NeuroFeedback For Depression and Anxiety Alex Ng Wei Siong Ramsay - - PowerPoint PPT Presentation

NeuroFeedback For Depression and Anxiety

Alex Ng Wei Siong

Ramsay Sime Darby Medical Center Subang Jaya (Selangor, Malaysia) Loh Guan Lye Specialist Center (Penang, Malaysia)

Clinical Depression

 Loss of the ability to experience pleasure  Unexplained or prolonged sadness or crying spells  Significant changes in appetite and sleep patterns  Diurnal variation of mood  Irritability, anger, worry, agitation, anxiety  Pessimism, indifference  A sense of hoplessness/helplessness 

Clinical Depression

 Loss of energy, persistent lethargy, pathological fatigue  Feelings of guilt, worthlessness  Inability to concentrate, indecisiveness  Social withdrawal  Difficulty with personal hygiene  Unexplained aches and pains  May have delusions or hallucinations  Recurring thoughts of death or suicide

Clinical Anxiety

• Restlessness or feeling keyed-up or on edge
• Being easily fatigued
• Difficulty concentrating or mind going blank
• Irritability
• Muscle tension
• Sleep disturbance
• Although not a diagnostic feature, suicidal

ideation and completed suicide have been associated with generalized anxiety disorder

Physical Symptom Indicators

• Fatigue
• Pain
• Sleep disturbances
• GI disorders (IBS)

– unexplained by medical testing

Atypical Presentations

• Anxiety/panic symptoms
• Irritability
• Hysterical symptoms
• Hypochondriacal symptoms
• Unexplained pain syndromes
• Substance abuse presentations
• “Personality disorder”

Slow Waves: Robust Predictable Oscillatory Synchrony

• Delta: 1-3 Hz

– Deep Sleep, Repair, Problem Solving

(wake up with the answer!)

– Reduced responsiveness to sensory perturbations – Predominates during infancy as connectivity is still weak

• Theta: 4-7 Hz

– Sleep-wake transitions

• Hypnagogic hallucinations
• Hypnapompic hallucinations

– Creativity, Insight, – Uncritical acceptance, self- correcting thoughts – Altered States, – Super-learning in young children – Slow wave disorders: foggy thinking, epilepsy, ADHD, coma

Alpha and SMR: Bridging Internal Operations with External Stimuli

• Alpha: 8-12 Hz

– Calm Alertness, Meditation, Body Awareness, Daydreaming – ‘Reduced during eye movements – More dominant posteriorly, however, years of meditation promotes spread to the pre-frontal cortex…neurofeedback can hasten this process

• Coherence, reflection, attunement, integrative thinking
• Bottom-Up Processing
• Resolution of cognitive dissonance
• Sensory Motor Rhythm (SMR) or Mu

– 10-15 Hz within sensory-motor strip – Physically Relaxed, Poised for Action, Calm Vigilance

Faster Waves: Interference Prone Complexity

• Beta: 13-20 Hz

– Focused Thought, Sustained Attention, Industrious Behavior – Characteristics of motor cortices actively engaged in directing movement – Brain is desynchronized due to attending to variety of tasks

• High Beta : 21-30 Hz

– Hyperalertness, Anxiety…especially if right beta exceeds left beta

Specific Higher Executive Functional Area (reversed)

• Feelings of sadness, emptiness or unhappiness
• Angry outbursts, irritability or frustration, even over

small matters

• Loss of interest or pleasure in normal activities, such as

sex

• Sleep disturbances, including insomnia or sleeping too

much

• Tiredness and lack of energy, so that even small tasks

take extra effort

• Changes in appetite — often reduced appetite and

weight loss, but increased cravings for food and weight gain in some people

Cont…

• Anxiety, agitation or restlessness — for example,

excessive worrying, pacing, hand-wringing or an inability to sit still

• Slowed thinking, speaking or body movements
• Feelings of worthlessness or guilt, fixating on past

failures or blaming yourself for things that are not your responsibility

• Trouble thinking, concentrating, making decisions and

remembering things

• Frequent thoughts of death, suicidal thoughts, suicide

attempts or suicide

• Unexplained physical problems, such as back pain or

headaches

Clinical Reports – Depression with Anxiety Disorder

• Treated 50 subjects with moderate depressive

disorder with Mild to Moderate Anxiety Symptoms

• Train on C4 SMR vs C3 SMR vs Cz SMR
• Sustained remission of the depression in all 50

subjects in 20 sessions

• All reduced or discontinued medication

Take Home Points

• Neurofeedback is biofeedback for the Central Nervous System

– Targets firing patterns (brain rhythms) and regional blood flow

• Brain rhythms correspond to certain behavioral and cognitive states
• Cortical brain rhythms are detectable non-invasively (EEG)
• As the EEG inclines towards a desired frequency, a rewarding stimulus is

applied

• The stimulus is auditory and/or visual

? ? ?

? ? ? ? ?