Category Archives: Neurofeedback

ADHD and Neurofeedback

In the most recent edition of European Child and Adolescent Psychiatry, an international group of researchers published a meta-analysis of studies done on neurofeedback. It shows that the effects of neurofeedback training on youth with diagnoses of ADHD are sustained at least six months after training.  The authors found their results promising and called for more study of longer-term effects, as well as non-specific effects.  You can find this study here and an overview of the study here.

https://link.springer.com/article/10.1007/s00787-018-1121-4

https://www.brainclinics.com/meta-analysis-confirms-sustained-effects-of-neurofeedback-adhd

Although neurofeedback practitioners know anecdotally from contact with former clients that the benefits last years, there are few studies that look that far ahead.  One that did was conducted in Australia close to 15 years ago.  It found that children with a diagnosis of ADHD who received 40 sessions of neurofeedback not only did not lose the benefits of training a year later, they actually improved their focus.

Trying to Decide Whether Neurofeedback is for You?

The longest part of the journey is said to be the passing of the gate.”

Ancient Roman scholar Marcus Terentio

I like to research pretty much anything before I make a significant purchase. I dig up as much data as I can find, make a decision based on those facts, waver, then decide again and again.  Eventually, I make a final decision that usually makes me happy.  My process of constantly revisiting data points drives my husband a little batty, but I happen to enjoy it.

The truth, though, is that after finding all the pros and cons for each option I’m seriously considering, I set aside the facts and choose the one that feels right to me—the option that makes me feel good about my choice. The data I gather inform my decision, but they don’t make it for me. It’s really a gut and intuition thing in the end.  And when I don’t do this, I’m often quite sorry about the choice I’ve made.

I suspect that although most people probably don’t savor the decision-making process itself like I do, most end up taking a leap of faith in the end that they’re making the right choice for them and their situation. If one doesn’t trust her gut, making a choice can be overwhelming.  If money is involved in the decision-making process, choosing to move forward with a decision can be downright daunting.  Questions arise about whether the expenditure of funds make sense for the family, whether you’ll get your money’s worth, whether you’ll be satisfied in the end, etc.

Choosing to spend on a tool like neurofeedback is harder still. It’s one thing to invest in something like a new pair of shoes and trusting that they’ll feel comfortable and serve you well when you get them home and another thing altogether to invest money in something that you’re not even certain you know what it is, let alone that it will help whatever it is you’re hoping it will help.

Making things more complicated is all the noise out there about who is and who is not a good brain trainer. No amount of advanced degrees or certifications matters if that person doesn’t serve YOU well or isn’t really as competent at providing a service as they are at marketing themselves as the very best.

So, what do you do? Gather more data?  Read a few more books?

My opinion is that you step beyond online searches and journal articles and books to find your comfort level. Reach out and interview a practitioner. If that person feels like a good fit and in your gut you have a sense of trust, then you’re probably going to be in good hands, even if you still feel nervous about trying something that, due to the cost and investment of time to work has still not become as wildly popular as I personally think it should be.  (Obviously, if you don’t have a good feeling about a person or clinic’s competence, caring, or ethics, step away.)

People who are considering neurofeedback can reach out to me and schedule a free consultation with no pressure. I do this because I think fitting well with someone is as important as competence with the technology.

I also think environment is important, and I want potential trainees to feel the environment I’ve created for them. If you step into my waiting room, my hope is that you will not feel like you’ve stepped into a medical office.  I have comfy upholstered chairs, an antique table, and a bookcase full of titles you’re welcome to pull down and browse.  I have water and tea available to enjoy, too.

My training space is, I hope, similarly inviting. I try to keep the space as calm and non-clinical as possible for a tool that involves things like EEG devices and electrodes and whatnot. You’ll find even more comfortable chairs, scenes of nature on the wall, and natural elements like rocks and fossils and seashells for those who need fidget items to hold.

As a result, if you’re expecting white lab coats, linoleum floors, and stainless steel trays, I may not be the right fit for you. If you’re looking for competence combined with deep caring and a soothing environment intended to promote relaxation for training, I’m probably an excellent fit. And, perhaps surprisingly for a high-technology solution like neurofeedback, the softer quality of fit really does matter.

