NEUROFEEDBACK THERAPY TRAINING
Neurofeedback therapy training is not a new concept and has been the subject of the study of researchers for several decades. This method had been developed based on neuroplasticity characteristics of the brain: a capacity of neurons and neural networks in the brain to change their connections and behavior in response to new information, sensory stimulation, development, damage, or dysfunction. Neuroplasticity refers to the physiological changes in the brain that happen as the result of our interactions with our environment. Neuroplasticity allows our brains to continuously change and adapt, forging new neural connections as needed and abandoning pathways we no longer use. Neurofeedback therapy training can help you to rewire the brain for optimal performance, get rid of pathological states, and allow you to rule your life successfully and healthily.
At the root of all our thoughts, emotions and behaviors is the communication between neurons within our brains. Neurons communicate with each other through electrochemical signals which can be measured as wave-like patterns called brainwaves. Brainwaves are produced by synchronized electrical pulses from masses of neurons communicating with each other. They can be measured by electroencephalography (EEG), a non-invasive method of recording electrical activity using sensors attached to the scalp.
Different brain waves could be recognized by their amplitudes and frequencies. Frequency indicates how fast the waves oscillate which is measured by the number of waves per second (Hz), while amplitude represents the power of these waves measured by microvolt (μV). There are five main patterns of brain waves: DELTA (1-4 Hz), THETA (4-8 Hz), ALPHA (8-12 Hz) (includes Lower Alpha (8-10 Hz), and Upper Alpha (10-12 Hz)), BETA (12-30 Hz) (includes Lower Beta or so-called Sensorimotor rhythm – SMR (13-15 Hz) Beta (15-18 Hz) and High Beta (19-30 Hz)) and GAMMA (30-100 Hz).
Each brainwave state represents a particular physiological function and corresponds to a different state of awareness. In summary, delta waves are observed in the EEG signal when a person is asleep, theta waves when a person is sleepy, alpha waves when a person is relaxed and his/her muscles are loose but he/she is awake, beta waves when a person is alert and gamma waves are observed when a person is trying to solve a problem. Detailed information regarding brainwaves and their function you can find here.
Neurofeedback therapy training is a painless EEG biofeedback – a non-invasive procedure that aimed to register a brain activity involved in the thoughts, sensations, actions, and emotions in the form of brainwaves and provide a feedback signal, which teaches self-control of brain functions (see video explanation). Neurofeedback usually provides audio and/or video feedback. Positive or negative feedback is produced for desirable or undesirable brain activities, respectively. Detailed information regarding how neurofeedback works you can find here.
To detect and register these brainwaves the electrode sensors are attached to the scalp in the different parts of the head and to the ear according to the international 10-20 electrode placement system. Detailed instructions and a practical guide for 10-20 EEG electrode placement systems you can find here.
NEUROFEEDBACK THERAPY TRAINING IN DIFFERENT BRAIN REGION
Each region of the brain represents a specific feeling or task. Thus identification of these areas provides the best and the most accurate neurofeedback treatment. Multiple studies had discovered that lesions occurring in specific regions of the brain produce specific symptoms mostly related to these regions.
In the Frontal lobes, the electrode location at FP1, FP2, FPZ, FZ, F3, F4, and F7 is responsible for immediate and sustained attention, time management, social skills, emotions, empathy, working memory, executive planning, moral fiber, or character.
In the Parietal lobes, the electrode location at PZ, P3, and P4, solves problems conceptualized by the frontal lobes. Complex grammar, naming of the objects, sentence construction, and mathematical processing are identifiable to the left parietal lobe while map orientation, spatial recognition, and knowing the difference between right and left are entire functions of the right parietal lobe.
In the Temporal lobes, the electrode location at T3, T4, T5, and T6 have various functions. Left hemisphere functions are associated with reading (word recognition), memory, learning, and a positive mood, while right hemisphere functions are related to music, anxiety, facial recognition, and a sense of direction.
In the Occipital lobes, the electrode location at O2, O1, and Oz have usually processed the visual memories, accurate reading, and traumatic memories accompanying visual flashbacks. The other functions of this lobe include helping to locate objects in the environment, seeing colors and recognizing drawings and correctly identifying objects, reading, writing, and spelling.
