What is Neurofeedback, and is it right for me?

I first heard about Neurofeedback circa 2012 and barely understood what it was! Since being given the opportunity to train as a practitioner in 2017 I have had many conversations with friends and clients who are wondering what it is and how it works.  This is a compilation of what I know, what I don’t, and what you might want to know if you, your loved one, or (perhaps) your client is interested in a brain-based approach to managing mental health symptoms.

Please note—I am a licensed therapist, NOT a medical doctor!  Any content presented here is for informational purposes only and is not intended to provide medical advice or treatment.  

Biofeedback, Neurofeedback, EMDR, Yoga, Meditation, Massage, Therapy—there are myriad options emerging for individuals and families to take alternative routes to manage symptoms related to various mental health and physical health diagnoses, so how do you sort out what is best for you?

This post will focus on Neurofeedback and hopefully help you start to answer that question for yourself!

What is Neurofeedback?

  Neurofeedback is a therapy that uses EEG (electroencephalogram) technology to provide nearly real-time information to the brain about what it is doing to enable the brain to increase self-regulation.  The process typically uses electrodes placed on the head to collect information on the brain activity and then this is transmitted via audio-visual and/or tactile (physically experienced) feedback, often in the form of watching a movie or images on a screen. It is not presented as a cure, but as an adjunct tool to help that particular brain perform at its best and often with a goal of assisting in symptom management.  It has many applications, but was first used in humans with epilepsy with effective results (p. 44, 46-47; A Symphony in the Brain) and then spread into other diagnoses.  My clients typically seek Neurofeedback to help manage mental health diagnoses such as Anxiety, ADHD/ADD, PTSD, Depression, addiction, and Autism Spectrum Disorder. Providers also use Neurofeedback to treat issues as broad as sleep disorders, physical pain, bed-wetting in children, Parkinson’s, dementias, to improve peak performance in athletes, and many, many other conditions.

It should be noted, Neurofeedback is not represented as appropriate to be used in lieu of necessary medical treatment.  Medications and/or other treatments should not be stopped or changed except as advised by your medical doctor.

How does it work in the brain?

At present, we are not precisely sure how Neurofeedback has an impact. There are various theories ranging from it being a process that teaches the brain to increase/decrease certain types of brainwaves to the results having to do with how the brain sends signals, but as of yet we do not have a clear answer.

Is Neurofeedback just a placebo effect?

Even though we don’t fully understand HOW it works, there are reasons to believe that it is more than just placebo.  The first reason is that it works in animals as well as in people.  While humans have reasons to want their goals to happen, animals do not share that drive and yet have demonstrated the ability to show changes in types of brain waves they are producing based on the feedback (p.43, A Symphony in the Brain).  Secondly, not all results of Neurofeedback are in line with the client’s goals.  A client may have symptoms return if settings are wrong, may get too energized or too slowed down, etc.  If it was only a placebo, we would expect to see similar results regardless of what we did.  That being said, double blind studies are difficult with this modality and so the research has been done via different types of studies. 

What will my provider do in a session?

While there are several different approaches, all will use some combination of the following aspects.  Electrodes are placed on the scalp and forehead to capture brain wave activity, a way to show that to the brain (often through watching a video or playing a video game), a knowledgable provider to assess the client’s needs and develop a plan, and ways to assess and re-assess for progress.  An electrode is a small receptor attached to a wire which transmits back to a machine.  These are electrodes like those used in sleep studies and for EEG (electroencephalogram) readings that are done by medical doctors and can be medical grade.  While not necessarily all are, in general the equipment used in Neurofeedback is FDA regulated.  During a session you will likely be sitting or reclining comfortably in a chair that faces the feedback via a tv or computer screen.  Your provider may or may not be in the room depending on the approach. 

If you are working with me, you will be the only client in the room.  Our sessions will involve checking-in on how you have been since the last session, discussing any observed symptom changes, placing the electrodes, and then 30 minutes of training. 

Initial sessions take about an hour to complete all tasks, over time they shorten to about 45 minutes.

What will I experience in a session?

