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NEUROTHERAPFOR Y PSYCHOLOGICAL DISORDERS

Conclusions

We have found that the evidence for the efficacy of Neurotherapy for psychological disorders is generally limited by the use of outcome measures that have questionable psychometric and ecological validity. More important, the experimental control conditions are sufficiently weak so that the criteria for efficacious treatments (Chambless et al., 1998; Chambless et al., 1996) have not yet been met for ADHD, substance dependence, anxiety disorders, mood disorders, or dissociative disorders. At the present time, the most optimistic conclusion is that Neurotherapy might meet the criteria for "Possibly Efficacious" treatment for Generalized Anxiety Disorder (Vanathy et al., 1998). However, methodological and statistical problems render even these conclusions as questionable, and the findings of Rice et al. (1993) suggest that nonspecific treatment factors are responsible for symptom reduction.

Suggestions for Future Research

Herbert's (2000) critique of the criteria for empirically supported treatments (Chambless et al., 1998; Chambless et al., 1996) is based on the need for strong tests of the specific effects of any treatment procedure. Such tests are those that provide for the experimental disconfirmation of the putative pathological conditions that are treated, or the therapeutic mechanisms that derive from the procedures (Borkovec & Castonguay, 1998; Hazlett-Stevens, & Borkovec, 1998). The inclusion of such control conditions in Neurotherapy treatment research is critical as some neurofeedback efficacy studies have shown that changes in clinical symptoms can occur independent of the changes in brain waves (Fenger, 1998; Vanathy et al., 1998). It would appear that Neurotherapy techniques, and the neurophysiological theory upon which they are based, are ideal candidates for such strong experimental tests. Despite over 20 years of research on neurofeedback, however, it appears that nearly all of the experimental tests published in peer-reviewed journals are surprisingly weak. Only a very small proportion of such studies provide even the minimal wait list control comparison (Linden et al., 1996; Rice et al., 1993; Vanathy et al., 1998), and only one (Rice et al., 1993) has manipulated specific and nonspecific features of Neurotherapy treatment. Future research on the efficacy of Neurotherapy could include component comparisons or yoked-control procedures. The former might include comparison of augmentation feedback vs augmentation combined with suppression feedback of specific frequencies, depending on the theory of the disorder (e.g., ADHD). The latter could include the comparison of a standard Neurotherapy protocol with a false-feedback control condition, or EMG biofeedback (c.f., Rice et al., 1993). Moreover, the comparison of Neurotherapy to alternative treatments without the use of a wait list control (Rossiter & La Vaque, 1995; Peniston & Kulkosky, 1989, 1990, 1991) are not informative as they cannot provide evidence for the efficacy of Neurotherapy per se (Borkovec & Castonguay, 1998).

If the proponents of Neurotherapy wish to promote their treatment as specific and efficacious, they must do so on the basis of efficacy experiments that provide strong experimental tests. For example, it appears that depressive symptoms and the anterior asymmetry that accompanies them could be a productive focus for the test of neurofeedback theory and efficacy. Efficacy studies that provide wait list controls, nonspecific factor controls, and controls for the modification of specific brain wave functions could be strong experimental tests of the putative pathological processes and their therapeutic modification. However, we suggest that until such tests are forthcoming, behavior therapists should be cautious about the efficacy of Neurotherapy, and AABT should be more circumspect about participation in the promotion of Neurotherapy.

References

 

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