TOPIC: Neurofeedback Frequently asked questions: 1.  What is biofeedback? What is neurofeedback? 2.  What is mindfulness training? 3.  Are these processes well researched? 4.  What are the benefits of this training? 5.  How is a client evaluated? 6.  What equipment is used? 7.  Are biofeedback and neurofeedback regulated? 8.  How can I learn more? 9.  Comprehensive bibliography at ISNR.org.   10. Protocols and technical details 1. What is biofeedback? What is neurofeedback? Biofeedback is how we all learned to become accomplished. Watch a baby. The child’s senses of vision, touch, smell and taste all "feed-back" information to the brain and contribute to learning to grasp and eat a cookie. Too much muscular effort and the cookie is crumbled. Too little and the goal is not attained. Fluid filled canals with sensory fibers feed-back information to our brains regarding our orientation in space. We learn to crawl, stand, walk, run, skate, and ride bicycles because of biofeedback. Then we grow up, accumulate stress, and perhaps start wearing out. How much more could we learn to do if the more mysterious inner workings of our bodies and minds were accurately fed back to us? Could we balance and control the tension headaches, the high blood pressure, the anxiety, poor sleep, the pain, the brainwaves of inattention, depression, and agitation? Modern biofeedback instruments are multi-channel amplifiers which connect a computer to sensors applied to your body. Your trainer can show you the amount of electrical activity in your brain or muscles, the shape and variability of your heart beat, the rhythms of your breath, skin conductance, and skin temperature… even the percentage of oxygen in your blood or carbon dioxide in your breath. All of these physiological activities are tools you use to grasp the enjoyment and security life can offer. All of these are abilities of your body and mind which you can control for your well-being. Practicing our smiles in a reflective pool of water is biofeedback that has been with us for eons. Balancing the theta and beta waves in our brains is an exercise that needed the arrival of the modern computer. Both can be tools you use and enjoy to create a vibrant and capable future. Neurofeedback is a specialty in biofeedback. It is concerned with the monitoring and training of specific frequencies of brain activity over specific regions of the brain. Neurofeedback is sometimes called neurotherapy, EEG operant conditioning, or EEG biofeedback in the scientific literature. 2. What is mindfulness training? It is possible that most of the books you have seen with the word “mindfulness” in the title have been books about meditation, often Christian or Buddhist in orientation. Perhaps you would be surprised to know that the University of California in Los Angeles (UCLA) has a “Mindfulness Awareness Project”, or that the Massachusetts General Hospital has its “Mindfulness Based Stress Reduction Project” which has treated thousands of patients. Definition: Mindfulness refers to the self-regulation of the awareness of inner or mental states, often subtle, fleeting, and associated with the accurate perception of life as it is lived in the moment. Mindfulness Meditation or Training refers to a broad group of activities taught for many centuries in a wide variety of cultural and religious contexts. Basically, it is the self-regulation of the awareness of mental states accompanied by attitudes of curiosity, openness, appreciation, amusement and tolerance (C.O.A.A.T.) PBS’s Scientific American Frontiers with Alan Alda showed Tibetan monks trained in mindfulness meditation raising their body temperatures 15 degrees to dry wet and freezing sheets draped over their bodies. This is no more an accomplishment than that of the woman or man who uses biofeedback to learn to control blood flow or brain waves to stop migraines or seizures. The definition of mindfulness as “self-regulation of states of mind accompanied by attitudes of curiosity, openness, appreciation, amusement, and tolerance” could also describe the biofeedback process, wherein one learns to recognize and control various states of body and mind in a supportive and enjoyable environment. 3. Are these processes well researched? First, a recent (Jan 2007) article obtained from the United States National Institute of Health website (www.pubmed.gov): “Neurofeedback (NF) is an electroencephalographic (EEG) biofeedback technique for training individuals to alter their brain activity via operant conditioning. Research has shown that NF helps reduce symptoms of several neurological and psychiatric disorders, with ongoing research currently investigating applications to other disorders and to the enhancement of non- disordered cognition.” (emphasis mine) Angelakis E, et al (2007) - EEG neurofeedback: a brief overview and an example of peak alpha frequency training for cognitive enhancement in the elderly. Clin Neuropsychol. 