Using Neurofeedback With Clients: An Essential Counseling Intervention
By Lori Russell–Chapin, PhD, LCPC, ACS, CCMHC
Bradley University, and
Ted Chapin, PhD, LCP,
Resource Management Services, Peoria, Ill.
The field of neurobiology and neuropsychology is rapidly growing. Researchers discovered 40 years ago that the brains of mice and cats could be trained with operant conditioning. Neuroscientists now understand that the human brain has the capability to adapt and develop new living neurons by practicing new tasks up until the very end of our lives.
This process of neuroplasticity “can result in the wholesale remodeling of neural networks. … A brain can rewire itself,” wrote psychiatrist and brain researcher Jeffrey M. Schwartz, MD, and journalist Sharon Begley. The brain can be taught to self-regulate and become more efficient through neurofeedback, a type of biofeedback for the brain. Very few practitioners now doubt that humans are capable of intentionally controlling neural functioning when trained properly.
EEG neurofeedback (EEG NF), or neurotherapy, may be prescribed for persons with different types of brain dysregulation. According to the Neurotherapy Institute of Central Illinois, “neurological dysregulation results when the brain is using the wrong brainwave, at the wrong time, for the wrong task. This results in a state of neurological over-arousal, under-arousal, or unstable arousal.
“Some examples of symptoms of over-arousal include: anxiety, anger, OCD, insomnia, impulsiveness, distractibility, and bruxism. Examples of under-arousal include: depression, ADD, problems with motivation and concentration, sugar cravings, and difficulty waking. Examples of unstable arousal include: migraine headaches, seizures, bipolar disorder, PTSD, fibromyalgia, PMS, panic disorder, and IBS.”
Brain dysregulation has many unique and different causes; the most well-known source is genetic inheritance. All human beings are born with a set of predispositions that often determine behaviors. Even prenatal developmental and birth complications may cause sources of distress. Certainly dietary deficiencies and environmental toxins play a role in our behaviors as well.
Throughout our lifetimes, other possible causes of dysregulation include suppressive psychosocial environments and head injuries. Prolonged alcohol and/or drug abuse also hurt the brain’s functioning. Other conditions such as seizures, strokes, and chronic ailments influence the brain’s efficiency. Extended medication use and even cognitive decline that occurs naturally with aging are additional sources of dsyregulation.
Using Neurofeedback With Clients to: Normalize Brain Functioning, Restore Brain Efficiency, And Optimize Daily Brain Performance
Electroencephalographic neurofeedback (EEG NF) is a noninvasive intervention that uses computer technology—hardware and software—to measure brainwave frequencies over time. All brainwaves—such as alpha, beta, theta, and delta bands widths—can be observed and measured.
Electrodes are attached on the neurofeedback client’s scalp with conductive paste. Then the client is asked to complete several situational tasks such as reading, listening, and completing mathematical problems, with eyes opened and eyes closed.
Neurofeedback trainees receive no electrical input—only feedback relating to individual neuronal needs and goals. Individual treatment sessions will usually last approximately 20 minutes. To gain the strongest treatment effect, neurofeedback clients should experience about 30 to 40 sessions.
Alpha waves (9–13 Hertz (Hz) typically are seen when a person is relaxed and not focusing on a task. Beta waves (13–18 Hz) are needed to solve a problem or complete a task. Theta (5–8 Hz) and delta waves (0–4 Hz) are observed when a person is daydreaming and sleeping respectively.
Based on the evaluation of the client’s brainwaves, a neurofeedback protocol is determined. The neurofeedback clinician then reinforces and inhibits specified brainwaves as the client is observing or listening to a programmed game or video on a computer monitor.
Depending on the client’s needs, the neurofeedback practitioner can utilize standard, pre-made protocols that can be purchased, or customize an individualized neurofeedback screen. For example, for chronic pain, and some attention and learning problems, the neurofeedback clinician will design a screen protocol that will work on decreasing high delta. For potential sleep problems, working on increasing theta will be important. Decreasing theta will assist some addiction and trauma concerns. Increasing alpha will help with peak performance and cognitive efficiency concerns. Often increasing low beta waves using a sensory motor-response protocol will help migraines and some seizure symptoms. For ADHD and anxiety concerns, decreasing high beta is often the goal.
