Travma Sonrası Stres Bozukluğunun Tedavisinde EEG-Dayalı Nörofeedback Yönteminin Kullanımı

Travma Sonrası Stres Bozukluğu, hayatı tehdit edici travmatik olayları takiben gelişebilen mental bir bozukluktur. Elektroensefalografi dayalı nörofeedback, farklı bilinç ve duygu durumlarına özgü elektroensefalografi dalga aktivitesi modellerinin, kişinin istenilen becerileri elde etmesi için edimsel (operant) koşullanma çerçevesi içinde biyofeedback yolu ile değiştirilmesini amaçlayan, girişimsel olmayan bir yöntemdir. Bu yöntem, travma sonrası stres bozukluğunu da içeren birçok nöropskiyatrik hastalıklarda alternatif tedavi yöntemi olarak kullanılmaktadır. Bu derlemede, travma sonrası stres bozukluğu tedavisinde elektroensefalografi dayalı nörofeedback yöntemin etkinliğini değerlendirmek için, Pubmed, EMBASE, EBSCOhost, ULAKBİM veri tabanları taranmış ve farklı nörofeedback tedavi protokolleri kullanan 14 çalışma incelenmiştir. Bu inceleme sonucu, farklı tedavi protokollerine bağlı olarak, özgün olası etki mekanizmaları üzerinden elektroensefalografi dayalı nörofeedback yönteminin uygulanmasının, travma sonrası stres bozukluğu tedavisi ve semptomlarının iyileştirilmesi üzerinde anlamlı derecede olumlu etkiler gösterdiği belirlenmiştir. Elektroensefalografi dayalı nörofeedback yöntemimin, travma sonrası stres bozukluğu tedavisi üzerinde kesin etki mekanizmalarını ortaya koyabilmek ve bireye ve/veya hastalığın semptomlarına özgü standardize tedavi protokollerini belirleyebilmek, ilaç kullanımı, terapist-hasta özellikleri ve diğer terapötik süreçleri gibi travma sonrası stres bozukluğu tedavisine etki edebilecek diğer faktörleri de hesaba katarak, elektroensefalografi dayalı nörofeedback tedavisinin uzun süreli olumlu etkisinin araştırılmasına yönelik, daha kapsamlı kontrollü çalışmaların yapılması hedeflenmelidir.

Anahtar Kelimeler:

Elektroensefalografi biyofeedback, nörofeedback, tedavi protokolleri, travma sonrası stres bozukluğu, psikoterapi

The Use of EEG-Based Neurofeedback Method in the Treatment of Posttraumatic Stress Disorder

Post-traumatic stress disorder is a mental disorder that can develop following life-threatening traumatic events. Electroencephalography-based neurofeedback is a non-invasive method that aims to modify electroencephalography wave activity patterns specific to different states of consciousness and emotion by biofeedback within the framework of operant conditioning to achieve the desired skills. This method is used as an alternative treatment for many neuropsychiatric diseases involving post-traumatic stress disorder. In this review, Pubmed, EMBASE, EBSCOhost, ULAKBIM databases were searched and 14 studies were evaluated using different neurofeedback treatment protocols to evaluate the effectiveness of electroencephalography-based neurofeedback method in the treatment of post-traumatic stress disorder. Findings showed that electroencephalography-based neurofeedback method has significantly different positive effects on the treatment of post-traumatic stress disorder and the improvement of symptoms depending on specific treatment protocols. More comprehensive controlled studies should be aimed at intended for sustained positive effect of electroencephalography-based neurofeedback treatment to put forward the exact mechanisms of electroencephalography-based neurofeedback method on post-traumatic stress disorder treatment and to determine standardized treatment protocols specific to the individual and /or symptoms of the disorder, also taking into using medication therapist-patient characteristics, and other therapeutic processes, including other factors that may affect post- traumatic stress disorder treatment.

