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Pros

  • Easy to use and attractive product
  • Clear feedback to user based on an unbiased biomarker (EEG rhythms)

Cons

  • More expensive than most other products
  • Not clear that achieving better EEG rhythms can counteract clinical depression or anxiety

Description

Muse is a wearable device in the form of a headband that senses the electrical rhythms of the brain (EEG). The headband is coupled with a smartphone app (Calm) that monitors the user’s brain electrical activity and gives immediate feedback so that a “calm” or meditative pattern can be achieved. Use of this device over time is thought to help reduce distractibility, improve stress control and improve mood.

Ease of Use

The headband is light and comfortable but requires a bit of experience to fit properly and to transmit reliable signal by BlueTooth to the associated smartphone app. The device will not work with older versions of many smartphones (such as the iPhone 4). The instructions for use are very simple and easy to follow and the program is up and running within minutes. Once one gets started, it is very easy to adjust settings and to personalize the program.

User Interface

The user is asked to sit quietly with eyes closed and to focus on counting expirations. The app displays one of two pleasant visual backgrounds that are also associated with sounds of wind or water. The volume and frequency of these weather sounds decreases as the EEG rhythm comes closer to the “calm” state. Therefore, one gets immediate and easy to understand feedback as to how one is doing. The sessions can be set to last from 3 minutes to 45 minutes.

Appropriateness of Feedback

Immediately after finishing a session the app provides a graphical depiction of one’s EEG rhythm, grouped into “calm”, “neutral”, or “active” bands. The app calculates the amount of time spent “calm” and awards points for “calm” time. The points are associated with certain awards and expressions of positive feedback. In addition, the app graphically displays the percentage of time spent “calm” over a variety of sessions, and prescribes several challenges to increase performance of time. All of this is very attractive and easy to understand and to manipulate.

Ease of Account Management

The company’s website provides a great deal of information regarding frequently asked questions and troubleshooting. When I submitted a question to the company over the website I received an answer within hours. The app allows one to give permission for session data to be aggregated by the company for research purposes. I think it is useful to share personal data, because they may ultimately help us determine how effective the device might be.

Scientific Basis

The Muse headband is a remarkable technological advance over earlier versions of EEG neurofeedback technologies. Neurofeedback is a technique that has been employed for mental health conditions for more than a decade and formerly required a link between traditional EEG recording devices with desktop or laptop computers. Through the process of operant conditioning, these techniques seek to alter brain functioning by giving live feedback about EEG rhythms to the patient. Patients are rewarded if they are able to achieve certain EEG rhythm characteristics, such as a decrease in theta activity (4-7 cycles per second), or an increase in alpha activity (12-15 cycles per second). A higher proportion of alpha wave activity is thought to be associated with focused attention, and a feeling of calm or well-being.

