Neurofeedback

Editor's Notes

• #2: These are SAMPLE NOTES…You can develop your own presentation notes or feel free to use these… I have been a clinician for ____ years. Adding Neurofeedback to my practice has not only been beneficial for my clients, but has added value to my practice.
• #3: When you go to the gym, you’re exercising in order to be stronger, more resilient and able to handle stress better. Neurofeedback exercises the brain to make it stronger, more resilient and better able to perform tasks.
• #4: You can’t talk about brain training (Neurofeedback) without talking about the brain. It’s the brain that does all the work. If we better understand the brain – and its impact on every aspect of our life, then we can start to talk about the impact of exercising the brain. The brain can adjust – regulate itself. That’s it’s job. When you see someone who is struggling with depression, do you think about it only as a psychological problem? Imaging studies show us that its often a problem with the brain, specifically the frontal lobe. If someone has been traumatized, the amygdala, part of the Temporal Lobe, plays a significant role in how they respond to knew situations. If there are sensory integration problems, such as tactile sensitivity, the Parietal Lobe is involved. It is difficult to tackle these problems without addressing the brain directly.
• #5: How organized can you be if your Pre-Frontal lobe isn’t operating well? How well can you control being impulsive, or switching your attention from one task to another? With Neurofeedback you can train different parts of the brain for increased activation and better timing.
• #6: If you’re driving down the road and you see a policeman right next to the street with his radar gun, the sign says 35 and you’re going 50, does your heart instantly start racing? Can you slow it down? Once you are aware of it you can, by quieting yourself, by breathing. You can consciously control breathing, heart rate, even changing the temperature in your fingertips.
• #7: When you become aware of your brain activity, which we typically aren’t, you can change it. Neurofeedback helps you learn to change your brain.
• #8: When you learn to change brain activity, it has some very positive affects on your brain’s ability to regulate itself.
• #10: When you change the brain, you change the mind.
• #11: When you use Neurofeedback, (exercise your brain) you are promoting better attention, better emotional control and greater control over stress.
• #12: When you exercise the brain and the brain becomes better regulated, you function better.
• #13: Neurofeedback is fairly simple. We use two computers – one that the therapist looks at and one that the client looks at. We place sensors on the client’s head, which read their brain activity and feed that information back to the computer.
• #14: This is a Pac-Man like game. When you play this game, you do not use your hands. It’s just the brain making the Pac-Man move. Your goal is to keep the Pac-Man yellow, moving and beeping. When it slows down, or turns black, that means that your brain is either going a little too slow, or a little too fast.
• #15: In this game, the object is to keep the middle ship moving. When it does, it represents your brain being alert, awake and paying attention. The purple and yellow ships should not be moving and should be sitting at the bottom of the screen. The purple ship represents your brain running slow; the yellow ship represents your brain running fast. The feedback encourages you every half second by rewarding you when the center ship moves and the other two don’t.
• #16: Clinicians use this screen in order to set the reinforcement schedule, that is how many rewards the client can get when their brain does the right thing.
• #17: We assume that most of you have not been looking at EEGs – so this just looks like squiggly lines. However, if you look at the very top line, which is labeled C3-A1, you will notice that it is a very small line with a lot of little waves very close together. This in fact represents an active, alert, attentive brain. Also notice at the bottom, there are colored bars which are all very small. This is a colored spectral representation of the EEG.
• #18: Notice the top line here. This wave form is much different – the waves are taller and farther apart. This represents excessive slow activity in the brain. You can also see that the colored spectral bars at the bottom are much taller than the previous EEG screen. If someone’s brain is going this slowly, it will interfere with their ability to pay attention or to think clearly; or affect their mood or their ability to quit worrying.
• #19: Think of the top EEG, which is small, with the waves very close together, as an engine running smoothly, almost purring. Think of the bottom EEG as a car that is vibrating too much, and which may stall unexpectedly under stress.
