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''''Neurofeedback (NFB)''', also called '''neurotherapy''', '''neurobiofeedback''' or '''EEG biofeedback''' is a type of alternative medicine, more specifically a type of [[biofeedback]] that uses realtime displays of [[electroencephalography]] 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 display]]s or sound. ==Definition== Neurofeedback is a type of [[biofeedback]] that uses [[electroencephalography]] to provide a signal that can be used by a person to receive feedback about brain activity. ==Training process== Some approaches believe that conscious understanding and mediation of that information is important for the training process; however, this claim has never actually been verified. Those approaches also believe that neurofeedback training can be understood as being based on a form of operant and/or classical conditioning. In that frame of reference, when [[Electroencephalography|brain activity]] changes in the direction desired by the trainer directing the training, a positive "reward" feedback is given to the individual, and if the change is in the opposite direction from what was intended, then either different feedback is given or the provision of otherwise attained "positive" feedback is inhibited (or blocked). These ideas can be applied in various combinations depending on the protocol decided upon by the trainer. Rewards/Reinforcements can be as simple as a change in pitch of a tone or as complex as a certain type of movement of a character in a video game. This experience could be called [[operant conditioning]] for internal states even though no research has yet demonstrated that clear operant response curves occur under those scenarios. Nonetheless, a number of different brainwave goals have been proposed by different researchers in the field following on these general ideas. Usually, these goals are based upon extrapolations from research describing abnormal EEG patterns or on results from a quantitative EEG (QEEG - also known as brain mapping) upon the particular client being offered neurofeedback training. A popular goal is the increase of activity in the 12–18 Hz band ([[mu rhythm]]/[[sensorimotor rhythm| sensorimotor rhythm (SMR)]]) and a decrease in the 4–8 Hz and/or 22–28 Hz bands ([[theta rhythm|theta]] and/or [[beta rhythm|beta]]). The most common and well-documented use of neurofeedback is in the treatment of [[attention deficit hyperactivity disorder]]: multiple studies have shown neurofeedback to be useful in the treatment of ADHD.<ref>[http://www.aapb.org/add.html The Association for Applied Psychophysiology and Biofeedback (AAPB)]</ref><ref name = "Butnik">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</ref><ref>Masterpasqual, Frank and Healey, Katherine N. "Neurofeedback in psychological practice." ''Professional Psychology: Research & Practice.'' Dec 2003, Vol. 34 Issue 6, p652-656</ref> 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;<ref name = "Butnik" /> however, alternative patterns have also been described making the overall picture inconclusive at this time. Some ADHD researchers are unconvinced by these studies, including the psychiatry professor and author of several books on ADHD, [[Russell Barkley]]. Barkley opines that neurotherapy's effectiveness in treating ADHD can be ascribed to either uncontrolled [[case studies]] or the [[placebo effect]].<ref>[http://addadhdadvances.com/neurofeedback.html add adhd advances]</ref> In return, neurofeedback advocates note that Barkley has received research funds and personal remuneration from drug giant [[Eli Lilly and Company]] and other drug companies.<ref>[http://www.playattention.com/attention-deficit/articles/adhd-study-faster-diagnosis-urged/ The Play Attention Solution]</ref><ref>[http://www.ahrp.org/infomail/05/10/10.php Alliance for Human Research Protection]</ref><ref>[http://www.russellbarkley.org/about-dr-barkley.htm Russel Barkley's website]</ref> Other areas where neurofeedback has been researched include treatment of [[substance abuse]],<ref name = "EEG info">[http://www.eeginfo.com/research/ EEG info research]</ref>, [[anxiety]],<ref name = "EEG info" /> [[clinical depression|depression]],<ref name = "EEG info" /> [[epilepsy]],<ref name = "EEG info" /> [[OCD]],<ref name = "EEG info" /> [[learning disabilities]],<ref name = "EEG info" /> [[bipolar disorder]],<ref name = "EEG info" /> [[conduct disorder]],<ref name = "EEG info" />, cognitive impairment,<ref name = "EEG info" /> migraines,<ref name = "EEG info" /> [[headaches]],<ref name = "EEG info" /> chronic pain,<ref name = "EEG info" /> [[autism spectrum disorder]]s,<ref name = "EEG info" /> sleep dysregulation,<ref name = "EEG info" /> [[PTSD]]<ref name = "EEG info" /> and [[concussion]].