Medline Search

Affective Disorders


Choi, S. W., S. E. Chi, et al. (2011). "Is alpha wave neurofeedback effective with randomized clinical trials in depression? A pilot study." Neuropsychobiology63(1): 43-51.


Frontal asymmetric activation has been proposed to be the underlying mechanism for depression. Some case studies have reported that the enhancement of a relative right frontal alpha activity by an asymmetry neurofeedback training leads to improvement in depressive symptoms. In the present study, we examined whether a neurofeedback training designed to increase the relative activity of the right frontal alpha band would have an impact on symptoms of depressive subjects suffering from emotional, behavioral, and cognitive problems. Our results indicated that the asymmetry neurofeedback training increased the relative right frontal alpha power, and it remained effective even after the end of the total training sessions. In contrast to the training group, the placebo control group did not show a difference. The neurofeedback training had profound effects on emotion and cognition. First, we replicated earlier findings that enhancing the left frontal activity led to alleviation of depressive symptoms. Moreover, cognitive tests revealed that the asymmetry training improved performance of executive function tests, whereas the placebo treatment did not show improvement. We preliminarily concluded that the asymmetry training is important for controlling and regulating emotion, and it may facilitate the left frontal lobe function.


Dias, A. M. and A. van Deusen (2011). "A new neurofeedback protocol for depression." Span J Psychol 14(1): 374-384.

CONTEXT: Neurofeedback represents an exciting complementary option in the treatment of depression that builds upon a huge body of research on electroencephalographic correlates of depression. OBJECTIVE: The objectives of this article are threefold: review the literature on neurofeedback protocols for depression; introduce a new protocol, which aims to synthesize the best qualities of the currently available protocols; and present the results of a small clinical experiment with the new protocol. METHOD: Structured survey of the literature; software development; clinical trial with one subject, submitted to ten sessions of neurofeedback (one hour each). RESULTS: Currently there are twenty-one articles in neurofeedback for depression, among which only six present original experimental results. All of them report positive results with the technique. The most used protocols focus on Alpha inter-hemispheric asymmetry, and Theta/Beta ratio within the left prefrontal cortex. Our new protocol integrates both dimensions in a single circuit, adding to it a third programming line, which divides Beta frequencies and reinforces the decrease of Beta-3, in order to reduce anxiety. The favorable outcome of our clinical experiment, suggests that new research with this protocol is worthwhile.


Hamilton, J. P., G. H. Glover, et al. (2011). "Modulation of subgenual anterior cingulate cortex activity with real-time neurofeedback." Hum Brain Mapp 32(1): 22-31.


The advent of real-time neurofeedback techniques has allowed us to begin to map the controllability of sensory and cognitive and, more recently, affective centers in the brain. The subgenual anterior cingulate cortex (sACC) is thought to be involved in generation of affective states and has been implicated in psychopathology. In this study, we examined whether individuals could use real-time fMRI neurofeedback to modulate sACC activity. Following a localizer task used to identify an sACC region of interest, an experimental group of eight women participated in 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 instructions to decrease sACC activity; and (3) a neurofeedback-free post-training scan. An additional nine women in a yoked feedback control group saw sACC activity from the participants in the experimental group. Activity in the sACC was significantly reduced during neurofeedback training in the experimental group, but not in the control group. This training effect in the experimental group, however, did not generalize to the neurofeedback-free post-training scan. A psychophysiological interaction analysis showed decreased correlation in the experimental group relative to the sham control group between activity in the sACC and the posterior cingulate cortex during neurofeedback training relative to neurofeedback-free scans. The finding that individuals can down-modulate the sACC shows that a primary emotion center in which functional abnormality has been strongly implicated in affective disorders can be controlled with the aid of neurofeedback.


Johnston, S., D. E. Linden, et al. (2011). "Upregulation of emotion areas through neurofeedback with a focus on positive mood." Cogn Affect Behav Neurosci11(1): 44-51.


Real-time functional magnetic resonance imaging can be used to feed back signal changes from the brain to participants such that they can train to modulate activation levels in specific brain areas. Here we present the first study combining up-regulation of brain areas for positive emotions with psychometric measures to assess the effect of successful self-regulation on subsequent mood. We localized brain areas associated with positive emotions through presentation of standardized pictures with positive valence. Participants up-regulated activation levels in their target area during specific periods, alternating with rest. Participants attained reliable self-control of the target area by the last of three seven-minute runs. This training effect was supported by an extensive network outside the targeted brain region, including higher sensory areas, paralimbic and orbitofrontal cortex. Self-control of emotion areas was not accompanied by clear changes in self-reported emotions; trend-level improvements on depression scores were counteracted by increases on measures of fatigue, resulting in no overall mood improvement. It is possible that benefits of self-control of emotion networks may only appear in people who display abnormal emotional homeostasis. The use of only a single, short, training session, overlap between positive and negative emotion networks and aversive reactions to the scanning environment may have prevented the detection of subtle changes in mood.


