Neurofeedback

Last updated

Neurofeedback training process diagram Neurofeedback Process Diagram.png
Neurofeedback training process diagram

Neurofeedback is a form of biofeedback that uses electrical potentials in the brain to reinforce desired brain states through operant conditioning. This process is non-invasive neurotherapy and typically collects brain activity data using electroencephalography (EEG). Several neurofeedback protocols exist, with potential additional benefit from use of quantitative electroencephalography (QEEG) or functional magnetic resonance imaging (fMRI) to localize and personalize treatment. [1] [2] Related technologies include functional near-infrared spectroscopy-mediated (fNIRS) neurofeedback, hemoencephalography biofeedback (HEG), and fMRI biofeedback.

Contents

Neurofeedback is FDA-cleared for PTSD treatment, and training for ADHD and major depressive disorder shows promising results. It has been shown to trigger positive behavioral outcomes, such as relieving symptoms related to psychiatric disorders or improving specific cognitive functions in healthy participants. These positive behavioral outcomes rely on brain plasticity mechanisms and the ability of subjects to learn throughout life. [3]

History

In 1898, Edward Thorndike formulated the law of effect. In his work, he theorized that behavior is shaped by satisfying or discomforting consequences. This set the foundation for operant conditioning.[ citation needed ]

In 1924, the German psychiatrist Hans Berger connected several electrodes to a patient's scalp and detected a small current by using a ballistic galvanometer. In his subsequent studies, Berger analyzed EEGs qualitatively, but in 1932, G. Dietsch applied Fourier analysis to seven EEG records and later became the first researcher to apply quantitative EEG (QEEG).

In 1950, Neal E. Miller of Yale University was able to train mice to regulate their heartbeat frequency. Later on, he continued his work with humans, training them through auditory feedback. [4]

The first study to demonstrate neurofeedback was reported by Joe Kamiya in 1962. [5] [6] Kamiya's experiment had two parts: In the first part, a subject was asked to keep their eyes closed, and when a tone sounded, to say whether they were experiencing alpha waves. Initially, the subject would guess correctly about fifty percent of the time, but some subjects would eventually develop the ability to better distinguish between states. [7]

M. Barry Sterman trained cats to modify their EEG patterns to exhibit more of the so-called sensorimotor rhythm (SMR). He published this research in 1967. Sterman subsequently discovered that the SMR-trained cats were much more resistant to epileptic seizures after exposure to the convulsant chemical monomethylhydrazine than non-trained cats. [8] In 1971, he reported similar improvements with an epileptic patient whose seizures could be controlled through SMR training. [9] Joel Lubar contributed to the research of EEG biofeedback, starting with epilepsy [10] and later with hyperactivity and ADHD. [11]

Neuroplasticity

In 2010, a study provided some evidence of neuroplastic changes occurring after brainwave training. In this study, half an hour of voluntary control of brain rhythms led to a lasting shift in cortical excitability and intracortical function. [12] The authors observed that the cortical response to transcranial magnetic stimulation (TMS) was significantly enhanced after neurofeedback, persisted for at least twenty minutes, and was correlated with an EEG time-course indicative of activity-dependent plasticity [12]

Types of neurofeedback

The term neurofeedback is not legally protected. There are various approaches that give feedback about neuronal activity, and as such are referred to as "neurofeedback" by their respective operators. Distinctions can be made on several levels. The first takes into account which technology is being used (EEG, [13] [14] [15] [16] [17] fMRI, [18] [19] [20] [21] fNIRS, [22] HEG). Nonetheless, further distinctions are crucial even within the realm of EEG neurofeedback, as different methodologies of analysis can be chosen, some of which are backed up by a higher number of peer-reviewed studies, whereas for others, scientific literature is scarce, and explanatory models are entirely missing.

Despite these differences, a common denominator can be found in the requirement of providing feedback. Usually, feedback is provided by auditory or visual input. While original feedback was provided by sounding tones according to neurological activity, many new ways have been found. It is possible to listen to music or podcasts where the volume is controlled as feedback, for example. Often, visual feedback is used in the form of animations on a TV screen. Visual feedback can also be provided in combination with videos and films, or even during reading tasks where the brightness of the screen represents the direct feedback. Simple games can also be used, where the game itself is controlled by the brain activity. Recent developments have tried to incorporate virtual reality (VR), and controllers can already be used for more involved engagement with the feedback.

