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 functioning disturbances.
What disorders have clinical evidence?
All of the following disorders have clinical reports or case histories for EEG biofeedback; many have scientific reports:
| Addiction | Epilepsy |
| Anxiety | Fetal Alchohol Syndrome |
| Attachment Disorder | Learning Disabilities |
| ADHD/ADD | Migraine |
| Autism | Obsessive-Compulsive Disorder |
| Autoimmune Dysfunction | Pre-Menstrual Syndrome |
| Chronic Pain | Post-Traumatic Stress Disorder |
| Chronic Fatigue Syndrome | Sleep Disorders |
| Conduct Disorders | Stroke |
| Depression | Tourette’s Syndrome |
| Eating Disorder | 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?
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| The 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. | A 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. | The 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. |
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| Each 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. | With 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.
Each 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 of biofeedback.
My doctor takes a dim view of biofeedback.
What can I tell her?
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:
- 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, pp.301-312.
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.