“Being ignorant is not so much a shame, as being unwilling to learn.”
— Benjamin Franklin
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Neurofeedback
Brain training organizes the central and peripheral nervous systems to be more resilient, flexible, and responsive and, at the same time, less reactive and less hyper-vigilant. This training can be done without any cognitive, emotional, or behavioral feedback, but purely by means of modulating brainwaves of different frequencies at different locations in the brain.
This training requires 20 to 40 sessions of brainwave neurofeedback and forms of biofeedback such as heart-rate variability, progressive relaxation, and breathing yoga (pranayama). It results in more organized and resilient cognition, emotions, and metabolism.
The equipment required for neurofeedback is noninvasive. It consists of an amplifier to record electrical measurements at anywhere between three and 20 sites on the client’s scalp, and a computer to process the signals. The system’s sensitivity to muscle artifact requires the client to remain still and relaxed for the 20- to 40-minute duration of the sessions.
During this time, they may watch simple animations that vary in motion, color, or contrast, or listen with their eyes closed to audio, whose changes in rhythm and volume reflect dominant changes in their brainwave patterns. They might be given a goal, such as reaching some displayed score, but generally the only suggestion is to be comfortable and relaxed.
Dramatic physical and mental changes often result over the course of training. Neurofeedback is one of the most effective treatments for substance addiction and is uniquely effective in restoring balance in the case of central nervous system conditions such as attention deficit, insomnia, anxiety, depression, traumatic brain injury, stroke, compulsive and reactive behaviors. Brainwave training does not directly address behavioral categories listed in the Diagnostic and Statistical Manual, which are often misunderstood to be physiological states.
New brainwave patterns learned by operant conditioning can result in:
- Improved executive function, which is the organization of thoughts, associations, and memory.
- Improved prosody: the sensitivity to subtle cues in the speech, expression, and behavior, and consequently becoming more expressive in one’s own speech and behavior.
- Improved proprioception: the awareness and control of the body in space.
- Expanded awareness, resulting in greater tolerance of uncertainty and unresolved issues, less cogitation and rumination, improved mindfulness, and deeper self-reflection.
- Better physiological regulation involving coordination of the sympathetic and parasympathetic nervous systems, as well as improved connection between the cerebral and enteric systems. This results in better control of circadian rhythms, improved diet, lessened reactive tendencies, and improved emotional stability.
Cerebral nervous system training can be approached by either training the nervous or cognitive systems, since the two are linked. Training the nervous system is accomplished through computer-assisted neurofeedback.
The nervous system can be trained using cognitive and emotional techniques that correlate with the nervous systems. Rather than focusing on behavior, as in cognitive-behavioral therapy, training the nervous system aims to improve one’s aptitudes, leading to more enduring and fundamental metabolic changes.
paintings by Mark Rothko
A Content-Free Approach
Brain training is unique in being a content-free approach to remediating conflicts and restoring balance. As a skill building exercise, the client is not thinking, regressing, or confronting issues, situations, or opportunities. Clients typically respond to brainwave training by noticing nothing, which is an obstacle to investing in the training. Instead, clients perceive situations changing around them without effort or engagement. Mood improves, relationships improve, situations lose their urgency, and previous reactive responses weaken or disappear.
I remember in my training I had the unusual experience of expanded awareness, as if I had been living in a conceptual box whose walls were taken away. I noticed dramatic improvement in my aim in throwing objects, and a heightened emotional sensitivity. One’s subjective experience rarely changes, but one perceives people reacting differently to them. Despite requiring no effort, neurofeedback training is mentally tiring.
Neurofeedback-aided therapy is a different and complementary approach to psychotherapy, as it does not deal, or deals indirectly, with intellectual and emotional function. There is effectively no resistance to change in brainwave training because the client has no cognitive or emotional experience of obstacles to new brainwave states. Clients encounter their own limits in flexibility, strength, mood, focus, and resilience, but these are experienced as neurological states rather than intellectual situations, if they’re experienced at all.
Psychosomatic Training
Neurofeedback shares features of physical trainings, which work through biofeedback of the peripheral nervous system. Training in music, athletics, speaking, and endurance coordinate the body’s central systems without directly engaging cognitive or emotional obstacles, and leads to functional improvements in cognitive and emotional performance.
In my psychotherapy practice, I encourage an abstract approach to cognitive and emotional issues. I ask my clients to focus not on their issues, but on how they react to and process their situation. I’m directing their attention to the way they perceive and respond, rather than the triggers they respond to or the goals they have in mind.
For example, for a client in distress with his or her relationship, I will focus on how they form and maintain relationships, and the role of relationship in the larger context of their lives. This sounds academic, and I will support that interpretation, even though it is not my intention. My intention is to bring attention to and enable greater control of their nervous system, regardless of their thoughts and feelings.
For a client struggling with anxiety, I will direct them to engage with their own sense of balance, security, history, and reflex reactions. The issues causing their anxiety become tools rather than targets, and we use them to retune their perception of and invention of anxiety itself.
