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Research: Neurofeedback


ATTENTION DEFICIT DISORDER

1. Arns, M., de Ridder, S., Strehl, U., Breteler, M., & Coenen, A. (2009). Efficacy of neurofeedback treatment in ADHD: The effects on inattention, impulsivity and hyperactivity: A meta-analysis. Clinical EEG and Neuroscience, 40(3), 180-189. An examination of multiple studies, regarding the effectiveness of neurofeedback in diminishing attention deficit and hyperactivity symptoms. Upon examination of these studies, controlling for limitations, the meta-analysis found the neurofeedback in the treatment of ADHD was clinically meaningful.  Looking at three randomized studies, in particular, it was concluded that neurofeedback for ADHD was effective and specific, with a large effect size for inattention and a medium effect size for hyperactivity. 

 2. Micoulaud-Franchi, J-A., Geoffroy, P. A., Fond, G., Lopez, R., Bioulac, S., Philip, P. (2014). EEG neurofeedback treatments in children with ADHD: An update meta-analysis of randomized controlled trials. Frontiers in Human Neuroscience, 8(906), 1-7.  An analysis of five studies, of 146 patients treated with neurofeedback, scores showed significant improvement over controls. 

3. Steiner, N. J., Frenette, E. C., Rene K. M., Brennan, R. T., & Perrin, E. C. (2014). In-school neurofeedback training for ADHD: Sustained improvements from a randomized control trial. Pediatrics, 133(3), 483-492. In a study of 104 subjects, six months after intervention, those subjects treated with neurofeedback made significant gains (over the control group) in a number of parent rating scales for both hyperactivity and attention.  

ANXIETY

 1. Kerson, C., Sherman, R.A., & Kozlowski, G.P. (2009).  Alpha Suppression and Symmetry Training for Generalized Anxiety Symptoms.  Journal of Neurotherapy, 13 (3), 146-155.  28 anxious adults were assessed for frontal lobe alpha asymmetry, a brain state associated with both depression and anxiety.  12 agreed to neurofeedback treatment.  All subjects exhibited significant improvement in both state and trait anxiety scores at the 6-month follow-up. 

 2.  White, E.K.,et al.  (2017).  Combined Neurofeedback and Heart Rate Variability Training for Individuals with Symptoms of Anxiety and Depression:  A Retrospective Study.  Neuroregulation 4(1), 37-55.  183 children and adults with symptoms of anxiety and/or depression underwent neurofeedback and heart rate variability training.  The majority of individuals with pre-treatment symptoms of anxiety (82.8%) or depression (81.1%) experienced significant improvement, as measured by the Achenbach System of Empirically Based Assessment Questionnaire.

 3.  Koberda, J.L. (2014).  Z-score Loreta Neurofeedback with 31 Patients with Depression and Anxiety.  Neuroconnections, Spring Issue, 52-55.  Most patients were found to have QEEG abnormalities including alpha power increase, asymmetry and/or loreta electrical dysregulation in frontal areas.  Patients underwent between 10-15 neurofeedback sessions.  77% were found to have both subjective improvement and objective improvement (improvement of QEEG abnormalities).

CHRONIC PAIN

1. Jensen, M. P., Grierson, C., Tracy-Smith, V., Bacigalupi, S. C., Othmer, S. (2007). Neurofeedback treatment for pain associated with complex regional pain syndrome. Journal of Neurotherapy, 11(1), 45–53.  Eighteen subjects were given neurofeedback treatment and administered a pain rating scale.  There was a substantial and significant pre- to post-session decrease in pain intensity following neurofeedback treatment.

2. Sime, A. (2004). Case study of trigeminal neuralgia using neurofeedback and peripheral biofeedback. Journal of Neurotherapy, 8(1), 59–71. Trigeminal neuralgia is an intense pain condition that has been traditionally difficult to treat.  A patient with intense pain and poor sleep was advised that her next intervention would be to sever the trigeminal nerve.  She was given 29 sessions of neurofeedback, as well as biofeedback training and stress management counseling. Following treatment, the subject was able to discontinue use of propoxyphene and avoid the surgery.  In a 13-month follow-up, she reported having an active life style and managing her pain quite well.

