Neurotherapy

Iza Boesler, MDBetty Jarusiewicz, PhD

EEG Spectrum

732-801-4505E-mail: bjarus@comcast.net

Contents

• Background/Overview– What is

Neurofeedback/Neurotherapy/EEG Biofeedback

– How it Differs From Biofeedback– Types/Frequency Ranges/Uses/With

Other Therapies– Why NT and Brain Regulation Works – Research Basis (Thumbnail sketch)

Contents (cont’d)

Relationship to Genetics and EnvironmentImmune System

Important Current Research

- QEEGs - Loretta - HBOT

- Blood Flow Analysis

Background

• Other Names

– EEG Biofeedback

– Neurotherapy (NT)

– Neurotraining (NT)

• How it Differs from Biofeedback

Contents (cont’d)

• Delivery of NT – What it looks like– Places of delivery– Types of measurement

• Our Research - Various Efficacy trials - Use of new measurement equipment - School use

- Particular Protocols

Contents Cont’d

• Assistance to Families and/or Schools– Neurotherapy– Counseling during NT training– Group information sessions

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)GAMMA 35Hz+ Some evidence of association with

peak performance states

High Beta 18-35 Hz High correlation with anxiety, whendominant

Mid Beta 15-18 Hz Active, external attention

SMR Beta 12-15 Hz Relaxed, external attention

Alpha 8-12 Hz Very relaxed, passive attention

Theta 4-7 Hz Deeply relaxed, inwardly focused

Delta 0.5-3 Hz Sleep

Some Documented Uses of Neurofeedback

(See www.isnr.org for Comprehensive Bibliography)

• Beta/SMR– ADD/ADHD– Learning Disabilities– Sleep– Anxiety, Impulsivity- Depression- Epilepsy- Autism

• Alpha/Theta (after Beta/SMR)– Emotional and behavioral instability– Addiction(Note: NFB is approved by FDA for relaxation)

Integration with other Therapies/Approaches

• ADHD, Learning Disabilities, Autism, 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)

– Disregulated Brains• Jarusiewicz – initial control pilot study• Coben – use of supplemental devises

– Blood flow, QEEGs– Mirror Neurons

• San Diego Jaime P

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”

Disregulated vs Regulated Brain

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 Chartfor Electrode Placement

Brain Training SessionScreens

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 2-3 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- Speech/language

specialization- Processing- Focus

The right brain “Style”: Holistic

– 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

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)

Autism StudyAverage Behavior

Changes (ATEC) by Type

• Sociability 33%• Speech/language/communication

30%• Health 26%• Sensory/cognitive awareness 16% p <. 010 for sociability p < .000 for speech

p < .015 for health p <. 000 for sensory

Behavior Improvement Interview Results

Treatment Effectiveness Survey Results

• 1. Behavior Modification• 2. Speech Therapy• 3. Occupational Therapy

Sensory IntegrationNeurofeedback

*based on parents reports received to date, considering all types of therapies in their experience

What you can do for your child

• Be clear as to assessment of talents, skills, and issues to overcome (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