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ORIGINAL ARTICLE pissn 1226-6396, eissn 2234-4942 J of Oriental Neuropsychiatry 2014;25(3):271-286 http://dx.doi.org/10.7231/jon.2014.25.3.271 뇌파를이용한생기능자기조절 ( 뉴로피드백 ) 훈련에대한임상연구동향 - 2000 년부터 2013 년까지국내학술지논문을중심으로 - 임정화, 성우용 부산대학교한의학전문대학원한방신경정신과교실 The Review for Studies of Neurofeedback Training Jung Hwa Lim, Woo-Young Seong Department of Neuropsychiatry, School of Korean Medicine, Pusan National University Received: September 4, 2014 Revised: September 14, 2014 Accepted: September 15, 2014 Correspondence to Woo-Young Seong Department of Neuropsychiatry, School of Korean Medicine, Pusan National University, Beoma-ri, Mulkueum-eup, Yangsan, Korea. Tel: +82-55-360-5555 Fax: +82-55-360-5890 E-mail: Sayeo@hanmail.net Acknowledgement This work was supported by a 2-Year Research Grant of Pusan National University. Objectives: The purpose of this study is to investigate the clinical trial research trends in regards to the neurofeedback training (NFT) in Korean journals. Methods: We researched articles published in Korean journals from 2000 up to 2013 and were related to the NFT. We searched six electronic databases to find relevant articles, using the term neurofeedback. Results: 1) 6 single group comparative studies and 31 randomized controlled trials were found. 2) Healthy volunteers and students were most frequently studied with neurofeedback training. Other studies included attention deficit hyperactivity disorder (ADHD), Poststroke, panic disorder, premenstrual dysphoric disorder (PDD), temporomendibular disorder (TMD), and obesity. NFT interventions were attempted in diverse training protocols and assessed with many different outcome measurements. 3) Most studies showed effective results after NFT. Conclusions: NFT is increasingly studied and used in various clinical fields. Also, there have been efforts to adopt NFT in Korean medical clinics and researches, and more rigorous and innovative studies are needed in the future. Key Words: Neurofeedback Training, NFT, Korean Medicine, Clinical Trials. Copyright 2014 by The Korean Society of Oriental Neuropsychiatry. All rights reserved. CC This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

272 The Review for Studies of Neurofeedback Training I. 서론 뇌파를이용한생기능자기조절 ( 뉴로피드백 ) 훈련 ( 이하뉴로피드백훈련 ) 은조작적조건형성 (operant conditioning) 이론에근거하여특정뇌파를강화하거나억제시켜뇌기능의향상을도모하는훈련기법으로 1), 뇌의전기적인활동인뇌파가정신상태를반영하고이러한뇌파는훈련으로변화가가능하다는기본적원칙에근거를두고있으며, 자신의뇌파를실시간으로검토하고시각및청각적되먹임을받아훈련자스스로뇌파를의도하는방향으로조절하는훈련이다 2). 뉴로피드백훈련은경련성질환치료를위해처음으로사용된이후 3), 알코올의존환자 4), 주의력결핍과잉행동장애 5), 우울증, 불안장애 6), 수면장애 7), 뇌손상환자의인지저하의치료 8) 과더불어, 정상인의수행력증가목적 9) 등, 현재까지뇌기능과관련된여러증상과다양한분야에걸쳐활용되고있다. 뉴로피드백훈련은기계장치를이용하지만불수의적정신신체상태를조절한다는측면에서동양의요가, 선, 기공, 명상등과목적및방법에서공통점을갖는다 10). 또한측정된신체정보를이용하여정신상태를파악하여, 비정상적으로증가된뇌파를낮추고비정상적으로감소된뇌파를강화하는자기조절을통해치료하는뉴로피드백훈련은심신일여 ( 心身一如 ) 의인체관을기반으로음양의균형과조기치신 ( 調氣治神 ) 의방법으로건강을유지하고질병을치료하는 한의학적인접근과많은부분유사하다 11). 뉴로피드백훈련은한의학적치료접근법과공유하는부분이많아앞으로한의학임상현장에서보다많은증상에폭넓게응용될것으로예상되나, 관련된국내한의학계연구는주로주의력결핍과다행동장애 12,13), 뚜렛장애 14), 진전 15), 울증 16), 사회공포증 17) 등에뉴로피드백훈련을한방치료와병행하여적용한증례보고에치우쳐있으며, 임상연구로는호흡명상과함께시행하여정상성인의기억과집중력에미치는영향 18) 에대한단하나의보고만있는실정이다. 이에본연구에서는한의학분야에서의뉴로피드백훈련의보다체계적인임상활용및임상연구를위한기초자료를마련하고자국내학술지에발표된뉴로피드백훈련에대한기존논문을검색, 분석하여연구동향을고찰하였다. II. 연구대상및방법 2000 년부터 2013 년까지국내학술지에발표된뇌파를이용한생기능자기조절 ( 뉴로피드백 ) 훈련에대한임상연구논문들을대상으로하여검색하였으며, 발표초록이나업적집, 학술대회발표등은배제하였다. 논문의검색은학술논문검색데이터베이스인 DBpia (http://www.dbpia.co.kr/), 학술데이터베이스인 KISS (http://kiss.kstudy.com/), 학술정보검색데이터베이스인과학기술학회마을 (http://society.kisti.re.kr/main.html), 한국교욱학술정보원 (KERIS) 에서제공하는 RISS (http:// Fig. 1. Flow diagram preferred reporting items for review.

JH Lim, WY Seong 273 www,riss. kr/ index.do), 한국과학기술정보연구원에서제공하는국가과학기술정보센터 NDSL (http://www.ndsl. kr/index.do), 한국한의학연구원에서제공하는전통의학포털시스템 OASIS (http://oasis.kiom.re.kr/main.jsp) 을활용하였으며 neurofeedback', ' 뉴로피드백 을검색어로사용하였다. III. 결과 검색한결과 DBpia 에서 73편, KISS 에서 94편, 과학기술학회마을에서 105편, RISS에서 162편, NDSL 에서 107편, 오아시스에서 20편이검색되었다이중검사결과에중복이되는것, 발표초록, 업적집, 학술대회, 기사, 공학논문, 원문을확인할수없는논문등을제외한 65편중, 종설논문 9편, 증례보고 9편, 질적연구 1편, 뉴로피드백훈련에대한연구가아닌 9편을제외하고총 37편을선정하였다 (Fig. 1). 37편의논문중단일군연구가 6편, 뉴로피드백훈련과다른치료를병행하거나다른치료와비교한연구가 8편이었고, 가짜뉴로피드백훈련을실시한대조군연구는 2편이었다. 검색된 37편의연구대상, 처치방법, 평가기준, 결과등을정리, 분석하였다 (Table 1). 1. 연구의질평가 37편의논문중무작위배정을시행한다고표현한논문은 16편이었으며 1편의논문에서번호뽑기를시행하여무작위배정을시행하였다고언급하였다. 9편의논문에서탈락과중도포기를기재하였으며, 모든논문에서이중맹검을시행하지않았다. Jadad Quality Assessment Scale 점수는 4편의논문이 2점이고나머지는모두 1점이하로대체로논문의질이낮았다. 2. 연구대상및질환전체임상연구중특정질환이나증상을호소하지않는비질병인을연구대상으로한논문중대학생혹은대학원생을대상으로한연구가 4편, 초, 중, 고등학생을대상으로한연구는 10편, 유치원생을대상으로한연구는 6편, 성인이대상인연구는 3편, 청각장애학생대상연구 2편, 장기요양시설노인, 골프선수, 바둑기사를대상으로한연구가각각 1편이었다. 특정질환이나증상에대한연구는 9편으로, 주의력결핍과잉행동장애혹은학습능력저하및주의력저하를호소하는아동을대상으로한연구가 3편, 만성뇌졸중환자를대상으로한연구가 2편, 공황장애, 월경전불쾌장애, 측두하악장애, 비만환자를대상으로한연구가각각 1편이었다. 3. 치료 1) 단독치료임상연구논문에서실험처치에뉴로피드백훈련만이시행된단독치료연구는단일군연구를포함하여모두 29편이었다. 2) 병용치료뉴로피드백훈련과함께다른치료가함께시행된병용치료연구로는두개천골요법을결합한연구가 2편, 근력강화트레이닝, 호흡명상, 약물치료, 재활치료를결합한연구가각각 1편이었다. 뉴로피드백훈련과다른치료방법의효과를비교한연구중뉴로피드백훈련과두개천골요법을비교한연구가 2편, 뉴로피드백훈련과뇌교육을비교한연구가 2편, 뉴로피드백훈련과약물치료를, 뉴로피드백훈련과컴퓨터보조인지재활훈련을비교한연구가각각 1편이었다. 4. 뉴로피드백훈련모드뉴로피드백훈련모드는연구목적및질환에따라다양하였다. 2편의논문에서는뉴로피드백훈련방법에대한기술이없었고, 16편의논문에서는훈련모드를훈련전뇌파측정을하여훈련자의전전두엽뇌파의상태에따라결정하도록하였다. 훈련모드로는측두하악장애, 뇌졸중후유증환자, 주의력저하아동, 골프선수를연구대상으로하는 4편의연구에서 beta-smr 모드를, 공황장애, 뇌졸중후유증, 비만환자를연구대상으로하는 3편의연구에서 bata-smr 모드와 alpha-theta 모드를함께사용하였다. Alpha 파강화훈련을한연구는 2편으로사격선수의사격수행력과초등학생의재인, 회상기억향상에대한연구였다. 그밖에월경전불쾌장애환자를대상으로전두엽 Alpha 파대칭성훈련을한연구가 1편, 호흡명상과함께두뇌이완훈련, 집중력훈련, 좌우뇌균형훈련을시행한연

