Laurence Hirshberg | Brown University (original) (raw)

Papers by Laurence Hirshberg

Research paper thumbnail of Double-Blind Placebo-Controlled Randomized Clinical Trial of Neurofeedback for Attention-Deficit/Hyperactivity Disorder With 13-Month Follow-up

Journal of the American Academy of Child & Adolescent Psychiatry

Research paper thumbnail of Consensus on the reporting and experimental design of clinical and cognitive-behavioural neurofeedback studies (CRED-nf checklist)

Brain

Neurofeedback has begun to attract the attention and scrutiny of the scientific and medical mains... more Neurofeedback has begun to attract the attention and scrutiny of the scientific and medical mainstream. Here, neurofeedback researchers present a consensus-derived checklist that aims to improve the reporting and experimental design standards in the field.

Research paper thumbnail of Consensus on the reporting and experimental design of clinical and cognitive-behavioural neurofeedback studies (CRED-nf checklist)

This checklist is intended to encourage robust experimental design and clear reporting for clinic... more This checklist is intended to encourage robust experimental design and clear reporting for clinical and cognitive-behavioural neurofeedback experiments.

Research paper thumbnail of A Pilot Study of Neurofeedback for Chronic PTSD

Applied Psychophysiology and Biofeedback, 2016

EEG Biofeedback (also known as neurofeedback) has been in use as a clinical intervention for well... more EEG Biofeedback (also known as neurofeedback) has been in use as a clinical intervention for well over 30 years; however, it has made very little impact on clinical care. One reason for this has been the difficulty in designing research to measure clinical change in the real world. While substantial evidence exists for its efficacy in treating attention deficit/hyperactivity disorder, relatively little evidence exists for its utility in other disorders including posttraumatic stress disorder (PTSD). The current study represents a "proof-of-concept" pilot for the use of neurofeedback with multiply-traumatized individuals with treatment-resistant PTSD. Participants completed 40 sessions of neurofeedback training two times per week with sensors randomly assigned (by the study coordinator, who was not blind to condition) to sensor placements of either T4-P4 or T3-T4. We found that neurofeedback significantly reduced PTSD symptoms (Davidson Trauma Scale scores averaged 69.14 at baseline to 49.26 at termination), and preceded gains in affect regulation (Inventory of Altered Self-Capacities-Affect Dysregulation scores averaged 23.63 at baseline to 17.20 at termination). We discuss a roadmap for future research.

Research paper thumbnail of EEG alpha asymmetry as a gender-specific predictor of outcome to acute treatment with different antidepressant medications in the randomized iSPOT-D study

Clinical Neurophysiology, 2015

To determine whether EEG occipital alpha and frontal alpha asymmetry (FAA) distinguishes outpatie... more To determine whether EEG occipital alpha and frontal alpha asymmetry (FAA) distinguishes outpatients with major depression (MDD) from controls, predicts antidepressant treatment outcome, and to explore the role of gender. In the international Study to Predict Optimized Treatment in Depression (iSPOT-D), a multi-center, randomized, prospective open-label trial, 1008 MDD participants were randomized to escitalopram, sertraline or venlafaxine-extended release. The study also recruited 336 healthy controls. Treatment response was established after eight weeks and resting EEG was measured at baseline (two minutes eyes open and eyes closed). No differences in EEG alpha for occipital and frontal cortex, or for FAA, were found in MDD participants compared to controls. Alpha in the occipital and frontal cortex was not associated with treatment outcome. However, a gender and drug-class interaction effect was found for FAA. Relatively greater right frontal alpha (less cortical activity) in women only was associated with a favorable response to the Selective Serotonin Reuptake Inhibitors escitalopram and sertraline. No such effect was found for venlafaxine-extended release. FAA does not differentiate between MDD and controls, but is associated with antidepressant treatment response and remission in a gender and drug-class specific manner. Future studies investigating EEG alpha measures in depression should a-priori stratify by gender.

