{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,3]],"date-time":"2026-03-03T02:11:09Z","timestamp":1772503869549,"version":"3.50.1"},"reference-count":64,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2023,8,28]],"date-time":"2023-08-28T00:00:00Z","timestamp":1693180800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Open Access Publishing Fund of the Free University of Bozen-Bolzano"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Behavioral Sciences"],"abstract":"<jats:p>Depression is one of the most common mental disorders worldwide. Dysthymia, a long-lasting form of depressive disorder that is also known as persistent depressive disorder (PDD) with pure dysthymic syndrome according to the Diagnostical and Statical Manual of Mental Disorders (DSM-5), is characterised by being difficult to treat. The most prominent therapeutic approaches in treating dysthymia are pharmacotherapy and psychotherapy, but recent studies also demonstrate the success of neurofeedback in treating individuals with depressive disorders. However, infra-low-frequency (ILF) neurofeedback, the main new neurofeedback protocol, lacks empirical evidence, and there is no evidence that it can treat dysthymia. This case report investigates the ILF neurofeedback method in a male patient with dysthymia. After 45 sessions of ILF neurofeedback combined with ILF synchrony, a decrease in symptom severity was found on assessment after treatment, and these results remained consistent at a low level at a 6-month follow-up. Additionally, the patient reported benefits on interpersonal and cognitive levels and in daily life situations. This study should incentivise further investigations into using ILF neurofeedback to treat dysthymia and all variations of depressive disorders.<\/jats:p>","DOI":"10.3390\/bs13090711","type":"journal-article","created":{"date-parts":[[2023,8,28]],"date-time":"2023-08-28T06:10:22Z","timestamp":1693203022000},"page":"711","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Infra-Low-Frequency Neurofeedback Treatment in Dysthymia: A Case Study"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5406-4144","authenticated-orcid":false,"given":"Reinhard","family":"Tschiesner","sequence":"first","affiliation":[{"name":"Faculty of Education, Free University of Bozen\/Bolzano, 39042 Brixen, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2023,8,28]]},"reference":[{"key":"ref_1","unstructured":"World Health Organisation (2023, June 23). Depressive Disorders (Depression). Available online: https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/depression."},{"key":"ref_2","unstructured":"Eurostat (2023, June 23). 7.2% of People in EU Suffer from Chronic Depression. Available online: https:\/\/ec.europa.eu\/eurostat\/web\/products-eurostat-news\/-\/edn-20210910-1."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"69","DOI":"10.3389\/fnhum.2015.00069","article-title":"Consciousness, not only intentionality, yields self-harming behavior","volume":"9","author":"Tschiesner","year":"2015","journal-title":"Front. Hum. Neurosci."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1007\/s40211-012-0024-8","article-title":"Zur Epidemiologie suizidalen Verhaltens: Eine empirische Untersuchung im Gesundheitsbezirk Brixen","volume":"9","author":"Tschiesner","year":"2012","journal-title":"Neuropsychiatrie"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"801","DOI":"10.1016\/S2215-0366(20)30099-7","article-title":"Review of dysthymia and persistent depressive disorder: History, correlates, and clinical implications","volume":"7","author":"Schramm","year":"2020","journal-title":"Lancet Psychiatry"},{"key":"ref_6","unstructured":"Bundes\u00e4rztekammer, Kassen\u00e4rztliche Bundesvereinigung, and Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (2023, June 23). NVL Unipolare Depression (2022). Available online: https:\/\/www.leitlinien.de\/themen\/depression\/version-3."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"487","DOI":"10.1001\/archpsyc.1995.03950180073010","article-title":"Family study of early-onset dysthymia: Mood and personality disorders in relatives of outpatients with dysthymia and episodic major depression and normal controls","volume":"52","author":"Klein","year":"1995","journal-title":"Arch. Gen. Psychiatry"},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"APA (2013). Diagnostic and Statistical Manual of Mental Disorders, American Psychiatric Publishing. [5th ed.].","DOI":"10.1176\/appi.books.9780890425596"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1016\/0165-0327(95)00076-3","article-title":"Social adjustment in dysthymia, double depression, and episodic major depression","volume":"37","author":"Leader","year":"1996","journal-title":"J. Affect. Disord."