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==Criticism==
Other studies have found that, while the use of EEGs and biofeedback can be used to modify brain waves, the practice does not provide therapeutic benefit.<ref>{{cite journal|last=Kline|first=John|coauthors=Corinne N. Brann, Bryan R. Loney|title=A Cacophony in the Brainwaves: A Critical Appraisal of Neurotherapy for Attention-Deficit Disorders|journal=The Scientific Review of Mental Health Practice|date=Summer 2002|volume=1|url=http://www.srmhp.org/0101/neurotherapy-for-add.html|accessdate=19 November 2012}}</ref> Significant flaws have also been pointed out in the research methodologies used by neurofeedback supporters.<ref>{{cite journal|last=Lohr|first=Jeffrey|coauthors=Suzanne A. Meunier, Lisa M. Parker, John P. Kline|title=Neurotherapy does not qualify as an Empirically supported Behavioral Treatment for Psychological Disorders|journal=Science & Pseudoscience Review in Mental Health|year=2002|month=November|url=http://web.archive.org/web/20010603063635/www.pseudoscience.org/Neurotherapy/title-page.htm|accessdate=19 November 2012}}</ref>

These criticisms; however, are now moot as research continues to confirm that neurofeedback is an efficacious treatment intervention. In October 2012, the American Academy of Pediatrics recognized that the scientific literature on biofeedback (including neurofeedback) provides "Level 1, Best Support" as an evidence-based child and adolescent psychosocial intervention. <ref>{{cite journal|last=American Academy of Pediatrics|title=evidence-based child and adolescent psychosocial intervention|year=2012|month=October|url=http://www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/Mental-Health/Documents/CRPsychosocialInterventions.pdf}}</ref>


==See also==
==See also==

Revision as of 20:07, 25 January 2013

Sofware real time data of neurofeedback training.

Neurofeedback (NFB), also called neurotherapy, neurobiofeedback or EEG biofeedback is a type of biofeedback that uses realtime displays of electroencephalography or functional magnetic resonance imaging (fMRI) to illustrate brain activity, often with a goal of controlling central nervous system activity. Sensors are placed on the scalp to measure activity, with measurements displayed using video displays or sound.

Definition

Neurofeedback is a type of biofeedback that uses electroencephalography or fMRI to provide a signal that can be used by a person to receive feedback about brain activity.

Proponents claim that neurofeedback is an effective intervention for ADHD and epilepsy, and research is being performed to investigate the effectiveness of the technique for treating autism, headaches, insomnia,[1] anxiety, substance abuse, TBI.[2]

Multiple studies have shown neurofeedback to be useful in the treatment of ADHD.[3][4][5] QEEG has been ambivalent with some studies showing that some forms of ADHD can be characterized by an abundance of slow brainwaves and a diminished quantity of fast wave activity.[4]

Some ADHD researchers were unconvinced by the early studies on neurofeedback, including the clinical neuropsychologist, professor of psychiatry, and author of several books on ADHD, Russell Barkley. Barkley and Loo [6] reviewed the available literature in 2005 on neurotherapy's effectiveness in treating ADHD and concluded that most early studies were uncontrolled case studies, failed to use any control groups,did not use blinded methods to insure that parents, teachers, and clinicians were not aware of treatment assignments of the patients, and thus could have results largely if not entirely due to the placebo effect.

Other studies used improper techniques for statistical analysis of their data and most failed to show if changes occurred in the EEG as a consequence of training which is critical if one is claiming that any resulting improvements in ADHD are due to the training itself. One also needs to show whether such changes in the EEG were statistically related to the improvements reported in ADHD symptoms. The authors concluded that evidence for the effectiveness of neurofeedback for ADHD was far from definitive and far more rigorous research was needed.

