Neurofeedback: A Promising Tool
By D. Corydon Hammond, Ph.D.
The Evolution of Neurofeedback EEG biofeedback, popularly called neurofeedback, has been evolving since initial research began in the late 1960’s and 1970’s. Neurofeedback provides innovative treatment options for brain-related disorders. In epilepsy, for example, drug treatment is unsuccessful in controlling seizures in one-third of patients. But placebo-controlled, blinded research studies have found that in the most serious cases of uncontrolled epilepsy, 82% of patients have been able to obtain significant reductions in seizure rates.
Other research, summarized by Vince Monastra, Ph.D.,–the ADHD doc”– has found that close to 80% of individuals with ADD/ADHD are able to make significant and enduring improvements with neurofeedback treatment.
Recently an exciting randomized control group study that utilized pre- and post-treatment functional MRI evaluations verified positive changes not only in behavior but also in brain function following neurofeedback for ADHD. These results supported previous studies showing positive outcomes in behavior and with EEG measures.
Stimulant medication is commonly associated with side effects and many clinicians are unaware that the average medication outcome study only has a 3 week follow-up. Thus reviews have concluded that stimulant medication treatment for ADD/ADHD has not been established as effective in the long term, nor has it been sufficiently validated in treating adolescents or adults.
A preliminary study published 3 years ago in Cancer Letters found that 100% of children who were prescribed ritalin developed chromosomal aberrations within 3 months, which could potentially increase their future risk of cancer. Thus neurofeedback provides an important alternative to medication In the treatment of ADD/ADHD.
Although further research is needed in many areas of application, neurofeedback is now being used with a wide range of clinical problems including alcoholism and drug abuse, learning disabilities, rehabilitation of head injuries and stroke, anxiety, depression, autism, and other conditions. Readers wishing to review a comprehensive bibliography of published outcome studies may find it at www.isnr.org.
Frank H. Duffy, M.D., a Professor and Pediatric Neurologist at Harvard Medical School, was sufficiently encouraged to state in an editorial in the January 2000 issue of the journal Clinical Electroencephalography that scholarly literature now suggests that neurofeedback “should play a major therapeutic role in many difficult areas. In my opinion, if any medication had demonstrated such a wide spectrum of efficacy it would be universally accepted and widely used@ (p. v). “It is a field to be taken seriously by all@ (p. vii).
Protecting the Public
A robust body of past research has documented that psychotherapy can occasionally have iatrogenic effects. Similarly, data has been accumulated which shows that neurofeedback also has the potential to cause side effects or adverse effects if it is misapplied.. Most commonly side effects associated with neurofeedback tend to be mild, infrequent, and can be quickly reversed by competent clinicians. However, there is evidence that inappropriate neurofeedback training has the potential to increase seizures, depression, anxiety, OCD symptoms, sleep disturbance, headaches, anger, emotional lability, and increase mental fogginess. Thus individualization of treatment and clinician competency are important.
Of particular concern is the fact that some equipment manufacturers are seeking to fly under the FDA’s radar and not registering their equipment. Consequently, an increasing number of lay persons are inappropriately and illegally obtaining neurofeedback equipment, which according to FDA regulations should only be sold to licensed health care professionals or with their written prescription. Many of these lay persons somehow presume that they are qualified to put electrodes on the heads of people with serious psychological and medical problems and to then seek to alter how their brain functions.
Therefore, it is vitally important for psychologists to be aware of the need for consumer protection. Lay practitioners not only have the potential to harm members of the public or to simply be ineffective, but they also jeopardize the specialty of neurofeedback because such practices will undoubtedly result in (1) future legal actions for harm done (one current case is pending), and (2) the disparagement of the field by legitimate professionals and disillusioned members of the public.
It is crucial for licensed professionals to report lay neurofeedback practitioners to state regulatory bodies as practicing psychology and medicine without a license when they are found to be offering services for medical, psychiatric and psychological conditions. It is also important that licensed professionals obtain thorough training when adding EEG biofeedback as an additional specialty.
Licensed clinicians obtaining training in neurofeedback are strongly encouraged to pursue specialty certification from the Biofeedback Certification Institute of America (www.bcia.org) and to become associated with the professional societies within this specialty (the International Society for Neurofeedback and Research [www.isnr.org] and the Association for Applied Psychophysiology and Biofeedback [www.aapb.org]) .
Dr. Hammond is a Psychologist and a Professor in Physical Medicine & Rehabilitation, University of Utah School of Medicine. His eâ€“mail is D.C.Hammond@utah.edu
Source: The National Psychologist (May/June 2008), 17(3), p. 7