Timing Neurofeedback Training

One of the most frequent questions I’m asked is how often and for how long one must do neurofeedback training to see results that stick. The answer, “it depends,” can be frustrating, so let me share the range possibilities, because I customize work for each client.

Consistency Over Time is the Key

The number and frequency of sessions can change depending upon individual goals and timeframes, but if you want to see results and have them last, it’s necessary to do regular training over time. I like to compare exercising the body to exercising the brain, in that you wouldn’t expect exercising once a week, then skipping a few weeks before going back, to result in greater fitness.  It’s the same with neurofeedback.  To see results, it’s important to come consistently, with no more than a week in between sessions.

The typical person who does brain training comes for sessions twice a week for about five months, then tapers off to once a week and then once every other week before stopping somewhere around the 40-session mark. That said, many want to see results quickly or get as much training in as possible over as short a time as possible.  During spring and summer break from school, for example, many students will come in three or four times a week rather than the usual twice.  They still need the same overall amount of sessions, but condensing the timeframe opens them up to move on and do other things.

It is okay, though, to train more frequently, even every day, if you want to get training over with quickly. For someone that determined, all it takes is commitment to come five days a week. I once had a client who was leaving the area and had a hard deadline for squeezing in as much training as possible.  We did 90-minute sessions (rather than the usual 60 minutes) twice a day for a few weeks and got good results.  It was quite tiring for the trainee, and this extreme commitment to training isn’t for everyone, but it helps show how neurofeedback can be adapted to meet one’s schedule and needs.

The opposite—a little training, spaced out broadly, is not recommended, but it can be done if the trainee is truly dedicated. About a dozen years ago, I studied under a clinical psychologist who had a client that lived several hours away, in an area with no neurofeedback practitioners.  The parents brought the boy consistently, every other week for five years.  Five years!  It took that long to achieve results that lasted, but because the training was never missed, it eventually worked.  This family was highly motivated in ways that most of us are not, so you will find that most practitioners highly frown on such a practice. I personally will not work with anyone less than once a week, and I only agree to do once a week training under special circumstances, simply because it stretches out the process too long.

The other variable in training is the overall number of sessions needed. Most people need about 40 sessions, but I’ve done as few as 20 for people whose brains are already in good shape.  For others, especially those who are older and have more entrenched patterns, as many as 60-70 sessions might be in order.  Then, there are those with really stuck brains, and they may need upward of 100 sessions.  Knowing this can be upsetting, but the reality is that most people can achieve their goals in just a few months.

The bottom line is that neurofeedback training can be customized to meet your needs, as long as you are willing to make the commitment to do the work that will improve your quality of life.

 

Seven Signs You’re a Good Candidate for Neurofeedback

People often ask me whether they are a good candidate for neurofeedback. Brain training is not a medical treatment, so it’s not like filtering out whether you’re a good candidate for something like Lasik, for example.  Instead, it’s more a matter of attitude.  If you’re thinking about  trying brain training, consider these seven signs that it might work well for you.

1. You can attend consistently over time. Training the brain is akin to training the rest of the body in that you can’t just go every now and then and expect results. If you’re willing to come to regular appointments, neurofeedback is likely to work well for you. Conversely, I’ve had to turn away people whose travel schedules meant that they couldn’t attend regularly.  For them, it’s a waste of time and money.

2. You’re willing to provide feedback. Neurofeedback is not about a practitioner waving a magic wand. Rather, it’s about trainer and trainee working together to achieve a mutual goal. For this to happen, people who do brain training must be willing to provide feedback to the person managing their training.

3. Your thyroid is under control. Neurofeedback “sticks” the way learning any new skill sticks in the brain. Some things, however, impede this process, and unregulated thyroid disorders top the list. If you want to do neurofeedback and know your thyroid is wonky, it’s preferable to start working with a physician first to be sure that your thyroid is under control.

4. You are ready to let go of any addictions to drugs or alcohol. Neurofeedback is a gentle teaching tool and can be undone by leaving a session and going home to get high. Talk to a practitioner about your drug or alcohol usage and how it might affect training sessions.