3. Hassan MA, Fraser M, Conway BA, Allan DB, Vuckovic A. The mechanism of neurofeedback training for treatment of central neuropathic pain in paraplegia: a pilot study. BMC Neurol. 2015Patients' EEG active. Pain patients were given up to 40 training sessions in neurofeedback.  Six of seven patients reported immediate reduction of pain during neurofeedback training. Four patients reported clinically significant long-term reduction of pain (>30%) which lasted at least a month beyond the therapy.

DEPRESSION

1. Cheon, E.J., Koo, B.H., Choi, J.H. (2016). The efficacy of neurofeedback in patients with major depressive disorder: an open labeled prospective study. Applied Psychophysiology & Biofeedback, 41(1), 103-110.  Twenty subjects were given neurofeedback treatment, at least twice a week for eight weeks.  Cumulative response rates of the Hamilton Rating Scale for Depression was 75.0 % at 8 weeks, and  corresponding cumulative remission rates on the same scale was 55%.

2. Wang, S.-Y., Lin, I.-M., Peper, E., Chen, Y.-T., Yeh, Y.-C., Chu, C.-C. (2016). The efficacy of neurofeedback among patients with major depressive disorder. Preliminary study. NeuroRegulation, 3(3), 127-134. Fourteen patients were given one hour neurofeedback training for six weeks.  Depression (and anxiety) scores decreased in the treatment group from pre to post intervention. 

3. Baehr, E., Rosenfeld, J. P., & Baehr, R. (2001). Clinical use of an alpha asymmetry neurofeedback protocol in the treatment of mood disorders: Follow-up study one to five years post therapy. Journal of Neurotherapy, 4(4), 11–18.  A follow-up study of patients previously treated with asymmetry training to address depressive disorders.  Of the original six patients in the study, four were available for follow up.  Three had been diagnosed with unipolar depression; they reached the training criteria for non-depressed range by the end of initial training.  Follow-up Beck Depression Inventory scores were within normal range.  All had discontinued medication.

4.  Choobforoushzadeh, A., Neshat-Doost HT., Molavi, H., and Abedi, MR.  Effect of neurofeedback training on depression and fatigue in MS patients.  Applied Psychophysiology and Biofeedback. 2015 Mar: 40 (1) 1-8.  24 MS patients with primary fatigue and depression were divided into 16 sessions of neurofeedback and "treatment as usual".  Neurofeedback significantly reduced depression and fatigue compared to control group treatment, and these gains were maintained at two-month followup.

INSOMNIA AND SLEEP DISORDERS

1.  Hauri, P (1981). Treating psychophysiologic insomnia with biofeedback. Archives of General Psychiatry, 38 (7), 752.  Patients with psychophysiological insomnia were divided into high tension and low tension groups.  High tension level correlated positively with sleep improvement for the Alpha/Theta groups while  low tension or relaxed insomnia patients responded only to SMR neurofeedback.  Both Alpha/Theta and SMR focus training are two commonly used protocols today.

2.  Cortoos,  A., DeValck, E.,  Arns,  M., Bretler, M.H. , & Cluydts, R. (2010).  An exploratory study on the effects of tele-neurofeedback and tele-biofeedback on objective and subjective sleep in patients with primary insomnia.  Applied Psychophysiology and Biofeedback, 35 (2), 125-134.  In 20 sessions of neurofeedback over 8 weeks, increasing SMR while inhibiting theta and hibeta decreased sleep onset latency in a study of 17 patients while only SMR resulted in a significant increase in total sleep time.

