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Manic behavior is identified typically with Bipolar Disorder. It is usually episodic. The difficulty in working with this condition is that it is often not perceived as a problem. It can be a very creative, productive, and exciting time for people. The piper will be paid later. Neurofeedback / EEG Biofeedback has a bit of an advantage here over the medications in that it does not appear to blunt the person, which can occur with the medications. So the fear among creative people that they may lose their edge is misplaced when it comes to Neurofeedback. We have a number of case histories where professional people became more effective in their careers after Neurofeedback gave them some needed stability.
Mania is an instance of a fairly common problem encountered in Neurofeedback. The person seeking help is not looking for a "cure" but rather for management. Control is the operative word from our perspective. People at issue here would like for their lives to be more predictable and less chaotic. But they would be unwilling to toss out the good with the bad. Fortunately, that is what Neurofeedback can accomplish. Successful training means a greater level of internal control for the brain.
Many people come to us who are using marijuana as medication. There is just no question that for these people marijuana serves the purpose of giving them better function or relief from symptoms. Many use it routinely to calm down from anxiety and the pressures of professional life. Others use it to combat nausea or to control seizures. The argument as to whether or not marijuana is a medication revolves about something else entirely. There is no question that THC, the relevant ingredient in marijuana, is a biologically active agent that can be employed for medical purposes. Our pharmaceutical companies would just rather that it came delivered with fixed dosages in a pill, as opposed to users harvesting their own.
The issue of medical effectiveness is also separate from the question of whether marijuana presents a long-term hazard to our brains. Many medications present a hazard to our livers, but we see no alternative. And of course our society allows smoking cigarettes, which presents significant long-term risks. With the individuals that we see, the immediate benefits trump any concern about the long term.
The good news is that with Neurofeedback / EEG Biofeedback, nearly all of these individuals ended up abandoning marijuana. They were not particularly trying to give up marijuana, and we were not urging them to. They just did. So when their brains no longer needed it, marijuana lost its attraction for them. Some would report this change with an air of surprise---something to the effect of "I can't believe that just happened."
This is a highly significant observation. For us, it represents confirmation-if any more were needed-that we can effect significant improvement in brain self-regulation with our methods, and that such improvement is sufficient to allow the client to reduce or even eliminate their "medications."
How might this translate into recreational use of marijuana? We don't hear as much about this because our clients may not report on such use openly to us if they don't consider it problematic. They are not looking for a lecture that they suspect would be forthcoming. Overall, we do know from our addictions work generally that the relationship to the recreational drugs and the drugs of abuse changes for the better. This could occur at the top level of the physiological response to the drug. It could occur through functional improvement generally that reorders the person's life. And it could also occur at a deeper level of the resolution of traumas and the "banishment of personal demons."
Meditation is listed here because it is helpful in complementing the understanding of Neurofeedback. Meditation is a mental discipline that over time can also effect changes in habits of mental functioning. For many who rely on meditation, it serves essentially as a substitute for pharmacological remedies. For them, "meditation is medication." Two issues are paramount here on which Neurofeedback may have a bearing. The first is that often novices do not know when they are accomplishing the intended objective. The second is that the mental practice may be quite time-consuming and may extend for years.
Neurofeedback / EEG Biofeedback, in at least one of its major implementations, has been referred to as "meditation with handrails." It guides the process with lots of cueing back to the person with respect to their instantaneous state. Secondly, the process is a lot more time efficient. Meditators who are struggling with their discipline may wish to investigate Neurofeedback to empower their process. The state rewarded in Neurofeedback may not be identical to what is strived for in the meditation routine, but the process may still potentiate the meditation discipline.
Meditation in the service of spiritual practice may take people to such extremes in physiological state that they actually become disregulated. Heart function may be put under stress to the point of showing heart rhythm anomalies, and cognitive function may suffer. The latter could occur simply because the person had a prior minor brain injury. If meditation should lead to reduced mental performance, or to anxiety and depression, Neurofeedback can be helpful in restoring better function.
Memory is such a complicated process that there are various ways in which it can fail. The most important feature from the perspective of Neurofeedback is that memory is not localizable in the brain like it is in a computer memory. Memory resides in broadly distributed networks in the brain. This means that we have to have brain functional integrity globally in order to have good memories. This is just what Neurofeedback aims for. It can be seen as targeting global communication relationships in our central nervous system.
