Essay Grade

College of Doctoral Studies
Prospectus Extraction Template
Introduction
This section briefly overviews the research focus or problem, why the study is worth
conducting, and how the study will be completed.
The recommended total length for this section is one paragraph.
•
Identify the dissertation topic.
The dissertation intends to address efficacy of
19ZNF in a clinical setting, through a
retrospective evaluation of clinical outcomes,
as measured by clinical assessments and
QEEG z-scores.
•
State whether the study is quantitative
or qualitative.
The study has been completed as a
quantitative analysis of pre-post outcome
measures with group data
•
Describe how the study extends prior
research or fills a “need” or “defined
gap” from current literature.
Background of the Problem
The background section explains both the history and the present state of the problem and
research focus.
The recommended total length for this section is two to three paragraphs.
•
Identify the “need,” or “defined gap”
for the research study.
The study fills the gap in the reporting of
group QEEG z-score mean data in the present
QNF research. Rigorous scientific studies
evaluating 19ZNF have not been found,
which poses a gap in the literature. There is a
gap in the literature in that the only peerreviewed information available to date,
regarding 19ZNF, are reviews, clinical report
presentations, and single case studies. The
secomdary gap, in terms of methodology
exists.
•
Discuss how the “need” or “defined
gap” has evolved historically into the
NF has seen increasing acceptance as a
therapeutic technique while recent empirical
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current problem or opportunity to be
addressed by the proposed study.
and peer-reviewed published literature
includes reviews and meta-analyses which
establish a recognition of NF as effective for
the specific condition of attention deficit
hyperactivity disorder.
Theoretical Foundations
This section identifies the theory(-ies) or model(s) that provide the foundation for the research.
This section should present the theory(-ies) or models(s) and explain how the problem under
investigation relates to the theory(-ies) or model(s). The theory(-ies) or models(s) guide the
research questions and justify what is being measured (variables) as well as how those variables
are related (quantitative) or the phenomena being investigated (qualitative).
The recommended total length for this section is one paragraph.
•
Identify the theory(-ies), model(s)
relevant to the variables (quantitative
study) or phenomenon (qualitative
study).
the foundations of EEG and QEEG and models
of NF (traditional, QNF, and ZNF)
Note: quantitative studies should have
a theory for each variable.
•
Describe how the theories relate to the
research problem.
Review of the Literature
This section provides a broad, balanced overview of the existing literature related to the
proposed research topic. It describes the literature in related topic areas and its relevance to the
proposed research topic findings. It provides a short one-two sentence description of each
theme/topic, and it identifies the relevance of the literature to the research topic supporting it
with at least one citation from the literature.
The recommended total length for this section is one to two paragraphs.
•
List the major themes or topics related to the
study.
•
Provide a short description of each
theme/topic.
•
Identify the relevance of each theme to the
research topic supporting each with at least
one citation.
3
Problem Statement
This section includes the problem statement, the population affected, and how the study will
contribute to solving the problem.
The recommended total length for this section is one paragraph.
•
Copy and paste the problem statement
from the dissertation.
•
After reading this section, describe the
magnitude and importance of the
problem, supporting it with citations
from the dissertation.
Research Question(s) and/or Hypotheses
This section narrows the focus of the study and specifies the research questions to address the
problem statement. Based on the research questions, it describes the variables or groups and
their hypothesized relationship (for a quantitative study) or the phenomena under investigation
(for a qualitative study).
The recommended total length for this section is two to three paragraphs.
•
Copy and paste the research questions and
from the dissertation.
•
For a qualitative study, describe the
phenomenon to be studied.
For a quantitative study, identify the
hypotheses and variables.
Significance of the Study
This section identifies and describes the significance of the study and the implications of the
potential results based on the research questions and the problem statement, hypotheses, or
investigated phenomena. It describes how the research fits within and will contribute to the
current literature or body of research. It describes potential practical applications from the
research.
The recommended total length for this section is one paragraph.
•
Describe how the proposed research
will contribute to the literature,
relating it specifically to other studies
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from the Background of the Problem
and Problem Statement, above.
