EEG Biofeedback: The Old and the New

by Siegfried Othmer, Ph.D.

Original, 1994; revised, 2004

The Historical Background

During the sixties, Joe Kamiya explored his earlier finding that people could become aware of their own brain electrical activity, the EEG. In this evolution of his early work, it was found that EEG activity could be altered deliberately by means of feedback of EEG information to the subject. Alpha wave activity was trained while the subject's eyes were closed. In this manner, a more relaxed state could be facilitated and different experiential states explored.

In roughly the same timeframe, M. Barry Sterman of the UCLA School of Medicine was doing sleep studies on cats, and finding that a certain rhythmic activity, at 14 Hz, was present in both the sleeping and waking state. He was successful in training that activity as well, with manifest consequences for sleep in these cats. For the first time, it was demonstrated that behavior could be altered by EEG conditioning. Fortuitously, NASA approached Sterman in that timeframe about a problem they were having with their astronauts. It was suspected that toxic rocket fuel was influencing cognitive function even at low levels of extended exposure in the Apollo module. The rocket fuel was already known to be toxic, and to be capable of inducing seizures at higher levels. Would he, Barry Sterman, be willing to test the rocket fuel on animals? He was. The rocket fuel did indeed induce seizures in cats, but there was a wide variation is seizure threshold. As it turned out, those cats which had undergone the brainwave training had a significantly higher seizure threshold than the others. Apparently, brain wave training could impact favorably on a neurological condition.

This little experiment launched a lengthy period of research in which it was rigorously demonstrated that seizure incidence, intensity, and duration could be reduced with EEG training. The training occurred in the same spectral band, about 12-15 Hz. Human brains did not usually show a prominent 14-Hz rhythm in the waking state as did the cats. However, some similar controlling mechanism appears to operate in that frequency range in both species. The activity was called sensorimotor rhythm (or SMR rhythm) for its appearance at sensorimotor cortex) in the waking state.

The alpha training became popular in the culture of the sixties and seventies, which of course rendered it unfit for serious study by most university researchers. In that climate, Sterman was careful to distinguish his own work with SMR training from the "popular" version of EEG biofeedback. The work was sound; it was replicated by a number of other groups; but the technique remained obscure. The training took a long time in most subjects; the training was provided by Ph.D.'s, so it was expensive; and Sterman depended in his clinical work on referrals from neurologists. Hence, the training was received mostly by very severe cases of seizure disorder.

Perhaps most significantly, these findings---intriguing though they were---could not be fitted into a framework in which they could be understood at the time. EEG neurofeedback was therefore a glaring case of “prematurity in science,” a discovery made before its time. Significant advances would be necessary in the neurosciences before the realm of EEG frequencies could be understood and integrated into the body of scientific knowledge. This is only happening now, some two to three decades later. At the time, the results remained as scientific curiosities and as such soon fell by the wayside.

During the course of the early research work, it was observed that hyperactivity in epileptics also seemed to subside with the training. One of Sterman's associates, Joel Lubar, pursued the matter further with rigorous studies. Over the years it was established that the technique could be helpful not only with hyperactivity but also with attention deficit disorder in the absence of hyperactivity, as well as with specific learning disabilities. Things grew from there: We are now finding in our own clinical work that the technique can be helpful with a broader range of conditions. Just as the ADHD work grew out of epilepsy studies, these insights and findings accrue incrementally.

Attention deficit hyperactivity disorder (ADHD) can, for example, be looked upon as an underarousal condition. This was an early model attributed to Satterfield (1971). This may seem paradoxical, but it is at least consistent with the fact that stimulant or anti-depressant medication helps the condition. At the present time we still see a significant arousal component in ADHD, although we now talk in terms of “disregulation of arousal” more than underarousal per se.

The Larger Context

One is tempted to ask the question: If EEG training can help the type of ADHD that responds to anti-depressants, might it help other conditions which respond to anti-depressant medication, in particular pure depression? Clinical evidence suggests that this is indeed the case.

