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Neurofeedback Betty Jarusiewicz, PhD, CADC Atlantic Counseling Center, Inc Atlantic Research Institute, Inc The Lighthouse Network, Inc Atlantic Highlands, NJ 732-872-8700 732-801-4505 E-mail: [email protected] www.autism-home.com Contents • Background/Overview – What is Neurofeedback/Neurotherapy/EEG Biofeedback/How it Differs From Biofeedback – Types/Frequency Ranges/Uses/With Other Therapies • Research Basis (Thumbnail sketch) • Why NT Works – Theory – Measurements Contents (cont’d) • Delivery of NT – What it looks like – Places of NT Delivery/Types of Measurement • • • • Clinicians Other Therapists Home Schools • Our Research – Autism Efficacy – School Pilot – General Experience Data Background • Other Names – EEG Biofeedback – Neurotherapy (NT) – Neurotraining (NT) • How it Differs from Biofeedback Background: What is Neurofeedback and What does it do? (Neuroregulation) • the process of operant conditioning which changes one’s state (stabilizes CNS) and improves behavior • using equipment that monitors and measures the electrical activity of the brain and TRAINS the brain to be more available to life’s requirements Background: Types of Neurofeedback • Beta/SMR – Eyes Open – Frequency Range 12-18 Hz • Alpha/Theta – Eyes Closed – Frequency Range 0-11 Hz Background - Terminology : Brainwave Frequencies (Brain States) 35Hz+ Some evidence of association with peak performance states High Beta 18-35 Hz High correlation with anxiety, when dominant Mid Beta 15-18 Hz Active, external attention SMR Beta 12-15 Hz Relaxed, external attention Alpha 8-12 Hz Theta 4-7 Hz Delta 0.5-3 Hz GAMMA Very relaxed, passive attention Deeply relaxed, inwardly focused Sleep Some Documented Uses of Neurofeedback (in addition to Autism Study) (See www.isnr.org for Comprehensive Bibliography) • Beta/SMR – – – – - Epilepsy ADD/ADHD Sleep Anxiety, Impulsivity Depression • Alpha/Theta (after Beta/SMR) – Emotional and behavioral instability – Addiction (Note: NFB is approved by FDA for relaxation) Integration with other Therapies/Approaches • Autism, Learning Disabilities, AD/HD, Epilepsy – – – – – Behavioral Therapies Speech Therapies Occupational Therapies Counseling Other (I.e. Assistive Learning) • Headaches (Migraines), Sleep, Anxiety, Impulsivity, Emotional and Behavioral Instability – Counseling – Medication • Addictions, Peak Performance – Counseling Research Basis • 1974: Sterman, MacDonald, & Stone – Noted: seizures reduced by 66% on 4 individuals – Used SMR combined with inhibition of excessive slow wave activity (6-9 Hz) • 1976 SMR: Lubar – Hyperactivity Effects noted: – subsided during training for epileptic seizure reduction – reduced even in absence of seizures – More effective than stimulant medication alone Research Basis (cont’d) • 1984: Lubar – SMR,with inhibits technique extended to attentional deficits and learning disabilities – Significant academic performance enhanced by use of Beta (12-15 Hz) • 1989: Penniston & Kulkowsky – – – – Addition of Alpha Theta Work Operant conditioning with eyes closed For use in meditation and mental imagery Useful for Addiction, PTSD, and Peak Performance work Research Basis (cont’d) • 1989 – Othmer – Initial work with Epilepsy – Development of Software/Hardware for Operant Conditioning Process – Development of EEG Spectrum Inc. – Expansion to other conditions, setting up protocols, training practitioners Research Basis (Cont’d) • To Date –Researchers per ISNR Bibliography) – Epilepsy: 37 – ADD/ADHD, Learning Disabilities, & AcademicCognitive Enhancement: 63 – Anxiety Disorders, PTSD, & Sleep Disorders: 33 – Depression Hemispheric Asymmetry, Anger & Pre Menstrual Syndrome: 21 – Addictive Disorders: 15 – Brain Injury, Stroke, Coma, Spasticity, & Cerebral Palsy: 22 Research Basis (Cont’d) • To Date –Researchers per ISNR Bibliography – Chronic Fatigue Syndrome, Fibromyalgia & Autoimmune Dysfunction 6 – Pain & Headache:11 – Schizophrenia: 3 – Obsessive Compulsive Disorder: 1 – Parkinson’s