By Peter Jaret
Like most 16-year-old boys, Adam Brock* loves video games. Unlike a lot of kids his age, though, he can honestly say that playing a video game turned his life around.
For years Adam suffered from Tourette’s syndrome, a neuropsychiatric condition that causes people to blurt out sounds or words or make involuntary movements such as blinking, shrugging, or twitching. Afraid of being embarrassed or made fun of at school, he managed through sheer willpower to suppress or disguise his tics in class. But by the time he got home, he was often physically and emotionally exhausted from the effort. “He would be just wiped out,” his mother, Carol, recalls.
Weekends offered some relief. But as Monday approached, the stress of having to face another week of school sometimes made him physically sick. “His dad would be waiting in the car outside to take him to school, and Adam would be dragging his feet and saying he didn’t want to go,” Carol says.
Like many Tourette’s sufferers, Adam also developed obsessive-compulsive disorder, which made school even tougher for him. “He’d have a writing assignment at school,” his mother remembers, “and while the other kids were finishing their essays, he’d still be writing the first sentence over and over again, obsessed with getting it perfect.”
Medications helped control his symptoms, but even so, Adam was struggling. He began missing days of school, and when he fell behind in classes, he became even more anxious. “He was really in a downward spiral,” says Carol. “Finally, one day he came home from school and was having so many tics he couldn’t even complete a sentence. It was heartbreaking. We knew we had to try something else.”
That’s when the Brocks decided to consult Michael Anderson, a psychiatrist in private practice in McLean, Virginia. After hearing their story, Anderson suggested a therapy that he acknowledged was unconventional. Called neurofeedback, it’s a form of biofeedback designed to help people alter their brain waves in ways that can have a profound effect on their behavior, mood, and thinking. Carol was skeptical. But not Adam, who had seen a show on television about neurofeedback. “I thought the idea was pretty cool myself,” he says.
A week later, with three electrodes attached to his scalp, Adam sat in front of a computer screen playing a video game unlike any he had tried before. “There were three rockets, side by side. The point was to make the rocket in the middle move ahead but keep the other two from moving,” he says. What made the game unusual was that Adam didn’t manipulate it with a joystick or computer mouse. Instead, psychotherapist Deborah Stokes, a practitioner at Neurofeedback Consultants of Northern Virginia, told him to move the rockets around simply by using his brain waves.
And he did. “That first session, I did it for only like ten minutes, but I got the hang of it pretty quickly,” Adam remembers. “It’s weird. All you know is you’re supposed to move things around on the screen in a certain way, but you don’t know how you’re supposed to do it. When your brain does the right thing, the rockets move the right way, and you sort of think, yes, that’s what I want to do.”
Even after just one session, Adam felt calmer and more in control than he had in a long time. When he went back the next time, he was even better at manipulating the rockets. Long afterward, he felt more focused and less anxious. With each subsequent treatment, the benefits were more pronounced and longer lasting.
Teaching the brain new tricks
In an age dominated by pharmaceutical approaches to treating the brain, neurofeedback has emerged as a bold new nonchemical alternative—one that is surging in popularity among patients frustrated by the limitations and side effects of anti-depressants, stimulants, and other drugs.
Unlike traditional biofeedback, which measures heart rate, respiration, and electrical skin responses, neurofeedback provides information about the type and intensity of brain waves being generated.
“Brain function is both chemical and electrical in nature,” explains psychologist Jim R. Evans, professor emeritus at the University of South Carolina and coeditor of the book Introduction to Quantitative EEG and Neurofeedback. “We know you can change it by altering the chemistry. Neurofeedback has shown us you can also change it by altering electrical patterns.”
It was first used for stress reduction, as a means to help people generate more of the calming alpha brain waves. And that remains the only use approved by the FDA. But proponents say it holds promise as a way to treat many other brain-related disorders as well, from Tourette’s and hyperactivity to anxiety, sleep disorders, alcoholism, autistic spectrum disorder, and the consequences of brain injuries.
“Neurofeedback is like holding up a mirror to the mind,” says Deborah Stokes. “By showing an image of brain wave activity, it can allow people to train their brains into new, healthier patterns.”