Neurofeedback is an individual experience because all brains are unique.  The approach I use is symptoms-based, which means we will adjust based on what you are experiencing in and after the sessions. You may experience a variety of physical sensations (calming/tensing, emotional changes, changes in energy level) during a session but not everyone does.  I talk to you about what you might expect based on your symptom profile, but there is not a “right” response to Neurofeedback in my world!  If you have a highly sensitive nervous system, then I do expect that we will need to work a little more slowly and precisely.  

Does everyone use the same settings?

During the initial 7-12 (approximately) sessions we will be working to identify your ideal settings, which is called a protocol.  Settings have to do with where we place the electrodes and what types of brain waves that will best benefit you (this is also called your optimal frequency).  Your brain’s ideal setting is where you are able to feel simultaneously calm, relaxed, and alert.  This may be seen in session or in changes over the next few days.  Some may notice changes in sleep, differences in intensity or frequency of emotional reactions, a lasting sense of calm, and other changes.  From your assessment we will be tracking a handful of symptoms to help us hone in your personal settings (called a protocol).  As we see (or do not see) progress towards your goals we will adjust as needed. 

There are no true “side effects” of Neurofeedback, but during the process of protocol development you may experience an increase of the symptoms you are seeking to better manage. If this happens, it shows us that 1) your brain is aware and responding to what we are doing and 2) guides us towards better settings. Communication is key! Always tell your provider promptly if you are seeing an increase in unwanted symptoms so that adjustments can be made and those symptoms can be addressed.

How often will I do Neurofeedback?

In the beginning, an ideal session frequency is 2-3 times a week.  The effects of a session will last around 24-48 hours and over time you should see a longer lasting impact.  Once the session impact is longer, sessions can be spaced out until the client has achieved their goals.  At this point, a client may choose to end sessions or move to being seen only when symptoms flare up.

Who can Neurofeedback help?

Because of the passive nature of Neurofeedback it can be effectively utilized with people of all ages, in some cases it has even been used with infants!  The majority of those who utilize Neurofeedback are children of school age up to adults.  The method can also effectively be adapted to benefit individuals with auditory and visual impairments. 

Can MY kid do Neurofeedback?

You may wonder if your energetic, wiggly, or perhaps anxious/overly cautious child will be able to handle having electrodes put on their head and sitting still for a half an hour.  As each child is unique there is a bit of trial and error, but in general children become engaged with the feedback and are able to stay still enough to benefit.  If there is a tendency to touch the electrodes or otherwise fidget the child can be given a small toy to play with to engage their hands, the child can stand during the session, or we will get creative and find what works!  Many children end up enjoying the sessions even if initially cautious.

Is it ok to do Neurofeedback and…?

There are no hard and fast reasons a person can’t do Neurofeedback, however, there are times when the timing is not right or other factors need to be ruled out prior to starting.  In general, you should not start multiple forms of therapy at the same time, regardless of what is being addressed.  If you are starting a new medication or other therapy, then ideally that will begin before trying Neurofeedback or after you know how Neurofeedback impacts your brain.  For each of these tools to work their best, your providers need to be able to clearly see their individual impact on you.

If there is a question of an unresolved medical issue, that should be explored first.  Outside of these considerations, Neurofeedback can be effectively used at the same time as medication, therapy, occupational therapy, chiropractic, and even other related approaches such as sound therapy.   

Who provides Neurofeedback?

Neurofeedback is provided by individuals trained in the method who may be considered practitioners themselves or who are operating under the license of a trained professional such as a medical doctor.  Each Neurofeedback approach will have its own way of deciding who can provide the services.  Commonly though, it is provided by licensed professionals such as Professional Counselors, Nurses, Chiropractors, and Medical Doctors.  

Is there Certification for Neurofeedback?

Yes, there are certifications but at present practitioners are not required to obtain one.  I am certified in the Othmer Method, a process that requires self-led learning, 400 hours of experience, 10 hours of coaching, 3 in-person courses, and a minimum of 30 hours of personal Neurofeedback.  Another common certification is via the Biofeedback Certification International Alliance.  Their requirements also include coursework, a test, personal experimental hours, 100 client hours, and 25 supervisory hours. 

