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Therapeutic Applications of Neurofeedback/EEG Biofeedback
Posted on Tuesday December 29, 2009- Absence Seizures
The early research in Neurofeedback / EEG Biofeedback was in connection with motor seizures. However, absence seizures did not typically yield to the early methods. That has since changed. With the latest of Neurofeedback techniques, the training should be considered for absence seizures at any age. That is to say, the child is never too young to be trained. No research is available that deals with Neurofeedback for absence seizures specifically, but by now it is apparent that Neurofeedback is effective for a variety of seizure types.
Effectiveness in this context means a reduction in seizure incidence of greater than 30%, averaging better than 50%, with many children becoming entirely seizure-free and even reducing or eliminating their meds. In other words, Neurofeedback is at least as effective as the addition of a new anti-convulsant is expected to be for an already medicated child.
Addiction is a brain-based problem, and it demands a brain-based solution. The will is over-rated when it comes to the addicted brain. Fortunately, a new era opened up at the outset of the "Decade of the Brain" with the publication in 1989 of Eugene Peniston's epoch-making study of Viet Nam Veteran alcoholics (see Alcoholism below). Our own research group participated in a replication of this work, and it included a variety of drugs of choice. The result was that outcome was in no way dependent on the drug of preference, whether we were talking about heroin or crack cocaine or methamphetamine or alcohol.
The inclusion of Neurofeedback in residential treatment tripled the favorable outcome in terms of relapse prevention over the best conventional treatment when looked at one year post-treatment. At three years, the ratio was even better.
It is estimated that for every dollar spent in addictions treatment, the society saves $7. This appears to be the case even with simply abominable outcome statistics in conventional treatment. Multiply this by a factor of three and we see that the society is better off by $21 for every dollar spent in treatment. And the formerly addicted person is clearly better off as well. The implementation of Neurofeedback-augmented treatment programs should be a priority for our society.
Other Resources:
Substance Abuse and Addictions Research
Age-Related Cognitive Decline (ARCD)
Studies have been done that show improvement in cognitive function with the simplest of techniques, even including standard light-sound brain stimulation. These stimulation techniques can readily be managed by the elderly person even on their own. Better results can no doubt be achieved with personalized, targeted, and clinically guided Neurofeedback training. But one need not start there. Improved mental function is available to all the elderly at very modest cost of entry.
Used in combination with a program of physical exercise and guided nutrition, the elderly have the potential of significant enhancement of quality of life in their declining years.
We have seen only a very small number of cases of agenesis of the corpus callosum. The functional deficits here tend to be in the area of complex social relationships rather than functions such as the coordination of movement. Neurofeedback can be helpful here, and a trial of the training is to be recommended. The same should hold for those who had their corpus callosum surgically severed to reduce seizure incidence. In an individual case, it is never clear what symptoms may traceable to the absence of a functioning corpus callosum. The point is simply that the existence of this organic deficit is no reason not to undertake a trial of Neurofeedback / EEG Biofeedback.
The traditional view of aging as a relentless process of functional decline is being displaced by a new optimism about the positive influence we might have over that process. So many problems have been written off simply to "aging" and then the status quo becomes accepted. Neurofeedback is one of a number of interventions that can now make a substantial difference in the quality of life of the elderly. The list of common complaints among the elderly that can be impacted by Neurofeedback includes: anxiety and agitation; depression; sleep onset problems; frequent waking; incontinence; irritability; age-related cognitive decline; dementia; Parkinsonism; motor symptoms such as Dystonia and essential tremor; deterioration of memory function; pain syndromes; mental confusion and even paranoia. Each of these topics is discussed separately below.
Since a number of the above issues are grounded in degenerative processes, once Neurofeedback is undertaken to improve function it may also be necessary to continue the training on some schedule in order to maintain gains. This can be done on a home-training basis under clinical supervision.
The standard anti-depressants are not really designed for agitated depression. Remediating agitated depression is more appropriately left to Neurofeedback / EEG Biofeedback. Techniques have been devised to train the brain toward stability and toward enhanced emotional regulation. The techniques need to be tailored to the person, and it is expected that a person would respond to the training within a modest number of training sessions.
