Brain Wave Biofeedback: Benefits of Integrating Neurofeedback in Counseling

Consistent with the 2009 Standards of the Council for Accreditation of Counseling and Related Educational Programs, counselors must understand neurobiological behavior in individuals of all developmental levels. This requires understanding the brain and strategies for applying neurobiological concepts in counseling practice, training, and research. Neurofeedback, biofeedback for the brain, is one modality based in neuroscience that empowers individuals to recognize, monitor, and self‐regulate brain wave activity to create greater wellness. Neurofeedback has significant potential in counseling preparation, research, and practice.     

Neurofeedback and the Brain

Neurofeedback is an emerging neuroscience-based clinical application, and understanding the underlying principles of neurofeedback allows the therapist to provide referrals or treatment, and provides clients with a framework for understanding the process. The brain's electrical patterns are a form of behavior, modifiable through “operant conditioning,” with the excessive brain frequencies reduced, and those with a deficit are increased. The learning curve for EEG has been described (Hardt, 1975).     

Neurofeedback Treatment of Depression and Anxiety

A robust body of research documents that there are biological predispositions that often exist for depression, anxiety, and obsessive–compulsive disorder. However, new research has shown that medication is only mildly more effective than placebo in the treatment of these problems. In treating these conditions, neurofeedback (EEG biofeedback) may offer an alternative to invasive treatments such as medication, ECT, and intense levels of transcrancial magnetic stimulation. This paper reviews the neurofeedback literature with these problems, finding particularly positive research support for the treatment of anxiety disorders. New findings on the neurofeedback treatment of depression are presented.     

Neurobiologische Korrelate der Psychotherapie von Zwangsst?rungen

Obsessive-compulsive disorders are associated with different neuropsychological impairments concerning executive functions, error monitoring, decision making and other basic functionalities. Contemporary neurocircuitry models emphasize the dysfunction of the fronto-striato-thalamo-cortical network related to parietal regions, the orbitofrontal cortex, the anterior cingulate cortex and other limbic structures. In brief, studies on the functional neuroanatomy of psychotherapy effects realized by positron emission tomography (PET) and functional magnetic resonance imaging (fMRI) are reported. Perspectives concern combined process-outcome research with repeated neuroimaging and highly resolved (daily) self-ratings focussing the nonlinear dynamics of psychotherapeutic change processes. New therapeutic approaches could explore the combination of psychotherapy with fMRI-based real-time neurofeedback and noninvasive neuromodulation with coordinated reset stimulation focusing on the desynchronization of pathologically oversynchronized neural populations and networks.     

The Development and Experience of Combat‐Related PTSD: A Demand for Neurofeedback as an Effective Form of Treatment

Veterans experience a considerable course of posttraumatic stress disorder (PTSD), and because of several psychosocial issues, traditional interventions and traditional intervention settings are ineffective for this population. A new cutting‐edge approach, known as neurofeedback, trains clients to control and manipulate their central nervous system and ameliorate physiological symptoms of stress disorders. The authors delineate how neurofeedback can be an effective and innovative intervention for PTSD experienced by the military population.     

Evaluating Group-Based Interventions When Control Participants Are Ungrouped

Individually randomized treatments are often administered within a group setting. As a consequence, outcomes for treated individuals may be correlated due to provider effects, common experiences within the group, and/or informal processes of socialization. In contrast, it is often reasonable to regard outcomes for control participants as independent, given that these individuals are not placed into groups. Although this kind of design is common in intervention research, the statistical models applied to evaluate the treatment effects are usually inconsistent with the resulting data structure, potentially leading to biased inferences. This article presents an alternative model that explicitly accounts for the fact that only treated participants are grouped. In addition to providing a useful test of the overall treatment effect, this approach also permits one to formally determine the extent to which treatment effects vary over treatment groups and whether there is evidence that individuals within treatment groups become similar to one another. This strategy is demonstrated with data from the Reconnecting Youth program for high school students at risk of school failure and behavioral disorders.     

