Transcript NEUROFEEDBACK - NRBS | The Northeast Regional Biofeedback

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.
Sterman’s 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
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 overdifferentiation)
 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
One second



Predominant in sleep
Should be low while awake
High delta can interfere with
emotional or cognitive processing
Theta 4-8 Hz
One second




Pre-sleep, trance
Inattentive
Distractible
Lack of focus
Alpha 8-12 Hz
One second




Relaxed (parietal)
Spacey
Unmotivated
Inattentive and depressed
SMR 12-15 Hz
One second





Calm, external attention
Regulates impulsivity and
hyperactivity
Promotes body awareness
Helps control anxiety; anger
Movement Inhibition
Beta 15-20 Hz
One second



Active, external attention
Enhances cognitive processing
Improves concentration, attentiveness,
focus
High Beta 22-36 Hz
One second



Body tension
High state of arousal
Excited / anxious / stressed
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 QEEGguided 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 1220hz. 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
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 used…It is a field to be taken seriously
by all."
(Editorial, Clinical Electroencephalography,
January 2000)
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.”
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.
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: [email protected]
www.peakmindbody.com
?
?
?
?
?
?
?
?