Source: Jim Robbins, Psychology Today, May/June 1998
EPILEPSY. ADD. DEPRESSION. PMS. INSOMNIA. WHAT DO ALL
THESE CONDITIONS HAVE IN COMMON? THEY'RE BEING TREATED WITH A NEW FORM
OF HIGH-TECH BRAIN BIOFEEDBACK. SO OPEN YOUR RADICAL SCIENCE HORIZONS.
HERE, A REPORT ON THE CRESTING EDGE OF THE BRAINWAVE.
Jake's birth was a long shot. Three
months premature, he weighed just a pound, and his early birth took a heavy
neurological toll. When he was four, he entered his parents' room one
evening, drooling and unable to speak. As they watched, horrified, one
side of his body went into seizure and he lost consciousness. Jake's
seizures often happened at night, and his parents kept an overnight bag
packed for trips to the hospital emergency room, where he received
injections of Valium. he often had petit mal seizures during the day. He
was also diagnosed with cerebral palsy which diminished his fine and
gross motor skills. His learning disabilities included attention deficit
disorder and hyperactivity. He had speech problems and ground his teeth
constantly. His sleep was troubled, and he often woke up ten or eleven
times in a night.
Like many children with epilepsy, Jake
took two heavy-duty anti-seizure medications: Depakote and Tegretol.
Both are depressants, and both have serious side effects. As a result,
the boy was logy and often tired. "We felt that Jake was losing his
personality," says his mother. "He was zoned out."
I had known Jake since his birth; the
incredible story of his survival had made him something of a celebrity
in our town of Helena, Montana. Two years ago, I was in Santa Fe doing a
piece on the use of different technologies to enhance brain performance;
while I was there, I heard about a new technique for the treatment of
epilepsy -- a natural treatment called electroencephalograph (EEG)
biofeedback, or neurofeedback, that often reduced or eliminated the need
for drugs. I was skeptical, but I mentioned it to Jake's mother at a
Christmas party. They drove three hundred miles to Jackson, Wyoming; for
a week at the local hospital, Jake underwent two hour-long sessions a
day on a computerized biofeedback program.
Within just a few days, Jake's condition
had improved. "His teeth-grinding and sleep problems
disappeared," says his mother. "We could carry on a
conversation for the first time ever. He wanted to cut and draw and zip
and button. He could never do any of that." Unprompted, friends and
relatives remarked that Jake seemed more centered.
Later, Jake repeated the protocol for
another week. The results were similar. Jake's pediatric neurologist,
Don Wight -- who had been extremely skeptical -- examined the boy. When
he was done, he concluded that he found a new and exciting way to
supplement his practice: "There was a qualitative and quantitative
improvement in the way he was functioning," says Wight. "It
was very real."
Jake's parents bought one of the machines
and donated it to the local hospital where Wight is using it in his
practice. "For most people, taking one kind of medication to
control seizures is a pretty good deal," he says. "I would
like to use neurofeedback with people who are on two medicines, on high
doses, or whose seizures are not being controlled." And Jake?
Through he may need to continue neurofeedback training for the rest of
his life, the quality of that life will most likely be forever changed.
Neurofeedback is a new type of
computerized biofeedback that has begun to wend its way into the health
care system with dramatic effects. It's a far cry from the old kind of
biofeedback that was developed in the 1960s and used primarily for
relaxation and to treat stress, incontinence, and pain. For some
applications -- epilepsy, attention deficit disorder, and closed head
injuries -- a number of studies and much anecdotal evidence suggest
neurofeedback is effective. Other research suggests it may help treat
chronic substance abuse and posttraumatic stress disorder. For other
conditions, such as Tourette's syndrome, sleep disorders, depression,
and autism, individual case studies are glowing but few, if any,
controlled substance studies have been conducted. "The phenomenon
is robust," insists Siegfried Othmer, Ph.D., physicist and founder
of EEG Spectrum, one of a handful of companies in the U.S. that sell
biofeedback equipment. Othmer and his wife Sue fell into the biofeedback
business in 1987 when treatment caused a miraculous change in their son
who, like Jake, suffered from life-threatening epileptic seizures.
