Neurofeedback is a training procedure that teaches you, the client,
self-regulation specific to the brain to improve it's function
Neurofeedback Is . . .
The amazing brain is made up of many different systems, one of which is bioelectrical. This is a biological system of electricity. The bioelectrical profile is the composition of thought, and the context in which thinking occurs including chemical composition, metabolic state, hormonal state and the physiological connection to the body. It is with this system that the brain communicates with the use of neurotransmitters and the various brainwaves that help us think, move, sleep, work and so forth. We are not aware, most of the time, that our brain has an electrical system. However, the brain can and does become disregulated, often resulting in ADHD and other learning disabilities, depression, seizures, etc. Neurofeedback is a way to overcome these and other problems of the brain.
The feedback the brain receives is just that - feedback. While in a neurofeedback session, the client is hooked up to the computer and sends the brain's electrical information to it. The computer displays this information and sends reward messages. Since it favors reward over non-reward, the brain will respond on a very basic level to the positive feedback. For example, if it is suggested that there should be more beta waves, the brain will make a concerted effort to add more. Ultimately this will change the impaired bioelectrical profile to a more functional one.
For example, people who suffer with ADHD symptoms will often have an over-abundance of theta frequency wave in the frontal part of the brain. Since this wave is associated with falling asleep and awakening, and is considered a fuzzy state, having too much theta in the front part of the brain, where we do most of our thinking, causes loss in focus. If the feedback suggests that this part of the brain decrease theta frequency waves, the brain responds positively and the person's electrical profile will be expressed with less theta, making it easier for the person to attain more focus.
A Typical Neurofeedback Session
A neurofeedback session includes the client sitting in a comfortable chair in a quiet room. He or she will have 2,3 or 4 electrodes placed on the part of the scalp from where the electrical information will be received. The computer screen and audio speakers will allow the client to see and hear what is happening in their bioelectrical system.
When the brain's electrical system is performing optimally, the computer will feed sound and visual approval; the brain responds on a very basic level. After a number of sessions, the brain learns how to attain this newly-trained state and it can be achieved when you need it to be. Subtle to dramatic changes occur with this new ability. Many forms of visual and auditory feedback are available and it's up to your clinician to program the one that makes it easiest for you to achieve learning. At Marin Biofeedback, we include a second form of reward for children by counting points that are later exchanged for rewards that are decided by the child and parents (or caregivers).
Remote neurofeedback training is the rental of a neurofeedback system that you use in conjunction with software readily available online. This affords you the luxury to do your training at your home, hospital or office when traveling to Marin Biofeedback is not easy. We work with you during your session via the internet (currently we use GoToMeeting). You will be taught how to apply the sensors and Dr. Kerson will perform the session remotely as if you were in her office. Then you will only need to come to Marin Biofeedback every 6 weeks.
Other forms of home training include audio visual entrainment (AVE) or cranial electrical stimulation (CES) with devices that are readily available online. You can simply use one of these devices or use them as an augment to your twice weekly neurofeedback sessions. You can purchase these and Dr. Kerson will assist in programing them so they work best for you.
The Brain's Electrical Profile
There are four different wave ranges within the brain's electrical continuum. They are delta, theta, alpha and beta. The waves start at .5 Hz and continue to 40 Hz. A Hz is the amount of times a wave is repeated within a second. For example, a 1 Hz wave means there is only one wave in one second, while a 20 Hz wave means there are 20 in a second. Therefore, a delta wave, which is .5 to 3.5 Hz is much slower than a beta wave that is between 12.5 and 40 Hz.
The electrical profile of the brain varies. It changes under different demands and during different tasks. For example, alpha waves are more dominant when the eyes are closed. Additionally, different parts of the brain function better when functioning with different electrical patterns.
A common brain wave profile is alpha and theta dominance while meditating, especially in the parietal area (below). Obsessive thoughts tend to include a dominance of very high beta waves in the frontal area. Fuzzy or confused thinking is just the opposite - too much theta and alpha frontally.
A common protocol is the SMR training. With this training, we are encouraging a frequency pattern between 12 and 15 Hz in the central area. When this electrical profile is optimized, it sets the brain up to communicate to the body's motor systems to calm down. This training was designed by Dr. Barry Sterman when researching seizure patterns with feral cats in the early 80's.
Delta: The delta waves are predominant in the sleep state, especially during stages 3 and 4 sleep. They range from .5 to 3.5 Hz. We don't usually train in the delta frequency range, unless it's very clear that the training is needed.
Theta: This range is associated with hypnogogic states such as falling asleep and awakening. It is commonly associated with creativity and meditation. When uptraining theta, it is almost always involving these issues. When training to reduce theta, it is commonly to reduce fuzzy thinking and attention issues. It is the frequency between 3.5 and 7.5.
