Neurofeedback

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Neurofeedback session

List of Neurofeedback devices:

Neurofeedback (NF) stems from electroencephalography (EEG), the method of measure brain activity. Neurofeedback (also called 'EEG biofeedback' or 'brain–computer interface training') consists in providing its user information about his or her cortical activity, especially the frequency of brain waves, in an understandable way. It is supposed that the information allows him or her to change undesirable frequencies and improve his or her mental state in this way.[1] It is used as a treatment of anxiety, attention deficit hyperactivity disorder (ADHD) or for an improvement of user's mood. However, the efficacy of the therapy was not convincingly proved yet.[2]

Main Characteristics

Neurofeedback is a method in which participants learn how to influence electrical activity of their brains.[3] It is a part of biofeedback technique. Biofeedback consists in measuring different body features as temperature, blood pressure or heart rate, and teach participants to control their body processes by this knowledge. Neurofeedback focuses on the brain activity, which is measured by EEG.[4]

The activity is measured by electrodes. The activity is displayed in a form of brain waves. The brain waves differ in frequencies. There are four basic groups of frequencies: beta (more than 13 Hz), alpha (8 - 13 Hz), theta (4 - 8 Hz), and delta (0.5 - 4 Hz). EEG can diagnose brain death, coma, seizure, sleep disorder or alertness.[5] The aim of neurofeedback is to measure the brain activity and give a user a feedback if there are certain wrong patterns. The device delivers visual, auditive or audio-visual information which help users of neurofeedback devices to know, if they reduce the undesirable brain activity and increase the desirable one.[1]

The neurofeedback is used in medical clinics to treat ADHD epilepsy, autism, or insomnia. The treatment is, however, still experimental. The efficacy of neurofeedback has not been convincingly proven yet. There are also various non-medical clinics, which provide neurofeedback. They promised their customers reduction of certain disorders as anxiety, anger, an improvement of mood or an enhancement of cognitive skills as memory, attention, creativity, or intelligence.[6] There could be also purchased device for using neurofeedback at home.[7]

Biofeedback Music Instrument, a neurofeedback device from 1974

Purpose

Neurofeedback is a method used to treat neuropsychiatric disorders, by teaching users how to regulate brain activity. The mothod has also potential to enhance certain cognitive skills.

Historical overview

The history of a measurement of an electrical activity of a brain began in 1875 when Richard Caton discovered that there is an electrical activity in a brain.[5] The measurement of this activity, electroencephalography (EEG) was introduced by Hans Berger between 1929 and 1938 in several papers.[8] Neurofeedback as a treatment was developed in 60s and 70s, while the research on this method was conducted primarily by the U.S. researchers. The subjects of the research were firstly cats but the researchers began the trials with human subjects soon after the introduction of the method. Neurofeedback was used for a therapeutic treatment as a reduction of seizures.[9] In 1969, Joe Kamiya claimed in an article that healthy individuals might benefit from using neurofeedback as an enhancement.[1] Joel Lubar treated a child with hyperkinetic syndrome by neurofeedback in 1976 and described a reduction of hyperactivity and distractibility in his paper based on the results of the research.[10] Lubar's study is considered the first study on the effects of neurofeedback in ADHD.[11]

Important Dates

  • 1875: Richard Caton discovered electrical activity in brain of animals[5]
  • 1929-1934: Hans Berger described the measurement by a EEG device[8]
  • 1960-1970: the development of neurofeedback as a treatment of seizures[9]
  • 1969: J. Kamiya claimed that neurofeedback could be used as an enhancement by healthy inviduals[1]
  • 1976: Joel Lubar used neurofeedback as a treatment of children suffering with ADHD[11]

Enhancement/Therapy/Treatment

Neurofeedback session

Neurofeedback was used as a treatment of several disorders as addiction, anxiety, autism, depression, migraine, insomnia or post-traumatic stress disorder (PTSD).[12] However, the majority of research was focused on the treatment of ADHD.

