Taking back the brain: Trialling neurofeedback for voice-hearing

Hearing voices (also referred to as ‘auditory verbal hallucinations’) need not be associated with problems. However, for a number of people, they are. Problems are particularly likely to arise if the voices are frequent, say negative things, and if the person has no control over them.

Different people want differ ways to cope with their voices, as our research has previously found. For some, medication may be the solution. For others, approaches such as cognitive behavioural therapy or the Hearing Voices Movement’s Maastricht Interview may provide answers and peace.

Another potential way of coping is neurofeedback.

Neurofeedback works by showing people their brain activity in real-time, and then training them to manipulate this. It allows you to control your own brain.

I have just received some funding from the US-based Brain & Behaviour Research Foundation to test whether EEG-based neurofeedback can help people distressed by voice-hearing. My thanks go to them and to their donors for making this research possible.

The trial will be done in collaboration with Dr Michael Keane at the Dublin-based neurofeedback clinic, Actualise.

Work will start towards the end of 2017, when I will be looking to recruit a post-doc to work on this trial with me.

Hopefully this approach will prove effective and give people who are distressed by their voices another therapeutic option to choose from.

More soon.

SMJ

Advertisements

How do antipsychotic drugs have their effect?

Today I’d like to draw your attention to a new paper just published by Moritz and colleagues (link here), which examines how antipsychotic drugs have their effect.

What did it do?

This on-line study involved 95 people, who had experience of taking antipsychotics, completing a questionnaire called the Effect of Antipsychotic Medication on Emotion and Cognition, which asked 49 questions about the subjective effects of antipsychotics. The participants had a range of psychiatric diagnoses, with 69 having a probable diagnosis of psychosis. They appear to have been mainly recruited through moderated German discussion forums for psychosis and other psychiatric disorders.

What did it find?

  • “patients strongly and rather consistently attributed a dampening of emotion,
    clouding of cognitive faculties and decreased joy to antipsychotic treatment”
  • “patients reported that antipsychotics decreased their emotionality, creativity and also exerted a detrimental effect on their cognitive faculties”
  • “Negative effects largely prevailed”
  • “patients reported that they were more doubtful due to antipsychotics”

[the measure of doubt included items such as mistrusting one’s own thinking, being indecisive about what is wrong, higher self-doubt]

  • “the majority of patients reported somewhat greater hard-headedness under antipsychotics”

[the authors explain their term ‘hard-headedness, by indicating that people predominantly endorsed the response option “narrow-minded and not open to other ideas”].”

  • “Doubt, numbing and withdrawal were the main subjective antipsychotic effects”

What do the authors conclude?

The authors conclude that “The induction of doubt and the dampening of emotion may be one reason why antipsychotics reduce positive symptoms” and note that their findings of reported antipsychotic effects including cognitive and emotional numbing, and social withdrawal are “disquieting”.

Limitations of the study

The authors note that the limitations of their study mean that they “have to refrain from bold conclusions”.

The first limitation was “that self-report assessments might be problematic in psychosis patients, as they have been consistently shown to lack metacognitive awareness”.

But this seems to suggest that people diagnosed with psychosis can’t be relied on to accurately report their experiences of antipsychotics being problematic, which is at best a questionable statement. Also, if a person said antipsychotics worked for them, would anyone question whether they were right on the basis that they may be saying this due to a lack of “metacognitive-awareness”?

The authors also note another important limitation, namely that the Internet population (where they recruited people from) “is probably different from a clinical population as it contains a subgroup of subjects who are not willing to undergo treatment and are thus less compliant with the psychiatric health care system”.

Summary

It is clear we need better ways to help people. And we need them yesterday.

 

Reference

I’d encourage you to read the paper for yourself. The reference (and link) is:

Moritz, S., Andreou, C., Kilngberg, S., Thoring, T., Peters, M. J. V. (2013). Assessment of subjective cognitive and emotional effects of antipsychotic drugs. Effect by defect? Neuropharmacology. http://dx.doi.org/10.1016/j.neuropharm.2013.04.039

If you can’t access the paper on-line, I’m that sure if you emailed the authors that they would be happy to send you a copy for your own examination.

