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PhD studentship in Clinical Neuroscience “Neurofeedback for the treatment of post traumatic stress disorder, depression and obsessive compulsive disorder.” Full-time PhD studentship for three years from October 2010, funded by The Open University. Supervisors: Dr Antonio Martins-Mourao (Department of Life Sciences) and Professor Steve Swithenby (Department of Physics and Astronomy), Faculty of Science, The Open University, Milton Keynes. Background The experience of trauma, either through exposure to abuse, torture or combat situations can have devastating and long-lasting psychological effects. The victims are likely to suffer from impaired cognitive neurobiological function in key brain areas such as the amygdala (involved in the identification and processing of threatening stimuli), the hippocampus (involved in the encoding of traumatic memories) and the prefrontal cortex. Damage to the prefrontal cortex specifically creates a negative feedback loop that amplifies the effects of subsequent stressful events, leaving the victims in a never-ending cycle of fear, anxiety and post-traumatic stress disorder (PTSD) that may take decades, if not a lifetime, to heal. Furthermore, the evidence also suggests that PTSD may manifest as depression and obsessive-compulsive disorder (OCD), with studies showing that 36% of depressed patients also screened positive for PTSD, and up to 22% of people with PTSD may also receive a diagnosis of OCD. The crucial issue of whether these co-morbid disorders have any electro-physiological aspects in common remains, however, unclear. Traditional treatments for PTSD have included psychotherapy and medication but only have limited success. The changes facilitated by psychotherapy are difficult to measure and positive outcomes can only be expected over an extended period of time. Studies have also shown that a majority of patients continued to report substantial residual symptoms after psychotherapeutic interventions. Finally, a recent review has shown that nearly a thousand people exposed to traumatic events revealed that psychotherapy had not been effective in preventing PTSD in the early stages after a traumatic experience. In terms of medication, researchers agree that drugs may contribute to some symptomatic relief, but changes in brain activity also take considerable time to work. Yet, these are not permanent and unwanted side effects are common. Work in progress and proposed A new and alternative method for the treatment of PTSD is currently known as neurofeedback (NF). NF is a technique that uses quantitative electroencephalography (QEEG) to train the brain to regulate functions of the brain and mind, by providing a signal that informs individuals about their brain activity. Sensors are placed on the scalp to measure electro-cortical activity and patients are taught, along several sessions, to interpret and use the feedback provided via a computer screen to modify their cognitive responses. The technique has several strengths: it draws upon the brain's own ability to learn and adapt, whilst giving patients the skills to modify and control their own brain waves. It is medication-free, does not require verbal exchanges and is a safe and non-invasive technique that both children and adults find non-threatening. NF is also significantly less expensive than other brain imaging methods and produces results in weeks rather than months. The use of NF for the treatment of PTSD has, however, important obstacles that limit theoretical predictions about its potential therapeutic outcomes. Firstly, although there is evidence that NF may accelerate changes in patterns of neuronal activation in response to experience (neuroplasticity), leading to clinical improvement and altered behaviour, little is still known about the neurophysiological mechanisms responsible for these changes. Secondly, recent reports suggest that behaviourally homogeneous populations (i.e. populations with the same diagnosis and similar symptoms as defined in the Diagnostic and Statistical Manual of Mental Disorders, the DSM-IV-TR) could, in fact, amalgamate distinct neurophysiological subtypes. For example, a group of children with ADHD was shown to include at least five different neurophysiological subtypes, each affecting different cortical areas within the frontal lobes. Clearly, the elucidation of neurophysiological subtypes within behaviourally homogeneous populations could help clarify the mechanisms