9-8-8 Suicide Crisis Helpline (Canada): Call or text 9-8-8 for immediate, 24/7 support; learn more at 988.ca.
Distress Centres of Greater Toronto (DCGT): 24/7 emotional support and suicide-prevention line 416-408-4357 (408-HELP); info at dcogt.com.
Gerstein Crisis Centre (Toronto): 24/7 crisis line 416-929-5200; Substance Use Crisis Team 416-962-0220 (10:00–18:
Mobile Crisis Intervention Teams (MCIT, Toronto): Access via 9-1-1 for active crises or Toronto Police non-emergency 416-808-2222 for non-urgent situations; program info at tps.ca › Mobile Crisis Intervention Team.
Kids Help Phone (youth & young adults): Call 1-800-668-6868
211 (Community & Social Services Navigation): Dial 2-1-1 (24/7; 150+ languages) or 1-877-330-3213 for up-to-date local mental-health, housing, and other supports; search 211Ontario.ca
The following studies represent some of the strongest peer reviewed evidence supporting neurofeedback as a clinically meaningful brain based therapy. All links lead to published research on PubMed, PubMed Central, or peer reviewed journals.
One mechanism suggested for the effects of sensorimotor rhythm (SMR) neurofeedback as well as TBR (Theta-Beta-Ratio) training is that it helps to normalize sleep and thus improves ADHD symptoms such as inattention and hyperactivity/ impulsivity. ADHD patients were compared to a control group to investigate if differences existed in sleep components including Sleep Onset Latency (SOL), Sleep Duration (DUR) and overall reported sleep problems (PSQI). They also examined if ay associations were seen between sleep=parameters and ADHD symptoms. Also, this study investigated the effects of SMR and TBR on symptoms, sleep parameters, and if they were mediated in the treatment outcomes. They found that there was a relationship between self-reported sleep problems (PSQI) and inattention in adults both with and without ADHD. TBE resulted in a small reduction of SOL. This change in SOL didn’t correlate with change in ADHD symptoms, and the reduction in SOL only happened in the latter half of treatment. This effect was not specifically related to TBR neurofeedback. SMR specifically reduced the SOL, and pSQI score and these changes PSQI were strongly correlated with changes in inattention and the reduction in SOL was achieved in the first half of treatment. SMR neurofeedback may have SOL mediated through the course of treatment. TBR and SMR had similar effects of symptoms reduction in ADHD. The effects of training may have different working mechanisms in the amelioration of ADHD symptoms.
This article covers the basics of neurofeedback. ADHD is characterized by hyperactivity, impulsivity, and inattention. This disorder is heterogeneous and often comorbid of associated problems from other psychiatric disorders are prevalent. ADHD can be accompanied by cognitive and motivational problems as well as abnormalities in the resting-state, associated with impaired brain activity in neuronal networks. Multimodal treatments should be utilized with comprising (NF). NF provides brain activity feedback using visual or auditory signals, which allow the participant to gain control over neuronal processes. NF can be used to improve underlying neuronal deficits or establish self-regulatory skills that can help compensate for behavioural difficulties. Most often ODD/ conduct or tic disorders are prevalent as comorbid disorders.
EEG studies often cite that Theta/Beta ratio (TBR) is a specific measure which is characteristic of ADHD. This meta-analysis covers the literature on Theta/Beta Ratio in ADHD. This study analyzed TBR during Eyes Open at location Cz. Individuals between the ages of 6-18 were measured both with and without ADHD. This study identified 1253 individuals with ADHD and 517 without, over nine studies. They found that the mean effect size for 6-14-year-olds were 0.75 and for 6-18-year-olds were 0.62. Heterogeneity is significant within these populations. The Effect Sizes are misleading and may be an overestimation. Throughout the developmental span, TBR tends to decrease. Although excessive TBR is not a reliable diagnostic measure of ADHD; a significant subgroup of ADHD patients were found to have large TBR measures in the study. Thus, excess theta and TBR can potentially be used as a prognostic measure rather than a diagnostic measure.
Neurofeedback for ADHD has multiple protocols including TBR training and training of slow cortical potentials (SCPs). In this article, mechanisms of action are questioned. Frameworks for NF models namely, conditioning-and-repair model and the skill acquisition model are also discussed at length. This underlying model impacts NF application as well as selection and evaluation strategies. Empirical data is presented. It is hypothesized that different models may hold true depending on the process and behaviours to be addressed by the nF protocol. SCP may relate to skill acquisition model.
