"Therapists are using neurofeedback to treat ADHD, PTSD and other conditions"
From The Washington Post
By Arlene Karidis By Arlene Karidis
January 19, 2015
In September 2013, Chris Gardner went from kicking and spinning as a black belt in taekwondo to being locked in a world where he could not follow conversations — or even walk his dog. The 58-year-old Vienna, Va., resident had just had brain surgery to remove a large tumor, and the operation affected his mobility and cognition.
After nine months of physical and occupational therapy, he’d made little progress. So he tried neurofeedback, hoping this controversial treatment would improve his balance and mental processes.
Neurofeedback — a type of biofeedback — uses movies, video games, computers and other tools to help individuals regulate their brain waves. A patient might watch a movie, for example, while hooked to sensors that send data to a computer. A therapist, following the brain activity on a monitor, programs the computer to stop the movie if an abnormal number of fast or slow brain waves is detected or if the brain waves are erratic, moving rapidly from fast to slow waves.
The stop-and-start feedback, repeated over and over in numerous sessions, seems to yield more-normal brain waves. Researchers who endorse the technique say they don’t know exactly how it works but they say the changes in brain waves result in improved ability to focus and relax.
Better focus and relaxation can seemingly help improve or eliminate such conditions as migraines (imbalanced brain waves are associated with certain symptoms like pain) and anxiety.
Clinical social worker Mary Lee Esty demonstrates the hookup of neurofeedback sensors on Cliff Drake, who says the procedure has helped him deal with post-traumatic stress disorder, depression and other ailments. (Linda Davidson/The Washington Post)
Neurofeedback, which is also used for post-traumatic stress disorder and attention-deficit hyperactivity disorder, has been around since the 1960s. Some research has found it promising. Other studies have been inconclusive, and some have shown no positive outcomes.
The most solid data concern ADHD, especially a recent trial involving 104 children published in March in the Journal of Pediatrics. Those who received neurofeedback had improvements in attention and impulse control, while those who did not receive the therapy did not. These improvements persisted after six months. The authors concluded that neurofeedback may be a “promising attention training treatment for children with ADHD.”
Gardner had read that the technique could aid in recovery from brain injuries.
“I was skeptical. But I was desperate. I felt like I was wrapped in miles of cotton and could not reach through it to touch or feel anything,” said Gardner, an electronic technology consultant. His doctor was projecting a two-to-three-year recovery period, based on Gardner’s slow progress nine months after surgery.
By his ninth neurofeedback session, he was driving, taking power walks and working from home.
Neurofeedback treatments vary. In Gardner’s case, he sat in a chair while tiny, pulsed signals were sent to his brain. Research suggests that these signals enable the brain to revive its communication channels, which can become impaired after a brain injury.
“I couldn’t feel anything” while the treatments were underway, Gardner said. “I just sat there with my eyes closed. My therapist explained that the pulses basically reboot the brain.”
He has just completed the last of 10 treatments. “I am not 100 percent. I probably won’t stand on my head or get on a roller coaster. But I can do almost everything I couldn’t do before,” said Gardner, who’s back to his martial arts.
“Do most people become totally normal? No. But they improve,” said Michael Sitar, a Bethesda psychologist certified in neurofeedback. He uses it to treat depression, ADHD, chronic pain and some other conditions.
“I find [that] people with focus problems can switch tasks easier. Kids who repeat themselves and who are emotionally labile become calmer and don’t repeat as much,” Sitar said. “With some complicated cases, like bipolar disorder, people may get by on less medication. Though less common, there are documented cases of nonverbal people who become verbal.”
Like riding a bike
Deborah Stokes, an Alexandria psychologist, compares neurofeedback to riding a bike: It’s non-conscious learning, based on the feedback, that, with repetition, can be long-lasting, she said.
“We don’t know exactly how neurofeedback works,” she said. “It’s a process where if clients get out of their own way, they relax. Over time, they get the desired brain pattern, feel calm and function better. This encourages them to stay with it.” Her team sees 30 patients a week.
Thomas Nicklin, whose family was living in Alexandria, saw Stokes for debilitating migraines. A year and a half after beginning a drug regimen prescribed by a neurologist, he was not getting better.
Nicklin, a teenager who was in boarding school, did 45 neurofeedback sessions over three months last year.
“Over time, Thomas went from three or four blinding migraines a week, vomiting and daily pain, to no symptoms,” said his mother, Pat Nicklin.
Silver Spring psychologist Robb Mapou is among the skeptics.
“I have not seen enough well-controlled, rigorous studies in most conditions for which it is recommended to show, definitively, that neurofeedback is effective. I also think there are other therapeutic factors that can contribute to an individual’s outcome, such as discussing their problems with a therapist.”
Michelle Harris-Love, a neuroscience researcher at the MedStar National Rehabilitation Network in Washington, agrees.
“I believe it is applied in some situations where we do not have enough information on the cause of a disorder or how recovery happens,” she said.
But Rex Cannon, past president of the International Society for Neurofeedback and Research, based in McLean, Va., cited nearly 200 peer-reviewed published articles that indicate neurofeedback’s effectiveness. This includes a meta-analysis of 10 studies on epilepsy patients: Although they had not responded to medications, they had a significant reduction in seizures after neurofeedback treatment. And a study on migraine patients reported, “Neurofeedback appears to be dramatically effective in abolishing or significantly reducing migraine frequency in the great majority of patients.”
Patients usually have sessions two or three times a week, for a total of 10 to 40. Most sessions are 30 to 60 minutes long. They can be expensive — from $50 to $130 each. Some insurance policies cover neurofeedback, depending on the diagnosis.
Practitioners who use neurofeedback for medical and psychological disorders must have health-care degrees and are regulated by state agencies.
About 1,850 professionals have been certified through the Biofeedback Certification International Alliance. To earn that credential, they must undergo 36 hours of study in neurophysiology and related topics, complete a mentoring program to learn clinical skills and pass a standardized exam.
Mary Lee Esty, a Bethesda clinical social worker, has a small study underway treating veterans with PTSD. In an earlier study of seven veterans who used neurofeedback, she reported, the results were promising.
“These people [in the early study] initially had minimal function. They could not work, and many attempted suicide,” she said. “One is getting a PhD now. One has a full scholarship when he could not read after his head injury. All of them are doing well.”
Other studies describe results of the therapy in a similar way, as promising but requiring further examination.
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Esty, who received a National Institutes of Health grant for an earlier study of brain-injured patients, has used neurofeedback to treat more than 2,500 people, mainly with brain injuries or PTSD. In her most recent and still ongoing study, she collaborates with the Uniformed Services University of the Health Sciences, which gives participants in her program post-treatment evaluations.
“I am in this collaboration because I want to get the hard data out there,” Esty said.
Karidis is a freelance writer.
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