Brian Othmer Foundation
Neurofeedback in Healthcare
By Siegfried Othmer, Ph.D.
In the early nineties, there was widespread concern among economists that all the money being spent by corporations on Information Technology (IT) was not paying off in terms of improved productivity. Had all this fancy computer technology been a false hope, after all? If so, then it had been a very costly junket indeed. But then along came the Internet revolution, and quite suddenly all those concerns were laid to rest. What made the difference was connectivity. A universally accessible network was created, and a network of networks emerged. Distance disappeared as an issue when it came to communication. The financial barrier to entry became insignificant. The network effect eased the path to scaling up. The economy boomed as this new technology came to play its natural role. This was disruptive technology at its best.
We are at the threshold of a similar revolution in brain function, and that will potentiate a social revolution paralleling the one that has taken place in the economic realm. This development can actually be understood by analogy to the Internet revolution. Of course our brains already come equipped with a network of networks. What matters here is the behavior of those networks, the quality and ease of communication that takes place on those networks. To potentiate this revolution two major developments were needed, and both occurred in the mid-nineties just as the Internet revolution was really taking off. One was the acknowledgement, finally, of the concept of brain functional plasticity. The other was the beginning of brain functional imaging.
Both of these concepts were needed in order to shift the scientific perspective to the behavior of our neural networks. Brain imaging rendered the functioning brain visible to us. It gave us new perspectives and raised new questions. And brain plasticity promised utility for the information newly uncovered. Neurofeedback is the action item that most directly engages the behavior of our neural networks, allowing them to be brought to a state of more appropriate function.
Neurofeedback has existed for decades already, but it could not move front and center in the neurosciences and in health care until the conditions were favorable. The conversation had to be moved to the topic of the behavior of our neural networks. Similarly, all the developments required for the Internet revolution had been in place years before. It still took a while before the point of takeoff was reached. The same will hold for neurofeedback. The point of takeoff will only be apparent in retrospect. But we already know that it is coming.
Failures in brain function, of whatever kind, have functional consequences that may be usefully targeted with neurofeedback. Over the past couple of decades we have accumulated evidence of just how far that process can take us. It is clear by now that neurofeedback can make substantial inroads into our most daunting social problems. There is, first of all, the looming crisis in the mental decline of our aging population. With neurofeedback we can help with the dementias and with Parkinson’s, as well as with the more ordinary decrements in function that go along with aging. At the other end of the age range, we face the daunting problem of educational failure for a substantial percentage of our population. Neurofeedback can make a tremendous difference here, particularly with those who are lagging behind the farthest. Related to this are the problems of criminality and of addiction, where neurofeedback can contribute a great deal. All of us are living in an environment of greater stress than less complex societies had to deal with. Many are succumbing to these stresses in various ways, gradually sinking into ever greater levels of dysfunction.
Finally, all of us confront the looming crisis in medical care. The existing system of care delivery is failing us on many counts. It has even become a health concern in its own right. Considering only the primary factors involved, medical errors and medication-related disabilities, our system of medical care has itself become the third-largest cause of death and disability. If the adverse impact of the health care system is appraised more comprehensively, it actually moves into first place. Even so, such appraisals only consider the errors of commission, not those of omission, where the need for medical intervention was either not recognized or people lacked access to care. But even if the health care system does not kill or disable, it does not deliver what it promises. It does not give us health. Our health care enterprise is a disease management system, not a health care delivery system.
Now to be fair, the above only counts the adverse consequences of our system of care delivery. It does not count the positives. My own life has been ‘saved’ three times by means of major medical procedures. And if my life were ever to become a statistic in the annals of medical errors, those prior successes—which were by no means guaranteed—would not be counted in the balance. The point here is not to bash medicine, but to find a better path forward.
The biggest adverse impact of our system of medical care is that we rely on it inappropriately and too exclusively. The dominance of the medical model means that medical care often pre-empts the more appropriate remedy. Most of what shows up in primary care does not rise to the level of medical attention and is therefore ignored. The issue here is not disease or serious mental disorder but rather mere dysfunction. The problem is what we call disregulation, and if that is not attended to, it is likely to be progressive. Self-regulation is the remedy. It is neurofeedback that will turn this around and place the focus where it ought to be: on the augmentation and maintenance of our level of functionality. To that enterprise our brains are key. That is where the opportunity lies because that is where we can exploit functional plasticity.