After seeing Jake's transformation up
close and talking to other who had used neurofeedback, my curiosity was
piqued. What could it do for a relatively healthy 42-year-lld with the
usual assortment of mid-life problems: Occasional fatigue, a little mild
depression, intermittent problems with sleep? when I started work on
this article, I also started a serious of training sessions. The results
were surprising. But first a look at just what neurofeedback is -- a
potential method for changing what drugs and therapy sometimes can't --
and at the window it may provide on the greatest mystery of all, the
human brain.
MUSIC of the Brain
Neurofeedback is part hero and part
orphan these days. Despite some powerful research that testifies to its
impact, it is only peripherally concerned with what has become the hot
topic in neuroscience: neurotransmitters. Far less fashionable than
Prozac or Paxil, neurofeedback seems to work by intervening in the realm
of frequency. Frequency is the rate at which electrical charges move
through brain cells. The human brain is measured by four basic frequency
ranges. In delta, the sleep state, signals are moving through clusters
of neurons very slowly, just 4 cycles per second, or hertz (Hz). Just
above that is theta, around 4 to 8 Hz, a deeply relaxed state. Nest is
alpha, a slightly less relaxed state at 8 to 13 Hz. The most rapid brain
waves are beta, and they reflect normal waking consciousness. However,
there's a range of beta, from low beta which is a relaxes but alert
state of 12 to 15 Hz, to mid-range beta around 15 to 19 Hz, up to an
excited hyper state of high-beta -- as high as 35 Hz.
Even though our measures of frequency
(through EEG) are relatively crude, they seem to provide a window into
excitability within the brain. Researchers believe that problems crop up
when the operating speed of someone's brain is either too low
(underarousal) or too high (overarousal). As Othmer puts it, "some
people can't find the gas pedal while some people can't take their foot
off it." There is speculation that arousal levels may be a major
component in a whole host of disorders -- and their prevalence may be
the key to neurofeedback's sometimes miraculous effect. The goal? To
stabilize the brain, to render it more robust so that it does not tip
easily into overarousal or underarousal.
Viewing the human mind this way, through
the prism of neurofeedback, harkens back to a theory of arousal that was
popular in the 1950s. This approach essentially cuts across the spectrum
of psychological diagnostic categories with just tow physiological
measures: Stability and arousal. According to this theory, optimal
idling speed for the human brain is about 14 Hz. If the brain's major
activity is a speed lower than that -- 8 to 13 Hz -- a person can feel
tired and might seek stimulation through coffee or stimulating behavior.
They might suffer from depression, ADD, and mild dissociative disorder.
Overarousal, on the other hand, means a person has trouble unwinding and
might seek out several glasses of wine at the end of the day to modulate
their arousal level. Or they might need Valium. Anxiety attacks,
hypervigilance, stress, and obsessive behavior are all symptoms of
overarousal.
HOOKED UP to Happiness.
Neurofeedback sessions are surprisingly
fun and simple: They're like playing computer games where every move is
made by the mind. The technology utilized in neurofeedback, however, is
fairly sophisticated, and unit prices can run from $3,000 to $9,000.
Brain waves must be mapped and analyzed for deviations from the norm. If
there is, for instance, too much theta -- which often occurs in brain
trauma as well as in depression -- and not enough beta, the practitioner
will set parameters for slightly healthier brain wave map. A session may
consist of playing some kind of computer game -- in which a smiling
Pacman gobbles up enemy blobs or a balloon tries to float up to the sky
-- while the patient's brain waves are continuously monitored. Each time
the brain waves find their way into the optimal state set by the
practitioner, the patient is rewarded with positive feedback: Pacman
eats his enemy or a pleasant tone sounds. After anywhere from five to
fifty sessions, the brain seems able to find the optimal state on its
own.
One of the ingenious aspects of
neurofeedback is that it is perfectly tailored to each individual.
Training is always set to be challenging and exciting but not too
difficult so that patients can move slowly and steadily into their
optimal brain states.
BIOFEEDBACK'S Bold Beginnings.
