Infralow neurofeedback in the treatment of substance use disorders: a randomized controlled trial

Karin Berle Gabrielsen, Thomas Clausen, Siri Håvås Haugland, Stig Arvid Hollup, John-Kåre Vederhus, Karin Berle Gabrielsen, Thomas Clausen, Siri Håvås Haugland, Stig Arvid Hollup, John-Kåre Vederhus

Abstract

Background: Infralow neurofeedback (ILF-NF) was recently developed as a subtype of traditional, frequency-based neurofeedback that targets cerebral rhythmic activity below 0.5 Hz and improves brain self-regulation. The efficacy of ILF-NF in the treatment of substance use disorder has not yet been evaluated, but clinical evidence suggests that it may prevent relapse by improving functioning in various life domains. The current study aimed to fill this research gap and extend empirical evidence related to this issue.

Methods: Ninety-three patients with substance use disorders at an outpatient unit in Norway were randomized to receive 20 sessions (30 minutes each) of ILF-NF training combined with treatment as usual (TAU), or TAU alone. The primary outcome was quality of life post-treatment as an overall measure of functioning. We analyzed between-group differences using Student t tests.

Results: We found no significant differences in quality of life between groups. We found similar nonsignificant results for most of the secondary outcome measures, including drug use, sleep, anxiety and depression. Compared to TAU, the ILF-NF + TAU group reported significantly lower restlessness scores post-treatment (mean difference -1.8, 95 % confidence interval -3.1 to -0.5; p = 0.006).Limitations: This study was limited by broad inclusion criteria and a lack of placebo control (sham neurofeedback treatment).

Conclusion: ILF-NF offered limited additional benefit when combined with TAU, except in the area of restlessness. Future studies could further investigate the relationship between ILF-NF, restlessness and substance use in targeted subpopulations to illuminate relapse mechanisms.

Clinical trial registration: ClinicalTrials.gov: NCT03356210.

Conflict of interest statement

Competing interests: None declared.

© 2022 CMA Impact Inc. or its licensors.

Figures

Figure 1
Figure 1
Study flow chart of participant selection, randomization and completion. ILF-NF = infralow frequency neurofeedback.

