A normal EEG? The patient sits comfortably in a chair with many electrodes on his head. The computer in front of him, on its monitor, shows, via electric probes, the activities that go on within his head. But something is different. The patient is significantly more interested than the doctor in the displayed images derived from the processed data. These images are constantly changing: now a field of flowers with vibrant colours appears, then the image becomes pale and grey.
To watch oneself thinking
The data coming from the EEG of the patient doesn’t only find its way into the patient’s medical chart, but are also in this case a means to an end in itself. If the patient virtually simultaneously – in real time – gets to see the result of the activity of their central nervous system, he or she can, with a little practice, influence it himself or herself. Bright colours, when nerve cells attenuate certain brain regions or employ them at full steam, according to demand. Murky clouds, when the patient’s thoughts are misdirected. That’s what neurofeedback is – to see oneself while in the process of thinking.
Treating mental disorders without pharmaceutical products and addressing nerve cells within the brain almost individually – this sounds to some like charlatanism and quackery. At the same time more and more success stories on this treatment strategy turn up in prestigious professional journals, and more and more clinical pictures in which this method was used has lead to significant improvement.
Balanced Theta und Beta waves
Examples? There have been not only individual reports of miraculous healings, but also systematic studies, for example with Attention Deficit Disorder (ADHD).
Holger Gevensleben from the University Hospital of Göttingen last year published a large study of more than 100 children. More than half a year after neurofeedback training, the test results were still better than those achieved with computer-assisted attention training. The focus of the training was to have a balance of beta and theta waves, which is normally impaired in ADHD patients. “Children with ADHD also are able to learn to control their brain waves,” explains Ulrike Leins from the University of Tübingen.
In the clinic, a pupil views a screen in which a boy is balancing on a rope. In order to win the “game”, he has to get his thoughts so organised, that theta activity decreases and that of beta waves increases. Every time he succeeds, he helps the acrobatic artist take one step further towards the finishing line. Training proceeds in a similar way for slow cortical potentials (SCP, which represent cortical excitability). Here the task is to divert a ball from its straight course either up (= decrease in excitability) or down (increase). Other programs work with images such as a field of flowers and withering plants. “Buzz: A Year of Paying Attention” is a book by Pulitzer-Prize winner Katherine Ellison on the medical treatment of her ADHD-affected son, which also includes neurofeedback, about which she talks in a large article in the New York Times.
Epilepsy, autism and chronic pain syndromes such as fibromyalgia are other experimental fields for use of this technology. Neurofeedback, employed as a serious treatment option, should always be used under the supervision of an expert, but does not need to take place in the expert’s clinic. Investigations by Aisha Cortoos from Brussels show meanwhile that even tele-feedback is indeed successful. Under her guidance through their first contacts with EEG, and later via telephone and online support, patients suffering from insomnia trained their theta waves at home and increased their effective sleep time.
In any case, however, where a more precise localisation of the nerve center, which is to be trained, is needed, one needs to go to the clinic. In contrast to the “superficial” EEG, electrodes used in electrocorticography sit under the skin of the skull over the cortex surface. The absence of interfering signals increases sensitivity and specificity. The direct contact with the brain however also harbours risks, such as an infection. So far, surgical experience has been limited to short-term implants in epilepsy patients and in animal experiments using monkeys. Things have moved further using a technique which generates data via functional magnetic resonance. This technique makes it possible to orient oneself during mental training based on the activity level of certain brain areas. Nora Volkow from the American National Institute for Drug Abuse succeeded in such a way in working with substance addiction, with the aim of decoupling the desire for alcohol or nicotine from the assumed “reward”.
FDA: an aid to relaxation without medical indication
All of these training sessions however cost a lot of money, the amount usually being in four figures. The absence of large studies has not as yet convinced the U.S. Food and Drug Administration of the effectiveness of neurofeedback and has it classified as an aid to relaxation, but not yet as an effective treatment for medical indications. Similarly, German medical insurance also only pays for the treatment in exceptional cases. Where the boundaries between biofeedback (including treatment such as neurofeedback) and bioresonance are blurred, the battle-lines between opponents and supporters are still quite clear, as the reactions to a biofeedback article published in DocCheck last Autumn showed. Where the matter is, for instance, one of motor rehabilitation following a stroke using electromyography feedback, a systematic Cochrane-Review reaches few concrete conclusions and demands further study.
Going beyond medical indications, feedback experts are conducting research on further applications. fMRI-neurofeedback could help sociopathic criminals recover missing signals from the amygdala. Without negative integration of their acts through the amygdala, such criminals can’t recognise their guilt, Niels Birbaumer from the University of Tübingen is convinced.
In order to rid themselves of accusations of expensive quackery, biofeedback providers will probably have to undergo strict quality control in the future. The American “International Society for Neurofeedback and Research” has already begun to do this. Some members have been certified by the Biofeedback Institute of America and have committed themselves to a “Code of Ethics” for their therapies. Together with further study evidence and reduced costs, this might also possibly convince the insurance funds of the effectiveness of neurofeedback therapy.