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Similar to EEG, fMRI provides an indirect measure of neuronal activity, by recording the hemodynamic response in the brain - known as the blood oxygenation level-dependent (BOLD) signal 5. Moreover, functional magnetic resonance imaging (fMRI) has rapidly emerged as an alternative technique for neurofeedback protocols. As the technique is non-invasive and side-effects such as headache or fatigue due to the attentional demands are minimal, EEG neurofeedback has been discussed a promising alternative, non-medical treatment option. A voluminous literature describes the robustness of EEG abnormalities found in a high proportion of psychiatric patients and the clinical implications, depending on the psychiatric disorder targeted.
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The interest in EEG neurofeedback over the last 30 years can be understood in the light of accumulating research on the electrophysiological basis of various psychiatric disorders, such as Attention Deficit Hyperactivity Disorder (ADHD), Autism Spectrum Disorder (ASD), schizophrenia, Obsessive Compulsive Disorder (OCD), anxiety, depression, Tourette syndrome and anorexia nervosa. The general rationale behind neurofeedback is that this conditioning will be related to behavioral improvements. This operant conditioning of selected brainwave frequencies is achieved by giving real-time audio and/or visual feedback cues. Neurofeedback was originally described as a method in which specific frequency bands of the electroencephalographam (EEG) are used to train the electrical activity of the brain through biofeedback. Neurofeedback, EEG biofeedback, treatment, psychiatry, ADHD, ASD, OCD, GAD, depression, review, meta-analysis Introduction Large, well-designed studies are needed to elucidate whether neurofeedback is a viable treatment option in the field of psychiatry. Therefore at present, it cannot be concluded that EEG neurofeedback can be regarded as an evidence-based treatment for ADHD, ASD, OCD, GAD and depression. One study on depression showed a large effect for neurofeedback when compared to semi-active treatment.Ĭonclusion: Although 30 studies could be included, our review of the literature reveals serious limitations of the body of research currently performed. Two GAD studies found neurofeedback to be similar or inferior to EMG biofeedback. Three OCD studies showed varying results, depending on the type of control group used. For ASD, combining five studies resulted in a superior effect of neurofeedback in reducing general symptomatology subgroup analyses showed that neurofeedback was more effective than passive/semi-active treatment (four studies) and placebo (based on a single study). Subgroup analyses showed that neurofeedback was superior to passive/semi-active treatment (medium effects), while efficacy was similar to placebo (only one study) and drug treatment. For ADHD, combining nineteen trials in meta-analysis yielded small to medium effect sizes for symptoms of inattention, hyperactivity and impulsivity. Results: We retrieved 30 studies including 1171 participants, evaluating neurofeedback for ADHD, autism, OCD, GAD and depression. Effect sizes were calculated for individual studies and when possible combined in meta-analysis (Hedges’s g).
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Method: Only studies comparing neurofeedback to a control group (passive/semi-active, placebo, or drug treatment) were included. Background: This article provides a comprehensive overview of studies investigating the efficacy of EEG neurofeedback in the treatment of psychiatric disorders.