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An Exploratory Study of Intensive Neurofeedback Training for Schizophrenia
Wenya Nan ,1,2 Feng Wan ,2 Lanshin Chang ,3 Sio Hang Pun ,4 Mang I. Vai,2 and Agostinho Rosa 5
Academic Editor: Ting Zhao
www.hindawi.com/journals/bn/2017/6914216/
Abstract
Schizophrenia is a chronic and devastating brain disorder with ongoing cognitive, behavioral, and emotional deteriorated functions. Neurofeedback training, which enables the individuals to regulate their brain activity using a real-time feedback loop, is increasingly investigated as a potential alternative intervention for schizophrenia. This study aimed to explore the effect of short but intensive neurofeedback training for schizophrenic patients with difficulty for long-time training. A middle-aged woman with chronic schizophrenia completed the intensive training of alpha/beta2 (20–30 Hz) in four consecutive days with a total training duration of 13.5 hours. The results showed that her alpha/beta2 increased over sessions, and her behavior performance including short-term memory, mood, and speech pattern was improved at the end of neurofeedback training. Importantly, a 22-month follow-up found a dramatic improvement in both positive and negative symptoms. These positive outcomes suggest that such intensive neurofeedback training may provide new insight into the treatment of schizophrenia and thus deserves further study to fully examine its scope.
1. Introduction
Schizophrenia is regarded as the most devastating brain disorder with ongoing cognitive, behavioral, and emotional deteriorated functions. The life qualities of the schizophrenic patients dramatically decrease. The traditional treatment for schizophrenia is antipsychotic medication. However, antipsychotic medications have side effects when used long term, which leave patients with limited and deteriorated functions. Moreover, antipsychotic medications do not treat negative symptoms effectively [1]. Therefore, current pharmacological treatment is insufficient and the development of new treatment options is necessary.
In recent decades, neurofeedback (NF) as an innovative noninvasive technique aiming at self-regulating the brain activity using a real-time feedback loop mechanism under operant control has been demonstrated more and more benefits on human brain functions and behavior performance for not only healthy people but also patients with a variety of diseases [2–5]. With respect to NF for schizophrenia, some researchers have investigated electroencephalography (EEG) NF as a potential nonpharmaceutical alternative for treatment of schizophrenia. During EEG NF, the EEG signal is recorded from the electrodes placed on human scalp and the relevant EEG components are extracted and fed back to the training individual using an online feedback loop in the form of audio, visual, or their combinations [6]. An earlier study in Gruzelier et al. [7] reported that 16 schizophrenic patients were able to learn control the left-right asymmetry in slow potential negativity at the sensory motor area (C3 and C4). Bolea [8] employed NF on more than 70 hospital inpatients with chronic schizophrenia and found improvements in the EEG patterns and in cognitive, affective, and behavioral patterns. Another study from Surmeli et al. [1] also reported positive effects on 51 inpatients by quantitative EEG- (qEEG-) guided NF training. Besides the EEG NF, with the development of modern real-time brain imaging technology, some studies investigated the feasibility of real-time functional magnetic resonance imaging (rtfMRI) NF in patients with schizophrenia [9–11]. In Ruiz et al. [10], nine schizophrenic patients learned self-control of the blood oxygenation level-dependent (BOLD) signal of the bilateral anterior insula cortex by rtfMRI NF, which led to changes in the perception of emotions and modulations of the brain network connectivity. In addition to anterior insula cortex, the BOLD signal of the anterior cingulate cortex (ACC) could also be successfully regulated by rtfMRI NF, which were associated with symptom enhancement in patients with schizophrenia [9, 11].
The aforementioned EEG NF studies which showed very promising results adopted larger session number, longer training process, and personalized training parameters [1, 8]. Bolea [8] suggested that enhancement of alpha and reduction of fast beta seemed very important in inpatients with chronic schizophrenia, but its process spread longer time and thus it did require patience, while for some schizophrenic patients, it is very difficult to perform the long term NF training. For example, patients who live home will be very difficult to follow NF training for a longer period of time. Thus, we wonder whether short but intensive NF training could also show benefits on patient with schizophrenia. A middle-aged woman with chronic schizophrenia was recommended and voluntarily participated in this study. The NF training was to increase the relative amplitude of alpha/beta2 (20–30 Hz) ratio within four consecutive days for a total training duration of 13.5 hours. Both immediate effect and long-lasting effect of a 22-month follow-up were examined.