Dystonia: 1 – Tourettes Syndrome: 1 – Autism: 3 – Creativity & Optimal Functioning: 5 Research Basis (Cont’d) • To Date – Researchers per ISNR Bibliography – – – – – – – Cognitive Decline with Aging: 2 Hypertension: 1 Dissociative Disorders: 2 Tinnitus: 3 Criminality: 1 Adverse Reactions: 3 Theoretical-Conceptual, Standards, & Review Articles: 14 – General Articles on Slow Cortical Potential Neurofeedback: 10 – Hemoencephalography (HEG): 5 Why Neurofeedback Works (Operant Conditioning) – Brain can change with assistance directed by rewards: light, movement, and sound – Brain assists in finding best/better approach (New pathways? More dendrites?) – Brain will remain in new state as it “feels better” – Brain is continually used, maintaining “new skill” Base EEGs and States of Arousal With thanks to Harold Burke, Ph.D. Normal Adult EEG (line 1) with subgroups of frequencies (low = line 2, medium = line 3, and high = line 4) With thanks to EEG Spectrum International, Inc and Harold Burke, Ph.D. Female Age 7: Base EEG with Sub frequencies (Epileptic spikes/seizures and ADD) With thanks to EEG Spectrum International, Inc. and Harold Burke, Ph.D. Male Age 5: Base EEG with Sub frequencies (Delta activity, ADD and CD) With thanks to EEG Spectrum International, Inc. and Harold Burke, Ph.D. Male Age 8: Base EEG and Sub frequencies (High frequency activity, OCD) With thanks to EEG Spectrum International, Inc. and Harold Burke Ph.D. Example of Similar Exercise Model • Cardio respiratory Exercise – Stronger heart and improved regulation – Sleep improved – Mood improved – Lower basal metabolism With thanks to Harold Burke, Ph.D. In Summary, EEG Biofeedback: • Enhances the ability of an individual to access and maintain different states of physiological arousal and to navigate from high-vigilance to rest. (trains the brain to regulate itself better) • Hence, the treatment of disorders, such as ADHD, depression, and anxiety. With thanks to Harold Burke, Ph.D. Summary (cont.) • Enhances and supports the mechanisms by which the brain manages cortical hyper excitability and promotes stability. • Hence, stabilization against “minor” problems, such as temper tantrums, vertigo, tics, OCD, bipolar disorder, panic attacks, and PMS; and against even lesser disruptions, such as attention problems, sequential and parallel processing, and normal sleep. Summary (cont.) • Reinforces equilibrium states. • Hence, normalization of pain thresholds, appetite, and blood glucose levels. What about the Placebo Effect? • The effects of the training are highly specific to electrode placement and to training frequency band. • Training protocols exist which can commonly elicit effects opposite to those desired. • The effects of training with one protocol can be reversed with another. With thanks to Harold Burke, Ph.D. What Brain Training Sessions Look Like: Client “Hookup” Universal 10 20 Chart for Electrode Placement Brain Training Session Screens Therapist (EEG) Client (Game) Therapist’s Screen • Measurement of total EEG signal at the scalp with electrode or two • Amplification of microvolt-level signals for computer processing; • Extraction of low, medium, and high frequencies How is it done? (cont.) • Progress is monitored every session; • Initial sessions should be at a rate of 23 per week until progress is seen (probably by 20 sessions). Research study: B. Jarusiewicz Control by Right and Left Brain* The left brain “Style”: Analytic The right brain “Style”: Holistic - Speech/language specialization - Processing - Focus – Superior visuospatial performance – Emotions/tension – Anxiety And Left Brain/Right Brain 5th Ed 1998, Springer, S & Deutsch, G Brain Frequencies “Spectrals” (Note: Every person is different) Autistic * Typical * (note extensive delta, theta and alpha frequencies) Measurement of Change • By Client – Establish changes client wishes to make – Develop reporting mechanism Measurement of Change • By Therapist – Review behavior changes (checklists, drawings) – Review how client