Aims: The goal of this study was to assess the effect of independent component neurofeedback (NFB) on EEG and clinical symptoms in patients with obsessive-compulsive disorder (OCD). Subsequently, we explored predictors of treatment response and EEG correlates of clinical symptoms. Methods: In a randomized, double-blind, parallel design, 20 inpatients with OCD underwent 25 sessions of NFB or sham feedback (SFB). NFB aimed at reducing EEG activity in an independent component previously reported abnormal in this diagnosis. Resting-state EEG recorded before and after the treatment was analyzed to assess its posttreatment changes, relationships with clinical symptoms and treatment response. Results: Overall, clinical improvement in OCD patients was not accompanied by EEG change as assessed by standardized low-resolution electromagnetic tomography and normative independent component analysis. Pre- to posttreatment comparison of the trained component and frequency did not yield significant results; however, in the NFB group, the nominal values at the downtrained frequency were lower after treatment. The NFB group showed significantly higher percentage reduction of compulsions compared to the SFB group (p = 0.015). Pretreatment higher amount of delta (1-6 Hz) and low alpha oscillations as well as a lower amount of high beta activity predicted a worse treatment outcome. Source localization of these delta and high beta oscillations corresponded with previous EEG resting-state findings in OCD patients compared to healthy controls. Conclusion: Independent component NFB in OCD proved useful in percentage improvement of compulsions. Based on our correlation analyses, we hypothesize that we targeted a network related to treatment resistance.

1.
Bloch MH, Landeros-Weisenberger A, Kelmendi B, Coric V, Bracken MB, Leckman JF: A systematic review: antipsychotic augmentation with treatment refractory obsessive-compulsive disorder. Mol Psychiatry 2006;11:622-632.
2.
Menzies L, Chamberlain SR, Laird AR, Thelen SM, Sahakian BJ, Bullmore ET: Integrating evidence from neuroimaging and neuropsychological studies of obsessive-compulsive disorder: the orbitofronto-striatal model revisited. Neurosci Biobehav Rev 2008;32:525-549.
3.
Kamiya J: Conscious control of brain waves. Psychol Today 1968;1:56-60.
4.
Wyrwicka W, Sterman MB: Instrumental conditioning of sensorimotor cortex EEG spindles in the waking cat. Physiol Behav 1968;3:703-707.
5.
Beauregard M, Lévesque J: Functional magnetic resonance imaging investigation of the effects of neurofeedback training on the neural bases of selective attention and response inhibition in children with attention-deficit/hyperactivity disorder. Appl Psychophysiol Biofeedback 2006;31:3-20.
6.
Arns M, de Rider S, Strehl U, Breteler M, Coenen A: Efficacy of neurofeedback treatment in ADHD: the effects on inattention, impulsivity and hyperactivity: a meta-analysis. Clin EEG Neurosci 2009;40:180-189.
7.
Sterman MB, Egner T: Foundation and practice of neurofeedback for the treatment of epilepsy. Appl Psychophysiol Biofeedback 2006;31:21-35.
8.
Moore NC: A review of EEG biofeedback treatment of anxiety disorders. Clin Electroencephalogr 2000;31:1-6.
9.
Hammond DC: QEEG-guided neurofeedback in the treatment of obsessive compulsive disorder. J Neurother 2003;7:25-52.
10.
Congedo M, Lubar JF, Joffe D: Low-resolution electromagnetic tomography neurofeedback. IEEE Trans Neural Syst Rehabil Eng 2004;12:387-397.
11.
Cannon R, Lubar J, Congedo M, Thornton K, Towler K, Hutchens T: The effects of neurofeedback training in the cognitive division of the anterior cingulate gyrus. Int J Neurosci 2007;117:337-357.
12.
Congedo M, Sherlin L: EEG source analysis: methods and clinical implications; in Coben R, Evans JR (eds): Neurofeedback and Neuromodulation Techniques and Applications. New York, Academic Press, 2010, pp 25-46.
13.
Congedo M, John RE, De Ridder D, Prichep L: Group independent component analysis of resting state EEG in large normative samples. Int J Psychophysiol 2010;78:89-99.
14.
Kopřivová J, Congedo M, Horáček J, Praško J, Raszka M, Brunovský M, Kohutova B, Höschl C: EEG source analysis in obsessive-compulsive disorder. Clin Neurophysiol 2011;122:1735-1743.
15.
Endrass T, Klawohn J, Schuster F, Kathmann N: Overactive performance monitoring in obsessive-compulsive disorder: ERP evidence from correct and erroneous reactions. Neuropsychologia 2007;46:1877-1887.
16.
Luu P, Tucker DM, Makeig S: Frontal midline theta and the error-related negativity: neurophysiological mechanisms of action regulation. Clin Neurophysiol 2004;115:1821-1835.
17.
World Health Organization (WHO): ICD-10: the ICD-10 Classification of Mental and Behavioural Disorders: Clinical Descriptions and diagnostic Guidelines. Geneva, World Health Organization, 1992.
18.
American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), ed 4. Washington DC, American Psychiatric Association, 1994.
19.
Goodman WK, Price LH, Rasmussen SA, Mazure C, Fleischmann RL, Hill CL, Heninger GR, Charney DS: The Yale-Brown Obsessive Compulsive Scale. I. Development, use, and reliability. Arch Gen Psychiatry 1989;46:1006-1011.
20.
Beck AT, Emery G: Anxiety Disorders and Phobias: A Cognitive Perspective. New York, Basic Books, 1985.
21.
Beck AT, Ward C, Mendelson M: Beck Depression Inventory (BDI). Arch Gen Psychiatry 1961;4:561-571.
22.