EEG neurofeedback

Frequency band / amplitude training

Amplitude training, or frequency band training (used synonymously), is the method with the largest body of scientific literature; it also represents the original method of EEG neurofeedback. [5] [9] [11] The EEG signal is analyzed with respect to its frequency spectrum, split into the common frequency bands used in EEG neuroscience (delta, theta, alpha, beta, gamma). The activity involves training the amplitude of a certain frequency band on a defined location on the scalp to higher or lower values.

Depending on the training goal (for example, increasing attention and focus, [23] [24] reaching a calm state, [25] reducing epileptic seizures, [9] [26] [27] etc.), the electrodes have to be placed in different positions. Additionally, the trained frequency bands and the training directions (to higher or lower amplitudes) might vary according to the training goal.

Thus, EEG wave components that are expected to be beneficial to the training goal are rewarded with positive feedback when appearing and/or increasing in amplitude. Frequency band amplitudes that are expected to be hindering are trained downwards by reinforcement through the feedback.

As an example, considering ADHD, this would result in training low-beta or mid-beta frequencies in the central-to-frontal lobe to increase in amplitude, while simultaneously trying to reduce theta and high-beta amplitudes in the same region of the brain. [28] [29] [30]

In the sports domain, SMR training has garnered attention, with a substantial body of research suggesting that enhancing it could improve performance. [31]

SCP training

For SCP (slow cortical potentials) training, one trains the DC voltage component of the EEG signal. The application of this type of EEG neurofeedback training was mostly endorsed by research done by Niels Birbaumer and his group. The most common symptom base for SCP training is ADHD, whereas SCPs also find their application in brain-computer interfaces. [32]

LORETA (low resolution electromagnetic tomography analysis) training

Normal EEG signals are restricted to the surface of the scalp. Using a high number of electrodes (19 or more), the source of certain electrical events can be localized. Similar to a tomography that renders a 3D image out of many 2D images, the many EEG channels are used to create LORETA images that represent in 3D the electrical activity distribution within the brain. The LORETA method can be used in combination with MRI to merge structural and functional activities. It is able to provide even better temporal resolution than PET or fMRI. For the application with live neurofeedback, however, 19-channel neurofeedback and LORETA has limited scientific evidence, and until now, shows no benefit over traditional 1- or 2-channel neurofeedback. [33]

Effectiveness

Neurofeedback is FDA-cleared for PTSD treatment. A 2023 systematic review and meta-analysis of ten clinical trials found that electroencephalographic neurofeedback significantly reduces PTSD symptoms, with a 79.3% remission rate compared to 24.4% in control groups, and suggests that improvements are associated with neurophysiological changes in brain activity. [34] [35]

Neurofeedback training for ADHD shows promising results, with some protocols offering better outcomes, though its efficacy remains controversial [36] and requires further research to determine the best approach. [37] A meta-analysis of 22 studies found that neurofeedback significantly improves depressive symptoms, neurophysiological outcomes, and neuropsychological function in individuals with major depressive disorders, with longer interventions enhancing psychological outcomes and shorter sessions benefiting neurophysiological measures. [38]

There is ongoing discussion about the effect size of neurofeedback in the scientific literature. As neurofeedback is explained mostly based on the model of operant conditioning, [39] the sensitivity of the feedback (the difficulty to receive a reward) also plays a role. It has been shown that the desired conditioning can be reversed if threshold values are set too low. [40] Other publications have not found any effect of neurofeedback, apart from placebo, when using automatic thresholds that update every thirty seconds in order to maintain a constant success rate of 80%. [41] [42]