One is tempted to ask further: Since epilepsy often results from cases of head injury, could EEG training help other symptoms of head injury besides seizures? We’re thinking here of symptoms such as cognitive deficits, chronic pain, visual disturbances, extreme fatigue, mood swings, irritability, inability to plan one’s activities, and sleep disturbances? The answer is that it does. Profound recoveries have been induced with EEG training in persons who have been stable for years after head injury, where further spontaneous recovery would not have been expected.

A third area where improvements have been observed with EEG training is in sleep disorders. Insomnia, sleep onset problems, frequent waking, bedwetting, night terrors, and even sleep apnea have responded to the training in clinical settings. With these new findings, EEG training in the 12-19 Hz (or low beta) frequency range is experiencing a growth in clinical application, aided by new computerized instrumentation and a proliferation of centers where the training is offered.

The alpha training remained for some time under a cloud of its unfulfilled early promise and indiscriminate popularization. Around 1990, alpha-theta training was shown by Eugene Peniston to be very effective with treatment-resistant alcoholics (Viet Nam veterans) and that revived interest. We ourselves were then involved in a large-scale replication of the alpha-theta training for drug addiction. As with Peniston’s work, the training is included as part of a comprehensive treatment program. The results matched the promise of the early results obtained with the veterans.

As a result of a number of replication studies, the traditional alpha/theta training is now experiencing a renaissance as well. Ironically, this is also in the context of remediation and rehabilitation of dysfunction, which was never Joe Kamiya’s original interest. He was inquiring into ways of characterizing a variety of states of brain function, tying them to qualities of awareness.

A Common Mechanism May be Operative

What are the larger implications of these new findings? First of all, a connection suggests itself among the various conditions that ostensibly respond to this training. Firstly, Attention Deficit Disorder is correlated with sleep problems such as bedwetting and night terrors. More than half of all seizures occur at night, suggesting an intimate connection of seizures with disordered sleep. There is a high correlation of attention deficit disorder with birth trauma, a kind of head injury. And many of the deficits resulting from head injury in the mature person look like attention deficit disorder. Also, depression is a common symptom resulting from head injury. Finally, other underarousal conditions, such as depression, also manifest in sleep disorders and cognitive deficits such as we see in ADHD. Perhaps a common “neurological substrate” or pathway underlies the attention problems, sleep problems, depression, and head injury deficits which respond to the training. If so, it must be very basic to be common to such a variety of observables.

A Discussion of Mechanisms

In our work, we distinguish between training at higher frequencies (15-18 Hz, which we refer to as "beta") and at lower frequencies (12-15 Hz, or "SMR" training) within the overall beta range of frequencies. These have vastly different effects. In beta training we appear to be dealing with conditions of underarousal, either induced by trauma of some kind, or of genetic origin. In SMR or alpha training, we appear to be dealing with conditions of overarousal, of anxiety, of hypervigilance, of heightened stress susceptibility. Taken together, the training appears to help normalize physiological arousal, i.e. to restore normal modulation and control of arousal level. The increase in seizure threshold with training suggests that the training confers increasing stability in the face of cortical hyperexcitability. The training appears to enhance self-regulation of fundamental arousal mechanisms where these are deficient.

The Centrality of Arousal

Physiological arousal is under the management of the brain stem, which also regulates the sleep-wake cycle and modulates the pain response. The regulation of cortical function is mediated by the thalamus which, among other things, modulates inputs to the sensorimotor cortex where our (beta) training conventionally takes place. A distribution of frequencies within the low beta range of 12-19 Hz appears to be operative in regulating a variety of cortical functions. Training those specific frequency bands can then be used to elicit certain effects. Among these are regulation of sleep cycles, improved cognitive function, modulation of attention, and increased stability of mood. As suggested above, if one modality has such diverse effects, it must be true that a very central and basic function such as arousal control is being affected by the training. If brain stem function and arousal level are being trained, certain predictions would follow. In particular, we might expect effects on pain mechanisms. As it happens, we have observed a profound effect on headache syndromes and on chronic pain.

