The Effects of Different Theta and Beta Neurofeedback Training Protocols on Cognitive Control in ADHD

Abstract

Neurofeedback (NF) is an important treatment for attention deficit/hyperactivity disorder (ADHD). In ADHD, cognitive control deficits pose considerable problems to patients. However, NF protocols are not yet optimized to enhance cognitive control alongside with clinical symptoms, partly because they are not driven by basic cognitive neuroscience. In this study, we evaluated different EEG theta and/or beta frequency band NF protocols designed to enhance cognitive control. Participants were n = 157 children and adolescents, n = 129 of them were patients with ADHD (n = 28 typically developing (TD) controls). Patients with ADHD were divided into five groups in the order of referral, with four of them taking part in different NF protocols systematically varying theta and beta power. The fifth ADHD group and the TD group did not undergo NF. All NF protocols resulted in reductions of ADHD symptoms. Importantly, only when beta frequencies were enhanced during NF (without any theta regulation or in combination with theta upregulation), consistent enhancing effects in both response inhibition and conflict control were achieved. The theta/beta NF protocol most widely used in clinical settings revealed comparatively limited effects. Enhancements in beta band activity are key when aiming to improve cognitive control functions in ADHD. This calls for a change in the use of theta/beta NF protocols and shows that protocols differing from the current clinical standard are effective in enhancing important facets of cognitive control in ADHD. Further studies need to examine regulation data within the neurofeedback sessions to provide more information about the mechanisms underlying the observed effects.

Effects of Digital Interventions on Neuroplasticity and Brain Function of Individuals With Developmental Disabilities: A Systematic Review (Preprint)

“…In 8 out of 10 studies, theta waves decreased following the intervention. Three studies reported an increase in beta waves [25,46,47], two showed no difference [27,52], and one indicated a decrease [34]. Of the six studies measuring alpha waves, four reported increase [27,33,34,47], while of the six studies measuring theta/beta ratio, three reported decrease [25,38,47].…”

Effects of Neurofeedback on Cognitive Function, Productive Activity, and Quality of Life in Patients With Traumatic Brain Injury: A Randomized Controlled Trial

“…Theta/beta NFB, considered the gold standard of NFB, trains patients to decrease activity in the theta (θ) frequency band and concomitantly increase activity in the beta (β) frequency band (ie, a θ↓β↑ protocol) to improve cognitive control deficits. 17 Beta and theta band fluctuations have been associated with memory and attention. 18…”

“…Theta/beta NFB, considered the gold standard of NFB, trains patients to decrease activity in the theta (θ) frequency band and concomitantly increase activity in the beta (β) frequency band (ie, a θ↓β↑ protocol) to improve cognitive control deficits. 17 Beta and theta band fluctuations have been associated with memory and attention. 18 A previous study introduced the technique of low-resolution electromagnetic tomography analysis (LORETA) Z-score NFB (LZNFB); this technique involves a greater number of electrodes (19-channel scalp sensors) during treatment and achieves faster effective results than conventional surface NFB.…”