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Marcu GM, Dumbravă A, Băcilă IC, Szekely-Copîndean RD, Zăgrean AM. Increasing Value and Reducing Waste of Research on Neurofeedback Effects in Post-traumatic Stress Disorder: A State-of-the-Art-Review. Appl Psychophysiol Biofeedback 2024; 49:23-45. [PMID: 38151684 DOI: 10.1007/s10484-023-09610-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2023]
Abstract
Post-Traumatic Stress Disorder (PTSD) is often considered challenging to treat due to factors that contribute to its complexity. In the last decade, more attention has been paid to non-pharmacological or non-psychological therapies for PTSD, including neurofeedback (NFB). NFB is a promising non-invasive technique targeting specific brainwave patterns associated with psychiatric symptomatology. By learning to regulate brain activity in a closed-loop paradigm, individuals can improve their functionality while reducing symptom severity. However, owing to its lax regulation and heterogeneous legal status across different countries, the degree to which it has scientific support as a psychiatric treatment remains controversial. In this state-of-the-art review, we searched PubMed, Cochrane Central, Web of Science, Scopus, and MEDLINE and identified meta-analyses and systematic reviews exploring the efficacy of NFB for PTSD. We included seven systematic reviews, out of which three included meta-analyses (32 studies and 669 participants) that targeted NFB as an intervention while addressing a single condition-PTSD. We used the MeaSurement Tool to Assess systematic Reviews (AMSTAR) 2 and the criteria described by Cristea and Naudet (Behav Res Therapy 123:103479, 2019, https://doi.org/10.1016/j.brat.2019.103479 ) to identify sources of research waste and increasing value in biomedical research. The seven assessed reviews had an overall extremely poor quality score (5 critically low, one low, one moderate, and none high) and multiple sources of waste while opening opportunities for increasing value in the NFB literature. Our research shows that it remains unclear whether NFB training is significantly beneficial in treating PTSD. The quality of the investigated literature is low and maintains a persistent uncertainty over numerous points, which are highly important for deciding whether an intervention has clinical efficacy. Just as importantly, none of the reviews we appraised explored the statistical power, referred to open data of the included studies, or adjusted their pooled effect sizes for publication bias and risk of bias. Based on the obtained results, we identified some recurrent sources of waste (such as a lack of research decisions based on sound questions or using an appropriate methodology in a fully transparent, unbiased, and useable manner) and proposed some directions for increasing value (homogeneity and consensus) in designing and reporting research on NFB interventions in PTSD.
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Affiliation(s)
- Gabriela Mariana Marcu
- Division of Physiology and Neuroscience, Department of Functional Sciences, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.
- Department of Psychology, "Lucian Blaga" University of Sibiu, Sibiu, Romania.
| | - Andrei Dumbravă
- George I.M. Georgescu Institute of Cardiovascular Diseases, Iaşi, Romania
- Alexandru Ioan Cuza University Iaşi, Iaşi, Romania
| | - Ionuţ-Ciprian Băcilă
- Scientific Research Group in Neuroscience "Dr. Gheorghe Preda" Clinical Psychiatry Hospital, Sibiu, Romania
- Faculty of Medicine, "Lucian Blaga" University of Sibiu Romania, Sibiu, Romania
| | - Raluca Diana Szekely-Copîndean
- Scientific Research Group in Neuroscience "Dr. Gheorghe Preda" Clinical Psychiatry Hospital, Sibiu, Romania
- Department of Social and Human Research, Romanian Academy - Cluj-Napoca Branch, Cluj-Napoca, Romania
| | - Ana-Maria Zăgrean
- Division of Physiology and Neuroscience, Department of Functional Sciences, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
