Is There Evidence for EEG-Neurofeedback Specificity in the Treatment of Internalizing Disorders? A Protocol for a Systematic Review and Meta-Analysis
DOI:
https://doi.org/10.15540/nr.8.1.22Keywords:
EEG, Neurofeedback, Internalizing Disorders, Emotional Disorders, Affective DisordersAbstract
Background: Mental illnesses are increasing worldwide with the internalizing disorders (IDs; e.g., anxiety disorders, depressive disorders) being the most prevalent. Current first-line therapies (e.g., pharmacotherapy) offer high failure rates and substantial side effects. Electroencephalographic neurofeedback (EEG-NFB) has been shown to be an effective and safe treatment for these conditions; however, there remains much doubt regarding the existence of specificity (i.e., clinical effects specific to the modulation of the EEG variables of interest). This is a protocol for a quantitative review that will attempt to determine if there is evidence for EEG-NFB specificity in the treatment of IDs. Methods: We will consider all published and unpublished randomized, double-blind (i.e., trainees and raters), sham/placebo-controlled (i.e., feedback contingent on a random signal, the activity from a different person’s brain, or an unrelated signal from the trainee’s own brain) trials involving humans with at least one ID diagnosis without exclusion by language, locality, ethnicity, age, or sex. Effect sizes will be calculated for individual studies and combined in a meta-analysis. Discussion: This protocol outlines the research methodology for a quantitative review undertaken to assess for evidence of EEG-NFB specificity in the treatment of IDs. Registration: This review was registered with the International Prospective Register of Systematic Reviews (PROSPERO; registration number: CRD42020159702).
References
Alhaj, H., Wisniewski, G., & McAllister-Williams, R. H. (2010). The use of the EEG in measuring therapeutic drug action: Focus on depression and antidepressants. Journal of Psychopharmacology, 25(9), 1175–1191. https://doi.org/10.1177/0269881110388323
Alkoby, O., Abu-Rmileh, A., Shriki, O., & Todder, D. (2018). Can we predict who will respond to neurofeedback? A review of the inefficacy problem and existing predictors for successful EEG neurofeedback learning. Neuroscience, 378, 155–164. https://doi.org/10.1016/j.neuroscience.2016.12.050
Alvares, G. A., Quintana, D. S., Hickie, I. B., & Guastella, A. J. (2016). Autonomic nervous system dysfunction in psychiatric disorders and the impact of psychotropic medications: A systematic review and meta-analysis. Journal of Psychiatry & Neuroscience, 41(2), 89–104. https://doi.org/10.1503/jpn.140217
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.
Andrade, L. H., Alonso, J., Mneimneh, Z., Wells, J. E., Al-Hamzawi, A., Borges, G., ... Kessler, R. C. (2014). Barriers to mental health treatment: Results from the WHO World Mental Health surveys. Psychological Medicine, 44(6), 1303–1317. https://doi.org/10.1017/S0033291713001943
Arns, M., Batail, J.-M., Bioulac, S., Congedo, M., Daudet, C., Drapier, D., ... The NExT group. (2017). Neurofeedback: One of today's techniques in psychiatry? L'Encéphale, 43(2), 135–145. https://doi.org/10.1016/j.encep.2016.11.003
Arns, M., Heinrich, H., & Strehl, U. (2014). Evaluation of neurofeedback in ADHD: The long and winding road. Biological Psychology, 95, 108–115. https://doi.org/10.1016/j.biopsycho.2013.11.013
Askovic, M., Watters, A. J., Coello, M., Aroche, J., Harris, A. W. F., & Kropotov, J. (2019). Evaluation of neurofeedback for posttraumatic stress disorder related to refugee experiences using self-report and cognitive ERP measures. Clinical EEG and Neuroscience, 51(2), 79–86. https://doi.org/10.1177/1550059419849170
Bandelow, B., & Michaelis, S. (2015). Epidemiology of anxiety disorders in the 21st century. Dialogues in Clinical Neuroscience, 17(3), 327–335. https://doi.org/10.31887/DCNS.2015.17.3/bbandelow
Banerjee, S., & Argáez, C. (2017). Neurofeedback and biofeedback for mood and anxiety disorders: A review of clinical effectiveness and guidelines. Ottawa, ON: Canadian Agency for Drugs and Technologies in Health.