Unsurprisingly, therefore, Neurofeedback / EEG Biofeedback can often produce significant benefits for memory function. Also, improved memory plays into other improvements in cognitive function that are routinely seen with Neurofeedback. Word problems in math on intelligence tests are an example.
Finally, there is the issue of working memory, the ability to hold in our minds a variety of aspects of a problem in order to bring them into juxtaposition and to perform logical operations on them. Neurofeedback seems to have a clear impact on working memory, although this is almost never tested directly.
Menopausal symptoms can be significantly helped with Neurofeedback, hot flashes in particular. A hot flash can be considered a "paroxysm" of the autonomic nervous system. With an increase in brain stability achieved with Neurofeedback / EEG Biofeedback, there is increased stability as well in autonomic function. Other symptoms of menopause are similar to those of PMS, and these typically yield to Neurofeedback training to the point where they are no longer bothersome.
Evidence is accumulating that even the brains we label mentally retarded are capable of substantially enhancing function through Neurofeedback / EEG Biofeedback and related techniques. Those cases where measurements have tracked progress tend to fall in the range of mild mental retardation, the range of IQ from 50-70. In this range improvements in the twenty-point range have been documented. Mostly these are reports from clinicians around the country and the world. In one such report, a child improved from 48 to 70 after having been seen only intermittently over a period of four years.
A recent publication tracked two identical twins over five years post-Neurofeedback and found the gains to hold over that time. Another study by a psychiatrist in Turkey showed significant improvements in an entire cohort of MR kids. Individual measures of comprehension, vocabulary, attention, speech, and verbal facility were used rather than formal IQ tests. However, major improvements in IQ are indicated. Out of sixteen kids, only one failed to show significant improvement. This study included not only moderately impaired MR children but also those who were severely and profoundly impaired (3 moderate, 8 severe, 5 profound). Additionally, behavioral improvement was noted, along with increased social engagement.
The largest gain ever recorded was 42 points, from an IQ of 70 to 112, over the course of a year of training. One would have been hard-pressed at the outset to imagine that such a thing was possible with the child in question. Yet there can be very little doubt that the change was real, as the child's life was essentially transformed.
Children with even more severe impairments can also benefit from Neurofeedback. Here we may be concerned with victims of near-drowning, where nervous systems may be severely compromised. Profound functional improvements can be achieved with Neurofeedback in many of these cases. The training will be long-term, responsibility for which is generally assumed by the family in these cases, with clinician support.
Looking at all of the clinical experience of which we are aware, it is clear that we have no way of predicting the recovery capacity of a given nervous system. The training simply needs to be tried for a period of time. Initial results should be seen very early on in training, so the family can be reassured that they are not wasting its time and resources. However, there are likely to be benefits from continuing the training over the long term.
The story in a nutshell is that for quite a number of years now it has been known that biofeedback techniques are the best available remedy for migraines. This is well documented in the published literature that has accumulated over the years. The problem has been in getting the story out to those who need it. After all, the first point of contact of a migraineur is with his or her MD, not with a biofeedback practitioner. And the medical world is going to prefer its own set of remedies first, namely medication.
The other fly in the ointment is that the traditional biofeedback techniques weren't all that much better than the medications at the outset. Often the medications gave people a kind of quick honeymoon period with their migraines, whereas biofeedback techniques had to be learned over time. Eventually, however, the medications tend to accumulate their own sets of problems; they may no longer work so well, and they may cause rebound headaches. Medication strategies can become complicated. Over that same timeframe, the biofeedback path increasingly shines. By the time three years have elapsed from the outset of therapy, biofeedback is distinctly superior to the medication-only route.
Of course it's not really an either-or situation. If biofeedback strategies are learned, then the medications can simply play a more minor back-stopping role so that over-medication effects can be avoided. So biofeedback strategies are available for any migraine sufferer, irrespective of whether they are fond of their medications.
But now the story gets even better. Over the last several years, two new techniques have emerged that are dramatically superior to the traditional biofeedback methods (which have relied on things like the training of hand temperature and/or muscle tension, as well as on biofeedback-assisted relaxation training).
The first of these was developed by psychologist Jeff Carmen, who had been working with traditional temperature training for many years with his migraine population. Having observed that migraines locally raise cortical temperature right in the region that is most painful, he found that training cortical temperature in a biofeedback configuration got the central nervous system to do the right thing and abort the migraine---sometimes right on the spot, right within the session. Now the aborting of an ongoing migraine is not something that was routinely possible with the traditional biofeedback techniques, which are more of a migraine-abatement strategy. So Carmen knew fairly quickly that he made a significant new finding. Over the years he refined his technique, and then published a study of one hundred successive cases in his practice. Of these, some 95% can be declared a treatment success. No medication or combination of meds can begin to touch these kinds of results.
