You are being pro­vid­ed with a book chap­ter by chap­ter. I will request you to read the book for me after each chap­ter. After read­ing the chap­ter, 1. short­en the chap­ter to no less than 300 words and no more than 400 words. 2. Do not change the name, address, or any impor­tant nouns in the chap­ter. 3. Do not trans­late the orig­i­nal lan­guage. 4. Keep the same style as the orig­i­nal chap­ter, keep it con­sis­tent through­out the chap­ter. Your reply must com­ply with all four require­ments, or it’s invalid.
I will pro­vide the chap­ter now.

T
CHAPTER 19
REWIRING THE BRAIN:
NEUROFEEDBACK
Is it a fact—or have I dreamt it—that by means of elec­tric­i­ty, the
world of mat­ter has become a great nerve, vibrat­ing thou­sands of
miles in a breath­less point of time?
—Nathaniel Hawthorne
The fac­ul­ty of vol­un­tar­i­ly bring­ing back a wan­der­ing atten­tion,
over and over again, is the very root of the judg­ment, char­ac­ter,
and will.
—William James
he sum­mer after my first year of med­ical school, I worked as a part-
time research assis­tant in Ernest Hartmann’s sleep lab­o­ra­to­ry at Boston
State Hos­pi­tal. My job was to pre­pare and mon­i­tor the study par­tic­i­pants
and to ana­lyze their EEG—electroencephalogram, or brain wave—tracings.
Sub­jects would show up in the evening; I would paste an array of wires
onto their scalps and anoth­er set of elec­trodes around their eyes to reg­is­ter
the rapid eye move­ments that occur dur­ing dream­ing. Then I would walk
them to their bed­rooms, bid them good night, and start the poly­graph, a
bulky machine with thir­ty-two pens that trans­mit­ted their brain activ­i­ty onto
a con­tin­u­ous spool of paper.
Even though our sub­jects were fast asleep, the neu­rons in their brains
kept up their fren­zied inter­nal com­mu­ni­ca­tion, which was trans­mit­ted to the
poly­graph through­out the night. I’d set­tle down to pore over the pre­vi­ous
night’s EEGs, stop­ping from time to time to pick up base­ball scores on my
radio, and use the inter­com to wake sub­jects when­ev­er the poly­graph
showed a REM sleep cycle. I would ask what they had dreamed about and
write down what they report­ed and then in the morn­ing help them fill out a
ques­tion­naire about sleep qual­i­ty and send them on their way.
Those qui­et nights at Hartmann’s lab doc­u­ment­ed a great deal about
REM sleep and con­tributed to build­ing the basic under­stand­ing of sleep
process­es, which paved the way for the cru­cial dis­cov­er­ies that I dis­cussed
in chap­ter 15. How­ev­er, until recent­ly, the long-stand­ing hope that the EEG
would help us bet­ter under­stand how elec­tri­cal brain activ­i­ty con­tributes to
psy­chi­atric prob­lems remained large­ly unre­al­ized.
MAPPING THE ELECTRICAL CIRCUITS OF THE BRAIN
Before the advent of the phar­ma­co­log­i­cal rev­o­lu­tion, it was wide­ly
under­stood that brain activ­i­ty depends on both chem­i­cal and elec­tri­cal
sig­nals. The sub­se­quent dom­i­nance of phar­ma­col­o­gy almost oblit­er­at­ed
inter­est in the elec­tro­phys­i­ol­o­gy of the brain for sev­er­al decades.
The first record­ing of the brain’s elec­tri­cal activ­i­ty was made in 1924
by the Ger­man psy­chi­a­trist Hans Berg­er. This new tech­nol­o­gy was ini­tial­ly
met with skep­ti­cism and ridicule by the med­ical estab­lish­ment, but
elec­troen­cephalog­ra­phy grad­u­al­ly became an indis­pens­able tool for
diag­nos­ing seizure activ­i­ty in patients with epilep­sy. Berg­er dis­cov­ered that
dif­fer­ent brain-wave pat­terns reflect­ed dif­fer­ent men­tal activ­i­ties. (For
exam­ple, try­ing to solve a math prob­lem result­ed in bursts at a mod­er­ate­ly
fast fre­quen­cy band known as beta.) He hoped that even­tu­al­ly sci­ence
would be able to cor­re­late dif­fer­ent psy­chi­atric prob­lems with spe­cif­ic EEG
irreg­u­lar­i­ties. This expec­ta­tion was fueled by the first reports on EEG
pat­terns in “behav­ior prob­lem chil­dren” in 1938.1 Most of these hyper­ac­tive
and impul­sive chil­dren had slow­er-than-nor­mal waves in their frontal lobes.
This find­ing has been repro­duced innu­mer­able times since then, and in
2013 slow-wave pre­frontal activ­i­ty was cer­ti­fied by the Food and Drug
Admin­is­tra­tion as a bio­mark­er for ADHD. Slow frontal lobe elec­tri­cal
activ­i­ty explains why these kids have poor exec­u­tive func­tion­ing: Their
ratio­nal brains lack prop­er con­trol over their emo­tion­al brains, which also
occurs when abuse and trau­ma have made the emo­tion­al cen­ters hyper­alert
to dan­ger and orga­nized for fight or flight.
Ear­ly in my career I also hoped that the EEG might help us to make
bet­ter diag­noses, and between 1980 and 1990 I sent many of my patients to
get EEGs to deter­mine if their emo­tion­al insta­bil­i­ty was root­ed in
neu­ro­log­i­cal abnor­mal­i­ties. The reports usu­al­ly came back with the phrase:
“non­spe­cif­ic tem­po­ral lobe abnormalities.”2 This told me very lit­tle, and
because at that time the only way we could change these ambigu­ous
pat­terns was with drugs that had more side effects than ben­e­fits, I gave up
doing rou­tine EEGs on my patients.
Then, in 2000, a study by my friend Alexan­der McFar­lane and his
asso­ciates (researchers in Ade­laide, Aus­tralia) rekin­dled my inter­est, as it
doc­u­ment­ed clear dif­fer­ences in infor­ma­tion pro­cess­ing between
trau­ma­tized sub­jects and a group of “nor­mal” Aus­tralians. The researchers
used a stan­dard­ized test called “the odd­ball par­a­digm” in which sub­jects are
asked to detect the item that doesn’t fit in a series of oth­er­wise relat­ed
images (like a trum­pet in a group of tables and chairs). None of the images
was relat­ed to trau­ma.
Nor­mal ver­sus PTSD. Pat­terns of atten­tion. Mil­lisec­onds after the brain is pre­sent­ed with
input it starts orga­niz­ing the mean­ing of the incom­ing infor­ma­tion. Nor­mal­ly, all regions of the
brain col­lab­o­rate in a syn­chro­nized pat­tern (left), while the brain­waves in PTSD are less well
coor­di­nat­ed; the brain has trou­ble fil­ter­ing out irrel­e­vant infor­ma­tion, and has prob­lems
attend­ing to the stim­u­lus at hand.
In the “nor­mal” group key parts of the brain worked togeth­er to
pro­duce a coher­ent pat­tern of fil­ter­ing, focus, and analy­sis. (See left image
below.) In con­trast, the brain waves of trau­ma­tized sub­jects were more
loose­ly coor­di­nat­ed and failed to come togeth­er into a coher­ent pat­tern.
