EEG Biofeedback as a Treatment for Sbstance Use Disorders: Review, Rating of Efficacy, and Recommendations for Further Research
Tato M. Sokhadze - Rex L. Cannon - David L. Trudeau
Electroencephalographic (EEG) biofeedback has been employed in substance use disorder (SUD) over the last three decades. The SUD is a complex series of disorders with frequent comorbidities and EEG abnormalities of several types. EEG biofeedback has been employed in conjunction with other therapies and may be useful in enhancing certain outcomes of therapy. Based on published clinical studies and employing efficacy criteria adapted by the Association for Applied Psychophysiology and Biofeedback and the International Society for Neurofeedback and Research, alpha theta training—either alone for alcoholism or in combination with beta training for stimulant and mixed substance abuse and combined with residential treatment programs, is probably efficacious. Considerations of further research design taking these factors into account are discussed and descriptions of contemporary research are given.
William C. Scott, B.S.W., C.C.D.P - David Kaiser, Ph.D. - Siegfried Orthmer, Ph.D. - Stephen L. Sideroff, PhD.
This study examined whether an EEG biofeedback protocol could improve outcome measures for a mixed substance abusing inpatient population. Method. One hundred twenty-one volunteers undergoing an inpatient substance abuse program were randomly assigned to the EEG biofeedback or control group. EEG biofeedback included training in Beta and SMR to address attentional variables, followed by an alpha-theta protocol. Subjects received a total of 40 to 50 biofeedback sessions. The control group received additional time in treatment equivalent to experimental procedure time. The Test of Variables of Attention (TOVA), and MMPI, were administered with both tester and subject blind as to group placement to obtain unbiased baseline data. Treatment retention and abstinence rates as well as psychometric and cognitive measures were compared. Results. Experimental subjects remained in treatment significantly longer than the control group (p<0.005). Of the experimental subjects completing the protocol, 77% were abstinent at 12 months, compared to 44% for the controls. Experimental subjects demonstrated significant improvement on the TOVA (p<.005) after an average of 13 beta-SMR sessions. Following alpha-theta training, significant differences were noted on 5 of the 10 MMPI-2 scales at the p<.005 level. Conclusions. This protocol enhanced treatment retention, variables of attention, and abstinence rates one year following treatment.
Neurofeedback Effects on Evoked and Induced EEG Gamma Band Reactivity to Drug-related Cues in Cocaine Addiction
Timothy Horrel - Ayman El-Baz - Joshua Baruth - Allan Tasman - Guela Sokhadze - Christopher Stewart - Estate Sokhadze
Preoccupation with drug and drug-related items is a typical characteristic of cocaine addicted individuals. It has been shown in multiple accounts that prolonged drug use has a profound effect on the EEG recordings of drug addicts when compared to controls during cue reactivity tests. Cue reactivity refers to a phenomenon in which individuals with a history of drug abuse exhibit excessive psychophysiological responses to cues associated with their drug of choice. One of the aims of this pilot study was to determine the presence of an attentional bias to preferentially process drug-related cues using evoked and induced gamma reactivity measures in cocaine addicts before and after biobehavioral treatment based on neurofeedback. Another aim was to show that central SMR amplitude increase and frontal theta control is possible in an experimental outpatient drug users group over 12 neurofeedback sessions.
Method—Ten current cocaine abusers participated in this pilot research study using neurofeedback combined with Motivational Interviewing sessions. Eight of them completed all planned pre- and post –neurofeedback cue reactivity tests with event-related EEG recording and clinical evaluations. Cue reactivity test represented a visual oddball task with images from the International Affective Picture System and drug-related pictures. Evoked and induced gamma responses to target and non-target drug cues were analyzed using wavelet analysis.
Results—Outpatient subjects with cocaine addiction completed the biobehavioral intervention and successfully increased SMR while keeping theta practically unchanged in 12 sessions of neurofeedback training. The addition of Motivational Interviewing helped retain patients in the study. Clinical evaluations immediately after completion of the treatment showed decreased self reports on depression and stress scores, and urine tests collaborated reports of decreased use of cocaine and marijuana. Effects of neurofeedback resulted in a lower EEG gamma reactivity to drug-related images in a post-neurofeedback cue reactivity test. In particular, evoked gamma showed decreases in power to non-target and to a lesser extent target drug-related cues at all topographies (left, right, frontal, parietal, medial, inferior); while induced gamma power decreased globally to both target and non-target drug cues. Our findings supported our hypothesis that gamma band cue reactivity measures are sufficiently sensitive functional outcomes of neurofeedback treatment. Both evoked and induced gamma measures were found capable to detect changes in responsiveness to both target and non-target drug cues.
