- What is biofeedback?
- What is EEG neurofeedback?
- What is videofeedback (DVD neurofeedback)?
- How is EEG neurofeedback done?
- How does EEG neurofeedback work?
- Why is this method effective?
- Who is neurofeedback suitable for?
- Are there any age restrictions?
- What effects can be achieved?
- How long will it take to achieve effects?
- Are the effects of the training permanent?
- Does EEG training change personality?
- How long does the training usually take?
- How frequent should training sessions be?
- Is EEG training covered by insurance?
- My doctor is skeptical of neurofeedback.
- Can neurofeedback have side effects?
- How do experts rate neurofeedback?
- The effectiveness of neurofeedback
WHAT IS BIOFEEDBACK?
The simplest interpretation: biofeedback is a mirror. Biofeedback, which we all practice every day, is a look in the mirror. We don’t see what other people see – and what the mirror “sees”. Our face, what we show ourselves to the “world”, to other people all the time, what they recognize us by. What everyone else sees when they look at us, we cannot see without a tool, without a mirror.
The most telling information about ourselves, the face and its expression, is only seen by other people – and the mirror. In the mirror we see ourselves as we are seen at all, as others see us. The mirror shows other people how they look at us, how they see us. Others are always in the mirror: even when they are not standing next to us, so that we can see the look on their faces when they see us. After all, we always already have their gaze in our imagination, in our memory… in our mirror.
For the others, that is, those whom the mirror expresses, we initially comb, wash, paint, we first adjust our facial expression for the others in order to make ourselves look acceptable, to look good… And those “others”, their gaze, are in the end, ourselves. We want to feel better, to look better for our own sake – for the sake of our image.
The principle of biofeedback is at its core this mirroring. Seeing through an aid, a tool, an instrument, what cannot be seen without it. Using tools/apparatuses to gain information about ourselves so that we know what we are mirroring: to adjust it, to improve it … to heal it. Whether it is the way we look, what the scale tells us, the thermometer, the regularity of our heartbeat, or the image of the electrical currents produced by the brain. Biofeedback is a unique way to change.
Scientific Explanation. In this sense, biofeedback has accompanied civilization since the beginning. Culture is defined by the use of images that represent something – symbols. The first societies, ancient Egypt and others, used mirrors and scales. The scales are the object; but the weight of something, the measure of weight, is the symbol. (*) Biofeedback is an essential, defining part of human culture; without it, there is no culture at all.
Every time we look in the mirror, step on a scale, take our temperature with a thermometer, we are using biofeedback – feedback mediated by an instrument/device. The scale conveys the information if we overdid it with the Christmas candy. The thermometer will tell us if we have a fever and should go to bed. Both tools give us “feedback” – information about our condition, a picture of ourselves. Armed with this information, we can take steps to improve our condition. Když máme horečku, jdeme do postele – pokud ovšem na signály svého těla dáme. Když jsme přibrali na váze, rozhodneme se méně jíst – a dokonce to někdy uděláme.
Psychologists, doctors, professionals working with biofeedback, use the signals of their more or less complicated devices in the same way that everyone uses a scale or a thermometer: so look at yourself!
(*) Illustrative is the child’s answer to the classic trick: Is a kilo of iron or a feather heavier? Even a very intelligent eight-year-old child answered me: “a kilo of iron, sure”. He still doesn’t understand the kilogram as a symbol – as the equivalent of weight, the same for heavy and light things.)
So-called feedback is used in all learning, training, treatment. The doctor saying “lose weight”, the teacher saying “you read that right”, the coach shouting “add more”, they all give feedback by speech. The psychologist as a friend by profession gives feedback: “talk yourself out of it”, or “relax your muscles, take slow deep breaths…” Feedback informs us that we have a problem. Biofeedback equipped with a device automatically and continuously gives us information about how we can fix it.
WHAT IS EEG BIOFEEDBACK (NEUROFEEDBACK)?
EEG biofeedback, or neurofeedback for short, is a method that allows you to control the electrical activity produced by the brain (as measured on the surface of the skull).