The breakthrough study on the application of Neurofeedback / EEG Biofeedback to alcoholism was performed by Eugene Peniston, psychologist on the staff at Fort Lyons Veterans Administration Hospital in Colorado. The treatment outcome for alcohol addiction treatment for Viet Nam veteran pilots was abysmal at the time. Peniston had personally experienced biofeedback and Neurofeedback at the Menninger Clinic where an early research group in EEG biofeedback was continuing its work. The group was aware of the benefits of EEG biofeedback for alcoholism, but that was not their real interest.
Peniston took the method back with him to Fort Lyons where he undertook a controlled study. The results were striking. Every veteran who did the Neurofeedback (ten out of ten) was no longer abusing alcohol after the training, whereas everyone in the control group, which received the regular in-patient treatment, continued the pattern of addiction after release. The contrast could not have been more dramatic.
These results were then replicated by others, including our own research group (see Addictions, above). The result is that we now have a technique for the remediation of alcohol dependency that has high predictability. The problem with the acceptance of these results is that they are seem too good to be true, given the dreadful outcome record of traditional addictions treatment. That is in fact the key problem with a lot of claims around Neurofeedback. They sound too good to be true, so the information is simply not processed by people steeped in mainstream thinking.
Other Resources:
Subtstance Abuse and Addictions Research
Neurofeedback / EEG Biofeedback is not a treatment for allergies. However, Neurofeedback training can result in reduced reactivity to the triggers of an allergic response, and suffering may be reduced. Some of the improvement seen in ADHD children is no doubt attributable to the fact that they are less susceptible to allergic reactions after the Neurofeedback training. The effect is not so large that people with allergies should seek out Neurofeedback specifically as a remedy. Rather, if someone is training for another purpose, reduction in allergic susceptibility may well be a fringe benefit.
Case Report:
The following report came from a Neurofeedback professional:
"Something unexpected and wonderful has happened since training myself with EEG feedback. My lifelong severe allergies have nearly disappeared!
I am the guy that was jokingly referred to by the staff at the allergist office as "Mister Allergy" when I went for testing some years ago. Out of the forty substances I was tested for, I was severely allergic to all but four. The allergist recommended that I not go outdoors any more, it was so bad.
But thanks to Neurofeedback I have sneezed only four or five times this season. And this while those around me have had the worst allergy problems in years! This was an unexpected effect of training because I thought that allergies were one of the things that Neurofeedback didn't usually help. I can think of nothing else to attribute my improvement to."
A Clinician's Report:
A 40-year-old man was training with me for immune system problems (which resulted in complete hair loss, including eyelashes). He is now growing hair all over, patchy but very full. He is also a diabetic and now has drastically reduced his insulin intake. He had tried a number of things before for his hair loss, to no avail.
In the early stages of the disease process, functional improvement may well be obtained with Neurofeedback / EEG Biofeedback. It has been estimated that if the onset of symptoms can be postponed for even two years, the savings to our nation would amount to some $50B. The data to support specific claims are not yet in hand, but it seems at least plausible that such a two-year objective lies within reach with Neurofeedback, or at least with Neurofeedback in conjunction with optimum nutrition and detoxification strategies. If this clinical approach bears fruit consistently, the annual cost of delivering Neurofeedback to an estimated 400,000 new entrants into the program per year would be no more than $1B/year. If other costs of care were thus abated for at least two years, we would project a benefit/cost ratio of 25:1. The value of misery thus avoided is impossible to quantify.
Our own clinical experience with Alzheimer's dementia is quite limited, but what we have is, on balance, favorable. Training should be started at the very first sign of symptoms that hint at the possibility of an AD diagnosis. Once training is begun with a degenerative condition such as this, it needs to be maintained on some schedule to retain the gains achieved in training. Fall-off in cognitive and memory skills may follow within weeks upon a cessation of the training. It is likely that stimulation techniques can be helpful here as they are in Age-Related Cognitive Decline. However, that has not been shown.
This condition is commonly encountered in connection with head trauma. Remediation of amnesia has been achieved with Neurofeedback. However, this typically occurs early in the post-trauma period where some spontaneous recovery is also expected. So it is not always clear whether the Neurofeedback made the difference. But if a person is suffering from amnesia under such circumstances, Neurofeedback should certainly be tried.