This meta-analysis is utilized to demonstrate the utility of QEEG theta/beta ratios in the present in ADHD vs. the normal populations. Individuals had to have met criteria from the DSM-IV for diagnosis of ADHD. 9 studies with N=1498) were observed and the theta/beta ratio was summarized. The Effect size found was 3.08 for ADHD versus controls. This encompassed a control group of children adolescents and adults. This indicates that there may be up between 94-98% specificity of using theta/beta ratios for identifying ADHD. Controlled group studies were often limited in the sense that measured among the general population the specificity may be lower. 29/32 studies found in the literature demonstrated results consistent with the meta-analysis. The results are supported by the observation that TBR follows age-related changes in ADHD symptom presentation. TBR is a well-observed trait in ADHD compared to normal controls. Theta/beta ratio may rise with other condition, a study covering differential diagnosis would be required to determine generalization to this protocol to clinical applications. Standardization of QEEG technique is also needed for controlling the mental state, drowsiness, and mediation of participants.
This article aimed to examine the effectiveness of a 7-week neurofeedback training programme that acted to increase the range of the alpha band and improve abnormal anxiety in patients with panic disorder. A randomized controlled trial was conducted where patients were assigned to one of two groups; Neurofeedback training and a control group. The neurofeedback group received 20 sessions of personalized training whereas the control group received baseline routine care. The results showcased significantly higher changes in the neurofeedback group than the control group. This was characterized through the increased range of the alpha band in the neurofeedback group. In conclusion, an intervention involving neurofeedback significantly improved abnormal anxiety in adverse situations.
This systematic review looked at 587 journal articles that reported using neurofeedback as a treatment for autism. From these studies, ninety-four percent of nonrandomized controlled and experimental trials observed positive results and long-term positive effects.
Autism spectrum disorder is characterized by abnormal function in core social brain regions. In this repeated-measured design clinical trial, 15 autism spectrum disorder patients were enrolled in a 5-session training program of real-time functional magnetic resonance imaging neurofeedback targeting facial emotion expressions processions, using the posterior superior temporal sulcus as region-of-interest. Participants modulated the activity in this region-of-interest over multiple sessions. Participants were able to control their own brain activity in this social brain region, with positive clinical and neural effects.
Neurofeedback (NFB) is a means through which participants can have voluntary control on their brain waves being expressed on the EEG. Forty-two autistic children received a NFB therapy aiming at improving their cognitive abilities. Neurofeedback succeeded in decreasing children’s high theta/beta ratio by inhibiting theta activity and intensifying beta activity over different sessions. Following therapy, the children’s cognitive functions were found to show comparative improvement compared to pre-treatment assessment on a range of different tasks. Auxiliary improvements were found in their social, thought and attention domains.
In this article, a neurofeedback protocol using slow cortical potentials (SCPs) was utilized on 41 male adolescents with ASD to determine if neurofeedback could reduce core symptomatology of ASD. The experimental group underwent 24 EEG -based training sessions, while the active control group underwent a conventional treatment – clinical counselling. Core autistic symptomatology was measured at six different time points during the interventions. Konicar et al. found improvements in core ASD symptomatology in the experimental group while only seeing slight improvement in the control group. As well, continuous decreases in delta power along with increases in alpha power were also found. These analyses suggest that SCP neurofeedback has a positive impact on individuals with ASD and that behavioural and neural changes related to neurofeedback training are complex and non-linear.
Brezis et al. hypothesized that the intervention of biofeedback would decrease participants’ anxiety and autism symptoms, and increase their self-awareness, self-determination, and empathy. Fourteen adults with ASD, residing in assisted living, were provided with 16 weekly half-hour contemplative-biofeedback sessions with non-professional trainers, in which they learned to reduce their arousal levels through combined biofeedback and contemplative techniques, and apply those to everyday life. Data was collected both pre- and post- intervention, to determine changes in participants’ self awareness, self-determination, anxiety, autism symptoms, and empathy. Participants were capable of successfully improving their physiological arousal levels on the biofeedback setup, indicating feasibility of the technique. Further, initial indications for reduction in autism symptoms and increased self-determination were found. Qualitative reports found participants applied the techniques in many real-life situations, and these had far-ranging effects on their emotional regulation, work and social motivation, and self-determination.
