Comprehensive Neurofeedback Training in the Context of Psychotherapy for Tranformational Change
By Karen Cochrane

A doctoral dissertation submitted to the Dean of Behavioural Health, July 2010.

Six Case Studies Examining the Effectiveness of a Comprehensive Adaptive Approach to Neurofeedback for Attention Deficit in an Educational Setting
By Shannon Warwick, MA

Union Institute and University at Vermont College, Asheville, North Carolina.

The Effects of EEG Neurofeedback and Neuro-Cognitive Processing in the Educational Environment of an Arts-Based Private Elementary | Middle School
By Lise 'DeAndre' DeLong

The purpose of this study was to ascertain measurable differences in academic outcomes among two groups of learners within a creative arts curriculum that employed a self-directed, stress-reduced, and individualized curriculum. One group was provided with EEG neurofeedback and neuro-cognitive coaching for stress reduction, while the other was not. This study measured the rate of improvement in academic progress that a learner can achieve when formalized learning takes place in a stress-reduced arts-based learning environment with EEG neurofeedback and neurocognitive coaching.

Neurofeedback with Anxiety and Affective Disorders
By D. Corydon Hammond, PhD, ABEN/ECNS

Physical Medicine and Rehabilitation, University of Utah School of Medicine, PM&R 30 No 1900 East, Salt Lake City, UT 84132-2119, USA.

Brain-Mind Operational Architectonics Imaging: Technical and Methodological Aspects
Andrew A. Fingelkurts, Alexander A. Fingelkurts

BM-Science – Brain & Mind Technologies Research Centre, P.O. Box 77, FI-02601, Espoo, Finland.

Efficacy of EEG Biofeedback in Addressing Cognitive Dysfunction in Cancer Survivors
By Jean Alvarez, David L. Granoff, Allan Lundy

This study examined the efficacy of EEG biofeedback (neurofeedback) in addressing the cognitive sequelae of cancer therapy, commonly known as “chemobrain” or “chemofog.” Approximately fifty percent of breast cancer survivors exhibit cognitive impairment within three weeks of beginning chemotherapy, and half of those have not recovered one year later. Neurofeedback, unlike compensatory strategies currently recommended by the National Cancer Institute and major cancer centers, has the potential to restore cognitive function.

Effectiveness of EEG Biofeedback as Compared with Methylphenidate in the Treatment of Attention-Deficit | Hyperactivity Disorder: A Clinical Outcome Study
Mohammad Ali Nazari1, Laurent Querne2, Alain De Broca2, Patrick Berquin2

1Department of Psychology, University of Tabriz, Tabriz, Iran; 2Department of Paediatric Neurology, Lab. Neurosciences Fonction- nelles & Pathologies, Amiens, France.

Effectiveness of Neurofeedback Training In Chronic Insomnia
Okunola O,1 O'Malley E,2 O'Malley M2

1 Norwalk Hospital, Norwalk, Connecticut, Norwalk, CT, USA, 2 Norwalk Hospital, Norwalk, CT, USA.

Improvement | Rehabilitation of Memory Functioning with Neurotherapy | QEEG Biofeedback
The Journal of Head Trauma Rehabilitation
December 2000 - Volume 15 - Issue 6 - p 1285-1296

Focus on Clinical Research and Practice, Part 2.

Neurofeedback Treatment for Traumatic Brain Injury

International Brain Injury Association

**Neurofeedback is often also referred to as EEG Biofeedback, NF or NFB.

The Reroute Home: Neurofeedback Helps Vets Find Their Way -

Healing Ben's Brain: Our Adventures in Neurofeedback

Our 11-year old son is very bright and extremely self aware, but he has often floundered in school and sometimes has a difficult time following simple house rules. Evaluations over the years pointed repeatedly to the same conclusion: Ben has ADHD. Attention deficit hyperactivity disorder (ADHD) has been one of the most talked about disorders in the general public for the past twenty years. Like religion and politics, everyone has an opinion about it. The number of children who are afflicted seems to have skyrocketed, not because they truly have ADHD but because the system is quick to label the normally rambunctious or day-dreaming child as afflicted. But Ben's ADHD is very real. We have done something very few people do to confirm the diagnosis. We have looked at Ben's brain. His EEG (brainwave) test has conclusively detected the brain dysregulation of ADHD.

The recognized experts in the field of ADHD have become very precise at describing the syndrome, but very few are looking at the role of brain dysregulation. This is what we wanted to understand. The central feature of ADHD is poor regulation of the brain's arousal state. One way of conceptualizing brain arousal is to think of the intensity of light in a room. Robert Hill and Eduardo Castor expand on this metaphor in Healing Young Brains: The Neruofeedback Solution: The “dimmer switch” of arousal in the brain is located in a part of the brain known as the thalamus. Like a dimmer switch that adjusts light levels in a room, the thalamus automatically adjusts the intensity of arousal for the task at hand.