274 The Review for Studies of Neurofeedback Training Table 1. Summary of Treating Neurofeedback Training in Clinical Trials Author (year) Subjects (M/F) Sample size Children with attention deficit, degradation of learning ability, ADHD Sin KS 19) (2009) Bak KJ 20) (2007) Roh OB 21) 5~12 years old children (12/8) K-ARS score over 7 or ADDES - HV inattention score over19 Primary students showing degradation of learning ability, attention deficit, psychological problems (25/25) Treatment Duration 20 NFT 30 min. 2~3 times/week 20 sessions 25 (A) NFT 40~60 min. 2~3 times/week over 30 sessions 25 (B) Control waiting ADHD children 11 (A) NFT 30 min. 2 3 times/week 20 sessions Chronic stroke patients Lee YS 22) Chronic stroke patients (2013) with hemiparalysis MMSE-K score 14 23 Jung MW 23) (2012) Patients with stroke hemiparalysiswithin 3 months 1 year under 24 score MMSE-K 9 (B) NFT+Medication 9 (C) Medication 10 (A) NFT 30 min. 5 times/week 4 weeks 10 (B) Control waiting 14 (A) Conventional rehabilitation training + NFT 30 min. 5 times/week 6 weeks 14 (B) Conventional rehabilitation training + Computer Assisted Cognitive Rehabilitation 30 min. 5 times/week 6 weeks 16 (B) Conventional rehabilitation training 30 min. 5 times/week 6 weeks Assessment Outcome measurement Results Training mode K-ARS, ADDES - HV The subscale of mean inattention and impulsivity/ hyperactivity score of ARS was reduced significantly. The subscale of inattention, impulsivity, and hyperactivity scores of ADDES-HV were reduced significantly. SRQ, ATQ, ASQ POMS The Amen Clinic ADD type Questionnaire (Healing ADD) The ATQ and ASQ were significantly increased in (A) group. The mood was significantly improved, and attention-deficit characteristics was significantly decreased in (A) group. K-ARS The inattention score of (A) group significantly decreased more than that of the medication group. Brain wave activity: QEEG-8 (Laxtha3208, Laxtha Inc., Korea) Stroop test, MMSE-K, DST MMSE-K MFT Absolute α-power of (A) group increased and absolute θ-power decreased significantly compared to (B) group. The MMSE-K score of (A) group has increased significantly, and the error in Stroop Test and DST in (A) has decreased significantly compared to (B) group. MMSE-K score was increased significantly in all three groups, but there was no statistically significant difference among groups. Total NFT score was increased significantly in all three groups, but there was no statistically significant difference among groups. Beta-SMR mode attention training Inattention subtype enhancing β wave training Hyperactivity/impulsivity subtype enhancing SMR wave training Mixed subtype enhancing β wave training+enhancing SMR wave training Beta-SMR mode and alphatheta mode Beta-SMR mode NFT: Neurofeedback training, K-ARS: Korean-Attention-Deficit/Hyperactivity Disorder Rating Scale, ADDES-HV: Attention Deficit Disorder Evaluation Scale - Home Version, SRQ: Self Regulation Quotient, ATQ: Attention Quotient, ASQ: Anti-stress Quotient, POMS: Profile of Mood, ADHD: Attention Deficit/Hyperactivity Disorder, DST: Digit Span Test, MMSE-K: Mini-Mental State Examination-Korea, MFT: Manual Function Test, K-APPQ: Korean Albany Panic and Phobia Questionnaire, PMDD: Premenstrual Dysphoric Disorder, SPAF: Shortened Premenstrual Assessment Form, TMD: Temporomandibular Disorder, PSQI: Pittsburgh Sleep Quality Index, OHIP-14: Oral Health Impact Profile, BRQ: Basic Rhythm Quotient, ACQ: Activity Quotient, EQ: Emotion Quotient, CQ: Corelation Quotient, BQ: Brain Quotient, BIS/BAS: the Behavioral Inhibition System/Behavioral Activation System scale, TTCT; Torrance Tests of Creative Thinking, VAS: Visual Analog Scale, DHQ: Daily Hassles Questionnaire, SF-36: 36-Item Short-Form Health Survey, AMPQ: Adolescent Mental Problem Questionnaire, K-WAIS: Korean Wechsler Adult Intelligence, HRSD : Hamilton Rating Scale for Depression, STAI: State - Trait Anxiety Inventory, BDI: Beck Depression Inventory, HRV: Heart Rate Variability, K-ABC: Kaufman Assessment for Children, K-WPPSI: Korean Wechsler Preschool and Primary Scale of Intelligence, K-Raven CPM: K-Raven CPM (coloured progressive matrices), MIDAS-MYC: Korean Multiple Intelligence Development Assessment Scale-My Young Child, BDNF: Brain Derived Neurotropic Factor, NGF: Nerve Growth Factor.