  • ADHD
    Neurofeedback has been studied most extensively in Attention Deficit Hyperactivity Disorder, for which at least 5 randomized controlled trials with mixed results have been published
    Bink M, van Nieuwenhuizen C et al: Neurocognitive effects of neurofeedback in adolescents with ADHD: A randomized controlled trial. J Clin Psychiatry 75:535-542, 2014
  • major depression
    Peeters F, Oehlen M et al: Neurofeedback as a treatment for major depressive disorder – a pilot study. PLoS One. 2014 Mar 18;9(3):e91837. doi: 10.1371/journal.pone.0091837. eCollection 2014
  • performance anxiety
    Gruzelier JH, Thompson T et al: Application of alpha/theta neurofeedback and heart rate variability training to young contemporary dancers: state anxiety and creativity. Int J Psychophysiol 93:105-111, 2014
  • obsessive-compulsive disorder
    Koprivova J, Congedo M et al: Prediction of treatment response and the effect of independent component neurofeedback in obsessive-compulsive disorder: a randomized, sham-controlled, double-blind study. Neuropsychology 67:210-223, 2013
  • reading disabilities
    Nazari MA, Mosanezhad E et al: The effectiveness ofneurofeedback training on EEG coherence and neuropsychological functions in children with reading disability. Clin EEG Neurosci, 43:315-322, 2012
  • autism spectrum disorders
    Kouijzer ME, van Schie HT et al: Is EEG-biofeedback an effective treatment in autism spectrum disorders? A randomized controlled trial. Appl Psychophsiolo Biofeedback 38:17-28, 2013
  • traumatic brain injury
    Nelson DV, Esty ML: Neurotherapy of traumatic brain injury/posttraumatic stress symptoms in OEF/OIF veterans. J Neuropsychiatry Clin Neurosci 24:237-240, 2012
  • insomnia
    Hammer BU, Colbert AP et al: Neurofeedback for insomnia: a pilot study of Z-score SMR and individualized protocols. Appl Psychophysiol Biofeedback 36:251-264, 2011.
  • A number of other studies have proposed benefits in cognitive performance for normal subjects or in meditators.
    • Gruzelier JH: EEG-neurofeedback for optimizing performance. I: A review of cognitive and affective outcome in health participants. Neuroscience and Biobehavioral Reviews 44:124-141, 2014
    • Ros T, Munneke MAM, Ruge D, Gruzelier JH, and Rothwell JC: Endogenous control of waking brain rhythms induces neuroplasticity in humans. European Journal of Neuroscience, 31:770-778, 2010
    • Vidyarthi J and Riecke BE: Interactively mediating experiences of mindfulness meditation. International Journal of Human-Computer Studies 72:674-688, 2014

Traditional neurofeedback techniques have never been fully tested in psychiatric conditions for several reasons. First, these techniques are not protected by exclusive intellectual property so industrial funding for large-scale trials has not been available. Similarly, devices designed to deliver neurofeedback have not been seen as unique medical devices by the FDA, which could be protected by patents. Furthermore, there is some disagreement as to which pattern of EEG rhythms would be most therapeutic for particular groups of patients. I was not able to locate references to clinical trials using the Muse technology specifically.
Although not formally approved for clinical use by the FDA, many clinics currently offer neurofeedback treatments. However, widespread clinical adoption of neurofeedback has not occurred due to concerns about cost relative to the uncertainties about efficacy. Most protocols recommended that individuals come to a supervised clinical setting for multiple sessions per week over several months. This is a time consuming and expensive endeavor which, due to lack of published scientific data on efficacy, is not reimbursed by insurance companies. With the Muse technology, EEG neurofeedback has entered the world of self-directed activity using a wearable device coupled with a smart phone app. Therefore, the cost is much reduced and it becomes feasible to decide individually whether the techniques is a worthwhile investment of time.

Qualitative Review of Efficacy

I have been interested in mediation techniques throughout my career, but have never been very good at sticking with them, and have hesitated to recommend these techniques to patients for a variety of reasons. However, the Muse platform is so simple and attractive that I look forward to using it, especially since there is now an easy way to monitor whether I have achieved the desired result. So far, I have only logged about 100 minutes, but I know of others who have crossed the 1000-minute mark and have heard no disparaging remarks. There are many customer reviews posted on Google Play (4.4/5), Amazon (4.0/5) and iTunes (4.5/5), which are largely favorable. While it remains to be seen whether this technique can provide lasting benefit to people with more severe forms of anxiety or depression, the financial cost and risk of side effects are low and I think for some patients this could be very helpful.

Estimate of Efficacy Relative to Similar Products

Brainbot is most directly comparable, but is still in beta testing. We hope to have information available on Brainbot soon. We have not yet made direct comparisons of Muse to other Mindfulness products listed on our site (Be Mindful, buddhify, Calm, Headspace and Mayo Clinic Meditation), but hope to review these in depth as well. However, the other Mindfulness products are either on-line courses or various forms of guided meditation. Muse is unique in that it uses the EEG signal as a biomarker to measure progress. Thus its efficacy for individual patients may be easier to demonstrate.

Cost
The Muse headband cost $299 and the app is free. This appears to be a very reasonable cost given the complexity of the technology and the amount of information that is obtained with its use.

Reviewed April 2015