•
Describe how the proposed research
will contribute to the literature on the
selected theory(-ies) or model(s) that
comprise the Theoretical Foundation
for the study.
•
Describe how addressing the problem
will have practical value for the real
world considering the population,
community, and/or society.
Rationale for Methodology
This section clearly justifies the methodology the researcher plans to use for conducting the
study. It argues how the methodological framework is the best approach to answer the research
questions and address the problem statement. It uses citations from textbooks and articles on
research methodology and/or articles on related studies.
The recommend total length for this section is one paragraph.
•
Identify the methodology for the study
(quantitative, qualitative, or mixed).
•
Justify the research methodology to be
used for the study by discussing why it
is the best approach for answering the
research questions and addressing the
problem statement.
Nature of the Research Design for the Study
This section describes the specific research design to answer the research questions and why
this approach was selected. It describes the research sample being studied as well as the
process that will be used to collect the data on the sample.
The recommend total length for this section is one paragraph.
•
Identify the specific type of research
design chosen for the study.
•
Identify the sample for the study
•
Discuss why the selected design is
appropriate to address the research
questions.
5
Purpose of the Study
The purpose statement section provides a reflection of the problem statement and identifies
how the study will be accomplished. It explains how the proposed study will contribute to the
field.
The recommend total length for this section is one paragraph.
•
Copy and paste the purpose statement
from the dissertation.
•
Identify the target population,
phenomena (qualitative), and variables
(quantitative).
Instrumentation or Sources of Data
Describes, in detail, all data collection instruments and sources (tests, questionnaires,
interviews, data bases, media, etc.). Discusses the specific instrument or source to collect
data for each variable or group (quantitative study). Discusses specific instrument or source
to collect information to describe the phenomena being studied (qualitative study).
The recommend total length for this section is one paragraph.
•
Identify the types of data that will be
collected to answer each research
question (qualitative study) or the data
that will be collected for each
variable/group (quantitative study).
Data Collection Procedures
This section details the entirety of the process used to collect the data. It describes each step
of the data collection process in a way that another researcher could replicate the study.
The recommended total length for this section is two paragraphs.
•
Define the target population and the
expected sample size, which comprises
the people or organizations being
studied, as defined in the problem
statement.
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•
Include the steps the researcher used to
collect data. (e.g., obtaining initial
informed consent from participating
organization; IRB review; sample
selection; groupings; protecting
rights/well-being; maintaining data
security; sample recruitment; data
collection instruments and approaches;
field testing instruments; notifying
participants; collecting the data, etc.)
Data Analysis Procedures
This section describes how the data were collected for each variable or group (quantitative
study) or for each research question (qualitative study). It describes the type of data to be
analyzed, identifying the descriptive, inferential, and/or non-statistical analyses. Demonstrates
that the research analysis is aligned to the specific research design.
The recommend total length for this section is one paragraph
•
Describe the analysis to examine
each stated research question and/or
hypothesis.
•
For quantitative studies, describe
the analyses including the
inferential and/or descriptive
statistics to be completed.
.
For qualitative studies, describe the
specific analytic approach
appropriate for the Research Design
and each research question to be
completed
Ethical Considerations
This section discusses the potential ethical issues surrounding the research as well as how
human subjects and data will be protected. It identifies how any potential ethical issues will
be addressed.
The recommended total length for this section is one paragraph.
•
Describe how the identities of the
participants in the study and data will
be protected.
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•
Describe subject recruiting, informed
consent, and site authorization
processes.
References
Include an APA-formatted reference for each citation presented above.
Evaluating 19-Channel Z-score Neurofeedback:
Addressing Efficacy in a Clinical Setting
Submitted by
Nancy L. Wigton
A Dissertation Presented in Partial Fulfillment
of the Requirements for the Degree
Doctorate of Philosophy
Grand Canyon University
Phoenix, Arizona
May 15, 2014
UMI Number: 3625170
All rights reserved
INFORMATION TO ALL USERS
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a note will indicate the deletion.
