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Perez TM, Adhia DB, Glue P, Zeng J, Dillingham P, Navid MS, Niazi IK, Young CK, Smith M, De Ridder D. Infraslow Closed-Loop Brain Training for Anxiety and Depression (ISAD): A pilot randomised, sham-controlled trial in adult females with internalizing disorders. COGNITIVE, AFFECTIVE & BEHAVIORAL NEUROSCIENCE 2025:10.3758/s13415-025-01279-z. [PMID: 40102367 DOI: 10.3758/s13415-025-01279-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/06/2025] [Indexed: 03/20/2025]
Abstract
INTRODUCTION The core resting-state networks (RSNs) have been shown to be dysfunctional in individuals with internalizing disorders (IDs; e.g., anxiety, depression). Source-localised, closed-loop brain training of infraslow (≤ 0.1 Hz) EEG signals may have the potential to reduce symptoms associated with IDs and restore normal core RSN function. METHODS We conducted a pilot randomized, double-blind, sham-controlled, parallel-group (3-arm) trial of infraslow neurofeedback (ISF-NFB) in adult females (n = 60) with IDs. Primary endpoints, which included the Hospital Anxiety and Depression Scale (HADS) and resting-state EEG activity and connectivity, were measured at baseline and post 6 sessions. RESULTS This study found credible evidence of strong nonspecific effects as evidenced by clinically important HADS score improvements (i.e., reductions) across groups. An absence of HADS score change differences between the sham and active groups indicated a lack of specific effects. Although there were credible slow (0.2-1.5 Hz) and delta (2-3.5 Hz) band activity reductions in the 1-region ISF-NFB group relative to sham within the targeted region of interest (i.e., posterior cingulate), differences in activity and connectivity modulation in the targeted frequency band of interest (i.e., ISFs = 0.01-0.1 Hz) were lacking between sham and active groups. Credible positive associations between changes in HADS depression scores and anterior cingulate cortex slow and delta activity also were found. CONCLUSIONS Short-term sham and genuine ISF-NFB resulted in rapid, clinically important improvements that were nonspecific in nature and possibly driven by placebo-related mechanisms. Future ISF-NFB trials should consider implementing design modifications that may better induce differential modulation of ISFs between sham and treatment groups, thereby enhancing the potential for specific clinical effects in ID populations. TRIAL REGISTRATION The trial was prospectively registered with the Australia New Zealand Clinical Trials Registry (ANZCTR; Trial ID: ACTRN12619001428156).
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Affiliation(s)
- Tyson M Perez
- Department of Surgical Sciences, University of Otago, Dunedin, 9016, New Zealand.
- Department of Psychological Medicine, University of Otago, Dunedin, New Zealand.
| | - Divya B Adhia
- Department of Surgical Sciences, University of Otago, Dunedin, 9016, New Zealand
| | - Paul Glue
- Department of Psychological Medicine, University of Otago, Dunedin, New Zealand
| | - Jiaxu Zeng
- Department of Preventative & Social Medicine, Otago Medical School-Dunedin Campus, University of Otago, Dunedin, New Zealand
| | - Peter Dillingham
- Coastal People Southern Skies Centre of Research Excellence, Department of Mathematics & Statistics, University of Otago, Dunedin, New Zealand
| | - Muhammad S Navid
- Centre for Chiropractic Research, New Zealand College of Chiropractic, Auckland, New Zealand
- Donders Institute for Brain, Cognition and Behaviour, Radbout University Medical Center, Nijmegen, The Netherlands
| | - Imran K Niazi
- Centre for Chiropractic Research, New Zealand College of Chiropractic, Auckland, New Zealand
| | - Calvin K Young
- Department of Psychology, University of Otago, Dunedin, New Zealand
| | - Mark Smith
- Neurofeedback Therapy Services of New York, New York, NY, USA
| | - Dirk De Ridder
- Department of Surgical Sciences, University of Otago, Dunedin, 9016, New Zealand
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Hohn VD, Tiemann L, Bott FS, May ES, Fritzen C, Nickel MM, Gil Ávila C, Ploner M. Neurofeedback and attention modulate somatosensory alpha oscillations but not pain perception. PLoS Biol 2025; 23:e3002972. [PMID: 39847605 PMCID: PMC11756787 DOI: 10.1371/journal.pbio.3002972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 12/06/2024] [Indexed: 01/25/2025] Open
Abstract
Pain is closely linked to alpha oscillations (8 < 13 Hz) which are thought to represent a supra-modal, top-down mediated gating mechanism that shapes sensory processing. Consequently, alpha oscillations might also shape the cerebral processing of nociceptive input and eventually the perception of pain. To test this mechanistic hypothesis, we designed a sham-controlled and double-blind electroencephalography (EEG)-based neurofeedback study. In a short-term neurofeedback training protocol, healthy participants learned to up- and down-regulate somatosensory alpha oscillations using attention. Subsequently, we investigated how this manipulation impacts experimental pain applied during neurofeedback. Using Bayesian statistics and mediation analysis, we aimed to test whether alpha oscillations mediate attention effects on pain perception. The results showed that attention and neurofeedback successfully up- and down-regulated the asymmetry of somatosensory alpha oscillations. However, attention and neurofeedback did not modulate pain ratings or related brain responses. Accordingly, somatosensory alpha oscillations did not mediate attention effects on pain perception. Thus, our results challenge the hypothesis that somatosensory alpha oscillations shape pain perception. A causal relationship between alpha oscillations and pain perception might not exist or be more complex than hypothesized. Trial registration: Following Stage 1 acceptance, the study was registered at ClinicalTrials.gov NCT05570695.
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Affiliation(s)
- Vanessa D. Hohn
- Department of Neurology, School of Medicine and Health, Technical University of Munich (TUM), Munich, Germany
- TUM-Neuroimaging Center, School of Medicine and Health, TUM, Munich, Germany
| | - Laura Tiemann
- Department of Neurology, School of Medicine and Health, Technical University of Munich (TUM), Munich, Germany
- TUM-Neuroimaging Center, School of Medicine and Health, TUM, Munich, Germany
| | - Felix S. Bott
- Department of Neurology, School of Medicine and Health, Technical University of Munich (TUM), Munich, Germany
- TUM-Neuroimaging Center, School of Medicine and Health, TUM, Munich, Germany
| | - Elisabeth S. May
- Department of Neurology, School of Medicine and Health, Technical University of Munich (TUM), Munich, Germany
- TUM-Neuroimaging Center, School of Medicine and Health, TUM, Munich, Germany
| | - Clara Fritzen
- Department of Neurology, School of Medicine and Health, Technical University of Munich (TUM), Munich, Germany
- TUM-Neuroimaging Center, School of Medicine and Health, TUM, Munich, Germany
| | - Moritz M. Nickel
- Department of Neurology, School of Medicine and Health, Technical University of Munich (TUM), Munich, Germany
- TUM-Neuroimaging Center, School of Medicine and Health, TUM, Munich, Germany
| | - Cristina Gil Ávila
- Department of Neurology, School of Medicine and Health, Technical University of Munich (TUM), Munich, Germany
- TUM-Neuroimaging Center, School of Medicine and Health, TUM, Munich, Germany
| | - Markus Ploner
- Department of Neurology, School of Medicine and Health, Technical University of Munich (TUM), Munich, Germany
- TUM-Neuroimaging Center, School of Medicine and Health, TUM, Munich, Germany
- Center for Interdisciplinary Pain Medicine, School of Medicine and Health, TUM, Munich, Germany
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Chikhi S, Matton N, Sanna M, Blanchet S. Effects of one session of theta or high alpha neurofeedback on EEG activity and working memory. COGNITIVE, AFFECTIVE & BEHAVIORAL NEUROSCIENCE 2024; 24:1065-1083. [PMID: 39322825 DOI: 10.3758/s13415-024-01218-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/15/2024] [Indexed: 09/27/2024]
Abstract
Neurofeedback techniques provide participants immediate feedback on neuronal signals, enabling them to modulate their brain activity. This technique holds promise to unveil brain-behavior relationship and offers opportunities for neuroenhancement. Establishing causal relationships between modulated brain activity and behavioral improvements requires rigorous experimental designs, including appropriate control groups and large samples. Our primary objective was to examine whether a single neurofeedback session, designed to enhance working memory through the modulation of theta or high-alpha frequencies, elicits specific changes in electrophysiological and cognitive outcomes. Additionally, we explored predictors of successful neuromodulation. A total of 101 healthy adults were assigned to groups trained to increase frontal theta, parietal high alpha, or random frequencies (active control group). We measured resting-state EEG, working memory performance, and self-reported psychological states before and after one neurofeedback session. Although our analyses revealed improvements in electrophysiological and behavioral outcomes, these gains were not specific to the experimental groups. An increase in the frequency targeted by the training has been observed for the theta and high alpha groups, but training designed to increase randomly selected frequencies appears to induce more generalized neuromodulation compared with targeting a specific frequency. Among all the predictors of neuromodulation examined, resting theta and high alpha amplitudes predicted specifically the increase of those frequencies during the training. These results highlight the challenge of integrating a control group based on enhancing randomly selected frequency bands and suggest potential avenues for optimizing interventions (e.g., by including a control group trained in both up- and down-regulation).
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Affiliation(s)
- Samy Chikhi
- Laboratoire Mémoire, Cerveau et Cognition, Université Paris Cité, F-92100, Boulogne-Billancourt, France.
- Integrative Neuroscience and Cognition Center, Université Paris Cité, F-75006, Paris, France.
| | - Nadine Matton
- CLLE - Cognition, Langues, Langage, Ergonomie, Université de Toulouse, Toulouse, France
- Fédération ENAC ISAE-SUPAERO ONERA, Université de Toulouse, Toulouse, France
| | - Marie Sanna
- Laboratoire Mémoire, Cerveau et Cognition, Université Paris Cité, F-92100, Boulogne-Billancourt, France
| | - Sophie Blanchet
- Laboratoire Mémoire, Cerveau et Cognition, Université Paris Cité, F-92100, Boulogne-Billancourt, France
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Kober SE, Wood G, Berger LM. Controlling Virtual Reality With Brain Signals: State of the Art of Using VR-Based Feedback in Neurofeedback Applications. Appl Psychophysiol Biofeedback 2024:10.1007/s10484-024-09677-8. [PMID: 39542998 DOI: 10.1007/s10484-024-09677-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/30/2024] [Indexed: 11/17/2024]
Abstract
The rapid progress of commercial virtual reality (VR) technology, open access to VR development software as well as open-source instructions for creating brain-VR interfaces have increased the number of VR-based neurofeedback (NF) training studies. Controlling a VR environment with brain signals has potential advantages for NF applications. More entertaining, multimodal and adaptive virtual feedback modalities might positively affect subjective user experience and could consequently enhance NF training performance and outcome. Nevertheless, there are certain pitfalls and contraindications that make VR-based NF not suitable for everyone. In the present review, we summarize applications of VR-based NF and discuss positive effects of VR-based NF training as well as contraindications such as cybersickness in VR or age- and sex-related differences. The existing literature implies that VR-based feedback is a promising tool for the improvement of NF training performance. Users generally rate VR-based feedback more positively than traditional 2D feedback, albeit to draw meaningful conclusions and to rule out adverse effects of VR, more research on this topic is necessary. The pace in the development of brain-VR synchronization furthermore necessitates ethical considerations on these technologies.
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Affiliation(s)
- Silvia Erika Kober
- Department of Psychology, University of Graz, Universitaetsplatz 2/III, 8010, Graz, Austria.
| | - Guilherme Wood
- Department of Psychology, University of Graz, Universitaetsplatz 2/III, 8010, Graz, Austria
| | - Lisa Maria Berger
- Department of Psychology, University of Graz, Universitaetsplatz 2/III, 8010, Graz, Austria
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Recio-Rodriguez JI, Fernandez-Crespo M, Sanchez-Aguadero N, Gonzalez-Sanchez J, Garcia-Yu IA, Alonso-Dominguez R, Chiu HY, Tsai PS, Lee HC, Rihuete-Galve MI. Neurofeedback to enhance sleep quality and insomnia: a systematic review and meta-analysis of randomized clinical trials. Front Neurosci 2024; 18:1450163. [PMID: 39568666 PMCID: PMC11576419 DOI: 10.3389/fnins.2024.1450163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2024] [Accepted: 10/25/2024] [Indexed: 11/22/2024] Open
Abstract
Objective This systematic review and meta-analysis of randomized-clinical trials aims to analyze the effect of interventions incorporating surface neurofeedback techniques on self-perceived sleep quality and insomnia in patients with or without sleep disturbances. Methods The review was completed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement and was deposited in the Prospero international prospective registry of systematic reviews (CRD42024528401). Seven clinical trials with different main outcomes but with pre-post intervention records of self-perceived sleep quality or insomnia symptoms assessed by questionnaires met our inclusion criteria, including a publication date within the last 10 years. Five trials investigated sleep quality through scores on the Pittsburgh sleep quality Index (PSQI) and three trials signs of insomnia severity assessed with validated scales. The methodological quality of the included studies was assessed using the Cochrane Collaboration's tool for assessing the risk of bias and showed a high quality of them. Results A total of 5 studies that evaluated sleep quality with the PSQI total score were included in the meta-analysis. The results revealed that control conditions succeeded in improving PSQI-assessed sleep quality more than the analyzed Neurofeedback interventions (PSQI total score 0.57; 95% CI 0.13 to 1.01; p = 0.01). On the other hand, a total of 3 studies that evaluated insomnia severity with various insomnia scales were included in the meta-analysis The results revealed that neither the NF interventions nor the control conditions show a favorable outcome relative to each other (-0.13; 95% CI -0.44 to 0.18; p = 0.41). Conclusion The interventions studied mostly apply a neurofeedback training protocol based on maintaining alpha waves in a range between 8 and 12 Hz, with electrode positioning in the frontal area or in the sensorimotor cortex and with a number of neurofeedback sessions ranging from 8 to 20 sessions. The meta-analysis showed that interventions incorporating surface neurofeedback do not produce additional benefits in self-perception of sleep quality or insomnia compared to a wide variety of control conditions including cognitive behavioral treatment or other biofeedback modalities. Systematic review registration PROSPERO - International prospective register of systematic reviews - CRD42024528401 https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=528401.
