Emotional Control and Neurofeedback

A recent issue of Psychology Today published this article that seems to advocate expressing more negative emotions: https://www.psychologytoday.com/articles/201501/beyond-happiness-the-upside-feeling-down.

I have some issues with this article. When most of us experience negative emotions, we are able to cognitively recognize that we need to process them in ways that are ultimately productive to ourselves and those around us. We use these emotions as a touchstone about the events in our lives and their relative importance to each of us as individuals. Then we prioritize getting ourselves into situations with more positive emotional results.

However in some instances, this article seems to be advocating letting at least some emotional reactions go unchecked. I largely disagree with that premise. Having unbridled negative emotions will quickly lead to trouble with interpersonal relationships. In our society, those who display strong and/or frequent negative emotions rapidly become marginalized. Many of us have experienced this in our own lives: the coworker who yells at everyone, the child who has frequent meltdowns, the family member who is always down and complaining about something….. We monitor our own, usually negative, emotional reactions to these people and then try our best to avoid interacting with them.

There is a good reason why people who express a lot of negative emotions are viewed as immature. Appropriate control of emotions is one of the ways that adults are different from toddlers–we have developed mature prefrontal lobes to our brains. The prefrontal lobes are some of the last areas of the brain to develop fully, and like just about every part of the brain, the more they are utilized in positive ways, the better they perform–especially in negative circumstances.

If you are concerned about whether your emotions are appropriately controlled, you should consult with a qualified therapist. Neurofeedback can play an important part in learning to maintain emotional control. Prefrontal control networks over the limbic (emotional control) system can be stimulated and strengthened. Practicing positive behaviors and control encourages positive experiences and lives!

Chronic Stress

Evidence continues to mount that chronic stress takes a significant toll on the brain and body. Science News has a great overview of our current understanding:

Chronic stress can wreak havoc on the body

Even while we find ways as individuals and as a society to improve the circumstances that cause chronic stress, we need to recognize that for many it is difficult to avoid. Neurofeedback can help reduce brain stress and eventually help guide to a lifestyle that maximizes healthful, stress-reducing behaviors and practices.

Healing the Brain and Brain Plasticity

A great essay from the weekend Wall Street Journal about maintaining brain health through aging, injury, and disease processes. There are no guarantees in life, but there is excellent proof that physical, emotional, intellectual, and social engagement in life enhances brain function into middle and old age. This article did not mention neurofeedback, but does discuss other forms of brain entrainment like auditory therapy. Neurotherapy is unique in that it persuades the brain’s own white and gray matter to perform training tasks on their own. It is a “learned” process that is dependent on the brain plasticity described in the article.


Use of Complementary and Alternative Medicine in Children with Neurological Conditions

A study of children in the US with certain common neurological conditions such as headaches, migraines, and seizures showed that they were nearly twice as likely to use some form of complementary or alternative medicine (CAM) than children without these conditions. http://www.ncbi.nlm.nih.gov/pubmed/24753991 Of the CAM techniques used, the most popular were mind-body techniques.

This data seems to reflect how poorly current medical models for treatment of these conditions perform in real world settings. In my practice, I see two main issues. The first is the lack of effective treatments, mostly in the form of medicines. However, even such highly technological and expensive procedures as deep brain stimulators seem to have only limited efficacy. Even more prominently, is the problem of unacceptable side effects. So many medicines that are meant to correct certain aspects of brain function cause symptoms that can be just as debilitating or worse than the original problem. The biggest issue is often sedation. In children as well as adults, being “out of it” for much of the time makes them inaccessible for high quality social interactions, learning, exercise, and other activities that are essential for normal brain development and maintenance.

No wonder these children, or more likely their parents, are turning to CAM.

While neurofeedback is not a panacea, it tends to have some significant positive impact on most brain-based conditions. Its lack of side effects is one of its most notable benefits over medicines or invasive surgical procedures. Neurofeedback allows most brains to re-engage with their environment. Then social skills improve, learning become easier, physical activity levels increase, and overall well-being makes improvements.

