What is Neurofeedback?
Neurofeedback is direct training of brain function, by which the brain learns to function more efficiently. We observe the brain in action from moment to moment. We show that information back to the person. And we reward the brain for changing its own activity to more appropriate patterns. This is a gradual learning process. It applies to any aspect of brain function that we can measure. Neurofeedback is also called EEG biofeedback, because it is based on electrical brain activity, the electroencephalogram, or EEG. Neurofeedback is training in self-regulation. It is simply biofeedback applied to the brain directly. Self-regulation is a necessary part of good brain function. Self-regulation training allows the system (the central nervous system) to function better.
What is Neurofeedback good for?
Neurofeedback addresses problems of brain disregulation. These happen to be numerous. They include the anxiety-depression spectrum, attention deficits, behavior disorders, various sleep disorders, headaches and migraines, PMS, emotional disturbances. It is also useful for organic brain conditions such as seizures, the autism spectrum, and cerebral palsy.
May this be considered a cure for some of these conditions?
In the case of organic brain disorders, it can only be a matter of getting the brain to function better rather than of curing the condition. When it comes to problems of disregulation, we would say that there is not a disease to be cured. Where disregulation is the problem, self-regulation may very well be the remedy. But again the word cure would not apply.
But the symptoms may go away, so it's all the same in the end?
Indeed, with Neurofeedback the symptoms may be entirely suppressed. A person with diagnosed Attention Deficit Disorder may be able to train the brain to pay attention, so that condition will no longer be diagnosable. A person coming in with migraines may no longer have them. (However, that person may still have a greater "vulnerability" to migraines than the average person on the street.) A person with epilepsy may no longer have seizures. (Although that person still retains a vulnerability to seizures.) A child with severe rages and temper tantrums may not have them again. Etc.
How is this done?
We apply electrodes to the scalp to listen in on brainwave activity. We process the signal by computer, and we extract information about certain key brainwave frequencies. (All brainwave frequencies are equal, but some are more equal than others...) We show the ebb and flow of this activity back to the person, who attempts to change the activity level. Some frequencies we wish to promote. Others we wish to diminish. We present this information to the person in the form of a video game. The person is effectively playing the video game with his or her brain. Eventually the brainwave activity is "shaped" toward more desirable, more regulated performance. The frequencies we target, and the specific locations on the scalp where we listen in on the brain, are specific to the conditions we are trying to address, and specific to the individual.
What conditions can be helped?
We are especially concerned with the more "intractable" brain-based problems of childhood whose needs are not currently being met. This includes first of all seizures and febrile convulsions. It includes the severely disruptive behavior disorders, such as conduct disorder and bipolar disorder. It includes the autistic spectrum and pervasive developmental delay. It includes cerebral palsy, acquired brain injury and birth trauma. Many children have sleep problems that can be helped: bedwetting, nightmares and night terrors, sleep walking, and teeth grinding. We can also be helpful with many of the problems of adolescence: drug-taking, suicidal behavior, anxiety and depression. And we can also help to maintain good brain function as people get older. The good news is that almost any brain, regardless of its level of function, can be trained to function better.
How do you know how to train a particular brain?
Over the years, certain training protocols have been developed that are helpful with certain classes of problems such as attention, anxiety and depression, seizures and migraines, as well as cognitive function. There are a number of assessment tools we use to help us decide which protocols to use. These are simple neurodiagnostic and neuropsychological tests.
What is neurodiagnostic and neurophysiological testing?
Neurofeedback addresses issues of brain function, and hence assessment likewise is aimed at measuring function: We employ a continuous performance test called the TOVA ® (Test of Variables of Attention) and the QIK in order to characterize impulsivity and attention. We offer other tests of cognitive function and memory. We do screenings for certain visual problems that are ordinarily overlooked. And we can measure the EEG with quantitative and statistical assessments, a technique referred to as Quantitative EEG, or simply qEEG.
What is Quantitative EEG (qEEG)?
QEEG is one of the modern brain imaging techniques. Whereas PET and SPECT and fMRI scans look at how metabolic activity is distributed in the brain, the qEEG looks at how electrical activity is distributed over the scalp. In terms of imaging, nothing else is as fast in revealing brain activity as the qEEG. It is also completely non-invasive, and can be done in a clinician's office. It is well suited to the needs of the Neurofeedback clinician. Often a qEEG will be recommended for clients with clients with brain injury or developmental disorders, in order to help determine the path toward improved function.
What happens if Neurofeedback clients are taking medications?
With successful Neurofeedback training, the medications targeting brain function may very well no longer be needed, or they may be needed at lower dosages, as the brain takes over more of the role of regulating itself. This decrease in medications is particularly striking when the medications play a supportive role in any event, as is often the case for the more severe disorders that we are targeting with our work. It is important for clients to communicate with their prescribing physician regarding Neurofeedback and medications.
Who provides Neurofeedback?
