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2006 Los Angeles Times |Physical therapy for the brain

2006 Los Angeles Times |

Physical therapy for the brain

Treating certain ailments without drugs is possible with

neurofeedback. It lets patients view and modify their mind's

activity.

By Eric Jaffe, Special to The Times

November 27, 2006

EVERY week for two years, Michael Hammett stared at a

computer screen, trying to open a flower with his mind.

Hammett had developed a case of carpal tunnel syndrome so

severe he needed surgery. But being a former opiate abuser, he

refused to use the medications that would be needed to control

the resulting pain. Having already tried physical therapy, he set

his mind on another alternative: neurofeedback.

In neurofeedback, people with mental or psychological

conditions learn to regulate and reduce their symptoms - in

Hammett's case, pain - by monitoring their brain waves on a

computer. The treatment is an increasingly popular cousin to

biofeedback, in which people control physical stress by

monitoring their heart rate or muscle tension.

Hammett learned to do both. Electrodes attached to his scalp

transmitted electrical signals from his brain to a computer

displaying a closed white flower. Other sensors were attached to

muscles in both his hands and arms. As Hammett learned what

it felt like to relax these muscles, and therefore reduce his pain,

the flower began to open. Over time, he trained his brain to

calm his central nervous system whenever the pain recurred.

"That image of the flower opening is so burned into my psyche,

in conjunction with the moment of relaxation," the 48-year-old

Santa Monica resident says, three years after finishing his

therapy.

Neurofeedback has been used for decades in private clinics, but

few well-controlled research studies have been done - giving it

an unscientific reputation. That's beginning to change.

Researchers are now studying and refining the therapy - with

promising results. Neurofeedback is being used to treat a

growing number of conditions, including chronic pain, attention deficit

hyperactivity disorder, asthma, migraines, post-traumatic

stress disorder, substance abuse, autism and a variant of

autism called Asperger's syndrome.

"We've done some definitive studies finally that show it works in

important ways," says Eran Zaidel, a professor of behavioral

neuroscience and cognition at UCLA's Brain Research Institute.

"It's still considered an alternative approach to medicine, but

some people won't do conventional medicine at all," he says.

"Many, many people are very eager to use this method."

Studies show the advantages

Neurofeedback therapy emerged from work done in the 1960s

by psychologist Barry Sterman, now professor emeritus at the

Mark Boster / LAT UCLA School of Medicine. He wired electrodes to the

heads of cats, then rewarded them whenever their brain waves

reached a frequency that indicated a relaxed state. In subsequent

experiments, Sterman found, cats that had learned to relax

themselves this way had a higher resistance to the onset of

seizures.

The medical applications seemed obvious: If people learned to

relax in such a way, they too might be able to stave off seizures

or anxiety attacks.

Such a method has advantages over simply taking a pill, says

Rob Kall, a neurofeedback practitioner in Newtown, Penn.

"When you're done with medication, it goes out of your system,"

Kall says. But when you're done with neurofeedback training,

the benefits remain.

Performers, athletes see a new way to focus

Performers and athletes are also discovering the benefits of

neurofeedback and a related form of biofeedback to help

them focus mentally and remain calm under pressure.

"The most dangerous thing for a performer is to get ahead or

behind themselves," says John Cheek, a bass singer with

the New York Metropolitan Opera. "That's what the

neurofeedback helps you do- to stay in that moment."

To train Cheek, psychotherapist Rae Tattenbaum applies

electrodes to the singer's scalp. These sensors send

electrical signals to a computer. When the signals appear

blue and a Tibetan bell sounds, Cheek knows his brain is

relaxed and calm. When Tattenbaum sees an abnormal

brainwave, she tells Cheek to refocus.

Over time, Cheek's brain reaches a relaxed state naturally,

enabling him to tune out distractions and concentrate on his

delivery.

Perhaps the most researched and accepted application of

neurofeedback is with patients who suffer from ADHD.

In 2002, a clinical team led by psychology professor Vincent J.