{{Or|date=July 2010}} Studies have shown that use of neurofeedback may improve memory by up to 10%.<ref>[http://www.neurofeedback-scotland.com/alzheimer-treatment.html Neurofeedback Scotland]</ref> Other approaches to understanding and providing neurofeedback training use non-linear dynamical control processes and joint time-frequency analyses to characterize the ongoing dynamics of EEG during the training process itself. These approaches understand the functioning of the CNS in a more integrated or comprehensive fashion, including the structural ideas of the Russian neuropsychologist Luria and neuropsychiatrist Karl Pribram. 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.<ref name = "Kaiser">Kaiser, David A. "Basic Principles of Quantitative EEG." ''Journal of Adult Development'', Vol. 12, Nos. 2/3, August 2005</ref> 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).<ref name = "Kaiser" /> Later, Joe Kamiya popularized neurofeedback in the 1960s when an article<ref name=Kamiya1971>{{cite journal | author = Kamiya, J. | year = 1971 | title = Operant Control of the EEG Alpha Rhythm and Some of its Reported Effects on Consciousness | journal = Biofeedback and Self-Control: an Aldine Reader on the Regulation of Bodily Processes and Consciousness }}</ref> 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 rhythm|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. Neurofeedback appealed greatly to the social movements of the 1960s as well, when altered states were a lifestyle. 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.<ref name=Hardt1978>{{cite journal | author = Hardt, J.V. | coauthors = Kamiya, J. | year = 1978 | title = Anxiety change through electroencephalographic alpha feedback seen only in high anxiety subjects | journal = Science | volume = 201 | issue = 4350 | pages = 79–81 | doi = 10.1126/science.663641 | pmid = 663641 }}</ref> However, this is not cause to reject the concept of biofeedback entirely. Many other biofeedback treatments have emerged, since Kamiya’s alpha experiments. At one point, [[Martin Theodore Orne|Martin Orne]] and others challenged the claim that alpha biofeedback actually involved the training of an individual to voluntarily regulate brainwave activity.<ref name=Paskewitz1973>{{cite journal | author = Paskewitz, D.A. | coauthors = Orne, M.T. | year = 1973 | title = Visual Effects on Alpha Feedback Training | journal = Science | volume = 181 | issue = 4097 | pages = 360–363 | doi = 10.1126/science.181.4097.360 | pmid = 4719909 }}</ref> James Hardt and Joe Kamiya, then at [[University of California, San Francisco|UC San Francisco]]'s [[UCSF Medical Center|Langley Porter Neuropsychiatric Institute]] published a paper,<ref name=Hardt1976>{{cite journal | author = Hardt, J.V. | coauthors = Kamiya, J. | year = 1976 | title = Conflicting results in EEG alpha feedback studies | journal = Applied Psychophysiology and Biofeedback | volume = 1 | issue = 1 | pages = 63–75 | url = http://www.springerlink.com/index/Q6XU641775678664.pdf | accessdate = 2007-12-05 }}</ref> 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 (scientist)|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.<ref name=Sterman1962>{{cite journal | author = Sterman, M.B. | coauthors = Clemente, C.D. | year = 1962 | title = Forebrain inhibitory mechanisms: cortical synchronization induced by basal forebrain stimulation | journal = Exp Neurol | volume = 6 | pages = 91–102 | accessdate = 2007-12-05 | doi = 10.1016/0014-4886(62)90080-8 | pmid = 13916975 }}</ref> This training has been used in the treatment of epilepsy <ref name=Sterman1972>{{cite journal | author = Sterman, M.B. | coauthors = Friar, L. | year = 1972 | title = Suppression of seizures in an epileptic following sensorimotor EEG feedback training | journal = Electroencephalogr Clin Neurophysiol | volume = 33 | issue = 1 | pages = 89–95 | accessdate = 2007-12-05 | doi = 10.1016/0013-4694(72)90028-4 | pmid = 4113278 }}</ref><ref name=Sterman2000>{{cite journal | author = Sterman, M.B. | year = 2000 | title = Basic concepts and clinical findings in the treatment of seizure disorders with EEG operant conditioning | journal = Clin Electroencephalogr | volume = 31 | issue = 1 | pages = 45–55 | accessdate = 2007-12-05 | pmid = 10638352 }}</ref>, attention deficit disorder and hyperactive disorder,<ref name=Lubar1995>{{cite journal | author = Lubar, J.F. | coauthors = Swartwood, M.O.; Swartwood, J.N.; O'Donnell, P.H. | year = 1995 | title = 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 | journal = Applied Psychophysiology and Biofeedback | volume = 20 | issue = 1 | pages = 83–99 | url = http://www.springerlink.com/index/L2213885102N16W6.pdf | accessdate = 2007-12-05 }}</ref>. 