Another piece of corroborative evidence is the finding that the human brain is peculiarly sensitive to whiplash injury. Even a minor car accident, entailing no loss of consciousness but involving whiplash, can leave lingering deficits of the type mentioned above. In whiplash it is the brain stem that is being impacted, yet cortical function suffers! Likewise in birth injury it is frequently the spinal cord and brain stem which
take the brunt. A final straw in the wind is that PET studies show the thalamus and the sensorimotor cortex to be in a stage of rapid growth and organization, their most vulnerable period, right at the time of birth.

A mutually consistent view is that the EEG is the "window in" to the functioning of the cortex, as it is regulated in interaction with subcortical structures such as the brain stem/midbrain, which structures are vulnerable to injury. The EEG training renormalizes this regulatory mechanism. Above all, cortical function must be understood as a network, a web of interactions, and the quality of functioning of that network is exquisitely revealed to us in the EEG.

Many of the above findings of efficacy of EEG training are only clinical, and remain to be confirmed in systematic research. This is because research and publication is the pathway to acceptance by the scientific community at large. However, the essential validity of our claims has already been established clearly enough when all of the pieces of evidence are taken together. Unfortunately, new research initiatives have not been funded in recent years.

Here again, EEG biofeedback/neurofeedback has to live down its own history. It was deemed to have had its chance early on during the seventies. Unrecognized is the fact that all of the relevant scientific milestones were met by EEG feedback at the time. The results were not inadequate---they were just not understood or appreciated. Neurology was drawn instead to the exciting frontier of psychoactive medications. This was not misguided by any means. It just left out other aspects of brain function, namely the organization in the bioelectrical domain.

Another problem is that behavioral techniques really belong in the realm of psychology, not medicine. This involves a different literature, which neurologists and other mental health professionals do not read. A final problem is that many of the conditions we work with have a troubled research history in any event. In much of traumatic brain injury, organic injury is often impossible to document. MRI and CAT scans are frequently negative The case is similar for PMS and for many pain conditions. There is nothing to go on but the person’s complaints. Recently functional tests such as SPECT and fMRI have come to rescue, revealing areas of dysfunction previously not observed. And no functional test is more revealing of the “instantaneous” brain activity than the EEG! In the face of the novelty and excitement of SPECT and fMRI, the EEG is eclipsed as old-shoe. After all, it has been around since 1930. But modern mathematical analysis techniques are revealing a subtlety there that was not anticipated.

If one wished to construct a new intellectual edifice, it should not be around such squirrelly conditions as traumatic brain injury, PMS, chronic fatigue syndrome, and fibromyalgia! As it happens, these conditions point to a huge domain of “functional” disorders rather than of structural deficits. Like dark matter and dark energy in astrophysics, we know this category exists but we cannot measure it with our usual instruments. And just like dark matter/energy could be the largest constituent of nature, functional deficits could likewise be the larger issue in mental health.

Putting it crudely, we may have a small, elusive "hardware error" that leads in turn to prominent and obtrusive "software errors" in the human brain. The EEG training appears to be able to reinforce the control codes in our "fuzzy-logic" brain and thus remediate functional deficits. Two findings promise to shift attention to the claims of EEG biofeedback. The first is the report by Alan Zametkin of the NIMH that the brains of hyperactive adults show lowered glucose uptake in the sensorimotor and frontal regions. That is, there is a discernible functional distinction and it is consistent with underarousal. Secondly, we have the recent report by Lewis Baxter of UCLA that behavior therapy for obsessive-compulsive behavior results in activity level changes in the caudate nucleus similar to those elicited by medication for this condition. Even successful psychodynamic therapies result in neurological changes observable in tests of function. There is no iron-clad case here for pharmacological remedies even when a “physiological correlate” is identified.

