What is the history of EEG Biofeedback treatment?
Human EEG biofeedback was first attempted in the 1960s by Joe Kamiya at the University of Chicago. Early investigations focused on operant conditioning of alpha brain waves primarily to facilitate deep relaxation and meditation. In addition, SMR/beta biofeedback was later developed from US military research of operant conditioning of EEGs in cats' demonstrated with top military fighter pilots. Dr. Barry Sterman, Professor Emeritus of UCLA, discovered that cats exposed to toxic airplane fuel chemicals that induced epileptic seizures who had trained the middle to high EEG frequency range (12-20 Hz) in a previous experiment had a greater latency to seizure onset and a higher threshold than untrained cats (Sterman, 1976).
These results were replicated with monkeys suffering from seizures and then people with epilepsy. The results with humans have been subsequently replicated in over twelve research centers in more than twenty clinical studies. We are expanding on this research in Vancouver in collaboration with Vancouver General Hospital, University of BC dept of Medicine and BC Children's and Woman's Hospital Neurological Outpatient department.
After years of treating patients with intractable seizures using SMR biofeedback, it has been noted that in addition to decreased seizure activity in hyperactive children, their behavior improved as well! Consequently, by the mid 70's, Dr. Joel Lubar at theUniversity of Tennesseestudied the effect of neurofeedback on hyperactivity in people without seizures. This established the use of EEG Biofeedback for helping people with attention disorders and hyperactivity that has since been replicated by Dr. Michael, MD and Dr. Lynda Thompson, PhD in Toronto, Ontario.
By 1989 Eugene Peniston of the Fort Lyon, Colorado VA Medical Center undertook a groundbreaking study of alcoholics who received alpha-theta neurofeedback training in addition to the program normally provided. Five years following treatment, 70% of the participants were still abstinent, a phenomenal result and accomplishment for the field of medicine!
Research in EEG Biofeedback continues throughout the world expanding the clinical data and results on it's application for addictions, Alzheimer's, ALS, anxiety, panic attacks, autism, epilepsy, headaches, migraines, chronic pain, gastrointestinal disorders, learning disabilities, motor vehicle accidents, Parkinson's, post-traumatic stress disorder, trauma, ALS, and more.
What is the mechanism underlying EEG biofeedback efficacy?
The original epilepsy seizure protocol developed by Dr Barry Sterman trained motor system excitability and was consequently used in motor seizures. The sensorimotor strip was the site specified for training and the frequency domain was beta (12-19 Hz). It became obvious the training was also effective for temporal lobe seizures, now called complex-partial seizures (Lantz and Sterman). The training enhanced CNS stability in more generality despite the seizure activity.
The human brain has (10) to the exponential power of 12 neurons. In learning, strength of preexisting synaptic connections alters. The persistance of the synaptic connection change is how memory is stored in animal models. Moreover, new protein synthesis occurs during long-term memory. (Nobel Lecture, Eric, Kandel, Dec 8, 2000).
CNS Functions and Activation.
It appears the activation/deactivation cycle of a variety of CNS functions is managed by rhythmicity in certain EEG frequencies. EEG rhythms have been shown to originate in thalamocortical circuits (Sterman). These can range from a highly rhythmic bursting mode to a relatively desynchronized tonic firing mode (Steriade, McCormick). The entire range of rythmicity between these extremes is behaviorally relevant and manages the activation of neural circuitry subserving physiological arousal, autonomic nervous system balance, attention, and affective state. (EEG Spectrum International, 2001)
The enormous range of clinical conditions addressed with a simple set of protocols is strongly supportive of the model that EEG rhythmicity plays a key role in neuroregulation. Some mechanisms are believed to be operative. It is also apparent that current neurochemical models of neuroregulation are of no help in addressing the complementary mechanisms operative in the time domain and the bioelectrical domain, two areas which still needs to be better understood. (EEG Spectrum International, 2001)
Could Neurofeedback results be due to a placebo effect?
A placebo effect can occur with all treatments including prescription medications. Despite this, the results and treatment success we have experienced as well as that which is published demonstrates it is more than simply a placebo effect and is specific to the electrodes??placement on the client's scalp and the frequency trained. The results are also aligned with the neuropsychological expectations regarding function localization.
Training protocols exist for specific conditions and their effects can be effectively reversed through other training methods when desired. In addition, the number of sessions a person has correlates with the extent of the changes observed until a maximum responsiveness occurs and stabilization is achieved. Consequently, training effects are cumulative rather than fading over time as seen with placebos and trained populations can significantly exceed control subjects in performance. That would be not possible if it were strictly a placebo effect.
