Fielenbach Sandra, Donkers Franc C L, Spreen Marinus, Visser Harmke A, Bogaerts Stefan
FPC Dr. S. van Mesdag, Groningen, Netherlands.
Tilburg University, Tilburg, Netherlands.
Front Psychiatry. 2018 Jan 25;8:313. doi: 10.3389/fpsyt.2017.00313. eCollection 2017.
Effective treatment interventions for criminal offenders are necessary to reduce risk of criminal recidivism. Evidence about deviant electroencephalographic (EEG)-frequencies underlying disorders found in criminal offenders is accumulating. Yet, treatment modalities, such as neurofeedback, are rarely applied in the forensic psychiatric domain. Since offenders usually have multiple disorders, difficulties adhering to long-term treatment modalities, and are highly vulnerable for psychiatric decompensation, more information about neurofeedback training protocols, number of sessions, and expected symptom reduction is necessary before it can be successfully used in offender populations.
Studies were analyzed that used neurofeedback in adult criminal offenders, and in disorders these patients present with. Specifically aggression, violence, recidivism, offending, psychopathy, schizophrenia, attention-deficit hyperactivity disorder (ADHD), substance-use disorder (SUD), and cluster B personality disorders were included. Only studies that reported changes in EEG-frequencies posttreatment (increase/decrease/no change in EEG amplitude/power) were included.
Databases Psychinfo and Pubmed were searched in the period 1990-2017 according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, resulting in a total of 10 studies. Studies in which neurofeedback was applied in ADHD ( = 3), SUD ( = 3), schizophrenia ( = 3), and psychopathy ( = 1) could be identified. No studies could be identified for neurofeedback applied in cluster B personality disorders, aggression, violence, or recidivism in criminal offenders. For all treatment populations and neurofeedback protocols, number of sessions varied greatly. Changes in behavioral levels ranged from no improvements to significant symptom reduction after neurofeedback training. The results are also mixed concerning posttreatment changes in targeted EEG-frequency bands. Only three studies established criteria for EEG-learning.
Implications of the results for the applicability of neurofeedback training in criminal offender populations are discussed. More research focusing on neurofeedback and learning of cortical activity regulation is needed in populations with externalizing behaviors associated with violence and criminal behavior, as well as multiple comorbidities. At this point, it is unclear whether standard neurofeedback training protocols can be applied in offender populations, or whether QEEG-guided neurofeedback is a better choice. Given the special context in which the studies are executed, clinical trials, as well as single-case experimental designs, might be more feasible than large double-blind randomized controls.
有效的罪犯治疗干预措施对于降低再次犯罪风险至关重要。关于罪犯中发现的潜在异常脑电图（EEG）频率的证据正在不断积累。然而，诸如神经反馈等治疗方式在法医精神病学领域很少应用。由于罪犯通常患有多种疾病，难以坚持长期治疗方式，并且极易出现精神失代偿，因此在神经反馈训练方案、疗程数量以及预期症状减轻等方面需要更多信息，才能在罪犯群体中成功应用。
对在成年罪犯中使用神经反馈以及这些患者所患疾病的研究进行分析。具体纳入了攻击性、暴力行为、再犯、犯罪、精神病态、精神分裂症、注意力缺陷多动障碍（ADHD）、物质使用障碍（SUD）以及B类人格障碍。仅纳入报告了治疗后EEG频率变化（EEG振幅/功率增加/减少/无变化）的研究。
根据系统评价和Meta分析的首选报告项目，在1990 - 至2017年期间检索了数据库Psychinfo和Pubmed，共得到10项研究。可以确定在ADHD（n = 3）、SUD（n = 3）、精神分裂症（n = 3）和精神病态（n = 1）中应用神经反馈的研究。未发现针对B类人格障碍、攻击性、暴力行为或罪犯再犯应用神经反馈的研究。对于所有治疗人群和神经反馈方案，疗程数量差异很大。神经反馈训练后行为水平的变化范围从无改善到显著症状减轻。关于目标EEG频段的治疗后变化结果也不一致。只有三项研究确立了EEG学习标准。
讨论了这些结果对神经反馈训练在罪犯群体中适用性的影响。对于具有与暴力和犯罪行为相关的外化行为以及多种合并症的人群，需要更多关注神经反馈和皮层活动调节学习的研究。目前尚不清楚标准神经反馈训练方案是否可应用于罪犯群体，或者定量脑电图（QEEG）引导的神经反馈是否是更好的选择。鉴于研究开展的特殊背景，临床试验以及单病例实验设计可能比大型双盲随机对照试验更可行。