Finally, we have the recent confirmation by Chris Mann of what had already been well-established, namely that the EEG statistics of ADHD children are significantly different from those of normals, and in line with the underarousal hypothesis. These results may begin to draw the attention of a reluctant medical community to this promising new field. One key reason for the lack of interest by the medical research community is that the current focus in neurophysiology is on neurotransmitter mechanisms and interactions at the molecular level. The phenomenology we are concerned with cannot be described in those terms. ADHD may involve observable differences in serotonin, norepinephrine, and dopamine function, but these may be effects rather than causes. To understand "disorder", we must look at how the brain maintains "order". We must look at the brain as a control and feedback mechanism. A functioning serotonin system is a necessary but insufficient condition for maintenance of "order".

An Emerging Synthesis

When one considers how the brain must organize sequential processing activity, or how it must recognize a particular visual image, splayed across the visual cortex, as belonging together, we realize that an incredible amount of parallel processing must occur, and nearly simultaneous communication between different parts of the brain. It is belaboring the obvious to say that timing, and the coherence of timed events over a larger interval, are important for the completion of sequential processing tasks. Various parts of the brain must be successively alerted to play their role in the completion of a particular task. This is all managed through the selective activation of the relevant circuits, and such activation is mediated by timed events. This is the business of the brain stem, of the midbrain, and of the thalamus in particular. And this process is out to lunch in the head-injured, the depressed, the over-anxious, the sleep-deprived, the person in pain, and the ADHD child or adult.

Sterman long ago postulated that the mechanism being affected by EEG training is that by which the thalamus regulates and stabilizes the intrinsically hyperexcitable cortex. This mechanism is presumed to act rhythmically in the 12-19 Hz domain. The thalamus has both specific and non-specific nuclei. The specific nuclei project to localized regions of the brain, whereas the nonspecific ones project to broad regions of the cortex. By varying the training frequency within the band, and by varying electrode location, we are able to elicit highly specific effects, in addition to the general benefit of training activation. In this we are guided by what neuropsychologists and neuroanatomists have learned with respect to localization of function. The specific effects confirm that we are able to train the brain circuits involving both the specific and the nonspecific thalamic nuclei. They also prove that we are not simply dealing with placebo effects.

NIMH stopped funding Sterman’s epilepsy research in 1985, arguing that the field had been plumbed. In fact, the field had just begun. One of the most promising findings in this decade of the brain is how amenable the brain is to effecting change in its own function, if only it is given appropriate cues. One of these days all this will be considered obvious. Why shouldn't the brain be able to adapt to new information about itself? It is called learning. That's what our brain does well.

Just as in agriculture a slow transition is taking place from the pesticide war against nature to using more biological means of control, we will emerge from a singular focus on pharmacotherapy and surgery to recognizing the brain's own potential for healing. We know it exists. In one of its aspects, it is known as the placebo effect. In another of its aspects, we know it as "spontaneous remission". What the brain is known to be capable of randomly, we may be able to elicit systematically. Let me hasten to say that neurofeedback is much more than a re-packaging of the placebo effect. The placebo effect is merely being cited here as the evidence for brain plasticity that every MD has already encountered in his own practice, and that everyone believes in already.

Some Concrete Examples

Science in general, and in particular medical science, is not impressed by individual case histories, which are routinely dismissed as "anecdotal data". However, they can nevertheless be useful in the present context to calibrate the reader's expectations of what this new technique may be used to accomplish. They are also useful scientifically, by forcing our attention on new phenomena that have simply not yet been studied extensively, but point the way to the future. Science must start somewhere, and it could do worse than start with the startling evidence of individual case histories. The 29-foot long jump by Bob Beamon in the Mexico City Olympics was a singular event, but it could not be dismissed in terms of what it said about human potential.

In the case of major head injuries, significant spontaneous recovery has never been reported in the literature more than a couple of years post-injury. After such an interval, significant recovery would be as exceptional and noteworthy as an amputee starting to regrow a limb. The following are some representative case histories:

Traumatic Brain Injury

A professional woman in her thirties was referred for EEG biofeedback training more than four years post-injury, an automobile accident in which she suffered whiplash. At the time she came for training, she was unable to live independently. She had to be brought to the office because she could neither find the way nor remember her
appointments. She could no longer read, and even the simple act of boiling water at home could get her into trouble.

