 
We are dealing here with something that goes beyond the ordinary brief storms of childhood. Rather, we are concerned here with more extended rage behavior that does not yield to conventional parental interventions. Parents may well end up living in fear of what they own child may be capable of doing, even children of pre-school age.
It is very tempting to simply suggest a different parenting style, but it should be recognized that we may also be dealing here with a brain-based problem rooted in the disregulation of basic emotional functions. A clean division between what is “neurological” or “neurophysiological” or “psychological” in such cases is not in prospect. This may well account for the fact that these children are not well managed. They are not therapeutically at home within any existing mental health discipline. They fall between the chairs.
A good starting point for therapy here is Neurofeedback / EEG Biofeedback. The quick gains that may be achieved will allow the family to move forward from a very different vantage point, both in terms of actual functionality on the part of the child and of understanding on the part of the parents. What does it mean about the child when temper tantrums just simply fall away, not to be observed again? This can happen despite the fact that the child may have been resistant to doing the neurofeedback. Also, the temper tantrums were never up for discussion between child and therapist. The target of intervention is the brain, not the child.
- Temporomandibular Joint Disorder (TMJ)
TMJ can be helped with Neurofeedback / EEG Biofeedback just as we are able to help with bruxism. In this case, however, there most likely should be complementary therapies as well. Neurofeedback probably influences symptom severity in TMJ through several mechanisms. The first and most obvious is through improved regulation of the setpoint of motor system activation. The second is through the promotion of greater nervous system stability, including in particular the level of arousal. The third mechanism is through enhanced awareness on the part of the person. As with bruxism, one of the first things that happens in training is that the person has greater awareness of clenching.
Thrill-seeking behavior is in the same category with mania, some illicit drug use, and aspects of Tourette Syndrome in that the person may focus only on the positive side and not recognize that there may be a problem. No one sees a mental health practitioner for their thrill-seeking behavior. But it helps to recognize the problem when it walks in the door for another reason. At the top level we see this kind of behavior as very much associated with Tourette Syndrome. At another level, this could be discussed in terms of our internal reward system. The positive report that comes from people engaged in extreme sports and such things as bungee-jumping is that “it makes me feel alive.” The remedy lies in retuning the nervous system to the point where these people can also feel alive without risking life and limb.
It was pointed out by Thom Hartmann that the “need to feel alive” should be regarded as one of our primary needs. If so, then that need should be fed by the entirety of our existence, not only by extreme events that by their nature are going to be rare in our experience. What is called for here is nothing less than the re-normalization of our internal reward circuitry. This observation has obvious implications for all the other consequences of a disregulated reward system, such as we see in the various addictions, obsessions and compulsions, etc.
Tinnitus, a persistent ringing in the ears, is clearly responsive to Neurofeedback / EEG Biofeedback in a substantial majority of instances that we see. In some 80% of cases, tinnitus is perceived as a distinct tone, and in some 20% of cases it is perceived more as a hissing sound or just as noise. The phenomenon is finally coming into some focus in the neurosciences. It appears that we are dealing with a problem that cannot be entirely blamed on the ear or entirely blamed on the brain. It involves both. Selective hearing loss is involved, which alters the brain's processing of the auditory signal stream. The result is the perception of a tone that is independent of the incoming sound stream.
Physical brain trauma can induce tinnitus, and over-stressing our hearing apparatus can do so as well. But tinnitus is often stress-dependent, situationally-dependent, or otherwise variable. If it is variable for any reason, then the brain may be modulating the signal. That is to say, the tinnitus is state-dependent, and if we train the brain's regulation of state, we may also affect the level of severity of the perceived tone. Clinical experience is confirming this in the majority of cases.
