Neur-o-feed-back [noor-o-feed-bak]

1. a type of biofeedback training, focused on training the brain

2. a method of learning to control one’s brain functions by monitoring one’s brain waves

3. the technique of making unconscious or involuntary bodily processes (brain waves) perceptible to the senses (as by the use of an EEG) in order to manipulate them by conscious mental control

Neurofeedback training actually teaches the brain to function better, helping to improve attention, focus, motivation, and fostering a positive outlook. For those reasons, it is of intense interest to people challenged with ADHD, Anxiety, Depression, and other mental/emotional challenges. This may all sound like science fiction, but neurofeedback is based on strongly established neuroscience, and been extensively researched and practiced since the late 1960s. It is considered by many experts in the field of mental health to be as effective as medication, without the side effects. You can read a few quotes from some of these experts, as well as key research data, in the “Results” section of this page.

Successful neurofeedback training requires a few things. Our clients supply the brain, and the desire to improve it. We supply the technology and the structured treatment process required to further the client’s goals. The results speak for themselves. Read more about the science behind these topics below, or, for more detail on how those principals are applied in the context of a typical client’s experience, click the “How We Help” tab.

The Brain:

Arousal is a physiological and psychological state of being alert. It involves activation of regions in the brain stem, connections running through the cortex, autonomic nervous system, and endocrine system. Many leaders in the field of mental health believe that the “arousal model” is the most accurate way to view brain activity regulation and corresponding mental function. More importantly, the arousal model is particularly valuable in helping us to understand both what is going on in a dysfunctional brain, as in cases of ADHD, depression, and anxiety, and what steps can be taken to remedy the dysfunction.

During waking hours, one needs to have a sufficient level of arousal to function properly, but you can also have too much of a good thing:

• Low arousal during waking hours leads to feelings of sluggishness, sleepiness, a lack of focus, or being in a mental “haze”. Chronic low arousal will seriously compromise a person’s ability to accomplish even the most basic of tasks.  
• Optimal arousal levels create a condition of sensory alertness making the individual fully “awake”, calm but focused, in what has been described as the “fighter pilot” state of mind.This level of arousal is associated with motivation, vigilance, and empowerment.
• Over arousal can cause the mind and heart to race, preventing productive thought processes, bringing on feelings of anxiety, and possibly jumpy or circular thoughts. Not only does this compromise quality of life and productivity when awake, but it can also create problems with sleep, as an over aroused person won’t be able to “wind down” at night, worsening their problem. Triggering of the “fight or flight” response is an example of extreme over arousal.

To put it another way, in a simplified arousal model:

• Depression is caused by a chronic under arousal of certain brain regions.
• Anxiety resides at the other end of the spectrum, resulting from an uncontrollable over arousal in the brain.
• ADHD is also very solidly explained by the arousal model. Arousal research has revealed the underlying brain dysfunction that causes ADHD, as well as explaining why stimulants are effective in calming a hyperactive child (which can seem very counterintuitive on the surface). The short answer is that people with ADHD have several brain regions which are under aroused, making it tough for them to pay attention. Fidgeting and hyperactivity occur when they attempt to elevate their abnormally low arousal level through self- stimulation. Without realizing it, they are trying to literally “wake up” their under aroused brain regions through an elevated activity level (tapping a toe, fiddling with a paper clip, etc…). Unfortunately, these activities are often highly counterproductive, and only further contribute to the problem.

The components that contribute to a given level of arousal include both electrical brainwave activity, and the brain’s chemical neurotransmitters, acetylcholine, norepinephrine, dopamine, and serotonin. When viewed through this arousal frame, one can see why both medication and neurofeedback can be effective in relieving symptoms of an arousal regulation problem in the brain. Medication is attempting to correct the problem with a chemical approach, by affecting levels of neurotransmitters, while neurofeedback takes an electrical activity centered approach, affecting the amount and frequency of brainwaves. Arousal, and therefore symptoms, can be altered through either approach.

The Technology:

 CT Mind Training offers our clients a variety of neurofeedback technologies to help optimize their brain function. Depending on the client’s needs, we will select from systems developed by leaders in the neurofeedback field as well as by NASA (who uses the technology to train astronauts for optimal brain function).

