Neurofeedback ….EEG-guided biofeedback…..Brainwave biofeedback.

All these terms refer to the same exciting new technology, which has been shown to be highly effective in treating many physical and psychological disorders. It has also been used for individuals who just want to perform at peak efficiency.

Neurofeedback was originally used successfully to help individuals suffering from epilepsy. It was then found to be applicable to many other disorders. It is not the cure-all, end-all treatment with millions of promises, but it is a new and exciting treatment that has shown clinical success on a variety of disorders.

Such institutions as the famed Menninger Clinic used EEG biofeedback for the successful treatment of alcohol and drug addiction. Many businesses in the United States and Japan trained their management personnel in peak performance protocols to enhance creativity, coping skills and critical thinking.

I first heard about neurofeedback from two social workers, who told me about an exciting treatment modality that was helping them “get patients sleeping”, and helping to stabilize mood. I did not have to hear much more to convince me that if I wanted to be offering state-of-the-art treatment, I had to explore this modality. After consulting with experienced practitioners, and investigating the treatment itself, I realized that neurofeedback has the potential to help many patients achieve mood stability, emotional regulation and resilience when standard psychiatric treatment and psychotherapy have been inadequate. The possibility of helping patients with a modality that might both improve symptoms, and lessen the need for noxious medications motivated me to energetically pursue this option for my practice.

Since then, I have invested heavily in time, money , training and effort to become the first and for now the only psychiatrist in this region to provide this extraordinary new treatment. I have heard reliable and experienced clinicians describe excellent results with their patients, and have begun to see excellent results in the small number of patients who I have trained with neurofeedback to sleep better, feel less pain, have improved mood, and reduce their need for alcohol.

THE MODEL for NEUROFEEDBACK

A healthy brain has the versatility to modulate states of arousal and attention styles as demanded by specific situations. The disordered brain has reduced ability to respond to these specific demands. The immature, injured, or disordered brain seems to lack the normal elasticity of the healthy brain. There appear to be discontinuities in cortical processes or breakdowns in intra-cortical communications. The disordered brain seems to get “stuck” and exhibits inappropriate brain waves for the immediate situation. For example, the ADD child tends to exhibit more day-dreaming type brainwaves with less than normal concentrating type brainwaves. Some persons who can’t stay asleep or who wake up too easily exhibit too much of a brain wave called “alpha”….which keeps them not awake enough during the day, and not asleep enough at night. People can actually learn to reduce their alpha intrusion….and improve their wakeful states and their sleep states.

EEG biofeedback training teaches a person what specific brain wave states feel like and how to turn those states on at will. The trainee can “move” to different physiological states depending on what the immediate situation requires. NEUROFEEDBACK DOES NO MORE THAN TRAIN A PERSON TO CHANGE TO A DIFFERENT PHYSIOLOGICAL BRAIN STATE….this can correspond to improvements in emotional and wakefulness states that are more adaptive, more functional. Often the learning that occurs is unconscious, like the learning to balance a bike is mostly unconscious. The brain just does it when the person attends to the information coming in through biofeedback.

Psychologists have been training people for many years to change their physiological states through temperature and EMG training. Neurofeedback simply uses the more “central” brain information of EEG instead of periperal (skin temperature, pulse) measures.

If we can make the brain more flexible, it may have a generalizing effect on other functions such as the full nervous system, the immune system, the endocrine systems, the body’s ability to heal itself and general cognitive functioning.

SELF-HEALING IS WHAT BIOFEEDBACK IS ALL ABOUT. IT DOESN’T DO ANYTHING TO ANYBODY EXCEPT TEACH THEM TO LISTEN IN ON THEMSELVES.

IN PROVIDING NEUROFEEDBACK INFORMATION TO A PATIENT, I AM SIMPLY TEACHING THEM. ANY GOOD THERAPIST IS A TEACHER. FOR YEARS I HAVE BEEN TEACHING PATIENTS TO LISTEN TO THEIR THOUGHTS, TO THEIR EMOTIONS AND TO THEIR BEHAVIOR. NOW WITH NEUROFEEDBACK, I CAN TEACH PEOPLE TO LISTEN IN ON THEIR OWN BRAIN PHYSIOLOGY AND TO CHANGE THEIR PHYSIOLOGICAL AND PSYCHOLOGICAL STATES.