JH Lim, WY Seong 275 Table 1. Continued 1 Author (year) Subjects (M/F) Panic disorder, obese womwen, PMDD, TMD Kang SW 24) Panic disorder, refractory to (2006) cognitive-behavioral therapy and medication (3/3) Rhee SY 25) (2007) Oh EH 26) (2009) Park JH 27) Obese Korean women (BMI over 25 kg/m 2 ) who failed to 12 week medical nutritional therapy (0/15) Unmarried women with PMDD (0/16) Sample size Treatment Duration 6 NFT 1 hour 3 times/week 20 sessions 15 NFT 30~60 min. 1 time/week 8 sessions 8 (A) NFT 24 min. 2 times/visit 20 sessions 8 (B) Control waiting TMD (0/14) 7 (A) NFT 30 min. 2 times/visit, 20 sessions 7 (B) Control waiting Undergraduate and graduate students Kum MH 28) Nursing students 121 NFT (2012) 30 min. 2 times/week 10 weeks Chi YK 29) (2009) Song YS 30) (2007) Right - handed under graduate and graduate students (0/17) 9 (A) NFT to increase the left frontal activity 4 min. 5 times/day 15 sessions 8 (A) NFT to increase the right frontal activity 4 min. 5 times/day 15 sessions Nursing students (0/36) 18 (A) NFT 30 min. 3 sessions/week 6 weeks 18 (B) Control waiting Assessment Outcome measurement Results Training mode K-APPQ The score of total K-APPQ, agrophobia, and interoceptive fear were significantly deceased after NFT. Anthropometry Biochemical analysis Eating pattern analysis Diet quality index Food intake behavior Total body fat, body fat percentage and fasting plasma glucose were significantly decreased, and insulin concentration were significantly increased after neurofeedback intervention. The energy from carbohydrate intake were significantly decreased after neurofeedback intervention. The scores of cognitions about dietary method and regularity were significantly decreased after neurofeedback intervention. SPAF The score of affective, behavioral and physical symptoms of (A) group were reduced significantly compared to (B) group. Jaw pain: VAS PSQI OHIP-14 SRQ, BRQ, ATQ, ACQ, EQ, ASQ, CQ, BQ BIS/BAS Responses to emotionally evocative film clips VAS of jaw pain was significantly decreased (A) group more than (B) group. The score of PSQI was significantly decreased (A) group more than (B) group. The score of OHIP-14 was significantly improved (A) group more than (B) group. SRQ, ATQ, ACQ, EQ, ASQ, BQ were significantly increased after the NFT. BAS score of (A) group was significantly higher BAS score than (B) group. The emotional responses to obvious emotional film clips of (A) group were stronger than that of (B) group. TTCT The scores of flexibility and creativity were increased significantly in (A) group compared to (B) group. Beta-SMR mode+alpha-theta mode Beta-SMR mode+alpha-theta mode Alpha symmetry training Beta-SMR mode (A) Inhibiting alpha wave activity of the left frontal lobe (B) Inhibiting alpha wave activity of the right frontal lobe Alpha symmetry training Creativity training Mind piece game NFT: Neurofeedback training, K-ARS: Korean-Attention-Deficit/Hyperactivity Disorder Rating Scale, ADDES-HV: Attention Deficit Disorder Evaluation Scale - Home Version, SRQ: Self Regulation Quotient, ATQ: Attention Quotient, ASQ: Anti-stress Quotient, POMS: Profile of Mood, ADHD: Attention Deficit/Hyperactivity Disorder, DST: Digit Span Test, MMSE-K: Mini-Mental State Examination-Korea, MFT: Manual Function Test, K-APPQ: Korean Albany Panic and Phobia Questionnaire, PMDD: Premenstrual Dysphoric Disorder, SPAF: Shortened Premenstrual Assessment Form, TMD: Temporomandibular Disorder, PSQI: Pittsburgh Sleep Quality Index, OHIP-14: Oral Health Impact Profile, BRQ: Basic Rhythm Quotient, ACQ: Activity Quotient, EQ: Emotion Quotient, CQ: Corelation Quotient, BQ: Brain Quotient, BIS/BAS: the Behavioral Inhibition System/Behavioral Activation System scale, TTCT; Torrance Tests of Creative Thinking, VAS: Visual Analog Scale, DHQ: Daily Hassles Questionnaire, SF-36: 36-Item Short-Form Health Survey, AMPQ: Adolescent Mental Problem Questionnaire, K-WAIS: Korean Wechsler Adult Intelligence, HRSD : Hamilton Rating Scale for Depression, STAI: State - Trait Anxiety Inventory, BDI: Beck Depression Inventory, HRV: Heart Rate Variability, K-ABC: Kaufman Assessment for Children, K-WPPSI: Korean Wechsler Preschool and Primary Scale of Intelligence, K-Raven CPM: K-Raven CPM (coloured progressive matrices), MIDAS-MYC: Korean Multiple Intelligence Development Assessment Scale-My Young Child, BDNF: Brain Derived Neurotropic Factor, NGF: Nerve Growth Factor.

276 The Review for Studies of Neurofeedback Training Table 1. Continued 2 Author (year) Song YS 31) (2006) Subjects (M/F) Sample size Treatment Duration Nursing students 18 (A) NFT 30 min. 3 sessions/week 6 weeks 18 (B) Control waiting Primary, middle, high school students Ahn SK 32) Primary students (28/20) 24 (A) NFT (2009) 40 min. 3 times/week Weon HW 33) (2008) Weon HW 34) (2013) Ahn SK 35) Ahn SK 36) (2010) Ahn SK 37) High school students (62/0) High school students (0/11) Middle school students (32/28) 24 (B) Control waiting 29 (A) NFT 30 min. 3 times/week 12 weeks 33 (B) Control waiting 5 (A) NFT 40 min. 2 times/week 20 sesseions 6 (B) Control waiting 30 (A) NFT 40~60 min. 2~3 times/week over 40 sessions 30 (B) Control waiting Primary school students 26 (A) NFT 40 min. 2~3 times/week over 30 sessions Primary school students (25/25) 26 (B) Control waiting 25 (A) NFT 40~60 min. 2~3 times/week, over 40 sessions 25 (B) Control waiting Assessment Outcome measurement perceived fatigue: VAS perceived stress: VAS Lymphocyte (n/μl)% of NK cell ASQ, Body stress index, Mental stress index Academic achievement BRQ, SRQ, ATQ, ACQ, EQ, ASQ, CQ, BQ DHQ SF-36 AMPQ SRQ, ATQ, ACQ, EQ, ASQ, CQ, BQ SRQ Self-directed learning ability SRQ, training protocol, maximum deviation Self-directed learning ability ATQ, BQ School achievement motivation Results Training mode Perceived fatigue and perceived stress were decreased significantly in (A) group. The number of lymphocyte was increased significantly in (A) group. ASQ were increased significantly and body stress and metal stress indexes were decreased significantly in (A) group. The scholastic achievement/competence were increased significantly and anxiety was decreased in (A) group. SRQ, ATQ, ACQ, CQ, and BQ were increased significantly in (A) group compared to (B) group. The score of total stress, friend stress, family stress and school stress were decreased significantly in (A) group compared to (B) group. ASQ, and EQ were significantly increased in (A) group compared to (B) group. SRQ was significantly increased in (A) group com - pared to (B) group. Self-directed learning ability score was statistic increased significantly in (A) group compared to (B) group. SRQ and training protocol were significantly increased in (A) group compared to (B) group, and maximum deviation were significantly decreased in (A) group compared to (B) group. The score of self regulation ability were significantly increased in (A) group after neurorfeedback training. Brain function quotient were statistic significantly increased (A) group compared to (B) group. The score of school achievement motivation was statistic significantly increased (A) group compared to (B) group. Breathing Concentration training Attention training NFT: Neurofeedback training, K-ARS: Korean-Attention-Deficit/Hyperactivity Disorder Rating Scale, ADDES-HV: Attention Deficit Disorder Evaluation Scale - Home Version, SRQ: Self Regulation Quotient, ATQ: Attention Quotient, ASQ: Anti-stress Quotient, POMS: Profile of Mood, ADHD: Attention Deficit/Hyperactivity Disorder, DST: Digit Span Test, MMSE-K: Mini-Mental State Examination-Korea, MFT: Manual Function Test, K-APPQ: Korean Albany Panic and Phobia Questionnaire, PMDD: Premenstrual Dysphoric Disorder, SPAF: Shortened Premenstrual Assessment Form, TMD: Temporomandibular Disorder, PSQI: Pittsburgh Sleep Quality Index, OHIP-14: Oral Health Impact Profile, BRQ: Basic Rhythm Quotient, ACQ: Activity Quotient, EQ: Emotion Quotient, CQ: Corelation Quotient, BQ: Brain Quotient, BIS/BAS: the Behavioral Inhibition System/Behavioral Activation System scale, TTCT; Torrance Tests of Creative Thinking, VAS: Visual Analog Scale, DHQ: Daily Hassles Questionnaire, SF-36: 36-Item Short-Form Health Survey, AMPQ: Adolescent Mental Problem Questionnaire, K-WAIS: Korean Wechsler Adult Intelligence, HRSD : Hamilton Rating Scale for Depression, STAI: State - Trait Anxiety Inventory, BDI: Beck Depression Inventory, HRV: Heart Rate Variability, K-ABC: Kaufman Assessment for Children, K-WPPSI: Korean Wechsler Preschool and Primary Scale of Intelligence, K-Raven CPM: K-Raven CPM (coloured progressive matrices), MIDAS-MYC: Korean Multiple Intelligence Development Assessment Scale-My Young Child, BDNF: Brain Derived Neurotropic Factor, NGF: Nerve Growth Factor.

