Brain Training: Neurofeedback

Bereitschaftspotential augmentation by neuro-feedback training in Parkinson's disease

OBJECTIVE: Decreased early Bereitschaftspotential (BP) is one of the electrophysiological characteristics in patients with Parkinson's disease (PD). We examined whether PD patients could increase BP amplitude by means of neuro-feedback (NFB) training for their slow cortical potentials (SCPs). METHODS: We worked with 10 PD patients and 11 age-matched controls. BP was measured for self-paced button pressing by their right thumb. The subjects were instructed to make the introspective efforts to produce negative SCPs (negativation). The one-day session consisted of three trials, that is, the first BP, NFB training and the second BP, and each patient performed this routine for 2-4 days. Amplitudes of the first and second BPs were compared between the two groups that were divided depending on NFB performance. RESULTS: Good NFB performance had the tendency of larger early BP in the second BP recording than in the first one, whereas in the poor NFB performance the early BP was smaller in the second BP recording than in the first one in both patient and normal groups (p < 0.001). CONCLUSIONS: Good NFB performance of negativation could increase excitatory field potentials of pyramidal cells for the generation of early BP. SIGNIFICANCE: Voluntary regulation of SCPs could enhance BP in PD patients and in aged controls.

The morphology of midcingulate cortex predicts frontal-midline theta neurofeedback success

Humans differ in their ability to learn how to control their own brain activity by neurofeed back. However, neural mechanisms underlying these inter-individual differences, which may determine training success and associated cognitive enhancement, are not well understood. Here, it is asked whether neurofeedback success of frontal-midline (fm) theta, an oscillation related to higher cognitive functions, could be predicted by the morphology of brain structures known to be critically involved in fm-theta generation. Nineteen young, right-handed partici pants underwent magnetic resonance imaging of T1-weighted brain images, and took part in an individualized, eight-session neurofeedback training in order to learn how to enhance ac tivity in their fm-theta frequency band. Initial training success, measured at the second train ing session, was correlated with the final outcome measure. We found that the inferior, supe rior and middle frontal cortices were not associated with training success. However, volume of the midcingulate cortex as well as volume and concentration of the underlying white matter structures act as predictor variables for the general responsiveness to training. These findings suggest a neuroanatomical foundation for the ability to learn to control one's own brain activi ty.

Effects of neurofeedback versus stimulant medication in attention-deficit/hyperactivity disorder: a randomized pilot study

OBJECTIVE: The purpose of this pilot study was to compare the effects of 30 sessions of neurofeedback (NF) with stimulant medication on attention-deficit/hyperactivity disorder (ADHD) patients. METHODS: Thirty-two medication-naïve ADHD patients, ages 7-16, from a neuropsychiatric clinic, were randomized to NF (n=16) or drug treatment (n=16). Other actions, such as parent management training, information, or support in school were given as needed, with no differences between the groups. All participants were assessed before treatment on two rating scales, each with parent and teacher forms. In addition, quantitative electroencephalogram (QEEG) and event-related potentials (ERPs), which included behavioral data from a go/no go test were administered. NF training took place in the clinic over a period of 7-11 months, and was followed by a repeat of the same assessment tools. The mean time interval between pre- and postassesment was not significantly different in the two groups. The 18 symptoms of ADHD (American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, 4th ed. (DSM-IV)) were used as the primary outcome measure. RESULTS: Analysis of covariance revealed a significant difference between the groups at evaluation in favor of medication, with a large effect size. This picture was confirmed by other outcome measures. The QEEG spectral power in the theta and beta bands did not change in either group. In ERP, the P3 no go component increased significantly in 8 of 12 patients who had a clinically relevant medication effect, but did not increase in the medication nonresponders or the NF group. CONCLUSIONS: Our study supports effects for stimulants, but not for NF. Effects of NF may require thorough patient selection, frequent training sessions, a system for excluding nonresponders, and active transfer training. The P3 no go ERP component may be a marker for treatment response.

Mind over chatter: plastic up-regulation of the fMRI salience network directly after EEG neurofeedback

Neurofeedback (NFB) involves a brain-computer interface that allows users to learn to voluntarily control their cortical oscillations, reflected in the electroencephalogram (EEG). Although NFB is being pioneered as a noninvasive tool for treating brain disorders, there is insufficient evidence on the mechanism of its impact on brain function. Furthermore, the dominant rhythm of the human brain is the alpha oscillation (8-12 Hz), yet its behavioral significance remains multifaceted and largely correlative. In this study with 34 healthy participants, we examined whether during the performance of an attentional task, the functional connectivity of distinct fMRI networks would be plastically altered after a 30-min session of voluntary reduction of alpha rhythm (n=17) versus a sham-feedback condition (n=17). We reveal that compared to sham-feedback, NFB induced an increase of connectivity within regions of the salience network involved in intrinsic alertness (dorsal anterior cingulate), which was detectable 30 min after termination of training. The increase in salience network (default-mode network) connectivity was negatively (positively) correlated with changes in 'on task' mind-wandering as well as resting state alpha rhythm. Crucially, we observed a causal dependence between alpha rhythm synchronization during NFB and its subsequent change at resting state, not exhibited by the SHAM group. Our findings provide neurobehavioral evidence for the brain's exquisite functional plasticity, and for a temporally direct impact of NFB on a key cognitive control network, suggesting a promising basis for its use to treat cognitive disorders under physiological conditions.

Biofeedback in rehabilitation

This paper reviews the literature relating to the biofeedback used in physical rehabilitation. The biofeedback methods used in rehabilitation are based on biomechanical measurements and measurements of the physiological systems of the body. The physiological systems of the body which can be measured to provide biofeedback are the neuromuscular system, the respiratory system and the cardiovascular system. Neuromuscular biofeedback methods include electromyography (EMG) biofeedback and real-time ultrasound imaging (RTUS) biofeedback. EMG biofeedback is the most widely investigated method of biofeedback and appears to be effective in the treatment of many musculoskeletal conditions and in post cardiovascular accident (CVA) rehabilitation. RTUS biofeedback has been demonstrated effective in the treatment of low back pain (LBP) and pelvic floor muscle dysfunction. Cardiovascular biofeedback methods have been shown to be effective in the treatment of a number of health conditions such as hypertension, heart failure, asthma, fibromyalgia and even psychological disorders however a systematic review in this field has yet to be conducted. Similarly, the number of large scale studies examining the use of respiratory biofeedback in rehabilitation is limited. Measurements of movement, postural control and force output can be made using a number of different devices and used to deliver biomechanical biofeedback. Inertial based sensing biofeedback is the most widely researched biomechanical biofeedback method, with a number of studies showing it to be effective in improving measures of balance in a number of populations. Other types of biomechanical biofeedback include force plate systems, electrogoniometry, pressure biofeedback and camera based systems however the evidence for these is limited. Biofeedback is generally delivered using visual displays, acoustic or haptic signals, however more recently virtual reality (VR) or exergaming technology have been used as biofeedback signals. VR and exergaming technology have been primarily investigated in post-CVA rehabilitation, however, more recent work has shown this type of biofeedback to be effective in improving exercise technique in musculoskeletal populations. While a number of studies in this area have been conducted, further large scale studies and reviews investigating different biofeedback applications in different clinical populations are required.