2007 Jan; 21(1):110-29 How about this earlier statement from a Harvard Medical School educator: “The literature… suggests that EEG biofeedback therapy should play a major therapeutic role in many difficult areas. In my opinion, if any medication had demonstrated such a wide spectrum of efficacy it would be universally accepted and widely used.” Frank H. Duffy, MD, Associate Editor for Neurology, Neurologist at Boston Children’s Hospital, Harvard Medical School, January 2000. The psychologist Abraham Maslow once said, “Science is the only way of shoving truth down the reluctant throat.” I find it very interesting to look through decades of literature where pioneers have investigated new uses for biofeedback and their colleagues have analyzed its effects. Rather than give you a description of the historical developments in biofeedback and neurofeedback at this time, I will direct you to the United State’s own governmental repository of world-wide medical literature, www.pubmed.gov. If you go to www.pubmed.gov on the internet you can search the U.S. governments database for any topic. Towards the end of 2007 I found the following topics discussed. The numbers In parenthesis indicate the number of extant articles discussing the topic. Heart rate variability (10126) Biofeedback (5972) EEG operant conditioning (450) Neurofeedback (92) Neurotherapy (37) Please note that neurofeedback, neurotherapy and EEG operant conditioning are alternate names for the same procedure. You could find even more articles if you reworded the searches to include, for example, “temperature training” or “EEG feedback”. But these general searches suffice for the moment. You may wonder about the large number of references to “heart rate variability.” I will provide a separate section soon to deal with this crucial and interesting topic. At this point I want you to know that this incredibly important measure of heart-mind functioning is easy to acquire and easy to train. 4. What are the benefits of this training? (In 2008) the most comprehensive and up-to-date list of conditions known to respond well to neurofeedback is located at ISNR.org. It is compiled by D. Corydon Hammond, PhD, Professor of Physical Medicine & Rehabilitation, University of Utah School of Medicine. I think we all know what we mean by “chronic illness”. It can be anything from acne to fatigue or frequent pain to cancer. Our bodies do not do what we want them to do! They hurt, make sores, confuse us, irritate us, and cause us worry and pain. Our politicians have legalized a group of professionals using surgery, radiation, and petroleum-based drugs to compel us towards a state of "health" sanctioned by their brothers in the insurance industry. At present we are still free to exercise our bodies and minds and to seek our own personal health and happiness. It is a simple matter, really, to alter our lifestyle with neurofeedback or diet or exercise, and determine whether or not the results are worth the effort. It is quite another thing, though, to find a way of thinking that empowers us to function more freely and more effectively. More on this later. In some states biofeedback is covered by insurance companies. They, for whom the dollar is supreme, would not pay for a treatment that was not effective. Biofeedback and neurofeedback have been shown to be effective for a wide variety of complaints. You can verify this for yourself at the websites of the "Association for Applied Psychophysiology and Biofeedback" www.aapb.org and The "International Society for Neurofeedback Research" at "www.isnr.org. But it is important to understand that biofeedback and neurofeedback (as well as any other exercises or activities) are not remedies for any particular disease. They are ways to increase your mental and physiological flexibility. They are also ways to reduce the damage caused by the stress of life. They are ways to rest the parts of you that need recuperation. They are also ways to exercise the parts of you that are most challenged. Biofeedback and neurofeedback are provided across the world by doctors, nurses, and therapists with many and diverse degrees, licenses and credentials. Currently, these services can also be provided by unlicensed and unsupervised individuals who can afford the equipment. It is up to you to choose wisely. In the United States you can (hopefully) trust in a person’s professional license. So, what can biofeedback or neurofeedback do for you? If you become more attuned to your strengths and weaknesses, if you can better control the distribution of your body’s resources, if you can better focus your attention and strength as needed, then you will more efficiently cope with life’s challenges. 5. How is a client evaluated? If you see a primary care provider (medical doctor, chiropractor, acupuncturist, counselor, etc) then you will most likely be evaluated in that practitioner's traditional manner, which may or may not include an evaluation for biofeedback or neurofeedback. However, you may decide to see an individual who primarily practices biofeedback, with or without a formal clinical education. If your biofeedback practitioner does not have a state-sanctioned professional license, then it is doubtful that you will be discussing any possible physical or mental illnesses. It is illegal to provide mental or physical or legal advice without a license. Some skilled but unlicensed biofeedback practitioners will offer ‘relaxation’ training with their equipment and techniques. This can be very effective for relaxation purposes. And it is legal. But it may not be the best option for you. The ideal situation may be to find a primary health care provider who is willing to help teach you self-regulation while