Neurotherapy and Neurofeedback

Brain-Based Treatment for Psychological and Behavioral Problems

Theodore J. Chapin, Lori A. Russell-Chapin

• Publisher: Routledge
• Year: 2013
• ISBN:
  9781135099909
• Edition: 1
• Topic: Psychology
• Subtopic: Psychotherapy Counselling
• Index: Psychology

The fields of neurobiology and neuropsychology are growing rapidly, and neuroscientists now understand that the human brain has the capability to adapt and develop new living neurons by engaging new tasks and challenges throughout our lives, essentially allowing the brain to rewire itself. In Neurotherapy and Neurofeedback, accomplished clinicians and scholars Lori Russell-Chapin and Ted Chapin illustrate the importance of these advances and introduce counselors to the growing body of research demonstrating that the brain can be taught to self-regulate and become more efficient through neurofeedback (NF), a type of biofeedback for the brain. Students and clinicians will come away from this book with a strong sense of how brain dysregulation occurs and what kinds of interventions clinicians can use when counseling and medication prove insufficient for treating behavioral and psychological symptoms.

1
Introduction to Neurotherapy and Neurofeedback

The human brain is estimated to have about a hundred billion nerve cells, two million miles of axons, and a million billion synapses, making it the most complex structure, natural or artificial, on earth.

— Tim Green, Stephen Heinemann, Jim Gusella

When the authors of this book combine their past counseling work experiences, we have an amazing and varied clinical counseling history. Ted has been a licensed clinical psychologist for several decades and has been in private practice for the past 25 years. Lori has been counseling as a licensed clinical professional counselor and teaching graduate counseling courses for the past 25 years. During this time period, discussions inevitably evolve to outcome-based questions such as, “Does counseling actually work? If so, how do helping professionals know that it works?”

These questions stimulate wonderful personal and classroom debates about counseling’s efficacy. The conversations usually go something like this: There have always been counselors and a variety of other helping professionals throughout the history of mankind. From the village shaman to the wise sage to local pastors to licensed clinical professionals, people have been seeking out experts to help sort out the problems of daily living. In the beginning, the answer to “Does counseling work?” seemed a bit obvious.

Yes, counseling does work because “clients” come back and say they are feeling better in some way. When probing a bit more deeply, the answer is narrowed down further by specifically stating that the problem was gone or the presented behavioral symptoms have been reduced. Through research on counseling effectiveness, the largest predictor of counseling success is therapeutic alliance, over gender of therapist to theoretical orientation (Smith & Glass, 1977; Landman & Dawes, 1982; Lambert & Cattani, 1996).

Sometimes when cognitive therapy does not seem to be helpful, we then turn to medicine and psychopharmacology to assist us in reducing symptoms. Results of meta-analyses indicate that often the combination of counseling and medication is the best solution for many of our depressed adolescent clients (Bhatia & Bhatia, 2007). In the past, counseling and medication have been the two mainstay approaches for the treatment of behavioral and psychological symptoms.

Just as discussions revolve around counseling efficacy concerns, every year discussions arise about the brain. For years, we have been saying that in the future the advances in neuropsychology, neurobiology, and neurorehabilitation will change the way we all conduct counseling. That future has arrived with the advances in neuroscience and fMRI research. We were correct; this new information has changed our thinking about counseling. It must change how we conduct our counseling strategies and interventions. These advances in neuroscience allow clinicians to understand more fully the above beliefs about why clients change and how symptom reduction occurs.

Fortunately we have a third option for treatment of behavioral and psychological symptoms, neurotherapy and neurofeedback.

