Research and publications
Summary of research in the field:
Neurofeedback training for depression and mood disorders
Research tables and summary: by our trainer- Maria Vittoria Zulli
At an electrophysiological level, depression appears to be associated with a difference in alpha activity between the right and left prefrontal cortex, known as alpha asymmetry. Alpha activity is inversely correlated with brain activity; increased alpha waves indicate decreased activation in the corresponding brain area, while decreased alpha activity indicates an increase in brain activity (Choi et al., 2011). In cases of depression, there is typically more left prefrontal alpha activity than right prefrontal alpha activity, indicating less activation in the left frontal area (Bruder et al., 1997; Stewart et al., 2011).
The left frontal hemisphere is associated with more positive affect (emotions), motivation and memories (Stewart et el., 2011), while the right frontal hemisphere is more involved in negative emotions, withdrawal behaviour, and comorbid depression and anxiety (Mathersul et al., 2008). Because of the frontal alpha asymmetry observed in depression, individuals may be less aware of positive emotions while being more in touch with the negative emotions associated with the right hemisphere. Moreover, when the left hemisphere is ‘stuck’ in an alpha idling rhythm, there is a deficit in positive affect and an increase in withdrawal behaviour.
A literature review conducted by Dias and Deusen (2011) revealed that Alpha inter-hemispheric asymmetry and Theta/Beta ratio within the left prefrontal cortex were the most commonly used neurofeedback protocols for depression and had positive results during training.
Summary of research in the field:
Neurofeedback training for alleviating depression symptoms
The clinical use of an alpha asymmetry protocol in the neurofeedback treatment of depression: Two case studies.
Baehr, E., Rosenfeld, J. P., & Baehr, R. (1997)
In this study we are presenting case studies of two depressed women who were trained with more than 34 sessions each of EEG biofeedback (neurofeedback) using an Alpha Asymmetry protocol, the purpose of this training was to determine if depression could be alleviated when the subjects learned toincrease the activation of the left hemisphere and/ or decrease the activation of the right hemisphere.
The MMPI-2 Wasadministered before and after training to measure changes in personality factors, including depression.
The results suggest thatAlpha Asymmetry neurofeedback training may be an effective adjunct to psychotherapy in the treatment of certain types of mood disorders.
Clinical use of an alpha asymmetry neurofeedback protocol in the treatment of mood disorders: Follow-up study one to five years post therapy.
Baehr, E., Rosenfeld, J. P., & Baehr, R. (2001)
Background: This studyreports on three of six patients who have completed an average of 27 neurofeedback sessions using a patented alpha asymmetry protocol for the treatment of depression.
Method: The follow-up data, from one to five years post therapy, werederived from a single session re-test using the same alpha asymmetry protocol and the Beck Depression Inventory.
Results: Thethree patients originally diagnosed as having unipolar depression reached the training criteria for the non-depressed range by the end of their initial training, and they have maintained their normal scores for right hemisphere alpha asymmetry training over time.The follow-up Beck Depression Inventory scores were also within the normal range.
Discussion: This finding is contrary to the previously held demonstrations by Davidson and Henriques regarding the stability of decreased left anterior cortical activation in remitted depression. While some patients have reported mood changes with life's vicissitudes, none have experienced clinicaldepression since they have terminated therapy.
Is alpha wave neurofeedback effective with randomized clinical trials in depression? A pilot study.
Choi SW, Chi SE, Chung SY, Kim JW, Ahn CY, Kim HT. (2011)
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 frontalalpha 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 evenafter 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 leftfrontal 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.
EEG-based upper-alpha neurofeedback for cognitive enhancement in major depressive disorder: a preliminary, uncontrolled study.
Escalano, C., Navarro-Gil, M., Garcia-Campayo, J & Minguez, J. (2013)
Conditioning of the upper-alpha rhythm to improve cognitive performance in healthy users by means of neurofeedback (NF) has been evaluated by several studies, however its effectiveness in people with severe cognitive deficits, such as depressive subjects,remains underexplored. This paper reports on a preliminary uncontrolled study to assess the effects of an upper-alpha NF intervention on patients with major depressive disorder (MDD).
The NF effects on the EEG and cognitive performance were assessed. The EEG results showed that patients were able to modulate the upper-alpha rhythm in task-related EEG and duringtraining, in both cases across the executions of the NF sessions, and pre and post within each session.
The behavioral resultsshowed the effectiveness of this intervention in a variety of cognitive functions such as working memory, attention, and executive functions.
Neurofeedback treatment of depression with the Roshi.
Hammond, D. C. (2001)
Introduction. A patient with severe, medication resistant depression was found to have the frontal alpha asymmetry described in Davidson's (1998a) research as demonstrating a predisposition to depression.
Treatment. Initial sessions of EEG neurofeedback using Rosenfeld's (1997) protocol for correcting the alpha asymmetry were discouraging, actually producing slight negative change. Therefore, treatment shifted to using the Roshi, a two channel unit combining neurofeedback and photic stimulation, doing primarily left hemisphere beta training.
Results. The very first Roshi session produced positive changes, and within five sessions the patient reported feeling less depressed and more energetic. At the conclusion of thirty training sessions, objective testing documented dramatic reductions in depression, somatic symptoms, over emotionality, anxiety, rumination, and fatigue.
Discussion. In support of Henriques and Davidson's (1991) belief that hypoactivation of the left hemisphere results in an “approach deficit” and more withdrawal behavior, post-testing and interview data also documented that the patient had become less withdrawn, more active, sociable, and less distrustful. Eight and one-half month follow-up documented maintenance of changes. Continued exploration of left hemisphere beta protocols in treating depression, and of the combined use of neurofeedback with photic stimulation are encouraged.
