Peak Resilience: Stress, Mood, & Trauma

Effectiveness of Neurofeedback Therapy in Children with Separation Anxiety Disorder

Background: Anxiety disorders are one of the most common psychiatric disorders in children. Its incidence is 2-5% of children and adolescents under age 18. Anxiety disorders are more common in girls than boys. It may start in pre-school, but mostly are in age of 7 to 8 years old. Method: The main objective of this article was to find out the effect of neurofeedback therapy in children with separation-anxiety disorder. Study population was Children from 7 to 12 years old with separation anxiety disorder who were referred to the child psychiatric clinic and they were divided randomly into two groups of 12. One group (N=12) received neurofeedback therapy and the other group (N=12) received sham neurofeedback therapy (placebo). Data was analyzed with t- test by 21th version SPSS software. Results: According to calculated t-test in neurofeedback group (8.18), neurofeedback was effective in reducing separation anxiety and the efficacy of treatment was great. But according to calculated t-test in sham group (4.42), reduction of separation anxiety was moderate. Therefore the efficacy of treatment in neurofeedback and sham groups was different. Conclusion: The results revealed that the efficacy of treatment of neurofeedback and sham groups on separation anxiety in children is different. Comparison of efficacy shows that effectiveness of neurofeedback treatment on separation anxiety was much more in the group treated with Neurofeedback than in the sham group.

QEEG-Guided Neurofeedback for Anger/Anger Control Disorder

Previous observations suggested that chronic anger may be associated with persistent excessive high-frequency beta activity in one or more cortical areas and that poor anger control may be associated with excessive slowing of the EEG. We hypothesized that downtraining of elevated high-frequency beta activity would reduce anger and that downtraining of excessive cortical slow wave activity would improve anger control. Forty-six individuals underwent neurofeedback training to downtrain excess beta and slow wave activity. This protocol resulted in significantly improved anger control and a reduction in the frequency of outbursts.

Cranial Electrotherapy Stimulation in the Treatment of Posttraumatic Stress Disorder: A Pilot Study of Two Military Veterans

This case study investigated the effects of cranial electrotherapy stimulation (CES) on the prevalence and intensity of posttraumatic stress disorder (PTSD) symptoms and self- perceived improvement of performance and satisfaction in daily activities in war veterans. Two male Caucasian veterans (ages 54 and 38) diagnosed with PTSD participated in these case studies with a pretest–posttest design. The Canadian Occupational Performance Measure (COPM) and the PTSD Symptom Scale–Interview (PSS-I) were administered before and after the 4-week CES treatment. The participants self-administered the 4-week CES treatment protocol using Alpha-Stim SCS CES device in their home for 20 to 60 min a day, 3 to 5 days a week with a comfortable, self-selected, current level between 100 and 500 microamperes. They were asked to document the settings and responses in a daily treatment log. Through visual trend analysis and change scores, the results revealed daily PTSD symptoms decreased in frequency and severity for both participants from PSSI-I and daily treatment log. Self-perceived efficacy of performance and satisfaction as measured by the COPM also improved in the 54-year-old participant as his change scores (performance: +5.4; satisfaction: +7.9) were over the clinical significance of 2 points of COPM. Both participants reported a decrease in PTSD symptoms and an overall improvement in self-perceived occupational performance after a trial of CES. Findings from this study suggest that future research could contribute to the role of occupational therapists using CES in the treatment of veterans with PTSD. This preliminary study, if confirmed, indicates that CES could provide occupational therapists with a safe and effective way to reduce the symptom burden of PTSD while facilitating occupational performance for a rapidly increasing population of war veterans.

Schizophrenia and the Efficacy of qEEG-Guided Neurofeedback Treatment: A Clinical Case Series

Schizophrenia is sometimes considered one of the most devastating of mental illnesses because its onset is early in a patient’s life and its symptoms can be destructive to the patient, the family, and friends. Schizophrenia affects 1 in 100 people at some point during their lives, and while there is no cure, it is treatable with antipsychotic medications. According to the Clinical Antipsychotic Trials for Interventions Effectiveness (CATIE), about 74% of the patients who have discontinued the first medication prescribed within a year will have a relapse afterward. This shows an enormous need for developing better treatment methods and better ways to manage the disease, since current therapies do not have sufficient impact on negative symptoms, cognitive dysfunction, and compliance to treatment. In this clinical case series, we investigate the efficacy of quantitative electroencephalography (qEEG)-guided neurofeedback (NF) treatment in this population, and whether this method has an effect on concurrent medical treatment and on the patients. Fifty-one participants (25 males and 26 females) ranging from 17 to 54 years of age (mean: 28.82 years and SD: 7.94 years) were included. Signed consent was received from all patients. Most of the participants were previously diagnosed with chronic schizophrenia, and their symptoms did not improve with medication. All 51 patients were evaluated using qEEG, which was recorded at baseline and following treatment. Before recording the qEEG, participants were washed out for up to 7 half-lives of the medication. After Food and Drug Administration (FDA)-approved Nx-Link Neurometric analysis, qEEGs suggested a diagnosis of chronic schizophrenia for all participants. This was consistent with the clinical judgment of the authors. The participants’ symptoms were assessed by means of the Positive and Negative Syndrome Scale (PANSS). Besides the PANSS, 33 out of 51 participants were also evaluated by the Minnesota Multiphasic Personality Inventory (MMPI) and the Test of Variables of Attention (TOVA), both at baseline and following treatment. Each participant was prescribed an NF treatment protocol based on the results of their qEEG neurometric analysis. Each session was 60 minutes in duration, with 1 to 2 sessions per day. When 2 sessions were administered during a single day, a 30-minute rest was given between the sessions. Changes in the PANSS, MMPI, and TOVA were analyzed to evaluate the effectiveness of NF treatment. The mean number of sessions completed by the participants was 58.5 sessions within 24 to 91 days. Three dropped out of treatment between 30 and 40 sessions of NF, and one did not show any response. Of the remaining 48 participants 47 showed clinical improvement after NF treatment, based on changes in their PANSS scores. The participants who were able to take the MMPI and the TOVA showed significant improvements in these measures as well. Forty were followed up for more than 22 months, 2 for 1 year, 1 for 9 months, and 3 for between 1 and 3 months after completion of NF. Overall NF was shown to be effective. This study provides the first evidence for positive effects of NF in schizophrenia.