WHAT IS BIOFEEDBACK?

Biofeedback is like eavesdropping on our body’s internal conversations and using this information to change negative patterns that are contributing to poor physical and mental health. Our bodies are a sea of information and communication, every organ talking to every other organ. As a general rule, we don’t pay attention to these inside-the-skin conversations. With sophisticated listening devices we can collect this information and feed it back to our brains through our ears, eyes, and touch. With practice, we can then begin to change inside-the-skin events to make us healthier. You already use biofeedback. If you charge up the steps noticing your heart rate and respiration go up, you slow down. Now medical science is able to help us listen in to the quieter messages that otherwise go unnoticed until we have medical or emotional problems. With biofeedback we can change temperature, heart rate, blood pressure, muscle tension, chemical responses, electrical impulses, and yes, even brainwaves.

WHAT IS BRAINWAVE BIOFEEDBACK?

By recording electrical activity produced by the brain and collecting this activity into frequency bands (sort of like tuning into a station on the radio), we are able to identify what electrical activity determines different subjective states of consciousness such as relaxation. Patients training in neurofeedback are able to either enhance this state or change this state. Therefore, a person can learn to do a much more efficient job at such tasks as concentrating or relaxing. Brainwave feedback, is again, taking a very subtle inside-the-skin event and using it to change our level of functioning. This is the fine art of self-mastery -- making one less dependent on others, drugs, machines or medical technology.

THE LEARNING PROCESS

All biofeedback is a learning process that involves both physical and mental skills. It’s learning how to change your body by listening to your body’s messages. Some biofeedback processes, like temperature training, may take only a few sessions, whereas brainwave feedback may take ten to twenty sessions before you begin to grasp what a particular brainwave state “feels” like. Then, more training sessions to perfect the skills. Learning to modify a brainwave state in the correct direction to sustain a desired mental state is a “discovery” process. A process of gaining more and more control over our thoughts, feelings and behaviors.

DISORDERS THAT HAVE BEEN SUCCESSFULLY TREATED WITH EEG BIOFEEDBACK:

Depression

Panic Attacks

Anxiety

Bipolar Disorder

Attention Deficit Disorder (ADD)

Attention Deficit Hyperactivity Disorder (ADHD)

Migraines

Tension Headaches

PMS

Alcohol and Drug Addiction

Sleep Disorders

Chronic Pain

Bruxism (Teeth Grinding)

Mild Closed Head Injury

Oppositional and Conduct Disorders

Epilepsy

Chronic Fatigue Syndrome

Stroke

Multiple Chemical Sensitivities

Autoimmune Dysfunction

Tinnitus

Glucose metabolism dis-regulation Type II Diabetes, hypoglycemia

Specific Learning Disabilities / Dyslexia

General Information About Neurofeedback

Explain the EEG Biofeedback treatment process:

The clinician attaches electrodes to the patient’s scalp in locations determined by their over -arousal / under-arousal and other symptom profile. These are measured / located via a tape measure and calculation process according to standardized locations and the size of the persons scull. They are adhered to the scalp after cleaning the locations with a scrub cleaner, then conductive paste holds the electrodes in place temporarily throughout the treatment period. (The scalp is cleaned off in these locations afterward with alcohol.) Electrodes are attached in the same manner to the earlobe for reference and grounding signals. None of these electrodes send any electricity into the head. They detect EEG readings, which are then amplified and sent to the therapist’s computer, and monitored by the computer.

Prior to training the patient, the clinician has assessed what brain-wave patterns need to be trained, and at what site on the head. In other words, the clinician has selected a reward/inhibit protocol considered most likely to improve the patient’s ability to choose and achieve a brain state conducive to the treatment goals. (Treatment goals might include relaxation, reduced physical anxiety, improved sleep, improved concentration / attention / focus, improved mood, reduced rumination, etc.) The clinician programs the computer to reinforce the patient (via visual and auditory cues…on the computer monitor) for changing his/her brain wave frequencies in the direction preferred at those sites where the electrodes have been placed.