Furthermore, the effects of training usually lie beyond spontaneous recovery ranges. In many of our clients, their doctors??did not believe the extent of recovery experienced was possible and beyond traditional treatment methods results (Wunderlich, 2004). One of our clients, hit by a moving vehicle at age 3, was 19 in grade 4 English when he came to us and has now graduated high school within a year of training! Not only were there drastic improvements in his speech, neurological functions, but also in his cognitive and psychological awareness of his behaviour and the impact his actions have on others.
Is treatment training non-specific?
Training is certainly not "non-specific" in the usual sense held by critics (the placebo argument). Treatment is specific to underlying thalamocortical rhythmic activity that sets levels of activation of numerous neurological functions including attention, arousal, and affect. However, it is claimed to be non-specific with respect to clinical disorders and QEEG manifestations of disregulation (EEG International, 2001). The goal of EEG biofeedback is to work with what functions within the brain and is believed to use neural plasticity to restore and maximize the brain's functions rather than focusing energy on what isn't functioning well.
Why are we only becoming aware of Biofeedback if research began in the 1970s?
Funding and interest in this field dried up when the NIH shifted from a behavioral to fundamental molecular biochemistry focus to further neurophysiology advances in the mid-eighties. This was naturally due to limited revenue that could be generated from a treatment approach that resolves underlying conditions'symptoms by targeting the cause rather than just treating the symptoms. This trend has been seen in many areas of medicine, including Homeopathic and Naturopathic medicine which could not be patented and sold at the same lucrative prices as pharmaceutical medicine thus are not as profitable. At one point, the AMA (American Medical Association) was even asked to revoke all medical licenses of medical physicians who were trained in medicine and practiced Homeopathic medicine which was previously post graduate studies. (The Homeopathic Remedies for the Home)
Complementary and alternative medical approaches are now reemerging due to consumer awareness of traditional pharmaceutical based medicines side-effects and lack of efficacy for treating resistant conditions (such as HIV, cancer, ALS, epilepsy, Alzheimer's and Parkinson's Disease) as not all cases are responsive to current medications. In addition, though medications often offer a quick fix people are seeking without requiring lifestyle changes or personal effort, their side effects and development of resistance to the medication can compromise people's quality of life as they must increase their dosage to achieve the same initially desired response. Naturally, this is not an issue with EEG Biofeedback and other approaches and it leaves clients available for other combinational treatment methods to further increase efficacy and results.
Despite the political agendas many health companies and funding agencies, there have been systematic replications of Sterman's findings by others in the late 80's confirming the controlled studies. The second challenge contributing to the lack of awareness is related to the theoretical treatment model. Medical professionals were seeking a consistent model to explain the EEG phenomenology and discoveries made by Sterman. Unfortunately, the knowledge and understanding of the brain and representational models of the time could not explain how remediation could occur. Remediation could be decoupled from explicit EEG changes according to the training protocol.
What is the minimum age for Neurofeedback to be effective?
Many offices have worked with children as young as two and three. Some have been chronologically three years, but of a mental age of six months. Our facility has worked with clients ranging from5to 70 years old. Many of these very young children were compromised with Cerebral Palsy, near-drowning victims, prenatal substance exposure, essential tremors, psychological trauma victims, etc. Irrespectively, these compromised nervous systems are able to respond to the training.
Why are there limited double blind placebo studies in Neurofeedback?
Double-blind studies cannot be done with behavioural techniques where the clinician has to know what is occurring. Single-blinded studies, where the client doesn't know which group he/she is in and the source of the information he/she is responding to (referred to as sham training), were done for both epilepsy and ADD when those techniques were allowed under the previous ethical standards that have now progressed and are more sensitive ensuring no harm or treatment denial occurs with human subjects. However, studies have been effectively done using an A-B reversal designs.
Why are there not more controlled studies being done?
The ethical environment has changed. For the interest of people and their well-being, the Human Subjects Review Boards have ruled out sham training as unethical in some instances; they have also ruled out reversal designs. You are no longer allowed to make people worse, frustrate them, as in sham training, or even require them to abandon an established, efficacious treatment modality (i.e. medication) for purposes of a study.
Outcome studies are gaining legitimacy (Martin Seligman, American Psychologist, 1996, 51, 1072-9). Outcome studies are more appropriate to the clinical setting where the work is taking place especially since FDA approval is not required as Biofeedback does not use any foods or drugs for treatment.
