AMPLITUDE NEUROFEEDBACK: A REVIEW OF THE RESEARCH

Transcription

1 AMPLITUDE NEUROFEEDBACK: A REVIEW OF THE RESEARCH ANSA CONFERENCE 2018, BRISBANE MOSHE PERL, PHD, BCN, QEEGD, MAPS DAVID PERL, BE(HONS)/BSC info@neurotherapy.com.au

2 Introduction What is the published research on neurofeedback? What can be said about the various neuromodulation modalities available today? Is there evidence that one modality is superior to another? Is there evidence that one modality is better for certain issues, while another modality is better for other issues? This project aims to help answer some of these questions.

3 The project The search began at ISNR reviewing their comprehensive bibliography - I was interested in: When were the studies published? What kinds of neuromodulation techniques were used? How many subjects were involved in these experiments? What disorders?

4 The project Once we started looking, we saw that there were all sorts of other studies in the bibliography. There were many studies on proof of concepts showing that a particular modality was having some effect on brain function, usually not directly clinically relevant. We wanted to know, how many studies measure actual treatment outcomes, as opposed to book chapters, reviews, meta-analyses, non-clinical experiments, etc?

5 The project We decided to only to consider peer reviewed studies. Why? When a study is peer reviewed, one has some assurance that the author of the study has employed at least a modicum of scientific rigour in the preparation of the article, that the outcomes reported seem reasonable and that the methodology is given in enough detail to allow replication.

6 Amplitude neurofeedback For purposes of clarity, I decided to group all amplitude training modalities together. These included: Beta/SMR training Alpha training Alpha-Theta training Theta/beta ratio training and other ratio trainings One case study using Neuro Optimal methodology

7 Other modalities included Slow cortical potential training - SCP QEEG based training Coherence training LENS training 19 channel z-score training Infra low frequency training Haemoencephalography (HEG)

8 Other modalities (cont.) Stimulation Audiovisual entrainment (AVE), including photic stimulation, Roshi Alpha Stim Photic stimulation Vagus stimulation Neurofield magnetic stimulation

9 Other modalities (cont.) Direct current stimulation Transcranial magnetic stimulation fmri neurofeedback

10 Two modalities used in one study Two Modalities Head to Head: 3 randomised control studies (RCT) Both modalities counted (as all studies found both modalities equally beneficial) Two modalities used to treat subject: QEEG based amplitude and coherence 5 studies not counted as cannot determine which modality was crucial to success

11 Classification of type of study We settled on four categories: Case study (1 3 cases) Case series, with pre and post measures. Cherry picking only positive outcome cases was not accepted. Some controls, such as a waiting list control, two groups, one clinical one non-clinical, partial randomisation. Review of past records for somewhat matching clients, who received different treatment was not accepted as a control group. RCT studies, cross over repeated measures with alternate treatment, contrasting two effective modalities with random assignment.

12 Classification of outcome This is a high level study, so we simply classified outcomes as Positive researchers deemed results to be significantly positive Negative researches deemed results to not be significantly positive

13 Classification by date of publication We divided the neuromodulation timeline into three: 2009 the present and earlier

14 Search for other studies Time constraints did not permit search far beyond the ISNR bibliography listing We also looked for additional material on SCP and LENS: Reviewed over 50% of relevant studies from these two sites We will be happy to add other studies to the database we have developed We will be happy to share the database with those interested.

15 Results 690 studies listed on ISNR s bibliography as of April 5, more added for SCP and LENS 4 duplicate errors 146 duplicates studies belonging to more than one condition For these, we currently only list them in their first location i.e. for only one disorder For 73 articles only their abstract was found 33 articles were not found 170 articles were book chapters, reviews, or theoretical 70 articles were studies that did not involve treatment of a disorder 2 articles had flawed methodologies

16 By Year , 89 Pre 1999, , 88

17 By Study Type Case Study, 71 RCT, 44 Control, 58 Case Series, 97

18 By Modality - Overall Modality No. Studies Successful Amplitude SCP QEEG guided 7 7 LENS 7 6 Coherence 3 3 Z Score 7 7 HEG 6 6 Modality No. Studies Successful Infra-low 2 2 Stimulation rtms 3 3 tdcs 1 1 fmri 4 4 Head to head 3 3 Combined 6 6

19 By Modality vs Study Type Modality No. Studies RCT Control Case Series Case Study Amplitude SCP QEEG guided LENS Coherence Z Score HEG

20 By Modality vs Study Type p2 Modality No. Studies RCT Control Case Series Case Study Infra-low Stimulation rtms tdcs fmri Head to head Combined

21 By Disorder Disorder No. ADHD 83 Addiction 17 Anxiety 11 ASD 15 Decline 2 Depression 17 Dissociation 3 Epilepsy 34 Disorder No. Immune System 7 LD 2 Medical 8 OCD 4 Pain / headache 13 Parkinsons 4 Peak 13 Personality disorder 1 Disorder No. Prison 3 PTSD 6 Schizophrenia 2 Sleep 3 TBI 17 FASD 1 Tourettes 1 Anger 1

22 Example Disorder - ADHD Coherenc Head to Total Amplitude SCP HEG Stimulation fmri e Head

23 Example Disorder - Addiction Total Amplitude SCP

24 Example Disorder - Anxiety Total Amplitude LENS

25 Questions / Discussion

26 Conclusions Amplitude training still constitutes the vast majority of studies With neuromodulation methodologies diversifying, we need good studies so that we know which technique works best for which disorder

27 Conclusions roles studies can play Case studies remain very important, especially for clients with unusual presentations Case series give stronger support to a methodology: Strong how to component replicability is the key We need to know your methodology If several practitioners, practicing independently validate a particular approach, with a particular client group, that is very powerful endorsement

28 Conclusions roles studies can play Clinic studies with controls eliminate some of the non-specific/unspecified elements (some say placebo) of the intervention as the cause of change We need studies that are done with controls in a clinical setting for several reasons: We don t really care about the non-specifics, we want to maximise them We don t randomly accept clients they choose us Clinic clients reflect real world conditions the same as what walks through our doors RCTs are best for indicating the specific effect of a treatment. They are needed to help gain mainstream recognition of neuromodulation

29 Conclusions don t worry Don t get overwhelmed by complexity. Amplitude training still works, and still works well. It never didn t work well. Every practitioner in this room, regardless of which modality/form of neuromodulation they use, is working to do the best that they can do to help their clients. And we need to support each other in this endeavour and not get in each other s way.