Listening to the brain - All neurofeedback training starts with Electroencephalography (EEG), which involves the recording of the electrical activity of the brain, through the use of non-invasive sensors placed on the scalp. The most common use of EEG is simple recording the brain’s activity, usually for about 30 minutes, which is done in order to allow for diagnostic analysis. This is done in hospitals worldwide to detect epilepsy, tumors, and other focal brain disorders, and also for brain function investigation in research settings.

Neurofeedback is a newer application of EEG technology, which uses advanced software to make the real-time EEG data useful not just as a record of past brain activity, but instead turns it into a tool for immediately shaping upcoming brain activity, leading to long-term changes in brain function. The EEG data is fed back to the client through what you might think of as a specialized video game, but instead of controlling the game with your hands, you do it with your brainwaves.

Everyone’s brain is constantly trying different firing patterns and frequencies, but without neurofeedback, the brain doesn’t have the input or feedback needed to let it know when it gets things “right”. Neurofeedback rewards the brain every time it does the right thing, leading to a challenging experience which spurs it to strengthen the desired patterns and leads to a consistent migration in the desired direction. Consistent training has the capacity to dramatically change the brain’s function over a period of just a few months, and leads to an increased awareness and differentiation of mental states.

The process:

We believe that a well defined and structured process is the only way to achieve predictable results. Our standardized method moves through a few distinct stages that we have outlined below.

1. Client interview and protocol selection – At the CT Mind Gym, new clients meet with our staff and discuss their goals, challenges, diagnoses, and past therapies and courses of treatment. Some of our clients come to us with a diagnosed disorder, and while we prefer to avoid “labeling” people, this diagnosis can often provide the framework around which we can build a personalized solution. More important than any “label” is the clear idea of where our client is today, where they want to be in 6-months, and the step by step plan that will help them to successfully overcome their challenges. Other clients come to us from outside this “medical diagnosis” framework because, while they are considered “healthy” in a medical sense, they have felt that they could be achieving so much more if only they could strengthen their weakest cognitive or emotional links.

Based on the client’s history, challenges, and goals, we will determine a neurofeedback system and training program to use as a starting point, which will focus on shifting the brainwave patterns in specific brain region. Over time, the clients response will dictate gradual increases in the level of challenge, or moves to training other brain regions which also need work.

2. Training sessions – Through consistent training over a period of weeks, neurofeedback naturally encourages the brain’s “neuro-plasticity”, which refers to its innate ability to change and develop increased control, strength, and new healthier patterns of function. Neurofeedback training literally rewards the brain every time it does the right thing, and it does so hundreds of times in  every training session.  

As the client’s brain function improves, we continually increase the challenge level, leading to further improvements or, when a satisfactory improvement has been made, we switch to improving other areas in which the client needs help (i.e. switching from improving attention to reducing anxiety). Just as with physical workout routine, brain fitness requires consistent effort and practice, but predictably rewards persistence with improvement.

Research continues to show that brain exercise can not only help the brain to become more fit and functional in children, but that it is in fact also critical in maintaining brain function into old age. A highly functional brain is absolutely essential if one hopes to reach their full potential, as it is a prerequisite for even the most simple of activities…like thinking clearly, paying attention for extended periods, and having a reliable memory.

3. Maintenance program – Once the client’s goals are achieved, they are shifted to a maintenance program of less frequent training sessions, sometimes simply on an “as needed” basis, to prevent any backsliding.

For more detail on how those principals are applied in the context of a typical client’s experience, click the “How We Help” tab.

The results:

We use a fact based methodology in our practice, and believe that it is facts that are most effective in conveying the results that neurofeedback can deliver. The following section contains a brief overview of key research, quotes from leaders in the healthcare field concerning their opinions on neurofeedback, and testimonials from clients who have received treatment. Our intent here is to summarize key points, so for more detail on the specific studies mentioned, please click the “News & Research” tab above.

The Big Picture - A meta-analysis of dozens of controlled studies and clinical trials has uniformly shown that 70-80% of participants get significant benefits from neurofeedback, which was measured using both computerized attention tests and standardized behavior rating scales. This compares very favorably with the success rates of pharmaceutical treatments for ADHD and Depression.

Neurofeedback for ADHD – Researchers from Tübingen University (Germany), Radboud University (Nijmegen, the Netherlands), Brainclinics and EEG Resource Institute conducted at meta-analysis (a big picture review of numerous other studies). After reviewing all data available,  they concluded that neurofeedback constitutes an “Evidence-Based” treatment for ADHD. “Evidence-Based” medicine is based on the concept of applying the best available evidence provided by the scientific method, for the use of making critical medical decisions.