The effects of neurofeedback in the default mode network: pilot study results of medicated children with ADHD

Children with attention deficit hyperactivity disorder (ADHD) have difficulty activating the Default Mode Network (DMN) in a resting or quiet state. The DMN function assists in processing and understanding a person's internal, reflective world and the world of self and others. Neurofeedback (NFB), a type of EEG operant conditioning, trains self-regulation skills using a brain-computer interface. The hardware and software have audio/video capabilities to correct irregular brainwave patterns and regional cerebral blood flow associated with mental health and cognitive concerns. Individual treatment sessions usually last approximately 20 min; to gain the largest overall treatment effect, NFB users need to experience about 30 to 40 sessions. This study randomly assigned 12 children diagnosed with ADHD and currently on a stimulant medication to a treatment or control group. Subjects in the treatment group completed 40 NFB sessions. Pre- and posttest fMRIs were administered on the treatment and control groups. Evidence showed that the forty 20-min sessions of Sensory Motor Rhythm NFB consolidated the DMN allowing for appropriate activation in the posterior cingulate, precuneus, the temporoparietal junction and the cerebellar tonsils. In addition to regulating and increasing SMR at 12-15 Hz, our research results showed activation of the DMN in a resting state after 40 NFB sessions. Assisting children with ADHD to appropriately activate the DMN may help them be more adaptive and reflective and to better understand their own internal world and the world of others

Real-time fMRI links subjective experience with brain activity during focused attention

Recent advances in brain imaging have improved the measure of neural processes related to perceptual, cognitive and affective functions, yet the relation between brain activity and subjective experience remains poorly characterized. In part, it is a challenge to obtain reliable accounts of participant's experience in such studies. Here we addressed this limitation by utilizing experienced meditators who are expert in introspection. We tested a novel method to link objective and subjective data, using real-time fMRI (rt-fMRI) to provide participants with feedback of their own brain activity during an ongoing task. We provided real-time feedback during a focused attention task from the posterior cingulate cortex, a hub of the default mode network shown to be activated during mind-wandering and deactivated during meditation. In a first experiment, both meditators and non-meditators reported significant correspondence between the feedback graph and their subjective experience of focused attention and mind-wandering. When instructed to volitionally decrease the feedback graph, meditators, but not non-meditators, showed significant deactivation of the posterior cingulate cortex. We were able to replicate these results in a separate group of meditators using a novel step-wise rt-fMRI discovery protocol in which participants were not provided with prior knowledge of the expected relationship between their experience and the feedback graph (i.e., focused attention versus mind-wandering). These findings support the feasibility of using rt-fMRI to link objective measures of brain activity with reports of ongoing subjective experience in cognitive neuroscience research, and demonstrate the generalization of expertise in introspective awareness to novel contexts.

One Size Fits All? Slow Cortical Potentials Neurofeedback: A Review

Objective: The intent of this manuscript was to review all published studies on slow cortical potentials (SCP) neurofeedback for the treatment of ADHD, with emphasis on neurophysiological rationale, study design, protocol, outcomes, and limitations. Method: For review, PubMed, MEDLINE, ERIC, and Google Scholar searches identified six studies and six subsequent publications. In addition to five studies focusing on children with Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV) –diagnosed ADHD, one study reports on adults. Results: SCP protocols utilize unipolar-electrode placement at Cz, randomized bidirectional signal regulation, feedback/transfer trials, and discrete feedback/rewards. Results demonstrated learning of SCP self-regulation, moderate to large within group effect sizes for core ADHD symptom reduction, and enhancement of event-related potentials/electroencephalogram components. Neurophysiological and session variables were predictive of treatment outcome, but open questions of specific and nonspecific effects remain. Study limitations and future directions are discussed. Conclusion: SCP is an efficacious and standardized neurofeedback protocol that addresses behavioral and neurophysiological deficits in ADHD.

Clinical Perspectives of 19-Channel Z-Score Neurofeedback: Benefits and Limitations

Z-Score neurofeedback has expanded to include 19-channel models (19ZNF) such that clinicians now have the option to use from 1 to 19 electrodes in a z-score neurofeedback protocol. Benefits and limitations of this new model are discussed from the clinical perspective of an early adopter of 19ZNF who has more than 4 years of experience with this modality after having several years of experience with QEEG-guided NF (QNF). Comparisons between QNF and 19ZNF are discussed. It has been suggested that 19ZNF can bring about positive clinical outcomes in fewer sessions than traditional NF, which matches the author's experience (average of 38 with QNF vs. an average of 11 with 19ZNF). Unique implications of 19ZNF that have not yet been discussed in the literature, such as the advantage of once-per-week sessions, or questions about whether there could be times when change can occur too fast, are introduced. Directions for future research to further evaluate 19ZNF are suggested.

The effect of EEG biofeedback on reducing postcancer cognitive impairment

BACKGROUND AND HYPOTHESES: Postcancer cognitive impairment (PCCI) is observed in a substantial number of breast cancer survivors, persisting for as long as 20 years in some subgroups. Although compensatory strategies are frequently suggested, no restorative interventions have yet been identified. This study examined the feasibility of EEG biofeedback ("neurofeedback") and its potential effectiveness in reducing PCCI as well as the fatigue, sleep disturbance, and psychological symptoms that frequently accompany PCCI. STUDY DESIGN: This was a 6-month prospective study with a waitlist control period followed by an active intervention. Participants were female breast cancer survivors (n = 23), 6 to 60 months postchemotherapy, with self-reported cognitive impairment. METHODS: Four self-report outcome measures (Functional Assessment of Cancer Therapy-Cognitive Function [FACT-Cog], Functional Assessment of Chronic Illness Therapy-Fatigue [FACIT-Fatigue], Pittsburgh Sleep Quality Index [PSQI], and Brief Symptom Inventory [BSI]-18) were administered 3 times during a 10-week waitlist control period, 3 times during a 10-week (20-session) neurofeedback training regimen, and once at 4 weeks postneurofeedback. RESULTS: All 23 participants completed the study, demonstrating the feasibility of EEG biofeedback in this population. Initially, the sample demonstrated significant dysfunction on all measures compared with general population norms. Repeated-measures ANOVAs revealed strongly significant improvements (P < .001) on all 4 cognitive measures (perceived cognitive impairment, comments from others, perceived cognitive abilities, and impact on quality of life [QOL]), the fatigue scale, and the 4 psychological scales (somatization, depression, anxiety and global severity index) as well as on 3 of 8 sleep scales (quality, daytime dysfunction, and global). Two of the other sleep scales (latency and disturbance) were significant at P < .01, and 1 (use of medication) at P < .05; 2 were not significant. Improvements were generally linear across the course of training, and were maintained at the follow-up testing. At the follow-up testing, the sample no longer differed significantly from normative populations on 3 of the 4 FACT-Cog measures (impairment, impact on QOL, and comments), FACIT-Fatigue, PSQI sleep quality and habitual efficiency, or any of the BSI-18 measures of psychological disturbance. CONCLUSIONS: Data from this limited study suggest that EEG biofeedback has potential for reducing the negative cognitive and emotional sequelae of cancer treatment as well as improving fatigue and sleep patterns.

