A Meta-Analysis of the Effect of Neurofeedback on Depression
DOI:
https://doi.org/10.15540/nr.8.2.104Keywords:
Neurofeedback, depression, biofeedback, arousal-withdrawal model, frontal alpha asymmetry, amygdalaAbstract
This meta-analytical study examined the effect of neurofeedback on decreasing depression. The main finding of the meta-analysis was that neurofeedback resulted in a large (g = -0.91) decrease in depression. This finding can be explained through the various roles of brainwave oscillations in terms of both the formation and persistence of depression and the development of oscillatory patterns less compatible with depressive states. One plausible mechanism for NF’s depression-reduction effect is that of the approach-withdrawal model as related to not only the asymmetrical activation of the frontal regions but also the hypoactivity of the amygdala. Future research might uncover other possible explanations for NF’s observed efficacy as a means of reducing depression. The findings of the study provide some support for the utilization of neurofeedback as either a complement to the pharmaceutical treatment of depression or, given its effect size, a standalone therapy. However, because NF research base is immature in comparison to the research base on pharmaceutical antidepressants, additional analysis remains necessary.
References
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Harmon-Jones, E., Gable, P. A., & Peterson, C. K. (2010). The role of asymmetric frontal cortical activity in emotion-related phenomena: A review and update. Biological Psychology, 84(3), 451-462. https://doi.org/10.1016/j.biopsycho.2009.08.010
Harris, S., Hundley, G., & Lambie, G. (2021). The effects of neurofeedback on depression, anxiety, and academic self-efficacy. Journal of College Student Psychotherapy, 35(1), 15-29. https://doi.org/10.1080/87568225.2019.1606689
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Peng, C. Y. J., & Chen, L. T. (2014). Beyond Cohen's d: Alternative effect size measures for between-subject designs. The Journal of Experimental Education, 82(1), 22-50. https://doi.org/10.1080/00220973.2012.745471
Sathappan, A. V., Luber, B. M., & Lisanby, S. H. (2019). The dynamic duo: combining noninvasive brain stimulation with cognitive interventions. Progress in Neuro-Psychopharmacology and Biological Psychiatry, 89, 347-360. https://doi.org/10.1016/j.pnpbp.2018.10.006
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Suslow, T., Konrad, C., Kugel, H., Rumstadt, D., Zwitserlood, P., Schöning, S., ... & Dannlowski, U. (2010). Automatic mood-congruent amygdala responses to masked facial expressions in major depression. Biological Psychiatry, 67(2), 155-160. https://doi.org/10.1016/j.biopsych.2009.07.023
Takamura, M., Okamoto, Y., Shibasaki, C., Yoshino, A., Okada, G., Ichikawa, N., & Yamawaki, S. (2020). Antidepressive effect of left dorsolateral prefrontal cortex neurofeedback in patients with major depressive disorder: A preliminary report. Journal of Affective Disorders, 271, 224–227. https://doi.org/10.1016/j.jad.2020.03.080
Tomarken, A. J., Davidson, R. J., Wheeler, R. E., & Doss, R. C. (1992). Individual differences in anterior brain asymmetry and fundamental dimensions of emotion. Journal of Personality and Social Psychology, 62(4), 676–687. https://doi.org/10.1037/0022-3514.62.4.676
Van Der Vinne, N., Vollebregt, M. A., Van Putten, M. J., & Arns, M. (2017). Frontal alpha asymmetry as a diagnostic marker in depression: Fact or fiction? A meta-analysis. Neuroimage: Clinical, 16, 79-87. https://doi.org/10.1016/j.nicl.2017.07.006
Victor, T. A., Furey, M. L., Fromm, S. J., Öhman, A., & Drevets, W. C. (2010). Relationship between amygdala responses to masked faces and mood state and treatment in major depressive disorder. Archives of General Psychiatry, 67(11), 1128-1138. https://doi.org/10.1001/archgenpsychiatry.2010.144
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
Young, A. H., & Moulton, C. D. (2020). Antidepressants do work after all. Journal of Psychopharmacology, 34(10), 1071–1073. https://doi.org/10.1177/0269881120933127
Young, K. D., Siegle, G. J., Zotev, V., Phillips, R., Misaki, M., Yuan, H., Drevets, W. C., & Bodurka, J. (2017). Randomized clinical trial of real-time fMRI amygdala neurofeedback for Major Depressive Disorder: Effects on symptoms and autobiographical memory recall. The American Journal of Psychiatry, 174(8), 748–755. https://doi.org/10.1176/appi.ajp.2017.16060637