Therefore, the main purpose of this book is to provide a thorough understanding of many of the aspects surrounding the world of neurotherapy and neurofeedback. In Chapter 1, Introduction to Neurotherapy and Neuro-feedback, we will discuss in general terms the definition of neurotherapy (NT) and neurofeedback (NFB), the goals of neurotherapy and neurofeedback, and the basic principles. In-depth analysis of those topics will be covered in separate chapters. Chapter 2, The History of Neurotherapy, offers the reader an historical perspective of neurotherapy and neurofeedback. Then we showcase several of the pioneers in this field who have dramatically influenced the progress of neurofeedback. In Chapter 3, Sources of Brain Dysregulation, a thorough explanation of many of the reasons our brains become dysregulated are presented, from genetic predisposition to chronic illnesses. Chapter 4, The Neurophysiology of Self-Regulation, provides essential information to better understand the biological underpinnings of neuro-therapy and neurofeedback, explaining the functions of the autonomic nervous system and the polyvagal system. The remaining six chapters offer specific information about NT and NFB. For example, in Chapter 5, Strategies for Self-Regulation, distinct categories of NT are presented from biofeedback to neurofeedback. Chapter 6, Basic Concepts and Principles in Neurofeedback, describes the needed instruments, computers, electroencephalographs, and the learning principles of operant and classical conditional that allow NFB to work. Chapter 7, Assessment, Treatment Planning, and Outcome Evaluation, outlines the step-by-step procedures and processes necessary to conduct NFB. This chapter describes the expectations and types of assessments needed to gather information on each NFB client. Following a logical order, Chapter 8, Neurofeedback Training, Protocols, and Case Studies, delineates actual NFB protocols designed for specific symptoms from ADHD to Peak Performance. We offer several NFB case studies to illustrate the needed protocols and presenting symptoms. Chapter 9, Neurofeedback Efficacy Research, offers essential and useful information about efficacy ratings and NFB research. Chapter 10, The Future of Neurotherapy and Other Professional Issues, is our final chapter advocating for further NFB research, available resources, and ethical codes. We briefly visit the world of epigenetics and its impact on NFB.

Neurotherapy and Neurofeedback Defined

Neurotherapy is a form of neuromodulation. Neuromodulation simply means the alteration of some aspect of neuronal functioning. This could happen because of a variety of experiences, whether that occurs through physical exercise, learning a novel task, or neurofeedback. In future chapters, we will go more in depth about differing types of neurotherapy, but for now we will focus on neurofeedback (NFB), a type of neurotherapy involving a brain-computer interface (BCI) that maps certain aspects of a client’s neurophysiology (e.g., brain wave amplitudes for various frequency bands) to some form of feedback, usually audio or video, that allows the brain to monitor and manipulate the underlying EEG activity. NFB, sometimes called EEG operant conditioning, is a type of self-regulation training (Swingle, 2010). Sometimes neurofeedback is labeled biofeedback for the brain, noninvasive brain surgery, or a neurological tune-up. When applied correctly, NFB has been found to lead to clinical improvements in several mental health disorders (Yucha & Montgomery, 2008). According to Yucha and Montgomery’s thorough reviews, the authors rated the combined efficacy of biofeedback and neurofeedback a Level 4—“Efficacious” for anxiety reduction, attention disorders, chronic pain, epilepsy, and headaches. NFB “reinforces an optimal baseline of central nervous system self-regulation” (Legarda, McMahon, Othmer & Othmer, 2011, p. 1050). In addition, this self-regulation often decreases the need for multiple medications.

The Goals of NFB

Many neurotherapists believe that because of living life and allowing life to happen, our brains become dysregulated. Chapter 3 will emphasize many of the occurrences that may cause dysregulation. For this discussion, though, here are a few examples for dysregulation: high fevers, accidentally falling on your head, personal trauma, or misuse of alcohol and drugs. These situations may cause three very different categories of brain states: overarousal, underarousal and/or unstable arousal. Overaroused persons may have symptoms ranging on a continuum from highly anxious to chronic pain. Under-aroused persons may have symptoms from depression to ADHD, and the unstable aroused persons may be prone to anything from migraines to bipolar concerns.

The goal of NFB for any of these arousal states would be to reregulate and normalize brain functioning. Neurofeedback has the capacity to restore brain efficiency and begin to optimize personal and behavioral performance once again. This is accomplished with the principles of operant and classical conditioning. A neurotherapist will select a reinforcement brainwave target for a particular symptom such as ADHD. Perhaps there is not enough low beta in a child with ADHD, so the reinforcement target might be around 12–15 Hertz. Because the brain loves to be challenged, it will search for that targeted brainwave. When it hits that specified brainwave, it will be reinforced with a reward such as a full puzzle unfolding or a game moving forward. This is the action behind the principles of operant conditioning and learning in general.

There may be excess brainwaves causing symptoms as well. This same child with ADHD may have excess in theta and high beta. The neurotherapist might need to set two inhibits to help condition the brain to lower theta and high beta. These inhibits could have sounds attached to them, such as birds chirping, to remind the client there is too much theta. To remind them there may be too much high beta, a foghorn-like sound could be associated with high beta. When the client hears these sounds, it is a reminder, consciously and unconsciously, to lower those brainwaves. The brain wants those noises to go away and wants its goal to occur. Often, a client might work too hard or try too hard to make these sounds go away or make the puzzle unfold. The neurotherapist then has to teach the client to allow this natural process to occur. This may mean teaching the client some basic relaxation techniques or heart rate variability techniques. Eventually the brain wins out, and reinforcement and inhibit goals are achieved. Again these are basically the same principles of classical and operant conditioning and the principles of learning that change any behavior. These conditions all work together to assist the dysregulated brain to function in a more normal, regulated, and efficient manner.