Conclusion—Our study emphasizes the utility of cognitive neuroscience methods based on EEG gamma band measures for the assessment of the functional outcomes of neurofeedback-based biobehavioral interventions for cocaine use disorders. This approach may have significant potential for identifying both physiological and clinical markers of treatment progress. The results confirmed our prediction that EEG changes achieved with neurofeedback training will be accompanied by positive EEG outcomes in a cue reactivity and clinical improvements.
Changes After EEG Biofeedback and Cognitive Retraining in Adults with Mild Traumatic Brain Injury and Attention Deficit Hyperactivity Disorder
Timothy P. Tinius, PhD - Kathleen A. Tinius, MSW
Introduction. Adults diagnosed with mild traumatic brain injury (mTBI) or Attention Deficit Hyperactivity Disorder (ADHD) were treated with EEG Biofeedback and cognitive retraining.
Methods. Psychological and neuropsychological tests were completed at pre-treatment and post-treatment and compared to a normal control group that did not receive training, but tested on two occasions.
Results. The results found significant improvement on full scale attention and full scale response accuracy of a continuous performance task in the mTBI and ADHD groups compared to the control group. A self report showed a significant decline in symptoms in the mTBI and ADHD groups compared to the control group. Errors on a problem solving task decreased only in the mTBI group.
Discussion. The treatment model used in this study showed significant improvement in the sustained attention of individuals diagnosed with mTBI and ADHD after twenty treatment sessions.
Patrick N. Friel, BS
Electroencephalogram (EEG) biofeedback, also known as neurofeedback, is a promising alternative treatment for patients with attention deficit/hyperactivity disorder (AD/HD). EEG biofeedback therapy rewards scalp EEG frequencies that are associated with relaxed attention, and suppresses frequencies associated with under- or over-arousal. In large scale clinical trials, the efficacy of EEG biofeedback for AD/HD is comparable to that of stimulant medications. Many different EEG biofeedback protocols for AD/HD are available. Single-channel protocols developed by Lubar and interhemispheric protocols developed by the Othmers are widely practiced and supported by large-scale clinical studies. (Altern Med Rev 2007;12(2):146-151)
Effect of Neurofeedback training on the neural substrates of selective attention in children with attention deficit/hyperactivity disorder: A functional magnetic resonance imaging study
Johanne Levesque - Mario Beauregard - Boualem Mensour
Attention Deficit Hyperactivity Disorder (AD/HD) is a neurodevelopmental disorder mainly characterized by impairments in cognitive functions. Functional neuroimaging studies carried out in individuals with AD/HD have shown abnormal functioning of the anterior cingulate cortex (ACC) during tasks involving selective attention. In other respects, there is mounting evidence that neurofeedback training (NFT) can significantly improve cognitive functioning in AD/HD children. In this context, the present functional magnetic resonance imaging (fMRI) study was conducted to measure the effect of NFT on the neural substrates of selective attention in children with AD/HD. Twenty AD/HD children—not taking any psychostimulant and without co-morbidity-participated to the study. Fifteen children were randomly assigned to the Experimental (EXP) group (NFT), whereas the other five children were assigned to the Control (CON) group (no NFT). Subjects from both groups were scanned 1 week before the beginning of the NFT (Time 1) and 1 week after the end of this training (Time 2), while they performed a Counting Stroop task. At Time 1, for both groups, the Counting Stroop task was associated with significant loci of activation in the left superior parietal lobule. No activation was noted in the ACC. At Time 2, for both groups, the Counting Stroop task was still associated with significant activation of the left superior parietal lobule. This time, however, for the EXP group only there was a significant activation of the right ACC. These results suggest that in AD/HD children, NFT has the capacity to normalize the functioning of the ACC, the key neural substrate of selective attention.
Evaluation of th Effectiveness of EEG Neurofeedback Training for ADHD in a Clinical Setting as measured by changes in T.O.V.A Scores, Behavioral Ratings, and WISC-R Performance
Joel F. Lubar - Michie Odle Swartwood - Jeffery N. Swartwood - Phyllis H. O'Donnell
Three individual studies were done to assess the effectiveness of neurofeedback treatment for Attention Deficit Hyperactivity Disorder (ADHD). The subject pool for these studies consisted of 23 children and adolescents ranging in age from 8 to 19 years with a mean of 11.4 years who participated in a 2 to 3 month summer program of intensive neurofeedback training. Feedback presentations were contingent on the production of 16-20 hz. (beta) activity in the absence of 4-8 hz. (theta) activity. Changes in EEG activity, Test of Variables of Attention (T.O.V.A.) performance, Attention Deficit Disorder Evaluation Scale (ADDES) behavior ratings, and WISC-R performance following neurofeedback training were assessed. Our results were as follows: Study I indicated that subjects who successfully decreased theta activity showed significant improvement in T.O.V.A. performance; Study II revealed significant improvement in parent ratings following neurofeedback training; and Study III indicated significant increases in WISC-R scores following neurofeedback training. These studies are important in that they examine the effects of neurofeedback training on both objective and subjective measures of Attention Deficit Disorder under relatively controlled conditions. The results support and extend previous published findings, indicating that neurofeedback training is an appropriate and efficacious adjunctive treatment for ADHD.
