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Xia Z, Yang PY, Chen SL, Zhou HY, Yan C. Uncovering the power of neurofeedback: a meta-analysis of its effectiveness in treating major depressive disorders. Cereb Cortex 2024; 34:bhae252. [PMID: 38889442 DOI: 10.1093/cercor/bhae252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 05/25/2024] [Accepted: 06/04/2024] [Indexed: 06/20/2024] Open
Abstract
Neurofeedback, a non-invasive intervention, has been increasingly used as a potential treatment for major depressive disorders. However, the effectiveness of neurofeedback in alleviating depressive symptoms remains uncertain. To address this gap, we conducted a comprehensive meta-analysis to evaluate the efficacy of neurofeedback as a treatment for major depressive disorders. We conducted a comprehensive meta-analysis of 22 studies investigating the effects of neurofeedback interventions on depression symptoms, neurophysiological outcomes, and neuropsychological function. Our analysis included the calculation of Hedges' g effect sizes and explored various moderators like intervention settings, study designs, and demographics. Our findings revealed that neurofeedback intervention had a significant impact on depression symptoms (Hedges' g = -0.600) and neurophysiological outcomes (Hedges' g = -0.726). We also observed a moderate effect size for neurofeedback intervention on neuropsychological function (Hedges' g = -0.418). As expected, we observed that longer intervention length was associated with better outcomes for depressive symptoms (β = -4.36, P < 0.001) and neuropsychological function (β = -2.89, P = 0.003). Surprisingly, we found that shorter neurofeedback sessions were associated with improvements in neurophysiological outcomes (β = 3.34, P < 0.001). Our meta-analysis provides compelling evidence that neurofeedback holds promising potential as a non-pharmacological intervention option for effectively improving depressive symptoms, neurophysiological outcomes, and neuropsychological function in individuals with major depressive disorders.
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Affiliation(s)
- Zheng Xia
- Key Laboratory of Brain Functional Genomics (MOE&STCSM), Affiliated Mental Health Center (ECNU), School of Psychology and Cognitive Science, East China Normal University, 3663 North Zhongshan Road, Shanghai 200062, China
- Shanghai Changning Mental Health Center, 299 Xiehe Road, Shanghai 200335, China
| | - Peng-Yuan Yang
- Department of Methodology and Statistics, Faculty of Behavioral and Social Sciences, Tilburg University, Warandelaan 2, 5037 AB, Tilburg, The Netherlands
| | - Si-Lu Chen
- Shanghai Changning Mental Health Center, 299 Xiehe Road, Shanghai 200335, China
| | - Han-Yu Zhou
- Shanghai Key Laboratory of Mental Health and Psychological Crisis Intervention, Affiliated Mental Health Center (ECNU), School of Psychology and Cognitive Science, East China Normal University, 3663 North Zhongshan Road, Shanghai 200062, China
| | - Chao Yan
- Key Laboratory of Brain Functional Genomics (MOE&STCSM), Affiliated Mental Health Center (ECNU), School of Psychology and Cognitive Science, East China Normal University, 3663 North Zhongshan Road, Shanghai 200062, China
- Shanghai Changning Mental Health Center, 299 Xiehe Road, Shanghai 200335, China
- Key Laboratory of Philosophy and Social Science of Anhui Province on Adolescent Mental Health and Crisis Intelligence Intervention, Hefei Normal University, 1688 Lianhua Road, Hefei 230601, China
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Ubeda Matzilevich E, Daniel PL, Little S. Towards therapeutic electrophysiological neurofeedback in Parkinson's disease. Parkinsonism Relat Disord 2024; 121:106010. [PMID: 38245382 DOI: 10.1016/j.parkreldis.2024.106010] [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: 09/11/2023] [Revised: 01/10/2024] [Accepted: 01/12/2024] [Indexed: 01/22/2024]
Abstract
Neurofeedback (NF) techniques support individuals to self-regulate specific features of brain activity, which has been shown to impact behavior and potentially ameliorate clinical symptoms. Electrophysiological NF (epNF) may be particularly impactful for patients with Parkinson's disease (PD), as evidence mounts to suggest a central role of pathological neural oscillations underlying symptoms in PD. Exaggerated beta oscillations (12-30 Hz) in the basal ganglia-cortical network are linked to motor symptoms (e.g., bradykinesia, rigidity), and beta is reduced by successful therapy with dopaminergic medication and Deep Brain Stimulation (DBS). PD patients also experience non-motor symptoms related to sleep, mood, motivation, and cognitive control. Although less is known about the mechanisms of non-motor symptoms in PD and how to successfully treat them, low frequency neural oscillations (1-12 Hz) in the basal ganglia-cortical network are particularly implicated in non-motor symptoms. Here, we review how cortical and subcortical epNF could be used to target motor and non-motor specific oscillations, and potentially serve as an adjunct therapy that enables PD patients to endogenously control their own pathological neural activities. Recent studies have demonstrated that epNF protocols can successfully support volitional control of cortical and subcortical beta rhythms. Importantly, this endogenous control of beta has been linked to changes in motor behavior. epNF for PD, as a casual intervention on neural signals, has the potential to increase understanding of the neurophysiology of movement, mood, and cognition and to identify new therapeutic approaches for motor and non-motor symptoms.
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Affiliation(s)
- Elena Ubeda Matzilevich
- Movement Disorders and Neuromodulation Division, Department of Neurology, University of California San Francisco, CA, USA
| | - Pria Lauren Daniel
- Movement Disorders and Neuromodulation Division, Department of Neurology, University of California San Francisco, CA, USA; Department of Psychology, University of California San Diego, CA, USA.