In the 1960s, neurofeedback was a
revolutionary way to look at the mind and its capabilities, and it
coincided with other, more dubiously regarded revolutions. Neurofeedback
was adopted by people interested in mind expansion, often in the forms
of LSD and meditation, and its association with Eastern mystics and
parapsychology earned it a crackpot reputation with the mainstream
scientific community. But when I actually went and looked at the early
research, I was astonished at some of the remarkable studies. One of the
crucial pioneers of neurofeedback and biobehavioral psychiatry at the
UCLA School of Medicine, who was the first to experiment with a kind of
beta wave called sensory motor rhythm (SMR),in the 12 to 15 Hz range of
beta, and was able to actually treat epilepsy.
Sterman's original work in the 1970s was
on cats. Using implants and EEG equipment in a study funded by the
National Institutes of Health, he found that cats could be trained to
control their brain waves. He then discovered that when he exposed those
trained cats to toxic vapors that usually induce epileptic seizures,
they had far fewer seizures than untrained cats. The experiment was
replicated with monkeys. In both cases, deep probes showed that the
training produced physiological changes in the brains neurons.
Moving on to humans with refractory
epilepsy -- the most severe kind -- Sterman achieved a 60% reduction of
seizures in 60% of his patients. Numerous other experiments at more than
a dozen other institutions have demonstrated even higher success rates,
and the treatment of epilepsy is the most established is the most
established of the protocols for neurofeedback. Sterman, who is now
research director at EEG Spectrum, has theorized that training may
activate healthy adjacent neurons to take the place of damaged ones. We
are still a long way from a real understanding of why neurofeedback does
what it seems to, but Sterman maintains that "if the neural
substrate is intact, the neurons can be trained."
One of Sterman's researchers, Joel Lubar,
Ph.D., of the University of Tennessee at Knoxville, took their work even
further and in a different direction. He had noticed that hyperactivity
decreased in patients treated for epilepsy and, based on this, created
the protocol now used for treatment of ADD.
WIRED in the Schools.
One place where the treatment of ADD has
been put to the test is the Enrico Fermi Center for the Performing Arts
in Yonkers, New York. Three years ago, Linda Vergara, an assistant at
the school, was faced with taking her son from a private school because
he was hyperactive. Within several sessions, she says, her son began to
change. Profoundly. "He started sitting through dinner," she
says, "and finishing his homework."
Her experience convinced her to bring an
EEG neurofeedback machine into the inner-city school of about one
thousand minority students. Three years and sixty kids later, the
program has worked. "It has turned people's lives around,"
says Vergara. The program is being expanded to two other schools in
Yonkers, and eventually , school board members say, to all twenty-two
schools in the district. So far, neurofeedback has kept twenty students
out of expensive special-education classrooms and thereby saved the
district an estimated $500,000. When I visited the school recently,
parents, teachers, and children raved about this alternative to Ritalin.
"If it works here, says psychologist Mary Jo Sabo, PH.D., who
helped Vergara bring the technique to Fermi, "it will work
anywhere."
And here's fascinating news: Even when
treating ADD, therapists and teachers see other positive changes in
behavior. Sterman saw ADD diminish with treatment for epilepsy, and he
saw sleep improve. Rachel Campanella, a fourth-grade teacher at Fermi,
told me a stroy about a boy in her class named Nelson. "His parents
were worried about him. He would come into class and put his head down
on the desk," says Campanella. "He had no self-esteem, there
was no social interaction. If I spoke to him, he would nod his head. For
months I never knew if he had teeth, because he never smiled. He was
like an infant in a big guy's body."
Nelson started EEG training in March of
1997. "In June," Campanella says, "he raised his hand for
the first time ever. He started to speak, to smile. He spoke in complete
sentences. Now he comes by with a grin and says 'Hello, Mrs.
Campanella.'" Though case-by-case examples such as that of Nelson
do not offer proof of this or any treatment's efficacy, they do make an
impression.
Another area where neurofeedback has
proven successful is in the treatment of closed head injury. Symptoms of
head injury can range from mood swings and irritability to short-term
memory loss, confusion, headaches, nausea, and blurred vision. There are
no drugs to treat closed head injury; any recovery usually occurs on its
own within two years. Psychologist Steven Stockdale, Ph. D., director of
the NeuroHealth Center in Colorado Springs, is one of several
practitioners using neurofeedback for mild closed head injury. In an
ongoing three-year study of sixty patients already past the two-year
recovery mark yet still suffering from symptons, he has found that
"about 80% of the people we work with learn to do the feedback. In
those patients, there is a 75% reduction in symptoms. They just clear
up."
