BACKGROUND: By enabling individuals to self-regulate their brainwave activity in the field of optimal performance in healthy individuals, neurofeedback has been found to improve cognitive and artistic performance. Here we assessed whether two distinct EEG neurofeedback protocols could develop surgical skill, given the important role this skill plays in medicine. RESULTS: National Health Service trainee ophthalmic microsurgeons (N = 20) were randomly assigned to either Sensory Motor Rhythm-Theta (SMR) or Alpha-Theta (AT) groups, a randomized subset of which were also part of a wait-list 'no-treatment' control group (N = 8). Neurofeedback groups received eight 30-minute sessions of EEG training. Pre-post assessment included a skills lab surgical procedure with timed measures and expert ratings from video-recordings by consultant surgeons, together with state/trait anxiety self-reports. SMR training demonstrated advantages absent in the control group, with improvements in surgical skill according to 1) the expert ratings: overall technique (d = 0.6, p < 0.03) and suture task (d = 0.9, p < 0.02) (judges' intraclass correlation coefficient = 0.85); and 2) with overall time on task (d = 0.5, p = 0.02), while everyday anxiety (trait) decreased (d = 0.5, p < 0.02). Importantly the decrease in surgical task time was strongly associated with SMR EEG training changes (p < 0.01), especially with continued reduction of theta (4-7 Hz) power. AT training produced marginal improvements in technique and overall performance time, which were accompanied by a standard error indicative of large individual differences. Notwithstanding, successful within session elevation of the theta-alpha ratio correlated positively with improvements in overall technique (r = 0.64, p = 0.047). CONCLUSION: SMR-Theta neurofeedback training provided significant improvement in surgical technique whilst considerably reducing time on task by 26%. There was also evidence that AT training marginally reduced total surgery time, despite suboptimal training efficacies. Overall, the data set provides encouraging evidence of optimised learning of a complex medical specialty via neurofeedback training.

BMC Neurosci. 2009 Jul 24;10:87. Ros T, Moseley MJ, Bloom PA, Benjamin L, Parkinson LA, Gruzelier JH. Department of Psychology, Goldsmiths, University of London, London, UK. t.ros@gold.ac.uk

Real-time functional magnetic resonance imaging (fMRI) affords the opportunity to explore the feasibility of self-regulation of functional brain networks through neurofeedback. We localised emotion networks individually in thirteen participants using fMRI and trained them to upregulate target areas, including the insula and amygdala. Participants achieved a high degree of control of these networks after a brief training period. We observed activation increases during periods of upregulation of emotion networks in the precuneus and medial prefrontal cortex and, with increasing training success, in the ventral striatum. These findings demonstrate the feasibility of fMRI-based neurofeedback of emotion networks and suggest a possible development into a therapeutic tool.

Neuroimage. 2009 Jul 29. Johnston SJ, Boehm SG, Healy D, Goebel R, Linden DE. Bangor Imaging Unit, Wolfson Centre for Clinical and Cognitive Neuroscience, School of Psychology, Bangor University, Bangor, UK.

Full Title: Efficacy of neurofeedback treatment in ADHD: the effects on inattention, impulsivity and hyperactivity: a meta-analysis

Since the first reports of neurofeedback treatment in Attention Deficit Hyperactivity Disorder (ADHD) in 1976, many studies have investigated the effects of neurofeedback on different symptoms of ADHD such as inattention, impulsivity and hyperactivity. This technique is also used by many practitioners, but the question as to the evidence-based level of this treatment is still unclear. In this study selected research on neurofeedback treatment for ADHD was collected and a meta-analysis was performed. Both prospective controlled studies and studies employing a pre- and post-design found large effect sizes (ES) for neurofeedback on impulsivity and inattention and a medium ES for hyperactivity. Randomized studies demonstrated a lower ES for hyperactivity suggesting that hyperactivity is probably most sensitive to nonspecific treatment factors. Due to the inclusion of some very recent and sound methodological studies in this meta-analysis, potential confounding factors such as small studies, lack of randomization in previous studies and a lack of adequate control groups have been addressed, and the clinical effects of neurofeedback in the treatment of ADHD can be regarded as clinically meaningful. Three randomized studies have employed a semi-active control group which can be regarded as a credible sham control providing an equal level of cognitive training and client-therapist interaction. Therefore, in line with the AAPB and ISNR guidelines for rating clinical efficacy, we conclude that neurofeedback treatment for ADHD can be considered "Efficacious and Specific" (Level 5) with a large ES for inattention and impulsivity and a medium ES for hyperactivity.

Clin EEG Neurosci. 2009 Jul;40(3):180-9. Arns M, de Ridder S, Strehl U, Breteler M, Coenen A. Brainclinics Diagnostics, Nijmegen, The Netherlands. martijn@brainclinics.com

Full Title: Distinct EEG effects related to neurofeedback training in children with ADHD: A randomized controlled trial

In a randomized controlled trial, neurofeedback (NF) training was found to be superior to a computerised attention skills training concerning the reduction of ADHD symptomatology (Gevensleben et al., 2009). The aims of this investigation were to assess the impact of different NF protocols (theta / beta and slow cortical potentials (SCP) training) on the resting EEG and the association between distinct EEG measures and behavioral improvements. In 72 (of initially 102) children with ADHD, aged 8-12, EEG changes after either a NF training (n=46) or the control training (n=26) could be studied. The combined NF training consisted of one block of theta / beta training and one block of SCP training, each block comprising 18 units of 50 minutes (balanced order). Spontaneous EEG was recorded in a two-minutes resting condition before the start of the training, between the two training blocks and after the end of the training. Activity in the different EEG frequency bands was analysed. In contrast to the control condition, the combined NF training was accompanied by a reduction of theta activity. Protocol-specific EEG changes (theta/beta training: decrease of posterior-midline theta activity; SCP training: increase of central-midline alpha activity) were associated with a decrease of the hyperactivity/impulsivity subscale of the German ADHD rating scale. Related EEG-based predictors were obtained. Thus, differential EEG patterns for theta / beta and SCP training provide further evidence that distinct neuronal mechanisms may contribute to similar behavioral improvements in children with ADHD.