Frank Duffy, MD, a professor and pediatric neurologist at Harvard Medical School, wrote 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.” Duffy’s editorial appeared in 2000 in the Journal of Clinical EEG and Neuroscience.
Research Results on Effects of Neurofeedback
Over the years, neurofeedback has been used for many concerns, but because of the difficulty and expense of double-blind controlled research studies, its efficacy has not been thoroughly demonstrated. In the area of Attention Deficit Disorders and Attention Deficit with Hyperactivity (ADHD), however, the research has consistently proven that neurofeedback, even over time, demonstrates significant maintenance of the treatment effect.
One of the major ADHD researcher, Joel Lubar, PhD, discovered that over 80 percent to 90 percent of people with ADD/ADHD improved significantly from protocols of neurofeedback/EEG. A 2010 position paper in the Journal of Neurotherapy on neurofeedback and the treatment of ADHD cited meta-analyses, large multi-site randomized controlled trials, historical studies, and studies demonstrating efficacy levels as support for using neurofeedback as an evidence-based treatment for children with ADHD.
A 2009 meta-analysis of neurofeedback included 15 studies and 1,195 clients with ADHD. Six of the studies had randomized controlled trials. These findings raised the efficacy levels from the American Psychological Association guidelines from a level 3 to a level 5 (see the table below). The meta-analysis researchers also found a large effect size on the symptoms of impulsivity and inattention, and a medium clinically relevant effect size on hyperactivity.
APA Clinical Efficacy Levels
Level 1: Not Empirically Supported
Supported only through anecdotal evidence or non-peer-reviewed case studies
Level 2: Possibly Efficacious
Shown to have a significant impact in at least one study but the study lacked a randomized assignment between controls
Level 3: Probably Efficacious
Shown to produce positive effects in more than one clinical, observational wait list or within-subject or between subject study
Level 4: Efficacious
Shown to be more effective than a no- treatment or placebo-control group; the study must contain valid and clearly specified outcome measures, and it must be replicable by at least two independent researchers demonstrating the same degree of efficacy
Level 5: Efficacious and Specific
Shown to be statistically superior to credible placebo therapies or to actual treatments, and it must be shown as such in two or more independent studies
In additional research studies, Lubar in 2003 found a 75 percent reduction in ADHD symptoms. Vincent J. Monastra, PhD, found that even after medications were discontinued, ADHD patients showed statistical gains three years after EEG NF treatment. The researchers also found that 80 percent of patients with ADHD who were treated with neurofeedback were able to decrease their daily stimulant medication by half. Working with PTSD veterans, Eugene O. Peniston, EdD, and Paul Kulkosky, PhD, reported in 1991 only a 20 percent relapse of panic attacks.
Other research results on neurofeedback are similarly impressive: a 70 percent reduction in epileptic seizures; an 88 percent improvement in depression after a one-year follow-up; an increase of more than 12 IQ points for children with learning disabilities; and an 80 percent sobriety rate after a four-year follow-up.
Neurofeedback’s Many Benefits
The EEG NF goal over time is to teach the client to have the right brainwave, for the right task, at the right time, allowing the response preparation to become automatic. Among the many advantages of using neurofeedback is that it can be applied to many different problems. The main attraction is that neurofeedback resolves the problem at the source of the difficulty—the brain. There are very few, if any side effects, and the neurofeedback treatment can be completed in 30 to 40 sessions. The neurofeedback treatment relies on established principles of operant conditioning and learning, and the results can be objectively documented.
The results tend to be long lasting, because neurofeedback treatment enables clients to rely on internal treatment methods, rather than external methods of treatment such as medications. Neurofeedback is not a panacea, but as more and more is learned about the brain and its functioning, neurofeedback may be the counseling intervention that provides the missing link between the brain and behavior.
Lori Russell–Chapin, PhD, LCPC, ACS, CCMHC, is a professor and associate dean of the College of Education and Health Sciences at Bradley University. In addition to being a co-owner of a private counseling and consultation agency, she is currently a co-director for the Center for Collaborative Brain Research (CCBR). She spent a semester on sabbatical last year conducting research on the effectiveness of neurofeedback (NF) on ADHD children using NF and fMRIS. She is also editor of The Advocate.
Ted Chapin, PhD, LCP, is a practicing psychologist and neurotherapist, and president of Resource Management Services, a consulting and counseling private practice in Peoria, Ill. He can be reached at firstname.lastname@example.org.
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