UMI 3625170
Published by ProQuest LLC (2014). Copyright in the Dissertation held by the Author.
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© by Nancy L. Wigton, 2014
All rights reserved.
Abstract
Neurofeedback (NF) is gaining recognition as an evidence-based intervention grounded
in learning theory, and 19-channel z-score neurofeedback (19ZNF) is a new NF model.
Peer-reviewed literature is lacking regarding empirical-based evaluation of 19ZNF. The
purpose of this quantitative research study was to evaluate the efficacy of 19ZNF, in a
clinical setting, using archival data from a Southwest NF practice, with a retrospective
one-group pretest-posttest design. Each of the outcome measures framed a group such
that 19ZNF was evaluated, as it relates to the particular neuropsychological constructs of
attention (n = 10), behavior (n = 14), executive function (n = 12), as well as
electrocortical functioning (n = 21). The research questions asked if 19ZNF improves
these constructs. One-tailed t tests performed, compared pre-post scores for included
clinical assessment scales, and selected quantitative electroencephalographic (QEEG)
metrics. For all pre-post comparisons, the direction of change was in the predicted
direction. Moreover, for all outcome measures, the group means were beyond the
clinically significant threshold before 19ZNF, and no longer clinically significant after
19ZNF. All differences were statistically significant, with results ranging from p = .000
to p = .008; and effect sizes ranging from 1.29 to 3.42. Results suggest 19ZNF improved
attention, behavior, executive function, and electrocortical function. This study provides
beginning evidence of 19ZNF’s efficacy, adds to what is known about 19ZNF, and offers
an innovative approach for using QEEG metrics as outcome measures. These results may
lead to a greater acceptance of 19ZNF, as well as foster needed additional scientific
research.
Keywords: Neurofeedback, QEEG, z-score neurofeedback, 19ZNF, EEG biofeedback
v
Dedication
This dissertation is dedicated to my Lord and Savior, Jesus. From my first
thoughts of considering a doctoral program being divinely inspired and directed, through
to the last step I will take across a graduation stage, the Father, Son, and Holy Spirit are
always the center point, the anchor. To that end, three Bible passages capture the
experience of my journey.
The way of God is perfect, the Lord’s word has stood the test; He is the shield of
all who take refuge in Him. What god is there but the Lord? What rock but our
God? – the God who girds me with strength and makes my way blameless, who
makes me swift as the deer and sets me secure on the mountains (Psalms 18:3033, New English Bible).
“Commit your life to the Lord; trust in Him and He will act. He will make your
righteousness shine clear as the day and the justice of your cause like the sun at noon”
(Psalms 37:5-6).
“Not to us, O Lord, not to us, but to thy name ascribe the glory, for thy true love
and for thy constancy” (Psalms 115:1).
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Acknowledgments
It is only through the Lord’s strength and wisdom that this dissertation came to
fruition. Next, I acknowledge the man with whom the Lord has made me one, my
husband. You are truly the wind beneath my wings, and without you I would not have
had the wherewithal to complete this endeavor. Thank you for all your support and
sharing your perseverance for my good. I also wish to acknowledge, with unbounded
gratitude, the most perfect dissertation committee possible for this journey.
To my chair, Dr. Genomary Krigbaum, words are insufficient to fully express the
depth and breadth of my appreciation for your support, guidance, and direction. When I
first read descriptions of what the ideal chair would be, with characteristics inclusive of
mentor, advocate, role model, teacher, defender, guide, supervisor, coach, encourager,
and friend, I wondered if it would ever be possible to find all those elements in one
person. Yet in you, I found them all, and more. Por siempre agradecida. Moreover, thank
you for encouraging me to build on the methodology you started. To Dr. Daniel Smith, I
am grateful that you joined my dissertation team. I knew I could count on you for your
statistical expertise, and you did not disappoint. Thank you for the many conversations
prior to my dissertation journey, and in helping to pave the way for the best committee
possible. To Dr. Genie Bodenhamer-Davis, as a most respected neurofeedback
practitioner and educator, I am humbled and honored that you were willing to assist me in
my dissertation journey. Thank you, so much, for your counsel over the last 3 years. To
Dr. Ron Bonnstetter, thank you for your support in being my adjunct dissertation reader.