Micoulaud-Franchi, J. A., E. Fakra, et al. (2012). "[Towards a new approach of neurophysiology in clinical psychiatry: functional magnetic resonance imaging neurofeedback applied to emotional dysfunctions]." Neurophysiol Clin 42(3): 79-94.


Emotions color in a singular way our everyday life and constitute important determinants of human cognition and behavior. Emotional regulation is an essential process involved in neuropathophysiology and therapeutic efficacy in many psychiatric disorders. Yet, traditional psychiatric therapeutic has focused on symptomatic rather than neurophysiological criteria. Therefore, it was proposed to teach patients to modify their own brain activity directly, in order to obtain a therapeutic effect. These techniques, which are named neurofeedback, were originally developed using electroencephalography. Recent technical advances in fMRI enable real-time acquisition, and open opportunities to its utilization in neurofeedback. This seems particularly interesting in emotion regulation, which, at a neurofunctional level, lies on cortico-limbic pathways that, in great parts, were previously identified by traditional fMRI paradigms. This emotion regulation plays a central role in the etiopathogeny psychiatric, especially depressive and anxious, disorders. It is possible to devise new therapeutic strategies and research approach for addressing directly the neurophysiological processes of emotion regulation by integrating the neurofunctional activities of a subject. These prospects seem to be in line with the neurophenomenology project, which proposes to establish a link between subjective experiences and objective neurophysiological measures.

Anxiety Disorders (including PTSD)


Nelson, D. V. and M. L. Esty (2012). "Neurotherapy of traumatic brain injury/posttraumatic stress symptoms in OEF/OIF veterans." J Neuropsychiatry Clin Neurosci 24(2): 237-240.


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.


Surmeli, T. and A. Ertem (2011). "Obsessive compulsive disorder and the efficacy of qEEG-guided neurofeedback treatment: a case series." Clin EEG Neurosci42(3): 195-201.


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.


van Boxtel, G. J., A. J. Denissen, et al. (2012). "A novel self-guided approach to alpha activity training." Int J Psychophysiol 83(3): 282-294.

Fifty healthy participants took part in a double-blind placebo-controlled study in which they were either given auditory alpha activity (8-12Hz) training (N=18), random beta training (N=12), or no training at all (N=20). A novel wireless electrode system was used for training without instructions, involving water-based electrodes mounted in an audio headset. Training was applied approximately at central electrodes. Post-training measurement using a conventional full-cap EEG system revealed a 10% increase in alpha activity at posterior sites compared to pre-training levels, when using the conventional index of alpha activity and a non-linear regression fit intended to model individual alpha frequency. This statistically significant increase was present only in the group that received the alpha training, and remained evident at a 3 month follow-up session, especially under eyes open conditions where an additional 10% increase was found. In an exit interview, approximately twice as many participants in the alpha training group (53%) mentioned that the training was relaxing, compared to those in either the beta (20%) or no training (21%) control groups. Behavioural measures of stress and relaxation were indicative of effects of alpha activity training but failed to reach statistical significance. These results are discussed in terms of a lack of statistical power. Overall, results suggest that self-guided alpha activity training using this novel system is feasible and represents a step forward in the ease of instrumental conditioning of brain rhythms.




Bakhshayesh, A. R., S. Hansch, et al. (2011). "Neurofeedback in ADHD: a single-blind randomized controlled trial." Eur Child Adolesc Psychiatry 20(9): 481-491.


Neurofeedback treatment has been demonstrated to reduce inattention, impulsivity and hyperactivity in children with attention deficit/hyperactivity disorder (ADHD). However, previous studies did not adequately control confounding variables or did not employ a randomized reinforcer-controlled design. This study addresses those methodological shortcomings by comparing the effects of the following two matched biofeedback training variants on the primary symptoms of ADHD: EEG neurofeedback (NF) aiming at theta/beta ratio reduction and EMG biofeedback (BF) aiming at forehead muscle relaxation. Thirty-five children with ADHD (26 boys, 9 girls; 6-14 years old) were randomly assigned to either the therapy group (NF; n=18) or the control group (BF; n=17). Treatment for both groups consisted of 30 sessions. Pre- and post-treatment assessment consisted of psychophysiological measures, behavioural rating scales completed by parents and teachers, as well as psychometric measures. Training effectively reduced theta/beta ratios and EMG levels in the NF and BF groups, respectively. Parents reported significant reductions in primary ADHD symptoms, and inattention improvements in the NF group were higher compared to the control intervention (BF, d (corr)=-.94). NF training also improved attention and reaction times on the psychometric measures. The results indicate that NF effectively reduced inattention symptoms on parent rating scales and reaction time in neuropsychological tests. However, regarding hyperactivity and impulsivity symptoms, the results imply that non-specific factors, such as behavioural contingencies, self-efficacy, structured learning environment and feed-forward processes, may also contribute to the positive behavioural effects induced by neurofeedback training.