Finally, even if the condition is not directly responsive to training, Biofeedback/ Neurofeedback can moderate the degree of suffering that is experienced. This is similar to our experience with chronic pain. If the pain or the noise level cannot be diminished with training, it is still possible to train the central nervous system to largely ignore the signal so that it does not intrude as much upon the person's quality of life. The pain or the noise is no longer front and center in consciousness; effectively it leaves the stage. If one checks in with it, the tinnitus is still there. But one does not have to dwell on it, and it does not dominate one's perceptual world. So one can have quality of life even if the tinnitus persists.
This issue is of particular relevance to the elderly, where some hearing loss is commonplace. Many elderly folks experience some level of tinnitus from time to time, or when they pay attention to it. Yet it recedes into the background at other times. This state of affairs represents a training opportunity to contain the tinnitus so that it does not become obtrusive over time as hearing loss progresses.
Torticollis is another of the movement disorders, one characterized by either sudden head-jerking or steady-state deviations in head position. Biofeedback methods have been helpful here historically, and Neurofeedback / EEG Biofeedback can be used to target the same regulatory circuits.
Tourette Syndrome (TS) was initially viewed narrowly in terms of its diagnostic features, motor and vocal tics. Increasingly, however, the perspective of TS as a spectrum disorder is taking hold. Many behaviors are seen in close association with TS, and this needs to be understood if we are to find toward a more fundamental understanding of TS. We see TS as a particular state of brain function characterized by extremely high physiological arousal and high activation of the motor circuitry and of sensory systems. Associated with this are disregulations of the reward circuitry, leading to such things as thrill-seeking behavior and obsessive-compulsive symptoms. Such compulsive tendencies, thrill-seeking, and reward deficiencies often manifest in hyper-masculinity, hypersensuality (trying to stay G-rated here), and pathological gender relations.
In the more severe manifestations of TS we see a high incidence of a trauma history going back to early childhood. The combination of trauma and a TS brain may be particularly calamitous.
Neurofeedback can be helpful here in many ways. The first order of business is to train the TS brain to live out of calmer states. The second is to train the pre-frontal circuits to re-normalize inhibitory function. The pre-frontal training is our pathway in to the dopamine circuitry that is involved not only with reward but with the regulation of movement. A combination of a few relatively straight-forward techniques can help the person suffering from TS enormously. If there is a trauma history, additional trainings may be brought to bear down the line.
Tourette Syndrome is among those conditions that offer a lot of upsides to the person. This means that most people coming for help with this condition are certainly not looking for a “cure.” They are seeking help with one or another disagreeable aspect of their TS. That is as it should be. Looked at from the inside, TS is not really separable from how the person sees himself or herself. And much of what the person is aware of is positive. Touretters have the benefit of a brain that is readily engaged and typically highly mentally competent. These people are often relentlessly driven to succeed. A little compulsiveness and a little hypomania are not such a bad thing in the commercial world.
They just need a little help to moderate the excesses of drives, to tone down nervous system excitability in general, to permit the tonic rather than merely the phasic experience of reward, and to banish the unbidden eruptions into motor and vocal tics, coprolalia, etc.
This is too broad and general a topic for a mere thumbnail sketch. But trauma has been mentioned in a number of contexts in this recitation, and the basic ideas can be briefly summarized. All trauma, even physical trauma, is also psychologically traumatizing. The response breaches the body-mind divide, so that it cannot be fully described either in medical (i.e., structural) or psychological terms. A unitary description is needed for the response of the “body-mind.” We find that in an enlarged concept of memory, one that includes not only the explicit, historical, and declarative memory but also the implicit, unconscious “state memory.” The body-mind registers not only the external threats but the instantaneous state of the system as a unitary memory.
The result may be a distortion of our response system in answer to the demand of either threat or injury. This learning may well have protective features in an emergency state, yet it may be inappropriate for our general state of being. Further, it may be very costly to maintain. We witness the consequences of such derangements of our regulatory competence in many of the symptoms and conditions discussed in this compilation.