JH Lim, WY Seong 277 Table 1. Continued 3 Author (year) Byun YE 38) Byun YE 39) Yang HR 40) (2010) Adults Chung SY 18) (2008) Subjects (M/F) Primary, middle, high school students (18/27) Primary, middle,high school students (18/27) 4th year primary students (21/15) Healthy adult volunteers (12/13) Sample size Treatment Duration 18 NFT Male group 25~30 min. 2~3 times/week 20~25 sessions 27 NFT Female group 25~30 min. 2~3 times/week 20~25 sessions 45 (A) NFT 25~30 min. 2~3 times/week 20~25 sessions 45 (B) Control waiting 18 (A) NFT 30 min, 2 times/week 4 sessions 18 (B) Control sham NFT 13 (A) breath meditation with NFT 15 min. 3 times/week 10 sessions 12 (B) breath meditation with sham NFT 15 min. 3 times/week 10 sessions Assessment Outcome measurement BRQ, SRQ, ATQ, ACQ, EQ, ASQ, CQ, BQ BRQ, SRQ, ATQ, ACQ, EQ, ASQ, CQ, BQ Training performance Recall memory Recognition memory Cognitive functions assessment K-WAIS, HRSD, STAI, BDI VAS about amnesia, HRV Results Training mode Primary students: SRQ was significantly increased in (A) group. ATQ, ACQ, ASQ, and BQ were significantly increased in (B) group. Middle school students: ATQ, ASQ, and BQ were significantly increased in (A) group. ATQ, ACQ, and BQ were significantly increased in (B) group. High school students: ACQ, ASQ) were significantly increased in (A) group. ATQ, EQ, BQ were significantly increased in (B) group. Primary students: SRQ, ATQ, ACQ, ASQ, and BQ were significantly increased in (A) group after NFT. Middle school students: SRQ, ATQ, EQ, ASQ, and BQ were significantly increased in (A) group after NFT. High school students: ATQ, ACQ, EQ, and BQ were significantly increased in (A) group after NFT. The scores of training performance of (A) group were enhanced as the training session progressed. The overall scores of recall and recognition perform - ance of (A) group were enhanced by the administration of the training itself and as the training sessions advanced compared to (B) group. Concentration, and cognition strength were increased significantly in (B) group compared to (A) group. Not described Not described Enhancing alpha wave Relaxation training Concentration training Alpha symmetry training NFT: Neurofeedback training, K-ARS: Korean-Attention-Deficit/Hyperactivity Disorder Rating Scale, ADDES-HV: Attention Deficit Disorder Evaluation Scale - Home Version, SRQ: Self Regulation Quotient, ATQ: Attention Quotient, ASQ: Anti-stress Quotient, POMS: Profile of Mood, ADHD: Attention Deficit/Hyperactivity Disorder, DST: Digit Span Test, MMSE-K: Mini-Mental State Examination-Korea, MFT: Manual Function Test, K-APPQ: Korean Albany Panic and Phobia Questionnaire, PMDD: Premenstrual Dysphoric Disorder, SPAF: Shortened Premenstrual Assessment Form, TMD: Temporomandibular Disorder, PSQI: Pittsburgh Sleep Quality Index, OHIP-14: Oral Health Impact Profile, BRQ: Basic Rhythm Quotient, ACQ: Activity Quotient, EQ: Emotion Quotient, CQ: Corelation Quotient, BQ: Brain Quotient, BIS/BAS: the Behavioral Inhibition System/Behavioral Activation System scale, TTCT; Torrance Tests of Creative Thinking, VAS: Visual Analog Scale, DHQ: Daily Hassles Questionnaire, SF-36: 36-Item Short-Form Health Survey, AMPQ: Adolescent Mental Problem Questionnaire, K-WAIS: Korean Wechsler Adult Intelligence, HRSD : Hamilton Rating Scale for Depression, STAI: State - Trait Anxiety Inventory, BDI: Beck Depression Inventory, HRV: Heart Rate Variability, K-ABC: Kaufman Assessment for Children, K-WPPSI: Korean Wechsler Preschool and Primary Scale of Intelligence, K-Raven CPM: K-Raven CPM (coloured progressive matrices), MIDAS-MYC: Korean Multiple Intelligence Development Assessment Scale-My Young Child, BDNF: Brain Derived Neurotropic Factor, NGF: Nerve Growth Factor.

278 The Review for Studies of Neurofeedback Training Table 1. Continued 4 Author (year) Lee JE 41) (2010) Lee JE 42) (2008) Subjects (M/F) Sample size Treatment Duration Middle aged women (0/71) 17 (A) NFT 30 min. 3 times/week,10 sessions 17 (B) Cranio-sacral therapy 60 min. 1 time/week,10 sessions 19 (C) NFT + Cranio-sacral therapy 18 (D) Control Health counselling 4 sessions Middle aged women (0/71) 17 (A) NFT 30 min. 3 times/week 30 sessions 17 (B) Cranio-sacral therapy 60 min. 1 time/week 10 sessions 18 (C) NFT + Cranio-sacral therapy 19 (D) Control waiting Kindergarten kids Bak KJ 43) Kindergarten kids (31/17) 24 (A) NFT (2009) 30 min. 2 times/week Bak KJ 44) (2010) Bak KJ 45) Jang SO 46) (2009) Kindergarten children (27/13) Kindergarten children (31/22) 5-years-old Kindergarten children (31/29) 24 (B) Control waiting 20 (A) NFT 30 min. 2 times/week 20 (B) Control waiting 26 (A) NFT 30 min. 2 times/week 26 (B) Control waiting 30 (A) NFT 25 min. 3 times/week, 90 sessions 30 (B) Control waiting Assessment Outcome measurement Subjective symptoms of fatigue Perceived stress ATQ, Body stress index ASQ, EQ, BQ ATQ, ASQ CQ (symmetry, corelation) ASQ, body stress index, mental stress index AQ, ASQ, CQ K-ABC BQ, BRQ, SRQ, ATQ, ACQ, EQ, ASQ, CQ K-WPPSI Results Training mode There were no significant differences among all groups on the score of perceived fatigue and stress. There were no significant differences among (A), (B), (C) groups on brain function quotients. There were no significant differences among (A), (B), (C) groups. The corelation was significantly increased in (A) group. ASQ were significantly increased in (A) group com - pared to (B) group. The indexes of body stress, mental stress were significantly decreased in (A) group compared to (B) group. ATQ, CQ were increased significantly in (A) groups compared to (B) group. The score of master ability was increased in (A) groups compared to (B) group after NFT. BQ, SRQ, ATQ, ACQ, EQ, ASQ, CQ were significantly increased in (A) group after neufeedback training. The total IQ score and performance intelligence quotient score were significantly increased in (A) group. NFT: Neurofeedback training, K-ARS: Korean-Attention-Deficit/Hyperactivity Disorder Rating Scale, ADDES-HV: Attention Deficit Disorder Evaluation Scale - Home Version, SRQ: Self Regulation Quotient, ATQ: Attention Quotient, ASQ: Anti-stress Quotient, POMS: Profile of Mood, ADHD: Attention Deficit/Hyperactivity Disorder, DST: Digit Span Test, MMSE-K: Mini-Mental State Examination-Korea, MFT: Manual Function Test, K-APPQ: Korean Albany Panic and Phobia Questionnaire, PMDD: Premenstrual Dysphoric Disorder, SPAF: Shortened Premenstrual Assessment Form, TMD: Temporomandibular Disorder, PSQI: Pittsburgh Sleep Quality Index, OHIP-14: Oral Health Impact Profile, BRQ: Basic Rhythm Quotient, ACQ: Activity Quotient, EQ: Emotion Quotient, CQ: Corelation Quotient, BQ: Brain Quotient, BIS/BAS: the Behavioral Inhibition System/Behavioral Activation System scale, TTCT; Torrance Tests of Creative Thinking, VAS: Visual Analog Scale, DHQ: Daily Hassles Questionnaire, SF-36: 36-Item Short-Form Health Survey, AMPQ: Adolescent Mental Problem Questionnaire, K-WAIS: Korean Wechsler Adult Intelligence, HRSD : Hamilton Rating Scale for Depression, STAI: State - Trait Anxiety Inventory, BDI: Beck Depression Inventory, HRV: Heart Rate Variability, K-ABC: Kaufman Assessment for Children, K-WPPSI: Korean Wechsler Preschool and Primary Scale of Intelligence, K-Raven CPM: K-Raven CPM (coloured progressive matrices), MIDAS-MYC: Korean Multiple Intelligence Development Assessment Scale-My Young Child, BDNF: Brain Derived Neurotropic Factor, NGF: Nerve Growth Factor.

