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Read the research that sparked the idea for Versus.

Below you’ll find abstracts from published papers on the efficacy of neurofeedback for performance enhancement and treating a variety of medical conditions. This content is for informational purposes only.

The scientific principles examined in this research were considered during the design of Versus. However, Versus is not a registered neurofeedback device and is not intended to diagnose, treat, cure, or prevent any disease or disorder. You should always seek the advice of your physician or other qualified health provider on any questions you may have regarding a medical condition.

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Versus is the product of decades of research and innovation, detailed in the peer-reviewed papers below.


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This review article summarizes some recent developments in psychiatry such as personalized medicine, employing biomarkers and endophenotypes, and developments collectively referred to as neuromodulation with a focus on ADHD. Several neurophysiological subtypes in ADHD and their relation to treatment outcome are reviewed. In older research the existence of an “abnormal EEG” or “paroxysmal EEG” was often reported, most likely explained by the high occurrence of this EEG subtype in autism, as the diagnosis of autism was not coined until 1980. This subgroup might respond best to anticonvulsant treatments, which requires more specific research. A second subgroup is a beta-excess or beta-spindling subgroup. This group responds well to stimulant medication, albeit several studies suggesting that neurophysiologically this might represent a different subgroup. The third subgroup consists of the “impaired vigilance” subgroup with the often-reported excess frontal theta or excess frontal alpha. This subgroup responds well to stimulant medication. Finally, it is proposed that a slow individual alpha peak frequency is an endophenotype related to treatment resistance in ADHD. Future studies should incorporate this endophenotype in clinical trials to further investigate new treatments for this substantial subgroup of patients, such as NIRS-biofeedback, transcranial Doppler sonography biofeedback, hyperbaric oxygen therapy, or medications such as nicotine and piracetam.

Until recently, treatment has been limited to management through the use of powerful stimulant drugs, such as methylphenidate (Ritalin), and behavior modification. Medication has significant side effects, and even the most elaborate behavior modification programs do not generalize to nontrained behaviors or carry over to the school environment (Gaddes & Edgell, 1994). Cessation of either treatment results in the rapid return of pretreatment symptoms and dysfunction. In contrast to symptom management approaches, neurotherapy (brainwave biofeedback) provides a rehabilitative approach, but may take as many as 40 to 80 sessions. In this chapter, we introduce a new hypnotic-attentional instruction procedure to facilitate normalization of EEG and to accelerate neurotherapy retraining by reducing the number of sessions required by half. We also review the most recent diagnostic considerations, prevalence issues, and traditional treatments.

Although Attention-Deficit/Hyperactivity Disorder (AD/HD) affects millions of females worldwide, our understanding of AD/HD continues to be based heavily on male-dominated research. Significant sex differences reported in the presentation and diagnosis of AD/HD can no longer be ignored; females with AD/HD are different from males with the disorder. Electroencephalography (EEG) is a valuable tool for measuring electro-cortical activity and has been found useful in AD/HD research. Preliminary studies have shown that females with AD/HD have EEG abnormalities different from those found in males with AD/HD. This article reviews the current literature on EEG activity of females with AD/HD and concludes that the lack of comprehensive research draws attention to the necessity for sex-specific EEG research within AD/HD populations.
Learned enhancement of EEG frequency components in the lower beta range by means of biofeedback has been reported to alleviate attention deficit hyperactivity disorder (ADHD) symptoms. In order to elucidate frequency-specific behavioural effects and neurophysiological mediators, this study applied neurofeedback protocols to healthy volunteers, and assessed impact on behavioural and electrocortical attention measures. Operant enhancement of a 12–15 Hz component was associated with reduction in commission errors and improved perceptual sensitivity on a continuous performance task (CPT), while the opposite relation was found for 15–18 Hz enhancement. Both 12–15 Hz and 15–18 Hz enhancement were associated with significant increases in P300 event-related brain potential amplitudes in an auditory oddball task. These relations are interpreted as stemming from band-specific effects on perceptual and motor aspects of attention measures.
This is a case report of an adult female patient with ADHD, temporal seizure disorder, and Borderline Personality Disorder treated with 30 weekly sessions of SMR neurofeedback and carbamazepine. Posttreatment measures showed improvements in T.O.V.A., self report, and QEEG. Both neurofeedback and carbamazepine showed the most effect in early treatment. Progress continued after discontinuance of the drug.
An electroencephalographic (EEG) biofeedback procedure was used in a pilot study to decrease the percent of time in alpha wave activity with five mentally retarded adults while engaged in an arithmetic test. Analysis of intrasubject and intersubject data revealed an overall significant decrease in the number of alpha events and percent of time in alpha wave activity as compared to baseline conditions. Such a decrease indicated facilitated attention by EEG definition. A collateral increase in percent of problems completed correctly and decrease in the number of distractible head-turning responses were noted. An automated method of determining head position was used and shown to be reliable in comparison to a human observer.
Introduction. Studies performed during the last decades suggest that neurofeedback (NF) training can effectively reduce symptomatology in children with Attention deficit hyperactivity disorder (ADHD). Yet questions remain concerning specific effects of NF training in ADHD children, because these studies did not use a randomized, placebo-controlled approach. To address this issue, such an approach was used in the present study to measure the impact of NF training on inhibitory capacities. Method. Nine ADHD children (with no comorbidity), aged 8 to 13 years, were randomly assigned to either an experimental group (n = 5) or a placebo group (n = 4). For both groups, training protocols comprised 40 one-hr sessions (20 meetings of 2 sessions each). Sensorimotor rhythm/Theta training was used in the experimental group. Prerecorded sessions of the first author’s EEG activity were used in the placebo group. Pre- and posttraining assessments consisted of the Conner’s Parent Rating Scales (CPRS–R) and neuropsychological tests. A multiple case study strategy was applied for data analysis using a Reliable Change Index when applicable. Results. One experimental participant was a dropout, and one placebo participant had to be discontinued due to adverse effects. The latter participant accepted to undergo posttraining evaluations; hence an Intention-to-Treat analysis was performed on this participant’s data. Remaining participants showed significant improvements on the CPRS–R. Improvements were measured on the Variability measure of the CPT–II consistently across the placebo group and on the Inhibition Condition of the Stroop Task for all but one placebo participant. The same trend was found for the Inhibition/Switching Condition (Stroop Task) across the experimental group (n = 4). Conclusion. The small sample size precludes from evaluating specific neurofeedback effects. Still, the presence of placebo responses suggests that other factors, such as motivation or expectations, might contribute to the outcome of NF training in children with ADHD.
This study replicated T. R. Rossiter and T. J. La Vaque (1995) with a larger sample, expanded age range, and improved statistical analysis. Thirty-one AD/HD patients who chose stimulant drug (MED) treatment were matched with 31 patients who chose a neurofeedback (EEG) treatment program. EEG patients received either office (n = 14) or home (n = 17) neurofeedback. Stimulants for MED patients were titrated using the Test of Variables of Attention (TOVA). EEG (effect size [ES] = 1.01–1.71) and MED (ES = 0.80–1.80) groups showed statistically and clinically significant improvement on TOVA measures of attention, impulse control, processing speed, and variability in attention. The EEG group demonstrated statistically and clinically significant improvement on behavioral measures (Behavior Assessment System for Children, ES = 1.16–1.78, and Brown Attention Deficit Disorder Scales, ES = 1.59). TOVA gain scores for the EEG and MED groups were not significantly different. More importantly, confidence interval and nonequivalence null hypothesis testing confirmed that the neurofeedback program produced patient outcomes equivalent to those obtained with stimulant drugs. An effectiveness research design places some limitations on the conclusions that can be drawn.
In this research, the effectiveness of neurofeedback, along with virtual reality (VR), in reducing the level of inattention and impulsiveness was investigated. Twenty-eight male participants, aged 14–18, with social problems, took part in this study. They were separated into three groups: a control group, a VR group, and a non-VR group. The VR and non-VR groups underwent eight sessions of neurofeedback training over 2 weeks, while the control group just waited during the same period. The VR group used a head-mounted display (HMD) and a head tracker, which let them look around the virtual world. Conversely, the non-VR group used only a computer monitor with a fixed viewpoint. All participants performed a continuous performance task (CPT) before and after the complete training session. The results showed that both the VR and non-VR groups achieved better scores in the CPT after the training session, while the control group showed no significant difference. Compared with the other groups, the VR group presented a tendency to get better results, suggesting that immersive VR is applicable to neurofeedback for the rehabilitation of inattention and impulsiveness.
Introduction: Neurofeedback is an alternative treatment for Attention Deficit Hyperactivity Disorder (ADHD), but its efficacy is unknown. This narrative review examines rigorous studies conducted utilizing neurofeedback as a treatment for ADHD. Methods: Studies were located by searching the Web of Science and PsycINFO databases with the keywords ADHD or attention deficit hyperactivity disorder AND neurofeedback or EEG biofeedback or electroencephalogram biofeedback. Located studies were chosen for initial review if they met the following criteria: (a) randomized controlled trial or quasi-experiment, (b) ADHD diagnosis based on DSM criteria, (c) published at any time prior to March 2010, (d) English language, and (e) published in a peer-reviewed journal. Participants included children, adolescents, and adults diagnosed with ADHD. Results: Twelve articles reporting 9 different studies met the eligibility criteria and were included in the review. All 9 studies produced results that indicated significant improvements on either tests scores or behavioral conduct for individuals who were treated with neurofeedback for ADHD. Alternative treatments also demonstrated effectiveness. Conclusion: Neurofeedback may be an effective treatment for ADHD. Future research is needed with larger sample sizes, comparing the efficacy of neurofeedback with the efficacy of other ADHD treatments and comparing different neurofeedback protocols.
This study investigated the treatment outcome of males dependent on crack cocaine participating in an inpatient treatment facility in which electroencephalographic operant conditioning training (EEG-OC) was added to the treatment protocol. Eighty-seven men were assessed twelve months after completion of the EEG portion of the program. Follow-up procedures of urinalyses, self-report measures, length of residence, and scores on a measure of depression were obtained and showed significant changes after treatment. The addition of EEG-OC to crack cocaine treatment regimens may promise to be an effective intervention for treating crack cocaine abuse and increasing treatment retention.
Introduction. This study is a long-term follow-up of an early replication of the Peniston EEG biofeedback (EEG-BFB) Protocol for chemical dependency (Peniston & Kulkosky, 1989, 1990). Method. This clinical trial included 16 chemically dependent adult participants treated with the Peniston Protocol in a university outpatient clinic between 1993 and 1995. Ten participants were probationers classified as high risk for rearrest. Treatment effects were assessed using pre/posttreatment measures (Beck Depression Inventory, Minnesota Multiphasic Personality Inventory-2) and long-term follow-up of abstinence and rearrest rates. Probationer rearrest rates were compared to an equivalent probation sample (n = 24) that did not receive EEG-BFB. Results. Initial Beck Depression Inventory scores indicated mild/moderate depression but were significantly reduced posttreatment to within normal limits. Substantial differences were noted posttreatment on 7 Minnesota Multiphasic Personality Inventory-2 clinical scales suggesting less psychopathology following treatment. Long-term (74–98 months) follow-up indicated that 81.3% (n = 13) participants were abstinent. Rearrest rates and probation revocations for the probationer subgroup were lower than the comparison group (40% vs. 79.16%). Conclusion. This study provides evidence of the durability of Peniston Protocol results over time but has the usual limitations of a clinical trial with a small sample, nonrandomized, and uncontrolled design. Implications for further research are discussed including the relevance of recent modifications to the Peniston Protocol and qEEG–based protocols in treating substance abuse.
The present study evaluated quantitative electroencephalogram (QEEG)-guided and Scott/Peniston neurofeedback compared with a wait-list control in the treatment of substance abuse in an outpatient setting. Participants completed an intake assessment, 40 neurofeedback sessions, and a posttraining assessment. Change scores of the clinical scales of the Personality Assessment Inventory were used for outcomes. Compared with controls, QEEG-guided neurofeedback resulted in improvement on three scales, whereas Scott/Peniston training resulted in improvement on two scales. Findings showed significantly decreased symptoms of anxiety, schizophrenia, alcohol problems, and drug problems. The changes in outcome scores related more strongly to the participants’ diagnoses and predominant drugs of abuse than to the type of neurofeedback intervention. Due to the small numbers in this study, efficacy differences between the two neurofeedback approaches were inconclusive.
A controlled case study was conducted of effects of EEG alpha and theta brainwave training with a recovering alcoholic patient who experienced craving and fear of relapse after 18 months of abstinence. Training consisted of six sessions of thermal biofeedback to increase central nervous system (CNS) relaxation. Effects were documented with pretreatment and post-treatment personality testing, 20-channel digitized EEG evaluations both under relaxed conditions and under stress, minute-by-minute physiologic recordings of autonomic and EEG data during each training session, blood pressure, and heart rate indications taken both during relaxation and under stress, and by clinical observation. Results replicated those of a previous controlled study with chronic alcoholic patients not abstinent prior to treatment. New findings include post-treatment indications of more relaxed CNS functioning under stress, and of reduced autonomic activation both during relaxation and under stress. Brain-mapping indications of anxiety associated with painful cold-pressor stimulation were seen only in the pretest readings; at post-test the brain map indicated pain-associated EEG activity in the contralateral somatosensory area, but no apparent anxiety-associated EEG activity. At 4 months post-treatment the patient’s wife and colleagues report the patient appears to function in a more relaxed way under the impact of stress, and he reports no longer experiencing craving for alcohol. Overall, support is provided for the possibility that alpha and theta brainwave training may be a useful intervention for the abstinent alcoholic experiencing stress-related craving and fear of relapse.
The effects of alpha conditioning on the habits of four methadone maintained patients were assessed. All four learned some control over alpha acitivity in the 5-week, 10-session training period. The most striking results, however, related to the subjects’ substitution of self-initiated mental states associated with alpha for previously used drug-seeking or self-medicating methods of coping with everyday problem situations. All four subjects reported a decrease in illicit drug usage and an increased feeling of self-control. Verification of improvement in adjustment and drug abuse was shown by counseling reports and narcotic screens from the maintenance program.
Introduction. 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 sensorimotor rhythm (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 postneurofeedback 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 nontarget drug cues were analyzed using wavelet analysis. Results. Outpatient participants 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 postneurofeedback cue reactivity test. In particular, evoked gamma showed decreases in power to nontarget and to a lesser extent target drug-related cues at all topographies (left, right, frontal, parietal, medial, inferior), whereas induced gamma power decreased globally to both target and nontarget 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 nontarget 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
Twenty-four volunteer college students who were regular drug users were randomly allocated to three training groups of equal size: alpha feedback, EMG feedback and a joked control group. The subjects were unaware of which feedback condition they received and were asked to practise at home during a six-month follow-up period in order to achieve a relaxed state similar to that experienced during training. No group was successful in retaining gains made in their alpha levels during each session, but the EMG group significantly reduced their muscular activity during training and retained the improvement during follow-up. The alpha and joked groups did not greatly improve their EMG during training but at follow-up achieved the same levels as the EMG group. There was evidence to suggest that a reduction in drug use among light and medium users was maintained during follow-up. Significant and lasting improvements were made by each group in the duration and quality of their sleep and anxiety levels were reduced.
The Minnesola Mulliphasic Pasonality Inventory (MMPI) was used 10 assess personality changes in vietnam combat veterans wilh post-traumatic stress disorder (PTSD), after either traditional medical treatment (TC) or alpha-theta brainwave neurofeedback therapy (BWT). Application of brainwave training or thirty 30-minule sessions resulted in decreases in M M PI T-scores on clinical scales labelled hypochondriasis, depression, hysteria, psychopathic devialt, masculinity-femininity, paranoia, psychasthenia, schizophrenia, hypomania, and social introversion-extroversion. The traditional medical control group showed decreases in T-scores only on the scale labeled schizophrenia. All fourteen BWT patients initially receiving psychotropic medication reduced their dosages after treatment. But only one of 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.
Introduction. This study used a flanker task with NoGo elements to investigate frontal executive function deficits in 19 cocaine abusers. The executive functions of interest in this study were cortical inhibition or ability to withhold motor response, the ability to select an appropriate response among several competing ones, the ability to inhibit inappropriate responses, and the ability to detect error and exercise corrective control. Method. These processes were evaluated with specific frontal and parietal event-related potentials (ERPs) registered during performance on this speeded reaction time task with conflicting motor response demands. Specifically we used behavioral response measures, stimulus-locked anterior (frontal N200, N450) ERP markers of conflict detection, response inhibition (NoGo-N2 and NoGo-P3), and response-locked error-related negativity that represent different time points of signal classification, motor response conflict detection, response inhibition, and error monitoring processes. Results. The results revealed that the higher level executive motor control attributed to the prefrontal cortex is hypoactive in cocaine abusers and therefore is incapable to effectively resolve response conflicts arising between the competing motor response alternatives. It was also demonstrated that the mesial frontal structures, such as the anterior cingulate cortex, implicated in motor response conflict detection and error monitoring functions were also compromised in addicts. Conclusion. It is reasonable to propose that a “hypofunctional” prefrontal and midfrontal processing results in a diminished ability to effectively override strong habitual automated response tendencies controlled by the lower level neural mechanisms triggered by the external stimuli. The results propose a neurobiological basis for the understanding why cocaine abusers are facing difficulties in controlling their drug-seeking and drug-taking behaviors and why their drug-related habitual behavior is so vulnerable to be triggered by external (e.g., drug-related items and environment) cues.
In an earlier study on patients with alcohol problems, an experimental group given 10 hour-long alpha biofeedback training sessions showed greater improvement on State and Trait Anxiety scores than did a control sample. In the present study an 18-month follow-up was done on those Ss. The differences between the experimentals and controls in State and Trait Anxiety after 18 months were essentially identical to the differences between them immediately after treatment, which indicates that alpha training had longrange therapeutic effects. A difference between the groups on the Alcohol Rehabilitation Followup Questionnaire also suggested that alpha training may have been associated with some reduction in alcohol consumption as well.
Adverse and iatrogenic effects associated with psychotherapy have been substantiated in research for more than 40 years. Controlled research also exists in the field of neurofeedback (electroencephalographic biofeedback) that documents that negative effects can occur from inappropriate training. This article presents accumulating evidence, taken directly from acknowledgments by neurofeedback practitioners of the existence of both transient side effects and of more serious adverse reactions that have occurred. Unlicensed and unqualified practitioners pose a risk to the public and to the integrity and future of the profession. It is vitally important that both professionals and professional societies emphasize standards of practice and that the public be protected from individuals seeking to use neurofeedback to work with medical, psychiatric, and psychological conditions for which they are not qualified and licensed to work. Some in the field propose pursuing biofeedback or psychophysiology licensure as a means to establish standards of practice and address ethical concerns. This is a reasonable option to consider, although it may take many years to implement in various states. In the meantime it is vitally important that individuals offering neurofeedback services for clinical diagnostic conditions be licensed to lawfully provide services for such conditions.
Eight epileptic patients with mixed seizures refractory to medical control participated in a double-blind crossover study to determine the effectiveness of operant conditioning of the EEG as an anticonvulsant procedure. Baseline levels of seizures were recorded for four months prior to the beginning of treatment. participants then received false (noncontingent) feedback for two months followed by an ABA-patterned training program lasting a total of ten months. Subjects were assigned to three treatment groups based on different schedules of EEG feedback. They were first trained (A1, phase) either to suppress slow activity (3 to 8 Hz), to enhance 12- to 15-Hz activity, or to simultaneously suppress 3- to 8-Hz and enhance 11- to 19-Hz activity. This was followed by a B phase, in which patients were trained to enhance slow activity (3 to 8 Hz). In the final phase (A2), the initial training contingencies were reinstated. Neuropsychological tests were performed before and after training, and changes in EEG activity as determined by Fast Fourier spectral analyses were analyzed. Five of eight patients experienced a decrease in their mean monthly seizure rate at the completion of feedback training as compared with their initial baseline level.
Neurofeedback overtraining in vulnerable patients can cause transient, site-specific functional decline that may be distressing to the patient and trainer. Susceptible patients can be identified before training with a checklist, and overtraining then avoided by close observation of training response. Procedures are described and a possible mechanism is offered.
Instead of looking at impediments to neurofeedback treatment successes as indicative of client vulnerabilities, understanding client sensitivity, hardiness, reactivity, and behavioral suppression, the therapist can better predict the course of treatment, provide an enhanced basis for continuous informed consent, and reframe self-perceived deficits as validation of patient talents. A self-report questionnaire is appended.

