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- Impulse Control Disorders
Impulsivity is another primary marker for Attention Deficit Hyperactivity Disorder, but the problem is seen much more broadly. Fortunately, this kind of impulsivity yields very nicely to Neurofeedback training. The deficit here is largely in the functional domain. That is to say, the brain that is capable of being impulsive is also capable of functioning normally. The brain resources to do so are typically available. The brain simply needs to be trained. Once trained, the benefit tends to last. That is to say, once the brain acquires the capacity to function well, then life itself acts as a kind of reinforcer that keeps these skills honed.
This is another principal marker for Attention Deficit Hyperactivity Disorder. Much of the inattention observed in an ADHD child yields quite readily to Neurofeedback training. But matters are not quite so unambiguous as they are in the case of impulsivity. Children may be inattentive for reasons of birth trauma or prior traumatic brain injury that may not necessarily yield to the training. So we see children falling into two categories: either we do well with Neurofeedback, or we don't do well at all, when it comes to inattention. We assume that in the first category we are encountering a simple problem of a deficiency in brain functional organization. In the latter case, the deficit may have a more severe and intractable source. We don't know how to predict outcome, so the best approach is to try the training.
Incontinence can have a variety of causes, but the most common of them yield readily to biofeedback intervention. In fact, the research on biofeedback for incontinence among girls is stronger than for nearly all other conditions. We are talking here about the traditional biofeedback in which one is training the pelvic floor musculature into better coordinated control and movement. (See www.incontinet.com).
It has been found through clinical observation that incontinence also responds to Neurofeedback / EEG Biofeedback training. So we can think of this problem also in terms of deficits in central regulation. Given the delicacy of this issue among young children, it may be easier on everyone just to handle this problem with brain training.
Matters can also go the other way. In some kinds of Neurofeedback the muscle system is targeted directly and relaxation is the objective. It may happen that with success of the treatment a problem with incontinence may arise that had not been troublesome before. This may be an issue particularly among the elderly. If this occurs, the training needs to be altered so as to tighten these people up again, and the design protocol for the original complaint will have to be adjusted.
Garden-variety insomnia tends to fall into two categories: difficulty falling asleep and difficulty staying asleep through the night (or of falling asleep again after nocturnal waking). We distinguish between these because in some approaches they train somewhat differently. There is an association between the sleep-onset difficulty and anxiety, and between the sleep maintenance issue and depression. And just as we might train depression and anxiety somewhat differently, the same goes for the related sleep issues.
Good sleep is more than the absence of insomnia. The training of brain function gives one the possibility of achieving sound sleep even if one has not experienced it since perhaps infancy! This is one area where Neurofeedback diverges from medical remedies for insomnia. The medications do help one sleep, but by and large they extract a price. Over the long term there is the hazard of dependency, and over the short term there may also be a price to pay in terms of quality of sleep.
When the first attempts were made to specify a measure called "Intelligence" at the beginning of the twentieth century, the hope was that this measure would be a stable throughout life. Otherwise its value would be more limited. By and large that has turned out to be correct. The confirmation of stability in this measure has given rise to an even stronger position, namely that it is impossible to alter IQ, except possibly for the worse. When studies were coming forward in which IQ could be substantially enhanced through Neurofeedback, the results tended to be rejected out of hand.
By now (in 2006) the evidence is some sixteen years old that substantial improvement in intellectual functioning (as testified to by IQ tests) is achievable in mildly neurologically impaired children (nominally twenty points on average). The evidence is up to 14 years old that major improvements in measured IQ score can be achieved in ADHD children with Neurofeedback / EEG Biofeedback (ranging in studies from 4 points to 23 points in different studies). Those scoring less than 100 in IQ score at the outset made gains in the thirty-point range, so the greatest gains were seen among those in the greatest deficit. The gains were across the board in the IQ tests, but they were also highly individual at the subtest level. Finally, the evidence is some ten years old that major improvements can be achieved even in mildly mentally retarded children. (See Mental Retardation)
Significantly, these results rule out any kind of placebo effect as an explanation for what is going on with Neurofeedback. Not only that, but these results show that Neurofeedback must be regarded in a larger frame. Improved IQ was not an objective in any of the above studies. It was simply the outcome. The results demonstrate that Neurofeedback impinges on our cerebral function quite broadly.
