1
|
Diotaiuti P, Corrado S, Tosti B, Spica G, Di Libero T, D’Oliveira A, Zanon A, Rodio A, Andrade A, Mancone S. Evaluating the effectiveness of neurofeedback in chronic pain management: a narrative review. Front Psychol 2024; 15:1369487. [PMID: 38770259 PMCID: PMC11104502 DOI: 10.3389/fpsyg.2024.1369487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 03/28/2024] [Indexed: 05/22/2024] Open
Abstract
The prevalence and impact of chronic pain in individuals worldwide necessitate effective management strategies. This narrative review specifically aims to assess the effectiveness of neurofeedback, an emerging non-pharmacological intervention, on the management of chronic pain. The methodology adopted for this review involves a meticulous search across various scientific databases. The search was designed to capture a broad range of studies related to neurofeedback and chronic pain management. To ensure the quality and relevance of the included studies, strict inclusion and exclusion criteria were applied. These criteria focused on the study design, population, intervention type, and reported outcomes. The review synthesizes the findings from a diverse array of studies, including randomized controlled trials, observational studies, and case reports. Key aspects evaluated include the types of neurofeedback used (such as EEG biofeedback), the various chronic pain conditions addressed (like fibromyalgia, neuropathic pain, and migraines), and the methodologies employed in these studies. The review highlights the underlying mechanisms by which neurofeedback may influence pain perception and management, exploring theories related to neural plasticity, pain modulation, and psychological factors. The results of the review reveal a positive correlation between neurofeedback interventions and improved pain management. Several studies report significant reductions on pain intensity, improved quality of life, and decreased reliance on medication following neurofeedback therapy. The review also notes variations in the effectiveness of different neurofeedback protocols and individual responses to treatment. Despite the promising results, the conclusion of the review emphasizes the need for further research. It calls for larger, well-designed clinical trials to validate the findings, to understand the long-term implications of neurofeedback therapy, and to optimize treatment protocols for individual patients.
Collapse
Affiliation(s)
- Pierluigi Diotaiuti
- Department of Human Sciences, Society and Health, University of Cassino and Southern Lazio, Cassino, Lazio, Italy
| | - Stefano Corrado
- Department of Human Sciences, Society and Health, University of Cassino and Southern Lazio, Cassino, Lazio, Italy
| | - Beatrice Tosti
- Department of Human Sciences, Society and Health, University of Cassino and Southern Lazio, Cassino, Lazio, Italy
| | - Giuseppe Spica
- Department of Human Sciences, Society and Health, University of Cassino and Southern Lazio, Cassino, Lazio, Italy
| | - Tommaso Di Libero
- Department of Human Sciences, Society and Health, University of Cassino and Southern Lazio, Cassino, Lazio, Italy
| | - Anderson D’Oliveira
- Department of Physical Education, CEFID, Santa Catarina State University, Florianopolis, Santa Catarina, Brazil
| | - Alessandra Zanon
- Department of Human Sciences, Society and Health, University of Cassino and Southern Lazio, Cassino, Lazio, Italy
| | - Angelo Rodio
- Department of Human Sciences, Society and Health, University of Cassino and Southern Lazio, Cassino, Lazio, Italy
| | - Alexandro Andrade
- Department of Physical Education, CEFID, Santa Catarina State University, Florianopolis, Santa Catarina, Brazil
| | - Stefania Mancone
- Department of Human Sciences, Society and Health, University of Cassino and Southern Lazio, Cassino, Lazio, Italy
| |
Collapse
|
2
|
Hannemose SZ, Laugesen Attardo H, Vindbjerg E, Carlsson J. Exploring expectations of neurofeedback treatment among trauma-affected refugees. Nord J Psychiatry 2024; 78:46-53. [PMID: 37755151 DOI: 10.1080/08039488.2023.2261905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 09/19/2023] [Indexed: 09/28/2023]
Abstract
BACKGROUND The use of Neurofeedback (NF) to assist individuals in learning to regulate their brain wave activity has shown promising results in reducing symptoms of posttraumatic stress disorder (PSTD). However, few studies have focused on the patients' understandings of NF and even fewer explore the perspective of refugees. PURPOSE To evaluate NF treatment for trauma-affected refugees by focusing on their expectations and understanding of NF. METHODS This qualitative study was a part of a mixed method study carried out at an outpatient mental health centre in Denmark, offering 34 trauma-affected refugees 12 sessions of NF. In this qualitative study, a subsample of seven participants was interviewed. Using in-depth semi-structured interviews, the participants' thoughts and expectations prior to participating in NF treatment were examined. The analysis was carried out in four steps, using a hermeneutic and phenomenological approach. RESULTS The analysis resulted in two themes: (1) Rationale and working mechanisms of NF and (2) Motivators for participating in the study. CONCLUSION The findings show that NF treatment for trauma affected refugees was challenged by difficulties in communicating the message about the NF equipment capabilities as well as the expected treatment outcome. These challenges included e.g. health professionals' ability to explain and the participants' cultural frame of reference. This is consistent with previous research, showing that compared to the native population, the dissemination of health information to refugees is more difficult and comprehensive. Further studies on how to ensure mutual understanding of the content of NF and expected treatment outcome are needed. TRIAL REGISTRATION ClinicalTrials.gov ID: NCT05055037. Retrospectively registered on the 06/07-2021.