Many behavioural techniques are also often assessed by outcome measures. Blindness can be assured by having the assessments done in blinded fashion while the training is done unblinded. Controlled studies are done mainly to control for the placebo effect, which is not relevant for behavioral therapy. However, this can be ruled out by a comparative study approach comparing biofeedback with another well known effective treatment modalities such as medication where the placebo effect is known or by using a cross-over study where everyone is exposed to the same potential placebo effect and results are compared.
What is the Difference Between Neurofeedback and Biofeedback?
Neurofeedback is a form of biofeedback focusing on the brain and neurological functions.
How is it done?
It involves first meeting with the clinician, obtaining a history, list of symptoms and confounding factors. The clinician then attaches a variety of sensors to the body's skin (Galvonic Skin Response; a.k.a. the lie detector, more appropriately called the Guilty Knowledge Test), brain (Electroencephalogram), heart (Electrocardiogram), etcetera to monitor the body's conductivity, temperature, respiration, blood pressure, heart rate, corresponding neurological functions and other unconscious body responses.
A baseline of the client's typical functions is obtained and regular training sessions are scheduled. The clinician and/or trainer then teaches them how to control their body's responsiveness to enable healing through relaxation, proper breathing, circulation, nutrition, improved focus, concentration and attention enhancing daily performance. In turn, this also reduces stress, anxiety, tension, irregular neurological, psychological and biological functions.
How long does EEG Biofeedback training take? Typically, changes begin to be observed following 5-10 sessions of weekly 40-60 minute sessions (once to 3 times/week) and there are no confounding factors (additional life stressors). Thereafter, clients begin to learn how to improve on the techniques so their brain and body can incorporate the strategies into daily activities. Changes are often first noticed by relatives, teachers, friends and family between 10-20 sessions depending on the condition and its severity. The remaining sessions hone the client's performance, enhance regulation of their body, further reduce symptoms and address other confounding factors not previously addressed through other treatment therapies pursued.
Most of our clients??find they can make a turnaround between 40-80 sessions and are comfortable with scaling back sessions thereafter to maintain gains, clarity of focus and performance. The extent of training required will depend on the person's ability to learn, build confidence in the techniques and develop new patterns of behaviour and habits.
In cases with an organic cause, training will take longer to allow for chemical cascades and biological markers to be activated and areas to regenerate that impact the levels of neurotransmitters and enzymes produced and broken down. Many conditions have taken years to develop and may not fully reverse within 1 year simply from biofeedback.
In these cases, the clinician will advise you of additional therapeutic methods, support services and strategies to best assist you with your situation. This may involve referral to other medical services, support groups, family assistance and community support services that you are open to. The extent of the training required will be determined and discussed with you during the preliminary assessment and intake meeting so you can make the best possible decision for you and your family.
How does the training process work? This process enables the client to slowly change and self-regulate their body's automatic responsiveness to situations and is combined with coaching and counseling for psychological conditions. It is based on simple operant conditioning that is drug-free and non-invasive. Consequently, underlying neurological, psychological and physiological changes begin to occur enabling the developments to be long-lasting. This can be seen in kindling epilepsy research by Dr. Jun Wada, one of Vancouver's leading retired Neurologists, Teresa de La Boursodiere's UBC research in 1998 as well as in Dr. Barry Sterman's epilepsy and sleep studies results since the 1976 at UCLA.
Will it enable me to reduce my medications? Clients??are able to work with their physicians to reduce their medication when the training takes effect. However, the decision to reduce or increase medications and dosing should be discussed with and determined by the patient's primary treating physician as conditions vary and have confounding factors such as a medication's half life, time lag when medication changes occur and biochemical cascades. Parents and clients should never make changes to their medications and medical care without first consulting a qualified physician.
Extended Health Insurance Coverage
Each person's extended health plan will vary depending on the policy contract, the extent of coverage, and the categories that the provide can claim under. Many insurers have categories for medical diagnostics or laboratory testing as well as rental or leasing/purchase of medical devices. In addition to these categories of claiming, the client can claim under other allied health services. Maximising one's extended health benefits can be complex and requires referring to the booklet and, at times, the group or individual policy contract. We will review these items with you during your initial assessment.
Treatment Approaches and Protocols
There are several models of treatment and protocols used for ranging conditions by professionals around the world. As a result, it is very important to know the results, education, professional training, success rates as well as the professional designation of the clinician you are seeing. Dr. Barry Sterman is my supervisor and mentor whom I respect and consult with closely while maintaining a healthy awareness of improvements new approaches may provide.