Yu, S. H., Tseng, C. Y., & Lin, W. L. (2020). A neurofeedback protocol for executive function to reduce depression and rumination: A controlled study. Clinical Psychopharmacology and Neuroscience : The Official Scientific Journal of the Korean College of Neuropsychopharmacology, 18(3), 375–385. https://doi.org/10.9758/cpn.2020.18.3.375
Zotev, V., Mayeli, A., Misaki, M., & Bodurka, J. (2020). Emotion self-regulation training in major depressive disorder using simultaneous real-time fMRI and EEG neurofeedback. Neuroimage: Clinical, 27, 102331. https://doi.org/10.1016/j.nicl.2020.102331
Baxter, A. J., Scott, K. M., Ferrari, A. J., Norman, R. E., Vos, T., & Whiteford, H. A. (2014). Challenging the myth of an “epidemic” of common mental disorders: Trends in the global prevalence of anxiety and depression between 1990 and 2010. Depression and Anxiety, 31(6), 506-516. https://doi.org/10.1002/da.22230
Beck, A. T., Steer, R. A., & Brown, G. (1996). Beck Depression Inventory–II [Database record]. APA PsycTests. https://doi.org/10.1037/t00742-000
Briesemeister, B. B., Tamm, S., Heine, A., & Jacobs, A. M. (2013). Approach the good, withdraw from the bad—a review on frontal alpha asymmetry measures in applied psychological research. Psychology, 4(03), 261. http://dx.doi.org/10.4236/psych.2013.43A039
Bubonya, M., Cobb-Clark, D. A., & Wooden, M. (2017). Mental health and productivity at work: Does what you do matter? Labour Economics, 46, 150-165. https://doi.org/10.1016/j.labeco.2017.05.001
Cheon, E. J., Koo, B. H., & Choi, J. H. (2016). The efficacy of neurofeedback in patients with major depressive disorder: an open labeled prospective study. Applied Psychophysiology and Biofeedback, 41(1), 103-110. https://doi.org/10.1007/s10484-015-9315-8
Choi, S. W., Chi, S. E., Chung, S. Y., Kim, J. W., Ahn, C. Y., & Kim, H. T. (2011). Is alpha wave neurofeedback effective with randomized clinical trials in depression? A pilot study. Neuropsychobiology, 63(1), 43-51. https://doi.org/10.1159/000322290
Cohen, J. (2013). Statistical power analysis for the behavioral sciences. Cambridge, MA: Academic Press.
Davidson, R. J. (1992). Anterior cerebral asymmetry and the nature of emotion. Brain and Cognition, 20(1), 125-151. https://doi.org/10.1016/0278-2626(92)90065-T
Harmon‐Jones, E. (2003). Clarifying the emotive functions of asymmetrical frontal cortical activity. Psychophysiology, 40(6), 838-848. https://doi.org/10.1111/1469-8986.00121
Harmon-Jones, E., Gable, P. A., & Peterson, C. K. (2010). The role of asymmetric frontal cortical activity in emotion-related phenomena: A review and update. Biological Psychology, 84(3), 451-462. https://doi.org/10.1016/j.biopsycho.2009.08.010
Harris, S., Hundley, G., & Lambie, G. (2021). The effects of neurofeedback on depression, anxiety, and academic self-efficacy. Journal of College Student Psychotherapy, 35(1), 15-29. https://doi.org/10.1080/87568225.2019.1606689
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. Advance online publication. https://doi.org/10.1002/brb3.2024
James, S. L., Abate, D., Abate, K. H., Abay, S. M., Abbafati, C., Abbasi, N., ... & Briggs, A. M. (2018). Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990–2017: A systematic analysis for the Global Burden of Disease Study 2017. The Lancet, 392(10159), 1789-1858. https://doi.org/10.1016/S0140-6736(18)32279-7
Jia, H., Zack, M. M., Thompson, W. W., Crosby, A. E., & Gottesman, I. I. (2015). Impact of depression on quality-adjusted life expectancy (QALE) directly as well as indirectly through suicide. Social Psychiatry and Psychiatric Epidemiology, 50(6), 939-949. https://doi.org/10.1007/s00127-015-1019-0
Kelly, B. D. (2020). Psychiatry’s future: Biology, psychology, legislation, and “the fierce urgency of now.” Indian Journal of Psychological Medicine, 42(2), 189-192. https://dx.doi.org/10.4103%2FIJPSYM.IJPSYM_492_19
Kim, J. H., & Kim, S. Y. (2015). Effects of neurofeedback training on unilateral neglect and depression in patients with stroke. Journal of Digital Convergence, 13(9), 361-368. https://doi.org/10.14400/JDC.2015.13.9.361
Kim, Y. (2015). Preface. In Y. Kim (Ed.), Major depressive order: Cognitive and neurobiological mechanisms (pp. ix-x). Rijeka: IntechOpen.