Attention Deficit Hyperactivity Disorder

Attention deficit hyperactivity disorder (ADHD) is a mental disorder, which symptoms usually appears early in the ages from 3 to 6. The disorder is characterised by inattention, hyperactivity and impulsivity. Certain patients suffer only one symptom from three previously mentioned, but the combined type is more common, especially among children. The disorder could persist during adolescence and adulthood, but its symptoms could also change. There are more male than female suffering ADHD.[13]

Among other treatments, neurofeedback was investigated as a possible treatment of ADHD. The treatment focuses of reduction of theta brain waves and increase of beta brainwaves.[14] Several studies were conducted, which claimed that there is a significant improvement of ADHD patients that had been treated by neurofeedback.[15] [16] However, the meta-analysis which Cortese and his colleagues publish in 2016 point out that the majority of studies which claimed the efficacy of neurofeedback were not blinded. If the double-blinded studies are taken into account the efficacy of neurofeedback is not conclusive.[2] To sum up, more double-blinded studies are needed to decide convincingly if neurofeedback is beneficial for patients suffering from ADHD or not.

Cognitive enhancement

It is deemed that neurofeedback could also improve alertness, meditation practise and lessen anxiety.[17] This positive impact has not, however, conclusively been proved yet, therefore certain psychologists are more reserved about benefits of neurofeedback.[18] In addition, there is no consensus how the NF session should be designed in order to increase the benefits.[1]

The wearable devices which are currently available are focused primarily on the improvement of meditation as Muse or Melomind. There are also devices which should improve concentration as Mindset, Hit The Gold, or Brainno, reduce the level of stress as 4DForce or improve the working memory as Melon.

Ethical & Health Issues

A woman using 4DForce

The main issue linked with neurofeedback is the fact that the efficacy of the method has not yet been conclusively proved,[2] as was discussed in a previous section. Therefore the preference of this treatment over the currently approved treatments could be controversial, especially with respect to the fact that the neurofeedback sessions are quite expensive. If a NF treatment is preferred at the expense of a treatment that is proved to be effective, it could also possibly badly affected patient's condition.[19]

Another issue is linked primarily with consumer neurofeedback devices. Namely, these devices has to struggle is the accuracy of their measurement. First, the signal from the brain could be mingled with electric signal which was produced by a different part of body. Second, the consumer NF devices used dry electrodes, which are less reliable that wet electrodes used in the clinics, since the wet increases the conductivity.[20] Third, there is considerably less electrodes and amplifiers in the consumer devices than in the devices used in medical trials, which could also influence accuracy of the devices. Fourth, the interpretation of the results should be done by experts. The layman could misinterpret results he or she acquires from the device.[7]

Although neurofeedback is considered to be not as invasive as other methods of brain stimulation, certain side effects of it were reported. It could cause headache, muscle twitches, tics, mental fogginess, sleep disturbance, fatigue, anxiety or irritability. There is also risk that a long-term NF training might lead to a permanent microstructural changes in grey- and white-matter of a brain.[6]

