Description of Neurofeedback
Neurofeedback is a non-invasive, non-cognitive treatment that works by engaging the brains own mechanisms for self-regulation. Neurofeedback is NOT a form of mindfulness training or cognitive-behavioral therapy and is inaccurately assumed to be a form of biofeedback to teach relaxation. It uses real-time displays of electroencephalographic (EEG), brain activity to alter brain functioning in positive directions and its underlying processes maps to one of the most exciting areas of neuroscience: the plasticity of neural networks and their impact on mental and physical well-being. (see Closed-loop brain training: the science of neurofeedback, Nature: Neuroscience 2017). It is based on over 40 years of research and thousands of published research papers including, animal studies, reversal designs and random assignment to treatment.
Neurofeedback as a treatment has several advantages which allow it to be used effectively with high risk (ACE scores of 4 and higher), non- respondent populations of almost any age, and over a wide variety of conditions. It can impact concentration, sleep, mood, anxiety, pain, emotional regulation, impulse control, energy, social awareness. It has been used to address PTSD, TBI, Depressive Disorders, Autism Spectrum Disorders, ADD/ADHD, substance abuse disorders, achieving almost immediate and sustainable improvement, over the course of a standard protocol of 20+ 45 minutes sessions (30 minutes of actual feedback experience, twice weekly in the optimal sequence of scheduling). In a neurofeedback session, the actual therapy simply involves the client watching movies of their choice, in which the feedback is embedded. The feedback is how the movie shrinks and expands in relation to their brain activity.
For the client, the process is largely passive in that they need only watch the movie. They are not requested to do anything. For the provider, the two principle concerns in are 1) selecting the frequency at which brain activity is monitored, and 2) selecting the sites at which the two active electrodes will be placed. Usually a standard initial placement and frequency setting is selected. Then by a careful process of incremental adjustment, and based on feedback from the client which can be almost immediate, a setting is found where the client is most comfortable, with only modest adjustments over the course of treatment, based on protocols established by the EEG Institute of Los Angeles (https://www.eeginfo.com/ ) which has pioneered development in the neurofeedback field and now leads in the development of the “ILF” or ultra-low frequency approach.
Despite this seemingly minimal intervention, there is ample evidence that the brain can use this feedback to improve the regulation of it’s own activity. ( see Sitaram, R., Ros, T., Stoeckel, L., Haller, S., Scharnowski, F., Lewis-Peacock, J., et al. (2017). Closed-loop brain training: the science of neurofeedback. Nature Reviews Neuroscience , 18 (86), 86–100.)
Neurocognitive testing and symptom tracking have regularly demonstrated that the improvements are real and beyond what might be attributed to expectancy or placebo effects. Even skeptical or reluctant clients typically report that they are noticing positive changes in themselves. Motivation to continue has historically been excellent, even with very difficult populations. The effects of treatment are improvements in focus, anxiety, depression, frustration tolerance, impulsivity, headaches, sleep and better tolerance of stress and pain. For clients with PTSD there is often resolution of long-standing trauma triggers. There are numerous articles that speak to the scientific legitimacy of neurofeedback and its specific application to PTSD. A link to a video about neurofeedback and vets can be found at https://www.youtube.com/watch?v=t-5metrcUA4&t=66s
Unlike therapies which encounter, or engender, resistance and no-show behavior, neurofeedback is a “client-centered modality that appeals to clients. It makes sense to clients that their brain is stuck in hypervigilance and/or dysregulation and that this is not by choice but a consequence of events in their life. It is very engaging as the client choses from movies, YouTube, Netflix or video games as the source for the feedback. It relies on the client’s own choice of concerns as the metric to measure treatment progress. It can be done by existing service providers without a need to use specialists. Professionals and paraprofessionals in mental health can be trained in 5 days to competently conduct this treatment. Supervision to insure program adherence and effectiveness can be conducted at a distance and at little to no cost. Neurofeedback can be either a stand-alone or an adjunctive treatment as part of a comprehensive treatment program. It is the first scalable behavioral treatment for our health care system. It is the first behavioral treatment that regularly receives “upgrades” and “updates”.