Begemann, M. J. H., Florisse, E. J. R., van Lutterveld, R., Kooyman, M., & Sommer, I. E. (2016). Efficacy of EEG neurofeedback in psychiatry: A comprehensive overview and meta-analysis. Translational Brain Rhythmicity, 1(1), 19–29. https://doi.org/10.15761/TBR.1000105
Bell, A. N., Moss, D., & Kallmeyer, R. J. (2019). Healing the neurophysiological roots of trauma: A controlled study examining LORETA z-score neurofeedback and HRV biofeedback for chronic PTSD. NeuroRegulation, 6(2), 54–70. https://doi.org/10.15540/nr.6.2.54
Buchan, H., Sunderland, M., Carragher, N., Batterham, P., & Slade, T. (2014). Investigating age-related differences in responses to screening items for internalising disorders in three national surveys. Journal of Affective Disorders, 152–154, 229–236. https://doi.org/10.1016/j.jad.2013.09.015
Buzsáki, G., & Watson, B. O. (2012). Brain rhythms and neural syntax: Implications for efficient coding of cognitive content and neuropsychiatric disease. Dialogues in Clinical Neuroscience, 14(4), 345–367. https://doi.org/10.31887/DCNS.2012.14.4/gbuzsaki
Carragher, N., Krueger, R. F., Eaton, N. R., & Slade, T. (2015). Disorders without borders: Current and future directions in the meta-structure of mental disorders. Social Psychiatry and Psychiatric Epidemiology, 50(3), 339–350. https://doi.org/10.1007/s00127-014-1004-z
Cheon, E. J., Choi, J. H., Lee, G. W., Koo, B. H., Seo, W. S., Kim, H. G., ... Keum, M. S. (2017). P.2.f.009 – Neurofeedback treatment on depressive symptoms and functional recovery and brain-derived neurotrophic factor in treatment-resistant major depression. European Neuropsychopharmacology, 27(Suppl. 4), S851. https://doi.org/10.1016/S0924-977X(17)31529-8
Chiba, T., Kanazawa, T., Koizumi, A., Ide, K., Taschereau-Dumouchel, V., Boku, S., ... Kawato, M. (2019). Current status of neurofeedback for post-traumatic stress disorder: A systematic review and the possibility of decoded neurofeedback. Frontiers in Human Neuroscience, 13, 233. https://doi.org/10.3389/fnhum.2019.00233
Collura, T. F. (2013). Technical foundations of neurofeedback. London, UK: Taylor & Francis.
Cosgrove, V. E., Rhee, S. H., Gelhorn, H. L., Boeldt, D., Corley, R. C., Ehringer, M. A., ... Hewitt, J. K. (2011). Structure and etiology of co-occurring internalizing and externalizing disorders in adolescents. Journal of Abnormal Child Psychology, 39(1), 109–123. https://doi.org/10.1007/s10802-010-9444-8
Demyttenaere, K., Bruffaerts, R., Posada-Villa, J., Gasquet, I., Kovess, V., Lepine, J. P., ... Chatterji, S. (2004). Prevalence, severity, and unmet need for treatment of mental disorders in the World Health Organization World Mental Health Surveys. JAMA, 291(21), 2581–2590. https://doi.org/10.1001/jama.291.21.2581
Duffy, M. E., Twenge, J. M., & Joiner, T. E. (2019). Trends in mood and anxiety symptoms and suicide-related outcomes among U.S. undergraduates, 2007–2018: Evidence from two national surveys. Journal of Adolescent Health, 65(5), 590–598. https://doi.org/10.1016/j.jadohealth.2019.04.033
Enriquez-Geppert, S., Huster, R. J., & Herrmann, C. S. (2017). EEG-neurofeedback as a tool to modulate cognition and behavior: A review tutorial. Frontiers in Human Neuroscience, 11, 51. https://doi.org/10.3389/fnhum.2017.00051