Int J Psychophysiol. 2009 Aug 24. Gevensleben H, Holl B, Albrecht B, Schlamp D, Kratz O, Studer P, Wangler S, Rothenberger A, Moll GH, Heinrich H. Child & Adolescent Psychiatry, University of Göttingen, v.Siebold-Str. 5, D-37075 Göttingen, Germany.

Full Title: Improvements in Spelling after QEEG-based Neurofeedback in Dyslexia: A Randomized Controlled Treatment Study

Phonological theories of dyslexia assume a specific deficit in representation, storage and recall of phonemes. Various brain imaging techniques, including qEEG, point to the importance of a range of areas, predominantly the left hemispheric temporal areas. This study attempted to reduce reading and spelling deficits in children who are dyslexic by means of neurofeedback training based on neurophysiological differences between the participants and gender and age matched controls. Nineteen children were randomized into an experimental group receiving qEEG based neurofeedback (n = 10) and a control group (n = 9). Both groups also received remedial teaching. The experimental group improved considerably in spelling (Cohen's d = 3). No improvement was found in reading. An indepth study of the changes in the qEEG power and coherence protocols evidenced no fronto-central changes, which is in line with the absence of reading improvements. A significant increase of alpha coherence was found, which may be an indication that attentional processes account for the improvement in spelling. Consideration of subtypes of dyslexia may refine the results of future studies.

Appl Psychophysiol Biofeedback. 2009 Aug 27. Breteler MH, Arns M, Peters S, Giepmans I, Verhoeven L. EEG Resource Institute, P.O. Box 31070, 6503 CB, Nijmegen, The Netherlands, r.breteler@eegbiofeedback.nl.

BACKGROUND: For children with attention deficit/hyperactivity disorder (ADHD), a reduction of inattention, impulsivity and hyperactivity by neurofeedback (NF) has been reported in several studies. But so far, unspecific training effects have not been adequately controlled for and/or studies do not provide sufficient statistical power. To overcome these methodological shortcomings we evaluated the clinical efficacy of neurofeedback in children with ADHD in a multisite randomised controlled study using a computerised attention skills training as a control condition. METHODS: 102 children with ADHD, aged 8 to 12 years, participated in the study. Children performed either 36 sessions of NF training or a computerised attention skills training within two blocks of about four weeks each (randomised group assignment). The combined NF treatment consisted of one block of theta/beta training and one block of slow cortical potential (SCP) training. Pre-training, intermediate and post-training assessment encompassed several behaviour rating scales (e.g., the German ADHD rating scale, FBB-HKS) completed by parents and teachers. Evaluation ('placebo') scales were applied to control for parental expectations and satisfaction with the treatment. RESULTS: For parent and teacher ratings, improvements in the NF group were superior to those of the control group. For the parent-rated FBB-HKS total score (primary outcome measure), the effect size was .60. Comparable effects were obtained for the two NF protocols (theta/beta training, SCP training). Parental attitude towards the treatment did not differ between NF and control group. CONCLUSIONS: Superiority of the combined NF training indicates clinical efficacy of NF in children with ADHD. Future studies should further address the specificity of effects and how to optimise the benefit of NF as treatment module for ADHD.

J Child Psychol Psychiatry. 2009 Jul;50(7):780-9. Epub 2009 Jan 12. Gevensleben H, Holl B, Albrecht B, Vogel C, Schlamp D, Kratz O, Studer P, Rothenberger A, Moll GH, Heinrich H. Child & Adolescent Psychiatry, University of Göttingen, Germany.

In the present study, we propose a neurofeedback-based motor imagery training system for EEG-based brain-computer interface (BCI). The proposed system can help individuals get the feel of motor imagery by presenting them with real-time brain activation maps on their cortex. Ten healthy participants took part in our experiment, half of whom were trained by the suggested training system and the others did not use any training. All participants in the trained group succeeded in performing motor imagery after a series of trials to activate their motor cortex without any physical movements of their limbs. To confirm the effect of the suggested system, we recorded EEG signals for the trained group around sensorimotor cortex while they were imagining either left or right hand movements according to our experimental design, before and after the motor imagery training. For the control group, we also recorded EEG signals twice without any training sessions. The participants' intentions were then classified using a time-frequency analysis technique, and the results of the trained group showed significant differences in the sensorimotor rhythms between the signals recorded before and after training. Classification accuracy was also enhanced considerably in all participants after motor imagery training, compared to the accuracy before training. On the other hand, the analysis results for the control EEG data set did not show consistent increment in both the number of meaningful time-frequency combinations and the classification accuracy, demonstrating that the suggested system can be used as a tool for training motor imagery tasks in BCI applications. Further, we expect that the motor imagery training system will be useful not only for BCI applications, but for functional brain mapping studies that utilize motor imagery tasks as well.

J Neurosci Methods. 2009 Apr 30;179(1):150-6. Epub 2009 Jan 29. Hwang HJ, Kwon K, Im CH. Department of Biomedical Engineering, Yonsei University, Wonju-si, Kangwon-do, Republic of Korea.