Obsessive Compulsive Disorder and the Efficacy of qEEG-Guided Neurofeedback Treatment: A Case Series

While neurofeedback (NF) has been extensively studied in the treatment of many disorders, there have been only three published reports, by D.C. Hammond, on its clinical effects in the treatment of obsessive compulsive disorder (OCD). In this paper the efficacy of qEEG-guided NF for subjects with OCD was studied as a case series. The goal was to examine the clinical course of the OCD symptoms and assess the efficacy of qEEG guided NF training on clinical outcome measures. Thirty-six drug resistant subjects with OCD were assigned to 9–84 sessions of QEEG-guided NF treatment. Daily sessions lasted 60 minutes where 2 sessions with half-hour applications with a 30 minute rest given between sessions were conducted per day. Thirty-three out of 36 subjects who received NF training showed clinical improvement according to the Yale-Brown obsessive-compulsive scale (Y-BOCS). The Minnesota multiphasic inventory (MMPI) was administered before and after treatment to 17 of the subjects. The MMPI results showed significant improvements not only in OCD measures, but all of the MMPI scores showed a general decrease. Finally, according to the physicians' evaluation of the subjects using the clinical global impression scale (CGI), 33 of the 36 subjects were rated as improved. Thirty-six of the subjects were followed for an average of 26 months after completing the study. According to follow-up interviews conducted with them and/or their family members 19 of the subjects maintained the improvements in their OCD symptoms. This study provides good evidence for the efficacy of NF treatment in OCD. The results of this study encourage further controlled research in this area.

Volitional Control of Anterior Insula Activity Modulates the Response to Aversive Stimuli. A Real-Time Functional Magnetic Resonance Imaging Study

Background A promising new approach to cognitive neuroscience based on real-time functional magnetic resonance imaging (rtfMRI) demonstrated that the learned regulation of the neurophysiological activity in circumscribed brain regions can be used as an independent variable to observe its effects on behavior. Here, for the first time, we investigated the modulatory effect of learned regulation of blood oxygenation level-dependent (BOLD) response in the left anterior insula on the perception of visual emotional stimuli. Methods Three groups of participants (n = 27) were tested: two underwent four rtfMRI training sessions receiving either specific (n = 9) or unspecific feedback (n = 9) of the insula's BOLD response, respectively, and one group used emotional imagery alone (n = 9) without rtfMRI feedback. During training, all groups were required to assess aversive and neutral pictures. Results Participants able to significantly increase BOLD signal in the target region rated the aversive pictures more negatively. We measured a significant correlation between enhanced left anterior insula activity and increased negative valence ratings of the aversive stimuli. Control groups performing either rtfMRI training with unspecific feedback or an emotional imagery training alone were not able to significantly enhance activity in the left anterior insula and did not show changes in subjective emotional responses. Conclusions This study corroborates traditional neuroimaging studies demonstrating a critical role of the anterior insula in the explicit appraisal of emotional stimuli and indicates the adopted approach as a potential tool for clinical applications in emotional disorders.

Neurofeedback Treatment of Chronic Inpatient Schizophrenia

This is a study on the effect of neurofeedback on chronic inpatient complex paranoid schizophrenics. The purpose of this research was twofold: first, to determine the effects of the application of neurofeedback to very chronic cases of schizophrenia that had been resistant to years of inpatient medical and psychological treatment and second, to propose a connection paradigm of schizophrenia. The author obtained progress using neurofeedback with more than 70 hospital inpatients with chronic schizophrenia. Improvements were seen in the EEG patterns and in cognitive, affective and behavioral patterns that often resulted in successful release from the hospital to live in the community. A 2-year follow up found that positive changes were sustained. It is the author's impression that reinforcement of right parietal alpha and inhibiting frontal delta and fast beta activity obtained the best results.