Is Neurofeedback permanent?

Neurofeedback is not represented as a cure for any issue, but typically clients see goal progress around 20 sessions and some aspects of the training may become permanent at this point. This does not mean the symptoms you struggle with never return, but rather the goal is that over time the symptoms are some combination of less severe, more infrequent, or when they appear the you are better able to manage them. 

EEG info’s website additionally explains some of the nuances of this by noting that for general disregulation issues in the brain (anxiety, sleep disorders), there is a certain permanence but for degenerative conditions (Parkinson’s, dementias) ongoing training will likely be necessary.

What is a Neurofeedback Intensive?

For some clients it is difficult to do weekly sessions due to travel and time commitments.  This modality can be done as often as 3 sessions daily, though practitioners rarely do more than 2.  If a fit for the client, providers may offer an intensive approach where the client can complete multiple sessions daily for a set period of time.  The sessions are evenly spaced throughout the day to allow time to see the session impact and make any needed adjustments.  If you are interested in this type of approach, please note this when you fill out the contact form and I will be happy to discuss if this is a fit for you.

Should my therapist and I discuss adding Neurofeedback?

  As a therapist, there are periodically times that I have to consider if something else needs to be added to my client’s work.  Neurofeedback typically comes up if you are struggling to make progress or have stagnated with your therapy work while still needing healing.  For some individuals there is a need to work through trauma but it is too hard to do so via the therapy process, for others there have been years of therapy but there is a stuck point in the progress.  In the same way that there comes a time to discuss an intervention like a medication for anxiety or depression, this is another tool that can be added. 

How do I find a provider?

Well, you’ve found me! If you are interested in a discussion about your specific situation, please reach out via my contact page and set up a free consultation. If my location, services, etc. are not a good fit for you, you can often identify providers via services such as Psychology Today. In Georgia, the Biofeedback and Clinical Neuroscience Association has a listing of practitioners here.

Honey if you love me–please smile!

In middle school I remember many parties where we entertained ourselves by playing the game “Honey if you love me—please smile!”  The game consisted of the person who was “it” going around the circle repeating that phrase in hopes of getting someone to crack a smile—while the circle members did their best to resist.  Though simple, a good deal of strategy was employed in choosing the circle member to approach—who giggles the easiest?  Who can’t resist laughing at a funny voice?  Who will lose their cool if I’m 2 inches from his or her face?

As we approach Valentine’s day and our thoughts turn towards the relationships in our lives I wonder how many out there are playing “Honey if you love me—please smile!” on a day-to-day basis?  I don’t mean playing games with those you love, but rather trying to identify and manage the emotions of those close to you.  This is different than noticing when a friend or loved one is feeling up or down and responding accordingly, instead I mean when the focus is primarily on the other person to the neglect of noticing your own emotions.

Sometimes when a child grows up in a home full of chaos, perhaps due to a parent struggling with addiction or active abuse in the home, he or she learns to read the emotions of the adults in the family and seeks to manage their emotions.  This is a self-protective coping mechanism which can be vitally important at the time—if the child’s father is drunk when he comes home, for instance, the child needs to be able to sort out whether it is safer to stay out his way or engage and placate him.  However, the coping mechanisms we rely on in a survival mode, can turn into a hindrance once we are in safe and healthy relationships.

Still, you may wonder how being aware of the emotions of others can hurt.  As I noted, it’s ok to notice how those around us are feeling—but does it allow you to not pay attention to your own emotions?  Do you ignore your own bad day in order to run over and fix someone else’s?  The danger here is not as much being aware of others as allowing that to replace being aware of what you are feeling.  When we ignore our own emotions and needs it opens us up to having our boundaries violated, not caring for ourselves when needed, and potentially depression and other mental illnesses.  If you find yourself rushing to identify the emotions of those around you, take a moment to consider what you’re feeling at that moment.  Can you identify your own emotion?  Is it difficult to identify?  Do you feel guilty acknowledging how you feel?  Those who answer yes, may be struggling with codependent patterns in relationships.  Next time we will more closely define codependency and consider another way it shows up—when our caring for others becomes caretaking.  See you then!