赌博障碍的认知功能缺陷及神经基础

赌博障碍是指持续且反复的赌博行为,给个人、家庭和社会都带来了严重后果,近年来受到越来越多研究者的关注。本研究总结了赌博障碍的认知功能缺陷及其神经基础,主要集中在如下四个方面：①认知扭曲、②奖赏和惩罚敏感性、③注意偏向和④决策。未来研究应多从认知神经科学角度深入探究赌博障碍的发生机制和发展过程,关注大脑结构变化及功能网络改变,并将其整合到一个统一的神经生物机制框架中,找到更加有效的干预和治疗手段。     

Integrated Group Psychotherapy Program [IGGP] for Multi-Diagnosed Clients

This article describes a group therapy–centered program geared toward the treatment of individuals with co-occurring disorders, including addictive disorders, borderline personality disorder and other mental health issues which involve difficulties with emotion regulation. Group therapy plays a vital role in their recovery. Over 18 years, the author has developed a treatment model that offers an integrative approach to group therapy and individual treatment encompassing psychodynamic and other empirically based therapies, especially dialectical behavior therapy (DBT). Its value lies in its therapeutic effectiveness with hard to reach clients, in its practice-based evidence, its team-building and management approach, its training component and its capacity for replication.     

Pharmacological treatment effects on eye movement control

The increasing use of eye movement paradigms to assess the functional integrity of brain systems involved in sensorimotor and cognitive processing in clinical disorders requires greater attention to effects of pharmacological treatments on these systems. This is needed to better differentiate disease and medication effects in clinical samples, to learn about neurochemical systems relevant for identified disturbances, and to facilitate identification of oculomotor biomarkers of pharmacological effects. In this review, studies of pharmacologic treatment effects on eye movements in healthy individuals are summarized and the sensitivity of eye movements to a variety of pharmacological manipulations is established. Primary findings from these studies of healthy individuals involving mainly acute effects indicate that: (i) the most consistent finding across several classes of drugs, including benzodiazepines, first- and second- generation antipsychotics, anticholinergic agents, and anticonvulsant/mood stabilizing medications is a decrease in saccade and smooth pursuit velocity (or increase in saccades during pursuit); (ii) these oculomotor effects largely reflect the general sedating effects of these medications on central nervous system functioning and are often dose-dependent; (iii) in many cases changes in oculomotor functioning are more sensitive indicators of pharmacological effects than other measures; and (iv) other agents, including the antidepressant class of serotonergic reuptake inhibitors, direct serotonergic agonists, and stimulants including amphetamine and nicotine, do not appear to adversely impact oculomotor functions in healthy individuals and may well enhance aspects of saccade and pursuit performance. Pharmacological treatment effects on eye movements across several clinical disorders including schizophrenia, affective disorders, attention deficit hyperactivity disorder, Parkinson’s disease, and Huntington’s disease are also reviewed. While greater recognition and investigation into pharmacological treatment effects in these disorders is needed, both beneficial and adverse drug effects are identified. This raises the important caveat for oculomotor studies of neuropsychiatric disorders that performance differences from healthy individuals cannot be attributed to illness effects alone. In final sections of this review, studies are presented that illustrate the utility of eye movements for use as potential biomarkers in pharmacodynamic and pharmacogenetic studies. While more systematic studies are needed, we conclude that eye movement measurements hold significant promise as tools to investigate treatment effects on cognitive and sensorimotor processes in clinical populations and that their use may be helpful in speeding the drug development pathway for drugs targeting specific neural systems and in individualizing pharmacological treatments.     

赌博障碍的认知功能缺陷及神经基础

赌博障碍是指持续且反复的赌博行为,给个人、家庭和社会都带来了严重后果,近年来受到越来越多研究者的关注。本研究总结了赌博障碍的认知功能缺陷及其神经基础,主要集中在如下四个方面：①认知扭曲、②奖赏和惩罚敏感性、③注意偏向和④决策。未来研究应多从认知神经科学角度深入探究赌博障碍的发生机制和发展过程,关注大脑结构变化及功能网络改变,并将其整合到一个统一的神经生物机制框架中,找到更加有效的干预和治疗手段。     