JH Lim, WY Seong 279 Table 1. Continued 5 Author (year) Cho SJ 47) (2012) Cho SJ 48) The elderly Youn MK 49) (2012) Subjects (M/F) 5-years-old Kindergarten children 5-years-old kindergarten children The elderly with long-term care insurance service The hearing impairments Bak KJ 50) The hearing impairments (2010) students (8/8) Bak KJ 51) Athletes Park JS 52) (2005) Bak KJ 53) (2008) Kim JS 54) (2013) The hearing impairments students (21/18) High school shooting players (6/0) Sample size Treatment Duration 30 (A) Brain education 20 min. 2 times/week, 12 weeks 30 (B) NFT 20 min. 2 times/week, 12 weeks 30 (C) Control waiting 30 (A) Brain education 20 min. 2 times/week, 12 weeks 30 (B) NFT 20 min. 2 times/week, 12 weeks 30 (C) Control waiting 5 (A) NFT 30 min. 3 times/week 60 sessions 6 (B) Control waiting 16 NFT 40 min. 2 times/week 25 (A) NFT 40 min. 2 times/week 9 months 14 (B) Control waiting 6 NFT 20 min. 6 times/week, 3 weeks Baduk players (30/0) 15 (A) NFT 20~30 min. 3 times/week 30 sessions Collegiate golf athletes (30/0) 15 (B) Control waiting 10 (A) Muscular strength 90 min. 3 times/week 12 weeks 10 (B) Muscular strength + NFT 1 hour8 2 times /week 12 weeks 10 (C) Control waiting Assessment Outcome measurement K-Raven CPM MIDAS-MYC BRQ, SRQ, ATQ, ACQ, EQ, ASQ, CQ K-Raven CPM MIDAS-MYC ATQ, ASQ, EQ, BQ ASQ, body stress index, mental stress index ASQ, ATQ POMS 10.5% aiming rate: coaching machine (Shooter training system, Russia) ATQ,EQ, ASQ Baduk strength BDNF, NGF Competition ability Results Training mode All sub-factors of thinking ability were significantly im - proved in (B) group compared to other groups. All sub-factors of multiple intelligence were significantly improved in (A) group compared to other groups NFT had no great difference from control group in the side of strengthening correlation among multiple intelligence, thinking power, and sub-factors of braining functions. Brain education training strengthened correlations with multiple intelligence, thinking power, and correlations between sub-factors of braining functions. Brain function quotient were increased significantly in (A) group compared to (B) group. ASQ were significantly increased) and the body stress and mental stress indexes were significantly decreased. Brain function quotient were statistic significantly increased (A) group compared to (B) group. The mood of (A) group was improved significantly after NFT. 10.5% aiming rate during NFT was significantly better than that before NFT. Brain function quotient in (A) gruop were increased significantly after the NFT Baduk strength of (A) gruop after the neurofeedback was significantly bigger than (B) group. BDNF was significantly increased in (B) group than other groups. Competition ability was not significant difference between groups. Breathing Relaxation & tension training Corelation training Breathing Relaxation & tension training Corelation training Enhancing alpha wave Beta-SMR mode NFT: Neurofeedback training, K-ARS: Korean-Attention-Deficit/Hyperactivity Disorder Rating Scale, ADDES-HV: Attention Deficit Disorder Evaluation Scale - Home Version, SRQ: Self Regulation Quotient, ATQ: Attention Quotient, ASQ: Anti-stress Quotient, POMS: Profile of Mood, ADHD: Attention Deficit/Hyperactivity Disorder, DST: Digit Span Test, MMSE-K: Mini-Mental State Examination-Korea, MFT: Manual Function Test, K-APPQ: Korean Albany Panic and Phobia Questionnaire, PMDD: Premenstrual Dysphoric Disorder, SPAF: Shortened Premenstrual Assessment Form, TMD: Temporomandibular Disorder, PSQI: Pittsburgh Sleep Quality Index, OHIP-14: Oral Health Impact Profile, BRQ: Basic Rhythm Quotient, ACQ: Activity Quotient, EQ: Emotion Quotient, CQ: Corelation Quotient, BQ: Brain Quotient, BIS/BAS: the Behavioral Inhibition System/Behavioral Activation System scale, TTCT; Torrance Tests of Creative Thinking, VAS: Visual Analog Scale, DHQ: Daily Hassles Questionnaire, SF-36: 36-Item Short-Form Health Survey, AMPQ: Adolescent Mental Problem Questionnaire, K-WAIS: Korean Wechsler Adult Intelligence, HRSD : Hamilton Rating Scale for Depression, STAI: State - Trait Anxiety Inventory, BDI: Beck Depression Inventory, HRV: Heart Rate Variability, K-ABC: Kaufman Assessment for Children, K-WPPSI: Korean Wechsler Preschool and Primary Scale of Intelligence, K-Raven CPM: K-Raven CPM (coloured progressive matrices), MIDAS-MYC: Korean Multiple Intelligence Development Assessment Scale-My Young Child, BDNF: Brain Derived Neurotropic Factor, NGF: Nerve Growth Factor.