Collapse
Affiliation(s)
- Sigrid Zeuthen Hannemose
- Competence Centre for Transcultural Psychiatry, Mental Health Center Ballerup, Copenhagen University Hospital - Mental Health Services CPH, Copenhagen, Denmark
| | - Henriette Laugesen Attardo
- Competence Centre for Transcultural Psychiatry, Mental Health Center Ballerup, Copenhagen University Hospital - Mental Health Services CPH, Copenhagen, Denmark
| | - Erik Vindbjerg
- Competence Centre for Transcultural Psychiatry, Mental Health Center Ballerup, Copenhagen University Hospital - Mental Health Services CPH, Copenhagen, Denmark
| | - Jessica Carlsson
- Competence Centre for Transcultural Psychiatry, Mental Health Center Ballerup, Copenhagen University Hospital - Mental Health Services CPH, Copenhagen, Denmark
- Dept of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
3
|
Choi YJ, Choi EJ, Ko E. Neurofeedback Effect on Symptoms of Posttraumatic Stress Disorder: A Systematic Review and Meta-Analysis. Appl Psychophysiol Biofeedback 2023; 48:259-274. [PMID: 37314616 DOI: 10.1007/s10484-023-09593-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2023] [Indexed: 06/15/2023]
Abstract
Posttraumatic stress disorder (PTSD) encompasses various psychological symptoms and a high early dropout rate due to treatment unresponsiveness. In recent years, neurofeedback has been implemented to control PTSD's psychological symptoms through physiological brain regulation. However, a comprehensive analysis concerning its efficacy is lacking. Therefore, we conducted a systematic review and meta-analysis to determine neurofeedback's effect on reducing PTSD symptoms. We analyzed randomized and non-randomized controlled trials (RCTs) from 1990 to July 2020, evaluating neurofeedback treatments for those diagnosed with PTSD and their symptoms. In addition, we calculated the standardized mean difference (SMD)using random-effects models to estimate effect sizes. We assessed ten articles comprising 276 participants, with a - 0.74 SMD (95% confidence interval = - 0.9230, - 0.5567), 42% I2, moderate effect size, and - 1.40 to -0.08 prediction intervals (PI). Neurofeedback was more effective for complex trauma PTSD patients than single trauma. Increasing and lengthening sessions are more effective than fewer, condensed ones. Neurofeedback positively affected arousal, anxiety, depression, and intrusive, numbing, and suicidal thoughts. Therefore, neurofeedback is a promising and effective treatment for complex PTSD.
Collapse
Affiliation(s)
- Yun-Jung Choi
- Chung-Ang University, Red Cross College of Nursing, Seoul, South Korea.
| | - Eun-Joo Choi
- Department of Nursing, Kyung-In Women's University, Incheon, South Korea
| | - Eunjung Ko
- Department of Nursing, Kyungbok University, Namyangju, South Korea
| |
Collapse
|
4
|
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.
