How Good is Neurofeedback?

Neurofeedback practitioner Catherine Rule, left, of Northampton often works with children with attention problems. She checks to see that the electrodes which measure brain waves are properly attached during a session with 7-year-old Lucas Klinge. CATHERINE HIRSCHMAN photo


Friday, March 16, 2001 — The Hampshire Gazette

Two years ago, when Kyle moved into his new foster home, he was out of control, his foster parents say.

A 3-year-old victim of abuse, neglect and a succession of guardians, Kyle couldn’t sleep more than two or three hours a night because of screaming terrors. When he did sleep, he ground his teeth continuously to the point of wearing them down. He was violent and antisocial, hoarding food and hitting and biting. He was self-abusive, had no language skills, and could not sit still for even a minute.”It was a horror show,” says Kyle’s foster father, James Vieira, the target of most of the boy’s outbursts. “He was uncontrollable.”

Bonnie Schmidt, who was Kyle’s day-care provider at Davenport Child Care Center in Chesterfield, agrees.

“He was wild,” she says of his behavior when he first came to the center. “He was bouncing off the walls. He was very aggressive and had a major, major biting issue.”

The Vieiras had taken Kyle into their Hilltown home after Kim got to know him through her job as his one-on-one nursery school aide. A ward of the state Department of Social Services at the time, the boy needed a healthy home environment, Kim Vieira says.

Kim says Kyle affected her from the moment she met him. “The first day, he bit my hand,” she recalls. But when he saw the slight wound he had made to her skin, “he kissed it. I saw then there was someone sweet in there.”

After a couple of weeks, though, the Vieiras, who have no other children, were nearing the end of their rope, they say.

James and Kim differed at first on how they viewed their roles as Kyle’s foster parents. Kim was closer and more committed to the boy, they both acknowledge. James, who works as a stonemason, feared that Kyle’s behavior would pull them apart.

They were getting no sleep and had to be constantly on guard. They were aware of Kyle’s scarring past, how the boy had sometimes been left in his room for days on end, how he’d once fallen out a third-story window and hit his head. But given Kyle’s rage and constant fits of violence, James was finding it difficult to accept the boy into the household – and more difficult to believe that he could ever be a loving member of the family.

Then, by a stroke of serendipity, the Vieiras discovered neurofeedback, a technique that would quickly turn their lives – and Kyle’s – around, they say.

The technique was recommended by their landlord at the time, Sebern Fisher of Northampton, co-owner of EEG Spectrum International, a California company that sells neurofeedback equipment and trains people to use it. Fisher put the Vieiras in touch with her associate, Catherine Rule, a Northampton neurofeedback practitioner who often works with children.

Kyle had already been treated with medication and psychotherapy, both before and after the Vieiras took him in, but these had had no discernible effect on the boy’s behavior, James says. “We didn’t hold out a lot of hope for anything working at that point.”

But he and his wife felt neurofeedback was worth a try, they say, and scheduled an appointment with Rule.

Form of biofeedback

Neurofeedback, say advocates, can help treat any number of conditions – from depression to physical pain to attention deficit disorder – by teaching people how to regulate their brain waves to allow them to function at their peak. Computer games which reward the appropriate kind of brain waves are one tool in neurofeedback training. JERREY ROBERTS photo

Neurofeedback is a form of biofeedback that trains people to regulate their brain-wave frequencies. By doing so, the theory says, people can better control their behavior. Biofeedback was first developed in the early 1960s by Joseph Kamiya, a psychologist at the University of Chicago, who found that some people could control their brain-wave frequencies when provided with feedback about the waves’ characteristics. The development of computerized feedback instruments has allowed the technique to have broader applications.During a neurofeedback session, a practitioner attaches electrodes to a person’s scalp to amplify brain waves and translate them into a pattern on a computer screen; then the practitioner monitors the frequency range within which a person is functioning. Neurofeedback clients engage in activities like computer games or aural exercises to try to produce a healthy balance of brain waves – to relax if they are agitated, for example, or to bring about more energetic behavior if they are lethargic.

Neurofeedback targets frequency ranges within either the left or right brain to alter behaviors. The right brain, operating within lower frequencies, tends to focus on issues and problems with a wider perspective, such as creative endeavors and conceptual thinking.

“The left brain sees all the pieces,” as Catherine Rule puts it. “The right brain sees the big picture.”

Some scientists and practitioners theorize that the human brain operates best within particular ranges of neurotransmitted frequencies. Each session of neurofeedback aims to train the recipient’s brain to operate in optimal ranges.

