Neurotherapy Iza Boesler, MD Betty Jarusiewicz, PhD EEG Spectrum
732-801-4505 E-mail:
[email protected]
Contents • Background/Overview – What is Neurofeedback/Neurotherapy/EEG Biofeedback – How it Differs From Biofeedback – Types/Frequency Ranges/Uses/With Other Therapies – Why NT and Brain Regulation Works – Research Basis (Thumbnail sketch)
Contents (cont’d) Relationship to Genetics and Environment Immune System Important Current Research - QEEGs - Loretta - HBOT - Blood Flow Analysis
Background • Other Names – EEG Biofeedback – Neurotherapy (NT) – Neurotraining (NT)
• How it Differs from Biofeedback
Contents (cont’d) • Delivery of NT – What it looks like – Places of delivery – Types of measurement
• Our Research - Various Efficacy trials - Use of new measurement equipment - School use - Particular Protocols
Contents Cont’d • Assistance to Families and/or Schools – Neurotherapy – Counseling during NT training – Group information sessions
Background: What is Neurofeedback and What does it do? (Neuroregulation) • the process of operant conditioning which changes one’s state (stabilizes CNS) and improves behavior
• using equipment that monitors and measures the electrical activity of the brain and TRAINS the brain to be more available to life’s requirements
Background: Types of Neurofeedback • Beta/SMR – Eyes Open – Frequency Range 12-18 Hz
• Alpha/Theta – Eyes Closed – Frequency Range 0-11 Hz
Background - Terminology : Brainwave Frequencies (Brain States) 35Hz+
Some evidence of association with peak performance states
High Beta
18-35 Hz
High correlation with anxiety, when dominant
Mid Beta
15-18 Hz
Active, external attention
SMR Beta
12-15 Hz
Relaxed, external attention
Alpha
8-12 Hz
Theta
4-7 Hz
Delta
0.5-3 Hz
GAMMA
Very relaxed, passive attention Deeply relaxed, inwardly focused Sleep
Some Documented Uses of Neurofeedback (See www.isnr.org for Comprehensive Bibliography)
• Beta/SMR – ADD/ADHD – Learning Disabilities – Sleep – Anxiety, Impulsivity - Depression - Epilepsy - Autism
• Alpha/Theta (after Beta/SMR) – Emotional and behavioral instability – Addiction (Note: NFB is approved by FDA for relaxation)
Integration with other Therapies/Approaches • ADHD, Learning Disabilities, Autism, Epilepsy – Behavioral Therapies – Speech Therapies – Occupational Therapies – Counseling – Other (I.e. Assistive Learning)
• Headaches (Migraines), Sleep, Anxiety, Impulsivity, Emotional and Behavioral Instability – Counseling – Medication
• Addictions, Peak Performance – Counseling
Research Basis • 1974: Sterman, MacDonald, & Stone – Noted: seizures reduced by 66% on 4 individuals – Used SMR combined with inhibition of excessive slow wave activity (6-9 Hz)
• 1976 SMR: Lubar – Hyperactivity Effects noted: – subsided during training for epileptic seizure reduction – reduced even in absence of seizures – More effective than stimulant medication alone
Research Basis (cont’d) • 1984: Lubar – SMR,with inhibits technique extended to attentional deficits and learning disabilities – Significant academic performance enhanced by use of Beta (12-15 Hz)
• 1989: Penniston & Kulkowsky – – – –
Addition of Alpha Theta Work Operant conditioning with eyes closed For use in meditation and mental imagery Useful for Addiction, PTSD, and Peak Performance work
Research Basis (cont’d) • 1989 – Othmer – Initial work with Epilepsy – Development of Software/Hardware for Operant Conditioning Process – Development of EEG Spectrum Inc. – Expansion to other conditions, setting up protocols, training practitioners
Research Basis (Cont’d) – Disregulated Brains • Jarusiewicz – initial control pilot study • Coben – use of supplemental devises – Blood flow, QEEGs – Mirror Neurons
• San Diego Jaime P
Why Neurofeedback Works (Operant Conditioning) – Brain can change with assistance directed by rewards: light, movement, and sound – Brain assists in finding best/better approach (New pathways? More dendrites?) – Brain will remain in new state as it “feels better” – Brain is continually used, maintaining “new skill”
Disregulated vs Regulated Brain
Example of Similar Exercise Model • Cardio respiratory Exercise – Stronger heart and improved regulation – Sleep improved – Mood improved – Lower basal metabolism
With thanks to Harold Burke, Ph.D.
In Summary, EEG Biofeedback: • Enhances the ability of an individual to access and maintain different states of physiological arousal and to navigate from high-vigilance to rest. (trains the brain to regulate itself better) • Hence, the treatment of disorders, such as ADHD, depression, and anxiety. With thanks to Harold Burke, Ph.D.
Summary (cont.) • Enhances and supports the mechanisms by which the brain manages cortical hyper excitability and promotes stability. • Hence, stabilization against “minor” problems, such as temper tantrums, vertigo, tics, OCD, bipolar disorder, panic attacks, and PMS; and against even lesser disruptions, such as attention problems, sequential and parallel processing, and normal sleep.
Summary (cont.) • Reinforces equilibrium states.
• Hence, normalization of pain thresholds, appetite, and blood glucose levels.
What about the Placebo Effect? • The effects of the training are highly specific to electrode placement and to training frequency band. • Training protocols exist which can commonly elicit effects opposite to those desired. • The effects of training with one protocol can be reversed with another. With thanks to Harold Burke, Ph.D.
What Brain Training Sessions Look Like: Client “Hookup”
Universal 10 20 Chart for Electrode Placement
Brain Training Session Screens Therapist (EEG)
Client (Game)
Therapist’s Screen • Measurement of total EEG signal at the scalp with electrode or two • Amplification of microvolt-level signals for computer processing; • Extraction of low, medium, and high frequencies
How is it done? (cont.) • Progress is monitored every session; • Initial sessions should be at a rate of 23 per week until progress is seen (probably by 20 sessions).
Research study: B. Jarusiewicz
Control by Right and Left Brain*
The left brain “Style”: Analytic
The right brain “Style”: Holistic
- Speech/language specialization - Processing - Focus
– Superior visuospatial performance – Emotions/tension – Anxiety And
Left Brain/Right Brain 5th Ed 1998, Springer, S & Deutsch, G
Brain Frequencies “Spectrals”
(Note: Every person is different)
Autistic * Typical * (note extensive delta, theta and alpha frequencies)
Measurement of Change • By Client – Establish changes client wishes to make – Develop reporting mechanism
Measurement of Change • By Therapist – Review behavior changes (checklists, drawings) – Review how client feels – Review brain activity (measured averages etc) – Review spectrals
Child’s Family Drawing at Beginning of NF - 8/3/94 (with thanks to L. Hirshberg)
Drawing after Twenty Sessions 9/8/94
Drawing after forty sessions 11/25/94
Hill and Castro ADD/HD Checklist
Measurement of Change • For Research – Use of “standard” tests (ADI, ADOS, Checklists, IQ, memory and reading) – Corroborative Evidence (videos, interviews, school or other therapy reporting tests)
Autism Study Average Behavior Changes (ATEC) by Type • • • •
Sociability Speech/language/communication Health Sensory/cognitive awareness p
