Mar 24, 2006, 08:52

Part One
By: Sebern F. Fisher, MA, BCIA

What is Neurofeedback?

Neurofeedback is a form of biofeedback directly to the brain. It was first discovered, as often happens in science, somewhat serendipitously in the mid-sixties. At that time, a sleep researcher at UCLA, Dr. Barry Sterman, inherited a NASA grant to research whether human beings could learn to control brain seizure activity by using biofeedback. NASA was concerned about its astronauts who were experiencing seizure-like activity from unpreventable exposure to the fumes of rocket fuel.

Sterman began his research with cats and found that those he used in his sleep research had a much higher threshold against seizures than others in the study. These cats had already stabilized against seizures by learning how to create a certain frequency in their brainwaves. He conducted this research by hooking the cats up to a machine that recorded their EEG (electroencephalogram, which traces the brain's electrical activity) and rewarded them with milk whenever their brainwave activity was within the 12-15 Hz range. (Hz stands for Hertz, or cycles per second.) After this success, Sterman replicated the study first with monkeys, and then, using light and sound rather than milk as a reward, with human patients whose seizures were so serious they were awaiting psychosurgery at UCLA Medical Center. With neurofeedback, each was able to control their seizures either on their own or with medication that had not helped them in the past, and none returned for surgery.

Sterman demonstrated that the brain (a bioelectrical organ) could organize itself in the frequency or electrical domain, which indicated neurofeedback could be useful in addressing other disorders. Dr. Joel Lubar at the University of Tennessee and many others in the field have extensively researched its efficacy in dealing with the problems of ADD. As clinicians follow the lead of Sterman and other researchers, neurofeedback is becoming widely used for a range of disorders including autism, Asperger's Syndrome, PTSD, reactive attachment disorder, LD and traumatic brain injuries.

The claim that one approach can address all of these apparently diverse disorders can seem at first like the claims for snake oil. However, once we understand that the organization or disorganization of the brain underlies all of a person's competencies and emotional problems, and once we understand we can operantly condition these brainwaves, it makes sense to address brainwaves to help a person achieve optimal mental health. The brain is the infrastructure of the mind, and if it is working properly, the mind will also work well. What Sterman, numerous researchers and many clinicians have found is that neuronal patterns and neural circuitry hold the key to regulation and brain organization. Neurofeedback provides us access to this realm of brain function.

How is neurofeedback training achieved?

In brief, trainees sit in comfortable upright chairs and play video games without joysticks to learn to control the way their brains fire. They play these games with their brains. The trainer applies sensors to the trainees' scalp, which pick up the real time EEG that is displayed on the trainers monitor. As the trainee watches a video game directly linked to their EEG, he or she learns how to increase certain frequencies while reducing others. Most children in residential care will learn to make calming frequencies, usually 12-15 Hz or below, on the right side of their brains. Part Two of this series will further explain this process.

All but the most damaged brains continually make all frequencies between one and forty-five Hertz when they are awake. Each frequency band represents a state of arousal. When the brain is at rest (Delta waves), it cycles predominately between 1-3 Hz (1 to 3 cycles per second). The Theta range of brain activity falls within the 4-7 Hz range, which corresponds to the frequency range in adults as they fall asleep and enter the hypnagogic dream-like state. Meditators cultivate Theta states, but young children come by them naturally until age seven or so, when they make their developmental shift into Beta (13-18 Hz). Most children's brain waves are dominated by the slower frequency Theta, and the younger the child, the more Theta he or she naturally produces. Activity in the 8-11 Hz, or Alpha range, represents relaxation. If you were recording an EEG of a person in a state of relaxation, they would be making a preponderance of 8-11 Hz activity. For those who find it difficult to relax, neurofeedback can teach the brain to make these frequencies and when the brain learns, the brain's owner will become more relaxed.

