Neurofeedback: What is it and How does it work?

The term Neurofeedback Encompasses all techniques based on the training of individuals to help them control their own brain and thus improve their functioning, this is done giving you feedback on what is happening in your brain at all times.

Neurofeedback was first used in the 1960s and has since been used to treat multiple disorders, although it has not been shown to be effective in all disorders in which it has been used.

Neuroimaging techniques, such as real-time functional magnetic resonance imaging, and increasingly accurate investigative protocols are now being used to determine exactly how neurofeedback works, since more effective therapies can be developed with better understanding of the mechanism.

Today, the use of neurofeedback in private clinics is being extended to treat any type of disorder. The price depends on the location (country, city...) in which the clinic is located, the type of disorder to be treated and the duration of the sessions, but usually around € 50 per session (in sessions of 20-30 minutes ).

If you are planning to attend a neurofeedback training, make sure the clinic has the necessary accreditation to perform it ( Biofeedback Certification International Alliance) And, if you finally decide to do so, ask them to do tests related to the behavior that you want to modify to find out if the neurofeedback treatment is actually being effective.

What is neurofeedback?

Neurofeedback is a technique that records the brain activity of an individual while it tries to regulate it, in this way the individual receives feedback or feedback at all times and can learn to control certain brain parameters, which will eventually result in a Improvement of an individual's symptom or behavior.

The key to this technique is that we can actually change and regulate some parameters of our brain activity, a fact that seemed impossible until recently and many people do not end up believing. Although we must keep in mind that there are brain functions that can not be changed at the moment, and that the mechanisms that underlie the self-regulation of brain activity are still unknown.

Neurofeedback training is usually performed with the support of some neuroimaging technique, usually the Electroencephalography (The recording of electrical activity of the brain), although there are also some professionals who use functional magnetic resonance imaging.

Neurofeedback with EEG

Electroencephalography was the first noninvasive technique capable of showing the brain behavior in vivo, that is, while it was occurring. It is therefore not surprising that it is the first neuroimaging technique used to perform neurofeedback treatments and is one of the most studied.

Studies have been conducted to test the efficacy of neurofeedback in numerous disorders such as Attention deficit disorder and hyperactivity (ADHD), the epilepsy , the depression , the anxiety and the Parkinson's disease among others.

Some of these studies have demonstrated the effectiveness of the treatment, but most of them have obtained inconclusive results or have been performed with little scientific rigor, for example, by comparing the results of two groups of participants (healthy participants and with the disorder, for Example), these groups differing significantly in their sociodemographic characteristics, such as age or level of education.

So it can be concluded that neurofeedback is not effective for any type of disorder or to modify any behavior, as it happens with other types of treatments. For example, a particular psychotropic drug may be useful for anxiety, but not for depression.

How does neurofeedback work with EEG?

The functioning of neurofeedback is explained differently depending on the psychological current that describes it:

• From the point of view of behavioral psychology, neurofeedback follows the principles of operant learning. That is, positive stimuli must be conditioned or matched for the patient with the desired behavior so that it increases, so aversive or neutral stimuli must be coupled with the unwanted behavior so that it decreases or at least does not increase.
• According to cognitive psychology neurofeedback works thanks to the cognitive restructuring that occurs during training, this restructuring would change biological and psychophysiological aspects that would eventually translate into a change in behavior.

These ways of explaining the functioning of neurofeedback are not exclusive, they are simply two ways of explaining the same phenomenon, the first focusing on behavior and the second on cognitive and psychophysiological changes.

Regardless of the psychological current that the professional follows, in neurofeedback with EEG there are three parameters in which he usually focuses to modify the behavior of the patient:

• The arousal or activation level Is often targeted to change to various disorders such as ADHD, epilepsy, anxiety and addictions. In ADHD and epilepsy there is a hypofunction of arousal so it is sought to increase it, whereas in anxiety disorders and addictions it is sought to decrease arousal levels. Arousal is related to specific activation frequencies occurring in localized areas of the brain, thus arousal could be increased by increasing Beta waves (13-30 Hz) located in the central frontal zone while to reduce the arousal would have to increase the Theta waves (4-8Hz) located in the front area and / or Alpha waves (8-12 Hz) located in the occipital area (posterior).
• Emotional Valence Is usually the target to be modified in major depressive disorder, since this disorder is characterized by patients suffering a negative bias, it is as if they only see the negative aspect of everything that happens to them and never see the positive. Therefore, the objective would be to make the emotional valence more positive, for this the alpha waves of the left side of the frontal cortex must be diminished since these waves are related to the susceptibility to appreciate the facts as negative.
• The dream Usually the main goal to change in sleep disorders such as insomnia , Characterized by a lack of sleep quality. In these cases a sleep study prior to neurofeedback training is usually done to check for peaks of activity of some frequency during sleep states 2 and 3, as these peaks could be impeding the natural sleep cycle and decreasing the quality of sleep. Sleep of the patient. During training, we would try to reduce mu (μ) waves originating in areas of the sensorimotor cortex, since there are studies that have found a relationship between these waves and the appearance of peaks of activity during sleep.