The sleep EEGs of eight medically refractory epileptic patients were examined as part of a double-blind, ABA crossover study designed to determine the effectiveness of EEG biofeedback for the control of seizures. The patients were initially reinforced for one of three EEG criteria recorded from electrodes placed over sensorimotor cortex: (a) suppression of 3- to 7-Hz activity, (b) enhancement of 12- to 15-Hz activity, or (c) simultaneous suppression of 3- to 7-Hz and enhancement of 11- to 19-Hz activity. Reinforcement contingencies were reversed during the second or B phase, and then reinstated in their original form during the final A′ phase. All-night polysomnographic recordings were obtained at the end of each conditioning phase and were subjected to both visual and computer-based power spectral analyses. Four of the patients showed changes in their nocturnal paroxysmal activity that were either partially or totally consistent with the ABA′ contingencies of the study. The spectral data proved difficult to interpret, though two trends emerged from the analyses. Decreases in nocturnal 4- to 7-Hz activity were correlated with decreases in seizure activity, and increases in 8- to 11-Hz activity were correlated with decreases in seizure activity. These findings were shown to strengthen the hypothesis that EEG biofeedback may produce changes in the sleep EEG that are related to seizure incidence.

The intent of this study was to examine whether brief alpha biofeedback training would alter the degree of physiological and experiential stress evidenced in an aversive laboratory situation. While occipital alpha and heart rate were monitored, 36 subjects underwent 8 presentations of a warning tone preceding fingertip electric shock by 30 sec. Subjects were then placed into one of three treatments taking place in dim light with eyes open. Group 1 received 24 min of contingent feedback. Group 2 received an equivalent amount of non-contingent feedback and Group 3, a no-feedback control condition, listened to music. Following the treatment period, 12 additional tone-shock pairings were presented, equally divided between eyes-open and eyes-closed trials, also with and without continuation of the treatment period “signal” (i.e. contingent, non-contingent feedback, or music). The results revealed that, in general, enhanced alpha density was maintained by the contingent feedback group during the post-treatment aversive situation. However, the reduction in alpha suppression was not systematically accompanied by corresponding heart rate and self-report reductions in situational reactivity. It was concluded that alpha feedback training was not sufficient to produce a generalized relaxation to the aversive situation. Alternative accounts of the results, focusing primarily on independence of response systems, are discussed.
Subjects who were either high or low in trait anxiety used alpha feedback to increase and to decrease their electroencephalographic alpha activity. The alpha changes were tightly linked to anxiety changes, but only in high anxiety subjects (for whom anxiety was reduced in proportion to alpha increases, and was increased in proportion to alpha suppression). Low trait-anxiety subjects were superior at both enhancement and suppression training, but their alpha changes were not related to anxiety changes. In both groups, anxiety changes were generally unrelated to either resting levels or changes in frontalis electromyograms and respiration rate. These results suggest that long-term alpha feedback training (at least 5 hours) may be useful in anxiety therapy.
In Phase One, 44 subjects participated in a 2 (instructions to increase alpha, no instructions to increase alpha) × 2 (alpha biofeedback, no alpha biofeedback) factorial experiment. Results indicated that increases in alpha production were due to instructions to increase alpha and that biofeedback had no effect on alpha production. In Phase Two, the 44 subjects from Phase One were exposed to a threat of shock whereas 11 additional subjects in a control condition were not. The design employed in Phase Two was a 2 (previous instructions and stress, no previous instructions and stress) × 2 (previous biofeedback and stress, no previous biofeedback and stress) plus 1 (no previous instructions/no previous biofeedback, no stress). Results indicated that the threat of shock was effective in increasing arousal (as measured by heart rate and skin resistance) but previous EEG-alpha biofeedback training was not effective in helping subjects decrease arousal while in the stressful situation. The results indicate that it is the instructions (and related information concerning alpha) rather than the biofeedback that is critical in alpha biofeedback training and that this training does not appear to have utility for controlling arousal under stress.
Background. Impairments of attention are a frequent and well documented consequence of head injury. The purpose of this study was to evaluate if Neurofeedback Therapy (NFT) can enhance remediation of attention deficits in patients with closed head injuries (CHI) who are still in the phase of spontaneous recovery. Method. Feedback of beta-activity (13–20 Hz) was used for the treatment of attentional impairments in twelve patients with moderate closed head injuries. A matched control group of nine patients was treated with a standard computerized training. All patients were tested before and after treatment with a set of attention tests. Results. After ten sessions the analyses of beta activity showed that eight patients were able to increase their beta activity while the remaining four patients showed a decrease of beta activity. Mean duration of beta activity was prolonged about 50% after training. Patients who received NFT improved significantly more in the attention tests than control patients. Conclusion. The results suggest that neurofeedback is a promising method for the treatment of attentional disorders in patients with traumatic brain injuries. It is suggested that NFT should focus not only on the enhancement of beta activity, but also on the duration patients are able to hold beta activity. It is proposed to use NFT also with patients in the early phase of rehabilitation.
Background. Previous research on information processing by the primate brain prompted further investigation of phase synchronized alpha brain wave activity at five loci in humans. The results of this investigation indicated that a particular form of attention was associated with production of whole brain synchrony. Method. Patients were treated with a dual approach, a systematic program of attention training coupled with the regular practice of multi channel alpha phase synchrony training. One hundred thirty-two clinical patients were treated for a variety of stress related symptom categories by six therapists in different locations. Patients were rated for symptom intensity, frequency and duration. Results. It was found that learning to develop this particular form of attention, coupled with the regular practice of multi-channel alpha phase synchrony were effective in resolving many common stress related disorders. Analysis of 132 cases using this dual approach found that more than 90 percent of the patients reported an alleviation of symptoms. These positive results were found with stress-induced headache, joint pain, and gastrointestinal disease. Conclusion. The authors propose that there exists a common mechanism operating in these widely different successful applications; to wit, attentional flexibility, which is achieved through systematic practice of audio taped attention exercises and neurofeedback phase synchrony training. Patients who participated in this program generally reported experiencing a release from their symptoms and from emotional conditioned responses in favor of more flexibility and more stable homeostasis. The significance of this “release experience” is discussed and attention-neurofeedback training is compared to other interventions, which rely exclusively on peripheral modalities of biofeedback training.
Background: The purpose of this study was to evaluate the effects of alpha-increase neurofeedback training (Performance Enhancement Training) on blood pressure, stress reduction, attention, and observe changes in brainwave patterns. A forty-nine-year-old male college student diagnosed with essential hypertension controlled by medication had undergone twenty-six sessions of alpha-increase biofeed-back (8-13 Hz) at PZ electrode site for a period of 15 weeks. Method: Pre- and post-blood pressure measurements were taken for every session. At the beginning of week number eight, the participant discontinued his medication as advised by his physician. Pre- and post-visual TOVA CPT test was administered to assess the changes in accuracy, reaction time (RT), and RT variability. Osterkamp and Press Self-Assessment Stress Inventory was administered before and after training to assess the level of stress. QEEG evaluation was conducted prior, as well as upon completion of the study. Results: Mean Arterial Blood Pressure (MAP) yielded statistically significant results between pre- and post-sessions within participant blood pressure measurements. The participant’s systolic and diastolic blood pressures during the first thirteen sessions were not significantly different from those of the last thirteen sessions when his medication was discontinued, suggesting his ability to control his blood pressure within normal limits without the use of medication. The results of the TOVA test clearly indicate an improvement in individuals’ reaction time and the reaction time variability. The results of the Osterkamp and Press Self-Assessment Stress Inventory indicated an improvement in two of the scales: Work and Social Life. Statistical analysis showed that before and after QEEG evaluations were within normal limits. Discussion: The mechanism through which Performance Enhancement Training simultaneously affects blood pressure, reaction time (RT), and variability needs further investigation. However, the positive changes in the measured variables appear to be a function of enhanced self-awareness that leads to the improved self-regulation.
Assessed the differential effects (on experiential reports of anxiety) of actual performance and perceived success at an EEG biofeedback task. 10 college students who were high in trait anxiety (MMPI, State-Trait Anxiety Inventory) underwent training in either the suppression of enhancement of EEG alpha activity with the expectation that success at their biofeedback task would result in reductions of chronic anxiety levels. Both groups experienced significant reductions in both trait and state anxiety. Anxiety reductions were highly correlated with the trainees’ ratings of perceived success at the feedback task but were unrelated to either the direction or magnitude of the changes in their alpha activity.
Forty-five individuals with generalized anxiety (38 with GAD as defined by DSM-III) were randomized to 4 treatment conditions or a waiting list control. Patients received 8 sessions of either frontal EMG biofeedback, biofeedback to increase EEG alpha, biofeedback to decrease EEG alpha, or a pseudomeditation control condition. All treated subjects showed significant reductions in STAI-Trait Anxiety and psychophysiologic symptoms on the Psychosomatic Symptom Checklist. Only alpha-increase biofeedback subjects showed significant reductions in heart rate reactivity to stressors at a separate psychophysiological testing session. Decreased self-report of anxiety was maintained at 6 weeks posttreatment.
During the Spring semester of 1982, a program of stress management workshops was developed at Baruch College to bring the benefits of stress reduction to students. The program employed the Open Focus attention training technique. Data for 4 semesters have been examined to evaluate the results of using Open Focus attention in this program. During the first two semesters, Open Focus attention training was used without biofeedback training. In Spring 1983, biofeedback training was incorporated into the program an f used during the Spring and Fall 1983 semesters. Changes in grade point average (GPA),stress-related symptoms, and physiological measures were examined. Two studies have been previously reported (Valdes, 1985a, 1985b). In the first study, the experimental subjects’ stress data were reported. In the second study, changes in GPA and stress data for experimental and control subjects were reported. The third stud , reported in the present paper, introduced an additional control led group: the conversation “rap session” control group. Changes in the same variables for experimental, control non-treatment, and conversation “rap session” control subjects were evaluated. Students in the control group showed decreased GPA, while those who participated in Open Focus training showed a trend toward improved GPA. All selected stress-related variables representative of different categories of stress showed significant improvement, as did physiological measures in all biofeedback modalities in which the experimental subjects were trained. Significantly greater improvement was shown by the experimental subjects over the control non-treatment and “rap session” control groups. No significant change was found between the two control groups. As in the previous studies, these results support the hypothesis that the workshops were successful in reducing stress levels, and suggest that additional research, with other populations, be conducted to replicate these findings.
This study examined neurofeedback training, reading humorous stories, and emotion in children diagnosed with Asperger’s Syndrome (AS). In a pre-posttest design (before and after the story), positive and negative affect were compared between controls and two experimental groups of children with AS—those beginning training (<4 sessions) and those near completion of training (>40 sessions). Children with AS who had more than 40 sessions of neurofeedback responded the same way to the reading materials as the normally functioning controls with increases in positive affect and decreases in negative affect. Children with AS with less than 4 sessions of neurofeedback did not display this change.
Introduction. Behavioral and cognitive improvements in clients with Asperger’s Syndrome (AS), employing continuous performance tests (CPTs), intelligence and academic measures, and electroencephalographic data, have been reported following 40 sessions of neurofeedback (NFB) training combined with coaching in metacognitive strategies. However, measures of executive functions (EFs) in this population have not been commonly employed and NFB is still not commonly used as a treatment for AS. Therefore, this pilot project used Tower of London – Drexel University (ToLDX), an individually administered test of EFs, in addition to the previously mentioned measures. The goal of the current study was to investigate the utility of ToLDX as an assessment tool for clients with AS as well as further study the effects of NFB and training in metacognitive strategies on executive functioning in clients with AS. Method. Nineteen consecutive clients at the ADD Centre, Toronto, Canada (M age = 12 years 0 months) recruited over a 2½-year period all had full clinical assessment, completed age appropriate questionnaires, and were tested pre- and post-40 NFB sessions. Results. Following the training, clients with AS were able to plan more efficiently, inhibit premature responses, and shift set with greater ease, as well as solve problems more quickly as measured by their ToLDX scores. On CPTs, clients with AS showed a trend toward less impulsivity. Finally, improvement in their scores on ToLDX was not affected by age or IQ. Conclusion. These data are important because they provide an extension of results of previous studies (Reid, 2005), demonstrate the utility of tests of executive functions in a clinical setting with clients with AS, and suggest directions for further controlled research in this area.
This article reports the pilot study of electroencephalogram (EEG) biofeedback to improve focusing and decrease anxiety in 10 adolescent boys diagnosed with Asperger’s syndrome attending a therapeutic day school. Five of the boys dropped out of the study before 12 sessions were completed. The analysis of pre- and post-intervention quantitative EEGs for the five students who completed the study showed a trend to ‘normalization’, but did not reach statistical significance. All five boys who completed 24 sessions showed improved behavior as rated by parents and teachers, but other factors, such as maturation could not be ruled out as causes of the improvement. The challenges facing this research and proposals for further exploration are outlined.
This paper describes an EEG pattern the author has found to be associated with an allergic response. A consistent 22 Hz frequency pattern has now been observed in more than 100 cases in recordings made with a bipolar (sequential) montage at F4-T4. Case illustrations with examples of this EEG pattern are provided.
Administered EEG biofeedback training to an asthmatic boy over 10 weekly sessions. S learned to emit the 14±.7 Hz brainwave. EEG sensorimotor biofeedback training resulted in a cessation of respiratory difficulties and asthma attacks. In addition to the halting of a 42-mo history of asthma attacks, S remained symptom-free on follow-up 1 yr later.
Introduction. It has been reported that individuals with Autism Spectrum Disorder (ASD) have abnormal reactions to the sensory environment and visuo-perceptual abnormalities. Electrophysiological research has provided evidence that gamma band activity (30–80 Hz) is a physiological indicator of the coactivation of cortical cells engaged in processing visual stimuli and integrating different features of a stimulus. A number of studies have found augmented and indiscriminative gamma band power at early stages of visual processing in ASD; this may be related to decreased inhibitory processing and an increase in the ratio of cortical excitation to inhibition. Low frequency or “slow” (≤1HZ) repetitive transcranial magnetic stimulation (rTMS) has been shown to increase inhibition of stimulated cortex by the activation of inhibitory circuits. Method. We wanted to test the hypothesis of gamma band abnormalities at early stages of visual processing in ASD by investigating relative evoked (i.e., ∼100 ms) gamma power in 25 participants with ASD and 20 age-matched controls using Kanizsa illusory figures. In addition, we wanted to assess the effects of 12 sessions of bilateral “slow” rTMS to the dorsolateral prefrontal cortex on evoked gamma activity using a randomized controlled design. Results. In individuals with ASD evoked gamma activity was not discriminative of stimulus type, whereas in controls early gamma power differences between target and nontarget stimuli were highly significant. Following rTMS individuals with ASD showed significant improvement in discriminatory gamma activity between relevant and irrelevant visual stimuli. We also found significant improvement in the responses on behavioral questionnaires (i.e., irritability, repetitive behavior) as a result of rTMS. Conclusion. We propose that slow rTMS may have increased cortical inhibitory tone, which improved discriminatory gamma activity at early stages of visual processing. rTMS has the potential to become an important therapeutic tool in ASD treatment and has shown significant benefits in treating core symptoms of ASD with few, if any side effects.
Neuroimaging technologies and research has shown that autism is largely a disorder of neuronal connectivity. While advanced work is being done with fMRI, MRI-DTI, SPECT and other forms of structural and functional connectivity analyses, the use of EEG for these purposes is of additional great utility. Cantor et al. (1986) were the first to examine the utility of pairwise coherence measures for depicting connectivity impairments in autism. Since that time research has shown a combination of mixed over and under-connectivity that is at the heart of the primary symptoms of this multifaceted disorder. Nevertheless, there is reason to believe that these simplistic pairwise measurements under represent the true and quite complicated picture of connectivity anomalies in these persons. We have presented three different forms of multivariate connectivity analysis with increasing levels of sophistication (including one based on principle components analysis, sLORETA source coherence, and Granger causality) to present a hypothesis that more advanced statistical approaches to EEG coherence analysis may provide more detailed and accurate information than pairwise measurements. A single case study is examined with findings from MR-DTI, pairwise and coherence and these three forms of multivariate coherence analysis. In this case pairwise coherences did not resemble structural connectivity, whereas multivariate measures did. The possible advantages and disadvantages of different techniques are discussed. Future work in this area will be important to determine the validity and utility of these techniques.
Despite the fact that seizures are commonly associated with autism spectrum disorder (ASD), the effectiveness of treatments for seizures has not been well studied in individuals with ASD. This manuscript reviews both traditional and novel treatments for seizures associated with ASD. Studies were selected by systematically searching major electronic databases and by a panel of experts that treat ASD individuals. Only a few anti-epileptic drugs (AEDs) have undergone carefully controlled trials in ASD, but these trials examined outcomes other than seizures. Several lines of evidence point to valproate, lamotrigine, and levetiracetam as the most effective and tolerable AEDs for individuals with ASD. Limited evidence supports the use of traditional non-AED treatments, such as the ketogenic and modified Atkins diet, multiple subpial transections, immunomodulation, and neurofeedback treatments. Although specific treatments may be more appropriate for specific genetic and metabolic syndromes associated with ASD and seizures, there are few studies which have documented the effectiveness of treatments for seizures for specific syndromes. Limited evidence supports l-carnitine, multivitamins, and N-acetyl-l-cysteine in mitochondrial disease and dysfunction, folinic acid in cerebral folate abnormalities and early treatment with vigabatrin in tuberous sclerosis complex. Finally, there is limited evidence for a number of novel treatments, particularly magnesium with pyridoxine, omega-3 fatty acids, the gluten-free casein-free diet, and low-frequency repetitive transcranial magnetic simulation. Zinc and l-carnosine are potential novel treatments supported by basic research but not clinical studies. This review demonstrates the wide variety of treatments used to treat seizures in individuals with ASD as well as the striking lack of clinical trials performed to support the use of these treatments. Additional studies concerning these treatments for controlling seizures in individuals with ASD are warranted.
Background. The efficacy of neurofeedback training was evaluated in 12 children in the autistic spectrum with matched controls, based on established training protocols for other conditions with similar symptoms. Method. Twenty-four autistic children were divided into two groups, matched by sex, age, and disorder severity. One group received neurofeedback training and the second acted as a control group. Responses to the Autism Treatment Evaluation Checklists (ATEC) and parental assessments of problem behaviors were analyzed to evaluate the effectiveness of neurofeedback training for this condition. Results. Neurofeedback training resulted in a 26% average reduction in total ATEC rated autism symptoms, compared to 3% for the control group. Parental assessments reported improvement in all behavioral categories: socialization, vocalization, anxiety, schoolwork, tantrums, and sleep, compared with minimal changes in the control group. Discussion. Autistic spectrum children who underwent neurofeedback training showed significant improvements in autism symptoms and behaviors. The magnitude of improvement was independent of initial severity or age.
Previously we demonstrated significant improvement of executive functions and social behavior in children with autism spectrum disorders (ASD) treated with 40 sessions of EEG neurofeedback in a nonrandomized waiting list control group design. In this paper we extend these findings by reporting the long-term results of neurofeedback treatment in the same group of children with ASD after 12 months. The present study indicates maintenance of improvement of executive functions and social behavior after 12 months in comparison with the immediate outcomes. Neurofeedback mediated suppression of theta power is supposed to promote more flexible functioning of the brain by enhancing activation in the medial prefrontal cortex and improving flexibility of activation in the default mode network supporting the improvement of executive functions and theory of mind in ASD.
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.
Introduction. Error monitoring and correction is one of the executive functions and is important for effective goal-directed behavior. Deficient executive functioning, including reduced error monitoring ability, is one of the typical features of such neurodevelopmental disorders as autism, probably related to perseverative responding, stereotyped repetitive behaviors, and an inability to accurately monitor ongoing behavior. Our prior studies of behavioral and event-related potential measures during performance on visual oddball tasks in high-functioning autistic (HFA) children showed that despite only minor differences in reaction times (RTs) HFA children committed significantly more errors. Method. This study investigated error monitoring in children with autism spectrum disorder (ASD) with response-locked event-related potentials—the error-related negativity (ERN) and error-related positivity (Pe) recorded at fronto-central sites. The ERN reflects early error detection processes, whereas the Pe has been associated with later conscious error evaluation and attention reallocation. RTs in correct trials and posterror slowing in RTs were measured. In this study 14 participants with ASD and 14 age- and IQ-matched controls received a three-category visual oddball task with novel distracters. Results. ERN had a lower amplitude and longer latency in the ASD group but was localized in the caudal part of anterior cingulate cortex in both groups. The Pe component was significantly prolonged in the ASD group but did not reach significance in amplitude differences compared to controls. We found significant posterror slowing in RTs in controls and posterror acceleration in RTs in the ASD group. Conclusion. The reduced ERN and altered Pe along with a lack of posterror RT slowing in autism might be interpreted as insensitivity in the detection and monitoring of response errors and a reduced ability of execute corrective actions. This might result in reduced error awareness and failure in adjustment when dealing with situations where erroneous responses may occur. This deficit might be manifested in the perseverative behaviors often seen in individuals with ASD. The results are discussed in terms of a general impairment in self-monitoring and other executive functions underlying behavioral and social disturbances in ASD.
A 21 year old patient reported a relatively rapid onset of serious chronic fatigue syndrome (CFS), with her worst symptoms being cognitive impairments. Congruent with research on rapid onset CFS, she had no psychiatric history and specialized testing did not suggest that somatization was likely. Neuroimaging and EEG research has documented brain dysfunction in cases of CFS. Therefore, a quantitative EEG was done, comparing her to a normative data base. This revealed excessive left frontal theta brainwave activity in an area previously implicated in SPECT research. Therefore, a novel treatment approach was utilized consisting of a combination of EEG neurofeedback and self-hypnosis training, both of which seemed very beneficial. She experienced considerable improvement in fatigue, vigor, and confusion as measured pre-post with the Profile of Mood States and through collaborative interviews with both parents. Most of the changes were maintained at 5, 7, and 9 month follow-up testing.
EEG neurofeedback has been identified as a potential diagnostic and treatment protocol with chronic fatigue syndrome (CFS) symptoms. In the present case study, the authors applied an EEG neurofeedback biofeedback paradigm as a treatment modality with a CFS patient. Baseline data were acquired using the Wechsler Adult Intelligence Scale-Revised and qualitative and subjective ratings of cognitive improvement. Test results and clinical findings revealed improvements in the patient’s cognitive abilities, functional skill level, and quality of life. The patient showed significant differences in pre- and posttest levels on the Wechsler scale.
In this study we are presenting case studies of two depressed women who were trained with more than 34 sessions each of EEG biofeedback (neurofeedback) using an Alpha Asymmetry protocol, the purpose of this training was to determine if depression could be alleviated when the subjects learned to increase the activation of the left hemisphere and/ or decrease the activation of the right hemisphere. The MMPI-2 was administered before and after training to measure changes in personality factors, including depression. The results suggest that Alpha Asymmetry neurofeedback training may be an effective adjunct to psychotherapy in the treatment of certain types of mood disorders.
Introduction. It is well established that the number of people diagnosed and suffering from depression is on the increase. Many of these patients are not responsive to first-line pharmacological intervention or simply cannot use medications for other reasons. As such, there has been a growing need for nonmedication approaches to treatment. The purpose of this study was to examine the use of auditory-visual EEG entrainment (AVE) at a 14 Hz (beta) frequency to decrease symptoms of depression with corresponding changes in neurophysiology. Method. Sixteen participants ranged in age from 20 to 67 years and were screened utilizing the Beck Depression Inventory–II (BDI–II) and broken into two groups of 8 (simulated, AVE treatment groups), with a cross-over design. Both groups were given the BDI–II and QEEG testing at baseline, 4 weeks following either AVE or simulated treatment, and then again after an additional 4 weeks and a switch in treatment in the cross-over design. Results. Results revealed significant reduction of depression only after the 4 weeks on AVE therapy of the BDI–II scores (p > .01). QEEG scores adjusted for normal age deviations demonstrate significant EEG change scores over time in cortical regions associated with mood regulation. Conclusion. The findings indicate that AVE therapy may be a viable nonmedication therapeutic intervention.
Introduction. A patient with severe, medication resistant depression was found to have the frontal alpha asymmetry described in Davidson’s (1998a) research as demonstrating a predisposition to depression. Treatment. Initial sessions of EEG neurofeedback using Rosenfeld’s (1997) protocol for correcting the alpha asymmetry were discouraging, actually producing slight negative change. Therefore, treatment shifted to using the Roshi, a two channel unit combining neurofeedback and photic stimulation, doing primarily left hemisphere beta training. Results. The very first Roshi session produced positive changes, and within five sessions the patient reported feeling less depressed and more energetic. At the conclusion of thirty training sessions, objective testing documented dramatic reductions in depression, somatic symptoms, overemotionality, anxiety, rumination, and fatigue. Discussion. In support of Henriques and Davidson’s (1991) belief that hypoactivation of the left hemisphere results in an “approach deficit” and more withdrawal behavior, post-testing and interview data also documented that the patient had become less withdrawn, more active, sociable, and less distrustful. Eight and one-half month follow-up documented maintenance of changes. Continued exploration of left hemisphere beta protocols in treating depression, and of the combined use of neurofeedback with photic stimulation are encouraged.
A double reversal single-subject experimental design was used to study the effects of visual feedback on the hemispheric alpha asymmetries of a male subject during a linguistic task. Results indicated that the subject demonstrated flexibility in hemispheric alpha and corresponding processing strategies employed when an alpha biofeedback procedure was used. These results provide further support for the notion that right and left hemispheric activation is associated with different, yet compatible, cognitive strategies and that both can be manipulated under conditions of feedback.
This study examined the effects of electroencephalographic-(EEG-) driven photic stimulation on a case of depressive disorder, as measured by a psychometric test of mood states, EEG parameters, and several autonomic indices. The EEG-driven photic stimulation enhances the alpha rhythm of brain waves using photic signals, the brightness of which is modulated by a subject’s own alpha rhythm. The patient was a 37-year-old businessman, who was treated for depression with medication during the 13 months prior to his first visit to our hospital. He underwent two sets of inpatient treatment sessions, comprising first 16 and then 18 treatment sessions. The treatments brought about the following changes: an improvement in general mood state, alpha rhythm increase, cardiac parasympathetic suppression, and increased skin conductance level. In addition, significant correlations between alpha rhythm increase and cardiac parasympathetic suppression or cardiac sympathetic predominance were observed with each inpatient treatment. Significant correlations between alpha rhythm increase, cardiac parasympathetic suppression, or cardiac sympathetic predominance and the improvement of general mood state were also observed. Thus, from these observations, it was concluded that the alpha enhancement induced by EEG-driven photic stimulation produced an improvement in the patient’s depressive symptomatology connected with cardiac parasympathetic suppression and sympathetic predominance.
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.
Depression is a common and serious interictal problem in patients with epilepsy. The genesis of depressive disorders is multifactorial. One aetiological aspect focuses on psychosocial factors. It was hypothesized that uncontrollable, unpredictable chronic aversive events (i.e. epileptic seizures) result in cognitive deficits ofexternal control orientation. If this is true, biofeedback training could represent a possible treatment strategy to lower depression, because biofeedback is known to mediate success experiences and control. Measures of depression and locus of control were administered to 20 patients with refractory partial epilepsy before and after biofeedback treatment. The biofeedback consisted of slow cortical potentials or breathing parameters in 10 patients each. A clear relationship occurred between depression and locus of control in the subjects. After biofeedback training control orientation moved towards a more internal locus of control. Also, depression scores were significantly reduced six months after training. Results show that in patients with refractory epilepsy depression is highly correlated with locus of control, in a way that external control orientation relates to high depression scores. Biofeedback is able to improve internal control orientation through personal success mediation.

