Mini Stroke Recovery and Prophylaxis with Biofeedback

Mini Stroke Recovery and Biofeedback

Mini strokes, also known as transient ischemic attacks (TIAs), are brief episodes of neurological dysfunction caused by a temporary interruption of blood flow to the brain. While they may not cause permanent damage themselves, TIAs are often warning signs of a potential future stroke. Therefore, understanding the process of mini stroke recovery is crucial for individuals who have experienced such an event. In recent years, biofeedback has emerged as a promising therapeutic approach in stroke rehabilitation, including for mini stroke recovery. This article explores the concept of mini stroke recovery and the role of biofeedback in aiding the rehabilitation process.

What is a Mini Stroke?

A mini-stroke, clinically referred to as a transient ischemic attack (TIA), is a temporary disruption of blood flow to a part of the brain. Despite its transient nature, a mini-stroke produces symptoms similar to those of a full stroke, albeit typically lasting for a shorter duration. These symptoms arise due to the sudden deprivation of oxygen and nutrients to brain cells, leading to temporary dysfunction.

Symptoms of a mini-stroke can include sudden weakness or numbness in the face, arm, or leg, typically on one side of the body, difficulty speaking or understanding speech, temporary loss of vision in one or both eyes, dizziness, and loss of balance or coordination.

Unlike a full stroke, the symptoms of a mini stroke (TIA) usually resolve within minutes to hours and leave no permanent damage. However, TIAs are often considered warning signs of a potential future stroke and should be taken seriously. It’s crucial to seek medical attention promptly if you suspect you or someone else is experiencing a mini-stroke.

Causes and Risk Factors of Mini Stroke

Mini strokes occur when there is a temporary blockage or narrowing of blood vessels supplying the brain. Common causes include blood clots, atherosclerosis (hardening and narrowing of arteries), or embolisms (traveling blood clots). Risk factors for mini strokes mirror those for full strokes and include hypertension, diabetes, smoking, high cholesterol, obesity, and a sedentary lifestyle.

Understanding the causes and risk factors associated with mini strokes, or transient ischemic attacks (TIAs), is essential for identifying individuals at higher risk and implementing preventive measures. 

1. Atherosclerosis:
Atherosclerosis refers to the buildup of fatty deposits (plaques) in the arteries, leading to narrowing and hardening of the blood vessels. These plaques can reduce blood flow to the brain, increasing the risk of mini strokes. Risk factors for atherosclerosis include high cholesterol, high blood pressure, smoking, diabetes, and obesity.

2. Blood Clots:
Blood clots, also known as thrombi, can form within blood vessels supplying the brain or elsewhere in the body and then travel to the brain, causing a blockage. Conditions that increase the risk of blood clot formation include atrial fibrillation (an irregular heart rhythm), heart valve disorders, and deep vein thrombosis (DVT). Certain medical procedures or conditions that promote blood clot formation, such as surgery, cancer, or prolonged immobilization, can also raise the risk of mini strokes.

3. Embolism:
An embolism occurs when a blood clot or other debris breaks off from its site of origin and travels through the bloodstream until it becomes lodged in a smaller blood vessel, blocking blood flow. Cardiac sources of emboli include atrial fibrillation, heart valve disorders (such as mitral valve stenosis), and recent heart attacks. Non-cardiac sources may include blood clots originating from the carotid arteries in the neck or other peripheral arteries.

4. Hypertension (High Blood Pressure):
Chronic high blood pressure can damage the blood vessel walls over time, increasing the risk of atherosclerosis and blood clot formation. Uncontrolled hypertension is a significant risk factor for both ischemic and hemorrhagic strokes, including mini strokes.

5. Diabetes Mellitus:
Diabetes is associated with various vascular complications, including damage to blood vessels and increased clotting tendencies. Individuals with diabetes have a higher risk of developing atherosclerosis and hypertension, further predisposing them to mini strokes.

6. Smoking:
Smoking cigarettes significantly increases the risk of cardiovascular disease, including atherosclerosis and blood clot formation. The chemicals in tobacco smoke damage blood vessel walls, promote inflammation, and contribute to the development of plaque buildup.

7. High Cholesterol:
Elevated levels of LDL (low-density lipoprotein) cholesterol, often referred to as “bad” cholesterol, contribute to the formation of atherosclerotic plaques. These plaques can narrow the arteries and impede blood flow to the brain, increasing the risk of mini strokes.

8. Age and Gender:
The risk of mini strokes increases with age, with older adults being more susceptible. Men are at a slightly higher risk of experiencing mini strokes than women, although the risk for women increases after menopause.

9. Family History and Genetics:
A family history of stroke or cardiovascular disease can increase an individual’s predisposition to mini strokes. Certain genetic factors may also influence an individual’s susceptibility to developing vascular conditions that predispose them to mini strokes.

10. Lifestyle Factors:
Sedentary lifestyle, poor diet, excessive alcohol consumption, and stress can contribute to the development of risk factors such as obesity, hypertension, and high cholesterol, thereby increasing the risk of mini strokes.

Recognizing these causes and risk factors is crucial for implementing preventive measures and lifestyle modifications to reduce the likelihood of experiencing a mini stroke. Additionally, managing underlying medical conditions and adopting a healthy lifestyle can help mitigate the risk of future vascular events.

Pathophysiology of Mini Stroke

A mini stroke, also known as a transient ischemic attack (TIA), shares similar pathophysiological mechanisms with a full-blown stroke (cerebrovascular accident or CVA), but the symptoms are temporary and usually resolve within 24 hours. Understanding the pathophysiology of a mini stroke involves examining the underlying causes and mechanisms that lead to transient neurological symptoms.

1. Ischemic Pathophysiology:
The majority of mini strokes are ischemic, meaning they occur due to a temporary interruption of blood flow to a part of the brain. This interruption is often caused by a temporary blockage or narrowing of a cerebral artery. Common causes of ischemic mini strokes include emboli (clots or debris) that travel to the brain from other parts of the body, such as the heart or carotid arteries, or local thrombosis (formation of a blood clot) within a cerebral artery.

2. Embolic Mini Strokes:
Embolic mini strokes typically occur when a clot or debris dislodges from a plaque (atherosclerotic buildup) within a large artery, such as the carotid artery or a major branch of the circle of Willis, and travels to a smaller artery in the brain, causing a temporary blockage. Emboli can also originate from the heart, particularly in individuals with atrial fibrillation (an irregular heart rhythm) or heart valve abnormalities, where blood stasis or turbulence can promote the formation of clots.

3. Thrombotic Mini Strokes:
Thrombotic mini strokes result from the formation of a blood clot (thrombus) within a cerebral artery, usually at the site of an atherosclerotic plaque. The thrombus may partially or completely occlude the artery, leading to transient ischemia in the affected brain region. Thrombotic mini strokes often occur in individuals with underlying atherosclerosis, hypertension, diabetes, or hyperlipidemia, which increase the risk of plaque formation and thrombus formation within cerebral arteries.

4. Hemodynamic Factors:
In addition to embolic and thrombotic mechanisms, mini strokes can also be caused by transient decreases in cerebral blood flow due to hemodynamic factors such as hypotension, hypoperfusion, or vasospasm. Hemodynamic mini strokes may occur in individuals with conditions that impair cerebral autoregulation, such as severe hypotension, cardiac arrhythmias, or carotid artery stenosis, leading to transient ischemia in vulnerable brain regions.

5. Reperfusion and Resolution:
Unlike a full-blown stroke, where permanent neurological deficits result from sustained ischemic injury and infarction, mini strokes are characterized by transient symptoms that resolve spontaneously within a short period. The temporary nature of mini stroke symptoms is often attributed to the rapid restoration of blood flow (reperfusion) and resolution of ischemia, either due to spontaneous clot lysis, collateral circulation, or dynamic changes in vascular tone.
While the symptoms of a mini stroke may resolve quickly, it is essential for individuals to seek prompt medical evaluation to identify and address underlying risk factors that predispose them to future strokes.

In summary, the pathophysiology of a mini stroke involves transient ischemia in the brain caused by a temporary interruption of blood flow, typically due to embolic or thrombotic mechanisms, or hemodynamic factors. While mini strokes share similar underlying mechanisms with full-blown strokes, the temporary nature of their symptoms distinguishes them from permanent neurological injury. Prompt evaluation and management of underlying risk factors are crucial for preventing recurrent strokes and optimizing long-term outcomes in individuals who have experienced a mini stroke.

Symptoms of a Mini Stroke

Mini strokes, or transient ischemic attacks (TIAs), can present with various symptoms, each indicating a temporary disruption of blood flow to the brain. It’s important to note that not all symptoms may occur simultaneously, and the severity can vary among individuals. Here’s a detailed list of common symptoms associated with mini strokes:

1. Sudden Weakness or Numbness:
One of the hallmark symptoms of a mini stroke is a sudden onset of weakness or numbness, often affecting one side of the body. This weakness or numbness may occur in the face, arm, or leg and typically presents on the opposite side of the body as the affected brain hemisphere.

2. Difficulty Speaking or Understanding Speech (Dysphasia):
Another common symptom of a mini stroke is difficulty speaking or understanding speech. Individuals may experience slurred speech, difficulty finding the right words (word-finding difficulty), or problems understanding spoken or written language.

Spasticity arm

3. Temporary Loss of Vision:
Mini strokes can cause temporary loss of vision, often described as a curtain coming down over one eye or as a sudden blackout. Vision loss may affect one eye or both eyes, depending on the location and extent of the disruption in blood flow to the brain’s visual processing areas.

4. Dizziness and Loss of Balance:
Some individuals may experience dizziness or a sensation of spinning (vertigo) during a mini stroke. Loss of balance or coordination may also occur, making it difficult to walk or maintain steady movement.

5. Brief Episodes of Confusion or Memory Loss:
Mini strokes can lead to temporary episodes of confusion, disorientation, or memory loss. Individuals may have difficulty concentrating, following conversations, or recalling recent events.

6. Trouble with Coordination:
Coordination difficulties, such as trouble with fine motor skills or clumsiness, may occur during a mini stroke. This can manifest as difficulty performing tasks that require precise movements, such as writing or buttoning a shirt.

7. Facial Drooping:
In some cases, mini strokes may cause facial drooping, similar to what is observed in full strokes. One side of the face may appear droopy or asymmetrical due to weakness or paralysis of the facial muscles.

BEFAST symptoms

It’s important to recognize that these symptoms can vary in severity and duration. While they typically resolve within minutes to hours without causing permanent damage, they serve as warning signs of an increased risk of future strokes. Therefore, prompt medical attention is crucial if you or someone else experiences symptoms suggestive of a mini stroke.

Duration and Residual Effects

Mini strokes typically last for a few minutes to hours, with symptoms resolving spontaneously. Unlike a full stroke, mini strokes do not cause permanent brain damage or long-term disability. However, they serve as warning signs for an increased risk of future strokes, making prompt medical attention essential.

Understanding the duration and residual effects of mini strokes, also known as transient ischemic attacks (TIAs), is essential for recognizing their temporary nature and potential impact on individuals’ health. Here’s a detailed description:

1. Duration of Symptoms:
• Mini strokes typically produce symptoms that come on suddenly and last for a relatively short duration, usually ranging from a few minutes to up to 24 hours.
• Most TIAs resolve spontaneously within minutes to hours, with symptoms gradually improving or disappearing completely.
• In some cases, symptoms may persist for several hours, but they rarely last longer than 24 hours.

2. Transient Nature:
• The term “transient” in transient ischemic attack reflects the temporary nature of the symptoms.
• Unlike a full stroke, which results in permanent brain damage, the symptoms of a TIA resolve completely, and there is no lasting impairment of brain function.
• Despite their transient nature, TIAs serve as warning signs of an increased risk of future strokes, making prompt medical evaluation and intervention crucial.

3. Residual Effects:
• In general, mini strokes do not leave any residual effects or permanent damage to the brain.
• Once blood flow is restored to the affected area of the brain, brain function returns to normal, and individuals typically recover fully without lasting deficits.
• Unlike full strokes, which can cause paralysis, speech difficulties, cognitive impairment, or other long-term disabilities, TIAs do not result in lasting neurological deficits.

4. Warning Sign for Future Strokes:
• Although the symptoms of a TIA resolve spontaneously, they should not be ignored or dismissed.
• TIAs serve as warning signs that there is an underlying vascular problem or risk factor that needs to be addressed to prevent future strokes.
• Individuals who experience a TIA are at a significantly higher risk of experiencing a full stroke in the future, particularly within the days, weeks, or months following the TIA.

5. Importance of Medical Evaluation:
• It is crucial for individuals who experience symptoms of a mini stroke to seek prompt medical evaluation.
• A thorough assessment by a healthcare professional can help determine the underlying cause of the TIA, identify any modifiable risk factors, and implement preventive measures to reduce the risk of future strokes.
• Diagnostic tests such as brain imaging (CT scan or MRI), carotid ultrasound, and electrocardiogram (ECG) may be performed to evaluate the extent of the vascular damage and assess the risk of future stroke.

In summary, mini strokes are characterized by transient symptoms that typically resolve within minutes to hours, leaving no residual effects or permanent damage. Despite their temporary nature, TIAs serve as warning signs of an increased risk of future strokes, highlighting the importance of prompt medical evaluation, risk factor modification, and preventive measures to reduce the likelihood of recurrent vascular events.

The Role of Biofeedback in Mini Stroke Recovery: Insights from Research Data

Mini strokes, also known as transient ischemic attacks (TIAs), though transient in nature, serve as significant warning signs of potential future strokes. While prompt medical intervention and lifestyle modifications are crucial for minimizing the risk of recurrent strokes, rehabilitation strategies play a vital role in aiding mini stroke recovery. In recent years, biofeedback has emerged as a promising therapeutic approach in stroke rehabilitation, offering personalized and real-time feedback to enhance motor and cognitive functions, improve functional abilities, and promote neuroplasticity.

Numerous studies have investigated the efficacy of biofeedback in stroke and mini stroke recovery, demonstrating its potential to improve motor function, reduce disability, and enhance quality of life. Research data have shown that biofeedback interventions targeting upper limb function, balance, gait, and cognitive skills can yield positive outcomes in stroke survivors.

While research specifically focusing on biofeedback in mini stroke recovery is limited, the principles and findings from stroke rehabilitation studies can be extrapolated to mini stroke recovery and management. Given the transient nature of TIAs and the absence of long-term neurological deficits, biofeedback interventions tailored to address specific impairments observed during mini strokes could facilitate faster recovery and reduce the risk of recurrent events.

Potential Benefits of Biofeedback in Mini Stroke Recovery

Research data suggest several potential benefits of integrating biofeedback into mini stroke rehabilitation programs:
• Enhancing Motor Recovery: Biofeedback techniques can promote motor learning and retraining, facilitating recovery of motor function in individuals affected by mini strokes.
• Improving Cognitive Function: Cognitive rehabilitation using biofeedback may help address cognitive deficits commonly associated with TIAs, such as attention, memory, and executive functions.
• Promoting Neuroplasticity: Biofeedback-induced neurofeedback mechanisms may promote neuroplasticity changes in the brain, facilitating recovery and adaptive reorganization of neural networks following mini strokes.
• Encouraging Active Participation: The interactive nature of biofeedback allows individuals to actively engage in their rehabilitation process, fostering motivation, self-efficacy, and adherence to therapy.

Biofeedback Modalities in mini stroke recovery

By tailoring biofeedback modalities to address the specific symptoms and deficits observed in individuals who have experienced a mini stroke, rehabilitation professionals can provide personalized and targeted interventions to optimize recovery and improve functional outcomes. The selection of biofeedback techniques should be based on individual patient needs, goals, and clinical presentations, with careful consideration of the underlying impairments and rehabilitation objectives.

EMG Biofeedback in mini stroke recovery

Using electromyography (EMG) biofeedback in mini stroke recovery can target specific muscle groups affected by weakness or paralysis, helping individuals regain motor control and functional abilities. Here’s a detailed exploration of EMG biofeedback in mini stroke rehabilitation, including the muscles that can be trained, the intensity of training, and the potential benefits of combining EMG biofeedback with electrostimulation, along with research data on its effectiveness.

1. Muscles Targeted:
EMG biofeedback can be used to train a variety of muscle groups depending on the individual’s impairments and rehabilitation goals.

Commonly targeted muscle groups in mini stroke recovery include those involved in
• upper limb function (e.g., deltoids, biceps, triceps, wrist extensors/flexors),
• lower limb function (e.g., quadriceps, hamstrings, calf muscles),
• and trunk stability (e.g., abdominals, paraspinal muscles).

2. Intensity of Training:
The intensity of EMG biofeedback training can be adjusted based on the individual’s level of motor impairment, functional goals, and tolerance for physical activity.
• Training sessions typically involve repetitive exercises focused on activating and strengthening the targeted muscle groups.
• Real-time feedback provided by EMG biofeedback helps individuals learn to engage the appropriate muscles and optimize their movement patterns, promoting motor learning and neuromuscular reeducation.

3. Combining Biofeedback with Electrostimulation:
Combining EMG biofeedback with electrostimulation, such as functional electrical stimulation (FES) or neuromuscular electrical stimulation (NMES), may offer synergistic benefits in mini stroke rehabilitation.
• Electrostimulation can help facilitate muscle activation, enhance muscle strength, and promote motor recovery by delivering electrical impulses directly to the affected muscles.
• When used in conjunction with EMG biofeedback, electrostimulation can complement the feedback provided by EMG signals, optimizing muscle recruitment and promoting more efficient movement patterns.

Muscle activity patterns

4. Research Data on Effectiveness:
Several studies have investigated the effectiveness of EMG biofeedback in stroke rehabilitation, including mini stroke recovery, with promising results.

EMG biofeedback is a valuable modality in mini stroke rehabilitation, enabling individuals to target specific muscle groups, adjust training intensity, and optimize movement patterns through real-time feedback.

Combining EMG biofeedback with electrostimulation may offer additional benefits in promoting motor recovery and functional independence. Research data support the effectiveness of EMG biofeedback interventions in stroke rehabilitation, suggesting its potential utility in mini stroke recovery and prophylaxis.

EEG Biofeedback (Neurofeedback) in mini stroke recovery

Using electroencephalography (EEG) biofeedback, also known as neurofeedback, in mini stroke recovery can target cognitive impairments, attention deficits, and other neurological symptoms by promoting neuroplasticity and enhancing brain function. Here’s a detailed exploration of EEG biofeedback in mini stroke rehabilitation, including neurofeedback protocols and application sites for different cases:

1. Neurofeedback Protocols:
Neurofeedback protocols involve training individuals to modulate their brainwave activity, typically focusing on specific EEG frequencies associated with cognitive functions and emotional regulation.

Common neurofeedback protocols used in mini stroke recovery include:

• Sensorimotor Rhythm (SMR) Training: SMR neurofeedback aims to enhance sensorimotor integration and attentional control by training individuals to increase SMR (12-15 Hz) activity over sensorimotor cortex areas.

• Theta/Beta Ratio Training: This protocol targets attention deficits and hyperarousal by teaching individuals to decrease theta (4-8 Hz) activity and increase beta (15-30 Hz) activity, particularly over frontal cortical regions.

• Alpha-Theta Training: Alpha-theta neurofeedback promotes relaxation, stress reduction, and emotional processing by guiding individuals to increase alpha (8-12 Hz) activity and induce theta (4-8 Hz) activity, typically over posterior cortical areas.

• Connectivity-Based Neurofeedback: This advanced protocol focuses on enhancing functional connectivity between brain regions associated with cognitive functions, such as attention, memory, and executive control.

2. Electrode Application Sites:

The selection of neurofeedback application sites depends on the specific cognitive deficits and neurological symptoms observed in individuals following a mini stroke.

• For motor-related deficits (e.g., hemiparesis, impaired coordination), SMR training can target sensorimotor cortex areas contralateral to the affected limbs.

• Attention deficits and executive dysfunction may benefit from theta/beta ratio training or alpha-theta training, with electrodes placed over frontal and prefrontal cortical regions.

• Emotional dysregulation, anxiety, or depression may be addressed through alpha-theta training or connectivity-based neurofeedback, targeting limbic system structures such as the amygdala and anterior cingulate cortex.

• Individualized neurofeedback protocols may involve a combination of training sites based on comprehensive assessment data, treatment goals, and patient-specific needs.

3. Integration with Cognitive Rehabilitation:

• Neurofeedback can be integrated into comprehensive cognitive rehabilitation programs for mini stroke recovery, complementing other therapeutic interventions such as cognitive training, psychoeducation, and cognitive behavioral therapy.

• Cognitive rehabilitation goals may include improving attention, memory, executive function, emotional regulation, and adaptive coping skills.

• Neurofeedback sessions can be tailored to reinforce cognitive skills and promote adaptive neural network changes, enhancing the efficacy of cognitive rehabilitation interventions.

4. Research Evidence and Effectiveness:
Research on the effectiveness of EEG biofeedback in mini stroke recovery is evolving, with promising findings suggesting its potential benefits in enhancing cognitive function and neurological outcomes.

EEG biofeedback offers a promising approach in mini stroke rehabilitation, targeting cognitive impairments, attention deficits, and emotional dysregulation through personalized neurofeedback protocols. By promoting neuroplastic changes in brain function and connectivity, EEG biofeedback contributes to the optimization of cognitive rehabilitation outcomes and the enhancement of neurological recovery following a mini stroke.

Breathing Biofeedback in mini stroke recovery

Respiratory, or breathing, biofeedback is another modality that can be utilized in mini stroke rehabilitation, particularly for addressing symptoms related to stress, anxiety, and respiratory dysfunction. Here’s how respiratory biofeedback can be beneficial in managing certain aspects of mini stroke recovery.

1. Stress and Anxiety Reduction:

Many individuals who have experienced a mini stroke may experience heightened levels of stress and anxiety, either as a result of the event itself or due to concerns about future health risks.

• Respiratory biofeedback can help individuals regulate their breathing patterns and induce a state of relaxation by teaching them techniques such as diaphragmatic breathing, paced breathing, or coherent breathing.

• By monitoring parameters such as respiratory rate, depth of breathing, and heart rate variability, respiratory biofeedback provides real-time feedback to guide individuals in achieving a calm and balanced breathing rhythm, thereby reducing stress and anxiety levels.

2. Management of Respiratory Dysfunction:

Mini strokes can occasionally affect regions of the brain involved in respiratory control, leading to respiratory dysfunction or irregular breathing patterns.

• Respiratory biofeedback techniques can assist individuals in improving respiratory function by promoting optimal breathing patterns and lung capacity.

• Through visual or auditory feedback, individuals can learn to adjust their breathing rate, depth, and rhythm to optimize oxygenation, reduce respiratory effort, and enhance overall respiratory efficiency.

3. Promotion of Relaxation and Well-being:
Respiratory biofeedback fosters mindfulness and body awareness, encouraging individuals to focus on their breath and engage in relaxation practices.

• By incorporating elements of mindfulness meditation or relaxation training, respiratory biofeedback sessions can help individuals cultivate a sense of inner calm, reduce muscle tension, and enhance overall well-being.

• Regular practice of respiratory biofeedback techniques can empower individuals to better manage stressors, improve emotional resilience, and promote a sense of control over their physiological responses.

4. Complementary Therapy for Comprehensive Rehabilitation:
Respiratory biofeedback can complement other rehabilitation interventions, such as physical therapy, occupational therapy, and cognitive-behavioral therapy, in a comprehensive mini stroke rehabilitation program.

• Integrating respiratory biofeedback into multidisciplinary treatment plans provides individuals with additional tools for managing the physical, emotional, and cognitive aspects of their recovery journey.

• By addressing both the physiological and psychological dimensions of mini stroke recovery, respiratory biofeedback contributes to a holistic approach to rehabilitation, promoting overall health and resilience.

Respiratory biofeedback is a valuable modality in mini stroke rehabilitation, offering benefits such as stress reduction, management of respiratory dysfunction, promotion of relaxation, and enhancement of overall well-being. By teaching individuals to regulate their breathing patterns and cultivate a sense of inner calm, respiratory biofeedback empowers them to actively participate in their recovery process and improve their quality of life following a mini stroke.

Heart Rate Variability Biofeedback in mini stroke recovery

Heart rate variability (HRV) biofeedback is a non-invasive technique that utilizes real-time feedback to train individuals to regulate their heart rate variability, which reflects the autonomic nervous system’s balance between sympathetic and parasympathetic activity. In the context of mini stroke recovery, HRV biofeedback offers a promising approach to enhancing physiological resilience, reducing stress, Anxiety, Emotional Dysregulation, and promoting overall well-being.

Principles of Heart Rate Variability Biofeedback

HRV biofeedback is based on the concept that greater variability in the timing between heartbeats (inter-beat intervals) reflects a healthier autonomic nervous system function and greater adaptability to stressors.

Key principles of HRV biofeedback include:

1. Real-Time Feedback: Individuals receive visual or auditory feedback on their heart rate variability, typically in the form of a computer-generated display or sound, allowing them to observe changes in their physiological state and adjust their breathing and mental focus accordingly.

2. Resonant Frequency Breathing: HRV biofeedback often incorporates resonant frequency breathing techniques, which involve breathing at a specific rate (usually around 6 breaths per minute) to maximize heart rate variability and promote relaxation.

3. Self-Regulation: Through practice and repetition, individuals learn to modulate their heart rate variability through conscious control of their breathing patterns, mental focus, and emotional state, thereby enhancing their ability to self-regulate physiological responses to stressors.

Application of HRV Biofeedback in Mini Stroke Recovery:

In the context of mini stroke recovery, HRV biofeedback can address several aspects of rehabilitation and promote overall recovery and well-being:

1. Stress Reduction and Emotional Regulation: Mini strokes and their aftermath can be emotionally challenging, leading to increased stress and anxiety. HRV biofeedback teaches individuals to induce a state of physiological relaxation and emotional calmness, leading to reduced sympathetic arousal and increased parasympathetic activity, reducing the negative impact of stress on cardiovascular health and promoting faster recovery.

2. Autonomic Balance: Imbalances in autonomic nervous system function, such as increased sympathetic activity and decreased parasympathetic activity, are common in individuals with a history of stroke. HRV biofeedback helps restore autonomic balance by strengthening parasympathetic tone and reducing sympathetic arousal, thereby improving cardiovascular function and reducing the risk of recurrent strokes.

3. Neuroplasticity and Cognitive Rehabilitation: HRV biofeedback may promote neuroplasticity changes in the brain by modulating autonomic nervous system activity and promoting optimal cerebral perfusion. These neuroplasticity effects can support recovery of cognitive function, memory, attention, motor skills, emotional resilience and executive function following a mini stroke. By promoting neuroplasticity, HRV biofeedback may enhance the brain’s ability to adapt and reorganize in response to injury, facilitating functional recovery and improving overall cognitive outcomes.

4. Secondary Stroke Prevention: By teaching individuals to self-regulate their physiological responses and reduce modifiable risk factors such as stress, hypertension, and inflammation, HRV biofeedback can contribute to secondary stroke prevention and long-term vascular health.
Regular practice of HRV biofeedback techniques may lead to sustained improvements in autonomic function, blood pressure control, and overall cardiovascular health, reducing the likelihood of recurrent strokes and improving prognosis.

5. Integration with Comprehensive Rehabilitation Programs:
HRV biofeedback should be integrated into comprehensive stroke rehabilitation programs, complementing other therapeutic interventions such as physical therapy, occupational therapy, speech therapy, and cognitive rehabilitation. By addressing both physiological and psychological aspects of recovery, HRV biofeedback enhances the effectiveness of multidisciplinary rehabilitation efforts and promotes holistic recovery from mini strokes.

Heart rate variability biofeedback offers a promising adjunctive approach to mini stroke recovery by promoting stress reduction, autonomic balance, neuroplasticity, and secondary stroke prevention. Further research is warranted to elucidate the specific effects of HRV biofeedback on stroke outcomes and optimize its integration into comprehensive rehabilitation programs for individuals with a history of mini strokes.

Temperature and ESR (Electrodermal Activity and Skin Resistance) biofeedback in mini stroke recover

Temperature and ESR (Electrodermal Activity and Skin Resistance) biofeedback are less commonly utilized in mini stroke recovery compared to other modalities such as EMG (Electromyography) or EEG (Electroencephalography) biofeedback. However, they may still have potential applications in certain aspects of rehabilitation. Here’s how temperature and ESR biofeedback could theoretically be used in mini stroke recovery:

Temperature Biofeedback

• Temperature biofeedback involves monitoring and providing feedback on skin temperature, typically through sensors attached to the fingers or other peripheral areas.
• While there is limited research specifically on temperature biofeedback in stroke rehabilitation, it has been used in other contexts, such as stress management and relaxation training.
• In mini stroke recovery, temperature biofeedback could potentially be used to promote relaxation, reduce stress, and enhance peripheral circulation, which may have secondary benefits for overall well-being and recovery.
• Individuals recovering from a mini stroke may experience heightened stress or anxiety, and temperature biofeedback could provide a non-invasive, self-regulatory technique for managing these emotional responses.

ESR Biofeedback (Electrodermal Activity and Skin Resistance)

• ESR biofeedback involves monitoring changes in skin conductance or resistance, which reflect sympathetic nervous system activity and emotional arousal.
• Like temperature biofeedback, ESR biofeedback has been primarily used in stress management and anxiety reduction interventions.
• In mini stroke recovery, ESR biofeedback could potentially be used to help individuals regulate their autonomic nervous system responses, reduce emotional arousal, and promote relaxation.
• By learning to modulate skin conductance or resistance levels through biofeedback training, individuals may develop greater awareness and control over their physiological stress responses, which could contribute to overall well-being and recovery.

While temperature and ESR biofeedback have theoretical potential in mini stroke recovery, it’s important to note that their effectiveness and specific applications in this context have not been extensively studied. As such, they are not typically considered primary interventions in stroke rehabilitation protocols. However, they may be used as adjunctive or complementary techniques in comprehensive rehabilitation programs, particularly for addressing emotional and psychophysiological factors that can impact recovery outcomes.

Before implementing temperature or ESR biofeedback in mini stroke rehabilitation, it’s essential for healthcare professionals to conduct a thorough assessment, consider individualized treatment goals, and ensure that the chosen interventions align with the patient’s needs and preferences. Additionally, further research is needed to evaluate the efficacy and potential benefits of these biofeedback modalities in mini stroke recovery.

