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===Non-medical===
===Non-medical===
In addition to a variety of medical applications, neurofeedback has been investigated as a way to increase athletic performance in sports. The demands placed on the brain differ according to which sport is being played and research in sports psychology has begun to examine the various brainwave patterns associated with different types of peak performance.<ref name=Hammond>{{cite journal|last=Hammond|first=D. Corydon|title=Neurofeedback to improve physical balance, incontinence, and swallowing|journal=Journal of Neurotherapy|year=2005|volume=9|issue=1|pages=27–36|doi=10.1300/J184v09n01_03|url=http://www.tandfonline.com/doi/pdf/10.1300/J184v09n01_03}}</ref> In marksmanship, experienced marksmen exhibited less [[Electroencephalography|EEG activity]] (i.e., increased [[Alpha wave|alpha]] and decreased [[beta wave|beta]] and [[gamma wave]]s) at all sites while aiming when compared with novice shooters. This is consistent with the notion that skilled marksmen require less cortical effort to process the relevant information required to successfully aim at a target.<ref>{{cite journal|last=Haufler|first=Amy J.|coauthors=Spalding, Thomas W.; Santa Maria, D.L.; Hatfield, Bradley D.|title=Neuro-cognitive activity during a self-paced visuospatial task: comparative EEG profiles in marksmen and novice shooters|journal=Biological Psychology|date=1 July 2000|volume=53|issue=2-3|pages=131–160|doi=10.1016/S0301-0511(00)00047-8|url=http://ac.els-cdn.com/S0301051100000478/1-s2.0-S0301051100000478-main.pdf?_tid=086cc7c8-cdf3-11e2-94fe-00000aacb360&acdnat=1370445629_be175eca5ba310f29188b6f67ee2a875}}</ref> Neurofeedback used to increase alpha activity and enhance concentration while minimizing distraction may prove useful in sports that require careful aiming such as marksmanship, archery, and golf. However, athletes in different sports may need neurofeedback to decrease alpha activity in order to produce a different kind of concentration or arousal required for peak performance. Research has demonstrated that the wrong type of neurofeedback can also decrease performance and thus a one-size-fits-all solution can’t be applied indiscriminately across all varieties of sports.<ref name=Hammond/><ref>{{cite journal|last=Landers|first=D.M.|coauthors=Han, M.; Salazar, W.; & Petruzzello, S.J.|title=Effects of learning on electroencephalographic and electrocardiographic patterns in novice archers|journal=International Journal of Sport Psychology|year=1994|volume=25|issue=3|pages=313–330}}</ref>

The applications of neurofeedback to enhance performance extend to the arts in fields such as music, dance, and acting. A study with conservatoire musicians found that [[alpha wave|alpha-theta]] training benefitted the three music domains of [[musicality]], communication, and technique.<ref>{{cite journal|last=Egner|first=Tobias|coauthors=Gruzelier, John H|title=Ecological validity of neurofeedback|journal=NeuroReport|date=1 July 2003|volume=14|issue=9|pages=1221–1224|doi=10.1097/00001756-200307010-00006|url=http://www.brainwavevirtuosity.com/pdf/musical_performance.pdf}}</ref> Historically, alpha-theta training, a form of neurofeedback, was created to assist creativity by inducing [[hypnagogia]], a “borderline waking state associated with creative insights”, through facilitation of neural connectivity.<ref name=Gruzelier>{{cite journal|last=Gruzelier|first=John|title=Neurofeedback and the performing arts|journal=Neuroscience Letters|date=1 July 2011|volume=500|pages=e15|doi=10.1016/j.neulet.2011.05.106|url=http://www.deepdyve.com/lp/elsevier/neurofeedback-and-the-performing-arts-5CUVl0oHyT}}</ref> Alpha-theta training has also been shown to improve novice singing in children. Alpha-theta neurofeedback, in conjunction with [[heart rate variability|heart rate variability training]], a form of [[biofeedback]], has also produced benefits in dance by enhancing performance in competitive ballroom dancing and increasing cognitive creativity in contemporary dancers. Additionally, neurofeedback has also been shown to instil a superior [[flow (psychology)|flow state]] in actors, possibly due to greater immersion while performing.<ref name=Gruzelier/>
The applications of neurofeedback to enhance performance extend to the arts in fields such as music, dance, and acting. A study with conservatoire musicians found that [[alpha wave|alpha-theta]] training benefitted the three music domains of [[musicality]], communication, and technique.<ref>{{cite journal|last=Egner|first=Tobias|coauthors=Gruzelier, John H|title=Ecological validity of neurofeedback|journal=NeuroReport|date=1 July 2003|volume=14|issue=9|pages=1221–1224|doi=10.1097/00001756-200307010-00006|url=http://www.brainwavevirtuosity.com/pdf/musical_performance.pdf}}</ref> Historically, alpha-theta training, a form of neurofeedback, was created to assist creativity by inducing [[hypnagogia]], a “borderline waking state associated with creative insights”, through facilitation of neural connectivity.<ref name=Gruzelier>{{cite journal|last=Gruzelier|first=John|title=Neurofeedback and the performing arts|journal=Neuroscience Letters|date=1 July 2011|volume=500|pages=e15|doi=10.1016/j.neulet.2011.05.106|url=http://www.deepdyve.com/lp/elsevier/neurofeedback-and-the-performing-arts-5CUVl0oHyT}}</ref> Alpha-theta training has also been shown to improve novice singing in children. Alpha-theta neurofeedback, in conjunction with [[heart rate variability|heart rate variability training]], a form of [[biofeedback]], has also produced benefits in dance by enhancing performance in competitive ballroom dancing and increasing cognitive creativity in contemporary dancers. Additionally, neurofeedback has also been shown to instil a superior [[flow (psychology)|flow state]] in actors, possibly due to greater immersion while performing.<ref name=Gruzelier/>