The broad adoption of neurofeedback within society is part of a larger revolution that is underway. It is the revolution in self-care. Up to now, we have placed our fortunes in the hands of experts when it comes to health care. For disease management, that’s all well and good. For health and wellness, however, we have no choice but to become the operative authority on ourselves, just as we take primary responsibility for ourselves in other aspects of our lives. Going forward, we no longer have to accept the brains we have as a given. And just as we all feel obligated to reach a level of competence in handling automotive and computer technology, we will come to see the importance of understanding how our brains function and how their functionality may be enhanced. This cannot be outsourced because it is here that we come to terms with our own uniqueness and individuality.
When the topic is the enhancement of brain function, it is natural to think in terms of cognitive skills. Indeed the promise of a higher IQ is part of what is on offer with neurofeedback. But the promise of neurofeedback is far broader than this. It covers the emotional domain as well, and includes all those regulatory functions where the brain plays a role. This is how neurofeedback will move toward a central place in the coming revolution of health care. An orientation to optimum functioning will keep the brain on track during early development, empower people during their productive years, and forestall many of the chronic ills that beset the human body as it ages. This development will be looked back upon as a key achievement of the 21st century.
Neurofeedback in Education
By Siegfried Othmer, Ph.D.
In 1990, a clinical psychologist named Michael Tansey, practicing independently in New Jersey, evaluated the emerging technique of neurofeedback with 21 mildly neurologically impaired children. He obtained an average improvement in their IQ test scores of 20 points. That was an astonishing finding, and it flew in the face of professional certainty that IQ was not substantially alterable.
Upon hearing of those results, we were inspired to replicate them with ADHD children. We arranged to have the testing done independently, so that the results would not be subject to complaints of bias on our part. Our results were the same: an average improvement in IQ score of greater than 20 points.
Alas, neither of these studies had any impact on the field of education. This is because the studies were done before scientists had generally accepted the notion of brain plasticity. It seemed impossible at the time that IQ could be significantly changed. As a result of this oversight, the entire field of education has continued to exist in a pre-scientific mode of thinking.
At the present time, there is an enormous cultural bias in our society against the proposition that serious intellectual disabilities can be substantially helped. This cultural bias is not a natural occurrence, however. It has been actively brought about with the support of social science research. The book titled “The Bell Curve,” by Richard Herrnstein and Charles Murray, published in the mid-nineties, put forward the case that social expenditures on the lower end of the bell curve were largely ineffectual in mobilizing the escape from the mire of dysfunction. This set the stage in many ways for the current bias against increasing social expenditures for the remediation of intellectual deficits.
The evidentiary basis for pessimism was daunting, but not absolute. “The Bell Curve” was written before there was any awareness within the social sciences of the potential of neurofeedback, or even of its existence. But times have changed, and we now have grounds for the old biases to be investigated and overturned. The last 20 years have validated the hope that was kindled by those two early studies on the possibility of improving IQ. Nearly every neurofeedback study in which IQ tests were administered has shown respectable improvements. And if we dig into the particulars, we find that those who are in greatest deficit are often helped the most.
This is highly significant, because conventional methods tend to fall short with those in greatest deficit, thus supporting the conventional biases that regard severe deficits to be intractable. We now realize that whereas severe deficits must be understood in terms of a neurophysiological model, they are not inaccessible to us for remediation. That is to say, the deficits often lie in the functional domain, making them viable targets for training.
With neurofeedback it is easy to explore, and then to exploit, the potential of training the brain to better function. This is not a project of creating baby Einsteins or scary-smart computer geeks. Rather, it is a way of allowing every person to train his or her own brain to its native potential, whatever that may be. It is our observation that what holds people back is often not intellectual dysfunction at all, but rather problems in the emotional realm.
As a case in point, consider the following report from a clinician in our network who had just heard from a happy parent:
“I just had a father call me and brag that after 20 sessions his ADHD son went from failing grades to above average even in math, his poorest subject. But the best change is that he went from being a very shy, fearful and sometimes very hyperactive boy to an outgoing, confident, calm, joy-filled child. The change was so dramatic and happened so fast with the addition of the inter-hemispheric placement. I was surprised that it only took 20 sessions!”
Here progress was observed across all of the domains where the child had problems. That illustrates the potential of neurofeedback. The whole brain can be trained toward better function. The clinician was particularly enthusiastic here because such a great outcome does not always happen, and even if it does, the process often takes longer. Even though this case is something of a standout, it illustrates what is possible. Significantly, there was no way anybody could have known ahead of time what the real potential of this child was. And that’s the take-home message with regard to children who are not thriving. We have no idea about the intrinsic potential of such a child until the brain is trained. In consequence, we have a moral obligation to give every child that opportunity.