Pharmacological treatment effects on eye movement control

The increasing use of eye movement paradigms to assess the functional integrity of brain systems involved in sensorimotor and cognitive processing in clinical disorders requires greater attention to effects of pharmacological treatments on these systems. This is needed to better differentiate disease and medication effects in clinical samples, to learn about neurochemical systems relevant for identified disturbances, and to facilitate identification of oculomotor biomarkers of pharmacological effects. In this review, studies of pharmacologic treatment effects on eye movements in healthy individuals are summarized and the sensitivity of eye movements to a variety of pharmacological manipulations is established. Primary findings from these studies of healthy individuals involving mainly acute effects indicate that: (i) the most consistent finding across several classes of drugs, including benzodiazepines, first- and second- generation antipsychotics, anticholinergic agents, and anticonvulsant/mood stabilizing medications is a decrease in saccade and smooth pursuit velocity (or increase in saccades during pursuit); (ii) these oculomotor effects largely reflect the general sedating effects of these medications on central nervous system functioning and are often dose-dependent; (iii) in many cases changes in oculomotor functioning are more sensitive indicators of pharmacological effects than other measures; and (iv) other agents, including the antidepressant class of serotonergic reuptake inhibitors, direct serotonergic agonists, and stimulants including amphetamine and nicotine, do not appear to adversely impact oculomotor functions in healthy individuals and may well enhance aspects of saccade and pursuit performance. Pharmacological treatment effects on eye movements across several clinical disorders including schizophrenia, affective disorders, attention deficit hyperactivity disorder, Parkinson’s disease, and Huntington’s disease are also reviewed. While greater recognition and investigation into pharmacological treatment effects in these disorders is needed, both beneficial and adverse drug effects are identified. This raises the important caveat for oculomotor studies of neuropsychiatric disorders that performance differences from healthy individuals cannot be attributed to illness effects alone. In final sections of this review, studies are presented that illustrate the utility of eye movements for use as potential biomarkers in pharmacodynamic and pharmacogenetic studies. While more systematic studies are needed, we conclude that eye movement measurements hold significant promise as tools to investigate treatment effects on cognitive and sensorimotor processes in clinical populations and that their use may be helpful in speeding the drug development pathway for drugs targeting specific neural systems and in individualizing pharmacological treatments.     

Noncontingent reinforcement for the treatment of severe problem behavior: An analysis of 27 consecutive applications

Noncontingent reinforcement (NCR) is a commonly used treatment for severe problem behavior displayed by individuals with intellectual and developmental disabilities. The current study sought to extend the literature by reporting outcomes achieved with 27 consecutive applications of NCR as the primary treatment for severe problem behavior. All applications of NCR were included regardless of treatment outcome to minimize selection bias favoring successful cases. Participants ranged in age from 5 to 33 years. We analyzed the results across behavioral function and with regard to the use of functional versus alternative reinforcers. NCR effectively treated problem behavior maintained by social reinforcement in 14 of 15 applications, using either the functional reinforcer or alternative reinforcers. When we implemented NCR to treat problem behavior maintained by automatic reinforcement, we often had to add other treatment components to produce clinically significant effects (five of nine applications). Results provide information on the effectiveness and limitations of NCR as treatment for severe problem behavior.     

Neural Circuitry Associated with Risk for Alcohol Use Disorders

The core features of risk for alcohol use disorders (AUD), including behavioral disinhibition, affective dysregulation, and executive dysfunction, map onto distinct neural circuits that have been found to be abnormal in the offspring of alcohol dependent individuals. Components of the cerebellothalamocortical system and the extended limbic network may provide the underpinnings for the behavioral and emotional dysfunction observed in individuals at heightened risk for AUD. In addition, abnormalities in these structures appear to be altered in individuals with the predisposition for other psychiatric conditions that may share a similar genetic diathesis. This review proposes several neurobehavioral mechanisms of genetic vulnerability that may account for phenotypic characteristics in individuals at risk for AUD.     

Short-Term Outcomes of a 12-Step Program among Women with Anorexia,Bulimia, and Eating Disorders

I examined the short-term effectiveness of a 12-Step, inpatient program incorporated into a multimodal approach to the treatment of eating disorders, and the differences among individuals with different types of eating disorders. Results showed that at the 6-month follow-up, all individuals were within the pathological range on all subscales of the EDI-2 instrument. No statistically significant differences were found between the groups on any of the demographic characteristics. Fourteen of the 42 subjects (33.3%) identified themselves as abstinent or devoid of undesirable eating behaviors at the 6-month time period, with 23.8% identified as being at least “somewhat” in relapse.     