de Zambotti, M., M. Bianchin, et al. (2012). "The efficacy of EEG neurofeedback aimed at enhancing sensory-motor rhythm theta ratio in healthy subjects." Exp Brain Res 221(1): 69-74.


Scientific evidence supporting the reliability of neurofeedback (NF) in modifying the electroencephalographic (EEG) pattern is still limited. Several studies in NF research and clinical setting have been focused to increase sensory-motor rhythm (SMR) and simultaneously decrease theta activity with the aim of increasing attention performance and reducing hyperactive and impulsive behaviors. The goal of the present study was to assess the efficacy of NF training to enhance the SMR/theta ratio across sixteen sessions of training in eight healthy volunteers. Results suggested an increase of SMR/theta across weeks of training. Theta activity was strongly and steadily inhibited since the first session of training with slight decreases in the following weeks; instead, SMR was strongly inhibited at the beginning and progressively increased across sessions. These results suggest that individuals are able to inhibit theta activity easily while they fail to increase SMR in the first sessions. On the other hand, a separate analysis performed on the baseline preceding NF revealed a decreasing trend of SMR/theta ratio across the 8 weeks of training. Results point to the importance of providing EEG data in addition to behavioral modification, during NF training, to avoid possible misinterpretation of results.

Bakhtadze, S. Z., M. T. Dzhanelidze, et al. (2011). "Changes in cognitive evoked potentials during non pharmacological treatment in children with attention deficit/hyperactivity disorder." Georgian Med News(192): 47-57.


Attention deficit/hyperactivity disorder (ADHD) is one of the most widely spread condition of school aged children affecting 5% of children of this age. The unified consensus of the precise diagnosis of this condition is still absent. This fact encourages the researchers to seek the alternative neurometric tools which will help the clinicians in diagnosis making process of ADHD. The neurophysiologic approaches especially event-related potentials (ERPs) are mostly important from this point of view. The later response of ERPs (P3) reflects the most important parts of executive functioning frequently affected in ADHD children - the process of mental effortfullness to select the appropriate behavior and decision making. Besides the diagnosis the treatment of ADHD is also the point of concern of neurologists and neurophyschologists. In recent years EEG biofeedback ( Neurofeedback-NF) have become the alternative treatment as in some cases pharmacological drugs are non effective. The positive impact of NF was based on improvement detected by various questionnaires which are less valid but its effectiveness on ERPs parameters is still unknown. Thus we aimed to study the changes of ERPs after NF therapy. METHODS: We have studied 93 children with ADHD of combined subtype (ADHDcom) without any kind of pharmacological treatment. Age range 9-12 years. The children were divided into two subgroups: The first ADHDcom-1 (48 children) were children where NF treatment was carried out and the second subgroup of ADHDcom-2 (45 children) were non treated children. RESULTS: We have observed statistically significant improvement of parameters of later response like P3 in ADHD-1 compared with ADHD-2 whereas NF was non effective for earlier component like N1. CONCLUSIONS: NF can positively affect on the P3 parameters which is very important in ADHD children as P3 reflects the speed of information processing as well as selection of appropriate action and decision making which are frequently affected in ADHD children.


Buitelaar, J. K., C. C. Kan, et al. (2011). ADHD in adults : characterization, diagnosis, and treatment. Cambridge ; New York, Cambridge University Press.

"Although the phenomenon of ADHD (Attention-Deficit Hyperactivity Disorder) is well described in children, it is now thought that in up to 60% of cases the symptoms persist into adulthood. This volume reviews our growing knowledge of adult ADHD and presents a transatlantic perspective on the identification, assessment and treatment of the disorder. The introductory section covers the history of ADHD, as well as the epidemiology, consequences, gender differences and legal aspects. Detailed descriptions of the clinical features of ADHD in adults are then given to enhance the reader's clinical recognition and assessment. Subsequent sections cover treatment strategies, emphasising pharmacological, psychological and social interventions. Written and edited by experts internationally renowned for their work in ADHD, this is an essential resource for all mental health workers who encounter adults presenting with neurodevelopmental disorders"--


Gevensleben, H., B. Holl, et al. (2010). "Neurofeedback training in children with ADHD: 6-month follow-up of a randomised controlled trial." Eur Child Adolesc Psychiatry 19(9): 715-724.