Lenart, L. & Fekete, A. (2021). Angiotensin receptor 1 blockade as an antidepression strategy. In C. Martin, L-A Hunter, V. Patel, V. Preedy, & R. Rajendram (Eds.), The neuroscience of depression (pp. 283-292). London: Academic Press.
Mennella, R., Patron, E., & Palomba, D. (2017). Frontal alpha asymmetry neurofeedback for the reduction of negative affect and anxiety. Behaviour Research and Therapy, 92, 32-40. https://doi.org/10.1016/j.brat.2017.02.002
Peng, C. Y. J., & Chen, L. T. (2014). Beyond Cohen's d: Alternative effect size measures for between-subject designs. The Journal of Experimental Education, 82(1), 22-50. https://doi.org/10.1080/00220973.2012.745471
Sathappan, A. V., Luber, B. M., & Lisanby, S. H. (2019). The dynamic duo: combining noninvasive brain stimulation with cognitive interventions. Progress in Neuro-Psychopharmacology and Biological Psychiatry, 89, 347-360. https://doi.org/10.1016/j.pnpbp.2018.10.006
Schwartz, J. M., Stapp, H. P., & Beauregard, M. (2005). Quantum physics in neuroscience and psychology: A neurophysical model of mind–brain interaction. Philosophical Transactions of the Royal Society B: Biological Sciences, 360(1458), 1309-1327. https://doi.org/10.1098/rstb.2004.1598
Shin, D., Kim, N. W., Kim, M. J., Rhee, S. J., Park, C. H. K., Kim, H., ... & Ahn, Y. M. (2020). Cost analysis of depression using the national insurance system in South Korea: a comparison of depression and treatment-resistant depression. BMC Health Services Research, 20, 1-11. https://doi.org/10.1186/s12913-020-05153-1
Suslow, T., Konrad, C., Kugel, H., Rumstadt, D., Zwitserlood, P., Schöning, S., ... & Dannlowski, U. (2010). Automatic mood-congruent amygdala responses to masked facial expressions in major depression. Biological Psychiatry, 67(2), 155-160. https://doi.org/10.1016/j.biopsych.2009.07.023
Takamura, M., Okamoto, Y., Shibasaki, C., Yoshino, A., Okada, G., Ichikawa, N., & Yamawaki, S. (2020). Antidepressive effect of left dorsolateral prefrontal cortex neurofeedback in patients with major depressive disorder: A preliminary report. Journal of Affective Disorders, 271, 224–227. https://doi.org/10.1016/j.jad.2020.03.080
Tomarken, A. J., Davidson, R. J., Wheeler, R. E., & Doss, R. C. (1992). Individual differences in anterior brain asymmetry and fundamental dimensions of emotion. Journal of Personality and Social Psychology, 62(4), 676–687. https://doi.org/10.1037/0022-3514.62.4.676
Van Der Vinne, N., Vollebregt, M. A., Van Putten, M. J., & Arns, M. (2017). Frontal alpha asymmetry as a diagnostic marker in depression: Fact or fiction? A meta-analysis. Neuroimage: Clinical, 16, 79-87. https://doi.org/10.1016/j.nicl.2017.07.006
Victor, T. A., Furey, M. L., Fromm, S. J., Öhman, A., & Drevets, W. C. (2010). Relationship between amygdala responses to masked faces and mood state and treatment in major depressive disorder. Archives of General Psychiatry, 67(11), 1128-1138. https://doi.org/10.1001/archgenpsychiatry.2010.144
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
Young, A. H., & Moulton, C. D. (2020). Antidepressants do work after all. Journal of Psychopharmacology, 34(10), 1071–1073. https://doi.org/10.1177/0269881120933127
Young, K. D., Siegle, G. J., Zotev, V., Phillips, R., Misaki, M., Yuan, H., Drevets, W. C., & Bodurka, J. (2017). Randomized clinical trial of real-time fMRI amygdala neurofeedback for Major Depressive Disorder: Effects on symptoms and autobiographical memory recall. The American Journal of Psychiatry, 174(8), 748–755. https://doi.org/10.1176/appi.ajp.2017.16060637
Yu, S. H., Tseng, C. Y., & Lin, W. L. (2020). A neurofeedback protocol for executive function to reduce depression and rumination: A controlled study. Clinical Psychopharmacology and Neuroscience : The Official Scientific Journal of the Korean College of Neuropsychopharmacology, 18(3), 375–385. https://doi.org/10.9758/cpn.2020.18.3.375
Zotev, V., Mayeli, A., Misaki, M., & Bodurka, J. (2020). Emotion self-regulation training in major depressive disorder using simultaneous real-time fMRI and EEG neurofeedback. Neuroimage: Clinical, 27, 102331. https://doi.org/10.1016/j.nicl.2020.102331
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2021-06-30
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