The role of Biofeedback modalities in mini stroke prophylaxis

Biofeedback techniques have the potential to play a role in the prophylaxis or prevention of recurrent strokes after mini stroke recovery. While biofeedback is typically associated with rehabilitation and symptom management, it can also be utilized as a preventive measure to address underlying risk factors and promote healthy behaviors. Here’s how biofeedback may contribute to stroke prevention after mini stroke recovery:

1. Blood Pressure and Stress Management:
• Hypertension (high blood pressure) is a major risk factor for stroke, including mini strokes. Biofeedback techniques, such as heart rate variability (HRV) biofeedback and relaxation training, can help individuals regulate their autonomic nervous system responses, lower stress levels, and reduce blood pressure.
• By learning to modulate physiological markers of stress and arousal through biofeedback, individuals can adopt healthier coping strategies, manage hypertension, and reduce the risk of recurrent strokes.

2. Lifestyle Modification:
• Biofeedback interventions can support lifestyle modifications aimed at reducing stroke risk factors such as obesity, sedentary behavior, and unhealthy diet. For example, biofeedback can be used to promote physical activity adherence, encourage mindful eating habits, and reinforce relaxation techniques to combat stress-related eating.
• By providing real-time feedback on physiological responses to lifestyle behaviors, biofeedback empowers individuals to make positive changes and maintain healthier habits over the long term, thus lowering their risk of future strokes.

3. Medication Adherence:
• Medication non-adherence is a common issue in stroke prevention, particularly among individuals with multiple comorbidities. Biofeedback can be integrated into medication adherence interventions by reinforcing positive behaviors and providing feedback on physiological markers associated with stress reduction and relaxation.
• Through biofeedback-enhanced interventions, individuals may develop greater motivation, self-efficacy, and accountability in managing their medications and following prescribed treatment regimens, thereby reducing the risk of recurrent strokes.

4. Cognitive and Emotional Health:
• Cognitive impairments and emotional distress are associated with an increased risk of stroke recurrence. Biofeedback techniques targeting cognitive function, attention, and emotional regulation can support ongoing cognitive rehabilitation efforts and promote resilience against future strokes.
• By incorporating cognitive and emotional health components into biofeedback-based interventions, individuals can develop adaptive coping strategies, enhance cognitive resilience, and mitigate the impact of psychological risk factors on stroke recurrence.

While biofeedback interventions have the potential to contribute to stroke prevention after mini stroke recovery, it’s important to recognize that they are most effective when integrated into comprehensive secondary prevention strategies. These strategies should include medication management, lifestyle modifications, regular medical monitoring, and ongoing education and support for individuals and their caregivers. Additionally, further research is needed to evaluate the long-term effectiveness and sustainability of biofeedback-based prophylaxis interventions in reducing stroke recurrence rates and improving overall outcomes.

Future Directions and Considerations

While the potential benefits of biofeedback in mini stroke recovery are promising, further research is needed to establish its efficacy, optimal parameters, and long-term outcomes in this population. Large-scale clinical trials, standardized protocols, and comparative effectiveness studies are warranted to validate the role of biofeedback as an adjunctive therapy in mini stroke rehabilitation. Additionally, considerations such as accessibility, cost-effectiveness, and patient preferences should be taken into account when integrating biofeedback into clinical practice.

Conclusion

Biofeedback holds promise as a valuable adjunctive therapy in mini stroke recovery, offering personalized and targeted interventions to enhance motor and cognitive functions. While research data supporting its efficacy in this population are limited, insights from stroke rehabilitation studies underscore its potential benefits. Further research is needed to elucidate the optimal use of biofeedback techniques in mini stroke rehabilitation and to translate these findings into clinical practice for improved outcomes and enhanced quality of life for individuals affected by TIAs.

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7. Sitaram, R., Ros, T., Stoeckel, L., Haller, S., Scharnowski, F., Lewis-Peacock, J., . . . Sulzer, J. (2016). Closed-loop brain training: The science of neurofeedback. Nature Reviews Neuroscience, 18(2), 86–100. doi:10.1038/nrn.2016.164
8. Yang, Q., Wu, S., Yao, C., Zhang, N., Yu, L., & Wang, J. (2020). The effects of biofeedback therapy on upper limb function after stroke: A meta-analysis of randomized controlled trials. Journal of Stroke and Cerebrovascular Diseases, 29(7), 104870. doi:10.1016/j.jstrokecerebrovasdis.2020.104870

Neurofeedback for OCD treatment is the best option

Neurofeedback for OCD is the Best Option

Obsessive-Compulsive Disorder (OCD) presents a complex interplay of intrusive thoughts and repetitive behaviors, often disrupting daily life and causing significant distress. While traditional treatments like medication and cognitive-behavioral therapy (CBT) have shown effectiveness, some individuals find limited relief or experience unwanted side effects. In recent years, a promising alternative has emerged: neurofeedback for OCD. This innovative approach harnesses the brain’s remarkable ability to adapt and regulate itself, offering new hope for those seeking relief from the relentless grip of OCD symptoms. In this exploration, we delve into the world of neurofeedback tailored specifically for OCD management, examining its principles, applications, and potential to transform the landscape of OCD treatment.

What is Obsessive-Compulsive Disorder (OCD)?

Obsessive-Compulsive Disorder (OCD) is a debilitating mental health condition characterized by a cycle of intrusive, distressing thoughts (obsessions) and repetitive behaviors or mental acts (compulsions) performed in an attempt to alleviate anxiety or prevent a feared outcome. These obsessions and compulsions can significantly impair daily functioning, relationships, and overall quality of life for individuals affected by the disorder.

While 21 to 38% of individuals in the population endorse obsessions and/or compulsions, only a small minority meet the criteria for clinical OCD diagnosis. The lifetime prevalence of OCD is believed to be between 1% and 3%, and patients can experience chronic or episodic OCD symptoms throughout their lifetime. OCD is a time-consuming and distressing psychiatric disorder that has higher disability-adjusted years than Parkinson’s disease and multiple sclerosis combined, making OCD one of the top 10 most disabling medical conditions. OCD is believed to diminish the quality of life of the patient, similar in extent to those individuals with schizophrenia.

Definition:

OCD is defined by the presence of obsessions, compulsions, or both. Obsessions are recurrent and persistent thoughts, urges, or images that cause significant anxiety or distress. Compulsions, on the other hand, are repetitive behaviors or mental acts that an individual feels driven to perform in response to an obsession or according to rigid rules. While these compulsions may temporarily alleviate anxiety, they are not realistically connected to the situation they are meant to address.

Causes:

The exact causes of OCD are not fully understood, but a combination of genetic, biological, environmental, and psychological factors is believed to contribute to its development. Research suggests that abnormalities in neurotransmitter systems, particularly serotonin, may play a role in OCD. Additionally, structural and functional abnormalities in certain brain regions, including the orbitofrontal cortex, anterior cingulate cortex, and striatum, have been implicated in the pathophysiology of OCD.

Symptoms:

Symptoms of OCD can vary widely among individuals but often include intrusive thoughts related to contamination, harm, symmetry, or orderliness, as well as corresponding compulsive behaviors such as washing, checking, arranging, or counting. Other common symptoms may involve hoarding, repeating rituals, or seeking reassurance. These symptoms can cause significant distress and impairment in various areas of life, leading to avoidance behaviors and difficulties in social and occupational functioning.

OCD has 3 main elements:
• obsessions – where an unwanted, intrusive, and often distressing thought, image or urge repeatedly enters your mind
• compulsions – repetitive behaviors or mental acts that a person with OCD feels driven to perform as a result of the anxiety and distress caused by the obsession
• emotions – the obsession causes a feeling of intense anxiety or distress

The compulsive behavior temporarily relieves the anxiety, but the obsession and anxiety soon return, causing the cycle to begin again.

Most people with OCD experience both obsessive thoughts and compulsions, but one may be less obvious than the other.

Some common obsessions that affect people with OCD include:

  • fear of deliberately harming yourself or others – for example, fear you may attack someone else, such as your children
  • fear of harming yourself or others by mistake – for example, fear you may set the house on fire by leaving the cooker on
  • fear of contamination by disease, infection, or an unpleasant substance
  • a need for symmetry or orderliness – for example, you may feel the need to ensure all the labels on the tins in your cupboard face the same way

You may have obsessive thoughts of a violent or sexual nature that you find repulsive or frightening. But they’re just thoughts and having them does not mean you’ll act on them.

These thoughts are classed as OCD if they cause you distress or have an impact on the quality of your life.

Types of Obsessions and Compulsions

Compulsions start as a way of trying to reduce or prevent anxiety caused by obsessive thought, although in reality, this behavior is either excessive or not realistically connected.

Common types of compulsive behavior in people with OCD include:

  • cleaning and hand washing
  • checking – such as checking doors are locked or that the gas is off
  • counting
  • ordering and arranging
  • hoarding
  • asking for reassurance
  • repeating words in their head
  • thinking “neutralizing” thoughts to counter the obsessive thoughts
  • avoiding places and situations that could trigger obsessive thoughts

Most people with OCD realize that such compulsive behavior is irrational and makes no logical sense, but they cannot stop acting on it and feel they need to do it “just in case”.
Not all compulsive behaviors will be obvious to other people.

Obsessive Compulsive Disorder (OCD) Test & Self-Assessment

This quiz is NOT a diagnostic tool. Mental health disorders can only be diagnosed by licensed healthcare professionals.

There are currently numerous inventories available to clinicians to measure symptoms of OCD. The Yale–Brown Obsessive Compulsive Scale (Y-BOCS) and the Obsessive–Compulsive Inventory-Revised (OCI-R) are the two most commonly used measures.

The Y-BOCS is a semi-structured interview and consists of a checklist of common obsessions and compulsions and a 10-item measure of symptom severity, which determines symptom severity regardless of symptom subtype.

Total scores on the measure range from 0 to 40, with a score of

  • 0–7 indicating subclinical symptoms,
  • 8–15 mild symptoms,
  • 16–23 moderate symptoms,
  • 24–31 severe symptoms,
  • 32–40 extreme symptoms.

Pathological Changes in the Brain

Neurochemical mechanism

The differential effects of serotonin-reuptake inhibitors on obsessive-compulsive disorder (OCD) were sufficient to presume that a serotonin regulatory disorder is the most essential part of the pathophysiology of OCD. In patients with OCD, however, a high dose of serotonin-reuptake inhibitor monotherapy may not be sufficient, and approximately half of patients were noted to be treatment-resistant.

Some studies show positive treatment responses to the dopaminergic antagonists. This suggests that other neurotransmitter systems, such as dopamine, are involved in the pathophysiology of OCD. Preclinical, neuroimaging, and neurochemical studies have provided evidence demonstrating that the dopaminergic system is involved in inducing or aggravating the symptoms that are indicative of OCD.

Structural mechanism

Neuroimaging studies have identified structural and functional abnormalities in the brains of individuals with OCD, particularly in regions involved in cognitive and emotional processing, such as the orbitofrontal cortex, anterior cingulate cortex, and basal ganglia. These abnormalities are thought to contribute to the repetitive thoughts and behaviors characteristic of OCD.

The most widely accepted model of obsessive-compulsive disorder (OCD) assumes brain abnormalities in the “affective circuit”, mainly consisting of volume reduction in the medial orbitofrontal, anterior cingulate, and temporolimbic cortices, and tissue expansion in the striatum and thalamus. The research found that OCD patients had smaller grey matter volume than health controls in the frontal eye fields, medial frontal gyrus, and anterior cingulate cortex. However, there was an increase in the grey matter volume in the lenticular nucleus, caudate nucleus, and a small region in the right superior parietal lobule. OCD patients also had a lower fractional anisotropy (FA) in the cingulum bundles, inferior fronto-occipital fasciculus, and superior longitudinal fasciculus, while increased FA in the left uncinate fasciculus.

Traditional Treatments and Their Effectiveness

Traditional treatments for OCD typically include medication and psychotherapy. Selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants are commonly prescribed medications that help regulate serotonin levels in the brain and reduce the frequency and intensity of obsessive thoughts and compulsive behaviors. Cognitive-behavioral therapy (CBT), particularly exposure and response prevention (ERP), is a type of psychotherapy that helps individuals confront their fears and reduce the urge to engage in compulsive rituals.

OCD treatment methods vary in their approach, characteristics, and effectiveness, highlighting the importance of individualized treatment planning and considering patient preferences and treatment goals.

Here’s a list of OCD treatment methods along with their specifications, characteristics, and effectiveness based on literature data

 1. Cognitive-behavioral therapy (CBT) with Exposure and Response Prevention (ERP):

  • Specification: CBT with ERP involves exposing individuals to feared stimuli (exposure) while preventing them from engaging in compulsive behaviors (response prevention).
  • Characteristics: Structured, evidence-based therapy focusing on changing dysfunctional thoughts and behaviors associated with OCD.
  • Effectiveness: Approximately 60-80% effectiveness in reducing OCD symptoms.
  • Side Effects: Minimal to none. Estimated incidence of adverse effects is less than 5%. Some individuals may experience temporary increases in anxiety or distress during exposure sessions.

2. Selective Serotonin Reuptake Inhibitors (SSRIs):

  • Specification: SSRIs are a class of antidepressant medications that increase serotonin levels in the brain.
  • Characteristics: Medication-based treatment targeting underlying neurotransmitter imbalances associated with OCD.
  • Effectiveness: Approximately 40-60% effectiveness in reducing OCD symptoms.
  • Side Effects: Common side effects include nausea, headache, insomnia, sexual dysfunction, and weight gain. In some cases, SSRIs may increase anxiety or worsen depressive symptoms. Common side effects occur in approximately 20-30% of individuals. Severe side effects are rare, occurring in less than 5% of cases.

3. Deep Brain Stimulation (DBS):

  • Specification: DBS involves implanting electrodes in specific brain regions to modulate neural activity.
  • Characteristics: Invasive procedure reserved for severe, treatment-resistant cases of OCD.
  • Effectiveness: Approximately 60-70% effectiveness in reducing OCD symptoms in carefully selected patients.
  • Side Effects: Potential surgical risks, including infection, bleeding, and damage to surrounding brain structures. Common side effects of stimulation may include transient mood changes, speech difficulties, or sensory disturbances. Surgical risks occur in less than 10% of cases. Common side effects of stimulation occur in approximately 20-30% of individuals, with severe side effects occurring in less than 5% of cases.

4. Transcranial Magnetic Stimulation (TMS):

  • Specification: TMS uses magnetic fields to stimulate nerve cells in the brain.
  • Characteristics: Non-invasive procedure targeting specific brain regions implicated in OCD.
  • Effectiveness: Approximately 30-40% effectiveness in reducing OCD symptoms.
  • Side Effects: Common side effects include headache, scalp discomfort, and transient changes in hearing or vision. Rarely, TMS may trigger seizures in individuals with a predisposition to epilepsy. Common side effects occur in approximately 10-20% of individuals, with rare but serious side effects occurring in less than 5% of cases.

5. Mindfulness-Based Interventions:

  • Specification: Mindfulness-based interventions involve cultivating present-moment awareness and acceptance.
  • Characteristics: Non-invasive, skills-based approach focusing on developing mindfulness skills to manage OCD symptoms.
  • Effectiveness: Approximately 30-40% effectiveness in reducing OCD symptoms.
  • Side Effects: Minimal to none, with reported adverse effects occurring in less than 5% of cases. Some individuals may experience temporary increases in distress or emotional discomfort as they confront challenging thoughts or emotions.

6. Antipsychotic Medications:

  • Specification: Antipsychotic medications may be used to augment SSRIs in severe cases of OCD.
  • Characteristics: Medication-based treatment targeting psychotic symptoms and augmenting serotonin levels.
  • Effectiveness: Approximately 20-30% effectiveness in reducing OCD symptoms.
  • Side Effects: Common side effects include sedation, weight gain, metabolic changes, and movement disorders (e.g., tardive dyskinesia). Antipsychotics may also increase the risk of diabetes and cardiovascular complications. Common side effects occur in approximately 20-30% of individuals, while severe side effects occur in less than 5% of cases.

7. Dialectical Behavior Therapy (DBT):

  • Specification: DBT combines cognitive-behavioral techniques with mindfulness-based strategies.
  • Characteristics: Structured, skills-based therapy focusing on emotion regulation and interpersonal effectiveness.
  • Effectiveness: Approximately 30-40% effectiveness in reducing OCD symptoms.
  • Side Effects: Minimal to none, with reported adverse effects occurring in less than 5% of cases. Some individuals may experience temporary increases in emotional discomfort or distress as they learn new coping skills and strategies.

8. Neurofeedback Therapy:

  • Specification: Neurofeedback therapy involves providing real-time feedback on brainwave activity to teach self-regulation of neural functioning.
  • Characteristics: Personalized, non-invasive treatment targeting specific brain regions implicated in OCD symptoms.
  • Effectiveness: Approximately 50-60% effectiveness in reducing obsession symptoms, 45-55% effectiveness in reducing compulsion symptoms, and 40-50% effectiveness in improving related behaviors.
  • Side Effects: Generally considered safe and well-tolerated, with reported side effects occurring in less than 5% of cases. Rare side effects may include mild headache or fatigue during or after sessions.

While these treatments can be effective for many individuals with OCD, they may not work for everyone, and some individuals may experience only partial symptom relief or intolerable side effects. Therefore, there is a need for alternative or adjunctive treatments, such as neurofeedback, to address the diverse needs of individuals living with OCD.

Introduction to Neurofeedback for OCD Treatment: How Does Neurofeedback Work for OCD?

In the realm of mental health interventions, neurofeedback for OCD emerges as a promising avenue, offering innovative approaches to symptom management and relief. Neurofeedback, also known as EEG biofeedback or neurotherapy, represents a non-invasive therapeutic technique that leverages real-time monitoring of brainwave activity to empower individuals in self-regulating their brain function. The core principle underpinning neurofeedback is the brain’s inherent capacity for adaptation and learning, commonly referred to as neuroplasticity. Through the provision of feedback on brain activity, typically through visual or auditory cues, individuals can actively learn to modulate their brainwave patterns towards more favorable states.

At the heart of neurofeedback for OCD lies a fundamental understanding of the disorder’s neural correlates and mechanisms. OCD is characterized by a dysregulation in brain circuits implicated in cognitive control, emotion regulation, and habitual behaviors. Key regions such as the orbitofrontal cortex, anterior cingulate cortex, and striatum exhibit aberrant activity and connectivity patterns in individuals with OCD, contributing to the hallmark symptoms of obsessions and compulsions.

The process of neurofeedback entails individuals receiving real-time feedback on their brainwave activity, typically through visual or auditory cues, contingent upon achieving desired brainwave states associated with relaxation, focus, or emotional regulation. By repeatedly reinforcing these target states, individuals can learn to self-regulate their brain activity, fostering adaptive neural pathways and diminishing the intensity and frequency of OCD symptoms.

Moreover, neurofeedback therapy offers a personalized and non-invasive approach to OCD treatment, allowing for the customization of treatment protocols based on individual neurobiological profiles and symptom presentations. Through a series of neurofeedback sessions, individuals can gradually develop greater awareness and control over their brain activity, empowering them to manage their OCD symptoms more effectively.

Traditional treatments for OCD, including medication and psychotherapy, have demonstrated efficacy for many individuals, yet significant challenges remain, such as partial response, side effects, and treatment resistance.

Herein lies the allure of neurofeedback for OCD – its potential to offer personalized, targeted interventions that complement existing treatments and address treatment gaps.

In essence, neurofeedback therapy serves as a powerful tool in the arsenal of OCD treatment modalities, offering a tailored and innovative approach to symptom management. By harnessing the brain’s inherent capacity for adaptation and learning, neurofeedback provides individuals with the opportunity to take an active role in their recovery journey, fostering a sense of empowerment and control over their mental health.

Neurofeedback for OCD Treatment: Techniques and Protocols

Electrode Placement Sites

The selection of electrode sites and neurofeedback protocols for OCD treatment should be based on a comprehensive assessment of the individual’s neurobiological profile, symptom severity, and treatment goals.

  • Fp1/Fp2 (Frontopolar): Located at the frontal pole, these sites are associated with executive functioning, decision-making, and emotional regulation. Targeting these areas may help modulate cognitive control processes involved in OCD symptomatology.
  • Fz (Frontal Midline): Positioned at the midline of the frontal lobe, Fz is involved in attention, working memory, and cognitive flexibility. Training at this site may enhance cognitive control and reduce compulsive behaviors in individuals with OCD.

Target Frontal Sites (Fp1, Fp2, Fz) sites for protocols aimed at enhancing cognitive control, emotional regulation, and decision-making processes implicated in OCD.

  • Cz (Central Midline): Positioned at the midline of the central region, Cz is involved in sensorimotor processing and self-regulation. Training at Cz may promote relaxation and inhibit hyperarousal states associated with OCD symptoms.
  • Pz (Parietal Midline): Positioned at the midline of the parietal lobe, Pz is involved in sensory integration and attentional processing. Training at Pz may enhance attentional focus and reduce rumination or intrusive thoughts in individuals with OCD.
  • T3/T4 (Temporal): Located over the temporal lobes, T3 and T4 are involved in emotional processing and memory. Training at these sites may help regulate emotional reactivity and reduce anxiety or distress associated with OCD symptoms.

These electrode sites are selected based on their functional relevance to cognitive and emotional processes implicated in OCD. By targeting specific brain regions associated with symptom expression, neurofeedback can promote adaptive changes in neural functioning and alleviate the distressing symptoms of OCD.

Neurofeedback Protocols

Several neurofeedback protocols can be utilized to treat OCD, each targeting different aspects of neural functioning and symptom presentation. Choose neurofeedback protocols based on the individual’s specific symptom profile and treatment goals. For example, use SMR training to enhance attention and cognitive flexibility, alpha-theta training to promote emotional processing and relaxation, and beta training to enhance cognitive control and reduce compulsive behaviors.

  • Sensorimotor Rhythm (SMR) Training:
    One of the primary techniques used in neurofeedback for OCD is sensorimotor rhythm (SMR) training. SMR training involves the reinforcement of brainwave activity in the 12-15 Hz frequency range, typically over sensorimotor cortex regions (Cz, Pz). By promoting SMR activity, individuals can experience improvements in attention, relaxation, and cognitive functioning, which may help mitigate the symptoms of OCD.
  • Alpha-Theta Training:
    Another neurofeedback technique commonly employed in OCD treatment is alpha-theta training. Alpha-theta training involves the reinforcement of brainwave activity in the alpha (8-12 Hz) and theta (4-8 Hz) frequency ranges, typically over central an occipital brain regions (Cz, Pz, O1, O2). This technique aims to promote states of deep relaxation and heightened awareness, facilitating emotional processing and the resolution of underlying psychological conflicts associated with OCD symptoms.
  • Beta Training:
    Beta training involves reinforcing brainwave activity in the beta (15-30 Hz) frequency range, typically over frontal and central regions (F3, F4, Cz, C3, C4). Beta waves are associated with active concentration, alertness, and cognitive processing. This protocol aims to enhance focus, attention control, and cognitive flexibility, which may help reduce compulsive behaviors and intrusive thoughts in individuals with OCD.
  • SCP (Slow Cortical Potentials) Training:
    SCP training typically involves electrode placement at central and parietal sites on the scalp (Cz, C3, C4, P3, P4) reinforcing slow cortical potentials, which are shifts in the brain’s electrical activity associated with cortical excitability and arousal level. This protocol aims to modulate cortical arousal and enhance self-regulation, promoting adaptive responses to OCD-related triggers and reducing compulsive behaviors.

These neurofeedback protocols can be tailored to the individual needs and symptom presentations of each OCD patient, offering a personalized approach to treatment that addresses the underlying neurobiological mechanisms of the disorder.

In addition to specific neurofeedback techniques, various protocols may be utilized to optimize treatment outcomes for individuals with OCD. These protocols often involve a series of neurofeedback sessions conducted over several weeks or months, during which individuals receive real-time feedback on their brainwave activity and learn to modulate their neural functioning.

In summary, neurofeedback techniques and protocols tailored for OCD treatment offer a promising avenue for individuals seeking relief from the debilitating symptoms of the disorder. By harnessing the brain’s inherent capacity for adaptation and learning, neurofeedback empowers individuals to take an active role in their recovery journey, fostering a sense of empowerment and control over their mental health.

Neurofeedback for OCD: Benefits and Limitation

Benefits

1. Non-Invasive and Drug-Free: Neurofeedback offers a non-invasive and drug-free alternative to traditional OCD treatments like medication, making it appealing to individuals who prefer naturalistic approaches or who experience intolerable side effects from medication.

2. Personalized Treatment: Neurofeedback allows for individualized treatment protocols based on each patient’s unique neurobiological profile and symptom presentation. This personalized approach enhances treatment efficacy and may result in better outcomes compared to one-size-fits-all interventions.

3. Promotion of Self-Regulation: Neurofeedback empowers individuals to take an active role in their treatment by providing real-time feedback on their brainwave activity. Through repeated practice, individuals learn to self-regulate their neural functioning, fostering a sense of control over their OCD symptoms.

4. Potential for Long-Term Effects: Neurofeedback therapy has the potential to induce neuroplasticity changes in the brain, leading to lasting improvements in neural functioning and symptom relief. This may result in sustained benefits even after the completion of neurofeedback training.

Limitations

1. Limited Availability and Accessibility: Despite its potential benefits, neurofeedback therapy may not be widely available or accessible to all individuals with OCD due to factors such as cost, geographical location, and availability of trained practitioners.

2. Variable Treatment Response: The efficacy of neurofeedback for OCD can vary widely among individuals, with some experiencing significant symptom reduction while others may see minimal improvement. Factors such as severity of symptoms, comorbidities, and individual differences in neurobiology may influence treatment response.

3. Time and Commitment: Neurofeedback therapy typically requires a significant time commitment, with sessions lasting several weeks to months. Additionally, individuals may need to engage in regular practice outside of sessions to maximize treatment benefits, requiring dedication and motivation.

4. Need for Further Research: While existing research on neurofeedback for OCD is promising, further well-designed studies are needed to establish its efficacy, optimal treatment protocols, and long-term effects. Additionally, more research is needed to identify predictors of treatment response and factors that may influence treatment outcomes.

In conclusion, neurofeedback therapy offers a range of potential benefits for individuals with OCD, including non-invasiveness, personalized treatment, and promotion of self-regulation. However, it also has limitations such as limited availability, variable treatment response, and the need for further research. Despite these challenges, neurofeedback remains a promising avenue for OCD treatment, with the potential to improve symptom management and enhance the quality of life for individuals living with the disorder.

Furthermore, the integration of neurofeedback with other therapeutic modalities, such as cognitive-behavioral therapy (CBT) or mindfulness-based interventions, may enhance treatment efficacy and promote long-term symptom relief for individuals with OCD. By combining neurofeedback with evidence-based psychotherapeutic approaches, clinicians can offer a comprehensive and holistic treatment approach that addresses both the neurobiological and psychological aspects of OCD.

Combining Cognitive-Behavioral Therapy (CBT) with neurofeedback therapy for OCD appears to enhance treatment effectiveness compared to monotherapy approaches. The combined treatment approach shows promising results in reducing obsession and compulsion symptoms, as well as improving related behaviors, with effectiveness rates ranging from 70-85%. Furthermore, the combined treatment is generally associated with minimal to no additional side effects, making it a favorable option for individuals seeking comprehensive and personalized OCD treatment.

List of References

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Nomophobia treatment

Nomophobia treatment. Biofeedback.

In the digital era, the pervasive phenomenon of Nomophobia, or the fear of being without one’s mobile phone, has given rise to a pressing need for effective interventions. Among the innovative approaches, Nomophobia treatment through biofeedback emerges as a promising solution. Biofeedback, leveraging advanced technology, offers a tailored and dynamic method to address the escalating concerns associated with smartphone dependency. This treatment modality allows individuals to gain insight into their physiological responses during moments of phone separation anxiety, fostering self-awareness and real-time control. By combining the power of biofeedback modalities technology with personalized interventions, Nomophobia treatment aims to empower individuals to manage and alleviate the adverse effects of smartphone-related stress, promoting a healthier and more balanced relationship with digital devices.

What is nomophobia?

New technologies have become an integral part of our lives. Rapidly spreading all over the world, smartphones and their applications now play a key role in social connections, expression, information sharing, and achievement development. Smartphones have become essentials rather than accessories, due to their capacity to perform many tasks with features including advanced operating systems, touch screens, and internet access. Information is easily transmitted and received through text messages, phone calls, emails, faxes, games, movies, videos, and social media. Smartphones can also combine services, such as “commutainment” (entertainment and communication) and “edutainment” (education and entertainment). Like other modern technologies, many variables must be considered in evaluating their overall benefit and utility. For example, while smartphones provide ready, convenient access to the internet, and a sense of comfort and connection to others, they may also result in an unhealthy, negative psychological dependency, anxiety, and possible fear. Smartphones have countless impacts on our lives, potentially including problematic health issues that may develop as a consequence of overuse.

The increasingly symbiotic relationship between humans and their handheld devices has given rise to a new psychological phenomenon known as nomophobia, or the fear of being without one’s mobile phone. This modern malady underscores the profound impact of technology on our lives, raising questions about how it alters not only our behavior but also our very brains.

The term NOMOPHOBIA or NO MObile PHone PhoBIA is used to describe a psychological condition when people have a fear of being detached from mobile phone connectivity (being out of contact with a mobile phone, having no mobile networks, or having insufficient balance or battery). The term NOMOPHOBIA is constructed on definitions described in the DSM-IV, it has been labeled as a “phobia for particular/specific things”.

It’s not officially recognized as a mental disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), but it is often used informally to describe the emotional and psychological distress that can result from being separated from one’s mobile device. While it’s not an officially recognized phobia, it can have a real impact on a person’s daily life and mental well-being.

In contrast to other forms of addiction such as gaming or gambling addiction which has been categorized as a distinct disease entity according to the International Classification of Disease (ICD), excessive smartphone use is a more general behavioral addiction that has not been officially classified as a disorder. Compared with drug dependence, which affects structural and functional neural correlates through chemical pathways, changes associated with behavioral addiction are more likely through operant learning that involves rewards and punishments for behavioral impacts.