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.<ref name=Sterman2000 /> 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.<ref>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</ref><!--unclear what the results of this study mean.--> A significant bibliography on the efficacy of EEG biofeedback documented in refereed journals is listed at isnr.org. For years, EEG biofeedback was treated as a minor part of the field of biofeedback, particularly by the primary biofeedback organization, [http://www.aapb.org AAPB]. In 1993, three different efforts, somewhat overlapping, dramatically increased the energy and influence of EEG biofeedback. In February 1993, Rob Kall, president of Futurehealth, organized the first annual [http://www.brainmeeting.com Winter Brain Meeting], in Key West Florida. The meeting brought together many of the leading figures in the field and it created a setting where the leaders could discuss and plan strategies for building greater influence and organization to move the field forward. In April 1993, Ken Tachiki, Jim Smith and Bob Grove organized a meeting of leaders in the field of Neurofeedback on Catalina Island, immediately before the 1993 AAPB meeting. Further planning took place at this meeting and the beginnings of SSNR occurred. SSNR= Society for the Study of Neuronal Regulation. Since then, SSNR has evolved to become ISNR International Society for Neuronal Regulation, and is now known as the International Society for Neurofeedback & Research [http://www.isnr.org ISNR]. Immediately after the Catalina meeting, at the 1993 AAPB meeting, a new EEG section was formed, after plenty of lively discussion. It quickly grew to become the biggest section of the organization. Things were never the same at AAPB. Neurofeedback had become a mainstream part of the field, though it took a few years to fully integrate into the annual meeting and journals. 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 [http://www.neurofeedback-scotland.com/alpha-theta-brainwave.html], other addictions as well as [[anxiety]] [http://www.neurofeedback-scotland.com/anxiety-disorders.html]. 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 physiological mechanisms behind these therapies are very unclear. And the same has been true for most medical breakthroughs throughout history. When [[endorphins]] were discovered in the body for example, they were named after morphine. The word is in fact derived from short forms of the word "[[endogenous]]" and "morphine", to indicate that it is "like morphine". In other words, people knew that morphine worked long before we knew that the body had receptor sites for morphine, or that there was even a chemical in the body that was similar to morphine. It wasn't until the work of [[Candace Pert]] that the real mechanism was discovered. The same is true for neurofeedback. The topic of mechanisms is hotly debated, and many individuals believe they have the answer, but the question of research and efficacy is a separate question. A doctor would not refuse to give a patient morphine to ease his pain just because she didn't understand the mechanism behind its functioning. ==Neurofeedback in practice== A common professional neurofeedback therapy session today goes as follows: # 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. # 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 ("quantative 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. # 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. # 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. See also: '''[[Psychophysiology]]''', the study of the connections between [[neurobiology]] and [[psychology]]. ==Evidence based== In 2009 in collaboration with researchers from Tübingen University (Germany), Radboud University (Nijmegen, the Netherlands), Brainclinics and EEG Resource Institute a meta-analysis <ref>Arns, M., de Ridder, S., Strehl, U., Breteler, M. & Coenen, A. Efficacy of Neurofeedback Treatment in ADHD: The effects on Inattention, Impulsivity and Hyperactivity: a Meta-Analysis. EEG and Clinical Neuroscience; 40(3), 180-189.