Subsequent studies of this treatment for ADHD have now been published using larger samples, more appropriate control groups receiving alternative, attention placebo, or even sham neurofeedback control treatments as well as better assessment methods for ADHD symptoms. These more recent studies along with any early ones using appropriate scientific methods and published through 2010 were recently reviewed by Nicholas Lofthouse, Ph.D. and colleagues [7] and discussed in a separate paper [8] that concluded that neurofeedback was probably efficacious but that the available evidence was hardly conclusive. Neither of these reviews included the results of his own rigorously conducted randomized trial of neurofeedback against sham feedback reported at a recent scientific meeting that found no benefits of biofeedback compared to the sham control condition.

Of two studies published in 2010-2011 that both used attention placebo or sham control treatment groups, one found evidence of specific treatment effects only on inattention but not hyperactive or impulsive symptoms while the other smaller study found chiefly placebo effects.[9][10] A separate meta-analysis by Arns and colleagues in 2009 found a larger magnitude of treatment effects on ADHD symptoms than did the Lofthouse review but this was mainly due to Arns and colleagues [11] including many of the earlier poorly controlled studies that did not meet the methodological requirements for inclusion in the Lofthouse review.

Further research on the benefits of neurofeedback for ADHD is clearly warranted given this history of mixed results, especially in the more recent and better conducted studies. As Lofthouse and colleagues admonished in their reviews, future research on this treatment needs to employ appropriate sham neurofeedback or other attention-placebo control groups, double-blinded procedures to insure that parents, teachers (and clinicians reporting on outcomes) are not aware of treatment group assignment, and measures of ADHD collected both in school and at home to better evaluate the efficacy of this treatment for ADHD.

Other areas where neurofeedback has been researched include treatment of substance abuse, anxiety, depression, epilepsy, OCD, learning disabilities,[12][13] bipolar disorder, conduct disorder, cognitive impairment, migraines, headaches, chronic pain, autism spectrum disorders, sleep dysregulation, PTSD and concussion.[14][15][original research?][citation needed]

Related technologies include hemoencephalography biofeedback (HEG).

History and application

In 1924, the German psychiatrist Hans Berger connected a couple of electrodes (small round discs of metal) to a patient's scalp and detected a small current by using a ballistic galvanometer. During the years 1929-1938 he published 14 reports about his studies of EEGs, and much of our modern knowledge of the subject, especially in the middle frequencies, is due to his research.[16]

Berger analyzed EEGs qualitatively, but in 1932 G. Dietsch applied Fourier analysis to seven records of EEG and became the first researcher of what later is called QEEG (quantitative EEG).[16]

Later, Joe Kamiya popularized neurofeedback in the 1960s when an article[17] about the alpha brain wave experiments he had been conducting was published in Psychology Today in 1968. Kamiya’s experiment had two parts. In the first part, a subject was asked to keep his eyes closed and when a tone sounded to say whether he thought he was in alpha. He was then told whether he was correct or wrong. Initially the subject would get about fifty percent correct, but some subjects would eventually develop the ability to distinguish between states and be correct a highly significant percentage of the time. In the second part of the study, subjects were asked to go into alpha when a bell rang once and not go into the state when the bell rang twice. Once again some subjects were able to enter the state on command. Others, however, could not control it at all. Nevertheless, the results were significant and very attractive. Alpha states were connected with relaxation, and alpha training had the possibility to alleviate stress and stress-related conditions.

Despite these highly dramatic claims, the universal correlation of high alpha density to a subjective experience of calm cannot be assumed. Alpha states do not seem to have the universal stress-alleviating power indicated by early observations.[18]

At one point, Martin Orne and others challenged the claim that alpha biofeedback actually involved the training of an individual to voluntarily regulate brainwave activity.[19] James Hardt and Joe Kamiya, then at UC San Francisco's Langley Porter Neuropsychiatric Institute published a paper,[20] proving the efficacy of EEG biofeedback training, and that it was not just related to visuo/motor eyes open or closed factors.

In the late sixties and early seventies, Barbara Brown, one of the most effective popularizers of Biofeedback, wrote several books on biofeedback, making the public much more aware of the technology. The books included New Mind New Body, with a foreword from Hugh Downs, and Stress and the Art of Biofeedback. Brown took a creative approach to neurofeedback, linking brainwave self-regulation to a switching relay which turned on an electric train.