The technique is a form of operant conditioning, says Rule, in which a practitioner – or coach, as she sometimes refers to herself – rewards certain responses to external stimuli in order to produce a desired result.

Neurofeedback, Rule continues, is just what its name suggests: the process of giving information back to the person. “We’re increasing a person’s repertoire to move from one brain state to another, gracefully transitioning from one to another without effort,” she says.

Reactive attachment disorder

Diagnosed with reactive attachment disorder (RAD), which results in aggression and lack of conscience in people separated from their mothers in early infancy, Kyle was functioning in a very high frequency range, which is typical of RAD children, when he began his sessions in November 1998, says Rule.

“He was in a very high state of arousal,” Rule says. So high, in fact, that in early sessions he would only pound the chair with his fists and stomp his feet.

Kyle’s favorite neurofeedback activity, “Space Race,” is a sort of flight simulator on which he learned to manipulate his brain waves to control the way three spaceships – each one representing a different frequency range – moved on a computer screen. When he relaxed, the middle ship, which represented the brain waves characteristic of a low-stress state, would move along in front. The more he relaxed, the more points were compiled by the game, until a “reward” was granted, a dazzling explosion of graphic colors and shapes on the screen.

By relaxing, and being rewarded for relaxing during each session, Kyle exercised his brain’s ability to experience that state, Rule explains, to get used to what it feels like to be calm. Increasingly, he has become able to achieve that state of relaxation at will in his everyday life.

The night after his first neurofeedback session with Rule, Kyle slept for 12 hours, the Vieiras say. After a week of daily sessions, his teeth-grinding and night terrors disappeared and he was sleeping regularly through the night. For the Vieiras, it meant a return to a somewhat normal life.

Now at age 6, after more than 200 sessions of neurofeedback training, at a cost of more than $10,000 to the Vieiras, Kyle has the demeanor and personality of a well-adjusted boy: engaging and courteous, alert yet calm, energetic and playful. He wears a constant smile and, though his language skills are underdeveloped for his age, he converses enthusiastically.

Bonnie Schmidt, who has kept in contact with Kyle and the Vieiras since he left her day-care center last summer to begin kindergarten, says she has been impressed with the boy’s progress.

“He’s come a long way,” said Schmidt of Kyle after speaking with him on the telephone recently. “When he said, ‘Hi, Bonnie, I’ve been missing you,’ I wouldn’t ever have thought I was talking to the same kid.”

James and Kim Vieira, who are both certified naturopaths (naturopathy is a type of health care that relies on remedies such as diet, exercise, fresh air and rest), acknowledge that Kyle’s neurofeedback training hasn’t been solely responsible for his vast improvement. They accompanied it with medication and with holding therapy, a naturopathic technique in which they wrapped Kyle tightly in a blanket and held him as they attempted to establish a bond through steady, calming eye contact. And much of his development is likely the result of living in a caring, nonabusive environment for the first time in his life, they say.

But the couple has no doubt that it’s the boy’s neurofeedback training that enabled him to relax and remain calm, and therefore benefit from a positive home environment.

Kyle’s case, say proponents of neurofeedback, is an example of how the technique can help people overcome mental and physical disorders and a range of bothersome behaviors. Rule estimates that in the Pioneer Valley, more than 500 people have received neurofeedback training directed toward a variety of symptoms and afflictions: depression, epilepsy, chronic physical pain, stage fright, agoraphobia – even a habitual lack of concentration on their golf swing.

Not everyone is convinced of the legitimacy of neurofeedback, though. An offshoot of biofeedback, the technique is regarded skeptically by some because of its association with the metaphysical experimentation and consciousness-expanding exercises of the 1960s. Others regard neurofeedback as a form of mind control. Some medical professionals cite a lack of clinical research to back up the claims made by neurofeedback supporters.

But the Vieiras, after witnessing Kyle’s turnaround, are convinced that neurofeedback works.

Optimal Brain Institute

Rule and Fisher, together with 14 other practitioners, are part of the Optimal Brain Institute, a consortium of neurofeedback practices in Massachusetts and Connecticut. Rule’s private Northampton practice serves as the institute’s hub.

Because neurofeedback aims to regulate the brain to operate at its peak proficiency, the range of problems it addresses is wide, according to Rule. The main objective of neurofeedback, she says, is not necessarily to eradicate specific symptoms, but rather to increase an individual’s ability to regulate his brain’s functioning and address his own problem areas.

“It’s about control,” says Rule, “improved ability to focus. This is a self-regulating system. We teach people how to self-regulate their brain.”

Neurofeedback is a relative newcomer as mental-health therapies go. In contrast to traditional methods like psychotherapy and psychiatry, which have long histories, neurofeedback has been around for a short time – only about 10 years as it is currently practiced.