She was extremely fatigued, and was not sleeping well. She was emotionally volatile, and suffered from frequent crying spells. All therapies to help her had terminated long before she came to EEG biofeedback training. At the third training session, she reported sleeping better. At session five, she reported having more energy. By session 11, she was reading newspaper ads. At session 15, she declared: "I am becoming the woman I was before". By session 30, she was able to read her whole legal file at one sitting. At session 47 she reported "feeling 100% human again for the first time." The training continued on to session 80. Subsequently, she reentered professional life and was remarried. If her doctor had been told at the beginning of neurofeedback training what her level of function would be at the end of training, he would have declared that to be utterly out of the question.

A second case involved a woman in her thirties who was three years post-injury, a car accident in which she had suffered whiplash, and was unconscious for a period of time. Her spine was fractured. When she came for EEG biofeedback training she was still totally disabled due to a variety of problems: chronic pain behind one eye; vision problems (central area gray, periphery fuzzy); dragging left leg; slurred speech; diminished memory function. She had continuous digestive complaints; headaches; dyslexia; and mental confusion. All therapies had been terminated except that she was still visiting her chiropractor, who referred her for biofeedback.

The digestive problems she reported were 75% improved by the fourth session, and completely eliminated by the eighth. Sleep was reported improved by session ten. By the time of completion of training at session 24, the pain behind the eye had been remediated, and her vision significantly improved. Her speech was no longer slurred; she was no longer dragging her foot; and there was no more uncontrolled crying. She was able to return promptly to a full-time occupation.

A third case involved a man in his fifties. After an automobile accident he was brought into the hospital DOA. His family was summoned. A family member observed the body to move under the blanket on the gurney, and drew attention to it. "Oh, bodies do that," she was told. The movements continued, and the medical staff thereupon resumed attempts to resuscitate the man. He subsequently made a major recovery, and came to us years later after his condition had stabilized. With the training, his mood became more elevated, and his memory gradually returned. He had studied some seven languages in his youth, and this language ability was gradually recovered. He also improved in terms of balance and gait.

Stroke

A woman in her fifties came to us for EEG training 19 months post-stroke, and after all other therapies had been terminated. She was having difficulty with concentration, with speech, and with word retrieval. There was some loss in fine motor control, and symptoms of depression. She came from out of town and could only obtain six training sessions during her stay. Nevertheless, it was reported upon her return home that she resumed writing correspondence; that she was again playing the piano; and that she was much more verbal, once again bossing everyone around in her household. Her original vitality had returned.

Another case: A man came to us some three years post-stroke, having suffered extensive damage to left-side speech and motor areas. His speech consisted of only partial words--often the wrong ones--and some consonants were still lacking. He was on a cane, and had limited use of his right hand. He was depressed and withdrawn. All therapies had ended with the exception of speech therapy, which was just about to end. The training effected first a remediation of the depression. He became much more active and interested in the life of his family. His speech therapist observed a sudden burst of improvement in speech (within two weeks of start of training for the speech deficit). By session 27 he was speaking again in simple but complete sentences. By session 46 he had given up his cane; by session 60 he was using his right hand again to shake hands. By session 90 he trusted himself to go skiing again, and was picking up newspapers to read. Speech is still halting and slow; but he is fully engaged again in the life of the family.

Drug Baby

A three-year-old girl was referred to another EEG practitioner for reasons of behavioral dyscontrol. She had screaming episodes lasting for hours. These were so common that it was impossible to find foster care placement for the girl. She was hospitalized at the time of the training. Within three sessions, the crying episodes were reduced to three minutes, and after ten sessions the case worker pronounced that the girl was functioning like a normal three-year-old. She was placed in foster care without difficulty.

Fetal Alcohol Syndrome

A five-year old adopted boy was starting to develop severe behavior problems at home. Fetal alcohol syndrome was then diagnosed. The child so fractured the family life that the mother (an obstetric nurse) thought her only option was to "put the child back into the system". The boy was totally resistant to doing the training. "I don't have a brain", he announced. Nevertheless, after a few training sessions over much resistance, the boy mellowed. His anger diminished, and it became possible to reason with him. After 32 training sessions total, he was winning "student of the week" awards at his school. His intrinsic charm was now showing.