Full Title: A theory of alpha/theta neurofeedback, creative performance enhancement, long distance functional connectivity and psychological integration

Professionally significant enhancement of music and dance performance and mood has followed training with an EEG-neurofeedback protocol which increases the ratio of theta to alpha waves using auditory feedback with eyes closed. While originally the protocol was designed to induce hypnogogia, a state historically associated with creativity, the outcome was psychological integration, while subsequent applications focusing on raising the theta-alpha ratio, reduced depression and anxiety in alcoholism and resolved post traumatic stress syndrome (PTSD). In optimal performance studies we confirmed associations with creativity in musical performance, but effects also included technique and communication. We extended efficacy to dance and social anxiety. Diversity of outcome has a counterpart in wide ranging associations between theta oscillations and behaviour in cognitive and affective neuroscience: in animals with sensory-motor activity in exploration, effort, working memory, learning, retention and REM sleep; in man with meditative concentration, reduced anxiety and sympathetic autonomic activation, as well as task demands in virtual spatial navigation, focussed and sustained attention, working and recognition memory, and having implications for synaptic plasticity and long term potentiation. Neuroanatomical circuitry involves the ascending mescencephalic-cortical arousal system, and limbic circuits subserving cognitive as well as affective/motivational functions. Working memory and meditative bliss, representing cognitive and affective domains, respectively, involve coupling between frontal and posterior cortices, exemplify a role for theta and alpha waves in mediating the interaction between distal and widely distributed connections. It is posited that this mediation in part underpins the integrational attributes of alpha-theta training in optimal performance and psychotherapy, creative associations in hypnogogia, and enhancement of technical, communication and artistic domains of performance in the arts.

Cogn Process. 2009 Feb;10 Suppl 1:S101-9. Epub 2008 Dec 11. Gruzelier J. Department of Psychology, Goldsmiths, University of London, Lewisham Way, New Cross, London, SE14 6NW, UK. j.gruzelier@gold.ac.uk

According to DSM-IV, personality disorder constitutes a class only when personality traits are inflexible and maladaptive and cause either significant functional impairment or subjective distress. Classical treatment of choice for personality disorders has been psychotherapy and/or psychopharmacotherapy. Our study is to determine if subjects with antisocial personality disorders will benefit from quantitative EEG (qEEG) guided neurofeedback treatment. Thirteen subjects (9 male, 4 female) ranged in age from 19 to 48 years. All the subjects were free of medications and illicit drugs. We excluded subjects with other mental disorders by clinical assessment. Psychotherapy or psychopharmacotherapy or any other treatment model was not introduced to any of the subjects during or after neurofeedback treatment. For the subject who did not respond to neurofeedback, training was applied with 38 sessions of LORETA neurofeedback training without success. Evaluation measures included qEEG analysis with Nx Link data base, MMPI, T.O.V.A tests and SA-45 questionaries at baseline, and at the end of neurofeedback treatment. Lexicor qEEG signals were sampled at 128 Hz with 30 minutes-neurofeedback sessions completed between 80-120 sessions depending on the case, by Biolex neurofeedback system. At baseline and after every 20 sessions, patients were recorded with webcam during the interview. Twelve out of 13 subjects who received 80-120 sessions of neurofeedback training showed significant improvement based on SA-45 questionaries, MMPI, T.O.V.A. and qEEG/Nx Link data base (Neurometric analysis) results, and interviewing by parent/family members. Neurofeedback can change the view of psychiatrists and psychologists in the future regarding the treatment of personality disorders. This study provides the first evidence for positive effects of neurofeedback treatment in antisocial personality disorders. Further study with controls is warranted.

Clin EEG Neurosci. 2009 Jan;40(1):5-10. Surmeli T, Ertem A. Living Health Center for Research and Education, Gazeteciler Mah. Saglam Fikir Sokak. No: 17 Esentepe, Sisli, Istanbul 34387, Turkey. neuropsychiatry@yahoo.com

Full Title: Differentiating a network of executive attention: LORETA neurofeedback in anterior cingulate and dorsolateral prefrontal cortices

INTRODUCTION: This study examines the differential effects of space-specific neuro-operant learning, utilizing low-resolution electromagnetic tomographic (LORETA) neurofeedback in three regions of training (ROTs), namely, the anterior cingulate gyrus (AC) and right and left dorsolateral prefrontal cortices (RPFC and LPFC respectively). METHODS: This study was conducted with 14 nonclinical students with a mean age of 22. We utilized electrophysiological measurements and subtests of the WAIS-III for premeasures and postmeasures. RESULTS: The data indicate that the AC shares a significant association with the RPFC and LPFC; however, each of the ROTs exhibits different cortical effects in all frequencies when trained exclusively. DISCUSSION: LORETA neurofeedback (LNFB) appears to enhance the functioning and strengthening of networks of cortical units physiologically related to each ROT; moreover, significant changes are mapped for each frequency domain, showing the associations within this possible attentional network.

Int J Neurosci. 2009;119(3):404-41. Cannon R, Congedo M, Lubar J, Hutchens T. Brain Research and Neuropsychology Laboratory Department of Psychology, Suite 312 Austin Peay Bldg, University of Tennessee, Knoxville, TN 37996, USA. rcannon2@utk.edu

Full Title: Power spectral frequency and coherence abnormalities in patients with intractable epilepsy and their usefulness in long-term remediation of seizures using neurofeedback

Medically intractable seizures appear to be highly correlated with focal slow activity (delta or theta). They also correlate highly with decreases in the coherence of theta. Normalization of focal slowing and of decreased theta coherence will probably be the neurofeedback approaches most likely to decrease or eliminate seizures in future cases. Neurofeedback has been used for over 35 years to reduce the incidence and severity of seizures. With power training to decrease theta and increase the sensorimotor rhythm (12-15 Hz), an average of 82% of patients experienced a significant reduction in seizure frequency, and occasional remissions were seen. Recent improvements using QEEG to guide neurofeedback training have made it possible to eliminate seizures in most patients, even those with intractable seizures. Following our previous study in 2005, we report an additional 25 patients so treated. We also report an analysis of the frequency of QEEG abnormalities in this patient group. All of the intractable epileptic patients had one or more slow foci (excessive theta or delta compared with the normal database). One third had a relative deficiency of beta power. One fourth had a deficiency of absolute delta. Eighteen percent had excessive absolute alpha power, 18% had deficient absolute alpha power, 18% percent had excessive absolute beta power, and 18% percent had deficient absolute beta power. Hypocoherence of theta was found in 75%, and decreases in alpha coherence were noted in 42%. Hypocoherence of beta was found in 50%, and hypocoherence of delta was found in 25%. Increases in alpha coherence were noted in 33%. Seventeen percent had no coherence abnormalities. When most of the power and coherence abnormalities were normalized with neurofeedback training, all the patients became seizure-free; 76% no longer required an anticonvulsant for seizure control.

