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American Psychiatric Association Annual Meeting, Course: Intro to Neurofeedback, San Francisco May 19, 2003 ABSTRACT After a brief introductory review on the history of EEG biofeedback (neurofeedback) and its current applications in psychiatry, the course will launch into an extended demonstration with hands-on experience for participants. A demonstration of a Quantitative EEG (QEEG) will be performed on a volunteer. After the recording is analyzed, the database comparison will be used to develop an individualized neurofeedback protocol. A short technical lecture on the QEEG will follow. Next, all participants will have an opportunity to experience neurofeedback. Several neurofeedback systems will be used in the demonstration, including an experimental biofeedback-videogame interface. A short technical lecture on neurofeedback will follow The final segment will present the latest data from a rigorously designed study of Attention Deficit-Hyperactivity Disorder (ADHD) children which compared “traditional” neurofeedback videogames to a new type of Sony PlayStation interface. In a preliminary study, both the videogame and standard neurofeedback improved the attention skills functioning of children with ADHD above the benefits of medication. The videogame technology provided advantages over standard neurofeedback treatment in terms of enjoyability for the children and positive parent perception, and possibly has stronger quantitative post-treatment effects on the QEEG. Using Neurofeedback in Your Practice: Latest Trends and Hands-On Experience XIII. Course Time Schedule 4 hours, total QEEG Demonstration w/ audience discussion Quantitative EEG In Clinical Practice Additional Audience discussion [10 minutes] Break [20 minutes] EEG Neurofeedback Demonstration w/ audience discussion EEG Neurofeedback Fundamentals Additional Audience discussion [10 minutes] New Biofeedback Interfaces for ADHD Children Closing: Audience discussion with faculty [15 minutes] XIV. Outline of Each Faculty Member’s Presentation I. Introduction (Brod) Historical review: from “alpha” relaxation training to Sterman’s seizure regulation Clinical EEG Neurofeedback Applications (ADHD subtypes, traumatic brain injury, mood instabilities, etc)
II. QEEG Brain Mapping Basics and Applications (Isaacs) Diagnostic For Many Conditions And “Puzzle-Cases” Applications:
Neurofeedback
QEEG: The Concepts
EEG Measures
ADHD And QEEG
QEEG Markers For Depression & Subtypes
QEEG Markers For OCD & Subtypes
QEEG Markers For Explosive Disorders & Subtypes
QEEG Markers For Anxiety & Subtypes
QEEG Markers For Schizophrenia & Subtypes
III. Foundations of Neurofeedback (Delgado)
IV. New Biofeedback Interfaces for ADHD Children (deBeus) Objectives • This project was a randomized and controlled technology concept study, funded by NASA’s Langley Research Center • Assessed whether a new videogame biofeedback technology developed at NASA Langley Research Center was as effective as traditional neurofeedback in treating Attention-Deficit Hyperactivity Disorder (ADHD), and whether there were significant differences in its appeal as a clinical method compared to standard neurofeedback treatment • The study was conducted in the Behavioral Medicine Clinic at Eastern Virginia Medical School Subjects • 22 children with ADHD of the hyperactive-impulsive subtype (DSM-IV criteria plus physician diagnosis) • Age range: 9-13 years, 3 girls and 19 boys • All the children were on short-acting medications for ADHD • The children had to be of at least normal intelligence, and have no history of affective problems or learning disabilities Design • The children were randomized to treatment groups: videogame (n=11) vs. standard neurofeedback (n=11) • Children in both groups completed 40 individual treatment sessions, usually seen once or twice a week. • The children came for one test session before and after treatment, where they completed QEEG, TOVA and neuropsychological tests. • BASC Monitor data and actigraph (physical activity) data was collected pre-and post-treatment and every ten sessions • Children in both groups were trained with a single active Cz electrode, with reference electrode and ground attached to the earlobes Summary of Findings • Both the videogame and standard neurofeedback groups improved significantly on most main ADHD outcome measures. No significant difference in treatment change was seen in group comparisons • Parents’ subjective appraisal of treatment effect on ADHD was more positive for the videogame group • The videogame treatment was rated significantly more enjoyable by both parents and children • Trends on pre-post QEEG change maps indicate that the videogame training may have advantages in creating more quantitative EEG effect in the therapeutic direction • We conclude that the videogame biofeedback technology, as implemented in the NASA prototype tested, produces equivalent results to standard neurofeedback in effects on ADHD problems • Both the videogame and standard neurofeedback improve the functioning of children with ADHD substantially above the benefits of medication • The videogame technology provides advantages over standard neurofeedback treatment in terms of enjoyability for the children and positive parent perception, and possibly has stronger quantitative post-treatment effects on EEG XV. Literature References Barabasz A., & Barabasz M. Treating AD/HD with