280 The Review for Studies of Neurofeedback Training 구가 1편, 전두엽 Alpha 파비대칭성이동기에미치는영향에대한연구가 1편, 주의력결핍과잉행동장애아동의아형에따라서로다른뇌파대역을강화한연구가 1편이었다. 그외 6편의논문에서는뉴로피드백훈련프로그램에있는훈련방법과훈련게임에대해기술하였다. 훈련횟수나기간을정확히기재하지않은연구가 9편이었으며, 회기당훈련시간은최소 15분에서최대 60분, 훈련기간은최소 3일부터최대 9개월, 훈련횟수는최소 4회기에서최대 90회기, 훈련빈도는연구마다 1일 1회부터주당 1회까지다양했다. 5. 평가도구임상연구중가장많이사용된평가척도는뇌기능지수 (Brain Function Quotient) 로뇌기능지수를평가도구로사용된연구는 21편이었으며그중뇌기능지수만을평가도구로사용한연구가 6편이었다. 뇌기능지수외다양한설문검사및신체검사가시행되었다. 주로시행된설문검사는한국판간이정신상태검사 (Mini-Mental State Examination - Korea; MMSE-K), 한국판주의력결핍및과잉행동장애평가척도 - 부모용 (Korean-Attention-Deficit/Hyperactivity Disorder Rating Scale; K-ARS), 기분상태설문지 (Profile of Mood ; POMS), 색채누진행렬지능검사 (K-Raven CPM [coloured progressive matrices]; K-Raven CPM), 교사용유아다중지능평가검사지 (Korean Multiple Intelligence Development Assessment Scale-My Young Child; MIDAS-MYC), 자기주도학습능력설문지 (Self-directed learning ability questionnaire) 2편이었으며, 대상질환및평가대상에따라스트레스척도, 피로척도, 삶의질척도, 우울척도, 불안척도불면척도, 공황장애척도, 증상에대한시각화척도, 지능검사등이사용되었다. 객관적인신체검사로는신경가소성예측인자 (BDNF, NGF), 심박변이도, 면역세포, 신체계측, 혈액생화학적분석이사용되었다. IV. 고찰 본연구에서는국내학술지에발표된뉴로피드백훈련을시행한임상연구를선별하여그결과를분석하였다. 국내 데이터베이스에서본연구목표에합당한연구 37편을선정하였으며, 이중단독치료 ( 뉴로피드백훈련 ) 군과대기군을대조군으로하여비교한연구가 23편으로가장많았으며, 단일군전후비교연구 6편, 병행치료 ( 뉴로피드백훈련군과다른치료를결합 ) 를실시하거나다른치료군과비교한연구가 8편이었다. 선정된임상연구논문중뉴로피드백훈련시행전후비교연구와대기군을대조군으로한연구에서는모두뉴로피드백훈련이유의한효과를보인다고보고하였다. 뉴로피드백훈련을시행한결과, 공황장애증상의호전, 월경전불쾌감증상감소, 주의력결핍및과잉행동충동성척도점수감소, 비만환자에서의체지방량감소와식사행동의변화, 주의력상승, 좌우뇌균형상승, 창의력척도점수상승, 피로, 스트레스척도점수감소, 면역력이증가하고, 뇌기능지수의개선이보이고각종정서, 건강척도, 뇌파활성화, 인지기능척도상승, 자기주도학습능력, 통증, 수면질, 삶의척도개선, 바둑수행력, 사격수행력상승이나타났다 19-22,24-27,29-39,43-46,49-52). 가짜뉴로피드백훈련을대조군으로한논문이 2편있었는데대조군의피험자에게는뇌파상태와무관하게무선으로변화하는시각적자극을제시하였다 18,40). 호흡명상과뉴로피드백훈련을병행한연구 18) 에서는가짜뉴로피드백훈련을시행한대조군에서집중력과인지강도에서유의한향상을보였으며, 초등학생을대상으로뉴로피드백훈련후회상기억과재인기억수행변화를관찰연구 40) 에서는뉴로피드백훈련집단이유의하게우수한수행결과를보였다. 또한뉴로피드백훈련과다른치료방법을병행하거나다른치료방법과비교한 8편의연구 18,21,23,41,42,47,48,54) 중, 근력복합트레이닝과뉴로피드백훈련을함께한실험군의혈중 BDNF 수치가근력복합트레이닝훈련군보다유의하게높았으며 54), 주의력결핍과잉행동장애아동의부주의와과잉행동 / 충동성점수는뉴로피드백훈련집단에서약물치료집단에서보다유의하게감소되었다 21). 그러나다른 6편의연구에서뉴로피드백훈련은다른치료방법과효과면에서유의한차이를보이지않았다. 뉴로피드백훈련후긍정적효과가보고된논문은대부분훈련전후비교연구나, 대기군을대조군으로한연구였다. 가짜뉴로피드백훈련을대조군으로한연구와뉴로피드백훈련과다른치료를비교한연구들의결과가일관되게나타나지않아 Fuchs 등의연구 55) 에서제기된바와같이뉴로피

JH Lim, WY Seong 281 드백훈련의플라시보효과에대한가능성이어느정도인정된다고할수있다. 또한, 보고된긍정적효과가뉴로피드백훈련에의한것만이아니라훈련자의의무감, 새로운치료법에대한기대감, 치료사에대한신뢰, 기타생활변화등이모두반영된결과일수도있다. 향후피험자의기대와같은사회심리학적요소가뉴로피드백훈련의치료효과에공헌하는측면, 다른치료방법과구분되는뉴로피드백훈련이갖는차별적인효과에대해서연구가이루어져야할것으로사료된다. 본연구는뉴로피드백훈련을다양한질환과대상에적용한연구결과를모두취합하였기때문에다양한훈련방법과평가도구가사용되었다. Bata-SMR 모드를사용한연구가 4편, bata-smr 모드와 alpha-theta 모드를사용한연구는 3편, Alpha 파강화훈련을시행한연구 2편, 전두엽 Alpha 파대칭성훈련을한연구가 1편, 전두엽 Alpha 파의비대칭성을유도한훈련을한연구가 1편이었고, 두뇌이완훈련, 집중력훈련, 알파파의전두엽에서의좌우균형훈련을사용한연구가 1편이었다. ADHD 아동을대상으로한연구에서는연구대상자의증상에따라훈련모드를달리하였고, 그외 15편의연구에서훈련전피험자의자기조절능력을분석후피검자가피드백한뇌파중상대적비율이낮은주파수를피검자의훈련모드로선택하였다. 뇌영역에따라출현하는뇌파가다르고특정활동에따라주된활동을보이는뇌파가다르므로, 훈련자가뉴로피드백훈련으로활성화하거나억제하려는뇌파는관련질환과연구목적에따라차이를지니게된다 56). 대표적인뉴로피드백훈련모드중 bata-smr 모드는집중력장애, 불안, 우울, 간질, 통증, 뇌졸중등두뇌손상후유증등의치료에주로이용하며 57), 체성감각을억제시켜근육의긴장도를낮추고 58), 수면의질을개선시킨다는보고가있다 59). Alpha-theta 모드는편도를포함한변연계를안정화시키는효과가있는것으로알려져있으며대개무의식영역에서기원하는공포증, 외상후스트레스장애등의증상치료및치유되지않는감정적기억의완화, 깊은명상의유도등을위해사용된다 57,60). 전두엽비대칭은정서와밀접한관련이있어우울증환자에게서전두엽에서의알파파의비대칭이우울증환자에게서나타나고 61), 좌반구전전두엽은접근체계로서의욕구행동및긍정적정서를발생시키고우반구전전두엽은철수체계로서혐오적인자극에서철수하 려는경향성과부정적정서를발생시킨다는보고가있다 62). 그러나뇌파와특정인지능력혹은감정에대한관련성은연구마다일관적이지않아 47) 특정질병에특정훈련을일괄적으로적용하는것은무리가있어훈련전뇌파분석을통해서훈련자의뇌파상태에맞는훈련모드를사용하는것이임상현장에서는보다실제적일것으로사료된다. 평가지표로공황장애, 주의력결핍과다행동장애, 월경전평가척도, 스트레스, 피로, 정서, 지능, 인지, 동기, 삶의질, 통증척도등의설문평가와신체계측, 혈중신경인자, 혈액학적분석, 면역세포, 심박변이도등과같이신체변화를측정하는객관적평가가사용되었다. 그중가장많이사용된평가지표는뇌기능지수인데뇌기능지수는특정뇌파의세기나주파수, 혹은뇌파간의비율을점수화한것이다 63). 임상연구에서뉴로피드백훈련후뇌기능지수가유의미하게변한것은뉴로피드백훈련이훈련자의뇌파를변화시켜원하는뇌파상태를유도하였다는것으로해석할수있으나뇌기능지수가신체적, 정서적건강과인지, 지능등의객관적지표로활용되기위해서는경험적증거의축척과관련성연구등의후속연구가필요할것으로사료된다. 뉴로피드백훈련의훈련시간과훈련횟수는 15분에서 60 분, 4회에서최대 90회로다양하였고, 훈련빈도와훈련기간도주 1회부터 1일 1회, 3일부터 9개월까지다양하였다. 몇몇의연구에서원하는뉴로피드백훈련의긍정적인효과와이를지속적으로유지하는데필요한훈련횟수를 20회이상으로보고하고있으나 64), 표준화된치료빈도및기간을확립하기위한향후연구가필요할것으로생각된다. 뇌파는인간의정서및정신의활동상태와관련을가지므로심신일여 ( 心身一如 ) 의전인적인체관에기반한한의학에서진단적, 치료적활용가능성이높으며 11), 뇌파의변화를측정하여원하는방향으로변화시키는뉴로피드백훈련또한인체항상성을유지하기위한자생력을키워가는자율적훈련이란점에서한방정신요법과일맥상통한면이있다 65). 실제한의학임상현장에서뉴로피드백훈련이사용되고있고그효과와한의학적활용에대해서관심이높아지고있으나한의학계에서의임상연구는증례보고에치우쳐있다. 이에본연구에서는먼저국내학술지에발표된뉴로피드백훈련연구동향을살펴서실제임상현장에서의치료도구로의활용과한의학연구의설계에참고하고자했다.

