Brain training for ADHD and Psychiatric Treatment

In the article “Brain training: The future of psychiatric treatment?” author Tedi Asher explains how neurofeedback has the ability to change how the brain functions. She discusses that neurofeedback is like a video game but for the brain, it has the brain associate with good and bad aspects and tells it how to respond based on what it naturally does. 

According to Asher, “Research over the last several decades indicates that our brains are, in fact, malleable.” Now, we just need to know how to influence it. She demonstrates that operant conditioning is how we encourage our brains to act in more positive ways and change our behaviors. Operant conditioning uses rewards to help create associations between a behavior and a consequence. The best example is dog training. If you give a treat to a dog every time it sits on command, then it will learn to associate the delicious treat with sitting. This means that he will likely sit quickly on command and even without a command in hopes of getting a treat. With frequent practice, the treats can be decreased and the dog will learn to sit whenever the command is given.

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Neurofeedback training is creating an association between the brain functions and the rewards in the game or movie. Any difference or change that occurs in games and movies provides rewards to the brain. An electroencephalography (EEG) or functional magnetic resonance imaging (fMRI) are utilized to detect these long-lasting changes in brain activity through repeated exposure. An EEG uses electrodes placed on the scalp to measure electrical impulses from the cortex and records the location and frequency of the brain’s brain waves. An fMRI scan, on the other hand, measures the blood flow to inner and outer regions of the brain telling researchers where most brain activity takes place. These can help researchers determine which regions of the brain are stimulated while having a conversation with the patient or while watching a video game.

Neurofeedback can also be used to treat diseases as research has shown that brain activity is specific to various psychiatric disorders (Asher). These patterns are noticeable because of EEG and fMRI-based neurofeedback training. Because children with ADHD struggle to focus their attention, they have more theta brain waves than beta waves. As a result, neurofeedback training aims to minimize the presence of lower frequency theta waves and improve the occurrence of higher frequency beta waves (Asher). During neurofeedback and operant conditioning, their brains can essentially view how it’s functioning with the EEG and are rewarded for modifying the functioning to produce more efficient and positive behaviors.

Asher continues to discuss how “neurofeedback training as a therapy for ADHD may be even more effective than the standard medication (Methylphenidate/Ritalin) used to treat this disorder.” For instance, a study was conducted in 2002 by Vincent Monastra and colleagues at the FPI Attention Disorders Clinic in New York, where 100 children diagnosed with ADHD were observed. Half of them were prescribed Ritalin, while the other half participated in neurofeedback training. 

Co-author Brad Wierbowski mentioned that “Immediately after the 1-year treatment period, the Ritalin-only group showed moderate improvement in the behavioral symptoms of ADHD while showing no improvement in patterns of brain activity associated with the ability to focus attention. By contrast, children treated with medication and neurofeedback training showed significant improvements in both behavior and brain activity patterns” (qtd. In Asher).

Asher recounted that the children who participated in neurofeedback training and took Ritalin “showed greater improvements in focus and a significant decrease in hyperactive/impulsive behavior” (Asher). Whereas, those who took Ritalin and did not participate in the neurofeedback training did not experience those same long-term changes.

Furthermore, Asher expressed that neurofeedback treatments are not the be all and end all as there are some drawbacks or concerns:

“One example is the fact that many clinical trials testing the efficacy of neurofeedback training do not randomize the subjects into treatment groups, since it is considered more ethical to let patients choose which treatment group they prefer. As a result, it is possible that the treatment groups may not be composed of comparable subject populations at the outset of the experiment, which in turn may skew the results of the study” (Asher).

For now, medication and various forms of therapy are the main treatments for ADHD patients. Nevertheless, neurofeedback training is rising above as more and more portable and affordable neurofeedback devices are developed. 

Neurofeedback provides advanced ways to aid individuals’ brains in self regulating and thereby treating symptoms from their Anxiety, ADHD, Autism Spectrum Disorder (ASD), Depression, migraines, PTSD, sleep disorders, Trauma, TBI, and more.

For more information on neurofeedback, please Contact Us or visit San Diego Center for Neurofeedback, APPC.

Written by Lily Schmitt and Tanya L. Hilber, PsyD

References

Asher, Tedi. Wierbowski, Brad. “Brain training: The future of psychiatric treatment?” SITN. 2 Feb. 2017. http://sitn.hms.harvard.edu/flash/2017/brain-training-future-psychiatric-treatment/#:~:text=Brain%20training%20is%20becoming%20increasingly,their%20own%20brains%20work%20naturally. 

Monastra VJ, Monastra DM, George S. The effects of stimulant therapy, EEG biofeedback, and parenting style on the primary symptoms of attention-deficit/hyperactivity disorder. Appl Psychophysiol Biofeedback. 2002 Dec;27(4):231-49. doi: 10.1023/a:1021018700609. PMID: 12557451. https://pubmed.ncbi.nlm.nih.gov/12557451/

Choosing a Neurofeedback Program: Cygnet, NeurOptimal, LENS and More

There are many types of neurofeedback programs that aid the human brain in various ways. Neurofeedback (EEG Biofeedback) trains the brain to self regulate and function in the most optimal and stabilized ranges. This is executed by placing electrodes on the scalp to listen to or read brainwave activity. These neurofeedback programs then take the brainwave activity and provide it back to the person and their brain in various forms of feedback (auditory, visual and sometimes tactile). This feedback then helps the brain gain information on how it’s functioning and can learn how to function optimally with practice and immediate feedback during the treatment. 