Collapse
|
5
|
Kirk HW, Dahl MG. Infra Low Frequency Neurofeedback Training for Trauma Recovery: A Case Report. Front Hum Neurosci 2022; 16:905823. [PMID: 35978981 PMCID: PMC9376603 DOI: 10.3389/fnhum.2022.905823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 05/23/2022] [Indexed: 11/17/2022] Open
Abstract
This paper reviews how and why ILF Neurofeedback has proven to be a parsimonious and efficient way to remediate the neuro-physiological effects of trauma. Reference is made to several large- and small-scale institutional proof of concept experimental studies each addressing a specific kind of trauma. It ends with a case report by the author (Kirk) working with an American combat veteran. It makes the argument that given its success that ILF Neurofeedback and Alpha-Theta training become accepted as part of an integrative and holistic approach for treating survivors of trauma.
Collapse
Affiliation(s)
- Hanno W. Kirk
- National Association of Social Workers, Washington, DC, United States
- *Correspondence: Hanno W. Kirk
| | | |
Collapse
|
6
|
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
| |
Collapse
|
7
|
Pinheiro J, Simões de Almeida R, Marques A. Emotional self-regulation, virtual reality and neurofeedback. COMPUTERS IN HUMAN BEHAVIOR REPORTS 2021. [DOI: 10.1016/j.chbr.2021.100101] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
|
8
|
Sonne C, Mortensen EL, Silove D, Palic S, Carlsson J. Predictors of treatment outcomes for trauma-affected refugees - results from two randomised trials. J Affect Disord 2021; 282:194-202. [PMID: 33418367 DOI: 10.1016/j.jad.2020.12.095] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 10/15/2020] [Accepted: 12/22/2020] [Indexed: 01/22/2023]
Abstract
INTRODUCTION Treatment effects in trials with trauma-affected refugees vary considerably between studies, but the variability in outcome between individual patients is often overlooked. Consequently, we know little about why some patients benefit more from treatment than others. The aim of the study was therefore to identify predictors of treatment outcome for refugees with Posttraumatic Stress Disorder (PTSD). METHODS Data was derived from two randomised trials including 321 refugees, who had all participated in a 6-7 months bio-psycho-social treatment programme. Outcome measures were the Harvard Trauma Questionnaire (PTSD, self-rating), Hopkins Symptom Checklist-25 (depression and anxiety, self-rating) and Hamilton Depression and Anxiety rating scales (observer-ratings). Using hierarchical regressions models, associations were analysed between pre- to post treatment score changes (dependent variable) and a range of variables including sociodemographics, pre-migration trauma, post-migratory stressors, baseline symptom scores and level of functioning. RESULTS A high baseline score (=more symptoms) and a high level of functioning were found to be associated with improvement on all ratings. Additionally, the following variables were associated with symptom improvement on at least one outcome measure: short time in host country, full time occupation, young age and status as family reunified (in contrast to refugee status). Being Muslim was inversely correlated with improvement. LIMITATIONS Translated self-ratings were used, which could impact reliability. CONCLUSION These results call for screening and early interventions for arriving refugees. For clinical populations, level of functioning should be included in assessments of refugees, to possibly begin stratifying samples to different interventions based on their likelihood of responding.
Collapse
Affiliation(s)
- Charlotte Sonne
- Competence Centre for Transcultural Psychiatry, Mental Health Centre Ballerup, Maglevaenget 21, 2750 Ballerup, Denmark.