managing any on-going health issues you have. Biofeedback (BF) and neurofeedback (NF) practitioners often provide a fairly standard “stress” analysis early in the sessions. In a typical stress test the client is connected to sensors for respiration, heart rate and variability, muscle activation, skin conductance (sweat), skin temperature, and perhaps brain waves. The practitioner, with the aid of computer analysis, can gain insight into how your body deals with stress. You may also be able to determine which of your physiological systems are most disrupted by stress. In addition to the standard evaluation and stress test, you may be given a continuous performance test (CPT). This well-researched computerized test measures your reaction times, your tendency to errors of omission or commission, and your performance under stress. It is very sensitive to changes in your functioning and is often an early indicator of improvement with training. You may also be given a QEEG (quantitative electroencephalogram). This test involves attaching 19 or more electrodes to your scalp and recording your brain waves which are later analyzed by a computer. It is often the case that injuries, genetics, or habits have led the brain into functional states that restrict its performance. The colorful maps of brain wave amplitude and coherence may be used for diagnosis by your doctor or for the establishment of personalized neurofeedback protocols by a qualified neurofeedback practitioner. 6. What equipment is used? Sometimes we collect a full EEG brain scan, produce a qEEG (quantitative electroencephalogram), and compare the results with a normative database (SKIL). The client may bring a qEEG from another practitioner. In either event, before each session a brief assessment is made and then the client starts training using a high speed data acquisition device, completely isolated from power lines, to record brain waves at the scalp and transmit them to the computer. The hardware and software may also monitor heart rate variability, electrodermal skin response, skin temperature and respiration. In some situations the client observes the main clinician screen along with me, in other cases a second screen is observed. In so-called deep states training the client may recline in a special chair, eyes-closed, and listen to audio signals of current brain activity. In each case the goal is the same - to become aware of alterations in state and then to reproduce these states at will. 7. Are biofeedback and neurofeedback regulated? It seems odd that you can spend $10,000 on highly calibrated, well- engineered neurophysiology hardware and software that is regulated as a "relaxation" device. But that seems to be the case with bio- and neurofeedback gear. Ethical companies restrict the sale of such devices to those who are appropriately qualified and educated. But in many ways the practice of bio- and neurofeedback is not much better regulated than that of instructors in meditation and physical fitness. The fact that bio- and neurofeedback attract doctoral level practioners and researchers worldwide attests to its efficacy and robustness. The fact that some beginners do it on themselves with parts from Radio Shack attests to its general safety. Fortunately there are national and international organizations that regulate the education and certification of practitioners of this science and art. The Biofeedback Certification Institute of America www.bcia.org requires collegiate clinical education, a state license to practice therapy, a rigorous exam, and many hours of personal supervision and self-training before awarding its certification. Physicians and therapists from many countries come to the U.S. to train and ultimately seek the certification, currently the only one if its type in the world. 8. How can I learn more? You may need to revisit this website to get my answer, since it is under construction. I will be posting suggested reading and informative links in the near future. You can also call or email me at the locations below. In the meantime for an introduction to neurofeedback I recommend the enjoyable book "A Symphony in the Brain" by Jim Robbins. Also, please take advantage of the resources linked to the following section 9, "Research". You can also explore my portals (above) for "Music, Arts, & Peak Performance", and "PTSD". 9. Research Comprehensive bibliography at ISNR.org. I have arranged some abstracts here as HTML or .doc. The last 2 are big files. 10. Protocols and technical details Clients: If another practitioner has already recommended a certain protocol or training and you are looking for someone in this area, then please call me. Mentoring: If you are looking for a BCIA certified mentor in biofeedback and/or  neurofeedback, then please call me. Sample screen shots from actual sessions: Below: 2 channel neurofeedback including heart rate variability (TAG Sync) Below: Electroencephalogram (EEG) acquisition & Analysis (Mitsar’s WinEEG). Below: Comparison of captured EEG with a database of expected values. (SKIL database - Sterman Kaiser Imaging Laboratories). Below: Training 2 channels of EEG using DVD for feedback using TAG Sync on Thought Technologies ProComp Infiniti. Below: Monitoring and training real-time z-scores (deviations from expected qEEG values) during TAG Sync session.