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"872","DOI":"10.1176\/ajp.2006.163.5.872","article-title":"Ten-year prospective follow-up study of the naturalistic course of dysthymic disorder and double depression","volume":"163","author":"Klein","year":"2006","journal-title":"Am. J. Psychiatry"},{"key":"ref_11","unstructured":"World Health Organisation (2023, June 23). ICD-11 for Mortality and Morbidity Statistics (Version 01\/2023). Available online: https:\/\/icd.who.int\/browse11\/l-m\/en#\/http%3a%2f%2fid.who.int%2ficd%2fentity%2f334423054."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1002\/wps.20825","article-title":"An organisazion- and category level comparison of diagnostic requirements for mental disorders in ICD-11 and DSM-5","volume":"20","author":"First","year":"2021","journal-title":"World Psychiatry"},{"key":"ref_13","unstructured":"NICE (2023, June 23). Depression in Adults: Treatment and Management 2022. Available online: www.niche.org.uk\/guidance\/ng222."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"8878857","DOI":"10.1155\/2021\/8878857","article-title":"The Current Evidence Levels for Biofeedback and Neurofeedback Interventions in Treating Depression: A Narrative Review","volume":"2021","author":"Melnikov","year":"2021","journal-title":"Neural Plast."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1016\/j.psc.2013.01.005","article-title":"Neurofeedback: An emerging technology for treating central nervous system dysregulation","volume":"36","author":"Larsen","year":"2013","journal-title":"Psychiatr. Clin. N. Am."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"273","DOI":"10.1023\/A:1021061318355","article-title":"Template for developing guidelines for the evaluation of the clinical efficacy of psychophysiological interventions","volume":"27","author":"Hammond","year":"2002","journal-title":"Appl. Psychophysiol. Biofeedback"},{"key":"ref_17","unstructured":"Tan, G., Shaffer, R., Lysle, R., and Teo, I. (2016). Evidence-Based Practice in Biofeedback and Neurofeedback, Association for Applied Psychophysiology and Biofeedback."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"30","DOI":"10.15540\/nr.5.1.30","article-title":"Infra-Low frequency neurofeedback in depression: Three case studies","volume":"5","author":"Othmer","year":"2018","journal-title":"NeuroRegulation"},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Haus, K.M., Held, C., Kowalski, A., Krombholz, A., Nowak, M., Schneider, E., Strau\u00df, G., and Wiedemann, M. (2016). Praxisbuch Biofeedback und Neurofeedback\u20142. Auflage, Springer.","DOI":"10.1007\/978-3-662-47748-9"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"387","DOI":"10.1080\/026999398379655","article-title":"Frontal brain asymmetry and depression: A self-regulatory perspective","volume":"12","author":"Tomarken","year":"1998","journal-title":"Cogn. Emot."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"939","DOI":"10.1016\/S0006-3223(96)00260-0","article-title":"Regional Brain asymmetries in major depression with or without an anxiety disorder: A quantitative Electroencephalographic study","volume":"41","author":"Bruder","year":"1997","journal-title":"Biol. Psychiatry"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"438","DOI":"10.1111\/j.1469-8986.1990.tb02340.x","article-title":"Topographic quantitative EEG in elderly subjects with major depression","volume":"27","author":"Pollock","year":"1990","journal-title":"Psychophysiology"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"478","DOI":"10.1016\/S0006-3223(02)01458-0","article-title":"Neural and behavioral substrates of mood and mood regulation","volume":"52","author":"Davidson","year":"2002","journal-title":"Biol. Psychiatry"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1016\/S0165-0327(01)00425-6","article-title":"EEG mapping in seasonal affective disorder","volume":"72","author":"Volf","year":"2002","journal-title":"J. Affect. Disord."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"285","DOI":"10.1007\/BF01135566","article-title":"Quantitative EEG in elderly depressives","volume":"4","author":"Shagass","year":"1992","journal-title":"Brain Topogr."},{"key":"ref_26","unstructured":"Tart, C.T. (1969). Altered States of Consciousness, John Wiley and Son."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1016\/0013-4694(72)90028-4","article-title":"Supression of seizures in an epileptic following sensorimotor EEG feedback training","volume":"33","author":"Sterman","year":"1972","journal-title":"Electroencephalogr. Clin. Neurophysiol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1152\/physrev.1990.70.1.1","article-title":"Slow potentials of the cerebral cortex and behavior","volume":"70","author":"Birbaumer","year":"1990","journal-title":"Physiol. Rev."