Calming Your Internal Storms
(appeared in MORE magazine, February 2011)

A type of biofeedback that helps soothe people with ADHD may also quell the squalls of menopause.  Here’s how a high-tech treatment made one woman more low-key.
by Katherine Ellison

I was sitting in psychologist Jan Davis’s Northern California office with electrodes stuck to my scalp, looking like the bride of Frankenstein, when Davis suddenly glanced up from her computer screen, grinned and said, “You just had a hot flash, didn’t you?”

Davis, who has a Ph.D in psychology and used to treat patients through Jungian analysis, now specializes in a controversial, costly but increasingly popular treatment known as neurofeedback.  Practitioners tout it as a non-invasive way to tame the symptoms of conditions as diverse as attention-deficit/hyperactivity disorder (ADHD), brain injury, autism, migraines and, of particular relevance to me, menopause.  Still, none of the testimonials I’d heard had prepared me for having my personal climate change reflected as a burst of activity on a screen.

I hadn’t turned to neurofeedback for help with menopause per se, even though, at 51, I was two years into it.  I worried less about hot flashes than about my hot headedness; I’ve always had a bad temper, but lately I was having near-constant clashes with my spouse, my 12 year old son and various telemarketers.  I was also having trouble sleeping and, on occasion, problems remembering my kid’s names.  And I often awoke in the middle of the night feeling as if I’d just trekked through the Amazon.  Hmm…maybe I was in Davis’s office for help with menopause after all.

Davis said neurofeedback could help me with the hot flashes.  Her business and life partner, Penel Thronson (the two share offices in Larkspur and San Jose, California), made an even more compelling promise:  “Neurofeedback can help you enjoy your world more.”

What is Neurofeedback?
This treatment uses technology to map your brain waves, then applies the information to help you change your habitual responses.  Here’s how it works.

Electrodes are placed on your scalp to track the constant storm of electrical impulses that help your brain cells communicate with one another; the oscillating patterns are then recorded in an electroencephalogram (EEG).  These patterns have different frequencies, or speeds.  Theta waves, among the slowest, are dominant when you’re near sleep; alpha waves are strongest when you’re relaxed and relatively unfocused; beta waves, when you’re mentally aroused and engaged.  For instance, people with concentration problems, such as those with ADHD, generally have a dominant pattern of too many theta waves in the executive (frontal) section of their brains.

Once your brain waves are mapped, the practitioner compares them with those considered normal.  “Practitioners look for brain wave patterns  that are different compared with the reference brains of people who are able to more or less accomplish their goals and aspirations   and seem to be functioning well,” says Garrett Sullivan, M.D.,  clinical assistant professor in the Program in Integrative Medicine at the University of Kansas Medical Center in Kansas City.  Davis and Thronson established that my brain waves displayed a hyperactive beta pattern.  They explained that having excessively fast beta waves, especially in the frontal area of the brain (a situation that describes me), is associated with irritability and flying off the handle easily.   My neurofeedback goal was to tame my crankiness by slowing those waves; if I was lucky the treatment might also rid me of hot flashes and other menopause-related symptoms.

My Secret Garden
Neurofeedback works on the principle of operant conditioning, which says that people learn to change behavior when they are rewarded, just as a puppy learns to roll over to get a treat.  “Operant conditioning is a simple, basic process that happens in the brain,” says Cynthia Kerson, Ph.D, of Marin Biofeedback in San Rafael, California.  “It’s more about intention than thinking.  We just give the patient a challenge, for example, and ask him or her to keep working on it.”

The setup requires two computers.  One displays brain wave patterns derived from electrodes placed on the scalp.  The second translates the information onto an image or a game.  For instance, if the practitioners want to train you to switch between different kinds of waves, they might connect you to program that beeps and sends a rocket shooting off the screen when you’re using beta waves but goes silent and shows a rocket falling when you’ve moved to theta waves.  You might get points every time you navigate this transition successfully; after you earn a certain number, you “win” the game.

I played those kinds of games during my first few sessions at Davis and Thronson’s comfortable Larkspur office, on the ground floor of their wood-shingled home.  They gave me a choice of software options, each offering different images on which I was expected to focus.  My favorite was a picture of a garden.  Whenever my brain slowed down, the landscape would bloom into colors, accompanied by chirping birds and soothing music.  When my brain sped up, the flowers wilted.  This level of concentration is normally difficult for me; for example, I usually get frustrated when I try to meditate because I’m easily distracted.  But as I looked at the garden images, the computer itself helped me stay on track, reminding me to pay attention to my fleeting states of mind.

I liked how I felt after the sessions, and I found myself increasingly looking forward to them.  After my first month or so of treatment, my husband said that he noticed the steam was no longer billowing out of my ears.  But I knew something was really kicking in when I caught myself halfway through my 40 treatments, feeling impatient one afternoon while waiting in line at the post office—and suddenly imagined the sound of music and of birds chirping.  As I did, I felt a rush of peacefulness.  By the end of the treatments, I also slept better and was less bothered by hot flashes.