Neurofeedback (NF) could help to improve attentional and self-management capabilities in children with attention-deficit/hyperactivity disorder (ADHD). In a randomised controlled trial, NF training was found to be superior to a computerised attention skills training (AST) (Gevensleben et al. in J Child Psychol Psychiatry 50(7):780-789, 2009). In the present paper, treatment effects at 6-month follow-up were studied. 94 children with ADHD, aged 8-12 years, completed either 36 sessions of NF training (n=59) or a computerised AST (n=35). Pre-training, post-training and follow-up assessment encompassed several behaviour rating scales (e.g., the German ADHD rating scale, FBB-HKS) completed by parents. Follow-up information was analysed in 61 children (ca. 65%) on a per-protocol basis. 17 children (of 33 dropouts) had started a medication after the end of the training or early in the follow-up period. Improvements in the NF group (n=38) at follow-up were superior to those of the control group (n=23) and comparable to the effects at the end of the training. For the FBB-HKS total score (primary outcome measure), a medium effect size of 0.71 was obtained at follow-up. A reduction of at least 25% in the primary outcome measure (responder criterion) was observed in 50% of the children in the NF group. In conclusion, behavioural improvements induced by NF training in children with ADHD were maintained at a 6-month follow-up. Though treatment effects appear to be limited, the results confirm the notion that NF is a clinically efficacious module in the treatment of children with ADHD.

Hoekstra, P. J. (2011). "Is there potential for the treatment of children with ADHD beyond psychostimulants?" Eur Child Adolesc Psychiatry 20(9): 431-432.


Lansbergen, M. M., M. van Dongen-Boomsma, et al. (2011). "ADHD and EEG-neurofeedback: a double-blind randomized placebo-controlled feasibility study." J Neural Transm 118(2): 275-284.


Electroencephalography (EEG)-neurofeedback has been shown to offer therapeutic benefits to patients with attention-deficit/hyperactivity disorder (ADHD) in several, mostly uncontrolled studies. This pilot study is designed to test the feasibility and safety of using a double-blind placebo feedback-controlled design and to explore the initial efficacy of individualized EEG-neurofeedback training in children with ADHD. Fourteen children (8-15 years) with ADHD defined according to the DSM-IV-TR criteria were randomly allocated to 30 sessions of EEG-neurofeedback (n=8) or placebo feedback (n=6). Safety measures (adverse events and sleep problems), ADHD symptoms and global improvement were monitored. With respect to feasibility, all children completed the study and attended all study visits and training sessions. No significant adverse effects or sleep problems were reported. Regarding the expectancy, 75% of children and their parent(s) in the active neurofeedback group and 50% of children and their parent(s) in the placebo feedback group thought they received placebo feedback training. Analyses revealed significant improvements of ADHD symptoms over time, but changes were similar for both groups. This pilot study shows that it is feasible to conduct a rigorous placebo-controlled trial to investigate the efficacy of neurofeedback training in children with ADHD. However, a double-blind design may not be feasible since using automatic adjusted reward thresholds may not work as effective as manually adjusted reward thresholds. Additionally, implementation of active learning strategies may be an important factor for the efficacy of EEG-neurofeedback training. Based on the results of this pilot study, changes are made in the design of the ongoing study.


Lee, J. H., J. Kim, et al. (2012). "Real-time fMRI-based neurofeedback reinforces causality of attention networks." Neurosci Res 72(4): 347-354.

In this study, we investigated the efficacy of a real-time functional magnetic resonance imaging (rtfMRI)-based neurofeedback method for the modulation of the effective connectivity (EC) of causality between attention-related neuronal activities. In participants who received the feedback of attention-related neuronal activity, the EC estimated from Granger causality analysis was reinforced within the task-related network, such as between the bilateral cingulate gyri and frontal cortices, whereas the EC between the task-related network and task-unrelated resting-state network, including the inferior parietal lobule, was diminished. On the other hand, only marginal changes were observed in participants who received "sham" feedback. This "dynamic" characteristic measure of EC based on causality may be useful for evaluating the efficacy of methods designed to modulate brain networks, including rtfMRI-based neurofeedback.


Liechti, M. D., S. Maurizio, et al. (2012). "First clinical trial of tomographic neurofeedback in attention-deficit/hyperactivity disorder: evaluation of voluntary cortical control." Clin Neurophysiol 123(10): 1989-2005.