Resisting werewolves, and (via the Bonzos) onto TMS and beyond…

What is the hardest part of research? Getting a grant to study an area in the first place? Gaining ethical approval for one’s study? Publishing a paper on one’s work? Although tricky, none of these make the number one slot. This spot has to be claimed by the devilish difficulty of resisting the urge, when doing literature searches, to probe into the  completely tangential papers and areas which such searches inevitably throw up.

Today I had to struggle with werewolves.

As I was trawling through search results relating to the most recent papers on hearing voices, with a search string pretty specific to this area, up popped a paper on werewolves.

Thank you Twilight.

This was not an idiosyncratic, rambling paper from many years gone by either. This was a new 2012 review paper published in a psychiatry journal. For the interested reader (and how could you not be) the abstract of the paper is here: http://www.ncbi.nlm.nih.gov/pubmed/22261984. This looks a really fascinating area, slapbang at the intersection of psychiatry and culture.

A wild struggle then ensued in which I tried to stop myself from doing out-of-hours research into werewolves. This pretty much succeeded. However, this led into another digression as I don’t know what you think of when you hear the term ‘werewolf’ but the exploding tuba of genius that was the Bonzo Dog Doodah Band springs to my mind, due to their version of the Monster Mash (‘the guests included wolfman, Dracula and his son…’). If you haven’t heard of the the Bonzo’s before, you must check out their album ‘Tadpoles’.

Although the Brainiac device in the Bonzo’s video is (thankfully) nothing like the effects of low frequency repetitive Transcranial Magnetic Stimulation (rTMS), which is painless and typically doesn’t lead to seizures, this started my mind on this area and I remembered a recent paper I had found (before the werewolf digression) on TMS for hearing voices, but with the TMS not focussed over the left temporoparietal junction as usual, but over Heschl’s gyrus.

Given that activation of Heschl’s gyrus doesn’t appear in that many fMRI symptom capture studies of auditory verbal hallucintions (AVHs: sorry the acronyms are coming thick and fast now), this area had (understandably) not been probed specifically before with TMS. I would have been somewhat skeptical of the likelihood of TMS in this area being effective for AVHs, and indeed, the authors reported that TMS over this area was ineffective.

In fact, at present the evidence base in general for TMS for AVHs is somewhat contradictory.

On the one hand a recent review of treatments, just published, argues that TMS “is capable of reducing the frequency and severity of auditory hallucinations” and goes on to “recommend low frequency rTMS directed at the left temporoparietal area for the treatment of AVH”. This conclusion is based on earlier studies and meta-analyses (e.g., Aleman et al., 2007). Yet, three of the authors of this review paper recommending TMS for AVHs have recently published a large 62 patient trial of TMS which reported it to be ineffective for AVHs.

As I argue in my book, I think it likely that there are some voice-hearing people for whom  TMS may be helpful, potentially individuals with a specific subtype of AVHs (based on some of Ralph Hoffman’s findings in this area, see this paper).

However, the authors of the large 62 patient trial concluding that TMS is ineffective for hearing voices argue that “It might be time for a change of paradigm and for a search for more effective treatment regimens”.

So I don’t think I’m howling at the moon when I say, Neurofeedback anyone?

Early Intervention in Psychosis in Bondi

Bondi beach

Last week I was lucky enough to visit the Early Intervention in Psychosis (EIP) team in Bondi, Sydney.

Up from the hill from the world famous Bondi beach, in a quiet leafy lane with sufficient garden spiders to slight rattle a still aclimatising Englishman, the EIP team manages to seamlessly integrate research and clinical support for clients.

I already knew about the team’s research and clinical work which attempts to intervene early to prevent the weight-gain often associated with the use of antipsychotic medication, and their publications on this topic.

What I didn’t know about was other research by the team showing that exercise in EIP populations increases hippocampal brain volumes and cognitive functioning, the EEG lab they have which aids the integration of research with treatment services, the in-house gym, and the healthy eating programs they run (including practical cooking and shopping help).

It was really nice to see consumer’s physical health needs being so clearly addressed, particularly given in a recent paper I had flagged the need for greater attention to this area based on a meta-synthesis of qualitative studies of the experience of psychosis.

Well done to Jackie Curtis and the rest of the team! Hopefully this holistic model of working will soon become standard practice.