Gains such as those cited above are not available generally. The results clearly apply to populations of children exhibiting a variety of attentional, cognitive, and behavioral deficits. However, there is a fairly broad tendency for IQ scores to increase at least somewhat across the board. And sometimes even high performers show some significant gains. One might argue that Neurofeedback training serves as a kind of "brain tune-up" even for those not in manifest deficit. Secondly, even those who show high performance may be laboring under a deficit with respect to their native potential.
We know of no way at this point to predict the outcome of Neurofeedback training for IQ measures. The ethical way to proceed would be to make cognitive skills training in general, and Neurofeedback / EEG Biofeedback in particular, available to every child early in their educational career so that they are not laboring unnecessarily against remediable handicaps.
- Intermittent Explosive Disorder
This is an uncommon diagnosis, but important from the perspective of Neurofeedback. 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 / EEG Biofeedback 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.
Neurofeedback / EEG Biofeedback can be surprisingly helpful for an irritable bowel, which at first sight seems surprising. We know that stress can worsen the condition, and it has been shown that it can be helped long-term with a few as a dozen sessions of hypnotherapy, and even with cognitive behavior therapy. So the brain and the mind are very much involved here in symptom expression. In one intractable case, a mere four sessions of Neurofeedback were required to end a persistent irritable bowel that had prevented an airline pilot from continuing his career. Of course more sessions were done just to be sure that the problem had been mastered. Four sessions to resolution is highly unusual, but it does show what a profound impact can be had with Neurofeedback. It also eliminates the possibility that other ongoing therapies were responsible for the relief in this case. In practice, of course, one would not choose to do just Neurofeedback for this condition.
Like pain sensation, itching is something we do to ourselves to alert us to a problem. The similarities go further. As in the matter of pain, chronic itching can get to the point where it intrudes on quality of life and resists efforts at relief. Chronic itching can get in the way of good sleep, even to the point where it affects our life expectancy. It can even drive people to suicide. In all these respects, it is similar to our experience with chronic pain.
Our typical response to the occasional itch is to scratch the region calling for attention, which points to another connection with pain. The neural systems dedicated to itch and to pain must be closely coupled in our periphery because one can override the other. The typical architecture of sensory neurons is such that when they are activated they will also act to suppress the activity in the surrounding region. So most likely scratching works by generating an over-riding signal that shuts down competitive pathways. Pain overrides itch, and for the moment we even welcome the pain sensation because it offers relief from itching.
When itching becomes chronic, this mechanism no longer works. And this may be for the same reason that many people end up in chronic pain even though there is no evidence of an immediate cause for the pain. The quieting of the "surround" of an activated sensory neuron is produced by tiny inter-neurons that function in an inhibitory capacity. These are highly vulnerable to attrition and atrophy over time in a nervous system that is chronically irritated. So eventually the small coupling that must exist between the itch and the pain-sensing neurons becomes predominantly excitatory, and scratching the itch no longer offers relief. There is now confusion in the ranks, and even pain signals can be perceived as an itch, and vice versa.
Medical remedies for the condition typically act on the central nervous system where we appraise pain and itch---the opiate drugs. Or one can moderate the excitability of the nervous system in other ways, as with anti-convulsant medication such as gabapentin. Or topical remedies may be tried.
The utility of the opioid and anti-convulsant drugs opens the door to trying Neurofeedback / EEG Biofeedback, which can also help to regulate the central nervous system. Both chronic pain and chronic itching are difficult to treat under any circumstances, but Neurofeedback training may very well be worthwhile. A major proportion of cases of chronic itching is seen in connection with excema and psoriasis. The severity of these conditions is tied into the activation of the immune system. Another pathway for Neurofeedback efficacy may be the calming down of immune system activation in such cases.
Finally, the downward spiral in health status that one may see in chronic itching cases could also be the secondary consequence of sleep disturbance attributable to the relentless itching. The Neurofeedback training may be helpful in restoring restful sleep, and thus put the person back on an upward trajectory.
- Siegfried Othmer, PhD
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