What is a typical neurofeedback session with EEG?

I suppose you wonder what exactly a EEG neurofeedback session is about. I will try to explain it in simple but detailed steps.

1. The patient sits on a chair and electrodes are placed on the scalp and sometimes on some areas of the face and ears. Normally a hat is placed that is similar to the hat of the swimmers that already has the integrated electrodes to expedite the process.
2. If required, the impedance of the electrodes is reduced, ie the resistance offered by the skin to the electricity emitted by the electrodes. Electrical synapses . This is done to receive more signal intensity and is usually done by applying a conductive gel (gel with salt) and rubbing the scalp.
3. Once the electrodes are placed the electrical activity of the patient begins to be recorded and can be observed represented by waves on a screen. The professional must register and observe the activity of the patient at rest first and detect the parameters that must be modified (amplitude, frequency, latency...). Usually, this procedure takes time and requires the patient to return to a second session.
4. Once the parameters to be modified have been differentiated, the patient is instructed to perform some task related to the disorder or the behavior that he wants to modify while controlling the parameter for a particular parameter. For example: the patient is given the instruction to perform an attentional task while trying to increase the amplitude of the waves located in the occipital area.
5. During the performance of the task is given to the patient feedback on their performance, both positive and negative feedback can be given, that is to say the patient can be warned both if he makes a mistake and if he gets to modify the parameter correctly, depending on what Occur more frequently (if many errors are commented feedback will be given when done correctly and vice versa). The type of feedback can be visual or auditory, there are numerous ways to give feedback, but the most used are visually with some computer game in which something changes depending on what the patient does (for example, a roller coaster that rises to measure That the patient increases the amplitude of a wave), this type of feedback usually works very well with children. Another type of feedback is used simpler like the appearance of a tone or a light at a certain time.

It often takes several sessions to begin to notice improvements and each session can last between 30 and 60 minutes.

Uses of neurofeedback with EEG

Treatment of Attention Deficit Disorder (ADHD)

The treatment of ADHD with neurofeedback has been the most studied until now and possibly also the most used since it has proven to be quite effective, especially in symptoms related to attention deficit. In addition, although in the short term it may be less effective than psychotropic drugs, it has been shown that in the long run their effectiveness is equal to or greater than these.

As discussed above, the treatment of ADHD is to train the patient to increase their arousal and this could be achieved by increasing the Beta waves (13-30Hz) located in the central front zone.

Treatment of Autistic Spectrum Disorders (ASD)

The treatment of autism spectrum disorders with neurofeedback is the second most studied by researchers and also one of the most used. Neurofeedback training in this type of disorder has been shown to be quite effective, but it seems to act mostly on inattention symptoms present in patients suffering from ADHD in addition to ASD, which occurs in approximately 40-50% of patients. Patients with ASD.

The neurofeedback treatment of patients with ASD would be similar to that of patients with ADHD.

Treatment of epilepsy

Treatment with neurofeedback in adults with drug-resistant epilepsy has been well studied and is being widely used because of its demonstrated efficacy and the other alternative of these patients is to undergo surgery.

Patients with epilepsy suffer from a decrease in arousal levels, so treatment with neurofeedback is focused on increasing these levels in the same manner as in the treatment of patients with ADHD and ASD.

Treatment of Anxiety Disorders

Within the Anxiety Disorders, where the benefits of treatment with neurofeedback have been studied the most are in Generalized Anxiety Disorder (GAD) and in Obsessive Compulsive Disorder (TOC), and in both cases has been shown to be quite effective. But it must be borne in mind that it has not been proven to be more effective than Cognitive-behavioral therapy , Which is the most used to treat this type of patients. So, professionals are advised to use neurofeedback in this case as an adjunct to their therapy or in cases where cognitive-behavioral therapy is not working (for example, in patients who find it hard to relax).

Treatment of Anxiety Disorders with neurofeedback is based on decreasing arousal levels of the patient and this can be achieved by increasing theta waves (4-8Hz) located in the frontal area and / or by increasing localized alpha (8-12Hz) waves In the occipital area (posterior).

Treatment of addictions

There have not been many studies on the effectiveness of treatment with neurofeedback in people suffering from some form of addiction since there are many types of addictions and they usually present along with other disorders such as GAD, ADHD or even other addictions (eg, Very often being addicted to alcohol and tobacco).

The studies that have been carried out so far have proven to be effective mainly in the improvement of symptoms related to anxiety.

The treatment of addictions with neurofeedback is basically the same as the treatment of Anxiety Disorders, since it is precisely the anxious symptoms that are intended to improve.

Treatment of Major Depressive Disorder

Researchers who have studied the efficacy of treatment of Major Depressive Disorder with neurofeedback have not obtained conclusive results. It is necessary to use other neuroimaging techniques, such as Functional magnetic resonance imaging (FMRI) to determine whether biological changes due to treatment have occurred.