Neurofeedback Treatment for Attention-Deficit/Hyperactivity Disorder in Children: A Comparison With Methylphenidate
Thomas Fuchs - Niels Birbaumer - Werner Lutzenberger - John H. Gruzelier - Jochen Kaiser
Clinical trials have suggested that neurofeedback may be efficient in treating attentiondeficit/hyperactivity disorder (ADHD). We compared the effects of a 3-month electroencephalographic feedback program providing reinforcement contingent on the production of cortical sensorimotor rhythm (12–15 Hz) and beta1 activity (15–18 Hz) with stimulant medication. Participants were N D34 children aged 8–12 years, 22 of which were assigned to the neurofeedback group and 12 to the methylphenidate group according to their parents’ preference. Both neurofeedback and methylphenidate were associated with improvements on all subscales of the Test of Variables of Attention, and on the speed and accuracy measures of the d2 Attention Endurance Test. Furthermore, behaviors related to the disorder were rated as significantly reduced in both groups by both teachers and parents on the IOWA-Conners Behavior Rating Scale. These findings suggest that neurofeedback was efficient in improving some of the behavioral concomitants of ADHD in children whose parents favored a nonpharmacological treatment.
The Effects of Stimulant Therapy, EEG Biofeedback, and Parenting Style on the Primary Symptoms of Attention-Deficit/Hyperactivity Disorder
Vincent J. Monastra - Donna M. Monastra - Susan George
One hundred children, ages 6–19, who were diagnosed with attention-deficit/hyperactivity disorder (ADHD), either inattentive or combined types, participated in a study examining the effects of Ritalin, EEG biofeedback, and parenting style on the primary symptoms of ADHD. All of the patients participated in a 1-year, multimodal, outpatient program that included Ritalin, parent counseling, and academic support at school (either a 504 Plan or an IEP). Fifty-one of the participants also received EEG biofeedback therapy. Posttreatment assessments were conducted both with and without stimulant therapy. Significant improvement was noted on the Test of Variables of Attention (TOVA; L. M. Greenberg, 1996) and the Attention Deficit Disorders Evaluation Scale (ADDES; S. B. McCarney, 1995) when participants were tested while using Ritalin. However, only those who had received EEG biofeedback sustained these gains when tested without Ritalin. The results of a Quantitative Electroencephalographic Scanning Process (QEEG-Scan; V. J. Monastra et al., 1999) revealed significant reduction in cortical slowing only in patients who had received EEG biofeedback. Behavioral measures indicated that parenting style exerted a significant moderating effect on the expression of behavioral symptoms at home but not at school.
EEG Neurofeedback: A Brief Overview and an Example of Peak Alpha Frequency Training for Cognitive Enhancement in the Elderly
Efthymios Angelakis - Stamatina Stathopoulou - Jennifer L. Frymiare - Deborah L. Green - Joel F. Lubar - John Kounios
Neurofeedback (NF) is an electroencephalographic (EEG) biofeedback technique for training individuals to alter their brain activity via operant conditioning. Research has shown that NF helps reduce symptoms of several neurological and psychiatric disorders, with ongoing research currently investigating applications to other disorders and to the enhancement of non-disordered cognition. The present article briefly reviews the fundamentals and current status of NF therapy and research and illustrates the basic approach with an interim report on a pilot study aimed at developing a new NF protocol for improving cognitive function in the elderly. EEG peak alpha frequency (PAF) has been shown to correlate positively with cognitive performance and to correlate negatively with age after childhood. The present pilot study used a double-blind controlled design to investigate whether training older individuals to increase PAF would result in improved cognitive performance. The results suggested that PAF NF improved cognitive processing speed and executive function, but that it had no clear effect on memory. In sum, the results suggest that the PAF NF protocol is a promising technique for improving selected cognitive functions.
