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Neurofeedback / EEG Biofeedback can be helpful for the common eating disorders. But it is actually difficult to discuss the eating disorders under one conceptual umbrella, that is to say, as a single entity. The conditions are in fact quite multi-faceted. But all of them do involve disregulations of brain function of various kinds. We start by considering appetite, hunger, and satiety as regulatory functions managed by our body-mind. They are not absolutes, but rather judgment calls by our own bodily systems. As such, they can be badly off with respect to the actual realities that they are supposed to reflect. And the good news is that appetite is trainable.
The first order of business with eating disorders is to restore regulatory integrity, and that is likely to have favorable consequences for appetite as well. Many people are just not getting the necessary signals from their bodies about when they are hungry and when they are sated. Or else the signal is delayed. This is all manageable.
Additionally, there is the issue of compulsive behavior around food. As discussed in the section on compulsive behavior, this can be helped rather comprehensively regardless of the specific nature of the compulsive activity.
A third issue is that eating disorders may be seen in association with such conditions as depression or anxiety, or other mental health condition. In these cases, Neurofeedback can help not only with the eating disorder directly, but it can also help to relieve the associated condition.
A fourth issue is that eating disorders are frequently associated with conditions of underweight or overweight. This likely means that the person is not receiving optimum nutrition, on the one hand, and it means that the person is even more likely to be disregulated in general. So we have a kind of vicious circle in which the status of weight and of nutrition feeds back on the state of disregulation and exacerbates it further.
Neurofeedback / EEG Biofeedback can be very helpful here, but it should be imbedded in a comprehensive treatment program that is attentive to the nutritional and other factors as well.
Finally, eating disorders are very highly correlated with early childhood trauma. In such cases, food may play a soothing and ameliorating role in the short term, while costing the person over the long term. Resolution of the eating disorder should address the trauma issue as well, which can be accomplished with the aid of Neurofeedback also.
The more severe eating disorders, including bulimia, anorexia, body dysmorphic disorder, and rumination syndrome are discussed separately in this compilation.
Elimination disorders have been treated successfully with biofeedback for years using conventional measurements of peripheral physiology. The pelvic floor muscle system is trained for better control. In such a method, it is not entirely clear just what is being trained. If function is deficient, are the muscles intrinsically too weak or is there a deficiency in regulatory control? Even clinical success in these conditions doesn't quite tell us the answer.
When we do Neurofeedback / EEG Biofeedback for these conditions, matters are less ambiguous. If we are indeed solving the problem, then it must be through our influence on central nervous system regulation. As it happens, we do solve the problem in the vast majority of cases, which means that the problem should really be reappraised as involving a deficit in central regulation rather than a deficiency in the muscles themselves.
It is fortunate that this should be the case because it goes without saying that children are mortified when they are equipped with anal sensors, etc. for conventional biofeedback. It is nice to be able to avoid all that discussion and embarrassment by just training the brain instead.
There is another issue that is probably at work in many of these cases. The dyscontrol is often episodic. There is no steady-state deficiency of any kind, either in the muscle system or in the control electronics. But episodically the child may lose control because of a seizure-like event in the brain. If that event does not rise to the level of actually causing a seizure, it is unlikely to be recognized. The result is inappropriate treatment.
Fortuitously, EEG biofeedback is once again the remedy of choice to help with the sub-clinical seizure activity (called paroxysmal activity). Training the brain toward greater stability can cause these phenomena to disappear, whereas most of the conventional treatments won't.
There is also a big-picture issue here that must be discussed. We often see encopresis in children who have been abused or traumatized in some way. As we already know from our work collectively, trauma is profoundly disruptive of brain function, even giving rise to paroxysmal or sub-clinical seizure-like activity. If a trauma history could be at issue in a particular case, it is the trauma that should be the organizing principle of therapy, not the encopresis. Here we have yet another rationale for beginning by training the brain.
Most enuresis that we see in our clinic is seen in conjunction with the common childhood disorders of the ADHD spectrum. Resolution is usually obtained with Neurofeedback along with the other aspects of disregulation. If enuresis were the only issue, then one might well resort to a less costly and time-consuming technique. However, that is hardly ever the case with the children we get to see. Neurofeedback in these cases confer multiple benefits that generally appear to be worthwhile to the parents-and not just a resolution of the bed-wetting problem.
In fact, nocturnal enuresis should be seen as an index to a kind of disregulation of sleep. So even if no other prominent symptoms are observable in the child, such sleep disregulation is actually worthy of attention in its own right. The problem is that we are not clinically oriented toward the investigation of sleep issues. If the quality of sleep were attended to, many children would function a lot better than they do. The absence of significant behavioral or attentional issues is too low a bar.
A small percentage of children survives without resolution of this issue into adulthood. For these, we have not found a good remedy either. The problem then surfaces once again among the aged. In fact, it is said that incontinence is the biggest reason for referrals to nursing homes. Fortunately for the nursing home industry, it is not well-known that a perfectly good remedy is available for incontinence. It is traditional biofeedback (see www.incontinet.com). And Neurofeedback is helpful as well. Since the elderly typically contend with the decline of brain function generally, one might obtain multiple benefits from a Neurofeedback strategy for the aging.
The most solid and extensive body of research in Neurofeedback / EEG Biofeedback relates to seizure disorders. In fact, the principal method employed in this technique was inadvertently discovered in animal research related to seizure susceptibility. Over the decades since, it has been established that Neurofeedback can be helpful for various kinds of seizures. The nature and locus of the seizure focus does not seem to matter. This is not as surprising as it may seem. The same is true of the medications. These impact upon the whole brain, not the seizure focus in particular. Neurofeedback trains the whole brain to be less susceptible to the onset of a seizure. The technique raises the threshold of onset of a seizure; it discourages the generalization of seizure-like activity at the focus into a full-blown seizure. It presumably does nothing for the seizure focus specifically.