Clin EEG Neurosci. 2008 Oct;39(4):203-5. Walker JE. Neurotherapy Center of Dallas, 12870 Hillcrest, Dallas, Texas 75230, USA. admin@neurotherapydallas.com

The objective of this work was to explore Neurofeedback (NFB) effects on EEG current sources in Learning Disabled (LD) children, and to corroborate its beneficial consequences on behavioral and cognitive performance. NFB was given in twenty 30-min sessions to 11 LD children to reduce their abnormally high theta/alpha ratios (Experimental Group). Another five LD children with the same characteristics received a placebo treatment (Control Group). In the Control Group no changes in behavior or EEG current source were observed. In the Experimental Group, immediately after treatment children showed behavioral and cognitive improvements, but current source analysis showed few modifications; however, 2 months after treatment many changes occurred: a decrease in current of frequencies within the theta band, mainly in left frontal and cingulate regions, and enhancement in current of frequencies within the alpha band, principally in the right temporal lobe and right frontal regions, and of frequencies within the beta band, mainly in left temporal, right frontal and cingulate cortex regions. In conclusion, NFB is a possibly efficacious treatment for LD children with an abnormally high theta/alpha ratio in any lead. The changes observed in EEG current sources may reflect the neurophysiological bases of the improvement that children experienced in their behavioral and cognitive activities.

Appl Psychophysiol Biofeedback. 2007 Dec;32(3-4):169-83. Epub 2007 Nov 3. An exploratory study.Fernández T, Harmony T, Fernández-Bouzas A, Díaz-Comas L, Prado-Alcalá RA, Valdés-Sosa P, Otero G, Bosch J, Galán L, Santiago-Rodríguez E, Aubert E, García-Martínez F. Departamento de Neurobiología Conductual y Cognitiva, Instituto de Neurobiología, Campus UNAM-UAQ, Universidad Nacional Autónoma de México, Boulevard Juriquilla # 3001, Juriquilla, Querétaro, 76230, Mexico. thalia@servidor.unam.mx

by Debra Burdick, LCSW

Imagine a world where you could place electrodes on your head, send your brainwaves to a computer, and control a video game without using your hands, just by changing your brainwaves. Picture a world where you could teach your brain to perform better. Perhaps you could improve your IQ, concentrate better, or sleep better. Maybe you could organize better at work, close more sales, get better grades, or be more productive. Maybe you could spiff up your memory that you have noticed is slipping lately. Visualize getting rid of that chronic depression or those nasty panic attacks and eliminating those medications you hate to take.

[More]

by Debra Burdick, LCSW

Although parenting can be one of the most rewarding and joyful roles in the world, at the same time it can also be one of the most demanding, frustrating, exhausting and even overwhelming jobs in the world. If you are like most parents, you know that parenting a child can sometimes be really hard. Parents are on demand 24/7.

[More]

by Debra Burdick, LCSW

We often hear about Attention Deficit/Hyperactivity disorder (ADD/ADHD) in our lives today. Have you ever wondered if you have it, or perhaps your child or spouse? In fact, ADHD was diagnosed in approximately 8%-10% of the school-age population in the 2000 census, 60% of whom eventually become adults with ADHD. This translates into approximately 4% of adults. That's a lot of people.

[More]

by Debra Burdick, LCSW

Did you know that 75-90% of all visits to primary care physicians are due to stress-related illness? We've all heard about stress: what causes it, what it does to us. But have you really thought about the stressors in your life? And have you developed healthy habits for managing stress?

[More]

by Debra Burdick, LCSW

Everyone has normal ups and downs in how they feel. Sometimes an episode of feeling down or sad turns into Depression and persists for some time. And sometimes depression is a result of a medical condition. Whether you bounce back quickly from feeling depressed or whether you suffer from chronic or recurrent episodes of Major Depression, use the following suggestions to help yourself feel better.

[More]

by Debra Burdick, LCSW

Until the last 10-15 years, scientist believed that our brains were essentially hardwired and we were not able to change them much over our lifetime. More recent research has proven without a doubt that we do have the ability to change our minds; that in fact we can actually change the neurons and neuronal networks in our brains.

[More]

by Debra Burdick, LCSW

Protecting your brain is an extremely important component of optimum brain fitness. Damage can occur in a variety of ways including obvious ones like accidents and illness. But be wary of those cleaning products and even cosmetics that we expose ourselves and our children to on a routine basis. Just think how your bathroom smells after a shower or a cleaning. Many of those fragrances and chemicals act as neurotoxins to our brain. One author calls this 'chemical brain injury'.

[More]

Electroencephalogram (EEG) signals are highly subject-specific and vary considerably even between recording sessions of the same user within the same experimental paradigm. This challenges a stable operation of Brain-Computer Interface (BCI) systems. The classical approach is to train users by neurofeedback to produce fixed stereotypical patterns of brain activity. In the machine learning approach, a widely adapted method for dealing with those variances is to record a so called calibration measurement on the beginning of each session in order to optimize spatial filters and classifiers specifically for each subject and each day. This adaptation of the system to the individual brain signature of each user relieves from the need of extensive user training. In this paper we suggest a new method that overcomes the requirement of these time-consuming calibration recordings for long-term BCI users. The method takes advantage of knowledge collected in previous sessions: By a novel technique, prototypical spatial filters are determined which have better generalization properties compared to single-session filters. In particular, they can be used in follow-up sessions without the need to recalibrate the system. This way the calibration periods can be dramatically shortened or even completely omitted for these 'experienced' BCI users. The feasibility of our novel approach is demonstrated with a series of online BCI experiments. Although performed without any calibration measurement at all, no loss of classification performance was observed.