The work of Barry Sterman, Joel F. Lubar and others has indicated a high efficacy for beta training, involving the role of sensorimotor rhythmic EEG activity.[21] This training has been used in the treatment of epilepsy,[22][23] attention deficit disorder and hyperactive disorder,.[24] The sensorimotor rhythm (SMR) is rhythmic activity between 12 and 16 hertz that can be recorded from an area near the sensorimotor cortex. SMR is found in waking states and is very similar if not identical to the sleep spindles that are recorded in the second stage of sleep.

For example Sterman has shown that both monkeys and cats who had undergone SMR training had elevated thresholds for the convulsant chemical monomethylhydrazine. These studies indicate that SMR is associated with an inhibitory process in the motor system and therefore increasing SMR through operant conditioning increases the ability to control seizures.[23]

Neuroimaging studies have correlated ADHD with abnormal functioning in the anterior cingulate cortex (ACC) during tasks involving selective attention. In 2006, Johanne Levesque et al. published results from their fMRI study showing normalization of ACC activation during a selective-attention task in ADHD subjects who had undergone neurofeedback training. Subjects in the study were randomly assigned to either the neurofeedback treatment group or a no-treatment control group, and subjects from the latter showed no difference in ACC activation compared to their baseline.[25]

Within the last 5–10 years, neurofeedback has taken a new approach, in taking a second look at deep states. Alpha-theta training has been used in the treatment of alcoholism,[26] other addictions as well as anxiety.[27] This low frequency training differs greatly from the high frequency beta and SMR training that has been practiced for over thirty years and is reminiscent of the original alpha training of Elmer Green and Joe Kamiya. Beta and SMR training can be considered a more directly physiological approach, strengthening sensorimotor inhibition in the cortex and inhibiting alpha patterns, which slow metabolism. Alpha-theta training, however, derives from the psychotherapeutic model and involves accessing of painful or repressed memories through the alpha-theta state. The alpha-theta state is a term that comes from the representation on the EEG.

The most recent development in the field is a conceptual approach called the Coordinated Allocation of Resource Model (CAR) of brain functioning which states that specific cognitive abilities are a function of specific electrophysiological variables which can overlap across different cognitive tasks.[28] The activation database guided EEG biofeedback approach initially involves evaluating the subject on a number of academically relevant cognitive tasks and compares the subject's values on the QEEG measures to a normative database, in particular on the variables that are related to success at that task.

The approach has been able to improve auditory memory some 3 standard deviations (or 300%) in a group of 20 memory impaired learning disabled and attention deficit disorder children. The subject's memory was better than the control group following the treatment.[29] Reading memory in a group of 7 reading disabled children has been shown to increase by some 2.4 standard deviations (or 334%) with this approach.[13] Published research has also indicated a 2.61 standard deviation improvement in a group of 19 mild-moderate traumatic brain injured patients. These patients also were performing above the control group at the end of the treatment period.[14][15]

Organizations

The Association for Applied Psychophysiology and Biofeedback (AAPB) is a non-profit scientific and professional society for biofeedback and neurofeedback. The International Society for Neurofeedback and Research (ISNR) is a non-profit scientific and professional society for neurofeedback.[30] The Biofeedback Foundation of Europe (BFE)] sponsors international education, training, and research activities in biofeedback and neurofeedback.

Certification

The Biofeedback Certification International Alliance (formerly the Biofeedback Certification Institute of America) is a non-profit organization that is a member of the Institute for Credentialing Excellence (ICE). BCIA certifies individuals who meet education and training standards in biofeedback and neurofeedback and progressively recertifies those who satisfy continuing education requirements. BCIA offers biofeedback certification, neurofeedback (also called EEG biofeedback) certification, and pelvic muscle dysfunction biofeedback certification. BCIA certification has been endorsed by the Mayo Clinic,[31] the Association for Applied Psychophysiology and Biofeedback (AAPB), the International Society for Neurofeedback and Research (ISNR), and the Washington State Legislature.[32]

