Does combined training of biofeedback and neurofeedback affect smoking status, behavior, and longitudinal brain plasticity?

Abstract

Introduction: Investigations of biofeedback (BF) and neurofeedback (NF) training for nicotine addiction have been long documented to lead to positive gains in smoking status, behavior and to changes in brain activity. We aimed to: (a) evaluate a multi-visit combined BF/NF intervention as an alternative smoking cessation approach, (b) validate training-induced feedback learning, and (c) document effects on resting-state functional connectivity networks (rsFCN); considering gender and degree of nicotine dependence in a longitudinal design.Methods: We analyzed clinical, behavioral, and electrophysiological data from 17 smokers who completed five BF and 20 NF sessions and three evaluation stages. Possible neuroplastic effects were explored comparing whole-brain rsFCN by phase-lag index (PLI) for different brain rhythms. PLI connections with significant change across time were investigated according to different resting-state networks (RSNs).Results: Improvements in smoking status were observed as exhaled carbon monoxide levels, Total Oxidative Stress, and Fageström scores decreased while Vitamin E levels increased across time. BF/NF promoted gains in anxiety, self-esteem, and several aspects of cognitive performance. BF learning in temperature enhancement was observed within sessions. NF learning in theta/alpha ratio increase was achieved across baselines and within sessions. PLI network connections significantly changed across time mainly between or within visual, default mode and frontoparietal networks in theta and alpha rhythms, while beta band RSNs mostly changed significantly after BF sessions.Discussion: Combined BF/NF training positively affects the clinical and behavioral status of smokers, displays benefit in smoking harm reduction, plays a neuroprotective role, leads to learning effects and to positive reorganization of RSNs across time.Clinical Trial Registration:https://clinicaltrials.gov/ct2/show/NCT02991781.

Integrated use of biofeedback and neurofeedback techniques in treating pathological conditions and improving performance: a narrative review

“…Although the reviews taken into consideration present limitations, both at the level of the included studies (for example: methodological limitations such as the lack of a control group, a sample consisting of few subjects or non-standardized clinical outcomes) and at the level of the reviews themselves (for example: a small number of studies included and a poor quality of the same), the results show that these alternative approaches constitute promising measures to help smokers to quit smoking, facilitating the modulation of the activity of the Central and Autonomic Nervous System. Similarly, the study by Pandria et al (2023) confirms what emerged from the reviews examined, demonstrating the effectiveness of an integrated BF + NF approach on the clinical, behavioral, and cognitive aspects of smokers. At present, it is not possible to determine whether this integrated approach produces better results than the two approaches applied individually, as there are no effect size measures either in the reviews considered or in the study by Pandria and collaborators.…”

“…The increased synchronization between the visual network and other resting-state networks (RSNs) is considered an indicator of better integration of sensory information ( Dobrushina et al, 2020 ). Finally, Modi et al (2015) found that trait anxiety is associated with reduced connectivity between the DMN and the VIS, thus the reduction in STAI trait anxiety scores observed in the study by Pandria et al (2023) it may reflect the increase in connectivity observed in these two networks.…”

“…Smoking in fact leads to an increase in oxidative damage ( Kamceva et al, 2016 ; Karademirci et al, 2018 ) which leads to the generation of free radicals and inflammatory responses ( Csordas and Bernhard, 2013 ; Messner and Bernhard, 2014 ) and has been shown that there is a correlation between oxidative stress and the number of cigarettes smoked ( Kamceva et al, 2016 ). From these results we could suggest a protective role of BF + NF training against the oxidative load induced by smoking, as the participants in the study by Pandria et al (2023) who were highly dependent on nicotine still managed to achieve a significant reduction in oxidative stress levels. Smoking also causes dysregulation of hormonal responses to stress ( Childs and de Wit, 2009 ), leading to the establishment of abnormal anxiety thresholds.…”

Resting-state electroencephalography theta predicts neurofeedback treatment 4-month follow-up response in nicotine addiction

“…Finally, the brain mechanism of the theta predictor might be located in the OFC. Several pre-post EEG studies on behavioural approaches 15 and hypnosis-induced 16 reductions in smoking have identified enhanced theta oscillations. Consistent with these findings, our study observed an increase in the frontal theta PSD in the real-feedback group after two neurofeedback training sessions compared with the yoked-feedback group.…”

Biofeedback Interventions for Impulsivity-related Processes in Addictive Disorders

“…Besides the interventions with only central or peripheral measures of biofeedback, the combination of both measures could also be an interesting approach to benefit from the features of each method. In that sense, Pandria and colleagues carried out an intervention with combined peripheral biofeedback from skin temperature and EEG-NFB for smoking cessation in people with nicotine addiction [82]. Both biofeedback interventions were performed separately and showed changes across sessions.…”