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Affiliation(s)
- Jose I Recio-Rodriguez
- Facultad de Enfermería y Fisioterapia, Universidad de Salamanca, Unidad de Investigación de Atención Primaria de Salamanca (APISAL), Instituto de Investigación Biomédica de Salamanca (IBSAL), Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS), Salamanca, Spain
| | - Mei Fernandez-Crespo
- Universidad de Salamanca, Unidad de Investigación de Atención Primaria de Salamanca (APISAL), Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain
| | - Natalia Sanchez-Aguadero
- Facultad de Enfermería y Fisioterapia, Universidad de Salamanca, Unidad de Investigación de Atención Primaria de Salamanca (APISAL), Instituto de Investigación Biomédica de Salamanca (IBSAL), Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS), Salamanca, Spain
| | - Jesús Gonzalez-Sanchez
- Facultad de Enfermería y Fisioterapia, Universidad de Salamanca, Unidad de Investigación de Atención Primaria de Salamanca (APISAL), Instituto de Investigación Biomédica de Salamanca (IBSAL), Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS), Salamanca, Spain
| | - Irene A Garcia-Yu
- Universidad de Salamanca, Unidad de Investigación de Atención Primaria de Salamanca (APISAL), Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain
| | - Rosario Alonso-Dominguez
- Facultad de Enfermería y Fisioterapia, Universidad de Salamanca, Unidad de Investigación de Atención Primaria de Salamanca (APISAL), Instituto de Investigación Biomédica de Salamanca (IBSAL), Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS), Salamanca, Spain
| | - Hsiao-Yean Chiu
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Pei-Shan Tsai
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Hsin-Chien Lee
- College of Humanities and Social Sciences, Graduate Institute of Humanities in Medicine, Taipei Medical University, Taipei, Taiwan
| | - Maria I Rihuete-Galve
- Facultad de Enfermería y Fisioterapia, Universidad de Salamanca, Instituto de Investigación Biomédica de Salamanca (IBSAL), Hospital Universitario de Salamanca, Salamanca, Spain
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Misaki M, Tsuchiyagaito A, Guinjoan SM, Rohan ML, Paulus MP. Whole-brain mechanism of neurofeedback therapy: predictive modeling of neurofeedback outcomes on repetitive negative thinking in depression. Transl Psychiatry 2024; 14:354. [PMID: 39227376 PMCID: PMC11371824 DOI: 10.1038/s41398-024-03066-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 08/20/2024] [Accepted: 08/23/2024] [Indexed: 09/05/2024] Open
Abstract
Real-time fMRI neurofeedback (rtfMRI-NF) has emerged as a promising intervention for psychiatric disorders, yet its clinical efficacy remains underexplored due to an incomplete mechanistic understanding. This study aimed to delineate the whole-brain mechanisms underpinning the effects of rtfMRI-NF on repetitive negative thinking in depression. In a double-blind randomized controlled trial, forty-three depressed individuals underwent NF training targeting the functional connectivity (FC) between the posterior cingulate cortex and the right temporoparietal junction, linked to rumination severity. Participants were randomly assigned to active or sham groups, with the sham group receiving synthesized feedback mimicking real NF signal patterns. The active group demonstrated a significant reduction in brooding rumination scores (d = -1.52, p < 0.001), whereas the sham group did not (d = -0.23, p = 0.503). While the target FC did not show discernible training effects or group differences, connectome-based predictive modeling (CPM) analysis revealed that the interaction between brain activity during regulation and brain response to the feedback signal was the critical factor in explaining treatment outcomes. The model incorporating this interaction successfully predicted rumination changes across both groups. The FCs significantly contributing to the prediction were distributed across brain regions, notably the frontal control, salience network, and subcortical reward processing areas. These results underscore the importance of considering the interplay between brain regulation activities and brain response to the feedback signal in understanding the therapeutic mechanisms of rtfMRI-NF. The study affirms rtfMRI-NF's potential as a therapeutic intervention for repetitive negative thinking and highlights the need for a nuanced understanding of the whole-brain mechanisms contributing to its efficacy.
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Affiliation(s)
- Masaya Misaki
- Laureate Institute for Brain Research, Tulsa, OK, USA.
- Oxley College of Health & Natural Sciences, The University of Tulsa, Tulsa, OK, USA.
| | - Aki Tsuchiyagaito
- Laureate Institute for Brain Research, Tulsa, OK, USA
- Oxley College of Health & Natural Sciences, The University of Tulsa, Tulsa, OK, USA
| | - Salvador M Guinjoan
- Laureate Institute for Brain Research, Tulsa, OK, USA
- Department of Psychiatry, Oklahoma University Health Sciences Center at Tulsa, Tulsa, OK, USA
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Grössinger D, Spann SM, Stollberger R, Pfeuffer J, Koten JW, Wood G. Real-time fMRI neurofeedback of the anterior insula using arterial spin labelling. Eur J Neurosci 2024; 60:5400-5412. [PMID: 39193617 DOI: 10.1111/ejn.16502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 07/02/2024] [Accepted: 07/28/2024] [Indexed: 08/29/2024]
Abstract
Arterial spin labelling (ASL) is the only non-invasive technique that allows absolute quantification of perfusion and is increasingly used in brain activation studies. Contrary to the blood oxygen level-dependent (BOLD) effect ASL measures the cerebral blood flow (CBF) directly. However, the ASL signal has a lower signal-to-noise ratio (SNR), than the BOLD signal, which constrains its utilization in neurofeedback studies. If successful, ASL neurofeedback can be used to aid in the rehabilitation of health conditions with impaired blood flow, for example, stroke. We provide the first ASL-based neurofeedback study incorporating a double-blind, sham-controlled design. A pseudo-continuous ASL (pCASL) approach with background suppression and 3D GRASE readout was combined with a real-time post-processing pipeline. The real-time pipeline allows to monitor the ASL signal and provides real-time feedback on the neural activity to the subject. In total 41 healthy adults (19-56 years) divided into three groups underwent a neurofeedback-based emotion imagery training of the left anterior insula. Two groups differing only in the explicitness level of instruction received real training and a third group received sham feedback. Only those participants receiving real feedback with explicit instruction showed significantly higher absolute CBF values in the trained region during neurofeedback than participants receiving sham feedback. However, responder analyses of percent signal change values show no differences in activation between the three groups. Persisting limitations, such as the lower SNR, confounding effects of arterial transit time and partial volume effects still impact negatively the implementation of ASL neurofeedback.
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Affiliation(s)
| | - Stefan M Spann
- Institute of Medical Engineering, Graz University of Technology, Graz, Austria
| | - Rudolf Stollberger
- Institute of Medical Engineering, Graz University of Technology, Graz, Austria
- BioTechMed-Graz, Graz, Austria
| | - Josef Pfeuffer
- Siemens Healthcare, Application Development, Erlangen, Germany
| | | | - Guilherme Wood
- Institute of Psychology, University of Graz, Graz, Austria
- BioTechMed-Graz, Graz, Austria
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Oprea DC, Mawas I, Moroșan CA, Iacob VT, Cămănaru EM, Cristofor AC, Dobrin RP, Gireadă B, Petrariu FD, Chiriță R. A Systematic Review of the Effects of EEG Neurofeedback on Patients with Schizophrenia. J Pers Med 2024; 14:763. [PMID: 39064017 PMCID: PMC11278179 DOI: 10.3390/jpm14070763] [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: 06/14/2024] [Revised: 07/16/2024] [Accepted: 07/17/2024] [Indexed: 07/28/2024] Open
Abstract
Schizophrenia is a neuropsychiatric disorder affecting approximately 1 in 300 people worldwide. It is characterized by a range of symptoms, including positive symptoms (delusions, hallucinations, and formal thought disorganization), negative symptoms (anhedonia, alogia, avolition, asociality, and blunted affect), and cognitive impairments (impaired memory, attention, executive function, and processing speed). Current treatments, such as psychopharmacology and psychotherapy, often do not fully address these symptoms, leading to impaired everyday functionality. In recent years, there has been a growing interest in neuromodulation due to computer and engineering science making extraordinary computational advances. Those put together have reinitiated the spark in the field of neurofeedback (NF) as a means for self-regulation and neuromodulation with the potential to alleviate the daily burden of schizophrenia. We review, in a systematic way, the primary reports of electroencephalogram (EEG)-based NF as a therapeutical tool for schizophrenia. The main body of research consists mostly of case studies and case reports. The results of a few randomized controlled studies, combined with case studies/series, underscore the potential use of NF as an add-on treatment option for improving the lives of suffering individuals, being sustained by the changes in brain function and symptomatology improvement. We aim to provide important evidence of neuromodulation using NF in patients with schizophrenia, summarizing the effects and conclusions found in several clinical trials.
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Affiliation(s)
- Dan Cătălin Oprea
- Department of Medicine III, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy of Iasi, 700115 Iasi, Romania; (D.C.O.); (I.M.); (C.A.M.); (V.T.I.); (E.M.C.); (A.C.C.); (B.G.); (R.C.)
- Institute of Psychiatry “Socola”, 36 Bucium Street, 700282 Iasi, Romania
| | - Iasmin Mawas
- Department of Medicine III, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy of Iasi, 700115 Iasi, Romania; (D.C.O.); (I.M.); (C.A.M.); (V.T.I.); (E.M.C.); (A.C.C.); (B.G.); (R.C.)
| | - Cătălina Andreea Moroșan
- Department of Medicine III, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy of Iasi, 700115 Iasi, Romania; (D.C.O.); (I.M.); (C.A.M.); (V.T.I.); (E.M.C.); (A.C.C.); (B.G.); (R.C.)
- Institute of Psychiatry “Socola”, 36 Bucium Street, 700282 Iasi, Romania
| | - Vlad Teodor Iacob
- Department of Medicine III, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy of Iasi, 700115 Iasi, Romania; (D.C.O.); (I.M.); (C.A.M.); (V.T.I.); (E.M.C.); (A.C.C.); (B.G.); (R.C.)
- Institute of Psychiatry “Socola”, 36 Bucium Street, 700282 Iasi, Romania
| | - Eliza Mihaela Cămănaru
- Department of Medicine III, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy of Iasi, 700115 Iasi, Romania; (D.C.O.); (I.M.); (C.A.M.); (V.T.I.); (E.M.C.); (A.C.C.); (B.G.); (R.C.)
- Institute of Psychiatry “Socola”, 36 Bucium Street, 700282 Iasi, Romania
| | - Ana Caterina Cristofor
- Department of Medicine III, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy of Iasi, 700115 Iasi, Romania; (D.C.O.); (I.M.); (C.A.M.); (V.T.I.); (E.M.C.); (A.C.C.); (B.G.); (R.C.)
- Institute of Psychiatry “Socola”, 36 Bucium Street, 700282 Iasi, Romania
| | - Romeo Petru Dobrin
- Department of Medicine III, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy of Iasi, 700115 Iasi, Romania; (D.C.O.); (I.M.); (C.A.M.); (V.T.I.); (E.M.C.); (A.C.C.); (B.G.); (R.C.)
- Institute of Psychiatry “Socola”, 36 Bucium Street, 700282 Iasi, Romania
| | - Bogdan Gireadă
- Department of Medicine III, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy of Iasi, 700115 Iasi, Romania; (D.C.O.); (I.M.); (C.A.M.); (V.T.I.); (E.M.C.); (A.C.C.); (B.G.); (R.C.)
- Institute of Psychiatry “Socola”, 36 Bucium Street, 700282 Iasi, Romania
| | - Florin Dumitru Petrariu
- Department of Preventive Medicine and Interdisciplinarity, Grigore T. Popa University of Medicine and Pharmacy of Iasi, 700115 Iasi, Romania;
| | - Roxana Chiriță
- Department of Medicine III, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy of Iasi, 700115 Iasi, Romania; (D.C.O.); (I.M.); (C.A.M.); (V.T.I.); (E.M.C.); (A.C.C.); (B.G.); (R.C.)
- Institute of Psychiatry “Socola”, 36 Bucium Street, 700282 Iasi, Romania
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Schmidt C. The potential of infra-low frequency neurofeedback training in peak performance: The first double-blinded placebo-controlled longitudinal study in healthy adults. J Psychiatr Res 2024; 175:280-286. [PMID: 38759495 DOI: 10.1016/j.jpsychires.2024.04.035] [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: 02/02/2024] [Revised: 04/09/2024] [Accepted: 04/18/2024] [Indexed: 05/19/2024]
Abstract
Infra-low frequency neurofeedback training (ILF-NFT) has shown promise in addressing cognitive and affective distress symptoms across a range of psychiatric disorders. This study tested ILF-NFT's effects in a double-blinded, placebo-controlled longitudinal context in healthy psychology students. Across five weeks, forty-two healthy psychology students (aged 18-35) were randomly allocated into two groups, receiving ten sessions of 30 minutes of active and sham ILF-NFT. Dependent variables were measured before, following, and two months after the intervention and were comprised of: heartrate variability assessments as a measure of stress resilience; digit span, n-back, trail making and go-no-go task measures of executive functioning performance; and SCL-90-R, WHOQOL-Bref, and peak performance measures of subjective self-report. Statistical analysis was performed using an ANCOVA and compared across groups correcting for baseline differences and multiple comparisons. ANCOVA analyses revealed no significant differences across active and placebo groups in any dependent variables, when correcting for multiple comparisons. Thus, the remaining analyses focused on questionnaire correlations. Here, significant correlations were observed between the novel peak performance questionnaire with the SCL-90-R and WHOQOL-Bref, confirming its construct and retest validity. Despite several methodological limitations, including a potential type-2 error, this study highlights limited effects of ILF-NFT in healthy volunteers. Future research should thus focus on clinically driven experimental designs to explore ILF-NFT's potential in psychiatric contexts. Further research utilization of the novel peak performance questionnaire is recommended for measures of peak performance.
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Affiliation(s)
- Casper Schmidt
- Department of Communication and Psychology, Aalborg University, Rendsburggade 14, 9000, Aalborg, Denmark.
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10
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Pfeiffer M, Kübler A, Hilger K. Modulation of human frontal midline theta by neurofeedback: A systematic review and quantitative meta-analysis. Neurosci Biobehav Rev 2024; 162:105696. [PMID: 38723734 DOI: 10.1016/j.neubiorev.2024.105696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 03/27/2024] [Accepted: 04/26/2024] [Indexed: 05/19/2024]
Abstract
Human brain activity consists of different frequency bands associated with varying functions. Oscillatory activity of frontal brain regions in the theta range (4-8 Hz) is linked to cognitive processing and can be modulated by neurofeedback - a technique where participants receive real-time feedback about their brain activity and learn to modulate it. However, criticism of this technique evolved, and high heterogeneity of study designs complicates a valid evaluation of its effectiveness. This meta-analysis provides the first systematic overview over studies attempting to modulate frontal midline theta with neurofeedback in healthy human participants. Out of 1261 articles screened, 14 studies were eligible for systematic review and 11 for quantitative meta-analyses. Studies were evaluated following the DIAD model and the PRISMA guidelines. A significant across-study effect of medium size (Hedges' g = .66; 95%-CI [-0.62, 1.73]) with substantial between-study heterogeneity (Q(16) = 167.43, p < .001) was observed and subanalysis revealed effective frontal midline theta upregulation. We discuss moderators of effect sizes and provide guidelines for future research in this dynamic field.
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Affiliation(s)
- Maria Pfeiffer
- Institute of Psychology, Department of Psychology I, Würzburg University, Marcusstr. 9-11, Würzburg D-97070, Germany
| | - Andrea Kübler
- Institute of Psychology, Department of Psychology I, Würzburg University, Marcusstr. 9-11, Würzburg D-97070, Germany
| | - Kirsten Hilger
- Institute of Psychology, Department of Psychology I, Würzburg University, Marcusstr. 9-11, Würzburg D-97070, Germany.
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11
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Kober SE, Wood G, Schuster S, Körner C. Do Miniature Eye Movements Affect Neurofeedback Training Performance? A Combined EEG-Eye Tracking Study. Appl Psychophysiol Biofeedback 2024; 49:313-327. [PMID: 38492124 PMCID: PMC11101551 DOI: 10.1007/s10484-024-09625-6] [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] [Accepted: 02/08/2024] [Indexed: 03/18/2024]
Abstract
EEG-based neurofeedback is a prominent method to modulate one's own brain activity in a desired direction. However, the EEG signal can be disturbed by artifacts, e.g., eye movements, which can consequently confound the neurofeedback performance. Involuntary miniature eye movements can be hardly detected by conventional EEG correction methods such as recording the electro-oculogram (EOG) and subtracting EOG activity from the EEG signal. However, such miniature eye movements can influence EEG activity, especially in the Gamma frequency range, enormously. In the present study, we investigated whether power in different EEG frequencies can be effectively modulated by self-control of brain signals during neurofeedback training and/or whether changes in EEG power are provoked by miniature eye movements during the training. To this end, 24 participants performed one session of SMR and one session of Gamma neurofeedback training. Additionally, in each training session sham feedback was performed. An eye tracker was used to detect miniature eye movements (< 1°) during neurofeedback training. About two thirds of the participants were able to increase their SMR power over the course of NF training, while one third was able to increase Gamma power. Generally, miniature eye movements induced a strong Gamma power increase. The number of eye movements also increased numerically over the course of the NF training. However, we did not find a significant relationship with the NF training performance. This is a first indication that miniature saccades do not affect NF training performance, but should not be neglected during NF training. Our results have to be confirmed in future studies.