| | - Erik Lykke Mortensen
- Institute of Public Health and Center for Healthy Aging, University of Copenhagen, Denmark
| | - Derrick Silove
- School of Psychiatry, University of New South Wales, Australia
| | - Sabina Palic
- Competence Centre for Transcultural Psychiatry, Mental Health Centre Ballerup, Maglevaenget 21, 2750 Ballerup, Denmark
| | - Jessica Carlsson
- University of Copenhagen/Competence Centre for Transcultural Psychiatry, Mental Health Centre Ballerup, Denmark
| |
Collapse
|
9
|
Zhang J, Wong SM, Richardson JD, Jetly R, Dunkley BT. Predicting PTSD severity using longitudinal magnetoencephalography with a multi-step learning framework. J Neural Eng 2020; 17. [PMID: 33166947 DOI: 10.1088/1741-2552/abc8d6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 11/09/2020] [Indexed: 12/29/2022]
Abstract
Objective The present study explores the effectiveness of incorporating temporal information in predicting Post-Traumatic Stress Disorder (PTSD) severity using magnetoencephalography (MEG) imaging data. The main objective was to assess the relationship between longitudinal MEG functional connectome data, measured across a variety of neural oscillatory frequencies and collected at two-timepoints (Phase I & II), against PTSD severity captured at the later time point. Approach We used an in-house developed informatics solution, featuring a two-step process featuring pre-learn feature selection (CV-SVR-rRF-FS, cross-validation with support vector regression and recursive random forest feature selection) and deep learning (long-short term memory recurrent neural network, LSTM-RNN) techniques. Main results The pre-learn step selected a small number of functional connections (or edges) from Phase I MEG data associated with Phase II PTSD severity, indexed using the PTSD CheckList (PCL) score. This strategy identified the functional edges affected by traumatic exposure and indexed disease severity, either permanently or evolving dynamically over time, for optimal predictive performance. Using the selected functional edges, LSTM modelling was used to incorporate the Phase II MEG data into longitudinal regression models. Single timepoint (Phase I and Phase II MEG data) SVR models were generated for comparison. Assessed with holdout test data, alpha and high gamma bands showed enhanced predictive performance with the longitudinal models comparing to the Phase I single timepoint models. The best predictive performance was observed for lower frequency ranges compared to the higher frequencies (low gamma), for both model types. Significance This study identified the neural oscillatory signatures that benefited from additional temporal information when estimating the outcome of PTSD severity using MEG functional connectome data. Crucially, this approach can similarly be applied to any other mental health challenge, using this effective informatics foundation for longitudinal tracking of pathological brain states and predicting outcome with a MEG-based neurophysiology imaging system.
Collapse
Affiliation(s)
- Jing Zhang
- Hospital for Sick Children, Toronto, Ontario, M5G 1X8, CANADA
| | - Simeon M Wong
- Hospital for Sick Children, Toronto, Ontario, CANADA
| | | | - Rakesh Jetly
- Canadian Forces Health Services HQ, Ottawa, Ontario, CANADA
| | - Benjamin T Dunkley
- Diagnostic Imaging, Hospital for Sick Children, Toronto, Ontario, CANADA
| |
Collapse
|
10
|
Panisch LS, Hai AH. The Effectiveness of Using Neurofeedback in the Treatment of Post-Traumatic Stress Disorder: A Systematic Review. TRAUMA, VIOLENCE & ABUSE 2020; 21:541-550. [PMID: 29890906 DOI: 10.1177/1524838018781103] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Neurofeedback is an innovative treatment for post-traumatic stress disorder (PTSD) that is readily accessible to mental health therapists. As a widespread mental health concern with potentially devastating long-term consequences on psychosocial functioning, PTSD can also adversely impact biophysiological processes, particularly those related to the brain. Neurofeedback has shown promise in alleviating overall PTSD symptoms, including these underlying neurobiological consequences. Successful results have been found among clients with PTSD who have not been responsive to prior treatment modalities. While a strong base of clinical anecdotes and case studies supports its success in treating PTSD, intervention studies on neurofeedback have been critiqued for lack of rigor and poor methodological design. A current systematic review of the literature on the effectiveness of neurofeedback in treating PTSD was conducted. Unlike prior reviews which emphasized neurobiological changes, this study was written for the mental health therapist and focused solely on behavioral outcomes. Ten studies met the criteria for inclusion in this review. Neurofeedback demonstrated salubrious results in at least one outcome measure for the majority of participants across all studies. Interpretations, however, are limited by wide discrepancies in sample sizes, study designs, outcome measures, and the extent of reported results. Future research in this area would benefit from prioritizing randomized controlled trials with larger sample sizes and longitudinal follow-up results.