This is a multi-case study involving 67 patients diagnosed with a traumatic brain injury that were subjected to Z-score neurofeedback therapy. Most of the patients were diagnosed with mild traumatic brain injury and treated within the first year after brain injury. A few patients were diagnosed with more severe traumatic brain injury and treated after one year or later following their head injury incident. Most of the patients complained of headaches and cognitive problems while some of them also suffered from dizziness and overlapping depression. Those who complained of cognitive problems were subjected to analysis with computerized cognitive testing before and after ten sessions of neurofeedback. In addition, QEEG maps were completed before each neurofeedback session initiation in order to see an objective improvement of QEEG abnormalities. Subsequent analysis revealed that 59 out of 67 patients noticed subjective improvement of their symptoms within 10 sessions of neurofeedback therapy, out of which most of them reported an improvement after only 1-3 neurofeedback sessions. 54 patients also had an objective improvement of QEEG maps manifesting as reduction of excessive beta activity and/or normalization of delta or theta power. 45 patients completed prior and post neurofeedback neurocognitive testing with 34 patients having significant cognitive enhancement. These results are very encouraging and indicate high potential of Z-score LORETA neurofeedback rehabilitation of patients suffering from traumatic brain injury.
The purpose of this review was to assess the strengths of the available published literature on the therapeutic efficacy of neurofeedback for traumatic brain injuries and provide recommendations for future research in this area. Google Scholar was used to find 22 examples of primary research. Measures of symptom improvement, neuropsychological testing, and changes in subjects’ quantitative electroencephalogram were included in the analysis. A single reviewer classified each study according to a rubric devised by 2 societies dedicated to neurofeedback research. It was found that all studies demonstrated positive findings, in that neurofeedback led to improvement in measures of impairment, whether subjective, objective, or both. However, placebo-controlled studies were lacking, some reports omitted important details, and study designs differed to the point where effect size could not be calculated quantitatively. The authors conclude that neurofeedback is a promising treatment that warrants double-blind, placebo-controlled studies to determine its potential role in the treatment of traumatic brain injury.
This study explores electroencephalogram neurofeedback therapy induced in vivo changes in traumatic brain injury patients. 2 patients with moderate head injury who had more than 7 post-concussion symptoms and poor cognitive performances were subjected to 20 sessions of electroencephalogram neurofeedback therapy. Neuropsychological test scores, post-concussion symptoms and MRI scan of the brain were recorded pre-post to electroencephalogram neurofeedback therapy. It was found that during electroencephalogram neurofeedback therapy the cognitive scores and concussion symptoms improved significantly suggesting significant potential to change and regulate impaired neural networks among patients with traumatic brain injury. Furthermore, the quality of life for moderate disability and poor cognitive performance can be significantly improved using electroencephalogram neurofeedback therapy.
The aim of this preliminary study was to evaluate the effect of neurofeedback training on the continuous attention and short term memory of seventeen participants with moderate traumatic brain injuries using a randomized controlled clinical trial. Participants were randomly allocated in two intervention and control groups and then evaluated for continuous attention and short term memory at the start of the training period and at the end of the training period. The training period lasted for a total of four weeks. Although the results of the study yielded that 20 sessions of neurofeedback training has no effect on the continuous attention and short term memory of patients with mild traumatic brain injury, the authors call for more research to be done to explore the impact of different protocols including more sessions of treatment, longer time of follow-up and larger sample sizes of participants.
The aim of this study was to address the long standing questions regarding resting state oscillatory brain activity in patients with a history of mild traumatic brain injury (mTBI) and chronic post concussive symptoms who are stratified based on the severity of their PTSD symptoms. Primary analysis focused on alpha-band power, Participants on medication were not excluded from this study as the authors note that there is no significant difference in alpha frequency between medicated and non medicated patients with PTSD, although there are differences in power demonstrated at faster frequencies. Data generated from the study demonstrated a reduction in resting-state alpha activity involving much of the dorsolateral prefrontal cortex bilaterally in mTBI patients with significant PTSD symptoms compared to those without significant PTSD symptoms. It is that reductions in prefrontal resting-state alpha-band power may also be tested as a biomarker for the identification of those patients with PTSD who may benefit from a variety of treatments to increase prefrontal alpha-band power.