| | - Simon Little
- Movement Disorders and Neuromodulation Division, Department of Neurology, University of California San Francisco, CA, USA
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Voigt JD, Mosier M, Tendler A. Systematic review and meta-analysis of neurofeedback and its effect on posttraumatic stress disorder. Front Psychiatry 2024; 15:1323485. [PMID: 38577405 PMCID: PMC10993781 DOI: 10.3389/fpsyt.2024.1323485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 02/09/2024] [Indexed: 04/06/2024] Open
Abstract
Background To date, only one systematic review and meta-analysis of randomized controlled trials (RCTs) has evaluated the effect of neurofeedback in PTSD, which included only four studies and found an uncertainty of the effect of EEG-NF on PTSD symptoms. This meta-analysis is an update considering that numerous studies have since been published. Additionally, more recent studies have included fMRI-NF as well as fMRI-guided or -inspired EEG NF. Methods Systematic literature searches for RCTs were conducted in three online databases. Additional hand searches of each study identified and of systematic reviews and meta-analyses published were also undertaken. Outcomes evaluated the effect of neurofeedback vs. a control (active, sham, and waiting list) on their effects in reducing PTSD symptoms using various health instruments. Meta-analytical methods used were inverse variance random-effects models measuring both mean and standardized mean differences. Quality and certainty of the evidence were assessed using GRADE. Adverse events were also evaluated. Results A total of 17 studies were identified evaluating a total of 628 patients. There were 10 studies used in the meta-analysis. Results from all studies identified favored neurofeedback's effect on reducing PTSD symptoms including BDI pretest-posttest [mean difference (MD): 8.30 (95% CI: 3.09 to 13.52; P = 0.002; I 2 = 0%)]; BDI pretest-follow-up (MD: 8.75 (95% CI: 3.53 to 13.97; P < 0.00001; I 2 = 0%); CAPS-5 pretest-posttest [MD: 7.01 (95% CI: 1.36 to 12.66; P = 0.02; I 2 = 86%)]; CAPS-5 pretest-follow-up (MD: 10 (95% CI: 1.29 to 21.29; P = 0.006; I 2 = 77%); PCL-5 pretest-posttest (MD: 7.14 (95% CI: 3.08 to 11.2; P = 0.0006; I 2 = 0%); PCL-5 pretest-follow-up (MD: 14.95 (95% CI: 7.95 to 21.96; P < 0.0001; I 2 = 0%). Other studies reported improvements using various other instruments. GRADE assessments of CAPS, PCL, and BDI demonstrated a moderate/high level in the quality of the evidence that NF has a positive clinical effect. Conclusion Based on newer published studies and the outcomes measured, NF has demonstrated a clinically meaningful effect size, with an increased effect size at follow-up. This clinically meaningful effect appears to be driven by newer fMRI-guided NF and deeper brain derivates of it.
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Affiliation(s)
- Jeffrey D. Voigt
- Medical Device Consultants of Ridgewood, LLC, Waldwick, NJ, United States
| | - Michael Mosier
- EMB Statistical Solutions, LLC, Topeka, KS, United States
| | - Aron Tendler
- Department Life Sciences, Ben-Gurion University of the Negev, Be’er Sheva, Israel
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Marcu GM, Dumbravă A, Băcilă IC, Szekely-Copîndean RD, Zăgrean AM. Increasing Value and Reducing Waste of Research on Neurofeedback Effects in Post-traumatic Stress Disorder: A State-of-the-Art-Review. Appl Psychophysiol Biofeedback 2024; 49:23-45. [PMID: 38151684 DOI: 10.1007/s10484-023-09610-5] [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] [Indexed: 12/29/2023]
Abstract
Post-Traumatic Stress Disorder (PTSD) is often considered challenging to treat due to factors that contribute to its complexity. In the last decade, more attention has been paid to non-pharmacological or non-psychological therapies for PTSD, including neurofeedback (NFB). NFB is a promising non-invasive technique targeting specific brainwave patterns associated with psychiatric symptomatology. By learning to regulate brain activity in a closed-loop paradigm, individuals can improve their functionality while reducing symptom severity. However, owing to its lax regulation and heterogeneous legal status across different countries, the degree to which it has scientific support as a psychiatric treatment remains controversial. In this state-of-the-art review, we searched PubMed, Cochrane Central, Web of Science, Scopus, and MEDLINE and identified meta-analyses and systematic reviews exploring the efficacy of NFB for PTSD. We included seven systematic reviews, out of which three included meta-analyses (32 studies and 669 participants) that targeted NFB as an intervention while addressing a single condition-PTSD. We used the MeaSurement Tool to Assess systematic Reviews (AMSTAR) 2 and the criteria described by Cristea and Naudet (Behav Res Therapy 123:103479, 2019, https://doi.org/10.1016/j.brat.2019.103479 ) to identify sources of research waste and increasing value in biomedical research. The seven assessed reviews had an overall extremely poor quality score (5 critically low, one low, one moderate, and none high) and multiple sources of waste while opening opportunities for increasing value in the NFB literature. Our research shows that it remains unclear whether NFB training is significantly beneficial in treating PTSD. The quality of the investigated literature is low and maintains a persistent uncertainty over numerous points, which are highly important for deciding whether an intervention has clinical efficacy. Just as importantly, none of the reviews we appraised explored the statistical power, referred to open data of the included studies, or adjusted their pooled effect sizes for publication bias and risk of bias. Based on the obtained results, we identified some recurrent sources of waste (such as a lack of research decisions based on sound questions or using an appropriate methodology in a fully transparent, unbiased, and useable manner) and proposed some directions for increasing value (homogeneity and consensus) in designing and reporting research on NFB interventions in PTSD.
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Affiliation(s)
- Gabriela Mariana Marcu
- Division of Physiology and Neuroscience, Department of Functional Sciences, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.
- Department of Psychology, "Lucian Blaga" University of Sibiu, Sibiu, Romania.
