American Psychiatric Assoc. Annual Meeting May 11, 2005, Atlanta
Course Title: 491-Using Neurofeedback in Your Practice (Part II): Applications
IX. Educational Learning Objectives: At the conclusion of this course, the participant should be able to recognize indications for neurofeedback in a psychiatric practice, identify how neurofeedback can compliment medication usage, and develop a relevant program of continuing education in the field.
X. Course Description
How can Neurofeedback (EEG Biofeedback) be integrated into the practice of a reasonably tech-savvy psychiatrist?
Neurofeedback creates changes in brain neuronal activation that impact clinical syndromes. Beyond well-known effects on arousal and attention mechanisms and its role in the treatment of ADHD, recent exponential growth of clinical research and experience has led to its application in a wide range of disorders. With applications as disparate as mood and anxiety disorders, Tourettes syndrome, post-traumatic brain injuries, attachment disorders, PTSD, substance abuse, and adolescent acting out, neurofeedback mirrors the scope of many general psychiatric practices. Neurofeedback is complementary to dynamic psychotherapy.
This course will focus on those applications. While apposite research will be reviewed, and some of the fascinating theoretical issues of brain self-regulation and plasticity will be noted, this four-hour course will be directed with an eye on practical issues.
Faculty are practitioners invited for their exceptional teaching ability.
XI. Target Audience: Adult and Child Psychiatrists in Clinical Practice who have taken the introductory course, or are considering using neurofeedback applications in clinical work.
XII. Format: Lecture & Discussion
Use Neurofeedback in Psychiatric Practice (Part II):
Intermediate level theory and practice
XIII. Course Time Schedule 4 hours, total
Thomas M. Brod, MD, Course Director
Michael Cohen, Course Co-Director
Angelo Bolea, Ph.D.
Stephen E. Buie MD
Wm Scott, BSW
Sebern Fisher, MA
Emily Stevens, Ph.D.
Michael OBannon, Ph.D.
Introduction: Neurofeedback Interventions and the Self-Regulating Brain (Brod) 20 minutes
In-Patient Psychiatric Populations (Bolea) 25 minutes
Mood and Affect Regulation, Bipolar Disorder (Buie) 25 minutes
Audience discussion 15 minutes
Substance Abuse (Scott) 25 minutes
Audience discussion 10 minutes
[subtotal 2:00 hrs]
Break 20 minutes
PTSD (Fisher) 25 minutes
Audience discussion 10 minutes
Adolescent Disturbances (Stevens) 25 minutes
Audience discussion 10 minutes
Practical Issues for Clinicians (Cohen/OBannon) 20 minutes
Closing: Audience discussion with faculty & Evaluations 10 minutes
[subtotal 2:00 hrs]
XIV. Outline of Each Faculty Members Presentation
Introduction: Neurofeedback Interventions and the Self-Regulating Brain
Thomas M. Brod, MD, DFAPA
Pondering the EEG and neurofeedback
The complexity problem of EEG dynamics for neurofeedback
Neurofeedback, complexity & brain plasticity
The psychobiology of gene expression
The issues of cortical coupling, phase shifts, and neurotherapy
Signal propagation and inhibition
The implications of static vs dynamic models (non-locality issues)
Neurofeedback Intervention with Inpatient Psychiatric Population
Angelo S. Bolea, Ph.D.
Types of Psychiatric Conditions Treated with Neurofeedback
Complex Head Injury, Seizure, Tourette, OCD, Capgras, Dementia
Selection of Brainwave Rhythms to be Modified
Placement of Sensors on the Scalp
Length and Number of Sessions
Rationale: Applied Brain function, Neurodisconnecion Hypothesis
EEG Spectral Analysis
Changes in Behavioral Management
Changes in Cognition, Thought & Affect, Self Regulation
Enchanced Benefit from Other therapies: Psychotherapy, Milleau Rx
Enhanced responsiveness to Medication
Community Placement (after 10-20 years in hospital)
Treatment of Bipolar Disorder with Neurofeedback
Stephen E. Buie, M.D., D.F.A.P.A.
EEG Biofeedback: An Overview and Key Points
Functional Brain Anatomy and Mood
Core Concept: Brainwave training and Timing Disregulation
Case Study 50 y/o male bipolar disorder
Effective therapy changes the brain
Problems Associated with Frontal Lobe Dysfunction
Rhythm and the Thalamus The Conductor of the Symphony
Case Study Conclusion
Wm. Scott, BSW
Alpha-Theta Feedback for Substance Abuse
Alpha-theta is brain state training
Alpha - Reducing abnormal alpha reduces reactivityincreasing ability to interact mindfully with their environment.