Keywords:

Electroencephalography biofeedback, neurofeedback, treatment protocols, post-traumatic stress disorder, psychotherapy,

PDF

___

1. Marzbani H, Marateb HM, Mansouria M. Methodological note: neurofeedback: a comprehensive review on system design, methodology and clinical applications. Basic Clin Neurosci. 2016; 7(2): 143-58.
2. Gruzelier JH, Thompson T, Redding E, Brandt R, Steffert T. Application of alpha/theta neurofeedback and heart rate variability training to young contemporary dancers: state anxiety and creativity. Int J Psychophysiol. 2014; 93(1): 105-11.
3. Harris S. An Investigation of the effects of neurofeedback training on attention deficit-hyperactivity disorder (ADHD) symptoms, depression, anxiety, and academic self-efficacy in college students [PhD dissertations]. Orlando: University of Central Florida; 2017.
4. Little BD. Evaluating the effectiveness of a school-based neurofeedback intervention on decreasing anxiety in an adolescent female. The Chicago School of Professional Psychology [PhD dissertations]. Chicago: the Chicago School of Professional Psychology; 2015.
5. Schoenberg PL, David AS. Biofeedback for psychiatric disorders: a systematic review. Appl Psychophysiol Biofeed. 2014; 39(2): 109-35.
6. Foldes ST, Weber DJ, Collinger JL. MEG-based neurofeedback for hand rehabilitation. J Neuroeng Rehabil. 2015; 12: 85.
7. Thibault RT, MacPherson A, Lifshitz M, Roth RR, Raz A. Neurofeedback with fMRI: a critical systematic review. NeuroImage. 2018; 172: 786-807.
8. Liu N, Cliffer S, Pradhan AH, Lightbody A, Hall SS, Reiss AL. Optical-imaging-based neurofeedback to enhance therapeutic intervention in adolescents with autism: Methodology and initial data. Neurophotonics. 2017; 4(1): 011003.
9. Mano M, Lécuyer A, Bannier E, Perronnet L, Noorzadeh S, Barillot C. How to build a hybrid neurofeedback platform combining EEG and fMRI. Front Neurosci. 2017; 11: 140.
10. Demos JN. Getting started with neurofeedback (1st ed, Vol 1). New York: W.W. Norton & Company; 2005.
11. Vernon DJ. Can neurofeedback training enhance performance? an evaluation of the evidence with implications for future research. Appl Psychophysiol Biofeedback. 2005; 30(4): 347-64.
12. Hammond DC. What is neurofeedback: an update. J Neurother. 2011; 15(4): 305-36.
13. Chiba T, Kanazawa T, Koizumi A, Ide K, Taschereau-Dumouchel V, Boku S, et al. Current status of neurofeedback for post-traumatic stress disorder: a systematic review and the possibility of decoded neurofeedback. Front Hum Neurosci. 2019; 13: 233.
14. Askovic M, Watters AJ, Aroche J, Harris AWF. Neurofeedback as an adjunct therapy for treatment of chronic posttraumatic stress disorder related to refugee trauma and torture experiences: two case studies. Australas Psychiatry. 2017; 25(4): 358-63.
15. Noohi S, Miraghaie AM, Arabi A, Nooripour R. Effectiveness of neuro-feedback treatment with alpha/theta method on PTSD symptoms and their executing function. Biomed Res. 2017; 28(5): 2019-27.
16. Ros T, Frewen P, Théberge J, Michela A, Kluetsch R, Mueller A, Candrian G, Jetly R, Vuilleumier P, Lanius RA. Neurofeedback tunes scale-free dynamics in spontaneous brain activity. Cereb Cortex. 2017; 27(10): 4911-22.
17. van der Kolk BA, Hodgdon H, Gapen M, Musicaro R, Suvak MK, Hamlin E, et al. A randomized controlled study of neurofeedback for chronic PTSD. PLoS One. 2016; 11(12): e0166752.
18. Nicholson AA, Ros T, Frewen PA, Densmore M, Théberge J, Kluetsch RC, et al. Alpha oscillation neurofeedback modulates amygdala complex connectivity and arousal in posttraumatic stress disorder. Neuroimage Clin. 2016; 12: 506-16.
19. Gapen M, van der Kolk BA, Hamlin E, Hirshberg L, Suvak M, Spinazzola J. A Pilot study of neurofeedback for chronic PTSD. Appl Psychophysiol Biofeedback. 2016; 41(3): 251-61.
