What is EEG Biofeedback?EEG
Biofeedback is a learning strategy that enables persons to alter their
brain waves. When information about a person's own brain wave
characteristics is made available to him, he can learn to change them.
You can think of it as exercise for the brain.
What is it used for?EEG
Biofeedback is used for many conditions and disabilities in which the
brain is not working as well as it might. These include Attention
Deficit Hyperactivity Disorder, conduct problems, Reactive Attachment Disorder (RAD), Autistim, Aspergers,
specific learning disabilities, and related issues such as sleep
problems, teeth grinding, migraines and chronic pain such as frequent
headaches or stomach pain.
The training is also helpful with the
control of mood disorders such as anxiety and depression, as well as
for more severe conditions such as medically uncontrolled seizures,
traumatic brain injury, or cerebral palsy.
How is it done?An
initial interview is done to obtain a description of symptoms, and to
get a picture of the health history and family history. Some testing
may be done as well. The person may do the first EEG training session,
at which time we look at the EEG. This may take about two hours. (The
details may differ among the various affiliate offices.) In some
offices a full brain map, or quantitative EEG, is routinely obtained,
this may require a separate office visit. More extensive testing may be
done if the clinician feels it necessary. Subsequent training sessions
last anywhere from 20 minutes to an hour,depending upon the
individual's need. Sessions are conducted from one to five times per
week. Some improvement is generally seen within ten sessions. Once
learning is consolidated, the benefit appears to be permanent, although
booster sessions may be helpful for some individuals.
EEG biofeedback training is a painless,
non-invasive procedure. One or more sensors are placed on the scalp,
and one to each ear. The brain waves are monitored by means of an
amplifier and a computer-based instrument that processes the signal and
provides the proper feedback. This is displayed to the trainee by means
of a video game or other video display, along with audio signals. The
trainee is asked to make the video game work by means of his brain
activity. As activity in a desirable frequency band increases, the
video game moves faster, or some other reward is given. As activity in
an non desirable band increases, the video game is inhibited.
Gradually, the brain responds to the cues that it is being given, and a
"learning" of new brain wave patterns takes place. The new pattern is
one which is closer to what is normally observed in individuals without
What disorders have clinical evidence?
All of the following disorders have clinical reports or case histories for EEG biofeedback; many have scientific reports:
||Fetal Alchohol Syndrome|
||Post-Traumatic Stress Disorder|
|Chronic Fatigue Syndrome
||Traumatic Brain Injury|
What results do we obtain?In the case of ADHD,
impulsivity, distractibility, and hyperactivity, all may respond to the
training. This may lead to increased success in school performance.
Cognitive function may improve as well. In several controlled studies,
increases of 10 points in IQ score were found for a representative
group of ADHD children. And in two clinical studies, an average
increase of 19 and 23 points was demonstrated.
Behavior may improve in other ways as well: If the child has a lot
of temper tantrums, is belligerent, and even violent or cruel, these
aspects of behavior may come under the child's control.
In the case of depression, there can be a gradual recovery of
"affect", or emotional responsiveness, and a reduction of effort
fatigue. In the case of anxiety and panic attacks, there is gradual
improvement in "regulation", with a dropoff in frequency and severity
of anxiety episodes and panic attacks until the condition normalizes.
In the case of epilepsy, we observe a reduction in severity
and incidence (frequency of occurrence) of seizures. In many cases
.(old sentence) The dosage of anticonvulsant medication may ultimately
be reduced (if ordered by the referring neurologist), and side effects
of such medication may diminish.
Can a successful outcome be predicted?It is not
possible to predict with certainty that training will be successful for
a particular condition. But for the more common conditions we see, a
reasonable prediction of outcome is usually possible. More important,
however, the effectiveness of the training can usually be assessed
early in the course of training. For most conditions, there are no
known adverse side effects of the training, provided that it is
conducted under professional guidance.
Why does this training procedure work?
The brain is amazingly adaptable, and capable of learning. It can
also learn to improve its own performance, if only it is given cues
about what to change. By making information available to the brain
about how it is functioning, and asking it to make adjustments, it can
do so. When the mature brain is doing a good job of regulating itself,
and the person is alert and attentive, the brain waves (EEG) show a
particular pattern. We challenge the person to maintain this
"high-performance", alert and attentive state. Gradually, the brain
learns, just like it learns anything else. And like with other
learning, the brain tends to retain the new skill.
We observe that if the EEG is not well-behaved under these
circumstances, there may be adverse impacts on learning ability, on
moods, on sleep, and on behavior. With training, these may be gradually
brought under control, along with normalization of the EEG.
