Appl Psychophysiol Biofeedback. 2005 Jun;30(2):95-114.
Electroencephalographic biofeedback in the treatment of attention-deficit/hyperactivity disorder.
Monastra VJ, Lynn S, Linden M, Lubar JF, Gruzelier J, LaVaque TJ.
FPI Attention Disorders Clinic, Endicott, New York 13760, USA. drmonastra@stny.rr.com
Historically, pharmacological treatments for attention-deficit/hyperactivity disorder (ADHD) have been considered to be the only type of interventions effective for reducing the core symptoms of this condition. However, during the past three decades, a series of case and controlled group studies examining the effects of EEG biofeedback have reported improved attention and behavioral control, increased cortical activation on quantitative electroencephalographic examination, and gains on tests of intelligence and academic achievement in response to this type of treatment. This review paper critically examines the empirical evidence, applying the efficacy guidelines jointly established by the Association for Applied Psychophysiology and Biofeedback (AAPB) and the International Society for Neuronal Regulation (ISNR). On the basis of these scientific principles, EEG biofeedback was determined to be “probably efficacious” for the treatment of ADHD. Although significant clinical improvement was reported in approximately 75% of the patients in each of the published research studies, additional randomized, controlled group studies are needed in order to provide a better estimate of the percentage of patients with ADHD who will demonstrate such gains in clinical practice.
PMID: 16013783
Biol Psychiatry. 2004 Apr 1;55(7):772-5.
Training of slow cortical potentials in attention-deficit/hyperactivity disorder: evidence for positive behavioral and neurophysiological effects.
Heinrich H, Gevensleben H, Freisleder FJ, Moll GH, Rothenberger A.
Department of Child and Adolescent Psychiatry, University of Gottingen, Gottingen, Germany.
BACKGROUND: Learned self-control of slow cortical potentials (SCPs) may lead to behavioral improvement in attention-deficit/hyperactivity disorder (ADHD). Hence, training effects should also be reflected at the neurophysiological level. METHODS: Thirteen children with ADHD, aged 7-13 years, performed 25 SCP training sessions within 3 weeks. Before and after training, the German ADHD rating scale was completed by parents, and event-related potentials were recorded in a cued continuous performance test (CPT). For a waiting-list group of nine children with ADHD, the same testing was applied. RESULTS: ADHD symptomatology was reduced by approximately 25% after SCP training. Moreover, a decrease of impulsivity errors and an increase of the contingent negative variation were observed in the CPT task. CONCLUSIONS: This study provides first evidence for both positive behavioral and specific neurophysiological effects of SCP training in children with ADHD.
PMID: 15039008
Neuroreport. 2001 Dec 21;12(18):4155-9.
Learned self-regulation of EEG frequency components affects attention and event-related brain potentials in humans.
Egner T, Gruzelier JH.
Department of Cognitive Neuroscience and Behaviour, Faculty of Medicine Imperial College of Science, Technology and Medicine, St Dunstan’s Rd, London W6 8RF, UK.
Learned enhancement of EEG frequency components in the lower beta range by means of biofeedback has been reported to alleviate attention deficit hyperactivity disorder (ADHD) symptoms. In order to elucidate frequency-specific behavioural effects and neurophysiological mediators, this study applied neurofeedback protocols to healthy volunteers, and assessed impact on behavioural and electrocortical attention measures. Operant enhancement of a 12-15 Hz component was associated with reduction in commission errors and improved perceptual sensitivity on a continuous performance task (CPT), while the opposite relation was found for 15-18 Hz enhancement. Both 12-15 Hz and 15-18 Hz enhancement were associated with significant increases in P300 event-related brain potential amplitudes in an auditory oddball task. These relations are interpreted as stemming from band-specific effects on perceptual and motor aspects of attention measures.
PMID: 11742256
Clin Neurophysiol. 2004 Jan;115(1):131-9
EEG biofeedback of low beta band components: frequency-specific effects on variables of attention and event-related brain potentials.
Egner T, Gruzelier JH.
Department of Cognitive Neuroscience and Behaviour, Faculty of Medicine, Imperial College London, St Dunstan’s Road, London W6 8RF, UK. te2111@columbia.edu
OBJECTIVE: To test a common assumption underlying the clinical use of electroencephalographic (EEG) biofeedback training (neurofeedback), that the modulation of discreet frequency bands is associated with frequency-specific effects. Specifically, the proposal was assessed that enhancement of the low beta components sensorimotor rhythm (SMR: 12-15 Hz) and beta1 (15-18 Hz) affect different aspects of attentional processing. METHODS: Subjects (n=25) were randomly allocated to training with either an SMR or beta1 protocol, or to a non-neurofeedback control group. Subjects were assessed prior and subsequent to the training process on two tests of sustained attention. The neurofeedback participants were also assessed on target P300 event-related potential (ERP) amplitudes in a traditional auditory oddball paradigm. RESULTS: Protocol-specific effects were obtained in that SMR training was associated with increased perceptual sensitivity ‘d prime’ (d’), and reduced omission errors and reaction time variability. Beta1 training was associated with faster reaction times and increased target P300 amplitudes, whereas no changes were evident in the control group. CONCLUSIONS: Neurofeedback training of SMR and beta1 band components led to significant and protocol-specific effects in healthy subjects. The data can be interpreted as indicating a general attention-enhancing effect of SMR training, and an arousal-enhancing effect of beta1 training.