The technique may even help in
posttraumatic stress disorder. New York City, psychiatrist Daniel Kuhn,
M.D., treats veterans of the Israeli war of 1973. Even if PTSD is
resolved with standard psychotherapy, there are residual cognitive
problems. "You can't talk people out of these. Nothing works as
well to clear them up as EEG neurofeedback," says Kuhn.
FEEDING MY HEAD
Beta training was where I started my
journey with neurofeedback. I was curious about the technology,
especially after I heard talk of the Clean Windshield Effect. Bernadette
Pedersen, an EEG technician from the local hospital, came and helped me
hook up the first few times. Through the equipment -- two computers, an
neuroamplifier, and some EEG electrodes -- is relatively easy to use,
one does need training, and for therapeutic uses a trained doctor or
psychologist is necessary. For a half houror so, I watched a game: White
lines formed in the middle of the highway and a beep sounded when I
produced the right brain waves. About an hour after that, it was as if
someone had flipped a switch. The world looked sharp and crystalline,
its colors richer. My thinking was sharper, and I had a quiet kind of
energy. It lasted a couple of hours.
After five or six sessions, the
God-just-painted-the-world effect dissipated, but I noticed other
changes. I felt calmer and more centered. I felt more secure in social
situations. Particularly important to me was that my mornings were much
more productive. I always drink coffee and drag my tail until late
morning. Lately I've been getting up, ready to go. By the fifteenth
session, the change was unmistakable. As of this writing, it has lasted
about a month.
I was also interested in trying another
kind of training known as the alpha-theta protocol. The technique is
very different from the work in beta. It takes place in the lower
registers of the brain's frequencies. The first EEG-produced study of
the effectiveness of the alpha-theta protocol on substance abusers was
begun in 1982 by Eugene Peniston, a researcher at the Sam Rayburn
Memorial Veterans' Center in Bonham, Texas. He treated ten severe
alcoholics with traditional counseling only, and ten more with the added
element of the alpha-theta training on a neurofeedback instrument.
Peniston hypothesized that alcoholics drink because they cannot get into
alpha states naturally, and therefore cannot produce self-soothing
neurotransmitters on their own. Peniston claims an unheard-of 80%
success rate with the group who used the neurofeedback -- compared to a
ceiling of 20% to 30% for traditional therapies. However, because of his
small sample size, more studies are needed to buttress his claims. There
have been other impressive small studies since then, but again the cure
rate seems improbably high. We won't know the actual impact of this
therapy until larger samples are studied. Alfonso Ermea, M.A., of the
Life Sciences Institute in Shawnee, Kansas, who has also used this
technique says, "With conventional therapy a lot of people take a
white-knuckle approach. They say, 'Dammit, I'm not going to drink.' With
neurofeedback, people no longer have the desire to drink. They're no
longer fighting the urge."
Alpha-thea training had a pleasant, if
not revolutionary, effect on me when I tried it. I laid down on a
mattress in my office, and Bernadette hooked me up. Eyes closed, I
started to relax. On the EEG Spectrum machine I was using, a stream
began to babble as alpha was produced. Then, as I sank deeper, a series
of alpha bings sounded. As theta came into play, I heard a roaring ocean
and the deep, resonant bongs of a Tibetan bowl. These sounds held me on
the edge of sleep for nearly half an hour. It's an interesting place,
that twilight zone between sleep and wakefulness. During that time, my
mind produced a host of intriguing, dream-like images, but none of them,
in my few sessions, was revelatory.
FEEDING THE FUTURE
Neurofeedback may be of help in the
treatment of a host of problems besides epilepsy, ADD, closed head
injuries, and addiction. Its applications are being explored, but all of
them have yet to be subjected to controlled studies. EEG Spectrum has
treated more than two thousand people clinically in the past ten years.
-- some for such problems as Tourette's syndrome, PMS, depression, teeth
grinding, migraines, insomnia, strokes, menopause, and chronic pain.
Los Angeles writer Margaret Sachs
underwent neurofeedback training for symptoms of menopause after she saw
its dramatic effect on her daughter's ADD. "I was waking up in the
middle of the night totally drenched with sweat," she says.