3.  Hammer, B., Colbert, A., Brown, K., & Ilioi, E. (2011) Neurofeedback for Insomnia: A Pilot Study of Z-Score SMR and individualized protocols. Applied Psychophysiology and Biofeedback, 36 (4), 251-264.  This study compared two distinct types of Z-score neurofeedback - a modified SMR protocol and an individually-selected QEEG-guided protocol. Both groups using variants of Z-score neurofeedback showed an improvement in sleep and daytime functioning, decreasing the severity of insomnia as well as increasing sleep efficiency and total sleep time.

4.  Schabus et. al.  (2014). Enhancing sleep quality  and memory in insomnia using instrumental sensorimotor rhythm conditioning.  Biological Psychology. 95,126-134.tested whether SMR protocols could improve insomnia in 24 patients with 10 sessions of neurofeedback.  Results showed a decrease in the number of nighttime awakenings and an increase in slow wave sleep (an important sleep stage for physiological healing and restoration of bodily functioning) using 10 sessions of SMR training.

Research shows SMR training and Alpha-Theta training have been successful neurofeedback modalities for insomnia patients, decreasing the time to get to sleep, reducing nighttime awakenings and increasing slow wave (deep) sleep and total sleep time. 

MIGRAINES 

1. Koberda, J.L. et al.  Effectiveness of Loreta Z-score Neurofeedback in the Treatment of Headaches.  20 patients underwent 10 neurofeedback sessions.  80% reported subjective improvement and 70% of patients exhibited both subjective and objective improvement (reduction of beta activity in QEEG).  Improvement in headaches lasting longer than 3 months were usually observed.  An additional “refresher” neurofeedback therapy was completed for those patients who subsequently experienced recurrence of headaches.  (TallahasseeNeurobalanceCenter.com) 

2. Stokes, D.A., & Lappin, M.S. (2010).  Neurofeedback and Biofeedback with 37 Migraineurs:  A Clinical Outcome Study.  Behavioral & Brain Functions, 6, (9).  37 migraine patients underwent an average of 40 neurofeedback sessions combined with thermal biofeedback in an outpatient biofeedback clinic.  26 patients (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.  50% experienced a 50% reduction in frequency of headaches.  

3. Walker, J.E. (2011).  QEEG Guided Neurofeedback for Recurrent Migraine Headaches.  Clinical EEG & Neuroscience.  42 (1), 59-61.  71 patients with recurrent migraine headaches aged 17-62, from one neurological practice, completed the QEEG.  All indicated an excess of high frequency beta activity (21-30 Hz) in 1-4 cortical areas.  46 selected neurofeedback while the remaining 25 chose to continue on drug therapy.  Neurofeedback protocols consisted of reducing 21-30 Hz activity and increasing 10 Hz activity (5 sessions for each affected site).  For the neurofeedback group, the majority (54%) experienced complete cessation of their migraines, and 39% experienced a reduction in migraine frequency of greater than 50%.  4% experienced a decrease in headache frequency of less than 50%.  Only one patient did not experience a reduction in headache frequency.  The control group who chose to continue drug therapy experienced no change in headache frequency (68%), a reduction of less than 50% (20%), or a reduction greater than 50% (8%).  

TRAUMATIC BRAIN INJURY/CONCUSSIONS 

1.  Duff, J. (2004).  The Usefulness of Quantitative EEG (QEEG) & Neurotherapy in the Assessment & Treatment of Post-Concussion Syndrome.  Clinical EEG & Neuroscience, 35 (4), 198-209.  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 & CT scans.  While cognitive rehabilitation and psychological support are widely used, neither has shown to be effective in addressing the core deficits of Post-Concussion Syndrome.  Neurofeedback has been shown in a number of studies to be affective in significantly improving or addressing the symptoms of Post-Concussion Syndrome, as well as improving similar symptoms in non-TBI patients.  