One of the easiest conditions to work with using Neurofeedback / EEG Biofeedback is garden-variety anger control. One trains the brain, and anger simply falls away. This is startling to mental health therapists who have struggled with this for years, and it may even be startling to the person training his brain. Traditionally we have aimed to have the client take responsibility for his anger and to bring it under control.
· If the anger just goes away with training, where is the "I" in this transaction?
· What does the will have to do with it?
· The self seems diminished if the problem is resolved without the "I" being at the table.
· "Wait, I want my anger back!"
· "Sorry, you can't have it..."
In actual fact, nothing has been lost. The capacity for anger remains. What has been gained is a measure of control. Our internal experience of untrammeled anger is that it is a good fit to the circumstances. After Neurofeedback, the outside world just doesn't seem quite so deserving of our anger. Our perceptions both of ourselves, of the other, and of the situation will have broadened, and that is an unalloyed good.
Anorexia is one of the most difficult of the eating disorders to treat. Neurofeedback should be part of a comprehensive treatment program, but it should not stand alone. The perplexing misperceptions with respect to self-image do not yield readily to psychotherapy, but they may well respond to brain-training. Traumatic aspects in the chain of causation can also be helped with Neurofeedback. Depressive behavior patterns can be helped, as well as obsessive and compulsive features of the eating disorder. And appetite itself is a self-regulatory response that yields to Neurofeedback training.
This topic deserves a longer discussion, but in this thumbnail sketch let it just be said that the bread and butter of the biofeedback field is the treatment of anxiety disorders. There are any number of ways in which a person's physiology can be trained to function in a calmer fashion at lower levels of physiological arousal or state of agitation. A lot of the work with anxious people involves teaching them the ways in which they can help their own condition with conscious influence on their own physiology.
A simple change in breathing strategy, for example, can bring about profound changes in health and well-being. One does not have to go around thinking about one's breathing all the time, either. The learning of new ways of functioning will lead to the adoption of new habits by the body-mind. One is consciously engaged with one's physiology only a small fraction of the time-perhaps when one is under challenge, or one is standing on the threshold of a command performance.
Neurofeedback / EEG Biofeedback can help as well. Gently the brain is trained to operate out of a calmer place. Initially this may take the anxious person out of his or her historical comfort zone. Even if this is actually a zone of discomfort, it is still what the person is accustomed to. The loss of anxiety may actually seem like the loss of a kind of safety. Anxiety may not feel good; but it is at least keeping the person alive! The sudden disappearance of anxiety may leave the person feeling exposed and insecure.
So it is important to train people toward calmer states while keeping them within their comfort zones. The training is therefore highly individualized, and that is the breakthrough that Neurofeedback has made possible. We encounter three classes of anxiety: 1) anxiety so severe that it is practically disabling to the person; 2) an anxiety level that interferes with the quality of life and keeps the person from optimum functioning; and 3) living in a condition of high arousal that costs a person in terms of energy expenditure now and possibly depression or even reduced life expectancy later; however, the state may not be felt as one of anxiety. Such a high-wire act may in fact be seen as a pathway to success and be rewarded as such. But it is costly, and not at all necessary because it is inefficient and ultimately exhausting.
Each of these takes a different approach in training. The more severe condition may also have its roots back in the early childhood history of the sufferer, and that also has implications for what is to be done. Fortunately, with Neurofeedback one can even reach back figuratively into early childhood history and alter the present consequences of such early trauma. If the present experience of anxiety is rooted in early memories, then a thoroughgoing resolution of the issue will involve a retraining of the physiology that will involve a reworking of the early trauma history. With Neurofeedback, that can all take place quite benignly through sequential training procedures.
The benefit of resolving anxiety conditions are not just to be seen narrowly with respect to anxiety per se, but will influence the person's entire quality of life. Altered will be how the person pays attention; emotional relationships will change; and the person will relate differently to the perceived "self." This is not something that the anxious person is necessarily even capable of imagining. It may simply have to be experienced. - Siegfried Othmer, PhD
Case Vignettes:
Reports from clients:
"I feel mellow all the time now. I'm not panicking over things like I used to. I can stay in the moment and be focused. I am much more productive and energetic. My creativity and energy level is up. I feel clear-headed. A lot of people are asking what is different about me. They notice a change. I sleep well. Overall, I feel happier."
