D. Corydon Hammond

Meta-analysis of EEG biofeedback in treating epilepsy

About one third of patients with epilepsy do not benefit from medical treatment. For these patients electroencephalographic (EEG) biofeedback is a viable alternative. EEG biofeedback, or neurofeedback, normalizes or enhances EEG activity by means of operant conditioning. While dozens of scientific reports have been published on neurofeedback for seizure disorder, most have been case series with too few subjects to establish efficacy. The purpose of this paper is to meta-analyze existing research on neurofeedback and epilepsy. We analyzed every EEG biofeedback study indexed in MedLine, PsychInfo, and PsychLit databases between 1970 and 2005 on epilepsy that provided seizure frequency change in response to feedback. Sixty-three studies have been published, 10 of which provided enough outcome information to be included in a meta-analysis. All studies consisted of patients whose seizures were not controlled by medical therapies, which is a very important factor to keep in mind when interpreting the results. Nine of 10 studies reinforced sensorimotor rhythms (SMR) while 1 study trained slow cortical potentials (SCP). All studies reported an overall mean decreased seizure incidence following treatment and 64 out of 87 patients (74%) reported fewer weekly seizures in response to EEG biofeedback. Treatment effect was mean log (post/pre) where pre and post represent number of seizures per week prior to treatment and at final evaluation, respectively. Due to prevalence of small groups, Hedgess g was computed for effect size. As sample heterogeneity was possible (Q test, p=.18), random effects were assumed and the effect of intervention was −0.233, SE= 0.057, z −4.11, p<.001. Based on this meta-analysis, EEG operant conditioning was found to produce a significant reduction on seizure frequency. This finding is especially noteworthy given the patient group, individuals who had been unable to control their seizures with medical treatment.

WHAT IS NEUROFEEDBACK: AN UPDATE

Written to educate both professionals and the general public, this article provides an update and overview of the field of neurofeedback (EEG biofeedback). The process of assessment and neurofeedback training is explained. Then, areas in which neurofeedback is being used as a treatment are identified and a survey of research findings is presented. Potential risks, side effects, and adverse reactions are cited and guidelines provided for selecting a legitimately qualified practitioner.

Inhibited sexual desire in women

A multifaceted study was conducted to identify differences in biopsychosocial characteristics between a clinical group of 59 married women who complained of inhibited sexual desire (ISD) and 31 married women who expressed normal sexual desire (non-ISD). Areas of examination included personality, endocrine, relationship, and sexual dimensions. Instruments of data collection included the MMPI, Dyadic Adjustment Scale, radioimmunoassay of testosterone and prolactin levels, and a questionnaire which focused on demographic, relationship, and sexual information. Statistical analyses indicated nonsignificant between-group differences on demographic characteristics, personality variables, and hormonal evaluation. Statistically significant differences were found between the two groups with regard to sexual history and several marital and sexual dimensions. The ISD group reported significantly greater dissatisfaction with these areas than the non-ISD group. Implications for clinical practice and research are discussed.

Template for Developing Guidelines for the Evaluation of the Clinical Efficacy of Psychophysiological Interventions

An essential function of both the Association for Applied Psychophysiology and Biofeedback (AAPB) and the Society for Neuronal Regulation (SNR) is the systematic evaluation of psychophysiological interventions that have been developed for the treatment of medical and psychiatric disorders. In order to address scientific concerns regarding the efficacy of specific clinical applications of biofeedback, these two societies formed and Efficacy Task Force. The process to be used in the assessment of treatment efficacy, specificity and clinical utility is presented in the form of a template that will serve as the foundation for a series of scientific reviews and practice guidlines to be published by both societies.

Review of the Efficacy of Clinical Hypnosis with Headaches and Migraines

Abstract The 12-member National Institute of Health Technology Assessment Panel on Integration of Behavioral and Relaxation Approaches into the Treatment of Chronic Pain and Insomnia (1996) reviewed outcome studies on hypnosis with cancer pain and concluded that research evidence was strong and that other evidence suggested hypnosis may be effective with some chronic pain, including tension headaches. This paper provides an updated review of the literature on the effectiveness of hypnosis in the treatment of headaches and migraines, concluding that it meets the clinical psychology research criteria for being a well-established and efficacious treatment and is virtually free of the side effects, risks of adverse reactions, and ongoing expense associated with medication treatments.

