: 11/30/2022]
Abstract
Neurofeedback (NF) is often criticized because of the lack of empirical evidence of its specificity. Our present study thus focused on the specificity of NF on three levels: band specificity, cognitive specificity, and baseline specificity. Ten healthy middle-aged individuals performed ten sessions of SMR (sensorimotor rhythm, 12-15Hz) NF training. A second group (N=10) received feedback of a narrow gamma band (40-43Hz). Effects of NF on EEG resting measurements (tonic EEG) and cognitive functions (memory, intelligence) were evaluated using a pre-post design. Both training groups were able to linearly increase the target training frequencies (either SMR or gamma), indicating the trainability of these EEG frequencies. Both NF training protocols led to nonspecific changes in other frequency bands during NF training. While SMR NF only led to concomitant changes in slower frequencies, gamma training affected nearly the whole power spectrum. SMR NF specifically improved memory functions. Gamma training showed only marginal effects on cognitive functions. SMR power assessed during resting measurements significantly increased after SMR NF training compared to a pre-assessment, indicating specific effects of SMR NF on baseline/tonic EEG. The gamma group did not show any pre-post changes in their EEG resting activity. In conclusion, SMR NF specifically affects cognitive functions (cognitive specificity) and tonic EEG (baseline specificity), while increasing SMR during NF training nonspecifically affects slower EEG frequencies as well (band non-specificity). Gamma NF was associated with nonspecific effects on the EEG power spectrum during training, which did not lead to considerable changes in cognitive functions or baseline EEG activity.
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Affiliation(s)
- Silvia Erika Kober
- Department of Psychology, University of Graz, Austria; BioTechMed-Graz, Austria.
| | | | - Christa Neuper
- Department of Psychology, University of Graz, Austria; BioTechMed-Graz, Austria; Laboratory of Brain-Computer Interfaces, Institute of Neural Engineering, Graz University of Technology, Austria.
| | - Guilherme Wood
- Department of Psychology, University of Graz, Austria; BioTechMed-Graz, Austria.
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42
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Alegria AA, Wulff M, Brinson H, Barker GJ, Norman LJ, Brandeis D, Stahl D, David AS, Taylor E, Giampietro V, Rubia K. Real-time fMRI neurofeedback in adolescents with attention deficit hyperactivity disorder. Hum Brain Mapp 2017; 38:3190-3209. [PMID: 28342214 PMCID: PMC5434828 DOI: 10.1002/hbm.23584] [Citation(s) in RCA: 81] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 03/06/2017] [Accepted: 03/13/2017] [Indexed: 02/05/2023] Open
Abstract
Attention Deficit Hyperactivity Disorder (ADHD) is associated with poor self-control, underpinned by inferior fronto-striatal deficits. Real-time functional magnetic resonance neurofeedback (rtfMRI-NF) allows participants to gain self-control over dysregulated brain regions. Despite evidence for beneficial effects of electrophysiological-NF on ADHD symptoms, no study has applied the spatially superior rtfMRI-NF neurotherapy to ADHD. A randomized controlled trial tested the efficacy of rtfMRI-NF of right inferior prefrontal cortex (rIFG), a key region that is compromised in ADHD and upregulated with psychostimulants, on improvement of ADHD symptoms, cognition, and inhibitory fMRI activation. To control for region-specificity, an active control group received rtfMRI-NF of the left parahippocampal gyrus (lPHG). Thirty-one ADHD boys were randomly allocated and had to learn to upregulate their target brain region in an average of 11 rtfMRI-NF runs over 2 weeks. Feedback was provided through a video-clip of a rocket that had to be moved up into space. A transfer session without feedback tested learning retention as a proximal measure of transfer to everyday life. Both NF groups showed significant linear activation increases with increasing number of runs in their respective target regions and significant reduction in ADHD symptoms after neurotherapy and at 11-month follow-up. Only the group targeting rIFG, however, showed a transfer effect, which correlated with ADHD symptom reductions, improved at trend level in sustained attention, and showed increased IFG activation during an inhibitory fMRI task. This proof-of-concept study demonstrates for the first time feasibility, safety, and shorter- and longer-term efficacy of rtfMRI-NF of rIFG in adolescents with ADHD. Hum Brain Mapp 38:3190-3209, 2017. © 2017 The Authors Human Brain Mapping Published by Wiley Periodicals, Inc.
