Evaluation of a Dissertation on Neurofeedback

Introduction
The Wigton (2014) dissertation is about the efficacy of 19-channel z-score neurofeedback (19ZNF), one of the newer types of neurofeedback methods. Wigton (2014) uses quantitative methods in a clinical setting to evaluate the effectiveness of 19ZNF. According to the author, there has been a lack of empirical evidence supporting the use of this particular neurofeedback mechanism, in spite of the fact that neurofeedback itself is widely used in clinical practice. The specific outcome meausures used include attention, behavior, executive functioning, and electrocortical functioning.
Background
Neurofeedback, also known as elecroencephalographic (EEG) feedback, is a type of biofeedback using brainwaves. As a biofeedback process, neurofeedback is ultimately based on the basic premises of behaviorism and operant conditioning. Neurofeedback can be used to provide immediate insight into how the brain reacts to specific behaviors or stimuli, thereby enabling individuals to change their behavior or responses to their environments. With neurofeedback, the person is hooked up with EEG scalp sensors, which are connected with computer hardware and software. Neurofeedback devices have evolved and improved over the past decade or so. The current study evaluates the latest neurofeedback device at the time of writing: the 19-channel ZNF (19ZNF). Because 19-channel ZNF is so new, there has been a dearth of empirical evidence supporting its use in therapeutic interventions.
The current dissertation research is designed to both fill a gap in the literature, and also to add to the growing body of evidence supporting the use of neurofeedback in clinical settings. Specific applications of neurofeedback include for attention deficit hyperactivity disorder, behavioral disorders, cognitive and mood disorders, autism, learning disabilities, migraines, and more. One of the hypothesized advantages to using 19ZNF neurofeedback in particular is that it can reduce the needed number of sessions for achieving desired results. The implications of the study are therefore clear: to provide the most cost-effective and evidence-based neurofeedback method for treating a number of clinical problems.
Theoretical Foundations
The theoretical focus in the Wigton (2014) dissertation is on learning theory. Learning theory shows why all biofeedback can be used for self-determined behavioral change. Moreover, biofeedback is bi-directional. The device offers the objective feedback; the individual using the device makes changes to cognitive or behavioral states in order to achieve specific outcomes with the goal of internalizing new behaviors or states of mind. Learning theory is used because the process of neurofeedback is akin to operant conditioning. The person receives real-time feedback from the device, while also being able to alter cognitive or behavioral states and receive actual reinforcement of those changes. Seeing the results on the computer screen is the reward for the changes to behavior or mental state. For learning and behavioral change to take place, there must be a significant amount of motivation in place. Using the neurofeedback device can be considered a tangible sign of human motivation. The difference between classical and operant conditioning is demonstrated well with neurofeedback, which depends on voluntary behavioral changes. Both classical and operant conditioning are at work when modifying behavior using neurofeedback (Wigton, 2014, p. 33).
Review of Literature
The review of literature covers problem background, including the history of neurofeedback in general, the theoretical foundations of neurofeedback focusing on learning theory, and an assessment of outcome measures used in the literature. In addition to published scientific papers, the author also included conference summaries and peer-reviewed poster presentations. Academic databases were used to collect the bulk of published studies. The history of neurofeedback can be traced to the late 18th century, when electrical activity in the bodies of animals was first being detected. Human electroencephylography first started in the late 19th century. The 20th century and the evolution of computers enabled exponential growth and technological progress. As technology advanced, so too did the understanding of how neurofeedback could be used in treatment. Specific sub-themes include those related to traditional versus amplitude models of neurofeedback (Wigton, 2014, p. 33), the QNF model of neurofeedback (Wigton, 2014, p. 35), and the ZNF model of neurofeedback (Wigton, 2014, p. 38). The review of literature also covers the theme of 4ZNF specifically, the “forerunner to 19ZNF,” (Wigton, 2014, p. 47). Wigton’s (2014) review of literature highlights the need for more quantitative studies on the efficacy of 19ZNF in treating certain disorders. Computerized performance tests for ADHD, rating scales, and other specific outcome measures are all evaluated in the review of literature.
Significance of the Study
The significance of this study is that it focuses on an emerging technology in neurofeedback, which offers highly specific and real-time evidence of what is going on in the brain during specific cognitive states, mood states, situational stimuli, or behavioral triggers. Although 19ZNF has been in use for a number of years, there is still insufficient data on the efficacy of the method in treating specific disorders. If clinicians want to use neurofeedback in their practice to help clients, they need to support their decisions with evidence. Likewise, insurance companies are more likely to cover the costs of the intervention if its efficacy has been definitively illustrated in the literature. The current research therefore contributes to a growing body of evidence on neurofeedback in general, and may lead to greater acceptance of its use in the future.
Data Collection
Unlike previous studies on 19ZNF, the current dissertation uses quantitative measures. As valuable as qualitative measures like case studies can be, quantitative measures are essential for proving actual effectiveness of neurofeedback for the broader population. This study uses a quasi-experimental design, a retrospective one-group method with a pre-test and a post-test. The study is designed to measure whether neurofeedback can lead to measurable and meaningful change in behaviors and cognitive states. The independent variable was the use of 19ZNF. Dependent variables included results from clinical instruments measuring ADHD including IVA, DSMD, and BRIEF psychometric tests. The population sample was taken from both adults and children who had sought out health services for ADHD symptoms. Therefore, there was no random selection or active recruitment of the participants. It was a convenience sample. Using pre-existing ADHD cases was in many ways necessary in this research. Informed consent was obtained. The author also defends the use of a small (n = 21) sample size (p. 67-68). Clinical assessment instruments are all widely used in clinical settings when diagnosing and assessing the symptom severity of ADHD. The current research design used a pre-test and post-test model, taking into account scores from the IVA computerized performance test, DSMD and BRIEF rating scales, and Neuroguide software. All results had already existed; the authors collected data from pre-existing test scores rather than administering the tests anew. Therefore, data collection was highly standardized, using reliable points of reference for measuring outcomes and also for measuring the neurofeedback results.







References

Wigton, N.L. (2014). Evaluating 19-Channel Z-score Neurofeedback: Addressing Efficacy in a Clinical Setting. A Dissertation Presented in Partial Fulfillment of the Requirements for the Degree Doctorate of Philosophy, Grand Canyon University.