What type of freedom do you choose?

These days we typically think of ourselves as “free” in our choices and how we live our lives.  However, for those struggling with mental illness and addiction the idea of freedom is often shaped by years of twisted thinking and recovery can seem an insurmountable obstacle due to fears of additional failure and the simple unknown.  Freedom sometimes comes to be seen in staying in the known entity of depression or addiction, choosing to be bound.

In these conversations I am often reminded of the following quote from Margaret Atwood’s A Handmaid’s Tale:  “There is more than one kind of freedom…Freedom to and freedom from.  In the days of anarchy, it was freedom to.  Now you are being given freedom from.  Don’t underrate it.” (p.24).  The quote is in a recollection by the main character of how her now fully controlled society was presented as she and other women were indoctrinated into their new profession as “Handmaids.”  The book is a first person narrative from a woman known as “Offred” (Fred being the man whose handmaid she is).  She shares this quote early in the book while considering the sharp contrast of the current society to her own past, when women lived in fear of rape or attack by men–a problem her society has “eliminated” by introducing extreme control.

This line always stood out vividly for me as a perspective on the different freedoms that one gains by avoidance vs. license.  In Offred’s current world, she is free of the fear of sexual violence, but lacks the freedom to be in any other type of relationship with men than as a handmaid (and faces serious consequences if she breaks the law).  In some ways she has adjusted, but when she is given a new taste of “freedom to,” she clings to it desperately.  As noted, the idea of “freedom from” becomes tempting for those dealing with mental illness, particularly when individuals become discouraged and begin to wonder if the fight is worthwhile.  There is a type of safety in the known aspects of the sadness, anger, fear, or broken relationships.  That perceived safety makes the unknown of change appear to be an overwhelming risk, leading to thoughts along the line of “at least I know what each day will bring if I stay here.”  The struggle with the illness can seem more daunting than the illness itself–particularly when the depression, etc. has been a part of daily life for many years.  Individuals can be tempted to draw back in to the pain and dysfunction, knowing they are losing other options, but choosing freedom from the struggle.

Returning to our example, Offred is torn at various points between the safety of status quo and her internal desire for a different type of freedom.  Ultimately, her desire draws her into the danger of pursuing it.  Likewise, though the struggle was difficult, I have yet to meet the individual who has tasted freedom from addiction or mental illness and was hoping to return back into the pain and bondage of the past.  Is a change scary if you have lived with this way for many years?  Absolutely!  Will working through your issues ensure you a perfect life?  No.  But it comes with the benefit of being able to experience life in a more full, connected, and (hopefully!) joyful way.

So what is the big picture?  No matter what your story is, there will be points where you will have choices about whether to press forward towards the hope of healing or to retreat into the familiar emotions and coping skills of the past.  There are certainly appropriate times for “freedom from,” but my hope is that you will trust those who have gone before you that change and healing ARE possible.  Change is not instant, easy, or even a straight line progression, it will have times of mistakes and feel strange, but a life with a healed outlook and managed illness is a worth fighting for.

 

Finding Your Quiet Space

What draws you to what you read?  I found myself pondering this with my nose stuck in Alexander McCall Smith’s latest 44 Scotland Street novel.  The books are quiet, winding stories around 10-12 characters who all live in Edinborough, Scotland.  They offer escape by allowing the reader to lose him or herself in the small-scale dramas of a “stolen” teacup or lying little girls in the schoolyard.  Problems and complications abound, but so do growth, restoration, and eventually solutions.

The book creates a calm and warm space, allowing a respite from the many true evils and tragedies in our world.  This is increasingly necessary due to the barrage of information our world daily places in front of us.  Even social media, which once revolved around sharing photos and connecting with friends, has become a highly efficient way to spread information about causes, issues, and seemingly unsolvable problems.  I would guess that for many, this barrage leads to anxiety and sadness over an overwhelmingly complicated world.