Neurofeedback: A promising tool for the self-regulation of emotion networks

Real-time functional magnetic resonance imaging (fMRI) affords the opportunity to explore the feasibility of self-regulation of functional brain networks through neurofeedback. We localised emotion networks individually in thirteen participants using fMRI and trained them to upregulate target areas, including the insula and amygdala. Participants achieved a high degree of control of these networks after a brief training period. We observed activation increases during periods of upregulation of emotion networks in the precuneus and medial prefrontal cortex and, with increasing training success, in the ventral striatum. These findings demonstrate the feasibility of fMRI-based neurofeedback of emotion networks and suggest a possible development into a therapeutic tool.

Randomized controlled trials of psychological therapies for management of chronic pain in children and adolescents: an updated meta-analytic review

The purpose of this meta-analytic review was to quantify the effects of psychological therapies for the management of chronic pain in youth. Specifically, in this review we updated previous systematic reviews of randomized controlled trials by including new trials, and by adding disability and emotional functioning to pain as treatment outcomes. Electronic searches of the Cochrane Register of Randomised Controlled Trials, MEDLINE, PsycLIT, EMBASE, and the Social Sciences Citation Index were conducted from inception through August 2008. Methodological quality of the studies was assessed, and data extracted on the three primary outcomes of interest. Twenty-five trials including 1247 young people met inclusion criteria and were included in the meta-analysis. Meta-analytic findings demonstrated a large positive effect of psychological intervention on pain reduction at immediate post-treatment and follow-up in youth with headache, abdominal pain, and fibromyalgia. Small and non-significant effects were found for improvements in disability and emotional functioning, although there were limited data on these outcomes available in the included studies. Omnibus cognitive-behavioral therapy, relaxation therapy, and biofeedback all produced significant and positive effects on pain reduction. Studies directly comparing the effects of self-administered versus therapist-administered interventions found similar effects on pain reduction. Psychological therapies result in improvement in pain relief across several different pain conditions in children. Future trials are needed that incorporate non-pain outcome domains, that focus significant therapeutic content on reductions in disability, and that include extended follow-up to better understand maintenance of treatment effects.

Deconstructing the "resting" state: exploring the temporal dynamics of frontal alpha asymmetry as an endophenotype for depression

Asymmetry in frontal electrocortical alpha-band (8-13 Hz) activity recorded during resting situations (i.e., in absence of a specific task) has been investigated in relation to emotion and depression for over 30 years. This asymmetry reflects an aspect of endogenous cortical dynamics that is stable over repeated measurements and that may serve as an endophenotype for mood or other psychiatric disorders. In nearly all of this research, EEG activity is averaged across several minutes, obscuring transient dynamics that unfold on the scale of milliseconds to seconds. Such dynamic states may ultimately have greater value in linking brain activity to surface EEG asymmetry, thus improving its status as an endophenotype for depression. Here we introduce novel metrics for characterizing frontal alpha asymmetry that provide a more in-depth neurodynamical understanding of recurrent endogenous cortical processes during the resting-state. The metrics are based on transient "bursts" of asymmetry that occur frequently during the resting-state. In a sample of 306 young adults, 143 with a lifetime diagnosis of major depressive disorder (62 currently symptomatic), three questions were addressed: (1) How do novel peri-burst metrics of dynamic asymmetry compare to conventional fast-Fourier transform-based metrics? (2) Do peri-burst metrics adequately differentiate depressed from non-depressed participants? and, (3) what EEG dynamics surround the asymmetry bursts? Peri-burst metrics correlated with traditional measures of asymmetry, and were sensitive to both current and past episodes of major depression. Moreover, asymmetry bursts were characterized by a transient lateralized alpha suppression that is highly consistent in phase across bursts, and a concurrent contralateral transient alpha enhancement that is less tightly phase-locked across bursts. This approach opens new possibilities for investigating rapid cortical dynamics during resting-state EEG.

Client Perception of the Neurofeedback Experience: The Untold Perspective

Alpha Suppression and Symmetry Training for Generalized Anxiety Symptoms

Twenty-eight anxious adults were assessed for frontal lobe alpha asymmetry, a brain state associated with depression and anxiety. Fifteen of the 28 exhibited significant asymmetry and 12 agreed to participate in a biofeedback program addressed at reducing frontal alpha asymmetry. Method. The program consisted of earlobe temperature biofeedback (ETB) and two forms of neurofeedback, alpha suppression and alpha symmetry training. Individuals were instructed to warm their right earlobe for six sessions, and half succeeded, though success was not required to advance to the next stage of training. For subsequent EEG training, two anterior sites were selected on the basis of poor alpha coherence. Individuals were trained to reduce alpha magnitude at these sites by 10% for 30 min or more, which took from 6 to 16 sessions to achieve. Once successful with alpha suppression, individuals were trained to improve alpha symmetry between the sites by 15% for 30 min or more. Results. This feat took 8 to 32 sessions to achieve, and eventually all eight individuals were able to reduce alpha asymmetry. The State-Trait Anxiety Inventory (STAI) was used to measured anxiety levels after each training type and both state and trait scores significantly improved by a 6-month follow-up. Conclusion. Participants also completed a daily shortened version of the STAI, which indicated that anxiety improved after neurofeedback but not after ETB.

