More Info on Neurofeedback
Train for a Clear Mind
EEG "Brainwave" Neurofeedback and Biofeedback :
a few notes by Thomas M. Brod, MD
Distinguished Fellow, American Psychiatric Assn.
Sr. Fellow, Biofeedback Certification Inst. of America
Assoc. Clinical Professor, Psychiatry, UCLA
topics
ADHD, Inattention, Hyperactivity,
revised March25 , 2008
EEG Neurofeedback, sometimes called "brainwave biofeedback" has had enormous growth as a clinical field since 1989 when I brought it into my practice of mind-body medicine, Self-Regulation Medical Group.
From the start, I was most interested in "states of mind" and how to deepen relaxation training through what was known as "alpha-theta" training. But I was fascinated to be able to apply new research for other applications ("SMR/Beta" training) for seizure disorders, ADHD and attention/inattention disorders (hyperactivity and executive dysfunction), headaches, sleep disorders...and the list has kept growing. (See More than Stress Management, below). Recently, I have been exploring neurofeedback in the management of bipolar mood disorders, panic, and head injuries with satisfying results. A clear mind allows the most powerful states of mind.
Over the years, I realized that eeg neurofeedback does not really work on the basis of operant conditioning (although that and classical conditioning are part of the story). The brain is an organ dedicated to information processing of vast complexity, and the brain's "modules" communicate in linked systems that go beyond simple nerve-to-nerve signals. The non-linear dynamic model allows us to conceive of neurofeedback as a kind of brain exercise--we give the brain information about itself and it responds complexly and dynamically to change its patterning more adaptively...remodeling through self-regulation, not because we are telling the EEG "waves" how to change.
If you are looking for basic eeg or brainwave neurofeedback information.... A good web site to start looking into clinical neurofeedback is the site of the International Society for Neurofeedback and Research.
There are many other sites loaded with information; some are EEG Spectrum International, EEG Info The Complete Neurofeedback Resource, Additionally, AboutNeurofeedback.com offers information for new practitioners, but currently is in need of updating. These sites also list practitioners as do Zengar, Ochslabs, AAPB, BCIA, and ADNF (Europe).
Regarding EEG Neurofeedback equipment, I currently use three systems, Zengar NeuroCare Pro, BrainPaint, and LENS (Low-Energy Neurofeedback System) Each of these systems are on the leading edge of innovation in the field, each taking a different approach to brain self-regulation through non-linear dynamic feedback and highly sophisticated digital signal processing. In these systems, the computer-brain interface is feedback about the dynamics of brain electrical activity (= information) back to the brain in a kind of machine language that the brain uses without thinking about it. The first two systems are classic biofeedback, in that they put nothing into the brain but information. Unlike the others, the LENS system makes use of a very small spectrum of extremely low level electromagnetic energy in the wires of the sensors to inform the brain about the moment-to-moment dominant/peak EEG frequency.
In my opinion, the best program for working at home on relaxation and self-regulation skills is the Healing Rhythms program from www.wilddivine.com. In the office, my staff and I can teach you how to make the best use of that program in your own home.
One of the most under-reported uses of EEG neurofeedback is its applications related to marijuana. You will find my comments at the bottom of this page.
This page is developing. Ultimately, EEGym ®- Self Regulation Medical Group, will offer more detailed information about EEG neurofeedback and biofeedback on-line--and the opportunity to request more detailed information.
Since 1979
Self-Regulation Medical Group
has been a leading force in
Mind-Body Medicine.
EEG Neurofeedback...more than Stress Management...
for:
• Anxiety/Panic;
• Attention Disorders and other problems with concentration and executive function;
• Head injury; closed head trauma, concussion, "whiplash" type brain microtrauma (including sports injuries); and other "foggy brain" conditions; see comments, below.
• Migraine and other Headaches;
• Hypertension;
• Tinnitus;
• Pain;
• Irritable Bowel;
• & Sleep Problems, etc;
• Mood and energy disorders; .
• Psychological trauma (old wounds) and emotional shock (PTSD);
• Smoking Cessation- Stop Smoking Program;
• Substance Abuse/Marijuana Clean-up (see comment below).