feels – Review brain activity (measured averages etc) – Review spectrals Child’s Family Drawing at Beginning of NF - 8/3/94 (with thanks to L. Hirshberg) Drawing after Twenty Sessions 9/8/94 Drawing after forty sessions 11/25/94 ATEC Checklist (www.ari/atec.com) Hill and Castro ADD/HD Checklist Measurement of Change • For Research – Use of “standard” tests (ADI, ADOS, Checklists, IQ, memory and reading) – Corroborative Evidence (videos, interviews, school or other therapy reporting tests) Pilot Study Plan • 24 Autistic Spectrum children chosen for pilot, 12 chosen to train, 12 as controls • Matched: age, gender, level of autism • All assessed with : Othmer Assessment, Rimland ATEC, Greenspan Video (15 min free play) Description of Individuals Trained • • • • Ages: 4.4-13.2 years, average 6.8 years Gender: 11 males, 1 female Autism Spectrum Level (per ATEC): 26-118.5, average 65 Types of Impairment (per ATEC) - Speech/Language/Communication Avg 13.7 (Range:6-25, ATEC max 28) - Sociability Avg 14.6 (Range:2-24, ATEC max 40) - Sensory/Cognitive Awareness (Range:10-21, ATEC max 36) - Health (Range:8-49, ATEC max 75) Avg 17.7 Avg 19.3 Other Information • Early onset: 2 • Late onset: 10 • Family Histories – ADD/ADHD –56% – Learning Disabilities/late speech – 56% – Addiction – 56% – Anxiety and/or Depression – 56% Numbers of Individuals Showing Types of Behavior Problems (as reported by parents) • • • • • • Anxiety Sleep Problems Vocalization Socialization Schoolwork Tantrums 9 4 11 12 9 4 Results of Study • Number of children completing study: 12 • Overall average reduction of autism level: 26 %, after average of 36 sessions • Compare with control group (no training): 3% change over 4.5 months Results per ATEC Assessments p < .000 for total change Average Behavior Changes (ATEC) by Type • • • • Sociability Speech/language/communication Health Sensory/cognitive awareness p <. 010 for sociability p < .015 for health p < .000 for speech p <. 000 for sensory 33% 30% 26% 16% Behavior Improvement Interview Results Treatment Effectiveness Survey Results • 1. Behavior Modification • 2. Speech Therapy • 3. Occupational Therapy Sensory Integration Neurofeedback *based on parents reports received to date, considering all types of therapies in their experience School Pilot • Type of School: private, autistic spectrum focus • 1 class – Teacher: maintaining regular tracking, only showing date of NFB start – NFB clinician: ATECs, Spectrals, Behavior notes, parent reports School Pilot Results to Date • After 10 sessions – Spectral Changes – Developed installation plans • Future School Possibilities – Integrate with other therapies – Include in planning IEP – Begin use with 1-2 behaviors • Collect data • Move to other behaviors/needs when ready – Include parents Typical Spectral At Beginning After 10 Sessions Protocol Research • Simple Placements – Electrode Placement variations – Frequency correlation to behaviors • Multiple Placements • QEEGs Comments • Clinic/School: Develop team to plan individual therapy approach for each child – Initial and periodic reviews by “managing” group/individual – Begin 1 therapy at a time to assess value – Develop decision tree approach as to conditions leading to initial uses of various therapies – Track results • Research – Longitudinal Studies – Therapy integration studies – Combined therapy approaches (Speech/NFB, Counseling/NFB, Behavior/NFB) – Impact of Inflammation and stress What you can do for your child • Be clear as to assessment of talents, skills, and issues to overcome(Autism – ATEC, Treatment Summary, Full assessment with history, and videos) • Determine a method of on-going measurement (per session, per time period) • Choose one new approach at a time • Measure, measure, measure What you can do for your child • Determine impact of and plan accordingly for – Family issues • Diet • Schedule/Rules – School issues • Placement • Simultaneous therapies – Social issues Questions References (send e-mail request to [email protected]) The End