HEALING THE BRAIN WITH NEUROFEEDBACK

Cindy Perlin, LCSW

Biofeedback

Uses sensitive electronic instruments to detect physiological changes with far greater sensitivity than a person can alone.

This information is used to teach the individual to control their physiology

Biofeedback Modalities

Muscle (EMG) Temperature Heart rate Respiration Skin Conductance (GSR) Brainwave

(Neurofeedback)

Neurofeedback

Training the electrical activity and timing of the brain to improve brain functioning

The first major neurofeedback study was done with cats by Dr. Barry Sterman …

Experimental Work of Barry Sterman, Ph.D.

Sterman trained cats to increase their SMR (12-15hz) through operant conditioning

Showed that cats could be trained to increase SMR

Published in Brain Research, 1967

Dr. Sterman’s Next Study

Studied seizure thresholds for cats’ exposure to rocket fuel.

Some of the cats did not have seizures at the known threshold levels.

Dr. Sterman checked his records and found the seizure resistant cats were the ones who had SMR training.

Avg 2 hours+ for seizures with EEG trained cats vs. 1 hour for untrained cats

Sterman’s original 1967 Study for NASA -Cats exposed to rocket fuel

Sterman’s Work With Humans Dr. Sterman then decided to investigate

whether neurofeedback would help humans with seizure disorders.

His studies showed a decrease in seizure severity and frequency with SMR training.

Patients with seizure disorders who also had ADHD showed an improvement in ADHD symptoms, which led to studies of neurofeedback with people with ADHD.

Characteristics of Brainwaves

Frequency (hertz) Amplitude (microvolts) Coherence (under or over-

differentiation) Location (10-20 System)

10-20 system The International 10-20 System of

Electrode Placement is the most widely used method to describe the location of scalp electrodes.

Each site has a letter (to identify the lobe) and a number or another letter to identify the hemisphere.   

10-20 System

A disregulated brain often has too much slow activity.

This individual’s eyes are open. Their brain isn’t very alert and awake.

This brain is alert and awake. In EEG terms, smaller means more regulated, better functioning.

Delta .5-4 Hz

Predominant in sleep Should be low while awake High delta can interfere with

emotional or cognitive processing

One second

Pre-sleep, trance Inattentive Distractible Lack of focus

One second

Theta 4-8 Hz

Relaxed (parietal) Spacey Unmotivated Inattentive and depressed

One second

Alpha 8-12 Hz

Calm, external attention Regulates impulsivity and

hyperactivity Promotes body awareness Helps control anxiety; anger Movement Inhibition

SMR 12-15 Hz

One second

Active, external attention Enhances cognitive processing Improves concentration, attentiveness,

focus

One second

Beta 15-20 Hz

One second

Body tension High state of arousal Excited / anxious / stressed

High Beta 22-36 Hz

Protocol Selection

Functional Based on presenting symptoms and areas of the brain

known to be related to these symptoms.

QEEG Measurement of amplitudes, frequencies and coherence

at 19 sites Results compared to normative data bases Sites 2 standard deviations or more from the mean are

targeted for training.

Current Clinical Uses ADHD Seizure disorders Alcoholism/substance abuse Traumatic brain injury PTSD Anxiety Depression Chronic Fatigue Syndrome Fibromyalgia Chronic Pain OCD Tourette’s Syndrome

Sleep disorders Autism Asperger’s Bipolar disorder Reactive attachment disorder Peak Performance Age related memory loss Parkinson’s Migraines PMS Schizophrenia

Studies of Neurofeedback

and ADHD Several uncontrolled studies showed that

neurofeedback: Improved attentiveness and impulse control Decreased hyperactivity Raised intelligence scores Improved academic performance

(Grein-Yatsenko et al., 2001; Lubar, Swartwood, Swartwood & O’Donnell, 1995; Thompson & Thompson, 1998)

Controlled studies comparing neurofeedback to other treatments for ADHD

Alhambra, Fowler and Alhambra (1995): After 30 sessions of neurofeedback, 16 of 24 patients

taking medications were able to lower their dose or discontinue medications totally

Monastra, Monastra and George (2002) studied 100 children with ADHD receiving Ritalin,

parent counseling and academic support. 50 children also received neurofeedback.

While all children improved on the TOVA and an ADD evaluation scale while taking Ritalin, only those who had EEG biofeedback sustained those improvements after discontinuing Ritalin.

Studies of Neurofeedback and ADHD (continued)

The most recent study, in China (Xiong, Shi and Xu, 2005):

60 ADHD children studied 40 sessions of neurofeedback Over 90% significantly improved their

scores on the IVA-CPT (Integrated Visual and Auditory Continuous Performance Test)

A Meta-Analysis of 19 Studies of EEG Biofeedback for Epilepsy(Sterman MB, 2000)

82% of studies demonstrated significant seizure reduction

Average reduction exceeded 50% Studies reported reduction in seizure

severity About 5% of patients had complete

control at one year follow-up

QEEG-guided Neurofeedback for Seizure Disorders

Johnathan Walker, MD “trains away” QEEG-identified abnormalities of power (amplitude) and coherence and reports a 100% success rate in patients with partial complex seizures

All patients became seizure free and many were able to stop their anticonvulsant treatment (Walker and Kozlowski, 2005)

Studies of Neurofeedback for Traumatic Brain Injury Neurofeedback appears to improve memory in

persons with brain injury (Thornton, 2000). Neurofeedback improves attention and

response accuracy of a performance task and decreases errors in a problem solving task (Tinius & Tinius, 2000).