The Potential of Neurofeedback in the Treatment of Eating Disorders: A Review of the Literature

Abstract Neurofeedback is defined as the training of voluntary regulation of localised neural activity using real‐time feedback through a brain‐computer interface. It has shown initial success as a potential clinical treatment tool in proof of concept studies, but has yet to be evaluated with respect to eating disorders. This paper (i) provides a brief overview of the current status of eating disorder treatments; (ii) describes the studies to date that use neurofeedback involving electroencephalography, real‐time functional magnetic resonance imaging or near‐infrared spectroscopy; and (iii) considers the potential of these technologies as treatments for eating disorders. Copyright © 2013 John Wiley & Sons, Ltd and Eating Disorders Association.

Prediction of treatment response and the effect of independent component neurofeedback in obsessive-compulsive disorder: a randomized, sham-controlled, double-blind study

AIMS: The goal of this study was to assess the effect of independent component neurofeedback (NFB) on EEG and clinical symptoms in patients with obsessive-compulsive disorder (OCD). Subsequently, we explored predictors of treatment response and EEG correlates of clinical symptoms. METHODS: In a randomized, double-blind, parallel design, 20 inpatients with OCD underwent 25 sessions of NFB or sham feedback (SFB). NFB aimed at reducing EEG activity in an independent component previously reported abnormal in this diagnosis. Resting-state EEG recorded before and after the treatment was analyzed to assess its posttreatment changes, relationships with clinical symptoms and treatment response. RESULTS: Overall, clinical improvement in OCD patients was not accompanied by EEG change as assessed by standardized low-resolution electromagnetic tomography and normative independent component analysis. Pre- to posttreatment comparison of the trained component and frequency did not yield significant results; however, in the NFB group, the nominal values at the downtrained frequency were lower after treatment. The NFB group showed significantly higher percentage reduction of compulsions compared to the SFB group (p = 0.015). Pretreatment higher amount of delta (1-6 Hz) and low alpha oscillations as well as a lower amount of high beta activity predicted a worse treatment outcome. Source localization of these delta and high beta oscillations corresponded with previous EEG resting-state findings in OCD patients compared to healthy controls. CONCLUSION: Independent component NFB in OCD proved useful in percentage improvement of compulsions. Based on our correlation analyses, we hypothesize that we targeted a network related to treatment resistance.

A Proposed Multisite Double-Blind Randomized Clinical Trial of Neurofeedback for ADHD: Need, Rationale, and Strategy

Objective: Additional treatments with persisting benefit are needed for ADHD. Because ADHD often shows excessive theta electroencephalogram (EEG) power, low beta, and excessive theta-beta ratio (TBR), a promising treatment is neurofeedback (NF) downtraining TBR. Although several nonblind randomized clinical trials (RCTs) show a medium-large benefit for NF, a well-blinded, sham-controlled RCT is needed to differentiate specific from nonspecific effects. Method: Experts in NF, ADHD, clinical trials, and statistics collaborated to design a double-blind multisite RCT. Results/Conclusion: At four sites, 180 children aged 7 to 10 years with rigorously diagnosed ADHD and TBR ≥ 5 will be randomized to active TBR-NF versus sham NF of equal duration, intensity, and appearance. Sham, utilizing prerecorded EEGs with participant artifacts superimposed, will keep participants and staff blind. Treatment fidelity will be trained/monitored by acknowledged NF leaders. Multidomain assessments before, during, and after treatment (follow-up to 2 years) will also include tests of blinding and sham inertness.

Ending the Evidentiary & Insurance Reimbursement Bias Against Neurofeedback to Treat ADHD: It will take Clinician Action in addition to the Compelling Science

Neurofeedback for Adult Attention-Deficit/Hyperactivity Disorder: Investigation of Slow Cortical Potential Neurofeedback—Preliminary Results

Attention deficit/hyperactivity disorder (ADHD) is characterized by symptoms of inattention, impulsivity, and hyperactivity. Compared to ADHD in children, only a few studies have investigated ADHD in an adult population, and even less have investigated new forms of treatment such as neurofeedback. Neurofeedback has been applied effectively in various areas, especially in the treatment of children with ADHD, and symptom improvements were associated with increased amplitude of the contingent negative variation (CNV). This study investigated if any behavioral and electrophysiological changes reflected in the CNV can be observed after 15 sessions of SCP neurofeedback training. Furthermore, a comparison of CNV amplitude in adults with ADHD and a healthy control group was conducted. Continuous 22-channel EEG was acquired from 10 adults who met DSM-IV criteria for ADHD and 8 matched healthy controls. EEG recordings were collected pre/midtreatment and included resting EEG, P300, and CNV tasks as well as ADHD behavioral questionnaires. The adult ADHD group received 15 sessions of SCP training at Cz (referenced to A1, ground A2). The control group only underwent the EEG recording. After 15 sessions of SCP-training a significant improvement in self-ratings of ADHD symptoms was reported. In addition, a trend in increasing CNV mean amplitude was observed after training. A significant difference in baseline CNV between the adult ADHD group and the healthy control group was observed. These results give a promising outlook to the outcome after the completion of 30 sessions of SCP training. The differences in CNV amplitude between the ADHD group and healthy controls are in line with other studies about adult ADHD and CNV. This supports the idea of impaired self-regulation in adult ADHD. The behavioral improvements and increase in CNV after SCP training suggests that SCP training has a positive effect on adult ADHD symptoms and their origin.

Double-blind single-session neurofeedback training in upper-alpha for cognitive enhancement of healthy subjects

This paper reports on a single-session neurofeedback (NF) training procedure on the user-specific upper alpha band for cognitive enhancement in healthy users. A double-blind study was designed using a NF group and an active control group. Control group performed as the NF group but received sham feedback, minimizing the non-specific factors of training. This design aimed to (i) investigate upper alpha as a NF parameter, (ii) evaluate the NF effects on upper alpha during the execution of a cognitive task, and (iii) evaluate the effects on cognitive performance by means of a cognitive task and a battery of psychological tests. Results of EEG analysis show the key role of the feedback: only the NF group enhanced upper alpha during the training, and it led to a desynchronization increase during the execution of the cognitive task. Regarding the behavioral results, a strong learning effect was observed, with the NF group performing better in almost all measurements but many of them without statistical significance.

Brain Wave Biofeedback: Benefits of Integrating Neurofeedback in Counseling

Consistent with the 2009 Standards of the Council for Accreditation of Counseling and Related Educational Programs, counselors must understand neurobiological behavior in individuals of all developmental levels. This requires understanding the brain and strategies for applying neurobiological concepts in counseling practice, training, and research. Neurofeedback, biofeedback for the brain, is one modality based in neuroscience that empowers individuals to recognize, monitor, and self-regulate brain wave activity to create greater wellness. Neurofeedback has significant potential in counseling preparation, research, and practice.

Effects of Neurofeedback Training on Attention in Children with Intellectual Disability

This study investigated effects of neurofeedback (NFB) training on attention in children with intellectual disability (ID). Twenty-one children with ID were assigned to an NFB training group (n = 7), to a visual perception (VP) training group (n = 7), or to a no-treatment group (n = 7). Two groups received 36 sessions of NFB or VP training, respectively, over 12 weeks. Children's Color Trails Test-2, Stroop Color and Word Test, and Digit Span were administered to all participants before and after training. The follow-up study was conducted with both the NFB and VP groups in the same way after 3 months. The EEGs of the NFB group also were measured. The NFB group showed significantly improved scores on the all tests compared to the 2 control groups. The brainwaves of the frontal lobes of the NFB group declined significantly in theta wave amplitude and theta-to-beta ratio. The NFB results were maintained in the follow-up study. Beta/SMR uptraining seemed to be an effective way to enhance attention in children with ID.

