An
Introduction to Neurotherapy
In the late 1960's and 1970's we learned that it was possible to
recondition and retrain brainwave patterns. Some of this work began with the
training of alpha brainwave activity for relaxation, while other work
originating at UCLA focused on uncontrolled epilepsy. This training is called
Neurotherapy or EEG biofeedback or Neurofeedback.
Before discussing this in more detail, let me provide you with
some preliminary information about brainwaves. Brainwaves occur at various frequencies.
Some are fast and some are quite slow. The classic names of these EEG bands are
delta, theta, alpha, and beta. They are measured in cycles per second or hertz
(Hz).
Beta
brainwaves (above 13 Hz) are small, faster brainwaves associated with a state
of mental, intellectual activity and outwardly focused concentration. This is
basically a "bright-eyed, bushy-tailed" state of alertness.
Alpha brainwaves (8-12 Hz.) are slower
and larger. They are associated with a state of relaxation and basically
represent the brain shifting into an idling gear, relaxed and a bit disengaged,
waiting to respond when needed. If we merely close our eyes and begin picturing
something peaceful, in less than half a minute there begins to be an increase
in alpha brainwaves. These brainwaves are especially large in the back third of
the head.
Theta brainwaves (4-8 Hz) represent
a day dreamy, spacey state of mind that is associated with mental inefficiency.
At very slow levels, theta brainwave activity is a very relaxed state,
representing the twilight zone between waking and sleep.
Delta brainwaves (0-3.5 Hz) are the
slowest, highest amplitude brainwaves, and are what we experience when we are
asleep. In general, different levels of awareness are associated with dominant
brainwave states.
Each of us, however, always has some degree of each of these
brainwave bands present in different parts of our brain. Delta brainwaves will
also occur, for instance, when areas of the brain go "off line" to
take up nourishment. If we are becoming drowsy, there are more delta and slow
theta brainwaves creeping in, and if we are inattentive to external things and
our mind is wandering, there is more theta present. If we are exceptionally
anxious and tense, an excessively high frequency of beta brainwaves is often
present. Persons with ADD, ADHD, learning disabilities, head injuries, stroke, Tourette’s syndrome, epilepsy, and often chronic fatigue
syndrome and fibromyalgia tend to have excessive slow waves (usually theta and
sometimes excess alpha) present. When an excessive amount of slow waves are
present in the executive (frontal) parts of the brain, it becomes difficult to
control attention, behavior, and/or emotions. Such persons generally have
problems with concentration, memory, controlling their impulses and moods, or
with hyperactivity. They can’t focus very well and exhibit diminished
intellectual efficiency.
Neurofeedback training is brainwave biofeedback. During typical
training, a couple of sensors are placed on the scalp and one or two are
usually put on the ear lobe. Then, high-tech electronic equipment provides you
with real-time, instantaneous audio and visual feedback about your brainwave
activity. The electrodes measure the electrical patterns coming from the
brain--much like a physician listens to your heart from the surface of your
skin. No electrical current is put into your brain. Your brainwave patterns are
relayed to the computer and recorded.
Ordinarily, we cannot influence our brainwave patterns because we
lack awareness of them. However, when you can see your brainwaves on a computer
screen a few thousandths of a second after they occur, it gives you the ability
to influence and change them. The mechanism of action is operant conditioning.
We are literally reconditioning and retraining the brain. At first, the changes
are short-lived, but the changes gradually become more enduring.
With continuing feedback, coaching, and practice, we can usually
retrain healthier brainwave patterns in most people. It is a little like
exercising or doing physical therapy with the brain, enhancing cognitive
flexibility and control. Thus, whether the problem stems from ADD/ADHD, a
learning disability, a stroke, head injury, deficits following neurosurgery,
uncontrolled epilepsy, cognitive dysfunction associated with aging, depression,
anxiety, obsessive-compulsive disorder, or other brain-related conditions,
Neurofeedback training offers additional opportunities for rehabilitation
through directly retraining the brain. The exciting thing is that even when a
problem is biological in nature, we now have another treatment alternative than
just medication. Neurofeedback is also being used increasingly to facilitate
peak performance in "normal" individuals and athletes.
Frank H. Duffy, M.D., a Professor and Pediatric Neurologist at
Harvard Medical School, stated in an editorial in the January 2000 issue of the
journal Clinical Electroencephalography that scholarly literature now
suggests that Neurofeedback "should play a major therapeutic role in
many difficult areas. In my opinion, if any medication had demonstrated such a
wide spectrum of efficacy it would be universally accepted and widely
used" (p. v). "It is a field to be taken seriously by
all" (p. vii).
Once an assessment is complete and treatment goals have been
established, we usually place two sensors on the scalp and one or more on the
earlobes during neurotherapy training sessions. The trainee then watches a
display on the computer screen and listens to audio tones, sometimes while
doing a task such as reading. These training sessions are designed to teach the
person to slowly change and retrain their brainwave pattern. With continuing
feedback, coaching, and practice, the healthier brainwave patterns are
maintained. Some persons may need to learn to increase the speed or size of
brainwaves in some parts of the brain. Other individuals need training to
decrease the speed of brainwaves in certain areas of the brain. In a sense, it
is like exercising or doing physical therapy with the brain, enhancing
cognitive flexibility and control. Neurofeedback training usually requires at
least 25, and most commonly 40-50 sessions of about 40 minutes in length.