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Affiliation(s)
- Analucia A. Alegria
- Department of Child and Adolescent PsychiatryInstitute of Psychiatry, Psychology and Neuroscience, King's College LondonLondonUnited Kingdom
| | - Melanie Wulff
- Department of Child and Adolescent PsychiatryInstitute of Psychiatry, Psychology and Neuroscience, King's College LondonLondonUnited Kingdom
| | - Helen Brinson
- Department of Child and Adolescent PsychiatryInstitute of Psychiatry, Psychology and Neuroscience, King's College LondonLondonUnited Kingdom
| | - Gareth J. Barker
- Centre for Neuroimaging Science, Institute of Psychiatry, Psychology and Neuroscience, King's College LondonLondonUnited Kingdom
| | - Luke J. Norman
- Department of Child and Adolescent PsychiatryInstitute of Psychiatry, Psychology and Neuroscience, King's College LondonLondonUnited Kingdom
| | - Daniel Brandeis
- Department of Child and Adolescent Psychiatry and PsychotherapyCentral Institute of Mental Health, Medical Faculty Mannheim/Heidelberg UniversityMannheimGermany
- Department of Child and Adolescent Psychiatry and Psychotherapy, Psychiatric HospitalUniversity of ZurichZurichSwitzerland
- Center for Integrative Human Physiology, and Neuroscience Center Zurich, University of ZurichZurichSwitzerland
| | - Daniel Stahl
- Department of BiostatisticsKing's College LondonLondonUnited Kingdom
| | - Anthony S. David
- Department of Psychosis StudiesInstitute of Psychiatry, Psychology and Neuroscience King's College LondonLondonUnited Kingdom
| | - Eric Taylor
- Department of Child and Adolescent PsychiatryInstitute of Psychiatry, Psychology and Neuroscience, King's College LondonLondonUnited Kingdom
| | - Vincent Giampietro
- Centre for Neuroimaging Science, Institute of Psychiatry, Psychology and Neuroscience, King's College LondonLondonUnited Kingdom
| | - Katya Rubia
- Department of Child and Adolescent PsychiatryInstitute of Psychiatry, Psychology and Neuroscience, King's College LondonLondonUnited Kingdom
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43
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Neurofeedback in Substance Use and Overeating: Current Applications and Future Directions. CURRENT ADDICTION REPORTS 2017. [DOI: 10.1007/s40429-017-0137-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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44
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Yahata N, Kasai K, Kawato M. Computational neuroscience approach to biomarkers and treatments for mental disorders. Psychiatry Clin Neurosci 2017; 71:215-237. [PMID: 28032396 DOI: 10.1111/pcn.12502] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 12/19/2016] [Accepted: 12/25/2016] [Indexed: 01/21/2023]
Abstract
Psychiatry research has long experienced a stagnation stemming from a lack of understanding of the neurobiological underpinnings of phenomenologically defined mental disorders. Recently, the application of computational neuroscience to psychiatry research has shown great promise in establishing a link between phenomenological and pathophysiological aspects of mental disorders, thereby recasting current nosology in more biologically meaningful dimensions. In this review, we highlight recent investigations into computational neuroscience that have undertaken either theory- or data-driven approaches to quantitatively delineate the mechanisms of mental disorders. The theory-driven approach, including reinforcement learning models, plays an integrative role in this process by enabling correspondence between behavior and disorder-specific alterations at multiple levels of brain organization, ranging from molecules to cells to circuits. Previous studies have explicated a plethora of defining symptoms of mental disorders, including anhedonia, inattention, and poor executive function. The data-driven approach, on the other hand, is an emerging field in computational neuroscience seeking to identify disorder-specific features among high-dimensional big data. Remarkably, various machine-learning techniques have been applied to neuroimaging data, and the extracted disorder-specific features have been used for automatic case-control classification. For many disorders, the reported accuracies have reached 90% or more. However, we note that rigorous tests on independent cohorts are critically required to translate this research into clinical applications. Finally, we discuss the utility of the disorder-specific features found by the data-driven approach to psychiatric therapies, including neurofeedback. Such developments will allow simultaneous diagnosis and treatment of mental disorders using neuroimaging, thereby establishing 'theranostics' for the first time in clinical psychiatry.
