About biofeedback

WHAT IS EEG Biofeedback?

EEG Biofeedback is a learning strategy that enables people to alter their brain waves. When information about a person’s own brain wave characteristics is made available to him/her, he or she can learn to change them. You can think of it as an exercise for the brain.

WHAT IS IT USED FOR?

EEG biofeedback is used for many conditions and disabilities in which the brain is not working as well as it should. These include Attention Deficit Hyperactivity Disorder and more severe conduct problems, specific learning disabilities, and related issues such as sleeping disorders, enuresis in children, speech disorders, teeth grinding, and chronic pain such as frequent headaches or stomach pain, or pediatric migraines.

The training is also helpful with the control of mood disorders such as anxiety and depression, as well as for more severe conditions such as medically uncontrolled seizures, minor traumatic brain injury, or cerebral palsy.

HOW IS IT CONDUCTED?

An initial interview is done to obtain a description of symptoms and to get a picture of the health history and family history. Some testing may be done as well. The person also takes the first EEG training session, during which their EEG signal is analysed. This all may take about two hours.

Subsequent training sessions last usually 45 minutes (we set the usual school class format as it is the most suitable for both educational and psychological reasons). Some improvement is generally seen within ten to twenty sessions. Once learning is consolidated, the benefit appears to be permanent in most cases.

The biofeedback training is a painless non-invasive procedure. One or more sensors are placed on the scalp, and one on each ear. The brain waves are monitored by means of an amplifier and a computer-based instrument that processes the signal and provides the proper feedback. This is displayed to the trainee by means of a video game or other video display, along with audio signals. The trainee is asked to make the video game go along with his brain. As activity in a desirable frequency band increases, the video game moves faster, or some other reward is given. As activity in an adverse band increases, the video game is inhibited. Gradually, the brain responds to the cues that it is being given, and a “learning” of new brain wave patterns takes place. The new pattern is closer to what is normally observed in individuals without such disabilities.

WHAT DISORDERS HAVE CLINICAL EVIDENCE?

Following disorders have scientific reports from multi-subject and controlled studies:

ADHD (Attention Deficit Hyperactivity Disorder), Dyslexia, Anxiety Disorders, Alcoholism, Epilepsy, Headache, Sleep Disorders, Traumatic Brain Injury. There is over 1,200 studies (NF & EEG BF altogether), demonstrating efficacy at 30+ clinical / educational / professional conditions in peer-reviewed journals, abstracted in the US National Library of Medicine online (www.ncbi.nlm.nih.gov/pubmed). Many more at other websites devoted to scientific research – over 3,000 articles at www.sciencedirect.com

WHAT RESULTS DO WE OBTAIN?

In the case of ADHD, impulsivity, distractibility, and hyperactivity usually all respond to the training. This may lead to much more successful school performance. Cognitive functions may improve as well. In several controlled studies, increases of 10 and more points in IQ score were found for a representative group of ADHD children.

Behavior may improve in other ways as well: If the child has a lot of temper tantrums, is belligerent, and even violent or cruel, these aspects of behavior may come under the child’s control.

In the case of depression, there can be a gradual recovery of affect, or emotional responsiveness, and a reduction of effort fatigue. In the case of anxiety and panic attacks, there is a gradual improvement in regulation of emotions, with a drop-off in frequency and severity of anxiety episodes and panic attacks until the condition normalizes.

It is a well documented historical fact in the case of epilepsy, that in controlled studies we observe a reduction in severity and incidence of seizures or total cessation of seizures. In many cases, the dosage of anticonvulsant medication may ultimately be reduced and side effects of such medication may diminish.

HOW LONG DOES TRAINING NORMALLY TAKE?

EEG training is a learning process, and therefore results are seen gradually over time. For most conditions, initial progress can be seen within about ten to twenty sessions.

Fastest response: at stress induced, usually sleep onset Insomnia good sleep is reached quite often during the first night – right after the first initial session. It can be fixed in 10 sessions.