For the particulars, the reader may wish to consult other sub-headings in this compilation: Motor seizures; temporal lobe epilepsy; absence (petit-mal) seizures. Most of the formal research on seizure suppression was done in the early decades of the field. Even with the more primitive techniques available at that time, overall seizure reduction averaged more than 50%, with more than 80% of trainees benefiting at a level of 30% or more in severity and incidence. Many became seizure free, and many also became medication-free. All of these data refer to patients who were stable on their meds but their seizures were still not controlled. So the above refers to the incremental benefit beyond the best that can currently be done with medication management.
No doubt if Neurofeedback / EEG Biofeedback were the first intervention rather than the last resort, the above percentages would look considerably better. At the present time, and with modern procedures, the percentage of cases that do not respond to a degree that is considered worthwhile is exceedingly small. Neurofeedback is to be recommended to anyone considering brain surgery for intractable seizures. The cost of a Neurofeedback trial is trivial compared to the cost of surgery, and the option of surgery is not foregone. A trial of Neurofeedback should be considered as a matter of prudent caution, of conservative medicine, and of ethical practice.
Neurofeedback should be considered particularly by those who face life-threatening descent into status epilepticus. Such individuals can be trained in the technique so that they also have it available on an emergency basis. The Neurofeedback capability can even be combined with continuous monitoring of the EEG for incipient excursions into disregulation.
Epilepsy and Brain Surgery
It is estimated that there are some 400,000 to 600,000 cases of medically intractable cases of epilepsy in the United States. Many of these are considered candidates for brain surgery to eliminate or reduce their seizures. However, the total number of such brain surgeries is only on the order of 3,000 per year. Some two-thirds of these see essential elimination of their seizures with the surgery in the year following, with perhaps some loss of function in the bargain. This is obviously insufficient to make real inroads on the reservoir of intractable cases.
Undoubtedly the brain surgery option is resource-limited, either financially or in terms of the availability of suitably skilled personnel. In addition, many candidates are reluctant to take such an extreme measure. Neurofeedback may be a useful screen for brain surgery. A potential candidate for surgery should do Neurofeedback first to see whether the brain surgery is in fact necessary. At the cost of about one to two percent of the cost of brain surgery, most surgery candidates are likely to see substantial improvement in their condition, and thus be in a much better position to make a decision respecting surgery. Most surgery candidates will find that they will be able to forego the procedure. Surgeries can then be targeted on those individuals whose seizure disorder does not substantially resolve with the Neurofeedback.
- Episodic Explosive Disorder
This is an uncommon diagnosis, but important from the perspective of Neurofeedback / EEG Biofeedback. This behavior is characterized by distinct episodes of aggressive behavior that may leave the person remorseful, embarrassed, or regretful afterwards. The behavior is inconsistent with the character of the person, and it does not fit with other disorders involving aggressive behavior.
On the other hand, it has all the earmarks of a seizure-like disorder. The person may even be aware of pre-cursor phenomena such as a feeling of tension or heightened arousal. Since Neurofeedback was originally researched in connection with seizure control, it might be helpful as well for this condition. And indeed this is what we have found.
It is in tremor that the rhythmic basis of the organization of movement becomes apparent, and it is the rhythmic basis of brain organization to which we appeal with Neurofeedback. So it should not be a surprise at all that with Neurofeedback training we should be able to reduce symptom severity in tremor. Outcome turns out to be highly variable, however. In some cases, tremor resolves in a few sessions and does not return for a long time. In other cases, we only succeed in reducing the symptom severity. Clients may in these cases want to avail themselves of a home-training option, under clinical supervision.
The training can also be helpful for the tremor of Parkinson's, but we refer the reader to that sub-heading.
- Excessive Daytime Sleepiness
Much of this is due to lifestyle issues that nibble away at the hours we should be spending asleep. But the problem is actually bigger than that. Our lifestyles in the Western world also drive us toward living in brain-states that make it difficult for us to climb down later into restful, deep sleep. Much can be done for this state of affairs in the realm of self-care. However, when the brain has gotten into bad habits over decades, the payoff for the perfunctory adoption of a self-care remedy may be modest at the outset, and not sufficient to be sustained. Neurofeedback can give the brain a strong reminder of what it is like to sleep well. Once that is in place, sound health practices are easier to maintain. So even though excessive daytime sleepiness is not an issue that calls for emergency measures, the payoff for serious attention to this issue might well be huge in terms of quality of life and function. There should also be benefits down the line in terms of longevity through improved immune system function, etc.
A variety of biofeedback techniques can be helpful here, many of them quite accessible to the home user. The case for doing Neurofeedback is strengthened if there are other issues related to brain function that could also benefit from some attention, and we find that there usually are. In doing Neurofeedback / EEG Biofeedback for a variety of conditions, we find that the quality of sleep is usually one of the first things to improve, and it does so quite irrespective of whether sleep was thought to be a problem.
Many people just accept their own sleep patterns as being normal, or at least tolerable, not realizing how much better things could be. Sleep researchers tend to see functional improvements in their patients as secondary to improvements in sleep. We who do Neurofeedback don't disagree with this, but would shift the perspective slightly: the quality of sleep is an index to the quality of self-regulation, and the latter influences both waking states and sleep. Improved self-regulation is our objective, and improved sleep is not only a consequence but also a measure of our success.
- Executive Function Deficit
Specific executive function deficits have been identified in ADHD children, although they are not actually present either consistently or uniformly in that population. When testing has been done to characterize one or another of the executive functions, improvements have been noted with Neurofeedback. Mostly these improvement were brought about with the same general protocols that were found helpful with ADHD in general. In future, it may well be the trend to target particular deficits more specifically.
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