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Affiliation(s)
- Noriaki Yahata
- Department of Youth Mental Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,Department of Molecular Imaging and Theranostics, National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan.,ATR Brain Information Communication Research Laboratory Group, Kyoto, Japan
| | - Kiyoto Kasai
- Department of Neuropsychiatry, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Mitsuo Kawato
- ATR Brain Information Communication Research Laboratory Group, Kyoto, Japan
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Schabus M, Griessenberger H, Gnjezda MT, Heib DPJ, Wislowska M, Hoedlmoser K. Better than sham? A double-blind placebo-controlled neurofeedback study in primary insomnia. Brain 2017; 140:1041-1052. [PMID: 28335000 PMCID: PMC5382955 DOI: 10.1093/brain/awx011] [Citation(s) in RCA: 80] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 12/01/2016] [Accepted: 12/06/2016] [Indexed: 12/16/2022] Open
Abstract
See Thibault et al. (doi:10.1093/awx033) for a scientific commentary on this article.Neurofeedback training builds upon the simple concept of instrumental conditioning, i.e. behaviour that is rewarded is more likely to reoccur, an effect Thorndike referred to as the 'law of effect'. In the case of neurofeedback, information about specific electroencephalographic activity is fed back to the participant who is rewarded whenever the desired electroencephalography pattern is generated. If some kind of hyperarousal needs to be addressed, the neurofeedback community considers sensorimotor rhythm neurofeedback as the gold standard. Earlier treatment approaches using sensorimotor-rhythm neurofeedback indicated that training to increase 12-15 Hz sensorimotor rhythm over the sensorimotor cortex during wakefulness could reduce attention-deficit/hyperactivity disorder and epilepsy symptoms and even improve sleep quality by enhancing sleep spindle activity (lying in the same frequency range). In the present study we sought to critically test whether earlier findings on the positive effect of sensorimotor rhythm neurofeedback on sleep quality and memory could also be replicated in a double-blind placebo-controlled study on 25 patients with insomnia. Patients spent nine polysomnography nights and 12 sessions of neurofeedback and 12 sessions of placebo-feedback training (sham) in our laboratory. Crucially, we found both neurofeedback and placebo feedback to be equally effective as reflected in subjective measures of sleep complaints suggesting that the observed improvements were due to unspecific factors such as experiencing trust and receiving care and empathy from experimenters. In addition, these improvements were not reflected in objective electroencephalographic-derived measures of sleep quality. Furthermore, objective electroencephalographic measures that potentially reflected mechanisms underlying the efficacy of neurofeedback such as spectral electroencephalographic measures and sleep spindle parameters remained unchanged following 12 training sessions. A stratification into 'true' insomnia patients and 'insomnia misperceivers' (subjective, but no objective sleep problems) did not alter the results. Based on this comprehensive and well-controlled study, we conclude that for the treatment of primary insomnia, neurofeedback does not have a specific efficacy beyond unspecific placebo effects. Importantly, we do not find an advantage of neurofeedback over placebo feedback, therefore it cannot be recommended as an alternative to cognitive behavioural therapy for insomnia, the current (non-pharmacological) standard-of-care treatment. In addition, our study may foster a critical discussion that generally questions the effectiveness of neurofeedback, and emphasizes the importance of demonstrating neurofeedback efficacy in other study samples and disorders using truly placebo and double-blind controlled trials.
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Affiliation(s)
- Manuel Schabus
- Laboratory for Sleep, Cognition and Consciousness Research, Department of Psychology, University of Salzburg, Austria
- Centre for Cognitive Neuroscience Salzburg (CCNS), University of Salzburg, Austria
| | - Hermann Griessenberger
- Laboratory for Sleep, Cognition and Consciousness Research, Department of Psychology, University of Salzburg, Austria
| | - Maria-Teresa Gnjezda
- Laboratory for Sleep, Cognition and Consciousness Research, Department of Psychology, University of Salzburg, Austria
| | - Dominik P. J. Heib
- Laboratory for Sleep, Cognition and Consciousness Research, Department of Psychology, University of Salzburg, Austria
- Centre for Cognitive Neuroscience Salzburg (CCNS), University of Salzburg, Austria
| | - Malgorzata Wislowska
- Laboratory for Sleep, Cognition and Consciousness Research, Department of Psychology, University of Salzburg, Austria
- Centre for Cognitive Neuroscience Salzburg (CCNS), University of Salzburg, Austria
| | - Kerstin Hoedlmoser
- Laboratory for Sleep, Cognition and Consciousness Research, Department of Psychology, University of Salzburg, Austria
