The Effect of EEG Biofeedback on Depression and Improve the Quality of Life of Patients With Multiple Sclerosis (MS)


Abstract

Introduction: Due to some physical and mental symptoms and failure to accept the reality, Multiple Sclerosis (MS) patients suffer from negative mood disorders and trauma, and this would have negative effects on their quality of life. This study aimed to investigate the effectiveness of EEG biofeedback on MS patients’ quality of life and depression symptoms.
Methods: The design is Quasi-experimental with pre-test, post-test and follow-up. The sample, 20 patients in experiment (10) and control (10) groups, is all of the MS patients of Yazd that have a record in clinics or MS Association, and is chosen by convenience sampling. Before the treatment started, patients had filled the HADS depression scale and MSQOL-54 quality of life questionnaire, then, in the post-test and follow-up stages, these evaluations were done again. The treatment lasted for 15 sessions, two sessions per week, and the follow-up was done three months after the post-test. The data obtained from the questionnaire were analyzed by SPSS17 software using descriptive tests (mean and standard deviation) and inferential tests (covariance analysis).
Results: Research findings shows that EEG biofeedback decreases the depression level and increases the quality of life of patients with MS.
Conclusions: MS results in many symptoms, and its sufferers may need a mental rehabilitation in future, therefore, EEG biofeedback can be applied by therapists as a complementary therapy in clinics and therapeutic centers.

Keywords

Multiple Sclerosis; Neurofeedback; Depression; Quality of Life

The Effect of EEG Biofeedback on Depression and Improve the Quality of Life of Patients With Multiple Sclerosis (MS)


Authors

Reza Bidaki

Affiliation: Research Center of Addiction and Behavioral Sciences, Shahid Sadoughi University of Medical Sciences, Yazd, Iran. Diabetes Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran

Fariba Sepehri

Affiliation: Department of Clinical Psychology, University of Isfahan, Isfahan, Iran

Rezvan Sadr Mohammadi

Affiliation: Department of Clinical Psychology, Kar Higher Education Institute of Rafsanjan, Rafsanjan, Iran

Omid Kamali

E-mail: omidkamali99@yahoo.com
Affiliation: Department of Clinical Psychology, Islamic Azad University, Yazd Branch, Yazd, Iran

Mojtaba Babaei Zarch

Affiliation: School of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran

Hamid Mirhoseini

Affiliation: Department of Psychiatry, Shahid Sadoughi University of Medical Sciences and Health Services, Yazd, Iran

The Effect of EEG Biofeedback on Depression and Improve the Quality of Life of Patients With Multiple Sclerosis (MS)


full text

INTRODUCTION

Multiple sclerosis (MS) is a potentially life-changing immune mediated disease of the central nervous system. It is the most commonly acquired neurological disorder affecting young adults of reproductive age with an approximately 3:1 female to male ratio. MS significantly impacts the lives of individuals with the disease and their families. Recent advances in the understanding of the immunopathology and management of MS have made this field of care dynamic and challenging [1].

 Mood swings are characterized by unexpected and sudden shifts in mood that are uncharacteristic of the person’s usual mood. A symptom that is another common aspect of MS is its effect on mood dysfunction, which brings on depression or elation resulting in unexpected or inappropriate mood swings [2].

The course of MS is unpredictable. Most people having a relapsing- remitting course marked by periodic attacks or exacerbations that only generally partially remit. The major depressive disorder is the most common psychiatric disorder in these patients. This patients suffering of persistent feelings of sadness, hopelessness about the future, perceptions about theirs disability and disability, persistent mental preoccupation with negative thoughts that they are adverse consequences of depression, even they can cause extreme behaviors such as suicide attempts. Depression can discourage individuals from pursuing medications for illness and increase symptoms of Illness. Furthermore, depression may also have an adverse effect on process of adjusting and adapting to new conditions [3].

It is recognized that patients with multiple sclerosis have a high lifetime risk for major depression. Major depression is common in MS patients and estimations show that 50/0 of MS patients suffer from major depression. Major depression often occurs in MS patients aged 18 to 45 years and most commonly associated with suicidal ideation [4-6]. The results indicate that drugs (including interferon) can accelerates the depression in MS.

Complications of MS in patients has led to a decrease in performance and thus the quality of their role and status of the job and ultimately MS might negative effect on the quality of life of patients [1]. On the other hand, multiple sclerosis disease causes loss of individual autonomy and social well-being and leads to reduce restrictions on the practice of sustainable quality of life [7]. Research has also shown that increased rates of depression, psychological distress and anxiety that associated with reduction social function and quality of life [8].