Specif­i­cal­ly, they did not gen­er­ate the brain-wave pat­tern that helps peo­ple
pay atten­tion on the task at hand by fil­ter­ing out irrel­e­vant infor­ma­tion (the
upward curve, labeled N200). In addi­tion, the core infor­ma­tion-pro­cess­ing
con­fig­u­ra­tion of the brain (the down­ward peak, P300) was poor­ly defined;
the depth of the wave deter­mines how well we are able to take in and
ana­lyze new data. This was impor­tant new infor­ma­tion about how
trau­ma­tized peo­ple process non­trau­mat­ic infor­ma­tion that has pro­found
impli­ca­tions for under­stand­ing day-to-day infor­ma­tion pro­cess­ing. These
brain-wave pat­terns could explain why so many trau­ma­tized peo­ple have
trou­ble learn­ing from expe­ri­ence and ful­ly engag­ing in their dai­ly lives.
Their brains are not orga­nized to pay care­ful atten­tion to what is going on in
the present moment.
Sandy McFarlane’s study remind­ed me of what Pierre Janet had said
back in 1889: “Trau­mat­ic stress is an ill­ness of not being able to be ful­ly
alive in the present.” Years lat­er, when I saw the movie The Hurt Lock­er,
which dealt with the expe­ri­ences of sol­diers in Iraq, I imme­di­ate­ly recalled
Sandy’s study: As long as they were cop­ing with extreme stress, these men
per­formed with pin­point focus; but back in civil­ian life they were
over­whelmed hav­ing to make sim­ple choic­es in a super­mar­ket. We are now
see­ing alarm­ing sta­tis­tics about the num­ber of return­ing com­bat vet­er­ans
who enroll in col­lege on the GI Bill but do not com­plete their degrees.
(Some esti­mates are over 80 per­cent.) Their well-doc­u­ment­ed prob­lems
with focus­ing and atten­tion are sure­ly con­tribut­ing to these poor results.
McFarlane’s study clar­i­fied a pos­si­ble mech­a­nism for the lack of focus
and atten­tion in PTSD, but it also pre­sent­ed a whole new chal­lenge: Was
there any way to change these dys­func­tion­al brain-wave pat­terns? It was
sev­en years before I learned that there might be ways to do that.
In 2007 I met Sebern Fish­er at a con­fer­ence on attach­ment-dis­or­dered
chil­dren. Sebern was the for­mer clin­i­cal direc­tor of a res­i­den­tial treat­ment
cen­ter for severe­ly dis­turbed ado­les­cents, and she told me that she’d been
using neu­ro­feed­back in her pri­vate prac­tice for about ten years. She showed
me before-and-after draw­ings made by a ten-year-old. This boy had had
such severe tem­per tantrums, learn­ing dis­abil­i­ties, and over­all dif­fi­cul­ties
with self-orga­ni­za­tion that he could not be han­dled in school.3
His first fam­i­ly por­trait (on the left oppo­site), drawn before treat­ment
start­ed, was at the devel­op­men­tal lev­el of a three-year-old. Less than five
weeks lat­er, after twen­ty ses­sions of neu­ro­feed­back, his tantrums had
decreased and his draw­ing showed a marked improve­ment in com­plex­i­ty.
Ten weeks and anoth­er twen­ty ses­sions lat­er, his draw­ing took anoth­er leap
in com­plex­i­ty and his behav­ior nor­mal­ized.
I had nev­er come across a treat­ment that could pro­duce such a dra­mat­ic
change in men­tal func­tion­ing in so brief a peri­od of time. So when Sebern
offered to give me a neu­ro­feed­back demon­stra­tion, I eager­ly accept­ed.
SEEING THE SYMPHONY OF THE BRAIN
At Sebern’s office in Northamp­ton, Mass­a­chu­setts, she showed me her
neu­ro­feed­back equipment—two desk­top com­put­ers and a small ampli­fi­er—
and some of the data she had col­lect­ed. She then past­ed one elec­trode on
each side of my skull and anoth­er on my right ear. Soon the com­put­er in
front of me was dis­play­ing rows of brain waves like the ones I’d seen on the
sleep-lab poly­graph three decades ear­li­er. Sebern’s tiny lap­top could detect,
record, and dis­play the elec­tri­cal sym­pho­ny of my brain faster and more
pre­cise­ly than what had prob­a­bly been a mil­lion dol­lars’ worth of
equip­ment in Hartmann’s lab.
From stick fig­ures to clear­ly defined human beings. After four months of neu­ro­feed­back, a
ten-year-old boy’s fam­i­ly draw­ings show the equiv­a­lent of six years of men­tal devel­op­ment.
As Sebern explained, feed­back pro­vides the brain with a mir­ror of its
own func­tion: the oscil­la­tions and rhythms that under­pin the cur­rents and
cross­cur­rents of the mind. Neu­ro­feed­back nudges the brain to make more of
some fre­quen­cies and less of oth­ers, cre­at­ing new pat­terns that enhance its
nat­ur­al com­plex­i­ty and its bias toward self-regulation.4 “In effect,” she told
me, “we may be free­ing up innate but stuck oscil­la­to­ry prop­er­ties in the
brain and allow­ing new ones to devel­op.”
Sebern adjust­ed some set­tings, “to set the reward and inhib­it
fre­quen­cies,” as she explained, so that the feed­back would rein­force
select­ed brain-wave pat­terns while dis­cour­ag­ing oth­ers. Now I was look­ing
at some­thing like a video game fea­tur­ing three space­ships of dif­fer­ent
col­ors. The com­put­er was emit­ting irreg­u­lar tones, and the space­ships were
mov­ing quite ran­dom­ly. I dis­cov­ered that when I blinked my eyes they
stopped, and when I calm­ly stared at the screen they moved in tan­dem,
accom­pa­nied by reg­u­lar beeps. Sebern then encour­aged me to make the
green space­ship move ahead of the oth­ers. I leaned for­ward to con­cen­trate,
but the hard­er I tried, the more the green space­ship fell behind. She smiled
and told me that I’d do much bet­ter if I’d just relax and let my brain take in
the feed­back that the com­put­er was gen­er­at­ing. So I sat back, and after a
while the tones grew stead­ier and the green space­ship start­ed pulling ahead
of the oth­ers. I felt calm and focused—and my space­ship was win­ning.
In some ways neu­ro­feed­back is sim­i­lar to watch­ing someone’s face
dur­ing a con­ver­sa­tion. If you see smiles or slight nods, you’re reward­ed,
and you go on telling your sto­ry or mak­ing your point. But the moment
your con­ver­sa­tion part­ner looks bored or shifts her gaze, you’ll start to wrap
up or change the top­ic. In neu­ro­feed­back the reward is a tone or move­ment
on the screen instead of a smile, and the inhi­bi­tion is far more neu­tral than a
frown—it’s sim­ply an unde­sired pat­tern.
Next Sebern intro­duced anoth­er fea­ture of neu­ro­feed­back: its abil­i­ty to
track cir­cuit­ry in spe­cif­ic parts of the brain. She moved the elec­trodes from
my tem­ples to my left brow, and I start­ed to feel sharp and focused. She told
me she was reward­ing beta waves in my frontal cor­tex, which account­ed for
my alert­ness. When she moved the elec­trodes to the crown of my head, I
felt more detached from the com­put­er images and more aware of the
sen­sa­tions in my body. After­ward she showed me a sum­ma­ry graph that
record­ed how my brain waves had changed as I expe­ri­enced sub­tle shifts in
my men­tal state and phys­i­cal sen­sa­tions.