Common symptoms of nomophobia

The symptoms of nomophobia include anxiety, panic attacks, and agitation when the phone is not in one’s possession, physical symptoms like trembling, sweating, tachycardia, and disorientation when without the phone, and a persistent need to have the phone within reach at all times. These symptoms are often driven by a deep-seated fear of disconnection, isolation, or the inability to communicate and access information, aligning with the concept of nomophobia.

The below-mentioned signs and symptoms are observed in Nomophobia cases

• Anxiety
• Respiratory alterations
• Trembling
• Perspiration
• Agitation
• Disorientation
• Tachycardia.
• Irritability or restlessness when unable to use the phone.

Prevalence of nomophobia

Nomophobia has been found to occur in 18.5–73% of college students, depending on factors including age, gender, self-image, self-esteem, self-efficacy, impulsivity, and. People with nomophobia may never turn their phone off or stay away from it even at bedtime, and tend to carry an extra phone, battery, or charger as a precaution should they lose their phone, run out of battery life, or lose service connectivity.

One study showed that 95% used smartphones to watch YouTube, WhatsApp, or other media to induce sleep; 72% could not stay away from their smartphones, and usually kept their phones just five feet from them. The prevalence of nomophobia is similar between developed and developing countries; both show a prevalence of between 77 and 99% and highest among young adult populations.

Nomophobia treatment in children

Nomophobia is not limited to adults; children and adolescents are equally susceptible to this phenomenon. Defined as the fear or anxiety associated with being separated from one’s mobile phone, it often manifests as an intense reliance on smartphones for social validation, entertainment, and a sense of security. It can result in a range of behavioral and emotional changes in young individuals.

Causes and predisposition for nomophobia

Certain people are more susceptible to developing nomophobia. Factors that can accelerate chances of developing the condition are having:

• Pre-existing anxiety
• Low self-esteem
• Struggles with emotional regulation
• Insecure attachment styles
• A lack of personal relationships

Nomophobia can be influenced by a variety of predisposing factors. These factors can vary from person to person, and the development of nomophobia is often the result of a combination of multiple influences. Some common predisposing factors for nomophobia include:

1. Smartphone Dependency: Excessive smartphone use and reliance on the device for communication, entertainment, and information can predispose individuals to nomophobia. The more dependent one becomes on their smartphone, the more likely they are to experience anxiety when separated from it.

2. Attachment Style: People with anxious attachment styles, characterized by a strong need for emotional closeness and reassurance, may be more prone to nomophobia. The smartphone can serve as a means of seeking constant connection and reassurance.

3. Social Media Usage: Heavily engaging in social media and seeking social validation online can contribute to nomophobia. The constant need for likes, comments, and online interaction can intensify the fear of missing out and the desire to stay connected.

4. High Stress and Anxiety Levels: Individuals with high levels of stress and anxiety may be more vulnerable to developing nomophobia. The smartphone can become a source of distraction and a way to cope with anxiety, leading to a reliance on the device.

5. Low Self-Esteem: Individuals with low self-esteem may use their smartphones as a means of boosting their self-worth through social media validation. The fear of being without the device can be linked to a fear of losing this source of self-esteem.

6. Peer Pressure: Social pressures and peer influence can play a significant role in the development of nomophobia. If a person’s peers are constantly connected and expect them to be as well, it can create a fear of social exclusion.

7. FOMO (Fear of Missing Out): The fear of missing out on social events, news, or online interactions can be a powerful driver of nomophobia. Individuals who experience a strong FOMO are more likely to be anxious when not connected to their phones.

8. Previous Negative Experiences: Past negative experiences, such as missing important messages or events due to being without a phone, can contribute to the fear of being without one’s mobile device.

9. Family or Cultural Factors: Family dynamics and cultural norms can influence smartphone usage and the development of nomophobia. In some cultures, constant connectivity may be emphasized, leading to greater phone dependency.

10. Accessibility and Availability of Technology: The ease of access to smartphones and the constant availability of technology can make it more likely for individuals to become dependent on their devices.

Nomophobia treatment in schoolchildren

11. Childhood Exposure: Early exposure to smartphones and mobile technology can impact a person’s attachment to these devices. Growing up with constant access to smartphones can contribute to a stronger dependency.

It’s important to note that these factors can interact and compound, leading to the development of nomophobia. Additionally, individual vulnerabilities and predispositions can vary, making the experience of nomophobia unique to each person. Understanding these predisposing factors can be helpful in addressing and managing nomophobia through awareness, self-regulation, and, if necessary, professional support.

What mental conditions can contribute to and potentially accelerate development of nomophobia

Several mental health conditions and psychological factors can contribute to and potentially accelerate the development of nomophobia (the fear of being without one’s mobile phone). It’s important to note that these conditions may not directly cause nomophobia but can increase the likelihood and severity of the condition. Some of these mental health conditions and factors include:

1. Generalized Anxiety Disorder (GAD): Individuals with GAD experience excessive and uncontrollable worry and anxiety about various aspects of their lives. This chronic anxiety can make people more susceptible to the fear and anxiety associated with being without their mobile phones.

2. Social Anxiety Disorder: Social anxiety often involves a fear of social interactions and judgment. Smartphones can serve as a means of coping with social anxiety by providing a distraction and a barrier to face-to-face interactions, contributing to increased phone reliance.

3. Obsessive-Compulsive Disorder (OCD): OCD is characterized by intrusive and distressing thoughts (obsessions) and repetitive behaviors or mental acts (compulsions). In some cases, checking and rechecking the smartphone for messages or notifications can become a compulsive behavior, intensifying the fear of being without the phone.

4. Depression: People with depression may turn to their smartphones as a source of distraction and emotional relief. Constant smartphone use can provide a temporary escape from negative emotions and may lead to dependency.

5. Attention-Deficit/Hyperactivity Disorder (ADHD): ADHD is associated with difficulties in impulse control and attention regulation. Individuals with ADHD may be more likely to use smartphones excessively, leading to a heightened risk of nomophobia.

6. Post-Traumatic Stress Disorder (PTSD): PTSD can lead to hypervigilance and heightened anxiety. The constant checking of the smartphone can be a way to stay prepared for potential threats, which can contribute to phone dependence.

7. Negative Body Image and Eating Disorders: Individuals with body image issues may use their phones for reassurance or distraction. The fear of being without a smartphone can be linked to the fear of facing negative body image thoughts without a distraction.

8. Substance Abuse Disorders: Individuals with substance abuse issues may use smartphones to connect with their support networks or to distract themselves from cravings or withdrawal symptoms. This can lead to a strong dependence on the phone.

9. Stress and Burnout: Chronic stress and burnout can lead to a desire for constant distraction and relief, making people more likely to turn to their smartphones excessively.

10. Cyberbullying: Experiences of cyberbullying can lead to increased phone reliance as individuals may want to stay informed about online threats or negative comments.

It’s essential to recognize that these mental health conditions can interact with individual vulnerabilities and other life circumstances to accelerate the development of nomophobia. Treating and managing the underlying mental health condition, along with addressing smartphone dependency, can be crucial in preventing or alleviating nomophobia. If you or someone you know is experiencing these mental health conditions and smartphone-related anxieties, seeking professional help is advisable.

Impact of nomophobia to the health

Nomophobia can have various effects on an individual’s health, encompassing both mental and physical well-being. Here are some ways in which nomophobia can impact health:

1. Increased Stress and Anxiety: The constant need to be connected and the fear of missing out can lead to heightened stress and anxiety levels. The anticipation of not having a mobile phone or being unable to check messages may induce a persistent state of anxiety.

2. Sleep Disturbances: Excessive use of mobile phones, especially before bedtime, can disrupt sleep patterns. The blue light emitted by screens can interfere with the production of melatonin, a hormone essential for sleep regulation, potentially leading to insomnia.

3. Impaired Cognitive Function: The constant checking of messages and notifications can contribute to cognitive overload. This continuous cognitive stimulation may affect concentration, memory, and overall cognitive function.

4. Social Isolation: Paradoxically, while mobile phones facilitate virtual connections, nomophobia can lead to social isolation. Individuals may withdraw from face-to-face interactions, relying more on digital communication, which can impact social skills and relationships.

5. Physical Health Issues: Constant use of smartphones can contribute to physical health problems, including eye strain, neck and back pain (text neck), and repetitive strain injuries from prolonged phone use.

6. Reduced Productivity: Nomophobia may lead to decreased productivity, as individuals may find it challenging to focus on tasks without the constant distraction of their phones. This can affect work and academic performance.

Nomophobia treatment - academic performance
Level of Nomophobia

7. Negative Impact on Mental Health: Over time, the fear of being without a mobile phone can contribute to the development or exacerbation of mental health conditions such as depression and social anxiety. It may also lead to a diminished sense of well-being.

8. Compromised Personal Relationships: Excessive phone use and the fear of separation from one’s device can strain personal relationships. Individuals may prioritize their phones over face-to-face interactions, leading to misunderstandings and a sense of emotional distance.

It’s essential to recognize the potential health impacts of nomophobia and take proactive steps to foster a healthy relationship with technology.

What changes in behavior cause nomophobia

Nomophobia can lead to various changes in behavior. These behavioral changes can have a significant impact on an individual’s daily life, relationships, and overall well-being. Common behavioral changes associated with nomophobia include:

1. Excessive Smartphone Use: People with nomophobia tend to use their smartphones excessively, often checking their devices for messages, notifications, or updates even when it’s not necessary. This behavior can lead to reduced productivity and increased distraction.

2. Avoidance of Certain Situations: Individuals with nomophobia may avoid situations or places where they know they won’t have phone signals or access to their phones. This can affect their willingness to engage in social activities, travel, or attend events.

3. Reduced Face-to-Face Social Interaction: Excessive phone use can lead to decreased in-person social interactions. People with nomophobia may prioritize virtual connections over real-world relationships, impacting their ability to build and maintain meaningful connections with others.

4. Increased Anxiety and Stress: Constantly checking the phone for messages or updates can lead to heightened anxiety and stress levels. This behavior can be a response to the fear of missing out (FOMO) on important information or social interactions.

5. Sleep Disruption: The use of smartphones before bedtime, often associated with nomophobia, can disrupt sleep patterns. Blue light emitted by screens can interfere with the body’s production of melatonin, a hormone that regulates sleep, leading to insomnia or poor sleep quality.

6. Impaired Concentration and Productivity: Frequent phone checking and social media use can make it difficult for individuals to focus on tasks, whether at work or in school, leading to reduced productivity and concentration. There are some researches that found a strong association between academic performance and nomophobia and show weaker academic performance among students with severe nomophobia.

7. Distraction While Driving: Nomophobia can lead to dangerous behavior, such as using a smartphone while driving. Distracted driving is a significant safety concern and can lead to accidents.

8. Negative Impact on Mental Health: The constant need to be connected can contribute to feelings of loneliness, depression, and anxiety. This behavioral change can have long-term consequences for mental well-being.

9. Relationship Issues: Nomophobia can strain personal relationships, as partners or family members may feel neglected or frustrated when someone is more focused on their phone than on spending time with loved ones.

10. Difficulty Disconnecting: People with nomophobia often find it challenging to disconnect from their phones, even during vacations or leisure time. This can prevent them from fully enjoying moments of relaxation.

It’s important to recognize these behavioral changes associated with nomophobia, as they can have a negative impact on an individual’s quality of life.

What changes in brain and its function cause nomophobia

There is ongoing research into the specific changes in the brain that may be associated with nomophobia. However, some research suggests that the fear and anxiety associated with nomophobia may be linked to changes in brain activity and neurochemistry, similar to other forms of addiction or anxiety disorders. Here are some potential brain-related factors:

1. Dopamine Release: When individuals receive notifications or messages on their phones, the brain often releases dopamine, a neurotransmitter associated with pleasure and reward. Over time, excessive smartphone use can lead to alterations in the brain’s reward system, making people more dependent on their phones for these pleasurable experiences.

2. Cortisol Levels: The constant need to check and respond to messages, notifications, or social media updates can create a sense of pressure and stress, leading to increased levels of the stress hormone cortisol in the brain. Chronic stress can have negative effects on brain health.

3. Prefrontal Cortex Activity: The prefrontal cortex is involved in decision-making and impulse control. Excessive smartphone use may alter the functioning of this region, making it harder for individuals to resist the urge to check their phones constantly.

Moreover, some research has found atrophy (shrinkage or loss of tissue volume) in gray matter areas. Volume loss was also seen in the striatum, which is involved in reward pathways and the suppression of socially unacceptable impulses. A finding of particular concern was damage to an area known as the insula, which is involved in our capacity to develop empathy and compassion for others and our ability to integrate physical signals with emotion. Aside from the obvious link to violent behavior, these skills dictate the depth and quality of personal relationships.

4. Altered Sleep Patterns: Overuse of smartphones, especially at night, can disrupt sleep patterns due to the blue light emitted by screens. Sleep disruption can affect cognitive functions and mood regulation.

5. Neuroplasticity: The brain is highly adaptable and can rewire itself based on repeated behaviors. If a person is constantly engaged with their smartphone, the brain may reorganize its neural connections to prioritize this behavior, potentially at the expense of other important activities and interactions.

It’s important to note that these changes are not unique to nomophobia but are related to excessive smartphone use in general. The specific neural changes associated with nomophobia may vary from person to person, and more research is needed to fully understand the neurological aspects of this phenomenon. Additionally, the impact of excessive smartphone use on brain function and mental health can vary depending on the individual and the extent of their phone dependency.

Prevention of nomophobia development

Preventing or proactively addressing nomophobia (the fear of being without one’s mobile phone) involves a combination of awareness, self-regulation, and healthy technology habits. Here are some strategies for nomophobia prophylaxis:

1. Digital Detox Days: Designate regular “digital detox” days where you intentionally disconnect from your smartphone and other devices. This can help you become less reliant on your phone for entertainment and social interaction.

2. Set Boundaries: Establish clear boundaries for smartphone use. For example, avoid using your phone during meals, in the bedroom, or while engaging in other important activities. Stick to these boundaries to prevent excessive phone use.

3. Silent Hours: Designate certain hours of the day as “silent hours” where you turn off or silence your phone. This can provide a break from notifications and constant connectivity.

4. Selective Notifications: Customize your smartphone’s notification settings. Turn off non-essential notifications or set them to “Do Not Disturb” during specific hours to reduce constant interruptions.

5. Offline Activities: Engage in offline activities that you enjoy, such as hobbies, exercise, or face-to-face social interactions. These activities can help reduce the time spent on your phone.

6. Digital Well-Being Tools: Many smartphones offer digital well-being features that can help you track and manage your screen time. Use these tools to set daily limits on app usage.

7. Mindfulness and Relaxation: Practice mindfulness and relaxation techniques to manage stress and anxiety without relying on your phone. This can help reduce the need to constantly check your device.

8. Self-Awareness: Reflect on your smartphone usage and its impact on your daily life. Recognize the situations or emotions that trigger your nomophobia and work on addressing them.

9. Seek Support: If nomophobia is significantly affecting your life and well-being, consider seeking support from a mental health professional or a therapist. They can help you explore the root causes and develop coping strategies.

10. Parental Guidance: For children and adolescents, parents play a crucial role in preventing nomophobia. Set limits on their screen time, educate them about the potential negative effects of excessive smartphone use, and encourage a healthy balance between online and offline activities.

11. Education: Stay informed about the potential risks of excessive smartphone use and educate yourself about digital well-being. The more you know about the impact of technology on your life, the better equipped you are to make informed choices.

12. Role Modeling: Be a role model for responsible smartphone use. Children and adolescents often learn by observing the behavior of adults, so demonstrate a healthy relationship with your phone.

Prophylaxis for nomophobia is about creating a balanced and mindful approach to smartphone usage. It involves understanding the role of technology in your life, recognizing the signs of dependency, and actively taking steps to maintain control over your digital habits. By implementing these strategies, you can reduce the risk of developing nomophobia or mitigate its effects if you’re already experiencing it.

Preventing nomophobia in children

Preventing nomophobia in children and adolescents involves establishing healthy digital habits, fostering responsible technology use, and promoting a balanced relationship with smartphones and other devices. Here are some strategies for preventing nomophobia in young individuals:

1. Educate About Digital Well-Being:
Start by educating children and adolescents about the potential risks of excessive smartphone use, including the development of nomophobia. Teach them to recognize the signs of smartphone dependency.

2. Set Screen Time Limits:
Establish daily screen time limits for the recreational use of smartphones and other devices. Consider using parental control apps or built-in features to enforce these limits.

3. Create Tech-Free Zones:
Designate specific areas in the home where smartphone use is not allowed, such as the dinner table, bedrooms, and study areas. These zones promote face-to-face interactions and better sleep habits.

4. Encourage Outdoor Activities:
Promote outdoor activities, physical exercise, and hobbies that do not involve screens. Encourage children and adolescents to explore the real world and engage in physical play.

5. Model Responsible Behavior:
Be a positive role model by demonstrating responsible smartphone use. Show that you can disconnect from your phone when needed and prioritize in-person interactions.

6. Open Communication:
Create an open and non-judgmental environment where children and adolescents can discuss their feelings and experiences related to smartphone use. Encourage them to talk about any anxieties or insecurities they may have.

7. Teach Time Management:
Help children and adolescents develop effective time management skills. Teach them how to allocate time for homework, chores, relaxation, and digital entertainment.

8. Set Tech-Free Bedtime Rituals:
Establish tech-free bedtime rituals to help children and adolescents unwind and prepare for restful sleep. Encourage them to leave their phones outside the bedroom to avoid sleep disruption.

9. Monitor Online Activity:
Keep an eye on your child’s online activity, especially on social media platforms. Be aware of any cyberbullying or negative experiences that may contribute to anxiety.

10. Limit Social Media Comparison:
Discuss the potentially harmful effects of comparing oneself to others on social media. Teach children and adolescents to appreciate their uniqueness and self-worth.

11. Teach Digital Literacy:
Promote digital literacy and critical thinking skills. Help young individuals recognize and evaluate the credibility of online information.

12. Encourage Offline Social Interactions:
Foster opportunities for children and adolescents to interact with peers in person. Encourage group activities, playdates, and involvement in clubs or sports.

13. Reward Offline Achievements:
Recognize and reward offline achievements, such as academic success, sports accomplishments, or creative endeavors. Celebrate non-digital milestones.

14. Seek Professional Help if Necessary:
If you notice signs of nomophobia or severe smartphone dependency in a child or adolescent, seek the guidance of a mental health professional. They can provide specialized support and intervention.

Preventing nomophobia in children and adolescents requires a holistic approach that combines awareness, parental involvement, education, and the cultivation of a balanced digital lifestyle. By taking proactive steps and providing guidance, parents, and caregivers can help young individuals develop a healthy relationship with technology and reduce the risk of experiencing nomophobia

You can check if you have nomophobia by answering this questionnaire.

What is nomophobia treatment?

Treatment for nomophobia, like treatment for other technology-related behavioral issues, focuses on reducing dependency, managing anxiety, and establishing healthier habits around smartphone use. Here are some strategies and treatments that can help address nomophobia:

1. Cognitive-Behavioral Therapy (CBT): CBT is a common therapeutic approach for treating anxiety disorders. A therapist can work with individuals to identify and challenge irrational thoughts and behaviors related to their smartphone use and fear of being without it.

2. Exposure Therapy: This type of therapy involves gradually exposing individuals to situations where they would typically experience anxiety due to being without their phone. Over time, this can help desensitize them to the fear.

3. Mindfulness and Relaxation Techniques: Learning mindfulness and relaxation exercises can help individuals manage anxiety and stress associated with nomophobia. Breathing exercises, meditation, and yoga can be beneficial.

4. Coping Skills Training: Therapists can teach individuals healthy coping mechanisms to deal with the fear of being without their phone. This may include identifying alternative activities and strategies for managing anxiety.

5. Setting Boundaries: Establishing clear boundaries for smartphone use is essential. This can involve creating designated “phone-free” times or places, such as during meals or in the bedroom.

6. Digital Detox: Periodically disconnecting from the smartphone for an extended period can help break the cycle of dependency. Some individuals may benefit from technology-free weekends or vacations.

7. Support Groups: Joining support groups or seeking the support of friends and family who understand the issue can be beneficial. Sharing experiences and strategies for managing smartphone use can provide a sense of community and accountability.

8. Behavioral Interventions: Behavior modification techniques, such as reward systems for reducing smartphone use, can be effective. Positive reinforcement for meeting goals can help individuals gradually reduce their phone attachment.

9. Educational Workshops: Some organizations and mental health professionals offer workshops or educational sessions on digital well-being and smartphone addiction. These can provide information and tools to manage smartphone use effectively.

10. Self-Help Apps: Various smartphone apps are designed to help individuals track and manage their phone usage. These apps can provide insights into usage patterns and help set limits.

11. Consultation with a Mental Health Professional: If nomophobia is significantly impacting an individual’s life and well-being, it may be advisable to consult with a mental health professional, such as a psychologist or psychiatrist, for a personalized treatment plan.

Treatment for nomophobia should be tailored to the individual’s specific needs and the severity of the condition. It’s important to remember that addressing nomophobia is not about eliminating smartphone use but about finding a healthy balance and reducing the negative impact of excessive phone dependency on one’s life.

Biofeedback in nomophobia treatment

Biofeedback is a therapeutic technique that helps individuals gain awareness and control over physiological processes in their bodies, such as heart rate, muscle tension, and skin conductance. While biofeedback is not typically used as a direct treatment for nomophobia, it can be a valuable component of a broader treatment plan aimed at managing anxiety and stress, which are often associated with nomophobia. Here’s how biofeedback can be integrated into the treatment of nomophobia:

1. Stress Management: Nomophobia is often accompanied by stress and anxiety. Biofeedback can be used to teach individuals how to recognize and reduce the physiological signs of stress, such as increased heart rate and muscle tension. By learning to control these responses, individuals can better manage the anxiety that can trigger their dependence on their smartphones.

2. Self-Regulation: Biofeedback helps individuals develop self-regulation skills. By monitoring their physiological responses in real time, they can learn to control responses consciously. This can be particularly useful for individuals who experience anxiety when separated from their phones.

3. Relaxation Techniques: Biofeedback training often involves teaching relaxation techniques, such as deep breathing and progressive muscle relaxation. These techniques can be used to counter the anxiety and restlessness associated with nomophobia.

4. Awareness: Biofeedback can enhance awareness of one’s physiological responses to stress, including the physical sensations that may accompany nomophobia. This increased awareness can help individuals recognize their anxiety triggers and develop strategies to cope with them.

5. Biofeedback Apps and Wearables: There are biofeedback apps and wearable devices available that can measure and provide real-time feedback on physiological parameters. These tools can help individuals track and manage their stress and anxiety, making it easier to address the emotional aspects of nomophobia.

6. Integration with Other Therapies: Biofeedback can be integrated into a broader treatment plan that includes cognitive-behavioral therapy (CBT) or exposure therapy, which are commonly used to address anxiety-related issues like nomophobia. Biofeedback can complement these therapies by helping individuals manage the physical symptoms of anxiety.

It’s important to note that biofeedback is not a standalone treatment for nomophobia but rather a component of a comprehensive approach. A mental health professional, such as a therapist or psychologist, can work with individuals to determine how best to integrate biofeedback into their treatment plan and address the psychological and emotional aspects of nomophobia. The goal is to help individuals manage their anxiety and stress in healthier ways, ultimately reducing their dependency on their smartphones.

What biofeedback modalities can be used for nomophobia treatment?

Various modalities of biofeedback can be used, and the choice of modality depends on the specific physiological factors contributing to an individual’s nomophobia. Here are some common biofeedback modalities and how they can be used:

1. Heart Rate Variability (HRV) Biofeedback:
• How it works: HRV biofeedback measures the variations in time between successive heartbeats. It reflects the balance between the sympathetic (fight or flight) and parasympathetic (rest and digest) branches of the autonomic nervous system.
• Relevance to nomophobia treatment: Many individuals with nomophobia experience increased heart rate and a “fight or flight” response when separated from their phones or experiencing phone-related anxiety. HRV biofeedback can help individuals learn to regulate their autonomic nervous system, reduce heart rate, and promote relaxation in these situations.

2. Electrodermal Activity (EDA) Biofeedback:
• How it works: EDA biofeedback measures skin conductance or sweat gland activity. It reflects the activity of the sympathetic nervous system, which is responsible for the body’s stress response.
• Relevance to nomophobia treatment: People with nomophobia often experience increased sweat gland activity when they are anxious about being without their phones. EDA biofeedback can help individuals recognize and control these physiological responses, leading to decreased anxiety and improved stress management.

3. Respiration Biofeedback:
• How it works: Respiration biofeedback involves monitoring and controlling one’s breathing patterns. It helps individuals achieve a balanced and controlled breathing rate.
• Relevance to nomophobia treatment: Anxiety often leads to shallow and rapid breathing. Respiration biofeedback can teach individuals to slow their breathing and engage in deep, diaphragmatic breathing, which triggers the body’s relaxation response. This can help counteract the stress response associated with nomophobia.

4. Temperature Biofeedback:
• How it works: Temperature biofeedback measures skin temperature, which is influenced by blood flow and circulation. It is linked to the body’s relaxation response.
• Relevance to nomophobia treatment: Stress and anxiety can lead to peripheral vasoconstriction (reduced blood flow to the extremities), resulting in cold hands and feet. Temperature biofeedback can help individuals increase peripheral blood flow and warm their extremities, promoting relaxation and reducing the physical symptoms of anxiety.

5. Muscle Electromyography (EMG) Biofeedback in nomophobia treatment:
• How it works: EMG biofeedback measures muscle tension and provides feedback on muscle activity.
• Relevance to nomophobia treatment: People with nomophobia may experience muscle tension and physical discomfort when separated from their phones or when they experience anxiety related to phone use. EMG biofeedback can help individuals recognize and reduce muscle tension, promoting physical relaxation.

The choice of biofeedback modality for the treatment of nomophobia should be based on an individual’s specific physiological responses and needs. In therapy, a trained professional can conduct an assessment to determine which modality would be most effective. The goal of using biofeedback is to increase self-awareness, develop self-regulation skills, and reduce the physiological markers of anxiety and stress, ultimately helping individuals manage their nomophobia-related symptoms more effectively.

EEG (Electroencephalography) biofeedback in nomophobia treatment

EEG (Electroencephalography) biofeedback, also known as neurofeedback, is a therapeutic technique that involves real-time monitoring of brainwave activity to provide individuals with information about their brain functioning. While the direct application of EEG biofeedback specifically for nomophobia is a relatively novel area, the general principles of neurofeedback can be explored for potential benefits in managing the underlying factors contributing to nomophobia.
Here’s how EEG biofeedback could be considered for the treatment of nomophobia:

Understanding Brain Activity in Nomophobia:

1. Identifying Stress Patterns:
• EEG biofeedback allows for the identification of specific brainwave patterns associated with stress and anxiety.
• Nomophobia often involves heightened stress responses when individuals are separated from their phones. EEG can pinpoint these stress-related brainwave patterns.

2. Neurological Correlates of Nomophobia:
• Research could be conducted to identify neurological correlates of nomophobia using EEG technology.
• Understanding how the brain responds during situations that trigger nomophobia could inform targeted neurofeedback interventions.

Potential Benefits of EEG Biofeedback in Nomophobia Treatment

1. Self-Regulation Training:
• EEG biofeedback enables individuals to learn how to regulate their own brain activity consciously.
• Nomophobia treatment can involve training individuals to self-regulate their stress responses by modulating specific brainwave patterns associated with anxiety.

2. Alpha-Theta Training:
• Alpha-theta neurofeedback has been used for anxiety and stress management.
• This type of biofeedback involves enhancing alpha brainwaves (associated with relaxation) and theta brainwaves (associated with deep relaxation and creativity). It could potentially help individuals achieve a calmer state, reducing nomophobia-related stress.

3. Cognitive Behavioral Therapy Enhancement:
• EEG biofeedback can complement traditional therapeutic approaches, such as Cognitive Behavioral Therapy (CBT).
• By incorporating neurofeedback, individuals may gain insights into the physiological aspects of their anxiety and enhance the effectiveness of cognitive strategies to manage nomophobia.

4. Real-Time Feedback during Exposure:
• Individuals can receive real-time feedback during exposure to situations that trigger nomophobia.
• The biofeedback process can help individuals understand and control their physiological responses, gradually reducing the anxiety associated with being without a mobile phone.

5. Individualized Treatment Plans:
• EEG biofeedback allows for individualized treatment plans based on the unique brainwave patterns of each person.
• Tailoring interventions to address specific neurological aspects contributing to nomophobia enhances the effectiveness of the treatment.

Neurofeedback Protocols for Nomophobia:

1. Alpha Training (Occipital Lobe – O1, O2):
• Aim: Increase alpha brainwave activity.
• Rationale: Alpha waves are associated with relaxation and a calm mental state. Training individuals to enhance alpha activity may help reduce overall stress and anxiety related to nomophobia.

2. Theta Training (Frontal Lobe – F3, F4):
• Aim: Increase theta brainwave activity.
• Rationale: Theta waves are associated with deep relaxation and creativity. By encouraging theta activity, individuals may experience a more tranquil mental state, potentially alleviating the anxiety associated with phone separation.

3. SMR (Sensory-Motor Rhythm) Training (Central Cortex – C3, C4):
• Aim: Increase SMR (12-15 Hz) brainwave activity.
• Rationale: SMR is associated with a calm and focused state. Enhancing SMR activity may contribute to better attention regulation and stress reduction.

4. Beta Training (Frontal Cortex – F3, F4):
• Aim: Normalize beta brainwave activity.
• Rationale: Abnormal beta activity has been associated with increased anxiety. Normalizing beta levels may help individuals maintain a more balanced and less anxious state.

Application Sites According to the 10-20 System

• O1 and O2: Occipital lobe electrodes for alpha training.
• F3 and F4: Frontal lobe electrodes for theta and beta training.
• C3 and C4: Central cortex electrodes for SMR training.

Challenges and Considerations

1. Research and Validation:
• Rigorous research is needed to establish the effectiveness of EEG biofeedback specifically for nomophobia.
• Validating the neurological correlates of nomophobia and developing targeted interventions require comprehensive studies.

2. Integration with Behavioral Therapy:
• Combining EEG biofeedback with behavioral therapy approaches is crucial for a comprehensive treatment plan.
• Neurofeedback should complement, not replace, traditional therapeutic methods.

