Neurotherapy FAQ
Q1. What is Neurofeedback (or Neurotherapy)?
A1. Neurofeedback is physical therapy for the brain. It is a learning technique that enables persons to visualize their brain waves and in making a person's own brain waves available, he or she can learn to control and change them directly. Also known as EEG biofeedback, it is used for many mental health conditions and disabilities in which the brain is not functioning optimally. For those with a psychology background, neurofeedback is operant conditioning on EEG parameters. Typically the training reinforces specific EEG frequencies and inhibits others.
Q2. What is it used for?
A2. Neurofeedback is used for dozens of mental health conditions and disabilities in which the brain is not working well including epilepsy, Attention Deficit Hyperactivity Disorder, anxiety and mood disorders, brain injury, specific learning disabilities, and general health issues such as insomnia, teeth grinding, and chronic pain and migraines.
Q3.How is it done?
A3. An initial clinical interview is done to obtain a description of symptoms, and to get a picture of the health history and family history. Some testing may be done as well. And the person does the first EEG training session, at which time we get a look at the EEG. This all may take about 2-4 hours. In some offices a full brain map, or quantitative EEG, is routinely obtained.) Subsequent training sessions typically last about an hour, and are conducted from one to five times per week. Some improvement is generally seen within 10 sessions for most disorders but not all. Once learning is consolidated, the benefit sustained and appear to be permanent in most cases.
Neurofeedback is a painless, non-invasive procedure. One or more brainwave sensors are placed on the scalp and on each ear. Brain waves are monitored by means of an amplifier and a computer that processes the signal and provides visual and auditory feedback to healthy organization of brain wave activity (e.g., specific rhythms or shared rhythms between brain sites). An individual is asked to make the video game work with only his brain activity. As activity in a desirable frequency band increases, the video game moves faster, or some other reward is given. As activity in an adverse band increases, the video gameplay slows or stops. Gradually, the brain responds to the cues that it is being given, and a "learning" of new brain wave patterns takes place. The new pattern is one which is closer to what is normally observed in individuals without such disabilities.
Q4.How long does the neurofeedback training take?
A4.EEG training may require some 15 to 40 sessions for attention, learning, and behavior problems, in order for consolidation of learning to take place. In some cases, particularly if there is organic injury involved, such as in epilepsy or traumatic brain injury, the training may need to be extended to a 100+ sessions, and some benefit may continue to be observed as the training is continued indefinitely.
Q5. What is the history of this treatment technique?
A5. EEG biofeedback was first attempted in the 1960s by Joe Kamiya at the University of Chicago. Early investigations focused on operant conditioning of alpha brain waves (8-13 Hz) primarily to facilitate deep relaxation and meditation. SMR biofeedback (12-19 Hz) developed from operant conditioning of cats' EEG. Barry Sterman of UCLA seredipitiously discovered that when cats were exposed to toxic chemicals that usually induce epileptic seizures, those who had been trained in the middle to high frequency range from a previous unrelated experiment had greater latency to seizure onset, and a higher threshold for seizure onset, than untrained cats. These results were replicated in monkeys and humans and more than 60 papers have been published in 40 years of research in dozens of research centers. After several years of treating patients with intractable seizures with SMR biofeedback, it was noted that the hyperactive children not only had decreased seizure activity, but their behavior improved as well. In the mid 70's, Joel Lubar at the University of Tennessee examined the effect of neurofeedback on hyperactivity absent any seizure history and this led to its use in ADHD.
Q6. Might the outcome of neurofeedback training be due to a placebo effect?
A6. No, and here are the reasons why:
The effects of EEG biofeedback training are highly specific to electrode placement and to training frequency band
Training protocols exist which can commonly elicit effects opposite to those desired
The effects of training with one protocol can be reversed with another
The effect of the training is cumulative, rather than fading with time, as is common with placebos
If neurofeedback were to be explained in terms of placebo phenomena, it would be a first time that placebos are dose-dependent.
Training effects are in line with expectations from neuropsychology regarding localization of function
Populations can be moved to levels of performance which exceed those of naïve populations
Effects of the training often lie outside the range of expectations for spontaneous recovery or placebo effects, not only with respect to the magnitude of the changes elicited but also with respect to the consistency with which they are produced, and the timescale over which they occur.
Neurofeedback was discovered in test animals who were not being treated; in fact, the researcher was blind, since the discovery was by way of a confound of an unrelated experiment (Sterman,1976).
Q7. What is the mechanism underlying EEG biofeedback efficacy?
A7. The original Sterman protocol for seizures trained motor system excitability, and likely increased GABAergic synaptic density in the sensorimotor pathways. This protocol was site- specific (sensorimotor strip) and frequency-specific (12-19Hz in cats, 12-15 Hz in humans). Over time, it became apparent that this training was also effective for temporal lobe seizures (complex-partial) which suggests it promoted CNS stability more generally. Thalamocortical circuits are responsible for 4-20 Hz rhythms (cf. research of Steriade, McCormick) and the entire EEG spectrum is believed to be behaviorally relevant. By managing activation of neural circuits subserving physiological arousal, autonomic nervous system balance, attention, and mood and other behavioral states can be stabilized or improved. For this reason, we assess a wide range of the EEG spectrum to establish which frequencies exhibit abnormalities compared to healthier individuals.
Q8. What else should I know about Neurofeedback and Quantitative EEG assessment?
A8. Read the this
additional material.