Taking Back the Brain: Could Neurofeedback Training Be Effective for Relieving Distressing Auditory Verbal Hallucinations in Patients With Schizophrenia?

S. McCarthy-Jones
2012 Schizophrenia Bulletin  
Progress in identifying the neural correlates of auditory verbal hallucinations (AVHs) experienced by patients with schizophrenia has not fulfilled its promise to lead to new methods of treatments. Given the existence of a large number of such patients who have AVHs that are refractory to traditional treatments, there is the urgent need for the development of new effective interventions. This article proposes that the technique of neurofeedback may be an appropriate method to allow the
more » ... on of pure research findings from AVH-research into a clinical intervention. Neurofeedback is a method through which individuals can self-regulate their neural activity in specific neural regions/frequencies, following operant conditioning of their intentional manipulation of visually presented real-time feedback of their neural activity. Four empirically testable hypotheses are proposed as to how neurofeedback may be employed to therapeutic effect in patients with AVHs. Key words: psychosis/brain-computer interface/hearing voices Auditory verbal hallucinations (AVHs), the experience of hearing a voice in the absence of an appropriate external stimulus, are often associated with severe distress and social and occupational impairment. Approximately, 3 in 4 patients with schizophrenia will experience AVHs 1 (henceforth termed SZ:AVHþ). While the past decade has seen significant progress in identifying the neural activity underpinning AVHs, researchers now face the challenge of translating this improved understanding into therapeutic interventions. The urgency of this arises from the limitations of existing treatments. Although the exact percentage is unclear, 1 a consensus exists that a significant minority of SZ:AVHþ, possibly as high as 25%-30%, have antipsychotic medication-resistant AVHs. 2 Furthermore, the evidence base for cognitivebehavioral therapy for AVHs is weak, (S.M.-J. et al, unpublished data, 2011) and despite a recent meta-analysis finding transcranial magnetic stimulation (TMS) over the left temporoparietal junction to be effective for AVHs, 3 a recent large randomized controlled trial (RCT) of TMS for AVHs has reported negative results. 4 There is hence a pressing need for novel therapeutic developments for SZ:AVHþ, grounded in and guided by pure research findings. This article will argue that one such promising option is neurofeedback. Neurofeedback Neurofeedback involves individuals using a braincomputer interface to manipulate their own neural activity. This is achieved by feeding back real-time information of an individual's brain activity to them, allowing them to undertake endogenous control of neural activity in vivo. 5 In electroencephalography-based (EEG) neurofeedback studies, the power of participants' neural oscillations in a given frequency (eg, alpha, gamma) are visually displayed to them, typically in the form of a bar graph whose height is proportional to the real-time EEG amplitude and which fluctuates accordingly. 5 Participants try to learn to manipulate this visual feedback, increasing/decreasing it to a predefined threshold level, with an operant conditioning paradigm employed involving a reward when amplification/suppression to this threshold is achieved. 5,6 Participants are not typically given explicit instructions or mental strategies as to how to achieve control over their EEG but are told to be guided by the visual feedback process. 6 The ability of healthy individuals to manipulate their own EEG amplitudes using neurofeedback has been repeatedly demonstrated. 5-7 For example, Keizer and colleagues 7 found that eight 30-minute EEG neurofeedback sessions spread over 10 days, resulted in participants being able to intentionally increase the power of their gamma frequency signal (at the Oz electrode). Of interest for the application of neurofeedback to clinical conditions is what has been termed the "transfer effect." Schizophrenia Bulletin
doi:10.1093/schbul/sbs006 pmid:22323675 pmcid:PMC3406539 fatcat:w5fppdgm4jde7ig5wzfsgpilum