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The study addresses the question of whether infra-low frequency (ILF) neurofeedback has positive effects on adults suffering from an eating disorder. To find out, the participants in the study were divided into two groups, with one group receiving ILF neurofeedback and the other group receiving only a placebo. The study “Infra-Low Frequency Neurofeedback in the Treatment of Patients With Chronic Eating Disorder and Comorbid Post-Traumatic Stress Disorder” by Winkler et al. shows that the positive effect of neurofeedback treatment is already measurable after 12 sessions.

Background / diagnosis:

Eating disorders (ED) are associated with severe impairment and reduced life expectancy. Mortality rates are more than five times higher for anorexia nervosa and around 1.5 times higher for bulimia nervosa and binge eating disorder than in the respective age group of the general population (Fichter and Quadflieg, 2016). In addition, 9% to 24% of those affected by ES suffer from comorbid post-traumatic stress disorder (Rijkers et al., 2019). PTSD can cause symptoms such as flashbacks, nightmares, increased irritability and emotional numbness, which significantly impairs quality of life (National Institute of Mental Health, 2020).

The authors' clinical experience is that treating individuals with eating disorders and (complex) PTSD is particularly challenging. Eating disorder symptoms generally improve more slowly than in those without severe comorbidities, even in an intensive supportive inpatient treatment setting. Many patients report that they deliberately use hunger, binge eating or vomiting to alleviate or temporarily suppress distressing, trauma-associated emotions such as shame, anger and disgust, which makes it particularly difficult for them to refrain from the symptoms of the eating disorder.

The study:

The randomized control trial investigated whether ILF neurofeedback can improve symptoms in people with eating disorders and comorbid post-traumatic stress disorder (PTSD) in an inpatient treatment program. The intervention group received ILF neurofeedback in addition to regular therapy, while the control group received a placebo intervention in the form of media-supported relaxation. Before and after treatment, the participants assessed their eating disorder symptoms using the Eating Disorder Examination Questionnaire (EDE-Q) and their post-traumatic stress symptoms using the Impact of Event Scale-Revised (IES-R).

The study included people aged 18 and over who were treated as inpatients for eating disorders at the Parkland Clinic for Psychosomatic Medicine and Psychotherapy between May 2019 and April 2021. Both groups received 12 individual sessions of around 40 minutes. Each session began with a brief discussion about the course of symptoms since the last session, followed by 30 minutes of ILF neurofeedback or a placebo intervention. All sessions were conducted by trained staff in a quiet room and took place twice a week over a period of 6 weeks. Participants sat in a comfortable armchair in front of a monitor with loudspeakers. After 30 minutes, they were asked how their condition had changed during the session.
 

Results and implications:

The study shows that ILF neurofeedback in an inpatient setting can improve symptoms of eating disorders and trauma-related stress. Patients with eating disorders and PTSD who received 12 sessions of ILF neurofeedback showed significant improvements in eating behavior compared to those who received a placebo. Underweight patients in the ILF neurofeedback group tended to gain more weight than those in the placebo group.

It was also found that the people treated accepted the neurofeedback well. There were fewer severe complications and the treatment outcome tended to be rated better. People who received ILF neurofeedback were more likely to rate themselves as “slightly improved” at the end of their treatment, which indicates a noticeable positive change (cf. Haase et al., 2021).
 

Sources

Fichter, M. M., and Quadflieg, N. (2016). Mortality in eating disorders - results of a large prospective clinical longitudinal study. Int. J. Eat. Disord. 49, 391–401. doi: 10.1002/eat.22501 

Haase, I., Winkeler, M., and Imgart, H. (2021). Ascertaining minimal clinically meaningful changes in symptoms of depression rated by the 15-item centre for epidemiological studies depression scale. J. Eval. Clin. Pract. doi: 10.1111/jep. 13629. 

National Institute of Mental Health. (2020). Post-traumatic stress disorder (PTSD). https://www.nimh.nih.gov/health/topics/post-traumatic-stress-disorder-ptsd

Rijkers, C., Schoorl, M., van Hoeken, D., and Hoek, H. W. (2019). Eating disorders and posttraumatic stress disorder. Curr. Opin. Psychiatry     32,510–517. doi: 10.1097/YCO.0000000000000545