Jensen Martin, Alanis Jose Carlos Garcia, Hüttenrauch Eva, Winther-Jensen Matilde, Chavanon Mira-Lynn, Andersson Gerhard, Weise Cornelia
Division of Clinical Psychology and Psychotherapy, Department of Psychology, Philipps University Marburg, 35032 Marburg, Germany.
Eriksholm Research Centre, 3070 Snekkersten, Denmark.
Brain Commun. 2023 Jun 26;5(4):fcad185. doi: 10.1093/braincomms/fcad185. eCollection 2023.
Previous studies showed that alpha/delta ratio neurofeedback was effective in reducing unpleasant psychological, emotional and perceptual consequences of tinnitus. The main goal of the present study was to investigate, whether the specific combination of enhancing alpha frequency band activity and reducing delta frequency band activity was necessary, or merely sufficient, to obtain a positive treatment outcome regarding tinnitus distress and intensity. A second research aim was to assess the relative contribution of neurofeedback-related non-specific and general non-specific effects in neurofeedback treatment. In a three-arm, randomized controlled trial, 94 chronic tinnitus patients were randomly assigned to one of three conditions: alpha/delta ratio neurofeedback ( = 31), beta/theta ratio neurofeedback ( = 28) and non-neurofeedback minimal treatment intervention ( = 35). Neurofeedback participants underwent 10 treatment sessions over a 4-week period. Outcome measures were collected pre-, mid- and post-interventions and at 3-months follow-up. The Tinnitus Handicap Inventory and the Tinnitus Magnitude Index were used as primary outcome measures for tinnitus distress and tinnitus intensity. EEG data recorded during training supplemented primary outcomes. Since data were repeated measures, the analyses used a two-level mixed effects model approach including by-subject random effects (random intercept). For the Tinnitus Handicap Inventory, the results showed no interaction effect. For the Tinnitus Magnitude Index, the analysis showed a significant time × group interaction, indicating that both alpha/delta ratio neurofeedback and beta/theta ratio neurofeedback reported reduced tinnitus intensity. Analysis of EEG data showed a consistent pattern for the alpha/delta ratio over the course of training. Compared to beta/theta ratio neurofeedback, alpha/delta ratio neurofeedback showed an elevated response. Conversely, for the beta ratio to theta ratio, the pattern was more inconsistent, with no clear indication of superiority for beta/theta ratio neurofeedback over alpha/delta ratio neurofeedback. The main question of this piece of research was whether alpha/delta ratio neurofeedback demonstrated frequency band specificity in the alleviation of tinnitus distress and perceived intensity. Results showed that alpha/delta ratio neurofeedback was sufficient but importantly 'not' necessary to achieve a positive outcome on both the Tinnitus Handicap Inventory and Tinnitus Magnitude Index, when compared to beta/theta ratio neurofeedback. Still, the data suggest a trend towards specificity for alpha/delta ratio neurofeedback. Because of this, it may be too premature to discard alpha/delta ratio neurofeedback in the treatment of tinnitus. Recommendations for future studies are outlined.
先前的研究表明，α/δ比率神经反馈在减轻耳鸣令人不适的心理、情绪和感知后果方面是有效的。本研究的主要目的是调查，增强α频段活动和降低δ频段活动的特定组合对于获得关于耳鸣困扰和强度的积极治疗结果是必要的，还是仅仅是充分的。第二个研究目标是评估神经反馈相关的非特异性和一般非特异性效应在神经反馈治疗中的相对贡献。在一项三臂随机对照试验中，94名慢性耳鸣患者被随机分配到三种情况之一：α/δ比率神经反馈（n = 31）、β/θ比率神经反馈（n = 28）和非神经反馈最小治疗干预（n = 35）。神经反馈参与者在4周内接受10次治疗。在干预前、干预中期、干预后以及3个月随访时收集结果测量数据。耳鸣障碍量表和耳鸣严重程度指数被用作耳鸣困扰和耳鸣强度的主要结果测量指标。训练期间记录的脑电图数据补充了主要结果。由于数据是重复测量，分析采用了两级混合效应模型方法，包括个体随机效应（随机截距）。对于耳鸣障碍量表，结果显示没有交互作用。对于耳鸣严重程度指数，分析显示出显著的时间×组交互作用，表明α/δ比率神经反馈和β/θ比率神经反馈均报告耳鸣强度降低。脑电图数据分析显示在训练过程中α/δ比率有一致的模式。与β/θ比率神经反馈相比，α/δ比率神经反馈显示出更高的反应。相反，对于β比率与θ比率，模式更不一致，没有明确迹象表明β/θ比率神经反馈优于α/δ比率神经反馈。这项研究的主要问题是α/δ比率神经反馈在减轻耳鸣困扰和感知强度方面是否表现出频段特异性。结果表明，与β/θ比率神经反馈相比，α/δ比率神经反馈对于在耳鸣障碍量表和耳鸣严重程度指数上取得积极结果是充分的，但重要的是“并非”必要的。尽管如此，数据表明α/δ比率神经反馈有特异性趋势。因此，在耳鸣治疗中摒弃α/δ比率神经反馈可能为时过早。文中概述了对未来研究的建议。
