Effects of Neurofeedback on Adult Patients with Psychiatric Disorders in a Naturalistic Setting

Abstract

Few well-controlled studies have considered neurofeedback treatment in adult psychiatric patients. In this regard, the present study investigates the characteristics and effects of neurofeedback on adult psychiatric patients in a naturalistic setting. A total of 77 adult patients with psychiatric disorders participated in this study. Demographic data and neurofeedback states were retrospectively analyzed, and the effects of neurofeedback were evaluated using clinical global impression (CGI) and subjective self-rating scales. Depressive disorders were the most common psychiatric disorders (19; 24.7 %), followed by anxiety disorders (18; 23.4 %). A total of 69 patients (89.6 %) took medicine, and the average frequency of neurofeedback was 17.39 ± 16.64. Neurofeedback was applied to a total of 39 patients (50.6 %) more than 10 times, and 48 patients (62.3 %) received both β/SMR and α/θ training. The discontinuation rate was 33.8 % (26 patients). There was significant difference between pretreatment and posttreatment CGI scores (<.001), and the self-rating scale also showed significant differences in depressive symptoms, anxiety, and inattention (<.001). This is a naturalistic study in a clinical setting, and has several limitations, including the absence of a control group and a heterogenous sample. Despite these limitations, the study demonstrates the potential of neurofeedback as an effective complimentary treatment for adult patients with psychiatric disorders.

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References

  1. American Psychiatric Association & American Psychiatric Association Task Force on DSM-IV (2000). Diagnostic and statistical manual of mental disorders: DSM-IV-TR (4th ed.). Washington, DC: American Psychiatric Association.

  2. Angelakis, E., Stathopoulou, S., Frymiare, J. L., Green, D. L., Lubar, J. F., & Kounios, J. (2007). EEG neurofeedback: A brief overview and an example of peak alpha frequency training for cognitive enhancement in the elderly. The Clinical Neuropsychologist, 21(1), 110–129.

    Article  PubMed  Google Scholar 

  3. Arns, M., & Kenemans, J. L. (2014). Neurofeedback in ADHD and insomnia: Vigilance stabilization through sleep spindles and circadian networks. Neuroscience and Biobehavioral Reviews, 44, 183–194.

  4. Baehr, E., Rosenfeld, J. P., & Baehr, R. (1997). The clinical use of an alpha asymmetry protocol in the neurofeedback treatment of depression: Two case studies. Journal of Neurotherapy, 2(3), 10–23.

    Article  Google Scholar 

  5. 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.

    Article  Google Scholar 

  6. Busner, J., & Targum, S. D. (2007). The clinical global impressions scale: Applying a research tool in clinical practice. Psychiatry (Edgmont), 4(7), 28–37.

    Google Scholar 

  7. Busner, J., Targum, S. D., & Miller, D. S. (2009). The Clinical Global Impressions scale: Errors in understanding and use. Comprehensive Psychiatry, 50(3), 257–262.

    Article  PubMed  Google Scholar 

  8. Choi, S. W., Chi, S. E., Chung, S. Y., Kim, J. W., Ahn, C. Y., & Kim, H. T. (2011). Is alpha wave neurofeedback effective with randomized clinical trials in depression? A Pilot Study. Neuropsychobiology, 63(1), 43–51.

    Article  PubMed  Google Scholar 

  9. Cortoos, A., Valck, E., Arns, M., Breteler, M. H. M., & Cluydts, R. (2009). 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.

    Article  Google Scholar 

  10. Cuijpers, P., van Straten, A., Andersson, G., & van Oppen, P. (2008). Psychotherapy for depression in adults: A meta-analysis of comparative outcome studies. Journal of Consulting and Clinical Psychology, 76(6), 909–922.

    Article  PubMed  Google Scholar 

  11. Dehghani-Arani, F., Rostami, R., & Nadali, H. (2013). Neurofeedback training for opiate addiction: Improvement of mental health and craving. Applied Psychophysiology and Biofeedback, 38(2), 133–141.