Collapse
Affiliation(s)
- Lisa S Panisch
- Steve Hicks School of Social Work, University of Texas at Austin, Austin, TX, USA
| | - Audrey Hang Hai
- Steve Hicks School of Social Work, University of Texas at Austin, Austin, TX, USA
| |
Collapse
|
11
|
Marlats F, Bao G, Chevallier S, Boubaya M, Djabelkhir-Jemmi L, Wu YH, Lenoir H, Rigaud AS, Azabou E. SMR/Theta Neurofeedback Training Improves Cognitive Performance and EEG Activity in Elderly With Mild Cognitive Impairment: A Pilot Study. Front Aging Neurosci 2020; 12:147. [PMID: 32612522 PMCID: PMC7308493 DOI: 10.3389/fnagi.2020.00147] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 04/30/2020] [Indexed: 01/17/2023] Open
Abstract
Background: Neurofeedback (NF) training, as a method of self-regulation of brain activity, may be beneficial in elderly patients with mild cognitive impairment (MCI). In this pilot study, we investigated whether a sensorimotor (SMR)/theta NF training could improve cognitive performance and brain electrical activity in elderly patients with MCI. Methods: Twenty elderly patients with MCI were assigned to 20 consecutive sessions of sensorimotor (SMR)/theta NF training, during 10 weeks, on a basis of two sessions each week. Neuropsychological assessments and questionnaires, as well as electroencephalogram (EEG), were performed and compared between baseline (T0), after the last NF training session at 10 weeks (T1), and 1-month follow-up (T2). Results: Repeated measures ANOVA revealed that from baseline to post-intervention, participants showed significant improvement in the Montreal cognitive assessment (MoCa, F = 4.78; p = 0.012), the delayed recall of the Rey auditory verbal learning test (RAVLT, F = 3.675; p = 0.032), the Forward digit span (F = 13.82; p < 0.0001), the Anxiety Goldberg Scale (F = 4.54; p = 0.015), the Wechsler Adult Intelligence Score-Fourth Edition (WAIS-IV; F = 24.75; p < 0.0001), and the Mac Nair score (F = 4.47; p = 0.016). EEG theta power (F = 4.44; p = 0.016) and alpha power (F = 3.84; p = 0.027) during eyes-closed resting-state significantly increased after the NF training and showed sustained improvement at a 1-month follow-up. Conclusion: Our results suggest that NF training could be effective to reduce cognitive deficits in elderly patients with MCI and improve their EEG activity. If these findings are confirmed by randomized controlled studies with larger samples of patients, NF could be seen as a useful non-invasive, non-pharmacological tool for preventing further decline, rehabilitation of cognitive function in the elderly. Clinical Trial Registration: This pilot study was a preliminary step before the trial registered in www.ClinicalTrials.gov, under the number of NCT03526692.
Collapse
Affiliation(s)
- Fabienne Marlats
- Department of Clinical Gerontology, Broca Hôspital, Assistance Publique-Hôpitaux de Paris (AP-HP), Research TEAM EA4468, Paris Descartes University, Paris, France
| | - Guillaume Bao
- Clinical Neurophysiology Laboratory, Department of Physiology, Raymond Poincaré Hôspital, Assistance Publique-Hôpitaux de Paris (AP-HP), INSERM U1173, University of Versailles Saint Quentin en Yvelines, Garches, France
| | - Sylvain Chevallier
- Versailles Engineering Systems Laboratory (LISV), University of Versailles Saint Quentin en Yvelines (UVSQ), Vélizy, France
| | - Marouane Boubaya
- Clinical Research Unit, Avicenne Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Bobigny, France
| | - Leila Djabelkhir-Jemmi
- Department of Clinical Gerontology, Broca Hôspital, Assistance Publique-Hôpitaux de Paris (AP-HP), Research TEAM EA4468, Paris Descartes University, Paris, France
| | - Ya-Huei Wu
- Department of Clinical Gerontology, Broca Hôspital, Assistance Publique-Hôpitaux de Paris (AP-HP), Research TEAM EA4468, Paris Descartes University, Paris, France
| | - Hermine Lenoir
- Department of Clinical Gerontology, Broca Hôspital, Assistance Publique-Hôpitaux de Paris (AP-HP), Research TEAM EA4468, Paris Descartes University, Paris, France
| | - Anne-Sophie Rigaud
- Department of Clinical Gerontology, Broca Hôspital, Assistance Publique-Hôpitaux de Paris (AP-HP), Research TEAM EA4468, Paris Descartes University, Paris, France
| | - Eric Azabou