Thank you for your compliments on my writing and your assurance I have what it takes
to succeed as a scholar.
vii
Table of Contents
List of Tables ……………………………………………………………………………………………………… xi
List of Figures ……………………………………………………………………………………………………. xii
Chapter 1: Introduction to the Study…………………………………………………………………………1
Introduction ……………………………………………………………………………………………………..1
Background of the Study …………………………………………………………………………………..2
Problem Statement ……………………………………………………………………………………………4
Purpose of the Study …………………………………………………………………………………………5
Research Questions and Hypotheses …………………………………………………………………..6
Advancing Scientific Knowledge ……………………………………………………………………….8
Significance of the Study …………………………………………………………………………………..9
Rationale for Methodology ………………………………………………………………………………10
Nature of the Research Design for the Study………………………………………………………11
Definition of Terms…………………………………………………………………………………………13
Assumptions, Limitations, Delimitations …………………………………………………………..19
Summary and Organization of the Remainder of the Study ………………………………….22
Chapter 2: Literature Review …………………………………………………………………………………23
Introduction and Background to the Problem ……………………………………………………..23
Historical overview of EEG and QEEG. ……………………………………………….24
Historical overview of NF …………………………………………………………………..25
How problem/gap of 19ZNF research evolved into current form ……………..28
Theoretical Foundations and/or Conceptual Framework ………………………………………31
Foundations of EEG and QEEG …………………………………………………………..31
viii
Learning theory as applied to NF………………………………………………………….31
Traditional/amplitude-based models of NF ……………………………………………33
QNF model of NF ………………………………………………………………………………35
ZNF model of NF……………………………………………………………………………….38
Review of the Literature – Key Themes …………………………………………………………….39
QNF in the literature …………………………………………………………………………..39
4ZNF in the literature………………………………………………………………………….47
19ZNF in the literature………………………………………………………………………..50
Outcome measures for ZNF research ……………………………………………………53
Summary ……………………………………………………………………………………………………….59
Chapter 3: Methodology ……………………………………………………………………………………….61
Introduction ……………………………………………………………………………………………………61
Statement of the Problem …………………………………………………………………………………61
Research Questions and Hypotheses …………………………………………………………………62
Research Methodology ……………………………………………………………………………………64
Research Design……………………………………………………………………………………………..65
Population and Sample Selection………………………………………………………………………66
Instrumentation ………………………………………………………………………………………………68
Validity …………………………………………………………………………………………………………72
Reliability………………………………………………………………………………………………………74
Data Collection Procedures………………………………………………………………………………76
Data Analysis Procedures ………………………………………………………………………………..78
Ethical Considerations …………………………………………………………………………………….81
ix
Limitations …………………………………………………………………………………………………….82
Summary ……………………………………………………………………………………………………….84
Chapter 4: Data Analysis and Results ……………………………………………………………………..86
Introduction ……………………………………………………………………………………………………86
Descriptive Data……………………………………………………………………………………………..86
Data Analysis Procedures ………………………………………………………………………………..93
Results …………………………………………………………………………………………………………..96
Summary ……………………………………………………………………………………………………..103
Chapter 5: Summary, Conclusions, and Recommendations ……………………………………..105
Introduction ………………………………………………………………………………………………….105
Summary of the Study …………………………………………………………………………………..106
Summary of Findings and Conclusion ……………………………………………………………..107
Implications………………………………………………………………………………………………….113
Theoretical implications…………………………………………………………………….114
Practical implications ………………………………………………………………………..115
Future implications. ………………………………………………………………………….116
Recommendations …………………………………………………………………………………………117
Recommendations for future research. ………………………………………………..117
Recommendations for practice. ………………………………………………………….118
References …………………………………………………………………………………………………………120
