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Neurofeedback
is often used in the treatment of emotional disorders such as depression, anxiety, Post-traumatic Stress Disorder, Bipolar
Disorder and Obsessive-Compulsive Disorder. The goal is to treat underlying neurobiological
mechanisms that may be contributing to the symptoms of these disorders, which can be done in addition to more traditional
psychotherapies which teach the individual new ways to behave, think, feel and understand their worlds.
In the underlying
neurobiology of the brain, electrical and chemical activity continuously influence each other. The electrical
signals in the brain get transmitted at different speeds or frequencies. These frequencies help
determine our mental state at any moment and affect the chemical signals that the brain transmits. They
range from very slow frequency activity in sleep states, known as delta waves, to somewhat faster, but still slow
activity in semi-awake states, know as theta waves, to more relaxed but not outwardly attentive states dominated
by alpha waves, to more engaged and attentive states characterized by beta wave activity.
For example, in order to maintain alertness, engagement in the outside and a positive mood, there needs to be sufficient
beta activity in the frontal lobes. The frontal lobes are known as the executive parts of the brain, because
they are involved with coordinating and integrating all the other parts of the brain through processes such as attending,
planning, organizing, inhibiting, delaying, controlling our emotional responses, considering long-term consequences, and considering
alternative meanings of information and alternative courses of action. On the other hand, in order to relax
and inhibit feelings of fear and anxiety, there needs to be sufficient alpha activity in the right hemisphere of the brain,
which processes information involving danger. Other parts of the brain are, of course, involved in the
regulation of emotions, and the specific areas of the brain and brain wave frequencies to target vary from individual to individual.
Neurofeedback
works by training the brain to produce more or less electrical activity in selected parts of the brain. In
neurofeedback treatment, we monitor the individual’s brain wave state or EEG in a comfortable and painless way while
the individual sits in a comfortable chair and “plays” a video game-like exercise which is controlled by his or
her brain wave activity. For example, the exercise can be set up so when the individual’s brain wave
activity shows that he or she is increasing beta activity in the left frontal lobe, and inhibiting theta, or another form
of slow wave activity, a pattern which is sometimes trained to treat symptoms of depression, the individual earns points in
the “game” and the action on the screen advances. When the brain wave activity gets out of
the desired pattern, the action in the game stops, and the brain then has to find a way to get back into the desired pattern
to earn more points. The brain does this unconsciously through the individual attending to the visual and
auditory feedback that is provided when succeeding at the game. This is like exercise for the brain, and
the brain learns to produce this pattern on its own.
Since neurofeedback is designed to help the brain regulate itself
better, it is often used to help people with rapidly shifting moods, or intense moods, such as anger and rage.
This is usually done in a way that helps lower the arousal or activation level of selected parts of the brain, or helps
two parts of the brain change their way of working together.
In depression, the brain often needs to be activated more
in order to improve mood and counteract the tendency to withdraw. Furthermore, an active brain is better able to inhibit worrisome
thoughts that seem to be endlessly repeated in the minds of some depressed people. It has been found that,
in some forms of depression, there is an imbalance or asymmetry in the activity of the left and right prefrontal and frontal
lobes, in which the left frontal regions produce too much alpha activity and are, therefore, underactivated, and the right
frontal regions are overactivated. The left frontal region tends to be associated with more positive emotions
and the right frontal regions are more implicated with negative emotions. Neurofeedback training can target
these areas to come back into a healthier balance of activation through training of the brain wave activity in both hemispheres
of the brain.
Anxiety often involves too much activation in parts of the brain. There may be too much beta activity
in the right frontal lobe, in the center of the top of the head, or in the parietal area in the back of the head.
This might account for the agitation, the difficulty keeping one’s mind off one’s worries, and the problems
sleeping often see in anxiety disorders. Neurofeedback training for anxiety often targets different areas
of the brain to lower their level of activation, by training the brain to make less high frequency activity and make more
activity in a middle or low frequency.
Obsessive-Compulsive Disorder might involve several different regions of the brain,
such as the prefrontal cortex, where there might be too much slow wave activity, which might prevent the brain from inhibiting
unwanted thoughts and actions, and subcortical structures between the right and left frontal lobes, which might be overactivated,
resulting in repetitive thoughts, worries and urges. Neurofeedback can target these brain regions to activate
or lower their level of arousal and gauge the individual’s response.
Fear and anxiety symptoms often
underlie the symptoms of Post-Traumatic Stress Disorder, as well as alcoholism and drug abuse, personality disorders,
psychosomatic disorders, medical disorders that might have a strong psychological component, and reactive attachment
disorder. Fear and anxiety are often processed by the right hemisphere, with involvement of
the right temporal lobe (the part of the brain located above and behind the ear), and nearby subcortical structures that process
fear memories and motivate the individual to avoid certain situations that unconsciously remind the person of traumatic incidents.
Neurofeedback training can activate or relax different parts of the brain that might be involved in this fear response,
decreasing automatic emotional reactions that can be quite impairing, which could decrease automatic behaviors such as avoidance
of relationships and dysfunctional ways of self-regulation..
Since different brain regions might be involved in the symptoms
of different individuals, it is often helpful to have a brain map or quantitative electroencephalogram (qEEG) to guide the
neurofeedback treatment. Of course, no treatment works for everyone and there is always a potential risk of unwanted effects
in any form of treatment. That is why we encourage you to discuss this treatment with someone knowledgeable
about the scientific studies and the clinical applications of neurofeedback so you can make an informed choice for yourself
or your child.
Studies that deal with the use of neurofeedback in emotional disorders are the following:
Davidson, RJ (2004). What does the prefrontal cortex “do” in affect: perspectives on frontal
EEG asymmetry research. Biological Psychiatry, 67, 219-233.
Hammond, DC and Baehr, E (2009). Neurofeedback
for the treatment of depression: current status of theoretical issues and clinical research, in Budzynski, TH, Budzynski,
HK, Evans, JR & Arbanel, A (Eds.) Introduction to QEEG and Neurofeedback, Second Edition
Advanced Theory and Applications, Burlington, MA: Academic Press.
Hammond,
DC (2005). Neurofeedback
with anxiety and affective disorders, in Hirshberg, LM, Chiu, S & Frazier, JA (Eds.) Child and Adolescent Psychiatric Clinics of North America: Emerging Interventions, 14, 1, 105-123.
Peniston, EG and Kulkowsky, PJ (1990). Alcoholic personality and alpha-theta brainwave training.
Medical Psychotherapy, 2, 37-55.
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