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Affiliation(s)
- Silvia Erika Kober
- Department of Psychology, University of Graz, Universitaetsplatz 2/III, 8010, Graz, Austria.
- BioTechMed-Graz, Graz, Austria.
| | - Guilherme Wood
- Department of Psychology, University of Graz, Universitaetsplatz 2/III, 8010, Graz, Austria
- BioTechMed-Graz, Graz, Austria
| | - Sarah Schuster
- Department of Psychology, University of Graz, Universitaetsplatz 2/III, 8010, Graz, Austria
| | - Christof Körner
- Department of Psychology, University of Graz, Universitaetsplatz 2/III, 8010, Graz, Austria
- BioTechMed-Graz, Graz, Austria
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12
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Torres CB, Barona EJG, Molina MG, Sánchez MEGB, Manso JMM. A systematic review of EEG neurofeedback in fibromyalgia to treat psychological variables, chronic pain and general health. Eur Arch Psychiatry Clin Neurosci 2024; 274:981-999. [PMID: 37179502 PMCID: PMC11127810 DOI: 10.1007/s00406-023-01612-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 04/11/2023] [Indexed: 05/15/2023]
Abstract
This paper is the first up-to-date review of the various EEG-neurofeedback treatments for fibromyalgia patients and their psychological, physiological and general health consequences. Searches were made of the PubMed, PsycNet, Google Scholar and Scopus databases according to PRISMA guidelines for empirical peer-reviewed articles on EEG-neurofeedback treatment of fibromyalgia, yielding a final selection of 17 studies that met the inclusion criteria: (1) published articles and doctoral theses; (2) conducted between 2000 and 2022; (3) reporting empirical and quantitative data. These articles show that there is a wide range of protocols with different designs and procedures to treat fibromyalgia using EEG-neurofeedback techniques. The main symptoms that showed improvement were anxiety, depression, pain, general health and symptom severity, whilst the most commonly used method was traditional EEG neurofeedback based on a sensorimotor rhythm protocol. It may be concluded from the review that the lack of consistency and uniqueness of the protocols makes it very difficult to generalise results, despite the individual improvements identified. This review provides instructions and information that could guide future research and clinical practise, with the data extracted helping to gain a deeper understanding of the state of the art and the needs of the technique for this population group.
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13
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Gacek M, Smoleń T, Krzywoszański Ł, Bartecka-Śmietana A, Kulasek-Filip B, Piotrowska M, Sepielak D, Supernak K. Effects of School-Based Neurofeedback Training on Attention in Students with Autism and Intellectual Disabilities. J Autism Dev Disord 2024:10.1007/s10803-024-06400-8. [PMID: 38806749 DOI: 10.1007/s10803-024-06400-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/06/2024] [Indexed: 05/30/2024]
Abstract
In this study we aimed to assess the influence of school-based neurofeedback training on the attention of students with autism and intellectual disabilities. We assessed 24 students of a special education center who attended neurofeedback training sessions during the schoolyear; we also assessed 25 controls from the same center. We used two computer tasks to assess sustained attention in simple and cognitively demanding test situations, and we used a pen-and-paper task to assess selective attention. Each student who took part in the study was tested at the beginning and at the end of the schoolyear. Students from the experimental group significantly improved their performance in the task related to sustained attention to simple stimuli. No performance improvement related to neurofeedback treatment was observed in either sustained attention in cognitively demanding situations or selective attention. School-based neurofeedback training may improve sustained attention to simple stimuli in students with developmental disabilities.
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Affiliation(s)
- Michał Gacek
- Institute of Psychology, Jagiellonian University, ul. Ingardena 6, 30-060, Krakow, Poland.
| | - Tomasz Smoleń
- Department of Cognitive Science, Jagiellonian University, ul. Grodzka 52, 31-044, Krakow, Poland
| | - Łukasz Krzywoszański
- Institute of Psychology, The Pedagogical University of Krakow, ul. Podchorazych 2, 30-084, Krakow, Poland
| | | | - Beata Kulasek-Filip
- Special Education and Child Care Center No. 1 in Krakow, ul. Barska 45, 30-307, Krakow, Poland
| | - Maja Piotrowska
- Institute of Psychology, Jagiellonian University, ul. Ingardena 6, 30-060, Krakow, Poland
| | - Dominika Sepielak
- Institute of Psychology, Jagiellonian University, ul. Ingardena 6, 30-060, Krakow, Poland
| | - Katarzyna Supernak
- Special Education and Child Care Center No. 1 in Krakow, ul. Barska 45, 30-307, Krakow, Poland
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14
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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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15
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Fassi L, Hochman S, Daskalakis ZJ, Blumberger DM, Cohen Kadosh R. The importance of individual beliefs in assessing treatment efficacy. eLife 2024; 12:RP88889. [PMID: 38547008 PMCID: PMC10977967 DOI: 10.7554/elife.88889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/02/2024] Open
Abstract
In recent years, there has been debate about the effectiveness of treatments from different fields, such as neurostimulation, neurofeedback, brain training, and pharmacotherapy. This debate has been fuelled by contradictory and nuanced experimental findings. Notably, the effectiveness of a given treatment is commonly evaluated by comparing the effect of the active treatment versus the placebo on human health and/or behaviour. However, this approach neglects the individual's subjective experience of the type of treatment she or he received in establishing treatment efficacy. Here, we show that individual differences in subjective treatment - the thought of receiving the active or placebo condition during an experiment - can explain variability in outcomes better than the actual treatment. We analysed four independent datasets (N = 387 participants), including clinical patients and healthy adults from different age groups who were exposed to different neurostimulation treatments (transcranial magnetic stimulation: Studies 1 and 2; transcranial direct current stimulation: Studies 3 and 4). Our findings show that the inclusion of subjective treatment can provide a better model fit either alone or in interaction with objective treatment (defined as the condition to which participants are assigned in the experiment). These results demonstrate the significant contribution of subjective experience in explaining the variability of clinical, cognitive, and behavioural outcomes. We advocate for existing and future studies in clinical and non-clinical research to start accounting for participants' subjective beliefs and their interplay with objective treatment when assessing the efficacy of treatments. This approach will be crucial in providing a more accurate estimation of the treatment effect and its source, allowing the development of effective and reproducible interventions.
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Affiliation(s)
- Luisa Fassi
- MRC Cognition and Brain Sciences Unit, University of CambridgeCambridgeUnited Kingdom
- Department of Psychiatry, University of CambridgeCambridgeUnited Kingdom
- Department of Experimental Psychology, University of OxfordOxfordUnited Kingdom
| | - Shachar Hochman
- School of Psychology, University of SurreySurreyUnited Kingdom
| | - Zafiris J Daskalakis
- Department of Psychiatry, University of California, San DiegoSan DiegoUnited States
| | - Daniel M Blumberger
- Temerty Centre for Therapeutic Brain Intervention at the Centre for Addiction and Mental Health and Department of Psychiatry, Temerty Faculty of Medicine, University of TorontoTorontoCanada
| | - Roi Cohen Kadosh
- Department of Experimental Psychology, University of OxfordOxfordUnited Kingdom
- School of Psychology, University of SurreySurreyUnited Kingdom
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16
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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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17
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Jensen M, Alanis JCG, Hüttenrauch E, Winther-Jensen M, Chavanon ML, Andersson G, Weise C. Does it matter what is trained? A randomized controlled trial evaluating the specificity of alpha/delta ratio neurofeedback in reducing tinnitus symptoms. Brain Commun 2023; 5:fcad185. [PMID: 37680692 PMCID: PMC10481778 DOI: 10.1093/braincomms/fcad185] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 05/18/2023] [Accepted: 06/22/2023] [Indexed: 09/09/2023] Open
Abstract
Previous studies showed that alpha/delta ratio neurofeedback was effective in reducing unpleasant psychological, emotional and perceptual consequences of tinnitus. The main goal of the present study was to investigate, whether the specific combination of enhancing alpha frequency band activity and reducing delta frequency band activity was necessary, or merely sufficient, to obtain a positive treatment outcome regarding tinnitus distress and intensity. A second research aim was to assess the relative contribution of neurofeedback-related non-specific and general non-specific effects in neurofeedback treatment. In a three-arm, randomized controlled trial, 94 chronic tinnitus patients were randomly assigned to one of three conditions: alpha/delta ratio neurofeedback (n = 31), beta/theta ratio neurofeedback (n = 28) and non-neurofeedback minimal treatment intervention (n = 35). Neurofeedback participants underwent 10 treatment sessions over a 4-week period. Outcome measures were collected pre-, mid- and post-interventions and at 3-months follow-up. The Tinnitus Handicap Inventory and the Tinnitus Magnitude Index were used as primary outcome measures for tinnitus distress and tinnitus intensity. EEG data recorded during training supplemented primary outcomes. Since data were repeated measures, the analyses used a two-level mixed effects model approach including by-subject random effects (random intercept). For the Tinnitus Handicap Inventory, the results showed no interaction effect. For the Tinnitus Magnitude Index, the analysis showed a significant time × group interaction, indicating that both alpha/delta ratio neurofeedback and beta/theta ratio neurofeedback reported reduced tinnitus intensity. Analysis of EEG data showed a consistent pattern for the alpha/delta ratio over the course of training. Compared to beta/theta ratio neurofeedback, alpha/delta ratio neurofeedback showed an elevated response. Conversely, for the beta ratio to theta ratio, the pattern was more inconsistent, with no clear indication of superiority for beta/theta ratio neurofeedback over alpha/delta ratio neurofeedback. The main question of this piece of research was whether alpha/delta ratio neurofeedback demonstrated frequency band specificity in the alleviation of tinnitus distress and perceived intensity. Results showed that alpha/delta ratio neurofeedback was sufficient but importantly 'not' necessary to achieve a positive outcome on both the Tinnitus Handicap Inventory and Tinnitus Magnitude Index, when compared to beta/theta ratio neurofeedback. Still, the data suggest a trend towards specificity for alpha/delta ratio neurofeedback. Because of this, it may be too premature to discard alpha/delta ratio neurofeedback in the treatment of tinnitus. Recommendations for future studies are outlined.
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Affiliation(s)
- Martin Jensen
- Division of Clinical Psychology and Psychotherapy, Department of Psychology, Philipps University Marburg, 35032 Marburg, Germany
- Eriksholm Research Centre, 3070 Snekkersten, Denmark
- Copenhagen Hearing and Balance Center, Department of Otorhinolaryngology and Audiology, Rigshospitalet, 2100 Copenhagen, Denmark
| | - Jose Carlos Garcia Alanis
- Division of Clinical Child and Adolescent Psychology, Department of Psychology, Philipps University Marburg, 35032 Marburg, Germany
| | - Eva Hüttenrauch
- Division of Clinical Psychology and Psychotherapy, Department of Psychology, Philipps University Marburg, 35032 Marburg, Germany
| | - Matilde Winther-Jensen
- Department of Data, Biostatistics and Pharmacoepidemiology, Centre for Clinical Research and Prevention, Copenhagen University Hospital Bispebjerg-Frederiksberg, 2000 Copenhagen, Denmark
| | - Mira-Lynn Chavanon
- Division of Clinical Child and Adolescent Psychology, Department of Psychology, Philipps University Marburg, 35032 Marburg, Germany
| | - Gerhard Andersson
- Department of Behavioural Sciences and Learning, Linköping University, 58183 Linkoping, Sweden
| | - Cornelia Weise
- Division of Clinical Psychology and Psychotherapy, Department of Psychology, Philipps University Marburg, 35032 Marburg, Germany
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18
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Li BZ, Nan W, Pun SH, Vai MI, Rosa A, Wan F. Modulating Individual Alpha Frequency through Short-Term Neurofeedback for Cognitive Enhancement in Healthy Young Adults. Brain Sci 2023; 13:926. [PMID: 37371404 DOI: 10.3390/brainsci13060926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 05/31/2023] [Accepted: 06/01/2023] [Indexed: 06/29/2023] Open
Abstract
Human alpha oscillation (7-13 Hz) has been extensively studied over the years for its connection with cognition. The individual alpha frequency (IAF), defined as the frequency that provides the highest power in the alpha band, shows a positive correlation with cognitive processes. The modulation of alpha activities has been accomplished through various approaches aimed at improving cognitive performance. However, very few studies focused on the direct modulation of IAF by shifting the peak frequency, and the understanding of IAF modulation remains highly limited. In this study, IAFs of healthy young adults were up-regulated through short-term neurofeedback training using haptic feedback. The results suggest that IAFs have good trainability and are up-regulated, also that IAFs are correlated with the enhanced cognitive performance in mental rotation and n-back tests compared to sham-neurofeedback control. This study demonstrates the feasibility of self-regulating IAF for cognition enhancement and provides potential therapeutic benefits for cognitive-impaired patients.
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Grants
- 2020YFB1313502 The National Key Research and Development Program of China under Grant
- 2021ZD0201300 The National Key Research and Development Program of China under Grant
- SGDX20201103094002009 The Shenzhen-Hong Kong-Macau S&TProgram (Category C) of SZSTI
- MYRG2022-00111-IME The University of Macau
- MYRG2020-00098-FST The University of Macau
- MYRG2022-00197-FST The University of Macau
- 0144/2019/A3 The Science and Technology Development Fund, Macau SAR
- 0022/2020/AFJ The Science and Technology Development Fund, Macau SAR
- SKL-AMSV (FDCTfunded),SKL-AMSV-ADDITIONAL FUND, SKL-AMSV(UM)-2023-2025 The Science and Technology Development Fund, Macau SAR
- 0045/2019/AFJ The Science and Technology Development Fund, Macau SAR
- CP-017-2022 The Lingyange Semi-conductor Inc. Zhuhai City, Guandong, China
- CP-031-2022 The Lingyange Semi-conductor Inc. Zhuhai City, Guandong, China
- CP-003-2023 The Blue Ocean Smart System (Nanjing) Limited
- 2023A1515010844 The Guangdong Basic and Applied Basic Research Foundation
- 81901830 The National Natural Science Foundation of China
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Affiliation(s)
- Ben-Zheng Li
- State Key Laboratory of Analog and Mixed Signal Very-Large-Scale Integration (VLSI), University of Macau, Macau 999078, China
- Department of Electrical and Computer Engineering, Faculty of Science and Engineering, University of Macau, Macau 999078, China
- Department of Physiology and Biophysics, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
- Department of Electrical Engineering, University of Colorado Denver, Denver, CO 80204, USA
| | - Wenya Nan
- Department of Psychology, Shanghai Normal University, Shanghai 200234, China
| | - Sio Hang Pun
- State Key Laboratory of Analog and Mixed Signal Very-Large-Scale Integration (VLSI), University of Macau, Macau 999078, China
| | - Mang I Vai
- State Key Laboratory of Analog and Mixed Signal Very-Large-Scale Integration (VLSI), University of Macau, Macau 999078, China
- Department of Electrical and Computer Engineering, Faculty of Science and Engineering, University of Macau, Macau 999078, China
| | - Agostinho Rosa
- LaSEEB-System and Robotics Institute, LarSys, 1049-001 Lisbon, Portugal
| | - Feng Wan
- Department of Electrical and Computer Engineering, Faculty of Science and Engineering, University of Macau, Macau 999078, China
- Centre for Cognitive and Brain Sciences, Institute of Collaborative Innovation, University of Macau, Macau 999078, China
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19
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Autenrieth M, Kober SE, Wood G. Assessment of the capacity to modulate brain signals in a home-based SMR neurofeedback training setting. Front Hum Neurosci 2023; 16:1032222. [PMID: 36684842 PMCID: PMC9849904 DOI: 10.3389/fnhum.2022.1032222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 12/12/2022] [Indexed: 01/07/2023] Open
Abstract
Electroencephalogram (EEG)-based neurofeedback (NF) is mainly used in clinical settings as a therapeutic intervention or to optimize performance in healthy individuals. Home-based NF systems are available and might facilitate general access to NF training, especially when repeated training sessions are necessary. However, it remains an open question whether NF training at home is possible without remote monitoring. In the present study, we assessed the capacity of healthy individuals to modulate their own EEG activity when using a home-based NF training system in a comparable manner as if participants had purchased a commercially available NF system. Participants' face-to-face contact with experimenters was reduced to a minimum, and instructions were provided only in the form of written information or videos. Initially, 38 participants performed 9 sessions of sensorimotor rhythm (SMR) (12-15 Hz) based NF training (three generalization sessions, six training sessions). An active control group (n = 19) received feedback on random EEG frequencies. Because of technical problems, bad EEG data quality, or non-compliance, 21 participants had to be excluded from the final data analysis, providing first evidence for the difficulties of non-supervised home-based NF training. In this study, participants were not able to modulate their own brain activity in a desired direction during NF training. Our results indicate that personal interaction with a NF expert might be of relevance and that remote supervision of the training data and more direct communication with the NF users are necessary to enable successful NF training performance. We provide suggestions for the development and implementation of home-based NF systems.