Appendix A ……………………………………………………………………………………………………….136
Appendix B ……………………………………………………………………………………………………….137
x
Appendix C ……………………………………………………………………………………………………….138
Appendix D ……………………………………………………………………………………………………….139
xi
List of Tables
Table 1.1. Research Questions and Variables …………………………………………………………….8
Table 4.1. Descriptive Data for All Groups ……………………………………………………………. 91
Table 4.2. Shapiro-wilk Results for Difference Scores ……………………………………………. 95
Table 4.3. Summary of Results – All Groups………………………………………………………….104
xii
List of Figures
Figure 1.1. Formation of Sample Groups ………………………………………………………………. 13
Figure 4.1. IVA Group Pre-Post Scores…………………………………………………………………. 97
Figure 4.2. DSMD Group Pre-Post Scores …………………………………………………………….. 99
Figure 4.3. BRIEF Group Pre-Post Scores …………………………………………………………… 101
Figure 4.4. QEEG Group Pre-Post Scores …………………………………………………………… 102
1
Chapter 1: Introduction to the Study
Introduction
Neurofeedback (NF) is an operant conditioning brainwave biofeedback technique,
which is also referred to as electroencephalographic (EEG) biofeedback. This modality,
dating back to the 1970s (Lubar & Shouse, 1976; Sterman, LoPresti, & Fairchild, 2010),
trains electrical signals of targeted frequencies and involves recording EEG data from
scalp sensors with an amplifier, which is subsequently processed by computer software.
The software provides visual and sound display feedback to the trainee, thereby
providing a reward stimulus when the brain is functioning in the target range. This
reward process generates learning such that the brain’s functioning is conditioned in the
intended manner.
Over the years, new models of NF have been developed, and the most current
iteration is a style of NF which is termed z-score NF (ZNF). ZNF is different from more
traditional NF models in that it incorporates into the NF session real-time quantitative
EEG (QEEG) z-score metrics making it possible to combine operant conditioning with
real-time assessment using a normative database (Collura, Thatcher, Smith, Lambos, &
Stark 2009; Thatcher, 2012). In 2006, a 4-channel ZNF (4ZNF) technique was
introduced, which in 2009 was expanded to include all 19 sites of the International 10-20
System (of electrode placement) to allow for a 19-channel ZNF (19ZNF). To date, case
study and anecdotal clinical reports within the field indicate this new 19ZNF approach is
an improvement over traditional NF models (J. L. Koberda, Moses, Koberda & Koberda,
2012a; Wigton, 2013). However the efficacy of this new model has not yet been
established from empirical studies. This research is different from prior qualitative
2
studies; it has been completed as a quantitative analysis of pre-post outcome measures
with group data, and thus, it is a beginning in establishing empirical evidence regarding
19ZNF.
The remainder of this chapter formulates this dissertation through a review of the
study background, problem statement, purpose and significance, and how this research
advances the scientific knowledge. Moreover the research questions and hypotheses are
presented, together with the methodology rationale and the nature of the research design.
An extended Definition section is included to review the many technical terms germane
to this research. Readers unfamiliar with NF or QEEGs may find it helpful to review the
definitions first. Finally, to establish the scope of the study, a list of assumptions,
limitations, and delimitations are included.
Background of the Study
In recent years NF has seen increasing acceptance as a therapeutic technique.
Current literature includes reviews and meta-analyses which establish a recognition of
NF as effective for the specific condition of attention deficit hyperactivity disorder
(ADHD) (Arns, de Ridder, Strehl, Breteler, & Coenen 2009; Brandeis, 2011;
Gevensleben, Rothenberger, Moll, & Heinrich, 2012; Lofthouse, Arnold, Hersch, Hurt, &
DeBeus, 2012; Niv, 2013; Pigott, De Biase, Bodenhamer-Davis, & Davis, 2013).