Neuroplasticity and Neurogenesis

Through the advances of neuroscience, we better understand the brain, its functions, and its capabilities. In the last decade, brain research has debunked some old ideas, validated other existing beliefs, and offered new and encouraging interventions for helping people grow and learn. For years, educators and helping professionals believed that the brain matured around 12 years of age. Now with the help of functional magnetic resonance imaging (f MRI), researchers know that the adolescent brain is fully developed in the middle twenties (Giedd, 2004). However, neuroscientists now understand that the brain has the capability to adapt and develop new living neurons up until the very end of our lives, according to Dr. Norman Doidge, a psychiatrist at Columbia University Center for Psychoanalytic Training and Research in New York. This process is called neuroplasticity. “Neuroplasticity can result not only in one region of the brain colonizing another—with remarkable effects on mental and physical functions—but also in the wholesale remodeling of neural networks” (Doidge, 2007, p. 16). A brain can rewire itself, as authors Schwartz and Begley demonstrate in their 2003 book called The Mind and the Brain: Neuroplasticity and the Power of Mental Force.

The brain is no longer considered a stagnant organ, but rather three to four pounds of plastic, fluid, and malleable tissue. Human beings can change their brains and develop new pathways through repetition and learning new skills. Challenging and taxing the brain with new tasks such as learning a foreign language can forge different pathways in the brain. The capacity to restructuring our brain allows our brain span to match our life span. The old adage, “you can’t teach an old dog new tricks,” no longer holds true.

One of the early neurorehabilitation pioneers, Dr. Paul Bach-y-Rita, recounts a poignant, personal story about his beginnings in the world of neuroplasticity (Bach-y-Rita, 1980). His father, Pedro Bach-y-Rita, a 65-year-old widower, had a disabling stoke. Pedro was paralyzed and unable to speak. Dr. Bach-y-Rita’s brother, George, a medical student at that time, took his father in and was determined to help him recover. George first taught Pedro to crawl through painstaking and frustrating incremental movements. Then they begin to work on daily survival tasks such as washing dishes. They turned normal daily activities into life exercises. After months of struggles, Pedro slowly got better and better. Three years later, Pedro was able to return to his love of writing, poetry, and teaching. Pedro even remarried and became active in traveling and hiking. This story in itself has a wonderful and unique ending, but the best part of the story is yet to come. When Pedro was 72, he died of a heart attack while climbing in the high mountains of Colombia. Paul, curious about his father’s astonishing recovery, requested an autopsy. He wanted to see slides of his father’s brain. Paul’s emotions ran from shock to amazement. Paul could actually see the part of his father’s brain that had the lesion from the stroke. Ninety-seven percent of the nerves that went from his cerebral cortex to his spine were destroyed. The remainder of the slides, however, showed Pedro’s brain had reorganized itself and built new nerve growth that restored his higher life functions. Pedro’s brain slides dramatically demonstrated the devastation from the stroke and the creation of new growth. His determination, struggle, and hard work were clearly worthwhile. This dramatic story and countless other research results can also be read in Dr. Doidge’s remarkable 2007 book, The Brain That Changes Itself.

Our brains are changeable and malleable organs for the positive and negative, and we know we can reorganize and maintain our brains for the better. Negative neuroplasticity can occur through trauma, repeated negative events, poor environmental conditions, and even constant negative thinking. Positive neuroplasticity can develop by challenging the brain with a new task such as learning a musical instrument, physical exercise, and even counseling.

The research and stories described above are only the beginning of this exciting new frontier into our changing brains and neurorehabilitation. Neuro-feedback is just one more way we can help our brains. Swingle stated, “The mind is capable of astounding regeneration, growth and change” (2010, p. 31). Having the capacity to build new neuronal pathways, or neurogenesis, has far-reaching implica...

Table of contents

• Cover
• Title
• Copyright
• Dedication
• CONTENTS
• Foreword
• 1 Introduction to Neurotherapy and Neurofeedback
• 2 The History of Neurotherapy
• 3 Sources of Brain Dysregulation
• 4 The Neurophysiology of Self-Regulation
• 5 Strategies for Self-Regulation
• 6 Basic Concepts and Principles in Neurofeedback
• 7 Assessment, Treatment Planning, and Outcome Evaluation
• 8 Neurofeedback Training, Protocols, and Case Studies
• 9 Neurofeedback Efficacy Research
• 10 The Future of Neurotherapy and Other Professional Issues
• Index