What's Possible
Case Commentary
The Story Of Tony, Dyslexic:
by Sebern Fisher
The Unregulated Brain:
Tony, a tall, husky, visibly distressed, 27-year-old man with severe dyslexia came to see me because a friend told him that I could “change his brain.” He paced my office as he described what it felt like to live with dyslexia. Since earliest childhood, classmates had teased him mercilessly. By eighth grade, he felt so humiliated, angry, and filled with self-hatred that his parents thought it best to send him to a boarding school specializing in learning disabilities. “If it hadn’t been for that school,” Tony said, “I’d be either dead or in jail.”
Being with others who were dyslexic, and with teachers who understood and empathized with his condition, made his life bearable. As with most dyslexics, reading was very difficult, and Tony got through school only with the help of tutors and special programs. He was accepted at a community college with a center for learning-disabled students, but he quit after the first semester, discouraged, bitter, and depressed because it was too hard. Since then, he’d worked sporadically as a manual laborer. He told me he dreamed of becoming a filmmaker, because he “thought better in pictures than in words,” but doubted that he ever could succeed in anything.
Tony attributed virtually every problem he had—his chronic depression and seething anger, his excessive drinking, his inability to find a good job, and his history of unstable relationships with women—to dyslexia, either directly or indirectly. He often flew into rages, breaking anything at hand. He couldn’t hold on to relationships or jobs, had panic attacks, couldn’t sleep, and chewed his nails. At the point he came to see me, he was drinking a case of beer a night to manage his agitation and despair.
Although I usually use psychotherapy in conjunction with neurofeedback, all Tony wanted was the neurofeedback. No talk therapy. I thought this would be a good case in which to test the effects of using neurofeedback exclusively.
Before beginning the training, I did a complete assessment of the problematic patterns in Tony’s brainwaves. I began with a symptom-focused questionnaire to systematically evaluate his arousal. Once I’d completed that assessment, I determined that, to control his temper, drink less, and even stop biting his nails—symptoms that indicate a high degree of arousal in the right hemisphere—Tony needed to learn to produce calming alpha waves on the right side of his brain, the hemisphere devoted to affect regulation. So, one treatment goal was to teach Tony to lower arousal in this hemisphere. Additionally, to address the dyslexia, which Tony considered to be the primary symptom, he needed to increase the arousal in the left hemisphere of his brain. Tony’s initial EEG assessment also revealed that he was producing an excess of delta and theta waves in both hemispheres, which interfered with the alertness required for such tasks as driving a car or reading an article. As a result, for Tony, concentrating on reading was like swimming across a lake against huge waves. Another treatment goal, then, was to train Tony’s brain to inhibit the production of excess slow waves and excess fast waves, both of which interfered with his ability to remain focused and relaxed, in addition to encouraging him to produce the frequencies that lowered arousal in the right hemisphere and raised arousal in the left.
Putting on the Brakes, Stepping on the Accelerator:
We were ready to begin Tony’s neurofeedback training. As I do with all clients, I explained that the video game he was about to play was linked directly to his EEG, and that its beeps and displays would encourage and reward his brain for the production of the brain waves that would, over time, change his experience. He sat in a comfortable chair in front of a computer screen, and I applied sensors to his head to detect his brain’s electrical activity. The EEG signal was displayed across the top of my computer screen. It showed his brain activity in three bandwidths: the band I wanted to encourage, or the “reward band,” and the two bandwidths I wanted to discourage, or “inhibit bands.”
Tony’s screen had a video game with three spaceships set to respond to his brain waves. The middle space ship represented the frequency that I wanted him to increase. The other two represented the very slow and very fast frequencies that I wanted him to decrease. Whenever Tony’s brain generated the optimal brain-wave pattern, the middle spaceship would pull ahead, and he’d score points in the video game. It was a simple video game, but without a joystick: Tony had to control the game solely with his brain.
Most clients, including Tony, have difficulty believing that “trying” to make the spaceships move doesn’t work. But they don’t know, at first, how not to try. Tony asked several times how to do it, and I couldn’t tell him, any more than I could tell him how to ride a bike. I just assured him that his brain would learn what it had to learn. When he tried to make the space ship move, it stayed in its dock. When he relaxed, the space ship flew out into space. Every time his brain “happened on” the correct frequencies, the center space ship would move ahead, while the other two would fall behind. Tony’s brain gradually began to learn, automatically and without conscious volition, to use this instantaneous feedback as a road map of which way to go. Unlike drug therapies, neurofeedback is a process of learning—the brain learns to regulate itself.
