By Johny Tran
Neurofeedback (NFB) treatment seems like part of a plot derived from a science fiction film. Simply by playing a video game, patients are able to self-regulate and improve their brain function. Using either EEG or fMRI NFB, subjects are monitored and presented with their brain activity in the form of a game, so that they are able to alter their brain activity towards more desired levels. With the non-invasive approach of NFB, many patients have been able to treat their mental disorders with cognitive therapy and brain enhancement (Zotev, Phillips, Yuan, Misaki, & Bodurka, 2014). NFB is a very real concept, and is making waves in the world of neuroscience.
To date, NFB has been shown to be promising for a range of psychological conditions. In patients with disorders such as anxiety and depression, NFB has been seen to significantly improve outcomes for these patients, with the suggestion that it may serve as a better alternative to traditional medications as a form of treatment (Cheon et al., 2015; Hammond, 2005). In patients with depression, clinical trials controlled for the placebo effect have found that half of participants in the NFB treatment group have had meaningful and lasting improvements in the reduction of their depression (Choi et al., 2011). NFB has also been shown to alleviate symptoms of ADHD in both children and adults, with results regarded as clinically meaningful (Arns, de Ridder, Strehl, Breteler, Coenen, 2009; Hillard, El-Baz, Sears, Tasman, Sokhadze, 2013). In patients with chronic pain, NFB training has allowed these patients to control and reduce the activation of their pain perception, thereby alieving their symptoms (DeCharms et al., 2005). In patients suffering from PTSD, NFB has allowed patients to reduce their states of anxiety and has been shown to change brain connectivity to increase calmness in these patients (Kluetsch et al., 2014). Treatment of PTSD with NFB has also been found to be better tolerated by patients than traditional exposure therapies (S. Othmer & S.F. Othmer, 2009). In patients diagnosed with chronic schizophrenia, NFB has been shown to be effective in improving their symptoms of schizophrenia based on tests that measure for psychological deviations (Surmeli, Ertem, Eralp, & Kos, 2012).
However, many psychological diagnoses are based on the reportings of the patients themselves, creating results that can be seen as subjective. Psychological findings can then be difficult to prove objective, as these reports depend on the perceptions and psychological states of the patients being treated. Furthermore, findings from NFB studies can fall victim to the placebo effect, where patients will report improved symptoms based on the belief that NFB will positively affect them. Nonetheless, in psychological studies where reporting is less subjective, results have also been promising. For example, in patients with intractable seizures, NFB was shown to significantly reduce seizure frequency in eighty-two percent of participants, with seventy-six percent of the patients no longer requiring anticonvulsants for seizure control after treatment (Walker, 2008). Patients treated with NFB were also found to maintain the reduced events of seizure nearly ten years after treatment (Strehl, Birkle, Wӧrz, & Kotchoubey, 2014). In another example, patients who suffered a stroke six months prior to NFB treatment were observed to have significantly improved sensorimotor rhythm, dual-task performance, and gait (Lee, Bae, Lee, & Kim, 2015). Therefore, NFB is clearly creating new avenues for non-invasive treatment in the physical world.
Regardless of whether or not we can definitively prove that NFB works beyond the shadow of a doubt, the results are very promising, and the impact is very real for the patients. This, then, begs the question: Can we hack into the mental resources of our mind, and take advantage of these abilities to help patients subconsciously heal themselves with their thoughts more efficiently? If so, can we use these mental capabilities to help patients undergoing surgical trauma or physical therapy, allowing mental rehabilitation to manifest itself into the physical realm? Can we simplify this process into an algorithm, so that we can rehabilitate patients along the fastest possible route? What are the limitations to the power of our mind? What other potential diseases can NFB treat non-invasively? Neurofeedback is introducing a host of new questions, and the research is not far behind in answering them.
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.
2. Cheon, E., Koo, B., Seo, W., Lee, J., Choi, J., & Song, S. (2015). Effects of Neurofeedback on Adult Patients with Psychiatric Disorders in a Naturalistic Setting. Applied Psychophysiology and Biofeedback, 40(1), 17-24.
3. Choi, S., Chi, S., Chung, S., Kim, J., Ahn, C., & Kim, H. (2011). Is Alpha Wave Neurofeedback Effective with Randomized Clinical Trials in Depression? A Pilot Study. Neuropsychobiology, 63(1), 43-51.
4. DeCharms, R., Maeda, F., Glover, G., Ludlow, D., Pauly, J., Soneji, D., Gabrieli, J., & Mackey, S. (2005). Control over brain activation and pain learned by using real-time functional MRI. Proceedings of the National Academy of Sciences of the United States of America, 102(51), 18626-18631.
5. Hammond, D. (2005). Neurofeedback Treatment of Depression and Anxiety. Journal of Adult Development, 12(2-3), 131-137.
6. Hillard, B., El-Baz, A., Sears, L., Tasman, A., & Sokhadze, E. (2013). Neurofeedback training aimed to improve focused attention and alertness in children with ADHD: a study of relative power of EEG rhythms using custom-made software application. Clinical EEG and Neuroscience, 44(3), 193-202.
7. Kluetsch, R., Ros, T., Théberge, J., Frewen, P., Calhoun, V., Schmahl, C., Jetly, R., & Lanius, R. (2014). Plastic modulation of PTSD resting-state networks and subjective wellbeing by EEG neurofeedback. Acta Psychiatrica Scandinavica, 130(2), 123-136.
8. Lee, Y., Bae, S., Lee, S., & Kim, K. (2015). Neurofeedback training improves the dual-task performance ability in stroke patients. The Tohoku Journal of Experimental Medicine, 236(1), 81-88.
9. Othmer, S. & Othmer, S.F. (2009). Post Traumatic Stress Disorder—The Neurofeedback Remedy. Biofeedback, 37(1), 24-31.
10. Strehl, U., Birkle, S., Wӧrz, S., & Kotchoubey, B. (2014). Sustained reduction of seizures in patients with intractable epilepsy after self-regulation training of slow cortical potentials - 10 years after. Frontiers in Human Neuroscience, 8(1), 604.
11. Surmeli, T., Ertem, A., Eralp, E., & Kos, I. (2012). Schizophrenia and the efficacy of qEEG-guided neurofeedback treatment: a clinical case series. Clinical EEG and Neuroscience, 43(2), 133-144.
12. Walker, J. (2008). Power spectral frequency and coherence abnormalities in patients with intractable epilepsy and their usefulness in long-term remediation of seizures using neurofeedback. Clinical EEG and Neuroscience, 39(4), 203-205.
13. Zotev, V., Phillips, R., Yuan, H., Misaki, M., & Bodurka, J. (2014). Self-regulation of human brain activity using simultaneous real-time fMRI and EEG neurofeedback. NeuroImage, 85(3), 985-995.