What does EEG Biofeedback look like?
therapist computer is usually positioned behind the patient. This
enables the therapist to monitor the patient's EEG at any time during
the session without disturbing the biofeedback.
single electrode is placed on the scalp (above the motor strip,
typically) using gel or paste and two other electrodes are attached to
the earlobes. Most patient recline during training.
game computer is placed a few feet away, directly in front of the
patient. The patient interacts (only using her EEG) with the game
computer for the next 30 minutes. |
display contains four EEG data streams (below each stream are text and
average data values). The top line, slightly squiggly, is the person's
entire EEG recorded from the scalp by the single active electrode. The
three wavy lines below show activity in three separate EEG frequency
bands or rhythms -- here, theta, SMR, and high beta bands. The
patient's goal is to increase certain EEG frequency bands (e.g., SMR)
while decreasing others (e.g., theta & high beta).The patient
monitors her EEG frequency band activity NOT as wavy lines on the
therapist machine, but as elements of a game on the game computer. Each
frequency band appears as a colored rectangle which grows larger or
smaller in response to her brain wave activity.
her brainwaves she is playing the game called "Islands." Frequency band
activity is displayed at the bottom of the screen -- two square
"inhibit" boxes on either side on a large "enhance" rectangle. At this
instant, she is doing quite well, inhibiting or reducing the activity
of the bands represented by purple & yellow (at the moment, mere
dots in each corner of the screen). She has increased her SMR activity
to a point where it overflows the middle (blue) rectangle. As long as
she keeps this up, she is rewarded in the game with visual and auditory
stimuli. During the 30 minute session, she will work to keep purple and
yellow small and make blue large as long as possible. A hundreds of
times she may need to alter her brain activity in order to achieve a
brain state which scores the most points. For every half second that
her brainwaves stay in the desired state or "zone", she scores another
point, an additional seagull appears in the sky (top of screen, barely
visible), a new stripe segment is drawn on the highway (middle of
screen), and a beep sounds to announce it all. If or when she attains
500 points, the volcano (middle left) will erupt! |
How long does training normally take?EEG training is
a learning process, and therefore results are seen gradually over time.
For most conditions, initial progress can be seen within about ten
sessions. Initial training goals may be met by twenty sessions, at
which time the initial retests are usually performed. In the case of
hyperactivity and attention deficit disorder, training is expected to
take about forty sessions, or even more in severe cases. Teeth grinding
usually responds in twenty sessions. Some symptoms of head injury often
respond in less than twenty sessions (quality of sleep; fatigue;
chronic pain), whereas others may require longer training before they
show an initial response (memory function, for example).
How frequent should the training sessions be?In the
initial stages of learning, the sessions should be regular and
frequent, at two, three, or even more sessions per week. After learning
begins to consolidate, the pace can be reduced. Daily sessions can be
very beneficial as well.
Is EEG biofeedback covered by insurance?Many medical
and psychological insurance plans now cover biofeedback for various
conditions. Some require co-payments. Other plans have annual caps. A
prescription for the training, along with a diagnosis, may be required
from a physician under the medical part of the plan, or from a licensed
psychologist under the mental health services part of the plan.
Medicare pays for EEG biofeedback for some conditions.
insurance company has their own guidelines regarding the coverage of
EEG Biofeedback. Check with your insurance company and ask if
they cover "biofeedback". It is recommended that you use the word
"biofeedback" as most insurance companies only have access to that
wording. EEG biofeedback or neurofeedback is a particular type
My doctor takes a dim view of biofeedback.Your
doctor may not know of this specific type of biofeedback. He or she
will maintain a healthy skepticism about any new approach claiming
numerous benefits. If your doctor is familiar with EEG biofeedback in
general, he may still be thinking in terms of the more common early
experiments with alpha wave training, rather than with the training we
are dealing with here. Ask your doctor to examine the recent research
on the effectiveness of EEG biofeedback in treating various disorders
such as attention deficit disorder and epilepsy. The following
references are a place where he or she can start:
What can I tell her?
- Lubar, J.F. and Bahler, W.W. (1976). Behavioral management of epileptic seizures
following biofeedback training of the sensorimotor rhythm. Biofeedback
and Self-Regulation, 1, pp.77-104.
- Lubar, J.F. and Shouse, M.N (1976). EEG and behavioral changes in a hyperactive
child concurrent training of the sensorimotor rhythm (SMR): A preliminary
report. Biofeedback and Self-Regulation, 1, pp.293-306.
- Lubar, J.O. and Lubar, J.F. (1984). Electroencephalographic biofeedback
of SMR and beta for treatment of attention deficit disorder in a clinical
setting. Biofeedback and Self-Regulation, 9, pp.1-23.
- Shouse, M.N. and Lubar, J.F. (1979). Operant conditioning of EEG rhythms and
Ritalin in the treatment of hyperkinesis. Biofeedback and Self-Regulation,4,
How much does the training cost?
The cost of the training differs among offices depending on location, the professional
status of the person delivering the service, as well as the experience and speciality of each neurofeedback clinician.
Typically, individual sessions run from $75 to $175.