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Barrett's esophagus is only listed here because it can be the diagnosis of record for people coming in for gastroesophageal reflux disease (GERD). This is discussed in its separate listing below. Barrett's esophagus involves physical alteration of the esophagus that may have a common origin with GERD. The resolution of the latter may be accompanied by some improvement in the extent of Barrett's tissue. The condition is relatively rare, but of concern in that it can to esophageal cancer. Neurofeedback represents a more categorical remedy for GERD, for which the reader is referred to that listing.
Barrett's Esophagus -
(http://digestive.niddk.nih.gov/ddiseases/pubs/barretts/index.htm)
There have been numerous but isolated reports of benefit of Neurofeedback for Bell's Palsy. The difficulty we confront is that the condition tends to be episodic, so that in time it resolves even without treatment. For that reason it is difficult to establish from individual case histories whether Neurofeedback contributed to resolution, or whether the condition simply continued its natural course. Given such uncertainty, matters must be left to the client's judgment. Neurofeedback training can be undertaken for the condition, and the client must decide whether the felt benefit is worthwhile.
Some 57 years ago the efficacy of lithium was discovered in Australia for what was then called "Manic-Depressive Illness." The finding took another fifteen years or so to gain acceptance in the United States, but then lithium changed the face of American psychiatry almost single-handedly. By now, of course, treatment with lithium and the anti-convulsants is standard. But we are still just trying to manage the condition with the medications.
Neurofeedback now seems so tailor-made for Bipolar Disorder that we may well be on the way to a second revolution in psychiatry to supersede the pharmacological revolution spurred on by lithium. The problem is one of brain instability, and this instability appears to be lodged in the cerebral networks. Neurofeedback can be used to train the brain toward stability.
The fact that Neurofeedback represents a more organic remedy is buttressed by the reports that people don't experience the constriction of their functionality that is sometimes seen with the meds. Successful training may mean that trainees must forego the euphoria that can attend uncontrolled mania, but at least there is no evidence that function is constrained or that a person's spark and spunk are somehow dulled.
In practice, Neurofeedback / EEG Biofeedback is usually combined with a medication strategy. People will usually already be well medicated when they seek us out for Neurofeedback, and successful training will usually result in a downward titration of the medication dose. Where that process ends is a very individual matter, and also depends on the judgment of the responsible physician.
We have recently witnessed a bulge in what is called Childhood Bipolar Disorder, and all such diagnostic novelties are typically first met with controversy. About the fact that we have a lot more raging kids with majorly fluctuating moods there can be little doubt. Perhaps we should not let the labeling obscure the reality. So regardless of whether the child is brought in for rage, for "Episodic Explosive Disorder," or for Childhood Bipolar Disorder is for us of secondary concern.
It is cerebral instability and emotional regulation that drive the training. Calming the brain and training it toward stability, plus a focus on the networks of emotional regulation, constitute the remedy. Age and maturity are not strong drivers. Amazingly, we have in the last few years seen four-year-olds capable of terrorizing their parents. This is clearly new.
Although the focus here is on Neurofeedback, it must be said that we may also be dealing with children here who have "starving brains," in the graphic imagery of Jacqueline McCandless. In the entire realm of childhood behavioral, attentional, and learning disorders, we encounter evidence for nutritional deficiencies and of toxic influences. The same holds true for our bipolar children. A multi-faceted approach is called for. That said, Neurofeedback appears to be the approach capable of producing functional improvement more rapidly and consistently, and should therefore be considered a priority. - Siegfried Othmer, PhD
Case Vignette:
A clinician reports:
"A man with Bipolar Disorder became my client just after I was trained in neurofeedback. He was in his early sixties, and had been diagnosed with Bipolar Disorder some fifteen years previously. He was on 7...yes seven!!...anti-depressants and anti-psychotics and had been on them for about 10 years. His mood swings had stopped, but so had all his emotions. Nothing made him happy or sad, nothing was funny...he didn't react to anything at all. He was uncommunicative, focused without moving for the full half-hour session every time. He insisted on doing only the Innertube game...so for 37 sessions that was what we did!"
This was in 2007. After 24 sessions he went to see his psychiatrist to have his meds decreased. She was angry...knew nothing about neurofeedback and refused to reduce the meds. However, they sat and talked for an hour and at the end she said: "I've known you for all these years and have never seen you like this! I hardly recognize you as the person I know!" She then proceeded to slowly take him off his meds. It took a year before he was off the last one and it's been about 18-20 months since that time. He's never had any regression at all, despite several very stressful episodes in that time, which he handled very well. In fact his wife says that he continues to improve even up until the present.
Why would we even list birth injury in this compilation of conditions where Neurofeedback / EEG Biofeedback might be helpful? Isn't birth injury a given? Aren't we stuck with the consequences, whatever they may be? Actually we are not. And therein lies a big part of the story. The field of medicine, in its concreteness, has always focused on the structural evidence that underlies dysfunction. When it comes to the brain, however, we may also have functional injury that leaves no trace in measures of structural damage. That is the big story in traumatic brain injury of every stripe.