OBJECTIVE: Tomographic neurofeedback (tNF) training was evaluated as a treatment for attention-deficit/hyperactivity disorder (ADHD). To investigate the specificity of the treatment, outcomes were related to learning during tNF. METHODS: Thirteen children with ADHD trained over 36 lessons to regulate their brain activity in the anterior cingulate cortex (ACC) using both theta-beta frequency and slow cortical potential (SCP) protocols. Thirty-channel electroencephalogram (EEG) was used to calculate low-resolution electromagnetic tNF and to assess the course of the training. Pre- and post-assessments included questionnaires, tests of attention, EEG recordings, and cognitive event-related potentials. RESULTS: Despite behavioural improvement and EEG artefact reduction, only partial learning was found for ACC parameters. Successful regulation was observed only for a simple feedback variant of SCP training, but with ACC-specific effects. Over training, resting EEG analysis indicated individual frequency normalisation rather than unidirectional changes across subjects. CONCLUSIONS: These results indicate that clinical improvement after ACC-tNF training can parallel artefact reduction without substantial learning of improved cortical control. However, individual normalisation of resting EEG activity and partial SCP control proved possible in this specific brain region affected in ADHD using tNF. Further studies are needed to clarify which critical aspects mediate region-specific learning in neurofeedback. SIGNIFICANCE: This study is the first to systematically investigate tNF in children suffering from a psychiatric disorder.


Lofthouse, N., L. E. Arnold, et al. (2012). "A review of neurofeedback treatment for pediatric ADHD." J Atten Disord 16(5): 351-372.


OBJECTIVE: The aim of this paper was to review all randomized published trials and unpublished conference presentations on the neurofeedback (NF) treatment of pediatric ADHD, and their relevance, strengths, and limitations. METHOD: Via PsychInfo and Medline searches and contacts with NF researchers 14 studies were identified and reviewed. RESULTS: The majority were conducted from 1994 to 2010, with 5- to 15-year-olds, usually male and White with the combined type of ADHD. Most studies used theta/beta NF with a unipolar-electrode placement at Cz and demonstrated, where reported, an overall ADHD mean effect size of d=0.69, a medium effect. Main study strengths, within some studies, include use of randomization, treatment control conditions, Diagnostic and Statistical Manual of Mental Disorders criteria, evidence-based assessment of ADHD, standard treatment outcome measures, multidomain assessment, and, for some studies, moderate sample size, some type of blind and the identification of medication as a concomitant treatment. Main study limitations (and directions for future research) include the lack of adequate blinding of participants, raters and NF trainers, a sham-NF/blinded control treatment condition, posttreatment follow-up, generalizability, specific details about delivery of NF, identification and control of comorbidity, and the identification, measurement, and control of concomitant treatments and potential side effects. CONCLUSION: Based on the results and methodologies of published studies, this review concludes that NF for pediatric ADHD can be currently considered as "probably efficacious."


Roman, M. W. (2010). "Treatments for childhood ADHD part II: non-pharmacological and novel     treatments." Issues Ment Health Nurs 31(9): 616-618.

Stankus, T. (2008). "Can the Brain be Trained? Comparing the Literature on the Use of EEG     Biofeedback/Neurofeedback as an Alternative or Complementary Therapy for Attention Deficit     Hyperactivity Disorder (ADHD)." Behavioral & Social Sciences Librarian 26(4): 20-56.

Psychologists, social workers, and school counselors are increasingly adding neurofeedback (NFT), a controversial alternative or complementary therapy to their treatment plans for patients with Attention Deficit Hyperactivity Disorder. NFT involves training the patient in selfregulation of brain wave patterns, employing a standard diagnostic tool, the EEG, in an interactive operant conditioning mode not often used by neurologists or psychiatrists. Some NFT therapists claim in their books that they have sufficient expertise to advise parents against the use of Ritalin (TM) and amphetamines, which are part of the conventional multimodal therapy strongly endorsed in a wide variety of clinical publications. In return, some of the leading conventional physicians and Ph.D. researchers in the field of ADHD have traditionally ignored or disparaged the literature of NFT as being insufficiently scientific and appearing largely in obscure journals or books published outside the mainstream medical presses. While most librarians are unlikely to have sufficient scientific or clinical credentials to pass judgment, one way or another, on NFT as a treatment for ADHD, an examination of the credentials of authors, their books, book reviews, journals, and the publishers in which opponents and proponents make their case is entirely within our purview, and such an analysis is provided. [ABSTRACT FROM AUTHOR]


Steiner, N. J., R. C. Sheldrick, et al. (2011). "Computer-based attention training in the schools for children with attention deficit/hyperactivity disorder: a preliminary trial." Clin Pediatr (Phila) 50(7): 615-622.