Previous studies in neurophysiology have found a higher beta activity of electroencephalography (EEG) at the posterior cortex among patients with comorbid major depressive disorder and anxiety symptoms. Thus, this present study aimed to examine the effect of alpha-symmetry neurofeedback (ALAY) and high-beta down-training (beta) neurofeedback in symptoms of depression and anxiety. Eighty-seven patients with comorbid MDD and anxiety symptoms were allocated to the ALAY, Beta, or control groups. Both neurofeedback groups received ten-sessions of neurofeedback and all three groups partook in various psychological tests. The results showcased that both neurofeedback groups displayed decreased symptoms of depression and anxiety. The Beta group specifically was more effective in decreasing high-beta power at the parietal cortex compared to other groups. This study concludes that the non-invasive psychological intervention of neurofeedback can be used to aid patients with comorbid MDD and anxiety symptoms.
Real-time neurofeedback techniques allow one to map the controllability of sensory, cognitive and affective centres in the brain. The subgenual anterior cingulate cortex (sACC) is thought to be involved in the generation of affective states. In this study, researchers examined whether individuals could use real-time fMRI neurofeedback to modulate sACC activity. An experimental group of eight women partook in the study. Initially a localizer task was used to identify an sACC region of interest, followed by four scans: (1) a pretraining scan in which they were asked to decrease activity in the sACC without neurofeedback; (2) two training scans in which sACC neurofeedback was presented along with instruction to decrease sACC activity; and (3) a neurofeedback-free post-training scan. In addition to this a control group was made so as to compare results across the board. Post-training results showcased significantly reduced activity in the sACC during neurofeedback training in the experimental group, but not in the control group. The findings that individuals can down-modulate sACC activity shows that neurofeedback training can aid in controlling a primary emotion centre in which functional abnormalities have a strong implication in affective disorders.
Stress is a normal response to situational pressures and demands. This study aims to investigate the effects of employing brainwave neurofeedback training on life stress and depression in female college students. Twenty-six subjects were chosen and randomly assorted into the experimental group and the control group. The neurofeedback sessions ran for a total of 8 weeks, after which post-training results were taken. The results showed a statistically significant difference between both the experimental group and the control group for life stress and depression. In both cases, the experimental group showed significantly decreased life stress and depression levels than the control group. The results observed from this study allow researchers to conclude that neurofeedback training for the decrease of life stress and depression, has a positive effect.
At least 30% of patients with major depressive disorder (MDD) do not respond to standard pharmacological and/or psychological treatments, and a considerable number of those who do respond to standard treatment go on to develop a chronic remission cycle. Through this study researchers explore the feasibility of a brain self-regulation technique that utilizes neurofeedback with functional magnetic resonance imaging (fMRI). Eight patients with depression learned to upregulate brain areas involved in the generation of positive emotions. This was done over the span of four neurofeedback sessions. Their clinical symptoms were assessed using the 17-item Hamilton Rating Scale for Depression (HDRS), and showed significant improvement. This study supports the notion that neurofeedback may in fact be a useful adjunct to current therapies for depression.
In this report, the author details the biological component associated with anxiety, depression and obsessive compulsive disorder, noting the findings from a robust body of research, including EEG studies. In addition to documenting biological predispositions that exist for anxiety, depression, and obsessive compulsive disorders, new research has also shown that medication is only mildly effective in the treatment of these problems when compared to a placebo. This report offers a detailed review of available research of uncontrolled studies that investigate the efficacy of neurofeedback treatment. Although the findings from these uncontrolled studies are promising, the author notes that there is a need for controlled research due to the fact that the current pool of research only represents uncontrolled studies. The author concludes by providing his own impressions from incorporating neurofeedback into private practise, noting the significant and enduring improvements seen in clients who have the same kind of alpha frontal symmetry that reflects a biological predisposition to depression.