• #20: Here is another example, using a different kind of graph, of these tall brainwaves which represent slow brain activity.
• #21: This is another example of tall, slow waves. If this person was asleep, this might be okay. Unfortunately, they are awake, but their brain isn’t fully awake.
• #22: Notice with this brain, the waves and shorter, no big waves stand out. This is the alert, awake brain.
• #23: Neurofeedback uses Operant Conditioning which is a type of behavioral training that reinforces change in the brain.
• #24: Many of you have heard the term EEG and you may remember that particular frequencies are associated with specific brain states. When you see a large amount of Delta waves, it typically suggests that the person is sleeping.
• #25: If you are watching a client’s EEG and their eyes are open, if you observe a lot of Theta waves, it is associated with being distracted, daydreaming or they’re thinking about something.
• #26: Alpha waves tend to be associated with being relaxed, or possibly spacey.
• #27: When you see increased amounts of SMR activity and lesser amounts of Alpha, Theta and Delta, it is associated with a calm, attentive state.
• #28: Beta is a very activated state – very alert, very awake. This is where tasks really get done.
• #29: Let’s consider a child sitting in a classroom. He is supposed to be paying close attention to the teacher. However, if you could see his EEG, you notice large waves of Theta while he’s supposed to be paying attention. This would make it difficult for him to pay attention easily. By definition, large amounts of Theta mean his focus of attention is internal – that is, he’s in his head. If large Theta bursts only occurred once every 5 seconds it would still be difficult to compete with other children who are mostly paying attention. Is the excessive Theta a psychological problem? No, this is a physiological measure. This child is struggling with his own brain. By the way, does anyone here need a cup of coffee? Guess what that helps?
• #30: This particular frequency of High Beta occurs around too much excitement, feeling anxious, feeling tense. All of the frequencies that we described – High Beta, Theta, Alpha, Delta, SMR are all normal under the proper circumstances. Would it be appropriate for you to experience High Beta if I screamed at you? Yes, absolutely. The question is, how long should it take before that High Beta activity reverts to normal. 5 minutes? 15 minutes? Remember, this will interfere with your performance. You still need to pay attention. Perhaps 15 minutes is a reasonable time to calm down. How many of you know someone who, 2 days later, still feels the affects of being yelled at. When you see excessive High Beta, or excessive Theta, it could represent being “stuck in state”, unable to switch from too much High Beta, or too much Theta. By exercising the brain, we seem to greatly improve state flexibility – being in the appropriate state for the appropriate situation.
• #31: Why do we have a picture of a NASA emblem and a cat? The initial Neurofeedback research was an accident. Dr. Barry Sterman, a neuroscience researcher from UCLA, had been doing SMR brainwave training with cats to see if it could be done.
• #32: After showing that cats could increase EEG activity, he published that research in 1967. After completing this experiment, he received a contract from NASA to study the effects of rocket fuel and seizure activity. NASA was concerned that astronauts were being exposed to rocket fuel in flight which caused hallucinations. NASA thought these hallucinations were precipitated by low level seizure activity.
• #33: Dr. Sterman used some of the same SMR cats in his rocket fuel experiments. Notice the solid line, called control. It showed that half of the cats, upon exposure to the fuel, went into seizure within 60 minutes. Unexpectedly, half of the cats took more than 2 hours to go into seizure from the same fuel exposure. These were the cats which he had trained in increasing SMR brain activity. This was the first time that he identified training SMR activity reduces seizures.
• #34: Once the EEG training was tried on humans by Dr. Sterman it turned out that training SMR dramatically reduced the number of seizures and the intensity of seizures. 1 year after training was completed, the reduction in seizures held. It should be noted that the patients he trained were referred from doctors at UCLA and were patients with seizures thus far uncontrolled with any medications. These were the toughest cases.
• #35: In January 2000, Dr. Sterman published an article citing 19 studies showing significant reduction of seizures across all the studies.
