Time course of clinical change following neurofeedback

ABSTRACT Neurofeedback – learning to modulate brain function through real‐time monitoring of current brain state – is both a powerful method to perturb and probe brain function and an exciting potential clinical tool. For neurofeedback effects to be useful clinically, they must persist. Here we examine the time course of symptom change following neurofeedback in two clinical populations, combining data from two ongoing neurofeedback studies. This analysis reveals a shared pattern of symptom change, in which symptoms continue to improve for weeks after neurofeedback. This time course has several implications for future neurofeedback studies. Most neurofeedback studies are not designed to test an intervention with this temporal pattern of response. We recommend that new studies incorporate regular follow‐up of subjects for weeks or months after the intervention to ensure that the time point of greatest effect is sampled. Furthermore, this time course of continuing clinical change has implications for crossover designs, which may attribute long‐term, ongoing effects of real neurofeedback to the control intervention that follows. Finally, interleaving neurofeedback sessions with assessments and examining when clinical improvement peaks may not be an appropriate approach to determine the optimal number of sessions for an application. HIGHLIGHTSTemporal pattern of symptom change following neurofeedback shared across studies.Symptoms continued to improve for weeks after neurofeedback.Neurofeedback studies should follow up subjects to maximize power.Crossover designs may be contaminated by significant carryover effects.Optimizing number of sessions by embedding assessments not recommended.

[1]  M. Ruf,et al.  Alterations of amygdala-prefrontal connectivity with real-time fMRI neurofeedback in BPD patients. , 2016, Social cognitive and affective neuroscience.

[2]  Jonathan D. Cohen,et al.  Closed-loop training of attention with real-time brain imaging , 2015, Nature Neuroscience.

[3]  T. Deckersbach,et al.  Behavior therapy for children with Tourette disorder: a randomized controlled trial. , 2010, JAMA.

[4]  Gaoyan Zhang,et al.  Functional Alteration of the DMN by Learned Regulation of the PCC Using Real-Time fMRI , 2013, IEEE Transactions on Neural Systems and Rehabilitation Engineering.

[5]  Dimitri Van De Ville,et al.  Maintenance of Voluntary Self-regulation Learned through Real-Time fMRI Neurofeedback , 2017, Front. Hum. Neurosci..

[6]  D. Cohen,et al.  The Yale Global Tic Severity Scale: initial testing of a clinician-rated scale of tic severity. , 1989, Journal of the American Academy of Child and Adolescent Psychiatry.

[7]  D. Keeser,et al.  Short and long-term effects of sham-controlled prefrontal EEG-neurofeedback training in healthy subjects , 2016, Clinical Neurophysiology.

[8]  Michael Erb,et al.  Physiological self-regulation of regional brain activity using real-time functional magnetic resonance imaging (fMRI): methodology and exemplary data , 2003, NeuroImage.

[9]  Aribert Rothenberger,et al.  Neurofeedback in attention-deficit/hyperactivity disorder – different models, different ways of application , 2014, Front. Hum. Neurosci..

[10]  Niels Birbaumer,et al.  Volitional Control of Anterior Insula Activity Modulates the Response to Aversive Stimuli. A Real-Time Functional Magnetic Resonance Imaging Study , 2010, Biological Psychiatry.

[11]  B. Peterson,et al.  Course of Tic Severity in Tourette Syndrome: The First Two Decades , 1998, Pediatrics.

[12]  E. Kandel,et al.  The Molecular and Systems Biology of Memory , 2014, Cell.

[13]  W. Goodman,et al.  The Yale-Brown Obsessive Compulsive Scale. I. Development, use, and reliability. , 1989, Archives of general psychiatry.

[14]  D. O. Hebb,et al.  The organization of behavior , 1988 .

[15]  N. Fineberg,et al.  Remission of obsessive-compulsive disorders and syndromes; evidence from a prospective community cohort study over 30 years , 2013, International journal of psychiatry in clinical practice.

[16]  Jarrod A. Lewis-Peacock,et al.  Closed-loop brain training: the science of neurofeedback , 2017, Nature Reviews Neuroscience.

[17]  W. Singer,et al.  Selection of intrinsic horizontal connections in the visual cortex by correlated neuronal activity. , 1992, Science.

[18]  Han Yuan,et al.  Resting-State Functional Connectivity Modulation and Sustained Changes After Real-Time Functional Magnetic Resonance Imaging Neurofeedback Training in Depression , 2014, Brain Connect..

[19]  Bettina Sorger,et al.  fMRI neurofeedback facilitates anxiety regulation in females with spider phobia , 2015, Front. Behav. Neurosci..

[20]  Nicholas B Turk-Browne,et al.  Neurocognitive therapeutics: from concept to application in the treatment of negative attention bias , 2015, Biology of Mood & Anxiety Disorders.

[21]  Takeo Watanabe,et al.  Learning to Associate Orientation with Color in Early Visual Areas by Associative Decoded fMRI Neurofeedback , 2016, Current Biology.

[22]  L. Yao,et al.  Improved Working Memory Performance through Self-Regulation of Dorsal Lateral Prefrontal Cortex Activation Using Real-Time fMRI , 2013, PloS one.

[23]  Joseph R. Whittaker,et al.  Neurofeedback training for alcohol dependence versus treatment as usual: study protocol for a randomized controlled trial , 2016, Trials.

[24]  Alex Martin,et al.  Direct modulation of aberrant brain network connectivity through real-time NeuroFeedback , 2017, bioRxiv.