References

    1. Sitaram R, Ros T, Stoeckel L, et al. . Closed-loop brain training: the science of neurofeedback. Nat Rev Neurosci 2017;18:86–100.
    1. Burkett VS. Treatment effects related to EEG-biofeedback for crack cocaine dependency: changes in personality and attentional variables [dissertation]. Ann Arbor (MI): University of North Texas; 2005.
    1. Peniston EG, Kulkosky PJ. Alpha-theta brainwave training and beta-endorphin levels in alcoholics. Alcohol Clin Exp Res 1989;13: 271–9.
    1. Trudeau DL. EEG biofeedback for addictive disorders — the state of the art in 2004. J Adult Dev 2005;12:139–46.
    1. Sokhadze TM, Cannon RL, Trudeau DL. EEG biofeedback as a treatment for substance use disorders: review, rating of efficacy and recommendations for further research. Appl Psychophysiol Biofeedback 2008;33:1–28.
    1. Dousset C, Kajosch H, Ingels A, et al. . Preventing relapse in alcohol disorder with EEG-neurofeedback as a neuromodulation technique: a review and new insights regarding its application. Addict Behav 2020;106:106391.
    1. Horrell T, El-Baz A, Baruth J, et al. . Neurofeedback effects on evoked and induced EEG gamma band reactivity to drug-related cues in cocaine addiction. J Neurother 2010;14:195–216.
    1. Sunder KR. The progression of neurofeedback: an evolving paradigm in addiction treatment and relapse prevention. MOJ Addict Med Ther 2017;3:75–8.
    1. Callaway TG. Treatment outcomes related to EEG-biofeedback for chemical dependency: changes in MMPI-2(TM) personality measures and long term abstinence rates. Diss Abstr Int B Sci Eng 2006;66: 3941.
    1. Dehghani-Arani F, Rostami R, Nadali H. Neurofeedback training for opiate addiction: improvement of mental health and craving. Appl Psychophysiol Biofeedback 2013;38:133–41.
    1. Rostami R, Dehghani-Arani F. Neurofeedback training as a new method in treatment of crystal methamphetamine dependent patients: a preliminary study. Appl Psychophysiol Biofeedback 2015;40: 151–61.
    1. Unterrainer HF, Chen MJ, Gruzelier JH. EEG-neurofeedback and psychodynamic psychotherapy in a case of adolescent anhedonia with substance misuse: mood/theta relations. Int J Psychophysiol 2014; 93:84–95.
    1. Keith JR, Rapgay L, Theodore D, et al. . An assessment of an automated EEG biofeedback system for attention deficits in a substance use disorders residential treatment setting. Psychol Addict Behav 2015;29:17–25.
    1. Lackner N, Unterrainer HF, Skliris D, et al. . The effectiveness of visual short-time neurofeedback on brain activity and clinical characteristics in alcohol use disorders: practical issues and results. Clin EEG Neurosci 2016;47:188–95.
    1. Gabrielsen KB. Bruk av nevrofeedback i rusbehandling — en studie av nytte og gjennomførbarhet på et lite, klinisk utvalg [Use of neurofeedback in treatment of substance use disorder — a pilot study] [dissertation]. Kristiansand, Norway: University of Agder; 2012.
    1. La Vaque TJ, Hammond DC, Trudeau D, et al. . Template for developing guidelines for the evaluation of the clinical efficacy of psychophysiological interventions. Appl Psychophysiol Biofeedback 2002;27:273–81.
    1. Grin-Yatsenko VA, Ponomarev VA, Kara O, et al. . Effect of infralow frequency neurofeedback on infra-slow EEG fluctuations. In: Schwartz M, editor. Biofeedback. London: IntechOpen; 2018: 75–87.
    1. Othmer S, Othmer SF, Kaiser DA, et al. . Endogenous neuromodulation at infralow frequencies. Semin Pediatr Neurol 2013;20:246–57.
    1. Leong SL, Vanneste S, Lim J, et al. . A randomised, double-blind, placebo-controlled parallel trial of closed-loop infraslow brain training in food addiction. Sci Rep 2018;8:11659.
    1. Hendershot CS, Witkiewitz K, George WH, et al. . Relapse prevention for addictive behaviors. Subst Abuse Treat Prev Policy 2011;6:17.
    1. Laudet AB, Becker JB, White WL. Don’t wanna go through that madness no more: quality of life satisfaction as predictor of sustained remission from illicit drug misuse. Subst Use Misuse 2009; 44:227–52.
    1. Brekke E, Lien L, Biong S. Experiences of professional helping relations by persons with co-occurring mental health and substance use disorders. Int J Ment Health Addict 2018;16:53–65.
    1. McEntegart DJ. The pursuit of balance using stratified and dynamic randomization techniques: an overview. Drug Inf J 2003;37: 293–308.
    1. Oostenveld R, Praamstra P. The five percent electrode system for high-resolution EEG and ERP measurements. Clin Neurophysiol 2001;112:713–9.
    1. Sheehan DV, Lecrubier Y, Sheehan KH, et al. . The Mini-International Neuropsychiatric Interview (M.I.N.I): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. J Clin Psychiatry 1998;59:22–33.
    1. Kokkevi A, Hartgers C. EuropASI: European adaptation of a multidimensional assessment instrument for drug and alcohol dependence. Eur Addict Res 1995;1:208–10.
    1. Lindholt JS, Ventegodt S, Henneberg EW. Development and validation of QoL5 for clinical databases. A short, global and generic questionnaire based on an integrated theory of the quality of life. Eur J Surg 2002;168:107–13.
    1. Ventegodt S, Merrick J, Andersen NJ. Quality of life theory I. The IQOL theory: an integrative theory of the global quality of life concept. ScientificWorldJournal 2003;3:1030–40.
    1. Ventegodt S, Merrick J, Andersen N. Measurement of quality of life II. From the philosophy of life to science. ScientificWorldJournal 2003;3:962–71.
    1. Pasareanu AR, Opsal A, Vederhus JK, et al. . Quality of life improved following in-patient substance use disorder treatment. Health Qual Life Outcomes 2015;13:35.
    1. Ventegodt S, Merrick J, Andersen NJ. Measurement of quality of life V. How to use the SEQOL, QOL5, QOL1, and other global and generic questionnaires for research. ScientificWorldJournal 2003;3:1002–14.
    1. Rosen CS, Drescher KD, Moos RH, et al. . Six- and ten-item indexes of psychological distress based on the Symptom Checklist-90. Assessment 2000;7:103–11.
    1. Strand BH, Dalgard OS, Tambs K, et al. . Measuring the mental health status of the Norwegian population: a comparison of the instruments SCL-25, SCL-10, SCL-5 and MHI-5 (SF-36). Nord J Psychiatry 2003; 57:113–8.
    1. Parkin D, Devlin N. Is there a case for using visual analogue scale valuations in cost-utility analysis? Health Econ 2006;15:653–64.
    1. Miller SD, Duncan BL, Brown JB, et al. . The outcome rating scale: a preliminary study of the reliability, validity, and feasibility of a brief visual analog measure. J Brief Ther 2003;2:91–100.
    1. Miller SD, Bargmann S. The Outcome Rating Scale (ORS) and the Session Rating Scale (SRS). Integr Sci Pract 2012;2:28–31.
    1. Vederhus JK, Birkeland B, Clausen T. Perceived quality of life, 6 months after detoxification: is abstinence a modifying factor? Qual Life Res 2016;25:2315–22.
    1. Bergquist KL, Fox HC, Sinha R. Self-reports of interoceptive responses during stress and drug cue-related experiences in cocaine-and alcohol-dependent individuals. Exp Clin Psychopharmacol 2010;18:229–37.
    1. Seo D, Sinha R. The neurobiology of alcohol craving and relapse. Handb Clin Neurol 2014;125:355–68.
    1. Larimer ME, Palmer RS, Marlatt GA. Relapse prevention. An overview of Marlatt’s cognitive-behavioral model. Alcohol Res Health 1999; 23: 151–60.
    1. Proctor SL, Llorca GM, Perez PK, et al. . Associations between craving, trauma, and the DARNU scale: dissatisfied, anxious, restless, nervous, and uncomfortable. J Subst Use 2016;5:479–83.
    1. Szczypinski J, Jakubczyk A, Kopera M, et al. . Impulsivity Scale-12 and its utilization in alcohol use disorder. Drug Alcohol Depend 2021;225:108809.
    1. Karlsson AT, Vederhus J-K, Clausen T, et al. . Levels of impulsivity, hyperactivity, and inattention and the association with mental health and substance use severity in opioid-dependent patients seeking treatment with extended-release naltrexone. J Clin Med 2021;10:4558.
    1. Arns M, Heinrich H, Strehl U. Evaluation of neurofeedback in ADHD: the long and winding road. Biol Psychol 2014;95:108–15.
    1. Farnia V, Mousavi SB, Tatari F, et al. . Prevalence of childhood attention-deficit/ hyperactivity disorder (ADHD) in methamphetamine dependence: a descriptive study. Iran J Psychiatry Behav Sci 2018;12: e61329.

Source: PubMed

Patrocinadores e Colaboradores

Condições médicas

Intervenções de drogas

3
Se inscrever