1. HEALING THE BRAIN WITH NEUROFEEDBACK
Cindy Perlin, LCSW

2. Biofeedback
Uses sensitive electronic instruments to detect physiological changes with far greater sensitivity than a person can alone.
This information is used to teach the individual to control their physiology

3. Biofeedback Modalities
Muscle (EMG)
Temperature
Heart rate
Respiration
Skin Conductance (GSR)
Brainwave (Neurofeedback)

4. Neurofeedback
Training the electrical activity and timing of the brain to improve brain functioning

5. The first major neurofeedback study was done with cats by Dr
The first major neurofeedback study was done with cats by Dr. Barry Sterman …

6. Experimental Work of Barry Sterman, Ph.D.
Sterman trained cats to increase their SMR (12-15hz) through operant conditioning
Showed that cats could be trained to increase SMR
Published in Brain Research, 1967

7. Dr. Sterman’s Next Study
Studied seizure thresholds for cats’ exposure to rocket fuel.
Some of the cats did not have seizures at the known threshold levels.
Dr. Sterman checked his records and found the seizure resistant cats were the ones who had SMR training.

8. Sterman’s original 1967 Study for NASA - Cats exposed to rocket fuel
Avg 2 hours+ for seizures with EEG trained cats vs. 1 hour for untrained cats

9. Sterman’s Work With Humans
Dr. Sterman then decided to investigate whether neurofeedback would help humans with seizure disorders.
His studies showed a decrease in seizure severity and frequency with SMR training.
Patients with seizure disorders who also had ADHD showed an improvement in ADHD symptoms, which led to studies of neurofeedback with people with ADHD.

10. Characteristics of Brainwaves
Frequency (hertz)
Amplitude (microvolts)
Coherence (under or over-differentiation)
Location (10-20 System)

11. 10-20 system
The International System of Electrode Placement is the most widely used method to describe the location of scalp electrodes.
Each site has a letter (to identify the lobe) and a number or another letter to identify the hemisphere.   

12. 10-20 System

13. A disregulated brain often has too much slow activity.

14. This individual’s eyes are open. Their brain isn’t very alert and awake.

15. This brain is alert and awake
This brain is alert and awake. In EEG terms, smaller means more regulated, better functioning.

16. Delta .5-4 Hz Predominant in sleep Should be low while awake
One second
Predominant in sleep
Should be low while awake
High delta can interfere with emotional or cognitive processing

17. Theta 4-8 Hz Pre-sleep, trance Inattentive Distractible Lack of focus
One second
Pre-sleep, trance
Inattentive
Distractible
Lack of focus

18. Alpha 8-12 Hz Relaxed (parietal) Spacey Unmotivated
One second
Relaxed (parietal)
Spacey
Unmotivated
Inattentive and depressed

19. SMR 12-15 Hz Calm, external attention
One second
Calm, external attention
Regulates impulsivity and hyperactivity
Promotes body awareness
Helps control anxiety; anger
Movement Inhibition

20. Beta 15-20 Hz Active, external attention Enhances cognitive processing
One second
Active, external attention
Enhances cognitive processing
Improves concentration, attentiveness, focus

21. High Beta 22-36 Hz Body tension High state of arousal
One second
Body tension
High state of arousal
Excited / anxious / stressed

22. Protocol Selection Functional
Based on presenting symptoms and areas of the brain known to be related to these symptoms.
QEEG
Measurement of amplitudes, frequencies and coherence at 19 sites
Results compared to normative data bases
Sites 2 standard deviations or more from the mean are targeted for training.

23. Current Clinical Uses ADHD Seizure disorders
Alcoholism/substance abuse
Traumatic brain injury
PTSD
Anxiety
Depression
Chronic Fatigue Syndrome
Fibromyalgia
Chronic Pain
OCD
Tourette’s Syndrome
Sleep disorders
Autism
Asperger’s
Bipolar disorder
Reactive attachment disorder
Peak Performance
Age related memory loss
Parkinson’s
Migraines
PMS
Schizophrenia

24. Studies of Neurofeedback and ADHD
Several uncontrolled studies showed that neurofeedback:
Improved attentiveness and impulse control
Decreased hyperactivity
Raised intelligence scores
Improved academic performance
(Grein-Yatsenko et al., 2001; Lubar, Swartwood, Swartwood & O’Donnell, 1995; Thompson & Thompson, 1998)

25. Controlled studies comparing neurofeedback to other treatments for ADHD
Alhambra, Fowler and Alhambra (1995):
After 30 sessions of neurofeedback, 16 of 24 patients taking medications were able to lower their dose or discontinue medications totally
Monastra, Monastra and George (2002)
studied 100 children with ADHD receiving Ritalin, parent counseling and academic support. 50 children also received neurofeedback.
While all children improved on the TOVA and an ADD evaluation scale while taking Ritalin, only those who had EEG biofeedback sustained those improvements after discontinuing Ritalin.

26. Studies of Neurofeedback and ADHD (continued)
The most recent study, in China (Xiong, Shi and Xu, 2005):
60 ADHD children studied
40 sessions of neurofeedback
Over 90% significantly improved their scores on the IVA-CPT (Integrated Visual and Auditory Continuous Performance Test)

27. A Meta-Analysis of 19 Studies of EEG Biofeedback for Epilepsy (Sterman MB, 2000)
82% of studies demonstrated significant seizure reduction
Average reduction exceeded 50%
Studies reported reduction in seizure severity
About 5% of patients had complete control at one year follow-up

28. QEEG-guided Neurofeedback for Seizure Disorders
Johnathan Walker, MD “trains away” QEEG-identified abnormalities of power (amplitude) and coherence and reports a 100% success rate in patients with partial complex seizures
All patients became seizure free and many were able to stop their anticonvulsant treatment (Walker and Kozlowski, 2005)

29. Studies of Neurofeedback for Traumatic Brain Injury
Neurofeedback appears to improve memory in persons with brain injury (Thornton, 2000).
Neurofeedback improves attention and response accuracy of a performance task and decreases errors in a problem solving task (Tinius & Tinius, 2000).
Another study showed significant improvement in attention deficits in those receiving neurofeedback compared to a matched control group (Keller, 2001).