hypnosis and neurotherapy. Child Study Journal, 2000; 30(1), 25-42. Brod TM: Notes On Brainwave Biofeedback For Young People: AD/HD and related issues. in Incorvia JA, Mark-Goldstein BS, and Tessmer D (eds): Understanding, Diagnosing And Treating AD/HD Children And Adolescents. Jason Aronson 1999 Chabot RJ, diMichele F, Prichep L, John ER:The clinical role of computerized EEG in the evaluation and treatment of learning and attention disorders in children and adolescents. J Neuropsychiatry and Clin Neuroscience, 2001; 13: 171-186 Evans J, Abarbanel A (eds), Quantitative EEG and Neurofeedback, San Diego, Academic Press, 1999 Hammond DH, Adverse reactions and potential iatrogenic effects in neurofeedback training (Clinical Corner), J of Neurotherapy, 2001; 4:57-69. Hammond DC: Medical justification for neurofeedback with ADD/ADHD. Journal of Neurotherapy, 2000; 4(1), 90-93. Hoffman DA, Lubar JF, Thatcher RW, et al: Limitation of the American Academy of Neurology and American Clinical Neurophysiology Society Paper on QEEG. J Neuropsychiatry and Clin Neurosci 1999 11:401-407 Hughes JR and John ER: Conventional and Quantitative Electroencephalography in Psychiatry. J Neuropsychiatry Clin Neurosci 1999 11:190-208 Isaacs J, Patten AJ: Report on a double-blind study of the Biocircuit,a putative subtle-energy-based relaxation device. J Intl Soc for the Study of Subtle and Energy Medicine, 1992; 2:1-28. Kaiser DA, Othmer S: Effect of Neurofeedback on variables of attention in a large multi-center trial. Journal of Neurotherapy, 2000 4(1), 5-15. Lantz D, & Sterman MB: Neuropsychological assessment of subjects with uncontrolled epilepsy: Effects of EEG biofeedback training. Epilepsia, 1988; 29(2), 163-171. Lubar JF: Neocortical Dynamics: implications for understanding the role of neurofeedback and related techniques for the enhancement of attention. Applied Psychophysiology and Biofeedback, 1997 22: 111-25. Lubar JF and Lubar JO: Neurofeedback Assessment And Treatment For Attention Deficit/Hyperactivity Disorders. in Evans JR and Abarbanel A (eds): Introduction to Quantitative EEG and Neurofeedback Academic Press 1999 Meyer-Lindenberg A, Ziemann U, Hajak G, et al:. Transitions between dynamical states of differing stability in the human brain. Proc Natl Acad Sci U S A. 2002; Aug 20;99(17):10948-53. Monastra VJ, Lubar JF, Linden M: the development of a quantitative electroencephalographic scanning process for attention deficit hyperactivity disorder: reliability and validation studies. Neuropsychology, 2001 15: 136-144. Othmer S, Othmer SF, and Kaiser DA: EEG Biofeedback: an emerging model for its global efficacy. in Evans JR and Abarbanel A (eds): Introduction to Quantitative EEG and Neurofeedback Academic Press 1999 Peniston EG, Kulkosky PJ: Alpha-theta brainwave training and beta-endorphin levels in alcoholics. Alcohol: Clinical & Experimental Research, 1989; 13(2), 271-279. Peniston EG, Marrinan DA, Deming WA, and Kulkosky PJ: EEG Alpha-Theta Brainwave Synchronization In Vietnam Theater Veterans With Combat-Related Post-Traumatic Stress Disorder And Alcohol Abuse. Adv Med Psychotherapy 1993 6: 37-30 Pizzagalli D, Pascual-Marqui R, Nitschke J, et al: Anterior cingulate activity as a predictor of degree of treatment response in major depression:Evidence from brain electrical tomography analysis. Amer J of Psychiatry, 2001; 158: 405-415 Pulvermuller F, Mohr, Schleichert H, Veit, R: Operant conditioning of left hemispheric slow cortical potentials and its effect on word processing. Biological Psychology, 2000; 53, 177-215. Rosenfeld JP: An EEG Biofeedback Protocol for Affective Disorders. Clin Electroencephalography 2000:7-12 Scott W, & Kaiser D: Augmenting chemical dependency treatment with neurofeedback training. Journal of Neurotherapy, 1998;3(1), 66. Sterman MB, Howe RD, Macdonald LR: Facilitation of spindle-burst sleep by conditioning of electroencephalographic activity while awake. Science, 167, 1970; 1146-1148. Sterman MB: Basic concepts and clinical findings in the treatment of seizure disorders with EEG operant conditioning. Clinical Electroencephalography, 2000;31(1), 45-55. Sterman MB: Physiological Origins And Functional Correlates Of EEG Rhythmic Activities: implications for self-regulation. Biofeedback and Self-Regulation 1996 21:3-34 Thatcher RW: EEG Database-Guided Neurotherapy. in Evans JR and Abarbanel A (eds): Introduction to Quantitative EEG and Neurofeedback Academic Press 1999 Tinius TP, Tinius KA: Changes after EEG biofeedback and cognitive retraining in adults with mild traumatic brain injury and attention deficit disorder. Journal of Neurotherapy, 2001; 4(2), 27-44. Yoo SS, Jolesz FA: Functional MRI for neurofeedback: feasibility study on a hand motor task. Neuroreport. 2002 Aug 7;13(11):1377-81. XVII. Self-Assessment Questions
2. To record EEG, one uses
3. Depression has been typically associated with
4. The best montage for the clinical use of the EEG asymmetry protocol involves
5. The Sensorimotor Rhythm is deemed to reflect the following:
6. The EEG neurofeedback training promotes higher EEG amplitudes for the following reasons:
7 The early research on seizures was not accepted by the scientific community because (Name the exception):
8. Controlled studies of EEG conditioning have been performed for the following conditions (Name the exception):
XVIII. Self-Assessment Answers
XVIX. Background Articles
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