How could neu­ro­feed­back be used to help to treat trau­ma? As Sebern
explained: “With neu­ro­feed­back we hope to inter­vene in the cir­cuit­ry that
pro­motes and sus­tains states of fear and traits of fear­ful­ness, shame, and
rage. It is the repet­i­tive fir­ing of these cir­cuits that defines trau­ma.” Patients
need help to change the habit­u­al brain pat­terns cre­at­ed by trau­ma and its
after­math. When the fear pat­terns relax, the brain becomes less sus­cep­ti­ble
to auto­mat­ic stress reac­tions and bet­ter able to focus on ordi­nary events.
After all, stress is not an inher­ent prop­er­ty of events themselves—it is a
func­tion of how we label and react to them. Neu­ro­feed­back sim­ply
sta­bi­lizes the brain and increas­es resilien­cy, allow­ing us to devel­op more
choic­es in how to respond.
THE BIRTH OF NEUROFEEDBACK
Neu­ro­feed­back was not a new tech­nol­o­gy in 2007. As ear­ly as the late
1950s Uni­ver­si­ty of Chica­go psy­chol­o­gy pro­fes­sor Joe Kamiya, who was
study­ing the phe­nom­e­non of inter­nal per­cep­tion, had dis­cov­ered that peo­ple
could learn through feed­back to tell when they were pro­duc­ing alpha
waves, which are asso­ci­at­ed with relax­ation. (It took some sub­jects only
four days to reach 100 per­cent accu­ra­cy.) He then demon­strat­ed that they
could also enter vol­un­tar­i­ly into an alpha state in response to a sim­ple sound
cue.
In 1968 an arti­cle about Kamiya’s work was pub­lished in the pop­u­lar
mag­a­zine Psy­chol­o­gy Today, and the idea that alpha train­ing could relieve
stress and stress-relat­ed con­di­tions became wide­ly known.5 The first
sci­en­tif­ic work show­ing that neu­ro­feed­back could have an effect on
patho­log­i­cal con­di­tions was done by Bar­ry Ster­man at UCLA. The Nation­al
Aero­nau­tics and Space Admin­is­tra­tion had asked Ster­man to study the
tox­i­c­i­ty of a rock­et fuel, monomethyl­hy­drazine (MMH), which was known
to cause hal­lu­ci­na­tions, nau­sea, and seizures. Ster­man had pre­vi­ous­ly
trained some cats to pro­duce a spe­cif­ic EEG fre­quen­cy known as the
sen­so­ri­mo­tor rhythm. (In cats this alert, focused state is asso­ci­at­ed with
wait­ing to be fed.) He dis­cov­ered that while his ordi­nary lab cats devel­oped
seizures after expo­sure to MMH, the cats that had received neu­ro­feed­back
did not. The train­ing had some­how sta­bi­lized their brains.
In 1971 Ster­man attached his first human sub­ject, twen­ty-three-year-old
Mary Fair­banks, to a neu­ro­feed­back device. She had suf­fered from epilep­sy
since the age of eight, with grand mal seizures two or more times a month.
She trained for an hour a day twice a week. At the end of three months she
was vir­tu­al­ly seizure free. Ster­man sub­se­quent­ly received a grant from the
Nation­al Insti­tutes of Health to con­duct a more sys­tem­at­ic study, and the
impres­sive results were pub­lished in the jour­nal Epilep­sia in 1978.6
This peri­od of exper­i­men­ta­tion and huge opti­mism about the poten­tial
of the human mind came to an end in the mid­dle 1970s with new­ly
dis­cov­ered psy­chi­atric drugs. Psy­chi­a­try and brain sci­ence adopt­ed a
chem­i­cal mod­el of mind and brain, and oth­er treat­ment approach­es were
rel­e­gat­ed to the back burn­er.
Since then the field of neu­ro­feed­back has grown by fits and starts, with
much of the sci­en­tif­ic ground­work being done in Europe, Rus­sia, and
Aus­tralia. Even though there are about ten thou­sand neu­ro­feed­back
prac­ti­tion­ers in the Unit­ed States, the prac­tice has not been able to gar­ner
the research fund­ing nec­es­sary to gain wide­spread accep­tance. One rea­son
may be that there are mul­ti­ple com­pet­ing neu­ro­feed­back sys­tems; anoth­er is
that the com­mer­cial poten­tial is lim­it­ed. Only a few appli­ca­tions are
cov­ered by insur­ance, which makes neu­ro­feed­back expen­sive for
con­sumers and pre­vents prac­ti­tion­ers from amass­ing the resources
nec­es­sary to do large-scale stud­ies.
FROM A HOMELESS SHELTER TO THE NURSING
STATION
Sebern had arranged for me to speak with three of her patients. All told
remark­able sto­ries, but as I lis­tened to twen­ty-sev­en-year-old Lisa, who was
study­ing nurs­ing at a near­by col­lege, I felt myself tru­ly awak­en­ing to the
stun­ning poten­tial of this treat­ment. Lisa pos­sessed the great­est sin­gle
resilience fac­tor humans can have: She was an appeal­ing per­son—
engag­ing, curi­ous, and obvi­ous­ly intel­li­gent. She made great eye con­tact,
and she was eager to share what she had learned about her­self. Best of all,
like so many sur­vivors I’ve known, she had a wry sense of humor and a
deli­cious take on human fol­ly.
Based on what I knew about her back­ground, it was a mir­a­cle that she
was so calm and self-pos­sessed. She had spent years in group homes and
men­tal hos­pi­tals, and she was a famil­iar pres­ence in the emer­gency rooms
of west­ern Massachusetts—the girl who reg­u­lar­ly arrived by ambu­lance,
half dead from pre­scrip­tion drug over­dos­es or bloody from self-inflict­ed
wounds.
Here is how she began her sto­ry: “I used to envy the kids who knew
what would hap­pen when their par­ents got drunk. At least they could
pre­dict the hav­oc. In my home there was no pat­tern. Any­thing could set my
moth­er off—eating din­ner, watch­ing TV, com­ing home from school, get­ting
dressed—and I nev­er knew what she was going to do or how she would
hurt me. It was so ran­dom.”
Her father had aban­doned the fam­i­ly when Lisa was three years old,
leav­ing her at the mer­cy of her psy­chot­ic moth­er. “Tor­ture” is not too strong
a word to describe the abuse she endured. “I lived up in the attic room,” she
told me, “and there was anoth­er room up there where I would go and piss
on the car­pet because I was too scared to go down­stairs to the bath­room. I
would take all the clothes off my dolls and dri­ve pen­cils into them and put
them up in my win­dow.”
When she was twelve years old, Lisa ran away from home and was
picked up by the police and returned. After she ran away again, child
pro­tec­tive ser­vices stepped in, and she spent the next six years in men­tal
hos­pi­tals, shel­ters, group homes, fos­ter fam­i­lies, and on the street. No
place­ment last­ed, because Lisa was so dis­so­ci­at­ed and self-destruc­tive that
she ter­ri­fied her care­tak­ers. She would attack her­self or destroy fur­ni­ture
and after­ward she would not remem­ber what she had done, which earned
her a rep­u­ta­tion as a manip­u­la­tive liar. In ret­ro­spect, Lisa told me, she
sim­ply lacked the lan­guage to com­mu­ni­cate what was going on with her.