Certification in Neurofeedback Therapy
Sixty years of research, coupled with the burgeoning fields of neurophysiology and neuropsychology, has produced a surfeit of literature in neurofeedback (Thompson & Thompson, 2015). Several specialities are recognized, and entry level neurofeedback certification is offered through the BCIA (Biofeedback Certification International Alliance, https://www.bcia.org/nf-entry-level ), estimated to cost from US$1,500 to US$4,000 beyond a BA/BS degree.
Entry level certification requires:
- BA/BS degree in a healthcare field.
- a current license/credential to practice in an approved health care field when using neurofeedback to treat medical or psychological disorders, or practice under supervision.
- Neuroanatomy, neurophysiology, and physiological psychology course(s) taken from an accredited institution or a BCIA-approved provider (US$250 through https://stresstherapysolutions.com/)
- 36-hours of didactic education in the science, history, and theory of neurofeedback (US$1,250 from https://stresstherapysolutions.com/)
- 25 hours of supervision with a BCIA-approved mentor to learn clinical skills, including 100 patient/clients sessions, 10 case study presentations, and 10 sessions of self-regulation ($0 for supervision in a work/study context, to $2,500 for private supervision).
Integrating Neurofeedback with Psychotherapy
Providing neurofeedback training can be done in conjunction with psychotherapy, but the alternative focus—developing mental skills versus resolving personal issues—usually directs clients along one path or the other. Both neurofeedback and counseling could be done together, but at double the time, cost, and commitment.
There are connections between collective neural excitations and cognitive-emotional states. We know that excess high frequency amplitudes in the frontal lobes correlate with anxiety, and that rebalancing brainwave activity in the frontal lobes can reduce depression (Cheon et al., 2016) and enhance executive function. The widely practiced technique of eye movement desensitization and reprocessing (EMDR), used to release the emotional charge of traumatic memories, is easily seen to increase the synchrony between the brainwaves in the right and left hemispheres suggesting explanations of why the technique works (Harper et al., 2009). Many clinical observations have led to techniques and protocols in which the training of specific brain waves has been found to address various cognitive-emotional dysfunctions (ISNR, 2022). These approaches are based on clinical correlations. A deeper understanding of causation must wait for a microscopic theory of mind.
In the past and up to the present, neurofeedback required the careful connection of scalp sensors and adjustments of computer feedback. This made it difficult for a person with this equipment to train themselves. Two innovations are making neurofeedback more accessible. One is dry scalp sensors that are easily applied and require little more than wearing a headband.
The other is the emergence of general, less specific training protocols, requiring less configuration, tuning, and hardware that can be offered as non-medical performance enhancement. Lower manufacturing requirements and decreased legal liability open the possibility of direct sale to the client from the manufacturer without requiring the supervision of a trained mental health practitioner. Much like yoga and other forms of psychosomatic training, neurofeedback devices aimed at enhancing sleep, relaxation, and mindfulness provide essential benefits at a lower price with less supervision (Urban, 2022; Hunkin et al., 2019).
Most clients are not prepared for brain training because most practitioners do not offer or understand it. Despite the dramatic and unique results, neurofeedback remains a poorly understood and narrowly available modality (Banerjee & Argáez, 2017). It will remain under appreciated until practitioners and clients understand that a large part of mental health depends on how our minds work, rather than what our minds think.
If you’d like to explore how you think frames what you see, call me. I can suggest ways to expand both of these.
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References
Banerjee, S., & Argáez, C. (2017 Nov 13). Neurofeedback and Biofeedback for Mood and Anxiety Disorders: A Review of Clinical Effectiveness and Guidelines [Internet], Canadian Agency for Drugs and Technologies in Health. Retrieved from: https://www.ncbi.nlm.nih.gov/books/NBK531603/
Cheon, EJ., Koo, BH., & Choi, JH. (2016 Mar). The efficacy of neurofeedback in patients with major depressive disorder: An open labeled prospective study, Applied Psychophysiology and Biofeedback, 41 (1): 103–110. https://doiorg/10.1007/s10484-015-9315-8
Harper, M. L., Rasolkhani-Kalhorn, T., & Drozd, J. F. (2009). On the neural basis of EMDR therapy: Insights from qEEG studies, Traumatology, 15 (2): 81–95. https://doi.org/10.1177/1534765609338498
Hunkin, H., King, D. L., & Zajac, I. T. (2019). Wearable devices as adjuncts in the treatment of anxiety‐related symptoms: A narrative review of five device modalities and implications for clinical practice, Clinical Psychology: Science and Practice, 26 (3), Article e12290. https://doi.org/10.1111/cpsp.12290
ISNR (2022). Recommended reading, International Society for Neuronal Regulation. Retrieved from https://isnr.org/recommended-reading
Thompson, M. & Thompson, L. (2015). The neurofeedback book, 2nd edition, Association for Applied Psychophysiology and Biofeedback.
Urban, N. (2022 Dec 11). 16 best affordable neurofeedback devices [2023 Review] for at-home brain training, Outliyr LLC. Retrieved from: https://outliyr.com/best-home-neurofeedback-devices-machines
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