Photographer (after 17 Cygnet sessions)
"Before I started I was having anxiety all the time and couldn't shake my depression. Now, I feel stable, calm, relaxed, and have no anxiety or depression anymore. My friends say I am more energetic. My thinking is clearer and I'm happier. I'm not obsessing over everything like I used to. My mother says I'm not as argumentative. I let things go more."
Receptionist (after 14 Cygnet sessions)
"It's been a life changing experience and the only thing that has really worked for me. All my anxiety has gone away and I no longer need Xanax. I have more clarity of thought. I feel grounded. I'm not overreacting to things that are normally drama loaded. I have no more gloom and doom. I have as much stuff going on in my life, but I'm dealing with it differently. All I had been offered was drugs. I'm so glad I found neurofeedback."
Business Consultant (after 12 Roshi/Amiga sessions)
Other Resources:
One of the contributory issues in weight control is simply the fact that the appetite may not be well regulated. Like other regulatory functions, the sense of appetite can respond to Neurofeedback training. Those who find themselves struggling to regulate their food intake; those who eat by the clock; and those for whom fullness is the first hint of satiety may all benefit from a sequence of Neurofeedback sessions. Success in this regard may make a comprehensive weight loss strategy more successful.
Speech articulation may respond quite readily to a specific Neurofeedback protocol that targets Broca's area. If that does not promptly yield benefit, then a number of related protocols suggest themselves for trial. EEG properties under challenge may also be used to guide protocol. If the problems are developmental, some significant functional improvement may be expected. In the case of stroke or traumatic brain injury, the gains are less predictable. Nevertheless, the training should be attempted. New opportunities for functional reorganization arise over a period of years subsequent to a stroke, so the training should be investigated periodically for new learning opportunities.
Recent advances in Neurofeedback protocols have given considerable impetus to work with Asperger's Syndrome. The advantage here is that the person at issue may in fact exhibit considerable intellectual gifts, which can be helpful in Neurofeedback. Training for this condition involves a primary focus on emotional regulation, with a secondary focus on anxiety (worry) and obsessional features that may be present. Other non-verbal learning disabilities may also be present, and these may require specific attention.
Case Report:
Adolescent training for Asperger's and Migraine
A 13-year old was brought to the office by his mother. He did not come willingly.
The mother brought the child for his Asperger's, and not for his daily migraine headaches. The mother was concerned because the son was not picking up facial cues. He also had occasional violent meltdowns, anger episodes, and rages. He was severely depressed.
In the boy's world view, if he had to be here for Neurofeedback it was going to be for his sleep issues. He was very negative about the training, thinking it was for "losers" and "retards," so he denied any association between the Neurofeedback and problems of the brain. The headaches turned out not to be a motivator for the training because he had absorbed the notion that he would just have to live with those.
The boy had a slight headache after the first Neurofeedback session. That evening he went for a walk with his dad, with whom he famously did not get along. This was unprecedented. A headaches was experienced after the second session as well, and then again just before session #7.
Only at that time did the switch get made to the headache protocol. With the switch to the migraine protocol no further headaches were experienced until session #18. By this point his sleep had also improved, and there was less emotional reactivity. The parents' focus throughout remained more on school and social issues than on the headaches.
At session twenty the decision was made to move the family into home training. Ten sessions were done at home under these circumstances, at which point the son refused to do any more sessions. Some time later the boy experienced another bad headache. The mother immediately put him on the instrument and got rid of the headache. This led to the son accepting more sessions somewhat grudgingly. The family came in for a mid-course correction session at the office at session 37.
Some time later the boy declared that he no longer wanted to be in his algrebra class. It turned out that he was very competitive, and that if he couldn't do better than the others in a class such as algebra then he just didn't want to be there. Left frontal training was recommended to the family. They did one session of the training, and the very next day the son got the highest mark in the class in algebra. This helped change the son's attitude toward the training somewhat, but he remained in a slightly oppositional stance. It seems like he could not fail to interpret matters in terms of something being wrong with his brain, and he could not go there.
With sessions having become merely episodic in the household, the Neurofeedback instrument was returned, and the family will come to training as necessary at the office. At this point there is no issue any more with emotional melt-downs or anger episodes or rages. The youngster could still benefit from additional training, but it is no longer an emergency.