Despite the fact that we are giving implicit support to the classic diagnostic categorizations by even compiling this list, the need for a more inclusive model is apparent. Trauma is one of the key organizing principles of a more inclusive model. Trauma disregulates brain function, and that has lingering consequences either because of organic loss or because the disregulation is encoded in state memory and progressively reinforced by subsequent untoward events.
In our clinical work we see a bifurcation into two populations. There are people who have the kinds of symptoms that mildly interfere with their life. The problems may be attention related. These clients may have an occasional migraine, or PMS may be a nuisance for them, or their sleep is not ideal. There may be mild cognitive deficits that prevent them from reaching their goals. Then we see people who complain of the same symptoms but their severity is something else completely. Their migraines may be frequent and of long duration. Their PMS may be totally disabling. Their depression is irremediable, and their anxiety intolerable. If they were born with a tendency toward Tourette Syndrome, their tics, obsessive and compulsive tendencies are in the extreme range. If they suffer a mild traumatic head injury, their symptoms are inexplicably worse than when a similar injury happens to someone else. A psychologically traumatizing event can put their lives in complete chaos. They may exhibit dissociative features and fall into altered-state phenomena such as the severe eating disorders. Mental health therapists may label many of these people “borderline” and want to have nothing to do with them.
This is the story of trauma, and it is far more commonplace than imagined because many of these traumas are not available to us for ready recall. The traumas may have occurred at a pre-verbal stage, or they may even consist of events that in our adult perspective we would not regard as critical. The diligent and devoted therapist may whack away at the symptoms for some while but never quite be able to offer relief. The symptoms have a deeper source that must in time be addressed before the person can find peace within herself.
Neurofeedback / EEG Feedback offers not only a strategy for the renormalization or refinement of regulatory function, but in another of its applications it offers an invitation to self-healing at a deeper level. The farther we go in that direction, the more the person has to undertake his or her own journey. The therapist cannot go there, and even neurofeedback cannot give a specific prescription or road map. All that neurofeedback can do is to remove the barriers that have stood in the way of such a process, and to issue an invitation into the experience. This experience is a profound encounter with self.
Some people experience this through long-term meditation, but that is not necessary. The traumatized brain is straining to be given this opportunity, and extreme symptoms are the means of expression for a crushed and wounded self. The opportunity can be available in a few hours just as it can be available through years of mental discipline. Our complicated Western lives tend to interfere with this deeper healing process. The opportunity never quite arrives for this more fundamental healing to get underway because of the prevailing noise level in our lives. The process must therefore be facilitated, and neurofeedback does that. Superficial remedies will just give temporary relief before the symptoms either return or a new set of symptoms surfaces some time later.
The understanding of the trauma response gives us extraordinary explanatory power for many of the particular symptoms and for the symptom clusters we call disorders. Trauma also presents us with the impossibility of picking these problems apart into their constituent pieces. Therapy has not been more successful in the past because the essential unity of our experience has been ignored in our search for specific remedies for specific problems. The broad effectiveness of neurofeedback across such a variety of conditions stands as proof that in principle there must exist a theory that is equally encompassing. This is the theory of disregulation, namely that the core issue in many conditions is the inability of the brain to regulate its functions properly. Trauma is a key causal explanation for this state of affairs, but of course not the only one. There are many ways for the brain to become disregulated. Trauma presents us with just one coherent narrative from cause to consequence, albeit one of the most important.
The whole realm of what is called “minor” traumatic brain injury has historically been one of the worst instances of medical neglect in our modern medical history. The problem has been that people were often significantly disabled by apparently minor head injuries such as whiplash. On the one hand, emergency medicine typically found nothing amiss and sent these people home. And on the other hand, insurance companies did not want to pay for the perpetual care of someone who did not have a documented medical injury. Both have been abetted by a paper back in 1925 that accused head-injured persons of malingering.
It is only with the increasing availability of functional imaging that this picture is gradually changing. Now that we are able to see the brain in action, evidence of injury is becoming apparent. Still, there is more than is not readily seen. Some of the most disruptive consequences of minor traumatic brain injury lie in the functional domain. This may or may not show up in our imagery.
