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Neurofeedback: Significance for Psychiatry: Page 7 of 7

Neurofeedback: Significance for Psychiatry: Page 7 of 7

Based on QEEG, 5 protocols were used for ADHDTable – Based on QEEG, 5 protocols were used for ADHD where effect siz...
images of changes in theta after 11 sessions of LORETA neurofeedbackFigure 1
Movement of z scores in a 12-year-old boy with ADHD after 11 sessions.Figure 2


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.



Post-tests, credit request forms, and activity evaluations must be completed online at www.cmeoutfitters.com/PT (requires free account activation), and participants can print their certificate or statement of credit immediately (80% pass rate required). This Web site supports all browsers except Internet Explorer for Mac. For complete technical requirements and privacy policy, visit www.neurosciencecme.com/technical.asp.




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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