Neurofeedback is typically provided by mental health professionals such as psychologists, family therapists, and counselors. These professions usually work with people one-on-one. The training may also be provided by nurses, clinical social workers, rehabilitation specialists, and educators. MDs also provide the service, but with the exception of psychiatrists will usually have the service provided by a trained staff person.
If Neurofeedback deals with so many conditions, why have I not heard of it before?
Neurofeedback involves "operant conditioning" of the EEG. As such, it is a psychological technique more than a medical one. The technique is not generally taught in medical school, but operant conditioning is a well-known technique in the science of psychology. On the other hand, most psychologists do not usually deal with the kinds of problems we are targeting. Hence we need to attract a greater variety of professionals to this field. The Brian Othmer Foundation exists for this purpose, among others.
Is Neurofeedback a reimbursable treatment?
There are insurance codes for biofeedback, under which Neurofeedback is covered. And there are codes for combining psychotherapy with biofeedback/neurofeedback. However, coverage for chronic mental health concerns is rarely adequate in the United States, so parents may have to advocate strongly with their insurance company for reimbursement. This, more than anything else, makes it necessary for the Brian Othmer Foundation to exist.
What are the customary costs of Neurofeedback training?
The typical per-session fee ranges from $50 to $125 depending on the part of the country and the qualifications of the professional. In addition there are costs of assessment, which are usually billed separately. Discounts may be available for massed practice, or for pre-payment plans.
Is home-training a possibility?
Many of the conditions we address with Neurofeedback involve long-term training, as the brain's capacity to function is gradually enhanced. For some children, Neurofeedback may remain a useful challenge over their life span. To make this economically viable, remote training is an available option for parents. Remote training refers to home training under the (remote) supervision of a clinician. After parents have had their child trained with a clinician for at least twenty sessions, they may transition to remote training and continue on that basis, consulting with the clinician regularly to monitor progress and determine changes in protocol. Then training can be done frequently and consistently, on an affordable basis.
Neurofeedback sounds like a real breakthrough. Is it? And should I be hopeful for my child?
The most significant scientific frontier in health care at this time is to understand how our brain functions. We are beginning to learn the brain's "operating system," and these findings are not without clinical implications. We have already learned how to make almost any functioning brain function better. But we can promise only progress, not perfection. The parent's first role in this is to resist the message "there is nothing more that can be done for your child," and to move forward to experience what Neurofeedback may offer.
Do the effects of the training really last?
If the problem being addressed is one of brain disregulation, then the answer is yes, and that covers a lot of ground. This is quite as it should be. Neurofeedback involves learning by the brain. And if that brings order out of disorder, the brain will continue to use its new capabilities, and thus reinforce them. Matters are different when we are dealing with degenerative conditions like Parkinson's or the dementias, or when we are working against continuing insults to the system, as may be the case in the autism spectrum. In such cases the training needs to be continued at some level over time. Allergic susceptibilities and food intolerances make it more difficult to hold the gains. Poor digestive function will pose a problem, as does poor nutrition. A child living in a toxic environment (in either the physical or the psychological sense) will have more difficulty retaining good function.
What is the success rate?
Through our twenty years of experience with Neurofeedback, we have reached the point of having very high expectations for success in training. When such success is not forthcoming, or if the gains cannot hold, then there is usually a reason for that which needs to be pursued. In the normal course of events, Neurofeedback ought to work with everybody. That is to say, nearly everyone should make gains that they themselves would judge to be worthwhile. Our brains are made for learning and skill-acquisition. On the other hand, we are working with many families whose expectations have been lowered by their past experience. And they need to see progress before they will share our optimism. We understand that. It turns out that among the vast majority of clients (>95% in one clinician's experience) the actual outcome exceeds the prior expectations. Against such low expectations, the changes that can be produced with Neurofeedback may even appear miraculous. One Neurofeedback office has a sign on its front desk: "We expect miracles. If none occur, something has gone wrong." What appears miraculous in all of this is really nothing more than the incredible capacity of our brains to recover function when given a chance.
Less Frequently Asked Questions:
What about the Placebo Effect?
The Placebo Effect is something for the drug companies to worry about, not us. Drug companies have to show that any medication is better than doing nothing, the glorified term for which is the placebo. That's a rather low bar, don't you think? Better than doing nothing? We should hope so, at those prices... But in fact the placebo presents a rather formidable hurdle to the drug companies. Why should that be? It is because the body/mind has a remarkable capacity for self-recovery. In the placebo arm of controlled research, it is our natural recovery mechanisms that are being tracked. So, the necessity for controlled research in drug testing is driven by our manifest robust capacity for self-recovery.
Now self-recovery just happens to be our cause. In fact, it's our whole agenda. The client's choice is either to just wait for spontaneous recovery, or to take action to bring it about. In Neurofeedback, we have found one effective way to promote self-recovery. And the clients are perfectly capable of judging for themselves whether the progress they are making in training is worthwhile for them personally.