Quality of life (QoL) has presently a firmly established position as an important endpoint in medical care [9].

Neurofeedback (NF) refers to an operant conditioning paradigm where participants can learn voluntary control of distinct parameters of their electrical brain activity as measured by the electroencephalogram [10]. EEG learned self-regulation of specific EEG frequency components has proven to be of considerable value in clinical settings with applications in various. Additionally, more recent research focused on healthy individuals providing evidence that subjects are able to gain some control over different EEG components and thereby increase performance levels [11]. Because neurofeedback training is a novel therapeutic approach and its effectiveness in the treatment of various disorders, we need more research. This study is also in line with the need to evaluate the effectiveness of neurofeedback in reducing depression in patients with multiple sclerosis.

Quality of life in patients with MS is significantly lesser than chronic diseases such as from other patients with rheumatoid arthritis, inflammatory bowel disease, diabetes and epilepsy. Because of the chronic, recurrent, and disability in physical activity of the patient, the disease can have different degrees of influence on the psychosocial aspects [12].

The aim of this study is to investigate the effectiveness of EEG biofeedback on MS patients’ quality of life and depression symptoms in Yazd.

METHODS

The method of such study is experimental. Also study design is as pre testing, post testing and follow up with control group. The statistical study consisted of patients with multiple sclerosis that they have file in clinical and MS community in Yazd in 2013-2014.

Inclusion criteria: Have clinically diagnosed following the McDonald et al. were in a stable phase of the disease, without relapsing in the last 2 months. Participants ages above 18 years old and also experienced depression. The exclusion criteria: acute relapse of MS within the last month, the presence of additional neurological or psychiatric disorders, epilepsy and other chronic diseases.

The Hospital Anxiety and Depression Scale (HADS) [13] consists of 14 items; 7 items measure the severity of depression and 7 items measure the severity of anxiety. Hospital Anxiety and Depression Scale (HADS) HADS was applied to assess the presence and severity of depression and anxiety. This is a 14-item self-report screening scale developed to detect the presence of anxiety and depression symptoms in the setting of a medical non psychiatric outpatient clinic [10]. The HADS scores seven anxiety symptoms and seven depression symptoms, and each item presents a four-point Likert type. The maximum score for both scales is 21points for depression and anxiety each one. Scores adding up to 0– 7 are considered normal, 8–10 indicate mild anxiety and/or depression and _11 indicates clinically relevant anxiety and/or depression. The Spanish version was validated by Herrero et al. [11]. This version has a Cronbach’s alpha coefficient of 0.90 for the full scale, 0.84 for the depression subscale and 0.85 for the anxiety subscale. The cut-off point for depressive disorder is 5 (sensitivity 77.8%; specificity 80.9%), and for anxiety disorder is 8 (sensitivity 89%; specificity 77.2%).

Multiple Sclerosis Quality of Life (MSQOL)-54 Instrument: The MSQOL-54 is a multi-dimensional health-related quality of life measure that combines both generic and MS-specific items into a single instrument. The developers utilized the SF-36 as the generic component to which 18 items were added to tap MS-specific issues such as fatigue, cognitive function, etc. This 54-item instrument generates 12 subscales along with two summary scores, and two additional single-item measures. The subscales are: physical function, role limitations-physical, role limit ations-emotional, pain, emotional well-being, energy, health perceptions, social function, cognitive function, health distress, overall quality of life, and sexual function. MSQOL-54 scale scores were assembled using the Likert method for summed ratings and the raw scores were linearly transformed into 0-100 scales: the higher the transformed score, the better the patient’s HRQOL [14].

Intervention: Neurofeedback treatment to be run for 15 40-minute sessions twice a week, individually. The main tool used Neurofeedback was biography device manufacturer thought technology company in Canada. The system is connected to the computer with the USB cable and with using EEG sensors, information collected from the surface of the body is transferred to the computer monitor. This information is viewed, analyzed, and recorded. Intervention was conducted by the specialist trained in psychology clinic.

Implemented protocols for subjects:

1-            Reduction θ (4-8) and α (8-12), increase β (15-18), on F3 for 10 min.

2-            Reduction θ (4-8) and α (8-12), increase smr (15-18) on F3 for 10 min.

3-            Reduction ∆ (0-4) and β (23-35), increase α (8-12) on Fz for 20 min

4-            Threshold of meeting 1-5(25-75-25), threshold of meeting 6-10 (30-70-30), threshold of meeting 11-15(35-65-35).