},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Zuckerman, M. (2007). Sensation Seeking and Risky Behavior, Maple Vail Press.","DOI":"10.1037\/11555-000"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1007\/s40211-012-0002-1","article-title":"Sensation Seeking, Traumaerleben und Bew\u00e4ltigungsstrategien: Eine empirische Untersuchung an Einsatzkr\u00e4ften","volume":"26","author":"Tschiesner","year":"2012","journal-title":"Neuropsychiatrie"},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Tschiesner, R., Moretti, M.E., and Happacher, J. (2022, January 4\u20136). Sensation Seeking and coping in young adults. Proceedings of the 14th International Conference on Education and New Learning Technologies, Palma, Spain.","DOI":"10.21125\/edulearn.2022.1556"},{"key":"ref_32","unstructured":"Barradas, I., Tschiesner, R., and Peer, A. (2022). HCI International 2022\u2014Late Breaking Papers. Multimodality in Advanced Interaction Environments. HCII 2022. Lecture Notes in Computer Science, Springer."},{"key":"ref_33","unstructured":"Othmer, S.F. (2017). The Neurofeedback Clinicians\u2019 Protocol Guide, EEGInfo."},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Haus, K.M., Held, C., Kowalski, A., Krombholz, A., Nowak, M., Schneider, E., Strau\u00df, G., and Wiedemann, M. (2016). Praxisbuch Biofeedback und Neurofeedback\u20142. Auflage, Springer.","DOI":"10.1007\/978-3-662-47748-9"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"192","DOI":"10.3389\/fnhum.2020.00192","article-title":"Modulation of Intrinsic Brain Connectivity by Implicit Electroencephalographic Neurofeedback","volume":"14","author":"Dobrushina","year":"2020","journal-title":"Front. Hum. Neurosci."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"211","DOI":"10.1017\/S0033291709006114","article-title":"The effects of psychotherapy for adult depression are overestimated: A meta-analysis of study quality and effect size","volume":"40","author":"Cuijpers","year":"2010","journal-title":"Psychol. Med."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"46","DOI":"10.1159\/000484412","article-title":"Does childhood maltreatment moderate the effect of the cognitive behavioral analysis system of psychotherapy versus supportive psychotherapy in persistent depressive disorder?","volume":"47","author":"Klein","year":"2018","journal-title":"Psychother. Psychosom."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"380","DOI":"10.1177\/0706743719828965","article-title":"Current and common definitions of treatment-resistent depression: Findings from a systematic review","volume":"64","author":"Brown","year":"2019","journal-title":"Can. J. Psychiatry"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"621","DOI":"10.1002\/da.22236","article-title":"Efficacy and acceptability of acute treatments of persistent depressive disorder: A network meta-analysis","volume":"31","author":"Kriston","year":"2014","journal-title":"Depress. Anxiety"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"658","DOI":"10.1097\/00005053-198811000-00003","article-title":"A longitudinal study of an untreated sample of predominantly late onset characterological dysthymia","volume":"176","author":"McCullough","year":"1988","journal-title":"J. Nerv. Ment. Dis."},{"key":"ref_41","unstructured":"Hautzinger, M., Keller, F., and K\u00fchner, C. (2006). BDI-II. Beck Depressions Inventar Revision\u2014Manual, Hogrefe."},{"key":"ref_42","doi-asserted-by":"crossref","unstructured":"Beck, A.T., Steer, R.A., and Brown, G.K. (1996). Manual for the Beck Depressions Inventory-II, Psychological Coorporation.","DOI":"10.1037\/t00742-000"},{"key":"ref_43","unstructured":"Franke, G.H. (2017). Brief-Symptom-Checklist, Hogrefe."},{"key":"ref_44","unstructured":"Franke, G.H. (2014). Symptom-Checklist 90\u2014Standard, Hogrefe."},{"key":"ref_45","unstructured":"Beesdo-Baum, K., Zaudig, M., and Wittchen, H.U. (2019). SCID-5-CV. Strukturiertes Klinisches Interview f\u00fcr DSM-5-St\u00f6rungen\u2014Klinische Version, Hogrefe."},{"key":"ref_46","unstructured":"Beesdo-Baum, K., Zaudig, M., and Wittchen, H.U. (2019). SCID-5-PD. Strukturiertes Klinisches Interview f\u00fcr DSM-5-St\u00f6rungen\u2014Pers\u00f6nlichkeitsst\u00f6rungen, Hogrefe."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"e01894","DOI":"10.1002\/brb3.1894","article-title":"Psychometric properties of structural clinical interview for DSM-5 Disorders-Clinician Version (SCID-5-CV)","volume":"11","author":"Shabani","year":"2021","journal-title":"Brain Behav."},{"key":"ref_48","unstructured":"EEG Info (2023, June 25). Qik-Test und EEG-Expert. Available online: https:\/\/media.voog.com\/0000\/0044\/8343\/files\/QIK_EEGEXPERT_Anleitung_DE_2.3_20111007.pdf."