• #36: Neurofeedback was first used for seizures in Epilepsy. But these patients with Epilepsy often had problems with Sleep, ADD, etc. It was observed, not only was the Epilepsy improving, but so were Sleep, ADD and Mood. The field has continued to grow as more researchers and clinicians have observed that training the brain helps in many different areas. Dr. Joel Lubar, who worked for Dr. Sterman, went on to specialize in studying ADD with Neurofeedback, and has published many studies in this field.
• #37: Many different brain imaging studies have helped the field of Neurofeedback by pointing to areas of the brain associated with depression, OCD, ADD and other problems. This information has helped Neurofeedback clinicians target brain problems more effectively.
• #38: Dr. Vince Monastra is the author of Parenting Children with ADHD : 10 Lessons That Medicine Cannot Teach, published by the American Psychological Association.. Here’s a summary of one of his studies, published in 2003, (part of which is from the abstract). “ One hundred children, ages 6 to 19, who were diagnosed with attention-deficit/ hyperactivity disorder (ADHD), either inattentive or combined types, participated in a study examining the effects of Ritalin, EEG biofeedback and parenting style on the primary symptoms of ADHD. All of the patients participated in a one-year, multi-modal, outpatient program that included: Ritalin, parent counseling, and academic support at school (either a 504 Plan or an IEP). Fifty-one of the participants also received EEG biofeedback therapy.”
• #39: “ After the treatment, the Ritalin was stopped and another assessments conducted. This post treatment assessment included the Test of Variables of Attention (T.O.V.A.; L.M. Greenberg, 1998) and the Attention Deficit Disorders Evaluation Scale (ADDES; S.B. McCarney, 1995), which had also been used while on Ritalin. ONLY those who had received EEG biofeedback sustained these gains when tested without Ritalin. Those who did not get the EEG biofeedback reverted back to baseline – that is, they didn’t learn. The ones who had EEG biofeedback did keep gains after the Ritalin was removed. The results of an EEG revealed significant reduction in cortical slowing only in patients who had received EEG biofeedback. Behavioral measures indicated that parenting style exerted a significant moderating effect on the expression of behavioral symptoms at home but not at school.”
• #40: This study came from Dr. John Gruzelier of Imperial College in London (the MIT equivalent in England). They worked with high school music students at the prestigious Royal Conservatory of music. These were the cream of the crop of music students in England.
• #41: Each student performed for 10-15 minutes on video prior to the beginning of the experiment. Then they signed up to train for 2 months using one of several programs – One group had well established skills training for sports performance, one group used an exercise program, one used Alexander technique for breathing and posture, and there were 3 different types of Neurofeedback groups.
• #42: After 2 months of training for each group, another video was made performing the same piece. All the videos were sent to expert musicians for assessment. They used some standard scales to assess improvements in musical performance. Only the group that did Alpha-Theta training showed significant improvements. For the other groups, there was no significant change. The changes – if you look at the tall colored bars which represents the performance after Alpha-theta, showed improvements in several categories, including overall quality, musical understanding and interpretative imagination. These, we are told, are difficult factors to influence with training. It suggests that it improved the creative aspects of performance.
• #43: Tansey in 1991 showed a 1 standard deviation change – more than 15 IQ points, in 22 out of 24 subjects who did Neurofeedback training. This research hasn’t been formally replicated. However, in surveying psychologists and other providers who test kids and use neurofeedback clinically – this is pretty typical of what therapists report for their clients. Does it mean neurofeedback makes the kids smarter in a relatively short time? Or does it mean the kids are simply better able to take the test – better attention, less anxious, clearer thinking? It seems like the latter. Yet those are all factors that do affect how these tests are taken. There’s more to be sorted out, but the research and clinical experience seems to be very promising.