- Clinical Neurophysiology Laboratory, Department of Physiology, Raymond Poincaré Hôspital, Assistance Publique-Hôpitaux de Paris (AP-HP), INSERM U1173, University of Versailles Saint Quentin en Yvelines, Garches, France
| |
Collapse
|
12
|
Askovic M, Watters AJ, Coello M, Aroche J, Harris AWF, Kropotov J. Evaluation of Neurofeedback for Posttraumatic Stress Disorder Related to Refugee Experiences Using Self-Report and Cognitive ERP Measures. Clin EEG Neurosci 2020; 51:79-86. [PMID: 31132893 DOI: 10.1177/1550059419849170] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background. Neurofeedback holds promise as an intervention for the psychophysiological dysfunction found in posttraumatic stress disorder (PTSD). Few empirical studies have assessed the efficacy of neurofeedback for PTSD, and none in individuals with refugee trauma. A proposed mechanism for neurofeedback efficacy in PTSD is through remediating deficits in cognitive control. We assessed pre- and postchanges in symptoms and neurocognitive functioning of refugee clients participating in a neurofeedback intervention for PTSD. Methods. Clinical data for 13 adult refugees with chronic PTSD who participated in neurofeedback combined with trauma counseling (NFT) was compared with 13 adult refugees placed on a waitlist to receive neurofeedback. Waitlist clients continued to receive trauma counseling alone (TC). NFT was additionally assessed pre- and posttherapy for changes in event-related potentials (ERPs) and behavioral indices of cognitive control using a visual continuous performance task (VCPT). Comparison VCPT data from healthy controls (HC) was available from the Human Brain Index database. Results. Posttherapy, NFT had significantly lower symptoms of trauma, anxiety, and depression compared with TC. NFT demonstrated an increased P3 amplitude and improved behavioral performance suggesting a normalization of cognitive control. Conclusions. These preliminary observations are consistent with a possible benefit of neurofeedback for remediating PTSD. This may be achieved at least partially by an improvement in cognitive control. Further confirmation of the effectiveness of the treatment now requires a randomized controlled trial that considers issues such as placebo response, nonspecific therapist effects, and duration of treatment.
Collapse
Affiliation(s)
- Mirjana Askovic
- New South Wales Service for the Treatment and Rehabilitation of Torture and Trauma Survivors (STARTTS), Carramar, New South Wales, Australia.,Brain Dynamics Centre, The Westmead Institute for Medical Research and Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Anna J Watters
- New South Wales Service for the Treatment and Rehabilitation of Torture and Trauma Survivors (STARTTS), Carramar, New South Wales, Australia.,Brain Dynamics Centre, The Westmead Institute for Medical Research and Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Mariano Coello
- New South Wales Service for the Treatment and Rehabilitation of Torture and Trauma Survivors (STARTTS), Carramar, New South Wales, Australia
| | - Jorge Aroche
- New South Wales Service for the Treatment and Rehabilitation of Torture and Trauma Survivors (STARTTS), Carramar, New South Wales, Australia
| | - Anthony W F Harris
- Brain Dynamics Centre, The Westmead Institute for Medical Research and Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Jury Kropotov
- N.P. Bechtereva Institute of the Human Brain of the Russian Academy of Sciences, Saint-Petersburg, Russia
| |
Collapse
|
13
|
BAHADIR A. Travma Sonrası Stres Bozukluğunun Tedavisinde EEG-Dayalı Neurofeedback Yönteminin Kullanımı. DÜZCE ÜNIVERSITESI SAĞLIK BILIMLERI ENSTITÜSÜ DERGISI 2020. [DOI: 10.33631/duzcesbed.660176] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
|
14
|
Michael T, Schanz CG, Mattheus HK, Issler T, Frommberger U, Köllner V, Equit M. Do adjuvant interventions improve treatment outcome in adult patients with posttraumatic stress disorder receiving trauma-focused psychotherapy? A systematic review. Eur J Psychotraumatol 2019; 10:1634938. [PMID: 31489131 PMCID: PMC6711134 DOI: 10.1080/20008198.2019.1634938] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 05/27/2019] [Accepted: 06/06/2019] [Indexed: 01/21/2023] Open
Abstract