Whereas the placebo effect is the chief adversary for the drug companies, for us it an ally because it testifies to the capacity for self-recovery. The shoe is therefore on the other foot. It will be observed that people always talk about the placebo "effect" and never about the "cause." The cause is what any scientist ought to be interested in. Why is that question almost never asked? Most likely, it is because the answer really gets in the way when you are trying to sell drugs.
Isn't there still the need for controlled research?
Yes, and yes again. Indeed there is an obligation to prove that Neurofeedback is more than the placebo effect with a high price tag. But in fact that question was already answered with the very first scientific study that was ever done - more than forty years ago now. That research was done with cats, who are not subject to the wishes of the experimenter or the placebo, and it was a blinded experiment as well because Neurofeedback was discovered by accident! The research had been set up to study cat behavior, not to remediate seizures. But that is indeed what happened; moreover, it was even contrary to the experimenter's intentions. So the whole field was launched in what turned out to be the perfect (blinded and controlled) experimental design.
Since then there have been a number of controlled studies--in ADHD, seizure management, addictions treatment, optimum performance. But we do have a methodological problem here. Whereas the drug companies are comparing A versus B, drugs versus placebo, we are comparing spontaneous self-recovery with induced self-recovery. That's like comparing A with A, or rather A+. The two can only be distinguished in terms of rate of progress and results achieved. Fortunately, the results in Neurofeedback usually become obvious early in training. Secondly, our work shows a learning curve that is progressive, counter to what is expected for the naked placebo. And many of our results go way beyond ordinary expectations. There is no placebo model for 23-point improvements in IQ, for example.
Mostly we work with relatively "intractable" conditions against long baselines of prior care. All the prior therapies in a particular case also offered a chance for the placebo effect to manifest itself. Why should the placebo effect suddenly make its appearance when the person first visits a Neurofeedback office years later? So, in the real world clients have no difficulty making the common-sense judgment that if we get rid of their migraines in a few sessions, the training probably had something to do with it.
What is the state of research on all the other conditions?
Neurofeedback is not really a "treatment" for any diagnosis - even if we may have given that impression ourselves. That's the wrong perspective for the work. Neurofeedback addresses disregulation in brain regulatory networks. And such disregulation plays more or less of a role in all mental health issues. So one does not have to study every condition as if these all represented independent scientific challenges. The broad efficacy of Neurofeedback for such a large variety of conditions should be understood as indicating that disregulation is a big issue in all of them - a much bigger issue than anyone thought. Disregulation is therefore a worthy target no matter what diagnosis the client brings in the door.
What complementary therapies should be considered in conjunction with Neurofeedback?
Since Neurofeedback training can be costly over time, it is prudent to consider less expensive alternatives that may avoid the need for the full course of training. Some of these are considered further below. If a client exhibits Irlen Syndrome, a visual processing disorder, then Neurofeedback is not going to resolve the problem. It therefore needs to be identified early on and dealt with. Also, if the client is suffering predominantly because of stress, then simpler and more cost-effective biofeedback procedures are available. The option of Heart Rate Variability training is discussed specifically below, but other options are available as well. Alternatively, a combination of approaches would be the most efficient. Clients whose nervous systems need calming may benefit from Cortical Electrical Stimulation, such as provided by the Alpha-Stim.
Additionally, there needs to be adequate nutritional support for the work. This is not just an issue of intake, but of digestive competency. So questions may need to be asked about the status of gut function. Allergies need to be attended to independently if possible, and food intolerances identified. Dietary adjustments may be recommended as well, such as reduction in sugar intake and aspartame-containing soft drinks. Spices and chocolate may need to be avoided.
In the larger scheme of things, a systems approach is needed to address problems of disregulation. We have found in practice, however, that Neurofeedback represents the single strongest approach in addressing such conditions.
What is Irlen Screening?
Irlen Syndrome, or Scotopic Sensitivity Syndrome, was first identified by Educational Psychologist Helen Irlen while she was working with adult learners in the early 1980's. Until described in her book, Reading by the Colors (Avery Press, 1991), there was no explanation or treatment for this perceptual disorder, and many people with this disorder would be misdiagnosed as dyslexic or slow learners. In 1991, Dr. Margaret S. Livingstone of Harvard Medical School published research which offered a medical explanation for this disorder.
Individuals with Irlen Syndrome perceive the printed page and sometimes their environment differently. They must constantly make adaptation or compensate. Individuals are often unaware of the extra energy and effort they are putting into reading and perception.
Reading may be slow and inefficient, or there may be poor comprehension, strain, or fatigue. It can also affect attention span, listening, energy level, motivation, work production, and mental health.
People with Irlen Syndrome are often seen as underachievers or having behavioral, attitude or motivational problems. These problems can also coexist with other learning problems, such as attention deficit disorder, dyslexia, or autism. Treatment for Irlen Syndrome can alleviate many of the symptoms of these disorders in many cases.
What is Freeze-Framer?
The Freeze-Framer is a simple, easy to use interactive software program that displays your heart rhythms and shows you how stress may be affecting you. Much more than a heart monitor this revolutionary technology will help you transform stress and anxiety into free energy for personal and professional effectiveness.
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