Tarnow Articles

Let Your Brain Fix Your Brain By Ron Swatzyna, Ph.D., LCSW

The brain is a data collection and feedback mechanism that can be employed to correct itself.

When given immediate feedback and enough practice, people can change certain types of brain function. This therapeutic discipline, known as neurofeedback or EEG biofeedback meets the American Association of Child and Adolescent Psychiatry's criteria for clinical guideline for treatment of ADHD, seizure disorders, anxiety (OD, GAD, PTSD), phobias, depression, reading disabilities, and addictive disorders.

Research has shown that with regard to ADHD, the effectiveness of EEG biofeedback is equivalent to stimulant medication. This is all the more intriguing given that the therapy consists almost entirely of merely showing the patient what his or her brain is doing at that moment.

Of course, that is something of an oversimplification, because while the therapeutic interaction consists almost exclusively of a patient monitoring his or her own brain function, the therapeutic protocol, the correct course of sessions and appropriate diagnosis are complex and require a great deal of expertise in both the clinician who administers the therapy and the neurologist who interprets diagnostic QEEGs and based on this diagnosis develops a treatment protocol.

QEEG in Summary

With the precise placement of electrodes along the scalp, the functioning of various brain centers can be sampled by an EEG (electroencephalograph). The wave forms in their amplitude (size) and frequency (speed), provide information about how the brain is functioning.

EEG data is collected at various physical sites in the brain with eyes open, eyes closed and while the patient is engaged in various mental challenges such as reading and solving simple math problems. The wave form data is converted to digital data which is then statistically analyzed and compared to a large database of normative functioning. This allows the interpreter to determine whether a brain is functioning abnormally and if so, at what locations, to what degree and in which frequency band. This digital analysis of EEG data is called QEEG, with the Q standing for quantitative, referring to the digital mapping of brain function.

Valuable Diagnostic Tool

QEEG information can be a valuable diagnostic tool, pointing out potential brain damage, neurochemical imbalances, and sites where the underlying brain structure deviates from normal. QEEG is particularly effective in fine diagnostic discriminations where similar symptoms can emerge from differing dysfunctions.

QEEG diagnostics also provide a window into brain anomalies that stem from dysfunctions in how the brain communicates with itself. In this model, called "thalamocortical dysrhythmias," the brain can be thought of as an interconnected series of sub-routines that must be managed in concert to produce what we think of as normal brain function. If the timing of this coordination is disrupted, healthy functioning is impaired.

A disorder of this nature would be akin to a symphony orchestra with each instrument functioning perfectly, just not at the same speed or at random volumes. There is nothing wrong with the individual instruments or even the notes they are playing, but the sound the orchestra produces will be unpleasant.

This model suggests that many psychological problems stem from dysfunction in the brain as an operating system and as a control system. The failure of the brain to regulate and control function appears to arise from:

  • Inappropriate activation/dysfunction at certain sites,
  • Inadequacies in communication along the network or
  • Inappropriate coupling between different EEG frequencies.

Effective Therapeutic Protocol

Once QEEG data on an individual has been collected and analyzed vs. a normative database, neurofeedback can be used to re-regulate brain function towards more normal patterns. In situations where abnormalities don't stem from organic brain damage or trauma, brain abnormalities can be returned to normal. Even in cases where organic damage has occurred, brain functioning can be improved.

An article in the January 2005 issue of Child and Adolescent Psychiatric Clinics of North America reviews several open case series and controlled studies showing significant benefits from EEG neurofeedback for patients with traumatic brain injury. The studies, conducted primarily with adults, have yielded improvements on measures of attention, executive function, cognitive flexibility, problem solving, information processing, verbal fluency and depression.

EEG neurofeedback uses electrodes on the surface of the scalp to display a patient's brain function in real time. Patient use that visual display and feedback from the neurotherapist to induce their brain functioning to move closer to the norm. The placement of the electrodes, the brain centers involved and the training schedule are developed earlier in the QEEG diagnostic phase.

With practice, the brain is trained into new patterns of functioning and thus, new ways of performing desired skills emerge. Positive changes in daily functioning then reinforce the learned behavior. In some cases, monthly/yearly follow up may be needed but for 70-80% of individuals, re-regulation is effective and is permanent. It should be noted that EEG neurotherapy isn't a cure-all and in 20-30% of patients experience no benefit.

Effective for a variety of disorders

EEG neurofeedback meets the American Academy of Child and Adolescent Psychiatry's criteria for clinical guideline for treatment of ADHD, seizure disorders, anxiety (OD, GAD, PTSD, phobias, depression, reading disabilities, and addictive disorders.

Based on empirical evidence currently available, we recommend EEG neurofeedback as a good alternative to stimulants for treatment of ADHD when parents or patients prefer not to use medication or when the side effects of medication make its use undesirable. Similarly, with epilepsy, anxiety and depression, addictive disorders and traumatic brain disorder, EEG neurofeedback should be considered when medication proves ineffective or poorly tolerated.

This is not an either/or proposition. EEG neurofeedback can be used in conjunction with psychopharmacology and psychotherapy.

Current research also suggests that EEG neurofeedback can prove effective in treating migraines and reactive attachment disorder. In addition, a strong consensus is emerging that approximately 70-80% of patients with autistic spectrum disorder (ASD), can achieve substantial benefit from EEG neurofeedback therapy. Improvements have been seen in attention and other aspects of executive function, in anxiety and emotional self-regulation and in the degree to which the child is focused on the world around him rather than on his internal state.

There are few risks or contra-indications for EEG neurofeedback.

The Tarnow Center will begin offering QEEG diagnostic services and EEG neurofeedback therapy this summer. The services will be coordinated with Dr. Johnathan Walker of the Neurotherapy Center of Dallas. He is a world-renowned researcher and practitioner in the field, having developed many of the diagnostic and treatment protocols currently being employed in the field. He will provide all QEEG interpretations and will develop EEG neurofeedback training protocols.