Objective. This study examined the efficacy of 2 computer-based training systems to teach children with attention deficit/hyperactivity disorder (ADHD) to attend more effectively. Design/methods. A total of 41 children with ADHD from 2 middle schools were randomly assigned to receive 2 sessions a week at school of either neurofeedback (NF) or attention training through a standard computer format (SCF), either immediately or after a 6-month wait (waitlist control group). Parents, children, and teachers completed questionnaires pre- and postintervention. Results. Primary parents in the NF condition reported significant (P < .05) change on Conners's Rating Scales-Revised (CRS-R) and Behavior Assessment Scales for Children (BASC) subscales; and in the SCF condition, they reported significant (P < .05) change on the CRS-R Inattention scale and ADHD index, the BASC Attention Problems Scale, and on the Behavioral Rating Inventory of Executive Functioning (BRIEF). Conclusion. This randomized control trial provides preliminary evidence of the effectiveness of computer-based interventions for ADHD and supports the feasibility of offering them in a school setting.

Wangler, S., H. Gevensleben, et al. (2011). "Neurofeedback in children with ADHD: specific event-related potential findings of a randomized controlled trial." Clin Neurophysiol 122(5): 942-950.


OBJECTIVE: In a randomized controlled trial, we could demonstrate clinical efficacy of neurofeedback (NF) training for children with ADHD (Gevensleben et al., 2009a). The present investigation aimed at learning more about the neuronal mechanisms of NF training. METHODS: Children with ADHD either completed a NF training or a computerized attention skills training (ratio 3:2). NF training consisted of one block of theta/beta training and one block of slow cortical potential (SCP) training, each comprising 18 training units. At three times (pre-training, between the two training blocks and at post-training), event-related potentials (ERP) were recorded during the Attention Network Test. ERP analysis focused on the P3, reflecting inter alia attentional resources for stimulus evaluation, and the contingent negative variation (CNV), primarily related to cognitive preparation. RESULTS: After NF training, an increase of the CNV in cue trials could be observed, which was specific for the SCP training. A larger pre-training CNV was associated with a larger reduction of ADHD symptomatology for SCP training. CONCLUSIONS: CNV effects reflect neuronal circuits underlying resource allocation during cognitive preparation. These distinct ERP effects are closely related to a successful NF training in children with ADHD. In future studies, neurophysiological recordings could help to optimize and individualize NF training. SIGNIFICANCE: The findings contribute to a better understanding of the mechanisms underlying NF training in children with ADHD.


Pain Syndromes


Collura, T. F. and R. W. Thatcher (2011). "Clinical benefit to patients suffering from recurrent migraine headaches and who opted to stop medication and take a neurofeedback treatment series." Clin EEG Neurosci 42(2): VIII-IX.


Kayiran, S., E. Dursun, et al. (2010). "Neurofeedback intervention in fibromyalgia syndrome; a randomized, controlled, rater blind clinical trial." Appl Psychophysiol Biofeedback 35(4): 293-302.


We designed a randomized, rater blind study to assess the efficacy of EEG Biofeedback (Neurofeedback-NFB) in patients with fibromyalgia syndrome (FMS). Eighteen patients received twenty sessions of NFB-sensory motor rhythm (SMR) treatment (NFB group) during 4 weeks, and eighteen patients were given 10 mg per day escitalopram treatment (control group) for 8 weeks. Visual Analog Scales for pain and fatigue, Hamilton and Beck Depression and Anxiety Inventory Scales, Fibromyalgia Impact Questionnaire and Short Form 36 were used as outcome measures which were applied at baseline and 2nd, 4th, 8th, 16th, 24th weeks. Mean amplitudes of EEG rhythms (delta, theta, alpha, SMR, beta1 and beta2) and theta/SMR ratio were also measured in NFB group. All post-treatment measurements showed significant improvements in both of the groups (for all parameters p < 0.05). NFB group displayed greater benefits than controls (for all parameters p < 0.05). Therapeutic efficacy of NFB was found to begin at 2nd week and reached to a maximum effect at 4th week. On the other hand, the improvements in SSRI treatment were also detected to begin at 2nd week but reached to a maximum effect at 8th week. No statistically significant changes were noted regarding mean amplitudes of EEG rhythms (p > 0.05 for all). However, theta/SMR ratio showed a significant decrease at 4th week compared to baseline in the NFB group (p < 0.05). These data support the efficacy of NFB as a treatment for pain, psychological symptoms and impaired quality of life associated with fibromyalgia.


Stokes, D. A. and M. S. Lappin (2010). "Neurofeedback and biofeedback with 37 migraineurs: a clinical outcome study." Behav Brain Funct 6: 9.

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.


Walker, J. E. (2011). "QEEG-guided neurofeedback for recurrent migraine headaches." Clin EEG Neurosci 42(1): 59-61.