Another study showed significant improvement in attention deficits in those receiving neurofeedback compared to a matched control group (Keller, 2001).

Studies of Neurofeedback for Autistic Spectrum Disorders 12 children receiving an average of 36 sessions

of neurofeedback based on functional deficits reduced autistic symptoms by 26% (Jarusiewicz, 2002)

37 children receiving 20 sessions of QEEG-guided neurofeedback showed a 40% decrease in autistic symptoms compared to a control group (Coben and Padolsky, 2007)

Clinical Reports - Depression

Cory Hammond, Ph.D., Professor of Physical Medicine & Rehabilitation,University of Utah School of Medicine:

Treated 25 patients with moderate to severe depressive disorder

Reduced left frontal alpha and increased 12-20hz. Also utilized photic stimulation

Sustained remission of the depression in all 25 patients in 20- 25 sessions

All reduced or discontinued medication

Clinical Reports – Bipolar Disorder

Ed Hamlin, Ph.D., at the Pisgah Institute in Asheville, North Carolina:

Treated about 40 patients with bipolar disorder

Interhemispheric protocol, increasing 11-14 or 13-16hz while inhibiting low frequency and high frequency brainwaves.

All of his patients have been able to significantly stabilize mood and improve functioning while decreasing or eliminating medication.

Case Report - ADHD 10 y.o. female with severe hyperactivity even

though medicated with Ritalin So hyperactive, it was doubtful at first she

could do neurofeedback 90 sessions over about 50 weeks Complete remission of hyperactivity with

improved school performance w/o medication Now age 16, retained improvements without

medication

Case Report – Sleep Disorder

65 y.o. male with 50 year history of delayed sleep onset of 4-5 hours nightly, following month long coma at age 15 due to measles encephalitis

After 8 sessions of SMR neurofeedback, rapid sleep onset even in unfamiliar environments

Case Report – TBI 29 y.o. male, seen 12 years after TBI from

auto accident, 3 months in coma Premorbid severe ADHD Active alcohol abuse at time of referral, with

history of multiple DWI arrests Problems with memory, concentration, word

retrieval, coordination, tremor, headaches, balance and weakness on the left side of his body, as well as frequent temper outbursts

Case Report – TBI (continued) Approximately 250 sessions in 3 years, with a 6

month break in treatment to attend a court mandated alcohol treatment program

1 session Thought Field Therapy for trauma Significant improvement in all presenting

symptoms, as reported by client and family members, including: Over 4 years sobriety Absence of temper outbursts Improved memory and focus Improved strength, balance and coordination Willing to read aloud in public

Case Report – Bipolar Disorder 10 y.o. male, also diagnosed with intermittent

explosive disorder Multiple psychiatric hospitalizations, special

school placement, almost daily explosive episodes

Medications: Lithobid and Abilify 60 sessions Elimination of explosive episodes, improvement

and stabilization of mood, while significantly reducing medication

Typical Neurofeedback Session

Twice a week sessions 20-45 minutes of feedback Auditory and visual rewards

when achieving thresholds 70%-90% reward frequency

Game provides client feedback

Mazes

Space Race

"In my opinion, if any medication had demonstrated such a wide spectrum of efficacy it would be universally accepted and widely used…It is a field to be taken seriously by all." (Editorial, Clinical Electroencephalography, January 2000)

Frank H. Duffy, M.D., Professor and Pediatric Neurologist, Harvard Medical School, wrote about neurofeedback:

Time Magazine, 1/19/07 “For decades the prevailing dogma in neuroscience was that

the adult human brain is essentially… hardwired, fixed in form and function so that by the time we reach adulthood we are pretty much stuck with what we have….The doctrine of the unchanging human brain has had profound ramifications. For one thing, it lowered expectations about the value of rehabilitation for adults who had suffered brain damage from a stroke or about the possibility of fixing the pathological wiring that underlies the psychiatric diseases….But research in the past few years has overthrown the dogma. In its place has come the realization that the adult brain retains impressive powers of ‘neuroplasticity’—the ability to change its structure and function in response to experience. The brain can be rewired.”

www.isnr.org : International Society for Neurofeedback and Research. This site contains a comprehensive bibliography of outcome research in neurofeedback, organized by disorder, as well as journal articles, provider list and other information.

www.eegspectrum.com: EEG Spectrum provides training, information, equipment and an affiliate network for information sharing, consultation and referral.

www.aapb.org: Association for Applied Psychophysiology and Biofeedback is the national biofeedback organization.

Resources: Web Sites

Resources – Books A Symphony in the Brain by Jim Robbins,

Atlantic Monthly Press, New York, 2000 Getting Rid of Ritalin by Robert W. Hill, Ph.D

and Eduardo Castro, M.D., Hampton Roads Publishing Co., Charlottesville, VA, 2002

ADD: the 20 Hour Solution by Mark Steinberg, Ph.D. and Siegfried Othmer, Ph.D., Robert D. Reed Publishers, Brandon, OR, 2004

Contact Information

Cindy Perlin, L.C.S.W.

Phone: (518) 439-6431

E-Mail: cperlin@nycap.rr.com

www.peakmindbody.com

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