Research paper thumbnail of Optimizing real time fMRI neurofeedback for therapeutic discovery and development

NeuroImage. Clinical, 2014

While reducing the burden of brain disorders remains a top priority of organizations like the Wor... more While reducing the burden of brain disorders remains a top priority of organizations like the World Health Organization and National Institutes of Health, the development of novel, safe and effective treatments for brain disorders has been slow. In this paper, we describe the state of the science for an emerging technology, real time functional magnetic resonance imaging (rtfMRI) neurofeedback, in clinical neurotherapeutics. We review the scientific potential of rtfMRI and outline research strategies to optimize the development and application of rtfMRI neurofeedback as a next generation therapeutic tool. We propose that rtfMRI can be used to address a broad range of clinical problems by improving our understanding of brain-behavior relationships in order to develop more specific and effective interventions for individuals with brain disorders. We focus on the use of rtfMRI neurofeedback as a clinical neurotherapeutic tool to drive plasticity in brain function, cognition, and behavi...

Research paper thumbnail of EEG Analyses in the Assessment of Autistic Disorders

Imaging the Brain in Autism, 2013

Research paper thumbnail of Rorschach images of symbiosis and separation in eating-disordered and in borderline and nonborderline subjects

Psychoanalytic Psychology, 1989

The Rorschach protocols of 62 eating-disordered women were analyzed for content expressing symbio... more The Rorschach protocols of 62 eating-disordered women were analyzed for content expressing symbiotic, separation, and counter-symbiotic strivings. Subjects were grouped into three symptom pattern groups and into borderline and nonborderline groups as measured by Gunderson's Diagnostic Interview for Borderlines (DIB). Very few differences in this content were found among the three symptom-based groups. Consistent and significant differences were found among these groups in the relation between overall Rorschach response productivity and the production of responses with this content. This suggests that the symptom patterns may reflect differing modes of self-regulation. Consistent and significant differences in the production of this content were also found between borderline and nonborderline groups, supporting clinically based claims that symbiotic Rorschach responses are diagnostic of borderline functioning.

Research paper thumbnail of A Proposed Multisite Double-Blind Randomized Clinical Trial of Neurofeedback for ADHD: Need, Rationale, and Strategy

Journal of Attention Disorders, 2013

Objective: Additional treatments with persisting benefit are needed for ADHD. Because ADHD often ... more Objective: Additional treatments with persisting benefit are needed for ADHD. Because ADHD often shows excessive theta electroencephalogram (EEG) power, low beta, and excessive theta-beta ratio (TBR), a promising treatment is neurofeedback (NF) downtraining TBR. Although several nonblind randomized clinical trials (RCTs) show a medium-large benefit for NF, a well-blinded, sham-controlled RCT is needed to differentiate specific from nonspecific effects. Method: Experts in NF, ADHD, clinical trials, and statistics collaborated to design a double-blind multisite RCT. Results/Conclusion: At four sites, 180 children aged 7 to 10 years with rigorously diagnosed ADHD and TBR ≥ 5 will be randomized to active TBR-NF versus sham NF of equal duration, intensity, and appearance. Sham, utilizing prerecorded EEGs with participant artifacts superimposed, will keep participants and staff blind. Treatment fidelity will be trained/monitored by acknowledged NF leaders. Multidomain assessments before, ...

Research paper thumbnail of Place of electroencephalograpic biofeedback for attention-deficit/hyperactivity disorder

Expert Review of Neurotherapeutics, 2007

Research paper thumbnail of Disorganized attachment associated with partner violence: A research note

Infant Mental Health Journal, 1999

Seventy-two low-income mothers and their 15-month-old infants were evaluated at home and in the l... more Seventy-two low-income mothers and their 15-month-old infants were evaluated at home and in the laboratory to determine whether mothers' reports of distress and partner violence were associated with infant-mother attachment and infant mastery motivation. As predicted, mothers who experienced more serious partner violence were more likely to have infants with disorganized attachments to them. There was no association between mothers' experiences of partner violence and infant mastery motivation. Future research should evaluate the interrelationships between partner violence in adult caregivers and infant-caregiver attachments. Clinically, the mother-infant relationship should be evaluated routinely in cases in which partner violence is apparent.

