The use of QEEG and LZNF may prove an effective treatment approach to psychiatric disorders. Larsen and Sherlin39 graded the evidence for neurofeedback on a 1 to 5 efficacy scale, where 1 indicates not empirically supported evidence that consists primarily of case studies or anecdotal reports, and 5 indicates active treatment superior to placebo in randomized controlled trials conducted at a minimum of 2 independent sites. Neurofeedback was deemed efficacious (level 4) or efficacious and specific (level 5) for epilepsy, ADHD, and anxiety spectrum disorders; probably efficacious (level 3) for traumatic brain injury (TBI), alcoholism/substance abuse, insomnia, and optimal/peak performance; and insufficient (level 2) for depressive disorders, autism, PTSD, and tinnitus.
Subsequent studies by Coben and colleagues20,21,25 would raise dyslexia to level 4 and would place autism into level 3. The level of efficacy of neurofeedback seen in various studies indicates that larger, well-controlled studies of efficacy are warranted.
Perhaps one of the most important areas to target for research is PTSD and TBI, especially considering the toll these diagnoses have taken on the military. Presently, there is a $5 million grant for research at Fort Campbell, Kentucky, using LZNF to target PTSD and TBI. Preliminary results have shown promise after only 10 sessions.
Studies using fMRI neurofeedback for PTSD in adults have also been promising. An intervention involved training participants to control amygdala activity after exposure to personalized trauma scripts. Examination of changes in resting-state functional connectivity patterns revealed normalization of brain connectivity consistent with clinical improvement.40
In another study, 21 adults who had a history of childhood abuse were trained to reduce the alpha rhythm (8-12 Hz) in a 30-minute neurofeedback session.41 The results were correlated with fMRI connectivity and subjective measures of state anxiety and arousal in a group of individuals with PTSD. The training was followed by a significant increase (rebound) in resting-state alpha synchronization. This synchronization was linked to increased calmness, greater salience network connectivity with the right insula, and enhanced default mode network connectivity with bilateral posterior cingulate, right middle frontal gyrus, and left medial prefrontal cortex.
A study involving 16 cases of servicemen with PTSD utilized LZNF. Based on Cohen’s analysis, large effect size was seen for the current source density in the region of interest ranging from 0.5 to 4.6 with an average of 1.4. A negative correlation between ES and psychotropic medication was found along with a trend toward requiring less medication as training progressed.42
Dr. Simkin is Clinical Assistant Professor, Department of Psychiatry, Emory University School of Medicine, Atlanta, GA. Dr. Lubar is Professor Emeritus, Department of Psychology, University of Tennessee, Knoxville, TN; and Affiliate Scientist for the Center of Complex Systems and Brain Sciences, Charles E. Schmidt College of Science, Florida Atlantic University, Boca Raton, FL.
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