HEAL AND TUNE YOUR BRAIN WITH NEUROFEEDBACK

1
HEAL AND TUNE YOUR BRAIN WITH NEUROFEEDBACK

• Cindy Perlin, LCSW

2
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

3
Biofeedback Modalities

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

4
Neurofeedback

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

5
The first major neurofeedback study was done with
cats by Dr. Barry Sterman
6
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

7
Dr. Stermans 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.

8
Stermans 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.

9
Characteristics of Brainwaves

• Frequency (hertz)
• Amplitude (microvolts)
• Coherence (under or over-differentiation)
• Location (10-20 System)

10
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.   

11
10-20 System
12
BRAIN FUNCTIONS BY REGION
13
A disregulated brain often has too much slow
activity.
14
This individuals eyes are open. Their brain
isnt very alert and awake.
15
This brain is alert and awake. In EEG terms,
smaller means more regulated, better functioning.
16
Delta .5-4 Hz
One second

• Predominant in sleep
• Should be low while awake
• High delta can interfere with emotional or
  cognitive processing

17
Theta 4-8 Hz
One second

• Pre-sleep, trance
• Inattentive
• Distractible
• Lack of focus

18
Alpha 8-12 Hz
One second

• Relaxed (parietal)
• Spacey
• Unmotivated
• Inattentive and depressed

19
SMR 12-15 Hz
One second

• Calm, external attention
• Regulates impulsivity and hyperactivity
• Promotes body awareness
• Helps control anxiety anger
• Movement Inhibition

20
Beta 15-20 Hz
One second

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

21
High Beta 22-36 Hz
One second

• Body tension
• High state of arousal
• Excited / anxious / stressed

22
Ultra-Low Frequency Training

• Bipolar training at less than 1hz, sometimes as
  low as .001hz
• Dealing with brain tides rather than waves
• Primitive brain stem rhythm has global effects on
  brain functioning
• Still controversial in the field
• Excellent results for chronic, severe overarousal
  and brain dysregulation in general

23
Protocol Selection

• Functional
• Based on presenting symptoms and areas of the
  brain known to be related to these symptoms or
  based on functions you want to improve.
• QEEG
• Measurement of amplitudes, frequencies and
  connectivity measures at 19 sites
• Results compared to normative data bases
• Sites 2 standard deviations or more from the
  mean are targeted for training if they relate to
  symptoms or functional improvements desired.

24
Current Clinical Uses

• ADHD
• Seizure disorders
• Alcoholism/substance abuse
• Traumatic brain injury
• PTSD
• Anxiety
• Depression
• Chronic Fatigue Syndrome
• Fibromyalgia
• Chronic Pain
• OCD
• Tourettes Syndrome

• Sleep disorders
• Autism
• Aspergers
• Bipolar disorder
• Reactive attachment disorder
• Peak Performance
• Age related memory loss
• Parkinsons
• Migraines
• PMS
• Schizophrenia

25
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 ODonnell, 1995 Thompson
  Thompson, 1998)

26
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 tests of attention
  and an ADD evaluation scale while taking Ritalin,
  only those who had EEG biofeedback sustained
  those improvements after discontinuing Ritalin.

27
Studies of Neurofeedback and ADHD (continued)

• Chinese study (Xiong, Shi and Xu, 2005)
• 60 ADHD children studied
• 40 sessions of neurofeedback
• Over 90 significantly improved their scores on
  standardized attention tests

28
Meta-analysis of studies of neurofeedback
treatment of ADHD

• Arns et al, 2009
• Evaluated 15 well designed studies involving 1194
  children with ADHD
• Found neurofeedback to be effective for
  inattention, impulsivity and hyperactivity
• Concluded that neurofeedback is a proven
  treatment for ADHD at the highest scientific level

29
Compare results to multimodal treatment study of
ADHD

• Long term study funded by NIMH of psychotherapy
  and stimulant medication (Molina et al, 2009)
• Study now in eighth year
• In 2009, reported that children who received
  stimulant medication and/or psychotherapy were no
  better off after two years than children with
  ADHD who were never treated
• Stimulants were found to stunt growth
• FDA requires stimulants to have warning labels
  for increased suicidality and sudden cardiac death

30
Safe and permanent

• Neurofeedback has no adverse effects when
  administered by an appropriately trained
  professional
• Effects appear to be permanent

31
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

32
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)

33
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).