5. You are taking other steps to improve your health. Some of my clients with the best outcomes have been those who most of the other things they need to do to take care of themselves: they try to create good sleep habits, improve their nutrition, see their physician if needed, get counseling if needed, and do other bodywork in the form of acupuncture, chiropractic care, massage, or cranial sacral work, if needed.  This doesn’t mean you need to be perfect in every way; it simply means you must be open to the idea that neurofeedback does not occur in a vacuum.

6. You follow your doctor’s instructions. Those who consult with and follow their treating physician’s advice tend to have better outcomes because their overall health improves.

7. You are fed up with the status quo and are ready for change. The number of people who are not really ready for change but give lip service to the idea of feeling different is surprising. I’m never quite sure whether it’s fear of the unknown or fear of spending time and money on something they know little about and so are skeptical, but most of my former clients will tell you that taking that leap of faith was worth it.  If you are ready to optimize your functioning in life and are prepared for changes, then neurofeedback may be right for you.

That’s really all there is to it. If you are interested in learning about how neurofeedback works, give me a call.

 

 

Side Effects of Neurofeedback

About once a year or so, I encounter someone who is afraid of neurofeedback and asks about the harm it can do. It feels like now is a good time to address this issue once again.

Neurofeedback is a form of biofeedback for the brain, which means that individuals have the metaphoric equivalent of a mirror held up to the brain and then receive rewards in the form of audio tones, making a movie go, or advancing in simple video games. It’s non-invasive, and many think of it as a teaching tool for a part of the body we don’t normally think we can control.  Given that it is such a gentle tool, it should come as no surprise that:

There are no scientific studies published in any peer-reviewed journals which indicate that a full training regimen of neurofeedback (25-60 sessions, depending upon the person) causes any lasting harm. None. 

This fact often isn’t enough to convince people, especially those who’ve read some of the wilder opinion pieces available from so-called authorities on the Internet, so they press for more details. Except, there really aren’t more details.  In the hands of a competent and attentive practitioner, the worst outcome is nothing changing.  This generally happens as a result of medications or conditions beyond the scope of neurofeedback.  It may also come from a practitioner using a one-size-fits-all approach to training rather than customizing training to individual needs.  Nothing changing is a frustrating waste of time and money, but it is not a physical harm.

The vast majority of the time, the opposite happens, and brain training feels good. Indeed, most of the so-called “side effects” of training please the people doing training.  Quite often, for example, people who train with me experience improved sleep, most likely because their bodies are relaxing for the first time in ages.  I’ve also had people experience side effects such as improving academic performance, learning to read music far more quickly than expected, and having aversions fade away.  My theory as to why this happens is that neurofeedback is not a tool that precisely targets specific pathways in the brain.  Instead, it trains pools of neurons within a couple of centimeters of each other.  This means that something as simple as training to relax results in the effects of relaxation in more than one aspect of life.

All this said, in the hands of incompetent or inattentive practitioners, there can be short-term troubles. I have heard stories of practitioners and technicians who have trained the wrong things during sessions and caused increased anxiety and/or panic attacks.  Even then, these are transitory—lasting less than a day—unless a person continues training the wrong thing for long enough that it becomes an ingrained pattern.  It’s hard to imagine a trainee tolerating that kind of negligence.

Occasionally, some individuals feel tired after sessions. This sense of fatigue most likely comes because the brain isn’t used to what the exercises are rewarding it for doing, and it almost always passes 10-15 minutes after the end of a session.  It is not practitioner error or a harm any more than tired muscles after a workout at the gym are a sign of harm.

The Real Question of Safety

The bottom line is that even though I have responded in this post directly to the question of harm, this generally isn’t really the question people want answered. The actual question which lies underneath this concern of harm is, “How do I know I can trust you with MY concern or with MY loved one?”

My response is that I do neurofeedback because I have passion for it as a tool. I’ve been using it for a long time, and I work on learning still more so that I am continually improving.  I have spent my entire professional career focused on appropriate service to others, and I promise to you that if you take the leap of faith to work with me, you will experience the caring that underlies my commitment to brain training.