Previous observations suggested that chronic anger may be associated with persistent excessive high-frequency beta activity in one or more cortical areas and that poor anger control may be associated with excessive slowing of the EEG. We hypothesized that downtraining of elevated high-frequency beta activity would reduce anger and that downtraining of excessive cortical slow wave activity would improve anger control. Forty-six individuals underwent neurofeedback training to downtrain excess beta and slow wave activity. This protocol resulted in significantly improved anger control and a reduction in the frequency of outbursts.

Background. This article is a case study review of the neurofeedback treatment of two female subjects with Type I diabetes mellitus. Both women had received regular medical treatment including the use of a restricted diet and short-term insulin treatment using an insulin pump. The study sought to discover the effects of neurofeedback treatment on the individuals’ perceptions of their quality of life and, any effects on measured glucose blood levels.

Method. Both the subjects received 20 sessions of neurofeedback training. These sessions took place three times a week, each session lasting approximately 45 minutes to 1 hour. The treatment consisted of training at C3, C4, and interhemispheric (C3-C4). The women were given symptom report checklists following each session and were interviewed prior to beginning of the treatment, at the conclusion of the 20 sessions, and 16 days after their final session. The interviews focused on self-reported changes in symptoms and the effect of these changes on their quality of life. Both the women also recorded their daily glucose levels and insulin dosage throughout the study.

Results. The subjects reported improvement in their perception of their quality of life (QOL). Additionally, both reported improvement in glucose levels as well as fluctuations and reduced dosages of insulin required on a daily basis.

Discussion. The existing research on the effectiveness of neurofeedback training for a broad variety of physical and emotional problems lead us to wonder if it might be helpful for either the physical or emotional aspects of Type I diabetes mellitus. Given the higher incidence of this condition, the significance of this research was considered to be important. The results of the study provide preliminary evidence that neurofeedback can be an important and valuable treatment for both the physical and emotional symptoms associated with Type I diabetes mellitus. Furthermore, research with larger numbers and stricter controls in the field is warranted.