[25]  T. Deckersbach,et al.  Randomized trial of behavior therapy for adults with Tourette syndrome. , 2012, Archives of general psychiatry.

[26]  M Agathon,et al.  [Behavior therapy]. , 1978, Psychotherapy and psychosomatics.

[27]  Audra K. Langley,et al.  Controlled comparison of family cognitive behavioral therapy and psychoeducation/relaxation training for child obsessive-compulsive disorder. , 2011, Journal of the American Academy of Child and Adolescent Psychiatry.

[28]  M. Kawato,et al.  Multivoxel neurofeedback selectively modulates confidence without changing perceptual performance , 2016, Nature Communications.

[29]  Dustin Scheinost,et al.  Biofeedback of Real-Time Functional Magnetic Resonance Imaging Data from the Supplementary Motor Area Reduces Functional Connectivity to Subcortical Regions , 2011, Brain Connect..

[30]  Y. Koush,et al.  Upregulation of the Rostral Anterior Cingulate Cortex can Alter the Perception of Emotions: fMRI-Based Neurofeedback at 3 and 7 T , 2014, Brain Topography.

[31]  R. Goebel,et al.  Real-Time Functional Magnetic Resonance Imaging Neurofeedback for Treatment of Parkinson's Disease , 2011, The Journal of Neuroscience.

[32]  D B Abrams,et al.  Effects of behavioral skills training and schedule of nicotine gum administration on smoking cessation. , 1989, The American journal of psychiatry.

[33]  Jerzy Bodurka,et al.  Randomized Clinical Trial of Real-Time fMRI Amygdala Neurofeedback for Major Depressive Disorder: Effects on Symptoms and Autobiographical Memory Recall. , 2017, The American journal of psychiatry.

[34]  Michelle Hampson,et al.  Real-Time fMRI Neurofeedback with War Veterans with Chronic PTSD: A Feasibility Study , 2016, Front. Psychiatry.

[35]  P. Jatlow,et al.  Psychotherapy and pharmacotherapy for ambulatory cocaine abusers. , 1994, Archives of general psychiatry.

[36]  Jong-Hwan Lee,et al.  Functional magnetic resonance imaging-mediated learning of increased activity in auditory areas , 2007, Neuroreport.

[37]  N Birbaumer,et al.  Stability of cortical self‐regulation in epilepsy patients , 1997, Neuroreport.

[38]  Hsin-Chieh Yeh,et al.  Effect of the 2011 vs 2003 duty hour regulation-compliant models on sleep duration, trainee education, and continuity of patient care among internal medicine house staff: a randomized trial. , 2013, JAMA internal medicine.

[39]  Y. Dudai.  The restless engram: consolidations never end. , 2012, Annual review of neuroscience.

[40]  M. Kawato,et al.  Functional MRI neurofeedback training on connectivity between two regions induces long-lasting changes in intrinsic functional network , 2015, Front. Hum. Neurosci..

[41]  R T Constable,et al.  Orbitofrontal cortex neurofeedback produces lasting changes in contamination anxiety and resting-state connectivity , 2013, Translational Psychiatry.

[42]  J. Knott.  The organization of behavior: A neuropsychological theory , 1951 .

[43]  C. Pittenger,et al.  Meta-Analysis of the Symptom Structure of Obsessive-Compulsive Disorder , 2015 .

[44]  A. Ertem,et al.  Obsessive Compulsive Disorder and the Efficacy of qEEG-Guided Neurofeedback Treatment: A Case Series , 2011, Clinical EEG and neuroscience.

[45]  R. Malach,et al.  The Day-After Effect: Long Term, Hebbian-Like Restructuring of Resting-State fMRI Patterns Induced by a Single Epoch of Cortical Activation , 2013, The Journal of Neuroscience.

[46]  T. Surmeli,et al.  Schizophrenia and the Efficacy of qEEG-Guided Neurofeedback Treatment , 2012, Clinical EEG and neuroscience.

[47]  R. Veit,et al.  Self‐regulation of regional cortical activity using real‐time fMRI: The right inferior frontal gyrus and linguistic processing , 2009, Human brain mapping.

[48]  John D E Gabrieli,et al.  Control over brain activation and pain learned by using real-time functional MRI. , 2005, Proceedings of the National Academy of Sciences of the United States of America.

[49]  S. W. Rieger,et al.  Learning Control Over Emotion Networks Through Connectivity‐Based Neurofeedback , 2015, Cerebral cortex.

[50]  Jong-Hwan Lee,et al.  Neurofeedback fMRI-mediated learning and consolidation of regional brain activation during motor imagery , 2008 .

[51]  Mitsuo Kawato,et al.  Decoded fMRI neurofeedback can induce bidirectional confidence changes within single participants , 2017, NeuroImage.

[52]  Julie M. Edmunds,et al.  Evidence Base Update for Psychosocial Treatments for Pediatric Obsessive-Compulsive Disorder , 2014, Journal of clinical child and adolescent psychology : the official journal for the Society of Clinical Child and Adolescent Psychology, American Psychological Association, Division 53.

[53]  W. Goodman,et al.  The Yale-Brown Obsessive Compulsive Scale. II. Validity. , 1989, Archives of general psychiatry.

[54]  Simon W. Bock,et al.  Manipulating motor performance and memory through real-time fMRI neurofeedback , 2015, Biological Psychology.

[55]  Bettina Sorger,et al.  Real-Time Self-Regulation of Emotion Networks in Patients with Depression , 2012, PloS one.