World-renowned neurologist, Professor Josef Faber, MD, DrSc, says that any statement we make about the brain can be true – because the human brain is so unimaginably complex that we can’t think of a thing that doesn’t fit it.
So we can also imagine – among a thousand other things – the brain as a gigantic power plant, made up of 100 billion tiny batteries (nerve cells) with 500 trillion interconnections between them.
Actually, we can’t – we can’t even imagine such numbers. We don’t yet know of a thing in the entire universe more complex than the human brain – except in the universe itself. Biologist Joseph put it this way: If our brains were so simple that we could understand them – then we ourselves would be too simple to understand anything.
This is self-learning of the brain through what is called biological feedback. When you get immediate, targeted, and accurate information about the tuning (or “out of tune”) of your brain waves, you can learn how to bring them into alignment.
The frequencies of electrical brain activity that the brain learns by feedback are determined by scientific knowledge of how the brain functions in certain states or during certain performances. They have been derived from studies of individuals whose electrical output of the cerebral cortex is somewhat “out of tune” through illness, injury, etc., as well as those whose electrical output is optimally “tuned”, such as pilots, athletes, yogis, etc.
WHAT IS VIDEOFEEDBACK?
Videofeedback is a new way to bring biofeedback closer to the everyday experience of modern people who watch TV, movies on the computer or in the cinema every day. The biofeedback is provided by an actual movie, chosen by the client.
The trainee watching the film on the screen sees the finished result of his or her current state of attention.
A realistic picture of the interplay of the factors we need to watch a movie (calm versus restlessness, relaxation versus tension, attention versus inattention) allows for multiple feedback or several kinds of feedback. For example, if the “viewer” is restless, unfocused, preoccupied with something else, the image breaks down and the film disappears. When the body is tense, the image fills with lightning. If the trainee does not show sufficiently sharp, sustained attention, the image will unravel (like the “ghosts” in analog television).
In order for the trainee to maintain the normal course of the film, or for a clear image to reappear, he needs to concentrate, for example. Of course, depending on the training setup, the feedback can be used to train relaxed, resting perception, or conversely to train peak performance in work, sports, art.
In summary, then, we also control the normal image of the film by the activity of the brain. When the brain activity increases in the desired brain wave band, the viewer watches the smooth flow of the movie as in a cinema. When the desired brain activity is insufficient, or when the activity in the undesired band increases, the image in the film becomes distorted until it is lost altogether. The motivating clue is the simple, “normal” plot of the film. It is a fast, efficient and automatic learning of a new, more appropriate spectrum of brain wave frequencies.
Videofeedback is particularly suitable for
– preschool children
– very restless children,
They use it to get the discipline they need at school – without realising that they are learning very intensively.
It is also beneficial for individuals who – perhaps as a result of an accident, stroke, etc. – have a weakened ability to perform, a weakened will to overcome obstacles.
HOW IS NEUROFEEDBACK DONE?
In the initial assessment we will find out what you need and want to improve about your brain functioning, whether concentration, attention, willpower, memory, relaxation, etc. We try to find out why your brain is not functioning as it should. We provide a recording of your EEG (an electroencephalogram is a description of the electrical activity of the brain).
We will do a trial neurofeedback training session to gauge what success may be possible for you. We will usually get this result after the first trial session, as we can read the so-called learning curve from it.
Neurofeedback training is non-violent, painless and playful. If it is carried out by a professional, it does not pose a risk because it has no side effects. It is not addictive and its effect is long-lasting.
The technique uses sensing electrodes attached to the top of the head and two electrodes attached to the ears. An EEG sensor picks up brain waves and transmits them to a computer. The computer analyses the signal and provides ‘feedback’. Feedback is information about how the brain waves are working at a particular moment.
HOW DOES NEUROFEEDBACK WORK?
Feedback in the form of a video game
You see the progress of your brain waves in front of you on the screen “translated” into the form of a video game that you play with the power of your thought alone – pure willpower, without a keyboard or mouse. The “game” is controlled only by the action of your brain. In other words: the brain controls itself. When brain activity increases in the desired brainwave band, the player is rewarded with successful results. Then, as activity in the undesirable band increases, success in the game disappears. The brain gradually responds to the motivational cues provided by the computer by rewarding it for good performance in the game. Thus the brain itself develops a process of learning new, more appropriate brain wave frequencies.