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Perez TM, Mathew J, Glue P, Adhia DB, De Ridder D. Is There Evidence for the Specificity of Closed-Loop Brain Training in the Treatment of Internalizing Disorders? A Systematic Review. Front Neurosci 2022; 16:821136. [PMID: 35360168 PMCID: PMC8960197 DOI: 10.3389/fnins.2022.821136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 02/10/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction Internalizing disorders (IDs), e.g., major depressive disorder (MDD), posttraumatic stress disorder (PTSD), obsessive-compulsive disorder (OCD) are the most prevalent psychopathologies experienced worldwide. Current first-line therapies (i.e., pharmacotherapy and/or psychotherapy) offer high failure rates, limited accessibility, and substantial side-effects. Electroencephalography (EEG) guided closed-loop brain training, also known as EEG-neurofeedback (EEG-NFB), is believed to be a safe and effective alternative, however, there is much debate in the field regarding the existence of specificity [i.e., clinical effects specific to the modulation of the targeted EEG variable(s)]. This review was undertaken to determine if there is evidence for EEG-NFB specificity in the treatment of IDs. Methods We considered only randomized, double-blind, sham-controlled trials. Outcomes of interest included self/parent/teacher reports and clinician ratings of ID-related symptomatology. Results Of the four reports (total participant number = 152) meeting our eligibility criteria, three had point estimates suggesting small to moderate effect sizes favoring genuine therapy over sham, however, due to small sample sizes, all 95% confidence intervals (CIs) were wide and spanned the null. The fourth trial had yet to post results as of the submission date of this review. The limited overall number of eligible reports (and participants), large degree of inter-trial heterogeneity, and restricted span of ID populations with published/posted outcome data (i.e., PTSD and OCD) precluded a quantitative synthesis. Discussion The current literature suggests that EEG-NFB may induce specific effects in the treatment of some forms of IDs, however, the evidence is very limited. Ultimately, more randomized, double-blind, sham-controlled trials encompassing a wider array of ID populations are needed to determine the existence and, if present, degree of EEG-NFB specificity in the treatment of IDs. Systematic Review Registration [https://www.crd.york.ac.uk/prospero], identifier [CRD42020159702].
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Affiliation(s)
- Tyson Michael Perez
- Department of Surgical Sciences, University of Otago, Dunedin, New Zealand
- Department of Psychological Medicine, University of Otago, Dunedin, New Zealand
| | - Jerin Mathew
- Centre for Health, Activity, and Rehabilitation Research, University of Otago, Dunedin, New Zealand
| | - Paul Glue
- Department of Psychological Medicine, University of Otago, Dunedin, New Zealand
| | - Divya B. Adhia
- Department of Surgical Sciences, University of Otago, Dunedin, New Zealand
| | - Dirk De Ridder
- Department of Surgical Sciences, University of Otago, Dunedin, New Zealand
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Ros T, Enriquez-Geppert S, Zotev V, Young KD, Wood G, Whitfield-Gabrieli S, Wan F, Vuilleumier P, Vialatte F, Van De Ville D, Todder D, Surmeli T, Sulzer JS, Strehl U, Sterman MB, Steiner NJ, Sorger B, Soekadar SR, Sitaram R, Sherlin LH, Schönenberg M, Scharnowski F, Schabus M, Rubia K, Rosa A, Reiner M, Pineda JA, Paret C, Ossadtchi A, Nicholson AA, Nan W, Minguez J, Micoulaud-Franchi JA, Mehler DMA, Lührs M, Lubar J, Lotte F, Linden DEJ, Lewis-Peacock JA, Lebedev MA, Lanius RA, Kübler A, Kranczioch C, Koush Y, Konicar L, Kohl SH, Kober SE, Klados MA, Jeunet C, Janssen TWP, Huster RJ, Hoedlmoser K, Hirshberg LM, Heunis S, Hendler T, Hampson M, Guggisberg AG, Guggenberger R, Gruzelier JH, Göbel RW, Gninenko N, Gharabaghi A, Frewen P, Fovet T, Fernández T, Escolano C, Ehlis AC, Drechsler R, Christopher deCharms R, Debener S, De Ridder D, Davelaar EJ, Congedo M, Cavazza M, Breteler MHM, Brandeis D, Bodurka J, Birbaumer N, Bazanova OM, Barth B, Bamidis PD, Auer T, Arns M, Thibault RT. Consensus on the reporting and experimental design of clinical and cognitive-behavioural neurofeedback studies (CRED-nf checklist). Brain 2020; 143:1674-1685. [PMID: 32176800 PMCID: PMC7296848 DOI: 10.1093/brain/awaa009] [Citation(s) in RCA: 147] [Impact Index Per Article: 36.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 10/10/2019] [Accepted: 10/28/2020] [Indexed: 02/02/2023] Open
Abstract
Neurofeedback has begun to attract the attention and scrutiny of the scientific and medical mainstream. Here, neurofeedback researchers present a consensus-derived checklist that aims to improve the reporting and experimental design standards in the field.