that may explain the effectiveness of NF interventions. It would also have obvious implications for the choice of treatment protocols leading to more positive clinical outcomes. Yet, choice of NF protocols is exclusively based on behavioural measurements (typically obtained via neuropsychological and psychometric testing), and currently excludes neurophysiological assessments. This studentship will use an innovative combination of neurophysiological (QEEG/ERP, or event related potentials) and behavioural pre- and post-measures (neuropsychological/ psychometric testing) to investigate: (1) the effectiveness of NF interventions, and (2) the relation between potential neurophysiological subtypes within behaviourally homogeneous groups as defined by the current DSM-IV diagnostic categories. Such strategy may, for example, help clarify whether PTSD, depression and OCD have any electro-physiological aspects in common, and whether the treatment of a common electrophysiological ‘root’ signature may reduce the symptoms of two (or more) independent mental disorders. Although the studentship is likely to focus on the study of populations with PTSD, depression and OCD, we will also take into consideration links and availability of other patient groups. The successful candidate will be supported to develop the appropriate clinical links and relevant technical, methodological and research skills. Studentship The Studentship provides a stipend of at least £13290 per year for 3 years plus tuition fees starting on the 1st of October 2010. The work will be full-time in the QEEG and Brain Research lab at the Department of Life Sciences, Open University, Milton Keynes, and the student will need to be conveniently placed to travel to the University on a daily basis. The project will adopt an interdisciplinary approach to the clinical effectiveness of NF and the ideal candidate should have a first or upper second class degree in psychology, experimental psychology, physiology, physics or related subjects. A Masters qualification (or equivalent) in clinical psychology, neurophysiology, neuroscience or research methods would be an advantage. The successful candidate will be expected to engage fully with the OU departmental programme of seminars 2 and journal clubs. He or she will also be supported by the several training opportunities provided, including short courses in research writing, research ethics, safety, and many others. Informal enquires are encouraged and should be made to Dr Antonio Martins-Mourao, [email protected]; tel. 01908 332027. To apply go to www3.open.ac.uk/employment, call Janet Vroone on 01908 659297, or email [email protected]. For information about the OU’s research degree prospectus go to http://www3.open.ac.uk/study/research-degrees/index.htm. Closing date: 9th July 2010. Equal Opportunity is University Policy. References Grin-Yatsenko, V. A.; Baas, I; Ponomarev, V. A.; Kropotov, J. D (2010). Independent component approach to the analysis of EEG recordings at early stages of depressive disorders. Clinical Neurophysiology, 121, 281–289. Gunkelman, J. D.; Johnstone, J. (2005). Neurofeedback and the Brain. Journal of Adult Development, 12 (2/3), 93-98. Hammond, D. C. (2005). Neurofeedback with anxiety and affective disorders. Child & Adolescent Psychiatric Clinics of North America, 14(1), 105-123. Hardman, E., Gruzelier, J., Chessman, K., Jones, C., Liddiard, D., Schleichert, H., & Birbaumer, N. (1997). Frontal interhemispheric asymmetry: Self-regulation and individual differences in humans. Neuroscience Letters, 221, 117-120. Johnstone, J.; Gunkelman, J. and Lunt, J. (2005). Clinical database development: characterization of EEG phenotypes. Clinical EEG and Neuroscience, 36, 2, 99-107. Masterpasqua, F. & Healey, K. N. (2003). Neurofeedback in Psychological Practice. Professional Psychology: Research and Practice, 34 (6), 652–656. Kropotov, J. D.; Grin-Yatsenko; V. A., Ponomarev, V. A.; Chutko, L. S.; Yakovenko, E. A.; Nikishena, I. S. (2005). ERPs correlates of EEG relative beta training in ADHD children. International Journal of Psychophysiology, 55, 23– 34. Raymond, J., Varney, C., Parkinson, L. A., & Gruzelier, J. H. (2005). The effects of alpha/theta neurofeedback on personality and mood. Cognitive Brain Research, 23, 287-292. Saxby, E., & Peniston, E. G. (1995). Alpha-theta brainwave neurofeedback training: An effective treatment for male and female alcoholics with depressive symptoms. Journal of Clinical Psychology, 51(5), 685-693. 3