In the Sensory and Motor (Sensorimotor) cortex, the electrode location at CZ, C3, and C4 have functions of conscious control of all skeletal movements such as typing, playing musical instruments, handwriting, operation of complex machinery, speaking, and the ability to recognize where bodily sensations originate. The motor cortex helps the cerebral cortex to encode both physical and cognitive tasks. Therefore, subjects who have trouble seeing the logical sequence of cognitive tasks may benefit from neurofeedback therapy training along the left hemisphere sensorimotor cortex (C3). Training along the right hemisphere sensorimotor cortex (C4) may invoke feelings, emotions, or calmness. Training at the median may facilitate a mixed response. The subjects who suffer from epilepsy are usually trained along the sensorimotor cortex (C3) to increase SMR (12-15 Hz). Also, training along the sensorimotor cortex could be applied for the treatment of stroke, epilepsy, paralysis, ADHD, and disorders of sensory/motor integration.
Generally, electrodes are placed in a way that a particular EEG channel is located on one brain side. For instance, low beta and beta are trained on the right (C4) and left (C3) brain sides, respectively. If they were switched to the opposite brain side, undesirable results could be obtained. For example, training low beta waves on the left side will result in a depletion of mental energy instead of improvements in concentration. Thus, the location of the EEG electrodes during the neurofeedback procedure is important.
BRAIN LOBES WITH THEIR FUNCTIONS AND ELECTRODE APPLICATION SITES FOR NEUROFEEDBACK THERAPY TRAINING
|Electrode application sites
Left hemisphere (LH)
All odd numbered sites
Logical sequencing, detail oriented, language abilities, word retrieval, fluency, reading, math performance, science performance, problem-solving, verbal memory
Underactivation leads to depression
Right hemisphere (RH)
All even numbered sites
Episodic memory encoding, social awareness, eye contact, music, humor, empathy, spatial awareness, art performance, insight, intuition, non-verbal memory, seeing the whole picture
Overactivation leads to anxiety
Fp1, Fp2, Fpz, Fz, F3, F4, F7, F8
LH: Working memory, concentration, executive planning, positive emotions
Pz, P3, P4
LH: Problem-solving, math performance, complex grammar, attention, association
Dyscalculia, sense of direction, learning disorders
T3, T4, T5, T6
LH: Word recognition, reading, language, memory
Anger, rage, dyslexia, long-term memory disorders, closed head injury
O1, O2, Oz
Visual learning, reading, parietal- temporal-occipital functions
Cz, C3, C4
LH: Attention, mental processing,
Paralysis (stroke), seizure disorder, poor handwriting, Attention Deficit and Hyperactivity Disorders (ADHD) symptoms
Fpz, Fz, Cz, Pz, Oz
Mental flexibility, cooperation, attention, motivation, morals
Obsessions, compulsions, tics, perfectionism, worry, ADHD symptoms, Obsessive Compulsive Disorder (OCD) & Autistic Spectrum Disorder (ASD)
Dyslexia, poor spelling, poor reading
HOW DOES NEUROFEEDBACK THERAPY TRAINING WORKS?
During a neurofeedback session, the recorded by EEG brainwave frequencies are divided into bands that are displayed on a computer screen in the form of a video game or other kind of signals providing feedback. The person effectively “plays” the video game using his/her brain to reach the mental state in which the desired brain wave is achieved. As activity in a desirable frequency band increases, the video game either moves faster or the movie continues playing. When activity in an adverse band increases, the visual display is inhibited. During this process, the brain activity of the person is compared to a goal on the computer. The sounds and images act as rewards, telling the person immediately when their brain reaches the goal – as they are activating or suppressing the target brain area. Gradually, the brain responds to the cues it is given and a “learning” of new brain wave patterns takes place. The brain wave frequencies targeted in neurofeedback are specific to each individual.
When the brain wave frequencies move into the desired frequency pattern, symptoms may be greatly decreased or entirely eliminated. Training or treatment is then considered complete, and the results are permanent. It may not be possible to predict how successful training may be for every individual, but a reasonable expectation of results can usually be assured early in the course of training. Some health conditions are severe, and in many cases, working in conjunction with a primary care physician, neurofeedback therapy training can offer hope for improvement and be an effective alternative to medications or drugs, often reducing or eliminating the need for them.
THE SYMPTOMS AND DISORDERS ASSOCIATED WITH SPECIFIC BRAINWAVE IMBALANCE
Many pathological states and disorders are caused by poorly functioning patterns in the brain and imbalance of different brainwaves in the different region of the brain. Here is some of them.
