|
What is Biofeedback?
When Mary Obringer and her husband adopted a five-month-old
South Korean baby in May of 1987, she knew immediately that
something was wrong. "He developed slowly," Obringer says
of the infant, whom they named Max. "He had speech disabilities,
motor skill problems, social problems. He was hyperactive
and had trouble concentrating." As a toddler, Max couldn't
be in a large group of people without getting violent -- hitting,
kicking, and screaming. By the time he started kindergarten,
in Jackson, Wyoming, "It was clear right away he wasn't going
to be able to stay." Even after doctors diagnosed the boy
with attention deficit disorder (ADD) and put him on the drug
Ritalin, Max's condition still required that he be in a special-education
classroom. The family's frustration level was reaching a peaking
point. And then they met psychologist Michael Enright.
Enright, a member of the oversight board of the American
Psychological Association, told Obringer he knew of a treatment
that might help her son. The treatment was EEG biofeedback
-- a promising new approach than teaches patients to consciously
recognize and control their own brain-wave patterns.
Obringer was more than willing to give it a try. Twice a
week for the next six months, she brought Max to his thirty-minute
treatments in Enright's small, darkened EEG room at the Jackson
hospital. At the start of each session, Enright would dab
globs of conducting paste on Max's scalp and attach two electrodes
to amplify his brain waves, which were displayed on a computer
screen. A second machine was set up to run a variation of
the popular video game Pac-Man. Instead of using buttons or
a joystick, however, Max would play this game with his brain
waves alone. Whenever he generated certain patterns associated
with alert concentration, the little yellow monster would
gobble his way around a maze to reward him. And the more he
played, the better his technique became: As the weeks went
on, Max became something of a pro at generating those focused
brain waves.
Today, Obringer believes that EEG feedback has worked wonders
for her son. "We started seeing immediate results," she recalls.
"Within a couple of weeks he could sit in a chair and not
fidget." The violent outbursts stopped, too -- "no kicking,
no hitting, no fighting," his mother says with relief. And
though he still needs to take Ritalin, Max has begun to spend
part of every day in a regular classroom. "He's like every
other kid," she concludes, gratefully.
Max is one of a growing number of people turning to EEG biofeedback
-- a cutting-edge, if controversial, treatment used to relieve
a host of health complaints, both mental and physical. Though
some forms of EEG biofeedback have been around since the 1970s,
today researchers and practitioners are directing the technique
toward more than alleviating anxiety and stress. Problems
as diverse as closed-head injury, alcoholism, and learning
disabilities are being addressed by teaching people to consciously
change the rhythms in their own brain. "The field is just
exploding," says Joel Lubar, a professor of psychology at
the University of Tennessee and incoming a president of the
Association for Applied Psychophysiology and Biofeedback (APB),
the professional association that represents the biofeedback
field. Indeed, the Association has seen the number of EEG
specialists in its membership grow from a handful a decade
ago to a full 500 of its 2,300 members today. Among them are
psychologists, nurses, physicians, and educational specialists
variously affiliated with hospitals, clinics, university research
centers, and doctors' offices. All of them practice a treatment
that would seem the ultimate in self-healing: training the
brain to fix its own disorders.
REPROGRAMMING THE BRAIN
By broad definition, the term biofeedback refers to the process
in which subtle information on how a person's body and brain
are operating is amplified and shown back to that person.
Simple devices measuring muscle tension and body temperature,
for example, help people learn to regulate their blood pressure,
temperature, and other physical and mental processes not typically
under their conscious control. Many forms of biofeedback are
now well established as treatments for stress related conditions
such as migraine headaches and chronic pain. Today these types
of biofeedback are not only practiced at such bastions of
main stream medicine as the Mayo Clinic, but are increasingly
being paid for by insurance companies as well.
The branch of the field known as EEG biofeedback has remained
more controversial. Indeed, only in the last few years has
this approach attracted widespread research interest or clinical
use. Its premise: that many conditions -- from learning disabilities
to depression to panic attacks -- can be helped by teaching
patients how to alter their brainwave patterns.
In a typical EEG biofeedback session, electrodes are placed
on the scalp to pick up brain-wave activity ("No electricity
goes into the brain," one practitioner told us reassuringly.)