Revision as of 20:31, 18 July 2013

Software real time data of neurofeedback training.

Neurofeedback (NFB), also called neurotherapy or neurobiofeedback, is a type of biofeedback that uses realtime displays of electroencephalography (EEG) or hemoencephalography (HEG) to illustrate brain activity and teach self-regulation. EEG neurofeedback uses sensors that are placed on the scalp to measure brain waves, while HEG neurofeedback uses infrared (IR) sensors or functional magnetic resonance imaging (fMRI) to measure brain blood flow.


Definition

Neurofeedback is a type of biofeedback that measures brain waves or brain blood flow to produce a signal that can be used as feedback on brain activity to teach self-regulation. Feedback is commonly provided using video or sound, with positive feedback for desired brain activity and negative feedback for brain activity that is undesirable.

Related technologies include hemoencephalography biofeedback (HEG).

Uses

ADHD

Research into neurofeedback has been limited and of low quality.[1] While there is some indication on the effectiveness of biofeedback for ADHD it is not conclusive: several studies have yielded positive results, however the best designed ones have either shown reduced effects or non-existing ones.[1][2] No serious adverse side effects from neurofeedback have been reported.[1]

QEEG has been used to develop EEG models of ADHD. According to this model, persons with ADHD often have too many slow theta brain waves (associated with relaxation) and not enough fast beta wave activity (associated with mental focus).[3] Neurofeedback therapies for ADHD generally attempt to increase the production of beta waves and decrease the number of slower brain waves. This can be accomplished by allowing the patient to view their levels of brain waves on a screen and attempt to alter them, or by integrating brain waves into a video game.[citation needed]

Some ADHD researchers were unconvinced by the early studies, including Russell Barkley. Barkley and Loo [4] reviewed the available literature in 2005 on neurotherapy's effectiveness in treating ADHD and concluded that most early studies were uncontrolled case studies, did not use blinded methods to insure that those involved in the investigation were not aware of treatment assignments in order to rule out the placebo effect.

Better subsequent studies of this treatment for ADHD have now been published. These more recent studies along with any early ones using appropriate scientific methods were reviewed concluding that neurofeedback was probably efficacious but that the available evidence was hardly conclusive.[5][6] However, another meta-analysis, which included many of the earlier poorly controlled studies found a larger magnitude of treatment effects.[7]

Further research on the benefits of neurofeedback for ADHD is warranted given this history of mixed results. Future research on this treatment needs to employ appropriate sham neurofeedback or other attention-placebo control groups, double-blinded procedures and measures of ADHD collected both in school and at home to better evaluate the efficacy of this treatment for ADHD.

Other medical uses

Anecdotal research shows neurofeedback may be an effective intervention for a range of brain-related conditions. It has been used for addiction,[8] ADHD,[9] aggression, anxiety, autism,[10] depression,[11] epilepsy,[12] headaches,[13] insomnia,[14] Tourette syndrome,[15] and brain damage from stroke,[16] TBI,[17] and other causes.