Why Haven’t I Heard About Neurofeedback?

Usually, I can tell when someone wants to ask me why they haven’t heard of neurofeedback before or why, although they have heard of it, they haven’t heard more. People get a funny look on their faces, as if trying to find the right way to ask the question without sounding accusatory or rude.  After all, the question makes it sound a bit like they suspect some kind of snake oil promotion is afoot.

Obviously, I cannot answer why any one individual does not know more about neurofeedback, but I understand the point behind the question. Neurofeedback has been around since the late 1960s, and it works, so why isn’t it the most popular tool in town?  Those of us who use neurofeedback discuss this from time to time, and these are some of the answers we have for ourselves, in no particular order.

It’s a Tool, Not a Field. Most people have heard of occupations like chiropractor, acupuncturist, psychologist, or teacher.  Occupations usually have some professional, guild-like organizations behind them that promote interest in the field and increase awareness.  Neurofeedback, however, is not an occupation, it’s a tool.  And, the people who use neurofeedback span many occupational categories, including tutors, coaches, occupational/physical therapists, chiropractors, spiritual guides, doctors, mental health care providers, and enthusiasts with no related occupation at all.  The result of this broad usage means that because neurofeedback doesn’t belong to any one field, it doesn’t have any one champion.  Most people end up hearing about neurofeedback from a friend who’s had a good experience.

Infighting. Sadly, a subset of neurofeedback practitioners fight among themselves over who “owns” the right to use and practice neurofeedback.  Some, especially in the mental health care professions, even go after each other legally, accusing each other of practicing medicine or psychology without a license and dragging various professional licensing boards unwittingly into the fray.  It’s unseemly, ego- and money-driven, and this sort of infighting does nothing to improve the image of those who use neurofeedback.  It also does the opposite of what these people are hoping to achieve, undermining instead of improving the reputation of the tool.

Research. Neurofeedback is a gentle teaching tool for the brain, but many skeptics treat it like it’s a pharmaceutical and argue that because there aren’t “enough” double-blind, placebo-controlled studies, it must not be a valid tool.  One of the problems researchers run into when trying to create this gold standard type of study, though, is that many trainees can tell when their neurofeedback is sham training, so an approach more like doctors use with surgical techniques is probably more useful.  Moreover, when someone is trying to use neurofeedback for mental health reasons, they often run into the problem that the brain does not subscribe to the committee-created diagnoses contained within the Diagnostic and Statistical Manual of Mental Disorders (DSM-V).  So, researchers who are studying people with, say, depression, may not be looking at study participants with similar-looking brainwave patterns at all.

All that said, there are many well-done studies on neurofeedback showing that it works for people. The bigger problem is not the issue of how to design double-blind studies, it’s determining what is “enough.”  Someone who has a bias against neurofeedback will never accept its validity no matter how many studies get published in peer-reviewed journals, and someone who is gullible may not care even to ask the question.  Add this to what appears to be a concerted effort from the pharmaceutical industry to undermine the reputation of neurofeedback, and it is enough to keep some people dubious about whether neurofeedback works.

It Does Too Much.  In theory, neurofeedback can affect anything the autonomic nervous system covers.  In reality, neurofeedback’s impact is less than that, though still quite broad.  Researchers have shown that it works on a wide variety of training goals, and practitioners around the country use it for a long list of goals:  migraines; traumatic brain injuries including stroke and concussion; seizures/epilepsy; mental health diagnoses such as ADHD, anxiety, depression, and bipolar disorder, among others; personal performance improvement, especially with educational/school goals, sports, and musical performance; spiritual development; personal growth and awareness; serenity and calm; and still others that I may not even have heard of yet.  With so many potential uses and applications, it’s no wonder that the field ends up spread thin and not well known.

People Want Privacy. Some people like to share broadly about their experiences with neurofeedback (I’d have no practice if this weren’t the case.), but many others like to keep their training to themselves, almost as if it’s a secret weapon.  Neurofeedback is popular among professional and elite amateur athletes, and sometimes, you’ll hear about them in the media, as with the Canadian Olympic team prior to the Vancouver Olympic games.  More often, though, athletes seek confidentiality.  This means that, although it’s being used effectively, the public never knows that neurofeedback helped someone.