Alcoholism & Drug Abuse. EEG investigations of alcoholics
(and the children of alcoholics) have documented that even after prolonged
periods of abstinence, they have lower levels of alpha and theta waves and an
excess of fast beta brainwaves in their EEG's. This means that alcoholics and
the children of alcoholics tend to be hard-wired differently from other people,
and in a way that makes it difficult for them to relax. However, following the
use of alcohol, the levels of alpha and theta brainwaves increase. Thus,
individuals with a biological predisposition to develop alcoholism (and their
children) are particularly vulnerable to the effects of alcohol. Without
realizing it, alcoholics seem to be trying to self-medicate and treat their own
brain pathology. The relaxing mental state that occurs following alcohol use is
highly reinforcing to them because of the manner in which their brain is
functioning. Several research studies now show that the best predictor of
relapse is how excessive the beta brainwave activity is in alcoholics and
cocaine addicts (Bauer, 1993, 2001; Prichep et al.,
1996; Winterer, 1998).
Recently, EEG biofeedback training to teach alcoholics how to
achieve stress reduction and profoundly relaxed states through increasing alpha
and theta brainwaves and reducing fast beta brainwaves have demonstrated
promising potential as an adjunct to alcoholism treatment. Peniston
and Kulkosky (1989) used such training with chronic
alcoholics compared to a nonalcoholic control group and a traditional
alcoholism treatment control group. Alcoholics receiving 30 sessions of
brainwave training demonstrated significant increases in percentages of their
EEG record in alpha and theta rhythms, and increased alpha rhythm amplitudes.
The brainwave treatment group also demonstrated sharp reductions in depression compared
to controls. Alcoholics in standard (traditional) treatment showed a
significant elevation in serum beta-endorphin levels (an index of stress and a
stimulant of caloric [e.g., ethanol] intake), while those with brainwave
training added to their treatment did not demonstrate an increase in
beta-endorphin levels. On four-year follow-ups (Peniston
& Kulkosky, 1990), only 20% of the traditionally
treated group of alcoholics remained sober, compared with 80% of the
experimental group who received Neurofeedback training. Furthermore, the
experimental group showed improvement in psychological adjustment on 13 scales
of the Millon Clinical Multiaxial
Inventory compared to traditionally treated alcoholics who improved on only two
scales and became worse on one scale. On 16-PF personality inventory, the
Neurofeedback training group demonstrated improvement on 7 scales, compared to
only one scale among the traditional treatment group. Thus, Neurofeedback
training appears to hold encouraging promise as an adjunctive module in the
treatment of alcoholism, and in remediating damage done through drug abuse.
Posttraumatic Stress Disorder. Peniston and Kulkosky
(1991) added thirty 30-minute sessions of alpha/theta EEG biofeedback training
to the traditional VA hospital treatment provided to a group of PTSD Vietnam
combat veterans, and compared them at 30 month follow-up with a contrast group
who only received traditional treatment. On follow-up, all 14 traditional
treatment patients had relapsed and been rehospitalized,
while only 3 of 15 Neurofeedback training patients had relapsed. While all 14
patients treated with Neurofeedback had decreased their medication requirements
by follow-up, among traditionally treated patients, only one patient decreased
medication needs, two reported no change, and 10 required more psychiatric
medications. On the MMPI, Neurofeedback training patients improved
significantly on all 10 clinical scales--dramatically on many of them--while
there were no significant improvements on any scales in the traditional
treatment group.
ADD/ADHD & Learning Disabilities: Since the late 1970's,
Neurofeedback has been researched, refined, and tested with ADD/ADHD and
learning disabilities. Clinical work with Attention-Deficit/Hyperactivity
Disorder and learning disorders by Dr. Lubar and his
colleagues at the University of Tennessee and others has demonstrated that it
is possible to retrain the brain. This Neurofeedback research is quite strong
in demonstrating its effectiveness in treating ADD/ADHD. Whereas the average
stimulation medication study follow-up is only three weeks long and the longest
medication study is only 14 months long with ADD/ADHD, Dr. Lubar
(1995) has published 10 year follow-ups on cases and found that in about 80% of
patients Neurofeedback can substantially improve the symptoms of ADD and ADHD,
and these changes are maintained.
Rossiter and LaVaque (1995) found that 20
sessions of Neurofeedback produced comparable improvements in attention and
concentration to taking Ritalin, and Fuchs et al. (2003) likewise demonstrated
that Neurofeedback produced comparable improvements to ritalin.
In a one year follow-up, control group study, Monastra
et al. (2002) found that Neurofeedback produced superior improvements to ritalin, without needing to remain on drugs. Neurofeedback
training for ADD/ADHD is commonly found to be associated with decreased
impulsiveness/hyperactivity, increased mood stability, improved sleep patterns,
increased attention span and concentration, improved academic performance,
increased retention and memory, and increased IQ scores (often averaging 10 IQ
points in published studies).
Other Clinical Applications of Neurofeedback Training. Neurofeedback has good
research support for its effectiveness in treating anxiety (Moore, 2000). It is
also being used to work with other clinical problems such as depression (Baehr, Rosenfeld & Baehr,
2001; Hammond, 2001), chronic fatigue syndrome (Hammond, 2001), fibromyalgia
(Donaldson et al., 1998; Meuller et al., 2001), sleep
disorders, Tourette’s, obsessive-compulsive disorder
(Hammond, 2003), autism (Jarusiuwicz, 2002),
Parkinson’s tremors (Thompson & Thompson, 2002), and essential tremor.
Neurofeedback is being utilized in peak performance training, for instance in
enhancing musical (Egner & Gruzelier,
2003), with athletes, business executives, for cognitive enhancement in normal
college students (Rasey, Lubar,
McIntyre, Zoffuto & Abbott, 1996), for memory
enhancement in normal individuals (Vernon et al., 2003), and for "brain
brightening" to counter effects of normal aging. However, these areas of
application do not yet have strong research validation.