Too bad allopathic medicine is just beginning to realize what many health providers and health consumers have realized for a long time. Treatment of brain-based symptoms need to be carefully individualized. Frequently, CAM techniques like neurofeedback, which promotes brain regulation, are an excellent place to begin.

Efficacy of Brain Training

As a longterm neurofeedback practitioner, it is frustrating to see articles like this one in the New York Times Magazine, http://www.nytimes.com/2014/10/26/magazine/can-video-games-fend-off-mental-decline.html?smid=fb-share.

Neurofeedback is here and more widely available than ever. While it is important to keep refining our techniques and moving ahead with complementary techniques, the very existence of neurofeedback as an efficacious way to neuroregulation and improved brain health and function is totally missed.

We must also avoid relying solely on technology as “the answer” for promoting good brain health. The human component is essential for most people. The Othmer technique of neurofeedback includes that important person-to-person interaction that can make every difference in the response to treatment.

Deep Brain Stimulation

Scientific American has posted a guest blog on their MIND feature from psychiatrist Don Malone of the Cleveland Clinic. He has been involved with research on Deep Brain Stimulation (DBS) for a number of brain conditions including obsessive-compulsive disorder and depression. Here is his article:


My first reaction to this article was, “Why have the patients he describes received trials of medication, counseling, electro-convulsive therapy (ECT), and other treatment modalities, but not EEG neurotherapy before undergoing as drastic and invasive a procedure as DBS.” DBS involves introducing a foreign object, a wire, into the brain. It needs to be connected with the electronic stimulator. This has the potential to be a major cause of complications just as any time the integrity of the body is breached. On top of all this, it seems to work well in only about 50% of those who undergo the procedure and it is very expensive to set up and maintain.

EEG neurofeedback significantly helps around 80% of those who undergo neurotherapy for depression and OCD. It is non-invasive and usually costs considerably less than 1/10th of initial DBS. Few patients need follow up neurofeedback sessions to maintain their functional gains. Wouldn’t this be a much more productive way to spend our healthcare dollars? Those who seem to be good candidates for DBS after a fair trial of EEG neurofeedback could then be referred on for the procedure.

Secondly, I agree with the main premise of his blog. While a few people seem to grab better brain function and soar with it, others need to be coached and counseled into using their brains in ways that they have never know or realized possible. This is a learning process and like any learning process takes time, effort and persistence. Brain health needs to be supported by excellent health habits such as diet, exercise, sleep, appropriate brain challenges, good mental health support, and minimizing stress. Quick and easy fixes are rare.

The Evolution of Memory

Today’s Washington Post had an interesting interview of Michael Kahana of the University of Pennsylvania. He is working with the US military to develop an implantable device that will help those with memory disorders. However, his bottom line is that those of us with more-or-less normal brains need to go through the tedious task of practice to learn any skill in which we wish to be proficient. The practice is skill specific. So practicing mental exercises on the computer seems to improve one’s skills in those mental exercises. I know that my skills in crosswords and sudoku have improved remarkable in the years that I have enjoyed doing them, but it does not seem to help my ability to remember people’s names.

He implies that the converse, not practicing skills may promote losing the ability to do those skills, is also true. There is a discussion on relying on electronic devices as our memories. I believe in a compromise. Continue to keep up a regular intellectual tasks through a variety of exposures. However, since knowledge increases in such a spectacular way, knowing how to look something up on your electronic device is a wonderful way to further explore new intellectual and cognitive challenges.


Neurofeedback seems to be a good way to put the brain through a series of challenges to remediate or improve memory abilities. It’s utility in helping recovery from traumatic brain injury is well documented. Evidence that it can help stabilize deterioration in dementia has also been described. However, I agree with Professor Kahana that specific practice in the tasks that we wish our brain to perform must be part of any memory improvement scheme. After all, how many people do you know who learned how to speak Chinese by learning to ride a bicycle?