Monastra, director of the FPI Attention Disorders Clinic in

Endicott, N.Y., studied 100 children diagnosed with the

condition. All the patients received Ritalin and counseling, but

about half also received neurofeedback. Every week, Monastra

hooked electrodes to the frontal cortex of these patients and

taught them to increase arousal in that area. Heightened frontal

cortex activity reflects a reduction in hyperactivity and

improvements in attention.

After a year, all the patients showed some improvement. But

when the researchers discontinued treatment for a week and

reevaluated the patients, only those who received

neurofeedback retained those improvements.

The neurofeedback appeared to actually change the patients'

brain patterns, the research found, and neurological tests

showed greater activity in the parts of the brain responsible for

attention and behavioral control. The study was published in the

December 2002 issue of the journal Applied Psychophysiology

and Biofeedback.

Between drugs and neurofeedback, only the latter can

potentially offer long-lasting change, says clinical psychologist

Roger deBeus of Eastern Virginia Medical School in Norfolk,

Va. "As the brain becomes more normal, patients don't need as

much or any medication," he says.

Russ Ramsay, associate director of the Adult ADHD Treatment

and Research Program at the University of Pennsylvania, says

patients are intrigued by the possibilities. "More people are

seeking it out and entering into the treatment," he says.

Cravings can be lessened with neurofeedback too. Clinical

psychologist Stephen Sideroff of the UCLA School of Medicine

published the first controlled study examining neurofeedback as

a tool to help substance abusers. The study enrolled 120

patients from a residential treatment program in Los Angeles;

the group included those who were dependent on alcohol,

heroin, crack and methamphetamine.

In addition to counseling, half the patients received

neurofeedback, in which they learned to stabilize certain brain

waves related to stress that comes with the initial phases of

substance abuse recovery. After a year of treatment, 77% of the

users who had received neurofeedback training remained

abstinent, compared with 44% of the control patients, according

to research published in 2005 in the American Journal of Drug

and Alcohol Abuse.

Precision up for debate

Some critics of neurofeedback have said it's too imprecise.

Electrodes placed on the scalp can detect brain waves toward

the surface of the brain, they say, but might fail to measure

waves at sub-cortical levels, such as those involved in attention

and arousal regulation. Several advances in neurofeedback,

however, promise more precise readings.

Monastra now uses a technique known as multi-channel

neurofeedback. Instead of focusing on just one part of the brain,

the technique gives readings from many brain regions.

"As we become more aware of the different subtypes of

neurological problems, we use specific protocols to address

those problems," he says. "Chances are we'll start to get even

more robust results."

Multi-channel neurofeedback surveys the brain's surface to

locate an abnormality, but another type of therapy actually looks

into the core. The therapy - low-resolution electromagnetic

tomography - can show clinicians signals from regions deep

below the scalp.

"The idea is, if we can get more specific, we can intervene

faster and more effectively," says Leslie Sherlin, who is getting

his doctorate in psychology at Capella University in Minnesota.

In tests with obsessive-compulsive patients, Sherlin located

increased neural activity in the cingulate gyrus, an area toward

the brain's core that's involved in regulating attention and

arousal.

Over-arousal in this area causes patients to ruminate on germs

or other obsessions, he says. Teaching patients to regulate the

brain waves from the gyrus could lead to improved treatment of

obsessive-compulsive disorder, according to an analysis of the

technique that Sherlin published in Neuroscience Letters in

2005.

Promising but not yet accepted

Neurofeedback has yet to achieve widespread acceptance.

"Many people out there feel threatened by it, because people

are putting it out there as alternative," says psychologist Jeffrey

Bone, who runs a private practice in Orange County and began

using neurofeedback a year ago.

"I see it as a complement to medicine or psychotherapy, not a

challenge or alternative."

But neurofeedback researchers expect acceptance of the

therapy to grow.

For starters, the therapy is cost effective, they say. In the case

of asthma, for example, if a biofeedback session costs about $

150 - a typical rate in most clinics (neurofeedback costs about

the same) - then the patient has acquired an unlimited

therapeutic tool for the price of about four months of steroid

medication, says Paul Lehrer, professor of psychiatry at Robert

Wood Johnson Medical School in New Jersey.

Says UCLA's Sideroff: "There are a lot of obstacles. But it's an

effective tool, so I think it will keep growing."

2006 Los Angeles Times |