Effect level of neurofeedback in neuropsychiatric disorders – suggestions for appropriate clinical use
Clinical Neurophysiology / Volume 45, Issue 6, December 2015
Electroencephalographic neurofeedback: Level of evidence in mental and brain disorders and suggestions for good clinical practice
J.-A. Micoulaud-Franchi, A. McGonigal, R. Lopeze, C. Daudet, I. Kotwas, F. Bartolomei
Neurofeedback of brain waves (EEG Neurofeedback) is a method that was created in the 1970s. In this method, the brain waves of the person are measured, at the moment of processing and the required components are extracted from it, and then this information is presented in the form of sound or image. The goal is to change behavior by changing brain activity. Neurofeedback has created new therapeutic possibilities in the fields of psychiatry and neurology. However, the development of the practical use of this method in treatment requires 1) a good level of research evidence regarding the therapeutic effect of this method 2) a suitable clinical guide for it. This article has initially reviewed a selection of clinical trials that had the following indicators: having a control group, randomization of groups, blinding of the protocol, measurement of the main findings related to that disorder with standard assessment and treatment tools, definable neurophysiological purpose of brain waves. , based on the pathophysiology of the disorder. Trials have been found for disorders such as epilepsy, migraine, stroke, chronic insomnia, attention deficit/hyperactivity disorder (ADHD), autism spectrum disorders, major depression, anxiety, addictive behaviors, psychotic disorders.
In the second stage, the rules of neurofeedback treatment based on the learning hypothesis have been discussed. The following different treatment models fall into two ranges: the range of explicit and implicit learning and the range of the bio-medical model (on the axis of the disorder) and the model of the integration of biopsychosocial health (on the axis of the disease).
The main role of the learning model is to connect neurofeedback to the field of cognitive modification methods. The specificity of neurofeedback methodology should be determined through biological parameters that depend on neurophysiology. In appropriate clinical practice guidelines for neurofeedback, attention to technical problems of electrophysiology and learning is suggested. Validation of these cases requires fundamental structures for the practical use of neurofeedback in therapy.
The technique of electroencephalographic neurofeedback (EEG NF) emerged in the 1970s and is a technique that measures a subject’s EEG signal, processes it in real time, extracts a parameter of interest and presents this information in visual or auditory form. The goal is to effectuate a behavioral modification by modulating brain activity. The EEG NF opens new therapeutic possibilities in the fields of psychiatry and neurology. However, the development of EEG NF in clinical practice requires (i) a good level of evidence of therapeutic efficacy of this technique, (ii) a good practice guide for this technique. Firstly, this article investigates selected trials with the following criteria: study design with controlled, randomized, and open or blind protocol, primary endpoint related to the mental and brain disorders treated and assessed with standardized measurement tools, identifiable EEG neurophysiological targets, underpinned by pathophysiological relevance. Trials were found for: epilepsies, migraine, stroke, chronic insomnia, attentional-deficit/hyperactivity disorder (ADHD), autism spectrum disorder, major depressive disorder, anxiety disorders, addictive disorders, psychotic disorders. Secondly, this article investigates the principles of neurofeedback therapy in line with learning theory. Different underlying therapeutic models are presented didactically between two continua: a continuum between implicit and explicit learning and a continuum between the biomedical model (centred on “the disease”) and integrative biopsychosocial model of health (centred on “the illness”). The main relevant learning model is to link neurofeedback therapy with the field of cognitive remediation techniques. The methodological specificity of neurofeedback is to be guided by biologically relevant neurophysiological parameters. Guidelines for good clinical practice of EEG NF concerning technical issues of electrophysiology and of learning are suggested. These require validation by institutional structures for the clinical practice of EEG NF.