Introduction. This case study of a mature female executive with Dissociative Disorder Not Otherwise Specified (DDNOS) demonstrates the Quality of Life Continuum (QLC) and the efficacy of specific EEG biofeedback protocols in enhancing performance and improving global life functioning for people with clinical disorders. The QLC begins with the functioning level of people with severe clinical problems and ends with superior functioning people, with three levels of functioning in between those two ends of the continuum. It is a graphic for demonstrating that any level of functioning can be improved through the use of protocols specifically designed for optimal functioning. Method. Pre- and post-quantitative electroencephalograms (QEEGs) were done on the subject. Other measures of change were self-report and co-worker feedback. The subject was taught how to train independently with specific peak performance protocols. She did 60 fifteen-minute training sessions in two months. Results. The changes in her QEEGs were measured by a comparison of her pre- and post-scores on the Thatcher Life Span EEG Reference Database. The subject went from 166 abnormalities with significance levels ranging from p < .025 to p < .001 to only 17 abnormalities. The subject reported significant life improvement changes, including increased energy and motivation. Among the changes cited by co-workers was a decrease in her anger outbursts from an average of three times per week to two times per month. Discussion. The independent use of neurofeedback with specific peak performance protocols can enhance the quality of life for a person with a clinical diagnosis.
This pilot study assessed neuro-cognitive functioning in 7 adults treated with Vagus Nerve Stimulation (VNS) for refractory epilepsy over a 12-month period. All patients were assessed using the Critical Flicker Fusion (CFF) test, a sensitive measure of the ability of the central nervous system to discriminate items of sensory information, along with a standardized battery of neuropsychological and behavioral measures. Reduction in seizure frequency and psychiatric ratings was accompanied by a selective but significant (p < .05) improvement in CFF performance. These findings suggest that the CFF test could be a useful indicator of improvement in neurocognitive functioning during VNS.
The study aimed to explore the predictive value of neuropsychological tests within the context of acquisition of slow cortical potential (SCP) self-control, a technique which has beneficial effects on seizure frequency in epilepsy. Patients with epilepsy who successfully achieved SCP control had longer digit or block-tapping spans than less successful patients. Patients who showed a better learning rate across training also displayed better verbal memory and learning abilities. Seizure reduction was related to block-tapping spans only. The results indicate that measures of attention, as indicated by digit spans or block-tapping spans, offer some predictive value for acquisition of SCP control and treatment outcome, whilst measures of visuospatial or frontal lobe function are unrelated to SCP acquisition and seizure reduction.
Recent advances in the diagnosis of epilepsy include the development of a clinically useful classification of epileptic seizures and the recognition of specific epileptic disorders. These advances have been aided by the advent of x-ray computed tomography, long-term electroencephalographic telemetry, and video monitoring. Techniques for functional imaging of the human brain promise even greater diagnostic capabilities. New antiepileptic drugs have improved medical management, and technical and theoretical advances in pharmacokinetics have permitted physicians to design balanced dosing for individual patients. Although currently underused, surgical treatment of partial complex epilepsy can be safe and effective when used appropriately. Operant conditioning of electroencephalography may become another practical alternative therapy. Contributions of basic research to understanding the complications of status epilepticus have influenced treatment protocols and greatly improved the prognosis of this potentially lethal condition.
Sensorimotor rhythm (SMR) biofeedback training was attempted in a 13-year-old male with frequent epileptic seizures. Prior to training the subject was averaging almost eight clinical seizures an hour. The SMR filter was tuned sharply to 12 ± 1 Hz. Feedback was conducted over approximately six months and continues to the present. In that time the subject’s percentage of SMR increased from about 10%, prior to training, to 65% after the 34th training session. Correspondingly, his rate of clinical seizures decreased by a factor of 10 and a significant reduction in percentage of epileptiform discharges was noted. Beginning with trial 35, the subject was provided feedback of epileptiform activity in combination with 12 Hz activity. The combined effect of these two treatment variables was to reduce the trial-to-trial variance in the dependent variables of interest.
This is a case report of an adult female patient with ADHD, temporal seizure disorder, and Borderline Personality Disorder treated with 30 weekly sessions of SMR neurofeedback and carbamazepine. Posttreatment measures showed improvements in T.O.V.A., self report, and QEEG. Both neurofeedback and carbamazepine showed the most effect in early treatment. Progress continued after discontinuance of the drug.
A basic question in EEG feedback training of epileptic patients is whether the decrease in seizures is specifically due to the training or to other factors. Questions may also be raised as to what EEG changes are involved. Preliminary results in five patients suggest that seizure reductions can occur with training which are not due to placebo or nonspecific effects or to changes in medication compliance. These changes occurred rapidly during EEG-contingent feedback training but not when feedback was random in relation to the EEG. Reliable changes in the EEG were also observed, but the question of which mechanism accounts for these results has yet to be answered.
Over the past three decades, researchers have examined various behavioral approaches to the treatment of epilepsy. One prominent line of inquiry concerns the effectiveness of neurofeedback, which entails the entrainment of specific electroencephalographic frequencies for the purpose of decreasing seizure frequencies in patients with epilepsy. This article reviews the current literature on the efficacy of neurofeedback in reducing seizure frequency. While it is clear that neurofeedback had a positive effect in most of the studies reviewed, these findings are limited due to multiple confounding factors. In the absence of any rigorously controlled studies, the relationship between neurofeedback and seizure frequency cannot be firmly established. Despite these limitations, the promising role of neurofeedback as a treatment for epilepsy is illustrated.
The present study aimed at investigating to what extent the regulation of excitability in cortical networks, as indicated by surface-negative slow cortical potentials (SCPs), is impaired in epileptic patients and to what extent training of SCP self-regulation by means of biofeedback and instrumental learning procedures might affect seizure frequency. Twenty-five patients suffering from drug-refractory epilepsies (complex focal, grand mal, and absence type of seizures) participated in 28 1-h sessions of feedback and instrumental conditioning of their SCPs. Subjects’ EEGs were obtained from the vertex. Depending on discriminative stimuli DC shifts towards increased or suppressed negativity relative to the pre-trial baseline were demonstrated by on-line visual feedback during intervals of 8 s each; each session comprised 110 trials. While performance on the SCP self-regulation task was initially below normal (as compared to healthy subjects), significant increases in SCP control were achieved by the patients across the 28 training sessions. In 18 patients at least 1-year follow-up data are available. Changes in seizure frequency were related to transfer of SCP control with six of the patients becoming seizure-free. Age affected the ability to acquire SCP control and its impact on seizure frequency.
This report is a follow-up to a previous paper which described seizure rate changes with central cortical EEG feedback training in 8 poorly controlled epileptic subjects. Data examined here include associated training compliance and performance, sleep EEG spectra, clinical EEG and anticonvulsant blood levels. The study employed a double-crossover, single-blind ABA design applied to two subgroups of epileptic patients. Both groups had in common two training periods (A1, A2) in which either 12–15 c/sec (subgroup I, n = 4) or 18–23 c/sec (subgroup II, n = 4) was reinforced in the absence of 6–9 c/sec, movement or epileptiform discharge, and one training period (B) in which 6–9 c/sec was reinforced in the absence of 12–15 or 18–23 c/sec as well as movement and epileptiform discharge. Training periods occurred primarily in the home and lasted 3 months. Compliance with training instructions and response acquisition were demonstrated. Overall anticonvulsant blood levels were low and unrelated to EEG or seizure changes. Clinical EEG findings corresponded to sleep EEG and seizure rate outcomes. Power spectral analysis of sampled non-REM sleep from all-night EEG recordings obtained after each training phase indicated contingency specific changes which were limited to sensorimotor recordings in subgroup I and corresponded to the pattern of seizure rate changes in this group. EEG changes were also limited to sensorimotor cortex in subgroup II, but were linear and paralleled a progressive decrease in seizure rate. Both groups, however, showed the same pattern of EEG changes with seizure reductions; low and high frequencies were reduced and intermediate, rhythmic frequencies increased. Correlational analysis confirmed this relationship. The pattern, duration and topographic specificity of these changes suggested a normalization of sensorimotor EEG substrates related to the EEG feedback training.
About one third of patients with epilepsy do not benefit from medical treatment. For these patients electroencephalographic (EEG) biofeedback is a viable alternative. EEG biofeedback, or neurofeedback, normalizes or enhances EEG activity by means of operant conditioning. While dozens of scientific reports have been published on neurofeedback for seizure disorder, most have been case series with too few subjects to establish efficacy. The purpose of this paper is to meta-analyze existing research on neurofeedback and epilepsy. We analyzed every EEG biofeedback study indexed in MedLine, PsychInfo, and PsychLit databases between 1970 and 2005 on epilepsy that provided seizure frequency change in response to feedback. Sixty-three studies have been published, 10 of which provided enough outcome information to be included in a meta-analysis. All studies consisted of patients whose seizures were not controlled by medical therapies, which is a very important factor to keep in mind when interpreting the results. Nine of 10 studies reinforced sensorimotor rhythms (SMR) while 1 study trained slow cortical potentials (SCP). All studies reported an overall mean decreased seizure incidence following treatment and 64 out of 87 patients (74%) reported fewer weekly seizures in response to EEG biofeedback. Treatment effect was mean log (post/pre) where pre and post represent number of seizures per week prior to treatment and at final evaluation, respectively. Due to prevalence of small groups, Hedges’s g was computed for effect size. As sample heterogeneity was possible (Q test, p=.18), random effects were assumed and the effect of intervention was −0.233, SE= 0.057, z p<.001. Based on this meta-analysis, EEG operant conditioning was found to produce a significant reduction on seizure frequency. This finding is especially noteworthy given the patient group, individuals who had been unable to control their seizures with medical treatment.
EEG Biofeedback (Neurofeedback-NFB) is a learning strategy that enables people to alter their brainwaves. In the present case study, we applied a NFB protocol on three patients with Fibromyalgia Syndrome (FMS). The existing symptoms and clinical conditions of the patients attributed to FMS, Visual Analog Scale for pain and fatigue, Hamilton Depression and Anxiety Inventory Scales, Beck Depression and Anxiety Inventory Scales, and SF-36 were recorded before and after NFB training. Most of the symptoms were decreased after ten sessions. There was also improvement in all of the scales after the treatment. The results of the present study may suggest NFB training as a novel treatment method in FMS.
Thirty patients from a private clinical practice who met the 1990 American College of Rheumatology criteria for fibromyalgia syndrome (FS) were followed prospectively through a brainwave-based intervention known as electroencephalograph (EEG)-driven stimulation or EDS. Patients were initially treated with EDS until they reported noticeable 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.
Two functional magnetic resonance imaging (fMRI) experiments were undertaken to measure the effect of neurofeedback training (NFT), in AD/HD children, on the neural substrates of selective attention and response inhibition. Twenty unmedicated AD/HD children participated to these experiments. Fifteen children were randomly assigned to the Experimental (EXP) group whereas the other five children were randomly assigned to the Control (CON) group. Only subjects in the EXP group underwent NFT. EXP subjects were trained to enhance the amplitude of the SMR (12–15 Hz) and beta 1 activity (15–18 Hz), and decrease the amplitude of theta activity (4–7 Hz). Subjects from both groups were scanned one week before the beginning of NFT (Time 1) and 1 week after the end of NFT (Time 2), while they performed a “Counting Stroop” task (Experiment 1) and a Go/No-Go task (Experiment 2). At Time 1, in both groups, the Counting Stroop task was associated with significant activation in the left superior parietal lobule. For the Go/No-Go task, no significant activity was detected in the EXP and CON groups. At Time 2, in both groups, the Counting Stroop task was associated with significant activation of the left superior parietal lobule. This time, however, there were significant loci of activation, in the EXP group, in the right ACC, left caudate nucleus, and left substantia nigra. No such activation loci were seen in CON subjects. For the Go/No-Go task, significant loci of activation were noted, in the EXP group, in the right ventrolateral prefrontal cortex, right ACcd, left thalamus, left caudate nucleus, and left substantia nigra. No significant activation of these brain regions was measured in CON subjects. These results suggest that NFT has the capacity to functionally normalize the brain systems mediating selective attention and response inhibition in AD/HD children.
Background: A promising new approach to cognitive neuroscience based on real-time functional magnetic resonance imaging (rtfMRI) demonstrated that the learned regulation of the neurophysiological activity in circumscribed brain regions can be used as an independent variable to observe its effects on behavior. Here, for the first time, we investigated the modulatory effect of learned regulation of blood oxygenation level-dependent (BOLD) response in the left anterior insula on the perception of visual emotional stimuli. Methods: Three groups of participants (n = 27) were tested: two underwent four rtfMRI training sessions receiving either specific (n = 9) or unspecific feedback (n = 9) of the insula’s BOLD response, respectively, and one group used emotional imagery alone (n = 9) without rtfMRI feedback. During training, all groups were required to assess aversive and neutral pictures. Results: Participants able to significantly increase BOLD signal in the target region rated the aversive pictures more negatively. We measured a significant correlation between enhanced left anterior insula activity and increased negative valence ratings of the aversive stimuli. Control groups performing either rtfMRI training with unspecific feedback or an emotional imagery training alone were not able to significantly enhance activity in the left anterior insula and did not show changes in subjective emotional responses. Conclusions: This study corroborates traditional neuroimaging studies demonstrating a critical role of the anterior insula in the explicit appraisal of emotional stimuli and indicates the adopted approach as a potential tool for clinical applications in emotional disorders.
Understanding how to control how the brain’s functioning mediates mental experience and the brain’s processing to alter cognition or disease are central projects of cognitive and neural science. The advent of real-time functional magnetic resonance imaging (rtfMRI) now makes it possible to observe the biology of one’s own brain while thinking, feeling and acting. Recent evidence suggests that people can learn to control brain activation in localized regions, with corresponding changes in their mental operations, by observing information from their brain while inside an MRI scanner. For example, subjects can learn to deliberately control activation in brain regions involved in pain processing with corresponding changes in experienced pain. This may provide a novel, non-invasive means of observing and controlling brain function, potentially altering cognitive processes or disease.
Real-time functional magnetic resonance imaging (fMRI) affords the opportunity to explore the feasibility of self-regulation of functional brain networks through neurofeedback. We localised emotion networks individually in thirteen participants using fMRI and trained them to upregulate target areas, including the insula and amygdala. Participants achieved a high degree of control of these networks after a brief training period. We observed activation increases during periods of upregulation of emotion networks in the precuneus and medial prefrontal cortex and, with increasing training success, in the ventral striatum. These findings demonstrate the feasibility of fMRI-based neurofeedback of emotion networks and suggest a possible development into a therapeutic tool.
Neurofeedback of functional magnetic resonance imaging (fMRI) can be used to acquire selective control over activation in circumscribed brain areas, potentially inducing behavioral changes, depending on the functional role of the targeted cortical sites. In the present study, we used fMRI-neurofeedback to train subjects to enhance regional activation in the right inferior frontal gyrus (IFG) to influence speech processing and to modulate language-related performance. Seven subjects underwent real-time fMRI-neurofeedback training and succeeded in achieving voluntary regulation of their right Brodmann’s area (BA) 45. To examine short-term behavioral impact, two linguistic tasks were carried out immediately before and after the training. A significant improvement of accuracy was observed for the identification of emotional prosodic intonations but not for syntactic processing. This evidence supports a role for the right IFG in the processing of emotional information and evaluation of affective salience. The present study confirms the efficacy of fMRI-biofeedback for noninvasive self-regulation of circumscribed brain activity.
A brain–computer interface (BCI) based on real-time functional magnetic resonance imaging (fMRI) is presented which allows human subjects to observe and control changes of their own blood oxygen level-dependent (BOLD) response. This BCI performs data preprocessing (including linear trend removal, 3D motion correction) and statistical analysis on-line. Local BOLD signals are continuously fed back to the subject in the magnetic resonance scanner with a delay of less than 2 s from image acquisition. The mean signal of a region of interest is plotted as a time-series superimposed on color-coded stripes which indicate the task, i.e., to increase or decrease the BOLD signal. We exemplify the presented BCI with one volunteer intending to control the signal of the rostral–ventral and dorsal part of the anterior cingulate cortex (ACC). The subject achieved significant changes of local BOLD responses as revealed by region of interest analysis and statistical parametric maps. The percent signal change increased across fMRI-feedback sessions suggesting a learning effect with training. This methodology of fMRI-feedback can assess voluntary control of circumscribed brain areas. As a further extension, behavioral effects of local self-regulation become accessible as a new field of research.
We present an fMRI-based method that enables subjects to monitor and actively modulate their own brain activity as a form of biofeedback. On a 1.5 T clinical MR scanner, functional areas during a simple hand motor task were delineated by detecting signal variations associated with the brain activity. Then, the subject adopted a different strategy to expand the activation in motor and somatosensory areas that were not activated previously. Statistical maps of brain activity were visually presented back to the subject, being updated at the end of each segmented rest-task block in near real-time manner. Our results suggest that the visual feedback of the functional brain activation maps guided subjects to adjust their task performance to achieve the desired modulation of cortical activity. This method may offer a potential utility for fMRI-based neurofeedback.
Drawing on past reports of raised pain thresholds of yogis in a meditative state, the high alpha content during meditation, and reports of operant alpha wave conditioning, a hypothesis was formulated that a high alpha state and pain are incompatible behaviors, and thus the production of alpha could be used for symptomatic treatment of pain. A patient, who suffered from severe headaches resulting from head injuries, went through 67 alpha conditioning sessions and increased his alpha activity from 20 per cent time alpha with eyes closed to 92 per cent time alpha with eyes closed and 50 per cent with eyes open. Although the patient was not able to rid himself of pain by achieving a high alpha state, he was in some instances able to prevent pain by going into a high alpha state before the headache began.
Although biofeedback in the treatment of migraine and tension-type headache has been widely researched, there is little research examining biofeedback therapy in posttraumatic headache (PTH). In this retrospective study, 40 subjects with PTH who had received biofeedback-assisted relaxation at our headache clinic were questioned at least 3 months following the completion of therapy. Subjects were queried about improvements in headache, increases in ability to relax and cope with pain, and overall benefits, lasting effectiveness, and continued use of biofeedback in daily life. Results indicate 53% reported at least moderate improvement in headaches; 80% reported at least moderate improvement in ability to relax and cope with pain; 93% found biofeedback helpful to some degree; 85% felt headache relief achieved through biofeedback had continued at least somewhat; and 95% stated they were continuing to use biofeedback skills in daily life. A correlation analysis revealed a negative relationship between response to biofeedback and increased chronicity of the disorder. In other words, the more chronic the disorder, the poorer the response to treatment. A stepwise regression analysis found that chronicity of the disorder and number of treatment sessions significantly affected response to treatment. Data suggest that biofeedback-assisted relaxation should at least be considered when planning treatment strategies for posttraumatic headache.
Headache patients and healthy controls underwent alpha-EEG feedback training in 12 sessions. The present study does not support the literature which reports alpha increase by feedback training. The study included a patient group receiving feedback, a patient control group receiving pseudofeedback, and a volunteer group receiving feedback. Increase of alpha EEG was observed under feedback and pseudofeedback. However, there was always more alpha during baseline times than during training times. Alpha increase over time is suggested to be a habituation effect. Headache pain decreased with training (within the boundaries of a placebo effect), and there was no difference in headache decrease between feedback and pseudofeedback patients.
Migraine patients are characterized by increased amplitudes of slow cortical potentials (SCPs), representing pronounced excitability of cortical networks. The present study investigated the efficiency of biofeedback training of SCPs in young migraineurs. Ten children suffering from migraine without aura participated in 10 feedback sessions. They were compared with 10 healthy children for regulation abilities of cortical negativity and with 10 migraineurs from the waiting list for clinical efficacy. During the first two sessions, the migraine children were characterised by lacking ability to control cortical negativity, especially during transfer trials, compared with healthy controls. However, there was no difference following 10 sessions of training. Feedback training was accompanied by significant reduction of cortical excitability. This was probably responsible for the clinical efficacy of the training; a significant reduction of days with migraine and other headache parameters was observed. It is suggested that normalization of the threshold regulation of cortical excitability during feedback training may result in clinical improvement.
Background: Traditional peripheral biofeedback has grade A evidence for effectively treating migraines. Two newer forms of neurobiofeedback, EEG biofeedback and hemoencephalography biofeedback were combined with thermal handwarming biofeedback to treat 37 migraineurs in a clinical outpatient setting. Methods: 37 migraine patients underwent an average of 40 neurofeedback sessions combined with thermal biofeedback in an outpatient biofeedback clinic. All patients were on at least one type of medication for migraine; preventive, abortive or rescue. Patients kept daily headache diaries a minimum of two weeks prior to treatment and throughout treatment showing symptom frequency, severity, duration and medications used. Treatments were conducted an average of three times weekly over an average span of 6 months. Headache diaries were examined after treatment and a formal interview was conducted. After an average of 14.5 months following treatment, a formal interview was conducted in order to ascertain duration of treatment effects. Results: Of the 37 migraine patients treated, 26 patients or 70% experienced at least a 50% reduction in the frequency of their headaches which was sustained on average 14.5 months after treatments were discontinued. Conclusions: All combined neuro and biofeedback interventions were effective in reducing the frequency of migraines with clients using medication resulting in a more favorable outcome (70% experiencing at least a 50% reduction in headaches) than just medications alone (50% experience a 50% reduction) and that the effect size of our study involving three different types of biofeedback for migraine (1.09) was more robust than effect size of combined studies on thermal biofeedback alone for migraine (.5). These non-invasive interventions may show promise for treating treatment-refractory migraine and for preventing the progression from episodic to chronic migraine.
Seven male adolescents, ages 14 to 17 who were in a juvenile detention residential treatment program and diagnosed with the combined type of Attention Deficit Hyperactivity Disorder (ADHD-C) or with Conduct Disorder, participated in a study examining the effects of electroencephalographic (EEG) neurofeedback on sustained attention, response inhibition, executive functions, intellectual ability, and memory. All of the participants received 20 sessions of EEG biofeed-back therapy in conjunction with treatment received in a residential program. Pre- and post-treatment measures were collected within one week of treatment, and data were analyzed using an adapted model of Jacobson and Truax’s method of clinically significant change (Jacobson & Truax, 1991) which allows criterion scores to be set and 95 percent confidence intervals determined at the level of individual performance on the collected measures. Sixty-four percent experienced improved performance after EEG neurofeedback on one or more measures. Clinically significant and reliable improvements were observed on teacher ratings of the Global Executive Composite from the Behavior Rating Inventory of Executive Function (average improvement = .22 mean item raw score points; Gioia, Isquith, Guy, & Kenworthy, 2000). Normal range performance was enhanced on the Composite IQ measure of the Kaufman Brief Intelligence Test (average gain = 9 points; Kaufman & Kaufman, 1990), on the Omissions subscale from the Conners’ Continuous Performance Test (average decrease = 13 errors; Conners, 1994) and on the four subtest screening measures from the Wide Range Assessment of Memory and Learning (Sheslow & Adams, 1990), with average gains ranging from 2.0 to 3.67 scaled score points across the four subtests. The results are consistent with previous findings, and suggest that the methodology used for data analysis is a useful tool to assess individual levels of change, and indicate that EEG biofeedback may be a useful adjunct in the treatment of juvenile offenders.
Introduction. Atypical EEG and neuropsychological indicators have been observed among offenders. Dangerous offenders treated with a combined program that included neurofeedback (EEG biofeedback) and galvanic skin response (GSR) biofeedback demonstrated reduction in recidivism (Quirk, 1995). This study was designed to further evaluate the EEG findings of youth offenders and to provide an initial report on the effectiveness of a task-oriented analog/QEEG-based remedial neurofeedback training approach. Method. Five offenders with significant psychopathology were referred for treatment. The group was evaluated with attentional testing and analog/QEEG assessment prior to and following neurotherapy. Treatment consisted of 20 or 40 sessions of a task-activated analog/QEEG-based approach. Another group of thirteen offenders were assessed with attentional testing and provided with neurotherapy following QEEG assessment. Results. For all of the youth trained, in the analog/QEEG group, pre- vs. post-audio and visual attention testing demonstrated significant improvement within 20 remedial sessions. Three of the five youth showed rapid advancement in a residential grading system. Staff observational ratings suggested behavioral improvement in the QEEG group who in general were in training for a longer period of time. Conclusion. EEG abnormalities and deficits in neuropsychological testing were found among offenders. Neurotherapy as an adjunctive treatment appears to hold promise for improvement in cognitive performance as well as recidivism. It is anticipated that different neurofeedback protocols may enhance outcomes.
This report is a 2-year follow-up to a previous study describing positive behavioral changes and a spurt of EEG maturation with theta/alpha neurofeedback (NFB) training in a group of Learning Disabled (LD) children. In a control paired group, treated with placebo, behavioral changes were not observed and the smaller maturational EEG changes observed were easily explained by increased age. Two years later, the EEG maturational lag in Control Group children increased, reaching abnormally high theta Relative Power values; the absence of positive behavioral changes continued and the neurological diagnosis remained LD. In contrast, after 2 years EEG maturation did continue in children who belonged to the Experimental Group with previous neurofeedback training; this was accompanied by positive behavioral changes, which were reflected in remission of LD symptoms.
Twenty-four learning disabled adolescent boys with verbal IQ deficiencies were pretested on measures of convergent and creative thinking, assigned to eight weekly, 21-minute sessions of one of two bilateral EEG biofeedback training conditions or a no-training control condition, and post-tested two months after the pretest. The EEG biofeedback training produced baseline effects in the presumably dysfunctional left hemisphere and had an impact on arousal in-task, suggesting remedial potential for the possible hemispheric arousal deficits in learning disabilities. Training the right hemisphere toward higher arousal and the left hemisphere toward lower arousal resulted in a notable improvement in arithmetic.
Neurofeedback (NFB) is an operant conditioning procedure, by which the subject learns to control his/her EEG activity. On one hand, Learning Disabled (LD) children have higher values of theta EEG absolute and relative power than normal children, and on the other hand, it has been shown that minimum alpha absolute power is necessary for adequate performance. Ten LD children were selected with higher than normal ratios of theta to alpha absolute power (theta/alpha). The Test Of Variables of Attention (TOVA) was applied. Children were divided into two groups in order to maintain similar IQ values, TOVA values, socioeconomical status, and gender for each group. In the experimental group, NFB was applied in the region with highest ratio, triggering a sound each time the ratio fell below a threshold value. Noncontingent reinforcement was given to the other group. Twenty half-hour sessions were applied, at a rate of 2 per week. At the end of the 20 sessions, TOVA, WISC and EEG were obtained. There was significant improvement in WISC performance in the experimental group that was not observed in the control group. EEG absolute power decreased in delta, theta, alpha and beta bands in the experimental group. Control children only showed a decrease in relative power in the delta band. All changes observed in the experimental group and not observed in the control group indicate better cognitive performance and the presence of greater EEG maturation in the experimental group, which suggests that changes were due not only to development but also to NFB treatment.
This study investigated effects of neurofeedback (NFB) training on attention in children with intellectual disability (ID). Twenty-one children with ID were assigned to an NFB training group (n = 7), to a visual perception (VP) training group (n = 7), or to a no-treatment group (n = 7). Two groups received 36 sessions of NFB or VP training, respectively, over 12 weeks. Children’s Color Trails Test–2, Stroop Color and Word Test, and Digit Span were administered to all participants before and after training. The follow-up study was conducted with both the NFB and VP groups in the same way after 3 months. The EEGs of the NFB group also were measured. The NFB group showed significantly improved scores on the all tests compared to the 2 control groups. The brainwaves of the frontal lobes of the NFB group declined significantly in theta wave amplitude and theta-to-beta ratio. The NFB results were maintained in the follow-up study. Beta/SMR uptraining seemed to be an effective way to enhance attention in children with ID.
Introduction. The goal of this research was to ascertain whether basic reading, reading comprehension, the reading composite, and IQ scores could be improved using neurofeedback. Pre-test and post-test reading and cognitive assessments were administered to sixth, seventh and eighth graders identified as having learning problems. Control and experimental groups were chosen at random. With the exception of three students, every student in the control and experimental group had previously been diagnosed with Specific Learning Disabilities or as Other Health Impaired according to State and Federal guidelines for special education services. The three students were medically diagnosed as having ADHD and were on a 504 Accommodation Plan. Method. The research began in late August 2001 with securing administrative and parental permissions. Student participation began during the last week in September and lasted through the last week in April. A day was set aside to administer QEEGs (also called “brain maps”) to the students in the experimental group. Protocols were developed by following the brain maps and by using clinical judgment after staffing the students with their teachers on a regular basis; their psychoeducational evaluations were also used to plan the protocols. Following the statistics on the biofeedback machines also influenced protocol decisions. Neurofeedback training was provided to the participants of the experimental group only. Both the experimental group and the control group had their Individualized Educational Plans (IEP) or 504 Plans plus their general curriculum plans. Neurofeedback training lasted approximately 30 to 45 minutes within each one-hour time block. The sessions were conducted weekly for the seven-month period. Some students received more sessions than others because of absences, field trips, testing and other natural rhythms of home and school life. The average number of sessions per student was 28. Results. Neurofeedback was more effective in improving scores on reading tests than no neurofeedback training. There were significant interactions between neurofeedback and time on basic reading. Wilks’ lambda (Λ) = .69, F(1, 23) = 10.32, p < .01, on reading comprehension, Λ = .75, F(1, 23) = 7.62, p = .01, and on reading composite scores, Λ = .65, F(1, 23) = 12.59, p < .01. Neurofeedback training was more effective in improving both the Verbal and Full Scale IQ scores than no neurofeedback training. There was a significant interaction between neurofeedback and time on Verbal IQ, Λ = .62, F(1, 21) = 12.71, p<.01, and on Full Scale IQ, A = .56, F(1, 21) = 16.50, p < .01. However, there was not a significant interaction between neurofeedback and time on Performance IQ, Λ = .87, F(1, 21) = 3.00, p = .10. Discussion. The results support the hypothesis that biofeedback training is effective in improving reading quotients. Limitations of the study and ideas for further research are presented. Neurofeedback may be an effective supplement to special education in improving IQ and reading performance.
Introduction: Down syndrome is the most common identifiable cause of intellectual disability, accounting for almost one third of cases and approximately 1 in 800 births. Neurofeedback (NF) is an operant conditioning method for retraining brain wave (EEG) patterns. An increasing number of clinicians use operant conditioning of EEG activity as a method of helping children with Attention Deficit Hyperactivity and Generalized Learning Disability (ADHD/ADD or GLDO). Some Down syndrome children display symptoms of ADHD/ADD, GLDO or both. We believed that NF may have potential in helping children with Down syndrome. Methodology: Eight children with Down Syndrome (ages 6–14) were evaluated through questionnaire, parent interview, and pre- and post-treatment quantitative EEG’s. All eight children were seen by the first author and by the special educator at the baseline, and at the 20th, 40th and 60th treatment sessions. Pre-treatment QEEGs were analyzed using the NxLink normative database and generally showed excess delta and theta EEG patterns. None of the subjects were able to speak more than one word sentences and they had very limited vocabulary (between 5–10 words). They usually pointed a finger to communicate and were not able to engage in basic conversation. All children displayed very poor attention and concentration, poor memory, impulsivity, behavior problems, in some cases balance problems. The purpose of this preliminary study was to evaluate whether QEEG guided, bipolar montage NF training is effective in developing speech, improving attention and concentration, improving learning, decreasing behavioral problems or impulsivity, and alleviating balance problems in Down Syndrome children. All subjects were medication-free during treatment. NF training was conducted using Lexicor Biolex software with electrode placement guided by QEEG findings, seeking to normalize abnormal QEEG patterns. Training continued until the subjects demonstrated improvement and there were significant improvements in the reports of parents, or until a total of 60 treatment sessions were provided. Scores derived from a combination of questionnaire and parental ratings were obtained pre- and post-treatment in the areas of memory, speech and language, attention, behavior, and balance. Results. One subject dropped out after eight sessions. All seven children who completed NF training showed significant (p < .02) improvement in all areas evaluated based on the questionnaire and parent interviewing, and changes were found in QEEGs. Further study with a control group and additional outcome measures is warranted.
