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1 Financial Disclosure I have no significant financial relationship with a manufacturer of any product or service I intend to discuss. I do provide consulting and training services to help educate professionals and health consumers regarding neurofeedback, and run 3 centers in South Florida. Michael Cohen Director, Center for Brain Training,

2 What is EEG neurofeedback? (or neurotherapy, EEG biofeedback, neurobiofeedback) It works based on Neuroplasticity - The brain's ability to change itself. Measuring the EEG produces audio and visual feedback The brain responds by changing its pattern When a specific EEG pattern occurs - the game goes. Your brain fills in the gaps when the game stops by creating more of the desired pattern.

3 Total Research Publications 1972-present: Over 400 medical and psychological articles have been published on neurofeedback/eeg biofeedback. 78 appeared in PubMed/Medline (online access) A number were published in the ISNR Research Journal which only recently got on Medline. ADHD, Learning Disabilities, Academic and Cognitive Enhancement 2004 Present: 32 articles published, 16 in PubMed /Medline journals : 60 articles published, 15 in PubMed/Medline journals

4 Early History of Research 1967 SMR conditioning in general (cat research) 1973 Epilepsy 1976 ADHD 1977 Addiction 1978 Anxiety disorders 1978 Learning disabilities 1980 Sleep disorders 1995 Brain injury 1997 Mood disorders Dr. Rodolfo Llinás is the noted neuroscientist at the N.Y.U. School of Medicine, He believes abnormal brain rhythms help account for a variety of serious disorders, including depression and dysfunction associated with TBI. Addictive Disorders 2004-Present: 8 articles published, 3 have been published in PubMed/Medline journals (online access) : 14 articles published, 1 in PubMed/Medline journals (online access)

5 UCLA Addiction Study UCLA Addiction Study (n=121) EEG biofeedback: complements other treatment modalities helps improve retention increased odds for long term sobriety to 77% from 44% The American Journal of Drug and Alcohol Abuse, 31: , Effects of an EEG Biofeedback Protocol on a Mixed Substance Abusing Population. Participants in UCLA study 121 volunteers from Cri-Help, Inc. residential treatment program in Los Angeles. 61 controls. 60 Experimental at the start. Primary drug of choice at admission 31% heroin, 28% crack cocaine, 26% methamphetamine, 6% alcohol, 9% other controlled substances; 94% were multiple-drug users.

6 Results of UCLA Addiction study (Cri-Help) Increased number of days in treatment: 46% of control subjects had dropped out of treatment, compared to only 24% of those who received EEG biofeedback. Median length of stay was 147 days for experimental and 103 days for control subjects. Cri-Help Study Criteria - Abstinence Abstinence based on followup 12 months after treatment for subjects completing the study. No additional treatment. One relapse allowed less than 30 days. Abstinent 12 months following treatment Treatment included 12-step oriented program The experimental group also received EEG biofeedback sessions. The control group received additional treatment time equivalent to the biofeedback sessions.

7 Cri-Help abstinence rates Start of Study: 61 controls. 60 Experimental End of study (12 months post-treatment) With Neurofeedback, 36 of 47 were abstinent. Controls: 12 of 27 were abstinent Far more controls dropped out. Cri-Help Changes in MMPI-2 Experimental group exhibited significant improvement on 5 scales vs control subjects Hs (Hypochondriasis), D (Depression), Hy (Conversion Hysteria), Sc (Schizophrenia), Si (Social Introversion)

8 Cri-Help Changes in Impulsivity Attention Test Per TOVA (Computerized Test of Variables of Attention) Experimental group Significant improvement in impulsivity compared to control group. Bob Dickson Founder of Southwest Health Technology Foundation Mr. Dickson is the ex-director of the Texas Commission on Drug and Alcoholism rehab program and was responsible for treating 60,000 people annually. Helped fund the Houston Addiction Study

9 Houston Addiction Study EEG Biofeedback with Treatment of Crack Cocaine Dependence with the Homeless 2005, Journal of Neurotherapy, Vol. 9(2) 2005 Participants: 178 DSM-IV cocaine-dependent males residing in the Door Way drug treatment program. Each did 12 step, and 30 sessions of EEG biofeedback. Treatment included religious, educational, vocational, and basic health services Participants: 117 reported daily crack-cocaine use Years of crack abuse (mean) 84% were unemployed at intake 64% report previous incarcerations Houston Homeless Addiction Study RESULTS: One-year follow-up with 87 participants who completed 30 sessions of treatment: Almost 50% reported no crack use 12 months after completion. 40% used crack one to nine times after treatment, but were clean at follow-up % of participants had a regular residence, compared to 40% at intake % were employed or in training vs. 16.7% at intake -- 88% had no subsequent arrests 12 months post-treatment

10 Houston Homeless Addiction Study RESULTS Participants in biofeedback stayed in treatment 103 days longer than those who didn t Depression and anxiety scores significantly decreased P <.0005 Urine toxicology results for crack were in 98% agreement with the self-reports Houston Homeless Addiction Study RESULTS The 9 month addiction program was graduating 12 men per YEAR from their drug treatment program before neurofeedback. After neurofeedback, it increased to an average of 12 graduates per MONTH.

