For this post, I want to discuss something that has been getting a lot of attention in the trauma therapy community lately, but which I’ve found difficult to understand: Neurofeedback. In my quest to better understand neurofeedback, I spoke to a few different neurofeedback providers, did some internet research, and tried some treatments myself. To include all of that, I’m going to leave my usual interview format behind for this post.
Interest in the use of neurofeedback to treat trauma has in recent years largely because of the efforts of Bessel van der Kolk, an internationally acclaimed clinician, researcher, and teacher on the subject of post traumatic stress. Van der Kolk said in a recent interview at Psychotherapy.net that one of the biggest changes in his thinking in the past couple of years has been due to his exposure to neurofeedback.
"Learning how to interpret quantitative EEG's helped me to visualize better how the brain processes information, and how disorganized the brain becomes in response to trauma. What made it necessary to look for other, non-interpersonallybased therapies was the realization, followed by research that dramatically illustrated how being traumatized may interfere with teh ability to engage with other human beings to feel curious, open and alive."
A recent pilot study authored by Mark Gapen, van der Kolk and others found that neurofeedback significantly reduced PTSD symptoms and increased emotion regulation in multiply-traumatized individuals with treatment-resistant PTSD. A follow up study has now collected additional data that is currently being analyzed. I know I'm not the only trauma therapist who eagerly awaits the results of this study.
My Information Sources
My first introduction to neurofeedback was in the form of a brain map created by Betsy Carr at Aspen Neurofeedback in Longmont, CO. There will be more about what a brain map is below. I then spoke with Betsy about her interpretation of my brain map. Later I experienced neurofeedback using the non-traditional NeurOptimal® system, combined with caniosacral release provided by Joy Om of Boulder, CO. Finally, I had a wonderful conversation with the team at Interactive Brain Analysis (IBA), including Debi Elliot, Carolyn Dimson, and Sharon Day, about neurofeedback and the other biofeedback treatments they provide.
What is Neurofeedback?
Neurofeedback is a type of biofeedback, so let’s start by defining biofeedback. Biofeedback is interaction with a type of measurement from sensors attached to the skin. Biofeedback is used to make a person aware of certain processes in their physical body that they are not normally aware of, like brain wave activity, breathing patterns, heart rate, temperature, muscle tension, or sweat gland activity. The person receives real-time information about those processes, which creates an opportunity to learn to adjust them for more healthy functioning.
Neurofeedback is a type of biofeedback that measures brain waves and teaches self-regulation of brain function. In a neurofeedback session, brain waves are measured using an Electroencephalograph (EEG). The clinician places electrodes on specific locations on the scalp, to passively measure brain waves. If you’re a science nerd like me, you may be interested to know that the EEG measures voltage fluctuations resulting from ionic current within the neurons of the brain. But the important thing is that the measured brain waves can then be compared to desired brainwaves. Some kind of signal is given to the person about how their measured brainwaves compare to the desired brainwaves. That’s the feedback. The person’s brain can then figure out how to adjust to make brain waves that more closely resemble the desired pattern.
What is it good for?
Debi Elliott listed many conditions that biofeedback in general, and neurofeedback in particular, can be good for: ADD, learning disabilities, head injury, anxiety, depression, chronic pain, sleep disorders, tinnitus, high blood pressure, stress responses, obsessive compulsive disorder. She explained that because psychological trauma can be a huge piece of the picture in many of these conditions, it can have a profound effect on brainwave patterns.
As Joy Om explained it, neurofeedback supports the entire central nervous system in becoming more efficient, resilient and flexible, bringing it into present-time awareness (as opposed to caught up in the past or future). Joy told me that most of her clients report feeling more relaxed, less anxious, less emotional reactive, more mentally clear, and less prone to addictive behaviors after neurofeedback. She also claimed that coupling this with gentle, hands-on craniosacral release techniques helps integrate the new neural patterns learned through neurofeedback.
Different Types of Neurofeedback
One thing that I discovered pretty quickly after starting to research neurofeedback is that there are different types of neurofeedback. This is where things got confusing for me.
The type of neurofeedback that I discussed with the providers at IBA and Aspen Neurofeedback is considered a traditional neurofeedback approach. In traditional neurofeedback, the first step is an initial “brain map”, which is made by placing many electrodes around the scalp to measure different types of brain waves. (Side note: These electrodes are placed with a goopy gel. So be prepared to have messy hair after neurofeedback.)
Once the brain map is made, the resulting brain wave patterns are analyzed and interpreted, and compared to reported symptoms. From this, a plan is made for how your brain waves will be trained to change. The interpretation of the initial brain map and development of a brain training plan requires considerable expertise.
During the subsequent training sessions, the client’s brain waves are measured while they engage in an activity like playing a video game, or watching a movie. When the brain wave patterns match the desired patterns, the video game character or movie continues as desired. When they don't match the desired patterns, the game character or movie stop. The brain then figures out how to change the various brain waves into the desired pattern, to get the game or movie going again.