Real-time self-regulation of emotion networks in patients with depression

Many patients show no or incomplete responses to current pharmacological or psychological therapies for depression. Here we explored the feasibility of a new brain self-regulation technique that integrates psychological and neurobiological approaches through neurofeedback with functional magnetic resonance imaging (fMRI). In a proof-of-concept study, eight patients with depression learned to upregulate brain areas involved in the generation of positive emotions (such as the ventrolateral prefrontal cortex (VLPFC) and insula) during four neurofeedback sessions. Their clinical symptoms, as assessed with the 17-item Hamilton Rating Scale for Depression (HDRS), improved significantly. A control group that underwent a training procedure with the same cognitive strategies but without neurofeedback did not improve clinically. Randomised blinded clinical trials are now needed to exclude possible placebo effects and to determine whether fMRI-based neurofeedback might become a useful adjunct to current therapies for depression.

Cognitive Enhancement Using 19-Electrode Z-Score Neurofeedback

A 23-year-old man presented for a neurological evaluation due to cognitive problems restricting him from college education. He graduated successfully from high school but had problems in college, which caused his subsequent withdrawal. He was interested in trying neurofeedback (NFB) for possible cognitive enhancement. His initial computerized neurocognitive testing showed global cognitive standard score (GCS) of 93.1. The information processing speed standard score was 64.5 and was the lowest of scored domains. Quantitative electroencephalography revealed right frontal and temporal increase in delta power and left frontal and temporal beta power excess. Fifteen sessions of 19-electrode Z-score NFB lead to marked improvement of the patient's subjective cognitive perception as well as GCS on computerized neurocognitive testing. His post-NFB GCS was 104.1 and information-processing speed reached 85.2. Also a reduction of the right frontal and temporal delta power expression was achieved, as well as improvement in the left fronto-temporal beta power. This case report illustrates marked increase in cognitive performance achieved by Z-score 19-electrodes NFB training and justifies the initiation of larger studies to confirm these promising findings.

Taking back the brain: could neurofeedback training be effective for relieving distressing auditory verbal hallucinations in patients with schizophrenia?

Progress in identifying the neural correlates of auditory verbal hallucinations (AVHs) experienced by patients with schizophrenia has not fulfilled its promise to lead to new methods of treatments. Given the existence of a large number of such patients who have AVHs that are refractory to traditional treatments, there is the urgent need for the development of new effective interventions. This article proposes that the technique of neurofeedback may be an appropriate method to allow the translation of pure research findings from AVH-research into a clinical intervention. Neurofeedback is a method through which individuals can self-regulate their neural activity in specific neural regions/frequencies, following operant conditioning of their intentional manipulation of visually presented real-time feedback of their neural activity. Four empirically testable hypotheses are proposed as to how neurofeedback may be employed to therapeutic effect in patients with AVHs.

19-Channel Neurofeedback in an Adolescent with FASD

Fetal alcohol spectrum disorders (FASD), resulting from gestational exposure to ethanol alcohol, can result in a wide range of lifelong and severe challenging behaviors with a concomitant lowered quality of life. This article presents the results of neurofeedback treatment (80 sessions over 14 months) with an adolescent diagnosed with FASD and attention deficit hyperactivity disorder and who had a significantly low social adaptive quotient (<1 percentile) and marginally low intelligence (13th percentile). Significant neural dysregulation, as measured by quantitative electroencephalography, resolved almost entirely. This occurred with a parallel improvement of his challenging behaviors as subjectively reported by his family and one of his workers.

The effects of QEEG-informed neurofeedback in ADHD: an open-label pilot study

In ADHD several EEG biomarkers have been described before, with relevance to treatment outcome to stimulant medication. This pilot-study aimed at personalizing neurofeedback treatment to these specific sub-groups to investigate if such an approach leads to improved clinical outcomes. Furthermore, pre- and post-treatment EEG and ERP changes were investigated in a sub-group to study the neurophysiological effects of neurofeedback. Twenty-one patients with ADHD were treated with QEEG-informed neurofeedback and post-treatment effects on inattention (ATT), hyperactivity/impulsivity (HI) and comorbid depressive symptoms were investigated. There was a significant improvement for both ATT, HI and comorbid depressive complaints after QEEG-informed neurofeedback. The effect size for ATT was 1.78 and for HI was 1.22. Furthermore, anterior individual alpha peak frequency (iAPF) demonstrated a strong relation to improvement on comorbid depressive complaints. Pre- and post-treatment effects for the SMR neurofeedback sub-group exhibited increased N200 and P300 amplitudes and decreased SMR EEG power post-treatment. This pilot study is the first study demonstrating that it is possible to select neurofeedback protocols based on individual EEG biomarkers and suggests this results in improved treatment outcome specifically for ATT, however these results should be replicated in further controlled studies. A slow anterior iAPF at baseline predicts poor treatment response on comorbid depressive complaints in line with studies in depression. The effects of SMR neurofeedback resulted in specific ERP and EEG changes.

Self-modulation of primary motor cortex activity with motor and motor imagery tasks using real-time fMRI-based neurofeedback

Advances in fMRI data acquisition and processing have made it possible to analyze brain activity as rapidly as the images are acquired allowing this information to be fed back to subjects in the scanner. The ability of subjects to learn to volitionally control localized brain activity within motor cortex using such real-time fMRI-based neurofeedback (NF) is actively being investigated as it may have clinical implications for motor rehabilitation after central nervous system injury and brain-computer interfaces. We investigated the ability of fifteen healthy volunteers to use NF to modulate brain activity within the primary motor cortex (M1) during a finger tapping and tapping imagery task. The M1 hand area ROI (ROI(m)) was functionally localized during finger tapping and a visual representation of BOLD signal changes within the ROI(m) fed back to the subject in the scanner. Surface EMG was used to assess motor output during tapping and ensure no motor activity was present during motor imagery task. Subjects quickly learned to modulate brain activity within their ROI(m) during the finger-tapping task, which could be dissociated from the magnitude of the tapping, but did not show a significant increase within the ROI(m) during the hand motor imagery task at the group level despite strongly activating a network consistent with the performance of motor imagery. The inability of subjects to modulate M1 proper with motor imagery may reflect an inherent difficulty in activating synapses in this area, with or without NF, since such activation may lead to M1 neuronal output and obligatory muscle activity. Future real-time fMRI-based NF investigations involving motor cortex may benefit from focusing attention on cortical regions other than M1 for feedback training or alternative feedback strategies such as measures of functional connectivity within the motor system.