| | - Andrei Dumbravă
- George I.M. Georgescu Institute of Cardiovascular Diseases, Iaşi, Romania
- Alexandru Ioan Cuza University Iaşi, Iaşi, Romania
| | - Ionuţ-Ciprian Băcilă
- Scientific Research Group in Neuroscience "Dr. Gheorghe Preda" Clinical Psychiatry Hospital, Sibiu, Romania
- Faculty of Medicine, "Lucian Blaga" University of Sibiu Romania, Sibiu, Romania
| | - Raluca Diana Szekely-Copîndean
- Scientific Research Group in Neuroscience "Dr. Gheorghe Preda" Clinical Psychiatry Hospital, Sibiu, Romania
- Department of Social and Human Research, Romanian Academy - Cluj-Napoca Branch, Cluj-Napoca, Romania
| | - Ana-Maria Zăgrean
- Division of Physiology and Neuroscience, Department of Functional Sciences, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
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Askovic M, Soh N, Elhindi J, Harris AW. Neurofeedback for post-traumatic stress disorder: systematic review and meta-analysis of clinical and neurophysiological outcomes. Eur J Psychotraumatol 2023; 14:2257435. [PMID: 37732560 PMCID: PMC10515677 DOI: 10.1080/20008066.2023.2257435] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 07/22/2023] [Indexed: 09/22/2023] Open
Abstract
Background: Posttraumatic stress disorder (PTSD) is a debilitating condition affecting millions of people worldwide. Existing treatments often fail to address the complexity of its symptoms and functional impairments resulting from severe and prolonged trauma. Electroencephalographic Neurofeedback (NFB) has emerged as a promising treatment that aims to reduce the symptoms of PTSD by modulating brain activity.Objective: We conducted a systematic review and meta-analysis of ten clinical trials to answer the question: how effective is NFB in addressing PTSD and other associated symptoms across different trauma populations, and are these improvements related to neurophysiological changes?Method: The review followed the Preferred Reporting Items for Systematic Reviews and Meta analyses guidelines. We considered all published and unpublished randomised controlled trials (RCTs) and non-randomised studies of interventions (NRSIs) involving adults with PTSD as a primary diagnosis without exclusion by type of trauma, co-morbid diagnosis, locality, or sex. Ten controlled studies were included; seven RCTs and three NRSIs with a total number of participants n = 293 (128 male). Only RCTs were included in the meta-analysis (215 participants; 88 male).Results: All included studies showed an advantage of NFB over control conditions in reducing symptoms of PTSD, with indications of improvement in symptoms of anxiety and depression and related neurophysiological changes. Meta-analysis of the pooled data shows a significant reduction in PTSD symptoms post-treatment SMD of -1.76 (95% CI -2.69, -0.83), and the mean remission rate was higher in the NFB group (79.3%) compared to the control group (24.4%). However, the studies reviewed were mostly small, with heterogeneous populations and varied quality.Conclusions: The effect of NFB on the symptoms of PTSD was moderate and mechanistic evidence suggested that NFB leads to therapeutic changes in brain functioning. Future research should focus on more rigorous methodological designs, expanded sample size and longer follow-up.
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Affiliation(s)
- Mirjana Askovic
- New South Wales Service for the Treatment and Rehabilitation of Torture and Trauma Survivors (STARTTS), Sydney, NSW, Australia
- Specialty of Psychiatry, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
- Brain Dynamics Centre, Westmead Institute for Medical Research, University of Sydney, Sydney, NSW, Australia
| | - Nerissa Soh
- Specialty of Psychiatry, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| | - James Elhindi
- Research and Education Network, Western Sydney Local Health District, Sydney, NSW, Australia
| | - Anthony W.F. Harris
- Specialty of Psychiatry, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
- Brain Dynamics Centre, Westmead Institute for Medical Research, University of Sydney, Sydney, NSW, Australia
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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.
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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
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Kremer S, Blue T. Biofeedback as an Adjunct or Alternative Intervention to Cognitive Behavioral Therapy for Insomnia. Sleep Med Clin 2023; 18:85-93. [PMID: 36764789 DOI: 10.1016/j.jsmc.2022.10.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
Insomnia is highly prevalent and comorbid with many disorders. However, insomnia is underdiagnosed and undertreated in many populations. Cognitive behavioral therapy for insomnia (CBT-I) is not appropriate or sufficient for some individuals. Biofeedback has demonstrated efficacy in a range of disorders, including insomnia. The authors discuss the history and rationale for the use of biofeedback in the treatment of insomnia and other comorbid disorders. The article also presents current research on biofeedback for insomnia and comorbid disorders with recommendations for using biofeedback as an adjunct or alternative intervention to CBT-I.
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Affiliation(s)
- Stephanie Kremer
- Department of Psychiatry and Biobehavioral Sciences, UCLA David Geffen School of Medicine, UCLA Insomnia Clinic, Cousins Center for Psychoneuroimmunology, 300 Medical Plaza, Suite 3200A, Los Angeles, CA 90095, USA.
| | - Tanecia Blue
- VA Pacific Islands Healthcare System, 459 Patterson Road, Honolulu, HI 96819, USA
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Fedotchev AI. Correction of Stress-Induced States Using Sensory Stimulation Automatically Modulated by Endogenous Human Rhythms. NEUROSCIENCE AND BEHAVIORAL PHYSIOLOGY 2022; 52:947-952. [PMID: 36373061 PMCID: PMC9638486 DOI: 10.1007/s11055-022-01322-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 04/26/2021] [Indexed: 06/16/2023]
Abstract
This article considers the dynamics of the development of a potential approach to correcting stress-induced states in humans, i.e., adaptive neurostimulation. The approach consists of presenting sensory stimulation automatically modulated by intrinsic rhythmic human processes such as the respiratory rhythm, the heartbeat rhythm, and electroencephalograph (EEG) rhythms. Many examples have shown that real-time self-adjustment of the stimulation parameters by these rhythms leads to a high level personalization of therapeutic stimulation and increases in its efficacy in suppressing stress-induced states. The publications reviewed here point to the advantages of this approach for developing innovatory technologies using complex feedback from endogenous human rhythms to correct a wide spectrum of functional disorders.
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Affiliation(s)
- A I Fedotchev
- Institute of Cell Biophysics, Russian Academy of Sciences, Pushchino, Russia
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9
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Hong J, Park JH. Efficacy of Neuro-Feedback Training for PTSD Symptoms: A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13096. [PMID: 36293673 PMCID: PMC9603735 DOI: 10.3390/ijerph192013096] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 10/07/2022] [Accepted: 10/10/2022] [Indexed: 06/16/2023]
Abstract
If the negative emotions experienced in life become trauma, they affect daily life. Neuro-feedback technology has recently been introduced as a treatment, but many different neuro-feedback protocols and methods exits. This study conducted a meta-analysis of neuro-feedback training for post-traumatic stress disorder (PTSD) symptoms to evaluate the effects of functional magnetic resonance imaging (fMRI) and electroencephalogram (EEG)-based neuro-feedback training. A search of PubMed, the Cochrane Library, Web of Science, Science Direct, and ClinicalTrials.gov was conducted from January 2011 to December 2021. The studies' quality was assessed using the Cochrane risk of bias tool and publication bias was assessed by Egger's regression test. Seven studies that met the inclusion criteria were used for the systematic review and meta-analysis. EEG was more effective than fMRI for PTSD symptoms, and the effect on PTSD symptoms was higher than on anxiety and depression. There was no difference in the effectiveness of the training sessions. Our findings showed that EEG-based neuro-feedback training was more helpful for training PTSD symptoms. Additionally, the methods were also shown to be valid for evaluating clinical PTSD diagnoses. Further research is needed to establish a gold standard protocol for the EEG-based neuro-feedback training (EEG-NFT) method for PTSD symptoms.