3. Ethical Considerations:
• Ethical considerations, such as informed consent and ensuring the well-being of participants, are essential in utilizing neurofeedback for mental health applications.
In conclusion, while the direct application of EEG biofeedback for nomophobia is an evolving area, the potential lies in its ability to provide personalized insights into the neural mechanisms of stress and anxiety. Integrating neurofeedback with existing therapeutic strategies could offer a holistic approach to addressing the complex interplay of psychological and physiological factors associated with nomophobia.

Biofeedback devices that can be used in nomophobia treatment

 eSense Biofeedback devices for various biofeedback modalities

Breathing Biofeedback home-use device

Temperature Biofeedback home-use device

Heart Rate Variability Biofeedback home-use device

Electrodermal Skin Activity Biofeedback home-use device

Biosignals Biofeedback devices that combine all biofeedback modalities in one device provide a multimodal approach to nomophobia management and bring more effective and long-lasting results.

BioSignals Biofeedback 5 sensors Device

Biofeedback BioSignals Green Box 4 sensors

Biofeedback speech therapy for stuttering

Biofeedback speech therapy for stuttering

Stuttering is an action-induced speech disorder with involuntary, audible, or silent repetitions or prolongations in the utterance of short speech elements (sounds, syllables) and words. Stuttering typically begins in childhood and may persist into adulthood. It can vary in severity, with some individuals experiencing only mild stuttering while others may have more pronounced difficulties speaking fluently. Treatment for stuttering often involves a combination of therapeutic approaches tailored to the individual’s specific needs and goals. Biofeedback speech therapy for stuttering is a therapeutic technique that can be used as part of the treatment to help individuals gain better control over physiological processes, such as muscle tension and stress that may effectively contribute to stuttering. Several modalities of biofeedback speech therapy for stuttering can be used for treatment to help individuals gain better control over physiological processes that may contribute to disfluency.

What stuttering is?

Stuttering, or stammering, is a speech disorder characterized by disruptions or interruptions in the normal flow of speech. People who stutter may experience difficulty in the production of sounds, syllables, words, or phrases, which can manifest as repetitions of sounds or words, prolongations of sounds, or blocking where the person is unable to produce any sound for a brief period. These disruptions in speech can be accompanied by physical tension, such as facial grimaces or rapid eye blinking, as well as feelings of frustration and anxiety.

Stuttering typically begins in childhood and may persist into adulthood. It can vary in severity, with some individuals experiencing only mild stuttering while others may have more pronounced difficulties speaking fluently. The exact cause of stuttering is not fully understood, but it is believed to result from a combination of genetic, neurological, and environmental factors.

Treatment for stuttering often involves speech therapy, where a trained speech-language pathologist works with individuals to improve their fluency and reduce the frequency and severity of stuttering episodes. Therapists may use techniques such as speech modification, fluency shaping, and stuttering modification to help individuals manage their speech more effectively. Early intervention is crucial in helping children who stutter, as it can prevent the disorder from becoming more ingrained and severe.

It’s important to note that stuttering does not reflect a person’s intelligence or competence, and many individuals who stutter lead successful lives and careers with appropriate support and therapy. Supportive environments and understanding from family, friends, and peers can also play a significant role in helping individuals with stuttering feel more confident and comfortable in their communication.

Pathophysiology of stuttering

The pathophysiology of stuttering, or the underlying biological and neurological processes that contribute to the disorder, is not fully understood. Stuttering is believed to be a complex condition influenced by a combination of genetic, neurological, and environmental factors. While researchers continue to study the condition, there is no single, universally accepted theory that explains all aspects of stuttering. However, several theories have been proposed to shed light on the potential mechanisms involved:

1. Genetic Factors: There is evidence to suggest that stuttering may have a genetic component. Studies have shown that stuttering tends to run in families, and certain genetic variations may increase susceptibility to the disorder. However, no specific “stuttering gene” has been identified, and genetics alone cannot account for all cases of stuttering.

2. Neurological Factors: Stuttering is thought to involve abnormalities in the brain’s speech-processing areas and neural pathways. Some studies have identified differences in brain structure and function in individuals who stutter. For example, there may be variations in the size or activity of regions like the left inferior frontal gyrus, which is involved in speech production and language processing.

3. Neural Processing Differences: Stuttering may be associated with differences in how the brain processes speech and language. It is hypothesized that individuals who stutter may have difficulties with the timing and coordination of the neural circuits responsible for speech production, leading to disruptions in fluency.

4. Developmental Factors: Stuttering often begins in childhood during a period of rapid language and speech development. Some researchers suggest that developmental factors, such as the rate at which a child’s speech and language skills develop, may contribute to stuttering. Children who experience a rapid increase in speech demands without a corresponding increase in their abilities for motor control of speech may be more susceptible to stuttering.

5. Environmental and Psychological Factors: While genetic and neurological factors play a role, environmental and psychological factors can also influence the severity and persistence of stuttering. Stress, anxiety, and social pressure can exacerbate stuttering, while supportive and communicative environments can help individuals manage their stuttering more effectively.

It’s important to note that stuttering is a highly variable condition, and the pathophysiology may differ from one individual to another. Additionally, ongoing research continues to refine our understanding of the disorder, and new insights are regularly emerging. Speech-language pathologists and researchers work together to develop and refine therapies that address the specific needs of individuals who stutter, taking into account the complex interplay of genetic, neurological, and environmental factors.

Stuttering signs and symptoms

Stuttering signs and symptoms may include:

• Difficulty starting a word, phrase, or sentence,
• Prolonging a word or sounds within a word,
• Repetition of a sound, syllable, or word,
• Brief silence for certain syllables or words, or pauses within a word (broken word),
• Addition of extra words such as “um” if difficulty moving to the next word is anticipated,
• Excess tension, tightness, or movement of the face or upper body to produce a word,
• Anxiety about talking,
• Limited ability to effectively communicate.

Classification of stuttering

Stuttering can be classified into several categories or types based on various factors, including its characteristics and presentation. The classification of stuttering helps clinicians and researchers understand the nature of the disorder and tailor treatment approaches accordingly. Here are some common classifications of stuttering:

1. Developmental Stuttering:
• Developmental stuttering is the most common type and typically begins in childhood as a child is learning to speak.
• It often starts between the ages of 2 and 4 when language and speech skills are developing.
• Developmental stuttering can vary in severity, and many children naturally outgrow it with age or through speech therapy.

2. Neurogenic Stuttering:
• Neurogenic stuttering is associated with neurological conditions or injuries that affect the brain’s speech centers or motor control.
• It can result from conditions such as strokes, traumatic brain injuries, or other neurological disorders.
• Neurogenic stuttering may have a sudden onset and typically occurs in adulthood.

3. Psychogenic Stuttering:
• Psychogenic stuttering is thought to be related to psychological factors and is often a response to stress, anxiety, or psychological trauma.
• It can occur suddenly and may resolve with appropriate psychological therapy or intervention.

4. Cluttering:
• Cluttering is a speech disorder characterized by rapid and disorganized speech, which may include frequent interruptions, irregular pacing, and unclear articulation.
• Unlike stuttering, which involves disruptions in speech flow, cluttering often involves overly rapid and hasty speech.
• Treatment for cluttering focuses on slowing down speech and improving articulation.

5. Acquired Stuttering:
• Acquired stuttering refers to stuttering that develops later in life due to specific events, such as head injuries, illnesses, or psychological trauma.
• It can be associated with sudden and noticeable changes in speech fluency.

6. Persistency:
• This classification considers whether stuttering persists into adulthood or if it is outgrown during childhood.
• Some individuals continue to stutter into adulthood, while others naturally recover or see significant improvements.

7. Secondary Behaviors:
• Stuttering may also be classified based on the presence of secondary behaviors. These are physical or verbal reactions to stuttering, such as facial grimaces, eye blinking, or word substitutions, used to avoid stuttering.
• Stuttering with secondary behaviors can be more complex and challenging to treat.

8. Severity Levels:
• Stuttering can be classified by its severity, ranging from mild to severe. Severity is often determined by the frequency and duration of disfluencies, as well as the impact on communication.

It’s important to note that these classifications are not always mutually exclusive, and some individuals may exhibit characteristics of more than one type of stuttering. Additionally, the presentation and classification of stuttering can vary from person to person. Stuttering is a complex communication disorder, and assessment by a qualified speech-language pathologist is essential to determine the most appropriate treatment and management strategies for each individual.

Stuttering therapy

Treatment for stuttering often involves a combination of therapeutic approaches tailored to the individual’s specific needs and goals. Here is a list of some of the common therapeutic approaches used for the treatment of stuttering:

1. Speech Modification Techniques:

• Fluency Shaping: This approach focuses on teaching individuals who stutter to speak more fluently by modifying their speech patterns. Techniques may include slowing down speech rate, prolonging vowel sounds, and using gentle onsets (soft starts to words).
• Easy Onset: Encourages individuals to start words or sentences with gentle, easy starts instead of sudden or forceful starts, reducing tension and improving fluency.

2. Stuttering Modification Strategies:

• Cancellation: After a stuttering event occurs, individuals pause, acknowledge the stutter, and then repeat the word or phrase with reduced tension and increased fluency.
• Pull-Out: When stuttering starts, individuals pause and transition smoothly out of the stutter, correcting it mid-speech.
• Preparation: Individuals anticipate challenging words or situations and use techniques like stretching sounds or lightly tapping to reduce stuttering.

3. Cognitive-Behavioral Therapy (CBT):

CBT aims to address the emotional and psychological aspects of stuttering, such as anxiety, fear, and negative self-perceptions. It helps individuals develop coping strategies and improve their self-esteem.

4. Desensitization and Confidence-Building:

Therapy may involve desensitization techniques, such as voluntarily stuttering or speaking in challenging situations to reduce anxiety and build confidence.

5. Group Therapy:

Group therapy provides a supportive environment for individuals who stutter to practice fluency techniques, share experiences, and gain social confidence.

6. Parent/Caregiver Training:

Parents and caregivers can learn strategies to create a supportive communication environment for their child who stutters, helping them communicate more comfortably.

7. Stress and Anxiety Management:

Stress and anxiety can exacerbate stuttering. Techniques such as relaxation exercises, mindfulness, and stress reduction strategies can be integrated into therapy to manage emotional triggers.

8. Neurofeedback and Biofeedback:

Neurofeedback or biofeedback is used to gain better control over physiological responses associated with stuttering, such as muscle tension or stress.

9. Electronic Devices and Apps:

Speech therapy apps and devices may provide visual or auditory feedback to assist individuals in monitoring and improving their speech patterns.

10. Supportive Counseling:

Some individuals find it helpful to engage in counseling to discuss the emotional and psychological aspects of living with stuttering, such as self-acceptance and managing societal pressures.

It’s important to note that stuttering therapy should be personalized to meet the unique needs of each individual. A qualified and experienced speech-language pathologist (SLP) or therapist who specializes in stuttering can assess the specific challenges faced by the person who stutters and develop a tailored treatment plan. Early intervention is often crucial in helping children who stutter, but therapy can also be beneficial for teenagers and adults. The goal of therapy is to improve speech fluency, communication confidence, and overall quality of life.

Biofeedback speech therapy for stuttering

Biofeedback speech therapy for stuttering is a therapeutic technique that is used as part of the treatment of stuttering to help individuals gain better control over physiological processes, such as muscle tension and stress that may contribute to stuttering. While biofeedback is not a standalone treatment for stuttering, it can be a valuable component of a comprehensive therapy program. Here’s how biofeedback can be used in the treatment of stuttering:

1. Muscle Tension Monitoring:

Electromyographic (EMG) biofeedback speech therapy for stuttering can be used to monitor muscle tension, especially in the muscles associated with speech production (e.g., facial muscles, and neck muscles).

Individuals who stutter can learn to recognize patterns of excessive muscle tension during speech, which can contribute to disfluencies. Biofeedback provides real-time information about muscle activity, helping them become more aware of tension and relaxation in these muscles.

2. Relaxation Training:

Biofeedback can assist in teaching individuals relaxation techniques to reduce muscle tension and stress.

By seeing or hearing their physiological responses on a biofeedback monitor (e.g., muscle activity or skin conductance), individuals can practice relaxation exercises and learn to control their bodily responses.

3. Stress Reduction:

Stress and anxiety can exacerbate stuttering. Biofeedback can help individuals learn to manage stress and anxiety levels by providing feedback on physiological indicators of stress, such as heart rate variability or skin temperature.

With biofeedback, individuals can develop strategies to reduce stress and anxiety during speaking situations.

4. Breathing Control:

Breathing patterns play a significant role in speech production and fluency. Breathing biofeedback speech therapy for stuttering can be used to monitor and adjust breathing patterns during speech.

By providing feedback on respiratory rate and depth, individuals can learn to control their breath and reduce breath-related disfluencies.

5. Generalization and Self-Regulation:

The skills learned through biofeedback training can be applied in real-life speaking situations. Individuals can use the self-regulation techniques acquired during biofeedback therapy to improve their overall speech fluency.

6. Progress Monitoring:

Biofeedback sessions can track and record progress over time, allowing individuals and therapists to assess the effectiveness of relaxation and self-regulation strategies.
It’s important to note that biofeedback is typically used with other evidence-based stuttering therapy approaches, such as speech modification techniques, stuttering modification strategies, and cognitive-behavioral therapy. A qualified speech-language pathologist or therapist specializing in stuttering therapy can integrate biofeedback into an individualized treatment plan based on the specific needs and goals of the person who stutters.

The effectiveness of biofeedback in stuttering treatment can vary from person to person, and the choice to use biofeedback should be made in consultation with a qualified therapist. When integrated appropriately, biofeedback can help individuals become more aware of and better control the physiological factors contributing to stuttering, ultimately improving speech fluency and communication confidence.

What modalities of biofeedback speech therapy for stuttering can be used for effective treatment?

Several modalities of biofeedback can be used for stuttering treatment to help individuals gain better control over physiological processes that may contribute to disfluency. These modalities provide real-time feedback on specific physiological indicators, allowing individuals to monitor and adjust their responses. Here are some of the modalities of biofeedback that can be used in stuttering treatment:

1. Electromyographic (EMG) Biofeedback speech therapy for stuttering:

• EMG biofeedback measures muscle activity and tension by using electrodes placed on the skin’s surface or inside the mouth to monitor the activity of speech-related muscles.
• For stuttering treatment, EMG biofeedback can help individuals become aware of excessive tension in muscles involved in speech production (e.g., facial muscles, and neck muscles).
• By visualizing muscle activity in real-time, individuals can learn to relax these muscles during speech to reduce tension-related disfluencies.

2. Respiratory Biofeedback:

• Respiratory biofeedback focuses on monitoring and controlling breathing patterns, which are closely related to speech fluency.
• Individuals can use respiratory biofeedback to adjust their breathing rate, depth, and coordination during speech to reduce breath-related disfluencies.

3. Heart Rate Variability (HRV) Biofeedback:

• HRV biofeedback measures the variation in time between successive heartbeats, which reflects the body’s physiological response to stress and relaxation.
• It can help individuals learn to manage stress and anxiety levels, which can impact stuttering.
• By increasing heart rate variability, individuals can promote relaxation and reduce the physiological stress response during speaking situations.

4. Skin Conductance Biofeedback:

• Skin conductance biofeedback monitors the electrical conductance of the skin, which can indicate changes in emotional arousal and stress levels.
• Individuals can use skin conductance biofeedback to become aware of stress reactions and learn relaxation techniques to reduce stress-related disfluencies.

5. Temperature Biofeedback:

• Temperature biofeedback measures changes in skin temperature, which can be influenced by emotional and stress responses.
• It can help individuals learn to regulate their body’s temperature and reduce the physiological effects of stress on speech.

6. Neurofeedback or Brainwave (EEG) Biofeedback speech therapy for stuttering:

EEG biofeedback, also known as neurofeedback, monitors brainwave activity and provides feedback on brainwave patterns to help individuals regulate brain activity associated with speech production and anxiety.

7. Biofeedback Apps and Software:

• Various biofeedback apps and software programs are available for smartphones and computers.
• These apps may provide visual or auditory feedback on physiological indicators and can be used for self-regulation and practice outside of therapy sessions.

The choice of biofeedback modality depends on the specific needs and goals of the individual who stutters and should be determined in collaboration with a qualified speech-language pathologist or therapist who specializes in stuttering therapy. Biofeedback is often integrated into a comprehensive stuttering therapy program, along with other evidence-based therapeutic approaches, to help individuals improve speech fluency and communication confidence.

Role of EMG biofeedback in the treatment of stuttering

EMG (Electromyography) biofeedback is a therapeutic technique that can be used as a component of the treatment of stuttering. Its primary role is to assist individuals who stutter in gaining greater awareness and control over the muscle tension and coordination involved in speech production. Here’s how EMG biofeedback can be beneficial in the treatment of stuttering:

1. Muscle Tension Awareness: EMG biofeedback provides real-time feedback on the activity of specific muscles involved in speech production, such as the muscles around the mouth, lips, jaw, and throat. By monitoring muscle activity, individuals who stutter can become more aware of patterns of excessive tension and learn to recognize when they are tensing these muscles unnecessarily.

2. Tension Reduction: The visual or auditory feedback provided by EMG biofeedback can help individuals reduce excessive muscle tension during speech. When they see or hear that they are tensing their speech muscles, they can work to relax and release that tension, which can lead to smoother and more fluent speech.

3. Muscle Coordination: Stuttering often involves disruptions in the coordination of speech muscles. EMG biofeedback can assist in improving muscle coordination by helping individuals learn to activate and deactivate the relevant muscles at the right times during speech.

4. Biofeedback-Based Practice: EMG biofeedback allows individuals to practice speech with immediate feedback in a controlled environment. This practice can help them develop new, more fluent speech patterns while reducing tension-related behaviors.

5. Self-Regulation: Over time, individuals can learn to self-regulate their muscle tension and speech patterns without the need for continuous biofeedback. They can carry the skills and awareness gained from biofeedback sessions into their everyday communication.

6. Individualized Therapy: EMG biofeedback can be tailored to the specific needs of each person who stutters. Therapists can target specific muscle groups and patterns of tension that are unique to the individual’s speech difficulties.

It’s important to note that EMG biofeedback is often used as part of a comprehensive stuttering therapy program, which may include other therapeutic approaches such as speech modification techniques, stuttering modification strategies, and cognitive-behavioral therapy. The choice of therapy approaches and the inclusion of EMG biofeedback will depend on the individual’s specific needs and goals for improving their fluency and reducing stuttering.

As with any therapeutic intervention, the effectiveness of EMG biofeedback in stuttering treatment can vary from person to person. Therefore, it should be administered and supervised by a qualified speech-language pathologist or therapist who specializes in stuttering therapy and can tailor the treatment plan to the individual’s unique needs.

EMG electrode placement sites for biofeedback for stuttering

Electromyography (EMG) biofeedback involves placing electrodes on specific muscle groups associated with speech production and providing visual or auditory feedback to the individual about the activity of these muscles. This feedback can assist in reducing tension and improving muscle coordination during speech. Here are some common electrode placement sites for EMG biofeedback in stuttering therapy:

Head Muscles:

1. Orbicularis Oris Muscle: The orbicularis oris muscle is a circular muscle that surrounds the mouth and plays a significant role in speech production. This muscle controls lip movements during speech, and excessive tension in this muscle can lead to difficulties in articulation and fluency EMG electrodes can be placed on the corners of the mouth or along the upper and lower lips to monitor muscle activity. This can help individuals become aware of excessive muscle tension and facilitate relaxation.

2. Mentalis Muscle: The mentalis muscle is located in the chin area and can be involved in the lower lip and chin movements during speech. Excessive tension in this muscle can lead to difficulties in articulation and fluency. Electrodes can be placed on the chin to monitor this muscle’s activity and help individuals reduce unnecessary tension.

3. Frontalis Muscle: The frontalis muscle is located in the forehead and is involved in facial expressions. Although not directly related to speech, it can be monitored to assess overall muscle tension and relaxation.

4. Facial Muscles: Various facial muscles, including the frontalis (forehead) and corrugator supercilii (between the eyebrows), can become tense during stuttering moments, contributing to facial tension that may impact speech.

5. Buccinator Muscle: This muscle is located in the cheeks. It plays a role in controlling the oral cavity during speech. Tension in the buccinator muscle can influence articulation.

6. Temporalis Muscle: This muscle is located on the side of the head, it can influence jaw movement and tension.

7. Masseter Muscle: Masseter muscle is part of the jaw muscles, it can contribute to jaw tension during speech.

8. Palatal Muscles: These are muscles of the soft palate (velum), such as the palatoglossus and palatopharyngeus, which affect resonance and articulation.

Neck muscles

1. Suprahyoid Muscles: The suprahyoid muscles include muscles like the digastric and mylohyoid, which play a role in laryngeal control and swallowing. The suprahyoid muscles are located under the chin, and beneath the jaw, and are involved in jaw and tongue movement during speech, laryngeal control, and swallowing. Tension in these muscles can affect vocal control and fluency.
Electrodes may be placed along the neck or jawline to monitor the activity of these muscles.

2. Infrahyoid Muscles: The infrahyoid muscles (sternohyoid and omohyoid) are also located under the chin, below the suprahyoid muscles, can influence laryngeal control and voice production, and are also involved in speech-related movements. Monitoring and training these muscles can help reduce tension-related disfluencies.
Electrodes can be placed in the neck area to monitor these muscles.

3. Platysma Muscle: The platysma muscle is a thin sheet of muscle that covers the front of the neck. It can play a role in neck tension during speech. Electrodes may be placed along the neck to monitor platysma muscle activity.

4. Trapezius Muscle: The trapezius muscle is a large muscle that extends down the neck and upper back. Specifically, the upper portion of the trapezius muscle in the neck and upper back can become tense during stuttering and may contribute to neck and shoulder tension, affecting overall speech tension.

5. Sternocleidomastoid (SCM) Muscle: The sternocleidomastoid muscle runs from the base of the skull to the collarbone and sternum. Tension in the SCM can affect head and neck posture and potentially contribute to speech tension.

6. Scalene Muscles: The scalene muscles are located on the sides of the neck and play a role in neck movement and respiration. Tension in the scalenes can affect overall neck tension and posture during speech.

7. Longus Colli Muscle: This muscle is situated in the anterior (front) portion of the neck and contributes to neck flexion and head movement. Monitoring and training this muscle can help reduce tension in the front of the neck.

These muscles collectively contribute to the coordination, tension, and control involved in speech production. Monitoring and training them with EMG biofeedback can assist individuals who stutter in becoming more aware of and regulating muscle activity to improve speech fluency and reduce disfluencies.

The specific electrode placements may vary based on the individual’s unique speech patterns and muscle tension issues. The goal of EMG biofeedback is to help individuals become more aware of muscle tension patterns and learn to control and reduce tension during speech, ultimately improving fluency.

Role of Breathing Biofeedback in Stuttering Treatment

Breathing biofeedback can be a helpful component of stuttering therapy by assisting individuals in developing better control over their breathing patterns during speech. Proper breathing techniques can contribute to improved speech fluency and reduced stuttering. Here’s the role of breathing biofeedback in the treatment of stuttering and how it can be performed:

1. Increased Awareness: Breathing biofeedback helps individuals become more aware of their breathing patterns, such as shallow or irregular breathing, which can contribute to stuttering.

2. Controlled Breathing: It teaches individuals how to control their breath, allowing for more relaxed and controlled speech production.

3. Reduction of Tension: Proper breathing techniques can help reduce overall muscle tension, including tension in the speech muscles, which can enhance speech fluency.

4. Anxiety Management: Breath control techniques can also be beneficial for managing anxiety, which can exacerbate stuttering. Deep, slow breaths can promote relaxation and reduce anxiety-related tension.

Performing Breathing Biofeedback for Stuttering

Here are the general steps for Breathing biofeedback:

1. Assessment: The therapist will first assess the individual’s current breathing patterns and their impact on speech fluency. This may involve monitoring chest, diaphragmatic, or abdominal breathing, as well as the rate and depth of breaths.

2. Sensor Placement: Small sensors or electrodes may be attached to the individual’s chest, abdomen, or other relevant areas to monitor breathing patterns. These sensors are connected to a biofeedback device.

3. Feedback Display: The biofeedback device provides real-time visual or auditory feedback based on the individual’s breathing patterns. This feedback can be displayed on a computer screen or through audio cues.

4. Training: The therapist will guide the individual through exercises and techniques to improve their breathing patterns. This may include exercises to promote diaphragmatic breathing (deep belly breathing) and to control the rate and rhythm of breaths.

5. Practice: The individual practices these techniques while receiving feedback from the biofeedback device. They learn to make adjustments in their breathing to achieve smoother and more controlled speech.

6. Generalization: Over time, the goal is for the individual to apply these breathing techniques in their everyday communication, not just during therapy sessions. The therapist helps the individual transfer these skills to real-life situations.

7. Progress Monitoring: Progress is monitored throughout therapy to track improvements in breathing patterns and speech fluency. Adjustments to the treatment plan can be made as needed.

The effectiveness of Breathing biofeedback speech therapy for stuttering can vary from person to person, and it is essential to work with a qualified speech-language pathologist or therapist who can tailor the treatment to the individual’s specific needs and goals.

Role of Heart Rate Variability biofeedback speech therapy for stuttering

Heart Rate Variability (HRV) biofeedback is a therapeutic technique that can be used as part of the treatment of stuttering, particularly for managing stress and anxiety, which are known to exacerbate stuttering. HRV biofeedback focuses on regulating the variation in time between successive heartbeats, which reflects the body’s physiological response to stress and relaxation.

Here’s the role of HRV biofeedback in stuttering treatment and how it works:

1. Stress Reduction: Stuttering often occurs or worsens in stressful situations. HRV biofeedback helps individuals learn to manage stress by providing real-time feedback on their physiological responses, such as heart rate variability. By increasing HRV, individuals can promote relaxation and reduce the physiological stress response during speaking situations.

2. Anxiety Management: Anxiety is a common trigger for stuttering. HRV biofeedback can teach individuals to regulate their anxiety levels by monitoring changes in heart rate variability. As they become more skilled in HRV control, they can apply these techniques to reduce anxiety associated with speaking.

3. Emotional Regulation: Stuttering can lead to negative emotions, which, in turn, can exacerbate speech difficulties. HRV biofeedback can help individuals gain better control over their emotional responses by promoting emotional regulation and resilience.

4. Improved Self-Regulation: HRV biofeedback enhances an individual’s ability to self-regulate physiological responses. This can be especially valuable during moments of stuttering, as individuals can learn to stay calm and composed, reducing the likelihood of disfluencies caused by increased tension.

How HRV Biofeedback Works

1. Sensor Placement: HRV biofeedback typically involves the placement of sensors on the individual’s skin, often on the chest or wrists, to monitor heart rate variability.

2. Data Collection: The sensors continuously collect data on the time intervals between heartbeats (R-R intervals), which represent HRV.

3. Real-Time Feedback: The collected data are processed and displayed in real-time on a computer screen or through a mobile app. Individuals can see graphical representations of their HRV.

4. Breathing Techniques: HRV biofeedback often incorporates specific breathing techniques, such as slow, deep diaphragmatic breathing. The individual is guided to synchronize their breathing with the displayed HRV pattern.

5. Feedback and Practice: As individuals practice controlled breathing and see changes in their HRV patterns, they learn to associate specific breathing techniques with increased HRV and reduced stress. This reinforces relaxation and stress reduction skills.

6. Progress Monitoring: Over time, individuals can monitor their progress in increasing HRV and reducing stress and anxiety levels. They may see improvements in their ability to remain calm during speaking situations and experience fewer stuttering incidents.

7. Generalization: The self-regulation skills learned through HRV biofeedback can be applied in real-life speaking situations, helping individuals manage stress and anxiety while communicating.

HRV biofeedback, when integrated into a comprehensive stuttering therapy program, can be a valuable tool for individuals seeking to reduce the impact of stress and anxiety on their speech fluency. It empowers them with the skills to better regulate their physiological responses, ultimately contributing to improved speech confidence and fluency.

Role of acoustic biofeedback in stuttering treatment

Acoustic biofeedback is a therapeutic tool used in the treatment of stuttering to help individuals gain better control over their speech patterns and enhance their fluency. Acoustic biofeedback provides real-time auditory feedback on various aspects of speech, allowing individuals to monitor and adjust their speech production. Here’s the role of acoustic biofeedback in stuttering treatment:

1. Awareness of Stuttering Patterns: Acoustic biofeedback helps individuals who stutter become more aware of their stuttering patterns, including the frequency and severity of disfluencies (stuttering moments). By hearing their speech in real-time, individuals can identify specific problem areas and patterns.

2. Monitoring Speech Rate: Acoustic biofeedback can provide feedback on speech rate or speaking too quickly, which can contribute to stuttering. Individuals can learn to adjust their speaking rate to a more comfortable and controlled pace.

3. Smoothness and Fluency: Acoustic biofeedback can highlight moments of speech tension or disruptions in the flow of speech. By listening to their speech in real-time, individuals can work on producing smoother, more fluent speech patterns.

4. Pitch and Volume Control: Some acoustic biofeedback systems can provide feedback on pitch and volume variations in speech. This can help individuals achieve more consistent pitch and volume levels, which can contribute to fluency.

5. Delay or Altered Auditory Feedback: In some cases, acoustic biofeedback systems introduce a slight delay or alter the pitch of the individual’s voice. These alterations can create a “choral” effect, which may reduce stuttering and improve fluency for some individuals.

6. Practice and Self-Regulation: Acoustic biofeedback allows individuals to practice speech techniques and strategies while receiving immediate feedback. With guidance from a speech-language pathologist, they can develop self-regulation skills to adjust their speech in real-time.

7. Transfer to Everyday Communication: The goal of acoustic biofeedback therapy is to help individuals generalize the skills learned in therapy sessions to their everyday communication. They can apply the techniques and strategies to reduce stuttering and improve fluency in real-world situations.

8. Progress Tracking: Acoustic biofeedback sessions can track and record progress over time. This data can be used to evaluate the effectiveness of therapy and make adjustments to the treatment plan as needed.

The choice of therapy approaches and the inclusion of acoustic biofeedback will depend on the individual’s specific needs and goals for improving their fluency and reducing stuttering.

As with any therapeutic intervention, the effectiveness of acoustic biofeedback in stuttering treatment can vary from person to person. Therefore, it should be administered and supervised by a qualified speech-language pathologist or therapist who specializes in stuttering therapy and can tailor the treatment plan to the individual’s unique needs.

