Neurofeedback: is there a place for it in Clinical Psychiatry?


Pioneer work in neurofeedback began with Sterman and Lubar. In Sterman’s work, cats were connected to an EEG during operant conditioning. During traditional operant conditioning, a cat learned to push a lever when it was hungry. Then, a new element, a tone, was introduced. The cat learned to wait until the tone stopped to press the lever to receive the reward. Sterman noticed that while the cat was waiting for the tone to stop, a specific frequency rhythm of 12-15 Hz was observed.
Moreover, the cat could produce the sensorimotor frequency without the tone to get the reward , Sterman called this rhythm the sensorimotor frequency (SMR). Lubar was the first to use sensorimotor frequency training on a hyperkinetic child in 1976 by placing
electrodes at C3 and C4. The child learned to increase the beta rhythm of 12-14 Hz until the theta(4-8 Hz) rhythm was no longer seen. The result was an increase in attention and a decrease in hyperactivity. In 1991, Lubar used QEEG to match neurofeedback treatment (EEG biofeedback) to theta-beta ratio (TBR) abnormalities only in individuals with ADHD who were identified with a high TBR. QEEG treatment matching is used to match the abnormal EEG biomarker with the impairing symptom, thereby allowing neurofeedback protocols tailored to the individual. Slow cortical potential (SCP) neurofeedback measures slow activity (<1 Hz). An upward shift of the negative amplitude improves attention. Rockstroh and colleagues used SCP in 1993 for drug-refractory seizures; Heinrich and colleagues were the first to use SCP for ADHD in 2004.
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