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Affiliation(s)
- Jian Hong
- Department of ICT Convergence, The Graduate School, Soonchunhyang University, Asan 31538, Korea
| | - Jin-Hyuck Park
- Department of Occupational Therapy, Soonchunhyang University, Asan 31538, Korea
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Nan W, Wan M, Jiang Y, Shi X, Wan F, Cai D. Alpha/Theta Ratio Neurofeedback Training for Attention Enhancement in Normal Developing Children: A Brief Report. Appl Psychophysiol Biofeedback 2022; 47:223-229. [PMID: 35691974 DOI: 10.1007/s10484-022-09550-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2022] [Indexed: 01/12/2023]
Abstract
Attention plays an important role in children's development and learning, and neurofeedback training (NFT) has been proposed as a promising method to improve attention, mainly in population with attention problems such as attention deficit hyperactivity disorder. However, whether this approach has a positive effect on attention in normal developing children has been rarely investigated. This pilot study conducted ten sessions of alpha/theta ratio (ATR) NFT on eight primary students in school environment, with two to three sessions per week. The results showed inter-individual difference in NFT learning efficacy that was assessed by the slope of ATR over training sessions. In addition, the attention performance was significantly improved after NFT. Importantly, the improvement of attention performance was positively correlated with the NFT learning efficacy. It thus highlighted the need for optimizing ATR NFT protocol for the benefits on attention at the individual level. Future work can employ a double-blind placebo-controlled design with larger sample size to validate the benefits of ATR NFT for attention in normal developing children.
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Affiliation(s)
- Wenya Nan
- Department of Psychology, Shanghai Normal University, Shanghai, China
| | - Mengqi Wan
- Department of Psychology, Shanghai Normal University, Shanghai, China
| | - Yali Jiang
- Department of Psychology, Shanghai Normal University, Shanghai, China
| | - Xiaoping Shi
- Department of Psychology, Shanghai Normal University, Shanghai, China
| | - Feng Wan
- Department of Electrical and Computer Engineering, Faculty of Science and Engineering, University of Macau, Macau, China
- Centre for Cognitive and Brain Sciences, Institute of Collaborative Innovation, University of Macau, Macau, China
| | - Dan Cai
- Department of Psychology, Shanghai Normal University, Shanghai, China.
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Winkeler A, Winkeler M, Imgart H. Infra-Low Frequency Neurofeedback in the Treatment of Patients With Chronic Eating Disorder and Comorbid Post-Traumatic Stress Disorder. Front Hum Neurosci 2022; 16:890682. [PMID: 35601900 PMCID: PMC9121895 DOI: 10.3389/fnhum.2022.890682] [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: 03/06/2022] [Accepted: 04/06/2022] [Indexed: 11/20/2022] Open
Abstract
The treatment of patients suffering from an eating disorder and a comorbid post-traumatic stress disorder is challenging and often leads to poor outcomes. In a randomized control trial, we evaluated to what extent adding Infra-Low Frequency (ILF) neurofeedback could improve symptom reduction within an established inpatient treatment program. In a randomized two-group design, patients suffering from an eating disorder (anorexia nervosa, bulimia nervosa, or binge eating disorder) and comorbid post-traumatic stress disorder (N = 36) were examined while attending an inpatient treatment program in a clinic for psychosomatic disorders. The intervention group received ILF neurofeedback in addition to regular therapy, while the control group received “media-supported relaxation” as a placebo intervention. At the beginning and at the end of their treatment, all participants completed the Eating Disorder Examination-Questionnaire (EDE-Q) as a measure of eating disorder psychopathology and the Impact of Event Scale-Revised (IES-R) in order to assess symptoms of post-traumatic stress. Changes in EDE-Q and IES-R scores over time served as primary outcomes as well as an increase in body mass index in underweight patients. Secondary outcomes were the perceived benefit of the received intervention, global assessment of psychological treatment success, and complications in the course of treatment. Statistical evaluation was carried out with repeated measurement analysis of variance for the primary outcomes and with t-tests and Fisher’s exact test for the secondary outcomes. Our results indicate better treatment outcomes in the ILF neurofeedback group with regard to trauma-associated avoidance as well as with regard to restraint eating and increase in body weight. Furthermore, patients who had received ILF neurofeedback rated the intervention they received and, in tendency, their overall treatment more positively and they experienced fewer complications in the course of treatment. ILF neurofeedback is very well accepted by patients and seems to provide a relevant additional benefit in some aspects of symptom reduction. Findings confirm the feasibility of embedding this treatment approach in an inpatient setting and support the case for a larger study for greater statistical power. Clinical Trial Registration: “Infra-Low Frequency Neurofeedback training in the treatment of patients with eating disorder and comorbid post-traumatic stress disorder”; German Clinical Trials Registry (https://www.drks.de; Identifier: DRKS00027826).
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ZHANG JUNAN, GU LIPING, CHEN YONGQIANG, ZHU GENG, OU LANG, WANG LIYAN, LI XIAOOU, ZHONG LICHANG. MULTI-FEATURE FUSION EMOTION RECOGNITION BASED ON RESTING EEG. J MECH MED BIOL 2022. [DOI: 10.1142/s0219519422400024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
An important task of brain–computer interface (BCI) research is to read or decode mental content from a large number of electroencephalographic (EEG) signals, which is an exciting, attractive, and challenging goal. In this paper, resting EEG data are collected from spontaneous EEG, and 16 random features such as correlation coefficient, covariance, and brainpower spectrum are extracted as reference vectors. In the subsequent emotion recognition experiment, the same feature information is extracted and separated from the EEG signal, and the translation and normalization processing are carried out based on the resting-state features. Finally, with the machine learning methods such as [Formula: see text]-means clustering and multi-feature fusion, the positive, negative, and neutral emotional characteristic parameters were correctly separated. In a group of 12 subjects, the correct recognition rate of visual evoked positive, negative, and neutral emotions reached 83.9%, which was better than the literature mentioned in this paper. Another highlight of this method is that it can quickly, accurately, and efficiently select the number of features with the best matching and the least resource consumption from multiple features and multiple potential acquisition points. Further analysis and comparison of EEG characteristics can find the relationship between specific stimuli and corresponding EEG characteristic signals.