We trained two or three times a week, with 20 minutes of checking in and reassessment and 30 minutes of neurofeedback training each time. I used the quality of his sleep, the amount he was drinking, his appetite, his mood, and the frequency and intensity of his aggressive outbursts for my ongoing assessment of his progress. Changes in these markers indicated shifts in brain function. If the shifts were positive, I’d continue to train left and right hemispheres as I’d been doing. If the shifts were negative and he seemed worse in any of these areas, I’d reassess the training and change the brain-wave frequency of the reward band as needed.
By the fourth session, Tony reported that he was sleeping better, that he felt less angry, and that he’d started taking photographs again. He was also drinking less. But he still felt restless and dissatisfied with himself.
At session seven, he reported that he was bored with TV, that he was no longer sleeping during the day, and that he was feeling calmer and more organized. He could focus better and reported living “a more ordered life.” Tony was, it seemed, beginning to live in a more coherent brain. Neurofeedback training helped him feel increasingly calm and, as that happened, he became less fearful. It was also clear that Tony was beginning to trust me.
As with talk therapy, there are occasionally bumps in the road with neurofeedback. I had to be away for a month, and while I was gone, Tony’s father had a stroke. Tony also quit his new job in a rage and went out drinking several times with friends. The bright spot was that he found that soon after the initial binge, he didn’t want to drink at all. “I just don’t like it anymore.”
The stress of his father’s illness, coupled with the absence of training, accounted for the lapses in his ability to regulate his temper. All brains, particularly early in training, can default to older, familiar patterns of firing. Tony, however, was discouraged by his failures. I asked that he withhold his judgment while we continued to train.
Over the next several sessions, Tony spoke to me with increasing openness about his two most important relationships, his father and his girlfriend. He was still reporting problems with anger and depression, but he began to have more insight into these problems. He talked about his anger at his father, who was now recovering, and his feelings about his deceased mother. Talking like this was new to him, but he hardly seemed to notice. Almost inadvertently, he’d started to engage in talk therapy as well as neurofeedback. This isn’t uncommon with people who come in only for neurofeedback—the training enhances clients’ ability to relate.
At the twelfth session, Tony told me, “You might be interested. I read an entire book, for the first time.”
“What did you read?”
“A book about Vietnam. I’ve always been interested in Vietnam,” he said nonchalantly.
I couldn’t believe that the first book Tony would read, after never voluntarily reading more than a paragraph, was historical nonfiction! The brain’s electrical “short-circuits” had repatterned themselves and the printed page became accessible. The training was working. It was organizing him cognitively and quieting him emotionally.
Tony trained for 10 additional sessions. By the end, he was reading every day and we were talking at every session. He was holding down a steady job on a road crew and making plans for his future. He no longer suffered panic attacks, had stopped drinking, and had ended the relationship with his girlfriend, which he realized was destructive. He was sleeping well and rarely had explosive outbursts. He felt that neurofeedback had been more helpful to him than anything else he’d done, and that he’d accomplished most of what he’d sought to achieve. Most important perhaps, he felt good about himself.
I ran into Tony a year and a half later. He’d opened his own retail business. He was working at another job part time to support his fledgling endeavor, but would soon be making enough money to devote himself entirely to his new enterprise. I asked him, with equal parts curiosity and trepidation, if he was still reading. “Oh yeah.” he said, “that stuff you do must work.” He was reading a book on management, and he read fiction for pleasure. An inveterate channel surfer before neurofeedback, he no longer watched TV. The brain regulation that he’d learned in less than 12 hours of actual training time had held for 18 months without any further intervention, without any further training, with little psychotherapy, and with no medication.
Tony’s case demonstrates that biofeedback directly to the brain can help organize brain function, both cognitively and emotionally. It can do so predictably and efficiently, and it can do so even for the large part of the population in need of help who, like Tony, have no interest in psychotherapy. Through reducing overarousal, boosting underarousal, and organizing the brain to function closer to its optimal capacity, neurofeedback enhances clients’ ability to relate and, in many cases, makes therapy with them not only possible, but more deeply rewarding.