QEEG Guided Neurofeedback Therapy in Personality Disorders: 13 Case Studies

According to DSM-IV, personality disorder constitutes a class only when personality traits are inflexible and maladaptive and cause either significant functional impairment or subjective distress. Classical treatment of choice for personality disorders has been psychotherapy and/or psychopharmacotherapy. Our study is to determine if subjects with antisocial personality disorders will benefit from quantitative EEG (qEEG) guided neurofeedback treatment. Thirteen subjects (9 male, 4 female) ranged in age from 19 to 48 years. All the subjects were free of medications and illicit drugs. We excluded subjects with other mental disorders by clinical assessment. Psychotherapy or psychopharmacotherapy or any other treatment model was not introduced to any of the subjects during or after neurofeedback treatment. For the subject who did not respond to neurofeedback, training was applied with 38 sessions of LORETA neurofeedback training without success. Evaluation measures included qEEG analysis with Nx Link data base, MMPI, T.O.V.A tests and SA-45 questionaries at baseline, and at the end of neurofeedback treatment. Lexicor qEEG signals were sampled at 128 Hz with 30 minutes-neurofeedback sessions completed between 80–120 sessions depending on the case, by Biolex neurofeedback system. At baseline and after every 20 sessions, patients were recorded with webcam during the interview. Twelve out of 13 subjects who received 80–120 sessions of neurofeedback training showed significant improvement based on SA-45 questionaries, MMPI, T.O.V.A. and qEEG/Nx Link data base (Neurometric analysis) results, and interviewing by parent/family members. Neurofeedback can change the view of psychiatrists and psychologists in the future regarding the treatment of personality disorders. This study provides the first evidence for positive effects of neurofeedback treatment in antisocial personality disorders. Further study with controls is warranted.

Neuromodulatory Approaches for Chronic Pain Management: Research Findings and Clinical Implications

Two lines of evidence provide preliminary support for the role that brain state, measured via electroencephalogram (EEG), may play in chronic pain. First, research has identified a link between brain EEG activity and the experience of pain. Second, there are a number of published studies documenting the beneficial effects of interventions that impact the cortical activity associated with chronic pain. These interventions include neurobehavioral treatments such as neurofeedback and hypnosis as well as invasive and non-invasive brain stimulation. Preliminary data showing the efficacy of neuromodulatory strategies for treating pain provides compelling reason to examine how cortical activity (as measured by EEG) may underlie the experience of pain. Existing data already suggest specific approaches that neurofeedback clinicians might consider when treating patients with chronic pain. Reciprocally, observations by neurofeedback practitioners could provide important case data that could foster the design of more definitive randomized clinical trials using such strategies for the treatment of chronic pain.

Rhythms of Healing: A Case Study

Imagine for a moment living with a brain that cannot remember a simple tune or even a few words to a song, a brain that does not recall that there is music to life.

Attentional Bias to Drug- and Stress-Related Pictorial Cues in Cocaine Addiction Comorbid with PTSD

Cocaine addiction places a specific burden on mental health services through its comorbidity with other psychiatric disorders. Treatment of patients with cocaine abuse is more complicated when addiction is co-occurring with PTSD. This study used dense-array event-related potential (ERP) technique to investigate whether the patients with this form of dual diagnosis display excessive reactivity to both trauma and drug cues as compared to neutral cues. Cue reactivity refers to a phenomenon in which individuals with a history of drug dependence exhibit verbal, physiological, and behavioral responses to cues associated with their preferred substance of abuse. This study explores ERP differences associated with cue-related responses to both drug and trauma cues in a three-category oddball task using neutral, drug-, and trauma-related pictorial stimuli. The study was conducted on 14 cocaine dependent subjects, 11 subjects with cocaine dependence comorbid with PTSD, and 9 age- and gender-matched control subjects. A 128 channel Electrical Geodesics EEG system was used to record ERP during the visual three-category oddball task with three categories (neutral, drug, stress) of affective pictures. Patients with cocaine dependence and PTSD, as compared to patients with only cocaine addiction and control subjects, showed excessive cue reactivity to both drug- and trauma-related visual stimuli. Most profound differences were found in the amplitude and latency of frontal P3a, and centro-parietal P3b ERP components. Group differences were found as well between patients with cocaine abuse (both addiction-only and dual diagnosis groups) vs. controls on most ERP measures for drug-related cues. We propose that the employed ERP cue reactivity variables could be used as valuable functional outcome measures in dually diagnosed drug addicts undergoing behavioral treatment.