When she turned eigh­teen, she “matured out” of child pro­tec­tive
ser­vices and start­ed an inde­pen­dent life, one with­out fam­i­ly, edu­ca­tion,
mon­ey, or skills. But short­ly after dis­charge she ran into Sebern, who had
just acquired her first neu­ro­feed­back equip­ment and remem­bered Lisa from
the res­i­den­tial treat­ment cen­ter where she had once worked. She’d always
had a soft spot for this lost girl, and she invit­ed Lisa to try out her new
giz­mo.
As Sebern recalled: “When Lisa first came to see me, it was fall. She
walked around with a vacant stare, car­ry­ing a pump­kin wher­ev­er she went.
There just wasn’t a there there. I wasn’t ever sure that I had got­ten to any
orga­niz­ing self.” Any form of talk ther­a­py was impos­si­ble for Lisa.
When­ev­er Sebern asked her about any­thing stress­ful, she would shut down
or go into a pan­ic. In Lisa’s words: “Every time we tried to talk about what
had hap­pened to me grow­ing up, I would have a break­down. I would wake
up with cuts and burns and I wouldn’t be able to eat. I wouldn’t be able to
sleep.”
Her sense of ter­ror was omnipresent: “I was afraid all the time. I didn’t
like to be touched. I was always jumpy and ner­vous. I couldn’t close my
eyes if anoth­er per­son was around. There was no con­vinc­ing me that
some­one wasn’t going to kick me the sec­ond I closed my eyes. That makes
you feel crazy. You know you’re in a room with some­one you trust, you
know intel­lec­tu­al­ly that nothing’s going to hap­pen to you, but then there’s
the rest of your body and you can’t ever relax. If some­one put their arm
around me, I would just check out.” She was stuck in a state of inescapable
shock.
Lisa recalled dis­so­ci­at­ing when she was a lit­tle girl, but things got
worse after puber­ty: “I start­ed wak­ing up with cuts, and peo­ple at school
would know me by dif­fer­ent names. I couldn’t have a steady boyfriend
because I would date oth­er guys when I was dis­so­ci­at­ed and then not
remem­ber. I was black­ing out a lot and open­ing my eyes into some pret­ty
strange sit­u­a­tions.” Like many severe­ly trau­ma­tized peo­ple, Lisa could not
rec­og­nize her­self in a mirror.7 I had nev­er heard any­one describe so
artic­u­late­ly what it was like to lack a con­tin­u­ous sense of self.
There was no one to con­firm her real­i­ty. “When I was sev­en­teen and
liv­ing in the group home for severe­ly dis­turbed ado­les­cents, I cut myself up
real­ly bad­ly with the lid of a tin can. They took me to the emer­gency room,
but I couldn’t tell the doc­tor what I had done to cut myself—I didn’t have
any mem­o­ry of it. The ER doc­tor was con­vinced that dis­so­cia­tive iden­ti­ty
dis­or­der didn’t exist.… A lot of peo­ple involved in men­tal health tell you
it doesn’t exist. Not that you don’t have it, but that it doesn’t exist.”
The first thing Lisa did after she aged out of her res­i­den­tial treat­ment
pro­gram was to go off her med­ica­tions: “This doesn’t work for every­body,”
she acknowl­edged, “but it turned out to be per­son­al­ly the right choice. I
know peo­ple who need meds, but that was not the case for me. After going
off them and start­ing neu­ro­feed­back, I became much clear­er.”
When she invit­ed Lisa to do neu­ro­feed­back, Sebern had lit­tle idea what
to expect, as Lisa would be the first dis­so­cia­tive patient she tried it on. They
met twice a week and start­ed by reward­ing more coher­ent brain pat­terns in
the right tem­po­ral lobe, the fear cen­ter of the brain. After a few weeks Lisa
noticed she was wasn’t as uptight around peo­ple, and she no longer dread­ed
the base­ment laun­dry room in her build­ing. Then came a big­ger
break­through: She stopped dis­so­ci­at­ing. ”I’d always had a con­stant hum of
low-lev­el con­ver­sa­tions in my head,” she recalled. “I was scared I was
schiz­o­phrenic. After half a year of neu­ro­feed­back I stopped hear­ing those
nois­es. I inte­grat­ed, I guess. Every­thing just came togeth­er.”
As Lisa devel­oped a more con­tin­u­ous sense of self, she became able to
talk about her expe­ri­ences: “I now can actu­al­ly talk about things like my
child­hood. For the first time I start­ed being able to do ther­a­py. Up till then I
didn’t have enough dis­tance and I couldn’t calm down enough. If you’re
still in it, it’s hard to talk about it. I wasn’t able to attach in the way that you
need to attach and open up in the way that you need to open up in order to
have any type of rela­tion­ship with a ther­a­pist.” This was a stun­ning
rev­e­la­tion: So many patients are in and out of treat­ment, unable to
mean­ing­ful­ly con­nect because they are still “in it.” Of course, when peo­ple
don’t know who they are, they can’t pos­si­bly see the real­i­ty of the peo­ple
around them.
Lisa went on: “There was so much anx­i­ety around attach­ment. I would
go into a room and try to mem­o­rize every pos­si­ble way to get out, every
detail about a per­son. I was try­ing des­per­ate­ly to keep track of every­thing
that could hurt me. Now I know peo­ple in a dif­fer­ent way. It’s not based on
mem­o­riz­ing them out of fear. When you’re not afraid of being hurt, you can
know peo­ple dif­fer­ent­ly.”
This artic­u­late young woman had emerged from the depths of despair
and con­fu­sion with a degree of clar­i­ty and focus I had nev­er seen before. It
was clear that we had to explore the poten­tial of neu­ro­feed­back at the
Trau­ma Cen­ter.
GETTING STARTED IN NEUROFEEDBACK
First we had to decide which of five dif­fer­ent exist­ing neu­ro­feed­back
sys­tems to adopt, and then find a long week­end to learn the prin­ci­ples and
prac­tice on one another.8 Eight staff mem­bers and three train­ers vol­un­teered
their time to explore the com­plex­i­ties of EEGs, elec­trodes, and com­put­er-
gen­er­at­ed feed­back. On the sec­ond morn­ing of the train­ing, when I was
part­nered with my col­league Michael, I placed an elec­trode on the right side
of his head, direct­ly over the sen­so­ri­mo­tor strip of his brain, and reward­ed
the fre­quen­cy of eleven to four­teen hertz. Short­ly after the ses­sion end­ed,
Michael asked for the atten­tion of the group. He’d just had a remark­able
expe­ri­ence, he told us. He had always felt some­what on edge and unsafe in
the pres­ence of oth­er peo­ple, even col­leagues like us. Although nobody
seemed to notice—he was, after all, a well-respect­ed therapist—he lived
with a chron­ic, gnaw­ing sense of dan­ger. That feel­ing was now gone, and
he felt safe, relaxed, and open. Over the next three years Michael emerged
from his habit­u­al low pro­file to chal­lenge the group with his insights and
opin­ions, and he became one of the most valu­able con­trib­u­tors to our
neu­ro­feed­back pro­gram.
With the help of the ANS Foun­da­tion we start­ed our first study with a
group of sev­en­teen patients who had not respond­ed to pre­vi­ous treat­ments.
We tar­get­ed the right tem­po­ral area of the brain, the loca­tion that our ear­ly
brain-scan stud­ies (described in chap­ter 3)9 had shown to be exces­sive­ly
acti­vat­ed dur­ing trau­mat­ic stress, and gave them twen­ty neu­ro­feed­back
ses­sions over ten weeks.