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Affiliation(s)
- Tomas Ros
- Departments of Neuroscience and Psychiatry, University of Geneva; Campus Biotech, Geneva, Switzerland
| | - Stefanie Enriquez-Geppert
- Department of Clinical Neuropsychology, University of Groningen, Groningen, The Netherlands
- Department of Biomedical Sciences of Cells & Systems, University Medical Center Groningen, Groningen, The Netherlands
| | - Vadim Zotev
- Laureate Institute for Brain Research, Tulsa, Oklahoma, USA
| | - Kymberly D Young
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Guilherme Wood
- Institute of Psychology, University of Graz, Graz, Austria
| | - Susan Whitfield-Gabrieli
- Massachusetts Institute of Technology, Cambridge, MA, USA
- Northeastern University, Boston, MA, USA
| | - Feng Wan
- Department of Electrical and Computer Engineering, Faculty of Science and Technology, University of Macau, Macau, China
| | | | | | - Dimitri Van De Ville
- Institute of Bioengineering, Center for Neuroprosthetics, École Polytechnique Fédérale de Lausanne (EPFL); Campus Biotech, Geneva, Switzerland
| | - Doron Todder
- Faculty of Health, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Beer-Sheva Mental Health Center, Israel Ministry of Health, Beer-Sheva, Israel
| | - Tanju Surmeli
- Living Health Center for Research and Education, Istanbul, Turkey
| | - James S Sulzer
- Department of Mechanical Engineering, University of Texas at Austin, Austin, TX, USA
| | - Ute Strehl
- Institute for Medical Psychology and Behavioral Neurobiology, University of Tübingen, Tübingen, Germany
| | - Maurice Barry Sterman
- Neurobiology and Biobehavioral Psychiatry, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Naomi J Steiner
- Boston University School of Medicine, Department of Pediatrics, Boston, MA, USA
| | - Bettina Sorger
- Department of Cognitive Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Surjo R Soekadar
- Clinical Neurotechnology Laboratory, Neuroscience Research Center (NWFZ), Department of Psychiatry and Psychotherapy (CCM), Charité - University Medicine Berlin, Berlin, Germany
| | - Ranganatha Sitaram
- Institute of Biological and Medical Engineering, Pontificia Universidad Católica de Chile, Macul, Santiago, Chile
| | | | | | - Frank Scharnowski
- Department of Basic Psychological Research and Research Methods, Faculty of Psychology, University of Vienna, Vienna, Austria
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zürich, Zürich, Switzerland
| | - Manuel Schabus
- University of Salzburg, Centre for Cognitive Neuroscience and Department of Psychology, Salzburg, Austria
| | - Katya Rubia
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | | | - Miriam Reiner
- Technion, Israel Institute of Technology, Haifa, Israel
| | - Jaime A Pineda
- Cognitive Science Department, University of California, San Diego, CA, USA
| | - Christian Paret
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Germany
| | - Alexei Ossadtchi
- National Research University Higher School of Economics, Moscow, Russia
| | - Andrew A Nicholson
- Department of Basic Psychological Research and Research Methods, Faculty of Psychology, University of Vienna, Vienna, Austria
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zürich, Zürich, Switzerland
| | - Wenya Nan
- Department of Psychology, Shanghai Normal University, Shanghai, China
| | | | | | - David M A Mehler
- Department of Psychiatry, University of Münster, Münster, Germany
| | - Michael Lührs
- Department of Cognitive Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Joel Lubar
- Department of Psychology, University of Tennessee, Knoxville, USA
| | - Fabien Lotte
- Inria Bordeaux Sud-Ouest/LaBRI University of Bordeaux - CNRS-Bordeaux INP, Bordeaux, France
| | - David E J Linden
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | | | - Mikhail A Lebedev
- Center for Bioelectric Interfaces of the Institute for Cognitive Neuroscience, National Research University Higher School of Economics, Moscow, Russia
- Department of Information and Internet Technologies of Digital Health Institute; I.M. Sechenov First Moscow State Medical University, Moscow, Russia
- Duke Center for Neuroengineering, Duke University, Durham, NC, USA
| | - Ruth A Lanius
- Department of Psychiatry, Western University, London, Ontario, Canada
| | - Andrea Kübler
- Department of Psychology I, Psychological Intervention, Behavior Analysis and Regulation of Behavior, University of Würzburg