"And then I started waking up at three or four, and I could not go
back to sleep, as if I was on speed." A congenital heart murmur
began acting up, causing a rapid and irregular heartbeat. Dramatic mood
swings erupted, and her period became irregular.
After twenty sessions, she claims, every
single symptom subsided. "I felt grounded in a way I never had
before," the 47-year-old says. "When I got in a situation that
normally threw me for a loop, I not only stayed calm but I thought of
all the things I should have thought of, instead of thinking of them
later. I felt so in control of myself. It was a wonderful feeling.
" A few months later, her family moved, and the situation was
stressful for a while. The good feeling left her. It took a few
refresher sessions to bring it back.
Not surprisingly, there are critics of
neurofeedback. Joel Lubar questions claims that neurofeedback can be
used to treat problems such as PMS or migraine. "That's
speculative," he says.
"There need to be studies done for those applications." Many
practitioners worry that too much sloppy optimism will damage the
reputation of EEG neurofeedback in the same way that unproven claims did
to biofeedback in the 1960s.
Much of the criticism has come in the
area of ADD. "There's a tremendous placebo effect in a situation
like this," says Russell Barkley, director of psychology and
professor of psychiatry and neurology at the University of
Massachusetts. He is the author of a book about the treatment of ADD,
entitled Defiant Children: Management of Difficult Children.
He has not studied the use of
neurofeedback, but he has reviewed some of the studies, and he points
out that the use of "high technology in a medical environment has a
high placebo effect. And some children improve with maturation
alone."
On the other hand, "we do not have
any studies that say it's bad for you. I don't think it will do harm.
Basically, it's 'buyer beware'." Claims that neurofeedback can
alter brain physiology, says Dr. Barkley, are "totally unfounded
and unethical."
Indeed, all we can definitively say about
neurofeedback at this point is that it provides access to our internal
processes, and in ways we do not fully understand, sometimes allows us
to regulate them.
The claims that some practitioners make
about neurofeedback do alarm certain researchers, but Susan and
Siegfried Othmer are unrepentant. Fifteen years ago, their son Brian was
one of the first to be treated for severe epileptic seizures and
behavioral disorders. T hey saw dramatic positive changes in his
personality as well as in his physiological problems, and, says Susan,
"we knew right away this was something we had to be involved with.
We found out that it's not considered scientific to be enthusiastic.
We're sorry, but we're parents. We need to get this out there."
The Othmers now have three hundred or so affiliates
who have built a common body of knowledge, sharing information at
conferences and over the Internet. There are several other companies
that manufacture the equipment including American Biotec in Ossining,
New York.
The word about EEG has spread. Othmer
estimates the handful of practitioners ten years ago has grown to
fifteen hundred worldwide. Perhaps for good reason. Barry Sterman
belives there is no doubt that physiological changes take place, and
claims there are several careful studies to prove it. According to Joel
Lubar, neurofeedback "increases the blood flow into the brain.
Blood flow, metabolism, and high frequency electrical activity all work
together. " Increased blood flow may help the brain reset itself in
a normal range. And Don Wight, Jake's pediatric neurologist, says the
impact of neurofeedback is not a placebo effect. "Youwould
know," he says. "If the kids come off medicine, and stay off
it, and can function, you would know. It's real".
If neurofeedback works so well, why is it
virtually unknown. One reason may be that neurofeedback fits no
prevailing medical model. Nearly all research on the brain is in the
language of neurotransmitters and psychotropic drugs, and not in that of
frequency or of mental exercise. Science likes its medicine to fit
within the governing conceptual framework.
Othmer blames "panacea
paranoia." Something that works so well can't possibly be real.
There are also some real drawbacks: It's expensive, it's time-consuming,
and it must be conducted by trained personnel.
But beyond this, there is a problem with
the therapeutic potential of neurofeedback that is something of a
philosophical riddle. If the brain can be trained to deal with
depression physiologically, does a patient short-circuit the important
processes of recognizing, comprehending, and coming to grips with a deep
psychological problem? And -- to pose an entirely new question -- does
that matter?
For many people who have tried it, any
debate about neurofeedback is moot. As Jake's mother puts it: "It's
nothing short of a miracle for us."
Source: Jim Robbins, Psychology Today,
May/June 1998
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