PMID: 14706480
Int J Psychophysiol. 2003 Jan;47(1):75-85.
The effect of training distinct neurofeedback protocols on aspects of cognitive performance.
Vernon D, Egner T, Cooper N, Compton T, Neilands C, Sheri A, Gruzelier J.
Department of Cognitive Neuroscience and Behaviour, Imperial College London, Charing Cross Hospital, St. Dunstans Road, London W6 8RF, UK. d.vernon@ic.ac.uk
The use of neurofeedback as an operant conditioning paradigm has disclosed that participants are able to gain some control over particular aspects of their electroencephalogram (EEG). Based on the association between theta activity (4-7 Hz) and working memory performance, and sensorimotor rhythm (SMR) activity (12-15 Hz) and attentional processing, we investigated the possibility that training healthy individuals to enhance either of these frequencies would specifically influence a particular aspect of cognitive performance, relative to a non-neurofeedback control-group. The results revealed that after eight sessions of neurofeedback the SMR-group were able to selectively enhance their SMR activity, as indexed by increased SMR/theta and SMR/beta ratios. In contrast, those trained to selectively enhance theta activity failed to exhibit any changes in their EEG. Furthermore, the SMR-group exhibited a significant and clear improvement in cued recall performance, using a semantic working memory task, and to a lesser extent showed improved accuracy of focused attentional processing using a 2-sequence continuous performance task. This suggests that normal healthy individuals can learn to increase a specific component of their EEG activity, and that such enhanced activity may facilitate semantic processing in a working memory task and to a lesser extent focused attention. We discuss possible mechanisms that could mediate such effects and indicate a number of directions for future research.
PMID: 12543448 [PubMed – indexed for MEDLINE]
Am J Psychiatry. 2006 Jun;163(6):1033-43.
Comment in: Am J Psychiatry. 2006 Jun;163(6):957-60.
Parietal attentional system aberrations during target detection in adolescents with attention deficit hyperactivity disorder: event-related fMRI evidence.
Tamm L, Menon V, Reiss AL.
Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Rd., Stanford, CA 94305-5717, USA.
OBJECTIVE: Directed attention, the ability to allocate and direct attention toward a salient stimulus, is impaired in attention deficit hyperactivity disorder (ADHD). This construct is often assessed with target detection or oddball tasks, and individuals with ADHD perform poorly on such tasks. However, to date, the specific brain structures or neural mechanisms underlying target detection dysfunction in individuals with ADHD have not been identified. The authors’ goal was to investigate neural correlates of target detection dysfunction in ADHD using event-related fMRI. METHOD: Behavioral and brain activation data were collected while subjects performed a visual oddball task. Participants included 14 right-handed male adolescents with ADHD (combined type) and 12 typically developing age- and handedness-matched male comparison subjects. RESULTS: Individuals with ADHD made significantly more errors of commission than comparison subjects. Further, relative to comparison subjects, individuals with ADHD showed significantly less activation in the bilateral parietal lobes (including the superior parietal gyrus and supramarginal and angular gyri of the inferior parietal lobe), right precuneus, and thalamus. CONCLUSIONS: Adolescents with ADHD demonstrated significant impairments in their ability to direct and allocate attentional resources. These difficulties were associated with significant aberrations in the parietal attentional system, which is known to play a significant role in attention shifting and detecting specific or salient targets. Thus, dysfunction in the parietal attentional system may play a significant role in the behavioral phenotype of ADHD.
PMID: 16741204
Child Adolesc Psychiatr Clin N Am. 2005 Jan;14(1):137-62, vii.
Electroencephalogram biofeedback for reading disability and traumatic brain injury.
Thornton KE, Carmody DP.
Center for Health Psychology, Suite 2A, 2509 Park Avenue, South Plainfield, NJ 07080, USA. ket@chp-neurotherapy.com
The application of electroencephalogram (EEG) biofeedback with reading disability and traumatic brain injury (TBI) is relatively recent. There are many studies regarding the effectiveness (improving attention and IQ scores) of EEG biofeedback in patients with attention deficit hyperactivity disorder, who are known to have a high rate of comorbidity for learning disabilities. This suggests the possibility that EEG biofeedback specifically aimed at remediating reading disability and TBI would be effective. This article provides strong initial support for this idea and provides reason to believe that assessment and training under task conditions are likely to be fruitful. Given the significance of these problems and the absence of very effective alternatives for remediation of these conditions, efforts to complete the needed research seem warranted. Clinical use of this intervention seems to be warranted with informed consent.