There’s nothing new, of course, about measuring the electrical activity of the brain by charting its waves. Neurologists have done it for decades by using electrodes attached to the scalp, usually to look for signs of trouble after brain injuries or strokes.
The brain generates brain waves at different frequencies depending on what it’s doing: Theta waves show up when we’re falling asleep; delta waves are produced while we sleep; theta, beta, and gamma are activated when we’re putting our brains to serious work; and the sought-after alpha waves indicate a relaxed mental state, often associated with meditation. Neurofeedback researchers say they are even learning to identify measurable brain-wave abnormalities that are associated with ADHD.
Until fairly recently, however, researchers never imagined that people could actually alter their brain wave activity. But in the 1960s, an investigator at the University of Chicago noticed something unusual. When people were allowed to watch trackings of their brain activity, some were able to control it at certain frequencies. For instance, while watching a screen that depicted the rising and falling lines of alpha frequencies, subjects were somehow able to boost the power in those particular waves. It wasn’t clear exactly how they were doing it, but with that discovery, the field of neurofeedback was born.
During a typical treatment, which lasts about 20 to 30 minutes, practitioners first attach several electrodes to sites on the patient’s scalp. The sites are chosen depending on the kinds of symptoms and specific parts of the brain where activity is going to be measured. The electrodes are hooked by wires to a computer, which monitors brain waves and translates them into images on a screen. This is the part of the program that resembles a video game (and makes it appealing to young patients).
“Brain waves can be depicted in many different ways—as traditional waveforms, as multicolored graphs that rise and fall as different frequencies become quiet or active, or as video games or puzzles,” says Cynthia Kerson, a neurofeedback expert in San Rafael, California.
In one widely used program, viewers try to fill in an electronic jigsaw puzzle on the screen, square by square. A computer program processes the brain wave signals from the electrodes and, when the desired waves are generated, pieces of the puzzle appear.
“You can’t instruct people simply to change their brain waves,” says Kerson. “But by using feedback in the form of images or sounds, you can reward them each time their brains generate certain brain wave profiles.”
In some sessions, patients may simply watch the screen and figure out how to manipulate the feedback in the desired way. In other cases, they may be asked to perform mental tasks such as reading or doing math problems while the computer tracks their brain wave activity. Along with visual indications, sound cues such as clicks or musical notes from the computer also provide feedback on whether patients are producing the desired brain wave patterns.
There’s growing evidence that neurofeedback can make measurable and even lasting changes in the brain. In a study published this past January in the journal Clinical Neurophysiology, researchers at Imperial College London found that subjects who were trained to increase their low beta frequencies using neurofeedback were able to measurably improve their ability to pay attention. Those trained to increase higher-frequency beta waves boosted their alertness and reaction time.
“As more and more studies like this appear in mainstream medical journals,” says Lynda Kirk, president of the Association for Applied Psychophysiology and Biofeedback (AAPB) and a therapist in Austin, Texas, “neurofeedback is winning new respect.”
Two years ago, the AAPB and the International Society for Neuronal Regulation created a task force to evaluate the evidence for biofeedback’s benefits. The committee concluded that neurofeedback can be effective for treating several brain-related problems, including migraines, chronic pain, epilepsy, and substance abuse. It may also relieve depression, help stroke patients recover, and treat the memory problems and exhaustion that accompany chronic fatigue syndrome (CFS).
In a case study published in 2001, a researcher at the University of Utah School of Medicine treated a 21-year-old woman with rapid-onset CFS. Brain wave tests showed that she had excessive theta brain wave activity, which is usually generated just as people fall asleep. After sessions that combined neurofeedback and self-hypnosis, she showed considerable improvement in her energy level.
To be sure, not everyone benefits from neurofeedback, but the numbers of people who don’t respond are small—about 5 percent, according to Kirk. Studies of ADHD suggest that about 70 to 80 percent of patients improve after treatment. Neurofeedback appears to be particularly effective when it comes to treating this condition because it can help people train their brains to achieve a state in which it’s easier to concentrate.
Christopher Duncan, of Dumfries, Virginia, can testify to its powers in this arena. Diagnosed with ADHD when he was just four, Duncan had struggled for years at school. “Even on medications, he was having a tough time,” his mother, Karen, remembers. “He was doing poorly in classes and acting up outside of school, getting into fights. I read about neurofeedback and thought, okay, maybe we’ll give it a try.” After Christopher’s first session, she was amazed at how calm he seemed. “By the second session, his two sisters were already noticing a huge difference in his behavior,” she says. “After 20 sessions, he was off medication and now, at age 14, he’s doing better than I’ve ever seen him.”