The low Beta or Sensory Motor Rhythm (SMR) brain activity is within 12-15 Hz range, which represents a state of relaxed attention. As the frequencies increase, the brainwaves move higher up the arousal scale and so does the person. At 15-18 Hz, the brain is alert and particularly adept at linear, sequential and language based work. High Beta frequencies, which range between 18-38 Hz, usually reflect muscle tension. Gamma frequencies, which range above 40 Hz, are presently under investigation. The frequencies most often used in neurofeedback training fall between 0 to 18 Hz, which reflects the daily working frequencies of the brain. The left hemisphere, which supports the language and sequential processes, cycles at 15-18 Hz, while the right hemisphere manages emotional tone and cycles closer to 12-15 Hz. Affect regulation, is the primary task of the right hemisphere.

The vast majority of children in residential care for emotional problems (if not all), have great difficulty regulating their affect or feeling states. They exhibit high levels of arousal as well as the incapacity to regulate affect, which spills over into their behaviors, and their relationships or lack of relationships. When this child sits down to train, he or she will usually find that the sensor is placed on the right hemisphere. The child will score points on the video game when he or she achieves one of the calming frequencies. The neurofeedback clinician will decide on the optimal frequency reward based on a full clinical assessment of the child's arousal system. In addition to standard clinical evaluations, the clinician assesses the child's state of arousal based on criteria such as sleep patterns, attentional issues, patterns of emotional reactivity, aggression and other ways the individual trainee behaves. The clinician reassesses these indicators at each session. Part Three will address this in greater detail.

During the neurofeedback session, trainees receive beeps, capture gems and roll up the points when they make the target frequency. Between sessions, the neurofeedback clinician looks for a quieting of the nervous system, which is indicated by fewer aggressive outbursts, better sleep, fewer nightmares, better eye contact and many other factors specific to the individual. Most importantly, the neurofeedback provides the trainee with the capacity to better regulate and quiet the nervous system, increasing their ability to relate empathically to others.

If neurofeedback works so well, why isn't it more widely used?

This is a reasonable and frequently asked question. There are probably several answers, but the most salient is that neurofeedback presents science with a new paradigm because it requires looking at the brain in a new way. The brain is not just a biochemical organ to address with chemicals; it is a bioelectrical organ that whose frequencies can be changed through operant conditioning. The brain's chemistry supports its electrical functioning. Brain firing also regulates the brain chemistry. The brain's chemical and electrical aspects are mutually dependent properties. Science and medicine are notorious for resisting new paradigms, and the wide spread acceptance of neurofeedback appears to be caught in this resistance.

Hundreds of research studies, most of which are outcome studies, demonstrate the effectiveness of neurofeedback. The "gold standard" for scientific research is the double blind study. Until recently, there were few studies of this sort because it is difficult to "blind" recipients to the effects of neurofeedback for both technical and not so technical reasons. Researchers are developing new ways of addressing this problem. Presently, there are two new studies in press, which employed sham feedback for double blind purposes showing positive and enduring effects on ADHD with the use of neurofeedback.

In a guest editorial published in the January 2000 Journal of Clinical EEG, Dr. Frank Duffy, director of the Clinical Neurophysiology Laboratory at Children's Hospital in Boston, said, "The literature, which lacks any negative study of substance, suggests the EBT (neurofeedback by another name) should play a major therapeutic role in many difficult areas. In my opinion, if any medication had demonstrated such a wide spectrum of efficacy it would be universally accepted and widely used." All clinicians who have discovered the benefits of neurofeedback would agree.

About the Author:
Sebern F. Fisher, MA, practices psychodynamic psychotherapy and neurofeedback in Northampton, MA. She trains professionals nationally and internationally on neurofeedback, neurofeedback and attachment disorder, and the integration of neurofeedback with psychotherapy. Fisher was also the Clinical Director of a Residential Treatment Center for 10 years. She is presently consulting with the Sandhill Center in Los Lunas, NM, on the integration of neurofeedback into their treatment milieu.

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