For a restful sleep, the intensity is turned way down. For reading complicated materials, the switch is turned to a more brilliant level. Most activities fall somewhere between sleep and intense thinking. This is normally done automatically, but in the case of many disorders, particularly ADHD, the set point for the dimmer switch is set too low. This makes it impossible to concentrate, stay on task and complete most tasks. The chronically under-aroused brain will frequently seek stimulation in an effort to compensate for the low arousal. It is like an automatic defense mechanism to help the person stay in the world.

The result is inattention and hyperactivity and all of the related fall-out–the anguish and frustration of academic underachievement, the lack of concerns for the welfare for others, the disregard for authority, etc.

Under-arousal is why stimulant medications like Ritalin have an effect on hyperactive children. It seems paradoxical to give a hyperactive child a stimulant, but what actually happens is that the stimulant wakes up the sleepy brain.

Another consequence of the slow rhythmic activity associated with ADHD is sleep disturbance. Ben has a hard time getting to bed at a reasonable hour or enjoying a good night's sleep. This, of course, makes perfect sense given his brain activity–it is hard to sleep at night if the brain has been semi-asleep all day. As one can imagine, the sleep deprivation only serves to compound matters–elevating frustration, stress and anxiety all around.

The traditional “solution” for ADHD is some form of stimulant medicine to counter the under-arousal. Over the years, Ben was prescribed 9 different medications in varying doses and combinations. Ben responded better to some, but the side effects were discouraging–loss of appetite, mood problems, trouble falling asleep. We tried eliminating gluten from Ben's diet and struggled to curtail his sugar; we increased his level of daily physical activity and tried meditation and yoga instruction–but nothing really normalized his classroom presentation or his home functioning. While medication and diet do help many ADHD children, Ben's case is more complicated– most EEGs of ADHD brains indicate one dysregulation, Ben's has three–Mu activity in the 11Hz, slow wave activity in the posterior region, as well as excesses of slow wave in the temporal lobe regions. The more we learned, the more we understood the extent of the re-tooling that was required. This is why we started asking questions about alternative approaches.

We first became interested in brain plasticity over six years ago when we read Dr. Norman Doidge's book, The Brain That Changes Itself (see related reports). The idea that the brain is not fixed–as had been the widely-held dogma for centuries–but is, instead, malleable and always receptive to re-wiring, despite one's age, was a remarkable “aha” moment for us. It turns out that we have more control over our brains–and subsequently our moods and aptitudes–than we had ever dared imagine.

It was Norman that first suggested we look into neurofeedback to address ADHD.

Neurofeedback is a testimony to brain plasticity–a form of sophisticated biofeedback that actually trains the brain to normalize brainwave patterns.

Biofeedback is one of those terms most people have heard but may not really understand. The reality is that most people hear it, roll their eyes and immediately lump it into the same category as reading auras or balancing chakras. It is still encumbered by “flower child” connotations form the 1960s.

But technology has come a long way in the past few decades, offering up machines sophisticated enough to detect, amplify and record more subtle biological signals.

Biofeedback is also not widely embraced because it requires work. As Jim Robbins explains in A Symphony in the Brain: The Evolution of The New Brain WaveBiofeedback:

Despite solid scientific credentials, biofeedback is an ungainly stepchild in the medical world, primarily because the biofeedback model is very different from that of allopathic medicine. When health problems arise, most people are accustomed to having something done to them: they are given a pill, subjected to an x-ray or an MRI, have their gall balder taken out, or have new arteries made for their heart. Biofeedback requires the patient take some responsibility for his or her own health; it is about learning how the body and mind work and making changes based on that learning. It takes time and patience and a certain level of commitment.

Biofeedback is like eavesdropping on our body's internal conversations. When these inside-the-skin events are detected and fed back to us through electrical signals using sight, sound or touch, we can learn to use this information to change unwanted patterns that are contributing to poor physical or mental health. One of the pioneers in biofeedback was Dr. Elmer Green who spent years studying the remarkable self-regulating talents of India's many swamis and gurus. One of them, Swami Rama demonstrated that he could create a ten-degree temperature differential just two inches apart on the palm of his hand. It took him 13 years to learn how to do this.

The swami would watch the palm of his hand to get his biological feedback, focusing on making the hot spot red and the colder spot gray.When the one spot turned red, he knew that it was hotter that the surrounding area. This was obviously a result of changes in blood flow. But, here's the kicker. Using two temperature biofeedback machines, one of Dr. Green's graduate students was able to accomplish this same task in just two weeks–more than three hundred times faster than Swami Rama. This reinforces the notion that we can change any organ quickly if we provide it with appropriate information.

The same holds true of the brain. Neurofeedback works by nudging and rewarding the brain to make different wave patterns. Teaching by rewarding appropriate behavior is called operant conditioning. With this simple operant conditioning procedure, the brain begins to regulate itself, and undesirable behaviors begin to modify. Epilepsy was the key to understanding this feedback system. There are countless patients with epilepsy who are unresponsive to medication. They suffer dozens of seizures a day. One of neurofeedback's first applications was treating these uncontrollable cases. Neurofeedback technicians and therapists determined that by strengthening a certain brain wave pattern, they could reduce or even eliminate the seizures.