Technological advances, however, have made it accessible to more practitioners, and therefore to more clients. Rule says the cost is on a par with what other mental health practitioners charge, in the range of $50 to $125 per one-hour session (often with sliding fee scales for lower-income clients). Neurofeedback is not covered by most health insurance plans.

“For such a small area, we have a huge amount of practitioners,” Rule says of the Pioneer Valley. She attributes that partly to the openness of people in the Northampton area to alternative approaches to health and well-being. But also, she says, it’s due to the willingness of area practitioners to work in conjunction with other techniques.

“As much as I possibly can, I approach this training in a holistic way,” Rule says. Neurofeedback doesn’t provide all the answers all the time, she says, adding that it’s not unusual for neurofeedback clients to undergo other types of treatment simultaneously.

“Generally, people who call me have tried other approaches,” says Rule. But she says she has found that once a person’s brain becomes more regulated through neurofeedback, he or she is better able to respond to other therapies as well.

Kyung Kim, of Jaffrey, N.H., combines her neurofeedback training with acupressure, psychotherapy and a regimen of TheraZone, a drug prescribed by her psychiatrist.

Kim, 44, had been traveling to the Valley regularly for acupressure treatment, hoping for relief from chronic pain in her neck and shoulders brought on by a car accident. She has dealt with various levels of depression, sometimes serious, as well as multiple chemical and food sensitivities for years.

Kim began psychotherapy when she was 18 and at times has seen a psychiatrist. She has consulted a specialist to construct a diet and a lifestyle plan that address her food and chemical sensitivities. She has received periodic chiropractic adjustments and sees a naturopathic physician for her pain and depression.

But until about a year ago, none of these regimens was making inroads on her conditions. At the recommendation of her acupressurist, Sam McClellan, who practices in Hadley, she scheduled an appointment for neurofeedback training with Rule.

Considering all the therapies and treatments she had already tried, Kim – like the Vieiras – did not have high hopes.

But almost immediately after she began twice-weekly training sessions with the computer games, she says, “I started feeling perked up. I was able to focus. I had been rather spacy and inarticulate, quite anxious and fearful of people. It was quite traumatic.”

Within the first 10 sessions, Kim says, she experienced “a sense of freedom to interact with people. I’m not so fraught with anxiety now. It has dramatically altered my prospects; the clarity of thinking I can have now, the ability to make decisions. It’s just a different life.”

Kim continues to travel to Northampton once every two weeks for neurofeedback sessions with Rule. She says she still has work to do. But after more than a year and 50 sessions, Kim has reduced her TheraZone prescription by 50 percent with her psychiatrist’s consent, she says, and has cut back on acupressure treatment as well.

Lack of clinical research

Critics of the technique often cite a lack of clinical research about the claims made by neurofeedback professionals.

Russell Barkley, a professor of psychology and neurology at the University of Massachusetts Medical School in Worcester, is one of the country’s most vocal opponents of neurofeedback. While he acknowledges that no evidence exists that suggests that the treatment is harmful, he contends that the success claimed by the neurofeedback community is due largely to a placebo effect: reports of positive change by clients – particularly children – that are based on the power of suggestion. The author of “Defiant Children: Management of Difficult Children,” Barkley also has argued that without clinical testing carried out with control groups and “double-blind” participation, it’s irresponsible for anyone to make claims about neurofeedback’s effectiveness.

But people at EEG Spectrum International counter that double-blind studies, in which the identity of the test subject is concealed from the tester and fellow subjects, are appropriate only in testing the effectiveness of drugs. Educational therapy and psychotherapy are widely accepted types of treatment, they say, that have gained legitimacy by measuring outcomes of case studies – just as the neurofeedback community is now attempting to do.

Sebern Fisher says that so far funding has not been available for extensive scientific studies. Though a few studies have been carried out that support neurofeedback’s legitimacy, most of the claims of success have been based on anecdotal evidence: testimonials from clients who have benefited from it.

Bruce Goderez, a psychiatrist who trained in neurofeedback with EEG Spectrum International about five years ago and is now integrating the technique into his private practice in Hadley, says professionals in the fields of psychiatry and psychology have a justified tradition of skepticism regarding new forms of treatment.

“There’s this huge area of alternative medicine out there,” he says, mentioning some of the latest – dialectical behavior therapy (a meditative therapy used mostly to treat borderline personality disorder), past-life regression therapy, the use of magnetic fields. “There are a lot of cockamamie practices. And along comes this modality that claims to be effective,” he says of neurofeedback. “One has to be skeptical.”