What the Science Says
Was my brain really being retrained, or was I just experiencing some kind of fancy placebo effect?  The scientific evidence, while still preliminary, suggests the former.  Over the past several years, researchers in the United States and abroad have come up with encouraging support for claims that neurofeedback helps troubled brains.  The National Institute of Mental Health has been impressed enough by the existing research to sponsor a pilot study last year looking at whether neurofeedback can improve concentration and behavior in children with ADHD.

There has been no published research to date on whether neurofeedback can affect hot flashes or other menopausal symptoms.   Yet the lack of data hasn’t stopped many American therapists from using the technique for that purpose or from reporting promising results.  “Easing menopausal symptoms is something we have had enormous success with,” contends Abingdon, Virginia, psychologist Robert Hill, Ph.D, a neurofeedback practitioner for the past 25 years and coauthor of Healing Young Brains: The Neurofeedback Solution.

Here are some menopause-related symptoms that may respond to treatment, according to clinicians’ reports and some published studies.

  • Brain Fog  Mental Slowness is a classic scourge of menopause, but neurofeedback offers some hope.  According to an article in the journal, The Clinical Neurophysicist , a pilot study of neurofeedback training for “cognitive enhancement”  in elderly people found that the technique measurably improved the brain’s processing speed.
  • Insomnia  A study  by the University of Salzburg researchers, reported in the journal Sleep, found neurofeedback beneficial in treating this complaint, which is common in menopausal women.
  • Temper Tantrums  Several therapists I interviewed said neurofeedback intervention works particularly well for hotheadedness, which some described as a relatively inflexible brain getting “stuck” in problematic patterns.  “This seems like the easiest area of functioning to impact, “says Laurence Hirshberg, Ph.D, a clinical assistant professor in the department of psychiatry and human behavior at Brown University Medical School.  He estimates he’s treated more than 1,000 patients in the past several years, mostly children with ADHD, a disorder often accompanied by oppositional behavior.   “What I often hear from parents of these kids, early in the process, is, “I’m not sure his attention is better, but he certainly is easier to live with,” Hirshberg explains.
  • Hot Flashes  Deborah Stokes, Ph.D,  who runs the Better Brain Center in Washington D.C., and in Alexandria, Virginia, says that improving womens’ ability to tone down their response to stress can also help tamp down their hot flashes, since both involve the autonomic nervous system.  “Neurofeedback helps make people more resilient to stress by teaching them how to self-regulate better,” she notes.

So is this for you?
Reality check: Evidence that neurofeedback is effective stops well short of overwhelming.  And the treatment is pricey.  The average cost of a session is about $100, with 20 to 40 sessions required to make a difference.  The diagnostic brain map that clinicians usually require can add $800 or so to the bill. Most insurance companies do not cover any of this.

But consider the alternatives.  Doctors typically respond to women’s’ complaints of irritability, insomnia and hot flashes by offering antidepressants, which don’t always help much and can cause uncomfortable side  effects, such as weight gain and a diminished sex drive. Neurofeedback is much more—let’s just go ahead and haul out that 1970s word—empowering.  It is, after all, your brain helping itself, no drugs required.

So what’s the bottom line? I can’t claim that neurofeedback worked miracles for me.  My basic personality is the same, meaning I still have a temper and no one is going to mistake me for the Dalai Lama. On the other hand, a year after treatment, I’m still conscious of many subtle benefits, including the luxurious sense of a few extra milliseconds to decide whether I really need to strangle someone. What’s clearest to me is that I’ve become a lot more skilled in metacognition, a fancy word for the ability to be aware of your own patterns of thought.  It’s something less than enlightenment but a big improvement over my previously short fuse.  And for me, that was worth the expense.

The Savvy Consumer

The danger with this up-and-coming but largely unregulated treatment is that you can easily waste a lot of time and money- or even suffer side effects that, while mostly mild and temporary, are unnerving.  (In one documented case, a patient was so dazed when she left a neurofeedback session that she drove her car in to a nearby light pole.)

To avoid problems and have successful treatments, you obviously need a good therapist.  Most important:  She or he should be a licensed health or mental health professional. (That may also help you with insurance coverage.)

Check if your therapist has been certified by the Biofeedback Certification International Alliance (BCIA), which requires classroom training, mentoring and a nationally recognized examination.  Only about 500 of the estimated 7,500 neurofeedback practitioners in the United States have taken the time to fulfill this requirement, according to the BCIA’s certification director, Judith Crawford.  Two websites that can help you find a qualified therapist are eegspectrum.com and eeginfo.com.  A big temptation, considering the high cost of this therapy, is to buy or rent equipment to use at home.  As neurofeedback grows more popular, manufacturers are starting to mass-market gizmos on the Internet, making extravagant claims.  But keep in mind that the Food and Drug Administration has yet to approve any of these devices for uses other relaxation training.  Caveat emptor.

(Additional note: Only licensed health providers may use these devices “off label” for purposes other than relaxation so be sure that your provider holds a clinical license.)