APA 2005 Part I

Course Title: 430 - Using Neurofeedback in Your Practice, Part I:
Introduction, With Live Demonstration

IX. Educational Learning Objectives: At the conclusion of this course, the participant should be able to understand EEG basics, how training the EEG effects brain and mental function, recognize indications for EEG biofeedback (neurofeedback), understand how neurofeedback procedures are performed, and evaluate clinical neurofeedback research.

X. Course Description
How can a disregulated brain become better regulated? How do you train improved neuroregulation, and what are the clinical implications?

Neurofeedback, uses biofeedback to help change the brain. It’s a technology-based intervention to accelerate clinical outcomes. The course focuses on how it works, and how it's applied clinically. You'll review: 1) How to train the EEG; 2) how training changes arousal, activation, and inhibition; 3) what symptoms change; 4) a review of the research and underlying science. You'll also get to watch (or participate) in a live demonstration.

XI. Target Audience: Adult and Child Psychiatrists in Clinical Practice

XII. Format: Workshop/Demonstration and Lecture

Using Neurofeedback in Your Practice: Introduction with Hands-On Experience

XIII. Course Time Schedule 4 hours, total

Faculty
Thomas M. Brod, MD, DFAPA, Course Director
Michael Cohen, Course Co-Director
Angelo Bolea, PhD
Sebern Fisher, M.A.
Michael O’Bannon, Ph.D.
Emily Stevens, Ph.D.

Introduction (Brod) 20 minutes
EEG basics & Live Demonstration [audience discussion] (Cohen/Brod) 40 minutes
NF Clinical Applications (Fisher) 30 minutes
Audience discussion 10 minutes
break 20 minutes

[subtotal 2:00 hrs]

Research Review including critique (O’Bannon) 30 minutes
Audience discussion 10 minutes
NF and Affect Regulation (Bolea) 25 minutes
Models of How NF “Changes” the Brain (Stevens) 25 minutes
How is NF used in a Psychiatric Practice (Brod) 10 minutes
Audience discussion 10 minutes
Closing: Audience discussion with faculty 10 minutes

[subtotal 2:00 hrs]

XIV. Outline of Each Faculty Member’s Presentation

Introduction (including introducing speakers, outline of the program, video demo)
Thomas M. Brod, MD
Historical Overview, “Training” and the Self-Regulation Model

What is Neurofeedback?
Michael Cohen

Target brain problems based on neuropsych and imaging data
EEG basics and correlation to brainstates - review
How to identify brain disregulation in the EEG
How does it work?
LIVE DEMO [audience discussion] (Cohen/Brod)

Neurofeedback Clinical Applications
Sebern Fisher, M.A.

Clinical Applications for Neurofeedback (survey)
Regulating attention and behavior
Regulating Affect
Case Vignettes Asperger’s; Depression, PTSD; Rage Disorder
Seemingly diverse conditions all responded to neurofeedback training
Audience discussion

break

Research Review
Michael O’Bannon, Ph.D.

Overview of the status of research.
Issues and difficulties with research on neurofeedback.
Attention deficit disorders (ADD and ADHD).
Neurofeedback effects on cognitive functions.
Seizure disorders.
Anxiety-based disorders (GAD, PTSD, DID, and OCD).
Substance abuse treatment.
Depression.
Autism.
Summary of efficacy research.
Indications for use of neurofeedback.

Audience discussion

Neurofeedback and Affect Regulation
Angeleo Bolea, PhD

Affect Regulation and Neurofeedback
Case examples – interventions with range of Affect Disorders

Models of How Neurofeedback “Changes” the Brain
Emily Stevens, Ph.D.

Neurofeedback Theories of Brain “Change” Over Time
Symptom/Diagnosis Brainwave Change
Behavior Training Model
Arousal Mechanisms Model
Re-organization Model
Neurobiobehavioral Model
Models of How Neurofeedback “Changes” the Brain
Conclusion: research supports all of the models, only the neurobiobehavioral model considers all the mechanisms for change.

How is NF used in a Psychiatric Practice --dialogue with audience
Thomas M. Brod, M.D.

Audience discussion
(all faculty)
Closing and Evaluations

XV. Literature References

Barabasz A., & Barabasz M. Treating AD/HD with hypnosis and neurotherapy. Child Study Journal, 2000; 30(1), 25-42.