Despite thousands of stories like Christopher’s, neurofeedback is still deemed “controversial” by the National Institute of Mental Health. One reason is that few of the existing studies have pitted neurofeedback against a sham treatment or drug therapy. So far, most of the evidence comes from anecdotal reports from therapists and their patients. That kind of support is important, but it isn’t enough to convince many critics that the technique works better than a placebo.
Another reason skeptics remain unconvinced is that the science behind neurofeedback is still in its infancy, with many mysteries still to be unraveled. Some people with serious problems such as Tourette’s syndrome or ADHD have normal-looking brain waves, for example, so it’s hard to see how neurofeedback might benefit them. And even when the therapy does seem to help patients, it can be difficult to detect dramatic changes in brain wave patterns after treatment. “There’s no doubt we still have a lot to learn,” admits psychologist Evans.
Further complicating matters is that even proponents disagree on the best way to use the technique. Different schools of neurofeedback have emerged over the past few years, each with its own unique approach.
Some focus on adjusting imbalances in activity between the right and left hemispheres of the brain, while others try to alter the ratio of different brain wave frequencies. Some treat chronic fatigue syndrome by increasing power in the brain’s slower-moving waves; others say the most effective approach is to increase faster wave activity in the brain.
There’s also the not-insignificant cost associated with the treatment: Although many patients experience immediate benefits, creating lasting change in brain function may take dozens of sessions. Because very few insurance companies cover neurofeedback, a course of therapy can cost several thousand dollars. On the upside, once the treatments are over, patients rarely or only occasionally have to go back for more.
For now, proponents of neurofeedback say it has yet to gain the respect it deserves. “Ask most doctors what they know about neurofeedback and the answer is zero,” says Michael Anderson, Adam Brock’s psychiatrist. He himself had never looked into it until a patient mentioned he was using the technique to relieve anxiety.
“I was intrigued,” Anderson remembers. After looking over published studies, he was more than just interested—he was impressed enough to bring his daughter, who suffered from attention deficit disorder, in for neurofeedback treatment. “After several sessions, she suddenly had the experience of waking up. It’s what some people describe as the ‘clear windshield’ effect, an experience of sudden mental clarity.” The fog and confusion associated with ADHD began to lift for her.
Chance for a normal life
For Adam Brock, neurofeedback was nothing less than life-changing. Within weeks of beginning the treatments, he felt more relaxed and confident than he had in years. The tics and involuntary outbursts associated with his Tourette’s began to subside. After 15 treatments, his brain waves were at normal levels, possibly for the first time in his life.
“I used to have to spend so much mental energy on suppressing the tics that I had trouble concentrating on schoolwork,” says Adam. “After the treatments, I could pay attention to what was going on and not to the tics.”
There were other benefits, too. “A couple of weeks after starting the treatments, Adam went on a youth retreat, which was a huge thing for him,” his mother remembers. “Before, he would have said no because it would have been just like going to school. He would have had to suppress his tics and obsessive-compulsive behaviors. Now he could go and enjoy himself.”
Soon he was going on ski trips and other school outings, and his grades began to improve. Carol also noticed that he had more friends coming home to visit. And instead of dreading school, he couldn’t wait to get started in the morning. “Before I would have to push him to get ready and out the door, but now it’s ‘Come on, let’s go,’” she says. “We look at him and it’s hard to remember how bad things were for him before.” The Brocks credit neurofeedback with reducing Adam’s tics and obsessive-compulsive behavior by about 70 percent. During the worst period, he was on six medications to control the two conditions. Now he takes only one drug—for acne.
A year after his first neurofeedback session, Adam goes in now for “tune-ups” every few months. He went in for his last one just before starting his sophomore year in high school. “I knew it was going to be kind of stressful going back to school, so I sort of wanted a little refresher,” he says. Of course there’s another, simpler reason he likes to go back now and then: to test his wits against the computer game. As Adam says, “It’s fun.”
Courtesy of Alternative Medicine