Neurofeedback: The Un-Medication
The brain is a remarkable organ, we know now that new pathways are created and pruning continues well into the senior years commiserate with stimulation. As a data collection and feedback mechanism it can also be employed to correct their dysfunctional brain patterns and fix the problem.
When given immediate feedback and enough practice, people can correct their dysfunctional brain patterns and fix the problem. This therapeutic discipline, known as neurofeedback "meets the American Association of Child and Adolescent Psychiatry's criteria for ‘Clinical Guidelines' for treatment of ADHD, seizure disorders, anxiety (e.g., obsessive-compulsive disorder, GAD, posttraumatic stress disorder, phobias), depression, reading disabilities, and addictive disorders. Because of the high level of empirical support, the use of neurofeedback for ADHD will meet the most stringent American Psychological Association criterion of efficacious and specific, which requires two independent randomized controlled studies, among other factors" (Hirshberg et al., 2005, p. 12-13).
Research comparing neurofeedback to stimulant medications is non-existent. However, repeatedly the ADHD neurofeedback studies have demonstrated equivalent effectiveness as those of stimulant medication (Hirshberg et al., 2005, Child Adolescent Psychiatric Clinics of North America). 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. And, unlike medication that affects the whole body, neurofeedback targets only the dysfunctional areas.
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 and how it is within and between each lobe.
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 waveform 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.
Dysfunctions 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 based upon these data. In situations where abnormalities don't stem from organic brain damage or chemical toxicity, 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.
What takes place in session?
In a session, the neurotherapist attaches electrodes on the surface of the scalp to display a patient's brain function in real time. Patients 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, are based on protocols developed from the qEEG specific to the individual brain.
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 neurotherapy isn't a cure-all and in 20-30% of patients experience no benefit.
Application of Neurofeedback
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, neurofeedback should be considered when medication proves ineffective or poorly tolerated. This is not an either/or proposition. Neurofeedback can be used in conjunction with psychopharmacology and psychotherapy. There are no risks or contra-indications for neurofeedback.