Wenya Nan ,1,2 Feng Wan ,2 Lanshin Chang ,3 Sio Hang Pun ,4 Mang I. Vai,2 and Agostinho Rosa 5
Academic Editor: Ting Zhao
www.hindawi.com/journals/bn/2017/6914216/
Abstract
Schizophrenia is a chronic and devastating brain disorder with ongoing cognitive, behavioral, and emotional deteriorated functions. Neurofeedback training, which enables the individuals to regulate their brain activity using a real-time feedback loop, is increasingly investigated as a potential alternative intervention for schizophrenia. This study aimed to explore the effect of short but intensive neurofeedback training for schizophrenic patients with difficulty for long-time training. A middle-aged woman with chronic schizophrenia completed the intensive training of alpha/beta2 (20–30 Hz) in four consecutive days with a total training duration of 13.5 hours. The results showed that her alpha/beta2 increased over sessions, and her behavior performance including short-term memory, mood, and speech pattern was improved at the end of neurofeedback training. Importantly, a 22-month follow-up found a dramatic improvement in both positive and negative symptoms. These positive outcomes suggest that such intensive neurofeedback training may provide new insight into the treatment of schizophrenia and thus deserves further study to fully examine its scope.
1. Introduction
Schizophrenia is regarded as the most devastating brain disorder with ongoing cognitive, behavioral, and emotional deteriorated functions. The life qualities of the schizophrenic patients dramatically decrease. The traditional treatment for schizophrenia is antipsychotic medication. However, antipsychotic medications have side effects when used long term, which leave patients with limited and deteriorated functions. Moreover, antipsychotic medications do not treat negative symptoms effectively [1]. Therefore, current pharmacological treatment is insufficient and the development of new treatment options is necessary.
In recent decades, neurofeedback (NF) as an innovative noninvasive technique aiming at self-regulating the brain activity using a real-time feedback loop mechanism under operant control has been demonstrated more and more benefits on human brain functions and behavior performance for not only healthy people but also patients with a variety of diseases [2–5]. With respect to NF for schizophrenia, some researchers have investigated electroencephalography (EEG) NF as a potential nonpharmaceutical alternative for treatment of schizophrenia. During EEG NF, the EEG signal is recorded from the electrodes placed on human scalp and the relevant EEG components are extracted and fed back to the training individual using an online feedback loop in the form of audio, visual, or their combinations [6]. An earlier study in Gruzelier et al. [7] reported that 16 schizophrenic patients were able to learn control the left-right asymmetry in slow potential negativity at the sensory motor area (C3 and C4). Bolea [8] employed NF on more than 70 hospital inpatients with chronic schizophrenia and found improvements in the EEG patterns and in cognitive, affective, and behavioral patterns. Another study from Surmeli et al. [1] also reported positive effects on 51 inpatients by quantitative EEG- (qEEG-) guided NF training. Besides the EEG NF, with the development of modern real-time brain imaging technology, some studies investigated the feasibility of real-time functional magnetic resonance imaging (rtfMRI) NF in patients with schizophrenia [9–11]. In Ruiz et al. [10], nine schizophrenic patients learned self-control of the blood oxygenation level-dependent (BOLD) signal of the bilateral anterior insula cortex by rtfMRI NF, which led to changes in the perception of emotions and modulations of the brain network connectivity. In addition to anterior insula cortex, the BOLD signal of the anterior cingulate cortex (ACC) could also be successfully regulated by rtfMRI NF, which were associated with symptom enhancement in patients with schizophrenia [9, 11].
The aforementioned EEG NF studies which showed very promising results adopted larger session number, longer training process, and personalized training parameters [1, 8]. Bolea [8] suggested that enhancement of alpha and reduction of fast beta seemed very important in inpatients with chronic schizophrenia, but its process spread longer time and thus it did require patience, while for some schizophrenic patients, it is very difficult to perform the long term NF training. For example, patients who live home will be very difficult to follow NF training for a longer period of time. Thus, we wonder whether short but intensive NF training could also show benefits on patient with schizophrenia. A middle-aged woman with chronic schizophrenia was recommended and voluntarily participated in this study. The NF training was to increase the relative amplitude of alpha/beta2 (20–30 Hz) ratio within four consecutive days for a total training duration of 13.5 hours. Both immediate effect and long-lasting effect of a 22-month follow-up were examined.