The brain wave information is then fed into a computer which
translates its patterns into a user-friendly display on the
screen -- a game showing cars speeding along a highway, say,
or small squares whose size and color can be changed. There's
only one catch with these computer games: You can't use your
hands. Instead, the object is to try to manipulate what happens
on the screen by mind power alone.
While this kind of no-hands Nintendo may sound impossible,
practitioners say that, through trial and error, users can
actually be trained to increase and decrease their brain waves
at will. "It's like learning to ride a bicycle: You learn
by experimenting," says one. (EEG biofeedback therapy, used
to induce brain waves associated with relaxation is a simpler
process: Electrodes are attached to devices than emit audible
tones when the person gets into a relaxed state.) Sessions
typically last from forty-five minutes to an hour, and an
entire treatment program can take from ten to sixty sessions,
depending on the condition being addressed. Where other forms
of biofeedback aim to teach people a skill they can call upon
in specific situations -- for example, learning to relax deeply
to head off an impending migraine headache -- EEG biofeedback
may have a more enduring goal: to "retrain the brain" so it
gets in the habit of producing healthy brainwave patterns
on its own thereafter.
ALPHA WAVES FOR ADDICTION
To appreciate the different ways EEG biofeedback is being
applied today, it helps to understand some brain-wave basics.
The brain continuously produces combinations of four distinct
frequencies, or speeds, of brain waves -- delta, theta, alpha,
and beta -- and our state of consciousness depends on which
of these waves is dominant. When we sleep, delta waves take
over, with their slow-moving signals traveling at up to 4
cycles per second, or four hertz (Hz). Slightly faster are
theta waves (4 to 8 Hz), associated with the twilight consciousness
on the brink of sleep in which dreamlike mental images can
surface. Above theta is alpha (8 to 12 Hz), the calm and mentally
unfocused state typically connected with relaxation. In our
normal waking state, when our eyes are open and focused on
the world, beta waves are in charge. Within beta itself, scientists
recognize a range-from low beta, a relaxed but alert state
of 12 to 15 Hz, to the excited, anxious state of high beta,
which can climb as high as 35 Hz.
Much of the early interest in EEG biofeedback focused on
helping people learn to generate waves associated with deep
relaxation: alpha and theta. Alpha-theta biofeedback was pioneered
in the '70s by Elmer and Alyce Green of the Menninger Clinic
in Topeka, Kansas -- still a leading center for biofeedback
research -- and Joe Kamiya, a researcher in San Francisco.
The researchers found that if biofeedback users were alerted
with an audible tone when they generated sufficient alpha
waves, the subjects could, in just a session or two, get into
a deeply relaxed state -- a state as deep as that reached
by people who'd meditated for years. Today, alpha training
is commonly practiced to reduce stress and anxiety and to
help manage pain.
Recently, however, researchers have begun studying some surprising
new applications for alpha-theta training. In one provocative,
if small-scale, 1989 study, Eugene Peniston, a clinical psychologist
then of Fort Lyon Veterans Affairs Medical Center in Fort
Lyon, Colorado, gave ten chronic alcoholics thirty sessions
of biofeedback training focused on boosting their alpha and
theta waves. A second group was given conventional treatment,
including participation in a twelve-step program and antidepressant
medications. As part of what has since become known as the
"Peniston protocol," alcoholics in the first group were coached
in basic relaxation techniques, trained to boost their own
alpha-theta waves, and led through visualization and imagery
exercises (such as scenes in which they saw themselves refusing
an offered drink). Counseling was also provided to help subjects
work through any images and feelings that might surface. At
the end of a month of treatment, the biofeedback trainees
achieved an unprecedented 80 percent abstinence rate, compared
to 20 percent in the conventional group. What's more, when
the trainees were followed up five years after treatment's
end, their recovery rate remained an impressive 70 percent,
having declined by only 10 percent.
What's to account for the dramatic shift? Alcoholics before
treatment have trouble reaching and staying in the alpha state,
where "self soothing" neurotransmitters are produced, theorize
researchers. Often they turn to alcohol as an artificial means
of inducing this state of relaxation. But as biofeedback treatment
progresses, and those self-soothing neurotransmitters begin
to flow, the craving for a drink may be reduced.