Alpha: Alpha waves are considered the frequency range that enables one to be calm but alert. Depending upon where they are in the brain, however, they can also be associated with anxiety. Training an increase in alpha waves usually involves emotional and affective issues as well as well being and meditation enhancement. When training to reduce alpha, it is often because there is an overabundance of it causing anxiety and unclear thoughts. It is the range between 7.5 and 12.5.
SMR: SMR is described above. It is the range between 12 and 15.
Beta: There is a wide range of behaviors that are associated with beta waves, from attentive and problem solving to mind chatter to hysterical. Beta uptraining can help with attention, depression, sleep, executive processing and memory issues. When downtraining beta, it is usually due to "chatter minds" and for meditation enhancement. It is the range between 12 and 40 Hz.
(Very | Extremely | Rediculously Simple) Basic Brain Anatomy
The brain is made up of these four different cortical (or surface) lobes and the central strip.
Frontal: The frontal part of the brain is where we do our thinking. It is where we problem solve, cognize, socialize and process thought. Speech production, motivation and impulse control are mediated here as well. The area at the back of the frontal lobe is known as the motor cortex and is responsible for voluntary motor movement. This is where the SMR protocol is sited (see above). The frontal lobe is located behind the forehead to the middle of the top of the head.
Parietal: The foremost part of this lobe is important for bodily sensations of touch and kinesthetics, along with the integration of sensory input. It is known as the somatosensory cortex. The area behind the somatosensory cortex is responsible for spatial orientation, sense of direction and sense of touch. It is at the back of the head, above the occipital lobe (see below).
Occipital: The occipital area is the site where the optical nerves meld into the brain's cortex and is responsible for reorganizing the visual input so that it can be translated. This lobe is located at the lower portion of the back of the head.
Temporal: The temporal lobes are responsible for hearing. They also are implicated in memory and emotionality. They are the closest to the limbic areas of the brain, where emotions and memory are mediated. They are located just above the ear on each side of the head.
Central Strip: The central strip is a band that spreads from ear to ear and is indicated in brain-to-body communication, specifically involving volunteer motor control.
The alpha/theta training involves placing sensors on the parietal area or upper back part of the scalp, and with eyes closed, the client listens to a reward for the alpha and theta frequencies. These frequencies are best known for their relaxation and creative qualities. Studies show alpha/theta training results in significant increases in warmth, abstract-thinking, stability, conscientiousness, boldness, imaginativeness, and self-control. It is common to use this protocol for addition disorders, anxiety, meditation enhancement and stress reduction.
Beta Enhancement Training
Beta enhancement training is the enhancement of brain wave in the beta frequency range (12 Hz and up). It is commonly trained in the frontal areas for issues with attention. It's also used with certain types of headaches, learning disabilities, sleep disorders, memory issues and depression.
Correlation training is indicated with people who, through the brain map, show areas that either are hypercoherent or hypocoherent. This means that parts of the brain are too communicative (locked) or not communicative enough. The sites that are trained are very specific to the client. There are some markers and patterns that are common with people who are obsessive, have rage issues and who have memory problems.
SMR training is the uptraining of specific wave patterns in the sensory motor strip, located in the central part of the brain. This part of the brain is responsible for communicating to the muscular and skeletal systems. When the SMR brain wave patterns are not optimally proportional to the other brain waves in this area, the communication between the brain and the motor systems of the body becomes skewed. This exacerbates the chronic dysfunction of the muscle group that is in pain. SMR training can also aid in sleeping and creates a calming state. It is indicated for chronic fatigue and Fibromyalgia, TMD and bruxism, ADHD, anxiety, repetitive strain injuries, and Carpal Tunnel Syndrome.
Is neurofeedback reimbursable by health insurance?
More and more insurance companies are recognizing neurofeedback as a viable remedy for many brain function problems. Some companies require a prescription from your primary care-giver, some don't. We recommend you call your provider and ask them what they need in order for you to be reimbursed. The CPT code for biofeedback (including neurofeedback) is 90901.
How many sessions will it take?
This is a hard question to answer because people come in for many different health problems. At Marin Biofeedback, we recommend a 30 session program. Some people complete the program sooner, and some may take longer. This includes two 45 minute sessions per week.
What is the time required per week for neurofeedback to work?
Neurofeedback is a different process for each person. Some people prefer to allow the neurofeedback to take place without a lot of extra work; while others prefer to combine what they are learning at Marin Biofeedback with other parts of their daily life and augment the training with at-home training.
How do I get started?
Call Marin Biofeedback (415) 485-1342 and set up an appointment for a psychophysiological stress profile or QEEG. This takes about 1 to 1 1/2 hours. Once we get to understand your needs and physiological profile, we can begin the treatment process.
A Symphony in the Brain | Jim Robbins | Grove Press ISBN 08-0213-8195
Psychophysiology, Human Behavior and Physiological Response 3rd ed; John L. Andreassi, Erlbaum Associates ISBN0-8058-1104-4
Doing Neurofeedback: An Introduction | Richard Souter & Robert Longo | ISNR Research Foundation (can be purchased at www.bmedpress.com)