How to incorporate biofeedback as an evidence-based intervention. Neurofeedback study results for eating disorders.

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Not published is a controlled outcome study at a residential treatment center where 120 patients were administered psychological and EEG tests (Smith, Sams, Sherlin, ISNR Annual Conference, 2006). A variety of neurofeedback approaches were added to the standard treatment regimen for 21 anorexic and 54 bulimic patients. All neurofeedback approaches were successful compared to a traditional treatment control group.

Results

-Significant decrease in Beck Depression Inventory-2 scores, neuroticism scores, and all Eating Disorders Inventory-2 scores.

-Significant increase in extroversion scores.

-MMPI-2 changes reveal a reduction in symptoms associated with distress.

-Reduction in dosage of psychiatric medications ranged between 25% and 65%.

-Anorexics gained weight significantly. Bulimics lost 3 lbs/month during treatment.

Follow-up

-63 of the original 75 subjects responded to 6-month follow-up.

-80-100% reduction in depression on Beck Depression Inventory.

-Depression reduction was the key factor in sustained success.

-Weight changes continued in the proper direction. Anorexics gained about 1 lb per week. Overweight bulimics lost about 3 lbs per month.

-65% are doing well in recovery. 80% have had some resurgence of symptoms.

-Maintenance of preferred weight direction was better for anorexics (p>.05) than for bulimics (p>.08), and third for overweight.

-Overall, outcomes for neurofeedback group were twice as strong as the traditional treatment controls.

There is not just one way to do neurofeedback. Instead there are several camps that have each developed diverse yet successful approaches. Neurofeedback is done by some in a training model with the goal to optimize neurological functioning in people with or without symptoms. Others prefer a practice model that uses subjective and/or objective assessments such as a QEEG brain map to "target" neurofeedback training. For example, people with high anxiety, physical tension and incessant thinking frequently have excessive high frequency "beta" brainwave activity over the central sensorimotor and parietal association cortices. And there are several other approaches to the same case such as focusing on inter-site coherence, reducing turbulence of the EEG or training up regional cerebral blood flow with hemoencephalography (HEG). Other popular approaches to training will boost alertness, e.g., less frontal/central theta with more mid-range beta power or training will aim for a more relaxed state, e.g., more sensorimotor rhythm or more posterior alpha rhythm eyes closed. Neurofeedback equipment is generally more powerful, complex and expensive than peripheral biofeedback. Neurofeedback equipment can cost $1100 - $5000+. Most manufacturers have a version of their systems for clients to train at home under clinical supervision.

Take Home Points
With careful observation of what is really going on psychophysiologically, you can help people take charge of themselves. With this comes an increasing sense of self-efficacy and a belief in the controllability of previously uncontrollable emotional states. As this happens, much of the out-of-control panic feelings patients have will dissipate. Depression begins to lift rapidly and enduringly as patients realize there is actually something they personally can do to improve the way they feel and the way they operate their nervous system.

Your patients can benefit from learning to lower their anxiety and improve their ability to drop themselves at will into an emotionally and physically relaxed, but mentally alert and focused state. This is easy enough to promote with a variety of biofeedback methods, ranging from peripheral feedback of muscle tension and autonomic indicators to various aspects of the brain's electrical activity. A final excellent reason to add biofeedback to your practice is that patients volunteer to stay in treatment longer when neurofeedback is offered to them (Scott et al. 2005).

Historically, biofeedback efficacy has been recognized for some decades now, but it has been trivialized as relaxation training when in fact it offers a powerful pathway for enhanced self-regulatory status of the whole nervous system. This has particular import for conditions with a significant neurophysiological component that impedes recovery by conventional therapeutic methods. The role of biofeedback in recovery is particularly compelling when the dysregulation manifests in so many different systems, as is the case in eating disorders and in addictions, (Trocki, 2007).

References
Association for Applied Psychophysiology and Biofeedback: http://www.aapb.org

Biofeedback Certification Institute of American: http://www.bcia.org

International Society for Neurofeedback and Research: http://www.bcia.org

EEG neurofeedback for treating psychiatric disorders. Oubré A. (2002) Psychiatric Times, July 1, 2002, from click here

Benson, Herbert; Klipper, Miriam Z. 2000 Relaxation Response, New York, NY, Harper Collins.

The Neurological Basis of Eating Disorders. I: EEG Findings and the Clinical Outcome of Adding Symptom-Based, QEEG-Based, and Analog/QEEG-Based Remedial Neurofeedback Training to Traditional Treatment Plans. Peter N. Smith, PsyD, Marvin W. Sams, ND, Leslie Sherlin, BA. Presented at ISNR conference 2006.

Schwartz, M. & Olson, R. (1995). A historical perspective on the field of biofeedback and applied psychophysiology. (pgs 3-18). In M.S. Schwartz (Ed). Biofeedback: A Practitioner's Guide (2nd Ed). New York: Guilford Press.

Leher, Paul M, Woolfolk & Robert L. & Sime, Wesley E. Eds, (2007), Principles and Practices of Stress Management, New York, NY, The Guilford Press.

Neurofeedback in Psychological Practice. Masterpasqua, Frank; Healey, Kathryn N. Source: Professional Psychology: Research and Practice December 2003 Vol. 34, No. 6, 652-656

Is there an Anti-Neurofeedback Conspiracy? Karen F. Trocki Journal of Addictions Nursing, Volume 17, Issue 4 December 2006 , pages 199 202

Allen, K.D. (2006). Recurrent Pediatric Headaches: Behavioral Concepts and Interventions - JEIBI 3 (2), 211-218 http://www.behavior-analyst-online.org

Yucha, C. & Gilbert, C. (2004) Evidence-Based Practice in Biofeedback and Neurofeedback. Association for Applied Psychophysiology and Biofeedback. Colorado Springs, CO. Effects of an EEG Biofeedback Protocol on a Mixed Substance Abusing Population, William C. Scott, David Kaiser, Siegfried Othmer, and Stephen I. Sideroff, American Journal of Drug and Alcohol Abuse, 31(3), 455-469 (2005)

Gary Ames, M.A. is a licensed psychologist in private practice in Bala Cynwyd, PA near Philadelphia, see http://www.AlertFocus.com. He specializes in neurofeedback and advocates for greater acceptance of biofeedback in education, healthcare, criminal justice and executive training.

John K. Nash, Ph.D. is a Licensed Psychologist in Minnesota where he operates Behavioral Medicines Associates, Inc.,
http: //http://www.qeeg.com in Edina, MN, near Minneapolis. He uses a wide range of biofeedback modalities, including EMG, HRV and neurofeedback, coupled with individual and family therapy using the cognitive behavioral and family systems approaches. He is currently President-elect of the International Society for Neurofeedback and Research. The author can be contacted at johnnash@qeeg.com.

Authors Website: www.AlertFocus.com

Authors Bio:
Licensed Psychologist specializing in biofeedback, neurofeedback and neurotherapy since 2002.

I use the latest equipment to bring emotional calm, enhance mental focus and help people get a great night's sleep.
Work with ADHD, Autism, Migraine, Sleep, Anxiety, Depression, PTSD, Addictions. Peak performance for optimal flow and function.

Excellent track record in getting clients off of medications by healing the underlying disorder.