(2009)</ref> was conducted on published research about Neurofeedback treatment in ADHD which concluded that neurofeedback is an ‘[[evidence-based medicine|evidence-based]]’ treatment for ADHD. [http://qeegsupport.com/neurofeedback-is-an-%E2%80%98evidence-based%E2%80%99-treatment-for-adhd// See reference] ==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 <ref>[http://www.sciencedaily.com/releases/2010/03/100310114936.htm Science Daily]</ref>. 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]] <ref name=Ros2010>{{cite journal | doi = 10.1111/j.1460-9568.2010.07100.x | author = Ros T. | coauthors = Munneke M.A.M., Ruge D., Gruzelier J.H., Rothwell J.C. | year = 2010 | title = Endogenous Control of Waking Brain Rhythms Induces Neuroplasticity in Humans | journal = European Journal of Neuroscience | volume = 31 | issue = 4 | pages = 770–778 | url = http://www.mendeley.com/download/public/8514/2391824091/414751165a629a08e0c90c8b0f4b9a316fa11b26/dl.pdf | accessdate = 2010-2-12 | pmid = 20384819 }}</ref>. ==See also== * [[Brainwave synchronization]] * [[Comparison of neurofeedback software]] * [[Binaural beats]] * [[Electroencephalography]] * [[Mind machine]] * [[Human enhancement]] * [[Intelligence amplification]] * [[Neural oscillation]] * [[Evoked potential]] * [[Event-related potential]] * [[Induced activity]] * [[Ongoing brain activity]] ==References== {{Reflist|2}} ==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). == External links == '''Articles and research links:''' *[http://news.bbc.co.uk/2/hi/health/3091595.stm BBC article about neurofeedback improving the performance of musicians] *[http://archives.cnn.com/2000/HEALTH/alternative/02/17/neuro.feedback.wmd/ CNN article about growing field of bio- and neuro-feedback] *[http://www.eeginfo.com/research/ EEG Research links] *[http://www.coping-with-epilepsy.com/forums/f22/eeg-neurofeedback-501/ Summary of neurofeedback studies for epilepsy] *[http://www.bf-israel.org/neurofeedback/Gruzelier%20&%20Egner%202005.pdf Critical validation studies of neurofeedback] *[http://www.northwestern.edu/magazine/winter2008/feature/baehr.html On A Different Wavelength - NorthWestern Magazine article about Dr. Elsa Baehr] '''Organizations involved in research and development:''' *[http://www.isnr.org The International Society for Neurofeedback Research] hosts annual professional conferences, and publishes a peer-reviewed journal that focuses on neurofeedback. * [http://www.applied-neuroscience.org Society of Applied Neuroscience] is a nonprofit membership organization devoted to advancing neuroscientific applications including neurofeedback *[http://www.aapb.org The Association for Applied Psychophysiology and Biofeedback] hosts an annual and regional professional conferences on applied psychophysiology including neurofeedback. They have published a peer reviewed journal since about 1975. *[http://www.bcia.org The Biofeedback Certification Institute of America] is a recognized certification organization for professionals who demonstrate entry-level competence in applied psychophysiology, including biofeedback and neurofeedback. *[http://www.HomeComingForVeterans.org/ Home Coming for Veterans] is a national outreach program to provide free Neurofeedback training for veterans for the rehabilitation of Post-Traumatic Stress Disorder and issues of brain performance resulting from traumatic brain injury, blast injury, concussion, whiplash, and chemical exposure. *[http://openeeg.sourceforge.net/doc/ OpenEEG project] open source software for do-it-yourself EEG devices. '''Neurofeedback Web Sites of Interest''' *[http://www.eeginfo.com The EEG Info (Othmer) - The Othmer's have contributed greatly to the field of Neurofeedback. *[http://www.eegspectrum.com Spectrum International. *[http://www.bfe.org Biofeedback Foundation of Europe. *[http://www.neurofeedbackwellnesscenter.com Neurofeedback & Videos. *[http://www.eegvermont.com Neurofeedback of South Vermont (John Demos - Author / EEG Trainer) *[http://www.brainmaster.com Brain Master Technologies, Inc. *[http://www.swingleandassociates.com Dr Swingle & Associates (Latest Protocols for Neurofeedback) [[Category:Devices to alter consciousness]] [[Category:Clinical psychology]] [[Category:Medical tests]] [[Category:Electroencephalography]] [[Category:Evoked potentials]] [[Category:Neurotechnology]] [[Category:Behaviorism]] [[Category:Mental health]] [[Category:Alternative medical systems]] [[Category:Naturopathic medicine]] [[Category:Neuropsychology]] [[ar:ارتجاع عصبي]] [[de:Neurofeedback]] [[es:Neurorretroalimentación]] [[it:Neurofeedback]] [[lt:Neuroninis grįžtamasis ryšys]] [[nl:Neurofeedback]] [[pl:Neurotrening]]'