This study presents a clinical treatment regime for pathological interhemispheric dysfunction with respect to a population of learning disabled boys. The results obtained replicate and extend earlier findings with respect to operantly conditioned increases in amplitude of sensorimotor transactions and its positive effect on learning disability. Specifically, the biofeedback, and subsequent conditioning, of increased 14 Hz neural discharge patterns (sensorimotor rhythm — SMR) over the central Rolandic cortex, appeared to increase bilateral sensorimotor transactions resulting in substantive reduction/remediation in the learning disabilities of the recipients of such EEG biofeedback training.
Neurotherapeutic techniques continue to advance in sophistication and complexity, and as such so does the need to reference odd occurrences or adverse reactions as a result of training in different regions of the brain. This is important to the field of neurotherapy in addition to those practitioners who may encounter patients on medications at the time of training, and this type of information can only add to the armamentarium of tools at our disposal. We discuss noted odd occurrences that have transpired during our studies employing LORETA neurofeedback (LNFB) in both children and adults. We also discuss negative events reported by patients or parents and medications interactions with LNFB. Positive results are also discussed. The field of neurofeedback can benefit immensely from more reports of this type.
Through continuous feedback of the electroencephalogram (EEG) humans can learn how to shape their brain electrical activity in a desired direction. The technique is known as EEG biofeedback, or neurofeedback, and has been used since the late 1960s in research and clinical applications. A major limitation of neurofeedback relates to the limited information provided by a single or small number of electrodes placed on the scalp. We establish a method for extracting and feeding back intracranial current density and we carry out an experimental study to ascertain the ability of the participants to drive their own EEG power in a desired direction. To derive current density within the brain volume, we used the low-resolution electromagnetic tomography (LORETA). Six undergraduate students (three males, three females) underwent tomographic neurofeedback (based on 19 electrodes placed according to the 10-20 system) to enhance the current density power ratio between the frequency bands β (16-20 Hz) and α (8-10 Hz). According to LORETA modeling, the region of interest corresponded to the Anterior Cingulate (cognitive division). The protocol was designed to improve the performance of the subjects on the dimension of sustained attention. Two hypotheses were tested: 1) that the β/α current density power ratio increased over sessions and 2) that by the end of the training subjects acquired the ability of increasing that ratio at will. Both hypotheses received substantial experimental support in this study. This is the first application of an EEG inverse solution to neurofeedback. Possible applications of the technique include the treatment of epileptic foci, the rehabilitation of specific brain regions damaged as a consequence of traumatic brain injury and, in general, the training of any spatial specific cortical electrical activity. These findings may also have relevant consequences for the development of brain-computer interfaces.
In this study we compared the current density power and power asymmetry in 15 right-handed, medication-free chronically depressed females (of the unipolar type) and age-matched non-clinical female controls. We used frequency domain LORETA (Low-Resolution Electromagnetic Tomography). In the interhemispheric asymmetry analysis, compared with the control group, the depression group exhibited a left-to-right Alpha2 (10–12 Hz) current density dominance in the left postcentral gyrus. The pattern of left-to-right dominance included frontal (especially medial and middle frontal gyri) and temporal locations. The between groups comparison of spectral power revealed decreased activity in the right middle temporal gyrus in the depressed group. The decrease emerged in the whole frequency spectrum analyzed (2–32 Hz), although it reached significance in the Delta (2–3.5 Hz) band only. These findings are discussed in terms of the existing literature on affect using EEG, PET and SPECT.
The theta-over-alpha frequency crossover seen in alpha-theta neurofeedback, considered an important factor in the treatment’s success, has had little definitive research. This study examined 182 alpha-theta session graphs from 10 subject case files for interactions between frequency band activity and subject reports of imagery or biographical memories during crossovers, as well as treatment outcomes. Statistical analyses revealed significantly more reports of imagery/memories during crossover conditions having specific spectral, amplitude, and duration characteristics. Imagery reports were more likely to occur during crossover activity of 1 microvolt or more, lasting at least 3 minutes, and including 3.75µv of 15–20 Hz beta. This defined therapeutic crossover condition also was significantly related to better treatment outcome measures.
Advances in neuroscience are applied to the clinical applications of EEG neurofeedback by linking symptoms to functional networks in the brain. This is achieved by reviews of the last 20 years of functional neuroimaging studies of brain networks related to clinical disorders based on positron emission tomography, functional MRI, diffusion tensor imaging, and EEG/MEG inverse solutions. Considerable consistency exists between different imaging modalities because of the property of functional localization and the existence of large clusters of connections in the brain representing network modules and hubs. Reviewed here is new method of EEG neurofeedback called Z-Score Neurofeedback, and it is demonstrated how real-time comparison to an age-matched population of healthy subjects simplifies protocol generation and allows clinicians to target modules and hubs that indicate dysregulation and instability in networks related to symptoms. Z-score neurofeedback, by measuring the distance from the center of the healthy age-matched population, increases specificity in operant conditioning and provides a guide by which extreme Z-score outliers are linked to symptoms and then reinforced toward states of greater homeostasis and stability. The goal is increased efficiency of information processing in brain networks related to the patient’s symptoms. The unique advantage of EEG over other neuroimaging methods is high temporal resolution in which the fine temporal details of phase lock and phase shift between large masses of neurons is quantified and can be modified by Z-score neurofeedback to address the patient’s symptoms. The latest developments in Z-score neurofeedback are a harbinger of a bright future for clinicians and, most important, patients that suffer from a variety of brain dysfunctions.
This article describes three case studies where the Low Energy Neurofeedback System (LENS) was used to augment neurotherapy/neuro-development training to help overcome cognitive and developmental issues. Simultaneously applying neuro-developmental exercises and LENS training has reduced treatment time in our clinic for certain conditions such as Pervasive Developmental Disorder (PDD) and Autistic Spectrum Disorder. The LENS training actually seems responsible for allowing other forms of treatment to take place. The first case study was of 4 1/2-year-old identical twins, with developmental delay and autistic spectrum that completed their training within 18 months and graduated out of our program symptom-free, performing as normal 6-year-olds. The second case involved Attention Deficit Disorder with hyperactivity and Oppositional Defiant Disorder in a 12-year-old male with comorbid learning and memory issues compounded by undetected food allergies which had affected CNS functioning since birth. The final case was a 43-year-old female with a mild head injury and significant visual and auditory processing problems. In all cases the post-treatment quantitative EEG results demonstrated normalized Z-scores. Cognitive ability testing with the Woodcock-Johnson® III Tests of Cognitive Abilities (Woodcock, McGrew, & Mather, 2001) likewise documented that post-treatment cognitive abilities had normalized. Following the case presentations clinical impressions about LENS training and its effectiveness are presented.
Treatment planning for a patient diagnosed with fibromyalgia (FMS) requires neurotherapists to consider a wide range of potential causes during history taking. Effective treatment planning often involves interventions from multiple specialists coordinating treatments. Creation of a treatment team may involve, in addition to neurotherapy, medical specialties such as infectious disease, physical medicine, neurology, nutrition, and rheumatology, as well as cranial sacral and myofascial treatments, and surface electromyography (sEMG). Understanding the signs of common complications in those diagnosed with FMS is vital to effective treatment.
Fetal alcohol spectrum disorders (FASD) stem from prenatal exposure of the fetus to alcohol. Resulting problems vary on a continuum of severity but commonly involve structural and functional brain abnormalities resulting in problems with academic performance, ADD/ADHD, information processing, math performance, memory, social skills, and increased rates of psychopathology, all of which generally persist into adulthood. This article presents the first uncontrolled case report of neurofeedback treatment of an FASD case on the milder end of this spectrum, which resulted in significant behavioral and academic improvements that were sustained on follow-up at 42 months. It is possible that neurofeedback may hold potential to improve functioning in persons with FASD.
Background. Treatment of fibromyalgia syndrome (FMS) remains a clinical challenge. Pain, somatic and cognitive symptoms may be due to neurosensitization involving CNS-activated autonomic and musculoskeletal reactions, associated with EEG abnormalities that may respond to brainwave-based stimulation biofeedback. This study’s objective was to examine the efficacy and safety of a novel EEG neurobiofeedback treatment, the Flexyx Neurotherapy System® (FNS), and electrophysiological responses in persons with fibromyalgia. Methods. A randomized, double-blind, placebo-controlled clinical trial was conducted in two private practices: a free-standing neurobiofeedback center and a rheumatologist’s office at an academic medical center. Sixty-four participants with FMS (American College of Rheumatology criteria; Wolfe et al., 1990) for at least three years and symptoms for at least 48 months with no recent remission were randomized to treatment. A total of 22 treatment sessions were administered over at least 11 weeks of active (n = 33) or sham (n = 31) FNS therapy. Primary efficacy measures were the Clinical Global Impressions improvement scores, Clinician (CGI-I) and Participant (PGI-I) versions. Secondary outcomes included dolorimetry and tender point count, questionnaires (fibromyalgia symptom scales, CNS Dysfunction Questionnaire, Fibromyalgia Impact Questionnaire, Symptom Checklist-90-R), and EEG activity (delta, alpha, total amplitude). Results. More participants treated with active FNS than with sham improved partially or fully on the CGI-I at session 22 (p = .01) and follow-up (p = .04). The active FNS group had a higher CGI-I full response rate at session 22 (p < .05) but not at one-week post-treatment (p = .07). Significant active versus sham PGI-I responses were not detected (p>.10). There was no significant treatment effect on any secondary outcome measure and no specific symptom improved preferentially with active compared with sham FNS. The most commonly reported side effect was fatigue/tiredness. Pre-treatment delta/alpha EEG amplitude ratio < 1 was associated with PGI-I (but not CGI-I) response independent of treatment group assignment. Conclusion. FNS monotherapy is insufficient for treating chronic, nonremitting FMS.
Thirty patients from a private clinical practice who met the 1990 American College of Rheumatology criteria for fibromyalgia syndrome (FS) were followed prospectively through a brainwave-based intervention known as electroencephalograph (EEG)-driven stimulation or EDS. Patients were initially treated with EDS until they reported noticeable 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.
Objective: To conduct a preliminary experimental evaluation of the potential efficacy of Flexyx Neurotherapy System (FNS), an innovative electroencephalography (EEG)-based therapy used clinically in the treatment of traumatic brain injury (TBI). Participants: Twelve people aged 21 to 53 who had experienced mild to moderately severe closed head injury at least 12 months previously and who reported substantial cognitive difficulties after injury, which interfered with their functioning. Design: Participants were randomly assigned to an immediate treatment group or a wait-list control group and received 25 sessions of FNS treatment. They were assessed at pretreatment, posttreatment, and follow-up with standardized neuropsychological and mood measures. Results: Comparison of the two groups on outcome measures indicated improvement after treatment for participants’ reports of depression, fatigue, and other problematic symptoms, as well as for some measures of cognitive functioning. Most participants experienced meaningful improvement in occupational and social functioning. Conclusion: On the basis of these results, FNS appears to be a promising new therapy for TBI and merits more extensive evaluation.
Background. This paper presents the findings of an interdisciplinary committee on standards for quantitative electroencephalography (QEEG) in neurofeedback which has been unanimously accepted by the International Society for Neuronal Regulation (ISNR) Board as a position paper of ISNR. Method. The committee reviewed current standards for quantitative encephalography in other specialties as well as scholarly literature on QEEG. Results. The panel reached the following conclusions: Although clinical research indicates that a full 19 channel QEEG does not appear necessary for conducting successful neurofeedback training, an increasing number of clinicians are using comprehensive QEEG evaluations to guide their neurofeedback training. An impressive body of peer reviewed scientific literature attests to the utility of the QEEG in providing a scientifically objective and clinically practical assessment of a wide range of psychiatric, psychological and medical conditions. Many of the significant contributions to the field of QEEG have come from psychologists and the Board of Professional Affairs of the American Psychological Association has concluded that QEEG is within the scope of practice of psychologists trained in this specialty. Unlike neurology and psychiatry, where QEEG is principally used for purposes of diagnosing medical pathology, neurotherapists who use QEEG primarily do so to guide EEG biofeedback training. It is not necessary for a physician to screen raw EEG data as part of a QEEG evaluation for neurofeedback training. Conclusions. For the purpose of encouraging high standards, recommendations are made for areas of training and study in this specialty, for certification, for equipment/software, and for procedures in data collection and analysis.
Introduction. Blinded, placebo-controlled research (e.g., Sterman, 2000) has documented the ability of brainwave biofeedback to recondition brain wave patterns. Neurofeedback has been used successfully with uncontrolled epilepsy, ADD/ADHD, learning disabilities, anxiety, and head injuries. However, nothing has been published on the treatment of obsessive-compulsive disorder (OCD) with neurofeedback. Method. Quantitative EEGs were gathered on two consecutive OCD patients who sought treatment. This assessment guided protocol selection for subsequent neurofeedback training. Results. Scores on the Yale-Brown Obsessive-Compulsive Scale and the Padua Inventory normalized following treatment. An MMPI was administered pre-post to one patient, and she showed dramatic improvements not only in OCD symptoms, but also in depression, anxiety, somatic symptoms, and in becoming extroverted rather than introverted and withdrawn. Discussion. In follow-ups of the two cases at 15 and 13 months after completion of treatment, both patients were maintaining improvements in OCD symptoms as measured by the Padua Inventory and as externally validated through contacts with family members. Since research has found that pharmacologic treatment of OCD produces only very modest improvements and behavior therapy utilizing exposure with response prevention is experienced as quite unpleasant and results in treatment dropouts, neurofeedback appears to have potential as a new treatment modality.
The enhancement of EEG alpha through various meditative techniques and biofeedback has been shown to correlate with alterations in mental as well as muscular activity towards a state of relaxation. We thought that such mental relaxation might be reciprocally inhibitory to ruminative activity characteristic of the obsessive neurotic. Five ruminating obsessives were given 7–20 biofeedback training sessions to learn control of EEG alpha. Results indicate that (1) some obsessives can learn EEG control; (2) special augmented instructions seem no better than standard, minimal instructions in aiding Ss to produce alpha; (3) subjective states during alpha are reported as relaxed, daydreaming and not thinking; and (4) although difficult to generalize beyond the feedback situation, virtually no ruminations occur during alpha regardless of the amount of alpha produced. Further study is indicated before a treatment program can be considered.
While neurofeedback (NF) has been extensively studied in the treatment of many disorders, there have been only three published reports, by D.C. Hammond, on its clinical effects in the treatment of obsessive compulsive disorder (OCD). In this paper the efficacy of qEEG-guided NF for subjects with OCD was studied as a case series. The goal was to examine the clinical course of the OCD symptoms and assess the efficacy of qEEG guided NF training on clinical outcome measures. Thirty-six drug resistant subjects with OCD were assigned to 9–84 sessions of QEEG-guided NF treatment. Daily sessions lasted 60 minutes where 2 sessions with half-hour applications with a 30 minute rest given between sessions were conducted per day. Thirty-three out of 36 subjects who received NF training showed clinical improvement according to the Yale-Brown obsessive-compulsive scale (Y-BOCS). The Minnesota multiphasic inventory (MMPI) was administered before and after treatment to 17 of the subjects. The MMPI results showed significant improvements not only in OCD measures, but all of the MMPI scores showed a general decrease. Finally, according to the physicians’ evaluation of the subjects using the clinical global impression scale (CGI), 33 of the 36 subjects were rated as improved. Thirty-six of the subjects were followed for an average of 26 months after completing the study. According to follow-up interviews conducted with them and/or their family members 19 of the subjects maintained the improvements in their OCD symptoms. This study provides good evidence for the efficacy of NF treatment in OCD. The results of this study encourage further controlled research in this area.
Drawing on past reports of raised pain thresholds of yogis in a meditative state, the high alpha content during meditation, and reports of operant alpha wave conditioning, a hypothesis was formulated that a high alpha state and pain are incompatible behaviors, and thus the production of alpha could be used for symptomatic treatment of pain. A patient, who suffered from severe headaches resulting from head injuries, went through 67 alpha conditioning sessions and increased his alpha activity from 20 per cent time alpha with eyes closed to 92 per cent time alpha with eyes closed and 50 per cent with eyes open. Although the patient was not able to rid himself of pain by achieving a high alpha state, he was in some instances able to prevent pain by going into a high alpha state before the headache began.
Two lines of evidence provide preliminary support for the role that brain state, measured via electroencephalogram (EEG), may play in chronic pain. First, research has identified a link between brain EEG activity and the experience of pain. Second, there are a number of published studies documenting the beneficial effects of interventions that impact the cortical activity associated with chronic pain. These interventions include neurobehavioral treatments such as neurofeedback and hypnosis as well as invasive and non-invasive brain stimulation. Preliminary data showing the efficacy of neuromodulatory strategies for treating pain provides compelling reason to examine how cortical activity (as measured by EEG) may underlie the experience of pain. Existing data already suggest specific approaches that neurofeedback clinicians might consider when treating patients with chronic pain. Reciprocally, observations by neurofeedback practitioners could provide important case data that could foster the design of more definitive randomized clinical trials using such strategies for the treatment of chronic pain.
Introduction. Trigeminal neuralgia is characterized by brief episodes of extremely intense facial pain often radiating down the jaw. These episodes can occur spontaneously or be triggered by light touch, chewing or changes in temperature. The pain can be so intense as to be completely disabling. This case study concerns a 46 year-old nurse with a 15-month history of trigeminal neuralgia. She had been maintained poorly on propoxyphene napsylate/apap 100/650 mg (Darvocet-N100) over the previous year. Her neurologist’s next planned intervention was to sever the trigeminal nerve. Method. Over a period of nine months, this client had 10 peripheral biofeedback training sessions (including dynamic EMG biofeedback) and diaphragmatic breathing in conjunction with a program of stress management and counseling. She also received 29 sessions of neuro-feedback (including T4, C3, C4, C3-C4 and T3-T4). C3 seemed to be the most effective placement for sleep maintenance issues, and T3-T4 seemed to be the most effective placement for pain issues. Results. The client experienced a substantial reduction in pain and bruxism as well as improvement in sleep quality. Symptom reduction fluctuated with life stress issues and with adjustment in both peripheral and neurofeedback protocols. The success of this treatment allowed the client to avoid radical surgery (severing of the trigeminal nerve) and to discontinue use of propoxyphene napsylate/apap 100/650 mg. In a 13-month follow-up, the client reports having an active life style and managing her pain quite well on 20 mg of tramadol (Ultram) every 12 hours as long as she uses her self-regulation techniques. Conclusion. This case study suggests that a multi-modal approach of neurofeedback, peripheral biofeedback, stress management and counseling was clinically efficacious in treating the symptoms of this difficult and painful condition.
We assess the effects of EEG biofeedback training on levodopa-induced dyskinesia (LID) in patients with Parkinson’s disease (PD) using a sham feedback controlled study design. Nine subjects were randomized into either a treatment group or control group and underwent 24 sessions of either active feedback training or sham feedback. The training protocol aimed at increasing 8–15 Hz activity while inhibiting excess 4–8 Hz and 23–34 Hz activity at the C3-C4 derivation. There were no statistically significant differences baseline to post-active neurofeedback training as compared to sham feedback training in primary outcome measures assessing change in dyskinesia severity, nor in secondary outcome measures assessing change in clinical features of PD. Nonsignificant trends were observed in subjects’ PD home diaries indicating a decrease in the severity of motor fluctuations. Baseline to post-training comparisons of secondary outcome measures in quantitative EEG analysis showed significant interaction effects within and between frontal and posterior regions, accompanied by decreases in 25–30 Hz (high beta) relative power, cross spectral power and phase resets per second activity, and significant increases in 8–12 Hz (alpha) relative power, cross spectral power, and coherence activity. These results indicate that EEG biofeedback training can affect the spectral EEG topography of individuals with PD and LID and that training to increase 8–15 Hz activity and decrease 23–34 Hz activity may have been associated with a nonsignificant decrease in dyskinesia severity and an improved sense of well-being.
The purpose of this study was to examine the effect of NeuroField pulsed EMF stimulation on Parkinson’s Disease (PD) symptoms. Pretreatment, posttreatment, and follow-up QEEG was analyzed along with patient symptom ratings of PD symptoms. The results show significant differences in pre- versus post- versus follow-up QEEG. PD patient symptom ratings were significantly reduced by posttreatment and remained reduced on 30- and 180-day follow-up. NeuroField appears to have potential in reducing PD symptoms.
Background. This paper presents a theoretical framework for using a combination of EEG biofeedback plus regular biofeedback with clients who have movement disorders. Method. A case study is included that describes intervention and results with a 47-year-old woman with the dual diagnosis of Parkinsonapos;s disease and dystonia. The rational for adding biofeedback interventions to traditional medical treatment hinges on the fact that muscle spindles, which are involved in muscle movement and tone, have double innervations, cholinergic and sympathetic (Passatore, Grassi, & Filippi, 1985). Both of these systems can be operantly conditioned using biofeedback. There were two learning goals: (1) increase the production of 12 to 15 Hz activity since this sensor motor rhythm (SMR) is associated with decreased firing of the red nucleus and the red nucleus, in turn, has links to the muscle spindles (Sterman, 2000); (2) train for calm, relaxed auto-nomic nervous system functioning (decreased sympathetic drive and parasympathetic ascendance) because this may also have a beneficial effect on muscle tone by means of influencing muscle spindle activity (Banks, Jacobs, Gevirtz, & Hubbard, 1998). Training for balanced autonomic system functioning is facilitated by diaphragmatic breathing at a rate of about six breaths per minute. Diaphragmatic breathing results in respiration and heart rate variability, presented as a line graph, following the same sinusoidal pattern when viewed on a biofeedback screen, a pattern termed respiratory sinus arrhythmia (RSA, Budzynski, 1989). This dual training of neurofeedback to enhance SMR activity and RSA biofeedback for relaxed autonomic nervous system (ANS) functioning was done for 30 sessions over a six-month period. Results. Training was associated with significant reduction in dystonic movements. Additionally, the client became able to use diaphragmatic breathing to cue herself to turn on a mental state associated with increased SMR production and thus control incidents of freezing, a common problem in advanced Parkinsonapos;s disease. With twelve more sessions over the next 18 months, the improved quality of life has been maintained. Discussion. This work is reported to put forth a theoretical model of why neurofeedback plus biofeedback is helpful in movement disorders and to encourage research in this area.
Background. This study reports on a new method for golf performance enhancement employing personalized real-life neurofeedback during golf putting. Method. Participants (n = 6) received an assessment and three real-life neurofeedback training sessions. In the assessment, a personal event-locked electroencephalographic (EEG) profile at FPz was determined for successful versus unsuccessful putts. Target frequency bands and amplitudes marking optimal prefrontal brain state were derived from the profile by two raters. The training sessions consisted of four series of 80 putts in an ABAB design. The feedback in the second and fourth series was administered in the form of a continuous NoGo tone, whereas in the first and third series no feedback was provided. This tone was terminated only when the participants EEG met the assessment-defined criteria. In the feedback series, participants were instructed to perform the putt only after the NoGo tone had ceased. Results. From the personalized event-locked EEG profiles, individual training protocols were established. The interrater reliability was 91%. The overall percentage of successful putts was significantly larger in the second and fourth series (feedback) of training compared to the first and third series (no feedback). Furthermore, most participants improved their performance with feedback on their personalized EEG profile, with 25% on average. Conclusions. This study demonstrates that the “zone” or the optimal mental state for golf putting shows clear recognizable personalized patterns. The learning effects suggest that this real-life approach to neurofeedback improves learning speed, probably by tapping into learning associated with contextual conditioning rather than operant conditioning, indicating perspectives for clinical applications.
Introduction. Previous research has supported anecdotal reports of a possible correlation between the state of hypnagogia and the enhancement of creative ability (Green, 1972; Green, Green, & Walters, 1970, 1974; Parks, 1996; Stembridge, 1972; Whisenant & Murphy, 1977). Some psychologists (e.g., Maslow, 1963; Rogers, 1978) have suggested that there is also a correlation between creative ability and enhanced well-being. Methods. This study utilized an 8-week repeated-measures experimental design to investigate the effects of electroencephalogram (EEG) biofeedback on the willful use of hypnagogia for increasing creativity and well-being. The sample size of 62 (30 experimental subjects and 32 controls) was comprised of both sexes with a mean age of 45. The EEG parameters of hypnagogia were broadly defined as the presence and pre-dominance of alpha and theta brain wave activity. Creativity was defined by the three most readily agreed upon divergent thinking abilities: (a) fluency (the ability to generate numerous ideas), (b) flexibility (the ability to see a given problem from multiple perspectives), and (c) originality (the ability to come up with new and unique ideas). Results. Hypnagogia was analyzed through multiple univariate analyses of variance. The EEG data showed that both experimental and control participants were able to achieve light to deep hypnagogic states in every training session. T-tests results on fluency and originality scores from the Torrance Test of Creative Thinking and the Christensen-Guilford Associational Fluency Test showed no significant changes in pre- and post-tests for either group. However, flexibility in thinking, as measured by the Alternate Uses Test was significantly increased (p < .001) for all participants. Well-being, as measured by the Friedman Well-Being Scale, also significantly increased for all participants (p = .002). Discussion. The data suggest that willful use of hynagogia may indeed increase creativity and well-being. Participants reported increased personal creativity, stress reduction, heightened self-awareness, emotional equanimity, and improved work performance.
Biofeedback-assisted modulation of electrocortical activity has been established to have intrinsic clinical benefits and has been shown to improve cognitive performance in healthy humans. In order to further investigate the pedagogic relevance of electroencephalograph (EEG) biofeedback (neurofeedback) for enhancing normal function, a series of investigations assessed the training’s impact on an ecologically valid real-life behavioural performance measure: music performance under stressful conditions in conservatoire students. In a pilot study, single-blind expert ratings documented improvements in musical performance in a student group that received training on attention and relaxation related neurofeedback protocols, and improvements were highly correlated with learning to progressively raise theta (5–8 Hz) over alpha (8–11 Hz) band amplitudes. These findings were replicated in a second experiment where an alpha/theta training group displayed significant performance enhancement not found with other neurofeedback training protocols or in alternative interventions, including the widely applied Alexander technique.
The field of neurofeedback training has largely proceeded without validation. Here we review our studies directed at validating SMR, beta and alpha–theta protocols for improving attention, memory, mood and music and dance performance in healthy participants. Important benefits were demonstrable with cognitive and neurophysiological measures which were predicted on the basis of regression models of learning. These are initial steps in providing a much needed scientific basis to neurofeedback, but much remains to be done.
Alpha-theta neurofeedback has been shown to produce professionally significant performance improvements in music students. The present study aimed to extend this work to a different performing art and compare alpha-theta neurofeedback with another form of biofeedback: heart rate variability (HRV) biofeedback. Twenty-four ballroom and Latin dancers were randomly allocated to three groups, one receiving neurofeedback, one HRV biofeedback and one no intervention. Dance was assessed before and after training. Performance improvements were found in the biofeedback groups but not in the control group. Neurofeedback and HRV biofeedback benefited performance in different ways. A replication with larger sample sizes is required.
One approach to understanding processes that underlie skilled performing has been to study electrical brain activity using electroencephalography (EEG). A notorious problem with EEG is that genuine cerebral data is often contaminated by artifacts of non-cerebral origin. Unfortunately, such artifacts tend to be exacerbated when the subject is in motion, meaning that obtaining reliable data during exercise is inherently problematic. These problems may explain the limited number of studies using EEG as a methodological tool in the sports sciences. This paper discusses how empirical studies have generally tackled the problem of movement artifact by adopting alternative paradigms which avoid recording during actual physical exertion. Moreover, the specific challenges that motion presents to obtaining reliable EEG data are discussed along with practical and computational techniques to confront these challenges. Finally, as EEG recording in sports is often underpinned by a desire to optimise performance, a brief review of EEG-biofeedback and peak performance studies is also presented. A knowledge of practical aspects of EEG recording along with the advent of new technology and increasingly sophisticated processing models offer a promising approach to minimising, if perhaps not entirely circumventing, the problem of obtaining reliable EEG data during motion.
There have been many claims regarding the possibilities of performance enhancement training. The aim of such training is for an individual to complete a specific function or task with fewer errors and greater efficiency, resulting in a more positive outcome. The present review examined evidence from neurofeedback training studies to enhance performance in a particular area. Previous research has documented associations between specific cortical states and optimum levels of performance in a range of tasks. This information provides a plausible rationale for the use of neurofeedback to train individuals to enhance their performance. An examination of the literature revealed that neurofeedback training has been utilised to enhance performance from three main areas; sport, cognitive and artistic performance. The review examined evidence from neurofeedback training studies within each of these three areas. Some suggestive findings have been reported with regard to the use of neurofeedback training to enhance performance. However, due to a range of methodological limitations and a general failure to elicit unambiguous changes in baseline EEG activity, a clear association between neurofeedback training and enhanced performance has yet to be established. Throughout, the review highlights a number of recommendations to aid and stimulate future research.
This case study investigated the effects of cranial electrotherapy stimulation (CES) on the prevalence and intensity of posttraumatic stress disorder (PTSD) symptoms and self- perceived improvement of performance and satisfaction in daily activities in war veterans. Two male Caucasian veterans (ages 54 and 38) diagnosed with PTSD participated in these case studies with a pretest–posttest design. The Canadian Occupational Performance Measure (COPM) and the PTSD Symptom Scale–Interview (PSS-I) were administered before and after the 4-week CES treatment. The participants self-administered the 4-week CES treatment protocol using Alpha-Stim SCS CES device in their home for 20 to 60 min a day, 3 to 5 days a week with a comfortable, self-selected, current level between 100 and 500 microamperes. They were asked to document the settings and responses in a daily treatment log. Through visual trend analysis and change scores, the results revealed daily PTSD symptoms decreased in frequency and severity for both participants from PSSI-I and daily treatment log. Self-perceived efficacy of performance and satisfaction as measured by the COPM also improved in the 54-year-old participant as his change scores (performance: +5.4; satisfaction: +7.9) were over the clinical significance of 2 points of COPM. Both participants reported a decrease in PTSD symptoms and an overall improvement in self-perceived occupational performance after a trial of CES. Findings from this study suggest that future research could contribute to the role of occupational therapists using CES in the treatment of veterans with PTSD. This preliminary study, if confirmed, indicates that CES could provide occupational therapists with a safe and effective way to reduce the symptom burden of PTSD while facilitating occupational performance for a rapidly increasing population of war veterans.