Alpha-Theta Brainwave Neurofeedback Training: An Effective Treatment for Male and Female Alcoholics with Depressive Symptoms
Ellen Saxby - Eugene G. Peniston
This was an experimental study of 14 alcoholic outpatients using the Peniston and Kulkosky (1989, 1991) brainwave treatment protocol for alcohol abuse. After temperature biofeedback pretraining, experimental subjects completed 20 4-minute sessions of alpha-theta brainwave neurofeedback training (BWNT). Experimentally treated alcoholics with depressive syndrome showed sharp reductions in self-assessed depression (Beck's Depression Inventory). On the Million Clinical Multiaxial Inventory-I, the experimental subjects showed significant decreases on the BR scores: schizoid, avoidant, dependent, histrionic, passive-aggression, schizotypal, borderline, anxiety, somatoform, hypomanic, dysthmic, alcohol abuse, drug abuse, psychotic thinking, and psychotic depression. Twenty-one-month follow-up data indicated sustained prevention of relapse in alcoholics who completed BWNT.
Anxiety and Depression
D. Corydon Hammond
A robust body of research documents that there are biological predispositions that often exist for depression, anxiety, and obsessive–compulsive disorder. However, new research has shown that medication is only mildly more effective than placebo in the treatment of these problems. In treating these conditions, neurofeedback (EEG biofeedback)may offer an alternative to invasive treatments such asmedication, ECT, and intense levels of transcrancial magnetic stimulation. This paper reviews the neurofeedback literature with these problems, finding particularly positive research support for the treatment of anxiety disorders. New findings on the neurofeedback treatment of depression are presented.
Robert Coben, PhD - Ilean Padolsky, PhD
Background. Research reviewing the epidemiology of Autism (Medical Research Council, 2001) indicated that approximately 60 per 10,000 children (1/166) are diagnosed with Autistic Spectrum Disorder (ASD). Jarusiewicz (2002) published the only controlled study documenting the effectiveness of neurofeedback for Autism based on one outcome measure. The present study extended these findings with a larger sample size, broader range of assessments, and physiological measures of brain functioning.
Methods. Assessment-guided neurofeedback was conducted in 20 sessions for 37 patients with ASD. The experimental and control groups were matched for age, gender, race, handedness, other treatments, and severity of ASD.
Results. Improved ratings of ASD symptoms reflected an 89% success rate. Statistical analyses revealed significant improvement in Autistics who received Neurofeedback compared to a wait list control group. Other major findings included a 40% reduction in core ASD symptomatology (indicated by ATEC Total Scores), and 76% of the experimental group had decreased hyperconnectivity. Reduced cerebral hyperconnectivity was associated with positive clinical outcomes in this population. In all cases of reported improvement in ASD symptomatology, positive treatment outcomes were confirmed by neuropsychological and neurophysiological assessment.
Conclusions. Evidence from multiple measures has demonstrated that neurofeedback can be an effective treatment for ASD. In this population, a crucial factor in explaining improved clinical outcomes in the experimental group may be the use of assessment-guided neurofeedback to reduce cerebral hyperconnectivity. Implications of these findings are discussed.
Siegfried and Susan F. Othmer
Neurofeedback is a highly promising emerging therapy for the autism spectrum. At issue here is a tool for the direct training of brain function, one that has already shown itself highly effective in addressing a wide range of "mental health" concerns. As has been the case for other therapies, its application to the autism spectrum has been complicated by the inherent complexity of the condition we confront. In the following, we recapitulate the development of neurofeedback for the autism spectrum and give some guidance to both therapists and parents with regard to the choices open to them.
Mirjam E. J. Kouijzer - Jan M. H. de Moor - Berrie J. L. Gerrits - Marco Congedo - Hein T. van Schie
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 ration 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.
Neurofeedback is an intervention that is showing a lot of promise for people diagnosed with Autistic Spectrum Disorder (ASD). While other childhood behaviour disorders such as Attention Deficit Hyperactivity Disorder (ADHD) have been in the neurofeedback limelight for some years, it would appear that ASD is about to have its day in the sun. Recent research is showing that children with ASD are responding very well to both electroencephalographic (EEG) and haemoencephalographic (HEG) neurofeedback. Furthermore, our own research indicates that neurofeedback can be an effective schoolbased intervention for children in the autistic spectrum.