How to perform acoustic biofeedback for stuttering

Performing acoustic biofeedback for stuttering typically involves using specialized equipment and software under the guidance of a qualified speech-language pathologist or therapist who specializes in stuttering therapy. 

Here’s a general overview of how acoustic biofeedback for stuttering can be performed:

1. Assessment and Evaluation:
• Before starting acoustic biofeedback therapy, the speech-language pathologist (SLP) will conduct a comprehensive assessment to evaluate the individual’s stuttering patterns, speech characteristics, and specific needs.
• The SLP will determine which aspects of speech (e.g., speech rate, fluency, pitch, volume) would benefit from acoustic biofeedback.

2. Selecting and Setting Up Equipment:
• The SLP will choose appropriate acoustic biofeedback equipment and software based on the individual’s therapy goals and needs. This may include software designed for speech therapy that provides real-time auditory feedback.
• The equipment typically includes a microphone to capture the individual’s speech and speakers or headphones to deliver the auditory feedback.

3. Baseline Recording:
• The initial session may involve recording the individual’s baseline speech patterns without any biofeedback. This helps establish a starting point for therapy and provides a reference for progress.

4. Biofeedback Sessions:
• During biofeedback sessions, the individual will speak into the microphone while the system provides real-time auditory feedback.
• The feedback may focus on specific aspects of speech that are problematic, such as speaking rate, pitch, or fluency. For example, the system might provide auditory cues when the individual speaks too quickly or stutters.
• The individual will work with the SLP to develop strategies for adjusting their speech based on the feedback provided. This may involve practicing speaking at a more controlled rate, producing smoother speech, or adjusting pitch and volume.
• The individual and SLP will review and discuss the feedback during the session, identifying areas for improvement and setting goals for future sessions.

5. Practice and Generalization:
• The individual will practice the techniques learned in biofeedback sessions and attempt to generalize them to real-world communication situations.
• The SLP will work with the individual to apply the strategies learned in therapy to everyday speaking scenarios, such as conversations with family, and friends, and in various social contexts.

6. Progress Tracking and Adjustments:
• Throughout the course of therapy, progress will be monitored and tracked using data collected during biofeedback sessions.
• The SLP will make adjustments to the treatment plan based on the individual’s progress, changing therapy goals as needed.

7. Termination and Maintenance:
• Therapy may continue until the individual achieves their therapy goals or experiences significant improvement in fluency and stuttering management.
• After therapy is completed, individuals may benefit from periodic follow-up sessions to maintain their progress and address any challenges that arise.

The SLP will tailor the treatment plan to the individual’s unique needs and provide guidance and support throughout the therapy process. Acoustic biofeedback is just one component of a comprehensive stuttering therapy program that may include other therapeutic approaches and techniques.

Use of the Forbrain audio-vocal biofeedback device in the treatment of stuttering

The Forbrain audio-vocal biofeedback device was marketed as a tool that combines bone conduction and auditory feedback to help individuals improve their speech and communication skills. It was primarily designed to assist with various speech and language challenges, including stuttering. Here’s how the Forbrain device is typically used and its potential role in the treatment of stuttering:

1. Auditory Feedback: The Forbrain device includes a microphone and bone conduction technology that delivers auditory feedback directly to the wearer’s ears. It enhances the perception of their voice as they speak.

2. Voice Enhancement: Forbrain is designed to provide clearer and more resonant auditory feedback, which can help individuals become more aware of their speech patterns, including any stuttering or disfluencies.

3. Speech Practice: Users can practice speaking while wearing the device, and the device provides real-time auditory feedback, allowing individuals to monitor their speech.

4. Attention and Focus: Forbrain is also intended to help users improve their attention and concentration. By wearing the device during speech practice, individuals may become more focused on their speech, which can indirectly help reduce stuttering.

5. Neurological Training: The use of Forbrain may promote neuroplasticity, potentially leading to improved speech fluency and reduced stuttering over time.

Forbrain improves self-awareness which makes speech easier to correct. Forbrain helps correct the processing of sensory and auditory information and improves listening skills.

Role of neurofeedback in the treatment of stuttering. How to perform?

Stuttering has been linked to weakness in the fibers that carry nerve impulses among three regions: the thalamus, which relays sensory signals; the basal ganglia, which coordinates movements; and the cerebral cortex, which is involved in cognition and integration of sensory and motor signals.

There are many connections within and among these brain areas. In the cortex, a key fiber link is the arcuate fasciculus, which shows deficiencies in people who stutter. Other potentially poor connections are within the basal ganglia and in the network linking all areas, the cortico-basal ganglia-thalamocortical loop.

The International 10-20 System is a standardized method for electrode placement used in electroencephalography (EEG) to locate specific areas of the scalp relative to underlying brain regions. While the primary focus of the 10-20 system is on general brain activity monitoring, it can be adapted for speech neurofeedback by targeting regions of the brain associated with language and speech processing. Here are some electrode placement sites based on the 10-20 System that can be relevant for speech neurofeedback:

1. Frontal Electrodes:
F7 and F8: These electrodes are located over the left and right frontal lobes, respectively. They may be relevant for speech neurofeedback as the frontal lobes are involved in various aspects of language production and executive functions.

2. Temporal Electrodes:
T3 and T4: These electrodes are positioned over the left and right temporal lobes. The temporal lobes are crucial for language comprehension and auditory processing, which are integral to speech.

3. Central Electrodes:
C3 and C4: These electrodes are situated over the central region of the scalp and may be relevant for speech neurofeedback as they are associated with motor functions, including motor control of speech.

4. Parietal Electrodes:
P3 and P4: These electrodes are located over the left and right parietal lobes, which are involved in various aspects of language processing and sensory integration.

5. Frontocentral Electrodes:
FC5 and FC6: Positioned between the frontal and central regions, these electrodes may capture neural activity related to speech planning and execution.

6. Supplementary Motor Area (SMA):
FCz: Located at the midline of the scalp, FCz is associated with motor planning and may be relevant for speech motor control.

7. Broca’s Area (Left Hemisphere):
F5 and F3: These electrodes are located over the left frontal region and may be of particular interest in speech neurofeedback as Broca’s area is essential for language production and speech fluency.

8. Wernicke’s Area (Left Hemisphere):
T5: Positioned over the left temporal lobe, T5 may be associated with language comprehension and processing.

9. Angular Gyrus (Left Hemisphere):
P5: Over the left parietal lobe, P5 may play a role in language processing and comprehension.

Besides rewiring the brain in the specific brain area responsible for speech fluency neurofeedback can be effective also by regulating the conditions concomitant to stuttering.

1. Stress and Anxiety Management: Stuttering can often be exacerbated by stress and anxiety. Neurofeedback may help individuals learn to regulate their stress response and reduce anxiety levels, which can indirectly contribute to improved fluency by reducing tension associated with stuttering.

2. Attention and Concentration: Neurofeedback can be used to train individuals to enhance their attention and concentration abilities. Improved attention control may help individuals who stutter maintain focus on their speech and reduce the likelihood of stuttering interruptions.

3. Relaxation and Self-Regulation: Neurofeedback can teach individuals self-regulation skills, which may be beneficial for managing emotional responses and muscle tension during speech production.

It’s important to note that the choice of electrode placement should be guided by the specific objectives of the speech neurofeedback therapy and the individual’s unique needs. Electrode positions can be adjusted to target brain regions associated with speech production, language comprehension, and fluency. Additionally, a qualified clinician or therapist with expertise in neurofeedback for speech and language disorders should be consulted to determine the most appropriate electrode montage for achieving therapeutic goals.

The electronic devices that can be used for treatment of stuttering

Several electronic devices and technologies can be used to assist in the treatment and management of stuttering. These devices are often used in conjunction with traditional speech therapy techniques to provide real-time feedback and enhance therapy outcomes. Here is a list of some electronic devices and their descriptions:

1. SpeechEasy Device:
• SpeechEasy is a wearable electronic device that resembles a hearing aid. It uses delayed auditory feedback (DAF) or altered auditory feedback (AAF) to provide real-time auditory feedback to the individual who stutters.
• How It Works: When the person speaks, their voice is slightly delayed or altered in pitch, which can reduce stuttering frequency and severity.

2. VibroTactile Feedback Devices:
• These devices provide tactile (vibratory) feedback to help individuals monitor and control their speech rate and fluency.
• How They Work: VibroTactile feedback devices can be worn as wristbands or placed on the skin. They vibrate in response to specific speech patterns, providing a tactile cue to slow down or ease tension.

3. FluencyMaster Device:
• FluencyMaster is a handheld electronic device designed to assist individuals in practicing fluency-enhancing techniques.
• How It Works: The device generates a metronome-like beat that individuals can synchronize their speech with to achieve a more controlled and fluent speech pattern.

4. Apps and Software:
• Various smartphone and computer apps are available to support individuals in practicing speech techniques and monitoring their progress.
• Some apps provide visual or auditory feedback, such as fluency charts or metronome-like cues, to assist with speech modification and fluency shaping.

5. Voice Analysis Software:
• Specialized voice analysis software can be used to analyze speech patterns and provide visual feedback on pitch, intensity, and speech rate.
• This software can help individuals and therapists track progress and identify areas for improvement.

6. Biofeedback Devices:
• Biofeedback devices can monitor physiological indicators of stress and tension, which can be associated with stuttering.
• They may include sensors for measuring muscle tension, heart rate variability, or skin conductance. The data can help individuals learn to manage stress during speech.

7. Mobile Communication Devices:
• Mobile devices such as smartphones and tablets offer various apps and tools that can aid individuals in communication, including text-to-speech apps, speech synthesis software, and augmentative and alternative communication (AAC) apps.

It’s important to note that the effectiveness of electronic devices in stuttering treatment can vary from person to person. These devices are often used as adjuncts to traditional speech therapy techniques, and the selection of a specific device should be based on an individual’s needs, goals, and preferences. A qualified speech-language pathologist or therapist who specializes in stuttering therapy can help assess whether and how these devices may be beneficial and provide guidance on their use.

Conclusion

Biofeedback Speech Therapy for Stuttering represents a promising and innovative approach in the realm of stuttering treatment. This therapeutic method harnesses the power of real-time physiological feedback to empower individuals who stutter with tools for enhanced fluency and communication confidence. Through the precise monitoring and training of muscles, breathing patterns, and even neural activity, biofeedback speech therapy offers a holistic approach to address the multifaceted challenges associated with stuttering.

By delving into the principles, techniques, and potential benefits of biofeedback speech therapy for stuttering, we have uncovered a dynamic strategy that goes beyond traditional interventions. It equips individuals with the ability to gain better control over muscle tension, reduce stress and anxiety, and even modulate neural patterns related to speech production.

Biofeedback speech therapy for stuttering is a testament to the ongoing evolution of speech therapy practices, driven by a commitment to improving the lives of those affected by stuttering. This innovative approach reflects the interdisciplinary nature of stuttering therapy, drawing on insights from fields like psychology, physiology, and neurology to provide a comprehensive toolkit for clinicians and individuals alike.

As we look ahead, the continued research and application of biofeedback techniques in stuttering therapy hold the promise of even more personalized and effective treatments. The ability to tailor therapy plans to the unique needs of each individual, addressing their specific muscle tension patterns, emotional triggers, and neural responses, is a significant advancement in the field.

Biofeedback Speech Therapy for Stuttering reminds us that innovation, coupled with a deep understanding of the challenges faced by individuals who stutter, can lead to transformative results. As clinicians and researchers continue to explore the potential of biofeedback in stuttering therapy, we can anticipate brighter prospects for those seeking to unlock the fluent and confident communicators within themselves.

Biofeedback Speech Therapy for Stuttering Home Use Device

EMG Biofeedback Speech Therapy for Stuttering Home Use Device

Breathing Biofeedback Speech Therapy for Stuttering Home Use Device

HRV Biofeedback Speech Therapy for Stuttering Home Use Device

Temperature Biofeedback Speech Therapy for Stuttering Home Use Device

Skin Conductance Biofeedback Speech Therapy for Stuttering Home Use Device

Acoustic Biofeedback Speech Therapy for Stuttering Home Use Device

Motor tics

Neurofeedback for Tourette Syndrome

Tics are irregular, uncontrollable, unwanted, and repetitive movements of muscles that can occur in any part of the body. Movements of the limbs and other body parts are known as motor tics. Involuntary repetitive sounds, such as grunting, sniffing, or throat clearing, are called vocal tics. Tourette’s syndrome (TS) is a complex neurological disorder. It is characterized by multiple tics – both motor and vocal. It is the most severe and least common tic disorder. This disorder is related to multiple neuroanatomical and neurophysiological deviations, primarily reduced sensorimotor rhythm (SMR) and excessive fronto-central Theta activity. Recent research has proposed neurofeedback for Tourette Syndrome and Tic Disorders as a promising treatment option, particularly in terms of helping patients control their tics and treat the cognitive dysfunctions commonly associated with TS.

Tic disorders can usually be classified as motor, vocal, or Tourette’s syndrome, which is a combination of both. Motor and vocal tics can be short-lived (transient) or chronic. Tourette’s is considered to be a chronic tic disorder.

Children with transient tic disorder will present with one or more tics for at least 1 month, but for less than 12 consecutive months. The onset of the tics must have been before the individual turned 18 years of age. Motor tics are more commonly seen in cases of transient tic disorder than vocal tics. Tics may vary in type and severity over time. According to the American Academy of Child and Adolescent Psychiatry, a transient tic disorder, or provisional tic disorder affects up to 10% of children during their early school years.

Tics that appear before the age of 18 and last for 1 year or more may be classified as a chronic tic disorder. These tics can be either motor or vocal, but not both. A chronic tic disorder is less common than transient tic disorder, with less than 1% of children affected.

If the child is younger at the onset of a chronic motor or vocal tic disorder, they have a greater chance of recovery, with tics usually disappearing within 6 years. People who continue to experience symptoms beyond age 18 are less likely to see their symptoms resolved.

Some research suggests that tics are more common among children with learning disabilities and are seen more in special education classrooms. Children within the autism spectrum are also more likely to have tics.

Tourette’s syndrome (TS) is the most severe and least common tic disorder. The Centers for Disease Control and Prevention (CDC) report that the exact number of people with TS is unknown. CDC research suggests that half of all children with the condition are not diagnosed. Currently, 0.3% of children aged 6 to 17 in the US have been diagnosed with TS. Symptoms of TS vary in their severity over time. For many people, symptoms improve with age. TS is often accompanied by other conditions, such as attention deficit hyperactivity disorder (ADHD) and obsessive-compulsive disorder (OCD).

Tourette Syndrome is a neurodevelopmental disorder characterized by persistent, chronic, and involuntary tics. These tics manifest as either motor or phonic (vocalizations) and can range from simple tics such as blinking, sniffing, and head twitching to more complex such as repetitive swearing, spinning around, and jumping. The cause of Tourette’s is unknown but it is likely that both hereditary and nongenetic factors contribute to its development.

The onset of Tourette syndrome is usually in childhood between the ages of 2 and 21 years. The disorder affects more males than females with a ratio of approximately 3 males to every 1 female diagnosed. Tourette’s is a highly individualistic disorder with differing levels of severity, frequency, and impairment. 

Whilst the exact cause of Tourette Syndrome is unknown, it is believed that the presence of tics is associated with abnormalities in the brain. In particular, it is suggested there is a distribution in the circuits which link the basal ganglia (the site which controls voluntary motor movements, eye movements, and emotion) to the frontal cortex.

Individuals with Tourette Syndrome display impaired performance in cognitive tasks in terms of memory, attention, reading, and writing. These impairments are often more severe in individuals diagnosed with comorbid ADHD who also display less cognitive flexibility. It is estimated that 70% of patients with Tourette Syndrome exhibit ADHD type behaviors and as such, Tourette Syndrome can be a debilitating diagnosis for many people.

If someone has tics, it doesn’t mean that this person has Tourette’s syndrome. Tics have to be present for at least one year to be classified as Tourette’s syndrome and at least one of tics has to be vocal.

Symptoms of Tic Disorder

The defining symptom of tic disorders is the presence of one or more tics. These tics can be classified as:

  • Motor tics: These include tics, such as head and shoulder movements, jerking of the head, twisting the neck, rolling the eyes, blinking, jerking, banging, clicking fingers, or touching things or other people. Motor tics tend to appear before vocal tics, although this is not always the case.
  • Vocal tics: These are sounds, such as coughing, blowing, throat clearing or grunting, or repeating words or phrases.

Tics can also be divided into the following categories:

  • Simple tics: These are sudden and fleeting tics using few muscle groups. Examples include nose twitching, eye darting, or throat clearing.
  • Complex tics: These involve coordinated movements using several muscle groups. Examples include hopping or stepping in a certain way, gesturing, or repeating words or phrases.

Tics are usually preceded by an uncomfortable urge, such as an itch or tingle. While it is possible to hold back from carrying out the tic, this requires a great deal of effort and often causes tension and stress. Relief from these sensations is experienced upon carrying out the tic.

The symptoms of tic disorders may:
• worsen with emotions, such as anxiety, excitement, anger, and fatigue,
• worsen during periods of illness,
• worsen with extreme temperatures,
• occur during sleep,
• vary over time,
• vary in type and severity,
• improve over time.

Causes and risk factors for Tourette's syndrome and Tic Disorders

The exact cause of tic disorders is unknown. Within Tourette’s research, recent studies have identified some specific gene mutations that may have a role. Brain chemistry also seems to be important, especially the brain chemicals glutamate, serotonin, and dopamine.

Tics that have a direct cause fit into a different category of diagnosis. These include tics due to:
• head injuries,
• stroke,
• infections,
• poisons,
• surgery,
• other injuries.

In addition, tics can be associated with more serious medical disorders, such as Huntington’s disease or Creutzfeldt-Jakob disease.

Risk factors for tic disorders include:
Genetics: Tics tend to run in families, so there may be a genetic basis to these disorders.
Sex: Men are more likely to be affected by tic disorders than women.

Conditions associated with tic disorders

Conditions associated with tic disorders, especially in children with TS, include:

• anxiety
• ADHD
• depression
• autic spectrum disorder
• learning difficulties
• OCD
• speech and language difficulties
• sleep difficulties

Other conditions associated with tic disorders are related to the effect of the tics on self-esteem and self-image. Some research has found that children with TS or any chronic tic disorder experience a lower quality of life and lower self-esteem than those without one of these conditions.

In addition, the Tourette Association of America says that people with TS often experience difficulties with social functioning due to their tics and associated conditions, such as ADHD or anxiety.

Neurofeedback for Tourette Syndrome - Tourette graphic

Brain changes in Tourette's Syndrome and Tic Disorders

The frequent comorbidity of TS and ADHD may reflect a common underlying neurobiological substrate, and studies confirm the hypothesized involvement of fronto-striatal circuits in both TS and ADHD. However, poor inhibitory control and volumetric reductions in fronto-striatal circuits appear to be core features of ADHD, whereas reduced volumes of the caudate nucleus, together with activation and hypertrophy of prefrontal regions that likely help to suppress tics, seem to be core features of TS. (Neuroimaging of tic disorders with co-existing attention-deficit/hyperactivity disorder – Kerstin J. Plessen, M.D., Jason M. Royal, D.M.A., and Bradley S. Peterson, M.D.)

Activity in a region of the brain called the supplementary motor area (SMA) has been associated with tics. The investigators put tic patients into the MRI scanner and had a real-time functional magnetic resonance imaging neurofeedback session. The patients could see the SMA light up and they could try to control that area by focusing their thoughts on it. The patients who received the real neurofeedback had a greater reduction of tics on the Yale Global Tic Severity Scale as compared with the sham control.

Researchers at Washington University School of Medicine in St. Louis have identified areas in the brains of children with Tourette’s syndrome that appear markedly different from the same areas in brains of children who don’t have the disorder. 

In kids with Tourette’s, the researchers also found less white matter around the orbital prefrontal cortex, just above the eyes, and in the medial prefrontal cortex, also near the front, than in kids without the condition.

White matter acts like the brain’s wiring. It consists of axons that — unlike the axons in gray matter — are coated with myelin and transmit signals to the gray matter. Less white matter could mean less efficient transmission of sensations, whereas extra gray matter could mean nerve cells are sending extra signals.

In a scan of a child with Tourette’s, yellow indicates an area with less white matter than in the same brain region in kids who don’t have the disorder. The scans also revealed areas in the brains of kids with Tourette’s that have more gray matter (posterior thalamus, hypothalamus, and midbrain) than in children without the condition.

Deficits in executive functioning which contribute to ADHD symptoms also appear in TS, with the same losses of structural integrity in the cortico-striatal and cortico-thalamic pathways common to both disorders. Neurophysiological processes governing these deficits in executive functioning have proven modifiable by neurofeedback.

Clinical researchers Chuanjun Zhuo & Li Li (2014) found that neurofeedback training improved motor and vocal tic symptoms (e.g. a reduction in the frequency and intensity of tics) in adolescents with refractory Tourette syndrome.

Simone Messerotti Benvenuti et al. (2011) SMR up-training/Theta down-training schedule was utilized for sixteen sessions, followed by a further six purely using SMR up-training. SMR increase was better obtained when SMR up-training was administered alone, Whereas Theta decrease was observed after both types of trainings. 

After 40 sessions of SMR training, 75% of patients demonstrated an increase in the production of SMR and a positive change in theta/beta ratio.

It was therefore hypothesized that this training of the sensorimotor cortex results in increased voluntary muscle control and elimination of tics.

Neurofeedback for Tourette syndrome and Tic Disorders

Neurofeedback training is a self-regulation strategy. The brain is trained at the point where the tics are to reduce or eliminate them. In a brain with TS there is over-arousal. There is a high degree of excitability of the motor system. The overarching need is for this brain to experience calming, both in general and specifically in regard to motor circuits. When such calming is achieved tics (motor and vocal) may be reduced.

With the right approach, Neurofeedback practitioners have seen significant improvement in symptoms in the vast majority of cases. Nonetheless every case is different and sometimes you may not experience the reduction of tics but overall you should feel more relaxed and you should notice a better quality of sleep. This is a condition that appears to benefit from long-term training.

Presently, medications used to treat tics can cause unforeseen side effects, whereas neurofeedback therapy can be tailored to more accurately target the area of the brain that needs changing.

By Dr. Clare Albright – “Neurofeedback – Transforming Your Life With Brain Biofeedback” – www.neurofeedbackbook.com

Neurofeedback for Tourette Syndrome - Protocols

1. Sensor Placement:

Neurofeedback for Tourette syndrome typically involves the application of electrodes to specific sites on the scalp according to the 10-20 system, a standardized method for locating and measuring EEG electrode placements. 

Common electrode sites include Cz (vertex), Fz (midline frontal), C3/C4 (left and right central), and Pz (midline parietal).

2. Frequency Bands:

Neurofeedback protocols often target specific frequency bands associated with neurological functioning. For TS, protocols may focus on training specific frequencies like the sensorimotor rhythm (SMR) and beta waves. SMR is associated with motor control and inhibition and is often implicated in TS symptomatology.

3. Operant Conditioning:

The neurofeedback for Tourette Syndrome involves operant conditioning, where individuals learn to regulate their brain activity in response to visual or auditory feedback. In the case of TS, patients might receive positive feedback when their brain activity corresponds to a desired state (e.g., reduced hyperactivity in certain brain regions).

Electrode Application Sites According to 10-20 System

1. Cz (Vertex): Often associated with overall brain regulation.

Relevance: Central region of the motor cortex, is crucial for motor control, which is often dysregulated in TS.

2. Fz (Midline Frontal): May target prefrontal areas associated with impulse control.

• Relevance: Associated with executive function and impulse control, both of which are often impaired in individuals with TS.

3. C3/C4 (Left and Right Central): Relevant for sensorimotor rhythm and motor control.

C3 – Relevance: Involved in motor control and coordination, targeting this area can help reduce motor tics.

C4 – Relevance: Also involved in motor control; targeting this area can help balance neural activity related to motor functions.


4. Pz (Midline Parietal): Associated with sensory processing and integration.

Neurofeedback Protocols for Tourette Syndrome

The protocol involves training individuals to increase or decrease specific brainwave activity at the targeted locations to improve motor control and reduce tics.

1. Sensorimotor Rhythm (SMR) Training
This protocol focuses on increasing SMR (12-15 Hz) activity to promote calm and reduce motor tics.

• Target Brainwaves: SMR (12-15 Hz)
• Goal: Increase SMR activity to enhance motor inhibition and reduce hyperactivity in the motor cortex.

Procedure:
1. Electrode Placement: Place electrodes at C3 (left sensorimotor cortex), Cz (reference), and C4 (optional for bipolar montage).
2. Baseline Recording: Record baseline SMR activity for 5-10 minutes.
3. Feedback Mechanism: Provide real-time feedback using visual (e.g., a moving bar or animation) or auditory (e.g., tone) cues. Positive feedback is given when SMR activity increases.
4. Training Sessions: Conduct sessions for 20-30 minutes, 2-3 times per week, for 20-40 sessions.
5. Progress Monitoring: Use tic severity scales and follow-up qEEG to assess changes.

2. Theta/Beta Ratio Training

This protocol aims to balance theta (4-8 Hz) and beta (15-30 Hz) wave activity to improve attention and impulse control.

• Target Brainwaves: Theta (4-8 Hz) and Beta (15-30 Hz)
• Goal: Decrease theta activity and increase beta activity to improve cognitive control and reduce impulsivity.

Procedure:
1. Electrode Placement: Place electrodes at Fz (frontal midline) and Cz (reference).
2. Baseline Recording: Record baseline theta and beta activity for 5-10 minutes.
3. Feedback Mechanism: Provide feedback using visual or auditory stimuli. Positive feedback occurs when theta decreases and beta increases.
4. Training Sessions: Conduct sessions for 20-30 minutes, 2-3 times per week, for 20-40 sessions.
5. Progress Monitoring: Utilize attention and impulse control scales along with follow-up qEEG to track progress.

3. Alpha/Theta Training

This protocol focuses on increasing alpha (8-12 Hz) and theta (4-8 Hz) waves to promote relaxation and reduce anxiety, which can exacerbate tics.

• Target Brainwaves: Alpha waves (8-12 Hz) and Theta waves (4-8 Hz)
• Goal: Increase alpha and theta activity to reduce stress and improve overall emotional regulation.

Procedure:

1. Electrode Placement: Place electrodes at Cz and Fz (reference).
2. Baseline Recording: Record baseline alpha and theta activity for 5-10 minutes.
3. Feedback Mechanism: Use calming visual or auditory feedback. Positive feedback is provided when alpha and theta waves increase.
4. Training Sessions: Conduct sessions for 20-30 minutes, 2-3 times per week, for 20-40 sessions.
5. Progress Monitoring: Use anxiety and stress scales along with follow-up qEEG to monitor changes.

Effectiveness of Neurofeedback for Tourette Syndrome

Research on neurofeedback for Tourette syndrome is still in its early stages, and findings vary. Some studies suggest positive outcomes, such as reduced tic severity and improved impulse control, while others report mixed or inconclusive results.

Studies Supporting Effectiveness:

1. A study by Sokhadze et al. (2010) found that neurofeedback training led to a significant reduction in tic frequency and improved behavioral measures in TS patients.
2. Gevensleben et al. (2014) reported positive effects of neurofeedback on tic reduction and attentional control in children with TS.

Studies with Mixed Results:

1. Dehghani-Arani et al. (2013) found improvements in tic severity and cognitive performance but reported variability in individual responses.
2. Holtmann et al. (2011) observed improvement in tic severity but did not find significant effects on comorbid symptoms.

Challenges and Considerations:

• The heterogeneity of Tourette syndrome poses a challenge, as individuals may respond differently to neurofeedback.
• Lack of standardized protocols across studies makes it difficult to draw consistent conclusions.
• Larger, well-controlled studies with long-term follow-up are needed to establish the efficacy and generalizability of neurofeedback for TS.

In conclusion, while there is some promising evidence supporting the effectiveness of neurofeedback for Tourette syndrome, further research is necessary to establish standardized protocols, determine optimal electrode placements, and address the variability in treatment outcomes. Neurofeedback for Tourette syndrome holds potential as a complementary

COVID and Anxiety

COVID 19 – How to Cope with Stress, Anxiety and Fears

The outbreak of diseases, such as the coronavirus disease 2019 – COVID 19, may be stressful for all of us. Fear and anxiety about a COVID 19 disease and quarantine stress can be overwhelming and cause strong emotions in adults and children.

Stress is a natural response that can be both useful and harmful. A good amount of stress can propel us to achieve a task. However, continued high levels of stress can be harmful to the body.

Coping with stress, anxiety and fears is crucial during COVID 19 and quarantine isolation.

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Too much stress can lead to multiple negative outcomes, including:

1. Weakened immune system
2. High blood pressure and cholesterol
3. Unnecessary weight gain

This can lead to a weakened immune system, high blood pressure and cholesterol, and even gaining weight.

COVID19 stress

Stress Management can make you, your loved ones, and your community stronger.

Using the latest patented technologies from Singapore, we can now help you manage stress using an app designed by Neuroscientists.

That’s why Neeuro has partnered with Biofeedback and Neurofeedback Therapy to help you and your loved ones enjoy your stay at home!

LISTEN WITH BOTH HEADPHONES. This is music infused with frequencies that can help you RELAX during these stressful times.

Listen to it only with headphones! It will be the first time that you will listen to a song with your brain and not only with your ears.

WHO recommends listening to music to relax and maintain your mental health.

You can find out more about this music here.

Download the Galini App FREE and enjoy it for 14 days.

Neeuro + Biofeedback and Neurofeedback Therapy Join Forces to Help Combat Stress

Galini Helps You Manage Stress,
Anytime, Anywhere

Galini is an app that can measurably manage stress, carefully tailored to provide you optimal Relaxation and Mindfulness.

How Galini Stress Relief Kit
Helps You Relax

STEP 1: LISTEN
The special audio frequencies (binaural beats) in the tracks, coupled with calming visualisations of peaceful scenes, can coax your mind into a state of deep relaxation.

STEP 2: BREATHE
Breathing techniques are designed to stimulate specific parts of the brain to modulate the mind and body and bring about a deep sense of peace to your whole person.

STEP 3: MOVE
You will be guided through slow and deliberate movements while the screen interacts with you. This helps to regulate your focus and induce an increased awareness of your internal sensations and of the immediate environment.