Self-Regulation Medicine utilizes a collaboration between physician and patient and may include choices from many effective treatments:
--Brief, Ultra-brief, and/or Long-term Intensive (psychoanalytic) therapy;
--Biofeedback, EEG Brainwave biofeedback (neurofeedback), EFT, EMDR, Hypnosis;
--Medication, when appropriate, and Neutraceuticals.
For information, 2008 American Psychiatric Association Neurofeedback course , please go to "Course/Program Material "
Click For a current bibliography on EEG Neurofeedback (prepared Sept '07 for the '08 Course in Washington DC May 3.
ADHD--Hyperactive and Inattentive Types--and Neurofeedback:
Research (and a comment)
ADHD in children and adolescents is the area of EEG neurofeedback with really strong research to support the enthusiastic claims of clinicians. In my opinion, the best review article was published by Vincent Monastra PhD in the January 2005 edition of Child & Adolescent Clinics of North America (volume 14:1, pp. 55-82)
Dr. Monastra has posted his paper online. You can find it at http://www.theadhddoc.com/research_papers.php. Scroll down to the abstract for EEG Biofeedback (Neurotherapy) as a Treatment for Attention- Deficit/Hyperactivity Disorder:Rationale and Empirical Foundation and click on "Open Full Research paper."
Monastra's own research includes one of the best clinical studies done so far. To summarize--which is hardly fair to either the reader's curiosity or Dr. Monastra's intricate design--multiple measures demonstrated that neurofeedback was approximately as effective at treating ADHD symptoms and signs as medication, did not have adverse effects, and sustained after treatment over the long-term follow-up which stimulant medication did not.
Monastra's study has been carefully reviewed by David Rabiner PhD. He offers a thoughtful critique of the limitations of the study but concludes, "These results provide compelling evidence that incorporating neurofeedback into a comprehensive treatment approach for ADHD can yield important benefits." A version is available on the web site of the Attention Deficit Disorder Association, http://www.add.org/articles/TheRoleofNeurofeedbackintheTreatmentofADHD.html
Additional comment: It is a matter of considerable concern and frustration to my colleagues and myself that neurofeedback is not an industry and does not have the resources to support either sophisticated coordinated research or major marketing budgets to grab and hold the attention of practicing and academic physicians. For instance, every week I personally receive at least one or two, often more, publications presented in the format of medical journals or supplements to recognizable publications devoted to some aspect of ADHD. These are all "educational material" clearly targeted toward increased use of medications. Yes, they are helpful in raising physician awareness of ADHD and its co-morbidities, but I have never seen an informed comment about neurofeedback and ADHD (very rarely, there will be a highly qualified tag in a section on "other psychological approaches" in which EEG neurofeedback gets a passing mention). I stopped writing letters to the editorial staff about this a couple of years ago.
A particularly annoying example arrived last week. Date, February 2008. Title, Optimizing Patient Outcomes in Adult ADHD: Current and Emerging Therapies. It contained two articles in a large-format 4-page supplement to Psychiatric TImes, called Advances in Psychiatric Medicine. At the bottom of the front page was, "Supported in part by an unrestricted educational grant from Shire Pharmaceuticals, Inc." Included in the Disclosures statement was the following: "The editors of this educational activity have no financial relationship with the firm providing support in part by an unrestricted educational grant." I have nothing against Shire Pharmaceuticals; I write prescriptions for their Adderall XR and Vyvanse because they help my patients. But I recommend neurofeedback much more frequently because it too is helpful to my patients. Often remarkably so. Why isn't eeg or brainwave neurofeedback considered by this and so many other publications to be "current and emerging"? Question asked and answered!
• APA poster, 2002: Type-Specific EEG Biofeedback Improves Residential Substance Abuse Treatment
Additional comments on Marijuana, Medical Marijuana, and Amotivation Syndrome
One of the most under-reported uses of EEG neurofeedback is its applications related to marijuana.
Neurofeedback tends to spontaneously diminish marijuana use. I and other clinicians have unexpectedly observed over the years that people who come for ADHD treatment and have been using marijuana regularly and heavily tend to stop using it.
This surprising shift away from marijuana use is not usually an original goal of the patient (to say the least!) and has not been directly addressed during the treatment. It just seems that people lose interest in using marijuana when their brains are working better, their minds are clearer.