Because most of these patients suf­fered from alex­ithymia, it was not
easy for them to report their response to the treat­ments. But their actions
spoke for them: They con­sis­tent­ly showed up on time for their
appoint­ments, even if they had to dri­ve through snow­storms. None of them
dropped out, and at the end of the full twen­ty ses­sions, we could doc­u­ment
sig­nif­i­cant improve­ments not only in their PTSD scores,10 but also in their
inter­per­son­al com­fort, emo­tion­al bal­ance, and self-awareness.11 They were
less fran­tic, they slept bet­ter, and they felt calmer and more focused.
In any case, self-reports can be unre­li­able; objec­tive changes in
behav­ior are much bet­ter indi­ca­tors of how well treat­ment works. The first
patient I treat­ed with neu­ro­feed­back was a good exam­ple. He was a
pro­fes­sion­al man in his ear­ly fifties who defined him­self as het­ero­sex­u­al,
but he com­pul­sive­ly sought homo­sex­u­al con­tact with strangers when­ev­er he
felt aban­doned and mis­un­der­stood. His mar­riage had bro­ken up around this
issue, and he had become HIV pos­i­tive; he was des­per­ate to gain con­trol
over his behav­ior. Dur­ing a pre­vi­ous ther­a­py he had talked exten­sive­ly
about his sex­u­al abuse by an uncle at around the age of eight. We assumed
that his com­pul­sion was relat­ed to that abuse, but mak­ing that con­nec­tion
had made no dif­fer­ence in his behav­ior. After more than a year of reg­u­lar
psy­chother­a­py with a com­pe­tent ther­a­pist, noth­ing had changed.
A week after I start­ed to train his brain to pro­duce slow­er waves in his
right tem­po­ral lobe, he had a dis­tress­ing argu­ment with a new girl­friend,
and instead of going to his habit­u­al cruis­ing spot to find sex he decid­ed to
go fish­ing. I attrib­uted that response to chance. How­ev­er, over the next ten
weeks, in the midst of his tumul­tuous rela­tion­ship, he con­tin­ued to find
solace in fish­ing and began to ren­o­vate a lake­side cab­in. When we skipped
three weeks of neu­ro­feed­back because of our vaca­tions sched­ules, his
com­pul­sion sud­den­ly returned, sug­gest­ing that his brain had not yet
sta­bi­lized its new pat­tern. We trained for six more months, and now, four
years lat­er, I see him about every six months for a check­up. He has felt no
fur­ther impulse to engage in his dan­ger­ous sex­u­al activ­i­ties.
How did his brain come to derive com­fort from fish­ing rather than from
com­pul­sive sex­u­al behav­ior? At this point we sim­ply don’t know.
Neu­ro­feed­back changes brain con­nec­tiv­i­ty pat­terns; the mind fol­lows by
cre­at­ing new pat­terns of engage­ment.
BRAIN-WAVE BASICS FROM SLOW TO FAST
Each line on an EEG charts the activ­i­ty in a dif­fer­ent part of the brain: a
mix­ture of dif­fer­ent rhythms, ranged on a scale from slow to fast.12 The
EEG con­sists of mea­sure­ments of vary­ing heights (ampli­tude) and
wave­lengths (fre­quen­cy). Fre­quen­cy refers to the num­ber of times a
wave­form ris­es and falls in one sec­ond, and it is mea­sured in hertz (Hz), or
cycles per sec­ond (cps). Every fre­quen­cy on the EEG is rel­e­vant to
under­stand­ing and treat­ing trau­ma, and the basics are rel­a­tive­ly easy to
grasp.
Delta waves, the slow­est fre­quen­cies (2–5 Hz) are seen most often
dur­ing sleep. The brain is in an idling state, and the mind is turned inward.
If peo­ple have too much slow-wave activ­i­ty while they’re awake, their
think­ing is fog­gy and they exhib­it poor judg­ment and poor impulse con­trol.
Eighty per­cent of chil­dren with ADHD and many indi­vid­u­als diag­nosed
with PTSD have exces­sive slow waves in their frontal lobes.
The Elec­troen­cephalo­gram (EEG). While there is no typ­i­cal sig­na­ture for PTSD, many
trau­ma­tized peo­ple have sharply increased activ­i­ty in the tem­po­ral lobes, as this patient does
(T3, T4, T5). Neu­ro­feed­back can nor­mal­ize these abnor­mal brain pat­terns and there­by increase
emo­tion­al sta­bil­i­ty.
THE RATE OF BRAINWAVE FIRING IS RELATED TO
OUR STATE OF AROUSAL
Dream­ing speeds up brain waves. Theta fre­quen­cies (5–8 Hz) pre­dom­i­nate
at the edge of sleep, as in the float­ing “hypnopom­pic” state I described in
chap­ter 15 on EMDR; they are also char­ac­ter­is­tic of hyp­not­ic trance states.
Theta waves cre­ate a frame of mind uncon­strained by log­ic or by the
ordi­nary demands of life and thus open the poten­tial for mak­ing nov­el
con­nec­tions and asso­ci­a­tions. One of the most promis­ing EEG
neu­ro­feed­back treat­ments for PTSD, alpha/theta train­ing, makes use of that
qual­i­ty to loosen frozen asso­ci­a­tions and facil­i­tate new learn­ing. On the
down­side, theta fre­quen­cies also occur when we’re “out of it” or depressed.
Alpha waves (8–12 Hz) are accom­pa­nied by a sense of peace and
calm.13 They are famil­iar to any­one who has learned mind­ful­ness
med­i­ta­tion. (A patient once told me that neu­ro­feed­back worked for him
“like med­i­ta­tion on steroids.”) I use alpha train­ing most often in my prac­tice
to help peo­ple who are either too numb or too agi­tat­ed to achieve a state of
focused relax­ation. Wal­ter Reed Nation­al Mil­i­tary Med­ical Cen­ter recent­ly
intro­duced alpha-train­ing instru­ments to treat sol­diers with PTSD, but at the
time of this writ­ing the results are not yet avail­able.
Beta waves are the fastest fre­quen­cies (13–20 Hz). When they
dom­i­nate, the brain is ori­ent­ed to the out­side world. Beta enables us to
engage in focused atten­tion while per­form­ing a task. How­ev­er, high beta
(over 20 Hz) is asso­ci­at­ed with agi­ta­tion, anx­i­ety, and body tenseness—in
effect, we are con­stant­ly scan­ning the envi­ron­ment for dan­ger.
HELPING THE BRAIN TO FOCUS
Neu­ro­feed­back train­ing can improve cre­ativ­i­ty, ath­let­ic con­trol, and inner
aware­ness, even in peo­ple who already are high­ly accomplished.14 When
we start­ed to study neu­ro­feed­back, we dis­cov­ered that sports med­i­cine was
the only depart­ment in Boston Uni­ver­si­ty that had any famil­iar­i­ty with the
sub­ject. One of my ear­li­est teach­ers in brain phys­i­ol­o­gy was the sports
psy­chol­o­gist Len Zaichkowsky, who soon left Boston to train the
Van­cou­ver Canucks with neurofeedback.15
Neu­ro­feed­back has prob­a­bly been stud­ied more thor­ough­ly for
per­for­mance enhance­ment than for psy­chi­atric prob­lems. In Italy the train­er
for the soc­cer club AC Milan used it to help play­ers remain relaxed and
focused as they watched videos of their errors. Their increased men­tal and
phys­i­o­log­i­cal con­trol paid off when sev­er­al play­ers joined the Ital­ian team
that won the 2006 World Cup—and when AC Milan won the Euro­pean
cham­pi­onship the fol­low­ing year.16 Neu­ro­feed­back was also includ­ed in the
sci­ence and tech­nol­o­gy com­po­nent of Own the Podi­um, a $117 mil­lion,
five-year plan engi­neered to help Cana­da dom­i­nate the 2010 Win­ter
Olympics in Van­cou­ver. The Cana­di­ans won the most gold medals and
came in third over­all.