Neurofeedback for ADHD - A large scale study by Dr. Vincent Monastra and his colleagues [The Effects of Stimulant Therapy, EEG Biofeedback and Parenting Style on the primary symptoms of ADHD. Applied Psychophysiology and Biofeedback. 2002 Dec; 27 Dr. VJ Monastra et al] researchers compared 100 children aged 6-19. The subjects were studied over a period of 12-months, with half of the subjects using a traditional and comprehensive treatment plan of stimulant medication, behavior therapy, and parent/school consultation, and a second group which had all of those treatments PLUS neurofeedback.

After 12-months, the children in the neurofeedback group were doing significantly better than the children who did not receive neurofeedback, according to both parents and teachers, as well as performing better in a computerized test of attention (TOVA). EEG scans were also done, which showed that the neurofeedback group now had “Normal” brainwave activity, while the other children still produced ADHD type brainwave patterns. Most significantly, the neurofeedback treated children maintained the improvements to behavior and brainwave activity even AFTER medication was discontinued, while the non- neurofeedback group experienced a relapse into their previous ADHD behaviors once medication was no longer in their systems. This indicates that not only can neurofeedback treatment improve the short term reduction of symptoms, but also can actually make long term changes to brain activity allowing the individual to achieve a normal level of function without ongoing treatment. This study also showed that parenting style exerted a significant moderating effect on ADHD symptoms, but only in the home, and the improvements ceased when they child went to school.

Neurofeedback for ADHD – The most recent study, as of the time of this writing, was very comprehensive and similarly supportive of the place of neurofeedback in ADHD treatment [Gevensleben, et al., (2009). Is neurofeedback an efficacious treatment for ADHD? A randomized controlled clinical trial. Journal of Child Psychology and Psychiatry.].
The study was done in Germany and consisted of a group of children aged 8-12, about 80% of who were boys, who were carefully diagnosed with ADHD. About 90% of the subjects had never received medication treatment for ADHD. Half the group was randomly assigned to 36 sessions of neurofeedback training, with the other half of the group (the control group) was assigned to 36 sessions of (non-neurofeedback) computerized attention training.

The main type of measure used in this study was parent/teacher symptom ratings (using a standardized rating scale), and included more than just core ADHD symptoms. The additional areas rated included a range of other behaviors (conduct problems, oppositional behavior, social problems, emotional problems), and in all cases, ratings were done both before and after treatment.
Results showed that children treated with neurofeedback had a far greater reduction in symptoms than the control group, who received computerized attention training. These improvements also showed a high degree of consistency between parents and teachers (i.e. parents and teachers both reported similar results).

In addition, parent ratings indicated that the neurofeedback group showed greater reductions in oppositional and aggressive behavior. 
 
Neurofeedback for Autism – Research on people with autistic spectrum disorder (ASD) has shown that neurofeedback can alleviate anomalous brain activity, leading to symptom reduction and improvement in function. Past functional neuroimaging and EEG studies on people with ASD have shown that they have areas of excessive connectivity as well as areas with deficient connectivity, when compared to the general population. In layman’s terms, this means that some areas of the brain have excess internal communication (within that particular brain region) but are not able to get those communications out to the other brain regions that require the information in order to function properly.

A study done in 2006 showed that people with ASD experienced a 40% reduction in autistic symptoms, as well as observably better brain function.

Neurofeedback for Depression and Alcoholism – Research has shown that neurofeedback can be very effective for treating both depression and addiction. A study on 14 alcoholic outpatients showed that, after 20 neurofeedback training sessions, subjects showed significant reductions in self-assessed depression. They also showed decreases (improvements) in standardized test scores for behaviors including schizoid, avoidant, dependent, histrionic, passive-aggression, schizotypal, borderline, anxiety, somatoform, hypomanic, dysthmic, alcohol abuse, drug abuse, psychotic thinking, and psychotic depression. After 21 months, researchers collected follow up data which indicated sustained prevention of relapse in the alcoholics.

Quotes:

Frank Duffy, a noted Harvard Neurologist: “The literature, which lacks any negative study of substance, suggests that EBT (EEG Biofeedback Therapy) should play a major therapeutic role in many difficult areas. In my opinion, if any medication had demonstrated such a wide spectrum of efficacy it would be universally accepted and widely used.”