- Centre for Cognitive Neuroscience Salzburg (CCNS), University of Salzburg, Austria
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46
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Affiliation(s)
- Robert T Thibault
- Institute for Interdisciplinary Behavioral and Brain Sciences, Chapman University, Irvine, CA, 92618, USA
| | - Michael Lifshitz
- Institute for Interdisciplinary Behavioral and Brain Sciences, Chapman University, Irvine, CA, 92618, USA
| | - Amir Raz
- Institute for Interdisciplinary Behavioral and Brain Sciences, Chapman University, Irvine, CA, 92618, USA
- Departments of Psychiatry, Neurology and Neurosurgery, and Psychology, McGill University, Montreal, H3A 2B4, Canada
- The Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, H3T 1E4, Canada
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47
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Kroemer NB, Burrasch C, Hellrung L. To work or not to work: Neural representation of cost and benefit of instrumental action. PROGRESS IN BRAIN RESEARCH 2016; 229:125-157. [PMID: 27926436 DOI: 10.1016/bs.pbr.2016.06.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
By definition, instrumental actions are performed in order to obtain certain goals. Nevertheless, the attainment of goals typically implies obstacles, and response vigor is known to reflect an integration of subjective benefit and cost. Whereas several brain regions have been associated with cost/benefit ratio decision-making, trial-by-trial fluctuations in motivation are not well understood. We review recent evidence supporting the motivational implications of signal fluctuations in the mesocorticolimbic system. As an extension of "set-point" theories of instrumental action, we propose that response vigor is determined by a rapid integration of brain signals that reflect value and cost on a trial-by-trial basis giving rise to an online estimate of utility. Critically, we posit that fluctuations in key nodes of the network can predict deviations in response vigor and that variability in instrumental behavior can be accounted for by models devised from optimal control theory, which incorporate the effortful control of noise. Notwithstanding, the post hoc analysis of signaling dynamics has caveats that can effectively be addressed in future research with the help of two novel fMRI imaging techniques. First, adaptive fMRI paradigms can be used to establish a time-order relationship, which is a prerequisite for causality, by using observed signal fluctuations as triggers for stimulus presentation. Second, real-time fMRI neurofeedback can be employed to induce predefined brain states that may facilitate benefit or cost aspects of instrumental actions. Ultimately, understanding temporal dynamics in brain networks subserving response vigor holds the promise for targeted interventions that could help to readjust the motivational balance of behavior.
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Affiliation(s)
- N B Kroemer
- Technische Universität Dresden, Dresden, Germany.
| | - C Burrasch
- Technische Universität Dresden, Dresden, Germany; University of Lübeck, Lübeck, Germany
| | - L Hellrung
- Technische Universität Dresden, Dresden, Germany
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48
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Thibault RT, Raz A. When can neurofeedback join the clinical armamentarium? Lancet Psychiatry 2016; 3:497-8. [PMID: 27262039 DOI: 10.1016/s2215-0366(16)30040-2] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Revised: 04/08/2016] [Accepted: 04/08/2016] [Indexed: 11/24/2022]
Affiliation(s)
| | - Amir Raz
- McGill University, Montreal, QC, Canada; The Lady Davis Institute for Medical Research at the Jewish General Hospital, Montreal, QC, Canada; Institute for Community and Family Psychiatry, 4333 Côte St-Catherine Road, Montreal, QC H3T 1E4, Canada.
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49
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Schmidt J, Martin A. Neurofeedback Against Binge Eating: A Randomized Controlled Trial in a Female Subclinical Threshold Sample. EUROPEAN EATING DISORDERS REVIEW 2016; 24:406-16. [DOI: 10.1002/erv.2453] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Revised: 03/22/2016] [Accepted: 04/01/2016] [Indexed: 11/12/2022]
Affiliation(s)
- Jennifer Schmidt
- Department of Clinical Psychology and Psychotherapy; University of Wuppertal; Germany
| | - Alexandra Martin
- Department of Clinical Psychology and Psychotherapy; University of Wuppertal; Germany
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50
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Thibault RT, Lifshitz M, Raz A. The self-regulating brain and neurofeedback: Experimental science and clinical promise. Cortex 2016; 74:247-61. [PMID: 26706052 DOI: 10.1016/j.cortex.2015.10.024] [Citation(s) in RCA: 125] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Revised: 10/22/2015] [Accepted: 10/29/2015] [Indexed: 12/20/2022]
Affiliation(s)
| | | | - Amir Raz
- McGill University, Montreal, QC, Canada; The Lady Davis Institute for Medical Research, Montreal, QC, Canada.
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