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Affiliation(s)
| | - Silvia Erika Kober
- Institute of Psychology, University of Graz, Graz, Austria,BioTechMed-Graz, Graz, Austria
| | - Guilherme Wood
- Institute of Psychology, University of Graz, Graz, Austria,BioTechMed-Graz, Graz, Austria,*Correspondence: Guilherme Wood,
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20
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Lam SL, Criaud M, Lukito S, Westwood SJ, Agbedjro D, Kowalczyk OS, Curran S, Barret N, Abbott C, Liang H, Simonoff E, Barker GJ, Giampietro V, Rubia K. Double-Blind, Sham-Controlled Randomized Trial Testing the Efficacy of fMRI Neurofeedback on Clinical and Cognitive Measures in Children With ADHD. Am J Psychiatry 2022; 179:947-958. [PMID: 36349428 PMCID: PMC7614456 DOI: 10.1176/appi.ajp.21100999] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Functional MRI neurofeedback (fMRI-NF) could potentially be a novel, safe nonpharmacological treatment for attention deficit hyperactivity disorder (ADHD). A proof-of-concept randomized controlled trial of fMRI-NF of the right inferior frontal cortex (rIFC), compared to an active control condition, showed promising improvement of ADHD symptoms (albeit in both groups) and in brain function. However, comparison with a placebo condition in a larger trial is required to test efficacy. METHODS This double-blind, sham-controlled randomized controlled trial tested the effectiveness and efficacy of fMRI-NF of the rIFC on symptoms and executive functions in 88 boys with ADHD (44 each in the active and sham arms). To investigate treatment-related changes, groups were compared at the posttreatment and 6-month follow-up assessments, controlling for baseline scores, age, and medication status. The primary outcome measure was posttreatment score on the ADHD Rating Scale (ADHD-RS). RESULTS No significant group differences were found on the ADHD-RS. Both groups showed similar decreases in other clinical and cognitive measures, except for a significantly greater decrease in irritability and improvement in motor inhibition in sham relative to active fMRI-NF at the posttreatment assessment, covarying for baseline. There were no significant side effects or adverse events. The active relative to the sham fMRI-NF group showed enhanced activation in rIFC and other frontal and temporo-occipital-cerebellar self-regulation areas. However, there was no progressive rIFC upregulation, correlation with ADHD-RS scores, or transfer of learning. CONCLUSIONS Contrary to the hypothesis, the study findings do not suggest that fMRI-NF of the rIFC is effective in improving clinical symptoms or cognition in boys with ADHD.
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Affiliation(s)
- Sheut-Ling Lam
- Department of Child and Adolescent Psychiatry (Lam, Criaud, Lukito, Westwood, Simonoff, Rubia), Department of Neuroimaging (Kowalczyk, Barker, Giampietro), and Department of Biostatistics (Agbedjro), King's College London; Institute for Globally Distributed Open Research and Education (Criaud); Institute of Human Sciences, University of Wolverhampton, Wolverhampton, U.K. (Westwood); Department of Psychology, School of Social Science, University of Westminster, London (Westwood); Southwest London and St George's Mental Health NHS Trust, London (Curran); South London and Maudsley NHS Foundation Trust, London (Barret, Abbott); Great Ormond Street Hospital for Children NHS Foundation Trust, London (Liang); Department of Child and Adolescent Psychiatry, Technical University Dresden, Germany (Rubia)
| | - Marion Criaud
- Department of Child and Adolescent Psychiatry (Lam, Criaud, Lukito, Westwood, Simonoff, Rubia), Department of Neuroimaging (Kowalczyk, Barker, Giampietro), and Department of Biostatistics (Agbedjro), King's College London; Institute for Globally Distributed Open Research and Education (Criaud); Institute of Human Sciences, University of Wolverhampton, Wolverhampton, U.K. (Westwood); Department of Psychology, School of Social Science, University of Westminster, London (Westwood); Southwest London and St George's Mental Health NHS Trust, London (Curran); South London and Maudsley NHS Foundation Trust, London (Barret, Abbott); Great Ormond Street Hospital for Children NHS Foundation Trust, London (Liang); Department of Child and Adolescent Psychiatry, Technical University Dresden, Germany (Rubia)
| | - Steve Lukito
- Department of Child and Adolescent Psychiatry (Lam, Criaud, Lukito, Westwood, Simonoff, Rubia), Department of Neuroimaging (Kowalczyk, Barker, Giampietro), and Department of Biostatistics (Agbedjro), King's College London; Institute for Globally Distributed Open Research and Education (Criaud); Institute of Human Sciences, University of Wolverhampton, Wolverhampton, U.K. (Westwood); Department of Psychology, School of Social Science, University of Westminster, London (Westwood); Southwest London and St George's Mental Health NHS Trust, London (Curran); South London and Maudsley NHS Foundation Trust, London (Barret, Abbott); Great Ormond Street Hospital for Children NHS Foundation Trust, London (Liang); Department of Child and Adolescent Psychiatry, Technical University Dresden, Germany (Rubia)
| | - Samuel J Westwood
- Department of Child and Adolescent Psychiatry (Lam, Criaud, Lukito, Westwood, Simonoff, Rubia), Department of Neuroimaging (Kowalczyk, Barker, Giampietro), and Department of Biostatistics (Agbedjro), King's College London; Institute for Globally Distributed Open Research and Education (Criaud); Institute of Human Sciences, University of Wolverhampton, Wolverhampton, U.K. (Westwood); Department of Psychology, School of Social Science, University of Westminster, London (Westwood); Southwest London and St George's Mental Health NHS Trust, London (Curran); South London and Maudsley NHS Foundation Trust, London (Barret, Abbott); Great Ormond Street Hospital for Children NHS Foundation Trust, London (Liang); Department of Child and Adolescent Psychiatry, Technical University Dresden, Germany (Rubia)
| | - Deborah Agbedjro
- Department of Child and Adolescent Psychiatry (Lam, Criaud, Lukito, Westwood, Simonoff, Rubia), Department of Neuroimaging (Kowalczyk, Barker, Giampietro), and Department of Biostatistics (Agbedjro), King's College London; Institute for Globally Distributed Open Research and Education (Criaud); Institute of Human Sciences, University of Wolverhampton, Wolverhampton, U.K. (Westwood); Department of Psychology, School of Social Science, University of Westminster, London (Westwood); Southwest London and St George's Mental Health NHS Trust, London (Curran); South London and Maudsley NHS Foundation Trust, London (Barret, Abbott); Great Ormond Street Hospital for Children NHS Foundation Trust, London (Liang); Department of Child and Adolescent Psychiatry, Technical University Dresden, Germany (Rubia)
| | - Olivia S Kowalczyk
- Department of Child and Adolescent Psychiatry (Lam, Criaud, Lukito, Westwood, Simonoff, Rubia), Department of Neuroimaging (Kowalczyk, Barker, Giampietro), and Department of Biostatistics (Agbedjro), King's College London; Institute for Globally Distributed Open Research and Education (Criaud); Institute of Human Sciences, University of Wolverhampton, Wolverhampton, U.K. (Westwood); Department of Psychology, School of Social Science, University of Westminster, London (Westwood); Southwest London and St George's Mental Health NHS Trust, London (Curran); South London and Maudsley NHS Foundation Trust, London (Barret, Abbott); Great Ormond Street Hospital for Children NHS Foundation Trust, London (Liang); Department of Child and Adolescent Psychiatry, Technical University Dresden, Germany (Rubia)
| | - Sarah Curran
- Department of Child and Adolescent Psychiatry (Lam, Criaud, Lukito, Westwood, Simonoff, Rubia), Department of Neuroimaging (Kowalczyk, Barker, Giampietro), and Department of Biostatistics (Agbedjro), King's College London; Institute for Globally Distributed Open Research and Education (Criaud); Institute of Human Sciences, University of Wolverhampton, Wolverhampton, U.K. (Westwood); Department of Psychology, School of Social Science, University of Westminster, London (Westwood); Southwest London and St George's Mental Health NHS Trust, London (Curran); South London and Maudsley NHS Foundation Trust, London (Barret, Abbott); Great Ormond Street Hospital for Children NHS Foundation Trust, London (Liang); Department of Child and Adolescent Psychiatry, Technical University Dresden, Germany (Rubia)
| | - Nadia Barret
- Department of Child and Adolescent Psychiatry (Lam, Criaud, Lukito, Westwood, Simonoff, Rubia), Department of Neuroimaging (Kowalczyk, Barker, Giampietro), and Department of Biostatistics (Agbedjro), King's College London; Institute for Globally Distributed Open Research and Education (Criaud); Institute of Human Sciences, University of Wolverhampton, Wolverhampton, U.K. (Westwood); Department of Psychology, School of Social Science, University of Westminster, London (Westwood); Southwest London and St George's Mental Health NHS Trust, London (Curran); South London and Maudsley NHS Foundation Trust, London (Barret, Abbott); Great Ormond Street Hospital for Children NHS Foundation Trust, London (Liang); Department of Child and Adolescent Psychiatry, Technical University Dresden, Germany (Rubia)
| | - Chris Abbott
- Department of Child and Adolescent Psychiatry (Lam, Criaud, Lukito, Westwood, Simonoff, Rubia), Department of Neuroimaging (Kowalczyk, Barker, Giampietro), and Department of Biostatistics (Agbedjro), King's College London; Institute for Globally Distributed Open Research and Education (Criaud); Institute of Human Sciences, University of Wolverhampton, Wolverhampton, U.K. (Westwood); Department of Psychology, School of Social Science, University of Westminster, London (Westwood); Southwest London and St George's Mental Health NHS Trust, London (Curran); South London and Maudsley NHS Foundation Trust, London (Barret, Abbott); Great Ormond Street Hospital for Children NHS Foundation Trust, London (Liang); Department of Child and Adolescent Psychiatry, Technical University Dresden, Germany (Rubia)
| | - Holan Liang
- Department of Child and Adolescent Psychiatry (Lam, Criaud, Lukito, Westwood, Simonoff, Rubia), Department of Neuroimaging (Kowalczyk, Barker, Giampietro), and Department of Biostatistics (Agbedjro), King's College London; Institute for Globally Distributed Open Research and Education (Criaud); Institute of Human Sciences, University of Wolverhampton, Wolverhampton, U.K. (Westwood); Department of Psychology, School of Social Science, University of Westminster, London (Westwood); Southwest London and St George's Mental Health NHS Trust, London (Curran); South London and Maudsley NHS Foundation Trust, London (Barret, Abbott); Great Ormond Street Hospital for Children NHS Foundation Trust, London (Liang); Department of Child and Adolescent Psychiatry, Technical University Dresden, Germany (Rubia)
| | - Emily Simonoff
- Department of Child and Adolescent Psychiatry (Lam, Criaud, Lukito, Westwood, Simonoff, Rubia), Department of Neuroimaging (Kowalczyk, Barker, Giampietro), and Department of Biostatistics (Agbedjro), King's College London; Institute for Globally Distributed Open Research and Education (Criaud); Institute of Human Sciences, University of Wolverhampton, Wolverhampton, U.K. (Westwood); Department of Psychology, School of Social Science, University of Westminster, London (Westwood); Southwest London and St George's Mental Health NHS Trust, London (Curran); South London and Maudsley NHS Foundation Trust, London (Barret, Abbott); Great Ormond Street Hospital for Children NHS Foundation Trust, London (Liang); Department of Child and Adolescent Psychiatry, Technical University Dresden, Germany (Rubia)
| | - Gareth J Barker
- Department of Child and Adolescent Psychiatry (Lam, Criaud, Lukito, Westwood, Simonoff, Rubia), Department of Neuroimaging (Kowalczyk, Barker, Giampietro), and Department of Biostatistics (Agbedjro), King's College London; Institute for Globally Distributed Open Research and Education (Criaud); Institute of Human Sciences, University of Wolverhampton, Wolverhampton, U.K. (Westwood); Department of Psychology, School of Social Science, University of Westminster, London (Westwood); Southwest London and St George's Mental Health NHS Trust, London (Curran); South London and Maudsley NHS Foundation Trust, London (Barret, Abbott); Great Ormond Street Hospital for Children NHS Foundation Trust, London (Liang); Department of Child and Adolescent Psychiatry, Technical University Dresden, Germany (Rubia)
| | - Vincent Giampietro
- Department of Child and Adolescent Psychiatry (Lam, Criaud, Lukito, Westwood, Simonoff, Rubia), Department of Neuroimaging (Kowalczyk, Barker, Giampietro), and Department of Biostatistics (Agbedjro), King's College London; Institute for Globally Distributed Open Research and Education (Criaud); Institute of Human Sciences, University of Wolverhampton, Wolverhampton, U.K. (Westwood); Department of Psychology, School of Social Science, University of Westminster, London (Westwood); Southwest London and St George's Mental Health NHS Trust, London (Curran); South London and Maudsley NHS Foundation Trust, London (Barret, Abbott); Great Ormond Street Hospital for Children NHS Foundation Trust, London (Liang); Department of Child and Adolescent Psychiatry, Technical University Dresden, Germany (Rubia)
| | - Katya Rubia
- Department of Child and Adolescent Psychiatry (Lam, Criaud, Lukito, Westwood, Simonoff, Rubia), Department of Neuroimaging (Kowalczyk, Barker, Giampietro), and Department of Biostatistics (Agbedjro), King's College London; Institute for Globally Distributed Open Research and Education (Criaud); Institute of Human Sciences, University of Wolverhampton, Wolverhampton, U.K. (Westwood); Department of Psychology, School of Social Science, University of Westminster, London (Westwood); Southwest London and St George's Mental Health NHS Trust, London (Curran); South London and Maudsley NHS Foundation Trust, London (Barret, Abbott); Great Ormond Street Hospital for Children NHS Foundation Trust, London (Liang); Department of Child and Adolescent Psychiatry, Technical University Dresden, Germany (Rubia)
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21
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Kalokairinou L, Specker Sullivan L, Wexler A. Neurofeedback as placebo: a case of unintentional deception? JOURNAL OF MEDICAL ETHICS 2022; 48:1037-1042. [PMID: 34521768 PMCID: PMC9205641 DOI: 10.1136/medethics-2021-107435] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 08/18/2021] [Indexed: 05/27/2023]
Abstract
The use of placebo in clinical practice has been the topic of extensive debate in the bioethics literature, with much scholarship focusing on concerns regarding deception. While considerations of placebo without deception have largely centred on open-label placebo, this paper considers a different kind of ethical quandary regarding placebo without an intent to deceive-one where the provider believes a treatment is effective due to a direct physiological mechanism, even though that belief may not be supported by rigorous scientific evidence. This is often the case with complementary and alternative medicine (CAM) techniques and also with some mainstream therapies that have not proven to be better than sham. Using one such CAM technique as a case study-electroencephalography (EEG) neurofeedback for attention-deficit/hyperactivity disorder (ADHD)-this paper explores the ethics of providing therapies that may have some beneficial effect, although one that is likely due to placebo effect. First, we provide background on EEG neurofeedback for ADHD and its evidence base, showing how it has proven to be equivalent to-but not better than-sham neurofeedback. Subsequently, we explore whether offering therapies that are claimed to work via specific physical pathways, but may actually work due to the placebo effect, constitute deception. We suggest that this practice may constitute unintentional deception regarding mechanism of action. Ultimately, we argue that providers have increased information provision obligations when offering treatments that diverge from standard of care and we make recommendations for mitigating unintentional deception.