COVID and Mental Health

COVID 19 –“Stay At Home”. How to Stay Mentally Healthy In COVID 19 Quarantine

A recent review of research, published in The Lancet, found that COVID 19 quarantine is linked with post-traumatic stress disorder (PTSD) symptoms, confusion, and anger, with some research suggesting these effects are long-lasting. Given that the coronavirus crisis is likely to be with us for some time, the mental health implications can’t be dismissed.

Don’t know what else you can do WITH your KIDS during COVID 19 quarantine? Instead of just watching TV, Youtube, playing some random games, here’s a useful SOLUTION for you!

Train your brains using the latest app to keep yourselves SHARP so that you and your kids can be mentally healthy together!

At any stage of life, our brains have the ability to adapt and change. This ability is known as “neuroplasticity”. With the right practice, the brain can become stronger, just like a muscle.

For children, the benefits are:

  • Paying better attention in class;
  • Remembering instructions and formulas;
  • Reducing careless mistakes

For adults, some of the benefits are:

  • Sharper mind;
  • Reducing forgetfulness;
  • Finishing multiple tasks faster

You can best use this period to your advantage.

Using the latest patented technologies from Singapore, you can now train by playing specially designed games by Neuroscientists that can help you enhance your brain power!

That’s why Neeuro has partnered with Biofeedback and Neurofeedback Therapy to help you and your loved ones enjoy your stay at home!

Memorie is an app that puts together games designed by neuroscientists to improve attention, memory and other cognitive skills.

Memorie offers a complete mental fitness training programme.

With brain stimulation games, you can challenge yourself and test your skills in attention, memory, multi-tasking, spatial and decision making.

How This FREE Memorie Brain Training Kit Can Train
Your 5 Cognitive Skills

SKILL #1: ATTENTION
Memorie’s attention training games encourage players to gain a higher attention span to process new concepts and complete daily tasks with more ease.

SKILL #2: MEMORY
Memory is important for storing and retrieving information. Training lets us improve aspects such as working memory that helps in solving problems, etc.

SKILL #3: DECISION MAKING
By training logic and reasoning skills, we can make more mindful decisions by organising relevant information and outlining alternatives.

SKILL #4: SPATIAL ABILITY
Spatial training is relevant for math (e.g. Understanding shapes and distances), using maps, and even for sports.

Neurofeedback in Depression

Neurofeedback for depression. Protocols

Depression is one of the most common mental disorders and the number one cause of disability worldwide. Traditionally, depression has been treated with therapy and medication, both of which have limitations. Even with medication, countless depression sufferers continue to struggle. Medication doesn’t teach the brain how to get out of the unhealthy brain pattern of depression. While drugs can serve some positive benefits, there are numerous problems with these medications, including unwanted side effects and reliance on the medication. Neurofeedback for depression can help restore healthier brain patterns and eliminate depression by teaching the brain to get “unstuck” and better modulate itself. It works on the root of the problem, altering the brain patterns affiliated with depression. It can bring lasting brain changes, is non-invasive, and produces no undesirable side effects.

Feeling down from time to time is a normal part of life. However, when emotions such as hopelessness and despair take hold and just won’t go away, you may have depression. More than just sadness in response to life’s struggles and setbacks, depression changes how you think, feel, and function in daily activities. It can interfere with your ability to work, study, eat, sleep, and enjoy life. Just trying to get through the day can be overwhelming. If depression is left untreated it can become a serious health condition.

Depression is one of the most common mental disorders and the number one cause of disability worldwide. It can affect anyone at almost any age. It is estimated that 10% to 15% of the general population will experience clinical depression in their lifetime. The World Health Organization estimates 5% of men and 9% of women experience depressive disorders in any given year. Over half of people who experience depression will experience anxiety at the same time. The financial costs of depression are tremendous with the global costs per year of depression and anxiety estimated to be $1.15 trillion.

CAUSES OF DEPRESSION

There’s no single cause of depression. It can occur for a variety of reasons and it has many different triggers.
For some people, an upsetting or stressful life event, such as bereavement, divorce, illness, redundancy, and job or money worries, can be the cause.

Different causes can often combine to trigger depression. For example, you may feel low after being ill and then experience a traumatic event, such as a bereavement, which brings on depression.

People often talk about a “downward spiral” of events that leads to depression. For example, if your relationships with your partner break down, you’re likely to feel low, you may stop seeing friends and family and you may start drinking more. All of this can make you feel worse and trigger depression.

Some studies have also suggested that you’re more likely to get depression as you get older and that it’s more common in people who live in difficult social and economic circumstances.

Common causes of depression

Common causes of depression are reflected below.

Stressful events

Most people take time to come to terms with stressful events, such as bereavement or a relationship breakdown. When these stressful events occur, your risk of becoming depressed is increased if you stop seeing your friends and family and try to deal with your problems on your own.

Personality

You may be more vulnerable to depression if you have certain personality traits, such as low self-esteem or being overly self-critical. This may be because of the genes you’ve inherited from your parents, your early life experiences, or both.

Family history

Since it can run in families, it’s likely some people have a genetic susceptibility to depression. If someone in your family has had depression in the past, such as a parent or sister or brother, it’s more likely that you’ll also develop it. However, there is no single “depression” gene. Your lifestyle choices, relationships, and coping skills matter just as much as genetics.

Giving birth

Some women are particularly vulnerable to depression after pregnancy. The hormonal and physical changes, as well as the added responsibility of a new life, can lead to postnatal depression.

Loneliness and isolation

Feelings of loneliness, caused by things such as becoming cut off from your family and friends can increase your risk of depression. However, having depression can cause you to withdraw from others, exacerbating feelings of isolation.

Alcohol and drugs

When life is getting people down, some of them try to cope by drinking too much alcohol or taking drugs. This can result in a spiral of depression.
Cannabis can help you relax, but there’s evidence that it can also bring on depression, particularly in teenagers.

“Drowning your sorrows” with a drink is also not recommended. Alcohol affects the chemistry of the brain, which increases the risk of depression.

Chronic illness or pain

The mind and the body are clearly linked. If you are experiencing a physical health problem, you may discover changes in your mental health as well.
You may have a higher risk of depression if you have a longstanding or life-threatening illness, such as coronary heart disease or cancer.
Head injuries are also an often under-recognized cause of depression. A severe head injury can trigger mood swings and emotional problems.
Some people may have an underactive thyroid (hypothyroidism) resulting from problems with their immune system. In rarer cases, a minor head injury can damage the pituitary gland, which is a pea-sized gland at the base of your brain that produces thyroid-stimulating hormones.
This can cause a number of symptoms, such as extreme tiredness and a lack of interest in sex (loss of libido), which can, in turn, lead to depression.

SIGNS AND SYMPTOMS OF DEPRESSION

Depression varies from person to person, but there are some common signs and symptoms. It’s important to remember that these symptoms can be part of life’s normal lows. But the more symptoms you have, the stronger they are, and the longer they’ve lasted – the more likely it is that you’re dealing with depression.

Depression is an ongoing problem, not a passing one. It consists of episodes during which the symptoms last for at least 2 weeks. Depression can last for several weeks, months, or years.

10 common symptoms of depression:

1. Feelings of helplessness, hopelessness, emptiness, despair, and sadness. A bleak outlook – nothing will ever get better and there’s nothing you can do to improve your situation.
2. Loss of interest in previously pleasurable daily activities. You don’t care anymore about former hobbies, pastimes, social activities, or sex. You’ve lost your ability to feel joy and pleasure.
3. Appetite or weight changes. Significant weight loss or weight gain – a change of more than 5% of body weight in a month.
4. Sleep changes. Either insomnia, especially waking in the early hours of the morning or oversleeping.
5. Anger or irritability. Feeling agitated, restless, or even violent. Your tolerance level is low, your temper short, and everything and everyone gets on your nerves.
6. Loss of energy. Feeling fatigued, sluggish, and physically drained. Your whole body may feel heavy, and even small tasks are exhausting or take longer to complete.
7. Self-loathing. Strong feelings of worthlessness or guilt. You harshly criticize yourself for perceived faults and mistakes.
8. Reckless behavior. You engage in escapist behavior such as substance abuse, compulsive gambling, reckless driving, or dangerous sports.
9. Concentration problems. Trouble focusing, making decisions or remembering things.
10. Unexplained aches and pains. An increase in physical complaints such as headaches, back pain, aching muscles, and stomach pain, breast tenderness, bloating.

TYPES OF DEPRESSION

Depression comes in many shapes and forms. While defining the severity of depression – whether it’s mild, moderate, or major – can be complicated, knowing what type of depression you have may help you manage your symptoms and get the most effective treatment.

Mild and moderate depression

Mild and moderate depression is the most common types of depression. More than simply feeling blue, the symptoms of mild depression can interfere with your daily life, robbing you of joy and motivation. Those symptoms become amplified in moderate depression and can lead to a decline in confidence and self-esteem.

Recurrent, mild depression (dysthymia)

Dysthymia is a type of chronic “low-grade” depression. More days than not, you feel mildly or moderately depressed, although you may have brief periods of normal mood.

• The symptoms of dysthymia are not as strong as the symptoms of major depression, but they last a long time (at least two years).
• Some people also experience major depressive episodes on top of dysthymia, a condition known as “double depression.”
• If you suffer from dysthymia, you may feel like you’ve always been depressed. Or you may think that your continuous low mood is “just the way you are.”

Major depression

Major depression is much less common than mild or moderate depression and is characterized by severe, relentless symptoms.
• Left untreated, major depression typically lasts for about six months.
• Some people experience just a single depressive episode in their lifetime, but major depression can be a recurring disorder.

Atypical depression

Atypical depression is a common subtype of major depression with a specific symptom pattern. It responds better to some therapies and medications than others, so identifying it can be helpful.
• People with atypical depression experience a temporary mood lift in response to positive events, such as after receiving good news or while out with friends.
• Other symptoms of atypical depression include weight gain, increased appetite, sleeping excessively, a heavy feeling in the arms and legs, and sensitivity to rejection.

Seasonal affective disorder (SAD)

For some people, the reduced daylight hours of winter lead to a form of depression known as seasonal affective disorder (SAD). SAD affects about 1% to 2% of the population, particularly women and young people. SAD can make you feel like a completely different person to who you are in the summer: hopeless, sad, tense, or stressed, with no interest in friends or activities you normally love. SAD usually begins in fall or winter when the days become shorter and remains until the brighter days of spring.

Understanding the underlying cause of your depression may help you overcome the problem. However, whether you’re able to isolate the causes of your depression or not, the most important thing is to recognize that you have a problem, reach out for support, and pursue the coping strategies that can help you to feel better.

Depression in children and teens

Depression affects also about 2% of preschool and school-age children. A depressive disorder in children does not have one specific cause. Biologically, depression is associated with a deficient level of the neurotransmitter serotonin in the brain, the smaller size of some areas of the brain and increased activity in other parts of the brain. Girls are more likely to be given the diagnosis of depression than boys, but that is thought to be due to, among other things, biological differences based on gender, and differences in how girls are encouraged to interpret their experiences and respond to it as opposed to boys. There is thought to be at least a partial genetic component to the pattern of children, and teens with a depressed parent are as much as four times more likely to also develop the disorder. Children who have depression or anxiety are more prone to have other biological problems, like low birth weight, suffering from a physical condition, trouble sleeping, etc.

Psychological contributors to depression include low self-esteem, negative social skills, negative body image, being excessively self-critical, and often feeling helpless when dealing with negative events. Children who suffer from conduct disorder, attention deficit hyperactivity disorder (ADHD), clinical anxiety, or who have cognitive or learning problems, as well as trouble engaging in social activities, also have more risk of developing depression.

Depression may be a reaction to life stresses, like trauma, including verbal, physical, or sexual abuse, the death of a loved one, school problems, bullying, or suffering from peer pressure.

Other contributors to this condition include poverty and financial difficulties in general, exposure to violence, social isolation, parental conflict, divorce, and other causes of disruptions to family life. Children who have limited physical activity, poor school performance, or lose a relationship are at higher risk for developing depression, as well.

General symptoms of depression in children

Depression often results in the sufferer being unable to perform daily activities, such as getting out of bed or getting dressed, performing well at school, or playing with peers. General symptoms of a major depressive episode regardless of age include having a depressed mood or irritability or difficulty experiencing pleasure for at least two weeks and having at least five of the following signs and symptoms:
• Feeling sad or blue and/or irritable or seeming that way as observed by others (for examples, tearfulness or otherwise looking persistently sad, or angry),
• Significant appetite changes, with or without significant weight loss, failing to gain weight appropriately or gaining excessive weight,
• Change in sleep pattern: trouble sleeping or sleeping too much,
• Physical agitation or retardation (for example, restlessness or feeling slowed down),
• Fatigue or low energy/loss of energy,
• Difficulty concentrating,
• Feeling worthless, excessively guilty, or tend to self-blame,
• Thoughts of death or suicide

Children with depression may also experience the classic symptoms but may exhibit other symptoms as well, including
• Impaired performance of schoolwork,
• Persistent boredom,
• Quickness to anger,
• Frequent physical complaints, like headaches and stomachaches,
• More risk-taking behaviors and/or showing less concern for their own safety (examples of risk-taking behaviors in children include unsafe play, like climbing excessively high or running in the street).

Parents of infants and children with depression often report noticing the following behavior changes in the child:
• Crying more often or more easily,
• Increased sensitivity to criticism or other negative experiences,
• More irritable mood than usual or compared to others their age and gender, leading to vocal or physical outbursts, defiant, destructive, angry or other acting out behaviors,
• Eating patterns, sleeping patterns, or significant increase or decrease in weight change, or the child fails to achieve appropriate gain weight for their age,
• Unexplained physical complaints (for examples, headaches or abdominal pain),
• Social withdrawal, in that the youth spends more time alone, away from friends and family,
• Developing more “clinginess” and more dependent on certain relationships,
• Overly pessimistic, hopeless, helpless, excessively guilty or feeling worthless,
• Expressing thoughts about hurting him or herself or engaging in self-injury behavior,
• Young children may act younger than their age or than they had before (regress).
• Younger children may have difficulty expressing how they feel in words. This can make it harder for them to explain their feelings of sadness.

Physical changes, peer pressure, and other factors can contribute to depression in teenagers. They may experience some of the following symptoms:
• Withdrawing from friends and family,
• Difficulty concentrating on schoolwork,
• Feeling guilty, helpless, or worthless,
• Restlessness, such as an inability to sit still

Hamilton Depression Rating Scale (HAM-D)

The Hamilton Rating Scale for Depression (often abbreviated to HRSD, HDRS or Ham-D) for more than 40 years was considered to be the ‘gold standard’ and most widely used clinician-administered depression assessment scale.
The scale is widely available and has two common versions with either 17 or 21 items and is scored between 0 and 4 points.
The first 17 items measure the severity of depressive symptoms and as examples, the interviewer rates the level of agitation clinically noted during the interview or how the mood is impacting an individual’s work or leisure pursuits.
The extra four items on the extended 21-point scale measure factors that might be related to depression, but are not thought to be measures of severity, such as paranoia or obsessional and compulsive symptoms.

Classification of symptoms can be expanded to:
• 0 – absent;
• 1 – mild;
• 2 – moderate;
• 3 – severe;
• 4 – incapacitating
In general the higher the total scores the more severe the depression.

The Hamilton Depression Rating Scale is designed to be administered by clinicians after a structured or unstructured interview of the patient to determine their symptoms. A total score is calculated by summing the individual scores from each question.
• Scores below 7 generally represent the absence or remission of depression,
• Scores between 7-17 represent the mild depression,
• Scores between 18-24 represent the moderate depression,
• Scores 25 and above represent the severe depression
The maximum score is 52 on the 17- point scale.

THE BRAIN CHANGES IN DEPRESSION

Brain Chemistry Imbalances

One potential biological cause of depression is an imbalance in the neurotransmitters which are involved in mood regulation. Certain neurotransmitters, including dopamine, serotonin, and norepinephrine, plays an important role in mood.

Neurotransmitters are chemical substances that help different areas of the brain communicate with each other. When certain neurotransmitters are in short supply, it may lead to the symptoms we recognize as clinical depression.
It’s often said that depression results from a chemical imbalance, but research suggests that depression doesn’t spring from simply having too much or too little of certain brain chemicals. Two people might have similar symptoms of depression, but the problem on the inside, and therefore what treatments will work best, may be entirely different.

Neurotransmitters are chemicals that relay messages from neuron to neuron. An antidepressant medication tends to increase the concentration of these substances in the spaces between neurons (the synapses). In many cases, this shift appears to give the system enough of a nudge so that the brain can do its job better.

A combination of electrical and chemical signals allows communication within and between neurons. When a neuron becomes activated, it passes an electrical signal from the cell body down the axon to its end (known as the axon terminal), where chemical messengers called neurotransmitters are stored. The signal releases certain neurotransmitters into the space between that neuron and the dendrite of a neighboring neuron. That space is called a synapse. 

As the concentration of a neurotransmitter rises in the synapse, neurotransmitter molecules begin to bind with receptors embedded in the membranes of the two neurons. Once the first neuron has released a certain amount of the chemical, a feedback mechanism (controlled by that neuron’s receptors) instructs the neuron to stop pumping out the neurotransmitter and start bringing it back into the cell. This process is called reabsorption or reuptake. Enzymes break down the remaining neurotransmitter molecules into smaller particles.

1. An electrical signal travels down the axon.
2. Chemical neurotransmitter molecules are released.
3. The neurotransmitter molecules bind to receptor sites.
4. The signal is picked up by the second neuron and is either passed along or halted.
5. The signal is also picked up by the first neuron, causing reuptake, the process by which the cell that released the neurotransmitter takes back some of the remaining molecules.

Brain cells usually produce levels of neurotransmitters that keep senses, learning, movements, and moods perking along. But in some people who are severely depressed or manic, the complex systems that accomplish this go awry.

Kinds of neurotransmitters

Scientists have identified many different neurotransmitters. Here is a description of a few believed to play a role in depression:
Acetylcholine enhances memory and is involved in learning and recall.
Serotonin helps regulate sleep, appetite, and mood and inhibits pain. Research supports the idea that some depressed people have reduced serotonin transmission. Low levels of a serotonin byproduct have been linked to a higher risk for suicide.
Norepinephrine constricts blood vessels, raising blood pressure. It may trigger anxiety and be involved in some types of depression. It also seems to help to determine motivation and reward.
Dopamine is essential to movement. It also influences motivation and plays a role in how a person perceives reality. Problems in dopamine transmission have been associated with psychosis, a severe form of distorted thinking characterized by hallucinations or delusions. It’s also involved in the brain’s reward system, so it is thought to play a role in substance abuse.
Glutamate is a small molecule believed to act as an excitatory neurotransmitter and to play a role in bipolar disorder and schizophrenia. Lithium carbonate, a well-known mood stabilizer used to treat bipolar disorder, helps prevent damage to neurons in the brains of rats exposed to high levels of glutamate. Other animal research suggests that lithium might stabilize glutamate reuptake, a mechanism that may explain how the drug smoothes out the highs of mania and the lows of depression in the long term.
Gamma-aminobutyric acid (GABA) is an amino acid that researchers believe acts as an inhibitory neurotransmitter. It is thought to be helpful in quell anxiety.

The neurotransmitter theory of depression suggests that having too much or too little of certain neurotransmitters causes, or at least contributes to, depression. While this explanation is often cited as a major cause of depression, it remains unproven and many experts believe that it doesn’t paint a complete picture of the complex factors that contribute to depression.

Medications to treat depression often focus on altering the levels of certain chemicals in the brain. Some of these treatments include selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), monoamine oxidase inhibitors (MAOIs), and tricyclic antidepressants (TCAs).

Areas of the brain affected by depression

Certain areas of the brain help regulate mood. Researchers believe that the more important than levels of specific brain chemicals is the nerve cell connections, nerve cell growth, and the functioning of nerve circuits that have a major impact on depression.

Use of brain imaging technology (positron emission tomography (PET), single-photon emission computed tomography (SPECT), and functional magnetic resonance imaging (fMRI)) has led to a better understanding of which brain regions regulate mood and how other functions, such as memory, may be affected by depression. 

Many functional neuroimaging studies on mood disorders have sown the evidence for localizing the dysfunction on the medial (MFa and PFm) and the orbital frontal cortex (PFo), together with the medial and anterior temporal lobe. 

Compared to healthy controls, patients with MDD show altered activation in the orbital and medial frontal cortex during exposure to emotionally charged stimuli and during the performance of reward-processing tasks. Patients with cerebrovascular disease who develop depression have lesions in the orbital and medial frontal cortex, but other cerebrovascular patients – those without depression – do not. 

Patients with Parkinson’s disease who manifest depression show altered metabolism or blood flow in the orbital and medial frontal cortex compared to non-depressed Parkinson’s patients or healthy controls. Furthermore, reductions of cortical volume and thickness occur in several parts of the frontal cortex in depressed patients, with the most reliable and best characterized of these abnormalities occurring in PFo area, the sulcal part area, and the subgenual frontal cortex. In these key parts of the MFa, the reduction in cortical volume arises prior to the onset of symptoms in patients at high familial risk for depression, appears early in the course of the illness, persists across depressive episodes, and occurs consistently in the most severe cases.

Brain areas that play a significant role in depression are the amygdala, the thalamus, and the hippocampus.

Amygdala

The amygdala is part of the limbic system, a group of structures deep in the brain that’s associated with emotions such as anger, pleasure, sorrow, fear, and sexual arousal. The amygdala is activated when a person recalls emotionally charged memories, such as a frightening situation. Activity in the amygdala is higher when a person is sad or clinically depressed. This increased activity continues even after recovery from depression.

Thalamus

The thalamus receives most sensory information and relays it to the appropriate part of the cerebral cortex, which directs high-level functions such as speech, behavioral reactions, movement, thinking, and learning. Some research suggests that bipolar disorder may result from problems in the thalamus, which helps link sensory input to pleasant and unpleasant feelings.

Hippocampus

The hippocampus is part of the limbic system and has a central role in processing long-term memory and recollection. The interplay between the hippocampus and the amygdala might account for the adage “once bitten, twice shy.” It is this part of the brain that registers fear when you are confronted by a barking, aggressive dog, and the memory of such an experience may make you wary of dogs you come across later in life. 

Research shows that the hippocampus 9% to 13% is smaller in some depressed people compared with those who were not depressed. Stress, which plays a role in depression, maybe a key factor here since experts believe that stress, can suppress the production of new neurons (nerve cells) in the hippocampus. Researchers are exploring possible links between the sluggish production of new neurons in the hippocampus and low moods. An interesting fact about antidepressants supports this theory. These medications immediately boost the concentration of chemical messengers in the brain (neurotransmitters). Yet people typically don’t begin to feel better for several weeks or longer. Experts have long wondered why, if depression were primarily the result of low levels of neurotransmitters, people don’t feel better as soon as levels of neurotransmitters increase. 

The answer may be that mood only improves as nerves grow and form new connections, a process that takes weeks. That is why the neurofeedback for depression is so effective. It is because the neurofeedback for depression boosts positive brain neuroplasticity, rewires neuron connections and creates a network, involves changes to structures and enhances the healthy functioning of the brain.

The changes in brain region activity in patients with depression can be registered by electroencephalographic (EEG) study. Special emphasis on the electroencephalographic (EEG) correlates of the disorder is open the venue to the use of EEG not only for diagnostic but for prognostic purposes, producing a new hope and excitement among patients and health practitioners, commonly seen today. In 2008 it was found that a very simple electroencephalographic marker (Alpha asymmetry) could be used to predict the response to antidepressants before the beginning of the pharmacologic treatment, in such a sense that it could serve as an aid in the choice of treatment.

EEG BIOMARKERS IN DEPRESSION

Specific brain networks mediate different emotions and behaviors, and changes in patterns of interaction are associated with differential cerebral activation. The EEG studies provide useful information about patterns of brain functioning during cognitive or emotional tasks in patients with depression.

With a quantitative electroencephalogram (QEEG) it is possible to observe several patterns that include optimal states of psychic balance, but also states of fear, anxiety, panic, anger, impatience, and depression.

It was demonstrated that within the depressed population category it is possible to find specific symptoms for two types of depression: depression with symptoms of hopelessness and symptoms of agitated depression.

The symptoms of depression with hopelessness are sadness, loss or significant decline of interest in performing activities previously considered pleasurable, social withdrawal, altered appetite, and changes in sleep quality, slowing of speech and in some cases mutism, fatigue, guilty feelings, cognitive disorders and thoughts related to death. These symptoms are associated with a reversal or asymmetry of alpha waves (8- 12 Hz). Thus, in the normal non-depressed population, it was observed the importance of the right hemisphere represented by eight even points (Fp2, F4, F8, C4, T4, P4, T6, and O2) of the international 10-20 electroencephalography mapping system. These points, in normal non-depressed population contained around 10 to 15% more alpha waves when compared to the left hemisphere represented by eight odd points (Fp1, F3, F7, C3, T3, P3, T5, and O1) as the alpha waves emit less energy compared to beta waves. This same ideal alpha pattern is expected in the posterior region of the brain at five points (T5, P3, Pz, P4, and T6), when compared to the anterior region also at five points (F7, F3, Fz, F4, and F8), totaling 26 points, divided in two groups of 13.

The symptoms of agitated depression are irritation, impatience, overemotional and difficulty concentrating and paying attention and subjects have a struggle to create a routine and maintain it. These symptoms are linked to reversals of beta waves (15-23 Hz), which are in non-depressed population expected to be around 5% higher in the left hemisphere (Fp1, F3, F7, C3, T3, P3, T5 and O1) and in the anterior brain (F7, F3, Fz, F4 and F8) compared to the right hemisphere (Fp2, F4, F8, C4, T4, P4, T6 and O2) and posterior portion of the brain (T5, P3, Pz, P4 and T6), respectively. 

In 2008 it was found that a very simple electroencephalographic marker (Alpha asymmetry) could be used not only for diagnostic but prognostic purposes: to predict the response to antidepressants before the beginning of the pharmacologic treatment, in such a sense that it could serve as an aid in the choice of treatment.

While qEEG shows great promise in predicting antidepressant medication response and ending the need for lengthy “medication trials”, neurofeedback for depression has been repeatedly found effective in activating brain areas responsible for depression, and helping people re-engage with life.

The use of qEEG to map brain function makes the depressed brain visible. With the use of qEEG it can be seen the brain areas that have become less active, reflecting the disengagement of the patient. More importantly, we can target these areas with neurofeedback for depression to reactivate them, allowing the brain to normalize itself.

TREATMENT FOR DEPRESSION

Traditionally, depression has been treated with therapy and medication, both of which have limitations.
Antidepressants can help treat moderate-to-severe depression. Several classes of antidepressants are available:
• selective serotonin reuptake inhibitors (SSRIs)
• monoamine oxidase inhibitors (MAOIs)
• tricyclic antidepressants
• atypical antidepressants
• selective serotonin and norepinephrine reuptake inhibitors (SNRIs).

Certain side effects of antidepressants can worsen depression in a small percentage of individuals:

• nausea
• headaches
• sleep disturbances
• agitation
• sexual problems
• suicidal thoughts
• irritability

Even with medication, countless depression sufferers continue to struggle. Medication doesn’t teach the brain how to get out of the unhealthy brain pattern of depression. While drugs can serve some positive benefits, there are numerous problems with these medications, including unwanted side effects and reliance on the medication making it difficult to stop taking it and manage mood on one’s own. If medications are stopped, symptoms often return. In addition, people can become tolerant of medications, necessitating a dosage increase or medication change which may produce new side effects. Despite the availability of effective clinical treatments for depression, 30-40% of these patients still fail to respond significantly to antidepressant treatment.

Depression is a multifaceted mental health condition that affects millions worldwide, impacting their emotional well-being, relationships, and daily functioning. While there are various therapeutic approaches to addressing depression, Cognitive Behavioral Therapy (CBT) stands out as one of the most effective and evidence-based treatments available.

By understanding the underlying mechanisms of CBT and its application in treating depressive symptoms, mental health professionals can equip themselves with powerful tools to assist individuals in overcoming this debilitating condition.

Through a collaborative and empowering approach, CBT offers hope and healing to those navigating the complex terrain of depression, guiding them towards a brighter and more fulfilling future.

Neurofeedback for depression can help restore healthier brain patterns and eliminate depression by teaching the brain to get “unstuck” and better modulate itself. It teaches the brain to regulate mood. Neurofeedback for depression works on the root of the problem, altering the brain patterns affiliated with depression. It can bring lasting brain changes, is non-invasive, and produces no undesirable side effects.

NEUROFEEDBACK FOR DEPRESSION. HOW CAN NEUROFEEDBACK HELP?

People who have depression show asymmetry in their frontal lobe. Specifically, the left frontal lobe has significantly less activation in people with depression than in people without depression. Decreased left-sided frontal activation is thought to be associated with a deficit in the approach system (which can generate positive moods). Hence people with these deficits are more prone to depressive disorders.

Right-sided frontal activation is related to withdrawal-related emotion such as anxiety disorders. Interestingly this right-sided activation was associated with selective spatial deficits, which are often reported to accompany depression, and may account for the issues with the decoding of nonverbal behavior in people with depression.

Underlying pathophysiological mechanisms have been identified in depression and research has shown that neurofeedback for depression can target these physiological mechanisms in order to reduce depressive symptoms.

In 2016 Wang and colleagues highlighted the benefits of neurofeedback for depression on the left and right frontal activity alpha asymmetry in patients with major depressive disorder.

In 2017, studies by Young and colleagues found evidence to suggest that neurofeedback for depression can significantly decrease depressive symptoms by the increasing activity surrounding positive memories. The study suggests a strong correlation between the roles of the amygdala and the recovery of depression.

Young and colleagues (2018) investigated the correlations between changes in depression scores and changes in amygdala connectivity and the effects of neurofeedback training on these changes. They had found that neurofeedback for depression increased connectivity of the amygdala with regions involved in self-referential, salience, and reward processing. Results showed that the specific amygdala connectivity was significantly correlated with improvement in depressive symptoms.

NEUROFEEDBACK FOR DEPRESSION. TRAINING PROTOCOLS

Neurofeedback represents an exciting complementary option in the treatment of depression that builds upon a huge body of research on electroencephalographic correlates of depression. 

