Neurofeedback is often used in the treatment of emotional disorders such as depression, anxiety, Post-traumatic Stress Disorder, Bipolar Disorder and Obsessive-Compulsive Disorder. The goal is to treat underlying neurobiological mechanisms that may be contributing to the symptoms of these disorders, which can be done in addition to more traditional psychotherapies which teach the individual new ways to behave, think, feel and understand their worlds.
In the underlying neurobiology of the brain, electrical and chemical activity continuously influence each other. The electrical signals in the brain get transmitted at different speeds or frequencies. These frequencies help determine our mental state at any moment and affect the chemical signals that the brain transmits. They range from very slow frequency activity in sleep states, known as delta waves, to somewhat faster, but still slow activity in semi-awake states, know as theta waves, to more relaxed but not outwardly attentive states dominated by alpha waves, to more engaged and attentive states characterized by beta wave activity. For example, in order to maintain alertness, engagement in the outside and a positive mood, there needs to be sufficient beta activity in the frontal lobes. The frontal lobes are known as the executive parts of the brain, because they are involved with coordinating and integrating all the other parts of the brain through processes such as attending, planning, organizing, inhibiting, delaying, controlling our emotional responses, considering long-term consequences, and considering alternative meanings of information and alternative courses of action. On the other hand, in order to relax and inhibit feelings of fear and anxiety, there needs to be sufficient alpha activity in the right hemisphere of the brain, which processes information involving danger. Other parts of the brain are, of course, involved in the regulation of emotions, and the specific areas of the brain and brain wave frequencies to target vary from individual to individual.
Neurofeedback works by training the brain to produce more or less electrical activity in selected parts of the brain. In neurofeedback treatment, we monitor the individual’s brain wave state or EEG in a comfortable and painless way while the individual sits in a comfortable chair and “plays” a video game-like exercise which is controlled by his or her brain wave activity. For example, the exercise can be set up so when the individual’s brain wave activity shows that he or she is increasing beta activity in the left frontal lobe, and inhibiting theta, or another form of slow wave activity, a pattern which is sometimes trained to treat symptoms of depression, the individual earns points in the “game” and the action on the screen advances. When the brain wave activity gets out of the desired pattern, the action in the game stops, and the brain then has to find a way to get back into the desired pattern to earn more points. The brain does this unconsciously through the individual attending to the visual and auditory feedback that is provided when succeeding at the game. This is like exercise for the brain, and the brain learns to produce this pattern on its own.
Since neurofeedback is designed to help the brain regulate itself better, it is often used to help people with rapidly shifting moods, or intense moods, such as anger and rage. This is usually done in a way that helps lower the arousal or activation level of selected parts of the brain, or helps two parts of the brain change their way of working together.
In depression, the brain often needs to be activated more in order to improve mood and counteract the tendency to withdraw. Furthermore, an active brain is better able to inhibit worrisome thoughts that seem to be endlessly repeated in the minds of some depressed people. It has been found that, in some forms of depression, there is an imbalance or asymmetry in the activity of the left and right prefrontal and frontal lobes, in which the left frontal regions produce too much alpha activity and are, therefore, underactivated, and the right frontal regions are overactivated. The left frontal region tends to be associated with more positive emotions and the right frontal regions are more implicated with negative emotions. Neurofeedback training can target these areas to come back into a healthier balance of activation through training of the brain wave activity in both hemispheres of the brain.
Anxiety often involves too much activation in parts of the brain. There may be too much beta activity in the right frontal lobe, in the center of the top of the head, or in the parietal area in the back of the head. This might account for the agitation, the difficulty keeping one’s mind off one’s worries, and the problems sleeping often see in anxiety disorders. Neurofeedback training for anxiety often targets different areas of the brain to lower their level of activation, by training the brain to make less high frequency activity and make more activity in a middle or low frequency.
Obsessive-Compulsive Disorder might involve several different regions of the brain, such as the prefrontal cortex, where there might be too much slow wave activity, which might prevent the brain from inhibiting unwanted thoughts and actions, and subcortical structures between the right and left frontal lobes, which might be overactivated, resulting in repetitive thoughts, worries and urges. Neurofeedback can target these brain regions to activate or lower their level of arousal and gauge the individual’s response.
Fear and anxiety symptoms often underlie the symptoms of Post-Traumatic Stress Disorder, as well as alcoholism and drug abuse, personality disorders, psychosomatic disorders, medical disorders that might have a strong psychological component, and reactive attachment disorder. Fear and anxiety are often processed by the right hemisphere, with involvement of the right temporal lobe (the part of the brain located above and behind the ear), and nearby subcortical structures that process fear memories and motivate the individual to avoid certain situations that unconsciously remind the person of traumatic incidents. Neurofeedback training can activate or relax different parts of the brain that might be involved in this fear response, decreasing automatic emotional reactions that can be quite impairing, which could decrease automatic behaviors such as avoidance of relationships and dysfunctional ways of self-regulation..
Since different brain regions might be involved in the symptoms of different individuals, it is often helpful to have a brain map or quantitative electroencephalogram (qEEG) to guide the neurofeedback treatment. Of course, no treatment works for everyone and there is always a potential risk of unwanted effects in any form of treatment. That is why we encourage you to discuss this treatment with someone knowledgeable about the scientific studies and the clinical applications of neurofeedback so you can make an informed choice for yourself or your child.
Studies that deal with the use of neurofeedback in emotional disorders are the following:
Davidson, RJ (2004). What does the prefrontal cortex “do” in affect: perspectives on frontal EEG asymmetry research. Biological Psychiatry, 67, 219-233.
Hammond, DC and Baehr, E (2009). Neurofeedback for the treatment of depression: current status of theoretical issues and clinical research, in Budzynski, TH, Budzynski, HK, Evans, JR & Arbanel, A (Eds.) Introduction to QEEG and Neurofeedback, Second Edition Advanced Theory and Applications, Burlington, MA: Academic Press.
Hammond, DC (2005). Neurofeedback with anxiety and affective disorders, in Hirshberg, LM, Chiu, S & Frazier, JA (Eds.) Child and Adolescent Psychiatric Clinics of North America: Emerging Interventions, 14, 1, 105-123.
Peniston, EG and Kulkowsky, PJ (1990). Alcoholic personality and alpha-theta brainwave training. Medical Psychotherapy, 2, 37-55.