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Optimal functioning includes better regulated emotional responses, balanced and stable physiological systems, more effective mental performance and a regulated central nervous system. Neurofeedback can help individuals with issues such as anxiety, depression, attention or hyperactivity issues (ADHD), behavior disorders, various sleep disorders, headaches, migraines, PTSD, seizures, trauma, TBI, and those related to the Autism Spectrum.

There are a few key points to consider when choosing a neurofeedback brain training system.  

  1. Clinicians: Some protocol-based programs require a brain map or QEEG before starting and this requires clinicians who are experienced with administering and reading QEEGs. The QEEG then directs which protocols are used for the neurofeedback treatment. Some programs require clinicians to provide highly individualized training for the most effective impact. These include Cygnet and Othmer programs who use protocols as a guide, while still utilizing the clinician’s clinical judgment to modify the treatment plan based on the individual’s and brain’s responses. Other programs do not require a clinician or their clinical judgment and can provide a one-size fits all approach, making it easier to administer the neurofeedback at home, although decreases the individualized and responsive approach. 

    Here at San Diego Center for Neurofeedback, APPC (SDCNF), we utilize a protocol-based guided approach along with the clinical judgment of our clinicians to provide a highly individualized and responsive approach based on each client’s situation, symptoms, and their brain’s responses. Furthermore, SDCNF works as a team so each client receives input, knowledge and clinical experience from our two doctoral Clinical Psychologists and several Master’s level clinicians every week.

  2. Cost: In general, neurofeedback training is an investment in yourself, your family, and your future. There are many inexpensive products that declare to offer similar results in the $200 range that provide basic monitoring and triggering of the brain to change its state but can not keep up with the lightening speed of the brain (Baker, Natalie). Baker expressed that the “highest quality neurofeedback training systems range from $7,000 for a home system to over $10,000 for a professional one” (Baker, Natalie). 

    Some programs require a 3-D brain map or QEEG that can cost $700 to $3,000 prior to the actual neurofeedback training. Programs for rent to be used at home may cost from $600 to $900 a month, depending on the number of sessions and number of family members training. Most neurofeedback appointments in the office with a clinician range between $100 - $300. 

    San Diego Center for Neurofeedback, APPC provides appointments in the office, including evenings and weekends. Please contact us for the fee schedule. 

  3. Electrical Currents: Baker proclaims that it is necessary to know that “True neurofeedback devices do not add any electrical waves or currents to the brain” and if they do, is not a feedback device (Baker, Natalie). These devices work by introducing electrical currents to the scalp to affect one’s brain and change it which is why it’s important to first decide if you want the device to send additional electrical currents to your brain when picking out a system (Baker, Natalie).  

    San Diego Center for Neurofeedback, APPC neurofeedback program does not input any electrical currents or electromagnetic pulses into the brain. SDCNF’s true neurofeedback system only reads brainwaves and provides that information back to the brain in a way the brain can recognize and learn from itself. 

  4. Other aspects to consider when choosing the best fit for you:

    • Electrodes: a full 10-20 electrode cap versus a few electrodes; this is important if an individual is going to work, school, or in public afterwards as electrodes require EEG Paste for EEG reading and a few electrodes means significant less paste to remove before leaving the appointment

    • Experience with Children: neurofeedback treatment can be provided to such a wide range of ages from really young children to elderly, however finding a provider who is experienced in working with children is helpful as many children cannot report their symptoms or brain responses like adults

    • Appointment availability: recommended treatment is twice a week so finding a provider who is available twice a week on a consistent basis is ideal; evening and weekend appointments are a bonus

    • Symptom tracking: to determine the brain responses to neurofeedback, it’s recommended to track the individual’s symptoms; brain training and learning is a slow and steady process so it’s sometimes difficult to see the changes without the tracking (much like seeing a child’s growth every day versus seeing them once a year)

Neurofeedback Programs:

  • Cygnet - neurofeedback program that allows for Clinicians trained in the Othmer method to create each individual’s treatment plan, using research-based protocols as a guide and making clinical adjustments throughout the treatment to find optimal effectiveness. Cygnet and the Othmer method allow for a more hands-on and individualized interaction between the client and the clinician by modifying the training every step along the way based on current symptoms and the brain’s response for more effective and accelerated learning. Cygnet is able to provide both Infra-Low (below .1Hz) and Alpha Theta neurofeedback training (eeginfo.com).

    San Diego Center for Neurofeedback, APPC provides neurofeedback with this revolutionary Cygnet program and our providers are trained in the Othmer method to administer the most individualized and effective neurofeedback treatment.  