    Article  PubMed Central  PubMed  Google Scholar 

  12. Dias, A. M., & van Deusen, A. (2011). A new neurofeedback protocol for depression. The Spanish Journal of Psychology, 14(1), 374–384.

    Article  PubMed  Google Scholar 

  13. Earnest, C. (1999). Single case study of EEG asymmetry biofeedback for depression: An independent replication in an adolescent. Journal of Neurotherapy, 3(2), 28–35.

    Article  Google Scholar 

  14. Hammond, D. C. (2000). Neurofeedback treatment of depression with the Roshi. Journal of Neurotherapy, 4(2), 45–56.

    Article  Google Scholar 

  15. Hammond, D. C. (2005). Neurofeedback with anxiety and affective disorders. Child and Adolescent Psychiatric Clinics of North America, 14(1), 105–123. vii.

    Article  PubMed  Google Scholar 

  16. Henriques, J. B., & Davidson, R. J. (1990). Regional brain electrical asymmetries discriminate between previously depressed and healthy control subjects. Journal of Abnormal Psychology, 99(1), 22–31.

    Article  PubMed  Google Scholar 

  17. Herwig, U., Satrapi, P., & Schonfeldt-Lecuona, C. (2003). Using the international 10–20 EEG system for positioning of transcranial magnetic stimulation. Brain Topography, 16(2), 95–99.

    Article  PubMed  Google Scholar 

  18. Hill, R. W., & Castro, E. (2002). Getting rid of ritalin: How neurofeedback can successfully treat attention deficit disorder without drugs. Charlottesville, VA: Hampton Roads.

    Google Scholar 

  19. Johnston, S. J., Boehm, S. G., Healy, D., Goebel, R., & Linden, D. E. J. (2010). Neurofeedback: A promising tool for the self-regulation of emotion networks. NeuroImage, 49(1), 1066–1072.

    Article  PubMed  Google Scholar 

  20. Lam, R. W., Kennedy, S. H., Grigoriadis, S., McIntyre, R. S., Milev, R., Ramasubbu, R., et al. (2009). Canadian Network for Mood and Anxiety Treatments (CANMAT) clinical guidelines for the management of major depressive disorder in adults. Journal of Affective Disorders, 117, S26–S43.

    Article  PubMed  Google Scholar 

  21. Larsen, S., & Sherlin, L. (2013). Neurofeedback. Psychiatric Clinics of North America, 36(1), 163–168.

    Article  PubMed  Google Scholar 

  22. Linden, D. E., Habes, I., Johnston, S. J., Linden, S., Tatineni, R., Subramanian, L., et al. (2012). Real-time self-regulation of emotion networks in patients with depression. PLoS One, 7(6), e38115.

    Article  PubMed Central  PubMed  Google Scholar 

  23. Lynch, D., Laws, K. R., & McKenna, P. J. (2010). Cognitive behavioural therapy for major psychiatric disorder: Does it really work? A meta-analytical review of well-controlled trials. Psychological Medicine, 40(1), 9–24.

    Article  PubMed  Google Scholar 

  24. Moore, N. C. (2000). A review of EEG biofeedback treatment of anxiety disorders. Clinical Electroencephalography, 31(1), 1–6.

    Article  PubMed  Google Scholar 

  25. Moriyama, T. S., Polanczyk, G., Caye, A., Banaschewski, T., Brandeis, D., & Rohde, L. A. (2012). Evidence-based information on the clinical use of neurofeedback for ADHD. Neurotherapeutics, 9(3), 588–598.

    Article  PubMed Central  PubMed  Google Scholar 

  26. Peniston, E. G., & Kulkosky, P. J. (1989). Alpha–theta brainwave training and beta-endorphin levels in alcoholics. Alcoholism: Clinical and Experimental Research, 13(2), 271–279.

    Article  Google Scholar 

  27. Plotkin, W. P., & Rice, K. M. (1981). Biofeedback as a placebo: Anxiety reduction facilitated by training in either suppression or enhancement of alpha brainwaves. Journal of Consulting and Clinical Psychology, 49(4), 590–596.