After of the end treatment, both experimental and control groups after three months, re-evaluated, the data were analyzed statistically.

RESULTS

Quality of life score after intervention in the treatment group and control group respectively were 52.1 and 33.9. This significant difference continued to follow-up (49.8 vs 32).

According ANCOVA test was conducted, signification levels is lesser than 0.05, so assuming an effective therapy will be accepted on quality of life after intervention and follow-up in MS patients.

According ANCOVA test, signification levels is lesser than 0.05, Therefore, the intervention was effective in reducing depression after intervention and follow-up in MS patients.

 

Table 1. Statistical Information Related to the Pre-Test, Post-Test and Follow-up Quality of Life for the Experiment and Control Groups (n = 10)

  R Min Max Mean ± SD Variance
Pre-test          
control 63.45 12.00 75.45 37.41 ± 21.132 446.572
Experiment 64.25 12.35 76.60 37.65 ± 21.053 443.270
Post-Test          
control 57.31 12.00 69.31 33.90 ± 20.475 419.258
Experiment 63.71 25.54 89.25 52.13 ± 20.20 408.284
Follow-up          
control 55.35 11.20 66.55 32.08 ± 20.39 416.138
Experiment 53.12 24.70 77.82 49.85 ± 18.68 349.297

 

Table 2. Statistical Information Related to the Pre-Test, Post-Test and Follow-up Depression for the Experiment and Control Groups (n = 10)

  R Min Max Mean ± SD variance
Pre-Test          
Experiment 61.39 15.49 76.88 38.047 ± 18.27 334.00
control 8.00 10.00 18.00 14.40 ± 3.02 9.156
Post-Test          
Experiment 68.07 17.41 85.48 44.14 ± 21.34 455.76
control 13.00 7.00 20.00 14.80 ± 3.64 13.28
Follow-up          
Experiment 61.17 20.11 81.28 41.485 ± 18.15 329.59
control 6.00 14.00 20.00 17.400 ± 1.89 3.60

 

Table 3. Levine's Test for Quality of Life and Depression Post-Test and Follow-Up Scores the Experiment and Control Groups

  Fisher Test Df1 Df2 Sig
Quality Life        
Post-Test 0.019 1 18 0.892
Follow-up 0.127 1 18 0.725
Depression        
Post-Test 1.621 1 18 0.219
Follow-up 0.070 1 18 0.795

 

According to the Table 3, results of test for quality of variance showed the (H0) hypothesis is not rejected for all variables.

 

Table 4. Tests of Between-Group Variable: The Quality of Life Post-Test

  Type Third Sum Of Squares df Mean Square Statistics for Fisher Sig Eta Square
The Modified Model 3153.552 2 1576.776 4.500 0.027 0.346
Reciprocal 3184.159 1 3184.159 9.088 0.008 0.348
Post-Test 1491.705 1 1491.705 4.258 0.055 0.200
Group 1643.588 1 1643.588 4.691 0.045 0.216
Error 5956.173 17 350.363 - - -
Total 46123.272 20 - - - -
Total Corrected 9109.724 19 - - - -

 

According above table and ANCOVA test was conducted, signification levels is lesser than 0.05, so H0 rejected and assuming an effective therapy will be accepted on quality of life after intervention.

 

Table 5. Tests of Between-Group Variable: The Quality of Life Follow-up Scores

  Type Third Sum of Squares df Mean Square Statistics for Fisher Sig Eta Square
The Modified Model 2681.259 2 1340.630 3.939 0.039 0.317
Reciprocal 3237.534 1 3237.534 9.511 0.007 0.359
Post-Test 1102.395 1 1102.395 3.239 0.090 0.160
Group 1563.553 1 1563.553 4.594 0.047 0.213
Error 5786.523 17 340.384 - - -
Total 42038.600 20 - - - -
Total Corrected 8467.782 19 - - - -

 

According above table and ANCOVA test was conducted, signification levels is lesser than 0.05, so H0 rejected and assuming an effective therapy will be accepted on quality of life after follow-up.

 

Table 6. Tests of Between-Group Variable: The Depression Post-Test Scores

  Type Third Sum of Squares df Mean Square Statistics for Fisher Sig Eta Square
The Modified Model 169.849 2 84.924 12.995 0.000 0.605
Reciprocal 8.377 1 8.377 1.282 0.273 0.070
Post-Test 59.399 1 59.399 9.089 0.008 0.348
Group 113.362 1 113.362 17.346 0.001 0.505
Error 111.101 17 6.535 - - -
Total 3381.000 20 - - - -
Total Corrected 280.950 19 - - - -

 

According above table and ANCOVA test was conducted, signification levels is lesser than 0.05, so H0 rejected and assuming an effective therapy will be accepted on depression after intervention.