See also

References

  1. Mehler DM, Sokunbi MO, Habes I, Barawi K, Subramanian L, Range M, et al. (December 2018). "Targeting the affective brain-a randomized controlled trial of real-time fMRI neurofeedback in patients with depression". Neuropsychopharmacology. 43 (13): 2578–2585. doi:10.1038/s41386-018-0126-5. PMC   6186421 . PMID   29967368.
  2. Arns M, Drinkenburg W, Leon Kenemans J (September 2012). "The effects of QEEG-informed neurofeedback in ADHD: an open-label pilot study". Applied Psychophysiology and Biofeedback. 37 (3): 171–80. doi:10.1007/s10484-012-9191-4. PMC   3419351 . PMID   22446998.
  3. Loriette C (2021). "Neurofeedback for cognitive enhancement and intervention and brain plasticity". Revue Neurologique. 177 (9): 1133–1144. doi:10.1016/j.neurol.2021.08.004. PMID   34674879.
  4. Pickering TG, Miller NE (1 September 1975). "Learned Voluntary Control of Heart Rate and Rhythm in Two Subjects with Premature Ventricular Contractions" . Clinical Science. 49 (3): 17P –18P. doi:10.1042/cs049017Pd. ISSN   0301-0538.
  5. 1 2 Kamiya J (1979), "Autoregulation of the EEG Alpha Rhythm: A Program for the Study of Consciousness" , Mind/Body Integration, Boston, MA: Springer US, pp. 289–297, doi:10.1007/978-1-4613-2898-8_25, ISBN   978-1-4613-2900-8 , retrieved 28 April 2023
  6. Kamiya J (22 February 2011). "The First Communications About Operant Conditioning of the EEG". Journal of Neurotherapy. 15 (1): 65–73. doi: 10.1080/10874208.2011.545764 . ISSN   1087-4208.
  7. Frederick JA (September 2012). "Psychophysics of EEG alpha state discrimination". Consciousness and Cognition. 21 (3): 1345–1354. doi:10.1016/j.concog.2012.06.009. PMC   3424312 . PMID   22800733.
  8. Sterman MB (January 2000). "Basic Concepts and Clinical Findings in the Treatment of Seizure Disorders with EEG Operant Conditioning" . Clinical Electroencephalography. 31 (1): 45–55. doi:10.1177/155005940003100111. ISSN   0009-9155. PMID   10638352. S2CID   43506749.
  9. 1 2 3 Sterman M, Friar L (July 1972). "Suppression of seizures in an epileptic following sensorimotor EEG feedback training" . Electroencephalography and Clinical Neurophysiology. 33 (1): 89–95. doi:10.1016/0013-4694(72)90028-4. PMID   4113278.
  10. Seifert A, Lubar J (November 1975). "Reduction of epileptic seizures through EEG biofeedback training" . Biological Psychology. 3 (3): 157–184. doi:10.1016/0301-0511(75)90033-2. PMID   812560. S2CID   15698128.
  11. 1 2 Lubar JF, Shouse MN (September 1976). "EEG and behavioral changes in a hyperkinetic child concurrent with training of the sensorimotor rhythm (SMR): A preliminary report" . Biofeedback and Self-Regulation. 1 (3): 293–306. doi:10.1007/BF01001170. ISSN   0363-3586. PMID   990355. S2CID   17141352.
  12. 1 2 Ros T, Munneke MA, Ruge D, Gruzelier JH, Rothwell JC (February 2010). "Endogenous control of waking brain rhythms induces neuroplasticity in humans". The European Journal of Neuroscience. 31 (4): 770–8. doi:10.1111/j.1460-9568.2010.07100.x. PMID   20384819. S2CID   16969327.
  13. Lubar JF, Swartwood MO, Swartwood JN, O'Donnell PH (1 March 1995). "Evaluation of the 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" . Biofeedback and Self-Regulation. 20 (1): 83–99. doi:10.1007/BF01712768. ISSN   1573-3270. PMID   7786929. S2CID   19193823.
  14. Kluetsch RC, Ros T, Théberge J, Frewen PA, Calhoun VD, Schmahl C, Jetly R, Lanius RA (August 2014). "Plastic modulation of PTSD resting-state networks and subjective wellbeing by EEG neurofeedback". Acta Psychiatrica Scandinavica. 130 (2): 123–136. doi:10.1111/acps.12229. PMC   4442612 . PMID   24266644.
  15. Reiter K, Andersen SB, Carlsson J (February 2016). "Neurofeedback Treatment and Posttraumatic Stress Disorder: Effectiveness of Neurofeedback on Posttraumatic Stress Disorder and the Optimal Choice of Protocol" . Journal of Nervous & Mental Disease. 204 (2): 69–77. doi:10.1097/NMD.0000000000000418. ISSN   0022-3018. PMID   26825263. S2CID   25210316.
