Effectiveness of Neurofeedback in Reducing Rumination and Cognitive Avoidance in Patients with Obsessive Compulsive Disorder: A Clinical Trial

Abstract

Abstract Introduction: Obsessive-compulsive disorder (OCD) is a psychiatric condition characterised by persistent, intrusive thoughts and ritualistic behaviours. This study assesses the impact of qEEG-assisted neurofeedback on two critical components of OCD: rumination, a maladaptive focus on problem causes and consequences, and cognitive avoidance (CA), the tendency to evade distressing thoughts aiming to evaluate neurofeedback’s effectiveness in reducing rumination and CA severity in patients with OCD. Methods: This controlled prospective clinical trial with parallel design included patients diagnosed with OCD, with Yale-Brown Obsessive Compulsive Scale (YB-OCS) scores ≥ 16. Subjects were alternately assigned to either the neurofeedback or control groups maintaining a 1:1 ratio. The neurofeedback group underwent 25 sessions over six weeks, with outcomes measured through the Rumination Response Scale (RRS) and the Cognitive Avoidance Questionnaire (CAQ) pre- and post-intervention. Results: Of the initial cohort, 30 participants finished the study. Significant reductions in Rumination and CA were observed in the neurofeedback group with multivariate ANCOVA showing a significant impact on CAQ and RRS scores (Lambda Wilks p = 0.001) and univariate ANCOVA indicating marked decreases in CA (p = 0.001, Eta2 = 0.687) and Rumination (p = 0.001, Eta Squared = 0.636) compared to controls. Discussion: The findings substantiate qEEG-assisted neurofeedback’s role in significantly reducing rumination and cognitive avoidance in OCD, indicating neurofeedback’s potential to modulate brain regions implicated in OCD pathology, such as orbitofrontal cortex and anterior cingulate, thus enhancing self-regulation and reducing symptoms. Limitations: Limitations include no long-term follow-up, reliance on self-report measures, a small, single-centred sample, and convenience sampling, all of which affect the generalizability of the results. INTRODUCTION