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Affiliation(s)
- JUN-AN ZHANG
- Medical Instrumentation College, Shanghai University of Medicine and Health Sciences, Shanghai Wearable Medical Technology and Device Engineering Research Center, Shanghai 201318, P. R. China
| | - LIPING GU
- Department of Medical Ultrasound, Shanghai Jiaotong University Affiliated Sixth People’s Hospital, Shanghai 200240, P. R. China
| | - YONGQIANG CHEN
- Medical Instrumentation College, Shanghai University of Medicine and Health Sciences, Shanghai 201318, P. R. China
| | - GENG ZHU
- Medical Instrumentation College, Shanghai University of Medicine and Health Sciences, Shanghai 201318, P. R. China
| | - LANG OU
- West China Second University Hospital, Sichuan University, Chengdu 610044, P. R. China
| | - LIYAN WANG
- College of Rehabilitation Sciences, Shanghai University of Medicine and Health Sciences, Shanghai 201318, P. R. China
| | - XIAOOU LI
- Medical Instrumentation College, Shanghai University of Medicine and Health Sciences, Shanghai 201318, P. R. China
- Shanghai Wearable Medical Technology and Device Engineering Research Center, Shanghai 200240, P. R. China
| | - LICHANG ZHONG
- Department of Medical Ultrasound, Shanghai Jiaotong University Affiliated Sixth People’s Hospital, Shanghai 200240, P. R. China
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Lee JN, Whang MC, Kang BG. Process Design for Optimized Respiration Identification Based on Heart Rate Variability for Efficient Respiratory Sinus Arrhythmia Biofeedback. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:2087. [PMID: 35206277 PMCID: PMC8871855 DOI: 10.3390/ijerph19042087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 02/04/2022] [Accepted: 02/08/2022] [Indexed: 01/27/2023]
Abstract
Respiratory sinus arrhythmia (RSA) is a phenomenon in which the heart rate (HR) changes with respiration, increasing during inspiration and decreasing during expiration. RSA biofeedback training has an effect in relieving negative mental conditions, such as anxiety and stress. Respiration is an important indicator affecting the parasympathetic activation within the body during RSA biofeedback training. Although there are existing studies that consider individual differences when selecting optimized respiration using heart rate variability, the studies that use the high frequency components of HRV, which is an indicator of parasympathetic activation, are insufficient. For this reason, this paper proposes a process to identify optimized respiration for efficient RSA feedback, consisting of three steps: (1) application, (2) optimization, and (3) validation. In the application phase, we measured PPG data against various respiratory cycles based on the HF components of HRV and calculated the proposed heart stabilization indicator (HSI) from the data. Then, we determined the optimized respiration cycle based on the HSI in the optimization step. Finally, we analyzed seven stress-related indices against the optimized respiration cycle. The experimental results show that HSI is associated with the parasympathetic nervous system activation, and the proposed method could help to determine the optimal respiratory cycle for each individual. Lastly, we expect that the proposed design could be used as an alternative to improving the efficiency of RSA biofeedback training.
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Affiliation(s)
- Jung-Nyun Lee
- Research Institute of Industrial Technology Convergence, Korea Institute of Industrial Technology (KITECH), Ansan 15588, Korea;
| | - Min-Cheol Whang
- Department of Human-Centered Artificial Intelligence, University of Sangmyung, Seoul 03016, Korea;
| | - Bong-Gu Kang
- Research Institute of Industrial Technology Convergence, Korea Institute of Industrial Technology (KITECH), Ansan 15588, Korea;
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14
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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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15
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Steingrímsson S, Odéus E, Cederlund M, Franzén S, Helgesson C, Nyström K, Sondell J, Opheim A. Weighted blanket and sleep medication use among adults with psychiatric diagnosis - a population-based register study. Nord J Psychiatry 2022; 76:29-36. [PMID: 34106812 DOI: 10.1080/08039488.2021.1931713] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To measure rate of subscription of common sleep medication and diagnoses of substance use disorder (SUD) before and after receiving a prescribed weighted blanket (WB) among patients with psychiatric diagnoses. MATERIALS AND METHODS Using register-based data of health-related factors in a Swedish region, a total of 1785 adult individuals with a psychiatric diagnosis, received a WB and resided in the region during the study period were identified. Using each individual as their own control, the rate of one-year prior prescription of WB or diagnosed SUD was compared to rate after a half year wash-out after prescription of WB for a full year. RESULTS The number of patients without prescription of sleep medication increased by 3.3% (95% confidence interval (95%CI): 0.2-6.4, p=.04). Furthermore, the proportion without a prescription of benzodiazepine receptor agonist/antihistamines sleep medication increased by 5.5% (95%CI: 2.2-8.8, p=.001). Melatonin prescription increased after WB by 3.6% (95%CI: 1.1-6.2, p=.006). Younger age and unipolar-, anxiety-, attention-deficit/hyperactivity-, and post-traumatic stress disorder was associated with decreased use while psychotic-/bipolar- and personality disorder was not associated with a decrease in the use of sleep medication. The number of alcohol SUD diagnoses did not increase while sedative SUD rate increased statistically significantly by 0.7% (odds ratio = 1.63, p=.02). In a multivariate model, only younger age predicted discontinuation of sleep medication while psychotic-/bipolar- and personality disorder had statistically less decrease. CONCLUSION This observational register study found a statistically significant association between WB use and decreased use of common sleep medication except melatonin that increased slightly.