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Affiliation(s)
- Louiza Kalokairinou
- Department of Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | - Anna Wexler
- Department of Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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22
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Perez TM, Glue P, Adhia DB, Navid MS, Zeng J, Dillingham P, Smith M, Niazi IK, Young CK, De Ridder D. Infraslow closed-loop brain training for anxiety and depression (ISAD): a protocol for a randomized, double-blind, sham-controlled pilot trial in adult females with internalizing disorders. Trials 2022; 23:949. [PMID: 36397122 PMCID: PMC9670077 DOI: 10.1186/s13063-022-06863-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 10/22/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The core intrinsic connectivity networks (core-ICNs), encompassing the default-mode network (DMN), salience network (SN) and central executive network (CEN), have been shown to be dysfunctional in individuals with internalizing disorders (IDs, e.g. major depressive disorder, MDD; generalized anxiety disorder, GAD; social anxiety disorder, SOC). As such, source-localized, closed-loop brain training of electrophysiological signals, also known as standardized low-resolution electromagnetic tomography (sLORETA) neurofeedback (NFB), targeting key cortical nodes within these networks has the potential to reduce symptoms associated with IDs and restore normal core ICN function. We intend to conduct a randomized, double-blind (participant and assessor), sham-controlled, parallel-group (3-arm) trial of sLORETA infraslow (<0.1 Hz) fluctuation neurofeedback (sLORETA ISF-NFB) 3 times per week over 4 weeks in participants (n=60) with IDs. Our primary objectives will be to examine patient-reported outcomes (PROs) and neurophysiological measures to (1) compare the potential effects of sham ISF-NFB to either genuine 1-region ISF-NFB or genuine 2-region ISF-NFB, and (2) assess for potential associations between changes in PRO scores and modifications of electroencephalographic (EEG) activity/connectivity within/between the trained regions of interest (ROIs). As part of an exploratory analysis, we will investigate the effects of additional training sessions and the potential for the potentiation of the effects over time. METHODS We will randomly assign participants who meet the criteria for MDD, GAD, and/or SOC per the MINI (Mini International Neuropsychiatric Interview for DSM-5) to one of three groups: (1) 12 sessions of posterior cingulate cortex (PCC) ISF-NFB up-training (n=15), (2) 12 sessions of concurrent PCC ISF up-training and dorsal anterior cingulate cortex (dACC) ISF-NFB down-training (n=15), or (3) 6 sessions of yoked-sham training followed by 6 sessions genuine ISF-NFB (n=30). Transdiagnostic PROs (Hospital Anxiety and Depression Scale, HADS; Inventory of Depression and Anxiety Symptoms - Second Version, IDAS-II; Multidimensional Emotional Disorder Inventory, MEDI; Intolerance of Uncertainty Scale - Short Form, IUS-12; Repetitive Thinking Questionnaire, RTQ-10) as well as resting-state neurophysiological measures (full-band EEG and ECG) will be collected from all subjects during two baseline sessions (approximately 1 week apart) then at post 6 sessions, post 12 sessions, and follow-up (1 month later). We will employ Bayesian methods in R and advanced source-localisation software (i.e. exact low-resolution brain electromagnetic tomography; eLORETA) in our analysis. DISCUSSION This protocol will outline the rationale and research methodology for a clinical pilot trial of sLORETA ISF-NFB targeting key nodes within the core-ICNs in a female ID population with the primary aims being to assess its potential efficacy via transdiagnostic PROs and relevant neurophysiological measures. TRIAL REGISTRATION Our study was prospectively registered with the Australia New Zealand Clinical Trials Registry (ANZCTR; Trial ID: ACTRN12619001428156). Registered on October 15, 2019.
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Affiliation(s)
- Tyson M Perez
- Department of Surgical Sciences, University of Otago, Dunedin, New Zealand.
- Department of Psychological Medicine, University of Otago, Dunedin, New Zealand.
| | - Paul Glue
- Department of Psychological Medicine, University of Otago, Dunedin, New Zealand
| | - Divya B Adhia
- Department of Surgical Sciences, University of Otago, Dunedin, New Zealand
| | - Muhammad S Navid
- Centre for Chiropractic Research, New Zealand College of Chiropractic, Auckland, New Zealand
- Donders Institute for Brain, Cognition and Behaviour, Radbout University Medical Center, Nijmegen, The Netherlands
| | - Jiaxu Zeng
- Department of Preventative & Social Medicine, Otago Medical School-Dunedin Campus, University of Otago, Dunedin, New Zealand
| | - Peter Dillingham
- Coastal People Southern Skies Centre of Research Excellence, Department of Mathematics & Statistics, University of Otago, Dunedin, New Zealand
| | - Mark Smith
- Neurofeedback Therapy Services of New York, New York, USA
| | - Imran K Niazi
- Centre for Chiropractic Research, New Zealand College of Chiropractic, Auckland, New Zealand
| | - Calvin K Young
- Department of Psychology, University of Otago, Dunedin, New Zealand
| | - Dirk De Ridder
- Department of Surgical Sciences, University of Otago, Dunedin, New Zealand
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23
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Kalokairinou L, Choi R, Nagappan A, Wexler A. Opportunity Cost or Opportunity Lost: An Empirical Assessment of Ethical Concerns and Attitudes of EEG Neurofeedback Users. NEUROETHICS-NETH 2022; 15:28. [PMID: 36249541 PMCID: PMC9555209 DOI: 10.1007/s12152-022-09506-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 09/15/2022] [Indexed: 10/14/2022]
Abstract
Background Electroencephalography (EEG) neurofeedback is a type of biofeedback that purportedly teaches users how to control their brainwaves. Although neurofeedback is currently offered by thousands of providers worldwide, its provision is contested, as its effectiveness beyond a placebo effect is unproven. While scholars have voiced numerous ethical concerns about neurofeedback-regarding opportunity cost, physical and psychological harms, financial cost, and informed consent-to date these concerns have remained theoretical. This pilot study aimed to provide insights on whether these issues were supported by empirical data from the experiences of neurofeedback users. Methods Semi-structured telephone interviews were conducted with individuals who had used EEG neurofeedback for themselves and/or for a child. Results The majority of respondents (N = 36) were female (75%), white (92%), and of higher socioeconomic status relative to the U.S. population. Among adult users (n = 33), most (78.8%) resorted to neurofeedback after having tried other therapies and were satisfied with treatment (81.8%). The majority paid for neurofeedback out-of-pocket (72.7%) and considered it to be good value for money (84.8%). More than half (57.6%) considered neurofeedback to be a scientifically well-established therapy. However, of those, 78.9%were using neurofeedback for indications not adequately supported by scientific evidence. Conclusion Concerns regarding opportunity cost, physical and psychological harms, and financial cost are not substantiated by our findings. Our results partially support concerns regarding insufficient understanding of limitations. This study underlines the disconnect between some of the theoretical concerns raised by scholars regarding the use of non-validated therapies and the lived experiences of users.
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Affiliation(s)
- Louiza Kalokairinou
- Department of Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Rebekah Choi
- Department of Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ashwini Nagappan
- Department of Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Anna Wexler
- Department of Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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24
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Berger LM, Wood G, Kober SE. Effects of virtual reality-based feedback on neurofeedback training performance—A sham-controlled study. Front Hum Neurosci 2022; 16:952261. [PMID: 36034118 PMCID: PMC9411512 DOI: 10.3389/fnhum.2022.952261] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 07/13/2022] [Indexed: 11/21/2022] Open
Abstract
Electroencephalography-neurofeedback (EEG-NF) has become a valuable tool in the field of psychology, e.g., to improve cognitive function. Nevertheless, a large percentage of NF users seem to be unable to control their own brain activation. Therefore, the aim of this study was to examine whether a different kind of visual feedback could positively influence NF performance after one training session. Virtual reality (VR) seems to have beneficial training effects and has already been reported to increase motivational training aspects. In the present study, we tested 61 young healthy adults (mean age: 23.48 years; 28 female) to investigate, whether 3D VR-based NF training has a more beneficial effect on the sensorimotor rhythm (SMR, 12–15 Hz) power increase than a mere 2D conventional NF paradigm. In the 3D group, participants had to roll a ball along a predefined path in an immersive virtual environment, whereas the 2D group had to increase the height of a bar. Both paradigms were presented using VR goggles. Participants completed one baseline and six feedback runs with 3 min each, in which they should try to increase SMR power over Cz. Half of the participants received real feedback whereas the other half received sham feedback. Participants receiving 3D VR-based feedback showed a linear increase in SMR power over the feedback runs within one training session. This was the case for the real as well as for the sham 3D feedback group and might be related to more general VR-related effects. The 2D group receiving the conventional bar feedback showed no changes in SMR power over the feedback runs. The present study underlines that the visual feedback modality has differential effects on the NF training performance and that 3D VR-based feedback has advantages over conventional 2D feedback.
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Affiliation(s)
- Lisa M. Berger
- Institute of Psychology, University of Graz, Graz, Austria
- *Correspondence: Lisa M. Berger,
| | - Guilherme Wood
- Institute of Psychology, University of Graz, Graz, Austria
- BioTechMed-Graz, Graz, Austria
| | - Silvia E. Kober
- Institute of Psychology, University of Graz, Graz, Austria
- BioTechMed-Graz, Graz, Austria
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25
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Kvamme TL, Sarmanlu M, Overgaard M. Doubting the double-blind: Introducing a questionnaire for awareness of experimental purposes in neurofeedback studies. Conscious Cogn 2022; 104:103381. [PMID: 35947940 DOI: 10.1016/j.concog.2022.103381] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 07/18/2022] [Accepted: 07/19/2022] [Indexed: 11/29/2022]
Abstract
Double-blinding subjects to the experiment's purpose is an important standard in neurofeedback studies. However, it is difficult to provide evidence that humans are entirely unaware of certain information. This study used insights from consciousness studies and neurophenomenology to develop a contingency awareness questionnaire for neurofeedback. We assessed whether participants had an awareness of experimental purposes to manipulate their attention and multisensory perception. A subset of subjects (5 out of 20) gained a degree of awareness of experimental purposes as evidenced by their correct guess about the purposes of the experiment to affect their attention and multisensory perceptions specific to their double-blinded group assignment. The results warrant replication before they are applied to clinical neurofeedback studies, given the considerable time taken to perform the questionnaire (∼25 min). We discuss the strengths and limitations of our contingency awareness questionnaire and the growing appeal of the double-blinded standard in clinical neurofeedback studies.
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Affiliation(s)
- Timo L Kvamme
- Cognitive Neuroscience Research Unit, CFIN/MINDLab, Aarhus University, Aarhus, Denmark; Centre for Alcohol and Drug Research, Aarhus University, Aarhus, Denmark.
| | - Mesud Sarmanlu
- Cognitive Neuroscience Research Unit, CFIN/MINDLab, Aarhus University, Aarhus, Denmark
| | - Morten Overgaard
- Cognitive Neuroscience Research Unit, CFIN/MINDLab, Aarhus University, Aarhus, Denmark
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26
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Riha C, Güntensperger D, Kleinjung T, Meyer M. Recovering Hidden Responder Groups in Individuals Receiving Neurofeedback for Tinnitus. Front Neurosci 2022; 16:867704. [PMID: 35812211 PMCID: PMC9261875 DOI: 10.3389/fnins.2022.867704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 05/23/2022] [Indexed: 11/29/2022] Open
Abstract
The widespread understanding that chronic tinnitus is a heterogeneous phenomenon with various neural oscillatory profiles has spurred investigations into individualized approaches in its treatment. Neurofeedback, as a non-invasive tool for altering neural activity, has become increasingly popular in the personalized treatment of a wide range of neuropsychological disorders. Despite the success of neurofeedback on the group level, the variability in the treatment efficacy on the individual level is high, and evidence from recent studies shows that only a small number of people can effectively modulate the desired aspects of neural activity. To reveal who may be more suitable, and hence benefit most from neurofeedback treatment, we classified individuals into unobserved subgroups with similar oscillatory trajectories during the treatment and investigated how subgroup membership was predicted by a series of characteristics. Growth mixture modeling was used to identify distinct latent subgroups with similar oscillatory trajectories among 50 individuals suffering from chronic subjective tinnitus (38 male, 12 female, mean age = 47.1 ± 12.84) across 15 neurofeedback training sessions. Further, the impact of characteristics and how they predicted the affiliation in the identified subgroups was evaluated by including measures of demographics, tinnitus-specific (Tinnitus Handicap Inventory) and depression variables, as well as subjective quality of life subscales (World Health Organization—Quality of Life Questionnaire), and health-related quality of life subscales (Short Form-36) in a logistic regression analysis. A latent class model could be fitted to the longitudinal data with a high probability of correctly classifying distinct oscillatory patterns into 3 different groups: non-responder (80%), responder (16%), and decliner (4%). Further, our results show that the health-related wellbeing subscale of the Short Form-36 questionnaire was differentially associated with the groups. However, due to the small sample size in the Responder group, we are not able to provide sufficient evidence for a distinct responder profile. Nevertheless, the identification of oscillatory change-rate differences across distinct groups of individuals provides the groundwork from which to tease apart the complex and heterogeneous oscillatory processes underlying tinnitus and the attempts to modify these through neurofeedback. While more research is needed, our results and the analytical approach presented may bring clarity to contradictory past findings in the field of tinnitus research, and eventually influence clinical practice.
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Affiliation(s)
- Constanze Riha
- Department of Psychology, University of Zurich, Zurich, Switzerland
- Research Priority Program “ESIT—European School of Interdisciplinary Tinnitus Research,” Zurich, Switzerland
- *Correspondence: Constanze Riha, , orcid.org/0000-0002-6006-7018
| | | | - Tobias Kleinjung
- Department of Otorhinolaryngology, University Hospital Zurich, Zurich, Switzerland
- Neuroscience Center Zurich (ZNZ), ETH Zürich, Zurich, Switzerland
| | - Martin Meyer
- Department of Psychology, University of Zurich, Zurich, Switzerland
- Neuroscience Center Zurich (ZNZ), ETH Zürich, Zurich, Switzerland
- University Research Priority Program “Dynamics of Healthy Aging,” University of Zurich, Zurich, Switzerland
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Taylor JE, Yamada T, Kawashima T, Kobayashi Y, Yoshihara Y, Miyata J, Murai T, Kawato M, Motegi T. Depressive symptoms reduce when dorsolateral prefrontal cortex-precuneus connectivity normalizes after functional connectivity neurofeedback. Sci Rep 2022; 12:2581. [PMID: 35173179 PMCID: PMC8850610 DOI: 10.1038/s41598-022-05860-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 01/18/2022] [Indexed: 11/09/2022] Open
Abstract
Depressive disorders contribute heavily to global disease burden; This is possibly because patients are often treated homogeneously, despite having heterogeneous symptoms with differing underlying neural mechanisms. A novel treatment that can directly influence the neural circuit relevant to an individual patient's subset of symptoms might more precisely and thus effectively aid in the alleviation of their specific symptoms. We tested this hypothesis in a proof-of-concept study using fMRI functional connectivity neurofeedback. We targeted connectivity between the left dorsolateral prefrontal cortex/middle frontal gyrus and the left precuneus/posterior cingulate cortex, because this connection has been well-established as relating to a specific subset of depressive symptoms. Specifically, this connectivity has been shown in a data-driven manner to be less anticorrelated in patients with melancholic depression than in healthy controls. Furthermore, a posterior cingulate dominant state-which results in a loss of this anticorrelation-is expected to specifically relate to an increase in rumination symptoms such as brooding. In line with predictions, we found that, with neurofeedback training, the more a participant normalized this connectivity (restored the anticorrelation), the more related (depressive and brooding symptoms), but not unrelated (trait anxiety), symptoms were reduced. Because these results look promising, this paradigm next needs to be examined with a greater sample size and with better controls. Nonetheless, here we provide preliminary evidence for a correlation between the normalization of a neural network and a reduction in related symptoms. Showing their reproducibility, these results were found in two experiments that took place several years apart by different experimenters. Indicative of its potential clinical utility, effects of this treatment remained one-two months later.Clinical trial registration: Both experiments reported here were registered clinical trials (UMIN000015249, jRCTs052180169).