Research paper thumbnail of Initial adaptation in mothers and fathers following perinatal loss

Tradition-a Journal of Orthodox Jewish Thought, 1995

Two months following perinatal loss, 82 mothers out of a total of 205 whose infants died at a ter... more Two months following perinatal loss, 82 mothers out of a total of 205 whose infants died at a tertiary referral obstetrical hospital and 47 of their partners were assessed with regard to their reactions to the deaths of their infants. Sample to population comparisons indicated that those who participated in the investigation were more likely to be socially advantaged. Intensity of mothers' grief exceeded fathers', but in roughly 25% of cases fathers' grief exceeded mothers. Mothers with higher self-reports of ego strength reported lower intensity of grief. Fathers with less ego strength, less social support, and more stressful life events had significantly higher self-reported grief. A subgroup of parents who reported minimal grief was identified and characterized. Implitions of these findings for research on reactions to perinatal loss are discussed.

Research paper thumbnail of When infants look to their parents: I. Infants' social referencing of mothers compared to fathers

Child Development, 1990

12-month-olds were seen with their mothers and fathers in a laboratory procedure designed to comp... more 12-month-olds were seen with their mothers and fathers in a laboratory procedure designed to compare infants' solicitation of, emotional resonance to, and self-regulation on the basis of happy, fearful, and conflicting emotional signals from mothers versus fathers. Measures of positive and negative affect and affect lability; of look, approach, and proximity behavior; and of overall response pattern were obtained. Infants showed more positive and less negative affect and greater toy proximity with happy compared to fearful signals. Few differences emerged in infants' referencing response to mothers versus fathers. Infants looked more to mothers than fathers when no signals were given but did not differentiate between parents when only one was signaling or when both were signaling (conflict). In affective state and behavioral regulation, they were not differentially responsive to maternal versus paternal signals either when only one parent was signaling or when both were giving signals.

Research paper thumbnail of Disorganized attachment associated with partner violence: A research note

Tradition-a Journal of Orthodox Jewish Thought, 1999

Seventy-two low-income mothers and their 15-month-old infants were evaluated at home and in the l... more Seventy-two low-income mothers and their 15-month-old infants were evaluated at home and in the laboratory to determine whether mothers' reports of distress and partner violence were associated with infant-mother attachment and infant mastery motivation. As predicted, mothers who experienced more serious partner violence were more likely to have infants with disorganized attachments to them. There was no association between mothers' experiences of partner violence and infant mastery motivation. Future research should evaluate the interrelationships between partner violence in adult caregivers and infant-caregiver attachments. Clinically, the mother-infant relationship should be evaluated routinely in cases in which partner violence is apparent.

Research paper thumbnail of Mothers' representations of their infants are concordant with infant attachment classifications

Developmental Issues in …, 1994

Research paper thumbnail of Representations of Attachment in Mothers and Their One-Year-Old Infants

Journal of The American Academy of Child and Adolescent Psychiatry, 1993

Attachment classifications in mothers and their 1-year-old infants were independently and concurr... more Attachment classifications in mothers and their 1-year-old infants were independently and concurrently assessed using the Adult Attachment Interview and the Strange Situation Procedure. Overall concordance was significant (k = 0.62), with strong links apparent between mothers classified dismissing and infants classified avoidant and between mothers classified autonomous and infants classified secure. Mothers' classified preoccupied were not more likely to have infants classified resistant. Mothers' perceptions and interpretations of the emotional distress of an infant observed in a 4-minute videotape were related to both infant and mother attachment classifications. These results are compatible with the suggestion that attachment classification reflect differences in internal working models of relationships. Other measures of maternal psychosocial adjustment were not related to infant attachment classifications.