Ghaziri, J., & Thibault, R. T. (2019). 19 – Neurofeedback: An inside perspective. In A. Raz & R. T. Thibault (Eds.), Casting light on the dark side of brain imaging (pp. 113–116): Cambridge, MA: Academic Press. https://doi.org/10.1016/B978-0-12-816179-1.00019-0
Haidt, J., & Allen, N. (2020). Scrutinizing the effects of digital technology on mental health. Nature, 578, 226–227. https://doi.org/10.1038/d41586-020-00296-x
Haller, S. P. W., Cohen Kadosh, K., Scerif, G., & Lau, J. Y. F. (2015). Social anxiety disorder in adolescence: How developmental cognitive neuroscience findings may shape understanding and interventions for psychopathology. Developmental Cognitive Neuroscience, 13(C), 11–20. https://doi.org/10.1016/j.dcn.2015.02.002
Higgins, J. P. T., Thomas, J., Chandler, J., Cumpston, M., Li, T., Page, M. J., & Welch, V. A. (Eds.). (2020). Cochrane handbook for systematic reviews of interventions (version 6.1). Available from www.training.cochrane.org/handbook
Holtmann, M., Sonuga-Barke, E., Cortese, S., & Brandeis, D. (2014). Neurofeedback for ADHD: A review of current Evidence. Child and Adolescent Psychiatric Clinics of North America, 23(4), 789–806. https://doi.org/10.1016/j.chc.2014.05.006
Hou, Y., Zhang, S., Li, N., Huang, Z., Wang, L., & Wang, Y. (2021). Neurofeedback training improves anxiety trait and depressive symptom in GAD. Brain and Behavior, e02024. https://doi.org/10.1002/brb3.2024
Insel, T. R., & Wang, P. S. (2010). Rethinking mental illness. JAMA, 303(19), 1970–1971. https://doi.org/10.1001/jama.2010.555
Iosifescu, D. V. (2011). Electroencephalography-derived biomarkers of antidepressant response. Harvard Review of Psychiatry, 19(3), 144–154. https://doi.org/10.3109/10673229.2011.586549
James, A. C., James, G., Cowdrey, F. A., Soler, A., & Choke, A. (2015). Cognitive behavioural therapy for anxiety disorders in children and adolescents. Cochrane Database of Systematic Reviews, 2015(2), CD004690. https://doi.org/10.1002/14651858.CD004690.pub4
Jokić-Begić, N., & Begić, D. (2003). Quantitative electroencephalogram (qEEG) in combat veterans with post-traumatic stress disorder (PTSD). Nordic Journal of Psychiatry, 57(5), 351–355. https://doi.org/10.1080/08039480310002688
Kerson, C., & Collaborative Neurofeedback Group. (2013). A proposed multisite double-blind randomized clinical trial of neurofeedback for ADHD: Need, rationale, and strategy. Journal of Attention Disorders, 17(5), 420–436. https://doi.org/10.1177/1087054713482580
Kessler, R. C., Aguilar-Gaxiola, S., Alonso, J., Chatterji, S., Lee, S., Ormel, J., ... Wang, P. S. (2009). The global burden of mental disorders: An update from the WHO World Mental Health (WMH) Surveys. Epidemiologia e psichiatria sociale (Epidemiology and Psychiatric Sciences), 18(1), 23–33. https://doi.org/10.1017/s1121189x00001421
Kessler, R. C., Angermeyer, M., Anthony, J. C., De Graaf, R., Demyttenaere, K., Gasquet, I., ... Ustün, T. B. (2007). Lifetime prevalence and age-of-onset distributions of mental disorders in the World Health Organization's World Mental Health Survey Initiative. World Psychiatry, 6(3), 168–176.
