Biofeedback FAQ

WHAT IS EEG BIOFEEDBACK?
WHAT IS IT USED FOR?
HOW IS IT DONE?
WHAT DISORDERS HAVE CLINICAL EVIDENCE?
WHAT RESULTS DO WE OBTAIN?
CAN A SUCCESSFUL OUTCOME BE PREDICTED?
WHY DOES THIS TRAINING PROCEDURE WORK?
WHAT DOES EEG BIOFEEDBACK LOOK LIKE?
HOW LONG DOES TRAINING NORMALLY TAKE?
HOW FREQUENT SHOULD THE TRAINING SESSIONS BE?
IS EEG BIOFEEDBACK COVERED BY INSURANCE?
MY DOCTOR TAKES A DIM VIEW OF BIOFEEDBACK. WHAT CAN I TELL HER?
HOW MUCH DOES THE TRAINING COST?

WHAT IS EEG BIOFEEDBACK?

EEG Biofeedback is a learning strategy that enables persons to alter their brain waves. When information about a person's own brain wave characteristics is made available to him/her, he or she can learn to change them. You can think of it as exercise for the brain.

WHAT IS IT USED FOR?

EEG Biofeedback is used for many conditions and disabilities in which the brain is not working as well as it might. These include Attention Deficit Hyperactivity Disorder and more severe conduct problems, specific learning disabilities, and related issues such as sleep problems, enuresis in children, speech disorders, teeth grinding, and chronic pain such as frequent headaches or stomach pain, or pediatric migraines.

The training is also helpful with the control of mood disorders such as anxiety and depression, as well as for more severe conditions such as medically uncontrolled seizures, minor traumatic brain injury, or cerebral palsy.

HOW IS IT DONE?

An initial interview is done to obtain a description of symptoms, and to get a picture of the health history and family history. Some testing may be done as well. And the person does the first EEG training session, at which time we get a look at the EEG. This all may take about two hours. Subsequent training sessions last 30-45 minutes. Some improvement is generally seen within ten to twenty sessions. Once learning is consolidated, the benefit appears to be permanent in most cases.

The EEG Biofeedback training is a painless, non-invasive procedure. One or more sensors are placed on the scalp, and one to each ear. The brain waves are monitored by means of an amplifier and a computer-based instrument that processes the signal and provides the proper feedback. This is displayed to the trainee by means of a video game or other video display, along with audio signals. The trainee is asked to make the video game go with his brain. As activity in a desirable frequency band increases, the video game moves faster, or some other reward is given. As activity in an adverse band increases, the video game is inhibited. Gradually, the brain responds to the cues that it is being given, and a "learning" of new brain wave patterns takes place. The new pattern is closer to what is normally observed in individuals without such disabilities.

WHAT DISORDERS HAVE CLINICAL EVIDENCE?

Following disorders have scientific reports from multi-subject and controlled studies:
Attention Deficit Hyperactivity Disorder, Anxiety Disorders, Alcoholism, Epilepsy, Headache, Sleep Disorders, Traumatic Brain Injury. Altogether there are 650 studies demonstrating efficacy at 30+ clinical conditions in peer-reviewed journals cited on Medline.

WHAT RESULTS DO WE OBTAIN?

In the case of ADHD, impulsivity, distractibility, and hyperactivity may all respond to the training. This may lead to much more successful school performance. Cognitive function may improve as well. In several controlled studies, increases of 10 and more points in IQ score were found for a representative group of ADHD children.

Behavior may improve in other ways as well: If the child has a lot of temper tantrums, is belligerent, and even violent or cruel, these aspects of behavior may come under the child's control.

In the case of depression, there can be a gradual recovery of "affect", or emotional responsiveness, and a reduction of effort fatigue. In the case of anxiety and panic attacks, there is gradual improvement in "regulation", with a drop-off in frequency and severity of anxiety episodes and panic attacks until the condition normalizes.

In the case of epilepsy, we observe a reduction in severity and incidence of seizures or total cessation of seizures. In many cases, the dosage of anticonvulsant medication may ultimately be reduced and side effects of such medication may diminish.

CAN A SUCCESSFUL OUTCOME BE PREDICTED?

It is not possible to predict with certainty that training will be successful for an every particular condition. But for the more common conditions, as ADHD or Sleep Disorders, we see a reasonable prediction of outcome is usually possible, with the effectiveness reaching 90%. More important, however, the effectiveness of the training can usually be assessed early in the course of training. There are no known adverse side effects of the training, provided that it is conducted under professional guidance.

WHY DOES THIS TRAINING PROCEDURE WORK?

The brain is amazingly adaptable, and capable of learning. It can also learn to improve its own performance, if only it is given cues about what to change. By making information available to the brain about how it is functioning, and asking it to make adjustments, it can do so. When the mature brain is doing a good job of regulating itself, and the person is alert and attentive, the brain waves (EEG) show a particular pattern. We challenge the person to maintain this "high-performance", alert and attentive state. Gradually, the brain learns, just like it learns anything else. And like with other learning, the brain tends to retain the new skill.

We observe that if the EEG is not well behaved, there may be adverse impacts on learning ability, on moods, on sleep, and on behavior. With training, these may be brought under control along with normalization of EEG.

What does EEG Biofeedback look like?