I assume that the well-known "amotivation syndrome" of marijuana dependence thus responds to EEG Neurofeedback indirectly through two mechanisms, re-turning executive function and refining self-regard, while generally increasing brain efficiency and self-regulatory capacity.
Medical Marijuana
Under federal law (the Controlled Substances Act of 1970) marijuana use for any purpose is illegal. The federal law has not stopped a number of states from enacting medical marijuana legislation. California was one of the first.
On November 5, 1996, the people of California passed Proposition 215. Through this Initiative Measure, Section 11362.5 was added to the Health & Safety Code, and is also known as the Compassionate Use Act of 1996. The purposes of the Act include, in part:
"...To ensure that seriously ill Californians have the right to obtain and use marijuana for medical purposes where the medical use is deemed appropriate and has been recommended by a physician who has determined that the person's health would benefit from the use of marijuana in the treatment of cancer, anorexia, AIDS, chronic pain, spasticity, glaucoma, arthritis, migraine, or any other illness for which marijuana provides relief..."
Despite conflict with federal law, the Medical Board of California positively sanctions medical marijuana as " an emerging treatment modality."
COMMENT: It seems to me, however, that most of the indications for medical marijuana--other than appetite stimulation and glaucoma--usually respond to neurofeedback.
My opinion is that, for those suffering the more extreme conditions of pain, spasticity, sleep disorder and chemotherapy side-effects, most people would do well to consider neurofeedback and the powerful LENS system before turning to medical marijuana.
HEAD INJURY--Often Forgotten and Too Often Dismissed
Head Injuries are a common cause of many patients' problems with attention, concentration, ability to plan efficiently and carry out their plans. Recent work also suggests that a substantial number of substance abusers may have had head injuries before their drug and alcohol use got out of control. Yet, a significant number of those patients have "forgotten" their accident of injury (see Dr. Daniel Amen's many books or his web site BrainPlace.com for some helpful examples). Patients with significant lingering problems in functioning often have to be asked repeatedly whether they have had a concussion or head injury.
And it is common for patients who suffered a sharp blow to the head to have temporary impairment of consciousness or confusion--yet even those with significant problems who have been medically checked out are often dismissed because a clinical neurological examination or MRI can came out "normal" (an MRI can only reveal the anatomical disruption, not the kind of disruption that happens at the microscopic level where brain cells function--it takes a special examination of brain function such as a SPECT or PET brain scan to such injuries). Careful neuropsychological testing would reveal cognitive impairments, but these tests require hours of examination by a specialized psychologist. (Incidentally, at our office, we have a standardized computer-based cognitive screening battery that takes an hour to complete that can document impairments in several spheres of mental functioning).
Concussions with transient loss of consciousness may be associated with an absence of memory for the injury and even a few moments before ("retrograde amnesia"). But the phenomenon of underplaying the importance of, and forgetting, head injuries seems to be a separate issue.
Len Ochs, PhD, who devised the LENS neurofeedback system, has a theory that right after minor brain injuries and other "insults" the brain sort of seals itself off--builds an inhibition network--as a self-protective device. An analogy would be "muscle bracing" after a physical injury. We know empirically that LENS neurofeedback is remarkably effective for reversing cognitive effects of so-called "minor" head injury (and see Stephen Larsen's book, The Healing Power of Neurofeedback for examples of recovery from more substantial injuries and stroke).
On January 30, 2008 , the Wall Street Journal ran a piece about the serious effects of long-forgotten injuries entitled, "Studies Cite Head Injuries As Factor in Some Social Ills", discussing new research indicating that hidden traumatic brain injuries can cause social or educational failure, such as alcoholism or homelessness. Two quotes from the article highlight the significance of this issue:
- "Unidentified traumatic brain injury is an unrecognized major source of social and vocational failure," says Wayne A. Gordon, director of the Brain Injury Research Center at Mount Sinai School of Medicine in New York, where much of the research is being done.
- In 2006, Mount Sinai's Dr. Gordon began to work with Common Ground, a New York nonprofit that builds housing for the homeless. About 70% of 100 homeless people they tested came out in the 10th percentile or lower for memory, language or attention, says the group's director of psychiatric services, Jennifer Highley. Questioning uncovered that 82% had a significant blow to the head prior to becoming homeless, usually from severe parental abuse during childhood.