  16. Micoulaud-Franchi JA, Geoffroy PA, Fond G, Lopez R, Bioulac S, Philip P (2014). "EEG neurofeedback treatments in children with ADHD: an updated meta-analysis of randomized controlled trials". Frontiers in Human Neuroscience. 8: 906. doi: 10.3389/fnhum.2014.00906 . ISSN   1662-5161. PMC   4230047 . PMID   25431555.
  17. Omejc N, Rojc B, Battaglini PP, Marusic U (20 November 2018). "Review of the therapeutic neurofeedback method using electroencephalography: EEG Neurofeedback". Bosnian Journal of Basic Medical Sciences. 19 (3): 213–220. doi:10.17305/bjbms.2018.3785. ISSN   1840-4812. PMC   6716090 . PMID   30465705.
  18. Zotev V, Phillips R, Yuan H, Misaki M, Bodurka J (15 January 2014). "Self-regulation of human brain activity using simultaneous real-time fMRI and EEG neurofeedback". NeuroImage. Neuro-enhancement. 85: 985–995. arXiv: 1301.4689 . doi:10.1016/j.neuroimage.2013.04.126. ISSN   1053-8119. PMID   23668969. S2CID   2836232.
  19. Pindi P, Houenou J, Piguet C, Favre P (December 2022). "Real-time fMRI neurofeedback as a new treatment for psychiatric disorders: A meta-analysis". Progress in Neuro-Psychopharmacology and Biological Psychiatry. 119: 110605. doi: 10.1016/j.pnpbp.2022.110605 . PMID   35843369. S2CID   250586279.
  20. Linhartová P, Látalová A, Kóša B, Kašpárek T, Schmahl C, Paret C (June 2019). "fMRI neurofeedback in emotion regulation: A literature review" . NeuroImage. 193: 75–92. doi:10.1016/j.neuroimage.2019.03.011. PMID   30862532. S2CID   72333597.
  21. Nicholson AA, Rabellino D, Densmore M, Frewen PA, Paret C, Kluetsch R, Schmahl C, Théberge J, Neufeld RW, McKinnon MC, Reiss JP, Jetly R, Lanius RA (January 2017). "The neurobiology of emotion regulation in posttraumatic stress disorder: Amygdala downregulation via real-time fMRI neurofeedback". Human Brain Mapping. 38 (1): 541–560. doi:10.1002/hbm.23402. ISSN   1065-9471. PMC   6866912 . PMID   27647695.
  22. Kohl SH, Mehler DM, Lührs M, Thibault RT, Konrad K, Sorger B (21 July 2020). "The Potential of Functional Near-Infrared Spectroscopy-Based Neurofeedback—A Systematic Review and Recommendations for Best Practice". Frontiers in Neuroscience. 14: 594. doi: 10.3389/fnins.2020.00594 . ISSN   1662-453X. PMC   7396619 . PMID   32848528.
  23. Arns M, Clark CR, Trullinger M, deBeus R, Mack M, Aniftos M (June 2020). "Neurofeedback and Attention-Deficit/Hyperactivity-Disorder (ADHD) in Children: Rating the Evidence and Proposed Guidelines". Applied Psychophysiology and Biofeedback. 45 (2): 39–48. doi:10.1007/s10484-020-09455-2. ISSN   1090-0586. PMC   7250955 . PMID   32206963.
  24. Van Doren J, Arns M, Heinrich H, Vollebregt MA, Strehl U, K Loo S (March 2019). "Sustained effects of neurofeedback in ADHD: a systematic review and meta-analysis". European Child & Adolescent Psychiatry. 28 (3): 293–305. doi:10.1007/s00787-018-1121-4. ISSN   1018-8827. PMC   6404655 . PMID   29445867.
  25. Krylova M, Skouras S, Razi A, Nicholson AA, Karner A, Steyrl D, Boukrina O, Rees G, Scharnowski F, Koush Y (3 December 2021). "Progressive modulation of resting-state brain activity during neurofeedback of positive-social emotion regulation networks". Scientific Reports. 11 (1): 23363. Bibcode:2021NatSR..1123363K. doi:10.1038/s41598-021-02079-4. ISSN   2045-2322. PMC   8642545 . PMID   34862407.
  26. Sterman MB, Egner T (March 2006). "Foundation and Practice of Neurofeedback for the Treatment of Epilepsy" . Applied Psychophysiology and Biofeedback. 31 (1): 21–35. doi:10.1007/s10484-006-9002-x. ISSN   1090-0586. PMID   16614940. S2CID   1445660.
  27. Monderer RS, Harrison DM, Haut SR (June 2002). "Neurofeedback and epilepsy" . Epilepsy & Behavior. 3 (3): 214–218. doi:10.1016/S1525-5050(02)00001-X. PMID   12662600. S2CID   31198834.
  28. Van Doren J, Arns M, Heinrich H, Vollebregt MA, Strehl U, K Loo S (1 March 2019). "Sustained effects of neurofeedback in ADHD: a systematic review and meta-analysis". European Child & Adolescent Psychiatry. 28 (3): 293–305. doi:10.1007/s00787-018-1121-4. ISSN   1435-165X. PMC   6404655 . PMID   29445867.