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Affiliation(s)
- Jessica Elizabeth Taylor
- Department of Decoded Neurofeedback (DecNef), Computational Neuroscience Laboratories, Advanced Telecommunications Research Institute International (ATR), Hikaridai 2-2-2. Seika-cho, Soraku, Kyoto, 619-0237, Japan
| | - Takashi Yamada
- Department of Decoded Neurofeedback (DecNef), Computational Neuroscience Laboratories, Advanced Telecommunications Research Institute International (ATR), Hikaridai 2-2-2. Seika-cho, Soraku, Kyoto, 619-0237, Japan.,Department of Cognitive, Linguistic and Psychological Sciences, Brown University, Providence, USA.,Medical Institute of Developmental Disabilities Research, Showa University, Tokyo, Japan
| | - Takahiko Kawashima
- Department of Psychiatry, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yuko Kobayashi
- Department of Psychiatry, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yujiro Yoshihara
- Department of Psychiatry, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Jun Miyata
- Department of Psychiatry, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Toshiya Murai
- Department of Psychiatry, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Mitsuo Kawato
- Department of Decoded Neurofeedback (DecNef), Computational Neuroscience Laboratories, Advanced Telecommunications Research Institute International (ATR), Hikaridai 2-2-2. Seika-cho, Soraku, Kyoto, 619-0237, Japan
| | - Tomokazu Motegi
- Department of Decoded Neurofeedback (DecNef), Computational Neuroscience Laboratories, Advanced Telecommunications Research Institute International (ATR), Hikaridai 2-2-2. Seika-cho, Soraku, Kyoto, 619-0237, Japan. .,Department of Psychiatry and Neuroscience, Gunma University Graduate School of Medicine, Gunma, Japan.
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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: 10] [Impact Index Per Article: 2.5] [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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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: 4.5] [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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Lambert-Beaudet F, Journault WG, Rudziavic Provençal A, Bastien CH. Neurofeedback for insomnia: Current state of research. World J Psychiatry 2021; 11:897-914. [PMID: 34733650 PMCID: PMC8546766 DOI: 10.5498/wjp.v11.i10.897] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 05/18/2021] [Accepted: 08/27/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Chronic insomnia affects about 6%-13% of the Canadian population. Although treatments already exist, they each have their own issues. Neurofeedback is a neuromodulation technique that specifically targets abnormal brain activity and is gaining attention as a possible insomnia treatment.
AIM To review the latest studies pertaining to the use of neurofeedback in the treatment of insomnia.
METHODS In this non-systematic review, only experimental studies assessing the effects of neurofeedback on patients with insomnia were targeted across four bibliographic databases.
RESULTS A total of 12 studies were retained. All neurofeedback studies included in this study showed a clear improvement of subjective sleep. However, data concerning objective improvement are contradictory. Most studies regarding surface and z-score neurofeedback show that neurofeedback targeting the sensorimotor rhythm in the sensorimotor cortex may help improve subjective sleep. A placebo effect seems also to be present in some studies. Several limitations were present in each study.
CONCLUSION While studies concerning neurofeedback as a treatment for insomnia are encouraging, many methodological barriers remain to be resolved to prove its efficacy unequivocally. More studies using robust design parameters, as well as the replication of existing studies, are necessary to support neurofeedback as an effective treatment for insomnia.
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Affiliation(s)
| | | | | | - Célyne H Bastien
- Department of Psychology, School of Psychology Laval University, Québec G1V0A6, Canada
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Grosselin F, Breton A, Yahia-Cherif L, Wang X, Spinelli G, Hugueville L, Fossati P, Attal Y, Navarro-Sune X, Chavez M, George N. Alpha activity neuromodulation induced by individual alpha-based neurofeedback learning in ecological context: a double-blind randomized study. Sci Rep 2021; 11:18489. [PMID: 34531416 PMCID: PMC8445968 DOI: 10.1038/s41598-021-96893-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 08/06/2021] [Indexed: 02/08/2023] Open
Abstract
The neuromodulation induced by neurofeedback training (NFT) remains a matter of debate. Investigating the modulation of brain activity specifically associated with NF requires controlling for multiple factors, such as reward, performance, congruency between task and targeted brain activity. This can be achieved using sham feedback (FB) control condition, equating all aspects of the experiment but the link between brain activity and FB. We aimed at investigating the modulation of individual alpha EEG activity induced by NFT in a double-blind, randomized, sham-controlled study. Forty-eight healthy participants were assigned to either NF (n = 25) or control (n = 23) group and performed alpha upregulation training (over 12 weeks) with a wearable EEG device. Participants of the NF group received FB based on their individual alpha activity. The control group received the auditory FB of participants of the NF group. An increase of alpha activity across training sessions was observed in the NF group only (p < 0.001). This neuromodulation was selective in that there was no evidence for similar effects in the theta (4-8 Hz) and low beta (13-18 Hz) bands. While alpha upregulation was found in the NF group only, psychological outcome variables showed overall increased feeling of control, decreased anxiety level and increased relaxation feeling, without any significant difference between the NF and the control groups. This is interpreted in terms of learning context and placebo effects. Our results pave the way to self-learnt, NF-based neuromodulation with light-weighted, wearable EEG systems.
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Affiliation(s)
- Fanny Grosselin
- Sorbonne Université, Institut du Cerveau-Paris Brain Institute (ICM), INSERM U 1127, CNRS UMR 7225, Equipe Aramis, 75013, Paris, France.
- myBrain Technologies, 75010, Paris, France.
- INRIA, Aramis Project-Team, 75013, Paris, France.
| | | | - Lydia Yahia-Cherif
- Institut du Cerveau-Paris Brain Institute-ICM, Centre MEG-EEG, Paris, France
- CNRS, UMR 7225, F-75013, Paris, France
- Inserm, U 1127, Paris, France
- Sorbonne Université, Paris, France
| | - Xi Wang
- myBrain Technologies, 75010, Paris, France
| | | | - Laurent Hugueville
- Institut du Cerveau-Paris Brain Institute-ICM, Centre MEG-EEG, Paris, France
- CNRS, UMR 7225, F-75013, Paris, France
- Inserm, U 1127, Paris, France
- Sorbonne Université, Paris, France
| | - Philippe Fossati
- CNRS, UMR 7225, F-75013, Paris, France
- Inserm, U 1127, Paris, France
- Sorbonne Université, Paris, France
- Institut du Cerveau-Paris Brain Institute-ICM, Equipe CIA-Cognitive Control, Interoception, Attention, 75013, Paris, France
- AP-HP, Hôpital Pitié-Salpêtrière, Service de Psychiatrie Adulte, 75013, Paris, France
| | | | | | | | - Nathalie George
- Institut du Cerveau-Paris Brain Institute-ICM, Centre MEG-EEG, Paris, France
- CNRS, UMR 7225, F-75013, Paris, France
- Inserm, U 1127, Paris, France
- Sorbonne Université, Paris, France
- Institut du Cerveau-Paris Brain Institute-ICM, Equipe Experimental Neurosurgery, 75013, Paris, France
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Rubia K, Westwood S, Aggensteiner PM, Brandeis D. Neurotherapeutics for Attention Deficit/Hyperactivity Disorder (ADHD): A Review. Cells 2021; 10:2156. [PMID: 34440925 PMCID: PMC8394071 DOI: 10.3390/cells10082156] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 08/07/2021] [Accepted: 08/18/2021] [Indexed: 01/19/2023] Open
Abstract
This review focuses on the evidence for neurotherapeutics for attention deficit/hyperactivity disorder (ADHD). EEG-neurofeedback has been tested for about 45 years, with the latest meta-analyses of randomised controlled trials (RCT) showing small/medium effects compared to non-active controls only. Three small studies piloted neurofeedback of frontal activations in ADHD using functional magnetic resonance imaging or near-infrared spectroscopy, finding no superior effects over control conditions. Brain stimulation has been applied to ADHD using mostly repetitive transcranial magnetic and direct current stimulation (rTMS/tDCS). rTMS has shown mostly negative findings on improving cognition or symptoms. Meta-analyses of tDCS studies targeting mostly the dorsolateral prefrontal cortex show small effects on cognitive improvements with only two out of three studies showing clinical improvements. Trigeminal nerve stimulation has been shown to improve ADHD symptoms with medium effect in one RCT. Modern neurotherapeutics are attractive due to their relative safety and potential neuroplastic effects. However, they need to be thoroughly tested for clinical and cognitive efficacy across settings and beyond core symptoms and for their potential for individualised treatment.
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Affiliation(s)
- Katya Rubia
- Department of Child & Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neurosciences, King’s College London, De Crespigny Park, London SE5 8AF, UK;
- Department of Social Genetics and Developmental Psychiatry, Institute of Psychiatry, Psychology & Neurosciences, King’s College London, De Crespigny Park, London SE5 8AF, UK
- Department of Child & Adolescent Psychiatry, Transcampus, Dresden University, 01307 Dresden, Germany
| | - Samuel Westwood
- Department of Child & Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neurosciences, King’s College London, De Crespigny Park, London SE5 8AF, UK;
- Department of Social Genetics and Developmental Psychiatry, Institute of Psychiatry, Psychology & Neurosciences, King’s College London, De Crespigny Park, London SE5 8AF, UK
- Department of Psychology, Wolverhampton University, Wolverhampton WV1 1LY, UK
| | - Pascal-M. Aggensteiner
- Department of Child and Adolescent Psychiatry and Psychotherapy, Medical Faculty Mannheim, Central Institute of Mental Health, Heidelberg University, 68159 Mannheim, Germany; (P.-M.A.); (D.B.)
| | - Daniel Brandeis
- Department of Child and Adolescent Psychiatry and Psychotherapy, Medical Faculty Mannheim, Central Institute of Mental Health, Heidelberg University, 68159 Mannheim, Germany; (P.-M.A.); (D.B.)
- Department of Child and Adolescent Psychiatry and Psychotherapy, Hospital of Psychiatry, Psychiatric Hospital University, University of Zürich, 8032 Zürich, Switzerland
- Neuroscience Center Zürich, Swiss Federal Institute of Technology and University of Zürich, 8057 Zürich, Switzerland
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33
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A randomized-controlled neurofeedback trial in adult attention-deficit/hyperactivity disorder. Sci Rep 2021; 11:16873. [PMID: 34413344 PMCID: PMC8376871 DOI: 10.1038/s41598-021-95928-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 07/29/2021] [Indexed: 02/07/2023] Open
Abstract
Attention-deficit/hyperactivity disorder (ADHD) is a childhood onset disorder persisting into adulthood for a large proportion of cases. Neurofeedback (NF) has shown promising results in children with ADHD, but randomized controlled trials in adults with ADHD are scarce. We aimed to compare slow cortical potential (SCP)- and functional near-infrared spectroscopy (fNIRS) NF to a semi-active electromyography biofeedback (EMG-BF) control condition regarding changes in symptoms and the impact of learning success, as well as changes in neurophysiological parameters in an adult ADHD population. Patients were randomly assigned to SCP-NF (n = 26), fNIRS-NF (n = 21) or EMG-BF (n = 20). Outcome parameters were assessed over 30 training sessions (pre, intermediate, post) and at 6-months follow-up (FU) including 3 booster sessions. EEG was recorded during two auditory Go/NoGo paradigms assessing the P300 and contingent negative variation (CNV). fNIRS measurements were conducted during an n-back- as well as a Go/NoGo task. All three groups showed equally significant symptom improvements suggesting placebo- or non-specific effects on the primary outcome measure. Only when differentiating between learners and non-learners, fNIRS learners displayed stronger reduction of ADHD global scores compared to SCP non-learners at FU, and fNIRS learners showed specifically low impulsivity ratings. 30.8% in the SCP-NF and 61.9% of participants in the fNIRS-NF learned to regulate the respective NF target parameter. We conclude that some adults with ADHD learn to regulate SCP amplitudes and especially prefrontal hemodynamic activity during NF. We did not find any significant differences in outcome between groups when looking at the whole sample. When evaluating learners only, they demonstrate superior effects as compared to non-learners, which suggests specific effects in addition to non-specific effects of NF when learning occurs.
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34
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Ide-Walters C, Thompson T. A Sham-Controlled Study of Neurofeedback for Pain Management. Front Neurosci 2021; 15:591006. [PMID: 34381326 PMCID: PMC8350778 DOI: 10.3389/fnins.2021.591006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 06/25/2021] [Indexed: 11/26/2022] Open
Abstract
Background Neurofeedback (NFB) attempts to alter the brain’s electrophysiological activity and has shown potential as a pain management technique. Existing studies, however, often lack appropriate control groups or fail to assess whether electrophysiological activity has been successfully regulated. The current study is a randomized controlled trial comparing changes in brain activity and pain during NFB with those of a sham-control group. Methods An experimental pain paradigm in healthy participants was used to provide optimal control of pain sensation. Twenty four healthy participants were blind randomized to receive either 10 × NFB (with real EEG feedback) or 10 × sham (with false EEG feedback) sessions during noxious cold stimulation. Prior to actual NFB training, training protocols were individually determined for each participant based on a comparison of an initial 32-channel qEEG assessment administered at both baseline and during an experimental pain task. Each individual protocol was based on the electrode site and frequency band that showed the greatest change in amplitude during pain, with alpha or theta up-regulation at various electrode sites (especially Pz) the most common protocols chosen. During the NFB sessions themselves, pain was assessed at multiple times during each session on a 0–10 rating scale, and ANOVA was used to examine changes in pain ratings and EEG amplitude both across and during sessions for both NFB and sham groups. Results For pain, ANOVA trend analysis found a significant general linear decrease in pain across the 10 sessions (p = 0.015). However, no significant main or interaction effects of group were observed suggesting decreases in pain occurred independently of NFB. For EEG, there was a significant During Session X Group interaction (p = 0.004), which indicated that EEG amplitude at the training site was significantly closer to the target amplitude for the NFB compared to the sham group during painful stimulation, but this was only the case at the beginning of the cold task. Conclusion While these results must be interpreted within the context of an experimental pain model, they underline the importance of including an appropriate comparison group to avoid attributing naturally occurring changes to therapeutic effects.