PLoS ONE. 2008 Aug 13;3(8):e2967. Krauledat M, Tangermann M, Blankertz B, Müller KR. Machine Learning Laboratory, Berlin Institute of Technology, Berlin, Germany. kraulem@cs.tu-berlin.de

Electrical recordings from the surface of the skull have a wide range of rhythmic components. A major task of analysis of this EEG is to determine their source and functional significance. The hippocampal "theta rhythm" has been extensively studied in rats and its rhythmicity has recently been shown to be functionally significant, per se. Here, we use relevant aspects of the hippocampal literature to provide perspective on one of the most studied human EEG rhythms: frontal-midline theta.

[More]

The aim of this study was to determine the effects of alpha neurofeedback and EMG biofeedback protocols for improvement of musical performance in violinists. The sample consisted of 12 music students (10 violinists and 2 viola players) from the Faculty of Music, Skopje (3 males, mean age of 20 +/- 0 and 9 females, mean age = 20.89 +/- 2.98). Six of them had a low alpha peak frequency (APF) (< 10 Hz), and six a high APF (> 10 Hz). The sample was randomized in two groups.

[More]

The study of arousal and attention could be of prominent importance for elucidating both fundamental and practical aspects of the mind-brain puzzle. Defined as "general activation of mind" (Kahnemann in Attention and effort. Prentice-Hall, New Jersey, 1973), or "general operation of consciousness" (Thacher and John in Functional euroscience: foundations of cognitive processing. Erlbaum, Hillsdale, 1977), arousal can be considered as a starting point of fundamental research on consciousness.

[More]

The development of psychotherapy has been based on psychological theories and clinical effects. However, an investigation of the neurobiological mechanisms of psychological interventions is also needed in order to improve indication and prognosis, inform the choice of parallel pharmacotherapy, provide outcome measures and potentially even aid the development of new treatment protocols. This neurobiological investigation can be informed by animal models, for example of learning and conditioning, but will essentially need the non-invasive techniques of functional neuroimaging in order to assess psychotherapy effects on patients' brains, which will be reviewed here. Most research so far has been conducted in obsessive compulsive disorder (OCD), anxiety disorders and depression. Effects in OCD were particularly exciting in that both cognitive behavioural therapy and medication with a selective serotonin inhibitor led to a reduction in blood flow in the caudate nucleus. In phobia, brief courses of behavioural therapy produced marked reductions of paralimbic responses to offensive stimuli in line with the clinical improvement. Findings in depression are less consistent, with both increases and decreases in prefrontal metabolism being reported. However, they are important in pointing to different mechanisms for the clinical effects of pharmacotherapy (more "bottom up") and psychotherapy (more "top down"). For the future it would be desirable if the findings of psychotherapy changes to brain activation patterns were confirmed in larger groups with homogenous imaging protocols. Functional imaging has already made great contributions to the understanding of the neural correlates of psychopathology. For example, evidence converges to suggest that the subgenual cingulate is crucial for mood regulation. One current clinical application of these findings is deep brain stimulation in areas highlighted by such imaging studies. I will discuss their initial application in depression and OCD, and suggest potential alternative options based on recent developments in neurofeedback technology.

Eur Arch Psychiatry Clin Neurosci. 2008 Nov;258 Suppl 5:71-5. Linden DE. School of Psychology and North Wales Clinical School, Bangor University, Brigantia Building, Bangor, Wales, UK. d.linden@bangor.ac.uk

Neurofeedback of functional magnetic resonance imaging (fMRI) can be used to acquire selective control over activation in circumscribed brain areas, potentially inducing behavioral changes, depending on the functional role of the targeted cortical sites. In the present study, we used fMRI-neurofeedback to train subjects to enhance regional activation in the right inferior frontal gyrus (IFG) to influence speech processing and to modulate language-related performance. Seven subjects underwent real-time fMRI-neurofeedback training and succeeded in achieving voluntary regulation of their right Brodmann's area (BA) 45. To examine short-term behavioral impact, two linguistic tasks were carried out immediately before and after the training. A significant improvement of accuracy was observed for the identification of emotional prosodic intonations but not for syntactic processing. This evidence supports a role for the right IFG in the processing of emotional information and evaluation of affective salience. The present study confirms the efficacy of fMRI-biofeedback for noninvasive self-regulation of circumscribed brain activity. Hum Brain Mapp, 2008. (c) 2008 Wiley-Liss, Inc.

Rota G, Sitaram R, Veit R, Erb M, Weiskopf N, Dogil G, Birbaumer N. Institute for Natural Language Processing, University of Stuttgart, Stuttgart, Germany. Hum Brain Mapp. 2008 Jul 25.

OBJECTIVE: Half of the adults in the United States use complementary and alternative medicine with mind-body therapy being the most commonly used form. Neurology patients often turn to their physicians for insight into the effectiveness of the therapies and resources to integrate them into their care. The objective of this article is to give a clinical overview of mind-body interventions and their applications in neurology. METHODS: Medline and PsychInfo were searched on mind-body therapies and neurologic disease search terms for clinical trials and reviews and published evidence was graded. RESULTS: Meditation, relaxation, and breathing techniques, yoga, tai chi, and qigong, hypnosis, and biofeedback are described. Mind-body therapy application to general pain, back and neck pain, carpal tunnel syndrome, headaches, fibromyalgia, multiple sclerosis, epilepsy, muscular dysfunction, stroke, aging, Parkinson disease, stroke, and attention deficit-hyperactivity disorder are reviewed. CONCLUSIONS: There are several conditions where the evidence for mind-body therapies is quite strong such as migraine headache. Mind-body therapies for other neurology applications have limited evidence due mostly to small clinical trials and inadequate control groups.

