降high beta神經回饋方案對鬱症共病焦慮症狀患者之訓練中療效

目的：先前研究發現鬱症共病焦慮症狀患者呈現大腦過度活化之腦波病理現象，研究亦證實降high beta神經回饋方案可有效改善負向情緒，以及改善部分頂葉high beta。本研究進一步以腦波之可訓練性、獨立性與可解釋性作為客觀療效指標，探討鬱症共病焦慮症狀患者在降high beta神經回饋方案之訓練中療效。方法：本研究分析23位鬱症共病焦慮患者所進行五週共十次的降high beta神經回饋訓練中腦波資料，每次療程接受訓練前測、睜眼基準期、嘗試次(第二次療程共兩次嘗試、第三次至第十次療程共五次嘗試)，以及訓練後測之腦波測量，訓練目標為降低P3與P4的high beta(20-32 Hz)，並在前測與後測填寫貝克憂鬱量表(Beck Depression Inventory-II, BDI-II)與貝克焦慮量表(Beck Anxiety Inventory, BAI)。本研究以BioGraph Infiniti接受原始腦波訊號，在刪除腦波雜訊後輸出為以下的腦波頻帶：delta(1-4Hz)、theta(4-8Hz)、alpha(8-12Hz)、low beta(12-20Hz)以及high beta(20-32Hz)之波峰至波峰的振幅(peak to peak amplitude)，比較閉眼測量的訓練前測和訓練後測的腦波資料，以及比較睜眼測量的睜眼基準期和最佳嘗試次的腦波資料，以驗證降high beta方案在訓練中之可訓練性、獨立性和可解釋性。結果：(1)可訓練性：相依樣本二因子變異數分析(2次測量*5週)發現，在閉眼測量下，在W1至W5之訓練後測的P3 high beta顯著低於訓練前測、在W2至W5 之訓練後測的P4 high beta顯著低於訓練前測；此外，訓練後測在W5的P3 high beta顯著低於W1與W2、訓練後測在W5的P4 high beta顯著低於W1，然而訓練前測在W1至W5的P3與P4 high beta皆無顯著差異。在睜眼測量下，在W1至W5之最佳嘗試次的P3與P4 high beta皆顯著低於睜眼基準期；但睜眼基準期與最佳嘗試次在W1至W5的P3與P4 high beta皆無顯著差異。(2)獨立性：以成對樣本t檢定發現在閉眼測量下，訓練後測之P3與P4的low beta與high beta顯著低於訓練前測。在睜眼測量下，最佳嘗試次的P3與P4的low beta與high beta顯著低於睜眼基準期，但降high beta訓練未顯著改變delta、theta與alpha頻帶。(3)可解釋性：閉眼測量high beta改變量與量表(BDI-II總分和BDI-II認知分量表)改變量有顯著正相關，但睜眼測量high beta改變量與量表改變量無顯著相關。結論：本研究結果支持降high beta神經回饋方案在訓練後可顯著降低鬱症共病焦慮症狀患者之頂葉皮質過度活化現象，以及訓練後僅降低beta頻帶、未改變其他腦波頻帶，且high beta下降程度與憂鬱嚴重度下降程度呈顯著正相關。因此，由訓練中的腦波分析結果證實降high beta神經回饋訓練之可訓練性、獨立性與可解釋性。

關鍵字

鬱症；焦慮症狀；降high beta神經回饋；學習曲線；可訓練性；獨立性；可解釋性

並列摘要

Background: Higher beta activities in electroencephalography (EEG) were found in patients comorbid with major depressive disorder (MDD) and anxiety symptoms compared with normal controls; negative emotion and high beta activity could be decreased by high beta down-training neurofeedback (NFB) protocol. The purpose of present study was to utilize three objective parameters, including trainability, independency and interpretability, to validate the training effects on patients comorbid with MDD and anxiety symptoms during the high beta down-training sessions. Methods: The EEG data during NFB sessions of 23 patients comorbid with MDD and anxiety symptoms were analyzed. The NFB was administered with 10 sessions which lasted for 5 weeks, and each session composed a pre-training, an eye-open baseline, training trials (including two trials in session 2 and five trials from session 3 to 10), and a post-training. The training goals were to down-train high beta activities (20-32 Hz) at P3 and P4. Psychological questionnaires included Beck Depression Inventory II (BDI-II) and Beck Anxiety Inventory (BAI) were also completed before and after NFB sessions. EEG raw signals were recorded, analyzed and then transformed into peak to peak amplitude of delta (1-4Hz), theta (4-8Hz), alpha (8-12Hz), low beta (12-20Hz), and high beta (20-32Hz). Under eye-closed and eye-open conditions, pre-training was compared with post-training and eye-open baseline was compared with best training trial respectively, to confirmed the trainability, independency and interpretability of the high beta down-training NFB protocol. Results: (1) Trainability: Under eye-closed condition, P3 high beta of post-training was significantly lower than pre-training from Week 1 to Week 5, and P4 high beta of post-training was significantly lower than pre-training from Week 2 to Week 5. Additionally, P3 high beta at Week 5 was significantly lower than Week 1 and Week 2 in post-training, and P4 high beta at Week 5 was significantly lower than Week 1 in post-training. However, there were no significant differences among Week 1 to Week 5 of P3 and P4 high beta in pre-training. Under eye-open condition, P3 and P4 high beta of best training trial was significantly lower than eye-open baseline from Week 1 to Week 5, while there were no significant differences among Week 1 to Week 5 of P3 and P4 high beta neither in eye-open baseline nor in best training trial. (2) Independency: Under eye-closed condition, P3 and P4 low beta and high beta in post-training was significantly lower than pre-training. Under eye-open condition, P3 and P4 low beta and high beta in best training trial was significantly lower than eye-open baseline. In either conditions, there were no significant changes of delta, theta and alpha band after training. (3) Interpretability: There were positive correlations between the decrease of P3 and P4 high beta under eye-closed condition and the decrease of BDI-II scores. However, there were no significant correlations between the decrease of P3 and P4 high beta under eye-open condition and the decrease of BDI-II or BAI scores. Conclusion: This study indicated that hyperactivities of brain of patients comorbid with MDD and anxiety symptoms could be decreased through the high beta down-training sessions, and only beta band was decreased after training, with other bands unchanged. Also, the decrease of high beta positively correlated to the decrease of depression severity. Therefore, the trainability, independency and interpretability of the high beta down-training NFB protocol were confirmed.

並列關鍵字

major depressive disorder ； anxiety symptoms ； high beta down-training neurofeedback protocol ； learning curve ； trainability ； independency ； interpretability

參考文獻

Gruzelier, J., Egner, T., & Vernon, D. (2006). Validating the efficacy of neurofeedback for optimising performance. Progress in Brain Research, 159, 421-431. doi:10.1016/S0079-6123(06)59027-2

王三瑜(2018)。神經回饋對鬱症共病焦慮症狀患者之療效。高雄醫學大學心理系，碩士論文。