systematic review
Research Papers
Showing 6 of 11Neurofeedback for post-traumatic stress disorder: systematic review and meta-analysis of clinical and neurophysiological outcomes
Background: Posttraumatic stress disorder (PTSD) is a debilitating condition affecting millions of people worldwide. Existing treatments often fail to address the complexity of its symptoms and functional impairments resulting from severe and prolonged trauma. Electroencephalographic Neurofeedback (NFB) has emerged as a promising treatment that aims to reduce the symptoms of PTSD by modulating brain activity.Objective: We conducted a systematic review and meta-analysis of ten clinical trials to answer the question: how effective is NFB in addressing PTSD and other associated symptoms across different trauma populations, and are these improvements related to neurophysiological changes?Method: The review followed the Preferred Reporting Items for Systematic Reviews and Meta analyses guidelines. We considered all published and unpublished randomised controlled trials (RCTs) and non-randomised studies of interventions (NRSIs) involving adults with PTSD as a primary diagnosis without exclusion by type of trauma, co-morbid diagnosis, locality, or sex. Ten controlled studies were included; seven RCTs and three NRSIs with a total number of participants n = 293 (128 male). Only RCTs were included in the meta-analysis (215 participants; 88 male).Results: All included studies showed an advantage of NFB over control conditions in reducing symptoms of PTSD, with indications of improvement in symptoms of anxiety and depression and related neurophysiological changes. Meta-analysis of the pooled data shows a significant reduction in PTSD symptoms post-treatment SMD of -1.76 (95% CI -2.69, -0.83), and the mean remission rate was higher in the NFB group (79.3%) compared to the control group (24.4%). However, the studies reviewed were mostly small, with heterogeneous populations and varied quality.Conclusions: The effect of NFB on the symptoms of PTSD was moderate and mechanistic evidence suggested that NFB leads to therapeutic changes in brain functioning. Future research should focus on more rigorous methodological designs, expanded sample size and longer follow-up.
View Full Paper →Evaluation of Cognitive Behavioral Therapy on Improving Pain, Fear Avoidance, and Self-Efficacy in Patients with Chronic Low Back Pain: A Systematic Review and Meta-Analysis
BACKGROUND: Cognitive-behavioral therapy (CBT) is commonly adopted in pain management programs for patients with chronic low back pain (CLBP). However, the benefits of CBT are still unclear. OBJECTIVES: This review investigated the effectiveness of CBT on pain, disability, fear avoidance, and self-efficacy in patients with CLBP. METHODS: Databases including PubMed, EMBASE, Web of Science, Cochrane Library, and PsycINFO were searched. RCTs examining the effects of CBT in adults with CLBP were included. The data about the outcome of pain, disability, fear avoidance, and self-efficacy were retained. Subgroup analysis about the effects of CBT on posttreatment was conducted according to CBT versus control groups (waiting list/usual care, active therapy) and concurrent CBT versus CBT alone. A random-effects model was used, and statistical heterogeneity was explored. RESULTS: 22 articles were included. The results indicated that CBT was superior to other therapies in improving disability (SMD -0.44, 95% CI -0.71 to -0.17, P < 0.05), pain (SMD -0.32, 95% CI -0.57 to -0.06, P < 0.05), fear avoidance (SMD -1.24, 95% CI -2.25 to -0.23, P < 0.05), and self-efficacy (SMD 0.27, 95% CI 0.15 to 0.40, P < 0.05) after intervention. No different effect was observed between CBT and other therapies in all the follow-up terms. Subgroup analysis suggested that CBT in conjunction with other interventions was in favor of other interventions alone to reduce pain and disability (P < 0.05). CONCLUSION: CBT is beneficial in patients with CLBP for improving pain, disability, fear avoidance, and self-efficacy in CLBP patients. Further study is recommended to investigate the long-term benefits of CBT. This meta-analysis is registered with Prospero (registration number CRD42021224837).
View Full Paper →Results of Neurofeedback in Treatment of Children with ADHD: A Systematic Review of Randomized Controlled Trials
Attention-deficit/hyperactivity disorder (ADHD) is one of the most prevalent disorders in children and adolescents. Neurofeedback, a nonpharmaceutical treatment, has shown promising results. To review the evidence of efficacy of neurofeedback as a treatment for children and adolescents with ADHD. A systematic review of the specific scientific studies published in 1995–2021, identifying and analyzing randomized controlled trials (RCT). A total of 1636 articles were identified and 165 met inclusion criteria, of which 67 were RCTs. Neurofeedback training was associated with significant long-term reduction in symptoms of ADHD. Though limitations exist regarding conclusions about the specific effects of neurofeedback, the review documents improvements in school, social, and family environments.
