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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