Wahbeh H, Elsas SM, Oken BS. Department of Neurology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Mail Code CR120, Portland, OR 97239, USA. Neurology. 2008 Jun 10;70(24):2321-8.

OBJECTIVE: Half of the adults in the United States use complementary and alternative medicine with mind-body therapy being the most commonly used form. Neurology patients often turn to their physicians for insight into the effectiveness of the therapies and resources to integrate them into their care. The objective of this article is to give a clinical overview of mind-body interventions and their applications in neurology. METHODS: Medline and PsychInfo were searched on mind-body therapies and neurologic disease search terms for clinical trials and reviews and published evidence was graded. RESULTS: Meditation, relaxation, and breathing techniques, yoga, tai chi, and qigong, hypnosis, and biofeedback are described. Mind-body therapy application to general pain, back and neck pain, carpal tunnel syndrome, headaches, fibromyalgia, multiple sclerosis, epilepsy, muscular dysfunction, stroke, aging, Parkinson disease, stroke, and attention deficit-hyperactivity disorder are reviewed. CONCLUSIONS: There are several conditions where the evidence for mind-body therapies is quite strong such as migraine headache. Mind-body therapies for other neurology applications have limited evidence due mostly to small clinical trials and inadequate control groups.

Neurology. 2008 Jun 10;70(24) Wahbeh H, Elsas SM, Oken BS. Department of Neurology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Mail Code CR120, Portland, OR 97239, USA.

The self-paced control paradigm enables users to operate brain-computer interfaces (BCI) in a more natural way: no longer is the machine in control of the timing and speed of communication, but rather the user is. This is important to enhance the usability, flexibility, and response time of a BCI. In this work, we show how subjects, after performing cue-based feedback training (smiley paradigm), learned to navigate self-paced through the "freeSpace" virtual environment (VE). Similar to computer games, subjects had the task of picking up items by using the following navigation commands: rotate left, rotate right, and move forward ( three classes). Since the self-paced control paradigm allows subjects to make voluntary decisions on time, type, and duration of mental activity, no cues or routing directives were presented. The BCI was based only on three bipolar electroencephalogram channels and operated by motor imagery. Eye movements (electrooculogram) and electromyographic artifacts were reduced and detected online. The results of three able-bodied subjects are reported and problems emerging from self-paced control are discussed.

IEEE Trans Biomed Eng. 2008 Feb;55(2):675-82. Scherer R, Lee F, Schlogl A, Leeb R, Bischof H, Pfurtscheller G. Laboratory of Brain-Computer Interfaces, Institute for Knowledge Discovery, Graz University of Technology, Graz 8010, Austria. reinhold.scherer@tugraz.at

The effects of alpha-neurofeedback (ANF) on electroencephalographic alpha-activity were investigated. Each session consisted of a 2.5-min eye-opened state and 17.5-min of ANF, which was divided into 16 1.25-min bins. Alpha amplitudes were gradually increased as the session was repeated. The maximum value at the start of ANF gradually decreased as time passed, but the slowdown of alpha-activity during each session was decreased as the session was repeated. The correlation between alpha-activity at the end of ANF and at the following session's eye-opened state was highly significant. These results showed that ANF enhances the ability of alpha-activity to maintain itself rather than the increase of alpha-amplitude during intrasession and that the maintained alpha-activity during former training remained until the next session.

Neuroreport. 2008 Feb 12;19(3):315-7. Cho MK, Jang HS, Jeong SH, Jang IS, Choi BJ, Lee MG. Department of Pharmacology, Kyungpook National University, Daegu, Republic of Korea.

EEG Biofeedback (Neurofeedback-NFB) is a learning strategy that enables people to alter their brainwaves. In the present case study, we applied a NFB protocol on three patients with Fibromyalgia Syndrome (FMS). The existing symptoms and clinical conditions of the patients attributed to FMS, Visual Analog Scale for pain and fatigue, Hamilton Depression and Anxiety Inventory Scales, Beck Depression and Anxiety Inventory Scales, and SF-36 were recorded before and after NFB training. Most of the symptoms were decreased after ten sessions. There was also improvement in all of the scales after the treatment. The results of the present study may suggest NFB training as a novel treatment method in FMS.

Agri. 2007 Jul;19(3):47-53. Kay?ran S, Dursun E, Ermutlu N, Dursun N, Karamürsel S. Kocaeli University, Faculty of Medicine, Department of Physical Medicine and Rehabilitation, Kocaeli, Turkey.

Muscle and eye movement artifacts are very prominent in the ictal EEG of patients suffering from epilepsy, thus making the dipole localization of ictal activity very unreliable. Recently, two techniques (BSS-CCA and pSVD) were developed to remove those artifacts. The purpose of this study is to assess whether the removal of muscle and eye movement artifacts improves the EEG dipole source localization. We used a total of 8 EEG fragments, each from another patient, first unfiltered, then filtered by the BSS-CCA and pSVD. In both the filtered and unfiltered EEG fragments we estimated multiple dipoles using RAP-MUSIC. The resulting dipoles were subjected to a K-means clustering algorithm, to extract the most prominent cluster. We found that the removal of muscle and eye artifact results to tighter and more clear dipole clusters. Furthermore, we found that localization of the filtered EEG corresponded with the localization derived from the ictal SPECT in 7 of the 8 patients. Therefore, we can conclude that the BSS-CCA and pSVD improve localization of ictal activity, thus making the localization more reliable for the presurgical evaluation of the patient.

Conf Proc IEEE Eng Med Biol Soc. 2006;1:1002-5. Hallez H, Vergult A, Phlypo R, Van Hese P, De Clercq W, D'Asseler Y, Van de Walle R, Vanrumste B, Van Paesschen W, Van Huffel S, Lemahieu I. Dept. of Electron. & Inf. Syst., Ghent Univ.

by Jonathan D. Cowan, Ph.D.