• Cognitive Impairment
• Focus and Attention Issues
• Socially Inappropriate
• Easily distracted
• Excessive Speech
• Traumatic Brain Injury
• Learning Disorders
• Autism / Asperger’s
• Victim Mentality
• Excessive Self Concern
• Passive Aggressive
• Avoidance Behavior
• Withdrawal Behavior
• Tension Headaches
• Obsessive Thinking
• Excessive Rationalization
• Poor Emotional Self-awareness
• Panic Attacks
• Chronic Pain
• Dislike Change
NEUROFEEDBACK THERAPY TRAINING PROTOCOLS
Basically, there are two classical directions in neurofeedback therapy training. It is either focusing on low frequencies (alpha or theta) to strengthen relaxation and focus or emphasizing high frequencies (low beta, beta) for reinforcing activation, organizing, and inhibiting distractibility.
Neurofeedback treatment protocols mainly focus on the alpha, beta, delta, theta, and gamma training/treatment or a combination of them such as alpha/ theta ratio, beta/theta ratio, etc.
Various studies have been performed on the alpha protocol. The alpha wave of the brain is usually associated with alert relaxation. The alpha mood is described as a calm and pleasant situation. All alpha frequencies describe the creative activity of the brain so that it is used in the process of relaxation (relaxing the muscles), which eventually leads to sleep.
The most common frequency bandwidth for the alpha treatment is the 7-10 Hz frequency range, which is used for meditation, sleep, and reducing stress and anxiety. Also, a frequency of 10 Hz causes deep muscle relaxation, pain reduction, regulating breathing rate, and decreasing heart rate.
Alpha training is usually used for the treatment of various diseases such as pain relief (by 9 Hz simulation), reducing stress and anxiety (by 10 and 30 Hz simulation), memory improvement, improving mental performance, and treatment of brain injuries (by 10.2 Hz simulation).
SMR training is a common protocol used to improve attention and focus. The SMR frequency band (12-15Hz) is associated with an alert, attentive state coupled with calm or silent motor activities. SMR training improves focus and attention by decreasing drowsy, mind-wandering Theta waves and anxious or racing High Beta waves, while increasing the calm, focused SMR waves. SMR training also improves motoric precision and balance and the ability to relax.
SMR neurofeedback has a positive effect on the regulation of attention and tends to reduce motor activity because the SMR occurs only when one is still. SMR neurofeedback is commonly used in epilepsy because it has been demonstrated to reduce seizure activity.
The SMR is regulated by a thalamocortical loop. Regulation of attention is a function of certain areas in the thalamus, and therefore increasing SMR generally leads to a decrease in theta, which in turn is correlated with an increase in arousal. Thus, SMR training is used in some cases of ADHD.
When applying SMR feedback, localization of electrode placement is critical.
The SMR is functionally bound to the primary motor and sensory cortices found centrally within the brain at the most posterior part of the frontal lobe. In order to correctly measure SMR, the electrodes must be placed over these areas. Furthermore, the SMR has a unique pattern to it. Although it has a specific frequency band (12–15 Hz), simply up-training this frequency is not the most effective method. The SMR comes and goes in a spindle-like pattern, and the longer these spindles persist, the better. So, apart from uptraining the amplitude of the frequency band, one might also reward the patient when he can produce the frequency for increasingly longer periods (rewarding based on a duration above the threshold). This kind of SMR feedback is known as discrete SMR training because you reward each discrete spindle.
The electrodes are usually located on C4 or CZ.
Beta activity is a good indicator of mental performance and inappropriate beta activity represents mental and physical disorders like depression, ADHD, and insomnia. Beta brain waves are associated with conscious precision, strong focus, and the ability to solve problems. Medications that are used to stimulate alertness and concentration such as Ritalin and Adderall also cause the brain to produce beta brainwaves.
Beta training is used to improve focus and attention (simulation of increased beta 12-14 Hz), improve reading ability (simulation of 7-9 Hz), and introduce positive changes in school performance. It also improves computational performance, cognitive processing, reduction of worries, overthinking, obsessive-compulsive disorder (OCD), alcoholism, and insomnia (simulation of 14-22 Hz and 12-15 Hz). Meanwhile, this type of neurofeedback improves sleep cognitive performance as well as reduces fatigue and stress (simulation of light and sound of beta). The beta training in the range of 12-15 Hz (SMR) reduces anxiety, epilepsy, anger, and stress. The electrodes are usually located on C3, C4, and CZ.
Theta brain waves are related to a number of brain activities such as memory, emotion, creativity, sleep, meditation, and hypnosis. These waves are also associated with the first phase of sleep when the sleep is light and the person easily wakes up. Theta treatment reduces anxiety, depression, daydreaming, distractibility, emotional disorders, and ADHD.
THETA/BETA RATIO PROTOCOL
Theta Beta Ratio (TBR) reflects interactions between subcortical and prefrontal cortical areas in the brain.