The BCIA didactic education requirement includes a 36-hour course from a regionally-accredited academic institution or a BCIA-approved training program that covers the complete Neurofeedback Blueprint of Knowledge and study of human anatomy and physiology. The Neurofeedback Blueprint of Knowledge areas include: I. Orientation to Neurofeedback, II. Basic Neurophysiology and Neuroanatomy, III. Instrumentation and Electronics, IV. Research, V. Psychopharmalogical Considerations, VI. Treatment Planning, and VII. Professional Conduct.[33]

Applicants may demonstrate their knowledge of human anatomy and physiology by completing a course in biological psychology, human anatomy, human biology, human physiology, or neuroscience provided by a regionally-accredited academic institution or a BCIA-approved training program or by successfully completing an Anatomy and Physiology exam covering the organization of the human body and its systems.

Applicants must also document practical skills training that includes 25 contact hours supervised by a BCIA-approved mentor designed to them teach how to apply clinical biofeedback skills through self-regulation training, 100 patient/client sessions, and case conference presentations. Distance learning allows applicants to complete didactic course work over the internet. Distance mentoring trains candidates from their residence or office.[34] They must recertify every 4 years, complete 55 hours of continuing education (30 hours for Senior Fellows) during each review period or complete the written exam, and attest that their license/credential (or their supervisor’s license/credential) has not been suspended, investigated, or revoked.[35]

Neurofeedback in practice

A common professional neurofeedback therapy session today goes as follows:

  1. In an intake of about 90 minutes the patient will get a questionnaire and a first EEG reading. The questionnaire specifies the complaints and also helps to indicate if the referral to a specialist might be called for. In some cases but not all a full EEG will be recorded.
  2. If a full EEG is called for, the EEG recording is typically done on 19 - 21 sites on the scalp. It results in a brainmap ("quantitative EEG"). This is a series of maps (for each frequency one) where for each measured spot the average level of activity is shown. The brainmap is compared to a database to determine spots of over- and under activity compared to the average people of the patient's age and sex. There are several commercial providers of such databases.
  3. The actual session itself involves placing sensors on the head. The feedback may involve, for example, a simple light or tone or game that will move and play when certain brain activity is detected by the system. For other brain activity the rewarding tone, or light or game is taken away.
  4. A typical course of sessions takes 20 to 40 visits. At the beginning of each session the patient reports the course of his complaints and also mentions other mental effects. On the basis of this report the therapy may be adjusted. In some cases a patient is allowed to take a feedback machine home and have most - but not all - sessions there.

Neuroplasticity

In 2010, a study provided the first evidence of neuroplastic changes occurring directly after natural brainwave training. Half an hour of voluntary control of brain rhythms was shown to be sufficient to induce a lasting shift in cortical excitability and intracortical function.[36] Ros et al. observed that the cortical response to transcranial magnetic stimulation (TMS) was significantly enhanced after neurofeedback, persisted for at least 20 minutes, and was correlated with an EEG time-course indicative of activity-dependent plasticity.[37]