  29. Enriquez-Geppert S, Smit D, Pimenta MG, Arns M (28 May 2019). "Neurofeedback as a Treatment Intervention in ADHD: Current Evidence and Practice". Current Psychiatry Reports. 21 (6): 46. doi:10.1007/s11920-019-1021-4. ISSN   1535-1645. PMC   6538574 . PMID   31139966.
  30. Dashbozorgi Z, Ghaffari A, Karamali Esmaili S, Ashoori J, Moradi A, Sarvghadi P (10 September 2021). "Effect of Neurofeedback Training on Aggression and Impulsivity in Children with Attention-Deficit/Hyperactivity Disorder: A Double-Blinded Randomized Controlled Trial". Basic and Clinical Neuroscience. 12 (5): 693–702. doi:10.32598/bcn.2021.2363.1. PMC   8818111 . PMID   35173923. S2CID   237880490.
  31. Xiang MQ, Hou XH, Liao BG, Liao JW, Hu M (1 May 2018). "The effect of neurofeedback training for sport performance in athletes: A meta-analysis" . Psychology of Sport and Exercise. 36: 114–122. doi:10.1016/j.psychsport.2018.02.004. ISSN   1469-0292. S2CID   148988970.
  32. Birbaumer N, Ramos Murguialday A, Weber C, Montoya P (1 January 2009), "Chapter 8 Neurofeedback and Brain–Computer Interface: Clinical Applications" , International Review of Neurobiology, 86, Academic Press: 107–117, doi:10.1016/s0074-7742(09)86008-x, PMID   19607994 , retrieved 28 April 2023
  33. Coben R, Hammond DC, Arns M (1 March 2019). "19 Channel Z-Score and LORETA Neurofeedback: Does the Evidence Support the Hype?". Applied Psychophysiology and Biofeedback. 44 (1): 1–8. doi:10.1007/s10484-018-9420-6. ISSN   1573-3270. PMC   6373269 . PMID   30255461.
  34. Askovic M, Soh N, Elhindi J, Harris AW (2023). "Neurofeedback for post-traumatic stress disorder: systematic review and meta-analysis of clinical and neurophysiological outcomes". European Journal of Psychotraumatology. 14 (2): 2257435. doi:10.1080/20008066.2023.2257435. PMC   10515677 . PMID   37732560.
  35. Voigt JD, Mosier M, Tendler A (2024). "Systematic review and meta-analysis of neurofeedback and its effect on posttraumatic stress disorder". Frontiers in Psychiatry. 15: 1088. doi: 10.3389/fpsyt.2024.1323485 . PMC   10993781 . PMID   38577405.
  36. McGough JJ (2022). "Neurofeedback for ADHD: Time to Call It Quits?" . American Journal of Psychiatry. 179 (12): 888–889. doi:10.1176/appi.ajp.20220861. PMID   36453036.
  37. Rahmani J, Gharabaghi B, Ghaffari A (2023). "Clinical efficacy of neurofeedback protocols in treatment of Attention Deficit/Hyperactivity Disorder (ADHD): A systematic review and meta-analysis". Psychiatry Research. 319 (4): 114036. doi: 10.3390/cells12040624 . PMC   9953935 . PMID   36831292.
  38. Lu BY, Zhang ZY, Shi YR, Wang YH, Yao ZL, Li Y, Chen XL (2024). "Efficacy of neurofeedback for major depressive disorder: A systematic review and meta-analysis". Neuroscience & Biobehavioral Reviews. 158 (6): 105556. doi:10.1093/cercor/bhae252. PMID   38889442.
  39. Dessy E, Mairesse O, van Puyvelde M, Cortoos A, Neyt X, Pattyn N (10 March 2020). "Train Your Brain? Can We Really Selectively Train Specific EEG Frequencies with Neurofeedback Training". Frontiers in Human Neuroscience. 14: 22. doi: 10.3389/fnhum.2020.00022 . PMC   7077336 . PMID   32210777.
  40. Bauer R, Vukelić M, Gharabaghi A (1 September 2016). "What is the optimal task difficulty for reinforcement learning of brain self-regulation?" . Clinical Neurophysiology. 127 (9): 3033–3041. doi:10.1016/j.clinph.2016.06.016. ISSN   1388-2457. PMID   27472538. S2CID   3686790.
  41. Thibault RT, Raz A (October 2017). "The psychology of neurofeedback: Clinical intervention even if applied placebo". American Psychologist. 72 (7): 679–688. doi:10.1037/amp0000118. ISSN   1935-990X. PMID   29016171. S2CID   4650115.
  42. Thibault RT, Lifshitz M, Birbaumer N, Raz A (2015). "Neurofeedback, Self-Regulation, and Brain Imaging: Clinical Science and Fad in the Service of Mental Disorders". Psychotherapy and Psychosomatics. 84 (4): 193–207. doi:10.1159/000371714. ISSN   0033-3190. PMID   26021883. S2CID   17750375.

Further reading