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Affiliation(s)
- Steinn Steingrímsson
- Region Västra Götaland, Sahlgrenska University Hospital, Department of Psychiatry, Gothenburg, Sweden.,Sahlgrenska Academy, University of Gothenburg, Institute of Neuroscience and Physiology, Gothenburg, Sweden
| | - Ellen Odéus
- Sahlgrenska Academy, University of Gothenburg, Institute of Neuroscience and Physiology, Gothenburg, Sweden.,Region Västra Götaland, Queen Silvias Children's Hospital, Department of Occupational and Physiotherapy, Sweden
| | - Mats Cederlund
- Region Västra Götaland, Habilitation & Health, Gothenburg, Sweden
| | - Stefan Franzén
- Region Västra Götaland, The Swedish National Diabetes Register, Gothenburg, Sweden.,Health Metrics Unit, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Carina Helgesson
- Region Västra Götaland, Regional Primary Health Care Unit, Health Care Pharmacy and Medical Aid, Gothenburg, Sweden
| | - Kristina Nyström
- Region Västra Götaland, Habilitation & Health, Gothenburg, Sweden
| | - John Sondell
- Department of Data Management and Analysis, Head Office, Region Västra Götaland, Gothenburg, Sweden
| | - Arve Opheim
- Sahlgrenska Academy, University of Gothenburg, Institute of Neuroscience and Physiology, Gothenburg, Sweden.,Region Västra Götaland, Habilitation & Health, Gothenburg, Sweden
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16
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EEG Neurofeedback for Anxiety Disorders and Post-Traumatic Stress Disorders: A Blueprint for a Promising Brain-Based Therapy. Curr Psychiatry Rep 2021; 23:84. [PMID: 34714417 DOI: 10.1007/s11920-021-01299-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/05/2021] [Indexed: 12/12/2022]
Abstract
PURPOSE OF REVIEW This review provides an overview of current knowledge and understanding of EEG neurofeedback for anxiety disorders and post-traumatic stress disorders. RECENT FINDINGS The manifestations of anxiety disorders and post-traumatic stress disorders (PTSD) are associated with dysfunctions of neurophysiological stress axes and brain arousal circuits, which are important dimensions of the research domain criteria (RDoC). Even if the pathophysiology of these disorders is complex, one of its defining signatures is behavioral and physiological over-arousal. Interestingly, arousal-related brain activity can be modulated by electroencephalogram-based neurofeedback (EEG NF), a non-pharmacological and non-invasive method that involves neurocognitive training through a brain-computer interface (BCI). EEG NF is characterized by a simultaneous learning process where both patient and computer are involved in modifying neuronal activity or connectivity, thereby improving associated symptoms of anxiety and/or over-arousal. Positive effects of EEG NF have been described for both anxiety disorders and PTSD, yet due to a number of methodological issues, it remains unclear whether symptom improvement is the direct result of neurophysiological changes targeted by EEG NF. Thus, in this work we sought to bridge current knowledge on brain mechanisms of arousal with past and present EEG NF therapies for anxiety and PTSD. In a nutshell, we discuss the neurophysiological mechanisms underlying the effects of EEG NF in anxiety disorder and PTSD, the methodological strengths/weaknesses of existing EEG NF randomized controlled trials for these disorders, and the neuropsychological factors that may impact NF training success.
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17
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Neurofeedback for cognitive enhancement and intervention and brain plasticity. Rev Neurol (Paris) 2021; 177:1133-1144. [PMID: 34674879 DOI: 10.1016/j.neurol.2021.08.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 08/27/2021] [Indexed: 12/18/2022]
Abstract
In recent years, neurofeedback has been used as a cognitive training tool to improve brain functions for clinical or recreational purposes. It is based on providing participants with feedback about their brain activity and training them to control it, initiating directional changes. The overarching hypothesis behind this method is that this control results in an enhancement of the cognitive abilities associated with this brain activity, and triggers specific structural and functional changes in the brain, promoted by learning and neuronal plasticity effects. Here, we review the general methodological principles behind neurofeedback and we describe its behavioural benefits in clinical and experimental contexts. We review the non-specific effects of neurofeedback on the reinforcement learning striato-frontal networks as well as the more specific changes in the cortical networks on which the neurofeedback control is exerted. Last, we analyse the current challenges faces by neurofeedback studies, including the quantification of the temporal dynamics of neurofeedback effects, the generalisation of its behavioural outcomes to everyday life situations, the design of appropriate controls to disambiguate placebo from true neurofeedback effects and the development of more advanced cortical signal processing to achieve a finer-grained real-time modelling of cognitive functions.
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18
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Leem J, Cheong MJ, Lee H, Cho E, Lee SY, Kim GW, Kang HW. Effectiveness, Cost-Utility, and Safety of Neurofeedback Self-Regulating Training in Patients with Post-Traumatic Stress Disorder: A Randomized Controlled Trial. Healthcare (Basel) 2021; 9:healthcare9101351. [PMID: 34683031 PMCID: PMC8544423 DOI: 10.3390/healthcare9101351] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Revised: 09/29/2021] [Accepted: 10/07/2021] [Indexed: 11/16/2022] Open
Abstract
Post-traumatic stress disorder (PTSD) is characterized by neurophysiological and psycho-emotional problems after exposure to trauma. Several pharmacological and psychotherapy limitations, such as adverse events and low adherence, increase the need for alternative therapeutic options. Neurofeedback is widely used for PTSD management. However, evidence of its clinical efficacy is lacking. We conducted a randomized, waitlist-controlled, assessor-blinded clinical trial to assess the effectiveness, cost-utility, and safety of 16 sessions of neurofeedback on people with PTSD for eight weeks. Eleven participants were allocated to each group. One and two subjects dropped out from the neurofeedback and control groups, respectively. The primary outcome was PTSD symptom change evaluated using the PTSD Checklist-5 (PCL-5-K). The PCL-5-K levels improved more in the neurofeedback group (44.3 ± 10.8 to 19.4 ± 7.75) than in the control group (35.1 ± 18.5 to 31.0 ± 14.92). The change value was significantly improved in the neurofeedback group (24.90 ± 13.13 vs. 4.11 ± 9.03). Secondary outcomes such as anxiety, depression, insomnia, and quality of life were also improved. In an economic analysis using EuroQol-5D, the incremental cost-per-quality-adjusted life-year was approximately $15,600, indicating acceptable cost-utility. There were no adverse events in either group. In conclusion, neurofeedback might be a useful, cost-effective, and safe intervention for PTSD management.