The Flexyx Neurotherapy System (FNS), a novel variant of EEG biofeedback, was adapted for intervention with seven treatment-refractory Afghanistan/Iraq war veterans, and brought about significant decreases in bothersome neurobehavioral and posttraumatic stress symptoms. FNS may help ameliorate mixed trauma spectrum syndromes.

Background: Recently, psychologist Barry Sterman of the UCLA School of Medicine became involved in measuring the brain wave activity of pilots engaged in a variety of tasks for the purpose of identifying the brain wave correlates of peak performance under different load conditions. Sterman found that during a manageable periodic challenge the brain waves exhibited, in parietal areas, a consistent cycling between resting state alpha (when in the attentive readiness state) and an alpha desynchronized, elevated low beta state when engaged in the response mode. As the tasks came closer together, hence allowing for no alpha respite, there was a deterioration in performance accompanied by an increase in theta activity. In this paper, the effects of brief, eyes-open alpha brain wave enhancement training will be examined for the general purpose of suggesting possible methods for increasing functional integrity and cortical flexibility through increased alpha brain wave production. Methods: The subjects were 77 U.S. Army reservists. The EEG biofeedback system used was the BioIntegrator manufactured by the Bio-Research Institute. Alpha enhancement training was employed with electrode placement at Pz. Results: It was found that eyes-open alpha enhancement training resulted in substantial increases in activity in the feedback band (alpha) with smaller increases in low beta and decreases in theta. This is quite a different result than one would expect from general “relaxation” training that is usually accomplished with eyes closed and yields substantial increases in both alpha and theta. Conclusion: When engaged in this training, even for brief periods, the EEG moves in a direction quite different to that of Sterman’s burnout profile. It would be of interest to demonstrate rigorously that the training could, if administered preventatively, diminish poor performance in persons performing tasks that demand prolonged periods of external focus under high load conditions.
Introduction. It has been reported that individuals with Autism Spectrum Disorder (ASD) have abnormal reactions to the sensory environment and visuo-perceptual abnormalities. Electrophysiological research has provided evidence that gamma band activity (30–80 Hz) is a physiological indicator of the coactivation of cortical cells engaged in processing visual stimuli and integrating different features of a stimulus. A number of studies have found augmented and indiscriminative gamma band power at early stages of visual processing in ASD; this may be related to decreased inhibitory processing and an increase in the ratio of cortical excitation to inhibition. Low frequency or “slow” (≤1HZ) repetitive transcranial magnetic stimulation (rTMS) has been shown to increase inhibition of stimulated cortex by the activation of inhibitory circuits. Method. We wanted to test the hypothesis of gamma band abnormalities at early stages of visual processing in ASD by investigating relative evoked (i.e., ∼100 ms) gamma power in 25 participants with ASD and 20 age-matched controls using Kanizsa illusory figures. In addition, we wanted to assess the effects of 12 sessions of bilateral “slow” rTMS to the dorsolateral prefrontal cortex on evoked gamma activity using a randomized controlled design. Results. In individuals with ASD evoked gamma activity was not discriminative of stimulus type, whereas in controls early gamma power differences between target and nontarget stimuli were highly significant. Following rTMS individuals with ASD showed significant improvement in discriminatory gamma activity between relevant and irrelevant visual stimuli. We also found significant improvement in the responses on behavioral questionnaires (i.e., irritability, repetitive behavior) as a result of rTMS. Conclusion. We propose that slow rTMS may have increased cortical inhibitory tone, which improved discriminatory gamma activity at early stages of visual processing. rTMS has the potential to become an important therapeutic tool in ASD treatment and has shown significant benefits in treating core symptoms of ASD with few, if any side effects.
Introduction. Earlier studies have shown that brain stimulation by means of repetitive Transcranial Magnetic Stimulation (rTMS) over the primary motor cortex can decrease the motor impairments in Parkinson’s disease (PD). The present study focused on the clinical relevance of rTMS in the treatment of PD. Method. Thirteen PD patients received a minimum of 10 sessions of 2,000 pulses 5 Hz rTMS over the hand and leg area over the primary motor cortex, with a stimulation intensity of 120% of the motor threshold. In our analysis an effect could be considered as clinically relevant if the quality of life (QoL) improved with 30% or more. Results. Paired-sample t-tests revealed a significant improvement of Unified Parkinson’s Disease Rating Scale score, walking speed, and mood. A minority of the patients (38%) who underwent rTMS showed an improvement in QoL of greater than 30%. The improvements on QoL correlated significantly to scores of motor improvements on the Unified Parkinson’s Disease Rating Scale but not to improvements in mood as assessed by the Geriatric Depression Scale. The use of rTMS did not demonstrate any effects on tremor, freezing of gait, and activities of daily life, and rTMS had no effect on the stage of disease. It mainly improved rigidity, finger and hand movements, and leg agility. Conclusion. This study shows that although there can be significant group effects of rTMS on PD symptoms, these significant effects do not automatically imply that these are clinically relevant. Therefore we advise that future studies in the field of neuromodulation (rTMS, neurofeedback, etc.) also focus more on the clinical relevance of the treatment under investigation rather than only report “significant group differences.”
This is a study on the effect of neurofeedback on chronic inpatient complex paranoid schizophrenics. The purpose of this research was twofold: first, to determine the effects of the application of neurofeedback to very chronic cases of schizophrenia that had been resistant to years of inpatient medical and psychological treatment and second, to propose a connection paradigm of schizophrenia. The author obtained progress using neurofeedback with more than 70 hospital inpatients with chronic schizophrenia. Improvements were seen in the EEG patterns and in cognitive, affective and behavioral patterns that often resulted in successful release from the hospital to live in the community. A 2-year follow up found that positive changes were sustained. It is the author’s impression that reinforcement of right parietal alpha and inhibiting frontal delta and fast beta activity obtained the best results.
Slow cortical potentials (SCPs) are considered to reflect the regulation of attention resources and cortical excitability in cortical neuronal networks. Impaired attentional functioning, as found in patients with schizophrenic disorders, may covary with impaired SCP regulation. This hypothesis was tested using a self-regulation paradigm. Twelve medicated male schizophrenic inpatients and 12 healthy male controls received continuous feedback of their SCPs, during intervals of 8 s each, by means of a visual stimulus (a stylized rocket) moving horizontally across a TV screen. The position of the feedback stimulus was a linear function of the integrated SCP at each point in time during the feedback interval. Subjects were required to increase or reduce negative SCPs (referred to pretrial baseline) depending on the presentation of a discriminative stimulus. The correct response was indicated by the amount of forward movement of the feedback stimulus and by monetary rewards. Schizophrenics participated in 20 sessions (each comprising 110 trials), while controls participated in 5 sessions. Compared with the healthy controls, schizophrenics showed no significant differentiation between negativity increase and negativity suppression during the first sessions. However, in the last 3 sessions, patients achieved differentiation similar to controls, demonstrating the acquisition of SCP control after extensive training.
Schizophrenia is sometimes considered one of the most devastating of mental illnesses because its onset is early in a patient’s life and its symptoms can be destructive to the patient, the family, and friends. Schizophrenia affects 1 in 100 people at some point during their lives, and while there is no cure, it is treatable with antipsychotic medications. According to the Clinical Antipsychotic Trials for Interventions Effectiveness (CATIE), about 74% of the patients who have discontinued the first medication prescribed within a year will have a relapse afterward. This shows an enormous need for developing better treatment methods and better ways to manage the disease, since current therapies do not have sufficient impact on negative symptoms, cognitive dysfunction, and compliance to treatment. In this clinical case series, we investigate the efficacy of quantitative electroencephalography (qEEG)-guided neurofeedback (NF) treatment in this population, and whether this method has an effect on concurrent medical treatment and on the patients. Fifty-one participants (25 males and 26 females) ranging from 17 to 54 years of age (mean: 28.82 years and SD: 7.94 years) were included. Signed consent was received from all patients. Most of the participants were previously diagnosed with chronic schizophrenia, and their symptoms did not improve with medication. All 51 patients were evaluated using qEEG, which was recorded at baseline and following treatment. Before recording the qEEG, participants were washed out for up to 7 half-lives of the medication. After Food and Drug Administration (FDA)-approved Nx-Link Neurometric analysis, qEEGs suggested a diagnosis of chronic schizophrenia for all participants. This was consistent with the clinical judgment of the authors. The participants’ symptoms were assessed by means of the Positive and Negative Syndrome Scale (PANSS). Besides the PANSS, 33 out of 51 participants were also evaluated by the Minnesota Multiphasic Personality Inventory (MMPI) and the Test of Variables of Attention (TOVA), both at baseline and following treatment. Each participant was prescribed an NF treatment protocol based on the results of their qEEG neurometric analysis. Each session was 60 minutes in duration, with 1 to 2 sessions per day. When 2 sessions were administered during a single day, a 30-minute rest was given between the sessions. Changes in the PANSS, MMPI, and TOVA were analyzed to evaluate the effectiveness of NF treatment. The mean number of sessions completed by the participants was 58.5 sessions within 24 to 91 days. Three dropped out of treatment between 30 and 40 sessions of NF, and one did not show any response. Of the remaining 48 participants 47 showed clinical improvement after NF treatment, based on changes in their PANSS scores. The participants who were able to take the MMPI and the TOVA showed significant improvements in these measures as well. Forty were followed up for more than 22 months, 2 for 1 year, 1 for 9 months, and 3 for between 1 and 3 months after completion of NF. Overall NF was shown to be effective. This study provides the first evidence for positive effects of NF in schizophrenia.
In this report, the treatment of a 42-year-old female with a complaint of chronic sleep-onset insomnia is described. Following the unsuccessful use of relaxation training, treatment consisted of 11 sessions of EEG theta rhythm (4–7 Hz) biofeedback. Theta density and five sleep indices were monitored throughout baseline, placebo, and treatment sessions. A significant increase in theta density was accompanied by reports of a decrease in sleep latency and an increase in total sleep time. This improvement was maintained after withdrawal of medication and at 3-month follow-up.
The functional significance of sleep spindles for overnight memory consolidation and general learning aptitude as well as the effect of four 10-minute sessions of spindle frequency (11.6–16 Hz, sigma) neurofeedback-training on subsequent sleep spindle activity and overnight performance change was investigated. Before sleep, subjects were trained on a paired-associate word list task after having received either neurofeedback training (NFT) or pseudofeedback training (PFT). Although NFT had no significant impact on subsequent spindle activity and behavioral outcomes, there was a trend for enhanced sigma band-power during NREM (stage 2 to 4) sleep after NFT as compared to PFT. Furthermore, a significant positive correlation between spindle activity during slow wave sleep (in the first night half) and overall memory performance was revealed. The results support the view that the considerable inter-individual variance in sleep spindle activity can at least be partly explained by differences in the ability to acquire new declarative information. We conclude that the short NFT before sleep was not sufficient to efficiently enhance phasic spindle activity and/or to influence memory processing. NFT was, however, successful in increasing sigma power, presumably because sigma NFT effects become more easily evident in actually trained frequency bands than in associated phasic spindle activity.