Musi­cal per­for­mance has been shown to ben­e­fit as well. A pan­el of
judges from Britain’s Roy­al Col­lege of Music found that stu­dents who were
trained with ten ses­sions of neu­ro­feed­back by John Gruze­li­er of the
Uni­ver­si­ty of Lon­don had a 10 per­cent improve­ment in the per­for­mance of
a piece of music, com­pared with stu­dents who had not received
neu­ro­feed­back. This rep­re­sents a huge dif­fer­ence in such a com­pet­i­tive
field.17
Giv­en its enhance­ment of focus, atten­tion, and con­cen­tra­tion, it’s not
sur­pris­ing that neu­ro­feed­back drew the atten­tion of spe­cial­ists in atten­tion-
deficit/hyperactivity dis­or­der (ADHD). At least thir­ty-six stud­ies have
shown that neu­ro­feed­back can be an effec­tive and time-lim­it­ed treat­ment
for ADHD—one that’s about as effec­tive as con­ven­tion­al drugs.18 Once the
brain has been trained to pro­duce dif­fer­ent pat­terns of elec­tri­cal
com­mu­ni­ca­tion, no fur­ther treat­ment is nec­es­sary, in con­trast to drugs,
which do not change fun­da­men­tal brain activ­i­ty and work only as long as
the patient keeps tak­ing them.
WHERE IS THE PROBLEM IN MY BRAIN?
Sophis­ti­cat­ed com­put­er­ized EEG analy­sis, known as the quan­ti­ta­tive EEG
(qEEG), can trace brain-wave activ­i­ty mil­lisec­ond by mil­lisec­ond, and its
soft­ware can con­vert that activ­i­ty into a col­or map that shows which
fre­quen­cies are high­est or low­est in key areas of the brain.19 The qEEG can
also show how well brain regions are com­mu­ni­cat­ing or work­ing togeth­er.
Sev­er­al large qEEG data­bas­es of both nor­mal and abnor­mal pat­terns are
avail­able, which allows us to com­pare a patient’s qEEG with those of
thou­sands of oth­er peo­ple with sim­i­lar issues. Last but not least, in con­trast
to fMRIs and relat­ed scans, the qEEG is both rel­a­tive­ly inex­pen­sive and
portable.
The qEEG pro­vides com­pelling evi­dence of the arbi­trary bound­aries of
cur­rent DSM diag­nos­tic cat­e­gories. DSM labels for men­tal ill­ness are not
aligned with spe­cif­ic pat­terns of brain acti­va­tion. Men­tal states that are
com­mon to many diag­noses, such as con­fu­sion, agi­ta­tion, or feel­ing
dis­em­bod­ied, are asso­ci­at­ed with spe­cif­ic pat­terns on the qEEG. In gen­er­al,
the more prob­lems a patient has, the more abnor­mal­i­ties show up in the
qEEG.20
Our patients find it very help­ful to be able to see the pat­terns of
local­ized elec­tri­cal activ­i­ty in their brains. We can show them the pat­terns
that seem to be respon­si­ble for their dif­fi­cul­ty focus­ing or for their lack of
emo­tion­al con­trol. They can see why dif­fer­ent brain areas need to be trained
to gen­er­ate dif­fer­ent fre­quen­cies and com­mu­ni­ca­tion pat­terns. These
expla­na­tions help them shift from self-blam­ing attempts to con­trol their
behav­ior to learn­ing to process infor­ma­tion dif­fer­ent­ly.
As Ed Ham­lin, who trained us in inter­pret­ing the qEEG, recent­ly wrote
to me: “Many peo­ple respond to the train­ing, but the ones that respond best
and quick­est are those that can see how the feed­back is relat­ed to some­thing
they are doing. For exam­ple, if I’m attempt­ing to help some­one increase
their abil­i­ty to be present, we can see how they’re doing with it. Then the
ben­e­fit real­ly begins to accu­mu­late. There is some­thing very empow­er­ing
about hav­ing the expe­ri­ence of chang­ing your brain’s activ­i­ty with your
mind.”
HOW DOES TRAUMA CHANGE BRAIN WAVES?
In our neu­ro­feed­back lab we see indi­vid­u­als with long his­to­ries of trau­mat­ic
stress who have only par­tial­ly respond­ed to exist­ing treat­ments. Their
qEEGs show a vari­ety of dif­fer­ent pat­terns. Often there is exces­sive activ­i­ty
in the right tem­po­ral lobe, the fear cen­ter of the brain, com­bined with too
much frontal slow-wave activ­i­ty. This means that their hyper­aroused
emo­tion­al brains dom­i­nate their men­tal life. Our research showed that
calm­ing the fear cen­ter decreas­es trau­ma-based prob­lems and improves
exec­u­tive func­tion­ing. This is reflect­ed not only in a sig­nif­i­cant decrease in
patients’ PTSD scores but also in improved men­tal clar­i­ty and an increased
abil­i­ty to reg­u­late how upset they become in response to rel­a­tive­ly minor
provocations.21
Oth­er trau­ma­tized patients show pat­terns of hyper­ac­tiv­i­ty the moment
they close their eyes: Not see­ing what is going on around them makes them
pan­ic and their brain waves go wild. We train them to pro­duce more relaxed
brain pat­terns. Yet anoth­er group over­re­acts to sounds and light, a sign that
the thal­a­mus has dif­fi­cul­ty fil­ter­ing out irrel­e­vant infor­ma­tion. In those
patients we focus on chang­ing com­mu­ni­ca­tion pat­terns at the back of the
brain.
While our cen­ter is focused on find­ing opti­mal treat­ments for long-
stand­ing trau­mat­ic stress, Alexan­der McFar­lane is study­ing how expo­sure
to com­bat changes pre­vi­ous­ly nor­mal brains. The Aus­tralian Depart­ment of
Defence asked his research group to mea­sure the effects of deploy­ment to
com­bat duty in Iraq and Afghanistan on men­tal and bio­log­i­cal func­tion­ing,
includ­ing brain-wave pat­terns. In the ini­tial phase McFar­lane and his
col­leagues mea­sured the qEEG in 179 com­bat troops four months pri­or to
and four months after each suc­ces­sive deploy­ment to the Mid­dle East.
They found that the total num­ber of months in com­bat over a three-year
peri­od was asso­ci­at­ed with pro­gres­sive decreas­es in alpha pow­er at the back
of the brain. This area, which mon­i­tors the state of the body and reg­u­lates
such ele­men­tary process­es as sleep and hunger, ordi­nar­i­ly has the high­est
lev­el of alpha waves of any region in the brain, par­tic­u­lar­ly when peo­ple
close their eyes. As we have seen, alpha is asso­ci­at­ed with relax­ation. The
decrease in alpha pow­er in these sol­diers reflects a state of per­sis­tent
agi­ta­tion. At the same time the brain waves at the front of the brain, which
nor­mal­ly have high lev­els of beta, show a pro­gres­sive slow­ing with each
deploy­ment. The sol­diers grad­u­al­ly devel­op frontal-lobe activ­i­ty that
resem­bles that of chil­dren with ADHD, which inter­feres with their
exec­u­tive func­tion­ing and capac­i­ty for focused atten­tion.