Onton J, Delorme A, Makeig S: Frontal midline EEG dynamics during working memory in obsessive-compulsive disorder. NeuroImage 2005;27:341-356.
23.
Knyazev GG: Cross-frequency coupling of brain oscillations: an impact of state anxiety. Int J Psychophysiol 2011;80:236-245.
24.
Pascual-Marqui RD: Standardized low-resolution brain electromagnetic tomography (sLORETA): technical details. Methods Find Exp Clin Pharmacol 2002;24(suppl D):5-12.
25.
Westfall PH, Young SS: Resampling-Based Multiple Testing: Examples and Methods for p-Value Adjustment. New York, Wiley-Interscience, 1993.
26.
Talairach J, Tournoux P: Co-Planar Stereotaxic Atlas of the Human Brain. New York, Thieme Medical Publishers, 1988.
27.
Gevensleben H, Holl B, Albrecht B, Schlamp D, Kratz O, Studer P, Wangler S, Rothenberger A, Moll GH, Heinrich H: Distinct EEG effects related to neurofeedback training in children with ADHD: a randomized controlled trial. Int J Psychophysiol 2009;74:149-157.
28.
Lansbergen MM, van Dongen-Boomsma M, Buitelaar JK, Slaats-Willemse D: ADHD and EEG-neurofeedback: a double-blind randomized placebo-controlled feasibility study. J Neural Transm 2011;118:275-284.
29.
Kopřivová J, Horáček J, Tintera J, Praško J, Raszka M, Ibrahim I, Höschl C: Medial frontal and dorsal cortical morphometric abnormalities are related to obsessive-compulsive disorder. Neurosci Lett 2009;464:62-66.
30.
Fontenelle LF, Mendlowicz MV, Ribeiro P, Piedade RA, Versiani M: Low-resolution electromagnetic tomography and treatment response in obsessive-compulsive disorder. Int J Neuropsychopharmacol 2006;9:89-94.
31.
Knyazev GG: Motivation, emotion, and their inhibitory control mirrored in brain oscillations. Neurosci Biobehav Rev 2007;31:377-395.
32.
Laufs H, Kleinschmidt A, Beyerle A, Eger E, Salek-Haddadi A, Preibisch C, Krakow K: EEG-correlated fMRI of human alpha activity. Neuroimage 2003;19:1463-1476.
33.
Rauch SL, Dougherty DD, Cosgrove GR, Cassem EH, Alpert NM, Price BH, Nierenberg AA, Mayberg HS, Baer L, Jenike MA, Fischman AJ: Cerebral metabolic correlates as potential predictors of response to anterior cingulotomy for obsessive compulsive disorder. Biol Psychiatry 2001;50:659-667.
34.
Rauch SL, Shin LM, Dougherty DD, Alpert NM, Fischman AJ, Jenike MA: Predictors of fluvoxamine response in contamination-related obsessive compulsive disorder: a PET symptom provocation study. Neuropsychopharmacology 2002;27:782-791.
35.
Sherlin L, Congedo M: Obsessive-compulsive dimension localized using low-resolution brain electromagnetic tomography (LORETA). Neurosci Lett 2005;387:72-74.
36.
Velikova S, Locatelli M, Insacco C, Semeraldi E, Comi G, Leocani L: Dysfunctional brain circuitry in obsessive-compulsive disorder: source and coherence analysis of EEG rhythms. Neuroimage 2010;49:977-983.
37.
Vogt BA, Berger GR, Derbyshire SW: Structural and functional dichotomy of human midcingulate cortex. Eur J Neurosci 2003;18:3134-3144.
38.
Ullsperger M, von Cramon DY: Subprocesses of performance monitoring: a dissociation of error processing and response competition revealed by event-related fMRI and ERPs. Neuroimage 2001;14:1387-1401.
39.
Pascual-Marqui RD, Lehmann D, Koenig T, Kochi K, Merlo MC, Hell D, Koukkou M: Low resolution brain electromagnetic tomography (LORETA) functional imaging in acute, neuroleptic-naive, first-episode, productive schizophrenia. Psychiatry Res 1999;90:169-179.
40.
Choi JS, Kim HS, Yoo SY, Ha TH, Chang JH, Kim YY, Shin YW, Kwon JS: Morphometric alterations of anterior superior temporal cortex in obsessive-compulsive disorder. Depress Anxiety 2006;23:290-296.
41.
Shin YW, Yoo SY, Lee JK, Ha TH, Lee KJ, Lee JM, Kim IY, Kim SI, Kwon JS: Cortical thinning in obsessive compulsive disorder. Hum Brain Mapp 2007;28:1128-1135.
42.
Maihöfner C, Sperling W, Kaltenhäuser M, Bleich S, de Zwaan M, Wiltfang J, Thürauf N, Elstner S, Reulbach U, Lewczuk P, Kornhuber J, Ropohl A: Spontaneous magnetoencephalographic activity in patients with obsessive-compulsive disorder. Brain Res 2007;1129:200-205.
43.
Nagai M, Kishi K, Kato S: Insular cortex and neuropsychiatric disorders: a review of recent literature. Eur Psychiatry 2007;22:387-394.
44.
Shapira NA, Liu Y, He AG, Bradley MM, Lessig MC, James GA, Stein DJ, Lang PJ, Goodman WK: Brain activation by disgust-inducing pictures in obsessive-compulsive disorder. Biol Psychiatry 2003;54:751-756.
45.
Ciesielski KT, Rauch SL, Ahlfors SP, Vangel ME, Wilhelm S, Rosen BR, Hämäläinen MS: Role of medial cortical networks for anticipatory processing in obsessive-compulsive disorder. Hum Brain Mapp 2012;33:2125-2134.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.