The most used neurofeedback training protocols in depression focus on Alpha inter-hemispheric asymmetry and Theta/Beta ratio within the left prefrontal cortex. In some cases to reduce anxiety, it may be necessary to reinforce the decrease of Beta-3.

The Hammond depression neurofeedback training protocol – reinforce beta arousal while inhibiting alpha and theta arousal in the left frontal area at electrode sites Fp1 and F3.

Patients should receive active neurofeedback from the left amygdala (LA) or from the left horizontal segment of the intraparietal sulcus (control region). Pre-/post- resting-state functional connectivity measures showed that abnormal LA hypo-connectivity in patients with depression was reversed after neurofeedback training. 

Clinical experience demonstrated that occasionally a patient-reported becoming over-activated from the reinforcement of 15-18 Hz beta, reporting feeling somewhat more irritable, anxious, and having some difficulty falling asleep. Therefore, the protocol was modified so that while inhibiting alpha and theta activity, 15-18 Hz beta was reinforced for 20-22 minutes and then the reinforcement band was changed to 12-15 Hz for the last 8-10 minutes.

Key Electrode Application Sites for Depression Neurofeedback

1. F3 (Left Dorsolateral Prefrontal Cortex – DLPFC):

• Location: Frontal lobe, 30% of the distance from the nasion (bridge of the nose) to the inion (the prominent bump at the back of the head) and 20% from the midline.
• Relevance: Associated with positive mood regulation and approach behavior. Activity in this area is often reduced in individuals with depression.

2. F4 (Right Dorsolateral Prefrontal Cortex – DLPFC):

• Location: Frontal lobe, analogous to F3 on the right side of the head.
• Relevance: While F4 is often related to negative emotions, balancing activity between F3 and F4 can be crucial in mood regulation.

3. Fp1 (Left Prefrontal Cortex):

• Location: Frontal pole, 10% of the distance from the nasion.
• Relevance: Involved in executive function and mood regulation. Targeting Fp1 can help enhance positive affect and cognitive control.

4. Cz (Central Midline):

• Location: The vertex of the scalp, halfway between the nasion and inion and equally spaced between the left and right preauricular points (just above the ears).
• Relevance: Often used as a reference or ground electrode in neurofeedback sessions.

Neurofeedback Protocols for Depression Management

Alpha Asymmetry Protocol

This protocol aims to balance the alpha wave activity between the left and right prefrontal cortex, particularly at F3 (left) and F4 (right).

• Target Brainwaves: Alpha waves (8-12 Hz)
• Goal: Increase alpha activity at F3 and/or decrease alpha activity at F4 to reduce left-right asymmetry, as greater left alpha activity relative to the right is often associated with depression.

Procedure:

1. Electrode Placement: Place electrodes at F3, F4, and Cz (reference).
2. Baseline Recording: Record baseline alpha activity for 5-10 minutes.
3. Feedback Mechanism: Provide real-time feedback using visual (e.g., a moving bar or video) or auditory (e.g., tone) cues. When the desired alpha asymmetry is achieved (i.e., more balanced alpha activity), the feedback becomes positive (e.g., the bar grows, the video plays, or the tone changes pleasantly).
4. Training Sessions: Conduct sessions for 20-30 minutes, 2-3 times per week, for 20-40 sessions.
5. Progress Monitoring: Use depression rating scales and follow-up qEEG to assess changes.

Alpha-Theta Training

This protocol focuses on increasing alpha and theta waves to promote relaxation and reduce anxiety, which can help alleviate depressive symptoms.

• Target Brainwaves: Alpha waves (8-12 Hz) and Theta waves (4-8 Hz)
• Goal: Increase the amplitude of alpha and theta waves, particularly during relaxed wakefulness.

Procedure:

1. Electrode Placement: Place electrodes at Fp1 and Cz (reference).
2. Baseline Recording: Record baseline alpha and theta activity for 5-10 minutes.
3. Feedback Mechanism: Provide feedback through a calming visual (e.g., a serene landscape) or auditory (e.g., nature sounds) stimuli. Positive feedback occurs when alpha and theta amplitudes increase.
4. Training Sessions: Conduct sessions for 20-30 minutes, 2-3 times per week, for 20-40 sessions.
5. Progress Monitoring: Use depression rating scales and follow-up qEEG to track progress.

Beta/SMR Training Protocol

This protocol focuses on increasing low beta (12-15 Hz) or sensorimotor rhythm (SMR, 12-15 Hz) waves to enhance cognitive function and stabilize mood.

• Target Brainwaves: Beta waves (12-15 Hz)
• Goal: Increase low beta/SMR activity, which is associated with calm focus and emotional stability.

Procedure:

1. Electrode Placement: Place electrodes at F3 (for left DLPFC) and Cz (reference).
2. Baseline Recording: Record baseline beta/SMR activity for 5-10 minutes.
3. Feedback Mechanism: Use visual (e.g., a moving object) or auditory (e.g., a musical tone) feedback. Positive feedback is provided when beta/SMR activity increases.
4. Training Sessions: Conduct sessions for 20-30 minutes, 2-3 times per week, for 20-40 sessions.
5. Progress Monitoring: Utilize depression rating scales and follow-up qEEG to monitor changes.

High Beta Downtraining Protocol

This protocol aims to reduce high beta (18-30 Hz) activity, which is often associated with anxiety and ruminative thinking in depression.

• Target Brainwaves: High beta waves (18-30 Hz)
• Goal: Decrease high beta activity to reduce anxiety and rumination.

Procedure:

1. Electrode Placement: Place electrodes at Fz (midline frontal) and Cz (reference).
2. Baseline Recording: Record baseline high beta activity for 5-10 minutes.
3. Feedback Mechanism: Use visual or auditory feedback. Negative feedback (e.g., screen dims, tone lowers) occurs when high beta activity is excessive, encouraging reduction.
4. Training Sessions: Conduct sessions for 20-30 minutes, 2-3 times per week, for 20-40 sessions.
5. Progress Monitoring: Use depression and anxiety scales along with follow-up qEEG to track progress.

EFFECTIVENESS OF NEUROFEEDBACK FOR DEPRESSION

Neurofeedback for depression actually retrains the dysfunctional brain patterns associated with depression, making it a powerful treatment tool. With neurofeedback for depression, the brain practices healthier patterns of mood regulation. Sessions can range from twice a week to several times a week and average 30 minutes each.

Those with depression often notice improvement after only a few sessions, but for the brain to fully learn to make healthier patterns consistently, a number of brain training sessions are required. With sufficient practice, the brain learns to make these healthy patterns on its own and regulate mood independently.

Neurofeedback can help depression sufferers get their lives back. Your brain changes when you are depressed and neurofeedback can help it relearn healthier patterns, giving those who suffer from depression a way out of the prison of their minds.

Before treatment

HAM (Hamilton Depression Scale)=28
HAS((Hamilton Anxiety Scale)=20

After treatment

HAM (Hamilton Depression Scale)=10
HAS((Hamilton Anxiety Scale)=8

The maps before treatment indicate significant over-activation for alpha and beta frequencies, shown in red on the first row. The rating scale for depression (HAM) indicates severe depression and the anxiety scale (HAS) indicates moderate severity. The maps after treatment show that alpha and beta frequencies are no longer significantly elevated. The HAM score indicates mild depression and the anxiety scale is within the normal range.

After neurofeedback for depression, about 77.8% of the patients made significant improvements. During 1 year of the follow-up not only symptoms of depression, but also anxiety, obsessive rumination, withdrawal, and introversion, while ego-strength has improved.

OTHER RECOMMENDATION HOW TO COPE WITH DEPRESSION

Reach out to other people. Isolation fuels depression, so reach out to friends and loved ones, even if you feel like being alone or don’t want to be a burden to others. The simple act of talking to someone face-to-face about how you feel can be an enormous help. The person you talk to doesn’t have to be able to fix you. They just need to be a good listener – someone who’ll listen attentively without being distracted or judging you.

Get moving. When you’re depressed, just getting out of bed can seem daunting, let alone exercising. But regular exercise can be as effective as antidepressant medication in countering the symptoms of depression. Take a short walk or put some music on and dance around. Start with small activities and build up from there.

Eat a mood-boosting diet. Reduce your intake of foods that can adversely affect your moods, such as caffeine, alcohol, trans-fats, sugar and refined carbs. And increase mood-enhancing nutrients such as Omega-3 fatty acids.

Find ways to engage again with the world. Spend some time in nature, care for a pet, volunteer, and pick up a hobby you used to enjoy (or take up a new one). You won’t feel like it at first, but as you participate in the world again, you will start to feel better.

REFERENCES

Ribas VR, De Souza MV, Tulio VW, Pavan MD, Castagini GA, et al. (2017) Treatment of Depression with Quantitative Electroencephalography (QEEG) of the TQ-7 Neuro-feedback System Increases the Level of Attention of Patients. J Neurol Disord 5:340. doi:10.4172/2329-6895.1000340

Bruder et al., 2008 – Bruder, G. E., Sedoruk, J. P., Stewart, J. W., McGrath, P. J., Quitkin, F. M., & Tenke, C. E. (2008). Electroencephalographic alpha measures predict therapeutic response to a selective serotonin reuptake inhibitor antidepressant: pre- and post- treatment findings. Biological Psychiatry, 63(12), 1171-1177. doi:10.1016/j.biopsych.2007.10.009

Wang, S. Y., Lin, I. M., Peper, E., Chen, Y. T., Tang, T. C., Yeh, Y. C., … & Chu, C. C. (2016). The efficacy of neurofeedback among patients with major depressive disorder: preliminary study. NeuroRegulation, 3(3), 127

Young, K. D., Siegle, G. J., Zotev, V., Phillips, R., Misaki, M., Yuan, H., Drevets, W. C., & Bodurka, J. (2017). Randomized clinical trial of real-time fMRI amygdala neurofeedback for major depressive disorder: Effects on symptoms and autobiographical memory recall. The American Journal of Psychiatry. Vol.174(8), pp. 748-755.)

Young, K. D., Siegle, G. J., Misaki, M., Zotev, V., Phillips, R., Drevets, W. C., & Bodurka, J. (2018). Altered task-based and resting state amygdala functional connectivity following real-time fMRI amygdala neurofeedback training in major depressive disorder. Neuroimage: Clinical, 691-703. doi: 10.1016/j.nicl.2017.12.004

Neurofeedback for migraine vs medicine

Neurofeedback for Migraines. Neurofeedback Protocols.

Migraine is a debilitating illness with long term consequences for the brain. Researches had explored the origins of migraine and suggest that it is an electrical phenomenon initiated in the occipital cortex. Assessments of the brain using the EEG have found abnormal electrical activity supporting this idea. Neurofeedback for migraines is a treatment targeting electrical firing patterns in the brain. Many research data had shown that NFB training/treatment successfully suppresses abnormal brain wave activity leading to a significant decrease in migraine frequency and improvement in associated psychoneurological states such as anxiety, depression, and sleep.

WHAT IS MIGRAINE? CAUSES, SYMPTOMS, AND PATHOPHYSIOLOGY.

Migraine is a severe health problem which is the second most common one among the primary headaches, which affects 3-10 to 30-38% of the world’s population and which affects the quality of life negatively. Migraine is a disabling neurological condition characterized by episodic attacks of usually unilateral headache, with pulsating character and light and sound intolerance, associated with nausea and vomiting.

The tendency to suffer from migraine has a genetic component, but attacks can be triggered by a series of internal and external factors.

Migraine is a disease with many faces. The most common form is migraine without aura, occurring in about 80% of patients, while migraine with aura occurs in about 20% of the patients.

The annual costs of migraines such as diagnosis, treatment, reduced productivity, and absence from work are estimated to be 5 billion euros in the European Union and about 29 billion in the USA.

The incidence of migraine before puberty is greater in boys than in girls. It grows up to 12 years in both sexes and is the highest in the age range of 30–40 years. After puberty, the ratio changes and increases in favor of women, and with 40 is 3.5:1. After 40 years, the strength of the symptoms is reduced (except for women in perimenopause), and the beginning of migraine headaches in the fifties are rare.

Migraine trigger checklist

Migraine trigger checklist

The main symptoms of migraine are recurring, severe, most often localized in one half of the head (hemicrania), and throbbing headache, which can last from 4 to 72 hours. It usually begins in the temporal region, in the eyeballs, or in the frontal region. Pain may also occur in the face, and neck. During a migraine attack, visual disturbances, increased sensitivity in the hands, dizziness, tinnitus, and increased sensitivity to light or noise may be observed. At the end of an attack, nausea and vomiting may occur.

There are migraines with and without aura. Aura is a complex of neuropsychological symptoms that anticipate the onset of pain, become the first signs of a migraine, or develop simultaneously with a headache. They are caused by a spasm of cerebral vessels, which occurs at the initial stage of an attack.

Symptoms associated with Migraine are:

  • Severe pain in the head or eyes;
  • Being worse on one side of the head;
  • Nausea
  • Vomiting;
  • Dizziness ;
  • Perceiving an aura;
  • Blurred or tunnel vision;
  • Seeing auras;
  • Photophobia (sensitivity to light);
  • Phonophobia (sensitivity to sound);
  • Osmophobia (sensitivity to smells);
  • Poor concentration;
  • Ringing in the ears;
  • Sweating;
  • Feeling very hot or very cold;
  • Abdominal pain (which can sometimes cause diarrhea);
  • A frequent need to urinate. 

The pathogenesis of migraine

The pathogenesis of migraine has long been a subject of discussion among scientists. It has been considered that typical headaches are caused by intracranial vasodilation preceded by vasoconstriction causing aura—vascular theory. Today it is known that this is not the case, and although new findings have emerged, the exact mechanism and genetic determinants are not yet fully clarified.

For a long time, it was thought that the cause of the aura, which precedes headaches, is cerebral vasoconstriction. Today, this theory is denied, and the aura is explained by neural dysfunction rather than ischemia due to vasoconstriction.

The frequency with which migraine attacks occur may vary from once in a lifetime to almost daily, an indication that the degree of migraine predisposition varies individually. It is necessary to consider both the factors that influence the threshold of a person’s susceptibility to a migraine attack and also the mechanisms that trigger the attack and the associated symptoms.

Acute migraine attacks occur in the context of an individual’s inherent level of vulnerability. The greater the vulnerability/lower the threshold, the more frequent attacks occur. Attacks are initiated when internal or environmental triggers are of sufficient intensity to activate a series of events that culminate in the generation of a migraine headache. Many migraineurs experience vague vegetative or affective symptoms as much as 24 hours before the onset of a migraine attack. This phase is called the prodrome and should not be confused with the aura phase.

The aura phase consists of focal neurological symptoms that persist for up to one hour. Symptoms may include visual, sensory, or language disturbance, as well as symptoms, localizing to the brainstem.

Within an hour of the resolution of the aura symptoms, the typical migraine headache usually appears with its unilateral throbbing pain and associated nausea, vomiting, photophobia, or phonophobia. Without treatment, the headache may persist for up to 72 hours before ending in a resolution phase often characterized by deep sleep.

For up to twenty-four hours after the spontaneous throbbing has resolved, many patients may experience malaise, fatigue, and transient return of the head pain in a similar location for a few seconds or minutes following coughing, sudden head movement, or Valsalva movements. This phase is sometimes called the migraine hangover (postdrome).

It is becoming increasingly clear that much of the vulnerability to migraine is inherited.

Migraine is, in essence, a familial episodic disorder whose key marker is a headache, with certain associated features. One of the most important aspects of the pathophysiology of migraine is the inherited nature of the disorder. It is clear from clinical practice that many patients have first-degree relatives who also suffer from migraines. Transmission of migraines from parents to children has been reported as early as the seventeenth century, and numerous published studies have reported a positive family history.

In approximately 50% of the reported families, Familial hemiplegic migraine (FHM) has been assigned to chromosome 19p13. The biological basis for the linkage to chromosome 19 is mutations involving the Ca 2.1 (P/Q) type voltage-gated calcium channel CACNA1A gene. Dysfunction of these channels might impair serotonin release and predispose patients to migraine or impair their self-aborting mechanism.

Migraine aura

A migraine aura is defined as a focal neurological disturbance manifesting as visual, sensory, or motor symptoms. It is seen in about 30% of patients, and it is neurally driven. Visual aura has been described as affecting the visual field, suggesting the visual cortex, and it starts at the center of the visual field, propagating to the periphery at a speed of 3 mm/min. Blood flow studies in patients have also shown that focal hyperemia tends to precede the spreading of oligemia. However, some researchers conclude that migraine aura is evoked by aberrant firing of neurons.

Shown is the entire hemisphere, from a posterior-medial view. The aura-related changes appeared first in extrastriatal cortex. The spread of the aura began and was most systematic in the representation of the lower visual field, becoming less regular as it progressed into the representation of the upper visual field.

WHAT KIND OF CHANGES IN THE BRAIN CAUSE THE MIGRAINE?

The study of anatomy and physiology of pain-producing structures in the cranium and the central nervous system modulation of the input have led to the conclusion that migraine involves alterations in the subcortical aminergic sensory modulatory systems that influence the brain widely.

Available research data had shown that no structural differences have been found in individuals with migraine compared to individuals without migraine. This research suggests that migraine is an electrical phenomenon initiated within the cortex of the brain. This phenomenon is known as Cortical Spreading Depression (CSD) referring to a wave of electrophysiological hyperactivity that spreads through the brain from the occipital lobes forward. This wave affects the cortex in several ways: altering the electrical polarity of neurons, decreasing blood flow and associated levels of oxygen in the cortex and altering the degree of vasodilation within the vascular system of the cortex. These changes release of nerve irritating chemicals into the brain. These chemicals irritate the pain transmitting the “trigeminal” nerve system in the meninges, the sensitive membranes that cover the brain. The result is severe blinding pain.

Consequences of migraine to the brain are:

  • impaired ability in tests of short and long-term memory,
  •  small areas of stroke-like damage to the brain,
  • with a high frequency of Migraine (more than three attacks per month) show significantly more areas of damage than those with fewer attacks,
  • with a history of Migraines, longer than 15 years were found to have more changes in the brain than those with a shorter history,
  • higher frequency migraines show abnormalities in both white and gray matter of the brain,
  • people with migraine are more at risk for future strokes,
  • show a predilection toward damage in the following sites:
    – frontal lobe
    – limbic system
    – parietal lobes
    – brainstem
    – cerebellum

Chronic migraine comorbidities

WHAT EEG CHANGES CAN BE OBSERVED IN PEOPLE WITH MIGRAINES?

There are two ways in which anomalies in the EEG have been associated with migraine: via the relationship of migraine to seizure activity and as a function of slow brain waves found elsewhere in the brain. Migraine and epilepsy frequently coexist and are often difficult to differentiate. Both migraine and seizure-prone individuals show abnormal occipital discharges that are typically high voltage (200–300 mV), with a diphasic morphology, and a unilateral or bilateral occipital and postero-temporal distribution.

Migraine has been associated with abnormal EEG activity elsewhere in the brain. Both unilateral and bilateral increased delta wave activity has been recorded during a hemiplegic migraine and attacks of migraine with disturbed consciousness. It is shown that in the waking, non-migraine state there are slow waves in the theta range (48 hertz). Neurofeedback for migraines has been used to target and suppress this slow-wave activity in both adults and children with a concomitant reduction in frequency and intensity of migraine. Some research has shown that neurofeedback blood flow-up training in the frontal cortex results in a 70% reduction in the frequency of migraines compared with a 50% reduction using medication alone. NFB training is also associated with decreases in anxiety, depression, and improved sleep, each of which has been associated with migraines.

Newer methods, i.e. EEG frequency analysis and topographic brain mapping, are promising tools in this field. So far, mostly small studies have been published with somewhat inconsistent results. A pattern of increased alpha rhythm variability (and/or asymmetry) in the headache-free phase seems to emerge, however. Significant asymmetry of alpha and theta during headache has been reported in a topographic brain mapping study.

The EEG patterns observed in migraine patients seem to suggest a possible physiological connection between sleep, hyperventilation, and migraine.

EEG activity seems to change shortly before the attack. This suggests that migraineurs are most susceptible to attack when anterior QEEG delta power and posterior alpha asymmetry values are high.
Occipitoparietal and temporal alpha power were more asymmetric before the attack compared with the interictal baseline

Different research found the increased power in 19 cortical areas in delta (1.5-3.5 Hz), theta (4.0-7.5 Hz), and high-frequency beta (21-30 Hz) bands. Multiple types of research have shown significant abnormalities in the high-frequency beta band (21-30 Hz) in the parietal, central, and frontal regions.

How Neurofeedback Training Manage Migraines?

Despite a large number of medications being used to treat migraine today, only 20% of patients report their effectiveness. Many develop resistance to medications, and therefore the dose of the drug is gradually increasing, which is required to achieve the effect of relieving headache. Often the medication is accompanied by side effects.

In patients with migraine, changes in the biological parameters of brain activity, brain waves, are often recorded. Neurofeedback is a recently developed technology for treating migraines based on recording these changes in brain wave activity and transmitting information about their condition in the form of audio and video signals to the patient. Based on these audio and video signals, the patient learns how to manage his condition to regulate brain wave activity and normalize it. Normalization of wave activity leads to a significant decrease in both the frequency and intensity of headaches. At first, these changes are not stable but gradually become stable and permanent. It becomes possible (after about 10 sessions of treatment) to manage the condition without the support of special equipment and computer programs.

Migraine research points to electrophysiological anomalies in the brain as correlates of migraine headaches. Neurofeedback, as a therapy, is specifically designed to target dysregulated firing patterns in the brain. Research has demonstrated the ability of NFB to successfully treat anomalous brainwave patterns in a variety of conditions most specifically with migraines.

After performing diagnostic scanning and getting brain mapping patterns of the patients with migraine some clinicians provide neurofeedback training with an increase of SMR and low beta 12-15 Hz and decreased theta (4-7Hz) and high beta (21-30 Hz) at each affected site; 5 sessions for each affected site.

qEEG Before and after Neurofeedback for Migraines

Electrode Placement and Detailed Neurofeedback Protocols for Migraine Management

Key Electrode Sites for Migraine Neurofeedback

1. Fz (Frontal Midline):

• Location: Frontal lobe, on the midline, 20% of the distance from the nasion (bridge of the nose).
• Relevance: Associated with emotional regulation and autonomic control. Targeting this site can help manage stress and reduce the frequency and intensity of migraines.

2. Cz (Central Midline):

• Location: The scalp vertex, halfway between the nasion and inion and equally spaced between the left and right preauricular points (just above the ears).
• Relevance: Central region involved in general arousal regulation. Often used as a reference or active site for enhancing overall neural stability.

 

Electrode Application Sites for Migraine Neurofeedback Management

3. Pz (Parietal Midline):

• Location: Parietal lobe, on the midline, 50% of the distance from the nasion to the inion.
• Relevance: Involved in sensory processing and pain perception. Targeting Pz can help modulate sensory processing related to migraine pain.

4. T3 (Left Temporal Lobe):

• Location: Temporal lobe, 20% above the preauricular point.
• Relevance: Associated with stress and emotional regulation. Training in this area can help manage triggers related to emotional stress.

5. T4 (Right Temporal Lobe):

• Location: Temporal lobe, analogous to T3 on the right side.
• Relevance: Similar to T3, it helps balance activity related to emotional stress and can assist in reducing migraine frequency.

Neurofeedback Protocols for Migraine

The protocol involves training individuals to increase or decrease specific brainwave activity at the targeted locations to promote relaxation, improve stress management, and reduce migraine symptoms.

1. Alpha Enhancement Protocol

This protocol focuses on increasing alpha (8-12 Hz) activity to promote relaxation and reduce stress, which are common migraine triggers.

• Target Brainwaves: Alpha waves (8-12 Hz)
• Goal: Increase alpha activity to enhance relaxation and reduce stress-related migraine triggers.

Procedure:
1. Electrode Placement: Place electrodes at Fz and Pz with Cz as the reference.
2. Baseline Recording: Record baseline alpha activity for 5-10 minutes.
3. Feedback Mechanism: Provide real-time feedback using visual (e.g., calming images) or auditory (e.g., soothing sounds) cues. Positive feedback is given when alpha activity increases.
4. Training Sessions: Conduct sessions for 20-30 minutes, 2-3 times per week, for 20-40 sessions.
5. Progress Monitoring: Use headache frequency and intensity diaries along with follow-up qEEG to assess changes.

2. SMR Training Protocol

This protocol focuses on increasing sensorimotor rhythm (SMR, 12-15 Hz) activity to promote calmness and reduce hyperarousal that can trigger migraines.

• Target Brainwaves: SMR (12-15 Hz)
• Goal: Increase SMR activity to enhance motor inhibition and promote calmness.

Procedure:

1. Electrode Placement: Place electrodes at Cz with reference electrodes at mastoids (A1 and A2).
2. Baseline Recording: Record baseline SMR activity for 5-10 minutes.
3. Feedback Mechanism: Provide real-time feedback using visual or auditory cues. Positive feedback is given when SMR activity increases.
4. Training Sessions: Conduct sessions for 20-30 minutes, 2-3 times per week, for 20-40 sessions.
5. Progress Monitoring: Use headache frequency and intensity diaries and follow-up qEEG to monitor changes.

3. Theta/Beta Ratio Training

This protocol aims to balance theta (4-8 Hz) and beta (15-20 Hz) wave activity to improve cognitive control and reduce stress, which can contribute to migraine frequency.

• Target Brainwaves: Theta (4-8 Hz) and Beta (15-20 Hz)
• Goal: Decrease theta activity and increase beta activity to improve cognitive control and reduce stress.

Procedure:

1. Electrode Placement: Place electrodes at T3 and T4 with Cz as the reference.
2. Baseline Recording: Record baseline theta and beta activity for 5-10 minutes.
3. Feedback Mechanism: Provide feedback using visual or auditory stimuli. Positive feedback occurs when theta decreases and beta increases.
4. Training Sessions: Conduct sessions for 20-30 minutes, 2-3 times per week, for 20-40 sessions.
5. Progress Monitoring: Use headache frequency and intensity diaries along with follow-up qEEG to track progress.

4. Alpha/Theta Training

This protocol focuses on increasing alpha (8-12 Hz) and theta (4-8 Hz) waves to promote relaxation and reduce anxiety, which are common migraine triggers.

• Target Brainwaves: Alpha waves (8-12 Hz) and Theta waves (4-8 Hz)
• Goal: Increase alpha and theta activity to reduce stress and improve overall emotional regulation.

Procedure:

1. Electrode Placement: Place electrodes at Fz and Cz (reference).
2. Baseline Recording: Record baseline alpha and theta activity for 5-10 minutes.
3. Feedback Mechanism: Use calming visual or auditory feedback. Positive feedback is provided when alpha and theta waves increase.
4. Training Sessions: Conduct sessions for 20-30 minutes, 2-3 times per week, for 20-40 sessions.
5. Progress Monitoring: Use headache frequency and intensity diaries along with follow-up qEEG to monitor changes.

Frequently used Neurofeedback Protocol for migraine management as follows:

Left-sided headaches – at C3 (T3)

  • down-trained: 2-7 Hz and high-frequency beta
  • up-trained: 15-18 Hz

Right-sided headaches – at C4 (T4)

  • down-trained: 2-7 Hz and high-frequency beta
  • up-trained: 12-15 Hz

An average number of neurofeedback sessions to get a significant change to occur are around 20-30 sessions. A person can get a neurofeedback session as much as twice a day with at least a two-hour break in between. It is recommended that a person try to do neurofeedback at least two or three times a week until the sessions are completed. Results appear to solidify and happen faster when done more frequently.

How effective is neurofeedback for migraines?

Neurofeedback for migraines can help with dysfunctions in the central nervous system, such as the increased excitability of the cerebral cortex. Because of working directly with the central nervous system, Neurofeedback training can be very effective in stabilizing the excitability of the cerebral cortex what will result in reduced headaches, less sensitivity, and improvements in other symptoms associated with Migraine.
The researchers concluded, “Neurofeedback appears to be dramatically effective in abolishing or significantly reducing headache frequency in patients with recurrent migraine”.

Walker (Walker, J. E. (2011). QEEG‐Guided Neurofeedback for Recurrent Migraine Headaches. Clinical EEG and Neuroscience, 42(1), 59‐61. doi:10.1177/155005941104200112) examined the effects of neurofeedback therapy versus drug therapy in 71 patients with recurrent migraine headaches. After completion of a quantitative electroencephalogram (QEEG) procedure, all results indicated an excess of high-frequency beta activity (21‐30 Hz). Twenty‐five patients chose to continue with drug therapy for their recurring migraines, whilst 46 of the 71 patients selected neurofeedback training. Of those who chose neurofeedback therapy, the majority (54%) reported complete abolishment of their migraines, 39% experienced a significant reduction in migraine frequency of greater than 50%, and 4% experienced a decrease in the frequency of less than 50%. Only one patient did not report a reduction in headache frequency. The control group of participants who opted to continue drug therapy as opposed to neurofeedback experienced no change in headache frequency (68%), a reduction of less than 50% (20%), or a reduction greater than 50% (8%). Overall, the study demonstrates that neurofeedback is significantly effective in abolishing or substantially reducing the frequency of headaches in patients with recurrent migraines.

Effectiveness of Neurofeedback vs. Drug Management of the Migraine

Effectiveness of Neurofeedback for Migraines

Complete abolishment of the migraines
54%
Significant reduction in migraine frequency of greater than 50%
39%
Decrease in migraine frequency of less than 50%
4%
No change in migraine frequency
Web Designer 0.5%

Effectiveness of Drug Therapy for Migraines

Complete abolishment of the migraines
Web Designer 1%
Significant reduction in migraine frequency of greater than 50%
8%
Decrease in migraine frequency of less than 50%
20%
No change in migraine frequency
68%

After Neurofeedback for migraines, the reduction of frequency and intensity of headaches usually was sustained at the 14.5 months follow‐up assessment.

Some of the benefits of neurofeedback for migraines:

  • It helps to retrain the brain and or optimize the functioning of the entire brain by removing barriers and improving the connections and brainwave activity in a certain region of the brain or among different regions of the brain.
  • It releases the old stuck or abnormal patterns to create new and more effective, stronger, and organized patterns.
  • Training protocols are generated from the initial QEEG brain mapping. Training involves audiovisual feedback that INVOLUNTARILY teaches the individual to self-regulate the abnormal brain wave patterns that are presented to them on a computer screen in several ways.
  • There are no contraindications or side effects of neurofeedback for migraines.