Another possible reason for biofeedback's effectiveness is
that it can help subjects stay in a theta, or hypnagogic,
state for a sustained period of time. While people pass through
theta on their way to sleep every night, they quickly move
on to delta. "EEG helps people linger in theta," says Dale
Walters, of Topeka, Kansas, who conducted biofeedback ar the
Menninger Clinic and is currently working to set up a six-week
outpatient biofeedback program to treat addiction in Kansas
City, Missouri. In a theta state, says Walters, childhood
memories and buried emotions bubble spontaneously to the surface.
With the help of a psychologist, he says, such associations
can often be worked through. "Those experiences lead to unblocking
of intense emotions," says Walters.
Peniston's treatment is slowly beginning to make inroads
into clinical settings. In Topeka, Kansas, the Life Sciences
Institute of Mind-Body Health now offers an intensive outpatient
program that includes seven weeks of two-and-a-half hour daily
alpha-theta training sessions, coupled with intensive psychotherapy.
According to Carol Snarr, a registered nurse and biofeedback
therapist at the Institute, the program has so far treated
not only alcoholics but also drug addicts, people with eating
disorders, even smokers, some of whom have come across the
country for treatment. "It is truly a way to integrate body,
mind, emotion, and spirit," she says. Over the next few years,
the Institute will be following patients' progress as part
of a long-term follow-up study on Peniston's findings.
Helping ADD Children Focus
If this dreamy theta state is a boon to alcoholics, it's
a bane to children who suffer from attention deficit disorder
and attention deficit hyperactivity disorder (ADHD), according
to Joel Lubar, a professor of psychology at the University
of Tennessee. For more than two decades, Lubar has studied
biofeedback's applications with ADD and ADHD children and
adults, publishing his findings in such leading medical journals
as the Journal of Pediatrics and Pediatric Neurology. Lubar
has found that many children who suffer from ADD and ADHD
have brain-wave patterns high in theta and low in beta --
the latter waves being associated with alert concentration.
As a result of such brain-wave imbalance, these children can
go through life prone to daydreaming and unable to focus their
attention. Lubar says he has treated hundreds of children
with these two disorders, using a treatment protocol typically
aimed at boosting beta waves and decreasing those theta waves.
"Once they can control their minds, their native intelligence
comes out, and their self- worth increases," he says. Follow-up
studies on these children, notes Lubar show significant increases
in academic and behavior scores: Some can leap as much as
two and a half years in grade level achievement and boast
IQ increases of as much as 15 points. Thank in part to such
work, treatment of ADD and ADHD is one of the most widely
accepted applications for EEG biofeedback, says Francine Butler,
executive director of the AAPB.
Healing Head Injuries
EEG biofeedback is also offering hope for a condition
finding little help through mainstream medicine: mild closed-head
injury. These injuries result when the brain bangs against
the inside of the skull, causing bruising and impairing the
ability of the neurons to fire properly. Symptoms can range
from the psychological (flaring tempers, mood swings, irritability)
to cognitive (short- term memory loss and confusion) to physical
(headaches, nausea, blurred vision).
Psychologist Steven Stockdale, director of the Neuro-Health
Center in Colorado Springs, Colorado, is one of a small number
of clinicians across the country currently using this modality
to treat the head-injured. After giving his subjects a battery
of neurological tests to determine which parts of the brain
have been damaged, Stockdale hooks them up to an EEG biofeedback
machine to help them work toward trying to normalize brain-wave
activity in the damaged area. "It's a little like going to
the gym for your brain," he says. Exactly why such treatment
might work is still a matter of debate. "One of the theories
is that EEG biofeedback may help bring about increases in
`dendritic growth' or new connections in that area," Stockdale
says.
Even while the mechanism behind the treatment remains unclear,
results have been promising. Recently Stockdale concluded
a three-year-study (as yet not published) involving his patients'
progress. According to Stockdale, these subjects started treatment
two to four years after sustaining their injury -- past the
period when any spontaneous recovery would be expected to
have occurred. `About 80 percent of the people we work with
learn to do the feedback," says Stockdale. "Of that 80 percent,
there's a 75 to 90 percent reduction in symptoms. They clear
up."