View Full Paper →Neurofeedback of Alpha Activity on Memory in Healthy Participants: A Systematic Review and Meta-Analysis
Background: Neurofeedback training (NFT) has recently been proposed as a valuable technique for cognitive enhancement and psychiatric amelioration. However, effect of NFT of alpha activity on memory is controversial. The current study analyzed previous works in terms of randomized and blinded analyses, training paradigms, and participant characteristics to validate the efficacy of alpha NFT on memory in a healthy population. Objectives: A systematic meta-analysis of studies with randomized controlled trials was performed to explore the effect of alpha NFT on working memory (WM) and episodic memory (EM) in a healthy population. Methods: We searched PubMed, Embase, and Cochrane Library from January 1, 1999, to November 30, 2019. Previous studies were evaluated with the Cochrane risk of bias (RoB). A meta-analysis calculating absolute weighted standardized mean difference (SMD) using random-effects models was employed. Heterogeneity was estimated using I 2 statistics. Funnel plots and Egger's test were performed to evaluate the quality of evidence. Results: Sixteen studies with 217 healthy participants in the control group and 210 participants in the alpha group met the eligibility criteria. Alpha NFT studies with WM measures presented little publication bias ( P = 0.116), and 5 of 7 domains in the Cochrane RoB exhibited a low risk of bias. The overall effect size from 14 WM studies was 0.56 (95% CI 0.31–0.81, P < 0.0001; I 2 = 28%). Six EM studies exhibited an effect size of 0.77 (95% CI 0.06–1.49, P = 0.03; I 2 = 77%). Conclusion: Meta-analysis results suggest that alpha NFT seems to have a positive effect on the WM and EM of healthy participants. Future efforts should focus on the neurophysiological mechanisms of alpha NFT in memory.
View Full Paper →Applications of EEG indices for the quantification of human cognitive performance: A systematic review and bibliometric analysis
Background Neuroergonomics combines neuroscience with ergonomics to study human performance using recorded brain signals. Such neural signatures of performance can be measured using a variety of neuroimaging techniques, including functional magnetic resonance imaging (fMRI), functional near-infrared spectroscopy (fNIRS), and electroencephalography (EEG). EEG has an excellent temporal resolution, and EEG indices are highly sensitive to human brain activity fluctuations. Objective The focus of this systematic review was to explore the applications of EEG indices for quantifying human performance in a variety of cognitive tasks at the macro and micro scales. To identify trends and the state of the field, we examined global patterns among selected articles, such as journal contributions, highly cited papers, affiliations, and high-frequency keywords. Moreover, we discussed the most frequently used EEG indices and synthesized current knowledge regarding the EEG signatures of associated human performance measurements. Methods In this systematic review, we analyzed articles published in English (from peer-reviewed journals, proceedings, and conference papers), Ph.D. dissertations, textbooks, and reference books. All articles reviewed herein included exclusively EEG-based experimental studies in healthy participants. We searched Web-of-Science and Scopus databases using specific sets of keywords. Results Out of 143 papers, a considerable number of cognitive studies focused on quantifying human performance with respect to mental fatigue, mental workload, mental effort, visual fatigue, emotion, and stress. An increasing trend for publication in this area was observed, with the highest number of publications in 2017. Most studies applied linear methods (e.g., EEG power spectral density and the amplitude of event-related potentials) to evaluate human cognitive performance. A few papers utilized nonlinear methods, such as fractal dimension, largest Lyapunov exponent, and signal entropy. More than 50% of the studies focused on evaluating an individual’s mental states while operating a vehicle. Several different methods of artifact removal have also been noted. Based on the reviewed articles, research gaps, trends, and potential directions for future research were explored. Conclusion This systematic review synthesized current knowledge regarding the application of EEG indices for quantifying human performance in a wide variety of cognitive tasks. This knowledge is useful for understanding the global patterns of applications of EEG indices for the analysis and design of cognitive tasks.
View Full Paper →Electroencephalography-based neurofeedback as treatment for post-traumatic stress disorder: A systematic review and meta-analysis
BACKGROUND: Post-traumatic stress disorder (PTSD) is debilitating for patients and society. There are a number of treatment methods albeit not all patients respond to these and an interesting method using electroencephalography-based neurofeedback (EEG-NF) has become more prominent in recent years. This systematic review aimed to assess whether EEG-NF, compared with sham NF, other treatment, or no treatment, is effective for PTSD. Primary outcomes were self-harm, PTSD symptoms, level of functioning and health-related quality of life. METHODS: Systematic literature searches for randomized controlled trials (RCTs) were conducted in six databases. Random effects meta-analysis was performed. Certainty of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation. RESULTS: Four RCTs were included (123 participants). Suicidal thoughts were significantly reduced after EEG-NF compared with a waiting list in a small study. PTSD symptoms were assessed in all studies with different instruments. Results were consistently in favor of EEG-NF with large effect sizes (standardized mean difference -2.30 (95% confidence interval: -4.37 to -0.24). One study reported significantly improved level of executive functioning and one study a reduction in use of psychotropic medication. Complications were scarcely reported. Certainty of evidence was assessed as very low for the four assessed outcomes. CONCLUSIONS: Based on four RCTs, with several study limitations and imprecision, it is uncertain whether EEG-NF reduces suicidal thoughts, PTSD symptoms, medication use, or improves function. Although all studies showed promising results, further studies are needed to increase the certainty of evidence.
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