Mildly Mentally Retarded Boy

An adopted boy with an IQ of 70 underwent EEG training with another practitioner of our acquaintance, an MD in North Carolina. He was retested a year later, and his IQ tested at 112, an increase of 42. By itself, this result may appear startling. However, it is quite consistent with our own findings of increases in IQ test scores of more than thirty points when the children start at values less than 90. The training clearly facilitates the organization of mental functioning so that the child can exhibit his native intelligence. The results are so striking that they must compel us to revisit the whole issue of whom we are calling mentally retarded.

Attention Deficit Disorder; Conduct Disorder

A twelve-year-old boy was referred to us for EEG training because of conduct problems. He had been kicked out of seven schools, the last a school for severely emotionally disturbed children. He was being home-schooled at the time. He had suffered a birth injury, and a subsequent head injury at two years. He had significant sleep problems when he came to us.

After the first EEG session, he stopped talking in his sleep at night. After session nine, he reported that he did not get in as much trouble. He completed training at 29 sessions. Within a few months, he returned to regular public school. No one would call him emotionally disturbed any more. Also, his IQ score increased 34 points (WISC-R); he improved four grade levels in reading, and more than two in spelling, according to independent testing with the Wide Range Achievement Test.

Severely Emotionally Disturbed Boy

An eleven-year-old boy at a group foster home had a history of aggression, oppositional behavior, and ADHD. He was also suicidal. He had math and language disabilities. He was reluctant to undertake the training, and rarely did more than twenty-minute sessions. After twenty such sessions, he made a breakthrough. (This happened right after we made a change in training protocol.) He came to the next session enthusiastic about the training, declaring that he was a "new man". He was calmer, and much more cooperative. His aberrant behavior subsided. He was no longer suicidal. The staff psychologist said she had never seen a more dramatic change in a person in ten years of psychotherapy. After ten more sessions to consolidate his gains, the boy was released from the group home back to his closest living relative, an aunt.

(Post-script: Years later we inquired at the group foster home how this kid was doing after his graduation from the home. “Oh, he’s back in a home. But it’s not what you think. He is doing fine, it’s just that his caregiver is in prison on a drug charge, and he has nowhere else to live.”)

Depression

A woman in her forties came to us with a long history of depression, of eating disorders, of chronic pain, and bruxism (teeth-grinding). As part of the intake session, she took the TOVA test, which measures attentional variables. She was in the 5th percentile in terms of reaction time, and in terms of inattention and variability in response time. After only twenty training sessions, her TOVA scores were all better than her age-appropriate norms, a simply staggering improvement. We rejoiced. She was wistful.

"You are taking my disability away", she said. "I've lived with that all of my life." Change, though positive, can be somewhat frightening because of the uncertainty it brings. She is in the continuing care of her psychotherapist to manage these changes.

Dementia

An elderly man came to us diagnosed with "diffuse cortical atrophy". He had been a highly verbal, intellectual man--Rhodes scholar, company president, and public official. Now he was falling silent because he was losing himself in paragraphs and sentences, and he found that was too embarrassing for him. After nine training sessions in one week, his disorderly EEG was normalized (reduced in amplitude) by a factor of three. He became more verbal, and more animated. His wife said, "You have given me my husband back." He came for booster sessions a year later.

Subsequently he suffered an ischemic attack, leaving him with symptoms of disorientation and paranoia. These symptoms persisted for some months until he could come back to the training, at which time they were promptly remediated. As the organic deterioration continued its relentless course, he eventually needed the booster sessions more frequently. Ultimately, he benefited from the training for more than five years, until he succumbed to progressive supranuclear palsy. Whenever he got away from the instrument while on extended vacations, his mental function and mood would decline. It would come back once he returned home to once again train his brain.

