Abstract
The effectiveness of biofeedback and neurofeedback has been investigated in a range of psychiatric disorders. However, to date, there are few studies on the clinical usefulness of feedback-based techniques for eating disorders (EDs) and EDs-related symptoms (e.g., food craving). A systematic search of PubMed, Scopus and PsychINFO identified 162 articles. Among these, thirteen studies exploring the therapeutic use of biofeedback and neurofeedback in EDs or EDs-related symptoms were included. Biofeedback and neurofeedback were implemented respectively in five and eight of all reviewed articles. No studies incorporated different feedback modalities or both biofeedback and neurofeedback. The considered studies provide preliminary data of the usefulness of feedback-based techniques in the treatment of several dysfunctional eating behaviors (e.g., food craving, rumination). Although no significant effect has been reported for other important EDs-related symptoms (i.e., body image disturbance), feedback-based techniques are also associated with significant modifications of both sympathetic reaction to food-related stimuli and brain activity in several regions of the reward system (e.g., insula). Taken together the results of the present review suggest that feedback-based treatments may be useful in the treatment of several dysfunctional eating behaviors operating both on top-down and bottom-up individual coping strategies. Methodological and clinical issues are also discussed.
Highlights
Eating disorders (EDs) are severe and disabling conditions caused by multiple factors [1], which are associated with significant functional impairments [2], high mortality risk [3] and treatment difficulties [4]
According to guidelines for the evaluation of the clinical efficacy of psychophysiological interventions [46], as well as with previous systematic reviews focused of feedback-based treatments in psychiatric disorders [39,47], articles that provided the following information were included in the study: (i) feedback modality type, (ii) sample, (iii) study design, (iv) collection and analysis of neurophysiological (e.g., EEG power spectrum, electrodermal activity etc.), behavioral and/or psychological outcomes measure
The following search terms were entered into the databases: “biofeedback” OR “neurofeedback” AND “anorexia nervosa”, “bulimia nervosa”, “binge eating disorder”, “pica”, “rumination disorder”, “avoidant/restrictive food intake disorder”, “food intake disorder”, “food craving”, “binge eating”, “overeating”, “eating psychopathology”
Summary
Eating disorders (EDs) are severe and disabling conditions caused by multiple factors (e.g., genetic and psychosocial) [1], which are associated with significant functional impairments [2], high mortality risk [3] and treatment difficulties [4]. Loss of control over eating is a relatively frequent experience among both adolescents from the general population (i.e., about 17%) [29], adults with obesity (i.e., BMI ≥ 30 kg/m2 ) and patients with EDs [30]. It was positively associated with other psychopathological symptoms (e.g., non-suicidal self-injury, body dissatisfaction, higher depressive symptoms) [31]. Training sessions and modalities may be different according to the individual needs and/or the diagnosis [40], general protocol guidelines are provided [38]
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