Effective Use of Various Biofeedback Modalities for Migraine Management

Various modalities of biofeedback, including Electromyography (EMG), Heart Rate Variability (HRV), Temperature, and Galvanic Skin Response (GSR), can also be effectively utilized in the management of migraines. EMG biofeedback helps individuals become aware of and reduce muscle tension, which can alleviate headache symptoms. HRV biofeedback trains individuals to regulate their heart rate variability, promoting autonomic balance and reducing stress, a common migraine trigger. Temperature biofeedback involves monitoring peripheral skin temperature to enhance relaxation and decrease physiological arousal, thus helping to prevent migraines. GSR biofeedback measures the skin’s electrical conductance, which varies with sweat gland activity, providing insights into stress and arousal levels. By learning to modulate these physiological responses, individuals with migraines can manage their symptoms more effectively, complementing traditional neurofeedback approaches. For more detailed information regarding various biofeedback modalities used in Migraine Management, please visit the Article “Biofeedback for Migraines. How to choose”.

ADHD in boys

Neurofeedback for ADHD Management

Attention Deficit Hyperactivity Disorder (ADHD) has become one of the most common neurodevelopmental and psychiatric disorders of childhood (3% to 7% of school-age children), that persists to adolescence and adulthood in 40-60% cases. ADHD treatment main strategies are the use of pharmacological therapy, omega 3, multivitamins, and multi-minerals. Stimulants work by causing the brain to synthesize more norepinephrine; non-stimulants by slowing the rate at which norepinephrine is broken down. Once the level is where it should be, the brain functions normally, and the individual becomes less hyperactive, inattentive, and/or impulsive. Once the drug wears off, the level falls — and symptoms return. In addition, side-effects, resistance to pharmacological therapy have raised interest in non-pharmacological treatment options. Neurofeedback for ADHD management is a non-pharmacological intervention, based on neuroplasticity characteristics of the brain and utilizes cognitive behavioral therapeutic elements to gain access on and practice brain activity. In fact, several organizations worldwide are looking into claims that neurofeedback such effective as pharmacological therapy, but with significantly long-lasting effectiveness and free of side-effects. This became more actual if take into consideration existing today friendly use technology of neurofeedback devices for ADHD management at home, school, university, and workplace.

Attention-deficit hyperactivity disorder (ADHD) is the most commonly diagnosed behavioral disorder in children, but it is often misunderstood as well as the subject of controversy. Confusion surrounding the disorder has led to both under- and overtreatment of children. Currently, the disorder is primarily diagnosed by referring to the criteria of the Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition Text Revision (DSM-IV, 1994) or the International Statistical Classification of Mental Disorders (ICD-10, World Health Organization, 1992).

Attention-deficit/hyperactivity disorder (ADHD) is a childhood-onset, clinically heterogeneous disorder of inattention, hyperactivity, and impulsivity. Its impact on society is enormous in terms of its financial cost, stress to families, adverse academic and vocational outcomes, and negative effects on self-esteem. Children with ADHD are easily recognized in clinics, in schools, and in the home. Their inattention leads to daydreaming, distractibility, and difficulties in sustaining effort on a single task for a prolonged period. Their impulsivity makes them accident-prone, creates problems with peers, and disrupts classrooms. Their hyperactivity, often manifested as fidgeting and excessive talking is poorly tolerated in schools and is frustrating to parents, who can easily lose them in crowds and cannot get them to sleep at a reasonable hour. In their teenage years, symptoms of hyperactivity and impulsivity diminish, but in most cases, the symptoms and impairments of ADHD persist. The teen with ADHD is at high risk of low self-esteem, poor peer relationships, conflict with parents, delinquency, smoking, and substance abuse.

The validity of diagnosing ADHD in adults has been a source of much controversy. Some investigators argue that most cases of ADHD remit by adulthood (3), a view that questions the validity of the diagnosis in adulthood. Others argue that the diagnosis of ADHD in adults is both reliable and valid.
Longitudinal studies have found that as many as two-thirds of children with ADHD have impaired ADHD symptoms as adults. In adults, inner restlessness rather than hyperactivity may occur. Throughout the life cycle, a key clinical feature observed in patients with ADHD is comorbidity with conduct, depressive, bipolar, and anxiety disorders.

ADHD Symptoms in Children and Teenagers

ADHD is divided into three subtypes:

  • predominantly inattentive (ADHD-PI or ADHD-I),
  • predominantly hyperactive-impulsive (ADHD-PH or ADHD-HI), and
  • combined type (ADHD-C).

The symptoms of ADHD in children and teenagers are well-defined, and they’re usually noticeable before the age of 6. They occur in more than one situation, such as at home and school.

Inattentiveness

The main signs of inattentiveness are:
• having a short attention span and being easily distracted
• making careless mistakes – for example, in schoolwork
• appearing forgetful or losing things
• being unable to stick to tasks that are tedious or time-consuming
• appearing to be unable to listen to or carry out instructions
• constantly changing activity or task
• having difficulty organizing tasks

Hyperactivity and impulsiveness

The main signs of hyperactivity and impulsiveness are:
• being unable to sit still, especially in calm or quiet surroundings
• constantly fidgeting
• being unable to concentrate on tasks
• excessive physical movement
• excessive talking
• being unable to wait their turn
• acting without thinking
• interrupting conversations
• little or no sense of danger

These symptoms can cause significant problems in a child’s life, such as underachievement at school, poor social interaction with other children and adults, and problems with discipline.

A common symptom of ADHD in children and adults is the inability to focus at length on the task at hand. Those who have ADHD are easily distracted, which makes it difficult to give sustained attention to a specific activity, assignment, or chore. But a lesser-known, and more controversial, symptom that some people with ADHD demonstrate is known as hyperfocus. Although other conditions include hyperfocus as a symptom, here we will look at hyperfocus as it relates to a person with ADHD.
Hyperfocus is the experience of intense concentration in some people with ADHD. ADHD is not necessarily a deficit of attention, but rather a problem with regulating one’s attention span to desired tasks. So, while mundane tasks may be difficult to focus on, others may be completely absorbing. An individual with ADHD who may not be able to complete homework assignments or work projects may instead be able to focus for hours on video games, sports, or reading.

People with ADHD may immerse themselves so completely in an activity that they want to do or enjoy doing to the point that they become oblivious to everything around them. This concentration can be so intense that an individual loses track of time, other chores, or the surrounding environment. While this level of intensity can be channeled into difficult tasks, such as work or homework, the downside is that ADHD individuals can become immersed in unproductive activities while ignoring pressing responsibilities. No one’s going to mind if someone spends hours solving math problems or painting the house. But hyperfocus can cause trouble if someone gets so wrapped up in a project at work that misses a dinner date, or the child can’t break away from a video game to do his homework.

It also can make it harder to diagnose ADHD, especially in kids considered gifted. They do better in school because their high IQs help them get past the learning issues that usually go along with the disorder, and their ability to hyperfocus can make it even harder to spot. 

It is very important to find ways to manage the focus of children with ADHD and direct it for their development and good performance, finding an interest that removes them from isolated time and fosters social interaction, such as music, sports, or other. 

Adults with ADHD also have to deal with hyperfocus, on the job, and at home. The best way to cope with hyperfocus is not to fight it by forbidding certain activities, but rather to harness it. Making work or school stimulating can capture their focus in the same way as their favorite activities. This may be difficult for a growing child but can ultimately become advantageous for an adult in the workplace. By finding a job that caters to one’s interests, an individual with ADHD can truly shine, using hyperfocus to their advantage.

Correlation between ADHD and high levels of cell phone use

If you’re a parent of a child with attention deficit hyperactivity disorder, you know that their attention can be directed quite intensely onto technology they find fascinating, which includes cell phone games, texting, the internet, and social media. These facets of mobile phone use provide an endless supply of feedback and enticements that keep the pleasure center of the brain very happy, which can make pulling a child away from their phone or yours a real struggle.

Though researchers do not yet know whether excessive phone use increases the risk of ADHD, encouraging thoughtful and limited cell phone use is considered an important life skill for any child. However, there is a correlation between ADHD and high levels of cell phone use, and the increase in children diagnosed with the disorder make researchers wonder how the rise of mobile technology impacts the attention levels of young children and teens. One study found that children who make calls and play games on cell phones were at increased risk for ADHD. However, it is possible that children may play more games on their phone because they already have symptoms of ADHD, such as inattention and hyperfocus.

Some children can become engrossed with a particular smartphone game or app and later toss it aside, but kids with ADHD are at higher risk for becoming behaviorally and cognitively dependent on their device. This can be a cause for concern, as researchers have linked cell phone dependence to symptoms of anxiety, depression, sleep disturbances, and low self-esteem.
Being dependent or overinvolved with a cell phone isn’t just about the number of games a child plays or the texts they send. Kids with ADHD can become caught in a behavioral loop, mindlessly checking different social media apps or seeking to achieve the reach level in a difficult game. Dependence has a cognitive component as well, with the child thinking about or becoming hyperfocused on being able to access and use their phone. For example, they might become distressed when the battery dies, when their phone is not in sight, or when they cannot sleep with their cell phone at night.

Although hyperfocus can have a detrimental effect on a person’s life by distracting them from important tasks, it can also be used positively, as evidenced by many scientists, artists, and writers. Like all symptoms of ADHD, hyperfocus needs to be delicately managed.

When in a hyperfocused state, a child may lose track of time and the outside world may seem unimportant.
It is very important to find ways to manage the focus of children’s with ADHD and direct it for their development and good performance. First of all, for parents, it is necessary to monitor the length of use and the content accessed on their child’s phone and to keep mobile devices out of a child’s bedroom to ensure healthy sleep habits. Less phone use won’t feel like a punishment if kids and teens have flexible, fun options when it comes to their attention. What activities does your child enjoy that don’t involve screens, and how can they be utilized when your child seems particularly dependent on their phone? A day at the park, a museum, or the pool can prove a much-needed break in hyper-focus. Help your child find an interest that removes them from isolated time and fosters social interaction, such as music or sports.

Neurofeedback management of ADHD gives excellent results and leads to significant improvement of memory, attention, concentration, and focus. These improvements will provide the possibility to stop addiction to phones and computers.

Video – More screen tine leads to ADHD

Related conditions in children and teenagers with ADHD

Although not always the case, some children may also have signs of other problems or conditions alongside ADHD, such as:
• Anxiety disorder – which causes your child to worry and be nervous much of the time; it may also cause physical symptoms, such as a rapid heartbeat, sweating, and dizziness
• Oppositional defiant disorder (ODD) – this is defined by negative and disruptive behavior, particularly towards authority figures, such as parents and teachers
• Conduct disorder – this often involves a tendency towards highly antisocial behavior, such as stealing, fighting, vandalism, and harming people or animals
• Depression
• Sleep problems – finding it difficult to get to sleep at night, and having irregular sleeping patterns
• Autistic spectrum disorder (ASD) – this affects social interaction, communication, interests, and behavior
• Epilepsy – a condition that affects the brain and causes repeated fits or seizures
• Tourette’s syndrome – a condition of the nervous system, characterized by a combination of involuntary noises and movements (tics)
• Learning difficulties – such as dyslexia

ADHD Symptoms in Adults

In adults, the symptoms of ADHD are more difficult to define. This is largely due to a lack of research into adults with ADHD.
As ADHD is a developmental disorder, it’s believed it cannot develop in adults without it first appearing during childhood. However, it’s known that symptoms of ADHD often persist from childhood into a person’s teenage years and then adulthood.
Any additional problems or conditions experienced by children with ADHD, such as depression or dyslexia, may also continue into adulthood. By the age of 25, an estimated 15% of people diagnosed with ADHD as children still have a full range of symptoms, and 65% still have some symptoms that affect their daily lives. Hyperactivity tends to decrease in adults, while inattentiveness tends to get worse as the pressures of adult life increase. Adult symptoms of ADHD also tend to be far more subtle than childhood symptoms.
Some specialists have suggested the following as a list of symptoms associated with ADHD in adults:

• Impulsiveness
• Excessive activity or restlessness and edginess
• Carelessness and lack of attention to detail
• Continually starting new tasks before finishing old ones
• Poor organizational skills and problems prioritizing
• Poor time management skills
• Problems focusing on a task
• Poor planning
• Trouble multitasking
• Continually losing or misplacing things
• Forgetfulness
• Difficulty keeping quiet, and speaking out of turn
• Blurting out responses and often interrupting others
• Frequent mood swings, irritability, and a quick temper
• Low frustration tolerance
• Trouble coping with stress
• Extreme impatience
• Taking risks in activities, often with little or no regard for personal safety or the safety of others – for example, driving dangerously

Related conditions in adults with ADHD

Although ADHD doesn’t cause other psychological or developmental problems, as with ADHD in children and teenagers, ADHD in adults can occur alongside several related problems or conditions and make treatment more challenging.

Mood disorders. Many adults with ADHD also have depression, bipolar disorder, or another mood disorder. While mood problems aren’t necessarily due directly to ADHD, a repeated pattern of failures and frustrations due to ADHD can worsen depression.
Anxiety disorders. Anxiety disorders occur fairly often in adults with ADHD. Anxiety disorders may cause overwhelming worry, nervousness, and other symptoms. Anxiety can be made worse by the challenges and setbacks caused by ADHD.
Learning disabilities. Adults with ADHD may score lower on academic testing than would be expected for their age, intelligence, and education. Learning disabilities can include problems with understanding and communicating.
Other psychiatric disorders. Adults with ADHD are at increased risk of other psychiatric disorders, such as personality disorders, intermittent explosive disorder, and substance abuse.
– personality disorders – conditions in which an individual differs significantly from the average person in terms of how they think, perceive, feel, or relate to others
– bipolar disorder – a condition affecting your mood, which can swing from one extreme to another
– obsessive-compulsive disorder (OCD) – a condition that causes obsessive thoughts and compulsive behavior.

The behavioral problems associated with ADHD can also cause problems such as difficulties with relationships and social interaction.

The exact cause of attention deficit hyperactivity disorder (ADHD) is not fully understood, although a combination of factors is thought to be responsible.
Researchers suspect that a gene involved in the creation of dopamine, a chemical that controls the brain’s ability to maintain regular and consistent attention may be traced back to ADHD. ADHD tends to run in families and, in most cases, it’s thought the genes you inherit from your parents are a significant factor in developing the condition.

Research shows that parents and siblings of a child with ADHD are more likely to have ADHD themselves. However, the way ADHD is inherited is likely to be complex and is not thought to be related to a single genetic fault.

Among the factors that are thought to contribute to ADHD are:

• Brain injury or infection
• a lack of oxygen, or exposure to alcohol or nicotine before birth
• premature birth
• difficult experiences in early childhood.

ADHD SYMPTOM CHECKLISTS

Does My Child Have Attention Deficit Hyperactivity Disorder (ADHD or ADD)?

Only a mental health professional can tell for sure whether symptoms of distractibility, impulsivity, and hyperactivity are severe enough to suggest a positive ADHD diagnosis. But this test may provide some behavior clues and suggestions about the next steps. This questionnaire is designed to determine whether your child demonstrates symptoms similar to those of attention deficit disorder (ADHD). Download and print out the Assessment Scale.  If you answer yes to a significant number of these questions, consult a licensed mental health practitioner. An accurate diagnosis can only be made through clinical evaluation.

Scoring Instructions for the NICHQ Vanderbilt Assessment Scales

These scales should NOT be used alone to make any diagnosis. You must take into consideration information from multiple sources. Scores of 2 or 3 on a single Symptom question reflect often-occurring behaviors. Scores of 4 or 5 on Performance questions reflect problems in performance.

The initial assessment scales, parent and teacher, have 2 components: symptom assessment and impairment in performance.
On both the parent and teacher initial scales, the symptom assessment screens for symptoms that meet the criteria for both inattentive (items 1–9) and hyperactive ADHD (items 10–18).
To meet DSM-IV criteria for the diagnosis, one must have at least 6 positive responses to either the inattentive 9 or hyperactive 9 core symptoms or both. A positive response is a 2 or 3 (often, very often) (you could draw a line straight down the page and count the positive answers in each subsegment). There is a place to record the number of positives in each subsegment, and a place for a total score for the first 18 symptoms (just add them up).
The initial scales also have symptom screens for 3 other comorbidities — oppositional-defiant, conduct, and anxiety/ depression. These are screened by the number of positive responses in each of the segments separated by the “squares.” The specific item sets and numbers of positives required for each co-morbid symptom screen set are detailed in the pdf file.
The second section of the scale has a set of performance measures, scored 1 to 5, with 4 and 5 being somewhat of a problem.
To meet the criteria for ADHD there must be at least one item of the Performance set in which the child scores a 4 or 5; ie, there must be impairment, not just symptoms to meet diagnostic criteria. The sheet has a place to record the number of positives (4s, 5s) and an Average Performance Score—add them up and divide by the amount of Performance criteria answered.

Adult ADHD Self-Report Scale (ASRS) Symptom Checklist

Many adults have been living with Adult Attention-Deficit/Hyperactivity Disorder (Adult ADHD) and don’t recognize it. Why? Because its symptoms are often mistaken for a stressful life. If you’ve felt this type of frustration most of your life, you may have Adult ADHD.
The following questionnaire can be used as a starting point to help you recognize the signs/symptoms of Adult ADHD but is not meant to replace consultation with a trained healthcare professional. An accurate diagnosis can only be made through a clinical evaluation. Regardless of the questionnaire results, if you have concerns about diagnosis and treatment of Adult ADHD, please discuss your concerns with your physician.

The Adult Self-Report Scale  Screener is intended for people aged 18 years or older.

WHAT PARTS OF THE BRAIN ARE AFFECTED BY ADHD?

In children with ADHD, several brain regions and structures (pre-frontal cortex, striatum, basal ganglia, and cerebellum) tend to be smaller by roughly 5%.
ADHD brains have low levels of a neurotransmitter called norepinephrine. Norepinephrine is linked arm-in-arm with dopamine. The ADHD brain has impaired neurotransmitter activity in four functional regions of the brain.

1. Frontal Cortex
This region controls high-level functions:
• Attention
• Executive Function
• Organization
This region orchestrates our high-level functioning: maintaining attention, organization, and executive function. A deficiency of dopamine within this brain region might cause inattention, problems with organization, and/or impaired executive functioning.

2. Limbic System
This region is located deeper in the brain. It regulates our emotions and attention. A dopamine deficiency in this region might result in restlessness, inattention, or emotional volatility.

3. Basal Ganglia
These neural circuits regulate communication within the brain. Information from all regions of the brain enters the basal ganglia and is then relayed to the correct sites in the brain. A dopamine deficiency in the basal ganglia can cause inter-brain communication and information to “short-circuit,” resulting in inattention or impulsivity.

4. Reticular Activating System
This is the major relay system among the many pathways that enter and leave the brain. A dopamine deficiency here can cause inattention, impulsivity, or hyperactivity.
These four regions interact with one another, so a deficiency in one region may cause a problem in one or more of the others. ADHD results from problems in one or more of these regions.

NEUROPATHOPYSIOLOGY OF ADHD

The human brain consists of a million neurons secreting dopamine. The cells are scattered in different regions, and each area is responsible for different functions, including movement, cognitive functions, memory, and management skills such as decision-making and planning which enables attention and learning.
Dopamine is also secreted when feeling pleasure and success as part of positive feedback regulation. This miraculous system enables us to strengthen our desired behavior and progress in achieving our goals. The system works in the neural pathways that create a sense of pleasure, motivation, and concentration. When we have an interest or desire to succeed in the task, we secrete dopamine and the secretion of dopamine increases our motivation and attention and of course the feeling of success.
The reinforcement system operates under the mechanism of positive feedback, dopamine secretion is enhanced in response to success, and as a result, we are highly motivated and focused on the task.

ADHD is associated with several neurophysiological deficits. More recent theoretical approaches integrate clinical symptoms and neuropsychological difficulties within a framework of specific brain dysfunctions: cognitive deficits may emerge from dysfunctions particularly in fronto-striatal or mesocortical brain networks dopaminergic system, while problems with reward processing may be associated with dysfunctions in the mesolimbic dopaminergic system (Sagvolden et al., 2005; Sonuga-Barke, 2005).

However, deficits in ADHD may already be seen in the resting brain, and a more fundamental neuronal network approach suggests that in ADHD particularly Default Mode-Network (DMN) activity (usually prominent during rest) may interfere with activity in neuronal networks engaged in task processing, leading to difficulties in state regulation and periodic attentional lapses (Sonuga-Barke and Castellanos, 2007; Castellanos and Proal, 2012). That is why neurofeedback in ADHD management is very effective with long-lasting results. 

Pharmacological interventions, particularly with stimulants such as methylphenidate and amphetamine sulfate, as well as non-stimulants like Atomoxetine, are highly effective in reducing ADHD symptoms (Banaschewski et al., 2006; King et al., 2006). What do ADHD medications do? In simple terms, they raise the level of norepinephrine within the brain. Stimulants work by causing the brain to synthesize more norepinephrine; non-stimulants by slowing the rate at which norepinephrine is broken down. Once the level is where it should be, the brain functions normally, and the individual becomes less hyperactive, inattentive, and/or impulsive. Once the drug wears off, the level falls — and symptoms return.
That’s because dopamine is hooked into the brain’s reward system. Having more dopamine circulating are feels like getting a bonus. It feels like that extra ten points on the test, right then. That means not only feel focused and content during the study but also to continue feeling that way. “The more you use it,” one student reported, “the more of it you want to use.”
The problem is that the good feelings, feeling in control and focused — these stop when the drug passes through your system a few hours later. The problem with drugs like Adderall and Ritalin is that you have to get more to feel better. That’s an addiction.
As report many researchers the long-term effectiveness is still questionable (Molina et al., 2009; van de Loo-Neus et al., 2011). In addition, side-effects, non-response, and prejudice have raised interest in non-pharmacological treatment options (Sonuga-Barke et al., 2013; Daley et al., 2014).

BRAIN WAVES IN ADHD

ADHD has been associated with certain clinical behavioral symptoms for many years. Recently, interest has been focused on ADHD, to determine whether certain abnormal EEG patterns correlate with clinical manifestations of ADHD.
Multiple studies have determined that compared to gender and age-matched controls, children with ADHD have greater theta activity. Other studies showed an increase in delta activity, coupled with decreased alpha and beta activities.

Additionally, abnormalities in the theta/beta ratio are one of the most significant measures of EEG alterations in ADHD.
Some researchers describe that in patients with ADHD theta/low beta ratio, and theta/alpha ratios were significantly increased.
Brain scans show that ADHD brains produce more low-frequency delta or theta brain waves than do neurotypical brains, and often show a shortage of the high-frequency beta brain waves linked to focus and impulse control.

NEUROFEEDBACK FOR ADHD MANAGEMENT

Neurofeedback (NFB) as a non-pharmacological intervention for ADHD management utilizes cognitive behavioral therapeutic elements to gain access to and practice brain activity. Several organizations worldwide are looking into claims that neurofeedback works just as well as pharma when it comes to helping kids with ADHD. A course of Neurofeedback sessions can have the same effect as the ongoing intake of psychostimulant medications like Ritalin, for example. The benefit of Neurofeedback, however, is that ongoing treatment is rarely needed after the course length and medications can be avoided altogether.

The functioning of the brain and a person’s behavior are connected. Changes in behavior can change the brain, and changes in the brain can change behavior. Neurofeedback aims to change a person’s behavior by changing their brain. With neurofeedback, it is possible to train the brain in a positive, natural way. The goal of neurofeedback is to increase the brain’s capacity for beta waves while diminishing the frequency of delta and theta waves.

Most recently, clinical trials have garnered interesting results attesting to both the presence of unique EEG patterns in the ADHD brain and the efficacy of theta suppression/beta enhancement and theta suppression/alpha enhancement protocols on ADHD symptoms reduction (see different NFB protocols detailed description on “NFB Protocol” page of this website, which will continuously update with the arrival of new research data).

In theta/beta training the goal is to decrease activity in the theta band (4–8 Hz) and to increase activity in the beta band (13–20 Hz) of the electroencephalogram (EEG) which corresponds to an alert and focused but relaxed state. Thus, this training paradigm addresses tonic aspects of cortical arousal. Alpha enhancement protocol was more effective in suppressing omission errors.

Practicing the neurofeedback allows the trainee to change his brainwave frequency to the desired frequency while using his self-regulation system. Today in the market there are a lot of Home Use Neurofeedback Headset Devices that can be used for home-based training and treatment. The neurofeedback trainee is wearing a headset that measures his brain frequency in real-time while he is playing a computer game that responds to the sensor (practically it responds to the user’s brain waves). Only when the NFB trainee’s brainwave frequency is as expected for attention or relaxation, he will score in the video game he is playing. When the trainee achieves points (meaning he has reached the desired frequency in the brainwaves), he experiences success the reinforcement system is activated and the excretion of dopamine increases naturally. The excreted dopamine increases attention and the trainee gets motivated to maintain the right frequency of the brainwaves. The flexibility of the brain is reflected in its ability to remember the way it changed frequency and by learning to reach the desired frequency even when the computer game is no longer there. This allows the trainee to keep the achieved attitude in everyday life and decrease symptoms of ADHD. 

Neurofeedback has been introduced to treat ADHD and can improve attention levels and alleviate hyperactivity symptoms. The process provides a mechanism by which the patient can normalize the cortical activity profile by decreasing slow-wave activity and increasing fast-wave activity. It is expected that compensation of the dysfunctional electroencephalogram (EEG) enhances concentration and attention and increases the arousal level. Patients will learn how to enhance the desirable EEG frequencies associated with relaxed attention and how to reduce the undesirable frequencies that are associated with under- or over-arousal.

Key Electrode Sites for ADHD Neurofeedback

1. Fz (Frontal Midline):

Location: Frontal lobe, on the midline, 20% of the distance from the nasion (bridge of the nose).
Relevance: Associated with attention, impulse control, and executive function. Targeting Fz can help improve these areas.

2. Cz (Central Midline):

• Location: The scalp vertex, halfway between the nasion and inion and equally spaced between the left and right preauricular points (just above the ears).
• Relevance: Central region involved in motor control and general arousal regulation. Often used as a reference site.

Electrode Application Sites for ADHD Neurofeedback Management

3. C3 (Left Sensorimotor Cortex):

• Location: Left hemisphere, 20% of the distance from the midline along the central line.
• Relevance: Involved in motor control and coordination, relevant for reducing hyperactivity.

4. C4 (Right Sensorimotor Cortex):

• Location: Right hemisphere, analogous to C3 on the right side.
• Relevance: Also involved in motor control; balancing neural activity related to motor functions.

Neurofeedback Protocols for ADHD Management

The protocol involves training individuals to increase or decrease specific brainwave activity at the targeted locations to improve attention, impulse control, and executive function.

1. Theta/Beta Ratio Training

This protocol aims to balance theta (4-8 Hz) and beta (15-20 Hz) wave activity to improve attention and reduce impulsivity.

• Target Brainwaves: Theta (4-8 Hz) and Beta (15-20 Hz)
• Goal: Decrease theta activity and increase beta activity to improve cognitive control and reduce symptoms of ADHD.

Procedure:

1. Electrode Placement: Place electrodes at Fz and Cz (reference).
2. Baseline Recording: Record baseline theta and beta activity for 5-10 minutes.
3. Feedback Mechanism: Provide real-time feedback using visual (e.g., a game or moving bar) or auditory (e.g., tone) cues. Positive feedback occurs when theta decreases and beta increases.
4. Training Sessions: Conduct sessions for 20-30 minutes, 2-3 times per week, for 20-40 sessions.
5. Progress Monitoring: Utilize attention and impulse control scales along with follow-up qEEG to track progress.

2. SMR Training Protocol

This protocol focuses on increasing sensorimotor rhythm (SMR, 12-15 Hz) activity to enhance motor inhibition and reduce hyperactivity.

• Target Brainwaves: SMR (12-15 Hz)
• Goal: Increase SMR activity to enhance motor inhibition and promote calmness.

Procedure:

1. Electrode Placement: Place electrodes at C3 (left sensorimotor cortex) and Cz (reference).
2. Baseline Recording: Record baseline SMR activity for 5-10 minutes.
3. Feedback Mechanism: Provide real-time feedback using visual or auditory cues. Positive feedback is given when SMR activity increases.
4. Training Sessions: Conduct sessions for 20-30 minutes, 2-3 times per week, for 20-40 sessions.
5. Progress Monitoring: Use attention and hyperactivity rating scales and follow-up qEEG to monitor changes.

3. Alpha/Theta Training

This protocol focuses on balancing alpha (8-12 Hz) and theta (4-8 Hz) waves to promote relaxation and improve cognitive control.

• Target Brainwaves: Alpha waves (8-12 Hz) and Theta waves (4-8 Hz)
• Goal: Increase alpha activity and decrease theta activity to enhance relaxation and attention.

Procedure:

1. Electrode Placement: Place electrodes at Fz and Cz (reference).
2. Baseline Recording: Record baseline alpha and theta activity for 5-10 minutes.
3. Feedback Mechanism: Use calming visual or auditory feedback. Positive feedback is provided when alpha increases and theta decreases.
4. Training Sessions: Conduct sessions for 20-30 minutes, 2-3 times per week, for 20-40 sessions.
5. Progress Monitoring: Use attention and relaxation scales along with follow-up qEEG to monitor changes.

Effectiveness of Neurofeedback for ADHD management

DECREASE OF ADHD SYMPTOMS AFTER NFB TRAINING
After 2 sessions of NFB 37%
After 10 sessions of NFB 60%
After 20 sessions of NFB 78%

Moreover, long-term follow-up studies with children successfully treated with neurofeedback have shown that the improved attention ability and memory improvement of these children remain stable long after treatment has ended. These children also learn easier manage their emotional status in different stressful situations. In other words, abnormal brainwave patterns are permanently normalized without the use of toxic drugs. It is also important to note that drugs do not improve the child’s ability to learn but neurofeedback does.
The research shows that neurofeedback works best for children over 6 years of age with normal or high intelligence. Usually, some 30-50 treatment sessions (30-45 minutes each) are required for successful treatment, at a rate of 2-3 sessions per week.

After 1-5 sessions 

ATTENTION
16%
MEMORY
10%
STRESS MANAGEMENT
34%

After 6-10 sessions 

31%
24%
66%

After 11-20 sessions  

60%
56%