Research paper thumbnail of Double-Blind Placebo-Controlled Randomized Clinical Trial of Neurofeedback for Attention-Deficit/Hyperactivity Disorder With 13-Month Follow-up

Journal of the American Academy of Child & Adolescent Psychiatry

Research paper thumbnail of Consensus on the reporting and experimental design of clinical and cognitive-behavioural neurofeedback studies (CRED-nf checklist)

Brain

Neurofeedback has begun to attract the attention and scrutiny of the scientific and medical mains... more Neurofeedback has begun to attract the attention and scrutiny of the scientific and medical mainstream. Here, neurofeedback researchers present a consensus-derived checklist that aims to improve the reporting and experimental design standards in the field.

Research paper thumbnail of Consensus on the reporting and experimental design of clinical and cognitive-behavioural neurofeedback studies (CRED-nf checklist)

This checklist is intended to encourage robust experimental design and clear reporting for clinic... more This checklist is intended to encourage robust experimental design and clear reporting for clinical and cognitive-behavioural neurofeedback experiments.

Research paper thumbnail of A Pilot Study of Neurofeedback for Chronic PTSD

Applied Psychophysiology and Biofeedback, 2016

EEG Biofeedback (also known as neurofeedback) has been in use as a clinical intervention for well... more EEG Biofeedback (also known as neurofeedback) has been in use as a clinical intervention for well over 30 years; however, it has made very little impact on clinical care. One reason for this has been the difficulty in designing research to measure clinical change in the real world. While substantial evidence exists for its efficacy in treating attention deficit/hyperactivity disorder, relatively little evidence exists for its utility in other disorders including posttraumatic stress disorder (PTSD). The current study represents a "proof-of-concept" pilot for the use of neurofeedback with multiply-traumatized individuals with treatment-resistant PTSD. Participants completed 40 sessions of neurofeedback training two times per week with sensors randomly assigned (by the study coordinator, who was not blind to condition) to sensor placements of either T4-P4 or T3-T4. We found that neurofeedback significantly reduced PTSD symptoms (Davidson Trauma Scale scores averaged 69.14 at baseline to 49.26 at termination), and preceded gains in affect regulation (Inventory of Altered Self-Capacities-Affect Dysregulation scores averaged 23.63 at baseline to 17.20 at termination). We discuss a roadmap for future research.

Research paper thumbnail of EEG alpha asymmetry as a gender-specific predictor of outcome to acute treatment with different antidepressant medications in the randomized iSPOT-D study

Clinical Neurophysiology, 2015

To determine whether EEG occipital alpha and frontal alpha asymmetry (FAA) distinguishes outpatie... more To determine whether EEG occipital alpha and frontal alpha asymmetry (FAA) distinguishes outpatients with major depression (MDD) from controls, predicts antidepressant treatment outcome, and to explore the role of gender. In the international Study to Predict Optimized Treatment in Depression (iSPOT-D), a multi-center, randomized, prospective open-label trial, 1008 MDD participants were randomized to escitalopram, sertraline or venlafaxine-extended release. The study also recruited 336 healthy controls. Treatment response was established after eight weeks and resting EEG was measured at baseline (two minutes eyes open and eyes closed). No differences in EEG alpha for occipital and frontal cortex, or for FAA, were found in MDD participants compared to controls. Alpha in the occipital and frontal cortex was not associated with treatment outcome. However, a gender and drug-class interaction effect was found for FAA. Relatively greater right frontal alpha (less cortical activity) in women only was associated with a favorable response to the Selective Serotonin Reuptake Inhibitors escitalopram and sertraline. No such effect was found for venlafaxine-extended release. FAA does not differentiate between MDD and controls, but is associated with antidepressant treatment response and remission in a gender and drug-class specific manner. Future studies investigating EEG alpha measures in depression should a-priori stratify by gender.