Background: According to clinical guidelines, trauma-focused psychotherapies (TF-PT) such as trauma-focused cognitive behavioural therapy (TF-CBT) and eye movement desensitization and reprocessing (EMDR) are recommended as first-line treatments for posttraumatic stress disorder (PTSD). TF-CBT and EMDR are equally effective and have large effect sizes. However, many patients fail to respond or have comorbid symptoms or disorders that only partially decline with TF-PT. Thus, there is growing interest in augmenting TF-PT through adjuvant interventions. Objective: The current systematic review aims to assess whether adjuvant interventions improve outcome among adult PTSD patients receiving TF-PT. Methods: We searched the databases PubMed, PILOTS, Web of Science and the Cochrane Library for controlled clinical trials examining whether adjuvant interventions lead to more symptom reduction in adult PTSD patients receiving TF-PT. Thirteen randomized controlled trials fitted the inclusion criteria. These were evaluated for internal risk of bias using the Cochrane Handbook for Systematic Review of Interventions. Results: Most studies have a substantial risk for internal bias, mainly due to small sample sizes. Thus, no strong conclusion can be drawn from the current empirical evidence. Preliminary evidence suggests that exercise and cortisol administration may have an adjuvant effect on PTSD symptom reduction. Breathing biofeedback showed a trend for an adjuvant effect and an effect for accelerated symptom reduction. Conclusions: Currently, it is not possible to formulate evidence-based clinical recommendations regarding adjuvants interventions. While several adjuvant interventions hold the potential to boost the effectiveness of TF-PT, the realization of sufficiently powered studies is crucial to separate plausible ideas from interventions proven to work in practice.
Collapse
Affiliation(s)
- Tanja Michael
- Division of Clinical Psychology and Psychotherapy, Department of Psychology, Saarland University, Saarbrücken, Germany
| | - Christian G. Schanz
- Division of Clinical Psychology and Psychotherapy, Department of Psychology, Saarland University, Saarbrücken, Germany
| | - Hannah K. Mattheus
- Department of Child and Adolescent Psychiatry, Saarland University Medical Center, Homburg, Germany
| | - Tobias Issler
- Division of Clinical Psychology and Psychotherapy, Department of Psychology, Saarland University, Saarbrücken, Germany
| | - Ulrich Frommberger
- MediClin Department for Psychotraumatology, Durbach, Germany
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, Medical Center – University of Freiburg, University of Freiburg, Freiburg, Germany
| | - Volker Köllner
- Department of Behavioural Therapy and Psychosomatic Medicine, Rehabilitation Center Seehof, Teltow, Germany
- Psychosomatic Rehabilitation Research Group, Department of Psychosomatic Medicine, Center for Internal Medicine and Dermatology, Berlin, Germany
| | - Monika Equit
- Division of Clinical Psychology and Psychotherapy, Department of Psychology, Saarland University, Saarbrücken, Germany
| |
Collapse
|
15
|
Chiba T, Kanazawa T, Koizumi A, Ide K, Taschereau-Dumouchel V, Boku S, Hishimoto A, Shirakawa M, Sora I, Lau H, Yoneda H, Kawato M. Current Status of Neurofeedback for Post-traumatic Stress Disorder: A Systematic Review and the Possibility of Decoded Neurofeedback. Front Hum Neurosci 2019; 13:233. [PMID: 31379538 PMCID: PMC6650780 DOI: 10.3389/fnhum.2019.00233] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 06/25/2019] [Indexed: 11/13/2022] Open
Abstract
Background: Post-traumatic stress disorder (PTSD) is a neuropsychiatric affective disorder that can develop after traumatic life-events. Exposure-based therapy is currently one of the most effective treatments for PTSD. However, exposure to traumatic stimuli is so aversive that a significant number of patients drop-out of therapy during the course of treatment. Among various attempts to develop novel therapies that bypass such aversiveness, neurofeedback appears promising. With neurofeedback, patients can unconsciously self-regulate brain activity via real-time monitoring and feedback of the EEG or fMRI signals. With conventional neurofeedback methods, however, it is difficult to induce neural representation related to specific trauma because the feedback is based on the neural signals averaged within specific brain