Kessler, R. C., Berglund, P., Demler, O., Jin, R., Merikangas, K. R., & Walters, E. E. (2005). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62(6), 593–602. https://doi.org/10.1001/archpsyc.62.6.593
Keyes, K. M., Gary, D., O’Malley, P. M., Hamilton, A., & Schulenberg, J. (2019). Recent increases in depressive symptoms among US adolescents: Trends from 1991 to 2018. Social Psychiatry and Psychiatric Epidemiology, 54(8), 987–996. https://doi.org/10.1007/s00127-019-01697-8
Kotov, R., Krueger, R. F., Watson, D., Achenbach, T. M., Althoff, R. R., Bagby, R. M., ... Zimmerman, M. (2017). The Hierarchical Taxonomy of Psychopathology (HiTOP): A dimensional alternative to traditional nosologies. Journal of Abnormal Psychology, 126(4), 454–477. https://doi.org/10.1037/abn0000258
Kris, N. (2018, December 4). ‘Once in a generation’: The crucial passages from the mental health inquiry. https://thespinoff.co.nz/politics/04-12-2018/once-in-a-generation-the-crucial-passages-from-the-mental-health-inquiry/
Krueger, R. F., & Eaton, N. R. (2015). Transdiagnostic factors of mental disorders. World Psychiatry, 14(1), 27–29. https://doi.org/10.1002/wps.20175
Lancet Global Mental Health Group, Chisholm, D., Flisher, A. J., Lund, C., Patel, V., Saxena, S., … Tomlinson, M. (2007). Scale up services for mental disorders: A call for action. The Lancet, 370(9594), 1241–1252. https://doi.org/10.1016/S0140-6736(07)61242-2
Marzbani, H., Marateb, H. R., & Mansourian, M. (2016). Neurofeedback: A comprehensive review on system design, methodology and clinical applications. Basic and Clinical Neuroscience, 7(2), 143–158. https://doi.org/10.15412/J.BCN.03070208
Möller, H.-J., Bandelow, B., Volz, H.-P., Barnikol, U. B., Seifritz, E., & Kasper, S. (2016). The relevance of ‘mixed anxiety and depression’ as a diagnostic category in clinical practice. European Archives of Psychiatry and Clinical Neuroscience, 266(8), 725–736. https://doi.org/10.1007/s00406-016-0684-7
Neurofeedback Collaborative Group, Arnold, L. E., Arns, M., Barterian, J., Bergman, R., Black, S., ... Williams, C. E. (2020). Double-blind placebo-controlled randomized clinical trial of neurofeedback for attention-deficit/hyperactivity disorder with 13-month follow-up. Journal of the American Academy of Child & Adolescent Psychiatry. https://doi.org/10.1016/j.jaac.2020.07.906
Noohi, S., Miraghaie, A. M., Arabi, A., & Nooripour, R. (2017). Effectiveness of neuro-feedback treatment with alpha/theta method on PTSD symptoms and their executing function. Biomedical Research (India), 28(5), 2019–2027.
Omejc, N., Rojc, B., Battaglini, P. P., & Marusic, U. (2019). Review of the therapeutic neurofeedback method using electroencephalography: EEG neurofeedback. Bosnian Journal of Basic Medical Sciences, 19(3), 213–220. https://doi.org/10.17305/bjbms.2018.3785
Orndorff-Plunkett, F., Singh, F., Aragón, O. R., & Pineda, J. A. (2017). Assessing the effectiveness of neurofeedback training in the context of clinical and social neuroscience. Brain Sciences, 7(8), 95. https://doi.org/10.3390/brainsci7080095
Panisch, L. S., & Hai, A. H. (2018). The effectiveness of using neurofeedback in the treatment of post-traumatic stress disorder: A systematic review. Trauma, Violence, & Abuse, 21(3), 541–550. https://doi.org/10.1177/1524838018781103
Peters, S. K., Dunlop, K., & Downar, J. (2016). Cortico-striatal-thalamic loop circuits of the salience network: A central pathway in psychiatric disease and treatment. Frontiers in Systems Neuroscience, 10, 104. https://doi.org/10.3389/fnsys.2016.00104