11 Comment about treatment success combining neurofeedback and 12 step: Bob Dickson - ex-director Commission on Drug and Alcoholism rehab program After a few sessions, the urge to use substances disappears in many clients. So you don t have to fight that urge during the course of treatment. In addition: patients sleep better, they experience less stress. they re much more sociable they re much more compliant to the treatment program. It simply goes a lot farther than traditional therapy. What is EEG neurofeedback? EEG patterns increase or decrease as a result of feedback. Beep, Beep, Beep Beep, Typical training targets patterns that encourage more activation or less activation or improved connectivity.

12 Training the EEG improves brain stability, flexibility and activation - which helps: Alertness and attention Reduced anxiety and depression Stability of emotions Quieting the mind Speed up processing Improved sleep Problem with impulsivity? A history of poor choices/same mistake? Get overwhelmed by too much information? Where do you target? Frontal Lobe Pre-Frontal Lobe Temporal Lobe Parietal Lobe

13 Easily upset or very emotional? Poor memory retrieval? Where do you target? Frontal Lobe Pre-Frontal Lobe Temporal Lobe Parietal Lobe PTSD? Nightmares? Cognitive Decline? Where do you target? Frontal Lobe Pre-Frontal Lobe Temporal Lobe Parietal Lobe

14 Brainwaves are related to our state of general arousal (alertness/attention) Sleep or notactivated Sleepy, or thoughtful or out to lunch Relaxed, spacy or anxious Calm, focused attention More alert/ awake Too much beta - tense anxious, Changing the EEG has profound effect on brain state. Per Bill Scott author of the CriHelp Study: Threats of an ongoing recovery to an addicted brain triggers a defensive survival response EEG biofeedback trains the brain to avoid this reactive state This causes the brain to better integrate the treatment process

15 qeeg brain map helps target training Slow alpha at the anterior cingulate increases with eyes open. That s not normal (Obsessive tendencies) Changes in cortical timing (EEG) promotes changes (neuroplasticity): Behavior Attention Mood and Affect Emotional Regulation Ability to maintain calm (reduce anxiety) Sleep Cognition

16 How many sessions are needed? sessions to produce more profound changes 10 to 15 sessions can be used for short-term targets: Keeping client in treatment Reduced white knuckles Helping short term sleep, anxiety, mood More present during treatment Neurofeedback is learning Once the brain learns a new pattern, the effects tend to hold

17 Neurofeedback is really about NeuroPlasticity Book: The Brain that Changes Itself : Dr. Norman Doidge Plasticity relates to learning Changes can profoundly alter the pattern of neuronal activation in response to experience. Experience can actually change the brain's functional organization

18 History of SMR biofeedback (stabilization) Cats learned to change their EEG First study with cats on operant conditioning of the EEG done by M.B Sterman, UCLA, cats trained to produce EEG activity (SMR Hz over motor strip) for chicken broth & milk Published animal research study shows clear changes in EEG. Clearly no placebo effect.

19 Normal EEG Normal EEG Eyes open your brain is more activated. More alert, more focused, more calm, better able to shift gears. As long as you can slow down when you need. Excessive slow or fast EEG Disregulated EEG Less Stable (Unstable) Brain. Causes you to work harder. Brain is less efficient; Harder to control and regulate emotion, behavior, attention. Harder to switch gears. Disregulated EEG vs. Normal EEG

20 A disregulated brain often has too much slow activity. This brain is alert and awake. In EEG terms, smaller means more activated, better functioning.

21 Live EEG Demo Can individuals change their EEG? Observe changes in brain behavior There are a variety of ways to train the brain. This is just one approach. What does the EEG measure? There s over 100 billion neurons EEG measures millions of neurons doing the same thing at the same time Generated from multiple systems of oscillating rhythms Listen to the audio of Brain Science Podcast on Brain Rhythms. "Rhythms of the Brain" with Gyorgy Buzsaki is complex but very relevant superb explanation of this core function. Audio link is a very understandable 1 hour interview about the book concepts. Much easier to absorb. Google /brain scienc podcast Buzsáki

22 Neurofeedback works with medications and other therapies to help improve: Attention Emotional stability Behavior Affect regulation (Mood, anxiety) Cognition Sleep When your brain is more stable and efficient: You can think more clearly You are more present for therapy Medications can often a) work more efficiently, or b) reduce dosage

23 Observing subtle changes in clients helps guide the process Sleep Falling asleep, staying asleep, ease of waking, nightmares Emotions Mood, anxiety, racing thoughts, aggression, worry Attention and Processing Distractability, inattention, processing speed, listening, logic

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