Seventy-one patients with recurrent migraine headaches, aged 17-62, from one neurological practice, completed a quantitative electroencephalogram (QEEG) procedure. All QEEG results indicated an excess of high-frequency beta activity (21-30 Hz) in 1-4 cortical areas. Forty-six of the 71 patients selected neurofeedback training 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). All the patients were classified as migraine without aura. For the neurofeedback group the majority (54%) experienced complete cessation of their migraines, and many others (39%) experienced a reduction in migraine frequency of greater than 50%. Four percent experienced a decrease in headache frequency of < 50%. Only one patient did not experience a reduction in headache frequency. The control group of subjects who chose to continue drug therapy as opposed to neurofeedback experienced no change in headache frequency (68%), a reduction of less than 50% (20%), or a reduction greater than 50% (8%). QEEG-guided neurofeedback appears to be dramatically effective in abolishing or significantly reducing headache frequency in patients with recurrent migraine.


Motor Function


Basta, D., M. Rossi-Izquierdo, et al. (2011). "Efficacy of a vibrotactile neurofeedback training in stance and gait conditions for the treatment of balance deficits: a double-blind, placebo-controlled multicenter study." Otol Neurotol 32(9): 1492-1499.


OBJECTIVE: Vestibular rehabilitation strategies mostly require a long-lasting training in stance conditions, which is finally not always successful. The individualized training in everyday-life conditions with an intuitive tactile neurofeedback stimulus seems to be a more promising approach. Hence, the present study was aimed at investigating the efficacy of a new vibrotactile neurofeedback system for vestibular rehabilitation. STUDY DESIGN: Double-blinded trial. PATIENTS: One hundred five patients who experience one of the following balance disorders for more than 12 months were included in the study: canal paresis, otolith disorder, removal of an acoustic neuroma, microvascular compression syndrome, Parkinson's disease, and presbyvertigo. INTERVENTIONS: Vibrotactile neurofeedback training was performed daily (15 min) over 2 weeks with the Vertiguard system in those 6 tasks of the Standard Balance Deficit Test with the most prominent deviations from the normative values. MAIN OUTCOME MEASURES: Trunk and ankle sway, dizziness handicap inventory, and vestibular symptom score were measured in the verum and placebo group before the training, on the last training day and 3 months later. RESULTS: A significant reduction in trunk and ankle sway as well as in the subjective symptom scores were observed in the verum group. Such an effect could not be found in any of the outcome parameters of the placebo group. CONCLUSION: The vibrotactile neurofeedback training applied in the present study is a highly efficient method for the reduction of body sway in different balance disorders. Because the rehabilitation program is easy to perform, not exhausting, and time saving, elderly patients and those with serious, long-lasting balance problems also can participate successfully.


Bloom, R., A. Przekop, et al. (2010). "Prolonged electromyogram biofeedback improves upper extremity function in children with cerebral palsy." J Child Neurol25(12): 1480-1484.

Biofeedback of muscle activity is commonly used as an adjunct to physical therapy, but it has not previously been used for long-term treatment of movement disorders. The authors hypothesized that chronic daily use of biofeedback of muscle electrical activity might promote improved use of the upper extremity in children with cerebral palsy and upper extremity motor deficits. They constructed a portable electromyography (EMG) unit that includes a surface EMG sensor and amplifier, microcontroller-based nonlinear signal processing, and vibration feedback of muscle activity. A total of 11 children ages 6 to 16 years, with cerebral palsy or acquired static brain injury, wore the device at least 5 hours per day for 1 month. Changes in upper extremity function were assessed using an individualized Goal Attainment Scale. Results showed significant clinical improvement in all 10 children who completed the study. These results suggest that further testing of prolonged surface EMG biofeedback is warranted.


Chiew, M., S. M. LaConte, et al. (2012). "Investigation of fMRI neurofeedback of differential primary motor cortex activity using kinesthetic motor imagery." Neuroimage 61(1): 21-31.


Functional MRI neurofeedback (fMRI NF) is an emerging technique that trains subjects to regulate their brain activity while they manipulate sensory stimulus representations of fMRI signals in "real-time". Here we report an fMRI NF study of brain activity associated with kinesthetic motor imagery (kMI), analyzed using partial least squares (PLS), a multivariate analysis technique. Thirteen healthy young adult subjects performed kMI involving each hand separately, with NF training targeting regions of interest (ROIs) in the left and right primary motor cortex (M1). Throughout, subjects attempted to maximize a laterality index (LI) of brain activity-the difference in activity between the contralateral ROI (relative to the hand involved in kMI) and the ipsilateral M1 ROI-while receiving real-time updates on a visual display. Six of 13 subjects were successful in increasing the LI value, whereas the other 7 were not successful and performed similarly to 5 control subjects who received sham NF training. Ability to suppress activity in the ipsilateral M1 ROI was the primary driver of successful NF performance. Multiple PLS analyses depicted activated networks of brain regions involved with imagery, self-awareness, and feedback processing, and additionally showed that activation of the task positive network was correlated with task performance. These results indicate that fMRI NF of kMI is capable of modulating brain activity in primary motor regions in a subset of the population. In the future, such methods may be useful in the development of NF training methods for enhancing motor rehabilitation following stroke.