Positive behavioral and electrophysiological changes following neurofeedback training in children with autism
J.A. Pineda - D. Brang - E. Hecht - L. Edwards - S. Carey - M. Bacon - C. Futagaki - D. Suk - J. Toma - C. Birnbaum - A. Rork
Two electrophysiological studies tested the hypothesis that operant conditioning of mu rhythms via neurofeedback training can renormalize mu suppression, an index of mirror neuron activity, and improve behavior in children diagnosed with autism spectrum disorders (ASD). In Study 1, eight high-functioning ASD participants were assigned to placebo or experimental groups before 10 weeks of training of the mu frequency band (8–13 Hz). Following training, experimental participants showed decreased mu power and coherence, increased sustained attention ability, and improved scores on subscales of the ATEC compared to the placebo group. Both groups showed improvement in imitation ability. In Study 2, 19 high-functioning ASD children underwent a similar procedure with verified diagnoses, a modified double-blind protocol, and training of the high mu band (10–13 Hz). The results showed decreases in amplitude but increases in phase coherence in mu rhythms and normalization of mu rhythm suppression in experimental participants compared to placebo. Furthermore, like Study 1, participants showed improvements in sustained attention and in ATEC scores but no improvements in imitation following training. This suggests that training of the mu rhythm can be effective in producing changes in EEG and behavior in high-functioning ASD children, but does not affect imitation behavior per se.
Arthur G. Sichel - Lester G. Fehmi - David M. Goldstein
This article looks at the experience of Frankie, an autistic 8 and 1/2 year old boy. He was diagnosed mildly autistic by several specialists. One specialist claimed he was brain damaged and "autistic-like " and that there was no hope for improvement. At Frankie's mother's request, neurotherapy diagnosis and treatment was begun. After 31 sessions, Frankie showed Positive changes in all the diagnostic dimensions defining autism in DSM-111-P, This has profound implications for treatment in a field with few low-risk alternatives.
Neurofeedback treatment in autism. Preliminary findings in behavioral, cognitive, and neurophysiological functioning
Mirjam E.J. Kouijzer - Hein T. van Schie - Jan M.H. de Moor - Berrie J.L. Gerrits - Jan K. Buitelaar
Effects of neurofeedback treatment were investigated in children with autism spectrum disorders (ASD). Sixty percent of the participants in the treatment group successfully reduced excessive theta power during neurofeedback treatment. Reduction of theta power was confirmed by pre- and post-QEEG measures. Parents of participants in the neurofeedback treatment group reported significant improvements in reciprocal social interactions and communication skills, relative to the parents of the control group. Set-shifting skills improved following neurofeedback treatment relative to the control group. The reduction of theta power is assumed to reflect modulation of activity in the anterior cingulate cortex (ACC), which is known to be involved in social and executive dysfunctions in autism.
Alpha-Theta Brainwave Neuro-Feedback for Vietnam Veterans with Combat-Related Post-Traumatic Stress Disorder
Eugene G. Peniston - Paul J. Kulkosky
The Minnesota Multiphasic Personality Inventory (MMPI) was used to assess personality changes in Vietnam combat veterans with post-traumatic stress disorder (PTSD), after either traditional medical treatment (TC) or alpha-theta brainwave neuro-feedback therapy (BWT). Application of brainwave training for thirty 30-minute sessions resulted in decreases in MMPI T-scores on clinical scales labelled hypochondriasis, depression, hysteria, psychopathic deviate, masculinity-femininity, paranoia, psychasthenio, schizophrenia, hypomania, and social introversion-extroversion. The traditional medical control group showed decreases in T-scores only on the scale labelled schizophrenia. All fourteen BWT patients initially receiving psychotropic medication reduced their dosages after treatment, but only one of thirteen TC patients reduced dosage. A thirty-month follow-up study showed that all fourteen TC patients had relapsed, in contrast to only three of fifteen BWT patients. These findings indicate that application of alpha-theta brainwave training is a more efficacious treatment modality in the treatment of PTSD and prevention of relapse.
Anxiety Associated With Post Traumatic Stress Disorder—The Role of Quantitative Electroencephalograph in Diagnosis and in Guiding Neurofeedback Training to Remediate the Anxiety
Jonathan E. Walker, MD
The literature regarding neurofeedback treatment of anxiety associated with post traumatic stress disorder (PTSD) is reviewed. The results of quantitative electroencephalograph (QEEG) guided neurofeedback training for anxiety in nineteen PTSD patients is analyzed, along with the change in anxiety in four control patients who did not do neurofeedback. Those who did neurofeedback training experienced clinically significant reductions in anxiety, whereas there was no significant change in anxiety in the control group. QEEG-guided neurofeedback appears to be effective in a higher percentage of patients than non–QEEG-guided training in increasing alpha and theta, based on results in the published literature.