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Affiliation(s)
- Charlotte Ide-Walters
- Centre for Chronic Illness and Ageing, University of Greenwich, London, United Kingdom.,Cancer Research UK, London, United Kingdom
| | - Trevor Thompson
- Centre for Chronic Illness and Ageing, University of Greenwich, London, United Kingdom
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Trambaiolli LR, Cassani R, Mehler DMA, Falk TH. Neurofeedback and the Aging Brain: A Systematic Review of Training Protocols for Dementia and Mild Cognitive Impairment. Front Aging Neurosci 2021; 13:682683. [PMID: 34177558 PMCID: PMC8221422 DOI: 10.3389/fnagi.2021.682683] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 05/03/2021] [Indexed: 11/24/2022] Open
Abstract
Dementia describes a set of symptoms that occur in neurodegenerative disorders and that is characterized by gradual loss of cognitive and behavioral functions. Recently, non-invasive neurofeedback training has been explored as a potential complementary treatment for patients suffering from dementia or mild cognitive impairment. Here we systematically reviewed studies that explored neurofeedback training protocols based on electroencephalography or functional magnetic resonance imaging for these groups of patients. From a total of 1,912 screened studies, 10 were included in our final sample (N = 208 independent participants in experimental and N = 81 in the control groups completing the primary endpoint). We compared the clinical efficacy across studies, and evaluated their experimental designs and reporting quality. In most studies, patients showed improved scores in different cognitive tests. However, data from randomized controlled trials remains scarce, and clinical evidence based on standardized metrics is still inconclusive. In light of recent meta-research developments in the neurofeedback field and beyond, quality and reporting practices of individual studies are reviewed. We conclude with recommendations on best practices for future studies that investigate the effects of neurofeedback training in dementia and cognitive impairment.
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Affiliation(s)
- Lucas R Trambaiolli
- Basic Neuroscience Division, McLean Hospital - Harvard Medical School, Boston, MA, United States
| | - Raymundo Cassani
- Institut National de la Recherche Scientifique - Energy, Materials, and Telecommunications Centre (INRS-EMT), University of Québec, Montréal, QC, Canada
| | - David M A Mehler
- Institute for Translational Psychiatry, University of Münster, Münster, Germany
| | - Tiago H Falk
- Institut National de la Recherche Scientifique - Energy, Materials, and Telecommunications Centre (INRS-EMT), University of Québec, Montréal, QC, Canada
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36
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Skalski S, Pochwatko G, Balas R. Effect of
HEG
biofeedback on selected cognitive functions—Randomized study in children with
ADHD
and neurotypical children. INFANT AND CHILD DEVELOPMENT 2021. [DOI: 10.1002/icd.2242] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
| | | | - Robert Balas
- Polish Academy of Sciences Institute of Psychology Warsaw Poland
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Trambaiolli LR, Tiwari A, Falk TH. Affective Neurofeedback Under Naturalistic Conditions: A Mini-Review of Current Achievements and Open Challenges. FRONTIERS IN NEUROERGONOMICS 2021; 2:678981. [PMID: 38235228 PMCID: PMC10790905 DOI: 10.3389/fnrgo.2021.678981] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 04/28/2021] [Indexed: 01/19/2024]
Abstract
Affective neurofeedback training allows for the self-regulation of the putative circuits of emotion regulation. This approach has recently been studied as a possible additional treatment for psychiatric disorders, presenting positive effects in symptoms and behaviors. After neurofeedback training, a critical aspect is the transference of the learned self-regulation strategies to outside the laboratory and how to continue reinforcing these strategies in non-controlled environments. In this mini-review, we discuss the current achievements of affective neurofeedback under naturalistic setups. For this, we first provide a brief overview of the state-of-the-art for affective neurofeedback protocols. We then discuss virtual reality as a transitional step toward the final goal of "in-the-wild" protocols and current advances using mobile neurotechnology. Finally, we provide a discussion of open challenges for affective neurofeedback protocols in-the-wild, including topics such as convenience and reliability, environmental effects in attention and workload, among others.
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Affiliation(s)
- Lucas R. Trambaiolli
- Basic Neuroscience Division, McLean Hospital–Harvard Medical School, Belmont, MA, United States
| | - Abhishek Tiwari
- Institut National de la Recherche Scientifique, University of Quebec, Montreal, QC, Canada
| | - Tiago H. Falk
- Institut National de la Recherche Scientifique, University of Quebec, Montreal, QC, Canada
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Nagappan A, Kalokairinou L, Wexler A. Ethical and Legal Considerations of Alternative Neurotherapies. AJOB Neurosci 2021; 12:257-269. [PMID: 33759705 DOI: 10.1080/21507740.2021.1896601] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Neurotherapies for diagnostics and treatment-such as electroencephalography (EEG) neurofeedback, single-photon emission computerized tomography (SPECT) imaging for neuropsychiatric evaluation, and off-label/experimental uses of brain stimulation-are continuously being offered to the public outside mainstream healthcare settings. Because these neurotherapies share many key features of complementary and alternative medicine (CAM) techniques-and meet the definition of CAM as set out in Kaptchuk and Eisenberg-here we refer to them as "alternative neurotherapies." By explicitly linking these alternative neurotherapy practices under a common conceptual framework, this paper draws attention to, and critically considers, the cross-cutting ethical and legal issues related to the provision of these services. The first section of this paper provides an updated empirical overview of uses of SPECT neuropsychiatric evaluations, EEG neurofeedback, and experimental/off-label forms of brain stimulation. Next, drawing on CAM bioethics scholarship, we highlight the pertinent ethical issues in the alternative neurotherapy context, including the truthful representation of evidence base, marketing to vulnerable populations, potential harms, provider competency, and conflicts of interest. Finally, we consider the principal legal issues at stake for the provision of alternative neurotherapies in the U.S., namely those related to licensing and scope-of-practice considerations. We conclude with recommendations for future research in this domain.
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Schönenberg M, Weingärtner AL, Weimer K, Scheeff J. Believing is achieving - On the role of treatment expectation in neurofeedback applications. Prog Neuropsychopharmacol Biol Psychiatry 2021; 105:110129. [PMID: 33031860 DOI: 10.1016/j.pnpbp.2020.110129] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 10/01/2020] [Accepted: 10/03/2020] [Indexed: 11/16/2022]
Abstract
In neurofeedback applications, neural activity is recorded, processed in real-time and fed back to the user in order to facilitate self-regulation of the putative neural mechanisms that underlie cognition and behavior. Numerous studies suggest that neurofeedback interventions are an efficacious treatment particularly for patients with attention-deficit/hyperactivity disorder (ADHD). In recent years, however, findings of several well-controlled studies raised doubts concerning the proposed mechanism of action behind the behavioral effect of neurofeedback. This study investigated the impact of expectation on the efficacy of a sensorimotor rhythm (SMR) training. In a within-subjects design 30 blinded volunteers with ADHD symptoms received a standard SMR training session after inducing no (no-expectancy condition), positive (placebo condition), and negative (nocebo condition) expectations regarding the effectiveness of neurofeedback (by telling them that they would train a specific frequency band that was previously shown to be either unrelated to attention, should improve attention, or interfere with attentional processes). After each training, participants were presented with a cognitive test and subsequently requested to rate their performance on it. We could show that participants were able to successfully modify their EEG signal during training. Further, we found an effect over trainings on objective attentional performance. Most importantly, we found that the expectancy of positive or negative treatment effects considerably changed participants' perception of neurofeedback's efficacy even in the absence of any objective evidence. This study presents strong first evidence for a substantial effect of self-confirming response expectancies as one factor underlying the efficacy of neurofeedback. Future research has to carefully consider the impact of such psychosocial mechanisms when evaluating the (specific) efficacy of neuromodulatory treatments.
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Affiliation(s)
| | | | - Katja Weimer
- Department of Psychosomatic Medicine and Psychotherapy, Ulm University Medical Center, Germany
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Trambaiolli LR, Kohl SH, Linden DEJ, Mehler DMA. Neurofeedback training in major depressive disorder: A systematic review of clinical efficacy, study quality and reporting practices. Neurosci Biobehav Rev 2021; 125:33-56. [PMID: 33587957 DOI: 10.1016/j.neubiorev.2021.02.015] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 02/05/2021] [Accepted: 02/06/2021] [Indexed: 12/28/2022]
Abstract
Major depressive disorder (MDD) is the leading cause of disability worldwide. Neurofeedback training has been suggested as a potential additional treatment option for MDD patients not reaching remission from standard care (i.e., psychopharmacology and psychotherapy). Here we systematically reviewed neurofeedback studies employing electroencephalography, or functional magnetic resonance-based protocols in depressive patients. Of 585 initially screened studies, 24 were included in our final sample (N = 480 patients in experimental and N = 194 in the control groups completing the primary endpoint). We evaluated the clinical efficacy across studies and attempted to group studies according to the control condition categories currently used in the field that affect clinical outcomes in group comparisons. In most studies, MDD patients showed symptom improvement superior to the control group(s). However, most articles did not comply with the most stringent study quality and reporting practices. We conclude with recommendations on best practices for experimental designs and reporting standards for neurofeedback training.
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Affiliation(s)
- Lucas R Trambaiolli
- Division of Basic Neuroscience, McLean Hospital, Harvard Medical School, Boston, USA.
| | - Simon H Kohl
- JARA Institute Molecular Neuroscience and Neuroimaging (INM-11), Jülich Research Centre, Germany; Department of Child and Adolescent Psychiatry, Medical Faculty, RWTH Aachen University, Germany
| | - David E J Linden
- School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University, the Netherlands
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The Current Evidence Levels for Biofeedback and Neurofeedback Interventions in Treating Depression: A Narrative Review. Neural Plast 2021; 2021:8878857. [PMID: 33613671 PMCID: PMC7878101 DOI: 10.1155/2021/8878857] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Revised: 12/28/2020] [Accepted: 01/25/2021] [Indexed: 12/22/2022] Open
Abstract
This article is aimed at showing the current level of evidence for the usage of biofeedback and neurofeedback to treat depression along with a detailed review of the studies in the field and a discussion of rationale for utilizing each protocol. La Vaque et al. criteria endorsed by the Association for Applied Psychophysiology and Biofeedback and International Society for Neuroregulation & Research were accepted as a means of study evaluation. Heart rate variability (HRV) biofeedback was found to be moderately supportable as a treatment of MDD while outcome measure was a subjective questionnaire like Beck Depression Inventory (level 3/5, “probably efficacious”). Electroencephalographic (EEG) neurofeedback protocols, namely, alpha-theta, alpha, and sensorimotor rhythm upregulation, all qualify for level 2/5, “possibly efficacious.” Frontal alpha asymmetry protocol also received limited evidence of effect in depression (level 2/5, “possibly efficacious”). Finally, the two most influential real-time functional magnetic resonance imaging (rt-fMRI) neurofeedback protocols targeting the amygdala and the frontal cortices both demonstrate some effectiveness, though lack replications (level 2/5, “possibly efficacious”). Thus, neurofeedback specifically targeting depression is moderately supported by existing studies (all fit level 2/5, “possibly efficacious”). The greatest complication preventing certain protocols from reaching higher evidence levels is a relatively high number of uncontrolled studies and an absence of accurate replications arising from the heterogeneity in protocol details, course lengths, measures of improvement, control conditions, and sample characteristics.
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Kober SE, Neuper C, Wood G. Differential Effects of Up- and Down-Regulation of SMR Coherence on EEG Activity and Memory Performance: A Neurofeedback Training Study. Front Hum Neurosci 2020; 14:606684. [PMID: 33424569 PMCID: PMC7793696 DOI: 10.3389/fnhum.2020.606684] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 11/27/2020] [Indexed: 11/15/2022] Open
Abstract
Modulating connectivity measures in EEG-based neurofeedback studies is assumed to be a promising therapeutic and training tool. However, little is known so far about its effects and trainability. In the present study, we investigated the effects of up- and down-regulating SMR (12-15 Hz) coherence by means of neurofeedback training on EEG activity and memory functions. Twenty adults performed 10 neurofeedback training sessions in which half of them tried to increase EEG coherence between Cz and CPz in the SMR frequency range, while the other half tried to down-regulate coherence. Up-regulation of SMR coherence led to between- and within-session changes in EEG coherence. SMR power increased across neurofeedback training sessions but not within training sessions. Cross-over training effects on baseline EEG measures were also observed in this group. Up-regulation of SMR coherence was also associated with improvements in memory functions when comparing pre- and post-test results. Participants were not able to down-regulate SMR coherence. This group did not show any changes in baseline EEG measures or memory functions comparing pre- and post-test. Our results provide insights in the trainability and effects of connectivity-based neurofeedback training and indications for its practical application.
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Affiliation(s)
- Silvia Erika Kober
- Institute of Psychology, University of Graz, Graz, Austria
- BioTechMed-Graz, Graz, Austria
| | - Christa Neuper
- Institute of Psychology, University of Graz, Graz, Austria
- BioTechMed-Graz, Graz, Austria
| | - Guilherme Wood
- Institute of Psychology, University of Graz, Graz, Austria
- BioTechMed-Graz, Graz, Austria
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Skalski S. Impact of placebo-related instruction on HEG biofeedback outcomes in children with ADHD. APPLIED NEUROPSYCHOLOGY-CHILD 2020; 11:383-390. [PMID: 33349043 DOI: 10.1080/21622965.2020.1861546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Studies to date have not revealed any differences between biofeedback (BFB) methods vs. placebo treatment in reducing ADHD symptoms. The purpose of this randomized controlled study was to assess the impact of placebo expectations on gain in hemoencephalographic (HEG) BFB. The final cohort consisted of 33 children with ADHD aged 9-14. Individuals were assigned to one of two groups (with standard active training instruction vs. placebo-related instruction) and were subjected to five HEG BFB sessions. Children with standard instruction exhibited higher growth of regional cerebral blood oxygenation during the HEG BFB session as well as better results in cognitive tests (vigilance and visual search) at the end of the experiment compared to children with placebo-related instruction. The data obtained indicate the difficulty in designing studies assessing BFB efficacy. Placebo expectation may adversely affect HEG BFB outcomes in children with ADHD.
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Schmidt J, Martin A. The Influence of Physiological and Psychological Learning Mechanisms in Neurofeedback vs. Mental Imagery Against Binge Eating. Appl Psychophysiol Biofeedback 2020; 45:293-305. [PMID: 32990891 PMCID: PMC7644525 DOI: 10.1007/s10484-020-09486-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2020] [Indexed: 11/29/2022]
Abstract
In biofeedback research, the debate on physiological versus psychological learning has a long tradition and is still relevant today, regarding new developments of biofeedback for behavior modification. Analyzing the role of these learning mechanisms may help improving the protocols and answer the question, whether feedback of physiological functions is necessary to modify a target behavior. We explored the presence and impact of physiological (EEG changes) versus psychological learning (changes in somatic self-efficacy) in a recently developed EEG neurofeedback protocol for binge eating. The protocol targets a reduction of food-cue induced cortical arousal through regulation of EEG high beta activity. In an experimental study accompanying a randomized controlled trial, pre and post treatment EEG measurements were analyzed in a neurofeedback group (n = 18) and an active mental imagery control group without physiological feedback (n = 18). Physiological learning in terms of EEG high beta reduction only occurred in the neurofeedback group. Post treatment, participants with successfully reduced binge eating episodes (≥ 50% reduction) showed lower EEG high beta activity than unsuccessful participants (p = .02) after neurofeedback, but not after mental imagery. Further, lower EEG high beta activity at post-treatment predicted fewer binge eating episodes in neurofeedback only. In mental imagery, somatic self-efficacy predicted treatment success instead of EEG activity. Altogether, the results indicate that physiological changes serve as a specific treatment mechanism in neurofeedback against binge eating. Reducing cortical arousal may improve eating behaviors and corresponding neurofeedback techniques should therefore be considered in future treatments.