The next quickest: Nocturnal Enuresis or Tension Headache can be fixed by 20 sessions, too.

Teeth’s grinding usually responds in twenty sessions.

The assessment of the progress is ongoing during the training. Control consultations are performed regularly. In the case of hyperactivity and attention deficit disorder, training is expected to take about forty sessions, or even more in severe cases. Some mild symptoms of head injury often respond in 20–40 sessions (quality of sleep, fatigue, chronic pain), whereas others may require longer training before they show an initial response (memory function, for example).

CAN A SUCCESSFUL OUTCOME BE PREDICTED?

Yes. For the more common conditions, as ADHD or Sleep Disorders, we see a reasonable prediction of outcome is usually possible, with the effectiveness reaching over 90 % (specifically, over 95 % at Sleep Onset Insomnia and Nocturnal Enuresis of children and adolescents). More importantly, however, the effectiveness of the training can usually be assessed before the course of training from diagnostic EEG examination.

Empirical studies have established good enough measures for many “model” treatment plans. The number of training sessions necessary to fix some specific condition is in concordance with neighboring methods like verbal psychotherapy or rehabilitation. In summary:

Mild problems – examples insomnia, enuresis, simple tension headache: short term therapy, e.g. c. 20 sessions.

Moderate problems – examples ADHD, Learning Disabilities: mid term therapy, e.g. 40–80 sessions.

Severe problems – example chronic / farmacoresistent Epilepsy, Brain Injury, Cerebral Palsy, Mental Retardation: long term therapy, e.g. more than 100 sessions.

It is not possible to guarantee with 100 % certainty that training will be successful for really every particular condition. However, EEG assessments by an experienced expert allow reliable enough prognoses, e.g. 1, 2, 3 or more treatment units (blocks per 20 sessions).

Last but not least, the training is safe; there are no known adverse side effects of the training, provided that it is conducted under professional guidance.

WHY DOES THIS TRAINING PROCEDURE WORK?

The brain is amazingly adaptable, and capable of learning. It can also learn to improve its own performance, if only it is given cues about what to change. By making information available to the brain about how it is functioning, and asking it to make adjustments, it can do so. When the mature brain is doing a good job of regulating itself, and the person is alert and attentive, the brain waves (EEG) show a particular pattern. We challenge the person to maintain this “high-performance”, alert and attentive state. Gradually, the brain learns, just like it learns anything else. And like with other learning, the brain tends to retain the new skill.

We observe that if the EEG is not well behaved, there may be adverse impacts on learning ability, on moods, on sleep, and on behavior. With training, these may be brought under control along with normalization of EEG.

WHAT DOES A BIOFEEDBACK SESSION LOOK LIKE?

The therapist computer is usually positioned behind the client. This enables the therapist to monitor the client’s EEG at any time during the session without disturbing the biofeedback.

Sensors of a brain’s electrical activity are placed on the scalp using gel or paste (and/or some are attached to the earlobes, too). Most clients recline during training.

Each display contains six basic EEG frequency bands and actual data values. The top lines are color EEG spectrum and raw average EEG waves – the person’s entire EEG recorded from the scalp by the single active electrode. Six color windows below show activity in separate EEG frequency bands or rhythms – delta, theta, alpha, SMR, beta, and high beta2 bands. The client’s goal is to increase certain healthy EEG frequency bands – for instance frequencies of attention or self-regulation, while decreasing frequencies disturbing the healthy ones (e.g., too slow – theta or delta, or too fast – high beta).

The client’s EEG screen is placed a few feet in front of the client, usually transformed and presented in the form of a videogame. The client monitors their own EEG frequency band activity NOT as wavy lines on the therapist machine, but as elements of the game on the game screen. The client interacts with his/her EEG by playing the game for 45 minutes (the standard length of training sessions in Biofeedback Institute).