EEG Connectivity Patterns in Childhood Sexual Abuse: A Multivariate Application Considering Curvature of Brain Space

Introduction. A limitation of the bivariate electroencephalogram (EEG) coherence measure is low precision in location specification in anatomical space and functional connectivity. A more powerful use of functional connectivity of distributed brain systems maybe evaluation of patterns of correlations obtained through the functional connectivity matrix of Principal Component Analysis. The eigenimages that result from such analysis represent a descriptive characterization of anatomically distributed changes in the brain. There is little research exploring the relationship between childhood sexual abuse (CSA) and connectivity patterns in the brain. This study explored the connectivity patterns between 24 high-functioning, unmedicated adults with a history of CSA and age, gender, and handedness matched high-functioning adults with no history of CSA. Method. Resting eyes closed quantitative EEG (QEEG) was recorded from 19 scalp locations with a linked ears reference from 60 unmedicated adult research participants. The QEEG was subjected to measures of connectivity for analysis. Results. A robust analysis of QEEG cortical coherence revealed moderate to large effect sizes indicating patterns of both increased and decreased connectivity between brain locations, which differentiated the groups. Conclusion. The EEG coherence information extended previous work in nonclinical, unmedicated adults and suggested CSA impacts cortical function resulting in lateralized differences. Statistical methods for preventing small distribution changes from making large changes in power or probability coverage because of small and nonnormal samples is also discussed.

Integrating cognitive neuroscience research and cognitive behavioral treatment with neurofeedback therapy in drug addiction comorbid with Posttraumatic Stress Disorder: A conceptual review

Persons with co-occurring mental and substance use disorders have a more persistent and refractory illness course than those without dual diagnosis. However, few studies have assessed the effects of cognitive-behavioral and biobehavioral treatments on brain function and behavioral indices in people with comorbid drug abuse and posttraumatic stress disorder (PTSD). In this conceptual review, we propose an integrated approach to assessment and treatment utilizing cognitive neuroscience methods, conventional psychotherapeutic treatment and neurofeedback therapy to assess the recovery of cognitive and emotional functions affected by chronic psychostimulant drug abuse co-occurring with PTSD. We review cognitive and motivational factors (e.g., craving, hypersensitivity to drug- and threat-related cues, deficient executive top-down control etc.) involved in addiction and PTSD, and discuss reasons for their persistence and high vulnerability to relapse in cocaine and methamphetamine users with co-morbid PTSD undergoing behavioral treatment. Incorporating neuroscience assessment methods to assess the effects of psychotherapy and neurofeedback interventions for comorbid disorders may provide significant potential for identifying side-by-side psychophysiological with clinical markers of treatment progress, and may also provide useful information for planning interventions.

QEEG-guided neurofeedback for children with histories of abuse and neglect: Neurodevelopmental rationale and pilot study

Poor self-regulation of arousal is central to the behavioral difficulties experienced by children with traumatic caretaker attachment histories. EEG biofeedback teaches children to self-regulate brain rhythmicity, which may in turn affect global improvements in the areas of attention, aggression, impulse control, and trust formation. Research literature reports successful use of neurofeedback for children with ADHD, autism, asthma, stroke, and migraine. This study extends current research by investigating the effectiveness of neurofeedback in reducing behavioral problems commonly observed in abused/neglected children. Methods. Treatment records of twenty adopted children with histories of removal from their biological home by Child Protective Services were obtained from a private neurofeedback practice. All of the children were assessed prior to treatment using the Child Behavior Checklist (CBCL) and the Test of Variables of Attention (TOVA) and again after 30 sessions of individualized, qEEG-guided neurofeedback. Results. T-test analysis of pre- and post-scores on the CBCL showed significant changes in the areas of externalizing problems, internalizing problems, social problems, aggressive behavior, thought problems, delinquent behavior, anxiety/depression, and attention problems (p < .05). TOVA omission error, commission error, and variability scores also improved significantly following neurofeedback training (p < .05). Some pre-treatment qEEG patterns common to this group of children were identified. Conclusions. The CBCL and TOVA score improvements observed in this study indicate that neurofeedback is effective in reducing behavioral, emotional, social, and cognitive problems in children with histories of neglect and/or abuse.

Treatment Preferences for CAM in Children with Chronic Pain

CAM therapies have become increasingly popular in pediatric populations. Yet, little is known about children's preferences for CAM. This study examined treatment preferences in chronic pediatric pain patients offered a choice of CAM therapies for their pain. Participants were 129 children (94 girls) (mean age = 14.5 years ± 2.4; range = 8–18 years) presenting at a multidisciplinary, tertiary clinic specializing in pediatric chronic pain. Bivariate and multivariate analyses were used to examine the relationships between CAM treatment preferences and patient's sociodemographic and clinical characteristics, as well as their self-reported level of functioning. Over 60% of patients elected to try at least one CAM approach for pain. The most popular CAM therapies were biofeedback, yoga and hypnosis; the least popular were art therapy and energy healing, with craniosacral, acupuncture and massage being intermediate. Patients with a diagnosis of fibromyalgia (80%) were the most likely to try CAM versus those with other pain diagnoses. In multivariate analyses, pain duration emerged as a significant predictor of CAM preferences. For mind-based approaches (i.e. hypnosis, biofeedback and art therapy), pain duration and limitations in family activities were both significant predictors. When given a choice of CAM therapies, this sample of children with chronic pain, irrespective of pain diagnosis, preferred non-invasive approaches that enhanced relaxation and increased somatic control. Longer duration of pain and greater impairment in functioning, particularly during family activities increased the likelihood that such patients agreed to engage in CAM treatments, especially those that were categorized as mind-based modalities.