| | - Cornelia Kranczioch
- Neuropsychology Lab, Department of Psychology, University of Oldenburg, Oldenberg, Germany
| | - Yury Koush
- Magnetic Resonance Research Center (MRRC), Department of Radiology and Biomedical Imaging, Yale University, New Haven, CT, USA
| | - Lilian Konicar
- Medical University of Vienna, Department of Child and Adolescent Psychiatry, Vienna, Austria
| | - Simon H Kohl
- JARA-Institute Molecular neuroscience and neuroimaging (INM-11), Jülich Research Centre, Jülich, Germany
| | | | - Manousos A Klados
- Department of Psychology, The University of Sheffield International Faculty, City College, Thessaloniki, Greece
| | - Camille Jeunet
- CLLE Lab, CNRS, Université Toulouse Jean Jaurès, Toulouse, France
| | - T W P Janssen
- Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Rene J Huster
- Multimodal imaging and Cognitive Control Lab, Department of Psychology, University of Olso, Norway
| | - Kerstin Hoedlmoser
- University of Salzburg, Centre for Cognitive Neuroscience and Department of Psychology, Salzburg, Austria
| | | | - Stephan Heunis
- Electrical Engineering Department, Eindhoven University of Technology, The Netherlands
| | - Talma Hendler
- Sagol Brain Institute, Wohl Institute for Advanced Imaging, Sourasky Medical Center, Tel Aviv, Israel
| | - Michelle Hampson
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT, USA
| | - Adrian G Guggisberg
- Division of Neurorehabilitation, Department of Clinical Neurosciences, University Hospital Geneva, Geneva, Switzerland
| | - Robert Guggenberger
- Division of Functional and Restorative Neurosurgery, University of Tübingen, Tübingen, Germany
| | - John H Gruzelier
- Department of Psychology, Goldsmiths, University of London, London, UK
| | - Rainer W Göbel
- Department of Cognitive Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Nicolas Gninenko
- Institute of Bioengineering, Center for Neuroprosthetics, École Polytechnique Fédérale de Lausanne (EPFL); Campus Biotech, Geneva, Switzerland
| | - Alireza Gharabaghi
- Division of Functional and Restorative Neurosurgery, University of Tübingen, Tübingen, Germany
| | - Paul Frewen
- Department of Psychiatry, Western University, London, Ontario, Canada
| | - Thomas Fovet
- Univ. Lille, INSERM U1172, CHU LILLE, Centre Lille Neuroscience & Cognition, Pôle de Psychiatrie, F-59000, Lille, France
| | - Thalía Fernández
- UNAM Institute of Neurobiology, National Autonomous University of Mexico, Juriquilla, Mexico
| | | | - Ann-Christine Ehlis
- Psychophysiology and Optical Imaging, Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany
| | - Renate Drechsler
- Department of Child and Adolescent, Psychiatry and Psychotherapy, Psychiatric Hospital, University of Zürich, Zürich, Switzerland
| | | | - Stefan Debener
- Neuropsychology Lab, Department of Psychology, University of Oldenburg, Oldenberg, Germany
| | - Dirk De Ridder
- Department of Surgery, Section of Neurosurgery, University of Otago, Dunedin, New Zealand
| | - Eddy J Davelaar
- Department of Psychological Sciences Birkbeck, University of London, Bloomsbury, London, UK
| | - Marco Congedo
- GIPSA-lab, CNRS, University Grenoble Alpes, Grenoble-INP, Grenoble, France
| | - Marc Cavazza
- School of Computing and Mathematical Sciences, University of Greenwich, London, UK
| | - Marinus H M Breteler
- Radboud University Nijmegen, Department of Clinical Psychology, Nijmegen, The Netherlands
| | - Daniel Brandeis
- Department of Child and Adolescent, Psychiatry and Psychotherapy, Psychiatric Hospital, University of Zürich, Zürich, Switzerland
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - Jerzy Bodurka
- Laureate Institute for Brain Research, Tulsa, OK, USA
| | - Niels Birbaumer
- Institute for Medical Psychology and Behavioural Neurobiology, University of Tübingen, Tübingen, Germany
| | - Olga M Bazanova
- State Research Institute of Physiology and Basic Medicine, Novosibirsk, Russia
| | - Beatrix Barth
- Psychophysiology and Optical Imaging, Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany
| | | | - Tibor Auer
- School of Psychology, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
| | - Martijn Arns
- Brainclinics Foundation, Research Institute Brainclinics, Nijmegen, The Netherlands
| | - Robert T Thibault
- School of Psychological Science, University of Bristol, Bristol, UK
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, UK