282 The Review for Studies of Neurofeedback Training 선정된연구를살펴본바주의력결핍과잉행동장애, 공황장애, 뇌졸중후유증, 월경전불쾌장애, 측두하악장애, 비만환자, 유아, 아동, 청소년, 성인운동선수등다양한집단을대상으로뉴로피드백훈련에대한연구가수행되고있었으며, 증상개선, 스트레스감소, 뇌기능향상, 수행력증가에일정한효과가있었음을알수있었다. 그러나많은수의연구가비질병인을대상으로하고있고특정질환및증상을대상으로한임상연구는상대적으로적어서특정질환에대한뉴로피드백훈련의치료효과에대해일반화하기위해서는더많은후속연구가필요하다고생각된다. 또한연구의질이대체적으로낮고치료행위외다른요소가치료결과에반영될가능성이배제되지못하였기때문에, 향후연구에서는뉴로피드백훈련의플라시보효과의가능성과환자및치료자의특성등에따른다른치료요소가미치는영향을고려한정밀하고과학적인연구설계와분석방법이요구된다. 뉴로피드백훈련은환자의뇌파상태에맞는훈련모드를설정할수있고, 환자주도하에치료자와상호협조하여치료한다는점에서한방정신요법과유사한점이많아한방신경정신과질환의치료에응용될수있는가능성을크게지닌다. 따라서한의학임상교육에뉴로피드백훈련의임상적용을확대함으로써치료과정에적극적으로도입할수있을것이며, 다양한한의학적치료와함께활용함으로써뉴로피드백훈련방식을응용하는등의다양한시도가요구되며, 그유효성에대한연구도필요하다고하겠다. 본연구에서는국내에발표된뉴로피드백훈련에대한임상연구만을대상으로분석, 고찰하였으나향후해외여러나라에서이루어지고있는연구에대해서도지속적연구가필요할것이다. V. 결론 본연구는뇌파를이용한생기능자기조절 ( 뉴로피드백 ) 훈련의한의학임상에서의활용제고를위하여 2000 년부터 2013 년까지국내학술지에발표된논문을대상으로분석, 연구동향을고찰하여다음과같은결론을얻었다. 1. 뉴로피드백훈련에대한임상연구는총 37편으로단일군전후비교연구가 6편, 뉴로피드백훈련군과대기군을비교한연구가 23편, 뉴로피드백훈련과다른치료를결합 하거나다른치료군과비교한연구가 8편보고되었다. 2. 뉴로피드백훈련의대상이비질병인인연구가 28편으로가장많았으며, 그외주의력결핍과잉행동장애혹은학습능력저하및주의력저하를호소하는아동을대상으로한연구가 3편, 만성뇌졸중환자가대상인연구가 2편, 공황장애, 월경전불쾌장애, 측두하악장애, 비만환자를대상으로한연구가각각 1편으로보고되었다. 3. 뉴로피드백훈련방법절차, 시간, 회수, 빈도및평가방법은연구대상과질환에따라다양하게나타났다. 4. 뉴로피드백훈련후, 단일군전후비교연구와대기군을대조군으로한연구에서모두뉴로피드백훈련후유의성있는효과가보고되었으나, 가짜뉴로피드백훈련을대조군으로한연구는 2편중 1편에서뉴로피드백훈련과다른치료를비교한연구는 8편중 1편에서뉴로피드백훈련의유의성있는효과가보고되었다. REFERENCES 1. Weiskopf N, Scharnowski F, Veit R, Goebel R, Birbaumer N, Mathiak K. Self-regulation of local brain activity using real-time functional magnetic resonance imaging (fmri). Journal of Physiology-Paris 2004;98:357-73. 2. Nelson, L. A. The role of biofeedback in stroke rehabilitation: Past and future directions. Topics in Stroke Rehabilitation. 2007;14(4):59-66. 3. Sterman MB, Egner T. Foundation and practice of neurofeedback for the treatment of epilepsy. Appl Psychophysiol Biofeedback. 2006;31:21-35. 4. Peniston EG, Kulkosky PJ. Alcoholic personality and alphatheta brainwave training. Med psychother. 1990;3:37-55. 5. Moriyama TS, Polanczyk G, Caye A, Banaschewski T, Brandeis D, Rohde LA. Evidence-Based Information on the Clinical Use of Neurofeedback for ADHD. Neurotherapeutics. 2012;9:588-98. 6. Hammond DC. Neurofeedback with anxiety and affective disorders. Child Adolesc Psychiatr Clin N Am. 2005;14: 105-23. 7. Cortoos A, Valck E, Arns M, Breteler MHM, Cluydts R. An Exploratory Study on the Effects of Tele-neurofeedback and Tele-biofeedback on Objective and Subjective Sleep in Patients with Primary Insomnia. Applied Psychophysiology and Biofeedback. 2009;35:125-34. 8. Laibow RE, Stubblebine AN, Sandgrounda H, Bounias M. EEG-NeuroBioFeedback treatment of patients with brain injury: Part 2: Changes in EEG parameters. Journal of Neurotherapy. 2001;5(4):45-71. 9. Vernon DJ. Can Neurofeedback Training Enhance Perfor-

JH Lim, WY Seong 283 mance? An Evaluation of the Evidence with Implications for Future Research. Applied Psychophysiology and Biofeedback. 2005;30:347-64. 10. Lee, BK. Considerations about Meditation and Biofeedback from Viewpoint of Eastern and Western Viewpoints. Psychological Science. 2001;10(1):19-31. 11. Lee HJ, Park YB, Park YJ, Oh HS. A Review of Neurofeedback Studies. The Journal of the Korean Institute of Oriental Medical Diagnostics. 2007;11(2):13-26. 12. Kim JH, Oh YL, Lee JH, Kim TH, Lyu YS, Kang HW. A Case Report of Typical Oriental Medical Therapy in Combination with Neurofeedback on ADHD Child. Journal of Oriental Neuropsychiatry. 2006;17(3):157-64. 13. Kang JW, Park JG, Cheon YW, Han G, Park HC, Kim LH, Yoo G, Jeong EH. A Case Report of ADHD Child treated with Neurofeedback. Journal of Oriental Neuropsychiatry. 2005;16(2):243-49. 14. Chun YH, Kim BK. A Case of Inattentive Tourette Syndrome Patient with Side Neurofeedback Treatment. Journal of Oriental Neuropsychiatry. 2008;19(3):277-88. 15. Kim HI, Yoo JH, Kim GW, Koo BS. A Case of Autogenic training and Acupuncture treatment on facial tremor by neurofeedback. Journal of Oriental Neuropsychiatry. 2005;16(2):181-8. 16. Lim JH, Choi KW, Jung IC, Lee SR. The Case Study of a Patient with Simbiyangheo type Ul-zeong who has treared by Bibliotherapy and Neurofeedback. Journal of Oriental Neuropsychiatry. 2006;17(2):187-98. 17. Lee GE, We YM, Seong JW, Kim DY, Kang HW. A Clinical Report about a Patient Suffering from Social Phobia and Treated by Herbal Medicine with Neurofeedback. Journal of Oriental Neuropsychiatry. 2014;25(2):153-64. 18. Cung SY, Seo JW, Kim JW, Whaung WW. The Effects of Breath Meditation with Neurofeedback on Memory and Concentration of Healthy Adult Volunteers. Journal of Oriental Neuropsychiatry. 2008;19(2):15-39. 19. Kang SW, Lee KM, Park HB, Kim SH, Yoon DH, Kim MJ, Lee YJ. Neurofeedback Treatment of Panic Disorder.. J Korean Acad Fam Med. 2006 Sep;27(9):713-22. 20. Kum MH, Kang YM, Kim Kim HK, Jung HS, Han MY, Jung HS, Han MY. Study on Brain Function Enhancement and the Effects of Stress Reduction through Neuro-Feedback Training on Nursing Students of Busan. The Korean Journal of Health Service Management. 2012;6(2):111-9. 21. Rhee SY, Yim JE, Lee HO, Choue RW, Kim YS. Effects of Food Intake Behavior by Neurofeedback Training in Subjects with Obesity. Korean J Obes. 2007;16(3):116-24. 22. Park, JS, Shin, HS. The Effects of Brainwave Self- Regulation Training on Shooting Performance. Journal of Coaching Development. 2005;7(2):205-11. 23. Sin KS, Lee YJ, Lee YH, Sung HM, Suh HS. Neurofeedback Treatment for Improvement of Attention in Inattentive Children. okorean J Psychosomatic Medicine 2009; 17(1):23-9. 24. Bak KJ. A Study on the Effect of Neurofeedback Traing on the hearing impairments Student about Resistance Stress. Journal of academia-industrial technology. 2010; 11(9):3318-24. 25. Ahn SK, Bak KJ. The Effect of Brainwave Traing on Students' Acadamic Achievement and Ability of Resisting Stress -for the Primary Student-. Journal of academia-industrial technology. 2009;10(10):2952-8. 26. Chi YK, Choi SW. Ahn CY. The Effect of Manipulating the Frontal EEG Asymmetry by Neuro-feedback on the Motivational Response. The Korean Journal of Clinical Psychology. 2009;28(1):187-203. 27. Song YS, The Effect of Neurofeedback Training on Developing Creativity in Nursing Students. J Korean Acad Soc Nurs Edu. 2007;13(2):184-91. 28. Song YS. The Effect of Neurofeedback Training on Fatigue, Stress, and Immune Reaction in Nursing Students. Nursing Science. 2006;18(2):22-30. 29. Weon HW, Yi, SG, Kang HG. Effects of a Neurofeedback Program on Brain Function and Stress in High School Students J Korean Acad Child Health Nurs. 2008;14(3): 315-24. 30. Weon HW, Lim JY, Son HK, Kim MA. The Effects of the Neurofeedback training on the General health status, Mental health and problem behavior, and Brain function quotient among High school students. Journal of the Korea Academia-Industrial cooperation Society. 2013; 14(12):6309-16. 31. Lee YS, Kim SY, Kim CK, Jung DI, Kim KY. The effect of Neurofeedback training on brain wave activity and cognitive performance in chronic stroke patients. Journal of the Korea Academia-Industrial cooperation Society. 2013;14(5):2329-37. 32. Oh EH, Son CN. Kim HT. The Effects of Neurofeedback Training on Affective,Behavioral,Physical Symptom of Premenstrual Dysphoric Disorder. The Korean Journal of Clinical Psychology. 2009;14(2):775-93. 33. Youn MK, Hyun KS, Park PW, Lee KS, Jeong DL, Lee JE. The Effects of Neurofeedback Training on Brain Function Quotient of Elderly with Long-term Care Insurance Service. Journal of East-West Nursing Research 2012; 18(2):111-9. 34. Ahn SK. Research on the Effect of Neurofeedback Training on Self Directed Learning Ability of Middle Student. Journal of the Korea Academia-Industrial cooperation Society. 2011;12(8):3486-91. 35. Bak KJ. The Effect of Neurofeedback Traing on the hearing impairments Student about Emotional. Journal of the Korea Academia-Industrial Cooperation Society. 2011; 12(9):3897-903. 36. Ahn SK. The Effect of Neurofeedback Training on Attention and School Achievement Motivation of primary. Journal of the Korea Academia-Industrial Cooperation Society. 2011;12(12):5525-30.