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Affiliation(s)
- Jennifer Schmidt
- HSD Hochschule Döpfer University of Applied Sciences, Waidmarkt 3 & 9, 50676, Cologne, Germany.
| | - Alexandra Martin
- Clinical Psychology and Psychotherapy, University of Wuppertal, Wuppertal, Germany
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45
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Behavioral Medicine Methods in Treatment of Somatic Conditions. BIOMED RESEARCH INTERNATIONAL 2020; 2020:5076516. [PMID: 33204700 PMCID: PMC7655248 DOI: 10.1155/2020/5076516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 08/30/2020] [Accepted: 10/27/2020] [Indexed: 11/26/2022]
Abstract
Background The aim of this article is to present a short review of noninvasive, nonpharmacological treatment methods used in somatic illnesses that fall under the umbrella of approach called behavioral medicine. Methods The narrative review method was applied in the study. Science paper databases, including PubMed, had been used to retrieve papers on therapeutic methods used in clinical setting that meet the broad criteria of behavioral medicine definition as stated in the Charter of International Behavioral Medicine Society Results Main groups of methods, disorders in which they are being employed and their effectiveness, have been identified. Conclusions Behavioral medicine is grouping treatment methods and interventions that hold large potential for clinical setting. Two groups of methods can be distinguished by the scrutiny and level of evidence gathered in their effectiveness assessment; for biofeedback, guided imagery, and hypnosis techniques, comprehensive evidence reports in the framework of U.S. Evidence Synthesis Program exist. Meditation techniques, disclosure therapies, and relaxation methods are less well assessed. Broader employment of behavioral medicine therapies in clinical setting is possible after addressing two major problems in the field, which are deficiencies in quality evidence of effectiveness for many of the methods and their insufficiencies in underlying therapeutic mechanism knowledge.
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Pamplona GS, Heldner J, Langner R, Koush Y, Michels L, Ionta S, Scharnowski F, Salmon CE. Network-based fMRI-neurofeedback training of sustained attention. Neuroimage 2020; 221:117194. [DOI: 10.1016/j.neuroimage.2020.117194] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Revised: 07/07/2020] [Accepted: 07/20/2020] [Indexed: 11/29/2022] Open
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47
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Selected Abstracts From the 2019 International Neuroethics Society Annual Meeting. AJOB Neurosci 2020; 11:W1-W15. [PMID: 33196352 DOI: 10.1080/21507740.2020.1830869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
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48
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Dousset C, Kajosch H, Ingels A, Schröder E, Kornreich C, Campanella S. Preventing relapse in alcohol disorder with EEG-neurofeedback as a neuromodulation technique: A review and new insights regarding its application. Addict Behav 2020; 106:106391. [PMID: 32197211 DOI: 10.1016/j.addbeh.2020.106391] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 01/22/2020] [Accepted: 03/09/2020] [Indexed: 02/07/2023]
Abstract
Alcohol Use Disorder (AUD) has a disconcertingly high relapse rate (70-80% within a year following withdrawal). Preventing relapse or minimizing its extent is hence a challenging goal for long-term successful management of AUD. New perspectives that rely on diverse neuromodulation tools have been developed in this regard as care supports. This paper focuses on electroencephalogram-neurofeedback (EEG-NF), which is a tool that has experienced renewed interest in both clinical and research areas. We review the literature on EEG-based neurofeedback studies investigating the efficacy in AUD and including at least 10 neurofeedback training sessions. As neurofeedback is a form of biofeedback in which a measure of brain activity is provided as feedback in real-time to a subject, the high degree of temporal resolution of the EEG interface supports optimal learning. By offering a wide range of brain oscillation targets (alpha, beta, theta, delta, gamma, and SMR) the EEG-NF procedure increases the scope of possible investigations through a multitude of experimental protocols that can be considered to reinforce or inhibit specific forms of EEG activity associated with AUD-related cognitive impairments. The present review provides an overview of the EEG-NF protocols that have been used in AUD and it highlights the current paucity of robust evidence. Within this framework, this review presents the arguments in favor of the application of EEG-NF as an add-on tool in the management of alcohol disorders to enhance the cognitive abilities required to maintain abstinence more specifically, with a focus on inhibition and attentional skills.
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49
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Ros T, Enriquez-Geppert S, Zotev V, Young KD, Wood G, Whitfield-Gabrieli S, Wan F, Vuilleumier P, Vialatte F, Van De Ville D, Todder D, Surmeli T, Sulzer JS, Strehl U, Sterman MB, Steiner NJ, Sorger B, Soekadar SR, Sitaram R, Sherlin LH, Schönenberg M, Scharnowski F, Schabus M, Rubia K, Rosa A, Reiner M, Pineda JA, Paret C, Ossadtchi A, Nicholson AA, Nan W, Minguez J, Micoulaud-Franchi JA, Mehler DMA, Lührs M, Lubar J, Lotte F, Linden DEJ, Lewis-Peacock JA, Lebedev MA, Lanius RA, Kübler A, Kranczioch C, Koush Y, Konicar L, Kohl SH, Kober SE, Klados MA, Jeunet C, Janssen TWP, Huster RJ, Hoedlmoser K, Hirshberg LM, Heunis S, Hendler T, Hampson M, Guggisberg AG, Guggenberger R, Gruzelier JH, Göbel RW, Gninenko N, Gharabaghi A, Frewen P, Fovet T, Fernández T, Escolano C, Ehlis AC, Drechsler R, Christopher deCharms R, Debener S, De Ridder D, Davelaar EJ, Congedo M, Cavazza M, Breteler MHM, Brandeis D, Bodurka J, Birbaumer N, Bazanova OM, Barth B, Bamidis PD, Auer T, Arns M, Thibault RT. Consensus on the reporting and experimental design of clinical and cognitive-behavioural neurofeedback studies (CRED-nf checklist). Brain 2020; 143:1674-1685. [PMID: 32176800 PMCID: PMC7296848 DOI: 10.1093/brain/awaa009] [Citation(s) in RCA: 196] [Impact Index Per Article: 39.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 10/10/2019] [Accepted: 10/28/2020] [Indexed: 02/02/2023] Open
Abstract
Neurofeedback has begun to attract the attention and scrutiny of the scientific and medical mainstream. Here, neurofeedback researchers present a consensus-derived checklist that aims to improve the reporting and experimental design standards in the field.
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Affiliation(s)
- Tomas Ros
- Departments of Neuroscience and Psychiatry, University of Geneva; Campus Biotech, Geneva, Switzerland
| | - Stefanie Enriquez-Geppert
- Department of Clinical Neuropsychology, University of Groningen, Groningen, The Netherlands
- Department of Biomedical Sciences of Cells & Systems, University Medical Center Groningen, Groningen, The Netherlands
| | - Vadim Zotev
- Laureate Institute for Brain Research, Tulsa, Oklahoma, USA
| | - Kymberly D Young
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Guilherme Wood
- Institute of Psychology, University of Graz, Graz, Austria
| | - Susan Whitfield-Gabrieli
- Massachusetts Institute of Technology, Cambridge, MA, USA
- Northeastern University, Boston, MA, USA
| | - Feng Wan
- Department of Electrical and Computer Engineering, Faculty of Science and Technology, University of Macau, Macau, China
| | | | | | - Dimitri Van De Ville
- Institute of Bioengineering, Center for Neuroprosthetics, École Polytechnique Fédérale de Lausanne (EPFL); Campus Biotech, Geneva, Switzerland
| | - Doron Todder
- Faculty of Health, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Beer-Sheva Mental Health Center, Israel Ministry of Health, Beer-Sheva, Israel
| | - Tanju Surmeli
- Living Health Center for Research and Education, Istanbul, Turkey
| | - James S Sulzer
- Department of Mechanical Engineering, University of Texas at Austin, Austin, TX, USA
| | - Ute Strehl
- Institute for Medical Psychology and Behavioral Neurobiology, University of Tübingen, Tübingen, Germany
| | - Maurice Barry Sterman
- Neurobiology and Biobehavioral Psychiatry, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Naomi J Steiner
- Boston University School of Medicine, Department of Pediatrics, Boston, MA, USA
| | - Bettina Sorger
- Department of Cognitive Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Surjo R Soekadar
- Clinical Neurotechnology Laboratory, Neuroscience Research Center (NWFZ), Department of Psychiatry and Psychotherapy (CCM), Charité - University Medicine Berlin, Berlin, Germany
| | - Ranganatha Sitaram
- Institute of Biological and Medical Engineering, Pontificia Universidad Católica de Chile, Macul, Santiago, Chile
| | | | | | - Frank Scharnowski
- Department of Basic Psychological Research and Research Methods, Faculty of Psychology, University of Vienna, Vienna, Austria
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zürich, Zürich, Switzerland
| | - Manuel Schabus
- University of Salzburg, Centre for Cognitive Neuroscience and Department of Psychology, Salzburg, Austria
| | - Katya Rubia
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | | | - Miriam Reiner
- Technion, Israel Institute of Technology, Haifa, Israel
| | - Jaime A Pineda
- Cognitive Science Department, University of California, San Diego, CA, USA
| | - Christian Paret
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Germany
| | - Alexei Ossadtchi
- National Research University Higher School of Economics, Moscow, Russia
| | - Andrew A Nicholson
- Department of Basic Psychological Research and Research Methods, Faculty of Psychology, University of Vienna, Vienna, Austria
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zürich, Zürich, Switzerland
| | - Wenya Nan
- Department of Psychology, Shanghai Normal University, Shanghai, China
| | | | | | - David M A Mehler
- Department of Psychiatry, University of Münster, Münster, Germany
| | - Michael Lührs
- Department of Cognitive Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Joel Lubar
- Department of Psychology, University of Tennessee, Knoxville, USA
| | - Fabien Lotte
- Inria Bordeaux Sud-Ouest/LaBRI University of Bordeaux - CNRS-Bordeaux INP, Bordeaux, France
| | - David E J Linden
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | | | - Mikhail A Lebedev
- Center for Bioelectric Interfaces of the Institute for Cognitive Neuroscience, National Research University Higher School of Economics, Moscow, Russia
- Department of Information and Internet Technologies of Digital Health Institute; I.M. Sechenov First Moscow State Medical University, Moscow, Russia
- Duke Center for Neuroengineering, Duke University, Durham, NC, USA
| | - Ruth A Lanius
- Department of Psychiatry, Western University, London, Ontario, Canada
| | - Andrea Kübler
- Department of Psychology I, Psychological Intervention, Behavior Analysis and Regulation of Behavior, University of Würzburg
| | - Cornelia Kranczioch
- Neuropsychology Lab, Department of Psychology, University of Oldenburg, Oldenberg, Germany
| | - Yury Koush
- Magnetic Resonance Research Center (MRRC), Department of Radiology and Biomedical Imaging, Yale University, New Haven, CT, USA
| | - Lilian Konicar
- Medical University of Vienna, Department of Child and Adolescent Psychiatry, Vienna, Austria
| | - Simon H Kohl
- JARA-Institute Molecular neuroscience and neuroimaging (INM-11), Jülich Research Centre, Jülich, Germany
| | | | - Manousos A Klados
- Department of Psychology, The University of Sheffield International Faculty, City College, Thessaloniki, Greece
| | - Camille Jeunet
- CLLE Lab, CNRS, Université Toulouse Jean Jaurès, Toulouse, France
| | - T W P Janssen
- Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Rene J Huster
- Multimodal imaging and Cognitive Control Lab, Department of Psychology, University of Olso, Norway
| | - Kerstin Hoedlmoser
- University of Salzburg, Centre for Cognitive Neuroscience and Department of Psychology, Salzburg, Austria
| | | | - Stephan Heunis
- Electrical Engineering Department, Eindhoven University of Technology, The Netherlands
| | - Talma Hendler
- Sagol Brain Institute, Wohl Institute for Advanced Imaging, Sourasky Medical Center, Tel Aviv, Israel
| | - Michelle Hampson
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT, USA
| | - Adrian G Guggisberg
- Division of Neurorehabilitation, Department of Clinical Neurosciences, University Hospital Geneva, Geneva, Switzerland
| | - Robert Guggenberger
- Division of Functional and Restorative Neurosurgery, University of Tübingen, Tübingen, Germany
| | - John H Gruzelier
- Department of Psychology, Goldsmiths, University of London, London, UK
| | - Rainer W Göbel
- Department of Cognitive Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Nicolas Gninenko
- Institute of Bioengineering, Center for Neuroprosthetics, École Polytechnique Fédérale de Lausanne (EPFL); Campus Biotech, Geneva, Switzerland
| | - Alireza Gharabaghi
- Division of Functional and Restorative Neurosurgery, University of Tübingen, Tübingen, Germany
| | - Paul Frewen
- Department of Psychiatry, Western University, London, Ontario, Canada
| | - Thomas Fovet
- Univ. Lille, INSERM U1172, CHU LILLE, Centre Lille Neuroscience & Cognition, Pôle de Psychiatrie, F-59000, Lille, France
| | - Thalía Fernández
- UNAM Institute of Neurobiology, National Autonomous University of Mexico, Juriquilla, Mexico
| | | | - Ann-Christine Ehlis
- Psychophysiology and Optical Imaging, Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany
| | - Renate Drechsler
- Department of Child and Adolescent, Psychiatry and Psychotherapy, Psychiatric Hospital, University of Zürich, Zürich, Switzerland
| | | | - Stefan Debener
- Neuropsychology Lab, Department of Psychology, University of Oldenburg, Oldenberg, Germany
| | - Dirk De Ridder
- Department of Surgery, Section of Neurosurgery, University of Otago, Dunedin, New Zealand
| | - Eddy J Davelaar
- Department of Psychological Sciences Birkbeck, University of London, Bloomsbury, London, UK
| | - Marco Congedo
- GIPSA-lab, CNRS, University Grenoble Alpes, Grenoble-INP, Grenoble, France
| | - Marc Cavazza
- School of Computing and Mathematical Sciences, University of Greenwich, London, UK
| | - Marinus H M Breteler
- Radboud University Nijmegen, Department of Clinical Psychology, Nijmegen, The Netherlands
| | - Daniel Brandeis
- Department of Child and Adolescent, Psychiatry and Psychotherapy, Psychiatric Hospital, University of Zürich, Zürich, Switzerland
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - Jerzy Bodurka
- Laureate Institute for Brain Research, Tulsa, OK, USA
| | - Niels Birbaumer
- Institute for Medical Psychology and Behavioural Neurobiology, University of Tübingen, Tübingen, Germany
| | - Olga M Bazanova
- State Research Institute of Physiology and Basic Medicine, Novosibirsk, Russia
| | - Beatrix Barth
- Psychophysiology and Optical Imaging, Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany
| | | | - Tibor Auer
- School of Psychology, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
| | - Martijn Arns
- Brainclinics Foundation, Research Institute Brainclinics, Nijmegen, The Netherlands
| | - Robert T Thibault
- School of Psychological Science, University of Bristol, Bristol, UK
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, UK
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50
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Placebo Brain Stimulation Affects Subjective but Not Neurocognitive Measures of Error Processing. JOURNAL OF COGNITIVE ENHANCEMENT 2020. [DOI: 10.1007/s41465-020-00172-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
AbstractThe aim of this preregistered EEG study was to show how expectations about enhanced or impaired performance through transcranial stimulation affect feelings of agency and error processing. Using a single-blind experimental design, participants (N = 57) were attached to a transcranial direct current stimulation (tDCS) device, and in different blocks, they were verbally instructed to expect enhanced or impaired cognitive performance, or no effects of the brain stimulation. In all cases, but unbeknownst to the participants, we used an inert sham tDCS protocol. Subsequently, we measured their response to errors on a cognitive control task. Our expectancy manipulation was successful: participants reported improved subjective performance in the enhancement compared with the impairment condition—even though objective performance was kept at a constant level across conditions. Participants reported the highest feelings of agency over their task performance in the control condition, and lowest feelings of agency in the impairment condition. The expectancy manipulation did not affect the error-related negativity (ERN) in association with incorrect responses. During the induction phase, expecting impaired versus enhanced performance increased frontal theta power, potentially reflecting a process of increased cognitive control allocation. Our findings show that verbally induced manipulations can affect subjective performance on a cognitive control task, but that stronger manipulations (e.g., through conditioning) are necessary to induce top-down effects on neural error processing.
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