Study Objectives: To test whether instrumental conditioning of sensorimotor rhythm (SMR; 12–15 Hz) has an impact on sleep parameters as well as declarative memory performance in humans.

Design: Randomized, parallel group design

Setting: 10 instrumental conditioning sessions, pre- and posttreatment investigation including sleep evaluations

Participants: 27 healthy subjects (13 male)

Interventions: SMR-conditioning (experimental group) or randomized-frequency conditioning (control group); declarative memory task before and after a 90-min nap</p>

Measurement and Results: The experimental group was trained to enhance the amplitude of their SMR-frequency range, whereas the control group participated in a randomized-frequency conditioning program (i.e., every session a different 3-Hz frequency bin between 7 and 20 Hz). During pre- and posttreatment the subjects had to attend the sleep laboratory to take a 90-min nap (2:00–3:30 pm) and to perform a declarative memory task before and after sleep. The experimental design was successful in conditioning an increase in relative 12–15 Hz amplitude within 10 sessions (d = 0.7). Increased SMR activity was also expressed during subsequent sleep by eliciting positive changes in different sleep parameters (sleep spindle number [d = 0.6], sleep onset latency [d = 0.7]); additionally, this increased 12–15 Hz amplitude was associated with enhancement in retrieval score computed at immediate cued recall (d = 0.9).