Intermittent "real-time" fMRI feedback is superior to continuous presentation for a motor imagery task: a pilot study

BACKGROUND: Real-time functional MRI feedback (RTfMRIf) is a developing technique, with unanswered methodological questions. Given a delay of seconds between neural activity and the measurable hemodynamic response, one issue is the optimal method for presentation of neurofeedback to subjects. The primary objective of this preliminary study was to compare the methods of continuous and intermittent presentation of neural feedback on targeted brain activity. METHODS: Thirteen participants performed a motor imagery task and were instructed to increase activation in an individually defined region of left premotor cortex using RTfMRIf. The fMRI signal change was compared between real and false feedback for scans with either continuous or intermittent feedback presentation. RESULTS: More individuals were able to increase their fMRI signal with intermittent feedback, while some individuals had decreased signal with continuous feedback. The evaluation of feedback itself activated an extensive amount of brain regions, and false feedback resulted in brain activation outside of the individually defined region of interest. CONCLUSIONS: As implemented in this study, intermittent presentation of feedback is more effective than continuous presentation in promoting self-modulation of brain activity. Furthermore, it appears that the process of evaluating feedback involves many brain regions that can be isolated using intermittent presentation.

LORETA Neurofeedback: Odd Reports, Observations, and Findings Associated with Spatial Specific Neurofeedback Training

Neurotherapeutic techniques continue to advance in sophistication and complexity, and as such so does the need to reference odd occurrences or adverse reactions as a result of training in different regions of the brain. This is important to the field of neurotherapy in addition to those practitioners who may encounter patients on medications at the time of training, and this type of information can only add to the armamentarium of tools at our disposal. We discuss noted odd occurrences that have transpired during our studies employing LORETA neurofeedback (LNFB) in both children and adults. We also discuss negative events reported by patients or parents and medications interactions with LNFB. Positive results are also discussed. The field of neurofeedback can benefit immensely from more reports of this type.

A Review of Neurofeedback Treatment for Pediatric ADHD

Objective: The aim of this paper was to review all randomized published trials and unpublished conference presentations on the neurofeedback (NF) treatment of pediatric ADHD, and their relevance, strengths, and limitations. Method: Via PsychInfo and Medline searches and contacts with NF researchers 14 studies were identified and reviewed. Results: The majority were conducted from 1994 to 2010, with 5- to 15-year-olds, usually male and White with the combined type of ADHD. Most studies used theta/beta NF with a unipolar-electrode placement at Cz and demonstrated, where reported, an overall ADHD mean effect size of d = 0.69, a medium effect. Main study strengths, within some studies, include use of randomization, treatment control conditions, Diagnostic and Statistical Manual of Mental Disorders criteria, evidence-based assessment of ADHD, standard treatment outcome measures, multidomain assessment, and, for some studies, moderate sample size, some type of blind and the identification of medication as a concomitant treatment. Main study limitations (and directions for future research) include the lack of adequate blinding of participants, raters and NF trainers, a sham-NF/blinded control treatment condition, posttreatment follow-up, generalizability, specific details about delivery of NF, identification and control of comorbidity, and the identification, measurement, and control of concomitant treatments and potential side effects. Conclusion: Based on the results and methodologies of published studies, this review concludes that NF for pediatric ADHD can be currently considered as “probably efficacious.”

Modulation of subgenual anterior cingulate cortex activity with real-time neurofeedback

The advent of real-time neurofeedback techniques has allowed us to begin to map the controllability of sensory and cognitive and, more recently, affective centers in the brain. The subgenual anterior cingulate cortex (sACC) is thought to be involved in generation of affective states and has been implicated in psychopathology. In this study, we examined whether individuals could use real-time fMRI neurofeedback to modulate sACC activity. Following a localizer task used to identify an sACC region of interest, an experimental group of eight women participated in four scans: (1) a pretraining scan in which they were asked to decrease activity in the sACC without neurofeedback; (2) two training scans in which sACC neurofeedback was presented along with instructions to decrease sACC activity; and (3) a neurofeedback-free post-training scan. An additional nine women in a yoked feedback control group saw sACC activity from the participants in the experimental group. Activity in the sACC was significantly reduced during neurofeedback training in the experimental group, but not in the control group. This training effect in the experimental group, however, did not generalize to the neurofeedback-free post-training scan. A psychophysiological interaction analysis showed decreased correlation in the experimental group relative to the sham control group between activity in the sACC and the posterior cingulate cortex during neurofeedback training relative to neurofeedback-free scans. The finding that individuals can down-modulate the sACC shows that a primary emotion center in which functional abnormality has been strongly implicated in affective disorders can be controlled with the aid of neurofeedback.

Real-time functional magnetic resonance imaging neurofeedback for treatment of Parkinson's disease

Self-regulation of brain activity in humans based on real-time feedback of functional magnetic resonance imaging (fMRI) signal is emerging as a potentially powerful, new technique. Here, we assessed whether patients with Parkinson's disease (PD) are able to alter local brain activity to improve motor function. Five patients learned to increase activity in the supplementary motor complex over two fMRI sessions using motor imagery. They attained as much activation in this target brain region as during a localizer procedure with overt movements. Concomitantly, they showed an improvement in motor speed (finger tapping) and clinical ratings of motor symptoms (37% improvement of the motor scale of the Unified Parkinson's Disease Rating Scale). Activation during neurofeedback was also observed in other cortical motor areas and the basal ganglia, including the subthalamic nucleus and globus pallidus, which are connected to the supplementary motor area (SMA) and crucial nodes in the pathophysiology of PD. A PD control group of five patients, matched for clinical severity and medication, underwent the same procedure but did not receive feedback about their SMA activity. This group attained no control of SMA activation and showed no motor improvement. These findings demonstrate that self-modulation of cortico-subcortical motor circuits can be achieved by PD patients through neurofeedback and may result in clinical benefits that are not attainable by motor imagery alone.

European clinical guidelines for Tourette syndrome and other tic disorders. Part III: behavioural and psychosocial interventions

This clinical guideline provides recommendations for the behavioural and psychosocial interventions (BPI) of children and adolescents with tic disorders prepared by a working group of the European Society for the Study of Tourette Syndrome (ESSTS). A systematic literature search was conducted to obtain an update on the efficacy of BPI for tics. Relevant studies were identified using computerised searches of the Medline and PsycINFO databases and the Cochrane Library for the years 1950-2010. The search identified no meta-analyses, yet twelve (systematic) reviews and eight randomised controlled trials provided evidence for the current review. Most evidence was found for habit reversal training (HRT) and the available but smaller evidence also supports the efficacy of exposure with response prevention (ERP). Both interventions are considered first line behavioural treatments for tics for both children and adults and should be offered to a patient, taking into account his preference. Treatments that are considered second line or add-on behavioural treatments are contingency management, function based interventions and relaxation training. Neurofeedback is still experimental. Almost no research was identified that examined the efficacy of psychosocial interventions, e.g., psychoeducation and group work. Based on clinical practice, this guideline recommends behavioural treatment as first line offer to patients in most cases. It should be embedded within a psychoeducational and supportive context and can be combined with drug treatment.