2.  Koberda, J.L. (2015)  Loreta Z-score Neurofeedback Effectiveness in Rehabilitation of Patients Suffering from Traumatic Brain Injury (TBI).  Journal of Neurology & Neurobiology, 1(4), 113.  67 patients diagnosed with TBI completed z-score neurofeedback.  Most were diagnosed with mild TBI and treated within the first year after brain injury.  Most complained of headaches & cognitive problems while some suffered dizziness & overlapping depression.  59 out of 67 (88%) noticed subjective improvement within 10 neurofeedback sessions, out of which most reported improvement after only 1-3 sessions.  54% also had objective improvement of QEEG maps, 80% manifesting as reduction of excess beta activity and/or normalization of delta or theta power.  45 completed pre and post neurofeedback cognitive testing with 34 patients (76%) having significant cognitive enhancement.  

3. Surmeli, T. et al. (2016).  QEEG Neurometric Analysis Guided Neurofeedback Treatment in Post-Concussion Syndrome (PCS):  Forty Cases.  Clinical EEG & Neuroscience, 47.    Overall improvement was seen in all the primary and secondary measures.  The Neuroguide Traumatic Brain Index for the group also showed a decrease.  39 subjects were followed long term with an average follow-up length of 3.1 years.  All but 2 were stable and off medication. 

4.  Wand, P.H. (2019).  The Concussion Cure:  Three Proven Methods to Heal Your Brain.  Red Letter Editing.  Dr. Wand is an integrative neurologist who uses a medication called Nimodipine, neurofeedback, and hyperbaric oxygen therapy to heal his patients with concussions.  He uses the QEEG to evaluate the brain’s electrical functioning and then LORETA neurofeedback as he believes it is the “fastest type of neurofeedback to correct abnormal brain waves.

PERFORMANCE ENHANCEMENT

1.  Arns, M., Kleinnijenhuis, M., Fallahpour, K., & Bretler, R. (2007). Golf performance enhancement and real-life neurofeedback training using personalized event-locked EEG profiles. Journal of Neurotherapy, 11(4), 11–18. In a study of success in golf (putting), subjects received an assessment and three real-life neurofeedback training sessions.  The overall percentage of successful putts was significantly larger in the second and fourth series (with neurofeedback) of training compared to the first and third series (with no neurofeedback training). 

2. Egner, T., & Gruzelier, J. H. (2003). Ecological validity of neurofeedback: Modulation of slow wave EEG enhances musical performance. NeuroReport, 14(9), 1221–1224.  Neurofeedback was used to improve music performance under stressful conditions. In a pilot study, expert ratings documented improvements in musical performance in a student group that received training on attention and relaxation related neurofeedback protocols.

PTSD (POST-TRAUMATIC STRESS DISORDER)

1.  Penniston, E., and Kulkowsky, P.J. Neurofeedback for Vietnam veterans with combat-related Post-Traumatic Stress Disorder.  Medical Psychotherapy; An International Journal 4 (1991): 47-60.  15 combat veterans with PTSD and 14 control subjects received Alpha-Theta neurofeedback and standard treatment.  At 30 month followup, only 3 of the 15 treated with neurofeedback continued to have PTSD, while all 14 in the control group had returned to their original PTSD symptoms.

2.  Penniston, Marrinan, Deming & Kulkowsky, 1993.  Found PTSD symptoms eliminated by Alpha-Theta neurofeedback at 26 months followup for 16 of 20 combat veterans who had both PTSD and co-morbid alcohol abuse.  The remaining 4 had symptoms greatly decreased in frequency.

3.  Smith, Mark. A Father Finds a Solution: Z-score training.  NeuroConnections (April 2008):  22-25.  Found significant decrease in PTSD depression and improvement in attention with 10 combat veterans treated with 30 sessions of Alpha-Theta neurofeedback.

4.  Kleutsch et al., 2013.  Found decreased alpha amplitude and self-reported improvements in relaxation, calmness and clear-mindedness among 21 chronic PTSD sufferers after a study noting changes in the brain's salience network treated with neurofeedback and confirmed by fMRI (Ross et al., 2013).  The latter study also reported improved brain connectivity within both the salience network and the default mode network, both known to be dysregulated in sufferers of PTSD.




 


 

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