Conclusion: Relative SMR amplitude increased over 10 instrumental conditioning sessions (in the experimental group only) and this “shaping of one’s own brain activity” improved subsequent declarative learning and facilitated the expression of 12–15 Hz spindle oscillations during sleep. Most interestingly, these electrophysiological changes were accompanied by a shortened sleep onset latency.

Exteroceptive feedback was given for negative and positive shirts in slow potentials (SPs) recorded from Fz, Cz, or Pz (between groups design). Slow potentials at the feedback site were referred to adjacent scalp and non-cephalic electrodes, so as to confine SP shifts to the feedback location. Area-specific regulation of SPs was obtained at each midsagittal site after 3 days of feedback training. Subjects reported sensorimotor and emotional arousal when negative SP shifts were trained frontally, but not when negative shifts were trained parietally (cognitive/attentional strategies reported after parietal feedback). Area-specific regulation of SPs was subsequently abolished when behavioral tasks were added to further probe frontal/ parietal differences (dual-task procedure). These findings indicate that area-specific self-regulation of SPs is possible on the sagittal midline, and that self-regulated parietal SPs (in contrast to frontal ones) arise from non-motoric generators. The source of SP self-regulation was more readily probed by verbal reports of feedback strategy than by study of dual-task relations, because feedback control was disrupted by the dual-task requirement.
Background: Although several promising studies on neurofeedback training in Attention Deficit/Hyperactivity Disorder (ADHD) have been performed in recent years, the specificity of positive treatment effects continues to be challenged. Methods: To evaluate the specificity of a neurofeedback training of slow cortical potentials, a twofold strategy was pursued: First, the efficacy of neurofeedback training was compared to a group training program for children with ADHD. Secondly, the extent of improvements observed in the neurofeedback group in relation to successful regulation of cortical activation was examined. Parents and teachers rated children’s behaviour and executive functions before and after treatment. In addition, children underwent neuropsychological testing before and after training. Results: According to parents’ and teachers’ ratings, children of the neurofeedback training group improved more than children who had participated in a group therapy program, particularly in attention and cognition related domains. On neuropsychological measures children of both groups showed similar improvements. However, only about half of the neurofeedback group learned to regulate cortical activation during a transfer condition without direct feedback. Behavioural improvements of this subgroup were moderately related to neurofeedback training performance, whereas effective parental support accounted better for some advantages of neurofeedback training compared to group therapy according to parents’ and teachers’ ratings. Conclusion: There is a specific training effect of neurofeedback of slow cortical potentials due to enhanced cortical control. However, non-specific factors, such as parental support, may also contribute to the positive behavioural effects induced by the neurofeedback training.
An experiment was performed to investigate the self-regulation of slow cortical potentials (SCP) found in a previous study (Elbert et al. 1979). Seventeen subjects received continuous visual feedback fo their actual cortical shift perceptible as a rocket moving across a TV-screen during intervals of 6 sec; subjects had to direct the rocket into one of two goals representing more or less cortical negativity, depending on the pitch of two signal tones. Within two identical experimental sessions feedback trials alternated with test trials without feedback. Highly significant differences of SCP between the two required polarities were demonstrated. The most pronounced differences were observed during test trials without feedback of the second session in which a positive shift below baseline level occurred when positivity (or less negativity) was required.
Psychophysiological data support the concept that migraine is the result of cortical hypersensitivity, hyperactivity, and a lack of habituation. There is evidence that this is a brain-stem related information processing dysfunction. This cortical activity reflects a periodicity between 2 migraine attacks and it may be due to endogenous or exogenous factors. In the few days preceding the next attack slow cortical potentials are highest and habituation delay experimentally recorded during contingent negative variation is at a maximum. These striking features of slow cortical potentials are predictors of the next attack. The pronounced negativity can be fed back to the patient. The data support the hypothesis that a change in amplitudes of slow cortical potentials is caused by altered habituation during the recording session. This kind of neurofeedback can be characterized as “empirically based” because it improves habituation and it proves to be clinically efficient.
Subjects received exteroceptive feedback for bidirectional changes in slow cortical potentials or alpha power measured from the vertex. The slow potential group succeeded in shifting slow potentials toward negativity and positivity on feedback and transfer trials requiring these changes, after two sessions of training. Differentiation of negativity and positivity was accompanied by verbal reports of somatomotor activation that occurred on trials on which negative slow potentials were required (p < .01). Vertical and lateral eye movements, chin and frontalis electromyogram, and heart rate did not differentiate between negativity and positivity trials in the slow potential group. However, heart rate acceleration correlated between-subjects with slow potential negativity during feedback. Although the alpha power group did not succeed at controlling changes in alpha, evidence of a training effect appeared in verbal reports of emotional arousal (p< .05) and focused vision (p< .08) on alpha suppression trials in this group. We discuss the findings from the viewpoint that biofeedback tasks involving electrocortical responses are problems in the organization of action that subjects seek to solve.
The relationship between slow cortical potentials (SCPs) and response speed was investigated by training subjects to induce different cortical shifts by means of a biofeedback procedure. During two identical experimental sessions trials with visual feedback of the actual DC-shifts alternated with reaction time trials without feedback. In reaction time trials only the signal for the required change in polarity was provided. At the end of the signal interval an immediate button-press was required to stop a hissing noise. Two groups of 10 subjects each were investigated, one group receiving feed back from the left precentral recording(C3) and the other from the right precentral recording (C4). Results showed that subjects achieved control over their SCPs. At the end of the training period in the second session significant differences in SCPs between trials of the different required polarities were observed, during feedback trials as well as during reaction time trials without feedback. Subjects responded faster during trials in which a change toward more cortical negativity was required as compared to trials requiring less negativity.
Until recently, slow cortical potentials (SCP) training as a method of brainwave feedback has been widely ignored in the Anglo-American tradition of neurofeedback. One of the reasons was the lack of reliable and valid equipment outside a few research labs in Europe. In the meantime this has changed to the better. With devices now being available there is growing interest in SCP feedback. SCPs are very low shifts of brain activity. As they regulate excitation thresholds they may be used for self-regulation training in pathological conditions where excitation thresholds are impaired. This article explains technical requirements; describes training protocols; and gives a short overview on controlled research in epilepsy, attention deficit hyperactivity disorder, and migraine.
Background. Twenty-seven patients with brain injury, primarily from car accidents and stroke, were treated by computer-assisted electroencephalographic NeuroBioFeedback (EEG-NBF). Methods. Patients were distributed into five clinical classes, and changes in power spectra and in cardiovascular parameters were surveyed. A rationale was proposed for the calculation of the load of symptoms for each patient of each class, which in turn provided indices of rehabilitation rates. Results. Statistically significant correlations were observed between the number of NeuroBioFeedback (NBF) treatment sessions (SN#) needed and both the initial load of symptoms (SL%) and the final rate of improvement of patients’ clinical status (IMP%). When patients were considered in all five classes of defined SL%, the relationship exhibited a hyperbolic shape, although linearity could not be totally rejected, due to the variability of data. The improvement rates could be subdivided into two major classes, in which number (SN#) was hyperbolically related to the improvement rates. In addition, finger temperature responsiveness exhibited a significant correlation with the number of NBF sessions. Conclusion. The work suggests a rationale for the prediction of the duration of treatment, by considering the patients’ initial clinical status and the levels of improvement and rehabilitation considered achievable.
Introduction. A 43-year-old Caucasian woman presented with a series of physical and mental deficits following a right hemisphere cerebral artery embolus suffered at age 42. Method. For both the pretreatment and posttreatment evaluation, the client’s EEG data were collected. Prior to beginning neurofeedback a self-developed symptom checklist was provided to the participant and was repeated every 10 sessions. The participant received 52 neurofeedback sessions with the use of Neurocybernetics equipment. To determine statistical changes between the pretreatment and posttreatment conditions, average cross-spectral matrices were computed for bands delta (1–3.5 Hz), theta (3.5–7.5 Hz), alpha (7.5–12.5 Hz), beta1 (12.5–25 Hz), beta2 (25–32 Hz), and gamma (37–47 Hz). In this study the pretreatment cross-spectra for each epoch were then compared to the posttreatment epoch cross-spectra using the previously mentioned frequency band ranges. For each condition, cross-spectral matrices were computed and averaged over 2-s epochs resulting in one cross-spectral matrix for each epoch and for each of the discrete frequencies within each band. Based on previous LORETA analyses, we used a rectangular window. No time frame or frequency wise normalization was performed. Results. Following treatment, comparative QEEG and eLoreta analyses illustrated significant decreases in the absolute and relative power theta measures and significant elevations of absolute and relative power occipital beta. These findings correspond to client self-report data demonstrating improvement in cognitive functioning and depressed mood. Conclusion. Overall, findings suggest the utility of neurofeedback for the treatment of stroke,with particular gains noted in the areas of cognitive functioning, sleep quality, emotional regulation, and energy.
An innovative neurofeedback protocol for the treatment of problems with physical balance, incontinence, and swallowing is described. Successful case reports from four consecutively treated cases are presented. This protocol holds potential promise for work with the elderly, stroke and head injury patients, primary nocturnal enuresis, and in peak performance training where balance is important. Further controlled research is warranted.
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.
A 55-year-old male subject was treated with a two-tiered neurotherapy approach for a period of six months beginning approximately one year after a left-side CVA. Medical evaluation revealed left posterior temporal/parietal infarctions secondary to occlusion of the left internal carotid artery. The patient complained of hesitant speech with word finding difficulty and paraphasia, difficulty focusing his right eye, lack of balance and coordination, poor short-term memory, poor concentration, anxiety, depression, and tinnitus. A quantitative electroencephalograph (QEEG) analysis revealed increased left-side 4–7-Hz activity and alpha persistence on eye opening. Two neurotherapy approaches were used beginning with electroencephalographic entrainment feedback (EEF). This was followed by neurofeedback to inhibit 4–7 Hz and increase 15–21 Hz over sensorimotor and speech areas. At the conclusion of treatment there were significant reductions in slow-wave activity. Improvement was evident in speech fluency, word finding, balance and coordination, attention, and concentration. Depression, anxiety, and tinnitus were greatly reduced.
Many individuals with tinnitus have abnormal oscillatory brain activity. Led by this finding, we have developed a way to normalize such pathological activity by neurofeedback techniques (Weisz et al. (2005). PLoS Med., 2: e153). This is achieved mainly through enhancement of tau activity, i.e., oscillatory activity produced in perisylvian regions within the alpha frequency range (8–12 Hz) and concomitant reduction in delta power range (0.5–4 Hz). This activity is recorded from electrodes placed on the frontal scalp. We have found that modification of the tau-to-delta ratio significantly reduces tinnitus intensity. Participants who successfully modified their oscillatory pattern profited from the treatment to the extent that the tinnitus sensation became completely abolished. Overall, this neurofeedback training was significantly superiorin reducing tinnitus-related distress than frequency discrimination training.
Background and objective: Biofeedback is known as a possibility to control physiologic processes like body temperature or heart frequency. Neurofeedback is a form of biofeedback linked to aspects of the electrical activity of the brain such as frequency, location or amplitude of specific EEG activity. It has been successfully used in patients with closed head injury, hyperactivity disorder or epilepsy. Patients/methods: In this study 40 patients with tinnitus were treated with neurofeedback. They trained to upregulate the amplitude of their α-activity and downregulate the amplitude of β-activity during muscle relaxation and acoustic orientation on sounds or music in order to suppress their tinnitus. Results: After 15 sessions of training 24 patients with a duration of their tinnitus for an average of 1 year showed significant increase of a-amplitudes while 16 patients with duration of their tinnitus on an average of 7 years showed a decrease of β-amplitudes without any change in α-activity. After the training all patients had a significant reduction of the score in the tinnitusquestionaire of Göbel and Hiller. In a control-group of 15 persons without tinnitus we didn’t see any changes of α- or β-amplitudes during the same training. Conclusions: In conclusion neurofeedback is a new therapy for patients with tinnitus. Patients get the possibility of selfcontrol and therefore of influence on their disease.
Background: Persisting tinnitus is an often devastating disease condition with restricted and rarely successful therapeutic options. Patients and methods: The present study investigates the therapeutic effect of short term neurofeedback-based EEG-Alpha- and EEG-Beta-training in 40 patients suffering from “chronic decompensated tinnitus”. Patients were assigned to the Alpha or Beta group according to results of an initial EEG monitored stress-test. Four patients were excluded because they showed abnormal reactions in both EEG patterns. Results: During 12 sessions, 23 patients succeeded to increase EEG Alpha activity by 16% (p≤0.042) while 13 patients achieved no decrease of EEG Beta activity. However, both groups showed a significant reduction of subjective tinnitus annoyance by the end of the therapy (p≤0.001) Conclusions: The results indicate that neurofeedback may represent a new promising technique in the therapy of chronic decompensated tinnitus. However, it remains to be established whether the reduction of tinnitus annoyance results from the altered brain activity patterns supported by the neurofeedback learning process.

This study was conducted in an attempt to determine the efficacy of neurofeedback (NFB) in the treatment of patients suffering from vertigo or tinnitus. Results indicated that after NFB, power for delta and theta bands was reduced; however, an increase of power was noted for the alpha bands. Furthermore, normalization was observed for the vestibular evoked potentials (VestEP). After NFB, a normalization of the VestEP was also demonstrated in a patient suffering from a bilateral tinnitus. A follow-up study (12 months after NFB) demonstrated that the VestEP were normal.

This study presents a clinical treatment regime for the treatment of tic manifestation, both simple and complex. The response of a case of simple tic and a case of complex tic (Giles de la Tourette’s syndrome) to EEG sensorimotor rhythm biofeedback training are presented. Specifically, the simple and the complex tic, both of long duration, were eliminated via this EEG biofeedback training procedure. It is hypothesized that this exercising of the sensorimotor cortex resulted in increased activation of this cerebrocortical subsystem and was reflected in increased voluntary muscle control and a heightened threshold for random motor discharge, resulting in the elimination of both tics as in the response of cases of epilepsy with motor involvement to EEG sensorimotor rhythm biofeedback training. The additional psychophysiologic sequelae of the complex tic—attention deficit disorder—remediated in the manner of the response of learning-disabled to EEG sensorimotor rhythm biofeedback training.
Background. A group of 27 patients with brain injury were treated by electroencephalographic (EEG) NeuroBioFeedback under drug-free conditions. They were studied for distribution in classes of major syndromes for evaluation of treatment efficiency and rehabilitation rates with respect to associated EEG and other physiological changes. Methods. A total of 48 clinical symptoms were listed, each present in at least one patient. Classes of clinical signs have been computed using both medical and statistical criteria. Claimed and presented chief complaints, secondary complaints and all associated signs were incorporated in multivariate analysis. Results. Substantial intersection of medical and statistical distributions was observed. This provided a classification of symptoms into six classes representing the following syndromes of impaired functions: Q1 = motor; Q2 = language; Q3 = cognitive; Q4 = psychosocial; Q5 = pain-related; Q6(a & b) = neuropsychiatric; Q7 = metabolic. Membership of a patient in a defined clinical class was based on a numerical index computed from: (a) a weighted coefficient for the patient’s chief and secondary complaints, and (b) an index for both symptoms represented in the class and symptoms not represented in the class. Patients were unambiguously distributed in all classes except Q7. Conclusions. Using anon-selected group of head injured patients, this work provides a rationale for the membership of each patient in a set of classes of syndromes determined by the whole set of clinical signs specifically exhibited by this group of patients. Class-average rehabilitation rates ranged from 59% up to 87% following an average 23 to 132 treatment sessions, depending on syndromes.
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.
Background. Impairments of attention are a frequent and well documented consequence of head injury. The purpose of this study was to evaluate if Neurofeedback Therapy (NFT) can enhance remediation of attention deficits in patients with closed head injuries (CHI) who are still in the phase of spontaneous recovery. Method. Feedback of beta-activity (13–20 Hz) was used for the treatment of attentional impairments in twelve patients with moderate closed head injuries. A matched control group of nine patients was treated with a standard computerized training. All patients were tested before and after treatment with a set of attention tests. Results. After ten sessions the analyses of beta activity showed that eight patients were able to increase their beta activity while the remaining four patients showed a decrease of beta activity. Mean duration of beta activity was prolonged about 50% after training. Patients who received NFT improved significantly more in the attention tests than control patients. Conclusion. The results suggest that neurofeedback is a promising method for the treatment of attentional disorders in patients with traumatic brain injuries. It is suggested that NFT should focus not only on the enhancement of beta activity, but also on the duration patients are able to hold beta activity. It is proposed to use NFT also with patients in the early phase of rehabilitation.
The Flexyx Neurotherapy System (FNS), a novel variant of EEG biofeedback, was adapted for intervention with seven treatment-refractory Afghanistan/Iraq war veterans, and brought about significant decreases in bothersome neurobehavioral and posttraumatic stress symptoms. FNS may help ameliorate mixed trauma spectrum syndromes.
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.
This article summarizes clinical results using a neurofeedback approach that has been developed over the last several years and is seeing increasing clinical use. All participants used a form of live Z-score training (LZT) that produces sound and video feedback, based on a computation using a normative database to produce multiple targets. The client receives simple feedback that reflects a complex set of relationships between amplitude and connectivity metrics. Changes in the EEG are readily seen that conform to the reinforcement parameters being used in relation to the live Z-scores. In addition, over multiple sessions, QEEG data are seen to change significantly, generally on a path toward overall remediation. In this series of case studies LZT is seen to effectively address EEG abnormalities in a structured fashion and to facilitate normalization of the EEG. In individual cases, specific changes are observed, related to the initial conditions, and the brain’s ability to respond with appropriate changes. Overall, LZT is found to be a relatively efficient form of neurofeedback that can be demonstrated to be effective in a variety of clinical scenarios.