Neurofeedback for Traumatic Brain Injury

There are approximately 1.7 million traumatic brain injuries (TBI) in the US annually. Automobile accidents and falls account for the majority of these injuries. Recently, awareness of TBI is rising because of the need for rehabilitation of some 200,000 Americans who suffered head injuries in recent military conflicts and the publicity surrounding both acute and chronic head injuries in the National Football League.

Catastrophic head injuries are easily identified, but closed head injuries are often quite subtle. Part of the problem with diagnosing brain injury is the limitation of our imaging techniques. Conventional studies such as CT scanning and MRI may not be sensitive to the microscopic level of disruption of brain anatomy. Functional imaging techniques, such as fMRI, SPECT scanning, and PET scanning, are also limited since we are able to see only static “snapshots” of brain function, and scan readings are open to interpretation.

Even when structural disruptions of the brain are demonstrated, functional symptoms often do not closely correspond with known neuroanatomy. In fact, many symptoms of TBI, such as headache, dizziness, fatigue, cognitive deficits, anxiety, depression, irritability, mood swings, memory impairment, sleep disturbances, attention issues, and personality changes, are considered generalized and cannot be localized to a specific area of the brain.

In particular, headaches occur in about 70% of TBI and are still present in 40% of patients after 12 months. Interestingly, headaches are not correlated with the severity of the injury, but do correlate with past headache history and happen more often in female patients.

Because it is difficult to image changes in the brain due to TBI and symptoms may be non-specific, we need to think of many TBI injuries as disruptions on the level of neurons and neuronal circuitry. This certainly seems to be the case with the types of injuries, Post Concussion Syndrome and Chronic Toxic Encephalopathy, which have been described in NFL players. This is the area where neurofeedback can play an important role.

In animal models of brain injury, the initial healing response seems to be geared towards preservation of neurons and their axonal branches (neuron connectors). Unregulated regrowth of neurons may not restore previous connections within important functional networks. In addition, generalized metabolic activation may make it difficult for neurons to function correctly in distinguishing useful neuronal activity from background “noise”. So the patient experiences undesirable, non-specific symptoms. Unless the TBI patient can rewire their brain in beneficial ways, the ease and usefulness cognitive abilities will remain compromised.

This leads to the concept of “recovery burden”. TBI causes brain stress. It is well demonstrated that people under stress make inferior decisions that result in lessened cognitive performance. Repeating these behaviors tends to strengthen them. Thus dysfunctional patterns are reinforced. This is why rest is prescribed initially for TBI. Rest and sleep allow for brain repair without external distraction and demands.

Neurofeedback and other behavioral techniques have been demonstrated to decrease brain stress and restore functional connectivity in the brain. Othmer method neurofeedback enables brain calming by guiding the brain to lower activation states. Then once the brain is ready for gentle challenges, neurofeedback guides restoration of functional networks as an experienced clinician utilizes her skills in functional neuroanatomy to encourage coordination of brain function.

Studies using neurofeedback to enable functional recovery from TBI have been very encouraging.

Study 1: 16 patients, who were all at least 2 years post TBI, were given symptom questionnaires. All patients had been determined to be medically disabled and were no longer receiving active treatment. After regular neurofeedback treatments, all patients had at least 50% reduction in their TBI symptoms with an average of 85% reduction in symptoms. All 14 of the 16 patients who held jobs prior to their TBI were able to return to those jobs.

Study 2: 26 patients who were 3-70 months post TBI completed a course of neurofeedback. 25 of 26 patients showed an improvement of at least 50% (average improvement was 72%) on pre- to post-treatment symptom checklist.

In my practice, I have been impressed with how the combination of neurofeedback and rest has helped patients with mild-moderate TBI get back to their normal lives. The functional rehabilitation approach engendered by neurofeedback is a potentially power tool in recovery from TBI for many patients.