Over the same timeframe we have seen EEG Neurofeedback strategies also refined to address the problem of migraines. In the case of Neurofeedback, the technique turned out to be very similar to the one that has been found optimal for seizure disorder as well. The one finding reinforces the other. We have here a powerful technique for using the brain's own resources for stabilizing itself. As it happens, the success rate of the new technique was also in the range of 95%. Not only that, this success rate was being achieved with the most difficult migraine patients walking the planet.
Most people who just have an occasional migraine will typically content themselves with a medication strategy. Those who come for Neurofeedback tend to be those who have suffered majorly from migraine histories that have extended over decades. They are quite ready to be rescued from such a life, and they will accept the discipline-and the costs-of undertaking some twenty or more Neurofeedback training sessions.
Now there was only that "hard nut" of some 5% of migraineurs where our techniques were distinctly falling short. People were happy enough to have done the Neurofeedback, but they were still having occasional breakthrough migraines. Something was still missing.
Two more developments will bring us up to date. The first is that we discovered how to work effectively at the very lowest EEG frequencies between zero and three Hertz. Some Neurofeedback research has been going on in Europe for a long time in this frequency regime, but the work had not caught on in the United States. (Some years ago this work was recognized by the German government with a $2M award to the principal investigator, Niels Birbaumer of Tuebingen University.) The European work had shown benefit for the control of seizures. So why not with migraines? We did not adopt the European method directly, but rather just extended our own techniques down to low frequency. This turned out to be helpful for those very clients with whom we had not been entirely successful before.
The other development relates to the fact that migraines are known to be acutely sensitive to some lifestyle factors and dietary indiscretions (chocolate, red wine, coffee, etc.). With migraines ostensibly out of the way, people may relax their guard with respect to the known triggers. Eventually they may pay the price.
So we needed something for them to take home with them that keeps their brains in top regulatory form. We may have found it. Over the last few years research has shown that the device known as Enermed (www.Enermed.com) can be effective in sustaining a migraine-free life. This small device emits an extremely low-level electromagnetic signal that lies within the EEG range of frequencies. The stimulation frequency is altered every 12 seconds or so, and ranges among a small number of target frequencies that are tailored to the individual's needs.
Now this little device is not cheap, simply because the whole technology had to be developed on the private nickel (since as far as healthcare is concerned, we have a government of, by, and for the drug companies). But for those who need it, it may be a godsend. We tried the technology on six of our most resistant migraine clients. Two out of the six responded marvelously, and would not now be separated from their units. The third came back in to have the device reprogrammed, and is now successful as well.
Now 50% favorable response doesn't sound all that great, except when you consider that these were highly selected people who had bombed on all prior therapies. Naysayers at this point would rush in to point out that these numbers are small, etc. And how do you rule out the placebo effect? But of course our office is not the only one investigating the device. And published research backs up the claims as well. Our own modest experience base is just additive to the whole emerging story.
As for ruling out the placebo effect, the device has a nice built-in control. What sometimes happens is that people forget to change the battery (which needs to be done about once a month). Then a noticeable regression in regulatory control or even the return of symptoms reminds them to change the battery and a state of better function resumes. So there you have it: a controlled design in a state of nature. Every user can prove out for themselves at any time that the device is actually doing something for them.
The device is hung around the neck, and still the tiny signal manages to stimulate the brain. The fact that the tiny battery lasts a month is proof that the signal is tiny as well. There isn't enough energy storage capacity in the tiny battery for anything more! The signal is so tiny, in fact, that it would take sensitive instrumentation to even detect it. This in turn means that as far as electromagnetic signals are concerned, our brains are exquisitely sensitive to them if they fall into the EEG range of frequencies. (Hint: you may want to consider your usage of a cell-phone placed against your head!)
This has been a rapidly moving scenario over the past several years. And at this point, not many people are aware of how much things have actually changed in the clinical world of biofeedback and Neurofeedback. For most migraineurs, a comprehensive remedy for their migraines is now available with the combination of biofeedback, Neurofeedback, attention to lifestyle issues and risk factors, and if necessary the Enermed device. And all the "natural" remedies can be back-stopped by the medications if necessary.