20. Rastegar N, Dolatshahi B, Rezaei ED. The Effect of neurofeedback training on increasing sustained attention in veterans with posttraumatic stress disorder. J Pract Clin Psychol. 2016; 4(2): 97-104.
21. Kluetsch RC, Ros T, Théberge J, Frewen PA, Calhoun VD, Schmahl C, et al. Plastic modulation of PTSD resting-state networks and subjective wellbeing by EEG neurofeedback. Acta. Psychiatr Scand. 2014; 130(2): 123-36.
22. Nelson DV, Esty ML. Neurotherapy of traumatic brain injury/posttraumatic stress symptoms in OEF/OIF veterans. J Neuropsychiatry Clin Neurosci. 2012; 24(2): 237-40.
23. Othmer S, Othmer S. Post traumatic stress disorder—the neurofeedback remedy. Biofeedback. 2009; 37(1): 3-4.
24. Smith WD. The effect of neurofeedback training on PTSD symptoms of depression and attention problems among military veterans [PhD dissertations]. Minneapolis: Capella University; 2008.
25. Pop-Jordanova N, Zorcec T. Child trauma, attachment and biofeedback mitigation. Prilozi. 2004; 25(1-2): 103-14.
26. Peniston EG, Marrinan DA, Deming WA, Kulkosky PJ. EEG alpha-theta brainwave synchronization in Vietnam theater veterans with combat-related post-traumatic stress disorder and alcohol abuse. Adv Med Psychother. 1993; 6: 37-50.
27. Peniston EG, Kulkosky PJ. Alpha-theta brainwave neuro-feedback for Vietnam veterans with combat- related post-traumatic stress disorder. Med Psychother. 1991; 4: 47-60.
28. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (DSM-5®). Arlington: American Psychiatric Pub; 2013.
29. Schnurr PP, Friedman MJ, Engel CC, Foa EB, Shea MT, Chow BK, et al. Cognitive behavioral therapy for posttraumatic stress disorder in women: a randomized controlled trial. JAMA. 2007; 297(8): 820-30.
30. Dempster T. An investigation into the optimum training paradigm for alpha electroencephalographic biofeedback [PhD dissertations]. Canterbury: Canterbury Christ Church University; 2012.
31. Egner T, Gruzelier JH. EEG biofeedback of low beta band components: frequency-specific effects on variables of attention and event-related brain potentials. Clin Neurophysiol. 2004; 115(1): 131-9.
32. Gruzelier J. A theory of alpha/theta neurofeedback, creative performance enhancement, long distance functional connectivity and psychological integration. Cogn Process. 2009; 10(1): 101-9.
33. Surmeli T, Ertem A, Eralp E, Kos IH. Schizophrenia and the efficacy of qEEG-guided neurofeedback treatment: a clinical case series. Clin EEG Neurosci. 2012; 43(2): 133-44.
34. Ros T, Theberge J, Frewen PA, Kluetsch R, Densmore M, Calhoun VD, Lanius RA. Mind over chatter: Plastic up-regulation of the fMRI salience network directly after EEG neurofeedback. Neuroimage.2013; 65: 324-35.
35. Jokic-begi´c N, Begi´c, D. Quantitative electroencephalogram (qEEG) in combat veterans with post-traumatic stress disorder (PTSD). Nord J Psychiatry. 2003; 57(5): 351-5.
36. Wahbeh H, Oken BS. Peak high-frequency HRV and peak alpha frequency higher in PTSD. Appl Psychophysiol Biofeedback. 2013; 38(1): 57-69.
37. Reiter K, Andersen SB, Carlsson J. Neurofeedback treatment and posttraumatic stress disorder: effectiveness of neurofeedback on posttraumatic stress disorder and the optimal choice of protocol. J Nerv Ment Dis. 2016; 204(2): 69-77.
38. Ghaziri J, Tucholka A, Larue V, Blanchette-Sylvestre M, Reyburn G, Gilbert G, et al. Neurofeedback training induces changes in white and gray matter. Clin EEG Neurosci. 2013; 44(4): 265-72.
39. Niv S. Clinical efficacy and potential mechanisms of neurofeedback. Pers Individual Differences. 2013; 54(6): 676-86.
40. Menon V. Large-scale brain networks and psychopathology: a unifying triple network model. Trends Cogn Sci. 2011; 15(10): 483-506.