Pfeifer, J. H., & Allen, N. B. (2020). Puberty initiates cascading relationships between neurodevelopmental, social, and internalizing processes across adolescence. Biological Psychiatry, 89(2), 99–108. https://doi.org/10.1016/j.biopsych.2020.09.002
Pigott, H. E., Cannon, R., & Trullinger, M. (2018). The fallacy of sham-controlled neurofeedback trials: A reply to Thibault and colleagues (2018). Journal of Attention Disorders, 25(3), 448–457. https://doi.org/10.1177/1087054718790802
Pinter, A., Szatmari, S., Jr., Horvath, T., Penzlin, A. I., Barlinn, K., Siepmann, M., & Siepmann, T. (2019). Cardiac dysautonomia in depression – Heart rate variability biofeedback as a potential add-on therapy. Neuropsychiatric Disease and Treatment, 15, 1287–1310. https://doi.org/10.2147/NDT.S200360
Pizzagalli, D. A., Nitschke, J. B., Oakes, T. R., Hendrick, A. M., Horras, K. A., Larson, C. L., ... Davidson, R. J. (2002). Brain electrical tomography in depression: The importance of symptom severity, anxiety, and melancholic features. Biological Psychiatry, 52(2), 73–85. https://doi.org/10.1016/S0006-3223(02)01313-6
Reiter, K., Andersen, S. B., & Carlsson, J. (2016). Neurofeedback treatment and posttraumatic stress disorder: Effectiveness of neurofeedback on posttraumatic stress disorder and the optimal choice of protocol. The Journal of Nervous and Mental Disease, 204(2), 69–77. https://doi.org/10.1097/NMD.0000000000000418
Rhee, S. H., Lahey, B. B., & Waldman, I. D. (2015). Comorbidity among dimensions of childhood psychopathology: Converging evidence from behavior genetics. Child Development Perspectives, 9(1), 26–31. https://doi.org/10.1111/cdep.12102
Ros, T., Frewen, P., Théberge, J., Michela, A., Kluetsch, R., Mueller, A., ... Lanius, R. A. (2017). Neurofeedback tunes scale-free dynamics in spontaneous brain activity. Cerebral Cortex, 27(10), 4911–4922. https://doi.org/10.1093/cercor/bhw285
Schoenberg, P. L. A., & David, A. S. (2014). Biofeedback for psychiatric disorders: A systematic review. Applied Psychophysiology and Biofeedback, 39(2), 109–135. https://doi.org/10.1007/s10484-014-9246-9
Schönenberg, M., Wiedemann, E., Schneidt, A., Scheeff, J., Logemann, A., Keune, P. M., & Hautzinger, M. (2017a). Confusion regarding operant conditioning of the EEG –Authors' reply. The Lancet Psychiatry, 4(12), 897–898). https://doi.org/10.1016/S2215-0366(17)30437-6
Schönenberg, M., Wiedemann, E., Schneidt, A., Scheeff, J., Logemann, A., Keune, P. M., & Hautzinger, M. (2017b). Neurofeedback, sham neurofeedback, and cognitive-behavioural group therapy in adults with attention-deficit hyperactivity disorder: A triple-blind, randomised, controlled trial. The Lancet Psychiatry, 4(9), 673–684. https://doi.org/10.1016/S2215-0366(17)30291-2
Sherlin, L. H., Arns, M., Lubar, J., Heinrich, H., Kerson, C., Strehl, U., & Sterman, M. B. (2011). Neurofeedback and basic learning theory: Implications for research and practice. Journal of Neurotherapy, 15(4), 292–304. https://doi.org/10.1080/10874208.2011.623089
Sitaram, R., Ros, T., Stoeckel, L., Haller, S., Scharnowski, F., Lewis-Peacock, J., ... Sulzer, J. (2016). Closed-loop brain training: The science of neurofeedback. Nature Reviews Neuroscience, 18, 86–100. https://doi.org/10.1038/nrn.2016.164
Szewczyk, R. Ł., Ratomska, M., & Jaśkiewicz, M. (2018). The neglected problem of the neurofeedback learning (in)ability. In W. Hunek & S. Paskiel (Eds.), Biomedical Engineering and Neuroscience, Advances in Intelligent Systems and Computing (vol. 720, pp. 45–58). Switzerland: Springer, Cham. https://doi.org/10.1007/978-3-319-75025-5_6