 

Table 7. Tests of Between-Group Variable: The Depression Follow-up Scores

  Type Third Sum of Squares df Mean Square Statistics for Fisher Sig Eta Square
The Modified Model 247.941 2 123.970 45.216 0.000 0.842
Reciprocal 35.325 1 35.325 12.884 0.002 0.431
Post-Test 36.691 1 36.691 13.382 0.002 0.440
Group 214.376 1 214.376 78.190 0.000 0.821
Error 46.609 17 2.742 - - -
Total 4299.000 20 - - - -
Total Corrected 294.550 19 - - - -

 

According above table and ANCOVA test was conducted, signification levels is lesser than 0.05, so H0 rejected and assuming an effective therapy will be accepted on depression after follow-up.

 

DISCUSSION

The effectiveness of neurofeedback treatment of depression has been reported in different groups [15, 16]. Neurofeedback treatment used for various aspects of MS patients and its efficacy has been reported [17, 18].

According to the investigation and the data obtained from the questionnaire, these results were as follows:

EEG feedback therapy on quality of life in patients with multiple sclerosis in post-test and follow up Phase was effective. These findings indirectly coordinated with Choobforoushzadeh et al. [19], Pampa Reddy et al. [20], Hammond [21], Hammond [22]. Several studies regarding the effectiveness of EEG feedback therapy was conducted on patients with MS. However, in this topic still has not been studied in Iran. One of the main reasons to explain the effectiveness of EEG feedback to improve the quality of life in patients with MS is the effectiveness of EEG feedback on the mental aspect of quality of life. Mental status in patients with MS Recovered by reducing depression and mood enhancement and followed by reduction of the limitations of the disease can lead to improving the quality of life in these patients.

The results showed that depression in patients with multiple sclerosis in the experimental group than in the intervention and follow-up phase is lesser than depression in patients with MS in control group. Therefore it can be concluded that EEG feedback therapy leads to reduction depression in patients in the intervention and follow-up phase. The findings of the study are consisted to Hammond [22] and Hammond et al. [23].

In explaining the effectiveness of EEG feedback in reducing depression in patients with MS, we can say Statements with respect to the research, the balance of alpha wave is created on both sides of the frontal lobe decreases.

CONFLICTS of INTEREST

The authors declare that they have no competing interests

AUTHORS' CONTRIBUTIONS

" Fariba Sepehri carried out collect samples. Reza Bidaki carried out supervision stages of project. Rezvan Sadr Mohammadi participated in the design of the study and performed the statistical analysis. Omid Kamali conceived of the study, and participated in its design and coordination and helped to draft the manuscript. Mojtaba Babaei Zarch as well Hamid Mirhoseini wrote the final manuscript. All authors read and approved the final manuscript."

ACKNOWLEDGEMENTS

We appreciate MS Society and respectable patients for cooperation in this study

FUNDING SUPPORT

Islamic Azad University of Yazd.

The Effect of EEG Biofeedback on Depression and Improve the Quality of Life of Patients With Multiple Sclerosis (MS)


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The Effect of EEG Biofeedback on Depression and Improve the Quality of Life of Patients With Multiple Sclerosis (MS)


Citation tools

Vancouver

Bidaki R, Sepehri F, Sadr Mohammadi R, Kamali O, Babaei Zarch M, Mirhoseini H. The Effect of EEG Biofeedback on Depression and Improve the Quality of Life of Patients With Multiple Sclerosis (MS). Focus on Sciences. 2106; 3(3):1-5


APA

Bidaki, R., Sepehri, F., Sadr Mohammadi, R., Kamali, O., Babaei Zarch, M., & Mirhoseini, H. (2106). The Effect of EEG Biofeedback on Depression and Improve the Quality of Life of Patients With Multiple Sclerosis (MS). Focus on Sciences, 3(3), 1-5.


Chicago

Reza Bidaki, Fariba Sepehri, Rezvan Sadr Mohammadi, Omid Kamali, Mojtaba Babaei Zarch, and Hamid Mirhoseini "The Effect of EEG Biofeedback on Depression and Improve the Quality of Life of Patients With Multiple Sclerosis (MS)". Focus on Sciences 3, no. 3 (2106).

The Effect of EEG Biofeedback on Depression and Improve the Quality of Life of Patients With Multiple Sclerosis (MS)


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