Findings of Mild Traumatic Brain Injury in Combat Veterans With PTSD and a History of Blast Concussion
David L. Trudeau, M.D. - John Anderson, M.A. - Lisa M. Hansen, M.A. - Diana N. Shagalov, B.A. - Joseph Schmoller, M.M.E. - Sean Nugent, M.A. - Stephen Barton, M.D., Ph.D.
Veterans with chronic posttraumatic stress disorder were evaluated for a history of blast concussion, controlling for confounding conditions. Electroencephalograms were analyzed by discriminant function for traumatic brain injury. A difference was found in discriminant scores between veterans with and without blast concussion. More members of the blast group had attentional symptoms and attentional dysfunction. Combat veterans with a remote history of blast injury have persistent electroencephalographic features of traumatic brain injury as well as attentional problems. The authors hypothesize that these constitute a type of chronic postconcussive syndrome that has cognitive and mood symptoms overlapping those of posttraumatic stress disorder.
Siegfried Othmer, PhD - Susan F. Othmer, BA
The application of neurofeedback to post traumatic stress disorder (PTSD) in returning veterans is described herein and is illustrated with two case histories. Initially, frequency-based electroencephalogram training was employed to promote functional recovery, in the manner of the traditional sensorimotor rhythm/beta approach. An optimization procedure was employed in which the reinforcement frequency is tailored to the client on the basis of symptom response, with particular regard for the regulation of arousal. Low frequencies, down to .01 Hz, have been found especially useful in the remediation of posttraumatic stress disorder. This training was complemented with traditional alpha-theta work as pioneered at the Menninger Foundation and by Peniston. The objective here is experiential, because prior traumas typically are revisited in a nonforced, nontraumatic manner. The benign witnessing of traumas consolidates the experience of safety for which the prior training laid the groundwork. Collectively, this approach has been found to be much better tolerated than traditional exposure therapies. In addition, it is helpful in the shedding of substance dependencies that are common in treatment-resistant PTSD
Remediation of PTSD Symptoms Using Neurofeedback Training with Active Duty Service Members and Veterans
Siegfried Othmer, PhD
We are currently experiencing a breakthrough in the remediation of Post Traumatic Stress Disorder (PTSD) through neurofeedback training. With our own best efforts, and growing support from the clinical community, this will ultimately resonate through the military as well as the Department of Veterans Affairs, as the campaign continues to grow. The strongest evidence for this new approach in fact comes from within the military itself. By now more than 350 service persons have experienced neurofeedback at Camp Pendleton, one of six military bases where this work is being conducted. So these new methods are already being field-tested in real-world situations. Specifically, we are talking here about neurofeedback based on the slow cortical potential, what we refer to as Infra-Low Frequency (ILF) Training. This method belongs in the larger field of biofeedback, which has many related applications in the realm of neurophysiological dysfunction that are already well-established.
The Usefulness of Quantitative EEG (QEEG) and Neurotherapy in the Assessment and Treatment of Post-Concussion Syndrome
Mild traumatic brain injury (TBI) is associated with damage to frontal, temporal and parietal lobes. Post-concussion syndrome has been used to describe a range of residual symptoms that persist 12 months or more after the injury, often despite a lack of evidence of brain abnormalities on MRI and CT scans. The core deficits of post-concussion syndrome are similar to those of ADHD and mood disorders, and sufferers often report memory, socialization problems and frequent headaches. While cognitive rehabilitation and psychological support are widely used, neither has been shown to be effective in redressing the core deficits of post-concussion syndrome. On the other hand, quantitative EEG has been shown to be highly sensitive (96%) in identifying post-concussion syndrome, and neurotherapy has been shown in a number of studies to be effective in significantly improving or redressing the symptoms of post-concussion syndrome, as well as improving similar symptoms in non-TBI patients.
John A. Putman, MA, MS
Background. This single case concerns the treatment of a 71-year-old female stroke patient. The patient's MRI revealed that the location of the stroke was in the right side basal ganglia with damage extending into the anterior limb of the internal capsule. She presented with a virtual paralysis of the left side of her body (hemiplegia with immobilized left arm, contracted fist, minimal motor control over left leg, absence of muscle tonus in left side of face and slurred, monotonic speech).
Method: The client was provided with EEG biofeedback training on a one to two half-hour sessions per week schedule. Bipolar montages were used along with single site protocols. This was based largely on the idea of reciprocal communication loops between widely separated cortical generators. It was thought that encouraging communication between cortical sites would have a beneficial impact on impairments related to both functional and structural damage. EEG training protocols included SMR (12-15 Hz) enhancement at C4, C4-Pz and T3-T4 with theta suppression; beta (15-18 Hz) enhancement with theta suppression at C3, C3-Fpz and at C3-Fp1.