Poor sleep has been acknowledged as an increasingly prevalent global health concern. Neurofeedback technology was proposed to potentially facilitate restfulness and sleep onset, this was further explored through the creation and study of “Inter-Dream”, a novel multisensory interactive artistic experience driven by neurofeedback. Twelve participants were chosen for the study; they were individually rested, augmented by Inter-Dream. The results demonstrated a statistically significant decrease in pre-sleep cognitive arousal (p=0.01), negative emotion (p=0.008), and negative affect (p=0.004). EEG readings were also indicative of restorative restfulness and cognitive stillness, while interview responses described experiences of mindfulness and playful self-exploration. Taken together the work in the study highlights neurofeedback as a potential pathway for future research in the promotion of sleep, while also suggesting strategies for designing towards this within the context of pre-sleep.
The term sleep disorder refers to difficulty in initiating sleep, maintaining itor a relaxing sleep despite having enough time to sleep. Cognitive behavioural therapy is a non-drug muulti-dimensional treatment that targets behavioural and cognitive factors of this disorder. Some studies have shown that psychiatric and neurological disorders can be distinguished from distinct EEG patterns and neurofeedback can be used to make a change in these patterns. This study aimed to compare cognitive behavioral therapy and neurofeedback in the treatment of insomnia. The sample included patients, who had already been diagnosed with insomnia, Random sampling and the Pittsburg sleep quality index (PSQI) was used for the selection of the participants. The sample included 40 patients who were randomly selected, interviewed and then split into 3 groups. Data was analyzed using SPSS. Following the analysis the independent effect of the treatment was significant and one-way ANOVA with post hoc test L.S.D were carried out were on CBT and control (p=0.001), CBT and neurofeedback therapy (p=0.003), neurofeedback treatment and control (p=0.001). The results showed a significant difference between the groups. Based on the analysis the two aforementioned treatments, neurofeedback therapy in the first position and cognitive-behavioural therapy in the second position were most effective, and the control group showed the lowest efficiency. Both treatments were significantly effective, and so we can use both NF and CBT for the treatment of insomnia.
Insomnia is a common sleep disorder where you have a hard time falling and/or staying asleep. Studies have shown that the presence of cortical hyperarousal can contribute to an impairment of information processes which might interfere with normal sleep onset and/or consolidation. This study wanted to use tele-neurofeedback (NFB) and tele-biofeedback (BFB) to examine cortical hyperarousal and its influence on information processing. Seventeen insomnia patients were randomly assigned to either a tele-NFB or tele-BFB protocol and twelve control participants were used to compare the baseline sleep measures. At pre and post treatment, a polysomnography (a test used in the study of sleep) was performed. Results of the study showed that sleep onset latency decreased pre to post treatment in both groups but there was a significant improvement in Total Sleep Time only after the NFB protocol; which focused on the inhibition of theta and high beta along with the reinforcement of SMR. Furthermore, only NFB training resulted in an overall improvement of subjectively measured sleep at home.
Recent studies have suggested a role for sleep and sleep problems in the etiology of attention deficit hyperactivity disorder (ADHD) and a recent model about the working mechanism of sensori-motor rhythm (SMR) neurofeedback, proposed that this intervention normalizes sleep and thus improves ADHD symptoms such as inattention and hyperactivity/impulsivity. In this study adult ADHD patients (N=19) were compared to a control group (N=28) and investigated to determine if differences existed in parameters such as Sleep Onset Latency (SOL), sleep Duration (DUR) and overall reported sleep problems (PSQI) and is there is an association between sleep-parameters and ADHD symptoms. Secondly, 37 ADHD patients were investigated to determine the effects of SMR and Theta/Beta (TBR) neurofeedback on ADHD symptoms and sleep parameters and if these parameters would mediate the treatment outcome to sMR and TBR neurofeedback. A clear continuous relationship between self=reported sleep problems (PSQI) and inattention in adults with- and without-ADHD. TBR neurofeedback resulted in a small reduction of SOL, this change occurred in the last half of treatment which suggests that it may not be specifically related to TBR neurofeedback. SMR neurofeedback specifically reduced the SOL and PSQI score, and the change in SOL and PSQI correlated strongly with the change in inattention, and the reduction in SOL was achieved in the first half of treatment, suggesting the reduction in SOL mediated treatment response to SMR neurofeedback. Clinically, TBR and SMR neurofeedback has similar effects on symptom reduction in ADHD. These results suggest differential effects and different working mechniasms for TBR and SMr neurofeedback in the treatment of ADHD.