Neurofeedback Treatment for Pain Associated with Complex Regional Pain Syndrome Type I

Introduction. Complex Regional Pain Syndrome Type I (CRPS-I) is a devastating pain condition that is refractory to standard care. Preliminary evidence suggests the possibility that neurofeedback training might benefit patients with chronic pain, including patients with CRPS-I. The current study sought to address the need for more information about the effects of neurofeedback on pain in persons with chronic pain by (1) determining the average decrease in pain in patients with CRPS-I following neurofeedback training, (2) identifying the percent of patients reporting pain decreases that are clinically meaningful, and (3) documenting other benefits of neurofeedback training. Method. Eighteen individuals with CRPS-I participating in a multidisciplinary treatment program were administered 0-10 numerical rating scale measures of pain intensity at their primary pain site, as well as pain at other sites and other symptoms, before and after a 30 minute neurofeedback training session. A series of t-tests were performed to determine the significance of any changes in symptoms observed. We also computed the effect sizes and percent change associated with the observed changes in order to help interpret the magnitude of observed improvements in symptoms. Results. There was a substantial and statistically significant pre- to post-session decrease in pain intensity at the primary pain site on average, with half of the study participants reporting changes in pain intensity that were clinically meaningful. Five of seven secondary outcome measures also showed statistically significant improvements following neurofeedback treatment. Conclusions. The findings suggest that many patients who receive neurofeedback training report significant and substantial short-term reductions in their experience of pain, as well as improvements in a number of other pain- and nonpain-specific symptoms. The findings support the need for additional research to further examine the long-term effects and mechanisms of neurofeedback training for patients with chronic pain.

Current status of QEEG and neurofeedback in the treatment of clinical depression

Regulation of anterior insular cortex activity using real-time fMRI

Recent advances in functional magnetic resonance imaging (fMRI) data acquisition and processing techniques have made real-time fMRI (rtfMRI) of localized brain areas feasible, reliable and less susceptible to artefacts. Previous studies have shown that healthy subjects learn to control local brain activity with operant training by using rtfMRI-based neurofeedback. In the present study, we investigated whether healthy subjects could voluntarily gain control over right anterior insular activity. Subjects were provided with continuously updated information of the target ROI’s level of activation by visual feedback. All participants were able to successfully regulate BOLD-magnitude in the right anterior insular cortex within three sessions of 4 min each. Training resulted in a significantly increased activation cluster in the anterior portion of the right insula across sessions. An increased activity was also found in the left anterior insula but the percent signal change was lower than in the target ROI. Two different control conditions intended to assess the effects of non-specific feedback and mental imagery demonstrated that the training effect was not due to unspecific activations or non feedback-related cognitive strategies. Both control groups showed no enhanced activation across the sessions, which confirmed our main hypothesis that rtfMRI feedback is area-specific. The increased activity in the right anterior insula during training demonstrates that the effects observed are anatomically specific and self-regulation of right anterior insula only is achievable. This is the first group study investigating the volitional control of emotionally relevant brain region by using rtfMRI training and confirms that self-regulation of local brain activity with rtfMRI is possible.

The effects of alpha/theta neurofeedback on personality and mood

Alpha/theta neurofeedback has been shown to be successful both in treating addictions and in enhancing artistry in music students. How its effects are mediated are not yet clear. The present study aimed to test the hypothesis that alpha/theta neurofeedback works inter alia by normalising extreme personality and raising feelings of well being. 12 participants with high scores for Withdrawal (as measured by the PSQ) were given either alpha/theta neurofeedback or mock feedback and their personality and mood were assessed. Withdrawal scores on the PSQ-80 were not found to change in either group but significant effects were found for the Profile Of Mood States (POMS), with real feedback producing higher overall scores than mock feedback (P = 0.056). Real feedback caused participants to feel significantly more energetic (P &lt; 0.01) than did mock feedback. Sessions of real feedback made participants feel more composed (P &lt; 0.01), agreeable (P &lt; 0.01), elevated (P &lt; 0.01) and confident (P &lt; 0.05), whilst sessions of mock feedback made participants feel more tired (P &lt; 0.05), yet composed (P &lt; 0.01). These findings suggest that, whilst 9 sessions of alpha/theta neurofeedback was insufficient to change personality, improvements in mood may provide a partial explanation for the efficacy of alpha/theta neurofeedback.

Control over brain activation and pain learned by using real-time functional MRI

If an individual can learn to directly control activation of localized regions within the brain, this approach might provide control over the neurophysiological mechanisms that mediate behavior and cognition and could potentially provide a different route for treating disease. Control over the endogenous pain modulatory system is a particularly important target because it could enable a unique mechanism for clinical control over pain. Here, we found that by using real-time functional MRI (rtfMRI) to guide training, subjects were able to learn to control activation in the rostral anterior cingulate cortex (rACC), a region putatively involved in pain perception and regulation. When subjects deliberately induced increases or decreases in rACC fMRI activation, there was a corresponding change in the perception of pain caused by an applied noxious thermal stimulus. Control experiments demonstrated that this effect was not observed after similar training conducted without rtfMRI information, or using rtfMRI information derived from a different brain region, or sham rtfMRI information derived previously from a different subject. Chronic pain patients were also trained to control activation in rACC and reported decreases in the ongoing level of chronic pain after training. These findings show that individuals can gain voluntary control over activation in a specific brain region given appropriate training, that voluntary control over activation in rACC leads to control over pain perception, and that these effects were powerful enough to impact severe, chronic clinical pain.