Public & Media Impact and Presentation

A man wearing Brainno, a wearable consumer neurofeedback device
There are various comments and experiences in journals articles regarding neurofeedback. While Jini Reddy from The Sunday Times expresses her positive experience with neurofeedback sessions:
The results are astonishing. A day later, the mind chatter that rolls like a look in my head – the what ifs, the worries – simply disappears. It’s as if someone has turned down a radio blaring in the background. A few more sessions and I have voluntarily stopped mainlining chocolate. Seriously, I think, this stuff ought to be on the NHS.[17]
Winston Ross from Newsweek points out that neurofeedback was developed as a NASA project:
It sounds like quackery, but it isn’t. Neurofeedback, which uses real-time displays of brain activity to teach the brain to self-regulate, is a technique neurologists have wielded since the 1960s. Back then, NASA was concerned about astronauts having rocket fuel–induced seizures. They approached Barry Sterman, a researcher at the University of California, Los Angeles, School of Medicine, for help.[21]
Katie Drummond form The Verge reports that there already are studies which confirm that neurofeedback could cause changes in participants' brains:
But more scrupulous studies are starting to happen, and the results are intriguing. In one newly published study, a team at the University of Montreal performed a trial of neurofeedback designed, for the first time, to look for changes in the structure of the brain following treatment. Over a span of 13 weeks, 15 patients underwent thrice-weekly neurofeedback sessions designed to enhance attention levels, while 15 others partook in sham sessions instead. Patients who received genuine neurofeedback experienced improvements in their visual and auditory attention levels, and — most notably — MRI scans revealed that the brains of those patients showed structural changes in regions linked to attention skills.[12]
However, she quotes also researcher that point out that this study was not double-blinded. Klint Finley includes the claim of Kerri Walsh, a user of Versus:
Still, many people, such as Walsh, swear by neurofeedback. Asked whether the Versus had improved her performance quantfiabily, she admitted she wasn't sure. "I'm not a stats person," she says. "I want to say 'yes,' but I don't have the numbers to back that up." But she does say it makes her feel better. At the very least, it gives her the sense that she can control her state of mind. "I think it's definitely improved my quality of life," she says.[19]
There are also skeptical or warning voices, however. Christian Jarrett from Psychology Today stressed that the science behind neurofeedback was already debunked by Barry Beyerstein:
Unfortunately, the logic is flawed, as the late psychologist and skeptic Barry Beyerstein explained in a series of essays and book chapters published in the 80s and 90s. Just because a meditator in a state of bliss exhibits high levels of alpha waves doesn’t mean those alpha waves are playing a causal role in her state of bliss. As Beyerstein wrote, the correlation no more implies “that alpha wave production can produce a meditative state than opening one’s umbrella can make it rain.”[18]
Katherine Ellison stresses that neurofeedback have certain drawbacks:
The procedure is controversial, expensive and time-consuming. An average course of treatment, with at least 30 sessions, can cost $3,000 or more, and few health insurers will pay for it. Still, it appears to be growing in popularity.[9]
Jonathan Jones from UK National Elf Service concluded to the effect of neurofeedback on ADHD:
  • The findings from this meta-analysis suggest that neurofeedback cannot currently be recommended as a treatment for children with ADHD.
  • Future research should investigate the mechanisms of neurofeedback, factors that predict treatment response, long-term outcomes and implement standard neurofeedback protocols and sham control groups.[22]
Becca Caddy from Wareable quotes Dr Marina Papoutsi's claim:
"Back in the 60s and 70s biofeedback with EEG was quite popular, but was quickly associated with claims that had not been experimentally proven. Biofeedback devices would be used in holistic therapy and it was presented as the cure to almost everything. Admittedly this gave biofeedback and neurofeedback a "bad" name in scientific circles and research into more of these methods almost stopped. I think this is where we can learn from history and make sure that any claims made by commercially available systems are backed up with proper scientific evidence. Companies should provide such information."[7]

Public Policy

Hannah Maslen and her colleagues point out that there is a regulatory gap concerning brain stimulation devices, which are used for cognitive enhancement. They suggest that these devices should be regulated as medical devices.[6]

Biofeedback units (to which belong also neurofeedback devices) are classified as Class II. devices by the Food and Drug Administration (FDA) in the U.S. It means that they require pre-market approval before their shipping in the U.S.[23]

Related Technologies, Projects, or Scientific Research

ADHD could be also treated with medication, psychotherapy, or education and training.[13]