See also

3

References

  1. ^ Cortoos A, De Valck E, Arns M, Breteler MH, Cluydts R. (2010). "An exploratory study on the effects of tele-neurofeedback and tele-biofeedback on objective and subjective sleep in patients with primary insomnia". Appl Psychophysiol Biofeedback. 35 (2): 125–134. doi:10.1007/s10484-009-9116-z. {{cite journal}}: Check |doi= value (help)CS1 maint: multiple names: authors list (link)
  2. ^ Thornton, K. & Carmody, D. Efficacy of Traumatic Brain Injury Rehabilitation: Interventions of QEEG-Guided Biofeedback, Computers, Strategies, and Medications, Applied Psychophysiology and Biofeedback, 2008, (33) 2, 101-124
  3. ^ The Association for Applied Psychophysiology and Biofeedback (AAPB)
  4. ^ a b Butnik, Steven M. "Neurofeedback in adolescents and adults with attention deficit hyperactivity disorder." Journal of Clinical Psychology, May 2005. Vol. 61 Issue 5, p621-625
  5. ^ Masterpasqual, Frank and Healey, Katherine N. "Neurofeedback in psychological practice." Professional Psychology: Research & Practice. Dec 2003, Vol. 34 Issue 6, p652-656
  6. ^ Barkley, R. A. & Loo, S. (2005). Clinical utility of EEG in attention deficit hyperactivity disorder. Applied Neuropsychology, 12(2), 64-76
  7. ^ Lofthouse, N. et al. (2011). A review of neurofeedback treatment for pediatric ADHD. Journal of Attention Disorders, 1087054711427530, first published online November 16, 2011 as doi:10.1177/1087054711427530.
  8. ^ Lofthouse, N. et al. (2011). Biofeedback and neurofeedback treatment for ADHD. Psychiatric Annals, 41(1), 42-47.
  9. ^ Bakhshayesh, N. R. (2011). Neurofeedback in ADHD: A single-blind randomized controlled trial. European Child and Adolescent Psychiatry, online first, DOI 10.1007/s00787-011-0208-y.
  10. ^ Perreau-Linck, E. et al. (2010). Effects of neurofeedback training on inhibitory capacities in ADHD children. Journal of Neurotherapy, 14, 229-242.
  11. ^ Arns, M. et al. (2009). Efficacy of neurofeedback treatment in ADHD. Clinical EEG and Neuroscience, 40(3), 180-189.
  12. ^ Thornton, K. & Carmody, D. EEG Biofeedback for Reading Disabilities and Traumatic Brain Injuries. Child and Adolescent Psychiatric Clinics of North America, Jan., 2005, 137-162
  13. ^ a b Thornton, K, Carroll, C. 2010, Neuroconnections, The Coordinated Allocation of Resource (CAR) Model Intervention for Reading, Problems in two clinics, fall, 8-16
  14. ^ a b Thornton, K. & Carmody, D. Efficacy of Traumatic Brain Injury Rehabilitation: Interventions of QEEG-Guided Biofeedback, Computers, Strategies, and Medications, Applied Psychophysiology and Biofeedback, 2008, (33) 2, 101-124.
  15. ^ a b Thornton, K. & Carmody, D. Traumatic Brain Injury Rehabilitation: QEEG Biofeedback Treatment Protocols, Applied Psychophysiology and Biofeedback, 2009, (34) 1, 59-68.
  16. ^ a b Kaiser, David A. "Basic Principles of Quantitative EEG." Journal of Adult Development, Vol. 12, Nos. 2/3, August 2005
  17. ^ Kamiya, J. (1971). "Operant Control of the EEG Alpha Rhythm and Some of its Reported Effects on Consciousness". Biofeedback and Self-Control: an Aldine Reader on the Regulation of Bodily Processes and Consciousness.
  18. ^ Hardt, J.V. (1978). "Anxiety change through electroencephalographic alpha feedback seen only in high anxiety subjects". Science. 201 (4350): 79–81. doi:10.1126/science.663641. PMID 663641. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
  19. ^ Paskewitz, D.A. (1973). "Visual Effects on Alpha Feedback Training". Science. 181 (4097): 360–363. doi:10.1126/science.181.4097.360. PMID 4719909. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
  20. ^ Hardt, J.V. (1976). "Conflicting results in EEG alpha feedback studies" (PDF). Applied Psychophysiology and Biofeedback. 1 (1): 63–75. Retrieved 2007-12-05. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
  21. ^ Sterman, M.B. (1962). "Forebrain inhibitory mechanisms: cortical synchronization induced by basal forebrain stimulation". Exp Neurol. 6 (2): 91–102. doi:10.1016/0014-4886(62)90080-8. PMID 13916975. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