Birth injury may therefore represent a kind of stealth condition that typically remains unrecognized throughout life. We get acquainted with the children we have, and we accommodate to their limitations, believing them to be inherent. That was actually ok until Neurofeedback came along. Now we have the tools to "restructure" the world of brain function and we need no longer accept the limitations we were born with. So birth injury is now on the table for discussion.
The most common injury is due to simple anoxia during the birth process. The baby is born blue, and nobody knows how much that matters until the child reaches school age. At that point, the child may fall short, but no one makes the connection back to birth injury. The second issue is that the infant experiences enormous forces of extension and compression on the brainstem region during the birth process. We know what even minor whiplash injury can do to functional adults. Here we have a similar kind of hazard in the process of getting born. Soft injury to the brainstem can have functional implications throughout life. Now with Neurofeedback we can figuratively reach all the way down to the brainstem and reorganize function at this most basic level. The opportunity for such functional renormalization appears to remain available throughout our lives. (See also Traumatic Brain Injury; Whiplash)
This condition is characterized by exaggerated eye blinking and forced eye-closing due to inappropriate muscle control emanating from the sub-cortical regions, a condition referred to as Dystonia. There have been isolated cases here and there where Neurofeedback / EEG Biofeedback has been found to be helpful. This is consistent with what we see with other kinds of dystonia. The response to training is variable, but the attempt is generally worthwhile. The training can readily be continued on a home-training basis if that seems to be worthwhile.
Even though Neurofeedback depends on information derived from cortex, we are in fact training all of the cerebral networks, even impinging on sub-cortical nuclei, the thalamus and the brainstem.
People have found a variety of behavioral strategies helpful in suppressing the symptoms, and it is found that symptom incidence depends on stress and fatigue levels. These observations show that the phenomenon is subject to regulatory influences, and such influences can be promoted through Neurofeedback.
Distortions in the appraisal of one's body is a commonplace finding in anorexia. It is also encountered as a symptom of minor traumatic brain injury. Neurofeedback EEG Biofeedback protocols have been developed that impinge particularly on our sense of the body and on its relationship to space. Neurofeedback should therefore be considered as an intervention for this condition. As far as we can tell at this point, both our sense of the body and of its relationship to space respond to the same kind of training. So these two problem areas can be seen as related. We tend to see problems in relationship to space commonly among children in the autism spectrum, and among adults we see it in various phobias, such as the fear of heights and of enclosed spaces. Neurofeedback training can be very helpful.
- Borderline Personality Disorder
This condition is seen as so intractable by psychologists that some of them will not accept such patients in their practice. We are dealing here with a profound disturbance in the organization of the personality that is strongly associated with early childhood trauma, where the vulnerable child has no adequate defenses in place against threats. Such threats often involve caregivers and loved ones, which puts the child in an unresolvable bind. The child grows up in fear and terror, and is then incapable of judging any relationship, even that with the therapist, to be safe. Every relationship is tested until the breaking point is reached, thus confirming the early pattern through replication.
A multi-faceted Neurofeedback / EEG Biofeedback approach can constitute the major part of a therapeutic remedy. In the first approach, the client's potent survival skills are built upon through the conventional training to confer a sense of mastery. The person is then able to function more effectively in life, and many more life experiences are subsequently seen as positive. In the second approach, a zone of psychological safety is brought about through a very different kind of Neurofeedback. It is in the complete privacy of this zone of safety, and largely in the absence of verbal intrusions-either from the therapist or even from the self-that the person's essential self can reveal itself and become whole.
The essence of the approach, then, is to provide the context for the non-traumatic, non-verbal, and non-prescriptive means by which the client may resolve her early traumas and move on. The recovery, however, must be staged as above in order to be as effective as it can be. The first kind of Neurofeedback provides the support and scaffolding for the intellectual and emotional functioning of the individual so that the trauma can then be confronted.
Psychotherapy for Borderline Personality Disorder
The popular journal Science News (June 16, 2007 issue, p. 374) has just reviewed current psychotherapy methods for helping with Borderline Personality. Four different therapeutic styles are mentioned, but research is inconclusive as to relative effectiveness.
The absolute effectiveness, however, remains poor for all the methods under study. In one report, after a year of weekly to biweekly therapy sessions, only one of the techniques yielded any improvement at all in suicide threats, suicide attempts, and physical assaults on others. Modest outcome indeed. In yet another study, a mere reduction in symptoms was reported after three years of bi-weekly therapy sessions. No full resolution of Borderline Personality Disorder was reported in either study.
By contrast, with Neurofeedback / EEG Biofeedback one should be able to get to the point where Borderline Personality Disorder would no longer be diagnosed by a diagnostician naïve to the situation. This result should be achievable in a few months of three-per-week training sessions. Supportive psychotherapy should be available throughout the training process, and more heavily toward completion of the work.