Research paper thumbnail of Optimizing real time fMRI neurofeedback for therapeutic discovery and development

NeuroImage. Clinical, 2014

While reducing the burden of brain disorders remains a top priority of organizations like the Wor... more While reducing the burden of brain disorders remains a top priority of organizations like the World Health Organization and National Institutes of Health, the development of novel, safe and effective treatments for brain disorders has been slow. In this paper, we describe the state of the science for an emerging technology, real time functional magnetic resonance imaging (rtfMRI) neurofeedback, in clinical neurotherapeutics. We review the scientific potential of rtfMRI and outline research strategies to optimize the development and application of rtfMRI neurofeedback as a next generation therapeutic tool. We propose that rtfMRI can be used to address a broad range of clinical problems by improving our understanding of brain-behavior relationships in order to develop more specific and effective interventions for individuals with brain disorders. We focus on the use of rtfMRI neurofeedback as a clinical neurotherapeutic tool to drive plasticity in brain function, cognition, and behavi...

Research paper thumbnail of EEG Analyses in the Assessment of Autistic Disorders

Imaging the Brain in Autism, 2013

Research paper thumbnail of Rorschach images of symbiosis and separation in eating-disordered and in borderline and nonborderline subjects

Psychoanalytic Psychology, 1989

The Rorschach protocols of 62 eating-disordered women were analyzed for content expressing symbio... more The Rorschach protocols of 62 eating-disordered women were analyzed for content expressing symbiotic, separation, and counter-symbiotic strivings. Subjects were grouped into three symptom pattern groups and into borderline and nonborderline groups as measured by Gunderson's Diagnostic Interview for Borderlines (DIB). Very few differences in this content were found among the three symptom-based groups. Consistent and significant differences were found among these groups in the relation between overall Rorschach response productivity and the production of responses with this content. This suggests that the symptom patterns may reflect differing modes of self-regulation. Consistent and significant differences in the production of this content were also found between borderline and nonborderline groups, supporting clinically based claims that symbiotic Rorschach responses are diagnostic of borderline functioning.

Research paper thumbnail of A Proposed Multisite Double-Blind Randomized Clinical Trial of Neurofeedback for ADHD: Need, Rationale, and Strategy

Journal of Attention Disorders, 2013

Objective: Additional treatments with persisting benefit are needed for ADHD. Because ADHD often ... more Objective: Additional treatments with persisting benefit are needed for ADHD. Because ADHD often shows excessive theta electroencephalogram (EEG) power, low beta, and excessive theta-beta ratio (TBR), a promising treatment is neurofeedback (NF) downtraining TBR. Although several nonblind randomized clinical trials (RCTs) show a medium-large benefit for NF, a well-blinded, sham-controlled RCT is needed to differentiate specific from nonspecific effects. Method: Experts in NF, ADHD, clinical trials, and statistics collaborated to design a double-blind multisite RCT. Results/Conclusion: At four sites, 180 children aged 7 to 10 years with rigorously diagnosed ADHD and TBR ≥ 5 will be randomized to active TBR-NF versus sham NF of equal duration, intensity, and appearance. Sham, utilizing prerecorded EEGs with participant artifacts superimposed, will keep participants and staff blind. Treatment fidelity will be trained/monitored by acknowledged NF leaders. Multidomain assessments before, ...

Research paper thumbnail of Place of electroencephalograpic biofeedback for attention-deficit/hyperactivity disorder

Expert Review of Neurotherapeutics, 2007

Research paper thumbnail of Disorganized attachment associated with partner violence: A research note

Infant Mental Health Journal, 1999

Seventy-two low-income mothers and their 15-month-old infants were evaluated at home and in the l... more Seventy-two low-income mothers and their 15-month-old infants were evaluated at home and in the laboratory to determine whether mothers' reports of distress and partner violence were associated with infant-mother attachment and infant mastery motivation. As predicted, mothers who experienced more serious partner violence were more likely to have infants with disorganized attachments to them. There was no association between mothers' experiences of partner violence and infant mastery motivation. Future research should evaluate the interrelationships between partner violence in adult caregivers and infant-caregiver attachments. Clinically, the mother-infant relationship should be evaluated routinely in cases in which partner violence is apparent.

