HEALING THE BRAIN WITH NEUROFEEDBACK

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HEALING THE BRAIN WITH NEUROFEEDBACK

• Cindy Perlin, LCSW

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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

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Biofeedback Modalities

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

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Neurofeedback

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

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

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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.

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Stermans original 1967 Study for NASA -Cats
exposed to rocket fuel
Avg 2 hours for seizures with EEG trained cats
vs. 1 hour for untrained cats
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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.

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Characteristics of Brainwaves

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

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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.   

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

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

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Theta 4-8 Hz
One second

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

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Alpha 8-12 Hz
One second

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

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SMR 12-15 Hz
One second

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

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Beta 15-20 Hz
One second

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

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High Beta 22-36 Hz
One second

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

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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.

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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

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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)

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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.

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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)

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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

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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)

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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).

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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)

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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

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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.

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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

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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

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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

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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

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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

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Typical Neurofeedback Session

• Twice a week sessions
• 20-45 minutes of feedback
• Auditory and visual rewards when achieving
  thresholds
• 70-90 reward frequency

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Game provides client feedback
Mazes
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Space Race
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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)
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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.

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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.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.
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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

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Contact Information

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

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