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Affiliation(s)
- Jungtae Leem
- Research Center of Traditional Korean Medicine, Wonkwang University, 460, Iksan-daero, Sin-dong, Iksan 54538, Jeollabuk-do, Korea;
| | - Moon Joo Cheong
- Jangheung Integrative Medical Hospital, Wonkwang University, 121, Rohaseu-ro, Anyang-myeon, Jangheung-gun 59338, Jeollanam-do, Korea;
| | - Hyeryun Lee
- Department of Korean Neuropsychiatry Medicine, Wonkwang University, 460, Iksan-daero, Sin-dong, Iksan 54538, Jeollabuk-do, Korea;
| | - Eun Cho
- College of Pharmacy, Sookmyung Women’s University, 100, Cheongpa-ro, Cheongpadong, Yongsan-gu, Seoul 04310, Korea; (E.C.); (S.Y.L.)
| | - So Young Lee
- College of Pharmacy, Sookmyung Women’s University, 100, Cheongpa-ro, Cheongpadong, Yongsan-gu, Seoul 04310, Korea; (E.C.); (S.Y.L.)
| | - Geun-Woo Kim
- Department of Neuropsychiatry, Dongguk University Bundang Oriental Hospital, 268 Buljeong-ro Bundang-gu, Seongnam-si 13601, Gyeonggi-do, Korea
- Correspondence: (G.-W.K.); (H.W.K.); Tel.: +82-031-710-3700 (G.-W.K.); +82-031-390-2762 (H.W.K.)
| | - Hyung Won Kang
- Jangheung Integrative Medical Hospital, Wonkwang University, 121, Rohaseu-ro, Anyang-myeon, Jangheung-gun 59338, Jeollanam-do, Korea;
- Department of Korean Neuropsychiatry Medicine, Wonkwang University, 460, Iksan-daero, Sin-dong, Iksan 54538, Jeollabuk-do, Korea;
- Correspondence: (G.-W.K.); (H.W.K.); Tel.: +82-031-710-3700 (G.-W.K.); +82-031-390-2762 (H.W.K.)
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19
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Iloson C, Möller A, Sundfeldt K, Bernhardsson S. Symptoms within somatization after sexual abuse among women: A scoping review. Acta Obstet Gynecol Scand 2021; 100:758-767. [PMID: 33423277 DOI: 10.1111/aogs.14084] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 01/05/2021] [Accepted: 01/05/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Somatization, defined as a number of medically unexplained physical symptoms for many years, is a resource-intensive condition with much suffering. Adult somatization has been linked to childhood trauma in both men and women. Among women, sexual trauma affects somatization level to a greater extent than nonsexual trauma. Early diagnosis of a somatization disorder would be of great help for both patients and society. The purpose of this scoping review is to map and summarize the literature on symptoms within somatization in women who have been sexually abused, and investigate if any specific symptom can be linked to previous sexual abuse. MATERIAL AND METHODS A scoping review methodology was used. The databases PubMed, PsycINFO, and the Cochrane Library were searched for original qualitative and quantitative research published between 2008 and 2019 that matched the objectives of the review. RESULTS The database search identified 195 articles, of which 43 were retrieved in full text. Seven articles were included, involving 2076 women. All studies were quantitative. The included studies were heterogeneous. Four studies showed inconsistent findings regarding a link between sexual abuse and chronic or acute pain. Two studies showed an association between sexual abuse and increased incidence of somatic symptoms. One study showed an association between sexual abuse and symptoms of irritable bowel syndrome. No specific somatic symptoms in somatization were identifiable within the scope of this study. CONCLUSIONS This is to our knowledge the first scoping review on sexual abuse and symptoms of somatization. The findings suggest a link between sexual abuse and somatic symptoms, but the identified association with pain and irritable bowel syndrome is inconsistent. No studies have clearly identified specific symptoms within somatization associated with sexual abuse. Qualitative research on the topic was identified as a knowledge gap.
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Affiliation(s)
- Carina Iloson
- Kungshöjd Gynecology Clinic, Region Västra Götaland, Gothenburg, Sweden.,Competence Center on Intimate Partner Violence, Region Västra Götaland, Gothenburg, Sweden.,Department of Obstetrics and Gynecology, Institute of Clinical Science, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Anna Möller
- Department of Clinical Science and Education, Karolinska Institute, Stockholm, Sweden.,Department of Obstetrics and Gynecology, Stockholm South Hospital, Stockholm, Sweden
| | - Karin Sundfeldt
- Department of Obstetrics and Gynecology, Institute of Clinical Science, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Gynecology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Susanne Bernhardsson
- Research and Development Primary Health Care, Region Västra Götaland, Gothenburg, Sweden.,Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Unit of Physiotherapy, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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20
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Yeh WH, Hsueh JJ, Shaw FZ. Neurofeedback of Alpha Activity on Memory in Healthy Participants: A Systematic Review and Meta-Analysis. Front Hum Neurosci 2021; 14:562360. [PMID: 33469422 PMCID: PMC7813983 DOI: 10.3389/fnhum.2020.562360] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 12/04/2020] [Indexed: 11/30/2022] Open
Abstract
Background: Neurofeedback training (NFT) has recently been proposed as a valuable technique for cognitive enhancement and psychiatric amelioration. However, effect of NFT of alpha activity on memory is controversial. The current study analyzed previous works in terms of randomized and blinded analyses, training paradigms, and participant characteristics to validate the efficacy of alpha NFT on memory in a healthy population. Objectives: A systematic meta-analysis of studies with randomized controlled trials was performed to explore the effect of alpha NFT on working memory (WM) and episodic memory (EM) in a healthy population. Methods: We searched PubMed, Embase, and Cochrane Library from January 1, 1999, to November 30, 2019. Previous studies were evaluated with the Cochrane risk of bias (RoB). A meta-analysis calculating absolute weighted standardized mean difference (SMD) using random-effects models was employed. Heterogeneity was estimated using I 2 statistics. Funnel plots and Egger's test were performed to evaluate the quality of evidence. Results: Sixteen studies with 217 healthy participants in the control group and 210 participants in the alpha group met the eligibility criteria. Alpha NFT studies with WM measures presented little publication bias (P = 0.116), and 5 of 7 domains in the Cochrane RoB exhibited a low risk of bias. The overall effect size from 14 WM studies was 0.56 (95% CI 0.31-0.81, P < 0.0001; I 2 = 28%). Six EM studies exhibited an effect size of 0.77 (95% CI 0.06-1.49, P = 0.03; I 2 = 77%). Conclusion: Meta-analysis results suggest that alpha NFT seems to have a positive effect on the WM and EM of healthy participants. Future efforts should focus on the neurophysiological mechanisms of alpha NFT in memory.