References

  1. 1.0 1.1 1.2 1.3 1.4 VERNON, D. et al. Alpha Neurofeedback Training for Performance Enhancement: Reviewing the Methodology. Journal of Neurotherapy: Investigations in Neuromodulation, Neurofeedback and Applied Neuroscience, 13(4), 2009, pp. 214-227, Doi: 10.1080/10874200903334397 Available online at: http://www.isnr-jnt.org/article/view/16632 (Retrieved 1st August, 2017).
  2. 2.0 2.1 2.2 CORTESE, Samuele et al. Neurofeedback for Attention-Deficit/Hyperactivity Disorder: Meta-Analysis of Clinical and Neuropsychological Outcomes From Randomized Controlled Trials. Journal of the American Academy of Child & Adolescent Psychiatry, 55(6), 2016, pp. 444-455, Doi: 10.1016/j.jaac.2016.03.007 Available online at: http://www.sciencedirect.com/science/article/pii/S0890856716300958?via%3Dihub (Retrieved 1st August, 2017).
  3. VERNON, D. et al. The effect of training distinct neurofeedback protocols on aspects of cognitive performance. International Journal of Psychophysiology. 2003, 47(1), pp. 75-85. Doi: 10.1016/S0167-8760(02)00091-0 Available online at: http://www.sciencedirect.com/science/article/pii/S0167876002000910?via%3Dihub (Retrieved 2nd August, 2017).
  4. ROBERTS STOLER, Diane. What is Neurofeedback? Dr. Diane Brain Health [online]. Available online at: http://www.drdiane.com/treatments/neurofeedback/ (Retrieved 2nd August, 2017).
  5. 5.0 5.1 5.2 TEPLAN, M. Fundamentals of EEG measurement. Measurement Science Review, 2002, 2(2), Available online at: http://www.edumed.org.br/cursos/neurociencia/MethodsEEGMeasurement.pdf (Retrieved 3rd August, 2017).
  6. 6.0 6.1 6.2 MASLEN, Hannah et al. The regulation of cognitive enhancement devices: extending the medical model. Journal of Law and the Biosciences [online]. 2004, Mar. Doi:10.1093/jlb/lst003 Available online at: http://jlb.oxfordjournals.org/content/1/1/68.full (Retrieved 7th December, 2016).
  7. 7.0 7.1 7.2 CADDY, Becca. How mind reading wearables let us delve inside our brains. Wareable [online]. 2016, Jan 26. Available online at: https://www.wareable.com/wearable-tech/looking-inside-the-brain-2219 (Retrieved 3rd August, 2017).
  8. 8.0 8.1 KAISER, David A. Basic Principles of Quantitative EEG. Journal of Adult Development, 12(2/3), August 2005. Doi: 10.1007/s10804-005-7025-9 Available online at: https://link.springer.com/article/10.1007%2Fs10804-005-7025-9 (Retrieved 1st August, 2017).
  9. 9.0 9.1 9.2 ELLISON, Katherine. Neurofeedback Gains Popularity and Lab Attention. The New York Times [online]. 2010, Oct 4. Available online at: http://www.nytimes.com/2010/10/05/health/05neurofeedback.html (Retrieved 1st August, 2017).
  10. LUBAR, Joel F, SHOUSE, Margaret N. EEG and behavioral changes in a hyperkinetic child concurrent with training of the sensorimotor rhythm (SMR), Biofeedback and Self-regulation, 1976, 1(3), pp. 293–306. Available online at: http://neurofeedbackclinic.ca/journals/ADHD_ADD/adhd05.pdf (Retrieved 1st August, 2017).
  11. 11.0 11.1 ARNS, Martijn, HEINRICH, Hartmut, STREHL, Ute. Evaluation of neurofeedback in ADHD: The long and winding road. Biological Psychology, 2014, 95, pp. 108-115. Doi: 10.1016/j.biopsycho.2013.11.013 Available online at: http://www.sciencedirect.com/science/article/pii/S0301051113002469#bib0260 (Retrieved 1st August, 2017).