Case Study of Trigeminal Neuralgia Using Neurofeedback and Peripheral Biofeedback

Introduction. Trigeminal neuralgia is characterized by brief episodes of extremely intense facial pain often radiating down the jaw. These episodes can occur spontaneously or be triggered by light touch, chewing or changes in temperature. The pain can be so intense as to be completely disabling. This case study concerns a 46 year-old nurse with a 15-month history of trigeminal neuralgia. She had been maintained poorly on propoxyphene napsylate/apap 100/650 mg (Darvocet-N100) over the previous year. Her neurologist's next planned intervention was to sever the trigeminal nerve. Method. Over a period of nine months, this client had 10 peripheral biofeedback training sessions (including dynamic EMG biofeedback) and diaphragmatic breathing in conjunction with a program of stress management and counseling. She also received 29 sessions of neuro-feedback (including T4, C3, C4, C3-C4 and T3-T4). C3 seemed to be the most effective placement for sleep maintenance issues, and T3-T4 seemed to be the most effective placement for pain issues. Results. The client experienced a substantial reduction in pain and bruxism as well as improvement in sleep quality. Symptom reduction fluctuated with life stress issues and with adjustment in both peripheral and neurofeedback protocols. The success of this treatment allowed the client to avoid radical surgery (severing of the trigeminal nerve) and to discontinue use of propoxyphene napsylate/apap 100/650 mg. In a 13-month follow-up, the client reports having an active life style and managing her pain quite well on 20 mg of tramadol (Ultram) every 12 hours as long as she uses her self-regulation techniques. Conclusion. This case study suggests that a multi-modal approach of neurofeedback, peripheral biofeedback, stress management and counseling was clinically efficacious in treating the symptoms of this difficult and painful condition.

QEEG-Guided Neurofeedback in the Treatment of Obsessive Compulsive Disorder

Introduction. Blinded, placebo-controlled research (e.g., Sterman, 2000) has documented the ability of brainwave biofeedback to recondition brain wave patterns. Neurofeedback has been used successfully with uncontrolled epilepsy, ADD/ADHD, learning disabilities, anxiety, and head injuries. However, nothing has been published on the treatment of obsessive-compulsive disorder (OCD) with neurofeedback. Method. Quantitative EEGs were gathered on two consecutive OCD patients who sought treatment. This assessment guided protocol selection for subsequent neurofeedback training. Results. Scores on the Yale-Brown Obsessive-Compulsive Scale and the Padua Inventory normalized following treatment. An MMPI was administered pre-post to one patient, and she showed dramatic improvements not only in OCD symptoms, but also in depression, anxiety, somatic symptoms, and in becoming extroverted rather than introverted and withdrawn. Discussion. In follow-ups of the two cases at 15 and 13 months after completion of treatment, both patients were maintaining improvements in OCD symptoms as measured by the Padua Inventory and as externally validated through contacts with family members. Since research has found that pharmacologic treatment of OCD produces only very modest improvements and behavior therapy utilizing exposure with response prevention is experienced as quite unpleasant and results in treatment dropouts, neurofeedback appears to have potential as a new treatment modality.

A Review of EEG Biofeedback Treatment of Anxiety Disorders

Self regulation of electrocortical activity in schizophrenia and schizotypy: a review

Contrary to the belief that schizophrenic patients will be unable to learn self control of electrocortical activity due to attentional and motivational deficits, the two studies which have investigated this, both involving operant conditioning of slow cortical potentials, have demonstrated that self regulation can take place. This was particularly true of a study of interhemispheric control. Learning difficulties were found to be more to do with sustaining motivation towards the end of sessions or training programs, rather than in initial learning. Schizotypical features in the normal population have in the case of anhedonia been associated with slower learning, while withdrawn introversion has been associated with faster learning. In view of the affirmative evidence and advances in understanding the functional significance of electroencephalographic (EEG) rhythms, the undertaking of therepeutic regimens with electrocortical operant conditioning is warranted in the schizophrenia spectrum.

Treatment of chronic anxiety disorder with neurotherapy: A case study

The objective of the present case study is to report the effects of alpha-decrease biofeedback training on a patient diagnosed with Anxiety Disorder. Three Minnesota Multiphasic Personality Inventories (MMPI and MMPI-2) were used as objective measures of treatment efficacy. Following 15 sessions of slow wave inhibit/fast wave increase EEG feedback training, the patient reported a significant reduction in anxiety-related symptoms. At three year follow-up, results of an MMPI-2 showed all clinical scales within normal range. In addition, self-reports confirmed that the patient was symptom free. After treating the patient with several other clinical modalities, only the alpha-decrease feedback training produced effective, long-term improvement of symptoms

Biofeedback treatments of generalized anxiety disorder: Preliminary results

Forty-five individuals with generalized anxiety (38 with GAD as defined by DSM-III) were randomized to 4 treatment conditions or a waiting list control. Patients received 8 sessions of either frontal EMG biofeedback, biofeedback to increase EEG alpha, biofeedback to decrease EEG alpha, or a pseudomeditation control condition. All treated subjects showed significant reductions in STAI-Trait Anxiety and psychophysiologic symptoms on the Psychosomatic Symptom Checklist. Only alpha-increase biofeedback subjects showed significant reductions in heart rate reactivity to stressors at a separate psychophysiological testing session. Decreased self-report of anxiety was maintained at 6 weeks posttreatment.