- Siegfried Othmer, PhD
This is a vast area that is only beginning to be explored in consequence of the new imaging techniques. Historically brain injury was largely taken as a given, with little to offer by way of relief. The medical issues were dealt with: brain swelling; blood escaping into the brain; skull fracture. And then the brain was largely left to recover function for itself. Physical therapies would typically also soon be abandoned. When no medical symptoms were identified in the emergency room, the head-injured person would often be sent home with the pronouncemen that that all was well. The person was often left highly dysfunctional, and the rest of the world was typically unsympathetic.
The new functional imaging has revealed to us the extent of functional injury that may be present with even apparently minor insults. This is the area in which Neurofeedback has in fact distinguished itself for many years. Unfortunately, as long as the "system" was in denial about the problem, it could not very well acknowledge the remedy. Head-injured people who somehow found their way to a Neurofeedback therapist could often be helped substantially, but their own doctors would only shrug their shoulders in disbelief. The remedy could not be given more credence than had been given to the original symptom. A non-solution had been devised for what was seen as a non-problem. Competent Neurofeedback has been available for traumatic brain injury now for thirty years, and it is only now being "discovered."
Once it is recognized that the entire conversation here is actually about functional deficits, then the umbilical can readily be cut with any organic deficits that may be present. Such functional injury can, in fact, occur in a variety of ways: shock trauma is an obvious case in point. And the trauma may in fact have been pre-verbal and not even consciously remembered. In fact, not only is it possible for people to "forget" their psychological traumas, they also forget their physical head injuries as well. We often have to be probe extensively before people come up with such events out of their past.
So brain trauma must now include both psychological and physical causation. The consequences are often similar, and the remedies certainly are. Recovery from such functional injury has been shown in the published literature to be substantial. In one study, steady-state disabled head injury patients averaged a recovery of 85% of pre-injury functioning. All who had held jobs prior to their injury were able to resume employment after Neurofeedback. No mainstream practitioner would have held out any hope for these people. These are supposed to be the malingerers, the ones who complain endlessly and never want to be well. Oh, really? Give them half a chance to be well, and these people seem to take it. (See also Traumatic Brain Injury below).
One issue in the headlines these days is bringing the stealth nature of brain injury to the fore. It is the blast injuries being endured by our soldiers in Iraq. The soldiers who are severely injured are attended to, whereas those who are just mildly dazed by the blast are sent back to duty next day. These soldiers may well have suffered minor traumatic brain injury that puts their performance under high-demand conditions into question. They may start sleeping restlessly. Vision may become blurred episodically. There will be more headaches. Reaction time may be slowed, and cognitive function more sluggish. They may be much more ready to anger under the slights and insults that often pass among soldiers. Memory function suffers. To a man, these soldiers need Neurofeedback. - Siegfried Othmer, PhD
For more information visit: Homecoming for Veterans
Teeth-clenching and teeth-grinding are quite common, and they appear to be nothing more than a problem of disregulation of motor control, complete with a label. The brain can be trained toward better self-regulation, and the symptoms subside. This is even true for nocturnal bruxism, because indeed the brain is still in charge even while we are asleep. The Neurofeedback / EEG Biofeedback alters patterns of regulation, and these carry over into sleep.
Ironically, the first thing that a client may observe with Neurofeedback for bruxism is that he may be clenching more rather than less. Actually, we strongly suspect that what is really going on is that the person is simply becoming more aware of the clenching that had been happening beneath his notice. Among other things, Neurofeedback is training in awareness. After three or four sessions, the person will observe the clenching subsiding.
Successful Neurofeedback may make it possible for the client even to leave the nocturnal mouth guard on the night table. Jaw aches may be seen to disappear. If bad habits should happen to reassert themselves after some while, an occasional booster session can be helpful in restoring good regulation.
Bulimia is another of the principal eating disorders that present a clinical challenge. However, we have found that this condition is profoundly responsive to Neurofeedback. Bulimia can be seen as an "altered-state" phenomenon, in which people fall into a kind of ritual behavior. As recovery starts to take hold, the ritual behavior may still be indulged in for a time, but it becomes unrewarding, and is eventually abandoned. In one instance the person who had been binging and purging every day for more than a decade just stopped one day. Even more remarkably, she did not even think to point this out to the therapist. All she was aware of is that she did not "feel like it" that day, and so she didn't do what she had done every day since forever. In truth, there was nothing remarkable in her not binging that day. What was remarkable is that such a deeply ingrained pattern of behavior could be so suddenly erased.
Bulimia therefore illustrates for us a larger truth about Neurofeedback. The remedy impinges at the level of the brain, not at the level of the will. With training, there was simply no longer the physiological drive to binge and purge that had been there before.
It is important to recognize, however, that as with all of the major eating disorders, there is a high correlation with early childhood trauma. Symptom relief for bulimia is often so readily achieved with Neurofeedback that the larger agenda here-addressing the trauma response-may be neglected. The preliminary success with bulimia may be taken wrongly as an index to the resolution of the larger issue as well.
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