Case Study: Depression
AAPB and ISNR have established standards for Neurofeedback research [Moss & Gunkleman (2002)] that confer a status of Possible Efficacy for Depressive Disorders. A preliminary study by Neurofeedback Center of Virginia of 30 adult subjects showed "Moderate to Severe Depression " reduced to a status of "Mild Depression". Neurofeedback provides evidence-based practices on par with health care establishment demands (Gemon, Devon & Ramsey (2000), Sacket et al, (2000). Levels of evidence include: case reports, observational studies, randomized clinical trials, fMRI scans (Andrasik & Rime (2007), and so on. “Efficacy” determination of training or treatment effect is derived from systematic evaluation in controlled clinical trial (La Vaque et al (2002).
Case A
This case involved a fifty-four year old male who had completed substance abuse rehabilitation programs for alcoholism twice, and had been sober for over five years. The man reported lingering “burnout” as a fundamental cause of professional hypo-performance. He described feeling uninspired, noting his lack of concentration, diminished self-confidence, and chronic negative thoughts. In addition, the man complained of fatigue from sleep disruption and of irritability with an intermittent sense of hopelessness. These self-reported difficulties persisted despite prescribed medications that included a long-term course of two antidepressants, a mood stabilizer and a prescription sleep aid.
The man completed Neurofeedback training and at close of the second session reported feeling “uplifted”. He noted sleeping through the night without interruption. As training ensued the man reported “pleasant spinal sensations” at the end of each session. Shortly thereafter he reported mood improvements, along with a sense of feeling more detached from issues. He later reported feeling significantly more “unencumbered”, and noted improvement in his work performance. By mid-program the man had stopped using sleep medication and reported sleeping through the night consistently. As training progressed the man declared successful medically supervised cessation of one anti-depressant. He stated that even after a stressful day he was able to “hold up well” while remaining “energized and feeling motivated.” The man described an improved over-all quality of life along with work satisfaction, and felt he was no longer depressed. Later, he reported supervised cessation of all medications, but also reported experiencing some residual depression and irritability. He stated that he was better able to “cope with these rough spots” then in the past, and felt his symptoms would improve once his medication withdrawal symptoms passed. By end of Neurofeedback training the man reported general abatement of irritability and anxiety, and reported feeling “stable and content.” He was medication-free, reported that he was sleeping well, and noted reaching performance milestones within his normal range of productivity.
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Case B
This case involved a thirty-seven year old female who complained of depressed mood with periods of poor sleep, some mood fluctuations, extreme irritability, and occasional rages. The woman’s constellation of issues also included near-panic levels of anxiety, non-specific learning deficits (low attending skills, auditory processing difficulties), and general visuo-spatial issues. She was concerned over losing friends because of her inflexibility, and was battling increasing isolation, along with a lack of concentration and motivation. She felt these challenges were negatively impacting her professional performance and threatening her job security. She was medicated with multiple anti-depressants by her physician and the woman reported these were insufficient.
Early into completing some Neurofeedback sessions the woman reported feeling a "little less emotional", and also noted vivid dreams, but less sleep disruption. Shortly thereafter she reported sleeping through the night consistently for almost a week, and felt she was regaining her sense of humor. As her training continued she reported feeling more relaxed and better able to cope with issues, and was no longer feeling irritable or experiencing panic, even though her work situation continued to be very stressful and demanding. The woman reported enjoying the ability to maintain a "bigger picture perspective", and described being able to “concentrate and get things accomplished”, to her surprise. In addition, she reported graphomotor improvements, including more legible handwriting; something she felt was due to her ability to be calmer, which was aiding her ability to focus. Toward the end of treatment the woman was able to go for three weeks at a time without treatment and reported feeling significantly more stable then in the past. She had salvaged some nearly-ended relationships with friends, who commented that she seemed “more flexible and easy going”. Shortly thereafter she reported extreme stress from a demanding workload, which, along with a sudden death in the family was causing considerable setbacks. She noted she was "handling things better", but felt a need for increased frequency of neurofeedback. The woman resumed training on a schedule of two-week intervals until she felt stable and less stressed.
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