Brod TM: Notes on brainwave biofeedback for young people: AD/HD and related issues. in Incorvia JA, Mark-Goldstein BS, and Tessmer D (eds): Understanding, Diagnosing And Treating AD/HD Children And Adolescents. Jason Aronson 1999

Chabot RJ, diMichele F, Prichep L, John ER:The clinical role of computerized EEG in the evaluation and treatment of learning and attention disorders in children and adolescents. J Neuropsychiatry and Clin Neuroscience, 2001; 13: 171-186

Egner T, Gruzelier JH Learned self-regulation of EEG frequency components affects attention and event-related brain potentials in humans. Neuroreport 2001, 12:411-415

Egner T, Gruzelier JH Ecological validity of neurofeedback: modulation of slow wave EEG enhances musical performance. Neuroreport 2003a, 14:1223-1228

Egner T, Gruzelier JH EEG biofeedback of low bnd beta components: frequency-specific effects of variables of attention and event-related brain potentials. Clinical Neurophysiology, 2003b, in press

Evans J, Abarbanel A (eds), Quantitative EEG and Neurofeedback, San Diego, Academic Press, 1999

Fisher S Riding the Waves: Neurofeedback: A breakthrough withlearning disabilities? Psychotherapy Networker, Sept/October, page 77-83. 2004

Fuchs T, Birbaumer N, Lutzenberger W, Gruzielier JH, Kaiser J, Neurofeedback treatment for attention-deficit/hyperactivity disorder in children: a comparison with methylphenidate, Appl Psychophys Biofeedback 2003 Mar 28 (1):1-12

Goldberg E, The Executive Brain: Frontal Lobes And The Civilized Mind, Oxford, 2001

Hammond C. QEEG-Guided Neurofeedback in the Treatment of Obsessive Compulsive Disorder, Journal of Neurotherapy, 2003; Vol 7(2)

Hammond DH, Adverse reactions and potential iatrogenic effects in neurofeedback training (Clinical Corner), J of Neurotherapy, 2001; 4:57-69.

Hammond DC: Medical justification for neurofeedback with ADD/ADHD. Journal of Neurotherapy, 2000; 4(1), 90-93.

Jarusiewicz, B. Efficacy of Neurofeedback for Children in the Autistic Spectrum: A Pilot Study, Journal of Neurotherapy, 2002; Vol 6(4), 39-49

Kaiser DA, Othmer S: Effect of Neurofeedback on variables of attention in a large multi-center trial. Journal of Neurotherapy, 2000 4(1), 5-15.

Lantz D, & Sterman MB: Neuropsychological assessment of subjects with uncontrolled epilepsy: Effects of EEG biofeedback training. Epilepsia, 1988; 29(2), 163-171.

Loo SK, EEG and neurofeedback findings in ADHD The ADHD Report, 2003,. 11:3, 1-4

Lubar JF: Neocortical Dynamics: implications for understanding the role of neurofeedback and related techniques for the enhancement of attention. Applied Psychophysiology and Biofeedback, 1997 22: 111-25.

Lubar JF and Lubar JO: Neurofeedback assessment and treatment for attention deficit/hyperactivity disorders. in Evans JR and Abarbanel A (eds): Introduction to Quantitative EEG and Neurofeedback Academic Press 1999

Masterpasqua, F; Healey, KN Neurofeedback in Psychological Practice; Professional Psychology: Research & Practice, 2003; Vol 34(6), Dec. pp. 652-656

Meyer-Lindenberg A, Ziemann U, Hajak G, et al:. Transitions between dynamical states of differing stability in the human brain. Proc Natl Acad Sci U S A. 2002; Aug 20;99(17):10948-53.

Monastra VJ, Lubar JF, Linden M: the development of a quantitative electroencephalographic scanning process for attention deficit hyperactivity disorder: reliability and validation studies. Neuropsychology, 2001 15: 136-144.

Monastra VJ., Monastra DM., & George,S. . The effects of stimulant therapy, EEG biofeedback, and parenting style on the primary symptoms of attention-deficit/hyperactivity disorder. Applied Psychophysiology & Biofeedback, 2002, 27(4), 231-249.

Nash JK, Treatment of attention-deficit hyperactivity disorder with neurotherapy. Clinical Electroencephalography 2000, 31(1), 30-37

Peniston EG, Kulkosky PJ: Alpha-theta brainwave training and beta-endorphin levels in alcoholics. Alcohol: Clinical & Experimental Research, 1989; 13(2), 271-279.

Peniston EG, Marrinan DA, Deming WA, and Kulkosky PJ: EEG alpha-theta brainwave synchronization in Vietnam theater veterans with combat-related post-traumatic stress disorder and alcohol abuse. Adv Med Psychotherapy 1993 6: 37-30

Pulvermuller F, Mohr, Schleichert H, Veit, R: Operant conditioning of left hemispheric slow cortical potentials and its effect on word processing. Biological Psychology, 2000; 53, 177-215.

Rosenfeld JP: An EEG Biofeedback Protocol for Affective Disorders. Clin Electroencephalography 2000:7-12
Rossiter, T.R., & La Vaque, T.J. A comparison of EEG biofeedback and psychostimulants in treating attention deficit/hyperactivity disorder. Journal of Neurotherapy, . 1995; 1, 48-59

Ryback R, Bioelectrical modulators and the cell membrane in psychiatric medicine. Psychopharmacology Bulletin 35: 4,Autumn 2001, 5-44

Sacks O, Migraine, Vintage 1999

Scott W, & Kaiser D: Augmenting chemical dependency treatment with neurofeedback training. Journal of Neurotherapy, 1998;3(1), 66.

