Theta/SMR Neurofeedback Training Works Well for Some Forensic Psychiatric Patients, But Not for Others: A Sham-Controlled Clinical Case Series

Abstract

Electroencephalographic (EEG) neurofeedback could be a promising treatment for forensic psychiatric patients. Increasing evidence shows some patients are unable to regulate cortical activity. Before neurofeedback can be applied successfully, research is needed to investigate the interpersonal mechanisms responsible for patients’ ability to respond to neurofeedback. A single-case experimental design allows for close monitoring of individual patients, providing valuable information about patients’ response to the intervention and the time frame in which changes in clinical symptoms can be observed. Four patients with Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.; DSM-IV-TR) substance use disorder and various comorbidities participated in a sham-controlled clinical case study. Self-report level of impulsivity and craving were assessed. Results indicate that one patient showed more improvements on behavioral measures after the neurofeedback training than did the others. This patient reported less impulsivity and reduced levels of self-reported craving. However, these findings could not be attributed to the neurofeedback intervention. The findings suggest that there is insufficient evidence for the beneficial effects of a theta/sensorimotor rhythm (SMR) neurofeedback intervention on measures of impulsivity and craving, and that there may be great interindividual differences in patients’ ability to regulate cortical activity.

Benefits of EEG-Neurofeedback on the Modulation of Impulsivity in a Sample of Cocaine and Heroin Long-Term Abstinent Inmates: A Pilot Study

“…All the inmates in the NFB group got benefit from the treatment according to the improvement of their clinical symptoms, and this benefit was higher than in the control group. The current results are equivalent to those reported by a recent study reporting an improvement in behavior and impulsivity in a small group of forensic psychiatric individuals (Fielenbach et al, 2019).…”

“…All the inmates in the NFB group got benefit from the treatment according to the improvement of their clinical symptoms, and this benefit was higher than in the control group. The current results are equivalent to those reported by a recent study reporting an improvement in behavior and impulsivity in a small group of forensic psychiatric individuals (Fielenbach et al, 2019). When analyzing the evolution of the clinical symptoms from the temporal perspective along the period of treatment, there were two clearly differentiated periods: first one, from the beginning Mcs1) to Session 16 (Mcs4, with significant between-group differences in the "mean clinical state."…”

Brain regulation training improves emotional competences in patients with alcohol use disorder

“…2019 ), while some other studies could not attribute the findings of decreased impulsivity and craving directly to the SMR NF ( Fielenbach et al. 2018 , 2019 ). Based on several clinical findings of comorbid ADHD in patients with substance use disorder, the Peniston Protocol was further modified by Scott–Kaiser, who combined the EEG beta band and the SMR with the established AT training ( Scott and Kaiser 1998 ; Scott et al.…”

How far are N-of-1 studies suitable evaluation designs in forensic psychiatric sports therapy?

“…Besides the RCT design, four patients were additionally examined in an N-of-1 study design [10]. Results of the N-of-1 study showed that three patients completed all study phases, none of the patients followed the training like planned and the behavioral measures varied between the patients [23].…”