Neurofeedback training to treat this disorder would focus on changing the patient's emotional valence and making it more positive. For this the alpha waves of the left side of the frontal cortex are diminished since these waves are related to the susceptibility to appreciate the facts like negatives.

Treatment of chronic insomnia

The treatment of chronic insomnia with neurofeedback has also not been much studied, but the results of studies have shown that it is quite effective and can even improve memory.

Treatment with neurofeedback to improve sleep quality usually focuses on decreasing the number of activation peaks during sleep states 2 and 3 (non-REM sleep). This can be achieved by training the patient to decrease mu (μ) waves originating in areas of the sensorimotor cortex as there is a relationship between these waves and the appearance of peak activity during sleep.

References

1. Arns, M., de Ridder, S., Strehl, U., Breteler, M., & Coenen, A. (2009). Efficacy of neurofeedback treatment in ADHD: the effects on inattention, impulsivity and hyperactivity: the meta-analysis. Clin EEG Neurosci , 180-189.
2. Esmail, S., & Linden, D. (2014). Neural networks and neurofeedback in Parkinson's disease. NeuroRegulation , 240-272. Doi: 10.15540 / nr.1.3-4.240.
3. Haenschel, C., Baldeweg, T., Croft, R., Whittington, M., & Gruzelier, J. (2000). Gamma and beta frequency oscillations in response to novel auditory stimuli: a comparison of human electroencephalogram (EEG) data with in vitro models. Proc Natl Acad Sci USA , 7645-7650.
4. Hammond, D. (2005). Neurofeedback treatment of depression and anxiety. Journal of Adult Development , 131-137. Doi: 10.1007 / s10804-005-7029-5.
5. Holtmann, M., Steiner, S., Hohmann, S., Poustka, L., Banaschewski, T., & Bolte, S. (2011). Neurofeedback in autism spectrum disorders. Dev Med Child Neurol , 986-993.
6. Micoulaud-Franchi, J., McGonigal, A., Lopez, R., Daudet, C., Kotwas, I., & Bartolomei, F. (2015). Electroencephalographic neurofeedback: Level of evidence in mental and brain disorders and suggestions for good clinical practice. Neurophysiologie Clinique / Clinical Neurophysiology , 423-433. Doi: 10.1016 / j.neucli.2015.10.077.
7. Peeters, F., Oehlen, M., Ronner, J., van Os, J., & Lousberg, R. (2014). Neurofeedback as a treatment for major depressive disorder - a pilot study. PLoS One . Doi: 10.1371 / journal.pone.0091837.
8. Schabus, M., Heib, D., Lechinger, J., Griessenberger, H., Klimesch, W., & Pawlizki, A. (2014). Enhancing sleep quality and memory in insomnia using instrumental sensorimotor rhythm conditioning. Biol Psychol , 126-134.
9. Sherlin, L., Arns, M., Lubar, J., Heinrich, H., Kerson, C., & Streh, U. (2011). Neurofeedback and basic lerning therory: implications for research and practice. J Neurother , 292-304.
10. Siegle, G., Ghinassi, F., & Thase, M. (2007). Neurobehavioral therapies in the 21st century: summary of an emerging field and an extended example of cognitive control training for depression. Cogn Ther Res , 235-262.
11. Sterman, M., Howe, R., & Macdonald, L. (1970). Facilitation of spindle-burst sleep by conditioning of electroencephalographic activity while awake. Science , 1146-1148.
12. Stewart, J., Bismark, A., Towers, D., Coan, J., & Allen, J. (2010). Resting frontal EEG asymmetry as an endophenotype for depression risk: sex-specific patterns of frontal brain asymmetry. J Abnorm Psychol , 502-512.
13. Strijkstra, A., Beersma, D., Drayer, B., Halbesma, N., & Daan, S. (2003). Subjective sleepiness correlates negatively with global alpha (8-12 Hz) and positively with central frontal theta (4-8 Hz) frequencies in the human resting awake electroencephalogram. Neurosci Lett , 17-20.
14. Tan, G., Thornby, J., Hammond, D., Strehl, U., Canady, B., & Arnemann, K. (2009). Meta-analysis of EEG biofeedback in treating epilepsy. Clinical EEG and Neuroscience , 173-179. Doi: 10.1177 / 155005940904000310.
15. Thibault, R. T., Lifshitz, M., & Raza, A. (2016). The self-regulating brain and neurofeedback: Experimental science and clinical promise. Cortex , 247-261. Doi: 10.1016 / j.cortex.2015.10.024.
16. Zuberer, A., Brandeis, D., & Drechsler, R. (2015). Are treatment effects of neurofeedback training in children with ADHD related to the successful regulation of brain activity? A review on the learning of regulation of brain activity and a contribution to the discussion on specificity. Frontiers in Human Neuroscience , 1-15. Doi: 10.3389 / fnhum.2015.00135.