Biofeedback as a placebo: Anxiety reduction facilitated by training in either suppression or enhancement of alpha brainwaves

Assessed the differential effects (on experiential reports of anxiety) of actual performance and perceived success at an EEG biofeedback task. 10 college students who were high in trait anxiety (MMPI, State-Trait Anxiety Inventory) underwent training in either the suppression of enhancement of EEG alpha activity with the expectation that success at their biofeedback task would result in reductions of chronic anxiety levels. Both groups experienced significant reductions in both trait and state anxiety. Anxiety reductions were highly correlated with the trainees' ratings of perceived success at the feedback task but were unrelated to either the direction or magnitude of the changes in their alpha activity. (27 ref)

Effects of instructions and biofeedback on EEG-alpha production and the effects of EEG-alpha biofeedback training for controlling arousal in a subsequent stressful situation

In Phase One, 44 subjects participated in a 2 (instructions to increase alpha, no instructions to increase alpha) × 2 (alpha biofeedback, no alpha biofeedback) factorial experiment. Results indicated that increases in alpha production were due to instructions to increase alpha and that biofeedback had no effect on alpha production. In Phase Two, the 44 subjects from Phase One were exposed to a threat of shock whereas 11 additional subjects in a control condition were not. The design employed in Phase Two was a 2 (previous instructions and stress, no previous instructions and stress) × 2 (previous biofeedback and stress, no previous biofeedback and stress) plus 1 (no previous instructions/no previous biofeedback, no stress). Results indicated that the threat of shock was effective in increasing arousal (as measured by heart rate and skin resistance) but previous EEG-alpha biofeedback training was not effective in helping subjects decrease arousal while in the stressful situation. The results indicate that it is the instructions (and related information concerning alpha) rather than the biofeedback that is critical in alpha biofeedback training and that this training does not appear to have utility for controlling arousal under stress.

Anxiety Change Through Electroencephalographic Alpha Feedback Seen Only in High Anxiety Subjects

Metrics Abstract Subjects who were either high or low in trait anxiety used alpha feedback to increase and to decrease their electroencephalographic alpha activity. The alpha changes were tightly linked to anxiety changes, but only in high anxiety subjects (for whom anxiety was reduced in proportion to alpha increases, and was increased in proportion to alpha suppression). Low trait-anxiety subjects were superior at both enhancement and suppression training, but their alpha changes were not related to anxiety changes. In both groups, anxiety changes were generally unrelated to either resting levels or changes in frontalis electromyograms and respiration rate. These results suggest that long-term alpha feedback training (at least 5 hours) may be useful in anxiety therapy

Effects of Alpha Feedback Training on Occipital EEG, Heart Rate, and Experiential Reactivity to a Laboratory Stressor

The intent of this study was to examine whether brief alpha biofeedback training would alter the degree of physiological and experiential stress evidenced in an aversive laboratory situation. While occipital alpha and heart rate were monitored, 36 subjects underwent 8 presentations of a warning tone preceding fingertip electric shock by 30 sec. Subjects were then placed into one of three treatments taking place in dim light with eyes open. Group 1 received 24 min of contingent feedback. Group 2 received an equivalent amount of non-contingent feedback and Group 3, a no-feedback control condition, listened to music. Following the treatment period, 12 additional tone-shock pairings were presented, equally divided between eyes-open and eyes-closed trials, also with and without continuation of the treatment period “signal” (i.e. contingent, non-contingent feedback, or music). The results revealed that, in general, enhanced alpha density was maintained by the contingent feedback group during the post-treatment aversive situation. However, the reduction in alpha suppression was not systematically accompanied by corresponding heart rate and self-report reductions in situational reactivity. It was concluded that alpha feedback training was not sufficient to produce a generalized relaxation to the aversive situation. Alternative accounts of the results, focusing primarily on independence of response systems, are discussed.

Biofeedback of EEG alpha in the treatment of obsessive ruminations: An exploration

The enhancement of EEG alpha through various meditative techniques and biofeedback has been shown to correlate with alterations in mental as well as muscular activity towards a state of relaxation. We thought that such mental relaxation might be reciprocally inhibitory to ruminative activity characteristic of the obsessive neurotic. Five ruminating obsessives were given 7–20 biofeedback training sessions to learn control of EEG alpha. Results indicate that (1) some obsessives can learn EEG control; (2) special augmented instructions seem no better than standard, minimal instructions in aiding Ss to produce alpha; (3) subjective states during alpha are reported as relaxed, daydreaming and not thinking; and (4) although difficult to generalize beyond the feedback situation, virtually no ruminations occur during alpha regardless of the amount of alpha produced. Further study is indicated before a treatment program can be considered.