Neurofeedback Frequently Asked Questions
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What is neurofeedback (EEG Biofeedback)?
Neurofeedback is operant conditioning on EEG parameters. Typically the training reinforces specific EEG frequencies and inhibits others. However, training has also been done successfully with evoked potentials, as well as with individual unit activity of motor-neurons.
What is neurofeedback used for?
The most common application of neurofeedback is currently to the attention, learning, and behavior problems of children. However, other common applications are directed toward mood disorders, epilepsy, traumatic brain injury, sleep disorders, and the more severe developmental disorders of children.
More recently, neurofeedback has found application to alcoholism and other addictions, as well as to Post-traumatic Stress Disorder. The field divides into two domains: A domain of high-frequency training (12-19Hz) and a domain of low frequency training (4-12 Hz). The former is commonly referred to as SMR-beta training, and is directed mainly to physiological normalization. The latter is referred to as Alpha-theta training, and is used primarily for psychological resolution and integration.
The field has also been extended to non-clinical applications, as it has been found that normal, functional brains can benefit from these training regimens as well. In these "mental fitness", or "optimum performance" applications, both the high and low frequency domains have been found to be beneficial.
How long does the EEG biofeedback training take?
The EEG training may require some twenty to forty sessions typically for attention, learning, and behavior problems, in order for consolidation of learning to take place. In some cases, particularly if there is organic injury involved, such as in epilepsy or traumatic brain injury, the training may need to be extended to a hundred or more sessions, and some benefit may continue to be observed as the training is continued indefinitely.
In optimum performance applications, the training may be continued at some level for as long as optimum function remains an issue, by analogy to physical fitness training.
Is this training reimbursed by third-party payers?
Reimbursement experience is increasingly favorable as time goes on, and as third-party payers become acquainted with this new modality. Reimbursement is more likely for those conditions traditionally regarded as being within the purview of biofeedback modalities, such as pain and sleep disorders. It remains marginal in ADHD, where there is a cost disadvantage with respect to pharmacological intervention. Most practitioners specializing in ADHD with this modality are currently operating with a largely cash-based practice. Some insurance providers will invariably say, "Provide us with multi-center studies and multiple replications from numerous investigators before we will even consider this modality for coverage." However, the competitive climate will change these realities as the public begins to demand this service. The other driver of course is money, which is also more important than large-scale controlled studies. We can demonstrate favorable cost-benefit ratios in Motor Vehicle Accidents (MVAs, i.e. for post-concussion syndrome, whiplash), as well as in fibromyalgia, bipolar disorder, chronic pain, and addictions just for starters.
What is the history of this treatment modality? Neurofeedback History Link
Human EEG biofeedback was first attempted in the 1960s by Joe Kamiya at the University of Chicago. Early investigations focused on operant conditioning of alpha brain waves primarily to facilitate deep relaxation and meditation.
SMR/beta biofeedback developed from operant conditioning of cats' EEG. Barry Sterman of UCLA serendipitously discovered that when cats were exposed to toxic chemicals that usually induce epileptic seizures, those who had been trained in the middle to high frequency range (12-20 Hz) from a previous unrelated experiment had greater latency to seizure onset, and a higher threshold for seizure onset, than untrained cats. These results were replicated in monkeys and humans. The results with humans were subsequently replicated in some twelve research centers, comprising some twenty studies.
After several years of treating patients with intractable seizures with SMR biofeedback, it was noted that the hyperactive children not only had decreased seizure activity, but their behavior improved as well. In the mid 70's, Joel Lubar at the University of Tennessee examined the effect of neurofeedback on hyperactivity absent any seizure history.
Additional research took place during the 1980's.In 1989, Eugene Peniston of the Fort Lyon (CO) VA Medical Center undertook a groundbreaking study of alcoholics who received alpha-theta neurofeedback training in addition to the program normally provided by the facility. Five years after treatment, 70% of the participants were still abstinent.
Continuing through the present day, a number of researchers have worked to move the field forward.
For more information on Neurofeedback and it's history, read A Symphony in the Brain: The Evolution of the New Brain Wave Biofeedback by Jim Robbins.
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