30. Studies of Neurofeedback for Autistic Spectrum Disorders
12 children receiving an average of 36 sessions of neurofeedback based on functional deficits reduced autistic symptoms by 26% (Jarusiewicz, 2002)
37 children receiving 20 sessions of QEEG-guided neurofeedback showed a 40% decrease in autistic symptoms compared to a control group (Coben and Padolsky, 2007)

31. Clinical Reports - Depression
Cory Hammond, Ph.D., Professor of Physical Medicine & Rehabilitation, University of Utah School of Medicine:
Treated 25 patients with moderate to severe depressive disorder
Reduced left frontal alpha and increased 12-20hz. Also utilized photic stimulation
Sustained remission of the depression in all 25 patients in sessions
All reduced or discontinued medication

32. Clinical Reports – Bipolar Disorder
Ed Hamlin, Ph.D., at the Pisgah Institute in Asheville, North Carolina:
Treated about 40 patients with bipolar disorder
Interhemispheric protocol, increasing or 13-16hz while inhibiting low frequency and high frequency brainwaves.
All of his patients have been able to significantly stabilize mood and improve functioning while decreasing or eliminating medication.

33. Case Report - ADHD
10 y.o. female with severe hyperactivity even though medicated with Ritalin
So hyperactive, it was doubtful at first she could do neurofeedback
90 sessions over about 50 weeks
Complete remission of hyperactivity with improved school performance w/o medication
Now age 16, retained improvements without medication

34. Case Report – Sleep Disorder
65 y.o. male with 50 year history of delayed sleep onset of 4-5 hours nightly, following month long coma at age 15 due to measles encephalitis
After 8 sessions of SMR neurofeedback, rapid sleep onset even in unfamiliar environments

35. Case Report – TBI
29 y.o. male, seen 12 years after TBI from auto accident, 3 months in coma
Premorbid severe ADHD
Active alcohol abuse at time of referral, with history of multiple DWI arrests
Problems with memory, concentration, word retrieval, coordination, tremor, headaches, balance and weakness on the left side of his body, as well as frequent temper outbursts

36. Case Report – TBI (continued)
Approximately 250 sessions in 3 years, with a 6 month break in treatment to attend a court mandated alcohol treatment program
1 session Thought Field Therapy for trauma
Significant improvement in all presenting symptoms, as reported by client and family members, including:
Over 4 years sobriety
Absence of temper outbursts
Improved memory and focus
Improved strength, balance and coordination
Willing to read aloud in public

37. Case Report – Bipolar Disorder
10 y.o. male, also diagnosed with intermittent explosive disorder
Multiple psychiatric hospitalizations, special school placement, almost daily explosive episodes
Medications: Lithobid and Abilify
60 sessions
Elimination of explosive episodes, improvement and stabilization of mood, while significantly reducing medication

38. Typical Neurofeedback Session
Twice a week sessions
20-45 minutes of feedback
Auditory and visual rewards when achieving thresholds
70%-90% reward frequency

39. Game provides client feedback
Mazes

40. Space Race

41. Frank H. Duffy, M.D., Professor and Pediatric Neurologist, Harvard Medical School, wrote about neurofeedback:
"In my opinion, if any medication had demonstrated such a wide spectrum of efficacy it would be universally accepted and widely used…It is a field to be taken seriously by all."
(Editorial, Clinical Electroencephalography, January 2000)

42. Time Magazine, 1/19/07
“For decades the prevailing dogma in neuroscience was that the adult human brain is essentially… hardwired, fixed in form and function so that by the time we reach adulthood we are pretty much stuck with what we have….The doctrine of the unchanging human brain has had profound ramifications. For one thing, it lowered expectations about the value of rehabilitation for adults who had suffered brain damage from a stroke or about the possibility of fixing the pathological wiring that underlies the psychiatric diseases….But research in the past few years has overthrown the dogma. In its place has come the realization that the adult brain retains impressive powers of ‘neuroplasticity’—the ability to change its structure and function in response to experience. The brain can be rewired.”

43. Resources: Web Sites
: International Society for Neurofeedback and Research. This site contains a comprehensive bibliography of outcome research in neurofeedback, organized by disorder, as well as journal articles, provider list and other information.
EEG Spectrum provides training, information, equipment and an affiliate network for information sharing, consultation and referral.
Association for Applied Psychophysiology and Biofeedback is the national biofeedback organization.

44. Resources – Books
A Symphony in the Brain by Jim Robbins, Atlantic Monthly Press, New York, 2000
Getting Rid of Ritalin by Robert W. Hill, Ph.D and Eduardo Castro, M.D., Hampton Roads Publishing Co., Charlottesville, VA, 2002
ADD: the 20 Hour Solution by Mark Steinberg, Ph.D. and Siegfried Othmer, Ph.D., Robert D. Reed Publishers, Brandon, OR, 2004

45. E-Mail: cperlin@nycap.rr.com
Contact Information
Cindy Perlin, L.C.S.W.
Phone: (518)

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