Neurofeedback - History and Application

History and Application

In 1924, the German psychiatrist Hans Berger connected a couple of electrodes (small round discs of metal) to a patient's scalp and detected a small current by using a ballistic galvanometer. During the years 1929-1938 he published 14 reports about his studies of EEGs, and much of our modern knowledge of the subject, especially in the middle frequencies, is due to his research.

Berger analyzed EEGs qualitatively, but in 1932 G. Dietsch applied Fourier analysis to seven records of EEG and became the first researcher of what later is called QEEG (quantitative EEG).

Later, Joe Kamiya popularized neurofeedback in the 1960s when an article about the alpha brain wave experiments he had been conducting was published in Psychology Today in 1968. Kamiya’s experiment had two parts. In the first part, a subject was asked to keep his eyes closed and when a tone sounded to say whether he thought he was in alpha. He was then told whether he was correct or wrong. Initially the subject would get about fifty percent correct, but some subjects would eventually develop the ability to distinguish between states and be correct a highly significant percentage of the time. In the second part of the study, subjects were asked to go into alpha when a bell rang once and not go into the state when the bell rang twice. Once again some subjects were able to enter the state on command. Others, however, could not control it at all. Nevertheless, the results were significant and very attractive. Alpha states were connected with relaxation, and alpha training had the possibility to alleviate stress and stress-related conditions.

Despite these highly dramatic claims, the universal correlation of high alpha density to a subjective experience of calm cannot be assumed. Alpha states do not seem to have the universal stress-alleviating power indicated by early observations. However, this is not cause to reject the concept of biofeedback entirely. Many other biofeedback treatments have emerged, since Kamiya’s alpha experiments.

At one point, Martin Orne and others challenged the claim that alpha biofeedback actually involved the training of an individual to voluntarily regulate brainwave activity. James Hardt and Joe Kamiya, then at UC San Francisco's Langley Porter Neuropsychiatric Institute published a paper, proving the efficacy of EEG biofeedback training, and that it was not just related to visuo/motor eyes open or closed factors.

In the late sixties and early seventies, Barbara Brown, one of the most effective popularizers of Biofeedback, wrote several books on biofeedback, making the public much more aware of the technology. The books included New Mind New Body, with a foreword from Hugh Downs, and Stress and the Art of Biofeedback. Brown took a creative approach to neurofeedback, linking brainwave self-regulation to a switching relay which turned on an electric train.

The work of Barry Sterman, Joel F. Lubar and others has indicated a high efficacy for beta training, involving the role of sensorimotor rhythmic EEG activity. This training has been used in the treatment of epilepsy, attention deficit disorder and hyperactive disorder,. The sensorimotor rhythm (SMR) is rhythmic activity between 12 and 16 hertz that can be recorded from an area near the sensorimotor cortex. SMR is found in waking states and is very similar if not identical to the sleep spindles that are recorded in the second stage of sleep.

For example Sterman has shown that both monkeys and cats who had undergone SMR training had elevated thresholds for the convulsant chemical monomethylhydrazine. These studies indicate that SMR is associated with an inhibitory process in the motor system and therefore increasing SMR through operant conditioning increases the ability to control seizures.

Neuroimaging studies have correlated ADHD with abnormal functioning in the anterior cingulate cortex (ACC) during tasks involving selective attention. In 2006, Johanne Levesque et al. published results from their fMRI study showing normalization of ACC activation during a selective-attention task in ADHD subjects who had undergone neurofeedback training. Subjects in the study were randomly assigned to either the neurofeedback treatment group or a no-treatment control group, and subjects from the latter showed no difference in ACC activation compared to their baseline.

A significant bibliography on the efficacy of EEG biofeedback documented in refereed journals is listed at isnr.org.

For years, EEG biofeedback was treated as a minor part of the field of biofeedback, particularly by the primary biofeedback organization, AAPB. In 1993, three different efforts, somewhat overlapping, dramatically increased the energy and influence of EEG biofeedback.

In February 1993, Rob Kall, president of Futurehealth, organized the first annual Winter Brain Meeting, in Key West Florida. The meeting brought together many of the leading figures in the field and it created a setting where the leaders could discuss and plan strategies for building greater influence and organization to move the field forward.

In April 1993, Ken Tachiki, Jim Smith and Bob Grove organized a meeting of leaders in the field of Neurofeedback on Catalina Island, immediately before the 1993 AAPB meeting. Further planning took place at this meeting and the beginnings of SSNR occurred. SSNR= Society for the Study of Neuronal Regulation. Since then, SSNR has evolved to become ISNR International Society for Neuronal Regulation, and is now known as the International Society for Neurofeedback & Research ISNR.

Immediately after the Catalina meeting, at the 1993 AAPB meeting, a new EEG section was formed, after plenty of lively discussion. It quickly grew to become the biggest section of the organization. Things were never the same at AAPB. Neurofeedback had become a mainstream part of the field, though it took a few years to fully integrate into the annual meeting and journals.

Within the last 5–10 years, neurofeedback has taken a new approach, in taking a second look at deep states. Alpha-theta training has been used in the treatment of alcoholism, other addictions as well as anxiety. This low frequency training differs greatly from the high frequency beta and SMR training that has been practiced for over thirty years and is reminiscent of the original alpha training of Elmer Green and Joe Kamiya. Beta and SMR training can be considered a more directly physiological approach, strengthening sensorimotor inhibition in the cortex and inhibiting alpha patterns, which slow metabolism. Alpha-theta training, however, derives from the psychotherapeutic model and involves accessing of painful or repressed memories through the alpha-theta state. The alpha-theta state is a term that comes from the representation on the EEG. The most recent development in the field is a conceptual approach called the Coordinated Allocation of Resource Model (CAR) of brain functioning which states that specific cognitive abilities are a function of specific electrophysiological variables which can overlap across different cognitive tasks. The activation database guided EEG biofeedback approach initially involves evaluating the subject on a number of academically relevant cognitive tasks and compares the subject's values on the QEEG measures to a normative database, in particular on the variables that are related to success at that task. The approach has been able to improve auditory memory some 3 standard deviations (or 300%) in a group of 20 memory impaired learning disabled and attention deficit disorder children. The subject's memory was better than the control group following the treatment. Reading memory in a group of 7 reading disabled children has been shown to increase by some 2.4 standard deviations (or 334%) with this approach. Published research has also indicated a 2.61 standard deviation improvement in a group of 19 mild-moderate traumatic brain injured patients. These patients also were performing above the control group at the end of the treatment period.