PMID: 15564056
EEG sensorimotor rhythm biofeedback training: some effects on the neurologic precursors of learning disabilities.
Tansey MA. This study presents a clinical treatment regime for pathological interhemispheric dysfunction with respect to a population of learning disabled boys. The results obtained replicate and extend earlier findings with respect to operantly conditioned increases in amplitude of sensorimotor transactions and its positive effect on learning disability. Specifically, the biofeedback, and subsequent conditioning, of increased 14 Hz neural discharge patterns (sensorimotor rhythm-SMR) over the central Rolandic cortex, appeared to increase bilateral sensorimotor transactions resulting in substantive reduction/remediation in the learning disabilities of the recipients of such EEG biofeedback training. PMID: 6542077Int J Psychophysiol. 2005 Jan;55(1):23-34.
ERPs correlates of EEG relative beta training in ADHD children.
Kropotov JD, Grin-Yatsenko VA, Ponomarev VA, Chutko LS, Yakovenko EA, Nikishena IS.
Laboratory for Neurobiology of Action Programming, Institute of the Human Brain of Russian Academy of Sciences, ul. Academica Pavlova 12a, 197376 St. Petersburg, Russia.
Eighty-six children (ages 9-14) with attention deficit hyperactivity disorder (ADHD) participated in this study. Event-related potentials (ERPs) were recorded in auditory GO/NOGO task before and after 15-22 sessions of EEG biofeedback. Each session consisted of 20 min of enhancing the ratio of the EEG power in 15-18 Hz band to the EEG power in the rest of spectrum, and 7-10 min of enhancing of the ratio of the EEG power in 12-15 Hz to the EEG power in the rest of spectrum with C3-Fz electrodes’ placements for the first protocol and C4-Pz for the second protocol. On the basis of quality of performance during training sessions, the patients were divided into two groups: good performers and bad performers. ERPs of good performers to GO and NOGO cues gained positive components evoked within 180-420 ms latency. At the same time, no statistically significant differences between pre- and post-training ERPs were observed for bad performers. The ERP differences between post- and pretreatment conditions for good performers were distributed over frontal-central areas and appear to reflect an activation of frontal cortical areas associated with beta training.
PMID: 15598513
Child Adolesc Psychiatr Clin N Am. 2005 Jan;14(1):83-104, vi
Critical validation studies of neurofeedback.
Gruzelier J, Egner T.
Division of Neuroscience and Psychological Medicine, Imperial College London, St. Dunstan’s Road, London W6 8RF, United Kingdom. j.gruzelier@imperial.ac.uk
The field of neurofeedback training has proceeded largely without validation. In this article the authors review studies directed at validating sensory motor rhythm, beta and alpha-theta protocols for improving attention, memory, and music performance in healthy participants. Importantly, benefits were demonstrable with cognitive and neurophysiologic measures that were predicted on the basis of regression models of learning to enhance sensory motor rhythm and beta activity. The first evidence of operant control over the alpha-theta ratio is provided, together with remarkable improvements in artistic aspects of music performance equivalent to two class grades in conservatory students. These are initial steps in providing a much needed scientific basis to neurofeedback.
PMID: 15564053
Int J Psychophysiol. 2003 Jan;47(1):75-85
The effect of training distinct neurofeedback protocols on aspects of cognitive performance.
Vernon D, Egner T, Cooper N, Compton T, Neilands C, Sheri A, Gruzelier J.
Department of Cognitive Neuroscience and Behaviour, Imperial College London, Charing Cross Hospital, St. Dunstans Road, London W6 8RF, UK. d.vernon@ic.ac.uk
The use of neurofeedback as an operant conditioning paradigm has disclosed that participants are able to gain some control over particular aspects of their electroencephalogram (EEG). Based on the association between theta activity (4-7 Hz) and working memory performance, and sensorimotor rhythm (SMR) activity (12-15 Hz) and attentional processing, we investigated the possibility that training healthy individuals to enhance either of these frequencies would specifically influence a particular aspect of cognitive performance, relative to a non-neurofeedback control-group. The results revealed that after eight sessions of neurofeedback the SMR-group were able to selectively enhance their SMR activity, as indexed by increased SMR/theta and SMR/beta ratios. In contrast, those trained to selectively enhance theta activity failed to exhibit any changes in their EEG. Furthermore, the SMR-group exhibited a significant and clear improvement in cued recall performance, using a semantic working memory task, and to a lesser extent showed improved accuracy of focused attentional processing using a 2-sequence continuous performance task. This suggests that normal healthy individuals can learn to increase a specific component of their EEG activity, and that such enhanced activity may facilitate semantic processing in a working memory task and to a lesser extent focused attention. We discuss possible mechanisms that could mediate such effects and indicate a number of directions for future research.
PMID: 12543448