In my internet research, I noticed that many providers in the Boulder area use an alternative neurofeedback approach developed by NeurOptimal®. The NeurOptimal® system does not require a brain map and does not consider symptoms or goals. It also does not require knowledge of brain waves by the provider. Instead, it measures the stability over time of brain waves. Feedback is provided via sound (usually music). When the system detects that the brain waves have becomes less stable than they just were, feedback is provided to the brain as a click or scratch in the sound. This feedback creates an opportunity for the brain to adapt itself in response.
There are many other forms of neurofeedback, which are beyond the scope of this post. An interesting article to read if you would like more information is What is Neurofeedback by Diane Roberts Stoler.
My Experience and Conclusions
Please take my thoughts in this section with a grain of salt, keeping in mind that I tend to approach new things with skepticism balanced with optimism.
I was excited to have a chance to experience the brain mapping step with Betsy at Aspen Neurofeedback. This step often costs several hundred dollars. Unfortunately, I wasn’t allowed to take the interpretation of my brain map away from my appointment, so I have to report only what I can remember. I recall being quite surprised by the results. My sense was that the brain map did not match very well my own thoughts about my brain functioning. I expressed my surprise, and Betsy explained that our brains are so flexible that sometimes we are able to compensate for deficiencies in one area with strengths in another. That makes sense to me, although I would have had more confidence in the method if the brain map had matched my own experience of my brain.
I wish I had been able to show the team at IBA my brain map. I was thoroughly impressed by their clear explanation of strengths and limitations of the different types of biofeedback they provide, and how they choose which methods to use with a given client. I came to trust the depth of their expertise, and was delighted by their enthusiasm for their work. I have a feeling that they could have explained exactly why my brain map was different than I expected, and probably suggested several types of biofeedback that would have targeted exactly the issues I most want to improve in my own mental life.
I found Joy’s combination of NeurOptimal® neurofeedback with craniosacral therapy very comforting. I came out of that session feeling relaxed, and . . . held. At first I tried to understand a pattern for the clicks I heard with the music, but I couldn’t ever relate them to anything I noticed in my thoughts or feelings or my general mental state. It felt very random. I couldn’t intentionally make any changes in the feedback. After a while I stopped trying to figure it out. Joy said that many people sleep during it. So obviously it’s not a conscious type of feedback. But the session was very, very soothing, and I felt exceptionally calm and grounded for the rest of that day.
I’ve had a hard time understanding how the NeurOptimal® system works. I understand that the system compares the current signal with the signal taken just before it, while traditional neurofeedback compares the current signal with a desired signal based on the initial brain mapping. It’s not clear to me which would be preferred. What I can say for certain is that the difficulty finding specific information about the NeurOptimal® system makes me skeptical.
The NeurOptimal® system is relatively inexpensive to purchase and does not require expertise in interpreting brain wave patterns. The provider only needs to put the (relatively few) electrodes in place and turn on the system. I think the low cost and ease of use may partly explain why I noticed so many more NeurOptimal® providers.
The bottom line from in my experience is that if I had the funds I would sign up today with the team at IBA for whatever plan they thought would best meet my goals. They have a combined 76 years of biofeedback experience and 43 years of neurofeedback experience. And I'm the kind of person who needs to understand how things work, and needs reasons to trust my healthcare providers. I understand the idea behind traditional neurofeedback pretty clearly, and I was impressed with the depth of knowledge that the team at IBA showed.
If I didn’t have the funds to do a round of traditional neurofeedback at IBA, I would gladly go back for more work with Joy Om, and I would definitely consider renting her system for more sessions at home.
How Long Does it Take?
I asked the different providers I met with how many sessions are needed to experience results. They all agree that there seems to be a noticeable shift in most people somewhere between 10 to 20 sessions. For people with severe symptoms, everyone agreed that more sessions than that may very well be needed.
How Much Does This Cost?
As of the writing of this article, a half hour introductory session at IBA is $25. The initial brain mapping starts at $400 if you pay with cash or credit and don’t need a written report. Subsequent neurofeedback brain training sessions are $100 each if you pay with cash or credit. IBA is covered as an out-of-network provider by some insurance policies, and they offer to help you check your insurance to see if their services are covered.
Joy Om offers neurofeedback sessions combined with craniosacral release for $100. She is also covered as an out-of-network provider by some insurance policies. Another option is to rent a NeurOptimal® system from Joy to take home for a week for $200. This is possible because NeurOptimal® is simple to set up and does not require any clinical expertise to operate. If you did seven sessions per week, you could accomplish 21 sessions for only $600 this way.
Aspen Neurofeedback says that they have a scholarship fund established through corporate sponsors and private donors, that can subsidize the cost of neurofeedback for those who qualify.
I'd like to do a follow up to this post, with more information. If this discussion brings up more questions for you, as it did for me, please share them in the comments. I'll be happy to try to dig up answers and share them with you all.