Theta - Deep state theta associates with hypnogogic states
Crossover (alpha amplitude drops below theta)
seems to enable one to experience arousal stimuli without conditioned reactions
Alpha-Theta Feedback - Information, control, change of emotional states
Biofeedback Process Overview -
Typical Treatment Progression
Historic Research Review
Cri-Help Abstinence Study
Neurofeedback in the Treatment of PTSD & Attachment Disorders
Sebern F. Fisher M.A.
Affect Regulation Disorder
Fear, Shame, Despair and Rage
Borderline Example with Neurofeedback
PTSD in Children
Brain Development and Affect Regulation
Implications of Schores work on right hemisphere training
Neurofeedback and Neuronal Flexibility
Fear and PTSD
Child PTSD Example
Impact of Neurofeedback on Pregnant Female PTSD and Fetus/Baby
The Role of Neurofeedback in Treating Adolescents
Emily Stevens, PhD
Full Array of Diagnosis
ADHD, OCD, ODD, CD, PTSD, Depression, Bipolar, Anxiety, Substance Abuse
Clinical Settings: inpatient, residential, outpatient
Etiological considerations and relevant questions
Inpatient & Residential - Does neurofeedback play a role in these types of settings?
Neurofeedback Interventions - Case Studies
Outpatient Setting - addressing panoply of issues
Practical Issues For Psychiatrists Considering Neurofeedback
Michael Cohen, Michael OBannon Ph.D.
How do you get professional training for Neurofeedback?
What's the learning curve to become proficient?
What's the number and length of sessions for patients?
Is it practical for a psychiatrist to do it him/her-self?
What are the staffing requirements?
What reimbursement/insurance coverage is common?
How do you narrow your choices if you want to get started?
What referral sources are available?
Closing: Audience discussion with faculty 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: 75-86XVI. List of Relevant Web Sites, Faculty E-mail Addresses:
T.M. Brod, MD: email@example.com www.bol.ucla.edu/~tbrod
M. Cohen: firstname.lastname@example.org www.eegspectrum.com
Angelo S. Bolea, Ph.D: email@example.com
Stephen E. Buie, MD: firstname.lastname@example.org
Wm Scott, BSW: email@example.com www.eegbiofeedback.com
Sebern Fisher, MA: firstname.lastname@example.org
Emily Stevens, PhD: ChattaNeuro@aol.com
Michael O'Bannon PhD: email@example.com
Intl Society for Neuronal Regulation: www.isnr.org/index.html
Assoc. for Applied Psychophysiolgy and Biofeedback: www.aapb.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. The first placement of electrodes (sensors) in treatment of serious Inpatient Psychiatric conditions is:
A. Left frontal.
C. Right parietal.
2. Neurofeedback with bipolar disorder usually:
A. Supplants the necessity of medication management
B. Addresses underlying brain dysrhtymia.
C. Contributes to regression to the mean.
D. Is GABAergic.
3. Depression has been typically associated with:
A. Right frontal hypoactivation.
B. Left frontal hypoactivation.
C. Right parietal hypoactivation.
D. Left parietal hypoactivation.
4. M. Barry Stermans initial research with human eeg biofeedback was with:
A. Seizure disorders.
B. Human sleep disorders.
D. NASA gravitation devices.
D. Feline Amotivation Syndrome.
5. What does the term crossover mean?
A. The amplitude of beta crossing over theta.
B. The amplitude of alpha dropping below theta.
C. The amplitude of delta crossing over theta.
D. The amplitude of alpha crossing over beta.
E. Relapse into substance abuse.
6. Which of the following is the best evidence of proper alpha-theta protocol administration?
A. Sleep improves.
B. Brain maps and p300s improve to normal levels.
C. Frequency, duration, and intensity of symptoms is improving across sessions.
D. The patient becomes more animated.
E. Rise in SMR amplitude averages.
7. The latest alpha-theta research suggests:
A. Most improved variables are similar to chance but are in the right direction.
B. Replication studies are more difficult than evidence-based psychotherapeutic research because there are too many variables to control for.
C. Alpha theta training is likely more than just a relaxation exercise.
D. Beta smr training benefited music performance as much as alpha theta training which illuminates the placebo phenomenon.
E. PTSD is unresponsive.
8. Which patient population would be least likely to respond to FPO2 sensor placement?
A. AIDS orphans.
C. Unadopted children.
D. Children with OCD.
E. Children with right frontal head trauma.
9. Outpatient Neurofeedback of adolescents is not indicated for:
A. Peak Performance.
B. Addressing frontal lobe development issues and teen behavior.
C. Increasing performance and college prep.
D. Postpartum psychosis.
XVIII. Self-Assessment Answers
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. 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
5. Abstracts of selected clinical neurofeedback papers.