We have had a similar problem in the realm of pain. For decades doctors would argue with their patients about whether their pain was “real.” Medicine has finally capitulated and come to agree that pain is largely what the person says it is. There is a subjective component here that cannot be quantified through any of our measurement tools. So we will not have anything better to go on than how the person actually feels.
Similarly when it comes to minor traumatic brain injury, we have been systematically contradicting the patients’ reports about their own state. Compounding this double bind is the fact that the head-injured person may well not be sufficiently functional to be an advocate in his or her own cause.
Neurofeedback / EEG Biofeedback offers a fairly comprehensive remedy for the common symptoms of minor traumatic brain injury. In this classification, “minor” simply refers to the fact that there has not been skull fracture. It implies nothing about the severity of symptoms. In the early stages post-trauma, neurofeedback can be helpful with the head pain that is often experienced, as well as with nausea, irritability, mental confusion, and sleep difficulties. Over the longer term, neurofeedback can be helpful with energy level, vigilance, effort fatigue, cognitive dysfunction traceable to the injury, sensory hypersensitivity, and executive function. Eventually memory function should recover as well.
Many of these symptoms are known to recover spontaneously, so critics might wonder how we can be sure that neurofeedback was involved in the causal chain of remediation. It is well known that the spontaneous recovery process plateaus out within about 18 months post-trauma. In actual clinical experience, most of the head-injured clients don’t find their way to a neurofeedback practice until years have passed since their trauma. So they are quite stable with their symptoms.
In one of the first studies of MTBI, by Dr. Jonathan Walker, neurologist in Dallas, TX, recovery was observed to 85% of pre-morbid functioning in a cohort of 17 patients, all of whom were more than two years post-trauma. All were considered totally disabled at the outset. Yet every one of them who had held a job prior to their injury was able to resume productive employment after neurofeedback. There was not a malingerer among them. Most surprisingly, the average number of neurofeedback sessions was only 32. That is not a high price to pay for the recovery of a useful life. It is unfortunate that this price is nevertheless too high for our society—or its surrogates the insurance companies—to pay.
The above results were obtained with techniques that are now nearly ten years old. Significant improvements in training methods have been made within the last decade. The result is that head injury symptoms showing themselves to be resistant to remediation may be targeted more specifically. Additionally, there has been a broadening in the variety of neurofeedback techniques now available to the clinician. Some of these are suitable for home use, so that victims of traumatic injury can train themselves at home between office visits.
Finally, we are seeing the emergence of devices and techniques that very subtly stimulate the brain toward improved activation and control. These may allow people to adopt brain training and stimulation as a perpetual, ever-present factor in their lives, constantly helping to maintain optimal brain competence during the waking hours.
Neurofeedback has been found helpful for essential tremor, as well as for the tremors of Parkinson’s. Often the recovery has lasted some considerable time despite the continuing ravages of aging. If tremor returns, repeat training has been found helpful as well.
The symptom of hair pulling is seen typically in connection with Tourette Syndrome, and our story for trichotillomania is essentially the same as for TS in general. It may be useful to point out here that the phenomenon of “symptom substitution” is commonplace in TS. One may see quick results with trichotillomania only to find that the Touretter begins to report some other prominent symptom emerging. So it is not sufficient to target a particular symptom in TS. One must target the whole condition comprehensively.
Nerve pain is extraordinarily difficult to treat. However, we have had good clinical success with a number of cases of trigeminal neuralgia. One published paper on the method combines conventional biofeedback and neurofeedback, but we find that with the latest techniques neurofeedback is quite sufficient by itself to help with this condition. In this particular case the neurofeedback permitted the person to forego surgical resection of the cranial nerve, which was the last available medical option for her intractable condition. With the neurofeedback the severe chronic pain condition was essentially remediated, and the patient was also able to reduce her pain medications significantly.
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