Dogan-Aslan, M., G. F. Nakipoglu-Yuzer, et al. (2012). "The effect of electromyographic biofeedback treatment in improving upper extremity functioning of patients with hemiplegic stroke." J Stroke


Liu, H., R. Behroozmand, et al. (2011). "Laryngeal electromyographic responses to perturbations in voice pitch auditory feedback." J Acoust Soc Am 129(6): 3946-3954.


The present study was conducted to test the hypothesis that intrinsic laryngeal muscles are involved in producing voice fundamental frequency (F(0)) responses to perturbations in voice pitch auditory feedback. Electromyography (EMG) recordings of the cricothyroid and thyroarytenoid muscles were made with hooked-wire electrodes, while subjects sustained vowel phonations at three different voice F(0) levels (conversational, high pitch in head register, and falsetto register) and received randomized pitch shifts (+/-100 or +/-300 cents) in their voice auditory feedback. The median latencies from stimulus onset to the peak in the EMG and voice F(0) responses were 167 and 224 ms, respectively. Among the three different F(0) levels, the falsetto register produced compensatory EMG responses that occurred prior to vocal responses and increased along with rising voice F(0) responses and decreased for falling F(0) responses. For the conversational and high voice levels, the EMG response timing was more variable than in the falsetto voice, and changes in EMG activity with relevance to the vocal responses did not follow the consistent trend observed in the falsetto condition. The data from the falsetto condition suggest that both the cricothyroid and thyroarytenoid muscles are involved in generating the compensatory vocal responses to pitch-shifted voice feedback.


Cerebrovasc Dis 21(3): 187-192.


This study evaluated the effect of electromyographic biofeedback (EMG-BF) treatment on wrist flexor muscle spasticity, upper extremity motor function, and ability to perform activities of daily living in patients with hemiplegia following stroke. A total of 40 patients were enrolled and were randomly assigned to two groups: a group treated with EMG-BF (study group) and a untreated (control) group. Both groups participated in a hemiplegia rehabilitation program consisting of neurodevelopmental and conventional methods and verbal encouragement to "relax" spastic wrist flexor muscles. In addition, the study group received 3 weeks of EMG-BF treatment, 5 times a week, for 20 minutes per session at hemiplegic side wrist flexors. Clinical findings were assessed before and after rehabilitation using the Ashworth scale (AS), Brunnstrom's stage (BS) of recovery for hemiplegic arm and hand, the upper extremity function test (UEFT), the wrist and hand portion of the Fugl-Meyer scale (FMS), goniometric measurements of wrist extension, surface EMG potentials, and the Barthel Index (BI). There was no statistically significant difference between the two groups in terms of age, sex, systemic disease, and the etiology, side, and duration of hemiplegia. There also was no statistically significant difference in the pretreatment values between two groups. We found statistically significant improvements posttreatment in the AS, BS, UEFT, goniometric measurements of wrist extension, and surface EMG potentials in the study group. We also noted statistically significant differences in the wrist and hand portion of the FMS and the BI in both groups, but with significantly greater improvements in the study group. Our findings indicate a positive effect of EMG-BF treatment in conjunction with neurodevelopmental and conventional methods in hemiplegia rehabilitation.


Manyakov, N. V., N. Chumerin, et al. (2011). "Comparison of classification methods for P300 brain-computer interface on disabled subjects." Comput Intell Neurosci 2011: 519868.


We report on tests with a mind typing paradigm based on a P300 brain-computer interface (BCI) on a group of amyotrophic lateral sclerosis (ALS), middle cerebral artery (MCA) stroke, and subarachnoid hemorrhage (SAH) patients, suffering from motor and speech disabilities. We investigate the achieved typing accuracy given the individual patient's disorder, and how it correlates with the type of classifier used. We considered 7 types of classifiers, linear as well as nonlinear ones, and found that, overall, one type of linear classifier yielded a higher classification accuracy. In addition to the selection of the classifier, we also suggest and discuss a number of recommendations to be considered when building a P300-based typing system for disabled subjects.


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