At times when anxious and depressive thoughts begin to well up beyond what is manageable, it is helpful to remember that the world is always full of pain and anger and you can choose how to engage.  Taking a time-out from the things that breed those thoughts does not mean that you don’t care or won’t do something in the future.  Be free to shut down facebook/twitter/Pinterest, etc. for a day or two and do something renewing.  Read a book with a happy plot, journal, go for a walk in nature, play with a pet, watch a funny movie.  Find what gives you encouragement and strength in order to re-engage with the realities of a broken world.

For me, engaging in a story that I know will eventually lead to (most) all being right with the world helps me build a space for quiet and renewal–what will your space look like?

A Very Stepford Life

Facebook.  Pinterest.  Twitter.  Blogs.  We have become adept at remotely keeping tabs on our peers–and our peers have become adept at presenting us carefully edited versions of themselves, their relationships, and everything else.  Logically we know we are seeing mere snapshots of a life but we still buy into the fantasy and and can become bitter over our own lack of perfection.

Speaking of perfection, do you remember the premise of  Ira Levin’s “The Stepford Wives”?  The story is fascinating and terrifying as it chronicles the strange town of Stepford where all the women eventually become single-minded, beautiful, meek versions of themselves, wholly focused on cleaning their homes and catering to their men.  We know little of the men’s actual thoughts on the process, but we do see that they actively submit their wives to this transformation (the book is unclear on what must be done to achieve the result) but we do see them walking through a process of increasing dissatisfaction with their wives.  The process seems to start when the local illustrator draws a picture of the woman, presenting her as a flawless version and creating a “blueprint” for who she will become.  From there, the men slowly separate sexually, emotionally, and with their time as they put the blocks in place to achieve their goal of having the “perfect” wife.

As I read the descriptions of the transformations I found my mind wandering to the potential blueprints of ourselves we alternately pine after and project on our social networks. We rush to pin and share pictures of perfectly manicured homes, clothing, and tips to become ever more the domestic goddess/fantastic parent/perfect wife and so forth.  Has the Stepford fantasy become something we confuse with reality?

In Levin’s tale, the men become enamored with a fantasy over a real, flawed relationship and life.  It is easy to fall into that both in our relationship with ourselves and with others.  So much perfection is presented to us as being attainable it becomes easy to become angry with ourselves when we don’t measure up.  We are now the ones drawing the picture of who we should be and (figuratively) killing ourselves to achieve the fantasy.  That dissatisfaction can spread into our other relationships and show up in frustration when the people around us don’t conform to the life we are trying to create.

There isn’t anything wrong with striving for improvement (sometimes it is needed and achievable), however, when that striving causes us to resent the mixed bag of messiness and happiness that make-up healthy relationships things are heading down a slippery slope.  (Please note, I am not addressing the need for change in relationships with unhealthy patterns, but individuals in basically healthy relationships.)  While I doubt any of my readers would replace their spouse or child with an animatron in pursuit of perfection, we can often lose out on enjoying the good things in our relationships because of our desire for perfect things.

If you find yourself on the dissatisfaction slope, perhaps it is time to stop looking at the imperfect that surrounds you and focus on the good.  Complement yourself.  “Catch” your spouse being helpful and thank him or her.  Remind yourself that children’s noise and messiness can be a sign of a happy and active imagination. True satisfaction does not come from perfection but from embracing the good within the natural flaws of life.

So, next time you look at an image of a perfect house/child/body and begin to regret your own life, remember that perfection is rarely reality and consider its potential price.

 

A Picture of Waiting–Rebecca Rodgers’ “Between the Academy and a Profession”

My website header refers to the unexpectedness of life and recently mine has had a few twists and turns of its own.  I’ve found myself with less energy for writing and not enough time for reading!  Consequently I’m going to cheat a little today and direct you to an article I came across via a friend’s facebook wall that beautifully encapsulates the alternating pain and hope of times of waiting.  Rebecca Rodgers (author) writes from a perspective of Christian faith about her emotional struggles on the road to finding work, but her experience applies universally to anyone who has found themselves doing everything they can and yet coming up empty.  Rodgers also discusses how her faith has sustained her through this process and comes to some encouraging realizations for other Christians.