Technological Improvements. In the early days of neurofeedback, the equipment was large and expensive, meaning that very few had the means to use or apply neurofeedback tools.  Even though it existed as a tool, it was only for people with the passion and money to make it happen.

The advent of personal computers and, especially, the development and rise of laptop computing meant that the speed of everyday computers was enough to provide the brain with fast enough feedback. Plus, the cost of purchasing laptops and the gear required to do neurofeedback has fallen over the past 15 years, making it affordable for more and more people.  I suspect that as the technology improves, a greatly expanded number of people will know about and be able to apply neurofeedback in their lives.

Despite improvements in technology and decreasing costs, we’re still hamstrung to a large degree in bringing this into private homes. Professionals now find it affordable if they shop well, but the technology is costly enough that only people with powerful motivation are investing in and learning to do neurofeedback on their own.  And, despite burgeoning efforts to make free apps for anyone to use some aspects of neurofeedback/brain training, they are no match at all to seeing a professional practitioner.  However, even toy and game makers are interested in how to bring neurofeedback profitably to the masses, and if they succeed, the field of personal growth and development will expand dramatically.

The bottom line is not to let the absence of major, positive media coverage of neurofeedback stop you from considering whether to use neurofeedback on yourself or a loved one. If you do your homework, you’ll find that neurofeedback is safe, effective, and powerful—so powerful that it’s used for dozens of reasons by people from all walks of life—and the future looks bright.

Rewards in Neurofeedback Training

Neurofeedback is a rewards-based system. The idea of rewarding the brain for making changes in the direction a person wants it to go can be a tough concept to grasp, but in practice, it’s pretty simple.

Our brains are designed to detect novelty in our environment. It’s a primitive survival mechanism, because we humans need to notices changes in the world that might endanger our lives—think of noticing the movement of a venomous snake or the driver who suddenly decides to cross four lanes of traffic to make a turn.  It’s a part of our daily lives, and when it comes to noticing sound, I like to use the example of an ambulance siren.  There is a fire station not too far from my office, and emergency vehicles drive down the street in front of my building every day.  If I’m with a client, they continue to pay attention to our conversation or work, but a part of them notices the siren with an internal monologue that goes something along the lines of “Hey, what’s that?  Oh, I bet it’s an ambulance.  I wonder if there was a car accident?  I hope everyone’s okay.”

Neurofeedback is a bit like the ambulance siren. We believe that the brain notices the reward tones that the computer sends the same way it notices the siren:  as a novel change in the environment.

At the same time, we believe neurofeedback works much like the process of teaching a dog to sit. A puppy receives a reward in the form of a bit of tasty food every time its hind quarters go anywhere remotely in the right direction of a sitting position.  Eventually, the dog doesn’t need the treat to be able to associate the command with sitting.  Similarly, the brain gets the reward of novelty any time the sophisticated computer software determines that the brain is going anywhere remotely in the right direction of the electrical energy pattern the trainee hopes to achieve.  Like the puppy, eventually the person doing brain training no longer needs the tones as a reward for going the right direction, and the brain can use that new pattern when appropriate.

I use the expression “we believe” because neuroscience researchers have not yet proven the theory that neurofeedback is education for the brain, but in real life, the explanation seems to fit: a person comes for training with goals to achieve, the computer rewards the brain for learning the pattern associated with the goal, and the brain eventually can do it on its own without rewards.  It’s exciting every time I watch this pattern unfold, because it means that people are using technology to regulate their bodies by teaching themselves, all in a non-invasive and generally pleasurable way.

Don’t Play Name That Tune

Name That Tune was a television game show from the 1950s in which contestants competed to see who could identify pieces of music in the shortest time possible. A catchphrase from the show was “I can name that tune in X notes,” and the best among them would attempt to name a song in just three or four notes.