The objective of the study was to assess whether two distinct Z-Score NFB protocols, a modified sensorimotor (SMR) protocol and a sequential, quantitative EEG (sQEEG)-guided, individually designed (IND) protocol, would alleviate sleep and associated daytime dysfunctions of participants with insomnia. Both protocols used instantaneous Z scores to determine reward condition administered when awake. Twelve adults with insomnia, free of other mental and uncontrolled physical illnesses, were randomly assigned to the SMR or IND group. Eight completed this randomized, parallel group, single-blind study. Both groups received fifteen 20-min sessions of Z-Score NFB. Pre-post assessments included sQEEG, mental health, quality of life, and insomnia status. ANOVA yielded significant post-treatment improvement for the combined group on all primary insomnia scores: Insomnia Severity Index (ISI p<.005), Pittsburgh Sleep Quality Inventory (PSQI p<.0001), PSQI Sleep Efficiency (p<.007), and Quality of Life Inventory (p<.02). Binomial tests of baseline EEGs indicated a significant proportion of excessively high levels of Delta and Beta power (p<.001) which were lowered post-treatment (paired z-tests p<.001). Baseline EEGs showed excessive sleepiness and hyperarousal, which improved post-treatment. Both Z-Score NFB groups improved in sleep and daytime functioning. Post-treatment, all participants were normal sleepers.
The goal of this study was to determine if neurofeedback could improve basic reading, reading comprehension, reading composite, and IQ scores. Sixth, Seventh and Eighth graders identified as having learning difficulties were randomly assigned to neurofeedback or control groups. After an average of 28 sessions, it was found that neurofeedback improved scores on reading tests as well as Verbal and Full Scale IQ tests compared to no neurofeedback. These results support the notion that neurofeedback can help improve reading skills and IQ in students with learning disabilities.
Coben, R. et al (2015) studied 42 school-aged participants which were randomly assigned to 2-channel coherence neurofeedback or control groups. At the end of 20 sessions, it was observed that the neurofeedback group had improved reading scores compared to the control group. The neurofeedback group had an average reading enhancement of 1.2 grade levels.
The study looked at 10 children with learning disabilities that had higher than normal ratios of theta to alpha absolute power (theta/alpha) and divided them into the neurofeedback or control group. Neurofeedback was applied to the area with the highest ratio and was conducted for 30 minutes, twice per week. After 20 sessions, it was found that the neurofeedback group had significantly improved on the WISC (Wechsler Intelligence Scale for Children) test compared to the control group. As well, the neurofeedback group had decreased EEG absolute power in delta, theta, alpha and beta bands while the control group only showed decreased EEG absolute power in the delta band. Overall the neurofeedback group had better cognitive performance and greater EEG maturation than the control group indicating the neurofeedback treatment can have a positive impact on children with learning disabilities.
This study investigated the 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 all the 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.
Learning disabilities have an estimated prevalence between 5% and 9% in the pediatric population and are associated with difficulties in reading, arithmetic, and writing. EEG research has reported a lag in alpha-band development in specific learning disability phenotypes, which offers an explanation for differences in EEG maturation. In this study 40 adolescents aged 10-15 years with learning disabilities underwent 10 sessions of Live Z-Score training Neurofeedback (LZT-NF) Training to improve their cognition and behaviour. Based on their individual alpha frequency levels a group with normal alpha peak frequency and a group with low alpha peak frequency were compared in a pre-and-post-LZT-NF intervention. After the neurofeedback sessions both groups showed greater odds of moving impaired waves towards the norm.
A systematic literature review and meta-analysis was conducted to examine the effectiveness of neurofeedback treatment for people with obsessive compulsive disorder (OCD). The authors investigated nine controlled studies with a total sample size of 1211 patients with OCD. The primary outcome measure was OCD symptoms based on the DSM IV and the Yale-Brown Obsessive-Compulsive Symptom scale (Y-BOCS). Analysis showed that there was a significant and important benefit of neurofeedback treatment in comparison to other treatments or control. As such, the results provide preliminary evidence that neurofeedback could be an effective treatment method for OCD. The authors suggest that there is a need for more clinical trials to compare the use of other medical, neurological, and behavioural interventions to neurofeedback.