One final note: Among those with a long-term migraine history, it is likely that the migraines are just the "tip of the iceberg" of a more pervasive set of issues. In this introductory piece we have just focused narrowly on the migraine issue itself. The fact is that Neurofeedback represents a much more comprehensive strategy toward self-regulation that can also be of help with the other issues such as psychological trauma, etc., of which the migraine maybe just a signature.
Siegfried Othmer, Ph.D.
August, 2006
Case Reports
The following is a case vignette from a Neurofeedback therapist:
Recently more and more of my clients have gone back to ask their doctors why they weren't told about Neurofeedback. Another such case was a 12-year-old migraineur who came to me as a referral from a local psychologist. He looked pale and pasty and hadn't been out of the house much his entire life! He had never been able to go to school and missed all those developmental years academically and with peers. The response the doctor treating him at the Medical Hospital gave was, "We thought you couldn't afford it [Neurofeedback]." The mother was livid that she hadn't been told before about Neurofeedback and told the doctor so! Her son is now a migraine-free happy and healthy preteen!
Migraine Case Report:
A woman of middle age came in with chronic, daily, debilitating migraines, which she has had for 30 years. The severity was such that it led to frequent hospitalizations, at the rate of two to three per year. Over the years she tried "every drug on the books."
She heard about Neurofeedback a few years ago but did not consider it at the time. Finally, things got so bad that she overcame her resistances to investigate Neurofeedback for herself.
At the first session, the clinician attempts to optimize the reward frequency to the person, a process that can take a number of sessions. The client got a headache some time after the session. Amazingly, however, the headache went away on its own very quickly, as opposed to escalating. This was exceedingly unusual. Apparently even the first session already had a favorable effect.
Over the next several sessions the client kept feeling slight headaches coming on between sessions. On each occasion, she had the feeling that they would blossom into full-blown migraines, but they never did.
After five sessions she went on vacation, where she drank red wine (a huge trigger for her) and stayed up late. No headache was experienced during this vacation.
After she came back to Los Angeles she again had a number of headaches, but they were typically at the level of 2-3 in severity rather than maxing out at ten, which was the usual expectation.
Whenever she came to the office with a headache, training was done with passive infrared thermal feedback in order to expunge the headache. Otherwise EEG Neurofeedback was done. The client also complained of neck and shoulder tension, for which parietal placement was used for calming. At some point along the way, the client also complained of mental fogginess, for which left frontal training was done.
At the twenty-session review she said that she is feeling good, without any headaches. Nevertheless, she had the impression that the headaches remained an ongoing threat. She still did not feel entirely out of the weeds. With the objective of training to mastery, sessions were continued to forty. No headaches were experienced over that interval.
In the meantime, all cautions have been thrown to the wind. She drinks red wine and aged cheese; she stays up late; and she has gone back to leading a very stressful life. Yet there have been no headaches. Looking back from the perspective of the forty-session milestone at which she completed her training, we observe that from the first session on she never again had a characteristic migraine.
We first encountered motor and vocal tics in connection with our work with ADHD years ago because this is one of the side effects of stimulant medication for some children. When the children were helped to get off their stimulants with the Neurofeedback, the motor and vocal tics were likely to diminish as well. This allowed us to hope that we might be on a path to developing a Neurofeedback option for Tourette Syndrome. And indeed we were reinforced in that belief by a number of clients who were very responsive to Neurofeedback.
The early work, however, was disappointing for those we would have liked to help most, namely the ones for whom medication did not provide relief. It has taken us some years to find our way with motor and vocal tics. The answer lay largely in tailoring the training to the person, as opposed to figuring out a standard protocol for all. With such a program of individualization of the training, we have been able to help not only the motor and vocal tics we commonly see in children but also the more severe cases of Tourette Syndrome.
Historically the field of Neurofeedback that is principally under discussion here got its start in connection with research on motor seizures, where a particular kind of EEG training was fortuitously found to be helpful in seizure control. The training centered on the part of cortex that governs movement, which lent credibility to the finding. That early finding then gradually kindled the development of this whole field. Unfortunately, the finding did not make sense to neuroscientists at the time, so the intriguing research was not followed up within academia with any seriousness.