Neurofeedback Training to Enhance Learning and Memory in Patients with Cognitive Impairment

The brain tumours can make cognitive impairment especially when they involve the limbic system, the frontal or temporal lobes. The aim of the present study was to examine neurofeedback training (NFT) to enhance learning and memory in patients with cognitive impairment. Single case pre- and post-intervention study was adopted. The qEEG WISC-IV and CBCL test was compared pre and post NFT. Patient was given 40 sessions of NFT, 45 min / day, 3 days a week. The training incorporated video feedback to increase the frequency of Beta waves (15-18 Hz) and to decrease theta waves (3-7 Hz) in T3 and F3. Also, SMR training was performed in Cz to decrease the seizure attacks. qEEG showed prominent different in the brain activity. Results indicated decrease in theta and increase in Beta waves. The present study puts forward that NFT should be taken into account to plan for rehabilitation of patients with cognitive impairment for enhancement of performance in the school or university.

EEG-based upper alpha neurofeedback training improves working memory performance

Neurofeedback (NF) training has revealed its therapeutical effects to treat a variety of neurological and psychological disorders, and has demonstrated its feasibility to improve certain cognitive aptitudes in healthy users. Although promising results of NF training exist in recent literature, the reliability of its effects remains questioned due to a lack of deep studies examining its impact on the human electrophysiology. This paper presents a NF training aimed at improving working memory performance in healthy users by the enhancement of upper alpha band. A user-specific training was used (upper alpha was determined for each user using the individual alpha frequency) to reduce the unspecific factors of training the entire classical alpha band as traditional NF usually does. EEG assessments in active and passive open-eyes state were conducted pre/post the NF training. The EEG analyses reveal the UA enhancement during the active tasks which is independent of other frequency bands. UA was also enhanced in the passive state but independence could not be obtained in lower alpha band. Finally, significant improvement in working memory was obtained with regard to a control group.

Impaired Error Monitoring and Correction Function in Autism

Introduction Error monitoring and correction is one of the executive functions and is important for effective goal directed behavior. Deficient executive functioning, including reduced error monitoring ability, is one of the typical features of such neurodevelopmental disorders as autism, probably related to perseverative responding, stereotyped repetitive behaviors, and an inability to accurately monitor ongoing behavior. Our prior studies of behavioral and event-related potential (ERP) measures during performance on visual oddball tasks in high-functioning autistic (HFA) children showed that despite only minor differences in reaction times HFA children committed significantly more errors. Methods This study investigated error monitoring in children with autism spectrum disorder (ASD) with response-locked event-related potentials - the Error-related Negativity (ERN) and Error-related Positivity (Pe) recorded at fronto-central sites. The ERN reflects early error detection processes, while the Pe has been associated with later conscious error evaluation and attention re-allocation. Reaction times (RT) in correct trials and post-error slowing in reaction times were measured. In this study fourteen subjects with ASD and 14 age- and IQ- matched controls received a three-category visual oddball task with novel distracters. Results ERN had a lower amplitude and longer latency in the ASD group but was localized in the caudal part of anterior cingulate cortex (ACC) in both groups. The Pe component was significantly prolonged in the ASD group but did not reach significance in amplitude differences compared to controls. We found significant post-error slowing in RTs in controls, and post-error acceleration in RTs in the ASD group. Conclusions The reduced ERN and altered Pe along with a lack of post-error RT slowing in autism might be interpreted as insensitivity in the detection and monitoring of response errors and a reduced ability of execute corrective actions. This might result in reduced error awareness and failure in adjustment when dealing with situations where erroneous responses may occur. This deficit might be manifested in the perseverative behaviors often seen in individuals with ASD. The results are discussed in terms of a general impairment in self-monitoring and other executive functions underlying behavioral and social disturbances in ASD.

Pilot Project to Ascertain the Utility of Tower of London Test to Assess Outcomes of Neurofeedback in Clients with Asperger's Syndrome

Introduction. Behavioral and cognitive improvements in clients with Asperger's Syndrome (AS), employing continuous performance tests (CPTs), intelligence and academic measures, and electroencephalographic data, have been reported following 40 sessions of neurofeedback (NFB) training combined with coaching in metacognitive strategies. However, measures of executive functions (EFs) in this population have not been commonly employed and NFB is still not commonly used as a treatment for AS. Therefore, this pilot project used Tower of London - Drexel University (ToLDX), an individually administered test of EFs, in addition to the previously mentioned measures. The goal of the current study was to investigate the utility of ToLDX as an assessment tool for clients with AS as well as further study the effects of NFB and training in metacognitive strategies on executive functioning in clients with AS. Method. Nineteen consecutive clients at the ADD Centre, Toronto, Canada (M age = 12 years 0 months) recruited over a 21/2-year period all had full clinical assessment, completed age appropriate questionnaires, and were tested pre- and post-40 NFB sessions. Results. Following the training, clients with AS were able to plan more efficiently, inhibit premature responses, and shift set with greater ease, as well as solve problems more quickly as measured by their ToLDX scores. On CPTs, clients with AS showed a trend toward less impulsivity. Finally, improvement in their scores on ToLDX was not affected by age or IQ. Conclusion. These data are important because they provide an extension of results of previous studies (Reid, 2005), demonstrate the utility of tests of executive functions in a clinical setting with clients with AS, and suggest directions for further controlled research in this area.

Real-time fMRI feedback training may improve chronic tinnitus

OBJECTIVES: Tinnitus consists of a more or less constant aversive tone or noise and is associated with excess auditory activation. Transient distortion of this activation (repetitive transcranial magnetic stimulation, rTMS) may improve tinnitus. Recently proposed operant training in real-time functional magnetic resonance imaging (rtfMRI) neurofeedback allows voluntary modification of specific circumscribed neuronal activations. Combining these observations, we investigated whether patients suffering from tinnitus can (1) learn to voluntarily reduce activation of the auditory system by rtfMRI neurofeedback and whether (2) successful learning improves tinnitus symptoms. METHODS: Six participants with chronic tinnitus were included. First, location of the individual auditory cortex was determined in a standard fMRI auditory block-design localizer. Then, participants were trained to voluntarily reduce the auditory activation (rtfMRI) with visual biofeedback of the current auditory activation. RESULTS: Auditory activation significantly decreased after rtfMRI neurofeedback. This reduced the subjective tinnitus in two of six participants. CONCLUSION: These preliminary results suggest that tinnitus patients learn to voluntarily reduce spatially specific auditory activations by rtfMRI neurofeedback and that this may reduce tinnitus symptoms. Optimized training protocols (frequency, duration, etc.) may further improve the results.

Case Report: Impaired Memory and Disorientation Induced by Delta Band Down-Training Over the Temporal Brain Regions by Neurofeedback Treatment

A Position Paper on Neurofeedback for the Treatment of ADHD

This position paper provides the current evidence supporting the use of neurofeedback in the treatment of ADHD and recommendations on the implementation of neurofeedback in clinical practice. The paper also provides basic information regarding the diagnosis and psychophysiological etiology of ADHD. The paper does not focus on a specific age range of a clinical population. Unless otherwise noted, we are referring to all subtypes of ADHD (inattentive, hyperactive only, and combined). Conclusions and recommendation are based on the most recent research; however, we also refer to relevant historical studies that support our position on neurofeedback. The readers are strongly advised to research behavioral diagnostic criteria and testing methods elsewhere. This paper is not intended as a comprehensive educational tool for diagnosis or treatment of ADHD. Our purpose is to demonstrate the rationale and to reference the necessary support for neurofeedback in order to be recognized as a legitimate, scientific, and evidence-based intervention for the treatment of ADHD.

