The efficacy of neurofeedback treatment of burnout

Burnout is defined as ** a syndrome of emotional exhaustion, depersonalisation,
and reduced personal accomplishment* and is considered a pathological response
pattern to occupational stress.
Professional health care for patients with burnout comprises preventive as well
as curative care. In curative care for burnout patients, we can distinguish
interventions aiming at improving occupational conditions, e.g., the reduction
of stressors at the work place, and person-directed interventions aimed at
recovery and reinforcement of the patient's psychological resilience. Allthough
the literature holds several descriptions of interventions in the treatment of
burnout, a recent Cochrane Systematic Review makes clear that empirical
research into the efficacy of these interventions is scarce. The available
controlled studies, moreover, provide only very limited support for both
person-directed and work-directed approaches of burnout.
Neurofeedback employs basic principles of biofeedback. Patients receive
immediate feedback of the electrical activity of (parts of) their brain, that
allows them to learn how to regulate their mental condition. Neurofeedback
training is aimed on teaching trainees a method of self-regulation. The
learning process is governed by the laws of operant conditioning. When the
characteristics of the EEG-signals match the desired EEG profile, reward is
delivered. Through a trial-and-error process, although not necessarily at a
conscious level of processing, the trainee develops strategies to modify his
or her EEG to maximize reward, and thus learns to self-regulate brain
functioning to match the desired EEG-parameters.

The present study aims to initiate the testing of a new, curative,
person-directed, approach of patients with burnout, that uses neurofeedback,
also called EEG (electroencephalogram)-biofeedback.

A pilot study with within-subject comparisons with repeated measures, without
experimental controls.
Measurements:
1. pre-treatment
2. process measurement during treatment
3. post-treatment
4. follow-up after 6 weeks
5. follow-up after 12 weeks

Neurofeedback protocol:
The duration of the neurofeedback training is 10 weeks. Participants receive 20
training sessions of 60 minutes, including EEG preparation. The training is
performed using the NeuroCARE Pro Biofeedback system, implemented on a laptop
computer. Brain potentials are recorded with two AgCl electrodes which are
placed on the scull (at C3 and C4, in accordance with the international 10-20
system) and two electrodes at, respectively, the upper rim the right ear cup
(reference electrode) and the right ear lobe (ground). The impedance is checked
and kept below 5 k*. The skin is lightly abraded using scrubbing gel.
The feedback is given by interrupting (during 150 ms) the sound that
accompanies the viewing of a pleasant video movie, preselected by the
participant. The participants do not receive specific instructions during the
training.
The sampling rate is 256 Hz. Artifacts caused by eye or gross body movements
are corrected using an active wavelet-base de-noising routine. The frequency
range of the recorded brain activity is 0-60 Hz. The Neurocare Pro program uses
time-frequency filtering with the help of adaptive Gabor transformations. For
each of the 16 targets, the signal intensity traversing outside (either below
of above) the zone of variability surrounding the current value of that signal,
will be sufficient to interrupt the ongoing audio-visual stream. The size of
the target is recalculated dynamically and is also modified by the trainer.
Targets are CVB's (current value boxen): 0-2.5 Hz, 2.5-6.5 Hz, 8-13 Hz, 15-18
Hz, 20-23 Hz, 23-38 Hz, 33-37 Hz, 38-42 Hz, recorded over the left and right
hemisfere.

Neurofeedback treatment for burnout complaints is integral to the regular
mental health care program of institutions for mental health care in The
Netherlands. The treatment that is administered in this study comprises the
standard number of treatment sessions. The duration of the sessions conform to
standard practice. The treatment methodology conform to standard practice.
The extra burden associated with participation encompasses completion of two
questionnaires (UBOS, SCL-90) after treatment termination, and at follow-up
assessment after 6 and 12 weeks. Questionnaires are sent by mail to the
participants. They are requested to return these by mail in a prestamped and
addressed envelope.
In the clinical nor in the scientific literature any side effects, adverse
events or safety risks from the neurofeecback training have thus fare been
reported.