Non-medical

The applications of neurofeedback to enhance performance extend to the arts in fields such as music, dance, and acting. A study with conservatoire musicians found that alpha-theta training benefitted the three music domains of musicality, communication, and technique.[18] Historically, alpha-theta training, a form of neurofeedback, was created to assist creativity by inducing hypnagogia, a “borderline waking state associated with creative insights”, through facilitation of neural connectivity.[19] Alpha-theta training has also been shown to improve novice singing in children. Alpha-theta neurofeedback, in conjunction with heart rate variability training, a form of biofeedback, has also produced benefits in dance by enhancing performance in competitive ballroom dancing and increasing cognitive creativity in contemporary dancers. Additionally, neurofeedback has also been shown to instil a superior flow state in actors, possibly due to greater immersion while performing.[19]

History and application

In 1924, the German psychiatrist Hans Berger connected a couple of electrodes (small round discs of metal) to a patient's scalp and detected a small current by using a ballistic galvanometer. During the years 1929-1938 he published 14 reports about his studies of EEGs, and much of our modern knowledge of the subject, especially in the middle frequencies, is due to his research.[20] Berger analyzed EEGs qualitatively, but in 1932 G. Dietsch applied Fourier analysis to seven records of EEG and became the first researcher of what later is called QEEG (quantitative EEG).[20]

Later, Joe Kamiya popularized neurofeedback in the 1960s when an article[21] about the alpha brain wave experiments he had been conducting was published in Psychology Today in 1968. Kamiya’s experiment had two parts. In the first part, a subject was asked to keep his eyes closed and when a tone sounded to say whether he thought he was in alpha. He was then told whether he was correct or wrong. Initially the subject would get about fifty percent correct, but some subjects would eventually develop the ability to distinguish between states and be correct a highly significant percentage of the time.[22] In the second part of the study, subjects were asked to go into alpha when a bell rang once and not go into the state when the bell rang twice. Once again some subjects were able to enter the state on command. Others, however, could not control it at all. Nevertheless, the results were significant and very attractive. Alpha states were connected with relaxation, and alpha training had the possibility to alleviate stress and stress-related conditions.

Despite these highly dramatic claims, the universal correlation of high alpha density to a subjective experience of calm cannot be assumed. Alpha states do not seem to have the universal stress-alleviating power indicated by early observations.[23] At one point, Martin Orne and others challenged the claim that alpha biofeedback actually involved the training of an individual to voluntarily regulate brainwave activity.[24] James Hardt and Joe Kamiya, then at UC San Francisco's Langley Porter Neuropsychiatric Institute published a paper,[25] demonstrating the efficacy of EEG biofeedback training, and that it was not just related to visuo/motor eyes open or closed factors.

In the late sixties and early seventies, Barbara Brown, one of the most effective popularizers of Biofeedback, wrote several books on biofeedback, making the public much more aware of the technology. The books included New Mind New Body, with a foreword from Hugh Downs, and Stress and the Art of Biofeedback. Brown took a creative approach to neurofeedback, linking brainwave self-regulation to a switching relay which turned on an electric train.

The work of Barry Sterman, Joel F. Lubar and others has indicated a high efficacy for beta training, involving the role of sensorimotor rhythmic EEG activity.[26] This training has been used in the treatment of epilepsy,[27][28] attention deficit disorder and hyperactive disorder,.[29] The sensorimotor rhythm (SMR) is rhythmic activity between 12 and 16 hertz that can be recorded from an area near the sensorimotor cortex. SMR is found in waking states and is very similar if not identical to the sleep spindles that are recorded in the second stage of sleep.

For example Sterman has shown that both monkeys and cats who had undergone SMR training had elevated thresholds for the convulsant chemical monomethylhydrazine. These studies indicate that SMR is associated with an inhibitory process in the motor system and therefore increasing SMR through operant conditioning increases the ability to control seizures.[28]

Neuroimaging studies have correlated ADHD with abnormal functioning in the anterior cingulate cortex (ACC) during tasks involving selective attention. In 2006, Johanne Levesque et al. published results from their fMRI study showing normalization of ACC activation during a selective-attention task in ADHD subjects who had undergone neurofeedback training. Subjects in the study were randomly assigned to either the neurofeedback treatment group or a no-treatment control group, and subjects from the latter showed no difference in ACC activation compared to their baseline.[30]

Within the last 5–10 years, neurofeedback has taken a new approach, in taking a second look at deep states. Alpha-theta training has been used in the treatment of alcoholism,[31] other addictions as well as anxiety.[32] This low frequency training differs greatly from the high frequency beta and SMR training that has been practiced for over thirty years and is reminiscent of the original alpha training of Elmer Green and Joe Kamiya. Beta and SMR training can be considered a more directly physiological approach, strengthening sensorimotor inhibition in the cortex and inhibiting alpha patterns, which slow metabolism. Alpha-theta training, however, derives from the psychotherapeutic model and involves accessing of painful or repressed memories through the alpha-theta state. The alpha-theta state is a term that comes from the representation on the EEG.