• #44: Dr. Moshe Perl is a research oriented psychologist gathering data in Australia. He is planning to publish the data we are showing you. He is using a Test of Variables of Attention before and during the process of doing neurofeedback, This test is well normed and respected as an indicator of key attention variables related to ADD. You can see that of these 53 subjects, there were significant improvements – more than one standard deviation improvement after neurofeedback training in the scales for Inattention, for Impulsivity and for Variability – one of the key indicators related to ADD.
• #45: It’s harder in a clinical setting to get all the clients to come back in a year after they finished treatment. Dr. Perl so far has gotten 16 clients to come back in 1 year after treatment for retest of the TOVA – with no additional training. You’ll see that on average, the 14 month follow-up testing after neurofeedback as shown – with the blue bar - is slightly higher across the board than what the scores were at the end of the neurofeedback training (which was typically more than 40 sessions). What explains the fact that the scores were slightly higher than the scores after training? This is commonly reported by clinicians doing neurofeedback. It is thought that when you’ve improved the brain’s ability to pay attention, to be calm and more focused and clear, they continue to improve because they are building on a more stable brain.
• #46: What are the most common problems being trained with neurofeedback? ADD/ADHD is by far the most common. Anxiety is actually next. The rest you see – from TBI to addiction to autism have been reported by clinicians to be getting great benefit from better brain regulation.
• #47: What’s wrong with looking at all these issues – Pain, OCD, Anxiety, Depression, migraines? It sounds a lot like snake oil. It sounds like neurofeedback is making claims for everything. But in fact, neurofeedback is simply helping better regulate the brain. It is the better regulated brain that is able to stop obsessing or worrying, managing pain better, or being more alert, awake and paying better attention.
• #48: Some of the most promising areas within neurofeedback are developmental issues such as Autism and PDD. These are areas for which there aren’t many other effective interventions. A study on autism showing significant improvements in symptoms has already been published. Two more are in the works extending these findings. The reality is – if you have an autistic child, and you learn enough about neurofeedback, it seems worthwhile helping a very difficult brain become more calm and better regulated. Another issue is sleep – such as insomnia. It’s obvious the brain plays a role in regulating sleep. Clinicians report that sleep is one of the first things to improve as a result of neurofeedback training. This is widely observed in the field even though there have been no studies yet done in this area. It’s an example of the vast divide between academic researchers and clinicians. There is just beginning to be interest among researchers about neurofeedback. A 20 million dollar grant in Europe was just awarded to further research. The goal is – the research will help validate the clinical experience many PhD psychologists, MDs and other health providers are observing with patients.
• #49: It’s not the clinician that makes the change. It’s the client. They are the one exercising their brain. They are the one creating the changes. The clinician plays an important role. If you go to a gym, with special exercise equipment, you need someone to guide you on how to use it correctly - how to train correctly. Think of neurofeedback as an exercise tool for the brain. The clinician, through assessment and understanding how the brain works, helps the client target the areas that need the most work.
• #50: Neurofeedback has received increasing amounts of publicity, but there are 3 things which are making it more acceptable and better understood: There’s a growing number of credentialed professionals – including PhD psychologists and MDs who are using this modality with clients. When a new modality slowly continues to grow after 15+ years - it’s far more than a fad. Neurofeedback is growing because many professionals and clients see it working. The number of credible research publications on neurofeedback continues to grow. Over the last 4 years, a group of psychiatrists who use neurofeedback have been invited to present on neurofeedback at the International American Psychiatric Association. It’s gaining acceptance. Most importantly, both consumers and professionals have seen in the last 4-5 years, new brain imaging techniques. Articles about the brain have appeared in almost every major magazine – both consumer and science based. It’s become much more clear that brain plays an important role in the mind. Neurofeedback appears to be one of the most powerful ways to directly change the brain.
• #51: Here’s are several websites with information about Neurofeedback, and several books that you might find interesting.
• #53: Neurofeedback gives the client a tool to change their brain so that it is better regulated
• #54: Thank you for coming today. Are there any questions?