Thibault, R. T., Lifshitz, M., & Raz, A. (2016). The self-regulating brain and neurofeedback: Experimental science and clinical promise. Cortex, 74, 247–261. https://doi.org/10.1016/j.cortex.2015.10.024
Thibault, R. T., Veissière, S., Olson, J. A., & Raz, A. (2018). Treating ADHD with suggestion: Neurofeedback and placebo therapeutics. Journal of Attention Disorders, 22(8), 707–711. https://doi.org/10.1177/1087054718770012
Tiller, J. W. G. (2013). Depression and anxiety. The Medical Journal of Australia, 199(S6), S28–S31. https://doi.org/10.5694/mja12.10628
Tolin, D. F., Davies, C. D., Moskow, D. M., & Hofmann, S. G. (2020). Biofeedback and neurofeedback for anxiety disorders: A quantitative and qualitative systematic review. In Y.-K. Kim (Ed.), Anxiety disorders: Rethinking and understanding recent discoveries (pp. 265–289). Singapore: Springer Singapore. https://doi.org/10.1007/978-981-32-9705-0_16
Trullinger, M., Novian, A., Russell-Chapin, L., & Pradhan, D. (2019). Perspectives on Type III statistical errors: Exaggerating the effects of placebo in neurofeedback. NeuroRegulation, 6(1), 38–41. https://doi.org/10.15540/nr.6.1.38
Twenge, J. M., Cooper, A. B., Joiner, T. E., Duffy, M. E., & Binau, S. G. (2019). Age, period, and cohort trends in mood disorder indicators and suicide-related outcomes in a nationally representative dataset, 2005–2017. Journal of Abnormal Psychology, 128(3), 185–199. https://doi.org/10.1037/abn0000410
van der Kolk, B. A., Hodgdon, H., Gapen, M., Musicaro, R., Suvak, M. K., Hamlin, E., & Spinazzola, J. (2016). A randomized controlled study of neurofeedback for chronic PTSD. PLoS ONE, 11(12), e0166752. https://doi.org/10.1371/journal.pone.0166752
Van Doren, J., Arns, M., Heinrich, H., Vollebregt, M. A., Strehl, U., & K. Loo, S. (2019). Sustained effects of neurofeedback in ADHD: A systematic review and meta-analysis. European Child & Adolescent Psychiatry, 28(3), 293–305. https://doi.org/10.1007/s00787-018-1121-4
Wahbeh, H., & Oken, B. S. (2013). Peak high-frequency HRV and peak alpha frequency higher in PTSD. Applied Psychophysiology and Biofeedback, 38(1), 57–69. https://doi.org/10.1007/s10484-012-9208-z
Wang, S.-Y., Lin, I.-M., Fan, S.-Y., Tsai, Y.-C., Yen, C.-F., Yeh, Y.-C., ... Lin, H.-C. (2019). The effects of alpha asymmetry and high-beta down-training neurofeedback for patients with the major depressive disorder and anxiety symptoms. Journal of Affective Disorders, 257, 287–296. https://doi.org/10.1016/j.jad.2019.07.026
Wells, J. E., Oakley Browne, M. A., Scott, K. M., McGee, M. A., Baxter, J., & Kokaua, J. (2006). Te Rau Hinengaro: The New Zealand Mental Health Survey: Overview of methods and findings. Australian & New Zealand Journal of Psychiatry, 40(10), 835–844. https://doi.org/10.1080/j.1440-1614.2006.01902.x
Witte, M., Kober, S. E., & Wood, G. (2018). Noisy but not placebo: Defining metrics for effects of neurofeedback. Brain, 141(5), e40. https://doi.org/10.1093/brain/awy060
World Health Organization. (2018). ICD-11. International classification of diseases for mortality and morbidity statistics (11th Revision). Retrieved from https://icd.who.int/browse11/l-m/en
Zuberer, A., Brandeis, D., & Drechsler, R. (2015). Are treatment effects of neurofeedback training in children with ADHD related to the successful regulation of brain activity? A review on the learning of regulation of brain activity and a contribution to the discussion on specificity. Frontiers in Human Neuroscience, 9, 135. https://doi.org/10.3389/fnhum.2015.00135
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