(This is an abstract from an article which appeared in Subtle Energies & Energy Medicine Volume Seventeen, Number Two)

This paper proposes a new understanding of the relationship between brain, mind and other biofields based in the emergent properties of the brain's parallel structure, which creates a brain "laser." Several thalamocoritical rhythms, including a 40 cycle per second oscillation associated with event scanning and a faster EEG rhythm found in healers and others, are hypothesized to give rise to coherent electromagnetic radiation, as well as multifaceted coherent radiation in the additional dimensions posited by string theory. These rhythms cause repetitive excitation of the sugar/protein coatings of the parallel axons of the thalamocoratical columns. The synchronous excitation of these glycocalyxes of the parallel columns will cause similar chemical bonds to resonate and entrain one another, giving rise to coherent radiation. This electromagnetic/multifaceted radiation forms highly complex interference patterns (termed "mentaholomorphic fields") when they interact with each other and the electromagnetic/multifaceted activity in the cortical layers. The resulting mentaholomorphic fields may be related to thought, mind and particular sates of consciousness.

Jonathan D. Cowan, Ph.D. Peak Achievement Training 1103 Hollendale Way. Goshen, KY 40026 jon@peakachievement.com

Hypnosis has been shown to be efficacious in a range of clinical conditions, including the management of chronic pain. However, not all individuals are able to enter a hypnotic state, thereby limiting the clinical utility of this technique. We sought to determine whether hypnotic susceptibility could be increased using three methods thought to facilitate relaxation, with particular interest in an EEG neurofeedback protocol which elevated the theta to alpha ratio. This was compared with progressive muscle relaxation and self-hypnosis. Ten subjects with moderate levels of susceptibility (2-7/12) were randomly assigned to each condition and assessed for hypnotic susceptibility prior to and upon completion of 10 sessions of training. Hypnotic susceptibility increased post-training in all groups, providing further evidence that operant control over the theta/alpha ratio is possible, but contrary to our predictions, elevation of the theta/alpha ratio proved no more successful than the other interventions. Nonetheless, all three techniques successfully enhanced hypnotic susceptibility in over half of the participants (17/30), a similar incidence to that reported using other methods. As previously reported, the majority who were not susceptible to modification were at the lower levels of susceptibility, and the greater increases tended to occur in the more susceptible subjects. However, here enhancement was disclosed in some at low levels, and capability was found of reaching high levels, both features not typically reported. Further research is warranted.

Brain Res Bull. 2006 Dec 11;71(1-3):83-90. Batty MJ, Bonnington S, Tang BK, Hawken MB, Gruzelier JH. Imperial College, London W6 8RP, UK.

Two high resolution methods solving inverse problems potentially ill-posed, named 4-MUSIC and 4-RapMUSIC, are proposed. They allow for localization of brain current sources with unconstrained orientations from surface electro-or magneto-encephalographic data using spherical or realistic head geometries. The 4-MUSIC and 4-RapMUSIC methods are based on i) the separability of the data transfer matrix as a function of location and orientation parameters and ii) the fourth order (FO) virtual array theory. In addition, 4-RapMUSIC uses the deflation concept extended to FO statistics accounting for the presence of potentially but not totally coherent sources. Computer results display the superiority of the 4-RapMUSIC approach in different situations (two closed sources, additive Gaussian noise with unknown spatial covariance, ...) especially over classical algorithms.

Conf Proc IEEE Eng Med Biol Soc. 2006;1:4498-501. Albera L, Ferreol A, Cosandier-Rimele D, Merlet I, Wendling F. Lab. Traitement du Signal et de 1'Image, Rennes I Univ.

This paper attempts to make use of brain computer interface (BCI) in implementing an application called the media communication center for the paralyzed people. The application is based on the event-related potential called P300 to perform button selections on media and communication programs such as the mp3 player, video player, photo gallery and e-book. One of the key issues in such system is the usability. We study how various tasks affect the application operation, in particular, how typical mental activities cause false trigger during the operation of the application. We study the false acceptance rate under the conditions of closing eyes, reading a book, listening to music and watching a video. Data from 5 subjects is used to obtain the false rejection rate and false acceptance rate of the BCI system. Our study shows that different mental activities show different impacts on the false acceptance performances.

Conf Proc IEEE Eng Med Biol Soc. 2006;1:2954-7. Teo E, Huang A, Lian Y, Guan C, Li Y, Zhang H. Nat. Univ. of Singapore.

A previous design of a biofeedback system for Neurorehabilitation in an interactive multimodal environment has demonstrated the potential of engaging stroke patients in task-oriented neuromotor rehabilitation. This report explores the new concept and alternative designs of multimedia based biofeedback systems. In this system, the new interactive multimodal environment was constructed with abstract presentation of movement parameters. Scenery images or pictures and their clarity and orientation are used to reflect the arm movement and relative position to the target instead of the animated arm. The multiple biofeedback parameters were classified into different hierarchical levels w.r.t. importance of each movement parameter to performance. A new quantified measurement for these parameters were developed to assess the patient's performance both real-time and offline. These parameters were represented by combined visual and auditory presentations with various distinct music instruments. Overall, the objective of newly designed system is to explore what information and how to feedback information in interactive virtual environment could enhance the sensorimotor integration that may facilitate the efficient design and application of virtual environment based therapeutic intervention.

Conf Proc IEEE Eng Med Biol Soc. 2006;1:4925-8. Huang H, Chen Y, Xu W, Sundaram H, Olson L, Ingalls T, Rikakis T, He J. Harrington Dept. of Bioeng., Biodesign Inst., Tempe, AZ.

