Although well-intentioned, many double-blind placebo-controlled studies did not find differences between sham and neurofeedback. These studies used flawed methodologies that are not recognized as valid interventions for neurofeedback, including unconventional protocols; auto-thresholding (where a child is always rewarded even if there is no active learning); reinforcement that was set too high so that no learning occurred because it was too easy; and complicated neurofeedback (where it was difficult to determine whether feedback occurred due to entertainment or treatment).12 Unfortunately, such studies have helped to marginalize neurofeedback as a beneficial intervention for psychiatric disorders.
In response, a collaborative group of researchers was formed to develop a more precise double-blind placebo-controlled study. The NIH-funded study, led by Dr. Eugene L. Arnold, involves the use of a TBR greater than 4.5 in children with ADHD (normal TBR = 2.5).43 The high TBR was selected to determine if it can serve as a biomarker responsive to treatment regardless of ADHD subtype. This biomarker fits the RDoC and should show less variability than medication trials, which do not select for a biomarker.
Localized deep brain changes monitored by LORETA will be used to identify possible moderators and non-specific predictors of neurofeedback outcome. Improvement in event-related potential will also be examined as a possible mediator of neurofeedback therapeutic effect in those in whom TBR is decreased. Event-related potentials will measure attention; pre- and post-QEEGs will monitor progress.
Although more and larger studies are needed, neurofeedback shows promise as a tool to be utilized by psychiatrists. LZNF would provide a more accessible and affordable intervention than fMRI neurofeedback. And, LZNF and 19ZNF seem to be effective with fewer sessions than surface neurofeedback, making them more affordable to patients.
PLEASE NOTE THAT THE POST-TEST IS AVAILABLE ONLINE ONLY ON THE 20TH OF THE MONTH OF ACTIVITY ISSUE AND FOR A YEAR AFTER.
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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