EVALUATION OF THE “CONTROL OVER REINFORCEMENT” COMPONENT IN FUNCTIONAL COMMUNICATION TRAINING

The effectiveness of functional communication training (FCT) as a treatment for behavior disorders has been attributed to a number of variables, one of which is the individual's ability to exert control over the delivery of reinforcement. We evaluated this component of FCT by exposing individuals to conditions in which their behavior either did or did not affect the delivery of reinforcement. Three adults with mental retardation who engaged in self-injurious behavior (SIB) participated. Following a functional analysis of their SIB, the effects of FCT were compared to those of noncontingent reinforcement (NCR) in a multielement design. The amount of reinforcement during both conditions was equated by yoking the schedule of reinforcement during NCR sessions to that in effect during FCT sessions. Results indicated that FCT and NCR were equally effective in reducing the SIB of all participants and suggest that control over reinforcement delivery may not affect the degree to which FCT produces behavioral suppression. However, a different benefit of FCT was evident in the results: More consistent increases in the alternative response were observed during the FCT condition than during the NCR condition.     

Lumping versus splitting: A commentary on subtyping in OCD

This commentary discusses a number of pertinent concerns that were raised in this special series on subtyping in obsessive-compulsive disorders (OCD). The central question addressed in the three articles in the series is whether a better subtype classification of OCD could be developed if it is based on type of faulty cognition as well as symptom presentation. It is concluded that a more cognitive approach to OCD subtyping may not address many of the problems inherent in subtype research, nor will the development of special manualized treatment protocols for OCD subtypes necessarily yield significant improvements in treatment effectiveness. An alternative to OCD subtyping based on a categorical perspective is some form of profiling that recognizes the dimensional nature of OCD symptom and cognition variables.     

Feasibility,Acceptability, and Preliminary Target Engagement of a Healthy Physical Activity Promotion Intervention for Bulimia Nervosa: Development and Evaluation via Case Series Design

Bulimia nervosa (BN) is characterized by a pattern of binge eating and compensatory behaviors as well as an overemphasis on body weight and shape in self-evaluation. Although cognitive behavioral therapy (CBT) is efficacious, recent reviews suggest that only 30% of patients reach abstinence at posttreatment. One potential reason for these poor outcomes is that CBT fails to adequately reduce elevated negative affect (NA) and shape and weight concern, which have been shown to be correlated with poorer treatment outcomes in BN. Therefore, novel treatment components that focus on improving NA and shape and weight concern are needed in order to enhance outcomes. Promoting physical activity (PA) is a promising avenue through which to reduce NA and improve body image in healthy individuals, other clinical populations (e.g., individuals with depression or anxiety), and individuals with eating disorders. While prescribing PA for individuals with BN has been controversial (due to concerns that exercise maybe be used to compensate for binge episodes or become driven or compulsive), this approach may have many benefits, including promoting healthy lifetime exercise habits that reduce likelihood of relapse through the improvement of emotion regulation skills and weight regulation.Given the promise of PA for targeting key maintenance factors of BN, we developed a 12-session healthy PA promotion intervention for BN and tested initial feasibility, acceptability, and preliminary target engagement in an iterative case series design (n = 3). The treatment provided cognitive-behavioral skills designed to identify, practice, and achieve behavioral goals while asking patients to engage in up to 150 minutes of moderate-to-vigorous PA per week, which was preplanned during each session with the client’s therapist.Results suggested that the healthy PA promotion intervention was both feasible and acceptable to deliver. In addition, the intervention resulted in a clinically significant decrease in BN symptom frequency in each participant. Further, participants showed clinically significant decreases in NA and shape and weight concern.The current study demonstrates that healthy PA interventions can have beneficial effects on BN symptoms, NA, and shape and weight concern. However, due to the small sample size, conclusions must be treated with caution. Future research should investigate additional approaches for promoting healthy PA and include a larger sample in order to further test initial efficacy of this treatment approach.     

Characterizing the musical phenotype in individuals with Williams Syndrome.

