Virtual Reality and Biofeedback in Therapy and Research

[neuronstudies]

I was wondering what the view is on virtual reality (VR) and neurofeedback being used as a therapy/treatment?
I was looking at some earlier threads and there seemed to be concerns about neurofeedback being used as a therapy.

I'm curious about how much/what evidence from research needs to be done to in order to use these therapies responsibly w patients (especially due to the cost of neurofeedback)? And if you see psych (or certain subfields of psych) going more in this direction of VR and/or neurofeedback in the future?

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[Therapist4Chnge]

Biofeedback has research support and a long track record of being effective for certain diagnoses. Neurofeedback has neither.

VR work has been promising, particularly with PTSD. I believe a lab at UCSD was doing VR work with PTSD in the past 5-7 years, though i’m not sure of their current work.

 

[DynamicDidactic]

Biofeedback has research support and a long track record of being effective for certain diagnoses.

Can you provide any references? In my cursory reviews of the biofeedback literature in the past, I have not found strong evidence of its efficacy. Studies seem to be under-powered and lacking rigorous controls (e.g., Neurofeedback and Biofeedback for Mood and Anxiety Disorders: A Review of the Clinical Evidence and Guidelines – An Update - NCBI Bookshelf).

Personally, neurofeedback often appears pseudoscientific to me. VR has been talked about since I was an undergrad and I haven't seen any greater adoption of it.

 

[Ollie123]

RE: biofeedback - Depends what is being studied. Pretty solid for pain. Vary from modest to entirely non-existent for most other things.

RE: VR - I've still been underwhelmed by the tools I've seen, but its getting better. Just a LOT more slowly than expected. Every "OMG this new VR whatever is incredible and just like real life!" thing I've tried has been trash. People get overexcited about the technology, but we need to keep in mind the purpose. Generally speaking...mimicking reality for exposure. In many cases...in vivo exposures are readily accessible and easily doable, in which case its pointless. So until its dirt cheap, far more technologically advanced than it is at present and readily accessible...I just don't see the point.

RE: Neurofeedback - Largely a research tool. Actually some promise from new rt-fMRI techniques and similar. What you see being used clinically is usually qEEG garbage, with little scientific backing. There may be some very select legit uses out there (I'm not familiar with all of it), but certainly the overwhelming majority is junk. I think there is some merit to it, but we're a long ways off from it being ready to integrate into typical clinical practice.

 

[Therapist4Chnge]

Can you provide any references? In my cursory reviews of the biofeedback literature in the past, I have not found strong evidence of its efficacy. Studies seem to be under-powered and lacking rigorous controls (e.g., Neurofeedback and Biofeedback for Mood and Anxiety Disorders: A Review of the Clinical Evidence and Guidelines – An Update - NCBI Bookshelf).

Personally, neurofeedback often appears pseudoscientific to me. VR has been talked about since I was an undergrad and I haven't seen any greater adoption of it.

DD...I’m most familiar with biofeedback as it relates to chronic pain and to a lesser extend anxiety. I was trained on it through the VA, though I don’t provide it. I refer out to a local provider for certain pain cases and every once in awhile for patients with a strong physiologic response to anxiety. I can check my references, though I did the training a decade ago, so some of the references are likely dated.

I never refer for neurofeedback bc what i’ve seen in a clinical setting has been crap pseudoscience. I know researchers are trying to improve it, but it seems awhile off. It seems they continue to struggle with sensitivity and specificity, which are largely what seems to be holding it back for non-bogus clinical use. I still see quacks using it locally, but i’ve tried to educate other providers to the lack of scientific support for clinical use.

 

[deleted343839]

Heart rate variability biofeedback is reasonably useful for some types of pain. There are some old studies that tested biofeedback for GI symptoms (EGG) and I think there were some positive effects but I'm not as familiar with that literature.

I've yet to see any persuasive findings to support use of neurofeedback in clinical practice.

 

[ClinicalABA]

Adam Grabel at UMass is doing some interesting stuff with fNIRS (functional near-infrared spectroscopy). Here's a link to the publications section of his Lab websited, with some pdf links to research articles: Publications

Still pretty far removed from clinical applications, but may have some promise.

 

[flerfmcgerf]

Just saw this today in my email: Efficacy of Biofeedback for Medical Conditions: an Evidence Map (Efficacy of Biofeedback for Medical Conditions: an Evidence Map. - PubMed - NCBI)

"We included 16 good-quality systematic reviews examining biofeedback alone or as an adjunctive intervention. We found clear, consistent evidence across a large number of trials that biofeedback can reduce headache pain and can provide benefit as adjunctive therapy to men experiencing urinary incontinence after a prostatectomy. Consistent evidence across fewer trials suggests biofeedback may improve fecal incontinence and stroke recovery. There is insufficient evidence to draw conclusions about effects for most conditions including bruxism, labor pain, and Raynaud's. Biofeedback was not beneficial for urinary incontinence in women, nor for hypertension management, but these conclusions are limited by small sample sizes and methodologic limitations of these studies. "

Also the UCF RESTORES group does virtual reality work.

UCF Clinic Using Virtual Reality To Treat PTSD Expands To Reach More Patients

The University of Central Florida is using virtual reality to treat post-traumatic stress disorder. It's worked well enough that the Pentagon will fund…

wusfnews.wusf.usf.edu

"An additional $10 million dollar grant will allow the clinic to create virtual reality programs at Camp Lejeune, N.C., Fort Gordon, Ga., and the Naval Medical Center Portsmouth in Virginia."

https://www.sciencedirect.com/science/article/pii/S0887618517300038