But Goderez, who often works with children who have severe afflictions such as ADHD, brain injuries or autism, says that given neurofeedback’s harmlessness, plus the ineffectiveness of other mental-health approaches in some extreme cases, practitioners could be more open to trying it.

“In some of these difficult cases, what do you have to lose?” he asks. “I have seen many, many people benefiting [from neurofeedback] who have had very serious problems.” Goderez refers mostly to people with head and brain injuries, many of whom have not had satisfactory responses to medication for their symptoms, which can include personality changes, mood swings and lack of concentration. But he also says children diagnosed with ADHD have improved with neurofeedback training. “There are conditions that don’t respond at all to medication that respond to neurofeedback,” he says, adding that a few of his patients have been able to reduce their psychiatric drug prescriptions after training with neurofeedback. “My guess is that in 10 years, this will be a substantial technique.”

Sebern Fisher agrees that in time neurofeedback will become a more respected form of mental-health treatment. With a background in psychology, Fisher says, she understands the skepticism about accepting a new technique. “We are very early in the process,” she says of neurofeedback’s claims of legitimacy. “But I think it’s undeniable. Because it works.”

‘Use a tune-up’

It’s not only those with severe afflictions who say they have experienced improvement via neurofeedback.

Mardi Abuza, of Florence, had no well-defined, diagnosable maladies. But Abuza, a mother of two daughters aged 11 and 19, just didn’t “feel right,” she says, about the way she often over-reacted to her children’s everyday problems.

“I felt I could use a tune-up,” she says. “Certain things would happen with my children and I’d sort of freak out. It was nothing you could put a finger on. But it was clear I was living in a moderately high state of anxiety.”

Abuza, 45, and her younger daughter began neurofeedback sessions with Rule about a year ago, after her older daughter had undergone neurofeedback under Sebern Fisher’s guidance. After more than 50 sessions, she says, she is better able to handle life’s everyday stresses.

“I’m overall much calmer now,” she says, “much more able to take a fairly significant level of disturbance without over-reacting to it. People ask me now, ‘How do you stay so calm?’ I’m not easily baited. I’m not drawn into arguments.”

Abuza says she often recommends neurofeedback to others; it teaches people to regulate their own mental functioning without physically altering them, she says. The technique uses the tools that people already have, she says: It’s like exercising the brain.

“There’s nothing quite like it,” she says. “This is a profound tool.”

Rae Tattenbaum practices neurofeedback as part of her West Hartford, Conn., counseling business, Inner Act. She has combined the principles of sports psychology with neurofeedback, she says, to come up with a “peak-performance” program for the sports, business and performing-arts professionals she works with. “Neurofeedback is the foundation of helping a person transform mediocre performance to superior performance,” Tattenbaum says.

Nicole Laurenzi, a 17-year-old singer, dancer and actress from West Hartford, says she has experienced such a transformation as a result of her neurofeedback training with Tattenbaum. “It’s definitely changed my voice,” she says. By allowing her to relax mentally and physically, Laurenzi says, neurofeedback enables her to focus on utilizing her voice to its full extent. “It’s made my range higher. I don’t think I could have even begun to make these changes without neurofeedback.”

Continued to improve

As for Kyle, there’s no question he has changed since joining the Vieira family. To see him now, it’s hard to imagine the Vieiras’ descriptions of him as a boy out of control only a couple of years ago. He began kindergarten last fall and James and Kim say that his language and social skills and his physical coordination continue to improve.

The Vieiras are convinced that there is no other therapy that could have produced the kind of recovery that Kyle has had. Because of this, they are now among neurofeedback’s biggest supporters. The couple have been trained by EEG Spectrum International in the neurofeedback technique and administered the late portion of Kyle’s training sessions themselves with equipment they purchased from the company. Last summer James gave a presentation about their experience at a neurofeedback conference in Chicago. The Vieiras hope to begin a nonprofit agency that would assist RAD children in obtaining neurofeedback training.

In January, the couple legally adopted Kyle. Without neurofeedback, they say, it’s unlikely they would have done so. Now, says James Vieira, he and his wife expect that Kyle will become a “fully-functional member of society, probably with more compassion than the average person” because of what he’s been through.

“It’s like a fiber-optic network that has shut down,” says James of Kyle’s early mental state. “You have to repair the broken bond.” And that, he says, is what the therapy did. “Neurofeedback allowed him to trust us. Nothing else could have brought about such a change.”

Eric Sean Weld, a frequent contributor to Hampshire Life, is a free-lance writer and musician and assistant director of college relations at Smith College.