However, the type of NF covered in these reviews is limited to the oldest NF model
(theta/beta ratio) and/or slow cortical potential NF. Yet of note are reports in the literature
of a different NF model which is informed by QEEG data. This QEEG-guided NF (QNF)
is reported to be used for a much wider range of conditions; not only ADHD, but also
behavior disorders, cognitive dysfunction, various mood disorders, epilepsy,
3
posttraumatic stress disorder, head injuries, autism spectrum disorders, migraines,
learning disorders, schizophrenia, and mental retardation (Arns, Drinkenburg, &
Kenemans, 2012; Breteler, Arns, Peters, Giepmans, & Verhoeven, 2010; Coben &
Myers, 2010; J. L. Koberda, Hillier, Jones, Moses, & Koberda 2012; Surmeli, Ertem,
Eralp, & Kos, 2012; Surmeli & Ertem, 2009, 2010, 2011; Walker, 2009, 2010b, 2011,
2012b).
Yet, all the aforementioned models are limited in their use of only one or two
electrodes and they also require many sessions to achieve good clinical outcomes. For the
above-cited studies the reported average number of sessions was 40.5. Moreover,
Thatcher (2012, 2013) reports 40 to 80 sessions to be the accepted norm for these older
style models; thus leading to a sizeable cost to access this treatment. However, one of the
newest ZNF models shows promise to bring about positive clinical outcomes in
significantly fewer sessions (Thatcher, 2013). With 4ZNF there have been reports of
successful clinical outcomes with less than 25 sessions (Collura, Guan, Tarrant, Bailey, &
Starr, 2010; Hammer, Colbert, Brown, & Ilioi, 2011; Wigton, 2008); whereas clinical
reviews and recent conference reports (J. L. Koberda, Moses, Koberda, & Koberda,
2012b; Rutter, 2011; Wigton, 2009, 2010a, 2010b, 2013; Wigton & Krigbaum, 2012)
suggest 19ZNF can result in positive clinical outcomes, as well as QEEG normalization,
in as few as 5 to15 sessions. Therefore a NF technique which shows promise to bring
clinical improvement in fewer sessions – thereby reducing treatment cost – deserves
empirical study.
Currently in the peer-reviewed published literature, there are a couple of
descriptive and clinical review articles about the 19ZNF model (Thatcher, 2013; Wigton,
4
2013) and two single case study reports (Hallman, 2012; J. L. Koberda et al., 2012a);
however rigorous scientific studies evaluating 19ZNF have not been found, which poses
a gap in the literature. Therefore, before the question of efficiency and number of
sessions is examined, first its efficacy should be established. NF and ZNF efficacy has
been discussed in the literature as having the desired effect in terms of improved clinical
outcomes (La Vaque et al., 2002; Thatcher, 2013; Wigton, 2013), a definition that fits
well within the scope of this research. In this study, there are two types of clinical
outcome measures; one type (clinical assessments) is a set of psychometric tests designed
to measure symptom severity and/or improvement, the other type (QEEG z-scores)
provides a representative measure of electrocortical dysfunction and/or improvement.
Thus, this dissertation is intended to address efficacy of 19ZNF in a clinical setting,
through a retrospective evaluation of clinical outcomes, as measured by clinical
assessments and QEEG z-scores.
Problem Statement
It is not known, by way of statistical evaluation of either clinical assessments or
QEEG z-scores, if 19ZNF is an effective NF technique. This is an important problem
because 19ZNF is a new NF model currently in use by a growing number of practitioners,
yet scientific research investigating its efficacy is lacking. According to an Efficacy Task
Force, established by the two primary professional organizations for NF and biofeedback
professionals,1 anecdotal reports (regardless of how many) are insufficient as a basis for
1
The primary professional societies for neurofeedback and biofeedback are the International
Society for Neurofeedback and Research (ISNR; www.isnr.org) and the Association for Applied
Psychophysiology and Biofeedback (AAPB; www.aapb.org).
5
determining treatment efficacy, and uncontrolled case studies are scientifically weak (La
Vaque et al., 2002). Therefore, scientific evidence of efficacy for 19ZNF is needed.
The identified population for this study is made up of those seeking NF services
(both adults and children), and those who become NF clients. These individuals may
have an array of symptoms, which adversely affect their daily functioning; they may also
have previously diagnosed mental health disorders. When seeking NF services these
individuals must choose among a variety of NF models. However the dearth of scientific
literature regarding 19ZNF limits the information available to inform that