},{"key":"ref_49","unstructured":"EEG Info (2023, June 25). Symptom Tracking. Available online: https:\/\/eeg.expert\/symptom-tracking."},{"key":"ref_50","doi-asserted-by":"crossref","unstructured":"Haus, K.M., Held, C., Kowalski, A., Krombholz, A., Nowak, M., Schneider, E., Strau\u00df, G., and Wiedemann, M. (2016). Praxisbuch Biofeedback und Neurofeedback\u20142. Auflage, Springer.","DOI":"10.1007\/978-3-662-47748-9"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"81","DOI":"10.5298\/1081-5937-44.2.07","article-title":"Infra-low frequency neurofeedback for optimum performance","volume":"44","author":"Othmer","year":"2016","journal-title":"Biofeedback"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"299","DOI":"10.1007\/BF00237318","article-title":"The electrophysiological correlates of perceptual masking in monkeys","volume":"7","author":"Fehmi","year":"1969","journal-title":"Exp. Brain Res."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1300\/J184v05n01_05","article-title":"Attention and Neurofeedback Synchrony Training: Clinical Results and Their Significance","volume":"5","author":"McKnight","year":"2001","journal-title":"J. Neurother."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"4710","DOI":"10.1038\/s41598-021-83838-1","article-title":"Investigating the effect of a nap following experimental trauma on analogue PTSD symptoms","volume":"11","author":"Wilhelm","year":"2022","journal-title":"Sci. Rep."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"788","DOI":"10.1037\/0096-1523.33.4.788","article-title":"Cross-trail priming of element positions in visual pop-out search is dependent on stimulus arrangement","volume":"33","author":"Geyer","year":"2007","journal-title":"J. Exp. Psychol. Hum. Percept. Perform."},{"key":"ref_56","doi-asserted-by":"crossref","unstructured":"Schmidt-Atzert, L., Krumm, S., and Amelang, M. (2021). Psychologische Diagnostik\u20146. Auflage, Springer.","DOI":"10.1007\/978-3-662-61643-7"},{"key":"ref_57","unstructured":"Beutel, M.E., D\u00f6ring, S., Leichsenring, F., and Reich, G. (2010). St\u00f6rungsorientierte Manualisierung in der Therapeutischen Praxis, Hogrefe."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"263","DOI":"10.1159\/000360795","article-title":"The effectiveness of the cognitive behavioral analysis system of psychotherapy for chronic depression: A randomized controlled trail","volume":"83","author":"Wiersma","year":"2014","journal-title":"Psychohter. Psychosom."},{"key":"ref_59","unstructured":"Strehl, U. (2020). Neurofeedback: Theoretische Grundlagen Praktisches Vorgehen Wissenschaftliche Evidenz, Kohlhammer."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"203","DOI":"10.1007\/BF01000403","article-title":"Self-Regulation of Slow Cortical Potential in Psychiatric Patients: Depression","volume":"17","author":"Schneider","year":"1992","journal-title":"Biofeedback Self-Regul."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1017\/S0033291721004396","article-title":"Efficacy of bio- and neurofeedback for depression: A meta-analysis","volume":"52","author":"Grassi","year":"2022","journal-title":"Psychol. Med."},{"key":"ref_62","first-page":"133","article-title":"Neurofeedback training opiate addiction: Improvement of mental health and craving","volume":"32","author":"Rostami","year":"2013","journal-title":"Appl. Psychophysiol. Biofeedback"},{"key":"ref_63","unstructured":"Blume, R. (2012). Neurofeedbacktraining bei Kindern mit einer Aufmerksamkeitsdefizit-\/Hyperaktivit\u00e4tsst\u00f6rung (ADHS): Eine Untersuchung der Trainingsverl\u00e4ufe mit dem Versuch der Klassifikation von Lernen und Nicht-Lernen, Eberhard-Karls-Universit\u00e4t T\u00fcbingen."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"345","DOI":"10.1055\/s-2008-1067444","article-title":"Die n\u00e4chsten 10 Jahre Psychotherapieforschung. Eine Kritik des herrschenden Forschungsparadigmas mit Korrekturvorschl\u00e4gen","volume":"58","author":"Orlinsky","year":"2008","journal-title":"Psychother. Psychosom. Med. Psychol."}],"container-title":["Behavioral Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-328X\/13\/9\/711\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T20:40:33Z","timestamp":1760128833000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-328X\/13\/9\/711"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,8,28]]},"references-count":64,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2023,9]]}},"alternative-id":["bs13090711"],"URL":"https:\/\/doi.org\/10.3390\/bs13090711","relation":{},"ISSN":["2076-328X"],"issn-type":[{"value":"2076-328X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,8,28]]}}}