	The therapist computer is usually positioned behind the patient. This enables the therapist to monitor the patient's EEG at any time during the session without disturbing the biofeedback.
A single electrode is placed on the scalp using gel or paste and two other electrodes are attached to the earlobes. Most patient recline during training.
	The game computer is placed a few feet away, directly in front of the patient. The patient interacts (only using her EEG) with the game computer for the next 30 minutes.

Each display contains six basic EEG frequency bands and actual data values. The top lines are color EEG spectrum and raw average EEG waves - the person's entire EEG recorded from the scalp by the single active electrode. Six color windows below show activity in separate EEG frequency bands or rhythms - delta, theta, alpha, SMR, beta, and high beta bands. The patient's goal is to increase certain EEG frequency bands (e.g., SMR) while decreasing others (e.g., theta & high beta).The patient monitors her EEG frequency band activity NOT as wavy lines on the therapist machine, but as elements of a game on the game computer.

With her brainwaves she is playing the game called "The Car Driving". Frequency band activity is displayed in video game dynamic changes, and in scales at the bottom of the screen (each frequency band appears as a rectangle colored in response to her brain wave activity: green = good, red = wrong). At this instant, she is doing quite well: she has increased her attention/concentration EEG activity while reducing the activity of dumping and tension bands (all indicators in green). As long as she keeps this up, she is rewarded in the game with visual and auditory stimuli. During the 30-45 minute session, she will thousands of feedback stimuli. Hundreds of times she may need to alter her brain activity in order to achieve a brain state which scores the most points. For every 300 miliseconds that her brainwaves stay in the desired state or "zone", she scores another point, and a beep sounds to announce it all. It is dense, intensive learning process.

HOW LONG DOES TRAINING NORMALLY TAKE?

EEG training is a learning process, and therefore results are seen gradually over time. For most conditions, initial progress can be seen within about ten to twenty sessions. For instance, Insomnia can be fixed by 5-10 sessions, Nocturnal Enuresis or Headache/Migraine by 20 sessions. At that time the control consultations are performed. In the case of hyperactivity and attention deficit disorder, training is expected to take about forty sessions, or even more in severe cases. Teeth grinding usually responds in twenty sessions. Some symptoms of head injury often respond in less than twenty sessions (quality of sleep, fatigue, chronic pain), whereas others may require longer training before they show an initial response (memory function, for example).

HOW FREQUENT SHOULD THE TRAINING SESSIONS BE?

In the initial stages of learning, the sessions should be regular and frequent, at two, three, or even more sessions per week. After learning begins to consolidate, the pace can be reduced.

IS EEG BIOFEEDBACK COVERED BY INSURANCE?

Some medical and psychological insurance plans now cover Biofeedback for various conditions. Some require co-payments. A prescription for the training, along with a diagnosis, may be required from a physician under the medical part of the plan, or from a licensed psychologist under the mental health services part of the plan. Medicare pays for some conditions.

MY DOCTOR TAKES A DIM VIEW OF BIOFEEDBACK. WHAT CAN I TELL HER?

Your doctor may not know of this specific type of Biofeedback. He or she will maintain a healthy skepticism about any new approach claiming numerous benefits. If your doctor is familiar with EEG Biofeedback in general, he may still be thinking in terms of the more common early experiments with alpha wave training, rather than with the training we are dealing with here. Ask your doctor to examine the recent research on the effectiveness of EEG Biofeedback in treating various disorders such as attention deficit disorder and epilepsy. The following references are a place where he or she can start:

• Linden M, Habib T, Radojevic V. A controlled study of the effect of EEG biofeedback on cognition and behavior of children with attention deficit disorder and learning disabilities. Biofeedback Self Regul 21(1), 35-49 (1996).
• Lubar JO and Lubar JF (1984). Electroencephalographic Biofeedback of SMR and beta for treatment of attention deficit disorder in a clinical setting. Biofeedback and Self-Regulation, 9, pp. 1-23.
• Rossiter TR & La Vaque TJ (1995). A comparison of EEG biofeedback and psychostimulants in treating Attention Deficit Hyperactivity Disorders. Journal of Neurotherapy, 1, 48-59.
• Sterman MB, Macdonald, LR, Stone RK (1974). Biofeedback training of the sensorimotor EEG rhythm in man: Effects on epilepsy. Epilepsia, 15, 395-416.
  Sterman MB The scientific basis of neurofeedback treatment. In: The ADD Book, Sears, W. and Thompson, L., Little Brown Co., New York, 1998.
• Sterman MB Sensorimotor EEG feedback training in the study and treatment of epilepsy. In: Neurobehavioral Treatment of Epilepsy, D.J. Mostofsky and Y. Loyning (Eds.), Erlbaum Publishers, 1993, pp. 1- 17.
• Tansey MA (1991). Wechsler (WISC-R) changes following treatment of learning disabilities via EEG biofeedback training in a private practice setting. Australian Journal of Psychology, 43, 147-153.

HOW MUCH DOES THE TRAINING COST?

The cost of the training differs among offices depending on location, the professional status of the person delivering the service, and on supplementary services offered. Typically, individual sessions run from $50 to $125 in the U.S., c. 30 euro in the Czech Republic.

Health Care in:
EEG Biofeedback, Clinical Psychology, Psychotherapy, Neurology
Nikoly Tesly 6, Prague 6
CZ-16000 Czech Republic
Office Phone: +420-233 320 499
Mobile: +420-774 224 962
Tyl@centrum.cz