  22. ^ Sterman, M.B. (1972). "Suppression of seizures in an epileptic following sensorimotor EEG feedback training". Electroencephalogr Clin Neurophysiol. 33 (1): 89–95. doi:10.1016/0013-4694(72)90028-4. PMID 4113278. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
  23. ^ a b Sterman, M.B. (2000). "Basic concepts and clinical findings in the treatment of seizure disorders with EEG operant conditioning". Clin Electroencephalogr. 31 (1): 45–55. PMID 10638352.
  24. ^ Lubar, J.F. (1995). "Evaluation of the effectiveness of EEG neurofeedback training for ADHD in a clinical setting as measured by changes in TOVA scores, behavioral ratings, and WISC-R performance" (PDF). Applied Psychophysiology and Biofeedback. 20 (1): 83–99. Retrieved 2007-12-05. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
  25. ^ Levesque, Johanne and Mario Beauregard. "Effect of neurofeedback training on the neural substrates of selective attention in children with attention-deficit/hyperactivity disorder: A functional magnetic resonance imaging study." Neuroscience Letters, 394, 216-221
  26. ^ http://www.neurofeedback-scotland.com/alpha-theta-brainwave.html
  27. ^ http://www.neurofeedback-scotland.com/anxiety-disorders.html
  28. ^ Thornton, K. & Carmody, D. Eyes-Closed and Activation QEEG Databases in Predicting Cognitive Effectiveness and the Inefficiency Hypothesis, Journal of Neurotherapy, 2009, (13) 1, 1-22
  29. ^ Thornton, K. & Carmody, D. EEG Biofeedback for Reading Disabilities and Traumatic Brain Injuries. Child and Adolescent Psychiatric Clinics of North America, Jan., 2005, 137-162.
  30. ^ http://www.bfe.org/
  31. ^ Neblett, R., Shaffer, F., & Crawford, J. (2008). What is the value of Biofeedback Certification Institute of America certification? Biofeedback, 36(3), 92-94.
  32. ^ [1] Washington State Legislature WAC 296-21-280 Biofeedback Rules.
  33. ^ Gevirtz, R. (2003). The behavioral health provider in mind-body medicine. In D. Moss, A. McGrady, T. C. Davies, & I. Wickramasekera (Eds.). Handbook of mind-body medicine for primary care. Thousand Oaks, CA: Sage Publications, Inc.
  34. ^ De Bease, C. (2007). Biofeedback Certification Institute of America certification: Building skills without walls. Biofeedback, 35(2), 48-49.
  35. ^ Shaffer, F., & Schwartz, M. S. (in press). Entering the field and assuring competence. In M. S. Schwartz, & F. Andrasik (Eds.). Biofeedback: A practitioner's guide (4th ed.). New York: The Guilford Press.
  36. ^ Science Daily
  37. ^ Ros T. (2010). "Endogenous Control of Waking Brain Rhythms Induces Neuroplasticity in Humans" (PDF). European Journal of Neuroscience. 31 (4): 770–778. doi:10.1111/j.1460-9568.2010.07100.x. PMID 20384819. Retrieved 2010-02-12. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)

Further reading

  • Evans, J.R., and Abarbanel, A. An introduction to quantitative EEG and Neurofeedback. Academic Press: San Diego, 1999.
  • Steinberg, Mark, and Othmer, S. ADD: The 20-Hour Solution. Robert Reed Publishers: Bandon OR, 2004.
  • Hammond, Corydon D. "Neurofeedback Treatment of Depression and Anxiety." Journal of Adult Development, Vol 12, Nos. 2/3, August 2005
  • Trudeau, David L. "EEG Biofeedback for Addictive Disorders -- The State of the Art in 2004." Journal of Adult Development, Vol 12, Nos. 2/3, August 2005.
  • Vernon, D. (2005). Can neurofeedback training enhance performance? An evaluation of the evidence with implications for future research. Applied Psychophysiology and Biofeedback, 30(4), 347-364.
  • Hill PhD, Robert W. and Eduardo MD, C. Healing Young Brains: The Neurofeedback Solution. Hampton Roads Publishing; 1 edition (May 15, 2009).
  • Robbins, Jim "A Symphony in the Brain -- The Evolution of the New Brainwave Biofeedback." Grove Atlantic 1st Edition 2000; 2nd Edition 2008

Articles and research links:

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