Taking Back the Brain

Could Neurofeedback Training Be Effective for Relieving Distressing Auditory Verbal Hallucinations in Patients With Schizophrenia?

Simon McCarthy-Jones

Disclosures

Schizophr Bull. 2012;38(4):678-682. 

In This Article

Abstract and Introduction

Abstract

Progress in identifying the neural correlates of auditory verbal hallucinations (AVHs) experienced by patients with schizophrenia has not fulfilled its promise to lead to new methods of treatments. Given the existence of a large number of such patients who have AVHs that are refractory to traditional treatments, there is the urgent need for the development of new effective interventions. This article proposes that the technique of neurofeedback may be an appropriate method to allow the translation of pure research findings from AVH-research into a clinical intervention. Neurofeedback is a method through which individuals can self-regulate their neural activity in specific neural regions/frequencies, following operant conditioning of their intentional manipulation of visually presented real-time feedback of their neural activity. Four empirically testable hypotheses are proposed as to how neurofeedback may be employed to therapeutic effect in patients with AVHs.

Introduction

Auditory verbal hallucinations (AVHs), the experience of hearing a voice in the absence of an appropriate external stimulus, are often associated with severe distress and social and occupational impairment. Approximately, 3 in 4 patients with schizophrenia will experience AVHs1 (henceforth termed SZ:AVH+). While the past decade has seen significant progress in identifying the neural activity underpinning AVHs, researchers now face the challenge of translating this improved understanding into therapeutic interventions. The urgency of this arises from the limitations of existing treatments. Although the exact percentage is unclear,[1] a consensus exists that a significant minority of SZ:AVH+, possibly as high as 25%–30%, have antipsychotic medication-resistant AVHs.[2] Furthermore, the evidence base for cognitive-behavioral therapy for AVHs is weak, (S.M.-J. et al, unpublished data, 2011) and despite a recent meta-analysis finding transcranial magnetic stimulation (TMS) over the left temporoparietal junction to be effective for AVHs,[3] a recent large randomized controlled trial (RCT) of TMS for AVHs has reported negative results.[4] There is hence a pressing need for novel therapeutic developments for SZ:AVH+, grounded in and guided by pure research findings. This article will argue that one such promising option is neurofeedback.

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