WHY IS THIS METHOD EFFECTIVE?
First of all, because EEG training uses a combination of the essentials that the human mind needs:
– One need constant activity, hunger for stimuli and learning;
– the second need is simplification of activity, comfort and laziness, the desire to relieve oneself of problems and relax.
It follows that our brains like to learn how to make problem solving easier, faster, more enjoyable when shown how to do it.
The brain is extremely adaptable and capable of learning, and so it can improve its own performance if it is given immediate and targeted information on how to do so.
Giving the brain the opportunity to better control itself will bring you a whole host of benefits because it does it spontaneously and constantly. Therefore, the results of training are usually permanent (there are cases where the permanence of the effect has been observed for over twenty years).
The whole process is very similar to normal learning or exercise, but unlike that, you cannot overload your brain with learning. When the training process reaches its peak, it is already stored in memory and new functions.
WHO IS NEUROFEEDBACK SUITABLE FOR?
For anyone who wants to improve the functioning of their nervous system. There are many causes of various brain dysfunctions that are helped by improved neural regulation. At the end we give an overview of health problems for which neurofeedback has been successfully applied, compiled from scientific publications. It can be considered the method of choice, especially for disorders of attention, concentration, learning, etc.
DOES NEUROFEEDBACK TRAINING HAVE AGE RESTRICTIONS?
Practically no. Neurofeedback was discovered experimentally in cats, then documented in monkeys and dogs. This implies that it can be practiced by infants (clinical successes are reported as early as 2 years of age).
It is particularly suitable for children who have been advised to defer schooling in pre-school age, are in speech therapy, have difficulties in the kindergarten team, etc.: early correction of mild brain dysfunctions can spare the child, his parents and his teachers much more serious suffering at school.
For older people, neurofeedback has a positive effect on insomnia, cognitive functions (mental freshness, attention, memory), headaches or back pain.
WHAT EFFECTS CAN BE ACHIEVED?
Neurofeedback is effective depending on the severity of the problem.
The most effective applications are sleep disorders.
Nocturnal enuresis in children is corrected in about 20 sessions in 99% of cases. Insomnia type problem fall asleep almost as well. Insomnia type waking up at night in 95% (in about 30 sessions).
If you are suffering from the general effects of stress – the most common of which are difficulty falling asleep or insomnia – (e.g., managerial stress syndrome), your condition will generally calm down with training. Sleep will improve, and the ability to concentrate will return or improve. Your performance (memory, decision-making, planning) is accelerated, your willpower is strengthened.
If you have attention, concentration, learning, behavioural or similar problems (called mild brain dysfunction), your impulsivity, volatility, restlessness or aggression respond to the training during the training.
Your behaviour will calm down, you will control yourself better, you will strengthen your willpower.
Your thinking skills may also improve: children who have suffered from attention deficit disorder have been shown in a number of studies to have increased scores on IQ tests – around 10 points in various studies, and 20 points in the most successful cases.
If you suffer from sleep disorders, difficulty falling asleep and insomnia disappear, and night terrors and bedwetting disappear in children. Insomnia and enuresis are the most reliable indications for neurofeedback – the effectiveness is almost 100%!
In the indicated cases of chronic headaches (migraines), back pain and similar painful conditions, symptoms will subside to disappear in normal (tension) headaches in about 20 sessions, in migraines after about 30 sessions.
If anxiety and depression are among your problems, neurofeedback training will improve your mood.
Feelings of tiredness and weakness will be reduced, your contact with your surroundings will improve and your memory will sharpen.
The first clinical application of the method was in 1972 in an epilepsy patient; as of 2010, there are over 100 papers documenting the effect in epilepsy. A meta-analysis of 63 studies in chronic, medication-resistant epilepsy found a significant decrease in seizures in 74% of people (Clinical EEG and Neuroscience 2009). Seizures are less intense after training, their frequency decreases, and they disappear completely in mild and moderate conditions. In children and young people who do not have a long history of seizures, we record complete disappearance of seizures in 90% after 40-60 sessions.