This article details a systematic review and meta-analysis on the use of biofeedback in psychiatric disorders including obsessive-compulsive disorder (OCD) and related disorders (RD). Specifically, this review identified ten studies involved 102 OCD participants, with three being randomised controlled trials, primarily utilising neurofeedback (one study involved thermal biofeedback). Out of the neurofeedback studies, five were chosen for meta-analysis, encompassing 89 patients, including two randomised controlled trials. Results indicated a varying overall effect size within the treatment group, but significant heterogeneity and inconsistency were observed. The methodological quality of the studies was generally low, indicating a high risk of bias. In conclusion, while a beneficial effect of neurofeedback for OCD patients was identified, critical limitations in methodology and potential reporting bias were noted.
This paper focuses on a case series investigating the efficacy of qEEG-guided NF for individuals with OCD. The objective was to analyze the progression of OCD symptoms and evaluate the effectiveness of qEEG-guided NF training using clinical outcome measures.Thirty-six subjects resistant to conventional treatments for OCD underwent 9–84 sessions of qEEG-guided NF treatment. Each daily session, lasting 60 minutes, comprised two half-hour applications with a 30-minute rest between sessions.Of the 36 subjects who received NF training, 33 exhibited clinical improvement based on the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS). Seventeen subjects also completed the Minnesota Multiphasic Inventory (MMPI) before and after treatment, revealing significant improvements not only in OCD measures but also across all MMPI scores, indicating a general decrease. Physicians evaluated subjects using the Clinical Global Impression Scale (CGI), and 33 out of 36 were assessed as improved. Follow-up interviews conducted an average of 26 months after the study’s completion with 36 subjects revealed that 19 maintained improvements in their OCD symptoms. This study presents compelling evidence for the effectiveness of NF treatment in OCD.
This paper introduces a technique for training individuals to regulate activity in the orbitofrontal cortex (OFC) region associated with contamination anxiety using real-time functional magnetic resonance imaging (rt-fMRI) biofeedback. Elevated activity in this region is observed in both control subjects and individuals with obsessive-compulsive disorder (OCD), a prevalent and often debilitating psychiatric condition characterized by contamination anxiety. Abnormalities in the OFC are consistently identified in OCD, and hyperactivity in this region correlates with symptom severity, with reductions in hyperactivity linked to decreased symptom severity. Thus, mastering control over this brain area holds promise for improving obsessive-compulsive symptoms, including contamination anxiety. Recent studies demonstrate that individuals can learn to regulate the activity of specific brain areas through rt-fMRI biofeedback. This technique has shown success in targeting brain regions involved in emotion processing, inducing cognitive, emotional, or clinical changes in subjects. In all, this paper establishes that the use of rt-fMRI biofeedback could be a therapeutic intervention for OCD and calls for further research.
EEG biofeedback training was used as an adjuvant treatment for obsessive-compulsive disorder (OCD) in 79 patients, and the results showed a significant improvement in symptoms and cognitive functioning. Weekly cognitive behavioural therapy sessions and sertraline were administered to the study group, while EEG biofeedback sessions and the same regimen were given to the control group. Before and after the eight-week study, the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) and the Yale Brown Obsessive Compulsive Scale (YBOCS) were given. By the sixth week of treatment, the study group’s OCD symptoms had improved more than those of the control group. To evaluate the long-term impacts of biofeedback training, more investigation is required.
This study is a report of an on-going project that provides treatment for US combat veterans. Both PTSD and mild-traumatic brain injury involves a wide range of possible neural dysregulations, and thus, the authors posit that maximal treatment outcome will result from optimal specificity of assessment and treatment. In this study, 11 cases are analyzed and it is found that Loreta Z-Score neurofeedback results in specific neurophysiological normalization in the regions of training and quantified progressive reduction in symptoms. Paired t-tests demonstrate learning occurred in every case. Cohen’s d analyses of current source density improvements quantified large effect sizes in 9 of 10 cases and a moderate effect size in one case.
This study was a randomized, waitlist controlled trial of brain/computer interaction, electroencephalogram neurofeedback training in patients with chronic PTSD to explore the capacity of neurofeedback to reduce PTSD symptoms and increase affect regulation capacities. 52 individuals with chronic PTSD were randomly assigned to neurofeedback or waitlist (control) groups. After 24 sessions of neurofeedback were conducted, it was found that participants in the neurofeedback group treatment showed significant improvements in PTSD symptomatology that had not responded to at least 6 months of trauma-focused psychotherapy, compared to the waitlist group that continued to receive treatment as usual.