Over time the clinical procedures have been refined, and by now we have reached a fair amount of confidence that Neurofeedback can be helpful in reducing the incidence and severity of motor seizures. Nearly everyone who comes for help with seizures is already medicated. So the issue is breakthrough seizures. The addition of Neurofeedback is comparable in its effect to the addition of yet another medication. The gains are typically quite worthwhile.
- Multiple Chemical Sensitivities
Chemical exposure can shock the body and the nervous system into a kind of trauma response that leaves the person hypersensitive to chemical stimuli of various kinds. This is in addition to any functional loss that may also have resulted from the chemical exposure. It is as if the body-mind were permanently locked into a kind of threat-response mode.
Medical remedies have not been very helpful for this condition, so the response has mainly been along the lines of accommodation. The environment in which these people live must simply be cleansed of the offending substances so as not to trigger a response.
With Neurofeedback we are able to help not only with the consequences of the organic injury but also with the learned response of hypersensitivity to certain chemicals. This at least takes a person back partway toward restoration of functionality.
MS involves organic injury to the white matter of cortex, so one's first question might be: Why should Neurofeedback help with MS? Neurofeedback trains the neuronal resources that are trainable, whatever they may be. Even if there is neuronal loss, Neurofeedback can still help to organize brain function with what remains. The expectation would be for some fractional improvement in symptom severity. But it's not as simple as that because MS is typically episodic, with symptoms waxing and waning. So it may not always be clear just what the Neurofeedback might be contributing in a particular case. Ultimately such matters need to be addressed in formal group studies.
In reality we have the opposite problem. Sometimes Neurofeedback / EEG Biofeedback triggers more recovery than seems reasonable. This is what occurred in the first report of Neurofeedback on MS some years ago, where exceedingly good outcomes were obtained for three people, whereas three others hardly responded at all. Among the responders, people who had been totally disabled by MS were able to resume their professional lives. Such extraordinary results are not commonplace, however, and subsequent hopes along those lines have been disappointed.
The positive findings do need to be explained, however. It is possible that in these cases there was a positive influence on immune system regulation, so that the assault by the body on its own white matter may have been ameliorated. The Neurofeedback may have effected a down-regulation, or re-regulation, of immune system functioning in these particular cases.
The newer, more comprehensive Neurofeedback strategies may do better than the early ones in terms of this larger objective of neuro-regulation. Studies are badly needed to evaluate these hypotheses.
The whole approach of brain training using the EEG has spawned some other ideas in which the brain is stimulated continuously at a low level in order to keep the brain on its toes, if you will. Initial results with one of these technologies, the Enermed, are turning out to be favorable. At this point, we only have anecdotal reports. However, these reports refer to relatively advanced stages of the condition, where options are few. (www.Enermed.com)
One can see a pattern emerging here in which intensive Neurofeedback training is undertaken for both symptom suppression and immune system regulation, to be accompanied by steady-state stimulation to maximize brain function over the longer term.
Myotonic Dystrophy is the most common type of Muscular Dystrophy seen in adults. Here we only have a single case example to report, but it is a remarkable one:
A Neurofeedback practitioner in Australia reports the following story:
Almost two years ago I began training a then ten-year-old with Myotonic Dystrophy who had attention problems, low muscle tone, low energy, poor speech, sleep maintenance issues and sleep apnea. After about sixty sessions, this youngster showed greatly increased energy, improved concentration and speech, normalization of his sleep cycle and no sleep apnea. A formal sleep study documented normalization of his blood oxygen saturation levels when compared with studies conducted prior to Neurofeedback training, and confirmed that the sleep apnea issue had been resolved.
About six months later his mother called to say that he had lost all of the gains we had made with the Neurofeedback. So he came back in twice per week and we were again able to attain the same level of improvements. We now maintain those gains with sessions once per week during school terms. Myotonic Dystrophy is a degenerative condition in which the patient's health is expected to gradually deteriorate, so it seems this youngster needs ongoing Neurofeedback training to maintain gains and postpone the inevitable deterioration.
Now for the really good news!
Because of this well-known process of deterioration, medical specialists had previously predicted that this boy would be in a wheelchair by now. However, he is now twelve years old and a few months back was encouraged to try out for "Special Olympics." This is a program here in Australia in which children with disabilities are encouraged to take part in track and field events. The boy's mother told me last week that he is now running times in the 400 meters that would have qualified him to run in the open division at the 2000 Sydney Para Olympic Games. He is now being groomed to compete in several track events and the high jump in Athens in 2004. So much for the wheelchair!
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