In cerebral palsy, improvement in cognitive function (up to inclusion in normal school) and motor skills can be achieved in about 100 sessions.
In mental retardation, behaviour improves, seizures stop, etc. in more than 100 sessions.
Although neurofeedback usually produces very beneficial and lasting changes, there are understandably conditions where the damage to the brain is such that remediation is not possible – or (more often) the improvement may be only partial.
If the training is not helpful for the individual and their problem, the trained practitioner will openly communicate this.
HOW LONG DOES IT TAKE TO ACHIEVE EFFECTS?
Already from the initial EEG examination to determine whether the training will have the desired effect. The number of sessions is usually limited. As in any learning process, the results of training are seen gradually.
In general, the speed of onset of effect is related to the number of sessions required in total.
In adults who do not suffer from serious difficulties, the effect is often apparent after the first sessions.
For problems that are usually neurophysiologically “mild” and are remedied by training of about 20 sessions, the effect is usually seen after perhaps 5 sessions.
For most conditions, initial progress should be evident after ten sessions, with younger children developing an effect after about twenty sessions.
For severe conditions such as cerebral palsy or mental retardation, which need long-term training, it may take up to 40 sessions to develop an effect (if the child needs at least twenty sessions to sit still, the onset of actual training cannot be too rapid either).
ARE THE EFFECTS OF THE TRAINING PERMANENT?
The effect of neurofeedback is permanent; it is about learning, much like the art of reading and writing. Once the brain learns the relevant procedures, it stores them in memory and can use them automatically.
This is evidenced by the permanent changes in the brain detected by research and clinically: changes in electrical activity in EEG, evoked potentials, blood flow, and changes in organic tissue detected by magnetic resonance imaging. There are cases in which the permanence of the effect has been monitored for 30 years.
DOES EEG TRAINING CHANGE PERSONALITY?
Some aspects yes, some aspects not. Personality and character are shaped by long-term development in interpersonal relationships. However, if someone suffers from brain wave disharmony, causing inattention and distractibility, or restlessness, impatience, explosiveness, it shows in their behaviour. When these disharmonies are corrected and disappear from behavior, his true inner personality comes more to the surface:
– resistance to stress increases.
– Interpersonal relationships improve.
– Improvements in ability and performance will also increase the individual’s self-confidence and self-esteem, which tend to be understandably reduced in various dysfunctions.
For overall targeted personality change, psychoanalysis is the optimal method. However, neurofeedback, when appropriately indicated, requires only one-tenth of the sessions needed. In neurofeedback, the client does not usually talk about himself. It is therefore also an ideal method for people who do not like to confide and for those who carry various official and official secrets.
HOW LONG DOES THE TRAINING USUALLY TAKE?
The length of training depends on the goal you want to achieve, the severity of the difficulty and your age. As a guide, it can be graded as follows:
If you are an adult and your brain is functioning well, but you want to improve your performance (managers, entrepreneurs, mental workers), a conditioning training of 20 sessions is sufficient.
If you have mild problems, such as insomnia or anxiety, a basic treatment is about 20 sessions.
For simple attention disorders, lack of focus, distractibility, restlessness, about 40 sessions are needed for children, 30 sessions are enough for adults.
For more persistent dysfunctions such as learning disorders – dyslexia and dysgraphia, developmental speech defects such as dysphasia, or behavioural disorders such as hyperactivity/hypoactivity, and other so-called mild brain dysfunctions, 60 sessions are usually needed (about 40 for adults).
For severe conditions such as epilepsy, autism, conditions after mild (closed) head injury, etc., count on 60 to 80 sessions to achieve a significant and lasting effect.
For the most severe conditions such as combined neurological disorders (e.g. autism + epilepsy), cerebral palsy, mental retardation, severe head injuries, etc., 100 or more sessions are worthwhile.
HOW FREQUENT SHOULD THE TRAINING SESSIONS BE?
