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The largest documented experience base exists for PTSD among recent combat veterans.32 In a survey of some 300 trainees in the 2009–2011 time frame, about 25% recovered within 20 training sessions. Another 50% recovered within 40 sessions. The remaining 25% either took even longer, or recovered only partially. Recovery meant that symptom severity fell below clinical significance. Some 75 symptoms of dysregulation were tracked. 90% reported recovery from migraines. In 80% of those suffering from depression, scores were cut in half within 2 weeks, or less than 10 sessions. The same was found for anxiety. There was nominally 75% response for most symptom categories. The least responsive symptom was tinnitus, at 50%. These results were presented at a professional meeting but have not been published.
The ILF training can be profoundly helpful for the degenerative conditions, the dementias and Parkinson's, but a broad distribution in outcomes is to be expected. In all these cases, training has to be maintained at some level to retain gains. The training can be helpful with schizophrenia as well. In one astounding case, the trainee (who was also a 20-year veteran with PTSD) lost his interest in smoking by the fourth session, a signature of progress with respect to the schizophrenia and the nicotine dependency. He had had no intention of quitting when he came for training.
The most commonly used neurofeedback method at the present time is very likely to be a variant of the Sterman/Lubar SMR-beta training, since that has the largest research base behind it, and the largest trained practitioner community. We ourselves taught that method to several thousand clinicians for about 10 years starting in 1990. This protocol has been shown in 6 formal studies to match stimulant medication, as judged by a continuous performance test. The application is mainly to the ADHD spectrum, likely the largest category of referrals for neurofeedback. A meta-analysis covering this work has been published, and an update that also covers the research history was published four years later.33,34
The specific virtue of QEEG-based training is to target brain dynamics in the conventional EEG range of frequencies using mainly inhibit-based training protocols. Remarkable results have been published for application to schizophrenia and Down syndrome.35,36 QEEG-based training can also be very helpful for the localized deficits that may be found in traumatic brain injury and in cerebrovascular accidents.37,38
Multisite alpha band training serves to improve attentional function. It induces states similar to those achieved in meditation, and thus may be used in support of meditation. Alpha-Theta training is used very effectively in addictions treatment, and it also plays a role in recovery from PTSD. Long-term outcomes are very favorable with this method in comparison with standard treatments.39
Infralow frequency training is not the only technique that relies on the slow cortical potential for training. In Europe, a challenge-based method has been under development since the 1980s. It is called slow cortical potential (SCP) training and involves challenging the trainee to alter the slow cortical potential at Cz by several microvolts within a period of 8 sessions. The objective is to train the mechanisms of cortical activation.40,41
It is estimated that currently some 20,000 practitioners of neurofeedback are active in some 50 countries. Over 50 professional licenses are engaged in the practice of neurofeedback, and the work has been published in over 275 different refereed journals. In the US, most of the services are on a self-pay basis because third-party reimbursement remains marginal. The cost burden can be moderated in cases of long-term training by means of supervised home training by parents who have received a modicum of instruction in the method. Clinical decision-making remains in professional hands. Application to sports performance and to the performing arts is a growing interest, one that is not constrained by the bounds of licensure.
One can already project that in their mature implementation neurofeedback technologies will impact significantly on the mental health status of the population, and that it will at the same time decrease the overall medical cost burden, much of which is secondary to brain-based disorders.
Supportive Materials and Additional Reading
Those who wish to see more specifics on the above treatment may find the following publication helpful:
Othmer S, Othmer SF, Kaiser DA, Putman J. Endogenous neuromodulation at infra-low frequencies. Semin Pediatr Neurol. 2013;20(4):246–260.
See also the following Web-accessible monograph:
Othmer S. A Rationale and Model for Infra-Low Frequency Neurofeedback Training. http://www.eeginfo.com/research/researchpapers/A-Rationale-for-InfraLow-Frequency-Neurofeedback-Training.pdf.
- Raichle ME. The restless brain. Brain Connect. 2010;1(1):3–12.
- Broyd SJ, Demanuele C, Debener S, et al. Default-mode brain dysfunction in mental disorders: a systematic review. Neurosci Biobehav Rev. 2009;33(3):279–296.