areas. To overcome this difficulty, novel neurofeedback approaches such as Decoded Neurofeedback (DecNef) might prove helpful. Instead of the average BOLD signals, DecNef allows patients to implicitly regulate multivariate voxel patterns of the BOLD signals related with feared stimuli. As such, DecNef effects are postulated to derive either from exposure or counter-conditioning, or some combination of both. Although the exact mechanism is not yet fully understood. DecNef has been successfully applied to reduce fear responses induced either by fear-conditioned or phobic stimuli among non-clinical participants. Methods: Follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a systematic review was conducted to compare DecNef effect with those of conventional EEG/fMRI-based neurofeedback on PTSD amelioration. To elucidate the possible mechanisms of DecNef on fear reduction, we mathematically modeled the effects of exposure-based and counter conditioning separately and applied it to the data obtained from past DecNef studies. Finally, we conducted DecNef on four PTSD patients. Here, we review recent advances in application of neurofeedback to PTSD treatments, including the DecNef. This review is intended to be informative for neuroscientists in general as well as practitioners planning to use neurofeedback as a therapeutic strategy for PTSD. Results: Our mathematical model suggested that exposure is the key component for DecNef effects in the past studies. Following DecNef a significant reduction of PTSD severity was observed. This effect was comparable to those reported for conventional neurofeedback approach. Conclusions: Although a much larger number of participants will be needed in future, DecNef could be a promising therapy that bypasses the unpleasantness of conscious exposure associated with conventional therapies for fear related disorders, including PTSD.
Collapse
Affiliation(s)
- Toshinori Chiba
- Computational Neuroscience Laboratories, Department of Decoded Neurofeedback, Advanced Telecommunications Research Institute International, Kyoto, Japan.,Department of Psychiatry, Graduate School of Medicine, Kobe University, Kobe, Japan
| | - Tetsufumi Kanazawa
- Department of Neuropsychiatry, Osaka Medical College, Osaka, Japan.,The Florey Institute of Neuroscience and Mental Health, Melbourne, VIC, Australia
| | - Ai Koizumi
- Sony Computer Science Laboratories, Inc., Tokyo, Japan
| | - Kentarou Ide
- Computational Neuroscience Laboratories, Department of Decoded Neurofeedback, Advanced Telecommunications Research Institute International, Kyoto, Japan.,Flower of Light Clinic for Mind and Body, Tokyo, Japan
| | - Vincent Taschereau-Dumouchel
- Computational Neuroscience Laboratories, Department of Decoded Neurofeedback, Advanced Telecommunications Research Institute International, Kyoto, Japan.,Department of Psychology, University of California, Los Angeles, Los Angeles, CA, United States
| | - Shuken Boku
- Department of Psychiatry, Graduate School of Medicine, Kobe University, Kobe, Japan
| | - Akitoyo Hishimoto
- Department of Psychiatry, Graduate School of Medicine, Kobe University, Kobe, Japan
| | | | - Ichiro Sora
- Department of Psychiatry, Graduate School of Medicine, Kobe University, Kobe, Japan
| | - Hakwan Lau
- Computational Neuroscience Laboratories, Department of Decoded Neurofeedback, Advanced Telecommunications Research Institute International, Kyoto, Japan.,Department of Psychology, University of California, Los Angeles, Los Angeles, CA, United States.,Department of Brain Research Institute, University of California, Los Angeles, Los Angeles, CA, United States.,Department of Psychology, University of Hong Kong, Pokfulam, Hong Kong
| | - Hiroshi Yoneda
- Department of Neuropsychiatry, Osaka Medical College, Osaka, Japan
| | - Mitsuo Kawato
- Computational Neuroscience Laboratories, Department of Decoded Neurofeedback, Advanced Telecommunications Research Institute International, Kyoto, Japan.,RIKEN Center for Advanced Intelligence Project (AIP), Tokyo, Japan
| |
Collapse
|
16
|
|
17
|
Holt R, McLean L. Australian Psychotherapy for Trauma Incorporating Neuroscience: Evidence- and Ethics-Informed Practice. NEUROETHICS-NETH 2019. [DOI: 10.1007/s12152-019-09398-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|