Sometimes, it feels like some neurofeedback practitioners are engaged in their own version of Name That Tune, only instead of playing with songs, they claim they can Cure That Disorder in X sessions. The result of this rather absurd game is that some people start to believe that neurofeedback normally only takes as few as, say, six sessions.  Another reaction is that people who hear these stories begin to think that the field of neurofeedback is full of snake oil salesmen who peddle in false promises.

Neither is true. What may occur during a controlled experiment may, indeed, be faster than what happens in the real world, but the truth is that for most of us who live outside the research world, making significant and long-lasting changes to our bodies takes time and doesn’t involve curing anything.  And, despite sometimes too-good-to-be-true claims, most neurofeedback practitioners who do not engage in invasive techniques agree that anywhere between 20 and 60 sessions is a reasonable number.

The goal for most of us is not to play Name That Tune and go with the least number of sessions possible. Taking that path is likely to result in disappointment. It is far better to find a practitioner who can come close to finding the sweet spot that lies between doing too few sessions, which can result in backsliding, and too many sessions, which is just a waste of time and money.  It takes an experienced and intuitive practitioner to find that balance, but it can be done.

Timing Your Training

Now that we’re getting close to the end of the school year, I anticipate receiving the calls I usually get in late spring from parents who are planning ahead and trying to squeeze in neurofeedback training for their student over the summer, before school starts again in the fall. This makes it a good time to explain the timing of how I practice neurofeedback.

The usual format is twice weekly training sessions that start with whatever number of minutes the trainee can tolerate and work up to an hour-long session that includes about 40 minutes of brain training. This is because with once a week sessions, it often takes too long to start seeing results, and with more sessions, it gets difficult to schedule them into busy lives.  For those who I think would benefit from jump-starting their success and who can manage it, I suggest three sessions a week for the first several weeks, then scale back into twice weekly sessions.  Regardless of how the training regime is customized, however, a regular training program includes days that are not back-to-back, so that the results of training can be spread out better.

Some people don’t like this evenly spaced program and want a more intense training program.  Fortunately, it IS possible to accelerate results if one is in a hurry or has a deadline to meet.  For example, I have on more than one occasion conducted 90-minute training sessions twice a day, five days in a row, for two or three weeks.  I also know trainers who have had people fly in from out-of-state to conduct accelerated training programs like this—generally because no trainers are available in their geographic area.  Condensed training programs are often quite tiring for the trainee, and it requires clearing one’s schedule to the point of perhaps taking a vacation from work to do training, but it has been effective in my experience and satisfying for the person who needs to get it done asap.

The flip side of this is the person who is seeking to do fewer sessions than the norm. Often, this is someone who has read claims online that a full course of neurofeedback can be conducted in six or eight sessions and is therefore suspicious of anyone who conducts more sessions.  I will not agree to work with someone fewer than 20 sessions. This is because although I have in the past had trainees who achieved their results and had them stick in as few as 25 sessions, their rapid success has not been the norm.  Often, someone who achieves results rapidly is someone who is integrating multiple self-improvement or healing modalities at once.   The last person who finished in 25 sessions was someone who was simultaneously switching to a clean eating diet and receiving both acupuncture and chiropractic care at the same time as doing neurofeedback.  It was a lot of work for that person, but in the end it was a cost saving and speedy way to get to a point of living better and feeling better.  Such individuals are my favorite clients, but they are uncommon.

If you’re interested in getting started with neurofeedback, give me a call, and we can discuss what timing works best for you and your situation.

Neurofeedback and Cancer

Science Daily shared a University of Texas study showing that neurofeedback helped reduce neuropathy in chemotherapy-induced neuropathy.  I’ve seen neurofeedback increase brainwave coherence, thereby reducing brain fog or “chemo brain,” but this is a new and exciting development.  Read a summary of the study at:

https://www.sciencedaily.com/releases/2017/03/170303102858.htm

“A type of functional brain training known as neurofeedback shows promise in reducing symptoms of chemotherapy-induced nerve damage, or neuropathy, in cancer survivors, according to a study by researchers at The University of Texas MD Anderson Cancer Center. The pilot study, published in the journal Cancer, is the largest, to date, to determine the benefits of neurofeedback in cancer survivors.”