34
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)
• 7 children receiving 40 sessions of SMR/beta
  biofeedback significantly improved executive
  function, communication and social behavior
  (Kouijzer, 2008)

35
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 light stimulation
• Sustained remission of the depression in all 25
  patients in 20- 25 sessions
• All reduced or discontinued medication

36
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 stabilize
  mood and improve functioning while decreasing or
  eliminating medication.

37
Peak Performance Applications

• Improves concentration and memory
• Enhances creativity and problem solving
• Calms performance anxiety
• Reduces extraneous movement
• Builds confidence

38
Enhancement of learning in normal subjects

• Improved attention in normal college students
  (Rasey 1996)
• Improved memory and attention in normal adults
  (Vernon 2003)
• Improved cognitive processing speed and executive
  function in the elderly (Angelakis 2007)

39
Enhanced Musical Performance

• Alpha/theta training significantly improved
  musical performance by music students, as judged
  by independent raters (Egner Gruzelier, 2003)

40
Enhanced surgical skills

• SMR training of National Health Service trainee
  opthalmic microsurgeons produced significant
  improvement in surgical technique and reduced
  surgical time by 26 (Ros, 2009)

41
Improved Athletic Performance

• The Italian soccer team has a Mind Room where
  players routinely go to practice neurofeedback
  for performance enhancement. They credit
  neurofeedback for helping them win the World
  Soccer Cup.

42
Improved Athletic Performance

• NBA player Chris Kaman was misdiagnosed with ADHD
  at age 2 and was on Ritalin from age 2-1/2
  through high school. He hated taking it and it
  didnt help
• Discovered through neurofeedback assessment that
  he had an anxiety disorder, not ADHD
• Credits neurofeedback with significantly
  improving his game
• Finds it helps him be less impulsive off the
  court too

43
Typical Neurofeedback Session

• Twice a week sessions
• 30-45 minutes of feedback
• Auditory and visual rewards (video game,
  animation or movie)when achieving thresholds
• Typically 20-50 sessions to complete treatment

44
Game Space Race
45
Frank H. Duffy, M.D., Professor and Pediatric
Neurologist, Harvard Medical School, wrote about
neurofeedback
"In my opinion, if any medication had
demonstrated such a wide spectrum of efficacy it
would be universally accepted and widely usedIt
is a field to be taken seriously by all."
(Editorial, Clinical Electroencephalography,
January 2000)
46
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 neuroplasticitythe
  ability to change its structure and function in
  response to experience. The brain can be
  rewired.

47
Resources Web Sites
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.bcia.org National
credentialing organization for biofeedback
providers. Includes information on providers and
standards. www.aapb.org Association for Applied
Psychophysiology and Biofeedback is the national
biofeedback organization. Includes information
and a provider list.
48
Resources More websites

• www.eeginfo.com
• www.eegspectrum.com
• www.hope139.com

49
Resources Books

• A Symphony in the Brain by Jim Robbins,
• Getting Rid of Ritalin by Robert W. Hill, Ph.D
  and Eduardo Castro, M.D
• ADD the 20 Hour Solution by Mark Steinberg,
  Ph.D. and Siegfried Othmer, Ph.D., Robert D.
• Awakening the Mind A Guide to Mastering the
  Power of Your Brain Waves by Anna Wise

50
Contact Information

• Cindy Perlin, L.C.S.W.
• [phone]
• cperlin_at_nycap.rr.com
• www.peakmindbody.com

51
?
?
?
?
?
?
?
?
?
?
?