  • BrainPaint - neurofeedback program that requires a clinician who is able to follow the automated protocols and automated tools (brainpaint.com)

  • NeurOptimal - neurofeedback program that allows renting or purchasing equipment for at home use; more of a one-size fits all approach that can be administered by an individual who is not trained in neurofeedback (neuroptimal.com)

  • LoReta - requires a QEEG brain map, z-scores and a full 10-20 electrode cap along with an experienced clinician in the office (biofeedback-tech.com)

  • Other Brain Training products that can be used concurrently with Neurofeedback:

    • Low Energy Neurofeedback System (LENS) - a form of “stim” technology that provide pulsed electricity or pulsed electromagnetic signals to stimulate brain’s activity (chicagomindsolutions.com)

    • Alpha-Stim - cranial electrotherapy stimulation (alpha-stim.com)

    • NeuroSky - EEG Biosensor to read brain activity for apps (neurosky.com)

    • Muse - Senses your brain wave activity for meditation (choosemuse.com)

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Neurofeedback provides advanced ways to aid individuals’ brains in self regulating and thereby treating symptoms from their anxiety, ADHD, autism spectrum disorder, depression, migraines, PTSD, sleep disorders, trauma, TBI, and more. For more information on neurofeedback and why we chose Cygnet and are trained in the Othmer method, please Contact Us or visit San Diego Center for Neurofeedback, APPC.

~Written by Tanya L. Hilber, PsyD and Lily Schmitt.

References

Neurofeedback Treatment for ADHD

In the article, “Can Neurofeedback Effectively Treat ADHD?” author David Rabiner discusses why one should consider neurofeedback, what it is, and how it helps ADHD symptoms. 

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Neurofeedback is a source of therapy that trains the brain using EEG data to help patients improve their focus, impulse control, and executive function. This training involves providing feedback to the brain based on the brain waves and encouraging the brain to correct specific areas such as attention and self-control. Individuals with ADHD may pursue neurofeedback as their brains start off with low-frequency delta or theta brain waves. According to Rabiner, twenty to forty 30-minute training sessions are required to see a notable difference in one’s ADHD symptoms.

During neurofeedback sessions, practitioners use scalp sensors to read a patient’s brain activity by observing how and when a patient’s brain waves hit an optimal level (Rabiner). After an initial assessment , a treatment plan is set to provide specific feedback and encourage their brain to function in its optimal zone. Adjustments can always be made to the treatment plan as improvements occur.

Rabiner provided examples of individuals receiving neurofeedback and the results: 

  • Monastra, et al. (2002): 50 six to nineteen-year-olds with ADHD included neurofeedback in their treatment plan. They found that the youngest individuals had the most notable difference in their brain wave patterns, their brain waves had normalized. This pattern was found to be consistent after individuals discontinued their medication and only used neurofeedback. 

  • Levesque, et al. (2006): Rabiner stated that “20 eight to twelve-year-old children with ADHD were randomly assigned to receive 40 weekly neurofeedback treatment sessions, or to a waitlist control condition with no treatment.” fMRI scans showed that those who received neurofeedback experienced a significant change in their brainwave patterns versus no change for the children in the control group.

  • Gevensleben, et al. (2009): Rabiner explained that 102 eight to twelve-year-olds with ADHD were randomly chosen to receive 36 neurofeedback or computerized attention training sessions over a span of 18 weeks to help with homework difficulties. They found that the children in the neurofeedback group showed 60% greater reductions of their ADHD symptoms compared to the computer attention training group and consistently maintained those levels six months later (Rabiner). 

  • Meisel et al. (2013): Similar to the study above, “23 seven to fourteen-year-olds were randomly assigned treatment with methylphenidate or 40 neurofeedback sessions” (Rabiner). Both groups saw a significant reduction in parent and teacher ratings of their ADHD symptoms immediately after and 6 months later training ended (Rabiner). Rabiner reported that teachers saw “significant academic improvements in reading and writing skills for only the neurofeedback group…”

Even though most of the studies were not fully blind, the research conducted still suggests that neurofeedback is a promising therapy for ADHD. Biofeedback is also rated as a Level 1 - Best Support intervention by the American Academy of Pediatrics (AAP) for ADHD symptoms. Neurofeedback is not magic or the saving grace to difficulties with attention, hyperactivity or executive functioning, but it can help. 

For more information on how neurofeedback may help and lead to behavior improvements and overall reduction in ADHD symptoms, please visit San Diego Center for Neurofeedback, APPC or Contact us to schedule an appointment to start treatment right away.

~Written by Lily Schmitt and Tanya L. Hilber, PsyD.

Reference

Rabiner, David. “Can Neurofeedback Effectively Treat ADHD?” ADDitude. 3 Sep. 2020. https://www.additudemag.com/neurofeedback-therapy-treat-adhd/.

Evidenced-Based Child and Adolescent Psychosocial Interventions. (2011) Addressing Mental Health Concerns in Primary Care: A Clinician’s Toolkit. American Academy of Pediatrics.