Increased TBR is related to less self-reported attentional control and correlated to a stronger decline in attentional control after stress-induction which are core elements of cognitive performance anxiety (CPA); a phenomenon defined as when fears compromise an individual’s capacity to execute a task.
Application of a TBR Neurofeedback therapy training with the aim to reduce TBR might be effective in reducing attentional dysfunction as in ADHD patients and might possibly increase resilience to deleterious effects of stress on cognition.
TBR protocol aims to decrease theta (4–8 Hz) activity and increase beta (13– 20 Hz) activity. EEG electrodes usually apply in Cz.
Alpha/theta brainwave is an indicator of awareness and sleep. Alpha/theta neurofeedback therapy training is one of the most popular neurofeedback training for stress reduction. Also, this treatment is used for deep levels of depression, addiction, and anxiety while it increases creativity, relaxation, and musical performance, and promotes healing from trauma reactions. The electrodes are usually located on O1, O2, CZ, and PZ. The alpha/theta frequency range is 7-8.5 Hz with a typical value of 7.8 Hz. This treatment is done under the eyes-closed condition that increases the ratio of theta to alpha waves using auditory feedback.
Delta waves are the slowest brain waves, which are associated with stages 3 and 4 of sleep. They represent increased comfort, reduced pain, and sleep. Thus, they are used to alleviate headaches, traumatic brain injury, and learning disorders, and to treat hard and sharp contraction of muscles (by simulation of 1-3 Hz delta wave). They also reduce concerns and improve sleep.
Gamma waves have the highest frequency, and they are associated with cognitive processing and memory. Thus, when these waves are faster, the speed of recalling memory is faster. Gamma waves are fast rhythms that are responsible for the brain’s neural connections and data transfer to the outside world.
They are mainly observed in the hippocampus – an area of the brain that is responsible for converting short-term to long-term memory. Also, these rapid rhythms are observed in sudden attacks like seizures and spasms. Hence, gamma training is used for promoting cognition, mental sharpness, brain activity, and problem-solving tasks. It not only improves poor calculation, but also organizes the brain, improves the speed of information processing, and short-term memory, and reduces the number of migraine attacks.
NEUROFEEDBACK THERAPY TRAINING HOME USE DEVICE
Neurofeedback devices and systems are used for both medical and non-medical uses, and the dividing line between them may be thin. Non-medical application of neurofeedback can be considered primarily as personal improvement and conditioning for the brain and mind: to improve relaxation, attention, focus, concentration, and self-awareness, or as an adjunct to meditation, counseling, hypnosis, or achieving altered states of consciousness. It can be done without professional intervention. In cases where it is desired to relieve the conditions of a medical problem, professional help should be sought.
It is a fact that Neurofeedback systems are designed to allow the user to control a computer for recreational, educational, or entertainment purposes and are not medical instruments. You can find detailed information regarding indications, methods, and descriptions of different neurofeedback devices for home use here. However, if direct benefits are claimed for relaxation or relief from the symptoms of disorders, then the device is considered medical.
In the nonclinical embodiment, most of the same functions and capabilities are present, but they are presented in the context of an educational and recreational device. It is nonetheless true that the actual benefits may be essentially the same in both embodiments depending on how the user configures and applies the device, although the labeling and claims are different. The same instrument is being provided in both cases but with different intents.
Clearly, the difference between the medical and non-medical embodiment of NFB devices lies primarily in the claims, expectations, and applications of the user.
For example, although neurofeedback can be used to improve attention and concentration, and this can be considered as a personal improvement application, in cases of suspected or diagnosed Attention Deficit Hyperactivity Disorders the use of this procedure might be regarded as a medical procedure.
It may thus be argued that neurofeedback treatment intended to reduce the symptoms of ADHD, especially when the removal from stimulants (Ritalin, etc) is desired, that neurofeedback is being used in a medical context. However, if a parent, teacher, or counselor uses neurofeedback in a home or educational setting to educate a child on how to reach a state of relaxed attentiveness and improve academic success, the treatment may be considered education, not treatment.
Neurofeedback takes advantage of the brain’s ability to change itself through a process known as Neuroplasticity. It utilizes the same learning process that occurs whenever we acquire a new skill. The brain learns by forming connections between nerve cells and utilizing important pathways that connect different locations in the brain.
The more frequently you utilize these pathways the better the brain becomes at performing the associated task.
This type of learning is a type in which responses come to be controlled by their consequences. Quite simply, Neurofeedback offers the perfect learning conditions, since it facilitates awareness of when the brain is producing healthier brainwave patterns, provides reinforcement for the positive change, and multiple opportunities to provide practice during a training session.