Williams Syndrome (WS), a neurodevelopmental genetic disorder, is characterized by peaks and valleys in mental function: substantial impairments in cognitive domains such as reasoning, arithmetic ability, and spatial cognition, alongside relatively preserved skills in social domains, face processing, language, and music. We report the results of a comprehensive survey on musical behaviors and background administered to the largest sample of individuals with WS to date (n = 118, mean age = 20.4), and compare the results to those obtained from a control group of typically developing normal individuals (n = 118, mean age = 20.9) and two groups of individuals with other neurodevelopmental genetic disorders, Autism (n = 30, mean age = 18.2) and Down Syndrome (n = 40, mean age = 17.2). Individuals with WS were found to be rated higher in musical accomplishment, engagement, and interest than either of the comparison groups, and equivalent on most measures to the control group. Compared to all other groups including the controls, the WS individuals displayed greater emotional responses to music, manifested interest in music at an earlier age, and spent more hours per week listening to music. In addition, the effects of music listening (whether positive or negative) tended to last longer in the WS group. A factor analysis extracted seven principal components that characterize the musical phenotype in our sample, and discriminant function analysis of those factors was able to successfully predict group membership for the majority of cases. We discuss the neurobiological implications of these findings.     

EEG neurofeedback improves cycling time to exhaustion

ObjectiveThe role of the brain in endurance performance is frequently debated; surprisingly, few investigations have attempted to improve endurance performance by directly targeting brain activity. One promising but untested approach to modifying brain activity is electroencephalogram (EEG) neurofeedback. Consequently, our experiment is the first to examine an EEG neurofeedback intervention for whole-body endurance performance.MethodWe adopted a two-part experiment. The first consisted of a randomized parallel controlled design. Forty participants were allocated to three experimental groups; increase relative left cortical activity (NFL), increase relative right (NFR), and passive control (CON). They performed a depleting cognitive task, followed by either six 2-min blocks of EEG neurofeedback training (NFL or NFR) or time-matched videos of the neurofeedback display (CON). Next, they performed a time-to-exhaustion (TTE) test on a cycle-ergometer. We then tested participants of NFL and NFR groups in an additional experimental visit and administered the opposite neurofeedback training within a fully repeated-measures protocol.ResultsEEG neurofeedback modified brain activity as expected. As hypothesized, the NFL group cycled for over 30% longer than the other groups in the parallel controlled design, NFL: 1382 ± 252 s, NFR: 878 ± 167, CON: 963 ± 117 s. We replicated this result in the repeated-measures design where NFL: 1167 ± 831 s performed 11% longer than NFR: 1049 ± 638 s. There were no differences in pre-exercise fatigue, vigor or self-control; area under the curve group-differences for perceived effort were interpreted within a goal persistence framework.ConclusionThe brief EEG neurofeedback intervention elicited greater relative left frontal cortical activity and enhanced endurance exercise performance.     

AN ANALYSIS OF AND INTERVENTION IN THE SEXUAL TRANSMISSION OF DISEASE

Sexually transmitted diseases are a serious threat to the public health. Indeed, when an individual seeks medical treatment for a sexually transmitted disease, health authorities frequently attempt to identify, procure, and treat that individual's sexual contact(s). We conducted a comparative analysis of three alternative approaches to tracing the sexual partners of individuals diagnosed as having a sexually transmitted disease. The first approach involved counseling individuals (n = 27) infected with either gonorrhea or nongonococcal urethritis and exhorting them to procure their sexual partners for treatment. In addition to counseling, the second and third approaches involved distributing “occasion cards” for patients to use when informing sexual contacts of the need for treatment. Moreover, in the second approach, the counselor (a nurse or physician) informed infected patients (n = 19) that they and their partners could waive the $3 clinic fee contingent upon the partners seeking treatment within 1 week. In the third approach, the counselor asked infected persons (n = 19) to accept a follow-up telephone contact if their sexual partners failed to seek treatment within 1 week. The third approach was most effective. Ninety percent of the partners identified through this approach sought treatment, versus only about 60% of the partners in the other two conditions. The third approach was also the least expensive, costing about $2.95 to procure each partner for treatment.