Bruxism (teeth grinding)

A woman came to us after having had a $10,000 dental restoration for bruxism. She was a hyperactive adult with poor body awareness. She undertook the training for more than thirty sessions. By session six, she became aware of clenching her teeth during the day. By session twenty, the cessation of night-time bruxing behavior was indicated by remediation of the pain associated with it. Training continued to thirty sessions to consolidate the gains.

Anxiety and Panic Attacks

A woman came to us with a history of frequent panic attacks, migraine headaches, poor sleep patterns, and fatigue. She could not handle the stress of a job. Training in the SMR band helped her to relax; then training in the beta band (15-18Hz) helped her mental functioning (concentration, focus). Follow-up after 32 training sessions showed that she still felt somewhat anxious, but her panic attacks had been completely eliminated.

Temporal Lobe Epilepsy

A seventeen-year-old boy was trained for temporal lobe epilepsy, for which he was medicated with Tegretol and Dilantin. He was doing poorly academically, and was exhibiting many signs of psychological disturbance and instability. He was emotionally volatile, even explosive. He was depressed and angry. He exhibited self-mutilating
behavior and suicidal ideation. This behavior pattern had been observed for nine years prior to the onset of EEG training. After the training was initiated, the boy became friendly and talkative. His academic performance began to soar. The volatile emotions subsided. The suicidal thoughts vanished. He began to set long-term goals for himself:
getting into college, choosing a curriculum. He was able to eliminate the need for Dilantin entirely, and to significantly reduce his dose of Tegretol.

After a year of intensive training at two sessions per week, he succeeded in getting into college on the basis of his obvious change in performance, which made his prior record unrepresentative. By the end of the first year, he was near the top of his class in his chosen field of computer science. The biofeedback gave him a sense of control over his epilepsy, and over his brain. He began to take charge of his own training. He came to know his own brain very well. He could predict what the EEG instrument would show on a given day based on what he knew about himself. Eventually, he came to need the instrument less and less. He also learned other skills (breathing, yoga, meditation) which many other persons with seizure disorder have found to be helpful as well in managing their seizure threshold.

We have now managed over 2500 persons in EEG training in our own office, and our techniques are now in use with well over 5,000 other professionals who are getting similar results around the United States. The technique is in use in more than thirty countries around the world.

Summary and an Intimation of the Future

The results described above portend many new developments in terms of taking advantage of the ability of the brain to recover function. We are surely just at the beginning of discovering how this new tool of EEG training can be best applied in a particular individual. The boundary of our knowledge horizon is increasing rapidly, like ripples on a pond, raising more questions than we have so far answered. The results bespeak a general property of the human brain, which is the capacity for learning. This refers not only to content but also to learning skills, including self-management skills!

All parts of the brain are intrinsically responsive to information. That is the essential function of a nervous system. It is similarly obvious that the brain routinely responds to information about itself. The new findings indicate that it can also respond to information about itself that is provided externally, by biofeedback. The implications of this appear quite boundless at this point. We see the impact of this training particularly strongly in the most severe conditions with which brains are afflicted: epilepsy, traumatic brain injury, cerebral palsy, and the dementia of the aged. We see it impacting also on the largest issues confronting the field of mental health: depression and anxiety disorders.

We see it helping with some of our society's most vexing problems: irrational violence, criminal behavior, addictive behavior, and the devastation of psychological and physical trauma. We see it helping with so many of the learning problems that lead to unproductive lives. The efficacy of the training for some of the most disturbing behaviors we see in our fellow man (irrational aggressive behavior; sociopathy) implies that these behaviors are brain-based. They do not come from a deficient force of "will". In fact, the more extreme the behavior, the more likely it is that we are dealing with a neurological impairment. Fortunately, these impairments don't appear to be hard-wired.

In the last year we have seen a surge of interest by mental health professionals in this technique. We will soon see it available in many different settings. The impact of our emerging ability to train the brain is incalculable for our society. Clearly, this will have to be part of any national health plan that meaningfully addresses the problems people actually have. EEG biofeedback could lead to significant reduction in health care costs, as we address the underlying problems rather than the physical symptoms they give rise to. The frontier of health is, in large part, the frontier of the brain.