Here's how a neurfeedback session works. The patient is connected to a specialized EEG (electroencephalogram) computer system. One or two electrodes are placed on very specific spots on his or her head to pinpoint specific brain wave patterns–patterns which fluctuate across different regions of brain. By watching a monitor, the patient can see what his or her brainwaves are doing and through training can learn to change dysregulated brainwaves to more functional and flexible brainwave frequencies. The feedback is presented in the form of a beep (the brain knows that beeps are good and wants to make more of them) or in Ben's case, a rudimentary computer game in which he controls the momentum of a skateboard. When Ben's brain operates in the range we are targeting, the skateboard cooperates, jumps ramps and moves forward. When his attention wanes and his C3 alpha moves above its target threshold, the skateboard stops moving.

The changes we have seen in Ben after just 20 sessions–most ADHD cases take upwards of 60 20-minute sessions–are subtle but significant.

The first indication that something was shifting was that he started sleeping better. Then we heard the “yes, moms.” His tutor reported that he was more willing to work. As Ben's brain spends more time in the “paying attention” brainwave threshold, it learns what this state feels like and how to turn it on voluntarily. We are seeing clear evidence of a shift. Ben is aware of it as well.

Unlike medicine that simply masks symptoms of under-arousal, Ben's brain is learning how to change itself, and the changes are permanent. What neurofeedback is showing us first hand and what first excited us about brain plasticity, is that we actually have a great deal of control over our nervous system. We know the brain is active and it wants to learn. But what if it can learn more than algebra and Mandarin, what if it can also learn to pay closer attention, to relax more deeply and to even be more creative?

Prejudices remain and skeptics abound. Dr. Barry Sterman, whose pioneering research at UCLA on neurofeedback is widely viewed as unimpeachable, and who has published more than 150 papers in top journals, has applied for numerous grants to continue research. “But the National Institute of Health will not give us grants,” he said. “We've written solid grants but the minute you use the term neurofeedback certain people's minds snap shut. Sometimes I feel like Galileo.” Opponents of neurofeedback dismiss the wide-ranging benefits as anecdotal or temporary. But the stance that neurfoeedback lacks credible scientific proof–the history of which is outlined at length in Robbins' book–is becoming irrelevant. First, there are more studies showing neurofeedback is having remarkable results assuaging a number of issues ranging from depression to drug addiction.

Second, people are increasingly attracted to it because modern medicine is failing to deal effectively with emotional stress beyond the use of medicine; and third, because a revolution is under way in which people are taking more responsibility for their own health. As Robbins adds: “More people also believe that ’absence of evidence is not evidence of absence'; the fact that there are few rigorous studies of an idea doesn't mean the idea isn't powerful; it means that the science refuses, for whatever prejudices, to study the concept.”

Our limited but positive experience of brain training has us asking many questions. First and foremost, shouldn't we be exploring it for other aspects of our mental health? Or to boost our creativity or our capacity for clearer thought? We are just starting now to educate ourselves about alpha training–the spectrum of brain wave activity between 8- and 12-hertz, which is a relaxed but alert state. (A hertz is the number of cycles per second; the higher the hertz, the faster the brain wave. The human brain normally operates within the range from 1 to about 40 hertz.) As Dr. Les Fehmi, one of the pioneers of alpha training, observes, alpha is critical for stilling the mind so thoughts can be observed. “A person actualizes according to how clearly they can observe thinking,” he said. “The more you can watch thought, the slower it will move and the clearer it will be. That means clear thinking and it opens the door for more creative thinking. Most people are overthinking so much they are shutting the window to the creative process. Alpha is unbelievably powerful for helping a person learn to open the window and keep it open.” A hundred hours of alpha and alpha theta training over the course of a year or two would not only greatly transform the individual, he says, but also transform society.

Dr. Elmer Green, mentioned earlier in relation to his groundbreaking work with biofeedback, advocated the deepest-state training of all, theta, the 4- to 7-hertz band or the twilight realm. In an unusual three-volume set of books–The Ozawkie Book of the Dead: Alzheimer's Isn't What You Think, published in 2001–Green lays out his detailed cartography of spiritual consciousness. Much of it is based on his professed out-of-body travels and his wife's Alzheimer's diseases, which he says is a transitioning of the soul into the “bardo,” or afterlife realm, as the brain disassembles.

Where could we go with alpha and theta training? The hippies and flower children of the 1960s saw a way, with brainwave biofeedback, to change the world– to end war, reduce materialism, improve the lot of the poor, endenvironmental degradation. Maybe that promise is still there on some level.

The brain is really the last frontier. While we have broken the code of our genome and explored the farther reaches of our solar system, we have yet to fully understand the control we have over our own physiology. Should we settle for “normal”?