Hypnosis has been shown to be efficacious in a range of clinical conditions, including the management of chronic pain. However, not all individuals are able to enter a hypnotic state, thereby limiting the clinical utility of this technique. We sought to determine whether hypnotic susceptibility could be increased using three methods thought to facilitate relaxation, with particular interest in an EEG neurofeedback protocol which elevated the theta to alpha ratio. This was compared with progressive muscle relaxation and self-hypnosis. Ten subjects with moderate levels of susceptibility (2-7/12) were randomly assigned to each condition and assessed for hypnotic susceptibility prior to and upon completion of 10 sessions of training. Hypnotic susceptibility increased post-training in all groups, providing further evidence that operant control over the theta/alpha ratio is possible, but contrary to our predictions, elevation of the theta/alpha ratio proved no more successful than the other interventions. Nonetheless, all three techniques successfully enhanced hypnotic susceptibility in over half of the participants (17/30), a similar incidence to that reported using other methods. As previously reported, the majority who were not susceptible to modification were at the lower levels of susceptibility, and the greater increases tended to occur in the more susceptible subjects. However, here enhancement was disclosed in some at low levels, and capability was found of reaching high levels, both features not typically reported. Further research is warranted.

Brain Res Bull. 2006 Dec 11;71(1-3):83-90. Epub 2006 Sep 1.

Batty MJ, Bonnington S, Tang BK, Hawken MB, Gruzelier JH.

Imperial College, London W6 8RP, UK.

BACKGROUND: Neurofeedback (NF) is a form of behavioural training aimed at developing skills for self-regulation of brain activity. Within the past decade, several NF studies have been published that tend to overcome the methodological shortcomings of earlier studies. This annotation describes the methodical basis of NF and reviews the evidence base for its clinical efficacy and effectiveness in neuropsychiatric disorders. METHODS: In NF training, self-regulation of specific aspects of electrical brain activity is acquired by means of immediate feedback and positive reinforcement. In frequency training, activity in different EEG frequency bands has to be decreased or increased. Training of slow cortical potentials (SCPs) addresses the regulation of cortical excitability. RESULTS: NF studies revealed paradigm-specific effects on, e.g., attention and memory processes and performance improvements in real-life conditions, in healthy subjects as well as in patients. In several studies it was shown that children with attention-deficit hyperactivity disorder (ADHD) improved behavioural and cognitive variables after frequency (e.g., theta/beta) training or SCP training. Neurophysiological effects could also be measured. However, specific and unspecific training effects could not be disentangled in these studies. For drug-resistant patients with epilepsy, significant and long-lasting decreases of seizure frequency and intensity through SCP training were documented in a series of studies. For other child psychiatric disorders (e.g., tic disorders, anxiety, and autism) only preliminary investigations are available. CONCLUSIONS: There is growing evidence for NF as a valuable treatment module in neuropsychiatric disorders. Further, controlled studies are necessary to establish clinical efficacy and effectiveness and to learn more about the mechanisms underlying successful training.

J Child Psychol Psychiatry. 2007 Jan;48(1):3-16.

Heinrich H, Gevensleben H, Strehl U.

Child & Adolescent Psychiatry, University of Erlangen-Nürnberg, Germany. hheinri@arcor.de

Neurofeedback (NF) is an electroencephalographic (EEG) biofeedback technique for training individuals to alter their brain activity via operant conditioning. Research has shown that NF helps reduce symptoms of several neurological and psychiatric disorders, with ongoing research currently investigating applications to other disorders and to the enhancement of non-disordered cognition. The present article briefly reviews the fundamentals and current status of NF therapy and research and illustrates the basic approach with an interim report on a pilot study aimed at developing a new NF protocol for improving cognitive function in the elderly. EEG peak alpha frequency (PAF) has been shown to correlate positively with cognitive performance and to correlate negatively with age after childhood. The present pilot study used a double-blind controlled design to investigate whether training older individuals to increase PAF would result in improved cognitive performance. The results suggested that PAF NF improved cognitive processing speed and executive function, but that it had no clear effect on memory. In sum, the results suggest that the PAF NF protocol is a promising technique for improving selected cognitive functions.

Clin Neuropsychol. 2007 Jan;21(1):110-29.

Angelakis E, Stathopoulou S, Frymiare JL, Green DL, Lubar JF, Kounios J.

Department of Psychology, Drexel University, Philadelphia, PA 19102-1192, USA.

Recent advances in functional magnetic resonance imaging (fMRI) data acquisition and processing techniques have made real-time fMRI (rtfMRI) of localized brain areas feasible, reliable and less susceptible to artefacts. Previous studies have shown that healthy subjects learn to control local brain activity with operant training by using rtfMRI-based neurofeedback. In the present study, we investigated whether healthy subjects could voluntarily gain control over right anterior insular activity. Subjects were provided with continuously updated information of the target ROI's level of activation by visual feedback. All participants were able to successfully regulate BOLD-magnitude in the right anterior insular cortex within three sessions of 4 min each. Training resulted in a significantly increased activation cluster in the anterior portion of the right insula across sessions. An increased activity was also found in the left anterior insula but the percent signal change was lower than in the target ROI. Two different control conditions intended to assess the effects of non-specific feedback and mental imagery demonstrated that the training effect was not due to unspecific activations or non feedback-related cognitive strategies. Both control groups showed no enhanced activation across the sessions, which confirmed our main hypothesis that rtfMRI feedback is area-specific. The increased activity in the right anterior insula during training demonstrates that the effects observed are anatomically specific and self-regulation of right anterior insula only is achievable. This is the first group study investigating the volitional control of emotionally relevant brain region by using rtfMRI training and confirms that self-regulation of local brain activity with rtfMRI is possible.

Neuroimage. 2007 Apr 15;35(3):1238-46. Epub 2007 Jan 31.

Caria A, Veit R, Sitaram R, Lotze M, Weiskopf N, Grodd W, Birbaumer N.

Institute of Medical Psychology and Behavioral Neurobiology, Eberhard-Karls-University of Tübingen, Tübingen, Germany. andrea.caria@uni-tuebingen.de