Neurofeedback as a treatment for major depressive disorder – A pilot study.
Peeters, F., Oehlen, M., Ronner, J., van Os, J & Lousberg, R. (2014)
Biofeedback potentially provides non-invasive, effective psychophysiological interventions for psychiatric disorders. The encompassing purpose of this review was to establish how biofeedback interventionshave been used to treat select psychiatric disorders [anxiety, autistic spectrum disorders, depression, dissociation, eating disorders,schizophrenia and psychoses] to date and provide a useful reference for consultation by clinicians and researchers planning to administer a biofeedback treatment.
A systematic search of EMBASE, MEDLINE, PsycINFO, and WOK databases and handsearches in Applied Psychophysiology and Biofeedback, and Journal of Neurotherapy, identified 227 articles; 63 of which are included within this review. Electroencephalographic neurofeedback constituted the most investigated modality (31.7%).
Anxiety disorders were the most commonly treated (68.3%). Multi-modal biofeedback appeared most effective in significantly ameliorating symptoms, suggesting that targeting more than one physiological modality for bio- regulation increases therapeutic efficacy.
Overall, 80.9% of articles reported some level of clinical amelioration related to biofeedback exposure, 65.0% to a statistically significant (p < .05) level of symptom reduction based on reported standardized clinical parameters. Although the heterogeneity of the included studies warrants caution before explicit efficacy statements can be made.
Further development of standardizedcontrolled methodological protocols tailored for specific disorders and guidelines to generate comprehensive reports maycontribute towards establishing the value of biofeedback interventions within mainstream psychiatry.
EEG biofeedback on a female stroke patient with depression: A case study.
Putnam, J. A., (2001)
Background. This single case concerns the treatment of a 71-year-old female stroke patient. The patient's MRI revealed that the location of the stroke was in the right side basal ganglia with damage extending into the anterior limb of the internal capsule. She presented with a virtual paralysis of the left side of her body (hemiplegia with immobilized left arm, contracted fist, minimal motor control over left leg, absence of muscle tonus in left side of face and slurred, monotonic speech).
Method. The client was provided with EEG biofeedback training on a one to two half-hour sessions per week schedule. Bipolar montages were used along with single site protocols. This was based largely on the idea of reciprocal communication loops between widely separated cortical generators. It was thought that encouraging communication between cortical sites would have a beneficial impact on impairments related to both functional and structural damage. EEG training protocols included SMR (12-15 Hz) enhancement at C4, C4-Pz and T3-T4 with theta suppression; beta (15-18 Hz) enhancement with theta suppression at C3, C3-Fpz and at C3-Fp1.
Results. Patient showed significant improvement in gross motor control and range of movement of left arm and leg. The most dramatic improvement was observed in speech (articulation, strength and tone). While substantial improvements were observedin motor ability, restoration of mood stability proved somewhat more elusive. Since she was receiving additionaltreatment (physical therapy and medication management), it is impossible to attribute the improvement in functioning solely to the EEG training. However, the consensus among the attending medical personnel was that the improvements noted above took place with unusual expeditiousness.
Discussion. When performing EEG biofeedback it may be most practical to adopt an“exercise model” approach in which the regulatory mechanisms in the brain are challenged through the sequential use of multiple protocol configurations. In this case several different training protocols proved useful in her ongoing recovery. While improvements in functioning were a result of a concerted effort involving multiple therapeutic interventions, it is likely that neurofeedback played a vital synergistic role.
The effects of alpha/theta neurofeedback on personality and mood.
Raymond, J., Varney, C., Parkinson, L. A., & Gruzelier, J. H. (2005)
Alpha/theta neurofeedback has been shown to be successful both in treatingaddictions and in enhancing artistry in music students. How its effects are mediated are not yet clear.
The present study aimed to test the hypothesis that alpha/theta neurofeedback works inter alia by normalizing extreme personality and raising feelings of well- being.
12 participants with high scores for Withdrawal (as measured by the PSQ) were given either alpha/theta neurofeedback or mock feedback and their personality and mood were assessed. Withdrawal scores on the PSQ-80 were not found to change ineither group but significant effects were found for the Profile Of Mood States (POMS), with real feedback producing higher overall scores than mock feedback (P = 0.056).
Real feedback caused participants to feel significantly more energetic (P < 0.01) than did mock feedback. Sessions of real feedback made participants feel more composed (P < 0.01), agreeable (P < 0.01), elevated (P < 0.01) and confident (P < 0.05), whilst sessions of mock feedback made participants feel more tired (P < 0.05), yet composed (P < 0.01).
These findings suggest that, whilst 9 sessions of alpha/theta neurofeedback was insufficient to change personality, improvements in mood may provide a partial explanation for the efficacy of alpha/theta neurofeedback.
Alpha-theta brainwave neurofeedback training: an effective treatment for male and female alcoholics with depressive symptoms.
Saxby, E., & Peniston, E. G. (1995)
This was an experimental study of 14 alcoholicoutpatients using the Peniston and Kulkosky (1989, 1991) brainwave treatment protocol for alcohol abuse.
After temperaturebiofeedback pretraining, experimental subjects completed 20 40- minute sessions of alpha-theta brainwave neurofeedback training(BWNT).
Experimentally treated alcoholics with depressive syndrome showed sharp reductions in self-assessed depression (Beck'sDepression Inventory). On the Millon Clinical Multiaxial Inventory-I, the experimental subjects showed significant decreases on the BR scores: schizoid, avoidant, dependent, histrionic, passive-aggression, schizotypal, borderline, anxiety, somatoform,hypomanic, dysthymic, alcohol abuse, drug abuse, psychotic thinking, and psychotic depression.
Twenty-one-month follow-up dataindicated sustained prevention of relapse in alcoholics who completed BWNT.