284 The Review for Studies of Neurofeedback Training 37. Park JH, Son CN, Park SK. The Effects of Neurofeedback Training on Pain Reduction, Quality of Sleep, and Quality of Life in Patients with Temporomandibular Disorders. Korean journal of health psychology. 2011;16(1):135-50. 38. Pak KJ, Yi SG, Jeong SH. A Study on the Effect of Neurofeedback Training on the Improvement of Brain Function & Baduk Strength for Child Baduk Players. Journal of the Korea Academia-Industrial Cooperation Society. 2008; 9(5):1339-406. 39. Pak KJ, Yi SG, Park BW. A Reserch on the Effect Neurofeedback Traing before & After About Emotional and Attention Deficit Characteristics by Timeseries Linear Analysis : for Primary Student. Journal of information technology applications & management. 2007;14(4):43-59. 40. Pak KJ, Yi SG, Ahn SK. A Study on the effects of prefrontal lobe neurofeedback training on the corelation of children by timeseries linear analysis. Journal of the Korea Academia-Industrial Cooperation Society. 2009;10(7): 1673-9. 41. Bak KJ. A Study on the effects of neurofeedback training on the resistance stress of kids. Journal of the Korea Academia-Industrial Cooperation Society. 2010;11(3): 1066-70. 42. Bak KJ. A study on the effect prefrontal lobe neurofeedback traing on kids about master ability. Journal of the Korea Academia-Industrial Cooperation Society. 2011; 12(6):2548-53. 43. Ahn SK. A study on the effect prefrontal lobe neurofeedback traing on the primary student about selfregulation ability. Journal of the Korea Academia-Industrial Cooperation Society. 2010;11(11):4161-6. 44. Jang SO, Yi SG. A Study on the Effect of Prefrontal EEG-Neurofeedback on Development of Infants Brain Function and Intelligence. Journal of the Korea Academia- Industrial Cooperation Society. 2009;10(6):1317-28. 45. Byun YE, Park BW. The Effect of Neurofeedback Training on Sex differences groups in Adolescence. Journal of the Korea Academia-Industrial Cooperation Society. 2011; 12(3):1171-7. 46. Byun YE. The Effect of Neurofeedback Training on Age differences groups in Adolescence. Journal of the Korea Academia-Industrial Cooperation Society. 2011;12(6): 2560-6. 47. Yang HR, Lee JS. Effects of Self-Regulated Neurofeedback Training on Recall and Recognition. Korean Journal of the science of Emotion & sensibility. 2010;13(4):647-58. 48. Kim, Jung-Soo, Lee, Min-Ki, Lee, Mi-Young. Effects of Neurofeedback and combined muscle training on the Neurotrophins and competition ability in golfers. Exercise Science. 2013;22(3):193-201. 49. Lee JE. Effects of Neurofeedback, Cranio-Sacral Therapy and Mixed Therapy on Fatigue, Stress and The Brain Quotient in Korean Middle Aged Women. J. Kor. Soc. Cosm. 2010;16(4):1028-40. 50. Lee JE, Chae MS, Hyun KS, Park PW. Effects of Neurofeedback and Cranio-Sacral Therapy on Fatigue and the Stress Resistance in Korean middle Aged Women. J Korean Acad Psychiar Ment Health Nurs. 2008;17(2):129-39. 51. Roh OB, Son CN, Park TW, Park SK. The Effects of Neurofeedback Training on Inattention and Hyperactivity/ Impulsivity in Children with ADHD. The Korean Journal of Clinical Psychology. 2011;30.(2): 397-418. 52. Jung MW, Shim SH. Effects of Neurofeedback Training and Computer-Assisted Cognitive Rehabilitation on Cognition and Upper Extremity Function in PostStroke. Therapeutic Science for Neurorehabilitation. 2012;1(1): 57-70. 53. Cho SJ, Yoo SM, Shim JY. The Effects of Brain Education and Neuro-feedback Training on Thinking Ability and Multiple Intelligence in Young Children. The Journal of Eco-Early Childhood Education, 2012;11(1):67-94. 54. Cho SJ, Shim JY. A Study on the Relations between Brain Function, Thinking Power and Multiple Intelligence by Brain Development Training in Children. Jounal of Brain Education. 2011;7:1-32. 55. Fuchs T, Birbaumer N, Lutzenberger W, Gruzelier JH, KaiserJ. Neurofeedback treatment for Attention-Deficit/ HyperactivityDisorder in children a comparison with methylphenidate. Appl Psychophysiol Biofeedback 2003;28(1):1-12. 56. Krause, C. M., Sillanmaki, L., Koivisto, M., Saarela, C., Haggqvist, A., Laine, M., Hamalainen, H. The effects of memory load on event-related EEG desynchronization and synchronization. Clinical Neurophysiology. 2000; 111:2071-8. 57. Kim DG, Park HB, Ahn YW. Neurofeedback:Principles and Clinical Application. The Korean journal of stress research. 2005;13(2):93-8. 58. Howe RC, Sterman MB. Somatosensory system evoked potentials during waking behavior and sleep in the cat. Electroencephalogr Clin Neurophysiol. 1973;34(6):605-18. 59. Schabus M1, Hoedlmoser K, Pecherstorfer T, Anderer P, Gruber G, Parapatics S, Sauter C, Kloesch G, Klimesch W, Saletu B, Zeitlhofer J. Brain Res. Interindividual sleep spindle differences and their relation to learning-related enhancements. 2008;29(1191):127-35. 60. John ND. Getting started with neurofeedback. New York:Norton & Company. 2004:182-200. 61. Bruder GE, Fung R. Tenke CE, Leite P, Towey JP, Stewart JE. Regional brain asymmetries in major depression with or without an anxiety disorder : A quantitative electroencephalographic study. Biol Psychiatry. 1997;41:939-48. 62. Davidson RJ. Affective Style and Affective Disorders: Perspectives from Affective Neuroscience. Cognition and Emotion. 1998;12(3):307-30. 63. Park, PW. Interpretation method of EEG. Seoul: Korea Research Institute of Jungshin Science. 2005.

JH Lim, WY Seong 285 64. Egner, T, Gruzelier, J. H,EEG biofeedback of low beta band components: frequency-specific effects on variables of attention and event-related brain potentials. Clin Neurophysiol.2004;115(1):131-9. 65. Kang HW, Kim TH, Lyu YS. An introduction on Biofeedback & Application in Oriental Medicine. Journal of Oriental Neuropsychiatry. 2005;16(1):143-57.