The most recent development in the field is a conceptual approach called the Coordinated Allocation of Resource Model (CAR) of brain functioning which states that specific cognitive abilities are a function of specific electrophysiological variables which can overlap across different cognitive tasks.[33] The activation database guided EEG biofeedback approach initially involves evaluating the subject on a number of academically relevant cognitive tasks and compares the subject's values on the QEEG measures to a normative database, in particular on the variables that are related to success at that task.

Organizations

The Association for Applied Psychophysiology and Biofeedback (AAPB) is a non-profit scientific and professional society for biofeedback and neurofeedback. The International Society for Neurofeedback and Research (ISNR) is a non-profit scientific and professional society for neurofeedback.[34] The Biofeedback Foundation of Europe (BFE) sponsors international education, training, and research activities in biofeedback and neurofeedback.

Certification

The Biofeedback Certification International Alliance (formerly the Biofeedback Certification Institute of America) is a non-profit organization that is a member of the Institute for Credentialing Excellence (ICE). BCIA certifies individuals who meet education and training standards in biofeedback and neurofeedback and progressively recertifies those who satisfy continuing education requirements. BCIA offers biofeedback certification, neurofeedback (also called EEG biofeedback) certification, and pelvic muscle dysfunction biofeedback certification. BCIA certification has been endorsed by the Mayo Clinic,[35] the Association for Applied Psychophysiology and Biofeedback (AAPB), the International Society for Neurofeedback and Research (ISNR), and the Washington State Legislature.[36]

The BCIA didactic education requirement includes a 36-hour course from a regionally-accredited academic institution or a BCIA-approved training program that covers the complete Neurofeedback Blueprint of Knowledge and study of human anatomy and physiology. The Neurofeedback Blueprint of Knowledge areas include: I. Orientation to Neurofeedback, II. Basic Neurophysiology and Neuroanatomy, III. Instrumentation and Electronics, IV. Research, V. Psychopharmalogical Considerations, VI. Treatment Planning, and VII. Professional Conduct.[37]

Applicants may demonstrate their knowledge of human anatomy and physiology by completing a course in biological psychology, human anatomy, human biology, human physiology, or neuroscience provided by a regionally-accredited academic institution or a BCIA-approved training program or by successfully completing an Anatomy and Physiology exam covering the organization of the human body and its systems.

Applicants must also document practical skills training that includes 25 contact hours supervised by a BCIA-approved mentor designed to them teach how to apply clinical biofeedback skills through self-regulation training, 100 patient/client sessions, and case conference presentations. Distance learning allows applicants to complete didactic course work over the internet. Distance mentoring trains candidates from their residence or office.[38] They must recertify every 4 years, complete 55 hours of continuing education (30 hours for Senior Fellows) during each review period or complete the written exam, and attest that their license/credential (or their supervisor’s license/credential) has not been suspended, investigated, or revoked.[39]

Neuroplasticity

In 2010, a study provided some evidence of neuroplastic changes occurring after brainwave training. Half an hour of voluntary control of brain rhythms led in this study to a lasting shift in cortical excitability and intracortical function.[40] The authors observed that the cortical response to transcranial magnetic stimulation (TMS) was significantly enhanced after neurofeedback, persisted for at least 20 minutes, and was correlated with an EEG time-course indicative of activity-dependent plasticity.[41]