  12. 12.0 12.1 DRUMMOND, Katie. I think, therefore I heal: the weird science of neurofeedback. The Verge [online]. 2013, Apr 18. Available online at: https://www.theverge.com/2013/4/18/4226506/can-you-train-your-brain-to-heal-your-health (Retrieved 3rd August, 2017).
  13. 13.0 13.1 The National Institute of Mental Health. Attention Deficit Hyperactivity Disorder. The National Institute of Mental Health [online]. Available online at: https://www.nimh.nih.gov/health/topics/attention-deficit-hyperactivity-disorder-adhd/index.shtml (Retrieved 4th August, 2017).
  14. GEVENSLEBEN, H., HOLL, B., ALBRECHT, B. et al. Neurofeedback training in children with ADHD: 6-month follow-up of a randomised controlled trial. European Child & Adolescent Psychiatry. 2010, 19(9), pp. 715–724. Doi: 10.1007/s00787-010-0109-5 Available online at: https://link.springer.com/article/10.1007/s00787-010-0109-5 (Retrieved 4th August, 2017).
  15. DRESCHLER, R., STRAUB M., DOEHNERT M., et al. Controlled evaluation of a neurofeedback training of slow cortical potentials in children with attention-deficit/hyperactivity disorder (ADHD), Behavioral and Brain Functions. 2007, 35(3). Doi: 10.1186/1744-9081-3-352007. Available online at: https://behavioralandbrainfunctions.biomedcentral.com/articles/10.1186/1744-9081-3-35 (Retrieved 4th August, 2017).
  16. FUCHS, T., BIRBAUMER, N., LUTZENBERGER, W. et al. Neurofeedback Treatment for Attention-Deficit/Hyperactivity Disorder in Children: A Comparison with Methylphenidate. Applied Psychophysiology and Biofeedback. 2003, 28(1), pp. 1–12. Doi: 10.1023/A:1022353731579 Available online at: https://link.springer.com/article/10.1023%2FA%3A1022353731579 (Retrieved 4th August, 2017).
  17. 17.0 17.1 REDDY, Jini. The real brain wave. The Sunday Times [online]. 2013, Jan 27. Available online at: https://www.thetimes.co.uk/article/the-real-brain-wave-qsdf265b00s (Retrieved 4th August, 2017).
  18. 18.0 18.1 JARRETT, Christian. Read this before paying $100s for neurofeedback therapy. Psychology Today [online]. 2013. Feb 18. Available online at: https://www.psychologytoday.com/blog/brain-myths/201302/read-paying-100s-neurofeedback-therapy-0 (Retrieved 4th August, 2017).
  19. 19.0 19.1 FINLEY, Klint. The Internet of Anything: Brain Monitors Are Going Mainstream, Despite Skepticism. Wired [online]. 2015, May 5. Available online at: https://www.wired.com/2015/05/internet-anything-brain-monitors-going-mainstream-despite-skepticism/ (Retrieved 4th August, 2017)
  20. CHEN, Angela. Can headphones train you to focus better?: Maybe not. The Verge [online]. 2017, Mar 3. Available online at: https://www.theverge.com/2017/3/3/14802936/mindset-headphones-neurofeedback-eeg-attention-focus-brain-training (Retrieved 3rd August, 2017).
  21. ROSS, Winston. Rewiring Your Brain: Neurofeedback Goes Mainstream. Newsweek [online]. 2016, May 9. Available online at: http://www.newsweek.com/2016/05/20/neurofeedback-brain-regulation-neuroscience-457492.html (Retrieved 3rd August, 2017).
  22. JONES, Jonathan. Neurofeedback for ADHD in children. National Elf Service [online]. 2016, Jul 25. Available online at: https://www.nationalelfservice.net/mental-health/adhd/neurofeedback-for-adhd-in-children/ (Retrieved 11th August, 2017).
  23. STRIEFEL, Sebastian. Potential FDA Regulation of Biofeedback. Association for Applied Psychophysiology and Biofeedback [online]. Available online at: https://www.aapb.org/i4a/pages/index.cfm?pageID=3339 (Retrieved 3rd August, 2017).