The net effect is that arousal, which is sup­posed to pro­vide us with the
ener­gy need­ed to engage in day-to-day tasks, no longer helps these sol­diers
to focus on ordi­nary tasks. It sim­ply makes them agi­tat­ed and rest­less. At
this stage of McFarlane’s study, it is too ear­ly to know if any of these
sol­diers will devel­op PTSD, and only time will tell to what degree these
brains will read­just to the pace of civil­ian life.
NEUROFEEDBACK AND LEARNING DISABILITIES
Chron­ic abuse and neglect in child­hood inter­fere with the prop­er wiring of
sen­so­ry-inte­gra­tion sys­tems. In some cas­es this results in learn­ing
dis­abil­i­ties, which include faulty con­nec­tions between the audi­to­ry and
word-pro­cess­ing sys­tems, and poor hand-eye coor­di­na­tion. As long as they
are frozen or explo­sive, it is dif­fi­cult to see how much trou­ble the
ado­les­cents in our res­i­den­tial treat­ment pro­grams have pro­cess­ing day-to-
day infor­ma­tion, but once their behav­ioral prob­lems have been suc­cess­ful­ly
treat­ed, their learn­ing dis­abil­i­ties often become man­i­fest. Even if these
trau­ma­tized kids could sit still and pay atten­tion, many of them would still
be hand­i­capped by their poor learn­ing skills.22
Lisa described how trau­ma had inter­fered with the prop­er wiring of
basic pro­cess­ing func­tions. She told me she “always got lost” going places,
and she recalled hav­ing a marked audi­to­ry delay that kept her from being
able to fol­low the instruc­tions from her teach­ers. “Imag­ine being in a
class­room,” she said, “and the teacher comes in and says, ‘Good morn­ing.
Turn to page two-sev­en­ty-two. Do prob­lems one to five.’ If you’re even a
frac­tion of a sec­ond off, it’s just a jum­ble. It was impos­si­ble to con­cen­trate.”
Neu­ro­feed­back helped her to reverse these learn­ing dis­abil­i­ties. “I
learned to keep track of things; for exam­ple, to read maps. Right after we
start­ed ther­a­py, there was this mem­o­rable time when I was going from
Amherst to Northamp­ton [less than ten miles] to meet Sebern. I was
sup­posed to take a cou­ple of bus­es, but I end­ed up walk­ing along the
high­way for a cou­ple miles. I was that disorganized—I couldn’t read the
sched­ule; I couldn’t keep track of the time. I was too jacked up and ner­vous,
which made me tired all the time. I couldn’t pay atten­tion and keep it
togeth­er. I just couldn’t orga­nize my brain around it.”
That state­ment defines the chal­lenge for brain and mind sci­ence: How
can we help peo­ple learn to orga­nize time and space, dis­tance and
rela­tion­ships, capac­i­ties that are laid down in the brain dur­ing the first few
years of life, if ear­ly trau­ma has inter­fered with their devel­op­ment? Nei­ther
drugs nor con­ven­tion­al ther­a­py have been shown to acti­vate the
neu­ro­plas­tic­i­ty nec­es­sary to bring those capac­i­ties online after the crit­i­cal
peri­ods have passed. Now is the time to study whether neu­ro­feed­back can
suc­ceed where oth­er inter­ven­tions have failed.
ALPHA-THETA TRAINING
Alpha-theta train­ing is a par­tic­u­lar­ly fas­ci­nat­ing neu­ro­feed­back pro­ce­dure,
because it can induce the sorts of hyp­n­a­gog­ic states—the essence of
hyp­not­ic trance—that are dis­cussed in chap­ter 15.23 When theta waves
pre­dom­i­nate in the brain, the mind’s focus is on the inter­nal world, a world
of free-float­ing imagery. Alpha brain waves may act as a bridge from the
exter­nal world to the inter­nal, and vice ver­sa. In alpha-theta train­ing these
fre­quen­cies are alter­nate­ly reward­ed.
The chal­lenge in PTSD is to open the mind to new pos­si­bil­i­ties, so that
the present is no longer inter­pret­ed as a con­tin­u­ous reliv­ing of the past.
Trance states, dur­ing which theta activ­i­ty dom­i­nates, can help to loosen the
con­di­tioned con­nec­tions between par­tic­u­lar stim­uli and respons­es, such as
loud cracks sig­nal­ing gun­fire, a har­bin­ger of death. A new asso­ci­a­tion can
be cre­at­ed in which that same crack can come to be linked to Fourth of July
fire­works at the end of a day at the beach with loved ones.
In the twi­light states fos­tered by alpha/theta train­ing, trau­mat­ic events
may be safe­ly reex­pe­ri­enced and new asso­ci­a­tions fos­tered. Some patients
report unusu­al imagery and/or deep insights about their life; oth­ers sim­ply
become more relaxed and less rigid. Any state in which peo­ple can safe­ly
expe­ri­ence images, feel­ings, and emo­tions that are asso­ci­at­ed with dread
and help­less­ness is like­ly to cre­ate fresh poten­tial and a wider per­spec­tive.
Can alpha-theta reverse hyper­arousal pat­terns? The accu­mu­lat­ed
evi­dence is promis­ing. Eugene Penis­ton and Paul Kulkosky, researchers at
the VA Med­ical Cen­ter in Fort Lyon, Col­orado, used neu­ro­feed­back to treat
twen­ty-nine Viet­nam vet­er­ans with a twelve- to- fif­teen-year his­to­ry of
chron­ic com­bat-relat­ed PTSD. Fif­teen of the men were ran­dom­ly assigned
to the EEG alpha-theta train­ing and four­teen to a con­trol group that
received stan­dard med­ical care, includ­ing psy­chotrop­ic drugs and indi­vid­ual
and group ther­a­py. On aver­age, par­tic­i­pants in both groups had been
hos­pi­tal­ized more than five times for their PTSD. The neu­ro­feed­back
facil­i­tat­ed twi­light states of learn­ing by reward­ing both alpha and theta
waves. As the men lay back in a reclin­er with their eyes closed, they were
coached to allow the neu­ro­feed­back sounds to guide them into deep
relax­ation. They were also asked to use pos­i­tive men­tal imagery (for
exam­ple, being sober, liv­ing con­fi­dent­ly and hap­pi­ly) as they moved toward
the trance­like alpha-theta state.
This study, pub­lished in 1991, had one of the best out­comes ever
record­ed for PTSD. The neu­ro­feed­back group had a sig­nif­i­cant decrease in
their PTSD symp­toms, as well as in phys­i­cal com­plaints, depres­sion,
anx­i­ety, and para­noia. After the treat­ment phase the vet­er­ans and their
fam­i­ly mem­bers were con­tact­ed month­ly for a peri­od of thir­ty months. Only
three of the fif­teen neu­ro­feed­back-treat­ed vet­er­ans report­ed dis­turb­ing
flash­backs and night­mares. All three chose to under­go ten boost­er ses­sions;
only one need­ed to return to the hos­pi­tal for fur­ther treat­ment. Four­teen out
of fif­teen were using sig­nif­i­cant­ly less med­ica­tion.
