Brainwave Self-Regulation During Bispectral IndexTM Neurofeedback in Trauma Center Nurses and Physicians After Receiving Mindfulness Instructions

Abstract

Fifty-seven level I trauma center nurses/physicians participated in a 4-day intervention to learn relaxed alertness using mindfulness-based instructions and EEG neurofeedback. Neurofeedback was provided by a Bispectral IndexTM (BIS) system that continuously displays a BIS value (0–100) on the monitor screen. Reductions in the BIS value indicate that power in a high-frequency band (30–47 Hz) is decreased and power in an intermediate band (11–20 Hz) is increased. A wellbeing tool with four positive affect and seven negative affect items based on a 5-category Likert scale was used. The wellbeing score is the sum of the positive affect items (positive affect score) and the reverse-scored negative affect items (non-stress score). Of functional concern were four negative affect items rated as moderately, quite a bit, or extremely in a large percent. Of greater concern were all four positive affect items rated as very slightly or none at all, a little, or moderately in over half of the participants. Mean and nadir BIS values were markedly decreased during neurofeedback when compared to baseline values. Post-session relaxation scores were higher than pre-session relaxation scores. Post-session relaxation scores had an inverse relationship with mean and nadir BIS values. Mean and nadir BIS values were inversely associated with NFB cognitive states (i.e., widening the visual field, decreasing effort, attention to space, and relaxed alertness). For all participants, the wellbeing score was higher on day 4 than on day 1. Participants had a higher wellbeing score on day 4 than a larger group of nurses/physicians who did not participate in the BIS neurofeedback trial. Eighty percent of participants demonstrated an improvement in the positive affect or non-stress score on day 4, when compared to day 1; the wellbeing, non-stress, and positive affect scores were substantially higher on day 4 than on day 1. Additionally, for that 80% of participants, the improvements in wellbeing and non-stress were associated with reductions in day 3 BIS values. These findings indicate that trauma center nurses/physicians participating in an EEG neurofeedback trial with mindfulness instructions had improvements in wellbeing.Clinical Trial Registration: www.ClinicalTrials.gov, identifier NCT03152331. Registered May 15, 2017.

Bispectral Index Alterations and Associations With Autonomic Changes During Hypnosis in Trauma Center Researchers: Formative Evaluation Study

“…They also imply that reduced BIS values were associated with a state of physiologic relaxation, increased parasympathetic nervous system activity, and decreased sympathetic nervous system stimulation. In addition to the findings of improvements in participant well-being in our BIS neurofeedback study [73], this evaluation lends further support to the notion that the BIS monitor may be a valid device for use in neurofeedback investigations. Finally, the BIS monitor may subsequently be demonstrated to be considered as a hypnometer for continuously measuring hypnotic depth, as proposed by the former Harvard University investigator Solomon Gilbert Diamond [19].…”

“…Supplementary evidence for BIS reductions is the evidence provided during investigations of participants watching relaxing videos [10] or trying relaxing-guided imagery [11]. The brainwave physiology of BIS reductions, and similarity to stage I sleep, implies that such participants were in a relative state of cognitive or mental relaxation [73][74][75].…”

“…Our group demonstrated that trauma center nurses and physician participants could learn to self-regulate brainwave activity using an electroencephalography (EEG)-based BIS monitoring system during neurofeedback immediately after receiving mindfulness instructions [ 73 ]. Importantly, most participants also showed improvements in well-being scores after learning brainwave self-regulation.…”

Cortical Mechanisms of Visual Hypersensitivity in Women at Risk for Chronic Pelvic Pain

“…Mindfulness interventions that decrease general distress also affect top-down modulation ( Berkovich-Ohana et al, 2012 ; Farb et al, 2007 ; Grant et al, 2011 ; Jacobs et al, 1996 ; Travis et al, 2010 ) and even reduce SSVEP amplitude ( Schöne et al, 2018 ). A future enhanced mindfulness strategy combining simultaneous neurofeedback ( Dunham et al, 2019 ) from the visual task itself could be used to reprogram the neural circuitry responsible for MSH. Similarly, a key next step is determining whether other extant chronic pain treatments—transcranial magnetic stimulation ( Grisaru et al, 1998 ), anticonvulsants ( Harte et al, 2016 ), or antidepressants ( Sayar et al, 2005 )—could reduce MSH and these associated neural mechanisms in at-risk patients.…”

Improving Cognitive Workload in Radiation Therapists: A Pilot EEG Neurofeedback Study

“…For example, NF was tested among high-functioning professionals in managerial positions, who reported decreased perceived stress levels and increased concentration and focus ( Fronda et al, 2019 ). In a healthcare setting, studies suggest that NF can be used to teach physicians and nurses to enter into a state of relaxed alertness and improve their wellbeing ( Dunham, 2019 ). Additionally, previous research found NF to improve cognitive workload during working memory tasks ( Mazur et al, 2017 ).…”