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Keune PM, Hansen S, Sauder T, Jaruszowic S, Kehm C, Keune J, Weber E, Schönenberg M, Oschmann P. Frontal brain activity and cognitive processing speed in multiple sclerosis: An exploration of EEG neurofeedback training. NEUROIMAGE-CLINICAL 2019; 22:101716. [PMID: 30798167 PMCID: PMC6384325 DOI: 10.1016/j.nicl.2019.101716] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 01/22/2019] [Accepted: 02/10/2019] [Indexed: 12/20/2022]
Abstract
Background Cognitive deficits including impaired information processing speed as assessed by the Symbol Digit Modalities Test (SDMT) are common in multiple sclerosis (MS). Oscillatory markers of processing speed may be extracted from magnetoencephalographic (MEG) and electroencephalographic (EEG) resting-state recordings. In this context, an increased proportion of frontal slow-wave (theta, 4–8 Hz) to fast-wave (beta, 13–30 Hz) EEG activity was indicative of impaired SDMT performance. Such an increased theta/beta ratio may reflect oscillatory slowing associated with deficits in attention control. Therapeutic approaches that consider atypical oscillatory activity in MS remain sparse. Objectives In a cross-sectional design, we examined the relation between SDMT performance, the EEG theta/beta ratio and its components. We also explored longitudinally, whether EEG neurofeedback could be used to induce a putatively adaptive alteration in these EEG parameters, toward a pattern indicative of improved processing speed. Methods N = 58 MS patients (RRMS/SPMS/PPMS N: 18/35/3, 2 cases excluded) participated in a neuropsychological examination and a resting-state EEG recording. Subsequently, N = 10 patients received neurofeedback training for two weeks in a hospitalized setting. The purpose was to reduce the frontal theta/beta ratio through operant conditioning. Results In the cross-sectional examination, patients with slow SDMT speed displayed an increased theta/beta ratio, relative to those with normal speed. This involved increased frontal theta power, whereas beta power was equal across groups. The theta/beta ratio remained stable during neurofeedback across sessions of the two-week training period. In an exploratory secondary analysis, within sessions a reduction in the theta/beta ratio during active training blocks relative pre/post session resting-states was observed, driven by reduced theta power. Conclusions These findings provide support for utilizing frontal EEG theta activity as an inverse marker of processing speed in MS. Across sessions, there was no support for successful operant conditioning of the theta/beta ratio during the two-week training period. The observed state-specific shift within sessions, involving a transient reduction in theta activity, nevertheless may provide a rationale for a further investigation of neurofeedback as a treatment approach in MS. Frontal EEG slow-wave/fast-wave activity (theta/beta ratio) was increased in MS patients with slow cognitive processing speed The association involved a significant increase in theta activity, while beta did not vary with processing speed The frontal theta/beta ratio remained stable across sessions during a neurofeedback intervention Within sessions the theta/beta ratio was reduced during active training, relative to rest, driven by reduced theta activity Frontal theta may be a marker of processing speed and a further exploration of neurofeedback training may be feasible in MS
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Affiliation(s)
- Philipp M Keune
- Department of Neurology, Klinikum Bayreuth GmbH, Bayreuth, Germany; Department of Physiological Psychology, University of Bamberg, Germany.
| | - Sascha Hansen
- Department of Neurology, Klinikum Bayreuth GmbH, Bayreuth, Germany; Department of Physiological Psychology, University of Bamberg, Germany
| | - Torsten Sauder
- Department of Neurology, Klinikum Bayreuth GmbH, Bayreuth, Germany
| | - Sonja Jaruszowic
- Department of Neurology, Klinikum Bayreuth GmbH, Bayreuth, Germany; Department of Physiological Psychology, University of Bamberg, Germany
| | - Christina Kehm
- Department of Physiological Psychology, University of Bamberg, Germany
| | - Jana Keune
- Department of Neurology, Klinikum Bayreuth GmbH, Bayreuth, Germany
| | - Emily Weber
- Department of Neurology, Klinikum Bayreuth GmbH, Bayreuth, Germany
| | | | - Patrick Oschmann
- Department of Neurology, Klinikum Bayreuth GmbH, Bayreuth, Germany
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