At the beginning it is advisable to train regularly and intensively, on average 2 – 3 times a week or more. When you get noticeable results, you can slow the pace down to 1-2 sessions per week.
IS EEG TRAINING COVERED BY INSURANCE?
Unfortunately. Health insurance companies do not cover the methods as such, but their indicated use for selected medical disorders. If and when depends on a number of approval bodies and authorities, then health insurance companies, not operators. Certainly a recommendation by a specialist physician will be needed; neurofeedback is covered by this selective method in the USA and Germany. (The method was developed in the USA; it has a short tradition in the Czech Republic.)
The Health Insurance Act also allows coverage for treatment not included in the list of medical procedures (§ 16). According to the experience of our clients, health insurance companies have sometimes reimbursed training for severe conditions (epilepsy, conditions after brain injury). The decision is made by the insurance companies’ reviewing doctors on the basis of a previously submitted application.
The training may be covered by accident insurance, liability insurance, etc. This depends on the wording of the specific insurance policy.
It is also possible to apply to the Social Welfare Department for a medical allowance. There are many cases where social welfare has made a contribution.
MY DOCTOR IS SKEPTICAL OF NEUROFEEDBACK.
Biofeedback is a psychological method; not every doctor needs to know about every psychological method. A method that offers to improve problems that may have lasted for years can understandably cause scepticism. We can make available data from the 1000’s of research and clinical studies available to us, and offer personal consultation as well as our own experience. We offer an overview in the appendix
CAN NEUROFEEDBACK HAVE SIDE EFFECTS?
EEG Neurofeedback training, expertly performed, usually has no harmful side effects because it is a so-called non-invasive method: nothing is “put into the person”, the client works with his own expression.
Exceptionally, someone may feel tired, sleepy, congested, tense, anxious, or experience a headache. These feelings usually disappear within a short time after the session. Only very rarely (less than a per mille) have significant side effects been reported. (Statistics from the Biofeedback Institute Prague: approximately 5000 people have received training since the method was introduced in 1996. We have a case of headache following a training session in 2000 and another in 2009.)
The leader of the training is responsible for its safety. It is therefore essential that the training is conducted by a specialist who has received training in the method and can provide evidence of this with a certificate. The training should be led either by a university specialist in working with people (psychologist, teacher, doctor) or by a high school student working under his supervision and guarantee, who has completed practical training, theoretical training (min. basics of EEG and neurophysiology), training on himself, and also supervision of his work with clients in a proven institute.
During the EEG training of clinical cases, the centre cooperates with other specialists (neurologists, psychiatrists, psychologists, educators), provides relevant professional examinations (EEG, psychological tests, etc.) and, where appropriate, participates with the attending physician in the management of treatment.
HOW DO THE EXPERTS EVALUATE NEUROFEEDBACK?
The US Department of Health publishes reviews of effective protocols according to research findings.
The Department’s opinions: biofeedback is used to treat a very wide range of conditions and diseases, affecting blood pressure, temperature, brain wave activity, digestive functioning, etc.:
Stress
Sleep disorders
Migraine i. Headaches
Hypertension
Vascular and circulatory disorders
Respiratory disorders
Urinary and faecal incontinence
Muscle spasms
Partial paralysis
Muscular dysfunction due to injury
Epilepsy
Alcohol and other addictions
Source: U.S. Department of Health and Human Services: What is Biofeedback (Publication 83-1273) 1983.
Experts working with the method (mainly in universities) have compiled and published thousands of studies in scientific journals.
The most prominent figure promoting neurofeedback is neurosurgeon Karl Pribram – the founder of contemporary neuroscience, discoverer of the holographic structure of the brain, and one of the most respected figures in contemporary world science in general – who is co-editor of the seminal neurofeedback journal, the Journal of Neurotherapy, where much research on the effectiveness of the method has been published.
The expert who discovered the method after many years of laboratory research and successfully applied it in clinical practice (he published the first case of seizure reduction in epilepsy in 1972), neurophysiologist Professor Sterman, has worked for many years for NASA in training American astronauts and for the US Air Force in training military pilots.