The boy in the left picture drives a 3D robot to pick up candies: continuous, uninterrupted tight attention is necessary for picking and keeping the candy, until the robot puts it in a cap. The ultimate reward of this game is candies collected during the session.

In the right picture, he plays, by directing his brainwaves, the video game “Formula”, where he drives a car along the midline at a proper speed. Frequency band activity is displayed in video game dynamic changes, and in scales at the bottom of the screen. As long as he keeps this up, he is rewarded in the game with visual and auditory stimuli (scores). During the 45 minute session, he gets thousands of feedback stimuli. Hundreds of times he may need to alter his brain activity in order to achieve a brain state which scores the most points. For every 300 milliseconds that his brainwaves stay in the desired state or “zone”, he scores another point, and a beep plays to announce it all. It is quite a dense, intensive learning process.

HOW FREQUENT SHOULD THE TRAINING SESSIONS BE?

In the initial stages of learning, the sessions should be regular and frequent, at two, three, or even more sessions per week. After learning begins to consolidate, the pace can be reduced.

IS BIOFEEDBACK COVERED BY INSURANCE?

It is different from country to country, between different insurance companies, between specific biofeedback modalities, between various medical or psychological conditions, the last even between conditions of company or individual insurance plans. Typical for contrasting approaches are neighboring countries with similar social and economy systems and languages: Germany covers biofeedback quite benevolently (under Behavior Therapy), in Netherlands ther is no coverage for psychotherapy of any kind. These opposites exist even between different states and insurance companies in the U.S. A detailed examination of approved insurance codes in the system given and of individual treatment plan is necessary.

MY DOCTOR TAKES A SCEPTICAL VIEW OF BIOFEEDBACK. WHAT CAN I TELL HER?

Your doctor may not know of this specific type of biofeedback. He or she will maintain a healthy skepticism about any new approach claiming numerous benefits. If your doctor is familiar with biofeedback in general, he may still be thinking in terms of the more common early experiments with alpha wave training, rather than with the training we are dealing with here. Ask your doctor to examine the research on the effectiveness of biofeedback in treating various disorders such as attention deficit disorder and epilepsy.

The following references are a place where he or she can start:

Linden M, Habib T, Radojevic V. A controlled study of the effect of EEG biofeedback on cognition and behavior of children with attention deficit disorder and learning disabilities. Biofeedback Self Regul 21(1), 35-49 (1996).
Lubar JO and Lubar JF (1984). Electroencephalographic Biofeedback of SMR and beta for treatment of attention deficit disorder in a clinical setting. Biofeedback and Self-Regulation, 9, pp. 1-23.
Rossiter TR & La Vaque TJ (1995). A comparison of EEG biofeedback and psychostimulants in treating Attention Deficit Hyperactivity Disorders. Journal of Neurotherapy, 1, 48-59.
Sterman MB, Macdonald, LR, Stone RK (1974). Biofeedback training of the sensorimotor EEG rhythm in man: Effects on epilepsy. Epilepsia, 15, 395-416.
Sterman MB The scientific basis of biofeedback treatment. In: The ADD Book, Sears, W. and Thompson, L., Little Brown Co., New York, 1998.
Sterman MB Sensorimotor EEG feedback training in the study and treatment of epilepsy. In: Neurobehavioral Treatment of Epilepsy, D.J. Mostofsky and Y. Loyning (Eds.), Erlbaum Publishers, 1993, pp. 1- 17.
Tansey MA (1991). Wechsler (WISC-R) changes following treatment of learning disabilities via EEG biofeedback training in a private practice setting. Australian Journal of Psychology, 43, 147-153.

HOW MUCH DOES THE TRAINING COST?

The cost of the training differs among offices depending on the health and social care systems, locations, the professional statuses of the professionals delivering the service, possible supplementary services offered and so on. Typically, individual sessions run from $50 to $125 in the U.S., c. 30 euro in the Czech Republic.