Take a moment to read her story.  For those in a similar place, be encouraged that you are not alone.  For those who are walking alongside friends in this place, take away insight into the journey of waiting.

http://www.intervarsity.org/gfm/well/resource/between-academy-profession

 

No more foolin’

Well, I hope that you enjoyed a little light-heartedness for April Fools!  Sometimes laughter is as good as any medicine or therapeutic technique.  Thankfully the Sesame Street Intervention Gang retired after yesterday and we return to just enjoying the show.  We’ll be back to business as usual later this week–I think I promised additional Hunger Games postings!

Hope your April is off to a happy and healthy start!

Notes from the Sesame Street Therapy Room (part 2)

The Sesame Street intervention posse has struck again.

The Count was found counting the stones in his castle for the 10th time today and his friends were concerned that perhaps he is taking his love of counting too far.  The Count agreed to talk with a counselor, but insists that he simply LOVES counting and has been living this way happily for centuries.

Count Von Count

  • Hair Color—Black
  • Eyes—Black
  • Age—Unknown
  • Presenting Problem—Counting Compulsion
  • Assessment—The Count has a strong compulsion to count all objects around him and to create songs about what he is counting.  He sometimes speaks to people who are not there and has melded these delusions into his compulsion.  The delusions seems to also spur the compulsion as he insists that he must continue counting to “teach” the “children” he says are watching him.  It is not yet known what disaster he believes may happen if he ceases to count to song, but that will hopefully be discovered during therapy.  We plan to explore his beliefs about being watched to see if he fears some retribution should he stop counting.

Yikes!  Sounds serious–though perhaps some folks on Sesame Street are getting too excited about sending people to counseling 😉

Notes from Sesame Street’s Therapy Room (part 1)

Well, it has happened.  Cookie Monster has eaten up so many items that his friends suggested he be psychologically evaluated.  Here is the report on his condition:

Cookie Monster:

  • Hair color—blue
  • Eyes—black, tendency to roll around in his head, rule out seizure condition
  • Age—mid-forties (approximate)
  • Presenting Problem—Binge eating of cookies and other foods, lack of control with eating, occasional memory loss.
  • Assessment—Cookie Monster appears especially triggered to binge eat when presented with stimuli related to cookies.  He has been conditioned in recent years to additionally consume vegetables, but this does not appear to have dealt with the problem of binge eating.  Additionally, when he is unable to obtain the object he desires to eat he seems to go into a fugue-like state where he resorts to Pica (eating of non-food items) and will eat whatever item is in his hands at the time.  After this state has ended, he has no memory of where the object went.  It is recommended that he embark on serious psychoanalysis to get to the root of his love for cookies and how he is compensating for other problems by binge eating.  Further exploration will be needed to understand the fugue states.

 

Poor Cookie Monster!  Let’s hope he improves soon. Who will Sesame Street have evaluated next??  😉

Brief thoughts on Almond’s “Why Talk Therapy is on the Wane and Writing Workshops are on the Rise”

I came across this article today via Psychology Today’s twitter feed.  Sometimes I just re-tweet the interesting articles I find, but I wanted to add some additional commentary.  Steve Almond writes in his article “Why Talk Therapy is on the Wane and Writing Workshops are on the Rise,” about the growth of interest in creative writing in the last two decades and his own cathartic experiences as he began to explore his inner world through writing.  He highlights the wonderful aspect of literature as an exploration  of experiences and struggles of the author–perhaps not his or her exact struggles, but often linked to personal experience.  The demonstration of someone else’s struggle is why I find the books and articles I bring to you to be so rich for exploration as they provide a mirror of individual’s own struggles.  The hope being that it will lead to personal reflection.

As a trained counselor, I would point out that the history of counseling is broader than simply talk therapy as described by Almond, and there are actually many modalities (psychodrama, empty chair techniques, letter writing/journaling, among others) used alongside the “talking cure” of the therapy room.  However, I enjoyed his exploration of the cathartic and healing aspects of writing.  I hope you take a moment to read, enjoy, and consider what needs exploring in your own life–whether in the counseling office or on paper!

http://www.nytimes.com/2012/03/25/magazine/why-talk-therapy-is-on-the-wane-and-writing-workshops-are-on-the-rise.html?pagewanted=1&_r=1

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