Hypnosis and Irritable Bowel Syndrome: A Review of Efficacy and Mechanism of Action

Abstract Irritable bowel syndrome (IBS) is a functional gastrointestinal disorder characterized by abdominal pain, distension, and an altered bowel habit for which no cause can be found. Despite its prevalence, there remains a significant lack of efficacious medical treatments for IBS to date. In this paper we reviewed a total of 14 published studies (N = 644) on the efficacy of hypnosis in treating IBS (8 with no control group and 6 with a control group). We concluded that hypnosis consistently produces significant results and improves the cardinal symptoms of IBS in the majority of patients, as well as positively affecting non-colonic symptoms. When evaluated according to the efficacy guidelines of the Clinical Psychology Division of American Psychological Association, the use of hypnosis with IBS qualifies for the highest level of acceptance as being both efficacious and specific. In reviewing the research on the mechanism of action as to how hypnosis works to reduce symptoms of IBS, some evidence was found to support both physiological and psychological mechanisms of action.

Hypnosis in the treatment of anxiety- and stress-related disorders

Self-hypnosis training represents a rapid, cost-effective, nonaddictive and safe alternative to medication for the treatment of anxiety-related conditions. Here we provide a review of the experimental literature on the use of self-hypnosis in the treatment of anxiety and stress-related disorders, including anxiety associated with cancer, surgery, burns and medical/dental procedures. An overview of research is also provided with regard to self-hypnotic treatment of anxiety-related disorders, such as tension headaches, migraines and irritable bowel syndrome. The tremendous volume of research provides compelling evidence that hypnosis is an efficacious treatment for state anxiety (e.g., prior to tests, surgery and medical procedures) and anxiety-related disorders, such as headaches and irritable bowel syndrome. Although six studies demonstrate changes in trait anxiety, this review recommends that further randomized controlled outcome studies are needed on the hypnotic treatment of generalized anxiety disorder and in documenting changes in trait anxiety. Recommendations are made for selecting clinical referral sources.

The need for individualization in neurofeedback: heterogeneity in QEEG patterns associated with diagnoses and symptoms.

Very diverse assessment procedures are utilized by neurofeedback practitioners, many of which are not based on careful examination of raw EEG data followed by scientifically objective quantitative EEG (QEEG) database comparisons. Research is reviewed demonstrating the great heterogeneity in the EEG patterns associated with various diagnoses and symptoms. The fact that most patients qualify for dual diagnoses, with co-morbid psychiatric and medical conditions present, complicates the ability of clinicians to estimate what electrophysiological patterns may be associated with symptoms. In such cases treatment planning is characterized by a great deal of guesswork and experimentation. Peer reviewed publications have documented that neurofeedback treatment can sometimes be associated with both transient side effects as well as more serious negative effects. It is believed that the lack of comprehensive and objective assessment of brain functioning may increase the risk of neurofeedback either being ineffective or causing iatrogenic harm. QEEG provides reliable, non-invasive, objective, culture-free and relatively low cost evaluation of brain functioning, permitting individualization of treatment and added liability protection.

Evidence-based clinical hypnosis for obstetrics, labor and delivery, and preterm labor.

Abstract This paper reviews the benefits and effectiveness of hypnosis in obstetrics and labor and delivery, demonstrating significant reductions in the use of analgesics and anesthesia and in shorter Stages 1 and 2 labors. It presents empirical and theoretical rationales for use of hypnosis in preterm labor (PTL) and labor and delivery at term. The benefits of hypnosis in relation to labor length, pain levels, and the enjoyment of labor, as well as its effectiveness in preterm labor are noted in randomized controlled trials and in a meta-analysis. Risk factors are reported for preterm delivery; hypnosis significantly prolongs pregnancy. Six cases are presented of hypnosis stopping PTL a number of times and when indicated at term. A case report of successful use of hypnosis in quadruplets is presented with some scripts. Suggestions are made for further research.This paper reviews the benefits and effectiveness of hypnosis in obstetrics and labor and delivery, demonstrating significant reductions in the use of analgesics and anesthesia and in shorter Stages 1 and 2 labors. It presents empirical and theoretical rationales for use of hypnosis in preterm labor (PTL) and labor and delivery at term. The benefits of hypnosis in relation to labor length, pain levels, and the enjoyment of labor, as well as its effectiveness in preterm labor are noted in randomized controlled trials and in a meta-analysis. Risk factors are reported for preterm delivery; hypnosis significantly prolongs pregnancy. Six cases are presented of hypnosis stopping PTL a number of times and when indicated at term. A case report of successful use of hypnosis in quadruplets is presented with some scripts. Suggestions are made for further research.

Standards of Practice for Neurofeedback and Neurotherapy: A Position Paper of the International Society for Neurofeedback & Research

This position paper of the International Society for Neurofeedback and Research (ISNR) sets forth standards and guidelines for the practice of neurofeedback and neurotherapy. Issues discussed include competency, qualifications of practitioners, scope of practice, informed consent, pretreatment assessment, standards for remote training, record keeping and billing, accountability, standards for practitioner training and qualifications to be trained, adequate supervision and coaching of training sessions, ethical advertising, standards for professional societies, and standards for those who sell and manufacture neurofeedback equipment.