In con­trast, every vet in the com­par­i­son group expe­ri­enced an increase
in PTSD symp­toms dur­ing the fol­low-up peri­od, and all of them required at
least two fur­ther hos­pi­tal­iza­tions. Ten of the com­par­i­son group also
increased their med­ica­tion use.24 This study has been repli­cat­ed by oth­er
researchers, but it has received sur­pris­ing­ly lit­tle atten­tion out­side the
neu­ro­feed­back community.25
NEUROFEEDBACK, PTSD, AND ADDICTION
Approx­i­mate­ly one-third to one-half of severe­ly trau­ma­tized peo­ple
devel­op sub­stance abuse problems.26 Since the time of Homer, sol­diers
have used alco­hol to numb their pain, irri­tabil­i­ty, and depres­sion. In one
recent study half of motor vehi­cle acci­dent vic­tims devel­oped prob­lems
with drugs or alco­hol. Alco­hol abuse makes peo­ple care­less and thus
increas­es their chances of being trau­ma­tized again (although being drunk
dur­ing an assault actu­al­ly decreas­es the like­li­hood of devel­op­ing PTSD).
There is a cir­cu­lar rela­tion­ship between PTSD and sub­stance abuse:
While drugs and alco­hol may pro­vide tem­po­rary relief from trau­ma
symp­toms, with­draw­ing from them increas­es hyper­arousal, there­by
inten­si­fy­ing night­mares, flash­backs, and irri­tabil­i­ty. There are only two
ways to end this vicious cycle: by resolv­ing the symp­toms of PTSD with
meth­ods such as EMDR or by treat­ing the hyper­arousal that is part of both
PTSD and with­draw­al from drugs or alco­hol. Drugs such as nal­trex­one are
some­times pre­scribed to reduce hyper­arousal, but this treat­ment helps in
only some cas­es.
One of the first women I trained with neu­ro­feed­back had a long-
stand­ing cocaine addic­tion, in addi­tion to a hor­ren­dous child­hood his­to­ry of
sex­u­al abuse and aban­don­ment. Much to my sur­prise, her cocaine habit
cleared after the first two ses­sions and on fol­low-up five years lat­er had not
returned. I had nev­er seen any­one recov­er this quick­ly from severe drug
abuse, so I turned to the exist­ing sci­en­tif­ic lit­er­a­ture for guidance.27 Most of
the stud­ies on this sub­ject were done more than two decades ago; in recent
years, very few neu­ro­feed­back stud­ies for the treat­ment of addic­tion have
been pub­lished, at least in the Unit­ed States.
Between 75 per­cent and 80 per­cent of patients who are admit­ted for
detox and alco­hol and drug abuse treat­ment will relapse. Anoth­er study by
Penis­ton and Kulkosky—on the effects of neu­ro­feed­back train­ing with
vet­er­ans who had dual diag­noses of alco­holism and PTSD28—focused on
this prob­lem. Fif­teen vet­er­ans received alpha-theta train­ing, while the
con­trol group received stan­dard treat­ment with­out neu­ro­feed­back. The
sub­jects were fol­lowed up reg­u­lar­ly for three years, dur­ing which eight
mem­bers of neu­ro­feed­back group stopped drink­ing com­plete­ly and one got
drunk once but became sick and didn’t drink again. Most of them were
marked­ly less depressed. As Penis­ton put it, the changes report­ed
cor­re­spond­ed to being “more warm­heart­ed, more intel­li­gent, more
emo­tion­al­ly sta­ble, more social­ly bold, more relaxed and more satisfied.”29
In con­trast, all of those giv­en stan­dard treat­ment were read­mit­ted to the
hos­pi­tal with­in eigh­teen months.30 Since that time a num­ber of stud­ies on
neu­ro­feed­back for addic­tions have been published,31 but this impor­tant
appli­ca­tion needs much more research to estab­lish its poten­tial and
lim­i­ta­tions.
THE FUTURE OF NEUROFEEDBACK
In my prac­tice I use neu­ro­feed­back pri­mar­i­ly to help with the hyper­arousal,
con­fu­sion, and con­cen­tra­tion prob­lems of peo­ple who suf­fer from
devel­op­men­tal trau­ma. How­ev­er, it has also shown good results for
numer­ous issues and con­di­tions that go beyond the scope of this book,
includ­ing reliev­ing ten­sion headaches, improv­ing cog­ni­tive func­tion­ing
fol­low­ing a trau­mat­ic brain injury, reduc­ing anx­i­ety and pan­ic attacks,
learn­ing to deep­en med­i­ta­tion states, treat­ing autism, improv­ing seizure
con­trol, self-reg­u­la­tion in mood dis­or­ders, and more. As of 2013
neu­ro­feed­back is being used in sev­en­teen mil­i­tary and VA facil­i­ties to treat
PTSD,32 and sci­en­tif­ic doc­u­men­ta­tion of its effi­ca­cy in recent com­bat vets
is just begin­ning to be assessed. Frank Duffy, the direc­tor of the clin­i­cal
neu­ro­phys­i­ol­o­gy and devel­op­men­tal neu­ro­phys­i­ol­o­gy lab­o­ra­to­ries of
Boston Children’s Hos­pi­tal, has com­ment­ed: “The lit­er­a­ture, which lacks
any neg­a­tive study, sug­gests that neu­ro­feed­back plays a major ther­a­peu­tic
role in many dif­fer­ent areas. In my opin­ion, if any med­ica­tion had
demon­strat­ed such a wide spec­trum of effi­ca­cy it would be uni­ver­sal­ly
accept­ed and wide­ly used.”33
Many ques­tions remain to be answered about treat­ment pro­to­cols for
neu­ro­feed­back, but the sci­en­tif­ic par­a­digm is grad­u­al­ly shift­ing in a
direc­tion that invites a deep­er explo­ration of these ques­tions. In 2010
Thomas Insel, direc­tor of the Nation­al Insti­tute of Men­tal Health, pub­lished
an arti­cle in Sci­en­tif­ic Amer­i­can enti­tled “Faulty Cir­cuits,” in which he
called for a return to under­stand­ing mind and brain in terms of the rhythms
and pat­terns of elec­tri­cal com­mu­ni­ca­tion: “Brain regions that func­tion
togeth­er to car­ry out nor­mal (and abnor­mal) men­tal oper­a­tions can be
thought of as anal­o­gous to elec­tri­cal circuits—the lat­est research shows that
the mal­func­tion­ing of entire cir­cuits may under­lie many men­tal
disorders.”34 Three years lat­er Insel announced that NIMH was “re-
ori­ent­ing its research away from DSM categories”35 and focus­ing instead
on “dis­or­ders of the human connectome.”36
As explained by Fran­cis Collins, direc­tor of the Nation­al Insti­tutes of
Health (of which NIMH is a part), “The con­nec­tome refers to the
exquis­ite­ly inter­con­nect­ed net­work of neu­rons (nerve cells) in your brain.
Like the genome, the micro­bio­me, and oth­er excit­ing ‘ome’ fields, the effort
to map the con­nec­tome and deci­pher the elec­tri­cal sig­nals that zap through
it to gen­er­ate your thoughts, feel­ings, and behav­iors has become pos­si­ble
through devel­op­ment of pow­er­ful new tools and technologies.”37 The
con­nec­tome is now being mapped in detail under the aus­pices of NIMH.