- Menon V. Large-scale brain networks and psychopathology: a unifying triple network model. Trends Cogn Sci. 2010 15(10):483–506.
- Zhang G, Zhang H, Li X, et al. Functional alteration of the DMN by learned regulation of the PCC using real-time fMRI. IEEE Trans Neural Syst Rehabil Eng. 2013;21(4):595–606.
- DeCharms RC, Maeda F, Glover GH, et al. Control over brain activation and pain learned by using real-time functional MRI. Proc Natl Acad Sci USA. 2005;102(51):18626–18631.
- Jensen MP, Grierson C, Tracy-Smith V, et al. Neurofeedback treatment for pain associated with Complex Regional Pain Syndrome Type I. J Neurother. 2007;11(1):45–53.
- Kirk HW, ed. Restoring the Brain: Neurofeedback as an Integrative Approach to Health. Boca Raton, FL: Trumpeter Books; 2015
- Engel AK, Singer W. Temporal binding and the neural correlates of sensory awareness. Trends Cogn Sci. 2001;5(1):16–25.
- Nowlis DP, Kamiya J. The control of electroencephalographic alpha rhythms through auditory feedback and the associated mental activity. Psychophysiology. 1970;6(4):476–484.
- Sterman MB, Friar L. Suppression of seizures in an epileptic following sensorimotor EEG feedback training. Electroencephalogr Clin Neurophysiol. 1972;33(1):89–95.
- Hardt JV, Kamiya J. Anxiety change through electroencephalographic alpha feedback seen only in high anxiety subjects. Science. 1978;201(1):79–81.
- Lantz DL, Sterman MB. Neuropsychological assessment of subjects with uncontrolled epilepsy: effects of EEG feedback training. Epilepsia. 1988;29(2):163–171.
- Sterman MB. Basic concepts and clinical findings in the treatment of seizure disorders with EEG operant conditioning. Clin Electroencephalogr. 2000;31(1):45–55.
- Egner T, Sterman MB. Neurofeedback treatment of epilepsy: from basic rationale to practical application. Expert Rev Neurother. 2006 6(2):247–257.
- Tan G, Thornby J, Hammond, DC, Strehl U, Canady B, Arnemann K, Kaiser, DA. Meta-analysis of EEG biofeedback in treating epilepsy. Clin EEG Neurosci. 2009;40(3):1–7.
- Lubar JO, Lubar JF. Electroencephalographic biofeedback of SMR and beta for treatment of attention deficit disorders in a clinical setting. Biofeedback Self Regul. 1984;9(1):1–23.
- Kaiser DA, Othmer S. Effect of Neurofeedback on variables of attention in a large multi-center trial. J Neurother. 2000;4(1):5–15.
- Fleischman MJ, Othmer S. Case study: improvements in IQ score and maintenance of gains following EEG biofeedback with mildly developmentally delayed twins. J Neurother. 2006;9(4):35–46.
- Othmer S, Othmer SF, Kaiser DA. EEG biofeedback: an emerging model for its global efficacy. In: Evans JR, Abarbanel A, eds. Introduction to Quantitative EEG and Neurofeedback. Academic Press; 2006:243–310.
- Fehmi L, Robbins J. The Open-Focus Brain: Harnessing the Power of Attention to Heal Mind and Body. Boston: Trumpeter Books; 2007.
- Hardt J. The Art of Smart Thinking. Santa Clara, CA; Biocybernaut Press; 2007.
- Peniston, EG, Kulkosky PJ. The Peniston/Kulkosky Brainwave Neurofeedback Therapy for Alcoholism and Posttraumatic Stress Disorders: Medical Psychotherapist Manual. Library of Congress; 1989, 1995:1–25. See http://www.aaets.org/article47.htm.
- Scott WC, Kaiser DA, Othmer S, et al. Effects of an EEG biofeedback protocol on a mixed substance abusing population. Am J Drug Alcohol Abuse. 2005;31(3):455–469.
- Othmer S, Steinberg M. EEG Neurofeedback therapy. In: Brizer D, Castaneda R, eds. Clinical Addiction Psychiatry. Cambridge University Press; 2010:169–187.