See also

References

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  16. ^ Mihara M, Hattori N, Hatakenaka M, Yagura H, Kawano T, Hino T, Miyai I. (2013). "Near-infrared spectroscopy-mediated neurofeedback enhances efficacy of motor imagery-based training in poststroke victims: a pilot study". Stroke. 44 (4): 1091–1098. doi:10.1161/STROKEAHA.111.674507.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  17. ^ Thornton KE, Carmody DP. (208). "Efficacy of traumatic brain injury rehabilitation: interventions of QEEG-guided biofeedback, computers, strategies, and medications". Applied Psychophysiology and Biofeedback. 33 (2): 101–124. doi:10.1007/s10484-008-9056-z.
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  20. ^ a b Kaiser, David A. "Basic Principles of Quantitative EEG." Journal of Adult Development, Vol. 12, Nos. 2/3, August 2005
  21. ^ Kamiya, J. (1971). "Operant Control of the EEG Alpha Rhythm and Some of its Reported Effects on Consciousness". Biofeedback and Self-Control: an Aldine Reader on the Regulation of Bodily Processes and Consciousness.
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  25. ^ Hardt, J.V. (1976). "Conflicting results in EEG alpha feedback studies" (PDF). Applied Psychophysiology and Biofeedback. 1 (1): 63–75. Retrieved 2007-12-05. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
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  27. ^ Sterman, M.B. (1972). "Suppression of seizures in an epileptic following sensorimotor EEG feedback training". Electroencephalogr Clin Neurophysiol. 33 (1): 89–95. doi:10.1016/0013-4694(72)90028-4. PMID 4113278. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
  28. ^ a b Sterman, M.B. (2000). "Basic concepts and clinical findings in the treatment of seizure disorders with EEG operant conditioning". Clin Electroencephalogr. 31 (1): 45–55. PMID 10638352.
  29. ^ Lubar, J.F. (1995). "Evaluation of the effectiveness of EEG neurofeedback training for ADHD in a clinical setting as measured by changes in TOVA scores, behavioral ratings, and WISC-R performance" (PDF). Applied Psychophysiology and Biofeedback. 20 (1): 83–99. Retrieved 2007-12-05. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
  30. ^ Levesque, Johanne and Mario Beauregard. "Effect of neurofeedback training on the neural substrates of selective attention in children with attention-deficit/hyperactivity disorder: A functional magnetic resonance imaging study." Neuroscience Letters, 394, 216-221
  31. ^ http://www.neurofeedback-scotland.com/alpha-theta-brainwave.html
  32. ^ http://www.neurofeedback-scotland.com/anxiety-disorders.html
  33. ^ Thornton, K. & Carmody, D. Eyes-Closed and Activation QEEG Databases in Predicting Cognitive Effectiveness and the Inefficiency Hypothesis, Journal of Neurotherapy, 2009, (13) 1, 1-22
  34. ^ http://www.bfe.org/
  35. ^ Neblett, R., Shaffer, F., & Crawford, J. (2008). What is the value of Biofeedback Certification Institute of America certification? Biofeedback, 36(3), 92-94.
  36. ^ [1] Washington State Legislature WAC 296-21-280 Biofeedback Rules.
  37. ^ Gevirtz, R. (2003). The behavioral health provider in mind-body medicine. In D. Moss, A. McGrady, T. C. Davies, & I. Wickramasekera (Eds.). Handbook of mind-body medicine for primary care. Thousand Oaks, CA: Sage Publications, Inc.
  38. ^ De Bease, C. (2007). Biofeedback Certification Institute of America certification: Building skills without walls. Biofeedback, 35(2), 48-49.
  39. ^ Shaffer, F., & Schwartz, M. S. (in press). Entering the field and assuring competence. In M. S. Schwartz, & F. Andrasik (Eds.). Biofeedback: A practitioner's guide (4th ed.). New York: The Guilford Press.
  40. ^ Science Daily
  41. ^ Ros T. (2010). "Endogenous Control of Waking Brain Rhythms Induces Neuroplasticity in Humans". European Journal of Neuroscience. 31 (4): 770–778. doi:10.1111/j.1460-9568.2010.07100.x. PMID 20384819. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)

Further reading

  • Evans, J.R., and Abarbanel, A. An introduction to quantitative EEG and Neurofeedback. Academic Press: San Diego, 1999.
  • Steinberg, Mark, and Othmer, S. ADD: The 20-Hour Solution. Robert Reed Publishers: Bandon OR, 2004.
  • Hill PhD, Robert W. and Eduardo MD, C. Healing Young Brains: The Neurofeedback Solution. Hampton Roads Publishing; 1 edition (May 15, 2009).
  • Robbins, Jim "A Symphony in the Brain -- The Evolution of the New Brainwave Biofeedback." Grove Atlantic 1st Edition 2000; 2nd Edition 2008

Articles and research links:

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