The authors examine the reason behind why neurofeedback has made such little impact on approaches to clinical care, noting that designing research to measure clinical change in the real world presents itself as a barrier. As such, this paper offers a “proof-of-concept” pilot for the use of neurofeedback with multiply-traumatized individuals with treatment-resistant PTSD. After completing 40 sessions of neurofeedback training over the course of 2 weeks, the authors found that their protocol significantly reduced PTSD symptoms and preceded gains in affect regulation.
In this study, Health university students were randomly assigned to the experimental group, sham group or control group. Participants in the experimental group trained to enhance beta waves at F4 and P4. Attentional performance and MRI data were recorded one week before training and one week after training. Higher scores on auditory and visual sustained attention were present in experiment group. Gray matter volume increases were detected in cerebral structures involved in this type of attention. This study constitutes the first empirical demonstration that neurofeedback training leads to microstructural changes in white and gray matter.
In this study, veterans whose primary treatment for PTSD was artifact corrected neurofeedback were investigated. Participants underwent 40 half-hour sessions of treatment and were assessed by their auditory and visual performance as well as their general well-being. Assessments after 20 and 40 half-hour sessions showed significant improvements in both visual and auditory attention as well as well-being. Veterans were found to have greater enhancements in auditory vigilance, visual and auditory processing speed, along with visual and auditory focus after both 20 and 40 sessions. Improvements in well-being were significantly correlated with the increase in their overall auditory attention and processing speed. This study showcases the positive therapeutic effects of neurofeedback for veterans with PTSD.
This study focused on the effectiveness of Neurofeedback training on 40 kindergarten students who showed resistance to stress between the months of January 2008 and December 2008. 20 subjects were placed in an experimental group and the other 20 were placed in a comparative group. The brainwaves were adjusted by time series linear analysis and after observing the pre and post brain wave measurement results, the differences between both resistance stress was confirmed. Overall, the results suggest that Neurofeedback may positively affect the subjects’ mental state.
Athletic performance can be threatened by excessive tension and stress which is why the goal of this study was to help athletes manage their stress response through self-regulation of the autonomic and central nervous systems’ activation levels. This study involved 15 elite athletes who were preparing for the Vancouver 2010 Olympics. These athletes underwent a psychophysiological stress assessment, EEG, and bio-neurofeedback training. Athletes and coaches reported that the bio-neurofeedback training helped athletes manage the stress of training and competing. As a result, bio-neurofeedback helped produce better athletic performance.
Neurofeedback was conducted on 18 volunteers suffering from stress-induced disorders and it was revealed that there was a dominant narrow-band (0.4 – 0.6 Hz) oscillators in theta (4-8 Hz) and alpha (8-13 Hz) EEG bands. During two examinations, the volunteers were presented with classical music. The music would be interrupted for approximately three seconds if the amplitude of the volunteer’s theta (slow wave) exceeded the initial level, or if the amplitude of the volunteer’s alpha (middle wave) did not reach the initial level. Volunteers were then asked to maintain the functional state where the music would play continuously. The authors found that there was marked EEG normalization and evidence pointing towards the reduction of stress. The volunteers also had positive shifts in their mental and emotional states as early as the end of the first neurofeedback treatment.
This paper provides a comprehensive summary of critical information for neurofeedback training and describes the need for the development of content. This content acts as a stimulus which trains the client to control their brain activity in stressful conditions. The developed content involves audio and game. The audio is used to enhance the amplitude of alpha brainwaves in the left-prefrontal lobe, whereas the game is used to reduce the power of high-beta activity. The results indicate significant improvement in reducing stress levels.
This study involved 10-20 sessions of Alpha Neurofeedback training on 20 individuals who suffered from several stress symptoms. The subjects were clinically evaluated and their QEEG’s were recorded. 15 of the 20 subjects who showed clinical improvement had an 89% increase of their mean Alpha activity, whereas 5 subjects with little improvement didn’t show an increase of alpha at all.The difference of Alpha enhancement between both groups was statistically significant as it indicates that Alpha enhancement is a predictor of clinical outcome. As a result, this study had a 75% success rate after about 12 hours of treatment which means that Alpha wave neurofeedback training may be an effective method to treat stress.