Results: Patient showed significant improvement in gross motor control and range of movement of left arm and leg. The most dramatic improvement was observed in speech (articulation, strength, and tone). While substantial improvements were observed in motor ability, restoration of mood stability proved somewhat more elusive. Since she was receiving additional treatment (physical therapy and medication management), it is impossible to attribute the improvement in functioning solely to the EEG training. However, the consensus among the attending medical personnel was that the improvements noted above took place with unusual expeditiousness.
Discussion: When performing EEG biofeedback it may be most practical to adopt an "exercise model" approach in which the regulatory mechanisms in the brain are challenged through the sequential use of multiple protocol configurations. In this case several different training protocols proved useful in her ongoing recovery. While improvements in functioning were a result of a concerted effort involving multiple therapeutic interventions, it is likely that neurofeedback played a vital synergistic role.
EEG-NeuroBioFeedback Treatment of Patients with Brain Injury: Part 2: Changes in EEG Parameters versus Rehabilitation
Rima E. Laibow, MD - Albert N. Stubblebine, MSc - Henry Sandground - Michel Bounias, DSc
Background. A sample of 27 patients with brain injury distributed in five clinical classes was examined for pre- and post-treatment symptoms and associated power spectra.
Methods. Changes in electroencephalographic (EEG) compressed spectral arrays were analyzed with respect to the rate of rehabilitation and correlated with a checklist of symptoms for each patient and the group as a whole.
Results. Targeted decreases in slower (3-7 Hz) and higher (24-32 Hz) frequencies, and EMG (70-90 Hz), and increases of alpha (8-12 Hz) and mid-range beta frequencies (15-18 Hz) were achieved following Neuro-BioFeedback (NBF) treatment using positive reward tones and a simultaneous visual reward. The impact of gender and age class influence was assessed against treatment results. Single lead EEG power spectra changes were analyzed for hemispherectomized patients, stroke, car accident and trauma patients. A common EEG pattern was observed for a group of patients exhibiting vertigo with two subgroups in which vertigo resolved or did not resolve showing EEG differences.
Conclusions. EEG NeuroBioFeedback can successfully treat patients with brain injury with highly clinically-meaningful clinical results. Changes in Cz power spectra generally occur, but do not always immediately follow resolution of symptoms. Since EEG-NBF is limited to recording cortical surface potentials, it is possible that changes induced by the treatment which result in clinical changes may not always be reflected at the cortical surface and hence may not be available for recording and analysis there, despite subcortical integration.
Efficacy of Traumatic Brain Injury Rehabilitation: Interventions of QEEG-guided Biofeedback, Computers, Strategies, and Medications
Kirtley E. Thornton - Dennis P. Carmody
The onset of cognitive rehabilitation brought with it a hope for an effective treatment for the traumatic brain injured subject. This paper reviews the empirical reports of changes in cognitive functioning after treatment and compares the relative effectiveness of several treatments including computer interventions, cognitive strategies, EEG biofeedback, and medications. The cognitive functions that are reviewed include auditory memory, attention and problem solving. The significance of the change in cognitive function is assessed in two ways that include effect size and longevity of effect. These analyses complement the previously published meta-reviews by adding these two criteria and include reports of EEG biofeedback, which is shown to be an effective intervention for auditory memory.
Lonnie A. Nelson
Biofeedback has been applied to many aspects of stroke rehabilitation, with mixed results. This is largely due to the varying modalities, differences between study designs, and methods of measuring success and progress. How well biofeedback works appears to be inversely related to the direct observability of the function about which information is being provided. The more covert the function (e.g., swallowing muscle activity, attention, cortical functioning, etc.), the more helpful biofeedback is likely to be. However, biofeedback in general can have a very positive impact, even through indirect means. Improvements in self confidence, shifting of locus of control, and instantly being provided information regarding changes in one’s physical functioning as a result of mental activity can be helpful in setting the tone for success in rehabilitation more generally.
Howard W. Rasey, B.A. - Joel F. Lubar, Ph.D. - Anne McIntyre, Ph.D. - Anthony C. Zoffuto, B.S. - Paul L. Abbott, B.A.
College students diagnosed as free of any neurological or attention deficit disorder received EEG biofeedback to enhance beta (16-22 hertz) activity while simultaneously inhibiting high theta and low alpha (6-10 hertz) activity in order to evaluate improvements in attentional measures. Following short-term treatment (mean number of sessions=20), subjects were evaluated as either learners or non-learners based upon standard pre- versus post-treatment neurofeedback measures. Attention quotients taken from pre and post-treatment measurements using the Intermediate Visual and Auditory (IVA) Continuous Performance Test identified significant improvements in attentional measures in learners, while non-learners showed no significant improvements. Results suggest that some "normal" young adults can learn to increase EEG activity associated with improved attention. Twenty sessions, however, even for this population may represent the lower limit for achieving significant improvement.