    Article  PubMed  Google Scholar 

  28. Rosenfeld, J. P. (1997). EEG biofeedback of frontal alpha asymmetry in affective disorders. Biofeedback, 25(1), 8–25.

    Google Scholar 

  29. Rosenfeld, J. P. (2000). An EEG biofeedback protocol for affective disorders. Clinical Electroencephalography, 31(1), 7–12.

    Article  PubMed  Google Scholar 

  30. Rosenfeld, J. P., Cha, G., Blair, T., & Gotlib, I. H. (1995). Operant (biofeedback) control of left-right frontal alpha power differences: Potential neurotherapy for affective disorders. Biofeedback and Self Regulation, 20(3), 241–258.

    Article  PubMed  Google Scholar 

  31. Rush, A. J., Trivedi, M. H., Stewart, J. W., Nierenberg, A. A., Fava, M., Kurian, B. T., et al. (2011). Combining medications to enhance depression outcomes (CO-MED): Acute and long-term outcomes of a single-blind randomized study. American Journal of Psychiatry, 168(7), 689–701.

    Article  PubMed  Google Scholar 

  32. Saxby, E., & Peniston, E. G. (1995). Alpha–theta brainwave neurofeedback training: An effective treatment for male and female alcoholics with depressive symptoms. Journal of Clinical Psychology, 51(5), 685–693.

    Article  PubMed  Google Scholar 

  33. Scott, W. C., Kaiser, D., Othmer, S., & Sideroff, S. I. (2005). Effects of an EEG biofeedback protocol on a mixed substance abusing population. The American Journal of Drug and Alcohol Abuse, 31(3), 455–469.

    Article  PubMed  Google Scholar 

  34. Sokhadze, T. M., Cannon, R. L., & Trudeau, D. L. (2008). EEG biofeedback as a treatment for substance use disorders: Review, rating of efficacy, and recommendations for further research. Applied Psychophysiology and Biofeedback, 33(1), 1–28.

    Article  PubMed Central  PubMed  Google Scholar 

  35. Sterman, M. B., Macdonald, L. R., & Stone, R. K. (1974). Biofeedback training of the sensorimotor electroencephalogram rhythm in man: Effects on epilepsy. Epilepsia, 15(3), 395–416.

    Article  PubMed  Google Scholar 

  36. Thomas, J. E., & Sattlberger, E. (1997). Treatment of chronic anxiety disorder with neurotherapy: A case study. Journal of Neurotherapy, 2(2), 14–19.

    Article  Google Scholar 

  37. Thornton, K. (2000). Improvement/rehabilitation of memory functioning with neurotherapy/QEEG biofeedback. J Head Trauma Rehabil, 15(6), 1285–1296.

    Article  PubMed  Google Scholar 

  38. Vernon, D. J. (2005). Can neurofeedback training enhance performance? An evaluation of the evidence with implications for future research. Applied Psychophysiology and Biofeedback, 30(4), 347–364.

    Article  PubMed  Google Scholar 

  39. Weiskopf, N., Scharnowski, F., Veit, R., Goebel, R., Birbaumer, N., & Mathiak, K. (2004). Self-regulation of local brain activity using real-time functional magnetic resonance imaging (fMRI). Journal of Physiology-Paris, 98(4–6), 357–373.

    Article  Google Scholar 

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Acknowledgments

This work was supported by the 2011 Yeungnam University Research Grant.

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Correspondence to Bon-Hoon Koo.

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Cheon, E., Koo, B., Seo, W. et al. Effects of Neurofeedback on Adult Patients with Psychiatric Disorders in a Naturalistic Setting. Appl Psychophysiol Biofeedback 40, 17–24 (2015). https://doi.org/10.1007/s10484-015-9269-x

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Keywords

  • Neurofeedback
  • Adult psychiatric patient
  • Depression
  • Anxiety