THE EFFECTIVENESS OF NEUROFEEDBACK?
Effectiveness has been repeatedly verified using objective criteria. We found over 200 conditions in which neurofeedback was applied with positive effect in clinical application notes.
Serious studies
– studies with a control group
– studies involving hundreds of cases
– long-term follow-up of the durability of the effect
– repeated studies in a range of diagnoses
have been carried out many times, especially for cognitive disorders (ADHD, learning disorders, memory disorders, etc.), emotional disorders (anxiety disorders), behavioural disorders and seizure disorders. They consistently report a positive effect, measured by objective criteria (clinical symptoms, EEG, psychological tests).
As early as 2000, clinical effectiveness was assessed by independent neurologists as
– proven effective for the following diagnoses: attention deficit disorder, epilepsy, anxiety disorders
– probably effective in depression, addiction, brain injury.
The effect of neurofeedback is clearly positive. The method has been systematically used and monitored since 1958. The reported side effects over 55 years can be counted on the fingers.
In the last decade, the number of successful applications has expanded:
– in the field of the most severe medical conditions: successful applications in mental retardation, cerebral palsy and Down’s syndrome.
– in the field of development of peak abilities and performance:
successful applications in elite sports (gold medal winner in shooting at the Beijing Olympics shooting David Kostelecky, Canadian Olympic team – winner of the Vancouver Winter Olympics, winner of the 2006 World Cup Italy)
– Successful applications in high-end demanding professions – improving performance in eye surgeons, actors and dancers (study by Imperial College London)
The list of conditions for which neurofeedback has been proven to be effective is based on approximately 1000 research and clinical studies published in scientific journals. It is available on the Internet, in the largest collection of medical literature – abstracts of articles in scientific journals of the US National Library of Medicine (called Medline):
| INDICATIONS FOR NEUROFEEDBACK | Required number of sessions approx: |
| FITNESS | 20 |
| Psychofitness for mental health professionals | |
| Peak performances | – 30 |
| Peak experiences | |
| PROFESSIONAL: | 20 – 30 |
| Managers | |
| Pilots | |
| Drivers | |
| Operators | |
| Dispatchers | |
| Security services | |
| Athletes (especially shooting, golf etc..) | |
| Managerial syndrome | 30 |
| Tremor, tension before and during exercise | 20 |
| CLINICAL: | |
| Attention deficit + hyperactivity disorder | 40 |
| Specific learning disabilities, dyslexia, dysgraphia | 40 |
| Combined attention, learning, behavioural disorders | 60 |
| Sleep disorders (in childhood and adulthood): | |
| Trouble falling asleep, fear and anxiety | 20 |
| Enuresis nocturna (bedwetting) | 20 |
| Insomnia | 10 – 20 |
| Night terrors | 20 – 30 |
| Somnambulism | 30 |
| Sleep apnoea central | 40 (– 60) |
| Developmental speech disorders | 20 – 30 |
| Stuttering | 30 |
| Endogenous depression, manic-depressive disorder | 60 |
| Depression in childhood | 60 |
| Addictions (alcohol, smoking, drugs, gambling) | 40 |
| Tremor, tension before and during exercise | 20 – 30 |
| Tréma, napětí před a při výkonech | 20 |
| Post-traumatic stress disorder | 30 – 40 |
| Behavioural disorders | 40 – 60 |
| Chronic headaches (tension headaches) | 20 |
| Migraine | 30 |
| Premenstrual syndrome | 30 – 40 |
| Menopausal problems (flushing, etc.) | 30 |
| Allergies | 40 – 60 |
| Carbohydrate metabolism disorders (hypoglycaemia, diabetes II) | 30 |
| Chronic fatigue syndrome | 60 |
| Immunodeficiency | 60 |
| Epilepsy | 40 – 80 |
| Autism | 60 – 80 |
| Traumatic brain injury | 60 – 100 |
| Symptom relief/rehabilitation (speech, motor) after stroke | 60 – 100 |
| Symptom relief/rehabilitation for cerebral palsy, mental retardation, Down’s syndrome and other severe developmental disorders |
> 100 |