David. A. Kaiser, PhD
Siegfried Othmer, PhD
Background: Neurofeedback studies have been criticized for including small numbers of subjects. The effect of SMR-beta neurofeedback training on the Test of Variables of Attention was evaluated in more than 1,000 subjects from thirty-two clinics.
Methods: 1089 subjects (726 children, 324 females, 186 with ADHD or ADD diagnoses) underwent twenty or more sessions of SMR-beta neurofeedback training for attentional and behavioral complaints at thirty-two clinical settings affiliated with EEG Spectrum, Inc. Subjects were evaluated prior to training and at training completion. One hundred and fifty-seven subjects who elected extensive training (forty sessions or more) were tested after both twenty and forty training sessions.
Results: Neurofeedback training produced significant improvement in attentiveness, impulse control, and response variability. Significant clinical improvement in one or more measures was seen in eighty-five percent of those subjects with moderate pre-training deficits.
Conclusions: Neurofeedback training is effective in remediating attentional dysfunction. Nevertheless, large scale studies with greater control (e.g., wait-list designs) are sorely needed.
Frank Masterpasqua - Kathryn N. Healey
Advances in technology occasionally allow for innovations in the practice of psychology. Neurofeedback is one such modality; in it, individuals learn to change patterns of brain waves through operant conditioning. Research shows that a number of neurological and psychological disorders can be characterized by distinctive EEG patterns and that neurofeedback may help clients to change those patterns. The evidence regarding neurofeedback’s efficacy for attention-deficit/hyperactivity disorder (ADHD), depression, and other disorders is reviewed. Using control group designs, four different research teams have found neurofeedback to be effective for ADHD participants; research on outcomes for other disorders is at a much more preliminary stage. Practicing psychologists are encouraged to explore the potential of this alternative and distinctly psychological modality.
QEEG-Guided Neurofeedback for Children with Histories of Abuse and Neglect: Neurodevelopmental Rationale and Pilot Study
Lark Huang-Storms, MS - Eugenia Bodenhamer-Davis, PhD - Richard Davis, MS - Janice Dunn, MA
Background: 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 rythmicity, 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, interaizing 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.
David Vernon - Tobias Egner - Nick Cooper - Theresa Compton - Claire Neilands - Amna Sheri - John Gruzelier
The use of neurofeedback as an operant conditioning paradigm has disclosed that participants are able to gain some control over particular aspects of their electroencephalogram (EEG). Based on the association between theta activity (4–7 Hz) and working memory performance, and sensorimotor rhythm (SMR) activity (12–15 Hz) and attentional processing, we investigated the possibility that training healthy individuals to enhance either of these frequencies would specifically influence a particular aspect of cognitive performance, relative to a non-neurofeedback control-group. The results revealed that after eight sessions of neurofeedback the SMR-group were able to selectively enhance their SMR activity, as indexed by increased SMRytheta and SMRybeta ratios. In contrast, those trained to selectively enhance theta activity failed to exhibit any changes in their EEG. Furthermore, the SMR-group exhibited a significant and clear improvement in cued recall performance, using a semantic working memory task, and to a lesser extent showed improved accuracy of focused attentional processing using a 2-sequence continuous performance task. This suggests that normal healthy individuals can learn to increase a specific component of their EEG activity, and that such enhanced activity may facilitate semantic processing in a working memory task and to a lesser extent focused attention. We discuss possible mechanisms that could mediate such effects and indicate a number of directions for future research.
Horst H. Mueller - C.C. Stuart Donaldson - David V. Nelson - Mellisa Layman
Thirty patients from a private clinical practice who met the 1990 American College of Rheumatology criteria for fibromyalgia syndrome (FS) were allowed prospectively through a brainwave-based intervention known as electroencephalograph (EEG)-driven stimulation or EDS. Patients were initially treated with EDS until they reported notieable improvements in mental clarity, mood, and sleep. Self-reported pain, then, having changed from vaguely diffuse to more specifically localized, was treated with very modest amounts of physically oriented therapies. Pre- to posttreatment and extended follow-up comparisons of psychological and physical functioning indices, specific FS symptom ratings, and EEG activity revealed statistically significant improvements. EDS appeared to be the prime initiator of therapeutic efficacy. Future research is justified for controlled clinical trials and to better understand disease mechanisms.