Scott W, Kaiser D. Sideroff S, et al, Reduction in substance abuse recidivism when neurofeedback is a component of treatment. A J Alcohol Drug Abuse (in press) 2005

Schore A, Affect Regulation and the Origin of the Self,., Laurence Erlbaum, 1994

Schore A, Affect Dysregulation and Disorders of the Self,.,Norton, 2003

Schore A, Affect Regulation and the Repair of Self, Norton, 2003

Sterman MB, Howe RD, Macdonald LR: Facilitation of spindle-burst sleep by conditioning of electroencephalographic activity while awake. Science, 167, 1970; 1146-1148.

Sterman MB: Basic concepts and clinical findings in the treatment of seizure disorders with EEG operant conditioning. Clinical Electroencephalography, 2000;31(1), 45-55.

Sterman MB: Physiological origins and functional correlates of EEG rhythmic activities: implications for self-regulation. Biofeedback and Self-Regulation 1996 21:3-34

Tinius TP, Tinius KA: Changes after EEG biofeedback and cognitive retraining in adults with mild traumatic brain injury and attention deficit disorder. Journal of Neurotherapy, 2001; 4(2), 27-44.

Uhlmann C, Froscher W. Biofeedback treatment in patients with refractory epilepsy: Changes in depression and control orientation. Seizure 2001, 10(1), 34-38.

Vernon D, Egner T, Cooper N, Compton T, Neilands C, Sheri A, Gruzielier J, The effect of training distinct neurofeedback protocols on aspects of cognitive performance. Intl J Psychophys, 2003, 47: 75-86

XVI. List of Relevant Web Sites, Faculty E-mail Addresses:
T.M. Brod, MD: tbrod@ucla.edu • www.bol.ucla.edu/~tbrod
Michael Cohen: mcohen@yahoo.com • www.eegspectrum.com
Sebern Fisher, MA: sebern.fisher@verizon.net
Michael O'Bannon PhD: mob@mindspring.com.
Emily Stevens, PhD: ChattaNeuro@aol.com
Int’l Society for Neuronal Regulation: www.isnr.org/index.html
Assoc. for Applied Psychophysiolgy and Biofeedback: www.aapb.org
FutureHealth: www.futurehealth.org
Pubmed - abstacts: www.ncbi.nlm.nih.gov/entrez/query [search for Neurofeedback or EEG Biofeedback]
The discovery of EEG (from: Jim Hardt): http://biocybernaut.com/tutorial/eeg.html

XVII. Self-Assessment Questions

1. EEG represents the complex summation of:
A. Action potentials
B. Spikes
C. ERPs
D. Post-synaptic potentials (PSPs)

2. When you see excessive delta in the EEG while the patient is trying hard to do a task, the patient:
A. Is thinking
B. Didn't have enough sleep last night
C. It highly agitated
D. Cannot perform the task at an optimum level

3. Depression has been typically associated with
A. Right frontal hypoactivation
B. Left frontal hypoactivation
C. Right parietal hypoactivation
D. Left parietal hypoactivation

4. Frequency bands take information from the raw EEG and:
A. Filter it and display it
B. Average it over the total spectrum
C. Always uses 4-7, 12-15, and 22-30 hz
D. Analyze emergent variability

5. The sensorimotor rhythm is deemed to reflect the following:
A. The state of vigilance of the subject
B. The cortical stability of the subject
C. Motor system excitability
D Sensory acuity

6. The EEG neurofeedback training promotes higher EEG amplitudes for the following reasons:
A. Higher amplitudes are associated with the desired higher activation
B. Higher amplitudes trains the activation-relaxation dynamics
C. Higher amplitudes in the EEG are associated with greater cortical stability
D. Higher amplitudes are associated with improved signal-to-noise ratio.

7. M. Barry sterman’s initial research with EEG biofeedback was with:
A. Seizure disorders
B. Human sleep disorders
C. ADHD
D. Substance abuse

8. Controlled studies of EEG conditioning have been performed for the following conditions (name the exception):
A. Seizures
B. Attention Deficit Hyperactivity Disorder
C. Alcoholism
D. Tourette syndrome

XVIII. Self-Assessment Answers

1. D
2. B
3. B
4. A
5. C
6. B
7. A
8. D

XVIX. Background Articles

1. Brod TM: Notes On Brainwave Biofeedback For Young People: AD/HD and related issues. in Incorvia JA, Mark-Goldstein BS, and Tessmer D (eds): Understanding, Diagnosing And Treating AD/HD Children And Adolescents. Jason Aronson 1999

2. Egner T & Gruzelier JH, Learned self-regulation of EEG frequency components affects attention and event-related brain potentials in humans, NEUROREPORT 2001;12:4155-4159

3. Hammond DH, Adverse reactions and potential iatrogenic effects in neurofeedback training (Clinical Corner), J of Neurotherapy, 2001; 4:57-69

4. Loo SK, EEG and Neurofeedback Findings, in ADHD The ADHD Report, 2003,. 11:3, 1-4

5. Scott W, Kaiser D. Sideroff S, et al, Reduction in substance abuse recidivism when neurofeedback is a component of treatment. A J Alcohol Drug Abuse (in press) 2005

6. Selected abtracts