Epilepsy and Beyond
Those on the cutting edge of this twenty-first century
treatment believe its potential applications may be unlimited.
Currently, researchers are studying EEG biofeedback for conditions
ranging from premenstrual syndrome to depression to post-traumatic
stress disorder in Vietnam vets. At the Sepulveda Veterans
Affairs Medical Center in California, Barry Sterman, a professor
in the school of medicine ar UCLA and a career scientist at
the Sepulveda center, has had impressive results using the
treatment with epileptics resistant to standard drug treatment.
EEG biofeedback, he says, helps his subjects learn to control
the excitability that triggers seizures along the brain's
motor pathways. Published findings show a 60 percent seizure-reduction
rate in a full 70 percent of Sterman's patients.
Siegfried Othmer -- who founded his Encino, California-based
company, EEG Spectrum, after his epileptic son was treated
successfully with EEG biofeedback -- brims with an almost
evangelical fervor about the therapy's potential. "What's
remarkable about this new technique is that we're not stuck
with the brain we're born with," he enthuses. Othmer's four
California-based clinics have treated some 2,000 patients
-- not only sufferers of attention deficit disorder and anxiety,
but also people with Tourette syndrome, bipolar disorder,
premenstrual syndrome, even stutterers. What these disorders
have in common, he argues, is that they all can benefit from
stabilizing and normalizing brain patterns.
Take the case of Los Angeles writer Margaret Sachs, forty-seven,
a patient at one of Othmer's clinics who underwent EEG biofeedback
for mood swings associated with menopause. "I was waking up
in the middle of the night totally drenched with sweat," she
recalls. "I started waking up at three or four in the morning
as if I were on speed." But after twenty sessions of EEG biofeedback,
designed to teach her to stabilize her brain rhythm, her symptoms
vanished. "I felt grounded in a way I never had before," says
Sachs.
According to Othmer and other proponents, the promise of
EEG biofeedback may not be limited to the sick. Othmer has
worked with professional athletes to help them improve their
ability to focus. Others bring the benefits home with them:
Therapist Michael Enright from time to time pastes the electrodes
on his own scalp. "If I had an article that was due and I
had to have extended periods of mental activity without distraction,
I'd do beta protocol," says Enright. "It's much better than
a cup of coffee." And there's nothing that beats a bedtime
alpha session, he says, to foster a good night's sleep.
This explosion of interest worries some in the field who
believe that solid scientific proof of the effectiveness of
EEG biofeedback has not yet kept pace with the promises of
some of its practitioners. Indeed, while applications such
as ADD and epilepsy do have a growing body of research to
back them up, other applications must still be considered
experimental. "One of the criticisms of this field is that
there needs to be more scientific studies in peer-reviewed
journals -- and I absolutely agree with that," says researcher
and clinician Steven Stockdale, who notes that many such studies
are in fact on the way.
Adds Peter Parks, a biofeedback therapist at the Menninger
Clinic: "It is being used by reputable clinics, but it's still
considered controversial. You'll find doctors who use it and
doctors who are skeptical. In our clinical experience, EEG
biofeedback seems to be helpful." Certainly, with so many
factors unknown, potential subjects should be aware that they're
signing up for a therapy that is still unproven -- especially
if they're anticipating extended treatment.
And in some cases, note experts, EEG biofeedback may actually
be harmful. In its published guidelines, the Association For
Applied Psychophysiology and Biofeedback warns that patients
with a history of seizures should not be treated with EEG
biofeedback unless they coordinate that treatment with their
physician. People suffering from severe mental illnesses --
acute psychoses, major affective disorders, histories of dissociation
experiences, or borderline personality disorders -- also should
undertake treatment only in close conjunction with their doctors.
"If a person has a propensity toward mania and you do this
training wrong, you can put them into mania," cautions Othmer.
"Likewise with depression. In a clinical setting, people know
this and redirect the training."
But even if EEG biofeedback must be considered a brave new
world, for some it has offered relief where more-established
medical practices could not. Ask Mary Obringer. "I can't tell
you how important this is to our family," she says of her
son Max's experience. "Our family was falling apart because
of this. It has turned our lives around."
|