In the journal of Child and Adolescent Psychiatric Clinics of North America, volume editors assessed the degree of scientific support for neurofeedback using standards developed by the child psychiatry professional organization (AACAP). They concluded that neurofeedback meets the same standard as that for stimulant medication:

“EEG biofeedback meets the AACAP criteria for clinical guideline (CG) for treatment of ADHD, seizure disorders, anxiety (OCD, GAD, PTSD, phobias), depression, reading disabilities, and addictive disorders. This suggests that EEG biofeedback should always be considered as an intervention for these disorders by the clinician. Clearly there is stronger evidence of efficacy…for the use of EEG biofeedback for ADHD in children and adolescents. Due to this high level of empirical support, the use of EEG biofeedback for ADHD will (with the publication of the second RCT) meet the most stringent APA criterion of efficacious and specific, which requires two independent RCT’s among other factors.”

Dr. Katie Campbell Daley, Department of Medicine, Children’s Hospital Boston and in the Department of Pediatrics of the Harvard Medical School, as published in the journal Current Opinion in Pediatrics “Update on attention- deficit/hyperactivity disorder”:

“Overall, these findings support the use of multi-modal treatment, including medication, parent/school counseling, and EEG biofeedback, in the long term management of ADHD, with EEG biofeedback in particular providing a sustained effect even without stimulant treatment…parents interested in non- psychopharmacologic treatment can pursue the use of complementary and alternative therapy. The therapy most promising by recent clinical trials appears to be EEG biofeedback.”

As published in a Chicago Tribune article about the emerging and promising field of neurofeedback treatment:

“Dr. Elsa Baehr, director of NeurQuest Ltd. in Skokie, has treated people with neurofeedback therapy for 15 years. ‘We have data on patients 5 years, 10 years, 13 years after treatment,’ she said. ‘The condition is holding. They’re not depressed. It’s been a very effective treatment.’

Dr. Kyle R.Bonesteel, assistant professor of neurology at Loyola University Medical Center says that neurofeedback, used as part of a multifaceted treatment plan, improves a variety of specific cognitive impairments besides depression, ADD and ADHD. In his clinic, he helps people with insomnia, traumatic brain injury, post-traumatic stress, chronic fatigue, mild autism and epilepsy — often without medication. Research indicates that neurofeedback produces some of the same brain-wave changes as drugs used to treat ADD and ADHD. ‘You can chemically condition the brain with pills or do it with neurofeedback,’ Bonesteel said. ‘But neurofeedback trains more specifically than pills, without the side effects. It also changes the brain for the better in an ongoing way.’“

 We would also like to share the experiences of just a few of the people who have been helped by neurofeedback:

“A whole night’s sleep! Less irritability and impulsivity and improved attention – just some of the permanent improvements that my daughters experienced with Neurofeedback. As a mom and an occupational therapist, I believe that Neurofeedback training will revolutionize how we treat children with ADHD.”
Mother of child with ADHD

“The change in my daughter is remarkable. While doing homework she is focused; she is able to comprehend without going to blank-out and frustration; she is solving problems and feeling good about it. She is not panicking and falling apart over her present heavy course load. And she is now rarely irritable – a very pleasant change.”
Mother of college student with anxiety and depression

“Our son was just chosen to be one of five first graders out of 120 to receive an award at his elementary school for success in academic and social arenas as well as enthusiasm, cooperation, participation and respect for others. Last year, this would have seemed as far away as the moon, and it is still hard to believe the amazing progress that has been possible in such a very short time. Thank you. You have made the life he was supposed to have possible!”
Mother of high functioning autistic child

“Thank you for my new life. I can now sleep with no nightmares or night sweats, and I’m eating well. I feel very good most of the time.”
War veteran with PTSD for 10 years

“My son is doing AWESOME!!!! We are thrilled. Now that summer is here, I hope to train him every day. He finished school on a great note. He is becoming more independent there and needing his aides less. The biggest change is in his verbal skills. WOW!! is all I can say.”
Mother of autistic child

“My grandson is doing better in general and concentration is definitely improving, too. All in all positive. Thank you, thank you.”
Grandmother of an ADHD teenager

“After Neurofeedback training, I am finally pain free and able to live my life without the fear of being paralyzed by a migraine headache.”
Former migraine sufferer

To find out how we can help you, contact us now for a free consultation: 860-429-7945 / contact@ctmindtraining.com