Research paper thumbnail of Initial adaptation in mothers and fathers following perinatal loss

Tradition-a Journal of Orthodox Jewish Thought, 1995

Two months following perinatal loss, 82 mothers out of a total of 205 whose infants died at a ter... more Two months following perinatal loss, 82 mothers out of a total of 205 whose infants died at a tertiary referral obstetrical hospital and 47 of their partners were assessed with regard to their reactions to the deaths of their infants. Sample to population comparisons indicated that those who participated in the investigation were more likely to be socially advantaged. Intensity of mothers' grief exceeded fathers', but in roughly 25% of cases fathers' grief exceeded mothers. Mothers with higher self-reports of ego strength reported lower intensity of grief. Fathers with less ego strength, less social support, and more stressful life events had significantly higher self-reported grief. A subgroup of parents who reported minimal grief was identified and characterized. Implitions of these findings for research on reactions to perinatal loss are discussed.

Research paper thumbnail of When infants look to their parents: I. Infants' social referencing of mothers compared to fathers

Child Development, 1990

12-month-olds were seen with their mothers and fathers in a laboratory procedure designed to comp... more 12-month-olds were seen with their mothers and fathers in a laboratory procedure designed to compare infants' solicitation of, emotional resonance to, and self-regulation on the basis of happy, fearful, and conflicting emotional signals from mothers versus fathers. Measures of positive and negative affect and affect lability; of look, approach, and proximity behavior; and of overall response pattern were obtained. Infants showed more positive and less negative affect and greater toy proximity with happy compared to fearful signals. Few differences emerged in infants' referencing response to mothers versus fathers. Infants looked more to mothers than fathers when no signals were given but did not differentiate between parents when only one was signaling or when both were signaling (conflict). In affective state and behavioral regulation, they were not differentially responsive to maternal versus paternal signals either when only one parent was signaling or when both were giving signals.

Research paper thumbnail of Disorganized attachment associated with partner violence: A research note

Tradition-a Journal of Orthodox Jewish Thought, 1999

Seventy-two low-income mothers and their 15-month-old infants were evaluated at home and in the l... more Seventy-two low-income mothers and their 15-month-old infants were evaluated at home and in the laboratory to determine whether mothers' reports of distress and partner violence were associated with infant-mother attachment and infant mastery motivation. As predicted, mothers who experienced more serious partner violence were more likely to have infants with disorganized attachments to them. There was no association between mothers' experiences of partner violence and infant mastery motivation. Future research should evaluate the interrelationships between partner violence in adult caregivers and infant-caregiver attachments. Clinically, the mother-infant relationship should be evaluated routinely in cases in which partner violence is apparent.

Research paper thumbnail of Mothers' representations of their infants are concordant with infant attachment classifications

Developmental Issues in …, 1994

Research paper thumbnail of Representations of Attachment in Mothers and Their One-Year-Old Infants

Journal of The American Academy of Child and Adolescent Psychiatry, 1993

Attachment classifications in mothers and their 1-year-old infants were independently and concurr... more Attachment classifications in mothers and their 1-year-old infants were independently and concurrently assessed using the Adult Attachment Interview and the Strange Situation Procedure. Overall concordance was significant (k = 0.62), with strong links apparent between mothers classified dismissing and infants classified avoidant and between mothers classified autonomous and infants classified secure. Mothers' classified preoccupied were not more likely to have infants classified resistant. Mothers' perceptions and interpretations of the emotional distress of an infant observed in a 4-minute videotape were related to both infant and mother attachment classifications. These results are compatible with the suggestion that attachment classification reflect differences in internal working models of relationships. Other measures of maternal psychosocial adjustment were not related to infant attachment classifications.