Individual EEG Alpha Activity Analysis for Enhancement Neurofeedback Efficiency: Two Case Studies

The hypothesis was tested of whether neurofeedback training applied in order to increase or decrease power of individual EEG frequency ranges is more efficient than neurofeedback training of standard EEG frequency ranges. The sessions of decreasing the theta/beta ratio and reinforcing alpha neurofeedback training were carried out on two outpatients with attention deficit disorder (a schoolboy) and functional pain contraction (a professional musician). The neurofeedback utilizing standard EEG frequency ranges (theta 4-8, alpha 8-12, beta 13-18) was inefficient and even resulted in aggravation of symptoms in both cases. The individualized neurofeedback that utilized individual frequency ranges resulted in substantial clinical improvement.

Does Neurofeedback Help Reduce Attention-Deficit Hyperactivity Disorder?

Neurofeedback is an alternative treatment for Attention Deficit Hyperactivity Disorder (ADHD), but its efficacy is unknown. This narrative review examines rigorous studies conducted utilizing neurofeedback as a treatment for ADHD. Methods: Studies were located by searching the Web of Science and PsycINFO databases with the keywords ADHD or attention deficit hyperactivity disorder AND neurofeedback or EEG biofeedback or electroencephalogram biofeedback. Located studies were chosen for initial review if they met the following criteria: (a) randomized controlled trial or quasi-experiment, (b) ADHD diagnosis based on DSM criteria, (c) published at any time prior to March 2010, (d) English language, and (e) published in a peer-reviewed journal. Participants included children, adolescents, and adults diagnosed with ADHD. Results: Twelve articles reporting 9 different studies met the eligibility criteria and were included in the review. All 9 studies produced results that indicated significant improvements on either tests scores or behavioral conduct for individuals who were treated with neurofeed-back for ADHD. Alternative treatments also demonstrated effectiveness. Conclusion: Neurofeedback may be an effective treatment for ADHD. Future research is needed with larger sample sizes, comparing the efficacy of neurofeedback with the efficacy of other ADHD treatments and comparing different neurofeedback protocols.

Effects of Neurofeedback Training on Inhibitory Capacities in ADHD Children: A Single-Blind, Randomized, Placebo-Controlled Study

Studies performed during the last decades suggest that neurofeedback (NF) training can effectively reduce symptomatology in children with Attention deficit hyperactivity disorder (ADHD). Yet questions remain concerning specific effects of NF training in ADHD children, because these studies did not use a randomized, placebo-controlled approach. To address this issue, such an approach was used in the present study to measure the impact of NF training on inhibitory capacities. Method. Nine ADHD children (with no comorbidity), aged 8 to 13 years, were randomly assigned to either an experimental group (n1/45) or a placebo group (n1/44). For both groups, training protocols comprised 40 one-hr sessions (20 meetings of 2 sessions each). Sensorimotor rhythm=Theta training was used in the experimental group. Prerecorded sessions of the first author's EEG activity were used in the placebo group. Pre- and posttraining assessments consisted of the Conner's Parent Rating Scales (CPRS-R) and neuropsychological tests. A multiple case study strategy was applied for data analysis using a Reliable Change Index when applicable. Results. One experimental participant was a dropout, and one placebo participant had to be discontinued due to adverse effects. The latter participant accepted to undergo posttraining evaluations; hence an Intention-to-Treat analysis was performed on this participant's data. Remaining participants showed significant improvements on the CPRS-R. Improvements were measured on the Variability measure of the CPT-II consistently across the placebo group and on the Inhibition Condition of the Stroop Task for all but one placebo participant. The same trend was found for the Inhibition=Switching Condition (Stroop Task) across the experimental group (n1/44). Conclusion. The small sample size precludes from evaluating specific neurofeedback effects. Still, the presence of placebo responses suggests that other factors, such as motivation or expectations, might contribute to the outcome of NF training in children with ADHD.

Discrete-Trial SCP and GSR Training and the Interrelationship Between Central and Peripheral Arousal

Introduction. Slow Cortical Potential (SCP) neurofeedback and Galvanic Skin Response (GSR) biofeedback training were used to investigate self-regulatory control over central and peripheral arousal processes in two groups of healthy participants. Method. One group completed the SCP neurofeedback training procedure; the other group performed the GSR biofeedback procedure. Both groups underwent treatment while the other variable was passively recorded. The participants were instructed to either increase (Up trials) or decrease (Down trials) arousal. Twenty sessions were completed by each of the 18 participants over an 8-week period. Results. Participants in each group performed better on the variable they were trained on. In the GSR group, a significant increase in performance over blocks was obtained for both trial types (Up and Down). In the SCP group a better performance on the Down trials was obtained. When comparing performance of both trial types, the SCP-trained participants showed a marginal increase and the GSR-trained participants a significant increase over time preliminary-training. Conclusion. Overall, the results showed that GSR regulation is easier to learn than SCP training with neurofeedback, that both variables can be trained in a bidirectional design, and that the SCP training subjects were predominantly able to learn performance at the Down trials. Preliminary results from the cross-correlations are inconsistent over trial types, trained parameters, and participants. However, the general trend shows a more positive correlation at the end of training compared to the start of training. Cross-correlation analysis suggests that this training encourages positive correlation between the SCP and GSR. Future research directions should be aimed at improving motivational conditions, implementing contingent reward principles, and controlling confounding variables.

Practitioner Perspectives of Neurofeedback Therapy for Mental Health and Physiological Disorders

Introduction. This study utilized a systematic method to identify and to categorize practitioner perspectives related to neurofeedback therapy (NFT) for mental health and physiological disorders. We offer the identified themes for utilization in future research on practitioner variables influencing process and outcome variables, which adds to our knowledge and understanding of NFT. Method. Seventy-one practitioners completed online surveys gathering demographic information and responses to open-ended questions about advantages, disadvantages, practitioner characteristics, and essential components of NFT. We utilized Loftland and Loftland's (1984) systematic filing system and Berg's (2004) themes to concepts to analyze our data set, which allowed us to combine similar themes into categorical frameworks. Results. Our results provided five conceptual frameworks: advantages (84 concepts within 6 categories), disadvantages (53 concepts within 5 categories), knowledge (29 concepts in 4 categories), skills (35 concepts within 3 categories), and traits (36 concepts in 5 categories). Conclusion. An extensive number of themes revolved around three major findings. The first finding reported the ongoing NFT effectiveness of improving health conditions through symptom reduction and enhancing quality of life. The second finding emphasized an extensive practitioner commitment to overcoming the complexity of NFT. The final major finding described dissemination and financial issues related to NFT. Within this study, we expand on these issues and discuss the implication for future research and practice. We do not offer the findings within this study as a comprehensive list; rather, we offer this as a potential starting point for expanding the research of variables related to NFT.

Is It Better to Train Power First or Coherence First?

Introduction. This study was done to see to what extent power training would correct coherence abnormalities in head-injured patients and to what extent coherence training would correct power abnormalities in a similar group of head-injured patients. Method. Ten patients had power training first, and 10 patients had coherence training first (4 protocols with 5 sessions/protocol in each case). Results. Either power or coherence training first resulted in normalization of most power and coherence abnormalities. Coherence training first resulted in significantly more new power abnormalities (10/client vs. 5/client for new power abnormalities). Power training first resulted in significantly more new coherence abnormalities (6/client vs. 2/client). Conclusion. We did not find a clear-cut advantage for doing either power or coherence training first. However, we would recommend a repeat QEEG after doing either power or coherence first, since most original abnormalities will have resolved and there are likely to be several new abnormalities to be remediated.