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Affiliation(s)
- Wen-Hsiu Yeh
- Institute of Basic Medical Science, National Cheng Kung University, Tainan, Taiwan
| | - Jen-Jui Hsueh
- Mind Research and Imaging Center, National Cheng Kung University, Tainan, Taiwan
| | - Fu-Zen Shaw
- Institute of Basic Medical Science, National Cheng Kung University, Tainan, Taiwan
- Mind Research and Imaging Center, National Cheng Kung University, Tainan, Taiwan
- Department of Psychology, National Cheng Kung University, Tainan, Taiwan
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21
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Meeuwsen KD, Groeneveld KM, Walker LA, Mennenga AM, Tittle RK, White EK. Z-score neurofeedback, heart rate variability biofeedback, and brain coaching for older adults with memory concerns. Restor Neurol Neurosci 2021; 39:9-37. [PMID: 33386829 PMCID: PMC7990441 DOI: 10.3233/rnn-201053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND The three-month, multi-domain Memory Boot Camp program incorporates z-score neurofeedback (NFB), heart rate variability (HRV) biofeedback, and one-on-one coaching to teach memory skills and encourage behavior change in diet, sleep, physical fitness, and stress reduction. OBJECTIVE This prospective trial evaluates the Memory Boot Camp program for adults ages 55 to 85 with symptoms of Mild Cognitive Impairment (MCI) and subjective memory complaints. METHODS Participants were evaluated via the Montreal Cognitive Assessment (MoCA), NeuroTrax Global Cognitive Score, measures of anxiety, depression, sleep, quality of life, quantitative electroencephalography (QEEG), and HRV parameters at four timepoints: baseline, pre-program, post-program, and follow-up. The trial included a three-month waiting period between baseline and pre-program, such that each participant acted as their own control, and follow-up took place six months after completion of the program. RESULTS Participants' MoCA scores and self-reported measures of anxiety, depression, sleep quality, and quality of life improved after treatment, and these changes were maintained at follow-up. Physiological changes in HRV parameters after treatment were not significant, however, breathing rate and QEEG parameters were improved at post-program and maintained at follow-up. Finally, participants' improvement in MoCA score over the treatment period was correlated with their improvement in two brain oscillation parameters targeted by the z-score NFB protocol: relative power of delta and relative power of theta. CONCLUSIONS Trial results suggest that the Memory Boot Camp program is a promising treatment strategy for older adults with symptoms of MCI and subjective memory complaints.
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22
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Leem J, Cheong MJ, Yoon SH, Kim H, Jo HG, Lee H, Kim J, Kim HY, Kim GW, Kang HW. Neurofeedback self-regulating training in patients with Post traumatic stress disorder: A randomized controlled trial study protocol. Integr Med Res 2020; 9:100464. [PMID: 32714831 PMCID: PMC7378693 DOI: 10.1016/j.imr.2020.100464] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 06/22/2020] [Accepted: 06/23/2020] [Indexed: 11/30/2022] Open
Abstract
Background Post-traumatic stress disorder (PTSD) has become an important public health problem. However, the conventional therapeutic strategy, including pharmacotherapy and cognitive behavioral therapy, has limitations. Neurofeedback is a technique that utilizes electroencephalography (EEG) signaling to monitor human physiological functions and is widely used to treat patients with PTSD. The purpose of our study is to assess the efficacy and safety level of neurofeedback treatment in patients with PTSD using quantitative EEG. Methods This is a randomized, waitlist-controlled, assessor-blinded, clinical trial. Forty-six patients with PTSD will be randomly assigned at a 1:1 ratio into two groups. The participants in the treatment group will receive neurofeedback treatment for 50 min, twice a week, for 8 weeks (16 sessions). Quantitative EEG will be utilized to monitor the physiological functions and brain waves of the participants. A four-week follow-up period is planned. The participants in the control group will wait for 12 weeks. The primary outcome is the Korean version of PTSD Checklist-5 (PCL-5-K) score. The PCL-5-K scores on week 8 will be compared between the two groups. Anxiety, depression, insomnia, emotions, EEG, quality-of-life, and safety level will be assessed as secondary outcomes. Discussion This trial will describe a clinical research methodology for neurofeedback in patients with PTSD. The numerous subjective and objective secondary outcomes add to the value of this trial’s results. It will also suggest a therapeutic strategy for utilizing quantitative EEG in patients with PTSD. Our trial will provide basic evidence for the management of PTSD via an integrative treatment. Trial registration Clinical Research Information Service (CRIS): KCT0003271.
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Affiliation(s)
- Jungtae Leem
- Research and Development Institute, CY Pharma Co., Seoul, South Korea.,Chung-Yeon Central Institute, Gwangju, South Korea
| | - Moon Joo Cheong
- College of Education, Hanyang University, Seoul, South Korea
| | | | - Hyunho Kim
- Chung-Yeon Central Institute, Gwangju, South Korea
| | - Hee-Geun Jo
- Chung-Yeon Central Institute, Gwangju, South Korea.,Chung-Yeon Korean Medicine Hospital, Gwangju, South Korea
| | - Hyeryun Lee
- Department of Korean Neuropsychiatry Medicine, Wonkwang University, Iksan, South Korea
| | - Jeesu Kim
- Department of Korean Neuropsychiatry Medicine, Wonkwang University, Iksan, South Korea
| | - Hyang Yi Kim
- Department of Nursing, Kyung-In Women's University, Incheon, South Korea
| | - Geun-Woo Kim
- Department of Neuropsychiatry, Dongguk University Bundang Oriental Hospital, Seongnam, South Korea
| | - Hyung Won Kang
- Department of Korean Neuropsychiatry Medicine, Wonkwang University, Iksan, South Korea
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23
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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.
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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
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