The patient is given instructions to orient him/herself to the patient computer screen, to maintain to the best of their ability a relaxed state focused on the computer screen “game“. They see visual cues (packman in a maze/ spaceships moving forward/ boxes that expand and contract, etc). When the parameters set in the therapist computer are met by the brain waves the patient is creating, the patient sees the game progress in various ways. Certain brain waves will be reinforced or inhibited depending on the protocol set in the therapist computer.

The therapist evaluates the patient’s symptoms and progress before and during and after each session in order to assess the results of training. The therapist determines need for changes in the parameters set in the computer, or change in frequency or length of treatments.

The entire process, including assessment and attachment of the electrodes, takes approximately 30 to 45 minutes depending on the presentation / complexity of electrode positions.

Please describe the specific diagnoses for patients needing EEG Biofeedback treatments.:

Any patients with issues involving problematic or uncomfortable over arousal or under arousal symptoms may benefit from the eyes-open EEG-guided neuro-feedback treatment. The diagnoses that may respond include but are not limited to:

Difficulty with sleep (insomnia, depression, generalized anxiety, etc

Problems with physical anxiety/tension (Anxiety Disorder)

Need for improved physical relaxation (Affective Disorders and Anxiety disorders, Pain disorders

Problems with attention / focus/ concentration (ADD/ADHD)

Problems with motivation (Major Depression, other Affective Disorders.)

Problems with mood (Mood disorders, including depression, anxiety , and bipolar disorder)

So the symptoms that EEG -guided biofeedback can help with cross over the major diagnostic categories.

Other clinical uses for EEG-guided biofeedback include optimum performance, (reducing performance anxiety for work presentations, improved focus for competitive athletes, etc. ) Deep state experiences (the focus of the alpha-theta protocols) can result in transformational /spiritual experiences. Sometimes these deep state (Alpha-Theta protocols) can improve the symptoms related to PTSD, problems related to trauma, existential problems, and psychological conflicts that may impair psychological performance…thus improving the level of function for the individual. Again, these goals can apply to patients from a broad spectrum of diagnoses)

One way to look at the applicability of neuro-feedback is to think of it as similar to the anticonvulsants that are used for a broad array of symptoms that cross the major diagnostic categories: for example, Tegretol, Depakote are used for Mood disorders, panic disorders, PTSD, Impulse control disorders. Even though they have no FDA approval for such, often clinicians have found them useful to reduce symptoms.

What is your ongoing training in neurofeedback?

What is the selection process of patients that will need the treatment.

This is a complex process that includes a psychiatric eval, with particular attention to over- arousal / under -arousal sx, as well as any symptoms that might affect the protocol selection (migraines, seizures, bipolar disorder, all mood and anxiety sx, attention/ focus problems, head injury, etc). This will be performed by me. Other factors would involve the patient’s level of interest and comfort with this form of treatment as an adjunct to the psychiatric and psychological treatment they are already engaged in .

Are patients be referred to you for this treatment, or are they existing patients? If the patients are referred to you will you continue the patient’s medication management, or do they continue to see their physician?

Are the patients informed of the risks associated with this treatment? If so, please explain.

All patients will go through an informed consent process similar to the process I already use when I am prescribing a non-FDA approved medication. I will be using the informed consent form sent to you previously, and will additionally to that, explain some of the history of neuro-feedback, including the facts that it has been used for years for seizure disorders, relaxation, religious experiences, and that the more recent uses are for symptoms that can be related to mental disorders, mostly non-FDA approved uses. That it is a form of biofeedback, which has a long track-record for helping patients with relaxation. That opposed to other biological treatments, it is a training. That the theory behind neuro-feedback training is that the benefits depend on repetition so the brain can learn to change and maintain improved brain states.

I will also explain that just like other biological treatments, neuro-feedback can have uncomfortable or harmful outcomes. Neuro-feedback is largely safe, and the potential benefits outweigh the risks. I will be explaining the risks, such as worsening of symptoms, new problematic symptoms (seizures --which would be very unlikely, headaches, agitation, worsening of sleep), and that for the most part, these will disappear with time, or can be improved / eliminated by changing to a different protocol. It is well known by neurofeedback clinicians that initial negative responses, while short-lived are useful to clarifying protocol selection, and therefore sometimes very helpful.

I will also explain that some patients may need 40 or more sessions to see a sustained improvement. Some will need no more after that or fewer sessions. Some may need much less frequent sustained neuro-feedback to maintain their improvement