EEG Biofeedback Case Studies Using Live Z-Score Training and a Normative Database

This article summarizes clinical results using a neurofeedback approach that has been developed over the last several years and is seeing increasing clinical use. All participants used a form of live Z-score training (LZT) that produces sound and video feedback, based on a computation using a normative database to produce multiple targets. The client receives simple feedback that reflects a complex set of relationships between amplitude and connectivity metrics. Changes in the EEG are readily seen that conform to the reinforcement parameters being used in relation to the live Z-scores. In addition, over multiple sessions, QEEG data are seen to change significantly, generally on a path toward overall remediation. In this series of case studies LZT is seen to effectively address EEG abnormalities in a structured fashion and to facilitate normalization of the EEG. In individual cases, specific changes are observed, related to the initial conditions, and the brain's ability to respond with appropriate changes. Overall, LZT is found to be a relatively efficient form of neurofeedback that can be demonstrated to be effective in a variety of clinical scenarios.

Neurofeedback improves executive functioning in children with autism spectrum disorders

Seven autistic children diagnosed with autism spectrum disorders (ASD) received a neurofeedback treatment that aimed to improve their level of executive control. Neurofeedback successfully reduced children's heightened theta/beta ratio by inhibiting theta activation and enhancing beta activation over sessions. Following treatment, children's executive capacities were found to have improved greatly relative to pre-treatment assessment on a range of executive function tasks. Additional improvements were found in children's social, communicative and typical behavior, relative to a waiting list control group. These findings suggest a basic executive function impairment in ASD that can be alleviated through specific neurofeedback treatment. Possible neural mechanisms that may underlie neurofeedback mediated improvement in executive functioning in autistic children are discussed.

A Controlled Comparison of Audio-Visual Entrainment for Treating Seasonal Affective Disorder

Introduction. Seasonal Affective Disorder (SAD) affects up to 6% of the population, primarily in the winter months and at higher latitudes. Methods. Light-box therapy has been the traditional intervention for SAD, where the individual is exposed to a bright light for substantial periods in an effort to replace the lack of sunshine. Audio-visual entrainment (AVE) is a technique using flashing lights through a pair of specially designed glasses and pulses of tones through headphones. The expectation of AVE is to affect brain wave activity through auditory and visual stimulation at specific frequencies. The objective of this study was to determine if AVE is a viable treatment for SAD. The study involved 74 participants in a comparison design with a control group (no flashing lights or pulsed tones) and an AVE group that received a placebo treatment (AVE at 1 Hz flashing lights and pulsed tones) for 2 weeks, followed by an active treatment phase (20 Hz flashing lights and pulsed tones) for another 2 weeks. Results. The results indicated that the placebo phase produced mild reductions in depression and no improvements in anxiety sensitivity, whereas 20 Hz AVE reduced both depression and anxiety symptoms. Conclusion. The 20 Hz AVE treatment condition also produced significant improvements in social life with the family and at work, and increased happiness and energy. The 20 Hz treatment also produced a significant decrease in eating, appetite, and carbohydrate intake.

Slow Cortical Potentials Neurofeedback

Until recently, slow cortical potentials (SCP) training as a method of brainwave feedback has been widely ignored in the Anglo-American tradition of neurofeedback. One of the reasons was the lack of reliable and valid equipment outside a few research labs in Europe. In the meantime this has changed to the better. With devices now being available there is growing interest in SCP feedback. SCPs are very low shifts of brain activity. As they regulate excitation thresholds they may be used for self-regulation training in pathological conditions where excitation thresholds are impaired. This article explains technical requirements; describes training protocols; and gives a short overview on controlled research in epilepsy, attention deficit hyperactivity disorder, and migraine.

Is neurofeedback an efficacious treatment for ADHD? A randomised controlled clinical trial

BACKGROUND: For children with attention deficit/hyperactivity disorder (ADHD), a reduction of inattention, impulsivity and hyperactivity by neurofeedback (NF) has been reported in several studies. But so far, unspecific training effects have not been adequately controlled for and/or studies do not provide sufficient statistical power. To overcome these methodological shortcomings we evaluated the clinical efficacy of neurofeedback in children with ADHD in a multisite randomised controlled study using a computerised attention skills training as a control condition. METHODS: 102 children with ADHD, aged 8 to 12 years, participated in the study. Children performed either 36 sessions of NF training or a computerised attention skills training within two blocks of about four weeks each (randomised group assignment). The combined NF treatment consisted of one block of theta/beta training and one block of slow cortical potential (SCP) training. Pre-training, intermediate and post-training assessment encompassed several behaviour rating scales (e.g., the German ADHD rating scale, FBB-HKS) completed by parents and teachers. Evaluation ('placebo') scales were applied to control for parental expectations and satisfaction with the treatment. RESULTS: For parent and teacher ratings, improvements in the NF group were superior to those of the control group. For the parent-rated FBB-HKS total score (primary outcome measure), the effect size was .60. Comparable effects were obtained for the two NF protocols (theta/beta training, SCP training). Parental attitude towards the treatment did not differ between NF and control group. CONCLUSIONS: Superiority of the combined NF training indicates clinical efficacy of NF in children with ADHD. Future studies should further address the specificity of effects and how to optimise the benefit of NF as treatment module for ADHD.

Long-term effects of neurofeedback treatment in autism

Previously we demonstrated significant improvement of executive functions and social behavior in children with autism spectrum disorders (ASD) treated with 40 sessions of EEG neurofeedback in a nonrandomized waiting list control group design. In this paper we extend these findings by reporting the long-term results of neurofeedback treatment in the same group of children with ASD after 12 months. The present study indicates maintenance of improvement of executive functions and social behavior after 12 months in comparison with the immediate outcomes. Neurofeedback mediated suppression of theta power is supposed to promote more flexible functioning of the brain by enhancing activation in the medial prefrontal cortex and improving flexibility of activation in the default mode network supporting the improvement of executive functions and theory of mind in ASD.

Visual Stimuli Generated by Biochemical Reactions Discrete Chaotic Dynamics as a Basis for Neurofeedback

Introduction. In this article a novel methodology for a neurofeedback system is proposed. It is based on the visual stimuli generated by the distributed biochemical reactions discrete chaotic dynamics (BRDCD) of brain neurons. These visual stimuli take the form of symmetrical colored images known as mandalas. Method. The proposed biofeedback system applies a BRDCD mathematical model to transform an on-line recording of EEG signals into a simulated time-series EEG and into computer generated series of mandala images. Thus, these images represent experimentally measured EEG and therefore reflect the subject's mental state. Results. It will be shown that good qualitative similarity between simulated and experimental EEG was achieved. The examples of generating series of mandala images using experimental EEG will be demonstrated. Conclusion. Based on Jung's theory of the healing power of the psychological phenomenon of mandala images, it is proposed that visual stimuli in the form of mandalas could facilitate fast and effective neurofeedback training, thereby providing a therapeutic effect.