- Othmer SF. Protocol Guide for Neurofeedback Clinicians. Los Angeles: EEG Info Publications; 2006, 2008, 2012, 2013, 2015.
- Walker JE. QEEG-guided neurofeedback for recurrent migraine headaches. Clin EEG Neurosci. 2011;42(1):59–61.
- Othmer SF, Othmer S. Interhemispheric EEG training: clinical experience and conceptual models. In: Evans JR, ed. Handbook of Neurofeedback. Binghamton, NY; Haworth Medical Press; 2007:109–135.
- Schore AN. Early organization of the nonlinear right brain and development of a predisposition to psychiatric disorders. Dev Psychopathol. 1997;9(4):595–631.
- Pascual-Marqui RD, Lehmann D, Faber P, et al. The resting microstate networks (RMN): cortical distributions, dynamics, and frequency specific information flow. 2014. arXiv. http://arxiv.org/abs/1411.1949.
- Othmer S, Othmer SF, Legarda SB. Clinical neurofeedback: Training brain behavior. Treat Strateg Pediatr Neurol Psychiatry. 2011;2(1):67–73.
- Legarda SB, McMahon D, Othmer S, Othmer SF. Clinical neurofeedback: case studies, proposed mechanism, and implications for pediatric neurology practice. J Child Neurol. 2011;26(8):1045–1051.
- Othmer S, Othmer SF. Post traumatic stress disorder – the neurofeedback remedy. Biofeedback. 2009;37(1):24–31
- Arns M, de Ridder S, et al. Efficacy of neurofeedback treatment in ADHD: the effects on inattention, impulsivity and hyperactivity: a meta-analysis. Clin EEG Neurosci. 2009 40(3):180–189.
- Arns M, Heinrich H, Strehl U. Evaluation of neurofeedback in ADHD: the long and winding road. Biol Psychol. 2013. http://dx.doi.org/10.1016/j.biopsycho.2013.11.013.
- Surmeli T, Ertem A. EEG neurofeedback for patients with Down syndrome. J Neurother. 2007;11(1):63–68.
- Surmeli T, Ertem A, Eralp E, and Kos IH. Schizophrenia and the efficacy of qEEG-guided neurofeedback treatment: a clinical case series. Clin EEG Neurosci. 2012;43(2):133–144.
- Thornton KE, Carmody DP. Electroencephalogram biofeedback for reading disability and traumatic brain injury. Child Adolesc Psychiatr Clin N Am. 2005;14(1):137–162.
- Thornton KE, Carmody DP. Efficacy of traumatic brain injury rehabilitation: interventions of QEEG-guided biofeedback, computers, strategies, and medications. Appl Psychophysiol Biofeedback. 2008;33(2):101–124.
- Scott WC, Kaiser D, et al. Effects of an EEG biofeedback protocol on a mixed substance abusing population. Am J Drug Alcohol Abuse. 2005 31(3):455–469.
- Birbaumer N. Slow cortical potentials: plasticity, operant control and behavior effects. Neuroscientist. 1999;5(2):74–78.
- Strehl U, Leins U, Goth G, et al. Self-regulation of slow cortical potentials: a new treatment for children with attention-deficit/hyperactivity disorder. Pediatrics. 2006 118(5):e1530–e1540.
Dr. Siegfried Othmer and Susan F. Othmer have been involved with neurofeedback since 1985. The initial impetus was the brain-training of their son Brian for his seizure disorder. The training was life transforming for their son, and this redirected their professional lives to the further development of neurofeedback as well as to the promotion of its public acceptance.
Dr. Othmer is currently chief scientist of the EEG Institute and president of the Brian Othmer Foundation. Susan Othmer is clinical director at the EEG Institute, located in Woodland Hills (Los Angeles). The Othmers have pioneered a number of novel applications of neurofeedback over the years. The Othmers provide professional training in EEG biofeedback and sponsor a professional network of neurofeedback therapists, the EEG Associates. The Othmers have been developing premier instrumentation for neurofeedback continuously over the last 22 years, and this development is ongoing.
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