EEG Biofeedback, or Neurofeedback in Clinical Uses

1. EEG Biofeedback, or Neurofeedback in Clinical Uses By Peter Meilahn, M.A., MFT Intern Psychotherapist & EEG Biofeedback Practitioner Family Life Mental Health Center, Coon Rapids & The Minnesota Biofeedback Clinic, St. Louis Park and St. Paul

2. Resiliency Factors in Biofeedback • The core concept of biofeedback is immediate reward with good feelingsfor increasing or decreasing brain rhythms. We know from population studies what is low or high in certain brain profiles, so experiments have been done to see if changing or improving the brain behavior results in changed life behavior, mood, etc. And it does. This is another therapy that adds depth to the field. • The feedback is movies, music, games, or graphs of the brain behavior itself. • Sound tools can also “entrain” positive brain rhythm change (much more experimental- so this presentation focuses more on biofeedback/neurofeedback.

3. Basic Factors in Biofeedback • All research is based on weekly visits. • The sessions are at least 45 minutes and can be twice weekly at 30 minutes each. • Clients can pick the feedback. • Clients also see results right away, but first learn how they change what they do, and then get better at it while generalizing it. • Feedback change is recognized at 150 milliseconds to 300 milliseconds and clients change behavior to keep the reward. • It typically takes 500 milliseconds to think “consciously”. Habits are reformed while it works with other therapies in the room or in partnership with other therapists.

4. EEG Spectrum & Common Functions

5. The Full Connectivity

6. Peer Reviewed Clinical Outcomes • Depression; Multiple approaches, primarily to restore right brain regulation and functioning • Anxiety; primary goal is to reduce excess fast frequencies and restore relaxation response. • Chemical dependency; 80% success for Alcoholism compared to 20% of MN Model. These results have been repeated. • PTSD; uses same protocol as CD treatment.

7. Peer Reviewed Clinical OutcomesAnxiety, Depression & Neurofeedback • Insurance Supports Biofeedback for Anxiety Because of the Effectiveness. • Most of the research studies use either relaxed attention or focused attention for high results with performance anxiety, panic attacks, tension headaches related to anxiety, and general or other anxiety states. With CBT and other therapies it is effective for agoraphobia. • I have seen panic attacks stop, clients be able to reduce general anxiety, restore sleeping a full nights sleep after sleeping 4-5 hours a night, and other things. • http://www.sydney-neurofeedback.com.au/downloads/Hammond_b,%202005.pdf • http://www.neurofeedbackclinic.ca/journals/depression/dep.pdf

8. Peer Reviewed Clinical OutcomesADHD and Neurofeedback • ADHD; Supported by the American Academy of Pediatrics as of June 2010 and the state of Minnesota. One study showing it is as effective as stimulants. • One study shows that it is as effective as medication in improving behavior. On average IQ increases 7 points on intelligence tests in experimental groups. With underlying disabilities IQ can increase more- as much as 27 points when there is information processing cleared up. • Results are shown to stay 6 and 12 years after treatment in resaerch by J. Lubar. • The corpus callosum has been shown to become thicker after neurofeedback, increasing psychological integration and resources for integration of stimuli. • Recent clients include results such as; better sustained effort while reading, fewer upsets, more tasks completed • http://eegfeedback.org/pdf/o_donnell.pdf

9. Peer Reviewed Clinical OutcomesChemical Dependency • Early research was done in VA hospitals. • Often showing 80% success in preventing relapse in the first year. Traditional 12 step models show 25-30% prevention. • Clients first stabilize their mood and then reflect on triggers of anxiety while working towards visualizing positive choices. • They learn to enter the hypnogogic state of relaxation more easily while watching the mind like a movie- gaining perspective of their angst to not turn to chemicals in the mind body problem. • From a paper on neurofeedback for opiod dependency, “The Multivariate Analysis of Covariance (MANCOVA) showed that the experimental group, in comparison with control group, showed significantly more improvement in all three outcome measures. In the SCL-90-R, improvement was noted with the hypochondriacs, obsession, interpersonal sensitivity, aggression, psychosis, and general symptomatic indexes. In the HCQ, improvement was found in the anticipation of positive outcome, desire to use substance, and total average score. Finally, the QEEG showed positive changes in frontal, central and parietal delta, frontal and central theta, parietal alpha and frontal and central Sensory Motor Rhythm (SMR) amplitudes.”- http://eeg.sagepub.com/content/41/3/170.short

10. Peer Reviewed Clinical OutcomesChemical Dependency • Clients develop the calm needed to not drink while restoring brain connections. • Currently I have a client with 1000 hours of blackout drinking reported and he has done neurofeedback with leading practitioners for about 55 hours. He recently had an fMRI done at the U of MN where they saw no lesions in his brain which is unusual. • Personality changes can be highly dramatic as the reflective aspect of lead to integration and flexibility. • The early research was so effective that the APA sent investigators to look for fraud. • http://drug-and-alcohol-rehab-program.com/Drug-Rehab-Alcohol-Rehab-Addiction-Study.html • http://morestics.nl/Files/Gruzelier%202009%20Alpha%20theta%20neurofeedback.pdf

11. Peer Reviewed Clinical OutcomesPain and Neurofeedback • The research on chronic pain is mostly in case studies at this point except for migraines. There are several studies for migraines at this point. • I have seen clients rate their pain changing from 8-2 or 6-0 in a session. • I have a current client who was having migraines twice weekly for the last six months and has stopped them with only some tension pain in her eye where she recalls how she does it to reduce the pain. • http://neurotopiacentralcoast.com/wp-content/uploads/2012/09/NewInsights.pdf • http://www.stresstherapysolutions.com/kb_file/BrainMaster_Migranes.pdf

12. Frontiers • Autism: A handful of studies. • I hear reports of better sleep and a dramatic reduction in tantrums after neurofeedback. More intensive training is needed with a longer term commitment. • Family Dynamics in the brain: • i.e. I and other practitioners see patterns in family patterns that show up in the brain. One example is a parent whose anxiety is front brain, goal oriented or worrisome will over compensate with their child and the child will take on a more rear brain, cathartic anxiety that is more dissociative than hyper focused like the parent…then the pattern may continue. • Other patters are “mappable”. • Sounds: • University research at Duke, Cal State-Fullerton, University of Virginia and hospital research in the NHS in the UK and other places has shown effectiveness of sound entrainment of brainwave rhythms for attention, mental task performance, pain, mood, and other factors. • Sounds for sharing with clients can be found at www.flmhc.org/sound-tool.html or www.mindvolume.com

13. Other References • Symphony in the Brain, by Jim Robbins • How the Minds Bounce Back – Scientific American, March 2011 • Fitzgibbon, S. P., Pope, K. L., Mackenzie, L., Clark, C. R., Willoughby, J. O. (2004). Cognitive Tasks augment gamma EEG power. Clinical Neurophysiology, Vol 115, p. 1802-1809. • Liu, T., Shi, J., Zhou, D., Yang, J. (2008). The Relationship Between EEG Band Power, Cognitive Processing and Intelligence in School-Age Children. Psychology Science Quarterly, Vol 50, No.2. p. 259-268. • Loo S. K., Barkley R. A. (2005). Clinical Utility of EEG in Attention Deficit Disorder. Applied Neuropsychology, 12, No.2. p. 64-76.

14. More References • Zametkin A.J., Nordahl T.E., Gross M., King A.C., Semple W.E., Rumsey J., Hamburger S., Cohen R.M. (1990). Cerebral glucose metabolism in adults with hyperactivity of childhood onset. New England Journal of Medicine, 323, p. 1361-1366.